By Jesse Sloman
This commentary comes courtesy of Marine Corps veteran and CFR research associate Jesse Sloman. He observes that issues with military health care do not end with the Department of Veterans Affairs. Recent reporting has found similarly systemic issues in the Defense Health Agency, the health care system for active duty personnel directly administered by the Department of Defense. A truly inclusive solution to military health care must address problems in both of these systems.
In the midst of the various scandals engulfing the Veterans Health Administration, much of the media have missed a startling investigation into safety lapses and oversight failures in America’s other military health care system, the one run by the Pentagon for active-duty and retired service members. In a June 28 article, the New York Times reported that many military hospitals have a significantly higher rate of complications than their civilian counterparts. When serious or fatal mistakes occur, the hospitals frequently fail to conduct detailed causal inquiries.
For example, the Defense Department’s patient safety program received investigative reports for just 100 of the 239 unexpected hospital deaths that were identified between 2011 and 2013. Some of the most egregious problems involve children and infants. According to the Times, babies born at military hospitals are “twice as likely to be injured during delivery as newborns nationwide. …And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals.”
Although the sheer breadth of the malpractice the Times discovered is deeply disturbing, the inadequacies of many military hospitals will come as no surprise to anyone who has spent time on active duty. Anecdotal stories of shockingly poor treatment abound, such as the time a friend and his pregnant wife were forced to wait out a storm warning for hours without access to food while nearby staff blithely watched a loud action movie, or the Air Force C-17 pilot who was horrified to learn during a checkup in Jordan that his U.S. military dentist had left a piece of a tool and a cotton tuft inside one of his teeth. My own experiences, while comparatively prosaic, did not fill me with confidence: during a wisdom teeth extraction I was alarmed to discover that the dental assistant attending to me barely knew the names of his tools and could only find the correct implement after repeated chiding from the dentist.
To be sure, the vast majority of the men and women who serve in the military’s various medical services are skilled and devoted professionals. They have experienced the same grinding operational tempo as the rest of the force, spending months deployed in combat zones trying desperately to save the lives of severely wounded young troops. Their heroic and groundbreaking efforts in Iraq and Afghanistan have allowed thousands of service members to survive injuries that only a decade ago would have proven fatal. As the Times report makes clear, it is the system—not the individuals who staff it—that is primarily at fault.
Many of the problems stem from the military medical bureaucracy, which is divided into four largely independent branches representing the Army, Navy, Air Force and the Defense Health Agency (DHA). Although the Assistant Secretary of Defense for Health Affairs is nominally responsible for the entire system, he or she only has the power to make recommendations. Senior health officers from each of the services and the DHA have to approve any military-wide changes before they go into effect.
In practice, this means that important regulatory updates and other programs critical to patient safety are lost in bureaucratic gaps, fall victim to turf wars, and move forward at a slow pace, if at all. It has also hindered the adoption of advanced techniques for assessing patient risk, some of which are now standard practice in civilian hospitals. When new assessment methods are employed on a test basis, the numbers the Times cites are scary: “A…pilot study by the Pentagon last year found that nearly half the patients whose files were reviewed at a major military hospital had been harmed at least once. The study suggested 99 percent of harm at that hospital was not reported by medical workers.”
Partly as a response to the Veterans Affairs scandals, Secretary of Defense Chuck Hagel has ordered a thorough review of the military hospital system due by August 29th. However, a series of town-hall meetings at major medical installations appears to have been organized unevenly. At a few hospitals, the meetings seem to have been underpublicized or scheduled during work hours, preventing many beneficiaries from attending. Still, the review is a step in the right direction. Upon its release, the Pentagon and Congress must not waste any time implementing comprehensive reforms.
The 1.4 million men and women on active duty have nowhere else to turn; their health plans only allow treatment at civilian hospitals in the rarest of circumstances. We owe it to them to address these issues as thoroughly and as quickly as possible. For some, it could literally mean the difference between life and death.
Jesse Sloman is a research associate at the Council on Foreign Relations and a member of the Truman National Security Project’s Defense Council. He served on active duty in the Marine Corps from 2009 to 2013.