Medic741

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Any truth to this? Evidently stuck to the spending bill is ability for docs to get sued?
 

armytrainingsir

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.gov loves handing out money.

Intentions on every .gov program generally start out good, but such programs always end up as a feeding trough for a sizable minority.

Bad thing about this particular giveaway is there is a stick attached to the carrot and some nurse or MSC type will be swinging that stick at you.

No doubt, innocent soldiers get hurt by medical mistakes. But my fear is all the system failures are going to be hung around the doc's neck, remaining long after you leave the .mil.
 
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Mt Kilimanjaro

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Can now file for “malpractice” dating back to 2017. Will be interesting to see how this shakes out. Suspect this well-intentioned effort will have negative effects for docs and be tainted by a few bad apples.
 
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militaryPHYS

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IMO this is a good first step. Any patient (regardless of military or civilian) who feels they were victim of gross negligence should be able to file and have the case reviewed. This also still protects the MilMed physician practicing in a combat environment who may face limitations in care they can provide because of scarcity of resources or capabilities when deployed in an austere environment.
 

DrMetal

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IMO this is a good first step. Any patient (regardless of military or civilian) who feels they were victim of gross negligence should be able to file and have the case reviewed. This also still protects the MilMed physician practicing in a combat environment who may face limitations in care they can provide because of scarcity of resources or capabilities when deployed in an austere environment.
So what does this really mean for the practicing physician? We know she can be named in the suit, but can she be held financially (personally) liable? If so, when are we all getting our malpractice coverage (paid for by the gov't of course). And if the gov't refuses to cover us, can we refuse to see patients?

of course we'll take care of patients in the deployed environment). But if I'm sitting at home in my lovely CONUS Hampton Roads area MTF, why would I treat anyone without coverage, why assume that liability? (I can easily defer to the civilian network).
 

pgg

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So what does this really mean for the practicing physician? We know she can be named in the suit, but can she be held financially (personally) liable? If so, when are we all getting our malpractice coverage (paid for by the gov't of course). And if the gov't refuses to cover us, can we refuse to see patients?

of course we'll take care of patients in the deployed environment). But if I'm sitting at home in my lovely CONUS Hampton Roads area MTF, why would I treat anyone without coverage, why assume that liability? (I can easily defer to the civilian network).
I'm not sure where this line of worry is coming from - near as I can tell, absolutely nothing changes from our perspective. Still covered by FTCA.

It just looks like caring for active duty servicemembers at CONUS MTFs will be no different than caring for dependents or retirees. We've all been doing that since, well, forever. Now they've budgeted money to pay for claims from AD in addition to the money budgeted to pay for claims from non-AD.

It wouldn't hurt to have some official comment from the services' surgeons general, but my own needle on the Concern O' Meter hasn't moved.
 

DrMetal

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I'm not sure where this line of worry is coming from - near as I can tell, absolutely nothing changes from our perspective. Still covered by FTCA.

It just looks like caring for active duty servicemembers at CONUS MTFs will be no different than caring for dependents or retirees. We've all been doing that since, well, forever. Now they've budgeted money to pay for claims from AD in addition to the money budgeted to pay for claims from non-AD.

It wouldn't hurt to have some official comment from the services' surgeons general, but my own needle on the Concern O' Meter hasn't moved.
Here's what I fear (and what I think will happen):

So service member can now sue his doctor? that requires a new program, something to help the service member adjudicate his case. And of course each service will require their own unique program. The black and white cases will be easy, but of course there'll be a lot of gray area cases. Fast forward 10 years: this will all compile into a big bureaucratic mess that'll be costly making the medical corps even more expensive and inefficient, which is the exact reason why the DOD wants to get out of the business of healthcare, as we've discussed previously.
 

Gastrapathy

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So the devils in the details...will this become a way that everyone tries to “get theirs” like the VA disability process or will there be a high enough bar to compensation that only actual malpractice is compensated? Will physicians get reported to the databank as a result? Who will be the arbiters and what is their background?
That said, things happen that deserve compensation so this is the right thing and keeping it out of the federal courts seems like a good choice to me.
 
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So as a provider, if you are "sued" then is this something that you need to report to state board/certification boards as a malpractice claim?
 

Gastrapathy

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@GreenHousePub for physicians (not providers ) certification boards only care about your money. Hospital credentialing and state medical boards do care about claims paid but with differing thresholds and consequences. The military doesn’t report all claims >$30k to the NPDB but they can report a claim.
 

DrMetal

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So the devils in the details...will this become a way that everyone tries to “get theirs” like the VA disability process
Perfect analogy. Of course that's what this'll become. It'll be a total sht show, and it'll make all of our careers that much more complicated (in an already broken system). Look, I'm not that worried. I'm not a proceduralist. Five levels of failure have to occur before I'm to blame (certainly possible). But for those of you who probe or cut patients for a living, who already have to deal with shtty techs, poor OR turnover time, poor sterilization techniques, this could be catastrophic.
 
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So here’s where I am a little confused. From what I understand (maybe erroneously) prior to this passing we couldn’t individually be named in any case. It was simply Patient X vs United States. Our name could be included, but we didn’t have the target painted on our backs. Has that changed now that this has passed to where it can now be Patient X vs Dr. So-and-so??

That being said, if we can be sued individually do we get to choose our own counsel? Hey, nothing against our Jag pals but I’ve known a few that I wouldn’t want arguing a speeding ticket. If so, are we paying out of pocket? The next 18 month can’t go by fast enough for me...
 

DrMetal

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I think this would just allow the Active-Duty Service Member vs. United States Gov't (whereas before, only a retiree or dependent could sue the US). By the way, where the hell is this, is passed the House?, Has to pass the Senate.....do we see POTUS ever signing something like this into law?

The Feres Doctrine has broader implications than just medicine. Don't like your command climate, feel you were wrongfully terminated, you can sue. Hostile work environment, sue. Sexually harassed (not happy with the final adjudication), sue. And the U.S. gov't being the cash cow that it is would likely settle most of these cases, not go to court and defend. It'll be the private legal community's wet dream come true.

In this sense, the "companyization" of the the military will be complete. There will be no resemblance of a disciplined active duty force.

I'm moving to Canada. Vancouver is nice.
 
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pgg

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Perfect analogy. Of course that's what this'll become. It'll be a total sht show, and it'll make all of our careers that much more complicated (in an already broken system). Look, I'm not that worried. I'm not a proceduralist. Five levels of failure have to occur before I'm to blame (certainly possible). But for those of you who probe or cut patients for a living, who already have to deal with shtty techs, poor OR turnover time, poor sterilization techniques, this could be catastrophic.
Again I just don't get the source of this anxiety.

We already care for far more dependents and retirees than active duty, and they have always been able to sue for malpractice. We're not inundated with frivolous lawsuits from people trying to "get theirs" ...
 
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DrMetal

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Again I just don't get the source of this anxiety.

We already care for far more dependents and retirees than active duty, and they have always been able to sue for malpractice. We're not inundated with frivolous lawsuits from people trying to "get theirs" ...
Ok, I concede your point. You're probably right, the implications of this might not be so bad for the Medical Corps. (by the way, how would this fare for GMOs? )

I'm more concerned for the military as a whole. It stings me every time something changes to make the military more like a 'company', or more like the 'civilian' world, when clearly it's not. It's supposed to be a fighting force, not plagued with all this admin.

So let it all fly. Seaman Timmy now can file a SIMEO, SAPR, EO complaint, he can gripe on his Command Climate Survey about the CO---and if he gets a few of his friends to do the same, CO/CMC will be fired---and now he can file a medical complaint. All of this contributes to the social welfare state that has become our active duty military. And how exactly are we supposed to be a lethal force , poised to fight the Chinese and the Russians? (we don't stand a chance against them in a conventional war). When an E4 has a complaint in the Chinese/Russian Navy, I think he just kind of disappears!

We'd all agree that the black and white cases (rapes, hazing, sexual assault, gross medical negligence) deserve the right adjudication. The bureaucracy/problems lie in the gray area cases, which there will be a plethora of.
 
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Gastrapathy

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Again I just don't get the source of this anxiety.

We already care for far more dependents and retirees than active duty, and they have always been able to sue for malpractice. We're not inundated with frivolous lawsuits from people trying to "get theirs" ...
The bar in federal court is high. We are inundated with frivolous “document this or that” requests for the VA process and the coaches out there encourage it. It all depends on the roll out, if everyone learns that they can get $5k every time they wait too long in the ED or have a post-polypectomy bleed, it will be painful. If it only pays when there is a real error, then great.
 

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I wonder if this will change how the military staffs primary care for active duty. If active duty can sue will the military still use IDCs and GMOs?
 

pgg

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I wonder if this will change how the military staffs primary care for active duty. If active duty can sue will the military still use IDCs and GMOs?
That is a fascinating question. IDCs and GMOs, of course, only* provide care to AD servicemembers. They are the segment of caregivers most at risk for missed diagnoses by virtue of being incompletely trained, and 100% of their patient panels have previously had no legal recourse.

Maybe I've been thinking about this change wrong, just from the perspective of fully trained BC/BE physicians with mixed AD/dependent/retiree panels for whom not a lot is changing. Certainly the exposure of IDCs and GMOs has now increased.

There aren't enough bodies in uniform to stop using IDCs and GMOs. The trend is toward the use of more, not less, midlevel and physician extenders (this isn't just a military phenomenon, of course). There's no path I can conceive of for the USN to make a shift like that in the POM20 era.

I suppose there might be a push toward more formal supervisory relationships between them and BC/BE physicians, or more after-the-fact chart review? The additional burden to those BC/BE physicians could get out of hand, quickly.



* some exceptions to "only" that just prove the rule
 

pgg

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Ok, I concede your point. You're probably right, the implications of this might not be so bad for the Medical Corps. (by the way, how would this fare for GMOs? )
Your point and Perrotfish's point re: GMOs is a good one. I don't know, but maybe there's cause for them to have some of that anxiety I was dismissing ...
 

Perrotfish

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There aren't enough bodies in uniform to stop using IDCs and GMOs. The trend is toward the use of more, not less, midlevel and physician extenders (this isn't just a military phenomenon, of course). There's no path I can conceive of for the USN to make a shift like that in the POM20 era.
There are enough NPs either in uniform or who would accept a commission to eliminate IDCs, and there are enough FPs, IM docs, and Pediatricians to get rid of GMOs an move to the Army model of operational tours after residency. It would be a shift, particularly for the Navy, but its definitely possible.
 

armytrainingsir

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More NPs????????????


In their defense, GMOs are infinitely better trained than the legions of NPs running around, willy nilly tossing out Rocephin and steroids, errr, I mean providing primary care.

As physicians, we had more clinical hours after the first few months of third year clerkships than a newly minted NP. Nevermind the rest of the third year, the fourth year, and the 4000+ hours of internship......


Amazing how physicians so quickly discount the ability of new licensed physicians and prop up NPs.
 
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HighPriest

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Amazing how physicians so quickly discount the ability of new licensed physicians and prop up NPs.
-some- physicians.
NPs can be the worst. Not that they all are, but there’s an epidemic of not them knowing what they don’t know.
 
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Perrotfish

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More NPs???????????
Vs IDCs, yes. We are decades past the point where they should have completely replaced the IDC program. IDCs should be replaced with NPs.

Also from an organizational standpoint my experience is that nurses who have functioned as providers tend to have a more positive impact once they hit leadership positions.
 

Cooperd0g

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More NPs????????????


In their defense, GMOs are infinitely better trained than the legions of NPs running around, willy nilly tossing out Rocephin and steroids, errr, I mean providing primary care.

As physicians, we had more clinical hours after the first few months of third year clerkships than a newly minted NP. Nevermind the rest of the third year, the fourth year, and the 4000+ hours of internship......


Amazing how physicians so quickly discount the ability of new licensed physicians and prop up NPs.
Try not to let your vitriol disrupt your reading comprehension. @Perrotfish did not recommend replacing GMOs with NPs, he recommended replacing IDCs with NPs.
 

Matthew9Thirtyfive

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Try not to let your vitriol disrupt your reading comprehension. @Perrotfish did not recommend replacing GMOs with NPs, he recommended replacing IDCs with NPs.
They certainly wouldn’t be worse than IDCs, and a lot of them would be better.
 
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Perrotfish

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They certainly wouldn’t be worse than IDCs, and a lot of them would be better.
Almost all of them would be better. You might think 4 years nursing + 2 years NP Masters deggree is inadequate to make someone a provider, but its absolutely better than a made up 1 year course.
 

Matthew9Thirtyfive

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Almost all of them would be better. You might think 4 years nursing + 2 years NP Masters deggree is inadequate to make someone a provider, but its absolutely better than a made up 1 year course.
Totally agree. I've actually met a few of the GSN students while at USUHS, and they are smart folks.
 

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Most operational units are not deployed or in a war fighting posture. Most are 'in port' at home. You could make the argument that such units don't even need organic medical personnel, don't need an IDC, or NP, or a GMO. Somebody has a medical issue while 'in port' or at home? Then utilize the branch medical clinics, the MTF and it's ER. There's no reason to have second class medical care---in the form of an IDC, NP, GMO, whatever have you---when you're home, 1000 yards from a full-fledged MTF.

As a stupid analogy: civilian ship yard workers don't have a physician embedded with them (and their work can be dangerous). They do have paramedics on site at the waterfront, and local ER is 5 minutes away.

When you do actually deploy or do a remote exercise: then send a forward medical unit (consisting of BC'd internists, surgeons, etc).
 

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I agree. GMO's do not need to be attached to individual units. The Marines want their "docs" though and will likely require something to keep them happy. I think unit level medical is better reserved for plain old corpsmen, maybe an IDC or midlevel. Not physicians waiting to go to residency and definitely not board eligible/certified physicians.
 

Perrotfish

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Totally agree. I've actually met a few of the GSN students while at USUHS, and they are smart folks.
It also helps that the military is basically a best case scenarios for NP training. Most of them come through HPSP, and therefore through pretty good schools. Then they get multiple years of real nursing experience before they apply to the NP program, and finally they do their NP rotations in respected brick and mortar schools. The civilian model of community college RN -> online BSN -> online NP with no real nursing experience is much less prevalent.
 

narcusprince

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Again I just don't get the source of this anxiety.

We already care for far more dependents and retirees than active duty, and they have always been able to sue for malpractice. We're not inundated with frivolous lawsuits from people trying to "get theirs" ...
So what I am more concerned about are claims driven process changes. As you very well know we have certain practice standards that are different from civilian standards. Could potential claims be driven to align our practice to the civilian model? Care at MTFs should be the same as care at any civilian hospital.
 
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