Military Medical Providers: Everything You Need to Know about the Disciplinary Process

Military healthcare offers professionals a unique and rewarding way to both serve the country and to practice medicine.  It is a remarkably demanding and takes providers across the world and presents them with challenging cases under trying conditions.  Those who volunteer for this important work generally know to expect these challenges.  What surprises many is the complex regulatory and disciplinary system unique to military medical practice.  Military medical providers face far greater amounts of scrutiny and potential adverse consequences for the decisions they make every day.  These complex systems are something every military medical professional should understand, but few do until its too late.

Today’s System: The Defense Health Agency

Since before World War II, military medical providers operated under the “Defense Health System,” a patchwork of authorities and rules set by each service of the Armed Forces.  This approach kept authority in the hands of each service, so that medical rules and procedures were consistent with the other unique rules, standards, and practices of each branch of the Armed Forces.  That all changed in 2013.

Following a task force study highlighting deficiencies in the administration of military healthcare, the United States Department of Defense established the Defense Health Agency (DHA).  The establishment of this new, joint DOD medical entity was part of a larger effort to improve military medical programs and services.  The DHA is considered the “centerpiece” of today’s military heath system.  

Along with this organizational change came a huge regulatory shift, as military healthcare providers all became subject to a completely new set of regulations and rules governing their practice of medicine.

Credentialing and Privileging in the DHA World

In general, all healthcare organizations exercise some method of ensuring that their practitioners are qualified and capable to do their work.  The terms used in the DHA world are slightly different.

In civilian practice, “credentialing” is the process used by medical institutions to ensure providers have the proper license and documentation to provide treatment. Credentialing is meant to safeguard the well-being of patients and protect the medical facility from potential liabilities.  Contrastingly, the term “privileging” in civilian medicine relates to the specific skills a provider may perform.  This process ensures that each medical professional acts within the scope of their particular practice and provide competent care for the facility.

Because DHA covers facilities in many different locations and has providers licensed in different states, the terms Credentialing and Privileging are often used synonymously.  Technically speaking, the question of whether a DHA provider is “credentialed” really means whether that provider is properly licensed by a state medical board, and does not involve any grant of credential or certification by the DHA.  The key concept in the DHA world is privileging.  

For DHA providers, “privileging” refers to the formal grant of authority by a facility to an individual to practice medicine and provide medical care.  Privileging Authorities are usually the military commander of a hospital.  Essentially, a DHA provider must be “privileged” to do their job, and this privilege can be suspended or even revoked by the privileging authority.  The process by which a DHA provider potentially loses their privileges is known as the “Clinical Adverse Action Process.” 

Clinical Adverse Action Process

The Clinical Adverse Action Process is meant to address two main issues:

  • Patient Safety: Ensuring that every patient receives top-notch care is the military’s top priority.    
  • Professional Integrity: Maintaining the highest standards of medical professionalism is crucial for the trust patients place in their healthcare providers.

A preliminary review is the initial step when an allegation arises. Unless it’s immediately apparent that the allegations are baseless, the default response typically leans towards a full investigation. The DHA has been very aggressive in this regard: if evidence suggests that incompetence, impairment, or misconduct has potentially harmed patients or staff, adverse action is warranted.

Once the process begins, providers will find themselves under the spotlight of a Quality Assurance Investigation (QAI). These investigations can be intense and far reaching, with less due process than that afforded by administrative investigations normally conducted by the military.  A crucial part of this process is the QAI interview. 

Every word in a DHA provider’s statement during the QAI can impact the outcome, which is why having a skilled attorney familiar with military medical process is invaluable.  Following the QAI, a comprehensive review process will result in recommendations to the privileging authority.  Some of these may include suspension, modification, or even revocation of a provider’s privileges.  If serious adverse consequences are recommended, the provider may request a peer review hearing.  This is also the window where a provider may respond to the proposed recommendation in writing.  

It is important to remember that the Privileging Authority is not bound by any finding or recommendation, and that their decision is final.  These realities elevate the significance and seriousness of the responses and elections a provider makes, as this is the key moment to influence this process.    

Severe Consequences 

Facing clinical adverse action isn’t just about losing privileges at a particular facility in the military medical system; there are broader implications.  DHA provider careers are tied to their satisfactory performance under DHA rules, and any adverse action at any DHA facility will severely impact the future of a military medical provider.  Additionally, all DHA adverse action gets reported to the National Practitioner Data Bank (NPDB), which can impact future employment opportunities in the civilian sector.

How Sean F. Mangan Can Make a Difference

As a physician or medical provider, you trained to become an expert in your field, not in the law.  You’re not an attorney, and if you find yourself in this process, you’ll need one. Here’s how a skilled defense lawyer, like Sean Mangan, can assist:

  • In-depth Case Analysis: Understand every facet of your situation.    
  • Guidance and Representation: Navigate the complexities of military law and DHA clinical adverse action with confidence.    
  • QAI Statement: Make sure you maximize your opportunity to have your side of the story fairly explained and properly understood while under investigation.
  • Response to Findings: Effectively present your challenges to claims made against you
  • Peer Review Hearing: Have your “day in court” for the DHA process with a skilled advocate at your side. 
  • Protecting Your License: Minimize the chances of reportable actions against your credentials.

Remember, every medical provider has rights. It’s essential to protect those rights and ensure a fair and just process.

Reach Out to Mangan Law Today!

At Mangan Law, you have a military legal expert ready to champion your cause. Whether you’re facing allegations or seeking to understand your rights better, our team is here to help. Contact us today at 360-908-2203 for a consultation and ensure your career remains on the right track.