A new act in congress aims to let SMs sue the gov't for medical malpractice. Is this a good or bad idea?

I was Injured in Iraq. Spinal Cord Injury. At first I just had what seemed like minor nerve damage. The Army sent me to a civilian Neuro surgeon back in 2010. He opted not to do surgery even though he found a narrowing of my Spinal Column in my neck. Because he refused to do the surgery it is now 2019 and back in August I ended up in a wheelchair for the rest of my life. My condition kept progressing to the point that it became Irreversible. I had spinal surgery finally 2 years ago and the surgeon that did it was furious that the original surgeon I saw didn't perform this operation. He said had I had the operation back in 2010 I could have avoided the wheelchair and would still be walking today.

I am so sorry for you.SGT Warren Crutcher

It's all good because I know there are people out there that have worse issues than I do. It just seems it takes for ever to get anything done through the VA. All I have gotten the VA to do since August when I got in this chair is some small ramps installed to get in and out of my house. I just got notice today that they approved my HISA Grant. That will give me $6800 dollars to make modifications to my house. The contractors I got estimates from said that wouldn't even cover modifications to my bathroom to make it wheelchair compliant. So anything over the $6800 has to come out of my pocket.

SGT Warren Crutcher - Wow, that's messed up. Hang in there.

For normal care, it makes sense - but it needs to be narrowed down so that it does not apply civilian standards of medical care to combat casualties.

I have a PhD in Health Services Research and Policy, and have done a bit of research work in healthcare quality. The combat issue gets back to a point I raised in a healthcare quality class in grad school at Minnesota. Bob Kane was discussing angioplasty and CABG quality studies that showed that there is a clear discontinuity in quality between facilities that perform 1000 or more procedures a year and those who perform less - and suggested that it would be a good idea to centralize those procedures in high volume hospitals. I raised an objection and used my father-in-law's recent heart attack in International Falls, three hours from a tertiary hospital, as an example. Survival rates and other outcomes from heart attacks improve considerably with shorter times to reestablishing cardiac blood flow. I asked Bob about the case of low-population density areas, such as Alaska, Montana, or northern Minnesota - was the quality loss due to distance offset by the gains of centralizing in high-volume facilities?

That applies to emergency medicine and the treatment of combat casualties in particular. There is a significant difference in dealing with a scheduled surgery to repair a knee injury and dealing with one while also dealing with blood loss, a TBI, and multiple other fractures and internal injuries from a car wreck or IED. You see outcomes and decision-making impacted both by an overload of complex information and interactions as well as a shortened time horizon for action due to the severity of co-morbid injuries. This compresses the surgeon's OODA loop and increase the probability of what would be considered an avoidable error in the simple case. For example, prioritizing repairing a damaged femoral artery could leave the damaged knee untreated or even restrict the blood flow and cause greater injury to it --- but might be necessary to prevent death. Medics evacuating a combat casualty from a vehicle damaged by an IED than civilian EMTs evacuating from an auto accident, because they have to remove the victim under fire, compressing the time factor and preventing immobilization of injuries. One obvious case in purely civilian terms involves cesarean deliveries - due to time issues, emergency cases involve a vertical incision to save time to prevent long-term injury to a distressed baby or deal with life-threating conditions to a mother like a ruptured uterus. This, however, significantly weakens the uterine muscle and increases the likelihood of rupture in subsequent pregnancies. Where the mother and child are NOT in distress (as in the case of my son, who was in a troublesome but not immediately threatening breach position), a horizontal incision is used which cuts between, instead of across, the muscle fibers of the uterus and results in no significant increase in risk of uterine rupture in future pregnancies.


Because of the OODA compression due to time and complexity information in trauma cases, there will ALWAYS be a higher incidence of what would be an avoidable complication under routine conditions - but these errors may not be avoidable if the goal of stabilizing the casualty and saving the life is to be achieved. THAT is why this is a bad idea for cases involving the treatment of combat casualties - it is always going to be "meatball surgery" compared to routine civilian surgery, at least if the concern is more over saving the life of the casualty than avoiding potential errors.

George Avery Sir, I undersyand your point, and it is certainly not an irrelevant one. However, just like in the C-section example you gave, wherein a defense against malpractice is the urgency of the situation, so to would combat conditions protect from most malpractice issues. I say most... A field surgeon who amputates a perfectly good leg because (s)he read the wrong chart (PV2 Smith is supposed to have a leg amputated due to gangrene, but surgeon amputates SGT Jones' leg when he was already operated on and recuperating) should still be held to account. Even in a field hospital.