Report: Military hospitals not adequately checking doctor credentials

CNN News, By Charley Keyes, CNN, December 23, 2011

Congress and the military have examined how Maj. Nidal Hasan was
trained, evaluated and promoted as a military physician.

STORY HIGHLIGHTS

• Congress called for the General Accountability Office report after the Fort Hood shootings
• The report urges the Defense Department to speed efforts to revise the review process
• The military says its centralized system will be delayed without adequate funding

Washington (CNN) -- A federal watchdog took a bite out of military hospitals this month, warning it is impossible to tell if some doctors are licensed, properly trained and evaluated in their specialties.

"Army oversight and physician credentialing and privileging requirements were not sufficient to assure that MTFs (Medical Treatment Facilities) fully complied with existing requirements or completely documented information needed to support credentialing and privileging decisions," said the new General Accountability Office report.

"Specifically, Army Medical Command's oversight of individual MTFs' reviews of physicians' applications for privileges was insufficient to identify the instances of noncompliance and incomplete documentation," the report added.

In some cases the military had failed to check properly on the legitimacy of doctors' licenses to practice medicine, the report alleged.

"Some credentials files we reviewed lacked complete documentation to show that MTFs had primary source verified all of the physician's state medical licenses, including seven instances involving a physician's only active medical license," the report says.

Primary source verification of credentials means they are verified with a specific credential's source.

Congress called for the report in the aftermath of the Fort Hood, Texas, shooting in November 2009, for which an Army psychiatrist is charged with 13 murders.

Congress and the military have examined how Maj. Nidal Hasan was trained, evaluated and promoted as a military physician. Nine military officials, including doctors, were disciplined for their actions or failures in the Hasan case. He faces a court-martial, with a possible death penalty, in March.

The GAO report cast a wider net and urged the Defense Department to speed up its efforts to revise and standardize reviews of doctors' credentials. And it singles out the Army for problems at its facilities.

"Based on our review of 150 credentials files at the five Army MTFs we selected for our review, we found that none of the five Army MTFs fully complied with certain Army physician credentialing and privileging requirements," the GAO report said. "Specifically, we found that the selected MTFs did not fully comply with the Army's requirement to primary source verify all state medical licenses at the time of privileging and at renewal."

In a response included in the report, Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson wrote the department is progressing with standardization and centralization of credential files and improving how doctors can apply for and renew privileges to practice at military hospitals. But the military warned that its centralized system would be delayed "without adequate funding."

The report cited over-reliance of so-called peer reviews, especially in cases where coworkers might have only a limited familiarity with a doctor.

"In one file we reviewed, both peer recommendations were from individuals who indicated they had limited knowledge of the physician's clinical competence," the report says. "The department chief later told us that this physician was terminated within the first three months due to issues with the physician's competence and professionalism."

In another instance, a doctor had problems with errors in prescriptions, above what the hospital allowed. However, this was not reflected in the doctor's file. And the physician's department chief "was not aware of the negative prescription days but was 'not at all surprised' because there were current concerns about this physician," the report said.