Defense Secretary Chuck Hagel said a review found that the vast Military Health System serving active duty troops and a total of more than 9 million beneficiaries offers acceptable care despite regional shortcomings in access and patient care, Defense Secretary Chuck Hagel said Wednesday.
Levels of care in the MHS generally met average national standards, Hagel said, but "we cannot accept average. We can do better, we all agree we can do better."
Hagel said that a lengthy and wide-ranging review of the system found that "MHS provides good quality care that is safe and timely, and is comparable to that found in the civilian sector." However, he said eight military health facilities had a higher than expected rate of patients getting sick after treatment.
In a list of recommendations announced Wednesday, Hagel pledged by the end of the year that "DoD will have a detailed implementation plan to ensure that the military healthcare system becomes the top performing system we all expect it to be and want it to be."
Hagel said he would require military facilities providing substandard care to draw up plans for improvement within 45 days. Hagel also said that the Defense Department would set up a feedback system for patients and others to register complaints and comments.
The 700-page review conducted by Deputy Secretary Robert Work contrasted with investigative reports in the New York Times that prompted Dr. Jonathan Woodson, the assistant secretary for Health Affairs, to send a memo to all medical personnel stating that "the people we serve expect us to improve. The American public expects us to improve."
The New York Times reports widespread problems in infection control and patient safety, and found that babies born in military hospitals were twice as likely to suffer injuries as newborns nationally. The Defense Department did not challenge the reports.
Work's review concluded that "the MHS has created a culture of safety with effective processes for ensuring safe and reliable care of beneficiaries" while acknowledging significant differences in the level of care from region to region.
"The MHS demonstrates wide performance variability with some areas better than civilian counterparts and other areas below national benchmarks," the review said.
Independent experts who reviewed the data agreed in general with the conclusions of the review. Dr. Peter Pronovost, the John Hopkins Medicine senior vice president, said that the review "provided no evidence of substantive deficiencies in the safety, quality and access to care at the MHS that would warrant broad and urgent changes."
At a Pentagon briefing with the Surgeons General of all the services, Work declined to compare the problems in the MHS with those of the Department of Veterans Affairs, where scandals on access and care led to the resignation of Secretary Eric Shinseki.
The MHS and the VA were two different systems serving different populations, Work said.
"We have no crisis," he said.
Without giving specifics, Work said that care in the MHS was comparable on average with civilian health care systems but "there are other areas where performance falls short."
The review and data provided by MHS facilities showed that no hospitals in the system were falling short in terms of access, quality of care and patient safety, said Laura Junor, the deputy undersecretary of Defense for Personnel Readiness.
However, Junor said that patients interviewed in the course of the review "were telling us a slightly different story," particularly on timely access to care.
Work, Hagel and the others stressed that the review did not cover battlefield care provided by the MHS, but instead focused mainly on U.S. facilities.
MHS has 56 hospitals and 361 clinics worldwide serving 9.6 million beneficiaries, including 1.45 million active duty service members, 1.7 million active duty family members and 610,000 retired service members.
The beneficiaries are served by more than 133,000 military and civilian doctors, nurses, medical educators, researchers, and other health professionals.
The first public signs of potential problems in the MHS came on May 26 with the firing of Col. Steven Brewster, commander of the Womack Army Medical Center at Fort Bragg, N.C. Brewster was relieved after Lt. Gen. Patricia Horoho, the Army's Surgeon General, and other superiors "lost trust and confidence" in him.
Horoho, the former head nurse at Womack, also suspended the deputy commanders for clinical services, nursing and administration at Womack, the largest facility in the system.
Last month, Horoho suspended Brig. Gen. John M. Cho, who was in charge of military health care in 20 Western states and worked mainly out of Joint Base Lewis-McChord in Washington state.
At the Pentagon news briefing, Horoho declined to detail the reasons for the suspensions, but said that Brewster was relieved for "failed leadership" and Cho was relieved for "toxic leadership."
Cho had been in charge of oversight of the 11 Army military treatment facilities and 11 Warrior Transition Units across the entire 20-state Western region and the Army's health care delivery to nearly 400,000 active, National Guard and Reserve Soldiers, their families, retirees and their family members.
Shortly after Cho's suspension, Sen. Dick Durbin, D-Illinois, chairman of the Defense Appropriations Subcommittee, called on Hagel to investigate allegations of wrongdoing and malpractice at military hospitals and report his findings to the Subcommittee.
In a letter to Hagel, Durbin said that "in light of deeply concerning reports of subpar care and mismanagement within the Military Health System, I ask that all cases of permanent harm or death are thoroughly and impartially investigated."
-- Richard Sisk can be reached at firstname.lastname@example.org