A Quality Assurance Investigation (QAI or QA Investigation) involving a military medical provider is most commonly an investigation to determine whether the provider is clinically incompetent, though it can also be used to investigate professional misconduct or impairments, including mental or physical impairments. Such investigations are often triggered by missed or incorrect diagnoses, near miss events, adverse events including “sentinel events,” or patient complaints. The QAI is initiated by the MTF Commander or Credentialing Committee (CC) chairperson when needed to investigate any allegations of clinical incompetence, professional misconduct, or impairment. An investigating officer (IO) is appointed in writing and should be a peer of the provider (i.e., having similar clinical specialty, education, and training) under investigation. The IO should be a neutral, fair, and objective peer with no personal or professional interest in the outcome of the investigation. The purpose and scope of the QAI should be explicit in the written appointment. The investigating officer will submit a written report to the MTF CC for review.
An IO will normally interview witnesses including those that work closely with the provider under investigations. The IO will review the provider’s credential history. The IO, especially in clinical incompetency cases, will review substantial medical records to determine if the care by the provider met the standard of care. An IO’s written report is often very detailed and may include as enclosures medical records, witness statements, and other documents.
Up until recently, each military service has specific guidance on what information the provider has access to during the investigation and whether the provider had an opportunity to provide input into the investigation. With the Defense Health Agency (DHA) take-over of all MTFs, there is now one policy for all services. DHA-PM 6025.13 provides that after the investigation is provided to the CC a redacted copy should be given to the provider for an opportunity to provide a statement.
The provider is commonly removed from patient care duties during the QAI and placed in a Summary Suspension, though there is no requirement to do so. If the provider is removed from patient care at the MTF, the MTF Commander is required to withdraw any permission for the provider to engage in off-duty employment.
When completed, the QAI and any statement by the provider will be reviewed by the MTF’s credentialing committee who will make a recommendation to the MTF Commander as to whether the provider should be reinstated with or without monitoring and evaluation or a Peer Review Panel should be convened to further review the allegations made against the provider. A Peer Review Panel is only convened if the MTF Commander is considering an adverse privileging action against the provider (revocation, reduction, suspension, or denial).
The initiation of a QAI is the beginning of the adverse privileging action process and should not be taken lightly. The results of the investigation will shape the rest of the adverse action process as the QA Investigation is heavily relied upon by those involved. It is important that the provider under investigation intelligently exercise his or her due process rights during the investigation to defend against the allegations and build a favorable record.
Attorney Patrick Korody is a former Navy Judge Advocate (JAG) who as defended military medical providers facing adverse privileging actions at MTFs around the globe. He is one of the few lawyers natiowide that has substantial experience in handling QAIs and Peer Review Panels. He can be reached at (904) 383-7261.