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 investigation professional misconduct or impairments, including mental or physical impairments. Such investigations are often triggered by missed or incorrect diagnoses, near miss events, adverse events, or patient complaints. The QA Investigation is initiated by the MTF Commander or as designated by the MTF Commander 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 QA investigation will 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.
The provider under investigation generally has the right to provide a statement during the course of the QA Investigation. Each military service has specific guidance on what information the provider has access to during the investigation. At minimum, the provider should be on notice of the specific allegations under investigation.
The provider is commonly removed from patient care duties during the QA Investigation, 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 QA Investigation will be forwarded via the MTF’s credentialing committee to the MTF Commander to determine if 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 QA Investigation 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 who has defended military medical providers facing clinical adverse at MTFs worldwide. His office is located in Jacksonville, FL and he can be reached at (904) 383-7261.