Military health care providers who are removed from patient care based on allegations of clinical incompetence, professional misconduct, or impairment (medical, mental, substance abuse) will not be immediately reinstated unless the Military Treatment Facility (MTF) commander (also known as the Privileging Authority) determines that the allegations are baseless on their face.
If the allegations are not baseless – meaning there is at least a scintilla of evidence, such as the provider saw the patient who made a complaint – then the provider is normally placed in abeyance and reassigned to non-clinical duties. A quality assurance investigation (QAI) will be initiated. The QAI investigating officer should be an impartial peer with no professional or personal conflict of interest. However, in many small military hospitals or clinics, it’s very rare that a QAI investigating officer will not have at least some familiarity with the provider or the provider’s reputation. The bias can work both in favor of or against the provider under investigation.
A QAI should be completed and reviewed by the MTF Commander within 30 days, which is the standard period for an abeyance. If this investigation and/or review is not completed within 30 days, the abeyance automatically converts to a summary suspension of privileges.
The quality and completeness of the QAI is always a major concern. It should include detailed findings of fact supported by medical records, documents, witness interviews, professional articles, etc. and identify all evidence reviewed. Further, it should state the specific allegations made against the provider and provide findings (substantiated or not) for each allegation. Finally, it should state recommendation on further action (i.e. reinstate or convene a peer review panel).
The Credential Committee will review the QAI before it is provided to the MTF Commander. The Credential Committee can request additional investigative actions by the QAI investigating officer. The Credential Committee will make a recommendation to the MTF Commander. The MTF Commander then has 10 days to take action on the QAI.
The MTF Commander can take the following action:
- Reinstate
- Reinstate with a period of monitoring and evaluation (M&E)
- Convene a peer review panel (adverse action is possible)
If the provider is not reinstated, the provider will be placed in a suspension and the adverse action process will proceed, possibly ending with an adversarial Hearing Panel. It generally takes approximately 6 months from an abeyance to a hearing. Hearings are complex legal proceedings with high stakes – an unfavorable recommendation at a panel will undoubtedly result in an adverse privileging action.
It’s important to note that DoD overhauled the adverse action process in 2013. Some service regulations still conflict with the 2013 DoD instruction. When in conflict, the DoD guidance supersedes any service regulations.
Attorney Patrick Korody is a former Navy JAG with significant experience representing civilian, uniformed, and contractor medical professionals facing adverse privileging actions by the military. He offers a free case evaluation.