MMilitary doctor defense - peer review hearings
Subject of a Quality Assurance Investigation (QAI)?
The Regulations Favor a Full Investigation Following a Report of Professional Misconduct, Impairment, or Clinical Incompetence.
In addition to being licensed by a state, military doctors, military dentists, and other health care providers employed at military hospitals and clinics must maintain “privileges” with the privileging authority. Generally, authority to grant, suspend, and revoke privileges rests with the commanding officer of the military hospital or military treatment facility. If allegations are made that the provider engaged in misconduct or is impaired, the privileging authority must determine whether or not a full investigation is warranted. The rules favor a full quality assurance investigation (QAI) following any allegation of misconduct, incompetence, or impairment that is not determined to be baseless through preliminary inquiries. During the investigation, a privileging authority will normally place the provider’s privileges in summary suspension, meaning that he or she is commonly not permitted to practice medicine. A notice that a provider’s privileges are in summary suspension is normally the first notice given to the provider that their privileges are at risk of being suspended or revoked. Such action is commonly referred to as an Adverse Privileging Action.
In October 2019, with the advent of the Defense Health Agency, a new regulation was issued governing Adverse Privileging Actions. Specifically, Defense Health Agency Procedures Manual 6025.13 (DHA-PM 6025.13) replaced the Department of Defense governing instruction (DoDI 6025.13) and service-specific instructions.
Unfortunately, DHA-PM 6025.13, unlike it’s predecessors, requires notice to the National Practioner Data Bank (NPDB) if a Summary Suspension is in effect for more than 30 days. There is little that a provider can do to avoid this reporting. In our experience, it is uncommon that the QAI will be completed within the initial 30 days of the summary suspension.
A provider may also be clinically evaluated to determine the existence or extent of any alleged impairment or incompetence. This may entail supervised practice in a case alleging professional impairment or incompetence or substance abuse treatment in a case involving substance abuse.
What can i expect in a dHA quality Assurance Investigation?
Under DHA-PM 6025.13, Volume 3, a Quality Assurance Investigation (QAI) is a formal Medical Quality Assurance (MQA) process conducted pursuant to 10 U.S.C. § 1102 and the Defense Health Agency’s Clinical Quality Management framework. A QAI must be properly initiated by the appropriate authority and assigned to a qualified Quality Assurance Investigating Officer (QAIO) who is clinically and professionally capable of evaluating the issues presented and meets the regulatory definition of a “peer” — a healthcare provider with similar privileges and clinical specialty, level of training and experience.
Because the QAI forms the evidentiary foundation for any proposed adverse privileging action and any subsequent peer review hearing, DHA-PM 6025.13 requires that the investigation be impartial, evidence-based, and procedurally compliant to preserve due process and the integrity of the Medical Quality Assurance record.
The investigation should identify the specific allegations or clinical concerns, define the scope of review, and collect and evaluate all relevant materials, including patient records, operative reports, orders, diagnostic studies, policies, privileging documents, and other pertinent clinical data. The QAIO should conduct an objective analysis of whether the provider’s care met the applicable standard under the circumstances, rather than a retrospective or outcome-driven standard.
The written QAI report must articulate findings of fact, provide supporting rationale, apply the preponderance of the evidence standard, and include a recommendation for the Privileging Authority (normally the Director of the MTF) regarding the provider under review’s privileges.
The provider must be given a redacted copy of the QAI report and afforded an opportunity to submit a written response prior to further credentialing action. The QAI report, the provider’s response, and associated documentation are then forwarded through the Credentials Committee/Function to the Privileging Authority to determine whether to reinstate privileges or propose an adverse privileging action.
We Defend All Military Medical Providers.
- Army, Navy, Air Force, Coast Guard.
- Uniformed, Civilian (GS), Contractor.
If you are facing a QAI or Adverse Privileging Action, do not separate or resign. Action can be taken against the provider even after separation or resignation. It is important that the provider continue to exercise all due process rights.
We Fight The Government… And Win.
Military investigations. Federal indictments. Court-martial. Administrative Separation. Board of Inquiry. DHA Peer Review Hearings. Merchant Mariner credential actions. Security clearance revocations.
When Everything Is At Stake.
The government will take everything from you - life, liberty, happiness. Prosecutors build cases long before charges are filed.
Do not talk. Do not explain. Do not cooperate blindly.
Precision planning. Tactical execution. Controlled aggression.
We identify weaknesses in the government’s case and apply pressure where it matters most — whether the battlefield is federal court, a court-martial, a separation board, a white collar investigation, or a credential revocation proceeding.