Affected Patients Testified Recently at Congressional Hearing
DHA Director Lt. Gen. Ronald Place
WASHINGTON, DC — Dez Del Barba was only a short way into Army basic training at Fort Benning, GA, when he began to experience escalating pain in both legs. Physicians wrote it off as simple muscle soreness. Del Barba was given passes out of some parts of training and prescribed a series of exercises and stretches. The pain only grew worse.
A few days later, he was diagnosed with Strep A, but the Army physicians did not consider this a red flag. Two days later, Del Barba collapsed in his barracks and was taken to the emergency department. There, a physician cut into his leg to find rotting flesh—the result of necrotizing fasciitis caused by the strep infection.
Del Barba was put into a medically induced coma, suffered multiple debridement surgeries and the amputation of his left leg.
Testifying before the House Armed Services Committee last month, Del Barba voiced frustration not only over his fumbled diagnosis, but also the lack of answers he’s received after the fact.
“Today, as I sit in front of you all, 3 years and 19 days have passed … and I still have zero answers on whether or not the Army has conducted a prompt and thorough investigation into the medical care administered to me,” he told the committee. “I still do not have clear answers on the status of any quality assurance investigation that may or may not have been initiated promptly, or why it has taken over three years for it to be completed.”
Del Barba was the first witness in a hearing examining patient safety in the military health system. In 2017, Congress mandated that the Defense Health Agency (DHA) take over administrative responsibilities for military medical treatment facilities. In August 2019, the agency issued standardized clinical quality management procedures intended to ensure that individual providers are qualified to deliver care across all military departments.
A Government Accountability Office (GAO) report, the preliminary results of which were released last month, found that those procedures are not always followed, creating room for mistakes, malpractice and for servicemembers to sit waiting for answers.
The report focused on credentials and privileging, evaluations of providers and the handling of patient safety events. Of 100 providers examined from four selected medical facilities, in 1 out of 6, DHA did not verify all medical licenses. Of 20 focused evaluations examined by GAO, about half were improperly documented, raising questions about whether facilities’ concerns were addressed before returning providers to regular performance monitoring.
DHA also frequently went over the required time frame to conduct reviews on patient safety events and were lax in reporting providers to a national database when those reviews exceeded the required time frame, which DHA requires.
Overall, DHA does not sufficiently monitor facilities’ adherence to its clinical quality management procedures, the GAO report concludes.
Asked by committee members to respond to the report, military health leaders said these kinds of inconsistencies should be expected when only a few years into such a massive procedural overhaul.
“We’re working way better today than we were a year ago. And we were working way better a year ago than we were three years ago, and better three years ago than we were five years ago,” declared DHA Director Lt. Gen. Ronald Place. “The quality requirements that we have now that I signed off on as one of my first acts as director of the Defense Health Agency in 2019 was a marked expansion of the clinical quality requirements. Massive. And we are still in the process of implementing all of them perfectly.”
As for the GAO’s results, Place said he agreed with them, but noted that some of those results sound worse than they really are, most notably the failure to check all of a provider’s licenses before hiring them.
“[In one case] that particular provider had 10 licenses, and eight were primary source verified,” Place said. “Is the requirement that we verify all of them? Yes. Should we have done better? Yes. But I wouldn’t infer from that there’s no checking for the licensure of the providers.”
The leaders testified that, while DHA is still in the process of consolidating procedures, the COVID-19 pandemic proved that an integrated system can work.
“I think COVID taught us the power of our unified approach,” explained Rear Adm. Bruce Gillingham, surgeon general of the Navy. “The DHA did a terrific job, particularly as we got ready for vaccine distribution, then working closely with them, we were able to translate that into our unique operational environments. The rapid cycle feedback in terms of the practice management guidelines for the treatment of COVID—now in its eighth edition—demonstrates the power of having a central organization that can collate that experience and then allow us to execute through our respective services.”