By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Military physicians, Veterans Administration (VA) physicians, and former military and VA physicians often consult our firm concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is governed by one general Department of Defense (DOD) Regulation. It is called the Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, which became effective October 1, 2019. VA physicians have different but somewhat similar regulations that apply to them.
We are often consulted by these physicians, who no longer even serve with those agencies after action has already been taken to report them to the National Practitioner Data Bank (NPDB) for allegedly substandard care. Such reports go into the NPDB for fifty (50) years and are reported to all state licensing boards and the Federation of State Medical Boards (FSMB).
They can haunt a physician’s career for life.
What to Do When Notified of a Claim, Investigation, Peer Review Action, or Quality Assurance Investigation (QAI)?
At your first notice that you are the subject of or named by a Federal Tort Claims Act (FTCA) claim or any inquiry or investigation related to your care, you should consult a healthcare attorney with experience in such matters. We are few and far between, but you can find us if you look for us.
You will have at least two opportunities for input into such matters, but you must take advantage of your earliest opportunity to influence the outcome.
1. You do need to obtain and review a copy of the medical record.
2. You do need to have an expert in your medical field review the case for you.
3. You can request an extension of time if needed.
What Are Questions I Should Ask of an Attorney with Whom I Consult?
These are the questions that I suggest you ask any attorney you consult with:
1. What is your experience in dealing with the military or VA medical system?
2. How many similar matters of this nature have you handled?
3. Are you familiar with National Practitioner Data Bank (NPDB) reports, challenges, and appeals?
4. How many such NPDB matters have you handled?
5. How many cases have you handled in which you assisted in making statements for input into such investigations or inquiries?
6. Are you familiar with the Memorandum of Understanding (MOU) between the DOD and the Department of Health and Human Services (DHHS) taking DOD NPDB reports out from under the regular NPDB procedures?
7. How many military or VA quality assurance investigations have you represented physicians?
8. How many VA and military peer review/clinical privileges hearings have you done?
9. How familiar are you with hospitals and health systems?
10. How familiar are you with the military medical system, the roles of the Surgeons General, and the Department of Defense Division of Health Affairs (DOD HA)?
11. How familiar are you with DOD PM 6025.13?
12. How familiar are you with: VHA Directive 1190 (Peer Review for Quality Managment), VHA Handbook 1050.01 (VHA National Patient Safety Improvement Handbook), VHA Handbook 1100.17 (National Practitioner Data Bank (NPDB) Reports), VHA Handbook 1100.19 (Credentialing and Privileging), VHA Directive 2008-077 (Quality Management (QM) and Patient Safety Activities . . . ), VHA Directive 1026 (VHA Enterprise Framework for Quality, Safety and Management), and VA Handbook 5120/14 (Employee/Management Relations)?
Don’t Wait until after the Decision to Report You Has Been Made.
Be sure to obtain experienced legal counsel to represent you in defending yourself against allegations of substandard care before the final decision has been made. Avail yourself all opportunities to provide your concise, objective, and well-reasoned medical rationale for your care at the earliest stage you can.
Click here to read a prior blog on how our firm can assist you in your legal matter.
For additional information on our representation of military physicians and where we represent them,
click here.
For additional information on our representation of Veterans Administration (VA) physicians and where we represent them,
click here.
Consult a Health Law Attorney Familiar with Army, Navy, and Air Force Health Care Professionals and Their Problems.
The attorneys of The Health Law Firm have represented physicians, nurses, dentists, and other health professionals in the Army, Navy, and Air Force, active duty and retired, as well as physicians, nurses, and other health professionals working for the Veterans Administration (VA), the Indian Health Service (IHS) and the Public Health Service (PHS), nationwide in the U.S. and around the world. Representation includes assisting in making significantly involved provider (SIP) statements, Defense Health Agency (DHA) investigation representation, DHA-PM 6025.13 legal representation, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews, disciplinary actions, investigations, National Practitioner Data Bank (NPDB) actions, and appeals. Its attorneys include those who are board-certified by The Florida Bar in Health Law, as well as licensed health professionals who are also attorneys, and former military attorneys.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at
www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Attorney Positions with The Health Law Firm. The Health Law Firm always seeks qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
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