The Army, Navy and Air Force have not fully established procedures at their hospitals to monitor the quality of care provided there, according to an audit released to the public yesterday by the Office of the Inspector General.
Defense Department health officials, who received the report last week, said they have instituted several reforms, in response to earlier drafts of the audit, and they plan to add staff in an effort to monitor closely each service's compliance with medical care standards and to respond quickly when mishaps occur.
Secretary of Defense Caspar W. Weinberger emphasized the department's commitment to good medical care this week by calling the surgeons general from each service branch into a regular meeting with the service secretaries and the chiefs of staff, a Pentagon source said. Weinberger, who called for the audits in 1982, emphasized the need to have high-quality care in military hospitals, the source said.
The audit, a compilation of internal audits released by the three service branches this year plus a separate review by the Defense Department's inspector general, showed that "although each service is very active in implementing quality assurance programs . . . none of the services had fully implemented" such monitors. That conclusion is based on audits completed from May 1983 through October 1984.
"Certainly it is a report that is not pleasing," said David Newhall, the principal deputy assistant for health affairs in the Defense Department. "But it is a snapshot of a time in history. What is reflective of military health care in 1983 is not what military health care is in 1985."
The report, based on a review of eight Army, eight Navy and seven Air Force hospitals, lists several areas of concern and offers examples of what investigators found to be management troubles.
For example, 442 out of 446 doctors who were given permission to practice at 15 hospitals did not have documentation of their training and experience in their files, the audits said. At seven out of 12 emergency rooms reviewed, the staff did not have as much experience as it should. And a review of 435 medical records at six emergency rooms showed that 374 contained illegible or incomplete entries, the audit showed.
"In general, the auditors found that facilities were not fully complying" with standards outlined by the Joint Commission on Accreditation of Hospitals, a private nonprofit group that surveys and accredits hospitals.
Since an initial draft of the audit began circulating, the Defense Department's Health Affairs Office has issued orders for each service to institute tougher procedures for evaluating the military's 13,704 doctors and to include specific documents in doctors' review files.
Last week, the Defense Department decided to expand the staff of four persons who monitor how medical care is delivered to the 10.2 million active service personnel, retirees and dependents who are eligible to use the 168 medical facilities run by the military.
That staff will add two senior military physicians and a nurse to help conduct additional field studies scheduled to assess the care at all military hospitals, Newhall said.
Newhall added yesterday that the Defense Department and the inspector general are developing what will be known as a "quick response fact-finding team" designed to address serious incidents of medical mischance or mistake.