Serious deficiencies identified in an audit nearly two years ago continue to plague Navy medical facilities, including Bethesda Naval Hospital, according to an internal Navy report released yesterday.
A study of 13 Navy facilities in the United States and Europe released yesterday reported that patient records are often inaccurate and illegible, physician credentials are haphazardly verified and emergency rooms are routinely staffed by physicians lacking emergency medical experience.
The study released yesterday is the first clear indication that programs ordered by top military officials in an effort to improve medical service may not have been implemented.
The audit lays the blame directly on a lack of commitment by top Navy medical officials. It was released by Sen. Pete Wilson (R-Calif.), who charged that the report contradicts testimony on Capitol Hill in September by Vice Admiral Lewis H. Seaton, Navy surgeon general, that health care programs had improved.
"I am very disturbed that the very top personnel in the Navy medical system either did not know about these conditions or, perhaps worse, chose to misrepresent them," Wilson said in releasing the Navy document.
A Navy spokesman, acknowledging that the report "pointed out some serious deficiencies," said that "a variety of actions are under way or being studied to improve the quality of Navy medical management." He would not elaborate on those steps.
The report also stated that "virtually without exception, the doctors, nurses, medical service corps and enlisted personnel at the inspected activities are making a heroic effort to ensure that patients receive the highest quality of care possible."
The disclosures follow a year of newspaper accounts and congressional testimony detailing numerous shortcomings at military medical facilities. The most noted case is that of Navy Cmdr. Donal M. Billig, the former Bethesda Naval Hospital heart surgeon whose court-martial is under way on manslaughter charges connected with the deaths of five patients.
Unlike previous accounts describing medical horror stories, numerous deaths and medical malpractice lawsuits, this report focuses instead on some system-wide deficiencies that may have led to those problems.
Among the areas found to be unsatisfactory by investigators:
*Navy emergency rooms have historically been staffed at times by interns and physicians such as dermatologists and psychiatrists, untrained in emergency care. Despite improvements, some emergency room physicians still lack emergency training, leaving the Navy vulnerable to malpractice liability suits.
At Bethesda, according to the report, only one physician with emergency training was assigned to the emergency room in fiscal 1984, although the minimum needed was six. Navy officials, however, said yesterday that there are eight physicians assigned to the emergency room, one of whom is board-certified as an emergency room physician.
*Patient medical records are, in many cases, incomplete, inaccurate, disorganized and illegible.
*Inexperienced or untrained personnel are stationed at some facilities. "The record is replete with physicians detailed directly from training to remote duty stations where there is no back-up support readily available," the report states.
*Numerous deficiencies were found in verification of professional qualifications.
The study, conducted by the Navy inspector general between May and October last year, concludes that "very little progress has been made to correct the deficiencies" identified by a 1984 Navy audit.
"The common denominator in all areas where progress has been slow and/or unsatisfactory is an absence of a commitment to such progress by top Navy medical management, i.e. a resistance to change and a business-as-usual approach," the report said.
It also concludes that, while many problems can be resolved by redirecting priorities, "it is evident that some services to dependents and retirees must be curtailed."