By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawOur firm is often consulted by military physicians, Veterans Administration (VA) physicians, and former military and VA physicians concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is now governed by one general department. The Department of Defense (DOD) Regulation, that is, Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, 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 serve with those agencies, or 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 to the Federation of State Medical Boards (FSMB).
They can haunt a physician’s career for life.
What Should You Do When Notified of a Claim, Investigation, Peer Review Action, or Quality Assurance Investigation (QAI)?
When you first notice that you are the subject of or named in a Federal Tort Claims Act (FTCA) claim or any type of inquiry or investigation related to your care, you should consult with 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 usually have at least two opportunities to provide input into such matters, but you need to take advantage of the earliest opportunity to influence the outcome.
1.You must obtain and review a copy of the medical record.
2.You 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 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 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 Management), 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.
Don’t wait until the final decision has been made to report you to obtain experienced legal counsel to represent you in defending yourself against allegations of substandard care. Avail yourself of any and all opportunities to provide your concise, objective, and well-reasoned medical rationale for your care at the earliest stage you are allowed to do so.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. 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.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
