SAN DIEGO — Southern California Navy hospitals show alarmingly high rates of medical malpractice, symptomatic not of a handful of incompetent doctors but of a system overwhelmed and outflanked, trying to treat too many people with too few doctors and health workers.
A 4-month Times inquiry into malpractice and the quality of patient care at the three Navy hospitals--San Diego, Camp Pendleton and Long Beach--has found 25 cases involving malpractice errors that have left 13 people dead and 12 injured--including five babies who suffered birth injuries from which they cannot recover. Almost all of these cases have occurred in the last five years.
Navy records released under the Freedom of Information Act show a total of 53 malpractice cases at San Diego, Camp Pendleton and Long Beach that the government has settled since 1982--with an additional 169 pending. But the inquiry found evidence that naval records--which only have been computerized in the last couple years--are incomplete and that the true number of settled and pending malpractice cases may be greater.
Who Studied the Cases
Analysis of these and other Southern California Navy malpractice cases included reviews by civilian medical consultants, scrutiny of court and medical records and interviews with Navy and civilian doctors who treated the victims.
Although civilian and Navy attorneys agree settlements in military malpractice cases often are significantly lower than in civilian litigation, the Navy, at just these three hospitals, has paid at least $10.8 million to malpractice victims in the last three years--nearly six times per bed as much as the often-maligned Los Angeles County public hospital system.
While Navy and Defense Department figures that have been released do not cover the identical period, totals suggest pay-outs for the Southern California hospitals account for a disproportionate share of the Navy's total.
For 1982 and 1983, all Navy malpractice pay-outs totaled $14.5 million. From 1982 through 1984, malpractice payments for all three services increased from $29.0 million to $41.3 million a year.
Government and civilian experts cite two factors that hold down the number of lawsuits against military hospitals and physicians: the structured disciplinary system of the military that generally inhibits litigation, and a legal doctrine, now being challenged in Congress, that bars active-duty personnel from suing, no matter how badly they are injured by physicians and medical personnel.
'Apples and Pomegranates'
Though the Navy and the Department of Defense contend that military medicine in general and Navy medicine in particular result in malpractice allegations significantly less often than civilian practice, observers ranging from Sen. Pete Wilson (R-Calif.) to lawyers who specialize in medical litigation agreed that while a comparison of the military and civilian health-care systems is tempting, the two are so different that intelligent comparisons virtually are impossible.
"It's like apples and pomegranates," said one malpractice insurance executive with experience in civilian hospitals. The comparison is difficult because military health-centers function as sort of a cross between public facilities like County-USC Medical Center and programs like Kaiser's health- maintenance plan.
Figures that are available imply that the Navy's malpractice experience is far worse than that of the Los Angeles County Department of Health Services--$12,138 paid out in verdicts and settlements for each bed in the three Navy hospitals versus $2,071 per bed in the three largest county centers during the last three years--and that the three Navy hospitals in question pay nearly twice as much as the average California civilian hospital in claims the Navy settles or loses in court. Statewide, reported paid claims against hospitals averaged $103,873 in civilian centers last year, with the Navy paying an average of $204,297.
Wilson--who has taken what his aides say is an unexpected leadership role in Congress' mounting concern over the quality of military medicine--said in a Washington interview that he may ask congressional investigators to look systematically into military medical facilities all over the country. A separate General Accounting Office probe is under way, with a report expected in 1986.
Recent interest in Congress has been piqued by the case of Dr. Donal M. Billig, a Navy heart surgeon in Bethesda, Md., currently undergoing proceedings that could result in his being court-martialed for gross negligence in the deaths of five patients. It would represent the first court-martialing in memory for alleged negligence by a military doctor, the Defense Department said.