Defense Department Needs to Coordinate Revamp of Doc Credentialing

The U.S. Defense Department needs to establish a process coordinating all current and future efforts to revise credentialing and privileging requirements for physicians at military treatment facilities as well as establishing an oversight process to review credential samples to identify and address areas of noncompliance, according to a U.S. Government Accountability Office report.

The report was requested by Congress after Major Dr. Nidal Malik Hasan, a U.S. Army psychiatrist, was accused of killing 13 people in a Nov. 5, 2009 shooting spree at Fort Hood, Texas. His trial is set to begin March 5, 2012.

According to the GAO report, the competence review and credentialing requirements of the DOD, Army, Navy and Air Force “are in some cases inconsistent with DOD's requirements and each other's.” As an example, the report cited how the DOD calls for verification of all state licenses physicians have held throughout their careers while the Navy only requires verification for the previous 10 years.

For the report, the GAO said it reviewed credentials for 150 Army physicians and interviewed staff at five Army medical facilities.

In 34 cases, it found that complete career verification of state licenses had not been documented before privileges were granted and, in seven of these cases, there was no documentation of the doctor's current license, according to the report.

It was also noted that the facilities did not consistently document clinical competence with any peer recommendations or performance assessments. In some cases, performance assessments lacked required data to back up the assessment. The Army also requires a search of malpractice history, but “files often lacked information needed to determine if the MTF (military treatment facility) had documented a complete practice history, as required.”

“Weaknesses in Army requirements contributed to noncompliance and incomplete documentation,” the report concluded. “For example, MTFs did not consistently document follow-up on peer recommendations, in part because existing requirements do not clearly delineate responsibilities for documenting follow-up.”