DOD Medical Malpractice Questioned in Regards Serum Samples

The repository also is running out of space – bursting at the seams with more than 42 million specimens. More than 5 million of the repository's oldest specimens – collected before the Gulf War – are now stacked floor to ceiling in teetering cardboard boxes, inaccessible to researchers, while the Defense Department's health leaders slowly discuss how and where to build a new repository facility and who would run it.

The inventory continues to grow at more than 2 million specimens annually. Millions more specimens from the Gulf War era will need to be boxed up later this year.

And while leading civilian repositories now store frozen serum specimens in ultra-cold minus-80-degree Centigrade storage to minimize degradation, the Defense Department continues to store its newest serum specimens in outdated walk-in freezers at a comparatively balmy minus-30 degrees Centigrade, potentially harming the delicate protein and chemical biomarkers that might contain evidence of toxic and infectious exposures.

Urine specimens are another useful tool in monitoring health, as any doctor will attest. Yet the Defense Department discards the 2 million-plus urine specimens it collects every year during routine drug testing.

Monitoring health also requires access to modern medical records systems. Military hospitals in Iraq and Afghanistan are forced to use relatively archaic systems that don't communicate in real time with the rest of the electronic medical record. These systems don't even talk among themselves.

Doctors treating patients transported between facilities on the battlefield often can't access electronic records written by surgeons minutes earlier. Frustration has been so intense that doctors treating patients evacuated through Germany have developed a separate Web-based system to work around the problem. Confusion over which system the doctors in the field are supposed to be using continues, compromising the quality of the health data.

One solution, off-the-shelf Web-based technology – such as VPNs (virtual private networks), used commonly by corporations to allow remote access to computer networks – has yet to reach the battlefield. Service members stationed in Afghanistan on remote snowy mountainsides routinely access their personal e-mail on the Web, but medics are not empowered by the Defense Department to use the Web to view and interact with vital medical records stored on systems in the United States.

Instead, medics in the field are instructed to record medical information using outdated handheld computers that often break down or run out of power. More often than not, medics simply don't use them, leaving no trace of medical care and giving the impression of a falsely low rate of disease and illness among deployed troops.

Despite these problems, the Defense Department reassures Congress and the American public that service members have their health comprehensively monitored, including a lengthy reassessment a few months after they return from deployment.

These assessments are little more than poorly worded, multi-page forms of little use to clinicians and epidemiologists in screening for diseases. The reassessments have demonstrated little efficacy in increasing access to military mental or physical health care. They often distract doctors, nurses and other health workers from providing therapeutic patient care.

And now the requirement to complete this lengthy reassessment form is being waived for soldiers sent back into the war zone after serving more than a year there. Tragically, these overworked service members – the ones who need the most careful physical and psychological assessments – are often deploying again after completing a token two-page form containing only a single mental health question. Often, no one confirms both the accuracy of the information and the suitability of the service member for repeated deployment.

Because of this, large numbers of service members on psychoactive medications are still being deployed, including many on anti-psychotic medications and anticonvulsants. As many as one in seven deployed service members has a recent history of psychoactive medication use.

But just which of these deploying service members have potentially serious psychiatric disorders is unclear, because the data systems that monitor pharmacy prescriptions are not linked to the Defense Department's deployment database.

Nor are these linked to the larger medical surveillance database that tracks medical diagnoses. The Defense Department would be hard-pressed to quickly identify the service members deployed this year with a history of treatment for bipolar disorder or psychosis – in direct violation of its new policy.

What isn't monitored can't be measured or reported. Nor can it improve care to service members, or forecast what will be needed to care for the next generation of veterans.

The health data in the Defense Department's databases and the serum repository have shed light on possible causes of multiple sclerosis, schizophrenia and various cancers, and contributed to our understanding of the epidemiology of mental and physical diseases. But so much more could be done.

Sadly, many key military health organizations are led by careerists with little experience in this type of work. There is little incentive, and significant risk, for Defense Department health leaders to point out problems, to explore controversial findings or to contradict military leadership when the health of service members is at stake.

Monitoring the health of service members is a responsibility too important to be left to a military leadership distracted by the exigencies of war. Responsibility for monitoring health should be consolidated under a new Armed Forces Health Surveillance Center, under the direction of an independent civilian expert in public health. Service members cannot wait another 15 years.

Capt. Remington Nevin is a Johns Hopkins-trained Army public health physician currently serving in Afghanistan. His opinions do not reflect those of the Department of Defense.