Medical malpractice cases at Tripler Army Medical Center cost the federal government — and ultimately, taxpayers — millions of dollars.

Precisely how much is unclear, and the federal government has been unable or unwilling to clarify matters for The Advertiser, leaving the public largely in the dark about the overall cost.

The Army, responding to a Freedom of Information Act request, provided data showing the total paid for administrative settlements of malpractice claims, but that amount — more than $14 million over the past 20 years — does not include what the government paid to resolve Tripler cases that went to court. Those lawsuits often involve the largest amounts.

Tripler officials didn't respond to a written request from The Advertiser about the lawsuit-related payments, and the Army Medical Command, the Mainland-based headquarters that oversees all Army hospitals, said in response to a FOIA request that the information does not fall under its purview, nor does the command have "release authority" for the information.

A Washington, D.C., representative of the U.S. attorney's office, which defends the government in malpractice lawsuits involving military hospitals, said in response to a FOIA request that it didn't have the data.

Advertiser research came up with payments of about $61 million over the past two decades, but that understates the actual amount because an unknown number of out-of-court settlements, which sometimes are not publicly disclosed, were not included.

The Advertiser asked the hospital to provide totals spent over the past 10 and 20 years to resolve malpractice lawsuits and claims, but Tripler officials didn't respond.

After answering several sets of questions over several months, Tripler officials in November said they would no longer respond to The Advertiser's questions, including those about malpractice costs, given that the government was involved in defending pending cases.

Tripler officials said the medical command determined that responding to The Advertiser's questions at the time no longer would be in the best interests of Tripler or the federal government.

"That's a pretty incredible response," said Robert Stern, president of the Center for Governmental Studies in Los Angeles. "They're acting like a private company saying, 'It's none of your business.' "

Taxpayers, he said, "have every right to know" how much the overall malpractice problem is costing them.

Among the other questions that Tripler did not answer: