To Barb Cragnotti, the military healthcare system has two glaring shortcomings.

Its doctors can't be sued for malpractice.

And active-duty personnel, a big chunk of the patient pool at military hospitals, are prohibited from bringing malpractice claims against the federal government.

Both factors remove much of the accountability from the system, according to Cragnotti, an Oregon resident whose son suffered brain damage in 2000 at a Navy hospital on the Mainland. She now is with a nonprofit group seeking changes to the system.

Others share similar sentiments.

"I think the military is protective of their people," said Honolulu plaintiff attorney Mark Davis, who also faults the system for making information on sanctioned physicians difficult for the public to get.

Navy Capt. Kevin Berry, deputy commander for clinical services at Tripler, has a much different take.

He says the military system is more accountable and open than the civilian one.

Unlike civilian hospitals, Tripler can't keep malpractice cases confidential, Berry said in a June intervew. "They have cloaking devices that we don't have access to," Berry added, mentioning confidentiality clauses that are common in settlement agreements in the civilian sector.

He also cited the way the two systems handle problem doctors.

At civilian hospitals, officials typically will find administrative or economic reasons to prompt a physician to "drift away," Berry said, and it is possible for the doctor to go from hospital to hospital without being reported to the national databank that compiles malpractice information on individual practitioners.

At Tripler, a doctor suspected of malpractice would be dealt with in a way that affords due process but provides appropriate sanctions if a breach in the standard of care occurs, Berry said.

"We nail them in place administratively," Berry said, so "they're not going to leave" to become another institution's problem.

Berry said the vast majority of Tripler physicians have no reported incidents to the databank.

Tripler officials also noted that disciplinary actions against physicians must be reported to the state boards where they are licensed, and most boards have procedures for citizens to inquire about the records of individual practitioners.

But to check on a military doctor's disciplinary history, a consumer must know where the physician is licensed — information that is not always readily available to the public. Unlike civilians doctors, who must be licensed in the state where they practice, military ones can be licensed in any U.S. state or territory. About 40 percent of Tripler's active-duty physicians have Hawai'i licenses.

"The doctor kind of gets lost in the equation," attorney Davis said. "It's like they're immune (to accountability)."

Prohibiting military personnel from pursuing claims and giving doctors immunity from malpractice lawsuits create an environment that is more conducive to sloppy medical practices, according to the system's critics, including George Washington University law professor Jonathan Turley.

"There is simply no effective deterrent to medical malpractice," Turley said.

Yet the Army on one of its Web sites points out that Army patients file malpractice claims at a lesser rate than patients in the civilian system, even after adjustments are made to account for the ban that applies to active-duty personnel.

Between nine and 12 claims per 100 physicians were filed by Army patients in recent years, according to the Web site for Walter Reed Army Medical Center. By contrast, St. Paul Marine and Fire Insurance, a major civilian malpractice insurer, receives 13 to 15 claims per 100 physicians annually, the Army site said.

Another indicator reflecting the military hospitals' high quality of care is their accreditation track record, proponents say.

All but one of the Department of Defense's 142 hospitals and clinics are fully accredited, meaning they meet the same standards that apply to civilian hospitals, according to Mark Forstneger of the Joint Commission on Accreditation of Healthcare Organizations, the industry's main accrediting body.

Only an Army clinic in Alabama has a provisional accreditation.

Despite such data, critics continue to push for the elimination of the so-called Feres Doctrine, which applies not just to malpractice cases but to most personal-injury claims linked to military service.

A cadet who is raped at a military school, for instance, can't sue the government for damages related to the rape, critics say.

Cragnotti's nonprofit group, Veterans Equal Rights Protection Advocacy Inc., is seeking to abolish Feres and has been gathering signatures in an online petition to support efforts, so far unsuccessful, to get Congress to take such action.

A bill by U.S. Rep. Barney Frank, D-Mass., that would allow military members to pursue lawsuits for injuries caused by improper medical care has passed the House several times. But each time the legislation died in the Senate. Frank last proposed the measure in 2003.

Frank told The Advertiser that he has stopped introducing the bill because the chances of passage, given the current legislative climate, are slim.

But Frank, who chose to use a military hospital when he had major heart surgery in 1999, still believes that the legislation is needed.

"The medical practice in the military is good, but it's not perfect," he said. "And I don't think people in the military ought to have less rights than civilians (if malpractice occurs)."

Reach Rob Perez at rperez@honoluluadvertiser.com.