The U.S. military operates a flawed and sometimes deadly health care system that lacks the most significant safeguard protecting civilians from medical malpractice.

11-year-old Valerie Kay Houck holds her 5-year-old sister Emily -- left brain-damaged as a result of malpractice by a military physician -- as she takes her bottle. (Skip Peterson / Dayton Daily News).

The men and women in America's armed forces face unnecessary danger where they should be safest - in the military's own hospitals and clinics.

A year-long Dayton Daily News examination found the U.S. military operates a flawed and sometimes deadly health care system that lacks the most significant safeguards protecting civilians from medical malpractice.

The military system employs some of the country's finest physicians. But the examination also found doctors who failed several state medical board exams, doctors who had medical licenses revoked or suspended, doctors who lost their malpractice insurance - even doctors convicted of crimes.

The newspaper reviewed thousands of previously unreleased government records, interviewed more than 200 people in 12 states and analyzed more than a dozen computer databases, some obtained only after a federal judge ordered the military to release them. The examination found:

The military health care system is a magnet for problem doctors, offering them jobs without the burdensome restrictions and liabilities faced by civilian doctors. Military doctors are not required to have malpractice insurance, they do not have to be licensed in states where they practice and they are virtually immune from being sued by their patients.

The military doesn't warn the public of doctors whose mistakes cause injuries and even death. More than 75 military medical facilities never reported a doctor for medical malpractice to a database created by Congress in 1990 to protect the public from problem doctors. Those same facilities were the targets of claims alleging more than 1,000 incidents of medical malpractice, several involving deaths.

At least 77 physicians practiced in the armed services with "special" licenses issued only to doctors at military bases, Indian reservations, mental hospitals, prisons and labs handling organs for transplants. Nearly all the doctors either failed the state licensing exam or had no evidence in their files they took it. One failed 30 times.

Nurses, physician assistants and even medical technicians take on greater responsibility in the military than in the civilian health care system. Deaths and injuries have been linked to this practice.

Even with good doctors the system often fails. That's because there is little or no continuity of care. Patients often cannot choose the doctor they see, and many get a different doctor at every appointment. The chances of getting a bad doctor increase with every visit.

"I think if Mom and Dad send their sons and daughters in harm's way, they have an expectation that the medical care afforded them is as close to what they'd get at home as can be expected," said Donald A. Kroll, an Air Force Reserve doctor who heads the military committee for the American Society of Anesthesiologists. "Are they getting what they get at home? No."

In a nine-page response to the newspaper's findings, Department of Defense health officials said differences between the civilian and military health care systems do not lesson the quality of care given to service members.

"Military medicine rates highly when measured against the variety of quality indicators used by industry to determine how well hospitals" perform," said John F. Mazzuchi, deputy assistant secretary of defense for clinical services. "The most important thing to us in military medicine is concern for the health and well-being of our patients."

Mazzuchi said the services have taken steps to correct two problems examined by the newspaper.

The Department of Defense inspector general, he said, has initiated an audit to determine whether the services are following guidelines for reporting doctors linked to medical malpractice and misconduct. Mazzuchi also acknowledged that a number of military doctors practiced without proper licenses.

"We have initiated action to correct this situation," he said.