The lawmaker whose district includes Naval Hospital Bremerton has challenged the Navy over years of downsizing and staffing cuts at the facility, saying it has not only hurt readiness but also endangered patients.
"I had a service member who said that she was pregnant. ... With the closure of labor and delivery, she ended up seeking care from a local provider where she sat for eight hours in a waiting room and miscarried," Rep. Derek Kilmer, D-Wash., told Military.com in an interview Thursday.
In other cases, military personnel slated to ship out could not get required health reviews in time due to staffing shortages at Bremerton, and other patients were diverted to a local hospital where ambulances were sometimes forced to wait for hours, according to Kilmer and local media reports.
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Navy Secretary Carlos Del Toro now says the service will review the downsizing, which it had said was necessary due to a shrinking service member population around the facility.
The problems at Bremerton's hospital have been brewing for years. In 2014, the Navy announced the shuttering of the hospital's emergency room and replacing it with an urgent care clinic to handle non-life threatening medical concerns. More downsizing followed, including closure of the labor and delivery unit.
The story at Bremerton -- which serves the Navy's third largest concentration of sailors and equipment -- is not unique, either. Last April, Military.com reported that similar cuts at the naval hospital at Camp Lejeune, North Carolina, have led to long commutes and weeks-long waits for expectant mothers.
Kilmer said that, during a recently held 15-person roundtable with sailors, the participants all had experiences where the hospital's downsizing affected them, a family member or a military colleague.
"I have heard multiple instances where personnel, in essence, got benched because they couldn't get a health review before they were intended to ship out," Kilmer said.
A spokesman for the hospital, Douglas Stutz, said the leadership at Bremerton is working with the Defense Health Agency, Naval Medical Forces Pacific, the Navy Bureau of Medicine and Surgery, and its Patient Family Partnership Council to ensure it can meet the readiness, medical and wellness needs of its patient population.
"We appreciate Rep. Kilmer's interests and advocacy in support of the military health care system and our active-duty service members, retirees and their families,” Stutz said in an emailed statement Thursday. "We continue to work with his office to ensure shared understanding of the situation as it continues to evolve."
The hospital continues to provide preventative and wellness care, early prenatal care, and one of the Department of Defense's first walk-in clinics for contraceptive care and cervical cancer screening, according to Stutz.
"This clinic also provides a dedicated referral specialist to assist mothers with care navigation in support of obstetrical care in the surrounding community," he said.
At a congressional hearing last week, Del Toro said he "completely" agreed with Kilmer's concerns.
"I want to assure you that I personally have discussed this with the Office of Secretary of Defense, with the deputy, with the secretary of defense himself," Del Toro added.
The Navy hospital recommended patients with serious medical emergencies go to the nearest civilian emergency room or call 911 instead of going to the Bremerton facility, saying it lacked the necessary personnel, equipment and capabilities.
In April 2022, the hospital announced that it was also closing its labor and delivery unit, pointing to declining births in the area and staffing cuts. The hospital cited what it called an extensive analysis that found civilian facilities in the area could handle the births.
However, according to Kilmer and local reports, that couldn't be further from the truth.
"Unfortunately, St. Michael Medical Center, which is the local hospital tasked with filling this care gap, has had problems of their own," Kilmer explained.
Just four months after the naval hospital announced the closing of its labor and delivery unit, the Kitsap Sun reported that, of the nearly 1,000 ambulance trips to St. Michael in the previous month, 17 waited more than two hours and seven waited more than three hours before handing their patient over to hospital staff.
The local paper also reported that, on Aug. 12, "the worst day for delays to date" resulted in one ambulance waiting six hours and 22 minutes.
In October, a nurse at St. Michael was so overwhelmed with the number of patients in the hospital's waiting room that she resorted to calling 911, and local firefighters came out to help hospital workers, the newspaper reported.
Meanwhile, the other major hospital in the area, Madigan Army Medical Center, is nearly an hour away and is struggling with staffing issues of its own.
"Civilians, by and large, aren't expected to travel upward of an hour to go get health care," Kilmer said, before adding that the idea "that we're going to ask our sailors to do that seems just patently unfair."
Since at least 2013, the Department of Defense has been on a mission to bring down the rising cost of health care across the military. That year, it established the Defense Health Agency, a single agency designed to handle administrative and training functions that existed in triplicate across Army, Navy and Air Force medical commands.
Early in the process, there was an effort to manage costs by bringing patients back into military hospitals and clinics, However, in 2017, Congress gave the Pentagon broad authority to reevaluate and potentially scale back its facilities, which, in turn, led to a shift toward sending civilian patients for care in the communities surrounding bases.
Many of these cuts, including the ones at Bremerton and Lejeune, were justified by studies that showed that the communities around the facilities facing cuts could handle the additional patients.
Stutz, the hospital spokesman, told Kilmer in 2021 that Navy Medicine was "working to mitigate health care delivery gaps, by working closely with Tricare and our network partners." But in at least some cases, the analyses and reliance on civilian doctors to close the gap can be flawed.
"Part of the problem is they've overestimated the ability to hire civilian health care workers at Madigan, at Naval Hospital Bremerton, and in the community," Kilmer said.
A health provider at Lejeune's hospital told Military.com last year that the problem in their area was that the civilian network of doctors who were supposed to help support military patients didn't really exist.
Kilmer says he wants to see the Navy deploy personnel to fill the needed positions and bring back services that are not always readily available in the community. He called the decision to reduce capacity at Bremerton indefensible.
Del Toro told Congress that the Pentagon is "highly attuned" to the issues at the hospital.
"It's time to do another assessment ... to try to determine what the exact needs are," Del Toro said.
-- Konstantin Toropin can be reached at konstantin.toropin@military.com. Follow him on Twitter @ktoropin.
