A letter to Kyle Mullen

A former Navy doctor looks at how the medical system at Naval Special Warfare failed the 24-year-old SEAL candidate who died after finishing Hell Week.

Mark Hardman

This is a guest post by Dr. Mark Hardman, a former Navy physician who served 14 years in the Navy and Marine Corps. He is a clinical lipidologist certified by the American Board of Clinical Lipidology and served two tours of duty as a general medical officer. Dr. Hardman received his medical degree in 2018 from Uniformed Services University. He practiced law from 2007-2014 and served as a civilian prosecutor and defense attorney in the Marines. A graduate of Virginia Tech and the University of Virginia School of Law, Dr. Hardman is a graduate student in bioethics at Harvard Medical School.

Dear Kyle, 

I never had the honor of meeting you, but I consider you a brother in arms. You have a warrior's spirit, and your legacy will not be forgotten. 

Your commanding officer’s recent appearance on the Shawn Ryan Show motivated me to write to you publicly. You deserve an apology.

As a former Navy physician, I am confident that you should not have died regardless of cardiomegaly or the veracity of allegations of the use of steroids or other performance-enhancing drugs. You were denied the medical care and opportunity to live a full life. I apologize from my core.

As a former prosecutor and Marine Corps defense attorney, I am neither shocked nor surprised by the public relations game played on the Shawn Ryan Show by Capt. Brad Geary, the SEAL officer who was in charge of Basic Underwater Demolition/SEAL training or BUD/S at the time of your death. No legal hand-waving or misdirection can change the facts laid out by the Navy’s investigations.

Shortly before finishing Hell Week, you were hypoxic and delirious. A paramedic treated your respiratory distress and hypoxia with high-flow oxygen before discontinuing therapy. Instead of informing the physicians at Naval Special Warfare Center (NSWCEN) or transferring you to a higher echelon of care, the paramedic hid the severity of your condition from NSWCEN physicians and turned you over to fellow candidates who helped you walk to graduation. A final medical check revealed abnormal lung sounds, but the doctor who signed off on you after Hell Week did not order a chest X-ray or investigate further. Hours later, as you were dying without medical support, a junior sailor followed orders and phoned the on-call provider. That provider neither checked on you nor called for an ambulance.

SEAL candidate Kyle Mullen, 24, front right, runs across Silver Strand Blvd. in Coronado, California, on Feb. 22, 2022, during Hell Week. Mullen died two days later after successfully completing Hell Week.

How did this happen? Navy investigations blamed a flawed medical structure, inadequate supervision, and a series of concerning individual actions. Specifically, the Naval Education and Training Command’s investigation highlighted something that hasn’t gotten much attention but is a sign of the deeper problems with SEAL training. An unsigned BUD/S Medical operating manual (read it here) separated the medical department at SEAL training from NSWCEN. The manual gave doctors at NSWCEN no relationship, authority, or oversight over BUD/S Medical. This was a recipe for disaster. 

The unsigned manual sidelined physicians by design. Key medical decisions during Hell Week were made by the unlicensed Navy corpsmen who staffed and led BUD/S Medical and reported not to the Senior Medical Officer at NSWCEN but to Capt. Geary. No physician provided eyes-on-the-ground supervision during Hell Week when such supervision was needed most. Medical risk compounded to fatal levels. 

You might still be alive if someone had dialed 911. However, the Senior Medical Officer at NSWCEN, who had been sidelined from BUD/S, approved a post-Hell Week briefing cautioning you and your classmates not to seek outside medical help after Hell Week. Why? Because NSWCEN physicians knew that post-Hell Week candidates would be admitted to the hospital. Many candidates would have laboratory evidence of rhabdomyolysis, acute kidney injury, hepatic injury, or electrolyte abnormalities. Chest X-rays could show pulmonary edema. Medical documentation of such findings would interfere with the training pipeline and could even force changes in SEAL training. 

Why did you not receive a chest X-ray? The paramedic’s undisclosed oxygen treatment at the end of Hell Week likely masked the severity of your illness. Lack of turnover and documentation blinded the next provider. Because pulmonary edema was ubiquitous among SEAL candidates, the doctor who saw you after Hell Week likely anchored on this diagnosis. He underestimated its risk both with and without a superimposed pneumonia and likely did not want to interfere with your continued training with abnormal imaging. This was medical roulette, and you paid the ultimate price.

Your commanding officer did not discuss any of these matters on the Shawn Ryan Show.

I cannot help but wonder what might have been different. In December 2019, one of the best physicians I know was slated to take over medical care at BUD/S. He was the honor graduate of his medical training pipeline, an experienced line officer, and someone who has personally rescued me in the backcountry. The honor graduate wanted to but was not allowed to choose the prestigious billet at BUD/S. I am confident that he would have demanded the ability to supervise unlicensed personnel. I am confident that you would be alive if the honor graduate had been your physician. Instead, the physician who saw you after Hell Week was given priority billet selection due to family reasons.

Kyle Mullen and his mother, Regina. (Courtesy Regina Mullen)

You should know that an overwhelming majority of Navy medical professionals are committed to doing the right thing, committed to taking care of warfighters, and committed to learning from your tragedy. Those medical leaders have implemented meaningful reforms because of you. Nonetheless, many struggle to manage the problem of dual agency when obligations to the military and patients conflict. Your memory should remind physicians of their sacred oath to patients and their duty to protect warfighters when they are most vulnerable. 

Kyle, your loss felt personal to me. In 2001, a dear friend, also named Kyle, died training in a civilian facility. I carry the guilt of not intervening and can still hear the piercing notes of taps at his standing-room-only funeral. For the longest time I wanted to trade places with him. Today, I honor him by apologizing and speaking the truth directly with you. 

I hope to see you on the other side. God bless you and your family.

Semper Fidelis,

Mark Hardman