Those who accept their punishment in the NSW community always wind up rewarded after separation from the Navy. Weird how that happens. Or maybe it’s part of the NSW narrative control program.
I'd push back slightly. I understand the perspective, but one captain stood six and center at admirals mast and appears to have accepted responsibility. This is meaningful, even if he did so seeing the writing on the wall. This was an unmitigated disaster, but neither the commodore nor CAPT Geary are the most culpable. Neither is a physician and neither had the medical background to understand how truly disastrous this system was. Others cannot say the same.
The most difficult facts to explain will be 1)the post-Hell Week brief warning against outside medical care, 2) what appears to be an off-the-books medical record system intended to avoid Navy dive physicals by preventing documentation in MHS Genesis, 3) keeping BTC Medical records and care hidden from NSWCEN medical (see no turnover of Seaman Mullen to NSWCEN medical, 4) the appearance of unlicensed, unauthorized practice of medicine by the BTC civilian paramedic who treated Seaman Mullen, 5) the appearance of medical abandonment by the BTC civilian paramedic did not contact his medical director or any physician before discharging Seaman Mullen and did so without informed consent. Remembe, the had independently diagnosed pulmonary edema and delivered >1 hour of high flow oxygen (12-15 L O2) to a hypoxic (SpO2 82-86%) patient, 6) right ventricular hypertrophy consistent with significant pulmonary hypertension secondary to pulmonary edema and likely ARDS. This likely acute right ventricular remodeling is likely unrelated to PED use, 7) lung histopathology showing changes consistent with ARDS, 8) diarrhea while decompensating suggestive of toxic shock syndrome, 9) that if blood tests had been available, they would likely show overwhelming evidence of causality from group A strep bacteremia, and 10) that Seaman Mullen was bradycardic at time of EMS arrival and had a chance of living had the paramedics shown up just 45 minutes earlier. This would have allowed transfer to a trauma center with intubation, IV antibiotics, and extracorporeal membrane oxygenation (ECMO). Evidence suggests his life could have been saved it not for the the Senior Medical Officer’s endorsement of the post-Hell Week brief warning against obtaining outside care (again, see evasion of medical disqualification and the Navy dive physical). The NETC investigation suggests that Seama Mullen may have lived were it not for the on call provider who again discouraged junior enlisted from obtaining care for Seaman Mullen. These last missed opportunities to save Seaman Mullen are among the most tragic parts of this highly-irregular disaster.
I would confirm whether the off-the-books medical records were shared with the civilian specialty leaders when they wrote their expert opinions. If not, I would ask them to revise their opinions, taking into account the hypoxia present on the beach, treated by the paramedic. I anticipate the defense will attempt to focus on the EM specialty leader opinion discussing unusually rapid decompensation. It appears the EM specialty leader was unaware of the medical log book documenting Seaman Mullen’s hypoxia and treatment by the paramedic.
I would call an infectious disease expert to testify as to the unique danger of toxic shock syndrome and ARDS from group A strep pneumonia. I would also cite medical literature cautioning against ending bicillin prophylaxis given this risk. And I take on this EM opinion as lacking key information (the log books) and consideration of the rapid decompensation that can occur with toxic shock syndrome. This needs to be supported by an infectious disease expert and a pathologist testifying to the lung biopsies obtained at autopsy.
I would also confirm exactly what the BUMED standard of care investigation investigated. It is likely that the investigation found that the standard of care was met at the time of the post-Hell Week medical checks. I would ask expert witnesses whether advising patients to avoid outside medical help is standard. I would not allow the defense to extrapolate a singular finding to the entirety of the care during Hell Week.
I would hammer down on the why behind all of this. Why were the systems structured this way? I believe they were intentionally structured this way to avoid medical disqualification under the Navy dive physical. Instead of coordinating reform between WARCOM, BUMED, and any relevant parties, keeping medical conditions and treatment out of MHS Genesis appears to have been the path of least resistance; after understanding the “why,” you see that this level of medical risk was not necessary to train Seals but to avoid medical disqualification. The narrative of “this was necessary to keep America safe” falls apart.
I would introduce evidence of how the Army medically supervises similar high-risk training for its SF combat divers in Key West, FL, to show that this was not normal.
Finally, I would call the Navy Surgeon General, RADM Darin K. Via, to the witness stand, a physician with impeccable credentials, previously serving as the CENTCOM surgeon and an expert in anesthesia and critical care. I would walk the Surgeon General through these facts and others in painstaking detail and ask whether this is standard in America or the Department of Defense. I would ask the Surgeon General if he has kids. Then, I would ask whether this is the medical system he would want for his children.
Those who accept their punishment in the NSW community always wind up rewarded after separation from the Navy. Weird how that happens. Or maybe it’s part of the NSW narrative control program.
I'd push back slightly. I understand the perspective, but one captain stood six and center at admirals mast and appears to have accepted responsibility. This is meaningful, even if he did so seeing the writing on the wall. This was an unmitigated disaster, but neither the commodore nor CAPT Geary are the most culpable. Neither is a physician and neither had the medical background to understand how truly disastrous this system was. Others cannot say the same.
The most difficult facts to explain will be 1)the post-Hell Week brief warning against outside medical care, 2) what appears to be an off-the-books medical record system intended to avoid Navy dive physicals by preventing documentation in MHS Genesis, 3) keeping BTC Medical records and care hidden from NSWCEN medical (see no turnover of Seaman Mullen to NSWCEN medical, 4) the appearance of unlicensed, unauthorized practice of medicine by the BTC civilian paramedic who treated Seaman Mullen, 5) the appearance of medical abandonment by the BTC civilian paramedic did not contact his medical director or any physician before discharging Seaman Mullen and did so without informed consent. Remembe, the had independently diagnosed pulmonary edema and delivered >1 hour of high flow oxygen (12-15 L O2) to a hypoxic (SpO2 82-86%) patient, 6) right ventricular hypertrophy consistent with significant pulmonary hypertension secondary to pulmonary edema and likely ARDS. This likely acute right ventricular remodeling is likely unrelated to PED use, 7) lung histopathology showing changes consistent with ARDS, 8) diarrhea while decompensating suggestive of toxic shock syndrome, 9) that if blood tests had been available, they would likely show overwhelming evidence of causality from group A strep bacteremia, and 10) that Seaman Mullen was bradycardic at time of EMS arrival and had a chance of living had the paramedics shown up just 45 minutes earlier. This would have allowed transfer to a trauma center with intubation, IV antibiotics, and extracorporeal membrane oxygenation (ECMO). Evidence suggests his life could have been saved it not for the the Senior Medical Officer’s endorsement of the post-Hell Week brief warning against obtaining outside care (again, see evasion of medical disqualification and the Navy dive physical). The NETC investigation suggests that Seama Mullen may have lived were it not for the on call provider who again discouraged junior enlisted from obtaining care for Seaman Mullen. These last missed opportunities to save Seaman Mullen are among the most tragic parts of this highly-irregular disaster.
I would confirm whether the off-the-books medical records were shared with the civilian specialty leaders when they wrote their expert opinions. If not, I would ask them to revise their opinions, taking into account the hypoxia present on the beach, treated by the paramedic. I anticipate the defense will attempt to focus on the EM specialty leader opinion discussing unusually rapid decompensation. It appears the EM specialty leader was unaware of the medical log book documenting Seaman Mullen’s hypoxia and treatment by the paramedic.
I would call an infectious disease expert to testify as to the unique danger of toxic shock syndrome and ARDS from group A strep pneumonia. I would also cite medical literature cautioning against ending bicillin prophylaxis given this risk. And I take on this EM opinion as lacking key information (the log books) and consideration of the rapid decompensation that can occur with toxic shock syndrome. This needs to be supported by an infectious disease expert and a pathologist testifying to the lung biopsies obtained at autopsy.
I would also confirm exactly what the BUMED standard of care investigation investigated. It is likely that the investigation found that the standard of care was met at the time of the post-Hell Week medical checks. I would ask expert witnesses whether advising patients to avoid outside medical help is standard. I would not allow the defense to extrapolate a singular finding to the entirety of the care during Hell Week.
I would hammer down on the why behind all of this. Why were the systems structured this way? I believe they were intentionally structured this way to avoid medical disqualification under the Navy dive physical. Instead of coordinating reform between WARCOM, BUMED, and any relevant parties, keeping medical conditions and treatment out of MHS Genesis appears to have been the path of least resistance; after understanding the “why,” you see that this level of medical risk was not necessary to train Seals but to avoid medical disqualification. The narrative of “this was necessary to keep America safe” falls apart.
I would introduce evidence of how the Army medically supervises similar high-risk training for its SF combat divers in Key West, FL, to show that this was not normal.
Finally, I would call the Navy Surgeon General, RADM Darin K. Via, to the witness stand, a physician with impeccable credentials, previously serving as the CENTCOM surgeon and an expert in anesthesia and critical care. I would walk the Surgeon General through these facts and others in painstaking detail and ask whether this is standard in America or the Department of Defense. I would ask the Surgeon General if he has kids. Then, I would ask whether this is the medical system he would want for his children.