Expert in Medical and Legal Services

Analysis of medical training and quality assurance for BUD/S healthcare providers.

Thank you to Task & Purpose for giving voice to my views about medical supervision in military training (taskandpurpose.com/news…). Thank you to Seth Hettena who allowed me to post an open letter to Kyle Mullen, who tragically lost his life because of a failed medical system (theiceman.substack.com/…). And thank you to Jerry Carino at the Asbury Park Press (app.com/story/news/mili…).

The Department of Defense Inspector General recently released its much-anticipated report on the medical training of healthcare professionals assigned to BUD/S, as well as on medical risk, quality assurance mechanisms, and risk mitigation. However, there was one problem—the report provides no information about the actual medical training of physicians and other healthcare professionals assigned to BUD/S. I was shocked, but after rereading the National Defense Authorization Act for 2023, I understood why.

These are my thoughts not shared with Task and Purpose: I’ve had more time to digest the IG report, including both its strengths and limitations. The report’s strengths—of which there are many—include a detailed assessment of the risk mitigation strategies planned and in place to better care for BUD/S candidates. However, a significant limitation, in my view, is also worth highlighting.

The IG report failed to address one of the two core questions intended by Congress, as outlined in NDAA 2023, Section 745(a). Specifically, it did not meaningfully evaluate the quality of medical training for professionals responsible for the care of NSW operators and candidates. Instead, it focused primarily on whether minimum credentialing requirements were met (as seen in element 4 of the report).

Why did the IG report overlook the evaluation of medical training, despite this being a core element of NDAA 2023, Section 745? One of several possibilities could explain why the law was structured this way. Perhaps earlier versions of the legislation were refined or reduced during committee debates, leading to a final version of Section 745(b) that no longer fully aligned with the original intent of Section 745(a). It’s also possible that Section 745(b) was poorly drafted and did not understand what needed to be investigated (this is unlikely, given my conversations with legislative aids prior to NDAA 2023 who understood the problems in medical training). Alternatively, there may have been external pressures or compromises that led to a more constrained scope for the IG’s review, resulting in a narrow mandate that barely scratched the surface of the issue.

Regardless of the reason, the DoD IG adhered to the letter of the law as specified in Section 745(b). However, this narrow mandate meant failing to address what I see as a critical question for improving the quality of care for our special operators: Are the medical professionals assigned to these units fully equipped to handle the unique and high-stakes demands of their roles? The lack of a comprehensive evaluation on this front represents a missed opportunity to drive improvements in training, readiness, and ultimately, the well-being of those serving in some of the most challenging and dangerous environments.

In my opinion, the DoD IG report missed a chance to assess whether the Navy’s medical training adequately prepares physicians and other healthcare professionals to meet the specific and complex demands of providing care in NSW environments. These settings require a balance between two inherently conflicting priorities: safeguarding the health and safety of patients while supporting the essential, yet dangerous, training needed to maintain the world’s most elite special operators. Addressing this balance is needed to ensure that medical professionals are not only capable but also empowered to deliver the care these warfighters deserve.