Community Health & Wellness

Military health care cutbacks putting strain on civilian providers, health board says

Since closing its labor and delivery unit two years ago, Naval Hospital Bremerton – which once delivered a quarter of Kitsap County’s babies –  has relied on St. Michael’s Medical Center in Silverdale to provide delivery and obstetrics care to military patients.

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Kitsap Public Health officials say the reduction in obstetrics care is one of several cuts that have increasingly forced service members and their beneficiaries into an already understaffed civilian health care system and exacerbated long-standing capacity concerns.

“Our community, including those employed by and affiliated with the Department of Defense, faces an ongoing health crisis,” members of the Kitsap Public Health Board wrote in a May 7 letter to U.S. Secretary of Defense Lloyd Austin and other top military leaders. The letter urges the Defense Department to restore obstetrics and other services at Naval Hospital Bremerton.

Health Board members say reductions in service coincided with the formation of the Defense Health Agency in 2013, a Defense Department organization providing health care services to military personnel. DoD established the agency to streamline military care by placing medical facilities for the Army, Navy and Air Force under one entity.

“In Kitsap, we have witnessed first-hand the impacts of the formation of the Defense Health Agency in 2013, which attempted to reduce health care costs by pushing military medical care into the private sector,” Dr. Gib Morrow, Kitsap’s top Health Official, said at a May 7 Health Board meeting.

“At Naval Hospital Bremerton over that decade we have seen closures of inpatient, emergency, critical care, and most recently obstetrical services. That’s occurred even though the private sector health system in Kitsap has been increasingly over stressed and underserved.”

OB-GYN shortage

Like many communities across the country, local health officials are concerned about the shortage of OB-GYN providers and the impact that could have on health outcomes.

Only about 52% of county mothers who gave birth in 2021 received adequate prenatal care, according to a 2023 community health assessment from the Kitsap Public Health District. That is 18 points lower than the state average.

Given the magnitude of the military presence in Kitsap – and the impact outsourcing has had on the strained private sector health care system – Morrow said they would like federal defense officials to rebuild primary care, behavioral health service and obstetrics in Kitsap. The health district, he said, has concerns about the current availability of pre-partum and pregnancy-related care in addition to delivery services.

“There’s somebody at the hospital to catch a baby,” Morrow said. But “are (patients) getting good coordinated care every inch of the way through pregnancy? Not in all cases, absolutely not.”

Douglas Stutz, a spokesperson for Naval Hospital Bremerton, said the hospital  still has an OB-GYN Department that offers prenatal, contraceptive and pregnancy care. They also have a Patient Navigator Program to place military patients with providers at other hospitals and clinics when needed.

But the hospital relies on the Virginia Mason Franciscan’s St. Michaels Hospital in Silverdale to provide delivery and obstetrics care.

Low demand at Naval Hospital

Stutz said the hospital closed its delivery unit following a decades-long decrease in demand. Even with two aircraft carriers stationed in Bremerton, the hospital went from an average of over 50 births per month a decade ago to only six babies during its last month in operation.

“Our clinicians cannot maintain competency for such a low-volume, high-risk specialty,” he wrote in an email. St. Michaels has “the requisite volume that ensures safe, competent, and compassionate care for our beneficiaries. St. Michael’s has validated their ability to care for our beneficiaries on many occasions.”

The Family Birth Center at St. Michaels, along with other birthing centers around the region, filled an important gap with the closure of the Naval Hospital labor and delivery unit, said Chad Melton, president of St. Michael’s Medical Center.

St. Michaels has the physical capacity to serve the community based on current and projected future birthing trends, he said. The hospital accepts approximately 100 transfers each month from neighboring communities, in addition to its own patients.

Naval Hospital Bremerton.

However, he said the reduction of health care providers at military facilities compounded workforce shortages – particularly for prenatal care, primary care, behavioral health and urgent care.

To help bring back providers, St. Michaels has collaborated with local Navy leaders on an agreement that would allow military health providers, including OB-GYNs and other clinicians, to care for their patients at the Silverdale medical center.

“Rebuilding and strengthening our workforce at military health facilities would improve access to care,” Melton said. “We understand the cost of maintaining healthcare facilities and hope that this (agreement) will make it easier for a return of these providers.”

A renewed focus

Federal Defense Department leaders placed a renewed focus on repairing the military health care system over the last year.

In a December 2023 memo, Deputy Secretary of Defense Kathleen Hicks called on top Pentagon officials to stabilize the military health care system. Her directive calls for the Defense Department to add capacity, improve access and re-attract patients and beneficiaries to military healthcare facilities.

“This is an acknowledgement from senior military leadership and elected officials that there is a need to stabilize the system,” said Stutz, the Naval hospital spokesperson. “We look forward to hearing more detail regarding the implementation phase in the coming months.”

Alongside the memo, a new strategic plan for the military’s health system calls for increasing capacity of care for complex patients; improving access to primary, speciality and delivery services; and re-attracting beneficiaries to military facilities.

“We need to stabilize the military health care system and restore care to military treatment facilities like Naval Hospital Bremerton,” said U.S. Rep. Derek Kilmer, D-Gig Harbor. “The status quo is unacceptable.”

Citing the Defense Health Agency’s focus on shifting care to civilian providers, Kilmer said service members are seeking care elsewhere. Meanwhile, civilians are experiencing increased wait times for emergency department services and traveling out of county for maternity care.

“The Department of Defense’s work to stabilize the military health system and restore care to military treatment facilities is an important step to ensuring service members and their families have consistent and reliable access to quality healthcare,” he said. “In my opinion, it can’t happen fast enough.”

Conor Wilson is a Murrow News fellow, reporting for Gig Harbor Now and the Kitsap Sun, a newspaper in Bremerton, through a program managed by Washington State University.