EXCLUSIVE INTERVIEW: NAVAL MEDICAL CENTER COMMANDER ADDRESSES HEALTHCARE ACCESS DURING PANDEMIC

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By Helen L. Horvath
 
June 23, 2020 (San Diego) -- In an interview with Captain Bradford Smith, Commander, Naval Medical Center San Diego*, East County Magazine explored the issues and challenges associated with the COVID-19 pandemic for eligible active duty, veterans and family members residing in San Diego County. One of the greater challenges in the community is determining how healthcare can successfully be accessed by the community.

ECM:  Your experiences as an aviator, microbiologist, and later as a pediatrician are impressive and must be valuable during this pandemic.  Especially your work in leadership positions throughout the Navy and your work with the Veteran’s Administration.  What led you to become a pediatrician? 
 
Captain Smith:  I actually started out with a life plan of being a PhD scientist in science and math, so I first pursued economics. After graduating with my bachelor’s degree in economics, I began interviewing with banks and other industries – in the end they did not appeal to me.  I wanted to fly airplanes and decided to join the military and was interested in flying on aircraft carriers, so I spoke to the Navy recruiter and the Navy decided to let me fly.  I went to aviation flight school.  Eventually, I realized that I wanted to do something else to help the community, so I went on to get my master’s degree in cellular and microbiology in preparation to become a board certified pediatrician. 
 
ECM:  In a prior interview with the Director, San Diego VA Healthcare System, the interview shed some light on the specific challenges to the healthcare delivery system in government.  What has been some of the specific challenges to the Navy’s healthcare delivery system? 
 
Captain Smith:  All healthcare systems have shared common challenges.  The key question is how to deliver world class healthcare in the new (COVID-19) environment.  The unique mission of the Navy and military medicine is the ongoing challenge to support the military mission during war and peacetime.  Most importantly to deploy in defense of our nation.  The integrative military healthcare system must be combat ready while ensuring that the highest standards of care are met. 
 
At the beginning of the pandemic, as a tertiary hospital, there was a need to modify the medical center to meet new standards in the event that COVID-19 was treated at the Naval Medical Center.  Early on, the Naval Medical Center has added multiple negative pressure rooms to the facility in many areas.  This permits isolation rooms for those with COVID-19.  The medical center installed air handlers to ensure the safety of the patients and staff and rewired the center prior to installation of the negative pressure rooms for treatment. Much of the dental care is now provided in negative pressure rooms.  We maintained all of our medical product and service lines to provide needed care.  
 
ECM:  In reviewing the Navy's three step phase in plans for returning to a semblance of normalcy in service delivery to active duty, veterans, and family members, what steps has the Naval Medical Center taken currently to move from Phase I to eventually phase 3? 
 
Captain Smith:  The aim is to provide the four pillars of military medicine: increased readiness, better health, better care, and lower cost. The timing is based upon the Department of Defense requirements.
 
(Note: The Navy, Air Force and Army are jointly guided by their respective military branches and the Defense Health Agency (DHA).  DHA is a Combat Support Agency that leads the military healthcare system in the integration of readiness and health.)  
 
ECM:  As a fully staffed hospital does your facility provide regional medical support for Camp Pendleton’s hospital and the 9 medical clinics and dental clinics?
 
Captain Smith:  The regional coordination is part of the integrated healthcare system.  The Naval Hospital San Diego coordinates services with the Camp Pendleton Military Hospital, Marine Corps Air Ground Combat Center 29 Palms, Naval Air Station Lemoore, and other military medical clinics in the military healthcare system.  There is a shuttle that departs the hospital and goes to Camp Pendleton three times a day.  Often Navy sends staff to fill gaps or provide services (cooperative agreement and DHS combat readiness requirements).  The further out the care is from the San Diego Naval Medical Center the more important the use of telehealth becomes.
 
ECM:  With the stress and anxiety of the COVID-19 pandemic, has the Naval Medical Center seen an increase in mental health referrals or services?
 
Captain Smith:  The Medical Center began a proactive response to the mental health aspect of COVID-19 through the Resiliency Support Team (REST).  This program is designed to address concerns before issues become more (larger).
 
Dr. Savannah Woodard, Mental Health Services:  REST is a collection of services that were initially aimed at supporting our healthcare workers through the COVID pandemic.  This program has expanded to offering a daily open forum for staff members to talk about racial injustice and all of the civil unrest going on right now. 
 
ECM:  In researching the San Diego Naval Medical Center’s service delivery area, the research showed that your facility is responsible for the ships assigned to San Diego when in port for medical and dental care.  This includes the USNS Mercy.  In March 2020, the Mercy was sent to Los Angeles to permit non-military and VA hospitals to lighten the load of civilian medical centers.  Where did the Mercy obtain its staff for deployment?
 
Captain Smith:  The USNS Mercy is not fully staffed at all times.  It takes a few days (or longer) to prepare the Mercy for deployment.  The Mercy’s is generally staffed by the San Diego Medical Center and local military clinics. The staff consists of 800 plus doctors, nurses, technicians, and administrative staff when deployed.  The San Diego Naval Medical Center is responsible to staff the Mercy with personnel mostly from the Medical Center and local clinics.  
 
ECM:  For the USHS Mercy’s March 2020 deployment to Los Angeles, was the staff primarily active duty or a combination of active duty and reservist? 
 
Captain Smith:  The majority of the Mercy’s staff were active duty working at the Naval Medical Center San Diego with a couple dozen from Bremerton, Washington.  Additional staff were reservists.  No civilian employees were deployed.  
 
ECM:  According to Navy News, the Mercy treated a total of 77 patients whose treatment ranged from basic medical to surgical care during a six-week period.  How did the Mercy’s COVID-19 mission to Los Angeles impact healthcare delivery to the military and veteran families in the San Diego region?
 
Captain Smith:  The impact was minimal as the San Diego Naval Medical Center shifted operations and appointments to virtual appointments. There was a reduced request for services; yet, the Medical Center met the needs.  The demand for services at the San Diego Naval Medical Center also went down.  Care was provided to eligible patients.  If an increase would have occurred the Medical Center would have improvised, adapted, and overcome.    
 
The design of the entire (military) response to the COVID-19 pandemic for both the Mercy and Comfort hospital ships was to avoid what happened in Italy, Spain, and other countries where the healthcare system was overrun. Italy and Spain had terrible experiences and shortages in response to the COVID-19 pandemic (medical supplies and equipment). Navy and the various local, state, and federal government agencies worked to create a response plan that would not develop into the problematic situations in Italy and Spain.  The US Naval Hospital Ships Mercy and Comfort were deployed to locations that were thought to have the healthcare system overrun. The Mercy was sent to Los Angeles and Comfort was sent to New York.  The mission of augmenting the non-government hospitals and clinics was to take the overflow (non-COVID) patients.  This permitted civilian facilities to deal with the COVID patients while the Mercy and Comfort worked to keep routine hospital care operational. 
 
The military was not going to permit these issues in the civilian or military medical systems to occur, not on my watch.  Deploying the Mercy and Comfort requires preparation beyond 24 hours; rather, it takes days.  The great news was that the expected wave of COVID-19 patients did not materialize; yet [the Navy provided] the availability of the Comfort and Mercy options for routine medical services.  
 
ECM: Navy’s response to the COVID-19 onboard ships has been swift at times.  Yet, the ships are tight quarters and are like a miniature city.  Outside of the phase in plan and Mercy, what is the medical center’s role to ensure the health of those deployed and geographically outside of the San Diego area.  Does your Medical Center provide assigned medical personnel to these ships (e.g. Aircraft Carrier Theodore Roosevelt, Littoral Ships, etc)?
 
Captain Smith:  Each ship has their own imbedded medical staff that deploy with their own people. At times, the ship’s medical staff will be augmented by the San Diego Naval Medical Center.  When the ship docks that is when the care reverts back to the medical center.  
 
ECM:  This leads us into some of the challenging areas of our current healthcare delivery systems.  Specifically, for the San Diego Naval Hospital, how has the COVID-19 pandemic changed how the hospital operates.  Examples, include increased use of virtual work, logistics (supply/PPE), methods to continue to delivery healthcare, human resources, and other areas of employee engaged service delivery?  
 
Captain Smith:  The Medical Center is continually monitoring the supplies needed to operate day to day.  The logistics staff continues to have a close eye on the personal protective equipment (PPE) supply to ensure that supplies do not dwindle. In addition, the Medical Center has implemented virtual or Teleworks for some of the administrative staff.  The clinics at the Medical Center have begun to expand the use of virtual or telemedicine appointments. Patients are screened during the appointment process and primarily have virtual healthcare appointments.  In addition, awards are no longer held indoors and are moved to the lawn (with social distancing).  
 

In addition, the Medical Center looks different and is restricted to one of three entry points with the overall footprint looking different. Anyone entering the hospital will have a temperature check.  This minimizes employee and patient risk.  The hospital has separated the Fleet mission and Fleet members from the general authorized healthcare patients.  Patients who believe they have COVID-19 are directed to the COVID-19 tent for testing. The tent is fully wired (with technology and medical equipment) to care for the needs of the potentially infected patient.  


ECM:  Since COVID-19 is a virus without an immunization or cure currently available along with the fact that the virus mutates as it spreads, what has been the treatment method for the virus at the Medical Center?


Captain Smith:  The majority of the infected do not require hospitalization and are managed from a home care setting.  The spread of COVID-19 has no common thread.  Science is attempting to do in 20 months what normally takes years of research and development. It is possible that science has not caught up with facts.

 

ECM:  Are there any specific general or specialty clinics that are currently unable to operate due to COVID-19?


Captain Smith: The Medical Center is pretty much doing now what was previously done in a pre-COVID-19 medical environment.  Services have not been cut down as the various medical clinics continue to operate. The Naval Medical Center, San Diego is a tertiary (regional) medical center (for the military and veterans) – we do just about anything.  The first month of the pandemic, the entire health system shut down. Currently the Naval Medical Center San Diego has no (major) issues as services continued (throughout the pandemic). At the same time, one of the key factors that need to be worked on is the backlog of services, surgeries, and how the Medical Center will address the global healthcare issues. The Naval Medical Center San Diego needs time.


ECM:  With the need for round the clock childcare for medical staff, how is your medical center responding to employees’ childcare needs or lack of childcare during this pandemic?  This is based upon the fact that much of the overall military childcare system is either shut down or has reduced service hours according to discussions with Navy childcare facilities.  Has this been considered in the phase in plan for employees?


Captain Smith:  As a pediatrician, I can say that a child’s job is to find viruses and spread the germs. This is what happens in childcare centers creating a need to monitor the installation childcare facilities. The Navy is aware of the need for employee childcare and is working with staff to address the reduction in available childcare services on the installation.  


ECM:  Based upon the current modifications to medical operations, will the hospital continue to operate using the modifications (i.e. telehealth/medicine appointment, teleworks, and other innovations) to maintain your current workforce? Also, will the Navy continue to operate utilizing the current modifications to healthcare delivery and employee engagement?


Captain Smith:  As we are a medical center, we have begun to use telemedicine and virtual appointments for care not requiring face to face appointment.  This includes mental health, primary care, and other services.  


ECM:  How can the active duty, veteran and family members support the Medical Center’s efforts to continue healthcare while in the COVID-19 environment?


Captain Smith:  Stay informed through official websites and social media.  When a person is sick, go to the hospital to be seen.  A lot of authorized patients think they cannot go to the hospital.  Nothing is worse than having a mild illness and not receiving treatment and become more ill.


ECM:  What can we, as a community do better in both healthcare and life in general?


Captain Smith:  Do better?  I do not (specifically) know because there is so much that we do not know about the virus and how it behaves.  There are a lot of intelligent people providing advice.  Yet, we needs to have a consensus in the advice. The current guidelines are easy to follow (mask, social distancing, etc).


ECM:  Thank you for your time.  Is there anything else you would like to let the community know?  


Captain Smith:  Naval Medical Center, San Diego is here and ready to take care of you.  Use telehealth and other services available.  Let us get the message out there that we (Naval Medical Center, San Diego) are open.  Do not be shy, much (of healthcare) can be done virtually.  We would love to have you come in and receive care in our world.


NOTE:  Naval Medical Center, San Diego is open to active duty personnel, their authorized family members (i.e. spouses and children), veterans and their authorized family members, and at times provided emergency treatment through cooperative agreements in the San Diego community such as the Veterans Administration.


*The Naval Hospital San Diego is a 1.2 million square foot medical center.  It has 18 operating rooms, two Fisher House Homes, a 250-seat auditorium, a 200 seat chapel, and a medical and surgical simulation center used to teach aspiring doctors and medical staff.  On an average day, the Naval Medical Center completes 44 operating room cases, has 45 inpatient admissions, and will deliver six babies. Naval Medical Center also has a neonatal intensive care unit for premature babies. On any day, the Naval Medical Center, San Diego generally will fill 6,500 prescriptions, have 5,800 patient visits, 200 emergency visits a day, while managing a cadre of graduate medical students and sharing resources through cooperative agreements with the Veterans Administration and other healthcare facilities 


UCSD and the VA have a medical fellowship cooperative agreement program for most major medical specialties.  Additionally, the VA and Naval Medical Center have cooperative research and development agreements with government, universities, and industries.

 

Dr. Helen Horvath is an Army veteran, published author, psychologist, and organizational development consultant.  As a speaker, she has been invited to speak at the American Psychological Association Annual Conference, Society of Industrial and Organizational Psychology, and other key professional organizations. 


Dr. Horvath is a published author on a variety of psychology and business-related topics.  She is a former marriage and family therapist who also published a relationship book entitled “Put a Period to IT: When Divorce is the Option.”


East County Magazine gratefully acknowledges the Facebook Journalism Project for its COVID-19 Relief Fund grant to support our local news reporting during the COVID-19 pandemic. Learn more: #FacebookJournalismProject and https://www.facebook.com/fbjournalismproject/.

 

 


 

 

 


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