A U.S. Navy doctor examines a civilian patient in this undated photo. (Danny Nunez/U.S. Navy)
Some Defense Department civilians and retirees are decrying a recent policy change at a Navy hospital in Italy that they say limits their access to health care and was implemented with little notice.
Starting Monday, those groups will no longer be able to schedule family medicine appointments in advance at U.S. Naval Hospital Naples. They’ll be limited to same-day visits subject to space availability, according to a Facebook post June 2.
The hospital said the change is necessary to ensure that active-duty service members and their families continue to receive care during the permanent change of station season, when thousands of military personnel and dependents relocate and the demand for medical services increases.
On Thursday, the hospital updated its post to say the move was necessary to address upcoming provider shortfalls.
“This is a temporary adjustment that will end once our incoming providers are fully onboarded likely around September,” the update said, adding that hospital staff would work diligently to schedule civilians and retirees for open appointments.
The change applied only to the family practice department, so pharmacy, lab, radiology and emergency room services along with specialty clinics were unaffected, the hospital said. Officials previously said that obstetrics appointments and two-day newborn visits also were not affected.
Even so, the abrupt change alarmed civilians and retirees who rely on the hospital for their health care.
Besides reducing their medical options, it has left them unprepared to deal with language barriers, upfront payments and other challenges in seeking medical care from Italian providers, they said.
“You can’t predict certain things in life, and it would be nice to know that we can access medical care promptly if we need it,” said the wife of a DOD civilian.
The civilian spouse spoke on condition of anonymity because she feared retaliation for speaking publicly about the issue.
She worried that the change could affect access to a vital medication for one of her children. The drug is unavailable through the Italian health care system and requires periodic evaluations to renew the prescription.
If obtaining appointments at the Navy hospital becomes more difficult, the family may need to travel to the United States to ensure that the child’s treatment is not interrupted, she said.
U.S. Naval Hospital Naples did not respond to questions seeking more information, such as the number of civilian and retiree patients treated at the facility and how many space-available appointments typically are available each day.
It’s unclear how the hospital is informing affected patients beyond the two Facebook posts and a recent notice in a base newsletter, none of which offered a listing of English-speaking local doctors or resources for using the Italian health care system.
Several patients familiar with the policy said they did not receive a notification letter or email.
That may leave many people unaware of the changes and possibly the need to seek care elsewhere, said Emily Painter-Davis, the wife of a retired soldier who served in the Army for 23 years.
“That’s just not OK with me,” said Painter-Davis, whose husband now works as a contractor for the Navy.
Defense Department employees in various countries across the globe have faced long-standing challenges when seeking care off base.
Last year, the Pentagon launched a program designed to connect civilian employees in Japan with local medical providers and assist with appointments, billing and, more recently, interpreter services.
Officials said in March that the program had facilitated more than 1,400 appointments and reduced upfront costs, which can reach thousands of dollars.
Participants, however, raised concerns about the program’s limitations. Some said it excludes dependents, restricts access to specialty care and leaves patients confused about insurance procedures.
The pilot was one of the Pentagon’s primary responses to a backlash at a series of town halls in Japan regarding civilians’ access to health care in 2022 and 2023.
The Defense Health Agency, acting under a congressional mandate, was limiting civilian access to military health facilities to space-available appointments and encouraged them to seek care from local providers.
For some counterparts in Naples, the prospect of relying on the Italian health care system is worrisome. The family of the DOD civilian has sought specialty care from local Italian medical providers with mixed results, she said.
While a visit to a public hospital was good, a similar experience at a private medical facility resulted in a demand for payment that was significantly higher than the written, itemized estimate of 1,450 euros, the spouse said.
The family was told to pay 8,865 euros before leaving. They protested but the hospital workers wouldn’t budge, so the family paid the bill in full.
NSA Naples hospital officials initially said they would not help get the bill reduced, despite indicating they were familiar with similar situations, she said.
Ultimately, the family persuaded Naples officials who had recommended the Italian provider to help, and the bill eventually was cut down to about 4,000 euros.
“It was surprising to be taken advantage of like that,” the spouse said.
For Painter-Davis, the drop in appointment availability underscores what she called poor treatment of civilians and contractors.
She believes the DOD should do better at informing its civilians and contractors of the potential for problems in accessing medical care, housing and employment for spouses ahead of time.
“If you’re not going to treat us with respect and dignity, then you should stop bringing people over here that you’re not going to support,” she said.
Stars and Stripes reporters Marc Castaneda and Alex Wilson in Japan contributed to this story.
