The hospital at Yokosuka Naval Base, Japan, is now serving civilians only on a space-available basis.

The hospital at Yokosuka Naval Base, Japan, is now serving civilians only on a space-available basis. (Tyler Hlavac/Stars and Stripes)

YOKOSUKA NAVAL BASE, Japan — Naval Hospital Yokosuka is standing by a recent appointment policy change that makes it harder for non-military personnel to receive care.

Under the new protocol, which took effect in early November, patients who are not active duty or the dependent of a servicemember are restricted to making same-day medical appointments on a space-available basis.

The facility’s commander, Capt. Rosemary Malone, addressed recent criticism of the new procedure during an interview Friday with Stars and Stripes. She said federal guidelines demand that overseas military medical facilities give servicemembers priority, and her hospital is simply following rules that had already been established.

“In order to meet access to care standards we had to make this procedural change,” she said. “An active-duty servicemember would come in and the [doctor] would say come back in a week, and there was no appointment within a week … it was pushed out because the appointments were taken.”

Naval hospitals on Guam and Okinawa adhere to similar policies, she added.

The change has vexed many at Yokosuka, including Jim Collings, a civilian who works as a speech-and-language pathologist for on-base schools.

“It will be essentially impossible to serve my students without interruption and deal with the demands of this new appointment policy,” he told Stars and Stripes in an email. “I think my biggest personal issue with this latest announcement has to do with the hypocrisy related to being essential when it comes to the real daily threat living here … but being relegated to second or third class when it comes to getting basic medical care.”

Malone said some civilians — who are not put through the extensive medical screenings required of servicemembers and their dependents — have strained the hospital’s resources.

“A lot of times there are individuals who seek care with conditions that we would say you’re not suitable to go overseas if you were active duty,” she said. “Those that don’t go through overseas screening come here thinking, ‘I got the care in the states, I should be able to get it here,’ but it’s not the same. I’m a community-sized hospital basically and my branch clinics are primary care clinics.”

Those unable to get an appointment have the option of being treated at an off-base hospital. However, some Yokosuka residents say that Japanese health care is not the same as America’s, and that language barriers make it difficult to receive care.

Nicholas Gott, an emergency planner for Submarine Group 7 at Yokosuka, said he has had trouble navigating the Japanese health care system, even with help from his Japanese spouse.

“Japanese medicine is advanced, but does not cover some standard American treatments,” he said. “Someone is going to get hurt. Someone may die. Medical care is not the time to have language barrier problems.”

Gott added that Japanese hospitals are more restrictive with pain medications and tightly control prescriptions by offering only small doses and requiring frequent return visits for refills.

Another issue, he said, is that off-base providers do not accept American health insurance and require patients to pay for care immediately out of pocket and file later for reimbursements.

Malone denied that Japanese hospitals are substandard. She said her staff frequently trains with Japanese civilian medical staff and that servicemembers are often referred to Japanese hospitals for care. She said her facility and some insurance companies can provide lists of hospitals with English-speaking staff.

“We have strong relationships with our host nation hospitals and their staff,” she said, adding that she has visited several off-base facilities. “Japanese have a standard of care and it may not be the same and we may do things differently but we get similar good outcomes. We wouldn’t send our patients to their facilities if we didn’t trust how they provided care.”

The Navy’s Bureau of Medicine and Surgery will send teams to the hospital to examine its primary care procedures and evaluate whether it is adequately staffed to serve the base, Malone said.

“My staff go into the business of health care because they want to take care of people,” she said. “We would love to do that for all but we have to make sure those highest [priority levels] have that access. Our goal is to make sure patients can come here and that we have appointments.”

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