Air Force Staff Sgt. Connor Morris, a medical technician, trains on medical evacuation vehicles alongside members of the Kadena Air Base Critical Care Air Transportation Team on July 20, 2023 at U.S Naval Hospital Okinawa, Japan. (Beth Holliker/U.S. Air National Guard)
WASHINGTON — Faced with severe staffing shortages last summer, medical personnel at Kadena Air Base in Okinawa, Japan, urged pregnant women to give birth elsewhere.
The women were given two choices: use a Japanese hospital, where epidurals are rarely given and patients in labor can be denied admittance, or be flown to a location in the United States. Naval Hospital Okinawa, the only full-service medical center on the island, would not have enough staff to deliver babies from August to November, the chief medical officer at Kadena’s 18th Medical Group warned at the time.
The announcement was later rescinded, but the episode sowed panic in the community and highlighted the chronic capacity challenges in the military health system, especially in the Indo-Pacific region. The Pentagon’s inspector general documented problems with overseas care in a report last year.
A new bill proposed by Sen. Tammy Duckworth, D-Ill., aims to prevent a repeat Okinawa scenario by expanding options for service members and military families seeking care in the future.
It proposes establishing a program that would enable all Defense Department-affiliated personnel in the Indo-Pacific to access foreign medical treatment facilities during peacetime and wartime operations.
A similar provision introduced by Rep. Elissa Slotkin, D-Mich., was included in the House version of the annual defense authorization bill on Wednesday night.
The proposed program would be modeled on an initiative already in place in Korea, where the U.S. military has agreements with more than 40 hospitals on the peninsula to guarantee troops’ access to quality medical care.
The 2023 report by the Pentagon’s inspector general said some specialty care services are not available at Naval Hospital Okinawa and some specialties, such as obstetrics and physical therapy, have barriers to access.
Naval Hospital Okinawa and Kadena Health Clinic had the most unfilled contractor positions out of all overseas military treatment facilities, according to the report.
Air Force officials in Japan said a dozen civilian employees within a six-month period asked for tour curtailments, declined jobs or left due to concerns about on-base access to medical care. Two departed the island because of limited obstetrics care for their pregnant spouses.
The inspector general for the Marine Corps has identified significant challenges with civilians using off base medical care overseas, including language barriers, differences in how medical care is provided and a lack of availability for some U.S. prescription medications.
Epidurals are not available at most hospitals in Japan, and only one network hospital in Okinawa provides them, according to the Marine Corps. Japanese hospitals also routinely turn away patients for a variety of reasons.
But Duckworth said those differences can be bridged through an accreditation process or the development of standardization procedures that would ensure the quality of care is the same as at a military treatment facility. The Pentagon would collaborate with partner nations on the standards, according to the bill.
The senator, a former Army National Guard lieutenant colonel and Iraq War veteran, said she will strongly push to include her measure in the Senate’s version of the National Defense Authorization Act, an annual must-pass bill setting Pentagon priorities.
Duckworth’s legislation also mandates the creation of a medical readiness strategy in the Indo-Pacific.
“Far too many service members, dependents and [Defense Department]-affiliated civilians find it difficult to access care overseas,” she said. “That harms our military readiness.”
