[Ed. Note: Captain Bumgarner Qualified in Submarines in WOODROW WILSON (SSBN 624) as a line officer after an interim tour in GROUPER (AGSS 214), Nuclear School at Bainbridge and a five week SO/C course at Submarine SchooL He was released after 30 months on WILSON to attend Medical School on an active duty scholarship. He has been a Medical Corps officer since 1971 and has served as Force Medical Officer for SUBPAC.]
Thank you ladies and gentlemen. Commander Sach that was a most kind introduction. I am pleased to be with you, to join the staff of the Naval Undersea Medical Institute (NUMI) and distinguished visitors, namely family, to celebrate the graduation and qualification of the members of Undersea Medical Officer Class 9201, to be with you before you embark on your most satisfying ventures in operational medicine in this great Navy of ours.
And it is great to be back in Connecticut, the blue skyed coastal region of historically seafaring importance. I had three tours here, the first in 1968, starting on the USS Grouper (SS-214). We put to sea on a windy, cold 15°F sunny day, on, I believe, 15 January, into the wintery North Atlantic. A diesel sub that cannot dive in rough weather because of its righting moment is a bit different than a nuke. That deployment I’ll never forget. Next I attended NUMI out of med school, and finally, as you have heard, I was the pathologist here several years ago. This is a great community and a great base – none is finer, in my view.
Three weeks ago at the Uniformed Services University of Health Sciences commencement, Health and Human Services Secretary Louis Sullivan wryly observed that his graduation remarks should be brief for they wouldn’t be remembered. Dr. Sullivan recounted a story from General Norman Schwarzkopf of his West Point graduation. The General indicated to Dr. Sullivan, and a host of others, that at his West Point graduation he suffered through a 45 minute talk. General Schwarzkopf indicated that a 15 minute talk was fine, which Dr. Sullivan vowed he would do. Hopefully I’ll do even better; that is, my remarks will be shorter than that. I am also mindful that I must make stirring comments about nothing much in particular. We shall see how I do.
To be serious, your role in the greater context is to help our Defense establishment prevent war, and in a more specific context, your job is to keep your ship well. I will not dwell on that now, but I want you to think of it as we go along this morning.
To paraphrase General Colin Powell: sailors are different; sailors endure separation, loneliness, deprivation, confinement; sailors, particularly sub sailors, are incommunicado. You will work with people that sacrifice more than you might have imagined. For what? The answer lies in the fact that subs are the linchpin of the defense arsenal.
Historically, the Fleet Ballistic Missile Submarine concept was initiated and sponsored by Admiral Arleigh Burke. He recommended putting a missile on a submarine, where it would be protected and out of reach. The Polaris patrols that. started in 1960 still continue; our security requires it, armed for Armageddon, to prevent it. Subs are alone in their great work.
think in the eyes of the National Security Council, subs must be doomsday machines; when subs enter the fray, matters are very serious: it is a global affair. Yet America’s place in the New World Order depends on reliance in the creditable defense capability of the Fleet Ballistic Missile Submarine.
Let me relate to you a sort of experience you might find yourself involved in, while in port and a ship is at sea. Let me read you a message that echoes the remoteness of submarine duty alluded to by General Powell:
FM COMSUBGRU NINE
TO USS (SSBN ON PATROL)
INFO GOLD CREWCOMSUBRON SEVENTEEN
COMSUBPAC PEARL HARBOR HI
UNCLAS PERSONAL FOR CO FROM CHIEF OF STAFF //N00000//
SUBJ: HUMS RPT ICO LT (BLANK) USN,
- COMSUBGRU NINE REGRETS TO INFORM YOU OF THE DEATH OF LT (BLANK’S) FATHER. MR. (BLANK) DIED SHORTLY AFTER 2AM EST (DATE). DEATH CAME AFTER A LONG ILLNESS.FAMILY MEMBERS REPORTED THAT MR. (BLANK) DIED PEACEFULLY IN InS SLEEP.
2. THE FUNERAL WILL TAKE PLACE ON SATUR-DAY, OFEB.
3. INFORMATION PROVIDED BY LT (BLANK’S) BROTIIER INDICATES TIIATTHEIR MOTIIER IS DOING VERY WELL HE WANTED HIS BRO-TIIER TO KNOWTIIATTHEY UNDERSTAND THE IMPORTANCE OF HIS DUTY AND TIIAT HE SHOULD NOT FEEL BAD OVER NOT BEING ABLE TO COME HOME. THEY KNOW HE WU.L BE WITH THEM IN InS THOUGHTS. ALL SEND HEIRLOVE.
4. IN VIEW OF AVAIT…ABLE FAMILY SUPPORT AND OPERATIONAL CONSIDERATIONS, HUME-VAC IS NOT BEING RECOMMENDED.
5. CSS 17 AND COMSUBPAC SEND CONDOLEN-
Consider that message for a moment; consider your possible roles in assisting the respective crew member’s family and friends, and your responsibilities to the ship’s CO and the squadron commodore. Your new practice of undersea medicine can take some unusual and sensitive twists as you wind your way through these matters.
And your job is to make the ship well, so it can function, so it can protect America. To keep the ship or other unit well you must be assertive, but politely so. Think it through…consull..speak to us, your fraternity of Undersea Medical Officers. Remember, there is a difference between being frank and outspoken. Bear in mind that the very common factor in all of your equations is your CO’s personality. Understand him. Take care of his people, your people; train them, guide them, enable them, push them. Pay attention to details; heed history. The devil is in the details. You are the eyes and hands of Navy Medicine, and you are special counsel to your CO, or COs if you are the squadron doc. Sprinkle magic dust in the far comers of your kingdom. Watch what happens in your fiefdom as you get out of sick bay, walking the decks and spaces going about your unit, keeping the ship or ships well.
And note that to these ends, namely keeping the ships well, we need idea people. Don’t throw away a good idea merely because it is not well received; rather save it. Put the idea on the shelf, save it. Note the idea of the Diving Medical Officer (DMO) pin. An idea’s time may come when least expected. That DMO pin idea failed to be approved at least twice as official recommendations in the last several years. So if your CO says no, wait, keep your idea, but continue to help your CO accomplish his aim, to fight the ship. Advise him and look out for his people.
Your practice of medicine will be largely of a preventive nature. But a day a week in curative medicine in a traditional setting is an appropriate thing to do. You just have to protect your hard earned skills as a hands-on, caring physician.
In the end, do what you are happy with. Be true to your-selves; don’t bank too heavily on delayed gratification, as many of us did in med school. What if your desired payoff never comes? Remember, when the paradigm changes, things, many things, may go back to zero. Don’t leave yourself out. Keep in mind life after the Navy. But recognize that our greatest joy is accomplishment. Accomplishment is more important than anything else to most doctors, more important than location per se, unless there is a stressful, real family geographic situation. Placing physicians in billets that matched professional desires, abilities and requirements, which yielded a chance for true professional accomplishment, and satisfaction has been the key to the successful UMO assignment policy. Undersea Medical Officer billets are good jobs, all bard billets with solidly valida-ted requirements. All UMO billets provide superb professional satisfaction. So it is that undersea medicine is a special fraternity, that keeps its ships well.
Let me recount some dark moments, moments that led to the cementing of your roles as medical officers vis-a-vis your subordinate corpsmen, namely, Independent Duty Hospital Corpsmen (IDCs).
In 1984 on the USS DAVIDSON (FF-1045) there was a death due to adult respiratory distress syndrome, and in 1985 on the USS WORDEN (CG-18) a malaria death occurred in the face of inadequate medical care. There was, then, often no accountability afloat for medical care, especially in the surface Navy, not in sick bay nor on the bridge. There was inconsistent accountability ashore, too, in my view. Assignments were perfunctory for IDCs, and physician and command oversight often did not exist. After the courts-martial of a number of principal officers associated with these medical misadventures, COs inappropriately started holding the IDCs accountable for matters well beyond their capability or control. Morale and retention of corpsmen plummeted. No one wanted to be an IDC, which the Navy Inspector General (IG) somberly noted.
HMCM(SS) Steve Campbell, now on the Medical Inspector General Team, HMCM(SS) Tom Gray, now retired, and HMCM(SS) Charlie Williams, the Medical Force Master Chief, among other notables, and I wrote OPNAVINST 6400.1 as a response to a Navy IG tasker consequent to these two medical misadventures. OPNAVINST 6400.1 is the IDC Charter. It establishes a certification program and a training requirement, much like that which exists for physicians (where it is called credentialling and privileging) and others, such as the nonphysi-cian health care providers. The Instruction assures that only a properly qualified IDC is transferred into an IDC billet. Now remember, in 1985 there were two varieties of IDCs: surface and submarine. Today, because of the widespread problems we discovered, there are ftve varieties of IDCs, three being new ones: Marine Reconnaissance IDC, Special Warfare IDC, and Deep Sea IDC. We reasoned that if we were going to fiX the IDC problem, comply with the Navy IG’s charge, we must totally fiX it, all of it, and make it right. The plain fact was that the corpsmen assigned to these three new IDC warfare commu-nities were every bit as independent of medical officer support as our surface and submarine IDC communities, if not more so in certain ways I cannot discuss now.
The Instruction is to clarify responsibilities, to prevent witchhunts or creation of scapegoats for untoward results. Of most importance was the Good Samaritan clause in the Instruc-tion. It clearly took the IDC off the CO’s hook for an unto-ward event. All that the IDC could be held accountable for when faced with a medical crisis beyond his expected skill level was to provide care and comfort as best he could, which is in keeping with the Hospital Corpsman’s Oath. The Good Samaritan clause was hotly debated. But it is central, it is the heart of the Instruction and the conduct of the IDC program. The Instruction has become institutionalized, a part of the fabric of Navy Medicine upon which the fleet, the Marines and the SEAU; depend.
I doubt that the Instruction, however imperfect it may be, will be drastically altered at any time in the foreseeable future. It was simply too difficult to promulgate. Remember, take care of your IDCs who will keep yours ships well. Listen to your IDCs, help them, learn from them. They are your eyes and ears and hands out there, out of r:each, deep in the sea.
A last word about standards of the Manual of the Medical Department. Standards are the result of many bad, horrible experiences. True, standards change or evolve, but only with sanctioned reason. Don’t take it upon yourself to try to shoehorn a sailor back onto a ship, especially when he doesn’t meet medical standards. Even if the XO or CO insists, don’t do it. Keep the ship well. Do not encumber the ship with a long shot medical case. Help the captain fight his war. Keep his ship well, and don’t forget it. In cases you wonder about, call one of us old UMOs about it, one of us in your fraternity of UMOs. Talk to us, we’ll help you out. What you need in difficult cases when you are caught in the middle on an issue of standards is a waiver from the Chief of Naval Personne~ a waiver recommended by the Surgeon General, that is, the Director of Undersea Medicine. That is how we keep the ships well. We owe to you – more than that, we owe to each ship, the Navy, and indeed, our nation, our best efforts to help you keep the ships and units well.
Remember, too, that you have a special relationship to the CO. He fights the ship, and he really wants it well. Anything that could impact medically on that ship is his direct business. Leave the administrative stuff for the XO. Remember your special role as a physician, now that you’ve been ordained. Now you are really between the bean counters and the line types on one side and the patients – their patients, your patients, on the other side – and you are in the middle because you are qualified to make certain judgements.
Now I welcome you to Submarine Medicine. I’m most proud of you. I’m happy for you. You are now part of the finest medical fraternity. Enjoy your tours. And talk to us. Keep your ships well! Be happy as you go about your arduous but vitally important work. Now, we are almost out of time, but on time, ladies and gentlemen. It is time to go, you and me, it is time to depart from here, from NUMI and blue skyed Connecti-cut. I thank you for your kind attention and I thank you for having me here today to celebrate the initiation of your careers as Undersea Medical Officers.