Exclusive: U.S. Navy Service Members and Family Rarely Received Follow-Up Treatment After Troubling Blood Tests

Thousands of U.S. Navy service members, veterans, and their beneficiaries who tested positive in a screening typically used for colon cancer were never alerted to the results and few received follow up treatment, according to an internal document obtained by Newsweek.

Between 2012 and 2017, Navy Medicine identified patients who had a positive fecal occult blood tests but a subsequent review process never found documentation of a "result and next steps," notices and discussions which normally occur between doctors and patients, and are then listed on a patient's medical record.

More than 5,000 cases that have not been previously reported were discovered during a process improvement initiative at Naval Medical Center San Diego (NMCSD). The internally-circulated health analysis, titled Identification of Fecal Occult Blood Test (FOBT) Follow-Ups, found "no evidence of colonoscopy at any time" after receiving a positive test while undergoing examination at a military treatment facility.

The revelations come at a time of deep uncertainty within the military medical community. Budget cuts have vexed personnel for years, with persistent concerns for the future of programs—including routine care—available to active-duty members, veterans, and their families.

There are several methods of screening for colon cancer, one of which is the administering of stool blood tests. The stool sample tests are inexpensive and used widely in routine health examinations. The report noted the majority of those who did not receive follow-up examinations were screened at James A Lovell FHCC, NMC San Diego, and NMC Portsmouth.

The Navy Marine Corps Public Health Center was asked to conduct the review, obtained through a Freedom of Information Act request, by the Navy's Bureau of Medicine and Surgery (BUMED).

After releasing the July 2018 report Navy Medicine tasked hospitals and clinics with carrying out follow-ups. "Affected patients received letters with information on how to pursue appropriate follow-up care," a Navy Medicine West spokesperson said. "If the patient no longer lives in the vicinity of an military treatment facility, information about other steps they can take to receive care was included in the notification."

In an interview, Christopher B. Cornelissen, the former chief medical officer and deputy chief of staff for high reliability for Navy Medicine West, said it was not uncommon for patients not to receive follow-ups after abnormal test results and noted that sometimes the report was not necessarily an indicator of cancer.

"It would be safe to say that some patients may be notified at the point of care of that result," Cornelissen said, "but really the question is how was that notification documented."

He added, "We're aware of no patients that died as a result of not being notified."

Medical experts at Massachusetts General Hospital who Newsweek asked to independently review the report said it suggested follow-up procedures needed improvement. "It is quite surprising that a positive FOBT was not followed by a colonoscopy for further evaluation in such a large percentage of the population," said Dr. Andrew Chan, who specializes in gastroenterology at the hospital's Cancer Center. "Generally speaking, it is the responsibility of the provider and the health care system to notify patients they had a positive test and make sure they undergo further evaluation."

Patients aged between 18 and 49 years of age never received a follow-up 63 percent of the time. Those aged 50 and older did not receive a follow-up 59.8 percent of the time. The report notes that there are aspects of the "care pathway" that a population-based method like the one used in the analysis cannot assess, such as instances when patients were notified but no record was maintained or when patients went elsewhere for treatment.

In August, two weeks before retiring, the former Surgeon General of the Navy told a gathering of Marines, sailors, family members and retirees at an event in San Diego that despite administrative changes and future personnel cuts, the beneficiaries of Navy Medicine will maintain their access to services.

In 2018, the U.S. Department of Defense circulated its Project Objective Memorandum, outlining a planned reduction in medical staff, in an effort to fund ongoing combat and patrol operations. The budget for fiscal year 2020, released in March last year, proposed further cuts to health programs associated with military members. These changes could affect the Navy Medicine diaspora of more than 63,000 personnel globally, operating hospital ships, clinics, and research units.