The Navy increased medical monitoring and used performance-enhancing drug tests during Navy SEAL training after a candidate died of pneumonia in 2022, according to an inspector general report. However, the report found there was a lack of policy in the Navy's approach to sleep deprivation during SEAL training.

The report released this week examined the Navy's notoriously rigorous SEAL training and took a look at policies, personnel and medical procedures that gained attention after the death of SEAL candidate Kyle Mullen in February 2022, at the end of the Hell Week-day effort 108.5 consecutive hours of training in which candidates get less than four hours of sleep.

The IG did not question the need for SEAL candidates to be sleep-deprived, noting that such conditions were “operationally relevant” to determining how candidates perform individually and as a team and to placing them in an environment exposure that they would likely experience during combat. However, the report says the four hours of sleep candidates now get during Hell Week is not enshrined in an official policy. Navy officials, the report said, “were unable to provide concrete justification for the timing, length, or number of sleep periods, and we were unable to identify (Department of Defense) guidelines which provided the purpose, applicability and guidelines for the intentional sleep deprivation of candidates “sleep.”

Capt. Jodie Cornell, spokeswoman for Naval Special Warfare Command, said a study to develop a policy is underway.

The report also noted several positive new policies at the school, known as Basic Underwater Demolition/SEAL Training (BUD/S), and a culture shift toward safety.

Improvements after Class 352

Mullen, a 6-foot-4 former college football player who was a member of the Class of 352, pushed himself to the limit to be “on the edge” at the end of Hell Week. By midweek, he was falling behind and coughing up brown and pink fluid from his lungs before developing pneumonia. At one point, a fellow BUD/S student found Mullen spitting up dark fluids in the bathroom, just hours after he had ended the week with pneumonia, when Mullen said, “I'm such a bastard.”

“Kyle died in large part because he is so incredibly strong, because he is one of the few people who is actually capable of pushing his body to the point of death. That doesn't excuse all available intervention options,” said Mark Hardman, a former Navy captain and Marine lieutenant, chief medical officer and attorney who studies bioethics at Harvard University. “Still, Kyle's strength was an issue and that's why there needs to be a medic in the room to say, 'No more'.”

After Mullen spent the final hour of Hell Week in the back of an ambulance breathing from an oxygen tank, BUD/S medics and instructors sent him to the barracks without further medical care. There, survivors of Hell Week were monitored by young BUD/S students with no medical training. On February 4, 2022, Mullen was found lifeless in the barracks by his classmates and was pronounced dead at a local hospital.

The new IG report highlighted a number of changes in SEAL training since Mullen's death, including new guidelines on infectious disease prevention. A new practice the Navy has adopted is to give candidates a bicillin injection a week before Phase 1 assessment and crucible events. Prior to Class 352, there were an average of 2.2 cases of pneumonia during Hell Week. According to the war center, there have been 0.94 cases per class since the new injections.

The Navy is now also examining the county's ocean water tests for disease-causing pathogens to determine whether the waters are safe enough for training. If beaches are closed because of transboundary pollution in the Tijuana River Valley and the Pacific Ocean, officials will cancel or reschedule training. Between January 2022 and December 2023, the center hosted nearly 32% of its events in the water due to contamination.

The Navy's investigation found that medical care during the rigorous week of training was insufficient to address the high rates of illness and injury often experienced by trainees during this phase. Only one paramedic was assigned to each training event and the training of these paramedics was described as “poorly organized, poorly integrated and poorly managed.” Most were active duty and contractors with competent training, but none completed mandatory BUD/S-specific training, according to the report, although some did serve at the school for two years.

The Navy has since assigned two medics to each BUD/S development, according to the service's May 2023 report. However, given the 108.5 consecutive hours of training during Hell Week, IG Warfare Center staff told the IG that the manpower is a ” “big problem”. Therefore, the report recommended that the Department of Defense and the Navy evaluate the center's staffing capabilities to ensure they are meeting clinical needs and potentially reduce physician burnout.

The Warfare Center also conducted medical exams every 24 hours, including post-TOUR and Hell Week evaluations, with medical providers remaining on-site until candidates completed medical exams on Saturday morning. “High risk” candidates are observed in a medical center until a provider determines they are “low risk.” If they need follow-up treatment, they will be sent to a hospital, according to a Navy document on its updated policy.

One of the most intensive training courses in the military

Before Hell Week, SEAL candidates train for months before taking a course, completing ocean swimming, sand running and obstacle courses. Candidates then complete Phase 1 of Basic Underwater Demolition/SEAL training for seven weeks, during which they are pushed to their mental and physical limits. Hell Week takes place at the end of Phase 1.

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Typically, fewer than half of SEAL candidates drop out before Hell Week, but Mullen's early 2022 class lost nearly 80% of its candidates, according to a months-long Navy investigation. The safety investigation found that the school's culture of “no let-up” in training and lax supervision led officials to miss warning signs of Mullen's deteriorating condition despite numerous medical exams.

Hardman praised the changes the Navy made after Mullen's death, but also pointed to a larger structural problem not addressed in the IG report: the tension between medicine, medical diagnosis and treatment in special operations and other sophisticated operations. Value military special forces.

“How in God's name were people being treated with high-flow oxygen for pulmonary edema during Hell Week and that wasn't documented in MHS Genesis?” Hardman said. “Because you lose control of that information and its impact on a person’s future qualifications.”

Hardman also said the lack of qualified, experienced medical professionals increases the difficulty of challenging senior officials with their own medical advice.

“I've had conversations with senior doctors who just don't believe they're wanted at a place like BUD/S because they'd push themselves too hard,” he said. “You can’t have someone asserting themselves too much. You have to have someone who is really committed.”

In monitoring the candidates, Hardman also pointed to a section of the IG report that he said was representative of a cultural shift. During a development in September 2023, an exhausted and disoriented candidate told leadership he wanted to quit, but an instructor encouraged him to reach out to medical personnel instead of giving up. This is the “positive change” that people want, he said.

“Anytime you have a tragedy like this, which is very public, it can be the impetus for very positive cultural change. “What people want is hella hard training with proper safety precautions that still allows the fighters to go into depth,” Hardman said. “I don’t want Navy SEALs to be soft, and I don’t want their training to be easy. What I want is proper medical risk management.”