Naval Hospital Bremerton holds Change of Command

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

BREMRTON, Wash. (NNS) -- Capt. Christopher Quarles turned over responsibilities as commanding officer of Naval Hospital Bremerton (NHB) to Capt. David K. Weiss during a change of command ceremony, Aug. 14, marking Quarles' third successful tenure assigned to NHB.

"It's hard to believe that two years have gone by so fast," said Quarles, addressing distinguished guests, staff members, family and friends.

The Kansas City, Missouri, native completed his internship in Family Medicine at NHB after receiving his medical degree in 1992 from the University of Missouri, Kansas City, School of Medicine, where he was commissioned a lieutenant. After that initial NHB stint, he served as a general medical officer at-sea, before returning and completing his Family Medicine Residency in 1997.

"I am pleased to see many of our longtime supporters of all things NHB... We truly appreciate our collective work together to provide care for American's veterans," Quarles added.

During his time as NHB's commanding officer, Quarles lead staff members in fostering a unique partnership with Madigan Army Medical Center and Naval Hospital Oak Harbor, to take care of beneficiaries and provide as much care within the military care system as possible. Additionally, he ensured the culmination of several years of negotiation between NHB and Veterans Affairs Puget Sound Health Care System by signing a Sharing Agreement in 2014 that linked both organizations in providing specific types of medical care to current Veterans Affairs eligible beneficiaries.

Guest speaker, Rear Adm. Bruce L. Gillingham, Commander, Navy Medicine West, focused his remarks on the solid legacy that Quarles built upon as commanding officer and the continuing tradition of excellence by the staff.

"This is a day of celebration to honor the accomplishments of the departing skipper," the admiral said. "The NHB staff has set the standard that many others hope to emulate. The staff are hungry to build and anxious to prove. NHB has been essential in ensuring the fleet is healthy and ready and they will continue to meet and exceed expectations."

Much of Quarles comments were directed to NHB's approximately 1,400 active duty, activated reservists, civil service, contractor, and American Red Cross volunteers.

"NHB staff, thank you. It is your efforts, your care for our patients and your mutual respect for one another that make this command what it is. Any measure of success that we enjoy is because of your hard work and dedication to all that we do," Quarles said. "You changed our baseline services while continuing to provide cutting edge, safe patient care, and maintaining our exceptional readiness services to the fleet, including supporting the Navy's global missions by providing a ready medical force. It is no stretch to say you have exceeded all expectations. As NHB Sailors have done for the last century, you have further added to our reputation of service excellence."

Under Quarles' leadership, NHB has been endorsed and accredited by a host of outside organizations such as the Joint Commission, National Council of Quality Assurance, and other independent auditors. NHB has garnered two consecutive annual Department of Defense (DoD) -wide patient safety awards, as well as had five staff members nationally recognized for their expertise in the past six months.

Capt. Weiss reports to NHB after serving as Command Surgeon, United States Africa Command.

"Capt. Quarles has ably lead the last 24 months with timeless and steadfast leadership," Weiss said. "I'm delighted to join the team. I solemnly pledge to be ready and look forward to the challenges."

Weiss is a native of Nassau Bay, Texas, a 1986 graduate of Baylor University, and a 1990 graduate of the University of Texas Medical School at Houston. He has served with the initial surgical company to enter Iraq, assigned to 2nd Medical Battalion, 2nd Force Service Support Group, 2nd Marine Expeditionary Force as platoon leader for the Shock, Stabilization and Triage Platoon. He has also deployed to the Horn of Africa, and commanded the medical treatment facility USNS Comfort (T-AH-20), a tour highlighted by leading approximately 850 staff members in support of Operation Continuing Promise, in 2011 to nine countries in the Caribbean and South America.

Naval Hospital Bremerton Environmental Stewardship Recognized with Prestigious Award

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Naval Hospital Bremerton (NHB) was honored with a "Partner Recognition" award by Practice Greenhealth, the national membership organization for health care facilities committed to environmentally responsible stewardship, June 14.

The award was presented to Capt. Christopher Culp, NHB commanding officer, and recognized NHB for making significant progress toward environmental performance goals.

The honor is one of the organization's Environmental Excellence Awards given annually to honor environmental achievements in the health care sector.

"This award demonstrates our commitment to beneficiaries, staff and visitors in protecting and preserving our environment. I am honored to accept it on behalf of our command," said Culp.

As was the case last year, NHB's environmental stewardship at home also continues to impact communities overseas. By receiving this award, a full set of mercury-free digital thermometers and sphygmomanometers have been donated to seven hospitals in Bali, Indonesia in honor of the 2012 Environmental Excellence Award winners. Previously, 100 trees were planted in Tanzania on behalf of NHB which received the 'Making Medicine Mercury Free' award as part of Practice Greenhealth's 2011 Environmental Excellence Awards.

The Partner Recognition Award is for health care facilities that have begun to work on environmental improvements, achieved some progress, and have at least a ten percent recycling rate for the total waste stream.

Naval Hospital Bremerton is recognized not only for its 30 percent recycling rate, but also for the successful completion in expanding the pharmaceutical waste program to outlying clinics, training staff members in the Green Purchasing Program and for improving the dental mercury recovery operations.

According to complied figures by NHB's Environmental department, the main operating room (OR) is a prime example in recycling efforts at the command. Their surgical savings from recycling efforts for just three weeks in late 2011 was $11,508. Projected 2012 savings for the entire year in the main OR by recycling and usage of remanufactured items is estimated to be at $172,614.

The main OR used to throw away three, 30-gallon bags of garbage per total joint surgery case. Now they recycle three, 30-gallon bags of plastic and have just one 15-gallon bag that is now thrown away.

"It's a significant reduction in waste stream to the landfill. It's really an incremental amount of waste product, and we're staying on top of the process because it's easy to take for granted. We even recycle the instrument wrappings to use again," said Kevin Stevenson main OR nurse.

Compiled statistics at NHB show that the ongoing environmental awareness campaign of recycling is working. Recycled material (in tons) of paper and paperboard went from 52.25 in 2010 to 55 in 2011; plastic went from 15.53 in 2010 to 15.75; construction debris went from 2.55 in 2010 to 3.66 in 2011; metals and aluminum cans went from 1.90 in 2010 to 2.12 and batteries showed an increase from 0.43 in 2010 to 0.88 in 2011.

Concurrently, and as a direct result of the command's overall recycle efforts, trash disposed (in tons) fell from 198.50 in 2010 to 190.19 in 2011. Overall, average solid waste disposed by hospital staff per day fell from 1.18 pounds to 1.12 pounds per day.

"Our goal for 2012 solid waste disposal per person, per day, is one pound or under. We think that by continually being actively aware and getting as many people involved as we can, that we can achieve that," said Ramon Calantas, NHB environmental technician.

According to Calantas, the pharmaceutical waste program was implemented at the branch clinic level in 2011 after training clinic staff and coordinating the disposal of pharmaceutical waste with the area base (Naval Base Kitsap, Puget Sound Naval Shipyard, and Naval Station Everett) Hazardous Waste (HW) departments. This process took several months. Base HW staff had to review clinic processes and Wash. State Department of Ecology policy and regulations on pharmaceutical waste disposal prior to approving several areas in the clinics as satellite accumulation areas for hazardous waste. Collection areas in the clinics were added a few months after implementation as clinic staff identified additional areas were pharmaceutical waste was generated.

Pharmaceutical waste is defined as pharmaceuticals that cannot be used for their intended purpose or returned to the distributor for credit; expired/outdated repackaged medications; dropped pills, tablets, capsules; empty vials/carpules; partially used IV bags with medication; creams, lotions; and medicines left at the clinic by discharged patients. The patient info is removed prior to disposal and the clinic will attempt to contact patient prior to disposal.

"Empty plastic medication containers from the pharmacy are [also] recycled and the expired, unused medications are first presented to the Guaranteed Returns Vendor. If the vendor accepts them, we are given monetary credit. If they are rejected, we dispose them as pharmaceutical waste," added Calantas.

NHB's involvement in the Green Purchasing program has led to an increase in the command's efficiency in green procurement by using100 percent recycled content paper by deleting all other options from the supply catalog.

"Cindy Carlson, Material Management Department, sent some of her staff (her buyers) to the Department of Defense Course "Buying Green: A Multifunctional Approach to Pollution Prevention" training in early 2011. The course is about purchasing recycled content materials, energy and water efficient products, alternative fuel vehicles, biobased products, and environmental preferred products," Calantas said, noting that the staff check for green alternatives prior to buying requested material when any non-clinical supplies have to be ordered.

NHB's "Mercury Elimination Plan" started with an inventory of supplies, materials and equipment containing mercury; their locations, manufacturer and quantity, and an assessment of the feasibility of replacing with mercury-free alternatives as practicable. The plan also included requirements to ensure mercury free products are purchased, as well as involvement with maintenance and construction staff to ensure no mercury items are introduced during repairs or projects. Much of the progress made in the plan has been the focus on dental amalgams used in dental procedures now being captured and recycled.

"We have installed a combination of dental amalgam filter in tandem with mercury removal filters to exceed federal regulation for mercury in our wastewater," said Calantas. "We installed the same units in our newly deployed Mobile Dental Van currently at Everett. We invited Environmental Staff at Everett to showcase what we have installed in the van to comply with federal, state, and county regulations for wastewater disposal in the sewer systems. We continue to collect scrap amalgam from the dental clinics including the empty amalgam capsules. These are sent to a recycling company instead of disposing as hazardous waste."

The Mercury Elimination Plan has included having fluorescent lamps being replaced with green tipped, energy efficient, low mercury lamps; using digital radiology machines that eliminate any mercury products needed for wet X-ray processing

"Our goal is to eliminate all mercury from NHB as new alternatives become available." said Robert Mitchell, NHB environmental manager. "Fortunately, our industry and manufacturers have responded to this issue, and it's becoming easier to find safer, cost-effective alternatives. But to further minimize mercury's effect, Naval Hospital Bremerton has set standards that go beyond regulatory reductions."

Bremerton Culinary Artists Showcase their Skill at Armed Forces Competition

By Mass Communication Specialist 1st Class (SW) Charlemagne Obana, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Naval Hospital Bremerton (NHB) food service Sailors and civilian staff competed May 12 at the 2012 Armed Forces Day military culinary arts competition.

The event was hosted by Naval Base Kitsap (NBK) at the Olympic College student center.

"It was very tough to judge this event. They were all outstanding and represent the best of the best that the Navy and the military offers," said special guest and judge from Washington D.C., Karin George, program manager food service ashore and retired Navy chef. "This was a wonderful opportunity to showcase their skills and I never experienced anything like this when I was in the Navy."

The competition which originated 20 years ago as a chili cook-off between the area's Navy cooks has blossomed into a competition with representatives coming from throughout the greater Puget Sound area such as Joint Base Lewis-McCord, NBK, Naval Air Station Whidbey Island, Naval Hospital Bremerton, Naval Base Everett, and various ships in the Northwest Navy region.

"It really raises your opinion of the kind of chefs the Navy and the military has...these guys have skills," said Steve Zugschwerdt, freelance photographer and competition attendee.

NHB combined food services staff began their food preparations two days prior to the event and presented the most entries into the competition.

"Our strategy is to just do our best and to represent our command," said Culinary Specialist 1st Class (SW) Arturo Perez, NHB combined food services leading petty officer. "We tried to use the same winning recipes from last year until somebody beats us in that category. The main difference [this year] is in our presentation."

The categories for competition included garnish, chili, appetizer, pie, cake, ribs, wings, and the iron chef cook-off.

"There was no 'I' or 'my' product. Everyone had a hand in each item. We were very critical with each of our entries," said Chief Culinary Specialist (SW/AW) Renee Aquino, NHB Combined Food Service leading chief petty 0fficer.

"I think our entries in this competition are phenomenal," said NHB Command Master Chief Frank Dominguez. "They really hit a homerun with the ribs and the cake."

The efforts of the hospital Terrace Dining Room staff were rewarded with first place awards for both the cake and rib category, second place awards in chili and wings, another third place award for their rib entry, and a second overall award for the second consecutive year. According to command staff members who attended the event, the real winners of the competition are always the patrons of NHB Terrace Dining Room.

"Some of the products we prepare for competition make it on our menu at the hospital," said Aquino. "The sushi that won last year we served as part of our healthy menu during our nutrition month celebration."

The NHB galley began instituting healthier menu items in early 2011 according to Aquino.

"We took away serving hamburgers and fries everyday even though people liked it. We try to set their mind on something else [healthier for them]. We serve whole wheat pasta, brown rice, tofu dishes, and we serve a lot of fish on our menu during the week," said Perez.

"I'd like to see a healthy choice category for next year's competition. We could teach a lot of people that healthy food also tastes good."

"I think we would probably ace that category," said Aquino. "We serve a grilled crusted mahi-mahi [here], all we have to do is make a good sauce to go with it."

Medical and Dental Readiness Critical for All

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Operational Health Support Unit (OHSU) Naval Hospital Bremerton (NHB) provided important medical and dental screening requirements for Navy Reservists April 14-15.

The examinations are not only an annual responsibility to ensure all Navy Reserve personnel are fit for deployment, but the physical exams are potentially even more imperative due to the announced shift of manpower requirements for future individual augmentee (IA) responsibilities next year.

"Our goal is to achieve and maintain our medical and dental readiness to a level at least 95 percent of our total Navy Reservist force. We serve a fairly large region in Reserve Component Command Northwest, with NHB as the hub. NHB is right in the middle of a large Pacific Northwest regional concentration of submarine, surface and air assets. All of us on the Navy Medicine Team, including nurses, hospital corpsmen and medical/dental providers have to help ensure all of our Navy Reservist assets are up to date and ready to deploy if and when called upon," said Capt. Harry Ward, OHSU Bremerton senior medical executive, and physician specialist/professor of Medicine at the Geffen School of Medicine at UCLA.

"Taking care of our own is what we do. As such, we simply have to have medically and dentally ready forces. Our Reserve detachments back up and support many of our local commands in this area, and we bring reservist medical providers in from all over the region. We want to reach out and touch everyone and not be constrained by geography in any way when asked to support. One of the latest messages from Adm. Nathan, our Navy surgeon general, said that to maintain our fighting forces, our Navy Reserves have to continue to be a critical part and continue to contribute a lot," said Ward, who has served in Navy Reserves for over 20 years, with three deployments. He has been in Operation Desert Storm in 1991, Operation Enduring Freedom in Afghanistan for 2006, as well as Landstuhl Regional Medical Center in Germany during 2009.

Ward's experience in Desert Storm further solidifies his emphasis on having medical and dental readiness up to date. According to Ward, during Desert Storm, nearly 40 percent of Navy Reservists were deemed not qualified for active duty due to dental issues with periodontal disease.

Capt. William Creed, OHSU Reserve liaison officer (RLO) and head dental officer, also remembers well Desert Storm, as well as before.

"Historically, all of our efforts before that time were lax. We were recalling Reservists who were not medically or dentally qualified. Now it's much different. My main job is to coordinate the dental readiness for the whole region with all the Navy Operational Support Centers (NOSC) and Reserve Commands (REDCOMs)," said Creed, a Vancouver, Wash. resident.

Cmdr. Tim Labrosse, RLO and Reserve dentist, estimates that he and his dental team monthly provide an average of 70 to 80 screenings to Reservists.

"I can average eight to ten dental examinations an hour. Every Sailor I see is an important asset for us. My goal when they come in for the screening is to assess them for deployment and make sure they won't have emergency dental needs, if and when they deploy. Nothing is more costly than sending a person in and out of an IA assignment for dental care. There's lost manpower hours, logistical expenditures, and travel costs. It all adds up. Before a Sailor departs from here, they will know what category they are concerning their dental readiness," said Labrosse.

There are four classifications for dental readiness. Class 1. Patients not requiring dental treatment or reevaluation within 12 months. Class 2. Patients who have oral conditions that, if not treated or followed up, have the potential but are not expected to result in dental emergencies within 12 months. Class 3. Patients who have oral conditions that if not treated are expected to result in dental emergencies within 12 months. Patients should be placed in Class 3 when there are questions in determining classification between Class 2 and Class 3. Class 4. Patients who require dental examinations. This includes patients who require annual or other required dental examinations and patients whose dental classifications are unknown.

"Dental readiness is just an example of waking up to the need for healthy fighting forces ready to be part of the 'edge of the sword.' As part of those forces, we want to continue to contribute and maintain continuity and leadership with the large amount of Navy Reservists in the Pacific Northwest and throughout the Western states," Ward said.

OHSU Bremerton is currently handling medical and dental readiness screenings for18 detachments with approximately 900 total personnel stationed in North Dakota, South Dakota, Colorado, Utah, Wyoming, Montana, Idaho, Oregon, Washington, and Alaska. There are Navy Reserve centers in such places as Sioux Falls S.D., Fargo, N.D., Fort Carson and Denver Colo., Cheyenne, Wyo., Billings and Helena, Mont., Pocatello, Idaho, Central Point, Ore. Tacoma, Bangor, and Everett, Wash. and Fort Richardson, Alaska. There are also corpsmen coming to NHB from farther afield out of Minnesota and Texas (Current compiled official Navy figures from April 2, 2012, list the total number of U.S. Navy Reserve component as 64,118).

One innovative means to handle medical and dental readiness in the vast, mostly rural area is by sending a traveling team of core Navy medical staff to specific Navy Operational Support Centers.

"Our training team is made up of physician/providers, nurse practitioners, and dental officers to go out and handle medical and dental needs all over the 15 state regional commands. Many of our Navy Reserve centers are scattered over large areas of geiography, so it's value added to do all we can to keep that readiness up to date by going to the detachments, rather than having their personnel come to us," said Ward.

"The work never stops. It can take a lot of time to arrange logistics throughout our region to support Navy Medicine West, even as far away as Okinawa and Guam," said Ward.

Another important part of OHSU's overall mission is to backup and assist NHB and BUMED by providing doctors, nurses, hospital corpsmen and technician support.

"Whoever and whatever the CNO or Surgeon General needs, we will put out a message for support and operationally start looking at whom we have available," Ward said.

"What we have now in Navy Medicine and the Navy, as a whole, is a truly integrated service. It used to be that reservists were just backfill for some positions, but we are now integrated across the board. Camaraderie has really greatly improved since the first Gulf War," Ward said.