Seaman Kyle Mullen’s death a few hours after completing the brutal Hell Week portion of the SEALs’ selection course raised broad concerns about how the course is run.

A new Navy report on the sailor’s death claims that Navy SEAL trainees made repeated attempts to get assistance for a fellow trainee who was afflicted with pneumonia and whose heart stopped shortly after Hell Week ended but were repeatedly turned down by instructors and medical personnel. The other trainee died a few hours after Hell Week ended. In order to ascertain whether Seaman Kyle Mullen passed away while carrying out his responsibilities as a sailor, a report was ordered and released by Naval Special Warfare on Wednesday, more than eight months after he passed away at the SEAL training site in Coronado, California. It was discovered he had.

His passing after fighting with respiratory issues for days sparked widespread questions about how the Basic Underwater Demolition/SEAL Training, often known as BUD/S, was administered, including allegations of abusive instructors, drug usage, and subpar medical attention. In BUD/S, Hell Week is included. Later this fall, a second examination into the selection course’s problems has been authorized by senior Navy officials.

Cleaning house has already started within the Navy. The Navy has taken administrative action against the two highest commanders at the Coronado SEAL training base as well as the medical director there, according to a Navy spokesman, Cmdr. Ben Tisdale. Administrative sanctions can range from mild letters of advice to harsh reprimands that can effectively put an end to an officer’s career. Regulations, according to Commander Tisdale, prevent him from going into specifics about what was done.

The formal conclusions of the new report were limited to whether Seaman Mullen died while carrying out his official duties, a finding that may affect the benefits offered to his family. Nevertheless, the report also contained hundreds of pages of supporting documentation, including interviews with medical staff members and SEAL candidates who, for the first time, describe what they saw. According to the records, a medical team neglected to assist a sailor who had been in trouble for days despite repeated warnings from other sailors that his condition was getting worse.

The candidates’ and medical staff members’ accounts in the report occasionally read as though they were describing two distinct incidents. During the five-day storm of sleep deprivation, hypothermia, and physical fatigue known as Hell Week, medical staff members reported to Navy criminal investigators that Seaman Mullen looked to be well and only complained of minor knee pain. At the conclusion of the week, they claimed he passed a quick medical examination without any problems and then went to rest.

However, according to five SEAL hopefuls, Seaman Mullen was obviously in pain before his passing and they were frightened when he started coughing up a lot of brown mucus and wheezing. Halfway through Hell Week, a student who had received paramedic training told investigators that he attempted to take Seaman Mullen for medical attention but was directed by an instructor to turn around and return to training