same, however, allowing it 27 acute medicine and 30 acute psychiatric beds and suggesting a sharing agreement with the Navy.

The nearby Naval hospital is in need of extensive renovation, and some consideration has been given to building a new one. With four empty acute wards and a state-of-the-art intensive care unit at the North Chicago VAMC, an opportunity exists for the VA and the DoD to share this underutilized acute care resource. Therefore, in Option A, as in all the options in the Southern Market, a sharing agreement between the VA and the DoD is proposed. If that agreement were reached, the acute medical and surgical workload provided by the Navy, currently estimated to be about two wards or 60 patients, when added to the VA acute care workload, would provide a critical mass of acute care beds sufficient to justify ongoing acute inpatient care.

Even if a VA/DoD sharing agreement is not reached, all four options propose keeping a small acute medical service. With approximately 248 nursing home beds and approximately 100 psychiatric beds, acute medical beds will be needed on an ongoing basis to accommodate those long-term care patients who “decompensate.” Given the size of this campus and the spectrum of services, the incremental cost of these added acute beds is relatively small and clinically appropriate. This option also preserves the affiliation with Chicago Medical School. (Booz-Allen & Hamilton, 2001, pp. 5–12)

Each of the four options recommended 57 acute care beds (27 medical and 30 psychiatry) at the NCVAMC, in part to serve the needs of patients in the 541 non-acute beds it recommended that the NCVAMC have (248 nursing home, 67 long-term psychiatry, 186 domiciliary, and 40 residential rehabilitation treatment program) (Booz-Allen & Hamilton, 2001, pp. 5–12). According to the BAH report, the NHGL’s average daily census in its medical-surgical beds was 24 and in its acute psychiatric beds was 22, which BAH judged could be easily absorbed by the VA (Booz-Allen & Hamilton, 2001, pp. 8–20).

The VA secretary issued his decision on the restructuring of health care in VISN 12 in February 2002. The announcement focused on the decision to close inpatient care at the Lakeside VAMC and move all acute inpatient services to the West Side VAMC; the only reference to the disposition of inpatient and other services in North Chicago was the statement that “sharing opportunities between the North Chicago VA Medical Center and the adjacent Naval Hospital Great Lakes will be enhanced” (VA, 2002b). Before and shortly after the VA secretary’s announcement, serious discussions were opened between the VA and the DoD on the futures of the NCVAMC and the NHGL.

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