soon showed that more air-conditioning capacity was needed (Harnly, 2005). Although the Navy offered to operate the acute psychiatric unit, the NCVAMC preferred to provide the service and be reimbursed. The volume and acuity of patients and therefore the amounts of reimbursement were less than forecast, and, finding itself overstaffed and losing money, the NCVAMC sought more reimbursement, which the Navy was unwilling to pay (Harnly, 2005).

The NCVAMC held a press conference in November 2003 to announce that the transfer of mental health patients from the NHGL to the NCVAMC had begun. Representative Mark Kirk announced that construction on a $170 million joint VA/Navy health care facility next to the NCVAMC would begin in about 5 years. He told veterans at a Veterans Day ceremony the same day that “if the Navy moves into this facility, it can never close.” NCVAMC director Patrick Sullivan said that the expanded volume of Navy patients would lead to the addition of inpatient surgical services in 2005 (Susnjara, 2003).

Phase 2

The second phase of the VA/DoD partnership was the moving of inpatient surgical and medical services and emergency services from the NHGL to the NCVAMC. The Navy could have sent its inpatient and emergency cases to community hospitals, but using the NCVAMC promised to be less expensive and would allow Navy clinicians to maintain their surgical skills. The move would enable the NCVAMC to have a large enough workload to offer inpatient surgery for the first time since 1992 and to upgrade and enlarge its ED, which would benefit its veteran enrollees (VA, 2002). Before 2006, veterans needing surgery had to be sent 45 miles or more to another VAMC (located either west of Chicago at Hines, in Chicago at the Jesse Brown VAMC, or in Milwaukee, Wisconsin) or referred to a community hospital.

The Navy providers were understandably concerned about moving surgical services to a VAMC where inpatient surgeries had not been performed for 20 years. When they toured the VAMC, they were concerned about the poor condition of the operating suites (Interviews3). The Navy was unwilling to expand the partnership unless appropriate renovations were done at the NCVAMC.

The VA worked with Congress to allocate $13 million in fiscal year (FY) 2004 construction funds to renovate the ED and construct a new surgical center because VA renovation projects were limited to $4 million (Chu, 2003). The number of ED examination rooms was increased from 6

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3 This indicates information provided by anonymous interviews with Lovell FHCC staff.



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