Defense Infrastructure:

The Navy Needs Better Documentation to Support Its Proposed Military Treatment Facilities on Guam

GAO-11-206: Published: Apr 5, 2011. Publicly Released: Apr 5, 2011.

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The Navy determined that its current hospital on Guam does not meet modern facility standards. Moreover, the military population on Guam is expected to grow from 15,000 to over 39,000 due to DOD plans to move Marine Corps units from Okinawa, Japan to Guam and expand other on- island capabilities. The Navy plans to construct a new hospital and two outpatient clinics as part of its facility solution to replace the current hospital and accommodate additional health care requirements. This report (1) describes the Navy's plans for developing its military treatment facility solution to meet the expected increases in the military population on Guam, and (2) examines the extent to which the Navy is assured that its proposed military treatment facility solution on Guam will sufficiently meet the requirements for the expected increase in military population. To address these objectives, GAO reviewed documentation including the Navy's plans for its military treatment facility solution and interviewed key officials within the Military Health System

To accommodate the additional inpatient and outpatient requirements resulting from the expected increase in military population to Guam, the Navy plans to expand inpatient and outpatient care in the replacement hospital and move primary outpatient and dental care to two new branch health clinics. Primary outpatient care generally includes caring for acute and chronic illnesses, disease prevention, screening, patient education and follow-up care from hospitalization. The replacement hospital will be located on the site of the current hospital, while one of the new branch health clinics will replace medical and dental clinics currently in operation on Naval Base Guam, and the other clinic will be located in North Finegayan on the site of a proposed Marine Corps base. According to Navy officials, the development of the requirements for the clinics allowed the Navy to retain the size and footprint of an initially planned version of the replacement hospital, which was already programmed and approved prior to the announcement of the proposed military buildup on Guam. The two outpatient primary care clinics are to be funded by the government of Japan as part of the agreement to realign Marine Corps units from Okinawa, Japan to Guam, and DOD will fund the new hospital. The Navy's proposed military treatment facility solution on Guam expands on the health care services currently offered on Guam, but in instances when patients require care not offered on Guam, the Navy determined that it will continue to medically evacuate them to other military treatment facilities, such as Naval Hospital Okinawa, Tripler Army Medical Center in Hawaii, or Naval Medical Center San Diego. GAO found that the Navy's documentation used to support its recommended military treatment facility solution for Guam does not clearly demonstrate how the Navy determined the size and configuration of the proposed branch health clinics, nor could Navy officials adequately explain their analyses or assumptions. Navy officials indicated that the Navy's health care requirements analysis report was the basis for decisions regarding the size and configuration of the proposed military treatment facilities. The Navy's health care requirements analysis report estimates the overall health care workload for the services the Navy intends to offer on Guam following the realignment, but does not show how this workload translates into the size and configuration of the Navy's proposed facilities. Therefore, it is difficult for stakeholders to be fully assured that the facility solution will be the most cost- effective solution to meet beneficiary health care needs following the realignment. Without clear documentation of key analyses and identification of risks, the Navy cannot fully demonstrate that it is making the most cost-effective decisions with its proposed military treatment facility solution on Guam. GAO recommends that Navy clearly document the basis for health care workload and staffing on Guam. In commenting, DOD generally concurred and said that more information on the branch health clinics' planning has been developed by the Navy and is under review.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: The Assistant Secretary of Defense (Health Affairs) agreed with our recommendation to provide additional analyses and noted that since the draft report was issued, the Navy had already provided additional information to the Office of the Assistant Secretary of Defense (Health Affairs) related to the planning for the two branch health clinics. We found that documents which helped verify that a logical and appropriate process was followed to determine the size and configuration of the proposed branch health clinics included a "Healthcare Requirements Analysis for Guam Navy Medical and Dental Facilities" final report and a brief on "Review of Branch Health Care Clinics Apra Harbor and Finegayan Guam". The implementation of this recommendation helped to ensure that the branch health clinics on Guam have been appropriately sized and located to meet beneficiary health care needs.

    Recommendation: In order to ensure that the Navy's proposed branch health clinics on Guam are properly reviewed and are consistent with Military Health System goals of having appropriately sized and configured facilities to meet the health care needs of military beneficiaries in a cost-effective manner, the Secretary of Defense should direct the Secretary of the Navy to provide clearly documented analyses to TRICARE Management Activity as part of DOD's process for issuing design authorizations for military treatment facilities. These analyses should, at a minimum, provide details of the basis for its health care workload and staffing requirements on Guam. These documented analyses should also include the specific health care requirements to be met at each of the branch health clinics, and the methods and criteria for how staffing decisions for each facility were made.

    Agency Affected: Department of Defense


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