VA Health Care:

VA Plans Will Delay Establishment of Hawaii Medical Center

HRD-92-41: Published: Feb 25, 1992. Publicly Released: Feb 25, 1992.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) plans for establishing a medical center in Hawaii, focusing on whether: (1) VA could provide acute and long-term care services to the state's veterans sooner than planned; (2) VA has accurately projected acute care bed needs for Hawaii; and (3) excess bed capacity exists at the Department of Defense's (DOD) Tripler Army Medical Center that could be used to meet VA needs.

GAO found that: (1) VA plans to construct additional acute care capacity at Tripler will delay the creation of a distinct VA presence in Hawaii, duplicate existing care capacity, and increase costs without providing a commensurate increase in access to care for Hawaiian veterans; (2) VA allowed for adequate capacity, including 69 acute care beds, in renovations at Tripler to meet the acute care needs of Hawaii's veterans; (3) VA also has excess capacity in operating rooms and intensive care units; (4) at the time the Secretary of Veterans Affairs made the decision to construct additional acute care beds, he may not have been aware of the deficiencies in the projection of VA acute care bed needs, the existence of 69 acute care beds specifically for veterans at Tripler, and the concerns of veterans living on the outer islands about VA plans to make them use the planned VA medical center rather than community hospitals closer to their homes; and (5) VA has not considered the potential effects of the almost universal health insurance coverage available to Hawaiians.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA initially agreed to use existing space, but has since abandoned that agreement in favor of new construction. VA plans to renovate E-Wing to provide administrative space and build a new medical center and child care center. It has design funds for the medical center, but not construction funding. The Senate, in debate on VA's FY 1996 construction appropriation, dropped plans for constructing additional acute care beds at Tripler. VA did not seek restoration of the project in its FY 1997 appropriation request.

    Recommendation: The Secretary of Veterans Affairs should reconsider his decision to build additional acute care beds in Tripler's E-Wing. The Secretary, in cooperation with the Secretary of Defense should develop a joint-venture agreement that will give VA greater influence over the care provided to veterans in already renovated acute care space at Tripler. This could be accomplished either by integrating VA and DOD staff or transferring a mutually agreed upon number of acute care wards to VA. The agreement should also provide for meeting VA inpatient surgery and intensive care unit needs through use of existing capacity at Tripler.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Not Implemented

    Comments: Funds were appropriated for both design and construction of the nursing home.

    Recommendation: VA should use Tripler's E-Wing to accommodate its planned nursing home and other portions of its proposed medical center project, as appropriate.

    Agency Affected: Department of Veterans Affairs


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