The troops are arriving at Fort Lee
Base expansion puts pressure on area health-care providers to meet the region's growing needs
By Doug Childers

** Note: In the summer 2008 print edition of Nursing in Virginia , a photo caption incorrectly identified Lt. Col. Paula Davis-Bonner as commander of the Kenner A rm y Health Clinic at Fort Lee. Lt. Col. Davis-Bonner (below) is Kenner 's deputy commander for nursing.  Col.  Donna M. Diamond, is Kenner 's commander.

You might call it the yin-yang effect. On the one hand, the expansion of Fort Lee in Prince George County will bring a big boost to the region's economy. The expansion, approved by the Base Realignment and Closure Commission (BRAC) in 2005, will double the size of Fort Lee and bring 13,500 additional people to the base by 2011. According to the Defense Department's BRAC Environmental Impact Statement, direct jobs generated by the realignment could bring as much as $317 million in annual income to the region, and sales volume could total more than $411 million.

That's good news for everyone from retailers to residential contractors.

On the other hand, the Fort Lee expansion is expected to put a strain on the area's infrastructure. School divisions are incorporating the anticipated rise in the number of school-age children into their construction plans, and roads will have to be widened to handle the increased traffi c in the region. And then there's health care. With so many people moving into the region, will area health-care providers be able to handle the increased demand for care? The key may lie in how quickly those providers respond to Fort Lee's needs, with new facilities and with the expansion of specialized services.

Some of Fort Lee's health-care demands are met on-post. Kenner Army Health Clinic, Fort Lee's on-post medical facility, offers primary care services to active-duty personnel and their family members, as well as to retired members of the armed forces and their family members who are eligible for care there. Currently, the clinic employs 35 physicians, nurse practitioners and physician assistants, as well as 24 registered nurses and 16 licensed practical nurses.

Those numbers will climb to meet Fort Lee's growing health-care needs, says Lt. Col. Paula Davis-Bonner, Kenner's deputy commander for nursing. Military officials used an automated staffi ng assessment model to estimate how great the post's demand for health care will be, based on the population increase.

"From pre-BRAC to post-BRAC, we will increase our staff size by 104," Davis-Bonner says. The across-the-board expansion will include more doctors and administrative staff. "The hiring is projected to be fi nished by 2011. Not all of them are hired yet." The post also is adding a second on-site medical clinic. It will be completed by 2010, when the number of soldiers arriving on-post is expected to begin climbing significantly.

Kenner has a few specialty areas, including optometry, physical therapy and mental health services. But it doesn't offer emergency care, obstetrics, surgery or inpatient care. For that, military personnel turn to civilian hospitals in the area. (Veterans can also receive care at Hunter Holmes McGuire VA Medical Center.) And with the base expansion, the need for dialogue and partnerships between Fort Lee and civilian hospitals has increased.

"We've been talking with civilian hospitals to assess whether they can handle the expanded demand," Davis- Bonner says.

Petersburg's Southside Regional Medical Center, the largest hospital serving the region, and Hopewell's John Randolph Medical Center, which also serves the Tri-Cities area, provide most of the off-post health care for Fort Lee personnel. Both hospitals are working closely with Fort Lee to ensure that the increased demand for health care is met.

Southside Regional Medical Center recently agreed to handle up to 90 percent of Fort Lee's needs for inpatient mental health services, for example. Kenner's administrators decided to consolidate its inpatient needs primarily in one civilian hospital because it is helpful for a facility to "become familiar with the needs of soldiers," Davis-Bonner says. "It won't be exclusively Southside Regional, but the majority of active-duty soldiers in training will use that facility."

Southside Regional Medical Center also has a military liaison on staff to facilitate communication between the post and the hospital. And John Randolph Medical Center employs a business growth specialist who serves as the point of contact for Fort Lee.

"Fort Lee has been an absolutely wonderful partner, and they've done a great job describing their needs," says Beverly Smith, chief nursing offi cer for Southside Regional Medical Center. "We couldn't ask for a better partner." The need for more dialogue and interaction on health care continues to be important for the region, says Dennis Morris, executive director of the Crater Planning District Commission.

The commission is made up of 11 local governments in the southern portion of the Metro Richmond area, including Chesterfi eld County and the Tri-Cities area. Its major focus is economic, industrial and small-business development.

In February, the commission presented a plan to alert businesses and residents about the impact the Fort Lee expansion will have on the region. Now, it is in the early stages of developing Phase II of the plan, which will delve more deeply into the base expansion's impact on health care.

"We need to know where the region's health-care needs will be at the end of the BRAC process," Morris says. "We want to bring together a panel from Fort Lee and Kenner and health-care folks outside the gates, like John Randolph Medical Center and Southside Regional Medical Center, so we can have a better understanding and establish ongoing coordination."

Morris anticipates Phase II will take a year to complete. Meanwhile, Fort Lee's expanded population will benefi t in three key areas when Southside Regional Medical Center moves to a new, larger facility this summer.

The new hospital will feature the Tri- Cities' only birthing center, with expanded obstetrical services, larger delivery areas and an expanded neonatal intensive care unit (NICU). The facility also will have a larger emergency department, with 32 beds compared with the current 24. The hospital annually treats 45,000 patients in its emergency department.

"We're going from 9,600 square feet in the old facility's emergency department to 25,000 square feet in the new facility," says Dave Fikse, chief executive offi cer of Southside Regional Medical Center. "And we're a level three trauma center." And the new hospital's psychiatric/ mental health unit will provide up to 90 percent of Kenner's needs for mental health services.

The facility will have two more operating rooms than the current one has, and intensive care unit beds will increase from 18 to 28.

"We have to think about the support services that come into the area as a result of Fort Lee's expansion - restaurants, grocery stores, schoolteachers," Fikse says. "They all impact us, and our new hospital will be able to fully serve the infl ux of new business."

Fikse says the impact of the base expansion won't be as signifi cant as other types of expansion would be. "The population at Fort Lee is younger, and their utilization of health care is lower than a population over the age of 65. For instance, a new retirement community would have a much bigger impact."

Southside Regional Medical Center will hire more nurses to meet the new facility's increased need for staff. The search for nurses - a tough job with the current shortage - will be made easier by the fact that the hospital operates a school of nursing. And hospital administrators expect the new facility to attract nurses, as well.

"Nurses - especially young nurses - are looking for a high-tech facility," Smith says.

John Randolph Medical Center also is expanding its services to meet the area's growing demand for health care. The hospital opened the Appomattox Imaging Center last year, and it will open the Colonial Heights Ambulatory Surgery Center early next year. It also will open a new urgent care facility near Fort Lee in the fall.

"It will be staffed by family practitioner physicians, and we're working with Kenner to maximize military accessibility," says Bernie Boone, chief executive offi cer of John Randolph Medical Center.

The hospital also has expanded the operations of its emergency department and improved its ability to identify nonemergency patients and care for them in a fast-track area, thereby reducing their wait time and improving the department's care for patients requiring critical attention.

In addition, the hospital is working to improve coordination between its doctors and the ones at Kenner.

"We've given Kenner physicians access to our patients' electronic records here," Boone says. "So a soldier treated here over the weekend can go to his Kenner doctor on Monday, and the Kenner doctor has electronic access to his records."

Kenner's doctors also can retrieve X-ray reports electronically from the Appomattox Imaging Center.

As its outpatient services and facilities expand, John Randolph Medical Center will hire more nurses.

"We've been very aggressive in trying to meet the growing demand for health care," Boone says.

The region won't be equally well served, though. While the area north of Fort Lee is seeing strong residential development and health-care options, the area to its south has fewer service options.

"We're blessed with good hospitals north of Fort Lee, but not to the south," Morris says. "When you go south, the next hospital is in Emporia."