The promise of 24-hour urgent care at Mann-Grandstaff VA Medical Center has been delayed after the hospital signed on as a pilot project for the U.S. Department of Veterans Affairs’ $10 billion effort to update its electronic medical records.

Dr. Robert Fischer, who took over as Mann-Grandstaff’s director a year ago, said he wants to use all of 2019 to review the hospital’s operations in order to recruit doctors, better manage and push resources where they are needed to support the planned 24-hour operations at the urgent care, which currently operates 12 hours a day.

“What we want to make sure is that when we flip the switch, it’s not a two-way valve,” Fischer said last week. “Because that would be devastating for me, the medical center and for the veterans. If we go to 24-7, it’s got to be a permanent status. I can’t allow this back and forth.”

The VA hospital ended its 24-hour emergency room in 2014, and elected officials have been pushing since then to replace that service. Mann-Grandstaff serves about 32,000 veterans a year with a budget of $250 million for fiscal year 2019.

In October, U.S. Rep. Cathy McMorris Rodgers, R-Spokane, announced during a visit from VA Secretary Robert Wilkie that 24-hour urgent care at Mann-Grandstaff had a projected starting date of early 2019.

But last week, Fischer said he expects that opening to be pushed back until some time in 2020, largely because of the needs both to recruit doctors and upgrade the records system, designed by Kansas City, Missouri-based Cerner Corp.

“This is a fluid environment. They just signed the Cerner contract this past spring,” Fischer said. “You have to be flexible when you are leading a medical center to make sure your priorities also reflect those changes in circumstances.

“This Cerner transformation is huge,” he continued. “We are a pilot, meaning it has never been done in the VA. If there are going to be problems, we are going to experience them. I have to make sure our goal of providing timely and expedient care is supported at all costs.”

Reached Wednesday, McMorris Rodgers said she met with VA officials in Spokane in January 2018 and was told by Fischer that he expected the 24-hour urgent care to be open by early 2019.

“We just approved the highest funding level ever for the VA, and it’s time for the Spokane VA to stop with the excuses and open the 24/7 Urgent Care so our veterans receive the high-quality care they’ve earned,” McMorris Rodgers said in a statement to The Spokesman-Review. “It’s unfair to Eastern Washington veterans that the Spokane VA is moving so slowly, and I look forward to speaking with the director of the Spokane VA to better understand the cause of the delay.”

Fischer, 62, who retired from the U.S. Air Force and had served several years at the U.S. Army’s Landstuhl Regional Medical Center in Germany, said “there may have been a communication a year or six months ago” about going to 24-hour urgent care, but that was “before the signing of this contract” with Cerner.

“When I make a decision, I ask myself, ‘Can I get on a rostrum and explain what I’ve done and why I’ve done it?’ And if in my mind I can do that, then I’m comfortable making that decision. I would be irresponsible if I didn’t,” he said. “So can I understand how (McMorris Rodgers) may have misunderstood the current state? It’s not a lack from our communication, but communication can be difficult.”

Sen. Patty Murray, D-Wash., also has pushed VA officials to get the urgent care open.

“Getting the Spokane emergency room back to 24-hour coverage is incredibly important, and I have no doubt local VA leaders want to do it in a manner that works best for the veterans they serve,” Murray said in a statement to The Spokesman-Review. “I have pressed VA to achieve this and I stand ready to do whatever I can to help ensure the (Mann-Grandstaff) has the resources it needs, and that our country is fulfilling its commitment to care for those who served.”

While the current plan is not to return the hospital’s emergency room, Fischer said veterans would be hard pressed to tell the difference. He said he also plans to hire physicians who are prepared to handle almost anything.

“Frankly, while we are an urgent care center,” he said. “A veteran can’t distinguish between urgent care and an emergency room no matter what sign we put. So if somebody gets to us and they are critically ill, and that service could be better provided at Providence or Deaconess, that’s really the best thing for our veteran.”

But Fischer said he understands veterans’ worries about billing headaches if they must be seen by a non-VA hospital.

“If you ask the veteran, I think they’d say we want to be able to come” to Mann-Grandstaff, he said.