Mr. Speaker, I rise in strong support of H.R. 811 and thank
the gentleman from New Jersey, the Chairman of our Committee, for his leadership
on this important legislation. As
an original cosponsor of the Veterans’ Hospitals Emergency Repair Act, I
believe this legislation provides for undertaking many existing VA construction
needs in a more timely manner.
Because of the willingness of the Chairman to fully
consider and accept a number of suggestions offered during Committee
consideration of this legislation, this bill has been improved and perfected.
Our Ranking Member on the Subcommittee on Health, Bob Filner, recognized
this measure as originally proposed might not enable VA to address the
system’s many needs for seismic corrections.
As a result, the bill now before the House is intended to allow several
of the more expensive seismic projects to be undertaken promptly.
The Ranking Member of our Subcommittee on Oversight and Investigations,
Vic Snyder also identified the need to address research facility construction
needs as research is integral to the VA’s patient care mission.
As reported, this measure now includes research facilities as candidates
for emergency repair and construction activities.
This legislation addresses a serious problem confronting
VA. While VA is undertaking a
process to review its infrastructure needs for the future, known as CARES
(Capital Asset Realignment for Enhanced Services), there has been a virtual
moratorium on its major construction projects.
In a system with 5,000 buildings that have an average age of 50, it is
clear too little investment in infrastructure that has taken place in recent
years. The effect of this de facto
moratorium likely has placed veterans and VA employees at risk as buildings age
and deteriorate without necessary renovation and fortification.
From my perspective, the current construction funding
process has clearly had a dampening effect on both the quality and quantity of
projects that have been routed through and recommended by the agency.
As major construction funds have virtually evaporated, VA employees have
recognized proposals they develop are unlikely to be funded—not because they
lack merit—but because of the lack of availability of funds.
I believe that the availability of designated funding will encourage more
proposals from facilities, thereby enhancing the quality of projects from which
VA may select.
The legislation we are considering today will allow VA to
expedite selection, funding, and completion of “smaller” construction
projects it believes are in the best interest of the system within certain
guidelines developed by the Committee. The
Committee has prioritized projects that will improve facilities’ safety and
barrier-free access and develop its capacity for the programs most integral to
its mission—blind rehabilitation, programs for the seriously mentally ill,
substance use disorder treatment, other rehabilitation, long-term care,
amputation care, spinal cord injury, traumatic brain injury, and women’s
health. These categories are
largely consistent with the priority VA’s Capital Investment Board now assigns
to various construction projects it reviews.
Within these priorities, it will be possible for VA to choose a range of
projects that need not be held up by completion of the CARES process.
I believe it is appropriate to delegate the selection of
these projects to VA as an interim approach until the system has results from
its CARES process for a number of reasons.
CARES will produce guidelines for restructuring system assets within
market-basket areas—ultimately across the country. It is clear that some of the guidance it will produce will
have significant implications for local markets, but some areas (those with only
one VA medical center and high levels of acute workload) will be largely
unaffected. VA also is aware of the
areas (those in less populated areas whose mission has largely shifted to
outpatient care and areas with more than one medical center) that may have some
significant changes brought on by the CARES process. CARES may be a long-term project and projects must not be
postponed indefinitely because of it.
While it is appropriate for the agency to make investments
in locations that are likely to be less affected by the potential outcome of
CARES, it is not appropriate to delay construction indefinitely awaiting the
outcome of a process that may take a decade to complete.
I am concerned that some networks, such as VISN 12, may be delaying any
projects pending the outcome of the process there.
I am hopeful there will be a reasonable proposal available for the
Chicago area soon, however, options for this area have been considered for
almost a decade. Viable construction projects, such as replacement of the
badly deteriorated blind center at Hines, must be advanced to uphold safety
standards and assure quality.
I understand that, within the guidelines of this legislation, the Department will have more authority. It is my hope that Headquarters use a centrally guided and administered process, such as the Capital Investment Board, to select those projects it believes best advance the mission of the agency overall. It should not be a process which allocates funds to networks for use at the directors’ discretion. We have seen, on too many occasions that allocation of funds requested by the agency for special initiatives, such as waiting times or Hepatitis C, may not be used for these purposes.
Any construction planning exercise inevitably leads to the
question of mission. What should VA
be doing now and in the future? To
be sure, the veterans’ health care system has undergone many changes in the
last few years—some reflect better practices from the private sector; some
have redefined long-standing VA programs, such as mental health and long-term
care, throughout the system, and perhaps not for the better.
To the extent that construction planning and the CARES
process do not adequately “maintain the capacity” of VA’s long-term care
programs and services for veterans with special disabilities, I believe VA’s
planning outcomes will continue to face opposition from Congress and the
veterans who have come to rely upon VA for its health care services.
We cannot turn back the clock on these services, but we must ensure that
adequate resources are available to meet veterans’ needs—if not on an
inpatient basis than in the community or home.
I have heard from one network director who believes it is
not his responsibility to “maintain capacity”.
Unfortunately, it is evident from the October 2000 Capacity Report that
he is not alone in believing that the maintenance of capacity does not apply to
him. The report shows that VISNs 3
and 21 have not maintained capacity in the number of patients they treat for
spinal cord injury. VISNs 3 and 22 have significantly reduced their blind
rehabilitation workloads. Only a
few networks have bolstered traumatic brain injury workloads or dollars.
I am most concerned about VA’s substance abuse treatment
capacity for mentally ill patients. It’s
not just about dollars which are overall 64% of the funds spent for these
services in FY 1996. Very few
networks treated as many individuals with serious mental illnesses for substance
use disorders in fiscal year 1999 as in fiscal year 1996.
This disturbing trend must be reversed now.
I am also concerned about long-term care capacity.
There is no question that VA has closed a number of its nursing home beds
in recent years and diverted the mission of many others to subacute or
rehabilitative care. VA is in the process of identifying measures that indicate
its maintenance of capacity. VA
long-term care programs have been considered one of its finest activities.
If VA is to be responsive to veterans needs and not just duplicate
services that may already be available to them in the private sector, it must
continue to make these services a priority in its infrastructure and resource
utilization plans.
Mr. Speaker, there is clearly a need for approving H.R. 811 to begin to facilitate addressing some of many existing infrastructure needs within VA. I am pleased to recommend to this body the approval of the Veterans’ Hospitals Emergency Repair Act.