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Shannon L. Middleton

Shannon L. Middleton, Veterans Affairs and Rehabilitation Commission, Deputy Director, American Legion

Mr. Chairman and members of the Subcommittee:

Thank you for allowing The American Legion to present its views on the Department of Veterans Affairs (VA) construction process. With the rapid advancements in technology and medicine that the national health care system is experiencing, VA will be compelled to perpetuate the evolution of its health care delivery system far into the future.  An important part of this evolution is ensuring that VA has adequate facilities that are safe and located in needed areas to make access to its health care facilities readily available for veterans.

The health care delivery facilities of the Department of Veterans Affairs (VA) are increasingly aging physical plants in need of replacement; substantial renovation and improvements relating to fire, safety and privacy standards are necessary, as well as modernization and reconfiguration to meet the demands of the advances of medicine.  The increasing demands placed upon the outpatient and ambulatory care facilities of VA require substantial alterations to meet changing space requirements.

No health care delivery system can be expected to provide quality care if the physical settings that house that care are allowed to deteriorate to a state which places them beyond redemption.

In March 1999, the then General Accounting Office (now Government Accountability Office, GAO) published a report on VA’s need to improve capital asset planning and budgeting.  GAO cited the fact that Veterans Health Administration’s (VHA) asset challenge was due, for the most part, to four reasons.  First, VHA owned 4,700 buildings, over 40 percent of which have operated for more than 50 years, including almost 200 built before 1900.  Second, over 1,600 buildings (almost one-third) have historical significance.  Third, VHA used fewer than 1,200 buildings (about one-fourth) to deliver health care services to veterans.  They further noted that VA had over 5 million square feet of vacant space, which could cost as much as $35 million a year to maintain.  Fourth, VHA’s health care buildings have significant unused inpatient capacity.

Basically, the report found that VA’s asset plan indicated that billions of dollars might be used operating hundreds of unneeded buildings over the next 5 years or more.  The report went on to further state that VA did not systematically evaluate veterans’ or asset needs on a market (or geographic) basis or compare assets’ life-cycle costs and alternatives to identify how veterans’ needs could be met at lower costs.  

Additionally, GAO estimated that over the next few years, VA could spend one of every four of its health care dollars operating, maintaining, and improving capital assets at its then 181 major delivery locations including 4,700 buildings and 18,000 acres of land nationwide.  Recommendations stemming from the report included the development of asset-restructuring plans for all markets to guide future investment decision-making, among other initiatives.  

VA’s answer to GAO and Congress was the initiation and development of the Capital Asset Realignment for Enhanced Services (CARES) program. The CARES decision, released in May 2004, contained hundreds of construction requests, upgrades, and alterations of current buildings that will require a substantial increase in funding for Major and Minor Construction within VA.

During the initial stages of the CARES process, the construction budget was nearly flat-lined pending the outcome.  This caused a major backup in construction projects and needed seismic repairs.  Major and minor construction appropriations for VA have been consistently targeted for reduction since such funding is regrettably the most vulnerable to annual assault.  For several years VA facility directors have been forced to use non-recurring maintenance funds to provide care. Sufficient funding must be provided to maintain, improve and realign VA health care facilities.

The American Legion urges Congress to annually appropriate sufficient funds for the VA construction program to ensure the continued provision of quality health care to our nation’s veterans and the implementation of the CARES decisions.

Medical Construction And Infrastructure Support

VA has a vast physical plant inventory that represents a major investment of taxpayer dollars.  Despite the large number of aging facilities, construction funding has been limited.  VA is seeking to maximize its use of its facilities, through the CARES decision.  CARES construction is estimated at $6.1 billion over the next six years. Sufficient funding to implement new initiatives and the proposed physical plant changes will be critical to the success of the planning initiatives. 

Major Construction

The CARES process identified more than 100 major construction projects in 37 states, the District of Columbia, and Puerto Rico.  Construction projects are categorized as major if the estimated cost is over $7 million.  Now that VA has a plan to deliver health care through 2022, it is up to Congress to provide adequate funds.  The CARES plan calls for, among other things, the construction of new hospitals in Orlando and Las Vegas, and replacement facilities in Louisville and Denver for a total cost estimated to be well over $1 billion for these four facilities.  VA has not had this type of progressive construction agenda in decades.  Major construction money can be significant and proper utilization of funds must be well planned.  Recently, funding for a new VAMC in Denver was approved by Congress.  However, if timely completion of these projects is truly a national priority, providing adequate funding to satisfy this obligation is vital. 

In addition to the cost of the proposed new facilities are the many construction issues that have been “put on hold” for the past several years due to inadequate funding, and the moratorium placed on construction spending by the CARES process.  One of the most glaring shortfalls is the neglect of the buildings sorely in need of seismic correction.  This is an issue of safety.  The delivery of health care in unsafe buildings cannot be tolerated and funds must be allocated to not only construct the new facilities, but also to pay for much needed upgrades at existing facilities. 

Delays in the process have a profound impact on access to health care for veterans.  Restoration of the medical center in Biloxi, MS—which is consolidating with the medical center in Gulfport, MS—is only in Design Phase 1. The project’s estimated completion date is January 2012.   With the medical center in Gulfport completely closed, the medical center in Biloxi will have to provide services to even more veterans—but construction to accommodate this increase will not be completed for years to come. 

The American Legion believes that VA has effectively shepherded the CARES process to its current state by developing the blueprint for the future delivery of VA health care – it is now time for Congress to do the same and adequately fund the implementation of this comprehensive and crucial undertaking.

Minor Construction

VA’s minor construction program has also suffered significant neglect over the past several years.  Maintaining the infrastructure of VA’s buildings is no small task.  Because many buildings are old, renovations, relocations and expansions are quite common.  When combined with the added cost of the CARES program recommendations, it is easy to see that a major increase over the previous funding level is crucial and overdue.

The American Legion has long recognized the necessity for a health care system that revolves around the special needs of veterans.  Veterans serving in Iraq, Afghanistan and all corners of the globe are returning home with severely debilitating injuries and are now faced with new challenges they never considered before.  Loss of limb(s), traumatic brain injury, mental conditions, stress reactions, post-traumatic stress disorder, spinal cord injury and blindness are now realities to these young heroes.  VA must be there, leading the way, to help them heal and rehabilitate.  VA must be capable of providing the programs and services needed to help all qualified veterans lead the most productive and healthy lives possible.  VA must continue to look to the future and assess the needs of this ever-changing population.  To do this, adequate funding is a must.

Thank you Mr. Chairman, again, for this opportunity to appear before this Subcommittee.  We look forward to working with you to help shape the future of VA health care delivery.