RIGHT-SIZING THE DEPARTMENT OF

VETERANS AFFAIRS infrastructure

Hearing

before the

Committee on 

Veterans’ Affairs

House of Representatives

one hundred ninth congress

second session

May 11, 2006

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Committee on Veterans’ Affairs

Steve Buyer, Indiana, Chairman

Michael Bilirakis, Florida Lane Evans, Illinois, Ranking

Terry Everett, Alabama Bob Filner, California

Cliff Stearns, Florida Luis V. Gutierrez, Illinois

dan burton, Indiana Corrine Brown, Florida

Jerry Moran, Kansas Vic Snyder, Arkansas

richard H. baker, Louisiana Michael H. Michaud, Maine

Henry E. Brown, Jr., South Carolina Stephanie Herseth, South 

Jeff Miller, Florida Dakota

John Boozman, Arkansas Ted Strickland, Ohio

Jeb Bradley, New Hampshire Darlene Hooley, Oregon

Ginny Brown-Waite, Florida Silvestre Reyes, Texas

Michael R. Turner, Ohio Shelley Berkley, Nevada

John Campbell, California Tom Udall, New Mexico

 John T. Salazar, Colorado

JAMES M. LARIVIERE, Staff Director

(II)
CONTENTS

May 11, 2006

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Right-sizing the Department of Veterans Affairs Infrastructure .........................................................................................

OPENING STATEMENTS

Chairman Steve Buyer .............................................................. 

Hon. Bob Filner ..........................................................................

Hon. Henry E. Brown, Jr. .........................................................

Hon. Michael H. Michaud ..........................................................

Hon. Shelley Berkley .................................................................

Hon. Corrine Brown ..................................................................

STATEMENTS FOR THE RECORD

Hon. Jeff Miller ..........................................................................

Ilem, Joy J., Assistant National Legislative Director, Disabled

 American Veterans .................................................................

Witnesses

Hon. Richard Baker, 6th District of Louisiana ........................

Prepared statement of Mr. Baker .............................................

Hon. Charlie Melancon, 3rd District of Louisiana ...................

Prepared statement of Mr. Melancon .......................................

Hon. Tom Feeney, 24th District of Florida ..............................

Prepared statement of Mr. Feeney ...........................................

Perlin, Jonathan R., M.D., Under Secretary for Health, Veterans Health Administration, Department of Veterans 

 Affairs ......................................................................................

Prepared statement of Dr. Perlin ..............................................

Wiblemo, Cathleen C., Deputy Director, Veterans Affairs and 

 Rehabilitation Commission, The American Legion ...............

Prepared statement of Ms. Wiblemo ........................................

Cullinan, Dennis, Director National Legislative Service, Veterans of Foreign Wars ...........................................................

Prepared statement of Mr. Cullinan .........................................

(III)
Information for the Record

May 20, 2004 CARES report .......................................................

April 5, 2006 draft legislation requesting major facility construction ...................................................................................

Collaborative Opportunities Study Group report on “VA Southeast Louisiana Veterans Health Care System, Louisiana

 State University Health Care Services Division, Interiim Report - April 2006” .....................................................................

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101

115

(IV)
(1)

RIGHT-SIZING THE DEPARTMENT OF

VETERANS AFFAIRS INFRASTRUCTURE

Thursday, May 11, 2006

U.S. House of Representatives, 

Committee on Veterans’ Affairs,

Washington, D.C.

 The Committee met, pursuant to call, at 11:26 a.m., in Room 334, 

Cannon House Office Building, Hon. Steve Buyer [Chairman of the 

committee] presiding.

 Present: Representatives Buyer, Moran, Brown, Boozman, BrownWaite, Filner, Michaud, and Berkley.

 Staff Present: Jeff Weekly, Majority Counsel; David Tucker, Minority Counsel; and Jim Lariviere, Staff Director.

The Chairman. The full Committee of the House Veterans Affairs 

Committee will come to order, May 11, 2006. We are here today to 

evaluate the requests by the Secretary of Veterans Affairs for authorization for several major construction projects and leases which 

will improve, renovate, and/or update patient care facilities at various locations. I’d like to thank all of our panelists today for their 

testimony. The Department of Veterans Affairs must by law receive 

statutory authorization for all major medical facility construction 

projects and leases that exceed $600,000 per year before it may obligate or expend funds.

 Secretary Nicholson has requested authorization for $1.6 billion for 

major facility construction projects, and $25 billion for major facility 

leases in fiscal year 2006. For fiscal year 2007, the Secretary has requested authorization for $352 million in major facility construction 

projects and nearly $27 million in major facility leases.

 The Secretary’s requests include immediate funding authorization 

to ensure the restoration and continuation of care for veterans who

had depended on VA medical facilities damaged by Hurricane Ka-
2

trina in Biloxi, Mississippi, Gulfport, Mississippi, and New Orleans, 

Louisiana. Those veterans have our support and we commend the 

men and women of the VA and the Gulf for their exemplary work 

providing uninterrupted care to these veterans.

 Today we must also look to the long term. Yesterday the Appropriations Committee declined VA’s funding request for the replacement medical facility in Denver. The price had originally come in at 

over $700 million, and the price tag has now been reduced to $621 

million, which itself indicates that there is a credibility gap insofar as 

the facility pricing goes, and we’re interested in the Administration’s 

testimony. For those to whom this is a disappointment and/or a surprise, we must all recognize the need for improved facilities in the 

Denver area, and I suggest that all of us have a wake-up call, and a 

real opportunity before us. It does not have to cost nearly a $1 billion 

to build a world class medical center. Just last month, the VA’s General Andy Love and General Heiberg visited the new Clarian Hospital in Indianapolis. This is a private sector, leading edge facility. 

It’s in excess of 170 beds at a cost of $280 million. And having been 

in the facility, when you look around it looks like the Four Seasons. 

While the core services provided by the VA and Clarian differ, as well 

as some construction standards, there appears to be quite a disparity between the private sector and the public sector’s ability to build 

state of the art facilities at reasonable costs.

 If the writing is on the wall we must also have examples of approaches that can lead to a sustainable path of quality of care. We 

must consider the advantages and the virtues offered by a approaches more innovative than the status quo process that goes it alone, and 

misses out in opportunities for greater quality and efficiency.

 I commend the VA, in particular Dr. Perlin, and Mr. McClain, for 

seizing a great opportunity in Charleston, SC where the VA and the 

Medical University of South Carolina have a unique physical and 

business relationship, and have produced a collaborative report. In 

recent months, the two made progress on this enhanced collaboration and it will yield improved services to veterans. We now have 

what is called the Charleston Model, and before it could be enacted in 

Charleston we had Katrina. And it is now proposed to leverage the 

Charleston Model in the Gulf Coast region.

 The purpose of the Collaborative Opportunities Steering Group is 

to explore the benefits of collaboration, which could include the construction of separate bed towers that share services and some equipment while retaining the identity of a Veterans Health System. Their 

April 30th interim report called this sharing ``a very positive and 

exciting prospect that will enhance patient outcomes and efficiencies 

for both institutions.’’

 Innovation is not limited to examples set by the private sector, or 

the harnessing of collaboration between public and private sectors. 
3

Government agencies can work with each other to be more efficient. 

In a sign of progress, a 2002 agreement between the Navy and the VA

to share facilities in North Chicago is much closer to being fulfilled. 

Collaboration between the VA and the Pentagon, as we have seen, is 

essential for the seamless transition of servicemembers into the VA

and back again. We should commend these two agencies for their recent progress in developing an interoperable system of the sharing of 

electronic medical records. Yet, there is still more work to be done.

 There is no denying that medicine has undergone a revolution that 

has dramatically boosted its potential, but also the cost and complexity. Our response must also therefore be commensurate. In the face 

of examples such as in Clarian or in Charleston, and now perhaps 

New Orleans, preserving the status quo approach to bricks and mortar should be an affront to the much proclaimed excellence of the 

VA’s healthcare managers. The status quo approach to the bricks 

and mortar is certainly not good enough for America’s veterans, and 

we can do better.

 At this moment, I would yield to Mr. Filner for any opening comment that he would like to make.

Mr. Filner. I thank you, Mr. Chairman. Thank you for holding 

this hearing today to examine the major construction projects of the 

VA, and their lease requests, and to hear about the status of the 

CARES project.

 I appreciate that our three colleagues are here, Congressmen Baker, Melancon and Feeney, because they will provide us insight into 

the issues of building in New Orleans and southern Louisiana, and 

the long time need for a VA facility in Central Florida. As you said, 

Mr. Chairman, I hope this hearing will assist in moving along the 

provision of healthcare facilities for veterans in these states.

 I also appreciate the opportunity to hear testimony from the VA

and two of our Veterans Service Organizations about the status of the 

CARES process. This can be a very useful tool, if we use it well. The 

VA should have a comprehensive study of its current infrastructure 

and its future needs, and if used wisely, CARES can help us ensure 

that veterans get the full value of every health dollar that Congress 

provides.

 I was concerned that many construction projects were held up while 

we were waiting, longer than expected I guess, for the CARES report. 

I am concerned now that plans to accommodate mental healthcare 

and long term care were excluded from the CARES process. These 

two areas of service are becoming increasingly important. It has been 

estimated that at least one-third of returning troops have mental 

health issues. And increased life span is creating long term healthcare needs for our many veterans. The number of veterans ages 75 

and older is projected to increase from four million to four and a half 

million by 2010, and the number of those over 85 will triple to 1.3 
4

million in the same period. So I concur with the testimony of the Veterans of Foreign Wars that these services must be evaluated in terms 

of their facility needs. These questions are ones that I will pose to the 

VA and hope can be answered, if not today then very soon.

I am interested in finding out how CARES interacts with the Administration’s construction request. What does the VA plan on doing to enhance services, and not just close facilities? Are there any 

criteria for when CARES priorities will be ignored, as they were right 

away for a lower priority project? Though promises were made regarding funding for the CARES process, will the funding indeed be a 

reality in the future? We want to be certain that the CARES process 

lives up to its mission and does not leave veterans with a series of 

empty promises. I hope that the CARES report and a significant 

expenditure of resources does not end up on a shelf somewhere forgotten. We must make use of all the research and work that has 

been done and, Mr. Chairman, I thank you for holding this important 

hearing today.

The Chairman. I thank the gentleman. Mr. Moran, an opening 

statement?

Mr. Moran. No opening statement, Mr. Chairman.

The Chairman. Thank you. Mr. Michaud, opening statement?

Mr. Michaud. Thank you, Mr. Chairman. I want to thank you as 

well for having this hearing. I am looking forward to hearing from 

my three colleagues, what you have to say as well as the second panel. I am also really interested in the whole CARES process. Dr. Perlin, hopefully you will be able to address some of the concerns that 

we have about the inadequate funding. So, with that Mr. Chairman 

I yield back.

The Chairman. Thank you. Mr. Boozman? Ms. Berkley, you are 

recognized for an opening statement.

Ms. Berkley. Thank you, Mr. Chairman. I want to thank my colleagues for being here. We appreciate the fact that you are going to 

enlighten us regarding projects that probably have particular interest to your constituents. But I want to share my pain, and my constituents’ pain with you. So, hopefully we can all work together on a 

bipartisan basis to provide the necessary facilities that our veterans 

not only deserve but that we owe.

 As you may know, the CARES report recommended a new Las Vegas VA Medical Complex that would be built in my district. Today, 

and one of the reason I am here, not only to hear about your issues, 

but to get some clarification as to why the completion date has been 

pushed back from 2009 to mid-2010, and why the Complex will not 

be operational until 2011. I want to know what the hold up is. In my 

district, we build five thousand room hotels in 18 months, and they 

are ready to go, and we cannot build a VA facility of 80 beds. Something is very wrong here. I have got the fastest growing veterans 
5

population in the United States. It exceeds 200,000 veterans now. 

The need for a medical complex exists and it exists now.

Currently, my veterans are forced to take a shuttle to numerous 

clinics there are 10 different locations in the Las Vegas valley. What 

does that mean? That means that I’ve got 80 year-old veterans, 

standing there in 110 degrees temperature waiting for a shuttle to 

take them from location to location to have their promised and needed healthcare needs met.

 My veterans have been promised this facility, the money has been 

partially appropriated. We have had press conferences with the VA

Secretary in Southern Nevada, with great hoopla, and great excitement, and they are waiting, and waiting, and waiting. Las Vegas, as 

I mentioned, has the fastest growing veterans population. We need 

this facility now. Not 2009. Certainly not 2011. I can only imagine 

what the situation is going to be like in 2011 for my veterans.

 We simply cannot wait any longer, and I would like to know, as I’m 

sure you would, why this delay, and without any notification to us. 

So I’m still representing to my constituents, my veterans, whenever I

meet with them, we are online, we are on board, we are going to have 

this facility open in 2009. I find out I am complicit as a liar to my 

veterans. I do not like that. I do not think you guys do, either.

 Also, with every passing year the cost of building these facilities 

continues to increase. We now need an additional $147 million, which 

was promised to be in the 2007 budget. Low and behold, when the 

2007 Veterans Budget came before this Committee, that $147 million 

was nowhere to be found, with the promise, well, we promised you 

2007, now, we’re going to put it in the budget in 2008. Now, how do I

know that? And what am I going to do when I go back home and my 

veterans ask me this question?

 It is wrong. It is wrong at any time. It is particularly wrong during a time of war to treat our veterans in this manner. When we 

talk about supporting the troops, when we talk about standing up 

for our soldiers and giving them the strength they need to continue 

to fight and defend this nation, then we turn around and do this to 

our veterans? It’s a disgrace. And not one of us, not any one of the 

435 members of us should allow this to continue. It is a shame, it is a 

disgrace, and these people deserve better from us. And I am anxious 

to hear your testimony. Thank you very much.

The Chairman. Thank you, Ms. Berkley. Chairman Brown, recognized for an opening statement.

Mr. Brown of South Carolina. Thank you, Mr. Chairman. I would 

like to echo some of your remarks this morning as they relate to the 

new vision for VA and the infrastructure that will be required to meet 

the future veterans’ demands for healthcare services.

 In my opinion, there are few more important things we can do than 

engage in an earnest discussion about how the Department begins to 
6

prepare itself for the future. I am grateful that all of those in attendance today will help us better understand what the Department’s 

construction priorities are, how they match up with anticipated demands for health services, and how we re-engage in the business of 

building hospitals.

 As most of the people in this room know, VA has not constructed 

a new hospital in nearly 15 years. As a result, a good amount of the 

institutional memory has been lost, and we have to try to reassemble processes that will allow us to build appropriately sized facilities 

where they are truly needed, and at the same time be prudent stewards of the taxpayers’ money.

 With that in mind, Mr. Chairman, I have some real concerns about 

the Administration’s major construction request. It would appear 

that we are being asked to provide what I call ``blanket authorizations’’ for major projects in the absence of any real detailed information about the project. Additionally, the Appropriations Committee 

has made clear over the last several days that they have real concerns about some of those projects and the sprawling costs associated 

with them. That’s the bad news.

 The good news is that this Committee now has an opportunity to 

reevaluate its traditional thinking, and create new models for facilities financing and construction. In my opinion, some of those models 

should seek to take full advantage of existing and potentially collaborative relationships with medical universities and research partners, and others might seek to have private or nonprofit organizations finance the construction of new facilities.

It is this type of thinking that should energize us all to find new 

ways of providing for our veterans. The bottom line is that our veterans have real needs, and we have the responsibility to identify ways 

to match VA’s infrastructure to those needs. I personally believe a 

new level of creativity is called for, and I look forward to working with 

my colleagues to develop some of these new concepts.

 Again, Mr. Chairman, I thank you for assembling this very important hearing today, and I look forward to having a frank discussion 

with our witnesses. With that, I yield back the balance of my time.

The Chairman. I thank the gentleman.

Before we turn to the first panel, I would like to take a point of 

personal privilege. And that would be, in a bipartisan fashion, on 

behalf of my Democrat colleagues and staff, and the Republican side 

and the staff, I would like to recognize the Staff Director of the full 

Committee. Jim Lariviere, would you stand a moment? To let everyone know, we have known Jim Lariviere for 30 years. He is the only 

person I know here in Washington, D.C. that had ever dropped me 

for sit-ups as a freshman at the Citadel. Jim has commanded a rifle 

platoon in Beirut and lost a lot of good friends in the Beirut bombing 

as a Marine, commanded a rifle company, and commanded a weapons 
7

company. He served one year at the White House, and he also commanded the Honors Company. When you go to 8th and I, and you go 

to Iwo --he commanded the Honors Company for the Friday evening 

and Tuesday Parades. He’s commanded the 3rd Force Recon. He’s 

been called to active duty twice. He was recalled immediately after 

September 11th. He was the Operations Officer for the Marine AntiTerrorism Brigade. Jim Lariviere presently is the Assistant Commander of the Division, 4th Marine Division. He is the Assistant 

Commander, which means he is a full colonel in the Marine Corp., 

and he sits in a one star, a brigadier general’s slot.

Jim has been recalled to active duty. He will be going to Afghanistan, and be leaving us soon. He will be the Advisor to the Operations Officer of the Afghan National Army. And that is a three star 

position. So, you see Jim, you talk to Jim, but you do not know the 

contributions that he has made, not only in the past but also what 

he is about to do for our country. He will be leaving his wife Jen and 

four children. And they will keep the watch fires burning, but we 

also, Jim, want you to know that we will care for them, and we wish 

you Godspeed.

[Standing ovation]

 The Chairman. Mr. Michaud?

 Mr. Michaud. Yes, Mr. Chairman, I, too, would like to thank Jim 

for his service. I have not known Jim nearly as long as you have, Mr. 

Chairman, but I have known him for a little while, particularly his 

work on the House Veterans’ Affairs Committee. And I really appreciate his professionalism, his honesty, and his willingness to work 

hard for the Committee. But also, his commitment to the veterans 

of this country, and his service to our nation. I want to wish him the 

very best, and Godspeed, and our prayers and our thoughts will be 

with both him and his family. Thank you, Mr. Chairman.

The Chairman. Thank you, Mr. Michaud. We have before us today distinguished Members, and one of our Committee, Mr. Richard 

Baker representing Louisiana’s 6th Congressional District. Richard 

has been a stalwart advocate for our nation’s veterans, and it is a 

pleasure to have him before our Committee today. Also testifying is 

Mr. Charlie Melancon, representing Louisiana’s 3rd Congressional 

District. He serves on the Agriculture, Resources and Science Committee and has an interest in lowering the healthcare costs. Our 

third witness on the first panel is Mr. Tom Feeney, representing the 

24th District of Florida. Mr. Feeney serves on the Financial Services 

and Judiciary Committee, as well as the Science Committee.

 Gentlemen, it is a pleasure to welcome the three of you before the 

Committee. And Mr. Baker, we will start with you. You are now 

recognized.
8

STATEMENTS OF HON. RICHARD BAKER, A REPRESENTA-

 TIVE IN CONGRESS FROM THE STATE OF LOUISIANA; 

 HON. CHARLIE MELANCON, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF LOUISIANA; AND

 HON. TOM FEENEY, A REPRESENTATIVE IN CONGRESS

 FROM THE STATE OF FLORIDA

STATEMENT OF HON. RICHARD BAKER

 Mr. Baker. Thank you, Mr. Chairman. I appreciate your leadership 

in this matter. Certainly, provision of care for our nation’s veterans 

is of the utmost importance to every Member of the Committee, and 

of the Congress. In this instance, there is the unique circumstance of 

the natural disaster in Louisiana, Katrina-Rita, they’re now lumped 

as one. And the consequences for the provision of service in light of 

the tragic devastation that occurred in our state last year. Prior to 

landfall by Katrina, the VA facility in Orleans parish served 40,000 

patients, with 1700 employees, with an annual operating budget of 

$130 million, certainly a very significant healthcare provider in our 

region.

 As we move forward, the VA in February of this year issued its own 

report and recommendation with regard to replacement of that facility with a shared operational management perspective with Louisiana State University. And on its face, it’s certainly something that I

think is worthy for us to explore to realize savings of joint ownership, 

of food services, laundry, parking facilities, and other operational 

savings that can be accrued from such a joint partnership. There 

certainly are benefits to be gained from the academic residences that 

might be employed or utilized within the VA system for the provision 

of care. So, at all levels, this recommendation makes great sense. 

But as is often the case in Louisiana, rarely are things as they seem. 

And there are concerns that have been raised that I would like to 

bring to the Committee’s attention as we move forward.

 There is now a June 1 deadline for the subsequent report to be 

issued relative to the change in demographics, and who the facility might serve. There are now about two-thirds of the patient load 

returning to the Orleans area for care. What is not determined is 

whether the temporary dislocation that has already occurred will 

become permanent, skewing the numbers in the Baton Rouge area 

above the current capacity of facilities that are located there. I am 

not suggesting today that this is a Baton Rouge effort to take a facility out of Orleans. Merely that we should measure carefully the 

distribution of the veterans and where they might best be served in 

making this strategic decision as to how we rebuild.

 There is a second and dramatically more important revelation 

that I think the Committee should be made aware of. When Katrina 
9

struck, Governor Blanco created a Louisiana Recovery Authority to 

be the interface between the federal government and the state government in overseeing the resolution and rebuilding of Louisiana. 

That Recovery Authority on its own created a foundation of individuals who collect resources, and therefore engage in important studies 

to assist the Authority in making policy judgements going forward. 

In a recent engagement of Price Waterhouse Cooper, the foundation 

received a report relative to the status of healthcare in Louisiana, 

and it was very, very troubling. As we begin to speak about an LSUVA partnership, I think it’s extremely important for the Members of 

the Committee and for the leadership of the VA to be aware of and 

understand the implications of this important study.

 Let me just read one line that struck me most directly. ``The report 

finds that the charity system,’’ that is our publicly operated healthcare system, ``is detrimental to the health of all Louisianians, and is 

likely an important reason for the lower system quality, the high cost, 

and lack of public and private sector benefits.’’ The report goes on at 

great lengths to describe why the system is at fault.

 Why do I bring this to this Committee’s attention? Well, what is 

now being contemplated is an LSU-VA partnership. LSU is the administrator of the charity system. It would be like entering into a 

three-way partnership for a real estate development, and the third 

partner is bankrupt. We need to be very careful as we go forward.

 Now, this report has, I think, important implications for reform 

for the provision of healthcare going forward. It is estimated by the 

report that the charity system was underfunded in the last fiscal year 

by some $350 million. If the VA is entering into a partnership with 

LSU, we would need to be very careful about the supplanting of resources from one allocation to offset the losses in another.

 I’m going to be much more direct back in my home state and district. I really believe our charity system should be undone. We are 

the only state that provides care in this fashion. It is extremely 

expensive. It results in a dual system, for those with money and 

those without resources. And those without resources are receiving 

inordinately poorer care. I do not wish to see the implications of irreparable injury, certainly extended, may be unintentionally, to the 

care of our veterans. We have an opportunity here to do something 

extraordinary. We can enter into a partnership using private and 

public resources, leveraging with academia valuable research opportunity, and to raise the quality of care to a standard which few have 

thought possible in our state in years past.

 Mr. Chairman, I want to be very helpful as we go forward in this. 

Getting care restored to its pre-Katrina level is essential. But we 

should be very careful to deploy valuable taxpayer resources one 

time, in the most effective manner possible. And I hope to be helpful 

to you and the Committee as we go forward.
10

The Chairman. Thank you very much, Mr. Baker. Mr. Melancon?

[The statement of Hon. Richard Baker appears on p. 56]

[The attachment appears on p. 115]

 The Chairman. Thank you very much, Mr. Baker. Mr. Melancon, 

you are now recognized.

STATEMENT OF HON. CHARLIE MELANCON

 Mr. Melancon. Thank you, Chairman Buyer. Richard, does that 

mean we go on record for National Healthcare? We’re friends.

 Mr. Baker. We used to be friends.

 Mr. Melancon. Yes, we used to be, just until a minute ago.

 Mr. Chairman, Ranking Member, and Members of the Committee, 

I thank you for allowing me this opportunity to talk to you about an 

issue that is very important to me, and the citizens of my district: 

which is veterans’ healthcare.

 As everyone is well aware, after Katrina, the Gulf Coast suffered 

many devastating losses. The grief felt by the people of the Gulf 

Coast is incomprehensible. Hurricane Katrina was the worst natural 

disaster in this nation’s history, followed by the devastation wrought 

by Hurricane Rita. South Louisiana has experienced more hardship 

and more loss in a period of mere weeks than most communities, 

states or regions face in a lifetime. This is evidenced by the fact that 

nearly nine months after Katrina hit, we are struggling day by day to 

rebuild and recover. This is a long term project for us, because what 

was lost in Katrina was not just structures, but history, memories, 

culture, communities, and perhaps saddest of all, many lives.

 But the spirit to return and reclaim our place in the world is strong 

in the hearts of the people of South Louisiana. And though we are 

down, we are not out, not by a long shot. During our time of need, 

Louisiana has had many friends who have helped us in innumerable 

ways in the immediate aftermath of the storm, and continuing to this 

day.

 I would like to take this opportunity to thank the VA for its efforts 

to evacuate all of the 241 patients, the 272 employees, and the 342 

family members from the New Orleans VA Medical Center. Not only 

that, but by September 7th, 2005, all community-based outpatient 

clinics in the affected areas were operational, and five mobile clinics were sent to Louisiana. The VA’s efforts in the aftermath of the 

storm on behalf of the veterans’ community were outstanding and 

will not be forgotten.

 However, in this period of rebuilding, some are questioning whether 

the VA Medical Center in New Orleans should be rebuilt. As a result 

of the immense flooding in New Orleans after Hurricane Katrina, two 
11

LSU hospitals, Charity and University, which served as vital healthcare safety net and only level one trauma center in the area, remain 

closed due to extensive and irreparable damage. The VA Medical 

Center in New Orleans, which is located a block away from Charity 

Hospital, suffered a similar fate. In other words, much of the healthcare infrastructure of South Louisiana is in ruins, and with limited 

access to healthcare the region’s entire recovery is in jeopardy. That 

is why the recent proposal to build shared facilities for LSU and the 

VA holds some hope. This merger could provide the beds and doctors 

that the general population needs if the city is to have a chance at recovery, as well as restoring services to the thousands of area veterans 

who depend on the VA.

 And, off script, while I understand and agree in many ways with 

what Mr. Baker says, I think we can work through these problems of 

administration. 

 The burden on our veterans since the destruction of the VA in New 

Orleans has been enormous. Access to care for them has always been 

an issue, particularly for the veterans in my district who have to travel long distances for the services they need. The situation has only 

been made worse in the wake of Katrina and Rita. And every day my 

office hears from veterans who no longer have a place to go for the 

care they have earned with their service. Many had to evacuate the 

area altogether and with no operating VA facilities in New Orleans, 

may not ever return.

 It’s a situation that’s not limited to veterans. Right now thousands 

of families displaced from the Gulf Coast are looking at the recovery 

process and trying to decide whether or not to come home. Levees 

are being fortified in most areas. There are a growing number of 

jobs to be had. Homeowners can now expect to see at least some payment for their loss of housing. And some schools are starting to come 

online. A tremendous amount of effort has gone into making that 

simple list happen. But a family asking themselves whether they 

can move back, has to ask the questions, ``Where do I go if I get sick? 

What doctor can I see if I get hurt?’’

 The answers to those questions lie in a strong healthcare community. Of key importance is the need to rebuild not just bricks and mortar, but the human capital that it takes to delivery quality healthcare. 

The hospitals in the LSU system were not just providers of care, but 

were also teaching hospitals. Without these teaching hospitals, there 

is a huge hole in the fabric of medical professionals that are the foundation of a strong healthcare community. The LSU-VA plan gives us 

an opportunity to regenerate this important component. And again, 

there are ways.

This is an historic partnership for historic times. From an efficiency 

standpoint, it makes sense. From a fiscal standpoint, it makes sense. 

And from a moral standpoint, after everything these Gulf veterans 
12

have experienced and endured with these storms, it makes sense. I

urge the Committee to support those efforts to rebuild the healthcare 

infrastructure on the Gulf Coast for our veterans and for the rest of 

our citizens in these affected areas. Thank you, Mr. Chairman, and 

Members.

[The statement of Hon. Charlie Melancon appears on p. 63]

 The Chairman. Thank you, Mr. Melancon. Mr. Feeney, you have 

now been recognized.

STATEMENT OF HON. TOM FEENEY

 Mr. Feeney. Mr. Chairman, Members of the Committee, I am really delighted to be here, and am very grateful for the Committee’s 

time and providing me this opportunity. The veterans population 

in the United States currently stands at 26,549,704 veterans, give 

or take. More than 1.8 million of those veterans reside in the state 

of Florida. Our state has the second largest veterans population in 

the country, with over 350,000 veterans in the Central Florida area 

alone. This does not include veterans that like to visit our state, and 

a lot of veterans that winter in our state. We call them ``snowbirds’’ 

and there are snowbirds that served their country admirably, and 

they need service as well.

 And yet, Central Florida is the largest metropolitan area in the 

country without a VA medical facility. Many veterans residing in 

Central Florida average more than two hours travel time to get to 

a VA hospital located in Tampa, Gainesville, or Jacksonville. That 

includes veterans living in counties like Orange, Seminole, Brevard, 

Volusia, Osceola, Polk, and Lake. In fact, only 45 percent of veterans 

in the Orlando region are within the VA’s access standards for hospital care, meaning that 55 percent are not being treated in accordance 

with the standards. Central Florida is the number one destination 

for combat veterans over 65 years of age. It’s also the number one 

area for veterans who have 50 percent or more service connected disability. 18 percent of our veterans have Post-Traumatic Stress Disorder.

 There are 128 active veterans organizations in the Central Florida 

area alone. We have got a number of great American heroes and 

people that served their country ably have been working very, very 

hard to get a veterans hospital for some two decades plus, now. John 

Kellat, for example, some of the DAV veterans, leaders like Jerry 

Pierce, Charlie Brenner, Dr. Neil Euliano, Charlie Price and George 

Taylor are all friends of mine that have been working very hard for 

close to two decades. Also Bill Carlson, Earle Denton, and I could 

name many more.

Orlando and its surrounding area was identified by the VA through 
13

Capital Asset Realignment for Enhanced Services as an area in need 

of a new VA hospital. At the same CARES identified the need for 

a new facility in Las Vegas, and I appreciate the gentle lady’s frustration with the challenges that she has meeting the needs of her 

constituents. The need was both appropriate and warranted in Las 

Vegas, and they have received funding and are scheduled to break 

ground this year, although I guess there are some questions about 

that schedule which I will be paying close attention to.

 However, a hospital in Central Florida still remains, at this point, 

just an idea. Design and planning initiatives have been authorized 

by the VA, and efforts are underway to select a site that best suits the 

needs of the Central Florida veterans community. Balancing accessibility needs of Central Florida’s veterans with the long term economic 

impact the hospital will have on the state is essential as we look for 

ways to leverage funds to maximize investment benefits.

 I’m delighted to announce to you that the Florida Board of Governors recently approved a proposal for the University of Central Florida to build a new medical facility right in the East Orlando area. As 

Chairman Brown pointed out, there are huge benefits, I think Chairman Baker did as well, to co-locating a facility with a medical school. 

And the fact that you can build them at the same time is an enormous 

opportunity that I hope the Committee and the Site Selection Committee will consider. This will be valuable both to local veterans and 

the VA, as a medical school environment provides insight into innovative and cutting edge technology. We also believe we are going to 

have all sorts of spin off, and collateral biomedical research facilities 

that will be established in our area.

 The commitment to ensure that veterans have access to additional 

resources to further enhance the medical services to the VA is an 

important one. Concerns have arisen from the Central Florida Veterans Associations in the area that the Central Florida VA Medical 

Center may not come to fruition in a timely manner. Again, we have 

waited over two decades, and there is concern that we seem to be falling behind again, perhaps. On May 1 of this year, a public hearing 

was administered by the Orlando VA Hospital Site Selection Committee. Many veterans accused lawmakers throughout the country, 

including their own from Central Florida, of dragging their feet on 

this very important issue of servicing 350,000 unserved veterans.

Veterans in Central Florida have been waiting for nearly three 

decades for a complex that continuously has met with delays. Mr. 

Chairman, I urge the VA to select the site in a timely manner, so that 

our growing veterans population may finally have appropriate access 

to a much needed hospital. Again, I am very grateful for the willingness of this Committee to have me come and advocate on behalf of 

350,000 people that have ably served their country. And we would 

be grateful for any help you can give us in serving these people in 
14

return.

[The statement of Hon. Tom Feeney appears on p. 60]

 The Chairman. Thank you very much to my colleagues for your 

testimony. And, let me start with you, Mr. Baker. VISN 16 has been 

looking closely at the demographics issue, and I am glad you bring it 

to our attention. And maybe you can be insightful and helpful here 

to the Committee on what exactly is happening in New Orleans? I

know a lot of the population came into your area in Baton Rouge. 

Are people going back to New Orleans? Or do they now kind of like 

where they are, because now they have new jobs, and obviously the 

demographics may be changing Baton Rouge. And this could have 

an impact on site selection and negotiations with LSU, and where we 

are in working together to build a collaborative effort. If you could 

enlighten us a little bit more on that?

Mr. Baker. Thank you, Mr. Chairman. It is unclear at the moment 

exactly the ramifications of the storm. I think in Charlie’s district it 

is impossible for people to return, simply, in St. Bernard there is nothing there yet. There is no houses, it’s not a question of being damaged, 

there is just no structures. In Orleans Parish, it will vary depending 

on where one was. The central business district, the French Quarter, 

some areas are relatively and modestly affected. While other areas, 

the lakefront, Lakeview as it is known, or the Lower Nine, utter devastation, and no people are returning.

 The consequence of this is there are at least a hundred thousand 

people that are new to my congressional district that are in any 

number of housing circumstances, from the infamous FEMA trailer 

deployment, to absorption into whatever available rental market. 

Many business owners have simply relocated their businesses and 

bought real estate sight unseen and moved the business operation 

into the region. From the guess-timates that I have heard, it is that 

they believe a permanent dislocation as to veterans will be disproportionately low to the general population. Meaning, they believe that 

more veterans are likely to stay in the Orleans area for services than 

would be for a customary analysis of the business community or any 

other demographic sector.

 However, about a third of the current service area, served in the 

New Orleans area, is likely to be permanently located somewhere 

in the Baton Rouge marketplace. So there will be, in effect, and I

am very anxious to see the professional analysis that I hope will be 

made available early June, to help get a better understanding of the 

potential deployment. But, clearly, it is going to change the market, 

change it for a long time. And as to the speed of recovery, it is at a 

snail’s pace. Nothing will return to normalcy until we have a significant housing inventory for people to live in, and it simply is not 

happening. And the desolation is beyond imaginable scope, even en-
15

tering into this hurricane season. You know, I would ask everybody’s 

prayers that we be spared at least a year before we have to deal with 

the calamity of even a modest storm.

The Chairman. Well, you have to go back almost 60 years for our 

federal government to have had to face major construction projects. 

We have got five to six that are in front of us. It has been 15 years 

since we have built a major facility. There is a lot of institutional 

knowledge that has left. And it appears that the priority of all of 

these, now, is New Orleans. And, we are going to have to turn to and 

rely upon you for your counsel, and also your guidance to the VA. 

They also receive their input through the VISN, and through veterans. We really do not know where this is to go. We are going to have 

to rely upon you and your counsel. This is about not only where they 

presently are, but what is the forecast?

Mr. Baker. And the fact that it served from Eastern Texas to a 

great number of folks from Mississippi. This was a regional facility 

of great quality care, I might add, as well. So replacing it, and the 

services that are now lost, is a very difficult task. And I just counsel 

to move slowly and get all the professional advice we can get from any 

source before making what will be a very long term decision, and one 

that we cannot easily turn from once the deployment is made.

The Chairman. Thank you, Mr. Baker. Mr. Melancon, what is your 

best counsel? Not only to this Committee, but also, you know, you 

have got VA leadership behind you.

Mr. Melancon. Thank you, Mr. Buyer. Down in the bayou it’s Melancon, up the bayou it’s Melancon.

The Chairman. Melancon?

Mr. Melancon. Above Baton Rouge it’s Melancon. Here, just call 

me Charlie. It is a lot easier.

The Chairman. Melancon, this is de Buyer. For those who do not 

know me, it is Buyer.

Mr. Melancon. Richard, both of our districts have been impacted, 

and for that matter the entire region has been impacted. And to tell 

you where anybody has gone is somewhat of a guess. We have got 

some approximation of numbers, but as far as ethnic groups, or veterans, or who, or, you know, income levels, no one knows that number 

yet. But I do have a place, Richard, if you would like, at the intersection of 55 and I10, where we could put it in St. John the Baptist 

Parish. I am being facetious. But the need is definitely going to 

continue.

 The frustrations, I guess, and Richard has noted the state and its 

financial problems, are going to continue on for quite a while. Of 

course, the federal government and its continuing problems, as noted 

by Mr. Filner and Ms. Berkley..... You know, there is nobody out 

there that has a whole lot of money hanging around. But we have an 

obligation to all of our veterans that we made to them. And it goes 
16

back long before any of us sat in the Congress.

 I will support and do whatever it takes to protect our soldiers as 

long as they are at war. But I think that we need to make sure that 

we expend whatever capital it takes to make sure that when they 

come back, they will have their medical needs and services taken care 

of, as they are fully due. Thank you, sir.

The Chairman. My last question, Mr. Feeney. Have you endorsed 

a site at all, since you are working closely with the Site Selection 

Group?

Mr. Feeney. Well, I had not until about two months ago. And then, 

in conversations with your staff, and with Mr. Brown’s staff, we were 

able to determine that there was one site that apparently meets all of 

the criteria for co-location. And even before the University of Central 

Florida Medical School was approved by the Board of Governors,-this 

is now a done deal and there is funding in the state budget that has 

been passed just two weeks ago- I endorsed the site because of the 

potential and the likelihood of having a co-location. And that would 

be Site C, which is the Lake Nona Site.

 I should say, Chairman Buyer, that there is an ICP site that when 

veterans were asked to testify on the May 1st hearing, virtually all, 

if not all, of the veterans that testified that because of access reasons, 

that that would be their preferred location. And there were a couple 

questions about that Lake Nona site that I hope that we will take a 

look at and resolve that veterans have raised. There is a fourth runway of the Orlando International Airport which is active right now. 

And there are questions about things like the sound and noise disturbing veterans that have Post-Traumatic Stress Syndrome. There 

was also questions raised about emergency helicopters, and whether 

the flight patterns would be interrupted. I think those questions can 

be resolved as part of the site selection process.

 And the bottom line is that with respect to the entire Central 

Florida Congressional Delegation, I think including Congresswoman 

Brown, and all of my Republican colleagues, we want a quality site. 

And we want it as soon as possible. Where is a lot less important 

to us if we have the best quality site at the earliest possible time. I

think that probably sums up 99 percent of the feelings of the people 

of Central Florida.

 The Chairman. All right. Thank you, very much. Mr. Filner?

Mr. Filner. No questions.

The Chairman. Mr. Moran?

 Mr. Moran. No questions, sir.

The Chairman. Mr. Michaud? Ms. Berkley? Chairman Brown? 

Everybody’s being really kind to all of you guys. All right, this panel 

is excused. Thank you very much. If I could have the second panel, 

Dr. Jon Perlin, Under-Secretary of Health at the Veterans Health 

Administration. Dr. Perlin’s background includes healthcare qual-
17

ity management, health information technologies, medical education, 

and health services research. Dr. Perlin, you are now recognized.

STATEMENTS OF DR. JONATHAN R. PERLIN, UNDER SECRE-

 TARY FOR HEALTH, VETERANS HEALTH ADMINISTRA-

 TION; ACCOMPANIED BY HONORABLE TIM S. MCCLAIN,

 GENERAL COUNSEL, DEPARTMENT OF VETERANS AF-

 FAIRS; ROBERT L. NEARY, JR., ACTING CHIEF OF FACILI-

 TIES MANAGEMENT OFFICER, VETERANS HEALTH AD-

 MINISTRATION

STATEMENT OF DR. JONATHAN PERLIN

Dr. Perlin. Mr. Chairman, Members of the Committee, good morning. It is a pleasure to join you this morning. I am joined today by our 

General Counsel, Mr. Tim McClain, Mr. Bob Neary, the acting Chief 

of Facilities Management for VA.

 In July of 1999, GAO found that VA was spending $1 million a 

day on unneeded or unused facilities. In response, VA essentially 

declared a moratorium on new healthcare construction from 2000 to 

2004 to develop a coherent national plan for modernizing our facilities. Capital Asset Realignment for Enhanced Services, or CARES

Program, is that plan. It allows us efficiency in our healthcare operations and to more prudently use the funding taxpayers entrust to us. 

And it allows us to transform an infrastructure created for previous 

generations of veterans into one that provides 21st century care and 

21st century technology for 21st century veterans.

VA is the owner, tenant and operator of the largest healthcare related real estate portfolio in the United States. The Department also 

maintains facilities for the Veterans Benefits Administration, and 

most of our nation’s national cemeteries. VA’s goal is to always use 

these resources efficiently and effectively for the service of veterans.

 Former Secretary Anthony Principi released the CARES decision 

on May 7th, 2004. Since that time, 12 construction contracts under 

CARES have been awarded and are underway. We plan to award an 

additional 12 contracts by the end of this fiscal year. Guided by Secretary Nicholson’s Blue Ribbon Panel, the construction advisory board 

which is chaired by General Heiberg, this Board offers recommendations for contemporary, transparent and accountable approaches to 

construction. These are attributes amplified by our capital investment process.

VA’s draft bill to authorize construction for fiscal year 2007 was 

submitted to Congress on April 5th, 2006. In it, we are asking to reauthorize 19 previously approved CARES projects. Also, for six new 

construction authorizations, and approval of eight leases and two 
18

projects resulting from Hurricane Katrina’s devastation. In particular, a replacement facility for our New Orleans VA Medical Center, 

and the expansion of the Biloxi hospital to accommodate the workload from the now closed Gulfport campus. 

For fiscal year 2007, the President’s budget identifies a total of 

$714 million in capital funding. This includes $399 million for major 

construction projects, two projects of over $7 million in value, and 

$190 million for minor construction for projects under $7 million. It 

also identifies $85 million in grants for the construction of state veterans homes, and $32 million in grants for the construction of state 

veterans cemeteries.

VHA’s request for construction funding for medical facilities is $457 

million. This includes $307 million for major construction projects, 

and $150 million for minor construction. These resources will be devoted to implementing projects identified in our CARES program. If 

our 2007 budget request is adopted, VA will have received more than 

$3 billion to implement CARES to date.

 We appreciate Congress’ and the President’s support as we maximize veterans access to the high quality healthcare for which our 

Department is renowned. Let me highlight one of the projects currently funded under CARES, the renovation of our Biloxi VA Medical 

Center.

 Biloxi was damaged during Hurricane Katrina, and its Gulfport 

division was completely destroyed. The CARES report called for us to 

collaborate with Keesler Air Force Base to meet VA and DOD needs 

in the area, and to transport Gulfport’s current patient care services 

to the Biloxi campus. Katrina required us to accelerate the process, 

and with the $293 million emergency supplemental funding we received, we are proceeding rapidly with our DOD partners to meet the 

needs of Gulf Coast veterans, as well as servicemembers and their 

families.

 We are also working, as you know, collaboratively with New Orleans to bring state of the art medical care back to that city, and 

to the region. In February we signed an agreement with Louisiana 

State University to work together to develop plans for new medical 

facilities, maximizing efficiencies through sharing. Together, we 

hope to create sharing agreements that will benefit veterans and all 

the citizens of Louisiana, as well as the American taxpayer.

 Mr. Chairman, the $53.4 million in major construction funding, 

and the $25 million in minor construction are resources that this budget provides for the National Cemetery Administration will ensure 

that nearly 84 percent of veterans will be served by a burial option 

in a National or State Veterans Cemetery within 75 miles of their 

residence. The National Cemetery Administration is now engaged in 

its largest expansion since the Civil War, and is making all National 

Cemeteries it administers national shrines commemorating veterans’ 
19

service to our nation.

Thank you for your support in fulfilling our mission of service in 

honoring America’s veterans. Thank you.

[The statement of Dr. Jonathan Perlin appears on p. 65]

 The Chairman. Dr. Perlin, while I understand that the core services and construction standards themselves in the VA differ somewhat 

from the private sector, how do you explain what seems to be a drastic 

disparity between the cost estimates to construct a new state of the 

art facility for the VA and what is employed in the private sector?

 Dr. Perlin. Thank you, Mr. Chairman, for that question. I should 

note that VA facilities are built to higher standards in terms of security. The hardening of the first two floors is estimated to add about 

five percent to the cost of the facility.

 I would, however, suggest that the costs are not different when one 

actually looks at what the VA medical centers typically include. They 

often include spinal cord injury units, nursing home, and our patient 

population is an older and sicker, less mobile patient population. Because of the illnesses, the complexity of the illnesses, and the unique 

services VA offers, as well as facilities which are not just hospital 

bed towers but also include substantial ambulatory services, when 

one actually includes these other factors, as well as the federal labor 

requirements that are part of the construction process, it actually 

turns out that our construction costs are on par with private sector 

construction costs. I think it is fair to say that all of us are reeling from the inflation in not only construction in the United States, 

based in part on the inflation in fuel, in concrete, and in steel, with 

expansion in construction worldwide, but also with a hospital boom 

that is particularly affecting the cost of construction in the healthcare 

industry.

The Chairman. I have here the two Collaborative Opportunity Steering Group reports, one for Charleston, between the Medical University and the VA in Charleston. I also then have your interim report, 

of April, 2006, by the Collaborative Opportunity Steering Group for 

Louisiana, in particular the Southeast Louisiana Veterans Healthcare System and LSU. I would like for you to share with us what you 

have learned from this process, and where we are going from here.

Dr. Perlin. Let me first, Mr. Chairman, thank you and Chairman 

Brown for the opportunity to set a stage to really look at how we 

might improve our efficiency, both in terms of capital construction, 

as well as operating efficiency, by sharing and partnership. We believe that the Charleston approach to evaluating potential synergies 

was so successful that we have actually now called it the Charleston 

Model. We did not anticipate to, but because of the natural disaster, 

that was Katrina, and its tragic circumstances, have applied it very 

rapidly when we looked at the opportunities for those sorts of capital 
20

and operational synergies in New Orleans. And, indeed, we discovered that where there is an opportunity to collaborate we believe that 

we can reduce the cost to taxpayer, and improve the quality of services by creating sharing agreements. In fact, we believe that there 

are some unique opportunities in New Orleans, Louisiana, and the 

absence of a medical center.

 But we are still learning. What we learned in the New Orleans 

Model will bring us back to the Charleston Model, and will take us 

to another level of granularity as we evaluate potential synergies in 

that environment as well.

The Chairman. Thank you. Mr. McClain, I want to thank you for 

your efforts. My last question on the same subject is, do you have 

anything to add, since you personally participated in this process?

Mr. McClain. No, I think Dr. Perlin has stated it very eloquently. 

I think the one thing that I learned from it is that the first thing we 

have to do is for both parties to be talking on the same wavelength 

as far as a cost in one facility needs to be based on the same items 

as a cost in the other facility. And once you get to that level, which 

took us a while in Charleston, but now we have been able to apply in 

New Orleans, then you are able to talk apples to apples. And it really 

opens up the discussion on both sides. And the one thing about the 

Charleston Model, especially working with Dr. Greenberg at MUSC, 

was that once you get to that level, both sides open up and are then 

free to talk economics as to what really makes sense in any particular 

area. And I think that that really was helpful to us in talking with 

LSU and getting them and us quickly on the same page. And that is 

why we have been able to, I think accomplish the interim report in 

almost record time. And, as I understand it, the final report will be 

ready on June 1st.

The Chairman. Dr. Perlin, Michael Moreland, who is the Director 

of the VA Pittsburgh Healthcare System, is an extraordinary individual, a real asset to the VA, and so to the gentleman to your right, for 

leading these two efforts to define something anew, congratulations. 

With that, now I yield to Mr. Filner.

Mr. Filner. Thank you, Mr. Chairman. I just want to talk a little bit, if I might, Dr. Perlin, about the use of this CARES process 

and your prioritizing of projects. Can you first explain to us how the 

VA develops its annual construction request, and what role will the 

CARES report now play?

Dr. Perlin. Mr. Filner, thank you for that question. Let me, if I

might, start with the role of the CARES report. As I mentioned in my 

statement, we essentially had a moratorium on new construction for 

the better part of the last half decade. And the CARES initiative was 

a national inventory of our current physical infrastructure. And it 

sought to look at whether we were meeting the needs of veterans, and 

whether there was infrastructure that actually was taking resources 
21

away from serving veterans. So, it provided a plan, a template, a 

blueprint for 20 years.

 Now, I should let you know, while this is a schematic, we pay attention to world events. And it serves a template, absent any sorts 

of seismic shifts. We believe it is a good template for where veterans 

are, and it identifies some very pressing needs that are expressed 

in our 2007 budget request, and in the CARES projects for new construction that are put forward. Let me ask Mr. Bob Neary to talk 

about the annual process of prioritizing construction activities.

Mr. Filner. Did you use ``seismic shifts’’ metaphorically, or did 

--_

Dr. Perlin. Well, sir, I certainly hope so.

Mr. Filner. Me, too.

Mr. Neary. Thank you. We in VA have a state of the art capital planning process that has been developing over the past several 

years. It relies on linking our strategic benefits delivery goals to 

the infrastructure needs to support those goals. Some of the guiding principles, first of all, on the prioritization of projects relates to 

their sound business and economic principles; promoting a one VA

vision; the linkage of not only the Veterans Health Administration, 

but the Veterans Benefits Administration and the National Cemetery 

Program; alignment with the VA’s strategic goals as established by 

the Secretary and the Secretary’s key staff; and also supporting any 

Presidential management agenda items.

 Projects are all submitted, and the major construction programs 

submit what is referred to as an Office of Management Budget 300 

Application. A detailed description of the project and the economics 

of the project are prioritized, and then the budgets are established 

based on the priorities that arrive from that process. There are, of 

course, instances where for one or another reason, primarily patient 

safety or employee safety, might suggest that a project be moved up 

on the list. Or, there are some projects that are more complicated 

and take longer to plan for, and they might not be proposed in total 

consistency with the priorities. But other than that, we are proud 

that we stay strictly with our priorities as they are established in the 

process.

Mr. Filner. Let me just, since I am not sure that I understood everything you said, ask you specifically. Now, you had in your fiscal 

year 2007 request a project in Columbia, Missouri, that had a priority 

in CARES of 21, or 21 on the list. Why was that chosen ahead of others with higher priorities? Is that policy clearly stated somewhere, or 

is that just what you decided?

Dr. Perlin. Mr. Filner, I can take that, because I, in fact, bear some 

of the responsibility for the priority of that issue. As Mr. Neary said, 

the prioritization of projects is based on first, our service mission to 

veterans, second, making sure any special needs of veterans are met, 
22

and of nearly equal weight, and actually a mathematical process is 

used, is life safety. In fact, a change circumstance occurred at Columbia, and the operating room is having electrical failure and has some 

infrastructural failures, that presents immediate life safety issues, as 

well as limts the capacity to continue to serve veterans in that OR.

Mr. Filner. Why did the CARES process not take that into account?

Dr. Perlin. I think the CARES process reviewed things, but there 

were some failures of the infrastructure that became evident that 

needed to be addressed, and addressed immediately.

Mr. Filner. Okay.

Dr. Perlin. While the CARES process is a blueprint, this is a fairly 

fine point on that, and one that you would expect us to pay attention 

to in real time.

Mr. Filner. It is just sort of frustrating, and I think it needs further explanation, probably in the documents. We have been told for 

a long time that CARES is going to be an all-encompassing kind of 

thing, and we have to hold off capital investments until it is finished. 

Then it appears that there are projects that do not appear in the top 

ten, or even top 20, right after the plan is finished. So, you are going 

to build up a frustration, or a sense that, “Why did we go through all 

this?’’ if you continue to do that. Do you think that is a worry that 

we should have? 

Dr. Perlin. As I said, the CARES is a template, and this was a new 

circumstance, or a change in circumstance, that affected a particular 

operating suite with the patient care at risk there. And it needed immediate attention. Our goal is to be as accountable, transparent, as 

we possibly can, and I do appreciate the opportunity to discuss this 

particular circumstance.

Mr. Filner. Thank you.

The Chairman. I thank the gentleman. Mr. Moran?

Mr. Moran. No questions, sir.

The Chairman. Thank you. Mr. Michaud, you are recognized for 

questions.

Mr. Michaud. Thank you, Mr. Chairman. In the essence of time, I

will narrow it down to one question. Dr. Perlin, the VA has promised 

many in Congress an increase in community-based outpatient clinics, 

assuring us of an aggressive program to build these facilities. How 

many of these proposed clinics does the VA plan to build, activate or 

keep open within the next three years?

Dr. Perlin. Thank you, Mr. Michaud. Thank you for your support 

of the community-based outpatient clinics as one of the best ways to 

provide outreach services to veterans. In fact, in our appropriations, 

or budget hearings, the Secretary testified that in 2006 and 2007 that 

there will be a total of 58 community-based outpatient clinics under 

consideration in terms of developing operating plans. We will get 
23

those plans from each of the networks, and go over those. Ultimately, 

it will be up to and including that number of clinics. There may be 

reasons additional clinics would be brought forward. I would be unprepared to talk about years out beyond that in terms of the specific 

number of CBOC’s.

Mr. Michaud. I have a follow-up question. But what do you do, 

when the VISN personnel will not submit a plan. For instance, VISN

1, there is only one CBOC that is proposed. However, they will not 

even submit a plan for VA to consider because they have no money 

to deal with it.

Dr. Perlin. Sir, you are absolutely correct that the funding for the 

Community-based Outpatient Clinics comes from operating dollars. 

Their goal is to bring on the clinics not only in terms of what the operating dollars support, but also in terms of the ability to recruit and 

match the infrastructure to the patient needs. So they prioritize clinics over time. And I actually, along with my senior team, track the 

workload. And we know that, in particular, in Maine that there is an 

opportunity for one clinic that is coming up this year, and addresses 

one of the areas where there are workload issues that are not up to 

our standards. The other areas actually are within standard, but we 

recognize the need for introducing those clinics over time.

 Again, the CARES plan was a 20-year plan. And, in fact, it identified 156 clinics. I think the Secretary has testified to this body that 

58 are really under consideration in this year and 2007 alone. So, 

pretty substantial progress.

Mr. Michaud. In the essence of time, Mr. Chairman, I will submit 

the rest of my questions in writing, because I know we do have to go 

vote.

The Chairman. I thank the gentleman. Well, Mr. Michaud, there 

is nothing more important than this hearing, than this panel. So, we 

have got a 15 minute vote, and then a five, and we are going to come 

back. They are going to have to wait. I apologize, but we are going to 

have to come back. So, I will recognize you again, and then I will go 

to Mr. Brown. Is that fair?

Mr. Michaud. Okay. That is fair. Thank you, Mr. Chairman.

Mr. Brown of South Carolina. Thank you, Mr. Chairman. Dr. 

Perlin, following up on the Collaborative Opportunity Steering Group 

process in Charleston, several operational issues still remain unresolved. When can we expect the COSG 2 to be established to keep the 

Charleston collaboration going?

Dr. Perlin. Let me first, Mr. Brown, thank you very much for your 

endorsement of the approach, looking at Charleston, looking at New 

Orleans. It is a good template, and as I mentioned, we learned a lot 

in Charleston, and we also learned in Louisiana. So I will be returning and asking a group to come together this month to, again, look at 

another level of granularity on Charleston.
24

Mr. Brown of South Carolina. One further question, do you agree 

that public/private partnerships can be a catalyst for modernization 

and development of a new and improved service for veterans. You 

support that idea, do you not?

Dr. Perlin. Mr. Chairman Brown, we do support the opportunity 

for collaborations. We believe that there are opportunities where 

there are synergies, win-win’s. As our General Counsel mentioned, 

that the ability to use models such as the Charleston Model to understand the cost basis of activities for each partner, the opportunity to 

provide services to one another, to support capital infrastructure, all 

improve the opportunity to serve veterans and not only reduce the 

capital costs, but reduce the operating costs every time.

Mr. Brown of South Carolina. Thank you, and I will wait until the 

next session.

Dr. Perlin. Thank you, sir.

The Chairman. Ms. Berkley.

Ms. Berkley. Mr. Chairman, thank you very much. Dr. Perlin, 

thank you very much for being here. I am going to dispense with the 

niceties because I have got some very specific questions and I need 

some very specific answers. When are we breaking ground on the Las 

Vegas complex?

Dr. Perlin. Let me ask our Chief of Facilities Management to --

Ms. Berkley. And please do not tell me sometime later in 2006. We 

have been saying that for months. It is now later in 2006. When are 

we doing this?

Mr. Neary. We are scheduled to break ground in Las Vegas on the 

first phase of construction in August, 2006.

Ms. Berkley. You will let me know the exact date of that as soon 

as you know it?

Mr. Neary. Yes, ma’am.

Ms. Berkley. All right, number two. When is your estimated time 

of completion?

Mr. Neary. We anticipate, the current schedule to complete the 

entire project in August of 2010.

Ms. Berkley. Now why is that a year later than was originally 

anticipated?

Mr. Neary. When the design of this project began with two really 

nationally recognized healthcare architectural firms, they felt that 

the design schedule we had established was far too aggressive to be 

reasonably accomplished. They felt the design would take longer. 

And that is the primary contributor, really the only contributor.

Ms. Berkley. So we have no design yet?

Mr. Neary. We have completed the first phase of design, which is 

called schematic design.

 Ms. Berkley. Yeah, how many phases do we have in design?

Mr. Neary. There are three phases in design: schematic design, 
25

design development, and then the preparation of the construction 

documents.

Ms. Berkley. So where is the difficulty, in which phase? If one is 

done, is it number two or number three that is causing us the delay?

Mr. Neary. They felt that in each phase of the design our schedule 

was too aggressive.

Ms. Berkley. In what way? I would like to know what way that is 

going to be. I know how quickly buildings can go up in Las Vegas. I

want to know why this one is too aggressive and ambitious.

Mr. Neary. Not the construction, I do not think they felt construction was aggressive, but the design itself. In their view --

 Ms. Berkley. I would like to know exactly what it is, if you do not 

mind finding out from them and letting me know. And here is another question. Why is it going to take an extra year? I understand 

that completion is 2010, but we are not going to be operational until 

2011. Why the lag?

Mr. Neary. I think the reference to 2011, I assume, relates to the 

fiscal year.

Ms. Berkley. Can you find that out, too?

Mr. Neary. The building, when completed in August, should be 

able to be occupied within the next two to three months after that.

Ms. Berkley. I would think so. I just attended an opening, a viewing of a hospital in Pahrump, Nevada. It was completed, they did the 

tours, they disinfected it, and they opened it up, and it is taking care 

of patients. I need that hospital and complex open. We need it now, 

and now we know we have got another year delay. And, is the $147 

million, and I guarantee knowing the cost of construction is skyrocketing that is going to go up before this is completed. Will that money 

be in the 2008 budget? It was promised for the 2007, it was not in 

there. Secretary Nicholson sat right where you are, Dr. Perlin, and 

assured me in a not so pleasant conversation that this would be in the 

2008 budget. Will it be?

Dr. Perlin. Well, let me just say, we have $259 million in the bank 

to support this project.

Ms. Berkley. I know, that is what I keep telling my veterans.

Dr. Perlin. Obviously, we are not going to start a project and not 

complete it. We want to get this project open. As you know, we 

have to bring our budget forward through the Office of Management 

and Budget, and the President’s budget is ultimately published, and 

I would not preempt that. But it would be entirely, entirely illogical 

to assume that we would make a nearly $260 million investment and 

not follow through in a timely opening.

Ms. Berkley. That is not my question. My question is, will the 

$147 million be in the 2008 budget as promised by the VA Secretary 

as he sat in that very seat?

Dr. Perlin. I would have to defer to the Secretary’s testimony.
26

Ms. Berkley. Then the answer is, “yes?”

Dr. Perlin. I do not recall the specifics of -- 

Ms. Berkley. I recall it very well.

The Chairman. Ms. Berkley?

Ms. Berkley. Yes, sir?

The Chairman. We have about five minutes for our vote?

Ms. Berkley. Yes, and it takes about five minutes to get there. I 

thank you gentleman. I am very serious about this. We need this 

facility. Thank you.

The Chairman. We are going to recess for about 15 minutes, and 

return. The Committee stands in recess.

[Whereupon, at 12:38 p.m., the Committee recessed, to reconvene 

at 1:05 p.m., the same day.]

The Chairman. The hearing will come back to order. Dr. Perlin, I

want to ask a question regarding the Denver facility. And, perhaps, 

Mr. Neary, you can be helpful to us. As you are aware, the House 

Committee on Appropriations completed their Mark for fiscal year 

2007, the Military Quality of Life Appropriations Bill. The bill does 

not include any funding for a replacement medical facility in Denver, 

because of the large cost, which has doubled the previous estimates. 

So, what we have is an appropriations bill ahead of our authorization bill, but we want to take this issue up and address it. And I

am curious about the Administration’s reaction to this, and whether 

or not you have recommendations on how we should proceed in the 

authorization bill, so that the Appropriators get a signal that this is 

something that they can get their arms around.

Dr. Perlin. Mr. Chairman, thank you very much for the question 

focusing on Denver. This is a project that is tremendously important. 

It is part of the CARES decisions. It is also a project that received 

initial funding of $25 million in fiscal year 2004, I believe. It is an 

Administration priority. There is an infrastructure that needs improvements, and in the spirit of the same sort of opportunities for 

synergy if offers, the ability to provide ready sub-specialists that 

are university-based and opportunity for a geographic proximity to 

where University of Colorado is moving. And for both capital opportunities as well as operational efficiencies and improvements in care, 

we believe that the new site for Denver is particularly important and 

would like your authorization to proceed, certainly in obtaining land 

for this new facility.

The Chairman. When you propose to obtain the land, are you proposing that we take Denver and break it up incrementally?

Dr. Perlin. Mr. Chairman, I know that you have expressed, and 

the Committee has expressed, some concern about the cost of the project, and does really want to compel in us transparency, accountability 

and efficiency in the stewardship of the resources. And we welcome 
27

your oversight at any point in the process, but do recognize, as you 

have recognized to us, that delay leads to cost increases, inflation.

The Chairman. So, at a minimum in our authorization bill, we 

should authorize you to do the land acquisition. Do you know at approximately what cost, or is this something you need to get back to 

us on? Mr. Neary?

Mr. Neary. Mr. Chairman, there are multiple parcels involved. I

believe there are four parcels involved. The largest coming from the 

Fitzsimons Redevelopment Authority. It is estimated that three of 

the four parcels will cost $25 million, and the fourth parcel contains 

a recently completed new office building, which we expect we could 

purchase for $30 million and integrate that into our plan. It would 

lessen the need for construction of new space. And so, in total $55 

million.

The Chairman. Now, tell me whether I am accurate or not. You 

want us, the federal government, to spend $25 million for land that 

we had given away? Is that right, Mr. Neary? We, the federal government, gave away this land to the locals, and they in turn are going 

to charge us $25 million. Is that about accurate?

Dr. Perlin. Mr. Chairman, I might ask our General Counsel, who 

has been following this process to look at the history.

The Chairman. I do not blame you.

Mr. McClain. Sir, you are right. There was a BRAC process that 

occurred in 1995. Fitzsimons was part of the BRAC. It was put up 

and made available under the BRAC process for federal agencies, 

and so I cannot say that it was ever specifically offered to VA but it 

certainly was made available to federal agencies to express interest 

in this property. VA did not express interest at that time. Department of Education actually acquired some of the property, on which 

the University is located, and Children’s Hospital. And the rest of 

the property went to the Fitzsimons Redevelopment Authority, who 

paid a price, not a very high price, but paid a price for the property. 

And they now control the property, and that is who we are trying to 

purchase it from.

The Chairman. Okay, help me so that I can explain to the taxpayers 

why it is a good deal. Spending $25 million on property that we just 

gave to somebody does not feel good.

Mr. McClain. This is property that the FRA had originally designed to utilize as a tax base. They were going to have a convention 

hotel on it, I understand. Our greatest desire was to be close to our 

affiliate, the University of Colorado Health Sciences Center. This 

whole thing precipitated when the University decided to move the 

Fitzsimons. They are located, of course, right across the street from 

us in downtown, on Colorado Avenue. But when they moved, that 

created a problem for us. And we needed to accelerate our plans to 

stay with our affiliate.
28

 In fact, they were originally going to complete the move to Fitzsimons, I believe it was 2011. And now they have accelerated their 

plans, and they are going to complete the move by next year, by 2007. 

And, so we have a rather old hospital in downtown that is landlocked, 

and we wanted to be on Fitzsimons. And this is one of the last remaining properties on Fitzsimons that we could negotiate for. And so 

I think the good deal for the veterans and for the American taxpayer 

is that we are going to build a state of the art facility very close to our 

affiliate, and in very close proximity to other major medical facilities, 

such as Children’s Hospital.

The Chairman. So, you are saying that I should not view this as a 

shake down by the University of the VA?

Mr. McClain. This is not the University property, Mr. Chairman.

The Chairman. Well, the Redevelopment Authority.

Mr. McClain. This is the Fitzsimons Redevelopment Authority.

The Chairman. You know, a lot of people would love to have a VA

Hospital be placed on their land. In fact, they would also almost give 

you the land, because of the values which we bring, and all the other 

synergies, and things that could happen, Dr. Perlin, as you described. 

So I am trying to get there. Am I viewing this wrong? Is the Redevelopment Authority seeing this as an opportunity to milk the federal 

government for some money?

 Mr. McClain. No, sir, I do not believe. And I have been involved 

in some of the negotiations, and I do not view it that way. They certainly want to get value for their property, because they took control 

of it, they have it, they paid a certain amount for it, and they want to 

get value for it.

The Chairman. How much did they pay for all of this land?

Mr. McClain. Sir, I will have to get back to you on that. As to how 

many acres it was after Department of Education took their chunk, 

and the exact purchase price, I do not have that.

The Chairman. All right, let me ask this question: with regard to 

where your present facility is and the University, this affiliation, how 

far do the doctors travel today between hospitals?

Mr. McClain. Across the street.

The Chairman. Today?

Mr. McClain. Today. Or do you mean the new hospital that they 

have?

The Chairman. Right now, the present VA compared to where the 

University is.

Mr. McClain. When they complete their move to Fitzsimons, in 

other words, sir? I believe it’s in the neighborhood of 15 miles.

The Chairman. Fifteen miles. Let me ask you, is the University 

Hospital the only game in town?

 Mr. McClain. Not the only game in town, but we have an established affiliation with that hospital in Denver.
29

The Chairman. And if you let Denver know that you are willing to 

breach or sever that relationship because the Redevelopment Authority is gouging the taxpayer for money on property that we had already given back to them, is there another relationship that we could 

establish with someone else? I do not know, I am just asking.

Mr. McClain. And I think that that is a very, very fair question, 

and one that I know was looked into. And I would like to get back 

to you on that, if I could, as to what other opportunities there are 

available. I know it has been looked at, and the choice was to be on 

Fitzsimons, that would be our first choice. But I know that there 

were other options that were considered, and I would like to get back 

to you on what they were.

The Chairman. Well, the number one priority is either maintaining or increasing the quality of care for our veterans in Denver, and 

access. At the same time, being cognizant, or using your word, Dr. 

Perlin, being the good steward. And it just does not feel good to me, I

just want to let you know that. Something does not feel right, here.

Dr. Perlin. Mr. Chairman?

The Chairman. Yes.

Dr. Perlin. As you know, we currently have the opportunity to 

express interest in parcels of land under this current BRAC. And we 

are making known interest in 11 sites, seven Army, two Air Force, 

two Navy. Unfortunately, I agree with some of the feelings around 

what might have been available, but there was a timing problem after, of course, the mid-90’s BRAC, it was ‘95, and would that the conditions were that we could have expressed interest then.

 The University is not the only game in town. It is the game that offers certain specialty services, and certain sorts of synergies for subspecialties, as well as the opportunity to share workload through the 

use of fellows and trainees in an educational experience. So there are 

desirable attributes. The ability, for instance, if we need half of the 

very sub, sub-specialist’s time, to be able to go from one facility to the 

other, when we really do not need the full time of the person, is simply unlikely for an individual who has to travel that sort of distance. 

If it is across the street, if it is a couple miles, it is really feasible to 

share, particularly for procedural specialties. For the others, it really 

becomes more difficult.

 So, I agree with the sentiment. I appreciate your passion for the 

stewardship of resources. We do feel that the efficiencies that would 

be derived over the longer haul, operating efficiencies, make this a 

worthwhile investment.

The Chairman. All right. Puerto Rico, are you personally comfortable with spending nearly $300 million on renovations in San Juan, 

Puerto Rico considering we are talking about a facility that is already 

nearly 50 years old?

Dr. Perlin. The situation in Puerto Rico, Mr. Chairman, presents 
30

some unique challenges. It is a facility that is very convenient for 

veterans. It is on the light rail system. It is a facility where substantial renovations have already been made. Improvements in the 

nursing home, and minor construction projects, and parking garage 

improvements to outpatient clinic. It is a facility, also, that has seismic challenges, and we need to make seismic corrections to Building 

No. 1, about $145.2 million, as well as create a new bed tower. And 

the investment would be in the order of $230 million. At the end of 

the day, we would have an improved, functional facility, but you are 

right, the basic infrastructure would be 50 years old. It is one that 

raises that question, what are alternatives? And it is one that we 

explore.

 The challenge in that particular environment is that we have an 

immediate need and immediate occupancy requirements. And whatever the choice, we need to continue to care for veterans whether we 

invest it in this current facility, or seek to create a new one.

The Chairman. Gentlemen, have you seen the private/public business proposal as it relates to construction for a new medical facility 

in Puerto Rico? You have not?

Dr. Perlin. We have not seen it. We have heard that there is interest.

The Chairman. The delegate of Puerto Rico, a colleague of ours 

here, is interested in that. If you will note, also in the Appropriations Committee Mark under Puerto Rico, they are also asking that 

you begin to look at that a little bit further. I would, well, you need 

to look at it a little bit further, but we sent Committee staff down to 

Puerto Rico to examine the facility. And we want to work with you as 

to whether it would make any sense to consider the San Juan, Puerto 

Rico as a pilot site for the public/private partnership project. Given 

the substantial facility deficiencies that the Department is proposing 

to address with very expensive renovations that in the end will fall 

short of the capacity needed to handle the workload. So, we would 

like to work with you on the Puerto Rico sight, on the authorization, 

all right?

Dr. Perlin. Thank you, Mr. Chairman, we would be pleased to 

explore it.

The Chairman. With regard to Mr. Baker’s testimony, do you have 

any comment on his testimony?

Dr. Perlin. We appreciate the Congressman’s testimony, and do 

recognize that there is a deluge of, perhaps the wrong word, or quite 

a sizable population shifts up to the Baton Rouge area. As Congressman Baker testified, the New Orleans Medical Center was a Referral Center serving veterans from Mississippi to Texas. I think it is 

important to note that even if Orleans and St. Bernard Parish were 

not to repopulate, the environment would still support the need, very 

much support the need, for a Referral Hospital for Veterans region-
31

ally.

 The opportunity to partner, again, for all the reasons we discussed, 

introduces certain synergies. The Congressman made certain points 

regarding a report about the concerns of the Charity Hospital system. 

In fact, one of the reasons that LSU is interested in partnership with 

VA is because they have seen the transformation in VA from really 

serving as a safety net to becoming a prevention net. The great thing 

about that transformation is it not only provides individuals with better care, it is also far more efficient. So they would hope to take a 

page from our play book in the way that care is delivered.

 So on the basis of population, and the basis of synergy, and the 

belief that their philosophical interest in VA is because they want to 

model the way that VA now approaches care; health promotion and 

disease prevention, as opposed to a safety net. We view this as an important opportunity for improving service to veterans, and for them 

to improve service to their Louisiana patients.

The Chairman. Now, regarding the VISN and you, I do not know so 

I am asking this. You are investigating the demographics, the trends, 

as to where to properly go, where to build a collaborative site? You’re 

already doing a demographic study at LSU saying, ``Well, come to 

our site. Come on back downtown.” Tell us what’s happening here.

Dr. Perlin. Yes, sir. We’ve been working with actuaries to try to 

understand what the demographic shifts are, and not only in New 

Orleans but in the state of Louisiana, what the impacts are in terms 

of projected workload for a VA medical center in that region. In fact, 

even if St. Bernard Parish and Orleans Parish were not to repopulate, there is still absolutely a sizeable workload that is regionally 

based. In fact, the three new clinics, at Slidell, Hammond and La 

Place, which ring the New Orleans city area proper, but are part of 

the surrounding community, are extremely busy already, as is, in 

fairness, the clinic up in Baton Rouge. So there is already the workload to support to support a referral hospital. And even if, again, St. 

Bernard and Orleans were not to repopulate, the growth projections 

for the region, and the surrounding parishes of New Orleans proper, 

is very substantial. So it would seem to be appropriately placed.

The Chairman. Well, can I throw this to you? Let us go to your 

testimony, ``appropriately placed,’’ and let me

just ask this question. There is an emotional desire to rebuild New 

Orleans. If our goal is to increase quality and access, and we want 

to build up the levies, and even if we are to build a VA facility that 

would protect itself against a Category 4 storm or above, we could 

still find ourselves, the VA, as an island. So we would still have an 

access problem. Veterans would have to go somewhere else. I know 

that there are some that are saying, ``Well, if you are going to build 

this facility, or a collaborative effort, move to the population trends in 

Slidell or others.’’ Are we caught between this emotion to build New 
32

Orleans, yet we find ourselves compounded in a problem we have 

just gone through? Or are we to go where the population trends are, 

whereby we do not have a repeat?

Dr. Perlin. Mr. Chairman, I think every feeling American is sympathetic to the plight of the individuals of New Orleans, but I hope we 

will make our decision on the basis of good business and transparent 

analysis of the demographics. With that in mind, you raise a very fair 

point. Which is, okay, what would the risk be even for a hardened 

facility in that location? One permutation, because this is a question 

that, I can assure you, I asked and the Secretary asked, is how could 

you prevent, if the city were, heaven forbid, to flood again, how could 

you prevent the facility from becoming an island? In point of fact, 

above sea level is the expressway, and one permutation that has been 

proposed is to actually have an exit ramp built directly to these facility sites so that in fact there were elevated access to these facilities. 

One plot of land happens to be very proximate to that expressway. 

But a very fair question, for all of the reasons that you suggest.

The Chairman. I remember, when I was serving on the Katrina 

Commission, gosh, please do not ask me where I got this. This is one 

of those things that you just kind of remember. That areas that had 

some devastation by hurricane, 30 percent do not come back. Then 

they slowly trickle back, over time, and a decade later, they will return. So, take Hugo, for example. It took 10 years for them to come 

back, and then for the population to explode. Homestead, 50 percent. 

And, so this demographic and trend analysis will be pretty important. Mr. Michaud?

Mr. Michaud. Thank you very much, Mr. Chairman. I would like 

to follow up on where I left off previously. Dr. Perlin, since I have 

been here I have heard a lot about, the CARES process, that it is 

all encompassing and that we need it to hold off capital investments 

until it is completed. And we heard the Chairman talk about buying some land back that we gave away with a significant amount of 

dollars, and a lot of these other expenditures. I guess, how much is 

the Department still interested in the CARES planning? I am really 

having concerns because it is an all-encompassing plan. Granted, 

things might be a little different than when the plan originally came 

out, and I can understand that.

 However, in all of VISN 1, there is one CBOC recommended and 

four outreach clinics. VISN 1 hasn’t got the capability financially to 

even submit a business plan for the CBOC. So, if you have a VISN, 

and this is the same VISN that actually had to borrow money to make 

ends meet because they did not have the financial resources. So, 

if the CARES plan says, yes, a CBOC and four outreach clinics are 

important, granted it has to be a priority. But what I am seeing is 

now, when you look at some of the capital construction funds, other 

projects are jumping over another priority. I am just concerned that 
33

the Department is not maintaining, the CARES process as a top priority. Comments?

Dr. Perlin. Yes, thank you, sir, for the question. I want to tease 

apart two aspects. In terms of the CARES process, I think that is the 

major blueprint for the major capital infrastructural investments, 

and we have requests for authorization and reauthorizations in the 

Authorization Bill that the Department submitted. And so that really is a template. In terms of the Community-based Outpatient Clinics, the CARES plan, as you have alluded, also noted the need for 156. 

The CARES plan is a 20-year plan. I think it is pretty compelling 

that the VA has had a 350 percent increase in points of access over, 

nearly the past decade in terms of opening new clinics. I know that 

we make decisions, and I really want to stress this, not just on the 

basis of what is in the operating budget, but what is the immediate 

operational need.

 This is why, as we have discussed, the Lincoln Outreach Clinic is 

prioritized, but we recognize that there will be growth in other areas, and the network will bring them on. So I think it is important 

to recognize that dollars are important, but so are the operational 

needs will drive the timing of requests for particular clinics. And I

will track not only the individual clinics, but the workload at each of 

the facilities that the clinic would be in the catchman area of. And I

know that there are some in Maine, in particular, and you have my 

commitment to watch those.

Mr. Michaud. I appreciate that. And I will be watching it very 

closely myself. Because you could have some VISN’s, who have identified need and are entitled to a CBOC, and has the money to actually 

submit their business plan, but that CBOC might not be a higher 

priority than other VISN’s that cannot even submit a business plan 

because of lack of funding. And things do change, particularly when 

you look at different regions, and what is happening over in Iraq and 

Afghanistan creating more veterans. And that is my concern. VISN’s 

who are inadequately funded in the first place will fall further and 

further behind in opening CBOCS and outreach clinics because of the 

lack of the resource.

 My second question deals with a GAO report that just came out. In 

light of the GAO report that came out on the collaboration in Denver 

and in Charleston, have you changed or modified the Charleston 

Model, based on the GAO recommendations.

Dr. Perlin. Thank you for the question. I am going to ask Mr. 

Neary to provide comment on that.

Mr. Michaud. Thank you.

Mr. Neary. I think one of the things that we learned in Charleston 

is that we did not bring enough architectural support to the thinking 

that was going on in the group. So, in New Orleans we have added 

that component. We have the architectural firm of Leo Daly, a noted 
34

healthcare architectural firm, working with the Mike Moreland planning team to assist them in any way they can.

Mr. Michaud. Thank you. Okay, and my last question deals with 

--

The Chairman. Will the gentleman yield on this for a second?

Mr. Michaud. Yes.

The Chairman. I just want to share with you, if the focus is on 

communication, is what the GAO is saying, the history here is, with 

regard to the Denver facility, the hope was that was where the collaboration was going to be. But it did not work out. There was real 

conflict in personalities between a VISN Director and the University 

Hospital Director. And the architectural firm that did that, tried to 

do the Charleston Model, which really would have been the Denver 

Model, had it worked. Four years ago, I met with Charleston, and everybody wanted to run off and build their own facilities everywhere. 

And so Henry Brown, four or five years ago, we met with them and 

encouraged them to hire the architectural firm that did the planning 

in Denver, and did it in Charleston.

 And so we asked the GAO to come in and look at Denver. What 

were the lessons learned, why did it fail? Because some of the same 

input was given for Charleston, and to assess some of the, what, 

failings? So we could figure out how to improve it, and they really 

wanted to focus on communications. But I wanted to share with the 

gentleman sort of the history of that. I yield back.

Mr. Michaud. I appreciate that very much, Mr. Chairman. My last 

question, it seems that collaborative opportunities for the VA will increase, particularly with what happened in the Gulf Region, because 

of disasters. In the environment of constrained funding, how can the 

VA deal with the construction issues caused by disasters as well as 

move forward on the CARES process? Because clearly we have to 

take care of the hospitals damaged by disasters, but that is going to 

have an effect on the CARES process.

Dr. Perlin. Thank you, Mr. Michaud, for that question. I think it 

is important to say that our first mission is the care of veterans, the 

ability to improve the care of veterans, the ability to serve veterans is 

really what we hope to serve through any sort of collaborative activity, and that alone.

 Second, you have asked the question about how we prepare for 

disasters. This is one of the great advantages of being a national 

system. We are operational. We deal with the care of patients day 

in and day out, and because of that we have relationships with suppliers. We also have a system which also has a very systematic approach to readiness, and we exercise that.

 So, in point of fact, our infrastructure while in the shared environments with others is one that can actually be supported, bolstered 

by the national organization providing supplies, providing personnel, 
35

and providing resources in times of disaster. It is hard to believe, 

but come June 1 we again face the prospect of hurricane season, and 

some of the preparatory activity includes such things as beginning to 

stockpile certain supplies, rather than having our usual just in time 

inventory. But, we will continue to have a very systematic approach, 

it will be exercised to approach the specter not only of local emergency but of regional and even national emergencies.

The Chairman. Mrs. Brown?

Ms. Brown of Florida. Thank you, Mr. Chairman. Just one second, 

thirty seconds about me. I represent most of Florida. I have Jacksonville, Orlando, Gainesville, I have a lot of veterans in my area, and I

have got to tell you I want to say, I want to associate myself with the 

remarks of, I understand, Congressman Feeney came in here earlier. 

I have represented the area for 14 years. It has been a fight on this 

hospital for over 25 years. And the people that have lost have been 

the veterans in the Orlando, you know, Central Florida area. 

 Secretary Brown did come in and helped us a great deal when they 

recommended closing the Naval Training Center, and the Department of Defense gave it to the veterans and we in Congress got the 

money to renovate it. And it has been a good deal up until this point. 

We really need a hospital in that area. And I guess my first question 

is, once you are close to making a decision then where are we with the 

request for the funds, that is my first question.

Dr. Perlin. Yes, ma’am. Let me start by thanking you for your 

support of the Orlando facility. We are very excited about this finally 

coming to a decision point. As you may know, there was a site team 

that went down on May 2nd and 3rd, I believe those were the dates, 

and evaluated the contending sites. There are some that, for many 

of the reasons discussed today, appear to be favorable. But the Secretary will have the opportunity to review those data, and I believe 

begin to make a preliminary decision within the next few weeks.

Ms. Brown of Florida. Okay.

Dr. Perlin. And that is something that I very much look forward 

to, I’m sure, as you do.

Ms. Brown of Florida. I want to make sure my statement is included in the record, Mr. Chairman, pertaining to my written comments 

in the record, because it pertains to the Orlando facility.

The Chairman. You would like to submit a statement into the record?

Ms. Brown of Florida. Yes, sir.

The Chairman. Yes, hearing no objections, so ordered.

Ms. Brown of Florida. Now, we have a situation in Jacksonville 

that I have scheduled a meeting with the VA on Monday, and I am 

going to ask you a national question, but first of all you have got to get 

your local situation taken care of. So my first question is, it pertains 

to Jacksonville.
36

 I do not know whether you know, but I met 30 minutes ago with the 

President of the University of Florida who is over Shands Hospital. 

Two weeks ago I met with the Mayor of Jacksonville, and I met with 

the VA, and now I am putting all those same people in a room on Monday at 3:00, because I do not know what you do when failure is not an 

option. And we have been working, the city and Shands, they had a 

facility that they have torn down, and they moved an agency that was 

in there that has been a great disturbance to the community. And 

everybody thought we were moving forward, and then I heard it was 

some problem about the parking garage, or something. So I met with 

the mayor, they are willing to resolve it. So I do not really know the 

problem, but I hope everybody gets their notes together, and when 

we come together Monday, when we get out of that room this will be 

resolved and we will be moving forward.

Dr. Perlin. Well, Congresswomen, thank you very much for your 

support of us, and in particular bringing people together on Monday. 

I think this will be very helpful. As you know, we are very committed 

to the increasing outpatient presence needed in Jacksonville. The 

Deputy Secretary himself has been down there to really affirm VA’s 

commitment to serving veterans in that area, and we appreciate the 

relationship with Shands.

 I would be less than forthright if I did not acknowledge that there 

has been some wrestling over the number of parking spaces. I believe some of that has to do with city code, and I think that can be 

easily resolved, and I think some of it has to do with capacity of some 

buildings. And I would appreciate your help very much on Monday 

on bringing parties together such that we can provide the necessary 

parking for veterans, and get on with this activity.

Ms. Brown of Florida. Okay, and can you just give me an update 

on the cemetery in that area, also?

Dr. Perlin. If I might, I would refer to Mr. Bill Jayne of the National Cemetery Administration.

Ms. Brown of Florida. Yes, sir.

Mr. Jayne. Yes, ma’am, we just finished the environmental assessment for three properties that we are looking at, potential sites for 

the National Cemetery in Jacksonville that was authorized by Public 

Law 108-109. And we are reviewing the comments and we will be 

preparing a recommendation to the Secretary to make the final decision in the next couple of months. The process will probably take 

about that long, but it is going along well, and we feel like we have 

got some good potential sites. They are all located roughly north of 

the airport there in Jacksonville.

Ms. Brown of Florida. Well, good. My question is, do you all have 

this, I know that in order to expedite the time, that you all have some 

kind of a model that you all use, that you are using all over the country?
37

Mr. Jayne. What we try to do to expedite the provision of service 

is that we will divide the first phase of construction into what we 

call a Phase 1A and Phase 1B. And the Phase 1A will be intended 

to prepare some of the site, a small portion of the site, for burials as 

soon as possible. And we will rely to some degree there on temporary 

facilities, such as a temporary office, temporary maintenance facility, 

that will be replaced during Phase 1B with permanent facilities. But 

the idea is to bite off, if you will, a small workable chunk and design 

that in so that when the entire Phase 1 is done, it will meld into the 

rest of the cemetery. It will not look like it is part of something, a 

different project.

Ms. Brown of Florida. How long for each phase?

Mr. Jayne. We hope to be able to finish that Phase 1A by late 2008, 

early 2009.

Ms. Brown of Florida. And final completion?

Mr. Jayne. Final completion would be about a year later, of Phase 

1.

Ms. Brown of Florida. Of Phase 1?

Mr. Jayne. Right. And that would be, the Phase 1A would be open, 

available to veterans and their families in late 2008, early 2009, and 

about a year later we would be able to finish the rest of Phase 1, that 

is the permanent buildings and so forth.

Ms. Brown of Florida. Okay, thank you very much. On the national system, I just returned from New Orleans I guess about a month 

ago. And I met with the Army Corp. and wanted a status report as 

far as where we was as far as the levies is concerned. But my concern goes to, it is not just New Orleans. I mean, like you said, I live 

in Florida. The hurricane season is coming, and it is not just coming 

to New Orleans, but Florida. And the national system, my understanding was that part of the problem was the veterans, if they are 

displaced, and many were displaced after the hurricane. But, are we 

plugged in so that no matter where a veteran goes, you can pull up 

his records? Is that straight now?

Dr. Perlin. Yes, ma’am. Let me assure you that as we use our electronic health record, you can actually go to a function called remote 

data view, and see their medical conditions, refill prescriptions, also a 

function called VistaWeb. And we would certainly want to put in also 

back-up communications. And in fact, we are in the process of establishing, and we appreciate the help of our Office of Information and 

Technology, establishing satellite uplinks so that in the event there is 

not communication on, ground based fiber and cable, we can actually 

use high band width satellites to communicate between facilities.

Ms. Brown of Florida. So we will be able to assist the veterans no 

matter where this takes place?

Dr. Perlin. Yes, ma’am, absolutely.

Ms. Brown of Florida. Well, that is good. I want to thank the 
38

Chairman for what he did as far as the communications, making sure 

that we put that system in place, and we held up the money a little 

bit until we could really get a system that would serve the veterans. 

So, thank you, and thank you for the time.

[No statement was submitted. ] 

The Chairman. Thank you very much. I have just a few more questions. This is an authorization for a lot of money, so I know this is a 

long hearing, and I thank you for the patience of the American Legion 

and the VFW. We are going to get to you.

 As I go down the list, you also are asking for $189 million in Pittsburgh, Pennsylvania. So, let us turn to our buddy, Mr. Moreland. 

What is he doing?

Dr. Perlin. Sir, in Pittsburgh, Pennsylvania, it is actually an opportunity to improve service to veterans while improving efficiency. 

Pittsburgh has been operating virtually as three campuses, and in 

this area we will be able to consolidate down to two. And the University Drive campus, actually bring much of the workload to that 

facility, and also supports a second facility with improved residential 

treatment. Bring the management and the overhead of three facilities into two, improved access, improved facilities, improved technology, improved efficiency. So we appreciate the investment and realizing the promise of the CARES program.

The Chairman. What is Mike Moreland doing there with regard to 

collaboration, if any?

Dr. Perlin. Mr. Moreland is doing tremendous things in terms of 

collaboration. This is really a great example where, in collaboration 

with the University of Pittsburgh Medical Center, they share certain 

specialties. In other areas, they actually use some of our services, 

that makes it a long term win-win partnership. And in other areas, Mr. Moreland’s entrepreneurial approach has created a template 

that allows for leadership in programs that are extremely complex, 

like transplant surgery. And that facility is really an extremely well 

managed facility, as you would expect from Mr. Moreland, but one 

that benefits both from internally efficient operations as well as good 

collaborative relationships.

The Chairman. All right, as a Committee we have the challenge 

here in front of us. Earlier I had mentioned, it has been decades since 

the VA has found itself with this many major construction projects 

in front of it. The list goes on and on, with a lot of the consolidation 

of clinical and administrative functions, and outpatient clinics, ambulatory care, expansion of spinal care, seismic corrections, ward upgrades, electrical systems, bed renovations, I mean, the list goes on. 

But we have a challenge here in front of us. So I feel no differently 

from how the Appropriations Committee must have felt.

 You submit a request for us for $675 million for New Orleans, Loui-
39

siana. Appropriators put in an emergency supplemental in excess of 

$550 million, subject to an authorization to expire on June 30th. So, 

we as a Committee do not know where you want to go, and we need 

good counsel from you to us.

 We also have the Biloxi facility. And I know you just met with 

Mr. Taylor of Mississippi, and I know that he would love to keep the 

Gulfport facility, but I had to explain to him also, and I know you 

were very candid with him, about the realities, and to follow CARES, 

and that we are going to upgrade Biloxi. And I do not have a problem 

with that at all.

 But New Orleans, break this one out a little better for us. I mean, 

because I feel conflicted inside a little bit, just where I am with Denver. So, give me your best shot.

Dr. Perlin. Mr. Chairman, it is not possible at this moment to tell 

you exactly what corner, what intersection in New Orleans this facility will be located. What we can tell you is that for reasons that have 

convinced the Secretary, convinced me, we have the opportunity to 

improve efficiency and restore services to veterans with a facility in 

New Orleans proper.

 We appreciate the discussion and the responsible oversight provided by you and the Committee in asking the question, ``What if?’’ And 

that is something we take very seriously, having weathered Katrina 

as a hospital that was in a flooded area. The ability to assure access 

is something that is absolutely paramount. The ability for a facility 

to be hardened and withstand damage is absolutely paramount. And 

given that the demographics from actuaries demonstrate that there 

is still a population basis, even if Orleans and St. Bernard were not to 

repopulate, that would support the need for a tertiary referral center, 

now and in the future, our request is for authorization for a facility in 

New Orleans proper.

The Chairman. And if we were to do this in New Orleans, authorize 

it subject to the collaboration between you and LSU, do you have a 

problem with that?

Dr. Perlin. Mr. Chairman, we believe that the collaboration will 

offer efficiencies. Not only do we not have a problem, we look forward 

to not only approving care, but improving efficiency and the stewardship of resources.

The Chairman. And increasing the quality at the same time.

Dr. Perlin. Yes, sir.

The Chairman. All right. Mr. McClain and Mr. Neary, I know that 

there are some outstanding leases out there, and that we have got to 

get this authorization of the leases. Mr. McClain, our present liability, could you address that right now? I mean, we are in a present 

liability because of not having gotten this authorization done, so can 

you help explain about time being of the essence?

Mr. McClain. Many of the leases will run out, as I understand 
40

it, at the end of the fiscal year. So, unless we have authorization to 

reenter into those leases, or extend them, we are probably going to be 

paying more afterwards when we do get the authorization. We will 

be paying market rates or whatever the market rate will be at that 

point.

The Chairman. These are contract penalties?

Mr. McClain. Yes, sir. So I believe that that is the case. I defer 

actually to Mr. Neary.

The Chairman. Do we have any leases right now that have expired, 

which were in penalty?

Mr. Neary. No, Mr. Chairman, we do not. The leases for which 

we are requesting authorization in a couple of instances are new facilities, we do not have anything existing. As Mr. McClain said, the 

sooner we get authorization the sooner we can proceed to a contract 

and lock in that market rate. As we talked earlier, building costs are 

growing. And so, the sooner the better.

 The other leases are in situations where we are in an existing facility, the leases will be expiring. We will, if needed, attempt to work 

with that lessor to enter into an extension of the lease while we get 

authorization, and then acquire the new facility.

 So the only additional liability I believe we have at this point is, as 

Mr. McClain said, as the market increases, the sooner we can lock in 

the better.

The Chairman. Thank you, very much. These penalties would be 

approximately what over an annualized basis, per facility, would you 

know that? Someone I think had informed me one time it was around 

$100,000, is that right? Over a year, is that about accurate?

Mr. Neary. I think maybe penalty is not exactly the right word 

used. When we go and extend the lease, the lessor will obviously 

want to increase our rental rate to current market. And some of 

these are clinics that have been in existence 20 years, so we are paying a darn good rate now.

The Chairman. I guess I am calling it a penalty only in that if we do 

not get our job done on time, you have got to pay more money. That 

is a penalty to the taxpayer.

Mr. Neary. Correct.

The Chairman. I stand corrected. The $377,700,000 you are asking 

for on the Orlando facility, can you break this out for us?

Mr. Neary. Our working number currently for the site is $30 million. So the design and construction costs we have presently estimated $347 million.

The Chairman. So, your request to us is not 377 it is 347?

Mr. Neary. No, we would need authorization for the total of 377. 

We require authorization --

The Chairman. How much is the land, approximately?

Mr. Neary. Our working number is $30 million.
41

The Chairman. Your working number, but as of right now --

Mr. Neary. We are looking at six sites. As Dr. Perlin said, we will 

soon in the next few weeks be shortening that number up. We will 

then engage in real estate due diligence, seeking appraisals of the 

sites, begin negotiating with the landowner.

The Chairman. Obviously that is all being done before you announce.

Mr. Neary. I’m sorry? One of the requirements --

The Chairman. If I were a landowner I would love for you to announce that you are coming to buy my property.

Mr. Neary. We are required to follow --

The Chairman. Right? They are only going to put the price up.

Mr. Neary. Well, the good thing for us is we have choices. There 

are a number of competing sites.

The Chairman. Yes?

Dr. Perlin. Mr. Chairman, you are exactly right. We would caution, we do not want to bid against ourselves.

The Chairman. Yes, do not tell us, right?

Dr. Perlin. Exactly.

The Chairman. Mr. McClain, you go out there and you negotiate, 

and then you can tell us.

Dr. Perlin. Exactly.

The Chairman. All right. I’m good. Are you good with that, Mr. 

Michaud? Going down this list, Mr. Michaud, do you have anything 

further on any of these sites? I think we have covered them. The only 

thing I have would be this, and it is a follow-up from the conversation 

we had had.

 At some point in time, and from my conversation with General 

Love, is this idea of when the Secretary and your team have put together the time lines of this construction so you can begin to overlay 

and utilize this institutional knowledge, these time lines when you 

set them will be very helpful to us. And it is helpful also to OMB, 

because over this next decade, building these six facilities, we have 

not been here before. And as you lay that out to OMB, lay it out to us, 

and the appropriators, and the Senate, so everybody has confidence 

in your plan and in your number, and we all can proceed. For the veterans service organizations you have used, the word transparency, 

getting their input from the localities so that the national leadership 

of the organizations understand how it is going, and the time line. 

 When that happens, then you calm the emotion of a Ms. Berkley. 

Right? I mean, you calm the emotions of others. And we want to 

work with you to do that. Do you have anything that you would like 

to add?

Dr. Perlin. No, sir. We agree with you in terms of that, and in 

fact do have Gantt charts on play out layout, and we commit to being 

more transparent about making those very public so you are with us 
42

as we progress through these important constructions.

 As well, I would simply note again that General Heiberg’s advice 

and the Construction Advisory Board --

The Chairman. Hold on, just a second. Would you be willing to 

submit that for the record? Your chart?

Dr. Perlin. Absolutely, yes, sir.

The Chairman. All right, how do you identify your document?

Dr. Perlin. This is a Gantt chart on the construction timetable for 

Las Vegas.

The Chairman. The document shall be entered into the record, so 

ordered. Please, I’m sorry.

Dr. Perlin. I would simply conclude by saying that the Construction Advisory Board, that blue ribbon panel that the Secretary chartered, that really compels us to use the most contemporary, transparent and accountable approaches. We know how important that is, not 

only to the Committee, but to the taxpayer. We owe taxpayers and 

veterans that.

The Chairman. All right, thank you very much, gentlemen for your 

-- yes?

Dr. Perlin. If I might, sir, before we leave, it would be remiss if on 

behalf of our colleagues at the Department of Veterans Affairs we did 

not join you in expressing our admiration and appreciation for the 

service of Jim Lariviere. I would just like to really acknowledge his 

tremendous leadership and service.

The Chairman. Thank you. I will make sure he sees that. Thank 

you, gentlemen for you testimony. You are now excused. Third panel, please come forward.

 Mr. Salazar, I ask that the opening statement of Mr. Salazar shall 

be offered to be entered into the record. Hearing no objections, so 

ordered.

[No statement was submitted. ] 

The Chairman. Our final panel will receive the endurance award. 

I’ve got a couple like energy bars here, if you need them. Are you 

okay? You operate well on an empty stomach?

Mr. Cullinan. So far, so good, Mr. Chairman.

The Chairman. I do apologize to you. You have been here since 

10:30, but you also have been able to sit there and take in some very 

valuable testimony. Not only from our members, in particular our 

two members from the New Orleans/Baton Rouge area, and Mr. Feeney of Orlando. I mean, you get your input from your membership, 

but it is kind of interesting to listen from their perspective. At the 

same time, we have huge challenges in front of us on how we get this 

construction done and know what the plan is, and how we get it into 

the budgets. 

 So, thank you very much for enduring, but you were able to listen 
43

to all of this testimony.

 Representing the American Legion is Cathleen Wiblemo, a U.S. 

Army Veteran, and she is the Deputy Director for the Veterans Affairs and Rehabilitation Commission of the American Legion. And 

our final witness on this panel, Dennis Cullinan, is the Director of 

the National Legislative Services for the Veterans of Foreign Wars. 

Dennis was discharged from the United States Navy in 1970. Ms 

Wiblemo I did not say when you were discharged. That is because I

am a gentleman.

Ms. Wiblemo. Oh, thank you. Thank you.

The Chairman. Ms. Wiblemo, you are now recognized.

STATEMENTS OF CATHLEEN C. WIBLEMO, DEPUTY DIREC-

 TOR, VETERANS AFFAIRS AND REHABILITATION COMMIS-

 SION, THE AMERICAN LEGION; DENNIS CULLINAN, 

 DIRECTOR NATIONAL LEGISLATIVE SERVICE, VETERANS

 OF FOREIGN WARS

STATEMENT OF CATHLEEN C. WIBLEMO

Ms. Wiblemo. Good afternoon Mr. Chairman, and Members of the 

Committee. Thank you for the invitation to present the American 

Legion’s views on the Rightsizing of the Department of Veterans Affairs. The American Legion has a keen interest in this very important process. My oral remarks will be brief, but I ask that my written 

testimony be submitted in its entirety for the record.

The Chairman. Hearing no objections, it is so ordered.

Ms. Wiblemo. From the beginning of the CARES process, the 

American Legion has taken an active role. We have formed an advisory committee made up of volunteer legionnaires to look at facility assessment and possible use or reuse of reported vacant space. 

We appointed a volunteer legionnaire in every VISN to report on the 

local concerns on legionnaires regarding CARES. These volunteers 

also testified before the CARES Commission during the Commission 

Site Visits in 2003. We have sent a representative to every Local Advisory Panel meeting that has been held to date. If and when Stage 2 

starts and the LAPS resume, rest assured that we will be present. It 

is frustrating that we have tried since November to find out the status of the LAPS and have been unsuccessful. We even called all the 

LAP points of contact that were given to us, and they were as much 

in the dark as we were.

 The American Legion would like to emphasize that stakeholder 

input has been a key component in the CARES process. The LAPS

were set up to ensure continued stakeholder input. Veterans across 

the country were astonished to hear that after seven months of dormancy, and complete lack of communication with stakeholders, ma-
44

jor realignment decisions in 16 of the CARES affected communities 

are soon to be made by the Secretary of VA.

 The American Legion has conducted site visits to every medical 

center in the VA Healthcare System across America as part of our 

System Task Force mandate. We have recently visited Las Vegas, 

Denver and New Orleans. We have seen first hand the state of VA 

healthcare at these sites.

 The CARES decision was meant to be used as a blueprint, a guideline, a method of developing the tools necessary to shape the VA

healthcare system into the future. Congress tasked VA to come up 

with a plan, and they did. For many years, construction dollars were 

hard to come by awaiting the outcome of the CARES process. What 

we would like to see is a more pronounced sense of urgency to implement decisions that have already been made, and get quality, accessible healthcare to veterans in specific areas that the CARES determined are not only high priority but urgent and critical.

 It is time to move forward and fund major and minor construction 

throughout the VA healthcare system to catch up for the years when 

capital improvement projects were frozen awaiting the CARES plan, 

along with the years since CARES when funding has fallen short of 

the well-defined need.

CARES was triggered by a GAO report in 1999 that showed VA

was spending millions of dollars a year on unused space. Solving that 

problem guided CARES from beginning to end. Seven years later, 

this costly problem of inefficiency not only remains but has grown 

bigger. Former VA Secretary Principi warned that one of the biggest threats to CARES was ``paralysis by analysis.’’ It is the plan 

Congress asked for. It is a plan that envisions the right size for VA

healthcare and veterans deserve that. Thank you, and I look forward 

to your questions.

[The statement of Ms. Cathleen C. Wiblemo appears on p. 78]

 Mr. Chairman. Thank you very much. Mr. Cullinan?

STATEMENT OF DENNIS CULLINAN

 Mr. Cullinan. Thank you very much, Mr. Chairman. On behalf of 

the men and women of the Veterans of Foreign Wars of the United 

States, and our Ladies Auxiliary, I want to thank you for inviting us 

to participate in today’s most important and revealing hearing.

 As you know, the VFW handles the construction portion, and independent budget, and I will continue in that vein.

The Chairman. Does the gentleman have a written statement?

Mr. Cullinan. I would ask that our written statement be made a 

part of the record.

 The Chairman. Hearing no objection, it is so ordered.
45

 Mr. Cullinan. To begin, I would say that the VFW and the IBVSO’s 

continue to be supportive of sharing of collaborative ventures, you 

know, when they benefit both the veteran and indeed the community. 

We are, of course, concerned that VA maintain, it continue to protect 

VA’s identity as a provider of care and service --

 The Chairman. Mr. Cullinan, may I ask a question?

 Mr. Cullinan. Yes, sir.

The Chairman. Just for a point of clarity, your testimony here today, is it on behalf of the VFW, or is it also as the --

Mr. Cullinan. We are representing the IBVSO’s as well.

The Chairman. Okay.

Mr. Cullinan. So, IB.

The Chairman. Very good.

Mr. Cullinan. IB.

The Chairman. All right, thank you. So you are representing both 

here today, the Independent Budget and the VFW?

Mr. Cullinan. Well, the VFW is part of the Independent Budget, 

and we handle the construction portion.

The Chairman. I just want to make sure it is clear. You are here 

providing testimony, what hat are you wearing?

Mr. Cullinan. The IB.

The Chairman. Thank you.

Mr. Cullinan. You are welcome, sir. Some of the things that you 

are emphasizing here today, also pertain mightily, as far as we are 

concerned, with respect to collaborative ventures. It has to do with 

things like access. The facility has to be located somewhere where a 

veteran can get to it. Accessibility, we have talked about this before. 

If a facility happens to be, say, situated on a military base, you know, 

is the security too daunting for veterans to get in there. And what 

you really emphasize is the issue of quality. That is very, very important. In a sharing arrangement, we want to ensure that veterans will 

get quality care. That is a key issue with us.

We are, of course, and we testified to this extent before, with respect to funding of the Gulf Region. In past testimony, we have indicated that the money has to come not only just through the VA’s 

construction budget, but through other sources as well, and we are 

very pleased to see that there is money in the emergency supplemental for both Biloxi and New Orleans. But, with respect to New 

Orleans, I believe we share a concern with you that VA not be put in 

a position where it is acting prematurely with respect to building a 

new facility down in New Orleans. We have got to look at the demographics. There are safety issues of concern. Your image earlier of 

a VA medical facility as an island was pretty impressive and pretty 

daunting as well.

 So these are things that have to be looked at. We are concerned 

that there may be a tendency to want VA to sort of lead the way, and 
46

that may not be in veterans’ best interests, and that is where we are 

coming from on this issue.

 I also have to say that Mr. Baker’s testimony earlier was troubling 

indeed. I mean, usually when we are talking about, both with respect to New Orleans and sharing arrangements in general, usually 

when we are talking about a collaboration between a medical school 

and a VA facility, our biggest concern generally is that the VA not 

get pushed around, and everything not sort of work in the medical 

school’s favor. It would seem here, from what Mr. Baker was indicating, is that it could be a situation where VA could end up as a form 

of cash cow for a facility, and I do not know this, but for a healthcare 

system that is in jeopardy, that is in trouble. That is troubling to us. 

I cannot say how accurate of an assessment that is. I am sure Mr. 

Baker understands it very well, and it is something that we would 

ask for you to look at.

 You know our general budget number. I am not going to review 

those again. I would say, in earlier testimony we talked about the 

situation of non-recurring maintenance. As you know, that is not 

funded under budget. It is part of the healthcare funding. That sets 

a form of competition between providing care to veterans and keeping 

up with essential maintenance projects. The other issue there is that 

it is funded via VERA, which may be the best way going to fund medical care, but it can misdirect dollars with respect to construction. You 

can have an old facility that costs a whole lot of money to maintain, 

and not have very many veterans using it. If the decision is to keep 

that thing running, then it has got to be properly funded.

 Another area, we are pleased to note that the VA is going forward 

with some seismic corrections. However, it is indicated some 890 VA

facilities are at significant risk. We have to move forward with this. 

And we continue to support an architectural master plan.

 I have a little note to myself here. It says, ``Delays cost money.’’ 

This is a point we have made in earlier testimony, and then today it 

was revealed that there are now 14 projects which are not going to go 

forward in a timely basis. That costs a lot of money. It also means 

that veterans are denied, or are not getting, the care that these facilities should be providing. We have court support extending the authority to 2009 to provide it, but, again, this is a case where we are not 

doing the right thing by veterans and we are not doing the right thing 

by the taxpayer. And that is a concern. We are worried system-wide. 

You can have the best plan in the world, but if money is not there to 

pay for it, what happens next? So, and this was brought up in Senate 

testimony about a month ago. What do we do with CARES? What 

happens if the money is simply not there to pay for it? And there will 

be a time where the IB will ask to look at this, and say, ``Need we do 

something else?’’ If the money is not there to pay for it, what do we 

do? And we, all of us, the American people, the veterans’ community, 
47

have invested a lot of time, energy, money into this thing. It would 

be a shame to see it squandered.

 The last thing I would like to say here, Mr. Chairman, is that we 

very much appreciate your urging total transparency in the process, 

in the construction process. I mean, this is a situation we have not 

had to contend with for years and years with respect to building VA

facilities, figuring out where they have to go. It is essential that the 

local veterans be involved in the process. And that concludes my 

testimony. Thank you.

[The statement of Mr. Dennis Cullinan appears on p. 74]

 The Chairman. Yes, I definitely agree with your last statement. 

When we first began this issue on collaboration, a step beyond personnel to facilities, there was confusion at the local level as to what 

was going on. And then the mysteries and the boogie men started 

to appear. And you know what? It goes back to the communication. 

And it was very good that Mr. Michaud was present, because he also 

gave some good counsel to everyone to, wait a minute, let us make 

sure that everybody gets included in the process. One of the district 

Legion individuals was present, but the state commander did not 

know. And then you had your own intra-politics going on within your 

own groups. Whoa. But communication I think is beginning to work 

itself out, and I appreciate your final testimony on that point.

 Let me turn to Ms. Wiblemo of the American Legion. In your written statement, on page four, if you have it in front of you, if not let 

me just read this to you, with regard to this Charleston Model that 

is being leveraged, now in New Orleans. So under your paragraph 

regarding New Orleans, in the second paragraph, you said for the 

American Legion, you ``support the relationships that the VA enjoys 

with the medical school. However, we remain adamant that the VA

health system retain its own identity.’’ Carry that forward. What do 

you mean?

Ms. Wiblemo. Well, a lot of that has to do with the history, South 

Carolina being one of them, MUSC. And we are adamantly, it is a 

challenge, because I know with the collaborations, and the sharing 

that goes on, and we support sharing and collaborations, and that. 

We are very afraid that the VA will lose its identity, and lose its 

unique specialty. It holds a special place in veterans’, I mean, obviously, in veterans’ hearts, but to get --

The Chairman. Ma’am, have you seen, or read both of these?

Ms. Wiblemo. Yes, I have. No, I have not seen the New Orleans 

one, but I have read the MUSC one.

The Chairman. All right, I will tell you what. Before you leave here 

today, we will get you a copy of this one.

Ms. Wiblemo. Thank you.

The Chairman. Because when you read both of these, I think ev-
48

eryone has given the great assurance, and agrees, we want the VA to 

retain an identity.

Ms. Wiblemo. Right. And I will tell you, part of the South Carolina 

issue was veterans were not at the table at the time, and they were 

only briefed.

The Chairman. And early on they got confused because they were 

going to be in the same ward with civilians, and --

Ms. Wiblemo. There was a lot of confusion.

The Chairman. That is not going to happen. That is not what this 

is about.

Ms. Wiblemo. So, yeah.

The Chairman. So, if we are in agreement --

Ms. Wiblemo. That would be --

The Chairman. Pardon?

Ms. Wiblemo. That is very important, obviously. Not just to us, but 

I am sure to a lot of people.

The Chairman. It is important to me.

Ms. Wiblemo. Obviously.

The Chairman. It is important to Mr. Michaud. It is important to 

Mr. Brown.

Ms. Wiblemo. Yes.

The Chairman. So I want you to know that with regard to that 

statement as it appears in your testimony, we in fact all agree.

Ms. Wiblemo. Great.

The Chairman. Okay? So, as they proceed, it is the Charleston 

Model that is being leveraged now to New Orleans, and this one is 

going to try to_

Ms. Wiblemo. When did the New Orleans one come out? Was that 

just this month?

The Chairman. Yes, it just came out. April 30th.

Ms. Wiblemo. I have not seen that one. But I have read the other 

one.

The Chairman. Well, you will enjoy this.

Ms. Wiblemo. Thank you.

The Chairman. Because Mike Moreland, this is a very sharp individual, and he took the best of having gone through this process 

and leveraged it into New Orleans. And where we are from here, is, 

that now we need to go to Stage 2. Because this was the heavy lift. 

This was the identification of all of the no-go categories that must 

be defined. And once they got defined, then you have to go into the 

next step. And that is where we are to go, and we are going to move 

in tandem with both. So, it will be important. If you have any questions, IB, American Legion, as this proceeds, please stay in touch 

with us. We will be more than happy to let you know what we know 

as we know it.

 Ms. Wiblemo. Thank you.
49

The Chairman. Okay. All right? Will you make a copy of that right 

now? We are going to get it to you. Mr. Michaud, I yield to you, and 

then I have other questions.

Mr. Michaud. Okay, thank you very much, Mr. Chairman. I want 

to thank you both for your testimony and willingness to stay as well. 

I appreciate that very much. Getting back to, and the reason why 

I mention VISN 1 is that I am familiar with VISN 1 compared to 

the other VISN’s. And I am sure we are not unique in our concerns 

when you look at the whole CARES process. Do you think that this 

Committee, or the VA, should actually re-look at the whole CARES

process? See if it should be changed; what are your thoughts on that? 

Because, as you heard Dr. Perlin, it is a 20 year plan, and things do 

change in 20 years. They change from year to year. And priorities do 

change. But what is your overall thought as far as to make sure that 

CARES, the plan that is put out there, is still valid, you know, next 

month, next year, the year after?

Mr. Cullinan. Thank you, Mr. Michaud. I mean, clearly, we do 

not have another 20 years to wait. I mean, that is what I was afraid 

of when I was listening to Dr. Perlin. Was it about a month ago the 

Secretary was presented with the CARES report? Now is the time 

to look to see if something comes of this. If nothing comes of it, at a 

certain point, we are going to have to say_and I keep saying, I know 

it is vague to say a certain point. And I do not want to say, and there 

certainly is not agreement within the IB that the time is right now to 

say, ``Okay, CARES ain’t working because the money is not there.’’ 

But clearly, you know, within the not so distant future, if nothing is 

coming out of CARES, I mean, the construction has been held up for 

years because of CARES, waiting for CARES to emerge. Well, it is 

emerging now. So, let us see what comes of it, and let us see if the 

Congress will fund it.

Ms. Wiblemo. I suspect, CARES is just a plan to help guide the 

VA. It will be up to the VA managers and those of us that use the 

VA system, and oversee the VA system, that if it needs to change, or 

evolve, that we are involved in that process. I imagine that, 10 years 

from now, when technology is advanced even more, and the way that 

they deliver healthcare and where they deliver it is all going to be 

changed. It will all be changing. So we have to be open to that type 

of change that might be needed. And, you know, you could, VA is in 

genomic medicine right now. You know, they are talking about that. 

That is pretty futuristic, or it used to be.

 So, I think the CARES plan is good for what it was intended to do. 

We supported the process, and now it is up to VA management to 

take it and put it into place.

Mr. Michaud. Thank you. To follow up on your question, you mentioned about the VA keeping its identity, which I think is extremely 

important. I hear that a lot from veterans in Maine. And when you 
50

look at the CARES process, particularly as it relates to rural areas, 

would either of you comment on, as far as a collaborative effort what 

your thoughts are. For instance, it might not be cost effective for 

the VA to build their own outreach clinic or CBOC in the rural area 

where they can work closely with a federally qualified healthcare 

clinic, or hospital. Do you care to comment on that? Do you think 

that is something acceptable for your organizations?

Ms. Wiblemo. Absolutely. I mean, rural healthcare is its own little 

bit problem, access to rural healthcare, access to quality healthcare. 

And, I mean, we recognize the necessity to contract out to ensure that 

veterans that live in, I’m from South Dakota, you know veterans that 

live in Aberdeen, or out there in the west, you know, they are hundreds of miles from a hospital. And, yeah, sure. I mean, you have 

to recognize that as something that is needed. So, we recognize that 

and sure we would support that.

Mr. Cullinan. Mr. Michaud, we agree with that assessment. There 

are certain areas, certain parts of the country where that is the only 

way to provide care. And we do not want veterans denied simply because they live in a rural or a remote area.

Ms. Wiblemo. Could I just add one other thing? The only thing that 

we have ever, as far as contracting out, the only thing that we have 

ever really said about that, that we do not want it used as a blanket 

option for the VA. I mean, they need to look at other avenues. But, 

certainly we understand the need to have to do that. And in the rural 

areas.

Mr. Michaud. Great. Thank you. My last question, and Chairman 

Buyer had alluded to it. When we went down to South Carolina, we 

saw the bulk of the problem, and the reason why there is a lot of concern among veterans, is the fact that there was not that communication, they were not kept in the loop, so to speak. And at that time, Dr. 

Perlin had agreed to make sure that they will be kept in the loop from 

here on out. Is that a common practice, that your organizations have 

seen? Or is it just a rare occurrence where on big projects, whether 

it is the collaboration in South Carolina, or Denver, or the CARES

process, where your organizations are not kept in the loop.

Mr. Cullinan. Communication is key. I would say with the big 

projects our people are brought into the process. The problem is, a lot 

of times it is just too complicated, it is too technical. I mean, unless 

a great deal of effort is expended to make it clear. I mean, they could 

be brought in, but they are not really understanding what is going 

on, and that is a problem. Of course, that is in part inherent with 

the problem of construction, it is a very technical area. But I think 

sometimes, it has been better of late. Some of our people have felt 

that they have been talked down to, but.

Ms. Wiblemo. With the Chicago CARES Phase 1, the VA really after that, because one of the biggest problems with that was there was 
51

no buy in from the stakeholders from the beginning and they did not 

even have a voice. So, at the time, when Secretary Principi brought 

the stakeholders in and ensured us a voice, we have not run into 

that. I was kind of really surprised when I got the e-mail from the 

Department in South Carolina that said this was going on. Although 

we knew that the collaboration effort had started, because we wrote 

about it in one of our task force reports, that they were looking at 

that. This was years ago, I mean, 2002, 2003, that they were looking 

at it, and that it was starting. But I was kind of surprised for him to 

call and not have been kept in the loop. So I do not think that it is a, 

I do not think it is usually a problem. I mean, I know at the national 

level, Dr. Perlin and his people, they give us lots of, I mean, we are 

usually overwhelmed with information from them. But, usually it is 

not a problem. And South Carolina was probably an anomaly. That 

was a huge study going on. And they did not know anything about it, 

so.

Mr. Michaud. Great. Thank you very much. Thank you, Mr. 

Chairman.

The Chairman. Mr. Cullinan, you opened your testimony, and you 

mentioned the word ``quality’’ with regard to the collaborative efforts, 

and it is one of the drivers. It was an idea that I had on how I can increase the quality of care, and save money. Now, how do you do that? 

Think about that. That is a challenge, right? And what I learned is 

that too often in this town, and maybe it is even human behavior, it 

is easy to say no. ``Oh, do not do that. This is how we always do it, 

this is what we do. Oh, nah.’’

 And sometimes, you know, in this town, we will expend 80 percent 

effort to stop something, and 20 percent to do something. This is an 

unusual town. But maybe there is some human behavior there.

 But what got exciting about this was in those, I told you, those nogo areas, you know, and you read that in the report. It is fascinating 

to put all of these great minds together and say, ``Okay, wow, let us 

explore this.’’ And down in Charleston when they testified and said 

that a paradigm had been broken, to think that right now you have 

the tomotherapy, the machine has been purchased, they are building 

the room around it, and two angiographic suites are also included in 

it. And these are things whereby Dr. Greenberg at MUSC, because 

of the population and economies of scale, they really could not afford to buy. And this is equipment not even located in South Carolina or North Carolina. So, when the VA went and said, ``Okay,” we 

are intrigued by this effort of collaboration. And our first effort of 

building the trust was that we will go together.’’ The VA is going to 

purchase this, they are going to begin to do this collaborative effort, 

figure out how to do the clinical services, and the legal part, and all 

the other sides of this one, the finances and everything. It is all going to be explored, really, through this. And when they do this, and 
52

the treatment of cancer, what have we done? We have just elevated 

the quality of care that is delivered in South Carolina, or even North 

Carolina. People will want to go to it. And so, now all you have to do 

is replicate that with some other things.

 But one of the things that is important in all of this, and it was important to us in negotiation of this, is priority. It is our machine, we 

are going to let you use the machine, we are going to get reimbursement for it. But our veterans have priority with regard to utilization. So that goes back to, I think, your testimony about identity, you 

know? And that is what we want to do. And I want to take the time 

to be open and honest here with you, and just let you know where I

am coming from, and where the Committee comes from. And strike 

me if I am wrong, but Mr. Michaud has been working very well with 

Mr. Brown, in how we proceed forward, and both of them have been 

working very well together to do this. And as a matter of fact, the 

only caution on this one is before we can even begin to digest it, Katrina hits, New Orleans, leverage, you know what I mean, and it is 

moving.

 And so, Mr. Michaud that is where I want to make sure that now 

that we have these two collaborative studies now going, the smartest 

man on the block is Mike Moreland. The guy that has really done 

them both, along with Mr. McClain. I mean, that is the guy that now 

has the institutional knowledge of both of these things. And, not that 

we want to keep a watchful eye, well, maybe that is the thing. We 

want to figure out, how do we do this in the next stage, and to blend 

these two going forward. In other words, I do not want to go, ``Okay, 

we started with Charleston, we are going to go to New Orleans, we 

are going to do New Orleans, and then maybe sometime later we will 

go back to Charleston.’’ See what I mean? Let us proceed forward.

 And that is why my last question to Dr. Perlin was so important. I

did not even know they had done that chart. I had asked them before 

about doing that, graphing it, giving us a time line so that we can 

know. That was the first time, I did not even know that they had 

already done it.

Mr. Cullinan. We certainly did not know about it, Mr. Chairman.

The Chairman. Well, I did not either. Maybe Mr. Michaud knew 

about that.

Mr. Cullinan. I would have to say that we really appreciate your 

keeping a watchful eye on this. Because collaborative efforts, we 

think, are a great idea where they work. But it is something that has 

to be watched, our big fear.

The Chairman. They do not work everywhere.

Mr. Cullinan. No, I know. But generally, some places they will 

work and where they work we support them strongly. You know, at 

one point we had the specter of the VA healthcare system becoming 

the federal healthcare system, which kind of smacks of something 
53

else a little bit, too. But we just do not want to see that happening. And where there are collaborations we want to be sure that they 

work. And that issue, when you said priority, that veterans remain 

the top priority.

The Chairman. And you know what, I think, we are just having an 

open conversation. What kind of makes some people nervous is that, 

I do not think they want to say, ``Okay, this one is number one, and 

this one is number two, and this one is number three.’’ You know, 

you are going to upset Orlando, or do you upset Las Vegas? No, no, we 

will put it all on paper, and we are all working on it, you know? So 

they really do not like to do the time line thing. But from our perspective, on the authorization, we want to know these time lines. I just 

wanted to share that with you.

Mr. Michaud, do you have anything else?

 I will end where I started. And that is, the big lift in front of us. We 

have not built a new facility in 15 years. The last facility was built, 

a behemoth down in Florida with many floors that were not even 

used for patients. It was built under an old system. And we provide 

healthcare much differently today. And so, when you look at the 

map of the United States, we want to continue our valued collaboration with medical universities. We have Las Vegas and Orlando, and 

the states are saying, ``We want to build medical universities.’’ So 

now, UNLV wants to bring the medical university in close proximity, 

to our facility, to what we are doing in Las Vegas. And we think it 

makes sense to put this Orlando facility next to Central Florida, just 

to let you know. I do not know what they are going to be saying, but 

where we have been sending them, this makes sense.

 And then we have, you have heard my comments on Denver, I have 

read your testimony on Denver. Maybe I have to get over this pit in 

my stomach, because it has already happened. The federal government gave it away, and now we need to figure out where we are going. 

But I just do not feel good about this one.

 We then are left with three others, Charleston, New Orleans, and 

Puerto Rico.

And the last thing I will say about the Puerto Rico that I find is 

interesting is that this private partnership and enhanced use lease 

with the construction of a hospital is worthy of analysis. Right now, 

we cannot do it. The law would not permit you to do something like 

that. But it is worthy of looking at it. How are we going to build six 

major facilities in a short period of time?

 So, I am willing to explore different alternatives, how we can do it, 

and do it in a manner whereby we increase the quality and the access. And we want to continue to work with you, okay?

Mr. Cullinan. Thank you very much.

Ms. Wiblemo. Thank you, Mr. Chairman.

The Chairman. All right. Thank you very much. This panel is 
54

excused. I ask unanimous consent that the statement on behalf of 

the Honorable Cliff Stearns be submitted into the record. Hearing 

no objections, it is so ordered. And I also order that all Members of 

the Committee may have five legislative days to submit statements 

for the record. Hearing no objections, it is ordered. The hearing is 

now concluded.

[No statement was submitted for Hon. Cliff Stearns.] 

 [The statement of Hon. Jeff Miller appears on p. 55]

[Whereupon, at 2:32 p.m., the Committee was adjourned.]

 
(55)

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