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H.R. 1720, H.R. 116, H.R. 2307, AND H.R. 2349

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

JUNE 11, 2003

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–17

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEVE BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

SILVESTRE REYES, Texas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON HEALTH 

ROB SIMMONS, Connecticut, Chairman 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

CLIFF STEARNS, Florida 

TIM MURPHY, Pennsylvania 

CIRO D. RODRIGUEZ, Texas 

BOB FILNER, California 

VIC SNYDER, Arkansas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TIM RYAN, Ohio 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

DARLENE HOOLEY, Oregon

(II) 
(III)

C O N T E N T S 

June 11, 2003

Page

H.R. 1720, H.R. 116, H.R. 2307, and H.R. 2349 ................................................... 1

OPENING STATEMENTS 

Chairman Simmons ................................................................................................. 1

Prepared statement of Chairman Simmons ................................................... 52

Hon. Ciro D. Rodriguez ........................................................................................... 5

Hon. Bob Beauprez .................................................................................................. 17

Prepared statement of Congressman Beauprez ............................................. 60

Hon. Vic Snyder ....................................................................................................... 19

Hon. Ted Strickland ................................................................................................ 21

Hon. Luis V. Gutierrez, prepared statement of ..................................................... 56

Hon. Lane Evans, ranking democratic member, full committee, prepared 

statement of .......................................................................................................... 58

Hon. Bob Beauprez, prepared statement of ........................................................... 60

WITNESSES 

Atizado, Adrian M., Associate National Legislative Director, Disabled American Veterans ........................................................................................................ 9

Prepared statement of Mr. Atizado ................................................................. 92

Blake, Carl, Associate Legislative Director, Paralyzed Veterans of America ..... 11

Prepared statement of Mr. Blake .................................................................... 97

Hayden, Paul A., Deputy Director, National Legislative Service, Veterans 

of Foreign Wars .................................................................................................... 13

Prepared statement of Mr. Hayden ................................................................ 103

Jones, Richard, National Legislative Director, AMVETS .................................... 8

Prepared statement of Mr. Jones .................................................................... 87

Roswell, Robert H., M.D., Under Secretary for Health, Department of Veterans Affairs; accompanied by D. Mark Catlett, Principal Deputy Assistant 

Secretary for Management; and Robert L. Neary, Jr., Associate Chief Facilities Management Officer for Service Delivery ................................................... 25

Prepared statement of Dr. Roswell ................................................................. 107

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

Rehabilitation Division, The American Legion .................................................. 7

Prepared statement of Ms. Wiblemo ............................................................... 80

MATERIAL SUBMITTED FOR THE RECORD 

Bills: 

H.R. 1720, a bill to authorize the Secretary of Veterans to carry out 

construction projects for the purpose of improving, renovating, establishing, and updating patient care facilities at Department of Veterans 

Affairs medical centers ................................................................................. 35

H.R. 116, a bill to authorize the Secretary of Veterans Affairs to construct, lease, or modify major medical facilities at the site of the former 

Fitzsimons Army Medical Center, Aurora, Colorado ................................. 42

H.R. 2307, a bill to provide the establishment of new Department of 

Veterans Affairs medical facilities for veterans in the area of Columbus, 

Ohio, and in south Texas ............................................................................. 46

H.R. 2349, a bill to authorize certain major medical facility projects 

for the Department of Veterans Affairs ...................................................... 48
Page

IV

Charts: 

‘‘Construction Funding Deficit Reaches $6.1 Bill,’’ submitted by Department of Veterans Affairs .............................................................................. 3

‘‘Annual VA Construction Funding Is Insufficient to Maintain Infrastructure,’’ submitted by Department of Veterans Affairs ................................. 4

Statements: 

Hon. David Hobson, a Representative in Congress from the State of 

Ohio ................................................................................................................ 62

Hon. Joel Hefley, a Representative in Congress from the State of Colorado, with attachments ................................................................................. 64

Hon. Solomon P. Ortiz, a Representative in Congress from the State 

of Texas .......................................................................................................... 77

Hon. Deborah Pryce, a Representative in Congress from the State of 

Ohio ................................................................................................................ 78
(1)

H.R. 1720, H.R. 116, H.R. 2307, AND H.R. 2349

WEDNESDAY, JUNE 11, 2003

U.S. HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC 

The committee met, pursuant to notice, at 2:02 p.m., in room 

334, Cannon House Office Building, Hon. Rob Simmons (chairman 

of the subcommittee) presiding. 

Present: Representatives Simmons, Beauprez, Rodriguez, Snyder, 

Strickland, Berkley, Boozman, and Brown-Waite. 

OPENING STATEMENT OF CHAIRMAN SIMMONS 

Mr. SIMMONS. The subcommittee will come to order. If somebody 

could secure the door. I welcome everybody this afternoon. 

And before we move on, without objection, I’d like to enter into 

the record several statements, one from Congressman David Hobson of Ohio; also, Congressman Joel Hefley of Colorado; Congressman Solomon Ortiz of Texas; Congresswoman Deborah Pryce of 

Ohio; and Congressman Lane Evans, our Ranking Member of the 

committee. Without objection, those statements will be entered into 

the record. 

[The prepared statement of Congressman Evans appears on p. 

58.] 

[The prepared statement of Congressman Hobson appears on p. 

62.] 

[The prepared statement of Congressman Hefley appears on p. 

64.] 

[The prepared statement of Congressman Ortiz appears on p. 

77.] 

[The prepared statement of Congresswoman Pryce appears on p. 

78.] 

Mr. SIMMONS. The purpose of today’s legislative hearing is to authorize the Secretary of Veterans’ Affairs to carry out several major 

construction projects to improve, renovate, and update patient care 

facilities at various VA medical centers. We will be discussing four 

bills. And the bill summaries are in the members’ packets. It would 

be H.R. 1720, H.R. 116, H.R. 2349, and H.R. 2307. And I would ask 

the members that they refer to their packages for those summaries. 

I think we all know that the physical infrastructure of the VA 

health care system is one of the largest in the U.S. Government, 

if not the largest, with over 4700 buildings and thousands and 

thousands of acres of property. These buildings, many of which 

were built 50 years ago or more, are now substandard. And the se-
2

verity of this problem extends to those buildings in earthquake 

zones that we are afraid are in danger of collapsing. And this has 

actually happened. I believe out in California, we had a couple of 

collapses. So this is a serious matter. 

I think it’s painfully clear that VA’s investment in health care facilities infrastructure has not been satisfactory in recent years. And 

while many members of this committee support the concept of the 

VA CARES system, or Capital Asset Realignment for Enhancement 

Services system, there are concerns that the continued extension of 

the deadline of the CARES system is creating present for those facilities that I think many of us can agree need the investment and 

need the investment now. 

Some of the bills before us address specific properties. One of the 

bills before us addresses a general authority to the Secretary of 

Veterans Affairs to authorize him to make decisions and move forward on some of these projects. 

In particular, I note for the record that the West Haven VA medical facility in my state is a magnificent edifice from a distance as 

one drives by I–95. The sign is on the top. It stands on a prominent 

hill. And it’s very impressive. But when you get inside, lo and behold, the cracks, the peeling paint, the difficulties of cluttered, 

dingy, and some would even say seedy spaces, beg the argument 

that we need to do something about that facility. 

And consider this. They are a primary affiliate with Yale Medical 

School, one of the premiere medical schools in America. And so I 

think it’s important that we address these issues, not just in my 

district or in my state, but elsewhere across the country. 

If you refer to the charts that are set up on the side of the chamber, you will notice one chart that says, ‘‘Construction Funding Deficit Reaches 6.1 Billion.’’ And the green on the chart indicates the 

actual major and minor construction funding from FY ’97 through ’03. The orange reflects additional funding to reach a 4 percent of 

plant replacement value. That additional funding has not been 

there. 

A different way of looking at it is on the second chart that has 

two columns—one in green and one in red—which shows that the 

actual major and minor construction funding has gone down, and 

that the funding needed reflected by the orange towers behind 

those green bar graphs. So this is a visual illustration of the problem. 

(The provided material follows:)
3
4
5

Mr. SIMMONS. We have quite a bit of ground to cover. I know my 

colleagues are busy. We had some delayed votes today. I understand eight colleagues were caught in an elevator in the Rayburn 

Building. They had a chance to get together and get to know each 

other very well. A little bit of bonding, but it did delay the day. So 

we will move forward. 

And with that, I will recognize my colleague, the distinguished 

Congressman from Texas, Mr. Rodriguez. 

[The prepared statement of Chairman Simmons appears on p. 

52.] 

OPENING STATEMENT OF HON. CIRO D. RODRIGUEZ 

Mr. RODRIGUEZ. Thank you very much, Mr. Chairman. And I 

want to thank you for holding this particular meeting. I think it’s 

important. And I know that in the area of construction projects, we 

all have in our back yards, as well as throughout the country, sites 

that are in great need. 

It’s not an overstatement to say that the VA’s major medical construction program has been virtually dead in the last few years. We 

all know that regardless of what will happen with current or future 

planning activities, many of the VA facilities will be operating long 

into the future. 

Tragically, many of the VA medical centers are well past their 

prime. The average facility, as indicated, was over 50 years old. 

And I don’t have to tell you, that’s a little bit prior to the microwave. So in terms of just electrical, you know, they’re having some 

problems. 

The health care delivery has changed drastically since many VA 

facilities were built, and the infrastructure no longer corresponds 

to the way services are provided. Worse, in far too many cases, facilities are unsafe to occupy. 

We have a number of worthy projects that we are to consider 

today. One of the bills I’m co-sponsoring would fund a new health 

care delivery site in south Texas. And I have heard from many 

Texas veterans that have had to travel outrageous distances to obtain health care. And in some cases, it’s close to 300 miles to go 

to San Antonio in order to get access to health care. 

I know that in many other districts, there are many, you know, 

that also have to—you know, 4 hours, for example, from McAllen 

to San Antonio district, which is Congressman Ruben Hinojosa’s 

area. There’s a great need to expand that particular clinic there, 

and the services that are provided there. 

In the Valley and the Coastal Bend area of Texas, the VA is 

meeting its access standard for acute hospital care for fewer than 

3 percent enrollees. I want you to listen up on that. There’s no 

other market in the entire country where we’re so miserably failing 

our veterans, nowhere else than in south Texas, with those figures. 

Truly, something has to be done. 

I know that the Evans bill has a number of important initiatives. 

The VA must keep the faith with the Chicago veterans and build 

a new west side bed tower there. 

The Las Vegas area veterans desperately need a new ambulatory 

care center to replace its existing facility, which has been independently deemed unsafe for continued occupancy. 
6

San Diego is one of the VA’s highest risk seismic projects. And 

there’s many more. 

With all these, let me indicate that I was very pleased to see that 

Congressman Ortiz has also submitted a letter. Because the area 

that I was mentioning is serviced by both Congressman Ruben 

Hinojosa, Congressman Ortiz. And I have a portion of it, but the 

majority is under the other two congressmen. And, you know, there 

are a good number of—when you look at all the counties involved 

in those regions, the closest one is 150 miles to the nearest one, 

which is Nueces County, which is Corpus, which that county by 

itself has over 32,000 veterans. Hidalgo County has 25,000 veterans. Cameron County has close to 20,000 veterans. And there are 

some other surrounding counties around there. And so you see the 

number that are there. 

So I want to thank you for holding this hearing, and hopefully, 

we’ll be able to move forward and make something happen. 

Thank you, Mr. Chairman. 

Mr. SIMMONS. I thank the gentleman. 

Our first panel consists of several representatives from veterans’

service organizations, and I would ask them to come forward at 

this time. 

Some may recall that at our last hearing, we heard from the VA 

and other witnesses. But time ran out, and our veterans service organization representatives very kindly agreed to submit testimony 

and avoid having us to come back after a 45-minute round of votes. 

And as a matter of courtesy to the VSOs for all the work they do, 

we decided to put them up front this morning. I hope Dr. Roswell 

and others will accept that explanation. 

We have before us today, and we welcome, Cathleen Wiblemo, 

who’s Deputy Director, Health Care, Veterans Affairs and Rehab 

Division, the American Legion. Welcome. Mr. Richard Jones, National Legislative Director of AMVETS. Mr. Adrian Atizado, Associate National Legislative Director, Disabled American Veterans. 

We have Mr. Carl Blake, Associate Legislative Director, Paralyzed 

Veterans of America. And we have Paul Hayden, Deputy Director, 

National Legislative Service of the Veterans of Foreign Wars. 

Gentlemen, we have your statements—lady and gentlemen, we 

have your statements, and we suggest you summarize, give us 

some highlights. We will listen to all of you, and then have questions from our members. Please proceed. 

Ms. Wiblemo. 
7

STATEMENTS OF CATHLEEN C. WIBLEMO, DEPUTY DIRECTOR, 

HEALTH CARE, VETERANS AFFAIRS AND REHABILITATION 

DIVISION, THE AMERICAN LEGION; RICHARD JONES, NATIONAL LEGISLATIVE DIRECTOR, AMVETS; ADRIAN M. 

ATIZADO, ASSOCIATE NATIONAL LEGISLATIVE DIRECTOR, 

DISABLED AMERICAN VETERANS; CARL BLAKE, ASSOCIATE 

LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA; AND PAUL A. HAYDEN, DEPUTY DIRECTOR, NATIONAL 

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS 

STATEMENT OF CATHLEEN C. WIBLEMO 

Ms. WIBLEMO. It is a pleasure to be here today, and thank you, 

Mr. Chairman, for inviting the American Legion to present its 

views on these very important bills 

For many years, VA’s construction budget has virtually been ignored with regard to the funding needed to insure safety—in particular, seismic issues—modernization, and renovating of VA’s 

enormous infrastructure. With the implementation of the Capital 

Asset Realignment for Enhanced Services, or CARES, initiative in 

fiscal year 2000, construction has nearly come to a standstill. Many 

needed construction projects have gone unfunded due to this stagnation. 

For close to 3 years, VA has been assessing their infrastructure 

and health care need and demands into the years 2012 and 2022. 

Recently, the Veterans Integrated Services Network’s market plans 

were submitted to the Under Secretary for Health. Through the 

CARES process, hundreds of construction projects have been identified. It is not clear yet how they will be prioritized. The projects 

represented in these bills are but a drop in the bucket when you 

consider the staggering scope and magnitude of the CARES initiative. 

Although cognizant of the system-wide overhaul that may indeed 

result from the CARES initiative, the American Legion recognizes 

the specific facilities that require immediate attention, as well as 

the under-served areas in need of VA medical centers. The legislation being considered today is a welcomed relief. 

With regard to H.R. 116, the Veterans New Fitzsimmons Health 

Care Facilities Act of 2003, the American Legion is pleased to support this legislation. The VA medical center in Denver is operating 

out of a 50-year-old building with lead paint issues, among other 

system shortfalls. This move would help facilitate sharing with the 

Department of Defense and continue the affiliation with the university, an affiliation that has proven to be very valuable to VA, 

and in turn, to the veterans in the local community. Ultimately, a 

new state-of-the-art building will positively impact the quality of 

veterans’ care. 

With respect to H.R. 1720, the Veterans Health Care Facilities 

Capital Improvement Act, this legislation offers immediate remedies for VA’s critical construction needs, with a great deal of flexibility to allow the Secretary to target funding throughout the entire 

VA health care system. The American Legion is concerned that the 

local interests of the veterans’ community may not be reflected in 

the decision-making process within the administration when targeting funds for specific facilities that may be in more need of im-
8

mediate attention than others. Every effort must be made to insure 

that the true needs of the stakeholders are taken into consideration 

before projects are approved. 

H.R. 2349 authorizes certain major medical facility projects for 

the Department of Veterans Affairs, specifically at Chicago; San 

Diego; Clarke County, Nevada; and West Haven, Connecticut. The 

American Legion recognizes the fact that all of these facilities need 

immediate attention. 

The American Legion National Commander, Ron Conley, has visited over 50 VA medical facilities this year. At each facility, he encounters firsthand the challenges faced by VA administrators, and 

the problems they must overcome in order to provide timely access 

to quality health care. These four facilities are no different. The 

American Legion applauds Ranking Democratic Member Lane 

Evans for introducing this important legislation. 

I would like to add that Commander Conley’s findings are being 

compiled in a final report on the current status of VA health care. 

With the cooperation of Chairman Smith, Commander Conley will 

be delivering this report to joint session in July. 

H.R. 2307 provides for the establishment of new Department of 

Veterans Affairs medical facilities for veterans in the area of Columbus, OH, and in south Texas. Columbus, OH, is the largest city 

in the State of Ohio, and it is the largest city in the country without a VA medical center. Veterans in central Ohio have to travel 

an hour-and-a-half for surgeries, with Chillicothe being the closest 

VA medical center. 

In south Texas, veterans face the same problem. The population 

is currently under-served and has been for several years. There is 

a great need there also to correct that problem. 

Veterans in Columbus and south Texas will be better served 

through the enactment of H.R. 2307. The American Legion fully 

supports this bill. 

Mr. Chairman, the legislation before us today is a solid step in 

the right direction to address the immediate construction needs of 

the VA’s health care facilities. The American Legion commends you 

and the members of this distinguished subcommittee for the work 

that you have done and continue to do for the nation’s veterans and 

their families. 

That concludes my statement. I would be happy to answer any 

questions you or the subcommittee may have. 

[The prepared statement of Ms. Wiblemo appears on p. 80.] 

Mr. SIMMONS. I thank you for the statement. I think if the members accommodate me, we’d like to go through each of the five of 

you, and then ask our questions then. So Mr. Jones. 

STATEMENT OF RICHARD JONES 

Mr. JONES. Chairman Simmons, Ranking Member Rodriguez, 

members of the subcommittee, on behalf of National Commander 

W.G. ‘‘Bill’’ Kilgore and the nationwide membership of AMVETS, I 

thank you for this opportunity to present testimony on the bills before the panel. 

AMVETS strongly supports the legislation subject to this hearing. With many VA centers in critical need of repair, improvements 
9

to these facilities are essential to meet the health care needs of 

veterans. 

For several years, VA’s construction appropriation for major and 

minor projects has been in sharp decline. Coincident with declining 

levels of construction is the ongoing project of CARES, which continues to cause a great deal of foot-dragging on most of the construction projects authorized in the past by this subcommittee, and 

yet still needed by our veterans. 

At least to the eye of most observers, the CARES project seems 

to be the impediment to proper care of veterans. The unfortunate 

situation we face forces VA to endure major unmet needs throughout the system. The condition of our VA facilities is not only an infrastructure problem, but a patient and staff problem as well. Our 

veterans have earned their health care benefits through their sacrifice and service. 

When veterans use a VA facility, they should be assured that the 

facilities available to them not only have the equipment needed for 

their care, but are in safe condition for themselves and those who 

care for them. 

AMVETS has been supportive of the CARES process. However, 

we believe the efforts of the CARES process must remain separate 

from the urgent needs of the VA infrastructure and facilities. 

CARES is for tomorrow. But these facilities and the staff and patients they house need help today. Clearly, more resources are 

needed to be devoted to our medical care, and construction should 

not lag behind the need for medical care. 

With these concerns in mind, AMVETS is encouraged to see that 

H.R. 1720 would authorize appropriations of $500 million for major 

VA construction for the next fiscal year, and further increase that 

level by an additional hundred million over the next 2 fiscal years. 

AMVETS would also recommend increasing the limit for individual minor construction projects from the current level of $4 million to $10 million. By increasing this cap, we would enable VA to 

better address facility improvements. 

Mr. Chairman, AMVETS applauds the subcommittee’s efforts to 

authorize the needed resources to allow VA to maintain and modernize the over 2,000 buildings in its health care portfolio. 

Thank you again for the opportunity to present our testimony. 

We sincerely appreciate your vigilance and your care for the nation’s veterans. Thank you. 

[The prepared statement of Mr. Jones appears on p. 87.] 

Mr. SIMMONS. I thank you for your comments, Mr. Jones. Mr. 

Atizado. 

STATEMENT OF ADRIAN M. ATIZADO 

Mr. ATIZADO. Good afternoon, Mr. Chairman, members of the 

subcommittee. I am pleased to express DAV’s views on the four 

pieces of legislation which address infrastructure needs of the Department of Veterans Affairs. These bills recognize that for more 

than a decade, the VA has not been provided with adequate appropriated funds for its major and minor construction projects. Although DAV has no resolutions concerning these bills, we have addressed these issues in the independent budget. Therefore, we do 
10

not have objections to the favorable consideration of these bills by 

the subcommittee. 

H.R. 1720, the Veterans Health Care Facilities Capital Improvement Act, strikes directly at the matter before us. Many VA facilities need funds right now on an emergency basis for major and repair projects as well. Other facilities have more chronic needs for 

restoration and capital improvements that have lingered unfunded 

for years. While this bill authorizes $1.8 billion over 3 years, the Independent Budget recommends for fiscal year 2004 alone that Congress appropriate $926 million for major and minor construction. 

That is just over half for fiscal year 2004 alone. 

H.R. 2349 provides for seismic corrections of Building 1 of the 

San Diego VA medical center. Now, this building is classified as exceptionally high risk, and such constructions would mitigate life 

safety hazards and allow for continued operation, even after a seismic event. The bill would also provide for new construction projects 

for a multi-specialty outpatient clinic in Las Vegas, Nevada, and a 

bed tower to be consolidated with the West Side VA medical center 

in Chicago, Illinois. Such projects would accommodate the loss of 

a VA medical facility in both areas and preserve the full continuum 

of high-quality VA medical care. 

H.R. 116 would allow the Secretary of Veterans Affairs to carry 

out major medical facility projects at the former Fitzsimmons Army 

Medical Center in Aurora, Colorado. 

Now, DAV recognizes the need for a modern health care facility 

in the Denver area, and the value and importance of maintaining 

relationships with medical affiliates. However, we have serious concerns about an integrated inpatient facility with joint governance 

and management. 

So whatever options are approved for the Denver area, we believe VA should maintain a strong presence in this by keeping a 

separate identity with direct line authority in all areas involving 

care of veteran patients. This will allow VA to fulfill its primary 

health care mission to serve the needs of America’s veterans by 

providing primary care, specialized care, and related medical and 

social support services. 

H.R. 2307 would provide for medical construction projects in 

south Texas and on available federal land at the Defense Supply 

Center in Columbus, OH. We do note that the CARES process has 

recognized substantial needs for these facilities at these particular 

areas. 

The DAV, along with Independent Budget veterans service organizations, supports the CARES process. However, CARES has an 

continues to be a major contributing factor to VA’s diminutive annual budget for major medical construction projects. 

Deferrals of funds for needed construction projects were intended 

to permit CARES to proceed in an orderly way, avoiding unnecessary spending on health care facilities that might not be needed by 

veterans in the future, yet these deferrals negate the interim infrastructure needs. It has resulted in adverse effects on health care 

quality and capacity, as well as the loss of capital assets value. 

If construction funding continues to be inadequate, it will become 

increasingly difficult for VA to provide high-quality services, espe-
11

cially in old, inefficient, and unsafe patient-care settings. Clearly, 

more must be done through the regular appropriations process in 

the annual budget for VA construction. 

Mr. Chairman, we look forward to working with the members of 

this subcommittee and the full committee to obtain funding necessary to restore and maintain a viable modern world class health 

care system. 

This concludes my statement, Mr. Chairman. Thank you. And I’d 

be happy to answer any questions you may have. 

[The prepared statement of Mr. Atizado appears on p. 92.] 

Mr. SIMMONS. I thank you for that statement. Mr. Blake. 

STATEMENT OF CARL BLAKE 

Mr. BLAKE. Chairman Simmons, Ranking Member Rodriguez, 

members of the subcommittee, PVA would like to thank you for the 

opportunity to testify today on the proposed construction legislation. 

PVA strongly supports H.R. 1720, the Veterans Health Care Facilities Capital Improvement Act, introduced by you, the Chairman. 

PVA has been a leading advocate for similar measures in the past, 

because the Department of Veterans Affairs is indeed facing a 

crisis. 

Last Congress, PVA enthusiastically supported a similar measure, and many of our concerns remain the same. We previously testified that according to a Price Waterhouse study conducted in 

1998, the VA should be spending between 700 million and $1.4 billion annually, as well as similar amount for non-recurring maintenance. 

This year, the Independent Budget called for major construction 

appropriation of $436 million, as well as 400 million for CARES advanced planning and design initiatives. We are pleased that H.R. 

1720 authorizes $500 million in FY 2004 for the major construction 

projects identified in Section 2 of this legislation. 

PVA also applauds the subcommittee for its explicit recognition 

of the importance of spinal cord injury centers and specialized service programs within the scope of the Veterans Health Care Facilities Capital Improvement Act. We are pleased to see that improved 

accommodation for persons with disabilities, including barrier-free 

access, is a goal of this bill. 

PVA wants to state unequivocally that these much-needed construction funds must not come at the expense of or out of the medical care budget line item that provides direct health care service 

to our veterans. 

The VA medical system is facing a crisis brought about by inadequate funding, a crisis that has led to health care rationing and 

shocking waiting times faced by all veterans across this nation. The 

solution to this crisis lies in providing the funding required by VA 

health care in the medical care account. The crisis facing VA infrastructure, likewise, will be solved by providing the necessary additional resources in the construction line item. 

PVA has concerns regarding H.R. 116, the Veterans’ New Fitzsimmons Health Care Facilities Act of 2003. PVA stands committed 

to finding workable solutions for the delivery of veterans health 
12

care in the Denver area, and we’ve worked tirelessly toward this 

end. 

PVA understands that constructing a new, freestanding VA medical center at the Fitzsimmons site is no longer feasible due to 

space limitations at the site and cost concerns. We are adamantly 

opposed to any option that would essentially integrate Denver VA 

medical patients into the patient population of the University of 

Colorado Hospital. We are open to the many collaborative opportunities between the two entities, but integrating veteran patients in 

this manner would fundamentally change the way VA provides 

care. 

We believe that an option involving the VA leasing within a new 

facility could be a viable one, as long as many essential elements 

are included within such a plan. We also believe that a new spinal 

cord injury center is needed in the Denver area, and that this center should move forward, along with any decisions concerning 

Fitzsimmons. 

Any new SCI center must be operated, as all current centers are, 

with dedicated services and staff. The development of a new SCI 

center must follow the requirements of the Memorandum of Understanding between VA and PVA allowing for architectural review, 

must operate in compliance with all existing VA policies and procedures, and must continue the relationship between VA and PVA, 

allowing for site visits of SCI center facilities. 

PVA stands ready to work with the subcommittee to insure that 

veterans in Colorado are accorded the very best VA health care. 

PVA supports H.R. 2349. One of our gravest concerns over the 

CARES process was that this initiative would be used as an excuse 

to shutter VA facilities, rather than to enhance the health care provided to veterans and move the VA health care system into the 

21st century. We have increasing concerns as the CARES process 

unfolds that it will be easier for CARES planners to close facilities 

than it will be for them to actually produce the resources to make 

needed enhancement at other facilities at the same time. For this 

reason, we applaud the provision in H.R. 2349 which prohibits the 

disposal of the Lakeside Division medical facility in Chicago, Illinois, before the VA has entered into a contract to construct a new 

bed tower at the West Side medical center. 

Likewise, we support construction or facility authorization measures, such as H.R. 2307, if these measures address demonstrated 

needs. We have consistently stressed that necessary construction 

must proceed regardless of the CARES process. Veterans still seek 

health care, and these services must be provided. 

Likewise, the Independent Budget has stressed the importance of 

preserving VA’s historic structures, and the fact that the CARES 

process is ill-equipped to address this vital concern. The Independent Budget calls for the development of a comprehensive national program on historic properties and the provision of adequate 

funding for this important preservation work. 

In closing, the final outcome and the effective results of the 

CARES process remains to be seen. But this is no excuse to not 

provide vital construction and maintenance dollars, nor should it 

serve as an excuse to close hospitals without providing the enhanced services that are a key component of the CARES acronym. 
13

I’d like to thank you for the opportunity to testify today, Mr. 

Chairman, and I’d be happy to answer any questions you might 

have. 

[The prepared statement of Mr. Blake appears on p. 97.] 

Mr. SIMMONS. Well, thank you for that testimony. Mr. Hayden. 

STATEMENT OF PAUL A. HAYDEN 

Mr. HAYDEN. Mr. Chairman, members of the subcommittee, on 

behalf of the 2.6 million men and women of the Veterans of Foreign 

Wars of the United States and our Ladies Auxiliary, I would like 

to extend our appreciation for being included in today’s important 

hearing on these bills related to VA construction projects. 

While we, as well as this subcommittee, appropriately focus the 

majority of our attention on medical care, it is essential that we 

place an emphasis on VA’s decaying physical assets. 

VA has one of the largest building inventories in the Federal 

Government, nearly 5,000 buildings. Not only does the sheer size 

of the system create difficulties, age does too. Although many new 

facilities have been built in recent years, the average age of VA 

buildings is over 50 years old, and growing older each day. Despite 

recent increases, the amount of money appropriated for major construction is significantly lower than it was even 10 years ago, as 

the committee’s charts clearly show. 

It’s essential for VA to build, renovate, and maintain health care 

facilities that are able to provide quality health care without sacrificing patient and worker safety and convenience, so VA can continue to take care of our nation’s veterans long into the future. 

Therefore, the VFW is pleased to strongly support H.R. 1720, the 

Veterans Health Care Facilities Capital Improvement Act. We feel 

this legislation would be a great benefit to veterans, as it would 

significantly enhance VA’s ability to carry out major construction 

projects. 

First, it would improve VA’s ability to respond to its immediate 

needs by authorizing major construction projects. Second, it would 

provide VA with greater flexibility in choosing projects, resulting in 

timely repair of urgent priorities. Finally, and most importantly, it 

would authorize $500 million in appropriations for fiscal year 2004 

for major construction. 

Turning to H.R. 116, we are generally supportive of this legislation, as it would result in a new medical facility for Denver-area 

veterans. However, we do have some reservations. First, would veterans remain a priority? VA must have proper representation on 

the governing board of the complex, which would be constructed in 

cooperation with the University of Colorado. Without proper representation, we cannot be assured that veterans would receive the 

priority access and care they are entitled to. 

Second, how responsive could VA be to veterans’ needs, given a 

less-than-complete share of authority on that governing board? VA 

must be able to adapt to any changes in the veteran population, 

in technology, in health care, and business practices to remain able 

to effectively treat veterans. Without proper control and representation, the partnership may compromise this ability. 

If we can receive assurances in the answers to these questions, 

we will be pleased to support the legislation more strongly. We 
14

must be convinced, however, that the partnership will not erode 

VA’s ability to provide timely, accessible, high-quality care to Denver veterans. 

Finally, the VFW supports both H.R. 2349 and H.R. 2307. These 

bills authorize major construction projects at sites around the country to construct and repair inpatient and outpatient facilities, as 

well as to improve safety. 

In closing, we continue to believe that VA should not delay major 

construction projects if there is already a demonstrated need, yet 

that is exactly what the CARES process is preventing. While supportive of the CARES concept, the process has taken 3 years already. And just this past week in a memorandum dated June 4, VA 

Under Secretary for Health, Dr. Robert Roswell, stated that the 

process will be delayed again as they aim to gather more information. 

As we and other veterans organizations stated in the Independent Budget, while VA planning has ignored its current construction responsibilities and focused exclusively on the CARES 

promise of guidance, the perfect has become the enemy of the good. 

Mr. Chairman, this concludes my testimony. I would be pleased 

to answer any questions that you or members of the subcommittee 

may have. 

[The prepared statement of Mr. Hayden appears on p. 103.] 

Mr. SIMMONS. Thank you very much. Thank you all for your testimony. I have a couple of questions, and then we will go back and 

forth, as is our custom. 

For Mr. Jones, on page 3 of your testimony, you make reference 

to the Independent Budget and a recommendation to move the authority of the Secretary to approve minor construction projects from 

4 million to 10 million. As I recall, in the last cycle, we played with 

that number and got it as high as 8 million, but never got anything 

out of the pipeline. 

Do you recommend, for example, that in one of the bills before 

you, or even in a separate bill, that we include that threshold to 

give the Secretary that flexibility? Is that the recommendation of 

your organization? 

Mr. JONES. That is our recommendation, Mr. Chairman. What 

you attempted last year is still appropriate. The conditions remain 

the same. We do think, however, that $10 million might be a better 

level. Many of the facilities could stand some real improvements in 

these areas, and they simply can’t move forward under the current 

cap. 

Mr. SIMMONS. And so that might be considered as a markup 

item, let’s say, for H.R. 1720. 

Mr. JONES. Yes, sir. That would be an excellent place for it. 

Mr. SIMMONS. Does anyone else have a comment they would like 

to make on that subject? 

[No response.] 

Mr. SIMMONS. Hearing none, I have a second question with regard to the American Legion, Ms. Wiblemo. You expressed concern 

that with regard to H.R. 1720, the local interests of veterans’ community might be ignored in the process. Obviously, what that legislation is designed to do is give the Secretary substantial authority 

to break the log jam, if you will, on some of these projects. And it’s 
15

been crafted with an independent review by a board to either endorse or perhaps advise the Secretary. 

It seems to me that that provides some counterbalance there. 

But how would you recommend we incorporate the local inputs to 

that type of a system? 

Ms. WIBLEMO. As I stated in the testimony, the concern is that 

the veterans’ opinion or their needs will be overlooked for other 

reasons. The counterbalance of the board and the independent review is a good one. I mean, we definitely support that. 

We are just concerned that veterans aren’t always heard, and we 

would be suspect of any process that would have a tendency to 

overlook that. I don’t have any specific recommendations right now. 

I’d have to go back and look through that. 

Mr. SIMMONS. Thank you very much. One final question. I believe in the past, the PVA has testified with regard to their concern 

for historical preservation. And obviously, there’s good news and 

bad news in the veterans system. The good news is that we have 

some wonderful historic buildings out there. The bad news is that 

we have some wonderful historic buildings out there. And the challenge for us is how do we preserve and protect that history, but 

also provide our veterans with state-of-the-art health care. 

Expanding on that a little bit, hospice care, long-term care, certain types of residential environments are activities that the VA 

might logically be involved in. And maybe some of these older 

buildings would convert to that purpose, and scarce dollars could 

then be applied to newer facilities for top-of-the-line medical. 

Would you like to—Mr. Blake in particular, would you like to develop that concept? Is that something that your organization has 

a specific interest in? 

Mr. BLAKE. Mr. Chairman, we’d be happy to work with the subcommittee and the VA on that. Historic preservation has always remained a priority to us, along with, obviously, the spinal cord injury centers. And we recognize the fact that the VA infrastructure 

is aging rapidly. I believe last year in the Independent Budget, VA 

buildings had an average age of like 73 years, or somewhere in 

that range. And so just about every VA building, it seems, would 

qualify for historic preservation at this point, based on that 

number. 

But we don’t want to sacrifice those buildings at the cost of new 

construction. And I know yesterday, there was some discussion in 

the hearing about the cost to renovate many of these older buildings versus new construction would be greater, but we still don’t 

see it as—the means should not be to—or we should not eliminate 

these historic buildings for that end goal. If there is a use out of 

these buildings, we would like to explore it as much as possible. 

Mr. SIMMONS. I thank you for that comment. My father happened to be an architect for 65 years of his life, and he always said 

it’s more expensive to renovate an existing building than to build 

a new one. But if the renovated purpose is somewhat different, not 

top-of-the-line, lower tech, and his specialty was building hospitals, 

then you could preserve the historic building into an alternative 

use, and again apply your dollars to building new facilities to provide high-line or top-of-the-line medical care. 

So I thank you for that comment. 
16

Mr. Rodriguez. 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. I want to thank you 

all for being here. 

Let me—I guess a question to all of you, and then one to Mr. 

Blake. Because I know you mentioned that Price Waterhouse report. And what was the percentage of infrastructure that you felt 

that you came up with a 700 million figure? 

Mr. BLAKE. The number from the study said that the dollars 

spent that the VA should be spending annually on construction 

projects should range from I believe it was 700 million to $1.4 billion dollars. I don’t actually have the study, but I can certainly go 

back to the office and get all the information we have on that 

study, and I’d be happy to provide it to your office. 

Mr. RODRIGUEZ. And what percentage was that? Because I noticed the one we have up there is 4 percent for just the maintenance cost up there on this handout. 

Mr. BLAKE. That follows with what the charts were showing 

here. 

Mr. RODRIGUEZ. Okay. The same? 

Mr. BLAKE. Yes. 

Mr. RODRIGUEZ. Okay. And the other comment was my understanding was that most of the VA organizations were supportive of 

CARES initially, and now with what’s happening, I guess what 

happened in Chicago and the fact that—I’m wondering, you know, 

how you might feel about that now and the need to move forward, 

you know. And I’ll just get anybody’s reaction to that. 

Mr. JONES. AMVETS continues its support of CARES. We think 

it’s an appropriate process. It needs to be done. We need to look 

to the future. We do, however, find it very difficult to put some of 

the pieces of this puzzle together. As we look to the future and at 

some of the facilities that do not fit into that vision, we’re concerned about how we pay for the construction of those facilities 

that the CARES process finds are needed. 

It’s an age-old problem trying to get the Appropriations Committee to lever out some dollars for construction. It’s always easier 

to reduce funding for a facility that’s no longer needed, found to be 

obsolete. But we still have that problem at the other end of 

CARES. As Carl explained from PVA, it’s the E factor, isn’t it, 

Carl? 

Mr. BLAKE. That’s correct. 

Mr. RODRIGUEZ. Anyone else on that? 

Mr. BLAKE. I would say from PVA’s perspective, we’ve always 

been supportive of CARES. It’s underlying concept, you can’t help 

but support. 

The problem we’ve had with the CARES process is that there’s 

basically been a moratorium on all construction projects as a result 

of CARES. Everything has been—for the last few years, it’s been 

a discussion of ‘‘Well, let’s wait and see what the CARES process 

says or they come up with before we decide what to do in the realm 

of construction.’’ And in the meantime, we end up in a situation 

where we were talking about where we end up with buildings that 

are reaching a historic age because no construction is being done 

to renovate them. 
17

And the other problem we’ve had with the CARES process—like 

I said, we continue to support it—we also had a problem with the 

fact that long-term care was not given enough—or was not looked 

at in the CARES planning, I should say. 

Mr. RODRIGUEZ. How do you think we ought to handle—because 

I know I have a problem in south Texas in terms of not having access, period. We don’t have the old facilities. We never had them. 

So how do you—and I had that problem also with nursing home 

care, because this same committee here decided to fund—go with 

the recommendation of the existing groups to build construction of 

the old facilities when we were trying to get new ones. So how do 

you strike a balance there? 

Mr. ATIZADO. Well, sir, the need in south Texas, I’m sure you’re 

well aware veterans take about a 5- or 6-hour drive in DAV vans 

out of south Texas to seek medical care. The CARES process did 

identify that need. But as it’s been mentioned here, the CARES 

process has identified many areas that have many needs. 

And as I testified earlier, it’s not so much that we don’t believe 

the CARES process, that it will come out with enhanced services 

part, but that bills such as these that is on the agenda today will 

cause construction to come out of line. 

And the CARES process is a nationwide process. I understand 

that it’s a whole plan. And what these bills does is take specific 

construction needs in the CARES process and implements that if 

they’re enacted. And our concern is whether this would be mindful 

to the process in and of itself, since the goal is enhanced services. 

Mr. HAYDEN. The VFW, I’d just like to say, supports the concept 

of CARES. We do. And I agree with that concept. But we’d like to 

see it on a separate line item, though, from construction budgets. 

We would like to see the construction funds authorized and appropriated so we can go ahead with the projects that need to be done 

now, rather than waiting for the CARES process to be completed. 

So we’d like to see those almost funded on separate line items. 

Mr. RODRIGUEZ. Iraq had 2 billion for health care for Iraqis. 

Mr. SIMMONS. Mr. Beauprez. 

Mr. BEAUPREZ. Thank you, Mr. Chairman. Thanks for holding 

this hearing today. I think you’re fully aware that especially H.R. 

116 is close to my heart. I represent Colorado, so I’ll focus most of 

my comments on it. 

I’ll also disclose that I’ve got another hearing going on in another 

committee that is also close to my heart. So if I have to leave you 

suddenly, it is not for lack of interest. Dr. Roswell, my apologies. 

And Mr. Chairman, if I might, I’ll submit an opening statement 

for the record. 

Mr. SIMMONS. Without objection, so ordered. 

Mr. BEAUPREZ. Thank you. 

[The prepared statement of Congressman Beauprez appears on p. 

60.] 

Mr. BEAUPREZ. Relative to historic preservation, the Fitzsimmons 

campus actually holds a rather unique opportunity. The old 500 

Building, as it is called, the old Army hospital itself, is where 

President/General Eisenhower recovered from a heart attack back 

when. And it’s nice that that building is not only being maintained, 

but being restored. And the actual room he stayed in is being re-
18

stored to its original state, complete with furniture and appliances 

and incidentals that were there when Ike recovered, which is kind 

of fun. 

I want to again focus on Fitzsimmons. And gentlemen, especially 

Mr. Atizado—did I pronounce it correctly—— Mr. ATIZADO. Yes. 

Mr. BEAUPREZ (continuing). Mr. Blake and Mr. Hayden, your 

concerns are very much noted, and have been noted. And if I might 

summarize, your concerns are, one, independence, especially in the 

facility itself, physical independence, and especially governance, 

that the needs and the wants, the desires of veterans are not only 

initially heard, but that the veterans don’t become the tail on the 

dog, if we can put it in that context. 

I had heard that from my veterans back home. I had heard that 

from our various VSOs. I had heard it from the UVC in Colorado. 

And frankly, the very first time I raised this issue with Secretary 

Principi, he was the first one that brought it up. I didn’t have to 

bring it up. So I can tell you that it is the Secretary’s concern as 

well. 

And let me also share with you, because I’d like to get your reaction to this. We have met numerous times on site with representatives of the University of Colorado Hospital, with the veterans organizations, with the VISN director, with representatives of the 

VA, again, as well as DOD. One, there is a possibility, if we can 

find the ability to act relatively quickly and secure the pad site, to, 

in fact, construct a separate VA tower. That site planning has been 

done and enthusiastically supported by all the parties. So that 

independence, I think, is secured—again, if we can act relatively 

quickly—which excites a lot of us. 

From a governance standpoint, if I can put it in that context, I 

think everybody is in agreement that that can be handled contractually with the various parties so that you know who’s at the table, 

and how decisions get made, and how representation is dealt with. 

Mr. Blake, I believe you raised the question about a spinal cord 

injury center. I think that from our veterans, that is a huge priority. From my own personal standpoint, it is a huge priority. From 

the standpoint of the University of Colorado Health Sciences Center, it is obviously a huge priority, because it enhances their reasons for being. 

The synergy of this site, I think, holds tremendous opportunity, 

if those things can be realized. Here is my question. Independence, 

governance assured, and especially —and I think this is the most 

important part—expanded capability for good, quality medical care 

for our veterans, not only now, but for the future. If we can secure 

that, have we satisfied, essentially, your critical reservations about 

116? Mr. Hayden? 

Mr. HAYDEN. From the VFW’s standpoint, yes, sir. I mean, if we 

can get those assurances. You know, as long as VA is able to provide timely, you know, quality care to veterans, and veterans don’t 

become second-class citizens, you will definitely have resolved a lot 

of our issues with this, and we will strongly support that. 

Mr. BEAUPREZ. Thank you. Mr. Blake? 

Mr. BLAKE. Mr. Beauprez, I would say that you have addressed 

many of the issues that we’ve had. In my written statement, I men-
19

tioned that we had grave concerns with the governance. We would 

also like to see that the staff members who are providing the medical care remain federal medical center employees. There’s also 

some concerns with insuring that the VA continues to use its current policies and procedures with regards to pharmaceutical supplies and prosthetics, and that arena. 

But as laid out like you say it, it’s hard to not support your plan. 

But we would like to see that certainly, that’s the way to go. 

Mr. BEAUPREZ. You bet. Understood. Mr. Atizado. 

Mr. ATIZADO. Well, sir, as I mentioned earlier in the testimony, 

we don’t have a resolution to support the bill. But seen as what you 

have mentioned does address directly our concerns, we would have 

no objection to the legislation. 

Generally, in local issues such as this, we do defer to our department level, Disabled American Veterans—I’m sorry—state level organization, and the local veterans in the area as well, to see—and 

insure that they do have input in that. And if they believe that it 

is—that their concerns are going to be met, then we would leave 

it up to them, sir. 

Mr. BEAUPREZ. And not to leave you out, but Ms. Wiblemo and 

Mr. Jones, if I understood correctly, you’re pretty enthusiastic 

about this. 

Ms. WIBLEMO. Yes. We fully support this bill. 

Mr. JONES. It’s amazing that Eisenhower’s heart didn’t give out 

earlier, understanding how he had to deal with Montgomery. 

Mr. BEAUPREZ. I’ll take that as a yes. 

Mr. JONES. But he was the right man at the right time. He was 

the right man for that European theater. 

Mr. BEAUPREZ. Well, Mr. Chairman, just for the record, I would 

be remiss if I didn’t point out that I think there is a relatively narrow window of opportunity out here. Because this is one of the last 

remaining pads on the Fitzsimmons campus. I think it’s an aggressive and a great opportunity. And hearing the concerns of the veterans organizations, I think, is very important. 

And I would say also for the record that there is no single issue 

among my VSOs in Colorado and the UVC that so enthusiastically 

is supported as is this hopeful move to Fitzsimmons. And so noted 

the concerns of these witnesses today. They’ve been addressed on 

site and in repeated meetings. I think that they’re very justifiable. 

And I’m committed as a member of this committee to doing what 

I can to make sure that those concerns are addressed, and hopefully, we can move this great project forward. 

Thank you, Mr. Chairman. 

Mr. SIMMONS. I thank the gentleman, and I recognize Mr. 

Snyder. 

OPENING STATEMENT OF HON. VIC SNYDER 

Dr. SNYDER. Thank you, Mr. Chairman. I just have a couple of 

questions. Mr. Hayden, in your statement—and you’ve repeated 

here, I think discussed it, but you state, ‘‘We feel the CARES process is being used as an excuse to not do any major construction, 

all while the aged VA infrastructure deteriorates daily.’’ And you 

go on to say, ‘‘While we appreciate and support the idea of CARES, 
20

we strongly believe that this cannot preclude the VA from construction, especially high-risk buildings.’’ It reminds me a little bit about the base closure process in the 

military, which is we have a process that’s been talked about for 

years. But in no way has—there are two different tracks. Track 1 

is there’s a lot of construction going on at bases, because we feel 

that the military has needs now. And while we do have another— if we have another round of base closure, and I think we will, we 

clearly will close some bases that have some nice, relatively new 

buildings on it. 

But the trade-off is you don’t treat your personnel correctly, because years can go by while you’re talking about this process. I 

don’t know if that’s a correct comparison or not. 

The specific question I wanted to ask is with regard to research 

space and research facilities, several of you represent—probably all 

of you represent organizations that feel very strongly about the role 

of research at veterans facilities because of some of the special 

needs, whether it’s hepatitis C or neurological injury or spinal cord 

injury, all those kinds of things. 

In H.R. 1720, one of the priorities there is it specifically mentions 

that research. It says, ‘‘Improving, replacing, or renovating a research facility, or updating such facility to contemporary standards.’’ I may have missed it, but I don’t think any of you in your 

written statement make any reference to research. Are we all in 

agreement that that is something that you all think should be part 

of the priority of the construction? 

Mr. HAYDEN. I definitely agree that research should be part of 

that. I think it’s one of the key things that VA does, and it does 

well. And if that infrastructure is not upgraded along with the existing infrastructure, then, you know, it can be a detriment to our 

nation’s veterans. 

Ms. WIBLEMO. Yes. The American Legion feels the same way as 

far as research is concerned. We’re big supporters of it, and we 

would like to see a lot of the renovation take place so they can continue that work. 

Dr. SNYDER. I appreciate your statements. It’s, I guess, part of 

just the way the market works. To really get really good researchers, there’s a market out there for them. If they don’t have good 

facilities, they’re going to go with some place that does have good 

facilities, and that means working somewhere else. 

Thank you, Mr. Chairman. Thank you for your comments. 

Mr. SIMMONS. I thank the gentleman. And if the gentleman refers to page 3, line 16, of H.R. 1720, he will find reference to research facilities. 

Dr. SNYDER. No. I specifically read from page—my page 3 is line 

1, paragraph 6. Do we have different drafts of the bill? 

Mr. SIMMONS. That’s a possibility. 

Dr. SNYDER. Oh, yeah, down here. I see. 

Mr. SIMMONS. All I’m saying is that the language is very good 

language. It came from a very good source, and it includes research 

facilities. 

Dr. SNYDER. No. That’s the language I read from. 

Mr. SIMMONS. You’ll find it familiar. 

Dr. SNYDER. Yeah, that’s right. Thank you. 
21

Mr. SIMMONS. The Chair recognizes Mr. Boozman. 

Mr. BOOZMAN. I don’t have any questions. 

Mr. SIMMONS. The Chair recognizes Mr. Strickland. 

Mr. STRICKLAND. Thank you, Mr. Chairman, and thank you those 

of you who have provided testimony today. 

I was struck by the fact that you all support the CARES approach or philosophy. But you have legitimate concerns about what 

the final outcome may be, and whether or not the research that 

comes out of that process may be used in an appropriate way that 

will benefit the health care provided to veterans, rather than as an 

excuse to perhaps close facilities in a way that could be detrimental 

to the service the veterans receive. 

Is that an adequate summary of how you feel about the process, 

or am I trying to put words in your mouth? 

Mr. JONES. I think you express it well, sir. We don’t wish to see 

resources go inappropriately to obsolete facilities. So when those resources could be better used for health care of veterans or for improving the facilities in which veterans are cared for. 

Mr. STRICKLAND. Anyone else care to response to that? 

Mr. BLAKE. I don’t think it can be said any better than Mr. Jones 

just said it. 

Ms. WIBLEMO. I would just like to say for the American Legion 

that one of the biggest concerns we have—we do support the 

CARES process. We have from the beginning. And we have had 

concerns. A lot of them have been expressed here today. But one 

of the bigger concerns that we had from the beginning has been the 

compressed time schedule of the actual process, especially the 

Phase 2 portion of it, and then into the strategic planning, and the 

next iteration, if you will. 

But we have been very concerned over that compressed time 

schedule. So other than that, we definitely support CARES. 

Mr. STRICKLAND. Okay. And coming from Ohio, I guess I have a 

special interest in H.R. 2307, which would result in a facility being 

constructed in Columbus, OH, which I understand from some of my 

colleagues is the largest metropolitan area perhaps in the entire 

United States of America that does not have a major VA hospital. 

But I’m wondering, in your testimony today, are you prepared to 

endorse each of these bills in terms of what they’re trying to accomplish, or are you just simply saying that you support in concept the 

need to provide adequate facilities? 

I guess what I’m asking for—and something, you know, that I 

question myself—when the bill to construct the Columbus Hospital 

was introduced—obviously, I’m naturally supportive of that for 

rather parochial reasons, perhaps. But is it your opinion that—and 

I think you’ve answered this—that although you support the 

CARES process, you recognize that there is a need that exists now 

that should be addressed quickly, and that may mean the expenditure of significant sums of money before we get whatever the final 

recommendations are that may come from CARES? And that these 

bills that we have before us today that we’re looking at, if they 

meet a legitimate need, you would be very supportive of supporting 

to completion. 
22

Mr. JONES. Yes, sir. Take, for example, the Ohio situation. Is 

there a facility in Ohio that is obsolete? Is there no need in Ohio? 

Clearly, there’s a need, and clearly, funds should be spent there. 

The only surprise continually in these construction authorizations, that the lists are so small. In taking a look at the charts, it 

is clear that there have been construction projects that have fallen 

by the wayside and in the cracks over the years. 

There must be intense competition. And we’re pleased to see the 

facility in Ohio, we’re pleased to see the facility in south Texas, and 

other facilities where these hospital needs are so important. And 

we’d like to see one in Nevada as well. 

Mr. STRICKLAND. I spent several hours in Cleveland, OH, which 

is not in my immediate district, but, you know, serves people who 

are living in my district at the VA resources center there at the 

Federal Building. And then I went to the hospital there in Cleveland and spent a couple of hours. And I know in addition to the 

Columbus facility, there’s great interest in doing something with 

the old Brecksville facility, and either replacing it on site in 

Brecksville, or even perhaps the possibility of moving that operation to the Cleveland hospital site and building a new facility 

there. 

The needs are obviously out there. And I’m just happy to hear 

you say that you support the CARES process, but you don’t want 

to wait for it to be completed before we address these very critical 

needs that currently exist and should be addressed now. 

So I want to thank all of you for very helpful testimony today. 

Thank you. 

Mr. SIMMONS. I thank the gentleman. Before recognizing Ms. 

Brown-Waite, I will notify members that I hear there’s going to be 

a vote around 3:30. And we have Mr. Roswell waiting patiently. So 

I just let members know, and I now recognize Ms. Brown-Waite. 

Ms. BROWN-WAITE. In light of the hour and the 3:30 vote, I’ll 

pass at this time, Mr. Chairman. 

Mr. SIMMONS. I thank the lady. And I now recognize Ms. 

Berkley. 

Ms. BERKLEY. Thank you. 

Mr. SIMMONS. I’ll bet she has something to say. 

Ms. BERKLEY. I have a few things. (Laughter.) 

And thank you for recognizing me. Thank you, Mr. Chairman, for 

holding this very important hearing today. 

A multi-specialty outpatient clinic in Las Vegas is essential to 

meet the current and future needs of the veterans in my district. 

And I particularly want to thank Ranking Member Evans, the Department of Veterans’ Affairs, particularly Under Secretary 

Roswell, and this committee for making the new clinic a high priority. 

I appreciate the fact that you’re all here. I work very closely with 

all of your members in Las Vegas across the board with all of my 

VA organizations. And I can tell you that they are a strong and 

rabid group that I deal with on a daily basis, and I appreciate the 

fact that you are representing them here. 

I also appreciate the testimony of the American Legion for pointing out on page 4 the problems with the Las Vegas VA clinic that’s 

currently in the process of being closed. I sometimes think that my 
23

colleagues think I’m exaggerating. But when you read about the 

unsafe air pressure in the surgery room, which has never been 

used, inadequate floor supports, and filling the drains of the sink 

with disinfectant because sewer gases keep bubbling up and making the employees of the VA clinic sick, believe me when I tell you 

I am not exaggerating the problems that we have. 

As you are all aware, Clarke County has one of the fastest-growing veterans populations in the United States. The VA has projected that the number of enrolled veterans needing health care 

services in Las Vegas will increase by 18 percent over the next decade, a time when the rest of the nation’s veterans population is 

declining. 

The southern Nevada veterans health community is struggling, 

struggling to meet the needs of the population growth, and this has 

been compounded by the evacuation of the Adelaire Del Guy Ambulatory Care Clinic that is currently under way. 

Concerned about the current situation in Las Vegas, this committee sent a bipartisan team to visit the former clinic and several 

interim health care facilities throughout Las Vegas. The staff members were astounded at the decrepit condition of the former clinic, 

which I remind you is only 5 years old, and agreed that southern 

Nevada’s veterans deserve far better. As a matter of fact, I believe 

one of the staff members was overheard saying, ‘‘Let’s get out of 

here before it falls down on our heads.’’ You could imagine what 

my veterans feel, having to get health care there on a daily basis. 

For the next 3 years, veterans in my district will shuttle between 

10 different temporary locations to have their health care needs 

met until one full-service clinic can be constructed. In the past 3 

weeks, the VA has opened two of those temporary clinics. The VA 

is now in the process of opening the remaining eight clinics. 

While I’m pleased that the transition has moved forward fairly 

smoothly, I’m very concerned about the future challenges and inconveniences. I don’t want anybody to think for a minute, and I’m 

sure you’re hearing from your members, that the veterans are 

happy with the 10 temporary interim site solution. I can assure 

you that my veterans were up in arms at this solution, and the 

only way we were able to assuage their concerns and get them to 

calm down and accept an interim solution of 10 locations is the 

promise from the VA, the promise from me, the promise of other 

people in positions of authority, that they will, in fact, have a new 

clinic within 3 years. 

Veterans with multiple or specialized health care needs will still 

need to be shuttled between locations. Let me give you a for-instance, because any one of your members can be subjected to this. 

A veteran who needs a CAT scan may have to shuttle from their 

primary care location to another temporary site which houses the 

CAT scan technology, and then to another site for a prescription for 

the controlled narcotic, and still another site for the mental health 

services. Also, female veterans who need a mammogram or other 

gynecological services will have to shuttle to yet a different clinic. 

While veterans have shown tremendous resilience thus far adjusting to the temporary sites, let us not forget that the population 

we are talking about are rapidly aging people. Shuttling between 

locations for various services in 110-degree Nevada heat is a con-
24

siderable burden for anyone, particularly for our oldest and sickest 

veterans. Maintaining 10 separate locations is not an acceptable 

permanent solution. 

Southern Nevada’s veterans are facing a health care crisis, and 

I don’t think anything less than a crisis is the appropriate word. 

They have a fragmented clinic, no long-term care, no nursing home 

facility, and are forced to travel to veterans hospitals in California 

for essential hospital services. We need a health care clinic, and we 

need it now. 

Under Secretary Roswell, I am committed to pursuing every avenue to make sure the veterans in my community get this clinic that 

they so justly deserve and need. I hope that as the process moves 

forward, the VA will keep me informed of all major developments, 

that we’ll all be able to work together. Our top priority should be 

meeting the needs of our veterans throughout the United States, 

particularly in areas like Las Vegas, with high-growth veterans 

populations. And I hope we’re all going to work closely together in 

the coming months. 

And if I may, in addition to thanking all of you for being here, 

when Mr. Roswell comes to testify, I would be very grateful if he 

would answer a question. Because I want to make sure that the VA 

is moving forward with its commitment to providing one multi-specialty clinic to meet the needs of veterans in Las Vegas, rather 

than having 10 temporary locations becoming the permanent solution. I am extremely worried about this possibility, and I’d appreciate if Dr. Roswell would comment on this when he has an opportunity to testify. 

And I thank you all for taking your very valuable time to come 

and enlighten us and share your concerns with the committee. 

Mr. SIMMONS. I thank the lady for her question. 

Ms. BERKLEY. Was that okay? 

(Laughter.) 

Ms. BERKLEY. Was my question—do you agree? 

Mr. SIMMONS. Right. They’re all nodding, let the record show. I 

want to thank the panel for their testimony. And at this point, I 

would invite the second panel to come forward. We have the Honorable Robert H. Roswell, Under Secretary for Health, Department of 

Veterans’ Affairs. And he’s accompanied by Mr. Mark Catlett, who 

is Principal Deputy Assistant Secretary for Management; and Mr. 

Robert Neary, who’s the Associate Chief Facilities Management Officer for Service Delivery. 

And I thank all three of you gentlemen for coming promptly and 

listening to the first hour and 10 minutes of this hearing. I think 

you have a pretty good sense of what it’s all about. We already 

have one question for you on the record. But before we get to questions, why don’t we hear from you on your statements. 
25

STATEMENT OF ROBERT H. ROSWELL, M.D., UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS’ AFFAIRS; ACCOMPANIED BY D. MARK CATLETT, PRINCIPAL 

DEPUTY ASSISTANT SECRETARY FOR MANAGEMENT; AND 

ROBERT L. NEARY, JR., ASSOCIATE CHIEF FACILITIES MANAGEMENT OFFICER FOR SERVICE DELIVERY 

Dr. ROSWELL. Thank you, Mr. Chairman. We’re pleased to be 

here today to appear before the subcommittee. 

As you said, with me are Mr. Mark Catlett, our Principal Deputy 

Assistant Secretary for Management, and Mr. Bob Neary, the Associate Chief Facility Management Officer. 

The physical infrastructure of VA health care system remains 

one of the largest in the Federal Government, with over 5,000 

buildings and 150 million square feet inventory. It’s been a challenge for VA to maintain this aging infrastructure and to make the 

improvements necessary to meet the challenges of modern health 

care. 

With the conclusion of the CARES process early next year, it will 

be critical for the department to promptly address the infrastructure needs identified through that process, as well as pre-existing 

needs. 

I’ll briefly discuss the four bills on today’s agenda. First, VA 

wholeheartedly supports H.R. 1720, the Veterans Health Care Facilities Capital Improvement Act, which would authorize the Secretary to carry out construction of certain projects using funds appropriated for fiscal years 2004, ’5, and ’6 without requiring specific 

authorization on an individual project basis. 

Enactment would accelerate the process for correcting deficiencies in the infrastructure of VA hospitals, and help bring VA 

hospitals in compliance with existing federal standards. It would 

also facilitate the future planning of projects and greatly support 

the CARES process. 

VA also supports the intent of H.R. 116 to authorize the Secretary to carry out major medical projects at the site of the former 

Fitzsimmons Army Medical Center in Aurora, Colorado. The bill 

provides the Secretary flexibility in selecting the projects by providing that they may include acute, sub-acute, primary, and longterm care services. 

We have been involved in evaluating and planning for a facility 

for the Fitzsimmons site, and there is a strong potential for a joint 

venture with DOD to provide health care to both veterans and 

DOD beneficiaries. 

A number of issues still remain, including the availability of 

land, and how that land would be conveyed to the Department of 

Veterans Affairs. But I’m confident that VA would be able to work 

with University of Colorado and provide the report to Congress if 

this bill is enacted. 

Regarding H.R. 2307, VA agrees that the need for an expanded 

replacement outpatient clinic in Columbus is appropriate, as called 

for in H.R. 2307, and that this will likely be borne out by the 

CARES study from VISN 10. 

The outpatient workload at the existing clinic is increased well 

beyond the planning level projected when the clinic was open. However, with regard to the other part of H.R. 2307, we feel it’s pre-
26

mature to endorse a new facility proposed in south Texas, and we 

are currently reviewing the need for additional sites in CARES. 

Until that effort is complete, we don’t have a specific position on 

a facility in south Texas. 

VA supports Sections 1, 2, and 3 of H.R. 2349, and requests that 

the subcommittee consider the additional project leases requested 

in the President’s fiscal year 2004 budget. These would be authorizations for renewal leases for the Boston outpatient clinic, the 

Pensacola, Florida, outpatient facility, and a lease renewal for the 

Health Administration Center in Denver. 

VA requests an authorization for a lease instead of construction 

for the Las Vegas replacement ambulatory care center that Congresswoman Berkley spoke of. VA has determined that a lease can 

be procured sooner than construction, and that it will reduce the 

initial funding requirement. We believe that a lease authorization 

will allow us to complete construction by May of 2006, 3 years from 

now, and allow us to move into that new comprehensive facility in 

the most timely manner that best meets the needs of the greater 

Las Vegas area. 

VA also requests that you consider authorizing those seismic 

projects that were listed in the President’s 2003 budget. The facilities in Palo Alto, San Francisco, and west Los Angeles remain at 

a critical risk to the safety of patients and staff in the case of a 

seismic event, and remain a high priority for the department. 

We’re confident that the CARES studies will validate the continued 

need for these major facilities. 

Mr. Chairman, the department does not support Section 4 of 

H.R. 2349, which would prohibit VA from spending funds to dispose of VA’s Lakeside property until such time as VA is awarded 

a contract to construct a new bed tower on VA’s Westside campus. 

VA is proceeding with the design of the bed tower project for 

Westside, and concurrently taking steps needed to dispose of the 

Lakeside property as soon as possible through an enhanced-use 

leasing arrangement. Both projects are critical to VA’s successful 

realignment of health care activities to improve veterans health 

care in the city of Chicago and the greater metropolitan area, and 

both need to proceed on a concurrent basis. 

Planning and successful execution of real estate disposal in a 

major urban center like Chicago is time-consuming and complex, 

taking anywhere from 12 to 20 months, and sometimes longer. A 

complex enhanced-use project like Lakeside requires VA to take a 

number of actions before it can actually dispose of the property, including conducting environmental baseline surveys and related 

activities. 

Both activities are now on schedule, and actions are progressing 

independently without adversely impacting progress of either design or construction of Westside, or planning for the execution of 

the enhanced-use lease. Delaying these activities until after the 

scheduled August 2004 construction contract award at Westside 

would limit the department’s ability to use revenues generated by 

the disposal of Lakeside to fund various aspects of the VISN 12 

CARES Implementation Plan. 

VA appreciates the subcommittee’s interest and actions to improve the infrastructure of VA’s health care system. VA’s capital 
27

infrastructure has suffered for many years from an uncertainty of 

the demands and needs for the VA system. I can assure you that 

there needs to be a strong and viable infrastructure to support veterans health care, and that these bills will enable VA to meet those 

needs. We look forward to working with the subcommittee to insure 

that VA continues to fulfill a grateful nation’s obligation to care for 

its veterans. 

Mr. Chairman, we would be happy to answer any questions you 

or the members may have at this point. 

[The prepared statement of Dr. Roswell appears on p. 107.] 

Mr. SIMMONS. Thank you, Dr. Roswell. I’ll be brief, because I 

know that there’s time limitations here. The question came up earlier about increasing the threshold for individual minor construction projects from, I think, 4 million to 10 million. I’d be interested 

in your comment on that. 

And secondly, on the issues of the CARES process generally, I 

think we’ve heard that there’s wide support for the process, but the 

process is elongating in some quarters. In the other body, for example, they have suggested that the process is being manipulated in 

some ways. I think we have legislation before us which empowers 

the Secretary to make certain discreet decisions with fairly large 

numbers attached to it. 

I’d be interested in your comments generally on the $10 million 

and on the issue of providing specific authorization for the Secretary in certain areas while, again, this process hopefully comes 

to a speedy conclusion. 

Dr. ROSWELL. Thank you, Mr. Chairman. With regard to the 

minor construction limitation, generally, we would favor an increase of that limitation. Whether it’s 6 million, 8 million, 10 million,—any of those levels would represent additional flexibility in 

delegated authority to the Secretary. 

I would point out that the VISN 12 CARES plan, which is the 

one completed CARES plan, actually has one of the major provisions currently threatened because of that minor construction 

threshold at $4 million. 

In our north Chicago facility, we had made a commitment to 

work with the Department of Navy to renovate our ORs in that location. To our surprise, but not dismay, we found that the needed 

renovations in the ORs would cost slightly over $5 million. We now 

have no way to authorize that project because of the $4 million 

threshold. So I would very much favor raising that threshold in 

H.R. 1720. 

I think H.R. 1720 is a wonderful piece of legislation that really 

recognizes the need to delegate authority and give the Secretary 

discretion in moving the department forward and addressing specific needs which may occur on a short time line, such as the 

project in Denver that Mr. Beauprez spoke of. So we support H.R. 

1720. We would support the increased threshold. 

With regard to extending the time line on CARES, as I reviewed 

the market plan submitted by the 21 VISNs, I felt that while they 

addressed a number of critical issues, that other opportunities were 

not fully addressed. And I asked the VISN directors to readdress 

certain issues and consider other possible options that might be 
28

considered in crafting the national health care plan to be passed 

on to the CARES Commission. 

While we have extended this phase of the CARES process by approximately 60 days, we’ll make up some of that time on the other 

end of the process. And the Secretary is still fully committed to receiving the CARES Commission final recommendation and making 

a final decision this calendar year. 

With regard to concerns about long-term care being excluded 

from the CARES process, about domiciliary care being excluded 

from the process, that is not the case. What we have asked is that 

in the formulation of all the market plans submitted to me, including the options I’ve requested of the VISN directors, that we preserve the existing long-term care bed capacity, including nursing 

home beds, long-term mental health beds, and domiciliary beds. 

Where we’ve asked people to consider the option of consolidating 

from a two-campus operation to a one-campus operation, or converting a single campus into a 40-hour week operation, as opposed 

to a 24-by-7 operation, I have specifically instructed them to preserve that bed capacity. 

I would point out that long-term care is something that we still 

need to explore with this committee and the full committee, but 

that repeatedly, we have found that the cost of new construction 

is less than the cost of conversion of existing infrastructures, as 

you yourself pointed out, Mr. Chairman. 

I would also point out that trying to house long-term care in a 

historic hospital building doesn’t afford the standard of care, the 

quality of life, that those veterans deserve. A long-term care resident needs access to the outdoors. They need access to a variety of 

facilities. And a multi-story facility with limited access to outside 

recreational opportunities is not ideal. 

So consistently and repeatedly, we found that when we need 

long-term care, it’s more desirous to meet ADA requirements, to 

provide quality of life, as well as the lower construction cost to do 

that with new construction. And the CARES process will still afford 

us to expand our long-term care capacity in that manner. 

Mr. SIMMONS. Thank you very much for those answers. Mr. 

Rodriguez. 

Mr. RODRIGUEZ. Thank you very much. I think the CARES process showed that there were fewer than 3 percent of the enrollees 

in the Valley/Coastal Bend market, and that that’s, you know, one 

of the—it is the lowest in the country. And since you very forcefully 

indicated that you were reluctant to support any construction of 

any facility there, I was wondering if you had any other options for 

us there, and especially in the Corpus Christi area, with the Naval 

base there. 

And by the way, the region that I’m referring to is not my area, 

but it is within the San Antonio area that goes out there. And one 

of the difficulties that people have understood is, for example, we 

have Cameron County, you know, that’s close to 300 miles away 

from San Antonio, there’s about 20,000 veterans. Hidalgo County, 

25,000. Nueces County, which is Corpus Naval, about 32,000 veterans. 

Dr. ROSWELL. Yes, Mr. Rodriguez, you’re absolutely correct. I 

think we do have other options. Let me point out for the record 
29

that the CARES process identified many of the deficiencies you 

have spoke of. It identified what we called access gaps, as well as 

capacity gaps, for inpatient care in both Nueces County and in 

Cameron County. 

However, one of the CARES criteria, one of the principles is that 

hospitals—new hospital construction should be a minimum of 100 

beds is the general principle, and that we would not seek to own 

or operate a facility if it had less than 40 beds on an average daily 

census. 

Because of the relatively sparse population density in the area 

you speak of, we don’t meet that critical threshold of 100 beds, nor 

do we see even a threshold of 40 beds. 

Therefore, the other option would be to contract for veterans 

health care, veterans inpatient health care, in the Cameron County 

and in the Nueces County area. And we believe that there are 

sharing partners that would be available to work with the Department of Veterans Affairs to meeting that need for inpatient care in 

those areas, which you are very correct is an unmet need at 

present. 

Mr. RODRIGUEZ. Thank you. 

Mr. SIMMONS. Mr. Beauprez. 

Mr. BEAUPREZ. Thank you, Mr. Chairman. Dr. Roswell, good to 

see you again. I’ll try to be quick. 

Research has come up repeatedly, and frankly, as a new member 

of the committee, I’m a little bit embarrassed to say I was very 

taken when I saw the veterans budget to see the great volume of 

research that is funded through the VA, and the DOD, for that 

matter. I shouldn’t have been surprised, but I was. 

Given that, and understanding why, could you speak for just a 

minute about the research possibilities as they directly relate to 

veterans if we were successful in going forward with this Fitzsimmons campus? 

Dr. ROSWELL. We have certainly considered research. I believe—

and let me point out that many of the issues that were addressed 

by the previous panel have been fully addressed, and the option 

currently being favored under consideration. By conveying land to 

the VA either by a long-term lease or some other arrangement, VA 

would actually hold title to the bed tower that you spoke of. It 

would be a VA-owned-and-operated, VA-governed bed tower with a 

specific VA identity, staffed by VA physicians, VA nurses, VA support staff that would provide comprehensive high-quality care 

under direct VA management at that location. 

However, because of its co-location, it would still allow us to access some of the tertiary care and very specialized services available at that campus without making the capital investment to 

recreate and duplicate those services. So we’re very much in favor 

of that concept, and believe it’s a very viable option. 

We’ve also looked at research space at that location and believe 

that the most efficient way to acquire needed research space to 

support the Denver Medical Center’s current research portfolio 

would be to acquire that in a research building planned for construction on the campus, but not in the bed tower we’re speaking 

of. That could be obtained by either leasing that space or purchase, 
30

providing construction funds to build specific space in a new proposed research building at that location. 

Mr. BEAUPREZ. Yeah. I understand from my colleague Congressman Hefley’s testimony that he submitted, and from other information, that some 90 percent of the docs that now supply the patient 

care to the VA are part of the University of Colorado Health 

Science Center, and obviously devoted to research. 

Another advantage of the site, if I might just state it for the 

record, as I’m sure you’re aware, a Colorado State veterans nursing 

home has recently opened literally a stone’s throw away from the 

proposed site. 

Now, I haven’t said all those wonderful things about why there 

ought to be a new hospital at Fitzsimmons. What if we’re unsuccessful? For the sake of our veterans, what if we can’t build this? 

We’ve still got a very aged facility, perhaps not quite to the point 

of my colleague from Nevada, that facility that she described, but 

a very aged facility that is in bad need of repair. What’s Plan B? 

Dr. ROSWELL. The Las Vegas Clinic is 6 years old. 

Mr. BEAUPREZ. Ours isn’t that old. 

Dr. ROSWELL. The facility in Denver is 50 years old. So clearly, 

the facility in Denver is in need of major renovation. We have a 

tremendous amount of capital investment that must take place in 

that facility to maintain patient operations at that location. 

If we invested in renovating that 50-year-old facility, we would 

have, in the end, a renovated 50-year-old facility that is no longer 

located next to its faculty, its house staff, it’s medical students, its 

education, or its research mission. That’s why I strongly favor relocating the medical center to the new Fitzsimmons campus, where 

these collaborative opportunities exist, and I believe significant cost 

savings could be achieved. 

We’ve also cited a potential VA nursing home facility that’s actually adjacent to the state veterans home you spoke of on that campus, and believe that over time, three facilities—a research facility, 

co-located with the proposed University of Colorado Research 

Building; a long-term care facility; as well as the acute bed tower— are warranted. I believe H.R. 116 gives us the latitude to pursue 

all three of those options and support it. 

Mr. BEAUPREZ. I appreciate it, and I yield back. 

Mr. SIMMONS. I thank the gentleman. Ms. Berkley. 

Ms. BERKLEY. Thank you very much, Mr. Chairman. When you’re 

answering the first question that I asked earlier regarding the 

need for the clinic versus continuing in 10 separate locations, I’d 

also appreciate—I recall when the Adelaire del Guy facility was 

first opened. I wasn’t in Congress yet, but I attended the celebration. There were flags flying, and speeches were made, and veterans were crying, and we were oohing and ahing as we walked 

through the facility. And 6 years later, it’s condemned. 

Now, when we talk about a better deal for the American taxpayer in the long run, if we do a lease, as opposed to actual construction, I just want to make sure when we’re leasing this facility—which I agree with you. Whatever gets this done faster so my 

veterans can move into it faster is fine with me. But if this is the 

VA’s preferred option, what precautions are going to be taken to 

ensure that the construction of the new facility isn’t plagued by the 
31

same structural deficiencies as the building the VA is vacating 

now? What will we do to insure this never, ever happens again? 

Not only in Vegas, but anywhere. 

Dr. ROSWELL. Let me try to answer your questions in order. To 

begin with, with the 10 facilities, it would not only be ill-advised, 

it would be cost-inefficient and inappropriate for the patient care 

needed. Clearly, the veterans now will receive care in a number of 

locations simply because we could not identify existing space in a 

consolidated location to provide the full health care needs of the 

very significant growth in population in your district. 

It was only reluctantly that we sought to acquire a total of 10 

facilities, and I would point out at fairly substantial cost, not only 

in the acquisition cost to lease 10 different sites, but also in the 

operational cost to provide the security, the maintenance services. 

It represents a significant inefficiency when you have that distributed. 

It’s also ill-advised in delivering health care to ask a patient to 

go to one location, as you pointed out, for certain services, and then 

have to travel to another location. 

So unequivocally, I would be adamantly opposed to having a distributed facility, as opposed to a consolidated comprehensive multispecialty facility where all services available on an ambulatory 

basis could be obtained at one location. 

With regard to the safeguards in the lease mechanism, I’ll ask 

Mr. Neary to specifically address that. But let me point out that 

even when the current clinic was built, there was some significant 

concerns that weren’t met, and we’ve learned to regret that decision. We have a very aggressive construction oversight office. Bob, 

could you address—— Mr. NEARY. Certainly. Thank you. Fortunately, the experience in 

Las Vegas is unique. But as a result of that, we’ve made a couple 

of significant changes in the manner in which we oversee our large 

leases. The lessor will be required to submit their design documents and drawings to an independent AE firm for a peer review, 

and will be required to document any necessary changes as a result 

of that review. 

And we’ve also strengthened our on-site supervision through our 

resident engineer program to be more closely vigilant to insure that 

the construction company is constructing the building consistent 

with the design documents. 

Ms. BERKLEY. Thank you very much. I’d just like to thank you 

very much, Dr. Roswell. It’s been a pleasure working with you, and 

the Secretary. You’ve been very responsive to our needs. 

And also, I think it’s important for me to share with you how 

good a job the VA staff in Las Vegas does keeping all of this together. They have almost insurmountable challenges, and they’ve 

managed not only to reach out to the veterans, not only to reach 

out to the congressional delegation, but they’ve done a yeoman’s job 

identifying 10 locations. And I know. I was there every step of the 

way. It was not the choice that we all wanted, but we ended up 

reluctantly agreeing that that was the only thing to do. And you’ve 

implemented it very, very well, and I thank you. 

Dr. ROSWELL. Thank you for your understanding and your support, which has been very significant. 
32

Mr. SIMMONS. I thank the lady. Ms. Brown-Waite. 

Ms. BROWN-WAITE. Thank you, Mr. Chairman. I just have a 

basic question as a taxpayer. Is anybody going after the liability of 

the engineer or the builder or the architect on that building? 

Dr. ROSWELL. Yes. The short answer is yes. Bob, do you want to 

address that? 

Mr. NEARY. Yes. Our general counsel is evaluating the options 

that are available to us, and our Secretary has made it very clear 

that we’ll seek repayment for all the expenses that we’re forced to 

incur because of their failure. 

Ms. BROWN-WAITE. Well, I would suggest that you rush this 

process up. I was involved with a county building that was not 

built according to plans, that had lots of problems. And two of the 

counties that I represent, one of them made the time limit that the 

performance bond and that the surety bond had, and the other one 

didn’t. So I would suggest that you not dawdle too long, or you’re 

liable to miss that reimbursement train. 

Dr. ROSWELL. No. Believe me, we have been aggressive in seeking that out. We will suspend lease payments. We’ll also look at all 

the costs associated with the relocation, as well as the cost of the 

replacement leases in the 10 locations that the other congressman 

spoke of. And we’ll be seeking restitution for all of those expenses 

from the lessor. 

Ms. BROWN-WAITE. Let me ask a question about the CARES 

plan. When I read through the CARES plan—I think you and I had 

this discussion—the original draft for the VISN that I amended, 

VISN 8, we had less than 2 days to respond. Number one, I hope 

that that wasn’t repeated around the nation. 

And number two, the assumptions that were in that plan disturbed me. They were assumptions such as, ‘‘Well, there will be 

wealthy veterans moving there.’’ They’re veterans. And I think 

we’re losing the focus. 

So I have to tell you that as a newcomer, I am very, very concerned about assumptions that go into the CARES plan. To say, 

‘‘Oh, that’s a wealthy area,’’ or ‘‘Oh, that’s not a wealthy area,’’

we’re losing the focus here. They’re veterans. So I would like you 

to address that issue. 

And I have a third question for you, and that is when you see 

in states, whether it’s Arizona or Nevada or Florida, where you 

know veterans are moving to, are you ever in the mode of being 

forward thinking? And I don’t mean to imply that you haven’t been. 

But forward thinking of saying, ‘‘Okay, here is a development that 

is going to have 25,000 retirees. Probably 15,000 of them are going 

to be veterans. Let’s work with that builder and developer. Maybe 

he or she will donate some land, will work with us.’’

Because thus far, Doctor, I have a developer who is willing to donate land. He is willing to put up a building and lease it for a dollar a year to get a VA clinic there. And we don’t have any response 

yet. Is this so rare that the private sector steps up and says, ‘‘Hey, 

I’ll help you,’’ that your agency doesn’t know how to deal with it? 

Tell me how. 

And I can’t help but believe Mr. Rodriguez’s words of wisdom 

when I first came on this committee of ‘‘You’ll get tired of not getting answers.’’
33

Dr. ROSWELL. I apologize that you haven’t received answers timely. Let me address your question. 

Ms. BERKLEY. I haven’t received answers. 

Dr. ROSWELL. Okay. With regard to the CARES process, it’s a 

very aggressive time line. There’s no question about it. We do believe—and—that opinion was expressed on the previous panel, that 

the time for stakeholder input, including congressional offices, may 

not have been sufficient in the formulation of the VISN plans. 

That’s part of the reason that I’ve asked the individual VISN directors to go back and reassess their plans, and in certain cases, to 

consider additional options that might be considered in that 

process. 

Let me point out that once a national plan is formulated from 

the individual VISN plans, it will be shared with a CARES Commission, who will be specifically charged by the Secretary to seek 

extensive stakeholder input. And we certainly hope that that will 

be an additional opportunity to provide the kind of input you 

talked about. 

With regard to the planning data and looking only at low income 

or service-connected veterans versus higher-income veterans, you’re 

absolutely right. They’re all veterans. And to the extent that resources are made available to the department, they’re all entitled 

to care subject to that availability of resources. That’s exactly why 

the CARES planning data included all eight priorities of veterans 

in planning the demographic projections, and that was considered 

in the model. 

Finally, with regard to developers providing land to VA, I would 

point out that the last—the most recent new VA facility in Florida 

was actually provided on just such an arrangement. A land developer, a developer actually donated 77 acres of land to the VA for 

the purposes of developing a VA facility in Brevard County. And 

that site now hosts the Viera outpatient clinic, which is over 

100,000 square feet, and is providing state-of-the-art care to veterans in the east central portion of the state. 

I realize that’s not in your district. But we’re very much receptive to those types of opportunities, and we’ll certainly work with 

developers to acquire land on a low-cost basis. 

Ms. BROWN-WAITE. Mr. Chairman, if I might, I know I’ve exceeded my time, but just one follow-up question. 

Mr. SIMMONS. Please. 

Ms. BROWN-WAITE. Dr. Roswell, you don’t seem to understand. 

He not only will donate the land; he will construct the building according to VA standards. If only someone from the VA would get 

back to this man. My office has been waiting. This developer has 

been waiting. 

Dr. ROSWELL. That’s in the Villages area? 

Ms. BROWN-WAITE. Yes, sir, it is. 

Dr. ROSWELL. I am familiar with that, and it is being carefully 

looked at. 

Ms. BROWN-WAITE. But no one has contacted him. 

Dr. ROSWELL. I’ll be happy to check into that. 

Ms. BROWN-WAITE. Thank you. 

Mr. SIMMONS. I thank the lady. Does the contractor have any 

land in south Texas, by any chance? 
34

(Laughter.) 

Mr. SIMMONS. I want to thank the panel for being here. I will 

just share with you, Dr. Roswell, that I’ve been in government for 

quite a while. Whenever I hear the word ‘‘process,’’ it makes me 

nervous, you know? 

I served in Vietnam, and when a helicopter went down, the people on the ground didn’t want to hear about the ‘‘process’’ of recovery. They wanted, you know, the search and rescue guys to get out 

there and get them out. 

And when you go to an emergency room, you probably really 

don’t want to hear about the ‘‘process’’ of how you’re going to be 

treated. ‘‘Hey, Doc, take care of me. Fix me up. Get me out of here.’’ And for those of us who represent fairly substantial veterans 

populations, as we begin to hear about the CARES process and the 

fact that the process is being extended, the deadline is being extended, we’re getting that nervous feeling. And that’s, I think, what 

you’ve probably been hearing about a little bit today. 

That being said, I believe, and I think members of the committee 

believe, that we have some legislation before us which is important 

which does not degrade or undermine the CARES process—in fact, 

enhances and facilitates it—that we have some specific projects in 

various parts of the country that deserve to be moved in a timely 

fashion, and we’re interested in doing that. 

It would be my intent to move these bills in a regular order, 

which means to get them forward to a markup, hopefully as soon 

as June 24, which is when the subcommittee does plan a business 

meeting. And I call upon my colleagues on both sides of the aisle 

to work together to see if we can reach agreement on as much of 

this legislation as we can. 

That being said, we will have some additional questions for the 

record. And unless any of my colleagues have additional comments 

they would like to make. And hearing none, this hearing is adjourned. Thank you, everybody. 

[Whereupon, at 3:40 p.m., the subcommittee was adjourned.] 
(35)

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