FORMADON OF THE VA 'CIUCAGOHEALTH CARE 

SYSTEM 

FIELD ' HEARING 

BEFORE THE 

SUBCOMMITTEE OVERSIGHT AND INVESTIGATIONS 

OF THE 

COMMITTEE -ON VETERANS' AFFAIRS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFrH CONGRESS 

FIRST SESSION 

OCTOBER 16, 1997 -

Printed for the use of the Committee on Veterans' Affairs 

48-$17 CC 

Serial No. 105-24 

U.S. GOVERNMENT PRINTING OFFICE 

WASHINGTON : 1998 

For sale by the U,S, Government Printing Office 

Superintendent of Documents. Congressional Sales Office, Washington. OC 20402 

ISBN 0-16-056565-0 
COMMITTEE ON VETERANS' AFFAIRS 

BOB STUMP, Arizona, Chairman 

CHRISTOPHER H. SMITH, New JeI'lleY LANE EVANS, Illinois 

MICHAEL BILIRAKIS, Florida JOSEPH P. KENNEDY n, Maaaachuaetta 

FLOYD SPENCE, South Carolina BOB FILNER, Calitornia 

TERRY EVERETT, Alabama LUIS V. GUTIERREZ, Illinois 

STEVE BUYER, Indiana JAMES E. CLYBURN, South Carolina 

JACK QUINN, New York CORRINE BROWN, Florida 

SPENCER BACHUS, Alabama MICHAEL F. DOYLE, Pennsylvania 

CLIFF STEARNS, Florida FRANK MASCARA, Pennsylvania 

DAN SCHAEFER, Colorado COLLIN C. PETERSON, Minneeota 

JERRY MORAN, KaDau JULIA CARSON, Indiana 

JOHN COOKSEY, Louisiana SILVESTRE REYES, T_ 

ABA HUTCHINSON, Arkanau VIC SNYDER, Arkansas 

J.D. HAYWORTH, ArizoDa CIBO D. RODRIGUEZ, T_ 

HELEN CHENOWETH, Idaho 

RAY LAHOOD, ILUNOI8 

CABL D . CoMMBNATOR, Chief COU1U/e1 and Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

TERRY EVERETT, Alabama, Chairm4n 

BOB STUMP, Arizona 

FLOYD SPENCE, South Carolina 

STEVE BUYER, Indiana 

JAMES E. CLYBURN, South Carolina 

VIC SNYDER, Arkanaaa 

FRANK MASCARA, Penneylvania 

(II) 
CONTENTS 

OPENING STATEMENTS 

Hon. Ray Lahood, Acti~ Chairman ...................................................................... 1 

Hon. Lane Evans, Ranking Democratic Member, Full Committee on Veterans' 

Affairs .................................................................................................................... 2 

Hon. Luis V. Gutierrez ............................... ,............................................................ 3 

Hon. Danny K. Davis, a Representative in Congress from the State of Illinois 5 

WITNE~SES 

Balcer, James, Director, Veterans for the City of Chica~ .................................. . Colten, Harvey R., M.D., Dean, Vice President for Medical Affairs, Northwest- em University Medical School ................................................... : ....................... . Prepared statement of Dr. Colten ...... ;.,. ........................................................ . Cummings, Joan E., M.D., Network Dmietor, Veterans Integrated Service 

Network 12, Department of Veterans Affairs ................................................... . Prepared statement of Dr. Cummings ........................................................... . Griffin, Sol, Chairman, Minority Veterans Committee and Past National 

President of Montford Point Marines ................................................................ . Moore, Joseph L., Director, VA Chicago Health Care System, Department 

of Veterans Affairs .............................................................................................. . 

M08;,re~ sr.teM.D.~ ~~; ~~n:~··~f··M;U~i~~;··u~~~;~iy··~f"Ii~~i~··~i Chicago ................................................................................................................. . Prepared statement of Dr. MOBS .................................... , ................................ . Plante, Robert P., Supervisor, National Service Office; Chicago Disabled 

American Veterans .............................................................................................. . Terrence, Christopher F., M.D., Chairman, Integration Coordinating Committee, VA Chicago Health Care System, Department of Veterans Affairs ......... 

Wood~::~B=!::'Re~=~~~~··~f·~···73:··&~~··E~pi~y~ Intemational Union ............................................................................................ . 

6 

20 

42 

23 

45 

7 

26 

57 

18 

38 

9 

27 

63 

11 

MATERIAL SUBMITTED FOR THE RECORD 

Information on appointment waiting times for specialty clinics being mon- itored at Chicago Health Care System ............................................................... 31 

Statements: 

The American Legion ....................................................................................... 66 

Paralyzed Veterans of America ....................................................................... 70 

Irvin R. Tchon, President, Northwest Chicago Senior Citizens Legislative Council ........................................................................................................... 72 

(III) 

FORMATION OF THE VA CHICAGO HEALTH 

CARE SYSTEM 

THURSDAY, OCTOBER 18, 1997 

U.S. HOUSE OF REPRESENTATIVES, 

SUBCOMMITl'EE ON OVERSIGHT AND INvEsTIGATIONS, 

COMMITTEE ON VETERANS' AFFAIRS, 

Washington, DC. 

The subcommittee met, pursuant to notice, at9 a.m., in the 

Humboldt Field., House, 1400 North Sacramento Boulevard, Chicago, IL,.Hon. Ray LaHood presiding. 

Also 'Present: Representatives LaHood, Evans, Gutierrez, and 

Davis. 

OPENING STATEMENT OF HON. RAY LAHOOD, ACTING 

.CHAIRMAN 

Mr., LAHOOD. The hearing will come to order. Good morning, and 

welcome,aIl of you interested citizens and folks who" are also going 

to be testifying. 

My name is Congressman Ray LaHood. And I am sorry that Congressman Terry Everett, the chairman of the subcommittee, is not 

here.· Congressman Everett is from Alabama, and unfortunately he 

became ill a day or so ago and was not able to come. 

I had intended to come to this meeting and participate in the 

committee hearing,'and I was asked to chair the committee this 

morning. I am from the central part of the State. Peoria, IL, is my 

home town; and I represent the 18th District. I am also a, member 

of the full Veter~s' Committee. 

So I would lik~to just make a brief opening statement and then 

call on Congressman Evans, Congressman Gutierrez, and Congressman Davis for any statement they would like to make, and 

then we will go to our first panel. 

It is a pleasure to be, herein Chicago. This hearing by the Veterans' AffaIl'S Subcommittee on Oversight and Investigations on the 

formation of the VA Chicago Health Care System is at the request 

of our col1eagues, Congressman Evans.and Congressman Gutierrez. 

They have'taken a great deal {)finterest and,promoted this hearing, and we are guests today of Congressman Gutierrez, whose District we are presently in. And Congressman Davis has the adjoining District right next to Congressman Gutierrez. 

I want to welcome the minois veterans and other stakeholders 

in Chicago's integration process who are here today for this long- anticipated hearing. 

(D ' 
2 

I believe that this hearin~ will add to the committee's knowledge 

about VA facility consolidatIon and integration because they are occurring all across the country and more are expected. The Subcommittee on Health held a joint hearing with this subcommittee on medical facility integration this past July. The VA in 

Washington is still refining its guidance to regional network directors on now the integration process should operate. And by the way, the term "facility integration" means the 

combining of two or more medical facilities into one functional organization to provide a coordinated continuum of health care to 

veterans. 

We are working with the VA to improve health care for veterans 

by improving the way facility integrations are accomplished, and 

obviously there is a willingness on the part of the VA to improve 

the process and better address stakeholder concerns. 

It must be recognized that facility integration under the best of 

circumstances involves difficult issues, and stakeholders have legitimate interests that concern them greatly. Several of the Chicago area service or~anizations will present their views, as well as the Deans of the Umversity of Illinois School 

of Medicine and Northwestern School of Medicine, VA officials, and 

a representative of the Service Employees International Union. 

I would like to recognize now the ranking member of the full Veterans' Committee, Lane Evans, from Rock Island, for whatever 

statement he would like to make. 

OPENING STATEMENT OF BON. LANE EVANS, RANKING DEMO· 

CRATIC MEMBER, FULL COMMITTEE ON VETERANS' 

AFFAIRS 

Mr. EVANS. Thank. you, Mr. Chairman. I appreciate this oppor- tunity to participate with you, and am pleased that you have come 

as far as from Peoria to be here with us today. The interests of the 

two down-staters, myself and Congressman LaHood, I think indicates our strong concerns about the VISN process itself as it is 

being applied here in Chicago as well as throughout the whole 

United States. 

As a member of the Illinois delegation, I am concerned about possible changes in VA health care in the Chicago area as a result of inte~ation at West Side and Lakeside. I want to understand how 

the mtegration process is going and what veterans are to expect of 

their health care system in the coming years. 

I hope to hear from all parties concerned about how the Chicago 

system integration process is going. I also can assure everyone 

present that veterans have a real champion in the ranking member 

of our Subcommittee on Health, Con~essman Luis Gutierrez, who 

has been tireless about continuing his commitment to keeping the 

dialogue between veterans, employees, trainees, and officials of the 

VA system here in Chicago. 

In fact, at a recent hearing we held in Washington, he offered to 

buy all of us lunch if we came to join him here in Chicago, and that 

is why I am here today as well. 

It goes without saying that our colleague, Danny Davis, also has 

been a real fighter for veterans and larticularly here in the Chicago area, and we are pleased he coul join us as well. 
3 

This July we had a hearing in Washington to examine facility integration throughout the whole VA system. We learned that there 

are· a few things about the Chicago integration that make it especially tough, namely, that West Side· and Lakeside have similar patient care missions, are similar sizes, are close together, and have 

active medical school affiliations that are important players in 

their. hospitals. In hindsight, we should have expected tliis process 

to be_harder than most throughout the country. 

During July's hearing, we ended up talking about the process VA 

should use to coordinate their integrations and the benefits veteransmigbt gain by integratinJI some VHA activities and facilities 

with our current fundingenVll'Onment. Some facilities have saved 

millions of ,dollars. and retrenched this funding into increasing access to primary care and other care that veterans need. 

Where the advantages to integrating services are less apparent, 

however, conflicts always seem to follow. I believe that this is the 

case is Chicago, where specific goals and benefits to various stakeholders.have not been identified and the perceived losses to all parties are great. . The -lesson I took away from that hearing is how important communicating this information is and involving those interested in 

making decisions when they clearly understand their choices. VA 

managers must offer basic guidance in the goals, directions, and 

reasons for change proposed, and then assure that veterans and 

other stakeholders enter into the decision-making process. 

So I am pleased to join my colleagues today, and I think all of 

you can be assured that we are going to follow this beyond this 

hearing today. Thank you again, Mr. Chairman, for hosting the 

hearing. __ ' 

Mr. LAHOOD. Let me introduce Congressman Gutierrez for whatever statement he would like to make, and thank him and his staff, 

and also the Chicago Park District, for making this facility available to us. And I know that Congressman Gutierrez and his staff 

have worked very hard to arrange for this hearing this morning. 

OPENING STATEMENT OF HON. LUIS V. GUTIERREZ 

Mr. GUTIERREZ. Well, thank·you. I want to thank Congressman 

LaHood for being here with us in Chicago. Thank you for coming 

up. 

Before I proceed, I also would like to recognize the commitment 

that Chairman Terry Everett has made to veterans of this country. 

It is unfortunate that he is ill and not with us, because obviously 

his commitment is well-established in the Congress of the United 

States. 

I think that, of course, we had this hearin~ because Chairman 

Everett knows from his own experience back m Alabama that VA 

hospital integrations require congressional oversight, and more importantly.. that veterans, and I underscore veterans, and other 

stakeholders affected, by these integrations need to be heard in the 

process. 

We· should all be appreciative of Chairman Everett .'for convening 

this important hearing and a1lowin~ my friend, . Mr. LaHood Congr. essman LaHood, to sit in the chmr in his place. My good friend, 

Congressman Lane Evans, also deserves our thanks for making 
4 

this field hearing a reality. I know of no better advocate for veterans than Lane. He is a tireless worker for veterans and a leader 

and a mentor for my colleagues and I on the Veterans' Affairs Committee. 

He also has a good memory. I do recall mentioning at our hearing in July that if the committee came to Chicago, I would buy my colleagues lunch. I would like to say, however, that it was not so 

much a bribe as a promotion of the fine cuisine that we have here 

in Chicago. 

Representative Davis, DanIlX, thank you for joining us on the 

committee today. As both the West Side and the Lakeside hospitals 

are in your District, your leadership and interest in this issue is 

both welcome and required for this hearing to achieve its goals. While we are on the subject of goals, allow me to explain very quickly what I believe our goals should be. As you all know, the 

West Side and Lakeside hospitals are undergoing a very significant transformation that could affect-that will affect-the health care 

received by more than half a million veterans in Cook County and 

northern Indiana. The two hospitals have been administratively merged into VA Chicago. Thirty-two task forces, examining every aspect of health care and 

support services provided by these two hospitals, have completed thell' work by submitting their recommendations to the integration coordination-committee. 

While much has been accomplished to forward the integration of 

these two facilities, many questions remain unanswered at this 

point. The most important questions, I believe, regard the individual health care needs of our veterans. 

How will these service changes, from the kitchens to the inpatient rooms to the surgical units to outP,atient clinics affect the 

health care veterans receive? And what will the VA in Chicago look 

like in 2 months, 2 years, or longer, given these new realities? 

What can our veterans expect from the new VA? 

Back in Washington we hear quite often from health care experts and VA officials a60ut the future of the VA, and we are always debating budgets and deficits and shortfalls and costs. 

But unless we actually go out and listen to the brave men and 

women the VA was created to serve and allow these courageous individuals to hear directly from VA officials and other affected par- ties, we are not really doing our job. We are not really servin~ the 

people we represent and the veterans who served in the military 

on our behalf. 

In my conversations with veterans in my District, I have heard 

a number of concerns reading the integration process. Many veterans fear that intep-ation will mean longer waits at VA hospitals and service reductions that will force them to travel farther to access the health care they have earned and deserve. Many veterans 

also do not believe that the integration process has been as fair and 

open to their concerns as it should be. 

I am not convinced that veterans have had the complete role in 

the process that they deserve. Let me, however, underscore I do believe that Dr. Joan Cummings, the director of the Service Network 

12, and specifically Dr. Joe Moore, the director of the VA Chicago, and Dr. Christopher Terrence, the chairman of the Integration Co-
5 

"oniinatingCommittee, haveworkecttirelessly ,and chard to improve '. the,processtoincludethe .pmticipation ,of veterans ,and ,other ',stakeholders,-, and they JIbOuld .-commended. , fl'be .,affiliated medieal. achools certainly have .beguD:to.work coop-

','eratively ,t.o imprOve their ~latio~ wi!h,e~c~ ~er 'and the VA, .and that 18U excellent ·signal in1ihe. nght .direction .. ,However, I 

remain, ,..concerJm,',' d tbatthel', meessis~ :openenaugb.. ,and look forward today to 'openiD.g it up ,somewhat -further. ( 

':'That ·is why I am particularly pleased today that we will receive 

testimony from .all. Without the input of all, we cannot judge whether integration is a success or a failure. And we need to hear 

from veterans. Listening and learning from you is ultimately the 

chief objective of this hearing. I alsO want to suggest to others in our audience that if you have 

questions' or concerns, you can write them down and have them 

brought up to me 80 that I may , pose them to different witnesses 

as time permits. Otherwise, with the approval of the chairman, I 

will have these questions submitted for the official hearing record 

and answered at a later date by' our witnesses. 

Imake uttanimous request, Mr. Chairman, that we do that. 

Mr. LAHOOD. Without objection. 

Mr. 'GUTIERREZ. I want to "thank all of the people here todlly, our 

local veterans, all of those who work at the VA You are all very 

important to us for your interest in this important issue. And lastly, to sa1 the process may not have started out excellently, but the 

process 18 improving, and we are here to improve it further today. 

ThaJ)k you 80 much, Mr. Chairman. 

Mr. LAHOOD. Thank you, Congressm8l\ Gutierrez. 

Congressman Davis. 

OPENING STATEMENT OF RON. DANNY K. DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Mr. DAVIS. Thank you very much, Mr. Chairman. 

Let me first of all express m., appreciation to you for taking your time to come down, up in this mstance, really, from Peoria, to Chair 

the meeting. 

I would, also like to express appreciation to the ranking member 

of the full committee, Congressman Evans, for the outstanding job 

that he has done , in processing the activities of veterans' affairs in 

all aspects ofveteran life, in all aspects ofveteran activity. 

I would certainly want to extend appreciations to Congressman Gutierrez for the role that he has played not only in protecting the 

rights and interests of vet;erans, but in terms of establishing this 

hearing and bringing the subcommittee to Chicago to take a hard 

look. 

Although I am not a member of the Veterans' Affairs Committee, 

as Congressman Gutierrez indicated a moment ago, in my Congres- sional District there are three Veterans' Administration hospitals, 

Lakeside, West Side, and Hines. I guess we 'probably have more in 

the way of veteran resources than you would find in most Coqgr&ssional Districts throughout the Nation., Therefore, we would obviously have a very keen interest. 

My staff has been intimately involved and we have been intimately involved with the planning process, I guess from the very 
6 

beginning. And I would like to commend and compliment not only 

Mr. Moore and Dr. Cummings, but also the medical schools and 

hospitals as well as other stalreholders, for the process in which 

they have been engaged now for several months. 

And while it perhaps started out murky, I think that significant 

progress has been made to the extent that we are delighted to 

know that rather than talking about, as people earlier were, the 

possible closing of one of the facilities, we are now talking about 

the integration of the facilities into a system that can provide in 

a most cost-effective way the kind of services that the veterans of 

our city and region need, should have, and have, in fact, earned. 

So I am pleased to be here. I welcome you all. Thank you so 

much for coming. And I trust that when we finish, that the veterans throughout the region will be happy, satisfied, and well pleased with the kind of services and the kind of care that is being pro- vided for them. So I thank you, Mr. Chairman. 

Mr. LAHOOD. Thank you, Congressman Davis. 

We will begin with Panel 1, and we will ask each person to take 

up to 5 minutes to summarize your statement. Your entire statement will be made a part of the record. We have a court reporter here. All testimony, all questions, and all answers will be made a 

part of the permanent record of this particular hearing. 

We are delighted to welcome Mr. James Balcer, the Director of 

Veterans for the City of Chicago; Mr. Sol Griffin, Chairman, Minority Veterans Committee, past National Vice Chairman of Montford 

Point Marines, Mr. Robert Plante, Supervisor, National Service Office, Chicago disabled American Veterans, and Ms. Brenda 

Woodall, Business Representative of Local 73, Service Employees International Union. 

And I would ask Mr. Balcer, if you would like to go first. And 

we will proceed in this direction: Each take 5 minutes with whatever statement you want. Your entire statement will be made a 

Pllrt of the record. And then we will ask questions following Ms. 

Woodall's statement. 

Please proceed. 

STATEMENT OF JAMES BALCER, DIRECTOR, VETERANS FOR 

THE CITY OF CHICAGO; SOL GRIFFIN, CHAIRMAN, MINORITY 

VETERANS COMMITTEE AND PAST NATIONAL PRESIDENT 

OF MONTFORD POINT MARINES; ROBERT P. PLANTE, SUPERVISOR, NATIONAL SERVICE OFFICE, CHICAGO DISABLED 

AMERICAN VETERANS; BRENDA WOODALL, BUSINESS REP· 

RESENTATIVE OF LOCAL 73, SERVICE EMPLOYEES INTERNATIONAL UNION 

STATEMENT OF JAMES BALCER 

Mr. BALCER. Thank you, Mr. Chairman, Congressman Davis, 

Congressman LaHood, Congressman Gutierrez, Congressman EvaftS. 

My name is James Balcer and I am a former Marine, Vietnam 

veteran, Director of Veterans for the City of Chicago. 

Let me say first that I am honored to give testimony to this subcommittee on Oversight and Investigation. 
7 

I am a member of the Integration Coordination Committee for 

VA Chicago Health Care System. I have also been a patient at VA 

West Side since 1970. I have worked closely with VA Lakeside, 

West Side, North Chicago, Hines, and regional offices at 536 South 

Clark. I have worked with patients and staff for over 8 years. As a 

member of the Integration Committee, I can say that this committee chaired by Dr. Terrence has been sensitive to the needs and 

(:oncems of patients and staff when integration has been needed. 

The first question I have always asked is, how will integration 

affect the patient? Second, will an! staff lose a job or ,position? As 

someone who has been a patient, I know how-itis to take a long 

-bus ride and. stand' in lineSnd wait lor treatment. I have also been 

unemployed. The Integration Committee · has been an open and fair process with vigorous, debate and discussion when needed. To the best of 

my knowled,e,.there has notbeen'interference from anyone outside 

the Integration Committee. 

Let me close by saying that yes, integration of Lakeside and 

West Side is needed. However, the veter.ans and staff must be considered whenever integration occurs. 

Mr. LAHOOD. Thank you. Mr. Griffin. 

STATEMENT OF SOL GRIFFIN 

Mr. GRIFFIN. Distinguished Committee, I am honored to have 

this opportunity to testify as the chairman of the Minority Veter- ans Steering Committee and past national president of Montford 

Point Marines. 

Thank you for this opportunity to testify and speak as chairman 

of the Minority Veterans Steeling Committee about the process of integr~Ii theWest Side and Lakeside Veterans Medical--

Mr. . 000. Mr.,Griffin, could you pull your microphone a little 

closer? Thank you, sir.' 

Mr. GRIFFIN. Thank rou for this opportunity to testify and speak . as clmirman of the Minority Veterans Steering Committee about 

the process of integrating the West Side and Lakeside veterans' 

medical facilities in ChicaJo. I am also speaking as a veteran and 

the past national vice presldent of Montford Point Marines. , The Minority Veterans Steering Committee has been very concerned about the fate of the West Side VA Hospital. And you may 'know, I WilB ,actively 'involved in keeping this hospital open at a 

time when the VA considered closing this hospital to help reduce ,operating costs. We are certainly glad that never haP,P8ned. 

But I must say that we remain concerned that It could happen 

at some future date. Our concern is partly based on what we see 

happening so far with the facilities integration process. 

Weare concerned that so far we don~t see 1lIl even-handed approach in the integration process. For examp'le, the ~rson' who has 

been charpd with integrating the two facilities .is from Lakeside 

Hospital. Can a person who directs this process and is 'tied to one ',hospital really be objective in determining what ·resources.and personilel go to WhichJl08~tal? 

With the input of the stakeholder committee, which I serve on, 

it shouldn't matter who directs the process. But · the input of the 
8 

committee is often watered down or comes too late. For example, the committee has too often been presented with plans that have 

been approved beforehand by the director. 

We are not provided with sufficient information on the integra- tion process, how services will be integrated, how the changes will 

affect veterans, how much the changes will cost to implement, how 

much the hospitals will save, and how the Veterans Administration will reinvest the savings to benefit veterans. 

These are important q.uestions, and the committee can't provide useful input without this information. In addition, the committee 

needs to have some clout in the process. Otherwise, we are little 

more than a rubber stamp for the director. There needs to be a 

clear definition of the authority of the committee and the director 

and how the two should work together. 

We are concerned that the director may have more authority than he should in the process. We have heard m8I!Y cOID~laints 

and concerns from staff and veterans using West Side Hospital that the director tends to favor the Lakeside facility in making decisions about where services and personnel will remain and where 

they will be cut. 

We are concerned about this because the West Side Hospital has 

a stronger record of serving minority veterans that the Lakeside 

Hospital. The West Side Hospital also was the first to have a women's veterans program. What also concerns us is that we have heard from employees at 

West Side Hospital that are being intimidated or reprimanded about any com~laints th~y have about the process. For example, a 

worker at the West Side Hospital recently wrote me a letter. 

He said that when he wrote a letter to Senator Durbin, also a 

member of the stakeholder committee the letter was sent to his supervisor instead. He felt intimidated by this and was concerned 

that there was not an open process to listen to the opinions of the 

staff and the veterans served by the hospital. Several workers have reported that complaints are discouraged. If you speak up, you get fired. Some of them have told us-an employee who is also a veteran told us that he was afraid that if he 

spoke out about his concerns, he would lose his veterans' benefits. 

A former employee w~o left for another job wrote a letter about the 

intevation process and signed it, name withheld for fear of 

reJ:)nsal. 

Recently a Lakeside staffer was chosen as the chief of nursing staff over both hospitals despite the fact that a West Side staffer 

was preferred by the committee. The staff at West Side feels unable to comment about why the Lakeside staffer was chosen for 

fear of losing their jobs. 

How can we effectively integrate these facilities if we can't hear 

from the very people who work at the hospitals and are served by them? How can we hope to get honest input if hospital workers feel 

intimidated in the process, if their letters and comments are misdirected? Who could freely provide comment in such an environment? 

I recommend to you a pamphlet written by the GAO and pre- sented in testimony on making changes in VA health care. The 

pamphlet is very interesting because it talks about lessons learned 
9 

from facility integration. One thing mentioned was 'the need to pro- vide a detailed integration plan to stakeholders before any imple- mentation begins. What happens. with our committee is that by the time we hear 

of any .plarifJ,'thinp:are already done. There needs to be more gen- uine input by the. committee, and that means nothing should happen until the eommittee,has approved plans. Second, there needs to be mere oitjectivity in the decision-making 

process, more independent judgment that isn't.·tied to the interests 'ofone hoepital-over,the other. . FinallYt we need to apen .the process so that those people who 

work in the hospitals or'who -are served by them feel free to comment about their feelingsoD the process-ofthe integration. I am not here on -behalf of the Minority Veterans Steering Committee to ·ugue against the cost reductions. We know that cost-cuttingjs part DfreaHty for the health care of veterans, just like they 

are part of-reality for the private sector. 

But I· am here to argue · for a . more fair and reasonable process, 

one that' takes into account the needs of the veterans. The West 

Side Veterans' Hospital serves a .population that does not have the 

financial reS6UJPCe8 to get.medical care they desperately need. If the 'purpose of the facilities integration process is truly to serve the veterans, then let's look at what their needs are. 

Thank you again for this opportunity to voice the opinions of the 

Minority Veterans Steering Committee,and to urge you to make 

sure that the facilities integration process does not result in the 

closing ·of one of these hospitals, or an even distribution of services 

between the two hospitals. Thank you again. 

Mr. LAHOOD. Thank you, Mr. Griffin. 

Mr. Plante. 

STATEMENT OF ROBERT P. PLANTE 

Mr. PLANTE. Mr. Chairman and members of the subcommittee, 

on behalf of the 25,000 Illinois members of the Disabled American 

Veterans, I am pleased to present our views concerning the integration and consolidation planing of the ~artment of Veterans 

Affairs, VA Chicago Healtli Care System, eside and West Side 

Divisions. 

At this time, I would like to take this opportunity to commend 

Dr. Joan E. Cummings Network Director, Veterans Integrated 

Service Network 12, for her concentrated efforts to p~de quality health care services for all Chicago area veterans. Her tenacity it 

overcoming major obstacles to achieve this endeavor is in keeping with the highest traditions of the Veterans Health Administration. 

We believe in order to · continue to provide quality health care 

services to the Chicago area veteran population, the integration and consolidation of services at Lakeside and West Side divisions 

are necessary. We also believe it is essential to maintain both facilities to adequately care for this significant veteran population. 

The following information sets· out the services provided at the 

Lakeside and West Side facilities. 

Lakeside division is a 350-bed facility with 1,200 employees and 

a $96 million budget and 300 volunteers. It provides both primary and tertiary care to approximately 460,000 veterans in Cook Coun-
10 

ty, Illinois and Lake County, Indiana, trovided treatment for 

21,746 veterans in the fiscal year 1995, an attended to 6,600 inpatient admissions and 208,000 outpatient visitations. 

The West Side division is a 435-bed facility with 1,570 employees and a $123 million annual budget, providing primary and tertiary 

care to approximately 411,000 veterans in Cook County, Illinois. It 

provided treatment to 24,781 veterans in fiscal year 1995 and attended to 8,100 inpatient admissions and 280,000 outpatient visitations. 

It is our understanding that the integration and reorganization efforts of the VHA are to reduce operating costs, improve access to 

care, enhance and standardize the quality of patient care, and to 

improve satisfactions of services. In our view, these are attainable 

goals. We also believe integration and consolidation of service is a 

practical approach to reaching these goals. The formulation of the Management Assistant Council, the 

Stakeholders Advisory Group, and the veterans advisory council 

within the VISN provided for stakeholders organizations to become 

an integral part of the reorganization effort. This allowed for open lines of communication to acquire direct information and present 

feedback during the process. It also served to suppress the rumors 

regarding the closure of the West Side division. 

During the initial planning stage of integration, veterans service or~anizations accepted an invitation to meet with the University of 

Illinois Medical School, the affiliate at the West Side division, and 

its consultant to discuss the rumored closure of West Side. 

A rumor had been leaked to the local media prior to the formulation of the stakeholders advisory group. The VSOs made it clear 

that their concerns were focused on the continued availability of 

health care for local area veterans, insuring that no additional burden would be placed on veterans seeking necessary treatment. 

Soon after the media leak, local union representatives from West 

Side contacted VSOs to express their concerns and ask for support 

to establish lines of communications. We advised these individuals 

of our primary concern and offered to forward their concerns to the 

Management Assistance Council. 

VSOs then met with the General Accounting Office to express 

their views concerning the physical plant at West Side. The 

conversation focused on the VSOs' responsibilities to area veterans 

and the necessity of retaining West Side to serve the veteran 

population. 

The DAV was and remains concerned by the lack of input from 

stakeholders initially with the formulation of the Management Assistance Council. We believe that future efforts must include the 

involvement of stakeholder organizations in the initial design 

process. 

We believe that in the process of insuring across-the-board stakeholder involvement, the VISN entangled itself in a web of groups, committees, and councils, thereby ~enerating initial confusion and 

suppressing stakeholder participatIon. Presenting an overall plan 

pnor to implementation would have enhanced stakeholder partici- pation. 

In the beginning, communication with stakeholders was limited 

to one or two mediums. Efforts to utilize electronic mail, hot lines, 
11 

newsletters, and conference calls were none existent. We believe a 

more comprehensive communication plan would have averted the 

perceptions of impending closure olthe West Side facility. 

We believe it imperative to include stakeholders, affiliates, and 

the news media in the VHA's effort to communicate its plan and 

the processes necessary to achieve its objectives of quality health 

care. 

In closing, we believe that major hurdles have been overcome 

and Chicago-area veterans will be the beneficiaries of quality 

health care services provided by both Lakeside and West Side divisions of the Chicago VA Health Care System. 

Mr. Chairman,thank you for convening this hearin!l~ay, and 

thank you for your efforts on behalf of veterans · resi' in your 

Districts and throughout the Nation. 

This concludes my statement. I will BE happy to answer any questions you or the committee members may have. 

Mr. LAHOOD. Thank you, Mr. Plante. 

Ms. Woodall, I am sorry if I mispronounced your name earlier. 

Please proceed. 

Ms. WOODALL. Okay. 

Mr. LAHOOD. Would you pull that microphone closer to you, please? Thank you. 

STATEMENT OF BRENDA WOODALL 

Ms. WOODALL. Good morning, Chairman, Congressmen. I come 

here today representing the members of SEIU Local 73 who work 

at the Lakeside and West Side facilities. I understand my time to 

speak is brief, so I would like to address three points regarding the 

VA hospital consolidation process: the process by which the consolidation of services has taken place thus far, the impact the consolidation has had on the workers of the facility, and the impact of the 

consolidation on the quality of patient care. 

First, the process. Local 73, I was· asked to sit in on meetings on 

the Integration Committee. I assumed the purpose of my involvement was to inject the concerns of workers into the decision-making process. I was wrong. 

My voice, and therefore the voice of over 1,300 workers I rep- resented was drowned out· by the rest of the committee. I offered 

a proposal to address our concerns and was told that it would not 

be included in the final recommendation and to negotiate with the 

individual hospitals, which, as you know, does not make any sense 

at all. 

The concerns I raised were not taken seriously, and as a result 

the consolidation has had an extremely negative effect on hospital penonneland the quality of patient care. . The impact on the workers, I would like to talk about secondly. The cutbacks on staff have been devastating. We used to have 200 

people clean LakesidelW est Side VA. Since the consolidation, the 

same amount of .cleaning .has to be done with far less personnel. It equates to about one person responsible for cleaning 33,000 

square feet, where the national average is 15,000 square feet to be 

cleaned by one individual. I don't have to tell you what it means 

in terms of worker injuries and employee morale. And that doesn't 
12 

even get to the problem the consolidation has caused in terms of 

providing the best level of patient care ~ssible. 

This leads me to my third and most unportant concern, how this 

consolidation has impacted the patients. You can imagine what 

happens when you cut the cleaning staff. But what happens when 

you stop replacing administrative personnel and cut LPNs and 

nurses' aides, the people who provide the most direct patient care? 

Well, the first thing that is affected is the entry pomt to service 

delivery. With bare bones administrative staff, the waiting time for 

patients has increased dramatically, and once they ~et in, the time 

that someone can spend caring for them is cut conSIderably. When 

staff are forced into a situation where they have to run from bed 

to bed, nobody wins. 

The staff suffer from injuries and low morale because they are 

not able to give the best care possible, and patients suffer because 

they don't get the best care that is needed. 

Veterans deserve to be treated with dignity. This plan was developed and implemented without input from those who give the care 

and those who receive the care. Although the process of consolidation has started, I think it would still be worthwhile for management to meet with workers and veterans to assess the damage already done and figure out ways to minimize the negative effects for 

the future; 

I appreciate the opportunity to raise these concerns, and sincerely hope that what has happened here will serve as a lesson for 

others in the areas in which to be consolidated in the future. 

Thank you. 

Mr. LAHOOD. Thank you. We will begin with questioning by Mr. 

Evans, and we will use the 5-minute rule. And then if we need to 

have a second round, we can do that. 

Mr. EVANS. Mr. Chairman, I would like to ask all the veterans 

service organizations whether they have yet seen at this point any 

cost savings, increased patient access, or quality improvements 

since this integration process has started. 

Anyone have any comments? 

Mr. PLANTE. We certainly have seen a lot of cost savings based 

on the reduction of duplicative services at both Lakeside and West 

Side. And we believe that certainly is essential, you know, to the 

consolidation process and to achieve continued quality health care 

at both facilities. 

Mr. EVANS. Anybody else like ~ 

Mr. GRIFFIN. I would agree, the same thing. 

Mr. EVANS. Can you pull the microphone closer? 

Mr. GRIFFIN. I would agree, the same as my colleague. 

Mr. EVANS. All right. We came here very happy that things seem 

to be changing somewhat in terms of the dissemmation of information to veterans' groups, yet the Montford Marines feel that they 

have not-if I am reading you right, sir-been involved in the decisions that are being made. At a point where you are asked to give 

some input, it has already got so much momentum, quite often, 

that you have no real input whatsoever. 

Some other veterans' groups have indicated that they feel there 

has been better communicatIon, but you haven't seen that at this 

point? 
13 

Mr. GRIFFIN. Well, we have seen some communication. But I 

think that my statement basically is based on what we hear from 

employees . and veterans in terms of the-we are not against the .process.of,integration. That is notour issue at all . . The 'only.'thing .from the complaints that we get is how that the proces8 is going cIn r.eferencetothe intimidation and these kind of 

tbings,we.'are,very COllCemedcabout that because we feel that re- gardlessof how you feel'about the process, you should be able to 

express your views 'without, you know, any concern of intimidation. 

N'Ow,when we get these complaints,we feel that 'we should 

speak about it,and hopefully that ·this committee, maybe that some 

of these complaints might not even be true. I don't know. But I 

think that it would be·worth .or.hopefully that the committee would 

maybe look at some of these issues and investigate some of these 

things that we hear. 

Now, we feel that how we got into it, actually, we weren't involved in the .initial process. The Montford Point Marines were not. 

And I think ........ 1 have served on Congressman Gutierrez's Veterans' 

Affairs Committee, and how we got into it, after the press noted 

that there was a change in the health care system for these hospitals, we were riot invited to participate. 

And how we became a part was after that, and I was told that 

they didn't know anything about us even though we 'are a national 

veterans organization, the first blacks in the Marine Corps. And we 

were quite intimidated with that-that they had talked to all the 

other groups, in other words, American Legion, VFW, DAV, all of 

them. 

But our organization is structured to do the same things that 

these groups do, and we feel that we were not--but since that time, 

when we got, I guess, maybe we forced our way in, basically, to be 

heard, we have been. . And I sit down-I have made the stakeholder meetings. I don't 

think I have missed any of them. I have sat with the advisory council. I see a lot of good things in the process. But this one issue 

that really disturbs me and disturbs the people that I represent is, 

let's' bring it out, find out if these accusations are true, and if they 

are not true, so be it, and let's continue with the business. But we 

are concerned with that. 

Mr. EvANS. I thought we were doing pretty good by having two 

Marines on the first panel, and a sailor as well. That is not bad 

for representation here today. 

Let me ask you, Mr. Griffin, I don't understand. I was in the Marine Corps, so I understand a lot of the military acronyms, and the 

VA uses some acronyms. Are you-is your Veterans' Advisory Committee plugged into the Management Assistance Council, the 

Stakeholders .Advisory Group, or the Veterans' Advisory Council? 

Mr. GRIFFIN. Yes. I sit on the stakeholders and the advisory council. 

Mr. EVANS. But you don't feel minority veterans-as chairman of 

the minority. veterans group, that you have gotten the kind of input that you think you should? 

Mr. GRIFFIN. No, sir. I think we have got some of the input. In 

fact, when this process first started, I was very reluctant. But I 
14 

have looked at the process and meeting with Dr. Cummings, and 

I see a lot of things that are happening are good. The only thing that sort of still · gives me a little concern about 

is the same thing that I am seeing, is that whenever they make 

these decisions, who makes the decisions? I don't feel that any decisions should be made by one individual, whoever they are . . And yes, we are concerned about that. And we feel that we are 

getting some input by me being a member of the stakeholders 

committee. 

Mr . EvANS. Brenda, just one question. You referred to increases 

in patient waiting time. You are not talking about waiting in the 

clinics and waiting rooms; you are talking about inpatient waiting times for help for the individual patients when they need a procedure to be done or some other test to be carried out for them, some- ~y that is already in the hospital. 

Ms. WOODALL. Both. 

Mr. EVANS. Both? 

Ms. WOODALL. With the down-with integration, what is happen- ing is they are being considered to be one service, such as, say, xray. And with the moving of staff back and forth sometimes, which 

oCcurs, we don't have enough personnel to actually service the 

veterans. 

So you have increased times for patients to do tests in-house as 

well as the waitin, lines because of the staffing levels administratively even to get m to see a doctor, an RN, or what have you, or 

even with pharmacy lines have increased. Mr. EvANS. All right. Thank'you, Mr. Chairman. Mr. LAHOOD. Congressman Gutierrez. 

Mr. GUTIERREZ. Thank you, Mr. Chairman. And thank you to all 

of the members of the panel this moming. Welcome here. 

I guess as I sit here and listen to the testimony, it seems as 

though for the most part people feel the process is improving, that 

it is going in the right direction. But we still have some hurdles, 

some objections that we have heard here this moming, some hurdles, some problems in streamlining this process. If I hear you right the Service Employees Union representing 

the employees feels ~t they are one stakeholder in the process, ~ut that they are ptting shut out and that they are not being 

proper!y_ heard within the group. Is that a correct--

Ms. WOODALL. Yes. I would say that is correct. I mean, there are 

times where we are made aware of certain circumstances. But 

often the decisions already are made and we are coming in at the 

back half of it. 

And employees, you know, we are trying to explain what is going 

on and telling them it is getting better. I think the overall process 

is improving, but I think the problems came about in the first half 

where there wasn't that open line of communication so we can give 

people the support they need in order to be assured that they are 

going to be employed or that, you know, one hospital is not going 

to overrun the other hospital. 

I think the lack of communication from the whole process has 

been a significant problem. 

Mr. GUTIERREZ. So we started with a very murky, and Congressman Davis described, a muddled process of communication to one 
15 

that is improving but still leaves something to be desired. Because 

I-Mr. Balcer, I remember first of all saying to Mr. Balcer and Mr. 

Griffin, both of whom sit on my Veterans' Advisory Committee and 

have been such great help to me as a Congressman to understand . . I want to thank you and.all the other members that are here today. 

I want to thank both of you. Jim,:what do you think? I mean, you said earlier you were concerned about the veterans and you were concerned about the employees. 'From what you have eeen, what can we do better? 

Mr. BALCER. I would suggest, and lhear-if there is an issue of 

the veteran, how willthe ·veteran be treated, and what is the time 

traveling? That is what my higgest concern is,because I remember 

to this day having to take a .bus from 123rd and Normal to the tail 

end and spending hours on that bus, and then get in line and wait. 

What I try to look at is, what is the time? How will the patient be affected? What .are the employees,-I don't want to see anyone 

lose their job. I don't want to see anyone put on the street. So that 

is what has always been my concern, and I have always tried to 

be a voice to· those two groups, especially the veterans. 

It is not nice to have to take a bus and then stand in line. And 

I will admit, yes, that-at first there were problems with this process. But now it seems to be smoothing out. It is-and I brought along some information, some documentation, that we were given 

on each of the integration questions. This is what we were given every time we . were there. So the 

committee-the integration, speaking .of the integration, was given 

ample information to go over these questions. 

Mr. GUTIERREZ. Okay. And then in listening to you, Mr. Griffin, 

you-I am sorry-'you are raising some concerns, legitimately so, 

that you have heard from different people and from different 

sources. 

But you have · also stated that you think it is going in the right . direction. Y{)U think people are integrating more into the process 

and more are · being heard. But there are still some people you think and · some issues you think that need to be wrestled with and 

addressed? 

Mr. GRIFFIN. Definitely so. I think the process, like you say, is _going well compared to what it was when we started. And I think 

weall-as a veteran community, we know that we have to accept changes,. not only to the process. 

And I think that what I would like to see, you know, I hate to 

stand before this committee and to present these kinds of statements. Somehow I think that to clear the record in terms of things 

that I have voiced by opinion on, is I think it should be an evenhanded process, is that there should be some sort of investigation 

to either prove that this is right or this is wrong. _ But as far as the overall integration process, I think that what '·we see, even if there are some things basically we don't like but 

we know that we have to accept change because .of the economic 

structure. 

But for the veteran, we are very much concerned, and I would 

say that maybe if we look at both hospitals we are concerned 

about. But then when I look at the situation at the West Side, I 
16 

see the population of the homeless veterans and all these people 

who have to be served by that institution. 

And I think that one of the biggest problems, maybe, that they have with the statements that I am making is that there is a lack 

of communication between the director and the staff or the veteran. 

Mr. GUTIERREZ. I think, Mr. Plante, you put it probably as pre- cise as could be in terms of giving an historical overview. Do you think there is room for improvement in terms of this communication, and if you do, where do you think that room for improvement might exist, given where we started and where we are at today? 

Mr. LAHOOD. Could you use that large microphone, please? 

Thank you. 

Mr. PLANTE. kain, Congressman, I believe that we need some 

prior planning. We need to involve all parties concemed, not only 

the VSOs and the affiliates, but also the news media, and ensure 

that they know what is going on. The employees, obviously, fall 

into that stakeholder category. 

And we believe that if everyone would have been involved initially and prior to the formulation of all of the committees and 

councils and advisory boards, that the communication would have 

flown-would have flowed much easier, if you will. And being so, 

the communication problem would have at least brought itself 

down to a low roar. 

What we saw was an initial conflict, initial panic, and phone 

calls were just pouring in to all the veterans' service organizations that are located in the regional office. 

And we met to discuss what you should do to try to alleviate that 

problem. As to stakeholder participation in the initial Jllan, how 

are we going to look at this problem? How are we gomg to approach it? And how are we goin~ to address the concems that are ~oing to be brought up in the initial processes of consolidation and 

mtegration? 

Mr. GUTIERREZ. I think that maybe-and we will discuss this 

some more, and obviously we will have Mr. Moore and Ms. 

Cummings come up right after this panel and they will be able to 

answer some questions-but maybe if we could get some more information from them in terms of where we are going with the 

employees. 

How many employees do they see being in the integration, so 

that we can have a sense of where we are going and work more 

collectively with the labor unions? 

But I think if you knew where they were going, you could have 

a better sense of what the future-and you could have a better dialogue and discussion, and therefore ameliorate any issues and problems, and figure out a Elan of how you are going to get there so 

that the employees aren t affected-I am sure there are-you know, 

people don't have to lose a job. People-there are different ways 

that you can go about reassessing and reevaluating your personnel and assigning them to different issues. 

And I just want to say that I agree with Mr. Plante. You know, 

this process started out with so manhJ~kcusations and so much finger-pointing because the process-I t· the VA understands that, 

and I think they have made-from what I hear from all of you, because all of you agree on one thing, and I think that that is very 
17 

important, that it is heading in the right direction, that there is 

more communication and that there are room for improvement in 

that communication. 

So I think that is light years ahead of where we were at one year 

ago. And so I am happy that you all came. And I want to just state 

for the record, Mr. Chairman, that I think we are working in the 

right direction. 

I am happy that we are going to have Mr. Moore and Joe 

Cummings come up in the next panel, because I want to say one 

thing,and that is that I had a wonderful conversation with Mr. 

Moore. And ,I know while some people still have some reservations because of this LakesideJWest Side thing, I think he has taken a lot 

.of steps to make sure that there is a fair and equitable treatment 

in terms of his new-he is the new director. And he came from 

Lakeside, not West Side. 

But I think that given his history and given where he has been 

at and his commitment to veterans, I am happy to see that those 

kinds of accusations have not been raised here today, because I 

think that he is trying to do a very, very good job in integrating 

everybody and to be fair. 

And I am sure we will be able'to raise to Mr. Moore some things 

that Mr. Griffin and Ms. Woodall have brought up here today so 

that we can better flesh this out. That is part of the process. And 

I look forward to hearing from Mr. Moore and Joan Cummings at 

the next panel. Thank you very 'much. 

Mr. LAHOOD. Thank you. Mr. Evans, any further questions? 

Thank you all very much for being here. I believe it was-did you 

want to say something? 

Mr. BALCER. I just wanted to go on record as saying that ,I agree 

with Mr. Griffin. If there is any form of intimidation or retaliation, 

it should be investigated. It should be ferreted out, and let's get to 

the bottom of it to find out if it is reality or if it is false. Thank 

you, sir. 

Mr. LAHOOD. Thank you. Thank you all very much. 

It was S\1gge8ted that we take Panel 3 next. Is that okay withI believe that we will take Panel 3 now. Dr. Moss and Dr. Colten, 

if you could come forward, please. 

Those large microphones are the ones that will amplify your 

voice. So if you will use those. 

Dr. Gerald Moss is the Dean of the College of Medicine at the 

University of Illinois at Chicago, and Dr. Harvey Colten is the 

Dean ofthe-Vice-Presidentfor Medical Affairs, Northwestern University Medical School. 

If you would like to take 5 minutes to make a statement, your 

entire statement will become a part of the record. And then we will 

ask our members to ask questions. Whoever would like to go first 

may proceed.. 
18 

STATEMENT OF GERALD S. MOSS, M.D., DEAN, COLLEGE OF 

MEDICINE, UNIVERSITY OF ILLINOIS AT CmCAGO; AND HARVEY R. COLTEN, M.D., DEAN, VICE PRESIDENT FOR MEDICAL 

AFFAIRS, NORTHWESTERN UNIVERSITY MEDICAL SCHOOL 

STATEMENT OF GERALD S. MOSS, M.D. 

Dr. Moss. Good morning, Mr. Chairman, and distinguished 

members of the Veterans' Affairs Subcommittee on Oversight and 

Investigations. My name. is Gerald Moss. I am professor of surgery 

and dean of the College of Medicine at the University of Illinois at 

Chicago. 

Mr. LAHOOD. Let me just ask you to wait, sir. I wonder if those 

who are having conversations would step to the outside of the doors 

so that Dr. Moss may be heard by those who are in the room. 

Could we close the door back there, please? Thank you very much. I am sorry. Would you mind beginning 

over? Thank you, Dr. Moss. We missed part of your opening statement. 

Dr. Moss. Good morning, Mr. Chairman, and distinguished 

members of the Veterans' Affairs Subcommittee on Oversight and 

Investigations. My name is Gerald Moss. I am professor of surgery 

and dean of the College of Medicine at the University of Illinois at 

Chicago. 

I appreciate the opportunity to appear before you this morning and to update you on developments in the relationship of the VA 

Chicago I1ealth Care System with the UIC College of Medicine. . First, I want to express my thanks and the appreciation of the 

university to Mr. Gutierrez, Mr. Davis, Mr. Evans, and Senators 

Moseley-Braun and Durbin, and to former Member of Congress 

Cardiss Collins, for their outstanding leadership on this issue. 

I am convinced that their efforts have brought about many constructive developments in this evolving relationshi~, and have been 

of enormous value in meeting our joint responsibilities to provide 

care for veterans that is truly second to none. 

I am particularly proud to note that the University of Illinois and 

Northwestern University were the first two universities to establish a direct and formal relationship with the VA Health Care System more than half a century ago. 

All of us in health care are being challenged by enormous 

changes in the financing and delivery of health care, and many of 

those same changes are affecting the VA. We fully recognize that 

the VA must adapt and adjust to those new operational and fiscal 

realities, and I want to assure you that UIC is committed to working with the VA to make those changes in a way that benefits veterans and optimizes the educational environment of both intuitions. 

As you know, we have been concerned about the proposed 

changes in. the VA system here in Chicago. Many of us have been 

working over the past year and more to ensure that any decisions 

to be made were driven by accurate and relevant data, and that all 

of the affected constituencies were appropriately involve~J and that 

the best interests of veterans and those who care for tnem were 

foremost concerns. 
19 

The process to integrate services at Chicago VA, one established 

through your efforts and those of then-Secretary Jesse Brown approximately one year ago, have worked. well. I am_pleased to 1"eport 

to you today that the dean of the Northwestern University School 

of Medicine, Dr. Harvey Colten, and I have worked out an agreement that we are convinced will serve the VA, its patients, and our 

students well. 

Specifically, we have agreed ... thatwe will together propose to the 

director of VA Chicago Mr. Joseph Moore, a joint dean's committee 

made up of members-from· both. medical schools 'and both divisions 

of VA Chicago to ~h!:ce the existing two dean's committees. 

We believe that . joint committee will assist VA Chicago to realize operational efficiencies, to preserve the -high quality health 

care that our veterans deserve, and to maintain the. superb educational and research environment afforded by the VA system. In addition, UIC is working' actively with VISN 12 to help it 

evaluate health care needs of veterans in this region. This is clearly a work in progress; But there are lessons in the Chicago experience that will. be useful in other areas of the country as the VA 

strives to consolidate its facilities to reduce duplication and over- lappin~ efforts. 

I believe that a rational process for such consolidations would involve a number of steps I have listed in my written testimony. I 

would like to summarize those. 

First, the VISN director must identify those areas in which duplication of effort seems likely and where geography might permit 

service consolidations. 

Second, the stakeholders in existing facilities must be convened 

and a clear articulation of the problem must be presented. A mutually agreeable process must be established with adequate time to 

deliberate. Public discussion must occur. 

Third, all the data necessary to make fair, balanced, and equi- table decisions must be gathered, and appropriate consultations 

from a neutral third party is highly, highly desirable. -Finally, a durable oversight mechanism to insure that all parties 

are treated fairly should be in place. . In any undertaking of this complexity; mid-course corrections are 

inevitable. I would respectfully recommend that' this committee 

consider these criteria carefully, which may well serve to guide VA 

mergers or consolidations across the United States. 

There is one other area of concern to me and many of my fellow 

deans. The Veterans' Equitable Resource Allocation, known as 

VERA, is shifting money from VA systems in the northern tier of 

States to those in the southern tiers. We are concerned VERA does 

not take into account the health status of those veterans in the 

northern States, nor recognize that the majority of training programs, with their attendant higher costs, are located in these 

States. 

I hope that the committee will objectively evaluate the effects of 

this new resource allocation system and make corrections if they 

are found to be necessary. 

Mr. Chairman, I am grateful for your interest and leadership in 

this extremely important issue. The College of Medicine at the University of Illinois at Chicago, and I as a Navy Vietnam veteran my-
20 

self, are quite proud of the relationship we have with our affiliated 

VA Medical Center. I welcome the opportunity to answer any questions you may have. Thank you. 

[The prepared statement of Dr. Moss appears on p. 38.] 

Mr. LAHOOD. Thank you, Dr. Moss. 

Dr. Colten. 

STATEMENT OF HARVEY R. COLTEN, M.D. 

Dr. COLTEN. Thank you, Mr. Chairman, gentlemen, Mr. Evans, 

Mr. Gutierrez. I assume Mr. Davis is here. 

I, too, am pleased to have a chance to speak with you this morning. I came into this process relatively late, and it sounds like it 

was a good time to come in. There were many difficulties early in 

this process. That is not a surprise. Integration of medical services 

reqUIre enormous amounts of reshifting of thinking, resources, and 

as well as activities. . We are involved in a process that medical services are going 

through throughout this country. And we are leading the way in 

this process in a complex situation where two academic medical 

centers have a longstanding relationship with the VA, as you have 

heard from Dr. Moss. 

The cooperation that is developing between these two institutions, I believe, will not only facilitate the process, but will be sensitive to the stakeholders' concerns that we have heard about 

today. 

I want to point out to you, as I did in my submitted testimony, 

that the enVU'Onment within an academic medical center creates a 

kind of "sunshine culture," a culture in which the availability of 

data is wide open, where decisions can be data driven, where the 

best choice among difficult choices sometimes have to be made, and 

can be made in the presence of free and open information. That 

process has been taking place! 

My experience thus far is that the leadership of the VISN under 

Dr. Cummings and Dr. Moore as director of Chicago VA, and Dr. 

Terrence's leadership in the integration committee, has been most 

commendable. I believe I have never seen anywhere, as fair an effort to take into account the views of widely disparate groups. 

In the last analysis, not everyone will be ~I?PY with the solutions. But it seems to me, if the objective is the highest quality care 

at whatever cost savings we can accomplish, we have achieved the 

purpose by increasing the value of veterans' affairs and health care 

to veterans. Value, of course, is a product of quality and cost. 

I believe from what we have heard today that,we must redouble 

our efforts to be sensitive to the stakeholders even though I believed we were doing a good job. 

I think we have to take seriously what we have heard today; 

make an honest effort to hear out all the arguments, but then, as 

has been done ~ far (and I am impressed with it) make those decisions that seek the ultimate objective. If that objective is served, 

then I think all the veterans are served; the academic institutions 

are very supportive of that. 

Dean Moss has indicated one of the several steps that we have 

taken to streamline the information processing and distribution so 
21 

that we can:avoiderrors of ,communication that .occurred in the 

paat;that is, the "'COnstruction of a single,dean'scoDlmittee. 

I believetbat, is not , enough. 'We must -do more. -We must redouble" our efforts. We "are delighted that you are here to help us in 

that :effort,and we thank you very much for the opportunity to 

speak with you this morning. ,lThe_Prej)ared'statement of Dr. Coltenappears on p. 42.] 

Mr. LAHOOD. Thank you. Congressman Evans. _ Mr. EvANS. Thank you, Mr. Chairman. I think I can speak. for 

the entire Illinois dele¥ation when Is~y we are so 'happy that you have come up , with this compromise. There was a lot of effort put 

into it, I am sure, and we think this is definitely a step in the right 

direction. 

Let me ask you, though: I have heard that medical programs require a certain number of patients, a so-called critical mass, to operate effectively. Are you always sure that the patient populations 

using the divisions of the Chicago VA 'comprise a critical mass? 

And that would be ,particularly a concern about surgery. 

Dr. COL'i'EN.Yes, sir, when one is talking about surgery, in gen- eral, I believe that is true. There may be surgical subspecialties 

where consolidation is appropriate on that basis. 

This is not simply an educational requirement. It is a requirement for skill ,maintenance. Surgeons who are not doing a sufficient number of, procedures will, in fact, have their skills deteriorate to some extent. So 'these guidelines of service numbers include , both quality of care issues as well as educational issues. 

Dr. Moss. Well, it is confounded in the surgical.area by the fact 

that the surgeons, tend to move back and forth between the VA and 

the university. So while there are ebbs and flows of surgicalactivity at the VA or the university, they tend to cancel each other out 

at the other side. So both of us watch those numbers pretty carefully, as do the department heads in those surgical areas. 

And we are concerned about that, for sure, but at the moment 

I think the numbers are satisfactory. 

Dr. CoLTEN. Mr. Evans, ifl might add: for example, at the Lakeside division, while there are 147 VA-employed physicians, there 

are 263 physicians from the Northwestern faculty who contribute 

their services, but their principal practice is at Northwestern Memorial Hospital. What Dr. Moss says is very well supported by the 

statistics. 

Mr. EvANS. All'right. Thank you, Mr. Chairman. 

Mr. LAHOOD. Congressman Gutierrez. 

Mr. GUTIERREZ. Thank >,ou. Thank you very much, Dr. Moss, Dr. 

Colten, for being here this morning. I am delighted to have been 

able to read your testimony and to hear from you this morning. 

For many members of this committee and particularly for this 

member, sometimes it felt like it was a Big Ten game going on out 

there. And your alumni from each side are calling up and cheering and rooting for one side or the other, and they are all saying that 

Mr. Moore was an unfair referee and we had to get somebody else 

out there. ' 

And so, you know, I am happy, delighted, because, you know, 

here were the veterans and here were the hos:pitals, who are very 

necessary. Both of you are so necessary to thelr care. People need 
22 

to understand that independent of your own self-interest as institutions, you benefit the veterans, the men and the women that go to 

the hospital. . Sometimes I felt like not saying anything myself since I didn't 

feel that objective since my dad goes to Lakeside, and I said, maybe 

something I said might go wrong here. What about when the West 

Side folks find out my dad goes to Lakeside? You know, it gets real 

tricky for all of us, and was extremely difficult, I know, for Mr. 

Moore and for Joan Cummings and for others involved in this process. And I kept saying to myself that I knew that this is exactly what was going to happen. 

I said to myself-number one, I thought, doctors. In my view, 

who is a doctor? Somebody that I go to to get advice. I mean, I 

don't go into an office as a Congressman to go and argue the partisan debate with him. I go so that he can tell me how to get better. 

Then I thought, deans. And since now I have been graduated for 

25 years and I am not a university student, when I was an university student, I don't know if I held deans in that hi¥h regard. But 

25 years later, as someone who is about to have his daughter go 

to the university, obviously I have a whole different take. 

So between dean and doctors, I said-and the university, prestigious institution, University of nlinois, Northwestern, I said, I 

think they can figure this out, which was exactly my conversation 

with Mr. Moore when we sat down. I said, you know, I think they 

are going to figure it out in the end. 

And I want to commend you and congratulate you. Let us know, 

because I think Dr. Moss, your point is well taken. It is going to 

be about resources, about how we nationally apply those resources, 

those dollars. And they are shifting. And you are going to be-both of your institutions, I think, are 

going to be instrumental, fundamental, in relaying that information to the VA and being a source, an academic source, a credible, 

objective academic source, so that we can go and make those arguments when people want to say that all the veterans are going to 

Florida and Arizona and Southern California, and so you can do 

without this because we are going to shift those; that you can come 

back and supply that kind of coordinated message, not a message from the U of I and another one from Northwestern, but a coordinated message for our veterans. 

Because in the end, it is more than your institutions. I know 

that. In the end, it is about men and women that your doctors and 

your physicians and your medical experts serve, that I know you do everything possible to serve them well. 

So where those resources are at and, you know, some of these 

waiting periods and some of these problems, you know, are they 

independent of this consolidation? Because we have a consolidation 

that is occurring, and then people blame everything on the consolidation without looking at other objective factors, such as what is 

the Congress doing in terms of allocating resources. 

So, you know, if consolidation came about at a time of many resources, you would probably have a much happier consolidation. 

But were it to occur, and I don't want people to get blamed wrongfully for things that went wrong. I want-because otherwise you 

don't get a solution. All you get is scapegoating of the process. 
23 

So I thank you so much for being here. You know, in the begin- ning there was so much confusion, so much bickering and fighting 

and turmoil-at least that is the way I remember it-that I am 

happy that you are here, happy that you are working coordinated, 

which I knew was going to happen because, you know, you serve 

the State of Illinois well, you serve the City of Chicago well. 

I know what kinds of institutions you represent and I know what 

kind of men and women you represent. So thank you so much for 

being here. 

Dr. COLTEN. Thank you, sir. We are actually rooting for Chicago VA now, not for single institutions in the Big Ten. 

Dr. Moss. Let's hope for better luck in the future on our football 

teams. 

Mr. LAHOOD. Okay. Thank you both very much. 

We are going to take a 5-minute recess and then the next panel will come forward. Thank you both for being here. 

[Recess.) 

Mr. LAHOOD. We are going to reconvene now, and I ask all of you 

to take your seats for our final panel. Our final panel includes Dr. Joan Cummings, Network Director 

of Veterans' Integrated Services Network 12, Department of Veterans Affairs; Mr. Joseph Moore, Director of VA Chicago Health Care 

Systems, Department of Veterans Affairs; and Dr. Christopher Terrence, Chairman, Integration Coordinating Committee, VA Chicago Health Care System, D~partment of Veterans Affairs. 

We are grateful to all of you for being here, and ask that each 

of you take up to 5 minutes to make whatever statement you would 

like. Your entire statement will become a part of the record. And 

then we will ask questions. 

Whoever would like to go first. 

STATEMENT OF JOAN E. CUMMINGS, M.D., NETWORK DIRECTOR, VETERANS INTEGRATED SERVICE NETWORK 12, DEPARTMENT OF VETERANS AFFAIRS; JOSEPH L MOORE, DIRECTOR, VA CHICAGO HEALTH CARE SYSTEM, DEPARTMENT 

OF VETERANS AFFAIRS; AND CHRISTOPHER F. TERRENCE, 

M.D., CHAIRMAN, INTEGRATION COORDINATING COMMITTEE, VA CmCAGO HEALTH CARE SYSTEM, DEPARTMENT OF 

VETERANS AFFAIRS 

STATEMENT OF JOAN E. CUMMINGS, M.D. 

Dr. CUMMINGS. Thank you, Chairman LaHood, Congressman 

Evans, Congressman Gutierrez, and Congressman Davis, I would 

like to thank you all for this opportunity to discuss the integration of VA Chicago Health Care System at this field hearing. 

I would like to state that the LakesidelWeBt Side integration is 

actually one element of a . larger network strategy that is aimed at 

accomplishing .five principal goals, and I want to just briefly discuss those and their relevance. 

These ~als are applicable to many initiatives across the country, 

not just m our network. And one is the reduction of costs. And in 

this VISN, we need to reduce our annual expenditures over the fiscal years 1997, 1998, and 1999 by approximately $57 million. 
24 

With the new methodology for the allocation and procession of 

the funds for VA, this critical financial target will be achieved by 

our network, I think, in the framework of how we are doing things. 

We did manage to reco,!~ the $8 million in fiscal year 1997 with 

no reduction in service. We anticipate the $40 million reduction in 

fiscal year 1998 will occur also without reduction in service to veterans, and the remainder will be accomplished in fiscal year 1999. 

Cost of VA health care in Chicago is substantially higher than 

in the rest of the Nation, and the goal here, really, is not cost reduction for itself, but to bring VISN 12 into alignment with VA 

health care costs elsewhere. 

A siJmificant part of the problem in this regard is the overutilization o(VA inpatient care in the Chicago area. And I want to stress, 

as we convert ourselves from a hospital system into a health care 

system, that the costs are going to be reduced by making our programs more efficient, not by diminishing the quality of the amount 

of care we provide to Chicago area veterans. In fact, we plan to provide better, more accessible care to a larger number of veterans. 

We have reduced in this VISN over the last 2 years-l,600 acute 

care beds have been closed. This is with no waiting for admission, 

no denials of admission, and with occupancy rates across our VISN 

that still are not optimal. So the overutilization, historic inpatient 

care, is being accomplished without cuts to veteran service. 

Our second goal is increasing our access. And again, this is not 

just our VISN goal. This is a nationwide goal for VA, to increase 

the accessibility of VA health care. I totally concur with Mr. 

Balcer's comments about travel times and waiting and trying to get from the south side of Chicago to a veterans medical center for 

care. 

And we have a goal to increase our using population, those underserved Category As. When there are reductions in costs, those 

savings are being reallocated to increase access. We have been concerned for some time about veterans in the Austin area, where 

there is very poor access to VA. Hines has, with cooperation with 

the vets' center, opened a primary care clinic in Oak Park and collocated next door to the vets' center to increase that access. 

We have established a clinic in Woodlawn to attempt to increase 

access for primary care to veterans on the south side, and recently 

VA Chicago, which is the parent of that clinic, has expanded the 

hours of the Woodlawn clinic, again to promote the access. 

So as we create the efficiencies across our system, those savings 

will be put back into health care. We, as you may well know, have 

been approved to open a community-based clinic in Chicago Heights, another area within Cook County that has, really, very 

difficult travel to any of our medical centers and significant numbers of low income veterans. 

So our major goal about redirecting some of these resources will 

be to increase the access of veterans to care and increase the numbers of veterans that can actually get to us for that care. 

Third major goal for the integration is the modernization of VA 

health. care. There is a need to modernize both the manner in 

which veterans' health care is provided in Chicago as well as to 

modernize our facilities. For example, in this VISN we have had 

significant expenditures into our infrastructure to be able to accom-
25 

modate the computer age and be able to transfer information from 

site to site so that veterans' records and their health information 

is accessible wherever they receive care. And again, given the federalfunding realities, this also needs to be accomplished within 

what budget we have. 

We are changing from a hospita1system, which we ,had been historically, into ahea1th care system. And the infrastructure that we 

develop with our computer network will allow the outpatient care, 

which is going to be given hopefully in multiple areas across this 

VISN, to be effective and to assure that the veterans' records and 

medical information is available at, each one of those outpatient 

care sites. 

Our fourth goal is reallr the optimal utilization of VA capital assets. We have begun looking at elimination of unnecessary duplication or redundancy. We have consolidated-some of our administrative services. F;()r example, all of our contracting -for this area is 

done as a single entity, 'which gives us volume buying for eight facilities as well as efficiencies in the contracting. 

We have increased telemedicine usage to handle areas where 

scarce medical specialties aren't available. This is one of the areas 

that VA Chicago is an asset for us in terms of supporting some of 

the rural health care in our VI8N, such as at Iron Mountain, MI, 

where specialists, are not ,as available, 1lnd they will actually get 

support from V K Chicago without, those ' clinicians and specialists havmg to travel by the U8e of telemedicine. 

The fifth goal is ,to really insure conSistently high quality care, 

and many of',the performance measures'that,we are looking at and 

collecting data across the VlSN are to say that as we undergo these 

changes, that we ' give consistently high quality care throughout the 

network. 

This is-i>eing measured by a series of measures, both of our performance measures and in looking at our outcomes, but also by veterans' measures. And I agree with many of the previous panelists 

that the' people. we serve need to be included in that. "We haVe a Man8~ment -Assistance Council that had been referred to' e&l"lier ..commg,up in November, ami lwill be giving them 

information from ,our veteran' satisfaction survey which we just received, and I am very ,proud to tell you that this VISN has improved satisfaction in every measure on ,that satisfaction survey 

with the exception of family education, which"'we are, going to improve this year. 

This includes access 80 that the veterans who respond to our sat- -isfaction survey are indicating that'the changes we are making are ,.improving the care in areas , of access, and courtesy which is rated 

one of the, five hig1!est in the Nation by the veterans in terms of 

looking across the VISNs at the satisfaction survey. 

These are the kinds of measures that we need to continue to do. 

I don't have results of the Qutpatient surver,but we hope to J8t 

that in November. It is the kind of information we will be sharing 

With all the facilities and sites of care to see that they know exactly how the veterans that they serve are perceiving the care that they receive. 

I would also at this point like to take the opportunity to all here, 

both the committee and to all in the audience, to reaffirm my belief 
26 

that both the Lakeside and West Side divisions are essential, and 

that I and the department have no plans to close either division. 

However, if we are going to achieve the five goals that I just discussed-reduce costs, increase access, modernize our health care 

system, and optimally use our VA capital resource while insuring high quality care-:-there is a need to change how these facilities 

provide the care and what specific services they provide. 

I think one of the biggest changes that does cause concern is this 

move to outpatient care, as we set up outpatient clinics and community-based primary care sites with these two additions serving 

as the nub of their tertiary care. 

In terms of an update on the integration, the Integration Coordinating Committee met on October 1, 1997. The final reports were 

given. The committee felt that their work has been completed. Dr. 

Terrence, the chair of the committee, who has been absolutely invaluable to us in this VISN, thanked all of the members for their 

work and announced the final meeting of the group, as it had completed its task. 

The Stakeholders Advisory Group met yesterday, on October 15, 

and again, the members were thanked for their work. That advisory P.'0up as a separate group is being disbanded. Most of those 

indiVIduals are on either the Management Assistance Council or 

the Veterans' Advisory Council that I have. 

We will be reviewing the membership of that group to assure 

that those individuals on that Stakeholders Advisory Group are on 

one of those other groups to continue their input in the meetings 

we have, both at the facilities and separate meetings at the VISN 

office. 

Our Management Assistance Council is quite large. It meets 

twice a year. Because of that, we have had subcouncils of that set 

up so there are quarterly subcouncils with the Veterans' Service 

Organizations and the c~ngressional delegation, both in Illinois and 

then we repeat them in Wisconsin to assure that folks have access 

to them, that are held in addition to the Management Assistance 

Council. 

And we will assure that those individuals were put on those 

groups in place to continue that input, because I totally concur 

with many of the remarks that the input of the stakeholders is 

nothing but beneficial. 

It has improved the quality of the decision-making, I believe, of 

the integration coordinating committee and through the Veterans' 

Advisory Council and the MAC that I get, and I think improved the 

functioning of the VISN as a whole. 

That would conclude my remarks, and I would be happy for any 

questions, Mr. Chairman. 

[The prepared statement of Dr. Cummings appears on p. 45.1 

Mr. LAHOOD. Thank you very much. 

STATEMENT OF JOSEPH L. MOORE 

Mr. MOORE. Thank you. Mr. Chairman, members of the subcommittee, it is very nice to follow your boss. Then you can cut out 

most of your testimony. 

I want to silY' that when we embarked on this intep-ation process, we chose Webster's words on faith: "A firm belief m something 
27 

for which there is no proof." When we embarked upon this journey, 

my faith in the veterans, in the VA, and in the merits of the task 

before· us assured me that we would accomplish this with success. 

Well, I point out that many naysayers said it won't work. Well, 

I am here before you today with my faith intact, and to tell you 

that it will. 

And I would like to show off some of VA Chicago. I have my two 

associate directors, my two chiefs of staff, and my 16 department 

heads of VA Chicago. Please stand. 

Mr. LAHOOD. Welcome to you all. Great to have you all here. Welcome, Mr. Moore. 

Mr. MOORE. I think that is a diverse group. No matter what anyone says, I want you to know that they were chosen from equal 

measure. There are eight from VA Lakeside division and there are 

eight from VA West Side division. Thank you. 

I am not sure how we could convince the world more that we are 

here to do the right thing. But I think, in closing with my testimony, and I won't say all of these things because my boss has said 

it so eloquently, I saw a movie and it said, when there is a sparrow 

that is hurt in Central Park, ' 'I feel it. And so it is about VA 

Chicago. 

I am pleased to be here, and I will answer any of your questions. 

And you said my testimony in the whole will be in the record. 

Thank you. [The prepared statement of Mr. Moore appears on p. 57.] 

Mr. LAHOOD. It will. Thank. you, Mr. Moore. 

Dr. Terrence, welcome. 

STATEMENT OF CHRISTOPHER F. TERRENCE, M.D. 

Dr. TERRENCE. Mr. Chairman, other speakers and guests, good morning. Thank. you for this opportunity to discuss the Integration 

Coordinating Committee of the VA Chicago Health Care System. 

I have one advantage. I am an out-of-towner. I am not from Illinois. I am the chief of staff at the VA New Jersey. I was charged 

by Dr. Kizer on October 1996 to be the chair of the Integration Coordinating Committee of the VA Chicago Health Care System. . In his letter of appointment, Dr. Kizer stressed that there were 

"no preset determinations. The process should be open and data 

driven, and that all reports and recommendations reviewed by the 

VISN director and subsequent review at the Under Secretary of 

Health level." 

One of the guiding principles . that the Integration Coordinating 

Committee shared early in the process was the need for maximum 

involvement of the affiliates, the ., stakeholders, employees, and 

other interested individuals. 

As of today, over 300 individuals in the VA Chicago health system have been involved in the. ICC process as members of either 

committees'of'the ICC or subcommittees or the stakeholders group . . At the first'.meeting of the Integration Coordinating Committee, 

it was decided that we · would proceed forming chartered work 

groups with ,the support of the medical center director. The groups 

were given servic&'specific charges to develop a health system that 

would maintain the quality or enhance the overall service to the 
28 

veteran while minimizing the costs inherent in operating two tertiary care hospitals. The committee decided to start with the services that were relatively noncontroversial in order ~ prove that the process was 

valid and could be accomplished in the context of the VA Chicago 

Health System. When the group completed its proposal, the pro- posal was submitted to the Integration Coordinating Committee for 

its review and subsequent recommendation to the medical center 

director. 

The proposal was reviewed also by the Stakeholder Advisory 

Group, by the chairman of the various work groups. The recommendations from the Stakeholders Advisory Group were brought 

forward to the ICC in order to provide maximal input into the deliberations of the ICC. The various work groups were chaired by various service chiefs, 

but in some instances, such as surgery, medicine, and psychiatry, the groups were chaired by members of the University of Illinois 

Medicine faculty or representatives of the Northwestern University Medical School faculty. 

In order to keep the staff up to date at the two divisions, up to 

date on the process, we used a number of various means. The first 

was using town hall meetings. We held four town hall meetings at 

the various sites to discuss the work of the integration coordinating 

committee. 

There has also been regular updates of the ICC in the Chicago 

Health Care System newsletter and also the minutes of the-all 

meetings of the ICC were put on the centralized hospital computer. 

which meant that all the employees could look them up in the computer and see what the minutes contained. 

By October 1 of 1997. all the work groups have presented their 

recommendations to the ICC. Most of the recommendations have 

been forwarded to the medical center director with little changes. 

A few have been referred back to the services work groups for 

slight modifications. 

The ICC has approved the goals and mission statement of the VA 

Chicago Health Care System. In addition, the committee has recommended the replacement of angiography equipment at West Side 

and the replacement of cardiac cath equipment at the Lakeside 

division. 

The committee has recommended the integration of the ambulatory care services. The committee has built up a track record of accomplishment which has allowed us to deal with the thorny issues 

of affiliation interests and placement of bed services. 

In order to facility the process among the bed service work chiefs, 

Mr. Moore and I met with all the bed service chiefs in the begin- ning of this fiscal year to discuss with them the ongoing progress. 

In summary, I believe that the ICC of the VA Chicago Health 

Care System has worked very diligently in setting up a process and 

framework for integration of two tertiary care hospitals. That committee would never have been successful without the support of the 

four medical school deans who were members, the union representatives who contributed p-eatly, the chair of the stakeholders group, and other veterans se1'Vlce organizations. 
29 

Thank. ~ou for this opportunity to present this brief overview of 

the ICC. Thank. you, Mr. Chairman. 

[The prepared statement of Dr. Terrence appears on p. 63.1 

Mr. LAHOOD. Thank. you. Congressman Evans. 

Mr. EvANS. Thank. you, Mr. Chairman. 

Dr. Cummings, the network facility development plan that you participated in as a director at Hines Hos:pital and testified before 

one of our subcommittees in 1!)94 had a different plan for integra- tion .of services. The plan included all of the Chicago-area facilities, 

not just Lakeside and West Side. The recommendations were quite different from those made by the ICC. 

So I would like to ask you,do you still believe that the network 

facility development plan still offers a guide post for VISN plan- ning efforts, and if not, explain the reasons for your different view. 

Dr. CUMMINGS. Yes, Congressman Evans. That/Ian that was 

done as a pilot was the first time it was attempte to have more 

than one facility develop a development plan. Prior to that, the VA 

had always had individual facilities develop this development plan in a vacuum from what was around them. 

And as a pilot, they attempted to do this for the four facilities 

in the district. That plan actually was never finished, and the plan 

was never accepted by either the district or the regional director 

or Central Office. 

The recommendations and the workbooks we have on that that 

we did-and I was actually the chair of the district then-as facilities working together, I believe there is only one of the recommendations that was developed and accepted.by the VA. So that, 

really, still was the report of the consultants that were hired to develop that plan. . That is not to sal that that information .may not be useful to us 

in the future, but It >was never adopted as a plan for us to go forward. And as a matter of fact,prior to the reorganization of VA, 

there was an overt motion at our district council that stated that 

we had not accepted it,cand that we would take that information 

and use that as was needed in any future planing. 

It then subsequently became overtaken by the reorganization into VISNs, and we have not really used any of the recommendations in our planning. Some of the data about the square footage and some of the others have been used in our capital asset plan- ning. But we then began a planning of a much wider area. 

Mr. EvANS. You know, I know a lot of people say that the way the VA ought to be going is to more outpatient clinics. Can you tell 

us what tlie process is for determining where outpatient clinics are 

located? 

Dr. CUMMINGS. Yes. I am very pleased with this outcome; it is 

how we picked the Chicago Heights and the Woodlawn-what we 

have done is we have used the e:xistingdata. There is a veterans 

survey, and using that and the census, the U.S. Census, you actually can identify areas that have high Category A populations so 

that we can better provide for underserved areas. 

And we have used across the VISN that data technique. It identified the Austin area I told you, where less than 40 percent of the 

Category A veterans use any VA facilities, and yet we know the economics in Austin indicate it should be higher. 
30 

With that data, we identified the Woodlawn area, Chicago 

Heights. LaSallelPeru is one that we are working on, which also 

has very similar demographics. So we have used that and focused 

on areas where there is underserved need. 

And in addition, the City of Chicago-and I don't remember exactly where it came from, but they developed some years ago a 

transportation grid when they were looking at a health care 

system. 

We have that, and we have superimposed that over some of these 

demographics to look at access routes. And it has given us the information such as the fact that, really, from Chicago Heights you 

can't get to any of our VA hospitals without a car. 

So we have used demographics like that to try and locate the 

community-based clinics. 

Mr. EvANS. The SEIU, the Service Employees International 

Union, says that industry-wide an employee cleans an average 

space of about 1,500 square .feet, but that right now at the hospitals they have gone through a m~or reduction in cleaning employees. They used to have 286 people cleaning ten buildings. That 

is down to 179 employees, so that one person is now responsible 

for cleaning 33,000 square feet. 

Have you looked at those standards? If you can't tell me today, 

could you submit that to us for the record? I think it is one indication we can save money by downsizing, but if the quality diminishes, that is a real concern of ours. 

And also, we would be interested in your response to the allegations made that cuts in administrative staff and LPNs and nurses' 

aides are impacting waiting periods for patients within the clinic 

or within the hospital already. Do you have any thoughts on these 

issues? 

Dr. CUMMINGS. Well, yes. My general data-I have general data. 

Our length of stay at both Lakeside and West Side has continued 

to drop, increasing that they are accomplishing more in less time, 

so that we have dropped our bed days of care across the system. 

And Lakeside and West Side have both done this in similar kinds 

of proportion, almost by 50 percent over the last year, so that the 

length of stays at each of the facilities-and while I believe there 

can still be improvements, the efficiencies in terms of getting what 

needs to be done during an inpatient stay does not seem to have 

been adversely impacted. 

The access portion of the veterans survey information also indicates to us that the veterans we serve seem to have increased access. We do routinely monitor waiting times, Congressman Evans. . I can't tell you that I remember specifically the waiting times for 

clinics, but it certainly is something that we can send to you afterwards because we look at waiting times for all of our clinics and 

entry into specialty services. And that is one of our performance 

measures. And I would be happy to send that. 

Mr. EvANS. If you could submit those, Mr. Chairman, I would 

like that information made part of the record of the hearing. 

Mr. LAHOOD. Without objection. 

Dr. CUMMINGS. I would be happy to do that. 
31 

(Subsequently, the Department of Veterans Affairs submitted the 

following information): 

Apgolntment waiting times 

VACHCS is on target 

Waiting time for primary care is 24 hours or same day since the primary care 

FIRMs allow walk-in assessment of patients assigned to the FIRMs. 

Waiting1imes for specialty clinics were within 30 days: 

Appointment waiting time, 

Clilili<.. calendar days 

<:ardiology 6 

Ophthalmology 22 

Hematology/oncology 7 

Orthopedic 5 

Diabetes/endocrinology 1 

GU 30 

GYN/women veterans 19 

Although we currently are within national customer service standards and 

VISN 12 targets, we continue to review and monitor appointment waiting 

times for any necessary adjustments. West Side has increased clinic times and 

physician hOUTS. 

We plan to use the algorithm developed by the VISN 12 medical task force to 

review the average waiting times to the next new appointment and when 

necessary re-engineer practices in specialty clinics. 

SQuare Footage Assignment 

This is to inform you that the <:hicago Health <:are System is comprised of 

approximately 1.9 million square feet of floor space. Environmental 

Management Service is responsible for maintaining approximately 1.3 million 

square feet of this space. The service is authorized 123 housekeeping aids and 

currently have 105 on board. Each employee is responsible for 

cleaning/maintaining approximately 12-13 thousand square feet of floor space 

which is in line with the national cleaning standards (10- 12 thousand square 

feet per employee). 
32 

Mr. EVANS. Thank you, Mr. Chairman. 

Mr. LAHOOD. Congressman Gutierrez. 

Mr. GUTIERREZ. Well, first of all, Dr. Cummings, let me thank 

you for making the special effort of being here today. I know you 

were going to be in Washington, DC, but didn't want to miss this 

hearing. So I appreciate the effort that you have made to be here 

and to listen to the veterans of Chicago. 

Dr. Cummings, under the Veterans' Equitable Resource Allocation, VERA, funding structure, our local VA network is scheduled, 

as you testified, to lose $57 million during the next 3 fiscal years. 

I am sure that the integration process has taken into account these 

reductions and savings needed to recoup just the $57 million. 

I want to know, however, how much savings the integration of 

West SidelLakeside will incur for the next 3 fiscal years. 

Dr. CUMMINGS. I can't-the third fiscal year I can't give. I don't 

know that. But we do know if we restrict, and I think it is important to remember that we have to look at not just the integration 

but what else are we doing. 

For example, one of the major savings in our VISN is a single 

laboratory plan for testing of blood samples across the VISN, and 

that has accounted for about $2 million in savings this last fiscal 

year and hopefully more. 

So a lot of what we are doing, the reducing of the bed days of 

care and closure of acute beds that result in cost savings, aren't related to the integration. Those are VISN -wide goals. 

If we were to look at only the integration, in the last fiscal year 

that we are just finishing, estimatecf that attributable to integration itself is Frobably $2 million. And that has to do with the fact 

that many 0 the areas, as we begin to combine services and do 

things more effectively, that does decrease your cost. And we expect 

that a similar figure, our estimate for this coming fiscal year is in 

the range of $3 million. 

I must admit that it is very difficult for me to get beyond that 

to predict the further years since it really depends on what the 

work-you know, the continued single services, what plans they 

make. But we would expect probably $3 million in this year. 

Mr. GUTIERREZ. And you also stated that in VISN 12, by the year 

2002 you want to see veterans care in Chicago expanded to 28,000 

new users. This, of course, would occur as outpatient care is expanded throughout the region, and you have talked about 

Woodlawn and the West Side and having more settings for people 

to come and receive care. 

My concern is that under the new funding allocations that we 

just talked about, 57 million fewer dollars over the next 3 years, 

that Chicago will lose resources, obviously, and that the savings 

that you make up from the integration of duplicative service and 

reduction of waste will first have to be devoted to remedying the 

new mandated short falls. 

Is it realistic under this scenario, with resources diminishing and 

integration fading, first having to pay the short fall, the 57 million 

bucks, that that can really be expanded, fewer resources, integration, you have got to put the money-because you have $57 million. 

You are expanding. How do you do that? 
33 

Dr. CUMMINGS. I believe it can be done. And let me use our laboratory service plan as an example of that. 

We ran in this VISN eight separate hospital laboratories that, by 

and large, did 80 percent of the tests that commonly hospitals did. 

We no longer do that. As many of you know, laboratory testing is 

largely automated on huge machines. We analyzed the data and 

the work load and found out that, really, two of our facilities, the 

two large ones, Milwaukee and Hines, could handle the vast bulk 

of our laboratory testing, and that we didn't have to run eight separate full-service labs. 

We looked at some other private sector experiences. The Mayo 

Clinic hasn't had a lab in its building for years. In Indiana, the 

same circumstance. That is estimated to save us about $7 million 

a year just in its initial phase of implementation, and we think we 

can expand that kind of consolidation of workload to include some 

merged testing and other various types of testing. 

It has also enhanced our quality in that some tests, things like 

thyroid function and others, where the volume at anyone of the 

facilities was such that they only ran the test, say, once or twice 

a week, we now can run them daily. 

So I believe that we need to reengineer how we give the careone of the work groups in the integration has proposed that there 

only be one kitchen to serve those two facilities. That is-a lot of 

the world does that, and there is no reason not to do that. That 

will save money. 

We have looked at other kinds of_mechanisms. I have mentioned 

our consolidated contracting. So I believe that as- we reengineer 

how we do things and we do things as eight regional entities versus 

eight separate facilities, there are savings to be made to reinvest 

in outpatient care. 

The other major area that I am very pleased with, and unlike 

some of the other aspects of VERA, it is one where this VISN does 

well and, really, with the help of your committee as well as Congress itself, is our medical cost recovery. 

We now are able to retain third party insurance payments. This 

VISN is actually one of the VISN s in the country that is a leader 

in collecting insurance -funding. We appear to have at least a 

slightly higher rate of of intlividuals having insurance, and we have 

done well with collections. We think we can increase those 

collections. 

That also is another revenue source that we can use to increase 

our access into the outpatient clinic areas. So I believe it is pos- sible. I think that it will require more reenginee~g and more looking at what we are doing collectively across the VISN. 

We do ,have the Chicago He~hts clinic. We plan to open that, we 

would hope, as -soon as we finish the leasing things over the next 

several months and _ get the space there. As I said, -we have already 

expanded the Woodlawn clinic. We ~ct to open a clinic in LaSalleIPeru and one in Union Grove; which will probably serve, also, 

some of the veterans in northern Illinois this coming year. 

So I think it is possible. 

Mr. GUTIERREZ. Mr. Chairman, I would just like to take a moment to recognize Bob White from the Paralyzed Veterans of America, and ask that the record be kept open in order for the Paralyzed 
34 

Veterans of America's testimony to be included in the hearing record today. 

Mr. LAHOOD. Welcome, Mr. White, and the record will be held 

open. 

Mr. GUTIERREZ. Thank. you so much. 

Mr. LAHOOD. Thank. you for being here. 

Mr. GUTIERREZ. And we will include-we will keep the record 

open until you can submit that. Thank. you so much for being here, 

Mr. White. 

Dr. Cummings, there is a-the ICC and the SAG group got together and met and ended its formal function. Given some of the 

things that we have heard here today, and given that all of the 

process has not been completed, how do we end the process at one 

end in terms of the-I mean, one of the-and Chairman LaHood, 

you weren't around for all the beginning of this, but if you had, you 

would understand more keenly, given the lack of communication at 

the beginning, which I think we can say we didn't know how to do 

it any better; it wasn't that we didn't want to do it this wa~t every- »ody is delighted with what we got today-and given mat we 

haven't ended it _yet, shouldn't we keep a safeguard in there since 

we started Woodlawn, we started with none, we integrated one 

and now everybody has come here to talk about how they are ;Ii 

talking and working together, and then we are going to end without one. 

So how do we get the stakeholders in the end process? 

Dr. CUMMINGS. Yes, Congressman Gutierrez. As a matter of fact, 

we had a meeting yesterday with the veterans service organizations and some of the congressional staffers. I believe that the 

input is essential. 

Many of the members of that stakeholders council are either on 

my Veterans' Advisory Council or on the MAC, and as I mentioned 

in my testimony just briefly, I am going to take that group and 

make sure that all of them are on one of those groups. 

I think it is important to put them on that because that is prob- ably where the communication occurs. One of the issues that has 

come up in the integration is, we talk about things that are VISN 

initiatives, and yet since they are happening at West Side and 

Lakeside divisions, as they happen everywhere, somehow they get 

confused with the integration. 

Yesterday at the meeting that I had with the service organiza- tions, and we are_going to do this again with my MAC, we tookas you know, the VA is required to do these business plans and our 

strategic plans. Ours is due the end of October, beginning of 

November. 

I took all of the initiatives for that plan and gave them out to 

our stakeholders at those two meetings, and we will do it at the 

MAC, to solicit their input. And we discussed our initiatives-reducing the bed days of care, opening the community-based clinics. 

And I think that getting them in that group, they will have access to wider information and it will be more consistent because it 

will include things that impact Lakeside and West Side that don't 

have anythin~ to do with ilie integration. 

And I certainly agree with the testimony, and we will make sure 

that the groups who were on that stakeholders have access to those 
35 

meetings. And they meet quarterly with us here, and are on groups 

that can continue that input, because if there was anything that 

we could have done differently on · this integration, it \voulcf have 

been start the stakeholders council before the newspapers reported 

about integration. 

Mr. GUTIERREZ. So I am just-we can meet at another time. Obviously, because I think I know what is going to happen. I think 

we have got an excellent process going on, but I have pretty keen 

understanding about how a great process can fall apart at a very 

critical moment. 

So I will talk to Congressman Danny Davis, because he and I are 

good-not that Congressman Lane Evans won't hear from the 

stakeholders, but we ~ such in the vicinity, being from 

Chicago and having been involved in this process. I don't want it 

to fall aeart at this point. So let s try to find waYs where we can take the stakeholders who 

we have integrated into the process and keep them in the process 

at different levels and maybe have a little flexibility. We will talk 

about that some · more later on. 

And I look forward to having that opportunity to do that with 

YO~d I want to-I had a question. Somebody did raise a question, 

Mr. Chairman. They took me up on providing a question. And that 

question is to Dr. Cummings. 

What is being done to avoid pushing veterans who need longterm care out of the system? And, in parentheses, in the interest 

of saving money? .. We have learned of one Vietnam veteran who was discharged 

from North Chicago and had to fight for readmission, particularly 

after doctors in the private sector discovered he had cancer. Can 

we . avoid this from · recurring in the drive to reintegrate Lakeside 

and West Side? 

It is not my question, but if you could answer it as best you can. 

Dr. CUMMINGS. Obviously, I don't know the specifics-we could 

certainly try and investigate the particular incident. 

But let me just speak about long-term care. West Side and Lakeside-and this is mdependent of the integration; West Side and 

Lakeside have no long-term care, and have not in the past. So it 

is not a piece of the integration. 

We have long-term care sites at five of our VISN facilities. The 

whole issue of long-term care, particularly nursing home care, in 

the VA is one that-actually, there is a federal advisory committee 

the VA has chartered, and 1 am on it, to look at it, because as you 

are aware, in eligibility reform, there was no change in nursing 

home eligibility. 

We have not changed our numbers of lon(:term care beds in this 

VISN. We have actuallr increased them slightly in terms of the 

domiciliary in North Chicago. 

But the issue of the future needs for long-term care is one that 

I think needs a lot of lookin2 at and a lot of input. There has been 

concern across the country. We are looking at ways to continue as 

efticientl'yat possible the current long-term care we do, but also to 

look at the future. 
36 

For example-of all nursing home care that veterans use, VA 

provides approximately 15 percent of that nursing home care. That 

figure has been stable for, I believe, 10 or 15 years. So the VA is a significant player in nursing home care, as you 

are obviously aware. Except for VA, the major payers of nursing 

home care are the individual and ~ublic aid. 

So weare a significant player. But there has been no change in 

that number that we can see. I think that this is a challenge that 

VA needs to look at, nationally and I think it needs a national 

policy. 

The advisory committee is being asked to present to Dr. Kizer 

and VA recommendations on what should we do with long-term 

care. And I think we have had one meeting, and I think we are due 

for another meeting in November to look at that. 

It has a lot of experts in geriatrics and long-term care outside the 

VA to give advice on this. But I don't think the answer is clear to 

us on what is the VA's role and how much of a role in the longterm care that individuals need. 

Now, the other long-term care that is not nursing home care, I 

am very proud of. The VISN has got several task groups looking 

at expanding home care, making sure that we cover areas-certainly the major urban areas first, and then address how we provide home care in the rural. areas. 

And we have a long-term care task force thatis looking at both 

that and at adult day care. So I think in those areas of long-term 

care that come under eligibility reform, we have groups from across 

the VISN with representatives to look at that, and to make sure 

that we give access to those kinds of care to as many veterans as 

we can. 

Mr. GUTIERREZ. Well, I would like to end by saying to Dr. 

Cummings and Mr. Moore and Dr. Terrence, thank you so much 

for your leadership in continuing the ICC and keeping everybody together and workin,-to get everybody's recommendations together. 

And I would say, Dr. Cummings, congratulations. This is a far 

cry from-we are not past the goal line, but this is a far cry from 

when we were huddled back in my office. I don't know if you remember that cold day. 

I had an advisory committee meeting. I usually have about 15 

veterans, 15 to 20 veterans, at my advisory, and my office was full, 

if you remember. And Dr. Cummings was sitting there among 

about maybe 75 veterans. 

I am happy to say I keep in touch with all of them. Once they 

came, they continue to keep coming back. So it was very positive 

for me in terms of gathering information. So we are a far cry from 

there. 

And I still want to say-I want to leave one last thing for the 

record, because I think that while Dr. Cummings kind of took some 

of the slings and the arrows in the beginning because she started 

out this process and she was in charge of the VISN, much of the 

focus shifted quickly to Mr. Moore and his new ascendence to coordinating both facilities. 

And I want to say that I am delighted and excited about your 

presence here today and the work that you have been able to do, 

and I want to tell you, sometimes in the work with the public and 
37 

in developing public policy and in working, which you have dedicated your life to the public--

Mr. MOORE. Your job is safe right now. 

Mr. GUTIERREZ (continuing). It happens. It happens. So thank 

you very much, Mr. Moore, because I know how personally difficult 

it must have been at times for you. Thank you for being so steadfast and earnest and dedicated to your work. I know it could not 

have been easy. Thank )Tou all very much for your testimony. . Mr. LAHOOD. Mr. Evans, any further questions? Thanks so much for this panel . and for your testimony and your expertise. And I want to also· thank, again, Congressman Gutierrez 

for his efforts in arranging this hearing, the Chicago Park District 

for the availability of this facility, all the interested citizens who 

attended, and the interest of our members who testified and were 

willing to answer questions. 

And as was stated earlier, the record will be kept open and be 

available for anyone who would like to include anything else. 

And we are adjourned. Thank you all. 

[Whereupon, at 11:05·a.m., the subcommittee was adjourned.] 
38 

APPENDIX 

STATEMENT OF 

GERALD S. MOSS, MD 

DEAN 

COLLEGE OF MEDICINE 

UNIVERSITY OF ILLINOIS AT CHICAGO 

COMMITTEE ON VETERANS' AFFAIRS 

SUBCOMMITTEE ON· OVERSIGHT AND INVESTIGATIONS 

UNITED STATES HOUSE OF ·REPRESENTATIVES 

OCTOBER 16, 1997 

CHICAGO, ILLINOIS 
39 

Good morning, Mr. Chainnan and distinguished members of the Veterans' Affairs 

Subcommittee on Oversight and Investigations. . My name is Gerald Moss. ,I am a 

Professor of Surgery and Dean of the College of Medicine of the University of D1inois at 

Chicago. I appreciate the opportunity to appear before you this morning and to update you 

on developments in the relationship of the VA Chicago Healthcare System with the UIC 

College of Medicine. 

First, I want to express my thanks and the appreciation of the University to Mr. Gutierrez, 

Mr. Davis, Mr. Evans and Senators Moseley-Braun and Durbin and to former Member of 

Congress Cardiss Collins for their outstanding leadership on this issue. I am convinced 

that their efforts have brought about many constructive developments in this evolving 

relationship and have been of enonnous value in meeting our joint responsibilities to 

provide care for veterans that is truly second to none. I am particularly proud to note that 

the University of Dlinois and Northwestern University were the first two universities to 

establish a direct and fonnal relationship with the VA health care system more than a halfcentury ago. 

All of us in health care are being challenged by enonnous changes in the financing and 

delivery of health care, and many of those same changes are affecting the VA. We fully 

recognize that the VA must adapt and adjust to those new operational and fiscal realities, 

and I want to assure you that mc is committed to working with the VA to make those 

changes in a way that benefits veterans and optimizes the educational environment of both 

institutions. 

As you know, we have been concerned about proposed changes in the VA system here in 

Chicago. We became quite alarmed in May 1996 when a memorandum was issued by the 

Great Lakes Veterans Integrated Service Network announcing the intention to consolidate 

inpatient services in the city of Chicago at one of the two existing hospitals, and there were 

strong indications that the inpatient services to be closed would be those at Westside. The 

prospect of losing this critically important relationship which had worked for the benefit of 

both institutions for so many years was one we saw as warranting our undivided attention. 

In my view, the rationale for this action was not clear, the decision was not driven by hard 

data. and the process was arbitrary and indifferent to the concerns of the University and of 

the community. 

As a result of the involvement of the Dlinois Congressional delegation and of the thenSecretary of the Department of Veterans Affairs, a process was subsequently established 

which has addressed many of our concerns. Although there were several false starts, I am 

pleased to report to you today that the Dean of the Northwestern University School of 

Medicine, Dr. Harvey Colten, and I have worked out an agreement that we are convinced 

will serve the VA, its patients, and our students well. Specifically, we have agreed that we 

will propose to the Director of VA Chicago, Mr. Joseph Moore, a joint Dean's Committee 

made up of members from both ffiedica) schools and both divisions of VA Chicago to 

replace the two existing Dean's Committees. We believe that this joint committee will 

assist V A Chicago to realize operational efficiencies, to preserve the high quality health care 

that our veterans deserve, and to maintain the superb educational and research environment 

afforded by the V A system. 

GenIId S. MOIl. MO October 10. 1997 Pqel 
40 

This is clearly a work in progress, but there may be lessons in the Chicago experience that 

will be useful in other areas of the country as the VA strives to consolidate its facilities to 

reduce duplication and overlapping efforts. I believe that a rational process for such 

consolidations would involve the following steps: 

I. The VISN director would identify those areas in which duplication of effort seemed 

likely and where geography might permit service consolidation. 

2. The stakeholders in existing facilities would be convened and a clear articulation of the 

problem would be presented. 

3. A mutually agreeable process would be constructed with appropriate representation 

from all affected parties. 

4. Appropriate consultation from a neutral third party, preferably expert in health system 

consolidations or mergers, would be sought. 

5. All the data necessary to make a fair, balanced, and equitable decision with high face 

validity would be assembled. 

6. Adequate time for these deliberations would be provided. 

7. Appropriate opportunities for public explanation and input is essential. 

S. A durable oversight mechanism to ensure that all parties are treated fairly would be put 

in place. No merger of complex institutions can be accomplished in a short period of time 

and be expected to function exactly as its architects intended. Mid-course corrections will 

be inevitable. 

I would respectfully recommend that this Committee consider these criteria carefully, which 

may well serve to guide V A mergers or consolidations across the United States. 

UIC has been working with VISN 12 to establish a system to evaluate the health care needs 

of the veterans population of this area and to advise it on how VA might best meet those 

needs in the Great Lakes Network. I believe that this is a very tangible example of the kind 

of resource that academic institutions bring to the VA that have made these partnerships so 

mutually beneficial. 

I also want to emphasize a recommendation made by Dr. Jordan Cohen, Executive Director 

of the Association of American Medical Colleges, in his testimony before this committee on 

July 24, 1997: that the V A incorporate an assessment made by deans of affiliated medical 

schools in the annual evaluation of Network Directors. 

There is one other area of concern to me and many of my fellow deans. The Veterans 

Equitable Resource Allocation (VERA) is shifting money from VA systems in the northern 

tier of states to those in the southern tiers. We are concerned that the methodology 

employed does not take into account the health status of those veterans in the northern 

states, and it does not recognize that the majority of training programs (with their attendant 

higher costs) are located in these states. I hope that the Committee will objectively evaluate 

the effects of this new resource allocation system, and make corrections if they are found to 

be necessary. I also hope that there will be continued oversight of the V ACHCS integration 

process and in this regard, I recommend continued existence of the Stake Holders Advisory 

Group. 

Ger.dd s. Moss. MD October 10. 1997 Page 2 
41 

Mr. Chainnan, I am graceful for your interest and leadership in this extremely imponant 

issue. 1be College of Medicine of the University of Illinois at Chicago and I, as a veter.m 

myself, are extremely proud of the relationship we have with our affiliated VA Medical 

Center. 

I welcome the opportunity to answer any questions you may have. 

GcnI4 S. M-. MD Oco_ 10. 1997 ",3 
42 

Northwestern University Medical School 

IforIq R. CoItca. MD 

Dean Va_ror_ Affairs 

__ &ildin8~~56 

30' East ChlcaSO Avenue ChlcaSO. illinois 60611·3008 

(12) 3OM3040 

Pax OI2l303-7757 E..ma.II: coltenenwu.edu 

Teatimooy Before The OvetSight and Investigative Subcommittee 

. Of the Vetenms Affairs Committee 

United States House of Representatives 

Good morning. I am delighted to be here, and appreciate the opportunity to testify before this 

.committee on matters of importance to Chicago area vetenms and the provider.; and institutions 

that serve them. 

I am partic:uh!rly pleased to be able to report to you that efforts to integrate two fonnerly separate 

institutions - the Veterans Affairs West Side and Lakeside facilities - into a single VA Chicago 

Healthcare System are succeeding. This integration is producing a rational alignment of services 

bdween these two institutions and the rest of the V A Great Lakes Health Care System. Better 

quality health care for veterans and improved efficiency are the expected outcomes of this 

integration. 

The two affected medical schools are collaborating effcctively in the integration process. As one 

example, you will be glad to know that you will hear substantially the same message from Dean 

Moss and me this morning. 

The public-private partnership between the VA and Northwestern Univer.;ity, and the publicpublic pertner.;hip between the V A and the Univer.;ity of Illinois, have benefited the vetenms 

who seek health care at these institutions by ensuring the highest quality medical personnel are 

available. As acadC\l1ic medical center.;, both the Univer.;ity of Illinois and Northwestern 

Univer.;ity enjoy what might be described as a sunshine culture; an environment where data are 

openly available to be aDaJyzed and information is used to improve teaching, research and patient 

care. We have capitalized on this culture in the integration process, and we believe that our 

institutions and the veterans they serve will benefit from the stronger V A Chicago Health Care 

System that we are helping to create. 
43 

Let me \It:ginwith a bit of history 'ln thE' integration and background on Nonhwestern 

University's relationship with VA Lakeside. In June of 1996, the Department of Veterans 

Affairs announced the intent to integrate V A Lakeside and V A West Side under a <:OIIUDOII 

DllIlIII8ement structure, the V A Chicago Healthcare System. From its inception, the vision for the 

VA Chicago Health Care System has been to be the best in the nation - providing the best care as 

efficiently as possible. The leadership of the V A Chicago Hea1thcare System and the affiliated 

academic institutions share this vision and are committed to achieving it. We have worked 

diligently with members of Congress, the Department of Veterans Affairs, Chicago area medical 

schools, veterans, and other stakeholders to successfully integrate the operations of the two 

hospitals. This moming, I will briefly report to you on our progress. 

The VA md its III:8IIanic: pGtners have long recognizc:d the mutual benefits of collaboration. 

NortInvesteni University has been affiliated with V A Lakeside since the doors were opeaed in 

1954. In the case of the previous Northwestern University-VA Lakeside affiliation, over 21,000 

vetenns received health care services in 1995. The Lakeside Division of the VA Chicago Health 

Care System providt.. sa1ary support to 148 Northwestern University faculty; an addition.d 263 

Nonhwestem University faculty provide services without compensation to vetenms at the 

Lakeside Division. 

Finally, 545 medical residents each year provide patient care and acquire clinical skills in the 

Lakeside Division. 

The relationship between the University of Illinois and the West Side Division of the VA 

Chicago Health Care System has produced comparable benefits for both partners and, most 

importantly, for the veterans they serve. 

The integration process has progressed remarkably smoothly under the leadership of Joseph L. 

Moore, Director of the V A Chicago Health Care System. 

An Integration Coordinating Committee, which includes the Deans of all Chicago medical 

schools with a VA affiliation, oversees and coordinates the service specific integration work 

groups. Thirty-two work groups, with representation from both schools of medicine, are making 

recommendations concerning the integration of their re~;- ~ctive services. 

A Stakeholders Advisory Group provides constituent input to the Integration Coordinating 

Committee and the integration work groups. 

Thirty-one of the 32 work groups have submitted reports to the Integration Coordinating 

Committee. What has been accomplished already is impressive. Sixteen services are now 

consolidated under a single service chief: audiology and speech pathology, chaplain, engineering, 

environmental management, information resource management, library, medical administration, 

nursing, nutrition and food, phannacy, police and security. psychology, prosthetics and sensory 

aids, recreational therapy, social work, and voluntary. 

More single service chief appointments are likely during the next year. 
44 

This integration is one element of a larger V A Great Lakes Health Care System strategy aimed at 

accomplishing five goals: increased access, modernized V A healthcare, optimum utilization of 

VA capital assets, reduced costs, and high quality care. Because of the shared commitment to 

education, research and patient care shared among the V A Chicago Health ~ System, the 

University of Illinois, and Northwestern University, we are advancing toward these goals. 

Thank you for the opportunity to testify today, and your interest in veterans' health care in the 

Chicago area. I would be happy to answer any questions the Committee might have. 

Harvey R. Colt.cn, MD 

Dean, Northwestern University Medical School 

Vice President for Health Affairs, Northwestern University 
45 

STATEMENT OF 

JOAN E. CUMMINGS, M.D. 

NETWORK DIRECTOR 

VETERANS INTEGRATED SERVICE NETWORK II 

HINES, ILLINOIS 

October 16, 1997 

Mr. Chairman, other speakers and guests - Good morning and thank you for this opportunity to 

discuss the Urtegration of the VA Chicago Health Care System (Lakeside/West Side Divisions). 

I would like to state that the LakesidclWest Side V AMC integration is o~ element of a larger 

Networlt strategy aimed at accomplishing five principal goals. These goals are to: 

1. Reduce Costs: Over the tbrcc fiscal years 1997, 1998 and 1999, VISN 12 needs to 

reduce its annual expenditures by $57 million. Accordiug to the VERA methodology, 

• this critical financial target will be achieved by reducing Networlt expenditures by $8 

million in FY '97, $40 million in FY '98, and the remainder in FY '99. As you know, 

the cost of VA bealthcare in Chicago is substantially higher than in most of the rest of 

the Nation. The goal here is simply to bring VlSN 12 into better alignment with VA 

costs e1sewhere. A significant part of the problem in this regard is the over-utilization 

of VA inpatiart care in the Chicago ara. I want to stress that costs will be reduced by 

making our programs more efficiart-not by diminishing the quality or amount of care 

we provide Chicago-ama veterans. In tact, we plan to provide better, more accessible 

care to 1arger numbers of veterans. 

2. IDcreae Acceu: VA has systemwide goals of ~ the accessibility of VA 

bealthcare and of increasing the number ofveterans receiviDg care from VA by 20 

percent by 2002. For VlSN 12, this goal equates to inI;rQsing the number of persons 

who use VA by approximately 28,000. That is, over the next 5 years, we would like 

to see the veterans bealthcare system providing care fur an additional 28,000 veterans 

in Chicago and other areas ofVISN 12. To do this, we need to establish care sites 

that are nmch easier to access than the pRSellt hospitals. For example, we would like 

to see that veterans in high-uccd areas such as Austin on the West Side bave nmch 

better access to VA by establishing a conununity-based clinic there. As you know, 

bowevcr, there is DOt expected to be any DeW Federal funding to achieve the goal, so if 

we are going to increase the accessibility of VA' bealthcare, then we simply bave to do 

so by providing care more cfficiartly than we bave in the past and redirecting the 

savings to expand access. 

3. ModeraiR VA Haltbcare: There is a need to modcmizc both the manner in which 

veterans bcalthcare is provided in Chicago, as well as to modernize our tacilities. For 

example, in VlSN 12, we need to invest more in fiber-qrtic inftastructure and , 

computers. Again, given Federal funding realities, progress in this regard can only be 

achieved by finding savings in other areas. In this regard, I would again note that 

currart state-of-the-art medical practice and DeW technology is allowing much more 

care to be provided in outpatient settings than in hospitals and tbat in recent years 

healthcare has become primarily an ambulatory activity. 
46 

4. Optimize Utilization of VA Capital Assets: We need to optimi2:e the utilization of 

VA physical plan and capital assets to maximize the cost~ffectiveness of our services. 

To do this, we must. eliminate UIlDCCCSsary duplication or redundancy of services and 

technology, consolidate low-volume specialty services, coordinate resource decisions 

better, increase telemedicine usage, and achieve better economies of scale and 

productivity wherever feasible. For example, one of our Chicago inpatient surgical 

services has an occupancy rate of about 30%, while the generally accepted standard in 

health care is that this should be about 85%. Maintaining such low utilization neither 

uses ta.'Cpayer dollars prudently nor promotes quality care. 

5. Ensure Consis~ently Hip Quality Carc: Finally, we are trying to ensure that VA 

provides conSistently high quality care throughout the Network (as well as throughout 

the system). This will require more standardization of our services and better 

utilization of resources, including the elimination of certain low-volume services, than 

has occurred in the past. 

Mr. Chairman, I would also take this opportunity to reaffirm my belief that both the Lakeside and 

West Side Divisions arc essential and that I, and the Department, have no plan to close either 

Division. However, if we arc going to achieve the five goals: 1. Reduce costs; 2. Increase access; 

3. Modernize VA Hea1thcare; 4. Optimize utilization of VA capital assets; and 5. Ensure 

consistent1y high quality care, then there is a need to change how these facilities provide care and 

what specific services they each provide. I have serious concerns about suggestions that the 

integration process should be delayed until a complete master plan is available. Because of the 

decision to administratively integrate the two facilities, many work groups have been established 

and arc planning to implement the goal of a single entity providing primary and tertiary care to the 

veterans of Chicago. Part of that plan has included rcevaluating and assessing all equipment needs 

and putting them in the coot.ext of ODe VA. For example, there were two angiognphy suites 

planncd prior to the integration at a cost of $ 2.5 million ($1 .25 million per suite-construction and 

equipment) each. The work group analyzed the patient needs, location, space, etc., and decided to 

place ODe suite at West Side and eliminate the second suite. Not only did this save our VlSN $1.25 

million, because the work group recomme:odations were able to be implemented immediately we 

avoided any default on contracts or any unreasonable delay in providing the angiognphy exams to 

the patients of Chicago. 

There arc similar issues facing several other work groups including the ordering of replacement 

cardiac catheterization equipment. Lakeside has had to ~ cardiac angioplasty procedures 

inspite of having staffwell qualified and highly trained. The work group is again evaluating and is 

close to a recommendation. Patients for both angiognphy and cardiac angioplasty require referral 

to Hines in the interim, which can increase cost. 

The two divisions have eliminated 108 positions during our hiring freeze. Many of these vacancies 

were eliminated either through the bUYo()\lt or attrition in expectation of the work groups 

recommending a smaller number of employees and less supervisors. Not filling for a short period 

of time has been possible, but if these work groups arc not allowed to integrate services between 

the two divisions for any period of time, this becomes a serious problem. 

2 
47 

There is a need for replacement radiologic equipment at VA Chicago. The radiology group has 

started meeting. If any of their recommendations were delayed this would also preclude the 

ordering of replacement equipment. 

From the time the integration was administratively approved any service chief vacancy which 

occurred was not filled to allow for the integrated service to function .... ithout a loss of leadership. 

VA Chicago has eight service chicfvacancies, some of ~ have been integrated with a single 

chief such as Nutrition and Food Service. To fill the others would be difficult if not impossible 

when applicants would know that an integration was in process. Delaying the integration of a 

service until all other plans are approved would be very difficult .... ith one of the divisions having 

no pennaneDt chief or supervisor. Ail Acting Chief can provide short term coverage but real 

management requires a pennaneDt Chief. 

There are plans in the VlSN for another Reduction-In-Force and Staffing Adjustment ofTitle 38 

personnel due to our continued drop in length of stay and movement to more ambulatory care. 

When this.occurs we have been planning-to use both divisions and the integrated services will allow 

us to move employees across the two divisions ~y avoiding some separations. 

The Integration Coordinating Committee met on October I, 1997. Final reports were given and the 

Committee fi:lt their work bad been completed. The chair of the ICC thanked all of the members 

for their work and IIIII10UIICCd that this was the final meeting as the group bad completed its task. 

The Stakebolders Advisory Group met on October IS, 1997. The members were thanked for their 

valuable input and it was IIIII10UIICCd that this was the last meeting of the Stakebolders Advisory 

Group. Future updates to stabbolders will go through the regular mechanisms at meetings at the 

fiIcilities and separate meetings at the VlSN Office. 

The Nutrition and Food Service work group has recommended one kitchen to serve both divisions. 

Delaying the closure of the second kitchen while awaiting the total plan would also delay the 

savings from the closure of that second kitchen. The anticipated savings from the integration are in 

our plan for the coming fiscal year. To delay any implanentation until the entire plan is available 

for review by a body UDknown, would also force us to look for alternative sources for those savings 

and may cause a bigber number ofRIFIStaffing Adjustment requests and may impact 011 patient 

care programs directly. At. this point with the integration proceeding we would not expect any 

patient care program closure. We will proceed with following the Integration Coordinating 

Committee and Stakebolders Advisory Task Group findings and recommendations and thank you 

for the opportunity to present this overview. 
48 

Historical Background 

Lakeside and West Side VA Medical Centers 

COMPLEMENTARY MISSION AND SERVICES 

Lakeside and West Side VA Medical Centers (VAMCs) are both predominantly acute care, highly 

affiliated, urban medical care facilities. Both opened in 1954 and their respective academic affiliations 

have been in place since then. In addition, the two medical centers serve the same patient service area. 

They currently share programs and affiliations in nuclear medicine, chaplain support, music therapy, 

and human resources management. 

Laknide VA Medical Center, located on the near north side of Chicago, offers primary and tertiary 

care to 460,000 veterans living in Cook County, lllinois and Lake County, Indiana. Lakeside treated 

21,476 veterans in FY95 and had more than 6,600 inpatient admissions and 208,000 outpatient visits. 

It has 350.authorized beds, 1,200 employees, 300 volunteers and a $96 million annual budget. . 

Lakeside's Adam Benjamin, Jr. VA Outpatient Clinic, located 55 miles southeast of Chicago ill Crown 

Point, Indiana, provides ser?ces to veterans (46,700 visits in FY95) in northwest Indiana. Residents 

and medical students whq train at Lakeside rotate through the outpatient clinic as well. Lakeside 

services Vietnam Veterans Outreach Centers in Chicago Heights, lllinois and Gary, Indiana. 

Lakeside is a member of the McGaw Medical Center of Northwestem University, which also includes 

Children's Memorial Hospital, Evanston Hospital Corporation, Northwestern Memorial Hospital, and 

the Rehabilitation Institute of Chicago. Northwestern University Medical School is Lakeside's primary 

affiliation fur the training of 102 paid medical residents and fellows. All physician staff have faculty 

appointments at the affiliate. There are 22additionaJ affiliation agreements with 16 other institutions 

covering eight clinical and allied health professions. Lakeside has a diversified researcIV program 

cousisting of 40 VA-finlded and 30 non-VA-funded investigators with 175 projects and funding of 

approximately $5 million. 

West Side VA Medical CD/ter, located on the near west side of Chicago, is a 435-bed facility offering 

primary and tertiary care. West Side primarily serves the veterans of Cook County, Dlinois, who 

number 411,000. West Side treated 24,781 veterans in FY95 and bad more than 8,100 inpatient 

admissions and 280,000 outpatient visits. It has 1,570 employees and a $123 million annual budget. 

West Side has three community-based off-station programs: a Veterans Resource Center, a Drug 

Dependency Treatment Center and the Hyde Park outpatient clinic. 

The ·University ,of lllinois at Chicago is West Side's primaryaffiJiation for the training of 129 paid 

medical residents and fellows. Other training programs cover such areas as dentistry, nursing, 

podiatry, pharmacy and other allied health professions. West Side has a research program of 

approximately $1.6 million funding 20 medical investigators focusing on such areas as hematology, 

gastroenterology and, molecular biology. 

GEOGRAPHIC AREA 

Lakeside and West Side V AMCs share similar geographic and patient population areas: 
49 

• The commuting distance between Lakeside and West Side is about six miles and <:an be traversed 

by car in 10-20 minutes. 

• Both facilities an: accessible through a ","ely of public transportation networks. 

• Both Lakeside and West Side draw tbe majority of their patients &om Cook County, Dlinois -

67% for Lakeside and 90% for West Side. Another 19% of Lakeside's patients live in Lake 

County, Indiana, tbe site oftbe medical center's satellite outpatient clinic. -

• The geographic area comprising tbe two medical centers and their overlapping patient populations 

is also tbe site of several Vietnam Veterans Outreach Centers and additional access points. 

NATURAL PATIENT REFERRAL PATTERNS 

The proximity of tbe two facilities bas fostered a referral pattern that readily flows in both directions: 

Shared patients: 

Unique patients at Lakeside: 

Unique patients at West Side: 

HISTORICAL INFORMATION 

3,500 

21,476 

24,781 (excluding fee basis) 

• Due to their proximity (six miles and 10-20 minutes travel time), tbe integration of Lakeside and 

West Side VAMCs bas been discussed for many)an. In 1994, a VHA MaDagemeut 

Improvement Task Force, ODe of several nationally appointed task foR:es, evaluated potcatial 

FTEE savings from VA medical center integrations and consolidations. The task force ideIIIified a 

number of potential integrations sites, including Lakeside and West Side. In Mard1 1995, tbe 

Secretary of the ~ of Veterans Affilirs approved integrating sixtecD (16) medical centers 

into seven (7). Lakeside and West Side were not included 011 this initial list. Since that time, the 

Secretary bas approved thn:e additional integrations from that list, e.g., East OnmgeILyons, 

Pittsburgh-Highland DrivelPittsburgh-University Drive, and Hot SpringslFort Meade. 

• The fuur Chicago-arca V AMCs, under tbe auspices of the Chicago Network Council, cooducted 

tbe W:ility deveIopmcut planning (FOP) process as a si9glc, integrated planning group. Altbougb 

tbe plan identified tbe potcatial for integration of facilities, the Network Council took no action 

since the Veterans Integrated Service Network (VlSN) structure was being planned nationwide and 

it was believed that tbe VlSN would be the appropriate body to deal with most oftbese issues. 

• In August 1995, tbe Chicago Network Council consolidated the Human Resources Management 

Services of Hines, Lakeside, and West Side. The consolidated Service is located at Edward Hines, 

Ir. Hospital. Other potential administrative service consolidations were rderred to tbe VlSN for 

further evaluation. 

• Since tbe establishment of the VlSN in October 1995, one of the highest priorities bas been the 

review of the VlSN tertiary can: facilities for the most effective use of resources. Administrative 

and clinical integration and consolidation issues were discussed starting with initial visits by the 

VlSN Director to each of the eight facilities and meetings with the Deans of the affiliated medical 

.5 
50 

schools. At the employee "town hall" meetings, which were open to all employees (including union 

representatives), the Network Director discussed the need to review all clinical and administrative 

programs, identify appropriate efficiencies, including integrations and consolidations, and evaluate 

the potential for improvements in resource utilization and patient care. The most commonly 

identified programs were cardiac surgery, angioplasty, and neurosurgery. The Lakeside and West.. 

Side meetings were held in January of 1996. 

• Between November 1995 and May 1996, teams to evaluate Pathology and Laboratory Medicine, 

hnaging, and the development of a single Business Office for the VISN were established. The 

Communication Team has already implemented a computer network IiDking all eight of the VISN 

Medical Centers and is making plans for telemedicine and videoconferencing to enhance services at 

primary care/rural sites. 

• Between October 1995 and February 1996, the Network Director met with the Deans of the SL,,{ 

medical schools affiliated with the VISN 12 V AMCs. During these meetings, the Network 

Director discussed the similarities and proximity of the' tertiary care facilities, clinical 

redundancies, and the potential for cross-facility medical residency training. Edward Hines, Jr. 

Hospital already has multiple affiliations, specifically with Loyola University, University of llIinois 

at Chicago, and Chicago Medical School. 

• Both medical centers are located in the State of nlinois and therefore equally subject to the impact 

of existing and future state healthcare legislation. (The Adam Benjamin, Jr. VA Outpatient Clinic 

is located in Indiana). 

• Lakeside and West Side share the same U.S. Senators (paul Simon and Carol Moseley-Braun) and 

Congresswoman (Cardiss Collins). 

• Both facilities share the same labor market. Both are represented by GSEU, Local 73 of SEIU. In 

addition the nurses at West Side are represented by the llIinois Nurses Association (INA). 

SIGNIFICANT MILESTONES 

November 6, 1993 Joan E. Cummings, M.D. (Chairman of the Chicago Network Council and 

Director, Edward Hines, Jr. HospitjU) testified to a subcommittee of the 

House Veterans Affairs Committee about the Network Facility Development 

Plan then being formulated by Lakeside, West Side, Hines and North 

Chicago V AMCs and discussed planning options, including program and 

facility integration among these four Chicago-area V AMCs. 

June 1994 

August 1995 

October 15, 1995 

6 

Network Facility Development Plan finalized and forwarded to VHA 

Headquarters (then VACO). 

Human Resources Management Services of Hines, Lakeside and West 

Side are consolidated. 

Position of Director at Hines became vacant. There are immCdiate and 

widespread rumors that Lakeside and West Side will be integrated. 
January 22, 1996 

January 25, 1996 

January 25, 1996 

51 

Network Director visited Edward Hines, Jr. Hospital and held town hall 

meeting with employees. 

Network Director visited West Side V AMC and held town hall meeting 

with employees. 

Network Director met with the Dean of the College of Medicine of the 

University of DIinois at Chicago. 

January 30, 1996 Network Director visited Lakeside V AMC and held town hall meeting 

with employees, including teleconference hookup with employees 

of the Adam Benjamin, Jr. VA Outpatient Clinic in Crown Point, Indiana. 

January 30, 1996 Network Director met with the Dean of the Northwestern University 

Medical School. 

FebrUary 27, 1996 Network Director visited North Chicago V AMC and held town 

hall meeting with employees. 

February 27,1996 Network Director met with the Dean and department chairs of the Chicago 

Medical School. 

March 28, 1996 Network Director met with the representatives of the Chicago area 

Veterans Service Organizatioos and discussed the issues surrounding 

duplication of services. The Network Director emphasized the VISN 

position that the special uecds of psychiatry and rehabilitation patients 

preclude closure of any tiIcility. Coosolidation of medical/surgical inpatient 

services between the two Chicago V AMCs was identified as requiring study 

bytheVISN. 

March 29, 1996 Network Director met with a group comprising the Dean or his 

representative from five of the six medical schools affiliated with VISN 

V AMCs (the Dean from the University ofWISCOIlSin was unable to attend). 

The issue of medica1/surgical inpatient services in Chicago was reviewed at 

Imgth, including discussion of closUre ofbeds at either Lakeside or West 

Side and increased use of the beds at Hines. The group discussed the 

creation of a committee, whose members would have 110 links to Lakeside or 

West Side, to assess and make rccommendatioos to the Network Director 

regarding the placement of the medical/surgical inpatient services. 

April I, 1996 Network Director met with the staff of the Chicago area Congressional 

delegation. The clinical redundancies, as discussed with the Vetcrans 

Service Organizations, were presented, including the proposed evaluation of 

the placement of acute medicine and surgery inpatient services. 

April 7, 1996 The position of Director at West Side became vacant with the transfer of 

John DeNardo to the position of Director of Edward Hines, Jr. Hospital. 

7 
52 

April 16, 1996 Network Director briefed Secrewy Bro"n and his staff on discussions 

cooceming the poIentiaI for an integration of Lakeside and West Side in 

preparation for the Secrewy's meeting with Congresswoman Cardiss 

Collins and Dr. Gerald Moss, Dean of the College of Medicine of the 

University of Dlinois at Chicago. 

April 17, 1996 A newspaper for the tacuIty, staff; and students of the Univcrsity of Dlinois 

published an article{)!!posing consideration of filcility integration. 

April 24, 1996 Network Director held a second meeting with Dean Moss, University of 

Dlinois, and discussed integration issues, particularly the integration 

ofLakcside and West Side and the concept ofmultiplc medical 

school affiliations. 

May 8, 1996 An article regarding the possible integration of Lakeside and West Side 

appeared in tilt Business Section of tilt Chicago Tribune. 

May 13, 1996 NetworkDircctOr had a discussion with Dr. Hany N. Beaty, Dean of 

Northwestern regarding the poIentiaI for integration. Tb&: University is 

very COIlCCnIed regarding tilt maintenance of training prognuns with 

VA and wishes to work with tilt VISN on tilt implementation. of any 

plans for integration. Dr. Cwmnings stated her appreciation of the 

University's position and assun:d him that they would be full partners in 

the process. 

May 13, 1996 Letters were sent to the Unions by the Director ofLakcsidc and the Acting 

Director ofWcst Sidc.informing them of the potaItial for integration. 

May 13, 1996 Network Director sent letters to the stakc:boJden such as VSOs, 

Congrcssional delegation members and affiliated medical schools informing 

them of the planning for a possible integration of Lakeside and West Side 

VAMCs. 

June 27, 1996 Secrerary ofVcterans AffiIirs Jesse Brown announced his decision to 

iDlcgnde the Lakeside and West Side V AMCs under a single 

managaucat structure. • 

September 12, 1996 Network Director met with James A. Balcer, Director/Conmwnity 

Liai!oa, City of Chicago to provide the Mayor's Office with an 

overview of the inkgration. 

September 26, 1996 Network Director met with members of tilt Minority Vc:tcrans Steering 

Conunittee and tilt Montford Point Marine Association to provide them 

with an update on the integration. 

October 28,1996 First meeting of the VA Chicago Health Care System Integnltion 

Coordinating Conunittee chaired by Dr. Christopher Terrence, Chief of 

Staff, VA Ncw Jersey Health Care System. Subsequent meetings have 

taken place on Decanber I, 1996, Janwuy 29, 1997, March S, 1997, 

8 
October 28, 1996 

53 

April 23, 1997,lune 4, 1997,luly 16, 1997, and August 20,1997. The 

last meeting of the Committee was held on October I, 1997. 

First meeting of the VA Chicago Health Care System Stakeholders 

Advisory Group, chaired by George Cramer, Assistant Director, Dlinois 

Department of Veterans Affairs. Subsequent meetings have taken place 

on December 4,1996, February 20, 1997, May 7, 1997,luly 30, 1997, 

and September 3,1997. The last meeting of the Committee was held on 

October IS, 1997. 

STAKEHOLDER AWARENESS 

Background 

Prior to the implementation of the VlSNs in late 1995, the Chicago area VA facilities operated with a 

Network Council. A representative of the Veterans Service Organizations and the affiliate Deans as 

well as the VBA Regional Office Director were members of the Council. The management teams of 

these facilities ~ that, because of their geographic locations, planning needed to be done as a 

unit. The Chicago Network Council worked to develop a Veterans Health Administration (VHA) health 

care plan for the four VA facilities in the Chicago area: Hines, Lakeside, North Chicago, and West 

Side. The goal was a health system that would enhance service to veterans while minimizing the costs 

and inefficiencies inherent in operating four hospitals with similar missions in close proximity. To this 

end they adopted several assumptions which remain relevant in the current VISN. These assumptions 

include: 

• All patients are Network patients and are not identified as patients of a specific facility, but 

identified by physician providers. 

• All resources flow through the Network including resident allocation. 

• Primary care sites are the entry points for the Network. New Network participants are possible. 

• Facilities will be developed to meet the Network integration strategy. 

These issues will be continually discussed with stakeholders in the months to come. 

Discussions will be occurring against the backdrop of the current negotiations over balancing the 

Federal budget as well as the wide-ranging debate over the future of the Dation's health care system and 

how VA would fit into a reformed health care delivery system. Although the focus of the health care 

debate has shifted somewhat to the states since 1994, its impaet on the importance of facility and/or 

service integration remains high. 

Status 

Stakeholders will continue to be apprised of developments concerning the integration process by the 

Network Director. She has had several telephone conversations with staff members of the 

Congressional delegation and the news media and will continue to be available as needed. Network 

staff will continue to respond as rapidly as possible to letters of inquiry and other requests for 

information. 

Veterans Service Officers. Commanders. and Representatives 

9 
Ongoing dialogue about service integration will continue to take place with representatives of various 

Veterans Service Organizations during each facility's regularly scheduled meetings. The· Network 

Director will also continue to have frequent communication \\~th these important stakeholders. The 

following organizations will be included in this dialogue: 

• The American Legion 

• AMVETS • Disabled American Veterans 

• Jewish War Veterans 

• Military Order of the Purple Heart 

• Paralyzed Veterans of America 

• Veterans of Foreign Wars 

• Vietnam Veterans of America 

• Mootford Point Marine Association 

• Minority Velerans AffiIirs Steering Committee 

• Others' 

Congressiogal Representatives 

The Network Director will continue to keep all Congressional representatives involved in and apprised 

of the integration discussions. 

Employee Relations 

A key factor in any plan to integrate services is the impact on staffs at both Lakeside and West Side. 

Management will continue to keep employees informed of ongoing developments through staff 

meetings, newsletters, and other forums. 

The GSEU, Local 73 of Service Employees IntemationaI Union (SEIU) represents employees at both 

facilities. The ntinois Nursing Association (INA) also represents nursing persoonel at West Side. The 

unions will continue to be.infonned about integration discussions. 

Medical School Affiliates 

Northwestern University Medical School and the University of Dlinois at Chicago College of Medicine, 

will continue to be involved in and apprised of discussions cooceming integration. 

CURRENT STATUS AND ISSUES 

I) Integration of 

• medical inpatient services, 

• surgical inpatient services, 

• ambulatory care and access points, 

• physical medicine and rehabilitation services, 

• mental health services, 

• pathology and laboratory medicine, 

• dental, 

10 
55 

• information resources management, and 

• administration. 

2) The University of D1inois has voiced strong opposition to the consideration of integration of these 

two fucilities. 

3) Northwestern University is equally concerned but "ishes to work with the VISN staff to effect 

necessary program changes. -

4) The June 27, 1996 announcement by VHA Headquarters to integrate the Lakeside VAMC and West 

Side V AMC initiated the process to establish an Integration Coordinating Committee to oversee and 

coordinate: 

\ 

• developing a single management team, 

• developing a unified mission and vision, 

• developing recommendations for reducing UMCCCSSary service duplication, . 

• fostering maximum cost effectiveness, quality, consolidation and satisfi.ction, 

• integrating DccentraIized Hospital Computer Program (DHCP) databases, 

• developing an organizational chart. 

EV ALUA TING AND MONITORING THE PLAN 

An evaluation and monitoring plan will include: 

• customer service 

• resources utilization 

• quality of can: 

• access 

• timeliDcss 

REPORTS AND RECOMMENDA nONS FROM THE INTEGRA nON COORDINATING 

COMMITTEE (ICC) 

• Reviewed reports and l'CCOIIIIIICDdaons from 13 of the 14 ICC-cbartered work groups for the 

followiDg services and submitted recommendations and-comments to the VA Chicago Health Care 

System (V ACHS) Director: 

-itrfo1'1tlllJUm re&OIl1'CD mgmt. 

-nutrition & food 

-JHlllIoiogy & IIIboratory 

-diagnostic radiology 

-llIIest/Iesioiogy 

-nuclear medicitle -ambulatory care 

-nt!Mroiogy -IIII!I6citIt! 

-physical medicine & rehab -psyclliatry 

-rt!8t!IU'ClI -surgery 

..,lIeraptilltic radiology 

• Reviewed reports and reconunendations of 18 integration work groups for the following services 

and submitted recommendations and comments to the VACHCS Director: 

-audiology & speecll pallIology -jiscallMCCR (cost recovery) -police & security 

-clIapiain -lIospital based primary care -prostlletics 

-dmtal -library -psycllology 

-education -medical administration -recnat'l tllerapy 

11 
56 

-eng;n~uing -Ifursing -social work 

-enllironmental mgmL -pharmacy -11OIuntary 

• Rec:ommcnded a VA Chicago Health Care System integration goal starcment (approved) 

• Recommended a VA Chicago Health Care System mission (approved) 

• Endorsedc:ons:,lidation of several . administrative and. clinical· services, including audiology and 

speech pathology, chaplain, .. dental .environmental management, hospital based primary care, 

infonnation resources lJ13IIII!ement (approved), neurology, nuclear medicine, nutrition and food 

services (approved), pharmacy (approved), police and security services, prosthetics and voluntary 

(approved) services. 

• Recommended angiography equipment replacement at West Side and cardiac catheterization 

equipment replacement at Lakeside (both approved) 

• Recommended integration of pathology and laboratory medicine services 

• Recommeitded integration of ambulatory care services at the two divisions, including satellite 

outpatient clinic sites (Crown Point, Indiana, and 63'" and Stony Island, Chicago). 

INTEGRATION IMPLEMENTATION ACTIVITIES RECOMMENDATIONS FROM THE 

STAKEHOLDERS ADVISORY GROUP (STAG) 

• Single director (vs. two facility directors previously), VACHS. 

• Merged Lakeside and West Side divisions clinical and admiDistrative computer databases (DHCPDecentralized Hospital Computer Program) into a single VA Chicago Health Care System 

computer database 

• Consolidated medical care cost recovery section staff of Fiscal Service at West Side Division 

• Consolidated payron section staff of Fiscal Service at Lakeside Division 

• AppoiJJted single Chief, Information Resources Managemeot Service for both divisions 

• Appointed single Chief, Pharmacy Service for both divisions 

• Appointed single Chiet: Recreation Therapy Service for both divisions 

• Appointed single Chiet: Voluntary Service for both divisions 

• Appointed ooc Infonnation Systans Security Officer for both divisions 

• Appointed two Decision Support System persons for both divisions 

• Estimated cost savings identified to date in VACHS Director-approved wode group reports: 

$691,000 (13.8 FTE) 

12 
57 

STATEMENT OF 

JOSEPH L. MOORE 

DIRECfOR 

VA CHICAGO HEALTH CARE SYSTEM 

ON INTEGRATION AND CONSOLIDATION 

OF VA MEDICAL FACILITIES IN CHICAGO 

BEFORE 

THE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

COMMITTEE ON VETERANS' AFFAIRS 

CHICAGO, ILLINOIS 

OCTOBER 16, 1997 

Mr. Chairman and Members of the Subcommittee: 

I welcome the opportunity you have provided me to testify at this Field Hearing, for this is a meeting - and 

a topic -- whose significance cannot bc overstated. 

The facility integration that we have convened to discuss is the fIrSt -- and, thus far, the only one - of its 

kind. Moreover, despite chaUenges from within and without, the VA Chicago Health Care System is 

moving steadily forward. Indeed, we are making history. More importantly, we are making the changes 

necessary to continue providing our area's veterons with the comprehensive, compassionate health care 

that is their due. 

I am going to speak offaith as it is defined by Webster's: "the firm bcliefin something for which there is 

no proof." When we erobarked upon this journey, my faith - in veterans, in the VA and in the merits of 

the task before us - assured me of our mission's eventual success. Naysayers predicted this would not 

work; I stand before you with my faith intact. 

We have established a sound, solid foundation upon which to build u the inherently dynamic process of 

facility integration continues to unfold before us. 

I would like to begin by giving you some background, after which I will update you on where VA Chicago 

stands today - and where I see us beaded tomonnw. 
58 

A. member institutions ofVe!eraoa inregnted Service Network (VISN) #12, the former VA Lakeside and 

VA West Side Medical Confers had much in common right from the stu!. These two predominantly &Curecare, highly affiliated. urban medical facilities were approximarely the same age; their respective academic 

affiJiations began at about the same time; they had similar geognphic and patient population areas; and, 

prior to their integntion, they already shared programs in several services. 

On June 27, 1996, then-Secretary of Veterans Affairs J .... Brown announced his decision to integnre 

Chicago's two VA Medical Confers under a single management structure. (The name change to the VA 

Chicago Health Care Sysrem followed on October I of that year.) Given _ent and anticipated 

developments both within our nation's health care industry and at the federal filnding level, it was 

envisioned that the two Chicago facilities would be stronger as a single, unified institution than they had 

been as two. Through the pooling. reorganization and rcallocationof our resources according to where 

they could best be utilized, we at Lakeside and West Side could eliminate redundancies, enhance 

operational efficiency, conserve resources and maximize their utilization, ensure the continuation of high 

quality care during a period of declining resources. and perform our assigned roles in the continuum of 

care established, by our VISN. for the veterans in our geognphic arcs. 

in short, the Department of Vererans Affairs sought to establish in V A Chicago. fully integrated health 

care system that would cost-effectively provide. single, high standard of care for the veteran patients who 

are VA's very reason for being. 

On January I, 1997, the Lakeside Division and Wcst Side Division computer databases were merged, 

thereby forming one of the largest facility databases in the Department of Veterans Affairs. Residing at the 

West Side Division, the database's hardware is connected via teleconununication links to VA Chicago's 

other sites. 

While merging our databases was accomplished with relative ease, merging our other resources, human 

and otherwise, has required greater effort - as well as the input of many different partners. The integntion 

Coordinating Committee (ICC). operating under my oversigh~ set about reviewing the activities ofth. 32 

service-specific work groups under its purview, while the Stakeholders Advisory Group (SAG) provided 

input and advice from representatives of our various publics, including local US Congressional offices. 

These conunittees and work groups focused on such basic criteria as value of care. access to care, quality 

of care, customer satisfaction, and cost savings and avoidances. 

As of two weeks ago - October I. 1997 - the ICC completed their assigned task of structuring the 

LakcsidclWest Side integntion. Yesterday. Octoher IS, 1997 the SAG completed its work. Although 
59 

disbanded at the facility level our stakeholders will continue to have a voice through our VISN's 

stakeholders advisory group. 1he medical school deans of our two major academic offiIiatea, 

Northwestern Univenity aod the Univemty ofD1inois, are now working together closely. In the weeks 

shead, we intend to establish an integrated Deans' Committee drawn from the respective bodies at both 

univenities. Guided hy this new group, we will continue to forge our ongoing integration, particularly in 

the areas of medical education and residency \nining. 

Also on October I, the 16th service chiefwaa formally appointed to oversee upentions throughnut the VA 

Chicago Health Care System. Drawn from both divisions in perfectly equal meaaure, the .. VA Chicago 

chiefs - and their divisions of origin -- are as follows: 

Audiology and Speech Pathology: Kyle Dennis, PhD (West Side Division) 

Chaplain: Howard Jones (Lakeside Division) 

Engineering: Ronald Hughes (Lakeside Division) 

Environmental Management: Lenwood O'Neal (Lakeside Division) 

Information Resources Management: Howard Loewenstein (West Side Division) 

Library Service: Lydia Tkaczuk (Lakeside Division) 

Medical Administration: Sylvis Courtney (West Side Division) 

Nursing: Joe Caldwell, RN (Lakeside Division) 

Nutrition & Food: Gracie Bradford-Specks (Lakeside Division) 

Pharmacy: !!.ichard Rooney, PharmD (Lakeside Division) 

Police and Security: James Cony (West Side Divisinn) 

Prosthetic and Sensory Aids: Robert Bourn (Lakeside Division) 

Psychology: George Meschel, PhD (West Side Division) 

Recreation: John Clifton (West Side Division) 

Social Work: Timothy Buckley (West Side Division) 

Voluntary Service: Marie Bambakakis (Wesl Side Division) 

These chief. are responsible for oveneeing and coordinating the upentions of their respective services al 

both divisions, as wen as cmying oul fully their conunitments in the 1a~/managemenl arena. 

Within those services thai have nol yel been formally restructured, the service chief. and staff at both 

divisions are closely coordinating their efforts in order to ensure that our veteran patients receive the 

maximum possible benefit from our shared resources. 
60 

To date. the two divisioas have eliminated alUbstantial munber ofposiliom, primarily throuah boy-ouu, 

attritioo ODd UDfiI1ed vIIC....,ies -- wi1hou~ I would SIRlS, either the forcible terminatioo of a sioale 

employee or even thnlightest reductioo in our provision of patient care. While not a function of the 

integration, the diminutioo of our work force certainly "forces the issue." obliaiDs our two divisions to 

pool their programs ODd resourceo in order to maximize oot ooIy the efficiency ODd cost-effectiveness but 

also the quslity of the services that we at VA Chicogo provide. 

Indeed. such a maximization of resources is essential in order for us to fulfill our institutional mission: 

To provide ........... comprehensive (primary ODd tertiary). compassionate, timely and cost-effective 

health care for the Chicago (Cook County) and northwest Indiana veterans ate .. h of the divisioos ODd 

clinics of the VA Chicago Health Care System. 

Together with our lcademic and staff Iffiliates. to capture the innovltive opportunities offered by the 

integration of the two divisions in euhancing the delivety of health care, education and research. 

To develop programs ODd resources which enhaoce our ability to provide comprehensive services. 

To provide priDwy back-up for IICtive military.perso .... 1 ina war or national emergency. 

Fortunately, VA Chicago's DlIlltiple academic affiliatioDS ODd great size give us the means ODd flexibility 

oeeded to offer our veteranJ truly exceptional care. What', more, this care 

is provided by first class pnctitiooers: in Chicago Magazine's recent liII of the area's ''Top 500 Docton," 

72 physiciana - one in seven -- pnctice It VA Chicago. 

Thus equipped, the management and staff at both sites have I IlDique opportunity to work together toward I 

fully integrated ODd cohesive heshh care system for the veterans of Cook County and the surrounding area, 

directing our pooled programs and resources to more pltioolS and into more types of services than ever 

before. 

Already, some major pieces are falling into place. The West Side Division recently installed a new. greatly 

improved angiography suite. ODd the Lakeside Division has porchMed the equipment needed for a state-ofthe-art cardiac catheterization iaburatory. In addition, an innovative and cost-effective reaidential 

substance Ibuse program has been instituted at our West Side Division. Facilities and programs like these -

- to name but three - promise to enhance our overall capability as VA Chicago. 

It is, l think, important to keep in mind that never before have two major, highly affiliated, tertiary-care VA 

medical cooten been integrated UDder a single management structure. It thus came as 00 SUJPrise that the 

scrutioy given our efforts by the media, the community. aldenneo and clergy, our employees, their labor 

4 
61 

unioas ..... dIe CCIIIIIIIIIIIit .t .... e - DOl 10 IIIODIioIIdIe General ACCOIIIlIiDB Office ..... ·1IWIImJUI VA 

Hea1tb Systoms Raan:ben - bas been ..... 00IIIiDuea 10 be 10 iDIenae. 

Some Ullion IepreOeI1Iativea have tokal isIue with management's righlB (as affirmed in US Code, Title S, 

Subpart F, Seetion 7106) 10 make the decisions needed to bring facility ""''lIanization 10 fruition. 

However, I believe Ihst as labor continues 10 glOw in ilB understanding of this dynamic process, so too wiU 

ilB capocity 10 work in portDenbip with us 10 effect die beat possible """"""" for all concerned. 

FurIbcrmoI"e, NorIbwestom University IIId die Univenity of Illinois have often been depicted as in 

coafIict, ",ben • more occ:urate portrayal would abow die two institutions CODC\IITeDdy and, of late, 

cooperatively facing • COIIIIbOO challenge. 

Likewiae, there have been claims - widely tepOrted in the media - Ihst aU inpatient aervice would be 

tranafem:d 10 Lokaide, or Ihst Weat Side would be closed outright In fact, our position remoins 

1IJICbaD8ed: boch focililiea wiD come out of this initiative StroNger than they were before, in order Ihst we 

might more fUlly oddreu .U of our patiallB' needs. 

We have been edified by the examplea of olber institutions - up to • point Each facility brinp inlo the 

mix its own unique bistory, philosophy and patient population; every integration poses its own chaUenges 

and engenden ilB own lessons. Each such venture is an exploration, a journey into viQlin territory; those 

who work 10 accomplish facility integration are, by definition, pioneers. Thus, more than anything else, 

the extent of our success wiD be detmnined by our openness - by our willingness and Ibility 10 10IlD. 

In his report on behalf of our Suraery Work Group, which be chaired, Dr. Charlea Rice, Vice Dean of the 

Univenity of Illinois Medical Scbon~ used words Ihst apply, I would contend, to VA Chiclgo as • whole. 

- "A plan of coosolidation involving two complex servicea, .. be _, "cannot be complete in every 

detail. The plan abouJd be • template for an OD8oing process. The goodwill and good faith Ihst were 

ealBblisbed in the development of this conaolidation plan bodes wen for the future as means of 

coordinating and enhancing aervicea are sought In die past, organizations strategized to gain a oompetitive 

advantage. We want this consolidation to give us • cooperative advantage.-" 

That "cooperative advantage" is precisely what V A Chicago bas sought aU along. Seeing it take shape in 

new and unprecedented ways -- ways Ihst are geared, invariably, toward enhancing patient care - is the 

most gratifying reward Ihst any orus could hope 10 receive. 
62 

Facility integration means change, and change invariably invites criticism, particularly from those with a 

vested interest in maintaining the status quo. Yet when we committed 10 this course, we UIIdentood that 

change - not cosmetic 1wea1cing but intrinsic, significant change, major surgery -- necessarily would 

become our new, day-to-day reality. And so it must if we as a health care system are 10 not only survive, 

but thrive. 

Our nation is home 10 26 million men and women who, at various times throughout this century, put their 

lives on the line 10 protect and defend the cherished freedoms of which each and every American partakes 

daily. These unselfish and, all too often, unsung heroes did not shrink from their call to duty; they stepped 

forward and paid the price for your freedom and mine. Who amoDg us would suggest that we now shrink 

from the challenge before us - and, thus, from our commibnentto them? 

While our institution has been and continues to be in transition, one great constant remains: our mission of 

eating. In the fmal analysis, it is our very ability 10 change - in line with our newly-developed 

"cooperative advantage" -- that willanow us 10 not only maintain but fortify this mission of eating today, 

tomorrow and well into the next century. Our veterans deserve no less. 

6 
63 

STA'ICMENf OF 

CHRISTOPHER F. 1CRRENCE, M.D. 

CHAIRMAN, INTEGRATION COORDINATING COMMl1TEE 

VA CHICAGO HEALllI CARE SYSTEM 

BEFORE 

TIlE 

SUBCOMMI1TEE ON OVERSIGHT AND INVESTIGATIONS 

COMMl1TEE ON VETERANS' AFFAIRS 

CHICAGO, Il.LINOIS 

OCTOBER 16, 1997 

Mr. Chainnan, 0Iher speakers aDd guosIS - Good morning aDd thaDk )'011 for this opponunity to 

discuss the IntcpatioD Coonlinating Committee (ICC) of the VA Chicago Health Can: System. On 

October 10, 1996, I was cbarpd by Kenneth Kizer, M.D., MPH, Under SeCIetaIy for Health, to be the 

Chair of the Intcpation CoordinatiIl8 Committee for the VA Cbicago Health Can: System. In his letter of 

appointment Dr. Kizer sIJesIod thai there wen: '00 preset dcIcrminaIions. The ~ ~d be open 

aDd data drM:u aDd thai all rq>OIIS aDd ftalIIIIIICIIda reviewed by the VISN pi_, Iosn E. 

CnmJniDp, MD., aDd subocqucnt review at the Under SeCIetaIy of Health level.' One pf the guiding 

principlcs thai the Integration Commiru>c dwcd early on in the (IIOCCSS was the need for maximum 

involvement of the IffiIiatcs, the sIakdIoldcn, cmpIoyccs, aDd 0Iher int=sled individuals. M. of today 

over 300 individuals in the VA Cbicago Health Can: System have had input into the ICC. process either 

.. a member of the c:ommittee, subamuniru>c or S1akeho1dcrs AdviSOl)',Group. 

At its lint meeting, the Intcpation CoorcIinatin& Committee decided that .... -wi proceed in 

I'ornIiDi cbat1r%ed WOtk groupo with the approvIl of the McdicaI Center Director, Mr. I'*Ph Moore. 

These groupo wore service specific aDd wen: cIwpd with cIcveIopiDc a beal1h sysIcm thai -wi maimain 

the ~ or enbatIce the overall service to the __ wIIiIe IIIinimizina the COlIS inbcraIt in opcratill8 

'-boIpiIals with simiIIr missions in cIoIC pmximity. The oommittcc doc:idcd to IIaJt with services that 

wen: reIatMIy DOlI COIIIIUversiII in ~ to pmve that the ~ was VIlid, IIIId could be accompIisbcd 

in the contcxl of the VA Chic:a&o Health Can: System. When a group c:IlIIIpIced i~, the JIRlP05III 

was submitted to the Intcpation Coordinating Commiru>c for its review aDd subocqucnt recommendation 

to the Medic:aI Center Director. The pcopoal was IiIo reviewed at the StaIrcboIdcn AdYiaoty Group by 

the c:bairmcn of the various c:boncred WOtk IJ'OUPI. The _"""""""-from the SIakeboIdcn 

Advisory Group """" lJnIII8bIlOrwud to the ICC in order to provide maximal input into the dclibcntions 

of the IlIIqnIIioa CoordinatiIl8 CommiaIoc. 
64 

2. 

The various woot groups ~ usually chaired by a chief fJ{!IIOIVice. but tn some iDsIances SIICb as 

1UlJICIY. medic:ineand.poychiaUy. !be group was chaired by a UnMnity orIUinois ScbooI of Medicine 

repoaenI8tive or a Nonh-.n Univenity Medical School representative. 

In order to ka:p the sIa1f at tile two divisions up-to-date on tile process of the committee, we have 

'-' a number of formats to achi .... this goal. The Chair of !be Inregmion Coordinating Committee has 

bad four town ball style meetings at the Lakeside and West Siclc divisions. These meetings bad two goals. 

(I) 10 presenl the activities of the Integration Coordinatiog Committee and (2) to seck infonnation from 

!be sIa1f al tile two divisions concerning tile future pro<:eSS of the Integration Coordinating Committee. 

These meetings ~ extmnely well allCllded and were very infotmalive .. Then: has also been rquIar 

updates of !be prograsof tile Inregmion Coordinating Committee in tile VA Chicago Hea1th Care 

System NewsIeUer. as well as publication of tile Integration Coordinating Committee minutes in the 

dcc:cnIJaIi2lOd hospital computer program (DHCP). At tile 1ast town meeting il was also suggested thai we 

have a newsletter put 011 !be DHCP. 

By 0cIcber I. 1997. all the work groups have presented their RCOmmendations to the Integration 

c-dinaIing Committee. Moll of !bem:ommendations have been forwanlod to tile Medical Center 

DiJecIor with little chan&a. A few have been tdCmd bKIt to tile !IIOIVice wad< groups. As one can .... 

!be ~ is very time COJaIDIiDg, but !be COIIIDIittco believes Iha1 it is very WCIth wbiIe in Iha1 il 

iowlves !be maximum nwnber of people in !be proposing pIIlOeSI. Until tile inception of tile Integration 

Coordinating Committee. tbere bad been little active participation by the two divisions in coming up with 

joint plans as to coasoIidation. 

The ICC bas approyaI !be Goa1s A. Mission statement for !be VA ChieaSO Health Care SysICID. 

In addition !be comntittee bas a1ao rec:ollllllClldcdthe replaccmcnl of angiography equipmenl at tile West 

Side Division, and the rep/acemeIII. of!be cardiac c:atbet.erizalion cquipmenl81 tile Lakeside Division. 

The committee bas a1ao rec:ommended tile integration fJ{ Ambulatory Care Savices al !be two divisions 

wb.ic:b will indude tile satellite 0UIpaIiaU clinics 81 Crown Point, Indiana, and 63rd SIJect and Slony 

IsIaDd in Chicago. 

The committee bas buill up a track record of accompl.ishmenl which bas allowed \IS to deal with 

!be thorny issues of alIiIialion interests and placement ofbed service facilities. In orcler to facilitate tile 

proc:as among the bed service woddng groups. the Medical Center Director and I have bad meetings with 

!be Chain of the bed service chartcred work groups 10 faciliLtIC the intcrservice planning Iha1 was 

IIOCCSS8IY for a cobcn:nl proposal. 
65 

3. 

In 1WIlIII8J)', I ~ that the In/egIatioD Coordinating CommiU= of the VA Chi ...... Health 

Can: S)'IIcm has worlted very cIiJiaen!Iy in selling up a process and frame WOJk for the integration of two 

tertiary can: bospitals. This commiU= would have never been successtUl without tl,c support of the four 

medical school Deans. the union ~ who have contnbuted greatly, the chair of the 

stakeholders group and other veIera1IS service orpnization ~. 

Tbank you for the opportuDit;y 10 present this brief overview of the Integration Coordinating 

Commiu= of the VA CbiC880 Hcalth Can: S)'IIcm. 
66 

.n 

-.-

* WASHINGTON OFFICE * 1608 "K" STREET. N.W. * WASHINGTON. O.C. 20006-2847 * 

(2021 861-2700 * FAX (202) 861-2728 * 

For God a"nd Country 

November 4, 1997 

Honorable Terry Everett, Chairman 

House Veterans' Affairs Subcommittee on 

Oversight and Investigations 

335 Cannon House Office Building 

Washington, DC 20515 

Dear Chairman Everett: 

In lieu of p.ersonal testimony, The American Legion Department of Illinois is 

submitting a written statement relative to the Integration and Consolidation 

Planning of The Department of Veterans Affairs Medical Facilities in Chicago. The 

American Legion requests that this statement be made part of the October 16, 

1997 hearing record. 

We appreciate your compliance with this request. 

Sincerely, 

1{.s.\h 

Kimo S. Hoi Ingsworth, Deputy Director 

National Le islative Commission 
67 

TESTIMONY OF MARTIN F. CONATSER 

DEPARTMENT COMMANDER 

THE AMERICAN LEGION OF IUlNOIS 

TO THE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

COMMITTEE ON VETERANS' AFFAIRS 

UNITED STATES HOUSE OF REPRESENTATIVES 

ON 

INTEGRATION AND CONSOUDATION PlANNING OF THE DEPARTMENT OF 

VETERANS AFFAIRS MEDICAL FACIUTIES IN CHICAGO 

NOVEMBER 4. 1997 

Mr. Chairman and Membars of the Committee: 

The American Legion axprasses gratitude and appreciates tha opportunity to 

share its views on the integration process of tha VA Chicago Haalth Care Systein 

(LakesidelWest Side Divisions). The mission of the Department of Veterans Affairs 

(VA) Chicago Health Care System is to provide quality medical care for Chicego 

area veterans. 

A GAO report, Lessons Learned From Medical Facility Integrations. July 

1997, stated -facility integrations are a critical piece of VA's overall strategy to 

enhance the eff"lCiency and effectiveness of health service delivery to vaterans. 

VA's strategy is similar to how the private sector heelth care industry is evolving. 

In essence, integrations can allow VA to provide the same or higher quality 

services to veterans at a significantly reduced cost. - It further states that within a 

short period of time by unifying menagement and consolidating services, the 

integration of Westside and Lakeside would produce millions of dollars in savings 

that then could be reinvested in the VA system to further enhanca veterans care. 

On the other hand, an article in Hospital & Health Networks by Chuck 

Appleby titled Organized Chaos states -whether working in hospitals, clinics or 

private offices, doctors, nurses and other staff typically go about their work in an 

ad hoc fashion that relies more on oral history-the way we've always done it- than 

on bona fide studies of efficiency. Welcome to the world of clinical integration, 

which is still more theory than practice-. In the opinion of The American Legion, 

this is more typical of the integration process between West Side and Lakeside in 

Chicago. 

The buzz words often heard here are -date driven-. However, the reality of 

the situetion points out that in some cases consolidations have been more 

motivated by budget than quality. This is what The American Legion lees in this 

case. Budget driven consolidations can result in hardships, and can be harmful to 

patients. The biggest threat, under these conditions, is the reduction or 

elimination of services and professional steff. Examples of services that have been 

eliminated or reduced with other such integrations include inpatient and outpatient 

Mental Health, Substance. Abuse, and PTSD programs. 

In the field of Substance Abuse programs, The American Legion has already 

seen tha reduction of the number of patients treated; as inpatient wards close 

forcing longer commuting distances for patients seeking inpatient treatment. 

Studies conducted by the VA have found that increasing travel distances by 20 

miles can reduce the likelihood of outpatient follow-through by approximately 70 

percent. In urban areas, increasing the distance by 10-15 miles incurred 

significant drop-out by low income minority and lor veterans over the age of 60. 

Also, there has been a significant drop in resources across- the- board in funding 

for substence abuse program which includes the reduction of staff. There are 

facilities which justified closing their inpatient capabilities by claiming to reduce 
68 

2 

redundancy, and the intent to reinvest their savings into outpatient programs or 

community outreach programs. In many cases, that has not happen. In the field 

of mental health,resources have also been diverted from mantal health programs 

to non-mental health programs. These observations were confirmed by clinicians 

that The American Legion interviewed while in the field and by VA Headquarters 

staff. The American Legion has additionally, confirmed these observations with 

statistics from the Performance Measures for Seriously Mentally III Veterans FY 

1996, Department of Veterans Affairs Outcome Monitoring of VA Specialized 

Intensive PTSD Programs Fiscal Yeer 1996, and the Department of Veterans 

Affairs National Mental Health Program Performance Monitoring System Fiscal 

Year 1996 Report. 

The American Legion is concerned about the current reduction of employees 

'about one hundred) at these two divisions, as well as plens for another round of 

amployee reduction in the coming year. VA has already halted the construction of 

suites intended to provide specialty vascular testing for patients. Patients in need 

of advanced vascular testing are now forced to travel outside of Chicago to Hines 

Medical Center in west suburban Maywood. Again, The American Legion must 

repeat thet researchers have shown that distance or travel time between patient's 

home and the hospital is the most important determining factor whether a veteran 

will use a VA or non VA facility. Further cutbacks are supposedly planned over the 

next year, and The American legion is concerned the cuffbacks will negatively 

affect the quality of medical care available to Chicago area veterans. 

The American Legion has ' concur with the premise of the MCMANIS 

Associates report that stated stakeholder participation in the process would have 

been enhanced if VA had provided a detailed integration plan before 

implementation of the integration began. Some of the problems with winning early 

support of The American Legion were because VA did not provide sufficient 

information about the integration, such as how services will be integrated; how 

potantial changes will affect veterans and employees; why selected alternatives 

are the best ones available, how much the potential changes will cost to 

implement, how much the potential changes will save, and how VA will reinvest 

savings to benefit veterans. This is especially important since the Lakeside and 

West Side facilities have almost identical missions, are about the same size, and 

have strong affiliations with major medical schools. , Even though there is ample 

evidence that the VA made an effort to keep · yeterans, employees and 

stakeholders informed 'of changes, The American" Legion 'believes the timing of the 

.effort was too little ' and too late. During a Field Service site . visit by the national 

staff of The American Legion's National Veterans Affairs and Rehabilitation 

Commission in September, not one individual could be found who could 

satisfactorily answer most of the above questions. 

The previously cited GAO report mentioned that the -VA's incremental 

planning approach contributes to these communication problems beceuse it limits 

the amount of information available about the integration before implementation 

begins. Providing this information would enable VA to communicate more 

effectively with stakaholdars. Moreover, presenting such planning results in a 

written document that could be shared with stakeholders would further enhance 

the opportunity for effective communication by allowing VA to obtain "stakeholders 

views and gain support or -buy-in- for its proposed integration activities. 

Christopher F. Terrence M.D. Chairman, of the Integration Coordinating 

Committee reported that during their planning process the decision was made to 

form work groups. - The goal of the work groups to produce a health system that 

would meintain the quality or enhance the overall service to .the veterans while 

minimizing the costs inherent in operating two hospitals with similar missions in 

close proximity-. He explained how these work groups would study how to 

integrate individual services, then make their recommendations to the main 

Integretion Coordinating Committee and then on to 'approving authorities. The 
69 

American Legion questions how well these individual work groups will be 

coordinated to provide a unified master plan. The American Legion concurs with 

the GAO report which recommended that -VA's decision-making may be 

enhanced if it completes all planning for the integrated facilities before beginning 

to implement the integrations-. A master plan would have resulted in giving the 

VISN an even greater monetary savings which would have then allowed greater 

reinvestment opportunities, along with reducing the interest of third parties. This 

would have gained greater acceptance by The American Legion. 

The American Legion agrees with . the concept of the VISN 12 vision of 

the integration of Lakeside/Wellt Side as one el~ment of a larger Network strategy 

aimed et eccomplishing five principal goals to reduce cOllts, increase access, 

modernize VA healthcare, optimize utilization of VA capital assets and ensure 

consistently high quality care. The American Legion is aware that the elimination 

of unnecessary duplication or redundancy of services, and the coordination of 

resource decisions will achieve better economies of scale and productivity. The 

American Legion agreas with the approach. However, chartered work groups, 

chaired by a chief of service in some instances, a University of Illinois 

representative, or a Northwelltern School of Medicine representative seems to 

have brought an air of mistrullt among hospital lItaff of both facilities. 

Subsequently, any decisions from these groups given their composition may reflect 

the chairperson's own interests (as correctly pointed out by the GAO report). 

The Americen Legion wants to ensure that both the Lakeside and West 

Side Divisions remain open and that both division. continue to serve Chicago area 

veterans on both an inpatient and outpstient basis. 
70 

TESTIMONY 

FROM 

THOMAS. A. DUNCAN, JR. 

··EXECUTIVE'DIRECroR 

AND 

ROBERT H. WRrn: 

NATIONAL DIRECTOR 

ON BEBALF OF 

VAUGHAN CHAPTER 

PARALYZED VETERANS OF AMERICA 

OCTOBER, 1997 

My first experience with the Integration of the Chicago land Department of Veterans Affairs 

Hospital,W8S very chaotic and disorganized. Reaction to Congress mandated to balance the 

budget-no matter what. As a result, the VISN Director appeared to dictate "RIFF' integrations 

over West SidelLakeside Hospitals. Closing of departments without considering the fact of the 

VA employees, the community, the veterans, the unions, and the veterans service organizations 

who represent the VA constituency. 

It wasn't until PV A, Vaughan Chapter, took the initiative to call for a meeting at the request of 

the community leaders at the University of D1inois, and the unions, to bring some sense of order to 

the issue of integration. 

PVA's, Vaughan Chapter's, position from the beginning was that an environmental impact study 

should be conducted u related to the veterans, the employees, the community, and all of those 

who had a stake in the effect of any changes occurring in Chicago. 

After a great amount of dialogue and meaningful exchanges between administration and the 

veteran service organizations, it was finally conceived that the best way to make any changes wu 

to involve all the principals previously mentioned. As a result, you have one organized concept 

that you are now utilizing to make a smooth integration. Such u; the Integration Coordinating 

Committee, Veterans Advisory Council, Stakeholders Advisory Group, and the SCI Advisory 

Task Group. 
71 

We further feel that the expiration of the Integration Coordinating Committee's Commission and 

the end of the Stakeholders Advisory Group's mission, leaves no representation for the 

community and consumers in an oversight position as change takes place at Chicago 

LalcesidelWest Side VMAC. 

Now that a method seems immediate on the Integration of the Chicago LalcesideIWest Side 

VMAC, there Should be an oversight mechanism to ensure that all concerned contmue towards 

the agreed goals of the Integration Coordinating Committee. For without this oversight of the 

integration process, there may be a tendency or at least the opportunity for those charged with the 

integration changes to loose perspective of'the projected goals. Further there may be a tendency 

to stray from the pressures of cost cut backs, increased patient load, and modernization. Because 

of the reductions in funding that are planned over the next three (3) fiscal years, there is even 

more reason to maintain the consumer safesuards that have been put in place by the entities 

involved. We must an stay the course directed by the committees in order for it to work for an 

concerned. 

In closing, for an else to work, there must be a continuation of the oversight by the Stakeholders 

Advisory Committee at Chicago LalcesideIWest Side VMAC. This group is the most diversified 

and contains an needed elements for complete oversight. 

We at Vaughan Chapter PVA feel that this should have been done in the beginning; that this 

concept should be used throughout all the VISN'. for effective change. 
72 

, 

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Northwest,Chicago Senior Citizens Legislative C;'; 

Chicago Oepartment on Aging Copernicus Center 3160 Nor1bMlI_ A_.a.Ic:egO.lIIInO'-.fG818 (7n) 74408681 

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10-16-97 

TESTIMONY 

CONGRESSIO.NAL COMMITTBE ON VETERANS AFFAIRS 

IR.VIN R TeROH RPH. Membe"r 4th congressional 

Veterans Advisory Board,President Chicago Senic 

Legislative Council,AMVFTS Post .34, Polish 

Legion American Veterans,-Post '82,Disabled 

American Veterans andeb!na Burma India Hump 

pilots As.c. 

proposed plans for the Westside and Lakeside VA Rospital 

facilities in Chicago appear to be serving accounting anc 

cost savings, rather than clinical functions,quality care 

community accessability and transportation . The emphasis 

should be on NEED and not SAVINGS. 

The VA Plan appears to be an attemp~,to ~reat ~he whole 

person by REACHING BEYOND THE FORMER TRADITIONAL MEDICAL 

DIAGNOSIS,to assist and asse •• the .cono.ic,.ocial,~unctl 

proble ... and psychological prabl •• s that ""affect Veterans. 

This is a positive forward beneficial course of the V.A . . 

Modern coaputor Technology can now ae.sure BUCCes. and 

quali~y being delivered and future chanq •• required. 

Major Realth servic.;,whlch ".re operating below capacity 

should b. convert.d into Nursing Hoaes and Retire.ent Hom 

R •••• rch funding for T.aching Medical Centers should be 

continu.d. 

Hospital. should be outpatient and the u.e of their 

.atellit. clinic. be part of the system. Rin •• VA should be the Major "Hospitalization center for 

the Westside and Lak •• ide Hospitals. 

The Veteran prganis.tlons .nd Volunteers •• rving the V.A. 

should be enlarged and subsidized adequately •• to provi . 

• core of co.pa •• lonate,carrlng and ••• letin9 s.g.ent to 

THBRAPY and MONI~OaS of VETB~R HEALTH DELIVERY. 

Sinc.rel~' 

~~T~RON Rrf 3218 N central Pk. Chicago 60618,11 

GOD BLESS AMFRICA and AMERICAN VETERANS 

PROGRAMS 

Memorlel Day, Flag Oey, 4th 01 July, Labor Day, Veterans Day, HOIIplta1 Visitations 

o 

ISBN 0-16-056565-0 

9