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82–234 2014

VA CONSTRUCTION POLICY: FAILED PLANS 

RESULT IN PLANS THAT FAIL 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

TUESDAY, MAY 7, 2013 

Serial No. 113–18 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

HELEN W. TOLAR, Staff Director and Chief Counsel 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

MIKE COFFMAN, Colorado, Chairman 

DOUG LAMBORN, Colorado 

DAVID P. ROE, Tennessee 

TIM HUELSKAMP, Kansas 

DAN BENISHEK, Michigan 

JACKIE WALORSKI, Indiana 

ANN KIRKPATRICK, Arizona, Ranking 

Minority Member 

MARK TAKANO, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 

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C O N T E N T S 

May 7, 2013 

Page 

VA Construction Policy: Failed Plans Result In Plans That Fail ........................ 1 

OPENING STATEMENTS 

Hon. Mike Coffman, Chairman, Subcommittee on Oversight and Investigations ....................................................................................................................... 1 

Prepared Statement of Hon. Coffman ............................................................. 26 

Hon. Ann Kirkpatrick, Ranking Minority Member, Subcommittee on Oversight and Investigations ...................................................................................... 2 

Hon. Jackie Walorski, Member, Committee on Veterans’ Affairs, U.S. House 

of Representatives, Prepared Statement only ................................................... 26 

WITNESSES 

Lorelei St. James, Director of Physical Infrastructure Issues, Government 

Accountability Office ............................................................................................ 3 

Prepared Statement of Ms. St. James ............................................................ 27 

Raymond Kelley, Director of Legislative Service, Veterans of Foreign Wars ..... 5 

Prepared Statement of Mr. Kelley .................................................................. 32 

Glenn D. Haggstrom, Principal Executive Director, Office of Acquisition, Logistics, and Construction, U.S. Department of Veterans Affairs ..................... 6 

Prepared Statement of Mr. Haggstrom .......................................................... 34 

Accompanied by: 

Ms. Stella Fiotes, Executive Director, Construction and Facilities Management, Office of Acquisition, Logistics, and Construction, U.S. 

Department of Veterans Affairs 

QUESTIONS FOR THE RECORD 

Letter and Question Submitted by Rep. Beto O’Rourke, To: VA ......................... 36 

VA Response to Questions Submitted by Rep. Beto O’Rourke ............................ 36 

Additional Questions & Answers to VA from the Committee Members ............. 37 

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VA CONSTRUCTION POLICY: FAILED PLANS 

RESULT IN PLANS THAT FAIL 

Tuesday, May 7, 2013 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, Washington, D.C. 

The Subcommittee met, pursuant to notice, at 2:00 p.m., in Room 

334, Cannon House Office Building, Hon. Mike Coffman [Chairman 

of the Subcommittee] presiding. 

Present: Representatives Coffman, Huelskamp, Benishek, 

Walorski, Kirkpatrick, Kuster, and O’Rourke. 

OPENING STATEMENT OF CHAIRMAN COFFMAN 

Mr. COFFMAN. Good afternoon. I would like to welcome everyone 

to today’s hearing titled ‘‘VA Construction Policy: Failed Plans Result in Plans That Fail.’’ 

I ask unanimous consent that several of our colleagues from the 

Committee join us at the dais today to hear about construction developments affecting facilities that serve their constituents. Hearing no objection, so ordered. 

Providing veterans medical care is a core function of the VA. 

When the VA does health care right, it can be second to none. However, the process VA employs to build its health care facilities is 

abysmal and the results lead to delays for much-needed care to veterans. 

The Government Accountability Office’s recent report noted that 

VA’s four largest medical center construction projects have had an 

average of cost increase of $366 million and an average delay of 35 

months. One of the most distressing items in the VA report is that 

VA failed to learn from its mistakes as it went from project to 

project. I must add that many of these same issues have been identified by GAO in the past, and we seem to be no closer to a better 

result. 

Ultimately, it is not just major facilities that epitomize why VA’s 

construction policy is a debacle. A little more than a year, ago this 

Subcommittee held a hearing on VA’s failure to perform due diligence and failure to inform Congress of project increases regarding 

the proposed clinic in Savannah, Georgia. Based on subsequent correspondence with VA over the past year, I am not quite certain VA 

is getting the message that its construction program is dysfunctional and not in keeping with industry best practices or veterans’ 

expectations. 

Not only is VA building facilities over budget and late, but it is 

also failing to pay the contractors for the work in a timely manner. 

While ensuring taxpayer dollars are properly spent is of utmost imVACREP180 with DISTILLER

2 

portance, VA must pay its bills on time. Last week, I visited the 

Denver project and spoke directly with VA about prompt payment 

to contractors and subcontractors and was alarmed by VA’s response in the issue, and I will monitor their commitment to improving the process. 

Under the Prompt Payment Act and OMB’s guidance, a Federal 

agency is expected to, quote, ‘‘to ensure that prime contractors disburse the funds that they receive from the Federal Government to 

their small business subcontractors in a prompt manner,’’ unquote. 

The Prompt Payment Act also requires that the contractor certify 

that his or her subcontractors are receiving payment commensurate with the work performed. But as evidence shows, some contractors and subcontractors in these four projects have been waiting for months to be paid. 

Moreover, the Small Business Act explains that it is, quote, ‘‘the 

policy of the United States that prime contractors establish procedures to ensure the timely payment of amounts due pursuant to 

the terms of their subcontracts with small business concerns,’’ unquote. VA’s failure to abide by the laws governing payment to its 

contractors is unacceptable and is a problem in need of an immediate fix. 

Given the number and variety of facilities VA has built over the 

last several years, it is disturbing to me that VA continues to employ policies and techniques that have repeatedly fallen short. I 

look forward to hearing from today’s witnesses regarding VA’s construction policies and how we can move forward to effectively and 

efficiently build medical facilities for our veterans. 

Mr. COFFMAN. I now yield to Ranking Member Kirkpatrick for 

her opening statement. 

[THE PREPARED STATEMENT OF CHAIRMAN COFFMAN APPEARS IN

THE APPENDIX]

OPENING STATEMENT OF HON. ANN KIRKPATRICK 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman, for holding this 

hearing. 

The focus on the construction program of the Department of Veterans Affairs is one that needs to remain a top priority for this 

Subcommittee and necessary to ensure that veterans’ needs are 

being met. Hundreds of millions of dollars are authorized and appropriated every fiscal year to ensure that veterans are cared for 

in the safest, most state-of-the-art buildings to be built. The other 

priority, of course, is that, along with the building, there is in place 

quality and timely health care delivery to those who have earned 

it. 

Today’s hearing focuses on a recently released Government Accountability report on construction that is very concerning. GAO reports that some of the biggest construction projects have increased 

in cost by over 140 percent, while others have experienced delays 

in construction for up to 74 months. While I may understand the 

reasons for some of this, clearly there is a need for VA to scrutinize 

their construction program processes and make improvements 

where it may be necessary to do so. 

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I understand that just a few years ago, the VA put in place the 

Strategic Capital Investment Process, or SCIP. I look forward to 

hearing from the VA about how this process is working. Additionally, the Subcommittee has been informed that the Secretary, in an 

effort to improve the construction process, created a Construction 

Review Council to serve as the single point of oversight and performance accountability for the planning, budgeting, execution, and 

delivery of the VA real property capital-asset program. I look forward to hearing from the VA on how this Council’s report has been 

beneficial to the VA. 

This Committee has held numerous hearings on the VA’s construction process, and efforts have been made to improve and 

streamline construction projects. Having said that, I also believe 

the VA still struggles to effectively manage the program. From the 

Capital Asset Realignment for Enhanced Services to the recently 

implemented SCIP, problems and challenges remain. 

Mr. Chairman, I stand ready to work with my colleagues and 

with the VA as we tackle these issues in front of us today. 

Thank you, and I yield back. 

Mr. COFFMAN. Thank you, Ranking Member Kirkpatrick. 

I would now like to welcome the panel to the witness table, 

which you are there. On this panel we will hear from Lorelei, did 

I say that right, St. James, Director of Physical Infrastructure 

Issues for the Government Accountability Office; Raymond Kelley, 

Director of Legislative Services for the Veterans of Foreign Wars; 

Mr. Glenn Haggstrom, Principal Executive Director, Office of Acquisition, Logistics, and Construction for the Department of Veterans Affairs; and accompanying Mr. Haggstrom, Ms. Stella Fiotes, 

Executive Director, Construction and Facilities Management, Office 

of Acquisition, Logistics, and Construction, for the Department of 

Veterans Affairs. 

Ms. St. James, you are now recognized for 5 minutes. 

STATEMENTS OF LORELEI ST. JAMES, DIRECTOR OF PHYSICAL INFRASTRUCTURE ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE; RAYMOND KELLEY, DIRECTOR OF LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS; AND 

GLENN D. HAGGSTROM, PRINCIPAL EXECUTIVE DIRECTOR, 

OFFICE OF ACQUISITION, LOGISTICS, AND CONSTRUCTION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED 

BY STELLA FIOTES, EXECUTIVE DIRECTOR, CONSTRUCTION 

AND FACILITIES MANAGEMENT, OFFICE OF ACQUISITION, 

LOGISTICS, AND CONSTRUCTION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF LORELEI ST. JAMES 

Ms. ST. JAMES. Chairman Coffman, Ranking Member Kirkpatrick, and Members of the Subcommittee, I am pleased to be 

here today to discuss VA’s construction of major medical facilities 

and actions it should take to decrease the time and cost of these 

projects. My testimony today is based on our report published a few 

days ago. 

VA has an important mission of caring for over 6 million veterans. Right now, VA has 50 major medical facilities that it is eiVACREP180 with DISTILLER

4 

ther building or renovating, at a cost of more than $12 billion. This 

is a huge undertaking. Since before the Las Vegas facility was constructed, VA had not built a project of this size in over 15 years. 

GAO has reviewed VA’s approach to planning and building major medical facilities. These are facilities that cost over $10 million. 

VA, however, has struggled to match its aging infrastructure with 

the changing needs of veterans. It must also contend with a wide 

array of stakeholders, including Congress and veterans organizations. 

In our report, we found problems around two fundamental construction issues: time and money. But to be fair, most construction 

projects, private or public, change from design to opening day, and 

events, sometimes beyond anyone’s control, can easily add time and 

money. Even given this, for the VA facilities we reviewed, we remain concerned about the amount of time and the amount of cost 

increases from the time projects are to be finished and the time 

they are expected to be completed. Why is it taking so long to complete these facilities and why have costs increased so much? 

These answers are important. Over the next 10 years, VA plans 

to construct or renovate projects that have an estimated value of 

over $21 billion. 

Of the 50 projects in our review, we reviewed in detail four major 

medical facilities, in Denver, Orlando, New Orleans, and Las 

Vegas. So far, Denver is 18 percent complete, but it has taken 10- 

1/2 years from the selection of the design firm to VA’s recent estimated completion date. It also experienced a 144 percent cost increase from the initial cost estimate. In Las Vegas, the project took 

slightly more than 10 years. In contrast to VA, we found that the 

Naval Facilities Engineering Command, who builds similar medical 

facilities under similar regulations, designs and builds such facilities in about 4 years. Similar to Denver, Orlando has experienced 

a 143 percent cost increase, and New Orleans a 59 percent increase. 

While each facility has unique circumstances, we found several 

reasons for these increases, including some that were beyond VA’s 

control. For example, due to Hurricane Katrina, construction costs 

in Las Vegas skyrocketed. In Denver and New Orleans, political 

pressure, including pressure from some veterans groups, moved VA 

to change from shared facilities to stand-alone facilities. In Orlando, the site changed three times from 2004 to 2010, once because VA didn’t move quick enough to secure needed land. Lastly, 

unanticipated events, such as undetected underground storage 

tanks, as we saw in New Orleans, can impact estimates. 

In VA’s November 2012 Construction Review Council report it 

acknowledged several management problems and stated that, 

among other actions, it would submit initial designs to Congress 

that were 35 percent complete, beginning with its 2014 budget submission. These estimates are important. Congress uses them to 

make funding decisions and veterans use them to measure when 

medical services will be available. 

Lastly, in VA’s management of all major facilities, we recommended that VA issue guidance on when to use medical equipment planners and they should issue procedures to clarify to contractors the roles and responsibilities of all VA personnel involved 

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in projects. They should also streamline its change order process. 

VA and contractor officials all cited this as a fundamental management problem. VA agreed with our recommendations, and we are 

encouraged by its planned actions, but believe these actions should 

be implemented and monitored to ensure that real change occurs. 

Mr. Chairman, this concludes my statement. I am happy to answer any questions that you have. 

[THE PREPARED STATEMENT OF LORELEI ST. JAMES APPEARS IN

THE APPENDIX]

Mr. COFFMAN. Ms. St. James, thank you so much for your testimony. 

And I am going to go ahead and recess the Committee for votes 

and then we will reconvene right after voting. 

[Recess] 

Mr. COFFMAN. The Committee is called to order. 

Mr. Kelley, you are now recognized for 5 minutes. 

STATEMENT OF RAYMOND KELLEY 

Mr. KELLEY. Mr. Chairman, Ranking Member, Members of the 

Subcommittee, on behalf of the 2 million members of the Veterans 

of Foreign Wars and our auxiliaries, thank you for the opportunity 

to testify today. 

I know everyone has heard these statistics, but they are worth 

repeating. VA’s infrastructure is, on average, 60 years old. Utilization has risen from 80 percent to 121 percent in a matter of 6 

years. In that same time period, the facilities have eroded, the conditions of those facilities have eroded from 81 percent to 71 percent. The VA currently holds 50 major construction contracts and 

has identified a total of 130 major construction projects that need 

to be addressed, all at a cost of about $25 billion. VA has a monumental task of expanding and replacing its medical facilities, and 

they must maximize every dollar and implement processes that will 

expedite the construction process. 

The VFW has identified four major areas that need to be addressed to ensure the construction projects are done in a more efficient and cost-effective manner. First, VA must fully integrate the 

Electronic Contracts Management System. Second, VA needs to 

stop using the design-bid-build contracting practice. Third, VA 

must adopt a comprehensive facility master plan. And fourth, they 

should use medical equipment planners during the construction of 

all medical facilities. 

Due to time constraints, I will limit my remarks to just two of 

these areas of concern. 

VA has historically relied on the design-bid-build project delivery 

system when entering into contracts to build major facility projects. 

Of the 50 current VA major facility projects, 43 of them are designbid-build. With this model, an architect is selected to design the facility, the design documents are used to secure the bid, and then 

the successful contract bid-holder builds the facility. Design-bidbuild projects often encounter disputes between the consumer—in 

this case VA—and the construction contractor. Because these contracts are generally firm fixed price based on the completed design, 

the construction contractor is usually responsible for cost overruns 

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unless VA and the contractor agree on any needed or proposed 

changes that occur with change of scope, unforeseen site condition 

changes, or design error. VA and the contractor negotiate these 

changes through change orders. This process can become adversarial because neither party wants to absorb the costs associated 

with the change and each change order can add months to the 

project completion date. 

The flaws of design-bid-build projects have become apparent, 

highlighted by the delays in Orlando, Florida, with the new medical facility that has been delayed 39 months, due in part to change 

order disputes. This contract must be followed through to completion, but VA must use this as a lessons learned and change their 

contracting model to an architect-led design build model. A designbuild project teams the architect and the construction contractor 

under one contract. This method can save VA up to 6 months of 

time by putting the design phase of the construction and the construction performance metric together. Placing the architect as the 

lead from the start to finish and having the construction contractor 

work side by side with the architect, allows the architect to be an 

advocate for VA. Also, the architect and the construction contractor 

can work together early on the design phase to reduce the number 

of design errors, and it also allows them to identify and modify the 

building plans throughout the project. 

The VFW also believes VA would benefit from the use of medical 

equipment planners. Using these planners, which is an industry 

practice used by the Army Corps of Engineers and other Federal 

agencies, places an experienced medical equipment expert at the 

disposal of the architect and the construction contractor. When 

used properly, the medical equipment planner can work with the 

architect during the design phase and then the construction contractor during the build phase to ensure that needed space, physical structure, and electrical support are adequate for the purchased medical equipment, reducing change orders, work stoppages, and the demolition of newly built sections of a facility. Using 

the Orlando facility as an example again, issues with the purchase 

of medical equipment caused cost overruns of more than $10 million and construction had to be suspended until these issues were 

resolved. 

Mr. Chairman, this concludes my remarks, and I look forward to 

any questions you or the Committee may have. 

[THE PREPARED STATEMENT OF RAYMOND KELLEY APPEARS IN THE

APPENDIX]

Mr. COFFMAN. Thank you, Mr. Kelley. 

Mr. Haggstrom, you are now recognized and have 5 minutes, 

please. 

STATEMENT OF GLENN D. HAGGSTROM 

Mr. HAGGSTROM. Thank you, Mr. Chairman. 

Chairman Coffman, Ranking Member Kirkpatrick, distinguished 

Members of the Committee, I am pleased to appear here this afternoon to update the Committee on the Department of Veterans Affairs’ continuing efforts to improve construction procedures and 

planning processes to ensure timely execution of major construction 

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projects. Joining me this afternoon from the Office of Acquisition, 

Logistics, and Construction’s Office of Construction and Facilities 

Management is Ms. Stella Fiotes, the Executive Director. I will provide a brief oral statement and request that my full statement be 

included in the record. 

Through the Department’s capital-asset programs, which include 

major and minor construction, nonrecurring maintenance, and leasing, we are delivering the infrastructures necessary to fulfill our 

mission to care for and memorialize our Nation’s veterans. Our 

continuing goal in the Office of Acquisition, Logistics, and Construction is to improve construction procedures and planning processes to ensure timely execution of major construction and leasing 

projects to provide state-of-the-art facilities for our veterans. 

VA continues to make significant improvements in its real property capital-asset portfolio. Implemented with the fiscal year 2012 

budget, the Strategic Capital Investment Planning process, or 

SCIP, is a Department-wide planning process to track and 

prioritize the Department’s capital investment needs. Using this 

approach, VA has visibility across its entire property portfolio and 

is able to synchronize the projects we undertake in our major infrastructure programs to address our most critical needs. 

Some of the steps that we have taken to improve the management and oversight of major construction projects include implementing the recommendations of the 2009 GAO report and undertaking the VA Facilities Management transformation initiative, or 

VAFM, which works to improve planning processes, integrate construction and facility operations, and standardize the construction 

process. 

Last April, as a follow-on to the VAFM, Secretary Shinseki established a Construction Review Council to serve as the single point 

of oversight and performance accountability for the planning, budgeting, execution, and management of the Department’s real property capital-asset program. Chaired by the Secretary, the Construction Review Council identified four major findings to improve performance. Actions have been identified and are currently being implemented to address these findings. 

Finally, we are in the process of reviewing the GAO final report, 

which was released on May 3, 2013, and plan to take immediate 

actions to implement their recommendations. 

In the past 5 years, VA has also accomplished and delivered a 

significant number of projects for veterans. Most recently, in fiscal 

year 2012 and 2013 to date, VA has delivered nearly $1 billion 

worth of facilities. This includes 16 medical facilities, including the 

new Las Vegas hospital, and five new cemeteries or cemetery expansions, the vast majority of which were delivered without construction delay and within the appropriated funds. VA continues to 

work to complete 52 major construction projects to provide the 

much-needed facilities for our veterans and their families. 

I am pleased to update you that since I last appeared before the 

Committee to brief you on the construction of the new VA medical 

center in Orlando, the project has advanced from approximately 50 

percent completion to approximately 80 percent completion today. 

After issuing Brasfield & Gorrie a show cause notice in February 

of 2013, the Department has notified them that they will continue 

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as the contractor on the project. They have provided to VA a completion date of April 2014. We will continue to work closely with 

Brasfield & Gorrie to ensure they adhere to their projected 

timeline. 

The lessons we have learned from Orlando and other past major 

construction projects is guiding us in our management of the Denver and New Orleans replacement hospitals and future projects. 

In closing, VA has a strong history of delivering facilities to accomplish our mission to serve veterans, and we are committed to 

meeting our responsibility to design, build, and deliver quality facilities to meet the demand for access to health care and benefits. 

The lessons that we have learned from our past projects will continue to lead to improvements in the management and execution 

of our capital program as we move forward. 

Thank you for the opportunity to testify before the Committee 

today, and we look forward to answering any questions the Committee may have. 

[THE PREPARED STATEMENT OF GLENN D. HAGGSTROM APPEARS IN

THE APPENDIX]

Mr. COFFMAN. Thank you, Mr. Haggstrom. 

Mr. Haggstrom, the VA has 11 projects with a range of cost increases from 4 to 59 percent. In all but two of these projects the 

cost increases are over 10 percent. Has VA officially informed Congress regarding all of these increases? 

Mr. HAGGSTROM. Mr. Chairman, I don’t know specifically which 

projects you are referencing. But to the best of my knowledge, we 

are very diligent in notifying the Congress if there are cost overruns, and the amount of those costs, we must notify Congress. If 

you would provide me a list of those projects, I would be happy to 

supply the record for those. 

Mr. COFFMAN. It is the projects that are listed in the GAO report, the 11 projects listed in the GAO report. Do you need us to 

go over those? 

Mr. HAGGSTROM. No, I don’t. I am in receipt of the GAO report. 

And we will certainly look at those and will reply to the Committee. 

Mr. COFFMAN. So to the best of your knowledge, you don’t know 

whether or not Congress was informed? 

Mr. HAGGSTROM. To the best of my knowledge, we have fulfilled 

all our requirements in the notification of process. 

Mr. COFFMAN. So Congress was informed? 

Mr. HAGGSTROM. As far as I know, sir. 

Mr. COFFMAN. Mr. Haggstrom, does VA believe that their obligations for payment of construction completed extends only to the 

prime contractor? 

Mr. HAGGSTROM. Mr. Chairman, our contractual relationship is 

with the prime contractor and only the prime contractor. We do not 

have privity of contract with the subcontractors. However, as you 

had mentioned in your openings remarks, that we do require certification of the prime contractor to the VA to ensure that they are 

paying their subcontractors. 

When you look at what we do, go through the change order process, the pay application process, all those things are to be resolved 

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with the prime contractor in terms of what payments they are due 

and the payments that they would subsequently make to their subcontractors. 

I would like to add that the Miller Act, which was passed in 

1935, if you will, is really a safety net for subcontractors. The Miller Act specifically requires that for Federal projects over $150,000, 

that there is both a performance bond and a payment bond that is 

held by the prime contractor so that in the event if the prime contractor has a contractual relationship with that subcontractor for 

a certain amount, the subcontractor performs the portion of the 

project for that amount and the prime contractor does not pay that 

subcontractor, the subcontractor has recourse against the prime 

contractor through Federal court. 

Mr. COFFMAN. But doesn’t current law go above that, go beyond 

that in the Prompt Payment Act in terms of defining VA’s responsibilities to ensure that subcontractors are paid? 

Mr. HAGGSTROM. Absolutely. And we adhere to that as closely as 

we can. Once a month, we have what we call a pay application review with our prime contractor. And during this, the prime contractor will provide to VA the portions of the projects that have 

been executed between the last pay application meeting and the 

current pay application meeting. It is our goal and requirement 

that once we receive that information, to process that and make 

payment within 15 days to the prime contractor. 

Mr. COFFMAN. Let me just say that I think all of you referred to 

the VA facility that is being constructed in Denver, and I think 

that is well within the boundaries of the city of Aurora, which is 

in my congressional district. I think there has been a history of 

those subcontractors not being paid, and that is of concern to me. 

Ms. St. James, did contractors submit excessive or unwarranted 

change orders to drive up costs or cause delay? 

Ms. ST. JAMES. That wasn’t a central focus of our review. We understood that the Committee was looking into that. But in Orlando, 

we did hear of instances like that, and we are aware of the show 

cause notice. But we did not verify independently whether or not 

any of those charges were excessive or unwarranted. 

Mr. COFFMAN. Ranking Member Kirkpatrick. 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman. 

Ms. St. James, in our briefing book, we have four major hospitals: Las Vegas, Orlando, Denver, and New Orleans? And staff 

just gave me a list of just the Orlando problems with the contracting officer, with cure notices, show cause notices that really 

have delayed the project. Did you find that that was the case with 

the other three facilities? 

Ms. ST. JAMES. I think out of the four that we looked at, it was 

that the relationship between VA and the prime contractor was not 

as favorable, let’s say, as the other contracts that were out there. 

There seemed to be more problems in Orlando with the prime contractor than we saw in the other sites. 

Mrs. KIRKPATRICK. Thank you. Do you agree with Mr. Kelley’s 

recommendation that they go to an architect-design-build rather 

than just a regular design-build model? 

Ms. ST. JAMES. We looked at the different kinds of contracts, as 

you just mentioned, and quite frankly, if you have your requireVACREP180 with DISTILLER

10 

ments set up and agreed to and you have a contractor and you 

have a good relationship with that contractor, it doesn’t really matter the vehicle that you choose. A lot of it depends upon the relationships, requirements being defined, and the relationship between the sub and the prime as well. 

Mrs. KIRKPATRICK. So why is that relationship a problem at the 

VA? 

Ms. ST. JAMES. In Orlando? 

Mrs. KIRKPATRICK. In Orlando. 

Ms. ST. JAMES. It is a big project. There are lots of change orders. When subcontractors put in for the change orders, we saw 

that the prime would agree with those change orders, but VA 

would not agree with them, and therefore you have a disagreement. 

And when you have a very large project, you have lots of change 

orders. It is just natural to the construction. So we found that that 

was a major problem in Orlando, was the difference views of the 

cost information being provided in the change orders. Neither VA 

or the contractor agreed. 

Mrs. KIRKPATRICK. Thank you. 

Mr. Haggstrom, on these projects do you have somebody on the 

site who can review change orders who has the authority to approve them rapidly at each one of these facilities? 

Mr. HAGGSTROM. Yes, Congresswoman, we do. We have a resident engineering staff, we have a project executive, we have contracting officers assigned to all of these projects to help facilitate 

and move the change order process along. 

Mrs. KIRKPATRICK. So how would you explain the bad relationship that apparently exists between the contractor and the VA that 

ends up with these show cause hearings and orders to cure? 

Mr. HAGGSTROM. Well, if I could, the show cause and cure notices 

do not necessarily delay a project. Those are two contracting vehicles that the Federal Government uses as part of the procurement 

process to ensure our rights are protected with regard to the contract that was consummated between ourselves and the prime contractor and oversight and fiduciary responsibility for the money 

that you have provided us to construct these particular facilities. 

With regards to the Orlando project, early on in my previous testimony before the Committee, clearly VA had some problems in 

terms of errors and omissions when we started this project. Those 

errors and omissions were corrected through working with our AE 

and with our contractor. Those drawings were corrected and put 

back into place approximately a year ago, and we moved forward 

on those. 

There is a continuing, I think, discussion and issue with the 

prime contractor over the cost of these things. Whether or not perhaps the cost that they estimated were underestimated with regards to the subcontractors performing this work, again, I don’t 

know. But these are all possibilities that drive the relationship between ourselves and that prime contractor. 

Mrs. KIRKPATRICK. My time is almost expired, but I want to ask 

one other question, and that is, where does the CRC then fit in the 

whole scheme of things? You have somebody on site who can approve the change orders and then you have got the CRC. So what 

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is their role in terms of direct review and oversight of the construction on the site? 

Mr. HAGGSTROM. The Secretary has made it very clear when we 

formed the CRC that certain elements of the project would have to 

come before the CRC and himself in terms of any change orders, 

significant change orders that would drastically affect the cost or 

the schedule of completion. 

Mrs. KIRKPATRICK. My time is almost up. Does that delay then 

the decision on the change order? 

Mr. HAGGSTROM. It does not. 

Mrs. KIRKPATRICK. I yield back my time, but I would like another 

round of questioning if we have time. 

Mr. COFFMAN. We will have a second round. 

Mr. Huelskamp. 

Mr. HUELSKAMP. Thank you, Mr. Chairman. I am going to read 

what you have read once already from the GAO report. And I am 

quoting here. It notes: ‘‘Cost increases for these projects range from 

59 percent to 144 percent, representing a total cost increase of 

nearly $1.5 billion and an average increase of approximately $366 

million per project. The schedule delays range from 14 to 74 

months, with an average delay of 35 months per project.’’ 

And I have a question for Mr. Haggstrom, if I might. The GAO’s 

report makes clear that for a number of years—and you referenced 

the 2009 report—VA’s construction arm has not been doing a good 

job. Yet according to records I have, in 2009 you received a $20,470 

bonus, in 2010 you received an $18,022 bonus, and in 2011 you received a $16,300 bonus, all on top of your base pay. Given this 

GAO report and what we have heard here, do you really think you 

deserved these bonuses? 

Mr. HAGGSTROM. Congressman, those bonuses were not determined by myself. Those bonuses were determined by my supervisors in the senior leadership at VA. And with all due respect, I 

would ask you to take that up with them. 

Mr. HUELSKAMP. My question is with you. Do you think you deserve those bonuses in light of these GAO reports and these cost 

overruns and delays in construction? 

Mr. HAGGSTROM. Congressman, I believe I have answered your 

question. 

Mr. HUELSKAMP. Sir, let me re-ask it. Do you believe you deserved these bonuses? It is either yes or no or I refuse to answer 

the question. 

Mr. HAGGSTROM. I will answer one more time. Those bonuses 

were not by my own doing. Those were from my superiors. 

Mr. HUELSKAMP. Did they indicate to you, Mr. Haggstrom, why 

you deserved these bonuses when they gave them to you? 

Mr. HAGGSTROM. Congressman, I have answered as far as I can 

answer. 

Mr. HUELSKAMP. Did they indicate to you why you deserved 

these bonuses? Surely they told you. They didn’t tell you at all why 

you were given a $20,000 bonus in 2009, an $18,000 bonus? They 

didn’t tell you why you were given a bonus? 

Mr. HAGGSTROM. Those bonuses, I presume, were based on my 

performance plan and my performance that they viewed and how 

I did my job during those particular years. 

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Mr. HUELSKAMP. I wish you would answer that question. Apparently they didn’t tell you, then, why you deserved a bonus? 

Mr. HAGGSTROM. No. The bonus came down in my paycheck. 

Mr. HUELSKAMP. Just magically appeared, I guess, for no reason. 

And I would appreciate perhaps you might visit with your superiors, in light of the GAO report. I mean, we are talking about $1.5 

billion of cost overruns on four projects. Are you proud of these particular projects? 

Mr. HAGGSTROM. I am not, but I think you need to put those cost 

overruns in context. 

Mr. HUELSKAMP. I am putting it in a bonus context. 

Mr. HAGGSTROM. No, I am putting it in the fact that when you 

looked or when VA looked at these projects and they costed them 

out, many of these projects started out as nothing more than large 

health care centers when we started the requirements definition 

process. Those matured sometimes into full-fledged inpatient medical facilities, based on emerging needs. So you have got to look at 

ultimately what the VA planned to build as opposed, in the end, 

to what they started to build in the beginning. 

Mr. HUELSKAMP. Mr. Haggstrom, the VA for here is you. 

Mr. HAGGSTROM. Pardon me? 

Mr. HUELSKAMP. The VA today is you. It wasn’t somebody else, 

some other agency determined what they should be. It was based 

on your estimates, what you described to Congress of the money 

you needed for this project. And they come in at an average of $366 

million per project cost overrun. And you can’t blame it on the DoD 

made you do these. I mean, these are the VA estimates coming out 

of the GAO report. And that is what we have here. 

Mr. HAGGSTROM. These are VA estimates based on what we 

started with. 

Mr. HUELSKAMP. Did you have any— 

Mr. HAGGSTROM. When you move from a health care facility of 

several hundred thousand square feet to build a full-fledged medical inpatient care facility at sometimes 1.5 million square feet, you 

are going to have a change in the cost of that project. 

Mr. HUELSKAMP. Absolutely. Obviously, we were wrong on the 

first estimate. Obviously, you are going to have a massive change 

because you made a mistake at the beginning. And what bothers 

me is you are in charge of these, you are the gentleman sent here 

to represent why this wasn’t too bad, and these same folks give you 

a very, very big bonus, multiple years in a row, in light of these 

GAO reports, and you claim not to know why you got a bonus. 

That to me, Mr. Chairman, is very disappointing. Bonuses are 

not given just because. They are given for performance. And if I 

was giving a bonus here, we would actually dock your pay. And 

that is what most of my constituents say. 

One last thing I want to note, and you might indicate to your superiors as well. I have sent multiple letters to the VA that they 

have ignored on other budgetary issues. In particular, I sent a letter on September 23, 226 days ago, and the VA just says we don’t 

care what Congress thinks. And that is why you wonder why we 

get upset when you have cost overruns and you try to explain to 

us that your estimates initially were wrong and then you get massive bonuses. This is not a proper way to run an agency. 

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And I yield back, Mr. Chairman. 

Mr. COFFMAN. Thank you, Mr. Huelskamp. 

Ms. Kuster. 

Ms. KUSTER. Thank you very much. 

Mr. Haggstrom, my question is with regard to the change in 

scope of these projects. What were the factors that led to the 

change to a more complex facility? Did it have to do with the number of veterans that were coming back from Iraq and Afghanistan 

and the complexity of their issues? And where in the Veterans Administration is that type of decision-making made? 

Mr. HAGGSTROM. Certainly. When you look at the requirements, 

the requirements that we work to in construction and facilities 

management are determined by the administrations. Principally, 

we build for Veterans Health Administration, the medical facilities, 

and the National Cemetery Administration, our national cemeteries. Those are the folks who provide to us, the engineers, what 

they require in order to be built. They use multiple factors. They 

use the demographics. We use the databases that VA has maintained through the year. And all those things are subject to change. 

Let’s take a look, if you will, just at the Denver facility as an example. As we talked before, Denver started out as an outpatient 

community health center when we started to build that. Then 

through the years we went back and forth at the senior level in VA 

to decide is it going to be that or is it going to be an inpatient facility with bed towers or are we going to use shared facilities with 

the University of Colorado to handle our inpatient loads. 

Ms. KUSTER. Excuse me for interrupting, but was the Congress 

kept apprised as these decisions were made? 

Mr. HAGGSTROM. I am sorry, I can’t answer that. I was not a 

part of VA when those major decisions were being made. When 

Secretary Shinseki came in, one of the first things he directed as 

the Secretary of Veterans Affairs is directing us to build a full inpatient medical facility. And that is where I essentially pick up. 

All those things previous, though, until those decisions are made, 

you can’t design a facility. You may be able to look at pieces of it, 

but in terms of designing a full medical complex, the relationship 

of how all these clinics work, the inpatient, the diagnostic and 

treatment, all those can’t be completed until a decision is made on 

what is going to be the final scope of this facility. 

Ms. KUSTER. Thank you. I wanted to say I had a tour during our 

district work period of the VA facility in White River Junction, 

Vermont, New Hampshire being the only State that doesn’t have 

a full-service VA hospital, but my constituents go to Vermont. And 

I was very impressed, actually, and I understood the complexity, 

given the age of the building. But one of the things that was particularly impressive was the opening of a new women’s health facility. And I just would love to have you comment on the changing 

types of issues that you are dealing with and some of these issues 

that are coming back from the Iraq and Afghanistan war in particular. 

Mr. HAGGSTROM. Certainly. And while I am not a clinician, our 

involvement in working with the VA staff, the emerging requirements in health care today are so different from what our veterans 

faced from World War II and Korea and even Vietnam. When you 

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look at today, I believe almost 15 percent of our armed forces are 

women. And so years ago, when you walked into a VA hospital you 

would probably not find very many facilities that were equipped to 

handle women veterans and the special needs they have. These are 

all things that the Department is making very focused attention on 

in terms of modifying and modernizing our facilities to cope with 

these new requirements—traumatic brain injury, mental health, 

post-traumatic stress syndrome. 

All of those things are, if you will, perhaps they were present in 

previous conflicts. It is only now during our last two engagements 

that these are really coming to the surface and having the clinicians look at how we can better treat our veterans to help overcome 

these disabilities. 

Ms. KUSTER. Thank you. And just one quick question—my time 

is almost up—for Ms. St. James. 

How do you believe the VA can better communicate within their 

own organization and with contractors to improve upon this process 

so that we are not facing cost overruns and delays? 

Ms. ST. JAMES. In this regard, we noted that in the Council, the 

VA’s Council, Construction Review, that they plan to take action on 

this. And basically what is needed is a matrix which indicates who 

in VA has responsibility for what, so that the contractor knows the 

direction that they should follow. We did find in Orlando there was 

confusion there, and the contractor was directed in one case to go 

ahead and build a room, a part of the facility, and then was later 

directed, redesign it. 

So it is really common sense when you have a project that is as 

large and complex as these are, we are talking over a million 

square feet in some of these and 31 acres in some of these facilities, 

you absolutely must have clear communication. 

Ms. KUSTER. Thank you very much. 

I yield back the balance, which I do not have. 

Mr. COFFMAN. Mr. O’Rourke. 

Mr. O’Rourke. Thank you, Mr. Chairman. 

I am interested in the context of the projects that have been 

highlighted today within the SCIP list, or the Strategic Capital Investment Planning list. And my understanding is there are 3,900 

projects that have been identified on that capital list that need to 

be at some point built in order to fill the gaps in service to our veterans. 

When these projects go over these many months or these many 

dollars, what does it do to the projects behind them? 

Mr. HAGGSTROM. In terms of the time, it has no effect. When you 

look at—when you say ‘‘cost overruns,’’ what are we talking about 

in terms of a cost overrun? When you look at the projects that are 

under construction today, we are within the appropriated amounts 

that Congress has provided to us to construct those facilities, and 

so if a cost overrun could have two different meanings, the cost 

overrun vis-&-vis what the original project was bid at and— 

Mr. O’ROURKE. That is what I am trying to get at. So, if you are spending $366 million more than you originally budgeted, where is 

that money coming from if not from projects that would have been 

funded further down the list, or did you have a contingency of $366 

million for that project? 

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Mr. HAGGSTROM. No, there is not a contingency of $366 million. 

Conceivably, under what you are talking about, if those cost overruns were in fact correct, it would, of course, push the program out 

to the right and projects would not be funded as quickly as perhaps 

we would have liked them to be. 

Mr. O’ROURKE. And I see, you know, I am obviously most concerned about El Paso, the community I represent and the veterans 

there, who today have to go to Albuquerque for the nearest full 

service veterans hospital, which is a 10-hour roundtrip, and these 

are veterans, whose service extends as far back to World War II, 

going for cortisone treatment, for example. And so we desperately, 

in my opinion, need a full service VA hospital in El Paso, and I see 

we are number 79 in that list, and the 2014 request is zero dollars. 

A few projects up, there are dollar requests for those projects. 

So I can’t help but read into this that, but for these overruns or 

whatever the term of art is for spending more than we originally 

anticipated, we would have been able to get to these projects sooner. 

I don’t know, Ms. St. James, if in your analysis of the VA’s construction projects you were able to correlate, you know, these overruns in time and dollars to what it did to our ability to construct 

other projects further down the list. 

Ms. ST. JAMES. No, we really did not look at that. I would hope, 

though, that VA’s implementation of providing better estimates 

where the design is 35 percent complete at the time they submit 

it to you, that you would have a better idea of what the project 

would cost and that is what we would hope to see. 

When VA comes back to you for money, with having 35 percent 

complete done at the initial asking, you should have a better idea 

and a better knowledge of how much more it could actually increase. But a lot of things happened that are unanticipated as well, 

but we are aware of the SCIP process. It is relatively new, and we 

have looked at that in the past and within the last couple of years. 

Mr. O’ROURKE. And I guess, for Mr. Haggstrom again, in El 

Paso, it seems like we have a number of opportunities for a new 

VA facility, full service VA hospital. One is to co-locate it with the 

new William Beaumont, the DoD active duty hospital, which is 

moving forward now. Another is to find a partner within the public 

health community with Texas Tech, for example. What do those opportunities do in shortening construction time and reducing costs 

when we are co-locating with other facilities? Does that offer a community like El Paso an opportunity to jump up a little bit on the 

list since we have a partner with whom we can construct that facility with? 

Mr. HAGGSTROM. Congressman, with all due honesty, that is a 

very difficult question to answer with regards to how you put it because there are so many other factors that are taken into consideration when we look at the SCIP process and the planning and programming, and many of that goes to the demographics of the areas, 

what the needs of those veterans are and how they can be best 

served. 

If you would like to, for me to take that back as a question, I 

will certainly be more than happy to do that and try to provide 

that for the record. 

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Mr. O’ROURKE. I appreciate that. Thank you. 

Thank you, Mr. Chairman. 

Mr. COFFMAN. Thank you, Mr. O’Rourke. 

Ms. St. James, when we talk about say the facility in Aurora, 

Colorado, and the cost overrun issue and the time delay, it did 

start out as a—or I think there was discussion at least of being a 

joint facility and then it was a standalone facility, VA facility. How 

much did that contribute to the cost overruns or to the—that 

delay? But I understand, obviously, when it went to bid, it was sent 

out to bid as a standalone facility. I don’t think it was sent out to 

bid as a joint facility, so I don’t know how you can contribute that 

as it was contributed to the cost overruns. 

Ms. ST. JAMES. That is actually a good question. There are four 

cycles from beginning to end for a construction project, and we look 

at it from the very beginning, from the planning aspect, and so we 

felt that if you do not include that planning aspect in looking at 

how long it takes, then you are not really looking at the full picture 

of how VA manages this entire process, and in our report, we know 

that VA really wanted us to look at from the construction point on, 

but I think you have to realize that that—the risk is on the contractor from that point. Prior to that point, the risk is on VA. So, 

I think their estimates for these projects done decades ago were not 

done as well as they could have been, which is why they are looking at doing the 35 percent design to be complete in submitting it 

to you in the very beginning. 

Mr. COFFMAN. Is that normal to have a certain percentage of the 

design done before they go out to bid, because I know that is their 

practice. Is that also the practice in say the private sector? 

Ms. ST. JAMES. What we found in VA actually had an industry 

forum and the industry recommended to VA that they have a 35 

percent design complete. 

Mr. COFFMAN. Okay. Mr. Haggstrom, what is—now, I understand, first of all, I just want to commend you on putting—in our 

visit to Aurora, Colorado last week, at the facility, I think you or 

somebody associated with you has said that you-all, 2 months ago, 

put more resources in terms of personnel to process the change orders so that the prime gets paid and hopefully the subcontractors 

get paid in a more timely manner. And I will certainly be monitoring them, but I want to commend you on that. But obviously not 

having adequate resources on the ground has contributed to these 

delays, and so where—where—do the other facilities have the same 

problems that Aurora, Colorado, has in terms of the delay—a delay 

in payments and problems with subcontractors? 

Mr. HAGGSTROM. We experienced that with Orlando, Mr. Chairman, and we took the same steps to remedy that by putting additional resident engineers on staff and construction management 

support. I believe we certainly have taken our lessons learned from 

both Orlando and Denver in that we are staffing our project in 

New Orleans, which is currently on cost and schedule, to make 

sure that those same issues are not encountered. 

Mr. COFFMAN. Ms. St. James, other facilities of the Federal Government, I think, are managed by the GSA. Should that be the 

same case with the VA? Are their practices better? I mean, would 

the taxpayers and the veterans be better served if in fact the procVACREP180 with DISTILLER

17 

ess of constructing facilities like health care facilities were managed by the GSA instead of the VA? 

Ms. ST. JAMES. That is a good question. We actually have not 

looked at, GSA doing that, but I know that VA has reached out to 

GSA in terms of some of its management issues in the report that 

we have been referring to that they put out November 2012. But 

I can say that when you look at these four facilities, it really 

doesn’t matter the type of contract you have. The relationship that 

exists between a contractor, the prime or the subcontractor, taking 

8 to 10 years to build a facility, at the end of the line is the veteran, and that is where our concern also is. 

Mr. COFFMAN.—And, I just want to say as a Gulf War veteran 

and Iraq War veteran, I am very disappointed and I think that 

when there are delays in these projects and these projects are designed to meet the capacity needs of our veteran population, then 

I believe, and maybe let me refer to Mr. Kelley, I believe that care 

is ultimately delayed. Mr. Kelley. 

Mr. KELLEY. I agree with your statement that care is delayed. I 

want to commend VA for using the SCIP process. It really does outline what the needs are. They need to put processes in place to be 

able to achieve those. They understand that demographics change. 

If they were to use a master planning in the Las Vegas facility, 

they would have known that adding onto Nellis wasn’t going to cut 

it. They knew the demographics had changed. They knew the medical equipment and the processes that took place needed to change, 

and they needed a larger facility. 

So I think having a full master plan at each facility early on 

would provide them the insight to know, when we start this planning process, what do we really need, and then you don’t have a 

small facility turning into a large facility and you get quicker access to the veterans. 

Mr. COFFMAN. Ms. Kirkpatrick. 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman. 

Mr. Haggstrom, I have over 20 years experience as a health care 

hospital attorney. In that time period, we completely remodeled the 

hospital, project started and completed, then we built a huge new 

addition. That project was started and completed. Then we built a 

cancer center, and that project was started and completed. 

In all fairness to you, can you identify differences in your procedure between the private sector and the VA that would explain 

these huge delays in construction? 

Mr. HAGGSTROM. Congresswoman, I have never served in the private sector construction industry. My entire, almost 40 years in 

public service has been with Air Force civil engineering. I was a 

civil engineer for 28 years in the Air Force and subsequently with 

the Department of Agriculture here and VA. So, in all honesty, I 

am not that familiar with private sector developments and how 

they go about it, but I will tell you that there are different requirements when you deal with Federal contracting in terms of the contracting process, in terms of the due diligence, in terms of how we 

do our design and construction laws that have to be applied, perhaps like Davis-Bacon, the Miller Act, all those kinds of things. 

Those are not necessarily applied in the private sector. 

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When you look at it, I believe, when you look at the Federal sector and how we complete construction projects, we exercise significantly greater oversight in terms of what our contractors are doing, 

the quality of what they are doing, and the fact of the matter is, 

just because they tell us there is additional money required to finish this out does not necessarily mean that we will agree with 

those contractors. And we do our due diligence to ensure that what 

they are claiming is in fact the truth and the fact that they deserve 

payment. So there are a lot of— 

Mrs. KIRKPATRICK. Well, let me just interrupt you there. I can 

tell you, in the private sector, we do due diligence also and it 

doesn’t cause these kinds of delays, so I have a big concern about 

that. But let me switch to a different line of questioning. You mention that one of the reasons the Denver project took so long is 

that—the needs of the veterans were changing and you had to 

change the scope of the project and the design, but are you looking 

down the road at new delivery systems in health care, for instance, 

using technology. Do we still need these large medical facilities 

when we are entering an age of telemedicine? 

Mr. HAGGSTROM. I think that is an excellent point, and Dr. 

Petzel, who heads Veterans Health Administration, clearly is looking at the various ways of delivery and not necessarily sticking to 

infrastructure or bricks and mortar, if you will, in terms of care for 

veterans. Telemedicine, home telehelp, in-home health care, all 

those kinds of things I know are on the VHA’s plate in order to do 

better delivery and provide better care for our veterans. 

Mrs. KIRKPATRICK. One last question, and I direct this to Mr. 

Kelley. You know, it seems to me that when you have a 10-year 

delay in a completion of a project, by the time that project is complete, it is already obsolete. Do you see that in what you have investigated? Do you see the VA trying to come back to Congress asking for authorization to then remodel these facilities that have been 

10 years in the construction? 

Mr. KELLEY. I don’t know the facility becomes obsolete. I do 

know that the demographics change, that veterans have an expectation when VA comes out into the community and says, we are 

going to build a facility, this is what we are going to build, and 

here is the timeline we are going to build it. Now the veterans are 

invested in this, they are waiting, they have marked their calendar. And when that doesn’t come through, they start getting 

very, very anxious: Are we not going to get our hospital? Is it going 

to have the full services that we were promised? Where am I going 

to get my medical care? Now that the population has grown, the 

wait lines are getting longer where I am at. I have to travel further 

to receive this care. I have to do contract care with a doctor I don’t 

know. So, there are a lot of implications. I don’t know if it necessarily makes a facility obsolete, but it—quicker delivery would 

provide better care to our servicemembers and vets. 

Mrs. KIRKPATRICK. No question about it. You know, delayed care 

is denied care. I thank the panel. I thank the Chairman for having 

this hearing. 

Mr. COFFMAN. Thank you. 

Ms. Kuster. 

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Ms. KUSTER. Thank you very much, Mr. Chairman, and I, too, 

thank you for having this hearing. I think it is an important topic, 

anything that we can do to meet the needs of the veterans, but I 

also can appreciate the complexity in the health care delivery 

model throughout. And my experience, 25 years in the private sector on the legal side with health care delivery is that it is far more 

complex now than it certainly was. 

My question is along the lines of Representative O’Rourke in 

terms of those who are waiting for facilities, and I am looking at 

much, much smaller facilities. I don’t represent an urban area. I 

represent a very rural area in New Hampshire. We also have long 

distances to travel, mountains and weather and such, and so what 

we are looking at is a much smaller clinic model, and I am just 

wondering, this is just a question as to how you build facilities, do 

these big projects hold up a small clinic in a rural area? 

Mr. HAGGSTROM. I don’t believe so because the way the appropriation is structured and the way you provide us resources comes 

down in two different programs. Well, actually several different 

programs, but the two that focus on construction is the Major Construction Program, which are facilities at $10 million or greater. 

Ms. KUSTER. Right. 

Mr. HAGGSTROM. Those are line item appropriations where it 

very specifically says we will build X at Y. When you look at the 

Minor Construction Program, that is an appropriation. It is not a 

line item appropriation, and so it is much more flexible in terms 

of responding to the needs of our veterans and where those monies 

are placed to meet those critical needs. 

When you look at the third scenario and one that we have relied 

on very heavily, and that is usually with our community-based outpatient clinics and our health care facilities, we use a build-to-suit 

model, and there are several break points in that leasing process, 

if you will. The clear break point being that if we have an annual 

rent in excess of $1 million, we must attain approval from the 

Committee to move forward with that. For less than a million dollars on service rent during the course of a year, the Secretary has 

the authority to make those decisions for those facilities. 

So when you look at it, because when we do a build-to-suit model 

in putting these facilities on the ground, those leasing costs are 

borne by the medical facilities accounts or through the annual appropriations process. 

Ms. KUSTER. Trust me, where I am talking about, the rent will 

be significantly less that be a million dollars, so—and my other 

question, and if you have this information or if not, if you could get 

back to the Committee, I am very focused on serving women veterans, and in particular, those who have experienced military sexual trauma or assault. And I was so impressed by this White River 

Junction facility with a separate facility for women, separate entrance, very, very well thought through with a task force that included veterans in the planning and the architecture and the design to make women feel safer when they come to the hospital for 

treatment. Do you know, or any of the panel members, the number 

of facilities or the percentage of facilities nationwide that are now 

equipped to deal with the increasing numbers of women veterans 

separately from being mixed in the general population? 

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Mr. HAGGSTROM. Right off the top of my head, I don’t, but I 

would be happy to take that question and get the answer for you 

as a matter of record. 

Ms. KUSTER. Yeah, I would be very interested, and also, just as 

my time runs down, just for planning purposes, looking forward, 

whether that is something that is being included in the planning, 

and I see you nodding your head, if you would like to respond. 

Ms. FIOTES. Yes, it is, Congresswoman. I recently attended my 

first SCIP board meeting and was introduced to the process, and 

among the very many large number of projects and plans that were 

presented by the various medical centers and veterans integrated 

service networks, there was specific reference in several cases, in 

numerous cases, to the specific needs of women veterans, and they 

are considering that, and they are planning it in their programming going forward. 

Ms. KUSTER. Excellent. Thank you very much. 

I yield back my 2 seconds. 

Mr. COFFMAN. Mr. O’Rourke. 

Mr. O’ROURKE. Thank you. Mr. Kelley offered some suggestions 

to address some of the findings made by Ms. St. James and the 

GAO, and I wonder, Mr. Haggstrom, if you could give us your 

thoughts or your reaction to his suggestions. 

Mr. HAGGSTROM. Certainly. I fully agree that medical planners 

are a crucial part of these large projects, and we have already 

taken steps to include professional medical planners on both the 

Denver and the New Orleans project, so we are moving forward 

with that. 

With regards to eCMS. ECMS is a contract writing system. 

Mr. O’ROURKE. Right. 

Mr. HAGGSTROM. It is not a program management system, so we 

are in the process of fielding a new program management system 

which is specifically tailored to manage construction projects. What 

we will do, though, is look to interface the contract writing system 

with the program management system so that we do have a seamless process for contractual record and all the change orders or 

what goes on, on a project. 

When you look at an AE-led design build, to be honest with you, 

I have never been involved in a project with an AE design build, 

but when we looked at it and we talked about it because we did 

see that you mentioned it, we will take a look at it, but one of our 

initial reactions was bonding capacity of the AE firms. So, that 

could be somewhat problematic in terms of who is the lead, the 

bonding capacity that that particular firm may be able to attain, 

where typically you would probably see a much larger bonding capacity on the construction side as opposed to on the AE, but these 

are all things that we will certainly take a look at. 

Mr. O’ROURKE. I appreciate that. We in our office would be interested in hearing your answers to the specific recommendations 

made by Mr. Kelley. 

And then I want to follow up on something that Congresswoman 

Kuster brought up and I tried to address in my earlier questions, 

but essentially learning from what has gone less than ideally, I 

guess, in some of these projects that have been highlighted in this 

report, what can communities like ours who need new facilities and 

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need investment from the VA to serve veterans who currently are 

not able to get service in our communities and have to travel for 

that service, what can we do to improve that process, whether it 

is through a co-location, I talked about DoD, or through a university system, whether it is providing land and leasing opportunities, 

give us some guidance in El Paso on how we can partner with you 

to be able to service these veterans who aren’t getting that service 

today. 

Mr. HAGGSTROM. I think the things that you said are very relative to looking at the future needs. I know VHA, we are in many, 

many communities across the United States, sit down, talk with 

your medical center directors, talk about the requirements that you 

need in your community, make sure they are aware of those things, 

and those things can be put forth as we go into the planning and 

programming process. They can come up through the SCIP process, 

all those kinds of things. 

So, I think you are on the right track. I will tell you, as you 

noted, the number of projects that are in the queue as requirements, there is a substantial list, and certainly as part of the SCIP 

process, we do our best to ensure that the most critical needs that 

serve our veterans are first in the queue to make sure that they 

happen. 

Mr. O’ROURKE. And are the criteria you use to determine ranking within that SCIP process, are those published along with— 

Mr. HAGGSTROM. They would. In fact, I would like to ask Ms. 

Fiotes if she can go through that, having just— 

Mr. O’ROURKE. That would be great. 

Mr. HAGGSTROM.—been on the SCIP process. She is a board 

member, so she participates in that planning process. 

Ms. FIOTES. Thank you for the opportunity. 

Actually, the criteria are very well defined, and the entire process is very deliberative, comprehensive and integrated, and it 

starts with a 10-year planning horizon where all the VISNs, the 

networks, present their gaps and their proposals how to address 

these gaps, and by the way, in many cases, they also talk about 

non-capital ways to address the gaps, which goes to the Congresswoman’s question earlier about other, other than just building facilities, solutions. 

Mr. O’ROURKE. And those come from the local VHA directors or 

the regional? 

Ms. FIOTES. They come from what we call the Veterans Integrated Service Networks, there are 23, I believe, across the country, and they—those plans are presented to the SCIP board. Along 

with this 10-year planning horizon, we then do, subject matter experts then do a review of the proposed projects and the business 

cases for those projects, and this forms the basis for the annual 

budget request. 

So we go from the 10-year horizon to what should we be looking 

at for the upcoming year. The criteria, to get to your initial question, again, are defined and are used for the ranking, it includes 

improving safety and security, fixing what we already have, increasing access to veterans, right sizing the inventory, ensuring the 

value of the investment, then, of course, the department’s initiatives, so they’ve —and each criterion has sub-criteria that, again, 

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the entire process is data driven to allow us to do the most objective assessment and prioritization. 

Mr. O’ROURKE. Thank you. Appreciate that. 

Thank you, Mr. Chairman. 

Mr. COFFMAN. We will do one last round for anybody that has 

any clean-up questions. 

Mr. Haggstrom, I think you mentioned the electronic contract 

management system, and tell me what that is supposed to do 

again. 

Mr. HAGGSTROM. The eCMS or Electronic Contract Management 

System is a contract writing tool that we use in VA to put in place 

the various contracts, whether they be service contracts, construction contracts or commodity contracts. They are used by the contracting workforce to do this, and what it does is, it is an electronic 

repository for the contract files in terms of what the terms and conditions are, the standard clauses are, what the costs are, when it 

is gone out to bid, what those bids were, all those kinds of things. 

It is the electronic file for contracts. 

Mr. COFFMAN. Is it designed to make the system more efficient? 

Mr. HAGGSTROM. It is designed to make the contracting workforce more productive. It gets us out of the paper business. It is 

transportable so that multiple contracting officers can use the same 

file at different times. We can do our risk assessments electronically as opposed to having to go out to the contracting offices and 

look at the paper copies. So it is what we are moving to in the department in terms of our contracting records. 

Mr. COFFMAN. Ms. St. James, is that system being utilized by 

VA? 

Ms. ST. JAMES. I am sorry. Say again. 

Mr. COFFMAN. Is the Electronic Contract Management System 

being currently utilized, to your knowledge? 

Ms. ST. JAMES. That is a recommendation that again is coming 

out of their report, and I would wholeheartedly push VA to do that. 

Particularly when we were asking questions about the change orders and how long things were taking, they couldn’t really tell us. 

There was no system to do that. So for accountability and for tracking and for metrics, it certainly is something that I think needs to 

be done. 

Mr. COFFMAN. So it is not being currently used? 

Ms. ST. JAMES. Not that I am aware of. 

Mr. HAGGSTROM. Well, it is being used. When you look at the 

contracts that we are putting in place, the vast majority of—all the 

new contracts are in fact going through the Electronic Contracting 

System and into the Federal Procurement Data System. 

Ms. ST. JAMES. For the four that we looked at as well? 

Mr. HAGGSTROM. Yes. 

Ms. ST. JAMES. Okay. We just know that for the change orders, 

we couldn’t get that information easily. There was no real good system in order to give that to us. 

Mr. COFFMAN. Mr. Haggstrom, how long has this system been in 

place and been used? Apparently, there was a mandate in 2007. 

Mr. HAGGSTROM. That is correct. 

Mr. COFFMAN.—for this system. How long has it been utilized 

now? 

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Mr. HAGGSTROM. I believe the system was established, it was 

prior to my arriving there, back around 2006 or so. It was not well 

received. Our OIG did an audit on the usage of the system. At that 

particular time, it was down in the low 40s, the percentage, even 

lower than that. Through the years, this is one of the metrics that 

we track internally to the goal, and I believe we are now up in the 

high 70s to mid 80 percent usage of electronic contract writings. 

Mr. COFFMAN. Is this a mandate by Congress? I mean, is it the 

law? 

Mr. HAGGSTROM. No, it is a mandate of the department, sir. 

Mr. COFFMAN. It is a mandate by the—and you put out a memo 

two years ago for everybody to use it and not everybody is using 

it now? 

Mr. HAGGSTROM. There are pockets of folks that still have not 

fully developed their contracts within the system. We go through, 

we find those. We provide education. We provide learning engagements to those folks. 

Mr. COFFMAN. Well, I mean, you were in the United States Air 

Force. If you gave out a mandate—I mean, you should put a memo, 

we have got a copy of the memo 2 years ago that said everybody 

has got to use this system, and you are saying now people decide 

whether or not they want to use it. That is under your leadership? 

You are saying that that is the way things work? 

Mr. HAGGSTROM. There are cases where people have not used the 

system to the full capability that they should be using it to. We go 

out, we do audit reviews, we find those, we talk with the heads of 

the contracting agency. There is a hierarchy within the department 

from me as the acting chief acquisition officer to the heads of contracting authority within the various administrations and/or staff 

offices. These are the people that need to enforce through their 

leadership the use of these. I do not have administrative authority 

over all of the people who do contracting in the department. I just 

have functional authority. 

Mr. COFFMAN. Well, it sounds like you have got a real organizational problem. If you have got a system that is designed—you 

know, if you are—the problem is, you have got delays; you have got 

cost overruns; the system isn’t working; you are not utilizing the 

system that is designed to make it work; you are not able, in your 

position, to get people to use the very system that Congress mandated in 2007. I think that is problematic. 

Mr. Haggstrom, on another issue. Is VA requiring surety bonds 

of construction contracts currently? 

Mr. HAGGSTROM. Yes, they do. 

Mr. COFFMAN. Okay. Why is the VA making what appears to be 

arbitrary last minute cuts to monthly payments to the prime contractor, who then passes the cuts down to subcontractors? 

Mr. HAGGSTROM. It would be helpful to have a specific issue that 

that surrounds, but that could range from the work was not performed— 

Mr. COFFMAN. Specifically to Aurora, Colorado. 

Mr. HAGGSTROM. In those particular cases, we have encountered 

areas where the work was in fact not performed but was being 

asked payment for. We found that, in some cases, the work was 

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performed years prior, and the time for the request for those 

change orders and payments had been exceeded. 

And we have also found that, in Colorado, there is a request for 

payment above what the budgeted cost, but what that is absent of 

is any rationale of why it was budgeted at X dollars and now why 

it is at Y dollars. 

The contract that we have in place is not a cost-plus contract. It 

is a firm target price contract, where the contractor is to adhere to 

those budgeted amounts. In the case where there is clearly a reason, such as a change in scope or complexity or something like 

that, they are well within their rights to submit those changes to 

the VA, and we will respond to them. And if they are due additional payments, we will make those, based on what our government cost estimate is. 

Mr. COFFMAN. Why is the VA pushing the prime in subcontractors—in what project would this be? In Aurora, Colorado, to complete work without an approved change order? 

Mr. HAGGSTROM. Congressman, we, over the past two months, 

we just sat down with Kiewit Turner and worked to resolve 111 

change orders that Kiewit Turner provided to us as the greatest 

needs to come to resolution on. That was completed back in mid 

April. As a result of that, VA has issued to Kewitt Turner $4 million in change orders that Kiewit Turner can now invoice the VA 

for, for payment. 

Mr. COFFMAN. I will take a look at that. 

Mr. Kelley, does the VFW conduct any field work to evaluate 

VA’s construction program? 

Mr. KELLEY. No, we do not. 

Mr. COFFMAN. Very well. Mrs. Kirkpatrick. 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman. 

I want to follow up on your line of questioning regarding the 

change orders. It appears that the CRC made a recommendation, 

actually looked at the process for change orders, and they made a 

recommendation that the VA examine the authority levels of contracting officers in the field to execute change orders without additional reviews and that the VA consider support for hiring three 

additional attorneys to review change orders. 

Mr. Haggstrom, where are we in terms of those recommendations? 

Mr. HAGGSTROM. The authority for the change or the change orders for the contracting officers in the field has been increased from 

$100,000 to $250,000 per change order. That is in effect, and we 

are working with our general counsel to hire four additional attorneys that we—would be dedicated to helping us manage the contractual requirements required by these large contracts. 

Mrs. KIRKPATRICK. My last question is, does SCIP apply to these 

four major projects that we are looking at in Las Vegas, Denver, 

Orlando and New Orleans? 

Mr. HAGGSTROM. They do not. This is pre-SCIP. 

Mrs. KIRKPATRICK. And why is that? 

Mr. HAGGSTROM. SCIP was not, I guess, not envisioned when we 

started the planning and programming and ultimately requesting 

funds for these projects. It was not until fiscal year 2012 that the 

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SCIP came into being. All these projects were developed and appropriations requested prior to that. 

Mrs. KIRKPATRICK. Mr. Kelley, would the processes in SCIP help 

speed up completion of these projects? 

Mr. KELLEY. Appropriations at a level that would fund these 

would speed up the process. I don’t—I think SCIP can be used for 

part of the planning, but as soon as the contract is written, then 

that is where the delays begin, in my opinion. There is some delay 

in the planning of that because I think there is some long-term 

master planning that needs to happen that would allow them to 

have a better understanding prior to planning, but SCIP, SCIP lays 

out some of that. I think they can go in a little deeper, but I don’t 

think that—SCIP, in the process of determining need, affects the 

way the contracts are—in the end, are done or completed. 

Mrs. KIRKPATRICK. Ms. St. James, could you prioritize for us the 

top three changes that you think the VA needs to make to speed 

up completion of these projects? 

Ms. ST. JAMES. Well, we made three recommendations in our report that really were ran or systematic—systemic issues throughout, and one of them was on the medical planners. You absolutely 

need the medical planners to be involved up front and to have 

guidance on when they should be used and particularly in these 

very large complex medical facilities. The communication, that 

needs to be clearly laid out so that you don’t have delays in what 

the contractor understands that they need to do. And then the 

change order process, that change order process was really systemic throughout. And when you have delays, sometimes up to 6 

months, it doesn’t work well, and if they don’t get the process 

changed with the change orders and streamline that, then you are 

going to continue to see delays, and that is within the construction. 

VA needs to get their planning to go away from, and I understand that they are, from rough orders of magnitude and giving 

Congress what they think they need. They need to put that planning effort up front, which I believe they are trying to do, and then 

to manage that construction process, including correcting the 

change order. 

Mrs. KIRKPATRICK. Thank you. 

I yield back. 

Mr. COFFMAN. Thank you. My thanks to the panel. You are now 

excused. 

The obstacles facing VA construction are disheartening, but I 

look forward to working with the VA to improve its construction 

practices and to create a system that is both fair to the veterans 

who have served this country and to the taxpayers who foot the 

bill. 

With that, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and include extraneous material. 

Without objection, so ordered. 

I want to thank all Members and witnesses for their participation in today’s hearing. This hearing is now adjourned. 

[Whereupon, at 4:12 p.m., the Subcommittee was adjourned.] 

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A P P E N D I X 

Prepared Statement of Hon. Mike Coffman, Chairman 

Good afternoon. I would like to welcome everyone to today’s hearing titled ‘‘VA 

Construction Policy: Failed Plans Result in Plans That Fail.’’ 

Providing veterans medical care is a core function of VA. When VA does health 

care right, it can be second to none. However, the process VA employs to build its 

health care facilities is abysmal and the result leads to delays for much needed care 

to veterans 

The Government Accountability Office’s recent report noted that VA’s four largest 

medical-center construction projects have had an average cost increase of $366 million dollars and an average delay of thirty-five months. One of the most distressing 

items in the GAO report is that VA failed to learn from its mistakes as it went from 

project to project. I must add that many of these same issues have been identified 

by GAO in the past and we seem to be no closer to a better result. 

Unfortunately, it is not just major facilities that epitomize why VA’s construction 

policy is a debacle. A little more than a year ago, this Subcommittee held a hearing 

on VA’s failure to perform due diligence and failure to inform Congress of project 

increases regarding the proposed clinic in Savannah, Georgia. Based on subsequent 

correspondence with VA over the past year, I am not quite certain VA is getting 

the message that its construction program is dysfunctional and not in keeping with 

industry best practices or veterans’ expectations. 

Not only is VA building facilities over budget and late, but it is also failing to pay 

the contractors for their work in a timely manner. While ensuring taxpayer dollars 

are properly spent is of the utmost importance, VA must pay its bills on time. Last 

week, I visited the Denver project and spoke directly with VA about prompt payment to contractors and subcontractors and was alarmed by VA’s response to the 

issue. Under the Prompt Payment Act, and OMB’s guidance, a Federal agency is 

expected ‘‘to ensure that prime contractors disburse the funds that they receive from 

the Federal Government to their small business subcontractor in a prompt manner.’’ 

The Prompt Payment Act also requires that the contractor certify that his sub-contractors are receiving payment commensurate with the work performed. But as evidence shows, some contractors and subcontractors in these four projects have been 

waiting for months to be paid. 

Moreover, the Small Business Act explains that it is ‘‘the policy of the United 

States that its prime contractors establish procedures to ensure the timely payment 

of amounts due pursuant to the terms of their subcontracts with small business concerns.’’ VA’s failure to abide by the laws governing payment to its contractors is unacceptable and is a problem in need of an immediate fix. 

Given the number and variety of facilities VA has built over the last several 

years, it is disturbing to me that VA continues to employ policies and techniques 

that have repeatedly fallen short. 

I look forward to hearing from today’s witnesses regarding VA’s construction policy and how we can move forward to effectively and efficiently build medical facilities for our veterans. 

f 

Prepared Statement of Hon. Jackie Walorski 

Mr. Chairman and Ranking Member, it’s an honor to serve on this Committee. 

I thank you for holding this hearing on such an important issue for our veterans 

and the future of veteran health care. 

The Department of Veterans Affairs (VA) oversees an impressive health care delivery system comprised of 152 hospitals and 821 community-based outpatient clinVACREP180 with DISTILLER

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1Department of Veterans Affairs, National Center for Veterans Analysis and Statistics, ‘‘Department of Veterans Affairs Statistics at a Glance,’’ Updated 4 February 2013. http:// 

www.va.gov/vetdata/docs/Quickfacts/Winter—13—sharepoint.pdf. 2 Ibid. 

3There are an estimated 53,318 veterans in IN–02. This data was compiled on 09/30/2012, 

based on the district lines from the 112th Congress. http://www.va.gov/vetdata/Veteran—Population.asp. 1GAO, VA Construction: Additional Actions Needed to Decrease Delays and Lower Costs of 

Major Medical-Facility Projects, GAO-13-302 (Washington, D.C.: April 4, 2013). 2 U.S. Department of Veterans Affairs, Fiscal Year 2013 Budget Request. Construction IV 

(Washington, D.C.: 2012). 3The term ‘‘major medical-facility project’’ means a project for the construction, alteration, or acquisition of a medical facility involving the total expenditure of more than $10 million. See 

38 U.S.C. § 8104. These projects cost at least $10 million, some in the hundreds of millions of 

dollars. The project types include new construction, renovation of existing structures, expansion, 

or a combination of types. The total number of major VA medical-facility projects is based on 

agency data from November 2012. 4We identified reasons for selected facilities’ overall cost and schedule changes, but were not 

able to identify the extent to which specific reasons changed these costs and schedules, unless 

specifically noted. 

ics (CBOCs) in addition to close to 300 veteran centers. 1 These facilities have a reputation for providing quality care specific to veteran needs; however, many of these 

facilities are in desperate need of repair and modifications to accommodate the influx of new veterans as well as a veteran population composed of approximately 43 

percent who are 65 or older. 2

There is an obvious greater need for state-of-the-art facilities that can address the 

unique needs of all veterans. This is why I am determined to ensure the replacement CBOC proposed for South Bend remains on schedule to open in 2015. The approximately 53,000 veterans in Indiana’s Second Congressional District have earned 

access to the primary care and mental health services promised with this new facility. 3

The delays and significant cost increases for other VA medical center projects are 

disturbing. This is an issue which necessitates immediate action from the VA. 

I look forward to working with my colleagues and our panelists to establish a plan 

of action for the Department of Veterans Affairs which eliminates redundancies and 

streamlines processes that promote greater efficiency in the construction of major 

medical-facility projects. 

Thank you. 

f 

Prepared Statement of Lorelei St. James 

Chairman Coffman, Ranking Member Kirkpatrick, and Members of the Subcommittee: 

I am pleased to be here today to discuss our recent work examining cost increases 

and schedule delays at the Department of Veterans Affairs’ (VA) major medical-facility construction projects. 1 According to VA’s fiscal year 2013 budget submission 

to Congress, the Veterans Health Administration’s (VHA) existing infrastructure 

does not fully align with the current health care needs of the veteran population. 2

To help address this situation, VA has 50 major medical-facility projects 3 under 

way, including new construction and the renovation of existing medical facilities, at 

a cost of more than $12 billion. Although VA has taken steps to improve its process 

for managing these construction projects, opportunities exist for VA to improve its 

efforts. 

This testimony discusses VA construction management issues, specifically (1) the 

extent to which the cost, schedule, and scope for selected new medical-facility 

projects have changed since they were submitted to Congress and the reasons for 

these changes, (2) actions VA has taken to improve its construction management 

practices, and (3) the opportunities that exist for VA to further improve its management of the costs, schedule, and scope of these construction projects. This testimony 

is based on our April 2013 report. In that report, we discuss VA’s current 50 major 

medical-facility projects, including the original cost estimates and completion dates 

and the projects’ current status according to November 2012 data. 4 To understand 

issues involving costs estimates and completion dates, we took a more detailed review of four VA medical-facility projects in Las Vegas, Orlando, New Orleans and 

Denver. We also reviewed and analyzed construction documents, VA’s Strategic Plan 

Fiscal Years 2011 to 2015, and other relevant documents. We interviewed officials 

from VA; veterans support organizations; architectural and engineering firms; genVACREP180 with DISTILLER

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5 According to the Office of Management and Budget (OMB), federal agencies should keep a 

contingency fund of 10 to 30 percent above total estimated costs to address increased costs on 

construction projects. However, this guidance applies after construction has begun, and many 

of the cost increases we observed occurred before that time. The construction contractor is generally responsible for cost increases and schedule overruns under the terms of the fixed-price 

contract. OMB Circular No. A–11, Appendix 8 (2012). 

eral contractor construction firms; and construction management firms. The work on 

which this statement is based was conducted from April 2012 to April 2013 in accordance with generally accepted government auditing standards. For a more detailed explanation of our scope and methodology, see the April 2013 report. 

In summary, we recognize that some cost increases and schedule delays result 

from factors beyond VA’s control; however, our review of VA’s largest projects indicated weaknesses in VA’s construction management processes also contributed to 

cost increases and schedule delays. Given that VA is currently involved in 50 major 

medical-facility construction projects, including four large medical centers, VA 

should take further action to improve its management of costs, schedule, and scope 

of these projects. 

Cost Increases and Schedule Delays at the Four Largest Projects Occurred 

for a Variety of Reasons 

Cost Increases and Schedule Delays 

Costs increased and schedules were delayed considerably for VA’s four largest 

medical-facility construction projects, when comparing November 2012 construction 

project data with the cost and schedule estimates first submitted to Congress. Cost 

increases ranged from 59 percent to 144 percent, 5 representing a total cost increase 

of nearly $1.5 billion and an average increase of approximately $366 million per 

project. The schedule delays ranged from 14 to 74 months with an average delay 

of 35 months per project (see table 1). 

Source: GAO Analysis of VA data. 

a - The column titled ‘‘total estimated years to complete’’ is reported to the nearest 

quarter year and is calculated from the time VA approved the architecture and engineering firm to the current estimated completion date. We calculated the ‘‘number 

of months extended’’ column by counting the months from the initial estimated completion date to the current estimated completion date, as reported by VA. According 

to VA, the dates in the initial estimated completion dates are from the initial budget 

prospectus, which assumed receipt of full construction funding within 1 to 2 years 

after the budget submission. In some cases, construction funding was phased over 

several years and the final funding was received several years later. Naval Facilities 

Engineering Command officials we spoke with told us that historically, their medical facility projects take approximately 4 years from design to completion. We calculated the percentage change in cost by using the initial total estimated costs and 

total estimated costs, as reported by VA. 

b - VA provided time extensions to the Orlando, Florida contractor extending the 

contract completion date to July 2013. Because of an ongoing dispute between VA 

and the general contractor regarding performance of the contract in Orlando, VA 

issued a ‘‘show-cause’’ notice to the contractor on January 31, 2013. The show-cause 

notice provides the contractor an opportunity to present any facts relevant to the 

dispute. As of the publication of this testimony, VA has yet to determine the next 

steps to resolve this matter. July 2013 is considered the current completion date 

provided to us by VA officials. However, the general contractor disagrees with this 

date and has estimated that it will be spring 2014. 

Of the remaining 46 major medical-facility projects, 26 are under construction or 

were recently completed. Of these 26, half have experienced cost increases, but the 

other half experienced either no change in costs or a decrease in costs. Nineteen of 

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6 VA did not provide schedule data for both initial estimated completion date and current estimated completion date for two projects under construction. 7GAO, VA Construction: VA is Working to Improve Initial Project Cost Estimates, but Should 

Analyze Cost and Schedule Risks, GAO–10–189 (Washington, D.C.: Dec. 14, 2009). 8The Construction Review Council was comprised of officials from the VA, including the secretary, deputy secretary, chief of staff, under secretaries, and assistant secretaries, as well as 

key leaders across the department. The Secretary of VA chaired nine meetings from April 18 

through June 15, 2012, to review the VA construction program and identify challenges that led 

to changes in scope, cost over-runs, and scheduling delays of major projects. 9 VA, The Construction Review Council Activity Report (Washington, D.C.: November 2012). 

24 construction projects currently under construction or recently completed have experienced schedule delays. 6

In commenting on a draft of our April 2013 report, VA contends that using the 

initial completion date from the construction contract would be more accurate than 

using the initial completion date provided to Congress; however, using the initial 

completion date from the construction contract would not account for how VA managed these projects prior to the award of the construction contract. Cost estimates 

at this earlier stage should be as accurate and credible as possible because Congress 

uses these initial estimates to consider authorizations and make appropriations decisions. We used a similar methodology to estimate changes to cost and schedule of 

construction projects in a previous report issued in 2009 on VA construction 

projects. We believe that the methodology we used in our April 2013 and December 

2009 report on VA construction provides an accurate depiction of how cost and 

schedules for construction projects can change from the time they are first submitted to Congress. 7 It is at this time that expectations are set among stakeholders, 

including the veterans’ community, for when projects will be completed and at what 

cost. 

Reasons for Cost Increases and Schedule Delays at VA’s Four Largest 

Projects and Related Scope Changes 

At each of the four locations we reviewed, different factors contributed to cost increases and schedule delays: 

• Changing health care needs of the local veteran population changed 

the scope of the Las Vegas project. VA officials told us that the Las Vegas 

Medical Center was initially planned as an expanded clinic co-located with 

Nellis Air Force Base. However, VA later determined that a much larger medical center was needed in Las Vegas after it became clear that an inpatient 

medical center shared with the Air Force would be inadequate to serve the medical needs of local veterans. • Decisions to change plans from a shared university/VA medical center 

to a stand-alone VA medical center affected plans in Denver and New 

Orleans. For Denver and New Orleans, VA revised its original plans for shared 

facilities with local universities to stand-alone facilities after proposals for a 

shared facility could not be finalized. • Changes to the site location by VA delayed efforts in Orlando. In Orlando, VA’s site location changed three times from 2004 to 2010. It first changed 

because VA, in renovating the existing VA hospital in Orlando, realized the facility site was too small to include needed services. However, before VA could 

finalize the purchase of a new larger site, the land owner sold half of the land 

to another buyer, and the remaining site was again too small. • Unanticipated events in Las Vegas, New Orleans, and Denver also led 

to delays. For example, VA officials at the Denver project site discovered they 

needed to eradicate asbestos and replace faulty electrical systems from pre-existing buildings. They also discovered and removed a buried swimming pool and 

found a mineral-laden underground spring that forced them to continually treat 

and pump the water from the site. 

VA Has Taken Steps to Improve Its Construction Management Practices 

VA has made improvements in its management of major medical-facility construction projects, including creating a construction-management review council. In April 

2012, the Secretary of Veterans Affairs established the Construction Review Council 

to serve as the single point of oversight and performance accountability for the planning, budgeting, executing, and delivering of VA’s real property capital-asset program. 8 The council issued an internal report in November 2012 that contained findings and recommendations that resulted from meetings it held from April to July 

2012. 9 The report revealed that the challenges identified on a project-by-project 

basis were not isolated incidents but were indicative of systemic problems facing 

VA, and made several recommendations to address these problems. But VA has not 

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10 VA, Strategic Plan Refresh: FY2011–FY2015, (Washington, D.C). 11 VA, Construction Primer (Washington, D.C.: January 2013). 

yet developed specific guidance or instructions for how to implement the recommendations. 

VA has taken some other actions to improve construction project management. 

For example, VA has collaborated with other federal agencies involved in medical 

facilities construction to tap their experience, and convened a construction industry 

forum to communicate about ways to improve medical facilities construction practices. In addition, VA has taken steps to involve construction contractors earlier in 

some projects to allow coordination with the architectural and engineering firms in 

designing and planning a project. 

Opportunities Exist for VA to Further Improve Its Construction Management Practices 

Although VA has made improvements in its management of major medical-facility 

construction projects, many of these projects continue to experience cost increases 

and schedule delays. We recognize that some cost increases and schedule delays result from factors beyond VA’s control; however, our review of VA’s four largest 

projects indicates that weaknesses in VA’s construction management processes–in 

particular, those listed below—also contributed to cost increases and schedule 

delays: 

Using Medical Equipment Planners 

VA officials have emphasized that they need the flexibility to change their heath 

care processes in response to the development of new technologies, equipment, and 

advances in medicine. 10 Given the complexity and sometimes rapidly evolving nature of medical technology, many health care organizations employ medical equipment planners to help match the medical equipment needed in the facility to the 

construction of the facility. Federal and private sector stakeholders during our review reported that medical equipment planners have helped avoid schedule delays. 

VA officials told us that they sometimes hire a medical equipment planner as part 

of the architectural and engineering firm services to address medical equipment 

planning. However, we found that for costly and complex facilities, VA does not have 

guidance for how to involve medical equipment planners during each construction 

stage of a major hospital and has sometimes relied on local VHA staff with limited 

experience in procuring medical equipment to make medical-equipment- planning 

decisions. In Orlando, medical equipment specifications changed several times and 

led to cost increases of at least $14 million in addition to schedule delays, as these 

issues forced VA to suspend construction until the issues were resolved. In our April 

2013 report, we recommended that the Secretary of VA develop and implement 

agency guidance to assign of medical equipment planners to major medical construction projects. VA agreed and said it planned to address this recommendation. 

Sharing Information on the Roles and Responsibilities of VA’s Construction-Management Staff 

Construction of large medical facilities involves numerous staff from multiple VA 

organizations. Officials from the Office of Construction and Facilities Management 

(CFM) stated that during the construction process, effective communication is essential and must be continuous and involve an open exchange of information among 

VA staff and other key stakeholders. 11 However, we found that the roles and responsibilities of CFM and VHA staff are not always well communicated and that 

it is not always clear to general contracting firms which VA officials hold the authority for making construction decisions. This can cause confusion for contractors 

and architectural and engineering firms, ultimately affecting the relationship between VA and the general contractor. For example, contractor officials at one site 

said that VA’s project manager directed them to defer the design of specific rooms 

until medical equipment was selected for the facility; however, VA’s central office 

then directed the contractor to proceed with designing the rooms. This conflicting 

direction from VA could require the contractor to redesign the space, further expending project resources. Participants from VA’s 2011 industry forum also reported 

that VA roles and responsibilities for contracting officials were not always clear and 

made several recommendations to VA to address this issue. In April 2013, we recommended that the Secretary of VA develop and disseminate procedures for communicating—to contractors—clearly defined roles and responsibilities of the VA officials 

who manage major medical-facility projects, particularly those in the change-order 

process. VA agreed and stated they had actions underway to improve communication involving roles and responsibilities. 

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12 48 C.F.R. § 43.201 13 VA, VA Resident Engineer Handbook, ‘‘Chapter 3: Major Construction: Contract Changes’’ 

(3.24) (Washington, D.C.) 14Specifically, we interviewed the U.S. Army Corps of Engineers and Naval Facilities Engineering Command. We recognize that the Department of Veterans Affairs serve different populations in the defense community—active duty military personnel and veterans, respectively. 

However, these organizations construct similar medical facilities, in addition to abiding by federal government regulations for construction projects. 15 Although officials at one of these sites said that VA’s timeliness of the change order process 

has improved, they noted that a change order still takes an average of 2 to 3 months, indicating 

to them that further improvement is needed. 16GAO-13-302. 

Managing the Change- Order Process 

Most construction projects require, to varying degrees, changes to the facility design as the project progresses, and organizations typically have a process to initiate 

and implement these changes through change orders. Federal regulations 12 and 

agency guidance 13 state that change orders must be made promptly, and that there 

be sufficient time allotted for the government and contractor to agree on an equitable contract adjustment. VA officials at the sites we visited stated that change orders that take more than a month from when they are initiated to when they are 

approved can result in schedule delays, and officials at two federal agencies that 

also construct large medical projects told us that it should not take more than a 

few weeks to a month to issue most change orders. 14 However, officials at two sites, 

New Orleans and Orlando, said that it was common for VA to take 6 months to 

process a change order, even though VA has directed its staff to eliminate or minimize delays. 15 Processing delays may be caused by the difficulty involved in VA’s 

and contractors’ coming to agreement on the costs of changes and the multiple levels 

of review required for many of VA’s change orders. In April 2013, we recommended 

that the Secretary of VA issue and take steps to implement guidance on streamlining the change-order process based on the findings and recommendations of the 

Construction Review Council. 16 VA concurred with our recommendation and was reviewing the options proposed by the Construction Review Council to streamline the 

change-order process. 

We provided a draft of our April 2013 report for VA for review and comment. In 

its written comments, VA concurred with our recommendations. 

Chairman Coffman and Ranking Member Kirkpatrick, and Members of the Subcommittee, this completes my prepared statement. I would be pleased to respond to 

any questions that you may have at this time. 

Contacts and Acknowledgments 

If you have any questions about this testimony, please contact Lorelei St. James 

at (202) 512–2834 or stjamesl@gao.gov. Other key contributors to this testimony include are Ed Laughlin (Assistant Director), Nelsie Alcoser, George Depaoli, Raymond Griffith, Joshua Ormond, Amy Rosewarne, James Russell, Sandra Sokol, and 

Crystal Wesco. 

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f 

Prepared Statement of Raymond C. Kelley 

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: 

On behalf of the nearly 2 million men and women of the Veterans of Foreign Wars 

of the United States (VFW) and our Auxiliaries, I would like to thank you for the 

opportunity to testify today regarding VA construction policy. 

As the Department of Veterans Affairs (VA) strives to improve the quality and 

delivery of care for our wounded, ill and injured veterans, the facilities that provide 

that care continue to erode. With buildings that have an average age of 60 years, 

VA has a monumental task of replacing or expanding the existing medical facilities. 

From 2004 to 2010, utilization of VA health care facilities grew from 80 percent to 

121 percent, while the conditions of these facilities declined from 81 percent to 71 

percent over the same period of time. 

In 2010, VA adopted the Strategic Capital Investment Planning (SCIP) process to 

identify current and future infrastructure needs. Based on this process, VA identified 130 major construction projects that need to be completed by 2021 to eliminate 

the current and future gaps in utilization and safety. The price tag to close these 

major construction gaps is between $21 billion and $25 billion. To even come close 

to accomplishing these projects, VA must maximize every dollar and implement 

processes that will expedite the construction process. 

The VFW has identified four major areas that need to be addressed to ensure that 

construction projects are done in a more efficient and cost effective manner. First, 

VA must use the electronic Contract Management System (eCMS) to its fullest potential; second, VA needs to change from using the design-bid-build practice; third, 

VA must adopt a comprehensive facility master plan; and forth, VA should being 

using medical equipment planners on all major construction projects. 

eCMS is VA’s centralized electronic contract writing and management platform 

that is intended to replace the current contract writer. eCMS is designed to reduce 

costs, standardize the acquisition process, reduce workload and improve communication for any contract valued at $25,000 or more. 

Roll-out and utilization of eCMS has been slow. By VA’s own account, usage has 

gone from 17 percent in 2008, to 77 percent in 2012. The VA Office of Acquisitions 

and Logistics and Construction (OALC) has mandated that all contracts costing 

more than $25,000 must be processed through eCMS. However, design flaws within 

eCMS prevent it from being an effective tool in contract management and fiscal 

oversight, and causes contract officers who use the program to also write the contract through the National Acquisition Center’s Contract Management system. 

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Therefore, eCMS’s information is incomplete and cannot be relied upon for making 

sound procurement decisions and causes contract officers to duplicate their effort, 

which results in inefficient use of time and resources. 

VA projects that system upgrades to eCMS will be completed in 2014. Congress 

must ensure that the resources that are needed to complete these upgrades are 

available and they must provide oversight to confirm eCMS is being utilized. While 

the system is improving, OALC must follow through with its mandate to write contracts in eCMS, so OALC can consistently capture data, allowing them to make better acquisition decisions. 

VA has historically relied on the design-bid-build project delivery system when entering into contracts to build major medical facility projects. Of the 50 current VA 

major medical facility projects, 43 of them are design-bid-build. With this model, an 

architect is selected to design a facility, the design documents are used to secure 

a bid, and then the successful contract bid holder builds the facility. 

Design-bid-build projects often encounter disputes between the costumer – VA in 

this case – and the construction contractor. Because these contracts are generally 

firm-fixed-price, based on the completed design, the construction contractor is usually responsible for cost overruns, unless VA and the contractor agree on any needed 

or proposed changes that occur with a change of scope, unforeseen site condition 

changes or design errors. VA and the contractor negotiate these changes through 

change orders. This process can become adversarial, because neither party wants to 

absorb the cost associated with the change, and each change order can add months 

to the project completion date. 

The flaws of design-bid-build projects have become very apparent, highlighted by 

the delays in Orlando, Florida, where a new medical facility has been delayed by 

39 months due mostly to change order disputes. This contract must be followed 

through to completion, but VA must use this as a lessons-learned and change their 

contracting model to an Architect-led design-build model. 

A design-build project teams the architectural/engineering company and the construction contractor under one contract. This method can save VA up to six months 

of time by putting the design phase and the construction performance metric together. Placing the architect as the lead from start to finish, and having the construction contractor work side-by-side with the architect, allows the architect to be 

an advocate for VA. Also, the architect and the construction contractor can work together early on in the design phase to reduce the number of design errors, and it 

also allows them to identify and modify the building plans throughout the project. 

VA must also use master planning at all of its facilities. Master planning will 

allow VA to examine and project potential changes in technology, patient care practices and changes in veteran demographics. The new Las Vegas Medical Center is 

an example of not knowing the trend in the veteran population, causing the project 

to be delayed while the scope of the project was changed. Early on, VA only planned 

to expand an existing facility, later realizing that a much larger facility was needed 

to meet the needs of the veterans in the community. Having a thorough master plan 

could have eliminated some the 74-month delay in the construction of this facility. 

The last area the VFW would like to discuss that has been identified as causing 

delays in medical facility construction is the purchase of medical equipment. VA 

wants to equip its facilities with the most up-to-date equipment. However, procuring 

medical equipment after the design of the facility inevitably causes building delays 

while the designs are redrawn, and in some cases some demolition of recently constructed areas must take place to accommodate the newly purchased medical equipment. 

The VFW believes that VA would benefit from the use of medical equipment planners. Using these planners, which is an industry practice used by the Army Corps 

of Engineers and other federal agencies, places an experienced medical equipment 

expert at the disposal of the architect and construction contractor. When used properly, a medical equipment planner can work with the architect during the design 

phase and then the construction contractor during the build phase to ensure needed 

space, physical structure and electrical support are adequate for the purchased medical equipment, reducing change orders, work stoppages, and the demolition of 

newly built sections of a facility. 

Using a medical equipment planner can reduce schedule delays and cost overruns. 

Using the Orlando facility as an example again, issues with the purchase of medical 

equipment caused cost overruns of more than $10 million and construction had to 

be suspended until the issues were resolved. 

It is important for VA to become more efficient at constructing facilities. Veterans 

have expectations that medical facilities will be available when VA first states what 

the completion date will be. It is obvious by looking at the number of delays and 

cost overruns that the contracting and building procedures that VA currently uses 

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are antiquated and are costing VA millions of dollars more for each project and 

causing five to six year delays in much needed medical facilities. By implementing 

these four initiatives, future major construction projects will have better oversight, 

cost controls and more efficient procedures for unforeseen changes in the construction of facilities. 

Mr. Chairman, this concludes my remarks and I look forward to any questions 

you or the Committee may have. 

Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has not received 

any federal grants in Fiscal Year 2013, nor has it received any federal grants in 

the two previous Fiscal Years. 

f 

Prepared Statement of Glenn D. Haggstrom 

Chairman Coffman, ranking member Kirkpatrick, distinguished members of the 

subcommittee, I am pleased to appear here this afternoon to update the subcommittee on the Department of Veterans Affairs’ (VA) continuing efforts to improve 

construction procedures and planning processes to ensure timely execution of major 

construction projects. Joining me this afternoon is Stella Fiotes, Executive Director, 

Construction and Facilities Management, OALC. 

The Department’s infrastructure programs which include major and minor construction, non-recurring maintenance, and leasing are part of our ongoing mission 

to care for and memorialize our Nation’s Veterans. We are committed to meeting 

our responsibility to design, build, and deliver quality facilities as tools to meet the 

demand for access to health care and benefits. 

VA has made significant improvements in its real property capital asset portfolio 

to provide state of the art facilities to meet the needs of Veterans, allowing for the 

highest standard of service. We have taken on the challenge of updating our aging 

infrastructure to allow for management of increased workload demands; changing 

Veteran patient demographics; advances in medical technology; new complex treatment protocols and advanced procedures; delivering patient-centered care and services closer to where Veterans live; and evolving Federal requirements. 

The focus of my testimony today is on VA’s major construction program – our program identification, process improvements and challenges, and accomplishments. 

This will provide you a perspective of how we deliver VA’s major construction 

projects. 

Program Identification 

The Strategic Capital Investment Planning (SCIP) process was implemented with 

the fiscal year (FY) 2012 budget. This Department-wide planning process prioritizes 

the Department’s future capital investment needs to strategically target VA’s limited resources to most effectively improve the delivery of services and benefits to 

Veterans, their families and survivors by addressing VA’s most critical infrastructure needs and performance gaps and investing wisely in VA’s future. Using this 

approach, VA has visibility across its entire real property portfolio and is able to 

synchronize the projects we undertake in our major infrastructure programs to address our most critical needs. As part of this, VA has identified critical milestones 

for review in the life-cycle of a project from the planning and programming stages 

to the disposition of a facility when it is no longer functional for its purpose or needed to fulfill the mission. 

Process Improvements 

VA has taken several steps to improve the management and oversight of major 

construction projects. In 2009, the VA Facility Management (VAFM) transformation 

initiative was established to improve planning processes; integrate construction and 

facility operations; and standardize the construction process. VAFM identified a 

need for the following: 

1. An enterprise approach to integrated master planning - Plans were piloted 

in 2011 and are moving to full operation; 

2. Systems for project management - VA procured a collaborative project management software system in 2012 and is completing phase one fielding and will 

complete fielding in 2014. This software supports leases, major construction, 

minor construction as well as non-recurring maintenance (NRM), and; 

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3. Post occupancy evaluations (POE) - The POE program, piloted in 2012, is 

now standard practice for the major construction program and is expanding to 

the minor construction program. POE evaluates the completed construction to 

assure closure of all gaps and deficiencies noted in the approved project scope. 

In April 2012, as a follow on to the VAFM initiative, the Secretary of Veterans 

Affairs established the Construction Review Council (CRC) to serve as the single 

point of oversight and performance accountability for the planning, budgeting, execution, and management of the Department’s real property capital asset program. 

Chaired by the Secretary, the CRC identified findings to improve performance in 

four major areas: 

1. Development of requirements - Add rigor to the requirements development 

phase of the project and complete 35 percent of a project’s design prior to requesting major construction funds. This assures that full requirements are 

identified early, designed, costed and managed through the construction cycle 

which results in more complete cost estimates and scopes in VA’s budget submissions. 

2. Design Quality - VA has also implemented policy requiring constructability 

reviews as part of every design review. These reviews identify design errors and 

omissions prior to construction allowing the design to be corrected, thereby reducing changes during construction. 

3. Funding - VA is implementing an integrated approach to activation and 

funding to assure the project construction program is coordinated with information technology (IT) and medical equipment budgets and plans. This identifies 

the funding and planning for the procurement of medical equipment and IT infrastructure, and incorporating major equipment delivery and installation into 

the master construction schedule. 

4. Program Management and Automation - VA continues to educate and certify 

project managers and deploy modern collaborative tools for project management 

to ensure project cost, scope, and schedule growth is controlled. 

Further, VA has implemented the findings of the December 2009 Government Accountability Office’s (GAO) report on ‘‘VA Construction: VA is Working to Improve 

Estimates, but Should Analyze Cost and Schedule Risks’’ and now performs risk 

analysis for potential cost and schedule delays as part of the project design process. 

The recommendations in the May 2013 GAO report on ‘‘VA Construction: VA Additional Actions Needed to Decrease Delays and Lower Costs of Major Medical-Facility 

Projects’’ are improvements that were also previously identified and are currently 

being addressed. 

Challenges and Accomplishments 

VA bears the responsibility to manage all projects efficiently and to be good stewards of the resources entrusted to us by Congress and the American people. 

Last year we briefed the House Veterans Affairs Committee on the construction 

of the new VA medical center in Orlando. The Orlando project includes 134 inpatient beds, an outpatient clinic, a 120-bed community living center, a 60-bed domiciliary, parking garages, and support facilities all located on a new site. VA expects 

to serve nearly 113,000 Veteran enrollees. The construction project has advanced 

from approximately 50% completion a year ago to approximately 80 percent today. 

While the project has been challenged by design errors and omissions, medical 

equipment coordination, and contractor performance, VA remains committed to 

working with our contractor to ensure a quality project is delivered to meet the 

needs of Veterans and their families. 

The lessons learned from Orlando and past major construction projects are guiding us in our management of the Denver and New Orleans replacement hospitals. 

Both complexes will be full-service tertiary care medical centers that include specialty care; outpatient clinics; inpatient services; central energy plant and parking 

structures; as well as other support services. Both facilities are under construction 

with completion dates of 2015 and 2016 respectively. Lessons learned have resulted 

in increased staff to assure timely project and contract administration; partnering 

sessions that include VA and the construction and design contractors; early involvement of the medical equipment planning and procurement teams; and engagement 

in executive level on-site project reviews. VA will continue to provide regular updates to the Congressional Committees to ensure you are fully informed on the 

progress of these medical centers. 

While VA’s major construction program has encountered challenges, it has also 

completed and delivered significant projects for Veterans in the past five years. In 

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FY 2012 and FY 2013 to date, VA has delivered nearly $1 billion worth of facilities. 

This includes 16 medical facilities, including the new Las Vegas hospital, and five 

new cemeteries or cemetery expansions, the vast majority of which were delivered 

without construction delay and within the appropriated funds. VA continues work 

to complete 52 major construction projects to provide the much needed facilities for 

our Veterans and their families. 

Conclusion 

VA has a strong history of delivering facilities to accomplish our mission to serve 

Veterans. We continually seek innovative ways to further improve our ability to design and construct state-of-the-art facilities for Veterans and their families and we 

regularly engage in forums composed of both the private and public sectors that discuss best practices and challenges in today’s construction industry. The lessons 

learned from our past construction projects will continue to lead to improvements 

in the management and execution of our capital program as we move forward. 

Thank you for the opportunity to testify before the committee today. I look forward 

to answering any questions the Committee has regarding these issues. 

f 

Questions For The Record 

Letter and Question Submitted by Rep. Beto O’Rourke, To: VA 

May 10, 2013 

The Honorable Eric K. Shinseki 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Mr. Secretary: 

In reference to our Subcommittee on Oversight & Investigations hearing entitled, 

‘‘VA Construction Policy: Failed Plans Result in Plans That Fail,’’ that took place 

on May 7, 2013, I would appreciate it if you could answer the enclosed hearing questions by the close of business on June 10, 2013. 

Committee practice permits the hearing record to remain open to permit Members 

to submit additional questions to the witnesses. Attached are additional questions 

directed to you. 

In preparing your answers to these questions, please provide your answers consecutively and single-spaced and include the full text of the question you are addressing in bold font. To facilitate the printing of the hearing record, please e-mail 

your response in a Word document, to Jian Zapata at jian.zapata@mail.house.gov 

by the close of business on June 10, 2013. If you have any questions please contact 

her at 202–225–9756. 

Sincerely, 

MICHAEL H. MICHAUD 

Ranking Member 

CW:jz 

Questions Submitted by Representative Beto O’Rourke 

Mr. Glenn D. Haggstrom 

1. Please identify the factors that go into determining the Strategic Capital Investment Planning (SCIP) priority for a facility that is co-located with either a U.S. 

Department of Defense (DoD) facility or a private or public medical center. 

f 

VA Response to Questions Submitted by Rep. Beto O’Rourke 

Question Submitted by Representative Beto O’Rourke 

Question: Please identify the factors that go into determining the Strategic Capital Investment Planning (SCIP) priority for a facility that is colocated with either a U.S. Department of Defense (DoD) facility or a private 

or public medical center. 

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VA Response: The Department of Veterans Affairs (VA) Strategic Capital Investment Planning (SCIP) process provides an innovative and methodologically-rigorous 

approach to providing a single, integrated list of its prioritized capital investment 

projects. To identify projects that best meet the Department’s critical needs, SCIP 

relies on a data-driven approach that includes the use of gap analysis, strategic capital assessment, and long-term capital planning. 

For the President’s 2014 Budget proposal, VA ranked each capital project according to how well each addressed six major criterion it identified as critical for addressing the Department’s and Veteran-s’ needs. Criteria include improving safety 

and security for Veterans and VA staff; fixing and extending the useful life of current infrastructure; increasing access; right-sizing inventory; maximizing value; and 

the degree to which the project addresses mission critical initiatives that are outlined in the Department’s strategic plan. SCIP criteria also includes collaboration 

with the Department of Defense (DoD). Projects that have a VA/DoD component are 

given priority points that factor into the project’s overall prioritization score. Once 

a recommendation is made, the integrated list is reviewed by VA leadership for approval and inclusion in the annual budget request. It should be noted that DoD’s 

Capital Investment Decision Model (CIDM) also contains a scoring component in its 

criteria that awards incentive points for collaborative proposals that support both 

Departments. 

VA and DoD have a long list of collaborating in the provision of medical care to 

their respective beneficiaries. Support of capital construction collaborations with 

DoD comports with Departmental initiatives. The VA/DoD Joint Executive Council 

established a Construction Planning Committee (CPC) to facilitate collaboration between the Departments and ensure an integrated approach to planning, design, construction (major and minor), leasing and other real property-related initiatives for 

shared medical facilities. This integration enhances service delivery and assures 

projects that are mutually beneficial to both Departments. In order to enhance existing capital asset management planning processes, the CPC developed a common approach to identify and to share common data elements and to improve communication. In 2012, the CPC shared point-of-contact information with both VA and DoD 

planners as well as three data points: population, workload, and purchased care, for 

utilization in each Department’s capital planning processes. In 2013, the CPC added 

two additional data elements: access and available space, to aid in the early identification of potential joint construction and leasing opportunities at the field level. 

While supportive of collaboration, VA does not have statutory authority to construct or lease joint VA/DoD facilities. This is a significant impediment to the Department’s ability to collaborate effectively with DoD. To address this issue, VA and 

DoD have both proposed legislation in fiscal year 2014 that would alleviate existing 

roadblocks to planning and funding future joint medical facility projects. 

f 

Additional Questions & Answers to VA from the Committee Members 

1. VA previously stated that it concurred with GAO’s recommendations 

for improving VA’s construction management practices. As such, please 

provide an overview of what actions VA is taking to address these recommendations. 

VA Response: Included in GAO’s report, Appendix IV, are Comments of the Department of Veterans Affairs (VA). VA intends to address the report recommendations as follows: 

Recommendation 1: Develop and implement agency guidance for assignment of 

medical equipment planner to major medical construction projects. 

VA Comment: Concur. VA concurs that medical equipment planning is critical 

to mitigating project cost and schedule risks. 

In coordination with the Veterans Health Administration (VHA), the Office of Acquisition, Logistics, and Construction (OALC) is evaluating criteria for the assignment of medical equipment planners to major construction projects, as well as medical equipment planner project roles and responsibilities, and will develop and implement the appropriate VA guidance. Additionally, VA has ensured that medical 

equipment planners are incorporated into the Denver and New Orleans major construction project teams. 

Recommendation 2: Develop and disseminate procedures for communicating to 

contractors clearly defined roles and responsibilities of VA officials that manage 

major medical facility projects, particularly the change order process. 

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VA Comment: Concur. VA concurs with the importance of establishing and communicating clearly defined roles and responsibilities, particularly with respect to the 

change order process. 

VA currently addresses the roles and responsibilities under the contract with the 

designer at the design kickoff meetings and with construction contractors at the preconstruction conference. Roles and responsibilities relative to changes are discussed 

in detail and followed in writing. The contracting officer provides a letter specifically 

naming individuals with the authority to execute changes and the limits of their authority. The contractor is required to sign the letter, acknowledging understanding 

of the stipulated authorities and limits. 

VA’s project management plan (PMP) template requires the creation of a communications plan and matrix to assure clear and consistent communications with all 

parties. The communications plan must address the following: 

a. generation, collection, dissemination, and storage of project information; 

b. regular project communication, such as meetings and in-progress reviews; 

c. frequency and method of communication (e.g., e-mail, phone); and 

d. stakeholder roles and responsibilities. An appendix to the plan provides more 

specific information on the development of the plan and provides a sample of 

a typical communications plan matrix. VA will continue to review and define 

these communications plans and develop procedures to ensure distribution to 

all the stakeholders. 

VA has also added a Construction Peer Excellence Review to assure effective communication and collaboration are incorporated on projects during construction. This 

program is an adaptation of the General Services Administration (GSA) program. 

VA has GSA staff on loan to stand up the program and perform the initial reviews. 

The program involves industry leaders visiting the site and assessing individual and 

‘‘team’’ effectiveness. 

Recommendation 3: Issue and take steps to implement guidance on streamlining 

the change order process based on the findings and recommendations of the Construction Review Council. 

VA Comment: Concur. VA is developing and will implement guidance to streamline the change order process to reduce review time and increase proactive action. 

These strategic activities include: 

a. Establishing time goals for processing change orders and modifications to the 

contract. These time goals for processing will clearly convey to the staff the acceptable performance level. These time goals will be benchmarked with other 

Federal agencies to assure VA incorporates best practice initiatives; and 

b. Standing up a metrics program that will allow leadership to monitor change 

order processing time in order to affect resources to bring the change order 

processing time within acceptable standards. 

In order to immediately streamline the process, VA has placed contracting staff 

on-site in New Orleans, Orlando, Denver, Manhattan, and Palo Alto and has additional contracting officers available to deploy to any site requiring support to shorten review and processing time. Additionally, VA has hired four additional attorneys 

dedicated to the major construction program. These attorneys are being integrated 

into the project teams to assure timely counsel and review of actions. 

2. In response to GAO’s recommendation to develop and disseminate procedures for communicating to contractor’s clearly defined roles and responsibilities of VA officials responsible for managing major medical-facility projects, VA states that it will develop procedures to ensure distribution 

to all stakeholders. Please explain what these procedures might include to 

ensure all stakeholders are made aware of these roles and responsibilities. 

VA Response: Please refer to response to Question 1, Recommendation 2. 

3. In response to VA’s concerns with GAO’s methodology, VA recommends 

using an alternative methodology such as calculating the estimated completion date from when the construction contract was awarded, rather 

than when the project was first submitted to Congress. Can you please explain this methodology and why you think it is better model to use? 

VA Response: To clarify, VA did not recommend an alternative methodology. 

Rather, VA requested GAO to consider and include additional cost and schedule information that provides a more comprehensive perspective regarding changes to conVACREP180 with DISTILLER

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struction requirements and their impact on initial cost and schedule estimates. VA 

detailed this request in its March 27, 2013 response to the draft GAO report, and 

provides the same explanation below. 

VA has significant concerns with Tables 3 and 5 of the GAO report regarding the 

calculation of cost increases and schedule delays. Designs, initial cost estimates, and 

schedule completion dates are developed years prospectively, well before Congress 

appropriates funding and the contract to construct is awarded, which determines 

initial cost and ultimate completion date of the construction project. For example, 

GAO referenced numerous cost increases in the Denver project, which in some cases 

were driven by a change in requirements; however, they failed to mention that during the mid-2000s (i.e., 2004–2008), the construction market was experiencing extremely high cost escalation which greatly contributed to the project’s overall cost 

increases. This was highlighted in the prospectus submitted for the fiscal year 2008 

budget. 

As another example, Orlando indicated a completion date of April 2010 in the first 

prospectus included in the budget (referred to throughout the report as ‘‘Initial Estimated Completion Date’’). However, Orlando did not receive its final funding for the 

main hospital building until fiscal year 2010, making it impossible to complete the 

project any time during that fiscal year. 

As a result, VA asked GAO to consider and include a clarifying/amplifying footnote to the Initial ‘Estimated Completion Date’ column of Tables 3 and 5, as follows, 

‘‘The dates represented here are from the initial budget prospectus, which assumed 

receipt of full construction funding within one to two years after budget submission. 

In some cases, construction funding was phased over several years, and the final 

funding was received several years later.’’ 

A more accurate depiction of the project cost and construction schedule would be 

to make a comparison between the total appropriations received and the current 

total estimated cost. For schedule issues, a more accurate comparison would be the 

initial completion date established at the award of construction contract and the actual or estimated construction contract completion date. 

Therefore, VA recommended adding the table below to supplement Table 3: 

a. Considering that VA’s estimates are provided to Congress to authorize 

and appropriate funds to projects, please discuss the validity of these initial estimates? 

VA Response: The initial project construction cost estimates are valid, based on 

the situation at the time of submission; however, as noted above, the time of these 

initial estimates may precede actual appropriation by several years, during which 

significant changes in requirements (i.e., Veterans’ needs, material and labor costs, 

and market pricing) may necessitate adjustments to cost and schedule. 

b.What steps has VA taken to develop accurate cost estimates? 

VA Response: As noted in the November 2012 Construction Review Council report, VA began requiring that major construction projects reach 35 percent design 

completion prior to budget submission. The 35 percent design threshold will establish a true baseline cost estimate, reflective of all requirements, with the benefit of 

engineering studies. Furthermore, the 35 percent design threshold incorporates user 

group input, thus ensuring a coordinated facility approach. 

c.Would VA’s recommended methodology account for any delays experienced prior to awarding the construction contract? 

VA Response: To reiterate, VA did not recommend an alternative methodology; 

VA requested the inclusion of additional relevant cost and estimate data. VA believes that providing the above table based on final appropriations, along with Tables 3 and 5 of the report, based on initial budget estimates provides specific context 

and helps account for delays experienced prior to award of construction project contracts. 

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4. In response to GAO’s recommendation to develop and disseminate procedures for communicating to contractor’s clearly defined roles and responsibilities of VA officials responsible for managing major medical-facility projects, VA states that it will develop procedures to ensure distribution 

to all stakeholders. Please explain what these procedures might include to 

ensure all stakeholders are made aware of these roles and responsibilities. 

VA Response: Please refer to response to Question 1, Recommendation 2. 

5. Where are the contracting officers located? 

VA Response: Contracting Officers (CO) in support of OALC’s major construction 

program are currently located at four regional offices (National Region, Washington, 

DC; Eastern Region, Silver Spring, Maryland; Central Region, North Chicago, Illinois; Western Region, Mare Island, California), and at the project sites in Denver, 

Coloardo; New Orleans, Los Angeles; Orlando, Florida; and Palo Alto, California. 

OALC has Administrative Contracting Officers (ACO) who are Senior Resident Engineers (SRE) on every construction site. The ACOs/SREs hold Level I contracting 

warrants and have the authority to issue contract changes up to $100K each. 

a. If long distance, how well does the long-distance management model 

work when the Contracting Officer has the ultimate responsibility to ensure this gets done on time and within budget for the job site? 

VA Response: The acquisition team is comprised of a Project Manager (PM), CO 

and ACO. PMs hold a Federal Acquisition Certification for Program and Project 

Managers (FAC–P/PM) and ACOs hold a Federal Acquisition Certification for Contracting (FAC–C). The COs maintain close communications with on-site ACOs, PMs 

and SREs. The COs visit the project site as needed; have regularly-scheduled meetings with the contractors both in person and using available technology, and; hold 

conferences, review progress status reports, and participate in weekly progress 

meetings. 

b. How many projects are the Contracting Officers responsible for? 

VA Response: The number of COs varies from site to site, depending on the demands of the project. The average workload is four to six projects per CO. 

6. Has the VA developed specific guidance on implementing the recommendations of the Construction Management Review Council? 

VA Response: Yes, VA has developed specific guidance on implementing the recommendations of the Construction Review Council (CRC). 

a. Please provide this committee with a copy of that implementation 

plan. 

VA Response: VA has a draft Capital Programs Improvement Plan (CPIP) which 

details VA’s plan of action to implement the CRC report requirements. This plan 

has been drafted in coordination with the appropriate internal stakeholders and 

with the oversight of the former Deputy Secretary of VA. The draft CPIP is currently going through formal internal VA review and approval and VA will provide 

a copy upon completion. In the interim, progress continues to be made to close the 

CRC recommendations. 

b. Please provide a copy of the Construction Management Review Council’s report from November 2012. 

VA Response: A copy of the Construction Review Council report was provided 

to Congressional committees, including HVAC, on January 23, 2013. See Attachment A. 

7. What obstacles prevent VA from completing major medical-facility 

projects on time and within cost? 

VA has outlined its cost and schedule challenges in completing major medical facilities in the CRC Report. VA is working to eliminate these challenges and improve 

its delivery of major medical facility projects, on time and within budget. 

8. Can you describe in greater detail the problems you found with the 

way change orders are processed? When does VA plan on completing the 

development and implementation of new guidance concerning change orders? 

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VA Response: VA’s change order process involves several levels of internal and 

external review to ensure due diligence is taken. VA’s review of the process found 

several opportunities for improvement in the following areas: 

1. Construction change orders require analysis against the contractor’s Critical 

Path Method (CPM) project schedule. VA in-house expertise was over-extended, 

and this contributed to delays in analyzing time extension requests. VA is in 

the process of hiring CPM scheduler consultants for on-site support starting on 

the large projects. VA also has plans to maximize use of existing Indefinite Delivery/Indefinite Quantity contracts for additional support. 

2. VA has taken several steps to address any delays attributed to Office of General Counsel reviews. OALC’s Senior Procurement Executive granted individual 

deviations from VA Acquisition Regulation (VAAR) 801.602–83 (concerning the 

documents submitted for legal or technical review on contract modifications) for 

the Denver, New Orleans, and Orlando projects. The VAAR requires legal review of all unilateral contract modifications when one or more of the following 

conditions are met: 

• The total modification value is $100,000 or more. 

• The modification is for a time extension of sixty (60) days or more. 

• The contractor takes exception to VA’s accord and satisfaction language. 

The individual deviations granted exemption from legal review modifications with 

a value of $250,000 or less, and with time extensions of no more than sixty (60) 

days. The deviations for these projects provided an opportunity to expedite contract 

modifications under $250,000. In addition, VA has made additional positions available within the Office of General Counsel (OGC) to allow additional staffing to assist in processing reviews. This has increased the ability of COs, ACOs and SREs 

to process change orders. 

3. VA encountered Defense Contract Audit Agency (DCAA) audit delays on contractor’s proposals. OALC received a VAAR deviation for a third-party audit 

through the General Services Administration to mitigate dependence on DCAA. 

VA also engaged in a service agreement with VA Office of the Inspector General 

to assist OALC with the audit demands. 

4. In order to meet project demands due to the hiring problems, VA has temporarily assigned COs and ACOs/SREs with warrant authority to support the 

Denver project and complete the review of contracting modifications. There are 

contract specialists and one additional CO supporting the New Orleans project 

on-site. At the Orlando project, in addition to the onsite ACOs/SREs and a contract specialist, the CO travels to the site every other week. 

5. VA is in the process of developing internal project control measures to monitor progress and expedite the change order process. 

9. What actions can VA take if a prime contractor is not paying a subcontractor on time or at all for work that is completed? 

VA Response: VA requires all prime contractors provide a payment bond as required by the Miller Act (40 U.S.C. §§ 3131–3134). The performance bond guarantees the United States that the construction work will be performed to completion. 

The payment bond assures payment to subcontractors and suppliers supplying labor 

and materials in the course of performance of the contract. Any subcontractor or 

supplier who has so furnished labor or material under a contractual relationship 

with the contractor and who has not been paid in full within ninety (90) days after 

the last labor was performed or material supplied, may bring suit on the payment 

bond for the unpaid balance. Subcontractors and suppliers to second or lower-tiered 

subcontractors are not protected by the Miller Act. VA routinely provides the bond 

information to subcontractors that allege non-payment. VA also engages the prime 

contractor on all non-payment issues brought forward by subcontractors and reminds the prime contractor of its responsibility to pay subcontractors in a timely 

manner from the money VA provides for progress payments. Continued non-payment will impact the prime’s final performance evaluation. 

10. VA states that it is currently evaluating criteria for assigning medical 

equipment planners to major construction projects and will later develop 

and implement appropriate guidance for VA. What criteria are being 

weighed and when does VA expect to make a final decision on the matter? 

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VA Response: VA has directed that all major medical projects employ a medical 

planner. The medical planner will be provided by the designer and continue with 

the project through construction. 

VA’s goal is timely procurement of medical equipment. VA sent the following guidance to all project managers on May 15, 2013: 

‘‘Effective immediately, all medical projects that involve the medical center 

procuring medical equipment to be installed during the construction will retain the services of a Medical Equipment Planner. The Medical Equipment 

Planner services shall begin during design and continue through construction. The Medical Equipment Planner will work with the medical center Activation Team and provide reports to the Project Manager through the Design 

Manager and Senior Resident Engineer.’’ 

The Medical Equipment Planner is to provide the Project Manager with the information to update the Integrated Master Schedule and will provide advance notice 

of delays so the Project Manager has the opportunity to implement mitigation measures. Projects under construction and over 40 percent complete are considered far 

enough along that they do not need to hire Medical Equipment Planner services. 

Medical Equipment Planners are not required for parking structures, central energy 

plants, or other projects that do not include medical equipment. The Medical Equipment Planner role is being incorporated into the Project Management Plan. 

VA Central Office will issue a formal set of instructions by end of July 2013. 

11. How does the VA deal with the volatility of the construction market 

as experienced in Las Vegas? 

a. In its assessment of the Las Vegas medical-facility project, GAO notes 

that, ‘‘As construction of the medical facility progressed, the economic recession that began in 2008 drove construction costs lower than what was 

estimated. As a result, VA was able to add features back into the project 

that had been eliminated and still stay on budget.’’ What happens when the 

construction market picks back up and costs once again increase? 

VA Response: VA includes an allowance for cost escalation in every project estimate. OALC performs local market surveys for each major project area to keep 

abreast of factors that may affect construction costs and contractor bids. OALC also 

requires the design and Architect-Engineering firm to submit a local market survey 

with each design submission. Escalation factors are based upon these surveys and 

Office of Management and Budget (OMB) guidance. VA also structures Requests for 

Proposals to include deductive alternate bids that may be exercised in the event 

that bids exceed available funds. 

The years just prior to 2008 were a period of high cost escalation. Escalation rates 

far exceeded OMB projections and escalation allowances used by Federal agencies 

across the board. In order to mitigate market escalation, value engineering was conducted to reduce the cost of the Las Vegas VA Medical Center (VAMC) and all other 

projects under design during that period. In 2008 the construction market abruptly 

changed from one of hyper-escalation and little competition to one of hyper-competition and plummeting costs. This amplified the cost savings of value engineering 

measures that had been taken and resulted in project bids far below budget. 

Currently there are no indications that escalation will return to the double-digit 

rates experienced in the years immediately preceding the recession. All market surveys and industry analyst projections indicate escalation will be below five percent 

annually for the next three to five years. Projects in development include appropriate allowances for escalation based on their projected schedules. Costs may exceed current budget estimates should projects be delayed beyond the projected 

schedules. Value engineering measures would be taken and project scopes may need 

to be reduced. 

Question 12: In the recent GAO report, it was noted how additional 

phases of the Las Vegas medical center project – specifically the upgrade 

to the women’s clinic – have pushed the completion date back to June 2014. 

As female Veterans account for approximately 10 percent of the overall 

Veteran population, can you explain why the decision was made mid-construction to upgrade the women’s clinic? 

VA Response: VA completed the construction documents used to award the construction contract for the new medical center on May 22, 2008. The standards used 

in the design of the Women’s Clinic were from VHA Handbook 1330.1, dated July 

16, 2004. VA updated this VHA handbook on May 21, 2010, to incorporate new 

standards for the delivery of health care to Women Veterans. Since the new medical 

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center tower is still under construction, the Las Vegas VAMC decided to pursue upgrading the Women’s Clinic prior to the opening. On July 21, 2011, the Las Vegas 

VAMC requested approval from VA’s Capital Asset Board to upgrade to the Women’s Clinic to meet the new standards. The request was approved. VA has proceeded 

with the design and construction. 

Additionally, construction of four large Primary Care Clinics (PCC) was underway. Timing of construction at these PCCs allowed for modifications to meet these 

increased privacy standards. Change orders were issued to the three contractors 

adding the individual restrooms to four exam rooms at each PCC with minimal cost 

and no delay in schedule. The PCCs currently provide care to female Veterans until 

the new medical center can be completed. This has led to a good response from female Veterans enrolled in the program with improved convenience and access. The 

remodel of the Women’s Health Center at the medical center has not delayed or 

interfered with the activation of the rest of the facility. 

Question 12a: Did the VA utilize the women stakeholders in designing the clinic? 

VA Response: Yes. Throughout the design, women stakeholders participated in 

all user group meetings and VA solicited, reviewed, and incorporated comments/suggestions in the design. 

13. Please provide a status update on the Orlando, New Orleans, and Denver projects? When do you anticipate these projects will be completed? 

What major obstacles still remain for each project, if any? 

VA Response: Attached are the April 2013 fact sheets for the Denver (Attachment B), Orlando (Attachment C), and New Orleans (Attachment D) major construction projects, which include current project status and any major obstacles. VA is 

finalizing internal review of the May 2013 fact sheets, and will provide immediately 

after internal clearance. VA will continue to provide this information monthly. 

Æ 

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