99–006

107TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 107–473

VETERANS’ MAJOR MEDICAL FACILITIES CONSTRUCTION

ACT OF 2002

MAY 16, 2002.—Committed to the Committee of the Whole House on the State of

the Union and ordered to be printed

Mr. SMITH of New Jersey, from the Committee on Veterans’ Affairs,

submitted the following

R E P O R T

[To accompany H.R. 4514]

[Including cost estimate of the Congressional Budget Office]

The Committee on Veterans’ Affairs, to whom was referred the

bill (H.R. 4514) to authorize the Secretary of Veterans Affairs to

carry out construction projects for the purpose of improving, renovating, and updating patient care facilities at Department of Veterans Affairs medical centers, and for other purposes, having considered the same, reports favorably thereon with amendments and

recommends that the bill as amended do pass.

The amendments (stated in terms of the page and line numbers

of the introduced bill) are as follows:

Page 3, after line 9, insert the following new section (and redesignate the succeeding sections accordingly):

SEC. 3. AUTHORIZATION OF A MAJOR MEDICAL FACILITY

LEASE.

The Secretary of Veterans Affairs may enter into a lease

for a Satellite Outpatient Clinic, Charlotte, North Carolina, in an amount not to exceed $2,626,000.

Page 3, strike lines 10 through 14 and insert the following:

SEC. 4. AUTHORIZATION OF APPROPRIATIONS.

(a) IN GENERAL.—There is authorized to be appropriated

to the Secretary of Veterans Affairs for fiscal year 2003—

(1) for the Construction, Major Projects, account

$285,000,000 for the projects authorized in section 2;

and

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(2) for the Medical Care account, $2,626,000 for the

lease authorized in section 3.

Page 4, strike lines 6 through 14 and insert the following:

(b) APPLICABILITY TO PROJECTS ALREADY FUNDED.—The

amendment made by subsection (a) shall apply with respect to any facility project of the Department of Veterans

Affairs, except for a project for which the Secretary obligated funds before October 1, 2002.

Page 4, line 23, strike ‘‘shall’’ and insert ‘‘shall, to the extent

practicable,’’.

INTRODUCTION

The Committee in hearings, meetings, and through other oversight mechanisms reviewed over the course of this session of the

107th Congress the need to construct, renovate, and improve major

medical facilities of the Department of Veterans Affairs.

On April 24, 2002, the Subcommittee on Health received testimony on H.R. 4514, Veterans’ Major Medical Facilities Construction Act of 2002, and issues related to the Department’s major

medical facilities construction policies and planning. Those testifying at that hearing were: Mr. D. Mark Catlett, Principal Deputy

Assistant Secretary for Management, Department of Veterans Affairs (VA); accompanied by Mr. Robert L. Neary, Associate Chief

Facilities Management Officer, Mr. Gary Rossio, Chief Executive

Officer VA San Diego Health Care System, and Mr. Alex Spector,

Director Alaska VA Health Care System and Regional Office; Colonel David D. Gilbreath, Commander, Elmendorf Air Force Base

Hospital; Mr. Antonio Laracuente, Chairman, National Association

of Veterans’ Research and Education Foundations, on behalf of

Friends of VA Medical Care and Health Research (FOVA); and Dr.

Donald E. Wilson, Vice President for Medical Affairs and Dean,

University of Maryland School of Medicine. The Subcommittee also

received testimony from: Mr. Brian E. Lawrence, Associate National Legislative Director, Disabled American Veterans; Mr. Robert L. Jones, Executive Director, AMVETS; Mr. Thomas H. Corey,

National President, Vietnam Veterans of America; Mr. Paul A.

Hayden, Associate Director, National Legislative Service, Veterans

of Foreign Wars of the United States; Mr. Delatorro L. McNeal, Executive Director, Paralyzed Veterans of America; and Mr. James R.

Fischl, Director, National Veterans Affairs and Rehabilitation Commission, The American Legion.

The Subcommittee on Health met on May 1, 2002 to mark up

H.R. 4514, Veterans’ Major Medical Facilities Construction Act Of

2002. The bill was endorsed unanimously by the Subcommittee, as

amended, and ordered reported favorably to the full Committee.

On May 9, 2002, the full Committee met and ordered H.R. 4514,

as amended, reported favorably to the House by unanimous voice

vote.

SUMMARY OF THE REPORTED BILL

H.R. 4514, as amended, would:

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• Authorize the Secretary of Veterans Affairs to carry out ten

major medical facility construction projects, the cost of which

may not exceed the amount specified for each project, as

follows:

» Seismic corrections on Building No. 2 at the VA Medical

Center in Palo Alto, California, in the amount of

$14,020,000;

» Seismic corrections on Building No. 4 at the VA Medical

Center in Palo Alto, California, in the amount of

$21,750,000;

» Seismic corrections at the VA Medical Center in San

Francisco, California, in the amount of $31,000,000;

» Seismic corrections at the VA Medical Center in West Los

Angeles, California, in the amount of $27,200,000;

» Seismic corrections and clinical improvements at the VA

Medical Center in Long Beach, California, in the amount

of $24,600,000;

» Seismic corrections on Building No. 1 at the VA Medical

Center in San Diego, California, in the amount of

$47,100,000;

» Construction involving the consolidation of the Ambulatory Surgery and Clinical Care facilities at the VA Medical

Center in Cleveland, Ohio, in the amount of $32,500,000;

» Construction involving the consolidation of VA and DoD

health and benefits offices in Anchorage, Alaska, in the

amount of $59,000,000;

» Construction involving the renovation of certain wards at

the VA Medical Center in West Haven, Connecticut, in the

amount of $15,300,000; and,

» Construction involving the expansion of the Ambulatory

Care facility at the VA Medical Center in Tampa, Florida,

in the amount of $18,230,000.

• Authorize $285 million in appropriations to carry out the ten

projects.

• Increase the threshold for major medical facility construction

projects from $4 million to $6 million.

• Establish criteria for minor construction projects.

• Authorize a lease for a satellite outpatient clinic in Charlotte,

North Carolina, in the amount of $2,626,000, to be paid from

the medical care account.

BACKGROUND AND DISCUSSION

The reported bill would authorize the Secretary of Veterans Affairs to initiate ten major medical facility construction projects in

fiscal year 2003. These projects would improve, renovate, and update patient care facilities at VA Medical Centers (VAMC). These

particular projects were chosen from the Secretary’s top twenty

major medical facility construction projects submitted to Congress

on February 13, 2002, in accordance with requirements for such reporting under section 8107(d)(1) of title 38, United States Code.

In the First Session of the 107th Congress, the Honorable Christopher H. Smith, introduced H.R. 811, the Veterans Hospital Emergency Repair Act, with other Members. Unfortunately, the Senate

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did not address this measure. As a consequence, capital facilities

maintenance and repair have not kept pace with known needs in

the Department, and many facilities are deteriorating.

Veterans enrolled in VA health care--who are dependent on the

capital assets of the system to provide their care--deserve medical

facilities that provide quality services and improve access to their

health care. In addition, VA medical centers should be safe. The reported bill would help improve the safety of veterans who are provided medical care in VA health care as well as for the VA staff

who provide that care. The total amount authorized for ten projects is $285 million.

The bill particularly would address seismic risks at a number of

VA facilities. Those facilities receiving seismic upgrades and corrections or seismic bracing and anchorage of non-structural items

throughout the centers would include VA medical facilities in Palo

Alto, San Francisco, West Los Angeles, Long Beach, and San Diego,

California. Completion of these engineered upgrades would bring

each facility into conformance with current VA seismic standards,

and would eliminate significant risks to safety.

Another important project would authorize VA to replace the mechanical and electrical systems at the VA Medical Center in Cleveland, Ohio. They were installed in 1961 and are in dire need of attention.

The Anchorage, Alaska project would construct a consolidated

Veterans Affairs-Department of Defense health care and benefits

facility, to help address growing workload and demands, provide

space for additional personnel, and confirm the Committee’s strong

interest in encouraging the two departments to better share health

care resources under the Department of Veterans Affairs and

Department of Defense Health Resources Sharing and Emergency

Operations Act of 1982. The Anchorage VA-Air Force project is an

important step in promoting such coordination between these

departments.

A number of important improvements would be made at the VA

Medical Center in West Haven, Connecticut, if this bill is enacted.

These essential renovations to inpatient wards would correct patient privacy inadequacies; consolidate support services; correct deficiencies in air quality, comply with Americans with Disabilities

Act (ADA) accessibility, and improve the general safety of patients

and staff.

The construction project for the VA medical facility in Tampa,

Florida would relocate three Spinal Cord Injury (SCI) inpatient

wards and ancillary support functions to the new SCI building

dedicated in February 2002. The completion of this project would

allow more space for further expansion of the VAMC.

The reported bill would provide the Secretary authority to move

forward on VA’s highest construction priorities without further, unacceptable delays. The Department has indicated its intention to

rely on the ‘‘Capital Assets Realignment for Enhanced Services,’’ or

‘‘CARES’’ system to determine whether its capital projects in medical facilities are funded. By doing so, the Department continues to

delay funding projects that meet crucial and in some cases, emergent, needs. In its report to Congress under title 38, section 8107,

the Department of Veterans Affairs states that the following

projects represent its highest major medical facility priorities, yet

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only four of them were included in the President’s fiscal year 2003

budget request. The Committee agrees that these four are high priorities, but the reported bill would authorize an additional six

projects that the Committee concludes also warrant funding on a

high priority basis, without further delay. The synopsis of VA’s top

twenty projects is as follows, in order of priority presented by the

Secretary in his report to Congress:

1. Palo Alto, CA: This project would renovate Building 2, a

two-story inpatient building constructed in 1960, at the Palo

Alto Division. Renovations would include seismic corrections to

the entire building, correction of patient privacy deficiencies on

one nursing unit in C Wing, correction of fire safety deficiencies in C Wing, and functional improvements on one floor

for the Sierra Pacific Network’s Mental Illness Research, Education and Clinical Center (MIRECC). Building 2 would provide consolidated acute inpatient psychiatry services at the

Palo Alto Division. These services are currently located in several buildings on campus. Completion of this project would

allow occupancy of the building by three 26-bed psychiatric

nursing units as well as the MIRECC offices and dry labs.

2. Cleveland, OH: This project would renovate vacated space

on the second floor and basement for the relocation of the medical laboratory of the Wade Park Division, Veterans Integrated

Service Network (VISN) 10. The second floor space planned for

renovation is adjacent to the existing operating suites and recovery areas. This project would include the replacement of all

mechanical, electrical, and architectural systems installed in

this 1961 facility.

3. San Francisco, CA: This project would seismically upgrade the main inpatient Building 203 at the San Francisco

VA Medical Center, and bring the facility into conformance

with current VA seismic standards. In order to meet current

VA seismic design standards for life safety, this project would

seismically retrofit Building 203, a five-story concrete structure, by strengthening existing lateral force resisting elements,

adding supplemental members and non-structural systems,

and bracing equipment. Minor functional improvements for patient privacy, disability access, and building efficiency would be

included.

4. Anchorage, AK: The project would construct a new facility

next to the Joint Venture Medical Treatment Facility on Elmendorf Air Force Base (AFB), Alaska. The new facility would

address the Alaska Veterans Affairs Healthcare System and

Regional Office increasing workload demands and provide

space for the projected Veterans Health Administration (VHA)/

Veterans Benefits Administration (VBA) 500+ peak housed

personnel required to meet the station’s workload demands of

the future.

5. West Los Angeles, CA: The seismic upgrade of Building

500 would strengthen 16 of the 64 braced frames below the

second floor, strengthen collector plate connections to the

braced frames, and add new collector plates to transfer loads

in the central core area to the braced frames located at the

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wings. Seismic bracing and anchorage of non-structural items

throughout the hospital would also be included.

6. West Haven, CT: This project would substantially renovate three inpatient wards to correct for patient privacy inadequacies as well as consolidate associated support services. It

would correct deficiencies such as ADA accessibility, general

safety, air quality, and patient privacy. Correcting the deficiencies on these units would result in improved patient privacy, staff morale, and health care delivery efficiencies. This

project would involve renovating 3 wards in Building 1: two inpatient Medical, Surgical and Neurological as [KHC1]well as

one psychiatric unit.

7. Long Beach, CA: Building 7 of the VA Long Beach Medical Center would be seismically upgraded and retrofitted. The

project would provide an addition of 24,000 gross square feet.

The project would allow for the consolidation of specialty clinics, improve work processes, and maximize efficiency.

8. Palo Alto, CA: This project would renovate Building 4, a

three-story research building constructed in 1960, at the Palo

Alto Division. Renovations would include seismic corrections to

the entire building, correction of fire safety deficiencies

throughout the building, and functional laboratory improvements in areas formerly occupied by inpatient psychiatric

wards. Building 205, Menlo Park campus, would be demolished. Most research personnel, housed in Building 205, would

be relocated to Building 4. This includes members of the Geriatric Research and Education and Clinical Center (GRECC),

Health Services Research and Development (HSR&D), and the

Cooperative Studies program. Completion of this project would

allow consolidation of a large segment of wet and dry lab research programs. Building 4 would provide for consolidated research services at the Palo Alto Division. It would allow the

consolidation of the Menlo Park Division research programs

from Building 205 into a two or three major building complex

at the Palo Alto campus.

9. Tampa, FL: The project is an offshoot of the ‘‘Spinal Cord

Injury/Rehab Center, Phase 2’’ which would relocate three Spinal Cord Injury (SCI) inpatient wards and ancillary support

functions to a new SCI building. As a result of the relocation,

space would be vacated in the main hospital. This space needs

renovation for expansion and improvement of the outpatient

care facility. The Capital Investment Panel [KHC2]relates to

the renovation in the three vacated inpatient wards in the

main hospital and would involve asbestos abatement of the

space involved. The renovated space would house the hospital

functions now temporarily located in several modular buildings

adversely affecting smooth workflow and also taking up needed

space for parking.

10. VISN 4: This multi-facility project would renovate and

expand outpatient clinics at seven different medical centers located in VISN 4. The needed renovations and expansions

would address the insufficient space and accommodations that

negatively impact outpatient care delivery at seven VAMCs.

Six of the eight projects would renovate and expand primary

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and specialty care clinic areas. The other two projects would

expand outpatient ambulatory surgery and outpatient day programs. Together, the projects would renovate and expand

exam, treatment and operating rooms; staff support areas;

waiting, staff and patient education areas; and office space, including travel coordinator, information center and volunteer offices. Hazardous materials, such as asbestos, that are not already abated or whose containment would be disrupted as a result of construction would be removed according to regulations.

Windows would be replaced, and outdated, inadequate and unacceptable heating, ventilating, and air-conditioning (HVAC)

units and utilities, such as mechanical, plumbing and communications, would be upgraded and constructed to be compatible

with existing VAMC systems.

11. Beckley, WV: This project would consist of design and

construction of a 120-bed nursing home care unit at the VAMC

Beckley, West Virginia.

12. Lebanon, PA: The Lebanon VAMC is a 31-building campus on 215 acres that serves south central Pennsylvania. This

project would reconfigure two floors located in Building 2 at

the VAMC. Building 2 is currently unfit to house inpatients.

The project would be limited to renovations within the confines

of two floors of the building. The renovated space would include the following units: the Dementia Unit (floor 2), the Hospice Unit (floor 1), and the Adult Day Health Care Unit (floor

1). In addition, utilities would be upgraded or added as required to support the new areas. Further, a new elevator shaft

and entrance would be built to meet the needs of the patients.

13. San Diego, CA: This project would seismically strengthen the 854,000 square foot Medical Center (Building 1) by adding two new exterior unbonded braced frames at the end of

each building wing, replacing the braces in all of the existing

braced frames with new unbonded braces, and adding new collector elements. This seismic upgrade would correct significant

risks to life safety.

14. Hines, IL: Blind rehabilitation center (authorized and

appropriated in fiscal year 2002).

15. San Juan, PR: This project is needed so that the medical

center can sustain its daily operations after a seismic event. It

would also complete essential items that were not completed in

the Seismic Corrections Project due to dollar limitations. Additionally, three areas on the existing basement, first and second

floors would have the air conditioning repaired and overhauled

in conjunction with asbestos abatement.

16. VISN 6: This multi-facility, VISN-wide project would

renovate five VAMCs’ Mental Health (MH) and Spinal Cord Injury/Dysfunction (SCI/D) Units. The needed renovations would

occur only in special emphasis bed units. The project (with the

exception of VAMC Richmond) would completely replace each

special emphasis ward. Hazardous materials not already

abated or whose containment would be disrupted would be removed. Windows would be replaced. Inadequate HVAC and

utilities would be upgraded. Floor/room layouts would be

changed to provide private and semi-private bedrooms with adVerDate 11-MAY-2000 22:47 May 16, 2002 Jkt 099006 PO 00000 Frm 00007 Fmt 6659 Sfmt 6601 E:\HR\OC\HR473.XXX pfrm01 PsN: HR473
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jacent private or semi-private toileting/bathing facilities.

VAMC Richmond’s Special Emphasis wards require handrails

and handicap-designed door handles; some floor layout problems would also be addressed.

17. VISN 4: This multi-facility, VISN-wide project would

renovate and upgrade seven major VA medical centers. These

renovations would be made for patient safety and patient/employee welfare. This project would focus on critical major infrastructure needs in VISN 4, which encompasses Delaware,

Pennsylvania, and parts of Ohio, West Virginia, New York, and

New Jersey. The VISN 4 medical facilities that would benefit

from these proposed projects are: Butler, PA VAMC, Louis A.

Johnson VAMC (Clarksburg, WV), Coatesville, PA VAMC,

Philadelphia, PA VAMC, Pittsburgh, PA VAMC, Wilkes-Barre,

PA VAMC, and Wilmington, DE VAMC.

18. Atlanta, GA: This project would renovate three inpatient

floors of the VAMC Atlanta. The renovations would correct patient privacy issues, improve staff efficiencies, improve the

functional layout, and meet ADA requirements and female patient issues.

19. Tampa, FL: The project would provide for an addition of

approximately 1,170 parking spaces for the Tampa VA Medical

Center. This would be accomplished through construction of a

parking garage. There would be some ancillary work to be performed, such as road and access, pedestrian connections, utility

re-routing, and a possible pedestrian overpass.

20. Washington DC: This project would add a one-story addition onto the current Medical Center. The addition would be

adjacent to the existing ambulance entrance. The ambulance

entrance would be moved. The new addition would house the

primary care clinics and the specialty care clinics would expand and backfill the existing primary care clinics. The project

would allow for three new clinics to be added to the Medical

Center, and would improve patient flow between primary care

and specialty care clinics.

Since fiscal year 1998, the Department has requested an average

of two projects per year through fiscal year 2003. The average

funding requested by the Department to fund such projects was

$52.2 million for the major construction account. Congress, realizing the importance of safety, quality, and improved health care,

has authorized an average five projects and appropriated an average of $104.7 million for major construction projects during the

same time period.

From all available indications and based on past practices, the

Committee concludes that, absent Congressional authorization of

the projects identified in the Committee bill, VA’s CARES review

process in all likelihood would delay the initiation of these projects

by several additional years. Congress should not permit such

delays in meeting these important capital needs.

The Committee believes that facilities, which house VA medical

and prosthetic research, should be part of the VA’s capital improvement program. The Committee notes, and has reported previously

(House Report 107–28, March 26, 2001) that the Department does

not give sufficient priority to maintaining, upgrading, and replacVerDate 11-MAY-2000 22:47 May 16, 2002 Jkt 099006 PO 00000 Frm 00008 Fmt 6659 Sfmt 6601 E:\HR\OC\HR473.XXX pfrm01 PsN: HR473
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ing VA research facilities. Yet, the Department prominently and

regularly cites accomplishments and new discoveries generated by

VA research in its public documents and media releases. The Committee urges the Secretary to review the testimony presented to the

Subcommittee on Health at its hearing on April 24, 2002, and to

take appropriate action to ensure that VA research laboratories

and other facilities affiliated with its research programs receive

more infrastructure funding than VA has provided in the past.

SECTION-BY-SECTION ANALYSIS

Section 1 is the short title of the bill.

Section 2 would authorize ten major medical facility projects:

seismic corrections at the Department of Veterans Affairs Medical

Center, Palo Alto, California, building number 2, $14,020,000 and

building number 4, $21,750,000; seismic correction at the Department of Veterans Affairs Medical Center, San Francisco, California,

$31,000,000; seismic correction at the Department of Veterans Affairs Medical Center, West Los Angeles, California, $27,000,000;

seismic correction and clinical improvement at the Department of

Veterans Affairs Medical Center, Long Beach, California,

$24,600,000; seismic correction for building number 1 at the Department of Veterans Affairs Medical Center, San Diego, California, $47,100,000; ambulatory surgery and clinical consolidation

at the Department of Veterans Affairs Medical Center, Cleveland,

Ohio, $32,500,000; consolidation of Department of Veterans Affairs

and Department of Defense health and benefits offices, Anchorage,

Alaska, $59,000,000; ward renovation at the Department of Veterans Affairs Medical Center, West Haven, Connecticut,

$15,300,000; and ambulatory care expansion at the Department of

Veterans Affairs Medical Center, Tampa, Florida, $18,230,000.

Section 3 would authorize a lease for a Satellite Clinic in Charlotte, North Carolina, in the amount of $2,626,000.

Section 4(a) would authorize $2,626,000 in appropriations for the lease in section 3 and $285 million for major project construction

authorized in section 2 for fiscal year 2003.

Section 4(b) would limit the projects to: funds appropriated for

fiscal year 2003 pursuant to the authorization of appropriations in

subsection (a), funds appropriated for Construction, Major Projects

for a fiscal year before fiscal year 2003 that remain available for

obligation, and funds appropriated for Construction, Major Projects,

for fiscal year 2003 for a category of activity not specific to a

project.

Section 5(a) would amend title 38, United States Code, Section

8104, by increasing the threshold for major medical facility construction projects from $4,000,000 to $6,000,000.

Section 5(b) would state the amendment would not apply to any

project for which obligated funds have been made prior to October

1, 2002.

Section 6 would amend title 38, United States Code, Section

8103, by adding subsection (e). This subsection would define criteria the Secretary should, when practicable, observe in selecting

minor construction projects. These criteria were adapted from similar guidance that would have been provided to the Secretary had

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Congress enacted H.R. 811 as indicated above. Under the bill, the

projects selected would be prioritized for seismic protection; fire

safety; research facility improvements; utility systems; ancillary

patient care facilities; accommodation for persons with disabilities;

various improvements to blind rehabilitation centers; inpatient and

residential programs for seriously mentally ill veterans; residential

and rehabilitation programs for veterans with substance-use disorders; physical medicine and rehabilitation; long-term care; amputation care; spinal cord injury centers; traumatic brain injury programs; women’s health programs; and, facilities for hospice and

palliative care programs.

PERFORMANCE GOALS AND OBJECTIVES

The performance goals and objectives of VA programs dealing

with the major medical facility construction, the management of

the Department’s capital construction programs, maintenance of

the portfolio of minor construction projects, and the prioritization

of construction projects, are established in the Department’s annual performance plans and budget formulation processes, and are

subject to the Committee’s regular oversight.

STATEMENT OF THE VIEWS OF THE ADMINISTRATION

Views from the Statement of Mark Catlett, Principal Deputy Assistant Secretary for Management, Department of

Veterans Affairs, Before the Subcommittee on Health,

House Veterans’ Affairs Committee, April 24, 2002

The first four projects in the bill were included in the

President’s FY 2003 budget submission to Congress. The

selection of these projects was the result of a thorough capital investment selection process in which specific needs of

VA were balanced against the Department’s strategic

goals, within the parameters of annual budget constraints.

The ultimate result of this process was the selection of

four major construction projects that VA believes best

achieve this balance and that reflect a sound financial investment. Moreover, the projects selected by the Department are the least likely to be affected by the ongoing

CARES process. As you know, the CARES process has

been implemented to improve access and quality of veterans’ health care through realigning VA’s capital assets.

CARES is an objective evidence-based evaluation of clinical services required in the year 2020, by market area. We

believe it is premature at this time to recommend additional projects.

While I am addressing the projects included in H.R.

4514, I would like to mention that our FY 2003 budget requested authorization for the lease of a satellite outpatient

clinic in Charlotte, North Carolina, in the amount of

$2,626,000. We would ask that this authorization be included in the bill when it is marked up.

The physical infrastructure of the VA health care system

is one of the largest in the Federal government. While

some VA facilities are relatively new, the average age of

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VA buildings is 50 years. During the past few years, there

has been a reluctance to commit to capital investment out

of concern that VA was unsure of facilities that would

clearly be needed in the future. As we complete our

CARES initiatives that identify options to improve our

health care system and provide better access, infrastructure modifications will create a large number of projects

for future funding and authorization.

Section 4 of H.R. 4514 is entitled Increase in Threshold

for Major Medical Facility Construction Projects. Subsection (a) of Section 4 increases the dollar threshold that

defines a major construction project from its current dollar

amount of more than $4,000,000 to more than $6,000,000.

Subsection (b) of Section 4 seeks to identify those projects

to which the increased threshold applies. VA is currently

reviewing Section 4 of the bill and we will provide the

Committee with our views on this provision at a later

time.

Section 5 of H.R. 4514 is entitled Criteria For Minor Construction

Projects. The language of this section directs the Secretary to select

minor construction projects to improve, replace, renovate, or update

facilities to achieve improvements in one or more of five specific

areas. While this language may have been included to provide

guidance to VA in prioritizing the Department’s minor construction

projects, it eliminates the discretion that the Secretary now has in

identifying those minor construction projects that will best meet

the overall needs of the Department. VA’s comprehensive process

for selecting the minor construction projects that will best fulfill

VA’s mission makes Section 5 of the bill unnecessary. Accordingly,

I strongly recommend that it be removed from H.R. 4514.

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

The following letter was received from the Congressional Budget

Office concerning the cost of the reported bill:

U.S. CONGRESS,

CONGRESSIONAL BUDGET OFFICE,

Washington, DC, May 10, 2002.

Hon. CHRISTOPHER H. SMITH

Chairman, Committee on Veterans’ Affairs,

House of Representatives, Washington, DC.

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4514, the Veterans’ Major

Medical Facilities Construction Act of 2002.

If you wish further details on this estimate, we will be pleased

to provide them. The CBO staff contact is Sam Papenfuss, who can

be reached at 226–2840.

Sincerely,

DAN L. CRIPPEN,

Director.

Enclosure.

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CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

May 10, 2002 

H.R. 4514, VETERANS’ MAJOR MEDICAL FACILITIES CONSTRUCTION ACT

OF 2002, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON

VETERANS’ AFFAIRS ON MAY 9, 2002

H.R. 4514 would authorize the appropriation of $285 million in

2003 to be used for improving, renovating, and updating medical

centers in the Department of Veterans Affairs (VA). It also would

authorize about $3 million to lease an outpatient clinic in Charlotte, North Carolina. The bill would authorize specific projects for

improved earthquake protection, and other changes to existing facilities and set spending limits for each project. H.R. 4514 also

would raise the threshold for projects to be financed out of the appropriation for major medical facility construction from $4 million

to $6 million. (Thus, under the bill projects costing up to $6 million

would be considered minor construction.) Finally, H.R. 4514 would

define in greater detail the criteria for VA to use in selecting minor

construction projects.

CBO estimates that implementing H.R. 4514 would cost $13 million in 2003 and $279 million over the 2003–2007 period, assuming

appropriation of the authorized amounts. Because the bill would

not affect direct spending or receipts, pay-as-you-go procedures

would not apply.

H.R. 4514 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would

impose no costs on state, local, or tribal governments.

The CBO staff contact is Sam Papenfuss. This estimate was approved by Peter H. Fontaine, Deputy Assistant Director for Budget

Analysis.

STATEMENT OF FEDERAL MANDATES

The preceding Congressional Budget Office cost estimate states

that the bill contains no intergovernmental or private sector mandates as defined in the Unfunded Mandates Reform Act.

APPLICABILITY TO LEGISLATIVE BRANCH

The reported bill would not be applicable to the legislative

branch under the Congressional Accountability Act, Public Law

104–1, because the bill would only affect certain Department of

Veterans Affairs programs.

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution,

the reported bill is authorized by Congress’ power to ‘‘provide for

the common Defense and general Welfare of the United States.’’

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the

House of Representatives, changes in existing law made by the bill,

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics,

existing law in which no change is proposed is shown in roman):

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TITLE 38, UNITED STATES CODE

* * * * * * *

PART VI—ACQUISITION AND DISPOSITION OF

PROPERTY

* * * * * * *

CHAPTER 81—ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY FACILITIES; PROCUREMENT

AND SUPPLY; ENHANCED–USE LEASES OF REAL PROPERTY

* * * * * * *

SUBCHAPTER I—ACQUISITION AND OPERATION OF

MEDICAL FACILITIES

* * * * * * *

§ 8103. Authority to construct and alter, and to acquire sites

for, medical facilities

(a) * * *

* * * * * * *

(e) PURPOSE OF MINOR CONSTRUCTION PROJECTS.—In selecting

medical facilities (including research facilities) for projects under

subsection (a) other than major medical facility projects subject to

section 8104 of this title, the Secretary shall, to the extent practicable, select projects to improve, replace, renovate, or update facilities to achieve one or more of the following:

(1) Seismic protection improvements related to patient safety

(or, in the case of a research facility, patient or employee safety).

(2) Fire safety improvements.

(3) Improvements to utility systems and ancillary patient care

facilities (including such systems and facilities that may be exclusively associated with research facilities).

(4) Improved accommodation for persons with disabilities, including barrier-free access.

(5) Improvements at patient care facilities to specialized programs of the Department, including the following:

(A) Blind rehabilitation centers.

(B) Inpatient and residential programs for seriously mentally ill veterans, including mental illness research, education, and clinical centers.

(C) Residential and rehabilitation programs for veterans

with substance-use disorders.

(D) Physical medicine and rehabilitation activities.

(E) Long-term care, including geriatric research, education, and clinical centers, adult day care centers, and

nursing home care facilities.

(F) Amputation care, including facilities for prosthetics,

orthotics programs, and sensory aids.

(G) Spinal cord injury centers.

(H) Traumatic brain injury programs.

14

(I) Women veterans’ health programs (including particularly programs involving privacy and accommodation for

female patients).

(J) Facilities for hospice and palliative care programs.

§ 8104. Congressional approval of certain medical facility

acquisitions

(a)(1)***

* * * * * * *

(3) For the purpose of this subsection:

(A) The term ‘‘major medical facility project’’ means a project

for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than ø$4,000,000¿

$6,000,000, but such term does not include an acquisition by

exchange.

* * * * * * *

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