89–006

107TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 107–28

VETERANS HOSPITAL EMERGENCY REPAIR ACT

MARCH 26, 2001.—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. 811]

[Including cost estimate of the Congressional Budget Office]

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

bill (H.R. 811) 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, having considered the same, reports

favorably thereon with an amendment and recommends that the

bill as amended do pass.

The amendment is as follows:

Strike all after the enacting clause and insert the following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Veterans Hospital Emergency Repair Act’’.

SEC. 2. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS FOR PATIENT CARE IMPROVEMENTS.

(a) IN GENERAL.—(1) The Secretary of Veterans Affairs is authorized to carry out

major medical facility projects in accordance with this section, using funds appropriated for fiscal year 2002 or fiscal year 2003 pursuant to section 3. The cost of

any such project may not exceed $25,000,000, except that up to two projects per

year may be carried out at a cost not to exceed $30,000,000 for the purpose stated

in subsection (c)(1).

(2) Projects carried out under this section are not subject to section 8104(a)(2) of

title 38, United States Code.

(b) TYPE OF PROJECTS.—A project carried out under subsection (a) may be carried

out only at a Department of Veterans Affairs medical center and only for the purpose of—

(1) improving a patient care facility;

(2) replacing a patient care facility;

(3) renovating a patient care facility;

(4) updating a patient care facility to contemporary standards; or

(5) improving, replacing, or renovating a research facility or updating such a

facility to contemporary standards.

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(c) PURPOSE OF PROJECTS.—In selecting medical centers for projects under subsection (a), the Secretary shall 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 barrierfree 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 substanceuse 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.

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

(J) Facilities for hospice and palliative care programs.

(d) REVIEW PROCESS.—(1) Before a project is submitted to the Secretary with a

recommendation that it be approved as a project to be carried out under the authority of this section, the project shall be reviewed by a board within the Department

of Veterans Affairs that is independent of the Veterans Health Administration and

that is constituted by the Secretary to evaluate capital investment projects. The

board shall review each such project to determine the project’s relevance to the medical care mission of the Department and whether the project improves, renovates,

repairs, or updates facilities of the Department in accordance with this section.

(2) In selecting projects to be carried out under the authority provided by this section, the Secretary shall consider the recommendations of the board under paragraph (1). In any case in which the Secretary selects a project to be carried out

under this section that was not recommended for such approval by the board under

paragraph (1), the Secretary shall include in the report of the Secretary under section 4(b) notice of such selection and the Secretary’s reasons for not following the

recommendation of the board with respect to that project.

SEC. 3. AUTHORIZATION OF APPROPRIATIONS.

(a) IN GENERAL.—There are authorized to be appropriated to the Secretary of Veterans Affairs for the Construction, Major Projects, account for projects under section

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(1) $250,000,000 for fiscal year 2002; and

(2) $300,000,000 for fiscal year 2003.

(b) LIMITATION.—Projects may be carried out under section 2 only using funds appropriated pursuant to the authorization of appropriations in subsection (a), except

that funds appropriated for advance planning may be used for the purposes for

which appropriated in connection with such projects.

SEC. 4. REPORTS.

(a) GAO REPORT.—Not later than April 1, 2003, the Comptroller General shall

submit to the Committees on Veterans’ Affairs and on Appropriations of the Senate

and House of Representatives a report evaluating the advantages and disadvantages

of congressional authorization for projects of the type described in section 2(b)

through general authorization as provided by section 2(a), rather than through specific authorization as would otherwise be applicable under section 8104(a)(2) of title

38, United States Code. Such report shall include a description of the actions of the

Secretary of Veterans Affairs during fiscal year 2002 to select and carry out projects

under section 2.

(b) SECRETARY REPORT.—Not later than 120 days after the date on which the site

for the final project under section 2 is selected, the Secretary shall submit to the

committees referred to in subsection (a) a report on the authorization process under

section 2. The Secretary shall include in the report the following:

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(1) A listing by project of each such project selected by the Secretary under

that section, together with a prospectus description of the purposes of the

project, the estimated cost of the project, and a statement attesting to the review of the project under section 2(c), and, if that project was not recommended

by the board, the Secretary’s justification under section 2(d) for not following

the recommendation of the board.

(2) An assessment of the utility to the Department of Veterans Affairs of that

authorization process.

(3) Such recommendations as the Secretary considers appropriate for future

congressional policy for authorizations of major and minor medical facility construction projects for the Department of Veterans Affairs.

(4) Any other matter that the Secretary considers to be appropriate with respect to oversight by Congress of capital facilities projects of the Department

of Veterans Affairs.

INTRODUCTION

On March 1, 2001, the Chairman and Ranking Member of the

Committee on Veterans’ Affairs, the Honorable Christopher H.

Smith and the Honorable Lane Evans and other cosponsors, introduced H.R. 811, the Veterans Hospital Emergency Repair Act. The

bill would provide the Secretary of Veterans Affairs a specified

major Veterans Affairs medical facility construction authority for

fiscal years 2002 and 2003 for projects that cost less than $25 million each. Up to two projects in each of the two years could exceed

this limitation if the purpose is for urgent seismic correction. The

bill would authorize $250 million in appropriations for these purposes in FY 2002 and $300 million in FY 2003.

On March 13, 2001, the Committee on Veterans’ Affairs held a

hearing on the Veterans Hospital Emergency Repair Act. At its

hearing, the Committee received testimony from three panels of

witnesses, including the major veterans organizations and two panels of witnesses representing the Department of Veterans Affairs

(VA). Witnesses representing the veterans organizations were Mr.

Dennis Cullinan of the Veterans of Foreign Wars of the United

States; Mr. Thomas Davies, A.I.A., of Paralyzed Veterans of America; Ms. Joy Ilem of the Disabled American Veterans; Mr. James

Fischl of the American Legion; and Mr. Richard Jones of AMVETS

(American Veterans of WWII, Korea and Vietnam).

The two VA panels were led by the Honorable Thomas L.

Garthwaite, M.D., Undersecretary for Health, Veterans Health Administration (VHA), accompanied by Frances M. Murphy, MD,

MPH, Deputy Undersecretary for Health; Mr. D. Mark Catlett, Acting Assistant Secretary for Management, Office of Financial Management; and, Mr. Charles Yarbrough, VHA Chief Facilities Management Officer. The VA’s second panel consisted of VHA Veterans

Integrated Service Network (VISN) Directors, including Mr. Lawrence A. Biro, Director, VISN 4 [Pennsylvania–Delaware];

Jeannette Chirico-Post, M.D., Director, VISN 1 [New England]; Mr.

Kenneth Clark, Director VISN 22 [Southern California–Nevada].

Ms. Patricia A. Crosetti, M.B.A., Director, VISN 15 [Missouri–Kansas]; Mr. James J. Farsetta, Director, VISN 3 [New Jersey–New

York City and lower Hudson Valley]; and, Robert L. Wiebe, M.D.,

Director, VISN 21 [Northern California–Nevada].

On the basis of this hearing and oversight on these matters, the

Full Committee met on March 21, 2001, to mark up H.R. 811, the

Veterans Hospital Emergency Repair Act. The bill was endorsed

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unanimously by the Committee, and H.R. 811 was ordered reported

favorably, as amended, to the House.

SUMMARY OF BILL

H.R. 811 would:

1. Authorize the Secretary of Veterans Affairs to carry out major

medical facility construction projects in fiscal years 2002 and

2003, and would authorize appropriations of $250 million in

fiscal year 2002 and $300 million in fiscal year 2003 for these

purposes.

2. Authorize the Secretary to select patient care projects (and in

certain circumstances, research facilities) for construction

under this authority not to exceed $25 million for any single

project; the Secretary could select two seismic correction

projects in each of the two years estimated to cost up to $30

million.

3. Limit the type of project that could be funded under this authority to projects that would improve, replace, renovate or update facilities, including research facilities for patient safety,

seismic protection, privacy, and accommodation for disabilities.

4. Authorize the Secretary to improve the various high-priority

special disabilities programs of the Department.

5. Require the Secretary to consider recommendations of VA’s

independent board that reviews capital investment proposals

in selecting projects under this authority.

6. Permit the Secretary to use the Advance Planning Fund to design projects selected under the purposes of this bill.

7. Require the Secretary and the Comptroller General to make

reports to Congress on projects selected under this authority,

their purposes and costs, the results of the authorization process, and recommendations for amending or extending this authority, and other appropriate recommendations.

BACKGROUND AND DISCUSSION

The Committee has identified the need for Congress to address

what has become a troubling and lingering problem in some of our

Nation’s veterans hospitals: a crumbling, substandard and sometimes unsafe patient care infrastructure in the Department of Veterans Affairs (VA). The problem includes VA patient care buildings

that could collapse in earthquakes.

Many VA hospitals are deteriorating because VA is encountering

increasing difficulty in obtaining funding to update, modernize and

renovate patient care facilities for veterans in need of care. For the

past several years, the Committee has noted that the President’s

annual budgets for VA health care have requested little or no funding for major medical facility construction projects for America’s

veterans. Only six such projects were proposed in the past three

budget submissions to Congress. Only one project appeared in the

fiscal year 2001 budget request, but no funds were appropriated by

Congress in fiscal year 2001. Nevertheless, a number of major medical facility projects totaling $115.9 million were authorized for fiscal year 2001 in Public Law 106–419:

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—seismic project at the Long Beach VA Medical Center;

—120-bed gero-psychiatric unit replacement at Palo Alto’s

Menlo Park campus, which included seismic reinforcement;

—replacement of 32-year old electrical vault and wiring harness at the Miami VA Medical Center, destroyed in a fire in

April 2000; and,

—nursing home unit at Beckley WV Medical Center.

Also, in the same Act, Congress renewed an authorization of a

nursing home renovation project in Lebanon, PA, a $14 million

project that still awaits appropriation.

Last year in the Committee’s budget views and estimates letter,

dated February 25, 2000, the Committee stated that VA has engaged in an effort through independent organizations to determine

whether present VA health-care facility infrastructures are meeting

needs in the most appropriate manner. The VA’s effort is aimed at

ascertaining whether services to veterans can be enhanced with alternative approaches. This process, called ‘‘Capital Assets Realignment for Enhanced Services’’ (CARES), may not achieve its intended goals for several years. In the interim, the Committee is

concerned that a number of VA hospitals need additional maintenance, repair and improvements in order to address immediate

dangers and hazards, promote patient and staff safety, and sustain

a reasonable standard of care for the nation’s veterans.

Recent reports by independent consultants and VA have revealed

that dozens of VA health care buildings are at risk from seismic

damage. On February 28, 2001, in Tacoma, Washington, a tremor

of 6.8 magnitude seriously damaged two patient care buildings on

the campus of the American Lake VA Medical Center. The damaged buildings at American Lake were among those identified as

being at the highest levels of risk. This particular incident vividly

demonstrates that the CARES process cannot address the immediacy of some of VA’s facility maintenance problems.

A report by VA submitted to the Committee on March 14, 2000,

in response to section 322 of Public Law 104–262, the Veterans’

Health Care Eligibility Reform Act of 1996, identified $57 million

in improvements that are needed to address women’s health care

needs. These projects would primarily ensure improved standards

for protecting the privacy of women receiving VA care, a group that

is a growing subset of the veteran population seeking care at VA

facilities. The great majority of VA facilities were constructed for

male patients, and need to be revamped for the care of this rising

number of women patients.

Another report, commissioned by VA from the Price Waterhouse

firm, entitled ‘‘Independent Review of the Department of Veterans

Affairs Office of Facilities Management,’’ dated June 17, 1998, concluded that VA should be spending from 2 percent to 4 percent of

its ‘‘plant replacement value’’ (PRV), on upkeep and replacement of

its health care facilities. This PRV value in VA, according to the

report, is about $35 billion; thus, using the Price Waterhouse index

on maintenance and replacement, VA should be spending from

$700 million to $1.4 billion each year. In fact, in fiscal year 2001,

VA will spend only $170.2 million for minor construction in maintenance of its infrastructure.

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Congress has authorized a number of major medical construction

projects in the past three fiscal years, but these projects have received little funding through the appropriations process. Some of

the more recent deferrals of major VA construction funding were

partially intended to permit the CARES process to proceed in an

orderly fashion and avoid unnecessary spending on VA hospital facilities that might not be needed in the future. While the Committee generally agrees with this approach, especially for larger

projects that may be affected by CARES, there is a continuing need

for investment in many facilities. The Committee is concerned that

an unintended de facto moratorium on VA construction has resulted.

It should be noted that nothing in the Emergency Repair Act

would prevent either the Committee or Congress from considering

the merits of large-scale, major VA medical facility construction

project authorizations during the two fiscal periods that the bill

would cover. Should Congress decide to authorize additional

projects in the future, passage of this bill would not impede its ability to do so. By its nature, the Emergency Repair Act is intended

as a stopgap measure to grant the Secretary of Veterans Affairs

limited authority to keep the VA health care system viable while

the CARES process goes forward with its larger goals and timetables.

The Committee is convinced that this bill is justified by circumstances as well as policy. When the Committee requested that

VA provide information about immediate construction needs in VA

medical centers, a number of projects that would be appropriate for

such consideration were immediately identified. These include:

Location Purpose Cost

Atlanta Patient Wards Modernization $12.9 million

Cleveland Special Emphasis Renovation $19.6 million

Miami Energy Center Replacement $24.9 million

San Diego Seismic Corrections $35.6 million

VISN 6 Special Emphasis Renovation $17.1 million

Augusta Spinal Cord Injury Modernization $10.6 million

Boston Clinical Inpatient Improvements $25 million

Cleveland Ambulatory Surgery Consolidation $19.9 million

Dallas Mental Health Improvements $27.6 million

Palo Alto Seismic Corrections $26.6 million

Philadelphia Research Renovation $21.8 million

Pittsburgh Ambulatory Care Addition $28.2 million

San Francisco Seismic Corrections $29.4 million

Syracuse Clinical Expansion/MRI Addition $4.7 million

Tampa Ambulatory Care Addition $12 million

Washington Outpatient Clinic Expansion $20.8 million

West Haven Nursing Units Renovation $14.3 million

Los Angeles Seismic Corrections $26.6 million

The Committee believes that numerous meritorious projects

could be identified and approved under this proposed authority.

Many VA facilities need funds immediately for small projects, in

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particular those that have been authorized by Congress in recent

years.

While the Committee would authorize ‘‘replacement’’ projects in

this measure, such projects should serve the same or very similar

purposes as the facilities they supplant. For example, the Committee is not proposing to authorize the Secretary to replace a

nursing home with a new ambulatory care center. The Committee

also expects that replacement would primarily be necessitated by

unsafe conditions for veterans and VA staff.

The Committee supports CARES. The CARES process, however,

will not be concluded soon, and CARES has no results to support

the VA budget request for fiscal year 2002. The Committee is concerned that, in the short term, CARES does not address VA’s capital-maintenance needs, causes an unintended diminution of care

for veterans and raises the potential for danger in the case of

earthquake-prone VA facilities. In some cases, VA’s lack of funds

to repair and improve certain health-care structures may place veterans in considerable danger. This bill is intended to assist VA in

avoiding such risks, while improving the quality of care for America’s veterans.

PERFORMANCE GOALS AND OBJECTIVES

The reported bill would provide the Secretary of Veterans Affairs

authority for certain medical facility construction projects consistent with the purposes and objectives defined by the bill. A

board for evaluation of capital investment projects within VA but

independent of the Veterans Health Administration would be required to review project proposals for mission relevance and compliance with the purposes and objectives of the bill. The Secretary

would also be required to provide the Committees on Appropriations and Veterans’ Affairs a report on the purpose of each project

selected, the estimated cost, and the independent review of the

project.

STATEMENT OF ADMINISTRATION’S VIEWS

At a hearing before the Committee on March 13, 2001, the Honorable Thomas L. Garthwaite, M.D., Under Secretary for Health,

Department of Veterans Affairs, stated: ‘‘As such, the Department

supports H.R. 811 to the extent that it aligns with the President’s

Budget. If H.R. 811 were enacted, we believe that it could be useful

to VA in improving our ability to respond to immediate needs of

the system’s infrastructure, as well as, implement CARES. It would

provide the Department with greater flexibility in selecting major

construction projects and likely would result in more timely correction of deficiencies that currently impair the health care system’s

ability to provide care in safe and effective facilities in locations

that best meet veterans’ needs. The bill also would offer the incentive to medical centers to propose smaller projects targeted to more

focused requirements, such as special programs, seismic corrections, and utility systems, to name just a few.’’

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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, March 22, 2001.

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. 811, the Veterans’ Hospital Emergency Repair Act.

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.

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

H.R. 811, Veterans’ Hospital Emergency Repair Act, As ordered reported by the House Committee on Veterans’ Affairs on March 21,

2001

H.R. 811 would authorize appropriations of $250 million in 2002

and $300 million in 2003 to be used for improving, replacing, renovating, and updating medical centers in the Department of Veterans Affairs (VA). The bill would allow repair and renovation

projects for making improvements in earthquake protection, fire

safety, accommodations for people with disabilities and a variety of

improvements to specialized programs in VA medical centers. H.R.

811 also would require reports from the General Accounting Office

on the authorization process for VA construction projects and by

VA for both the specific projects and the authorization process.

CBO estimates that implementing H.R. 811 would cost $11 million in 2002 and $506 million over the 2002–2006 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. 811 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would

not affect the budgets of state, local, or tribal governments.

The CBO staff contact is Sam Papenfuss, who can be reached at

226–2840. This estimate was approved by Peter H. Fontaine, Deputy Assistant Director for Budget Analysis.

INFLATIONARY IMPACT STATEMENT

The enactment of the reported bill would have no inflationary

impact.

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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 and benefits recipients.

STATEMENT OF FEDERAL MANDATES

The reported bill would not establish a federal mandate under

the Unfunded Mandates Reform Act, Public Law 104–4.

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.’’

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