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41–372 2008

U.S. DEPARTMENT OF VETERANS AFFAIRS 

CONSTRUCTION AUTHORIZATION 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

FEBRUARY 27, 2008 

Serial No. 110–72 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

VACANT 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

JEFF MILLER, Florida, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

VACANT 

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 

February 27, 2008 

Page 

U.S. Department of Veterans Affairs Construction Authorization ...................... 1 

OPENING STATEMENTS 

Chairman Michael Michaud ................................................................................... 1 

Prepared statement of Chairman Michaud .................................................... 27 

Hon. Jeff Miller, Ranking Republican Member ..................................................... 1 

Prepared statement of Congressman Miller ................................................... 27 

WITNESSES 

U.S. Department of Veterans Affairs, Donald H. Orndoff, Director, Office 

of Construction and Facilities Management ...................................................... 16 

Prepared statement of Mr. Orndoff ................................................................. 33 

American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and 

Rehabilitation Commission ................................................................................. 4 

Prepared statement of Mr. Wilson .................................................................. 29 

Independent Budget, Dennis M. Cullinan, Director, National Legislative Service, Veterans of Foreign Wars of the United States .......................................... 3 

Prepared statement of Mr. Cullinan ............................................................... 28 

Vietnam Veterans of America, Richard F. Weidman, Executive Director for 

Policy and Government Affairs ........................................................................... 6 

Prepared statement of Mr. Weidman ............................................................. 31 

SUBMISSION FOR THE RECORD 

Salazar, Hon. John T., a Representative in Congress from the State of Colorado, statement .................................................................................................... 34 

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U.S. DEPARTMENT OF VETERANS AFFAIRS 

CONSTRUCTION AUTHORIZATION 

WEDNESDAY, FEBRUARY 27, 2008 

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

The Subcommittee met, pursuant to notice, at 10:02 a.m. in 

Room 334, Cannon House Office Building. Hon. Michael H. 

Michaud [Chairman of the Subcommittee] presiding. 

Present: Representatives Michaud, Brown of Florida, Miller, and 

Brown of South Carolina. 

OPENING STATEMENT OF CHAIRMAN MICHAUD 

Mr. MICHAUD. I would like to call the hearing to order. I would 

ask the first panel to come up. 

I would like to thank everyone for coming today. Today’s hearing 

is an opportunity for the U.S. Department of Veterans Affairs (VA), 

Veteran Service Organizations (VSOs) and Members of this Subcommittee to discuss legislation dealing with fiscal year 2009 VA 

construction. 

Title 38 United States Code requires statutory authority for all 

VA medical facility construction projects over $10 million and all 

medical facility leases more than $600,000 per year. This hearing 

is a first step in this process. 

I would like to note that this draft legislation is based upon the 

Department of Veterans Affairs fiscal year 2009 budgetary request 

and authorization for fiscal year 2008. I consider this draft to be 

a starting point. I look forward to hearing from the VA, the VSOs 

and Members of the Subcommittee about other construction 

projects that are important to them. 

I will take under consideration the discussion we have here today 

and any input that may come up. I will then introduce legislation 

in the very near future. 

I would now like to recognize the Ranking Member Miller for any 

opening statement that he may have. 

[The prepared statement of Chairman Michaud appears on 

p. 27.] 

OPENING STATEMENT OF HON. JEFF MILLER 

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

I appreciate you holding this hearing. I have a statement and I 

would like to go ahead and read it into the record if I might. I also 

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apologize ahead of time. I have an Armed Services Committee 

hearing going on at the same time, and I have to be going in and 

out. 

Important to delivering high quality care to our Nation’s veterans is the planning for construction, as we are doing, and renovation of VA’s substantial healthcare infrastructure. As you know, VA 

maintains an inventory of approximately 1,230 health facilities, including 153 medical centers, 135 nursing homes, 731 communitybased outpatient clinics (CBOCs) and 209 Vet Centers. 

VA initiated the Capital Asset Realignment for Enhanced Services (CARES) process to identify and address gaps in service and 

infrastructure about 8 years ago, and the CARES process is continuing to serve as the foundation for VA’s capital planning priorities. 

VA’s construction planning, however, is not without its challenges. The rising cost of construction has been significant at best. 

In fact, the draft legislation we are discussing today would provide 

over $670 million to account for cost increases for previously authorized construction projects. 

I am extremely concerned that VA has an inability to accurately 

project cost estimates, and it is adversely affecting the construction 

process. Escalating project costs continue to require this Committee 

to reexamine and increase authorizations for existing projects, hindering the ability to move forward with new projects important to 

improving access to care and supporting future healthcare demand. 

CARES identified Okaloosa County in my district in Northwest 

Florida as underserved for inpatient care. In fact, it is the only 

market area in Veterans Integrated Services Network (VISN) 16 

without a medical center. However, VA has yet to act to address 

the inpatient care gap in this region. 

There is a tremendous opportunity to collaborate with the U.S. 

Department of Defense (DoD) for medical services on the campus 

of Eglin Air Force Base (AFB) that would benefit both veterans and 

active-duty servicemembers in this area. 

Last September, I introduced H.R. 3489, the ‘‘Northwest Florida 

Veterans Health Care Improvement Act.’’ This legislation would expand partnership between Eglin AFB and the VA Gulf Coast Veterans Health Care System to provide more accessible healthcare to 

eligible DoD and VA patients in Northwest Florida. In collaboration with DoD, this bill would provide inpatient services and expand outpatient specialty care through the construction of a joint 

VA/DoD medical facility on the Eglin AFB campus. 

At our November 2007 Subcommittee hearing, Major General 

David Eidsaune, Commander of the Air Armament Center at Eglin 

Air Force Base, testified about the successful partnership that the 

VA and DoD had developed in the region and stated that ‘‘This cooperative effort should serve as a model for future efforts to support the healthcare needs of our Nation’s veterans.’’ 

Mr. Chairman, I am providing you with updated legislative language that reflects the intent of H.R. 3489, and I respectfully request that this language be included in the introduced version of 

the Department of Veterans Affairs Medical Facility Authorization 

and Lease Act of 2008 that will be considered by the full Committee. 

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I appreciate the opportunity to enter my statement into the 

record, and am available for questions at any time for you, Mr. 

Chairman, and I yield back. 

[The prepared statement of Congressman Miller appears on 

p. 27.] 

Mr. MICHAUD. Thank you very much, Mr. Miller, for your testimony. We definitely will consider that as we move forward dealing 

with important issues of construction and leases. I also would invite you to the good State of Maine. I know you are from the east 

coast, the southern part where it is nice and warm where we are 

getting a lot of snow up in Maine, and we have the dog sled races 

up in Northern Maine, so you are more than welcome to partake 

in dog sled races in Maine. 

Mr. MILLER. As you well know, anytime you offer I am on my 

way up to your great State. 

Mr. MICHAUD. Thank you. I also notice in the audience the announcer from the Maine broadcasters who is down here. I know we 

are getting a big snowstorm in Maine so I don’t know if she got 

delayed and can’t get out to head back to Maine. So glad to see you 

here as well. 

On our first panel, we have Dennis Cullinan who is Director of 

the Veterans of Foreign Wars (VFW) of the United States who is 

here on behalf of The Independent Budget; Joe Wilson who is here 

from the American Legion; and Rick Weidman who is here for the 

Vietnam Veterans of America (VVA). We look forward to your testimony this morning, and without further ado, we will start off with 

Dennis. 

STATEMENTS OF DENNIS M. CULLINAN, DIRECTOR, NATIONAL 

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF 

THE UNITED STATES, ON BEHALF OF THE INDEPENDENT 

BUDGET; JOSEPH L. WILSON, DEPUTY DIRECTOR, VETERANS 

AFFAIRS AND REHABILITATION COMMISSION, AMERICAN 

LEGION; AND RICHARD F. WEIDMAN, EXECUTIVE DIRECTOR 

FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA 

STATEMENT OF DENNIS M. CULLINAN 

Mr. CULLINAN. Thank you, Chairman Michaud and Mr. Miller. 

On behalf of the men and women of the Veterans of Foreign 

Wars and the constituent members of The Independent Budget (IB), 

I thank you for inviting us to present our views at this most important legislative hearing. As you know, the VFW handles the construction portion of the IB and we will be representing the collective position of The Independent Budget VSOs (IBVSOs) regarding 

the draft bill under discussion today cited as the ‘‘Department of 

Veterans Affairs Medical Facility Authorization and Lease Act of 

2008.’’ 

With respect to construction, the IB’s most fundamental objective 

is to produce a set of policy and budget recommendations that reflect what we believe will best meet the needs of America’s veterans. In this regard, and as we have recently testified, the Administration’s fiscal year 2009 budget request for major and minor construction is woefully inadequate. Despite hundreds of pages of 

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budgetary documents that show a need for millions of dollars of 

construction projects, the Administration has seen fit to have the 

major and minor construction accounts from the 2008 levels, failing 

to meet the future needs of our veterans. 

The legislative proposal under discussion today demonstrates 

that you and this Congress are fully prepared to advance VA’s construction priorities so that future generations of veterans—such as 

those currently serving in the deserts of Iraq and the mounts of Afghanistan—will have a first-rate VA healthcare system ready to 

fully meet their needs. We thank you. 

It is our view that the VA construction infrastructure maintenance must be carried out in a methodically planned and orchestrated manner. One of the strengths of the VA’s Capital Asset Realignment for Enhanced Services, CARES, process is that it was 

not just a one-time snapshot of needs. Within CARES, VA has developed a healthcare model to estimate current and future demand 

for healthcare services and to assess the ability of its infrastructure 

to meet this demand. VA uses this model throughout its capital 

planning process, basing all projected capital projects upon demand 

projections from the model. 

The model, which drives many of VA healthcare decisions that 

VA makes, produces a 20-year forecast of the demand for services. 

It is a complex model that adjusts for numerous factors including 

demographic shifts, changing needs for healthcare as the veterans’ 

population ages, projections for healthcare innovation and many 

other factors. 

It is one concern of ours, however, that there have been times in 

the past and are currently going on, and will undoubtedly will 

occur in the future were things outside of the CARES process such 

as political exigencies and local problems that would interfere with 

carrying out the CARES’ methodology. 

We realize this is a fact of life. It is something we would ask this 

Committee to keep an eye on. 

We applaud that the construction, renovation and maintenance 

projects covered in the draft bill are in keeping with this planning 

process. As you know, the IB recommendation for major construction is $1.275 billion, and minor construction is pegged at $621 million. 

Our last observation here is that we applaud section 5 of this bill 

for the authorization of additional appropriations for fiscal year 

2009 medical facility projects covered by this act and impacting 

major and minor construction projects of $1.635 billion and $345.9 

million, respectively. 

Mr. Chairman, thank you. That concludes my oral statement. 

[The prepared statement of Mr. Cullinan appears on p. 28.] 

Mr. MICHAUD. Thank you very much. Mr. Wilson? 

STATEMENT OF JOSEPH L. WILSON 

Mr. WILSON. Mr. Chairman and Mr. Miller, thank you for this 

opportunity to present the American Legion’s views on VA construction authorization within the Department of Veterans Affairs. 

The average age of VA healthcare facilities is approximately 49 

years old. Proper funding must be provided to update and improve 

VA facilities. With the enactment of Public Law 110–161, the ConWWOODS2 on PRODPC68 with HEARING

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solidated Appropriations Act for Fiscal Year 2008, VA was provided 

the largest increase in veterans’ funding in its 77-year existence. 

The American Legion applauds Congress for this much needed increase. 

However, there are questions, such as, whether or not construction funding adequately maintains VA’s aging facilities, as well as 

its ongoing requirement for major and minor construction. The fiscal year 2009 budget request was $582 million for major 

construction, falling far behind the amount recommended by former 

Secretary Anthony Principi. From 2004 to 2007, only $2.83 billion 

for CARES projects had been appropriated, an overall shortage of 

funding. 

Mr. Chairman, veterans’ healthcare is ongoing 24 hours daily, 7 

days weekly, and 365 days annually. In addition, returning veterans of Operation Enduring Freedom/Operation Iraqi Freedom are 

returning home and seeking healthcare within the VA healthcare 

system. 

The fiscal year 2009 budget does not begin to accommodate the 

needs of the Veterans Health Administration, not to mention 

planned projects of previous fiscal years. To date, various planned 

VA Construction projects, to include San Juan, Puerto Rico; Los 

Angeles, California; Fayetteville, Arkansas; and St. Louis, Missouri, have yet to receive adequate funding. Delays in funding 

cause delays in healthcare. 

Mr. Chairman, when the Veterans Hospital Emergency Repair 

Act was passed in 2001, there was a construction backlog that continued to grow. During the CARES process, there was the de facto 

moratorium on construction, but the healthcare needs for this Nation’s veterans didn’t cease during this time, and yet still the construction backlog increased. 

VA’s minor construction budget includes any project with an esti- mated cost equal to or less than $10 million. Maintaining the infrastructure of VA’s facilities is no minor task. This is mainly due to 

the average age of the facilities. These structures constantly require renovations, upgrades and expansions. 

From 2006 to date, the American Legion’s National Field Service 

Staff and System Worth Saving Task Force have visited a combined total of 113 VA medical centers (VAMCs), community-based 

outpatient clinics, or CBOCs, and Vet Centers in all 21 Veterans 

Integrated Service Networks or VISNs. During these visits, many 

facilities reported space and infrastructure as their main challenges. 

During the American Legion’s 2006 site visits, our overall report 

ascertained that maintenance and replacement of VA’s physical 

plant was an ongoing process and a major challenge to facility directors. It was reported that deferred maintenance and the need for 

entirely new facilities presented an enormous budgetary challenge. 

In 2007, the National Field Service Representatives focused on 

VA polytrauma centers and Vet Centers, but also maintained, in 

thought, their connection to the entire VA Medical Center System. 

During the American Legion’s visit to the St. Louis VA Medical 

Center on May 16, 2007, it was reported that major work was required on outpatient wards. These wards were previously converted 

from inpatient wards but were never renovated. The outpatient 

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clinics were in need of modernization. The overall report of this facility included an outdated facility and lack of space. 

Mr. Chairman, the issues mentioned are a microcosm of structural problems throughout the VA Medical Center System. Although not mentioned in this testimony, the American Legion 

maintains an account of its site visits in its annual publication of 

its ‘‘System Worth Savings’’ report. 

As time progresses, the demand for VA healthcare is increasing 

while failure to improve the infrastructure causes unsafe conditions 

for veterans, as well as VA staff. The American Legion continues 

to insist that sufficient funding must be provided to maintain, improve, and realign VA healthcare facilities. 

Mr. Chairman, Mr. Miller, the American Legion sincerely appreciates the opportunity submit testimony and looks forward to working with you and your colleagues to resolve this critical issue. 

Thank you. 

[The prepared statement of Mr. Wilson appears on p. 29.] 

Mr. MICHAUD. Thank you. Mr. Weidman? 

STATEMENT OF RICHARD F. WEIDMAN 

Mr. WEIDMAN. Mr. Chairman, on behalf of VVA National President, John Rowan, thank you for the opportunity to appear here 

today. Mr. Miller, thank you as well, sir. 

VVA is generally in support of this legislation but believes that 

it is not nearly aggressive enough in fulfilling the promise of the 

CAREs model and the bottled-up need, if you will, for both renovation and new construction. 

The physical plant is indicative of whether or not we are meeting 

our obligation to our Nation’s veterans. We all basically posit, because it just makes common sense, that it affects the quality of 

healthcare, but we don’t know that for a fact, and would encourage 

you, Mr. Chairman and Mr. Miller, to do a bipartisan call for a 

study of physical plant with medical outcomes, physical plant with 

staffing ratios of doctor/patient ratio, RN/patient ratios, et cetera, 

at facilities, and more importantly, as I said, medical outcomes for 

people who use that facility by DRG. It is something that certainly 

the U.S. Government Accountability Office (GAO) could accomplish 

in a relatively short order in just a couple of months. 

Secondly, we favor all of and would suggest that you add somewhere between at least a half and probably $1 billion to more aggressively pursue the schedule that was laid out pursuant to the 

CARES process. 

I would be remiss if I did not note for the record that VVA never 

‘‘agreed’’ to this CARES formula. When the people who developed 

this formula from Melbank turned to us and say, well, it is too 

complicated, you wouldn’t understand, my response was ‘‘try me.’’ 

I was one of only 13 George Komp Fellows at Colgate University, 

and they have never been forthcoming on that, but basically it is 

a civilian formula that does not take into account the wounds and 

maladies of war, does not take into account all the new veterans, 

does not take into account long-term care, and last but by no 

means least, it was developed for middle-class folks who can afford 

Preferred Provider Organizations and Health Maintenance Organizations, and the presentations on that, they figure an average of 

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one to three per person whereas at VA hospitals, we have five to 

seven presentations per individual who walks across the threshold. 

What that means is the burden rate, if you will, of usage is much 

higher. In other words, many more services have to be provided on 

average to each veteran who shows up versus each patient in the 

private sector, which obviously is going to affect your overall resources in terms of staffing, which is also going to affect your overall need for a physical plant that meets the needs of those staff 

wherein you can provide the highest quality medical care. So we 

would encourage you to get GAO to do that study. 

Secondly, I would like to talk about Puerto Rico for just a moment. Two billion dollars can be found for a new facility in Denver, 

Colorado, but they want to try and shore up a 1960s facility that 

is not hurricane proof even to the level of a Category 2 hurricane, 

and build a new bed tower, and the facilities in Puerto Rico are 

just simply inadequate. 

The veterans who returned home from their valiant service to 

Puerto Rico were no less brave and no less true to their country 

than those who returned to Colorado. I am just using that as an 

example. While the Colorado hospital is needed, it is time to stop 

doing short shrift on Puerto Rican veterans, and that is reflected 

in the parking facility, and there are a number of things that we 

recommended in a statement that we added to this bill this year, 

and would encourage you to work with the Hispanic Caucus toward 

that end. 

I am just about out of time so I want to thank you very much. 

I would be pleased to take any questions that you may have. 

[The prepared statement of Mr. Weidman appears on p. 31.] 

Mr. MICHAUD. Thank you very much. I know Mr. Miller has to 

leave for another Committee so I would recognize Mr. Miller. 

Mr. MILLER. Thank you, Mr. Chairman, and unfortunately, I 

think we are all going to have to leave shortly for a vote. 

One of my questions is, and I think all of you in your testimony 

recognize and said that there is certainly, I think you, Mr. 

Weidman, used the term while the legislation before us is good, it 

is not aggressive enough. I certainly understand that comment. 

In the interim, if VA is not able to keep up at the rate that you 

propose, the $1.275 billion, I think, Mr. Cullinan, that you were 

talking about, what suggestions do you have in the interim to provide for the needs of the veterans in the local communities? 

We talk about co-sharing a lot and we talk about contracting out 

a lot. I will give to whoever wants to take it, and if any of the three 

of you want to comment, that is fine. 

Mr. CULLINAN. Mr. Miller, I will speak to that briefly. I certainly 

don’t have a perfect solution. The IBVSOs have been, and remain 

to be, supportive of leasing options. We are cautious, though, that 

leasing not supplant VA’s own construction efforts. That is an area 

that could perhaps be pursued more vigorously. 

The issue of co-locations, that is something we are trying to get 

a handle on. Co-locations are good in that they make services readily available to veterans. On the other hand, it sometimes seems 

there is almost a pattern emerging between co-locations and 

delays, and Fitzsimmons is an example. There is a co-location, and 

this is a construction project that has been playing out over too 

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many years. We don’t know that co-location itself is the problem, 

but there is a pattern here. 

Other than that, the construction has to be pursued, leasing, and 

it is absolutely necessary, they are going to have to provide services 

through the private sector, but that is expensive. Thank you. 

Mr. WILSON. Mr. Chairman, Mr. Miller, I think there should be 

an actual overall assessment. Each VA medical center is unique. 

The American Legion has visited many medical centers and provided site visit reports on these respective VA medical centers. We 

found that they are very unique in nature in respect to their respective VISN, as well as their communities. For example, out in 

California there is the Hispanic population, while in other parts of 

the Nation there are other distinctive cultures, which aren’t exactly 

relegated to ethnic background but also a way of life. This alone 

makes each VA medical hospital unique. Just as there was provided a model for the construction of VA medical centers, there 

should be an overall assessment of every facility to ascertain 

whether or not more funding is required at such facilities. 

For example, the Sepulveda VA Medical Center is the only facility that has a Vet Center on its campus; currently there are no 

planned dollars for that particular structure. One could infer that 

the dollars were being borrowed from the VA medical center itself, 

or actually they lacked—they lacked funding, so that particular 

equipment went unrepaired. 

So I would say an overall actual assessment of each VA medical 

center would be more effective rather than providing a model for 

one site or VISN to cover the entire VA Medical Center System. 

Mr. WEIDMAN. Essentially, Congress put a hiatus on new construction until there was a reasonable plan about where you were 

going to go because folks were angry that moneys had been invested and then suddenly wards were closing and facilities were 

closing, wasting precious taxpayer dollars, and understandably so, 

the Congress said we want a plan that makes sense. 

This plan is, while it doesn’t go far enough because of the inadequacies of the formula itself, from my point of view, is in fact a 

reasonable plan that is laid before the Congress. We are not working the plan nearly fast enough, and that is the thrust of what I 

think we are saying to you is that with the plan VA has already 

laid out that was recommended by Secretary Principi, we can hike 

that up. There is nothing to preclude, in terms of organizational capacity to supervisor with the reorganization and separation of regular procurement of goods and services from construction procurement within the VA itself, they now have the organizational capacity to oversee many more both major as well as minor construction 

processes at the same time. So go to the CARES plan itself and 

hike it up a couple of years. 

In answer to your question about contracting out, you directed 

VA to make sense out of the contracting out 2 years ago, and so 

VA took that one foot, and took three country miles, three rural 

country miles with it, and came up with a proposal for the very 

misnomered ‘‘Project Hero’’ that was essentially a fire sale of VA 

services that would have further diminished VA organizational capacity to provide quality, full wellness service as well as sickness 

service to our veterans. 

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With the VSOs united, and it is somewhat more reasonable now, 

but the problem, Mr. Miller, is that every time you give them a 

reasonable thing to go and do, and rationalize, like contracting out 

where it makes sense, people use that at VA as license as opposed 

to a mandate to do something reasonable. 

So if I may suggest, sir, be very cautious in terms of directing 

contracting out because what may be pushed by, whether Domestic 

Policy Council, or by VHA, is going to be very different, Mr. Miller, 

than what you and the Chairman have in mind, if I may suggest. 

Mr. MILLER. I appreciate it, and please do not take my comments 

to mean that it is something that I expect this Committee to mandate to VA. My question was, and my time is out now, but my 

question was in the interim while these projects are being constructed what do we do? 

Mr. WEIDMAN. VVA, where it makes sense, would have no objection to contracting out if in fact there is not the capacity to do it 

within the VA facility, Mr. Miller. 

Mr. MICHAUD. Yes, I had a couple questions on that line of 

thought. If I understand your testimony correctly, you all agree 

that the CARES process might not be perfect but at least it gives 

us a roadmap of where to go. It has been about 4 years now since 

CARES came out. A lot of things have changed since then with the 

Iraq and Afghanistan wars, and the economy. 

What would you say about this as far as the construction? I know 

you say we ought to do more as far as giving more money to move 

this process a lot quicker. Is there anything we can do in the construction process that would help shorten the timeframe of getting 

these projects moving forward and hopefully do it in a cost-effective 

manner? 

Mr. CULLINAN. Chairman Michaud, again I don’t have a perfect 

answer. I don’t seem to have any of those today. There are certain 

things that should be looked at. For example, right now the $10 

million limit differentiate between a major and a minor construction, perhaps that should be a little bit higher. 

I know, for example, DoD, not to pick on DoD, is very good at 

what is called layering, splitting a project, say a $100 million 

project into 10 or 11 subparts. VA can pursue a similar course as 

well, but perhaps it would be better to elevate the $10 million 

limit. Then there is the issue of reprogramming authority. 

For example, a contract goes bust, it is clear that it can’t be carried out, sometimes it is difficult to get the money moved from 

that, at least temporarily, to fund projects into something that is 

viable. That is something that should be looked at. 

There are a certain type of—I am trying to think of the term— 

single-source contracts where you hire the same company to basically do the design and research work, and do the contraction. The 

private sector uses that quite a bit. That is very effective. That is 

something VA could look at, and for now our recommendations on 

that. 

Mr. MICHAUD. Thank you. Does anyone else have anything to 

add? 

Mr. WILSON. It is important that VA mandate a definitive start 

and complete date of construction projects to ensure it is understood that outsourced contracts are temporary. It is evident some 

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contracts have actually become permanent in nature. It must be assured patient care remains of VA culture; a culture that veterans 

are accustomed to. On the other hand, when services are contracted out in the communities for an extended period of time, it 

removes the veteran from the comfort of VA’s environment; which 

may impede adequate care. So I would say VA should establish and 

communicate a mandate to ensure such contracted projects are set 

for a complete date. VA should also make it concrete that contracting outside of the VA medical center environment is temporary. 

Mr. WEIDMAN. Mr. Chairman, as you know in my copious free 

time, of which there is none, I have the privilege of serving as 

chairman of the Veterans Entrepreneurship Task Force, and have 

looked at procurement right across the board, including very carefully at VA. VA and the U.S. Department of State are actually 

meeting the 3 percent, but there is much more that can be done, 

particularly in the area of construction. 

Bundling all too often happens, which freezes out all small business, and certainly service-disabled veteran-owned businesses 

(SDVOBs) that we know from all the studies that have been done 

by both Census and the Office of Advocacy at the U.S. Small Business Administration are less capitalized than their non-veteran 

counterparts. 

So the bundling freezes our folks out. There needs to be more set 

asides specifically for SDVOBs, service disabled veteran-owned 

businesses. VA now has authority under Public Law 109–461, 

passed by this body unanimously, and the same in the Senate, to 

move forward and to do set asides, not just for service disabled, but 

for veteran-owned businesses. 

If they stop bundling, break many of those particularly minor 

construction projects into segments that are essentially bite size, 

they can be handled by small and medium-sized enterprise, then 

we can speed up the process, one, two. You grow the organizational 

capacity of those businesses to do yet more in the future, and particularly in our non-urban areas, this becomes really important, 

that there not be somebody—if you make it large enough, the contractor that is going to come in from the outside—Togus, Maine, as 

an example. 

But if you break it into bite-size chunks, then in fact you grow 

the small businesses and medium-size enterprises that are indigenous to that area of the country, and frankly, have a more profound impact on the economy. 

Let me just make a point about that. Everybody is talking about 

the economic stimulus package as if going out and selling consumer 

goods is the way to go with that. While we fought hard to get service disabled veterans included in that stimulus package, one could 

argue that a much more sensible approach would be rebuilding the 

infrastructure of the Nation, and there is no better place to start 

than hiking up the schedule of rebuilding the infrastructure of the 

system to care for those who have been injured in service to country, and I would encourage you to—we certainly, if this Committee 

wants to take that lead, I think all the VSOs will unite behind you 

and carry that message on both sides of the aisle up to the leaderWWOODS2 on PRODPC68 with HEARING

11 

ship of the House as well as carry it on the other side of the Hill, 

sir. 

Mr. MICHAUD. And my last question touches upon contracting 

out while trying to move the CARES process forward. The CARES 

process recommended a lot of access points, particularly in the 

rural areas. I don’t envision the VA being able to build clinics in 

all of the rural areas, or it is going to take quite a lengthy amount 

of time for them to do that. Just very briefly, what is your feeling 

if there is, for instance, I will use Maine as an example, one of the 

access points, Holton. 

There is a hospital in Holton. It is in a rural area. They have 

plenty of capacity for space for the VA to use to take care of our 

veterans, and here is an opportunity where VA is not only unique 

to Maine, I am sure other rural areas across this country, where 

it can utilize what is already built there, and provide services a lot 

quicker because of the facilities there. What is your thought on 

something like that? 

Mr. CULLINAN. Chairman Michaud, on behalf of the IB, again the 

IB is supportive of contracting out only where absolutely necessary. 

Speaking on behalf of the VFW, the VFW believes that there are 

a number of instances, and Holton is one, where contracting out is 

the only viable option. 

The only thing I would add to that in many areas in parts of the 

country it is not just a question of lack of physical infrastructure, 

it is a lack of healthcare providers, sometimes then you are going 

to have to resort to some sort of sharing, contracting out. There 

just aren’t any other options, especially in these remote rural 

areas. 

Thank you, sir. 

Mr. WEIDMAN. Contracting out may make the only sense. I used 

to, when I first came home, teaching in Vermont at one of the 

Vermont State colleges and lived in Lamoille County, which is a 

big green part, which means there is no town of 2,500 or more in 

the middle of north-central Vermont, and so I am aware of the 

problems of rural healthcare. I never went to the VA. It was three 

hours away, and therefore, used the civilian medical system. 

For us, it would make sense for us to contract it out if, in fact, 

there is no viable option. One of the things, however, that VA has 

not done well, even in many of the CBOC contracts out, is train 

people in the wounds and maladies of war. They haven’t trained 

their own staff in many cases either, but the Veterans Health Initiative, and that is why in my written statement we encourage that 

you have a hearing on all of this, about making this a veterans’ 

healthcare system, and how does that affect not only the physical 

plant but also the planning process in terms of staffing needs in 

the future as well as training needs. 

The Veterans Health Initiative in taking of a military history 

and training, at least making available those curricula, which are 

on the Internet I might add, to any contractor is extremely important that they understand what are the particular problems of veterans. If it is just general healthcare that happens to be for veterans, we are going to be doing a disservice to those rural veterans 

who have served well. 

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12 

An example would be mental health. Many of the CBOCs, yes, 

they have ostensible medical health services out there, but you 

start to dig into it and they are not qualified counselors who know 

PTSD from ABCD, and therefore, are not going to be particularly 

useful to those veterans who need it the most. 

Mr. MICHAUD. Thank you. Mr. Brown? 

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman. 

I noted when I Chaired the Health Subcommittee, we went to 

Maine and looked at some of the rural healthcare delivery, and I 

know in South Carolina we have a lot of these community health 

centers, and it certainly looks like to me in some instances these 

are State run so that there could be some overlap there to be getting service, and we also looked at telemedicine too, which I think 

would certainly help fill that gap. 

My question is, I represent Charleston in Congress, and we have 

been looking at trying to combine some services between the VA 

and the medical university, and I guess in the last 3 weeks, we 

were able to go to the Oncology Center, which has a specialty type 

of equipment, actually an imaging piece of equipment that takes a 

picture of a tumor and actually treats just the cancer cells, and 

that piece of equipment costs like $3.5 million. The VA actually 

bought the piece of equipment in the Oncology Center at the medical university, and their doctors actually administer the treatment. 

We have been trying to work at some collaborative basis with the 

VA and the medical university to extend that, but we have done 

an extensive study, and I know Mr. Wilson mentioned the Charleston plan, and this is kind of what we were hoping to develop some 

kind of a model of cross-sharing services. After all, we are the same 

taxpayer that funds both VA and the medical university too, and 

the needs of the veterans are becoming more specialized than ever 

in the history of this Nation. 

So it is difficult to have that specialized service at every VA center, so it makes sense to make some combination of services. 

We are stuck in some kind of a warp, I guess, in Charleston because we have good medical facilities at the VA, though it is about 

50 years old, and it is sitting in a low area of the peninsula, and 

I know that—you mentioned, Mr. Weidman, that we just aren’t 

proactive enough, and you mentioned the situation down in Puerto 

Rico. It is the same situation here. 

The medical university is building a brand new facility. We could 

make some combination, be it the operating rooms, be it some of 

the recordkeeping or whatever, and put another bed in that proximity since 95 percent of the doctors are actually coming from the 

medical university to treat the patients at the VA center. 

It would make sense, but we are caught up in some kind of a 

CARES process that says, you know, we want to be sure we get the 

maximum use of the facilities that we have, and I am certainly for 

that. 

But I went to New Orleans and we are now doing catch-up instead of being proactive. All those veterans now have to go some 

place else for service because of the time lapse of being able to 

make another facility there. 

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13 

We were hoping to do the same thing in Charleston, but apparently we are caught up in some kind of a formal or some kind of 

a process that is going to put us in the same posture as New Orleans, and also Puerto Rico, too, I guess, if in fact we have another 

Class 4 hurricane to come in our region. 

I would be interested in some comments from you all, and I 

apologize for taking most of my time asking that question, but I 

just want to make that presentation. 

Mr. CULLINAN. Mr. Brown, I will speak on behalf of the VFW on 

this one. We believe that there are instances with respect to hightech, highly expense equipment, that the best thing to do is to engage in a sharing arrangement. There is no doubt about it. Magnetic Resonance Imaging (MRI) and other imaging devices, you are 

just not going to have one in every locality, and the same thing 

goes for certain types of service, cardiac care, for example. If you 

are going to do open heart surgery, you want to go somewhere 

where it is done all the time. 

So from the perspective of providing the best possible care in the 

most cost-effective manner, and in the safest manner for veterans, 

that is the way to proceed. 

The only thing I would add to that is that with respect to CARES 

and the planning process, we do know that there are times when 

it seems to be the overarching CARES process that is causing the 

problem with respect to sharing, and sometimes it is a local situation. It is just below the surface. 

Without mentioning the location, I know of one individual whose 

dad had had a heart attack, and there was a VAMC located directly across from a medical center, and there was an expectance 

at the VAMC supposedly that the care be provided there, whereas 

the medical facility, it came to light, was saying, well, we should 

be doing this, it makes perfect sense. We do it all the time. Why 

not us? 

Well, indeed, yes, there is an example of something where VA 

should simply defer to this private facility, but then we found out 

that actually what was going on, or a sub-story in all of this, was 

the fact that there was concern within VA that were they to go this 

route suddenly the private-sector hospital, medical facility, would 

be the only game in town, and the costs would go up exponentially. 

So it is a complicated business. Again, I mean just to reiterate, 

there are clearly instances where sharing, contracting out are the 

best way to go for the good of the veteran, but there are these other 

little things percolating beneath the surface. 

Thank you, sir. 

Mr. WEIDMAN. VVA would very much favor that kind of cost 

sharing on expensive equipment and on specialty tests where there 

is propinquity between the two facilities. 

I also might add that the co-location, when we have the opportunity, just makes sense. It depends on proactive leadership and it 

needs to start at the VISN level where there are opportunities developed to bring it to the attention of the under secretary. Something that VA has never done well is being proactive, and frankly, 

it seems to VVA that this Committee not only has the right, but 

the responsibility to press VA to start being proactive, and if they 

won’t be, to give you the information or to survey members, and 

WWOODS2 on PRODPC68 with HEARING

14 

that Charleston situation is an example of something that we 

would absolutely support 100 percent, and fight for, Mr. Brown. 

But there are other opportunities I am sure around the country 

beyond Puerto Rico, beyond Charleston, that VA should be pursuing. If you borrow the spots analogy, it is a West Coast offense. 

If they give you the long ball, you go for the long ball. If they will 

only give you the three-yard pass, take it. But we have to be looking on the outlook for that, and VA has not done a very good job 

of doing that. 

Mr. MICHAUD. Ms. Brown? 

Ms. BROWN OF FLORIDA. Yes. I am going to be very quick, but 

let me just say that I can report that the VA is doing a very good 

job in New Orleans. I just was there about a week ago, and they 

have really done a good job in providing services to the veterans 

in the area. 

I guess my question will go to—well, I want to say I am a strong 

opponent of design/build, because we have just funded the largest 

VA budget in the history of the United States, and we have a lot 

of projects, but if it is going to take us 10 years to build a project, 

it doesn’t make any sense, so we need to have models that work, 

and if the money is there. 

For example, you mentioned, Mr. Wilson, about the stimulus package. Well, what makes sense is that for every $1 billion that 

we spend, it creates 715 jobs, and certainly part of that work 

should go to veterans that have been certified, prepared to do the 

work, but they are having problems. I just met with a group last 

week in how do they do business with VA when they—they go 

through the General Services Administration (GSA), they are certified, but yet they feel like they are in the system and they can’t 

get any work. 

Mr. WEIDMAN. The VA has not done a great job of doing servicedisabled veterans set asides. You gave them that authority with 

Public Law (P.L.) 109–461. I meet and am in contact with the chief 

of staff of VA, and with the chief operating officer, Deputy Secretary Mansfield, literally every other week about where the heck 

are the regulations. They have now finally got them out of the 

building, part of the regulations, and they are over at the Office of 

Management and Budget. 

However, the Black Letter Law itself, that provision of P.L. 109– 

461, VA can go ahead and start doing those set asides right now. 

Frankly, while it is open to doing this to service-disabled veteran-owned businesses, it is not friendly to doing business with—— 

Ms. BROWN OF FLORIDA. Right. 

Mr. WEIDMAN (continuing). Service-disabled veterans. It is almost like Washington, DC, running around Capitol Hill. Is it accessible? Yes. Is it disabled friendly? It sure in heck isn’t. All my 

friends in wheelchairs have a hell of a time here, and it is only 

their determination that gets them around. We need to make the 

VA process of procurement and particularly in construction friendly 

to service-disabled vets. It may be something that you want to recommend to the Appropriations Committee is to put language in the 

report for the fiscal year 2009 appropriation that VA must set aside 

10 percent of all construction funds for veteran-owned businesses, 

of which a minimum of 3 percent of every major project go to servWWOODS2 on PRODPC68 with HEARING

15 

ice-disabled veteran-owned businesses. That only reiterates what is 

already in the law. 

Ms. BROWN OF FLORIDA. I am not disagreeing with you, but all 

I am saying the groups that have already certified, they are ready 

to work. They can’t get—they are given the run around. I guess we 

are saying the same thing. 

Mr. WEIDMAN. We are saying the same thing, and I would be— 

if I may talk to you off-line, Ms. Brown. 

Ms. BROWN OF FLORIDA. Yes. 

Mr. WEIDMAN. We have done a lot of work in pressing hard on 

where there are problems in VA. Some have been fixed and some 

have not. We brought it to the attention of the Secretary and Deputy Secretary Mansfield, to Mr. Frye and to the Chief of Staff, 

Thomas Bowman, repeatedly. We have a long way to go even at the 

VA, never mind the DoD which is still trying to figure out how to 

spell the word service disabled veteran-owned business. 

Ms. BROWN OF FLORIDA. Thank you. 

Mr. MICHAUD. Thank you very much, Ms. Brown, and I want to 

thank the panel for your testimony this morning, and there might 

be some further questions from the Subcommittee. So once again, 

thank you very much for coming. 

We will take a recess. There is, I understand, only one vote, so 

it should not take long, and then we will reconvene the Subcommittee hearing. Thank you. 

[Recess.] 

Mr. MICHAUD. Let us get started. I want to thank the second 

panel for coming today as well, and we have Donald Orndoff, who 

is the Director of Office of Construction and Facilities Management 

with the Department of Veterans Affairs. So I want to thank you 

for coming, and if you could introduce those who are accompanying 

you as well. 

Mr. ORNDOFF. Yes, sir. Thank you, Mr. Chairman. 

To my left is Mr. Jim Sullivan. He is from the Office of Asset Enterprise Management. To my right is Mr. Robert Neary. He is the 

Director of Service Delivery for the Office of Construction and Facilities Management. To my far right is Mr. Joseph Williams, the 

Assistant Deputy Under Secretary for Health. 

Mr. MICHAUD. Thank you very much. If you would begin your 

testimony. 

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16 

STATEMENT OF DONALD H. ORNDOFF, DIRECTOR, OFFICE OF 

CONSTRUCTION AND FACILITIES MANAGEMENT, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY ROBERT L. NEARY, JR., DIRECTOR, SERVICE DELIVERY OFFICE, 

OFFICE OF CONSTRUCTION AND FACILITIES MANAGEMENT, 

U.S. DEPARTMENT OF VETERANS AFFAIRS; JAMES M. SULLIVAN, DEPUTY DIRECTOR, OFFICE OF ASSET ENTERPRISE 

MANAGEMENT, OFFICE OF MANAGEMENT, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND JOSEPH WILLIAMS, JR., 

RN, BSN, MPM, ASSISTANT DEPUTY UNDER SECRETARY FOR 

HEALTH FOR OPERATIONS AND MANAGEMENT, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

Mr. ORNDOFF. Yes, sir. Mr. Chairman and Members of the Subcommittee, I am pleased to appear today to discuss the Department 

of Veterans Affairs draft authorization bill related to major construction and major lease projects. I will provide a brief oral statement and request that my full statement be included in the record. 

Mr. MICHAUD. Without objection. 

Mr. ORNDOFF. Let me begin by briefly reviewing the status of 

VA’s major construction program. 

The average age of the 5,000 VA-owned medical facilities is over 

50 years. Many of these older facilities were not designed or constructed to meet the demands of clinical care for the twenty-first 

century. 

VA is currently implementing the largest capital investment program since the immediate post-World War II period. This program 

results from the VA’s strategic plan and the Capital Asset Realignment Enhanced Services, or CARES program initiated systemwide 

in 2002 and began implementation in May 2004. 

Including our fiscal year 2009 request, VA will have received appropriations totaling $5.5 billion for CARES projects. Currently, VA 

has 40 active major construction projects. Thirty-three projects are 

fully funded, for a total cost of approximately $2.8 billion. Seven 

projects have received partial funding, totaling $560 million 

against a total estimated cost of $2.3 billion. 

For fiscal year 2009, VA is requesting $471 million in new construction appropriations for medical facility projects. This request 

will provide additional funding to five of the partially funded 

projects, and begin design on three new start projects. 

For fiscal year 2009, VA is seeking authorization for six major 

medical facility construction projects and 12 major medical facility 

leases. 

I would like to address VA’s proposed authorization bill recently 

submitted to the Speaker. 

Section 1, authorization of fiscal year 2009 major medical facility 

projects: section 1 of the proposed bill would authorize the Secretary to carry out four major medical construction projects in Lee 

County, Florida, Palo Alto, California, San Antonio, Texas, and San 

Juan, Puerto Rico. 

Section 2, additional authorization for facility for fiscal year 2009 

major medical facility construction projects previously authorized: 

section 2 of the proposed bill authorizes the Secretary to carry out 

two major medical facility projects located in Denver, Colorado, and 

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17 

New Orleans, Louisiana. Both projects were previously authorized 

for lesser sums under Public Law 109–461, but additional authorization is required to complete the construction projects at these locations. 

Section 3, authorization of fiscal year 2009 major medical facility 

leases: section 3 of the proposed bill authorizes the Secretary to 

carry out 12 major medical facility leases in fiscal year 2009. These 

leases will provide an additional eight outpatient clinics, expand 

two current outpatient clinics, and develop a primary care annex 

facility and provide needed research space. 

Section 4, authorization of appropriations: This section requests 

authorization for the appropriation of $477,700,000 for major construction projects in fiscal year 2009, and $1,394,200,000 for 

projects previously authorized for lesser sums. This section also 

provides $60,114,000 for medical facilities accounts to authorize 12 

major medical facility leases in fiscal year 2009. 

In closing, I would like to thank the Subcommittee for its continued support of the Department’s infrastructure needs. We look forward to working with the Subcommittee on these important issues. 

I urge you to support our proposed authorization bill so the Department can move forward on important projects to enable the highest 

level of care for veterans. 

Again, thank you for the opportunity to appear before the Subcommittee today. My colleagues and I stand ready to answer your 

questions. 

[The prepared statement of Mr. Orndoff appears on p. 33.] 

Mr. MICHAUD. Thank you very much. I really appreciate it. A few 

questions. 

The Department is requesting authorization for 12 leases and the 

Committee is aware that in October of last year, the General Services Administration recentralized leasing within the Federal Government at GSA. How will this action on the part of GSA affect 

VA’s ability to acquire these leases? 

Mr. ORNDOFF. Sir, I would like Mr. Neary to answer if I may. 

Mr. MICHAUD. Yes. 

Mr. NEARY. Thank you, Mr. Chairman. 

It is correct that late last year the General Services Administration recentralized much of the leasing that is done within the Federal Government. However, VA retains the authority to lease medical and medically related space in support of the Health Care System. And so for these 12 leases we will be managing the execution 

with VA. 

Mr. MICHAUD. Are these leases in VA affected by GSA’s action 

and what is the impact on VA? 

Mr. NEARY. There are many leases in VA that will be affected 

by GSA’s actions, particularly within Veterans Benefits Administration, staff offices and others. Any non-medical lease greater than 

20,000 square feet will now be required that the acquisition be by 

GSA for the VA. It is a very new direction, and we will be watching 

it closely, working closely with GSA to ensure that they are able 

to provide these leases in a timely manner to meet our needs. 

As I say, this has happened fairly quickly, and it would be my 

perspective that GSA has taken on a significantly increased workWWOODS2 on PRODPC68 with HEARING

18 

load, and we want to make sure that they have the capacity to deliver these spaces in time to meet our needs. 

Mr. MICHAUD. Thank you. 

In the first panel, we heard Mr. Weidman talk about the Puerto 

Rico facility, that it is outdated, and a non-hurricane proof VA 

medical facility, and there is a report out. Has your office seen that 

report that Mr. Weidman was referring to, and if you have seen it, 

what specific steps has VA taken to correct the problem, and how 

long will it take to correct the conditions in Puerto Rico? 

Mr. NEARY. Mr. Chairman, I am not sure if Mr. Weidman is referring to the congressionally mandated report that was required, 

I think, in the last session of Congress and that we responded to, 

but I am very familiar with Puerto Rico and the needs there, and 

we have a very active construction program ongoing. 

We are currently under construction with a six-story bed tower 

that will place all the hospital beds in seismically safe space. In the 

emergency supplemental funding that was provided last year, a 

component of that went to San Juan to construct one of three 

pieces of our plan for San Juan. This budget that is now before the 

Congress includes the funding for the second piece of that, and 

when those two are done, which involves construction of clinical 

and administrative space, we will then be in a position to demolish 

the existing bed tower there, and retrofit the lower floors, we call 

it the pancake, three or four floors at the base of the existing hospital will be retrofitted to provide not only modern but seismically 

safe space. 

So we have a plan which we believe effectively will meet the 

needs of veterans in Puerto Rico. 

Mr. Weidman mentioned parking. There is no question about it. 

There is a significant parking shortage there and we are looking 

for ways in our plan with some of the funding that we are getting 

and we will get down the road to address the parking needs as 

well. 

Mr. MICHAUD. How long do you think it will take you to deal 

with that? 

Mr. NEARY. The bed building is under construction and it will be 

completed next year. We expect to award a contract for an administrative building at the end of this fiscal year in early next year. 

Also in 2009, we will award a construction contract for additional 

floors of clinical space. That will take about 24 months to construct. 

As I say, when those are done, the main building will be freed up 

to address. 

So while it goes through 2013, by next year all the beds will be 

in new construction, and within 2 to 3 years the bulk of the administrative and clinical space will be either in new construction or in 

our current outpatient facility, which is only a few years old. 

Mr. MICHAUD. The CARES process was decided back in May of 

2005. When you look at the number of facilities, has your office 

done anything to actually try to speed up not only money, but try 

to shorten the length of time it takes to build a new facility? 

Mr. ORNDOFF. Yes, sir. Basically the process that we have is a 

fairly rigorous racking and stacking prioritization, if you will, of 

the priorities, and of course working within the Department’s comWWOODS2 on PRODPC68 with HEARING

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peting priorities for resources. We are moving as aggressively as we 

can on working down that list. 

We have made a lot of progress. Once a project has in fact been 

budgeted and authorized and appropriated, we are moving as aggressively as we can to bring it to completion and online. We are 

using every innovative approach that we can to try to address that. 

Speed of delivery is a metric that we see foremost in our business, 

and understand that once the commitment has been made we need 

to get that project online as quickly as possible. 

We have always tried to work this from the what can we get online quickly and where are the greatest needs. There is a combination of factors, of course, that go into which projects we are working first through an established process of prioritization, but I assure you that we are working as aggressively as we can on that. 

Mr. MICHAUD. As you know, as time goes on it costs more to 

build a facility. Is there anything that we can do in Congress to 

help speed up the process, whether it is what Ms. Brown had mentioned this morning, as far as to speed up the construction process? 

What can we do to help in that manner? 

Mr. ORNDOFF. Well, sir, as I said, I think we have the tools and 

we certainly are looking for every innovation and creative approach 

that we can. We are partnering very closely with industry to look 

at where industry is, to try to attract maximum competition on our 

jobs so we get the best overall pricing. We are looking at using different contracting techniques such as bringing the general contractor in very early in the process, the design process, so we can 

avoid some of the problems that might arise where we have design 

issues that turn into constructability problems and delays, so we 

avoid those kinds of situations. 

This is a project process known as construction manager is the 

constructor, where the general contractor comes in early and performs construction management duties, and then follows on as the 

actual general contractor completing the work. 

Probably the most significant thing that we are doing to address 

your specific issue is we are trying to improve planning and move 

the design process forward so we can actually get design done concurrent or prior to the appropriation of the dollars. So as soon as 

the dollars are appropriated, we can go immediately into the construction phase. 

That would actually be a timeline that is even more aggressive 

than the design/build approach. The design/build approach would 

take the appropriated dollars and then turn it over to a firm for 

design and then ultimately construction. If we have the design 

completed ahead of appropriation, then we can go immediately into 

construction, which is the shortest possible timeline. 

Mr. MICHAUD. So could you explain the process that you are 

going through right now? You have the CARES process. Is that the 

process that you are following as far as the top priorities under the 

CARES process? We are going to go one, two, three. Or do you deviate from that because things might have changed since 2004? How 

do you deal with that specific process as far as which ones are priorities and which ones are not? 

Mr. SULLIVAN. If I could, Mr. Chairman. Each year the VA individually assesses its needs for capital projects through a call procWWOODS2 on PRODPC68 with HEARING

20 

ess out to the field, and they rank those projects each year in terms 

of the priorities of VA. There is an established criteria that is used 

and the projects are put through that criteria, and ranked and 

stacked, and then we take the budget request and draw the line 

down basically as far as we can down that list and fund those new 

priorities. 

The only exception to that is projects that were already 

prioritized and Congress has already appropriated funds. These 

projects are put on the side, and are funded first based on our ability to continue to spend money and put construction in place. 

Mr. MICHAUD. So the initial process as far as how you rank 

under the CARES process, you ask the different VISNs to bring 

their priorities forward. 

Mr. SULLIVAN. That is right. 

Mr. MICHAUD. Now, under that process, it is my understanding 

because I know I have been trying to find out where CBOCs were 

in the budget. So if you have a VISN who might not have the 

money to move it forward even though it could be a priority, then 

you will never see that at Central Office, is that correct? 

Mr. SULLIVAN. Not quite. The projects we are talking about here 

are major construction projects, those projects over $10 million. The 

CBOC is different from the major construction process. It has a 

similar process that are for approval that is submitted with a business plan, and they are submitted in the budget each year, and 

Congress is notified of those CBOCs. So that is a separate process. 

This is just for the big, major construction. 

Mr. ORNDOFF. I might add that the project identification is not 

resource constrained. 

Mr. SULLIVAN. That is correct. 

Mr. ORNDOFF. It is a requirement identified and it is not until 

we get to the prioritization process that we would bring in the resource constraint. 

Mr. SULLIVAN. That is correct. 

Mr. MICHAUD. Okay. Since you don’t deal with the CBOCs, but 

you deal with major projects, is there a problem that VISNs might 

have if they don’t feel that they can handle that within their budget, that it might not get to your level or is that not a problem? 

Mr. SULLIVAN. You might add, Mr. Williams, to the comment. 

Mr. WILLIAMS. The process for CBOC review, assessment, identification would be such that it would raise any issues with regard 

to access to care, and that would help drive our need and 

prioritization of where and what size that CBOC would be. 

Typically we incorporate the plans for the CBOCs at least 2 

years in advance, and if we look back at the CARES, when that 

started, we have a queue of CBOCs that had been identified, and 

as we create the business plans for these CBOCs, then we bring 

those forward for further assessment or approval to be activated. 

Mr. MICHAUD. That is all depending on what is available for financial resources? 

Mr. WILLIAMS. Mr. Chairman, we continue to assess our priorities and we assess those priorities against the needs. We look at 

the funding that has been provided for us to meet those needs, as 

we move forward to bring our projects and CBOCs online. 

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Mr. MICHAUD. When you look at the issue of access, I mean 

under the CARES process, we talk about access points, and what 

we are talking about is whether we are doing construction. How 

closely have you worked, I know it just got up and running, with 

the Office of Rural Health within the VA system, because now I 

will use the Holton example. That is supposed to be an access 

point. However, you really don’t need to move forward with a separate building there because you can utilize existing resources with 

the hospital. 

Under the CARES process and when you are looking at trying 

to move forward on construction, whether it is major or minor, are 

you also looking at areas of the country where you might not want 

to build, but you might want to collaborate with a local healthcare 

facility, whether it is a hospital or a federally-qualified healthcare 

clinic to utilize them as an access point versus building a facility? 

Mr. WILLIAMS. Mr. Chairman, yes, we are, and part of that business plan or that prospective that is developed, we have to look at 

all viable options that are available to us, such as proximity to 

other services in the area, and DoD. We also review our ability to 

maximize the use of technology to reach some of these access 

points. 

Now, as you are aware, on February 20, the Secretary, Dr. James 

Peake, made an announcement relative to the creation of Rural 

Health National Advisory Committee, and that Committee in itself 

will be an asset in that it will go out and it will assess areas of 

need as it relates to rural health, and come back and advise the 

Secretary and the Under Secretary for Health with viable options. 

We look forward to the results of that Committee. Meanwhile, we 

rely on the medical centers, networks, headquarters, and support 

veteran service organizations to help us identify the opportunities 

that are there for us to meet or exceed our veterans’ expectations. 

Mr. MICHAUD. I just want to get to this line of questioning. When 

you do that process, are you saying, well, we get X amount of 

money so here are the next 20 CBOCs or access points that might 

be available? Are you looking at it that way or are you looking at 

it, well, here is the—I am not sure how many access points were 

in the CARES process now or how many are left to go, or are you 

looking at it, here, we have 500 access points nationwide. Within 

that 500 we know that we can’t build access points in all of those, 

so rural health, tell me which ones we might be able to move forward next year to really collaborate with local health providers, 

whether it is a hospital or a federally-qualified healthcare clinic. 

Are you looking at it broadly or are you looking at it narrowly, this 

is the next line, so how can we do that versus here is a whole list, 

it might be near the bottom of the list, it might not be a real high 

priority, but you can get it up and running very quickly because 

you don’t have to build, there is already a facility that you can 

work with other providers? 

Mr. WILLIAMS. Mr. Chairman, as I understand it, the rural 

health initiative will be one component of the process that we use 

to assess veteran needs across the country. Where we develop a 

CBOC is not driven by dollars. It is driven by identified needs for 

our veteran population. 

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To that end, the business plan for a CBOC comes forward driven 

by the access, driven by the needs of our veterans, and based upon 

the facilities and the networks’ determination of where their greatest need is to meet our veterans’ healthcare needs. 

With regards to the funding piece of it, as you know, we continue 

to prioritize the needs that we are presented with, and within that 

prioritization we make decisions about what starts when, but make 

no mistake, every effort is given to make sure that the highest priorities are met and addressed, and in as timely a fashion as we can 

address them. 

Mr. MICHAUD. Thank you. My last question actually will be a parochial one in that the fiscal year 2009 budget lists Togus as a specialty care addition for a potential major construction project that 

was under the CARES process. 

My office has been told that it would cost in the range of $50 million. As you know, Maine remains an underserved area. How can 

we move this project from a potentiality to a reality? How can we 

do it in a timely fashion to get the services to the veterans who 

need them today? 

Mr. SULLIVAN. Mr. Chairman, on our list of major construction 

projects, we don’t have a Togus. Is it minor construction or is it—— 

Mr. MICHAUD. It is a future—— 

Mr. SULLIVAN. Oh, a future one? 

Mr. MICHAUD. Yes. 

Mr. SULLIVAN. At this point in the process, we are conducting a 

2010 process, and there has been a data call that goes out to the 

field, get the list similar to the 2009 list together. That is currently 

under review and facilities are in the process of submitting their 

data. And as we go through the 2010 budget process, that was to 

come out. 

Mr. MICHAUD. Okay. 

Mr. SULLIVAN. I am not familiar with it. I can get you some information for the record on it. 

[The following was subsequently received:] 

‘‘2009 Togus, ME, Specialty Care Addition’’ 

This project addresses CARES projected workload and space gaps for the specialty 

care clinics, and permits expansion of ancillary and diagnostic services as well as 

administrative services to address space gaps and substandard space for these functions. The project proposes to construct a new specialty care clinic of 72,000 GSF 

and relocate selected specialty care functions to that space and out of Building 200/ 

200E for the ultimate purpose of backfilling the vacated space with ancillary/diagnostic services (28,000 GSF) and administrative services (12,000 GSF) in order to 

resolve the existing space gaps. Additional work required to assure the viability of 

this project will be to increase parking and expand site utilities to support the new 

space and correct existing vulnerabilities. 

Mr. MICHAUD. Yes. It is my understanding that it is for the potential major construction project, so I wanted to get it off that potentiality to make it a reality so I will know what the process is 

to do that. 

Mr. SULLIVAN. The process is those projects will be rated and 

ranked this summer, and they will be put up against the available 

resources in the budget, and as I said earlier, they will draw a line 

and see how far it goes. I don’t have any knowledge of where Togus 

is on that list, and they are still in the developmental stage, but 

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23 

we can try and get you some information on the scope of the 

project. 

Mr. MICHAUD. Now, when you deal with a project such as that, 

when you look at VISN 1, which is located in Boston, which is 

problematic if you want to expand or do anything in a highly metropolitan area like that, where it is a lot cheaper to deal with it 

in rural areas, are you also looking at that aspect as well when you 

deal with not only VISN 1 but other VISNs where there might be 

a need for an expansion to try to find the most cost-effective way 

to expand? 

Mr. SULLIVAN. Right. If it is proposed as a major project, they 

look at a potential, other alternatives, do other than major construction such as leasing to see if it is viable. But the priority list 

is need-based. Where it is in the country per se isn’t a factor, nor 

is the cost of construction a factor. It is based upon what is the veteran need, and we have seven bits of criteria, if you will, that they 

are judged against: how well does it improve the delivery of service 

to veterans; how much does it improve the asset, safeguarding the 

asset through security or safety concerns; does it have special emphasis programs for returning veterans, SCI, TBI, those types of 

programs in it; how well does it improve our asset portfolio goals. 

Those are the primary factors that the project is gauged against, 

if you will, and then it is prioritized based upon how well it does 

against those seven bits of criteria. 

Mr. MICHAUD. In that criteria, you actually heard Congressman 

Brown talk about this morning. If there are other entities other 

than the VA that are actually looking at building a new medical 

facility, and they could do it collaboratively, is that taken into consideration as well? 

Mr. SULLIVAN. Yes, especially if it is with another governmental 

element or DoD, those projects do get beneficial value, if you will, 

if they have that component in it. 

Mr. MICHAUD. Another governmental entity. What if it is a private nonprofit? 

Mr. SULLIVAN. I would have to check but I don’t believe that is 

given extra value if it is a private entity. 

[The following was subsequently received:] 

Projects that involve a private entity do not receive extra value in the 

prioritization process. 

Mr. MICHAUD. Okay. Thank you. Actually, I was asking all these 

questions giving Mr. Brown time to get back here. 

I will ask one more while Mr. Brown settles in. Also the CARES 

process actually recommended that in VISN 1, that to try to maximize saving costs, that they actually recommended that they work 

with the State’s veteran nursing home as well. When you look at 

construction or access points throughout the country, are you also 

looking at ways where you can collaborate, in this particular case, 

with the State veterans nursing home to help save on cost, but also 

when you look at veterans, you know, you have an opportunity to 

have a veterans complex versus building it someplace where there 

might not be a State veterans nursing home? Are you looking at 

those issues as well? 

Mr. NEARY. Mr. Chairman, as you know, there are several instances where the VA has provided the property to a State for the 

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construction of a State veterans nursing home. I believe there are 

some instances where VA and State veterans homes collaborate in 

terms of providing some services. 

So we obviously have close relationships with State homes, and 

would be glad to engage with any of them where there appear to 

be opportunities. There are obviously contracting rules that need to 

be considered, and you know, might get in the way or might not 

get in the way, but in each case you have to look at what kind of 

services you are talking about, and then move forward. 

But we would be glad to look at any particular instance where 

a State might have an interest. 

Mr. MICHAUD. Yes, this one actually—it has actually happened 

in Maine where I must say the new director at Togus is doing a 

fabulous job thinking outside the box and how he cannot only deliver services, but do it in a cost-effective manner, and actually the 

State veterans nursing homes, they do have a CBOC in Bangor, 

Maine. It is a renovated facility. It is old. It is outdated, and it is 

not really doing the job that it should. The State veterans nursing 

home is willing to actually build a brandnew building with their resources designed to what the VA needs, and it will really be costeffective. 

So those are some things that I am interested in, how can you 

collaborate to save resources, but also make sure veterans have the 

services that they need? So I do want to say I really appreciate all 

the work that your folks out there in the field are doing to try to 

deliver services to our veterans but also to do it in a manner that 

is cost-effective. 

Mr. Brown. 

Mr. BROWN OF SOUTH CAROLINA. Well, thank you, Mr. Chairman, and I apologize for taking a little bit longer than you did to 

get back, but we get involved in some other things. But thank you 

all for being here today. You were all here, I guess, when we had 

the previous panel from the service organizations, and we are just 

looking for—as a partnership with all groups, but with certainly 

the VA too, to try to find as much proactive dialog as we possibly 

can in order to bring the highest level of service, medical service 

to our returning veterans as possible, and I know you were here 

and you have certainly been involved with the Charleston model, 

which I am very interested in. 

It seems like that we have had a little movement on it, but not 

much movement, and it seemed like to me we are missing a real 

opportunity by not incorporating our plans to improve our services 

there for the veterans along with the medical university. 

We already have a cooperative arrangement with the Heart Research Center, and so this is nothing new to Charleston, to work 

interactively with the VA and the medical university. 

So could you all give me kind of an update of where we are on 

that project and where you think the next step might be? 

Mr. WILLIAMS. Mr. Chairman, Mr. Brown, thank you for the opportunity. 

As you are aware, there was a joint collaboration group that was 

put together several months back that was to focus on identifying 

opportunities for sharing between the medical center and the medical university. The medical center and the university have moved 

WWOODS2 on PRODPC68 with HEARING

25 

forward, and I would agree, some small steps have been achieved. 

Recently collaborated approaches include new equipment, tomography equipment that has been installed. There was a ceremony in 

January, I believe, a ribbon cutting to support this collaboration. 

We have had ongoing discussions about MRIs and various levels 

of negotiation with regard to that piece of equipment, but we are 

committed to working with the school, to move forward to address 

those opportunities. 

We have within the past year, 18 months, have a new director 

in place who is engaged and works very well from what I understand with local medical school leadership, and we are fortunate to 

have a new network director, Mr. Larry Barrow, who understands 

and works hard to meet the commitment to our veterans. 

I know you know that area better than anyone, and understand 

that although it is an old facility, you know, we continue to work 

hard to keep that facility in a condition that is acceptable for our 

veteran population. One of our biggest constraints is administrative 

space, and the local leadership, network leadership have been in 

discussions and are preparing presentations to move forward to address some of the most immediate needs. 

I would say to you that we continue to observe and respect the 

concerns locally. We remain committed to our responsibility to 

work with the local leaders to help find solutions that are mutually 

beneficial, and are reasonable to support not only the needs of the 

medical center and our veterans but also to be cognizant of the 

needs of the community. 

Thank you. 

Mr. BROWN OF SOUTH CAROLINA. If I may follow up on that. I 

think this is the third Secretary that we have been involved with 

in trying to come up with this new idea, and we did an extensive 

study with both agencies to try to determine what would be the 

best areas to collaborate, and so some of those were the imaging 

equipment, and some of them were maybe the operating space and 

some other areas. Never were we ever proposing to have separate 

bed towers, I mean, a single bed tower. We are always having separate bed towers so the veterans would have their own identity and 

their own facilities there. Only we would look at collaborating with 

those units that there could be high cost equipment, testing equipment, operating rooms, imaging equipment, this sort of thing. 

But we recognize that in order to make it a feasible operation we 

would have to have a closer proximity between the patient and the 

facilities. And so we are pretty close now as far as with a new facility that the medical university built, but to better use the land and 

the proposed plan for the overall medical university facility, the VA 

hospital where it sits is not in the same planned best use of the 

land facilities that both the university and the VA own. 

I know that the hospital, they have done a great job in maintaining that hospital, and you walk in and it looks like, you know, 

state-of-the-art, but you recognize that the state-of-the-art is not 

only on the inside, it is actually inside the walls, and some of that 

infrastructure is not there to support the high-tech which we need 

now to service our veterans in the best accommodating way. 

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So we just feel like it is an opportunity lost if we don’t incorporate the VA facilities with the medical university in their construction phase. 

I already see as we look at the CARES package, and Mr. Chairman, you might have noticed that some of the cost has doubled 

even before we start making the first foundation, and that is what 

is going to happen in this operation here. That is the reason I mentioned earlier with the other panel about becoming proactive, you 

know, not reactive, and I know we are all living with what happened down in New Orleans, and what is going to happen in Puerto Rico too apparently, but sometimes we are penny-wise, a dollar 

foolish, and so I would hope that we could work closer. 

I know Secretary Peake has certainly been apprised of this process, and so anyway, we certainly are grateful for your cooperation. 

I just think it is a window of opportunity. If we don’t seize upon 

it, it is going to be something that will never happen. So I would 

hope, Mr. Chairman, that we could find some facilities in order to 

make that work. 

Mr. WILLIAMS. Thank you, sir. 

Mr. MICHAUD. Thank you very much, Mr. Brown. I am sure that 

they definitely will be a lot more proactive if we give them the resources so they can be proactive, so that is one of the things that 

I think is very important, and as I stated earlier, if you look at an 

economic stimulus package, construction is definitely the way to go. 

If you want projects to put people to work, the quickest, fastest 

way to do it is through construction, but it is also investing in an 

infrastructure which desperately needs it. 

So hopefully we will be able to give you an opportunity to be 

more proactive in the future with the resources that we will be giving you. 

So in closing, I do want to thank each of you, Mr. Williams, Mr. 

Neary, Mr. Sullivan, and Mr. Orndoff for your time this morning. 

We look forward to working with you, and if there is ever anything 

that we can do to make your life easier as far as moving these 

projects forward, if needs change, please don’t hesitate to let us 

know. It is a collaborative effort. The only way that we are going 

to be able to help our veterans is if we work together with the VA 

and the VSOs to try to take care of some of the glitches that might 

be slowing down the process. We want to make it as smooth as possible for you so we can take care of our veterans. So once again, 

I want to thank each and every one of you for coming here this 

morning. 

So if there are no further questions, we will close the hearing. 

Thank you. 

[Whereupon, at 11:42 a.m., the Subcommittee was adjourned.] 

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A P P E N D I X 

Prepared Statement of Hon. Michael H. Michaud 

Chairman, Subcommittee on Health 

I would like to thank everyone for coming today. 

Today’s hearing is an opportunity for the VA, Veteran Service Organizations and 

Members of this Subcommittee to discuss draft legislation dealing with Fiscal Year 

2009 VA construction. 

Thirty-eight United States Code requires statutory authorization for all VA major 

medical facility construction projects over $10 million and all major medical facility 

leases more than $600,000 per year. This hearing is a first step in this important 

process. 

I would like to note that this draft legislation is based on the Department of Veterans Affairs’ Fiscal Year 2009 budget request and reauthorizations from Fiscal 

Year 2008. I consider this draft to be a starting point. I look forward to hearing from 

the VA, the VSOs and Members of the Subcommittee about other construction 

projects that are important to them. 

I will take under consideration the discussion we have today and any input that 

may come up. I will then introduce legislation in the very near future. 

f 

Prepared Statement of Hon. Jeff Miller 

Ranking Republican Member, Subcommittee on Health 

Thank you, Mr. Chairman. 

I appreciate your holding this hearing to discuss a draft bill that would authorize 

the Department of Veterans Affairs (VA) to carry out major medical facility projects 

and leases for fiscal year 2009. 

Important to delivering high quality care to our Nation’s veterans is the planning 

for the construction and renovation of VA’s substantial health care infrastructure. 

VA maintains an inventory of approximately 1230 health facilities. This includes 

153 Medical Centers, 135 Nursing Homes, 731 Community Based Outpatient Clinics, and 209 Vet Centers. 

VA initiated the Capital Asset Realignment for Enhanced Services (CARES) process to identify and address gaps in services or infrastructure eight years ago. The 

CARES process continues to serve as the foundation for VA’s capital planning priorities. 

VA’s construction planning, however, is not without challenges. The rising cost of 

construction has been significant. In fact, the draft legislation we are discussing 

today would provide over $670 million to account for cost increases for previously 

authorized construction projects. 

Mr. Chairman, I am extremely concerned that VA’s inability to accurately project 

cost estimates is adversely affecting the construction process. Escalating project 

costs continue to require this Committee to reexamine and increase authorizations 

for existing projects, hindering the ability to move forward with new projects important to improving access to care and supporting future health care demand. 

CARES identified Okaloosa County in my district in Northwest Florida as underserved for inpatient care. In fact, it is the only market area in the VISN, VISN 16, 

without a medical center. However, VA has yet to act to address the inpatient care 

gap in this region. 

There is a tremendous opportunity to collaborate with the Department of Defense 

(DoD) for medical services on the campus of Eglin Air Force Base that would benefit 

both veterans and active duty service members in this area. 

Last September, I introduced H.R. 3489, the Northwest Florida Veterans Health 

Care Improvement Act. This legislation would expand the partnership between 

Eglin Air Force Base (AFB) and the VA Gulf Coast Veterans Health Care System 

(VA GCVHS) to provide more accessible health care to eligible DoD and VA patients 

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in the Northwest Florida region. In collaboration with DoD, this bill would provide 

inpatient services and expand outpatient specialty care through the construction of 

a joint VA/DoD outpatient medical facility on the Eglin AFB campus. 

At our November 2007 Subcommittee hearing, Major General David Eidsaune, 

Commander, Air Armament Center, Eglin Air Force Base, testified about the successful partnership VA and DoD have developed in the region and stated that ‘‘This 

cooperative effort should serve as a model for future efforts to support the health 

care needs of our nation’s veterans.’’ 

Mr. Chairman, I am providing you with updated legislative language that reflects 

the intent of H.R. 3489. I respectfully request that this language be included in the 

introduced version of the ‘‘Department of Veterans Affairs Medical Facility Authorization and Lease Act of 2008’’ that will be considered by the Full Committee. 

I would be pleased to answer any questions. I yield back. 

Thank you, Mr. Chairman. 

f 

Prepared Statement of Dennis M. Cullinan, 

Director, National Legislative Service, 

Veterans of Foreign Wars of the United States 

on Behalf of The Independent Budget 

MR. CHAIRMAN AND MEMBERS OF THIS SUBCOMMITTEE: 

On behalf of the men and women of the Veterans of Foreign Wars of the U.S. and 

the constituent members of the Independent Budget, I thank you for inviting us to 

present our views at this most important legislative hearing. The VFW handles the 

construction portion of the IB and we will be representing the collective position of 

the IBVSOs regarding the draft bill under discussion today cited as the ‘‘Department of Veterans Affairs Medical Facility Authorization and Lease Act of 2008.’’ 

With respect to construction, the IB’s most fundamental objective is to produce 

a set of policy and budget recommendations that reflect what we believe will best 

meet the needs of America’s veterans. In this regard, and as we have recently testified, the Administration’s Fiscal Year 2009 budget request for Major and Minor construction is woefully inadequate. Despite hundreds of pages of budgetary documents 

that show a need for millions of dollars in construction projects, the Administration 

saw fit to halve the major and minor construction accounts from the FY 2008 levels, 

failing to meet the future needs of our veterans. 

The legislative proposal under discussion today demonstrates that this Congress 

is ready, able and willing to correct this situation, and to advance VA’s construction 

priorities so that future generations of veterans—such as those currently serving in 

the deserts of Iraq and the mountains of Afghanistan—will have a first-rate VA 

health care system ready to fully meet their needs. 

It is also our view that VA construction and infrastructure maintenance must be 

carried out in a methodically planed and orchestrated manner. One of the strengths 

of VA’s Capital Asset Realignment for Enhanced Services (CARES) process is that 

it was not just a one-time snapshot of needs. Within CARES, VA has developed a 

health care model to estimate current and future demand for health care services 

and to assess the ability of its infrastructure to meet this demand. VA uses this 

model throughout its capital planning process, basing all projected capital projects 

upon demand projections from the model. 

This model, which drives many of the health-care decisions VA makes, produces 

20-year forecasts of the demand for services. It is a complex model that adjusts for 

numerous factors including demographic shifts, changing needs for health care as 

the veterans’ population ages, projections for health care innovation and many other 

factors. 

We applaud that the construction, renovation and maintenance projects covered 

in this draft-bill are in keeping with this planning process, and will now briefly address its specific sections. 

Section 2 of this bill provides for up to $54 million for seismic corrections at the 

Denver VAMC; up to $66 million for construction of a Polytrauma Center at the 

VAMC in San Antonio, and up to $225.9 million for seismic corrections at the 

VAMC in San Juan. The IB supports these provisions. 

Section 3 provides for the modification of funding amounts for major construction 

projects previously authorized. Construction for the VAMC in New Orleans is authorized at $625 million from $300 million and the construction project at Denver 

moves from $98 million to $769.2 million. The cost of the correction of patient privacy deficiencies at the Gainesville VAMC is updated to $136.7 million from $85.2 

million. The construction of the new VAMC in Las Vegas is authorized at $600.4 

million from $400.6 million. We note that this reflects the rapid escalation of conWWOODS2 on PRODPC68 with HEARING

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struction costs over time and illustrates the IB view that construction and renovation projects be authorized, funded and then carried out in a timelier manner. The 

construction of a new VA outpatient clinic in Lee County, Florida is authorized at 

$131.8 million in place of $65.1 million. Construction of a new VAMC is set at 

$656.8 million from $377.7 million. Last under this section, consolidation of campuses in Pittsburgh rises from $189.205 million to $295.6 million. 

Section 4 authorizes major medical facility leases in FY 2009, Provided for: 

$4.326 million for an outpatient clinic in Brandon, Florida; $3.995 million for a clinic in Colorado Springs; $5.826 million, Eugene, Oregon; $5.891 million for the expansion of a clinic in Green Bay; $3.731 million for a clinic in Greensville, SC; 

$2.212 million for a clinic in Mansfield, Ohio; $6.276 million, Mayaguez, Puerto 

Rico; $5.106 million, Mesa, Arizona; $8.636 million for interim research space in 

Palo Alto; $3.168 million for a clinic expansion in Savannah; $2.295 million for an 

outpatient clinic in Sun City, Arizona; and, last under this section, $8.652 million 

for a primary care annex, Tampa, Florida. 

Section 5 provides for the authorization of appropriations for FY 2009 Medical 

Facility Projects covered under this act. Provided for: $345.9 million for projects authorized in section 2 and $1.635 billion for the increased amounts for projects modified by section 3. Under this section, $60.114 million is authorized for the leases 

provided for in section 4. 

Section 6 imposes a 60-day congressional reporting requirement on the Secretary regarding compliance with section 312A of Title 38 USC and is supported by 

the IB VSOs. Section 7 delineates a technical correction in which we concur. 

Mr. Chairman, this concludes my testimony and I will be pleased to respond to 

any questions you or the members of this Subcommittee may have. Thank you. 

f 

Prepared Statement of Statement of Joseph L. Wilson, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for this opportunity to present The American Legion’s views on ‘‘VA 

Construction Authorization’’ within the Department of Veterans Affairs (VA). 

Proper assessment and improvements to the infrastructure of the VA healthcare 

system is vital in ensuring America’s veterans are well served. The average age of 

VA health care facilities is approximately 49 years old. Proper funding must be provided to update and improve VA facilities. 

With the enactment of Public Law 110–161, the Consolidated Appropriations Act 

for FY 2008, VA was provided the largest increase in veterans’ funding in its 77- 

year existence. The American Legion applauds Congress for this much needed increase. 

However, there are questions, such as, whether or not current construction funding adequately maintains VA’s aging facilities, as well as its ongoing requirement 

for major and minor construction. 

Major Construction 

When former VA Secretary Anthony Principi testified before the House Veterans’ 

Affairs Subcommittee on Health in 2004, he stated that the Capital Asset Realignment for Enhanced Services (CARES) reflected a need for additional investments of 

approximately a billion dollars per year over five years to modernize VA’s medical 

infrastructure, as well as enhance veterans’ access to care. CARES became the premier plan for the correction and upgrade of VA’s infrastructure. 

The FY 2009 budget request was $582 million for Major Construction, falling far 

below the amount recommended by former Secretary Principi. From 2004 to 2007, 

only $2.83 billion for CARES projects had been appropriated, an overall shortage of 

funding. 

Mr. Chairman, veterans’ health care is ongoing, 24 hours daily, 7 days weekly, 

and 365 days annually. In addition, returning veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) are returning home and seeking health 

care within the VA health care system. 

The FY 2009 budget does not begin to accommodate the needs of the VHA, not 

to mention planned projects of previous fiscal years. To date, four of the 10 previously planned projects, to include San Juan, Puerto Rico; Los Angeles, California; 

Fayetteville, Arkansas; and St. Louis, Missouri, have received no funding. Delays 

in funding cause delays in health care. 

According to VA, the top three FY 2008 projects, Tampa, Florida; Bay Pines, Florida; and Seattle, Washington, would cost approximately $334 million, but none reWWOODS2 on PRODPC68 with HEARING

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ceived a funding request. In addition, the 10 partially funded projects have a balance of $1.59 billion. The aforementioned alone adds up to almost $2 billion. 

Mr. Chairman, when the Veterans Hospital Emergency Repair Act was passed in 

2001, there was a construction backlog that continued to grow. During the CARES 

process, there was the de facto moratorium on construction, but the health care 

needs for this nation’s veterans didn’t cease during this time, and yet still, the construction backlog increased. 

Minor Construction 

VA’s Minor Construction budget includes any project with an estimated cost equal 

to or less than $10 million. Maintaining the infrastructure of VA’s facilities is no 

minor task. This is mainly due to the average age of the facilities. These structures 

constantly require renovations, upgrades, and expansions. The health care delivery 

facilities of VA are increasingly aging and in need of substantial renovation and improvements related to fire, seismic safety and privacy standards that can be 

achieved with an adequate Minor Construction budget. 

A System Worth Saving Site Visits 

From 2006 to date, The American Legion’s National Field Service Staff and System Worth Saving Task Force have visited a combined total of 113 VA Medical Centers, Community Based Outpatient Clinics, and Vet Centers in all 21 Veterans Integrated Service Networks (VISNs). During these site visits, many facilities reported 

space and infrastructure as their main challenges. 

The American Legion receives daily calls from veterans who are concerned for 

their safety due to the closure of 24-hour emergency rooms in the rural areas such 

as Alabama and Louisiana. Within these rural areas, it was reported that the nearest VA facility was approximately one hour away. 

During The American Legion’s 2006 site visits, our overall report ascertained that 

maintenance and replacement of VA’s physical plant was an ongoing process and 

a major challenge to facility Directors. It was also reported that deferred maintenance and the need for entirely new facilities presented an enormous budgetary 

challenge. The repairs in most of the facilities visited were largely successful, however, some parts of the infrastructures still posed significant risk of further deterioration. For example, it was reported that the underground main at the Albany 

VAMC could fail at any time and, theoretically, deprive large parts of the facility 

of heating. 

During The American Legion’s April 27, 2006 site visit to the Wilmington VA 

Medical Center in Delaware, building issues included a shortage of usable space to 

allow for expansion of needed programs to accommodate the influx of new veterans. 

The facility lacked construction funding for this project. With regard to funding adequacy for ongoing construction projects at Wilmington, there were no approvals for 

the Wilmington facility for major or minor construction for FY 2006. 

The American Legion visited the Togus VA Medical Center in Augusta, Maine on 

January 9, 2006 to conduct a full site visit. It was reported the considerable maintenance required for the older buildings had been neglected, with management citing 

$61 million in deferred maintenance. Other areas urgently requiring work included 

remediation of structural deficiencies, masonry restoration, roof repairs, and reconstruction/repairs to roads and parking lots. 

In 2007, the National Field Service Representatives focused on VA Polytrauma 

Centers and Vet Centers, but also maintained, in thought, their connection to the 

entire VA Medical Center system. During The American Legion’s visit to the St. 

Louis VAMC on May 16, 2007, it was reported that major work was required on 

outpatient wards. These wards were previously converted from inpatient wards but 

were never renovated. The outpatient clinics were in need of modernization. The 

overall report of this facility included an outdated facility and lack of space. 

During The American Legion’s site visit to the VA Puget Sound Health Care System in Seattle, Washington on May 7, 2007, it was reported that there was a problem with various funding, which involved the operation of each building and their 

function. Puget Sound reported when it comes to funding construction projects, it 

is like ‘‘robbing Peter to pay Paul.’’ 

The Sepulveda Vet Center visit was one of the most unique site visits, being that 

it is the sole Vet Center to remain on VAMC grounds. The building that houses the 

Sepulveda Vet Center programs lacks heating due to an inoperable furnace. The Vet 

Center reported that there was no budget for that expense. Although our visit didn’t 

extend to the respective VA Medical Center, it gave rise to questions of their needs. 

Mr. Chairman, the issues mentioned are a microcosm of structural problems 

throughout the VA Medical Center system. Although not mentioned in this testiWWOODS2 on PRODPC68 with HEARING

31 

mony, The American Legion maintains an account of its site visits in the annual 

publication of its ‘System Worth Saving’ report. 

Conclusion 

As time progresses, the demand for VA health care is increasing while failure to 

improve the infrastructure causes unsafe conditions for veterans, as well as VA 

staff. The American Legion continues to insist that sufficient funding must be provided to maintain, improve and realign VA health care facilities. 

Mr. Chairman and members of the Subcommittee, The American Legion sincerely 

appreciates the opportunity to submit testimony and looks forward to working with 

you and your colleagues to resolve this critical issue. Thank you. 

f 

Prepared Statement of Statement of Richard F. Weidman 

Executive Director for Policy and Government Affairs, 

Vietnam Veterans of America 

Good morning Chairman Michaud, Ranking Member Miller, and distinguished 

members of this Subcommittee. Thank you for giving Vietnam Veterans of America 

(VVA) the opportunity to offer our comments the VA FY’09 Construction Authorizations. 

In the last few years, the VA has spent millions of dollars on a plan to restructure 

the VA health care system’s capital assets. After extensive study—although some 

of us believed it was flawed due to the absence of mental health and long-term care 

in its models—the report called for about $6 billion to be invested in the system. 

VVA believes this indicates the magnitude of the problem of a crumbling infrastructure that was, for the most part, built in the forties and fifties. 

The promises of VA’s Construction Acquisition and Restoration for Enhanced 

Services, or CARES, program has seemed far from fulfillment in the past three or 

four years as the coffers of medical facilities continued to be robbed to pay for medical services operations. It must be disheartening for hardworking and dedicated 

employees of the VA to compare the state of many of their facilities to those in the 

community. 

Some VA hospitals are barely maintaining accreditation because they cannot meet 

privacy and access standards because of overcrowding. The VA has delayed vital 

capital equipment purchases and non-recurring maintenance projects in order to 

fund gaps in veterans’ health care. Yet the Administration has proposed a decrease 

in construction funds. This is not only not a prudent or conservative response to the 

clear infrastructure needs of the VA health care system, it would appear to be wildly 

irresponsible and far from anything that could be considered prudent business practice, much less good medicine. This practice must cease. 

Dilapidated and over-crowded facilities are symbolic of the lack of consistent and 

concerted commitment toward meeting the obligation the federal government has to 

those who have served or would serve their nation, even after five years of a seemingly endless war. We can do better; we must do better. 

I would be remiss if I did not note for the record that VVA never ‘‘agreed’’ to the 

civilian formula being used in the CARES process because it does not take into account the diseases, wounds, and maladies that are due to military service, depending on the branch of service, when and where one serves, and what one actually 

did and was exposed to (including vaccines). 

VVA respectfully requests that this distinguished panel hold a future hearing on 

the dual subject of ‘‘caring for war wounded and ill’’ that would include the CARES 

formula, the need for VA clinicians to take a complete military history to assist in 

the diagnosis and treatment of veterans, and the general lack of attention to the 

VA’s Veterans Health Initiative (VHI) 24 curricula in the wounds and maladies of 

war. VVA reiterates that VA must truly become a ‘‘veterans health care system’’ instead of a general health care system that happens to be for veterans (which is generally what we have now, with a few add-on programs). Because this shift will affect 

plans for physical plants to adequately meet the needs of veterans in the future, 

it would be a much needed and quite useful hearing that would be directly related 

to the matter at hand of this hearing. 

Congress should restore and enhance the medical facilities budget by at least $.5 

billion for medical facilities in fiscal year 2009. It should increase VHA’s portions 

of major and minor construction by at least $1 billion. 

The VA FY’09 request for construction funding for health care programs is $750.0 

million—$476.6 million for major construction and $273.4 million for minor construction. 

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The VA budget request for major construction would provide additional funding 

and VVA fully supports authorization for the following five medical facility projects: 

• Denver, Colorado ($20.0 million)—replacement medical center near the University of Colorado Fitzsimons campus; 

• Lee County, Florida ($111.4 million)—new building for an ambulatory surgery/ 

outpatient diagnostic support center; 

• Orlando, Florida ($120.0 million)—new medical center consisting of a hospital, 

medical clinic, nursing home, domiciliary, and full support services; 

• San Juan, Puerto Rico ($64.4 million)—seismic corrections to the main hospital 

building; and 

• St. Louis, Missouri ($5.0 million)—medical facility improvements and cemetery 

expansion. 

VVA fully supports the FY’09 VA budget for major construction funding in that 

would allow construction of the three new medical facility projects listed: 

• Bay Pines, Florida ($17.4 million)—inpatient and outpatient facility improvements; 

• Tampa, Florida ($21.1 million)—polytrauma expansion and bed tower upgrades; 

and 

• Palo Alto, California ($38.3 million)—centers for ambulatory care and 

polytrauma rehabilitation center. 

In regard to Puerto Rico, however, we ask that this distinguished panel begin to 

champion the cause of correcting the shoddy infrastructure of VA facilities in Puerto 

Rico. VVA National President John Rowan led a fact-finding delegation to Puerto 

Rico in December 2006. What that delegation found was a shoddy, outdated, and 

non-hurricane proof VA medical center building, totally inadequate parking facilities 

for both staff and patients, and a cemetery that was literally ‘‘racking and stacking’’ 

remains of veterans (this last hardly qualifies as highest respect for these heroes, 

or the stated goal of making the national cemeteries ‘‘national shrines’’). 

The degraded physical plants were indicative of the degraded services provided 

to these veterans, who disproportionately served in the combat arms. The delay in 

adjudicating claims was much longer than the already too long national average. 

Perhaps indicative was the locked door to the ‘‘veteran’s service center’’ that had a 

‘‘Closed until further notice’’ sign. There were scant services for PTSD (and seemingly only desultory interest in improving care for PTSD). Both veterans and staff 

were driving to the VAMC at 3 and 4 in the morning and sleeping in their cars in 

order to get one of the very limited parking spaces. And there was clear evidence 

that an additional Vet Center was vitally needed (especially in light of the scant 

services at the VAMC). 

A report on the above was provided to the Secretary of Veterans Affairs, and VVA 

followed up with repeated conversations with top VA officials. VVA also discovered 

that our findings mirrored the findings of the Center for Minority Veterans and 

other VA entities. A copy of this report was also provided to the delegate from Puerto Rico and to the Hispanic caucus, with a copy to this Committee. 

It is worth noting that VVA sent a one-year later follow-up delegation in December 2007 led by VVA National Secretary Barry Hagge and including VVA Regional 

Board of Directors Member Carol Strumkopf. They found that there were some 

plans in the works, but that the basic situation was little changed. 

In fairness to the VA, there are plans to add a new Vet Center in Puerto Rico, 

to add a new bed tower, and to make some structural changes to strengthen the 

old VAMC building to make it a bit sturdier in the face of a major hurricane. 

VVA recommends that there be an entirely new hospital designed from the outset 

to withstand a category 3 or 4 hurricane. Why is it that $2 billion can be found to 

build an entirely new hospital in Denver but not in Puerto Rico? Were those who 

fought and returned home to Puerto Rico any less valiant or true to the United 

States than those who returned home to Colorado? VVA thinks not. Funds should 

be provided in FY’09 to put this vital move on the fast track. 

Further, VVA has urged the Administration to acquire land for a large new national cemetery now, with a view especially to the divestment by the Department 

of Defense of numerous parcels of land in Puerto Rico. 

VVA also strongly urges that the Congress provide funds that shall be used specifically to acquire land and build a new and large parking garage with a 6 AM to 

6 PM every 15 minute shuttle service to the VAMC. 

VVA believes that degraded physical plants lead to degraded medical services to 

the veterans who use the VA medical system. Therefore, we recommend that this 

committee secure a General Accountability Office (GAO) study of medical services, 

doctor/patient ratios, RN/patient ratios by facility to discover if there is a correlation 

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between poor physical facilities and the recruitment/retention of staff and the actual 

shape of medical services provided. Medical outcomes by DRG should also be studied 

to find out if new facilities improve the medical outcomes for veterans affected. 

VVA fully supports the Department of Veterans Affairs Construction Authorization as written. 

I thank you for affording VVA the opportunity to present our views, and thank 

you for what you are doing to assist veterans and their families. I will be pleased 

to answer any questions you may have. 

f 

Prepared Statement of Donald H. Orndoff, 

Director, Office of Construction and Facilities Management, 

U.S. Department of Veterans Affairs 

Mr. Chairman and members of the Committee, I am pleased to appear today to 

discuss the Department of Veterans Affairs (VA) draft bill to request authorization 

for six major medical construction projects and twelve major medical facility leases, 

as well as addressing other issues related to VA’s construction program. Joining me 

today are Joe Williams, Assistant Deputy Under Secretary for Health, Robert 

Neary, Executive-in-Charge, Office of Construction and Facilities Management, and 

Jim Sullivan, Deputy Director, Office of Asset Enterprise Management. Let me 

briefly begin by reviewing the status of VA’s major construction program. 

The Department is currently implementing the largest capital investment program since the immediate post-World War II period. This program represents implementation of the results from VA’s strategic plan and the Capital Asset Realignment 

for Enhanced Services program (CARES), initiated systemwide in 2002 and yielding 

results in May 2004. Including this year’s request, VA will have received a total of 

$5.5B for CARES projects. Currently, VA has 40 active Major Construction projects. 

Thirty-three of the 40 projects have been funded for a total cost of approximately 

$2.8 billion. The remaining seven projects have received partial funding totaling 

$560 million, and have a total estimated cost of $2.3 billion. VA is requesting $471 

million in Major Construction appropriations for FY09 for infrastructure improvements and enhancements to its medical facilities. This request will provide additional funding to five of the partially funded projects, and begin the construction 

process on three new starts. We are seeking authorization for six major medical facility construction projects and twelve major medical facility leases for FY09. 

VA has a real property inventory of over 5,000 owned buildings, 1,100 leases, 

32,000 acres of land and approximately 158 million gross square feet (owned and 

leased). VA has reduced in excess of 1.6 million square feet in the last two years. 

During the CARES process, the average age of VA facilities was calculated at well 

over 50 years old. Many of these older facilities are not designed or constructed to 

meet the demands of clinical care in the 21st century. VA’s management of these 

assets is critical to providing healthcare and services to our veterans. 

VA effectively manages its vast holding of capital assets through performance 

monitoring and analysis, decreasing underutilized and vacant space, improving facility conditions, decreasing operating costs, and reducing non-mission dependent 

assets. VA also develops energy savings performance contracts designed to reduce 

energy consumption in federally owned facilities, reducing the demand and dependence on natural resources. 

VA utilizes a multi-characteristic decision methodology to foster a decisionmaking 

approach in prioritizing its capital investment needs and requirements. Through 

this methodology, VA establishes its Five Year Capital Plan. The plan describes the 

selection of VA’s capital acquisitions and funding requests by incorporating a formal 

executive review process. The process begins with Veterans Health Administration 

(VHA) strategic planning initiatives that identify capital needs based upon demographic data, workload, actuarial projections, cost effectiveness, risk, and alternatives. Once a potential project is identified, it is reviewed and scored based on 

criteria VA considers essential to providing high quality services in an efficient 

manner. The new funding requirements are considered, along with existing program 

requirements and workload projection decisions, when determining the projects and 

funding levels requested as part of the VA budget submission. 

Selected projects based on VHA’s strategic process are then examined through the 

Department’s Capital Investment Panel (CIP) to ensure all projects are based upon 

sound principles, promote the ‘‘One-VA’’ vision, align with VA strategic goals, address the VA Secretary’s priorities, and support the President’s Management Agenda. The CIP then scores and analyzes the projects on these principles and submits 

the results to the Strategic Management Council (SMC) for consideration. The SMC 

is VA’s governing body responsible for overseeing VA’s capital programs and initiaWWOODS2 on PRODPC68 with HEARING

34 

tives. The SMC reviews the projects and submits its recommendations to the Secretary, who makes the final decision on which projects to include in the budget. 

Major capital investment needs are requested from facilities in the fall, prioritized 

through each Administration and the Departmental review process, and evaluated 

for the Secretary’s approval by the following summer. Under the current process, 

once a decision has been made to include a project in the Department’s budget, the 

design process begins with the selection of the design architect. The design process 

consists of three phases—schematic design, design development and construction 

document preparation. While the timing can vary with the size and difficulty of the 

project, design on average takes 18 months. Once design is complete, the construction contractor is obtained and construction begins shortly thereafter. Almost onethird of VA projects are executed using the design build method in which a contract 

is awarded to an architect/engineer (A/E) and construction contractor team who take 

a preliminary design provided by VA and completes the design and then constructs 

the project accordingly. Although VA does not have a preference for D/B generally, 

we do find it preferable for some small projects, such as parking lots, clinics, and 

office spaces. 

Mr. Chairman and members of the Committee, my further comments regard VA’s 

proposed bill submitted to the Speaker and will relate to the four sections separately, rather than the bill as a whole. 

Section 1. Authorization of Fiscal Year 2009 Major Medical Facility 

Projects 

Section 1 of the proposed bill would authorize the Secretary to carry out four 

major medical construction projects in Lee County, Florida; Palo Alto, California; 

San Antonio, Texas; and San Juan, Puerto Rico. 

Section 2. Additional Authorization for Fiscal Year 2009 Major Medical 

Facility Construction Projects Previously Authorized 

Section 2 of the proposed bill authorizes the Secretary to carry out two major 

medical facility projects located in Denver, Colorado and New Orleans, Louisiana, 

respectively. Both projects were previously authorized for lesser sums under Public 

Law 109–461, but additional authorization is required to complete the construction 

projects at these locations. 

Section 3. Authorization of Fiscal Year 2009 Major Medical Facility 

Leases 

Section 3 of the proposed bill authorizes the Secretary to carry out twelve major 

medical facility leases in fiscal year 2009. These leases will provide an additional 

eight outpatient clinics, expand two current outpatient clinics, develop a primary 

care annex facility, and provide needed research space. 

Section 4. Authorization of Appropriations 

This section requests authorization for the appropriation of $477,700,000 for 

major construction projects in fiscal year 2009 and $1,394,200,000 for the projects 

previously authorized for lesser sums. This section also provides $60,114,000 from 

the Medical Facilities account to authorize twelve major medical facility leases in 

fiscal year 2009. 

In closing, I would like to thank the Committee for its continued support for improving the Department’s physical infrastructure to meet the changing needs of 

America’s veterans, and we look forward to continuing to work with the Committee 

on these important issues. I urge you to support our proposed authorization bill so 

the Department can provide the highest level of care for veterans in these high priority areas. 

Again, thank you for the opportunity to appear before the Committee today. My 

colleagues and I would be glad to answer your questions. 

f 

Statement of Hon. John T. Salazar, 

a Representative in Congress from the State of Colorado 

Good morning Chairman Michaud, Ranking Member Miller and distinguished 

members of this subcommittee. 

Thank you for giving the Committee an opportunity to discuss construction authorization for 2009. 

The replacement and modernization of the VA Medical Center in Denver, located 

on the former Fitzsimons Army Base, is critically important to the Veterans of Colorado. 

The VA completed a study and secured land for the facility in 2006. 

As you know, the VA, wherever possible, builds new medical facilities next to existing medical schools. 

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This is done to save on costs and facilitate the exchange of resources between the 

institutions. 

This center is located adjacent to the University of Colorado Health Science Center (UCHSC). 

At its completion, the Fitzsimons campus will be a healthcare hub for all of Colorado. 

Construction is completed on the Children’s Hospital, the University Hospital and 

St. Joseph’s Hospital. 

For every month that passes, the cost of completing these projects skyrockets. 

Mr. Chairman, I thank you and the members of this committee for giving us the 

opportunity to discuss construction authorizations. 

Æ 

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