Veterans Administration Plans to Close Hospitals

Doug Rokke, PhD, is former Army Physicist and Head of US Army
Battlefield Clean Up Operations in Kuwait after Gulf War I. He
estimates that the Depleted Uranium casualty rate for veterans of Gulf
War I and troops subsequently stationed there is approximately 30
percent. 221,000 have been awarded disability, according to a Veterans
Affairs (VA) report issued September 10, 2002.

While there is no "proof" that Depleted Uranium exposure caused this
health crisis, the high levels of childhood cancers in areas of Iraq
hardest hit by DU weapons strongly suggests radiological or chemical
toxicity.  Government denials lack credibility because the government
denied for years that Agent Orange was disabling soldiers in Vietnam.

These factors, combined with government's intention of protracted
warfare, make this the worst time to close military medical
facilities, yet this is what is being planned.


 Washington Post, Thursday, October 9, 2003

Veterans Administration Eyes Hospital Closings in Health-Care Overhaul
http://www.washingtonpost.com/ac2/wp-dyn/A411-2003Oct8?language=printer

By Edward Walsh Washington Post Staff Writer

With little notice outside the veterans community, the Department of
Veterans Affairs has embarked on a major overhaul of its sprawling
health care system in an attempt to streamline an operation that the
General Accounting Office has said is wasting more than $1 million a
day on unused or unneeded facilities.

The process -- known as Capital Asset Realignment for Enhanced
Services, or CARES -- began last year and is "the first of its kind in
history," according to Robert H. Roswell, the department's
undersecretary for health. "We've never undertaken anything of this
magnitude and scope."

The process is being watched warily by veterans groups, which
acknowledge the VA's need to shed unneeded facilities and deliver
health care more efficiently, but worry about the impact on local
communities whenever the VA suggests closing a hospital or other
treatment center.

"Veterans have an affinity with their local facility, but when they
try to understand what the VA is doing, they say the devil is in the
details and they don't have enough details to make a decision," said
Bob Wallace, executive director of the Washington office of Veterans
of Foreign Wars.

The VA has proposed closing seven hospitals -- including one in Waco,
Tex., near President Bush's ranch in Crawford -- in most cases
transferring their functions to other, nearby VA facilities. This has
led to protests from local groups of veterans who fear they will be
cut off from health care or will have to travel much farther to
receive it.

But along with the closings, which are always painful and
controversial, the proposed CARES plan contains some carrots for
veterans. They include new medical centers in Orlando, Fla., and Las
Vegas, as well as new facilities for the blind and to treat spinal
cord injuries.

In Washington, Maryland and Virginia, the VA proposes to expand
existing outpatient clinics and build new ones, add outpatient mental
health care services, and build a new outpatient facility and add
parking at the VA Medical Center in Washington. It also proposes to
take part in a joint venture with the Armed Forces Retirement Home for
transitional housing for homeless veterans, lease a building in
downtown Baltimore for outpatient care, and build a new nursing home
facility and renovate some mental health care buildings at the Perry
Point Medical Center.

Roswell said the 1999 report by the GAO, the investigative arm of
Congress, was the "catalyst" for a mandate from lawmakers to overhaul
a massive health care system that developed almost by happenstance.

Providing health care to veterans was not the primary mission of the
VA when it was established in 1930. But by the mid-1940s, with the
approaching end of World War II, the agency faced the prospect of
absorbing millions of returning veterans, many of them in dire need of
health care.

In response, Roswell said, the VA went on a building boom from the
late 1940s through the 1950s that essentially put in place today's VA
health care infrastructure. The average VA hospital is more than 50
years old, he said.

But much has changed in the years since these VA facilities were
built. The veterans population, like the U.S. population in general,
has been moving to the South and West -- one rationale for the
proposed new medical centers in Orlando and Las Vegas.

Medical practices have changed, as well. Roswell said that in the
1950s, the "best practice" for treating mental illness was to
institutionalize the patient in a peaceful, quiet setting, which often
meant a rural location. But today, many mental illnesses are treated
on an outpatient basis close to the patient's home, he said.

In what Roswell described as a "very data-driven process," the VA did
an assessment of its facilities and projected the size of the veteran
population in 74 "market areas" around the country over the next 10 to
20 years. It then matched the two to determine where new facilities
might be needed and where others could be eliminated.

The result, unveiled in August, was a draft plan that Roswell contends
"eliminates unused space, adds clinics and hospitals, and improves
access."

But that was not the end of the process. The draft plan was turned
over to a 15-member commission headed by Everett Alvarez Jr., a former
Navy aviator who spent more than eight years as a prisoner of war in
Vietnam. The commission is conducting a series of hearings around the
country to gauge public -- and especially veterans' -- reaction before
it submits a final recommendation to Veterans Affairs Secretary
Anthony J. Principi.

Modeling his approach after the all-or-nothing process that Congress
has adopted when it considers military base closings, Principi has
said that he will accept or reject the commission's final
recommendation in its entirety.

Alvarez said the commission, which is close to completing a series of
public hearings on the plan, has received a mixed reaction in the
communities it has visited.

"Some local people can understand that it makes sense," he said. But
in other cases, the VA proposals are "very controversial, because
[opponents] think it's going to happen tomorrow. But all of this is a
strategic plan that will take place over the next 10 to 20 years."

John A. Brieden III, national commander of the American Legion,
reflected some of the ambivalence with which veterans groups view the
CARES process. He said that at a recent meeting with Principi, "I told
him we are not opposed to closings as long as vets have access to
care. That's the key point. I think some things may need to be done,
and I'm not against it being done if vets still have access."

"There is some truth that there are some savings that are able to be
made by some consolidations," Brieden added. "As long as the decisions
are needs-driven and not budget-driven, we can work with this."

Leaders of other veterans groups, however, expressed more skepticism.
Rick Weidman, director of government relations for the Vietnam
Veterans of America, and Steve Robinson, executive director of the
National Gulf War Resource Center, said they also are not opposed to
the CARES process in principle.

But they argued that the VA health care system has been seriously
underfunded for years, resulting in reduced services that discourage
visits by potential patients who are weary of the long waits they
encounter. In the VA's assessment of its facilities, they maintain,
that phenomenon distorted the real demand for health care services by
veterans.

"This is a patch; it isn't a fix," Robinson said. "The demand is still
going to be there."

Alvarez said the commission expects to deliver its final
recommendation to Principi in December. Principi has said he will
accept or reject the recommendation by the end of the year.