The VA fight: Issues, no answers

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``There should be no reduction of services at the VA. Not when you're fighting a war on two fronts. This is not the time.''

GILBERT LUGO, WALLA WALLA MAYOR

``We're going to push back on all fronts until they come to the table.

We're going to push back _ politically, legally, anything we can do. Just because you're a small facility doesn't mean you aren't worth saving.''

DUANE COLE, Walla Walla City Manager

Bright blue signs in the vacant corridor point the way.

Arrows on two signs point left to an outpatient clinic, various therapy rooms and even a theater.

A second sign, pointing right, directs visitors to ``Building 86 _ Hospital.''While those directions are straightforward, the future for the facility they are in, the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center, is not.

Uncertainty erupted last summer as a federal commission prepared a draft plan for an ambitious overhaul of the Department of Veterans Affairs system of medical care.

As noted by New York Times writer Carl Huse in August 2003, the plan by the Capital Asset Realignment for Enhanced Services commission ...``is the department's most ambitious effort to date in its struggle to put its services where the veterans are and catch up to the shift of medicine to outpatient care.''Since its inception in June 2002, the CARES commission has examined the VA's 5,044 buildings and projected veterans' populations and needs over the next 20 years with the aim of matching the agency's assets to its needs.

But the portion of the plan that deals with Walla Walla has sparked vocal opposition from veterans, local officials and others, which in turn has led to official hearings and public protests.

The commission's recommendations call for closing the present facility and moving outpatient services to an unspecified location.

Inpatient medicine, psychiatric care and nursing home care would be contracted out ``where appropriate'' to other agencies in the Walla Walla geographic area.

Before those actions take place, the VA must ensure there are ``viable alternatives'' in the community to the care currently being delivered and that criteria are in place to contract and monitor the delivery of services.

Those recommendations were sent to Anthony Principi, secretary of the Department of Veterans Affairs, in February.

Although Principi's decision was initially expected within 30 days, it has since been delayed.

Even after his decision, the CARES recommendations still face examination by Congress, which will have 60 days to review and comment on them.

The proposed changes have raised a host of questions about how care for veterans locally and regionally will be continued, where it will be administered and what is to become of the 84-acre hospital site with its 28 buildings, some dating back to the 19th century.

Hospital officials have been told not to comment publicly until a decision is made. The silence is frustrating to Walla Walla officials, who can't get an answer on how and when the plan would be implemented.

``That's another example of the close-mouthed nature of the VA,'' said Walla Walla City Manager Duane Cole. ``Right now everyone has to make up their own story because the VA isn't saying a bit.''That the VA would propose overhauling Walla Walla's facility comes as no surprise to Cole or to employees at the medical center.

The site has been targeted by the federal government for closure in the past, said Jeannie Locati, a transfer clerk in the medical records department.

``I can't even remember how many threats I've heard in 20 years,'' she said.

In 1987, the facility was spared from the chopping block. After a political battle, Congress passed a law saying no changes would take place at the facility that would alter the mission of the program.

Five years later, Walla Walla was visited by then-U.S. Secretary of Veterans Affairs Edward J. Derwinski.

Derwinski noted at the time that changes were ahead for the VA but with proper management all facilities would remain open.

He told the U-B that ``Walla Walla often comes up as an example of a VA facility that should be closed.''But, he added, it would be ``historically wrong'' to shut it down. He envisioned a long-term health-care facility at the site.

``There is always a practical use you can make of a facility...,'' he said.

``When you have a facility like this, the first thing you have to do is make sure it is permanent.''Local officials say the VA has not done that over the last 14 years.

They say little investment has been made to improve infrastructure. The outstretched campus is dotted with lead-paint coated and asbestos-loaded buildings that are inefficient to heat, cool and operate. Correcting the deficiencies would cost millions of dollars, officials say.

Cole said he understands the VA's desire to operate more efficiently. But with no effort to improve the campus and no apparent desire to work with local officials, he said only one conclusion can be drawn.

``For some reason there just doesn't seem to be a will on the part of the VA to have a federal presence here,'' he said.

In other communities with small facilities, the VA has formed partnerships that will help it continue offering services.

One example is Cheyenne, Wyo., where the VA has a relationship with the local university. VA medical facilities are used as training grounds for students in the Family Practice Residency Program, which develops family physicians who want to practice medicine primarily in rural areas.

Cole said officials in Walla Walla have not been included in any discussions on the changes at the local facility. He said he doesn't understand why successful programs in other communities couldn't be used as models to continue providing services here.

In Rutland, Vt., for instance, the VA allows family members of veterans to receive care at the facility through their own insurance coverage.

That program allows the medical center to be open to veterans at the same time it receives reimbursements from nonvets.

In its recommendation to close the campus and contract for inpatient services, the CARES commission assures that no changes will be made to service until alternatives are found in the community.

But officials say no consideration has been given to how it will affect employment in the Valley, what the actual cost-benefit will be or how to dispose of the facilities.

``We have yet to know what facilities and services are available to vets if this facility shuts down,'' said Walla Walla City Councilman Jerry Cummins.

Mayor Gilbert Lugo said with military action in Afghanistan and Iraq, more veterans will be relying on the VA for care.

``There should be no reduction of services at the VA,'' he said.

``Not when you're fighting a war on two fronts. This is not the time.''Officials believe the VA has underestimated how many people will need care in the future.

John King, director of the Washington State Department of Veterans Affairs, wrote in a September letter to the CARES commission that projections for enrollments, funding and need for facilities in the region covering Oregon, Washington, Idaho and Alaska are based on ``artificially low'' estimations.

Between 1990 and 2000, while the national veteran population declined by 5 percent, Washington state's grew 4 percent. He said projections for demand are based on current numbers. They don't take into account that approximately 60 percent of the region's vets are younger than 65 and demands for geriatric and long-term care will increase over the next 20 years.

According to the VA, Walla Walla's facility serves more than 12,000 patients annually. It draws from a 42,000-square-mile service area where 69,000 veterans live.

Walla Walla County Commissioner Greg Tompkins said ensuring good health care is the most important aspect of the equation.

``No matter what the cost is, the human side is we have to take care of (veterans),'' Tompkins said.

Jim Kuntz, executive director of the Port of Walla Walla, said he would like to see services continued in a new facility. He said local officials could help the VA create a master plan that would eventually lead to a modern, efficient facility.

Cole said the city is prepared to fight for the facility. He said the loss of quality health care and jobs is too great for a rural community, such as Walla Walla.

``We're going to push back on all fronts until they come to the table.

We're going to push back _ politically, legally, anything we can do,'' he said. ``Just because you're a small facility doesn't mean you aren't worth saving.''

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