In Washington state, hospitals are as multifunctional as Swiss army knives.
Apart from being round-the-clock providers of health care and community services, they contribute heftily to local economies as major employers and purchasers.
The notion of closing one arouses thoughts of potential devastation in communities, said Randy Revelle, vice president of the Washington State Hospital Association.
Hospital closures are so rare, he said, it is difficult to imagine all the ways a community could be affected.
``They not only have roles as social service agencies, but also as businesses,'' Revelle said. ``If you lose one, you're not only losing health-care capacity, but economic capacity.''That is a major concern for Walla Walla officials as services are threatened at the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center. Proposed changes at the facility would have financial consequences through losses in employment, purchasing and taxes.
A federal commission has recommended the Department of Veterans Affairs close inpatient services, including psychiatric and nursing home care, at the local VA facility, and relocate outpatient services.
The proposal is one piece of a massive overhaul of the federal VA system meant to better serve veterans. The point is to sharpen the operation by realigning facilities with the projected populations of veterans.
Early studies from the group _ the Capital Asset Realignment for Enhanced Services commission _ conservatively estimated the closure would result in the elimination of at least 100 jobs in Walla Walla.
That loss would be particularly hard to overcome, said Jim Kuntz, Port of Walla Walla executive director. The Valley could face the closure of Milton-Freewater call center Sykes Enterprises Inc.
and its roughly 265 jobs.
Additional jobs will be lost with the recent sale of food distribution service Bur-Bee Wholesale Distributors.
But what makes employment losses at the VA worrisome is the caliber of wages, Kuntz said at a March meeting on the CARES recommendation.
According to Port information, the VA is the eighth largest employer in the city and 13th largest in Walla Walla County, with 322 full-time workers and 43 part-timers. Based on an annual payroll estimated between $21 million and $24 million, wages at the facility break down to an average of $57,000 to $65,000 a year.
``In this economy, especially in a rural area, there's just no way we can replace jobs in this Valley at those wages,'' Kuntz said.
The CARES commission proposal calls for contracting with local hospitals and long-term care facilities to continue serving patients. But Kuntz said there is no guarantee contracts will be granted to Walla Walla agencies.
Through a competitive bid process, those services could be moved _ along with their funding _ to other cities.
``There's no assurances in looking at this report that contracting out will even happen in Walla Walla,'' Kuntz said. ``Yakima might get the low bid. The Tri-Cities might get the low bid.''Workers at the VA say the administration has been offering $25,000 buyouts to employees who opt for early retirement.
Kyle Garrison, a nurse who has worked at the VA for the last decade, said some of his co-workers have already left for jobs in other communities.
Others have said they are looking. Garrison said if the closure goes through, he will probably end up moving, too.
But he is hoping it won't come to that.
``I'm holding out to the end,'' Garrison said. ``I'm not ready to start someplace else at the bottom.''He said employees are not the only ones who will feel the pinch of closure.
A reduction in operations at the VA could have a ripple effect on other businesses that serve the facility, from local contractors on the grounds for small-scale construction projects to food distributors who fill the vending machines.
The VA's annual budget has been reported at around $35 million.
After salaries and benefits, which make up more than 50 percent of most hospitals' budgets, the second biggest chunk of spending generally goes to the purchase of goods and services, according to the Washington State Hospital Association.
In 2001, Washington hospitals dedicated 38 percent of their overall budgets to purchasing, the WSHA reported. Those expenditures include drugs, uniforms, food, paper products, lab testing, equipment repair and insurance.
Although the government-owned hospital is exempt from paying certain federal, state and local taxes, one area it does generate revenue for the local government is through sales taxes on local purchases. Those, too, would decrease with the reduction of services at the VA, officials say.
Relationships with community partners may also be at risk.
Marilyn Galusha, director of Walla Walla Community College's nursing program, said she worries about what will happen to partnerships with the local colleges if services are revamped at the VA.
Walla Walla Community College is expanding its nursing program to help meet demands for a statewide shortage of nurses. The VA facility has for years provided students an opportunity to get hands-on experience.
Similarly the medical center has worked with nursing students through the local branch of Washington State University as an education partner.
The hospital is used as a training ground for students to get experience with the specific care needed by veterans, Galusha said.
``To really understand and focus on distinctive vets needs _ there just isn't any other place in town that students could get that training,'' she said.
``If we're going to be educating nurses to be able to care for veterans, we have to have a training site.''Such concerns have permeated economic development meetings _ including the Port of Walla Walla's _ over the last two months.
The topic is somewhat unfamiliar territory to Walla Walla officials facing major changes in what has traditionally been a stable industry.
The state hospital association reports the hospitals are such big players in Washington, they rival Boeing and Microsoft in employment numbers.
But now local officials are thinking about how the area would rebound from losing so many high-paying jobs, not to mention health care for veterans.
``We just cannot let that slip away,'' Kuntz said.