A Department of Veterans Affairs advisory panel wants the government to close hospitals in Pennsylvania, Ohio and Mississippi and scale back most operations at a Texas facility, but it opposes VA proposals to shut facilities in other states.
The panel rejected the VA's proposal to close hospitals in Canandaigua, N.Y., Lexington, Ky., and Livermore, Calif., according to a copy of the commission report obtained by the Associated Press.
The 16-member panel agreed that a new hospital should be opened in Orlando, Fla., but advised against opening a new hospital in Las Vegas. Instead, the commission recommended that the VA continue partnering with Nellis Air Force Base in Nevada for care if it can meet veterans' needs that way.
The commission accepted or rejected a number of other proposals affecting dozens of VA facilities across the country as part of a 20-year plan. In some cases, the VA had not provided enough data to support changes in the mission of the facilities, the commission said.
The VA proposed converting some facilities to "critical access hospitals," but the commission said the agency did not clearly define what those are and so rejected those proposals.
The panel recommended closing hospitals in Pittsburgh, Cleveland and Gulfport, Miss., and transferring large portions of care away from the Waco, Texas, hospital. The 71-year-old Waco hospital employs 800 people, served 17,000 patients last year and has 250 beds, mainly for psychiatric services. It has the region's only rehabilitation program for blind veterans and is one of three veterans' hospitals in Texas with acute psychiatric care.
The commission found that money the VA was spending to maintain unused or underused buildings and excess land could be used to provide direct medical care to veterans.
"The commission believes that change is necessary to prepare the system for a new veteran demographic reality and a rapidly evolving approach to health care delivery," the panel members said in their report.
Veterans have shifted from northern cities such as Chicago, Detroit, Boston and New York to Sun Belt states like Florida, Texas and Arizona.
The recommendations are not final. VA Secretary Anthony Principi, who received the report Thursday afternoon, now gets to review the report and decide whether to approve, reject or change some of the recommendations.
Principi will withhold comment on the recommendations until he makes his decision, due in about a month, said Cynthia Church, assistant secretary for public and intergovernmental affairs.
A VA official told the Senate Veterans Affairs Committee this week that the agency was already working on 41 "likely" projects in anticipation of the commission's recommendations. But how quickly any changes would begin after Principi makes his decisions was uncertain.
The VA launched the massive restructuring after government auditors in 1999 predicted that the VA would spend billions of dollars to operate unneeded buildings and that as much as one in every four VA health care dollars would be devoted to maintenance and operation of facilities.
Senate Democratic leader Tom Daschle said political considerations -- the importance of Ohio and Pennsylvania in President Bush's re-election campaign -- could outweigh the commission's arguments in favor of closing some hospitals.
Daschle also said he is reluctant to close hospitals, even where the number of veterans has diminished, because there are "older veterans in particular who have no place else to go."
The commission recommended the government look into consolidating at one facility services offered at VA facilities in Brockton, Jamaica Plain, West Roxbury and at the Bedford Veterans Affairs hospital.
The panel rejected the Bush administration's proposal to change the mission of the Bedford hospital and transfer inpatient care to other nearby facilities.
Instead, the commission said the government should "conduct a thorough feasibility study of building a single appropriately sized replacement medical center in the Boston area."
The report stymied state lawmakers, who were told in earlier meetings that the panel did not want to disturb the Alzheimer's care and research program in Bedford. But state officials were relieved that there was no immediate call for changes at the Bedford VA.
The state's Congressional delegation met with VA officials on several occasions, and presented Principi with thousands of petition signatures from patients, families and others urging the Bedford facility be kept intact.
The commission also rejected a Bush administration proposal to shut down a 70-year-old veterans hospital in Canandaigua in western New York, opting instead for milder medicine: shifting 50 beds to other upstate health centers.
"The commission recommends that Canandaigua retain long-term care, including the nursing home, psychiatric nursing home care, and the domiciliary," it said in a report released today.
The commission recommended the transfer of all acute inpatient psychiatric beds, which account for about a quarter of the 200 beds at the hospital.
New York lawmakers had been fighting that proposal, but their argument did not fly with the commission.
"There is no evidence to suggest that either the quality of care or patient safety would be adversely affected by the transfer of the inpatient psychiatry beds to the tertiary care hospitals at Syracuse and Buffalo," each about an hour's drive away, the report said.
The commission reiterated long-standing concerns about "high overhead costs, unused or underutilized buildings, and the impact on the community and on employees."
It also maintains its earlier plan to establish a new spinal cord injury center in Syracuse.