My Comments To the Asheville Paper

Dear Mr. Flynn & Dear Editor.....That which Congressman Charles Taylor considers a victory is just a continueing example of his complete disreguard for Veterans until it comes down to the point he can do something that makes him look good. This is just a example of the way he continues to fool the people of WNC.

The clinic was first to be located within Cherokee County where it would most benifit the Veterans of Cherokee,Graham,Clay & Swain Counties. Now those from these counties face still haveing to go on to Asheville, Why? It is a better trip of about the same distance for us and we do not benifit from it.

It will only benifit Veterans of Jackson,Macon & Transivaina counties leaveing the vet's of the far Western District with their backs up against the wall. Not only has this been on the drawing board for the past 5 years without any action it would now appear that it is only to be used as a political ploy in a election. Veterans have fought long and hard for our country and we do not deserve politicians decideing our fate. Mr. Taylor is a non-veteran and has not got the slightest idea of Veterans Issues. Like the song says, "We all Been Fooled Again! This clinic is NOT the issue of Taylor pushing something through, It is the example of veterans and veterans Service Organizations working for it.

If Taylor was truly concerned about us then he would get out in the district and talk to us and find out about our problems. We never see him, ever! I am also sending you a current American Legion Magizine Article to help prove our point.We have been hoodwinked too long. It is time to do what is right for Americas Vets! Why dont you do us all a big favor and come west of the Balsams and do some interviews with veterans.

Concerned Members of the VFW,American Legion,Disabled American Vererans,Vietnam Veterans of America ,Brothers of the Nam
WNC Vet's For truth & Dignity

Attachment From Legion Magizine

The American Legion Magazine
July, 2006

At A Snail's Pace
Two years after CARES promised a bright new future for VA health care, veterans across America wonder where their facilities are.

By Jeff Stoffer

Anthony Principi went to the heart of the monster when he chose Las Vegas on May 7, 2004, to unveil the biggest decision of his four-year reign as VA secretary: a nationwide 20-year plan to realign veterans’ health-care facilities in measures unseen since the troops came home after World War II. Nearly a quarter-million veterans had ridden a torrent of growth into southern Nevada; no end to it was in sight. In a city where multi-million-dollar casinos and 5,000 room hotels gush up from the earth in a matter of months, Las Vegas had a VA health-care system strung together like Christmas lights from grandpa’s attic – some twinkling, some not – nearly a dozen clinics on short-term leases at various locations around the city. VA also had an agreement to share the active-duty hospital out at Nellis Air Force Base. And it had the cracked, sinking shell of a former ambulatory care center that was condemned due to safety reasons five years after it was built. The situation was such that some 1,500 veterans regularly traveled to southern California for VA medical attention. And it was the city with the fastest growing veteran population in America.

As a symbol of need, Las Vegas could not be disputed. And it was not alone.

By May 2004, 13 years had passed since the federal government built its last new VA hospital. Congress had frozen funds for major construction until a comprehensive long-term building plan was in hand; Principi went to work on that plan. By the time it came out, Vegas-like situations were everywhere. In rural areas, veterans were traveling hundreds of miles over treacherous roads to wait in line at outdated hospitals. In Togus, Maine, scaffolding was installed to keep bricks from falling off the hospital and onto patients. Central Florida, like Las Vegas, faced a soaring veteran population without a VA medical center within reasonable driving distance; only 45 percent of Orlando’s veterans were within VA’s own access standards for care. Bed towers in earthquake zones failed to meet seismic specifications. In some major cities, there were three VA medical centers. In others, none. The system had fallen, according to Principi, “out of step with changes in the practice of medicine, the veterans we serve, and with statutory changes in the VA health-care benefits package.”

Attention was focused on VA’s declining physical state in 1999 when a report calculated the U.S. government was spending about $1 million a day on unnecessary VA real estate and, without significant changes, would spend billions more in years to come. Blame was placed on the fact that VA continued to maintain a fleet of hulking 50 year-old and older hospitals, throwbacks to an era when multi-night stays were common for procedures that today are handled on an outpatient basis. With its collection of 1,400 or more hospitals, clinics, nursing homes and other facilities, VA got off to a slow start in the outpatient and home-health revolution well under way elsewhere in American medicine.

As quickly as it could, VA began to catch up. Hundreds of community-based outpatient clinics designed to situate care closer to where veterans live, sprang up in the mid and late 1990s. As they did, more VA hospital wings darkened, and many facilities – like the Livermore, Calif., complex built in 1925 as a tuberculosis sanitarium for World War I veterans – began converting their inpatient rooms into specialty care units where veterans were expected to visit but not spend the night.

The inpatient-to-outpatient metamorphosis came just in time for a dramatic increase in VA enrollee numbers. The Veterans Health Care Eligibility Reform Act of 1996 had opened VA’s medical services to all veterans, regardless of income or disability rating, and new patients were pouring into the system, more than doubling the workload in a six-year period. Congressional funding for VA health care did not match the pace of new demand. The rush of new patients created long and well-publicized waiting lines. At one point, more than 300,000 veterans were waiting 30 days or longer for VA doctor appointments, a problem Principi staunched by capping new enrollment of veterans with higher incomes.

The system was growing and changing fast. Principi, a Vietnam War combat veteran, stood on a stage outside one of Las Vegas’ leased clinics and announced in 2004 that he had in hand the strategy to manage this evolving empire. He told Nevada’s congressional delegation, city officials, national leaders of veterans organizations, doctors, nurses, patients and media that “the VA health-care system now stands at a crossroads between medical care of the past and the great possibilities of the future. The CARES Commission report is a well-reasoned roadmap to the 21st century.”

Two years later, veterans across America – including Las Vegas where Principi described the need as “urgent” – are still standing at that crossroads. And they are wondering why no one seems to be following the roadmap. Principi, who resigned at the beginning of the Bush administration’s second term, had made it clear that if CARES – VA’s Capital Asset Realignment for Enhanced Services endeavor it needed $1 billion a year in unique funding. It has not had $1 billion in– were to succeed, any year yet. And the 2007 budget recommendation calls for a quarter of that.

“Progress has been at a snail’s pace,” said Rep. Mike Michaud, D Maine, a member of the House Veterans Affairs Committee. “I’m very disappointed in the VA for not moving forward. The CARES process was established for good reasons. There was an understanding that they would move forward on it. It’s a funding issue.”

Last September, VA suspended local meetings in 18 communities across the country where CARES decisions remained unresolved. Veterans expecting a second stage of planning in the program logged onto the CARES Web site and were greeted with “TBD” – “to be determined” – where the next meeting notice was supposed to appear. As an acronym, CARES itself has begun to fade from the Washington lexicon. The new term is “right-sizing.” CARES vanished as a line item in the budget. Projects listed as priorities under CARES have been replaced by others that weren’t listed in 2004. Meanwhile, VA is trying to figure out how to restore a system in New Orleans in the aftermath of Hurricane Katrina. Congress-ional leaders say little or no headway has been made against the cost of maintaining excess property, which originally was the point that fueled the realignment effort. About 150,000 new veterans from operations in Iraq and Afghanistan are now using VA services for various needs, including notable increases in post-traumatic stress disorder, amputation rehabilitation and brain injuries. And hundreds of veterans of all war eras – from Waco, Texas, to Walla Walla, Wash. – who fought to have a say in the future of their VA health-care systems are now worried they wasted their breath in all those Local Advisory Panel meetings. VA Secretary Jim Nicholson suddenly announced in April, after months without word on CARES, that the medical center in Big Spring, Texas, will be spared, and he is nearly ready to decide the fates of the others.

“We don’t know what’s going to happen,” said Ted Pugh, a career Air Force veteran from Las Vegas. “Two years ago, Principi said we would have a building in two or three years. Now we are looking at 2010 or 2011.”

“Fifteen years from now, if I am lucky, we will see a VA hospital in Las Vegas,” adds disabled veteran Duane Gordon.

It took 16 months to build the Pentagon. The Empire State Building went up in 410 days. It now appears that seven years will pass between the CARES decision and Las Vegas’ long-awaited hopes. Meanwhile, the construction cost has ballooned by an estimated 40 percent. In the year it is supposed to break ground, 2006, the project awaits nearly a third of its funding, and because it was skipped in the 2007 budget, completion is delayed at least a year, if not two. Nothing but wind, sand and sagebrush can be found on the 200 acres VA received free from the Bureau of Land Management about 10 miles outside the city. “When you think the new facility won’t be finished until 2011,” Pugh says, “the average World War II veteran thinks, ‘Well, that’ll be after I die.’”

CARES IS VARIOUSLY DESCRIBED AS a process, a report, a decision, a downsizing, a build-out, a blueprint and a boondoggle. It stood to steer the entire philosophy of veterans health care in a new direction. Facilities nationwide – from major medical centers to long-term mental health operations – were identified for major changes. In places like Chicago, Pittsburgh, Canandaigua, N.Y., Waco, Texas, and Livermore, Calif., plans for reduction of services or closures ignited fury and protests among veterans. In places like Maine and the Northern Plains, where a doctor’s appointment can mean a 200 mile drive through the wind, snow and ice, veterans looked forward to new outpatient clinics closer to home, 156 of which were identified through CARES as priorities by 2012 across the country.

CARES came largely in response to a General Accounting Office (now Government Accountability Office) report that showed VA was spending about 25 percent of its health-care budget maintaining buildings. “In our view,” the report stated, “VA could enhance veterans’ health-care benefits if it reduced the level of resources spent on underused or inefficient buildings and used these resources, instead, to provide health care more efficiently in existing locations or closer to where veterans live.”

In Orlando, Denver and Las Vegas – where long-awaited hospitals appeared finally on the horizon thanks to CARES – there was elation. “Veterans were so happy,” says Leonard Wenson, a Vietnam War veteran who uses Las Vegas VA services when possible but also travels to Los Angeles or San Diego for treatment not provided locally. “Finally, we were getting a hospital. Morale was up. We were all talking about what we were going to get – different doctors, different specialty clinics.”

Rep. Shelley Berkley, D Nev., a member of the House Veterans Affairs Committee, is livid about the funding delay. “What if the money isn’t in the 2008 budget? Does that mean we go beyond that? I’ve got 80 year old veterans standing in 110 degrees temperature, waiting for a shuttle to pick them up to take them to this clinic to get this need meet, then back on the shuttle to go to another clinic to get that need met. They deserve better than that from their government officials. It makes me mad. I want the numbers. I want to know when. I want to know how. I want to know why it’s not what it once was.”

AT A PRESS CONFERENCE in Indianapolis last spring, House Veterans Affairs Committee Chairman Steve Buyer, R Ind., said of CARES that “there were individuals who saw this as an opportunity to do a massive build-out of the VA … who say VA should be a national health-care system for all veterans, to include dependents. They want to take CARES and do a massive build-out so that you have a veterans’ clinic in every corner of America. That’s not what this is supposed to be about.”

He called a committee hearing May 11 to evaluate the state of VA’s major construction projects and leases, and CARES was conspicuously missing from the agenda. Buyer did mention that one of the major projects identified in the 2004 decision – a replacement medical center for Denver – was rejected in appropriations after its cost estimate was reduced from $700 million to $620 million, posing what he described as “a credibility gap…We must all recognize the need for improved facilities in the Denver area. However, it does not have to cost nearly $1 billion to build a world-class medical center.”

The hearing went on to explore creative ways VA can maximize resources by collaborating with medical schools, the military, and other partners, including public and private entities.

By the end of the hearing, it was clear that major construction projects were overdue across the country – Orlando, Las Vegas, Denver, New Orleans, San Juan, Puerto Rico, and Charleston, S.C. “It has been decades since the committee had this many construction projects in front of it,” Buyer said. “The list goes on. How are we going to build six major facilities in a short period of time? I’m willing to look at the alternatives.”

Veterans in Las Vegas thought that had already been established – New Orleans notwithstanding – on May 7, 2004, when CARES was unveiled in the city where it was needed most. “I am very serious about this,” Berkley said. “We need this facility. I have 5,000 new residents a month pouring into Las Vegas. Many of them are veterans, and their needs are not going away.”

Jeff Stoffer is managing editor of The American Legion Magazine.