[Senate Hearing 109-405]
[From the U.S. Government Publishing Office]
S. Hrg. 109-405
REBUILDING THE GULF COAST FOLLOWING HURRICANE KATRINA
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
NOVEMBER 10, 2005
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
U.S. GOVERNMENT PRINTING OFFICE
27-353 WASHINGTON : 2006
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
COMMITTEE ON VETERANS' AFFAIRS
.........................................................
Larry E. Craig, Idaho, Chairman
Arlen Specter, Pennsylvania Daniel K. Akaka, Hawaii, Ranking
Kay Bailey Hutchison, Texas Member
Lindsey O. Graham, South Carolina John D. Rockefeller IV, West
Richard Burr, North Carolina Virginia
John Ensign, Nevada James M. Jeffords, (I), Vermont
John Thune, South Dakota Patty Murray, Washington
Johnny Isakson, Georgia Barack Obama, Illinois
Ken Salazar, Colorado
Lupe Wissel, Majority Staff Director
D. Noelani Kalipi, Minority Staff Director
C O N T E N T S
----------
November 10, 2005
SENATORS
Page
Craig, Hon. Larry E., U.S. Senator from Idaho.................... 1
Murray, Hon. Patty, U.S. Senator from Washington, prepared
statement...................................................... 2
Cochran, Hon. Thad, U.S. Senator from Mississippi................ 5
Prepared statement........................................... 6
Akaka, Hon. Daniel K., U.S. Senator from Hawaii.................. 6
Hutchison, Hon. Kay Bailey, U.S. Senator from Texas.............. 7
Salazar, Hon. Ken, U.S. Senator from Colorado, prepared statement 8
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 9
Lott, Hon. Trent, U.S. Senator from Mississippi.................. 18
Prepared statement........................................... 20
Landrieu, Hon. Mary, U.S. Senator from Louisiana, prepared
statement...................................................... 23
WITNESS
Nicholson, Hon. James R., Secretary of Veterans Affairs,
accompanied by Jonathan B. Perlin, M.D., Ph.D., Under Secretary
for Health; Tim S. McClain, General Counsel; and Robert Lynch,
M.D., Director, Veterans Integrated Service Network 16......... 9
Prepared statement........................................... 12
Response to written questions submitted by Hon. Daniel K.
Akaka...................................................... 16
REBUILDING THE GULF COAST FOLLOWING HURRICANE KATRINA
----------
THURSDAY, NOVEMBER 10, 2005
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 2:04 p.m., in
room SD-138, Dirksen Senate Office Building, Hon. Larry Craig,
(Chairman of the Committee) presiding.
Present: Senators Craig, Hutchison, Thune, Isakson, Akaka,
Murray, and Salazar.
Also Present: Senators Lott, Cochran, and Landrieu.
OPENING STATEMENT OF HON. LARRY E. CRAIG,
U.S. SENATOR FROM IDAHO
Chairman Craig. Good afternoon, ladies and gentlemen. The
Committee will come to order.
The Committee meets this afternoon to hear from the
Secretary of Veterans Affairs and his staff on the efforts VA
is undertaking to re-establish service and rebuild VA
facilities along the Gulf Coast in the aftermath of Hurricanes
Katrina and Rita.
Before we begin to talk about the future of the VA in the
region, I would like to spend just a moment to recognize VA's
past efforts, especially those in the weeks following Hurricane
Katrina's landfall. As many of you may know, VA was one of the
few bright lights to shine through the devastation that hit the
region.
Advanced planning and a well-known electronic medical
records system helped ensure that the VA could coordinate and
move thousands of staff and patients to facilities across the
United States without a single loss of life attributed to the
lack of medical attention. In addition, VA staff members,
volunteering thousands of hours of their time to assist
veterans and other citizens in the affected communities,
ensured that the aftermath of this storm went as smoothly as
possible.
While more people than I can possibly name are responsible
for that success, I want to especially recognize the gentlemen
sitting at our front table today, Secretary Nicholson, Dr.
Perlin, and Mr. McClain. Your efforts ensured that emergency
response plans were created in advance of the storm and
implemented.
In particular, though, I want to single out our fourth
member of the panel today, Dr. Lynch. Robert Lynch was VA's man
in charge on the ground in the Gulf. He and his staff worked
countless hours for the good of thousands of our veterans. Dr.
Lynch, I hope you know how proud we are of your efforts and
those of your staff. You lead a truly remarkable group of
individuals, and I hope you will pass on our highest
compliments to all of them.
Like so many private houses and businesses, the Department
of Veterans Affairs experienced a significant amount of
destruction and damage during Hurricane Katrina. The VA's
medical center in Gulfport, Mississippi, was totally decimated
by the storm.
In New Orleans, VA's medical facilities experienced
significant flooding on the lower floors and wind damage on the
upper floors. That damage, coupled with a lack of electricity
and ventilation, raises serious concerns as to whether the
interior of these buildings is beyond repair.
In addition, VA has no regional office in New Orleans at
this time to handle disability compensation payments and other
benefit matters. The office was located in a postal building in
downtown New Orleans that sustained water damage and has not
reopened. Even VA's one working medical facility in the Gulf
region, the Biloxi VA medical center, sustained some structural
damage and is in need of repair.
Putting all of these pieces together, or I should say back
together again, will be a massive undertaking. It will not be
easy or inexpensive. VA is confronted with the fact that there
is no real medical infrastructure at all in New Orleans.
Both LSU and Tulane medical schools, which were a
significant source of medical staff for VA facilities in the
region, are not open. Even many of the veterans who relied on
facilities along the coast are now living in other areas of
Mississippi and Louisiana.
To address the financial considerations facing VA, the
President recently sent his third hurricane supplemental
request to Congress. This request identified $1.15 billion to
help VA rebuild efforts at the facilities I have just
mentioned. Further, the bill includes $300 million to purchase
new equipment and replace pharmaceuticals which were lost or
destroyed during this emergency.
I look forward to the Secretary's testimony to get some of
the detailed information about this rebuilding effort and
perhaps some estimates on timelines and other challenges we
face.
With that, I will recognize Secretary Nicholson. Our
Ranking Member, Senator Akaka, is not here. Let me then turn to
my colleagues who are now here to see if there are any opening
comments before we turn to the Secretary.
Senator Murray. Patty.
Senator Murray. Mr. Chairman, thank you very much. I
apologize. I won't be able to stay for the hearing because we
have a transportation conference that I need to go to in a
minute.
But I would like to submit my statement for the record.
[The prepared statement of Senator Murray follows:]
Prepared Statement of Hon. Patty Murray, U.S. Senator from Washington
I want to thank Chairman Craig and Ranking Member Akaka for having
today's hearing and for the distinguished Members joining us from the
affected region.
I also wanted to thank Secretary Nicholson for being here to answer
our questions on how the VA is moving forward with rebuilding and
recovering from the destruction caused by Hurricane Katrina.
Mr. Secretary, we're here today to see that we take care of
veterans who have been displaced or whose services have been
interrupted by Hurricane Katrina.
However, as we do that, I want to make sure that we do not end up
jeopardizing or in any way compromising the quality of care available
to other veterans across the Nation.
The reason I raise this concern is that just this year, we faced a
situation in which bad planning and budgeting on your part led to a
massive shortfall in VA healthcare funding.
If I hadn't insisted on making sure we provided funding to meet
that shortfall--in spite of your assurances, our veterans would be in
serious trouble right now.
Mr. Secretary, I do not want to sit here 8 months from now and hear
that the VA underestimated the impact of Katrina and had to take money
away from veterans who need care to compensate for its mistake.
Now, let me say that I, like everyone in America, was saddened to
see the devastation in the Gulf region after Hurricane Katrina. The
families without homes, and the cities in tatters, were tragic. There
are many steps that need to be taken to rebuild that region.
But I am worried that Congress will do so by shortchanging programs
required by other Americans. That would be wrong.
As a long-time Member of the Senate Veterans Affairs Committee, I
am very concerned that veterans' medical services are susceptible to be
sacrificed in the name of reconstruction.
While we have an obligation to help Hurricane-affected areas
rebuild, we cannot do so by drawing out precious funding from other
important programs.
Unfortunately, Hurricanes Katrina and Rita came at a time when the
United States Government is running over an 8-trillion dollar deficit.
Add to this complicated equation, military activity in Afghanistan
and Iraq costing over 60 billion dollars a year.
And this number only represents occupation costs, not money for
rebuilding efforts or funding for soldiers as they return home from the
battlefront.
As Congress and this Committee consider how to move forward with
reconstruction in the devastated region, we must do so without shirking
other promises we've made, especially to our veterans.
Tomorrow is Veterans Day, a day to honor the sacrifices our
soldiers have made when called upon to serve this country.
When our Government asks them to leave their families and go to
foreign soil to represent this country, we promise them we will do our
part to care for them upon their return.
In times of budget shortfalls, massive deficits, and growing
pressure to keep costs down--we must remember our promise and fight to
fulfill it.
I'm here today to make it clear that Congress must provide the VA
the funding it needs to rebuild and not use Medical Services funding or
other VA funding to cover Katrina-related costs.
Secretary Nicholson, you and I have gone back and forth on the VA
budget and the budget shortfall.
I have spent the better part of a year fighting with the
Administration to get the funding our veterans need.
What we saw occur during fiscal year 2005 should not be repeated in
either fiscal year 2006 or in fiscal year 2007.
I hope Secretary Nicholson has a promising update on VA funding
both for reconstruction after Katrina and for medical care and
benefits.
Mr. Chairman, the VA did not adequately anticipate demand when it
set its 2005 budget. An increase in usage from veterans returning home
from war was up and, leading to increased strains on the VA.
I fought hard to prevent the $1 billion shortfall the VA reported
in June.
I asked three times to get additional funds to the VA to prevent
that shortfall, but you, Mr. Secretary, would not admit there was a
deficit.
After it came to light that there was indeed a shortfall.
Working with my colleagues I was able to secure $1.5 billion
dollars in supplemental funding to make sure that our veterans could
get the services promised to them.
But, as we know, that funding only covered the last fiscal year's
need.
I remain concerned that we will end up right back here in trying to
supplement the 2006 budget next year.
And I hope to hear from the Administration on how they have changed
their budget models to adequately prepare--especially in light of the
increased number of OIF and OEF veterans needing to access VA care.
Today, we are relying very heavily on Guard members.
Where traditional active duty members would access military
healthcare, we now have over 500,000 Guard members who have fought in
Iraq and Afghanistan, who have returned home, and who are now eligible
for VA care.
I have been informed by the VA that to date only $500 million
dollars of the $1.5 billion supplemental has been spent.
I have also been told the rest has been rolled over into fiscal
year 2006.
As you know Mr. Secretary, this rollover funding has been a
critical piece of the negotiation on the VA's fiscal year 2006 budget.
I hope to hear from you today about the nature of that rollover and
whether or not those funds will be used for medical services or to
assist in rebuilding in the Gulf.
I'm worried that the higher level of funding requested by the
Senate for 2006 will be reduced in conference.
This will force the entire system to be based on bare minimum
funding.
If one thing goes wrong--cost overruns in rebuilding VA facilities
in the Gulf, increased utilization, or an across the board cut--
veterans access to care will become limited.
On September 8, 2005, Secretary Nicholson, you told four
congressional Committees that--and I quote--``We will need additional
funding for clean up, repairing facilities, providing temporary
facilities and staffing.'' End quote.
The VA requested $1.2 billion dollars for reconstruction and $198
million dollars for medical care at VA hospitals and clinics in the
gulf coast region as a consequence of the Hurricanes.
Currently where did you get the funding to pay for bringing these
facilities back into operation?
How are CBOCs paying for the replacement supplies and
pharmaceuticals they need to care for area veterans?
How are you paying for the added staffing and transportation costs
right now?
Mr. Secretary, what are you doing to ensure that reconstruction
costs are not coming out of the medical services earmarked for our
veterans?
I sincerely hope to get answers from you on these important
questions today, Mr. Secretary--for the sake of our current and future
veterans.
Mr. Secretary, we have learned many lessons this past year when it
comes to VA funding.
I have learned to doubt your numbers, to question which accounts
are being used for what, and I am very concerned that when an
inadequate Katrina request is added in with limited VA funding, that we
are going to see a shortfall next year.
One lesson I think you should walk away with, Mr. Secretary, is
that we need a real VA budget for fiscal year 2007. No budget gimmicks.
No increased fees that Congress will never endorse.
A real budget that acknowledges that we have had over 1 million
Americans serve us in Iraq and Afghanistan since 2001.
A real budget that acknowledges that our veteran population is
aging and facing new mental health challenges.
A real budget that acknowledges that medical costs and utilization
rates are going up for the VA.
Mr. Secretary, the bottom line is that 8 months from now I don't
want to be hearing how shortfalls and ever-expanding Katrina costs are
hurting our veterans by keeping them from getting the care they
deserve.
Thank you for your time here today, Mr. Secretary.
I look forward to hearing your testimony.
Chairman Craig. Without objection.
Senator Murray. But let me just make a few comments. First
of all, obviously, the devastation with the hurricanes is
something that has impacted the VA immensely, and we all want
to make sure we have the funds there. They did a great job, and
we all want to be sure that we have the money there to take
care of it.
My concern is that we don't rob the existing funds within
the VA to do that. I am submitting some questions for the
record to make sure that is not the case. We had a long, drawn-
out battle about funding for VA. We are still, as Senator
Hutchison knows, in conference, making sure that we have the
dollars that were promised to our veterans there.
I want to make sure that the money that is out there for
our current veterans services isn't being used for this. That
we are asking for additional dollars to pay for that because
those funds are absolutely critical.
And Mr. Secretary, I particularly want to know about the
money that is being rolled over, the rollover account. I
believe $500 million has been rolled over from the
supplemental. I want to find out if that money is being used
for Katrina or if it is being used specifically for what we
were told it was, which was for our medical facilities and our
veterans across the country. But I will submit those questions
for the record.
I do want to take this opportunity, Mr. Chairman, to thank
you for your announcement today that you are stopping the
questioning of our soldiers with PTSD. I think that was
extremely positive. It positively impacted a lot of veterans
who were very concerned about that kind of interrogation, and I
do appreciate that.
And finally, Mr. Chairman, let me just say I hope we have
all learned our lesson. I hope we get from you real numbers,
real budget numbers. We have an increasing number of soldiers
returning home. We have our Guard and Reserve members, who are
increasingly accessing VA facilities now as they return from
the war. We have a number of aging veterans. We have,
obviously, the impacts of Katrina.
We need, as we go to the 2007 budget, which you will be
presenting to us fairly soon, we need to have a real number. So
8 months from now, we are not back in the same situation.
So, Mr. Secretary, thank you for being here today. Mr.
Chairman, I apologize for not staying. But I will submit my
questions for the record and would appreciate a response back
as quickly as possible.
Thank you.
Chairman Craig. Patty, thank you. And of course, those
questions will be for the record and submitted to the Secretary
for his response.
As most of you know, I invited all of the Senators who are
not Members of this Committee, but certainly Senators of the
affected States to participate in this hearing today as Members
of the Committee and ask the questions. And so, Senator Thad
Cochran is here, who is also, most importantly, beyond being
senior Senator from Mississippi, the Chairman of the
Appropriations Committee from which all money flows.
Senator Cochran. We are out of money.
[Laughter.]
Chairman Craig. Senator Cochran.
STATEMENT OF HON. THAD COCHRAN, U.S. SENATOR
FROM MISSISSIPPI
Senator Cochran. Unfortunate news. Thank you, Mr. Chairman.
Let me express our appreciation to you for your leadership
on the Veterans' Affairs Committee and also as a key advisor on
needs of the Veterans Administration. When it comes time to
making decisions about the level of appropriations and where
the priorities ought to be, we appreciate always the good
advice and counsel we receive from you and your Committee.
And today, we are particularly glad to see you looking at
the issue of damage and what needs to be done and is being done
to restore facilities to operational levels and repair damage
that needs to be repaired and what effect it may have long term
on veterans' interests in this region of our country.
I have a prepared statement, which I would hope you could
include in the record, along with some questions to submit to
Secretary Nicholson and his staff. We appreciate their work.
Outstanding leadership is being provided to the veterans and to
our country by these fine gentlemen.
Thank you.
Prepared Statement of Hon. Thad Cochran, U.S. Senator from Mississippi
The Mississippi Veterans Affairs facilities suffered a significant
amount of damage due to Hurricane Katrina. The Department of Veterans
Affairs administered two medical hospitals on the coast, one in Biloxi,
the other in Gulfport and a national cemetery in Biloxi. The Gulfport
VA Hospital was completely destroyed by the hurricane. Seventy-eight
patients were evacuated to the Biloxi facility before the hurricane and
20 patients were transferred to Jackson from Biloxi. The Biloxi VA
Hospital suffered roof damage, but it is fully operational. The
Department of Veterans Affairs was in the process of implementing their
Capital Asset Realignment for Enhanced Services (CARES) Plan before the
hurricane which would transfer the Gulfport operations to the Biloxi VA
Medical center and possibly lease the Gulfport property to developers.
The VA National Cemetery located on the Biloxi campus suffered some
damage including the uprooting of trees and some damages to roadways
and headstones.
The President's supplemental request provides $1.2 billion to
replace the medical center in New Orleans, LA, and to repair and
construct a bed tower to the medical center in Biloxi, MS. The request
also includes $198.3 million for the replacement of medical supplies,
equipment and pharmaceuticals and $1.8 million has been requested to
repair roads and other damage that was sustained to the national
cemetery.
Chairman Craig. Thank you very much.
Our Ranking Member has just arrived. I will turn to Senator
Akaka for any opening statement he would like to make.
STATEMENT OF HON. DANNY AKAKA, U.S. SENATOR
FROM HAWAII
Senator Akaka. Thank you very much, Mr. Chairman.
I want to welcome our panel. I want to welcome the
distinguished panelists here. I am delighted, and it is so
great to hear, Mr. Secretary, that the Department of Veterans
Affairs is suspending its plan to review 72,000 posttraumatic
stress disorder compensation claims.
This is great news for all veterans. Make no mistake. This
review would have put some veterans at risk of losing
compensation that they had already been awarded by VA. Many
times, VA compensation is sole source of income for veterans
and their families.
During October, Congressman Evans and I wrote to Secretary
Nicholson, asking that the PTSD review be suspended until VA
could complete its smaller review of just 22,100 claims. I am
pleased that upon completion of the smaller review, VA has
decided that they are not going to put veterans through the
anxiety that a widespread review of their disability claims
would create.
I am certain that veterans in New Orleans who were subject
to this planned review will be relieved that the benefits that
they have earned will not be put in jeopardy.
Mr. Chairman, this hearing on the reconstruction of VA
facilities along the Gulf Coast highlights our continued focus
in the aftermath of Hurricane Katrina. As we all know, VA
performed with distinction in its response to Hurricane
Katrina, and we are proud of that.
With no loss of life or injuries reported, the employees in
the affected area showed tireless dedication in some of the
most adverse conditions. VA kept its commitment to veterans and
patients at a time when they were most needed.
Now we must all follow through with the current task at
hand--fully restoring accessible health care and benefit
services to veterans. VA is compelled to make sound decisions
in a timely manner. VA must be proactive in its rebuilding
effort. With so many in dire need, we must not rest until we
finish the job of restoring critical services, such as in-
patient care in New Orleans and assisted living beds in Biloxi
and to the veterans in the affected region.
Our Committee is dedicated to assisting VA and helping
veterans affected by Hurricane Katrina. My goal is to seek
transparency in the planning process and reconstruction effort.
We must also ensure the funding for this effort does not come
at the expense of needed health care dollars for next year. Our
commitment to oversight as a means for VA, to let our veterans
know of the tireless effort in restoring quality service and
care.
Mr. Secretary, I look forward to taking those first steps
today and to be with you as we do it.
Thank you.
Chairman Craig. Thank you, Danny.
Senator Hutchison. Kay?
Senator Hutchison. Thank you, Mr. Chairman.
STATEMENT OF HON. KAY HUTCHISON, U.S. SENATOR
FROM TEXAS
Mr. Chairman, I am very pleased to be able to have this
hearing, and I am sorry I am going to have to leave for the
same conference as Senator Murray. And I am also chairing
another conference committee. That is what is happening this
week. All of the final hearings and conferences seem to be
coming at the same time.
But as the Chairman of the Veterans' Affairs Appropriations
Subcommittee, what you bring to us today is going to come to my
subcommittee. And I certainly intend to assure that everything
that was damaged in Hurricane Katrina or Hurricane Rita--and I
hope that we will not forget that there was another hurricane
that was very devastating on the Gulf Coast. It wasn't the
magnitude of Katrina, but it was pretty tough on the western
part of Louisiana and the eastern part of Texas. But we are
certainly going to work with you.
I do want to say how pleased I am that not one veteran lost
his life or her life in the evacuation from the Katrina
hurricane, and really, I was amazed at how well the Veterans
Affairs Department did in making sure that the records were
available where a veteran went later after evacuation. I think
it worked a whole lot better than anything in the private
sector, and I really appreciate that.
And certainly, we want to rebuild those facilities in a way
that we will assure that they can withstand a Category 5
hurricane in the future. But I think the care that was given to
our veterans is commendable. It is the right thing to do, but
the important thing is that you did it. And we appreciate that
kind of service.
And I also have to say that I appreciate the fact that some
of the Veterans Administration doctors and health care
professionals served anyone who walked in the door, not just
veterans. That is exactly what you ought to do in an emergency.
And thank heavens, they weren't in any way impeded from serving
whoever was in need, a citizen of our country.
So I thank you for the good work that was done, and it was,
I think, a fine hour for the veterans department. Now we are
going to have to rebuild and assure that the veterans who are
still evacuated will get the care they need. And that will be
the job of my subcommittee, along with Senator Feinstein, as we
go into the supplemental that will eventually come.
And I agree with Senator Murray that we want all of the
estimates to be for the supplemental, not anything that would
come from the veterans that we are treating in the normal
course of operations.
Thank you.
Chairman Craig. Kay, thank you very much.
Ken? Senator Salazar, any opening comment?
Senator Salazar. I have statement that I will just submit
for the record. But to summarize, I would just echo what my
colleagues here have said.
One, great job to the VA in the response. I think you were
a model of how a Federal agency should act, and I very much
applaud that. Two, it is important to open the doors in New
Orleans and other places, and I know that is what we are going
to hear about today. And three, as you look forward to working
on this major agenda, I just look forward to a continuing
success story on the part of VA.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Salazar follows:]
Prepared Statement of Hon. Ken Salazar, U.S. Senator from Colorado
Thank you Chairman Craig and Senator Akaka. Thank you Secretary
Nicholson and your staff for being here today.
Ever since the day Katrina made landfall I've heard stories about
the VA's herculean response to this storm and Rita and Wilma that
followed.
The more I learn about VA's efforts, the more inspirational the
story becomes.
The VA successfully evacuated hundreds of patients, including 10
patients on respirators. VA successfully transferred thousands of
patient records. The agency moved quickly to re-establish VHA presence
in affected areas. It successfully accounted for more than 3,000
employees. It offered employees temporary housing, mental health care,
and most importantly, a continued paycheck.
This is a success story that rightfully should be pointed to as a
model for disaster recovery. Each and every VA employee has a right to
be proud. You made us all proud.
However, we are not out of the woods yet. There is still no major
VA clinical capacity in New Orleans. VBA has yet to open its doors in
that city. There are many unknowns about the extent of the damage in
New Orleans, where evacuated veterans will end up, and what the Gulf
Coast will look like.
This hearing is about next steps, and ensuring that the VA's
response continues to be a success story. The VA has asked for $1.4
billion to recover from the storm. I hope we can get behind these
numbers and get a firm idea of when VA's new clinics will come online.
I also hope we can get a more solid understanding of the VA's
intentions in New Orleans. The people of New Orleans need to know that
they will have a world-class VA Medical Center within the city.
I hope we can all work together to ensure that the VA continues to
be a shining role model for the rest of the Government in its response
to Hurricane Katrina.
Chairman Craig. Ken, thank you.
Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON, U.S. SENATOR
FROM GEORGIA
Senator Isakson. In the interest of time, I only have one
comment. There have been many questions raised about the
performance of a number of agencies. But it is appropriate to
note two agencies, the Coast Guard and the Veterans
Administration's performance in the Gulf in the tragedy.
And Dr. Lynch, a lot of that is to your credit. It has just
been exemplary and outstanding. And I thank the Secretary and
the entire department for what they did and yield back the rest
of my time.
Chairman Craig. Thank you.
Mr. Secretary, we will now turn to you and the staff you
have brought with you, and we will give you such time as you
may need to present to the committee. Please proceed.
STATEMENT OF HON. R. JAMES NICHOLSON, SECRETARY OF
VETERANS AFFAIRS, ACCOMPANIED BY JONATHAN B. PERLIN, M.D.,
Ph.D., UNDER SECRETARY FOR HEALTH; TIM S. McCLAIN, GENERAL
COUNSEL; AND ROBERT LYNCH, M.D., DIRECTOR, VETERANS INTEGRATED
SERVICE NETWORK 16
Secretary Nicholson. Thank you, Mr. Chairman and Members of
the Committee.
I would like to submit a written statement for the record
as well.
Chairman Craig. Without objection, it will become part of
the record.
Secretary Nicholson. I am joined here today by Dr. Jonathan
Perlin, who is the Under Secretary for Health by Tim McClain,
who is the general counsel of the VA and has, for many months,
been the acting Under Secretary for Management, and on my right
is Dr. Robert Lynch, who is the Director of the VA South-
Central Health Care Network, VISN 16.
And I would like also, Mr. Chairman, to thank you for your
recognition of Dr. Lynch and his team, his heroic team down
there in the Gulf Coast region. And if time permits, it would
be a real privilege for me to recite the heroics of some of
those people who, for days, stayed in the hospitals, moved with
their patients to places they did not know where they were
going to end up, while their own homes were inundated, their
families, their locations were unknown to them. But they stayed
with their patients.
But Dr. Lynch provided the leadership there. And I know at
one period of time, he was up for 40 consecutive hours because
I would go to our crisis response center in the building, and I
went there at different random times throughout that period,
and Bob Lynch was always on duty, moving people, planning, he
just did an heroic job.
Thank you for providing us with this opportunity to discuss
the Department of Veterans Affairs ongoing repair and recovery
efforts now in the wake of Hurricanes Katrina and Rita. Mr.
Chairman, I want to thank you and, indeed, all of the Senate
for your resolution recognizing and commending the heroic
efforts of our employees through Hurricane Katrina.
In this brief testimony, I will speak first to the property
damage and plans for New Orleans, Gulfport, and other Veterans
Health Administration facilities, as well as the impact on VHA
employees at those facilities. Next, I will address the
recovery efforts of the Veterans Benefits Administration and
the National Cemetery Administration. And finally, I will
discuss a few of the lessons learned.
Before I begin, I want to assure the Committee and its
guests today that the VA continues serving and supporting
veterans affected by Hurricane Rita. Planning has been key to
our responsiveness. In early September, I directed senior
management to establish a Gulf Coast Planning Group as a result
of the extensive damage to VA facilities.
The group will coordinate VA infrastructure planning in the
region for the near, mid, and long term. The group, which is
chaired by Tim McClain, will also serve as a plans clearing
house, with particular sensitivity to previous CARES planning.
Addressing first the New Orleans experience and our plans
there for recovery. The New Orleans VA facility initially
weathered Hurricane Katrina with minimal damage. But then water
from the breached levies flooded the medical center,
compromising the facility's major electrical, mechanical, and
dietetics equipment.
The facility has been without electrical power or air
conditioning now for weeks, resulting in damage to equipment
and interior finishes by the effects of very high humidity over
a long period of time. And with so many structures inundated by
flood waters, mold and mildew are pervasive and have already
begun to take their toll on the medical center.
To address the immediate health care needs of veterans in
the greater New Orleans area, the VA plans to open several
clinics and expand operations in Baton Rouge, where we operate
a large and relatively new community-based clinic. We will
accelerate our plans for new CBOCs proposed under CARES, and we
have proposed those for Slidell, Hammond, and LaPlace, with a
goal of opening them early in 2006.
An ambulatory care clinic is being established at the New
Orleans medical center. We anticipate opening that clinic next
month. The VA is exploring all of our long-term options to re-
establish in-patient and tertiary care services for our
veterans in the New Orleans area.
Our affiliates down there, Louisiana State University and
Tulane Medical School, both plan to return to the New Orleans
area. But their major teaching hospitals, Charity and
University Hospitals, will require extensive repair or, indeed,
may have to be rebuilt.
The Mississippi experience. The VA medical center at Biloxi
weathered the hurricane quite well and remained fully
operational throughout the hurricane. Damage was mostly
cosmetic, with some broken windows and damage to building
exteriors.
Just 8 miles away, however, the Gulfport VA medical center
campus was essentially destroyed by Katrina's tidal surge.
Gulfport's workload and VA employees have been transferred to
Biloxi, which is 8 miles away.
Looking longer term, VA's CARES plan called for the closure
of Gulfport, with design funds provided for Biloxi in fiscal
year 2006 and full completion scheduled in 2010. We now propose
to accelerate this plan with the goal of replacing clinical
functions within 2 or 3 years. We are currently discussing
collaborative opportunities with Keesler Air Force Base, which,
as you know, was extensively damaged by the hurricane and which
is 2 miles away from our hospital in Biloxi.
The impact on employees. In New Orleans, all but 2 of VHA's
1,819 employees have been accounted for. A preliminary survey
suggests that approximately 40 percent of our New Orleans
medical center staff lost their homes. We have placed VHA
personnel in temporary positions at other VA medical centers,
and we will soon begin offering permanent positions via a
priority placement program for displaced New Orleans employees.
Already some of our employees have accepted positions at
other medical centers, while other employees have chosen to
take this opportunity for retiring from our workforce. Housing
for VA employees remains a concern.
In Biloxi-Gulfport, all 1,590 VHA employees have been
accounted for. Twenty-eight percent of them report that their
homes have been either totally destroyed or are uninhabitable.
Here, we are working with FEMA to establish temporary housing
for VA employees on our Gulfport campus. We have signed an MOU,
memorandum of understanding, with FEMA for more than 200 mobile
homes, with priority for VA employees and disabled veterans who
travel frequently to utilize VHA's health care services, which
would be there at Biloxi.
Recovery efforts of the Veterans Benefits Administration.
The New Orleans regional office, home to 197 VBA employees, was
housed in a General Services Administration building, where we
leased space, and its prime tenant was the New Orleans postal
office system, which sustained considerable flood damage and
utility outages.
VBA has transferred all pending compensation, that is
active claims and appeals, to the Muskogee and St. Louis
regional offices, and all pension claims to the Milwaukee
Pension Maintenance Center. For now, the VBA has acquired
leased space in nearby Gretna, and we expect to move into the
facility early next month.
Recovery efforts of the National Cemetery Administration.
The National Cemetery Administration's Biloxi staff of 11
people has restored a normal schedule at Biloxi National
Cemetery. The cemetery covers 57 acres, with more than 15,000
grave sites.
The cemetery sustained damage to its administrative
building, maintenance shop and compound, and the cemetery
grounds themselves. Clean-up continues, and disturbed grave
markers will be raised and realigned over time.
What were some lessons that we learned from this? One, we
learned, of course, the benefit of being prepared and
practicing and drilling our emergency response system, which we
did and has made me so proud.
Our VA employees throughout that area acted heroically in
every one of the many crises or sub crises that they faced. And
I am very proud of their abilities to have done that and to
confront the many challenges that nature put in front of them.
And as I said, I am very heartened by the effectiveness of our
preparation.
Of note is how our electronic medical records systems
continued to operate until after New Orleans was evacuated.
Backup copies of these records were transferred away from
danger and made available nationwide to treat Katrina evacuees.
I contend that VA's operations during and after the storms is
one of the really positive stories to emerge from the disaster.
In the wake of the storms, we know where we still need to
improve our response to future disasters. We know that we need
to harden our telecommunications infrastructure. Individual
systems may survive a storm, but maintaining both voice and
data transmission capabilities will facilitate our response to
future disasters.
We are considering expanding the use of fully equipped
mobile clinics as a ready response to future disasters, and we
are examining the logistics of having in place larger
inventories of pharmaceuticals that can be deployed and
dispensed directly to veterans as soon as the crisis has
passed.
In conclusion, Mr. Chairman, the administration is
demonstrating its continuing commitment to veterans affected by
the hurricanes by including $1.38 billion for VA recovery and
rebuilding in the recent request for supplemental
appropriations transmitted to the Congress. That request
includes funding to re-establish a full VA medical center
presence in New Orleans and accelerate the expansion of the
Biloxi facility because of the destruction of the Gulfport
complex.
It also includes funding for essential VBA and NCA needs
throughout these areas. In addition, the VA also is looking at
resources in terms of funding and employees to respond to the
move of veteran patients to the Houston medical center.
We look forward to working closely with this Committee and
with the Senate Appropriations Committee and Senators
representing the Gulf States regarding the important resource
issues created by Hurricanes Katrina and Rita.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Nicholson follows:]
Prepared Statement of Hon. R. James Nicholson, Secretary of Veterans
Affairs, Department of Veterans Affairs
Mr. Chairman, Members of the Committee and those Members visiting
the Committee from the States of Mississippi and Louisiana, I want to
start by thanking you, and indeed all of the Senate, for your
Resolution recognizing and commending the heroic efforts of our
employees through Hurricane Katrina. Our VA family was gratified by
your words, as well as the outpouring of support from our committees of
jurisdiction and the entire Congress.
Thank you for providing the Department of Veterans Affairs (VA)
this opportunity to discuss our ongoing repair and recovery efforts in
the wake of Hurricanes Katrina and Rita. These hurricanes challenged
our country with two of its greatest natural disasters. I am pleased to
report that all of VA rose to the enormous challenges these storms
created. From the time of preparation through evacuation to relief and
recovery efforts VA employees stepped up to meet the challenge.
Mr. Chairman, appended to my written statement is a 2-page graphic
timeline of our response efforts to Hurricane Katrina. I believe the
Committee will find it quite useful in reviewing VA's actions
throughout the disaster. Through long hours, considerable personal risk
and sacrifice, coupled with incredible resourcefulness and a total
sense of mission, thousands of VA professionals demonstrated what is
right about this country. They have made us all proud to be members of
the VA family.
Now we must look forward. The aftermath of these storms will test
how we meet our mission for years to come. While Hurricane Rita
produced significant disruptions, it did little permanent damage to
VA's infrastructure. Hurricane Katrina, on the other hand, produced
unprecedented damage to our facilities along the Mississippi Gulf Coast
and in New Orleans. Our facilities, the communities we serve, and the
homes of veterans and employees sustained destruction on an
unprecedented scale.
As a result of extensive damage to VA facilities caused by
Hurricane Katrina, the Deputy Secretary established a ``Gulf Coast
Planning Group'' in early September 2005 to assist in coordinating VA
infrastructure planning in the region. The group's mission is to assist
in describing and coordinating VA plans for the near, mid, and long-
term timeframes. An important role is to act as a ``clearinghouse'' for
VA plans by ensuring that the plans make sense, consider previous
Capital Assessment Realignment to Enhance Services (CARES) planning,
and pass a ``one-VA test.''
In my brief testimony, I will speak first to the property damage
and the plans for New Orleans, Gulfport, and other Veterans Health
Administration (VHA) facilities, as well as the impact on VHA employees
at those facilities. Next, I will address the recovery efforts of the
Veterans Benefits Administration (VBA) and the National Cemetery
Administration (NCA). And finally, I will discuss a few of our valuable
``lessons learned.''
THE NEW ORLEANS EXPERIENCE AND PLANS FOR RECOVERY
Forty-eight hours following Hurricane Katrina's landfall, as
quickly as weather conditions permitted, a VA damage assessment team
was dispatched to the Gulf region to survey VA facilities at New
Orleans, Biloxi, and Gulfport. At New Orleans, the VA facility
initially weathered the hurricane with minimal damage. Following the
hurricane, water from the breached levees flooded the entire area
around the medical center, including the basement and sub-basement of
the main building. These areas house the facility's major electrical,
mechanical, and dietetics equipment. The costs associated with
replacing this equipment are still under review. VA is still assessing
the total effects of having no electrical power and no air-conditioning
in the medical center for a prolonged period. A major cost of restoring
the facility to operational status will include those costs incurred
from damage to equipment and interior finishes. VA is continuing to
monitor the situation and estimating the costs of damage and repairs.
We are taking steps to mitigate the damage caused by flooding,
humidity, heat, mold and mildew. Efforts are underway to restore power,
water, limited climate control systems, elevators, and safety systems.
Some of these repairs are temporary and do not allow us to use the
building in its entirety. Through these interim measures, we will be
able to protect the medical center and its $85 million worth of
equipment from further moisture damage. Additionally, the measures will
allow us to more fully assess the functional capabilities of the
equipment and damage to the building. We are exploring all our long-
term options to re-establish inpatient and tertiary care services for
our veterans in New Orleans. We are in discussions with our affiliates,
Louisiana State University (LSU) and Tulane Medical Schools. Both of
these schools plan to return to New Orleans area. The major teaching
hospitals for these medical schools, Charity and University Hospitals,
will require extensive repair and, indeed, they may have to be rebuilt.
Our plans for New Orleans hinge in part on recovery efforts taken
by both the State of Louisiana and other Federal agencies. As the
United States' largest port in terms of gross tonnage and a critical
transportation lifeline for our Nation's heartland, New Orleans remains
one of America's great cities. VA is committed to continuing to serve
the veterans who live there.
To address the healthcare of veterans in the greater New Orleans
area, VA is planning to open several clinics and expand operations in
Baton Rouge. The city of Baton Rouge continues to be doubled in
population due to hurricane evacuees. This growth is similarly
reflected in the number of veterans seeking care at our clinic there.
Baton Rouge is the site of a large and relatively new Community Based
Outpatient Clinic (CBOC). VA will lease the old CBOC building to house
administrative and clinical support functions for the rest of the New
Orleans area clinics. Plans for new CBOCs proposed under CARES in
Slidell, Hammond, and LaPlace will be accelerated with a goal of
opening them early in 2006.
On the site of the New Orleans medical center, an ambulatory clinic
is being established. Space that suffered minimal damage is available
on the ninth and tenth floors of the medical center. It was previously
occupied by a 60-bed Nursing Home Care Unit. VA is restoring
electricity, water, fire safety systems, and elevator service to the
entire building which will support this clinic. We anticipate opening
the clinic in December 2005.
THE MISSISSIPPI EXPERIENCE AND PLANS FOR RECOVERY
Overall, the VA Medical Center at Biloxi remained operational both
during and after Hurricane Katrina. All building systems, with the
exception of emergency communications, continued to function normally
during this time. Damage at Biloxi included the asphalt shingle roofs
on several buildings, windows panes, seals and gaskets, doors and
interior finishes, and some damage to electrical and mechanical
systems. External to the medical center, significant damage occurred to
facility signage and to a large number of trees on the campus.
At Biloxi, in addition to repairing storm damage, temporary
buildings are being acquired to accommodate functions lost in Gulfport.
We are exploring with the Federal Emergency Management Administration
(FEMA) the option of placing approximately 200 trailers on 25
unimproved acres at the back of the Gulfport campus. We are asking FEMA
for priority use of these trailers for displaced VA staff and disabled
veterans who are patients of the VA Medical Center.
Damage at the Gulfport VA Medical Center, only 8 miles away, was
much more severe, to the point of catastrophic. The tidal surge from
Hurricane Katrina destroyed or made irreparable most buildings on the
campus. While the boiler plant and laundry survived, both would need
significant repair to resume operations. Other than recovery efforts,
no operations are active at Gulfport. Prior to the storm, Gulfport
employed 440 people. These employees are now working at the Biloxi
facility.
VA's CARES plan called for the closure of Gulfport and new
construction at Biloxi to house services displaced from Gulfport.
Design was scheduled to begin this fiscal year with full completion to
occur in 2010. VA now proposes to accelerate this plan with the goal of
replacing clinical functions within 2 or 3 years. As part of this
process, we are in discussions to determine if there are opportunities
to collaborate with Keesler Air Force Base in Biloxi as the military
replaces their bed tower as part of the Base Realignment and Closure
(BRAC) process.
While the Mississippi gulf coast has been set back, its long-term
prospects are positive. The State of Mississippi is taking steps to
help the economy in the region. It is likely that the population of the
Mississippi gulf coast will return to its pre-storm levels. VA must be
prepared to support the veteran population of this gulf region.
THE IMPACT ON EMPLOYEES
In Biloxi-Gulfport, all 1,590 VHA employees have been accounted
for. All have been able to inspect their houses and 28 percent report
that their homes have been either totally destroyed or are
uninhabitable. In New Orleans, all but 6 of 1,819 employees have been
accounted for. While not all employees have been able to assess the
habitability of their residences, a preliminary survey suggests that
approximately 40 percent of our New Orleans employees are without their
homes.
We confirmed that one employee perished at home during the
flooding. All VA personnel have been placed in temporary positions at
other VA medical centers.
The CBOC expansions in and around New Orleans will help address the
utilization of our displaced New Orleans employees. Many employees,
though not all, will be able to return to the area to staff these
clinics and related functions. A significant number of our staff may
choose not to return to New Orleans. Already some have accepted
positions at other VAMCs or have taken steps to retire. Shortly, we
will begin a priority placement program for displaced New Orleans
employees. This will give New Orleans employees priority for any
opening in VHA for which they are qualified. VA already has voluntary
early retirement authority and is exploring the use of buyouts as well.
RECOVERY EFFORTS OF THE VETERANS BENEFITS ADMINISTRATION
The New Orleans Regional Office is housed in General Services
Administration (GSA)-leased space in the New Orleans Postal Office
Tower Building. Access to this facility has been restricted due to
flood damage and utility outages, and VBA has no definitive information
as to when the building can again be occupied. Due to this uncertainty,
VBA has implemented an interim strategy to address the pending claims
workload and to re-establish a regional office presence in Louisiana.
In order to resume the processing of disability benefits claims,
VBA has transferred all pending compensation claims and appeals to the
Muskogee and St. Louis Regional Offices, and all pension claims to the
Milwaukee Pension Maintenance Center. Our dedicated New Orleans
employees have been working under very adverse conditions in the New
Orleans Regional Office facility to box and to ship more than 11,000
claims files to these offices. A special post office box was
established in Muskogee to receive claims information and other mail
from Louisiana veterans. Louisiana veterans participating in the
Vocational Rehabilitation and Employment Program are currently being
served through VBA's out-based office in Shreveport and our regional
offices in Houston and Little Rock.
To re-establish a presence in Louisiana, VBA has acquired leased
space in Gretna, Louisiana, approximately 10 miles from the regional
office location in New Orleans. Efforts are underway to prepare the
building for occupancy. The facility will accommodate up to 105
employees. VBA expects to move into the Gretna facility in December
2005.
Regional office operations will be resumed on a reduced scale in
Gretna pending more definitive information on the occupancy status and
expectations for the regional office building in New Orleans. VBA's
priority is to re-establish public contact and vocational
rehabilitation program activities, including benefits, counseling, and
assistance, outreach, fiduciary management services, and rehabilitation
and employment services.
RECOVERY EFFORTS OF THE NATIONAL CEMETERY ADMINISTRATION
NCA has no burial or memorial facilities in New Orleans. NCA staff
has worked to restore Biloxi National Cemetery. The cemetery is now
operating on a normal schedule. While substantial progress has been
made, cleanup will continue and disturbed grave markers will be raised
and realigned. The cemetery's storage, maintenance, and administrative
buildings were damaged and will require additional repairs. Telephone
service was disrupted and IT data connections continue to be
intermittent. NCA staff responded to the loss of access to the
centralized interment data base by manually entering information so
that no burial schedules are affected and accurate records are
maintained.
NCA employees in the region responded quickly to minimize
disruptions and hardships for veterans and their families during these
difficult times. Their resourcefulness and dedication have permitted
operations to resume, often despite their own personal adversity.
LESSONS LEARNED
VA is also using this opportunity to examine how to improve its
response in future disasters. I am including an abbreviated list of
lessons learned, to illustrate how this review will assist VA in
defining its response plans.
Telecommunications
Lessons learned during Hurricane Katrina regarding
telecommunications were already in place for Hurricanes Rita and Wilma.
Hardening our telecommunications infrastructure will be a priority as
we plan for future disasters.
Mobile Clinics
VA staged a total of 12 mobile clinics to support veterans affected
by Hurricanes Katrina and Rita. Four mobile clinics were sent to south
Florida in response to Hurricane Wilma. VA needs to examine the role of
such clinics, how they are staffed and equipped, and how they are
supported.
Pharmacy Issues
Massive power failures, destruction of homes and post offices and
mass evacuations made mail-based pharmaceutical delivery impractical.
VA is examining mobile caches of pharmaceuticals that can be deployed
to affected areas and be dispensed directly to veterans--even before
commercial operations are able to resume.
CONCLUSION
Mr. Chairman, we know the Committee and the Louisiana and
Mississippi delegations are true partners with VA in seeing that Gulf
area veterans, despite these disasters, continue to receive the
excellent health care, benefits, and other services VA provides.
The Administration is demonstrating its continuing commitment to
veterans affected by the hurricanes. The Administration has included
$1.38 billion dollars for VA recovery and rebuilding in its request to
Congress for supplemental appropriations. The request includes $1.15
billion to rebuild the New Orleans Medical Center and to repair and add
a bed tower to the medical center in Biloxi following the destruction
of the Gulfport complex. It also includes $25 million for two essential
VBA needs. One, VBA will furnish and activate a replacement regional
office in New Orleans. Two, VBA will be able to pay contracting costs
for benefits-related health examinations ensuring that veterans'
benefits processing continues as quickly as possible.Thank you for the
opportunity to be here today. I and my colleagues will be pleased to
answer any questions you may have.
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka
to James Nicholson
Question 1. Dr. Robert Lynch, Director of VISN 16, has stated that
with regard to the Biloxi VAMC, ``a definitive solution will take
Congressional approval and years to complete.'' Yet, he has also
indicated that there is an immediate need for interim space to
compensate for the loss of services at Gulfport VAMC. Please detail
both the interim and longer term timelines for patient accommodation
and continuity of services at the Biloxi campus. Since returning to the
standard of providing inpatient care is considered a long-term project,
what is the short-term plan for veterans who require inpatient services
at Biloxi?
Answer. All clinical services provided at the Gulfport campus have
been moved to the Biloxi campus, which remained fully operational
during Hurricane Katrina. Patients in the domiciliary, located on the
Biloxi campus, were moved to the Department of Veterans Affairs (VA)
Medical Center in Tuscaloosa, AL prior to Hurricane Katrina. The
vacated domiciliary building on the Biloxi campus is being used to
house the inpatient psychiatry program from the Gulfport campus.
Renovation of the domiciliary building is needed as an interim solution
and will be accomplished via the minor construction program.
The major construction project described in the response to
Question 5 is the long-term solution to the consolidation of all
Gulfport services on the Biloxi campus. Until the major construction
project can be completed (in 3-5 years) and construction of the
permanent warehouse space via the minor construction program is
accomplished, modular buildings will be used to house the
administrative and warehouse functions displaced from the Gulfport
campus.
A modular clinic is also planned for the Gulfport campus to provide
a clinical presence until a decision regarding the future reuse of the
campus is determined. Additionally, the Federal Emergency Management
Agency (FEMA) has requested the use of 25 unimproved acres at the back
of the Gulfport campus for the placement of approximately 200 trailers.
We are asking for priority use of these trailers for homeless VA staff
and disabled veterans who are patients of the VA Medical Center.
Question 2. Will any funding provided by Congress for the purposes
of rebuilding facilities in the region go directly into the general
construction account?
Answer. Yes. The construction funds provided by Congress will go
into the VA construction appropriation. Most of the funds required
would be appropriated into VA's construction accounts. However, these
funds would be provided for the specific purposes of rebuilding VA
facilities damaged by the recent hurricanes.
Question 3. With regard to the New Orleans VAMC, Dr. Lynch stated
that he does ``believe it is safe to say the VA will return to the
Crescent City.'' Please explain the factors in the decision to restore/
return services to New Orleans.
Answer. There are 57,485 veterans enrolled for care in the New
Orleans VA Medical Center. It is expected that the Tulane and LSU
Medical Schools will return to New Orleans. As the United States'
largest port, a major hub for our country's energy infrastructure, and
a critical transportation lifeline for the Nation's heartland, New
Orleans will remain one of the Nation's greatest cities. The VA must
have a clinical presence in the city and maintain its commitment to
serve the veterans who live there.
Question 4. VISN 16 has announced plans to open new clinics in La
Place, Hammond, Slidell, and New Orleans. I believe VA should establish
and operate these new clinics in the most expeditious and cost-
effective manner to provide the needed medical care to the area's
veteran population. Existing CBOCs in Louisiana and other areas in VISN
16 continue to provide cost-effective and high-quality outpatient
medical care to the area's veteran population. Please provide an
analysis of the projected costs and timing associated with the
establishment of these new CBOCs.
Answer. To address the health care of veterans in the greater New
Orleans area we are planning to accelerate opening of three clinics,
Hammond, LaPlace, and Slidell, proposed under the Capital Asset
Realignment for Enhanced Services (CARES) plan. Mobile clinics are
being used to provide care at this time in these locations. Our goal is
to open clinics by January 2006 contingent upon the availability of
leased space or modular clinics.
Due to the impact of Hurricanes Katrina and Rita, leased space and
modular clinics are in short supply and have increased significantly in
cost. For example, in Hammond, there is no adequate leased space
available; therefore, purchase of a modular building is planned.
LaPlace may also require a modular building while adequate leased space
may be available in Slidell.
Current cost for a turnkey 9,500 square feet clinical modular
building is approximately $1.8 million, which includes the modular
building, site prep, ground cover, and utilities. Build-out and the
cost of leasing the land will add another $200,000. The cost of leased
space in Slidell has not been determined.
Question 5. Since the damage caused by Hurricane Katrina leaves the
door open for accelerating the CARES plan in the region, how
comprehensive will the transfer of services from the Gulfport campus to
the Biloxi campus be? Are there any services that are unavailable or
non-transferable? Has there been an exact determination of how the
timeline will shift? And if so, what is the new timeline?
Answer. With the exception of the laundry, VA will consolidate all
services provided at the Gulfport campus to the Biloxi campus as part
of the CARES plan. A final analysis regarding laundry function has not
been completed. The consolidation will be accomplished through major
construction that will modernize patient care facilities at the Biloxi
campus and provide area veterans with health care in newly renovated
facilities. The project will consolidate and co-locate all clinical and
administrative functions of the two-division medical center at the
Biloxi campus and construct a new Blind Rehabilitation Center, also a
part of the CARES plan. Barring any significant delays the timeline for
award and construction of new clinical facilities is January of 2009.
Some administrative functions may lag until 2010.
Question 6. What are VA's short-term and long-term plans for
addressing the needs of its employees affected by Hurricane Katrina?
How does VA plan on compensating staff for temporarily relocating? Will
they be given TDY? What is being done to address the personal needs of
affected VA employees in the region?
Answer. All employees from the Gulfport facility have been absorbed
in the Biloxi facility. All employees displaced from the New Orleans
facility who want to work at this time have been placed in VA
facilities throughout the country. These New Orleans employees have
been detailed for a 120 days, and are paid temporary duty travel. They
were assisted in finding housing in the locations of their detail.
The proposed clinics and related functions in the greater New
Orleans area will not accommodate all of New Orleans current employees.
It will be several years until employment levels will return to pre-
storm levels. In an effort to reconcile our interim needs with current
employment levels, voluntary early retirements are being offered to New
Orleans' employees and buy-out authority is being explored through the
Office of Personnel Management (OPM). Negotiations with national labor
partners have begun in an effort to establish a Special Placement
Program in the Veterans Health Administration (VHA). The Special
Placement Program would give New Orleans employees displaced by the
hurricane first consideration for vacant positions anywhere in VHA for
which they qualify.
Employees placed as a result of this program would be eligible for
Permanent Change of Station travel funding. It may be necessary to
extend details of these employees to allow this process to occur.
Teams of mental health practitioners were assigned to work with
employees who are experiencing difficulties because of the hurricane.
The contact information for these mental health professionals has been
communicated through various means and published in the ``After the
Storm'' newsletter. Assistance has also been provided with accessing
support from FEMA, Red Cross, and other entities.
A needs survey has been distributed to Biloxi and New Orleans
employees. The intent of the survey is to determine the extent of
damage the employees sustained to their property and to identify their
needs. VA, through Veterans Canteen Service and Leadership VA Alumni
Association, established funds for donations to employees affected by
the hurricane. Over $600,000 has been donated in the two funds to date.
Distribution of these funds using information obtained from the needs
surveys will start shortly. Additionally, the Veterans Canteen Service
has allowed employees to establish credit of up to $1,000 at 0 percent
interest to allow those who lost household goods, etc. the ability to
replace those items.
Question 7. On October 14th, the Joint Field Officer in Baton
Rouge, Louisiana, was advised to notify VA to cease the provision of
housing because of the lack of interagency agreement with FEMA, or to
continue working on preparing their properties for housing evacuees at
their own financial risk. Please explain VA response to this situation.
Has VA formulated a plan for requesting reimbursement for making their
properties available to FEMA for the purposes of housing evacuees of
Hurricane Katrina?
Answer. VA removed properties from the sales market on September 9,
2005, in anticipation of FEMA using them as temporary housing for
evacuees of Hurricane Katrina. VA has not incurred any costs on these
properties other than normal management expenses. VA has spent no funds
with the expectation of being reimbursed by FEMA. VA and FEMA are in
the process of negotiating an updated agreement (existing agreement was
entered into in 1988) to facilitate the use of VA properties by
evacuees.
Question 8. What are the daily operating costs for both VHA and VBA
of each interim/temporary facility?
Answer. At present, the only interim facilities/operations that
currently exist are mobile clinics in Hammond, LA, Slidell, LA, and La
Place, LA, in addition to the expansion of the Baton Rouge Outpatient
Clinic operations.
Chairman Craig. Mr. Secretary, thank you very much for you
and your staff being here.
We have just been joined by Senator Lott of Mississippi, of
course. And Trent, do you have any opening comments before we
go to a round of questions of the Secretary and his staff?
Senator Lott. That would be appropriate, Mr. Chairman. And
let me ask consent that I have my prepared remarks put in the
record.
Chairman Craig. Without objection.
STATEMENT OF HON. TRENT LOTT, U.S. SENATOR
FROM MISSISSIPPI
Senator Lott. I want to thank you and your Ranking Member
Akaka for allowing me to testify or to make a statement here
and for your interest in our veterans and our veterans
facilities that were damaged by Hurricanes Katrina and Rita.
I want to thank the administrator for his leadership and
his concern for our veterans and for his service. And also the
fact that after he came to the office, we had to address some
tough issues, and working with Senator Craig and Senator Akaka,
we were able to provide some additional funds for our veterans.
We do have a chart there that shows you what we are up
against. You will note the lower part of the photograph there,
that was Highway 90, a 4-lane road that runs the length of the
coast in Harrison County, Biloxi-Gulfport, Pass Christian, and
Long Beach. And you will see that that road is washed out. But
you know, we very quickly got Highway 90 back in operation. And
then, beyond that, you see the protective barrier, and then the
red-topped buildings is the Gulfport VA facility.
One interesting thing to note about this is we did have
damage there this time, significant damage. But it had never
been damaged seriously by hurricanes before, even though it is
not in a high area. It had some damage, but not like we had
this time, that amount of damage. And this time, though, the
wood-frame buildings are gone, and there is significant damage
to the other buildings.
Now I know that questions have been raised about what do we
do with this? And can we move those veterans that were there,
incorporate them into the Biloxi facility? I believe it was the
CARES Commission had already recommended that the Gulfport
facility be closed. Obviously, I wasn't that happy about it.
But my main goal, like all of us, is to have the best service
for our veterans and make sure the facilities are repaired, and
they are available.
Part of the problem we have now along the Gulf Coast that I
want the group to think about--and I know that you are working
on--how do we deal with this particular piece of property? And
I understand that if the VA doesn't keep it, it reverts back to
the city of Gulfport, Mississippi. And they are having to think
about what they would want to do with that, and then in what
condition would it be returned?
And then, if we are going to have these veterans that were
at Gulfport at the Biloxi facility, what repairs are going to
have to be made there, and what would we do to make sure that
they receive the medical care that they need?
The plot thickens by the fact that Air Force officials had
recommended that the BRAC Commission close the Keesler in-
patient services and the hospital there. The plan to help the
veterans was that what we were going to be losing at Gulfport
would be picked up by Keesler Air Force Base hospital. Never
taking into consideration, frankly, that they didn't have the
capability to do that.
And even though that facility was taken off the BRAC list,
the Air Force still is resisting doing what is necessary to
make sure that we have surgery for residents, and in the out-
years, we have not been able to get something worked out
between the VA and DoD as to what we are going to do. And so, I
would urge you to look at what we need to do in servicing our
veterans in Louisiana and Mississippi and in Texas and Alabama.
And by the way, that facility in Mississippi, we do have some
services that we provide for our veterans in south Alabama and
the panhandle of Florida, as you well know.
So this is a multi-pronged thing that we need to have help.
What are we going to do with Gulfport? What condition is it
going to be in if it is returned to the city? What are we going
to do to make sure that Biloxi has the facilities that it
needs?
Now somebody has said, well, to accommodate these
additional veterans, you are going to have a bed tower. Now I
don't know what a bed tower is. It doesn't sound too enticing
to me. But it will only include a fraction of the medical
services that were originally available at this facility in
Gulfport.
So I would like to work with you on the Gulfport facility,
what we need to do at Biloxi, and how we come to terms with the
Air Force and the Pentagon about these veterans being able to
get access to the care they need and the surgery they need, for
instance, at the Keesler Air Force Base hospital.
One other thing, I don't begrudge anybody getting help.
Louisiana is desperate. They need a lot of help. But the
hurricane pounded Mississippi. When a hurricane goes ashore, it
doesn't stop at the coastline, No. 1. Number 2, the worst part
to be in is the Northeast quadrant. That is what we got.
The hurricane went in on the Pearl River, which means right
on the border between Louisiana and Mississippi. So the hardest
damage, the most wind damage and the most tidal surge damage,
came to Mississippi.
Now the problem in Louisiana was that they had hurricane
damage, but then their problem got worse. It was worse for them
on Friday, after the hurricane on Monday, than the day of the
hurricane because they had the levies break and the rising
water.
But the point I am trying to make is when you are looking
at $1.2 billion, I believe you mentioned that figure, didn't
you, Mr. Administrator? As I look at that, it looks to me like
the lion's share of that would be going to Louisiana. And for
instance, the supplemental included $1.2 billion to re-
establish medical care on the Gulf Coast, with most of that
money designated to replace the VA hospital in New Orleans,
which was flooded on the first floor, just like the Keesler
hospital.
My plea is make sure there is equity here. You can't put a
billion dollars on that one facility in New Orleans and not
deal with the needs we have in Mississippi. Now having said
that, thank you for what you have already done. I know you have
been there. I know you have met with our veterans. Same thing
to the leaders of this Committee.
Our veterans have not been forgotten in the aftermath of
the hurricane, But we have got a good piece to go, and we have
got some sticky problems that we need to address. And I hope
that you will allow me to work with you on that and have
impact.
Thank you, Mr. Chairman. That is basically the points I
wanted to make anyway.
[The prepared statement of Mr. Lott follows:]
Prepared Statement of Hon. Trent Lott, U.S. Senator from Mississippi
I would like to thank Chairman Craig and Ranking Member Akaka for
allowing me to testify regarding the repair and recovery effort to VA
facilities on the Gulf Coast.
Prior to hurricane Katrina, the Gulf Coast Veterans Health Care
System was a five-division system with major hospitals at Gulfport and
Biloxi, Mississippi, and three Community Based Outpatient Clinics
located in Alabama and Florida.
Approximately 242,000 veterans live in Mississippi today, and
almost 40,000 of those veterans received medical care last year from
the VA. In fiscal year 2003 alone, VA facilities in Mississippi had
8,966 inpatient admissions and provided 633,758 outpatient visits. Even
in the wake of Hurricane Katrina, the number of veterans in my State is
projected to significantly increase, not decrease.
The Biloxi VA hospital serves as the general medical facility,
providing outpatient and specialty care, and inpatient surgical
services. Prior to the storm, the Gulfport hospital provided inpatient
and outpatient mental health services, and also housed an Alzheimer's
dementia unit. Gulfport also included a psychology unit, rehabilitation
medicine including a therapeutic pool, primary care, and audiology.
This is a picture of the Gulfport VA today. Obviously, the Gulfport
facility sustained major damage in the hurricane.
Wooden buildings were largely destroyed, and patient buildings were
flooded on the first floor.
Thankfully, all patients were safely evacuated before the storm
hit; and only a few VA employees remain at Gulfport.
Given the extent of damage to the Gulfport VA, I understand that
the Veteran's Administration would like to permanently close the
facility, and transfer all Gulfport health care services to the Biloxi
VA or Keesler medical center.
The Committee may recall that the CARES Commission proposed in 2004
to transfer all Gulfport health care services to the Biloxi VA or
Keesler hospital; renovate the nursing home in Biloxi; and establish a
36-bed blind rehabilitation center at Biloxi.
As part of the consolidation, the VA also planned to open
outpatient clinics in Columbus, McComb, Pontotoc County, Tunica and
Grenada, Mississippi.
Although I was never enthused with the VA's decision to close the
Gulfport facility, I do appreciate that the CARES Commission made site
visits to the VA facilities and to Keesler, and held open hearings.
The Commission's recommendation regarding the Gulfport VA was based
on contingent assurances that patients would be treated at Keesler
hospital. Unfortunately, to date, I am not aware of any such commitment
by the Air Force to treat VA patients.
To the contrary, the Air Force medical community recommended during
the BRAC process to eliminate all outpatient capability from Keesler
Hospital--at the same time they were talking with the VA about the
possibility of absorbing patients.
And, even though the BRAC Commission rejected the Air Force's
recommendation to convert Keesler Hospital to an outpatient clinic, I
understand that the Air Force medical community continues unabated in
their desire to eliminate surgery residents by 2007.
Obviously, I strongly oppose the Air Force's continuing position
regarding elimination of any medical capability at Keesler hospital--
and will work to convince them otherwise.
Consequently, I believe it is ill-advised to assume that the Air
Force has agreed to takeover ANY of the medical services previously
performed by the VA in Gulfport.
Mr. Chairman, I'm not here today to throw water on the notion of
having our military and VA hospitals share capability and patients--I
believe the concept has merit.
However, the concept will only work if the VA and DoD formally
agree on the distribution of capability between Keesler Medical Center
and the Biloxi VA, and budget for the infrastructure that will be
required to achieve that goal, and maintain it.
Thus far, the recent Katrina supplemental request includes $1.2
billion to reestablish VA medical care on the Gulf Coast, with most of
that money designated to replace the VA hospital in New Orleans (which
was flooded on the 1st floor, just like Keesler hospital).
Of that $1.2 billion, I understand that less than 20 percent of
that money is available re-establish VA healthcare for Mississippians,
by building a new ``bed tower'' at the Biloxi VA.
While I'm not certain what a ``bed tower'' may be, or even how many
``beds'' it may hold, I'm fairly confident that it will only include a
fraction of the medical services that were originally available on the
50-acre campus of the Gulfport VA (reference the aerial picture).
Also, there is no money in the Katrina Supplemental for the Air
Force to absorb additional patients from the VA. And, again, I'll
emphasize that the Air Force would like to eliminate the surgery
program at Keesler Hospital.
Mr. Chairman, as the Committee does its important work of
considering how best to renew, recover, and rebuild VA facilities on
the Gulf Coast, I urge you to support the following:
(1) Commit to re-establishing the full-level of medical capability
that was available to Mississippi veterans prior to Hurricane Katrina;
(2) If veterans' medical care will be provided through a
partnership between the VA and Keesler hospital, the Air Force and the
VA must make long-term commitments regarding the budget and scope of
medical service that BOTH organizations intend to provide; and
(3) If those commitments and budgets are not forthcoming, the VA
should be prepared to go-it-alone and build all required infrastructure
on the Biloxi VA campus that is necessary to provide the full spectrum
of medical services that were previously available at the Gulfport VA.
Mr. Chairman, thank you again for the opportunity to testify
regarding this important matter.
Chairman Craig. Well, Trent, you have asked some to-the-
point questions that, in part, were addressed by the Secretary
in his opening comments.
We have Robert Lynch with us, who is the coordinator for
the region. Let me set the first question somewhat in the
context of what Senator Lott has spoken to, and why don't you
attempt to broaden on that?
You appointed a Gulf Coast Planning Group, which will
coordinate VA's plans, as you said, in the near-, mid-, and
long-term future timeframes. Last week, the President appointed
FDIC chairman Don Powell to coordinate all of the Federal
support for recovery and rebuilding efforts.
So I think my question, specific to some of what Trent has
asked, coupled with this coordinated planning effort, is the
right hand and the left hand communicating now? Is the
coordinating or the Gulf Coast planning council that is
coordinating VA's plans working with Chairman Powell and that
coordinated effort in concert with how we deal with Gulfport,
Biloxi, and all of that combination of events?
And you had mentioned, as we had talked about earlier, and
Dr. Perlin, you and I talked about what they might be able to
do to offset some of these needs. In that context, focus in on
that and respond to those questions, if you would, please.
Secretary Nicholson. Yes, sir, Mr. Chairman.
First of all, our Gulf Coast Planning Group is interior to
the VA because we want to make sure that our left hands know
what our right hands are doing, both in Washington and out
there in the VISN on the ground, what the needs are. That is
their charge to assess that, evaluate it, and then look at the
needs and develop a position that we, as an agency will
advocate. And we do anticipate working closely with Mr. Powell
and that sort of overarching Federal coordinating effort. So,
indeed, we will do that.
And as to your question, Senator Lott, we are very
sensitive, I think, to the respective situations in Mississippi
and Louisiana. And we are, as we are here speaking, seeking to
establish a collaborative endeavor with the Air Force in
Keesler because it just seems to me to make eminently good
sense for us to examine sharing some facilities and sharing
some services.
And we have now created some good models for that in some
other locations with DoD inside the United States. So we
wouldn't be doing something out of whole cloth there. There are
some models now for that. We have just initiated one in Chicago
with the Navy, and so we agree, and think that that makes good
sense.
Senator Lott. If I could just build on that?
Chairman Craig. Yes.
Senator Lott.
Senator Lott. The theory is good. We have got to make sure
that it is actually going to be there. I mean, the theory of
using Keesler Air Force Base hospital for these veterans that
were being served at Gulfport is good. But the question is, are
they going to have the facilities? So I hope that you will
collaborate with them on that.
Secretary Nicholson. One thing, if I might, Mr. Chairman,
to respond to bed tower?
Senator Lott. Yes, what is a bed tower?
Secretary Nicholson. A bed tower is the rubric used to
describe a multi-storied hospital building that has in-patient
beds in it. It is not an outpatient clinic facility. It has in-
patients, people who have to come and spend time in a hospital.
And that is efficient use of space because with elevators, you
don't have to build out linearly. You can stack utilities and
stack the construction of the building.
Senator Lott. While I am at it, Mr. Chairman, could I ask a
couple more questions?
Chairman Craig. Please proceed.
Senator Lott. I know there is a little squirm and stirring
around when I mentioned if we are going to close the Gulfport
facility. And you will note I didn't say we shouldn't do it. I
have discussed this with the Chairman. We are aware of what is
going on there, what the case may be.
But it is my understanding that if that happens, it would
revert to the city of Gulfport, Mississippi. If that is not the
case, I would like to know.
Secretary Nicholson. I will have to get back to you on that
because if that is the case, I am not aware of it. There could
be a covenant in that conveyance, and we will have to look at
that.
I will tell you the conversation that we are having
currently with FEMA and with the Governor and others is to put
some temporary housing in there. And we would enter into, and I
think, actually consummated a memorandum of understanding with
FEMA to put 200 units of temporary housing in there, with a
priority to patients that need care in nearby Biloxi hospital
and disabled veterans.
Senator Lott. Thank you, Mr. Chairman.
Chairman Craig. Thank you, Trent.
We have been joined by Senator Landrieu. Mary, thank you
for joining us. We will treat you as a full Member of this
Committee.
The Secretary has outlined, in large part, by his testimony
what their current plans are as we evolve out of Katrina and
Rita. So if you have an opening comment, please feel free to
make it, and then we will resume questioning.
Senator Landrieu. Thank you, Mr. Chairman. I will be brief
and wait my turn for questions. But I thank you and the Ranking
Member for including me.
Of course, this is a very important part of our recovery
effort and a very important part of our health care delivery
system for New Orleans, Louisiana, and the Gulf Coast region.
And as Senator Lott knows so well, we do try to work in
partnership, caring for the veterans that are in our area and
their families and between the Gulf Coast and New Orleans.
So I am going to submit my statement for the record.
Obviously, we have some strong views on how we can rebuild and
provide good services to our veterans, and I may have a few
questions. But I will wait my turn, Mr. Chairman, and I am
sorry that I couldn't get here earlier.
Thank you.
[The prepared statement of Ms. Landrieu follows:]
Prepared Statement of Hon. Mary Landrieu, U.S. Senator from Louisiana
Mr. Chairman: Thank you for calling this hearing to discuss
rebuilding the Veterans Affairs system in the Gulf region after
Hurricanes Katrina and Rita. I would like to start by again thanking
the VA for their immediate and heroic response to Hurricane Katrina. I
believe it speaks volumes about the Veterans Administration when over
1,000 patients, employees, and their families were evacuated, and all
without the loss of any life. That truly was a feat within itself.
Our country has never witnessed the destruction and devastation
seen in the Gulf Coast region following Hurricanes Katrina and Rita.
Lives have been lost; dreams and hopes shattered; buildings destroyed;
and parishes and part of a major city were under water. We are saddened
by the loss of life. We will never bring those people back, but we can
restore and rebuild cities and parishes, and once built, we can restore
dreams and hopes. It is my belief, that the Veterans Administrations is
a key to the revitalizing the entire Gulf region.
Before the storms, the State of Louisiana had an estimated 400,000
veterans, 37,000 throughout the Southeast region, 3 Veterans Medical
Centers (VAMC), 2 Out-Patient Clinics, and a few Community Based
Outpatient Clinics (CBOC) and Vet Centers. However, the unprecedented
events of Hurricanes Katrina and Rita have left the integrity of the
Louisiana VA system in jeopardy. Many of our veterans have evacuated,
structural damage has been sustained, and our other facilities are
becoming over-crowded.
The New Orleans VAMC is a 450-acute care bed facility that delivers
primary, secondary, and tertiary care. It provides state-of-the-art
outpatient and inpatient services for 57,485 veterans in a 23-parish
region and parts of Mississippi and the Florida panhandle. As you know,
this state-of-the-art facility sustained extensive flood and structural
damage and has been temporarily shut down. We are counting on VA
leadership to rebuild a great medical center.
It has been suggested by the Administration that we re-allocate
$1.4 billion of idle FEMA funds for emergency needs in the affected
areas of Hurricanes Katrina and Rita. In this request, it was suggested
that the VA receive $1.4 billion dollars. Of that $1.4 billion, $1.155
billion was allocated to ``replace the medical center in New Orleans,
Louisiana, and repair and add a bed tower to the medical center in
Biloxi, Mississippi, destroyed as a consequence of Hurricane Katrina.''
Of the $1.155 billion, $845 million has been identified for New Orleans
replacement and land acquisition only.
With some coordination with our State medical schools and other
partners, I believe we will rebuild a stronger facility. It is crucial
that in-patient services return to New Orleans, not only for the
veterans of Louisiana, but for those in the surrounding Gulf region.
In addition to my concerns regarding the rebuilding of our VA
system in the Gulf region, many issues surrounding Priority 7 and 8
veterans weigh heavily on my mind. Due to their surplus in income,
compared to other veterans, they are not eligible for healthcare from
the VA and they also pay additional co-payments others are not forced
to pay. I would like to know how the VA plans to tackle these issues
concerning this very important group of veterans.
In closing, I thank you for the work you have done so far. The
people of Louisiana truly appreciate your efforts. But, we are far from
finished with this enormous task. What I need from you is a detailed
plan laying out how you are going to restore the Louisiana VAMC,
complete with timelines, milestones, and funding details. With that, I
would like to proceed to a few questions.
Chairman Craig. Well, Mary, let me cut to the chase on a
specific question that I am sure you will want to chime in on
because I think it is reasonable in light of what is being
asked at the moment and the circumstances as they are evolving
in New Orleans, with the infrastructure and the support coming
out of those two medical schools that facilitated in large part
VA's capabilities in the New Orleans area.
So let me ask two questions together. And this is to get to
the point of where we go because Senator Lott has mentioned the
$1.2 billion and a substantial amount of that going to
Louisiana and New Orleans. So, in your testimony, you noted
that approximately 40 percent of the New Orleans employees have
lost their homes and that a significant number of your staff
may choose not to return, and some have retired and all of that
circumstance.
So the first question in the context of dealing with the
Louisiana issue and New Orleans would be, given the reality,
are you at all concerned about the ability to staff the new
infrastructure that you are seeking to build in New Orleans?
Now having said that, the President's supplemental
appropriation request identifies $845 million as needed for the
construction of a new VA medical center in New Orleans, and I
was one that looked at that number and went ``wow.'' At the
same time, I know how costly hospitals are to build as it
relates to modern infrastructure and all that comes to a
hospital room now, let alone all that is tied to the broader
infrastructure of a hospital.
What is driving the significant costs of the project? What
is the overall reality of what you are looking at, Mr.
Secretary, Dr. Lynch, as it relates to bringing these services
back versus remodeling the old facility, versus relocating to
have the infrastructure available to meet the services of the
veterans of the Louisiana area? Broaden on that, if you could,
please.
Secretary Nicholson. I will, Mr. Chairman, and then I will
ask my colleagues to join in, if they care to.
Starting out, the real determination on these things will
be driven by what is best for the veterans and those respective
veteran populations. And I am confident in saying that we will
end up with a new veterans hospital in New Orleans.
I cannot tell you what the resultant population of New
Orleans is going to be. We know from our sort of microcosmic
experience that some of our employees who have been temporarily
redistributed throughout the system are choosing to stay where
they have been put. We don't know what our partners in that
area are going to do. What is Tulane going to do? LSU, Charity?
Those are right now unanswered questions.
But we know that, in some configuration, we need a new
hospital. We need a hospital in New Orleans. And it appears to
us that we are going to have to build a new hospital, based on
our current evaluations of that structure. And ``where'' is the
question, and whether we would be able to be co-located with
other academic medical facilities, which we desire, which gives
that synergy of services and academic opportunities that good
staff doctors want.
And the same is true in Biloxi. I mean, we know that we
need the capacity to serve there, and we have lost capacity
because of the fact that the Gulfport hospital has been
obliterated. As Senator Lott said, there was a plan to expand
Biloxi, which is 8 miles away, to facilitate that before the
hurricane happened. We are going to try to accelerate that
planning to make that happen.
Meanwhile, we have temporary clinic facilities and modular
buildings that we are going to site at Biloxi to give that care
that is lost at Gulfport.
Chairman Craig. Recognizing that Senator Thune is here, I
just wanted to recognize him as I turn to Senator Landrieu.
And that is why I went to the heart of this question, Mary,
because obviously you are intimately involved in it, and it is
critical to you and your constituents. So you had asked a
question coming off from those comments?
Senator Landrieu. Well, I just wanted to maybe comment for
the record. I mean, this is a work in progress, and each day,
we learn something more. But just for the record, it is the
intention of Tulane and LSU, those medical schools, to reopen
and to function up to capacity.
They, of course, are quite challenged with the devastation
that has occurred. But our State has every intention of holding
those medical schools there, and it looks like we are going to
have to reorder the way the Charity Hospital system--and I
think Senator Lott is more familiar with this than others--but
it is a complex of medical hospitals all in the same area,
which brings a lot of synergy and efficiency and sharing and
opportunity.
So the veterans actually receive a tremendous amount of
care because you have two great medical schools right there.
And of course, New Orleans being a city, it is convenient for
people to get to from East and West, North. Nobody comes too
much from the South. A few people out of the water, but mostly
East and West and from the North.
But having said that, Mr. Chairman, this is a real
interesting opportunity for the VA to lead the rebuilding of a
great medical complex and to do it in a way that serves the
whole Gulf Coast, Senator Lott, in a way that is very helpful.
Because while we serve a great region, it is important to have
some activities in the Biloxi-Gulfport area and some to the
west of us in Texas to serve that great region of veterans.
So maybe we could visit a bit and perhaps make a
presentation. But I can assure you the LSU medical center and
Tulane medical center will be open and want to serve the
veterans. And perhaps the State would be willing, Mr. Chairman,
to put up some kind of proposal because we have got to
reconfigure the Charity Hospital building. That building is so
old, I don't think that our State will be able to rebuild
Charity.
So there is a new opportunity. And perhaps a hospital that
can be purchased for less than the $850 million that is
outlined and do the right thing by our veterans and do some
kind of regional approach now that we have the opportunity.
I am sorry I didn't come with all of the specific plans,
but I do want to assure you those medical schools are preparing
to reopen and are counting on you all to be a part of that.
Chairman Craig. Trent, do you have any additional comments
or questions?
Senator Lott. What if the Air Force and DOD continues to
resist or they don't do what we would hope that you could work
out with the Keesler Air Force Base hospital? What are you
going to do then about the medical services that you would be
losing at Gulfport if that facility, in fact, is not continued
to be used? How would you accommodate those veterans?
And with regard to Senator Landrieu, I think that probably
now, we do have, if you have a veteran that is needing heart
surgery, I think they have gone to New Orleans to get that
probably. So there is that sort of thing. The specialties, you
know, we have gone back and forth. We have veterans come from
the panhandle of Florida to Biloxi.
But we have got to work this problem out with Keesler, or
we have got to come up with an alternative plan. And we are
restricted in what the medical community can accommodate there
along the coast. We were in that bind before the hurricane.
That is one of the reasons why the BRAC Commission took Keesler
Air Force Base hospital, surgery and all, off the list because
there was no place for them to go. So what is going on with the
Air Force?
Secretary Nicholson. Well, we are having some conversation
with them, Senator Lott. I can't tell you that I am optimistic
it is going to end up in a collaboration that I think it
should. But we are working on it. And as I said, we have done
this now in some other areas. We just consummated one on the
north side of Chicago with the Navy, and it is a really, really
good arrangement for everybody.
If this doesn't come to pass, we will have to size the
Biloxi facility to meet the needs of the veterans in the
region.
Senator Lott. Thank you, Mr. Chairman.
Chairman Craig. Thank you.
Senator Akaka, questions of the Secretary?
Senator Akaka. Thank you very much, Mr. Chairman.
Mr. Secretary, in a response to my prehearing questions
concerning the fate of New Orleans hospital, it was stated that
VA would maintain some, and I am quoting, ``clinical presence
in the city.'' Can you explain what that means? Does that mean
hospital beds, clinics, or some combination of the two?
Secretary Nicholson. Yes, sir. What that means is that we
will be there, that we are there in a clinical way for people
to come and do outpatient visits. So that we are taking care of
if they have a problem, we diagnose it and treat it in those
clinics. We can't put them in a bed right there, but we can
refer them to one of our facilities if they need more acute
care.
Senator Akaka. As you know, Mr. Secretary, the White House
reallocation package includes funding for restoration of
medical services, possibly new hospitals and bed towers, and
restoring burial sites, as you have indicated in your
statement. I must ask, however, where will funds come from to
shore up personnel accounts to pay all the per diem costs that
are being expended on a daily basis for displaced personnel?
Secretary Nicholson. We are accounting for that, Senator
Akaka, and we have put that in our supplemental request for
reimbursement.
Senator Akaka. I was asking that because you haven't asked
for a supplemental, and I was wondering.
Secretary Nicholson. Some of it we expect to be reimbursed
by FEMA because of the emergency.
Senator Akaka. Mr. Secretary, this is more of a statement
than a question. At a meeting held last week, VA's chief
counsel stated that you and I, and I quote, and here is the
quote, ``are committed to giving Congress quarterly
briefings.''
I just want to say that in the aftermath of Hurricane
Katrina and with so much at stake, transparency and oversight
are essential to ensuring a successfully accomplished mission.
And I want you to know that I look forward to working with you
and the Chairman on these meetings.
Dr. Lynch, I am delighted to have you with us today. It is
my understanding that VA has decided that January 2009 is a
target for award and construction of new clinical facilities in
Biloxi, with some administrative functions lagging until 2010.
With so many veterans having been displaced and their care
put on hold, Dr. Lynch, is this an appropriate timetable, or
what can and cannot be expedited?
Dr. Lynch. That is an expedited schedule, Senator. The
original construction timelines for Biloxi, and we are
fortunate there because of the CARES process. Literally, the
week before the storm hit, we already had a design firm
developing concept drawings for what we might do in Biloxi. So
we were ahead of the game before the storm even hit.
The timelines, original timelines had us completing
clinical functions in 2010, probably mid to late 2010. If
things go well, we believe we can move that up to early 2009.
Obviously, we have to bridge between now and then.
Part of that is helped by the fact that I think our
employees' home losses mirror the community. Our staff live
around the area and are very representative, and that is
probably true of about most of the home stock. About a third of
it is gone, which means that people aren't living in those
homes now and will be trickling back in over the next couple of
years as they are rebuilt. So we have a little bit of a
breather in terms of the workload.
We are also able to support some of that workload right now
by shifting workload to Jackson for some of the functions. What
we largely lost at Gulfport was some outpatient clinic space,
where we had primary care, things like that. But mainly in
terms of in-patient functions was long-term care. About a third
of our in-patient long-term care capacity was at Gulfport. And
all of our psychiatric in-patient care was at Gulfport. That is
the part we are going to try to put back together.
We have a proposal, we are acquiring 30,000 square feet of
temporary buildings, which will help us offset some of this,
not all of it. We have also moved. We are using the
domiciliary, which was at Biloxi, after a construction project
to make it safe for psychiatric patients. That will be our
psychiatric in-patient center very shortly.
So we are putting together some interim plans. But I think
long term for the community, it is important for us to be able
to deal with all of the needs there. CARES said, and I think
this is still going to be true 20 years out, that we needed to
increase services across the board there, and that is what
those projects are designed to do. And we just need to get
there as fast as possible.
Senator Akaka. Thank you, Mr. Chairman. My time has
expired.
Chairman Craig. A follow-up question to what Senator Akaka
just asked. So you are telling me that the plans and the
timeline for the plans, because I would have to agree 2009
sounds like a long way off, are also a part of the growth? I
mean, it is an expansion. It is an expansion of existing to
meet, to accommodate what CARES saw as a future need along with
the present need. Is that correct?
Dr. Lynch. That is correct, sir. And just if there is any
fortune in this, we had those plans on the board before the
storm hit.
Chairman Craig. OK. Jim, Secretary Nicholson, I recently
visited the armed services retirement home here in Washington,
DC. As you know, there are more than 400 residents of the
Gulfport facility that were relocated due to the hurricane
damage.
The President's supplemental request includes $21 million
to cover the accommodations and living costs of the dislocated
residents. Although the homes are considered DoD civil
programs, they are a unique anomaly in the Federal system. I
think that is a better way of saying it, but they are part of
that civil program.
VA provides health care services to many of the residents
of both the Washington and the Gulfport facilities. Given this
fact and the fact that VA has experiences in delivering the
long-term care services that DoD does not, are you involved or
do you plan to be involved with DoD in future planning for the
Gulfport facility?
Secretary Nicholson. I am going to ask Dr. Perlin if he
wants to expand on my response. Senator, to my knowledge, we
haven't had a conversation with DoD specifically about the
Gulfport relocatees. But we have addressed it ourselves because
it is a matter of concern to us.
And I ask Dr. Perlin, do you have anything to add?
Dr. Perlin. Mr. Secretary, thanks. We have not had specific
conversations about any sort of new relationship there. But as
you know, we are providing a good deal of support to the
veterans from the Armed Forces Retirement Home in Gulfport who
are now here in Washington. Just as a note, many of those
veterans had previously used VA for care, and it has been
pretty easy for us to care for them because their electronic
health records were automatically available.
Chairman Craig. OK. Mary, additional questions?
Senator Landrieu. Can I just ask a few more questions? And
I am sorry, this may be in your testimony. But before the
hurricane, what were the general plans for the New Orleans
veterans hospital, basically to stay and grow?
And the facility, I have been there many times, is in
fairly decent shape. But tell me, Mr. Secretary, what were your
plans before the hurricane for that facility?
Secretary Nicholson. Well, we were very pleased with that
hospital. It was busy and doing a fine job and had planned for
it to continue on in that mode.
Senator Landrieu. And I understand, because I am familiar
with the general flooding, that it was just flooding through
the first floor of that area, basically. Electric systems and
such, some mold concern?
Secretary Nicholson. Yes, it has a sub-basement and a
basement, and those two sort of below-grade levels got most of
the water. But it damaged, it wiped out the elevator service,
the electrical service to the building. Some of the dietetics
were affected there, and the generators, so that our emergency
electricity system was jeopardized but never fully taken out.
Senator Landrieu. Now you know that has been true of many
buildings in New Orleans and the region. Have you had a rough
estimate of what it would be just to repair and fix and get the
hospital open? Do you have an estimate of that cost?
Secretary Nicholson. Well, we have plans to use as a clinic
part of that building right now. I will ask Dr. Lynch, because
he is working on that on a daily basis, to give you more
detail.
Senator Landrieu. But like, Doctor, if you had to open the
hospital and forget the fact that you don't have housing and
all of that. I am familiar with it. But if you had to open that
hospital like within 30 or 60 days, have you estimated what it
would cost to just get it back open and functioning up to the
level it was before the storm?
Dr. Lynch. We don't have a final estimate.
Senator Landrieu. Do you have a rough estimate? Is it a
portion of this $800 million for total replacement cost?
Dr. Lynch. It would be less than $800 million.
Senator Landrieu. Do you think it would be 50 percent of
the new cost estimate or less, or you don't know?
Dr. Lynch. I would just be guessing, but probably somewhere
in that ballpark. Regarding the Secretary's comments, our plans
to move back into the building in December with a clinic, the
building is really a series of constructions. The oldest part
of the building is early 1950s where the beds are, the bed
tower, if you will.
An addition, which includes the parking garage, and on top
of the parking garage sits a two-story nursing home. It
weathered both the storm and the effects of the flooding very
well, and we were able to lift air conditioning onto the roof
of that and plumb it down into the building.
After we restore electricity and once we restore the
elevators, people will be able to park in the garage and have
direct access to the nursing home without having going into the
building, where we could continue to do repairs, construction
as necessary. Which it just works out that will enable us and
the space lends itself to being converted to a clinic fairly
easily. It is ample space.
So we will actually be able to get that part of the
building online by December. But just getting the fire safety
systems, elevators, the air conditioning, beginning to drop the
humidity in the rest of the building and what have you before
you repair any of the other damage is going to cost us close to
$25 million just to do that.
Senator Landrieu. My question is are all of you happy with
the building and the location? I mean, there is ample land
around there and ample medical partners that a new facility
could be constructed in partnership with the city or the State.
Have you all had any conversations with the State of
Louisiana Recovery Authority, and if you could just brief me? I
don't want to take too much of the time. But a minute of
briefing on at least the initial conversations with the LRA?
Secretary Nicholson. I will take the first response,
Senator, and say, yes, we're very interested because we think
it is critical to be appropriately co-located with Tulane and
LSU. So part of our decision, I think, will be driven by what
they decide to do, and whether or not they stay in the area,
and would then be persuasive to us to justify spending the kind
of money that will be required to restore that rather old
facility that we have there.
Senator Landrieu. Well, Mr. Chairman, with that, I am going
to leave it there and just commit to work with you. And perhaps
because of this very strong and longstanding partnership
between Tulane and LSU and the veterans center, and I mean they
are literally right next to each other and have been for
decades, that perhaps we could facilitate a meeting with the
LSU and Tulane because they are making decisions now.
And I am led to believe that they are going to stay right
where they are and rebuild. Of course, they have got financial
challenges like we all do. But perhaps we could do that, and I
could include the Chairman and the Ranking Member in those
informal discussions, or your staff.
Chairman Craig. I appreciate that comment. I think those
are very legitimate discussions, whether you remodel an old
facility and bring it back online, or if you build something
new.
And of course, the partnerships VA has with private medical
schools and facilities is fundamental. It is valuable to both
sides of that equation in a very real way. For the students
themselves, for the services that are rendered, for the costs
of operation at the VA center, for the quality of health care,
all of that fits nicely. And it appears to me that the New
Orleans facility was really a regional facility of some
magnitude, and we see, of course, that kind of partnering going
on.
So, no, I think you are absolutely right. Those kinds of
conversations for final decisionmaking, either way we cut it, a
lot of money is going to get spent and needs to be spent. And
it needs to be spent, clearly, with an eye toward the future
and future services along with current services. So we
appreciate that greatly.
Let me ask this question, and maybe Dr. Lynch could respond
to it. We are going to do accelerated CBOCs you mentioned in
Slidell and Hammond and, let us see, one other one. Anyway, the
Slidell one appears to be almost on the border, is it not?
Dr. Lynch. It is pretty close to the border, sir. But it is
only 20 miles from downtown New Orleans. It is really a suburb
of the city of New Orleans.
Chairman Craig. Well, I guess it is, isn't it? I was just
wondering how much service you get cross border. Does it serve
a portion of Mississippi or Mississippi patients?
Dr. Lynch. It will probably draw some patients from
Mississippi. It is not open yet, but it almost certainly will
when it is open.
Chairman Craig. What is the timeline on that, do you know?
Dr. Lynch. We are hoping to have them opened in the first
part of 2006.
Chairman Craig. 2006.
Dr. Lynch. Subject to contracting and things like that.
That is sometimes out of our control.
Chairman Craig. OK. Danny, additional questions?
Senator Akaka.
Senator Akaka. Thank you very much, Mr. Chairman.
My questions have been answered. I just want to say that I
am proud of what our VA administration is doing there. You are
meeting the challenges, and you are working on it. It appears
to be something that we can work on together, and it seems as
though we will.
Again, proud to mention that I am looking forward to
quality briefings, and we can also talk as well there. But
thank you for what you are doing. And I want to wish you well,
and you can feel that we want to work with you to help the
cause.
Thank you.
Chairman Craig. Mr. Secretary, this may well be my last
question because part of the dialog that we had going on with
both of the S enators from Louisiana and Mississippi I think
answered some of our questions and some that I had prepared or
staff had prepared.
VA briefed my Committee about a new Office of Strategic
Initiatives, which is tasked with forecasting demand, market
delineation, cost estimates for the use in CARES
implementation. It seems to me that this is the same kind of
analysis that is needed along the Gulf Coast before we begin
building.
Have you considered using this new Office of Strategic
Initiatives to assist VA's internal Gulf Coast Planning Group
with its work?
Secretary Nicholson. Yes, we have, Mr. Chairman. As has
been touched on here at least, there are a lot of variables in
these things. For example, when we consider whether or not to
try to rehabilitate the New Orleans hospital versus
reconstructing one, a very big piece of that is life-cycle
costs.
What is the maintenance and operation cost of a
rehabilitated old hospital versus building a new one? And what
is the return on that investment in the new one because,
obviously, it would be run much more efficiently. And that is
part of what we are doing in this whole process.
Chairman Craig. Well, let me thank all of you for the work
that is under way. And I agree with Senator Akaka. Being kept
abreast of all of this will, in the long term, result in a good
deal less frustration or problems that arise by the uninformed
legislator, who may hear one thing coming from a constituent,
when, in fact, the plan is quite the opposite.
And here we have a very unique opportunity to not only
rebuild, but build a first-class service. I shouldn't say build
a first-class service. Build a new service that continues a
first-class service across a region that obviously will need
service.
Tragically enough, these kinds of opportunities don't come
along very often, thank goodness. But when they do, we ought to
look far enough out into the future that we are not just simply
replastering over old plaster when, in fact, a different
approach can do as you suggest, with life cycle, services, and
our needs and all of that.
So we thank you very much. That was part of the reason that
I wanted to initiate this hearing and begin this dialog as you
are planning and working so that we keep everybody well abreast
of it.
And also, as it relates to dealing with the retirement
center facility, that is an anomaly. It is a unique situation
that exists in part because of history, and I am not sure that
this may not be an opportunity in time to readjust its
relationships that would continue to serve that particular type
of retiree within our military services.
So, gentlemen, thank you very much for being with us today.
Secretary Nicholson. Thank you, Mr. Chairman.
[Whereupon, at 3:19 p.m., the Committee adjourned.]