"There's a great deal of skepticism in the veterans' community," said Senate Veterans' Affairs Committee Chairman Arlen Specter, R-Pa., at a hearing.
But Dr. Robert Roswell, the VA's undersecretary for health, sought to assure the panel that proposals to close, consolidate or otherwise change the mission of VA health facilities would not disrupt the treatment of veterans. "All care provided to veterans will continue throughout this process."
The overhaul, initiated by VA Secretary Anthony Principi, is aimed at adjusting the VA health care system to meet modern realities - that today's veterans are older and tend to live in Sunbelt states and that medical science has advanced to where more patients can be treated on an outpatient rather than inpatient basis.
"We're trying to provide 21st century veterans with 21st century medical care," he said.
The VA last year treated some 4 million patients at its 181 major health care delivery locations. Under a draft plan for a 20-year transformation of those facilities, some seven hospitals would close, new hospitals would open in Las Vegas and in Orlando, Fla., and other facilities would be assigned reduced or added medical missions.
Principi last December appointed a 16-member commission, headed by Everett Alvarez, Jr., to review the draft and make recommendations to him by the end of this year. Principi said that, after working with the commission, he would accept or reject their report in its entirety because "I don't want to be in a position to politicize" the issue.
But as with base closings, lawmakers don't want to see facilities in their states or districts shut down.
Specter acknowledged that one mental facility near Pittsburgh that is slated for closing is underused, but said there were "very grave concerns" whether the new health center to which the patients are to be moved will be completed before the old building is closed.
Sen. Kay Bailey Hutchison, R-Texas, said veterans in Waco, site of another proposed closing, feared they would lose access to VA medical care. The draft plan, she said, "neither enhances services nor wisely allocates resources."
Sen. Bob Graham of Florida, the top Democrat on the committee and a presidential contender, said in a statement that the overhaul process "seems to be lurching forward with little or no underpinning." He said he believed that "we must slow down and approach this critical task with much more deliberation."
The top lawmakers on the House Veterans' Affairs Committee, chairman Christopher Smith, R-N.J., and Rep. Lane Evans, D-Ill., also wrote Alvarez recently saying one of their greatest concerns was whether the process adequately addressed such specialized VA programs as geriatrics, long-term care, mental health, substance abuse and homelessness.
Alvarez, who was the first American aviator shot down over North Vietnam and was a prisoner of war for 8 1/2 years, told the panel that his commission had made no final decisions yet and was currently visiting VA facilities around the country to get input from veterans and local communities.
By Jim Abrams