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The following testimony was submitted by Senator Murray at the Capital Asset Realignment for Enhanced Services (CARES) Commission field hearing in Vancouver, WA on September 26, 2003.

The CARES Commission is charged with recommending whether or not the Veterans Administration should follow through with its proposal to close the VA facility in Vancouver.

Senator Patty Murray
United States Senator

Department of Veterans Affairs' Capital Asset Realignment for Enhanced Services Initiative Vancouver, WA -- September 26, 2003

"Let me begin by thanking the CARES Commission for coming to Vancouver today. I appreciate the task before you including your consideration of the important Vancouver VA facility. Though I wish your visit were under different circumstances, this community and the State of Washington is honored to host such a distinguished group of veterans and veterans' advocates.

I also want to thank all of the veterans here today. We are here to discuss your VA facility and your access to health care in your community. I congratulate the veterans in Southwest Washington who have rallied to support the Vancouver VA facility.

Mr. Chairman, I want the Commission to know that I have visited this Vancouver VA facility several times, most recently in August. And I know that the Vancouver facility is staffed by dedicated public servants who do wonderful work on behalf of our veterans.

I support the idea behind CARES. I think it's important that we realign services so we can better meet the needs of our veterans. Like the witnesses at today' hearing, I am committed to supporting a robust VA health care system in which our veterans receive the highest quality care in a timely fashion.

Unfortunately, I now fear the CARES process is losing its legitimacy. The Draft Report presented to the Commission by the Department of Veterans Affairs has been undermined by the VA itself.

As we all know -- under the CARES initiative -- the Department of Veterans Affairs asked its regional offices to study the health care needs of local veterans and to develop a plan to meet those needs.

VA planners in the field are to be commended for the excellent way in which stakeholders were involved in the CARES planning. However, as this process moved forward, there have been some troubling revelations, including the fact that stakeholder input has been seriously compromised.

Local experts in the VISN 20 region, which includes Alaska, Idaho, Oregon, and Washington, submitted a plan several months ago just as their counterparts did all across the country. The VISN 20 report highlighted dramatic enrollment growth, and significant gaps in areas like long-term care, primary care and specialty care.

The VA sat on this report for several months. The individual plans sent to Washington, DC were seen – and in most cases – approved by all relevant constituencies. But, just eight days before the scheduled release of the national report, the VA directed VISN leaders all across the country to rewrite their plans. The VA directed VISN leaders to resubmit local plans with specific language calling for the potential closure of more than two dozen facilities including Vancouver.

The CARES process is supposed to provide an objective accounting of the VA's ability to meet the increasing healthcare needs of our veterans. Here are my immediate concerns about the cares process.

  1. CARES is being driven more by budget concerns rather than the healthcare needs of our veterans. The CARES Commission must ensure that the VA's desire to generate revenue through enhanced use lease arrangements does not come at the expense of veterans.
  2. Another troubling aspect of the CARES process is the apparent disregard of veterans' long-term care and mental-health needs. The VA readily acknowledges that the number of veterans age 75 and older will increase from 4 million to 4.5 million by 2010. Both the VA and the GAO estimate that the veterans population most in need of nursing home care – veterans 85 years old or older – is expected to triple to over 1.3 million by 2012 and remain at that level through 2023. Clearly we've got to do more – not less – to meet this growing need. Instead, the report under review by this Commission calls for thousands of long-term care and inpatient psychiatric beds to be closed. The VA "Draft" plan fails veterans on long-term care.
  3. The CARES process offers a false promise to veterans. The VA asks veterans to agree to significant realignment of VA facilities including the closure of some vital facilities. In exchange, the VA holds out the promise of new clinics, services and hospitals. The false promise is all of the incentives for veterans are based on future appropriations that require the President's leadership. We are in the midst of a battle with the Administration and the VA over funding VA health care right now. I am concerned the Administration will not request the money to fund new services to veterans. With record budget deficits, there is no guarantee veterans will get new services.

Now let me turn to the Vancouver VA facility. I am absolutely opposed to the closure of the Vancouver facility. I respectfully urge the CARES Commission to reject the VA headquarters directive to study closure.

The Vancouver VA facility serves more than 13,000 patients annually from both Oregon and Washington. It was built in 1998 for over $30 million and currently employs 450 people. The Vancouver facility is in an ideal location on the I-5 corridor and is easily accessible for veterans from both states.

Vancouver is the fastest growing area of the Metropolitan Portland region. Veterans make up more than 11 percent of the Vancouver and Clark County population. Patient numbers have risen 17 percent this year at the combined Portland/Vancouver medical center – more than three times as fast as usual.

The Vancouver campus was constructed in part to alleviate the long delays at the Portland facility. Currently, there are over 5,000 veterans in the Portland VA system currently waiting to see a primary care physician. If the Vancouver campus is closed, Portland will be forced to pick up those patients further overburdening an already overwhelmed facility.

While the Portland facility offers no room for growth, the Vancouver campus has room to grow with our expanding veteran population. In fact, the City, Clark County, and the VA have been working for years to create an enhanced use facility that would compliment the services at the Vancouver facility.

Now, just a few weeks before the issuing of construction bonds, this plan may be in jeopardy. So, instead of the creative community-based partnerships that were proposed, the VA will potentially shut this facility in the fastest growing area of Metropolitan Portland.

Finally, long-term care is a major function of the Vancouver facility and part of the revised CARES plan involves transferring the 72 beds in Vancouver for nursing home and rehabilitation to other facilities.

The Commission should be aware there are no private nursing home facilities available in the area that are capable of handling the advanced needs of VA patients, or the capacity that would be required if this facility were closed.

The commission should also consider that state budget crises in both Oregon and Washington that have resulted in overburdened hospitals and urgent care clinics.

In closing, I implore the members of the Commission to take a fresh look at the overall CARES process. I encourage you to review closely the original VISN 20 submission prior to the interference from VA headquarters. The Vancouver facility should be enhanced to meet the diverse needs of this region's growing veterans' population

I again thank the members of the commission for coming to Vancouver. We have a tremendous interest in the challenge before you and we look forward to working closely with you and the VA."