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107th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 107-28
VETERANS HOSPITAL EMERGENCY REPAIR ACT
March 26, 2001.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 811]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 811) to authorize the Secretary of Veterans Affairs
to carry out construction projects for the purpose of
improving, renovating, and updating patient care facilities at
Department of Veterans Affairs medical centers, having
considered the same, reports favorably thereon with an
amendment and recommends that the bill as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Hospital Emergency Repair
SEC. 2. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS FOR PATIENT
(a) In General.--(1) The Secretary of Veterans Affairs is authorized
to carry out major medical facility projects in accordance with this
section, using funds appropriated for fiscal year 2002 or fiscal year
2003 pursuant to section 3. The cost of any such project may not exceed
$25,000,000, except that up to two projects per year may be carried out
at a cost not to exceed $30,000,000 for the purpose stated in
(2) Projects carried out under this section are not subject to
section 8104(a)(2) of title 38, United States Code.
(b) Type of Projects.--A project carried out under subsection (a) may
be carried out only at a Department of Veterans Affairs medical center
and only for the purpose of--
(1) improving a patient care facility;
(2) replacing a patient care facility;
(3) renovating a patient care facility;
(4) updating a patient care facility to contemporary
(5) improving, replacing, or renovating a research facility
or updating such a facility to contemporary standards.
(c) Purpose of Projects.--In selecting medical centers for projects
under subsection (a), the Secretary shall select projects to improve,
replace, renovate, or update facilities to achieve one or more of the
(1) Seismic protection improvements related to patient safety
(or, in the case of a research facility, patient or employee
(2) Fire safety improvements.
(3) Improvements to utility systems and ancillary patient
care facilities (including such systems and facilities that may
be exclusively associated with research facilities).
(4) Improved accommodation for persons with disabilities,
including barrier-free access.
(5) Improvements at patient care facilities to specialized
programs of the Department, including the following:
(A) Blind rehabilitation centers.
(B) Inpatient and residential programs for seriously
mentally ill veterans, including mental illness
research, education, and clinical centers.
(C) Residential and rehabilitation programs for
veterans with substance-use disorders.
(D) Physical medicine and rehabilitation activities.
(E) Long-term care, including geriatric research,
education, and clinical centers, adult day care
centers, and nursing home care facilities.
(F) Amputation care, including facilities for
prosthetics, orthotics programs, and sensory aids.
(G) Spinal cord injury centers.
(H) Traumatic brain injury programs.
(I) Women veterans' health programs (including
particularly programs involving privacy and
accommodation for female patients).
(J) Facilities for hospice and palliative care
(d) Review Process.--(1) Before a project is submitted to the
Secretary with a recommendation that it be approved as a project to be
carried out under the authority of this section, the project shall be
reviewed by a board within the Department of Veterans Affairs that is
independent of the Veterans Health Administration and that is
constituted by the Secretary to evaluate capital investment projects.
The board shall review each such project to determine the project's
relevance to the medical care mission of the Department and whether the
project improves, renovates, repairs, or updates facilities of the
Department in accordance with this section.
(2) In selecting projects to be carried out under the authority
provided by this section, the Secretary shall consider the
recommendations of the board under paragraph (1). In any case in which
the Secretary selects a project to be carried out under this section
that was not recommended for such approval by the board under paragraph
(1), the Secretary shall include in the report of the Secretary under
section 4(b) notice of such selection and the Secretary's reasons for
not following the recommendation of the board with respect to that
SEC. 3. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
Secretary of Veterans Affairs for the Construction, Major Projects,
account for projects under section 2--
(1) $250,000,000 for fiscal year 2002; and
(2) $300,000,000 for fiscal year 2003.
(b) Limitation.--Projects may be carried out under section 2 only
using funds appropriated pursuant to the authorization of
appropriations in subsection (a), except that funds appropriated for
advance planning may be used for the purposes for which appropriated in
connection with such projects.
SEC. 4. REPORTS.
(a) GAO Report.--Not later than April 1, 2003, the Comptroller
General shall submit to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives a report
evaluating the advantages and disadvantages of congressional
authorization for projects of the type described in section 2(b)
through general authorization as provided by section 2(a), rather than
through specific authorization as would otherwise be applicable under
section 8104(a)(2) of title 38, United States Code. Such report shall
include a description of the actions of the Secretary of Veterans
Affairs during fiscal year 2002 to select and carry out projects under
(b) Secretary Report.--Not later than 120 days after the date on
which the site for the final project under section 2 is selected, the
Secretary shall submit to the committees referred to in subsection (a)
a report on the authorization process under section 2. The Secretary
shall include in the report the following:
(1) A listing by project of each such project selected by the
Secretary under that section, together with a prospectus
description of the purposes of the project, the estimated cost
of the project, and a statement attesting to the review of the
project under section 2(c), and, if that project was not
recommended by the board, the Secretary's justification under
section 2(d) for not following the recommendation of the board.
(2) An assessment of the utility to the Department of
Veterans Affairs of that authorization process.
(3) Such recommendations as the Secretary considers
appropriate for future congressional policy for authorizations
of major and minor medical facility construction projects for
the Department of Veterans Affairs.
(4) Any other matter that the Secretary considers to be
appropriate with respect to oversight by Congress of capital
facilities projects of the Department of Veterans Affairs.
On March 1, 2001, the Chairman and Ranking Member of the
Committee on Veterans' Affairs, the Honorable Christopher H.
Smith and the Honorable Lane Evans and other cosponsors,
introduced H.R. 811, the Veterans Hospital Emergency Repair
Act. The bill would provide the Secretary of Veterans Affairs a
specified major Veterans Affairs medical facility construction
authority for fiscal years 2002 and 2003 for projects that cost
less than $25 million each. Up to two projects in each of the
two years could exceed this limitation if the purpose is for
urgent seismic correction. The bill would authorize $250
million in appropriations for these purposes in FY 2002 and
$300 million in FY 2003.
On March 13, 2001, the Committee on Veterans' Affairs held
a hearing on the Veterans Hospital Emergency Repair Act. At its
hearing, the Committee received testimony from three panels of
witnesses, including the major veterans organizations and two
panels of witnesses representing the Department of Veterans
Affairs (VA). Witnesses representing the veterans organizations
were Mr. Dennis Cullinan of the Veterans of Foreign Wars of the
United States; Mr. Thomas Davies, A.I.A., of Paralyzed Veterans
of America; Ms. Joy Ilem of the Disabled American Veterans; Mr.
James Fischl of the American Legion; and Mr. Richard Jones of
AMVETS (American Veterans of WWII, Korea and Vietnam).
The two VA panels were led by the Honorable Thomas L.
Garthwaite, M.D., Undersecretary for Health, Veterans Health
Administration (VHA), accompanied by Frances M. Murphy, MD,
MPH, Deputy Undersecretary for Health; Mr. D. Mark Catlett,
Acting Assistant Secretary for Management, Office of Financial
Management; and, Mr. Charles Yarbrough, VHA Chief Facilities
Management Officer. The VA's second panel consisted of VHA
Veterans Integrated Service Network (VISN) Directors, including
Mr. Lawrence A. Biro, Director, VISN 4 [Pennsylvania-Delaware];
Jeannette Chirico-Post, M.D., Director, VISN 1 [New England];
Mr. Kenneth Clark, Director VISN 22 [Southern California-
Nevada]. Ms. Patricia A. Crosetti, M.B.A., Director, VISN 15
[Missouri-Kansas]; Mr. James J. Farsetta, Director, VISN 3 [New
Jersey-New York City and lower Hudson Valley]; and, Robert L.
Wiebe, M.D., Director, VISN 21 [Northern California-Nevada].
On the basis of this hearing and oversight on these
matters, the Full Committee met on March 21, 2001, to mark up
H.R. 811, the Veterans Hospital Emergency Repair Act. The bill
was endorsed unanimously by the Committee, and H.R. 811 was
ordered reported favorably, as amended, to the House.
Summary of Bill
H.R. 811 would:
1. LAuthorize the Secretary of Veterans Affairs to carry
out major medical facility construction projects in fiscal
years 2002 and 2003, and would authorize appropriations of $250
million in fiscal year 2002 and $300 million in fiscal year
2003 for these purposes.
2. LAuthorize the Secretary to select patient care projects
(and in certain circumstances, research facilities) for
construction under this authority not to exceed $25 million for
any single project; the Secretary could select two seismic
correction projects in each of the two years estimated to cost
up to $30 million.
3. LLimit the type of project that could be funded under
this authority to projects that would improve, replace,
renovate or update facilities, including research facilities
for patient safety, seismic protection, privacy, and
accommodation for disabilities.
4. LAuthorize the Secretary to improve the various high-
priority special disabilities programs of the Department.
5. LRequire the Secretary to consider recommendations of
VA's independent board that reviews capital investment
proposals in selecting projects under this authority.
6. LPermit the Secretary to use the Advance Planning Fund
to design projects selected under the purposes of this bill.
7. LRequire the Secretary and the Comptroller General to
make reports to Congress on projects selected under this
authority, their purposes and costs, the results of the
authorization process, and recommendations for amending or
extending this authority, and other appropriate
Background and Discussion
The Committee has identified the need for Congress to
address what has become a troubling and lingering problem in
some of our Nation's veterans hospitals: a crumbling,
substandard and sometimes unsafe patient care infrastructure in
the Department of Veterans Affairs (VA). The problem includes
VA patient care buildings that could collapse in earthquakes.
Many VA hospitals are deteriorating because VA is
encountering increasing difficulty in obtaining funding to
update, modernize and renovate patient care facilities for
veterans in need of care. For the past several years, the
Committee has noted that the President's annual budgets for VA
health care have requested little or no funding for major
medical facility construction projects for America's veterans.
Only six such projects were proposed in the past three budget
submissions to Congress. Only one project appeared in the
fiscal year 2001 budget request, but no funds were appropriated
by Congress in fiscal year 2001. Nevertheless, a number of
major medical facility projects totaling $115.9 million were
authorized for fiscal year 2001 in Public Law 106-419:
--seismic project at the Long Beach VA Medical
--120-bed gero-psychiatric unit replacement at Palo
Alto's Menlo Park campus, which included seismic
--replacement of 32-year old electrical vault and
wiring harness at the Miami VA Medical Center,
destroyed in a fire in April 2000; and,
--nursing home unit at Beckley WV Medical Center.
Also, in the same Act, Congress renewed an authorization of
a nursing home renovation project in Lebanon, PA, a $14 million
project that still awaits appropriation.
Last year in the Committee's budget views and estimates
letter, dated February 25, 2000, the Committee stated that VA
has engaged in an effort through independent organizations to
determine whether present VA health-care facility
infrastructures are meeting needs in the most appropriate
manner. The VA's effort is aimed at ascertaining whether
services to veterans can be enhanced with alternative
approaches. This process, called ``Capital Assets Realignment
for Enhanced Services'' (CARES), may not achieve its intended
goals for several years. In the interim, the Committee is
concerned that a number of VA hospitals need additional
maintenance, repair and improvements in order to address
immediate dangers and hazards, promote patient and staff
safety, and sustain a reasonable standard of care for the
Recent reports by independent consultants and VA have
revealed that dozens of VA health care buildings are at risk
from seismic damage. On February 28, 2001, in Tacoma,
Washington, a tremor of 6.8 magnitude seriously damaged two
patient care buildings on the campus of the American Lake VA
Medical Center. The damaged buildings at American Lake were
among those identified as being at the highest levels of risk.
This particular incident vividly demonstrates that the CARES
process cannot address the immediacy of some of VA's facility
A report by VA submitted to the Committee on March 14,
2000, in response to section 322 of Public Law 104-262, the
Veterans' Health Care Eligibility Reform Act of 1996,
identified $57 million in improvements that are needed to
address women's health care needs. These projects would
primarily ensure improved standards for protecting the privacy
of women receiving VA care, a group that is a growing subset of
the veteran population seeking care at VA facilities. The great
majority of VA facilities were constructed for male patients,
and need to be revamped for the care of this rising number of
Another report, commissioned by VA from the Price
Waterhouse firm, entitled ``Independent Review of the
Department of Veterans Affairs Office of Facilities
Management,'' dated June 17, 1998, concluded that VA should be
spending from 2 percent to 4 percent of its ``plant replacement
value'' (PRV), on upkeep and replacement of its health care
facilities. This PRV value in VA, according to the report, is
about $35 billion; thus, using the Price Waterhouse index on
maintenance and replacement, VA should be spending from $700
million to $1.4 billion each year. In fact, in fiscal year
2001, VA will spend only $170.2 million for minor construction
in maintenance of its infrastructure.
Congress has authorized a number of major medical
construction projects in the past three fiscal years, but these
projects have received little funding through the
appropriations process. Some of the more recent deferrals of
major VA construction funding were partially intended to permit
the CARES process to proceed in an orderly fashion and avoid
unnecessary spending on VA hospital facilities that might not
be needed in the future. While the Committee generally agrees
with this approach, especially for larger projects that may be
affected by CARES, there is a continuing need for investment in
many facilities. The Committee is concerned that an unintended
de facto moratorium on VA construction has resulted.
It should be noted that nothing in the Emergency Repair Act
would prevent either the Committee or Congress from considering
the merits of large-scale, major VA medical facility
construction project authorizations during the two fiscal
periods that the bill would cover. Should Congress decide to
authorize additional projects in the future, passage of this
bill would not impede its ability to do so. By its nature, the
Emergency Repair Act is intended as a stopgap measure to grant
the Secretary of Veterans Affairs limited authority to keep the
VA health care system viable while the CARES process goes
forward with its larger goals and timetables.
The Committee is convinced that this bill is justified by
circumstances as well as policy. When the Committee requested
that VA provide information about immediate construction needs
in VA medical centers, a number of projects that would be
appropriate for such consideration were immediately identified.
Location Purpose Cost
Atlanta Patient Wards Modernization $12.9 million
Cleveland Special Emphasis Renovation $19.6 million
Miami Energy Center Replacement $24.9 million
San Diego Seismic Corrections $35.6 million
VISN 6 Special Emphasis Renovation $17.1 million
Augusta Spinal Cord Injury Modernization $10.6 million
Boston Clinical Inpatient Improvements $25 million
Cleveland Ambulatory Surgery Consolidation $19.9 million
Dallas Mental Health Improvements $27.6 million
Palo Alto Seismic Corrections $26.6 million
Philadelphia Research Renovation $21.8 million
Pittsburgh Ambulatory Care Addition $28.2 million
San Francisco Seismic Corrections $29.4 million
Syracuse Clinical Expansion/MRI Addition $4.7 million
Tampa Ambulatory Care Addition $12 million
Washington Outpatient Clinic Expansion $20.8 million
West Haven Nursing Units Renovation $14.3 million
Los Angeles Seismic Corrections $26.6 million
The Committee believes that numerous meritorious projects
could be identified and approved under this proposed authority.
Many VA facilities need funds immediately for small projects,
in particular those that have been authorized by Congress in
While the Committee would authorize ``replacement''
projects in this measure, such projects should serve the same
or very similar purposes as the facilities they supplant. For
example, the Committee is not proposing to authorize the
Secretary to replace a nursing home with a new ambulatory care
center. The Committee also expects that replacement would
primarily be necessitated by unsafe conditions for veterans and
The Committee supports CARES. The CARES process, however,
will not be concluded soon, and CARES has no results to support
the VA budget request for fiscal year 2002. The Committee is
concerned that, in the short term, CARES does not address VA's
capital-maintenance needs, causes an unintended diminution of
care for veterans and raises the potential for danger in the
case of earthquake-prone VA facilities. In some cases, VA's
lack of funds to repair and improve certain health-care
structures may place veterans in considerable danger. This bill
is intended to assist VA in avoiding such risks, while
improving the quality of care for America's veterans.
Performance Goals and Objectives
The reported bill would provide the Secretary of Veterans
Affairs authority for certain medical facility construction
projects consistent with the purposes and objectives defined by
the bill. A board for evaluation of capital investment projects
within VA but independent of the Veterans Health Administration
would be required to review project proposals for mission
relevance and compliance with the purposes and objectives of
the bill. The Secretary would also be required to provide the
Committees on Appropriations and Veterans' Affairs a report on
the purpose of each project selected, the estimated cost, and
the independent review of the project.
Statement of Administration's Views
At a hearing before the Committee on March 13, 2001, the
Honorable Thomas L. Garthwaite, M.D., Under Secretary for
Health, Department of Veterans Affairs, stated: ``As such, the
Department supports H.R. 811 to the extent that it aligns with
the President's Budget. If H.R. 811 were enacted, we believe
that it could be useful to VA in improving our ability to
respond to immediate needs of the system's infrastructure, as
well as, implement CARES. It would provide the Department with
greater flexibility in selecting major construction projects
and likely would result in more timely correction of
deficiencies that currently impair the health care system's
ability to provide care in safe and effective facilities in
locations that best meet veterans' needs. The bill also would
offer the incentive to medical centers to propose smaller
projects targeted to more focused requirements, such as special
programs, seismic corrections, and utility systems, to name
just a few.''
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
Congressional Budget Office,
Washington, DC, March 22, 2001.
Hon. Christopher H. Smith,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 811, the Veterans'
Hospital Emergency Repair Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Dan L. Crippen,
congressional budget office cost estimate
H.R. 811, Veterans' Hospital Emergency Repair Act, As ordered reported
by the House Committee on Veterans' Affairs on March 21, 2001
H.R. 811 would authorize appropriations of $250 million in
2002 and $300 million in 2003 to be used for improving,
replacing, renovating, and updating medical centers in the
Department of Veterans Affairs (VA). The bill would allow
repair and renovation projects for making improvements in
earthquake protection, fire safety, accommodations for people
with disabilities and a variety of improvements to specialized
programs in VA medical centers. H.R. 811 also would require
reports from the General Accounting Office on the authorization
process for VA construction projects and by VA for both the
specific projects and the authorization process.
CBO estimates that implementing H.R. 811 would cost $11
million in 2002 and $506 million over the 2002-2006 period,
assuming appropriation of the authorized amounts. Because the
bill would not affect direct spending or receipts, pay-as-you-
go procedures would not apply.
H.R. 811 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
The CBO staff contact is Sam Papenfuss, who can be reached
at 226-2840. This estimate was approved by Peter H. Fontaine,
Deputy Assistant Director for Budget Analysis.
Inflationary Impact Statement
The enactment of the reported bill would have no
Applicability to Legislative Branch
The reported bill would not be applicable to the
legislative branch under the Congressional Accountability Act,
Public Law 104-1, because the bill would only affect certain
Department of Veterans Affairs programs and benefits
Statement of Federal Mandates
The reported bill would not establish a federal mandate
under the Unfunded Mandates Reform Act, Public Law 104-4.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''