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107th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     107-28




 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 


  This Act may be cited as the ``Veterans Hospital Emergency Repair 

                    CARE IMPROVEMENTS.

  (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 
subsection (c)(1).
  (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 
        standards; or
          (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 


  (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.


  (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 
section 2.
  (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 
nation's veterans.
    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 
maintenance problems.
    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 
women patients.
    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. 
These include:

               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 
recent years.
    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 
VA staff.
    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:

                                     U.S. Congress,
                               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 
inflationary impact.

                  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.''