The Department of Veterans Affairs has long cited the necessity to repair aging buildings and construct modern facilities to meet the needs of veterans -- at an estimated cost of $60 to $70 billion.
But the department is just beginning a process to review its aging infrastructure, and officials have given few specifics on the state of those assets or how they would spend any funding they receive to address them.
With the agency slated to get more than $18 billion for its infrastructure needs under President Joe Biden's American Jobs Plan, members of the Senate Veterans Affairs Committee on Wednesday pressed the VA's director of the office of asset enterprise management for details on his plans for the proposed funding.
And they painted a grim picture of the facilities in their states.
In New Hampshire, for example, longstanding fly infestations in operating rooms led to canceled medical procedures for veterans in 2018 and 2019, according to Democratic Sen. Maggie Hassan.
At the Sonny Montgomery VA Medical Center in Jackson, Mississippi, the dialysis treatment center has closed its doors due to aging infrastructure, according to Pat Murray, director of legislative services at the Veterans of Foreign Wars.
And at the West Haven VA Medical Center in Connecticut last year, a routine maintenance operation turned deadly when a steam pipe exploded during replacement, killing two.
"The facility needs to be rebuilt, and two people are dead now because of a failure to take necessary steps to invest in this infrastructure," said Sen. Richard Blumenthal, D-Conn. "It is horrifying and outrageous."
Congress established an effort in 2018 for an independent review of the VA's real estate assets, infrastructure and construction needs and to make recommendations for future facilities. The Asset and Infrastructure Review commission, whose members have not yet been announced, is expected to oversee a process similar to the Defense Department's base closure and realignment commissions.
But final decisions by the commissioners, who are expected to deliberate for seven months and hold public hearings on their findings, aren’t expected until 2023.
Murray and others said repairs and maintenance can't wait two more years and the VA must take steps now to improve oversight of projects and make repairs.
"We must not wait for its completion to perform maintenance, upgrades and necessary construction. [The commission] represents the future of the footprint of VA, but there is 60-plus billion dollars of work needed now," Murray said.
But lawmakers increasingly are balking at providing more funds without seeing fixes in management that would improve oversight.
The VA's discretionary spending has risen by 291% since fiscal 2003, totaling $109.5 billion in fiscal 2021, and its mandatory spending has risen 313% to $133.8 billion -- increases that should have included investments in infrastructure, noted Kansas Sen. Jerry Moran, the committee's ranking Republican.
But projects undertaken in the past two decades, including construction of a new medical center in Colorado that took 14 years and ran $1 billion over budget, demonstrate that mismanagement at the VA is responsible for many of the problems, according to Moran.
"More focus is needed on the VA's business process that produced this dismal state of affairs," he said.
Officials with the Government Accountability Office agree. According to the GAO, the VA lacks the resources and skills needed to effectively manage projects, with staffing shortages and insufficient communication between its central office for construction and facilities management and local offices.
It also lacks a system that allows it to evaluate its asset performance, said Andrew Von Ah, director of physical infrastructure for the GAO.
"Without such indicators, VA will have difficulty knowing whether the system is working and where it may need to make improvements," Von Ah said.
Those who testified alongside VA officials, including Murray and Don Orndoff, senior vice president for national facilities services at health care company Kaiser Permanente, had a number of suggestions for the department to improve its infrastructure oversight and management. They included teaming with the Army Corps of Engineers -- which was called in to fix the troubled Colorado construction project -- and partnering with private industry.
Kaiser Permanente, Orndoff said, invests roughly $3 billion each year in infrastructure. He suggested that the VA standardize its facility design and use modular components for facilities; accelerate project delivery so hospitals and clinics aren't outdated by the time they are complete; and practice sustainment -- staying on top of issues at existing infrastructure to prolong their service life.
Brett Simms, the VA's director of the office of asset enterprise management, said the department would use the $18 billion in Biden's proposed budget to address immediate needs and build new facilities.
According to Simms, the VA would spend $3 billion immediately to upgrade facilities to support health care for female veterans, improve utility and building systems to increase energy efficiency, and make accommodations for aging veterans.
The remaining $15 billion would be used to modernize or replace 10 to 15 aging medical centers, although Simms did not say which ones.
And he asked senators to support legislation that would give the VA more flexibility in leasing clinics in 13 states.
"It offers much-needed flexibility for VA," Simms said.
Committee Chairman Sen. Jon Tester, D-Mont., said he would work to get that legislation passed, adding that he supports the commission.
"I'm hoping the VA makes this commission an opportunity to get rid of the excess VA infrastructure that is not being utilized, while building new leasing, new buildings and right-sizing facilities so they're able to meet the long-term needs of our veterans,” he said.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.