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Beleaguered Colorado VA hospital sees staffing, design challenges before 2018 opening

Aerial photo of the 12-building Department of Veteran Affairs replacement medical center under construction in Aurora, Colorado. The entire facility has been under U.S. Army Corps of Engineers' contract to Kiewit-Turner since November 2015. The project is on target for contract completion by January 2018. U.S. ARMY CORPS OF ENGINEERS

Hundreds of tasks need to be completed and hundreds of job openings filled before the new, overbudget and over-deadline Veterans Affairs hospital near Denver – scheduled to open this summer – begins accepting patients.

Even when the hospital opens its doors, the old Denver VA and other off-site facilities will remain in use indefinitely because of design flaws at the new campus, located in Aurora, Colo.

These findings were detailed in a House Committee on Veterans’ Affairs document obtained by Stars and Stripes on Tuesday and first reported on by The Denver Post. The document states that costs associated with the new hospital – which climbed more than $1 billion overbudget – are not likely to escalate further, but there are other challenges the VA must face before opening the new campus.

“It’s a gorgeous facility, but it’s odd. It’s strange. I told them, ‘You’re going to have a tough job with this,’” said Rep. Phil Roe, R-Tenn., chairman of the House VA committee. “But they’re ready to get in there, and I feel confident they’ll make it work.”

Roe, a former OB-GYN, and other committee members toured the old Denver VA and the under-construction hospital, recently named the Rocky Mountain Regional Medical Center, last week. They found some things that seemed impractical, such as a too-small emergency room and a layout that obviously wasn’t created with input from medical professionals, Roe said.

The committee will hold an oversight hearing on the issue Wednesday morning, with testimony from Stella Fiotes, acting principal executive director of VA acquisition, logistics and construction.

Former Rep. Jeff Miller, R-Fl., the previous chairman of the House VA committee, called on the VA in 2016 to fire Fiotes because of her involvement with the project. Government watchdogs have found that leaders behind the planned hospital agreed to a grandiose design and ignored repeated, early warnings about costs, driving the project into financial failure. An inspector general report didn’t specifically say Fiotes was involved.

‘Dauntingly large’ hospital doesn’t provide enough space

The Rocky Mountain VA has taken 20 years to develop. Construction costs were estimated in 2009 at about $538 million, with a target completion date of 2013. Latest estimates put the total cost at $1.7 billion, plus another $338 million for final work before the hospital opens.

That work involves 375 tasks, the document states, including installing fixtures and HVAC systems and configuring medical equipment. Workers must also fix mistakes with the facility, such as replacing walls in dental exam rooms that aren’t strong enough to support wall-mounted X-rays, and replacing plate glass windows in pharmacies that don’t allow employees to talk or pass items to patients.

Large-scale design problems mean the campus – at 1.21 million square feet – isn’t creating more useable clinical space when compared to the old, 600,000 square-foot Denver hospital. There’s more inpatient room at the new hospital – which the document describes as “dauntingly large” — but less space for primary care and outpatient services. The number of primary care rooms will decrease from 60 at the existing hospital to 34 at the new one.

Roe said the decrease in inpatient beds may not be as significant of a problem as it seems because health care systems countrywide are pushing more medical procedures into outpatient settings.

The layout could become an issue, though, he said. For example, Roe continued, inpatient services are located approximately 1,000 feet away from where X-rays are provided.

“I think one of the problems was, the architects and leadership didn’t involve the clinical people – the maintenance people, environmental services, nurses, physicians,” Roe said. “They should’ve been involved from day one. But that’s water over the dam now.”

Roe said it was a possibility the VA would have to lease community-based outpatient clinics in the Denver area in the near future.

VA researchers and a prosthetics lab will remain at leased, off-site facilities, and a PTSD Residential Rehabilitation Facility and seven patient-aligned care teams will remain at the old Denver hospital for at least three years, the document states.

A new PTSD building was part of initial plans for the new Rocky Mountain campus but eliminated when costs soared. A proposal is stalled in Congress for a PTSD facility to be added back into the project.

Maintaining services at the old VA will increase costs because of duplicate staffs for food, security and administration. The old hospital needs $350 million in improvements, and if the facility is still in use by 2023 those costs will have to be incurred, according to the document.

Hundreds of staff positions remain unfilled

The construction contract on the Rocky Mountain VA ends Jan. 23, at which point the VA will award another contract for design corrections, renovations and final completion. That work is estimated to be done in June, and then IT systems can be turned on, staff trained and patients moved.

Roe said the agency is aiming for an August completion.

Before then, the VA must hire 421 total new employees, the committee document states. It’s already hired 199 and has 222 positions remaining. If the VA doesn’t fill the jobs, the opening won’t be delayed, but it open unable to provide all services the agency said it would offer.

The existing VA campus in Denver was already facing hiring challenges, and local VA staff are pessimistic about filling new jobs, according to the document. Of the 2,787 positions at the existing VA, 653 are vacant, including 77 mental health professionals.

Roe said it would be a challenge – but it’s not one unique to Denver.

As of the end of June, the VA reported 34,000 job vacancies system-wide, and VA Secretary David Shulkin has said hiring mental health care professionals to meet demand is particularly challenging. The agency set a goal to hire 1,000 mental health care workers in 2017. The VA hired 900 last year, but lost 945.

“They’ll soldier on, and they’ll try to make this work for patients,” Roe said.

Roe found positive aspects of the campus – patient rooms are spacious, surgical rooms are state-of-the-art, and the spinal cord injury center will be first-rate, he said.

But it could take some getting used to.

“It’s a huge building, and if a veteran is just showing up for the first time, they’re going to be scratching your head about, ‘Where do I go?’” he said

“There are problems that need to be addressed yet.”

The House Committee on Veterans’ Affairs will meet at 10 a.m. EST on Wednesday. More information can be found at veterans.house.gov.

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© 2018 the Stars and Stripes

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