Testimony of Senator Hillary Rodham Clinton Before the Capital Asset Realignment for Enhanced Services (CARES) Commission VISN 2

Testimony of Senator Hillary Rodham ClintonBefore the Capital Asset Realignment for Enhanced Services (CARES) Commission VISN 2

Ladies and gentlemen of the CARES Commission, thank you for allowing me to present testimony on the Draft National CARES Plan. I am pleased that you recently decided to hold this hearing at this marvelous facility[Canandaigua Veterans Administration Medical Center], with its distinguished history and world class health care services.

As I will explain more fully in my testimony, I believe that the Draft National CARES Plan and the process used to develop it are deeply flawed. The Plan has not adequately taken into account the impact of these proposals on long term care, domiciliary care and mental health services. Moreover, this Commission and the Department of Veterans Affairs have not allowed veterans a meaningful opportunity to participate in the overall CARES process. The Department of Veterans Affairs needs to go back to the drawing board and develop its plan through a fair process that takes into account all relevant factors and allows veterans to fully participate in the plan's development. In the context of VISN 2[Veterans Integrated Service Networks], the VA's ill-considered recommendations regarding the Canandaigua VA hospital would have disastrous consequences for thousands of veterans in the region.

At this time in our nation's history, with U.S. troops bravely serving in Iraq, Afghanistan and elsewhere, it sends exactly the wrong message to propose such drastic changes in veterans' health care without proper thought and deliberation. Our troops are fighting overseas to defend our values and way of life. We owe it to our current and future veterans to make sure that we provide the best health care possible for them and not rush to implement recommendations that provide our veterans with less adequate health care.

The CARES Process As a starting point, our bottom-line goal should be the delivery of high quality health care services to our veterans, delivered as efficiently as possibly. Unfortunately, the hasty procedures that the Department of Veterans Affairs followed to develop these recommendations are fundamentally flawed.

The CARES process was supposed to provide for a considered and comprehensive examination of veterans health care needs and services. However, the original schedule was to have the Veterans Integrated Service Networks (VISNs) submit completed market plans and initiatives by November 2002, leaving only five months to develop recommendations.

Actually, the Market Plans were submitted in April 2003. The timeline was extended by four months but, in June 2003, the Department of Veterans Affairs sent back the plans of several VISNs and asked them to develop alternative strategies for consolidation. On June 12, 2003, I joined with several of my Senate colleagues in writing to Secretary of Veterans Affairs Anthony Principi objecting to this request as it appeared to target facilities with long-term, domiciliary and psychiatric beds.

Veterans' health care is too important an issue to require an adherence to artificial deadlines and hasty recommendations.
With literally the lives of veterans at stake, the Commission should not engage in a rush to judgment over closing VA facilities.

Failure to Consider Long Term, Domiciliary and Mental Health Needs As a result of the flawed CARES process, several important factors that are critical to veterans' health care have been neglected. In this rushed process, the impact of the proposed changes to long-term care, domiciliary care and mental health needs were not considered. The exclusion of these important factors taints the recommendations of the draft national plan. For example, the Draft National CARES Plan states that its mental health outpatient psychiatric provisions are "undergoing revision" and "should be available for next year's strategic planning cycle." Incredibly, despite this admission, the Draft National CARES Plan proposes reductions in beds in facilities that provide mental health services. Similarly, there is widely expected to be an increase in the demand for long term beds for veterans over the next 20 years. However, the Draft National Plan does not contain any analysis of how many long-term beds are needed in the coming decades and yet still recommends closing facilities with long-term beds.

During a meeting between members of the New York delegation and VA Secretary Anthony Princippi last week to discuss the draft plan's recommendations regarding the Canandaigua VA Hospital, Secretary Princippi acknowledged that a plan for long-term psychiatric needs has not yet been developed. With all due respect to Secretary Princippi and the Commission, it seems to me that developing a Draft National Plan before developing a plan for mental health needs is getting it exactly backwards. A plan for addressing mental health care should have been developed before the Draft National Plan was released, not after.

The Impact on Canandaigua VA Hospital The Draft National Plan's failure to consider long-term mental health care has disastrous implications for veterans who are served by the Canandaigua VA Hospital. I have visited the VA Hospital at Canandaigua and was greatly impressed by the quality of care provided at the facility as well as the overwhelming support that the VA hospital has in the community. And indeed, it is a cruel irony that Canandaigua has been recommended for closure in the same year that it received the highest facility rating in patient satisfaction in the country.

The Canandaigua VA has a total of about 276 long term care, domiciliary, and psychiatric beds. This total includes approximately 20 acute psychiatric beds, 10 long term psychiatric beds, 30 MICA (mentally ill and chemically addicted) beds and 50 domiciliary beds.

As I discussed earlier, the CARES Draft national plan ignores the mental health care needs of our veterans. The omission of mental health care needs from the Draft National Plan is particularly striking because of the effect that the closure of the Canandaigua VA will have on the veterans with mental health care needs who are currently receiving care at the facility. The acute psychiatric unit accepts involuntarily committed veterans. These veterans often present a danger to themselves and others and require immediate, intensive treatment which only a specialized unit can provide. The long term psychiatric beds are for those veterans with severe mental illness who have yet to be stabilized on psychiatric medicines.

The 30 MICA beds are for those veterans who require longer term care (45 days) in a structured treatment environment and who have a mental illness and a chemical addiction. This program provides individual, group, and family therapy; medication supervision; chemical addiction treatment; and vocation rehabilitation. Each patient's treatment is individualized to meet a range of problems. The chronic nature of the problems that veterans bring to the mental health setting often require a long term involvement if sufficient help is to be provided so that they do not become revolving door patients. The domiciliary beds are utilized for those veterans who are homeless, often chemically addicted and may suffer from less debilitating forms of mental illness. Patients may be moved from the MICA beds to the domiciliary beds as their functioning improves.

Just listing the number of beds and variety of services provided in one place at the Canandaigua VA indicates the unique care that it is provided there. By closing the Canandaigua facilities, the VA will be dispersing a staff that possesses a unique set of skills and expertise which is widely and highly regarded. Although the VA claims that there will be no reduction in the level of care when the inpatient and outpatient beds are terminated at Canandaigua, these assurances ignore the fact that the parceling out of these beds and services to other facilities will not reconstitute the level of care available at the Canandaigua VA.

If the Canandaigua VA were to close, only 38.6% of currently enrolled inpatient veterans fall within the CARES access standard. The CARES standard states that patients should have access to care within 60 minutes in urban counties and 90 minutes in rural areas. The distance for inpatient veterans to travel if Canandaigua closes would be: Bath - 85 miles, Buffalo
- 73 miles and Batavia - 57 miles. Data shows that veterans do not travel to receive psychiatric and nursing home care. As my colleague Senator Enzi has pointed out, the CARES national plan has not adequately taken into account the impact of the recommendations on rural health care. As I will explain in a moment, we plan to offer legislation to address that problem.

Listening to Veterans Since the release of the CARES National Plan, a frequent complaint that I have heard from area veterans has been that the VA has not been listening to their concerns. While I applaud the Commission for heeding my calls and those of other members of the NY delegation to hold the VISN 2 hearing in Canandaigua, the decision to originally hold the hearing in Syracuse, too far to travel for many of the veterans in VISN 2 affected by the recommendations, sent a troubling signal. And veterans who contributed to the VISN 2 market plan, which called for no closures in VISN 2, feel betrayed by the decision to overrule the market plan and call for this facility's closure.

In visiting Canandaigua and meeting with the veterans of this region, I have learned a tremendous amount about the value of this facility and the quality of health care that is delivered here. As letters to my office from veterans who use the facility demonstrate, the veterans' community in the region is united behind keeping this facility open.

One veteran who wrote to me explained that he suffered a massive blow to the head while serving in the Marines and suffers from Organic Brain Syndrome and Organic Affective Disorder. He currently uses the Canandaigua VA's Day treatment program. He wrote to me that "I have been coming to the Day Treatment Program in Canandaigua for over 2 years and feel that I got a lot out of the program… I have a lot of difficulty with my short term memory and the thought of losing one of the places that I am most familiar with bothers me. You don't know what it is like to need to have someone take you around because you get lost going on your own…it has taken a long time but I have finally reached a little bit of independence. By losing this hospital, I will be losing that independence. Also, the place that I live is very rural and there are no other facilities in my area. The idea of sitting around the house day after day depresses me."

Another veteran who received an early diagnosis of cancer at Canandaigua wrote to me that "I believe that my life was saved in April 2000" at the Canandaigua VA.

The daughter of a Korean War Veteran who has received psychiatric and medical care at Canandaigua wrote that without the services at the Canandaigua VA, her father "would not be where he is today and his quality of life would diminish. She also wrote that her mother has said "she will not be able to drive my father to the other VAs in VISN 2 because they are too far away….The solution of driving to another VISN 2 VA in response to the CARES proposal shows a definite lack of caring to veterans and their families."

I encourage you to listen to the veterans' community that is served by Canandaigua. Their experiences at the Canandaigua facility and their strong support for the hospital here cannot and should not be ignored.

Conclusion Our nation's veterans have served their country with distinction. Our nation made a pact with those who serve their country in the Armed Forces - a commitment that those who served would have access to quality health care through the VA hospital system. Yet this ill-considered and rushed Draft National CARES Plan threatens to undermine our commitment to our nation's veterans. That is why I will be offering legislation in the Senate with my colleague, Senator Enzi, to halt the current process until long-term, domiciliary, and mental health care as well as rural health care are adequately considered and veterans are allowed to fully participate in the CARES process. Before Congress requires it, I urge the CARES Commission to reject the current Draft National CARES plan and advise Secretary Principi that you are unable to develop appropriate recommendations under current CARES procedures. If the current recommendations are rejected, the Department of Veterans Affairs and the CARES Commission can begin anew by taking into account the proper factors and input from veterans.

Thank you.