Las Vegas: 'Not Your Grandpa's VA'

The new Las Vegas VA Medical Center hovers like a mirage on the southern Nevada landscape. Its tones are earthen, matching the original 150 acres of raw desert transferred from the Bureau of Land Management to VA and blessed by Paiute Indians in early 2006, 10 months before ground was broken on the site. Seven miles northeast of one of America’s fastest-growing cities, Las Vegas is the first full-fledged hospital built by VA in nearly two decades. While not all services were up and running by April 2012, that’s when it was no longer defined as a construction project but as a facility that could start seeing patients.

"All the innovations are here," says David Martinez, head of public affairs for the Southern Nevada VA Healthcare System, as he ambles past patients, clinics, labs, waiting areas and offices along indoor walkways bathed in natural light. Water sculptures gurgle in the corners of seating areas. The TVs are all tuned to nature shows. Robots deliver food. Every patient room has a view to the outdoors. Remote-control hoists have been installed to gently elevate patients from their beds when sheets need changed. "This is not your grandpa’s VA," Martinez says. "You should notice the investment in glass. If you provide enough sunlight, it’s very therapeutic. When they put this all together, they made it look and feel not quite like a hospital."

As the emergency department, women’s clinic and bed tower were within months of opening last spring, retiring Director John Bright reflected on the project that has taken a decade and nearly $600 million to stand up. "I think we are very well suited for the 21st century," Bright said, noting that three return visits to Congress were necessary during construction to acquire the funding needed to stay ahead of medical and technological changes while the war produced a growing number of new patients with different needs.

"One of the challenges is that when this hospital was designed, it was based on equipment available at that time," Bright said. "Things like power in the lab – I can’t tell you how much additional power we’ve had to put into the laboratories just to accommodate the new equipment. It’s those kinds of things. I tell people if I could do it all over again, I would do it all over again. Some of the pitfalls that you run into that you don’t see coming, you would avoid if you could do it over."

The final product, however, is a nearly finished 210-bed medical center that matches much of the spirit of the 2004 Capital Asset Realignment for Enhanced Services plan that gave birth to it. The CARES Commission identified Las Vegas as one of three cities in greatest need of new 24-hour acute-care VA hospitals. After a VA ambulatory care clinic was condemned in Las Vegas earlier in the last decade, veterans of southern Nevada were shuttled to 17 different leased clinics around the city, and when they needed acute and specialized services, they had to travel to neighboring states.

American Legion Alternate National Executive Committeeman Ron Michalski of Henderson, Nev., was a volunteer driver who transported veterans from appointment to appointment before the new hospital was built. "Oncology, eye care, audiology … we would take one person to four or five different clinics in one day," he said. "Here, you drop them off, and it’s all done at this hospital."

Veterans grumbled early that the new medical center was not going to be built downtown, a complaint that has since faded. "Really, it’s only five or six minutes from downtown Las Vegas, down I-15," Michalski said. "So, it’s really not that far out."

"It’s a disadvantage for some veterans," Bright admits. "For veterans from Laughlin, it added another 25 miles. I think, like everything, veterans are adjusting. We’ve got four large primary care centers in the community. They don’t have to drive out here for primary care. They’re only coming out here for specialty care or inpatient care."

Inner-city construction congestion was also avoided by building the medical center out in the desert, and if the facility’s parking needs exceed the 2,500 spaces now on location, "we can make room for more," Bright said.

Among the goals of CARES were to provide high-quality medical services closer to where veterans live and to reduce the cost of maintaining unnecessary facility space. To achieve those goals, in an ever-changing medical and fiscal environment, was not easy. Nor was it inexpensive.

"One of the reasons surgery has not opened yet here (by April 2013) is because we went back in and got permission to convert one of our operating rooms into what they call a hybrid O.R.," Bright said. "That’s, in essence, robotic surgery, where we can do vascular surgery, work on aneurysms and those kinds of things, so veterans now won’t have to go to (non-VA providers) or go to southern California for care. With that addition to our O.R. suite here, we’re truly comprehensive. Imaging equipment – which is upgraded on an almost-annual basis – we have about $35 million worth. We have a state-of-the-art mammography system. Only one private-sector facility in Nevada has the same mammography technology that we do, and that’s in Reno.

"Even between the time the hospital was designed and construction began, there was new technology and more programs (to add into the project)," Bright said. "We started new construction to do a women’s health clinic, which will be completed in the fall. That was not part of the initial plan, but we got it approved, and it’s going to be a great thing. Our female veterans will be able to come in on the west side of the building, through their own entrance, step off the elevator onto the third floor and be in the women’s health center."

Critical to the materialization of the new medical center was a broad base of support, including the Nevada congressional delegation, veterans service organizations and VA Central Office, Bright said. "Regardless of party affiliation, I have had great support from the Nevada delegation. If not for them – past members and current members – we would not be where we are today. That was the foundation. And then the secretaries after (Anthony) Principi have also supported this project. We have been very, very fortunate. We have had great support from the veterans groups. We meet with them monthly and give them updates. Sometimes their patience amazes me."

Mitch Roach, an American Legion department vice commander from Laughlin, Nev., says the medical center is now a magnet for veterans, instead of a reason to go someplace else for care. "All the people I talk to down in the Laughlin-Bullhead area think it’s amazing that a place like this finally came to fruition," Roach said. "It’s just such an outstanding, well-built facility … to the benefit of every veteran in the tri-state area. Californians come here. Arizonans come up here. Everyone is now utilizing this hospital.

"One of the biggest things right now is getting rural people to qualified medical care," Roach added. "They had to go to Prescott or Phoenix or some other place – 180 miles, 200 miles, 300 miles away – as compared to coming here, 100 miles. And now we have vans that run on a daily basis from the Laughlin area. It’s just so much easier right now."

The initial cost estimate of the Las Vegas medical center was $325 million with a completion date of April 2009. After changes that included the decision to build a stand-alone medical center rather than an expanded clinic attached to Nellis Air Force Base, the total cost grew to $585 million with 2014 as the new target date for full completion.

Bright says the most important result of the long road to a new medical center is that veterans seem to approve. "We treat 49,000 veterans – not every one of those are happy every day – but I think generally the veterans are very pleased with this project. I talk to veterans every day, and I am not hearing a lot of complaints. Finally, we’re where we need to be."