Kelton Sweet, chairman of The American Legion Department of Florida Veterans Affairs & Rehabilitation Commission, has been waiting for a new VA medical center since he retired from the Air Force. "I was 53 then," he said. "Now I’m 78, going on 79."

He enrolled for VA health care in 1987, six years after Orlando had come up as a likely candidate to get a new VA medical center to serve a population of veterans that has continued to soar over the last three decades. "I had left the military with a few bumps and bruises, and they turned me over to VA," Sweet said. "I was running between here and Tampa. When you do that, it’s like two hours, maybe, if the traffic is not bad."

He was thrilled to learn that Orlando was in the running to get a VA hospital of its own. "I found out there was change in the wind," Sweet said. "They had been trying to get another hospital in this area since 1981." He was encouraged. He kept waiting for news. It came in fits and starts, for more than 30 years.

His wait is about to end. On Veterans Way south of Orlando, a new state-of-the-art 65-acre VA medical center complex – 11 buildings, including four 30-bed Community Living Center long-term care "villages," a 60-bed domiciliary and 134 inpatient rooms, surrounded by 3,100 parking places – is expected to open in 2014.

Like New Orleans and Denver, the central Florida VA medical center project was hung up first by questions of where to build. Sweet says that debate paralyzed the project for nearly two decades as politicians battled over their preferred locations. "So, nothing happened," he said.

Then came the CARES report in 2004, which was clear in its recommendation: "With only 45 percent of area veterans within access standards for hospital care, the Orlando area needs a new medical center."

Location remained problematic. Between 2004 and 2010, according to last April’s GAO report, "VA’s site location changed three times." The first option was a renovation of Orlando’s massive, hospital-like clinic in a residential area of the city, but that property was deemed too small. The second option fell apart after the landowner of a larger parcel sold half of it before VA could close a deal. Finally, the facility was sited near Lake Nona where it would be co-located in a "medical city" to include the Central Florida College of Medicine, the Sanford-Burnham Medical Research Institute, the University of Florida Academic and Research Center and Nemours Children’s Hospital. Ground was finally broken in 2008 for the new VA medical center.

The UCF facility opened in 2009, as did the Sanford-Burnham Medical Research Institute. Meanwhile, the 1.2-million-square-foot VA facility – initially set to open in April 2010 – remained far from finished in August 2012 when House Committee on Veterans Affairs Chairman Rep. Jeff Miller, R-Fla., called most of the state’s congressional delegation to the construction site for a hearing to find out why it was taking so long and costing so much. Its estimated cost had soared by 143 percent to $616 million and was on its way to an opening more than 40 months past due.

Surrounding the head table of the hearing were stacks of change orders – design revisions – that the contractor, Brasfield & Gorrie, said were driving up costs and lengthening the process. Company President Jim Gorrie told the lawmakers and veterans at the hearing that "changes are still coming" and by that time, he said, the company lacked a complete list of medical equipment VA planned to install. "I can’t commit to something I don’t have," Gorrie said when asked at the hearing about a new target date for completion. "You have to have direction. We haven’t gotten it yet."

"I remember when this came up, and we went back and did some research," said Dennis Milsten, VA’s associate executive director of facility programs and plans. "While Orlando is higher than the norm, it is not that much higher than the norm for what we experience for medical facilities. They were not that far out (in terms of) changes per dollar or changes per square foot of what we experienced in Las Vegas."

Changes in medical technology and patient care during the construction phase have modified plans and slowed all four VA medical center projects across the country. "Every project is going to experience some of that," Milsten said. "Women’s clinics had some impact. There is also the mental health issue. As we develop new standards for treatment, we treat them just like new technology. We don’t build these things like, ‘Well, we designed it in 2005, and whatever we did in 2005 is what you’re going to get when it’s done.’ That is not the attitude we take. As new standards come out, as better treatments are available, as better technology is available, we do everything we can to accommodate that."

Another problem in Orlando was a leaky roof that had to be replaced. "We experienced some delays from that," Milsten said. "It kept us from getting the building weathered in as early as we would have liked. The contractor had a roof, had some quality issues, and agreed to a different roof system at no additional cost to the government."

Orlando’s journey included one afternoon of lost progress in February 2011 after authorities found six illegal immigrant workers (from a full contingent of about 500 employees and subcontractors) hiding in a ceiling of the unfinished hospital. That led to a protest at the site by union workers, veterans and others, who arrived at the worksite to find the project suspended for the afternoon and vacated of laborers.

Over the last year, however, the project has turned a corner. "The number of change orders has gone down exponentially," Milsten said. "That is also a product of where they are in the process."

"It has been a long time coming, but it is a massive undertaking," said Art Schwabe, American Legion Department of Florida commander. "You move from one piece of property to another one, naturally there’s going to be delays. And you’re working with the government. There are going to be delays (due to) that, in itself."

Like Las Vegas, New Orleans and Denver, Orlando is now poised to deliver a state-of-the-art medical center for its veterans – 400,000 of whom reside in central Florida – and, said Milsten, "We have learned a lot as we have come along."

One of the key lessons, he said, is to "pay very good attention to medical equipment. And to that point, there needs to be a medical equipment planner on our side that keeps us in tune with that. This comes back to the fact that our designer needs to get the information from the vendors that are selected, and then turn them into drawings that are actionable by the contractor. I am not so sure that, consistently, we did such a great job of that."

GAO Director of Physical Infrastructure Lorelei St. James testified in a May congressional hearing that medical equipment planners have helped private-sector projects avoid delays and cost overruns and recommended VA make better use of them, too. "In Orlando, medical equipment specifications changed several times and led to cost increases of at least $14 million in addition to schedule delays … these issues forced VA to suspend construction until the issues were resolved."

Relationship building could have been better in the early going, Milsten added. "There is not a problem in the world that doesn’t have better communications as a potential eliminator. Yes, communications could have been better. We could have had more, earlier involvement."

In April 2014, the new Orlando VA Medical Center is expected to become the second of its kind constructed in America in nearly two decades. It will have the latest in medical technology. It will be built for staff and space efficiencies. It will include all the aesthetic and therapeutic features. It will have a dedicated women’s clinic and enhanced mental health care program that were not envisioned back in 1981, when central Florida first appeared on VA’s hospital-construction radar.

Are these going to be the best hospitals in the nation?

"Yes," Milsten said. "But I would have to preface that – for a while."