Rocky Mountain Runaround

Nick Orchowski is what doctors call a walking quadriplegic. He was paralyzed from the neck down for months after being blown from the gunner's hatch of an armored Humvee when his convoy was ambushed between Baghdad and Sadr City. Three vertebrae were broken and a fourth was obliterated. Now, his spine is held together by two titanium plates, a bone graft and surgically fused vertebrae.

Orchowski is grateful he's able to walk after surgery relieved the pressure on his spinal cord. His physical therapists and his family - particularly his father - have dedicated themselves to helping him rebuild muscle, regain balance and learn to move his legs again. His right arm no longer works, and hot weather quickly exhausts him. Orchowski and his wife have a 3-year-old daughter and are expecting a son. It's easy to understand why he hates traveling long distances for medical care.

But if the 24-year-old Iraq war veteran and Denver-area resident needs treatment for his pinched spinal cord and mangled back, he has to go to Michigan, Florida, California or wherever else VA sends him. Instead of breaking ground on a desperately needed new hospital and spinal-cord injury treatment center this spring, VA again broke a promise to replace an aged and dilapidated medical center in Denver. Dr. James B. Peake is the third straight VA secretary to discard plans for new health-care facilities in the city.

Many Colorado veterans are enraged. They say they were shut out of the decision-making process and were repeatedly burned by VA, which in 2004 identified Denver as a city of urgent need for a new medical center. The urgency is compounded today, as thousands of young men and women come home from Iraq and Afghanistan with broken bones, missing limbs, traumatic brain injuries and post-traumatic stress disorder. In addition to that new wave of demand, more than 400,000 World War II, Korean War, Vietnam War and Gulf War-era veterans live in the region.

"I don't understand why it's not done yet," says Orchowski, who was a military policeman when he was injured in May 2004. "Guys and gals went over, fought for our country, lost lives for our country, and now we're back here fighting the mighty dollar to figure out why we're not building a new hospital. VA is falling back on their commitment to support us."

VA has talked about replacing its 1950s-era hospital for more than 20 years. Millions of federal dollars have been spent deliberating and drawing blueprints, without ever turning a shovelful of dirt. VA has twice walked away from less expensive propositions, including a 2000 offer of free land at the former Fitzsimons Army Medical Center and a joint venture with the University of Colorado Hospital (UCH). They would have shared in the building of a new inpatient treatment center at the Aurora site near Denver. UCH and VA were to share imaging equipment, operating rooms, laboratories and other costly equipment and services. VA would have had a separate outpatient clinic and other specialized-care areas exclusively for veterans. Buckley Air Force Base planned to use the new joint medical care center as well, saving taxpayers an estimated $1.2 billion over 20 years. The American Legion and other veterans groups endorsed the proposal.

But in 2002, then-VA Secretary Anthony Principi rejected the plan, saying the $288.6 million pricetag was too high, and the shared hospital would make it difficult to maintain VA's identity. Principi insisted that VA needed a completely separate inpatient hospital. Two years later, the Capital Asset Realignment for Enhanced Services (CARES) Commission ranked the Denver VA Medical Center as one of three such hospitals in the nation most in need of replacement, and urged swift action. VA soon proposed a stand-alone hospital and outpatient care center at Fitzsimons, including a new spinal-cord injury center with as many as 50 beds.

When Jim Nicholson took over as secretary, VA began looking over the available Fitzsimons land, which by then was rapidly disappearing. The Denver Children's Hospital and other medical groups rushed to join an emerging new health-care community. Congress balked at rising costs, by this time close to $621 million. The American Legion and veterans groups again rallied behind the plan to build at Fitzsimons, and Congress finally agreed to put up the funds. Colorado veterans believed their long-overdue health-care facility was in sight.

That changed after Peake took over as VA secretary last December. In January, designers presented him with detailed plans for the new Denver VA Medical Center and estimated it would then cost $1.1 billion. Peake not only kept the finalized master plan quiet, he set aside proposals that would have reduced the cost and, essentially, ditched the idea in favor of a new and different partnership with the University of Colorado, the Denver VA's academic affiliate. Colorado veterans were not advised of the change when VA began cutting a deal to lease floors from an inpatient tower that is still on the UCH's drawing board. Veterans found out their hospital plan had been scuttled by reading the morning newspapers in late April.

"We're trucking along, thinking we've got something, and we've got nothing," says Ralph Bozella, American Legion Department of Colorado past commander. "VA is like Lucy and we're like Charlie Brown, and they keep inviting us to run and kick the football."

Maintenance and upgrades to keep the current Denver VA Medical Center operating have soaked up about $52 million just since 2004, with an estimated $23 million in additional work yet to be completed. Meanwhile, VA has spent $56 million acquiring property at Fitzsimons and another $5.4 million on site studies, road design, utility design and other paperwork. VA still needs some $568 million for its latest construction plan, plus another $140 million to lease hospital space from UCH for 20 years, according to its own estimates. All of this does not include the cost of developing the other two hospital proposals.

Bottom line: VA easily could have built a world-class hospital, outpatient clinic and spinal-cord injury center for far less money if it had taken the free land and gone to work nearly a decade ago.

Vietnam War Veteran Artie Guerrero has long predicted that VA wouldn't make good on its promise to build a new Denver medical center. So he is not surprised by the latest setback. "When I came back to Fitzsimons from Vietnam, they put 70 of us in a 20?bed ward," Guerrero says. "It started from there. This country can afford to fix a toilet 400 miles up in space. But we can't take care of our veterans."

Sen. Ken Salazar, D?Colo., and Rep. Ed Perlmutter, D?Colo., are furious with Peake's decision to cancel plans for the stand-alone hospital. In a July 14 letter, they questioned whether or not VA purposely withheld key information and demanded an end to negotiations to simply lease space from UCH. They also questioned VA's failure to disclose that it had already spent $4 million designing the stand?alone hospital and spinal?cord center that CARES recommended.

VA appears to be pressing ahead with the new plan anyway. But Peake is sensitive to the backlash. He dispatched Deputy VA Secretary Gordon Mansfield to Denver in July to try to smooth things out, and his staff has actively courted key congressional aides. Peake also wrote a detailed letter to Salazar and Perlmutter, explaining his decision.

Among other things, Peake says he will use some of the money saved by not building a new VA hospital to construct more community-based outpatient clinics around Colorado. "You can do so much more now in an ambulatory-care environment," Peake told The American Legion Magazine in late August. "The demographics are changing. When you build something now - if you look traditionally - it's going to be there for 50 years. (A new inpatient hospital) is not what we are going to need in 50 years."

That does not mean, however, that VA is averse to building new medical centers in veteran-growth areas around the country. "We are building a place in Las Vegas because veterans are still going there," Peake said. "The population is growing. Orlando - veterans are going there. Denver - they're not. The population is going to come down; it's not going to be there in 20 or 30 years. So, we won't need that many beds. Denver itself is going to grow but not with veterans, unless something really changes."

Part of Peake's plan called for reducing the 50?bed spinal-cord injury center to no more than 30 beds - 12 in the leased hospital space and 18 in a nursing home-style building VA calls a restorative care center. "The number of truly severely injured veterans (from Iraq and Afghanistan) is very small," says Glen Gripper, VISN 19 director. "We have the inpatient facilities to take care of them."

Matt Keil, a quadriplegic who was shot in the neck by a sniper during his second tour in Iraq, is outraged by VA's argument to expand outpatient services at the expense of a hospital VA itself described as a critical need in 2004. "Do we want one really great place for medical care here in Denver or marginal improvement across the state?" Keil asks. "Why is that OK? Do they get to say, ‘I'm sorry we took what you deserve off the table, and now you get this'?"

Keil's wife, Tracy, is a veterans advocate and deeply involved in her husband's care; she shares her husband's frustration. "There is no polytrauma center in the middle of the country," she says. "We need a polytrauma center around Denver." She says such a center should be modeled after Craig Hospital, a private rehabilitation center in Englewood, Colo., where Keil was treated after he began seeking care outside VA.

Peake argues that technological advances in outpatient care and specialty medical centers make a new inpatient hospital unnecessary. That same mantra was often recited in the mainstream health-care industry in the 1990s but was abandoned after hospitals realized that aging baby boomers were creating unprecedented inpatient demand.

"Every hospital in the metro area is growing, not shrinking," says American Legion Past National Commander Thomas L. Bock of Aurora, Colo. "So how is it that VA thinks its patient population is going to shrink? Are they assuming there aren't going to be any more wars and, magically, kids won't need health care?"

A "hospital within a hospital" is a term Peake uses to describe leasing floors in the future UCH inpatient tower. "This is going to be the most beautiful VA footprint you've ever seen," Peake said in August. "It's right on the light rail. It will be a tremendous ambulatory environment. We want to build the parking into it, so that we have adequate parking for the first time. We want to be on the campus there (with) our academic partners."

Colorado veterans say the proposal fails to recognize that veterans have different health-care needs from others, says Luan Jones, who struggles to help a 30-year-old family friend get treatment for the severe PTSD he acquired in Iraq. The friend greatly fears crowded hallways and intense downtown traffic. It's nearly impossible to get him to seek care in the aging Denver VA Medical Center.

"If you lease a couple of floors in a new hospital, it's doing the same thing to veterans they are doing at the downtown hospital," Jones says. "Should we really let them run these guys with PTSD through a gantlet of people every time they go for treatment? This sort of stress greatly exacerbates their medical condition."

Adding yet another level of uncertainty: a new VA secretary will take office in January. Today's plan could be scrapped or revised, further delaying action. Colorado Legionnaires hope the new secretary will revive plans for a new Denver VA Medical Center.

Veterans say they are more than willing to help VA find ways to save construction costs. One idea they suggest is that VA build a new inpatient hospital and lease a couple of floors to UCH. Bock and other veterans say they will take their own shovels to Fitzsimons and start building a new hospital on their own, if something doesn't happen immediately.

Meanwhile, veterans are left feeling ignored. "We've got all of the money to send them over there to fight," Jones says. "But we've got nothing to take care of them once they return."

Ken Olsen is a frequent contributor to The American Legion Magazine.