LANDSTUHL, Germany — Landstuhl Regional Medical Center turns 60 this year, yet, thanks to millions of dollars spent on renovations and maintenance over the last two decades, the place looks, on the surface at least, almost new.

So when lawmakers visit and want to know why the Army has asked to replace its premier overseas hospital with a new, nearly billion-dollar facility, they’re ushered to the pediatrics clinic.

There, in an office away from public view, transparent plastic panels in the ceiling give a glimpse into the hospital’s age and the lengths to which engineers have gone to keep it running.

In 2009, chunks of concrete block crashed through the clinic’s drop ceiling, prompting an engineering and architectural study of the entire hospital, said Michael Arseneau, who is both Landstuhl’s facility manager and Europe Regional Medical Command facility director.

While the structure was found to be mostly sound, sections of the pediatric clinic’s ceiling were crumbling. The ceiling was patched over and a layer of chain link fencing was anchored above the entire clinic to catch falling debris, should the repairs not hold.

“This is what it looks like behind the scenes,” Arseneau said.

Landstuhl, which has treated virtually every U.S. servicemember medically evacuated from Afghanistan and Iraq, is reaching the end of its life span and becoming harder and costlier to maintain and upgrade to standards never considered when it was built in 1953, officials said.

Last year, more than 7,000 man-hours were spent on preventive maintenance to head off utility breakdowns and structural problems, and about double that went into repairs, Arseneau said.

That work and renovations at the hospital cost American taxpayers $8.3 million last year, he said, and between $8 million and $10 million each year over the last decade.

The renovations, which took up a large chunk of that cash, have transformed the hospital from a Cold War relic into something more in line with modern standards.

“We’re very proud of it,” Arseneau said, “even though it’s a 1950s-era facility.”

But the 1950s design, he and other officials said, doesn’t leave room for renovations needed to bring the hospital up to the current standard of world-class care.

Landstuhl’s rambling, spine-and-rib cantonment structure was built to handle mass casualties and confine damage from Soviet bombing that never happened. Patients, including new moms and wounded troops, sleep two or three to a room and share communal bathrooms down the hallways. Current standards call for single rooms with their own bathrooms, officials said.

An addition to the hospital in 1983 improved the hospital’s intensive care and operating rooms, “but those ORs are, like, 400 square feet, and the standard today is 650 square feet,” said Col. Brad Dunbar, the U.S. Army Health Facility Planning Agency’s program manager in Europe. No matter what new infrastructure is installed in the rooms, “it’s going to be constrained in terms of supporting surgery,” he said. “You can only take it so far.”

“That goes back to the size,” Arseneau said. “We can’t stretch the building, unfortunately.”

The facility doesn’t limit the staff’s ability to care for patients, “but there are risks with a building this old,” said Col. Barbara Holcomb, the hospital’s commander. “It’s prudent to replace the facility.”

Congress agrees, but has wrangled with the Pentagon over the new facility’s cost and scale amid a drawdown of forces from the continent and budget battles back home.

What they have agreed on is consolidating replacements for Landstuhl and an aging clinic at Ramstein Air Base in Germany. The new facility would be at the Army’s Rhine Ordnance Barracks in Kaiserslautern. Adjacent to Ramstein, the site will allow for a speedy transfer of wounded troops from the flight line — something Landstuhl, atop a steep hill about five miles from Ramstein, has never afforded.

Treating the wounded, though, isn’t the new facility’s top priority. According to defense officials, the hospital is being designed for peacetime operations, with the capacity to expand in case it’s needed for another war, and the decline in casualties from the last decade’s wars is not a factor in deciding what the new medical center requires.

The Pentagon initially wanted $1.2 billion for the facility, but Congress authorized just $750 million in the 2012 defense bill. Congress upped the authorization to $990 million in this year’s defense bill, which President Barack Obama signed Jan. 2.

Congress still wants the Pentagon to provide more data to justify the size and price of the new hospital, according to language in the defense bill, but raised the price tag because members “felt that the authorization needed to increase in FY13 (fiscal year 2013) to avoid further delay in the project since the FY14 (defense authorization bill) may not be completed fast enough to accommodate the construction schedule,” Kathleen Long, a spokeswoman for Senate Armed Services Committee Chairman Sen. Carl Levin, D-Mich., said in an email.

Still, authorizing the money isn’t the same as handing it over to be spent.

Congress has thus far appropriated just more than $70.5 million of the $990 million to start construction.

Another $127 million approved in the 2013 defense bill hasn’t been appropriated yet, and Congress won’t release any more until the Pentagon certifies the facility is the right size to support the forces and other beneficiaries who will be in Europe long term.

The Government Accountability Office also questioned the proposed size and cost of the new facility and is still waiting to hear back from the Pentagon on recommendations it made in May. GAO recommended that the Defense Department:

Provide clear and thorough documentation of how it determined the facility’s size and cost estimate. Correct any calculation errors. Update its cost estimate to reflect those corrections and recent changes in the number of forces in Europe. “We have reached out to them but do not have enough information yet to close out our recommendations yet as being implemented,” Chuck Young, a GAO spokesman, said in an email.

Regardless, at the pace the project is going forward, more funds may not be needed soon.

With the roughly $70.5 million appropriated for the project last year, the Army Corps of Engineers had planned to begin preparatory work at the site in October. A pair of lawsuits filed by German environmental groups in September dashed those plans.

A German court sided with the environmentalists in November, ruling that the German Defense Ministry erred in approving a waiver that the Army’s Installation Command–Europe asked for to exempt the project from a public comment period.

German and American officials decided not to appeal the ruling, and the public comment period will proceed, according to U.S. officials.

“Given the timeline for public comment, it is likely that site preparation work such as tree-cutting will not occur until next fall,” Army Maj. Ryan Donald, a spokesman for U.S. European Command, said in an email.

In the meantime, he said, U.S. and German agencies involved in the project are working on the design for the new facility, which is projected to reopen for business by 2021.

“We’re all pretty excited about the design of how the new hospital will look,” said Col. Lisa Snyder-Hendrix, the assistant deputy commander, nursing, at Landstuhl, who is aiding in that effort. “A lot of it is based on what doesn’t work” at Landstuhl.

That will mean building nursing stations near the center of wards to speed access to patients; condensing the hospital into an easy-to-navigate tower structure; increasing room size; providing nature views and sunlight; designing parking for easy access to the hospital; and many other improvements that no amount of renovations at Landstuhl could accommodate.

“I’m very excited for the new hospital,” Snyder-Hendrix said. “It’s not going to be here quick enough.”

millhamm@estripes.osd.milTwitter: @mattmillham

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