Beleaguered VA hospital in Colorado sees staffing, design obstacles before 2018 opening
By NIKKI WENTLING | STARS AND STRIPES Published: January 17, 2018
(This story has been updated.)
WASHINGTON — Hundreds of tasks need to be completed and hundreds of job openings filled before the new, overbudget and long-delayed Department of Veterans Affairs hospital near Denver can begin to accept patients for its scheduled opening this summer.
Even after the hospital opens its doors, the old Denver VA and other off-site facilities will remain in use for at least three years because of design flaws at the new campus, located in Aurora, Colo.
These findings were detailed in a House Committee on Veterans’ Affairs document obtained by Stars and Stripes on Tuesday and discussed during a committee hearing Wednesday morning.
“The road to completing this hospital has been long and bumpy. This situation must never happen again,” said Rep. Phil Roe, R-Tenn., chairman of the House VA committee.
Roe described the project, recently named the Rocky Mountain Regional Medical Center, as a “construction debacle” that changed the way the VA develops and constructs hospitals.
The hospital has taken more than a decade to develop, and construction costs soared from an estimated $538 million in 2009 to a final budget of $2 billion. Government watchdogs found that leaders behind the planned hospital agreed to a grandiose design and ignored repeated, early warnings about costs, driving the project into financial failure.
Since the findings, all VA projects totaling more than $100 million were placed under the management of the U.S. Army Corps of Engineers. Rep. Mike Coffman, R-Colo., said Wednesday that he wanted the VA’s authorities to oversee construction projects stripped even further, limiting the agency’s control to ones costing less than $10 million.
The construction contract on the Colorado hospital ends Jan. 23. As of Wednesday, it was 98 percent complete, and all but one building had been turned over to the VA for activation.
Next, the VA will award another contract for design corrections, renovations and final completion. That work is estimated to be completed in June, and then computer systems can be turned on, staff trained and patients moved. Roe said the agency is aiming for an August opening.
Costs associated with the new hospital, which extended more than $1 billion over budget, are not likely to increase, said Stella Fiotes, acting principal executive director of VA acquisition, logistics and construction.
But there are other challenges that the VA must face before opening the new campus this summer.
“It’s a gorgeous facility, but it’s odd. It’s strange. I told them, ‘You’re going to have a tough job with this,’” Roe said Tuesday in an interview.
Not enough space
Roe, a former OB-GYN, Coffman and other committee members toured the old Denver VA and the under-construction hospital last week.
They found some features that seemed impractical, such as a too-small emergency room and a layout that obviously wasn’t created with input from medical professionals, Roe said.
“I think one of the problems was, the architects and leadership didn’t involve the clinical people – the maintenance people, environmental services, nurses, physicians,” he said. “They should’ve been involved from day one. But that’s water over the dam now.”
Large-scale design problems mean the campus at 1.21 million square feet isn’t creating more useable clinical space when compared to the old, 600,000 square-foot Denver hospital. There’s more inpatient room at the new hospital, which the document describes as “dauntingly large,” but less space for primary care and outpatient services. The number of primary care rooms will decrease from 60 at the existing hospital to 34 at the new one.
Ralph Gigliotti, a network director with the VA, said local officials were looking to outsource some primary care work to nearby community-based outpatient clinics. The VA will also consider a new clinic in the Denver metro area, he said.
The layout could become an issue for patients, Roe said. For example, inpatient services are located approximately 1,000 feet away from where X-rays are provided.
“I think that the design, we can all agree, was probably more complex than it needed to be,” Fiotes said Wednesday, in response to criticisms about the layout. “We learned much from this design that we would not replicate. A more compact design would’ve been more efficient, functional and probably come at a lesser cost.”
VA researchers and a prosthetics laboratory will remain at leased, off-site facilities, and a PTSD Residential Rehabilitation Facility and seven patient-aligned care teams will remain at the old Denver hospital for another three to five years, the document states.
A new PTSD building was part of initial plans for the new Rocky Mountain campus but eliminated when costs soared. A proposal is stalled in Congress for a PTSD facility to be added back into the project.
Maintaining services at the old VA will increase costs because of duplicate staffs for food, security and administration. The old hospital needs $350 million in improvements, and if the facility is still in use by 2023 those costs will have to be incurred, according to the document.
Hundreds of jobs remain open
The VA has a list of 375 tasks to complete before the Rocky Mountain VA opens, the congressional document states, including installing fixtures and HVAC systems and configuring medical equipment. Workers must also fix mistakes with the facility, such as replacing walls in dental exam rooms that aren’t strong enough to support wall-mounted X-rays, and replacing plate glass windows in pharmacies that don’t allow employees to talk or pass items to patients.
Roe said they’re small tasks, but add up to a significant problem. He and other committee members said Wednesday they’d closely oversee the work.
Before August, the VA also must hire 421 new employees. Gigliotti said more than 250 jobs have already been filled.
The existing VA campus in Denver was already facing hiring challenges. Of the 2,787 positions at the existing VA, 653 are vacant, including 77 mental health professionals.
The problem isn’t unique to Denver, Roe said. As of the end of June, the VA reported 34,000 job vacancies system-wide, and VA Secretary David Shulkin has said hiring mental health care professionals to meet demand is particularly challenging. The agency set a goal to hire 1,000 mental health care workers in 2017. The VA hired 900 last year, but lost 945.
The document states local VA staff are pessimistic about filling new jobs, but Gigliotti insisted they were making good progress.
“We are making excellent progress,” he said. “We are confident we will be able to meet the staffing needs.”
Roe found positive aspects of the campus – patient rooms are spacious, surgical rooms are state-of-the-art, and the spinal cord injury center will be first-rate, he said.
But it could take some getting used to.
“It’s a huge building, and if a veteran is just showing up for the first time, [he or she is] going to be scratching [his or her] head about, ‘Where do I go?’” he said.
“There are problems that need to be addressed yet.”