Bogged down in the bluegrass

Fifteen years after a federal commission recommended that VA replace its 1950s-era hospital in Louisville, Ky., veterans worry the new medical center will never materialize. The reasons are familiar to those who have followed other troubled VA construction projects in recent years: endless delays, rising costs and controversy about the location. But Louisville faces another hurdle: a legal challenge from a neighboring community that wants VA to build a cemetery instead of a medical center on the land. 

Even if VA wins the lawsuit, Kentucky veterans are concerned that by the time ground is broken, construction costs will have increased to the point that Congress will abandon the project. Their fears are fueled by the legacy of VA hospital projects in Denver, Orlando, Las Vegas and New Orleans that drew the ire of lawmakers after going tens of millions of dollars over budget and running years behind schedule. 

Some Louisville residents have simply given up. “I’m going to be dead by the time it’s built,” says a Vietnam-era veteran who asked not to be named. 

That skepticism is widespread. “Some people believe it won’t even be built on that site,” Mike Moses, commander of the American Legion Department of Kentucky, says of the property east of Louisville that VA selected for its new hospital. “There’s also the worry a new VA secretary will come in and say, ‘We’re going to start over.’”

“Veterans are the ones who are suffering,” Moses adds. “They are being denied the best health care they can get in a state-of-the-art-facility.”

DOWNTOWN Louisville’s Robley Rex VA Medical Center opened on a 47-acre hilltop overlooking the Ohio River in 1951. The 114-bed hospital provides a full range of patient care, education and research programs, according to a 2005 report by the Capital Asset Realignment for Enhanced Services (CARES) Commission. Patients are referred to non-VA physicians in Louisville or other VA medical centers in the region for cardiac surgery, organ transplants, spinal-cord injury treatment and other specialized medical care.

The aging Louisville VA hospital is well-maintained but has daunting fire and safety problems. “These structural issues make it very difficult to create a safe, modern and secure environment,” the CARES report said. And there’s not enough room at the current site – which is steep and wooded – to fix the problems. CARES instead recommended VA build a new medical center downtown near the University of Louisville Hospital. 

There seemed to be momentum behind that proposal. Then-VA Secretary Jim Nicholson hinted that a downtown location would be chosen when he officially announced plans to build the new medical center in 2006. The University of Louisville and downtown business boosters were all on board.  

The medical community saw it as an opportunity to improve patient care, says Pat Padgett, executive vice president of the Kentucky Medical Association. “We have essentially three large hospital systems that are based in downtown Louisville: Norton Healthcare, University of Louisville and KentuckyOne. If the VA was going to move, then move downtown so they could work together.”

That would have made it easier to transfer VA patients to one of the downtown hospitals for more complex care, Padgett says. And it would have made it easier for physicians and medical residents who also work at other downtown Louisville hospitals to care for their VA patients. 

That didn’t gain much traction in the veterans community.  

“Few of the veterans who go to Robley Rex want to go downtown,” says Dan Klein, past commander of Shawnee American Legion Post 193, who was born and raised in Louisville. “It’s a hassle. Parking can be an issue. And there’s more crime.”  

Others thought a downtown medical center would quickly lose its veteran focus. “It would have been  under the control of the University of Louisville and that would have been the end of it,” says Randall Fisher, chairman of The American Legion’s national Legislative Commission. 

Fisher was a nurse, nurse practitioner and nurse manager during his 32 years at VA hospitals. He then spent 15 years as an American Legion service officer at the VA regional office in downtown Louisville. He shares Klein’s concerns about downtown traffic, particularly around University of Louisville and other hospitals, despite the city’s efforts to improve the situation since the new VA hospital was proposed. 

“Traffic has not improved, but gotten worse with all the new hotels and the rebuilt convention center,” Fisher says. “The city has pushed the VA to be downtown forever – but only the city would benefit.”  

PLAN B Most Louisville-area veterans prefer VA not move Robley Rex because the current location, just off Interstate 71, is easy to access. But former VA Secretary Eric Shinseki opted for a 36-acre parcel east of Louisville that is adjacent to the city of Crossgate. From the moment VA first expressed interest in the Brownsboro Road site, Crossgate – a community of 100 or so single-family homes – made it clear it didn’t want the VA medical center next door because of traffic and other issues. VA was so eager to push ahead, however, that it purchased the land five years before completing a mandatory environmental impact review. And when it closed the $12.9 million land deal in July 2012, VA paid $3 million more than the land had been appraised for roughly a year earlier. 

“It seems like there were some shenanigans going on there,” Klein says. “I think they overpaid for the property.” But the Brownsboro Road site wouldn’t have remained farmland forever, he adds. Another developer likely would have come along and turned the area into upscale housing. 

The VA Inspector General criticized VA’s Office of Acquisition, Logistics and Contracts for failing to obtain the appropriate review appraisal until long after it bought the property, then misleading the House Veterans Affairs Committee about the purchase details.

VA referred questions to the Justice Department because of pending litigation. According to DoJ, the lawsuit is ongoing.

VALUE ENGINEERING Even if critics can get beyond the amount VA paid for the 36 acres near Crossgate, the total project price tag is problematic. In 2015, VA asked a value engineering team to evaluate the plans for the new medical center. A value engineering team brings together experts in architecture, engineering, heating, electrical and other fields to provide a detailed, independent review of large construction projects. 

“It’s a rigorous and disciplined process,” says Rick Smith, a Vietnam veteran and mechanical engineer from Ohio who participated in the review along with about 30 other experts. “Within a week, we identified $140 million in potential savings.” 

For example, VA could save $8.4 million by buying locally manufactured brick. It could trim $40.5 million in heating and utility costs by reducing ductwork to a more appropriate size, using larger-capacity air handlers and eliminating a central steam plant. VA could save another $9.7 million by turning the old hospital into its Louisville regional office instead of building facilities at the new hospital site.

The cost-cutting recommendations were not well-received by VA. “They were so cold to us you could have frozen meat in that room,” Smith says. VA appears to have shelved the study, rather acting on the recommendations. “It highly irritates me that they squander our money like that.”

The value engineering team also told VA that its $670 million cost estimate for building the new hospital and regional office was about $300 million too low. VA dismissed that as well. But time has proven the value engineering team right. The projected price tag for the new Louisville medical center and regional office has risen to $925 million.

LEGAL CHALLENGE The value engineering study received little attention outside VA, and other issues have since taken center stage. The city of Crossgate filed a lawsuit in 2018 charging that VA’s environmental impact study violated the National Environmental Policy Act by failing to address all the ways the new medical center and regional office – 1 million square feet of building space – will affect the area. It will serve an estimated 1,500 patients a day, “profoundly impacting the traffic, transportation and land use in the area,” according to the suit, filed on behalf of Crossgate and Mayor Kirk Hilbrecht, a Desert Storm Army veteran. Crossgate also alleges that VA paid far too much for the vacant land where the proposed hospital is supposed to be constructed. 

Hilbrecht and the city of Crossgate want VA to turn the Brownsboro Road property into an extension of the Zachary Taylor National Cemetery and find another location for the new hospital – if it’s built at all. 

TRAFFIC JAM Supporters and critics of the new medical center site agree that traffic is going to get a lot worse. “We know it’s going to be a traffic nightmare at first,” Fisher says. “But Brownsboro Road was the best of all of the sites they had.” Turning the existing VA hospital into the regional office headquarters rather than adding those buildings to the new site would significantly reduce the traffic impacts, he adds.

Klein likes the new hospital site. 

“We’d rather go there than downtown or some of the other proposed locations,” he says. “It’s better than the old location in terms of parking.”

He views Crossgate’s opposition as a case of “not-in-my-backyard” syndrome. “They got their nice houses and now they don’t want anyone else out there,” Klein says. 

VA completed the hospital design in December. Revisions to enhance the pharmacy and the facility’s overall privacy should be completed this summer. But the project won’t move forward until Crossgate’s lawsuit is resolved. The Army Corps of Engineers will oversee construction, because Congress revoked VA’s authority to manage large building projects in 2015 after the long-overdue Denver VA was $1 billion over budget.

Traffic misgivings aside, Louisville veterans hope the new hospital will become a reality. “They made the decision,” Klein says. “Let’s get on with it.” More delays will force VA to continue putting money into the old hospital when it’s better spent on a new medical center, he adds.

“You’ve got to compromise and select a new location,” Moses says. “They’ve already spent over a decade with this thing. Let’s stop playing around and get it done.” 

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