Veterans are priceless; hospitals aren’t

Our veterans are as priceless as their service to this country. When they've been wounded in the discharge of their duties, and when they come home and slip toward poverty as a result of their health problems, we owe them whatever care they need to lead normal, productive lives.

The importance of this obligation was front and center last week, when Nevada's political class descended upon North Las Vegas to dedicate the valley's sparkling new Veterans Affairs Medical Center. It's the first new VA hospital to open in the United States in 17 years, and no area in the nation needed one worse than Southern Nevada.

Of the roughly 236,000 veterans in the region - including parts of Utah, Arizona and California - about 46,000 currently get their health care from the VA. For years, many thousands of these men and women have had to travel for procedures the VA's scattered local facilities couldn't provide. Within a matter of months, almost all of them will be able to get almost all their care at the new complex, just off the Las Vegas Beltway, a couple of miles west of Interstate 15.

For veterans and those who value them, last week's dedication was a moment worthy of celebration.

The fact that the hospital cost about $1 billion and will have taken more than six years to finish? Not so much.

Everyone seems eager to move on to the business of delivering better health care to local veterans, and to leave behind all the problems that caused the hospital's costs to explode and construction to be delayed. As for me, I just want to understand why it cost so much and why the job took so long, and to find out if anything's been done to prevent such problems when new VA hospitals come online in Colorado, Florida and Louisiana in a few years.

A billion bucks is a lot of money. And it's boatload of cash for a hospital. In Las Vegas, you need only drive down the Las Vegas Strip to see what billion-dollar projects look like. At a first glance, the VA hospital doesn't appear to be one. And it was never supposed to be one.

From 2005 to 2007, the construction cost estimates rose from $286 million to $406 million to $600 million. Meanwhile, promises of a 2009 opening gave way to a 2011 completion. Now it will be January 2013 before the hospital, which broke ground in October 2006, is fully operational and has all its equipment installed. Including the costs of that state-of-the-art equipment and set-up, the total bill comes to about $1 billion, the VA says.

According to the American Hospital Association, it typically costs between $1.5 million and $2 million per bed to construct and equip a new hospital. Other sources put the cost between $1 million and $1.5 million per bed, especially with design-build construction efficiencies.

The four new private-sector hospitals that have opened in the valley over the past decade - Spring Valley, Southern Hills, St. Rose San Martin and Centennial Hills - cost $458 million solely for construction and totaled more than 600 beds. And unlike the VA hospital, which was built on "free" federal land, these hospitals had to buy their property and pay taxes on it. Going off the industry standards, equipment would have put the total bill for those four hospitals just under or just over $1 billion.

However, the new VA Medical Center is not a typical hospital. It sits on 154 acres and has more than 1 million square feet. While its bed total is low - it will have 90 in-patient beds and 120 nursing home, extended care, rehabilitation and hospice beds - it includes vast hallways of clinical space, including 22 dialysis bays and centers for dental and eye care and prosthetics, among other specialties.

And it's absolutely gorgeous - without question the nicest hospital in the state. There's natural light everywhere. Everything from hallways to patient rooms, bathrooms and operating rooms are bigger than those of typical hospitals. VA spokesman David Martinez, while taking me on a tour of the place, noted that the main hall feels more like a shopping mall than a hospital. Every patient room has a lift system to safely move patients without blowing out nurses' backs. The views are spectacular.

If I got sick, I'd want to stay there. And that clearly was a driving principle in building the place - creating an environment that's uplifting for suffering veterans.

So why did the costs grow so fast? Much of the work was done during the Great Recession, when there was a surplus of labor and materials.

John Bright, director of the VA Medical Center, said the major reason was deeply flawed initial estimates made out of Washington, without the input of anyone local. He said that's one lesson learned going forward on future VA projects.

And what of the delays? The VA couldn't say. I asked if there were any contractor issues, work stoppages or accidents that stretched things out. No response. Photos clearly show most of the complex's major structural work was wrapped up 2½ years ago.

I talked to an ironworker who worked on the project, and he said he and his colleagues had never experienced such a counterproductive job site. He said everything took forever for no good reason.

It's maddening that so few public construction projects can come in on time and on budget. Rep. Shelley Berkley, D-Nev., one of the driving forces behind the hospital, griped for years that "we can build a 5,000-room hotel in Las Vegas in under two years and it takes five years to get a VA hospital completed." (Make that six, congresswoman.)

Time is money for a business. No expense was spared in building the VA hospital because the federal government worries about neither time nor money. Washington always figures it has plenty of both. This hospital could have been built much sooner for much less.

Veterans are priceless. Hospitals aren't.

Glenn Cook (gcook@reviewjournal.com) is a Review-Journal editorial writer. Follow him on Twitter: @Glenn_CookNV.