I am writing to you in regard to the final report of the Capital Asset Realignment for Enhanced Services (CARES) Commission delivered to you yesterday as they pertain to New York.

I appreciate the considerable attention you have placed on the CARES process, and how you have responded to several serious concerns about the Draft Plan which I have discussed with you and Commission members over the past months. As you know, some of the changes that I and my colleagues representing New York have urged have been incorporated into the final report - and that is good news for thousands of veterans dependent on the care and services that were threatened.

But I must also point out where I believe the CARES Commission's final recommendations still pose troubling consequences for veterans in New York and merit additional review. While I am pleased and grateful that the Commission has rejected proposals in the Draft National Plan to transfer long-term care beds from the Canandaigua VA and domiciliary beds from the Montrose facility, I am concerned about several recommendations that would impact New York's veterans who receive care at the Canandaigua, Montrose, and Manhattan VA hospitals.

Specifically, I urge you to reject (1) the transfer of psychiatric beds from the Canandaigua VA; (2) the transfer of inpatient services from the Montrose VA; and (3) consideration of the transfer of services from the Manhattan VA.

Canandaigua VA

I am pleased that, contrary to the proposals in the Draft CARES National plan, the Commission has recommended that the Canandaigua VA remain open. These changes are attributable in large part to the efforts of New Yorkers who mobilized and convinced Commission members that the Draft National Plan had to be changed. However, the proposal to move psychiatric beds from Canandaigua is ill-advised. Specifically, the Commission report recommends that psychiatric beds at the Canandaigua VA hospital be dispersed to distant VA facilities.

As a result of the introduction of the Clinton-Enzi CARES amendment to the fiscal year 2004 Senate VA-HUD appropriations bill, the House-Senate conferees specifically stated in the fiscal year 2004 Consolidated Appropriations conference report that they "are concerned that the realignment recommendations of the CARES Commission may lead to a reduction in long-term care, domiciliary care, and mental health services. The VA is expected to expedite the strategic planning process for these services. Based on the Secretary's statements the conferees urge that no closures or reduction in long-term care, domiciliary care, and mental health services, will take place until the full analysis is completed." The recommendation to move psychiatric services from Canandaigua before a study of mental health services is complete flies in the face of Congress's intent as declared in the conference report.

As you know, I have long been critical of the process used to develop the CARES recommendations. Specifically, several important factors that are critical to veterans' health care have been neglected. In this rushed process, the impact of the proposed changes to long-term care, domiciliary care and mental health needs were not considered. Indeed, during a meeting with the NY delegation, you acknowledged that studies regarding mental health care had not been completed. However, despite this admission, the CARES Report proposes shifting psychiatric beds away from Canandaigua.

The omission of mental health care needs from the Draft National Plan and the Commission report is particularly striking because of the effect that the closure of the Canandaigua VA beds will have on the veterans who are currently receiving care at the facility. The chronic nature of the problems that veterans bring to the mental health setting often require a long term involvement if sufficient help is to be provided so that they do not become revolving door patients. The hospital currently offers an acute psychiatric unit, long term psychiatric beds, and beds for veterans suffering mental illness and chemical addiction. The number of beds and variety of services provided in one place at the Canandaigua VA indicates the unique quality of care that is provided there. By splitting up the psychiatric beds, the VA will be dispersing a staff that possesses a unique set of skills and expertise which is widely and highly regarded. Although the VA claims that there will be no reduction in the level of care, these assurances ignore the fact that the parceling out of these beds and services to other facilities will not reconstitute the quality of care available at the Canandaigua VA.

In a letter sent last year to the leaders of several of the nation's leading Veterans Service Organizations, you wrote, "I am committed to, and I commit to you and your members, no net reduction in VA's capacity to provide inpatient mental health care and long-term care prior to the completion of a comprehensive assessment of veterans' need for these services." Because a comprehensive assessment of veterans' need for these services has not been completed, I urge you to reject the CARES Commission recommendation regarding the transfer of psychiatric beds from Canandaigua.

Montrose

The CARES Commission report also recommends the transfer of most in-patient services from the Montrose VA hospital, including psychiatric beds, to the Castle Point VA hospital. While I am pleased that the Commission rejected the Draft Cares National Plan to also move domiciliary-based residential rehabilitation programs and ambulatory care services from Montrose to Castle Point, the recommendation to move other in-patient services is a serious blow to veterans who currently rely on the Montrose VA hospital for their care.

The recommendation to move in-patient services to Castle Point is particularly puzzling given the Report's findings and recommendations regarding the need to do further study regarding long-term and psychiatric care. The CARES Report specifically found that:

• Developing a model for the deployment of [long-term care] beds is a complex undertaking hat VA has yet to complete; and
• VA has not developed a consistent rationale for the placement of [long-term care] units that address stake holder concerns regarding access to care. (CARES Report, p. 3-28)

Yet, despite the recommendation to develop a plan for long-term care before reconfiguring long-term capacity, the Commission ignores this recommendation with regards to Montrose. Specifically, the Montrose Campus is slated to lose an estimated 105 long term care beds, and 70 psychiatric beds. However, as mentioned previously, the need for long-term beds has not been properly assessed and current projections forecast that there will be a significant increase in the need for psychiatric beds through 2012. In order to ensure adequate capacity to handle the projected case load, local veterans organizations support retaining all services at Montrose and Castle Point.

Moving inpatient services from Montrose to Castle Point will require considerable financial resources and take at least 5 and maybe as many as 10 years to accomplish. However, the Commission Report provides no explanation for what will happen to services at Montrose in the meantime. Further, there is no analysis of how veterans will get services if future budgets do not include enough funds for the transition.

I urge you to reject the CARES Commission recommendation to transfer of inpatient services from Montrose to Castle Point.

Manhattan VA

The report also recommends studying the transfer of inpatient services from the Manhattan VA to Brooklyn. However, this recommendation does not take into account several factors. First, high quality tertiary services at the Manhattan VA attract veterans from New York, and other states including New Jersey and Pennsylvania. One of the reasons the Manhattan VA is able to serve these veterans is its accessibility, located, as it is, in the heart of Manhattan, at the center of a mass transit system that is unmatched anywhere else in the nation. Moving these services to Brooklyn will be a tremendous hardship on veterans, many of whom are disabled, who would have to make several transfers and take an extra hour to reach Brooklyn.

Second, NYU currently trains residents at the Manhattan VA. If Manhattan closes, NYU will be forced to reduce its residency program and both NYU and the patients that the residents serve will suffer.

Finally, one of the missions of the VA Hospital system is to serve as a backup in case of an attack or disaster. If the Manhattan VA were to close, NY would be losing tremendous capacity that would be needed in case of a tragedy. Consequently, I urge that the recommendation to study the transfer services from the Manhattan VA to Brooklyn be abandoned.

Conclusion

At this time in our nation's history, with U.S. troops bravely serving in Iraq, Afghanistan and elsewhere, it sends exactly the wrong message to propose such drastic changes in veterans' health care without proper thought and deliberation. Our troops are fighting overseas to defend our values and way of life. We owe it to our current and future veterans to make sure that we provide the best health care possible for them and not rush to implement recommendations that provide our veterans with less adequate health care.

I look forward to continuing to work with you, and hope to meet with you soon to discuss all of this in detail.