Sepulveda VA Hospital Faces Unclear Future

From the outside, the stately Sepulveda Veterans Administration hospital complex looks as if it weathered the Northridge earthquake fairly well.

Elderly veterans still stroll throughout its serene, campus-like grounds. Doctors, nurses and medical students bustle among offices and clinics. All of its brick-faced buildings are still standing.

But walk inside some buildings and it is clear that the 39-year-old federal medical center sustained heavy damage in the Jan. 17 quake.

The main hospital, Building 3, is uninhabitable, its corridors strewn with broken glass, damaged medical machinery and waterlogged chunks of ceiling. With dozens of pipes ruptured, there is no water service. The boiler room is unusable, depriving the hospital of heat.

As a result, most of the 331 patients evacuated on the day of the quake remain scattered among other VA hospitals in West Los Angeles, Long Beach and Loma Linda. So extensive is the damage that Congress recently appropriated $43.6 million just to clean up Sepulveda and reconnect its utilities.

But with that work under way, questions are being raised about the future of the hospital, which employs more than 1,700 people and has long been a center for geriatrics research and the training of medical interns and residents.

VA officials in Washington are quietly discussing whether to rebuild the 431-bed facility, at a cost of $188 million, or convert it into an outpatient care center. Conversion would carry a far smaller price tag of $119 million.

The debate has been joined by private hospitals in Los Angeles, which argue that given the thousands of empty hospital beds in the region, Sepulveda should not be rebuilt if its patients can be permanently absorbed at other VA facilities.

Veterans themselves, perhaps the most vocal and influential group in the controversy, are split on the issue. Some favor reconstruction while others say the hospital should change its focus from inpatient care to less expensive outpatient care.

Indeed, some veterans argue that the VA should take advantage of the quake damage to transform Sepulveda--as well as other hospitals in the nation’s largest medical system--into a model of health care reform, keeping in step with the Clinton Administration’s initiatives.

For six years, Sepulveda has been the site of a pilot outpatient program that proponents say could be extended to the entire, 172-hospital VA system. They argue that outpatient care makes more sense as the agency’s budget shrinks and the veterans’ population ages, creating a need for more long-term-care and fewer acute-care beds.

Some clinic services have reopened at Sepulveda, but Building 3 has been vacant since Jan. 17, when terrified patients were hurriedly evacuated by a small cadre of nurses and doctors.

Desperately gripping their mattresses, bedridden veterans were half-carried, half-dragged down several flights of darkened stairs as aftershocks swayed the six-story building and water from broken pipes cascaded into hallways.

By the time the shaking stopped, Building 3’s three wings had split away from the core structure, as they were designed to. Rooftop heating and cooling machinery was wrecked. Operating rooms were littered with waterlogged equipment, packages of anesthesia masks and tubes of bone cement.

“We don’t know how, when or if we’re going to be salvaging millions of dollars of equipment,” said the hospital’s chief engineer, Ed Safdie, during a recent inspection of Building 3.

Much of the damage to Building 3 and its equipment was caused by flooding from broken water pipes. With maintenance workers initially preoccupied with helping to get patients out of the building, the sprinkler system was not turned off until more than five hours after the quake.

But the quake also caused extensive damage by knocking computers, expensive medical machinery, cabinets and other equipment to the floor.

Safdie said the VA appropriated $500,000 for internal bracing and anchoring of equipment at Sepulveda two years ago. But that money was diverted for additional waterproofing at the hospital after severe flooding hit the Valley in the winter of 1992.

A VA spokeswoman in Washington said a number of buildings at Sepulveda are likely to be retrofitted against earthquakes, but she didn’t know what specific work would be done or how much it would cost.

Opened in 1955, the Sepulveda VA offered a range of hospital medical services as well as outpatient programs in primary care, substance abuse and mental health. It is also a teaching hospital affiliated with medical schools at UCLA and numerous other universities. Last year, 364 medical residents and interns trained at Sepulveda. The hospital’s budget this year is $112 million.

Sepulveda conducts research on aging, drug and alcohol abuse, neurological disorders, heart disease and other problems. In 1993, more than $8 million was spent on research activities.

Even before the quake, Sepulveda was edging away from traditional inpatient care under a pilot program known as PACE, or the Pilot Ambulatory Care and Education program.

Launched in 1988, the program uses teams of doctors, nurses, pharmacists and psychiatrists to treat veterans in an outpatient setting. It emphasizes preventive health care and is seen as a potential money-saving alternative to long-term hospitalization.

PACE survived the quake. But what to do with the hospital, given the degree of damage to it, is being debated from Los Angeles to Washington within the VA, Congress and veterans’ groups.

At a recent briefing in Washington for members of Congress from California, VA officials outlined the pluses and minuses of renovating the hospital or turning it into an outpatient center.

Under either option, the hospital’s 145-bed nursing home would remain.

By rebuilding, veterans in northern Los Angeles County would have continued access to acute medical care near their homes, and existing hospital employees could keep their jobs, the VA said. Also, existing research and outpatient programs would continue.

However, the cost of rebuilding would be over $71 million more than converting to an outpatient center, the VA said.

Also, renovation would mean that 193 previously empty beds at the West Los Angeles VA hospital--now filled with Sepulveda patients--would go unused again. The West Los Angeles hospital, the VA’s largest, has 1,157 inpatient beds, a 240-bed nursing home and a 300-bed domiciliary.

On the other hand, converting to outpatient services, the VA said, would put Sepulveda in the forefront of health care reform efforts. At the same time, the hospital could maintain its research programs in geriatrics and other areas.

But although it would save millions, turning the hospital into an outpatient center would make it harder for Valley-area veterans to get acute care, the VA said.

Driving to the West Los Angeles hospital would be “a significant barrier to veterans, given the realities of freeway congestion and traffic in the greater L. A. area,” said a briefing paper given to Los Angeles area members of Congress.

Largely due to pressure from politically influential veterans’ groups, and despite a large migration of veterans to Sun Belt states in the past 20 years, the VA has closed only one hospital anywhere in the country since 1965.

And many Los Angeles-area veterans--long accustomed to free, full-service medical care at Sepulveda--strongly support rebuilding the facility.

“I have a feeling that there’s going to be a consensus among our California legionnaires that they want that hospital completely rebuilt,” said John Hanson, director of veterans affairs for the American Legion in Washington.

Those who favor rebuilding are backed by the influential head of the House Veterans’ Affairs Committee, Rep. G. V. (Sonny) Montgomery (D-Miss.). Montgomery’s committee oversees the VA’s annual budget and has tremendous political leverage over the agency.

“I’m fully supportive of either rebuilding that hospital or building another hospital in the area and giving the same services,” Montgomery said.

“In the Northeast, you might could close hospitals. But most veterans are in California, Arizona and Florida. . . . I understand the problems of spending $170 million, but we need that facility, and that’s what I’m going to work towards,” he said.

But some veterans see wisdom in closing the hospital and converting to outpatient operations.

“You don’t need hospital beds as much as long-term care beds,” said Dave Gorman, deputy national legislative director for the Disabled American Veterans in Washington.

“The VA can’t maintain all these hospital beds, and maybe they shouldn’t,” he said. “They should be in the era of modern health care, like everyone else is.”

David Langeness, spokesman for the Hospital Council of Southern California, which represents mostly private hospitals, agreed, but for different reasons.

At the end of 1993, he said, nearly half of the 31,000 hospital beds in Los Angeles County were empty, placing a serious financial strain on hospitals. Given that surplus, and if veterans displaced from Sepulveda can be accommodated at other VAs, the Sepulveda hospital should be closed, he said.

“We think that the VA is going to make the same decision that other hospitals are going to--and that is to downsize,” he said.