Object 98: VFW Survey of VA Hospitals

In the spring of 1958, the Veterans of Foreign Wars (VFW) conducted a nationwide survey of safety and conditions at VA medical facilities. The organization’s findings led VA to launch a multi-year improvement plan to revitalize its historic medical center campuses.

The impetus for the survey was the Second Hoover Commission, a federal working group chaired by former President Herbert C. Hoover that was tasked with improving government efficiency. As part of its efforts to reduce federal spending, the commission sought to prune heavy expenditures at VA, including construction plans for future hospitals. The group also wanted to dispose of VA facilities that were deemed inadequate or no longer economically practical to operate, which included many of its oldest hospitals. In a final cost-cutting measure, the commission recommended requiring Veterans to show proof of financial need before receiving care and denying treatment altogether to those with non-service-connected medical conditions.

The American Medical Association backed the commission’s recommendations for downsizing VA despite the hardships this would cause for Veterans with medical problems. These Veterans would be forced to rely on a community care system that was ill-equipped to deal with their specific needs, such as prosthetics and various therapies. Not surprisingly, the VFW and other Veteran advocacy groups vehemently disagreed with the commission’s report.

The VFW decided to take its opposition a step further and carry out a survey of VA hospitals and residential care facilities in 1958. Under the leadership of Commander-in-Chief Richard L. Roudebush, the VFW dispatched field representatives to 179 VA facilities to assess their condition and determine what needed to be done to address their defects. VFW inspectors flagged everything that required attention from inadequate lighting, space, and equipment to campus-wide infrastructure issues like plumbing, flooring, and heating.

After completing the site visits, the VFW presented its survey to Congress in two bulging leather-bound binders. Each volume contained hundreds of pages of photos and notes documenting all of the deficiencies and flaws the VFW representatives had identified. The individual facility reports were arranged alphabetically under three headings: “Priority 1 (Urgent),” “Priority 2 (Work Needed),” and “Priority 3 (Good Condition).” The reports on the 49 hospitals that were classified as Priority 1 filled the entirety of the first volume. VA had already planned major renovations at several of these facilities to expand bed capacity, but the VFW survey called for much more extensive upgrades across the VA hospital network.

Unlike the Hoover Commission, the VFW did not support shutting down hospitals that were considered substandard. Instead, it devised a long-term plan to bring aging VA facilities around the country up to modern standards. VA leadership was receptive to VFW’s proposals. In 1959, VA’s Office of Construction completed its own study of the modernization needs of the 72 pre-World War II hospitals in the agency’s inventory. These facilities accounted for just over half of the bed capacity in VA’s hospital system. The following year, the agency mapped out a plan to update these hospitals while also replacing the 12 facilities acquired from the military after the war. The program got underway in 1961 and was expected to take 12 years to complete at a cost of around $900 million. A few years into the undertaking, VA revised its estimates, raising the projected expense to $1.3 billion and extending the timeline to 15 years.

By the middle of 1965, VA had made considerable progress with this effort. To date, it had received some $400 million in appropriations from Congress. VA used the money to complete dozens of improvement projects at existing facilities and build three new hospitals. The new construction included a 710-bed general hospital in Washington, DC, that replaced a facility half its size dating back to 1922. Work had also begun on another 10 hospitals and 7 more had been authorized but were awaiting funding.

The overall number of hospitals in service, however, declined from 170 in 1962 to 165 in 1966 as VA bowed to pressure from President Lyndon B. Johnson, who wanted to redirect some government spending to his “Great Society” initiatives to eliminate domestic poverty.  Johnson’s budget for fiscal year 1966 called for the elimination of 11 VA hospitals and 4 Veterans’ homes. The proposal produced a huge outcry from Veterans, their advocacy groups, and the politicians whose communities would be affected by the loss of these facilities. The pushback in Congress led Johnson to accept a compromise resulting in the closure of 6 hospitals and 2 homes in 1966.

Significantly, the president allowed VA to proceed with its plans to improve its hospital system. Over the final three years of his presidency, VA completed 9 more hospitals. Most replaced outdated facilities in the same area, but VA also took advantage of the program to build hospitals in new locations with large Veteran populations. The first of these “relocation” hospitals opened in Charleston, South Carolina, in 1966.

The modernization and replacement program initiated by VA in 1961 continued past its projected 1975 end date. The advancing ages of the World War II generation combined with the influx of Vietnam-era Veterans with their own complex medical needs created a surge in demand for VA healthcare services. Hospital admissions, after growing steadily from 537,000 to 689,000 in the 1960s, shot up in the early 1970s, topping 1 million by the middle of the decade. VA kept pace with the demand by continuing to expand its medical infrastructure. Between 1971 and 1978, the total number of VA hospitals in operation increased from 166 to 172. Much of this work occurred under the watch of VA Administrator Richard Roudebesh (1974-1977), who had commissioned the 1958 VFW hospital survey that helped lead VA down this path.