Building 7 on the campus of the Veterans Affairs Medical Center here is called Blind Rehab, a special unit for aging vets who have macular degeneration or diabetes-induced vision problems.
But this past year, Blind Rehab began to see a new type of patient: veterans barely past their 20th birthdays, blinded by gunshot wounds and bombs in Afghanistan and Iraq.
"These soldiers now have flak jackets and armor that protect their bodies and keep them alive, but we see traumatic limb injuries and traumatic head injuries," said Stan Poel, chief of Blind Rehabilitation Services at the Waco hospital. "Those are the things that are presenting a challenge to the VA."
These are also the kinds of patients the Department of Veterans Affairs now projects will flood an already overtaxed and underfunded health care system that treated more than 5 million veterans last year.
"Our number one priority is returning service members from the combat theater . . . and to provide world-class health care to veterans, as well as benefits," Veterans Affairs Secretary Jim Nicholson said after a tour late last week of the 127-acre Waco campus, whose neighbors to the west include the huge Army base of Fort Hood, with 41,000 soldiers, and President Bush's ranch in Crawford.
"The increase in demand for our services from what we projected is up 126 percent," he said. "We have to obviously be prepared to ramp up."
The Waco hospital, with its well-kept pre-World War II red-brick, red-roof-tiled buildings, has provided health care for veterans in central Texas for 73 years. Now it is on the chopping block, scheduled along with 17 other VA hospitals to be closed or downsized as part of an agency plan to restructure the health care system. A 1999 government study found the VA was spending $1 million a day on buildings it did not need, and in 2003 a government commission recommended closing older, underused hospitals, including the one in Waco. The Waco facility is part of the Central Texas Veterans Health Care System, which also includes a hospital in Temple and outpatient clinics in Austin and five other communities.
For the past two years, Waco officials, residents and veterans groups have been fighting back, emphasizing the importance of the facility's specialized blind rehabilitation, psychiatric and post-traumatic stress disorder units; the large and aging veteran population (Texas has the third-largest population of veterans in the country with 1.7 million, a third of whom received VA health care last year); and, now, the wave of veterans from the wars in Afghanistan and Iraq who will need its services.
"They guaranteed so many years ago that they will take care of [veterans], and I would say they're pretty much going back on their word," said Ron Peterson, 35, an engineer with the 91st Engineer Battalion, 1st Cavalry Division at Fort Hood. Peterson used a day off last week to provide a motorcycle escort for Nicholson's visit to Waco and to register his support for keeping the hospital there open.
Peterson was deployed to Iraq from January 2004 to this February. He was wounded twice, receiving the Bronze Star, two Purple Hearts and an Army Commendation Medal for valor in combat.
"They're not ready for everybody coming back," Peterson said. "They're trying to shut everything down and they're going to need PTSD units. The guys aren't seeing the things they saw in Vietnam, but they're seeing a lot of stuff."
This year, the post-traumatic stress disorder in-patient unit in Waco has seen more than 75 new cases of veterans from Operation Iraqi Freedom. The 15-bed blind rehab unit, which has helped 106 blind veterans this year learn skills such as how to use a walking cane, cook and negotiate e-mail, has a wait list of 73.
"This is the best PTSD facility in the union, and these [guys] are trying to close it down," said Bill Mahon, a Vietnam War veteran and the McLennan County veterans service officer. In the past two years, Mahon has organized several motorcycle rides to the gate of Bush's nearby ranch to protest the proposed closing. "This is not their hospital; it's our hospital."
Nationwide this fiscal year, 250,000 new patients -- 40 percent of them veterans from Afghanistan and Iraq and 60 percent of them veterans from other eras -- have entered the VA health care system, Nicholson said.
As Congress works to eliminate an emergency funding shortfall this year of at least $1 billion and a projected shortage in the VA health care budget of more than $1 billion in the coming fiscal year, VA hospitals have felt the impact nationwide.
According to documents released at recent meetings of the House and Senate Veterans Affairs committees, the VA hospital in White River Junction, Vt., was forced to shut its operating rooms temporarily because of a lack of maintenance funds to repair a broken heating, ventilation and air conditioning system. Hospitals in Arkansas, Oklahoma, Mississippi, Louisiana and eastern Texas stopped scheduling appointments for many veterans. The VA medical center in San Diego, with a waiting list of 750 veterans, diverted $3.5 million in maintenance funds to partially cover operating expenses and delayed filling 131 vacancies for three months to cover operating expenses. The Portland, Ore., hospital delayed non-emergency surgery for at least six months, and 7,000 veterans who use the VA facility in Bay Pines, Fla., are waiting longer than 30 days for a primary care appointment.
"I'm going to go to a civilian doctor rather than wait 70 to 90 days," Douglas McKee, 63, of Chilton, Tex., said as he left the Waco facility on Thursday afternoon. McKee, who said he was disabled by a mine explosion in Vietnam while serving with the 173rd Airborne Brigade, had just learned that his regular doctor was on duty in Iraq and that he could not get an appointment with a new physician until mid-October. He would also have to wait for some of his prescription refills, he said.
"We laid our life on the line and then got blowed up and then you come here and you get turned away. That ain't fair," said McKee, who suffers from a variety of ailments and uses a walker to get around. "And then they got all the kids coming back from Iraq."
Nicholson assured hospital employees and veterans gathered for his visit that no decision had been made about the facility's fate and that he had "no predispositions about this at all."
Nicholson, who visited the facility at the request of Sen. Kay Bailey Hutchison (R-Tex.), said he was concerned about the 300,000 square feet of vacant space at the Waco VA. A local advisory group suggested filling the space with nonprofit organizations such as the Salvation Army, which could tailor their services to veterans' needs.
Nicholson will make his decision about the Waco VA early next year, including a proposal to transfer its psychiatric and post-traumatic stress disorder services to Austin and Temple. He warned those gathered that his visit should not be interpreted as "an interception of the process." And he complimented the hospital for its track record. "This is the way the American people want veterans to be taken care of," he said.
As for the hospital's fate, Nicholson said, "the binding question is what's going to be the best for our vets? . . . They did what was best for us and for our country."