Worried in Waco

Waco, Texas, is threatened with the loss of its 72-year-old Veterans Affairs Department hospital, which provides nursing home and psychiatric care to about 350 veterans. The director of the regional network that includes Waco had recommended adding beds to meet a growing demand for mental health services. But the draft realignment plan released last year called for closing the facility and relocating its occupants to the VA hospital in Temple, Texas, less than an hour away.

"This really pulled the rug out from under us," says Waco Mayor Linda Ethridge. She and other local leaders did their best to persuade the commission reviewing VA's plan to reverse the verdict. Nearly 35,000 people signed petitions in favor of keeping the hospital open, and 300 more wrote letters. The local congressman and the two U.S. senators from Texas got involved, along with many city and state officeholders. The city government formed a bipartisan task force to push for alternatives.

But the commission concurred with the recommendation to close the hospital. Its 22 buildings, while historic and attractive after $80 million in renovations in recent years, are antiquated and underutilized. In 1945, the Waco hospital had 2,040 beds, but today more than 250,000 square feet of space stands vacant. The patient population has been declining as long-term hospitalization of mentally ill people has fallen out of favor.

But Mayor Ethridge argues that community-based outpatient care often is possible only when a hospital is available for backup during relapses and when medications have lost their effectiveness. She and others, including Rep. Chet Edwards, D-Texas, question the cost-benefit analysis that underpins the decision to close Waco. The numbers weren't available until after the decision was made, the mayor says, adding, "We think they're very flawed." Coke Mills, a Waco lawyer and co-chairman of the city task force, calls the planned closure "dumb as hell" in view of the increasing demand for mental health services for veterans.

City leaders are concerned about the fate of the hospital's 800 employees. The VA says no one will be laid off, but most employees probably will have to commute to Temple if Waco closes. The CARES commission recommended a new outpatient clinic for Waco, but it probably won't be on the hospital campus. The commission also recommended that patients and their families and Waco's regional network get extra time to make the transition and figure out what to do with the campus.

Meanwhile, city leaders vow to continue fighting.