By Jeffrey Felshman
The atmosphere was more tense than usual in Building 228, the psychiatry and substance abuse wing of the Edward Hines Jr. VA Hospital in Maywood. Two programs on the fifth floor had closed within a month of each other: first, educational therapy, then wood shop. A rumor was going around that the physical-therapy program known as kinesiotherapy, or KT, was next. Many of the veterans who used these programs were already depressed; now they were witnessing a domino effect. If KT closed, no program was safe.
The rumor was confirmed within weeks. On January 29, 1998, a notice went up outside the fifth-floor gym:
TO ALL PATIENTS
We regret to inform you that the KINESIOTHERAPY CLINIC and POOL Programs for the patients of bldg 228 will be eliminated as of FEB 17, 1998. If you have any questions about the elimination of these services, Please feel free to contact:
Dr. G. Borge at extension 2730
Dr. J Subbarao at extension 4981
Mr. R Massey at extension 4982
We deeply regret any inconvenience, stress or hardship that the elimination of these services creates. It has been the pleasure of the Kinesiotherapy Staff to serve each one of you. The Kinesiotherapy Staff had NO input as to the elimination of these services,
THE KINESIOTHERAPY STAFF
When a Vietnam veteran named Dave Albert read that note, he was no longer depressed. "I was pissed off," he recalls.
Albert knew these cuts were being forced on the hospital. The Veterans Administration was in financial straits--for years its health care budget had been flat, and "belt tightening" was a phrase heard repeatedly around the hospital campus. But Albert hadn't seen this coming. He'd never guessed that psychiatry and substance abuse would take the opening shots in a campaign to streamline the Veterans Health Administration.
The VA was seeking to change its health care system: the hospital-based model would have to give way to outpatient clinics and home-based therapy. The plan had been in the works for years. "There was no formal beginning to the reorganization process," says William Graham, director of network program support for the VA in Washington, D.C.
An earlier attempt to scale down facilities in Chicago had stalled--all four area VA hospitals remained in full operation. A couple years ago West Side VA almost lost its surgical program, but this move was blocked by an intense lobbying effort from the University of Illinois at Chicago's College of Medicine. Now Albert thought Hines was a target.
It was a big one. Hines is enormous, its upkeep formidable: 42 structures sprawl over 147 acres. Every building is in use. The first went up in 1921 after money and property was donated by Edward Hines Sr., owner of the Hines Lumber Company, whose son had been killed in action in France in 1918. Building 228, completed in 1989, is the most recent addition. Last year the hospital admitted 9,761 patients and recorded 369,491 outpatient visits.
When the government started its undeclared war against VA hospitals, Albert found himself at ground zero.
"Downsizing will begin here in Chicago," a VA official later told me. "For the VA, Chicago is the laboratory, if they can get through the politics and the special interests here. If they can do it here, they can do it anywhere."
The morning after the notice went up outside the gym in Building 228, Albert drove to Hines in his '89 Olds Cutlass Calais, took the elevator up to the fifth floor, and headed down the hall to KT, where he'd been going three to five times a week as an outpatient since 1993. He'd spent the previous night thinking about the guys who'd been studying for their GEDs in educational therapy, about the paralyzed World War II veterans who used the wood shop. Vietnam-era veterans like Albert were reaching their late 40s and early 50s, a time when medical care becomes a pressing issue. But to Albert that was beside the point: "These guys served their country and were promised free medical care for the rest of their lives. The promise isn't being kept. It's like they've gone 20 years of a 30-year mortgage and are saying 'I don't feel like paying for it anymore.' The guys from poor neighborhoods who can't afford insurance or other health care are out of luck."
Albert assumed there would be some sort of KT at the hospital even if the fifth-floor gym were closed. Developed in 1946 as a rehabilitative program for injured soldiers returning from Europe, kinesiotherapy has grown into a demanding discipline requiring 1,000 hours of training in subjects such as psychology, physiology, anatomy, and neurology. "KT raises serotonin levels and comforts depression," Albert says. "It's obvious, but now they finally have a study that says so."
He had been a binge drinker--one drink became three, which became ten, a glass chain that usually ended in the darkness of a blackout. He'd spent ten days drying out at Hines as an inpatient in 1992, but he believes it was the KT treatment that pulled him out of his downward spiral. He says he wouldn't have been able to stay clean without KT. "Some people get religion, some go to AA, but for me and a bunch of other guys, it's KT."
Albert sat pedaling a stationary bike in the KT gym. Another veteran was on the bike next to him. We ought to do something, Albert told him, write a letter, start a petition. Just then a big ex-marine named Bill Tracy limped into the gym with a sheaf of papers in his hand. "He already had a petition to stop them closing the wood shop," Albert recalls, "and he wanted us to sign it. I said, 'Hey, add KT and ET and I'll help you give it out.'"
A former drug addict who says he's been diagnosed with "somewhere between seven and ten psychological disorders," Tracy thought ET was a lost cause, but he agreed to add KT to the petition. Albert lived up to his end of the bargain, corralling outpatients in the halls of Building 228 and hanging around the inpatient ward on the fourth floor. This role didn't come naturally.
Albert had never been a joiner. He didn't belong to any veterans' organizations. He didn't join the army, and he didn't join the demonstrations against the Vietnam war. He'd thought the war was wrong, but he was suspicious of the demonstrators' motives. "Everybody was saying 'Don't go to the war, you're just fighting for Coca-Cola' and 'Killing the Vietnamese is wrong' and stuff like that. Everybody had all these noble-sounding reasons, but most people just didn't want to die."
Half-Irish, half-Cherokee, Albert grew up in Westchester, the eldest of three and the only boy. He was a teenage greaser who went to Elmhurst College, then dropped out to become eligible for the draft. "I didn't want someone else going in my place," he says. "I asked myself, 'Could I live with myself if I didn't go?'" The answer was no. "I didn't want any special treatment. I just wanted to be the average guy."
He was shipped off to Vietnam in 1968, where he reached the rank of Spec-4, or specialist fourth class, "sort of a corporal," Albert says. He was wounded in a freak accident when he thrust his hand down into a pile of two-by-fours. The hand came up with a nail through it. Before he entered the service he'd been a drummer in a couple bands; after the accident he could barely hold a drumstick. But he was in good physical condition. He boxed as an amateur middleweight and had a record of 13-0. He'd only been going to the VA since 1992. Before that he'd never expected to need it.
Now 52, Albert was living with his parents. He'd held a variety of jobs, including a stint at a state driver's license facility. He was working as a business broker when he began to distribute the petition. He'd never been so motivated. "I'm a strange character," he says. "I stopped working to do this.
"I knew it was going to be hard. I knew I'd be taking on the United States government. I knew I was lettin' myself in for a ton of bullshit."
Albert had figured it wouldn't be easy to fill Tracy's petition. Over the next week he was proved right. "People in psych and substance abuse are depressed already and become apathetic," he explains. "These guys are drugged, they're scared." Patients didn't want to put their names on paper. "It's a real mix in psych and substance abuse. Some of the guys have criminal records; some of them are too smart to stick their necks out." Many were afraid there would be reprisals if they rocked the boat.
The patients weren't the only ones who were scared. The KT notice was gone within a week. "I asked the guy on the staff who put it up why he took it down, and he said he couldn't tell me," Albert recalls. "He was shaking visibly, and this is a guy that doesn't shake easy."
Tracy and Albert didn't worry about being singled out. They managed to get 200 signatures on their petition. On February 13, 1998, the two went to see Dr. Gary Almy, associate chief of staff for mental health behavioral services at Hines. They had asked three other patients to accompany them in a show of force.
Silver-haired and solidly built, Almy wasn't alone either. The hospital's public relations officer, Pam Surges, sat beside him. Tracy settled into the first chair, and Albert sat behind him. The three other men stood like a chorus near the front door.
Tracy had decided to tape the proceedings because, he says, "my memory is bad." He turned on a tape recorder and introduced himself as "representing the hundreds of veterans that use these programs every week." He then invited Almy to speak.
"The issue here at Hines, and at many VAs across the country, is the budget reduction," Almy began. "And one of the ways that we have to deal with budget reduction is to look at all of our various and sundry programs at the hospital."
Almy assured the men he thought wood shop was a good program, but he felt the funds that paid for it would be better spent elsewhere. The staff person who ran the wood shop was needed for bedside therapy.
Tracy disagreed: "So you think it's better for one man who can run the wood shop for the whole day to see the few than the many. Is that right? I would say a good 40 or 50 veterans go through that one shop every day, and you think it's better that he see 4, maybe 5 patients a day than those 50?"
Almy said the evaluation process was ongoing but the VA had to face facts: "We don't have the same sort of luxury and the same sort of need to deliver the same sort of long-term programs with short-stay populations that we have in the past. The hospital is changing in many ways and we have to keep abreast of that change."
Tracy pointed out that there had been enough money to repave the parking lot outside Building 228. Plenty of money was spent on expanding and resurfacing places for cars owned by hospital staff.
Almy and Surges agreed that reconstructing the parking lot looked bad during a budget crunch, but Surges explained that the funds had been allocated for the project five years earlier. If the money hadn't been spent on the parking lot, it would've been lost.
"What looks bad in our eyes," Tracy answered, "is the fact that Building 228, when it was transferred over, when it was first built, psych and addiction lost two [wards], which was 40 beds each. That's 80 beds. You just closed four more, that's another hundred plus beds. Why do we have to bear the brunt of all these cuts?"
Voice rising, Tracy continued, "You know, we're being discriminated against as psychiatry and addicted patients and veterans, while, say, the blind center, they have a work program, they serve, tops, eight guys a day. Eight guys a day and I hate to be cold, but they can't see what they're doin', whereas we use this to calm our nerves, to work out our angers and such, and why do we in the psych building have to bear the brunt of all these?"
Almy's voice was calm, his manner placatory. "We've got your petition here," he said, "and we've got all the names. And it helps to meet with people to get a real sense of the personal involvement that you all have in a program like this, and..."
Tracy cut him off. "Well, if you wanted we could bring up all 200 people. I'm sure they'd like to come."
One of the men near the door spoke up: What other programs were on the chopping block? Almy quickly ran down a short list. At its end he mentioned that the swimming pool used for KT might be closed.
Albert spoke up. "The fifth-floor exercise facility for kinesiotherapy?"
"That's also being looked at," Almy said.
"But that's the core of your program right there," said Albert. "You know that."
A veteran from the chorus identified himself as Charles Payton and asked, "The fifth floor, is it being closed today? We heard it was being closed down today, it'll be discontinued as of today."
Almy answered that the fifth-floor KT gym was also on the schedule of cuts.
"When were the patients going to be informed of all these closures?" Tracy asked. "Just when you go up there and they were closed?"
Surges jumped in. "No," she said. "We've been talking to patients for several weeks that have been informed. Obviously..."
All five veterans began protesting at once. Over the babble, Tracy said, "I came up here and I was lied to when I came up here. I brought this pink sheet up here and it says to all patients, 'We deeply regret the inconvenience, stress, hardship, of the elimination of the services created,' that, uh, discrimination..."
"No!" Surges interrupted. "And I didn't lie to you."
"You said that the pool and the gym, KT, was not gonna be cut."
"No, I did not," she replied, a little flustered. "That says the KT clinic."
Surges told them that KT would still be offered in the hospital: "There's KT all over the place. KT is not closing down."
Disappointed, Tracy reminded her they were talking expressly about services in Building 228. "You knew what I was speakin' about."
"I really didn't," Surges insisted.
But neither Tracy nor Albert believed her. Albert explains, "Pam believes in what she says. I know a psych patient who believes he controls the world. The guy has a thick binder with the names of countries, companies, and symbols next to them. He believes he can kill any of them with the symbols if he wants to. Pam is kind of like that."
The meeting ended with no promises and no satisfaction, but Tracy and Albert knew it was just the beginning. Budget cuts might have seemed like a reasonable explanation for closing programs, but the wood shop wasn't a high-priced frill. They figured it cost $50,000 a year (Krist Samatra Vit, the staffer in charge of the program, told them it was more like $100,000). All the equipment was donated, it required one staffer to run, and some of the pieces crafted there were sold, with proceeds from the sales returning to the program. More to the point, the wood shop was important to the men who used it. "Some of the World War II guys had been in the wood shop for 25 years," Albert says. "It's a big part of their lives." He mentions a World War II veteran who'd been bayoneted 40 times: "He needed the wood shop to move his arms."
Educational therapy didn't appear to cost a lot either. "These guys were trying to make something of themselves," Albert says. "If you take a guy, raise his hopes--he's trying to get things going and then they cut it--it's worse."
Albert calls Hines "the crown jewel of the VA system." It had money, no question. It produced a four-color glossy newsletter every month, and there were new computers in administrative offices, where staff had recently been increased from 12 to 18.
So Tracy and Albert wrote a letter of protest and sent it along with copies of the petition to a wide range of politicians, "about 25," says Albert, including Senator Carol Moseley-Braun and congressmen Danny Davis, Henry Hyde, and Luis Gutierrez. After a round of form responses, only Gutierrez--who sits on the House Committee on Veterans' Affairs--seemed to hold out hope. "Gutierrez's letter was for real," Albert says. "It was an excellent letter." Gutierrez had written a detailed inquiry to Dr. Joan Cummings, the head of the regional Veterans Integrated Services Network, whose offices were located at Hines.
Gutierrez forwarded Cummings's response to Tracy. Cummings had assured Gutierrez that "physical conditioning programs will be continued," and that reassigning staff from the closed programs to other areas of the hospital would lead to "better opportunities for community reintegration and even gainful employment."
The letter continued, "While it is understood that the sense of accomplishment and pride realized by making such things as clock casings, footstools and lamps is beneficial, the overall benefit obtained has lesser impact than some other programs when viewed from a medical treatment standpoint.
"VA-wide changes are being made in the delivery of psychiatric and substance abuse care. Programs are now focusing on outpatient rather than inpatient models. This is, and has been the accepted modality of treatment in the private sector for quite some time."
Albert had seen the outpatient model in action on days when he hung around the lobby of Building 228. He'd watched veterans with psychiatric disorders fill prescriptions for antipsychotic drugs, then shamble out the revolving door to the curb. "When you see 'em walking around in a stupor, you know there's something wrong," he says. He thought some of the men were too dangerous to walk the street, but what did he know? He wasn't a psychiatrist.
On mentioning his concerns to a staffer, Albert was directed to a book by Almy. He found a copy and read it.
Addicted to Recovery: Exposing the False Gospel of Psychotherapy/Escaping the Trap of Victim Mentality boasts three authors: Almy, his wife, Carol Tharp Almy, and prolific Christian writer Jerry Jenkins. The book is critical of the use of psychotherapy by Christians and attacks 12-step programs. Almy writes near the end of the introduction: "As we have grown in Christ we have had to ask ourselves, when the church holds the diamonds of Scripture in its hands, why does it go elsewhere for counsel? Why is the church so fascinated with the polluted crumbs that fall upon it from Freud's table?"
Albert wasn't concerned by this so much as by a description of Almy's mentor, a psychiatrist named Michael Taylor: "He viewed psychotherapy as a waste of time, illogical, unscientific, and wrong. Mickey was an engaging, convincing teacher. I could not deny his conclusions....He took Viet Nam vets who entered the hospital truly insane, hearing voices, high on drugs, and genuinely psychotic, examined them, studied their lab reports, prescribed medication, monitored them, and sent them back to duty with minds cleared. I stood amazed and changed my direction toward 'biological psychiatry.'"
If Almy hadn't appeared terribly concerned about losing the wood shop or KT, Albert now thought he knew the reason why: "Almy doesn't believe in psychiatry," he said.
Almy says this isn't true. "Psychiatry can do a lot for people with brain disease," he says. "But obviously, I'm a Christian and in my religion you have to get right with God. Pop psychology blames everybody else--your mother, etc. As a Christian, I believe in original sin and personal responsibility, which is very different."
During 1998, Albert came up with other possible explanations for budget cuts initiated in psych and substance abuse. Though the department hadn't hindered Albert and Tracy's initial efforts at dissent, protest wasn't easy. The population of the fourth-floor ward turned over every 21 to 28 days. When Albert tried to get a second petition circulating, he had to explain the whole situation again to a fresh group.
He tried delegating the chore of distributing petitions. "I'd look for the natural or voted-in leader and get him involved. But I made an error--I told them what was going down and scared them.
"That's why it's so easy to pick on psych and substance abuse--the turnover." Though he occasionally saw a familiar face in the ward, none of the returning patients signed on. "They didn't want to get involved."
By April 1998, neither did Tracy. In forwarding Cummings's response, Gutierrez had seemed to accept the administration's version of events. Tracy was done.
"We all had an idea maybe we could change the mind of the administration, but we didn't stand a chance," Tracy says. "They lied to our faces. I can't stand much of their bull. I'm clean five years."
Albert says, "Everybody was down after Gutierrez's response, which just mimicked what the hospital told him. Tracy dropped out from stress."
Albert was stressed too. The protest seemed to have some effect: KT remained open. But for how long? "People got to know me as a troublemaker. I told them to demand KT, go to the director's office. The director's office doesn't want to hear from psych and substance abuse. Everybody got down. I almost gave up, but I couldn't get this thing out of my throat."
He spoke with Gutierrez's director of constituent services, Raymond Valadez, and in the fall of 1998 Valadez asked Albert to present his petitions to the congressman in person at a Veterans Advisory Committee meeting in December. At the meeting, Albert formally proposed that Gutierrez visit Hines. Gutierrez told him he would.
By then, Albert had gained allies--John Borg, another Vietnam veteran, helped pass out petitions, and "Nurse X," a hospital employee who believed she'd be fired if her identity was known, wrote letters and pushed Albert to keep fighting. Borg wasn't intimidated by the possibility of being shunned by patients or administrators. As a demolition man in Vietnam, he'd worn a pack filled with 20 pounds of C-4 explosive. He'd kept blasting caps in his shirt pocket. "Nobody wanted to be by me," he says. "Guys would ask, 'Where you going to sleep tonight?' so they could go somewhere else." With help from Nurse X, Borg and Albert drew up a charter formalizing their group and its mission. Veterans for Unification was formed in February 1999.
The name referred to the difficulties veterans with psychiatric and/or substance abuse problems had getting help from other veterans' organizations. Albert believed that something had to be done to unify veterans around health care. "Psych and substance abuse patients have no representation," he says. "No organization does anything for them." The Disabled American Veterans were nominally in their corner, but Albert says the psych and substance abuse group is treated like a redheaded stepchild. "Honestly, the Disabled Veterans doesn't do much for them--and the substance abusers are the worst ones to cut because they go right back to it. They need regularity to get a routine, so it's defeating the purpose."
Most of the difficulty lay in the generation gap that had played such a large part in public discourse during the Vietnam war. "Most of the veterans' organizations are run by the World War II veterans, who have a different point of view and are dying out. The World War II vets who run most of these organizations are more pliant, more comfortable with the way things are. And their feeling about psychological problems is, 'You've got psychological problems? There's nothing wrong with you!' Vietnam veterans and post-Vietnam have a different attitude."
Soon after the formation of Veterans for Unification, Gutierrez announced he would hold an open meeting at Hines on February 16. Valadez asked for help to get the word out and Albert canvassed the hospital. He spoke to veterans of every foreign war and veterans who never saw battle. He papered practically every corridor, no small job in one of the largest hospitals in the country. "Gutierrez was worried about attendance," Albert says. "He was hoping to get 50 people, 100 tops."
Three hundred veterans showed up. "They had to close the doors," Albert recalls. So many lined up to complain, Gutierrez had to stop the meeting before hearing everyone. He promised to return to Hines for a tour.
Budget cuts alone didn't explain the decline in services at Hines. It seemed everybody Albert knew had a story of medical care denied. Borg had gone to the emergency room with chest pains and couldn't be treated: there was no doctor in the emergency room. When he finally saw a doctor, he was given a prescription for antibiotics and an appointment to come back in three months. "Hell," Borg says, "by that time I could be dead. They'd probably be happy if I was." Bill Tracy had been brought into the Hines emergency room by his father on Thanksgiving night in 1998, crying from a pain in his hip. He'd requested hip surgery twice previously but had been turned away, he says, due to a note in his file that told hospital staff to be on the lookout for drug-seeking behavior. He was turned away again. "My son isn't faking," the senior Tracy argued. "He got shot in the chest and never cried." Tracy was given an appointment to see a doctor two weeks later. Six hours after he left Hines he was in the emergency room at Christ Hospital. His hip was septic. "I almost died," Tracy says. "I'm only one. Imagine how many thousands this must happen to."
Albert thought things might change after the meeting with Gutierrez, and he was right--things changed for the worse. A sign went up on the fifth floor announcing that KT had been renamed "Conditioning Activities." The name wasn't the only thing that changed--two kinesiotherapists had been replaced with Krist Samatra Vit, who'd previously run the wood shop. Even Samatra Vit believed he wasn't qualified to run KT--he isn't a kinesiotherapist, for one. For another, the pool is an integral part of KT. "Krist is a nice guy, works well with everybody, but he can't swim," says Albert. "If there's guys in the pool and a guy's drowning, a patient better save them." With Samatra Vit as the sole staffer, the program closed down whenever he took a day off.
In March 1999, the couch at the entrance of Building 228 disappeared. Veterans waiting for a prescription to be filled had no place to sit. Psych and substance abuse patients stood around the lobby, looking at the spot where the couch used to be, muttering darkly.
The couch was back in its place on April 9, the day of Gutierrez's tour. A few days later, it was gone again. "The administration fabricated stories about the sofa," Albert says. "They said they're getting a new one. It's not important, but it's the one thing everyone seems to focus on."
On April 16, word got out that the administration was planning to lay off 75 nurses and 25 doctors. Hines was already being run by a skeleton staff. Nurses worked mandatory double shifts, and physicians were in short supply--the emergency room borrowed doctors from the Loyola Medical Center next door. Banding together, doctors, nurses, and veterans rallied in front of the hospital entrance at Fifth and Roosevelt. The layoffs were put on hold.
Gutierrez returned in June, as promised, for another meeting at Hines. Even Almy stood up to decry the deterioration of services. Albert welcomed his new ally: "I was wrong about Almy. He's a stand-up guy." Gutierrez announced that Hines would be examined by the Inspector General's Office of the Department of Veterans Affairs. "Now something's going to happen," Albert said.
Hines was investigated in July. The Inspector General's report seemed to reveal nothing seriously awry. However, Gutierrez's press secretary, Billy Weinberg, says, "We showed it to people, particularly those on the House Veterans' Affairs Committee, staffers who'd been around a while, who read it and said the language that they're using here is pretty damning. So it was kind of a matter of reading between the lines. It wasn't a clean bill of health for the hospital."
Gutierrez asked Togo West, the secretary of veterans affairs, to read the report and act. But by the time the report reached West, the war had expanded beyond Hines.
There are four VA hospitals in the Chicago area. Hines is by far the largest. Though located in Maywood, the hospital is treated by the post office as its own town--the mailing address is Hines, Illinois. North Chicago VA is near Waukegan, in the city of the same name. West Side is at Damen and Taylor. Lakeside sits on some of the most valuable land in Chicago, at 333 E. Huron in Streeterville. These hospitals comprise four of the eight medical centers in VISN 12, the headquarters of which is on the grounds of Hines.
In April 1998, the Government Accounting Office released a report titled "Closing a Chicago Hospital Would Save Millions and Enhance Access to Services." The report suggested that "veterans would continue to have good access to health care if either Lakeside or West Side hospital is closed because most of the veterans using these facilities live in essentially the same residential areas....VHA could potentially generate millions of dollars in revenues through the lease or sale of property from the closed location."
In September 1999, the VHA delivered its response to the GAO. Six options were detailed in the "VISN 12 Delivery Systems Options Study," which was prepared by consultants AMA Systems and McGladrey and Pullen and reviewed by VA officials. Option One would shut down practically all of North Chicago and most of Hines and West Side--all acute medical, surgical, and neurological inpatient services from those hospitals would shift to Lakeside. Option Two redirected most inpatient programs from West Side and North Chicago to Lakeside and Hines. Option Three closed Lakeside and most of North Chicago, sending services to West Side and Hines. Option Four closed Lakeside, but left North Chicago untouched. Option Five closed Hines, relocating services to Lakeside and West Side. Only Option Six would leave Chicago-area VA hospitals unaffected--Madison would be closed and all its services shipped to Milwaukee.
Option One was recommended. A memo from Joan Cummings invited comment from "All stakeholders and interested parties," and encouraged electronic submissions to a VA Web site. By January 2000, the VA had received over 5,000 responses.
By then, Veterans for Unification was part of a pack condemning the attempted reorganization of the VA health system in Chicago. It included doctors, nurses, congressmen, senators, medical schools, and other veterans' groups. Most had a more than idealistic reason for opposing the options study: jobs and votes and money depended on the outcome. The politics that the VA would contend with in Chicago entered noisily.
Albert talked and wrote more than he ever had in his life. Suddenly congressmen and senators were taking his calls. "We're going to have a bipartisan effort," he told me at the time. "I talked to Henry Hyde, and he's one that didn't want to hear about it, and Dick Durbin, and he's another that didn't want to hear about it." He also complained bitterly, "I can't stand all these damn phone calls. All this bullshit. I'm a man who likes action. I know how politics works. I used to work for the secretary of state."
But he was on a mission. "This is about the whole future of the goddamn country. How are you going to have a military if the military goes back on its promises? Nobody's going to serve if the government doesn't take care of its own. And if you don't have a military, what happens to the country? We gotta get the word out. The public doesn't know what's going on. When I tell civilians about this, they're behind us. But a lot of the veterans don't want to get involved." He added, "They're going to need those cemeteries 'cause they're killing the veterans."
Albert bombarded politicians with letters and phone calls. He joined the American Legion and the Veterans of Foreign Wars. He watched Saving Private Ryan every night. "I ran up a hundred dollar bill at the video store," he says.
He wasn't surprised to learn most veterans had no idea the VA planned to shut down hospitals. "West Side didn't know about the options study," a veteran told him. "The only reason we knew at Hines was because of you guys."
Veterans for Unification, with 25 members by November, wrote letters and distributed broadsides condemning the options study. One sheet, entitled "Respond to the 'Options Study' Now," noted that Hines was the only area VA hospital with state-of-the-art radiotherapy equipment. It also said, "Traveling to Lakeside for care would be a difficult if not impossible task for many of our elderly, frail veterans, their spouses and families. Lakeside, located in the highly congested Gold Coast area of downtown Chicago, is the least accessible hospital for the largest number of veterans in our area."
More ominously, the sheet's anonymous author noted, "The data used by the Committee is incomplete, inaccurate and does not support the Committee's recommendation....There is evidence that some of the data which should have been included in the report was purposely destroyed."
Gutierrez held a meeting on October 30, 1999, in the basement of Holy Trinity High School at 1443 W. Division. It was attended by a diverse group of veterans as well as staff members from VA hospitals, a representative of the UIC medical school, and assorted interested citizens. Albert, Borg, and three other members of Veterans for Unification put up a banner on the back wall of the room and filled a table with handouts.
After remarks from Gutierrez and George "Buzz" Gray, the chairman of the VA's steering committee overseeing the options study, the audience was invited to comment. A woman claiming to be from the poor side of Alabama senator Howell Heflin's family charged cover-up. "Who could find this place easily today?" she asked. She continued for several minutes before concluding that all four Chicago-area hospitals should remain open. Gutierrez took the microphone, requesting that speakers be "more precise."
The crowd grumbled as a voice answered, "That was precise. Not concise, but precise."
The crowd was turning hostile. "If you want to fight with your friends in Illinois, go ahead," Gutierrez said forcefully. "We'll make politicians in Florida and Arkansas very happy. If you want to fight, go to congressmen Porter and Hyde, because they have been silent!"
He reminded the audience of his three meetings at Hines. He said he could have limited his advocacy to veterans from his district, "but that would be wrong." He sat down to general applause.
The lines to speak grew longer. A doctor from West Side said the VA was wrong about shifting populations. "The younger veterans won't be in Scottsdale, Arizona--they'll be the urban poor." A nurse from Hines questioned the data that formed the basis for recommending Option One. "A doctor at Hines sent the committee some documents which contained some patient-specific data and it was thrown out." Another speaker commented, "This is not a business decision, this is a political decision. This is about a moral decision--that you were told when you signed up that you would get a lifetime of medical care."
The VA's Gray answered, "There are no politics in the study, but what's done with the study will be wholly political. This is going to be replicated around the country. Miami has one VA hospital, Houston has one VA hospital, San Diego has one VA hospital. The VA has to streamline. This is a fact of life. The bottom line is that the money isn't there."
The next speaker was Dr. Charles Andrus, chief of surgery at Hines. "I spent a bad day yesterday, Friday, talking to a VA lawyer," he said. "I'm gagged. I could be prosecuted if I speak in public about the study." He had questions, though, and he wanted advice on how to rebut the recommended option. "Who's the chief on this study? Who are all the comments going to?" He exited to applause and calls of "bravo."
Andrus still can't discuss the options study, not officially. A request to interview him met with this response from VA network director William Graham: "Dr. Andrus can speak for himself, but not for the VA." Andrus calls that a trap. "In a 1994 memo from Jesse Brown, who was then [undersecretary of the VA], it says that if officials speak for VA inappropriately, they can be fined $500, imprisoned for up to one year, and lose their jobs.
"I will not speak for myself," Andrus says. "I will only speak in my capacity as chief of surgery. If I'm a threat to the security of the United States government, then there are a lot of people out there who are a threat."
Were documents destroyed? Albert had a letter purportedly from Andrus alleging that some statistics on surgeries had been ordered burned by the VISN 12 administration in November 1998. Andrus will neither confirm nor deny that he wrote the letter.
The meeting at Holy Trinity broke up, and Albert took down the Veterans for Unification banner. "It's such a goofy plan," said Myrna Mazur, an assistant vice chancellor of UIC Medical Center. "By closing North Chicago, they lose a medical school."
All of the Chicago-area VA hospitals are affiliated with medical schools: Hines with Loyola, Lakeside with Northwestern, West Side with UIC, and North Chicago with the Finch Medical School of the Chicago School of Medicine. UIC and Northwestern were at loggerheads during the attempted merger of Lakeside and West Side in mid-1998, says Gutierrez press secretary Billy Weinberg. He adds that UIC went so far as to hire Jasculca-Terman, a politically connected PR firm, to promote West Side. "We had to sift through all this PR, and what goes with PR."
In October 1999, the U.S. House of Representatives approved an additional $1.7 billion for VA health care. In November, Gutierrez and 13 other Illinois congressmen sent a letter outlining their objections to the options study to the acting undersecretary for health at the VA, Dr. Thomas Garthwaite. Senator Dick Durbin offered a proposal to keep North Chicago open; the proposal was later approved in February. When the GAO released a new report on April 6, 2000, criticizing the realignment process in Chicago, Option One appeared to be dead.
In testimony before a senate subcommittee, the GAO stated that the realignment plan was drafted in isolation. "Senior managers at headquarters were not actively involved until after stakeholders and others raised significant concerns about the recommended realignment option. VHA has since convened a special review group that has spent the last 2 months assessing stakeholders' concerns and deciding how such concerns could be best resolved. Now, 20 months after the study was initiated, this review group has decided to set aside the originally recommended option and consider others, including options that had not been considered before."
How did Option One come to be recommended? Joan Cummings says she has no idea. "We were not involved in it," she says. "It was commissioned by headquarters." VISN 12 only collected data for the study, she says. William Graham claims that the data collected were "good data" and that Option One isn't dead. "We're still documenting the decision process. At this point, everything's on the table and nothing's been decided."
Cummings is in favor of the VA's realignment and says she's not alone. "The veterans I've spoken with praise the [outpatient] clinics. They ask if they can have more of them. The VA needs to continue its efforts at reorganization. It still has a long way to go."
Almy says downsizing is inevitable. "There are 172 hospitals in the VA system. The buildings are getting older. The veterans are getting older. We'd have to have a major war to fully utilize existing hospitals. This promise was made in stone: 'for the veteran, his widow, and his children.' But the reality is, it has to downsize."
The Chicago area has too many hospitals, Almy says, and "every big, old hospital is a shadow of its former self." The trend in the private sector has been toward outpatient clinics, and "the VA is in a hurry-up mode to catch up." Most of Almy's patients are outpatients. "The medications we have are more effective, and you can just supervise people. The easiest thing to do is put someone in the hospital."
Almy says he understands why the veterans are upset. "You always expect patient reaction when things change. They don't want services taken away."
But Weinberg says the realignment process may have been inspired by politics as much as economics. The chairman of the house committee on veterans' affairs, Bob Stump, is from Arizona, and Cliff Stearns, who chairs the subcommittee on veterans' health, is from Florida. "Each of them represents areas where there are veterans who either moved there, retired there, or go down there for the winter and so they need health care either during those months or when they've moved down there," Weinberg says. "There is a socioeconomic dynamic at play there. There are some veterans who can afford to move to Florida and Arizona or to vacation there in the winter months. It's the people who are left in Chicago or Milwaukee or Buffalo or Detroit who have fewer economic options, though. Whether or not there's a shift in population to the south and southwest, the economic dynamics are such that the people who stay behind, so to speak, are probably those who need government help the most."
About the options study, Weinberg says, "The procedure itself for the study was just strange--it seemed to be a kangaroo court, so to speak. You have a steering committee that's clearly been charged with a certain goal in mind, and the VA hires this group, this south-side firm, to do a report, and lo and behold it's six options, none of which are the status quo necessarily, and it seems to be a self-fulfilling prophecy if you do it that way."
In late May, Gutierrez wrote to Togo West asking the VA to flatly reject the options study. For the moment at least, Albert had won.
Veterans for Unification held its first formal meeting November 3 in the basement of the Broadview Public Library. Though the group numbered 25, only seven men, two women, and one child showed up. "The sole reason we are here is to save the VA health care system for all veterans," Albert said. By its May 10 meeting, the group had grown to 40, but only eight men and two women sat in the library basement.
The mission remained unchanged. Albert directed members' attention to a photocopy from the April issue of U.S. Medicine: The Voice of Federal Medicine. An article detailed a new option: shutting inpatient services at Lakeside, West Side, and Hines, and building a brand-new superhospital by 2010. For the time being, Albert didn't really take this seriously. "Look at page two of Veterans' Voice," he said. "The article there says it all."
He was referring to a report quoting Cliff Stearns, who criticized the VA for its handling of the Chicago options study. "He says they spent more than a million dollars, and they're back at square one."
For now, there were pressing items on the agenda. Veterans for Unification's nonprofit status was still pending. John Borg had a Web site up and running. Hines had a new acting director, John Fears, who'd served as director years before. Though a hiring freeze was in effect, recent communications from the Hines administration assured patients that all services would remain open. Norm Seiff, a new member, wanted to talk about hepatitis C. And there was the matter of the May 27 Memorial Day Parade in the Loop.
Seiff stood up and introduced himself. His girlfriend, Judy, sat at a table next to him. A submarine officer during the Vietnam era, Seiff is now 48. Two years ago he'd been suffering aches and pains he attributed to arthritis. But when he lost 25 pounds in two weeks, Judy demanded he see a doctor. He had been in sales but hadn't been able to work. He didn't have medical insurance. "She dragged me to the VA," Seiff said, where he was diagnosed with hepatitis C.
"Does anyone remember getting 'air shots' in basic training?" he asked. A couple of men nodded. Military personnel were efficiently inoculated using the same needle in an air gun. "That's probably how I contracted the disease. If you got a blood transfusion in Vietnam or an air shot in basic training, you could have it too. If the first guy in line had hepatitis C, then you got it too." The virus, first identified in 1990, is transmitted through blood to blood contact. "There's a treatment but no cure," Seiff said. It can take up to 30 years to show itself, and when it does it can be a killer. Hepatitis C causes liver disease. There's no telling how many veterans are infected with it.
"I heard about the cuts at Hines, and I got scared," Seiff said. "I thought, 'I'm gonna die.' I saw the petitions from this group and I started collecting signatures. A lot of people were afraid to sign."
Seiff's treatment at Hines had been "wonderful," he said, and the interferon and ribovarin he was given had driven the virus down. While on hiatus from the drugs, his viral count had gone back up. Seiff sat down and Judy took his hand. Albert brought up plans for the parade.
Veterans for Unification would be in slot number 19, Albert said, a good slot. Members should meet at State and Wacker at 10 AM on May 27.
"We've got three, no, two vehicles from the VFW--a Model A and a '56 Chevy." He held up a sign that read "Support Our Vets!" "We've got these, but we don't have any sticks. We need sticks."
Seiff spoke up. "Why not call Hines Lumber?"
Albert was quiet. Veterans for Unification had petitions circulating on the east and west coasts now. For weeks he'd been talking about the parade to other veterans, to VFW post commanders, to representatives of the Vietnam Veterans of America, the Paralyzed Veterans of America, and the Italian-American War Veterans. He had commitments from marchers, who could number anywhere up to 400. Members had been contacting celebrities and asking them to march. Chuck Norris was a definite possibility--one of the members knew him. This was big. Albert spoke up: "I know we don't have many people here tonight. I want to read this quote from a book I read. It's from Aaron Taylor, an English dramatist who lived from 1685 to 1750. It says, 'The lion never counts the herd about him, nor weighs the flocks he has to scatter. That courage is poorly housed that dwells in numbers.'"
On May 27, they assembled at State and Kinzie in a steely drizzle under a drab gray sky. Marching bands surrounded a flatbed truck. Approximately 35 men, women, and children milled about behind a Veterans for Unification banner held by Albert and three others.
Everyone carried signs reading "Vets Unite NOW!" or "Support Our Vets!" or "Save VA Hospitals!" An SUV and a man on a motorcycle idled in the back of the group. Someone with a video camera exhorted the marchers: "Let's get in formation here. We look like a bunch of guys going for a beer!"
The sky didn't brighten as they marched down the middle of State Street, but the rain had stopped and the bands beat on drums. On both sides of the street, spectators raised tiny American flags, applauded, and saluted as the veterans marched by.
When the group passed the reviewing stand, an announcer said, "And with this group that speaks to the unification of veterans' ideals, I'd like to ask the grand marshal to come to the podium, I'd like to ask the grand marshal, the secretary of the air force, to say a few words about the meaning of Memorial Day."
Albert didn't notice. He was exhilarated. "We started from nothing and we're halfway there," he said. "This is just the first round."
Art accompanying story in printed newspaper (not available in this archive): photos/Lloyd DeGrane.