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In his five months in Iraq, Army Spc. Charlie Perdue saw his share of violence. One day stands out. It was when a car came barreling toward the checkpoint he was manning in Bayji. Perdue and others opened fire, riddling the car with bullets. He then had to pull a dead passenger from the vehicle. "There was a lot of blood," he says quietly. "That was upsetting." Ever since, he's been plagued with nightmares in which he relives that awful moment in graphic detail. After he returned to Texas, he sought help. Doctors diagnosed the 23-year-old vet with posttraumatic stress disorder, and arranged for him to receive round-the-clock treatment at the Veterans Administration hospital in Waco, Texas, the only VA facility in the state that specializes in PTSD. Perdue, who is married and has a baby son, now lives at the hospital, set on 127 tranquil acres just north of the Army's giant Fort Hood base, not far from President Bush's Crawford ranch.
It's not clear how much longer Perdue and the 39 other vets on the ward will be able to stay. The Waco hospital was one of several VA facilities slated for closure as part of a plan to revamp the aging health system for vets. In 1999, a government study found the agency was wasting $1 million a day on buildings it didn't need. Four years later, after a top-to-bottom study of the problem, a government commission recommended closing some older, underused facilities, including the one in Waco and another in upstate New York. They would be replaced with dozens of new clinics around the country, and new hospitals in Orlando, Fla., and Las Vegas, where vet populations are on the rise.
That was the idea, anyway. But when the first waves of wounded U.S. soldiers began returning home from Iraq in 2003, support for the plan evaporated. Veterans groups, already opposed to the hospital closings, stepped up the protests. Politicians in Washington were right behind them. VA head Anthony Principi was swamped with calls of complaint from Capitol Hill. Sen. Hillary Rodham Clinton protested closing the New York hospital. Texas Sen. Kay Bailey Hutchison weighed in against shuttering the Waco branch. "You don't want to be closing facilities that treat mental illness at a time when they're coming home," she said. Principi was prepared to take some heat. But when Texas vets began riding motorcycles up and down the streets near Bush's ranch in protest, the VA boss began taking flak from the commander in chief. "Tony, what are you doing in Waco?" Bush asked the next time he saw Principi. The two men talked about the pressures--a shifting vet population, returning troops, rising health costs. At the end of their chat, Principi says Bush told him, "Don't worry about the politics. Do what's right."
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Faced with a gathering political storm, VA officials turned to a time-honored Washington tactic: delay. The agency announced it would continue to evaluate the problem before making changes to select facilities, including Waco. Earlier this month the agency hired PricewaterhouseCoopers to conduct a $9.6 million study, to be completed in 2006. So the problem will be left in the lap of Principi's successor, Jim Nicholson.
Though hospital closings are never popular, the decisions can't be put off forever. Demand for veterans' health services has climbed 34 percent in the past four years. At the same time, the VA's budget, while increasing slightly, has not kept pace with inflation and rising costs. The influx of returning Iraq-war vets is putting even more strain on the system.
Just one example: doctors estimate that 15 to 20 percent of soldiers returning from Iraq will, like Charlie Perdue, suffer from varying degrees of posttraumatic stress disorder. "We're just starting to see a dramatic increase in the number of Iraq veterans coming in with PTSD," says Dr. Paul Hicks of the Central Texas Veterans Health Care System. Already, it's reported 75 new cases. By some estimates, Texas alone could eventually see 1,000 PTSD patients. If the Waco hospital is eventually closed, officials say the patients would be treated at another VA hospital about an hour's drive away. But currently that hospital has no inpatient PTSD unit. "It's not something you can just move around, like you would a Toyota factory from Japan to San Antonio," says Walter Penk, a professor of psychiatry and behavioral sciences at Texas A&M. "You would change the quality of care." For Charlie Perdue and thousands like him, this is just another battle in which failure is not an option.
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