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Historic hurdles delay planned PTSD center

    The new post-traumatic stress disorder residential treatment center will be built within view of Tripler Army Medical Center. It took years for Veterans Affairs to reach terms with historic preservation organizations to allow the \$10 million facility to be built.

Jason Ledford, who is part of a steering committee for a Veterans Affairs post-traumatic stress disorder residential treatment center at Tripler Army Medical Center, believes the program saves lives.

He should know: The Iraq war veteran went through it in 2007, and he credits the effort with giving him new hope and a positive outlook in life.

As strong of an advocate as he is for the program, he’s equally aggravated by what he calls a "bureaucratic impasse" that has delayed for years the construction of a larger standalone facility on Tripler grounds as the VA and historic preservation parties haggled over site plans.

The 14,000-square-foot, $10 million facility was approved by the VA and funded in 2006, and it was supposed to be completed in 2008 to replace a successful version of the program that operates inside Tripler itself, VA officials said.

The new center, intended to be on a hillside with a view of the ocean, was approved at the height of the Iraq war. As things stand now, the earliest that ground could be broken is later this year, with construction anticipated to take 18 months, a completion that would come after American troops are expected to be out of Iraq.

"Why has it taken them this long, when they know the magnitude of the war and how ongoing it is, to expand a needed program?" asked Ledford, 34, who now is pursuing a master’s degree in social work at the University of Hawaii to help other veterans.

"I think veterans should be taken care of, period," he added. "My friends did not give their lives so that people could enjoy the things they do in America without having the due respect of being taken care of when they are finished."

The reason for the long delay lies with the VA’s difficulty in navigating the National Historic Preservation Act of 1966, and Section 106 of that act, which requires federal agencies to take into account effects on historic properties, and consult with state and other preservation agencies over their proposed actions.

Craig Oswald, the facility strategic planner for the VA Pacific Islands Health Care System, admitted there were some local VA facility, management, engineering and logistics officials who had "very, very limited or no experience in that (Section 106) process at all" working on what he acknowledges now is a "very complex due process."

Within the past year, Tom King, a nationally recognized archaeologist, consultant and writer, was brought in by the VA, and King now is drafting a memorandum of agreement that’s expected to be circulated tomorrow as all parties near consensus, officials said.

"Everybody has agreed that the timeline (for the PTSD center) is way beyond reasonable," Oswald said. But he added that real progress has been made in recent months.

Pua Aiu, administrator for the State Historic Preservation Division, said it’s taken a long time to gain consensus on the project because it’s going in on the "relatively pristine" Tripler grounds, an area that’s eligible for listing on the National Register of Historic Places.

"And when that happens, (consultation) normally takes a long time," Aiu said.

Aiu said it’s not unusual for an agency to come in and "they believe their project is really good, and we believe their project is really good, but they have to accommodate the historic preservation rules. It’s a federal law."

The VA came in initially with a project "that was simply unacceptable to be put on a property that’s eligible for the (National Register)," she said.

To be sure, there’s been plenty of frustration to go around over the course of events.

Dr. Kenneth A. Hirsch, who manages the residential PTSD program, remembers being told in 2006 about plans for the new 16-bed PTSD residential treatment center. The VA provided the $10 million in funding for it, and the money sits waiting for that purpose.

The current facility has room for 12, and in six 7 1⁄2-week sessions can accommodate 72 service members a year. The new facility will have space for 16, and outpatient PTSD services. The center is intended to be away from the institutional setting of the hospital in a more peaceful and calming environment.

"It’s been extraordinarily frustrating because we have a huge demand," Hirsch said. "We have a substantial wait list and if we had been able to open on the date we had hoped to open, we would have been able to be treating 96 instead of 72 people a year. That’s a big difference."

Hirsch expects demand to keep up for years to come.

"It’s just like in any other war — folks typically don’t come in (right away) for treatment. There’s a delay," he said.

The residential treatment program is for acute cases of PTSD. It was moved to Tripler from Hilo in 2006 to serve the influx of service members from Iraq and Afghanistan and takes in veterans as well as active-duty members.

Ledford, the Iraq war soldier, was medically discharged from the Army as a staff sergeant in 2005 after racking up his knee during training.

He had lost friends when he was in Iraq and after his deployment with the 101st Airborne Division, and when he got out of the Army, he began to experience irritability and sleeplessness.

"I realized I had grief issues," he said.

He was living in Hawaii and the VA recommended the residential treatment program, which he believes has literally been a lifesaver for some who have gone through it. Participants meet in group therapy during the day and in the evening.

"All you have to do is look at the suicide statistics to see how well (in general) we are taking care of our veterans," Ledford said. "(This residential program) changes people’s lives, and I know individuals that have graduated and have gone on to finish their education and go back into the work force."

He is now on a steering committee for the program that includes a handful of former patients.

Back on Dec. 28, 2007, the VA initiated Section 106 consultation with the state on the planned new PTSD center. A hillside spot on Krukowski Road below the fire station — the same being considered now — was selected.

In early 2008, the same year the VA expected to build and occupy the new center, the state historic preservation officer wrote back with a warning that all of Tripler’s 367 acres were eligible for the National Register of Historic Places and that the landscape was "an integral and holistic design feature."

The state said Tripler’s design was conceived by the New York firm of York and Sawyer in tandem with landscape architect Robert O. Thompson.

"The design team considered a harmonious landscape as a key component of the healing process for wounded soldiers," the state historic preservation office said.

In May 2008, the state raised concern that the proposed metal roof didn’t "harmonize" with the tile roofs of adjacent buildings and said the design should also be sensitive to the berms, or hills, created by Thompson. The state a couple of months later asked if another location could be considered for the facility.

"We’ve been repeatedly asked, ‘Can you find another location?’ " the VA’s Hirsch said, "and we’ve been repeatedly saying this (first one selected) is ideal clinically, and, 2) this is the only one we can get (from the Defense Department)."

"This is a major source (of conflict) that took us years to get past," said Dewey Brown, chief engineer for the VA Pacific Islands system.

One other site at Tripler was examined, but that was identified as being for a potential biomedical research facility.

The National Trust for Historic Preservation got involved, and so did the Historic Hawaii Foundation and The Outdoor Circle. The agencies asked the VA to explore options to protect five monkeypod trees that are part of Thompson’s landscape design on the selected site, as well as to minimize cutting into the hillside he sculpted.

The Historic Hawaii Foundation complained in a 2010 letter to the VA that information the federal agency provided was vague and inadequate, with months passing before the consulting parties got a VA response.

The VA complained last week that it had to deal with a "revolving door" of people at the state historic preservation office.

Despite a rocky past few years, the two sides are now close to an agreement.

The VA has agreed to move the building site about 25 feet closer to Krukowski Road to interfere less with the hillside, and it will save three of five monkeypod trees and plant new ones, officials said.

Still to be agreed upon are window and door designs, and siding and roof types.

"We’re not trying to stop the project by any means," the state preservation office’s Aiu said, "but our job is to ensure that the historic preservation concerns are addressed — and it was a long and difficult and complex consultation."

The VA’s Oswald, meanwhile, said "there’s a lot of new knowledge that’s been attained by this process."

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