Perched atop a bluff in the remote Black Hills, a veterans hospital built of thick blocks of pink sandstone and topped with red-tiled roofs in a Spanish mission style overlooks the tiny town of Hot Springs, South Dakota, and has provided recovering soldiers a bucolic haven for more than a century.
Wounded warriors from Civil War battles at Antietam and Gettysburg came to the Battle Mountain Sanitarium for brief, intensive treatments for musculoskeletal and respiratory conditions. Physicians believed the dry air and warm, fabled mineral springs helped mend broken soldiers. Today, veterans from the Vietnam to Iraq wars suffering from ailments such as post-traumatic stress disorder and drug and alcohol abuse recuperate at this quiet retreat.
But this long tradition could soon end. Officials with the Department of Veterans Affairs have proposed shuttering the campus and relocating some of its services 60 miles north to Rapid City, the second largest city in the state, leaving only an outpatient clinic in Hot Springs, which the state calls "The Veterans Town."
One of the key issues driving a wedge between the VA and the veterans fighting to keep the hospital open is its remote location. Does the isolation and serenity of Hot Springs help heal patients or hold them back?
"We have not seen any evidence that proves serene environment versus a more city-like environment changes the outcome of the patients," said Jo-Ann Ginsburg, the acting director for the VA in the Black Hills.
But many of the region's veterans argue that the tranquil environment in a town of 3,500 people is just as crucial to healing today as at the beginning of the 20th century and cannot be replicated outside Hot Springs.
VA officials counter that moving the services north to Rapid City would help attract physicians, better accommodate female and single-parent veterans and link patients with job opportunities and occupational training.
A consulting firm hired by the Black Hills VA is expected by the end of the summer to release a draft report on the impact the proposed relocation and several alternatives would have on local communities. After two months for public comment, the VA anticipates a final report recommending the best course of action to be announced in the spring of 2016, according to an internal VA email provided to The Associated Press.
Much of the hospital campus has changed little since it was opened in 1907 to treat veterans of the Civil War and Spanish American War. The hospital housed men who served with Union Major General John Pope at Bull Run and with Major General George B. McClellan during the Peninsula campaign, according to an account penned by Dr. W.H. Johnson, a national surgeon general of the Grand Army of the Republic, who wrote of the hospital following his stay there in 1913.
"As the sun came up, the tints and then the brilliant, glorious rays thrown upon the clouds stretched over the eastern horizon, gave a picture that the best artist with brush and paint could only imitate," Johnson wrote of his view each morning from the hospital veranda. "The healthful, rare, crisp mountain air helps to the completeness of the beautiful scene which I wish I could describe to my readers."
The hospital domiciliary is built like a wagon wheel made of thick pink sandstone hauled from a nearby quarry. In the center, surrounded by massive columns, patients relax, read and smoke cigarettes outdoors in the sun and in peace.
Paul Kelly, who served in the U.S. Army in the 1970s, entered the sanitarium in the early 2000s after battling drug abuse for years and overdosing on cocaine three times.
"If they build something new, it's going to be so clinical and so sterile," he said. "It could never be duplicated."
Kelly, who had been through rehabilitation centers elsewhere, was so taken with the place that he later moved to the town. Now, he's a student at Mitchell Technical Institute in central South Dakota and hopes to become a motorcycle mechanic.
Curt Sandine, a veteran treated for PTSD at the domiciliary beginning in 2011 said the town is just as therapeutic as the mountain environment.
"Everybody in town knows who's in the programs and who's not; the community itself kind of looks after the VA patients," he said.
Sandine is part of the "Save the VA" organization, a group of veterans from the region who have been petitioning the Black Hills VA and the federal government for years to keep the facilities open.
In May, the group led a march through Hot Springs and picketed the hospital campus for a week, protesting the proposed closure.
There is merit to both sides of the argument over the hospital, said John Klocek, the director of the psychology clinic at Baylor University, who has studied and worked with veterans for years, including at a VA hospital.
While Klocek agreed with the VA that there is no proof treatment is better in tranquil environments, "we know that even from just everyday experience that being in an environment that is quieter reduces the amount of stimulation coming in; it helps folks relax and focus on what's at hand."
But he added that the access to employment and opportunities to help veterans re-enter society is also crucial.
Former patient Kelly said he knows the hospital helped him, whether the scientific data proves it or not.
"The place saved my life, I'll tell you that."