"El Paso is going to be seeing a huge influx of troops who, at some point, will need access to a veterans hospital, and we have to be prepared for that," El Paso County Commissioner Veronica Escobar said.

Fort Bliss is expected to grow by more than 65,000 soldiers and their families by 2013. Many of those soldiers could stay in the region and increase the demand for local health-care services.

The El Paso County Commission has asked Texas lawmakers in Washington to seek a federal assessment of the need for a veterans' hospital in light of the growth on base and in the veteran populations in Mexico and New Mexico.

But even before the first steps to establish a hospital have been taken, local political factions are already in a tug of war over where such a hospital should go. Some want it to be at the budding Medical Center of the Americas.

Others, however, say it makes more sense to build it with expansions that that are set for Beaumont Army Medical Center.

The assessment is the first step in the long process of campaigning for a hospital, which could cost as much as $500 million.

U.S. Rep. Silvestre Reyes, D-Texas, said he has asked the Veterans Affairs Department to reassess whether West Texas, Mexico and Southern New Mexico have enough veterans to support a hospital.

"What we need to know is what kind of veteran base we have," Reyes said.

Right now, Veterans Affairs operates a clinic adjacent to Beaumont.

Of the estimated 71,200 veterans in the El Paso area, the VA says, about 23,200 veterans used the clinic last year.

Recently, though, an internal survey ranked the El Paso VA system last in the nation in customer satisfaction.

Patients reported long waits on the phone system, waits for services and appointments, delays in getting prescriptions filled and poor staff morale.

Veterans also complain they often must travel as far as Albuquerque or Big Spring to get inpatient hospital care.

Lupe Weaver started a petition for a VA hospital in El Paso more than a year ago. She began gathering signatures after visiting her brothers in San Antonio and Dallas. As veterans there, she said, they had access to quality health care.

Veterans in El Paso, she said, aren't so lucky.

"Why can't we have something for them?" she asked. "They are the people who have put their lives in jeopardy in order to protect their country."

So far, Weaver said, she has gathered about 7,000 signatures.

During a visit to El Paso last week, VA Secretary James Peake lauded the recent hiring of about 40 new staffers and said about 100 more would be added.

U.S. Sen. Kay Bailey Hutchison, at a news conference with Peake, said VA services in El Paso would have to be expanded.

Whether the growth would include a new hospital or an expansion with Beaumont, she said, has not been decided.

The Department of Defense is considering whether to build a new Beaumont hospital to care for the thousands more active-duty soldiers and their families who are coming to Fort Bliss.

Lt. Col. Timothy Edman, Beaumont's chief of staff, said recently that about 100 acres have been identified near Loop 375 and Spur 601, which is under construction, in case a decision is made to relocate the hospital.

If a new VA hospital is to become reality, Rep. Reyes said, it would most likely be a part of construction related to Beaumont.

VA officials, he said, want to continue their operating relationship with Beaumont.

VA spokeswoman Jean Schafer said the department expected to continue the joint venture.

"We are currently evaluating the various models in collaboration with the Army to determine which model will fit the needs of both the VA and the Army in the future," she said in a written statement.

But some community leaders associated with the medical center argue that the best place for a VA hospital would be near the new Texas Tech University Health Sciences Center Paul L. Foster School of Medicine.

"We can provide a good, economical choice for the Veterans Administration," said Dr. Jose Manuel de la Rosa, founding dean at the medical school.

Texas Tech, he said, has already found land for a new building. Putting a VA hospital on the campus, he said, would allow it to share resources with Thomason Hospital and the university.

"You want to cluster your assets centrally," Thomason CEO Jim Valenti said. "And what we're building here is that renaissance É for health care."

The medical center is also more centrally located than Beaumont, he said.

Commissioner Escobar and Valenti pointed to the Audie Murphy Memorial Veterans Hospital, which is affiliated with the University of Texas Health Sciences Center at San Antonio.

"If we are able to achieve the goal of a veterans hospital, we need to talk about where it makes most sense to put it," Escobar said. "For me, the answer is clear: You've got one medical school in town."

Veterans and politicians in the Rio Grande Valley have been fighting for years to get a full-fledged VA hospital in their area. Veterans there must travel at least 500 miles round trip to San Antonio.

After years of fighting, only recently have they received assurances that the VA will expand its services in the Valley, said state Rep. Aaron Peña, D-Edinburg.

What helped gradually get the attention of federal lawmakers and administrators, he said, was the unified effort of the community.

"Part of what is important is to become unified in making your case," Peña said. "People who may not want to advance your cause may look for any weakness and divide your efforts."

Brandi Grissom may be reached at bgrissom@elpasotimes.com; 512-479-6606.