A new rating system now restricts the types of surgery performed at certain Veterans Affairs facilities in five states. The new policy will prompt some veterans to travel farther to reach other VA facilities or civilian hospitals for more complex surgeries. The policy comes after investigations found that surgical mistakes had caused nine deaths in the department's Marion, Ill., hospital a few years ago.

Under the new policy, the VA's 112 hospitals are now ranked according to whether they are able to perform standard, intermediate or complex surgical operations. The VA hospital in Fayetteville, N.C., is one of five facilities restricted to standard surgery only.

At first glance, the Fayetteville building looks more like a hotel than a hospital. Dedicated in 1939, the building stands out with its red brick facade and shiny brass front doors. But most patients these days come in through a modern side entry.

"This is our ambulatory entrance, and this is where the majority of our patients come in to get checked in for their outpatient visits," says the hospital's interim director, Ralph Gigliotti.

Inside, a long line of veterans winds its way through a cramped waiting room and all the way to the door. Under the VA's new guidelines, Gigliotti says, doctors here will no longer perform complex or intermediate procedures like joint replacements and stomach resections. This hospital doesn't have a bad reputation, but like other rural facilities, it has always struggled to recruit enough specialists.

"What we learned from Marion was you had to ensure that the infrastructure you have in place at your facility can support the services that you're offering — the equipment, the personnel, those type of things," Gigliotti says.

The new restrictions on the Fayetteville facility do not bother Wally Tyson, the national vice chairman of Disabled American Veterans. Tyson, who visited the hospital recently for a checkup, says very few complex procedures were performed here anyway.

"You know, it's not really a downgrade. Using 2009 as a reference, less than 4 percent of the surgeries performed at Fayetteville would have been affected by any of the change that had been done; 4 percent — that's very minor," Tyson says.

But that percentage is important to VA officials, who want to make sure the right surgeon performs the correct procedure in the optimal setting.

"It's not rational to think that we need heart surgery in every facility. But we do need to be able to provide at least standard level care in every facility," says the VA's national director of surgery, Dr. William Gunnar.

Gunnar says it's safer and more efficient to send patients at smaller and more rural hospitals elsewhere for complicated operations.

"Having said that, you can do a lot of surgery in a standard facility," Gunnar says. "You know, you have anesthesia support, you have a general surgeon, a urologist, you may or may not have an orthopedic surgeon — and that's the core group of people, and you can do a lot surgery and a lot of good for veterans in that rural community."

Gunnar says the mistake in Marion, Ill., was that one or two surgeons performed procedures they were not equipped to handle.

Robert Shelly, 43, doesn't mind the extra travel time to visit a facility that is fully outfitted. He's a former Marine with a bad back who relies on the VA for medical care.

"Things do happen in hospitals. It's a gamble sometimes, but going to see a specialist and you know this is what this guy does every day of the week, I'd rather go see him than anybody else," Shelly says.

Shelly says traveling farther is worth it to get the specialist he needs.