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ST. LOUIS COUNTY • If nothing else, the tall blond brick smokestack near the southern edge of Jefferson Barracks National Cemetery is still a useful landmark for Gerri Finazzo, 75.

Sometimes after she visits her husband’s grave, she looks up to the skyline for a visual guide across 346 acres of rolling hills lined with endless rows of white marble tombstones, to the grave of her brother-in-law, Phil Finazzo, a World War II veteran who died in 2007.

“There’s a big stack, and that’s where Phil is,” she said, standing at his grave Thursday, near the base of the smokestack.

But the landmark, part of a separate campus built in 1923 to treat World War I vets, will soon come down as more headway is made on a $366 million upgrade to the VA medical center, which abuts the cemetery.

There used to be more breathing room between the health care facilities and graves, but with more war, more aging veterans, more burials, each grew closer. And more outdated, officials say.

Now, five major structures are supposed to be built, including a new outpatient clinic, tenant building, energy plant, engineering warehouse and medical rehab facility for things such as occupational and physical therapy, a pool and chapel. More than a dozen buildings will be demolished — some are already gone — to make way for new construction and cemetery space.

“It will be a dramatic change to the Jefferson Barracks campus and definitely for the better,” said Gary Drikow, a VA engineer who is helping to coordinate the project. “It’s going to improve the health care for our nation’s veterans.”

The upgrade has been in the works since 2004. After years of paperwork, design and studies, St. Louis-based McCarthy Building Companies broke ground on the $65 million energy plant in 2012. A joint venture between Walsh Construction and Alberici Corp was recently awarded a $106 million contract to build the new tenant and outpatient clinic buildings.

Many offices have been moved to temporary trailers, or to leased space off site, to make way for the changes.

“The toughest part has been trying to schedule the multiple phases and coordinate them without impacting patient care,” Drikow said. “We have a lot of construction going on. We are an active medical center.”

About 29,000 people make up 180,000 outpatient visits each year at Jefferson Barracks. Department of Veterans Affairs officials expect the number of patient visits to increase by 30 percent over the next 20 years.

Keith Repko, associate director of the VA St. Louis Health Care System and chief engineer in the early stages, said there hadn’t been any opposition to the project once the cemetery was included in the plans. At 400 burials a month, the cemetery was getting desperate for space. So far, 15 acres of medical center land has been transitioned to the cemetery. An additional 15 acres are supposed to be transitioned at the end of the project, accommodating burial capacity into the year 2027.

“We tried for a few years to do it ourselves, just the medical center side, to get the project funding,” Repko said. “When we combined forces it was a much easier sell to get this done.”

Each major piece of the project requires approval from Congress. So far, about $200 million has been cleared for construction and design. The VA is now seeking funding for the second half of the upgrade. The whole project is supposed to be finished by 2018.

Officials say the new construction will add more services and make the facilities more modern, such as a revamped, $6.6 million Post Traumatic Stress Disorder clinic that opened at Jefferson Barracks in 2011, part of a different project. It alone serves about 2,500 vets a year, most of them from the Vietnam era but increasingly more vets from the wars in Iraq and Afghanistan.

With the upgrade to the 120-acre Jefferson Barracks campus, which is bordered by the Mississippi River and Interstate 255, fewer patients will need to shuttled into the city for services at the John Cochran VA Medical Center at 915 North Grand Boulevard. Mental health services are being expanded, as well as primary and specialty care such as dental, podiatry, optometry and ophthalmology. Radiology and blood labs will be expanded.

The new construction has come with a mixture of views. County Executive Charlie Dooley, a veteran, has welcomed the project. Some 2,500 people with various construction skills will have a stake in it.

But Harold Knoesel, 62, a heating and air conditioning technician, was concerned about space. He’ll no longer have the luxury of working out of a shop in his own separate building. The building dates to the 1920s. Thick sheets of paint are peeling from the exterior walls.

“The power plant is way outdated,” he admitted, “like all the stuff around here.”

Of all the things to get hung up on in a $366 million project, Repko, the associate director, said the most vocal complaints had been about the indoor pool. He said feedback was sought on the new design. The end result is supposed to be something that’s geared more toward spinal cord disease therapy than recreation.

“We couldn’t give everybody everything,” he said. “I think the end result will be a good compromise.”

Jerry Brooks, 75, a veteran who volunteers in the current recreation facility that’s on the demolition block, is part of the group that’s happy with the existing pool. Brooks, who helps people in rehab, said the new pool wouldn’t be big or deep enough to swim in.

“I don’t like it,” said Brooks. “It’s going to be a wading pool.”

“As many people are going to be in the new building, there isn’t going to be enough space,” added Douglas Clark, a former facilities director at Washington University School of Medicine, who was sitting nearby. “This building could be remodeled a lot cheaper, but I am sure they have plans that I don’t know about.”

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