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VAnguard

November/December 2002 1

outlook

Waiting for CareOperation Early Intervention

Boosting Security

Veterans Day 2002

November/December 2002

Waiting for CareOperation Early Intervention

Boosting Security

Veterans Day 2002

VAnguard

2 November/December 2002

Table of Contents

FeaturesOperation Early Intervention...............................................................6VBA steps up efforts to help servicemembers and their familiesBoosting Security...............................................................................................8the arming of VA’s police force is almost completeHistoric Preservation at National Cemeteries.........................11memorials inventory project now nearly halfway completeRx for the Future......................................................................................12consolidated mail outpatient pharmacies achieving efficiency, cost savingsFifty Years of Veterans’ Voices.............................................................14writing forum for veterans celebrates golden anniversaryWaiting for Care........................................................................................16VA tackling waiting times for appointmentsVeterans Day 2002...................................................................................2020th anniversary of the Wall

DepartmentsLetters...................................................................................................................3Management Matters......................................................................................4Outlook................................................................................................................5e-Learning.........................................................................................................23@Work...............................................................................................................24Introducing........................................................................................................25Around Headquarters...................................................................................26Medical Advances...........................................................................................29Have You Heard..............................................................................................30Honors and Awards.......................................................................................31Heroes...............................................................................................................32

On the coverVeterans are coming to VA for health care inrecord numbers, a trend that has left about265,000 veterans currently waiting for healthcare appointments. VA is tackling the backlogon a number of fronts. And while the goal isto eliminate it within six months, highdemand for appointments is expected tocontinue.

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VAnguardVA’s Employee MagazineNovember/December 2002Vol. XLVIII, No. 8

Printed on 50% recycled paper

Editor: Lisa RespessAssistant Editor: Matt BristolPhoto Editor: Robert TurtilPublished by the Office of Public Affairs (80D)

Department of Veterans Affairs810 Vermont Ave., N.W.Washington, D.C. 20420(202) 273-5746E-mail: [email protected]/pubaff/vanguard/index.htm

VAnguard


letters

Have a comment on something you’ve seen inVAnguard? We invite reader feedback. Sendyour comments to [email protected]. Youcan also write to us at: VAnguard, Departmentof Veterans Affairs, 810 Vermont Ave., N.W.,Washington, D.C., 20420, or fax your letter to(202) 273-6702. Include your name, title andVA facility. We won’t be able to publish everyletter, but we’ll use representative ones. We mayneed to edit your letter for length or clarity.

We Want to Hear from You

Corrections

The article in our Juneissue about the dedication ofthe L.A. National Cemeterychapel to Bob Hope incor-rectly credited the entertainerwith being the only privatecitizen to be granted honor-ary veteran status. WhileHope was the first to receivethat honor, he shares the dis-tinction with the lateZachary Fisher, a philanthro-pist and lifelong advocate forthe men and women servingin the nation’s armed forces.

In the September/Octo-ber issue, we identifiedVincent Alvarez, M.D., asthe chief of staff at the Nash-ville, Tenn., VA MedicalCenter. He is the chief medi-cal officer for VISN 9.

Also in the September/October issue, we left Timo-thy J. Eichman, Phoenix,Ariz., and Noel Victoriano,Mather, Calif., off the list ofVA employees called up foractive duty after 9/11.

New Look

I WOULD like tocompliment the staffon the best-lookingVAnguard I’ve seen ina very long time. Thefront cover is striking.The articles are great,the new look is fan-tastic, the paper qual-ity is the best, and thelarger writing is veryappealing to those of us whose eyesight hasstepped down a peg. Even if you can’t keep thepaper quality, the overhauled look is a winnerin my book. I will make this VAnguard a keep-sake. Congratulations!

Gail BucknerProgram Support Assistant

VA Central Office

POW/MIAsI RECENTLY reviewed theSeptember/October issue ofVAnguard and was pleasedwith the substantive articlesthat were included, especiallyappreciating the memorial toJesse Brown, a longtimefriend and colleague. I alsobelieve that it was very im-portant to recognize wherewe are one year after thetragic and horrifying terroristattack on our country.

It was unfortunate, how-ever, that there was no men-tion of our nation’sunreturned veterans—ourPOW/MIAs—despite thefact that National POW/MIA Recognition Day wason Sept. 20. This year, Secre-tary of Defense DonaldRumsfeld and Chairman ofthe Joint Chiefs of Staff Gen.Richard Myers addressed thenational ceremony at thePentagon, providing veryhigh-level signals that our na-tion stands behind those whoserve.

For the VA to fail to in-corporate this importantmessage is disappointing, asthere are several ways inwhich this could have oc-curred. As an example, therightful focus on contribu-tions of our Hispanic veter-ans could have included hon-oring those still missing andunaccounted for from ournation’s past wars and con-flicts.

In the future, I hopethat there will be greater at-tention to recognizing thatour nation’s POW/MIAsfrom all wars are unreturnedveterans who need the helpof all Americans to comehome—alive or dead—to usand to our country.

Ann Mills GriffithsExecutive Director

National League of Families

Active Duty RosterI WAS touched to find myname and so many others onthe “Called to Duty” rosterin the September/October is-

sue. My unit was activatedsoon after my wedding inNovember 2001. While onactive duty, I served as a so-cial worker in Fort Drum,N.Y. I will never forget thesoldiers and their storiesabout fighting in Afghani-stan. I was proud to serve mycountry. Now I’m proud toserve America’s veterans.

Bill SivleyChief Patient Advocate

Washington, D.C., VAMC

65th Infantry RegimentKUDOS all around for a su-perb job on the September/October issue! Obviously, Ihad particular interest in thearticle that highlighted thePuerto Rican 65th Infantryand my father and son. I was

elated to see the story inprint, and seeing it in Span-ish made it even more per-sonally rewarding. My fatherhas 10 brothers and sisters,all but one living still inPuerto Rico. There arecountless cousins, uncles andrelatives. Veterans organiza-tions operate in Spanish inPuerto Rico. I assure you allare keenly aware of the 65th.

Thanks to VAnguard, Iwill be able to share this withall my friends and family onthe island. You have done agreat honor to my family,but also to the men and thefamilies of the valiant 65th

Infantry Regiment.Francisco D. Maldonado

Area Emergency ManagerMiami VAMC

VAnguardmanagement matters


VA-DoD Sharing: We’re Making ProgressLeo S. Mackay Jr., Ph.D.Deputy Secretary of Veterans Affairs

One of President Bush’s topmanagement priorities is im-proving sharing and coopera-tion between the nation’s twolargest cabinet depart-ments—VA and the Depart-ment of Defense. Together,we spend more than $40 bil-lion in health care for currentor former military personneland their families.

President Bush is acutelyaware of the need for a seam-less continuum of service forAmericans who wear ournation’s uniforms. He knowsthat when the young menand women who are now de-fending freedom in Afghani-stan and other areas of theworld hang up their uni-forms and assume the hon-ored title of veteran, theyhave every right to expect VAto meet their health careneeds seamlessly—movingrecords from active duty filesto VA files; sharing criticalmedical information throughcoherent and timely transfersof health histories; and pro-cessing benefits claims as ifDoD and VA were, for all in-tents and purposes, oneshared system. This is whatour servicemembers haveearned and we are movingforward aggressively to seethat they get it.

My colleague and friendDr. David Chu, Under Sec-retary of Defense for Person-nel and Readiness, and Ihave held a series of jointmeetings to examine howour departments can collabo-rate on health care services.We are working together toanalyze our dual needs, planfor future resources, and put

in place compatible tech-nologies and clinical proto-cols. VA and DoD healthcare resources—and the sys-tems that support them—have a common purpose: tofield the most advancedmedical capabilities our gov-ernment owns to save livesand enhance the quality oflives.

We’ve made progress inour joint procurement proto-cols. We simply cannot con-tinue to award and adminis-ter expensive, mutually exclu-sive health care contracts forpharmaceuticals, medical and

surgical supplies, inventorymanagement systems, andhigh-tech medical equip-ment.

In January 2001, DoDconverted its pharmaceuticalpricing structure to VA’s ne-gotiated Federal SupplySchedule. Today our jointprocurement protocols bringtogether VA’s $4 billion phar-maceutical purchasing pro-gram and DoD’s $2 billionprogram to save millions oftaxpayer dollars in pharma-ceutical purchases. Since De-cember 2001, we have saved$98 million from sharedpharmaceutical contracts.Earlier this year, DoD beganimporting Federal SupplySchedule prices into theirsystem for medical and surgi-cal items, a move that will

undoubtedly show an in-crease in overall price reduc-tions. We are makingprogress, but there is stillwork to be done.

Dr. Chu and I also areexamining the coordinateduse of capital assets—coordi-nating services in cities whereVA and DoD maintain andoperate separate medical fa-cilities. In Chicago, we trans-ferred land to the Navy ear-lier this year in exchange forthe Navy’s agreement to pur-chase electricity and steamfrom a VA power station.

More recently, our

medical center in North Chi-cago strengthened its part-nership with the Navy to im-prove coordination of healthcare operations. Under anagreement finalized in Octo-ber, the Navy will use theNorth Chicago VA MedicalCenter for its inpatient andsurgical needs. Additionally,Navy surgical teams willwork at the VA hospital, pro-viding veterans increased ac-cess to surgical care whilemaintaining their surgicalproficiencies. We have simi-lar agreements in severalstates.

Another potential op-portunity for shared ser-vices—one that really goes tothe heart of how VA andDoD can move cooperativelytoward our mutual objec-

tives—is records manage-ment. A veteran’s health carerecord is an accumulation ofinformation gathered fromthe moment that person putson a military uniform untilthe day he or she comes toVA for health care or to file aclaim. We must developinteroperable electronicmedical records and adopt atransparent records exchangesystem that will allow us tomeet the health care needs ofactive duty personnel andveterans.

The operative words inthe VA-DoD sharing initia-

tive are cooperation and col-laboration, not necessarily in-tegration. We are intent onmaintaining the integrity ofour distinctive missions whileachieving President Bush’sgoal of greaterinteroperability and transpar-ency between our two sys-tems. Our facilities haveproven at the local level thatby working together we cansave taxpayer dollars whiledramatically improving ac-cess and services to militarybeneficiaries and veterans.We are taking that effort to anew level that promises bet-ter use of taxpayer dollarsand better service to thosewho have worn and thosewho now wear the militaryuniforms of the UnitedStates.

We are intent on maintaining the integrity of ourdistinctive missions while achieving President Bush’sgoal of greater interoperability and transparencybetween our two systems.

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outlook

Communicating Clear Objectives Key to MeetingHealth Care ChallengesRobert H. Roswell, M.D.Under Secretary for Health

My ultimate management goal—and it should beevery VHA manager’s—is to get all of our more than180,000 VHA employees moving together with a fullunderstanding of what we are trying to achieve.

Don’t miss your weeklyhelping of “VA News,”news for and about VAemployees delivered eachweek in a digestible 10-minute video shown dailyat 4 a.m., noon, 4 p.m.and 10 p.m. (EasternTime) over the VAKnowledge Network sat-ellite link to your facility.

Are You Watching?

The Veterans Health Admin-istration has become one ofthe nation’s recognized lead-ers in quality health care, in-creasingly being cited as thestandard to emulate. Em-ployees at all levels of our or-ganization can be proud ofwhat they have accom-plished.

At the same time, VHAhas serious challenges thatthreaten the gains we’vemade. We face the compli-cated reality of too many pa-tients and too few dollars. Inorder for us to assure consis-tent high quality health carefor America’s veterans, wehave to face our challengesand overcome them.

Finding more efficientways to deliver high qualitycare isn’t a job only for ourdedicated field staff. I’ve di-rected a reorganization ofVHA’s senior leadershipstructure, the National Lead-ership Board, and have givenspecific charges to its mem-bers to manage resources anddevelop plans that help fieldfacilities continue to providehigh quality care for the vet-erans we serve.

The NLB is made up ofour 21 Veterans IntegratedService Network directors,VHA’s chief officers, me, mychief of staff, and the threedeputy under secretaries.

The reorganized NLBlooks more like the gover-nance structure of otherhealth care systems, withcommittees to deal with op-erational issues. The NLBcommittees cover communi-cations, finance, health sys-tems, human resources,

informatics and data man-agement and strategic plan-ning.

Each committee has achair and vice-chair and eachhas a specific charter and re-sponsibility. There also is anexecutive committee respon-sible for assuring that activi-ties of all the committees arecoordinated.

The committees are in-tentionally aligned with theMalcolm Baldrige NationalQuality Program’s health carecriteria to give us a strongsystems approach for improv-ing leadership and manage-ment.

In 2001, VHA con-ducted an intense examina-tion of our central leadership

system using the Baldrige cri-teria. This assessment identi-fied the ways we work well—there are many—and areas inwhich we can improve.

The assessment showedwe need to focus on simplify-ing and clearly communicat-ing our national planningprocesses.

A major gap was that wedidn’t have our senior leaderseffectively engaged in devel-oping and clearly deployingstrategic plans and policies ina coordinated, consistentmanner. This led to the NLBreorganization and my chargethat it develop ambitious,clear VHA strategies and

policies that reinforce andclearly articulate our missionand that align the plans,goals, and directions of head-quarters, networks and facili-ties.

The NLB also will befocused on clearly communi-cating our vision, values andstrategic objectives through-out the organization. Thisnew leadership structure willincrease consistency acrossour system and give us thebest chance to overcome ourbudget and workload chal-lenges.

When the full NLB ap-proves its committees’ initia-tives, I will expect the initia-tives to be effectively imple-mented systemwide. For this

kind of consistency, we haveto have a centralized leader-ship system that successfullyengages leaders in decision-making. The new NLB willassure leaders are fully in-volved in developing and de-ploying effective strategiesand plans.

Every field facility de-serves clear, consistent direc-tions as it moves forward.My ultimate managementgoal—and it should be everyVHA manager’s—is to get allof our more than 180,000VHA employees moving to-gether with a full under-standing of what we are try-ing to achieve. That, I’m

sorry to say, has been miss-ing.

I have the utmost confi-dence in VHA employees.We’ve had serious challengesin the past and our employ-ees approached them withdedication and perseverance.

I also have confidence inour senior leaders. The newNLB will support field em-ployees by providing consis-tent messages and steadyguidance.

The threats and chal-lenges we face are very real.But I’m committed to mak-ing sure we have the bestteam approach possible, ourbest assurance of managingworkload, budget and allother challenges without

compromising our commit-ment to provide high qualityhealth care. Our veterans de-serve it.

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AS THE VA COUNSELOR ANDTHE VETERAN with whom shehas been working review theveteran’s aptitude test and interestevaluation, a vocational rehabilita-tion plan takes shape. The veteran

has some questions about disabilitycompensation and concerns aboutwho in VA he should contact whenhe relocates in a few weeks.

A veterans service representa-tive meets with the veteran to an-

swer his questions. A typical occur-rence in any VA regional office,with one difference. The “veteran”is still on active duty and recuperat-ing from injuries received in Af-ghanistan while participating in Op-eration Enduring Freedom.

Since last December, counselorsfrom the Washington, D.C., VA Re-gional Office’s newly establishedEarly Intervention Transition Assis-tance Service have provided voca-tional counseling and training, aswell as benefits information and ap-plication assistance, toservicemembers at Walter ReedArmy Medical Center who are un-dergoing treatment and rehabilita-tion for injuries sustained in the waron terrorism. Other regional officesnear major military separation cen-ters have developed similar early in-tervention programs to assistservicemembers facing medical dis-charges.

Yolanda Watkins, a veterans ser-vice representative from the Wash-

Operation Early Intervention

The young sons of two VA employeeslost their lives in separate military in-cidents that happened less than twoweeks apart in October.

Marine Lance Cpl. Antonio“Tony” Sledd, 20, died on Oct. 8 afterbeing shot by two Kuwaiti gunmenwhile participating in an urban as-sault training exercise near KuwaitCity in the Persian Gulf.

Sledd was the son of NormaFigueroa, a nurse manager at theJames A. Haley VA Hospital inTampa. The day after his death,

The High Price of Preserving Freedom

about 100 of his mother’s fellow em-ployees gathered in the hospital’schapel for a memorial Mass.

Sledd was buried at the Bay PinesNational Cemetery in Florida. Morethan 350 people attended the service,including members of Florida’s con-gressional delegation, Gen. James L.Jones, commandant of the MarineCorps, and Kuwaiti Ambassador SalemAbdullah Al-Jabr Al-Sabah.

A Purple Heart was presented tohis mother during the service. Sledd’sfather, Tom, and twin brother, Michael,

also survive him.Lt. Stephen N. “Nick” Benson

was among four Navy pilots killedwhen two F/A-18F jets crashed about80 miles southwest of Monterrey, Ca-lif., on Oct. 18. Benson, 26, was theson of Acting Under Secretary for Me-morial Affairs Eric Benson.

Memorial services for Bensonwere held at the Oceana Naval AirStation in Virginia Beach, Va., and atArlington National Cemetery. His sur-vivors also include his mother, Bar-bara, and two siblings.

VBA has been stepping up efforts to help servicemembers engaged inthe war on terrorism and their families

Medics secure an injured American soldier for transport from Bagram Air Base, Afghani-stan.

U.S. AIR FORCE PHOTO

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ington, D.C., VARO, visits militaryinstallations in the Washingtonmetropolitan area each week to as-sist hospitalized servicemembers whoare likely to file VA disability claimsupon discharge.

She explains what benefits areavailable and helps theservicemembers prepare their claimsso they can be processed as quicklyas possible once the members sepa-rate. Jeannie Lehowicz, a vocationalrehabilitation counselor, also visitsWalter Reed at least once a week tohelp recovering servicemembers de-velop a rehabilitation plan and toease their transition to civilian life.

Lehowicz says most of the in-jured she has worked with as part of“Operation Early Intervention,” asthe program is sometimes called,have been cautious at first, reluctanteven to hear about VA benefits orrehabilitation services.

“These soldiers are not ready to

talk about vocational rehabilitation.They want help coming to gripswith these enormous changes thatare occurring in their lives,” shesays. “They may not be ready to ac-cept the reality that they need toprepare for life outside the militaryand that they need help preparing toenter the civilian job market orschool.

“You just have to go slowly andgently and let them come to you,”adds Lehowicz, a former socialworker and USO program director.Some come around more readilythan others. After 10 or 12 visitswith one soldier, she told him,“You’re not ready to talk about vet-erans’ benefits yet and I don’t wantto be pushing you. If you changeyour mind and want to talk aboutthe [VRE] program, call me—anytime, night or day.”

One evening about a monthlater, the servicemember called.

Continued on page 15

The newest generation of combat veterans, including those now serving inAfghanistan and the war on terrorism, are eligible for two years of free medi-cal care from VA for most conditions. The policy is outlined in a directive is-sued by VHA’s Environmental Agents Service (VHA Directive 2002-049) inSeptember.

To receive free care, veterans must be able to show that they served ina theater of combat operations or in combat against a hostile force afterNov. 11, 1998. They do not have to prove that their health problems are ser-vice-connected, or have low incomes. The benefit does not, however, covertreatment for medical problems that are clearly not related to military ser-vice, like common colds, injuries from accidents that happened after theywere discharged from active duty, or disorders that existed before theyjoined the military.

The coverage lasts for two years after discharge from active duty. It ap-plies to VA hospital care, outpatient services and nursing home care. Aftertwo years, these veterans will be subject to the same eligibility and enroll-ment rules as other veterans. Most National Guard and Reserve personnelwho were activated and served in a theater of combat operations or in com-bat against a hostile force are also eligible. According to Mark Brown, Ph.D.,director of Environmental Agents Service, the policy came out of lessonslearned from the undiagnosed illnesses of Gulf War veterans and Vietnamveterans exposed to Agent Orange. It is expected to improve VA’s ability totrack the immediate post-discharge health status of combat veterans.

Free Medical Care for Combat Veterans

Lehowicz immediately drove to thehospital and has been workingclosely with him and his family eversince.

The vocational rehabilitationservices Lehowicz provides includeaptitude testing, interest evaluationand career counseling. The nextstep is to develop a rehabilitationplan that meets the separatingservicemember’s individual needsand goals.

Watkins, a member of theWashington, D.C., regional office’sBenefits Delivery at Dischargeteam, assists the sameservicemembers with whomLehowicz works, along with manyothers preparing for separation. TheBDD is designed to helpservicemembers separating within90 to 180 days who plan or expectto apply for disability compensation.

Fred Steier, Ed.D., the Wash-ington, D.C., VARO’s vocational re-habilitation and employment officer,says they already had agreementswith local military installations togive VA counselors access to mili-tary facilities and servicemembersbefore Sept. 11 last year, but theprogram was not as well organized orfast-moving as it is now. “We uppedthe ante in terms of how fast we canhelp servicemembers,” he says.

Although VA disability claimscannot be filed until servicemembersseparate from active duty, Watkinsmakes sure those about to separateunderstand what benefits they maybe entitled to, helps them preparetheir applications and expediteshandling of their claims when theyare filed.

Lehowicz prepares a vocationalrehabilitation plan that can be putinto action quickly, no matter wherethe veteran is located. She andWatkins aren’t just talking about ge-ography when they say, “Our mis-sion is to help them get to wherethey want to go.”

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Boosting Boosting

WARREN PARK

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SecuritySecurityPut on the fast track following an increase in violent incidents at VAfacilities, the arming of VA’s police force is now nearly complete

A PLAN TO ARM ALL VA PO-LICE OFFICERS with 9-millimetersemiautomatic pistols was put on thefast track following an increase inviolent incidents at VA facilities.

In the summer of 2000, lessthan 20 VA hospitals had an armedpolice force. Today, more than 1,900of VA’s approximately 2,200 policeofficers carry a firearm, according toLisa Foster, a security specialist withthe Office of Security and Law En-forcement. “We expect all officers tobe trained and armed by the end ofthis fiscal year,” she said.

It started slow and cautious. Of-ficers at five VA facilities began car-rying firearms in 1996 as part of apilot study. Their police chiefs re-ported that they appeared more con-fident and visible. Most said therewas a notable increase in both in-vestigative and traffic stops. By1999, a total of 12 VA facilities hadarmed their police forces. The planwas for 15 more to be added eachyear.

One of the first facilities to armits officers in 2000 was the Salisbury,N.C., VA Medical Center. Just twomonths later, two of the hospital’sofficers had to use their weapons tosubdue an 83-year-old veteran whoshot a physician in the heart. Theincident brought into sharp focusthe value of a properly trained and

armed police force capable of pro-tecting patients and employees.

A month after the shooting, theSecretary accelerated the firearmsrollout program. At least 30 hospi-tals would be armed each year underthe revised plan.

Before they are authorized tocarry firearms, officers must pass aphysical examination and a psycho-logical assessment. They also haveto qualify at the range. Foster, whois a former Marine firearms instruc-tor, said VA police officers must passa 40-hour qualification course beforethey receive firearms. And theyneed to re-qualify with their weap-ons every six months.

Hospitals must have a firearmspolicy and an approved armory be-fore receiving weapons. They alsoneed to have at least one of their of-ficers certified as a firearms instruc-tor through the 96-hour trainingcourse at the VA Law EnforcementTraining Center, located on thegrounds of the Little Rock, Ark.,VA Medical Center. The center hasan intensive firearms training planthat meets or exceeds the require-ments for federal law enforcementagencies, according to a review bythe head of the firearms school atthe FBI Academy.

“We decided from the very out-set that we wanted our officers to

have the best training and skills de-velopment so they can provide thebest possible protection to our veter-ans, their families and VA employ-ees. That’s why our standards are sohigh,” said Ronald R. Angel, anArmy veteran and director of theVA Law Enforcement Training Cen-ter.

Deputy Secretary Dr. Leo S.Mackay Jr., visited the training cen-ter in September to officially dedi-cate a new 15-lane indoor firingrange. The new range was a wel-

Russell Eilrich, a pistol instructor from theLittle Rock VA Law Enforcement TrainingCenter, traveled to Pittsburgh to train VApolice officers there.

WARREN PARK


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come addition. In the past, officers had to go to an out-door range at Camp Robinson, an Army NationalGuard base, to qualify with their weapons. Sometimes ittook up to two hours to transport students and equip-ment to the range—time that could have been spenttraining. “By having this new range, we’re going to savetime on travel and use it to intensify our training,” saidAngel.

The new range is equipped with a high-tech com-puter simulator used to teach trainees how to react tostressful situations. As an officer walks into the simula-tor room, they see a life-sized image projected onto ascreen. It could be a suspect with a knife, an uncoopera-tive psychiatric patient, or any number of scenarios.

The officer must decide how to deal with the situa-tion while being watched and graded by evaluators. “Weevaluate everything from verbal skills used to deescalatea situation to how proficient the officers are if they firetheir weapon,” said Angel. “We want to make sure ourofficers get the training they need to be effective.”

Police officers at all three campuses of the VA Pitts-burgh Healthcare System began carrying firearms onNov. 1. To prepare more than 50 officers for the transi-tion, the health care system established an on-site fire-arms training facility complete with BeamHit laser gunsand a firearms testing simulator.

“We wanted our officers to be very confident intheir abilities,” said Terry M. Gerigk, the system’s associ-

ate director. “We didn’t cut any corners in their train-ing.” Gerigk even joined the officers as they carried outtheir training exercises. “I wanted to familiarize myselfwith this as much as possible,” she explained.

Pittsburgh Police Chief Jack Crawford said most ofhis officers have had previous firearms experiencethrough civilian or military training. He expects asmooth transition to an armed force. “This is just an-other tool to help them do their jobs,” he said.

The Beretta 9-mm carried by VA police has beenmodified to include a magazine disconnect feature thatprevents it from being fired when the magazine is re-moved. Officers are required to remove their magazineswhen entering certain areas of the hospital. Using themagazine disconnect feature along with a special secu-rity holster reduces the likelihood of the firearm beingtaken and used by an unauthorized person.

As heightened security becomes the standard oper-ating procedure at federal facilities, VA police officersstand ready to provide a safe and secure environmentfor employees and veterans. For more information aboutVA police, visit the Office of Security and Law Enforce-ment Web site at www.va.gov/osle.

By Matt Bristol

Sgt. Thomas A. Miele, a police officer with the VA PittsburghHealthcare System (also pictured on p. 8), secures a firearm in thearmory.

WARREN PARK

National Firearms Program Coordinator Leroy Jackson, right, in-structs Conrad Hamp on the VA Law Enforcement Training Center’snew 15-lane indoor firing range.

JEFFERY BOWEN

“We want to make sure ourofficers get the training theyneed to be effective.”

Continued from page 9

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Last spring, the National CemeteryAdministration began working onthe first-ever comprehensive inven-tory of its memorials. Volunteersfrom all over the country are col-lecting data and photographs for allNCA memorial structures for his-toric and preservation purposes.

When the project began, NCAestimated that volunteers wouldcatalog about 300 memorials ormonuments in its 120 national cem-eteries and 33 related soldiers’ andConfederate lots. But according toNCA Historian DarleneRichardson, the project has been sowell received that it has been ex-panded to capture an estimated 500memorials or monuments, includingmore than 160 cenotaphs at Con-gressional Cemetery in Washington,D.C., where the government main-tains some lots.

Information collected throughthe Memorials Inventory Projectwill be shared with the publicthrough the Smithsonian InstitutionResearch Information System as part

of its Art Inventories database.NCA recruited volunteers for

the project through announcementsto veterans service organizations,VA employees, and a wide variety ofother groups. Nearly 150 would-bevolunteers contacted NCA, butmany of them did not live near amemorial. As of November, how-ever, 77 volunteers have begun orcompleted documentation of 174memorials.

The volunteers come from awide range of age groups, educa-tional backgrounds, interests andprofessions. They include elemen-tary through college-age students,active and retired military person-nel, VA employees, state historicpreservation office staff, archivists,historians, teachers, VSO members,Civil War history buffs and retirees.

A number of volunteers wereparents who saw the Memorials In-ventory Project as a way to create aneducational and entertaining week-end activity for the whole family.Some asked to be assigned to cem-

eteries out of their area, giving theman excuse to plan summer or fallgetaways.

Since many of the nationalcemetery memorials and monumentsdate to the Civil War and are con-sidered historic cultural artifacts, theproject appealed to some teacherswho saw it as an opportunity to pro-vide hands-on history lessons fortheir students. John Wilkes, a his-tory teacher at the Maggie L.Walker Governor’s School in Rich-mond, Va., is working with his se-nior history students to documentthe memorials at three Civil War-era national cemeteries in Virginia:City Point, Cold Harbor and SevenPines. And Paul LaRue, a researchhistory teacher at WashingtonCourthouse High School in Colum-bus, Ohio, volunteered his class torecord the memorials at nearbyCamp Chase Confederate Stockade.

Four officers stationed at FortLeavenworth, Kan., are document-ing memorials at Fort LeavenworthNational Cemetery as part of a com-munity affairs project.

Other volunteers were attractedby the chance to find out moreabout this aspect of military historylocated right in their own backyards.Most said getting involved with theproject allowed them to contributeto the preservation of America’sheritage resources and to honorfallen veterans.

NCA will continue recruitingvolunteers until all memorials havebeen surveyed. A list of memoriallocations still in need of volunteersis posted on the NCA Web site(www.cem.va.gov) under “History.”For more information about NCA’sMemorials Inventory Project, con-tact historian Darlene Richardson at(202) 565-5426 or by e-mail [email protected].

Memorial Inventory Nearly Halfway CompleteHistoric Preservation at National Cemeteries

History teacher Paul LaRue and his students at Washington Courthouse High School recordmemorials at Camp Chase Confederate Cemetery in Columbus, Ohio.

VAnguardfeature


THE ROOM PULSATED WITHACTIVITY in every direction. Attimes, voices were barely audibleover the constant hums and whinesof machinery. Hundreds of tubs pro-gressed on what seemed like miles ofconveyor belts while robotic armsefficiently moved items from onearea to another.

Though it seemed space-aged,this was not a tour of NASA—itwas VA’s own Consolidated MailOutpatient Pharmacy inLeavenworth, Kan. SecretaryPrincipi had taken National CMOPDirector Tim Stroup up on his offerto familiarize him with what thesefacilities do and how they do it.

The Consolidated Mail Outpa-tient Pharmacies provide prescrip-tion services by mail to VA patients.Though the methods are constantlyevolving, VA has been providingprescriptions by mail since the post-World War II era. In fact, VA wasthe first national health care organi-zation to routinely provide this kindof service to its patients.

A High-Tech WorkhorseInstallation of a new workhorse

began at the Leavenworth CMOPin October 2001—a Flexpickadopted from the cosmetics industry.Ron Boneberg, director of theLeavenworth CMOP, explained thatthe volume of the work was themain attraction for this piece ofequipment.

“The machine was spitting outcosmetics orders at an amazing rate,and the products (nail polish, per-fumes, makeup) were roughly thesame size as a large number of theprepackaged drug products,”Boneberg said.

The Flexpick is an immense A-

frame machine, about 4 feet wideand 50 yards long. Approximately840 sleeves (cells) drop productonto conveyor belts that run below.The machine can process prescrip-tion orders at the rate of 1,200 to1,400 per hour. Two smaller unitshave since been installed, and theseFlexpick machines now processabout 80 percent of the prescriptionsfilled.

The Flexpick systems are barcode-driven. As a section of con-veyor goes by a sleeve, the Flexpickreads the bar code on the tub anddrops the required product for thatzone. Each 8-foot section of con-veyor equals one patient order.

Secretary Principi seemed mostimpressed with the safety of theCMOP systems. Stroup describedsome of the safety measures, includ-ing accountability software. “Thesoftware tracks the product from thetime it comes in to the time itleaves the building,” he explained.“We can track where any product isat any given time.”

“Even if a mistake is made,”Boneberg added, “the bar code sys-tem prevents the machines from fill-ing the mistake.”

Their record speaks for itself—the CMOPs have the lowest pre-scription error rates in the VA sys-tem. They even have machines thatdo the labeling and capping, and ro-botic arms that move completedbottles into sorters for processing.

Each CMOP effectively servespatient care needs by functioning asa transparent extension to the VAhospitals’ outpatient pharmacy dis-pensing programs. After a patienthas been seen by a VA physician,the patient prescription data is en-tered into a computer system at the

local VA hospital. The pharmacistreviewing the prescription providesappropriate medication-related pa-tient education, and enters or veri-fies the prescription data into thesystem. If no problems are found,the original prescription is filled anddispensed to the patient.

For patients who need to haveprescriptions filled on a routine orongoing basis for chronic medicalconditions, medications can bemarked for refill dispensing by theCMOPs. The local facility main-tains control over what is sent tothe CMOP and what is to be dis-pensed.

Evolution of the CMOPIn the old days, prescription

mail services were handled usingmanual processing systems directlyfrom the VA hospitals. The functionwas typically carried out by pharma-cists who could perform this serviceat rates ranging from 8,000 to18,000 prescriptions per full-timeemployee per year. Studies indi-cated, however, that a centralizedsystem offered tremendous benefits,

Rx for the Future

Dan Williams, a pharmacy technician at the LeavenworthCMOP, scans a product bar code.

Rx for the Future

ELAINE BUEHLER

VAnguard


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including lower costs and improvedoperational efficiencies.

Centralized mail pharmacy sys-tems began in VA in the ’70s and’80s at district and regional levels.These initiatives were based prima-rily on sharing agreements betweeninterested local VA facilities. Thepotential benefits, such as lowercosts resulting from improved opera-tional efficiencies and volume pur-chasing power, were readily appar-ent.

Recognizing the potential, VAformed a task force in the late 1980sto review the processes and options.To maximize efficiencies, it was pro-posed that CMOPs operate as inde-pendent entities from the facilitypharmacies at the VA hospitals. Theprimary function would be to pro-vide refill prescription dispensingservices by mail.

Leavenworth was the first site ofa number of CMOPs to be strategi-cally located across the country. Thepilot program began in 1988 withthe Leavenworth CMOP dispensingrefill prescriptions for VA hospitalsin Leavenworth and Topeka, addingKansas City later. Although the pro-cessing systems were still manual,productivity improvements wereevident, raising the average number

of prescriptions processed to morethan 20,000 per employee.

That was just the beginning.The CMOP program began a com-parison of other mass mailing indus-tries, and adopted many of theirideas. Installation of the first auto-mated equipment at theLeavenworth CMOP began in Au-gust 1993, and the first automatedprescriptions were mailed from theCMOP on Jan. 4, 1994.

More automated systems havebeen added over the years, enhanc-ing the program with each new ad-dition. By March 1995, theLeavenworth CMOP’s annualworkload had grown to 3.5 millionprescriptions with a staff of 80. By1999, 51 percent of all VA prescrip-tions were being processed byCMOPs (40.3 million of the 78 mil-lion prescriptions).

Before the CMOP program wasimplemented, it was not uncommonfor patients to wait two weeks ormore to receive their prescriptionsby mail. Through electronic transferof information, and the consolidatedprocessing power of the CMOPs, pa-tients now typically receive theirmedications in three to five days vir-tually anywhere in the continentalUnited States.

And once the prescription dis-pensing process for a patient’s orderis completed at the CMOP, elec-tronic data verifying the dispensingactivity is sent back to the local VAhospital to update their patientrecords.

Uninterrupted ServiceThe terrorist attacks of Sept. 11

last year didn’t disrupt the CMOPs.Although airline transportation hadbeen brought to a standstill, VAmail prescriptions were still deliv-ered to their destinations.

The CMOPs have a contractwith consolidator RR Donnelly, thePostal Service’s largest partner. RRDonnelly is equipped to deliver

packages far into the postal system,resulting in faster, lower-cost deliver-ies. All seven CMOPs are now usingthis contract, reducing costs evenfurther.

Before Sept. 11, most of themail was transported by airplane.When all flights were grounded, RRDonnelly simply shifted transporta-tion to its trucks, moving the prod-uct to the post office responsible fordelivery.

This transportation flexibilityproved vital again during the an-thrax scare. Since the CMOPs couldget prescriptions so deep into thepostal system, in many cases deliver-ing to the appropriate post officeand bypassing the postal processingcenters, the potential for contami-nation by anthrax was dramaticallylessened.

The Value of CMOPsThe value of the Leavenworth

CMOP, and the six others across thecountry, seems self-evident. CMOPsnow fill about 70 percent of themore than 104 million prescriptionsfilled by VA. More than 70 millionprescriptions valued at $1.8 billionwere filled by VA’s mail-out pharma-cies during fiscal year 2002. Com-bining volume-purchasing abilitywith automation, CMOPs saved VAmore that $70 million last yearalone.

The improvements are stagger-ing. The Leavenworth CMOP alonefilled about 45,000 prescriptions perday in fiscal year 2002, totalingmore than 12.4 million for the year(an increase of 1.8 million from fis-cal year 2001). Prescriptions arenow being processed at rates of50,000 to 100,000 per employee peryear.

Interest in the CMOP programalso continues to grow. Pharmacy gi-ant Merck Medco has benchmarkedoff the VA CMOP program, andpartnerships are being explored with

Robotic arms like this one efficiently move items fromone place to another at the Leavenworth CMOP.

ELAINE BUEHLER


VAnguardfeature


The Therapy of Self-ExpressionFifty Years of Veterans’ Voices

Veteran Harlan Hall, a participant in the Corona, Calif., Vet Center’s writing group, dis-cusses his writing with Kristine Wegman, a social worker who leads the group.

Vietnam veteran Chuck Nesmithfelt the throbbing of his heart as hecrouched in the sweltering heat of aSoutheast Asian afternoon. He wasplaying the waiting game—waitingfor the Viet Cong soldier hidingacross from him to make the firstmove and give away his position.

Both predator and prey, eachman knew the other represented amodern-day grim reaper; his hood ahelmet, his scythe a rifle. Shotsshattered the silence. Nesmithshielded his face from shrapnel,while his opponent suffered directhits.

That afternoon in Vietnam,Nesmith won the waiting game, butbegan to carry the guilt of his sur-vival in the midst of death. Hewould not speak of the guilt for 20years.

For veterans like Nesmith whohave difficulty talking about theirwartime experiences, writing allowsthem to express feelings that havebeen bottled up for years. “The

floodgate opened,” said Nesmith,describing what happened when hebegan writing about his experiencesin Vietnam. Now he writes becausehe has to.

Chuck Nesmith not only writesabout his experiences, he also sharesthem with the world. His award-winning story, “The Waiting Game,”is featured in the Summer 2002 edi-tion of Veterans’ Voices.

A publication comprised ofpieces written by participants in theHospitalized Veterans WritingProject, Veterans’ Voices celebratesits 50th anniversary this year. Themagazine has provided a forum forveterans to publish their memoirs,fiction, poetry and prose for the pastfive decades.

Some veterans write of recover-ing from the physical and mentalwounds of combat. Others extol thebeauty of foreign lands they saw andthe pride they experienced whileserving their country in uniform.The topics and styles of the pieces

featured in the three annual editionsof Veterans’ Voices differ, but each se-lection represents the unique experi-ence of one veteran. They also high-light the efforts of VA employeesand volunteers who organize writinggroups and transcribe, edit and sub-mit stories for veterans.

Nesmith wrote his story whileparticipating in a writing groupstarted by Max Greenwald, formerteam leader at the Riverside, Calif.,Vet Center. The vet center hassince moved to Corona, Calif., andGreenwald transferred to the LosAngeles VA Regional Office, butthe writing group continues underthe guidance of Kristine Wegman, asocial worker.

Nesmith cannot speak highlyenough of VA employees who facili-tate writing groups. “It takes a spe-cial kind of person to take peoplewho have been damaged and walkthem out of the woods,” he said.

Van Garner served in the AirForce during the Korean War, but by1961 was hospitalized in theMurfreesboro, Tenn., VA MedicalCenter suffering from mental illness.During the first part of his two-yearhospitalization, he reported being ina haze. He was unaware of his sur-roundings, lost in his own thoughts.

His journey back to mentalhealth began with the HospitalizedVeterans Writing Project. He startedputting his thoughts on paper, andwas motivated to continue and im-prove his writing by the reward ofhaving his work included in Veter-ans’ Voices. “It feels like you’re doingsomething important and that otherpeople might like,” he said.

Garner has contributed count-less articles to Veterans’ Voice, manyof which explicitly deal with the


ROBERT PEDERSEN

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“An important part of this pro-gram is that if we can make someprogress here, then we can make aseamless hand-off of the claimsfolder, the VRE evaluation and therehabilitation plan to counselorswherever the servicemember goes af-ter separation,” says Steier. “Andthat’s important, because if theyhave this structure—and thesmoother we can make their transi-tion—the better it is for the veter-ans.”

Steier sums it up this way: “VA’smotto is to ‘care for him who shallhave borne the battle’ and one ofthe four primary goals in VA’s Stra-tegic Plan is to ensure a smoothtransition for veterans from activemilitary service to civilian life. I canthink of nothing truer to VA’s mis-sion than doing whatever it takes tohelp these severely battle-woundedsoldiers come to grips with theirsituation and begin preparing fortheir post-military lives.”

Injured active-duty militarymembers transitioning to civilianlife aren’t the only ones benefitingfrom expedited service in the wakeof the nation’s war on terrorism. Soare the families of servicememberswho die on active duty.

Last October, VAnguard re-ported on the Joint Service Survi-vors Assistance Center set up nearthe Pentagon and staffed by person-nel from the Department of De-fense, VA and various relief agenciesto assist families of those missing orkilled in the Sept. 11 attacks. For 15days, VA personnel at the assistancecenter provided information aboutVA benefits and programs andhelped family members ofservicemembers killed in the attackcomplete applications for survivors’benefits.

Acting on the lessons learnedduring that experience, VA hasstreamlined the Dependents Indem-nity Compensation claims process

for family members ofservicemembers who die on activeduty.

Since August, surviving spousesor dependent children of an in-ser-vice casualty no longer have to fillout lengthy, cumbersome forms.Working with DoD, the VeteransBenefits Administration has stream-lined the claims process by using aDIC Worksheet combined withDoD’s Report of Casualty form toprocess each in-service death DICclaim within 48 hours of receipt.

Survivors’ and dependents’ edu-cation assistance, GI Bill refunds,Servicemembers Group Life Insur-ance and loan guaranty benefits arealso being handled on an expeditedbasis for family members ofservicemembers who die while onactive duty.

“The overall mission of transi-tion services delivery becomes evenmore important as America’s attackon terrorism continues,” says RobertJ. Epley, VBA’s Associate DeputyUnder Secretary for Policy and Pro-gram Management. “We are proudof what we are doing and what wehave accomplished to assistservicemembers and their familiesinvolved in Operation EnduringFreedom.”

By Willie Alexander

healing power of writing. His piecein the Summer 2002 issue, “CanWriting Help Us?” addresseswriting’s curative aspect, urging oth-ers to put their feelings down on pa-per. He depends on Mary AnnAquadro, chief of recreation therapyat the Murfreesboro VAMC, to sub-mit his stories.

Without the support of VA em-ployees and volunteers who submitthe stories, veterans could not havethem included in the publication.“I’m happy to do whatever I can,”said Aquadro, explaining that itmakes Garner so happy.

Hospitalized Veterans WritingProject President Ann Ogden cred-ited volunteers with the success thatHVWP and Veterans’ Voices has ex-perienced throughout the last fivedecades.

“The ones who make the realcontribution are those who work inthe hospitals … encouraging thewriting and typing it, and seeingthat it is submitted,” she said.

Through publishing their sto-ries, veterans get the pride of receiv-ing public recognition for their bestwork, and they help their readers,who may be experiencing some ofthe same feelings.

To submit stories for possiblepublication in Veterans’ Voices, writethe Hospitalized Veterans WritingProject at: 5920 Nall, Room 105,Mission, KS, 66202, or call (913)432-1214 for more information.

By Andrea Strobel

Voices continued from page 14

Intervention continued from page 7

CMOPs continued from page 13

the Departments of Defense andHealth and Human Services to po-tentially fill many of their outpa-tient prescriptions.

“CMOPs are an essential com-ponent in the pharmacy manage-ment system that has made VA amodel for our nation,” said SecretaryPrincipi. “The exciting technologywe apply in our CMOPs, combinedwith on-site leadership, help VAcontrol costs by dispensing pharma-ceuticals effectively and efficiently.”

“They are still in their infancy

stage,” said Boneberg. “CMOPworkload is growing at an averagerate of 20 percent per year, and thepotential to double that over thenext five years would be a reason-able assumption.”

By Elaine Buehler

VAnguardcover story


Can access improvements really lead to reduced waiting times forappointments and better care at VA clinics? The Buffalo primary careteam’s experience suggests they can

Waiting for Care

WHEN JOHN SANDERSON,M.D., PRIMARY CARE MEDI-CAL DIRECTOR for the VAWestern New York Healthcare Sys-tem, attended the Institute forHealthcare Improvement’s Ad-vanced Clinic Access meetings in1999, he and his team at the BuffaloPrimary Care Groups were alreadyfamiliar with making major changesto improve the delivery of care.

In the early ’90s, when the pri-mary care movement came alongnationally, Buffalo replaced the oldsystem (“not a lot of emphasis onpatient needs; not a lot of emphasison continuity over time; and not alot of emphasis on coordinating thewhole package of services we coulddeliver,” as Sanderson recalls it)with functionally integrated careteams composed of physicians,nurses, and an array of services likepharmacy, dietary, social work andpsychology. “We used the birth ofprimary care to do a lot of goodthings many of us had alwayswanted to do,” Sanderson says.

Yet the primary care movementcame up short in some ways. Wait-ing times for appointments were of-ten long, and the promise of conti-nuity was difficult to keep if patientscouldn’t get in to see their own phy-sician when they needed to be seen.

As he sat and listened to the ex-planation of Advanced Clinic Ac-cess, Sanderson soon recognized it asan avenue to even better primarycare. “For me, it was the missing

link,” he says. “We saw right awaythat it could only mean betterthings for the quality of services andwhat we can do for patients. If wecould see them when they needed tobe seen, by the person who knowsthem best, in the most proper venuewithin our system, it would be adefinite improvement.”

For the Buffalo team, AdvancedClinic Access wasn’t just a matter ofreducing waiting times; it was a wayto further enhance care delivery.“Doing it for the patients was andstill is the overriding reason and ma-jor hook for most of my providerstaff,” Sanderson explains.

The results of the work they un-dertook following their first intro-duction to ACA shows the stronglink between improved access andgreater continuity of care. In 1999,only 10 percent of patients whowere triaged as needing an urgentcare visit actually saw their own pro-vider; by 2002, that figure had in-creased to 80 percent.

During the same time period,the time to next available appoint-ment as reported on VHA’s waitingtimes database improved from 44.9days in January 2000 to 21.1 days inJune 2002, while the number of en-rolled patients per provider almostdoubled.

Getting StartedThe first step for the Buffalo pri-

mary care team was to pull togethera core planning and implementation

team. Having both the clinical andadministrative primary care leadersparticipating worked well to drivethis initiative vigorously from thestaff. They were supported by a pri-mary care social worker assigned tocollect data a few hours a week. Theproject then went to the front-linetreatment team for input on manyoccasions prior to and duringrollout.

Dr. John Sanderson, center, primary care medical di-rector for the VA Western New York Healthcare System,escorts veteran Ullin A. Henry to the reception area,where Earnestine Parker, medical support assistant, isready to check him out after his appointment.

BARBARA J. SELLON

VAnguard


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VHA began a collaborative project with the Institute for Healthcare Improve-ment in July 1999 to reduce delays and wait times. Using best practices fromthe private sector, 132 teams from each of the 21 Veterans Integrated ServiceNetworks began piloting an Advanced Clinic Access Initiative in November1999.

Within six months, the median wait for an appointment for both primaryand specialty care clinics decreased from 48 to 22 days. This collaborativeproject, scheduled to end in December, continues to spread ACA practicesacross the country.

VHA’s goal is to build an advanced access system that can achieve andsustain access levels and patient flow times that meet or exceed the currentVHA performance standards in six clinics—audiology, cardiology, ophthalmol-ogy, orthopedics, primary care, and urology. The current standards are: newpatient appointments within 30 days; appointments with a specialist within 30days of referral; and patients see providers within 20 minutes of their sched-uled appointment.

What is the Advanced Clinic Access Initiative?

“Doing it for the patients wasand still is the overriding rea-son and major hook for mostof my provider staff. ”


Each person had a decent graspof their role, and also understoodhow behavior changes on the part ofother disciplines complementedtheir own. Another key, accordingto Sanderson, was “freeing people upnot only to talk, but to act. Empow-ering them—most love the heck outof that.”

Matching Supply andDemand

The Buffalo primary care teamundertook multiple changes at once.The first order of business was tomeasure supply and demand, andmatch the two. They knew theirstaffing supply, but didn’t know theirdemand, especially for urgent, same-day care.

To track demand, they measuredthe number of calls for same-daycare, the number of patients theywere able to see on the same day,and the number of patients they hadto deflect to the emergency room orwalk-in clinic—all on a provider-specific basis.

They quickly discovered thatdemand for urgent care was consis-tently higher on certain days of theweek, particularly Mondays and Fri-

days. They then looked at providerschedules and matched supply to de-mand, leaving space in their sched-ules for urgent care appointmentsbased on the data they had col-lected.

ExtendingIntervals forReturn Visits

Early on, the teamsaw that a large chunkof the demand was be-ing created not by thepatients, but by theproviders’ own behav-ior. Providers were routinely sched-uling patients for return visits inthree months, because that was howit had always been done.

As Sanderson explains, thosethree-month visits added up: “If Ihad 1,000 patients and saw them allfour times a year, then I’d need4,000 visits. But if I had the samenumber of patients and saw themtwice a year, then I’d only need2,000 visits to do the same work. Soin effect, we were creating our ownreturn demand.”

The change? Simple: schedulereturn visits based on a careful as-

sessment of patient needs, instead ofold habits. Sanderson admits that hehad to start by changing his own be-havior. “Every patient who comesin, as they’re leaving, you take fiveor 10 seconds to make your own as-sessment as to what the most suit-

able follow-up interval should be.And you base that assessment, firstand foremost, on how sick they are.Anyone who’s seriously ill shouldcome back as often as it takes—ev-ery day or two if necessary.”

Sanderson admits he shared theVA mindset that most of his pa-tients were old and sick and neededto be seen frequently. As time wenton, however, he came to realize thata large number of his patients hadchronic diseases and didn’t need tobe seen that often.

“If people are doing accuratehome monitoring of illness, such asblood sugars and blood pressures,and they’re able to recognizechanges in condition and conveythat information by phone or an-other means, we now feel very com-fortable about spreading them outfurther into the future,” he explains,“particularly when you know theyare reliable and will call you if some-thing goes wrong.”

Alternative VisitsBefore Advanced Clinic Access,

most Buffalo primary care patientsended up with a face-to-face pro-vider visit. Today, triage nurses as-sess the clinical needs that arise be-tween appointments and choose themost appropriate response. Some pa-tients can be seen by the nurse or

VAnguardcover story


The number of veterans enrolling in the VA health care sys-tem continues to grow at unprecedented rates. This unan-ticipated explosion in growth began after Congress madeevery veteran eligible for VA health care in 1996. Sincethen, the number of veterans VA treats has almostdoubled.

In the past year, the number of veterans receivinghealth care from VA increased by 30,000 veterans permonth. Currently, about 265,000 veterans are waiting forhealth care appointments. More than 164,000 new enrolleesare waiting for their first clinic appointment to be scheduled,and another 100,000 veterans are facing a wait of six monthsor more for follow-up or specialized care.

VA’s goal is to eliminate this health care backlog withinsix months, but the increased demand for appointments isexpected to continue. Another 600,000 veterans are pro-

jected to enroll for VA health care in 2003. Besides the Ad-vanced Clinic Access initiative, VA has been taking a num-ber of other actions to tackle the problem, including:

■ convening a task force to implement national strate-gies to reduce the backlog;

■ asking Veterans Integrated Service Networks toidentify local actions to eliminate the backlog;

■ starting a nationwide system to track patients onwait lists;

■ developing clear, concise national policy documentsthat identify the process each VISN will follow to enroll pa-tients for clinical care and when to put patients on a waitinglist; and

■ asking the Office of Personnel Management for per-mission to re-hire retired health care personnel for up to ayear without a reduction in their retirement benefits.

What Else is Being Done to Reduce Waiting Times?



even treated over the phone. Nurse clinic visits are alsoused for such things as blood pressure checks, blood glu-cose checks, minor irrigation and immunizations. Clerksand nurses can link patients directly with dietary, psy-chology, social work and even pharmacy.

Support staff is encouraged to contact providers fora hallway consult or telephone advice if they’re unsurehow to handle a particular situation. Some providersalso hold formal telephone clinics for routine follow-upof certain patients whose conditions do not require di-rect observation. The key is effective internal communi-cation, a prerequisite for any team trying to respond, onany given day and at any time, in a way that is bestsuited to the patient’s needs.

Adjusting to ChangeThese changes weren’t easy for all providers. At

first, some were nervous about extending intervals forreturn visits. One provider, for example, wanted to beable to sit down and discuss lab results with his patients.“What you do,” Sanderson explains, “is just say, well,not only is it possible for you to do that by phone with-out rebooking the patient, but 90 percent of your peersdown the hall do it that way and do it very effectively.”As providers looked around and saw the success otherswere having extending return visit intervals, it made iteasier for them to change their own behavior.

Staff satisfaction is quite high and turnover low inBuffalo primary care. “The nurses like it because theyfeel even more invested in a given patient’s care andoutcome of that care,” according to Sanderson. “In theold culture, a lot of people had a lot to offer, but were

Members of the Buffalo primary care team Vivian Hokes, L.P.N.,John Sanderson, M.D., and Chetana Shastri, M.D., review an elec-tronic medical record to determine the patient’s treatment options.

BARBARA J. SELLON

shackled and unable to deliver. But this is a systemwhere people are free to do what they’re trained to doand what they really got into health care for. Compared

VAnguard


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The wait is over for veterans withservice-connected disabilities rated50 percent or more. They now havepriority access to VA health carethanks to a new regulation signed bySecretary Principi.

“It is unacceptable to keep vet-erans with service-connected medi-cal problems waiting for care,” saidPrincipi. “These veterans are thevery reason we exist, and everythingwe do should focus first on theirneeds.”

The new regulation took effectOct. 1, 2002. It was brought on bythe increase in VA health care en-rollment, which has led to longerwaiting times.

Frustrated that disabled veteranswere waiting months for care, Secre-tary Principi ordered a covert opera-tion. He sent one of VA’s assistantsecretaries, a 100-percent service-disabled veteran, to eight differentVA clinics. His mission—try to en-

roll for VA health care.At four clinics he was turned

away. They were over capacity andcould not care for him. At oneclinic, he was told he’d have to goto a hospital more than 200 milesaway to get care. At another, a clerktold him he was sorry, but all veter-ans were created equal and he wouldhave to wait just like everyone else.

But he wasn’t like everyoneelse. He was wounded in combatand has spent more than half his lifein a wheelchair. Should he have towait like everyone else? The Secre-tary didn’t think so. He asked theOffice of General Counsel to draftnew regulations. He wanted severelydisabled veterans to have priorityaccess for hospitalization and outpa-tient care for both service-con-nected and non-service-connectedtreatment.

“Never again on my watch willa combat-disabled veteran be told

Severely Disabled Vets Get Priority AccessNew policy means no more waiting for some veterans

to the old days when we weren’table to see our people when they gotsick because of crammed schedules,we now have opportunities andopenings built in to see patients onthe day they need to be seen.”

Patients, too, had to adjust tothe new system. At first, some didn’tunderstand why they were comingback in six months instead of three.In addition to face-to-face educationof patients by clerks, nurses, and ev-eryone else on the care team, Buf-falo primary care now includes anorientation to Advanced Clinic Ac-cess for all new patients.

The message, Sanderson ex-plains, is “this is not the old way ofdoing business anymore. If you’recoming here, be ready for alterna-

that he or she is no different thanany other veteran,” the Secretarysaid. The new regulations, outlinedin VHA Directive 2002-057, weredistributed to VA medical facilitieson Sept. 26.

The new regulation is beingimplemented in two phases. Thefirst phase provides veterans withservice-connected disabilities rated50 percent or more with prioritytreatment for service or non-service-connected conditions. In the secondphase, which will be implementednext year, VA will provide priorityaccess to other service-connectedveterans for their service-connectedconditions.

The VA mission is traced to theCivil War. President Lincoln made acommitment to care for woundedsoldiers and the families of thosekilled on the battlefield. A 1996 lawopened VA health care to all eli-gible veterans who enrolled.

They came in record numbers,jeopardizing VA’s ability to care forveterans who needed it most. Thisnew regulation allows VA to getback to its roots and give prioritytreatment to veterans who dependon us for care.

tives to face-to-face visits, and beready to have reappointment inter-vals extended. Be ready to see otherteam members and not just yourdoctor if your need so dictates.”

Handouts reinforce the message:We’re changing, always trying tomake care better for you. Butchange does entail a new experiencefor you. Sanderson observes that,with his own patients, the “momentof truth” was the first time theycalled in with an urgent need andwere told, yes, they could come in at2:00 that afternoon. “Once thathappened,” he says, “you had a con-vert.”

By Jane Roessner, Ph.D.

ROBERT TURTIL


Institute for Healthcare Improvement

Veterans have been coming to VA for health care inrecord numbers since the system was opened to all eli-gible veterans who enrolled, jeopardizing VA’s ability tocare for those who needed it most.

VAnguardfeature


Veterans Veterans 20th Anniversary of the Wall

A Generation Comes of AgeWayne Miller glanced to his left and right as he slowlynudged his wheelchair along the path at the VietnamVeterans Memorial in Washington, D.C. Thousands ofpeople were gathered there on Veterans Day to markthe 20th anniversary of the Wall. But Miller wasn’t look-ing for Marines he served with in Vietnam. He waslooking for signs of anguish and pain.

“You can usually tell because they’ll be standing offby themselves,” said Miller, team leader at the SilverSpring, Md., Vet Center, as he navigated through thecrowd. “If they’re with family then we know they’ve gotsupport, but when they’re by themselves, that’s when weget concerned.” He extended his hand to a stocky manwearing a Marine Corps hat and offered a greetingheard throughout the day: “Welcome home, brother.”

Miller was one of about 30 vet center counselorswho spent Veterans Day weekend at the Wall helpingthose in need. “The main thing is being non-invasiveand building trust,” he said. “We ask if they’re OK andtell them about the vet center. We just want to let themknow that we’re here if they want to talk.”


Some 30 vet center counselors stationed themselves at the Wallover Veterans Day weekend to offer their support to veterans gath-ered there for the 20th anniversary of the memorial.

In a scene repeated many times over the Veterans Day weekend,Wayne Miller, right, team leader at the Silver Spring, Md., VetCenter, talks with a fellow Vietnam veteran. “Welcome home,brother,” was a common greeting.

The heavy rainsthat soaked theVeterans Day cer-emony at ArlingtonNational Cemeteryearlier in the dayhad slacked off bythe time the an-nual ceremony atthe Wall got under-way at 1:00 p.m.Thousands bravedthe elements to bea part of it.

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feature

“Veterans do not take life for granted. They know that duty and sacrificeare more than words. And they love America deeply, because they knowthe cost of freedom, and they know the names and faces of men andwomen who paid for it. …Free nations are in debt to the long, distin-guished line of American veterans, and all Americans owe our veteransour liberty.”

President George W. Bush

Day 2002Day 2002

Two Iron Mountain, Mich., VA Medical Center employees took part ina musical tribute at the Lincoln Memorial in Washington, D.C., on Nov. 6,to commemorate the 20th anniversary of the Vietnam Veterans Memorial.

Fran Rosenburg, administrative officer of the day at the medical center,and Neale Emerson, a respiratory therapist, were part of a line-up that in-cluded Paul Revere and the Raiders, Irish tenor John McDermott, and ScottMcKenzie, who hit it big in 1967 by urging Americans to go to San Fran-cisco, where they’d find lots of gentle people with flowers in their hair.

A Musical Tributeto Vietnam Veterans


VIETNAM VETERANS MEMORIAL FUND PHOTO

Neale Emerson, a respiratory therapist at the Iron Moun-tain, Mich., VA Medical Center, performs on the steps ofthe Lincoln Memorial during the musical tribute to Viet-nam veterans on Nov. 6.

EMERSON SANDERS

EMERSON SANDERS

On a Veterans Day thatfound Americans bracingfor the possibility of war,about 2,000 braved asteady rain to attend theannual Veterans Day cer-emony at Arlington Na-tional Cemetery. PresidentBush addressed the crowdin the amphitheater,above, during a ceremonyhosted this year by theBlinded Veterans ofAmerica, left.

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Emerson performed “Can You Hear the Wall Whis-per?,” a poem Rosenburg wrote after visiting the “Mov-ing Wall” in Kingsford, Michigan. (Listen, Sshh … Lis-ten. Do you hear it? Do you hear the Wall whisper?)

The “Moving Wall” is a half-scale replica of thememorial in Washington, D.C. It was developed in1984 so those who couldn’t make it to the nation’s capi-tal could still have an opportunity to view a replica ofthe memorial that has brought healing to so many. (Thewar is over, The Blood is shed. Now it is time. We honorour dead.)

“The entire poem is listening to the Wall in silencefor those who did not come back from the war,”Rosenburg said. She took the poem to Emerson, whohas been singing and composing since 1968.

He put the words to music and recorded it on acompact disk. “The catalyst for the song is the fact thatthe Wall won’t go away. It continues to be there and wecan’t ignore it,” Rosenburg said.

They submitted the CD to the Vietnam VeteransMemorial Fund and were selected to perform at the Lin-coln Memorial as part of the Wall’s 20th anniversary ob-servance. (50,000 plus are honored here. Where our great-est gift is a touch and a tear.)

Standing at his keyboard on the steps of the Lin-coln Memorial, Emerson softly encouraged the crowd toexperience the Wall’s healing power. (To walk the Wall.And say Good-Bye. Cherish the memories, take time tocry.)

A visit to the Wall can evoke many emotions—thepain of loss, the guilt of survival, or the anger of beingspurned. Seldom is this more evident than on VeteransDay.

Visitors brought flowers, photographs, letters andother personal items as a tribute to the fallen. “DearDad, it’s Veterans Day eve and I’m here in Washington,D.C., for the first time,” began one letter. “I can feelyour presence.”

A few feet away, Neil McKenna, a therapist fromthe Brockton, Mass., Vet Center, kept his finger on theemotional pulse of the crowd. “It’s been real intense,” hesaid. “It’s almost overwhelming to be a part of this.”

They came from across the country to mark theWall’s 20th anniversary. Cecilia F. Graff, a social workerat the Dayton, Ohio, VA Medical Center, thought it’dbe therapeutic for some of the hospital’s Vietnam veter-ans to visit the memorial.

She mentioned it to Dr. Arthur Aaronson, a clini-cal psychologist, and he agreed. Together with GregMeriwether, team leader at the Dayton Vet Center, theyraised enough money to bring 26 veterans to the obser-vance. It was the first visit for many. “Going up to theWall and finding the names of their fallen comrades ... Ithink a lot of them found healing,” said Meriwether.

As the ceremony came to a close, some of the vet-erans from Dayton split away from the group and satdown on nearby park benches. One first-time visitor wasso overcome that he couldn’t speak.

Others shook their heads in disbelief as they de-scribed meeting President George W. Bush earlier in theday when he made an unannounced visit to the Wall.“The President shook my hand and thanked me forserving in ’Nam,” said one veteran.

Aaronson didn’t overlook the impact of their en-counter with the President. “They’ve always felt forgot-ten and here the President comes up and thanks them.It did a lot to help them feel like what they did in Viet-nam was important,” he said.

About 50 veterans from Arizona visited the Wallas part of Operation Freedom Bird, sponsored by South-west Airlines. Vietnam veterans Bob Digirolamo, home-less coordinator at the Phoenix VA Medical Center,and Don McKisson, vice president of the Freedom BirdFoundation, were with the group.

McKisson, a former Marine Corps corpsman and re-tired VA nurse, said about 700 veterans have visited theWall since the operation began in 1987. “Most comeaway with a renewed sense of purpose,” he said. “It’s re-ally a unique experience. The Wall is mystical. Whenyou look at it, you’ll find whatever it is you’re lookingfor.”

The 20th Anniversary observance included the“Reading of the Names” ceremony. About 2,000 volun-teers recited all of the 58,229 names inscribed on thememorial—a roll call of the fallen. Secretary Principiread the first ten names, starting a process that took 65hours over four days.

Arto S. Woods, an associate manager in VA’s Read-justment Counseling Service Regional Office in Balti-more, spent the weekend at the Wall reaching out tothose in need. He was there when the Wall was dedi-cated in 1982 and again at the 10th anniversary in 1992.

The combat-wounded Marine Corps veteran hasseen some changes over the years. “In ’82 there was lotsof denial of the losses of friends, and also survivor guilt,”he said. “Now veterans are more accepting of their fates.Even though the psychological wars are not over formany, I think some finally found closure.”

Philip Hamme, regional manager in the Baltimoreoffice, offered his own insight. “I think a generation hasreally come of age.”

By Matt Bristol

Wall continued from page 20

Tribute continued from page 21

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e-learning

The VA Learning Catalog ischanging the way employeesget information about educa-tional opportunities, prod-ucts, satellite broadcasts, andonline learning available tothem. From January to Sep-tember, the online cataloghad more than 1.3 millionhits.

“The catalog is beingvisited by VA staff 24 hours aday, seven days a week,” saidMelissa McCanna, VA learn-ing resource group coordina-tor for the Employee Educa-

VA human resources man-agement specialists are log-ging on to a new Web-basedTitle 38 Personnel Manage-ment Development Seriescurriculum. Launched onOct. 9, this curriculum is ac-cessible on the Internet athttp://208.34.95.200/T38and on the Intranet throughthe Office of Human Re-sources Management Website at vaww.va.gov/ohrm andthe Employee Education Sys-tem Web site atvaww.ees.aac.va.gov/t38.

The curriculum offers aseries of courses designed tohelp HRM specialists de-velop and enhance theirknowledge of the complexTitle 38 system.

The first curriculum inthe series is “The Fundamen-

tals of Title 38 PersonnelManagement,” which in-cludes two courses on historyand background, and key at-tributes of the Title 38 Per-sonnel System. Courses onstaffing, pay, employee rela-tions, work life, labor rela-tions and staffing adjust-ments will soon be available.

This Web-based curricu-lum is a departure from thetraditional e-learning experi-ence in that it uses a sce-nario-based learning ap-proach to make the learningexperience as realistic as pos-sible. Course designers cre-ated a scenario featuring avirtual medical center, Cen-tral City VA Medical Center,which mirrors the work envi-ronment of a VA medicalcenter and the executive

team that manages the day-to-day HR functions.

Novice HR specialistsare introduced to the funda-mentals of the Title 38 Per-sonnel Management Systemas they study alongside ChrisPoplar, a virtual HR intern.Participants learn along withChris how to research rules,regulations and VA policies.They assume Chris’s role tocomplete a number of activi-ties that demonstrate whatthey’ve learned.

More experienced HRspecialists study and arementored by Central CityVAMC Senior HR SpecialistsBrian Lighthorse, Alan Bills,Larry Chung and Mary AlanBlake as they focus on skillsdevelopment. Senior HRspecialists solve advanced

problems with MarkMcBride, HR director, andhis staff of HR specialists.

A planning committeemade up of staff from theOffice of Human ResourcesManagement and EmployeeEducation System collabo-rated with a team of HRsubject-matter experts fromthe Office of Human Re-sources Management, VHAManagement Support andVA medical centers in Biloxi,Miss., Denver, Memphis,Tenn., and West Los Angelesto develop courses for thecurriculum.

Their goal is to ensurethe continued viability of theTitle 38 system. Retirementsand turnovers have cost VAmuch of its expertise in thisarea. The initiative is de-signed to train and supportcareer development for VA’sexperienced HR specialists,as well as provide new hiresthe training they need to dotheir jobs.

“I’ve been waiting forthis for years,” said SandraWilloughby, HRM officer atthe Cheyenne, Wyo.,VAMC, after logging on tothe Web-based curriculum.“Seems like the most cost-ef-fective and far-reaching wayto be sure the VA HR com-munity is well trained.”

Course developers hopethis Web curriculum willeventually serve as an anchorfor a blended learning experi-ence incorporating face-to-face, satellite, and otherlearning opportunities onTitle 38 personnel manage-ment.

For more informationon the Title 38 Web-basedcurriculum, contactMarianne Gray at (202) 273-9759 or by e-mail [email protected].

tion System. “That is impor-tant to meet all employeetraining needs in a large, per-formance and customer ser-vice-oriented organizationlike VA.”

Of the more than 1,700offerings in the catalog, some500 have been developed incoordination with VA clients

by the EmployeeEducation System.You will find edu-cational opportuni-ties and productsentered by the Vet-erans Benefits Ad-ministration, theOffice of PublicAffairs, the Officeof General Coun-sel, and the Office

of Human Resources Man-agement.

“Courses are beingadded to the catalog daily,”McCanna said. “This is aone-stop shop for all VA

learning. We’ve recentlyadded 993 courses offeredthrough VA LearningOnline. These are very popu-lar commercial courses of-fered to all VA staff throughan Internet connection.”

New offerings for 2003include satellite broadcastsfrom Training Systems Net-work covering professionaldevelopment, leadership, su-pervisory, and business skillstraining that have beenadded to the VA KnowledgeNetwork schedule. To findthese broadcasts, type TSNin the search box on the VALearning Catalog.

Visit the VA LearningCatalog atvaww.sites.lrn.va.gov/VACatalog/. For informationon how to add nationallyavailable products or pro-grams from your VA staff of-fice, contact McCanna [email protected].

Learning Catalog Passes One Million Hit Mark

Title 38 Course for HR Specialists Debuts on the Web

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Sixteen employees were se-lected for VA’s Senior Execu-tive Service Candidate Devel-opment Program. They madeit through a rigorous applica-tion, interview and selectionprocess that began in the lat-ter part of 2001 and was af-fected by the Sept. 11 terror-ist attacks and the anthraxscare.

Nearly 300 employeesapplied for the program.Thirty-nine candidates wereinterviewed, and 16 of thosewere selected by the Secretaryto participate.

SES candidate develop-ment programs are competi-tive programs designed tocreate a pool of qualified can-didates for SES positions.Candidates participate in avariety of activities aimed atpreparing them for success inthe SES, including develop-mental assignments, job

cal Center; Lily Fetzer, Hous-ton VA Regional Office;Willie Hensley, Office ofHuman Resources Manage-ment, VA Central Office; JoyW. Hunter, Veterans HealthAdministration, VA CentralOffice; Sonia Moreno, SanJuan, Puerto Rico, VA Re-gional Office;

Steve L. Muro, NationalCemetery Administration,Oakland, Calif.; RicardoRandle, Jackson, Miss., VARegional Office; James R.Sandman, Denver Distribu-tion Center; Linda D. Smith,Cleveland VA Medical Cen-ter; Rebecca Wiley, Augusta,Ga., VA Medical Center;Suzanne C. Will, RegionalCounsel, San Francisco; SallyWallace, Office of Informa-tion Technology, VA CentralOffice; and Keith Wilson,New Orleans VA RegionalOffice.

shadowing, working with anSES mentor and executivecoach, creating an individualdevelopment plan, and get-ting at least 80 hours oftraining on five ExecutiveCore Qualifications that ap-ply to all SES positions.These programs typically last12-18 months, depending onindividual development.They are open to GS-14s/15sor employees at equivalentlevels from within or outsidethe federal government.

Employees selected toparticipate in VA’s programfor 2003 are: Lou AnnAtkins, West Palm Beach,Fla., VA Medical Center;Ronald Bednarz, VeteransHealth Administration, VACentral Office; Ernesto D.Castro, Office of Informa-tion Technology, VA CentralOffice; Jeannette Diaz, SanJuan, Puerto Rico, VA Medi-

Sixteen Picked for SES Development Program

Fifteen Senior Executives Win Presidential Rank Awards

Shared ServiceCenter Realigned


The name has changed, butthe services available to VAemployees nationwidethrough the Shared ServiceCenter in Topeka, Kan., havenot.

Now called the HealthRevenue Center, the formerShared Service Center hasbeen realigned from the Of-fice of Human ResourcesManagement to VHA’s Busi-ness Office. None of thecenter’s workers will losetheir jobs from this move.Matt Kelly has been namedacting director of the center

Employees can still ini-

Three VA leaders receivedDistinguished ExecutiveAwards in the 2002 Presiden-tial RankAwards pro-gram. It’s anhonor be-stowed ononly 1 per-cent of ca-reer seniorexecutives inthe entirefederal gov-ernment.

They are: Alfonso R.Batres, director of VHA’s Re-adjustment Counseling Ser-vice; D. Mark Catlett, princi-pal deputy assistant secretaryfor management in VA Cen-tral Office; and Patricia A.McKlem, director of thePrescott, Ariz., VA MedicalCenter.

Another twelve VA ca-reer senior executives werehonored in the Meritorious

Executives category.Only 5 percent of ca-reer senior executivesare chosen for thishonor.

They are: JamesB. Donahoe, directorof VHA’s CanteenService;John J.DonnellanJr., director

of the VA NewYork HarborHealth Care Sys-tem; George H.Gray, director ofthe VA CentralArkansas HealthCare System; Tho-mas R. Jensen, VBA’s South-ern Area director, Nashville,

Tenn.; Kenneth H.Mizrach, director ofthe VA New JerseyHealth Care System;Michael E.Moreland, director ofthe VA PittsburghHealthcare System;Jimmy A. Norris,VHA’s chief financeofficer;

Y.C.Parris, directorof the Bir-mingham,Ala., VAMedical Cen-ter; George T.Patterson, ex-ecutive direc-tor/chief oper-ating officer of

the NationalAcquisition Center in Hines,Ill.; Thomas R. Wagner, di-

rector of theHouston VARegional Of-fice; JuliusM. WilliamsJr., directorof VBA’s Vo-cational Re-habilitationand Em-ployment

Service; and Timothy B. Wil-liams, chief executive officerof the VA Puget SoundHealth Care System.

Chosen through a rigor-ous selection process, Presi-dential Rank Award winnersare nominated by theiragency heads, evaluated byboards of private citizens,and approved by the Presi-dent. The evaluation criteriafocus on leadership and re-sults. A total of 348 careersenior executives receivedPresidential Rank Awardsthis year. About 6,100 federalemployees are career mem-bers of the Senior ExecutiveService.

Batres

Catlett

McKlem

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introducing

Toby Johnson will do what-ever it takes to get his clientsmotivated for life. Sometimesthat involves a couple of setson the bench press.

The 33-year-oldkinesiotherapist and personaltrainer is helping the Veter-ans Health Administrationmeet its core goal of buildinghealthy communities. He’sdoing it one veteran at a timein the domiciliary at the OlinE. Teague Veterans’ Center,part of the Central Texas Vet-erans Health Care System.

His clients are recover-ing from traumatic injury,depression or addiction.Some are trying to get backon their feet after years onthe streets. Others are learn-ing to adjust to prostheticlimbs or maneuvering awheelchair. All live in the do-miciliary.

He gets them started bydesigning individual exerciseprograms that emphasizetheir abilities. After settingspecific short-term goals, heand Rehabilitation AssistantBarbara DeLacour provide asteady dose of encourage-ment as the veterans worktoward achieving them.

“We get some folks inhere who are depressed ortrying to get over addictions

to alcohol or drugs,” Johnsonsaid. “I introduce them toweight training and try to getthem addicted to weights.Once you get those endor-phins going, it’s a naturalhigh and perfectly legal.”

Johnson leads by ex-ample. His 6-foot-2-inchframe is sculpted into 220pounds of lean muscle. Hesets strict guidelines andholds his clients responsiblefor putting in the effort.Some need a little motivat-ing, others don’t.

John Davis, a 52-year-old Vietnam veteran who lostboth hands in a natural gasexplosion, wanted to com-pete in a national bodybuild-ing contest sponsored by Ex-perimental Applied ScienceCorp. He had the drive, butthe injury to his hands madeit impossible to do some ofthe upper body exercises.

Or so he thought.Johnson fitted him with spe-cial-order hooks forweightlifting and adapted ex-ercises so he could work hischest and back.

By the end of the 12-week program, Davis hadgained 25 pounds of leanbody mass, dropped his bodyfat by 10 percent, and in-creased his bench press by

125 pounds. He submittedhis before-and-after photosand measurements and wasnamed first runner-up in theinspiration category.

Though Johnson trainedhim during the contest, he’sreluctant to take any creditfor helping Davis reach hisgoal. “John has a lot of gutsand determination,” he said.

An Army veteran,Johnson joined VA aftergraduating from the Univer-sity of Southern Mississippiin 1993. He did stints at theVA hospital in Lyons, N.J.,and the nursing home inMarlin, Texas, before takingon the Temple assignment in1999.

The first thing he no-ticed when he got there wasthe need for some modernequipment. “We needed to

Toby Johnson

get some new equipmentthat would be more benefi-cial for the patients,” he said.

He did, with help fromChief of Staff Dr. Valerie H.Van Wormer, DomiciliaryAdministrator Jay S. Butala,and his supervisor BarbaraSanders.

Today, the health main-tenance program looks morelike a mini health club, withmirrors lining the walls andveterans working out on thelatest exercise equipment.More than 100 veteranswork out each day as part ofJohnson’s program. Othershave seen the results he getsand are waiting to join.

“I have a mission for thefuture,” he said. “I want toget rid of the waiting list andmake this the best healthclub VA has to offer.”

Toby Johnson works with veteran Kevin Eric Mosely.


tiate transactions such ashealth insurance or CFC en-rollments, payroll deduc-tions, and updating personalinformation through the cen-ter. Use the Employee SelfService application page atwww.hrlinks.aac.va.gov, orcall 1-800-414-5272.

The center has about220 full-time employees whoanswer calls, research benefits

cases, process transactions,and provide retirement infor-mation. In fiscal year 2002,they answered more than240,000 calls and processedmore than 350,000 transac-tions.

Decisions are still beingmade about which HR andpayroll functions will remainat the center, and what staffwill be dedicated to Business

Office work. The decision tomove the center under theBusiness Office stemmed inpart from the need to cen-tralize some business officeprocesses and accounts re-ceivable work within VA.

Through a pilot pro-gram with the Medical CareCost Recovery Office forVISN 11 (Ann Arbor, Mich.)that began last May, about

30 center staff members havebeen calling veterans to re-mind them about their ap-pointments and update theirhealth insurance and billinginformation. Preliminary re-sults show this team’s effortsare making a difference inthe amount of money that isbeing collected from healthinsurance companies and vet-erans.

BOBBY POFF

VAnguardaround headquarters


Secretary Principi presentedthe top honor in the 2002Robert W. Carey QualityAward program to the Phila-delphia VA Insurance Centerduring a Sept. 12 ceremonyin Washington, D.C. It’s thesecond time since the award’sinception in 1992 that Phillyreceived the Carey Trophy.

“It really shows the qual-ity of people we’ve got work-ing here,” said Grace Parker,chief of Policy and Procedureat the Insurance Center, whocoordinated the Carey appli-cation. “Many of us knewRobert Carey and it’s anhonor to be recognized likethis because we know that’swhat Bob would havewanted.”

The Insurance Centerwon the Benefits Category inthe 2000 and 2001 CareyAward programs and capital-ized on past success to takethis year’s top spot. “Thefeedback we received helpedus focus on where we neededto go,” Parker said.

About 420 people workin the Insurance Center.They are responsible formanaging all aspects of gov-ernment life insurance pro-

grams for veterans, membersof the armed services, andtheir reserve components.

For the second year in arow, the Clinical ResearchPharmacy CoordinatingCenter located in Albuquer-que, N.M., swept the CareyAward program’s Health Carecategory.

Dr. Mike R. Sather, di-rector of the center, set thequality improvement ballrolling in the 1980s. Today,the center runs on communi-cation and teamwork.

Project managers meeteach Thursday in front of theStrategic Awareness Wall totalk about upcoming activi-ties for the next threemonths. “Everybody knowswhat we’re doing and wherewe’re going,” said ThelmaSalazar, assistant director foradministrative operations.

The Fort Custer, Mich.,National Cemetery won anachievement award in lastyear’s Carey program andmade good on their promiseto be back. They stepped itup a notch to take the topspot in the National Cem-etery category.

Fort Custer has strong

community support and anactive volunteer network.Five different honor guardsquads, one for each week-day, perform full militaryhonors for every veteran in-terred.

Honors in the UnifiedHealth Care and Benefitscategory went to the SparkM. Matsunaga VA Medicaland Regional Office Centerin Honolulu.

The center maintainslong-standing VA/DoD jointventures with Tripler ArmyMedical Center that have ledto the formation of the Ha-waii Federal Healthcare Part-nership. By leveraging re-sources with the Army hospi-tal, the center has improvedservice delivery to 130,000

Carey Quality Award Trophy Goes to Philly Insurance Centerveterans living in the Hawai-ian Islands.

Several VA facilities re-ceived achievement awardsfor excelling in at least oneaspect of the Carey Awardcriteria. Past achievementaward winners have gone onto excel in the program.

This year’s achievementwinners are the Riverside,Calif., National Cemetery;Loma Linda, Calif., VAMedical Center; Prescott,Ariz., VA Medical Center;and the White River Junc-tion, Vt., VA Medical andRegional Office Center.

For more informationon the Carey Quality Awardprocess, contact Darine Prokat (202) 273-6784 or MartyReiss at (202) 273-5131.

Philadelphia VA Insurance Center Director Joseph McCann, far left,holds the Carey Trophy while Secretary Principi talks with RobertCarey’s brother Leo, second from left, and widow Jean.

Amy Nicholson and Michael Chavez, both production controllers atthe Clinical Research Pharmacy Coordinating Center in Albuquer-que, N.M., flood fill blister cards.

EMERSON SANDERS

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around headquarters

The Congressional BlackCaucus Veterans Braintrustpresented a program featur-ing panels of African Ameri-can former POWs and theirwives on Capitol Hill Sept.13. Sponsored by Cong.Sanford Bishop (D-Ga.) andCong. Corrine Brown (D-

Longtime National CemeteryAdministration leader RogerRapp retired on Oct. 3. He’d

beenDeputyUnderSecre-tary forOpera-tionssinceMarch2000.In that

position, he was in charge ofoperations and constructionat VA’s 120 national cemeter-ies.

He was also responsiblefor the State CemeteryGrants Program, which pro-vides federal grants to help

Forty Russian nurses visitedVA Central Office on Oct.24 to learn how the nation’slargest “nurse force” takescare of U.S. veterans.

Speaking through atranslator, Charlotte Beason,Ed.D., R.N., program direc-tor in the Office of NursingServices, welcomed the groupand discussed the leadershiprole of nurses in VA. “Ournurses are caregivers, butthey are also leaders,” shesaid. She highlighted VAnurse initiatives in research,clinical innovation, and ad-ministration.

Joyce Bounds, R.N.,VHA Office of Special

VA Hosts Russian NursesNCA’s Roger Rapp Retires

“It was clear that theseveterans continue a patternof minimizing their physicalcomplaints and often sufferin silence,” said Dr. LarryLehmann, VHA liaison tothe Secretary’s advisory com-mittee, who provided infor-mation to the group aboutbenefits and services availableto former POWs. Staff fromVAMCs and vet centers alsoattended the program.

Former POWs and Families Share Stories of Conquering Stress

Dr. Larry Lehmann, VHA liaison to the Secretary’s Advisory Com-mittee on Former POWs, greets Harold Coleman, a Korean WarPOW from Jacksonville, Fla.

ROBERT TURTIL

Fla.), “The High Price ofFreedom” brought togetherformer POWs from WorldWar II, Korea and Vietnam,including Robert Fletcher, aKorean War veteran who is amember of the Secretary’sAdvisory Committee onFormer POWs.

While the formerPOWs’ war experiences werepart of the discussion, theirmain focus was how they hadadapted to stress and gone onto become active contribu-tors to their communities af-ter they got home. Theirwives described the impact oftheir POW status, includingthe medical problems themen have experienced, onfamily life.

states establish, expand andimprove state veterans cem-eteries.

During Rapp’s 20-yearcareer with NCA, 13 newnational cemeteries opened,and VA is positioned to openfive more. Last year, NCAscored a 93 percent customersatisfaction rating, the high-est achieved by any govern-ment entity included on theAmerican Customer Satisfac-tion Index.

Rapp began his VA ca-reer with the Veterans HealthAdministration in 1972. Hejoined NCA as director ofthe Philadelphia area officebefore moving to headquar-ters in 1987 as director offield operations.

Projects, introduced the visi-tors to the VA Virtual Learn-ing Center (www.va.gov/vlc),and encouraged them to reg-ister with the site to receiveautomatic e-mail notices ofthe latest lessons learned.“They’re trying to advancetheir nursing practice andthey are looking to VA forexamples,” said Bounds.“This is a way to share ideasinternationally.”

In recent months, VAhas hosted delegations frommany countries, includingthe Czech Republic, China,Jordan, Japan, Romania,Russia, the United Kingdomand Vietnam.

Joyce Bounds, left, and Charlotte Beason, center, talk with thetranslator for the Russian group.

EMERSON SANDERS

Rapp

VAnguardaround headquarters


VA Deputy Secretary Leo S.Mackay Jr., Ph.D., joinedother VA officials, NationalPress Club members andguests at a luncheon featur-ing Irish tenor and veterans’advocate John McDermott inWashington, D.C., on Nov.6. In pre-Veterans Day re-marks at the Press Club, the

I sing really speaks to the vet-erans’ experience and I feel agreat deal of respect for themen and women who puttheir lives on the line for thesake of their country.”

His work as an advocatefor homeless veterans is wellknown. The HopeMcDermott Day ProgramCenter at the New EnglandShelter for Homeless Veter-ans in Boston opened in2000. Named for his mother,it’s the first of what he hopeswill be many program cen-ters across the country tohelp veterans make the tran-sition from homelessness toself-sufficiency. In 1999, heattended groundbreaking cer-emonies in Washington,D.C., for the McDermottHouse, a transitional housingcooperative for up to 40D.C. area veterans.

McDermott considersVeterans Day 1999 a high-

light of his career. He at-tended the Veterans DayBreakfast at the White Houseand ceremony at ArlingtonNational Cemetery as a guestof VA.

Later that day, he per-formed the song, “TheWall,” written by Vietnamveteran Tim Murphy, at theannual commemoration cer-emony at the Vietnam Veter-ans Memorial. He earmarkedthe royalties from his record-ing of that song to supporthomeless veterans.

Last year, the Congres-sional Medal of Honor Soci-ety presented McDermotttheir Bob Hope Award, givento entertainers who distin-guish themselves throughoutstanding service to orpositive portrayals of theU.S. military. Earlier thatyear, he received the Chapelof Four Chaplains’ Humani-tarian Award.

Irish Tenor McDermott Speaks Out on His Veterans’ Advocacy

Entertainer Wayne Newton Honored for Service to Veterans

Las Vegas entertainer WayneNewton stopped by VA Cen-tral Office on Sept. 17 to re-

ceive an award from Secre-tary Anthony J. Principi hon-oring the time and effort he

has devoted over many yearsto supporting the men andwomen who have served thenation in uniform.“We aregrateful for all he has done tohonor our nation’s heroes,”said Principi. “I invited himhere to express the apprecia-tion of all VA employees andto personally thank him forhis efforts.”

The Secretary presentedNewton with a plaque thatread: “From a grateful nationto a great patriot who hasgiven a lifetime of service toAmerica’s veterans, fromVietnam to Afghanistan.Your heart for, and dedica-tion to, those who haveserved our nation in uniformexemplifies the very spirit ofAmerica.”

Newton’s commitmentto America’s veterans dates toVietnam, where he did twotours with the USO. The en-tertainer, who is chairman ofthe USO Celebrity Circle,has visited troops in theMediterranean, Persian Gulf,and most recently, Afghani-stan.

While in VA headquar-ters, Newton also met withVA Deputy Secretary Dr. LeoS. Mackay Jr., toured thebuilding, and spoke with VAemployees about their serviceto the nation’s veterans. “Iam humbled to be hereamong those who have givenso much more than I havegiven,” he said. “What I havegiven pales, but what I gavewas my best.”

Scottish-born resident ofCanada explored his personalcommitment to Americanveterans’ issues.

“The veterans popula-tion is virtually ignored out-side of one day a year, but Ihope that recent events willchange that,” McDermottsaid. “So much of the music

Deputy Secretary Dr. Leo S. Mackay Jr., looks on as JohnMcDermott talks about his commitment to veterans’ causes.

ROBERT TURTIL

Wayne Newton greets Anita Major, a program assistant in theOffice of Intergovernmental Affairs, during his visit to VACO. Look-ing on is Inez Proctor, a program analyst.

ROBERT TURTIL

VAnguard


medical advances

D.C. VA Hospital Aheadof Latest Hand-HygieneRecommendationsGuidelines released Oct. 25by the Centers for DiseaseControl and Prevention tout-ing the advantages of alco-hol-based gels or foams overhand washing (www.cdc.gov/handhygiene/) came as no sur-prise to the infection controlteam at the Washington,D.C., VA Medical Center.They’ve been using thequick-drying hand rubs forthe past couple of years.

They installed hand-dis-infectant dispensers in all in-patient and outpatient clinicrooms in August 2000 aspart of a two-year study.

During that time, thenumber of new cases of resis-tant staphylococcus aureusdecreased by 21 percent, andthe number of resistant en-terococcus decreased by 43percent. Both of these bacte-ria are associated with seri-ous, hospital-acquired infec-tions.

“It’s a quick, easy wayfor health care workers to

disinfect their hands, and it’seffective,” said MaureenSchultz, R.N., infection con-trol coordinator.

Preventing the spread ofgerms in the hospital is vital,as patients may have weak-ened immune systems mak-ing them vulnerable to infec-tion. Studies show the mainway germs spread from pa-tient to patient is on thehands of health care provid-ers. The CDC estimates asmany as 2 million patientsget an infection each year in

U.S. hospitals, and about90,000 die as a result.

In its hand-hygiene re-port, the CDC announcedthat alcohol-based hand rubskill more bacteria than soapand water and are morelikely to be used by busyhealth care providers. Tradi-tional hand washing takestime, a valuable commodityin a hectic emergency room.The CDC estimates in aneight-hour shift, an intensivecare nurse can save one hourof time by using a hand rubinstead of washing with soap

and water. The hand rubsaren’t always appropriate,however, such as when handsare visibly dirty. In thesecases, a thorough washingwith soap and warm water isthe only way to go.

Lack of Natural ‘Antibi-otics’ May ExplainDermatitis InfectionsPeople with the most com-mon form of eczema are vul-nerable to skin infections be-cause they lack certain germ-killing peptides, according toa study published in the Oct.10 New England Journal ofMedicine. The finding maylead to a new type of antimi-crobial cream based on thebody’s own chemicals.

“This may explain whypeople with atopic dermatitisget infections,” said co-inves-tigator Richard Gallo, M.D.,Ph.D., a dermatologist withthe VA San Diego HealthcareSystem and the University ofCalifornia, San Diego. Gallo,who in 1994 was the first todiscover antimicrobial pep-tides in mammalian skin,worked on this study withinvestigators at the Denver-based National Jewish Medi-cal and Research Center andother sites.

When the skin is pen-etrated by pathogens, whiteblood cells attack the invaderto prevent infection. How-ever, this immune responsedoes not appear to happenreadily in atopic dermatitispatients, who often suffer re-curring skin infections.

Atopic dermatitis is aninherited disease usually ac-companied by asthma and al-lergies. It is marked by red,itchy, swollen skin.

Researchers analyzedskin samples from six healthyadults, eight patients withatopic dermatitis, and 11 pa-tients with psoriasis, another

common inflammatory skindisease.

The normal skin con-tained almost no antimicro-bial peptides, as these com-pounds are made only asneeded. The psoriatic skinshowed high levels, as is typi-cal for many inflammatoryskin conditions. But the skinwith dermatitis containedmuch lower levels, almostlike the normal skin.

Arkansas VA Endocri-nologist Makes HRTBreakthroughScientists have identified asynthetic estrogen-like com-pound that reverses bone lossin mice without affecting thereproductive system, as doesconventional hormone re-placement therapy. The find-ing, reported in the Oct. 25edition of Science, could leadto new and safer therapies toprevent osteoporosis.

“We are developing anew class of pharmaceuticalagents with the potential forbone-building, sex-neutralhormone replacementtherapy,” said lead investiga-tor Stavros C. Manolagas,M.D., Ph.D., an endocri-nologist with the Central Ar-kansas Veterans HealthcareSystem and the University ofArkansas for Medical Sci-ences.

The new study is thefirst time scientists havedemonstrated in animals howsynthetic hormones can buildbone without affecting repro-ductive organs. Conventionalhormone replacementtherapy with estrogen orprogestin has been shown toincrease the risk for breastcancer and cardiovasculardisease. The new compound,estren, is still years awayfrom human testing but rep-resents a promising advancein hormone therapy.

Maureen Schultz, R.N.,infection control coordinator at the Washing-ton, D.C., VAMC, uses a hand-disinfectant dispenser at the facility.

ANDREW WHITE

VAnguardhave you heard


A new cemetery for Florida

Two VA hospitals cel-ebrated 50th birthdays in Sep-tember and October. TheEast Orange Campus of theVA New Jersey Health CareSystem held a rededicationceremony on Oct. 8 to markits 50th birthday. SecretaryPrincipi joined about 250people gathered for the cel-ebration. VA New Jersey Di-rector Kenneth J. Mizrachsingled out nine employeesand recognized them for 35-plus years of service at thehospital. The Salt Lake CityVA Medical Center turned50 on Sept. 4. Hundreds ofemployees, veterans, volun-teers and community mem-bers turned out to mark theoccasion. When it opened onSept. 4, 1952, the Fort Dou-glas VA Hospital Building, asit was originally named, hadan inpatient bed capacity of546. Today, the hospital is

part of the VA Salt Lake CityHealth Care System, whichlast year served nearly 30,000veterans in 300,000 visits.

The VA Southern Ne-vada Healthcare System inLas Vegas opens its doorsfour times a year to care forneedy children through apartnership with Los Ange-les-based Zelzah ShrinersHospital. VA Las Vegas pro-vides office space, X-rayequipment, technicians, andother support to visiting doc-tors from Shriners whospend the day providing freehealth care to needy kids. “Itis a heartwarming scene tosee kids getting the invalu-able care and treatment theymay not have been able toreceive [otherwise],” saidMike Agricola, administra-tive officer to the chief ofstaff at the Las Vegas VA hos-

pital. The children seekingcare come from throughoutSouthern Nevada. For moreinformation, contact DavidMartinez, public affairs of-ficer, at (702) 636-3010.

Employees of TurnerClassic Movies, a division ofAtlanta-based Turner Broad-cast Systems, Inc., volun-teered at the Atlanta VAMedical Center as part ofTurner Volunteer Day, Sept.14. They painted a mural inthe dining room; plantedtrees, shrubs and flowers inthe rooftop garden of thenursing home; played bingo,scrabble and other games

A much-needed new cemetery is coming to South Florida.On Sept. 4 Secretary Principi signed a sales contract forVA to purchase 313 acres in southern Palm Beach Countynear Boca Raton. VA studies showed South Florida has alarge number of veterans not served by a national or stateveterans cemetery.

National Cemetery Administration officials evaluatedthirteen potential sites for the new cemetery. The finalsite was chosen for its many positive characteristics, in-cluding a high capacity for casketed gravesites, maturetrees, and a location within five miles of Florida’s Turnpikeand Interstate 95. President Bush’s fiscal year 2003 bud-get requested $23.3 million for VA to build the cemetery.

Secretary Principi announces the newly acquired site for a na-tional cemetery in South Florida on Sept. 4 at the West PalmBeach VA Medical Center.

GARY DALE

with patients; and set up artsand crafts booths. MollyReynolds, public affairs of-ficer at the Atlanta VAMC,said it was a day the hospitalwon’t soon forget.

About 60 guests packedthe chapel at the McGuireVA Medical Center in Rich-mond, Va., to celebrate themarriage of a heart-trans-plant patient. The hospitalstaff had a big role in prepar-ing for the wedding. Theydecorated the chapel, pro-vided the cake, set up the re-ception area, and made surethe groom was properly at-tired in a tuxedo.

Blind golfer Doug Mason shot 91 for 18 holes on his wayto winning the 9th annual TEE Tournament for Blinded Vet-erans. The golf tournament is open to legally blind veter-ans receiving VA visual impairment services. It gives theman opportunity to develop new skills and strengthen theirself-esteem.

More than 270 community volunteers helped makethe tournament possible. One of those, Mike Owen, VISTcoordinator for the Iowa City VA Medical Center, receivedthe Vonnie Gould TEE Volunteer Award for the effort heput into making the event a success. A record turnout of131 golfers participated in the tournament. It is sponsoredby the Iowa City VAMC and the Blinded Veterans Asso-ciation.

Blind golfers TEE off

A record turnoutof 131 golfersparticipated inthis year’s TEETournament.

VAnguard honors and awards


Tuning in to the Veteran

The Lexington, Ky., VAMedical Center received aJohn M. Eisenberg PatientSafety Award on Oct. 1 inWashington, D.C. Theaward’s sponsors, the Na-tional Quality Forum andthe Joint Commission onthe Accreditation ofHealthcare Organizations,commended the LexingtonVA hospital for its long-standing “Honesty Policy” ofopenly disclosing medical er-rors. According to Chief ofStaff Dr. Steve Kraman,families are receptive to thecandor. “By receiving a genu-ine apology and learningwhat has been done to pre-vent others from becomingvictims, families see this assomething good that hascome out of their misfor-tune,” he said.

Clark T. Sawin, M.D.,medical inspector for theVeterans Health Administra-tion, was elected to serve aspresident of the AmericanThyroid Association for2003-2004 during the firstcompetitive election in theassociation’s 79-year history.The U.S. Army MedicalCorps veteran served as chiefof the Endocrine-Diabetessection at the Boston VAMedical Center for morethan 30 years before movingto VA Central Office inWashington, D.C.

Gerald F. DiBona,M.D., chief of medical ser-vices at the Iowa City VAMedical Center and profes-sor at the University of IowaCollege of Medicine, receivedthe Novartis Award for Hy-pertension Research on Sept.26 at an American Heart As-sociation meeting in Or-lando. DiBona has con-ducted research for VA since1969. He shared the award

with John Hall, Ph.D., of theUniversity of Mississippi

MedicalCenter.The workof both re-searchershas chal-lenged thelong-heldview thathigh blood

pressure causes kidney disor-ders. DiBona’s and Hall’sfindings suggest, rather, thatincreased nerve activity tothe kidneys limits their abil-ity to excrete salt and water,which results in hyperten-sion.

Lawrence Dolecki,Ph.D., chief of the domicili-ary at the Martinsburg,W.Va., VA Medical Center,was elected to a two-yearterm as chairperson of theWest Vir-ginia Trau-matic Brainand SpinalCord InjuryRehabilita-tion FundBoard. TheBoard con-sists of 23representatives from stateagencies, public and non-profit organizations, and dis-ability advocacy groups. It isresponsible for administeringthe state’s rehabilitation fundand developing an ongoingsystem of services for peoplewith traumatic brain or spi-nal cord injuries.

Healthcare Informaticsselected Gail L. Graham, di-rector of information assur-ance in VA Central Office, asone of the nation’s top ten“IT Innovators” in their Sep-tember 2002 issue. She wasone of only two women tomake the top-ten list. The

group of IT innovators in-cluded Donald Berwick,M.D., president of the Insti-tute for Healthcare Improve-ment, and Michael R.Cohen, president of the In-stitute for Safe MedicationPractices. The list represents“the best that human poten-tial has to offer” in the healthcare IT community, accord-ing to editors.

The New York Women’sAgenda and United Federa-tion of Teachers announcedthat Pedro Perez, medicalmedia manager at the Bronx

VA Medi-cal Cen-ter, wasselected asthe win-ner intheir logocompeti-

tion for the New York ReadsTogether program. His logowill be featured on all theprogram’s materials. His de-sign was chosen because itembodies the program’sgoals—to foster communityspirit, a love of reading andshow the uniqueness of NewYork. Perez has been with theBronx VA since 1984.

The Association of VAPsychologist Leaders pre-sented a Special Contribu-tion Award to Terence M.Keane, Ph.D., chief of psy-chology in the VA BostonHealthcare System, duringthe annual meeting of theAmerican Psychological Asso-ciation in Chicago. He wasrecognized for “sustained andsignificant career contribu-tions to VA psychology.”

Teresita R. Larican,chief of VA’s Office of Acqui-sition and Materiel Manage-ment Fiscal Division inHines, Ill., was awarded the

National2002 Fed-eral AsianPacificAmericanCouncilOutstand-ingAchieve-

ment Award. Nominationsfor the award were solicitedfrom all federal departmentsand agencies. Larican washonored for her contribu-tions to the advancement ofAsian Pacific Americans andfor promoting diversity andequal employment in thefederal workforce. Her manyaccomplishments include de-veloping and supporting in-ternships and job trainingopportunities for Asian Pa-cific students. Throughouther 24-year VA career, shehas championed diversityand equal opportunity,mentoring employees of allraces and backgrounds.

The Leadership VAAlumni Association pre-

sented its2002 Hon-orary Lead-ershipawards toTimothy J.Stroup, na-tional di-rector forthe Con-

solidated Mail OutpatientPharmacy program inLeavenworth, Kan., andJames J.Farsetta,VISN 3(Bronx,N.Y.) di-rector. Theannualawardshonor twoVA execu-tives for their leadership andaccomplishments.

DiBona

Dolecki

Farsetta

Stroup

Larican

VAnguardheroes


Firefighters and policeofficers at the Battle Creek,Mich., VA Medical Centerwere the first responders onthe scene when a chemicalvapor buildup caused an ex-plosion and flash fire atJohnson Controls Inc., acompany adjacent to the fa-cility. Seven employees andseveral firefighters weretreated for minor injuriesand chemical exposure. Dueto the quick response of theVA staff, the firefighters wereable to start extinguishingthe fire and assisting injuredemployees before local emer-gency officials arrived.

Richard MacDonald, avocational rehabilitationcounselor at the Spark M.Matsunaga VA Medical andRegional Office Center, wassitting in front of the FirstHawaiian Bank on Mauiwhen he heard a bank tellershouting they had just beenrobbed. MacDonald joinedother citizens chasing thesuspect and spotted himjumping into his getaway car.He ran up to the vehicle,smashed the window andtried to pull the suspect fromthe car. The suspect put thecar in reverse and draggedMacDonald across the pave-ment, scraping his arms andlegs and throwing him awayfrom the vehicle. He steppedon the gas and sped from thescene but was apprehended ashort time later. The MauiPolice Commissioner hon-ored MacDonald with a cer-tificate of merit for his effortsto try to stop the suspect.

Barbara Perkins, R.N.,helped a woman suffering aGrand Mal seizure whileriding the Metra train onemorning. She is one of agroup of registered nurseswho rate veterans’ disability

claims at the Chicago VARegional Office. She wasriding the train to workwhen the operator got on theintercom and asked if some-one with medical trainingcould come to the secondcar. Perkins responded andcould tell the woman wassuffering a Grand Mal sei-zure, characterized by loss ofconsciousness, falling downand rhythmic convulsions.She comforted the womanand checked her purse foridentification or medication.The woman had three moreseizures before the trainreached the station, butPerkins was there all along,doing what a trained profes-sional is supposed to do. Shenever mentioned the incidentwhen she got to work thatmorning, but a colleagueriding the same train saw itall and told managers whatshe did. They presented herwith a dozen roses for her ac-tions.

Police officers from theIowa City VA Medical Cen-ter nabbed a murder suspectwhen he dropped by the out-patient pharmacy to refill a

prescrip-tion. TheVA Officeof the In-spectorGeneralcontactedPoliceChief NickCappussi

and asked him to alert hisforce that the suspect waswanted by detectives in NewYork City on charges stem-ming from a double homi-cide. He was consideredarmed and dangerous.Cappussi and his officersworked with the FBI andother law enforcement agen-cies to set up surveillance at

the hospital. A month later,the suspect was spotted at thepharmacy. Chief Cappussi,along with Sgt. Randy Smithand Officers Merle Kelleyand Mike Barry, took thesuspect into custody andcalled detectives to let themknow they had their man.

Returning from routinesecurity checks on a publicroad just outside thegrounds of the Bath, N.Y.,VA Medical Center, PoliceOfficers Frank Judd andHarry Adler came upon the

Debbie Fowler stayed cool when she discovered thehomeless man sitting in her office was wanted in fourstates for multiple sexual assaults on women and chil-dren.

He had walked into Fowler’s office at the VA clinicin Colorado Springs, part of the Southern ColoradoHealthcare System, in search of a pair of shoes. Theydidn’t have his size, so she told him to come back.

He came back four days later, still looking for shoes,but also seeking a refill on his prescription. “Call the VAin Tucson,” he told her, “they have my file.” Staff at theTucson VA had more than his medical records—theyalso had the scoop on his crime spree.

As she hung up the phone, Fowler knew she had tocall the police and keep the fugitive in the clinic untilthey arrived. She sent him upstairs to check the dona-tion room one more time while she put in a call to theU.S. Marshal’s office. He came back empty-handed, butFowler had another trick up her sleeve. She told him herhusband wore the same size shoe and he had an extrapair he could have.

Take a seat, she told him, and she’d call her hus-band and have him bring a pair. Fifteen minutes later, of-ficers with the Colorado Springs Police Departmentburst in and took the man into custody. The arrest cameas producers from “America’s Most Wanted” were pre-paring a segment on the fugitive, who was wanted formultiple sexual assaults, kidnapping, attempted homi-cide and two burglaries.

Fowler isn’t sure how she managed to stay calmduring all this. “I don’t know how I did it,” she said. “Ijust asked the Lord to give me strength.”

Dangerous fugitive captured

Cappussi

scene of a vehicle accident.The driver was bleedingheavily from a hand injurythat had severed his indexfinger. Officer Judd immedi-ately took control of thescene, alerting local authori-ties and directing trafficaround the accident. OfficerAdler stabilized the victim,controlling his bleeding un-til local police and ambu-lance crews arrived. The of-ficers stayed on the scene toassist as needed. The victimwas airlifted to a nearby hos-pital.

waiting for care - united states department of veterans ... · taxpayer dollars in pharma-ceutical...

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