VAnguard Magazine by dfgh4bnmu


									          January/February 2009

Shinseki at the Helm
Veterans Treatment Court
30th Anniversary of VistA
Community Living Centers
                                                              V A nguard

                                                  Two More New VA National Cemeteries                                    6
                                                  Formal ceremonies are held in Pennsylvania and California
                                                  Helping Families Heal—One Session at a Time                            7
                                                  Vet centers counsel returning veterans on the ‘Road to Recovery’
6                                                 Wreaths Across America’s Rapid Growth                                  8
                                                  Ceremonies support the mission by remembering and honoring vets
                                                  A Day to Remember                                                      9
                                                  Washington, D.C., VAMC employees support the inauguration
                                                  Ensuring Efficient Patient ‘Handoffs’                                  12
                                                  A local software innovation is improving patient safety nationwide
                                                  Therapeutic Court for Veterans                                         14
                                                  Veterans charged with non-violent offenses are getting a second chance
                                                  Matching Veterans With VA Jobs                                         16
9                                                 Veterans employment coordinators are helping vets start new careers
                                                  Escape from Vietnam                                                    18
                                                  Employee gives back to the veterans who fought for his country
                                                  From ‘Underground’ to ‘World-Class’                                    20
                                                  VistA celebrates 30 years
                                                  Transforming Nursing Home Care                                         22
                                                  Gone are the outmoded practices of the traditional approach

22                                                Departments
                                                  3       Secretary’s Message                 31       Medical Advances
                                                  4       Outlook                             33       Have You Heard
                    VAnguard                      5       News You Can Use                    36       Honors
                  VA’s Employee Magazine          26      Around Headquarters                 39       Heroes
                  January/February 2009           30      Introducing                         40       Inauguration 2009
                  Vol. LV, No. 1
Printed on 50% recycled paper

Editor: Lisa Respess Gaegler
Assistant Editor/Senior Writer: Gary Hicks
Photo Editor: Robert Turtil                                                        On the cover
Photographer: Art Gardiner                                                         Retired Army Gen. Eric K. Shinseki
Staff Writer: Amanda Hester                                                        prepares to testify at his Senate
                                                                                   confirmation hearing. He took the oath of
Published by the Office of Public Affairs (80D)                                    office as the nation’s seventh Secretary of
                                                                                   Veterans Affairs on Jan. 21. A former Army
U.S. Department of Veterans Affairs                                                chief of staff, the West Point graduate
810 Vermont Ave., N.W.                                                             served two combat tours and was wounded
Washington, D.C. 20420                                                             in action in Vietnam. He went on to serve
(202) 461-7427                                                                     with distinction in Europe, the Pacific
E-mail:                                                            and stateside before his 2003 retirement.                                                    photo	by	Robert	Turtil

2	                                                 							January/February	2009
                          THE SECRETARY OF VETERANS AFFAIRS

Fellow Department Employees and Families,

       I am a Veteran, and I am deeply grateful to President Obama for the opportunity to
serve with you in meeting the obligations to the men and women who have kept our Nation
the land of the free and the home of the brave. For me, this is a noble calling, not just be-
cause of the President’s invitation, but also because it provides an opportunity to give back to
those who served with and for me during my 38 years in uniform.

       We have a solemn responsibility to our Veterans, not just for today, but in the months
and years to come as more Veterans enroll to secure the benefits and services they have al-
ready earned by their service to the Nation. I am committed to transforming our Department
so that it will be well-positioned to perform this duty even better during the 21st Century. I can-
not do this without your support and our adherence to the highest standards of conduct. How
we go about our duties each day—ethically and transparently—is as important as what we do.

       Creating the vision for transforming VA into a 21st Century organization requires a
comprehensive review. In that review, we must understand that people are central to every-
thing we do, that results count and we will be measured by what we accomplish, not by what
we promise, and that the best days of VA are ahead of us. We will fulfill President Lincoln’s
charge by redesigning and re-engineering ourselves for the future.

        Transforming any institution is supremely challenging. I know that from my experiences
in other proud and high-performing organizations. But even the best organizations must be
prepared to change to meet changing times and clients’ needs. Historically, organizations un-
willing or unable to undergo change soon find themselves irrelevant. Our Veterans do not de-
serve irrelevance.

         Providing them our best efforts to deliver the highest quality care and services we can
provide in a timely, consistent and fair manner is our responsibility—not theirs. Their welfare—
their lives—depend on how well we do our part. I take that responsibility seriously and ask for
your help and support every day to meet our obligation to them.

        Our path forward is challenging, but the President and the Congress support us and
have asked us to do this well—for our Veterans. I am honored to lead this organization of
dedicated and competent people. Together, we will transform the VA into an organization that
reflects the change and commitment our Nation expects and our Veterans deserve. I look
forward to meeting you as I get out and about, and I value your thoughts and insights as we
develop our 21st Century vision together.

                                                        Eric K. Shinseki
                       outlook                                 V A nguard

                   Stomping Out Unnecessary Collection and Use of SSNs
                   Sally Wallace
                   Associate Deputy Assistant Secretary for the Office of Privacy and Records Management

Once upon a time, people            thief. Specifically, agencies      of SSNs. The focus of the         identifier for use among the
didn’t worry about their Social     were told to develop alterna-      new policy is to reduce and,      various administrations and
Security numbers. They ap-          tive strategies for using the      where possible, eliminate the     VA systems. In the near term,
peared on our checks, driver’s      numbers as personal identifiers    collection and use of the SSN     we may need to develop one
licenses, bank accounts and tax     for federal employees and par-     as the primary identifier for     or more identifiers for each
forms. Businesses used them         ticipants in federal programs.     individuals.                      veteran or beneficiary, with a
to identify customers, and          Subsequently, the Office of             Beginning in February,       correlation among the identi-
federal agencies used them to       Management and Budget              each administration and staff     fiers maintained in a single
identify program participants       directed all federal agencies to   office must develop their own     authoritative data source. In
and employees.                      develop and implement a plan       SSN reduction plan and pro-       the long term, the Office of
      How times have changed!       to eliminate the unnecessary       vide quarterly updates to my      Information and Technol-
The introduction of the com-        use of SSNs.                       office, which will combine the    ogy is striving to develop and
puter and the Internet made it            In July 2007, former VA      information into a Depart-        implement an approach that
easy for unscrupulous people        Chief Information Officer          ment-wide plan.                   will reduce the collection
to collect all types of personal    Robert Howard created the               The Veterans Health          of SSNs and other PII and
information, including Social       VA SSN Working Group,              Administration will conduct a     maintain the information in a
Security numbers. With this         under the direction of my of-      thorough inventory of its SSN     single authoritative data source
information, identities can be      fice. This group, composed of      holdings this summer. My          instead of the current process
stolen, bank accounts emptied,
and credit histories ruined.
      Here at VA, we collect
                                    VA is committed to moving away from using the SSN as
and maintain information on         the primary identifier and authenticator for veterans and
more than 26 million veterans,      beneficiaries.
their dependents, and their
beneficiaries. We use the SSN       representatives from each of       office and the VA SSN Work-       of collecting and maintaining
to ensure that veterans receive     the administrations and staff      ing Group are collaborating       this information in multiple
the correct care, treatment and     offices, developed VA’s first      with VHA so that non-VHA          systems across the administra-
medications. We also use it as      overall plan to reduce the col-    organizations will be able to     tions.
the claim number to provide         lection and use of the SSN.        use their inventory for SSN             It will take time and
benefits. Every day, we need to           Our efforts to reduce the    data collection efforts. The      funding to develop and imple-
be extremely careful with how       use of SSNs began well before      survey data will be evaluated     ment new veteran identifiers.
we access and use this infor-       May 2006. Veteran identifica-      to make informed interim and      Until then, we will need to
mation.                             tion cards issued since 2004       long-term business decisions      continue to use the SSN to
      May 2006 was a turning        no longer display the number.      related to continued collec-      ensure the timely and accurate
point in how the government         SSNs have been removed             tion and use of the SSN. The      delivery of health care and oth-
and the public viewed person-       completely or reduced to the       outcome may include reduc-        er VA benefits to veterans and
ally identifiable information       last four numbers on corre-        ing, eliminating or replacing     their dependents. My office is
(PII) and the vulnerability of      spondence. VA’s Consolidated       the number with a different       working closely with the other
SSNs when President Bush            Mail Outpatient Pharmacies         unique identifier.                offices within OIT to continue
established the President’s         now use an internal tracking            VA is committed to mov-      to strengthen protections of
Task Force on Identity Theft        number instead of the SSN for      ing away from using the SSN       internal uses of Social Security
to provide a coordinated ap-        prescription labels, prescrip-     as the primary identifier and     numbers and other personally
proach among government             tion refill documents, and         authenticator for veterans and    identifiable information. For
agencies to combat identity         mailing labels.                    beneficiaries. However, we        more information, visit www.
theft.                                    We submitted VA’s initial    will continue to collect and
      The task force’s first rec-   SSN reduction plan to OMB          use the number for necessary
ommendation addressed the           in September 2007 and an up-       purposes, such as when match-      For more on VA’s efforts
need for government agencies        dated plan in September 2008.      ing records with other federal     to eliminate the unneces-
to reduce the unnecessary use       In November 2008, Howard           agencies.                          sary use of SSNs, go to
of the SSN, the most valuable       signed a VA-wide policy on              Finally, VA is considering
commodity for an identity           reducing the unnecessary use       the creation of a “One VA”

	                                                  							January/February	2009
                                                                V A nguard                                 news you can use

Department-wide Employee Health Initiative Gets Underway
On Sept. 23, 2008, former          based VISN 23’s Employee
VA Secretary James B. Peake,       Health Promotion Disease
M.D., and Alma Lee, presi-         Prevention Pilot kicked off
dent of the American Federa-       at the end of January. Called
tion of Government Employ-         “Wellness Is Now VA,” the
ees-National Veterans Affairs      WIN VA program seeks to
Council, jointly approved a        change unhealthy behaviors of
message to all VA employees        facility employees and aims to
announcing a new Depart-           integrate workplace safety, dis-
ment-wide health and well-         ease prevention and worksite
ness initiative. In the coming     health protection.
months, VA will develop and              The program’s focus
implement a strategic plan to      includes: ergonomics interven-       Robert Fischbach, assistant can-
communicate various activities     tion (safe patient movement          teen chief at the Minneapolis VA
taking place across the Depart-    and handling); work organi-          Medical Center.                                          april eilers
ment that can improve and          zation assessment; violence
enhance the health and well-       prevention; sharps injury            counseling and free nicotine       sure the effectiveness of the
being of all VA employees.         prevention; slips, trips and falls   replacement; stress interven-      program by employee partici-
      Led by VA’s Office of        prevention; aging workforce          tion at the individual level       pation and impact. Outcomes
Human Resources and Ad-            initiatives; and stress reduction    through a Web-based tool to        will be measured through such
ministration, and sponsored by     components.                          complement national work or-       metrics as disability costs and
VA’s National Quality Coun-              Other key health pro-          ganization efforts; face-to-face   days, workers’ compensation
cil, the program emphasizes        motion features include: a           health coaching; healthy living    costs, safety data, sick leave,
that a healthy lifestyle enhanc-   health risk appraisal; physical      classes and other educational      health insurance costs, and
es employee productivity and       activity programs to promote         opportunities; and ongoing         employee survey results.
reduces health care costs, rates   improved fitness and ability         health prevention monitoring            Visit www.prevention.
of illness, injury and employee    to work; healthy eating as-          and oversight at the facility for information on
absenteeism. Informational         sistance, including nutritional      level.                             planned local activities and
sessions will be offered on such   and caloric intake assessment              Working in partnership       promotional and marketing
topics as the importance of        with self-help tools; a tobacco      with employees across the or-      information on the Depart-
physical activity, weight man-     cessation program, including         ganization, VA plans to mea-       ment’s fitness programs.
agement, smoking cessation,
stress management, healthy
lifestyles, and nutrition.
                                   Design the 2009 National Veterans Day Poster
      A new VA Health &            Interested in designing a            be 18”x 24” at 300 dots per        the work of the artist and is
Wellness Committee, chaired        national poster to honor vet-        inch, but scale down submis-       not copyrighted material (i.e.,
by Willie L. Hensley, deputy       erans? Then the Veterans Day         sions to 9”x 12” and submit        photos and concepts). The
assistant secretary for human      National Committee would             electronic versions as JPEG        committee may select a par-
resources and administration,      like to hear from you. The           images or PDF files via e-mail     ticular submission but ask the
was formed to promote the          committee is seeking submis-         to: Alterna-       artist to make modifications to
health and wellness of all VA      sions for the 2009 national          tively, send copies of artwork     the original design. Additional
employees, their families and      Veterans Day poster.                 or a CD with artwork files         changes may be required prior
their local communities. The             The poster is distributed      to: Department of Veterans         to printing.
group held its kick-off meeting    to more than 110,000 schools         Affairs (002C), 810 Vermont
in January and will be meeting     nationwide, military installa-       Ave., NW, Washington, D.C.,        Correction
quarterly to collaborate on the    tions around the world, and to       20420. Do not send originals.      VAnguard neglected to credit
Department’s efforts.              federal agencies in the nation’s     The deadline for submissions       VFW Magazine Senior Writer
      Eager to begin, some fa-     capital. It also graces the cover    is May 1.                          Kelly Lanigan for material she
cilities around the nation have    of the official program booklet            To view Veterans Day         developed that was used in the
already started taking action      for the Veterans Day cer-            posters from previous years,       cover feature article “Tackling
on their own campuses. By          emony at Arlington National          visit and       a Growing Problem for Veter-
adding essential health promo-     Cemetery. The committee will         click on “Poster Gallery.”         ans” in the November/Decem-
tion elements to a strong na-      convene in May to review sub-        Submissions should include         ber 2008 issue. We regret the
tional occupational safety and     missions and select a finalist.      sufficient information to          oversight and thank Lanigan
health program, Minneapolis-             The final poster must          demonstrate that the image is      for the contribution.

	                                                   							January/February	2009	                                                           
                      feature                               V A nguard

Two More New VA National Cemeteries
Formal groundbreaking and dedication ceremonies are held in
Pennsylvania and California.

         he Department dedicated two near the location where, on the night                east of the city, Bakersfield National
         new national cemeteries in             of Dec. 25, 1776, Gen. George Wash-       Cemetery is a scenic 500-acre expanse
         the last two months of 2008,           ington crossed the Delaware River         of rolling hills, green meadows and
bringing the total number of dedica-            and went on to defeat the British at      300-year-old oak trees. Because the
tions to seven for the year. Former             the Battle of Trenton. “This country      ceremony took place on the 67th an-
Under Secretary for Memorial Af-                was founded because of the valor of       niversary of the attack on Pearl Har-
fairs William F. Tuerk hosted formal            American fighting men and women           bor, Tuerk spoke of the special con-
groundbreaking and                                                                                         tributions of veterans
dedication ceremonies                                                                                      from the World War
for the Washington                                                                                         II era. “They preserved
Crossing National                                                                                          this nation and ad-
Cemetery on Nov. 16                                                                                        vanced freedom around
and the Bakersfield                                                                                        the globe during those
National Cemetery                                                                                          horrific years,” he said.
on Dec. 7. These two                                                                                       “To them and to all
cemeteries will serve                                                                                      veterans, we owe a full
thousands of veterans                                                                                      degree of honor, respect
and their families in                                                                                      and reciprocation. We
the Philadelphia and                                                                                       re-affirm that debt to-
central California re-                                                                                     day with the dedication
gions.                                                                                                     of this new cemetery
     Hundreds of ex-          It was a blustery day outside the tent where                                 here in the great state
cited veterans, many          the Washington Crossing National Cemetery                                    of California.”
wearing the garb of           dedication was held on Nov. 16, 2008.                          jack widmaier       In its largest cem-
veterans service or-                                                                                        etery expansion since
ganizations, were on                                                                                        the Civil War, VA
hand at both ceremo-                                                                                        anticipates interments
nies to hear speeches                                                                                       at both cemeteries to
by local officials and                                                                                      begin in 2009. In 2008,
to witness the formal                                                                                       VA also dedicated Fort
groundbreaking and                                                                                          Jackson National Cem-
unveiling of the dedica-                                                                                    etery (Columbia, S.C.);
tion plaque. Sen. Arlen                                                                                     Jacksonville National
Specter (R-Pa.) and                                                                                         Cemetery (Fla.); Sara-
former Under Secretary                                                                                      sota National Cemetery
Tuerk delivered the                                                                                         (Fla.); Alabama Na-
keynote addresses at                                                                                        tional Cemetery (Mon-
Washington Crossing                                                                                         tevallo); and South
National Cemetery and                                                                                       Florida National Cem-
Bakersfield National                                                                                        etery (Lake Worth).
Cemetery, respec-             The undeveloped site of Bakersfield National Cemetery.            chris erbe
                                                                                                            First interments at
tively. Both ceremonies                                                                                     three of the new cem-
featured military honors from local             right here in Washington Crossing,”       eteries occurred in January, bringing
reserve units and the performance of            Specter remarked. “This country was       the total number of VA-operated na-
taps by a military bugler.                      preserved in the wars that followed.”     tional cemeteries to 128.
     The Washington Crossing area                   Located in the foothills of the Te-
is historically significant because it is       hachapi Mountains, 20 miles south-        By Chris Erbe
	                                               						January/February	2009
                                                          V A nguard                               feature

Helping Families Heal—One Session at a Time
Vet centers counsel returning veterans and their families on the ‘Road
to Recovery.’

           ichael Drummond served             veterans who served in a combat zone. the vet center program exists and
           in Iraq with the Army from         The centers also offer free counsel-        participates in events like the Road to
           2003 to 2005. His face is          ing services to the family members of       Recovery Conference, he said, stress-
somber as he talks about the fateful          veterans.                                   ing that the returning warrior needs to
day when six of his platoon leaders                The centers welcome home com- understand that they are not alone.
were killed and many of his fellow sol- bat veterans and offer a multitude                      Three vet center employees—
diers injured. One remains at Walter          of resources to help these veterans         Rafiq Raza, Eric Lundblom and Chris-
Reed Army Medical Center in Wash- during their transition from military                   topher Fillmore—staffed an outreach
ington, D.C., still recovering from his to civilian life. The support includes            booth at the conference. All three
wounds.                                       counseling (individual, employment,         used vet centers following their com-
     Drummond is trying to                    group, marital, family and bereave-         bat tours in Afghanistan or Iraq. Now
cope—both emotionally and physi-              ment), medical referrals, alcohol and       their mission is to rally around those
cally—with what happened. To help             drug assessments, and assistance with       veterans in their communities who
move past his time in Iraq, he and            applying for VA benefits.                   have recently returned from combat.
his fiancé, Melissa Leravi,                                                                         They visit schools, travel to
attended the Coalition to Sa-                                                                       conferences, give presenta-
lute America’s Heroes annual                                                                        tions and participate in the
Road to Recovery Confer-                                                                            Road to Recovery Conference
ence Dec. 7-11, 2008, at the                                                                        each year.
Walt Disney World Swan                                                                                   Other vet center em-
Resort in Orlando, Fla.                                                                             ployees, such as Dr. Greg In-
     Nearly 140 families                                                                            man, vet center team leader
attended the all-expenses-                                                                          in Raleigh, N.C., presented
paid educational and service                                                                        work sessions for couples and
gathering. The event provid-                                                                        families and addressed many
ed wounded service members,                                                                         of the interpersonal issues
their families and caregivers       Vet center em-                                                  confronting families during
one source of information           ployees Rafiq                                                   readjustment from the com-
about benefits, services, coun- Raza, Christo-                                                      bat zone to their communi-
                                    pher Fillmore
seling, insurance, health care, and Eric Lun-                                                       ties. Vet center counselors
financial support and employ- dblom (left to                                                        were also available through-
ment opportunities.                 right).                                          heather frank  out the four-day conference
     Drummond explained                                                                             to help with consultations,
that upon returning from Iraq, wound-              Dr. Robert T. Frame, a combat-         discussions or referrals to their local
ed service members are treated and            wounded soldier and retired Army            vet centers.
then released to return to their lives.       Reserve colonel who is the vet cen-               Reflecting on the conference,
But their lives have changed immea-           ters’ national Operation Enduring           Drummond said this American gen-
surably. Many are unsure about how            Freedom/Operation Iraqi Freedom             eration is just now starting to un-
to readjust to civilian life with their       returning warriors liaison, attended        derstand the needs of its newest war
new physical and mental challenges.           the Road to Recovery Conference.            veterans. The vet centers are work-
     At the forefront of the Road to          He said the first step toward recovery      ing to meet those needs. For more
Recovery Conference is VA’s vet               for many returning combat veterans          information on vet centers or to find
center program. There are more than           is to realize and accept that there is      the nearest one, call 1-800-905-4675
230 community-based vet centers that some sort of disconnect in their life.               (Eastern) or 1-866-496-8838 (Pacific),
offer readjustment counseling and             This disconnect can be mental, physi- or visit
outreach services in a caring man-            cal or even material, but it is normal
ner free of charge to all U.S. military       and somewhat expected. This is why          By Heather Frank
	                                               							January/February	2009	                                                  
                      feature                              V A nguard

Wreaths Across America’s Rapid Growth
Ceremonies support VA mission by remembering and honoring veterans.

           ational and state veterans        6,300 gravesites,” said cemetery work        Cemetery. That simple question from
           cemeteries teamed with the        leader Bruce Schaffer. “That’s up from a young boy caused quick action by
           Worcester Wreath Com-             about 20 people placing seven wreaths local citizens and resulted in 14,000
pany, veterans service organizations,        the year before.”                            wreaths being placed at the cemetery
community organizers and many oth-                Quantico National Cemetery in           this year.
ers to produce the most successful           Virginia had a similar experience. “It’s          Speaking to the large crowd at
“Wreaths Across America” campaign            getting bigger every year,” said Direc-      Houston National Cemetery about
to date on Dec. 13, 2008. The grass-         tor Karl MacDonald.                          the fallen veterans, former Under Sec-
roots effort to honor fallen veterans             The size of the ceremonies ranged retary for Memorial Affairs William F.
by placing holiday wreaths on their          from large (5,000 people at Houston          Tuerk said, “It is in their honor that
headstones or by holding wreath              National Cemetery) to small (24              each wreath be placed here today,
ceremonies in veterans cemeteries            people braved icy road conditions            as an expression of a grateful nation,
has become a national phenomenon.            to lay wreaths at New York’s Gerald          as a symbol of our collective respect
By any measure, this year’s Wreaths          B.H. Solomon Saratoga National               and appreciation for all that has been
Across America, with the support of          Cemetery). Young people supported            given, and for all that will be given if
VA, showed tremendous growth.                the events in significant ways through duty so requires, and as a modest sign
      Wreaths Across America traces          organizations like the Civil Air Patrol, of our determination to give some-
its roots to 1992, when Mor-                                                                       thing back.”
rill Worcester, president of the One of the many                                                        Former Secretary of Vet-
Worcester Wreath Company            volunteers lays a                                              erans Affairs James B. Peake,
                                    wreath at Fayetteville
in Harrington, Maine, do-           National Cemetery in                                           M.D., expressed his apprecia-
nated leftover wreaths to Ar-       Arkansas.                                                      tion to Worcester during a
lington National Cemetery for                                                                      ceremony at Arlington Na-
placement on the headstones                                                                        tional Cemetery by present-
of fallen veterans. The event                                                                      ing him the Secretary’s VA
caught on and grew larger                                                                          Commendation Award. “The
every year. In 2006, national                                                                      beautiful wreaths that are laid
and state veterans cemeteries,                                                                     gracefully every year continue
as well as private cemeteries                                                                      to remind us and future gen-
with veteran sections, held                                                                        erations of the sacrifices of
ceremonies of their own, and                                                                       our veterans and emphasize
Wreaths Across America was                                                                         the unity of our nation,” said
born.                                                                               bruce schaffer
                                                                                                   Peake as he presented the
     This year, participants                                                                       award. “We thank you for
placed more wreaths at veterans              which played a major role in organiz-        your generosity and commitment.”
cemeteries than ever before. In 2007,        ing ceremonies around the country.                From modest beginnings, Wreaths
32,000 wreaths were placed in 286                 Wreaths Across America, de-             Across America has developed into
cemeteries. In 2008, volunteers placed signed to “remember, honor and                     a dynamic opportunity to remember
105,000 wreaths in 354 cemeteries.           teach,” also reached a wide audience         our nation’s veterans. With the full
     “We were absolutely thrilled            through the media. Newspaper and             support and encouragement of VA,
with the turnout,” said Christopher          television outlets across the nation         momentum is increasing, with plans
Mannozzi, administrative officer at          produced hundreds of feature stories         already in place to expand activities
Pennsylvania’s National Cemetery of          on the wreath-laying events. There           in 2009.
the Alleghenies. “It was double what         were heartwarming stories, like that of           For more information about
it was last year.”                           6-year-old Alex DeMasi, of Humble,           Wreaths Across America, visit their
     Despite the cold weather, Arkan- Texas, who asked his father why                     Web site at www.wreaths-across-
sas’ Fayetteville National Cemetery          wreaths were laid in honor of veter-
also drew a large crowd. “We had             ans at Arlington National Cemetery
about 450 volunteers place wreaths on but not at nearby Houston National                  By Chris Erbe
	                                              						January/February	2009
                                                            V A nguard                          feature

    A Day to
    Washington, D.C.,
    VA Medical Center
    employees volunteer                     President Barack

    to support a history-                   Obama and his
                                            family wave to the
                                            crowd after his
    making inauguration.                    inaugural address
                                            on the west steps
                                            of the U.S. Capitol.                                                          dod

    t’s 9 p.m. on Monday, Jan. 19, the     Initially, nearly 400 D.C. VAMC           ambulances would be available due to
    Martin Luther King Jr., holiday,       employees volunteered to work the         shortages and transportation gridlock,
    and there’s excited chatter in the     9 p.m. to 9 p.m. shift, even though       the D.C. VAMC requested an ambu-
usually silent halls of the Washington,    most could have joined their families     lance from the Martinsburg, W.Va.,
D.C., VA Medical Center. Staff in          and the throngs making history at         VAMC for emergency transfers.
Redskins sweats, Betty Boop scrubs,        the Capitol and along Pennsylvania             That’s where the alphabet soup
well-worn blue jeans and fluffy slippers   Avenue.                                   of city health care oversight teams
sign in for duty—a 24-hour shift that           Inauguration events created a for-   came in. They include the Washing-
will take them through inauguration        midable planning task for capital city    ton, D.C., Department of Health, or
festivities on Jan. 20.                    hospitals. The D.C. VAMC started          DCDOH, and the District of Colum-
      Carrying pillows and overnight       work earlier than most. Chiefs of key     bia Emergency Health Coalition, or
bags to their assigned sleeping areas,     services began meeting shortly after      DCEHC.
they test the inflation on their air       Thanksgiving to assess staff and supply        Steve Mabley, VISN 5 (Balti-
mattresses, plug in personal TVs to        needs. Working within the guidance        more) regional emergency manager,
check crowd activity on the National       of the facility’s emergency manage-       represents the medical center on the
Mall, turn down their “Property of         ment plan and District of Columbia        Health Coalition, the umbrella or-
the Department of Veterans Affairs”        Hospital Association agreements, the      ganization for all emergency health
sheets and try to get some shut-eye        medical center would get all emergen-     operations in the capital city. The
before the big day.                        cy patients identified as veterans.       Health Coalition is the staging asso-
      More than 200 doctors, nurses,            Fernando O. Rivera, medical          ciation for regional hospital exercises
clerks, housekeepers, plumbers, phar-      center director, and Mike Dunfee,         and determines information-sharing
macists and administrators worked          associate director and commander of       strategies pertaining to potential vio-
that long shift. More than 100 of          the Emergency Command Center,             lence, infectious disease, bed availabil-
them were “sheltered in place” at the      decided to double the emergency           ity, ambulance service, transportation,
medical center as part of inauguration     department staff on duty. A general       housing for staff and more.
preparations that began many weeks         surgeon, an anesthesiologist, radiology        Hospitals communicate with each
before.                                    and surgical support staff would also     other on a dedicated radio frequency
      City and federal predictions of      be required.                              called the Hospital Mutual Aid Ra-
record-breaking crowds descending               Ambulance service was a major        dio System, or HMARS. This radio
on Washington, D.C., required major        hurdle to jump—accessibility and safe     system and a secure Web site, the
road and bridge closures. That meant       movement required complex choreog-        Healthcare Information Sharing Sys-
hospitals had to get people at their       raphy on a city-wide scale. Since there   tem, take the pulse of the city’s needs
posts prior to the potential onslaught.    was no assurance that commercial          throughout emergency situations
	                                              							January/February	2009	                                                9
                       feature                               V A nguard

and share data on an agreed-upon                   Fifty-two DCDOH health stations          to demonstrate their appreciation of
schedule, increasing communication            and five Disaster Medical Assistance          staff hard at work during this historic
frequency as the event progresses. Po-        Teams were deployed to strategic lo-          weekend. Two of the three hospital
lice and fire officials use the Web site      cations along the parade route and on         shuttles serving subway stations re-
when allocating patients and ambu-            the Mall. These mobile medical units          mained in operation for their conve-
lance runs. It’s also used to determine       took care of scrapes, bruises and freez-      nience. Meals were provided through-
which transport routes to open when           ing-cold fingers, freeing up emergency        out the 24-hour shelter period. The
traffic pile-ups, subway station clo-         departments for more serious cases.           canteen and retail store were open for
sures, and violent incidents occur.           DMATs had more than 100 ambu-                 business, and even the Starbucks Café
      Throughout the holiday weekend          lances at their disposal, many brought        was making lattes and smoothies. A
and on Inauguration Day, hospitals            in from distant locations.                    large flat-screen TV was moved into
shared bed counts and emergency                    With an estimated 1.8 million            the atrium café so that staff and vol-
room admissions on the Web site and           Americans and foreign nationals,              unteers could watch the proceedings
during daily Health Coalition confer-         working folks and dignitaries over-           of the day together. And for those
ence calls. There were more than 200          flowing streets and parks in the frigid       eager to keep their New Year’s resolu-
patients treated in emergency depart-         city, officials remarked that it is mirac-    tions, the hospital’s Wellness Center
ments throughout the city—eight at            ulous that D.C. hospitals did not en-         was open for workouts (and showers).
the D.C. VAMC. One primary care               counter more emergency admissions.                 The VA Maryland Health Care
clinic remained open to walk-in traf-         Thirty children were separated from           System supported the D.C. VAMC
fic and for transfers of non-emergent         their families over the weekend. Good         by providing additional medical sup-
patients from the emergency depart-           Samaritans brought them to police             plies well in advance of projected
ment. The Charlotte Hall, Md., com-           officials and all were safely returned to     road closures. “VISN 5 facilities really
munity-based outpatient clinic was            their families.                               pulled together, ensuring the D.C.
also open.                                         D.C. VAMC leaders took care              VAMC would be fully supported and

  Personally Invited to Be a Witness to History
  Va registered nurse anne stoefen returned home to minneapolis from washington, d.c., on jan. 21, like thousands of oth-
  ers who had traveled long distances to witness the historic inauguration of president barack obama. like many fellow trav-
  elers, she wore a button that proclaimed, “i was there!” her button should have read, “i was really, really there!”
       she was one of 41 people from across the
  country invited to spend the inaugural weekend                                                       VA nurse Anne Stoefen with
  in washington as personal guests of the obama                                                        First Lady Michelle Obama.
  family. she, her father and three sisters rode the in-
  auguration train to d.c. with the obamas, observed
  the swearing-in from a Vip area, and danced
  alongside the obamas at their first inaugural ball.
       “unbelievable,” said stoefen as she recalled
  the trip. as historic as the event was, it had even
  deeper personal meaning for her, mingling, as she
  put it, “excitement with sadness.”
       stoefen’s mother, beth wehrman, also an r.n.,
  was one of president obama’s earliest supporters.
  she had met him years before while working with
  hiV patients at a nonprofit needle exchange pro-
  gram she founded in illinois. she died of pancreatic
  cancer last october, but campaigned for the presi-
  dent-to-be through the fatigue and nausea of her
  illness. “she really believed in him and wanted to                                                            courtesy of anne stoefen

  see him become president,” stoefen said.
       the obamas kept in touch with wehrman during her illness. she died hours after casting an absentee ballot for him.
  she didn’t make the inauguration, but president obama made sure her family did. both families shared memories and tears
  on the train ride to washington.

10	                                                						January/February	2009
                                                              V A nguard                                   feature

                                                                                                trained Decontamination Team and
    Smoothing the Way for Visitors                                                              a well-equipped DECON Unit. The
    Garry bernard, a management analyst with the Veterans health administration                 team was activated for Inauguration
    at Va central office, was among the 15,000 volunteers chosen to assist with                 Day. In keeping with the facility’s
    crowd control and direction on the national mall for the presidential inaugura-             emergency management plan, equip-
    tion. on that day, he became an official greeter and guide.                                 ment and clothing were inventoried
          “my job was to greet visitors, welcome them to the national mall, and                 in advance. All equipment repairs or
    make sure that they had all of the information they needed to have a good                   replacements were dealt with prior to
    time,” he said. “i was placed along 7th street inside the mall, and directed visi-          the big weekend. A six-member DE-
    tors toward concession stands, medical tents, jumbtrons (okay, those were                   CON Training Unit comprised of VA
    obvious), port-a-potties, exits and metro stations.”                                        employees from around the nation was
          bernard said there were 900 volunteers working his “mall zone” between                called on to support the D.C. crew
    4th and 7th streets, all sporting “little red volunteer caps.”                              and to give them additional training.
          “the mall was the safest place on earth, with thousands of security per-                   Safety Officer Nancy Lansing had
    sonnel and medical staff,” he said. “i enjoyed being the friendly usher, provid-            the lion’s share of the logistics job for
    ing directions and information for anybody who needed it. if anything scary                 the medical center—managing the
    had happened, all i had to do was fetch one of the officers or doctors standing             emergency preparedness program is
    nearby.                                                                                     one of her functions. “Preparing for
          “there was a young woman there with her mother from minot, north da-                  this historic weekend was a monu-
    kota. her mother was in a wheelchair, and the young woman asked me if there                 mental task,” she said. “But with the
    was a place where they could stand to watch the inauguration without being                  professionalism and commitment of
    trampled on. i was able to take the young woman and her mother to a place                   our great staff, we were fully prepared
    that was roped off by the medical staff where they would not have a problem                 and ready to take care of all veterans
    watching the inauguration. both mother and daughter gave me a hug and said,                 no matter what happened. I’m proud
    ‘thank you.’ that made my day.”                                                             to be a part of this team.”
                                                                                                     Coordinated public affairs is
                                                                                                crucial in emergency situations. Em-
operational throughout the weekend,”          so quickly and efficiently determine              ployees were kept up-to-date on trans-
said Rivera. “It’s gratifying to be work-     needs and fulfill them.”                          portation, building security, access to
ing with leaders and staff who can                The D.C. VAMC has a well-                     supplies and the all-important meal
                                                                                                schedule through e-mail announce-
                                                                                                ments, hard copy fact sheets, and the
                                                                                                medical center’s Intranet site.
                                                                                                     A collegial spirit reigned among
                                                                                                the staff spending Inauguration Day
                                                                                                together, according to D.C. VAMC
                                                                                                officials. They shared the pride of hav-
                                                                                                ing an important mission—taking care
                                                                                                of veterans who had traveled across
                                                                                                the country to be in that place, at that
                                                                                                time. There was a sense of being a
                                                                                                part of history.
                                                                                                     Around noon, a large group gath-
                                                                                                ered in the medical center’s atrium
                                                                                                and together, in silence, they stood to
                                                                                                honor President Barack Obama and
                                                                                                Vice President Joseph Biden as they
                                                                                                took their oaths of office. Even those
                                                                                                in wheelchairs struggled to their feet.
                                                                                                Some stifled cries and wiped away
                                                                                                tears. Then they quietly dispersed to
                                                                              michelle spiVak   report back to their duty stations.
Nyoka Pyles staffs the reception desk in the D.C. VAMC Emergency Department; with her are
interns (left to right) Ryan Kar, M.D., Anish Nanavati, M.D., and Rahim Remtulla, M.D.          By Michelle Spivak
	                                                  							January/February	2009	                                                      11
                      feature                             V A nguard

         r. Kendrick is tired. Her long     unchanged,” said Richard Sowinski,         breakdowns are often cited as a root
         shift is coming to a close. Her    manager of application development         cause of sentinel events in hospitalized
         team has tended to at least 15     with the Roudebush team. The team          patients. The lack of details passed be-
patients on multiple wards. It’s time       has a long history of developing cut-      tween covering physicians contributes
for a new team to take over. “Now,          ting-edge technology that improves         to this decreased quality of care. The
what did that nurse tell me about Mr.       VA care.                                   goal is to avoid discontinuity, create
Savidge?” she wonders as she scribbles           The new standardized software,        seamless patient coverage and prevent
a multitude of pass-on details gathered     which underwent dramatic changes           adverse events.
during her hectic rounds.                   and testing as it made the transition           In 2005, the article, “Lost in
     The act of “handing off” a hospi-      from a class 3 local package to class 1    translation: challenges and opportuni-
tal patient from one medical caregiver      national distribution, was developed       ties in physician-to-physician com-
to another has always been a process        in conjunction with the Iowa City          munication during patient handoffs,”
of careful communication. Yet, even         VAMC, Washington, D.C., VAMC               was published in the journal Academic
in a hospital system deemed “the            and the University of Iowa College         Medicine by a group of Indianapolis
best care anywhere,” ensuring patient       of Medicine. The Physician Handoff         physicians that included Dr. Richard
safety can be challenging.                  Tool is one of the first field-based       Frankel. Frankel is a research scientist
     The software development group         software solutions to undergo the me-      with the Roudebush VAMC’s Health
at the Richard L. Roudebush VA              ticulous evolution from class 3 to class   Services Research and Development.
Medical Center in Indianapolis sig-         1 status, and then be released to every    The article discussed automating
nificantly contributed to a new tool        VA medical center in the country.          aspects of physician handoffs and
that helps with this critical communi-           “It’s been a pretty rigorous pro-     specifically mentioned the Roudebush
cation exchange.                            cess,” Sowinski said of the class 3 to     VAMC’s Physician Handoff Tool.
     Working with a team of collabo-        class 1 migration. “We had to test               “Handoffs involve the transfer

                    Ensuring Efficient
                    Patient ‘Handoffs’
      A local software innovation is helping to improve
                  patient safety nationwide.
rators from around the country, they        the software at multiple facilities and    of rights, duties and obligations from
developed a VistA-based “handoff            make changes so that people with           one person or team to another,” the
tool”—a simple graphical user inter-        disabilities can use it. It took about     journal article explained. “In many
face, or GUI, that standardizes physi-      five months to make the necessary          high-precision, high-risk contexts—
cian-to-physician communication.            changes and test them thoroughly at        such as a relay race or handling air
Released nationally in June 2008, the       multiple test sites. At the same time      traffic—handoff skills are practiced
Physician Handoff Tool is now in use        you are making the changes, you are        repetitively to optimize precision and
in at least 70 VA medical centers.          working with the national software         anticipate errors. In medicine, wide
     This powerful tool had humble          development specialists on documen-        variation exists in handoffs of hospi-
beginnings. In 1998, the Roudebush          tation and training materials. The de-     talized patients from one physician or
group received a request from a con-        veloper of this software, Charlet Cot-     team to another.”
cerned physician to create a handoff        tee, is one of the excellent developers          In 2006, the Joint Commission
computer interface for doctors. The         my team is blessed with.”                  published national patient safety goal
initial tool was quite simple, compared          The tool reduces communica-           (2E): “To improve physician-to-physi-
to the current one. “It satisfied the       tion failures in two main catego-          cian handoffs.”
requirements we were given, and we          ries—content omissions and illegible             The journal article and the safety
used it here for eight years, essentially   handwritten notes. Communication           goal “caught the attention of some
12	                                             						January/February	2009
                                                           V A nguard                                 feature
people in VA Central Office, and                Dr. Divya Shroff, associate chief                Shroff and Tom Ash (then a
Linda Nugent (now VA’s national di-        of staff-informatics at the Washing-             computer specialist at the Washing-
rector of Health Information Manage-       ton, D.C., VAMC, was instrumental                ton, D.C., VAMC) wrote an article
ment Systems) came out to see how          in helping design and implement the              about the Physician Handoff Tool for
we were using the tool,” said Sowin-       tool nationwide, according to So-                Hospitals & Health Networks magazine
ski. “She talked to me, and some doc-      winski. “To get something like this              and they won the “Most Wired” Fi-
tors, residents and nurse practitioners.   to go national, you need a physician             nalist Award.
She liked what she saw and passed          champion who can talk to doctors in                   “This was the icing on the cake,”
the information on to VA’s National        their own language. Doctors listen to            said Shroff. “Charlet Cottee, Richard
Patient Safety Center.                     other doctors. I can’t think of a bet-           Sowinski, Tom Ash and I accepted
     “After Linda’s visit, I got a call    ter physician champion for a clinical            the award at the Healthcare Leader-
from Noel Eldridge (executive as-          tool like this than Dr. Shroff. She has          ship Summit in San Diego. It was a
sistant at the National Patient Safety     presented this tool at multiple confer-          great collaboration, and I enjoyed
Center), and that’s when things really     ences, in front of hundreds of people,           working with a team that produced a
got interesting. Noel got us together      and that is what got people so excited           great product. It was a most rewarding
for a meeting in D.C. with doctors,        about using the tool.”                           experience for everyone involved, and
                                                                                            it really helps our nation’s veterans
    Richard Sowinski, manager                                                               receive better care. This has been
    of development and support                                                              proven by follow-up surveys of clini-
    at the Richard L. Roudebush
    VA Medical Center in India-                                                             cians using the tool (conducted by Dr.
    napolis, discusses elements                                                             Jaclyn Anderson, now at the Omaha,
    of the Physician Handoff                                                                Neb., VAMC). They are telling us
    Tool with IT Specialist Char-
    let Cottee.                                                                             the tool ensures more precise and ef-
                                                                                            ficient handoffs.”
                                                                                                 What’s next for the Indianapolis
                                                                                            Software Development Team? “The
                                                                                            one thing I can tell you,” said Sow-
                                                                                            inski, “is the ‘software skunkworks’
                                                                                            at Indianapolis is alive and well, and
                                                                                            we will have some interesting new
                                                                                            products to demonstrate at the Infor-
                                                                                            mation Technology Conference this

terry minton
                                                                                            By Terry Minton
                                            Dr. Jason Lewis, fourth-year medical student with
nurses and computer specialists from        the Roudebush VAMC Platinum Team, uses the
other VA medical centers around the         Physician Handoff Tool in the residents’ room
country to evaluate the Indy Physi-         on the medical surgery unit. During their 30-hour
                                            shift, the resident team tends to an average of 21
cian Handoff Tool. We wanted to see         veterans using the tool.
if they had any suggestions on how it
could be changed to make it better.
     “They had lots of suggestions! Ac-
tually, the Washington, D.C., VAMC
had its own Physician Handoff Tool
(developed by a former resident, Dr.
Danny Rosenthal). It had some nice
features, but it was not written in a
manner that would make it portable
to other VA medical centers. So
we adapted some of the user-based
features of that tool, combined them
with some of the features of our tool,
and we ended up with a nice product.”                                                                                   terry minton

	                                              							January/February	2009	                                                     13
      feature               V A nguard

 Court for
                                                  Dr. Elise Taylor, left,
                                                  is in charge of the
                                                  Veterans Treatment
                                                  Court program in Tul-
                                                  sa, Okla.; Dowanna
                                                  Wright is the Veterans
                                                  Treatment Court li-

                A program spreading across the country is
                giving veterans charged with non-violent
                alcohol or drug-related offenses a second
                chance to get their lives back on track.
1	               						January/February	2009

                                                                            john hasler
                                                           V A nguard                                feature

       any veterans return from war with PTSD, depression, or other com-
       bat-related issues that can greatly affect their day-to-day lives. Some
       of these men and women turn to drugs or alcohol to deal with the
aftermath of combat and wind up in the criminal justice system.

     The VA medical center and re-                “It’s a treatment-first approach        “However, the court will step in if the
gional office in Muskogee, Okla., are       over a punitive approach,” said Dr.           patient fails to abide by the program.
the latest VA facilities to recognize       Elise Taylor, a VA psychologist and           If they fail a drug screen or disobey
not only a need, but also an oppor-         substance abuse program supervisor            the court’s orders, they will be ar-
tunity, to reach out to veterans and        who is in charge of the Tulsa program.        rested and run back through the legal
help them rehabilitate and live a more      “We want to provide the care and              system.”
productive life in society. They have       treatment these veterans need, help                 Veterans who repeatedly fail drug
partnered with the local courts to help     them move forward in their lives and          screens, or are repeatedly noncompli-
veterans get their lives back on track      prevent repeat offenses.”                     ant with court-ordered treatment, are
after being arrested.                              It all starts at the time of arrest.   sanctioned by the court, which could
     “The Jack C. Montgomery VA             The program is voluntary for veter-           include community service, fines or
Medical Center is proud to be the           ans charged with non-violent crimes           jail time.
third VA in the nation to provide this      who are in need of mental health or                 “With 158 veterans arrested in
treatment option for our returning          substance abuse treatment. Veterans           Tulsa County in the month of Octo-
veterans who have difficulty readjust-      agree to enter into the program in            ber, there is clearly a need for this new
ing to civilian life,” said Director        writing during a hearing and also             therapeutic court,” said Tulsa County
Adam Walmus. “This joint venture            provide written consent to allow VA           Special Judge Sarah Smith, who hears
VA is doing with the Tulsa County           to communicate with the court about           veterans’ cases every Monday. “The
Drug Court and the City of Tulsa will       their treatment.                              Veterans Treatment Court offers a
give these deserving men and women                 “When a veteran is brought to          unique partnership between the VA,
a second chance.”                           jail, the officers ask them if they are       the court system and other veterans’
     In December 2008, the Muskogee         veterans while they are being pro-            organizations to provide treatment,
VA entered into a memorandum of             cessed,” said Taylor. “Our Treatment          compassion and hope to the men and
understanding with the 14th Judicial        Court liaison, Dowanna Wright,                women who served our country and
District to form a Veterans Treatment       helps with determining eligibility for        are struggling in the criminal justice
Court in an attempt to divert veterans      VA benefits. If they are eligible, they       system.”
from jail and into appropriate reha-        will be put on the Treatment Court                  As with all drug court partici-
bilitative programs.                        docket and then assessed.”                    pants, the records of those taking part
     The Veterans Treatment Court                 Veterans entered into the pro-          in the Veterans Treatment Court are
applies to veterans charged with            gram are assessed by a mental health          sealed once they’ve completed the
non-violent alcohol or drug-related         professional such as Taylor to deter-         program.
felonies who may be experiencing dif-       mine what type of treatment is needed               Tulsa is the third community in
ficulties transitioning to civilian life—   to best serve their needs.                    the country, and the first in the cen-
whether recently or long discharged               “They may just need outpatient          tral U.S., to implement a Veterans
from active duty.                           care, or they may need to be entered          Treatment Court. The first program
     Veterans are diverted and sen-         into an inpatient care program such as        was created in Buffalo, N.Y., followed
tences are either delayed or replaced       detox,” said Taylor.                          by a program in Alaska, with similar
with a period during which treatment              During the treatment process,           courts being considered in Rochester,
is provided by the VAMC, and court-         each veteran’s case is reviewed by            N.Y., Illinois, Las Vegas, and two in
appointed mentors provide guidance          the judge to determine their progress.        Pennsylvania. The Muskogee VA
on many matters, such as education,         VA’s treatment team and the judge             modeled its court on Buffalo’s success-
employment and housing.                     work closely together to keep the             ful program, which key leaders visited
     If the diversion is successful, the    veteran on track and on the road to           and sought advice from before starting
veteran is less likely to repeat the be-    recovery.                                     the Muskogee court.
haviors that resulted in his introduc-            “We don’t want them to fail and
tion to the court system.                   neither does the court,” said Taylor.         By Gary Hicks
	                                               							January/February	2009	                                                   1
                     feature                             V A nguard

        Matching Veterans
          With VA Jobs
          Veterans employment coordinators are helping veterans start
                      new careers with the Department.

      he new Veterans Employment Coordination Service           that may have focused too much on his disability. Fortu-
      is off to a good start helping veterans obtain a career   nately for Cornejo, Region 2 Coordinator Bob Mortenson
      with VA.                                                  was aware of his situation and gave him a call.
     Since the office opened for business last July, its nine        Working precisely as a regional veterans employ-
regional veterans employment coordinators have helped           ment coordinator was envisioned, Mortenson brought in
68 veterans land a job with VA. From Tampa, Fla., Wash-         Cornejo’s VR&E counselor and a local human resources
ington, D.C., and Hudson Valley, N.Y., to Austin, Texas,        specialist to help prepare employment packages for three
Los Angeles, Seattle, and more than 30 other VA facilities      VA positions. Shortly thereafter, Cornejo was offered, and
in between, the regional coordinators have directly assisted    accepted, a veterans service representative position with
veterans with starting a VA career.                             the Seattle VA Regional Office on Nov. 24, 2008, and
     “I’m really proud of what they’re doing all across the     now finds himself with not only a full-time job, but a satis-
country to help match veterans with VA jobs,” said VECS         fying one as well.
Director Dennis May, a retired Air Force personnel officer.          “I cannot think of a better career that will allow me
“We knew coming into this that our regional coordinators        to be in a position to serve our military men, women, and
would have to be real go-getters, and they are living up to     their families,” Cornejo said. “It is an honor to now be a
those expectations.”                                            part of the VA team.”
     VA has approximately 270,000 employees, and about               Each veteran’s story about working with their re-
30 percent are veterans. VECS is charged with increasing        gional veterans employment coordinator is unique—take
that percentage to 33. Severely injured veterans of Opera-      AnnMarie Bernard, for example. The combat veteran and
tion Enduring Freedom and Operation Iraqi Freedom are           mother of three tried for years to land a federal job, but
at the core of the program. One of the first things regional    two things were holding her back—lack of U.S. citizen-
coordinators did when assuming their new positions was          ship and limited knowledge of how to navigate the hiring
to begin the process of reaching out to more than 2,000         process.
known severely-disabled veterans from the Global War on              Enter Region 8 Coordinator Andree Sutton, who not
Terrorism to offer employment assistance.                       only collaborated with the Department of Labor to get
     Rafael Cornejo was one of those veterans. Medi-            Bernard’s employment case referred to VA, but also helped
cally discharged in 2004 after serving in Operation Iraqi       put together a job-winning packet resulting in Bernard
Freedom, he completed a teaching degree under VA’s              becoming the VA New York Harbor Healthcare System’s
vocational rehabilitation and employment program at City        newest medical support assistant. Bernard received her citi-
University of Seattle in 2007.                                  zenship prior to accepting her new position.
     With a degree under his belt, Cornejo found part-time           Regional coordinators use a wide array of tools and
work as both a family support specialist and a substitute       resources to reach out to veterans and, more importantly,
teacher in the Seattle area, but obtaining a permanent po-      match their skills with VA jobs. They participate in mili-
sition in education seemed unlikely with a school district      tary transition programs, and work with veterans service
1	                                            						January/February	2009
                                                                    V A nguard                             feature

                                                            robert turtil

                                                                                                                         joseph a. matthews

                                                             steVe judish

    Clockwise from top left: After being medically discharged in 2004,
    and experiencing difficulty breaking into the teaching profession,
    Rafael Cornejo is working as a veterans service representative at
    the Seattle VA Regional Office; Cornejo’s regional veterans em-
    ployment coordinator, Bob Mortenson, helped him land the job;
    AnnMarie Bernard, foreground, had tried for years to land a fed-
    eral job. With the help of her regional coordinator, Andree Sutton,
    she was finally successful; Denver VA Regional Office Veterans
    Service Center Manager Kathryn Malin was so pleased with the
    early performance of Scott Gardner, center, as a veterans service
    representative that she asked his regional coordinator, Mark Ber-
    ninger, right, to find more job candidates like him.

                                                                                                                             lamel j. hinton
organizations and other VA programs to promote careers
in the VA workforce.                                                        the pair to “find more veteran candidates like Scott Gard-
     One secret to their effectiveness is working closely                   ner.”
with VA managers and human resources offices to ensure                          And that is what the nine regional coordinators are
supervisors are aware of programs that make it easy to hire                 doing—bridging the gap between human resources and
veterans, such as the use of non-competitive appointments.                  veterans.
     Scott Gardner, a veteran who received a Purple Heart                       “Simply put, there is no better cure for what ails our
while serving in Iraq, was hired by the Denver VA Re-                       recovering job-ready veterans than the independence
gional Office under the 30 percent Special Hiring Author-                   gained through employment,” said VECS Deputy Director
ity. His regional coordinator, Mark Berninger, worked with                  Greg Alleyne, who is also the Region 9 coordinator. “Our
him and his VR&E counselor to land a veterans service                       coordinators understand it, many have lived it, and all are
representative position at the regional office.                             honored to serve as links in such an important chain.”
     Gardner’s early performance in his new position led
Veterans Service Center Manager Kathryn Malin to ask                        By Gary Hicks
	                                                      							January/February	2009	                                                     1
                     feature                              V A nguard

                                                                A harrowing journey on
                                                                the high seas leads one
                                                                employee to give back to
                                                                the veterans who fought
                                                                for his country.
Dai C. Phan                                      kenneth holt

           y hands clutched my older       namese army was rapidly approaching      the “re-education camps” along with
           brother’s arm tightly. We,      without constraint. To this very day,    thousands of others. My mother took
           along with our parents, were    I can still remember the blue flames     my brother and me to live with our
among a sea of people on Highway 1         of the rocket exhaust, the smell of      grandparents in Saigon while my fa-
trying to leave the city as the North      exploding ammunition, and the earth-     ther was imprisoned for the next two
Vietnamese army approached to wage         trembling concussions that followed.     years. Upon his release, we planned
the final battle of the war.                    As I ran past the entrance to the   to escape the country by boat. After
     We managed to arrive at the Da        harbor, I saw a soldier who I thought    months of secret planning, we board-
Nang airport with commercial airline       was soundly asleep. I turned to my       ed a bus to be taken to a boat waiting
tickets in hand, but our aircraft never    father and asked why he was oblivious    for us. Instead, we were swarmed by
arrived so we made our way to the          to all of the commotion. His reply:      police officers. The person who ar-
harbor in hopes of boarding a ship to      “Son, he is dead.” The rocket attack     ranged for our trip turned out to be
Saigon, the South Vietnamese capital.      terminated our attempt to escape the     a police informant. My father went
Exhausted, we waited there among a         city. As we returned to the highway      back to jail.
sea of thousands like us clinging to our   on foot, we knew it was all over when         A year later, in 1978, we tried
last sliver of hope that we would catch    we saw the North Vietnamese tanks        again. It was a risky move, but it was
a “ship of freedom.”                       rolling past more dead soldiers.         the only thing we could do. This
     That hope evaporated in an in-             Unable to leave the city, we re-    time, we left in a leaky, wooden fish-
stant as the high-pitched sound of in-     turned to our house, or what was left    ing boat along with 165 people. Cold
coming rockets pierced the air. Men,       of it. On April 30, 1975, the Vietnam    and cramped, we huddled together for
women and children began running           War came to an end.                      warmth as best we could.
for their lives as ordnance exploded            My father, a South Vietnamese            After a few hours in the ocean
from all directions. The North Viet-       army medical officer, was placed in      and in the midst of a heavy thunder-
1	                                            						January/February	2009
                                                         V A nguard                              feature

storm, we were spotted by a Vietnam-       stolen by the pirates during one of the   ter’s in prosthodontics from Marquette
ese patrol boat, which ordered us to       attacks. We could be drifting back to     University.
stop. We ignored its warnings, and         the Gulf of Thailand, where the pi-            Today, I am a staff maxillofacial
the patrol boat decided not to pursue      rates were waiting for us, or worse, we   prosthodontist at William Jennings
us in the rough seas. Our goal was to      could be drifting back to Vietnam.        Bryan Dorn VA Medical Center
be rescued by passing international              Days later, a man with a dark       Dental Service in Columbia, S.C. A
vessels. What a sight it was when one      complexion and curly hair that we         maxillofacial prosthodontist is a den-
evening, we finally saw a flashing light   knew could not be of Vietnamese           tal specialist who provides prosthetic
on the dark horizon.                       origin, paddled to us in a canoe. After   reconstruction for patients with facial
     Babies crying, women screaming        communicating through hand signals        or oral defects. Many of my patients
and the sounds of beatings were heard      and gestures, he led us to a small        require complex restorative needs, and
soon after we docked with our “savior”     and isolated Indonesian island called     I find my work to be both challenging
ship. It was not the salvation we had      Kuku.                                     and rewarding.
hoped for; instead, it was horror. It            We were among the first refugee          My parents worked hard to bring
was our first attack by foreign fisher-    settlers on this remote island, only      me to America—achieving the Amer-
men-turned-pirates who preyed on           to be joined later by other groups        ican dream does not come cheap. I
Vietnamese boat people in the Gulf         of boat people. Life was tough and        am privileged to serve the veterans
of Thailand. There were five more at-      diseases claimed many of us. During       who gave us the freedom we all enjoy
tacks that same night.                     bad weather, one of the hazards was       today. Many of my patients served my
     After drifting helplessly in the      falling coconuts. Imagine the irony of    native country more than 40 years ago
open ocean for several more days, we       being killed by a falling coconut after   in the city where I grew up.
could finally see something on the         all we had gone through and the odds           Having patients who fought for
horizon—the coconut tree-dotted Ma-        we had overcome. After spending           your country so long ago is not some-
laysian coast.                             nearly a year and a half on the island,   thing you’d encounter every day in
     The night was clear; the stars        my family was sponsored by the First      a typical dental practice. That’s why
seemed close enough to touch as our        Methodist Church of Portland, Ore.,       working for VA is so satisfying for me.
boat silently crept onto the shore         who offered us a chance to settle in      The veterans are very appreciative of
without being detected. One by one,        the United States.                        the services provided and it is reward-
we all made it ashore. The men stayed            In April 1980, we arrived in Bea-   ing to know that you are making a dif-
behind to sabotage and sink the boat,      verton, Ore., to begin our new life in    ference in their quality of life.
a common practice to avoid being           America, and I started my education            Every day, I thank the Vietnam
pushed back to sea.                        as a seventh-grader. I quickly learned    vets for their service to my country.
     After a week on the shore in          that assimilating to the new country      On more than one occasion, just a
makeshift tents, we were ordered onto      and culture was not easy. Kids made       simple and sincere “thank you” from a
a bus to be taken to a better facility.    fun of my English skills, but they        person who appreciates their sacrifice
Instead, we were taken to a naval base     didn’t dare lay a finger on me because    has brought closure to the pain and
where we were forced onto a boat that      they all thought I knew kung fu!          suffering they have endured for so
looked surprisingly familiar—the au-             After high school, I entered        many years.
thorities had recovered our boat and       Wichita State University, earning a            We must have compassion, un-
were towing us back out to sea.            bachelor’s degree in aerospace engi-      derstanding, and be willing to go out
     It was raining hard, and I could      neering. I was in engineering gradu-      of our way to provide the best service
see nothing but the white caps of the      ate school when I decided to make a       that we possibly can, because many
tall waves. People were either crying,     career change—the aerospace industry      have given up their lives for us. It is
praying, or both, as the small boat        in America was not very strong back       the very least we can do for our vets.
violently slammed into each passing        then. I knew then that a career in the    Being blessed with what I have be-
wave. In the midst of all the chaos,       health care profession would be an        come, I try to make myself a produc-
my mother handed me an empty gaso-         excellent choice for me.                  tive citizen and give back. Anything
line tank to hold on to. It was my life          My father, a physician, suggested   less would be a complete waste of my
preserver.                                 dentistry. Seeing him helping others      parents’ efforts and those of our vet-
     Around midnight, we were cut off      inspired me to be a health care pro-      erans.
from the towing ship and left strand-      vider. It was the best decision of my
ed. The boat was leaking water, and        life. I received my doctor of dental      Editor’s note: Dai C. Phan, D.D.S., is a
it was running on a meager auxiliary       surgery degree from the University of     staff dentist at the William Jennings Bryan
engine. The main engine had been           Missouri at Kansas City and my mas-       Dorn VA Medical Center in Columbia, S.C.

	                                              							January/February	2009	                                                 19
                        feature                       V A nguard
Dr. Ross Fletcher, chief of staff at the
Washington, D.C., VA Medical Center,
was among the VA visionaries who were
instrumental in the development and
growth of VistA. Accessing VistA in the
background are Dr. Divya Shroff, left,
associate chief of staff-informatics, and
fourth-year medical student Rita Fleming.

20	                                         						January/February	2009

                                                                          robert turtil
                                                        V A nguard                              feature

         From ‘Underground’ to ‘World-Class’:
              VistA Celebrates 30 Years
       he year was 1978—98 percent        Never losing steam, these innovators       favor. Soon after, Custis rescinded all
       of all American homes had          moved “underground” and plugged            orders to root out MUMPS comput-
       television; the launch of Space    ahead in hopes of making their work        ers, and the applications would be-
Invaders started the computer video       useful to VA medical centers by in-        come VA’s official medical computer
game craze, and VA visionaries were       tegrating the software into a compre-      program.
thinking of ways to improve health        hensive package.                                On Feb. 18, 1982, Administrator
care technology for veterans.                  Difficulties were multiplied for      Nimmo signed the Executive Order
                                          the Hard Hats working underground.         that set into motion what became
In the Beginning (1977-1978)              With slim resources and a lack of          DHCP, the Decentralized Hospital
     The story begins with VA em-         needed tape drives for their comput-       Computer Program.
ployees Joseph “Ted” O’Neill and          ers, portability was only accomplished
Marty Johnson and their vision to         via error-prone 300-baud modems. On        Transforming Technology (1990s
bring MUMPS (Massachusetts Gen-           top of that, the main challenge was        and Beyond)
eral Hospital Utility Multi-Program-      physically carrying cake tray-sized disk        DHCP underwent many make-
ming System), a high-level program-       packs from site to site.                   overs as it transformed into VistA.
ming language, into VA hospitals               While the Hard Hats made waves        Today, VistA has improved quality of
nationwide. Initial plans included ap-    inside and outside VA, momentum            care and patient safety and offers in-
plications for ambulatory care, dietet-   was building as the prototypes proved      teroperability with the Department of
ics, nuclear medicine, mental health      useful. So when VACO ordered that          Defense’s Military Health System.
and laboratory, among others.             several systems be turned off, physi-           No matter where or when a VA
     A meeting of the minds took          cians who relied on the programs           patient receives care, complete records
place at the Oklahoma City VA Med-        weren’t pleased. Paul Schafer, M.D.,       and numerous reports are instantly
ical Center during the Patient Care       executive director of the National         available, listing medications, aller-
Conference held Dec. 11-14, 1978.         Association of VA Physicians, began        gies, discharge summaries, clinical
The event would prove to be a signifi-    promoting the MUMPS efforts in his         notes and lab results. Vital signs such
cant milestone in the development of      role as the clinicians’ advocate.          as temperature, blood pressure, pulse
what we know today as VistA, VA’s              Congressional attention and           or pain levels are also available. New
world-class health IT system.             media coverage brought notice to           facets like VistA Imaging have cre-
     The Department of Medicine and       the Hard Hats’ work, and change was        ated a multi-media electronic health
Surgery (predecessor to the Veterans      in the air. Administrator Robert P.        record integrating traditional chart
Health Administration) hosted the         Nimmo and his deputy Chuck Hagel,          information with medical images.
event, and their new Computer As-         now a United States senator from Ne-            “That first meeting 30 years ago
sisted Systems Staff (CASS) in VA         braska, decided to take a fresh look.      planted the seeds for what today has
Central Office was eager to facilitate                                               become the best, most widely imple-
the vision.                               Becoming Legitimate (1981-1982)            mented clinical information system
                                               Two top VA officials, Chief           in the world,” said W. Paul Nichol,
The Underground Railroad (1979-           Medical Director Donald Custis,            M.D., director of medical informatics
1981)                                     M.D., and Jack Sharkey, director of        for patient care services. “It provided a
     The optimism in the air at Okla-     the Office of Data Management and          foundation for the transformation that
homa City would soon disperse as          Telecommunications, visited the            VA went through in the late ’90s to
resistance to a mainframe computer        Washington, D.C., VA Medical Cen-          become the system that provides ‘the
office mounted at VACO. Just a few        ter to see the system in action. Later     best care anywhere.’”
months later, CASS members were           on, VA physicians from all over the             The future looks even brighter for
reassigned to VA medical centers, no      country would get a first-hand look        VistA as teams continue to look for
longer reporting to VACO officials at     during a full-blown demonstration at       innovations in health care and tech-
the agency level.                         the annual Symposium on Computer           nology for today’s and future genera-
     The geographically dispersed         Applications in Medical Care.              tions of veterans and their families.
group of programmers and analysts              By the end of the conference, the
became known as the “Hard Hats.”          force had shifted in the Hard Hats’        By Monica A. Smith
	                                             							January/February	2009	                                                21
                      feature                            V A nguard

 Gone are the rigid schedules and other outmoded practices associated
 with the institutional approach of traditional nursing home care.

                                                                                       A gazebo on the grounds of the Batavia
                                                                                       VA Community Living Center in New York
                                                                                       provides a place for residents to gather
                                                                                       for events.
                                                                                                              courtesy of bataVia clc

         Community Living Centers:
      Transforming Nursing Home Care
       esidents and staff of the Brecks-   The Lake City VA Community Liv-            associated with traditional nursing
       ville VA Community Living           ing Center in Florida has a screened-      home care. Community living centers
       Center in Ohio now enjoy a          in porch and fountain where residents      offer comfortable environments that
coffee bistro where the former nurs-       can relax.                                 have the feel of home for the resi-
ing home lobby used to be. At Puerto            And some community living cen-        dents while their body heals or while
Rico’s San Juan VA Community Liv-          ters, such as those at Bay Pines, Fla.,    they prepare for death in comfort
ing Center, the nurse’s station was        and Northport, N.Y., use innovative        and dignity. In this reengineering of
removed to become a living room for        approaches such as recreation therapy      nursing home care, community living
residents recuperating from a recent       animals. Gussie Mae is the in-house        centers offer a dynamic array of short-
hospital stay and preparing to go          dog at the Poplar Bluff VA Commu-          or long-stay services in a manner that
home.                                      nity Living Center in Missouri. Frida      emphasizes excellence in clinical care
     Residents of the Batavia VA           the cat lounges around the San Juan        while tending to quality of life issues.
Community Living Center in New             center.                                         “We’re transforming the culture
York now have a gazebo and scenic               It’s all part of VA’s initiative to   of nursing home care where the mod-
grounds where they can hold events.        change the institutional approach          el of care is driven by the resident’s
22	                                            						January/February	2009
                                                          V A nguard                              feature

needs rather than by the medical diag-     and often become the source of im-
nosis,” said Dr. Madhu Agarwal, VA’s       proved relationships between staff and       A Home-Like
chief patient care services officer.       residents. Staff members are encour-         Alternative for
     The transformation is based on        aged to get residents to share stories
the HATCh Model (Holistic Ap-              with them about their personal items.        Veterans Who Need
proaches to Culture Change). Key el-            “Residents and staff can then get       Long-Term Care
ements of the model include changes        to know each other more personally,”
in the environment of care, care prac-     Burris said.                                 Veterans with illnesses, diseases or
tices, and work practices.                      “Whether a resident is in the           injuries that meet a nursing home
     And VA staff members play a           CLC for a short time or for the re-          level of care because they can no
large role in putting these changes        mainder of his or her days, the CLC          longer safely live alone now have
into practice.                             should feel like home,” Burris said.         the option to live in a medical foster
      “We’re challenging our com-                                                       home, where they can be provided
munity living centers to examine and       Care Practices                               for by qualified caregivers in a family
create new systems of care that move             Residents, regardless of their func-   setting.
away from rigid schedules, change          tional deficits or reasons for admission,          the medical foster home initia-
outmoded practices and help restore        are assessed for what gives meaning          tive came about to help veterans
the mind, body and spirit of the resi-     to their days. A variety of activities       who had lived independently for
dents,” said Dr. James F. Burris, chief    that encourage them to venture out of        years through the support of assis-
consultant for geriatrics & extended       the facility and into the community          tive devices and home care services
care with the Office of Patient Care       are being incorporated. These range          but were reaching the point where
Services, which oversees the program.      from going sightseeing, fishing, and to      it was no longer safe for them to
     Here are some examples of ap-         baseball games to planting vegetables        remain living alone. traditionally, this
proaches and key changes that are          and flowers. Some communities hold           situation is resolved through nursing
taking place.                              events, such as cookouts, or offer a         home placement.
                                           variety of games.                                  the program finds a caregiver
Environment of Care                              Veterans who are unable to en-         in the community who is willing to
     Transforming the environment of       gage in such outings are provided op-        take a veteran into their home and
care means making physical changes         portunities like music, art, reading and     provide 24-hour supervision as well
to a facility that translate into images   other bedside activities to soothe the       as needed personal assistance.
of home. This includes creating spaces     spirit and connect them to a world                 “these caregivers in the medi-
that offer the cues that a bedroom,        beyond their circumstances.                  cal foster homes are like angels,”
living room, dining room and kitchen             Activities provide the veteran op-     said tom edes, Va’s director of home
provide to reflect a home-like atmo-       portunities for re-engaging in aspects       and community-based care.
sphere and attention to privacy and        of life that may have brought them                 the caregivers agree to provide
comfort.                                   joy and a sense of tradition. Moreover,      lodging, meals and personal care.
     For example, offering residents a     providing activities and shaping use         Va’s home care team provides any
bedroom—instead of a bed in a hospi-       of time that is personalized to the age      health care services that are needed.
tal room—allows for more privacy and       and generation of the veteran may be         the expectation is for a long-term
comfort and sends a message to the         very appealing to younger veterans of        commitment, where the veteran may
residents that they do not live in the     Operation Enduring Freedom and Op-           live for the remainder of their life.
bedroom but rather in other spaces in      eration Iraqi Freedom.                             the caregivers provide care for
the home.                                        Residents are given more au-           three or fewer veterans in their own
     Many VA community living              tonomy over their schedules, helping         homes. most have had experience
centers are designed to look like hos-     develop a stronger sense of identity         caring for individuals with complex
pitals, with long corridors and little     with emphasis on meaningful use of           health needs—either through their
common space, making it difficult to       space and time as well as safety and         professional background or by caring
create smaller resident homes. As a        predictability.                              for a family member at the end of life.
result, facilities create neighborhoods          Times for bathing and grooming               “medical foster homes offer
or develop household models that           are now focused on accommodating             a less costly alternative to nursing
engage residents, family and staff to      the resident’s schedule, rather than         home placement for some veterans
name, decorate and own their place of      taking place at specific times. Resi-        who can function well in the com-
residence and work.                        dents are provided choices in sleep          munity with the added support of
     Personal items are encouraged,        and wake times.
	                                              							January/February	2009	                                                   23
                       feature                                V A nguard

 the medical foster home caregiver,” said dr. james burris,            initiative prompted the expansion of medical foster homes
 Va’s chief consultant for geriatrics and extended care. “this         at two additional sites in 2004. there are now seven opera-
 arrangement is safe, favorable to veterans, economically              tional sites: little rock and fayetteville, ark.; tampa; miami;
 advantageous to the Va facility, and helps contribute to com-         san juan; salt lake city; and sioux falls, s.d.
 munity development.”                                                        Va’s “support at home – where heroes meet angels”
      Va’s home-based primary care program is a key compo-             initiative is gearing up to implement medical foster homes
 nent of the medical foster home concept, and staff members            at an additional 31 sites. the medical foster homes program
 make home visits to provide assessment, caregiver educa-              currently cares for 110 veterans each day, and this number
 tion and patient care. spinal cord injury home care teams             will increase significantly as more sites become fully opera-
 provide services for veterans with spinal cord injuries and           tional.
 related disorders.                                                          Veterans who enter medical foster homes all meet
      medical foster home coordinators also make unan-                 nursing home level of care criteria, but are able to live in
 nounced monthly visits to the homes to monitor the care               the foster homes through medical care from home-based
 provided to veterans. if at any time the home-based primary           primary care and personal assistance from the foster home
 care staff or medical foster home coordinators find the               caregiver. as the veteran’s condition declines, they gener-
 veteran alone without adequate supervision, in an unsafe              ally will need more care, and caregivers are kept apprised
 situation, or with evidence of inadequate care, arrangements          of the veteran’s situation.
 will be made for an al-                                                                                                the veteran pays
 ternative home for the                                                                                           the caregiver from
 veteran.                                                                                                         $1,200 to $2,500 per
      these clear expec-                                                                                          month to provide the
 tations, combined with                                                                                           needed care. the
 the close monitoring by                                                                                          money covers room
 the home-based primary                                                                                           and board, 24-hour
 care program, result in                                                                                          supervision, assistance
 exceptional care and                                                                                             with medications, and
 safety. while caregiv-                                                                                           whatever personal
 ers are paid, the inter-                                                                                         care is needed.
 view process with the                                                                                                  the economics
 prospective caregiver                                                                                            are advantageous to all
 makes it clear that there Simon (far right) and Karla Bermudez                                                   parties involved. a vet-
 will be zero tolerance       of Tampa, Fla., have been providing                                                 eran choosing medical
 for neglect or poor care foster home care for veteran James                                                      foster home care pays
                              Holbrook for more than a year. At left
 of the veteran.              is Holbrook’s daughter.
                                                                                                                  for it. but the veteran is
                                                                                           courtesy of tampa Vamc
      home-based pri-                                                                                             assisted by maximizing
 mary care was first developed in 1977 after the central ar-           compensation and pension funds that they would receive
 kansas Veterans health care system established a compre-              from Va regardless of living arrangement.
 hensive interdisciplinary home care program in little rock,                 the administrative costs for Va are less than $10 per
 which soon expanded to the nearby hot springs area.                   day, and the cost of home-based primary care, medications
      by 1984, the aging veterans in the program—most                  and supplies averages less than $50 per day. approximately
 of whom were world war ii veterans—were becoming                      20 percent of these veterans are eligible for fully Va-paid
 increasingly frail and less able to care for themselves. a            nursing home care, yet they choose to spend their personal
 significant number lived alone in hot springs or in a nearby          funds for medical foster care because they greatly prefer
 area. they did not want to relinquish their independence and          this type of care.
 move into an institution. they began asking the team to find                “this is a win-win-win situation,” edes said. “the vet-
 them a place that was not a nursing home.                             eran wins because he or she obtains the care they need
      the medical foster home program began when several               while living in a family home. the caregiver’s life is enriched
 hot springs residents, with whom the home-based primary               while also getting paid. and Va wins by providing a low-cost
 care team had contact, were willing to take in and care for           option for long-term care for veterans that enables them
 the veterans for the remainder of their lives with assistance         to obtain needed safe, quality care in a way that best suits
 from the team, which provided the medical care in the home.           their personal situation.”
      the success of the hot springs medical foster home               - Bill Outlaw

2	                                                						January/February	2009
                                                           V A nguard                                     feature

     “We’re removing the stigma asso-      said Christa Hojlo, Ph.D., director                 singing with the birds,” said Peggy
ciated with the name ‘nursing home’        of VA’s community living center                     Murray, a nursing assistant at the cen-
by making community living centers a       program. “We know from recent                       ter in Wichita, Kan.
place to live, grow and make use of a      evidence that improved appetite and
person’s ability,” Burris said.            good nourishment enhance quality of                 Work Practices
     The delivery of meals on trays is     life.”                                                    Work schedules and staffing are
being replaced by service to residents           Another approach is to develop                being modified to meet the needs and
in a more personalized manner. More        activities that can positively impact               desires of residents at the centers.
choices are being offered and meals        individual lives physically and emo-                Expanding from the traditional three-
are enjoyed in a setting that is reflec-   tionally. Pets have been identified as              shift model of staffing provides for im-
tive of an elegant café or fine dining.    a source of comfort and enjoyment.                  proved overlap in continuity of care,
     Place settings for dining now         Recent evidence shows the positive                  as does permanent staff assignments.
include tablecloths, centerpieces and      impact of pets on quality of life and               The resident can depend on being
condiments on every table to deinsti-      health in several key areas, such as                known by the same staff members on
tutionalize dining. Discontinuing the      improved communication and mo-                      a regular basis.
use of trays and bibs is encouraged.       bility, and decreased stress. Studies                     Staff empowerment to make deci-
Dining rooms are brighter and more         have shown that animals can help                    sions at the bedside regarding resident
cheerful places to congregate.                                                                 needs improves personalized care
     These new approaches can be                                                               because staff members know the resi-
seen in newly renovated dining rooms                                                           dent. For example, at the Perry Point
at centers in Albany, N.Y., Dayton,                                                            center in Maryland, a certified nursing
Ohio, Danville, Iowa, and Brecksville.                                                         assistant is responsible for the conti-
Batavia, N.Y., and Buffalo offer other                                                         nence program. In many CLCs today,
examples of creative approaches to                                                             housekeeping and other staff members
dining. At the Buffalo and Orlando                                                             that know the residents are invited to
centers, residents can be seen eating                                                          participate in care planning meetings.
outside on the patio as often as pos-                                                                “The idea is to create an environ-
sible, weather permitting.                                                                     ment in which residents are respected,
     Additionally, guests are often                                                            treated with dignity, and invited to
invited and encouraged to dine with                                                            be an active participant in their own
residents. Residents at the Patriots                                                           care,” Hojlo said.
Harbor VA Community Living                                                                           Personalizing the delivery of care
Center in Charleston, S.C., recently        The atrium café at the community living            challenges providers to deinstitution-
                                            center in Battle Creek, Mich., offers an
enjoyed breakfast outside with Gov.         inviting space for residents to have meals         alize care, moving away from rigid tra-
Mark Sanford. Residents, families and       and visits with their families.                    ditional schedules and outmoded work
staff at California’s Loma Linda center                        courtesy of battle creek Vamc   practices such as waking all residents
enjoyed a Memorial Day barbecue.           lower blood pressure and decrease the               at the same very early hours in the
     Many centers have snacks and          mortality of patients in health care                morning so that staff can “get their
beverages available at all times. Staff    settings.                                           work done.” Or scheduling additional
members are available to assist those           “Animals have a positive influ-                staff to come in early to wake and
who are unable to obtain their own         ence on residents in increasing alert-              bathe residents before the resident’s
snacks or who may need guidance on         ness and the desire to become well,”                usual time preferences.
making better snack choices. Resi-         said Hojlo. “The physical act of pet-                     “This new emphasis engages em-
dents can also choose to enhance the       ting or holding an animal has been                  ployees in all aspects of decision-mak-
variety of snacks being offered.           shown to relax patients or residents                ing and information-sharing involving
     The Northport center has a des-       and provide physical health benefits                resident needs,” Hojlo said.
sert cart that residents can choose        such as alleviating pain.”                                “At a time when going to a nurs-
from. The single-serve coffee machine           Numerous centers have resident                 ing home for a short stay or for life
at the Butler center in Pennsylvania       dogs; others have cats. Chowhound                   is fraught with negative images, VA
allows residents access to coffee 24       the tortoise is a big hit at Bay Pines.             CLCs are providing needed post-hos-
hours a day.                                    At some centers, birds provide                 pital services in new and refreshing
     “The goal is to provide a choice      comfort and entertainment for resi-                 ways,” Burris said.
of snacks that are not only appealing      dents. “Many times you can walk by
but meet residents’ nutritional needs,”    and hear the veterans whistling and                 By Bill Outlaw
	                                              							January/February	2009	                                                        2
         around headquarters                                    V A nguard

Longtime Deputy Secretary Gordon Mansfield Gets Grand Send-Off
                                                                                                             and his service to veterans.
                                                                                                                   Peake announced the cre-
                                                                                                             ation of the Gordon Mansfield
                                                                                                             Veterans Advocate Award, and
                                                                                                             presented Mansfield with the
                                                                                                             first one. Mansfield also re-
                                                                                                             ceived his retirement certificate
                                                                                                             and a flag. Before joining VA,
                                                                                                             he was executive director of
                                                                                                             Paralyzed Veterans of America.
                                                                                                                   The standing-room-only
                                                                                                             crowd at the ceremony includ-
                                                                                                             ed former VA secretaries Jim
                                                                                                             Nicholson and Anthony Prin-
                                                                                                             cipi, both of whom Mansfield
                                                                                                             served under, numerous mem-
                                                                                                             bers of Congress, congressional
                                                                                                             staff, current and former VA
                                                                                                             senior staff, and former Sen.
                                                                                                             Bob Dole. VA employees
                                                                                                             came from as far away as Cali-
                                                                                                             fornia to pay tribute.
                                                                                                                   “There is not a man or
                                                                                                             woman in VA who would not
                                                                                           emerson sanders
                                                                                                             willingly follow Gordon Man-
Melvin Daley, exhibits specialist, presents a caricature he did of outgoing VA Deputy Secretary Gordon H.    sfield into battle for the rights
Mansfield during Mansfield’s farewell ceremony at headquarters on Jan. 15. At left is Mansfield’s senior     of our nation’s veterans,” said
advisor, Danny Devine.
                                                                                                             Peake, adding that the VA
VA said goodbye to longtime         years. In his first year at VA,     and services underwent a sea         mission “has no greater cham-
Deputy Secretary Gordon H.          he was assistant secretary for      change and achieved universal        pion” than Mansfield.
Mansfield during a farewell         congressional and legislative       acclaim. Outgoing Secretary                “I’m retiring, I’m not dis-
ceremony at headquarters on         affairs.                            James B. Peake, M.D., and            appearing,” said Mansfield. “I
Jan. 15. Mansfield had been               Mansfield’s tenure as         Chief of Staff Paul Hutter pre-      hope my path will cross with
the Department’s chief operat-      deputy secretary was marked         sided over the ceremony, pay-        many of yours many times
ing officer for the past seven      by a period in which VA care        ing tribute to the Vietnam vet       over the years to come.”

VA to Begin Offering Health Care to Previously Ineligible Veterans
VA plans to re-open enroll-         uniform package of medical          incomes above a set thresh-          ing the Department’s ability
ment in its health care system      benefits for all enrollees. The     old—was suspended on Jan.            to provide high-quality health
by July to about 265,000            legislation opened enrollment       18, 2003, although veterans in       care services to all enrolled vet-
veterans whose incomes exceed       in VA’s health care system to       that priority group who were         erans who are eligible for care.
current limits.                     all eligible veterans and re-       already enrolled for care were             VA’s computer systems
      The change affects vet-       quired that each year the Sec-      permitted to remain enrolled.        are being modified to accom-
erans whose incomes exceed          retary of Veterans Affairs assess        VA originally suspended         modate the changes, and the
the current VA means test and       veterans’ demand for services       enrollment for Priority 8 vet-       Department is preparing com-
geographic means test income        and determine if the necessary      erans because it was unable to       munication and education ma-
thresholds by 10 percent or         resources are available to pro-     provide all enrolled veterans        terials to ensure that Congress,
less. Congress provided funds       vide timely, quality care to all    with timely access to its health     veterans service organizations
in VA’s fiscal year 2009 bud-       enrollees.                          care due to a tremendous             and the public are aware of the
get to support the new enroll-            Enrollment for the lowest     growth in the number of vet-         coming changes.
ment.                               priority of the eight groups—       erans then seeking enrollment.             The new rule is expected
      In 1996, Congress estab-      veterans who are not being          VA now plans to re-open en-          to take effect by June 30 if the
lished a priority-based enroll-     compensated for a military-         rollment for a portion of these      regulatory process proceeds
ment system for VA and a            related disability and who have     veterans without compromis-          smoothly.

2	                                                  							January/February	2009
                                                                 V A nguard                                  around headquarters

VA Teams With DOT, DoD to Steer Veterans Toward Safe Driving
Motor vehicle crashes have
been identified as a leading
cause of death among combat
veterans during the first years
after their return home. Now
VA, the Department of Trans-
portation and the Department
of Defense are working togeth-
er to reduce these accidents.
      On Jan. 12, former VA
Secretary James B. Peake,
M.D., Acting Administrator of
the National Highway Traffic
Safety Administration David
Kelly, and Deputy Under Sec-
retary of Defense for Installa-
tions and Environment Wayne
Arny announced the creation
of a new program designed
to identify needed research
involving recently returned
veterans from Afghanistan and
Iraq and to increase awareness
of the importance of safe driv-                                                                                                   robert turtil
ing among newly-demobilized
veterans.                           NASCAR legend Richard Petty announces his partnership with VA, the Transportation Department and the
                                    Defense Department in the safe driving initiative. Looking on are Acting Administrator of the National
       “Together with our           Highway Traffic Safety Administration David Kelly, left, and former VA Secretary James B. Peake, M.D.
partners at DOT and DoD,
we will be able to collect and            The safe driving initiative    Richard Petty will also be an       both deaths and injuries from
analyze data that will be used      strives to increase awareness of     active partner in the initiative.   motor vehicle crashes have
to develop a comprehensive          motor vehicle crashes among                “Richard Petty Driving        gone down in the United
outreach initiative to target       veterans and the importance of       Experience is thrilled to be        States, due in part to increases
veterans with specific needs—       safe driving, seatbelt and hel-      working with VA, DOT and            in seatbelt use and decreases in
and ultimately to save lives,”      met usage, and other measures.       DoD on such a worthwhile            alcohol involvement.
said Peake.                         To reach out to veterans and         project to save veterans’ lives,”        Nonetheless, motor ve-
      Experts in transportation     their families, VA will create a     said Petty. “We want to bring       hicle accidents remain a major
safety, veterans’ health and        national educational program         more attention to the continu-      concern in the military and
public health are identifying       using the Department’s net-          ing problem of veteran drivers      among veterans as the greatest
gaps in current knowledge and       work of medical centers, com-        and their safety through our        cause of accidental fatalities.
developing a strategic plan for     munity clinics, vet centers and      involvement. Last year alone,       Several studies have reported
addressing key research ques-       benefits offices.                    we operated over 1,100 event        an increase in post-deployment
tions, in fields ranging from             The initiative will also in-   days, ran almost 1 million          deaths among military person-
epidemiology to psychology          clude outreach to mobilize na-       miles on track and had a staff      nel who served in a combat
and biomechanics.                   tional veterans service organi-      of professional drivers. We         zone compared to their non-
      Participants in the strate-   zations; the nation’s governors;     have the commitment, the            deployed counterparts, who
gic planning process include        state police, safety officers and    knowledge to teach, and the         are in the military but not
scientists and policy officials     highway safety officials; private    infrastructure to take this ini-    deployed to a war, after both
from VA, DOT, DoD and               sector employers; automobile,        tiative to many markets.”           the Vietnam War and the
the Department of Health            motorcycle and sports vehicle              According to DOT,             1991 Gulf War. Preliminary
and Human Services, as well         dealers and manufacturers;           motor vehicle crashes are the       evidence also indicates this is
as non-governmental experts.        the motor vehicle insurance          leading cause of death for all      the case with veterans from the
The resulting strategic plan        industry; and driving and            Americans between the ages          Global War on Terrorism.
will lay out research needs         motorcycle racing enthusiast         of 8 and 34. Men constitute              For more on the safe driv-
and identify priorities for the     organizations. NASCAR leg-           about 70 percent of all traf-       ing initiative for veterans, visit
initiative.                         end and safe driving advocate        fic deaths. In the past decade,

	                                                    							January/February	2009	                                                          2
        around headquarters                                   V A nguard

Longtime Veterans’ Advocate, Business Leader Ross Perot Saluted
Former VA Secretary James B. Peake, M.D., pre-
sented business leader and veterans’ advocate Ross
Perot a special award Jan. 7 for embodying “the
very spirit of America” in his selfless support of vet-
erans and the military.
     “Few Americans have done as much as Mr.
Perot to enhance the lives of our veterans, military
personnel, their families and their survivors,” Peake
said. “In a lifetime of behind-the-scenes service to
care for those who have defended our nation, he has
redefined the term veterans’ advocate.”
     Perot’s veterans’ advocacy first gained national
recognition in 1969, when he focused attention on
the brutal treatment of U.S. prisoners of war cap-
tured during the Vietnam War.
     “I am privileged and honored to receive this
award,” Perot said. “My contributions are insignifi-                                                       Ross Perot accepts his
cant compared to all the services and sacrifices of                                                        award from former VA
                                                                                                           Secretary James B. Peake,
our military heroes and their families. They are the                                                       M.D., during a Jan. 7 cer-
guardians at the gate of freedom for all of us.”                                                           emony.
                                                                                                                         emerson sanders
     He has quietly provided financial support to
the families of POWs, offered scholarships to the
children of soldiers killed in action and funded numerous USO events to entertain the troops. During the last 10 years, he has been a
major advocate on behalf of Gulf War veterans.
     A 1953 graduate of the U.S. Naval Academy, Perot founded Electronic Data Systems (EDS), one of the world’s largest technol-
ogy services firms, in 1962. Twenty-six years later, he founded Perot Systems Corp., another leader in the technology field.

Actress Bo Derek Honored for Her Work on Behalf of Veterans
                                                                                     Former VA Secretary James B. Peake, M.D., hon-
                                                                                     ored actress Bo Derek on Jan. 15 for her work to
                                                                                     increase public awareness of VA’s rehabilitative
                                                                                           “Ms. Derek has worked tirelessly to shine the
                                                                                     public spotlight on veterans, especially those who
                                                                                     have been severely injured while serving this na-
                                                                                     tion,” Peake said. “She has been a good friend of
                                                                                     veterans and a bright example of dedicated volun-
                                                                                           Since 2000, Derek has been the honorary chair
                                                                                     of VA’s National Rehabilitation Special Events,
                                                                                     improving public understanding of veterans issues,
                                                                                     encouraging veterans to take advantage of VA’s
                                                                                     rehabilitative programs and visiting VA medical cen-
                                                                                     ters around the country.
 Bo Derek with former VA
 Secretary James B. Peake,
                                                                                           “I am deeply humbled and honored to serve as
 M.D., at the award ceremony                                                         the honorary chair of VA’s National Rehabilitation
 Jan. 15.                                                         emerson sanders    Special Events,” Derek said. “I have met so many
                                                                                     amazing veterans who have sacrificed so much on
our behalf. They are truly among our nation’s finest citizens, and it is a privilege to stand by their side.”
    Derek has also taken part in USO tours to support troops and works with the Special Forces Association, which named her an
honorary Green Beret.
    Derek’s father, Paul Collins, was a radio operator during the Korean War, and both her stepfather and her late husband, actor
John Derek, were also veterans.

2	                                                							January/February	2009
                                                              V A nguard                                 around headquarters

Seven Recipients Honored in Homeless Veterans Awards Program
In its second year, the 2008      the VARO’s food drive for          veterans; and spearheaded the       residential treatment providers
Secretary’s Award for Out-        homeless veterans and their        development of a Faith-Based        for homeless veterans, offering
standing Achievement in           families.                          Federal Interagency Partner-        a full continuum of services.
Service for Homeless Veterans     n Dr. Estella Morris, program      ship initiative to sponsor cloth-   n Volunteers of America of
program honored seven recipi-     manager, Comprehensive             ing drives for San Francisco        Florida – services include
ents at a ceremony held Nov.      Homeless Program, Little           Bay homeless veterans.              education, training and em-
14, 2008. The Secretary’s         Rock, Ark., VA Medical Cen-        n Health Care for Home-             ployment to help homeless
Award program recognizes          ter – among the original 43        less Veterans program, New          veterans find permanent hous-
the outstanding achievements      founders of the Homeless           Orleans VA Medical Center           ing and keep them off the
of individuals, VA employ-        Chronically Mentally Ill pro-      – initially functioned with         streets; their Mobile Service
ees, VA organizations, and        gram sites; obtained six vol-      a 10-member staff prior to          Center, a 40-foot, state-of-
community- and faith-based        unteers through Volunteers in      Hurricane Katrina; re-estab-        the-art satellite telehealth
organizations that provide        Service to America to assist in    lished the Homeless Veterans        vehicle able to service homeless
exceptional service to home-      developing housing, employ-        Dental Program, providing           veterans’ medical and dental
less veterans and contribute to   ment and AIDS education;           205 homeless veterans with          needs, helped veterans during
ending the cycle of homeless-     and since 1997, the Little         immediate service; and in-          the 2004-2005 hurricane relief
ness among veterans.              Rock Comprehensive Home-           creased community awareness         efforts.
      Winners included:           less Center has been honored       of homeless veterans, expanded      n The Health and Resource
n Regina Alexander, homeless      with numerous awards for           the visibility of veterans’ ser-    Initiative for Veterans Every-
veterans outreach coordina-       service to homeless veterans       vices, and provided continuity      where (THRIVE) program,
tor, St. Petersburg, Fla., VA     under her leadership.              of care under extremely chal-       VA Palo Alto, Calif., Health
Regional Office – developed       n Roberta Rosenthal, network       lenging conditions.                 Care System – partner of sev-
and maintains the Homeless        homeless coordinator, VISN         n Retired Cmdr. Al Pavich,          eral VA agencies, including the
Program Directory for VISN        21 (San Francisco) – honored       CEO emeritus, Veterans Vil-         mobile medical team, Domi-
8 (Bay Pines, Fla.); works with   for ensuring seamless access       lage of San Diego – member          ciliary Care for Homeless Vet-
the Health Care for Homeless      and care to homeless veterans      of the Secretary’s Advisory         erans outreach team, Incarcer-
Veterans program to provide       and incarcerated veterans re-      Committee on Homeless Vet-          ated Veterans Re-Entry team,
VA benefits, rehabilitation,      siding in northern California,     erans; under his leadership, the    and Health Care for Homeless
education and related services    Nevada, Hawaii and Guam;           Veterans Village of San Diego       Veterans programs; goal is to
to homeless veterans; imple-      developed and manages one          evolved from an 87-bed early        increase access to health care,
mented the St. Petersburg         of VA’s first comprehensive        treatment facility to a nation-     establish continuity of care,
VARO’s Homeless Veteran           homeless centers that serves       ally recognized “Gold Star”         and return veterans to optimal
Claims Policy; and coordinates    more than 1,500 homeless           program and one of the largest      community living.

Twenty-two VA Employees Receive 2008 Presidential Rank Awards
Twenty-two VA employees           government performance and         ees were among the 292 award        M. Mackay, director of the
were among the 353 career         creating a more effective civil    recipients named Meritorious        VBA Office of Employee
federal executives who re-        service.”                          Executives, an honor limited        Development & Training at
ceived 2008 Presidential Rank          Ron H. Garvin, vice           to 5 percent of the corps.          VACO; Sonia M. Moreno, di-
Awards, announced in Sep-         chairman of the Board of           They were: Robert R. Camp-          rector of the San Juan VARO;
tember.                           Veterans’ Appeals at VA            bell, a research health science          Steve L. Muro, direc-
     “Winners of the pres-        Central Office, Dennis M.          specialist at the Tampa, Fla.,      tor of NCA Field Programs
tigious Presidential Rank         Lewis, director of VISN 20         VA Medical Center; John J.          at VACO; Robert L. Neary,
Awards represent the cream        (Portland, Ore.), and Stephen      Donnellan Jr., director of the      director of the Service Deliv-
of the crop within the federal    Warren, principal deputy as-       VA NY Harbor Healthcare             ery Office at VACO; James
executive ranks,” Office of       sistant secretary for the Office   System, Brooklyn campus; Lily       J. O’Neill, assistant inspector
Personnel Management Acting       of Information & Technology        D. Fetzer, director of the San      general for investigations at
Director Michael Hager said       at VACO, were among 61             Diego VA Regional Office;           VACO; Gary J. Rossio, direc-
in a statement announcing the     career employees nationwide        Nathan L. Geraths, director of      tor of the San Diego VAMC;
2008 awards. “Their profes-       to receive the honor of Distin-    the Hines, Ill., VA Hospital;       Dennis H. Smith, director of
sional dedication and commit-     guished Executive. That dis-       Han K. Kang, director of the        the VA Maryland Health Care
ment to excellence is helping     tinction is limited to 1 percent   War-Related Illness and Injury      System; Patrick L. Sullivan,
to advance President Bush’s       of the senior executive corps.     Study Center at the Washing-        director of the North Chicago
agenda for enhancing federal           Another 19 VA employ-         ton, D.C., VAMC; Dorothy                continued on page 30

	                                                 							January/February	2009	                                                       29
                  introducing                                V A nguard

Ericka Lewis
VA Clinical Informatics Nurse     a private entity, all the soft-    ics, as well as clinical outcome
Ericka Lewis, R.N., recently      ware is public domain and          measures, for nursing service.
earned a scholarship for her      available to others,” she said.    From resetting passwords to
essay about being a proud fed-    “Other organizations develop       creating scatter plots to order-
eral employee.                    technologies or conduct re-        ing new equipment, Lewis
      Lewis, who works at the     search to gain a profit. Federal   serves veterans every day.
James A. Haley Veterans’ Hos-     employees, on the whole, are             Lewis completed her un-
pital in Tampa, Fla., was one     motivated by altruism.”            dergraduate degree at the Uni-
of seven winners named by the          Raised in central Loui-       versity of Louisiana in Monroe
Federal Employee Education        siana, Lewis began her VA          and then made the hard choice
and Assistance Fund, which        career at the Alexandria, La.,     to return to school for her
sponsors the annual FEEA-         VA Medical Center in the           master’s in nursing administra-
National Treasury Employees       ICU/Telemetry unit. Current-       tion. She enrolled online at
Union Scholarship—the             ly a health informatics liaison,   Indiana State University in        Lewis
organization’s most prestigious   Lewis troubleshoots computer       Terre Haute, and will graduate     has given up home-cooked
award. Chosen from more           issues and teaches the CPRS        in May.                            meals for mommy to study;
than 4,000 applicants, Lewis      and Bar Code Medication Ad-              “I needed the flexibility    she has sacrificed ‘mommy and
received $6,000 to help fund      ministration system to nurses.     of this kind of program, and       me’ play dates so I could fin-
her higher education.                   An important part of her     the staff is amazing,” said the    ish my final reports and then
      In her essay, she made a    job is to monitor point of care    single mother. “Education          some,” she said. “Surprisingly,
strong case for the value fed-    medication delivery carts for      is a very strong family value      she does it all with few com-
eral employees bring to their     functionality and performance.     around our house. I have a         plaints. Except for the occa-
fellow Americans. Part of her     When things don’t go well,         supportive and loving family       sional ‘mommy, can you feed
job involves training fellow      she communicates with the          who have always encouraged         me?’ she’s hanging in there
nurses on VA’s state-of-the-art   vendors to explore solutions.      me to pursue excellence.”          with great tenacity.”
Computerized Patient Record            Communication with the              Lewis finds part-time              After earning her degree,
System (CPRS), an electronic      National Bar Code Resource         school and full-time work to       Lewis plans to continue in her
health records system with a      Office is critical in working      be an ideal combination. Every     current role with the VA hos-
proven capacity to lower costs,   with drug manufacturers and        class gives her more insight       pital, possibly helping to solve
reduce errors, and improve        the FDA to ensure quality bar      into the depth and breadth of      nationwide problems like the
quality of care. She sees her     code symbology on medication       today’s health care quanda-        nursing shortage and clinical
role as a VA employee as mak-     packaging. She also collects,      ries—labor relations, health       nursing outcomes.
ing people’s lives better.        analyzes and reports worker        insurance implications, and              “We have a unique op-
      “Because the VA is not      characteristics and demograph-     health disparities—that she        portunity to touch the lives of
                                                                     regularly applies to her career    our nation’s heroes and make
                                                                     by teaching, preparing reports,    a real difference in the health
  About the FEEA                                                     budgeting, and project plan-       and well-being of return-
  the federal employee education and assistance fund, a              ning.                              ing veterans and ultimately
  nonprofit charity that operates without government as-                   While dedicated to apply-    the community,” she said.
  sistance, was formed by federal leaders in 1986 to provide         ing lessons learned in school      “The men and women who
  a safety net for federal employees. annual scholarships,           to helping veterans at work,       have served to protect and
  along with no-interest loans and disaster grants, form the         Lewis admits that at times it      guard our freedom are to be
                                                                     can be a little overwhelming,      honored. What an honor to
  core of feea’s programs.
                                                                     but her 10-year-old daughter       serve those who have given so
        since its inception, feea has awarded more than $8.5         Cassidy is there to cheer her      much in the name of freedom
  million in scholarships. the size and number of scholar-           on and keep her going.             and justice. I serve them with
  ships depends on the amount of money raised from federal                 “My daughter has spent       humility and gladness. It’s my
  employees each year. to learn more, visit            long nights in the library when    way of saying ‘thanks!’”
                                                                     mommy is doing research; she       By Amanda Hester

Rank Awards cont.                 A. Valentino, chief consultant     under secretary for health at      management at VACO; and
VAMC; Charleen R. Szabo,          for pharmacy benefits man-         VACO; Joseph A. Williams,          Rodney W. Wood, director of
director of the West Palm         agement at VACO; Patricia          assistant deputy under secre-      the Financial Services Center
Beach, Fla., VAMC; Michael        Vandenberg, assistant deputy       tary for health, operations and    in Austin, Texas.

30	                                               							January/February	2009
                                                           V A nguard                               medical advances

VA-NIH Trial Backs Deep Brain Stimulation as an Effective Treatment for Some Parkinson’s Patients
A study funded by VA and the deep into the patient’s brain,        and older. That age group has 43 out of 134 patients (32
National Institutes of Health     where energy is used to stimu- been excluded from many pri- percent) showed meaningful
showed that Parkinson’s suf-      late areas linked to movement    or studies. In the new study,   improvements.
ferers who had electrodes         issues.                          the older surgery patients were       “First-line medication
implanted in their brains im-           The goal was to try to     able to control their move-     works quite well for some
proved substantially more than give patients more “on time,”       ments better, but younger ones window of time, occasionally
those who took only medicine. or time when treatment is            benefited even more.            one’s whole life, but typically,
      The study—conducted         effective and motor-func-             The age-related data       a patient takes more and more
at seven VA hospitals and six     tion problems abate. After       might prove helpful because     medications more often. Their
affiliated academic medical       six months, patients with the    there is some bias today        life is ruled by medication to
centers across the country be-    brain implants gained an aver- against using the technology in maintain a decent function,”
tween May 2002 and October age of 4.6 hours per day of on older patients for fear of com-          said Marks, who is director of
2005—required patients to         time, versus no gains at all in  plications and fewer benefits,  the VA Parkinson’s Disease
keep diaries documenting their the medical-therapy group.          according to Weaver and Wil- Research Center at the San
motor and physical function-      Patients with deep brain         liam J. Marks Jr., the study’s  Fransisco VAMC and associ-
ing throughout the day for six stimulation had improved            co-author.                      ate professor of neurology at
months.                                                                                            the University of California,
      The results—published                                                                        San Francisco. “This landmark
in the Jan. 7 Journal of the                                               The deep brain stimu-   study proved superior for such
American Medical Associa-                                                  lation technique in-    patients, rather than a tweak-
tion—showed the deep brain                                                 volves implanting two   and-adjustment [of medica-
                                                                           brain electrodes and a
stimulation technique reduced                                              pacemaker-like device.  tions] approach.”
tremors, rigidity and flailing of                                                                        Although both younger
the limbs and allowed people                                                                       and older patients gleaned sim-
to move freely for nearly five                                                                     ilar benefits from deep brain
extra hours a day.                                                                                 stimulation, older patients
      “We had one patient who                                                                      were more prone to adverse
felt so good he went up to                                                                         effects. The gains were bal-
repair his roof, fell down and                                                                     anced by a much higher rate of
broke both his legs,” said lead                                                                    adverse events—40 percent vs.
author Fran Weaver of the                                                                          11 percent—for patients with
Hines VA Hospital, outside                                                                         the implants.
Chicago. “Patients are feeling                                                                           Common complications
so much better, they forget                                                                        included infections at the
they still have Parkinson’s.”                                                                      surgical site, often where the
      There is no cure for Par-                                                                    power generator is implanted
kinson’s disease, which affects                                                                    in the chest, which is common
more than 1 million Ameri-                                                                         with deep brain stimulation.
cans. Patients suffer from         courtesy of medtronic                                           Weaver said 99 percent of the
increasingly severe tremors and                                                                    adverse events were resolved
periodically rigid limbs as their                                                                  within six months, including
brains stop making dopamine, motor function and scored                  In the surgery group, 86   some cases in which an infec-
a chemical needed for move-       significantly better on a qual-  out of 121 (71 percent) saw     tion required the removal of
ment. They can have trouble       ity-of-life measure. Their abil- meaningful improvements in      the generator from the chest.
walking, speaking and writing, ity to move without impedi-         movement, as scored by the            In the surgery group, 49
and often struggle with depres- ment improved in 71 percent        neurologists.                   people had serious problems,
sion.                             of the surgical patients and          Those findings will help   including infections, falls and
      Standard treatments         32 percent of the medication     older patients make decisions   one death because of compli-
include drugs to stimulate        patients.                        about treatment, said Dr.       cations from the surgery. In
dopamine. But over time, the            Other studies have shown Michael Okun, medical direc- the control group, only 15 en-
medicines can produce flailing improvements with surgery,          tor of the National Parkinson   countered serious problems.
movements that are as trou-       but this is the first and the    Foundation, who was not               “You don’t want to un-
bling as Parkinson’s tremors.     largest to look at how patients involved in the study. The       derestimate or overestimate the
The deep brain stimulation        70 or older fare compared        information on falls and other risks,” said Weaver, a specialist
technique involves implanting with their younger coun-             problems will help doctors give in chronic care. “It still is an
a pacemaker-like device in the terparts. One-fourth of the         better advice, he said.         individual decision between a
chest and then running wires      people in the study were 70           In the medication group,   patient and a physician.”

	                                               							January/February	2009	                                                   31
            medical advances                                  V A nguard

Yoga Study Finds Mix of Health Benefits
Drill sergeants and yoga instructors may seem like polar oppo-
sites. But a group of veterans at the VA San Diego Healthcare
System is now dutifully “following orders” from their yoga teach-
ers—and feeling less pain as a result.
      According to a pilot study appearing in the November Jour-
nal of Alternative and Complementary Medicine, veterans with
chronic low-back pain who took part in at least eight weekly yoga
classes reported a significant reduction in pain. They also reported
improvements in mood, energy and quality of life. The more
                                                                         Veterans (from left) “Big D”
classes they attended, the greater the gains.                            Donaldson, Jay Shufeldt and
      The data were based on survey feedback from 33 men and             Art Harrison take part in a
women, average age 55, who had back pain for at least six months yoga class with instructor
before starting yoga.                                                    Dawn Landon at the San
      “The decreased pain, decreased depression, and increased en- Diego VA.                                                  keVin walsh

ergy and quality of life are all very important findings,” said lead
author Erik G. Groessl, Ph.D., a psychologist and health-services researcher with VA and the University of California, San Diego.
“Pain is their main complaint, but depression is also important in this population.”
      VA physician Sunita Baxi, M.D., who studied yoga therapy extensively in India, started the classes at the San Diego VA in
2003. Weekly classes have been ongoing ever since, attracting a mix of veterans—including many recent returnees from Afghanistan
and Iraq.
      A study at the Tampa VA found that about 45 percent of returning veterans enrolling at the facility had pain of some kind. Of
those veterans, some 40 percent had low back pain.
      Yoga classes take place in at least a handful of other VA centers across the nation. The Minneapolis VA, for example, offers
yoga—as well as the gentle Chinese martial art tai chi—to recovering polytrauma patients. The Dallas VA offers a class as part of its
women’s wellness program. Outside VA, Walter Reed Army Medical Center in Washington, D.C., has also been using yoga, mainly
to treat PTSD in combat troops.
      Past research has found a wide range of health benefits for yoga, including reduced back pain. But these studies have typically
included mostly women. And they have not focused on people with multiple health problems. Baxi and Groessl’s VA study included
mostly men and analyzed a variety of outcomes covering physical and mental health. The researchers hope their results will help
broaden yoga’s appeal within VA, especially as a therapy for veterans with chronic pain.
      “People are realizing the danger of long-term use of narcotic pain medications and want something with no side effects,” said
      The group now plans a larger, longer trial of yoga that will measure outcomes such as pain, disability, function, depression,
anxiety, energy, and overall quality of life. - VA Research Currents

Data from a Recent Study Show Home Health Technology Improves Access to Care for Veterans
Veterans with chronic condi-    our health care system.”              VA’s home telehealth        for Health Dr. Michael J.
tions can manage their health        The study found a 25       program cares for 35,000 pa-      Kussman said the key to the
and avoid hospitalization by    percent reduction in the aver-  tients and is the largest of its  program’s success is VA’s
using special technology pro-   age number of days hospital-    kind in the world. Clinicians     computerized patient record
vided by VA in their homes,     ized and a 19 percent reduc-    and managers in health care       system. “Data obtained from
according to a recent study.    tion in hospitalizations for    systems, as well as information the home such as blood pres-
     “The study showed that     patients using home telehealth. technology professionals, have sure and blood glucose, along
home telehealth makes health    The data also show that for     been awaiting the results of      with other patient information
care more effective because it  some patients the cost of tele- the telehealth study, said Dr.    in the electronic system, allows
improves patients’ access to    health services in their homes  Adam Darkins, chief consul-       our health care teams to an-
care and is easy to use,” said  averaged $1,600 a year—much tant in VA’s care coordination ticipate and prevent avoidable
former VA Secretary James       lower than in-home clinician    program, who led the study.       problems,” he said.
B. Peake, M.D. “A real plus     care costs.                           “The results are not re-         VA health care officials
is that this approach to care        The authors of the study   ally about the technology,        emphasize that home tele-
can be sustained because it’s   in the December 2008 issue      but about how using it helps      health does not necessarily
so cost-effective and more vet- of the journal Telemedicine     coordinate the full scope of      replace nursing home care or
eran-centric. Patients in rural and e-Health are VA national    care our patients need,” said     traditional care but can help
areas are increasingly finding  telehealth staff members. The   Darkins. “It permits us to give veterans understand and man-
that telehealth improves their  study looked at health out-     the right care in the right place age chronic conditions such
access to care and promotes     comes from 17,025 VA home       at the right time.”               as diabetes, hypertension and
their ongoing relationship with telehealth patients.                  VA Under Secretary          chronic heart failure.

32	                                                							January/February	2009
                                                                 V A nguard                                   have you heard

Football Greats Visit
Tampa Fisher House                                                                                            Welcome Home for
Super Bowl week in Tampa,                                                                                     OEF/OIF Veterans in
Fla., brought two legends of                                                                                  Puerto Rico
football to the Fisher House at                                                                               Members of the Rehabilita-
the James A. Haley Veterans’                                                                                  tion Outcomes Research
Hospital. Mike Ditka, former                                                                                  Center from the North
Chicago Bears coach, and                                                                                      Florida/South Georgia
Rocky Bleier, former Pittsburgh                                                                               Veterans Health System’s
Steelers running back and                                                                                     Malcom Randall VA Medi-
Vietnam veteran, stopped by to                                                                                cal Center in Gainesville,
show their support for wound-                                                                                 Fla., recently participated in
ed veterans. They autographed                                                                                 a “Welcome Home!” event
footballs and visited with the                                                                                held Nov. 22, 2008, in
veterans and their families.                                                            kamryn jaroszewski    Puerto Rico.
      After his rookie season                                                                                       During the event,
with the Steelers, Bleier was       Mike Ditka autographs a ball for Army Spc. Billy Gudzak while Rocky
                                    Bleier talks with Gudzak’s stepfather, Chris Capsambelis.                 which was sponsored by the
drafted into the Army in De-                                                                                  VA Caribbean Healthcare
cember 1968, and shipped out to Vietnam in May 1969, where he served with the 196th Light                     System, several VA repre-
Infantry Brigade. On Aug. 20, 1969, Bleier was wounded in the left thigh when his platoon was                 sentatives and veterans ser-
ambushed in a rice paddy. While he was down, an enemy grenade exploded nearby, sending shrap-                 vice organizations distrib-
nel into his right leg. He was later awarded the Bronze Star and the Purple Heart. Bleier spent               uted information, including
eight months in the hospital recovering from his wounds. Doctors told him he would never play                 3,000 copies of a guide
football again. But he came back and helped the Steelers win four Super Bowls.                                created especially for Puerto
                                                                                                              Rican Operation Enduring
VA Police Help With San                                                                                       Freedom/Operation Iraqi
Diego Law Enforcement                                                                                         Freedom veterans.
Teddy Bear Drive                                                                                                    Called the “Guía de
For the past 10 years, the                                                                                    Ayuda Para el Reajuste
members of the police force at                                                                                Post-Movilización de Vet-
the VA San Diego Healthcare                                                                                   eranos/as Puertorriquenos Y
System have participated in the                                                                               Familiares” (“Post-deploy-
San Diego Regional Law En-                                                                                    ment Readjustment Guide
forcement Teddy Bear Drive.                                                                                   for Puerto Rican OEF/OIF
The yearlong drive, sponsored                                                                                 Veterans and Families”),
by local law enforcement agen-                                                                                the guide was created to
cies, collects brand-new stuffed                                                                              be culturally relevant to
animals and delivers them to                                                                                  the Puerto Rican veteran
hospitalized children at Rady                                                                                 population and their needs.
                                                                                                tammy brent
Children’s Hospital. Once a                                                                                   Published in Puerto Rican
month, uniformed police of-         A police car loaded with teddy bears is ready to deliver its cargo to a   Spanish, it aims to assist
ficers from agencies across the     children’s hospital.                                                      veterans with their transi-
region volunteer their time to visit with some of the county’s smallest patients and give them a              tion back into civilian life.
stuffed animal, hoping for a smile in return.                                                                 Due to overwhelming de-
      The collection of stuffed bears culminates each year with the Teddy Bear Caravan. Each De-              mand, an additional 3,000
cember, the VA police, along with nearly 100 police cars filled with teddy bears, leave a local police        guides will be printed and
department headquarters for the Children’s Hospital with a special escort by the California High-             distributed early this year.
way Patrol. Last year alone, 65,000 teddy bears were delivered to the hospital.

Compensated Work Therapy Supported Employment Program Improves West Virginia Veteran’s Life
Russell Martz, a Marine Corps veterans with mental illnesses. in Clarksburg, W.Va. After      “I am in a recovering state of
veteran with a passion for     After suffering from severe    extensive treatments, Martz’s   mind due to continual support
cooking, now has a job in the  mood swings, which left him    moods began to stabilize.       from my VA treatment team,”
food service industry thanks   unemployed, living in assisted      In 2005, Martz was re-     he says. “I am living in a house
to the assistance of VA’s      housing, and reliant on Social ferred to the CWT program       in the community, I am off
Compensated Work Therapy       Security payments, Martz       and was soon hired at the       disability, and I am back on
Supported Employment Pro-      sought help at the Louis A.    medical center, a move he       track thanks to my employ-
gram, which offers support for Johnson VA Medical Center      credits with saving his future. ment opportunity!”

	                                                    							January/February	2009	                                                        33
                 have you heard                                 V A nguard

                                                                        that spirit by adopting an entire Army battalion with a very spe-
                                                                        cial member: one of their own veterans service representatives.
                                                                        Capt. Crystal Ballard is an Army reservist currently deployed in
                                                                        support of Operation Enduring Freedom.
                                                                              Deciding to send a little taste of home, the VARO mailed
                                                                        12 boxes stuffed with candy, cookies, hot chocolate, peanut but-
                                                                        ter, stocking stuffers and holiday cards to the battalion. After re-
                                                                        ceiving the boxes, Ballard sent a note and a photo to the VARO
                                                                        employees. “I wanted to send you a quick thank you for the gift
                                                                        boxes that our soldiers and I just received from your organiza-
                                                                        tion. We have received so many wonderful boxes that we are
                                                                        even sharing with our multi-national partners stationed with us
                                                                        here,” wrote Ballard.

brian a. pounds/connecticut post

Gertrude Noone blows out the candles on her cake as grandniece
Deborah Woods looks on.
Oldest Known U.S. Veteran Gertrude Noone
Celebrates 110th Birthday in Connecticut
Gertrude E. Noone, the oldest known U.S. veteran, knows the
secret to a long life: “Just keep breathing.” And with that, Noone
celebrated her 110th birthday in style at a party filled with fam-
ily, friends and community members, including the mayor of
Milford, Conn., where she lives.
      One of 10 children, Noone was born Dec. 30, 1898. Never
married, she worked for Travelers Insurance in Hartford, Conn.,
before World War II. In 1943, during the war, she enlisted in
the U.S. Women’s Army Corps. Serving in the war effort as a
                                                                                                                                 bobbi Gruner
tech sergeant, she eventually attained the rank of staff sergeant
before discharge in 1949. She continued working as a secretary          Molla Shibeshi, supervisor of the blood bank on the grounds of the
in a private psychiatric hospital in Stamford until retiring in         Carl R. Darnall Army Medical Center at Fort Hood, Texas, which has
                                                                        teamed up with the VA medical center in Houston.
1962. Although currently residing in an assisted living facility,
Noone didn’t stop driving until 1990 and lived independently            Collaboration With Military Blood Bank Saves
until age 103.                                                          Precious Resources
                                                                        A recent collaboration between the Michael E. DeBakey VA
Christmas Greetings—With Love—to Hospitalized                           Medical Center in Houston and the Robertson Blood Center at
Veterans                                                                Fort Hood aims to save taxpayer money and maximize the use
Lindsay Gray, 8, a third-grader from Waco, Texas, wanted to do          of a valuable and perishable resource: blood. In a medical emer-
something special for hospitalized veterans and service members         gency, the most important element is the availability of blood.
for the holidays. So at the suggestion of her grandfather, Carl         The Blood Center, an Army blood bank on the grounds of the
Lowe, director of the Waco VA Regional Office, she embarked             Carl R. Darnall Army Medical Center, provides blood not im-
on a big project to send Christmas greetings.                           mediately needed by the Army to the DeBakey VAMC.
      Provided with the addresses of military hospitals, as well as a        “This partnership between the Army and the DeBakey
listing of all VA medical centers, Gray addressed and mailed 170        VAMC not only saves a tremendous amount of money and
Christmas cards. Inside each card was her handwritten message:          prevents waste of a precious resource, but more importantly, our
“Thank you for your service. Merry Christmas! Love, Lindsay.”           joint commitment helps save the lives of our nation’s heroes,”
She addressed each card to “Any Veteran,” allowing nursing              said Michael M. Ittmann, M.D., Ph.D., Pathology and Labora-
staff to give the card to a veteran who might not have received a       tory Medicine chief. Since May 2008, the DeBakey VAMC has
Christmas card otherwise. Gray said she would like to pursue a          saved more than $300,000.
similar project in the future and hopes her cards lifted the holi-
day spirits of those who received them.                                 National Congress of American Indians Held
                                                                        in Arizona
Denver VA Regional Office Packs Holiday Cheer                           VA joined American Indian tribal representatives in Phoenix for
for Active-Duty Employee                                                the annual convention of the National Congress of American
The holiday season is universally synonymous with the “spirit           Indians. Representatives from VA’s three administrations and
of giving.” The VA regional office in Denver heartily embraced          Readjustment Counseling Service staffed a booth at the conven-

3	                                                 							January/February	2009
                                                                V A nguard                                 have you heard

tion trade show to answer questions and share information with          ahead of some prestigious businesses and organizations and has
attendees. The convention visit was organized by VA’s Ad Hoc            the distinction of being the only federal agency in Maryland to
Working Group on American Indian, Alaska Native and Na-                 make the list for 2008. The 10 finalists for the competition were
tive Hawaiian veterans established by former Secretary James B.         selected based on employee responses to an online survey that
Peake, M.D., as a forum to improve the delivery of benefits and         was conducted by the Baltimore Business Journal over a three-
services to these veterans.                                             week period. To be eligible to participate in the competition,
     The Census Bureau estimates there are approximately                the health care system needed a minimum of 195 employees to
165,000 American Indian or Alaska Native veterans in the Unit-          complete the online survey. This is the second such honor for
ed States, a higher percentage of veterans than other ethnicities.      VA Maryland, which achieved a seventh-place ranking in the
In 1944, the NCAI was founded in response to termination and            2006 competition.
assimilation policies that the United States forced upon the tribal
governments in contradiction of their treaty rights and status as       New Law Authorizes Veterans’ Salutes During
sovereigns.                                                             National Anthem
                                                                        Veterans and active-duty military not in uniform can now
                                                                        render the military-style hand salute during the playing of the
                                                                        national anthem, thanks to changes in federal law that took ef-
                                                                        fect in October 2008. The new provision improves upon a little-
                                                                        known change in federal law in 2007 that authorized veterans to
                                                                        render the military-style hand salute during the raising, lowering
                                                                        or passing of the flag, but it did not address salutes during the
                                                                        national anthem. The 2007 provision also applied to members
                                                                        of the armed forces while not in uniform.
                                                                              Traditionally, members of the nation’s veterans service or-
                                                                        ganizations have rendered the hand salute during the national
                                                                        anthem and at events involving the national flag while wearing
                                                                        their organization’s official head gear. The most recent change,
                                                                        authorizing hand salutes during the national anthem by veterans
                                                                        and out-of-uniform military personnel, was included in the De-
                                                    edGardo caballero   fense Authorization Act of 2009, which President Bush signed
                                                                        on Oct. 14.
Nestlé employees’ recent volunteer improvement projects at the San
Francisco VA Medical Center included landscaping in front of clinic
                                                                        Classic Cars, Veterans Cruise Through VA Gulf
                                                                        Coast Health Care System
Nestlé Military Team Volunteers at San Francisco                        On Oct. 7, 2008, more than 1,000 cars and people gathered on
VA Medical Center                                                       the VA Gulf Coast Veterans Health Care System’s Biloxi, Miss.,
A group of 53 Nestlé employees recently spent a day volunteer-          campus for the annual “Cruisin’ the Coast VA Cruise-In.” The
ing at the San Francisco VA Medical Center, helping with im-            first official cruise-in kicked off in 2002, and a phone call from
provement projects around the facility. In an effort to give some-      a VA nurse started it all. “A nurse called and said how much it
thing back to veterans, the Nestlé Military Team completed              would mean to her patients if we could arrange to bring a few
landscaping projects in front of several clinic areas and donated       of the cars by for them to see,” said Coleen Kershaw, “Cruisin’
not only their skills and talent, but also $5,000.                      the Coast” manager. “A nurse told me that one patient, while
     Through the coordinated effort of VA’s Veterans Canteen            looking at the cars, said the name of a certain car out loud—this
Service and the medical center, the group completely trans-             patient hadn’t spoken in two years!”
formed the patient patio at the community living center, home                 Even the VA staff eagerly looks forward to the event. “This
to nearly 100 VA Medical Center inNestlé scrubbed and
DeBakey veterans. In addition, Team Houston and                         is a great way for residents to see the cars that bring back so
cleaned patients’ wheelchairs until they sparkled, much to the          many memories,” said Penny Bise, VA Gulf Coast speech pa-
the Robertson Blood Center at Fort Hood aims
delight and appreciation of the residents at the center. Nestlé         thologist.
to save taxpayer money and maximize the use
Military Team is a group of company employees, many of
of are veterans, whose primary function is to accommodate
the Defense Commissary Agency and who report directly to the              Returning Servicemembers Site
Department of Defense.                                                    returning operation enduring freedom/operation iraqi
VA Maryland Health Care System Named One of                               freedom service members have a newly enhanced Va
10 Best Places to Work in Baltimore                                       web site just for them. launched the week of the presi-
The VA Maryland Health Care System has officially been named              dential inauguration at, the returning
one of the 10 Best Places to Work in Baltimore. The health care           servicemembers site offers tailored information on Va
system competed with more than 90 other businesses, hospitals,            services and programs, as well as internet-savvy video
universities and financial institutions throughout the state for the      features, stories, and even a blog. hello, web 2.0!
honor. VA Maryland actually achieved a fourth-place ranking

	                                                   							January/February	2009	                                                      3
                        honors                                   V A nguard

                                                                         Management before focusing their efforts on transforming the
                                                                         government’s Student Career Experience Program into a primary
                                                                         talent pipeline for VHA. The team’s recommendations provide a
                                                                         solid foundation for making VHA’s student programs as success-
                                                                         ful for recruitment as those in best-practice organizations.
                                                                               VHA’s 2008 Annenberg Fellows are: Debra Crouch, ad-
                                                                         ministrative officer, Ann Arbor, Mich., VA Medical Center;
                                                                         Christine Edie, pharmacist, Cincinnati VA Medical Center;
                                                                         Jeanie Scott, VHA Office of Information, Albany, N.Y.; Cheryl
                                                                         Wisnieski, Workforce Management and Consulting Office,
                                                                         Columbia, S.C.; and David Isaacks, Health Revenue Center,
                                                                         Topeka, Kan.

                                                          GreG westlye
                                                                         VA Palo Alto Health Care System Research
                                                                         Scientist Receives APA Top Honor
Paul Perrin, left, discusses his award from the American Psychologi-     VA research scientist Keith Humphreys will receive the 2009
cal Association with two of his mentors: Dr. Leslie Gonzalez-Rothi,
center, program director of the Brain Rehabilitation Research Center
                                                                         American Psychological Association award for Distinguished
and professor of neurology at the University of Florida, and Dr. Mar-    Contributions to Psychology in the Public Interest for his efforts
tin Heesacker, investigator at the Brain Rehabilitation Research Cen-    building mental health service systems for VA and Iraq.
ter and professor of psychology at the University of Florida.                  Humphreys, director of VA’s Program Evaluation and Re-
                                                                         source Center in Palo Alto, Calif., was in Washington, D.C., in
VA Research Center of Excellence Student Wins                            2004 helping to develop VA’s national Strategic Plan for Mental
American Psychological Association Award                                 Health when he was asked to volunteer on a task force set up by
Paul Perrin, of the VA Brain Rehabilitation Research Center at           the Substance Abuse and Mental Health Services Administration
the Malcom Randall VA Medical Center in Gainesville, Fla.,               to rebuild the Iraqi Ministry of Health’s shattered mental health
received the American Psychological Association’s Psychology             care system. Humphreys has since conducted mental health
Student Award at its 2008 annual convention in Boston. The               training and policy consultations with Iraqi medical professionals
award recognizes an outstanding graduate student in the field of         in Turkey, Jordan, Egypt and Iraq, where he expects to return
rehabilitation psychology as demonstrated by research presented          this spring.
in poster format at the APA convention.                                        Meanwhile, he also helped guide a major increase in VA’s
     Perrin, a doctoral student, won with his presentation,              national web of mental health services that has positioned VA as
“Caregiver Psychosocial Variables and Functioning of Individu-           the largest and most recognized authority on mental health ser-
als with Stroke.” His study found that stroke caregivers find life       vices and therapies in the world.
less meaningful, manageable and comprehensible when their care
recipients are immobile, uncommunicative, unable to perform              Researcher Receives
normal daily activities, or disengaged from life. The study also         Presidential Award
found that caregivers feel a greater sense of burden and depres-         VA rheumatologist and bone re-
sion when care recipients are depressed and experiencing cogni-          searcher Mary Beth Humphrey,
tive difficulties. Perrin’s study shows the disabling effects of brain   M.D., Ph.D., is among a small
injury and disease extend beyond the affected person, which adds         group of scientists from 11 fed-
to the urgency of finding effective treatments for these problems.       eral agencies who received Presi-
     Perrin received his master’s degree in psychology at the Uni-       dential Early Career Awards
versity of Florida in 2007 and is now pursuing his doctorate in          for Scientists and Engineers at
rehabilitation counseling.                                               the White House in December
                                                                         2008. Humphrey sees patients
Partnership for Public Service Leadership                                and conducts lab research at the
Institute Has Five VA Graduates                                          Oklahoma City VA Medical
Five Veterans Health Administration employees graduated from             Center, where she specializes in
the Partnership for Public Service’s Annenberg Leadership Insti-         “osteoimmunology”—a rela-             Humphrey
tute, a seven-month program that prepares rising federal leaders         tively new field that merges bone biology with immunology. She
to solve pressing national issues by driving innovation, inspiring       studies osteoclasts, cells that chew away old bone so new bone
employees, and delivering results. Annenberg Fellows were se-            can be formed. In diseases such as osteoporosis, too many of
lected from eight federal agencies to participate in the program’s       these cells are active, resulting in bone loss.
inaugural year.                                                                The Presidential Award is the highest honor bestowed by
      The cornerstone of the Annenberg Leadership Institute is           the U.S. government on outstanding scientists and engineers
real-life application of lessons learned in the classroom. VHA’s         beginning their independent careers. As part of her award, Hum-
team addressed recruitment, benchmarking with best-practice              phrey will receive $125,000 over five years from VA’s Office of
organizations such as Procter & Gamble and the Bureau of Land            Research and Development in support of her research.

3	                                                  							January/February	2009
                                                             V A nguard                                   honors

NCMA Presents Patient Safety Center Employee
with Fellow Award
The National Contract Management Association awards com-
mittee designated James N. Phillips Jr., a management analyst
with VA’s National Center for Patient Safety in Ann Arbor,
Mich., as an NCMA Fellow and presented him with an achieve-
ment award during the 2008 Government Contract Manage-
ment conference in Bethesda, Md. “Jim has demonstrated years
of dedication and loyalty to the profession of contract manage-
ment and to NCMA,” said NCMA President Steve Ayers.
     Phillips is a 15-year member of NCMA and is well known
throughout the Ann Arbor area for his leadership roles and con-
tributions to enhance and expand the professional acceptance
of NCMA membership and certification. The former chapter
president and current membership chair of the Detroit chapter                                                                   scott watts
also sits on the national chapter relations committee and has        Tony Burgett, national service officer with the Military Order of
both authored and co-authored articles for NCMA’s highly re-         the Purple Heart, presents the organization’s Distinguished Service
garded Contract Management magazine. The Fellow designation is       Award to Dr. Jo Harbour, left, and Nancy Mullins, honoring their
                                                                     work improving care for former POWs.
NCMA’s third-highest award and is given to those who have made
outstanding contributions to the contract management discipline.     Employees Recognized for Work Treating POWs
                                                                     Two Jackson, Miss., VA employees were recognized by a nation-
NCA Employee Recognized By Disabled                                  al veterans group for their hard work, dedication and initiative
American Veterans                                                    in treating former prisoners of war. The Military Order of the
Daniel J. Barford, of Ohio’s Dayton National Cemetery, was           Purple Heart recognized Dr. Jo Harbour, ex-POW clinician at
presented the National Commander’s Outstanding Department            the G.V. “Sonny” Montgomery VA Medical Center, and Nancy
of Veterans Affairs Employee Award by the Disabled American          Mullins, ex-POW coordinator from the VA regional office.
Veterans during the organization’s 87th National Convention               Harbour and Mullins designed the Ex-POW Case Manage-
in Las Vegas last summer for his dedication and compassion in        ment Initiative Program that streamlines operations, provides
serving veterans and their families.                                 world-class, personalized VA service to former POWs, and tar-
      A Vietnam veteran, Barford joined the staff at Dayton Na-      gets specific problems associated with the processing of claims.
tional Cemetery as a cemetery representative in 2006. He is a        The program, a collaborative effort between the medical center
trained and licensed funeral director who is following a family      and regional office, is considered the gold standard for POW
tradition. His father served with the National Cemetery Admin-       service and treatment in VA. The Military Order of the Purple
istration and its forerunner for 25 years. “When I got into the      Heart presented the employees with the organization’s Distin-
funeral business in 1990, veterans’ services became a very impor-    guished Service Award.
tant part of my career,” he said. “It was very emotional for me,
and now it’s what I do every day.”                                   San Diego Nurse Inducted Into Spinal Cord
                                                                     Injury Hall of Fame
Tampa VA Nurse                                                       Kathleen L. Dunn, a registered nurse with the VA San Diego
Named Academy of                                                     Healthcare System Spinal Cord Injury Unit, was inducted into
Nursing Fellow                                                       the Spinal Cord Injury Hall of Fame during the 4th Annual SCI
Sandra K. Janzen, R.N., associ-                                      Hall of Fame Gala in New Orleans on Nov. 17, 2008. She was
ate director for patient care/                                       one of 17 selected from 150 nominees in the Disability Educator
nursing services at the James                                        category. Dunn was recognized for her outstanding leadership in
A. Haley Veterans’ Hospital                                          the local, national and international programs and education for
in Tampa, Fla., was inducted                                         people with spinal cord injuries.
into the American Academy of                                              Dunn is the only nurse to have received this prestigious
Nursing as one of the 2008 new                                       award. She was also recognized with an Advanced Practice Nurse
fellows. Janzen attended Wino-                                       Award by the Association of Rehabilitation Nurses a month be-
na State University for her un-                                      fore the Hall of Fame Gala. Dunn was recognized for her work
dergraduate work, and received                                       as a nurse in an advanced practice role for contributing to the
her master’s degree from the                                         advancement of rehabilitation nursing care.
University of Minnesota, with
doctoral work at the University Janzen                               Financial Management Awards Handed Out
of Florida. She has been the nurse executive at Haley for the past   Four VA employees received the first VA Chief Financial Officer
22 years, leading that organization to recognition as the Ameri-     Financial Management Awards at VA Central Office on Dec.
can Nurses Credentialing Center’s first VA Magnet hospital, and      17, 2008. Vicki Edmonds, business manager, South Central VA
winner of the inaugural Magnet Prize.                                Health Care Network (VISN 16) in Jackson, Miss., and Terry
	                                                 							January/February	2009	                                                            3
                       honors                                  V A nguard

Riffel, associate director, Financial Operations Service, Financial
Services Center in Austin, Texas, received the VA CFO Award
for Financial Management Innovation. Rachel Ann Mitchell,
chief financial officer, VA Capitol Health Care Network (VISN
5) in Baltimore, and Mitchel Sturm, director, Finance Service,
VBA Office of Resource Management at VACO, received the
VA CFO Award for Financial Management Program Improve-
ments. These awards recognize exceptional accomplishments
that have contributed to the Department’s success in financial
performance and management.

                                                                                                                               will ackerman

                                                                       Al Washko, director of the VA Nebraska-Western Iowa Health Care
                                                                       System, presents the World War II Medallion to Monsignor Richard

                                                                       Battle of Iwo Jima, has been a VA chaplain since 1984.
                                                        stephen naGy        Last summer, the monsignor was a speaker during the open-
                                                                       ing ceremony of the 28th National Veterans Wheelchair Games,
Dr. Stephen Nagy’s image was featured on the Scientific American
and National Geographic Web sites.                                     which the VA Nebraska-Western Iowa Health Care System
                                                                       co-hosted in Omaha. Retired Army Sgt. Maj. Nick Lapajenko,
Psychiatrist Takes Winning Photo Through                               who is on the NCOA national board of directors, was captivated
Microscope                                                             by Wolbach’s remarks during the ceremony and was inspired to
Stephen S. Nagy, M.D., a psychiatrist with the VA Montana              write the system’s director, Al Washko. “They were touched by
Health Care System in Fort Harrison, won third place in the            your remarks,” Washko said during the award ceremony. “You
2008 Olympus Bioscapes International Digital Imaging Com-              are a representative of why we’re here at the VA, and a represen-
petition, a photo competition for images taken through a light         tative of the Greatest Generation.”
microscope. His winning image, one of about 1,500 entries from
47 countries, was of the glass shell of an extinct marine diatom       Houston Earns Redesignation as Prestigious
that lived approximately 20 million years ago, named Actinopty-        Nursing Services Magnet
chus heliopelta Grunow.                                                The Michael E. DeBakey VA Medical Center in Houston has
     The winning image was taken through a rare type of mi-            been recertified with prestigious Magnet Recognition for Excel-
croscope that sends two beams of light through the slide, one          lence in Nursing. The American Nurses Credentialing Center,
through the specimen and the other next to it. The waves of            the nation’s leading nursing credentialing organization, granted
light that pass through the specimen are slowed down by the            Magnet Recognition redesignation to the Houston medical cen-
diatom, so when these two beams are recombined, the difference         ter in January.
between the waves is converted into a color difference. Nagy’s               Magnet status is the highest honor a health care organiza-
image was featured on the Scientific American and National Geo-        tion can receive for nursing services. ANCC has conferred this
graphic Web sites.                                                     national designation on some of the country’s most prestigious
                                                                       institutions, including the Mayo Clinic in Minnesota, the James
Non Commissioned Officers Association Honors                           A. Haley Veterans’ Hospital in Tampa, Fla., Cedars-Sinai Medi-
VA Nebraska-Western Iowa Chief Chaplain                                cal Center in Los Angeles and the Portland, Ore., VA Medical
Monsignor Richard Wolbach, chief chaplain at the VA Nebras-            Center. The Magnet program was developed to recognize health
ka-Western Iowa Health Care System, was recently honored by            care organizations that provide the best in quality patient care
the Non Commissioned Officers Association with its prestigious         and uphold excellence in professional nursing practice.
World War II Medallion as a tribute and salute to his sacrifice              To receive the ANCC’s Magnet designation, a team of
and service in answering the call to duty. Wolbach, who served         professionals appraises a hospital’s nursing services, clinical out-
in the Marine Corps during World War II and fought in the              comes, and patient care.

3	                                                							January/February	2009
                                                                  V A nguard                                heroes

                                                                        may have just ventured out of its nest too soon and was not yet
                                                                        strong enough to fly and return home. To prevent the eaglet
                                                                        from being attacked by other predators and to return it to its
                                                                        parents as soon as possible, a rescue center volunteer hooded
                                                                        the eaglet for safety and carried it up a ladder to a platform on a
                                                                        nearby tree. From there the eaglet could be heard by its parents,
                                                                        yet it was just far enough away to avoid undue disruption to the
                                                                        adult eagles and their nest containing another offspring.

                                                                        Quick Thinking and Teamwork Save a Life
                                                                        James Nackley, a respiratory therapist with the VA Hudson Val-
                                                                        ley Health Care System in New York, was on his way to work
                                                                        when he was flagged down by a toll collector on the Newburgh
                                                                        Beacon Bridge. She informed him that a man in his 50s had
                                                                        stopped to pay a toll and claimed he was going to the Castle
                                                                        Point campus to commit suicide that day. Nackley immediately
                                                                        contacted the campus police department, and officers there con-
                                                                        tacted the Newburgh Beacon Bridge Authority for assistance.
                                                                              After viewing security camera footage, the Bridge Authority
                                                        alilia mcneal   was able to provide a clear description of the vehicle being driven
                                                                        by the veteran. Patrol cars were assigned to canvas the route, and
Yi Chen worked around the clock for three days helping victims.
                                                                        they soon found the car on the Castle Point campus. Police of-
Employee Assists With Disaster Relief Efforts                           ficers stopped the vehicle and spoke with the veteran, gaining his
This past May, Yi Chen, a medical assistant in the ambulatory           trust and approval to search the car. No weapons were found.
care clinic at the Reno, Nev., VA Medical Center, was in China          With the help of Dr. Joseph Amato, suicide prevention coordi-
as a volunteer, assisting with preparations for the Olympics. On        nator at the facility, the officers were able to convince the veteran
May 12, 2008, a magnitude 8 earthquake hit Sichuan province             to seek help. He was evaluated at the urgent care area, where the
and the capital city of Chengdu, leaving communications and             decision was made to admit him to the facility so he could begin
roads devastated. Deaths were reported in eight surrounding             getting the care he needed.
provinces, soon totaling 125,000 and creating more than 8,000
orphans.                                                                Nurse Steps In to Help Airline Passenger in Crisis
      Chen contacted her VA supervisor and requested emergency          On a recent flight from Las Vegas to Wichita, Kan., a passenger
leave to assist in recovery efforts. With fluency in 15 Chinese         began having chest pains and soon lost consciousness. The crew
dialects, her translation skills were badly needed in the multina-      called for any trained medical personnel willing to help. Melissa
tional rescue effort underway. Chen contacted a local hospital,         Lee, a licensed practical nurse at the Robert J. Dole VA Medi-
gathered supplies of masks, gloves and bandages and arranged to         cal Center in Wichita, stepped forward. She quickly assessed the
be taken by helicopter into the devastated epicenter. She worked        woman, reporting her condition
night and day for three days helping foreign and Chinese medi-          as very serious, prompting the
cal teams treat the thousands of injured, with only a bottle of         pilot to divert the flight to seek
water and a small package of biscuits to sustain her. After three       advanced medical treatment.
days, the helicopter returned to pick her up.                           Lee worked to make the pas-
                                                                        senger comfortable as the plane
Festival Attendees Rescue Eaglet on Grounds                             landed. With the aircraft on the
of Perry Point VA Medical Center                                        ground, the crew thanked Lee
The Perry Point VA Medical Center is situated on 365 acres at           for her immediate response and
the confluence of the Susquehanna River and the Chesapeake              assessment leading to the criti-
Bay in Maryland. Its wooded campus and the surrounding                  cal decision to land.
waterfront provide an ideal natural habitat for a wide variety of             When asked about the
wildlife, including deer, geese, osprey and eagles.                     incident, she downplayed her
      At a recent Equal Employment Opportunity-sponsored Na-            actions as intuition. “I didn’t
tive American Festival held at the medical center, participants         think, I just reacted,” said Lee.
seized the opportunity to walk through the woods in hopes               “I’m just really glad to know
of glimpsing the eagles that have nested there. As they neared          she is okay.” “Melissa’s cou-                          curtis tasset

a nesting site, they were surprised to find an eaglet on the            rageous act was no more or          Lee
ground. Surmising that the eaglet may have injured a wing since         less than her natural reaction to someone in need,” said Tom
it didn’t try to fly away, the group contacted the Tri-State Bird       Sanders, medical center director. “This laudable attribute is
Rescue and Research Center in Delaware. After a thorough ex-            demonstrated daily in the compassionate care she provides to the
amination by a veterinarian, it was determined that the eaglet          veterans at the Robert J. Dole VA Medical Center.”

	                                                   							January/February	2009	                                                         39
Ready for the Big Day
final preparations are made for the swearing-in
ceremony of barack obama as the nation’s 44th
president on the west steps of the u.s. capitol.
Va employees were among those who volun-
teered to support the inaugural activities in the
nation’s capital (see story on page 9).


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