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									     VA n g u a rd              outlook

                         January/February 2005

                 A Defining Moment
                 End-of-Life Care
                 Foreign Medical Program
                 Veterans Construction Teams
January/February 2005                          1
                                                             VA n g u a rd

                                                  Comfort and Compassion                                                 6
                                                  VA is transforming end-of-life care for veterans
                                                  Caring for Veterans Worldwide                                          11
11                                                the foreign medical program helps overseas veterans get needed care
                                                  Holiday Heroes                                                         14
                                                  the holiday spirit was alive and well throughout VA
                                                  A Defining Moment                                                      16
                                                  outgoing secretary can count seamless transition among his successes
                                                  In Memoriam: Joseph O. Behnke                                          20
                                                  VA loses a family member in the war on terror
                                                  Working for a Better Future                                            21
                                                  VA, Army partnership helps homeless veterans get back on their feet

                                                  3        Letters
                                                  4        Management Matters
                                                  5        Outlook
                                                  22       Around Headquarters
                                                  26       Introducing
                                                  27       Medical Advances
27                                                28       Have You Heard
                                                  30       Honors and Awards
                                                  32       Heroes
                   VA’s Employee Magazine
                   January/February 2005
                   Vol. LI, No. 1
Printed on 50% recycled paper

Editor: Lisa Respess
Assistant Editor: Matt Bristol
Photo Editor: Robert Turtil                                                         On the cover
Published by the Office of Public Affairs (80D)
                                                                                    Marine Cpl. Anthony Alegre, 21, works out
U.S. Department of Veterans Affairs
                                                                                    with physical therapist Doug Mitchell on
810 Vermont Ave., N.W.                                                              the Active Duty Rehabilitation Unit at the
Washington, D.C. 20420                                                              Augusta, Ga., VA Medical Center. Alegre,
(202) 273-5746                                                                      from Centerville, Ga., was wounded May
E-mail: vanguard@mail.va.gov                                                        29, 2004, during combat operations in
www.va.gov/opa/feature/vanguard/index.htm                                           Ramadi, Iraq. He was admitted to the Au-
                                                                                    gusta VAMC rehab unit in October 2004.
                                                                                    photo by Ann Hamilton

2                                                      January/February 2005
                                                           VA n g u a rd                              letters

A Day in the Life                alone, almost 500 certified       hospitals around the nation.       tation program and will for-
Just received and read your      registered nurse anesthetists           I believe that without       ever be an advocate. The pro-
most recent publication. It      (CRNAs) provide anesthesia        the security and protection of     gram definitely made a dif-
was great and very touching      services for our veterans.        their lives and property pro-      ference in my life. In my
reading and seeing the many           I can appreciate the dif-    vided by the VA police, the        ministry I see so many
pictures in the article “A Day   ficulty in picking photos for     rest of the staff would not be     people who have been left to
in the Life of VA” (Novem-       the story but would hope for      able to perform their duties.      their own devices and are not
ber/December issue).             more than one photo. It is        It was very nice to see cooks,     aware that the VA provides
     Over the past year or so,   the dedication of our nursing     maintenance personnel,             such programs to help them
VAnguard has significantly       professionals, as well as many    nurses, doctors, etc., but         succeed in the civilian world
improved in quality and con-     others working within VA,         your article forgot us.            after dealing with the trau-
tent. Good job!                  that make A Day in the Life             We protect our facilities    mas of war. It can truly be a
            Pamela J. Monroe     happen.                           24 hours a day, seven days a       difficult transition.
                Chief, Medical                     Uwe Klemm       week. When others are sleep-                Raymond C. Hart Sr.
       Administration Service                             CRNA     ing we are on duty protecting                               Pastor
      Gainesville, Fla., VAMC               Indianapolis VAMC      staff, patients and VA prop-                    Washington, D.C.
                                                                   erty around the clock. Maybe
I enjoyed the recent issue of    I saw your very nice “A Day       since you forgot us you can        If Disaster Strikes
VAnguard, but was saddened       in the Life of VA” article,       consider an article about the      I read with interest the recent
by the lack of nursing repre-    but after looking through all     VA police—our history, du-         article on disaster prepared-
sentation in the “A Day in       the pictures, for some un-        ties and commitment to VA.         ness and the Grab-and-Go
the Life of VA” article.         known reason you forgot to                    Cyndia E. Ramirez      kits available for purchase
     The VA health care sys-     mention probably the most                           Police Officer   from the canteen (Septem-
tem is one of the largest em-    important part of our VA                  San Juan, P.R., VAMC       ber/October issue). I don’t
ployers of advanced practice     system, the VA police. There                                         know if these two items are
nurses, registered nurses and    is not a single picture of a VA   Proud VR&E Graduate                included in the kit or not:
licensed practical nurses. In-   police officer performing his     I would like to take a mo-         plastic whistle and chain, and
deed, within this network        or her duties at any of our       ment to thank you sincerely        a chemical snap and shake
                                                                   for taking the time to honor       light stick. The latter pro-
                                                                   this country’s veterans by         vides a light source for about
                                                                   bringing the accomplish-           8 hours. If you need a con-
                                                                   ments of many of us to the         tainer to hold these items,
                                                                   forefront of the hearts and        use a plastic wide-mouth wa-
                                                                   minds of those who support         ter bottle, attach a “D” ring
                                                                   us. I truly appreciated the ar-    to the lid and secure it to a
                                                                   ticle published in VAnguard        belt or belt loop.
                                                                   magazine (“Working Toward                                Ted Benn
                                                                   Recovery,” September/Octo-                   VHA Mail Manager
                                                                   ber issue).                                Health Administration
                                                                         I am proud to be a                                    Center
                                                                   graduate of the VA’s rehabili-                              Denver

                                                                     We Want to Hear from You
                                                                     Have a comment on something you’ve seen in
                                                                     VAnguard? We invite reader feedback. Send your
                                                                     comments to vanguard@mail.va.gov. You can also
                                                                     write to us at: VAnguard, Office of Public Affairs
                                                                     (80D), Department of Veterans Affairs, 810 Ver-
                                                                     mont Ave., N.W., Washington, D.C., 20420, or fax
                                                                     your letter to (202) 273-6702. Include your name,
                                                                     title and VA facility. We won’t be able to publish ev-
                                                                     ery letter, but we’ll use representative ones. We may
                                                                     need to edit your letter for length or clarity.

                                                     January/February 2005                                                         3
       management matters                                   VA n g u a rd

                    Transforming End-of-Life Care for Veterans
                    Thomas Edes, M.D.
                    Chief, Home and Community-Based Care

Our nation’s veterans, in         tent possible at the end of       support of hospice care.            tions, and because care and
growing numbers, are facing       their lives. I passionately             To turn that trend            education go hand-in-hand,
one last hill to take under       share that commitment, and        around, we need effective           we are creating an enduring
perilous conditions as they       I have been proud to partici-     hospice programs and pallia-        network of VA clinicians,
approach the end of their life    pate in the efforts of com-       tive care consultation teams        educators and administrators
spans. That fact should not       mitted VA staff to create a       operating in all VA medical         skilled in this burgeoning
be surprising, given the          comprehensive and seamless        centers. We also need the           health care field.
simple arithmetic that all of     system of end-of-life care        ability to refer veterans to        s VA now includes home
those who were old enough         within VA.                        home-based hospice pro-             hospice care in the annual
to join the armed forces in            VA is the nation’s largest   grams and, if necessary, to         budget submitted to Con-
1941 are now past age 80.         integrated health care system,    pay for that care. We must          gress.
But somehow the magnitude         caring for 6.8 million veter-     do a better job of document-        s Our Hospice-Veteran
of our veterans’ needs for        ans. Clearly, we can’t directly   ing veterans’ care preferences      Partnership initiative with
end-of-life care comes as a       provide all of the services our   through mechanisms such as          state and national organiza-
surprise to many who hear         aging and terminally ill veter-   advance directives. And we          tions strengthens VA alliances
the numbers for the first         ans will need.                    need to raise the level of ex-      with our community part-
time.                                  Working in concert with      pectation that veterans are         ners to improve access to
      And the sheer numbers       community providers is es-        entitled to hospice and pal-        end-of-life care. While the
are staggering. Eighteen hun-
dred veterans die in this
country every day, two-thirds     We have an obligation to recognize our veterans’
of them from World War II
and most of the rest from the     needs for end-of-life care that is high quality and
Korean and Vietnam eras. In       responsive to their expressed wishes and needs.
fact, more than a quarter of
all deaths in this country in
2005 will be veterans.            sential to ensuring that all of   liative care. If such care is not   department does not directly
      Their needs for high-       our nation’s dying veterans       forthcoming, we want to             provide comprehensive home
quality end-of-life care de-      have the right care at the        hear about it.                      hospice services, it is critical
mand a bold and determined        right time and in the right             Our mandate is to             to build solid working rela-
response from an appreciative     place, in accordance with         honor each veteran’s prefer-        tionships with the hospice
nation. The Department of         their expressed preferences.      ences for care at the end of        community in order to pro-
Veterans Affairs, in concert      And that is why the recent        life, and we are translating        vide these services to veterans
with dedicated staff in our       growth of partnerships be-        that mandate into action. For       under our care. VA has estab-
medical centers across the        tween VA medical centers          example:                            lished partnerships in a grow-
country and in collaboration      and community hospices is         s Hospice and palliative care       ing number of states and we
with community providers, is      so exciting to all of us at VA    are now covered benefits for        anticipate partnerships in all
now leading the way.              Central Office.                   all enrolled veterans.              states by the end of this fiscal
      Articles in this issue of         Opinion surveys show        s VA policy requires hospice        year.
VAnguard report on VA             that most Americans would         and palliative care consult               Most of all, as the ar-
progress in establishing a suc-   rather be in their own            team and/or inpatient units         ticles in this issue of
cessful and compassionate         homes, with their families, at    at every VA health care facil-      VAnguard reflect, we have an
end-of-life care program, our     the end of their lives. Unfor-    ity.                                obligation to recognize our
achievements introducing          tunately, far too many end        s As standard practice, VA          veterans’ needs for end-of-life
hospice and palliative care       up dying in hospitals, even in    now purchases comprehen-            care that is high quality and
into the fabric of the VA         intensive care units where        sive hospice services from the      responsive to their expressed
health care system, and VA’s      they receive technologically      local communities it serves.        wishes and needs. A nation
commitment to ensuring            intensive medical interven-       s VA managers are institu-          grateful for their enormous
that veterans’ care preferences   tions instead of the emotion-     tionalizing hospice and pal-        sacrifices on our behalf can
are honored to the fullest ex-    ally and spiritually intensive    liative care within our opera-      do no less.

4                                                     January/February 2005
                                                           VA n g u a rd                            outlook

                    Honoring the Nation’s Veterans in Perpetuity
                    John W. “Jack” Nicholson
                    Under Secretary for Memorial Affairs

Editor’s Note: Before depart-     and the West. Our challenge      mandated by Congress.            other types of work.
ing VA for the position of Sec-   is to ensure that burial space         In 2003 and 2004,                The ways our employees
retary of the American Battle     is located where it provides     NCA focused on quantifying       interact with veterans and
Monuments Commission,             reasonable access to veterans    the standards for appearance     family members in their time
Nicholson offered some part-      and their families.              and operations required to       of need, combined with the
ing thoughts on the past,               Five new national cem-     achieve National Shrine Sta-     appearance of our cemeteries,
present and future of NCA.        eteries are under construc-      tus. This resulted in the pub-   are the most meaningful
                                  tion, all offering the option    lication of updated “Opera-      measures of our mission ac-
Birl Britton was a veteran of     of columbarium as well as        tional Standards and Mea-        complishment. And, you
World War I who, in 1998,         casket interment. Six new        sures,” which then led to an     may ask, how is NCA doing
was awarded France’s highest      state veterans cemeteries        ambitious program of self-as-    with these goals?
decoration, the Legion of         opened in the past year,         sessment. In this highly suc-          In the 2004 American
Honor, in commemoration           funded under the State Cem-      cessful program, best prac-      Customer Satisfaction Index
of the 80th anniversary of        etery Grant Program. With        tices are identified for use     survey, NCA received the
the armistice that ended the      state cemeteries providing       throughout the system, and       highest rating ever achieved
Great War. In his final years,    burial options to increasing     problem areas are addressed      by a federal agency. VA’s
this Army veteran was a           numbers of veterans, our         for improvement.                 cemetery system scored a sat-
nursing home resident at the      partnerships through this              Also in 2004, the first-   isfaction rating of 95 out of a
VA Palo Alto Health Care          program are more important       ever NCA Training Center         possible 100 points. The
System in California. Follow-     than ever.                       opened in the vicinity of        challenge is to maintain—
ing his death at age 108 on             Looking to the future,     Jefferson Barracks National      and even improve—that level
Jan. 10, 2004, he was in-         NCA will fulfill the require-    Cemetery in St. Louis to pro-    of service. NCA plans to
terred at San Joaquin Valley      ments of the National Cem-       vide first-class training for    meet that challenge by
National Cemetery in central      etery Expansion Act of 2003,     cemetery directors, assistant    achieving National Shrine
California.                       which directed establishment     directors, foremen and cem-      Status at every cemetery, and
     The oldest veteran to be
interred at a national cem-
etery in 2004, Birl Britton is    America’s national cemeteries provide lasting, visible
among the many generations
of Americans who willingly        tributes to our veterans and ensure their legacy of
served to ensure the free-        service will burn brightly in the centuries to come.
doms that we all enjoy today.
The National Cemetery Ad-
ministration honors veterans      of six additional new na-        etery representatives, as well   by delivering impeccably
like him by providing a final     tional cemeteries in locations   as others on the NCA team.       courteous and caring service
resting place that commemo-       specific to the Act. These lo-   In addition to technical in-     to veterans and their family
rates their service to our na-    cations are: Philadelphia; Co-   struction, the center teaches    members every day.
tion, and by treating veterans    lumbia/Greenville, S.C.;         skills in helping veterans and         In this century, as in the
and their families with com-      Jacksonville, Fla.; Sarasota     their families cope with         last, our young men and
passion, dignity and respect      County, Fla.; Birmingham,        death and grieving, the role     women serve with distinction
in every interaction. NCA is      Ala.; and Bakersfield, Calif.    of spirituality, and other       in the armed forces to pre-
committed to fulfilling this           While annual inter-         techniques related to serving    serve America’s freedoms.
nation’s promise of care and      ments will peak in 2008,         veterans with genuine care       Some give their lives in that
support for veterans in per-      NCA’s inventory of gravesites    and compassion.                  heroic cause. America’s na-
petuity.                          is cumulative and will con-            These subjects help em-    tional cemeteries provide
     The burial needs of          tinue to increase every year.    ployees embrace their work       lasting, visible tributes to our
America’s veterans are chang-     Additional resources will be     as a calling—not as just an-     veterans and ensure their
ing and growing. Mirroring        required to bring all of our     other job. In fact, if employ-   legacy of service to our na-
the entire nation, more veter-    national cemeteries up to the    ees lack this compassion,        tion will burn brightly in the
ans have moved to the South       shrine status appearance as      they are asked to consider       centuries to come.

                                                     January/February 2005                                                        5
                   feature                           VA n g u a rd

Comfort and
There comes a time when all the cutting-edge medicine in the world
can’t cure the illness, treat the disease, or slow the aging process. As
the largest integrated health care system in the country, VA is well-
positioned to be a national leader in end-of-life care.

      tephen Pavon served in the        and refining a new model of expert,     Awards for exemplary end-of-life
      Marine Corps Air Wing from        compassionate, supportive care for      care. It is also the hub site for a net-
      1963 to 1967, including a tour    veterans nearing the end of their       work of six interdisciplinary hospice
in Vietnam. While on active convoy      lives.                                  and palliative care fellowship train-
duty, he was injured twice, patched          “I’ve never heard a ‘no’ here,”    ing programs within VA.
up and sent back out. During the        said Pavon. “The support is so com-           The unit’s staff includes psy-
“times of turmoil” that followed his    plete that it allows me to be com-      chologists, a half-time massage
discharge, Pavon was a fireman, a       fortable and to live my final days in   therapist, and 25 volunteers, in ad-
college student, and a hippie in Ber-   comfort. I get to personalize my        dition to the requisite hospice doc-
keley, Calif. Later, he taught tran-    room. I can still maintain control of   tors, nurses, social worker and chap-
scendental meditation, traveled the     my heart, my mind, and my intelli-      lain. Families, who often travel to be
world, and worked overseas as an        gence.”                                 near a loved one, may stay over-
engineer before finally landing as a         When the 25-bed Palo Alto          night on rollaway beds or in free fa-
horse trainer on a ranch in Nevada.     Hospice Care Center was created in      cilities on the hospital’s campus, says
     Now Pavon, 57, is fighting an-     1979, it was at the vanguard of a na-   Hallenbeck, who, in addition to his
other battle, one he will not win,      tional hospice movement that            role at the hospice care center is as-
against rectal cancer. He will spend    would transform care for dying          sistant professor of medicine at
his final days at the VA Palo Alto      people nationwide. Today, the cen-      nearby Stanford University.
Health Care System in California,       ter remains at the forefront of inno-
where Dr. James Hallenbeck, direc-      vation. It received a 2001 Citation     A Systemwide Transformation
tor of Palo Alto’s Palliative Care      of Honor through the American               Hospice care, whether it is pro-
Services, and his team are building     Hospital Association’s Circle of Life   vided in VA medical centers or in

6                                               January/February 2005
                                                         VA n g u a rd                      feature

patients’ private residences by             the Greatest Generation who won        has learned about such care with the
partnering community hospice pro-           World War II. Now in their 80s,        community agencies that provide
grams, combines expert symptom              they are nearing the end of their      the majority of hospice care to ter-
management and pain relief with             natural life spans. Veterans ac-       minally ill veterans.
compassionate attention to the psy-         counted for 28 percent of all deaths         Hospice-Veteran Partnerships
chological and spiritual dimensions         in the United States in 2004.          are part of a systemwide transforma-
and family dynamics that arise when              Through a national network of     tion aimed at honoring veterans’
confronting a terminal illness. Qual-       state and local Hospice-Veteran        preferences for care at the end of
ity of life becomes paramount when          Partnerships, VA is sharing what it    life, says Dr. Thomas Edes, who as
its quantity is limited. Hospice also
supports grieving family members for
a year or more after the patient’s
      For the national VA health care
system, recent advances in develop-
ing, refining and expanding hospice
and palliative care, an approach
aimed at bringing hospice’s holistic,
comfort-oriented care philosophy to
seriously ill patients earlier in their
disease progression, are not mere
frills. That is because an estimated
1,800 veterans die every day in this
country, most of them members of

  Right: Eileen Scheifer, a nurse on the
  VA Palo Alto Health Care System’s hos-
  pice unit, with a nurse trainee; below:
  An Interdisciplinary Hospice Team
  meeting. Photos courtesy of James
  Hallenbeck, M.D.

                                                    January/February 2005                                            7
                    feature                             VA n g u a rd

chief of Home and Community-              care teams may consult on pain and          notes, even though U.S. hospices
Based Care is VA’s top administrator      symptom management for outpa-               will care for 900,000 dying patients
overseeing this transformation. In        tient clinics as well as throughout         in 2004.
response to increasing and changing       the hospital. VA’s own home-based                “We’re doing a lot of things to
demands for end-of-life services, VA      primary care or specialized geriatric       bolster that institutionalization … a
has issued a number of recent direc-      services may also be involved in de-        lot of program development, a lot of
tives mandating hospice and pallia-       veloping end-of-life care programs.         action. The challenge now is to cre-
tive care.                                      “We will institutionalize, in the     ate an enduring network of skilled,
     “We now have a framework and         best sense of that word, hospice and        trained, committed professionals,”
a structure in place,” Edes says. “All    palliative care in the largest inte-        Edes adds. “It’s our privilege and our
of the pieces are aligned. Hospice is     grated health system in the nation,         responsibility to ensure that veterans
now a covered benefit for all en-         proactively creating an end-of-life         receive comfort, support and care as
rolled veterans, home hospice care is     care system while implementing per-         they face their final days and that
in the VA budget for the first time,      manent changes, making it an inte-          they have a choice of where they re-
and we have a national standard for       gral part of the fabric of what VA          ceive this care. Some don’t. I am
purchasing hospice care from com-         is,” says Diane Jones, a palliative         concerned that in the past far too
munity providers. We can track hos-       care consultant in headquarters.            many veterans have suffered quietly,
pice workload for resource allocation     That kind of integration has not yet        graciously accepting far less than the
and planning, and we have a hos-          happened in the private sector, she         services they rightly deserve.”
pice point of contact at every VA fa-
cility. We want to elevate expecta-
tions and make it easy for veterans
to access hospice and palliative
care.”                                       Hospice and Palliative Care
     While the largely autonomous            Are VA-Covered Benefits
local VA medical centers are given
flexibility to address end-of-life care      Palliative care is a comprehensive approach to care in which the primary
according to their veterans’ needs,          goal of treatment is comfort rather than cure in a person with advanced
national policy and standards stipu-         disease that is life-limiting and refractory to treatment. Palliative care pro-
late that each VA facility have the          vides symptom management and emotional and spiritual support, guided by
following resources and services:            individual preferences and generally provided by an interdisciplinary team.
s a designated hospice contact per-          Palliative care can be a complement to conventional, disease-modifying
son who is part of an integrated net-        medical therapies or it can be an alternative when such treatments are no
work for local and national commu-           longer effective or not desired by the patient.
nications and information dissemi-                Hospice, the most intensive form of palliative care, is provided to seri-
nation;                                      ously ill patients who have less than six months to live and who have
s provision of needed hospice ser-           agreed to enroll in hospice services, rather than to pursue aggressive at-
vices in all settings;                       tempts for cure of their illness. Hospice focuses on comfort for both pa-
s inpatient hospice beds or access           tients and loved ones, not cure. VA defines hospice and palliative care as a
to them in the community;                    continuum of comfort-oriented and supportive services provided across
s an interdisciplinary palliative care       settings, including hospital, extended care facility, outpatient clinic and pri-
consultation team;                           vate residence.
s assistance with referrals to com-               Hospice and palliative care are covered services, authorized in VA’s
munity hospices in its service area;         Medical Benefits Package, on an equal priority with any other medical ser-
and                                          vice. VA medical centers must provide or purchase hospice care when VA
s tracking of hospice and palliative         determines that an enrolled veteran needs it. VA medical centers must also
care services provided to veterans in        provide palliative care services through consultation teams that include a
all settings.                                physician, nurse, social worker and chaplain. Palliative care teams offer
     In many cases, the local ap-            consultation throughout a medical center, assisting with planning and guid-
proach may include a dedicated hos-          ance on managing a patient’s pain and other symptoms, especially when
pice unit, such as at the Palo Alto          these are complex or difficult to control.
VAMC, based in either a hospital or
an extended care facility. Palliative

8                                                 January/February 2005
                                                        VA n g u a rd                             feature

                                           Clockwise from left: Vietnam veteran Stephen Pavon lived on an isolated ranch in
                                           Nevada until cancer forced him to move to the VA Palo Alto Health Care System’s
                                           hospice unit; family room on the hospice unit; a wreath from the semi-annual me-
                                           morial service for veterans who die on the hospice unit. Each ribbon, tied by a fam-
                                           ily or staff member, is in memory of one of the patients. Photos courtesy of James
                                           Hallenbeck, M.D.

                                         routine advance care planning con-            five years ago, he was referred to a
                                         versations with seriously ill veterans        PTSD program at the nearby Menlo
                                         and their families.                           Park VA Outpatient Clinic.
                                               “Is there a well-functioning pal-            “That saved my life. The com-
                                         liative care team at every facility, as       munication skills they gave me
                                         we have mandated? Are those teams             helped me clean up my life,” he says.
                                         adequately trained and staffed? At            After five failed marriages and mul-
                                         this point, probably not,” Edes con-          tiple job changes, “I had turned iso-
     Although much has been ac-          cedes. “But we are raising expecta-           lation into a profession.”
complished in the last few years,        tions at the national and local lev-               More recently, Pavon was living
more must be done to consolidate         els, so that a terminally ill veteran         on his isolated Nevada ranch, where
and sustain the gains at every level.    can go to any VA facility and obtain          a hospice team from Barton Memo-
VA’s newly established ability to        hospice care. If needed hospice care          rial Hospital in South Lake Tahoe,
measure and track the types of end-      is not forthcoming, we want them to           Calif., visited and cared for him.
of-life care being provided in each      contact us. And we now have cham-             When he could no longer manage
facility—the workload—is a major         pions working in every VA facility,           living alone, even with the help of
step forward.                            so we are getting closer to our tar-          friends, “they had a room waiting for
     Changing the medical culture        get.”                                         me here on the VA hospice unit.”
from top to bottom at each facility is                                                 Before entering, Pavon wrapped up
another significant challenge. VA        ‘The Underlying Theme is                      his personal business, found a good
leaders aim to create an environ-        Comfort’                                      home for his horse, gave away his
ment in which VAMC staff are                 Stephen Pavon says he has en-             golf clubs and conga drums, and
comfortable referring patients to        countered the VA health care sys-             paid all of his bills—including a pre-
hospice and palliative care and          tem twice in his life, and both expe-         paid cremation service.
bringing up death and dying during       riences were positive. The first time,             When he came to the Palo Alto

                                                 January/February 2005                                                            9
                       feature                            VA n g u a rd

VA hospice unit, he expected to             life and on the cancer that has come     care and they’ve got me covered. If
find the same level of compassion-          to dominate but not define his final     something isn’t working, they come
ate, spiritually oriented, medically        days.                                    in and fix it and I’m back on the
expert hospice care that he had re-              Mellow and sanguine about his       road. Medically, they’re all up to
ceived from Barton Hospice—and              prospects, Pavon could be a spokes-      snuff. They know how to give me
he has. Sitting in his hospice room,        person for the hospice philosophy.       the tools I need and they don’t stop
wearing his black cowboy hat,               “The whole underlying theme here         until I’m in my comfort zone,” he
Pavon reflects on a restless but full       is my comfort. I’m under 24-hour         says.
                                                                                          Pavon observes, “Sometimes,
                                                                                     you find a simple word that explains
                                                                                     you. I can relate my whole current
     Hospice-Veteran Partnerships                                                    existence, my spirituality, anything,
                                                                                     to that concept of comfort.” People
     Promote Access                                                                  are born into this world in need of
                                                                                     comfort, he says. Sometimes, at the
     With support from VA headquarters, the National Hospice and Palliative
                                                                                     end, they need more help to main-
     Care Organization, the national Rallying Points office in Washington, D.C.,
                                                                                     tain a degree of comfort, and that’s
     the Center for Advanced Illness Coordinated Care in Albany, N.Y., and other
                                                                                     where hospice comes in.
     end-of-life advocates, Hospice-Veteran Partnerships are now forming at
                                                                                          In Pavon’s case, a percutaneous
     state and regional levels to increase access to appropriate end-of-life care
                                                                                     infusion catheter (PIC) and portable
     for veterans. They promote access by strengthening partnerships between
                                                                                     pump deliver high doses of Dilaudid,
     VAMCs and their community partners, and by expanding their mutual knowl-
                                                                                     a powerful synthetic form of mor-
     edge base.
                                                                                     phine that keeps his pain under con-
           Some states are already well advanced in this dialogue, while others
                                                                                     trol without sacrificing his lucidness.
     are just starting to talk. A Hospice-Veteran Partnership “toolkit” developed
                                                                                          “I’ve had great adventures.
     by the VA Hospice and Palliative Care Initiative and published by Rallying
                                                                                     Sometimes I wish I’d stayed a fire-
     Points is full of suggestions on how to do this. Partnerships often are co-
                                                                                     man—a nice, steady job,” Pavon
     sponsored by state hospice organizations while bringing together commu-
                                                                                     says. “But I traveled all over the
     nity hospices, community end-of-life coalitions, veterans service and alumni
                                                                                     world. I was always trying to fit in—
     organizations, private service clubs, state Departments of Veterans Affairs,
                                                                                     trying to find where I belonged.”
     state veterans homes, the National Cemetery Administration, local military
     treatment facilities, and VA professionals at the medical center and VISN
                                                                                     Epilogue: Stephen Pavon died on
                                                                                     the VA Palo Alto Health Care
           “So much can be accomplished just by sitting around the table and
                                                                                     System’s hospice unit on May 26,
     talking with each other,” says Kathleen Jacobs, Rallying Points Regional Re-
                                                                                     2004, peacefully and comfortably.
     source Center coordinator based at The Hospice of the Florida Suncoast in
     Largo. From there, coalitions typically assess unmet local needs, develop a
                                                                                     Editor’s Note: VAnguard thanks the
     strategic plan for how best to serve veterans in the area, and then share in-
                                                                                     National Hospice and Palliative Care
     formation with veterans’ groups and the public. “Florida is a prototype of
                                                                                     Organization for its cooperation in pro-
     what can be done through partnerships,” Jacobs says.
                                                                                     ducing this article, which appears in a
           The Florida state group designed Hospice-Veteran Partnership com-
                                                                                     12-page monograph, “VA Transforms
     memorative pins with a card that reads, “Thank you … for your military ser-
                                                                                     End-of-Life Care for Veterans,” by
     vice to America by advancing the universal hope of freedom and liberty for
                                                                                     freelance writer Larry Beresford. The
     all.” It distributed 20,000 of these pins in November 2003 to VA facilities,
                                                                                     monograph is being distributed nation-
     community hospices, veterans’ organizations, and public officials, as well as
                                                                                     ally to the organization’s members as
     at a number of commemorative events.
                                                                                     well as to VA facilities and state veter-
           “These events helped to bring greater awareness to end-of-life issues
                                                                                     ans homes. The publication can be
     and the need for advance care planning, without seeming morbid,” says
                                                                                     downloaded from NHPCO’s Web site
     Joanne King, director of social work for Hospice of Volusia-Flagler in Port
                                                                                     at www.nhpco.org/veterans. Limited
     Orange and a member of the Hospice-Veteran Partnership of Florida. The
                                                                                     copies of the publication are available
     coalition also co-sponsored a February 2004 statewide professional educa-
                                                                                     by contacting Chris Cody at
     tion teleconference on end-of-life care for veterans.
                                                                                     Christine.Cody@va.gov or Pat Kelley
                                                                                     at pkelley@nhpco.org.

10                                                   January/February 2005
                                                     VA n g u a rd                       feature

Caring for Veterans Worldwide
A unique program administered by the Health Administration Center in
Denver allows veterans living or traveling overseas to bill VA for service-
connected medical care.

          ith an extensive network      too, under the Foreign Medical Pro-    ing up 100 percent of the medical
          of medical centers and        gram.                                  bill.
          clinics throughout the             Managed by the VA Health                “The department established
United States, VA offers substantial    Administration Center in Denver,       the Foreign Medical Program to ful-
health care opportunities for veter-    the Foreign Medical Program gives      fill its responsibilities to our veterans
ans, but what do they do if they’re     veterans the ability to seek medical   who were temporarily or perma-
traveling or living overseas and find   care related to their service-con-     nently living outside the United
themselves in need of medical atten-    nected conditions in almost any        States,” said Ralph Charlip, director
tion? Well, VA has that covered         country in the world, with VA pick-    of the Health Administration Cen-

                                               January/February 2005                                                 11
                    feature                           VA n g u a rd

ter. “While it is not possible to have   specific condition.                      erans who seek treatment in Canada
a VA medical facility in every coun-         Once enrolled, if a veteran is       must go through the White River
try or every city, through the FMP,      traveling or living overseas and         Junction VA Medical Center in Ver-
service-connected veterans can still     needs medical treatment related to a     mont, and veterans traveling or liv-
obtain the medical and vocational        service-connected condition, they        ing in the Philippines are expected
rehabilitation services they earned      simply go to a health care provider      to go to the VA facilities in Manila.
while serving our country, no matter     and then send the bill to the For-            “It is very important to remem-
where they are.”                         eign Medical Program office in Den-      ber that the treatment must be re-
     Here’s how the                                                                                  lated to the
program works. A                                                                                     veteran’s service-
veteran who cur-                                                                                     connected condi-
rently lives overseas,                                                                               tion outlined in
or plans to travel                                                                                   the acceptance let-
overseas, sends a reg-                                                                               ter,” said Ted
istration form to the                                                                                Benn, plan admin-
Health Administra-                                                                                   istrator for the For-
tion Center, prefer-                                                                                 eign Medical Pro-
ably with a copy of                                                                                  gram. “For in-
their VA rating deci-                                                                                stance, if a veteran
sion. After processing                                                                               is traveling in
the form, the Foreign                                                                                Mexico and the
Medical Program of-                                                                                  prosthetic leg he
fice sends the veteran                                                                               received as a result
a letter confirming                                                                                  of a service-con-
enrollment in the                                                                                    nected condition
program and outlin-                                                                                  breaks and he falls
ing the conditions                                                                                   down and gets
that will be covered.                                                                                hurt, the Foreign
If the veteran does                                                                                  Medical Program
not provide a copy of                                                                                will pay for the re-
their rating decision,                                                                               lated medical ex-
the Foreign Medical                                                                                  penses. If the same
Program office will                                                                                  vet becomes hospi-
contact the veteran’s                                                                                talized in Mexico
VA regional office of                                                                                for food poisoning,
record to confirm                                                                                    the program will
their service-con-                                                                                   not pay for it.
nected status.                                                                                            “Unfortu-
                                                                                                     nately, due to the
A Growing Program                                                                                    fact that we are
     A unique aspect                                                                                 such a small pro-
of the program is that                                                                               gram, the vast ma-
unlike disability com-                                                                               jority of health
pensation or VA                                                                                      care providers
medical center treat-                                                                                overseas have not
ment categories, per-                                                                                heard of the pro-
centage of disability                                                                                gram, so the vet-
has no bearing on the payment for        ver. The bill is translated, the ex-     eran more often than not has to pay
treatment; whether a veteran is          change rate for the foreign currency     for the medical care up front out of
rated 1 percent or 70 percent for a      is determined and the veteran is re-     their own pocket, then send us the
service-connected condition, pay-        imbursed.                                claim for reimbursement.”
ment will be made to the provider             In Canada and the Philippines,           Currently 12,446 veterans are
in full for treatment related to that    however, the rules are different. Vet-   registered in the program and the

12                                               January/February 2005
                                                     VA n g u a rd                         feature

Denver office has received claims       particularly well-organized group of      quick death. After much discussion
from 131 different countries around     veterans in Mexico, led by Vietnam        Teresa and I decided I should apply
the world, the most coming from         veteran and cancer patient Don            to the FMP and stay at home in
Germany, Panama and Costa Rica,         Adams, has even had their experi-         Ajijic for treatment until the end.
respectively.                           ences with the program documented              “As of today I have far exceeded
     Although the beneficiary popu-     on several expatriate Web sites and       the time the VA doctors believed I
lation has grown steadily since the     publications. Their enthusiasm for        had left. My tumor is in full remis-
program’s inception in 1973, com-       VA has grown considerably since           sion and I’m stronger and healthier
pared with the number of veterans       enrolling in the program, as evi-         than I’ve been for a long time. I’ve
registered for VA health care domes-    denced by this letter Adams wrote         moved from the mountains of Jalisco
tically, that number is minute.         to the Health Administration Cen-         State to a volcanic sand beach in
      “VBA has told us that there are   ter in January.                           Colima State, and Teresa and I liter-
more than 15,000 veterans who live           “It seems strange to be writing a    ally have a new lease on life.
overseas and receive disability com-    fan letter to a government entity but          “Being able to receive treatment
pensation,” explained Charlip.          everyone needs to know how much           in my home, with a doctor of my
“We’ve registered just over 12,000,     my wife and I appreciate everything       choice, without tiring, expensive,
so we have at least another 3,000 to    that the employees of the Foreign         and aggravating travel has been a
go. And that only accounts for the      Medical Program have done for us.         major contributor to my present
people living overseas. I imagine            “We live in Mexico and are           state of remission. We cannot ad-
that thousands of veterans travel       very thankful for the services you        equately express our thanks for not
outside the United States every year.   provide, but especially the easy ac-      only an excellent benefit for those
I expect to see continued growth        cess to the representatives who an-       of us who choose to live outside the
from the traveling veteran commu-       swer the phones in Denver. Each           U.S., but also the caring profession-
nity.                                   time I call I receive a polite, useful,   alism of all of you who make the
     “We try to reach as many as we     and usable answer to my questions.        FMP work the way it was intended
can each year. As part of the HAC’s          “And we and the Mexican doc-         to.
outreach effort, we try to inform       tors are both surprised and pleased            “We are both writers and have
                                                                                  posted articles on several Mexico-
                                                                                  based English language Web sites
“While it is not possible to have a VA medical                                    and are currently working on a
                                                                                  piece for a U.S. newspaper with
facility in every country, through the FMP,                                       wide Mexico distribution. We’re
service-connected veterans can still obtain                                       convinced that our good experience
the medical and vocational rehabilitation                                         with the FMP is not unique and we
                                                                                  want to help spread the word about
services they earned while serving our coun-                                      this valuable program. Again,
try, no matter where they are.”                                                   thanks to all of you.”
                                                                                        Veterans who would like to
                                                                                  learn more about the Foreign Medi-
those veterans who travel about the     with the speed with which your            cal Program and how to enroll can
program. In FY 2004, we visited         claims people process my submis-          go the Foreign Medical Program
with 648 members of veterans ser-       sions and issue checks. Being able to     Web site at www.va.gov/hac/fmp.
vice organizations and more than        fax my claims to you is both safe and     They can also e-mail the Health
1,100 state and federal veteran ser-    fast, and one more indicator of the       Administration Center at
vice officers and provided them with    high degree of efficient service you      HAC.FMP@med.va.gov; call FMP
FMP information.”                       provide.                                  offices at (303) 331-7590; or write
                                             “I was diagnosed with a fast         to: VA Health Administration Cen-
Spreading the Word Abroad               moving small-cell cancer of the lung      ter, Foreign Medical Program, P.O.
     Word of mouth between veter-       (in addition to my existing metasta-      Box 65021, Denver, CO, 80206-
ans living or traveling overseas has    sized prostate cancer) and spent          9021, USA.
also been an effective avenue for       months traveling back and forth to
getting the eligible veteran popula-    Texas for treatment. The tumor kept
tion to sign up for the program. One    growing and my prognosis was for a        By Glenn A. Johnson

                                                January/February 2005                                               13
                     feature                               VA n g u a rd

  Heroes                                                                                                             DEBORAH F. EIRING

                                                                    When it came time to decorate the large tree that adorns
                                                                    the rotunda of the Hot Springs, S.D., VA Medical Center
                                                                    each holiday season, the Employee Association knew they
                                                                    wanted a red, white and blue theme. But to add more mean-
                                                                    ing to the tree this year, they asked employees to submit the
                                                                    names and photos of loved ones serving in the military. Tele-
                                                                    phone operator Mandy Fleming, above, then volunteered to
                                                                    make ornaments for the tree, each featuring the photo and
                                                                    name of an employee’s loved one in the military.

                                                 MICHAEL L. MOORE

Employees of the VA Office of Inspector General have par-
ticipated in the U.S. Marine Corps Reserve Toys for Tots pro-
gram for the past six years. Most years they collected more
than 100 toys, and last year’s total was around 250. But this                                                         MOLLY REYNOLDS
year’s donation of more than 350 toys for needy children in
                                                                Cold temperatures didn’t dampen the spirits of 16 veterans
the D.C. metropolitan area topped them all. Shirley Landes,
                                                                from the Alvin C. York campus of the Tennessee Valley
left, chief of the Freedom of Information Act section, and
                                                                Healthcare System who got to ride on the VA float or carry
Adrianne Mitchell, a management analyst, coordinated the
                                                                the banner in the Rutherford County Christmas parade
toy drive, and Secretary Principi was on hand when they
                                                                through downtown Murfreesboro. The float, with its theme,
presented the gifts to the Marines at their holiday party.
                                                                “Thank a Veteran,” won first place for a business/industry
                                                                entry, and drew lots of smiles, salutes and shouts of “Thank
                                                                you!” from the crowd. The float was made possible by dona-
                                                                tions from the Employee Associations, Voluntary Service,
                                                                and the Veterans Canteen Service, and by the after-hours
                                                                work of several employees.
14                                                  January/February 2005
                                                           VA n g u a rd                           feature

                                                    ROBERT TURTIL

The holiday spirit was alive and well at the Veterans Ben-
efits Administration headquarters. Employees collected 425
pounds of food, $285 in grocery store gift cards, plus several
boxes of clothing and toiletry items and donated them to lo-
cal organizations that work with homeless veterans, includ-
ing two VA vet centers. Left to right: James Harr, Frank
Bryceland, Domenic DeStefano and Shana Brown pack up
boxes ready for delivery. “Creating VBA Care Bags was just
an additional way to show our veterans they are not forgot-
ten,” said Brown.

                                                                                                         JOHNSON CITY (TENN.) PRESS PHOTO

                                                                    The Domiciliary Residents Advisory Council at the Mountain
                                                                    Home, Tenn., VA Medical Center works all year to raise
                                                                    money for the Christmas party they throw in the domiciliary’s
                                                                    recreation hall for 30 needy children from the community.
                                                                    Local businesses help out with donations of food, toys and
                                                                    other items, and the residents buy each child a $20 Wal-
                                                   CECTRIA ASHLEY   Mart gift card. Domiciliary resident Charles E. Cable played
Each year, all services and sections at the Overton Brooks          Santa at this year’s 11th annual party.
VA Medical Center in Shreveport, La., are invited to sponsor
a family for the holidays. Some choose a veteran and family,
while others pick a family at the facility’s adopted school,
Creswell Elementary. Thanks to the generosity of 25 ser-
vices, the facility was able to brighten the holiday season for
more than 30 families this year. Vin Joseph, president of the
medical center’s Employee Association, George M. Moore
Jr., director, and Dock Voorhies, chief of Social Work Ser-
vice, left to right, pose with boxes of food and gifts ready to
be delivered to the families.
                                                       January/February 2005                                                         15
               cover story                           VA n g u a rd

                                                                                         Principi set the tone in a Sep-
                                                                                    tember 2003 message to all employ-
                                                                                    ees. “Let me make it clear that every
                                                                                    military man or woman wounded,
                                                                                    injured or ill from training for or
                                                                                    fighting our war on terror receives
                                                                                    priority service at VA. None of
                                                                                    these heroes can ‘fall through the
                                                                                    cracks,’” he wrote.
                                                                                         He established a Seamless Tran-
                                                                                    sition Task Force in VA Central Of-
                                                                                    fice and sent social workers and ben-
                                                                                    efits counselors to military hospitals
                                                                                    across the nation. Their job was to
                                                                                    meet up with recovering
                                                                                    servicemembers, introduce them to
                                                                                    VA benefits, help them file claims,
                                                                                    and facilitate their transfer to VA
                                                                                    medical facilities where they could
                                                                                    be closer to their families.
                                                                                         The impact was immediate.
                                                                                    Wounded troops and their military
                                                                                    case managers now had face-to-face
                                                                                    contact with a VA representative.
                                                                                    From their perspective, VA became
                                                                                    a warm smile and a caring touch.
                                                                                         The seamless transition program
                                                                                    has made a huge difference, accord-
                                                                                    ing to Brian Austin, an assistant na-
                                                                                    tional service director with the Dis-
                                                                                    abled American Veterans in Wash-
                                                                                    ington, D.C., who works with

A Defining Moment
Outgoing VA Secretary Anthony J. Principi can
                                                                     ANN HAMILTON

                                                                                    wounded soldiers. He said the troops
                                                                                    are “ecstatic and overwhelmed that
count seamless transition among his successes.                                      someone is there to take care of

                                                                                     Marine Cpl. Anthony Alegre, 21, takes

      efining moments are unex-              Rather than take the easy road          his first steps since suffering a trau-
      pected and unrehearsed. They      by applying a quick fix based on             matic brain injury on May 29, 2004, in
      test our resolve and reveal our   their individual circumstances, he           Ramadi, Iraq. He is assisted by physi-
                                                                                     cal therapist Barry Dye, left, and occu-
character. For VA Secretary An-         resolved to enact fundamental                pational therapist Jason Vital on the
thony J. Principi, a defining moment    changes in how the department                Active Duty Rehab Unit at the Au-
came in August 2003, when two           cares for those wounded in the line          gusta, Ga., VA Medical Center. The
                                                                                     unit exemplifies the creativity of VA
veterans of the wars in Iraq and Af-    of duty. His response reinvigorated a        employees who have embraced the
ghanistan got lost in the transition    workforce and may ultimately define          seamless transition concept.
from military to VA care.               his term as VA Secretary.

16                                              January/February 2005
                                                        VA n g u a rd                            cover story

them and help submit their benefits      wounded troops first started coming          tals, reality sets in. “It’s a major cul-
packets.”                                to VA hospitals, the emphasis was            tural transition for them. And we
     It also helps VA, according to      on a smooth admission and top-               might need to reevaluate the envi-
his colleague Marc Burgess, who          quality care. Little emphasis was            ronment of care we provide these
heads up DAV’s transition service        placed on the environment of care.           patients and their families,” said
program. “It’s going to save the VA      It soon became apparent, however,            Kussman, noting that unlike typical
                                                                                      VA patients, these veterans may be
                                                                                      accompanied by young children or
“These are the veterans of the future. We                                             even their own parents.
want to bring them in and let them know                                                     As the new Seamless Transition
                                                                                      Coordination Office continues to
they’re welcome at the VA.”                                                           evolve, staff can look to the ideas of
                                                                                      VA employees across the country,
a tremendous amount of man hours         that the environment would be a              many of whom have come up with
down the road” by reducing appeals       major factor.                                unique ways of reaching out to our
and remands. “All injuries are being          The current environment in              newest generation of combat veter-
documented before the discharge so       military hospitals borders on the sur-       ans. There have been open houses
a favorable decision can be rendered     real. Politicians, movie stars and           and health fairs, benefits seminars
the first time around,” he said.         professional athletes regularly roam         and welcome home parades.
                                         the wards. There are news cameras            VAnguard took a closer look at two
Task Force Evolves                       and swarms of reporters. Troops get          seamless transition activities that
      When Principi started the          free tickets to sporting events and          truly reflect the flexibility and cre-
Seamless Transition Task Force in        dinners at fancy restaurants. Goody          ativity of the VA workforce.
the summer of 2003, American             bags stocked with Red Bull energy
troops had suffered about 2,500          drinks, DVDs, and the latest games           Active Duty Rehab Unit
combat casualties in Iraq. By Jan. 7     for Sony PlayStation and Microsoft               Much of the seamless transition
of this year, that figure had risen to   X-Box are handed out to them.                work involves greater cooperation
10,252. As casualties mounted,           They also have the support of their          between VA and the military. This
Principi transformed the original        peers—other young soldiers who lost          can lead to tough decisions about
task force into a permanent Seam-        limbs, eyesight or suffered disfiguring      the best use of resources. One of
less Transition Coordination Office      burns.                                       those decisions fell to Jim Trusley,
in VA headquarters.                           When they come to VA hospi-             director of the Augusta, Ga., VA
      A single office was necessary to
keep track of all the transition ac-
tivities, according to one of the task
force’s original co-chairs, Dr.
Michael J. Kussman, who now
serves as acting deputy under secre-
tary for health.
      “There are so many joint activi-
ties [between VA and DoD] and so
many people involved, sometimes
it’s hard to get your arms around it
all,” he said. Kussman hopes the
new office will become the central
clearinghouse for all joint VA/DoD
ventures and serve as the primary
interface with DoD.
      By delegating responsibility to                                                                                ROBERT TURTIL
one office, the department will be
able to coordinate transition activi-    Outgoing VA Secretary Anthony J. Principi addresses members of the original Seamless
                                         Transition Task Force in his office. The task force, which was made up of employees from
ties with a systematic, organized ap-    the Veterans Health Administration and Veterans Benefits Administration, has since
proach. For example, when                evolved into a new office.

                                                  January/February 2005                                                         17
                cover story                              VA n g u a rd

Medical Center, during a telephone
conversation with VISN 7 medical
director Carter Mecher, M.D., in
November 2003.
     The Army wanted VA rehabili-
tation therapists to come to Fort
Benning in Columbus, Ga., to work
with soldiers wounded in Iraq. But
Mecher reasoned it made more
sense to send the troops to the VA
hospital in Augusta, where rehab
specialists were already in place. He
asked if Trusley could set up a rehab
unit for active-duty troops.
     “I loved the idea,” Trusley later
explained. “These are the veterans
of the future. We want to bring
them in and let them know they’re
welcome at the VA.” But there was
a catch. He’d have to do it within
his existing budget—there was no
seed money.
     Trusley turned to Rose Trincher,
M.D., chief of spinal cord injury at
the hospital. “She’s a progressive
thinker and I knew she could pull it
off,” he said. Trincher didn’t disap-
point. By early February she had
carved out enough space for a few
patients. Her plan culminated in                                                                                        ANN HAMILTON
June 2004 with the official dedica-
tion of the new 30-bed inpatient re-
habilitation unit.
     The unit accepts patients from
all military branches. Most have suf-
fered multiple traumatic injuries—
amputations, burns, loss of eyesight,
brain injuries, PTSD—according to
the unit’s director, Dr. Dennis
Hollins. Their average age is 24.
     In the beginning, Hollins wasn’t
sure how the troops would like being
at the VA hospital or how the tradi-
tional patients would respond to the
active-duty troops. His uncertainty
soon vanished, however. “The local
veterans’ groups were so support-
ive—they just embraced the idea,”                                                                                          WILL TULLIS
he said. As for the soldiers, it’s just
like a military environment for           Top: Alegre talks with Dr. Dennis Hollins, director of the Augusta VAMC’s Active Duty Re-
them, he explained, yet they have         hab Unit, and occupational therapist Becky Bonin; above: Helping servicemembers regain
                                          function and mobility is a priority on the unit. Here occupational therapist Lisa Dowling,
access to all the VA services: neuro-     right, works with patient Cleotha Williams, a member of the National Guard. Across the
surgery, mental health, blind rehab,      table, therapist Jason Vital monitors the progress of Army reservist Ashley Brown.

18                                                  January/February 2005
                                                              VA n g u a rd                             cover story

                                                                                              “This is a very patriotic area and
                                                                                              we’re real proud of what our soldiers
                                                                                              did over there. We wanted to go to
                                                                                              their towns and let them know we
                                                                                              were there for them,” he said.
                                                                                                   Goldman set up an outreach
                                                                                              committee to figure out the best way
                                                                                              to reach these returning troops.
                                                                                              Committee member Scott Martin, a
                                                                                              social worker, suggested that instead
                                                                                              of asking the soldiers to come to the
                                                                                              hospital, outreach teams could visit
                                                                                              their armories during weekend drills.
                                                                                              That way they’d have a captive au-
                                                                                              dience. “I’m in the reserves myself,
                                                                                              so I know how the system works,”
                                                                                              Martin said.
                                                                                                   On Nov. 6 and 7, 2004, they
                                                                               ROY AVERETTE
                                                                                              put their plan into action. Martin
                                                                                              and his teams visited four armories
                                                                                              used by the Alabama National
                                                                                              Guard’s 877th Engineer Battalion,
                                                                                              which had more than 700 soldiers
                                                                                              who served tours in Iraq. That
                                                                                              weekend they helped about 200
                                                                                              with enrollment and case manage-
                                                                                              ment intervention.
                                                                                                   In all, the outreach teams have
                                                                                              brought in more than 600 returning
                                                                                              combat veterans, more than a third
                                                                                              of the soldiers who deployed from
                                                                                              their hospital’s 12-county service
                                                                                              area. The entire effort is done on a
                                                                                              voluntary basis, with team members
                                                                                              giving up their weekends for the
                                                                               ROY AVERETTE   mission. “Our teams really love what
                                                                                              they do and it shows,” said
Rather than waiting for returning troops to come to the VA hospital, teams from the
Tuscaloosa, Ala., VA Medical Center visited National Guard armories to meet with mem-         Goldman.
bers of the 877th Engineer Battalion and welcome them home from Iraq. Jane Billings, di-
rector of primary care (top), and Regina Toth, R.N., help soldiers with VA health care en-    Moving On
rollment and case management intervention.
                                                                                                   Secretary Principi may be mov-
                                                                                              ing on, but his seamless transition
spinal cord injury, and physical and           director of the Tuscaloosa, Ala., VA           initiative is here to stay. Perhaps this
occupational therapy.                          Medical Center, that meant coming              is the true measure of a defining mo-
    The unit has treated 91 active-            up with a plan to reach the 1,600              ment: it transcends time and leaves
duty patients as of January. Of those,         reservists and National Guard mem-             a lasting impression. Principi once
25 recovered well enough to return             bers in his service area returning             noted, “Our treatment of these new-
to active duty.                                from combat tours in Iraq and Af-              est veterans over the coming
                                               ghanistan.                                     months will define VA for their life-
Outreach Intensifies                                Sure, he’d send each a personal           time and ours.” It also just might de-
     Outreach has also been a major            letter welcoming them home and re-             fine his term as VA Secretary.
element of seamless transition ac-             minding them of their VA benefits,
tivities. For John Goldman, acting             but he knew he could do more.                  By Matt Bristol

                                                        January/February 2005                                                      19
                      feature                              VA n g u a rd

           In Memoriam: Joseph O. Behnke
VA lost the first member of its “family” in the war on         ing person in all respects.
terror—Sgt. Joseph O. Behnke, an employee of the                     On Dec. 18, Secretary Principi, along with New
Manhattan division of the VA New York Harbor                   York Harbor Healthcare System Director John J.
Healthcare System. He was killed Dec. 4 when he was            Donnellan Jr. and Chief Chaplain Andrew Sioleti, went
thrown from a Humvee that crashed into a barrier while to the Behnke residence in Brooklyn to personally offer
escorting a convoy                                                               their condolences to the family.
north of Baghdad.                                                                      A memorial service honoring
     Behnke, 45, from                                                            Behnke was held at the New York cam-
the Park Slope section                                                           pus on Dec. 22, attended by the family
of Brooklyn, was as-                                                             and hundreds of friends. The service also
signed to the Army                                                               was attended by Acting Under Secretary
Reserve’s 258th Field
Artillery Regiment. Ini-
tially sent to Iraq in
April 2004, he had just
completed a two-week
leave for R&R when he
returned to Iraq shortly
before his death.
     According to
friends and family members, his heart went out
to the barely clothed Iraqi children that he often
saw begging for scraps of food. Wanting to do
something to help, he collected clothing and
toys for the children of Iraq.
     The son of a Navy man, Behnke joined the
Army at 17, serving in the 82nd Airborne Divi-
sion from 1976 to 1980. Two years later, eager to
serve again, he joined the National Guard, where
he served for several years. After 9/11, compelled
by patriotic zeal, he once again joined the Na-
tional Guard.                                                                                                         LEO MARINACCI

     He started working for VA in 1985 as a car-
                                                       The Fort Hamilton Army Garrison Color Guard lowered the flag at the Man-
penter at the New York campus, progressively           hattan campus to half-staff in honor of Behnke; inset: Behnke serving in
moving up to his last position as a maintenance        Iraq with the Army Reserve’s 258th Field Artillery Regiment.
     “His love of country and family outshone all else,”       for Health Jonathan B. Perlin, M.D., who concluded his
said his brother-in-law Nelson Torres when asked how           remarks by saying, “May God rest the soul of Joseph
Behnke would be best remembered. Tributes by friends           Behnke; may God send comfort to Joe’s family and to all
and family members painted the life of Sgt. Joseph             who mourn him; and may God continue to bless
Behnke as soldier, citizen, fellow employee, true friend,      America, this great country that Joe defended.”
faithful husband, loving father and grandfather—a car-               Sgt. Joseph Behnke made the ultimate sacrifice for
                                                               the country he loved and honored with his service. A
                                                               devoted husband and family man, he leaves behind five
                                                               children, five grandchildren and his wife of 25 years,
VA loses a family member in the                                Miriam. He will be missed, but not forgotten.

war on terror.                                                     By Peter Juliano

4                                                    January/February 2005
                                                         VA n g u a rd                          feature

Working for a Better Future
VA, Army partnership helps homeless veterans get back on their feet.

       40-foot rappelling tower is         Rienzo. He said there are currently           Col. Anthony Kanellis is supportive
       one of a dozen construction         about 40 veterans working on roof-            of the Compensated Work Therapy
       projects underway at Fort           ing, fencing and interior renovation program and veterans on the con-
Devens, an Army Reserve training           projects at the fort. The rappelling          struction teams. “It’s the kind of
site located about 40 miles west of        tower is a particular source of pride         partnership the Army finds most ad-
Boston. But the work isn’t                                                                        vantageous … and a smart
being done by Army engi-                                                                          way for Devens—and ulti-
neers. It’s being completed                                                                       mately the Army—to have
by military veterans, under                                                                       quality construction work
a partnership between the                                                                         at a good price,” he said.
fort and nearby Bedford,                                                                               The program’s ultimate
Mass., VA Medical Cen-                                                                            goal is to help veterans get
ter.                                                                                              back on their feet. “That’s
     The Veterans Con-                                                                            what the Army is doing for
struction Teams are oper-                                                                         them,” said Cournoyer.
ated through the medical                                                                          “Homeless veterans aren’t
center’s Compensated                                                                              much different from any of
Work Therapy program,                                                                             us who served the country.
which helps veterans re-                                                                          They came home, and for
turn to work while receiv-                                                                        whatever reason, lost their
ing medical and mental                                                                            way for a while.” Most pro-
health services.                                                                                  gram “graduates” have gone
     Veterans who join the                                                                        on to compete for and win
construction teams un-                                                                            jobs with commercial firms.
dergo visible changes, ac-                                                                        One even started his own
cording to the team’s di-                                                                         construction company.
rector Bernie Cournoyer,                                                                               Work therapy programs
of the Bedford VAMC.                                                                              are in place at more than
They hone work-related                                                                            100 VA medical facilities
skills such as problem-                                                                           nationwide. They work best
solving, decision-making                                                                          in partnership with other
and interpersonal commu-                                                                          federal agencies, particu-
nications while learning                                                                          larly the Department of
construction trades. More                                                                         Defense. “The continued
importantly, they gain self-                                                           JUNE FORTE commitment of these orga-
confidence by overcoming                                                                          nizations sends a message
personal and career ob-        Lt. Col. Anthony Kanellis, Fort Devens Reserve Forces Training     to those who served the
                               Area commander, and Bobby Griffis, Fort Devens Engineering Of-
stacles and achieving          fice, review progress on a roofing project being completed by      country that they will not
project goals. “You can see members of the Veterans Construction Team based at the                be left behind,” said
their enthusiasm grow,         Bedford, Mass., VA Medical Center.                                 Cournoyer. He noted that
both individually and as a                                                                        the program’s success has
team,” said Cournoyer.                     among team members. When com-                 led VA medical centers in Texas,
     The relationship with Fort            pleted, it will be used by military           Oregon, New York, Ohio and Ken-
Devens has developed into a valu-          personnel, as well as local, state and tucky to explore the potential for es-
able and ongoing partnership, ac-          other federal agencies.                       tablishing their own veteran con-
cording to project manager Dave Di              Fort Devens commander Lt.                struction teams.

                                                   January/February 2005                                                   21
       around headquarters                                    VA n g u a rd

Nicholson Takes the Helm as Secretary of Veterans Affairs

R. James “Jim” Nicholson
was sworn in as Secretary of
Veterans Affairs on Feb. 1.
President Bush nominated
him to the position on Dec.
9, and he was confirmed by
the Senate on Jan. 26.
      During testimony at his
confirmation hearing before
the Senate Veterans’ Affairs
Committee on Jan. 24,
Nicholson said a background
in the military helped pre-
pare him for his new job.
The West Point graduate
served eight years on active
duty, including combat duty
in Vietnam, and 22 years in
the Army Reserve.
      “I have had the privilege
of wearing the uniform of
the United States Army in                                                                                               WHITE HOUSE PHOTO
combat,” he told the com-
mittee, “so I have seen both
the horrors of war and the
heroes of America making
the greatest sacrifices of mili-
tary service on behalf of their
comrades and our nation.
      “One cannot leave a
battlefield without having
profound respect for the
courage and cool of all who
have served there,” he con-
tinued. “Their example of
unwavering commitment to
their mission, no matter how
dangerous and uncomfort-
able, will always reverberate
with me, and readies me for
a mission of service to those
      Nicholson emphasized
that he will continue to work
                                                                                                                             ROBERT TURTIL
closely with the Department
of Defense to ensure a seam-
                                   Top: “I marvel at America, that a boy from Struble, Iowa, may serve in the President’s Cabinet. How
less transition for                could this happen?” said Nicholson, as President Bush announced his nomination. “For me, it is be-
servicemembers returning           cause of the opportunities that my country gave me as a cadet at West Point and as a soldier.” Above:
from the wars in Afghanistan       Nicholson testifies at his confirmation hearing on Jan. 24.
and Iraq. “The manner in
which the VA supports the          injured or became ill as a re-          Nicholson praised his        tion to the welfare of this
transition of today’s              sult of their service in com-      predecessor as “a man who         nation’s veterans.” He
servicemembers into veter-         bat areas, will define the de-     has provided outstanding          pledged to build on the “ter-
ans, especially those who are      partment for them,” he said.       leadership and tireless dedica-   rific strides” VA made in

22                                                       January/February 2005
                                                             VA n g u a rd                              around headquarters

health care, benefits delivery    deeply committed to earning        able for ensuring and har-         the Vatican. Prior to that, he
and memorial affairs during       the respect, trust and follow-     nessing our employees’ best        was chairman of the Republi-
Secretary Principi’s tenure. “I   ing of the men and women           efforts. It will be my job and     can National Committee
will strive to move the de-       of the VA who have made            my privilege to lead and har-      from 1997 to 2001. He has
partment to another level, by     service to veterans their life’s   ness this awesome force of         also been a housing devel-
building on all that has been     calling. The VA workforce          talented people so that all of     oper and lawyer in his home
put in place and improving        represents an enormous reser-      us have the same focus: our        state of Colorado.
upon those areas that remain      voir of dedicated, committed       veterans. It is critical that we         The new Secretary, 66,
a challenge,” he said.            talent that must be put to its     honor’s America’s debt to          is a native of Iowa. His older
     He also told the com-        best possible use,” Nicholson      those who have served us so        brother, Jack, served as VA
mittee he would focus much        said.                              faithfully.”                       Under Secretary for Memo-
of his attention on VA’s                “I will hold myself and           Nicholson most recently       rial Affairs from 2003 to
230,000 employees. “I am          my leadership team account-        served as U.S. ambassador to       2005.

Bidding a Fond Farewell to Secretary Anthony J. Principi

                                                   EMERSON SANDERS                                                      EMERSON SANDERS

VA Secretary Anthony J.                Principi’s nomination by
Principi said goodbye to em-      President Bush as Secretary
ployees at a farewell cer-        of Veterans Affairs was con-
emony held Jan. 19 in head-       firmed by the Senate on Jan.
quarters.                         23, 2001. His four-year term
      “I am privileged to call    was characterized by a reduc-
you my colleagues,” he told       tion in the benefits claims
the crowd gathered in the         backlog and processing
new G.V. “Sonny” Mont-            times; decreased waiting
gomery Veterans Conference        times for health care appoint-
Center. “The great progress       ments; record increases in
in service we have made, the      health care funding; the
initiatives we have begun, the    Capital Asset Realignment
awards and accolades we           for Enhanced Services, or                                                             EMERSON SANDERS
have received, and the good       CARES, plan to modernize
name we have perpetuated          the VA health care system;         Clockwise from left: Principi shares a laugh with VA Deputy Sec-
speak eloquently of your          and an unprecedented expan-        retary Gordon Mansfield at the farewell ceremony; the outgoing
                                                                     Secretary tries out his chair from the White House Cabinet
character, as it does the en-     sion of the national cemetery      Room. The chair was among several gifts he received during
during character of our de-       system.                            the ceremony; the new G.V. “Sonny” Montgomery Veterans Con-
partment. The legacy I leave           Prior to being appointed      ference Center was filled to capacity for the Jan. 19 event.
is, in truth, your legacy—a       VA Secretary, the combat-
testament to strength of pur-     decorated Vietnam veteran          government and business, in-       former President Bush. He
pose and commitment to ex-        held a number of executive-        cluding VA Deputy Secretary        was also a partner in a San
cellence.”                        level positions in the federal     during the administration of       Diego law firm.

                                                       January/February 2005                                                          23
       around headquarters                                     VA n g u a rd

Law Gives VA Flexible Pay for Physicians, Schedules for Nurses
The President signed a bill        and dentists will consist of         formance outcomes, reward-         contracts for medical and
on Dec. 3 that will improve        three elements—base pay lev-         ing such things as quality of      dental care are eliminated.
VA’s ability to recruit and re-    els matched to years of VA           care, timeliness and patient             The law also authorizes
tain top-quality physicians,       service, regionally based mar-       satisfaction.                      VA to offer registered nurses
dentists and nurses.               ket pay and performance pay.               “This new system re-         flexible work schedules in
      “Thanks to this legisla-          No current employees            tains the most positive fea-       which longer workdays could
tion, we’ll have the flexibility   will have their pay decreased.       ture of the old—assurance of       be selected in exchange for
to adjust salaries for market      The new pay levels create a          regular salary increases with      fewer total working hours.
pressures and reward perfor-       base pay for current employ-         continued VA service—and           Nurses would receive the
mance so VA can meet the           ees and future hires that            adds rewards for performance       same pay. Congress will re-
needs of a growing number          won’t be decreased even if           as well as market sensitivity      ceive VA certification annu-
of patients,” said Secretary       market pay levels for their          so VA can maintain a com-          ally that facilities have poli-
Principi.                          specialties go down. The             petitive stance in serving vet-    cies to prevent nurses in di-
      He said the current pay      “market” portion of pay lev-         erans,” said VA Acting Under       rect patient care from work-
system doesn’t adequately          els will vary from time to           Secretary for Health Dr.           ing longer than 12 consecu-
consider regional differences      time for new employees.              Jonathan Perlin.                   tive hours or more than 60
in pay among private-sector             Determination of mar-                 “The current system          hours in a week.
medical specialists. As a re-      ket pay for a physician or           only marginally considers                Additionally, the law al-
sult, VA depends heavily on        dentist will consider several        market-rate salaries,” said        lows VA to approve special
contract medical specialists.      criteria, including length of        Perlin. “This will give facility   pay to the top nurse—nurse
These contracts often are          experience in the specialty,         and regional executives the        executive—at each VA medi-
more expensive than the            degree of need for certain           flexibility to meet their local    cal center. The added pay
costs of employing the same        specialists at a facility, the la-   needs.”                            will range from $10,000 to
specialists as VA physicians       bor market in the area, board              VA officials said within     $25,000 per year to bring the
and dentists.                      certifications of the profes-        a few years the added cost of      executives’ salaries closer to
      Under the new law, the       sional and prior VA service.         the salary increases will actu-    that of their private-sector
VA Health Care Personnel                Performance pay will            ally decline as higher-cost        counterparts.
Enhancement Act of 2004,           clearly link a portion of each
beginning Jan. 8, 2006, VA’s       physician and dentist’s com-
pay system for physicians          pensation to quality and per-

                                                                           Contract Awarded to Complete
New Law Allows Higher Limits                                               CARES Plan Studies at 18 sites
in VA Home Loan Program                                                    VA has awarded a contract to Pricewater-
                                                                           houseCoopers to complete studies required by the
Legislation recently signed by     downpayment.                            Capital Asset Realignment for Enhanced Services,
President Bush makes home               The changes took effect            or CARES, plan. The $9.6 million contract calls
ownership more affordable          Dec. 10 when the President              for completing studies at 18 sites throughout the
for many veterans.                 signed into law the Veterans            country over a 13-month period.
     Changes under the law         Benefits Improvement Act of                  Study recommendations, including those from
mean veterans will be able to      2004. The law also allows for
get no-downpayment loans           loan limits to keep pace with
                                                                           stakeholders, will be reviewed by VA’s Under Secre-
of up to $359,700. The pre-        rising home values.                     tary for Health and the CARES Implementation
vious ceiling was $240,000.             The new law allows VA              Board, made up of senior VA officials, who will
     VA-guaranteed home            to guarantee one-year adjust-           make recommendations to the Secretary. The stud-
loans are made by banks and        able rate mortgages (ARMs)              ies will be completed by February 2006.
mortgage companies to veter-       and it extends, through                      CARES is designed to provide greater access to
ans, servicemembers and re-        2008, VA’s “hybrid ARM                  quality care closer to where most veterans live. It
servists. With VA guarantee-       program,” which allows vet-             allows VA to expand outpatient services and pro-
ing part of the loan, veterans     erans to lock in a favorable            vide more of the care veterans want and use.
can get a good interest rate       interest rate for at least three
without having to make a           years.

24                                                        January/February 2005
                                                           VA n g u a rd                             around headquarters

Talk Show Host Montel Williams Leads 2005 National Salute
Popular television talk show      emy Prep School and U.S.
host Montel Williams is           Naval Academy.
chairman of the 2005 Na-               While serving as super-
tional Salute to Hospitalized     vising cryptologic officer at
Veterans.                         Ft. Meade, Md., Williams
      He will lead VA’s annual    discovered a gift for public
patient recognition program       speaking. He ultimately gave
inviting the public to visit      up his naval commission to
and honor hospitalized veter-     pursue speaking full time,
ans during National Salute        leaving the Navy with the
Week, Feb. 13-19, and serve       rank of lieutenant com-
as national spokesperson for      mander.
nearly 100,000 volunteers              As a public speaker, Wil-
serving veterans at VA facili-    liams encouraged thousands
ties across the nation.           of parents, educators and
      Williams enlisted in the    business leaders to work to-
U.S. Marines in 1974 after        gether to address issues af-
graduating from high school.      fecting America’s youth.
While attending the Desert        These efforts ultimately led
Warfare Training Center at        to the Montel Williams
Twenty-nine Palms, Calif., he     Show.
was recommended for, and               Now in its 14th season,
accepted to, the Naval Acad-      the Montel Williams Show
emy Preparatory School at         received the 1996 Daytime
Newport, R.I.                     Emmy Award for Outstand-
      Williams went on to at-     ing Talk Show Host and has
tend the U.S. Naval Acad-         also been honored with Day-
emy at Annapolis, graduating      time Emmy nominations for        Williams
in 1980 with a degree in gen-     Outstanding Talk Show in
eral engineering and a minor      2001, and Outstanding Talk       Sclerosis (MS). He estab-         select organizations and insti-
in international security af-     Show and Outstanding Talk        lished The Montel Williams        tutions conducting research,
fairs. He was the first black     Show Host in 2002.               MS Foundation to further          raise national awareness, and
enlisted Marine to graduate            In 1999, Williams was       the scientific study of MS,       educate the public about the
from both the Naval Acad-         diagnosed with Multiple          provide financial assistance to   disease.

VA National Cemeteries Score Highest in Satisfaction Survey
Can you guess which federal       and their families deserve,”     higher than in 2001, the last     ranged for the interment of a
agency rates the highest          said Secretary Principi.         time the cemetery system was      loved one in a VA national
among Americans when it           “Honoring our heroes in per-     reviewed.                         cemetery within the past six
comes to satisfaction with        petuity and providing com-            Scores of 80 or higher       months to a year. More than
government services? It’s the     passionate service to their      on this survey are considered     2,800 people received the
system of 120 national cem-       families are among VA’s high-    strong; those near 90, excel-     survey and nearly 500 re-
eteries run by VA. In fact,       est callings. Our cemetery       lent. The ACSI is produced        sponded. A total of 93,000
VA’s cemetery system recently     staffs have always met that      through a partnership be-         burials were conducted at VA
received the highest rating       challenge superbly.”             tween the University of           national cemeteries last year.
ever achieved by a federal              The survey was the         Michigan Business School,              In addition, ACSI’s in-
agency in a nationwide cus-       2004 American Customer           the American Society for          dex for “user trust” produced
tomer satisfaction survey.        Satisfaction Index, and VA’s     Quality and the CFI Group,        a rating of 97 out of a pos-
     “These results tell us our   cemetery system scored a rat-    a consulting firm.                sible 100 for the cemetery
cemetery employees are pro-       ing of 95 on ACSI’s 100-              The survey polled next       system. That score, two
viding the services veterans      point scale. That’s two points   of kin or others who had ar-          continued on p. 26

                                                     January/February 2005                                                       25
                  introducing                               VA n g u a rd

Ray Dutra

An article in the September/      tories, departments, and vari-
October 2004 issue of             ous offices open to me; the
VAnguard highlighted the          occupants welcome me with
role of VA’s Vocational Reha-     amiable camaraderie and I
bilitation & Employment           dare say equality. Working
program in helping disabled       with the emergency room
veterans rebuild their lives.     staff has been one of the
One question the story didn’t     most rewarding experiences
address, however, is why the      in my life.
program puts so much em-                “Like keys to the king-
phasis on employment.             dom, my badge, a required
      To answer that question,    identity card on a clip to be
we turn to Navy veteran Ray       shown at all times by every
Dutra, who has been in the        hospital staff member, has al-
program off and on since          lowed me to walk with un-         Dutra
                                                                                                                          JAMES BURROWS

1987. Last year, he landed        sung heroes of America’s
his first job as an emergency     military. The warriors of         heroes fills my sails with revi-        “I know that I can’t es-
room greeter at the Provi-        yesterday’s battles come to       talizing wind. It is a lucky       cape all the demons that seek
dence, R.I., VA Medical           the VA medical center in          person who can find pride in       to take away my happiness,
Center and immediately dis-       droves, seeking treatment of      what one does for a living. I      but I have found that I can
covered the therapeutic value     pain of all types. I have been    consider myself a lucky man.       slay many through the act of
of work. The following is his     both staff and patient, and I           “My position as a volun-     serving others—the VA
account of how a new job          know that no one under-           teer started by meeting a vo-      medical center provides me
has given him a new outlook       stands a veteran more than        cational rehabilitation coun-      that opportunity. In thinking
on life.                          another veteran. That makes       selor at the Department of         of others I have saved myself.
      “I have worked in the       my job as a greeter and hos-      Veterans Affairs who enrolled           “Today the word ‘hero’
E.R. for a little more than six   pital staff more important        me in the Veterans Resource        has been bandied around a
months alongside the paid         than I sometimes realize. It is   Center (Compensated Work           great deal, but let us not for-
medical employees. In that        important for vets to be with     Therapy program), a place          get that once those heroes
time I have blended my tasks      other vets for the simple rea-    where disabled veterans re-        come home or get injured
of greeting incoming patients     sons of sharing concerns and      ceive counseling, guidance,        and seek treatment, the VA
and stocking shelves to the       commiserating together.           and some work therapy. I al-       health care system’s ‘heroes’
point that I feel part of the           “As a volunteer, my con-    most turned my back on the         will be there, ready to serve
medical team, while my job        tribution is only slightly re-    center when I thought I was        them.”
is not essential to the care of   munerated with a stipend,         more in control of my life
the veterans, per se.             but the rewards are far           than the people I met there.
      “The day I received my      greater than I can say, being           “I was wrong in more         Editor’s Note: Ray Dutra has
identity badge I had no idea      unable to find words that         ways than one. The men and         since taken an assignment in
what an impact the small          surpass miraculous; the sense     women at the center are            the hospital’s Supply, Process-
piece of plastic would have       of well-being cannot be mea-      some of the bravest people I       ing and Distribution section.
on my life. My badge speaks       sured. [Rising] from the dol-     have ever met. They taught         He “continues to do terrifi-
volumes to hospital staff that    drums of clinical depression      me that respect and honor          cally wherever he is assigned,”
recognize me as a volunteer       to performing regular acts of     should not be held in reserve      according to James Turner,
and a part of the emergency       kindness and bringing happi-      for those who seem worthy          chief of the Veterans Resource
room team. Doors to labora-       ness to more than deserving       by their outward appearance.       Center.

Cemeteries continued from p. 25
points above overall satisfac-    a recent VA survey that           satisfaction for government        and some local government
tion, indicates that respon-      showed 97 percent of next of      and industry in the United         services. ACSI allows
dents are exceptionally will-     kin were satisfied with their     States. It produces satisfac-      benchmarking between the
ing to say positive things        experience.                       tion scores for seven eco-         public and private sectors
about VA’s cemeteries.                 ACSI is the only uni-        nomic sectors, 41 industries,      and between one year’s re-
     The ACSI survey echoes       form measure of customer          200 private-sector companies       sults and the next.

26                                                    January/February 2005
                                                           VA n g u a rd                              medical advances

Tablet-Splitting                  cause the dose doesn’t have to   computerized patient records      M.D., from the University of
Saves Millions                    be as exact as with some         and our ongoing perfor-           Pennsylvania, conducted the
The VA health care system         other drugs. The drugs, while    mance measurement of pa-          study. They examined the
saved $46.5 million in 2003       hugely popular, are relatively   tient care ensure that veter-     bacterial, viral and protozoal
by having eligible patients       expensive. Parra offered the     ans receive the highest qual-     causes of gastrointestinal ill-
split their tablets of a popu-    example of one pharmacy          ity health care,” said Dr.        nesses and recommended the
lar cholesterol-lowering drug,    chain that sells 40mg and        Jonathan Perlin, VA’s acting      best ways to avoid getting
researcher David Parra,           80mg tablets of simvastatin      under secretary for health.       sick. “In nearly all instances,
PharmD, of the West Palm          for the same price, $147.79           The study was con-           transmission of acute gas-
Beach, Fla., VA Medical           per one-month supply. He         ducted by the RAND Cor-           trointestinal illness is due to
Center, announced on Nov.         said the annual savings for      poration, an independent          organisms that are present
10, 2004, during the Ameri-       one patient on 40mg who          think tank, in cooperation        transiently on the hands,”
can Heart Association scien-      splits an 80mg tablet could      with the University of Cali-      the researchers noted.
tific meeting in New Or-          be $850. “While this is a sig-   fornia at Los Angeles and the          Therefore, washing your
leans.                            nificant amount of money,        University of Michigan. It        hands with soap and warm
      Tablet-splitting saves      patients should not take it      was published in the Annals       water for 30 seconds is the
money because many pills          upon themselves to start         of Internal Medicine.             best way to avoid transmis-
are available in a higher dose    splitting any medication                                           sion. “Hand washing reduces
for the same price as the         without first consulting their   The Dirt on Anti-                 by about 95 percent the
lower dose. By splitting          health care provider,” cau-      Bacterial Soaps                   numbers of bacteria or vi-
higher-dose tablets in half,      tioned Parra.                    Antibacterial soaps are no        ruses that are applied to the
patients can get their usual                                       more effective than regular       hands experimentally or that
dose for about half the cost.     VA Care Beats                    soaps at killing germs that       are acquired exogenously un-
      Parra also shared find-     Private Sector                   cause diarrhea and vomiting,      der natural conditions, and
ings from a study that            A team of researchers found      according to a study on acute     hand washing clearly reduces
tracked 3,787 VA patients in      veterans treated at VA medi-     gastrointestinal illnesses pub-   the spread of acute gas-
Florida, Puerto Rico and          cal facilities received better   lished in the Dec. 2, 2004,       trointestinal illness in day-
Georgia who were taking           care than non-VA patients        issue of the New England          care and family settings.”
simvastatin, commercially         for 26 conditions, ranging       Journal of Medicine.              And don’t get fooled into
sold as Zocor, in 1999. Half      from depression to coronary           Researchers Daniel M.        paying more for antibacterial
the patients were converted       care. Researchers examined       Musher, M.D., from the            soaps. The researchers found
from whole to split tablets,      the medical records of nearly    Michael E. DeBakey VA             these soaps do not prevent
maintaining the same daily        600 VA patients and about        Medical Center in Houston,        acute gastrointestinal ill-
dose, while the other half        1,000 non-VA patients with       and Benjamin L. Musher,           nesses.
continued on their whole          similar health problems.
tablets. Tablet splitters and     They found VA patients re-
instructions were provided        ceived 67 percent of recom-
to those on the split tablets.    mended care, compared to
      After 12 months, both       51 percent for the non-VA
groups dropped roughly            patients. For preventive care,
eight points from their LDL,      such as pneumonia vaccina-
or “bad,” cholesterol scores.     tion and certain cancer
No difference was seen in         screenings, 64 percent of VA
liver function, a common          patients received the appro-
measure of drug toxicity, or      priate care, compared to only
in the percentage of patients     44 percent in the private sec-
who stuck to their prescrip-      tor.
tion. Based on this and other           Researchers attributed
research, VA doctors and          the difference to technologi-
pharmacies are progressively      cal innovations, such as VA’s
widening the tablet-splitting     computerized patient
program.                          records, and to policies hold-
      Splitting doesn’t work      ing top managers account-
with all medications, such as     able for standards in preven-
                                                                                                                                           GARY DALE
time-release tablets or those     tive care and the treatment of
with a special coating. Statins   long-term conditions. “This      Tablet-splitting saves money, but patients shouldn’t do it without consulting
are good candidates for it be-    study confirms that VA’s         their doctor, says researcher David Parra, of the West Palm Beach, Fla., VAMC.

                                                     January/February 2005                                                        27
             have you heard                                     VA n g u a rd

                                                                        service-connected disability      and ordered to bail out at
A familiar face at the bedside                                          with VA. After reading the        12,000 feet. He was uncon-
                                                                        article, Pittari found the        scious when he hit the
                                                                        veteran’s case file, which was    ground and hospitalized by
                                                                        pending review, and got a         German captors for 11 days.
                                                                        rating started right away. On     He was among the first
                                                                        Dec. 30, the regional office      American prisoners of war
                                                                        notified the veteran and his      repatriated in 1944 because
                                                                        wife that he will receive         of his medical condition.
                                                                        monthly payments at the           When he got home to Ohio,
                                                                        100 percent disability rate, as   he made a point of contact-
                                                                        well as a sizeable retroactive    ing the families of fellow
                                                                        payment.                          prisoners to give them mes-
                                                                              It took more than half a    sages and reassurance. Cleve-
                                                                        century, but Army Staff Sgt.      land VA Regional Office
                                                                        William H. “Shorty” Ross fi-      Veterans Service Center man-
                                                           J.R. GARZA
                                                                        nally received his Purple         ager Duane Honeycutt also
Denzel Washington visits Marine Corps veteran Jose “Joe”                Heart for wounds suffered         presented Ross the newer but
Cepeda at San Antonio’s Spinal Cord Injury Center.                      while bailing out of his          no less deserved Prisoner of
                                                                        stricken B-17 during his          War Medal during a special
Oscar-winning actor Denzel Washington visited spinal                    crew’s sixth bombing mission      Veterans Day ceremony.
cord-injured patients at the Audie L. Murphy Memorial                   over Nazi Germany in 1943.             New York VA Regional
Veterans Hospital in San Antonio, Texas, on Dec. 17. Ac-                The aerial gunner was hit by      Office counseling psycholo-
                                                                        shrapnel as his plane was at-     gist Art Bass couldn’t get the
companied by his wife Pauletta and three of their four
                                                                        tacked by German fighters         story out of his mind. His
children, the actor also met with Eric Alva, a Marine in-
jured in Operation Iraqi Freedom, and Wendall B. Rivers, a
World War II POW. Lorraine J. Dawson, an Army veteran
and patient at the hospital, was delighted when the actor                Retiring worn-out flags
stopped to chat with her during his visit. “He came straight
to where I was when he walked in the room,” she said.
“We had a long conversation. He even called over his wife
to meet me. He is so nice and easygoing.”
     Washington, who has starred in a number of films
with military themes, said the visit was a moving experi-
ence for him and his family. “All we have to give is our
time—to be here to listen and to hear whatever people
have to say, to encourage, and, as we’ve been doing all
day, to say thank you.” His visit was arranged by Rudi
Gresham, senior advisor to the Secretary.

                                                                                                                               KATHY TATE
      The wife of a New Or-       problems. The wife’s wed-
leans World War II veteran        ding ring had been stolen at
called it a “Christmas            gunpoint earlier in the year            What to do with a worn-out U.S. flag? It’s a frequent ques-
miracle.” New Orleans VA          and financial difficulties              tion, for which the Aleda E. Lutz VA Medical Center and
Regional Office decision re-      arose after her husband’s               DAV Chapter 117 have just the right answer—a drop-off
view officer Marlene Pittari      stroke in 2001. The article             box. Cong. Dale Kildee (D-Mich.) presided over dedication
called it just doing her job.     mentioned that the                      of the medical center’s new Flag Retirement Drop-off Box,
Pittari read a newspaper ar-      husband’s military records              above, in which Saginaw, Mich., citizens and groups are
ticle about the couple’s inten-   had been lost in the fire at            invited to deposit their worn-out flags. DAV members col-
tion to publicly renew their      the National Personnel                  lect the flags and ensure their dignified disposal in accor-
wedding vows to show that         Records Center in St. Louis             dance with flag etiquette.
love conquers all, including      years ago and that he was
their financial and health        having trouble establishing

28                                                   January/February 2005
                                                              VA n g u a rd                             have you heard

                                                                      former POWs for stroke and       community health policy
  new special’ volunteer
A ‘veryAmerican citizen                                               heart disease. He contacted a    leaders who toured the facil-
                                                                      local American Legion ser-       ity and learned about veter-
                                                                      vice officer for assistance in   ans health care. The group
                                                                      completing the veteran’s ap-     was particularly interested in
                                                                      plication for disability com-    the center’s substance abuse
                                                                      pensation as a former POW        program and astounded by
                                                                      and called the foreclosing       the swing-out concealed toi-
                                                                      bank to explain that forth-      lets in the center’s new Ur-
                                                                      coming VA benefits would         gent Care area. Do they have
                                                                      allow the couple to make         similar equipment in Russia?
                                                                      necessary payments to keep       “That’s a big nyet,” was the
                                                                      their home.                      reply. Many Russian health
                                                                           The congressionally-au-     care professionals and admin-
                                                                      thorized Open World Pro-         istrators have developed sig-
                                                                      gram opened the Robert J.        nificant partnerships with
                                                                      Dole VA Medical Center in        U.S. counterparts through
                                                      CURT CAMPBELL
                                                                      Wichita, Kan., to Russian        Open World.
Marine Cpl. Jason Poole raises his right hand to be sworn in as
an American citizen at the VA Palo Alto Health Care System.
Poole, a native of England, was injured in Iraq.
                                                                       Hoofprints across Amarillo
Marine Corps Cpl. Jason Poole is a patient on the VA Palo
Alto, Calif., Health Care System’s traumatic brain injury
unit and, as of November, a citizen of the United States.
Born in Bristol, England, Poole came to the United States
as a boy and graduated from Cupertino High School near
Palo Alto. He enlisted in the U.S. Marine Corps and was
sent to Iraq—not once, not twice, but three times. Ten
days before he was due to come home from his third tour,
a booby trap exploded and the young corporal was very
seriously injured.
     When he arrived at Palo Alto, he couldn’t walk, could
barely talk and breathed exclusively through a trache-
otomy. Four weeks later at his citizenship swearing-in cer-
emony, he talked non-stop, thrilled to have his family, girl-                                                           CAROLYN KINGHAM

friend and friends there to congratulate him. Poole’s
                                                                        Pat Lewallen, a volunteer at the Amarillo VA Health Care System
mother, Trudy, and twin sister traveled from England to be              who has a son who served in Iraq, poses with “Freedom.”
with him. “My son has come so, so far since his injury and
much of that is due to the tireless and dedicated staff at              Nothing represents freedom like the power and grace of a
this hospital,” said Trudy Poole. Under Secretary of Home-              horse, and that’s just what’s on display at the Amarillo,
land Security Eduardo Aguirre administered Poole’s oath                 Texas, VA Health Care System—a life-sized replica of an
of citizenship.                                                         American Quarter Horse. It’s part of a citywide public art
                                                                        project celebrating the history and spirit of the Quarter
                                                                        Horse. With funding to purchase the horse donated by a
                                                                        local businessman, a task force of VA volunteers and em-
son-in-law had told him of         couple and learned that the          ployees came up with a design painted onto the fiberglass
an elderly couple in New Jer-      husband was captured during          structure by a local artist with a grandson serving in Iraq.
sey he knew of whose home          the Battle of the Bulge 60           The chestnut-colored horse, named “Freedom,” is blan-
of 52 years was being fore-        years ago and was a POW for          keted by a U.S. flag and features the VA seal surrounded
closed on. The husband, a          six months. He recalled a VA         by the seals of the five military branches. This labor of
veteran, had suffered a num-       news release announcing ex-          love was placed near the center’s main entrance and
ber of heart attacks and all       pansion of benefits to former        dedicated on Veterans Day.
they were living on was So-        POWs and the Secretary’s de-
cial Security. Bass called the     cision to service-connect

                                                        January/February 2005                                                       29
        honors and awards                                   VA n g u a rd

                                                                    Vaupel is best known for his      veterans. The USS Orleck’s
Top honors in social work                                           ability to put patients at ease   keel was laid in Orange on
                                                                    with jokes, stories and a large   Nov. 24, 1944, and after res-
                                                                    dose of compassion.               toration the destroyer will be
                                                                          Paula Pedene, public af-    open to the public as a me-
                                                                    fairs officer at the Carl T.      morial.
                                                                    Hayden VA Medical Center               The VISN 2 Homeless
                                                                    in Phoenix, Ariz., won the        Team of Albany, N.Y., has
                                                                    Innovation Award in Institu-      won Modern Healthcare
                                                                    tional Programs from the          Magazine’s 2004 Spirit of Ex-
                                                                    Public Relations Society of       cellence Award for outstand-
                                                                    America (PRSA), Health            ing work by a homeless pro-
                                                                    Academy Section. The award        gram. Their selection for the
                                                                    honored the Strategic Public
                                                                    Affairs Plan she created for
                                                                    the medical center. The plan
                                                                    focused on improving the           Excellence
                                                                    hospital’s relationships with
                                                                    employees, patients, volun-        in teaching
                                                                    teers, congressional members
                                                                    and the community. The
                                                                    plan also earned PRSA’s pres-
                                                                    tigious Silver Anvil Award,
                                                  JAMES GLEISBERG   the Phoenix PRSA Chapter’s
Terry Harbert, left, chief of social work at the VA Eastern         Cooper Anvil Award and the
                                                                    VA Under Secretary for
Kansas Health Care System, received the VHA Social
                                                                    Health’s Communications
Work Pioneer Award, the most prestigious service award              Award.
for a VA social worker. Among Harbert’s many achieve-                     Biykem Bozkurt, M.D.,
ments during his VA career are implementing innovative              a physician at the Michael E.
programs, developing new models of service delivery and             DeBakey VA Medical Center
establishing strong community/government partnerships to            in Houston and associate
aid in patient recovery. Craig S. Howard, right, associate          professor of medicine at
director of the VA Eastern Kansas Health Care System,               Baylor College of Medicine,
                                                                    was awarded the W. Proctor          Keith Armstrong, above,
presented the award.
                                                                    Harvey Young Teacher Award          director of social work
                                                                    by the American College of          for San Francisco VA
                                                                    Cardiology for her dedication       Medical Center’s Mental
                                                                    and excellence in teaching.         Health Service, received
      The Central Alabama        ond-tier Progress Towards          Bozkurt teaches medical stu-        the Excellence in Teach-
Veterans Health Care Sys-        Excellence Award.                  dents and residents as well as      ing Award from the Uni-
tem won the Alabama Excel-            The Jefferson Awards,         specialty fellowship trainees.      versity of California, San
lence Award, the top award       sponsored by the American                With the Destroyer            Francisco, for his work
in a three-tier quality awards   Institute for Public Service       DD-886 USS Orleck in the
                                                                                                        with psychiatry resi-
program administered by the      (AIPS), honors the unsung          background, Maurillo
Alabama Productivity Cen-                                           Garcia-Maldonado, M.D.,             dents. The award is
                                 heroes who volunteer their
ter. The award is given for      time across America. This          Beaumont VA Outpatient              voted on by the psychi-
superior efforts in productiv-   year AIPS chose a VA Pitts-        Clinic executive, received the      atric medical residents
ity and quality as measured      burgh Healthcare System            Heritage Freedom Award at a         themselves rather than
by Alabama Quality Award         volunteer as one of 2004’s re-     ceremony in Orange, Texas.          by experts or others in
Program examiners. The ex-       gional honorees. William           Presented by the South East         the field. Armstrong re-
aminers use a variety of qual-   “Mr. Bill” Vaupel has volun-       Texas War Memorial Histori-         ceived more votes than
ity measurements including       teered at VA Pittsburgh for        cal Foundation in partner-          psychologists and psy-
on-site visits to assess a       15 years, escorting patients       ship with the Orange Naval          chiatrists who had also
facility’s leadership and com-   to medical procedures, clean-      Reserve Center, the award           been nominated.
mitment to productivity. Last    ing beds and stocking sup-         recognized Garcia-
year CAVHCS won the sec-         plies. A veteran himself,          Maldonado’s dedication to

30                                                   January/February 2005
                                                            VA n g u a rd                            honors and awards

award was based on improve-       has been in place at the VA       and largest nonprofit medical    Northern California Health
ments in providing access to      Maryland Health Care Sys-         specialty organization for pa-   Care System in Sacramento,
health care and services          tem for more than three           thologists, medical technolo-    received the Joan Oettinger
through the Homeless Team’s       years and has been imple-         gists and other laboratory       Memorial Award from the
continuum of care program.        mented for several medica-        professionals.                   University of California
The team credits the hard         tions. Due to its success,              Joy W. Hunter, dean of     Davis, School of Medicine.
work, dedication and com-         plans are underway to extend      the VA Learning University       The award recognizes contri-
mitment of team members,          it to other medications and       in Washington, D.C., re-         butions to research in cancer
support from senior leader-       to other VA facilities            ceived an industry leadership    disease. Weiss investigates
ship, and community part-         throughout the country.           award at the Learning in         growth control in cancer and
nerships that support their             Mary E. Burkhardt, a        Practice Awards competition      atherosclerosis, a condition
efforts.                          program manager with the          sponsored by Chief Learning      that causes lesions and limits
      Sharon Rounds, M.D.,        VA National Center for Pa-        Officer magazine. Hunter         blood flow in arteries.
chief of pulmonary/critical       tient Safety in Ann Arbor,        won the bronze award in the            The Pharmacy Society
care at the Providence, R.I.,     Mich., was named a Distin-        Learning Innovation category     of Wisconsin selected Lynnae
VA Medical Center and pro-        guished Alumnus by Wayne          for her role in supporting       M. Mahaney, chief of phar-
fessor of medicine at Brown       State University’s Pharmacy       technology-based training        macy at the William S.
University, was elected presi-    Alumni Association. She           opportunities for VA em-         Middleton Memorial Veter-
dent of the American Tho-         holds a bachelor’s degree in      ployees.                         ans Hospital in Madison,
racic Society. ATS, with more     pharmacy and a master’s in              Robert H. Weiss, M.D.,     Wis., as Pharmacist of the
than 13,500 members world-        hospital pharmacy adminis-        a nephrologist with the VA       Year.
wide, is an independent edu-      tration from the university.
cational and scientific society   Burkhardt was one of the
which focuses on respiratory      first pharmacists nationwide
and critical care medicine.       to work on patient safety is-       A new frontier in psychiatry
The society’s members help        sues on a full-time basis.
fight and prevent respiratory           The Colegio de
disease around the globe          Farmacéuticos de Puerto             Nick A. Kanas, M.D., below, associate chief of mental
through research, education,      Rico (Puerto Rico Pharma-           health at the San Francisco VA Medical Center, was
patient care and advocacy.        cists Association) has named        awarded the prestigious Royer Award for San Francisco
Rounds studies cell injury        Dr. Giselle Rivera, pharmacy        Bay-area physicians who have made significant contri-
and dysfunction, which are        clinical coordinator at the         butions to the fields of psychiatry and neurology. Kanas,
early symptoms of acute lung      San Juan VA Medical Cen-
                                                                                                      who is also a professor of
injury.                           ter, as recipient of the
      The VA Maryland             Abigail Robles Award for                                            psychiatry at the Univer-
Health Care System received       2004. It is the organization’s                                      sity of California, San
the 2004 Grace Hopper             most distinguished honor.                                           Francisco, is the founder
Government Technology             Rivera is a leader in the                                           of the new field of space
Leadership Award, Scientific      pharmacy profession in                                              psychiatry.
Advancement category, for         Puerto Rico. She currently                                               He has worked with
exceptional service to the        supervises 15 pharmacists                                           astronauts for more than
public, mission accomplish-       and coordinates the medical                                         35 years, studying the psy-
ment and cost effectiveness.      center’s anticoagulation                                            chological effects of
Their submission, the MUE         clinic.                                                             space travel, including as-
(Medication Use Evaluation)             Fred H. Rodriguez Jr.,
                                                                                                      sessing cultural factors in
Initiative, was selected from     M.D., director of pathology
among 260 applicants from         at the New Orleans VA                                               crewmember and crew-
all branches of government        Medical Center, was recently                                        to-ground interactions
by the Academy of Govern-         installed as president-elect of     during missions with the International Space Station.
ment Technology, consisting       the American Society for            Kanas’ work has previously been recognized both in
of 250 leading experts on the     Clinical Pathology. He has          1999, when he won the Aerospace Medical Association’s
federal government’s use of       served the society in various       Raymond F. Longacre Award, and in 2004, when his book
technology. The MUE Initia-       capacities through the years,       Space Psychology and Psychiatry won the Life Sciences
tive, a software tool that        including as vice president,        Book Award from the International Academy of Astro-
helps health care providers       secretary, and on the board         nautics.
choose and review their pa-       of governors. Founded in
tients’ medications wisely,       1922, the society is the oldest

                                                      January/February 2005                                                     31
                      heroes                              VA n g u a rd

                                                                  Herndon then called the Mi-      momma manatee followed
 A calm voice on the line                                         ami Seaquarium and the           her wandering baby into the
                                                                  Florida Fish and Wildlife        storm drain on the Miami
                                                                  Conservation Commission          campus through a nearby
                                                                  for assistance. It took about    creek. These endangered
                                                                  four hours for the small army    mammals, also known as “sea
                                                                  of five professional animal      cows,” number only around
                                                                  rescuers, VA police and as-      3,200. They lack the proper
                                                                  sorted hospital personnel        fins to move backwards, so
                                                                  equipped with two large con-     they were unable to escape.
                                                                  struction cranes to rescue the   “I’m ecstatic and kind of
                                                                  animals. After a quick veteri-   choking on tears,” Herndon
                                                                  nary checkup, the animals        said. “I’m an advocate for
                                                                  were released into the Miami     vets and now for mammals,
                                                                  River. Experts suspect that      too.”

                                                                   Right place and time to help
                                             DAMON A. STEVENSON

  Cynthia Hall, above, telephone operator at the Mont-
  gomery campus of the Central Alabama Veterans Health
  Care System, recently received a desperate cell phone
  call from a veteran experiencing chest pains while driv-
  ing from Mississippi to Michigan. Hall contacted the
  CAVHCS Life Support Unit (LSU) and then forwarded
  their recommendation that the veteran stop at the near-
  est hospital. The veteran responded that the VAMC was
  his only choice because he didn’t have insurance. Hall
  then asked the veteran to give her his cell number, a ve-
  hicle description, and his present location, and to re-
  main in contact with her.
        The veteran soon indicated that he was closing in
  on the medical center’s proximity, but did not know how
  to reach its exact location. Hall notified CAVHCS police                                                             CHRIS BAROODY
  that the stricken veteran was inbound, requesting they
  notify the LSU and emergency treatment staff of his ar-           As VA police officer Johnnie Scott, above, made early
  rival. She then provided real-time directions that en-            morning rounds on Nov. 16 at the Ralph H. Johnson VA
  abled the veteran to drive up to the LSU entrance. Hall’s         Medical Center in Charleston, S.C., his attention was
  calm, hands-on involvement led to a successful conclu-            drawn to a car with its door slightly open. “When I
  sion to this desperate situation.                                 opened the vehicle door I knew that this was a medical
                                                                    situation,” said Scott. He found the driver nearly uncon-
                                                                    scious, his left hand crumpled into a fist, his right clutch-
                                                                    ing a bottle labeled “Nitro Quick.” Scott realized that the
     “I’m glad I didn’t park   manhole to find a manatee            man could be having a heart attack and called for an
in my usual space,” said VA    mom and her year-old son             EMS response. He asked the driver if he needed the
social worker Cynthia          stuck in a three-and-a-half-         medication and the man nodded. Scott handed him a ni-
Herndon. On Dec. 28,           foot wide drain. Herndon             tro tablet, enabling him to self-medicate.
Herndon heard strange          hoped the animals would                   The driver had indeed suffered a heart attack, but
noises as she walked to her    somehow free themselves              has since returned home and is doing well thanks to
car in the Miami VA Medi-      with that evening’s incoming         Scott and the VA medical team. “I just was glad to be in
cal Center parking lot. Fol-   tide. But when she arrived           the right place at the right time to help,” said Scott.
lowing the “swooshing          the next morning, the mana-
sounds,” she peered into a     tees were still there.

32                                                 January/February 2005

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