November/December 2002

VAnguard outlook

Waiting for Care Operation Early Intervention Boosting Security Veterans Day 2002 November/December 2002 1 VAnguard

Table of Contents

Features Operation Early Intervention...... 6 6 VBA steps up efforts to help servicemembers and their families Boosting Security...... 8 the arming of VA’s police force is almost complete Historic Preservation at National Cemeteries...... 11 memorials inventory project now nearly halfway complete Rx for the Future...... 12 consolidated mail outpatient pharmacies achieving efficiency, cost savings Fifty Years of Veterans’ Voices...... 14 writing forum for veterans celebrates golden anniversary 19 Waiting for Care...... 16 VA tackling waiting times for appointments Veterans Day 2002...... 20 20th anniversary of the Wall

Departments Letters...... 3 Management Matters...... 4 20 Outlook...... 5 e-Learning...... 23 @Work...... 24 VAnguard Introducing...... 25 VA’s Employee Magazine Around Headquarters...... 26 November/December 2002 Vol. XLVIII, No. 8 Medical Advances...... 29 Printed on 50% recycled paper Have You Heard...... 30 Honors and Awards...... 31 Editor: Lisa Respess Heroes...... 32 Assistant Editor: Matt Bristol Photo Editor: Robert Turtil Published by the Office of Public Affairs (80D)

Department of Veterans Affairs On the cover 810 Vermont Ave., N.W. Veterans are coming to VA for health care in Washington, D.C. 20420 record numbers, a trend that has left about (202) 273-5746 265,000 veterans currently waiting for health E-mail: [email protected] www.va.gov/pubaff/vanguard/index.htm care appointments. VA is tackling the backlog on a number of fronts. And while the goal is to eliminate it within six months, high demand for appointments is expected to continue.

2 November/December 2002 VAnguard letters

sue. My unit was activated elated to see the story in soon after my wedding in print, and seeing it in Span- New Look November 2001. While on ish made it even more per- active duty, I served as a so- sonally rewarding. My father I WOULD like to cial worker in Fort Drum, has 10 brothers and sisters, compliment the staff N.Y. I will never forget the all but one living still in on the best-looking soldiers and their stories Puerto Rico. There are VAnguard I’ve seen in about fighting in Afghani- countless cousins, uncles and a very long time. The stan. I was proud to serve my relatives. Veterans organiza- front cover is striking. country. Now I’m proud to tions operate in Spanish in serve America’s veterans. Puerto Rico. I assure you all The articles are great, th the new look is fan- Bill Sivley are keenly aware of the 65 . tastic, the paper qual- Chief Patient Advocate Thanks to VAnguard, I Washington, D.C., VAMC will be able to share this with ity is the best, and the all my friends and family on larger writing is very 65th Infantry Regiment the island. You have done a appealing to those of us whose eyesight has KUDOS all around for a su- great honor to my family, stepped down a peg. Even if you can’t keep the perb job on the September/ but also to the men and the paper quality, the overhauled look is a winner October issue! Obviously, I families of the valiant 65th in my book. I will make this VAnguard a keep- had particular interest in the Infantry Regiment. sake. Congratulations! article that highlighted the Francisco D. Maldonado Gail Buckner Puerto Rican 65th Infantry Area Emergency Manager Program Support Assistant and my father and son. I was Miami VAMC VA Central Office

Corrections POW/MIAs For the VA to fail to in- The article in our June In the September/Octo- I RECENTLY reviewed the corporate this important issue about the dedication of ber issue, we identified September/October issue of message is disappointing, as the L.A. National Cemetery Vincent Alvarez, M.D., as VAnguard and was pleased there are several ways in chapel to Bob Hope incor- the chief of staff at the Nash- with the substantive articles which this could have oc- rectly credited the entertainer ville, Tenn., VA Medical that were included, especially curred. As an example, the with being the only private Center. He is the chief medi- appreciating the memorial to rightful focus on contribu- citizen to be granted honor- cal officer for VISN 9. Jesse Brown, a longtime tions of our Hispanic veter- ary veteran status. While friend and colleague. I also ans could have included hon- Hope was the first to receive Also in the September/ believe that it was very im- oring those still missing and that honor, he shares the dis- October issue, we left Timo- portant to recognize where unaccounted for from our tinction with the late thy J. Eichman, Phoenix, we are one year after the nation’s past wars and con- Zachary Fisher, a philanthro- Ariz., and Noel Victoriano, tragic and horrifying terrorist flicts. pist and lifelong advocate for Mather, Calif., off the list of attack on our country. In the future, I hope the men and women serving VA employees called up for It was unfortunate, how- that there will be greater at- in the nation’s armed forces. active duty after 9/11. ever, that there was no men- tention to recognizing that tion of our nation’s our nation’s POW/MIAs unreturned veterans—our from all wars are unreturned We Want to Hear from You POW/MIAs—despite the veterans who need the help fact that National POW/ of all Americans to come Have a comment on something you’ve seen in MIA Recognition Day was home—alive or dead—to us VAnguard? We invite reader feedback. Send on Sept. 20. This year, Secre- and to our country. tary of Defense Donald Ann Mills Griffiths your comments to [email protected]. You Rumsfeld and Chairman of Executive Director can also write to us at: VAnguard, Department the Joint Chiefs of Staff Gen. National League of Families of Veterans Affairs, 810 Vermont Ave., N.W., Richard Myers addressed the Washington, D.C., 20420, or fax your letter to national ceremony at the Active Duty Roster (202) 273-6702. Include your name, title and Pentagon, providing very I WAS touched to find my VA facility. We won’t be able to publish every high-level signals that our na- name and so many others on letter, but we’ll use representative ones. We may tion stands behind those who the “Called to Duty” roster need to edit your letter for length or clarity. serve. in the September/October is-

November/December 2002 3 management matters VAnguard

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

One of President Bush’s top in place compatible tech- undoubtedly show an in- tives—is records manage- management priorities is im- nologies and clinical proto- crease in overall price reduc- ment. A veteran’s health care proving sharing and coopera- cols. VA and DoD health tions. We are making record is an accumulation of tion between the nation’s two care resources—and the sys- progress, but there is still information gathered from largest cabinet depart- tems that support them— work to be done. the moment that person puts ments—VA and the Depart- have a common purpose: to Dr. Chu and I also are on a military uniform until ment of Defense. Together, field the most advanced examining the coordinated the day he or she comes to we spend more than $40 bil- medical capabilities our gov- use of capital assets—coordi- VA for health care or to file a lion in health care for current ernment owns to save lives nating services in cities where claim. We must develop or former military personnel and enhance the quality of VA and DoD maintain and interoperable electronic and their families. lives. operate separate medical fa- medical records and adopt a President Bush is acutely We’ve made progress in cilities. In Chicago, we trans- transparent records exchange aware of the need for a seam- our joint procurement proto- ferred land to the Navy ear- system that will allow us to less continuum of service for cols. We simply cannot con- lier this year in exchange for meet the health care needs of Americans who wear our tinue to award and adminis- the Navy’s agreement to pur- active duty personnel and nation’s uniforms. He knows ter expensive, mutually exclu- chase electricity and steam veterans. that when the young men sive health care contracts for from a VA power station. The operative words in and women who are now de- pharmaceuticals, medical and More recently, our the VA-DoD sharing initia- fending freedom in Afghani- stan and other areas of the world hang up their uni- We are intent on maintaining the integrity of our forms and assume the hon- distinctive missions while achieving President Bush’s ored title of veteran, they goal of greater interoperability and transparency have every right to expect VA to meet their health care between our two systems. needs seamlessly—moving records from active duty files surgical supplies, inventory medical center in North Chi- tive are cooperation and col- to VA files; sharing critical management systems, and cago strengthened its part- laboration, not necessarily in- medical information through high-tech medical equip- nership with the Navy to im- tegration. We are intent on coherent and timely transfers ment. prove coordination of health maintaining the integrity of of health histories; and pro- In January 2001, DoD care operations. Under an our distinctive missions while cessing benefits claims as if converted its pharmaceutical agreement finalized in Octo- achieving President Bush’s DoD and VA were, for all in- pricing structure to VA’s ne- ber, the Navy will use the goal of greater tents and purposes, one gotiated Federal Supply North Chicago VA Medical interoperability and transpar- shared system. This is what Schedule. Today our joint Center for its inpatient and ency between our two sys- our servicemembers have procurement protocols bring surgical needs. Additionally, tems. Our facilities have earned and we are moving together VA’s $4 billion phar- Navy surgical teams will proven at the local level that forward aggressively to see maceutical purchasing pro- work at the VA hospital, pro- by working together we can that they get it. gram and DoD’s $2 billion viding veterans increased ac- save taxpayer dollars while My colleague and friend program to save millions of cess to surgical care while dramatically improving ac- Dr. David Chu, Under Sec- taxpayer dollars in pharma- maintaining their surgical cess and services to military retary of Defense for Person- ceutical purchases. Since De- proficiencies. We have simi- beneficiaries and veterans. nel and Readiness, and I cember 2001, we have saved lar agreements in several We are taking that effort to a have held a series of joint $98 million from shared states. new level that promises bet- meetings to examine how pharmaceutical contracts. Another potential op- ter use of taxpayer dollars our departments can collabo- Earlier this year, DoD began portunity for shared ser- and better service to those rate on health care services. importing Federal Supply vices—one that really goes to who have worn and those We are working together to Schedule prices into their the heart of how VA and who now wear the military analyze our dual needs, plan system for medical and surgi- DoD can move cooperatively uniforms of the United for future resources, and put cal items, a move that will toward our mutual objec- States.

4 November/December 2002 VAnguard outlook

Communicating Clear Objectives Key to Meeting Health Care Challenges Robert H. Roswell, M.D. Under Secretary for Health

The Veterans Health Admin- informatics and data man- policies that reinforce and sorry to say, has been miss- istration has become one of agement and strategic plan- clearly articulate our mission ing. the nation’s recognized lead- ning. and that align the plans, I have the utmost confi- ers in quality health care, in- Each committee has a goals, and directions of head- dence in VHA employees. creasingly being cited as the chair and vice-chair and each quarters, networks and facili- We’ve had serious challenges standard to emulate. Em- has a specific charter and re- ties. in the past and our employ- ployees at all levels of our or- sponsibility. There also is an The NLB also will be ees approached them with ganization can be proud of executive committee respon- focused on clearly communi- dedication and perseverance. what they have accom- sible for assuring that activi- cating our vision, values and I also have confidence in plished. ties of all the committees are strategic objectives through- our senior leaders. The new At the same time, VHA coordinated. out the organization. This NLB will support field em- has serious challenges that The committees are in- new leadership structure will ployees by providing consis- threaten the gains we’ve tentionally aligned with the increase consistency across tent messages and steady made. We face the compli- Malcolm Baldrige National our system and give us the guidance. cated reality of too many pa- Quality Program’s health care best chance to overcome our The threats and chal- tients and too few dollars. In criteria to give us a strong budget and workload challenges we face are very real. order for us to assure consis- systems approach for improv- lenges. But I’m committed to mak- tent high quality health care ing leadership and manage- When the full NLB ap- ing sure we have the best for America’s veterans, we ment. proves its committees’ initia- team approach possible, our have to face our challenges In 2001, VHA con- tives, I will expect the initia- best assurance of managing and overcome them. ducted an intense examina- tives to be effectively imple- workload, budget and all Finding more efficient tion of our central leadership mented systemwide. For this other challenges without ways to deliver high quality care isn’t a job only for our dedicated field staff. I’ve di- My ultimate management goal—and it should be rected a reorganization of every VHA manager’s—is to get all of our more than VHA’s senior leadership 180,000 VHA employees moving together with a full structure, the National Lead- ership Board, and have given understanding of what we are trying to achieve. specific charges to its members to manage resources and system using the Baldrige cri- kind of consistency, we have compromising our commit- develop plans that help field teria. This assessment identi- to have a centralized leader- ment to provide high quality facilities continue to provide fied the ways we work well— ship system that successfully health care. Our veterans de- high quality care for the vet- there are many—and areas in engages leaders in decision- serve it. erans we serve. which we can improve. making. The new NLB will The NLB is made up of The assessment showed assure leaders are fully in- our 21 Veterans Integrated we need to focus on simplify- volved in developing and de- Are You Watching? Service Network directors, ing and clearly communicat- ploying effective strategies VHA’s chief officers, me, my ing our national planning and plans. Don’t miss your weekly chief of staff, and the three processes. Every field facility de- helping of “VA News,” deputy under secretaries. A major gap was that we serves clear, consistent direc- news for and about VA The reorganized NLB didn’t have our senior leaders tions as it moves forward. employees delivered each looks more like the gover- effectively engaged in devel- My ultimate management week in a digestible 10- nance structure of other oping and clearly deploying goal—and it should be every minute video shown daily health care systems, with strategic plans and policies in VHA manager’s—is to get all at 4 a.m., noon, 4 p.m. committees to deal with op- a coordinated, consistent of our more than 180,000 and 10 p.m. (Eastern erational issues. The NLB manner. This led to the NLB VHA employees moving to- Time) over the VA committees cover communi- reorganization and my charge gether with a full under- Knowledge Network sat- cations, finance, health sys- that it develop ambitious, standing of what we are try- ellite link to your facility. tems, human resources, clear VHA strategies and ing to achieve. That, I’m

November/December 2002 5 feature VAnguard Operation Early Intervention VBA has been stepping up efforts to help servicemembers engaged in the war on terrorism and their families swer his questions. A typical occur- rence in any VA regional office, with one difference. The “veteran” is still on active duty and recuperat- ing from injuries received in Af- ghanistan while participating in Op- eration Enduring Freedom. Since last December, counselors from the Washington, D.C., VA Re- gional Office’s newly established Early Intervention Transition Assis- tance Service have provided vocational counseling and training, as well as benefits information and application assistance, to servicemembers at Walter Reed Army Medical Center who are un- dergoing treatment and rehabilita- U.S. AIR FORCE PHOTO tion for injuries sustained in the war Medics secure an injured American soldier for transport from Bagram Air Base, Afghani- stan. on terrorism. Other regional offices near major military separation cen- AS THE VA COUNSELOR AND has some questions about disability ters have developed similar early in- THE VETERAN with whom she compensation and concerns about tervention programs to assist has been working review the who in VA he should contact when servicemembers facing medical dis- veteran’s aptitude test and interest he relocates in a few weeks. charges. evaluation, a vocational rehabilita- A veterans service representa- Yolanda Watkins, a veterans ser- tion plan takes shape. The veteran tive meets with the veteran to an- vice representative from the Wash-

The High Price of Preserving Freedom

The young sons of two VA employees about 100 of his mother’s fellow em- also survive him. lost their lives in separate military in- ployees gathered in the hospital’s Lt. Stephen N. “Nick” Benson cidents that happened less than two chapel for a memorial Mass. was among four Navy pilots killed weeks apart in October. Sledd was buried at the Bay Pines when two F/A-18F jets crashed about Marine Lance Cpl. Antonio National Cemetery in Florida. More 80 miles southwest of Monterrey, Ca- “Tony” Sledd, 20, died on Oct. 8 after than 350 people attended the service, lif., on Oct. 18. Benson, 26, was the being shot by two Kuwaiti gunmen including members of Florida’s con- son of Acting Under Secretary for Me- while participating in an urban as- gressional delegation, Gen. James L. morial Affairs Eric Benson. sault training exercise near Kuwait Jones, commandant of the Marine Memorial services for Benson City in the Persian Gulf. Corps, and Kuwaiti Ambassador Salem were held at the Oceana Naval Air Sledd was the son of Norma Abdullah Al-Jabr Al-Sabah. Station in Virginia Beach, Va., and at Figueroa, a nurse manager at the A Purple Heart was presented to Arlington National Cemetery. His sur- James A. Haley VA Hospital in his mother during the service. Sledd’s vivors also include his mother, Bar- Tampa. The day after his death, father, Tom, and twin brother, Michael, bara, and two siblings.

6 November/December 2002 VAnguard feature ington, D.C., VARO, visits military talk about vocational rehabilitation. Lehowicz immediately drove to the installations in the Washington They want help coming to grips hospital and has been working metropolitan area each week to as- with these enormous changes that closely with him and his family ever sist hospitalized servicemembers who are occurring in their lives,” she since. are likely to file VA disability claims says. “They may not be ready to ac- The vocational rehabilitation upon discharge. cept the reality that they need to services Lehowicz provides include She explains what benefits are prepare for life outside the military aptitude testing, interest evaluation available and helps the and that they need help preparing to and career counseling. The next servicemembers prepare their claims enter the civilian job market or step is to develop a rehabilitation so they can be processed as quickly school. plan that meets the separating as possible once the members sepa- “You just have to go slowly and servicemember’s individual needs rate. Jeannie Lehowicz, a vocational gently and let them come to you,” and goals. rehabilitation counselor, also visits adds Lehowicz, a former social Watkins, a member of the Walter Reed at least once a week to worker and USO program director. Washington, D.C., regional office’s help recovering servicemembers de- Some come around more readily Benefits Delivery at Discharge velop a rehabilitation plan and to than others. After 10 or 12 visits team, assists the same ease their transition to civilian life. with one soldier, she told him, servicemembers with whom Lehowicz says most of the in- “You’re not ready to talk about vet- Lehowicz works, along with many jured she has worked with as part of erans’ benefits yet and I don’t want others preparing for separation. The “Operation Early Intervention,” as to be pushing you. If you change BDD is designed to help the program is sometimes called, your mind and want to talk about servicemembers separating within have been cautious at first, reluctant the [VRE] program, call me—any 90 to 180 days who plan or expect even to hear about VA benefits or time, night or day.” to apply for disability compensation. rehabilitation services. One evening about a month Fred Steier, Ed.D., the Wash- “These soldiers are not ready to later, the servicemember called. ington, D.C., VARO’s vocational rehabilitation and employment officer, says they already had agreements Free Medical Care for Combat Veterans with local military installations to give VA counselors access to mili- The newest generation of combat veterans, including those now serving in tary facilities and servicemembers Afghanistan and the war on terrorism, are eligible for two years of free medi- before Sept. 11 last year, but the cal care from VA for most conditions. The policy is outlined in a directive is- program was not as well organized or sued by VHA’s Environmental Agents Service (VHA Directive 2002-049) in fast-moving as it is now. “We upped September. the ante in terms of how fast we can To receive free care, veterans must be able to show that they served in help servicemembers,” he says. a theater of combat operations or in combat against a hostile force after Although VA disability claims Nov. 11, 1998. They do not have to prove that their health problems are ser- cannot be filed until servicemembers vice-connected, or have low incomes. The benefit does not, however, cover separate from active duty, Watkins treatment for medical problems that are clearly not related to military ser- makes sure those about to separate vice, like common colds, injuries from accidents that happened after they understand what benefits they may were discharged from active duty, or disorders that existed before they be entitled to, helps them prepare joined the military. their applications and expedites The coverage lasts for two years after discharge from active duty. It ap- handling of their claims when they plies to VA hospital care, outpatient services and nursing home care. After are filed. two years, these veterans will be subject to the same eligibility and enroll- Lehowicz prepares a vocational ment rules as other veterans. Most National Guard and Reserve personnel rehabilitation plan that can be put who were activated and served in a theater of combat operations or in com- into action quickly, no matter where bat against a hostile force are also eligible. According to Mark Brown, Ph.D., the veteran is located. She and director of Environmental Agents Service, the policy came out of lessons Watkins aren’t just talking about ge- learned from the undiagnosed illnesses of Gulf War veterans and Vietnam ography when they say, “Our mis- veterans exposed to Agent Orange. It is expected to improve VA’s ability to sion is to help them get to where track the immediate post-discharge health status of combat veterans. they want to go.” Continued on page 15

November/December 2002 7 feature VAnguard BoostingBoosting

WARREN PARK

8 November/December 2002 VAnguard feature SecuritySecurity Put on the fast track following an increase in violent incidents at VA facilities, the arming of VA’s police force is now nearly complete

A PLAN TO ARM ALL VA PO- armed police force capable of pro- have the best training and skills de- LICE OFFICERS with 9-millimeter tecting patients and employees. velopment so they can provide the semiautomatic pistols was put on the A month after the shooting, the best possible protection to our veter- fast track following an increase in Secretary accelerated the firearms ans, their families and VA employ- violent incidents at VA facilities. rollout program. At least 30 hospi- ees. That’s why our standards are so In the summer of 2000, less tals would be armed each year under high,” said Ronald R. Angel, an than 20 VA hospitals had an armed the revised plan. Army veteran and director of the police force. Today, more than 1,900 Before they are authorized to VA Law Enforcement Training Cen- of VA’s approximately 2,200 police carry firearms, officers must pass a ter. officers carry a firearm, according to physical examination and a psycho- Deputy Secretary Dr. Leo S. Lisa Foster, a security specialist with logical assessment. They also have Mackay Jr., visited the training cen- the Office of Security and Law En- to qualify at the range. Foster, who ter in September to officially dedi- forcement. “We expect all officers to is a former Marine firearms instruc- cate a new 15-lane indoor firing be trained and armed by the end of tor, said VA police officers must pass range. The new range was a wel- this fiscal year,” she said. a 40-hour qualification course before Continued on page 10 It started slow and cautious. Of- they receive firearms. And they ficers at five VA facilities began car- need to re-qualify with their weap- rying firearms in 1996 as part of a ons every six months. pilot study. Their police chiefs re- Hospitals must have a firearms ported that they appeared more con- policy and an approved armory be- fident and visible. Most said there fore receiving weapons. They also was a notable increase in both in- need to have at least one of their of- vestigative and traffic stops. By ficers certified as a firearms instruc- 1999, a total of 12 VA facilities had tor through the 96-hour training armed their police forces. The plan course at the VA Law Enforcement was for 15 more to be added each Training Center, located on the year. grounds of the Little Rock, Ark., One of the first facilities to arm VA Medical Center. The center has its officers in 2000 was the Salisbury, an intensive firearms training plan N.C., VA Medical Center. Just two that meets or exceeds the require- months later, two of the hospital’s ments for federal law enforcement officers had to use their weapons to agencies, according to a review by subdue an 83-year-old veteran who the head of the firearms school at WARREN PARK shot a physician in the heart. The the FBI Academy. Russell Eilrich, a pistol instructor from the Little Rock VA Law Enforcement Training incident brought into sharp focus “We decided from the very out- Center, traveled to Pittsburgh to train VA the value of a properly trained and set that we wanted our officers to police officers there.

November/December 2002 9 feature VAnguard

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

Continued from page 9 come addition. In the past, officers had to go to an out- door range at Camp Robinson, an Army National Guard base, to qualify with their weapons. Sometimes it took up to two hours to transport students and equipment to the range—time that could have been spent training. “By having this new range, we’re going to save time on travel and use it to intensify our training,” said WARREN PARK Angel. Sgt. Thomas A. Miele, a police officer with the VA Pittsburgh The new range is equipped with a high-tech com- Healthcare System (also pictured on p. 8), secures a firearm in the armory. puter simulator used to teach trainees how to react to stressful situations. As an officer walks into the simula- ate director. “We didn’t cut any corners in their train- tor room, they see a life-sized image projected onto a ing.” Gerigk even joined the officers as they carried out screen. It could be a suspect with a knife, an uncoopera- their training exercises. “I wanted to familiarize myself tive psychiatric patient, or any number of scenarios. with this as much as possible,” she explained. Pittsburgh Police Chief Jack Crawford said most of his officers have had previous firearms experience “We want to make sure our through civilian or military training. He expects a officers get the training they smooth transition to an armed force. “This is just another tool to help them do their jobs,” he said. need to be effective.” The Beretta 9-mm carried by VA police has been modified to include a magazine disconnect feature that The officer must decide how to deal with the situa- prevents it from being fired when the magazine is re- tion while being watched and graded by evaluators. “We moved. Officers are required to remove their magazines evaluate everything from verbal skills used to deescalate when entering certain areas of the hospital. Using the a situation to how proficient the officers are if they fire magazine disconnect feature along with a special secu- their weapon,” said Angel. “We want to make sure our rity holster reduces the likelihood of the firearm being officers get the training they need to be effective.” taken and used by an unauthorized person. Police officers at all three campuses of the VA Pitts- As heightened security becomes the standard oper- burgh Healthcare System began carrying firearms on ating procedure at federal facilities, VA police officers Nov. 1. To prepare more than 50 officers for the transi- stand ready to provide a safe and secure environment tion, the health care system established an on-site fire- for employees and veterans. For more information about arms training facility complete with BeamHit laser guns VA police, visit the Office of Security and Law Enforce- and a firearms testing simulator. ment Web site at www.va.gov/osle. “We wanted our officers to be very confident in their abilities,” said Terry M. Gerigk, the system’s associ- By Matt Bristol

10 November/December 2002 VAnguard feature Historic Preservation at National Cemeteries Memorial Inventory Nearly Halfway Complete eteries out of their area, giving them an excuse to plan summer or fall getaways. Since many of the national cemetery memorials and monuments date to the Civil War and are considered historic cultural artifacts, the project appealed to some teachers who saw it as an opportunity to provide hands-on history lessons for their students. John Wilkes, a history teacher at the Maggie L. Walker Governor’s School in Rich- mond, Va., is working with his senior history students to document the memorials at three Civil War- era national cemeteries in Virginia: City Point, Cold Harbor and Seven History teacher Paul LaRue and his students at Washington Courthouse High School record Pines. And Paul LaRue, a research memorials at Camp Chase Confederate Cemetery in Columbus, Ohio. history teacher at Washington Courthouse High School in Colum- Last spring, the National Cemetery of its Art Inventories database. bus, Ohio, volunteered his class to Administration began working on NCA recruited volunteers for record the memorials at nearby the first-ever comprehensive inven- the project through announcements Camp Chase Confederate Stockade. tory of its memorials. Volunteers to veterans service organizations, Four officers stationed at Fort from all over the country are col- VA employees, and a wide variety of Leavenworth, Kan., are document- lecting data and photographs for all other groups. Nearly 150 would-be ing memorials at Fort Leavenworth NCA memorial structures for his- volunteers contacted NCA, but National Cemetery as part of a com- toric and preservation purposes. many of them did not live near a munity affairs project. When the project began, NCA memorial. As of November, how- Other volunteers were attracted estimated that volunteers would ever, 77 volunteers have begun or by the chance to find out more catalog about 300 memorials or completed documentation of 174 about this aspect of military history monuments in its 120 national cem- memorials. located right in their own backyards. eteries and 33 related soldiers’ and The volunteers come from a Most said getting involved with the Confederate lots. But according to wide range of age groups, educa- project allowed them to contribute NCA Historian Darlene tional backgrounds, interests and to the preservation of America’s Richardson, the project has been so professions. They include elemen- heritage resources and to honor well received that it has been ex- tary through college-age students, fallen veterans. panded to capture an estimated 500 active and retired military person- NCA will continue recruiting memorials or monuments, including nel, VA employees, state historic volunteers until all memorials have more than 160 cenotaphs at Con- preservation office staff, archivists, been surveyed. A list of memorial gressional Cemetery in Washington, historians, teachers, VSO members, locations still in need of volunteers D.C., where the government main- Civil War history buffs and retirees. is posted on the NCA Web site tains some lots. A number of volunteers were (www.cem.va.gov) under “History.” Information collected through parents who saw the Memorials In- For more information about NCA’s the Memorials Inventory Project ventory Project as a way to create an Memorials Inventory Project, con- will be shared with the public educational and entertaining week- tact historian Darlene Richardson at through the Smithsonian Institution end activity for the whole family. (202) 565-5426 or by e-mail at Research Information System as part Some asked to be assigned to cem- [email protected].

November/December 2002 11 feature VAnguard RxRx forfor thethe FutureFuture

THE ROOM PULSATED WITH frame machine, about 4 feet wide local VA hospital. The pharmacist ACTIVITY in every direction. At and 50 yards long. Approximately reviewing the prescription provides times, voices were barely audible 840 sleeves (cells) drop product appropriate medication-related pa- over the constant hums and whines onto conveyor belts that run below. tient education, and enters or veri- of machinery. Hundreds of tubs pro- The machine can process prescrip- fies the prescription data into the gressed on what seemed like miles of tion orders at the rate of 1,200 to system. If no problems are found, conveyor belts while robotic arms 1,400 per hour. Two smaller units the original prescription is filled and efficiently moved items from one have since been installed, and these dispensed to the patient. area to another. Flexpick machines now process Though it seemed space-aged, about 80 percent of the prescriptions this was not a tour of NASA—it filled. was VA’s own Consolidated Mail The Flexpick systems are bar Outpatient Pharmacy in code-driven. As a section of con- Leavenworth, Kan. Secretary veyor goes by a sleeve, the Flexpick Principi had taken National CMOP reads the bar code on the tub and Director Tim Stroup up on his offer drops the required product for that to familiarize him with what these zone. Each 8-foot section of con- facilities do and how they do it. veyor equals one patient order. The Consolidated Mail Outpa- Secretary Principi seemed most tient Pharmacies provide prescrip- impressed with the safety of the tion services by mail to VA patients. CMOP systems. Stroup described Though the methods are constantly some of the safety measures, includ- evolving, VA has been providing ing accountability software. “The ELAINE BUEHLER prescriptions by mail since the post- software tracks the product from the Dan Williams, a pharmacy technician at the Leavenworth World War II era. In fact, VA was time it comes in to the time it CMOP, scans a product bar code. the first national health care organi- leaves the building,” he explained. For patients who need to have zation to routinely provide this kind “We can track where any product is prescriptions filled on a routine or of service to its patients. at any given time.” ongoing basis for chronic medical “Even if a mistake is made,” conditions, medications can be A High-Tech Workhorse Boneberg added, “the bar code sys- marked for refill dispensing by the Installation of a new workhorse tem prevents the machines from fill- CMOPs. The local facility main- began at the Leavenworth CMOP ing the mistake.” tains control over what is sent to in October 2001—a Flexpick Their record speaks for itself— the CMOP and what is to be dis- adopted from the cosmetics industry. the CMOPs have the lowest pre- pensed. Ron Boneberg, director of the scription error rates in the VA sys- Leavenworth CMOP, explained that tem. They even have machines that Evolution of the CMOP the volume of the work was the do the labeling and capping, and ro- In the old days, prescription main attraction for this piece of botic arms that move completed mail services were handled using equipment. bottles into sorters for processing. manual processing systems directly “The machine was spitting out Each CMOP effectively serves from the VA hospitals. The function cosmetics orders at an amazing rate, patient care needs by functioning as was typically carried out by pharma- and the products (nail polish, per- a transparent extension to the VA cists who could perform this service fumes, makeup) were roughly the hospitals’ outpatient pharmacy dis- at rates ranging from 8,000 to same size as a large number of the pensing programs. After a patient 18,000 prescriptions per full-time prepackaged drug products,” has been seen by a VA physician, employee per year. Studies indi- Boneberg said. the patient prescription data is en- cated, however, that a centralized The Flexpick is an immense A- tered into a computer system at the system offered tremendous benefits,

12 November/December 2002 VAnguard feature including lower costs and improved of prescriptions processed to more packages far into the postal system, operational efficiencies. than 20,000 per employee. resulting in faster, lower-cost deliver- Centralized mail pharmacy sys- That was just the beginning. ies. All seven CMOPs are now using tems began in VA in the ’70s and The CMOP program began a com- this contract, reducing costs even ’80s at district and regional levels. parison of other mass mailing indus- further. These initiatives were based prima- tries, and adopted many of their Before Sept. 11, most of the rily on sharing agreements between ideas. Installation of the first auto- mail was transported by airplane. interested local VA facilities. The mated equipment at the When all flights were grounded, RR potential benefits, such as lower Leavenworth CMOP began in Au- Donnelly simply shifted transporta- costs resulting from improved opera- gust 1993, and the first automated tion to its trucks, moving the prod- tional efficiencies and volume pur- prescriptions were mailed from the uct to the post office responsible for chasing power, were readily appar- CMOP on Jan. 4, 1994. delivery. ent. More automated systems have This transportation flexibility Recognizing the potential, VA been added over the years, enhanc- proved vital again during the an- formed a task force in the late 1980s ing the program with each new ad- thrax scare. Since the CMOPs could to review the processes and options. dition. By March 1995, the get prescriptions so deep into the To maximize efficiencies, it was pro- Leavenworth CMOP’s annual postal system, in many cases deliver- posed that CMOPs operate as inde- workload had grown to 3.5 million ing to the appropriate post office pendent entities from the facility prescriptions with a staff of 80. By and bypassing the postal processing pharmacies at the VA hospitals. The 1999, 51 percent of all VA prescrip- centers, the potential for contami- primary function would be to pro- tions were being processed by nation by anthrax was dramatically vide refill prescription dispensing CMOPs (40.3 million of the 78 mil- lessened. services by mail. lion prescriptions). Leavenworth was the first site of Before the CMOP program was The Value of CMOPs a number of CMOPs to be strategi- implemented, it was not uncommon The value of the Leavenworth cally located across the country. The for patients to wait two weeks or CMOP, and the six others across the pilot program began in 1988 with more to receive their prescriptions country, seems self-evident. CMOPs the Leavenworth CMOP dispensing by mail. Through electronic transfer now fill about 70 percent of the refill prescriptions for VA hospitals of information, and the consolidated more than 104 million prescriptions in Leavenworth and Topeka, adding processing power of the CMOPs, pa- filled by VA. More than 70 million Kansas City later. Although the pro- tients now typically receive their prescriptions valued at $1.8 billion cessing systems were still manual, medications in three to five days vir- were filled by VA’s mail-out pharma- productivity improvements were tually anywhere in the continental cies during fiscal year 2002. Com- evident, raising the average number United States. bining volume-purchasing ability And once the prescription dis- with automation, CMOPs saved VA pensing process for a patient’s order more that $70 million last year is completed at the CMOP, elec- alone. tronic data verifying the dispensing The improvements are stagger- activity is sent back to the local VA ing. The Leavenworth CMOP alone hospital to update their patient filled about 45,000 prescriptions per records. day in fiscal year 2002, totaling more than 12.4 million for the year Uninterrupted Service (an increase of 1.8 million from fiscal year 2001). Prescriptions are The terrorist attacks of Sept. 11 now being processed at rates of last year didn’t disrupt the CMOPs. 50,000 to 100,000 per employee per Although airline transportation had year. been brought to a standstill, VA Interest in the CMOP program mail prescriptions were still deliv- also continues to grow. Pharmacy gi- ered to their destinations. ant Merck Medco has benchmarked The CMOPs have a contract off the VA CMOP program, and ELAINE BUEHLER with consolidator RR Donnelly, the partnerships are being explored with Robotic arms like this one efficiently move items from Postal Service’s largest partner. RR one place to another at the Leavenworth CMOP. Donnelly is equipped to deliver Continued on page 15

November/December 2002 13 feature VAnguard The Therapy of Self-Expression Fifty Years of Veterans’ Voices

featured in the three annual editions of Veterans’ Voices differ, but each selection represents the unique experience of one veteran. They also high- light the efforts of VA employees and volunteers who organize writing groups and transcribe, edit and submit stories for veterans. Nesmith wrote his story while participating in a writing group started by Max Greenwald, former team leader at the Riverside, Calif., Vet Center. The vet center has since moved to Corona, Calif., and Greenwald transferred to the Los Angeles VA Regional Office, but the writing group continues under the guidance of Kristine Wegman, a ROBERT PEDERSEN Veteran Harlan Hall, a participant in the Corona, Calif., Vet Center’s writing group, dis- social worker. cusses his writing with Kristine Wegman, a social worker who leads the group. Nesmith cannot speak highly enough of VA employees who facili- Vietnam veteran Chuck Nesmith floodgate opened,” said Nesmith, tate writing groups. “It takes a spe- felt the throbbing of his heart as he describing what happened when he cial kind of person to take people crouched in the sweltering heat of a began writing about his experiences who have been damaged and walk Southeast Asian afternoon. He was in Vietnam. Now he writes because them out of the woods,” he said. playing the waiting game—waiting he has to. Van Garner served in the Air for the Viet Cong soldier hiding Chuck Nesmith not only writes Force during the Korean War, but by across from him to make the first about his experiences, he also shares 1961 was hospitalized in the move and give away his position. them with the world. His award- Murfreesboro, Tenn., VA Medical Both predator and prey, each winning story, “The Waiting Game,” Center suffering from mental illness. man knew the other represented a is featured in the Summer 2002 edi- During the first part of his two-year modern-day grim reaper; his hood a tion of Veterans’ Voices. hospitalization, he reported being in helmet, his scythe a rifle. Shots A publication comprised of a haze. He was unaware of his sur- shattered the silence. Nesmith pieces written by participants in the roundings, lost in his own thoughts. shielded his face from shrapnel, Hospitalized Veterans Writing His journey back to mental while his opponent suffered direct Project, Veterans’ Voices celebrates health began with the Hospitalized hits. its 50th anniversary this year. The Veterans Writing Project. He started That afternoon in Vietnam, magazine has provided a forum for putting his thoughts on paper, and Nesmith won the waiting game, but veterans to publish their memoirs, was motivated to continue and im- began to carry the guilt of his sur- fiction, poetry and prose for the past prove his writing by the reward of vival in the midst of death. He five decades. having his work included in Veter- would not speak of the guilt for 20 Some veterans write of recover- ans’ Voices. “It feels like you’re doing years. ing from the physical and mental something important and that other For veterans like Nesmith who wounds of combat. Others extol the people might like,” he said. have difficulty talking about their beauty of foreign lands they saw and Garner has contributed count- wartime experiences, writing allows the pride they experienced while less articles to Veterans’ Voice, many them to express feelings that have serving their country in uniform. of which explicitly deal with the been bottled up for years. “The The topics and styles of the pieces Continued on page 15

14 November/December 2002 VAnguard feature

Intervention continued from page 7 for family members of stage,” said Boneberg. “CMOP servicemembers who die on active workload is growing at an average “An important part of this pro- duty. rate of 20 percent per year, and the gram is that if we can make some Since August, surviving spouses potential to double that over the progress here, then we can make a or dependent children of an in-ser- next five years would be a reason- seamless hand-off of the claims vice casualty no longer have to fill able assumption.” folder, the VRE evaluation and the out lengthy, cumbersome forms. rehabilitation plan to counselors Working with DoD, the Veterans By Elaine Buehler wherever the servicemember goes af- Benefits Administration has stream- ter separation,” says Steier. “And lined the claims process by using a that’s important, because if they DIC Worksheet combined with have this structure—and the DoD’s Report of Casualty form to Voices continued from page 14 smoother we can make their transi- process each in-service death DIC healing power of writing. His piece tion—the better it is for the veter- claim within 48 hours of receipt. in the Summer 2002 issue, “Can ans.” Survivors’ and dependents’ edu- Writing Help Us?” addresses Steier sums it up this way: “VA’s cation assistance, GI Bill refunds, writing’s curative aspect, urging oth- motto is to ‘care for him who shall Servicemembers Group Life Insur- ers to put their feelings down on pa- have borne the battle’ and one of ance and loan guaranty benefits are per. He depends on Mary Ann the four primary goals in VA’s Stra- also being handled on an expedited Aquadro, chief of recreation therapy tegic Plan is to ensure a smooth basis for family members of at the Murfreesboro VAMC, to sub- transition for veterans from active servicemembers who die while on mit his stories. military service to civilian life. I can active duty. Without the support of VA em- think of nothing truer to VA’s mis- “The overall mission of transi- ployees and volunteers who submit sion than doing whatever it takes to tion services delivery becomes even the stories, veterans could not have help these severely battle-wounded more important as America’s attack them included in the publication. soldiers come to grips with their on terrorism continues,” says Robert “I’m happy to do whatever I can,” situation and begin preparing for J. Epley, VBA’s Associate Deputy said Aquadro, explaining that it their post-military lives.” Under Secretary for Policy and Pro- makes Garner so happy. Injured active-duty military gram Management. “We are proud Hospitalized Veterans Writing members transitioning to civilian of what we are doing and what we Project President Ann Ogden cred- life aren’t the only ones benefiting have accomplished to assist ited volunteers with the success that from expedited service in the wake servicemembers and their families HVWP and Veterans’ Voices has ex- of the nation’s war on terrorism. So involved in Operation Enduring perienced throughout the last five are the families of servicemembers Freedom.” decades. who die on active duty. “The ones who make the real Last October, VAnguard re- contribution are those who work in ported on the Joint Service Survi- By Willie Alexander the hospitals … encouraging the vors Assistance Center set up near writing and typing it, and seeing the Pentagon and staffed by person- CMOPs continued from page 13 that it is submitted,” she said. nel from the Department of De- Through publishing their sto- fense, VA and various relief agencies the Departments of Defense and ries, veterans get the pride of receiv- to assist families of those missing or Health and Human Services to po- ing public recognition for their best killed in the Sept. 11 attacks. For 15 tentially fill many of their outpa- work, and they help their readers, days, VA personnel at the assistance tient prescriptions. who may be experiencing some of center provided information about “CMOPs are an essential com- the same feelings. VA benefits and programs and ponent in the pharmacy manage- To submit stories for possible helped family members of ment system that has made VA a publication in Veterans’ Voices, write servicemembers killed in the attack model for our nation,” said Secretary the Hospitalized Veterans Writing complete applications for survivors’ Principi. “The exciting technology Project at: 5920 Nall, Room 105, benefits. we apply in our CMOPs, combined Mission, KS, 66202, or call (913) Acting on the lessons learned with on-site leadership, help VA 432-1214 for more information. during that experience, VA has control costs by dispensing pharma- streamlined the Dependents Indem- ceuticals effectively and efficiently.” nity Compensation claims process “They are still in their infancy By Andrea Strobel

November/December 2002 15 cover story VAnguard Waiting for Care Can access improvements really lead to reduced waiting times for appointments and better care at VA clinics? The Buffalo primary care team’s experience suggests they can

WHEN JOHN SANDERSON, link,” he says. “We saw right away team. Having both the clinical and M.D., PRIMARY CARE MEDI- that it could only mean better administrative primary care leaders CAL DIRECTOR for the VA things for the quality of services and participating worked well to drive Western New York Healthcare Sys- what we can do for patients. If we this initiative vigorously from the tem, attended the Institute for could see them when they needed to staff. They were supported by a pri- Healthcare Improvement’s Ad- be seen, by the person who knows mary care social worker assigned to vanced Clinic Access meetings in them best, in the most proper venue collect data a few hours a week. The 1999, he and his team at the Buffalo within our system, it would be a project then went to the front-line Primary Care Groups were already definite improvement.” treatment team for input on many familiar with making major changes For the Buffalo team, Advanced occasions prior to and during to improve the delivery of care. Clinic Access wasn’t just a matter of rollout. In the early ’90s, when the pri- reducing waiting times; it was a way mary care movement came along to further enhance care delivery. nationally, Buffalo replaced the old “Doing it for the patients was and system (“not a lot of emphasis on still is the overriding reason and ma- patient needs; not a lot of emphasis jor hook for most of my provider on continuity over time; and not a staff,” Sanderson explains. lot of emphasis on coordinating the The results of the work they un- whole package of services we could dertook following their first intro- deliver,” as Sanderson recalls it) duction to ACA shows the strong with functionally integrated care link between improved access and teams composed of physicians, greater continuity of care. In 1999, nurses, and an array of services like only 10 percent of patients who pharmacy, dietary, social work and were triaged as needing an urgent psychology. “We used the birth of care visit actually saw their own pro- primary care to do a lot of good vider; by 2002, that figure had in- things many of us had always creased to 80 percent. wanted to do,” Sanderson says. During the same time period, Yet the primary care movement the time to next available appoint- came up short in some ways. Wait- ment as reported on VHA’s waiting ing times for appointments were of- times database improved from 44.9 ten long, and the promise of conti- days in January 2000 to 21.1 days in nuity was difficult to keep if patients June 2002, while the number of en- couldn’t get in to see their own phy- rolled patients per provider almost sician when they needed to be seen. doubled. As he sat and listened to the ex- BARBARA J. SELLON planation of Advanced Clinic Ac- Getting Started Dr. John Sanderson, center, primary care medical di- cess, Sanderson soon recognized it as The first step for the Buffalo pri- rector for the VA Western New York Healthcare System, escorts veteran Ullin A. Henry to the reception area, an avenue to even better primary mary care team was to pull together where Earnestine Parker, medical support assistant, is care. “For me, it was the missing a core planning and implementation ready to check him out after his appointment.

16 November/December 2002 VAnguard cover story Each person had a decent grasp days. They then looked at provider sessment of patient needs, instead of of their role, and also understood schedules and matched supply to de- old habits. Sanderson admits that he how behavior changes on the part of mand, leaving space in their sched- had to start by changing his own be- other disciplines complemented ules for urgent care appointments havior. “Every patient who comes their own. Another key, according based on the data they had col- in, as they’re leaving, you take five to Sanderson, was “freeing people up lected. or 10 seconds to make your own as- not only to talk, but to act. Empow- sessment as to what the most suit- ering them—most love the heck out Extending of that.” Intervals for Return Visits “Doing it for the patients was Matching Supply and Early on, the team Demand saw that a large chunk and still is the overriding rea- The Buffalo primary care team of the demand was be- son and major hook for most undertook multiple changes at once. ing created not by the The first order of business was to patients, but by the of my provider staff. ” measure supply and demand, and providers’ own behav- match the two. They knew their ior. Providers were routinely sched- able follow-up interval should be. staffing supply, but didn’t know their uling patients for return visits in And you base that assessment, first demand, especially for urgent, same- three months, because that was how and foremost, on how sick they are. day care. it had always been done. Anyone who’s seriously ill should To track demand, they measured As Sanderson explains, those come back as often as it takes—ev- the number of calls for same-day three-month visits added up: “If I ery day or two if necessary.” care, the number of patients they had 1,000 patients and saw them all Sanderson admits he shared the were able to see on the same day, four times a year, then I’d need VA mindset that most of his pa- and the number of patients they had 4,000 visits. But if I had the same tients were old and sick and needed to deflect to the emergency room or number of patients and saw them to be seen frequently. As time went walk-in clinic—all on a provider- twice a year, then I’d only need on, however, he came to realize that specific basis. 2,000 visits to do the same work. So a large number of his patients had They quickly discovered that in effect, we were creating our own chronic diseases and didn’t need to demand for urgent care was consis- return demand.” be seen that often. tently higher on certain days of the The change? Simple: schedule “If people are doing accurate week, particularly Mondays and Fri- return visits based on a careful as- home monitoring of illness, such as blood sugars and blood pressures, and they’re able to recognize What is the Advanced Clinic Access Initiative? changes in condition and convey that information by phone or an- VHA began a collaborative project with the Institute for Healthcare Improve- other means, we now feel very comment in July 1999 to reduce delays and wait times. Using best practices from fortable about spreading them out the private sector, 132 teams from each of the 21 Veterans Integrated Service further into the future,” he explains, Networks began piloting an Advanced Clinic Access Initiative in November “particularly when you know they 1999. are reliable and will call you if some- Within six months, the median wait for an appointment for both primary thing goes wrong.” and specialty care clinics decreased from 48 to 22 days. This collaborative project, scheduled to end in December, continues to spread ACA practices Alternative Visits across the country. Before Advanced Clinic Access, VHA’s goal is to build an advanced access system that can achieve and most Buffalo primary care patients sustain access levels and patient flow times that meet or exceed the current ended up with a face-to-face pro- VHA performance standards in six clinics—audiology, cardiology, ophthalmol- vider visit. Today, triage nurses as- ogy, orthopedics, primary care, and urology. The current standards are: new sess the clinical needs that arise be- patient appointments within 30 days; appointments with a specialist within 30 tween appointments and choose the days of referral; and patients see providers within 20 minutes of their sched- most appropriate response. Some pa- uled appointment. tients can be seen by the nurse or Continued on page 18

November/December 2002 17 cover story VAnguard

Continued from page 17 even treated over the phone. Nurse clinic visits are also used for such things as blood pressure checks, blood glu- cose checks, minor irrigation and immunizations. Clerks and nurses can link patients directly with dietary, psychology, social work and even pharmacy. Support staff is encouraged to contact providers for a hallway consult or telephone advice if they’re unsure how to handle a particular situation. Some providers also hold formal telephone clinics for routine follow-up of certain patients whose conditions do not require direct observation. The key is effective internal communi- cation, a prerequisite for any team trying to respond, on any given day and at any time, in a way that is best suited to the patient’s needs.

Adjusting to Change These changes weren’t easy for all providers. At first, some were nervous about extending intervals for return visits. One provider, for example, wanted to be able to sit down and discuss lab results with his patients. “What you do,” Sanderson explains, “is just say, well, not only is it possible for you to do that by phone without rebooking the patient, but 90 percent of your peers down the hall do it that way and do it very effectively.” As providers looked around and saw the success others were having extending return visit intervals, it made it BARBARA J. SELLON easier for them to change their own behavior. Members of the Buffalo primary care team Vivian Hokes, L.P.N., Staff satisfaction is quite high and turnover low in John Sanderson, M.D., and Chetana Shastri, M.D., review an electronic medical record to determine the patient’s treatment options. Buffalo primary care. “The nurses like it because they feel even more invested in a given patient’s care and shackled and unable to deliver. But this is a system outcome of that care,” according to Sanderson. “In the where people are free to do what they’re trained to do old culture, a lot of people had a lot to offer, but were and what they really got into health care for. Compared

What Else is Being Done to Reduce Waiting Times?

The number of veterans enrolling in the VA health care sys- jected to enroll for VA health care in 2003. Besides the Ad- tem continues to grow at unprecedented rates. This unan- vanced Clinic Access initiative, VA has been taking a num- ticipated explosion in growth began after Congress made ber of other actions to tackle the problem, including: every veteran eligible for VA health care in 1996. Since ■ convening a task force to implement national strate- then, the number of veterans VA treats has almost gies to reduce the backlog; doubled. ■ asking Veterans Integrated Service Networks to In the past year, the number of veterans receiving identify local actions to eliminate the backlog; health care from VA increased by 30,000 veterans per ■ starting a nationwide system to track patients on month. Currently, about 265,000 veterans are waiting for wait lists; health care appointments. More than 164,000 new enrollees ■ developing clear, concise national policy documents are waiting for their first clinic appointment to be scheduled, that identify the process each VISN will follow to enroll pa- and another 100,000 veterans are facing a wait of six months tients for clinical care and when to put patients on a waiting or more for follow-up or specialized care. list; and VA’s goal is to eliminate this health care backlog within ■ asking the Office of Personnel Management for per- six months, but the increased demand for appointments is mission to re-hire retired health care personnel for up to a expected to continue. Another 600,000 veterans are pro- year without a reduction in their retirement benefits.

18 November/December 2002 18 November/December 2002 VAnguard cover story Severely Disabled Vets Get Priority Access New policy means no more waiting for some veterans

The wait is over for veterans with roll for VA health care. service-connected disabilities rated At four clinics he was turned 50 percent or more. They now have away. They were over capacity and priority access to VA health care could not care for him. At one thanks to a new regulation signed by clinic, he was told he’d have to go Secretary Principi. to a hospital more than 200 miles “It is unacceptable to keep vet- away to get care. At another, a clerk erans with service-connected medi- told him he was sorry, but all veter- cal problems waiting for care,” said ans were created equal and he would Principi. “These veterans are the have to wait just like everyone else. very reason we exist, and everything But he wasn’t like everyone we do should focus first on their else. He was wounded in combat ROBERT TURTIL needs.” and has spent more than half his life Veterans have been coming to VA for health care in The new regulation took effect in a wheelchair. Should he have to record numbers since the system was opened to all eli- Oct. 1, 2002. It was brought on by wait like everyone else? The Secre- gible veterans who enrolled, jeopardizing VA’s ability to the increase in VA health care en- tary didn’t think so. He asked the care for those who needed it most. rollment, which has led to longer Office of General Counsel to draft waiting times. new regulations. He wanted severely that he or she is no different than Frustrated that disabled veterans disabled veterans to have priority any other veteran,” the Secretary were waiting months for care, Secre- access for hospitalization and outpa- said. The new regulations, outlined tary Principi ordered a covert opera- tient care for both service-con- in VHA Directive 2002-057, were tion. He sent one of VA’s assistant nected and non-service-connected distributed to VA medical facilities secretaries, a 100-percent service- treatment. on Sept. 26. disabled veteran, to eight different “Never again on my watch will The new regulation is being VA clinics. His mission—try to en- a combat-disabled veteran be told implemented in two phases. The first phase provides veterans with service-connected disabilities rated Continued from page 18 50 percent or more with priority treatment for service or non-service- tives to face-to-face visits, and be to the old days when we weren’t connected conditions. In the second ready to have reappointment inter- able to see our people when they got phase, which will be implemented vals extended. Be ready to see other sick because of crammed schedules, next year, VA will provide priority team members and not just your we now have opportunities and access to other service-connected doctor if your need so dictates.” openings built in to see patients on veterans for their service-connected Handouts reinforce the message: the day they need to be seen.” conditions. We’re changing, always trying to Patients, too, had to adjust to The VA mission is traced to the make care better for you. But the new system. At first, some didn’t Civil War. President Lincoln made a change does entail a new experience understand why they were coming commitment to care for wounded for you. Sanderson observes that, back in six months instead of three. soldiers and the families of those with his own patients, the “moment In addition to face-to-face education killed on the battlefield. A 1996 law of truth” was the first time they of patients by clerks, nurses, and ev- opened VA health care to all eli- called in with an urgent need and eryone else on the care team, Buf- gible veterans who enrolled. were told, yes, they could come in at falo primary care now includes an They came in record numbers, 2:00 that afternoon. “Once that orientation to Advanced Clinic Ac- jeopardizing VA’s ability to care for happened,” he says, “you had a con- cess for all new patients. veterans who needed it most. This vert.” The message, Sanderson ex- new regulation allows VA to get plains, is “this is not the old way of back to its roots and give priority doing business anymore. If you’re By Jane Roessner, Ph.D. treatment to veterans who depend coming here, be ready for alterna- Institute for Healthcare Improvement on us for care.

November/December 2002 19 feature VAnguard VeteransVeterans 20th Anniversary of the Wall A Generation Comes of Age

Wayne Miller glanced to his left and right as he slowly nudged his wheelchair along the path at the Vietnam Veterans Memorial in Washington, D.C. Thousands of people were gathered there on Veterans Day to mark the 20th anniversary of the Wall. But Miller wasn’t looking for Marines he served with in Vietnam. He was looking for signs of anguish and pain. “You can usually tell because they’ll be standing off by themselves,” said Miller, team leader at the Silver Spring, Md., Vet Center, as he navigated through the crowd. “If they’re with family then we know they’ve got support, but when they’re by themselves, that’s when we get concerned.” He extended his hand to a stocky man wearing a Marine Corps hat and offered a greeting heard throughout the day: “Welcome home, brother.” Miller was one of about 30 vet center counselors who spent Veterans Day weekend at the Wall helping those in need. “The main thing is being non-invasive ROBERT TURTIL and building trust,” he said. “We ask if they’re OK and In a scene repeated many times over the Veterans Day weekend, Wayne Miller, right, team leader at the Silver Spring, Md., Vet tell them about the vet center. We just want to let them Center, talks with a fellow Vietnam veteran. “Welcome home, know that we’re here if they want to talk.” brother,” was a common greeting. Continued on page 22

The heavy rains that soaked the Veterans Day ceremony at Arlington National Cemetery earlier in the day had slacked off by the time the annual ceremony at the Wall got under- way at 1:00 p.m. Thousands braved ROBERT TURTIL the elements to be Some 30 vet center counselors stationed themselves at the Wall a part of it. over Veterans Day weekend to offer their support to veterans gathered there for the 20th anniversary of the memorial.

ROBERT TURTIL 20 November/December 2002 VAnguard feature DayDay 20022002

EMERSON SANDERS

On a Veterans Day that found Americans bracing for the possibility of war, about 2,000 braved a steady rain to attend the annual Veterans Day ceremony at Arlington Na- tional Cemetery. President Bush addressed the crowd in the amphitheater, above, during a ceremony hosted this year by the Blinded Veterans of America, left. EMERSON SANDERS

A Musical Tribute to Vietnam Veterans

Two Iron Mountain, Mich., VA Medical Center employees took part in a musical tribute at the Lincoln Memorial in Washington, D.C., on Nov. 6, to commemorate the 20th anniversary of the Vietnam Veterans Memorial. Fran Rosenburg, administrative officer of the day at the medical center, and Neale Emerson, a respiratory therapist, were part of a line-up that included Paul Revere and the Raiders, Irish tenor John McDermott, and Scott VIETNAM VETERANS MEMORIAL FUND PHOTO McKenzie, who hit it big in 1967 by urging Americans to go to San Fran- Neale Emerson, a respiratory therapist at the Iron Moun- tain, Mich., VA Medical Center, performs on the steps of cisco, where they’d find lots of gentle people with flowers in their hair. the Lincoln Memorial during the musical tribute to Viet- nam veterans on Nov. 6. Continued on page 22

“Veterans do not take life for granted. They know that duty and sacrifice are more than words. And they love America deeply, because they know the cost of freedom, and they know the names and faces of men and women who paid for it. …Free nations are in debt to the long, distinguished line of American veterans, and all Americans owe our veterans our liberty.” President George W. Bush November/December 2002 21 feature VAnguard

Wall continued from page 20 The 20th Anniversary observance included the “Reading of the Names” ceremony. About 2,000 volun- A visit to the Wall can evoke many emotions—the teers recited all of the 58,229 names inscribed on the pain of loss, the guilt of survival, or the anger of being memorial—a roll call of the fallen. Secretary Principi spurned. Seldom is this more evident than on Veterans read the first ten names, starting a process that took 65 Day. hours over four days. Visitors brought flowers, photographs, letters and Arto S. Woods, an associate manager in VA’s Read- other personal items as a tribute to the fallen. “Dear justment Counseling Service Regional Office in Balti- Dad, it’s Veterans Day eve and I’m here in Washington, more, spent the weekend at the Wall reaching out to D.C., for the first time,” began one letter. “I can feel those in need. He was there when the Wall was dedi- your presence.” cated in 1982 and again at the 10th anniversary in 1992. A few feet away, Neil McKenna, a therapist from The combat-wounded Marine Corps veteran has the Brockton, Mass., Vet Center, kept his finger on the seen some changes over the years. “In ’82 there was lots emotional pulse of the crowd. “It’s been real intense,” he of denial of the losses of friends, and also survivor guilt,” said. “It’s almost overwhelming to be a part of this.” he said. “Now veterans are more accepting of their fates. They came from across the country to mark the Even though the psychological wars are not over for Wall’s 20th anniversary. Cecilia F. Graff, a social worker many, I think some finally found closure.” at the Dayton, Ohio, VA Medical Center, thought it’d Philip Hamme, regional manager in the Baltimore be therapeutic for some of the hospital’s Vietnam veter- office, offered his own insight. “I think a generation has ans to visit the memorial. really come of age.” She mentioned it to Dr. Arthur Aaronson, a clinical psychologist, and he agreed. Together with Greg Meriwether, team leader at the Dayton Vet Center, they By Matt Bristol raised enough money to bring 26 veterans to the observance. It was the first visit for many. “Going up to the Tribute continued from page 21 Wall and finding the names of their fallen comrades ... I Emerson performed “Can You Hear the Wall Whis- think a lot of them found healing,” said Meriwether. per?,” a poem Rosenburg wrote after visiting the “Mov- As the ceremony came to a close, some of the vet- ing Wall” in Kingsford, Michigan. (Listen, Sshh … Lis- erans from Dayton split away from the group and sat ten. Do you hear it? Do you hear the Wall whisper?) down on nearby park benches. One first-time visitor was The “Moving Wall” is a half-scale replica of the so overcome that he couldn’t speak. memorial in Washington, D.C. It was developed in Others shook their heads in disbelief as they de- 1984 so those who couldn’t make it to the nation’s capi- scribed meeting President George W. Bush earlier in the tal could still have an opportunity to view a replica of day when he made an unannounced visit to the Wall. the memorial that has brought healing to so many. (The “The President shook my hand and thanked me for war is over, The Blood is shed. Now it is time. We honor serving in ’Nam,” said one veteran. our dead.) Aaronson didn’t overlook the impact of their en- “The entire poem is listening to the Wall in silence counter with the President. “They’ve always felt forgot- for those who did not come back from the war,” ten and here the President comes up and thanks them. Rosenburg said. She took the poem to Emerson, who It did a lot to help them feel like what they did in Viet- has been singing and composing since 1968. nam was important,” he said. He put the words to music and recorded it on a About 50 veterans from Arizona visited the Wall compact disk. “The catalyst for the song is the fact that as part of Operation Freedom Bird, sponsored by South- the Wall won’t go away. It continues to be there and we west Airlines. Vietnam veterans Bob Digirolamo, home- can’t ignore it,” Rosenburg said. less coordinator at the Phoenix VA Medical Center, They submitted the CD to the Vietnam Veterans and Don McKisson, vice president of the Freedom Bird Memorial Fund and were selected to perform at the Lin- Foundation, were with the group. coln Memorial as part of the Wall’s 20th anniversary ob- McKisson, a former Marine Corps corpsman and re- servance. (50,000 plus are honored here. Where our great- tired VA nurse, said about 700 veterans have visited the est gift is a touch and a tear.) Wall since the operation began in 1987. “Most come Standing at his keyboard on the steps of the Lin- away with a renewed sense of purpose,” he said. “It’s re- coln Memorial, Emerson softly encouraged the crowd to ally a unique experience. The Wall is mystical. When experience the Wall’s healing power. (To walk the Wall. you look at it, you’ll find whatever it is you’re looking And say Good-Bye. Cherish the memories, take time to for.” cry.)

22 November/December 2002 VAnguard e-learning

Title 38 Course for HR Specialists Debuts on the Web VA human resources man- tals of Title 38 Personnel team that manages the day- problems with Mark agement specialists are log- Management,” which in- to-day HR functions. McBride, HR director, and ging on to a new Web-based cludes two courses on history Novice HR specialists his staff of HR specialists. Title 38 Personnel Manage- and background, and key at- are introduced to the funda- A planning committee ment Development Series tributes of the Title 38 Per- mentals of the Title 38 Per- made up of staff from the curriculum. Launched on sonnel System. Courses on sonnel Management System Office of Human Resources Oct. 9, this curriculum is ac- staffing, pay, employee rela- as they study alongside Chris Management and Employee cessible on the Internet at tions, work life, labor rela- Poplar, a virtual HR intern. Education System collabo- http://208.34.95.200/T38 tions and staffing adjust- Participants learn along with rated with a team of HR and on the Intranet through ments will soon be available. Chris how to research rules, subject-matter experts from the Office of Human Re- This Web-based curricu- regulations and VA policies. the Office of Human Re- sources Management Web lum is a departure from the They assume Chris’s role to sources Management, VHA site at vaww.va.gov/ohrm and traditional e-learning experi- complete a number of activi- Management Support and the Employee Education Sys- ence in that it uses a sce- ties that demonstrate what VA medical centers in Biloxi, tem Web site at nario-based learning ap- they’ve learned. Miss., Denver, Memphis, vaww.ees.aac.va.gov/t38. proach to make the learning More experienced HR Tenn., and West Los Angeles The curriculum offers a experience as realistic as pos- specialists study and are to develop courses for the series of courses designed to sible. Course designers cre- mentored by Central City curriculum. help HRM specialists de- ated a scenario featuring a VAMC Senior HR Specialists Their goal is to ensure velop and enhance their virtual medical center, Cen- Brian Lighthorse, Alan Bills, the continued viability of the knowledge of the complex tral City VA Medical Center, Larry Chung and Mary Alan Title 38 system. Retirements Title 38 system. which mirrors the work envi- Blake as they focus on skills and turnovers have cost VA The first curriculum in ronment of a VA medical development. Senior HR much of its expertise in this the series is “The Fundamen- center and the executive specialists solve advanced area. The initiative is designed to train and support Learning Catalog Passes One Million Hit Mark career development for VA’s experienced HR specialists, The VA Learning Catalog is tion System. “That is impor- learning. We’ve recently as well as provide new hires changing the way employees tant to meet all employee added 993 courses offered the training they need to do get information about educa- training needs in a large, per- through VA Learning their jobs. tional opportunities, prod- formance and customer ser- Online. These are very popu- “I’ve been waiting for ucts, satellite broadcasts, and vice-oriented organization lar commercial courses of- this for years,” said Sandra online learning available to like VA.” fered to all VA staff through Willoughby, HRM officer at them. From January to Sep- Of the more than 1,700 an Internet connection.” the Cheyenne, Wyo., tember, the online catalog offerings in the catalog, some New offerings for 2003 VAMC, after logging on to had more than 1.3 million 500 have been developed in include satellite broadcasts the Web-based curriculum. hits. coordination with VA clients from Training Systems Net- “Seems like the most cost-ef- by the Employee work covering professional fective and far-reaching way Education System. development, leadership, su- to be sure the VA HR com- You will find edu- pervisory, and business skills munity is well trained.” cational opportuni- training that have been Course developers hope ties and products added to the VA Knowledge this Web curriculum will entered by the Vet- Network schedule. To find eventually serve as an anchor erans Benefits Ad- these broadcasts, type TSN for a blended learning experi- ministration, the in the search box on the VA ence incorporating face-to- Office of Public Learning Catalog. face, satellite, and other Affairs, the Office Visit the VA Learning learning opportunities on of General Coun- Catalog at Title 38 personnel manage- sel, and the Office vaww.sites.lrn.va.gov/ ment. “The catalog is being of Human Resources Man- VACatalog/. For information For more information visited by VA staff 24 hours a agement. on how to add nationally on the Title 38 Web-based day, seven days a week,” said “Courses are being available products or pro- curriculum, contact Melissa McCanna, VA learn- added to the catalog daily,” grams from your VA staff of- Marianne Gray at (202) 273- ing resource group coordina- McCanna said. “This is a fice, contact McCanna at 9759 or by e-mail at tor for the Employee Educa- one-stop shop for all VA [email protected]. [email protected].

November/December 2002 23 @work VAnguard

Fifteen Senior Executives Win Presidential Rank Awards Three VA leaders received Another twelve VA ca- Tenn.; Kenneth H. rector of the Distinguished Executive reer senior executives were Mizrach, director of Houston VA Awards in the 2002 Presiden- honored in the Meritorious the VA New Jersey Regional Of- tial Rank Executives category. Health Care System; fice; Julius Awards pro- Only 5 percent of ca- Michael E. M. Williams gram. It’s an reer senior executives Moreland, director of Jr., director honor be- are chosen for this the VA Pittsburgh of VBA’s Vo- stowed on honor. Healthcare System; cational Re- only 1 per- They are: James Jimmy A. Norris, habilitation cent of ca- B. Donahoe, director VHA’s chief finance and Em- McKlem reer senior of VHA’s Canteen officer; ployment executives in Service; Y.C. Service; and Timothy B. Wil- the entire John J. Parris, director liams, chief executive officer federal gov- Donnellan of the Bir- of the VA Puget Sound Batres ernment. Jr., director mingham, Health Care System. They are: Alfonso R. of the VA New Ala., VA Chosen through a rigor- Batres, director of VHA’s Re- York Harbor Medical Cen- ous selection process, Presi- adjustment Counseling Ser- Health Care Sys- ter; George T. dential Rank Award winners vice; D. Mark Catlett, princi- tem; George H. Patterson, ex- are nominated by their pal deputy assistant secretary Gray, director of ecutive direc- agency heads, evaluated by for management in VA Cen- the VA Central tor/chief oper- boards of private citizens, tral Office; and Patricia A. Arkansas Health Catlett ating officer of and approved by the Presi- McKlem, director of the Care System; Tho- the National dent. The evaluation criteria Prescott, Ariz., VA Medical mas R. Jensen, VBA’s South- Acquisition Center in Hines, focus on leadership and re- Center. ern Area director, Nashville, Ill.; Thomas R. Wagner, di- sults. A total of 348 career senior executives received Sixteen Picked for SES Development Program Presidential Rank Awards this year. About 6,100 federal Sixteen employees were se- shadowing, working with an cal Center; Lily Fetzer, Hous- employees are career mem- lected for VA’s Senior Execu- SES mentor and executive ton VA Regional Office; bers of the Senior Executive tive Service Candidate Devel- coach, creating an individual Willie Hensley, Office of Service. opment Program. They made development plan, and get- Human Resources Manage- it through a rigorous applica- ting at least 80 hours of ment, VA Central Office; Joy Shared Service tion, interview and selection training on five Executive W. Hunter, Veterans Health process that began in the lat- Core Qualifications that ap- Administration, VA Central Center Realigned ter part of 2001 and was af- ply to all SES positions. Office; Sonia Moreno, San fected by the Sept. 11 terror- These programs typically last Juan, Puerto Rico, VA Re- The name has changed, but ist attacks and the anthrax 12-18 months, depending on gional Office; the services available to VA scare. individual development. Steve L. Muro, National employees nationwide Nearly 300 employees They are open to GS-14s/15s Cemetery Administration, through the Shared Service applied for the program. or employees at equivalent Oakland, Calif.; Ricardo Center in Topeka, Kan., have Thirty-nine candidates were levels from within or outside Randle, Jackson, Miss., VA not. interviewed, and 16 of those the federal government. Regional Office; James R. Now called the Health were selected by the Secretary Employees selected to Sandman, Denver Distribu- Revenue Center, the former to participate. participate in VA’s program tion Center; Linda D. Smith, Shared Service Center has SES candidate develop- for 2003 are: Lou Ann Cleveland VA Medical Cen- been realigned from the Of- ment programs are competi- Atkins, West Palm Beach, ter; Rebecca Wiley, Augusta, fice of Human Resources tive programs designed to Fla., VA Medical Center; Ga., VA Medical Center; Management to VHA’s Busi- create a pool of qualified can- Ronald Bednarz, Veterans Suzanne C. Will, Regional ness Office. None of the didates for SES positions. Health Administration, VA Counsel, San Francisco; Sally center’s workers will lose Candidates participate in a Central Office; Ernesto D. Wallace, Office of Informa- their jobs from this move. variety of activities aimed at Castro, Office of Informa- tion Technology, VA Central Matt Kelly has been named preparing them for success in tion Technology, VA Central Office; and Keith Wilson, acting director of the center the SES, including develop- Office; Jeannette Diaz, San New Orleans VA Regional Employees can still ini- mental assignments, job Juan, Puerto Rico, VA Medi- Office. Continued on page 25

24 November/December 2002 VAnguard introducing

Toby Johnson

Toby Johnson will do what- to alcohol or drugs,” Johnson ever it takes to get his clients said. “I introduce them to motivated for life. Sometimes weight training and try to get that involves a couple of sets them addicted to weights. on the bench press. Once you get those endor- The 33-year-old phins going, it’s a natural kinesiotherapist and personal high and perfectly legal.” trainer is helping the Veter- Johnson leads by ex- ans Health Administration ample. His 6-foot-2-inch meet its core goal of building frame is sculpted into 220 healthy communities. He’s pounds of lean muscle. He doing it one veteran at a time sets strict guidelines and BOBBY POFF in the domiciliary at the Olin holds his clients responsible Toby Johnson works with veteran Kevin Eric Mosely. E. Teague Veterans’ Center, for putting in the effort. part of the Central Texas Vet- Some need a little motivat- 125 pounds. He submitted get some new equipment erans Health Care System. ing, others don’t. his before-and-after photos that would be more benefi- His clients are recover- John Davis, a 52-year- and measurements and was cial for the patients,” he said. ing from traumatic injury, old Vietnam veteran who lost named first runner-up in the He did, with help from depression or addiction. both hands in a natural gas inspiration category. Chief of Staff Dr. Valerie H. Some are trying to get back explosion, wanted to com- Though Johnson trained Van Wormer, Domiciliary on their feet after years on pete in a national bodybuild- him during the contest, he’s Administrator Jay S. Butala, the streets. Others are learning contest sponsored by Ex- reluctant to take any credit and his supervisor Barbara ing to adjust to prosthetic perimental Applied Science for helping Davis reach his Sanders. limbs or maneuvering a Corp. He had the drive, but goal. “John has a lot of guts Today, the health main- wheelchair. All live in the do- the injury to his hands made and determination,” he said. tenance program looks more miciliary. it impossible to do some of An Army veteran, like a mini health club, with He gets them started by the upper body exercises. Johnson joined VA after mirrors lining the walls and designing individual exercise Or so he thought. graduating from the Univer- veterans working out on the programs that emphasize Johnson fitted him with spe- sity of Southern Mississippi latest exercise equipment. their abilities. After setting cial-order hooks for in 1993. He did stints at the More than 100 veterans specific short-term goals, he weightlifting and adapted ex- VA hospital in Lyons, N.J., work out each day as part of and Rehabilitation Assistant ercises so he could work his and the nursing home in Johnson’s program. Others Barbara DeLacour provide a chest and back. Marlin, Texas, before taking have seen the results he gets steady dose of encourage- By the end of the 12- on the Temple assignment in and are waiting to join. ment as the veterans work week program, Davis had 1999. “I have a mission for the toward achieving them. gained 25 pounds of lean The first thing he no- future,” he said. “I want to “We get some folks in body mass, dropped his body ticed when he got there was get rid of the waiting list and here who are depressed or fat by 10 percent, and in- the need for some modern make this the best health trying to get over addictions creased his bench press by equipment. “We needed to club VA has to offer.”

Continued from page 24 tiate transactions such as cases, process transactions, Office work. The decision to 30 center staff members have health insurance or CFC en- and provide retirement infor- move the center under the been calling veterans to re- rollments, payroll deduc- mation. In fiscal year 2002, Business Office stemmed in mind them about their ap- tions, and updating personal they answered more than part from the need to cen- pointments and update their information through the cen- 240,000 calls and processed tralize some business office health insurance and billing ter. Use the Employee Self more than 350,000 transac- processes and accounts re- information. Preliminary re- Service application page at tions. ceivable work within VA. sults show this team’s efforts www.hrlinks.aac.va.gov, or Decisions are still being Through a pilot pro- are making a difference in call 1-800-414-5272. made about which HR and gram with the Medical Care the amount of money that is The center has about payroll functions will remain Cost Recovery Office for being collected from health 220 full-time employees who at the center, and what staff VISN 11 (Ann Arbor, Mich.) insurance companies and vet- answer calls, research benefits will be dedicated to Business that began last May, about erans.

November/December 2002 25 around headquarters VAnguard

Carey Quality Award Trophy Goes to Philly Insurance Center

community support and an veterans living in the Hawai- active volunteer network. ian Islands. Five different honor guard Several VA facilities re- squads, one for each week- ceived achievement awards day, perform full military for excelling in at least one honors for every veteran in- aspect of the Carey Award terred. criteria. Past achievement Honors in the Unified award winners have gone on Health Care and Benefits to excel in the program. category went to the Spark This year’s achievement M. Matsunaga VA Medical winners are the Riverside, and Regional Office Center Calif., National Cemetery; in Honolulu. Loma Linda, Calif., VA The center maintains Medical Center; Prescott, long-standing VA/DoD joint Ariz., VA Medical Center; EMERSON SANDERS ventures with Tripler Army and the White River Junc- Philadelphia VA Insurance Center Director Joseph McCann, far left, holds the Carey Trophy while Secretary Principi talks with Robert Medical Center that have led tion, Vt., VA Medical and Carey’s brother Leo, second from left, and widow Jean. to the formation of the Ha- Regional Office Center. waii Federal Healthcare Part- For more information Secretary Principi presented grams for veterans, members nership. By leveraging re- on the Carey Quality Award the top honor in the 2002 of the armed services, and sources with the Army hospi- process, contact Darine Prok Robert W. Carey Quality their reserve components. tal, the center has improved at (202) 273-6784 or Marty Award program to the Phila- For the second year in a service delivery to 130,000 Reiss at (202) 273-5131. delphia VA Insurance Center row, the Clinical Research during a Sept. 12 ceremony Pharmacy Coordinating in Washington, D.C. It’s the Center located in Albuquer- second time since the award’s que, N.M., swept the Carey inception in 1992 that Philly Award program’s Health Care received the Carey Trophy. category. “It really shows the qual- Dr. Mike R. Sather, di- ity of people we’ve got work- rector of the center, set the ing here,” said Grace Parker, quality improvement ball chief of Policy and Procedure rolling in the 1980s. Today, at the Insurance Center, who the center runs on communi- coordinated the Carey application and teamwork. cation. “Many of us knew Project managers meet Robert Carey and it’s an each Thursday in front of the honor to be recognized like Strategic Awareness Wall to this because we know that’s talk about upcoming activi- what Bob would have ties for the next three wanted.” months. “Everybody knows The Insurance Center what we’re doing and where won the Benefits Category in we’re going,” said Thelma the 2000 and 2001 Carey Salazar, assistant director for Award programs and capital- administrative operations. ized on past success to take The Fort Custer, Mich., this year’s top spot. “The National Cemetery won an feedback we received helped achievement award in last us focus on where we needed year’s Carey program and to go,” Parker said. made good on their promise About 420 people work to be back. They stepped it in the Insurance Center. up a notch to take the top They are responsible for spot in the National Cem- Amy Nicholson and Michael Chavez, both production controllers at managing all aspects of gov- etery category. the Clinical Research Pharmacy Coordinating Center in Albuquer- ernment life insurance pro- Fort Custer has strong que, N.M., flood fill blister cards.

26 November/December 2002 VAnguard around headquarters

Former POWs and Families Share Stories of Conquering Stress

While the former “It was clear that these POWs’ war experiences were veterans continue a pattern part of the discussion, their of minimizing their physical main focus was how they had complaints and often suffer adapted to stress and gone on in silence,” said Dr. Larry to become active contribu- Lehmann, VHA liaison to tors to their communities af- the Secretary’s advisory com- ter they got home. Their mittee, who provided infor- wives described the impact of mation to the group about their POW status, including benefits and services available the medical problems the to former POWs. Staff from men have experienced, on VAMCs and vet centers also family life. attended the program.

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

The Congressional Black Fla.), “The High Price of Caucus Veterans Braintrust Freedom” brought together presented a program featur- former POWs from World ing panels of African Ameri- War II, Korea and Vietnam, can former POWs and their including Robert Fletcher, a wives on Capitol Hill Sept. Korean War veteran who is a 13. Sponsored by Cong. member of the Secretary’s Sanford Bishop (D-Ga.) and Advisory Committee on Cong. Corrine Brown (D- Former POWs. EMERSON SANDERS Joyce Bounds, left, and Charlotte Beason, center, talk with the NCA’s Roger Rapp Retires translator for the Russian group. Longtime National Cemetery states establish, expand and VA Hosts Russian Nurses Administration leader Roger improve state veterans cem- Rapp retired on Oct. 3. He’d eteries. Forty Russian nurses visited Projects, introduced the visi- been During Rapp’s 20-year VA Central Office on Oct. tors to the VA Virtual Learn- Deputy career with NCA, 13 new 24 to learn how the nation’s ing Center (www.va.gov/vlc), Under national cemeteries opened, largest “nurse force” takes and encouraged them to reg- Secre- and VA is positioned to open care of U.S. veterans. ister with the site to receive tary for five more. Last year, NCA Speaking through a automatic e-mail notices of Opera- scored a 93 percent customer translator, Charlotte Beason, the latest lessons learned. tions satisfaction rating, the high- Ed.D., R.N., program direc- “They’re trying to advance since est achieved by any govern- tor in the Office of Nursing their nursing practice and March ment entity included on the Services, welcomed the group they are looking to VA for 2000. American Customer Satisfac- and discussed the leadership examples,” said Bounds. Rapp In that tion Index. role of nurses in VA. “Our “This is a way to share ideas position, he was in charge of Rapp began his VA ca- nurses are caregivers, but internationally.” operations and construction reer with the Veterans Health they are also leaders,” she In recent months, VA at VA’s 120 national cemeter- Administration in 1972. He said. She highlighted VA has hosted delegations from ies. joined NCA as director of nurse initiatives in research, many countries, including He was also responsible the Philadelphia area office clinical innovation, and ad- the Czech Republic, China, for the State Cemetery before moving to headquar- ministration. Jordan, Japan, Romania, Grants Program, which pro- ters in 1987 as director of Joyce Bounds, R.N., Russia, the United Kingdom vides federal grants to help field operations. VHA Office of Special and Vietnam.

November/December 2002 27 around headquarters VAnguard

Irish Tenor McDermott Speaks Out on His Veterans’ Advocacy

I sing really speaks to the vet- light of his career. He at- erans’ experience and I feel a tended the Veterans Day great deal of respect for the Breakfast at the White House men and women who put and ceremony at Arlington their lives on the line for the National Cemetery as a guest sake of their country.” of VA. His work as an advocate Later that day, he per- for homeless veterans is well formed the song, “The known. The Hope Wall,” written by Vietnam McDermott Day Program veteran Tim Murphy, at the Center at the New England annual commemoration cer- Shelter for Homeless Veter- emony at the Vietnam Veter- ans in Boston opened in ans Memorial. He earmarked 2000. Named for his mother, the royalties from his record- ROBERT TURTIL it’s the first of what he hopes ing of that song to support Deputy Secretary Dr. Leo S. Mackay Jr., looks on as John will be many program cen- homeless veterans. McDermott talks about his commitment to veterans’ causes. ters across the country to Last year, the Congres- help veterans make the tran- sional Medal of Honor Soci- VA Deputy Secretary Leo S. Scottish-born resident of sition from homelessness to ety presented McDermott Mackay Jr., Ph.D., joined Canada explored his personal self-sufficiency. In 1999, he their Bob Hope Award, given other VA officials, National commitment to American attended groundbreaking cer- to entertainers who distin- Press Club members and veterans’ issues. emonies in Washington, guish themselves through guests at a luncheon featur- “The veterans popula- D.C., for the McDermott outstanding service to or ing Irish tenor and veterans’ tion is virtually ignored out- House, a transitional housing positive portrayals of the advocate John McDermott in side of one day a year, but I cooperative for up to 40 U.S. military. Earlier that Washington, D.C., on Nov. hope that recent events will D.C. area veterans. year, he received the Chapel 6. In pre-Veterans Day re- change that,” McDermott McDermott considers of Four Chaplains’ Humani- marks at the Press Club, the said. “So much of the music Veterans Day 1999 a high- tarian Award. Entertainer Wayne Newton Honored for Service to Veterans

has devoted over many years Newton’s commitment to supporting the men and to America’s veterans dates to women who have served the Vietnam, where he did two nation in uniform.“We are tours with the USO. The en- grateful for all he has done to tertainer, who is chairman of honor our nation’s heroes,” the USO Celebrity Circle, said Principi. “I invited him has visited troops in the here to express the apprecia- Mediterranean, Persian Gulf, tion of all VA employees and and most recently, Afghani- to personally thank him for stan. his efforts.” While in VA headquar- The Secretary presented ters, Newton also met with Newton with a plaque that VA Deputy Secretary Dr. Leo read: “From a grateful nation S. Mackay Jr., toured the to a great patriot who has building, and spoke with VA

ROBERT TURTIL given a lifetime of service to employees about their service Wayne Newton greets Anita Major, a program assistant in the America’s veterans, from to the nation’s veterans. “I Office of Intergovernmental Affairs, during his visit to VACO. Look- Vietnam to Afghanistan. am humbled to be here ing on is Inez Proctor, a program analyst. Your heart for, and dedica- among those who have given tion to, those who have so much more than I have Las Vegas entertainer Wayne ceive an award from Secre- served our nation in uniform given,” he said. “What I have Newton stopped by VA Cen- tary Anthony J. Principi hon- exemplifies the very spirit of given pales, but what I gave tral Office on Sept. 17 to re- oring the time and effort he America.” was my best.”

28 November/December 2002 VAnguard medical advances

D.C. VA Hospital Ahead disinfect their hands, and it’s and water. The hand rubs common inflammatory skin of Latest Hand-Hygiene effective,” said Maureen aren’t always appropriate, disease. Recommendations Schultz, R.N., infection con- however, such as when hands The normal skin con- Guidelines released Oct. 25 trol coordinator. are visibly dirty. In these tained almost no antimicro- by the Centers for Disease Preventing the spread of cases, a thorough washing bial peptides, as these com- Control and Prevention tout- germs in the hospital is vital, with soap and warm water is pounds are made only as ing the advantages of alco- as patients may have weak- the only way to go. needed. The psoriatic skin hol-based gels or foams over ened immune systems mak- showed high levels, as is typi- hand washing (www.cdc.gov/ ing them vulnerable to infec- Lack of Natural ‘Antibi- cal for many inflammatory handhygiene/) came as no sur- tion. Studies show the main otics’ May Explain skin conditions. But the skin prise to the infection control way germs spread from pa- Dermatitis Infections with dermatitis contained team at the Washington, tient to patient is on the People with the most com- much lower levels, almost D.C., VA Medical Center. hands of health care provid- mon form of eczema are vul- like the normal skin. They’ve been using the ers. The CDC estimates as nerable to skin infections be- quick-drying hand rubs for many as 2 million patients cause they lack certain germ- Arkansas VA Endocri- the past couple of years. get an infection each year in killing peptides, according to nologist Makes HRT a study published in the Oct. Breakthrough 10 New England Journal of Scientists have identified a Medicine. The finding may synthetic estrogen-like com- lead to a new type of antimi- pound that reverses bone loss crobial cream based on the in mice without affecting the body’s own chemicals. reproductive system, as does “This may explain why conventional hormone re- people with atopic dermatitis placement therapy. The find- get infections,” said co-inves- ing, reported in the Oct. 25 tigator Richard Gallo, M.D., edition of Science, could lead Ph.D., a dermatologist with to new and safer therapies to the VA San Diego Healthcare prevent osteoporosis. System and the University of “We are developing a California, San Diego. Gallo, new class of pharmaceutical who in 1994 was the first to agents with the potential for discover antimicrobial pep- bone-building, sex-neutral tides in mammalian skin, hormone replacement worked on this study with therapy,” said lead investiga- investigators at the Denver- tor Stavros C. Manolagas, based National Jewish Medi- M.D., Ph.D., an endocri-

ANDREW WHITE cal and Research Center and nologist with the Central Ar- other sites. kansas Veterans Healthcare Maureen Schultz, R.N.,infection control coordinator at the Washing- ton, D.C., VAMC, uses a hand-disinfectant dispenser at the facility. When the skin is pen- System and the University of etrated by pathogens, white Arkansas for Medical Sci- They installed hand-dis- U.S. hospitals, and about blood cells attack the invader ences. infectant dispensers in all in- 90,000 die as a result. to prevent infection. How- The new study is the patient and outpatient clinic In its hand-hygiene re- ever, this immune response first time scientists have rooms in August 2000 as port, the CDC announced does not appear to happen demonstrated in animals how part of a two-year study. that alcohol-based hand rubs readily in atopic dermatitis synthetic hormones can build During that time, the kill more bacteria than soap patients, who often suffer re- bone without affecting repro- number of new cases of resis- and water and are more curring skin infections. ductive organs. Conventional tant staphylococcus aureus likely to be used by busy Atopic dermatitis is an hormone replacement decreased by 21 percent, and health care providers. Tradi- inherited disease usually ac- therapy with estrogen or the number of resistant en- tional hand washing takes companied by asthma and al- progestin has been shown to terococcus decreased by 43 time, a valuable commodity lergies. It is marked by red, increase the risk for breast percent. Both of these bacte- in a hectic emergency room. itchy, swollen skin. cancer and cardiovascular ria are associated with seri- The CDC estimates in an Researchers analyzed disease. The new compound, ous, hospital-acquired infec- eight-hour shift, an intensive skin samples from six healthy estren, is still years away tions. care nurse can save one hour adults, eight patients with from human testing but rep- “It’s a quick, easy way of time by using a hand rub atopic dermatitis, and 11 pa- resents a promising advance for health care workers to instead of washing with soap tients with psoriasis, another in hormone therapy.

November/December 2002 29 have you heard VAnguard

pital. The children seeking with patients; and set up arts Blind golfers TEE off care come from throughout and crafts booths. Molly Southern Nevada. For more Reynolds, public affairs of- information, contact David ficer at the Atlanta VAMC, Martinez, public affairs of- said it was a day the hospital A record turnout ficer, at (702) 636-3010. won’t soon forget. of 131 golfers participated in this year’s TEE Employees of Turner About 60 guests packed Tournament. Classic Movies, a division of the chapel at the McGuire Atlanta-based Turner Broad- VA Medical Center in Rich- cast Systems, Inc., volun- mond, Va., to celebrate the teered at the Atlanta VA marriage of a heart-trans- Medical Center as part of plant patient. The hospital Blind golfer Doug Mason shot 91 for 18 holes on his way Turner Volunteer Day, Sept. staff had a big role in prepar- to winning the 9th annual TEE Tournament for Blinded Vet- 14. They painted a mural in ing for the wedding. They erans. The golf tournament is open to legally blind veter- the dining room; planted decorated the chapel, pro- ans receiving VA visual impairment services. It gives them trees, shrubs and flowers in vided the cake, set up the re- an opportunity to develop new skills and strengthen their the rooftop garden of the ception area, and made sure self-esteem. nursing home; played bingo, the groom was properly at- More than 270 community volunteers helped make scrabble and other games tired in a tuxedo. the tournament possible. One of those, Mike Owen, VIST coordinator for the Iowa City VA Medical Center, received A new cemetery for Florida the Vonnie Gould TEE Volunteer Award for the effort he put into making the event a success. A record turnout of 131 golfers participated in the tournament. It is sponsored by the Iowa City VAMC and the Blinded Veterans Asso- ciation.

Two VA hospitals cel- part of the VA Salt Lake City ebrated 50th birthdays in Sep- Health Care System, which tember and October. The last year served nearly 30,000 East Orange Campus of the veterans in 300,000 visits. VA New Jersey Health Care System held a rededication The VA Southern Ne- ceremony on Oct. 8 to mark vada Healthcare System in th its 50 birthday. Secretary Las Vegas opens its doors GARY DALE Principi joined about 250 four times a year to care for Secretary Principi announces the newly acquired site for a na- people gathered for the cel- needy children through a tional cemetery in South Florida on Sept. 4 at the West Palm Beach VA Medical Center. ebration. VA New Jersey Di- partnership with Los Ange- rector Kenneth J. Mizrach les-based Zelzah Shriners A much-needed new cemetery is coming to South Florida. singled out nine employees Hospital. VA Las Vegas pro- On Sept. 4 Secretary Principi signed a sales contract for and recognized them for 35- vides office space, X-ray VA to purchase 313 acres in southern Palm Beach County plus years of service at the equipment, technicians, and hospital. The Salt Lake City other support to visiting doc- near Boca Raton. VA studies showed South Florida has a VA Medical Center turned tors from Shriners who large number of veterans not served by a national or state 50 on Sept. 4. Hundreds of spend the day providing free veterans cemetery. employees, veterans, volun- health care to needy kids. “It National Cemetery Administration officials evaluated teers and community mem- is a heartwarming scene to thirteen potential sites for the new cemetery. The final bers turned out to mark the see kids getting the invalu- site was chosen for its many positive characteristics, in- occasion. When it opened on able care and treatment they cluding a high capacity for casketed gravesites, mature Sept. 4, 1952, the Fort Dou- may not have been able to trees, and a location within five miles of Florida’s Turnpike glas VA Hospital Building, as receive [otherwise],” said and Interstate 95. President Bush’s fiscal year 2003 bud- it was originally named, had Mike Agricola, administra- get requested $23.3 million for VA to build the cemetery. an inpatient bed capacity of tive officer to the chief of 546. Today, the hospital is staff at the Las Vegas VA hos-

30 November/December 2002 VAnguard honors and awards

The Lexington, Ky., VA with John Hall, Ph.D., of the group of IT innovators in- National Medical Center received a University of Mississippi cluded Donald Berwick, 2002 Fed- John M. Eisenberg Patient Medical M.D., president of the Insti- eral Asian Safety Award on Oct. 1 in Center. tute for Healthcare Improve- Pacific Washington, D.C. The The work ment, and Michael R. American award’s sponsors, the Na- of both re- Cohen, president of the In- Council tional Quality Forum and searchers stitute for Safe Medication Outstand- the Joint Commission on has chal- Practices. The list represents ing the Accreditation of lenged the “the best that human poten- Larican Achieve- Healthcare Organizations, long-held tial has to offer” in the health ment Award. Nominations commended the Lexington view that care IT community, accord- for the award were solicited VA hospital for its long- DiBona high blood ing to editors. from all federal departments standing “Honesty Policy” of pressure causes kidney disor- and agencies. Larican was openly disclosing medical er- ders. DiBona’s and Hall’s The New York Women’s honored for her contribu- rors. According to Chief of findings suggest, rather, that Agenda and United Federa- tions to the advancement of Staff Dr. Steve Kraman, increased nerve activity to tion of Teachers announced Asian Pacific Americans and families are receptive to the the kidneys limits their abil- that Pedro Perez, medical for promoting diversity and candor. “By receiving a genu- ity to excrete salt and water, media manager at the Bronx equal employment in the ine apology and learning which results in hyperten- VA Medi- federal workforce. Her many what has been done to pre- sion. cal Cen- accomplishments include de- vent others from becoming ter, was veloping and supporting in- victims, families see this as Lawrence Dolecki, selected as ternships and job training something good that has Ph.D., chief of the domicili- the win- opportunities for Asian Pa- Tuningcome out ofin their to misfor-the Veteranary at the Martinsburg, ner in cific students. Throughout tune,” he said. W.Va., VA Medical Center, their logo her 24-year VA career, she was elected to a two-year competi- has championed diversity Clark T. Sawin, M.D., term as chairperson of the tion for the New York Reads and equal opportunity, medical inspector for the West Vir- Together program. His logo mentoring employees of all Veterans Health Administra- ginia Trau- will be featured on all the races and backgrounds. tion, was elected to serve as matic Brain program’s materials. His de- president of the American and Spinal sign was chosen because it The Leadership VA Thyroid Association for Cord Injury embodies the program’s Alumni Association pre- 2003-2004 during the first Rehabilita- goals—to foster community sented its competitive election in the tion Fund spirit, a love of reading and 2002 Hon- association’s 79-year history. Board. The show the uniqueness of New orary Lead- The U.S. Army Medical Board con- York. Perez has been with the ership Corps veteran served as chief sists of 23 Dolecki Bronx VA since 1984. awards to of the Endocrine-Diabetes representatives from state Timothy J. section at the Boston VA agencies, public and non- The Association of VA Stroup, na- Medical Center for more profit organizations, and dis- Psychologist Leaders pre- tional di- than 30 years before moving ability advocacy groups. It is sented a Special Contribu- rector for to VA Central Office in responsible for administering tion Award to Terence M. Farsetta the Con- Washington, D.C. the state’s rehabilitation fund Keane, Ph.D., chief of psy- solidated Mail Outpatient and developing an ongoing chology in the VA Boston Pharmacy program in Gerald F. DiBona, system of services for people Healthcare System, during Leavenworth, Kan., and M.D., chief of medical ser- with traumatic brain or spi- the annual meeting of the James J. vices at the Iowa City VA nal cord injuries. American Psychological Asso- Farsetta, Medical Center and profes- ciation in Chicago. He was VISN 3 sor at the University of Iowa Healthcare Informatics recognized for “sustained and (Bronx, College of Medicine, received selected Gail L. Graham, di- significant career contribu- N.Y.) di- the Novartis Award for Hy- rector of information assur- tions to VA psychology.” rector. The pertension Research on Sept. ance in VA Central Office, as annual 26 at an American Heart As- one of the nation’s top ten Teresita R. Larican, awards sociation meeting in Or- “IT Innovators” in their Sep- chief of VA’s Office of Acqui- honor two lando. DiBona has con- tember 2002 issue. She was sition and Materiel Manage- VA execu- Stroup ducted research for VA since one of only two women to ment Fiscal Division in tives for their leadership and 1969. He shared the award make the top-ten list. The Hines, Ill., was awarded the accomplishments.

November/December 2002 31 heroes VAnguard

Firefighters and police claims at the Chicago VA the hospital. A month later, scene of a vehicle accident. officers at the Battle Creek, Regional Office. She was the suspect was spotted at the The driver was bleeding Mich., VA Medical Center riding the train to work pharmacy. Chief Cappussi, heavily from a hand injury were the first responders on when the operator got on the along with Sgt. Randy Smith that had severed his index the scene when a chemical intercom and asked if some- and Officers Merle Kelley finger. Officer Judd immedi- vapor buildup caused an ex- one with medical training and Mike Barry, took the ately took control of the plosion and flash fire at could come to the second suspect into custody and scene, alerting local authori- Johnson Controls Inc., a car. Perkins responded and called detectives to let them ties and directing traffic company adjacent to the fa- could tell the woman was know they had their man. around the accident. Officer cility. Seven employees and suffering a Grand Mal sei- Adler stabilized the victim, several firefighters were zure, characterized by loss of Returning from routine controlling his bleeding un- treated for minor injuries consciousness, falling down security checks on a public til local police and ambu- and chemical exposure. Due and rhythmic convulsions. road just outside the lance crews arrived. The of- to the quick response of the She comforted the woman grounds of the Bath, N.Y., ficers stayed on the scene to VA staff, the firefighters were and checked her purse for VA Medical Center, Police assist as needed. The victim able to start extinguishing identification or medication. Officers Frank Judd and was airlifted to a nearby hos- the fire and assisting injured The woman had three more Harry Adler came upon the pital. employees before local emer- seizures before the train gency officials arrived. reached the station, but Perkins was there all along, Dangerous fugitive captured Richard MacDonald, a doing what a trained profes- vocational rehabilitation sional is supposed to do. She Debbie Fowler stayed cool when she discovered the counselor at the Spark M. never mentioned the incident homeless man sitting in her office was wanted in four Matsunaga VA Medical and when she got to work that states for multiple sexual assaults on women and chil- Regional Office Center, was morning, but a colleague sitting in front of the First riding the same train saw it dren. Hawaiian Bank on Maui all and told managers what He had walked into Fowler’s office at the VA clinic when he heard a bank teller she did. They presented her in Colorado Springs, part of the Southern Colorado shouting they had just been with a dozen roses for her ac- Healthcare System, in search of a pair of shoes. They robbed. MacDonald joined tions. didn’t have his size, so she told him to come back. other citizens chasing the He came back four days later, still looking for shoes, suspect and spotted him Police officers from the but also seeking a refill on his prescription. “Call the VA jumping into his getaway car. Iowa City VA Medical Cen- in Tucson,” he told her, “they have my file.” Staff at the He ran up to the vehicle, ter nabbed a murder suspect Tucson VA had more than his medical records—they smashed the window and when he dropped by the out- also had the scoop on his crime spree. tried to pull the suspect from patient pharmacy to refill a As she hung up the phone, Fowler knew she had to the car. The suspect put the prescrip- car in reverse and dragged tion. The call the police and keep the fugitive in the clinic until MacDonald across the pave- VA Office they arrived. She sent him upstairs to check the dona- ment, scraping his arms and of the In- tion room one more time while she put in a call to the legs and throwing him away spector U.S. Marshal’s office. He came back empty-handed, but from the vehicle. He stepped General Fowler had another trick up her sleeve. She told him her on the gas and sped from the contacted husband wore the same size shoe and he had an extra scene but was apprehended a Police pair he could have. short time later. The Maui Cappussi Chief Nick Take a seat, she told him, and she’d call her hus- Police Commissioner hon- Cappussi band and have him bring a pair. Fifteen minutes later, of- ored MacDonald with a cer- and asked him to alert his ficers with the Colorado Springs Police Department tificate of merit for his efforts force that the suspect was burst in and took the man into custody. The arrest came to try to stop the suspect. wanted by detectives in New York City on charges stem- as producers from “America’s Most Wanted” were pre- Barbara Perkins, R.N., ming from a double homi- paring a segment on the fugitive, who was wanted for helped a woman suffering a cide. He was considered multiple sexual assaults, kidnapping, attempted homi- Grand Mal seizure while armed and dangerous. cide and two burglaries. riding the Metra train one Cappussi and his officers Fowler isn’t sure how she managed to stay calm morning. She is one of a worked with the FBI and during all this. “I don’t know how I did it,” she said. “I group of registered nurses other law enforcement agen- just asked the Lord to give me strength.” who rate veterans’ disability cies to set up surveillance at

32 November/December 2002