September/October 2004

VAnguard outlook

WorkingWorking TowardToward Recovery Recovery Infection:Infection: Don’tDon’t PassPass ItIt OnOn 2004:2004: YearYear ofof thethe HurricaneHurricane BehindBehind thethe NamesNames September/October 2004 1 VAnguard

Features

Infection: Don’t Pass It On 6 VA public health campaign gets underway Getting Their Lives Back 9 9 residential treatment program helps women vets cope with trauma Designing a Workplace Around the Mission 12 visual management approach is catching on 2004: Year of the Hurricane 14 storms spur largest-ever deployment of emergency responders Working Toward Recovery 16 Voc Rehab counselors are helping disabled veterans rebuild their lives Behind the Names 19 the third installment of a series profiles three more great Americans 26 If Disaster Strikes, Will You Be Ready? 22 at headquarters disaster preparedness event, the focus was on family

Departments

3 Letters 4 Management Matters 5 Outlook 24 Around Headquarters 32 28 Introducing 29 Medical Advances 30 Have You Heard VAnguard 31 Honors and Awards VA’s Employee Magazine 32 Heroes September/October 2004 Vol. L, No. 5 Printed on 50% recycled paper

Editor: Lisa Respess 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. Vietnam veteran David Wachter, a VR&E Washington, D.C. 20420 counselor at the Washington, D.C., VA Re- (202) 273-5746 gional Office, with one of his “graduates,” E-mail: [email protected] retired Air Force Col. Raymond Hart, who www.va.gov/opa/feature/vanguard/index.htm became a United Methodist minister through the VR&E program. Hart now serves as pastor at two Washington, D.C., churches, where he is working to keep youth away from drugs and violence. photo by Robert Turtil

2 September/October 2004 VAnguard letters

Dramatic Cover Photo dear to my heart. My dad is cation ceremony Memorial this hospital, as in most, I very much appreciated your a World War II veteran and Day weekend with my father. people tend to undervalue dramatic cover photo of the Purple Heart recipient; he Being at the ceremony the role that the floor clean- Pacific pavilion of the Na- was shot and nearly died in with him and the thousands ers play in maintaining a tional World War II Memo- the Battle of Buna of the of other vets was a moving healthy environment for rial (July/August issue). The New Guinea campaign (he event that even now brings a workers and patients alike. night shot captures the tells me the continual bouts tear to my eye when I see But the truth is that EMS is drama and impressive design with malaria were worse than your photo. It reminds me of our first defense against of the memorial. being shot!). I was fortunate the debt owed to my father germs and other pathogens The Pacific pavilion is to be able to attend the dedi- and his generation for their that are indigenous to hospi- many sacrifices on our be- tals and many other public half. Thank you. facilities. Jeff Chenoweth, M.D. The money spent to pay Radiologist EMS salaries and the acco- We Want to Hear from You St. Louis VAMC lades given to them are just so worthwhile. Thanks again, Have a comment on something you’ve seen in EMS is Our and please continue with the VAnguard? We invite reader feedback. Send your First Defense insightful articles. comments to [email protected]. You can also I think that the article about John A. Roberts write to us at: VAnguard, Office of Public Affairs the EMS (May/June issue) Electrician (80D), Department of Veterans Affairs, 810 Ver- was just a stroke of genius. In Dallas VAMC mont Ave., N.W., Washington, D.C., 20420, or fax your letter to (202) 273-6702. Include your name, title and VA facility. We won’t be able to publish every letter, but we’ll use representative ones. We may need to edit your letter for length or clarity.

ROBERT TURTIL There She Is

All 52 contestants in the Miss America Pageant visited patients at the Washington, D.C., VA Medical Center on Sept. 4. This year marked the 50th anniversary of the annual pageant, which was telecast live from Atlantic City, N.J., on Sept. 18.

September/October 2004 3 management matters VAnguard

Electronic Health Records: VA Leads the Way Robert M. Kolodner, M.D. Acting VHA Chief Health Informatics Officer

Earlier this year, President how valuable these capabili- patients, and that better of interoperability health Bush outlined a plan to en- ties are. CPRS has virtually quality care actually costs standards across federal agen- sure that most Americans eliminated medication errors less. CPRS gives health care cies. have electronic health records caused by illegible handwrit- providers immediate access In the area of informa- (EHRs) in 10 years, improving. Its automated allergies to information, eliminates tion exchange infrastructure, ing the quality, safety, effi- and alerts prevent potentially duplicate orders, and in- we are collaborating with the cacy, delivery and security of dangerous treatments from creases patient safety. CPRS Department of Defense to health care. Later, in July, the being ordered. The use of bar has helped VA become one develop an interoperable, national Health IT Summit code technology on all medi- of the best performing health electronic “virtual” health released its strategic frame- cations and on the patient’s systems in the United States, record. Today more than 2 work for realizing this goal. wristband ensures that each setting the benchmark for million unique DoD elec- For decades, VA staff patient receives the correct clinical performance indica- tronic records are available to across the country worked to medication, in the correct tors proven to save lives. For VA providers. Starting in late develop IT solutions to sup- dose, at the correct time. example, VA use of beta 2005, we will be able to port health care for veterans, And VistA imaging provides blockers after heart attack share all the health data including VistA (Veterans the ability to capture and dis- and of screenings for cancer stored in our data repository Health Information Systems play a wide variety of medi- “bests the best” reported else- with DoD, and they will be and Technology Architec- cal images as part of the where. able to share their clinical ture). In the last few years, we have initiated or joined in efforts with federal, state and In the last few years, we have initiated or joined in industry partners that help lay the groundwork for the efforts with federal, state and industry partners that President’s initiative. Our help lay the groundwork for the President’s initiative. evolving strategy addresses four key IT components: EHRs, personal health patient’s EHR. We are building the next data seamlessly with us. records, and two pieces criti- Today CPRS is being generation EHR system that We are now working cal to the exchange of health used by doctors, nurses and will shift care from being fa- with the Centers for Medi- information between them, other health professionals in cility-centric and make it care and Medicaid Services to namely, data and communi- VA. Our VistA system now person-centric. A Web-based, release VistA-Office EHR cations standards, and infor- contains more than 1.1 bil- personal health record for all early next year. We are con- mation exchange infrastruc- lion orders and half a billion veterans, My HealtheVet, will figuring this new version of ture. notes and reports. These transform the way veterans VistA to meet the needs of Today VistA supports a numbers are growing quickly. participate in their health community health clinics comprehensive EHR system. Each day, more than care experience and get infor- and office-based practices in Our Computerized Patient 865,000 orders and more mation about their wellness rural and underserved areas. Record System (CPRS) pro- than half a million progress and care. Version one con- In this effort and in oth- vides a single integrated ap- notes are entered electroni- tains health information re- ers, we are working to trans- plication to health care pro- cally by VA providers at VA sources. Next year, veterans form health care, in the belief viders in all VA medical cen- facilities, and 585,000 medi- and VA staff will be able to that we can make our veter- ters, nursing homes and clin- cations are administered us- have a secure copy of key ans and ultimately all Ameri- ics. Using CPRS, providers ing bar codes. portions of their health cans “HealthePeople.” can update a patient’s medi- Does this technology re- record from VA’s VistA sys- cal history, review any test really make a difference in tem. sults, submit orders, and ac- health care? Across VA, we In the area of standards, President’s goal: in 10 cess patient health informa- have demonstrated that this we were instrumental in the years, most Americans tion from any VA medical one component, EHRs, can formation of the Consoli- will have electronic center or clinic. help provide better, safer and dated Health Informatics ini- health records. As a physician, I know more consistent care to all tiative to foster the adoption

4 September/October 2004 VAnguard outlook

Assisting Veterans Interested in Federal Employment Willie Hensley Director, VA National Veterans Employment Program

Veterans leaving active mili- keting brochures developed, with the spirit and intent of disabled and 30-percent-or- tary service are among the and the program was intro- the law. We are also working more disabled veterans. best and brightest workers duced to veterans at military to develop partnerships that These noteworthy accom- our nation has to offer. For transition centers, job fairs will expand the One-Stop plishments set the example in any employer, public or pri- and other locations. Career Center concept of policy and practice for the vate, they bring a wealth of Today, NVEP continues providing employment assis- public and private sectors knowledge, experience, and to expand veterans’ access to tance to veterans at VA facili- and must be continued. leadership, often at levels far information on veterans’ ties across the country. Veterans’ preference is beyond their years. preference as well as opportu- As the agency entrusted not a handout or charity to That is why VA’s Na- nities for employment within to communicate, by way of the undeserving, but an op- tional Veterans Employment the department. New bro- service, the gratitude of our portunity for highly skilled, Program (NVEP) is so im- chures and posters that mar- nation to its veterans, we dedicated citizens to re-estab- portant. The program helps ket program services are in have an obligation to lead lish themselves in the civilian veterans understand how to production for placement in the way in assisting veterans workforce so they can con- use veterans’ preference to military transition centers, in their search for employ- tinue to serve. It is also the navigate what can sometimes veterans service organization ment. We must not only talk law. The National Veterans be a complex job search pro- offices, and VA facilities. The the talk of promoting veter- Employment Program will cess. program is briefed to service- ans’ preference in hiring, but continue advocating for the Since the Civil War, the members during transition also walk the walk by actively employment of veterans in United States has afforded its from active military service, employing and retaining vet- the federal government. You military veterans the oppor- job fairs and other veteran- erans in VA. Evidence sug- can be an advocate too, by tunity to continue to serve focused events. A new Web gests we are doing just that, learning more about veterans’ by granting them hiring pref- site is in production and fu- but we can do more. preference and putting the erence for federal govern- ture plans include making According to the latest law to work in your work- ment employment. With veterans’ preference informa- veterans’ employment report place. NVEP, veterans have a strong advocate that promotes education, under- Veterans’ preference is an opportunity for highly standing, and use of veterans’ preference and the various skilled, dedicated citizens to re-establish themselves in hiring flexibilities available to the civilian workforce so they can continue to serve. veterans seeking employment in the federal sector. In July 2001, the VA tion available to separating presented to Congress by the For additional informa- Veterans Employment Initia- servicemembers under the Office of Personnel Manage- tion on VA’s National Veter- tive (VEI) and the National Veterans Assistance at Dis- ment, VA led all civilian fed- ans Employment Program, Veterans Employment Pro- charge System. eral agencies in the number contact Greg Alleyne, program were established in NVEP has begun an of disabled veterans and 30- gram manager, at (202) 273- what is now the Office of awareness campaign to in- percent-or-more disabled vet- 9740. For more information Marketing and Veterans Em- crease the utilization of veter- erans employed, the number on veterans’ preference, visit ployment Outreach Service ans’ preference and hiring of newly hired disabled veter- the veterans’ reference guide under the Office of Human flexibilities among VA hu- ans, and in the promotion of at www.opm.gov/veterans. Resources Management. man resource specialists, hir- Through VEI, VA reached ing officials and recruiters. out to veterans service orga- The campaign is designed to On the Web nizations, military organiza- help foster an environment tions, and other federal agen- that takes an affirmative ac- For more information on veterans’ preference, check cies concerned with veterans’ tion approach to employing out the veterans’ reference guide on the OPM Web site issues. NVEP goals and strat- veterans under veterans’ pref- at www.opm.gov/veterans. egies were established, mar- erence statutes consistent

September/October 2004 5 feature VAnguard Infection:Infection: Don’t Pass ItIt OnOn VA campaign seeks to involve all health care staff, patients, visitors.

otherhood, apple pie, wash- Why a Campaign? ness. “Health care-associated infec- ing your hands, and cover- The campaign has several im- tions account for 50 percent of all Ming your coughs—who could portant rationales. One is the pro- major hospital complications and argue with any of these? Yet the motion of safety for patients and have occurred in about one in 20 Centers for Disease Control and staff, as well as their loved ones and patients admitted to U.S. hospitals Prevention reports that only about the community, and reduction of ill- in general, according to a 2003 re- four out of 10 health care workers follow recommended hand cleaning procedures. This means that in the average hospital around the country Infectious Disease Emergencies six of 10 health care workers may be walking around from patient to pa- Sometimes, an infection is so serious that it requires careful extra mea- tient or bathroom to patient or pa- sures to contain it. VA infection control professionals are the experts in tient to cafeteria passing along each hospital on what to do, and they work with staff throughout the facility. germs that lead to infection, illness, Several of them have been involved in developing and reviewing informa- or worse. tion for the campaign, “Infection: Don’t Pass It On,” working particularly on A new VA public health cam- materials dealing with the use of personal protective paign called “Infection: equipment, or PPE. Don’t Pass It On” aims to Wearing PPE is necessary for staff and other visitors help. “The campaign en- of patients on isolation due to some contagious infec- courages everyone in a tions. Some of these infections are rare or have not oc- VA health care facility— curred in VA hospitals at all, but could be dangerous to paid staff or volunteer, patients and staff if present. These include severe acute clinical or non-clinical, respiratory syndrome (SARS), smallpox, monkeypox, patient or visitor—to get avian influenza, and certain forms of hemorrhagic fevers. involved in preventing VA campaign staff sought existing material on how infections,” says Dr. Susan to don and safely remove PPE. Finding little available, Mather, chief officer for they developed three posters to address this need. public health and envi- Printed copies are being sent to VA infection control pro- ronmental hazards. fessionals for use in emergencies and in training ses- That office, the Na- sions. Additional copies and Spanish versions will be tional Center for Patient available to order through facility education contacts and Safety, and the Employee Education to download through the campaign Web site at www.publichealth.va.gov/ System, along with VA experts in infectiondontpassiton. infection control, are developing How does hand hygiene fit into the picture in an emergency? It remains educational materials and messages critical. The CDC reports that investigations of disease outbreaks show an for the VA health care system. The association between infections and understaffing or overcrowding, with a campaign both promotes basic pub- consistent link to lack of hand hygiene practices. Hand cleaning must be lic health measures (clean your done even if gloves are worn. All of the new PPE posters include steps of hands, cover your coughs and hand cleaning before donning PPE (including gloves) and entering an af- sneezes) and makes available key in- fected patient’s room, after removing PPE, and before leaving the room. formation to use in infectious disease emergencies (see sidebar, right).

6 September/October 2004 VAnguard feature

port by the National Academy of giene practices can actually save ria and other microorganisms. Science’s Institute of Medicine,” time and money, not to mention says Dr. James Bagian, director of spare patients, staff, and those Promoting Hand Cleaning VA’s National Center for Patient around them from needless infec- So how do you call attention to Safety. “Identifying and preventing tions and their consequences. The an age-old issue with important the causes of these infections is a costs of hospital infections outweigh priority for VA.” The number one the costs of stocking hand hygiene carrier for these infections, accord- products. The CDC estimates that For More ing to the CDC, is the hands of the cost of four or five infections of Information health care workers and others who average severity or of just one severe have patient contact. infection of a surgical site, a lower The Web site for the VA cam- A second rationale for the cam- respiratory infection, or a blood- paign is www.publichealth.va.gov/ paign is preparedness, both for natu- stream infection is as much or infectiondontpassiton. ral biological events such as flu sea- greater than the annual budget for CDC hand hygiene information son, and for manmade ones, such as hand hygiene products for a hospi- cited here is available at bioterrorist acts. tal. www.cdc.gov/handhygiene, par- A third rationale is compliance Newly developed products, particularly the article “Guideline for with regulations and guidelines. As ticularly alcohol-based hand rubs, Hand Hygiene in Healthcare Set- of 2004, the Joint Commission on can save even more time than tradi- tings: Recommendations of the Accreditation of Healthcare Organi- tional hand cleaning methods. The Healthcare Infection Control Prac- zations requires that hospitals com- CDC estimates that in an eight- tice Advisory Committee and the ply with the current CDC hand hy- hour shift, almost an hour of a HICPAC/SHEA/APIC/IDSA Hand Hy- giene guidelines. VA’s campaign re- nurse’s time in an intensive care giene Task Force.” flects and supports these guidelines, unit can be saved by using an alco- The Institute of Medicine refer- which focus on the use of alcohol- hol-based hand rub at the bedside ence is “Priority Areas for National based hand rubs or antimicrobial instead of going to a sink for hand Action,” available at www.nap. soap and water to decontaminate washing. The added benefit is that edu/catalog/10593.html. hands, and the proper use of gloves. the alcohol-based hand rubs are gen- It doesn’t hurt that hand hy- erally more effective at killing bacte-

September/October 2004 7 feature VAnguard

new-age implications and keep sets in English or Spanish can be or- other way to extend the reach of the people’s awareness up? The CDC dered by facility education contacts. campaign. Be on the lookout for also weighs in on this, saying strate- All of the posters were also designed colorful posters at your facility this gies to promote hand hygiene should to be printed or downloaded from fall and above all: Clean your hands be multifaceted and the Web and are a size and contrast and cover your coughs! multidisciplinary. that will work on office printers in Multifaceted is a good word for color or black and white—yet an- By Connie Raab the materials used in VA’s campaign. The campaign team is counting on color, variety, and even humor to convey that cleaning hands and How and When to Clean Your Hands covering coughs are important. To- gether they have come up with 60 When your hands are not visibly soiled, alcohol-based hand rubs are the posters (10 in Spanish) to carry the most effective way to clean them. A study cited by the CDC shows that these messages of the campaign. hand rubs can reduce more than 99 percent of bacteria on the hands. This is The posters are designed to be better than antimicrobial soap and much better than plain soap. And alcohol- rotated often to keep people inter- based hand rubs are less drying to the skin than antimicrobial soap. ested and to convey a range of infor- How do you clean your hands? mation through the use of photos, Using an alcohol-based hand rub (gel or foam), you: drawings, technical shots of bacteria, Apply to palm of one hand and cartoons of talking germs. Some Rub hands together vigorously, covering all surfaces, until dry posters are meant for clinical or staff Using antimicrobial soap, you: areas; most are meant for all areas of Wet hands with water the facility. One, which is also avail- Apply soap able in Spanish and has been cre- Rub hands together for at ated in both small and large sizes least 15 seconds and two designs, simply states: “Pa- Rinse and dry with dispos- tients and Visitors: It’s okay to ask able towel health care providers if they have Use towel to turn off faucet cleaned their hands.” When should you clean your The word multidisciplinary re- hands? Probably more often than flects the campaign approach. The you do now. campaign team is working through If you are in health care set- several disciplines in VA hospitals to tings, use alcohol-based hand rubs* get the messages out. Materials are before and after touching patients being sent to seven key contacts in or touching items in patients’ rooms. each facility—infection control pro- When your hands are visibly soiled, fessionals, patient safety officers, oc- use antimicrobial soap. cupational health staff, prevention Otherwise, when you are not in health care settings, use antimicrobial managers, public affairs officers, edu- soap and water or alcohol-based hand rubs (the former if hands are visibly cation contacts, and, through the soiled): latter group, patient educators. “This Before eating broad outreach is essential to getting After using the restroom the word out,” says Mather. “To- After coughing or sneezing gether these various professionals After being near someone sick or someone coughing or sneezing reach a wide range of people and we After touching trash plan to give them tools and lots of After touching pets encouragement to promote this im- *Alcohol-based hand rubs do not kill certain infectious agents, including portant and potentially life-saving norovirus and the bacterium Clostridium difficile. If these two are a problem campaign.” in your facility, use antimicrobial soap, plenty of water, and lots of hand rub- The 60 printed posters have bing. Your facility’s infection control professional can advise you further. been distributed to facility contacts in the seven disciplines. Additional

8 September/October 2004 VAnguard feature

Getting Their Lives BackCURT CAMPBELL

An intensive residential treatment program at that. My only regret is that I didn’t know about it years ago—so much the VA Palo Alto Health Care System’s Menlo of my life has been wasted.” Park Division is helping women veterans cope ‘The Tools to Face Life’ The WTRP staff is trying to with the aftermath of trauma. reach out to women who can benefit from this 60-day residential program for women veterans who are I’m a professional at isolation. Menlo Park Division of the VA Palo coping with the aftermath of After being assaulted and Alto Health Care System in Califor- trauma. Women come into the in- “raped in the Army, I spent the nia. The program was initially de- tense group therapy program in next 25 years fighting demons and signed to treat women with PTSD, classes, or cohorts, that work to- nightmares with psychiatric medica- but more often than not the women gether; some can’t handle the inten- tions and numerous hospitalizations. who come here were sexually as- sity and can’t continue, but many of I was afraid of everything. I moved saulted during their military service every year thinking the next place and suffer what is now referred to as would be better. But it never worked military sexual trauma. Above: Gloria Grace, program coordina- because wherever I went, there I “For 25 years I suffered alone,” tor for the Women’s Trauma Recovery Program, leads a group counseling ses- was.” said Lehmann. “I had barely gone sion. “Despite the adversity in these A Vietnam-era Army veteran, out of my house the six years prior women’s lives, they readily offer support Debra Jean “DJ” Lehmann is a to entering the WTRP. I was ready and guidance to the ‘band of sisters’ who follow them. It’s both humbling and graduate of the Women’s Trauma to get better and this program gave inspiring,” said Grace. Recovery Program (WTRP) at the me the courage and the tools to do

September/October 2004 9 feature VAnguard

these come back for a second try each other secrets that many of clinical laboratory division of the and finish successfully. them held inside for decades. National Center for PTSD, and uses “The program is not for every- “I did such a good job burying both established and cutting-edge one,” said Darrah Westrup, Ph.D., my past. Mostly I buried it with al- treatments to advance the clinical who oversees the WTRP along with cohol, but no more,” said Army vet- care and knowledge of women with Gloria Grace, a social worker and eran Alice Budway. “This program is PTSD. The unit is for female pa- the program coordinator. “The inter- giving me the tools to face life, the tients only. Most women are dually personal demands pose a challenge tools to cope. I used to have three diagnosed with PTSD and disorders to women who have been extremely panic attacks a week; I’m down to such as substance abuse, anxiety and isolated and find it difficult to trust maybe one now. I’m not well, but depression. Treatment occurs within others. If we could just reach these the staff here is making huge in- a therapeutic community model women early in their trauma years, roads.” with a strong emphasis on interper- we could save them so much pain,” The WTRP operates as the sonal skills. she added with a sigh. One such veteran is 22-year-old Joann Martinez, who was sexually assaulted while in Luxembourg A Welcome Relief when she was serving with the Air Force in Germany. “Nights were Reflecting on her struggle for equality, suffragette Charlotte Despard wrote, bad. I was afraid to go to sleep be- “... I was continually seeking to find expression for the force that was in cause of the nightmares, but I was so me, trying to learn, asking to serve with my life in my hand ready to offer, tired all I wanted to do was to go to and no one wanting it.” sleep. So I started drinking myself to When a young woman joins sleep,” she said, shaking her head at the military, it is in the service of the memories. bettering her life. Perhaps she Martinez found out about the wants to make a difference, to con- residential program after working tribute to her country. Perhaps she with the staff as a mental health wants to escape a bad situation, to outpatient. The outpatient program live a larger life, see the world, get was good, but it just wasn’t enough. an education. It is the best part of She was still barely leaving the her that has taken that step. house and “the anniversary month Unfortunately, as a result she of my rape was horrible.” But soon may experience tragedy—frighten- after being admitted to the inpatient ing, even horrific, events that she program, her anniversary month must somehow carry with her for rolled around and while she was dis- the rest of her life. tressed, she did not, in her words, Our program is geared towards “fall apart,” something she was quite healing these women and teaching proud of. them how to live a fulfilling life, even “If you had known me before when one is carrying heavy bur- [treatment at the WTRP], you dens. It is all about helping women wouldn’t think I was the same per- reclaim their sense of self-worth son. When my former doctor saw Westrup and personal power. me recently, she said, ‘You look I am moved repeatedly by the great. This is the first time in a year gratitude the women we serve express for our program. It is telling how I’ve seen you look connected.’ And surprised they are to realize that we genuinely care. They tell me how ex- that’s what happens when depres- traordinary it is to be heard, to have their medical and mental health needs sion and fear set in, you lose con- attended to, what a welcome relief it is to be understood and appreciated. nection with people.” Our team knows that progress is being made when the women we see Women of all ages and from all come to understand that it is we who are fortunate to have the opportunity walks of life come to the program. to contribute to their lives. -Dr. Darrah Westrup Most arrive on the brink of emotional disaster and must share with

10 September/October 2004 VAnguard feature

A Close-Knit Group “The interpersonal demands, in addition to the intensity of trauma work, are at times too rigorous for some women,” said Westrup. “Yet we wanted to be able to serve more women, so we established a second track in the program that involves less interpersonal and trauma work, and more skills building, for example anger management, relapse prevention and skills of daily living (financial management, goal setting, problem solving, etc.). Many times a woman will go through the skills building track and then come back for the intensive track.” Lydia Epson was stationed on the ammunition ship USS Shasta during the Gulf War. The ship was CURT CAMPBELL CURT CAMPBELL the first one in and the last one Left: “For 25 years I suffered alone,” said Army veteran Debra Jean “DJ” Lehmann. “I home. She came back injured and ill was ready to get better and this program has given me the courage and the tools to do and has been diagnosed with PTSD. that. My only regret is that I didn’t know about it years ago—so much of my life has “I tried my own version of ‘drug been wasted.” Right: Air Force veteran Joann Martinez, 22, is one of the youngest women to go through the Women’s Trauma Recovery Program. therapy’ for two years, before I realized this was getting me nowhere,” said Epson. “This program—these women—saved me and now I’m a strong advocate for women veterans’ health and benefits.” Although Lehmann, Martinez and Epson have “graduated” from the WTRP program, they continue to meet on a weekly basis with Westrup and with other graduates. They are a close-knit group who de- pend on each other and are thankful for the guidance and tools that helped them get their lives back. “I didn’t mind fighting for my country,” said Epson, who went through the program in 2002, “but someone has to take care of us when we come home.” No one believes that more than Westrup and the WTRP staff. For more information about VA Palo Alto Health Care System’s CURT CAMPBELL Lydia Epson, a graduate of the Women’s Trauma Recovery Program, shows Alice Budway, Women’s Mental Health Program one of the women currently going through the program, the panel she created for a quilt visit: www.womenvetsptsd.va.gov. her cohort put together. At the end of each cohort, the group works together to make a quilt. The quilts hang in the clinic building’s meeting rooms and hallways. Even though they’ve completed the program, Epson and other graduates continue to meet weekly with Westrup and with each other. By Kerri Childress

September/October 2004 11 feature VAnguard Designing a Workplace Around the Mission Visual management approach catching on both inside and outside VA.

aving worked her way through the ranks of the Vet- Herans Benefits Administra- tion, Kerrie Witty knows how important it is to stay focused on the mission. “Working with claim files and so much paperwork, it’s easy to lose focus of the human aspect to what we do,” she said. Now that she’s been promoted to assistant director of the St. Pe- tersburg, Fla., VA Regional Office (she started her VA career in 1991 as a claims examiner), Witty hopes to apply the lessons she learned to “keep the focus on employees and the veterans we serve.” That effort got underway on Memorial Day 2004 with the dedication of the Fallen Soldier Memo- rial in the lobby of the St. Peters- burg office. The memorial—a sculp- ture of a soldier’s rifle, boots, helmet and dog tags—is a tribute to Florid- ians killed in Operations Iraqi and Enduring Freedom. But to Witty, it stands as a visual reminder of the personal sacrifices behind the paperwork. The memorial is the first of several projects underway at the St. Pe- tersburg office intended to connect Under the leadership of Stew Liff, changes to the work environment at the Los Angeles the physical environment to the VA Regional Office have translated into changes in performance.

mission. The idea, called visual SUSAN FISHBEIN management, was developed over the last decade by Stewart Liff, di- out Your Organization, published by holds bachelor’s and master’s degrees rector of the Los Angeles VA Re- AMACOM books. in fine arts. gional Office. Liff recently co-wrote “It’s a concept rooted in fine His approach uses visual imag- a book with Pamela A. Posey on the arts and business principles where ery to connect people to a purpose, subject called Seeing Is Believing: you combine elements of the right stirring the brain’s creative right How the New Art of Visual Manage- brain and left brain to create a holis- side. It also relies on extensive use of ment Can Boost Performance through- tic organization,” said Liff, who performance data to stimulate the

12 September/October 2004 VAnguard feature brain’s analytical left side. “This lib- formance. When Liff arrived in Al Perry, director of the VA erates people because it gives them a 1994, the office’s Vocational Reha- Central California Healthcare Sys- chance to use their creativity,” Liff bilitation and Employment Division tem in Fresno, learned about visual explained. “As they begin to under- rehabilitated 46 veterans. For 2004 management several years ago when stand the concept, they become that figure is projected to exceed he attended a presentation by Liff at more interested in it and two things 383. Another key statistic is the rate a national conference. “I was abso- will happen. First, you increase the at which an office grants benefits. In lutely fascinated, mesmerized,” he bottom line. Second, it makes the 1996, that rate in Los Angeles was said. job more fun.” 42 percent, the lowest in the nation. Perry was so impressed he trav- So how does visual management In 2003, it had climbed to 61 per- eled to Liff’s office in Los Angeles enhance performance and make the cent, in line with the national aver- with two teams to gather ideas they job fun? It’s simple, according to age. could implement at the medical Gloria Young, who recently retired The performance results are center. One of them was to renovate after 26 years at the Los Angeles of- posted throughout the office. Liff the main patient reception area and fice. “We’re more in control. We believes managers aren’t the only install large graphics, photos and know what we’re doing and we ones who should know how the or- memorabilia depicting veterans’ know where we’re go- wartime experiences. ing,” she said. Perry is pleased with the It wasn’t always that outcome. “You cannot way. Before Liff arrived, walk through without they used to focus on an getting the idea that this antiquated process, said is a place where we honor Young. When he came and serve veterans,” he in talking about change, said. some people just shook Private companies their heads, like, here we are also taking note. Rep- go again. The skeptics resentatives from Amgen got onboard, though, Pharmaceutical, when he started sprucing Wellpoint Health Net- up the place: new car- works, Sempra Energy, pet, paint, lighting and the University of South- layout. “He focused on ern California, and employees and they SUSAN FISHBEIN Genentech have all vis- started to see that this Large banners and poster-sized photos of employees in their military ited the Los Angeles of- director is different, he’s uniforms hang from the ceiling at the Los Angeles VA Regional Office. fice to get a firsthand interested in us and he glimpse at how visual actually listens to our suggestions. ganization stacks up. He uses bulle- management works. Liff even hosted Everyone felt like they were part of tin boards to track daily individual representatives from the Cherokee the operation,” Young said. performance and television monitors Nation who are interested in adopt- Today the Los Angeles VA Re- to show group results and reward in- ing his techniques as a way to teach gional Office more closely resembles formation. There are balanced their culture and history to younger a museum than a government build- scorecards and road maps plotting generations. ing. Each floor is dedicated to a par- future goals. Liff is cautious about not letting ticular war. There are displays with His approach has generated in- all the attention detract from the wartime memorabilia donated by terest from other VA facilities. Vi- mission. “This isn’t about me. This area veterans. There are timelines sual management concepts have is about the organization and the showing the evolution of veterans’ been adopted at VA regional offices people who carry out the mission … benefits. And there are massive cen- in St. Petersburg, Honolulu, they come to work here for a reason, terpieces: a helicopter cockpit, a Wichita, Kan., Philadelphia, New because they want to serve veter- Civil War replica cannon, even a York, Montgomery, Ala., and At- ans,” he said. “Keeping that focus is tank. lanta, according to Liff. Some medi- what this is all about.” Changes to the environment cal centers are even getting in on have translated into changes in per- the act. By Matt Bristol

September/October 2004 13 feature VAnguard 2004: Year of the Hurricane Atlantic storms spur largest-ever deployment of VA emergency responders.

loridians will remember 2004 as level of support VA employees are By identifying volunteers prior the year of the hurricane. First willing to provide for veterans and to a disaster, the department is bet- FCharley, then Frances, Ivan the community,” Peters said. ter prepared to respond to requests and Jeanne. The succession of Many of the volunteers are reg- for assistance from other agencies storms—all occurred during a six- istered with the Disaster Emergency such as the Department of Health week period from Aug. 13 to Sept. Medical Personnel System and Human Services and the Fed- 25—brought a relentless battering to (DEMPS), a database of VA health- eral Emergency Management the Sunshine State. care professionals willing to use their Agency, said Carol Beard, a program Storm coverage in the media medical expertise to help the nation manager with the VA Emergency generally emphasized evacuations, in times of need. There were 1,725 Management Strategic Healthcare destruction, the death toll, and the potential volunteers in the database Group based in Martinsburg, W.Va. billions needed for recovery. Less as of Oct. 7. “When FEMA asks for help, was said of the hu- they need it right man compassion, away. [The database] of the hundreds, enables us to locate maybe thousands our personnel re- of people who dis- sources with specific regarded their own specialties in a timely safety and volun- manner,” Beard said. teered to help Visit vaww.va.gov/ those in need. emshg and click on That compas- the DEMPS link on sion was alive in the left for more in- the more than 400 formation. VA employees Peters was part from across the of the initial response country who de- team deployed to ployed to commu- south Florida. He nities devastated by and colleagues set up the storms. Their a staging area in Mi- collective efforts ami to coordinate lo- over those six gistical support for weeks constituted incoming volunteers. the largest single He said volunteers deployment of VA were needed to sup- volunteers during a port both community national disaster, and VA hospitals. according to Mike Approximately Peters, an area 240 VA health care emergency man- professionals de- ager with the Cen- ployed to community tral Iowa Health hospitals and shelters Care System. to aid hurricane vic- RAE DENISON “It was a tre- tims. Mary Jane mendous undertak- Rosenda Jewell, a licensed vocational nurse with the VA Palo Alto Health Care Viles, R.N., an ur- ing. It shows the System, heads out to Bay Pines, Fla., where she was deployed Sept. 3-10. gent care nurse at the

14 September/October 2004 VAnguard feature

Togus, Maine, VA Medical Center, back on her experience, deployed twice. She spent her first she feels fortunate to 14-day tour working in a county have participated in the hospital emergency room in relief effort. “Our help Kissimmee, Fla., following Hurri- was sorely needed. It cane Charley. Viles said the 26-bed was really a wonderful ER saw a “tremendous influx” of pa- thing the VA did,” tients in the storm’s wake. Clancy said. Five days after her return to In addition to the Maine, she was called up again to community relief efforts, aid victims of Hurricane Frances at a 163 employees deployed special needs shelter in Fort Pierce, to VA medical facilities Fla. The work was tiring, but re- to bolster staffing and warding. “As a nurse, I know I made ensure continuity of op- a difference in people’s lives,” she erations. Many ended said. Viles acknowledged that her up at the Miami VA volunteer efforts would not be pos- Medical Center, which sible without the support of col- received a significant leagues back home. “It takes a toll number of patients from on my co-workers, because they’ve storm-damaged West got to work shorthanded” while Palm Beach VA Medi- she’s gone, she said. cal Center. Also serving at the Fort Pierce Leon Ian Magniez, shelter was Kathleen E. Clancy, a a registered nurse from nurse practitioner from the Martinez the VA Palo Alto GARY DALE VA Outpatient Clinic, part of the Health Care System in VA carpenters, laborers and electricians, including Chris Krause (on Northern California Health Care California, spent two ladder), from Biloxi, Miss., and Tony Oakley, from San Francisco, System. She said the bulk of pa- weeks in Miami working were deployed to repair hurricane damage at the West Palm Beach tients in the shelter were 65 and on the medical/surgical VA Medical Center. older and in desperate need of basic floor. He said the pa- care. Many had gone a week with- tient census on the floor basically of Oct. 7, there were about 15 VA out a shower. So she and colleagues doubled due to the damage at West carpenters, laborers and electricians set up what they called the “VA Palm Beach. Both the veterans and repairing damage at the West Palm Spa” where they bathed patients, staff in Miami were glad to see him. Beach VAMC. Other emergency re- trimmed their nails, and inspected “Several people thanked me for sponders provide expertise in engi- their feet and skin. “This gave us the coming,” he said. “They sure needed neering, safety, logistics and admin- opportunity to look for signs of the extra manpower.” istrative fields. Together, they fulfill trouble,” Clancy explained. “We’d Health care professionals aren’t a key component of the listen to their heart and lungs and the only ones active in national di- department’s role in the national di- triage for other symptoms.” sasters. Approximately 30 area emer- saster response plan. Clancy learned a few lessons gency managers from across the from her two-week stint in Florida country deployed to Florida. And as By Matt Bristol that she now passes on to her regular patients. For example, many of her patients at the shelter had lost Help from the VA Family their medications in the storm and didn’t know the names of the drugs More than 600 VA employees and their families suffered serious property or how often they were supposed to damage from the hurricanes. To help them get back on their feet, Secre- take them. The problem could have tary Principi designated Oct. 18-22 as a “VA Week of Giving.” VA em- been easily fixed, Clancy said, if ployee associations and the Veterans Canteen Service set up collection they kept a list in their wallets of all points at facilities for contributions. The money raised is being distributed medications they were taking by to employees identified by their co-workers as deserving recipients. name, dose and frequency. Looking

September/October 2004 15 cover story VAnguard Working Toward Recovery

The war in Iraq is bringing increased attention to VA’s role in helping disabled veterans rebuild their lives. The department’s VR&E counselors are doing just that, one veteran at a time.

he war in Iraq has put renewed emphasis on one of VA’s key Tmissions—helping disabled veterans rebuild their lives after traumatic injury. Central to that mission are the employees of the Vocational Reha- LAUREL LEE SCHREINER bilitation and Employment (VR&E) David Boyd, a VR&E counselor with the Seattle VA Regional Office, talks with Kristopher Atherton, who lost part of his arm when his Humvee hit a land mine in Iraq. Atherton program. They provide counseling, served with the 2nd Battalion, 70th Armor Regiment, out of Fort Riley, Kan. His rehabilita- training and support services to help tion plan includes classes at Green River Community College with the goal of becoming a disabled veterans reach their fullest teacher. potential, whether that means independent living or starting a new ca- review led to several changes now our program,” said new VR&E Di- reer. underway. They range from an in- rector Judith A. Caden. “We had In May 2003, with an increasing creased emphasis on outreach to lost focus of the employment aspect number of U.S. forces suffering dev- wounded servicemembers to refocus- of VR&E. However, our staff is ab- astating injuries in Iraq, Secretary ing on the program’s primary goal of solutely committed to serving veter- Principi ordered a comprehensive helping disabled veterans find jobs. ans and they are trying to do their review of the VR&E program. The “This review has re-energized very best. We’re going to give them

16 September/October 2004 VAnguard cover story

the tools they need to succeed.” they mean it … it really chokes you Gonzalez isn’t sure if he’ll need up.” voc rehab benefits. His immediate Outreach a Priority On a recent visit to Beaumont focus is on getting better and rejoin- The review emphasized the im- hospital, Pellicano met Marine ing his unit. But if that isn’t pos- portance of outreach to returning Lance Cpl. Benjamin Gonzalez, 19, sible, he knows where to turn. “Mr. veterans. Now, instead of waiting for who was wounded June 18 near Pellicano came up here and told me Iraqi Freedom veterans to contact Fallujah, Iraq, when enemy forces how the VA can take care of me,” them, VR&E counselors are visiting attacked his security checkpoint. he said, adding that “it’s real conve- servicemembers at military and VA “It happened so fast … I re- nient” to have the counselor come hospitals, and calling recently dis- member hearing metal hit the pave- by the hospital. charged veterans who apply for dis- ment just a few feet behind me. A ability compensation to offer their grenade detonated and threw me A Time for Change services. “We’re providing a personal forward. I was lying there … I If there was ever a time to re- energize the VR&E program, this is it. Pentagon figures put the official number of Iraqi Freedom wounded at 7,026, as of Sept. 8. Of those, 3,836 suffered wounds so severe they were unable to return to duty. More than 2,000 OIF vets have already applied for VR&E benefits. One of those is Marine Sgt. Robert Pavon, 30, whose unit was ambushed April 4, 2003, in the town of At Tuwayhah, a dusty vil- lage six miles south of Baghdad. He was in the turret of his Humvee when the rounds started to fly. He remembers emptying his first magazine and stopping to reload. That’s when something knocked him off his feet. “I fell right back down in the turret and everything went blank. I was coughing up blood. I remember MONTI WALTHALL telling myself to relax, to stay calm. Louis Pellicano, a VR&E counselor from the Waco, Texas, VA Regional Office, meets with Marine Lance Cpl. Benjamin Gonzalez and his fiance Mindy Samaniego at the William I didn’t want to go into shock, Beaumont Army Medical Center in El Paso. Gonzalez was wounded June 18 near Fallujah, ’cause I thought for sure I was going Iraq, in a grenade attack. to die,” said Pavon during an Aug. 30 telephone interview from his touch, and I think it’s needed now couldn’t hear anything and I looked home in Coral Springs, Fla. more than ever,” said Caden. at my legs and my boot was blown He had been shot in the face. VR&E counselor Louis off and my pants were ripped. There The bullet entered his left cheek, Pellicano agrees. He works closely was blood everywhere. I yelled ‘I’m just below the eye socket, and exited with returning servicemembers at hit, I’m hit,’” Gonzalez said in an below his right ear, severing his ca- the El Paso VA Health Care Center, Aug. 17 telephone interview from rotid artery. He wasn’t the only ca- which is located adjacent to the his hospital room. sualty that day. Three other Marines William Beaumont Army Medical His recovery will be long and were wounded and three were killed. Center on Fort Bliss, Texas. “You painful. Both of his legs were shat- Pavon got an early start with his have to be there to see them,” he tered. He suffered severe nerve dam- VA paperwork by filing a claim for said. “It’s very difficult to describe. age and was riddled with what he es- disability compensation. Once he They are so young. Their parents are timated to be between 200 and 300 received a disability rating, he met there and they say ‘thank you’ and pieces of shrapnel. with VR&E counselor Carolyn

September/October 2004 17 cover story VAnguard

Lightfoot, who is based out of the St. Petersburg, Fla., VA Regional Office. She is helping him develop a new career plan to get back to work. Though he hasn’t yet decided what he wants to do, he is considering studying journalism. He hopes to one day write a book about his combat experiences. As for his dealings with VA and the voc rehab program, he is pleas- antly surprised. “Everything has gone really smooth,” Pavon said. “I haven’t had any problems.” He plans to tell all his friends about it, “at least the ones who got shot” in Iraq, he said. If they decide to seek vocational rehabilitation services, Lightfoot and her colleagues will be ready. Her office recently hired three additional counselors, filled a long-vacant sup- ROBERT TURTIL port position, and completed a new Vietnam veteran David Wachter, a VR&E counselor with the Washington, D.C., VA Re- gional Office, reviews a rehabilitation plan with Army Cpl. Armar Cave, 25, a fire direc- VR&E training initiative on trau- tion controller with the 1st Infantry Division who was wounded Oct. 9, 2003, near Ramadi, matic brain injury and PTSD. She Iraq, in an improvised explosive device attack. Cave is awaiting his medical review said her office is working to avoid board. He is enrolling for classes at the University of Maryland with the goal of becoming a child psychologist. what she called the cycle of Viet- nam, where “a lot of veterans got lost in the shuffle.” veteran’s abilities and interests. with Boyd. “Taking care of soldiers. Getting help with career goals is That’s what I did in the military and Focus on Employment the main reason veterans come to that’s basically what I do here,” he The primary goal of the VR&E David Boyd, a VR&E counselor at said. program is to help disabled veterans the Seattle VA Regional Office. He The bottom line is helping find rewarding and suitable employ- recently helped a former Army them achieve independence through ment. The VR&E program is cur- Ranger who lost a leg in Iraq be- suitable employment. “That’s what rently testing a new model designed come a police officer. “He was real we do,” said Boyd. “Every move we to get veterans back to work. Called gung-ho. Attitude is 100 percent of make is geared toward getting that veteran back to work.” Reaching out to returning “You have to be there to see them. It’s very servicemembers, increasing staff training opportunities, and piloting difficult to describe. They are so young. Their the Five-Track Employment Process parents are there and they say ‘thank you’ are just a few of the changes underway in the VR&E program. Others and they mean it ... it really chokes you up.” include establishing standards of practice, rewriting manuals, and the Five-Track Employment Process, the game,” said Boyd, a retired centralizing the quality assurance it offers five distinct options: return Army sergeant major. program. For more information on to a previous job, find a new job, Recovering from traumatic in- the VR&E program, visit the Web start a business, go back to school, jury can be a day-to-day struggle. site www.vba.va.gov/bln/vre/ or work toward independent living. VR&E counselors are often called index.htm. Veterans and their counselors can upon to provide emotional support choose an option depending on the and encouragement. But that’s fine By Matt Bristol

18 September/October 2004 VAnguard feature Behind the Names VA facilities nationwide bear the names of great Americans. Who were they? The third installment of this series surveys three great Americans who, by an act of Congress, have been or will soon be honored by having a VA facility named for them.

any VA facilities carry the for how he lived, and how he died. names of great Americans They join the list of Americans Mwho have contributed to the whose leadership, patriotism, heroic welfare of veterans or, in other ways, acts, medical innovations and vet- helped build and defend this nation. eran advocacy have led to the dedi- The first installment of this fea- cation of a VA facility in their ture series profiled the people be- honor. hind the names of national cemeter- ies located on settlements found on John J. McGuirk the edge of both the early western On May 7, the VA outpatient frontiers and U.S. history. The sec- clinic in New London, Conn., lo- ond installment surveyed the lives of cated on the grounds of the United four noteworthy Americans who States Coast Guard Academy, was have had VA medical centers dedi- re-dedicated as the John J. McGuirk cated to them. These men fought for Department of Veterans Affairs Out- their country, for their community patient Clinic. and for the health of veteran and Born in Massachusetts, John J. citizen alike. McGuirk moved to New London In this third installment, with his family when he was a tod- McGuirk VAnguard looks at individuals whose dler. As a teenager, McGuirk’s first names have recently been, or will job was as a lighthouse keeper on he had to be a diver. He soon began soon be, affixed to VA facilities by Race Rock Lighthouse at the edge of working for that company. an act of Congress. Three veterans, Long Island Sound. After he’d wit- McGuirk joined the Navy in two of whom served during World nessed a large ship run aground on 1943, continuing his civilian career War II and went on to advocate for the rocks and watched the salvage as a hardhat salvage diver. After at- veterans, and one who is honored company work the wreck, he knew tending the Navy’s salvage school in

September/October 2004 19 feature VAnguard

New York City, he was shipped to the Pacific, serving on the USS Layson Island. For the next two years, he dove on war’s devastation, from the grim wreckage of Pearl Harbor through the South Pacific and finally to a 1945 operation to reclaim $75 million in silver coins sunk by the U.S. and Philippine governments to prevent capture by the advancing Japanese in 1942. At 6 feet, 4 inches, “Big John” was an awesome sight, equipped with a heavy, old style brass diving helmet and breast- plate, full body canvas suit and weighted shoes. If the nickname “Big John” wasn’t enough, he earned the name of “Bull” in the boxing ring. After the war, McGuirk returned to New London, raised a family, worked in the salvage business and became an active member of the local American Le- gion. With particular concern for disabled and elderly veterans, he worked to promote improved care and to increase the number of VA health-care facilities in Connecti- BUCKS COUNTY (PA) COURIER TIMES PHOTO cut. He was instrumental in establishing the VA clinic that would Victor Saracini (inset) was killed when the United Airlines jet he was piloting on Sept. 11, 2001, crashed into the south tower of the World Trade Center. He left behind wife Ellen one day bear his name. McGuirk and daughters Brielle, left, and Kirsten, pictured here at his memorial service. died of a heart attack on Nov. 17, 2000, at age 83. After graduating with a Bach- rated officer with the Navy, having elor of Science degree in 1975, received the National Defense Ser- Victor J. Saracini Saracini was accepted to the Navy’s vice Medal, Navy E Ribbon and Ex- To those who knew him, Victor Aviation Officer Candidate School. pert Marksmanship Ribbon. In J. Saracini served as a symbol of He was commissioned as an ensign 1980, he separated from active duty where hard work and determination in December 1975 and received his and served in the Naval Reserve at can lead. Even though he dropped Naval Flight Officer wings the fol- Naval Air Station Willow Grove, out of high school, he went on to lowing year. Saracini then served on Pa., where he was a crewmember on earn a college degree, and then S-3A anti-submarine warfare aircraft a Lockheed P-3 Orion. He left the through service to his country, at- aboard the aircraft carrier USS military in 1985 with the rank of tained his dream of becoming a Saratoga. lieutenant. commercial pilot. He was an esteemed and deco- After leaving the Navy, Saracini

20 September/October 2004 VAnguard feature

flew as a corporate and commercial sented him the Medal of Honor. serving in Korea and Vietnam. He pilot before joining United Airlines On Feb. 19, 1945, 20-year-old retired from the military in 1969 in 1985. In all, Saracini flew com- Navy pharmacist’s mate Wahlen, a with 23 years of combined Navy/ mercial aircraft for 16 years. medic attached to the 2nd Battal- Army service. Wahlen then spent United Airlines Captain Victor ion, 26th Marines, 5th Marine Divi- 14 years employed at the Salt Lake J. Saracini died as the Boston to Los sion, went ashore with the initial City VA Regional Office. Angeles-bound 767 jetliner he was wave of Marines tasked to take stra- During that period he was in- piloting was hijacked and crashed tegic Iwo Jima. For the next 13 mur- strumental in establishing a state into the south tower of the World derous days, he treated the injuries veterans cemetery, and a nursing Trade Center at 9:03 a.m., Sept. 11, of his comrades, dismissing the home at the VA hospital that now 2001. He left behind a wife and two shrapnel he had taken to his right bears his name. Today, he continues young daughters. eye, shoulder Two weeks earlier, as Saracini and back. celebrated his 51st birthday, his 13- On the year-old daughter Kirsten had given last day him a poem she wrote called “Years Wahlen was gone by.” She read it at the Sept. 18 on the island, memorial service attended by more he suffered a than 1,500 people. “And for all the third wound years that come, I know one thing when an ex- will never change, you will always ploding shell be my daddy and I will always feel shattered his the same. I love you.” right ankle. “I Staff at the Philadelphia VA bandaged my- Medical Center had been searching self up, took a for a location for a new outpatient shot of mor- clinic north of the city. On the day phine and of the tragedy, they finally found the crawled over future site. Eighteen miles from and started Philadelphia, the new clinic is adja- helping a Ma- cent to NAS Willow Grove, where rine that had Saracini once served, and not far both his legs from his Bucks County home. It was blown off,” he the search committee’s recommen- recalled. dation to name the clinic in honor Wahlen put of Saracini. tourniquets on Final plans are still being made the wounded for the official renaming of the Marine’s legs, Horsham, Pa., Outpatient Clinic to then tried to the Victor J. Saracini Department of attend to an- Veterans Affairs Outpatient Clinic. other Wahlen wounded George E. Wahlen comrade, but his injuries overcame to volunteer his time for veterans in By Oct. 5, 1945, George E. him. He was soon evacuated. Utah. Wahlen had spent seven months in Wahlen’s Medal of Honor cita- The official dedication cer- military hospitals recuperating from tion chronicles this final day of self- emony changing the name of the wounds sustained during the battle sacrifice on the island, along with Salt Lake City Veterans Affairs for Iwo Jima. He would spend two- his courageous actions throughout Medical Center to the George E. and-a-half more months and face 12 previous days as he saved many Wahlen Department of Veterans Af- three surgeries before finally going from his unit and 14 more from an fairs Medical Center is scheduled for home. But on this day at the Marine adjacent unit. Nov. 10. hospital at Camp Pendleton, Calif., After the war, Wahlen attended President Harry S. Truman pre- college and then joined the Army, By Robert Turtil

September/October 2004 21 feature VAnguard If Disaster Strikes, Will You Be Ready? At headquarters disaster preparedness event, the focus was on family.

ore than a dozen organizations were on hand at ■ Preprogram all telephones with emergency response the National Preparedness Month Open House and family contact numbers. Mheld Sept. 17 in VA Central Office to encour- ■ Teach children how and when to call 911, to make age disaster preparedness in the home and community. long distance calls and to use a cell phone. The focus was on family as employees learned to take ■ Select a local and an out-of-state family member or steps before disaster strikes. friend as a point of contact in case of separation. Terrorism and natural disasters can have similar ef- ■ Choose alternate meeting places if returning home is fects. This year’s devastating hurricanes led to 121 not an option. deaths in this country and thousands more throughout ■ If you have children in school, you need to fully un- the Caribbean. Buildings were destroyed, emergency ser- derstand the school’s plans during an emergency. Con- vices were stretched, communications, power, and clean sider partnering with other parents in your children’s water distribution were disrupted, and millions of classes to develop joint emergency plans and shared Americans evacuated to safer shelter as homes from pickups. Florida to Virginia were left in ruins. ■ Identify official evacuation routes beforehand. “It’s heartbreaking to hear the stories of people who ■ Teach family members when and how to turn off lose their homes,” said Inge Jelescheff, of the American utilities (but have professionals turn the gas back on). Red Cross, in remarks to the audience. “First they say how grateful they are to have survived. Then they say Create Home, Office and Grab-and-Go Evacuation how much they wish they had gathered some supplies Emergency Kits ahead of time—important papers, treasured photos, pre- For the home: Pack a duffle bag or box with up to a scription drugs, flashlights, food and water.” two weeks’ supply of food (canned, MREs, no-cook) and Undoubtedly, those who had prepared for such up- water (one gallon per person per day); manual can heaval had more control over their situation than those opener and other tools; first aid supplies and manual; who had not. So it was troubling that in an unscientific medical items/14-day supply of prescription drugs; flash- survey of Open House attendees, virtually none of the light; battery-operated radio; extra batteries; fire extin- VACO employees had a family disaster plan. guisher; cell phone/charger. Exhibitors offered information as varied as their For the office: Pack a hands-free backpack (so you functions, but their suggestions on what actions should can Grab and Go) with sturdy shoes; change of clothes be taken at home were strikingly similar. (seasonal—think long walk home); two bottles of water; food or snacks; toiletries/personals bag; small first aid Create a Family Emergency Plan kit/manual; flashlight; portable radio or walkman; extra Discuss emergencies that could take place, the dan- batteries. gers and appropriate responses to: fire, flood, severe Grab-and-Go kit for evacuation: Pack hands-free weather, earthquake, toxic spill or terror attack. backpacks, ready to Grab and Go. Make sure all family ■ Identify multiple escape routes from all rooms and members know where the backpacks are located. Pack from your home. three days of food and water for each person; manual ■ Run a family evacuation drill. Teach children to drop can opener, other utensils and tools; sleeping bags/blan- and roll to extinguish a fire, and to crouch/crawl below kets; change of clothes (seasonal); sturdy shoes; toilet- smoke. ries/personals bag; first aid kit and manual; 14 days of ■ Purchase appropriate fire extinguisher equipment and prescription drugs; extra pair of glasses/contact lenses; instruct in proper use. flashlight; battery-powered radio; extra batteries; plastic

22 September/October 2004 VAnguard feature

ROBERT TURTIL

Top left: The Veterans Canteen Service offers seven different emergency kits, sold at cost. Pictured is the Deluxe Emergency Three Day Survival Kit for Two; bottom left: The FEMA publication“Are You Ready? A Guide to Citizen Preparedness” contains a wealth of information on how to prepare for and respond to both natural and manmade disasters. It is available through the FEMA publications warehouse (1-800- 480-2520). Ask for publication H-34. Or visit www.fema.gov/areyouready; above: Inge Jelescheff, of the American Red Cross, discusses emergency preparedness with VA Central Office employee Margaret Dickinson.

utility bags of various sizes; toilet paper and paper tow- stander provides the first assistance on scene. els. Pack a Grab-and-Go kit for your pet, too. The Hu- The American Red Cross is offering a new 90- mane Society urges people who must evacuate their minute first aid and preparedness presentation, which homes to take their pets, but remember that most they’re promoting as “the fastest way to prepare for an emergency shelters will not accept pets. emergency.” And they continue to offer courses in first Consider the following for all kits: cash/credit aid, CPR/AED and disaster preparedness training. Visit cards; copies (preferably in electronic format stored on www.redcross.org for more information. CD) of documents such as medical records, passports, fi- The Community Emergency Response Team pro- nancial account numbers, insurance policies/inventory gram is offered through your local Citizen Corps. This of valuables, birth and marriage certificates, names, ad- free, 20-hour program trains volunteers in disaster pre- dresses and telephone numbers of doctors, and treasured paredness, small fire suppression, basic disaster medical photos; entertainment items, such as cards, books and operations, and light search and rescue operations. Visit toys. Also remember to rotate items with a shelf life ev- www.training.fema.gov for more information. ery three to six months. USA Freedom Corps (www.usafreedomcorps.gov) is The Veterans Canteen Service sells emergency kits a clearinghouse for information on volunteering with for office, home, car, camper, airplane and boat. Kits are thousands of organizations throughout the country, in- sold at cost, ranging from $12.99 for a car kit to $151.00 cluding AmeriCorps, Citizen Corps, Senior Corps and for the Deluxe Emergency Three Day Survival Kit for more. Many local mass transit authorities have begun to Two (candles included). offer citizen training to assist in disasters. Your local police might have a Police Reserve Corps to assist in ad- Get Training and Volunteer as Needed ministrative work and some traffic control. Of course, As VAnguard’s Heroes column illustrates, first aid, fire departments give training to volunteers. And don’t CPR and Automated External Defibrillator training forget to give blood. can save a life long before emergency personnel arrive. In 95 percent of all emergencies, the victim or a by- By Robert Turtil

September/October 2004 23 around headquarters VAnguard

Use of VA’s Electronic Health Record System Expanding

One of the world’s most so- for health. “The expertise we medications are safely distrib- says health care information phisticated electronic health have gained, however, be- uted and used; and special technology will enhance the record (EHR) systems will longs to the American pub- features such as narrative quality of the service, reduce soon become accessible to lic. Through our partnership notes entries, laboratory re- the cost of medicine, and en- community health clinics with CMS, VA will extend sults displays, consultation sure that patients are at the and private doctor’s offices. the benefits of VistA to the requests, and alerts when ab- center of the entire health VA and the Center for Medi- citizens who have supported normal results are found. care decision-making process. care and Medicaid Services its development with their Since 2000, an esti- “We are excited to make (CMS) are developing VistA- tax dollars.” mated 216,000 VA health electronic health records Office EHR, a modified ver- VistA and a new version care professionals have used available to providers in rural sion of the electronic health currently under develop- VistA and its Computerized and underserved areas,” he record system used at more ment, HealtheVet-VistA, of- Patient Record System said. “VA’s EHR has been de- than 1,300 VA facilities fer health care providers inte- (CPRS), which integrates all signed by clinicians and be- throughout the U.S. grated records covering all as- aspects of patient care and gan to be deployed in 1997. VA has used its pioneer- pects of patient care and treatment. The American We now use CPRS for pa- ing Veterans Health Informa- treatment and include clini- College of Physician Execu- tients in all care settings tion Systems and Technology cal reminders for preventive tives said the VA system was across the nation, and we are Architecture (VistA) elec- health care and disease man- “at the leading edge of tech- confident it will adapt well to tronic health record system agement; electronic pharma- nology and health care.” use outside the agency.” For for more than a decade. The ceutical order entry and Robert M. Kolodner, more information on VistA- system contains records on management with real-time M.D., acting VHA chief Office EHR, contact Gail the 5 million eligible veterans order checking to ensure health informatics officer, Graham, (202) 273-9220. who receive their health care from the department each year. VA and CMS hope to stimulate widespread adop- 2004 Veterans Day Poster tion of electronic health records throughout the U.S. by providing this high-qual- Stacie Stevens, an Air Force veteran from Anchor- ity public domain solution to age, Alaska, is the artist behind the 2004 national supplement EHRs available Veterans Day poster. The poster is derived from a from private vendors. Before photograph she took at an exhibit. She submitted making the system fully it in the Veterans Day category for this year’s Na- available, the agencies are tional Veterans Creative Arts Festival held Oct. 9- configuring VistA to meet 16 in Salt Lake City, Utah. the needs of clinics and phy- Veterans from VA facilities across the country sician offices, improving the are eligible to participate in the festival’s competi- OB/GYN and pediatrics tion. All submissions are forwarded to the Veterans components of the current Day National Committee, composed of represen- VistA system, simplifying in- stallation and maintenance of tatives from veterans service organizations. They VistA, and providing for review all submissions before selecting the winning storage of outcome measures entry. in a Quality Improvement VA employees are also eligible to participate in Clinical Data Warehouse. the national Veterans Day poster competition. Distribution of the software Submissions can take the form of a photograph, is expected to begin in late painting, collage, design or other medium. How- 2005. ever, all submissions need to be sent in Portable Document Format (PDF) to the “VA is proud to lead the Veterans Day coordinator at [email protected]. Visit the Veterans Day Web site health care industry in the at www.va.gov/vetsday to view Veterans Day posters dating to 1978. use of information technology,” said Dr. Jonathan Perlin, acting under secretary

24 September/October 2004 VAnguard around headquarters

It’s That Time: Get Ready for Federal Benefit Open Seasons

It’s that time again! The Starting this open sea- cal expenses. To learn more basis. Employees also receiv- Thrift Savings Plan (TSP) son, OPM is offering a new about HSAs, visit OPM’s ing child-care subsidies Open Season began Oct. 15 health care option called new Web site at www.opm. should remember that the to- and ends Dec. 31, followed Health Savings Accounts gov/hsa. tal amount of pre-tax funds by the Federal Employees (HSAs). HSAs provide em- The Flexible Spending combined cannot exceed Health Benefits (FEHB) and ployees additional opportuni- Accounts Open Season is $5,000. All funds over Flexible Spending Accounts ties to save and better man- held each fall and runs con- $5,000 must be reconciled (FSA) open seasons, which age their hard-earned dollars. currently with the FEHB with the IRS when filing run concurrently from Nov. Eighteen high deductible Open Season. During this taxes. Account elections will 8 to Dec. 13. health plans will be offered time, eligible employees may not automatically roll over to Employees are being en- by the FEHB program in elect up to $5,000 for a De- future years. FSA elections couraged to make open sea- 2005. These health plans, to- pendent Care FSA and/or are 100 percent voluntary. son elections through Em- gether with an HSA or a $4,000 for a Health Care More information and en- ployee Express at www. Health Reimbursement Ar- FSA. Employees who wish to rollment procedures can be employeeexpress.gov, and to rangement, provide a tax- establish a flexible spending found at www.fsafeds.com. contact their local Human advantaged savings vehicle account must do so during (See FAQs for information Resources office if they need for paying employees’ medi- open season on an annual on child-care subsidies). more assistance. During the TSP Open Season, eligible employees may elect, change, or termi- nate contributions. This VA, Home Depot Sign ‘Hire a Vet’ Pact open season, FERS employees may elect to contribute Secretary Principi took part in a news conference on Sept. 21, below, announcing an up to 15 percent and CSRS agreement with The Home Depot in which the nationwide firm pledges to reach out to employees up to 10 percent service-disabled veterans for the 100,000 jobs it expects to fill this year. of their basic pay each pay “America’s veterans are one period. In addition, partici- of this nation’s economic trea- pants who are age 50 or older may be eligible to make sures,” the Secretary said. “I sa- catch-up contributions, up to lute the leadership of Home Depot an additional $4,000 in cal- for recognizing the talent, maturity endar year 2005. and professionalism that veterans TSP has a new toll-free can bring to any job.” number: 1-TSP-YOU- Robert Nardelli, president and FIRST (1-877-968-3778) CEO of The Home Depot, Secretary and TDD 1-TSP-THRIFT5 of Labor Elaine Chao and Defense (1-877-847-4385) for the Department Under Secretary hearing impaired. For addi- David Chu joined the Secretary in tional details visit www.tsp. Washington, D.C., for the an- gov. MICHAEL L. MOORE During the FEHB Open nouncement. Season, eligible employees Under the agreement, Home will be able to enroll, change Depot committed itself to encourage service-disabled veterans to seek employment options and/or plans, reduce with the company. The firm also pledged to consider service-connected disabled veter- or cancel health insurance, as ans in issues affecting promotion and job mobility. The agreement provides for regular well as enroll or make contact between Home Depot stores and VA’s vocational rehabilitation and employ- changes to premium conver- ment staff. sion. FEHB plan guides and Founded in 1978, The Home Depot is the world’s largest home-improvement re- brochures are available on the tailer, with more than 1,800 stores and 300,000 employees. The company last year hired Office of Personnel nearly 10,000 veterans and expects to surpass that number this year. Management’s Web site at www.opm.gov/insure/health/ index.asp.

September/October 2004 25 around headquarters VAnguard

Robert W. Carey Organizational Excellence Awards Announced

Pharmacy Center in Albu- Like the clinical phar- querque, N.M., and the macy center, the White River White River Junction, Vt., Junction VAMC has a record VA Medical Center. Both or- of excellence in the Carey ganizations were honored award program. The center Sept. 30 during a ceremony won Carey achievement in Washington, D.C. awards in 2002 and 2003. The clinical pharmacy The experience helped lay center has a staff of 80 who the groundwork for reaching manufacture, package and the top award. The medical distribute pharmaceuticals. center follows four strategic They have dominated the themes for success: excellence Carey award health care cat- in clinical care and scholar- egory in the past, winning in ship; maximizing financial

ROBERT TURTIL 2001, 2002 and 2003. This resources; community stew- Left to right: Gary Steinberg, VA deputy assistant secretary for plan- year they grabbed the top ardship; and promoting a ning; Mike Sather, director of the VA Clinical Research Pharmacy award by relying on a proven healthy workforce and work Center; Dr. Jonathan Perlin, acting under secretary for health; Gary system that emphasizes qual- environment. DeGasta, director of the White River Junction, Vt., VA Medical Cen- ter; and Sen. James M. Jeffords (I-Vt.) at the awards ceremony. ity products, employee devel- The Carey program also opment, teamwork and recognizes category and safety. achievement award winners. Applicants for this year’s department’s top quality The White River Junc- The Amarillo, Texas, VA Robert W. Carey Organiza- award, the Carey Trophy. tion, Vt., VA Medical Center Health Care System was this tional Excellence Awards pre- The award is based on the is a 60-bed facility with ac- year’s category winner. sented a serious challenge for Malcolm Baldrige National tive research and education Achievement awards were judges trying to select the Quality Award used by orga- programs. The center pro- presented to the Durham, most quality-oriented organi- nizations around the world vides inpatient and outpa- N.C., VA Medical Center, zation in VA—the competi- to improve efficiency and tient care to approximately the Michael E. DeBakey VA tion was too close to call. performance. 23,000 veterans in Vermont Medical Center in Houston, In the end, judges an- Sharing the trophy are and four bordering counties and the Riverside, Calif., Na- nounced a tie for the the VA Clinical Research in New Hampshire. tional Cemetery.

Secretary Honored by End-of-Life Care Organization

Secretary Principi accepted the National Hospice and Palliative Care Organization’s Person of the Year Award, left, Sept. 30 at the group’s national leadership conference in Washington, D.C. The award recognized the Secretary’s leadership and support in establishing hospice and palliative care as an integral element of the VA health care system. During the last three years, VA has transformed its end-of-life care through partnerships with hospice providers and realigning its own hospice and palliative care program with performance standards, reimbursement policies, interdisciplinary team training and a budget. “The comprehensive hospice programs we encourage, and the skilled palliative care services we offer, together, stand among the most personally gratifying achievements of my tenure as Secretary,” he said in accepting the award. NHPCO is the oldest and largest nonprofit membership organization rep- ANN CZAPIEWSKI resenting hospice and palliative care programs and professionals in the U.S.

26 September/October 2004 VAnguard around headquarters

VHA Technical Career Field Interns Meet in Nation’s Capital

sume duties at VA health eligible. By 2010, 60 percent care facilities throughout the of all VHA employees will country. fall into that category. More than half of these For the incoming class interns are new to federal of 2004, VHA has continued employment. Along with fos- to refine the TCF program. tering diversity by increasing There are 172 internships female, ethnic and youth em- funded for 2004, in three ployment, the program, de- separate fields: executive, veloped as a strategic initia- technical and leadership. The tive by the VHA Succession need for new recruits has led Planning Committee, is de- the TCF program adminis- signed to bring in new em- trators to focus not just on ployees to “cut the head off younger potential employees,

ROBERT TURTIL the entrenchment that some- but to reach out to minori- The first graduating class of VHA’s Technical Career Field Intern times happens in government ties, as well. “While the pro- Program spent three days in Washington, D.C., this summer learn- hiring,” according to Bea gram strives to meet our ing more about VA. The program was developed as a succession Erickson, program director. need for succession,” planning initiative. Integrating the TCF In- Erickson explained, “it is also tern Program with succession meeting our need to increase The 132 members of the first ference in the nation’s capital planning is of vital impor- diversity.” graduating class of VHA’s marked the midway point in tance to VHA—a large num- Two more areas of con- Technical Career Field Intern this two-year program. When ber of its workers will be eli- centration, inventory man- Program spent three days in they complete the program gible for retirement in the agement and volunteer ser- Washington, D.C., this sum- in 2005, interns in 10 differ- coming decade. By 2005, 98 vice, were added to the 2004 mer learning more about VA ent areas of concentration, percent of senior executives, class. Learning how to man- and building working rela- including accounting, engi- 80 percent of chiefs of staff, age and appreciate volun- tionships with fellow interns neering, health administra- and 95 percent of nurse ex- teers, who provide invaluable in other disciplines. The con- tion and prosthetics, will as- ecutives will be retirement- assistance to VHA in serving veterans, is considered an important addition to the in- New Program Will Improve Informed Consent ternship program. The conference in Washington, D.C., featured VA is adopting a new com- about risks and benefits of stand their choices through top VA officials addressing puter program to help pa- proposed treatments, gener- discussions of proposed treat- the interns about the broader tients make more informed ates and stores consent ments, reasonable alternatives scope of the VA mission. decisions about their care. forms, incorporates elec- to proposed care, risks and Morning sessions were de- The department will intro- tronic signatures into records benefits of each alternative. voted to guest speakers in- duce its Electronic Support and imports information The iMedConsent soft- cluding Dr. Jonathan Perlin, for Patient Decisions initia- from patient records. Al- ware was developed under acting under secretary for tive at all 158 VA medical though the program is de- the direction of VA’s Na- health; Richard centers within a year. Cus- signed primarily to assist tional Center for Ethics in Wannemacher, acting deputy tomized software called physicians, it also guides in- Health Care by Atlanta-based under secretary for memorial iMedConsent will provide formed-consent discussions software developer Dialog affairs; and Jack McCoy, di- patients with information between doctors and pa- Medical. “We are always rector of VBA’s Education about treatment options and tients. looking for ways to enhance Service. In the afternoon, the standardize procedures The goal of the in- the care we provide,” said Dr. group members attended among clinicians. formed consent process is to Ellen Fox, center director. breakout sessions in their The iMedConsent pro- ensure that patients are “By supporting patient deci- area of concentration. gram takes physicians step by knowledgeable participants sions on a systems level, we On the last day of the step through the informed in decisions about their are preventing problems be- conference, relocation expert consent process, displays de- health care. It generally re- fore they arise. We like to call Pam Silvis addressed the tailed educational materials quires that patients under- this ‘preventive ethics.’” continued on page 28

September/October 2004 27 introducing VAnguard

Kim Dickey, R.N.

Kim Dickey, R.N., has met needed to use the bathroom. every type of veteran during I offered him a bedpan, but her 20-year career as a VA he insisted on getting out of nurse. Some are proud and bed and onto the bedside patriotic. Others bitter or in- commode. I thought this different. She listens to their might become a lot of stories, tolerating even the trouble, because he still had most far-fetched tales of bra- tubes and lines everywhere vado. Some she remembers, and it was quite an ordeal to but most she forgets. get him up to the bedside Dickey is the first to ad- commode. Once he was fi- mit that she might have be- nally in place on the com- come a bit “hardened” over mode, he was quite a sight— JAMES BROADUS the years. In a way, you al- naked, tubes everywhere, most have to, so you don’t bruised, bandaged, weak. Dickey get too attached. But some- “His TV was on and the thing happened May 29 to World War II Memorial of the national anthem. Tears ings in my heart for him and wipe away any trace of disin- dedication ceremony was be- filled my eyes as I only imag- the many men and women terest or detachment. So ing broadcast in the back- ined that moment through that have given the utmost. I moved was Dickey that she ground. I was oblivious to his heart and his eyes. am grateful to him for allow- wrote about her experience the ceremony since my focus “When I helped lower ing me to share that moment in the employee newsletter at was on the patient, making his arm, he thanked me, low- with him—for touching me, the Harry S. Truman Memo- sure he was tolerating being ered his head and relaxed for melting and reshaping a rial Veterans Hospital in Co- up on the chair, making sure back on the chair. He softly hard place in my heart, for lumbia, Mo., where she that his pain stayed under began recalling his wartime helping me to remember works. What follows are ex- control, and he didn’t have experiences and shared that why I’m here. cerpts from her story. any arrhythmias. he still grieved for his dead “I may not remember “It was a routine day in “After a few minutes he comrades. I was aware of a the patient’s surgery, how he the ICU—my assignment began to sob—body-shaking hard lump in my throat as I progressed post-operatively, was to care for a second day sobs that made me think he walked back across the room. his medications or how he open-heart surgery patient. would fall out of the chair. I I felt so unworthy to have recovered physically. But I His care up to that point had panicked for a split second as stood there holding up the will forever remember the been routine. He was getting I rushed to his side inquiring man’s arm. I felt so ashamed image of that ‘soldier’ and on in years, mildly over- what was wrong. He looked for my ‘routine attitude’ to- the priority he gave our na- weight and balding. He up at me, looked at the TV ward this veteran. tional anthem and his love seemed like most of the other and mumbled, ‘I can’t get my “I don’t remember much for the country he and thou- patients I care for here. arm up to salute.’ I was of the rest of that day, but I sands of his comrades fought “… He was taken off stunned. As I looked up to know I was privileged to ex- and died for. I hope that af- the ventilator and several the TV, the ceremony had perience a loyalty, a passion ter reading this others will re- hours passed before he spoke. just opened. I was moved be- and a love that is rare in think what we do here, be re- He was quiet and pretty yond words as I lifted and today’s world. My words of vitalized in our mission, and wiped out from his surgery. held his arm in place while appreciation for this veteran remember that things aren’t He let me know that he he saluted during the singing don’t come close to the feel- always as they seem.”

TCF interns continued from page 27 group on the details of the the area of the country where out the country. VA mission to be a part of relocation that many of the VHA has the greatest need According to Erickson, them in their hearts and interns will undergo at the for their individual expertise. the three-day conference was souls,” she said. “Once we do end of the two-year program. VA pays the cost of reloca- aimed at giving the interns a that, once they get that pas- As a condition of being action. This allows VHA to better sense of what VA’s sion for the veteran, they’ll cepted into the TCF pro- match the talent they are de- mission is and how it is ac- be here for 30 years, just like gram, interns must sign a veloping in the program with complished. me. We want them to catch clause agreeing to relocate to the need for talent through- “We’re trying to get the the bug.”

28 September/October 2004 VAnguard medical advances

Major Breakthrough group A strep infection, but on Strep Vaccine without the harmful auto For years scientists have immune response. sought a vaccine for group A “This vaccine is without streptococcal infections. The a doubt the most complex last human tests of a poten- vaccine that’s ever been intro- tial vaccine were conducted duced,” Dale told The Balti- in 1969. They were stopped more Sun. Larger trials to after two children came confirm the vaccine’s safety down with rheumatic fever. and effectiveness are ex- Now it appears the wait pected. may be over. A new group A streptococcal vaccine tested VA Beats Managed on 28 adult volunteers in the Care for Diabetes Baltimore area between 1999 VA patients with diabe- and 2003 showed promising tes are more likely to receive results—it was safe and recommended tests and have stimulated a significant im- better outcomes than man- mune response against the aged care patients, according infections. The study ap- to a study published in the peared in the August 2004 Aug. 17 issue of the Annals of ROBERT J. FORD issue of the Journal of the Internal Medicine. Dr. James Dale developed a promising new strep vaccine. American Medical Association. Researchers looked at Group A streptococcal 1,285 diabetes patients at a researcher at the VA Ann afford prescribed medications infections are responsible for five VA medical centers and Arbor Healthcare System and after researchers discovered a variety of illnesses includ- 6,920 patients in eight com- assistant professor at the Uni- some people skip doses to ing strep throat, rheumatic mercial managed health care versity of Michigan. In 1995, conserve pills, but never tell fever and toxic shock syn- plans. They compared how VA instituted a series of qual- their doctors. Not only is drome. The Centers for Dis- often patients received stan- ity improvements for manag- skipping doses potentially ease Control estimates that dard processes of care, such ing chronic diseases, includ- harmful, researchers found up to 10,000 cases of serious, as recommended tests, and ing diabetes. Many of the physicians could provide life-threatening infections oc- their outcomes related to dia- changes reflected recommen- other options if they knew cur in the U.S. each year. betes control. The VA pa- dations subsequently pro- patients were underusing. The new vaccine is a tients fared better on receiv- moted by the Institute of Researchers from the VA prototype invented by Dr. ing appropriate care and for Medicine. Health Services Research James Dale, associate chief of two of three outcomes. In “These results are en- Program, the University of staff for education at the many cases, the differences in couraging because they dem- Michigan and Stanford Uni- Memphis, Tenn., VA Medi- quality were significant. onstrate that optimizing how versity conducted the study. cal Center, and chief of in- The study showed 98 care is delivered can translate They surveyed 660 chroni- fectious disease at the Uni- percent of VA patients had into clinical benefits for pa- cally ill patients from across versity of Tennessee. Dale’s an annual foot exam com- tients. However, we still need the country that admitted to vaccine incorporates a geneti- pared to 84 percent of man- to learn more about which of cutting back on their medi- cally modified version of the aged care patients, and 91 the many changes the VA in- cations because of costs. strep bacterium’s M proteins. percent of VA patients had stituted improve quality the One-third of those patients Researchers have long an annual eye exam com- most, so that managed care never told their doctors they known that when separated pared to 75 percent of man- health plans can implement weren’t following the pre- from the bacterium, M pro- aged care patients. these in the most cost-effec- scribed dosages. Researchers teins could boost the body’s “The VA has instituted tive manner,” said senior au- found most patients who immune system. But inject- system-wide standards, inte- thor Carol M. Mangione, spoke to their doctor about ing these detached M pro- grated care and a way to M.D., professor of medicine underusing medications re- teins causes the antibodies to track and monitor how their at the David Geffen School ceived free samples, generic attack the body’s own tissues, patients are doing. Other or- of Medicine at UCLA. drugs or information on as- especially the heart and kid- ganizations can learn from sistance programs. neys. With genetic engineer- VA and how they achieved Coping with The complete study ing, Dale created synthetic their quality improvements Prescription Drug Costs findings were published in M proteins capable of build- over the last 10 years,” said Doctors are being urged to the Sept. 13 issue of the Ar- ing the body’s defense to lead author Eve Kerr, M.D., ask their patients if they can chives of Internal Medicine.

September/October 2004 29 have you heard VAnguard

This year’s winners are from health issues and received Young people taking the lead VA facilities in Tomah, Wis.; health care through the In- White City, Ore.; Seattle, dian Health Service. He had Wash.; Topeka, Kan.; Day- been denied an Agent Or- ton, Ohio; Boise, Idaho; and ange claim years ago, prior to Silver Spring, Md. changes making certain con- More than 120 veterans ditions presumptive, but did from several bands of the have a low-rated service-con- Chippewa and Ojibwe Na- nected disability for another tions attended a Native issue. His wife had once ap- American outreach event plied for a wheelchair from held Aug. 10-12 at Cass VA, but was overwhelmed Lake, Minn. Representatives with the paperwork and gave from VISN 23 (Minneapo- up. She heard about the out- lis), the Fargo, N.D., VA reach event and had to plead WALT CODY Medical and Regional Office with her husband to get him Center and the St. Paul, to go. Once there, however, High school students hosted the eighth annual POW/MIA Minn., VA Regional Office he met with service officers Recognition Day Ceremony Sept. 17 at the Prescott, Ariz., joined veterans service orga- and was rated 100-percent VA Medical Center, above. Many are members of the nizations and other agencies disabled with a one-year ret- hospital’s youth volunteer program. They put on the cer- at the event. The story of a roactive award. He also got emony as a tribute to servicemembers held prisoner of tribal elder and Navy veteran help with the paperwork for war or declared missing in action. who served in World War II, a wheelchair. The veteran James Gray served as master of ceremonies. He Korea and Vietnam typified later commented that the VA has more than 500 volunteer hours at the medical center the event’s purpose. The vet- of today is “so much better” and is a recipient of the National Disabled American Vet- eran had diabetes and other than it was before. erans Jesse Brown Memorial Scholarship. Members of the Central Arizona Young Marines served as color guard and the Hi-Lites from Prescott High School performed a musical tribute. “The veterans really enjoy seeing the younger generation. It lets them know they are not for- gotten,” said Brenda Autery, of Voluntary Service.

VA medical facilities oc- sion, is an inpatient in the casionally host military medical center’s spinal cord award ceremonies where vet- injury unit. erans receive combat decora- Results are in for the tions they earned long ago 58th annual Bowlers to Vet- but never formally received. erans Link bowling tourna- The McGuire VA Medical ment. The event attracted 45 Center in Richmond, Va., bowling teams nationwide. hosted just such a ceremony Teams are organized through this summer. Except the Recreation Therapy or Vol- Testing disaster readiness decoration wasn’t earned in untary Service sections at VA World War II, Korea or Viet- hospitals, and office manag- The Lexington, Ky., VA Medical Center led a large-scale nam. In this ceremony, Staff ers at VA clinics and vet cen- disaster drill involving medical facilities from 20 sur- Sgt. Eugene Simpson re- ters. They play at community rounding counties. As part of the drill, “patients” were ceived a Purple Heart for bowling alleys and submit unloaded and triaged by VA staff at Bluegrass Airport combat wounds sustained in their scores to BVL head- before being sent to community hospitals. The exercise Operation Iraqi Freedom. quarters by mail, fax or the was a test of the National Disaster Medical System. Simpson, who served with Internet. Winners are then the Army’s 1st Infantry Divi- chosen in specific divisions.

30 September/October 2004 VAnguard honors

from the James A. Haley VA from traumatic injuries at Serving Alzheimer’s patients Hospital in Tampa, Fla.; Walter Reed Army Medical Francine C. Fraser, VISN 3 Center. Susan Eddy, an oc- (Bronx); and Rowland A. cupational therapist at the David Loreck, M.D., a psy- Christian, New Orleans VA Cheyenne, Wyo., VA Medi- chiatrist with the VA Regional Office. cal Center, won the Maryland Health Care Jim Young and Verda association’s scholarship com- System and assistant pro- Blome, volunteers at the petition and received a fessor at the University of Michael E. DeBakey VA $2,500 scholarship to con- Maryland School of Medi- Medical Center in Houston, tinue her education. cine, received The Daily were named Volunteers of Record newspaper’s 2004 the Year by the American Le- Maryland Health Care He- gion and American Legion roes Award. Loreck was Auxiliary. Young, who serves as a greeter at the hospital’s Helping nominated by the state information desk, has been a soldiers and chapter of the Alzheimer’s Loreck volunteer since 1993. Blome Association for his leader- volunteers in the surgery their families ship and service to Alzheimer’s patients and their fami- waiting area, comforting pa- lies. In the mid-1990s, Loreck co-founded an outpatient tients who are being trans- clinic at the Baltimore VA Medical Center that provides ferred from surgery to the full medical, cognitive, functional and psychosocial nursing ward. She has accu- evaluations for Alzheimer’s patients. By providing all ser- mulated more than 10,000 vices during a single visit, the clinic eliminates the need volunteer hours. for patients to make multiple trips to the hospital. Basil White, a management analyst with the Office of Information and Technol- ogy in VA Central Office, was chosen as the sole VA in- structor for the Presidential Two VA Voluntary Ser- the Virtual Learning Center, Classroom, a weeklong edu- vice officers were recognized an online database of best cational program for high- by professional organizations. practices throughout VA lo- achieving high school stu- Gloria Mancuso, manager of cated at www.va.gov/vlc. dents. The program, held at Luke the Voluntary Service pro- Among the VISN’s top sub- Georgetown University in gram at the Providence, R.I., missions is an idea for reduc- Washington, D.C., is de- Darren Luke, an assis- VA Medical Center, was ing time card limits to help signed to introduce students tant coach on the rating elected president of the New decrease the potential for to careers in public service. board at the Winston- England Association of Di- credit card fraud, submitted The Leadership VA Salem, N.C., VA Re- rectors of Healthcare Volun- by Angela Micalizzi and Dan Alumni Association recog- gional Office and cap- teer Services at their spring Downey, from the VA New nized three employees during conference in Chatham, York Harbor Health Care their leadership forum Aug. tain in the U.S. Army Re- Mass. The association is a re- System. 23-25 in Miami. Linda F. serve, was recognized gional affiliate of the Ameri- Five employees were Watson received the as Army Reserve Family can Hospital Association. honored for advancing equal association’s 2004 honorary Program Staff Member Bonnie Gunter, chief of Vol- employment opportunities in leadership award in the se- of the Year during an untary Service at the Hines VA during the Secretary’s nior executive category. Aug. 22 award cer- VA Hospital in Illinois, re- 15th Annual EEO Awards Watson began her VA career emony. The national ceived the Administrator of ceremony July 21 in Wash- as a nurse technician. Today award cited Luke for his the Year award from the As- ington, D.C. They are: she is director of VISN 7, “selfless service and sociation for Volunteer Ad- Sherry A. Zahirniak, from headquartered in Atlanta. untiring devotion” in ministration. the Waco, Texas, VA Re- Jim Mayer, LVA executive supporting the Army Re- VISN 3 was honored gional Office; William director, received the honor- during a June 2 ceremony at “Birt” Fraser, from the ary leadership award in the serve Family Readiness the Bronx VA Medical Cen- Fayetteville, N.C., VA Medi- GS 13-15 category. He was Group. ter for having the highest cal Center; Richard A. Sil- recognized for mentoring number of submissions to ver, who recently retired wounded soldiers recovering

September/October 2004 31 heroes VAnguard

cerned for him and his back and used his extin- Airborne emergency care neighbors,” she said. She guisher to put out the fire. learned the veteran had a He then gave it to the car’s stockpile of weapons in his owner to use in case the fire home and was prepared to flared up again. use them. She gained as Police Officer Howard much information as possible Spall saved the life of an 81- for VA Police Officers Jason year-old outpatient who Harrington and Raymond started choking in the can- Christie to provide local po- teen at the Spokane, Wash., lice who were enroute to the VA Medical Center. Spall veteran’s house. She kept the saw the veteran leaning over veteran on the phone until a table and grabbing his police arrived and convinced throat. His wife was there him to surrender peacefully but she was unable to help. so he could receive the help Spall approached the couple LYNNE KANTOR he needed. “This was a real and told the man he was go- Bronx VAMC nurse Corine Wright came to the aid of an team effort and I’m just glad ing to help. He then stepped ailing passenger on an airliner. to be a part of it,” said behind him and performed Bower. the Heimlich maneuver. On Corine Wright, a registered nurse on the intensive care VA police officers Rich- the third attempt, he success- unit at the Bronx VA Medical Center, was flying to Ja- ard Gliem, Raymond Show- fully dislodged a piece of maica with her husband and grandson when a fellow ers and Richard Steffen re- meat that was blocking the passenger became ill. Flight attendants got on the in- sponded when an elderly pa- man’s airway. The veteran tercom and asked if there was a doctor or nurse on tient crashed his car near the and his wife praised Spall for board. Wright responded and found the passenger in main building at the Des his quick actions. Moines Division of the VA Kathleen Painter, a reg- and out of consciousness and complaining of Central Iowa Health Care istered nurse at the lightheadedness. She was completely disoriented. System. The patient was try- Martinsburg, W.Va., VA Wright spoke with her husband and learned the ing to park, but instead of Medical Center, was relaxing woman had asthma and hypertension, but hadn’t taken hitting the brakes he stepped with her daughter-in-law at a her medicine that morning. She administered oxygen on the gas. The vehicle nearby swimming area. They until the woman regained consciousness. At that point, climbed an embankment, had not been there long the woman decided to take her asthma medication and crossed the street and slid when Painter’s daughter-in- began chugging it from the bottle. Wright realized the down another steep embank- law called for her to help as woman was likely overdosing on her medicine. She ex- ment before rolling over onto the lifeguard carried a small plained that this could be making her sick and in- the passenger side, trapping body from the water. Painter structed her on how to take the medication properly. the driver. The officers used a immediately found herself crowbar to pry off the bro- administering CPR to a 3- Wright stayed with the woman and monitored her con- ken windshield and rescue year-old boy. The youngster dition until they arrived in Jamaica, where an emer- the man. They kept him was totally unconscious but gency medical team was waiting. calm as they waited for para- eventually responded to ver- medics. He was treated and bal stimuli. He was trans- released with minor injuries. ported to the local commu- Larry Hardesty, safety nity hospital and then to officer at the Robert J. Dole Children’s Hospital in Wash- Teamwork between VA cerned for his safety and sig- VA Medical Center in ington, D.C. When com- police and local officers naled for colleagues to notify Wichita, Kan., was driving to mended for her actions, and averted a potential tragedy VA police and Kay Bower, a work on Sept. 8 when he saw for being at the right place at after a distraught veteran mental health nurse who a car on fire. He pulled to the right time, Painter simply called the telephone care pro- handles calls from patients at the side of the road and said, “I was just there and gram at the Salisbury, N.C., risk of hurting themselves or grabbed his fire extinguisher. God had control of this situ- VA Medical Center. Regis- others. As soon as she got on As he neared the vehicle, he ation.” She is grateful for her tered nurse Cynthia Ware the phone, Bower knew this saw the owner spraying work experience and the con- answered the call. As she would be an intense call. “He cleaning solvent at the fire, tinuing education the medi- talked with the veteran, she was giving me information causing the flames to spread. cal center provides and en- became increasingly con- that made me extremely con- He told the owner to step courages.

32 September/October 2004