Winter 2009/2010

Wounded Warrior Care Tragedy in Texas Recovery Act Spending Testing Disaster Readiness Features

Tragedy in Texas 6 VA offers support and mourns its own losses at Fort Hood Recovery Act Spending 11 Stimulating more than the economy 6 Building a Better Arm 14 Amputee veteran is on a mission to revolutionize prosthetics Charting a Course Towards Readjustment 16 Outward Bound partners with VA to offer expeditions for veterans Testing Disaster Readiness 18 National exercise evaluates new equipment and technology Better Care for Wounded Warriors 20 VA polytrauma team’s overseas visit furthers collaboration with DoD The Unbreakable Code 23 11 Navajo warriors are seeking support for a Code Talkers museum Veterans Day 2009 25 A photo tour of observances around the Department

Departments

3 Feedback 31 Medical Advances 4 Outlook 33 Have You Heard 5 News You Can Use 36 Honors 25 26 Around Headquarters 39 Heroes 30 Introducing 40 Pearl Harbor

VAnguard VA’s Employee Magazine On the cover Winter 2009/2010 Wounded troops from Afghanistan and Vol. LV, No. 6 Iraq arrive at Scott Air Force Base in Printed on 50% recycled paper Illinois, one leg of their long journey to various military and VA medical facilities Editor: Lisa Gaegler across the country. Their trip back to the Assistant Editor/Senior Writer: Gary Hicks states began at Landstuhl Regional Medical Photo Editor: Robert Turtil Center in Germany. A VA polytrauma Staff Writer:Amanda Hester team recently visited Landstuhl to gain valuable insights into wounded warrior Published by the Office of Public Affairs (80D) transport and care transition from DoD to VA. photo by Senior Airman Teresa M. U.S. Department of Veterans Affairs Jennings/U.S. Air Force 810 Vermont Ave., N.W. Washington, D.C. 20420 (202) 461-7427 E-mail: [email protected] To Our Readers: A Change for the Better www.va.gov/opa/publications/vanguard.asp You may have noticed that we’re calling this the Winter 2009/2010 issue. That’s not because we’re changing VAnguard from a bi -monthly to a quarterly. It’s to allow us to adjust our production schedule and bring the magazine to you in a more timely manner. Look for the next issue, March/April, in early March.

2 VAnguard • Winter 2009/2010 FEEDBACKFEEDBACKOUTLOOK

Where are the OEF/OIF eration Iraqi Freedom. August 2008, the VA volun- working there, volunteering Women Veterans? With my family’s help, I teer office suggested that I 80 to 90 hours each month in I always look forward to read­ wanted to give something back transfer my volunteer services conjunction with VA. It keeps ing each issue of VAnguard to the VA volunteers and those to the Hawaii State Veterans me mentally alert! as I find many of the articles who work so hard at our VA Cemetery, which is now do- D. Zane Schlemmer informative, educational, or hospital to help us recover. So ing veteran burials since the D-Day Veteran/Volunteer just plain inspiring. When I I started a T-shirt company National Memorial Cemetery State Veterans Cemetery saw on the cover that the Sep­ that gives its profits to VA vol­ of the Pacific is full. So I’m Hawaii tember/October issue included unteers and disabled veterans. an article on “The Nation’s I was honored that James A New Look for the Web Site Newest Veterans,” I eagerly Leahy, VA Canteen Service flipped to the article, only to supervisor, and Craig Fishbein, Same name, new face! On Veterans Day, VA rolled out the first be disappointed. Oklahoma City VA Medical phase of a large-scale Web renovation. This was a great op­ Center canteen supervisor, This is the first and most visible step in changing VA’s Web portunity to focus attention took a chance and allowed me domain to better serve veterans and their families by making it on women veterans as a sig­ (showed me, encouraged me) easier for them to find the information they need about benefits nificant portion of our newest to become a VA vendor. Craig and programs. Long term, VA’s goals for its Web presence are veteran population. While has ordered from my company to make it easier and more inviting for veterans by focusing the article did make mention twice. I used the profits to buy on topics and tasks rather than office functions, improving the of women in a few places, it Wii Fit games, TVs and more navigational disappointingly did not in­ for Richard Maxey, VA volun­ structure, and clude any photos of Operation teer supervisor in Oklahoma making it Enduring Freedom/Operation City. more visually Iraqi Freedom women veter­ I hope my company appealing. ans. grows to do more to give back The As women are in combat to the finest hospital and its new Web site zones, experiencing combat, staff, who really do care for design will though not assigned to infan­ its veterans. Not only getting cover more try or battery combat units, us well, but wanting us to be than 500 VA they very much are the face successful. My company Web Web sites and of our newest veteran. It is site is www.sittinprettyusa.com. about 80,000 often not VA staff but other Thank you for helping our pages. Ma­ older veterans and the public veterans. jor changes that don’t see the faces of Larry Van Schuyver include our newest combat veterans. Patient improve­ This article would have been Oklahoma City VAMC ments to the a great format to assure that navigational we all see women as not only 65th Anniversary structure that veterans but OEF/OIF combat of D-Day ensure consis­ veterans. You can imagine my surprise tency among all sites and consolidate major topics; a slideshow Thank you for your when I received and read the section that showcases current VA events or hot topics; and bot­ continued work and great July/August issue and found tom columns that feature news items, highlights and a “Quick magazine. my picture on pages 28 and List” with links to important applications such as Veterans On Kathy Zima-Sauer 30 with the article, “65th An­ Line Applications (VONAPP) and MyHealtheVet. Check out Women Veterans Program niversary of D-Day: France VA’s new Web face at www.va.gov. Manager Remembers.” VA Eastern Kansas Health Never in my wildest Care System dreams did I ever expect to be awarded the French Legion of We Want to Hear from You Canteen Service Giving Honor medal by the French Have a comment on something you’ve seen in VAnguard? Back to Veterans President Nicolas Sarkozy and We invite reader feedback. Send your comments to van­ I wanted to write and tell you to meet our President Barack [email protected]. You can also write to us at: VAnguard, Office how your Canteen Service is Obama, who mentioned me in of Public Affairs (80D), Department of Veterans Affairs, 810 giving back to veterans. I am his address there. Quite above Vermont Ave., N.W., Washington, D.C., 20420. Include a retired Navy Reserve master and beyond! your name, title and VA facility. We won’t be able to pub­ chief. I am 100 percent dis­ I also wanted you to lish every letter, but we’ll use representative ones. We may abled due to injuries received know that I’ve been a VA need to edit your letter for length or clarity. during my two tours in Op­ volunteer for many years. In

VAnguard • Winter 2009/2010 3 OUTLOOK

National Cemeteries: Transforming for the 21st Century Steve L. Muro Acting Under Secretary for Memorial Affairs

As VA Secretary Eric K. Virtually all NCA direc­ choose either the new medal­ ing of Washington Crossing Shinseki leads the department tors, foremen and other man­ lion, or a traditional govern­ National Cemetery in Bucks in fundamental and compre­ agers have attended superviso­ ment headstone or marker, County, Pa., in early 2010. In hensive change to become a ry and leadership training, and to memorialize veterans who late summer 2010, VA plans 21st-century organization, the front-line employees regularly died on or after Nov. 1, 1990, to conduct first burials at a National Cemetery Adminis­ attend courses related to their and are interred in privately- cemetery expansion to be con­ tration is striving to improve job functions, such as heavy marked graves in private cem­ structed on land leased from the access and quality of ser­ equipment operations, safety, eteries. We anticipate that the the Department of the Navy vices available at VA national landscape maintenance, cus­ medallion will be available in at Marine Corps Air Station cemeteries. tomer service or other topics early 2010. Miramar, Calif. Administered Already a national leader associated with the operational NCA’s newest responsi­ by Fort Rosecrans National in veteran-client service, NCA requirements of NCA. bility is to process first notices Cemetery, this expansion will earned the highest overall rat­ VA has streamlined the of death for veterans. In fiscal resume the option for the ing in customer satisfaction of process of burial eligibility year 2009, NCA captured and interment of casketed remains any federal agency or private determinations and interment entered data into VA informa­ for thousands of veterans in corporation participating in scheduling with establishment tion systems that ensured the the San Diego area. the American Customer Satis­ of the National Scheduling necessary discontinuance of Gravesite expansion faction Index survey, achieving Office, also located in St. Lou­ approximately $17.4 million projects are now underway to a score of 95 out of 100 in is. By January 2010, this office in monthly compensation pay­ ensure uninterrupted service at 2007. Our goal is to further improve the caring and com­ Our goal is to further improve the caring and passionate service that veterans receive at national cemeteries. compassionate service that veterans receive at national According to NCA’s cemeteries. internal 2009 Survey of Cus­ tomer Satisfaction: will handle interment requests ments for deceased veterans, 43 existing national cemeter­ n 95 percent of respondents for all VA national cemeter­ thereby contributing to the ies across the United States. rated the quality of service re­ ies, except those located in proper stewardship of funds. Seven new state veterans cem­ ceived from VA cemetery staff Puerto Rico and Hawaii. As We are now coordinating eteries—established through as excellent; a one-stop scheduling center, procedures to fulfill other VA the State Cemetery Grants n 98 percent rated the appear­ the National Scheduling Of­ responsibilities following the Program—are also under con­ ance of VA national cemeteries fice ensures timely, consistent death of a veteran, such as the struction. With the opening of as excellent; and eligibility determinations and cancellation of medical ap­ these new cemeteries, 90 per­ n 98 percent would recom­ is available for families and pointments and shipments of cent of veterans will have rea­ mend a national cemetery to funeral homes to schedule prescription medications. sonable access to burial space veterans’ families during their burials seven days a week. This Five new national cem­ in a national or state veterans time of need. innovation has freed cemetery eteries opened in 2009 to serve cemetery by the end of fiscal These results are a testa­ staff to devote more time to the areas of Columbia, S.C.; year 2011. ment to the dedication and their primary mission of serv­ Sarasota and Jacksonville, Nearly 20 percent of hard work of NCA employees ing veterans and their families. Fla.; Birmingham, Ala.; and NCA permanent hires in fis­ as they serve veterans and their VA is expanding the Bakersfield, Calif. As a result, cal year 2009 were veterans of families during difficult and government headstone and 668,000 previously unserved Operation Enduring Freedom/ emotional times. Our pro­ marker program to include veterans now have access to Operation Iraqi Freedom. grams for employee develop­ a new medallion option to a burial option in a national With more than 70 percent of ment—which are centered at acknowledge and honor the cemetery within a reasonable our permanent employees be­ our National Training Center service of eligible veterans bur­ distance (75 miles) of their ing veterans, all NCA employ­ in St. Louis—are crucial to ied in private cemeteries. This residence. ees understand the meaning of maintaining VA cemeteries as new product will be affixed to In the Philadelphia re­ service. They are committed national shrines, and to pro­ existing privately purchased gion, more than 580,000 to making VA an organization viding outstanding service at headstones and markers. Fam­ veterans will have access to a that is people-centric, results- every national cemetery. ily members will be able to burial option with the open­ driven and forward-looking.

4 VAnguard • Winter 2009/2010 NEWS YOUOUTLOOK CAN USE

First Lady Visits VACO to Thank Employees for Their Dedication

First Lady Michelle Obama made the 12th stop on her tour of federal agencies and departments when she visited VA Central Office on Oct. 20 to thank employees for their hard work and dedication to serving veterans. Speaking in the second- floor conference center to a gathering of employees who got randomly distributed tickets to the event, Obama joked about having to be driven the two blocks from the White House to VACO in­ First Lady stead of simply walking across Michelle Obama Lafayette Park. She also drew and Secretary Shinseki greet laughter from the crowd when VACO employees she said that she was supposed gathered in a to come earlier in the year, basement confer - but got “bumped” by her robert turtil ence room. husband—the President came in March for the celebration Taylor; Marilyn Twombly; realizes his efforts are only as ing, Obama shook hands and of VA’s 20th anniversary as a and Al Zanella. strong as the people on his posed for photos with employ­ Cabinet-level department. “One of the reasons why I team, the First Lady added ees; earlier, she greeted a larger Obama was introduced do this is because so often fed- that “it’s just important for group of employees who had by VA Secretary Eric K. Shin­ eral employees feel underap­ you to know that the President gathered in a basement confer­ seki, and joined onstage by preciated,” Obama said. “You and I are proud of you, just ence room to watch the event, several long-serving depart- often get a lot of the blame as proud as we are of the men which was broadcast live on ment employees: William R. but sometimes none of the and women who serve this VA’s television network. It was Bremby; Patricia J. Covington; thanks. And my simple job is country, the people that you also live-streamed, and avail­ Dorothy Dillard; James S. Mc­ to say thank you, because the serve. And we just urge you to able to employees around the Cain; David P. McLaughlin; job that you do is a big one.” keep it up.” nation via satellite and closed Loretta R. Rocko; Ralph L. Noting that the President After she finished speak- captioning capabilities. Under Secretary for Benefits Dunne to Step Down in Early 2010

VA Under Secretary for Benefits Patrick W. Dunne announced his resignation on Nov. 20, effec­ tive early next year. Dunne, who attained the rank of rear admiral in the Navy, has been with VA since 2006. As Under Secretary for Benefits since October 2008, Dunne has directed the administration of VA’s disability compensation, pension, education, home loan guaranty, vocational rehabilitation and employment, and life insurance programs through a nationwide network of 57 regional of­ fices, other special processing centers, and Veterans Benefits Administration headquarters. “I’ve appreciated the wonderful opportunity VA has given me to serve our nation’s veterans and their families,” said Dunne. “We have an obligation to care for our heroes and their depen­ dents, and I will fully support the transition of my successor to meet that moral responsibility.” “Pat Dunne has guided the Veterans Benefits Administration through a number of challenges during his tenure as Under Secretary. I applaud his service and loyalty to our team and thank him for his unfailing commitment to our nation’s veterans,” said VA Secretary Eric K. Shinseki. Born in Washington, D.C., and raised in Troy, N.Y., Dunne earned his undergraduate de­ gree in mathematics from the U.S. Naval Academy, and a master’s in mathematics from the Naval Patrick W. Dunne Postgraduate School. He is also a graduate of the Navy’s nuclear power training program.

VAnguard • Winter 2009/2010 5 First respond- ers transport a wounded soldier to an ambulance at Fort Hood, Texas, where a gunman’s attack on Nov. 5 left 13 dead and doz- ens injured.

u.s. army Tragedy in Texas In the midst of providing mental health services and other support to the Fort Hood community following the tragic shootings, VA mourned its own losses from the violence. ‘I need to do this’ Fort Hood, Texas, after Maj. Nidal need to help them.” Russell G. Seager, 51 Hasan allegedly went on a shooting Seager told his friends he was He didn’t have to do what he did. But spree. inspired to join the military after 9/11. then again, talk to people who knew Seager arrived at the post hours While teaching at Bryant and Strat­ him best, and they’ll tell you that for earlier en route to Afghanistan, where ton College, he interviewed for a new Russell G. Seager, there was no other he would be on the front lines to help position at the VA medical center way. And that’s what made him such soldiers with mental health issues im­ that would incorporate mental health a special person, and made his death mediately, instead of waiting until treatment into the primary care clinic. that much harder to take. It was also they got back home. He had joined Some veterans “are afraid to go to a stark reminder of the dangers troops the Army Reserve only four years mental health because of the stigma, face on a daily basis in the current earlier and pushed hard to get the de­ so we wanted to have a total approach wars. ployment. to help them,” explained Jim Bode, Seager, 51, a nurse practitioner “Russ, why do you need to go?” the primary care program manager who specialized in mental health Jennifer Hauger, his friend and col­ who interviewed and hired Seager. treatment at the Clement J. Zablocki league in the primary care clinic, re­ “I think he just loved to take care VA Medical Center in Milwaukee, called asking him. of vets. It was a passion of his. That’s was one of 13 people killed Nov. 5 at “I need to do this,” he told her. “I why he joined the Army in his mid-

6 VAnguard • Winter 2009/2010 40s. He wanted to do this. He needed Sue Lemcke, a nurse who worked Everyone’s Best Friend to do this,” Bode said. “We could tell in the office next to Seager, said he Juanita L. Warman, 55 when we interviewed him that he was took each case personally. “I remem­ More than 1,200 miles separate Fort really compassionate and really cared. ber he was treating a young man, and Hood, Texas, from Perry Point, Md., He called on his patients, scheduled I could tell by the tone of his voice but the tragedy that took place there his patients. He didn’t like just giving when he said ‘goodbye’ that he was Nov. 5 sent shock waves through the that to other people to do. He really really affected. He told me it was be­ Perry Point VA Medical Center and built a relationship with them. It’s go­ cause the man was close to his son’s the rest of the VA Maryland Health ing to take a long time to find some­ age, and he felt that connection.” Care System. Counted among the 13 one like him.” In the primary care clinic, there lives lost in the shootings was Juanita Although he believed he could are still little things to remind his co­ L. Warman, a 55-year-old nurse prac­ best serve the soldiers on the front workers of his presence. They wear red titioner and Army reservist who lines, it was tough for him to leave. ribbons with gold stars on their lapels, worked at the Perry Point VAMC. “He was very worried about his pa­ in honor of his service. tients here and wanted to make sure Lemcke, along with fellow nurse they were taken care of, and he want­ Laurie Lange, can’t help but smile as ed to make sure his position would be they talk about the last gift Seager here when he came back,” Bode said. gave them before he left—a peace lily Rev. Norm Oswald, chief chap­ plant in a glass that reads: “HOOAH! lain at the medical center, said his It’s an Army thing.”

u.s. army Juanita L. Warman Warman had been an integral and valued member of the Trauma Recovery Program team at the medi­ cal center since October 2005. Her colleagues said she took great pride in her work serving veterans as part of the VA Maryland Health Care Sys­ tem’s Returning Veterans Outreach courtesy of seager family Education and Care Program. Russell G. Seager “I always thought of Juanita as patients also knew they had someone “He made us promise that we ageless. She was everyone’s best friend special in Seager. “One of his patients would take care of it while he was because she got along with every­ told me that Russ wasn’t afraid to gone,” Lange said, blinking back tears. body,” said Dr. Christina Watlington, come into the darkness with him, and “Even though it was in pretty bad a staff psychologist who worked daily he stayed there until there was light. shape,” Lemcke added. “So we pulled with Warman. “She was a courageous To Russ, these were not patients. off the dead leaves and we fertilized it, woman who was truly dedicated to They were human beings with needs. and brought it back. New leaves are helping veterans.” They were not customers. He rebelled budding on it right now. We want to Warman, a lieutenant colonel against that word. They were fellow give it to his family because, for us, in the reserves who was about to em­ humans and he wanted to help them. that symbolizes that Russ is still here.” bark on her fourth deployment with It was really a gift that he could con­ her Kansas-based unit, the 1908th nect on their level.” By Gary J. Kunich Medical Detachment Combat Stress

VAnguard • Winter 2009/2010 7 Control, was highly respected by her men and women as they reintegrated ferral services in the aftermath of the colleagues for her knowledge of the into their local communities. She will tragedy. military and the psychological needs be greatly missed by her co-workers The 39-foot vehicles, outfitted of returning combat veterans. She ac­ and patients alike.” with two confidential counseling tively participated in outreach events Warman earned both bachelor’s rooms and state-of-the-art satellite for returning veterans and assisted and master’s degrees in nursing from communications, came from Fay­ the National Guard with the design the University of Pittsburgh. Born etteville, Ark., New Orleans, San and implementation of the Beyond into a military family, she “loved the Antonio and Midland, Tex. With 50 the Yellow Ribbon Reintegration Army and her family,” said her half- of these vehicles nationwide, the vet Program. Warman considered the sister, Kristina Rightweiser. Instru­ center program had the perfect tool military her family, which she demon­ mental in creating a Cognitive Pro­ for a quick VA response to this emer­ strated through her dedication to her cessing Group for veterans, Warman gency. work, particularly with returning and always found time to deliver profes­ Within hours of the shootings, women veterans. sional presentations to social workers Readjustment Counseling Service de­ “Ms. Warman was a brave Ameri­ and other health care professionals veloped an integrated plan and began can who voluntarily served in the who work with returning veterans and mobilizing the vehicles and bringing U.S. Army Reserve to protect and military families. staff to the area to provide counsel­ defend the freedom and liberties we “She was especially interested ing services to people impacted by cherish in this great nation,” said in helping women veterans,” said Lt. the tragic event. While the mobile Dennis H. Smith, director of the VA Col. Michael Gafney, who runs the vet centers were en route, the Killeen Maryland Health Care System. “Her reintegration program for the Mary­ Heights Vet Center was in full gear, selfless sense of commitment extended land National Guard. “That topic was staying open late and working over­ to her career here, where she gave dear to her heart. She loved meeting time to ensure that every client had generously to support returning service with and helping women soldiers been contacted to see how they were through the long and, many times doing. lonely, path they faced after returning Arriving with the mobile vet cen­ More VA Connections from war.” ters were more than 30 vet center staff Dorothy carskadon, 47, a social A resident of Havre de Grace, members from across the country. Lo­ worker and team leader at the Va Md., Warman helped establish the cated on-base at the PX and off-base vet center in madison, Wis., was post-traumatic stress disorder instruc­ at community centers, the four mobile wounded in the fort Hood attack. tion portion of the Yellow Ribbon vet centers, equipped with counselors a captain in the army reserve, she Reintegration Program for Maryland, and outreach workers, began seeing was preparing to deploy to afghani­ and she assisted Guard members and people immediately. stan with the madison-based 467th reservists returning from Afghanistan “The vet center staff who re­ medical Detachment. and Iraq with acclimating to civilian sponded to the Fort Hood tragedy carskadon has been team lead­ life. went above and beyond in assisting er at the madison Vet center since “We mourn the loss of someone the local community,” said Dr. Al­ 2006. she was released from Darnall who gave so much for others,” said fonso Batres, chief officer of Readjust­ army medical center at fort Hood to Brig. Gen. James Adkins, adjutant ment Counseling Service. continue her recuperation at home. general of Maryland. The Killeen Heights Vet Cen­ a former Va employee, michael ter and mobile vet centers saw more g. cahill, 62, was among the 13 killed By Rosalia Scalia than 8,200 veterans, soldiers, family at fort Hood. Working as a civilian members and civilians at Fort Hood contractor at the army base at the Counseling a Shaken and the surrounding area who were time of the shootings, the physician Community in need of counseling and emotional assistant previously worked at Va They made their debut earlier this support. facilities in montana, oregon and year. They’ve been on Capitol Hill, Since this was the first time the texas. on the grounds of VA medical cen­ mobile vet centers were deployed dur­ on an average day, more than ters, at post-deployment events and at ing a crisis of this magnitude, there 850 Va employees don uniforms stand downs. On Nov. 5, four of these were a lot of lessons learned, one of to serve military commitments in mobile vet centers were deployed which was location. “We learned reserve and National guard units to the Fort Hood area and put into quickly that our initial locations were across the country and overseas. action providing counseling, crisis not reaching the amount of people intervention, and information and re­ we expected,” said Robert Gombeski,

8 VAnguard • Winter 2009/2010 joel cHaVerri

joel cHaVerri

Above: Anthony Seamster, mobile vet center counselor, provides information to a family outside Wal-Mart at one of the four mobile vet centers deployed to Killeen, Texas, to offer counseling services in response to the shootings at Fort Hood; top right: Michelle joel cHaVerri Milonas, team leader at the New Orleans Vet Center, and Kevin Mickens, mobile vet center counselor, greet military members and local residents outside the mobile vet center at Wal-Mart; bot- tom right: Chuck Edens, veteran outreach specialist at the Killeen “We spent a lot of time speaking Heights Vet Center, talks with a soldier outside the mobile vet cen- ter deployed to the Warrior Way PX on Fort Hood. with both military and civilian workers who were feeling anxiety as Killeen Heights Vet Center team leader. “To connect with the community, we had to be creative and go where they a result of the events.” were—a place that was sure to have people visiting every day.” The incident hit close to home for many mental The solution: Wal-Mart. No sooner had the idea been health and hospital workers. “The staff at the hospital on brought up than staff members were talking with local base worked very hard to provide care for the victims and Wal-Mart management to request permission to set up the their families, but often they are the last to receive any mobile vet centers in their parking lot. Soon, the vehicles care themselves,” said Jacquelyn Cusick, a counselor with were set up outside two different Wal-Marts, where they the Killeen Heights Vet Center and on-site mobile vet were capable of seeing a large number of people each day, center counselor. many of whom knew someone involved in the shootings. The mobile vet center, with its ease of access and neu­ “We spent a lot of time speaking with both military tral location, was able to provide that care. Anyone need­ and civilian workers who were feeling anxiety as a result ing assistance could simply walk in and talk to a counselor of the events,” said Michelle Milonas, team leader at the without having to actually visit a clinic or hospital. This New Orleans Vet Center and on-site mobile vet center proved to be a vital aspect of the mission, since many sol­ counselor. “We’ve been able to answer questions and pro­ diers were initially fearful of returning to the base. vide therapy in this time of need.” “With some veterans, these shootings have re-trig-

VAnguard • Winter 2009/2010 9 ‘You are not going to die on me’ ana maldonado, a registered nurse at the audie l. murphy there and they will take you to the hospital.” memorial Veterans Hospital in san antonio, part of the maldonado helped assess the condition of the victims. south texas Veterans Health care system, was at fort Hood she also directed some fellow nurses and others who were on Nov. 5 attending her husband’s graduation ceremony. at the scene. maldonado, who was inside the auditorium, saw the band “i was asking people if they knew how to do cPr, take and the graduates suddenly rush in through the main doors. the pulses of those wounded and put pressure to help stop “i thought, this is not right,” maldonado said. then, she the bleeding.” heard gunshots. When the ambulances arrived, maldonado informed a soldier came in through the back entrance asking for the paramedics who needed to be taken first and who volunteers with com­ needed help. she bat experience, or stayed until all the any nurses, doctors wounded had been or emergency per­ taken to the hospital. sonnel. she started maldonado, who to respond, but her has two decades husband held her of experience as hand tightly. a combat nurse, “i looked at him said that being a and said, ‘i have to nurse and a veteran do this,’” maldonado helped her during recalled. the incident. from the audito­ after making rium, she and some a statement to the other volunteers ran fbi, maldonado re­ to the soldier and joined her husband. family readiness they returned to center, where the san antonio that shootings took place. night. When they got When she walked home, she wept. “i in, she saw blood was there for a rea­ everywhere. the luPe HerNaNDez son,” she said. people on her left, Registered nurse Ana Maldonado, who was at Fort Hood on Nov. 5 attending her about a week she soon realized, husband’s graduation ceremony, raced to the scene of the shootings to help the later, maldonado were already dead. victims.. went back to fort “i asked someone to get me some gloves. i took off my Hood for the memorial service. “the people i worked with boots and rolled up my pants and started looking at the vic­ that day recognized me,” she said. “they came over and tims,” maldonado said. said that they were looking for me. they said i must have “a soldier had his hand up, and he was the first one i been an angel because they could not find me.” went to,” she said. “He was still alive. i asked someone to in addition to her 20 years as an army nurse, mal­ give me their shirt; i rolled it up and used it to help stop the donado has 22 years of civil service—four at brooke army bleeding.” medical center and 18 at the south texas Veterans Health maldonado looked at the soldier and said, “you are not care system. she currently works in gastroenterology ser­ going to die on me. you are a soldier. the ambulance is out vice. - Genevieve T. Joson gered past events of combat,” said considerable impact on the soldiers, service to the Fort Hood community,” Vaughn DeCoster, team leader at the families and civilians who live on or said Louann Engle, RCS regional Fayetteville Vet Center and on-site around the base. Many are grateful for manager. “Their hard work reflects a mobile vet center counselor. “Most the timely support provided to them tremendous dedication that has really people think that something like this by the mobile vet center staff. paid off for those who needed care.” is not supposed to happen here.” “I’m proud of all the RCS staff The Fort Hood shootings made a for their commitment and sustained By Joel Chaverri

10 VAnguard • Winter 2009/2010 robert turtil

VA Central Office ARRA team members (left to right): Ruth Jane Peterson, senior policy advisor (Recovery); Allan Millington, systems accoun­ tant-team lead; Jonathan Lambert, deputy director, Financial Business Operations; Edward J. Murray, deputy assistant secretary for finance; Jill N. Cottine, administrative officer; and Jacqueline Hillian-Craig, Recovery support. Recovery Act Spending: Stimulating More Than the Economy A talented and creative team was assembled to oversee the spending of VA’s share of the funds.

n a previous article, VAnguard And find the right people they Spending it “properly” means asked, “How hard is it to spend did. meeting VA’s contracting perfor­ Inearly one and a half billion dol- From top-level managers at VA mance goals. Projects have to be lars?” Central Office to field contracting of- “properly solicited, competitively bid VA Deputy Assistant Secretary ficers, Murray and his team assembled and the work … done to satisfaction for Finance Ed Murray admitted it a talented and creative staff commit- before the contractor can be paid,” was easier said than done, noting, “It’s ted not only to spending VA’s share Murray said. VA is also holding to its definitely a lot of work and … we had of the American Recovery and Rein- goals for awarding contracts to small, to … find the right people that could vestment Act funds within the given minority, veteran and disabled veter­ contribute.” time frame, but to spend it properly. an-owned businesses.

VAnguard • Winter 2009/2010 11 robert kummer

As a result, the White House rec­ Nicole fiscus ognized VA for far exceeding goals in the areas of competition (more than Clockwise from left: Field-based ARRA 99 percent), obligations to small busi­ team members, including John Lombard, nesses (approximately 38 percent), Scott Fiscus and Tami Diaz have used a number of new tools and resources to and on-time completion. Further, the successfully manage and monitor Recov- changes instituted by Buck and his ery Act spending. team have established an infrastruc­ ture that can be used to improve the and energy,” Murray said. quality, timeliness and performance of One employee cited for helping all future VA procurements. reach these goals is Kenneth J. Buck, The impact of those changes Ph.D., director of acquisition policy, within the Veterans Health Admin­ who oversees a complex process in­ istration has been direct, immediate volving more than 1,300 individual and noticeable. contract actions totaling more than “We have incorporated a number $1.2 billion. of new tools and resources that have As the senior acquisition official, greatly enhanced our ability to man­ Buck deftly coordinates activities be­ age and monitor our performance, and tween experts in finance, legal, infor­ are able to provide an unparalleled mation technology, and the Office of amount of data that support our … russell lambert the Secretary. desire for a higher level of transparen­ And there’s a time limit—they In addition to drafting and cy and accountability in our business have 24 months to spend the money implementing acquisition policy and practices,” said Scott Fiscus, director without adding staff, while providing procedures, he designed significant en­ of VHA’s Recovery Act Acquisition an unprecedented level of transpar­ hancements to the electronic contract Program, Office of Procurement and ency not seen before in the federal management system (eCMS) so that Logistics. government. all contracts include provisions unique One new management tool, They also must meet VA Secre­ to ARRA acquisitions. He also devel­ eCMS, was still in its infancy when tary Eric K. Shinseki’s priority targets. oped performance indicators to track the Recovery Act was initiated. The “We were looking for projects that fell procurement milestones and put in Act, according to Fiscus, has propelled into one of three categories of patient place a quality assurance process that the system forward and forced con­ safety, security of the environment predicts and corrects problems. tracting officers to take advantage of

12 VAnguard • Winter 2009/2010 all its capabilities. tracting officers for their diligence and maintain the final resting places “The system provides the most commitment to meeting established for millions of veterans as national effective means we have of generating ARRA spending goals. shrines, the National Cemetery Ad­ recurring reports, and tracking any “Contracting officers working on ministration was provided $50 million individual project remotely,” Fiscus ARRA projects really stepped up to in ARRA funds. The funding allows said. “More importantly ... the system the plate and did an exceptional job NCA to immediately address a back­ offers acquisition planning functions meeting the expectations,” said Tami log of maintenance needs at VA cem­ that allow staff to adhere to a more Diaz, eCMS coordinator for the VA eteries. organized, structured, and risk-averse Healthcare System of Ohio (VISN “NCA is using these funds to raise acquisition process.” 10). and realign headstones and mark­ Similar sentiments were expressed The improvements in contract ers, renovate gravesites, and make at the field level, too. management, combined with the road repairs and other improve­ “Our contracting officers are us­ focus on competitive bidding and the ments to cemetery grounds and ing eCMS to document every step of efforts of the contracting officers, have facilities,” said Acting Deputy Un­ the procurement process,” reported provided an additional benefit. Most der Secretary for Memorial Affairs John Lombard, a contract specialist contracts have been awarded under Ron Walters. “NCA will also pur­ and eCMS application coordinator for the planned amounts. chase new equipment for cemetery the VA Northwest Health Network “These cost savings provided ad­ operations and conserve and repair (VISN 20). “We are able to create re­ ditional funding for projects that may 49 historic monuments at national ports … that offer a true reflection of not have been awarded this fiscal year cemeteries and soldiers’ lots across the where each procurement stands. This without the efforts of the contracting United States.” has created efficiencies in our Con­ officers,” noted Diaz. “These efforts Additionally, the funding will al­ struction Branch, and now we can just translate into meeting more needs for low NCA to finance projects that use look at eCMS to answer questions, the veterans.” wind turbines, solar power and other rather than spend time calling con­ While maintaining and upgrading measures to conserve energy and wa­ tracting officers to get the status.” 152 VA medical centers easily takes ter. So far, NCA has obligated more An important element of ARRA the lion’s share of VHA’s Recovery than $29 million for projects at 85 spending is increased transparency of Act funds, a sizeable portion, $399 national cemeteries. the process. million, has been designated for a In just nine months, VA has “All of our plans, projects and substantial number of energy initia­ obligated more than 54 percent of its weekly financial and program accom­ tives—projects incorporating energy Recovery Act funds, including more plishments are fully transparent to efficiency and renewable energy. than $465 million directly to more the American people on the ARRA- In an effort to put Recovery Act than 1.8 million veterans through the specific Web site that VA developed money directly into the hands of individual $250 checks they received within the first week after passage of veterans, the Veterans Benefits Ad­ in June. the Recovery Act,” said Murray. ministration began making $9,000 The American Recovery and Re­ This transparency is not just for and $15,000 payments required by the investment Act of 2009 was designed the public to better see how their Act to eligible Filipino veterans in to jumpstart America’s economy, cre­ government is conducting its busi­ April, and $250 payments to eligible ate or save millions of jobs, and put ness, but also for federal managers to veterans with disabilities in June. Ad­ a down payment on addressing long- be able to monitor the process and ditionally, VBA hired the first of neglected challenges so our country provide direction as needed to stay on 2,293 temporary employees to assist in can thrive in the 21st century. track. processing compensation and educa­ “VA is on its glide path to fully “I have not been involved in any­ tion claims in April. obligate all of its Recovery Act funds thing with as much scrutiny at such a “These actions required the de­ by September 2010,” Murray said. high level,” admitted Randy Harvel, velopment of business processes, ac­ VA is obligating the funds to the eCMS coordinator with the South quisition of workspace and equipment, improve benefits and services to veter­ Central VA Health Care Network training, and multiple changes to ans, while at the same time stimulat­ (VISN 16). “Requiring the contract­ VA’s automated systems,” said Jimmy ing the economy in and around the ing officers to work with and update Norris, VBA’s chief financial officer. communities that are home to hun­ milestones regularly helped to identify “A rapid, coordinated response was dreds of VA facilities and millions of and rectify problems early on.” delivered by multiple VA elements to the nation’s veterans. Across the board, eCMS coordi­ ensure this timely action.” nators complimented their field con­ Keeping its commitment to By Jim Benson

VAnguard • Winter 2009/2010 13 Building a Better Arm Amputee veteran Jonathan Kuniholm is on a mission to bring upper limb prosthetics into the 21st century.

n many ways, Jonathan Kuniholm is like a lot of young veterans Iacross the country. After serving three and a half years in the Marines, he went back to school and began his pursuit of a graduate degree in me­ chanical engineering at North Caro­ lina State University. Kuniholm enjoyed his studies, but he missed the camaraderie of his days in the military. So after starting a doc­ toral program in biomedical engineer­ ing at Duke University, he decided to join the Marine Corps Reserve’s 4th Combat Engineer Battalion. It was a Jonathan Kuniholm, left, has worked on a DARPA-funded compromise that would have allowed project to develop a prosthetic arm that looks, feels, per - him to continue to serve his country forms and is controlled like a natural limb. He tested a while studying nanotechnology at one modified version of Guitar Hero III developed by project en- of the country’s finest schools. gineers. Stuart Harshbarger, right, formerly led the project. mike mcgregor/coNtour by getty images “Part of the reason I joined a unit squarely in the blast zone. arm below the elbow. “But I was just was seeing the Marines stepping up The explosion was so severe that psyched to be alive.” and doing what we had all trained it snapped his rifle like a twig, nearly One of his fellow Marines wasn’t to do. I was prepared to deploy, but cut his right arm off and slammed his as fortunate, dying of internal injuries. didn’t think I’d get the warning order body hard to the ground. Severely Four more would not live to see Feb­ 48 hours after swearing in,” said Kuni­ wounded and under fire, he scrambled ruary. Kuniholm was headed back to holm. out of harm’s way, where a medic ap­ the states—facing rehab and life with­ Within a month, the unit was plied a tourniquet, saving his life. It out a right hand—but he was alive called to active duty, and the captain was New Year’s Day 2005. and thankful for it. was training to deploy to Iraq with “One of the medical officers For the next five months, Kuni­ his new platoon. Seven months later, told me that if it had been Vietnam, holm was in rehab learning how to Kuniholm was on foot patrol not far I would have died from the loss of use an array of prostheses, from the from the Euphrates River when Iraqi blood,” recalled Kuniholm, who most advanced electric hand to a insurgents detonated a bomb with him awoke in a hospital missing his right prosthetic hook that hadn’t changed

14 VAnguard • Winter 2009/2010 much in nearly 100 years. terpret these impulses and turn them said. “David Dorrance’s name is on into motion. The goal is to have a The reason for that, in spite of the 1912 patent, and is stamped on prosthesis that is controlled the same the need, is the size of the market. the titanium hook that I like to use,” way as your natural arm.” While just about every human be­ Kuniholm said. Compared to other inventions ing on the planet has a use for a car Kuniholm switched his studies and devices, prosthetics have been or cell phone, there are only a small at Duke from nanotech to prosthetic dramatically outpaced. The telephone, percentage of amputees, and most arms. He was now on a mission to the automobile and the split-hook ar­ can’t afford much. In the developed bring prosthetics into the 21st cen­ tificial arm were all in production dur­ world, there are probably fewer than tury. Since then he has worked on ing the early 1900s. By 1955, the car 200,000, with less than half of those numerous projects, including the featured power steering, a radio, and living in the United States. Defense Advanced Research Projects could be started with a key instead of The biggest hurdle for Kuniholm Agency (DARPA) Revolutionizing turning an engine crank mounted in and other amputees is getting the Prosthetics program, which has goals the grill. The rotary-dial telephone technology into production and af­ that recall the “Six Million Dol­ was in countless homes and one could fordable for the user. “While the ac­ lar Man,” or Luke Skywalker’s hand place a call from New York to Cali­ complishments of the research teams replacement in “The Empire Strikes fornia without a second thought. The have been impressive, in many ways Back.” prosthetic arm, meanwhile, remained the real challenge is figuring out how “When people think about pros­ basically the same. to get this stuff to the clinic and actu­ thetic arms, their impressions are Fast-forward to 2009. The tele­ ally on patients,” he said. often guided by science fiction,” said phone is now a “cell” that can go any­ He has some ideas about how to Kuniholm. “But what is actually avail­ where, make calculations, store hun­ make it happen. His plan involves able is a lot different.” dreds of songs, take photos and surf borrowing existing technology from Kuniholm’s participation in the the World Wide Web. Most cars are bigger industries, such as robotics project has been focused on using available with everything but autopi­ technology employed by the defense pattern-recognition software that lot, and a few models even automati­ industry. Where there’s been no de­ interprets thoughts into motions. In­ cally apply the brakes when needed, velopment of a useful technology, like stead of an amputee having to learn and sound an alarm if the driver starts the myoelectric pattern recognition how to use an artificial arm, the arm to doze off. The prosthetic arm? Basi­ Kuniholm wants to use to control will learn from the wearer. cally the same. arms, he hopes to find uses in bigger “When I imagine moving my “Despite what’s possible in other markets, such as electronic games and right hand, muscles produce electrical industries, and what science fiction entertainment. Finally, he plans to impulses that can be detected with makes us think ought to be possible, design the parts and software in the electrodes,” he explained. “We are prosthetic arms have simply been a open to increase innovation. teaching the arm’s ‘computer’ to in- wasteland for innovation,” Kuniholm “I could capture about a thou­ sandth of the video game market and exceed the entire prosthetic arm mar­ ket,” Kuniholm said. “That’s the kind of buying power I want solving my problem. And who wouldn’t want to be able to pull the trigger by moving their finger instead of pressing a but­ ton in Unreal Tournament 3?” While some have been skepti­ cal of his open strategy, Kuniholm has an answer. “I don’t know if this will work,” he said, “but I know that what we’ve done for the last 100 years hasn’t worked. And you wouldn’t believe the offers of help that I’ve gotten. I feel like Tom Sawyer white­ Using myoelectric pattern recognition to control the hand and wrist of his prosthetic washing his fence.” arm, Jonathan Kuniholm is able to crush a soda bottle. mike mcgregor/coNtour by getty images By Gary Hicks

VAnguard • Winter 2009/2010 15 ix months ago, Sgt. Neal Brace was trudging across the scorching desert Sof Ramadi, Iraq. This past October, Brace found himself hiking in the mountains of Appalachia. On both occasions, the packs were heavy, but the nature of this mis­ sion was much different. Instead of listening for enemy fire or searching for an IED, this small company of vet­ erans was hiking through the fall foli­ age of western North Carolina. Crows called, and silence welcomed them on top of a peak as they took a moment to reflect on their ascent. These six Afghanistan and Iraq veterans seized the opportunity to attend an Outward Bound course aimed at helping them reintegrate into civilian life. The goals of the Outward Bound veterans program are to physically, mentally and emotion­ ally challenge veterans, and to build the self-confidence, pride, trust and communication skills they need to successfully return to their families and communities following wartime service. The program is funded by a grant from the Sierra Club and Disabled Outward Bound Veterans of America. The grant al­ lows Afghanistan and Iraq veterans partners with VA to to sign up for a free Outward Bound course nationwide. offer returning Outward Bound has its roots in wartime. It was created in 1941 during veterans a free World War II out of a need to instill spiritual tenacity and the will to sur- Veteran Rhonda Burleson wilderness expedition. prepares for descent. courtesy of NortH caroliNa outWarD bouND Charting a Course Toward Readjustment

vive in young British seamen. participants. hear their stories and tell mine,” said In the early 1980s, Col. Bob The recent partnership between participant Rhonda Burleson. Rheault ran Outward Bound trips for the Charles George VA Medical Cen­ Outward Bound is working to Vietnam veterans out of a VA inpa­ ter in Asheville, N.C., and Outward reinvigorate its connection to VA tient post-traumatic stress disorder Bound marks the first time in decades facilities. The organization is currently treatment program in Northampton, that a custom course has served veter­ in dialogue with facilities across the Mass. Over the last 20 years, Outward ans enrolled in a specific VA facility. nation to schedule custom courses for Bound has run wilderness expeditions “It helped so much to know that there Afghanistan and Iraq veterans. specifically designed for war veterans are other people locally that have The recent five-day wilderness and service members at no cost to been in Iraq and Afghanistan, and to expedition in the Asheville area was

16 VAnguard • Winter 2009/2010 led by two seasoned instructors, Dave tion, as conflicts arose between par­ ers, this course was their first exposure Genova and Diana Belknap, with ticipants during challenging activities. to the wide array of services offered by the North Carolina Outward Bound On the course, veterans told each VA for Afghanistan and Iraq veterans. School. Outward Bound veterans pro­ other of their military experience and As the participants departed from gram course instructors include many adjustment to civilian life. “Coming the Charles George VAMC to begin who served in the military themselves, home from war is so very hard and their course, staff met with the group, and all instructors go through custom­ lonely,” participant Stacie Tindle said. providing them benefits information ized veterans training. The Asheville­ “It’s easy to hide from the rest of the and various program materials, as well area expedition included backpacking, world. On this course I have been as suicide prevention information. rock climbing and a high ropes course. able to share my experiences, my pain, Medical center leaders paved the way “Diversity played a role in this with other veterans.” for this partnership to occur, including being a successful course,” explained Connecting with fellow veterans Acting Director Dr. Mary Ann Curl, Genova, a Vietnam-era veteran and in the beauty of the country for which Associate Director Walter Hitch, 30-year instructor for Outward Bound. they served can be a meaningful expe­ Chief of Mental Health Service Dr. “Some veterans were struggling with rience for participants. “My transition Carole Rivers, and Chief of Social adjustment, others not so much. The from military to civilian life has been Work Service Richard Adams. age of participants ranged from 22 to a huge struggle,” said participant Mi­ Trevor Ridge said participating 47, and included two women. Some chael Seng. “This course has given me in the course was an important part participants returned home from Iraq an opportunity to meet up with others of his journey toward readjustment to as recently as two months ago, while on the same path.” civilian life. “As a veteran returning others have been home several years.” This contracted Outward Bound from an unpopular war, I have found Genova said they purposely cre­ course was not intended to be therapy, it difficult to adjust to life outside of ated a flexible course to empower but rather an adjunct to other VA the military,” he explained. “This the group to choose aspects of their services provided. VA social work staff course offered the best opportunity for trip, unlike the structure of military helped veterans enroll in the course, us to gain a sense of belonging in this expeditions. “We told the group, you and provided follow-up with veterans beautiful world.” can decide as a group to hike the trail post-course to assist with linkages to In the end, it may be on this around to camp or bushwhack up and VA services as needed. course that a veteran feels the first over the ridge.” For those already engaged in sprouting of insight or change. It may Instructors also encouraged par­ therapy, the course provided a rich ex­ be many months later, after a seed is ticipants to practice open communica- perience to debrief in session. For oth­ planted, that the impact is evident. “Over the period of this course, I changed in ways I didn’t think pos­ sible,” said Seng. “This experience will help me get back to my pre-war self,” said Ridge. “One thing I can say about the course: It uplifted me confidence-wise. I con­ quered many of my fears. More vets need to get into this.” Afghanistan and Iraq veterans interested in an Outward Bound open-enrollment course can contact admissions at (866) 820-9577 and speak to an admissions advisor. For custom contract courses like the one described here, contact Meg Ryan at Outward Bound, (866) 669-2362, extension 2374. For more information on Outward Bound programming for veterans, visit www.outwardbound.org/ Michael Seng belays a fellow veteran on a index.cfm/do/cp.veterans. rock face while Stacie Tindle provides back- up belay; rock site instructors stand by. courtesy of NortH caroliNa outWarD bouND By Hillary Bolter

VAnguard • Winter 2009/2010 17 he threat of hurricanes is a fact Medical Center and the community- step-by-step framework for planning, of life for coastal towns along based outpatient clinics located in developing, executing and evaluating Tthe Atlantic Seaboard. All VA Virginia Beach, Va., Morehead City, exercises. It also provides after-action hospitals located in high-threat areas N.C., Jacksonville, N.C., and Wilm­ reports and improvement plans in a are required to conduct evacuation ington, N.C., are all close enough to Department of Homeland Security exercises at least annually. While the water’s edge to make the threat of standardized format. some of those efforts are accomplished hurricanes a real concern. Likewise for On Sept.14, the fictional Hur­ in the form of table-top exercises, the VA facilities in VISN 8 located ricane Zulu intensified into a Category the Veterans Health Administration along the Florida coast. 4 storm and was expected to impact recently added an extra measure of re­ “Exercises like this one are vital the coast in the coming days close to ality to challenge its readiness by host­ to the success of our mission,” said the border between North Carolina ing the National Patient Movement Daniel F. Hoffmann, VISN 6 director. and Virginia. Simultaneously, an­ Exercise Sept 16-17. “Having had to evacuate the Hamp­ other hurricane was headed directly The purpose of the exercise was ton VAMC during Hurricane Isabel, toward South Florida. The leadership to evaluate the operational readiness we know the threat is real. This exer­ in VISNs 6 and 8 made the decision of personnel and equipment, and the cise allowed us to review and evaluate to evacuate the Hampton and West logistics required to support patient our processes, procedures and new Palm Beach medical centers. movement from one VA medical technology. Anything we can do to Successful patient evacuation center to others not affected by the better our readiness and response ac­ begins with the planning efforts of disaster. The foundation for this exer- tions goes a long way toward ensuring the emergency management team.

Exercise participants tested new ambulance buses used to evacuate Testing patients during an emergency. Disaster Readiness National exercise evaluates new equipment and technology to ensure continuity of care

during emergencies. sHeila bailey cise was data derived from the VHA we can and will provide continuity of For this exercise, Boucher was lead Emergency Management Strategic care regardless of the challenge.” planner for VISN 6 participation, and Health Care Group’s analysis of Hur­ According to Mike Boucher, Victor Ramos, VISN 8’s area emer­ ricane Katrina. This exercise looked at emergency management director gency manager, led the Florida team. equipment needs for coastal evacua­ at the Durham (N.C.) VA Medi­ Both VISN exercise-planning teams tion and became a technology test bed cal Center, planners used the VHA were in constant contact with Mick for VHA. Exercise Builder-Hospital product Feeser, lead planner for VHA, during Participating in this exercise were to plan the exercise. This product is exercise development and planning. the VA Mid-Atlantic Health Care a VHA-sponsored, Department of Their seven-month effort focused on Network (VISN 6) and the VA Sun­ Energy-developed database applica­ developing a comprehensive plan shine Healthcare Network (VISN 8). tion that assists emergency managers that would test every aspect of how to For VISN 6, the Hampton (Va.) VA and exercise planners by providing a safely prepare, load, transport, track

18 VAnguard • Winter 2009/2010 and deliver patients to VA medi­ Center and representatives from the tem Interconnect. This fully portable, cal centers in Richmond, Va., and Air Force’s Air Mobility Command, lightweight network system sets up Durham. “EMSHG area emergency who were evaluating these ambulance in less than 15 minutes and provides managers provided valuable support buses against what the Air Force is phone service and secure Internet throughout the exercise development using to shuttle patients from war access where service has been inter­ and planning,” said Boucher. “With­ zone to medevac locations, and from rupted, or in remote areas where there out EMSHG, this exercise would not aircraft to hospitals when they land in is no infrastructure or communica­ have happened.” the United States. tions are non-existent. Iridium satel­ According to Boucher, the scope Successful patient transportation lite phones were also tested. of this exercise reached far beyond the requires more than just getting them “VHA will use the results of the current emergency response capabili­ from point A to point B. Because VISN 6 and VISN 8 evaluations to ties by incorporating new technology the inpatients being evacuated may decide how to outfit the rest of the that deals with the many shortcom­ require critical care, accurate informa­ country,” Boucher said. ings that surfaced during Hurricane tion must flow between the medical The patient tracking software Katrina. Along with the common center being evacuated and the one tested is a program that was developed issue of transportation, the exercise receiving the patient before departure in VISN 6. This software, known as tested a variety of communications as well as en route. the VISN 6 Emergency Evacuation gear and a software program designed The difficulties of establishing Application, provides continuity of for evacuation. and maintaining communication links care by letting the evacuating hospital Both VISNs 6 and 8 tested and were brought to the forefront by Hur­ enter patient data and allowing the evaluated three new ambulance buses. ricane Katrina. “It’s typical that land receiving hospital to have the entire These prototype vehicles, made by lines will be lost, and while cell towers record of care. The Hampton VAMC Farber Specialty Vehicles of Colum­ may survive, they can quickly become loaded patient data into the system, bus, Ohio, are designed to fill a dual- overloaded,” said Boucher. “What we keeping the Richmond and Durham purpose role to ensure maximum cost need is a system that will work any­ medical centers apprised of the status benefit to VHA. When not being time, and in any weather. That’s why of the patients headed their way. used as emergency evacuation tools, we are testing a variety of systems dur­ Throughout the week, from the safely transporting patients with the ing this exercise.” first warning of the impending hur­ latest technology, the buses can be According to Boucher, the De­ ricane exercise until the threat passed, used for daily transportation, such as partment of Homeland Security has a team of VISN 6 employees stood shuttling patients from parking areas mandated interoperable communica­ watch in the command center, assist­ to the medical centers. tions, and is working with agencies ing and monitoring the progress of the The buses come in three sizes— around the country to build a nation­ evacuation through situation reports, 28, 30 and 34 feet long—and each wide system that will allow interface and managing the availability of beds is designed to quickly and easily be by local, state and federal responders. throughout network medical facilities. transformed from ordinary bus to One such system used in this exercise “It’s our job to activate the VISN state-of-the-art patient mover. The is North Carolina’s statewide Voice 6 Emergency Operations Plan, make buses carry from nine to 15 litters, Interoperability Plan for Emergency the decision to evacuate a facility, and and each bus has a hydraulic lift for Responders, commonly referred to as maintain consistent communications wheelchairs, along with ramps that VIPER. between all of our medical facilities allow loading and unloading from the The Durham VAMC was the first and VA Central Office,” said Joseph rear. The water-cooled generator un­ VA medical center in North Carolina Jenkins, VISN 6 command center di­ der the bus powers the redundant air to get the system. And according to rector for this exercise. conditioning units and provides 120­ Boucher, it lets him speak with virtu­ “This exercise went extremely and 240-volt power along the interior ally all state and local responders and well,” said Rick Rhodes, VISN 6 area walls of the bus, which allows provid­ has a range that allows communica­ emergency manager. “We had the op­ ers to use many of the monitors and tion anywhere within the state. Dur­ portunity to evaluate a good deal of cardiac care response tools used by Air ing the exercise, he used a hand-held technology, which should help VHA Force evacuation squadrons. VIPER radio to communicate directly decide how they want to equip medi­ More than 35 volunteers from with the Durham VAMC from be­ cal centers nationwide. We’re glad to around VISN 6 participated as “pa­ yond the Virginia border, more than have had the opportunity to partici­ tients” and evaluators. Also evaluating 70 miles away. pate.” the equipment were emergency re­ Another communication system sponse coordinators for Duke Trauma being tested is the F4W Portable Sys­ By Bruce Sprecher

VAnguard • Winter 2009/2010 19 VA polytrauma team’s overseas visit furthers collaboration with Department of Defense medical system.

The Army’s Landstuhl Regional Medical Center is the first stop for severely wounded troops from Afghanistan and Iraq before be- ing sent stateside for further medical care. u.s. air force Better Care for Wounded Warriors hen troops are severely wounded on the battlefield in Afghanistan or Iraq, they are taken to Landstuhl Regional Medical Center in Germany, where Wthe Army’s medical treatment teams perform emergency operations for a wide range of acute wounds, including severely damaged or severed limbs, traumatic brain injuries, paralysis, major burns, or combinations of these severe injuries. The acutely wounded service Landstuhl, the medical team there experienced before arriving at VA. members are usually at Landstuhl for rarely hears what happens to their Until now. less than a week before they are trans- former patient. And medical and re- A four-day visit to Landstuhl in ferred to the United States, where habilitation teams at VA receive little October by a team of two doctors and they will be sent to another military information about wounded warrior two nurses from VA’s polytrauma treatment facility or to one of VA’s transport, the full extent of the acute system of care has led to a regular polytrauma rehabilitation centers. care process the service member has exhange of information between Once a service member leaves undergone, or stress the patient has medical teams in the military and

20 VAnguard • Winter 2009/2010 VA. These exchanges provide a better of severely wounded service members communication and research between understanding of what service mem­ onto a bus for the 15-minute trip to the military and VA. Finally, VA staff bers experience from the time they are Landstuhl. visited the aerovac staging area at wounded on the battlefield to being “I was really impressed with the Ramstein, where service members are sent through a series of patient hand­ quality of care being provided in a prepared for their flight back to the offs from medical teams in the field to very hectic, chaotic environment,” United States. Landstuhl and then to VA. said Nina Pagel, R.N., polytrauma “I was particularly impressed Following the team’s visit, vid­ nurse manager at the Minneapolis VA with the bravery and resilience of eoconferences began taking place be­ Medical Center. “Every branch of the the service members, as well as the tween Landstuhl and VA polytrauma military meets their patients curbside professionalism and dedication of the staff, including Joint Theatre Trauma (at Ramstein), triaging them right doctors, nurses and therapists who are Surgeon colleagues, and Webinars there.” caring for the severely wounded,” said have been held on “Spinal Cord While at Landstuhl, each VA Brenda Stidham, R.N., who serves as Injuries in Combat Casualties” and team member met and shared infor­ VA’s polytrauma nurse liaison at Wal­ “Severe Traumatic Brain Injuries in mation with a broad segment of mili­ ter Reed Army Medical Center. Combat Casualties.” These videocon­ tary medical staff, including the base At the conclusion of their trip, ferences and Webinars will now occur commander, trauma surgeons, pulmo­ the VA team went back to Ramstein on a more frequent basis. nary physicians, neurologists, trauma for transport to the United States, In addition, the Landstuhl Clini­ nursing directors, psychologists, thera­ where they observed the transfer of cal Informatics Department is explor­ pists, intensive care unit attendants, patients and then flew with the pa­ ing use of a tool developed by DoD medical professionals and professionals tients and their families on the same and VA nurses for Walter Reed Army in charge of data collection. The VA return flight. Medical Center, National Naval team visited the program that houses “It helps to observe in person the Medical Center and VA polytrauma rehabilitation centers. This tool will “Now, I can pick up the phone and exchange standardize the nursing handoff of patients along the continuum of care. critical information about the patient with the If implemented at Landstuhl, it will providers at Landstuhl.” provide clinical data for DoD-VA per­ formance improvement initiatives. ambulatory patients, and shared in­ clinical and patient exchange taking “The teams communicated and formation about the trauma process, place and to understand the physical collaborated on the continuum of care clinical data and rehabilitation inter­ environment the patient has been in from the point of stabilizing severely vention. before he reaches us,” said Dr. Ted wounded service members through “This enables us to develop ways Scott, staff physiatrist for the polytrau­ the acute rehabilitation provided by to track patients from the beginning ma rehabilitation center at the Palo VA’s polytrauma system of care,” said and identify complications, with the Alto VA Medical Center. “It is good Dr. Lucille Beck, chief consultant for idea of performance improvement,” for us to be able to observe the inten­ the Department’s Office of Rehabili­ said Dr. Steven Scott, who serves as sive care unit to see what specialists tation Services, which oversees the chief of Physical Medicine and Reha- they have, and be able to exchange polytrauma system of care. “The visit bilitation/Polytrauma at the James A. ideas with them.” was important in enabling VA and Haley Veterans’ Hospital in Tampa. On the flight back to Andrews Landstuhl medical staff to exchange “This will establish a continuum of Air Force Base in Washington, D.C., information regarding wounded war­ care that is not solely DoD or VA, members of the VA team interacted rior transport and care transition, and and will help us develop one system of with some patients and family mem­ to develop a better understanding of care that benefits our patients.” bers, gaining valuable insights into the acute care process.” The team delivered a grand what they have been through before Each member of the VA team rounds presentation on the VA poly- they are sent to a polytrauma rehabili­ represented a different role in the trauma system of care for Landstuhl tation center. continuum of care and came from staff. They visited the facility’s Medi­ “Patients often arrive exhausted, different medical facilities in the cal Transient Detachment and trau­ and after experiencing delays in VA polytrauma system of care. They matic brain injury programs, holding travel,” said Dr. Ted Scott. “It is very landed Oct. 12 at Ramstein Air Base, discussions with staff about patient helpful for us to be able to understand where they observed military medical data collection and the documenta­ what they have been through before teams as they worked on the transfer tion process, with a focus on efficient they reach us.”

VAnguard • Winter 2009/2010 21 Left: Wounded troops arrive at Ramstein Air Base and are transferred onto a bus for the 15-minute trip to Landstuhl; below: Members of the VA team who made the trip to Landstuhl were (left to right): Dr. Steven Scott; Dr. Ted Scott; Nina Pagel, R.N.; and Brenda Stidham, R.N.

u.s. air force “We’re still learning what the stressors are for the families,” added Dr. Steven Scott. The genesis for the VA team’s trip to Landstuhl was an earlier visit in April by Dr. Shane McNamee, director of the polytrauma rehabilita­ tion center at the Hunter Holmes McGuire VA Medical Center in Richmond, Va. As the VA-DoD in­ tegration team examined transition issues for service members from the military to VA, they recognized that exchanging information about trans­ port and care transition for severely wounded service members would help VA develop a better understanding of the acute care process. The approach was supported by then Under Secre­ tary for Health Dr. Michael Kussman, courtesy of Dr. teD scott and retired Gen. Ron Winter, former critical care team for transport, to the better communicate with each other member of the VA-DoD integration surgical team at the medical facilities whenever they need to. team, who helped get DoD support. where they are sent. “The key is the relationships with Citing the significant potential “There is a remarkable level of the providers,” McNamee said. “Now, for errors, McNamee noted that coordination and communication tak­ I can pick up the phone and exchange he was impressed with the efficient ing place along the trauma continuum critical information about the patient transfer of severely wounded patients of care,” McNamee said. with the providers at Landstuhl. It from one area to another. A severely Across both VA staff visits to will help us provide better care for the wounded service member will be Landstuhl, all team members agreed recovery of the patient—and that’s transferred from a field medical team that the most important aspect of the most important thing about the to the acute surgical team in the field, the trips was the personal connec­ exchange of information.” to the critical care air transport team, tions that were made between DoD to the Landstuhl medical team, to the and VA specialists to enable them to By Bill Outlaw

22 VAnguard • Winter 2009/2010 Keith Little is president of

Code the Navajo Code Talkers Association.

courtesy of NaVajo coDe talkers associatioN Navajo warriors are seeking support for a museum that would preserve their legacy and recognize their unique contribution to the nation.

ommunicating. Sending and receiving messages. It’s something we do every day. It’s part of being human. It’s also at the heart of military operations and essential to suc­ Ccess in combat. Protecting these messages is equally important. Enter the use of codes. Encrypting, or using codes to hide or protect messages, has been around since the Egyptian pharaohs in 1900 B.C. One of the most effective codes ever used and the only military code never broken was developed by young Navajo warriors using

Unbreakable their ancient tribal language. Considered “hidden” because it had no alphabet or written form, the Navajo language was well-suited to meet the security requirements of military communications. At least, that was the belief of Philip Johnston, the son of a missionary to the Navajo. Johnston suggested the use of the Navajo language for military voice and wire commu­ nications to Marine Corps Maj. Gen. Clayton B. Vogel, commanding general of the Am­ phibious Corps for the Pacific fleet. With the help of four Navajos living in nearby Los Angeles and another on active duty in San Diego, Johnston set up a test that demonstrated the speed and accuracy of using the Navajo language for coded messages. In later tests under combat conditions, Navajo Code

The Talkers proved their ability to translate a classified message into Navajo, transmit, receive and decode the message back into English faster than the conventional cryptographic facili­ ties and techniques.

VAnguard • Winter 2009/2010 23 Navajo Code Talker Bill To­ were learning the code with the com­ Talkers were on hand for the unveil­ ledo, who saw action at Iwo Jima and puter we were born with,” explained ing and dedication of a special exhibit Bougainville, recalled being asked to Code Talker Frank Willetto. of photographs, equipment and the retrieve a classified message that had Initial skepticism about their original code, which were put on per­ frustrated the radioman for two hours. value by field commanders quickly manent display. The exhibit is a regu­ Toledo called a fellow Code Talker at evaporated as time and again the Na­ lar stop on the Pentagon tour. the source and “translated the message vajo Code Talkers assigned to their Now that their story can be told, in five minutes.” units proved instrumental in success­ a new effort to share their military his­ The Marine Corps’ Navajo Code fully executing their missions. tory and cultural values of service with Talker program began in September Navajo Code Talkers, who num­ future generations is underway. 1942 with the recruitment of 200 bered more than 400 by war’s end, With an understandable sense Navajos to be trained and assigned took part in every marine assault from of urgency, four of approximately 40 as Code Talkers to Marine units 1942 to 1945, including Guadalcanal, remaining Navajo Code Talkers came throughout the Pacific theater. Tarawa, Peleliu and Iwo Jima. to Washington, D.C., in October to Like other Marines, Navajo At Iwo Jima, Maj. Howard Con­ meet with administration and con­ recruits completed basic boot camp ner, signal officer for the 5th Marine gressional representatives to obtain training at Marine Corps Recruit Division, gave his unequivocal en­ support for a Navajo Code Talkers Depot San Diego before receiving dorsement, reporting, “Were it not Museum and Veterans Resource Cen­ their specialized training at Camp for the Navajos, the Marines would ter being planned near their reserva­ Elliott, Calif. They were also taught never have taken Iwo Jima.” Six Na­ tion outside Gallup, N.M. basic communications procedures and vajo Code Talkers worked around the They also visited the National equipment at Camp Pendleton, Calif. clock for the first two days of the bat­ Museum of the Marine Corps in The first 29 Navajo Code Talkers tle, sending and receiving more than Quantico, Va., not only as Marine had the added responsibility of assign­ 800 messages—all without error. Corps veterans, but to get ideas on ing words from their language to stand Although their primary mission how best to tell their own story in a for certain military terms and equip­ was to “talk,” transmitting vital op­ museum setting. The Marine Corps ment for which there was no Navajo erational information from command museum has its own Code Talker ex­ equivalent. Some examples: “besh-lo” elements to the field and back, the hibit. (iron fish) meant “submarine”; “dah­ men in their units found the Navajos Keith Little, president of the he-tih-hi” (hummingbird) meant were also good Marines and could do Navajo Code Talkers Association, “fighter plane”; and “chay-da-gahi” their share of fighting and other Ma­ explained his motivation to serve: “I (tortoise) meant “tank.” rine duties. wanted to protect my people, my land Many terms and names simply Concern that the darker-skinned and my country.” had to be spelled out, and for that Navajos might be mistaken for Japa­ Once punished for speaking their they devised a system whereby a Code nese soldiers was borne out in more native language, the Navajos have Talker would translate a Navajo word than a few instances; several Code witnessed an evolution of perceptions into its English equivalent, and then Talkers were taken “prisoner” by and attitudes toward their unique cul­ use only the first letter of the English their own forces, only to be released ture, preserved by that same language. word to spell out the message. To add upon validated identification from Their experience provides clear evi­ another layer of security and confound their commander. Thereafter, some dence of the individual, community the enemy, several Navajo alterna­ commanders assigned bodyguards to and national enrichment possible tives were used for each of the most accompany the Navajos during the when diversity is embraced from a commonly used letters in English. remainder of their assignment. sense of awareness, acceptance and Thus, the Navajo words for “ant,” The continued value placed upon appreciation. “apple” and “axe” all represented the the effectiveness of the Navajo-based It’s all about communicating. letter “a.” code by the military kept acknowl­ To compound the difficulty for edgement of and recognition for the By Jim Benson the Japanese, who had a well-earned Code Talkers as hidden as their lan­ reputation for their code-breaking guage. Want to Know More? skills, the Code Talkers had to memo­ Finally, in a Pentagon ceremony to learn more about the Navajo rize the entire code with all its vari­ held on Sept. 17, 1992, the Navajo code talkers and their quest for ables, as no printed documents about Code Talkers were honored for their a museum, visit their Web site at the code were sent into combat. contributions during World War II. www.navajocodetalkers.org. “We had no pads or pencils. We Thirty-five of the remaining Code

24 VAnguard • Winter 2009/2010 Veterans Day 2009

bryaN HoPkiNs

cHarles brosHous

micHelle coVert

aNgela taylor

berNt e. joHNsoN

Clockwise from bottom left: Joe Lacey said he’d never forget his visit with Miss America 2009 Katie Stam at the Baltimore VA Medi- cal Center; Indianapolis Colts players (left to right) Taj Smith, Eric Foster and Hank Baskett visited patients, including Nathan Florey, at the Richard L. Roudebush VA Medical Center; Rifle salute at the Fort Logan (Colo.) National Cemetery Veterans Day ceremony; California Gov. Arnold Schwarzenegger joined American Legion Commander John Johansen, of Palisades Post 283, to lay a wreath at Los Angeles National Cemetery; The Chalmers P. Wylie VA Am- bulatory Care Center joined city, county and state offices to bring the annual Veterans Day Parade to the city of Columbus, Ohio; The Booker T. Washington High School Marching Band participated in the 60th annual Veterans Day parade on the Tuskegee campus of the Central Alabama Veterans Health Care System. keNya griffiN

VAnguard • Winter 2009/2010 25 AROUND HEADQUARTERS

Bay Pines, Louisville Facilities Take Trophy in 2009 Carey Awards

The Bay Pines (Fla.) VA tional Cemetery, VA Sunshine position was created to work Albuquerque, N.M.; Healthcare System and the Healthcare Network Office closely with returning soldiers n Minneapolis VA Medical Louisville (Ky.) VA Medi­ (VISN 8), and other VA and through the Warrior Transi­ Center; and cal Center were awarded the non-VA tenant organizations. tion Unit at Fort Knox. The n White River Junction (Vt.) prestigious 2009 Robert W. The health care system Louisville VAMC has progres­ VA Medical Center. Carey Performance Excellence also includes a large outpatient sively moved up the Carey Performance Excellence Awards Trophy during a cer­ clinic in Fort Myers and seven awards ladder, earning the Per­ Winners emony in Washington, D.C., community-based outpatient formance Achievement Award n Central Arkansas Veterans on Oct. 30. clinics. Bay Pines provides a in 2007 and the Performance Healthcare System, Little The Carey awards are pre­ full continuum of veteran-cen­ Excellence Award in 2008. Rock; sented annually to recognize tered care, and has sustained The Carey program fol­ n James A. Haley Veterans’ VA organizations that have the highest performance levels lows the Malcolm Baldrige Hospital and Clinics, Tampa; demonstrated noteworthy lev­ among complex VA medical National Quality Award crite­ and els of performance excellence centers while caring for more ria. It provides a model against n South Texas Veterans in seven areas: leadership; stra­ than 93,000 patients with which organizations can assess Health Care System, San An­ tegic planning; customer and more than 1.1 million outpa­ their quality transformation tonio. market focus; measurement, tient visits annually. efforts, organizational effec­ analysis and knowledge man­ Bay Pines received the tiveness and performance in agement; workforce resource Carey Performance Excellence delivering service and satisfy­ focus; process management; Award in 2008. ing customers. and results. The Trophy is the The Louisville VA Medi­ There are four catego­ highest award given. cal Center provides care to ries of awards: Performance “We know that the Carey 41,000 veterans in a 35-county Achievement awards are program is not about winning area in north central Kentucky given to applicants that score a trophy. It’s about striving to and southern Indiana. Louis­ 340-429 points; Performance continuously improve service ville VAMC is a tertiary care Excellence awards are given to veterans by giving your­ facility classified as Clinical Re­ to applicants that score more selves an honest assessment, ferral Level 2, and operates six than 430 points; Trophy understanding your strengths CBOCs in Kentucky and two awards are selected by the and pursuing opportunities for in Indiana. Secretary from applicants improvement,” said VA Dep­ Through its 54 affiliations meeting Performance Excel­ uty Secretary W. Scott Gould with colleges and universities, lence requirements; Circle of during the awards ceremony. including the University of Excellence awards are given to “It’s about being the best at Louisville School of Medicine, recent Trophy winners that are providing veterans with the the Louisville VAMC trains not yet eligible to compete due highest-quality products and more than 750 university resi­ to a five-year waiting period services that meet their needs dents and students annually. after winning the Trophy. and expectations.” Training opportunities include Thresholds for Circle of Excel­ Bay Pines is a unique nursing, dentistry, pharmacy, lence are higher than Trophy. emersoN saNDers health care system with a 76­ social work, psychology, radiol­ For 2009, the minimum re­ The Bay Pines VA Healthcare System re­ year history of serving veterans. ogy, audiology, pastoral care quirements were 450 overall ceived top honors in the Carey awards, along with the Louisville (Ky.) VA Medical Center. The historic 330-acre campus and health care administration. score with all item scores at 30 includes a top-level acute care The medical center also percent or higher. Performance Achievement hospital offering a full range provides support to the Soldier The awards program is Winners of medical, surgical and acute Readiness clinic located at Fort dedicated to the memory of n Camp Nelson National psychiatric inpatient and out­ Knox. This clinic is respon­ the late director of the Phila­ Cemetery, Nicholasville, Ky.; patient care, community living sible for the mobilization and delphia VA Regional Office n Central Texas Veterans center, domiciliary, and resi­ demobilization of active duty and Insurance Center, who Health Care System, Temple; dential rehabilitation treatment troops for Operation Endur­ was known as a quality leader n VA Maryland Health Care programs such as military sexu­ ing Freedom/Operation Iraqi and champion for excellence System, Baltimore; al trauma and stress treatment, Freedom and serves as the in the federal government. n Veterans Health Care Sys­ with a total of 414 operating primary care site for all medi­ Circle of Excellence Winners tem of the Ozarks, Fayette­ beds. In addition, the campus cal hold soldiers at Fort Knox. n Cooperative Studies Pro­ ville, Ark.; and includes the St. Petersburg VA To ensure seamless transition gram, Clinical Research Phar­ n Washington (D.C.) VA Regional Office, Bay Pines Na­ in 2009, a military liaison macy Coordinating Center, Medical Center.

26 VAnguard • Winter 2009/2010 AROUND HEADQUARTERSOUTLOOK

Government-wide Veterans Employment Initiative Launched

On Nov. 9, President Obama nel Management to share les­ and OPM on establishing a up their own programs. signed an executive order sons learned and best practices coordinated government-wide “The Veterans Employ­ launching the government- to help set the tone for the effort to increase the number ment Initiative in a sense re­ wide Veterans Employment new initiative and help other of veterans employed by the quires other federal agencies to Initiative, designed to increase federal agencies hire more federal government; serving follow the VECS model,” said the number of veterans in the veterans. as a national forum for pro­ May. “They are now required federal workforce. The initia­ “It’s great to be at the moting veterans employment to have a Veterans Employ­ tive stresses the importance of front of this initiative, and opportunities in the executive ment Program office with peo­ recruiting and training veter­ we’ve understood the impor­ branch; and establishing per­ ple dedicated to hiring veter­ ans and helping them adjust tance for a long time,” said formance measures to assess ans and helping them navigate to government service as a VECS Director Dennis May. the effectiveness of the Veter­ the application process, just civilian. “President Obama’s initiative ans Employment Initiative and like we have been doing.” “Honoring our sacred highlights the importance and submit an annual report to the In addition to May, trust with America’s veterans significance of what we’ve President. VECS employs nine regional means doing all we can to help been doing and serves to rein­ “The federal government veterans employment coor­ them find work when they force our commitment to our has collected veteran hiring dinators strategically located come home so they never feel nation’s veterans.” data for a very long time,” said across the country who work as if the American collaboratively with Dream they fought to warrior transition defend is out of reach units, transition cen­ for them and their ters, veterans service families,” said Obama. organizations, VA’s “But this initia­ Vocational Rehabilita­ tive is about more tion and Employment than repaying our debt Service, and other for their courageous veteran stakeholders service and selfless to promote VA career sacrifice. It’s also about opportunities in the continuing to fill the veteran community. ranks of federal em­ Human resource ployees with men and offices VA-wide were women who possess also asked to designate the skills, dedication an HR specialist as and sense of duty that their local veterans Americans deserve employment coordina­ from their public robert turtil tor to help guide local servants. And few VA Deputy Secretary W. Scott Gould discusses the Department’s initiative to hire more efforts to attract and embody those quali­ veterans, now serving as a model for other federal agencies. recruit veteran appli­ ties like our nation’s cants for employment veterans.” VA Secretary Eric K. May. “The difference now is in VA’s workforce. It’s no secret that VA is Shinseki recently released that data will be submitted “VA believes that all dedicated to hiring veterans— a memo highlighting VA’s to the President and agen­ veterans deserve an opportu­ no other federal agency outside obligation to set the standard cies will be scored on their nity to successfully enter the of the Department of Defense for all federal agencies when performance. That kind of vis­ workforce and lead produc­ employs more veterans than it comes to hiring veterans. ibility and attention will have tive lives after service to our VA. As a matter of fact, VA The Veterans Employment a dramatic impact on hiring nation,” said May. “Through has a long history of commit­ Initiative establishes an inter­ veterans.” the VECS initiative and by ting to hire veterans and in agency Council on Veterans Since the signing of the helping to ensure that manag­ 2008 created the Veterans Em­ Employment that is co-chaired Veterans Employment Initia­ ers and supervisors throughout ployment Coordination Ser­ by the secretaries of Labor and tive, VECS has received a great VA are better aware of special vice with the goal of increasing Veterans Affairs. The OPM deal of attention while serving hiring authorities that help its veteran employee popula­ director serves as vice chair of as the benchmark for the pro­ bring veterans into our work­ tion from 30 to 33 percent. the council. gram. According to May, four force, VA will continue to In June, VECS was con­ The council is charged other federal agencies have open the doors of opportunity tacted by the Office of Person­ with: advising the President asked for VA’s help in setting for veterans.”

VAnguard • Winter 2009/2010 27 AROUND HEADQUARTERS

Defense Finance and Accounting Service Now VA’s Payroll Provider

secretary for Financial Busi­ board as the execution and two could communicate and ness Operations, who oversaw implementation phase of the transfer the records. The trans­ the migration. “In our Site $37 million project was rap­ fers were made in five separate 5 migration, which involved idly approaching. “He was groups. The first was made up 70,000 records, we only had able to get everyone working of three VISNs and 32,700 17 rejected transactions. That together with a clear focus and people. After that first success­ is amazing.” realistic goals in a short period ful migration, the following As the federal govern­ of time,” said Peña. four increased in number with ment’s second-largest agency Coles immediately fo­ each migration, ending with behind the Department of De­ cused on the technical work Site 5’s 70,000 payroll records. fense, VA’s massive migration to transfer the nearly 300,000 In the end, it took the co­ of records from one system to pay records from VA to DFAS ordination and cooperation of another makes for a notewor­ and between two different sys­ VA Central Office, the three thy accomplishment. The fact tems that couldn’t even com­ administrations, IT developers, robert turtil that very few employees even municate. the Financial Services Center, Linda Peña oversaw the payroll saw a hiccup in their pay is at­ To bring it all together, Quality Assurance, DFAS, migration project. tributable to the superb project VA first had to clean up the payroll staff in the field, Hu­ management practices VA fol­ data in PAID to make sure all man Resources offices and For most of the nearly lowed in this effort. of the records were correct, contractors to implement and 300,000 people employed “The successful comple­ and then define specific pay complete one of VA’s major by VA, Sept. 15 was just tion of an initiative of this requirements to DFAS. Unlike IT initiatives. another day, but for VA’s Fi­ magnitude does not just hap­ most federal agencies, VA em­ “The whole project ended nancial Business Operations, pen,” said Peña. “It required a ploys a large number of Title up being as seamless as pos­ it marked the completion of tremendous amount of plan­ 38 workers, such as doctors sible,” said Peña. “And amaz­ a major project that affected ning, defining accurate systems and nurses. Title 38 employees ingly enough, nothing made every single person that earns requirements, and flawless do not have linear pay scales it to the senior level no matter a paycheck from the Depart­ systems modifications to make like those of general schedule how complex the problem. ment. it happen. employees, and have some of That is a direct reflection of On that third Tuesday “The real key to the suc­ the most complex time and at­ how well Roy and the staff in September, the last of VA’s cess of this project was Roy tendance rules and regulations performed—tackling issues employees were transferred Coles, who pulled the whole in the federal government. before they became problems from the 40-year-old legacy project together and kept us all “The staff’s ability to de­ and never losing sight of the system PAID to the Defense on track,” she continued. “Roy velop and define crystal-clear goals.” Finance and Accounting Ser­ is the ‘Great Collaborator.’ He requirements, and especially In 2003, VA was directed vice (DFAS) payroll system. kept everyone informed and those of Title 38 employees, by the Office of Management “This is one of the first totally involved in the project. was critical and paved the way and Budget to move payroll major IT initiatives to be If we had questions, we could for DFAS to accurately modify processing to DFAS, which successfully completed in a go to anyone on the staff and its system to ensure employees uses the Defense Civilian Pay long time, and to have these get an answer. He kept every­ received their proper pay,” said System to process and execute conversions from one payroll one focused on the goals.” Peña. pay transactions. The system system to another occur with Coles, who assumed du­ Once the requirements has received numerous awards very few problems is really ties as director of HR/Systems were laid out, both VA and and certifications, and remains incredible,” said Linda Peña, and ePayroll for the office in DFAS had to modify their a state-of-the-art example of VA’s associate deputy assistant November 2007, came on­ respective IT systems so the pay technology.

Senior Executives Meet to Lay the Groundwork for Transformation

More than 100 of VA’s senior but also to lay the ground rate Senior Executive Manage­ rounded senior executives. executives met in Washington, work for Secretary Eric K. ment Office, covers traditional Secretary Shinseki opened D.C., Nov. 4-6 for the first of Shinseki’s plan to transform leadership topics such as per­ the forum with an hour-long four training sessions designed VA into a 21st-century orga­ sonnel management, strategic “Dialogue on Leadership,” in to not only bring newly ap­ nization. planning, public relations, which he shared a number of pointed senior executives up to The four-part program, ethical leadership and other personal lessons learned dur­ speed and promote leadership, organized through the Corpo­ skills necessary to develop well- ing his 38 years of military

28 VAnguard • Winter 2009/2010 AROUND HEADQUARTERSOUTLOOK service, as well as his views on tion on the transformation of objectives for the Department and retaining great people.” the leadership qualities needed VA was just a small portion of that are the collective respon­ Gould also outlined 13 in an organization. He empha­ the SES training, the topics he sibility of the Department as a major initiatives that represent sized qualities that make up a covered formed an outline ex­ whole.” the areas of utmost importance “competent organization”: plaining the Secretary’s vision The three integrated ob­ to VA: eliminating veteran n People operate outside their and priorities for VA: jectives are what VA will do homelessness; eliminating narrow lanes for the benefit of n Improve the quality and to accomplish the goals: make claims backlogs; automating the entire organization and the accessibility of health care, it easier for veterans and their GI Bill claims benefits; imple­ mission; benefits and memorial services families to receive the right menting a Virtual Lifetime n There is trust and confi­ while optimizing value; benefits and meet their expec­ Electronic Record; improving dence; n Increase veteran client satis­ tations for quality, timeliness mental health services; devel­ n Teamwork is valued; and faction with health, education, and responsiveness; educate oping seamless communication n People are provided the training, counseling, financial and empower veterans and with veterans; designing a vet­ proper training to ensure suc­ and burial benefits and ser­ their families through proac­ eran-centric health care model; cess. vices; tive outreach and effective ad­ expanding health care access While Secretary Shinseki n Raise readiness to provide vocacy; and build VA’s inter­ to women and rural veterans; focused on leadership, Deputy services and protect people nal capacity to serve veterans, ensuring readiness in cases of Secretary W. Scott Gould laid and assets continuously and in their families, employees and national emergency; measuring out much of VA’s strate­ performance to ensure gic plan and some of the consistent improvement challenges of transform­ and efficiency; establish­ ing VA. ing strong management “Our mission is to infrastructure; developing serve veterans, but today, and improving employees we face new challenges, with mission-essential and to meet them we skills; and conducting must be ready and willing research and development to collaborate with one to enhance the long-term another in new and dif­ health and well-being of ferent ways,” said Gould. veterans. “People at VA speak one “These initiatives of three languages: the represent the priorities of language of medicine; the the entire organization in language of business; and creating better outcomes the language of govern­ for veterans immediately ment. As leaders here at and into the future,” said VA, most of you speak Gould. “Although they Priscilla kates one of those languages may in some cases be led very well. President VA Deputy Secretary W. Scott Gould talks with Wanda Mims, director of the VA by a specific organiza­ Obama and Secretary Caribbean Healthcare System, at the SES Orientation and Leadership Forum. tion, they all will require Shinseki have charged us with times of crisis; and other stakeholders efficiently the collaboration and support transforming the Department n Improve internal customer and effectively. of the entire Department to to capture opportunities and satisfaction with management Promoting an increased achieve success.” to meet the emerging chal­ systems and support services to understanding of VA’s stra­ Three more SES training lenges of the 21st century. achieve mission performance tegic goals, objectives, strate­ sessions are planned for the “This transformation will and make VA an employer of gies and guiding principles to coming year. They will include require learning the other VA choice by investing in human senior executives helps prepare traditional leadership training languages you don’t speak and capital. the organization by ensuring as well as further guidance adapting to new realities, lever­ “Our plan for achieving everyone is on the same sheet on transforming VA into a aging new technologies, and these goals calls for a Depart- of music. more veteran-centric, results- proactively serving a diverse ment-wide effort, harnessing “We must commit our­ oriented and forward-looking range of veteran needs. We all of our talent to focus on selves to investing in the re­ organization better equipped must do so in a manner that the needs, expectations and ex­ newal of our internal capabili­ to adapt and serve the veterans is consistent with our guiding periences of veterans and their ties and building a foundation of today and those of tomor­ principles of being people- families, while maximizing for future innovation,” Gould row. For more information centric, results-driven and efficiency and value,” Gould said. “Together, we will build about the SES Orientation and forward-looking.” said. “To do this, we have a first-rate Department, com­ Leadership Forums, contact While Gould’s presenta­ committed to three integrated mitted to attracting, deploying [email protected].

VAnguard • Winter 2009/2010 29 INTRODUCING

Sharon Batala INTRODUCING To the Hopi Indians, the Navajo veterans, Batala often Grand Canyon is a sacred spot finds “they know they have believed to be the source of benefits, but they don’t know their origins. For VA Read­ how to start the process. I justment Counseling Service’s help them with their paper­ Sharon Batala, a Hopi her­ work, the follow-up, and so self, the Canyon is not only forth. I’m different from other sacred—it’s also a unique place counselors. Since I speak the where she delivers assistance to language, I can act as the go- the area’s veterans. between for them and the Every other month, Bata­ VA.” la, who works on the Hopi One of the difficulties Nation reservation, is flown Batala faces in such a rural in by helicopter to reach the area is distance. She spends elderly and disabled veterans much of her time on the road, art batala who live deep in the Canyon. frequently logging more than Unable to walk up the steep 100 miles a day. Often, she Although natural beauty abounds, reaching the remote reservations she serves are a challenge for Sharon Batala; she often logs more trail, with horses, mules or has to plan her trips around than 100 miles a day. helicopters as their only other the weather, which creates means of transportation, the road hazards, wintry condi­ acter. According to Batala, her “During the summer months, Supai veterans living in this tions, and no cell reception in large extended family connec­ because we are an agricultural remote location had been most areas. Her schedule also tions help the veterans relate to tribe, the veterans here suffer isolated until Batala arrived in revolves around the cultural her since they may be part of from PTSD less due to the 2001. Although only a handful calendar of the native tribes. the same clan or were raised in outside physical activities they of military veterans live there, “I know when things are busy, the same area. are doing,” Batala said. “When Batala helps resolve their pend­ quiet, or they’re in preparation Part of Batala’s job is they see things grow, it makes ing claims issues, providing for a ceremony,” said Batala. coordinating benefits between them happy. It can be thera­ much-needed support in an Her long commutes may VA, Indian Health Service, the peutic to take care of other area mostly forgotten by the seem extreme, but Batala state benefits counselor, and things.” rest of the world. stresses the importance of the the Hopi Tribe veterans office, For Batala, by helping On remote Native Ameri­ face-to-face conversations she where she began her career. veterans, she is also helping can reservations such as the has with veterans. “As Hopi, An Air Force veteran herself, their families. “I’ve learned she spent eight years in the so much from the veterans,” “As Hopi, we want to talk to you in military. she said. “Sometimes, I’m the “I’ve been through basic only person, the only witness, person, to see your eyes. Phone training,” Batala said. “I can they are willing to share their conversations don’t work.” relate to them on that level. story with. Most don’t even My experience was not that tell their families. I inform Hopi Nation in northern Ari­ we want to talk to you in different from theirs. I know them they’re not crazy. There zona, there is no public trans­ person, to see your eyes,” she how the military system works. is a diagnosis for what they portation. With most people said. “Phone conversations I know what it’s like to be are feeling. I work with the living on the lower end of the don’t work. For us, it’s not the away from your family.” families, explain why grandpa income scale, many veterans amount of time you spend— The Hopi culture itself is angry all the time and wants encounter difficulties reach­ it’s the quality. It may take me can often be instrumental in to be alone. I get them talking ing their nearest VA facilities. half a day to get there, but it’s healing war trauma, especially about it on a regular basis. Almost all of the veterans live worth it.” post-traumatic stress disorder. “Sometimes, I look at more than an hour from town. By tradition, Batala, “PTSD makes you so iso­ those who were angry, whose And at four hours away, the whose name means “reflection lated,” said Batala. “As Hopis, mood has changed, and I Prescott VA Medical Center off any body of water,” always it’s built into our culture that think ‘wow, I helped do that.’ is the closest VA medical cam­ introduces herself and her fam­ you rarely do things alone. Their quality of life changes. pus. ily background to the veterans You always do things together Now they can pay their bills, For the past 17 years, this she is helping. In Hopi tribes, and socialize.” buy a car, help put food on is where Batala has stepped in family lineage defines people Because of things the tribe the table. It changes their to help. Servicing anywhere and can give the veteran an does routinely, Hopi veterans whole life.” from 300 to 500 Hopi and indication of the person’s char­ actually have fewer symptoms. By Amanda Hester

30 VAnguard • Winter 2009/2010 MEDICAL ADVANCESOUTLOOK

Older Heart Bypass Method is Best, Study Shows The topic has been hotly de­ bated among surgeons and car­ diologists: Is it safer and more effective to do bypass surgery with or without a heart-lung pump that allows doctors to stop the heart while they oper­ ate? A clinical trial at 18 VA medical centers has found that while both methods are generally safe and effective, the more traditional on-pump method yields better outcomes after one year. The findings appear in the Nov. 5 New England Journal of Medicine. “There was good survival in both groups at one year, amaNDa Domaszek urrea but the conventional method proved safer and somewhat A clinical trial at 18 VA medical centers looked at whether it was safer and more effective to perform heart bypass surgery with or without a heart-lung pump that allows surgeons to stop the heart while they more effective than the newer operate. off-pump method,” said study co-leader Frederick Grover, the off-pump procedure, in­ a cardiopulmonary bypass method as enabling a quick re­ M.D., a heart surgeon with cluding quicker recovery and pump, or heart-lung machine. covery, with lower health care VA and the University of less impact on cognitive func­ During an “on-pump” proce­ costs and less risk of cognitive Colorado. tion. This study indicated a dure, the heart is stopped with decline. After a year, patients in consistent trend toward better medication and the machine Recent studies, though, the on-pump group fared bet­ outcomes in patients who had takes over blood circulation. have raised concerns about the ter on a composite measure undergone the conventional This allows doctors to work on newer procedure as well: Is it that included death, repeat on-pump technique.” a still heart. too technically difficult? Are cardiac procedures, or nonfatal The 2,203 veterans in An alternative, “off­ surgeons sometimes unable to heart attacks. Their vein grafts the study all had clogged or pump” method that has complete multiple grafts on a were also more likely to re­ narrowed coronary arteries, gained some popularity in the patient? Are the grafts more main open. The study includ­ resulting in less blood flow to past decade is also known as likely to fail? And as a result, ed follow-up angiograms per­ the heart. This can cause chest “beating heart” surgery. As the are patients more prone to formed by cardiologists who pain and increase the risk of name implies, the heart keeps heart attacks or repeat proce­ were “blinded” as to which heart attack. In bypass surgery, beating during the procedure dures? type of bypass the patients had also known as coronary artery and no heart-lung machine is No studies to date have undergone. bypass grafting (CABG), doc­ used. Doctors use special de­ been conclusive, but the new In particular, Grover tors take a healthy piece of vices to stabilize only the small VA trial results should greatly pointed to the fact that both vein from elsewhere in the section of heart where they are inform the debate. Grover groups scored equally well a body and sew it in place as a stitching in the graft. said he thinks the results may year after surgery on neuro- “detour” between the heart Controversy has existed as influence cardiology referrals psychology tests. Some experts and a point in the problem to which method is safer and and cardiac surgery practice, have believed the on-pump artery below the blockage. more effective. Some studies but he stresses that individual method is riskier for cognitive As long as the graft remains suggested that using the pump patient differences still need to health. open—“patent,” in medi­ could weaken heart function be taken into account. Patients According to first author cal terms—and doesn’t close after surgery, harm the lungs with certain risk profiles and A. Laurie Shroyer, Ph.D., the down over time, the heart and kidneys, result in more patterns of coronary damage, findings of the large, multisite enjoys a renewed flow of blood blood use during surgery and he said, may still be strong VA study contradict find­ and oxygen. longer hospital stays, and bring candidates for the off-pump ings from earlier studies that For more than 30 years, on problems with memory method, notwithstanding the showed “some advantages of most bypass procedures have and thinking. Many experts general results seen in the trial. [heart bypass] surgery using been done with the use of came to see the off-pump -VA Research Currents

VAnguard • Winter 2009/2010 31 MEDICAL ADVANCES

Comprehensive Study nam-deployed women were of Vietnam-Era Women studied in the 1980s. Then, it Veterans Gets Underway was about 8.5 percent. Understanding the experi­ “There are cases of remis­ ences of women who served sion, as well as new onset and in Vietnam and the long-term delayed onset. There could be health effects of their service is new traumas totally unrelated the goal of a new VA study. As to military service,” noted many as 10,000 women, most Magruder. “Also, we’re using now in their 60s, are expected different instruments now— to take part. The sample will there’s a whole new diagnostic include women who served in system. So we don’t know Vietnam and, for comparison, what we’re going to find.” those who served stateside or Chairing the study elsewhere in Asia, such as in with Magruder are Dr. Amy Japan, Korea, Guam or the Kilbourne, a mental health Philippines. researcher with the Ann Arbor “We’re going to be look­ (Mich.) VA Medical Center, ing at current and lifetime and Dr. Han Kang, who prevalence of a range of directs VA’s Environmental physical and mental health Epidemiology Service and the outcomes,” said study co-chair War-Related Illness and Injury Dr. Kathy Magruder, an epi­ Study Center in Washington, demiologist at the Charleston D.C. (S.C.) VA Medical Center. About 8,000 of the wom­ She noted that the study is the en VA expects to enroll in the NatioNal arcHiVes largest and most comprehen­ new study were part of earlier A U.S. Air Force flight nurse tends to American wounded aboard a sive effort to date to look at research by Kang on birth out­ C-141 prior to an aeromedical evacuation from Vietnam back to the this population. comes. That study, published United States in 1967. Among the key questions in 2000, found higher rates of the course of 40 years—will be pre-existing health conditions, the researchers hope to answer: birth defects in the children a challenge for the researchers. childhood traumas, wartime How many of the women de­ of women who had served in Most of the prospective re­ exposures or injuries, home­ veloped post-traumatic stress Vietnam compared with those spondents are nurses and have coming, social support, and disorder or depression after who had served elsewhere. The experience reporting health health behaviors, such as ciga­ their service, and how many causes for the increased risk re­ conditions. rette smoking or alcohol use. still cope with these conditions main unknown, but research­ In terms of mental condi­ Most of the women today? Are these conditions ers believe they may include tions, the researchers will ask expected to take part in the more prevalent among those exposure to herbicides such as mainly about PTSD, depres­ study have not been regu­ who served in Vietnam, and Agent Orange. sion, anxiety and substance lar users of VA health care. to what extent have they led to The new study will in­ abuse. The physical conditions Nonetheless, VA—which physical health problems? clude mail surveys, phone in­ they’ll focus on include car­ has ramped up programs for Magruder said it’s dif­ terviews and reviews of medi­ diovascular disease, diabetes, women in recent years—will ficult to predict whether the cal records. Teasing out the multiple sclerosis, Parkinson’s use the results to improve care prevalence of PTSD will be complex links between Viet­ disease, brain cancer, breast and services for this Vietnam- similar to what was found nam deployment and various cancer and gynecological era population. when smaller groups of Viet­ health factors—especially over cancers. Some of the condi­ “These women, for the tions have been linked in past most part, are in their early research to exposure to trauma 60s,” noted Magruder. “They Women in Vietnam or environmental toxins; oth­ may have a lot more years. It’s ers don’t have a particular important for us to know what n about 8,000 women served in Vietnam during the war, military tie-in but are common they’re dealing with.” some 85 percent as nurses. in total, some 250,000 women among aging women. The findings may also served in the u.s. military during the Vietnam era. Along with probing the shed light on what the newest n the new Va study will include mail surveys, phone prevalence of various condi­ generation of women—those interviews and medical chart reviews for 10,000 women tions, the researchers will ask returning from Afghanistan who served in or near Vietnam or in the u.s. during the about demographics and life and Iraq—may face in the Vietnam War. and military factors such as years ahead. years of nursing experience, - VA Research Currents 32 VAnguard • Winter 2009/2010

HAVE YOUOUTLOOK HEARD

First Lady Visits Bronx VA Medical Center San Francico VA First Lady Michelle Medical Center Obama visited patients Celebrates 75 and staff at the James J. Years of Service Peters VA Medical Cen­ on sept. 14, the san ter in the Bronx before francisco Va medi- attending Game 1 of the cal center celebrated World Series between its 75th anniversary of the New York Yankees providing care to vet- and the Philadelphia erans. Phillies on Oct. 28. Ac­ a ceremony was companied by Jill Biden, held for patients and wife of Vice President Joe Biden, the First Lady staff with marvin was at the medical center sleisenger, m.D., dis- to take part in Major jim blue tinguished physician League Baseball’s Wel­ First Lady Michelle Obama greets veterans at the James J. Peters VA and former chief of come Back Veterans ini­ Medical Center on Oct. 28. medicine at the cen- tiative, which helps connect returning Afghanistan and Iraq veterans with mental health ter, and lloyd “Holly” services and job opportunities. smith, professor emeri- Major League Baseball dedicated Game 1 of the World Series to veterans and their tus, university of cali- families. “I’m happy with every minute that I spend with our men and women in uni­ fornia, san francisco, form and our veterans,” Obama said. “Each and every day, they selflessly and coura­ providing remarks. geously serve this nation.” She called on all Americans to “take the time to be more aware both are responsible of these heroes in our midst, and honor them by doing more service not just for them, for the establishment but for all our communities.” After speaking to a crowd of patients and staff gathered in a hospital conference room, Obama visited patients in the spinal cord injury unit, handing of the affiliation be- out Yankee paraphernalia, including teddy bears and caps. tween the Vamc and ucsf, one of the most successful affiliations ‘Heroes at Heinz Field’ in the country. On Sept. 28, a unique the original plans partnership between VA Healthcare–VISN 4 and called for 21 buildings the Pittsburgh Steelers gave and a 500-bed hospital, 76 veterans a once-in-a­ but today the medical lifetime opportunity. The center serves more “Heroes at Heinz Field” than 50,000 veterans event—now in its second year—teamed local Op­ and had more than eration Enduring Freedom 400,000 outpatient vis- and Operation Iraqi Free­ its in fiscal year 2008. dom veterans with Steelers more than 700 ucsf players. trainees from 34 pro- To start the evening, grams rotate through veterans and their guests justiN guiDo/butler eagle the medical center caught passes, kicked field Pittsburgh Steelers linebacker Lawrence Timmons signs an autograph for goals and tossed footballs veteran Daniel Maguire and family. each year. it also has as 10 Steelers players stood the number one Va re- by, offering encouragement and expert tips. When the skills session ended one hour later, the pros search program in the posed for photos and broke out their Sharpies to autograph souvenir “Super Bowl Champions” nation, with more than caps for the former soldiers. The veterans and their guests then moved to the stadium’s North Club Lounge to enjoy a complimentary dinner overlooking the field. The event “lets veterans $77 million in expendi- know that we will go anywhere to make sure that they get an opportunity to be recognized and to tures in 2008. connect with us,” said VA’s VISN 4 Director Michael Moreland.

VAnguard • Winter 2009/2010 33 HAVE YOU HEARD

Little Rock’s Welcome Home Event Draws 4,500 Veteran Volunteer The Central Arkansas Veter­ Leaves His Entire ans Healthcare System hosted Estate to VA a Welcome Home event to VA Illiana Health Care honor Operation Enduring System recently had a re- Freedom/Operation Iraqi membrance program in Freedom veterans and their honor of Army veteran families in September. The John P. Wright. Wright event, which featured food, served as a VA volun- local live entertainment, games teer for nearly 40 years, and activities for adults and amassing a total of nearly children alike, included a rock 50,000 hours of service. wall, dunking booth and cake­ jeff boWeN walk. In addition, a four-hour Assigned to Recreation The Central Arkansas Veterans Healthcare System Welcome Home Therapy, Wright did golf tournament, which at­ event’s job fair drew more than 80 vendors. tracted 74 golfers, was held at most of his volunteering the local War Memorial golf course, and a job fair featuring more than 80 vendors took place on in the Recreation Hall. the west side of the stadium. He did not have family, The event attracted 4,500 veterans and family members and about 400 volunteers. It was but his extended family more than fun and games. The Emergency Medical Response Team administered 161 flu shots to was the Recreation/Vol- those in attendance that wanted the vaccination. Central Arkansas partnered with area businesses, untary Service staff. the Veterans of Foreign Wars, the American Legion, the American Legion Auxiliary, Disabled Michael E. Ham- American Veterans, the Salvation Army, AMVETS, Arkansas Army National Guard, Little Rock ilton, director, and Air Force Base, the City of Little Rock, Clear Channel Communications, and Channel 4 News. Jan Filicsky, acting chief of Voluntary Ser- ‘Scrubs’ Group Performs vice, unveiled a large at Dallas VA Medical check in the amount Center of $1,559,227.66 that What a treat when The Blanks Wright’s estate left to stopped by the Dallas VA VA Illiana to be used Medical Center to perform in Recreation Therapy. for patients. VAnguard read­ “What a wonderful gift ers may recognize them from guest appearances on the TV for Wright to give back series “Scrubs.” to his fellow veteran The Blanks were a delight with this donation. Out to hear and watch and made of Wright’s generosity, a special effort to visit with for many years to come patients on the units and sing veterans will be receiving for those who couldn’t come NaNcy gray this gift, ” said Hamilton. to the show. Veteran Kent Bell Veteran Kent Bell enjoys a bedside performance by The Blanks (left Staff at VA Illiana, was among those who received to right): George Miserlis, Paul Perry, Sam Lloyd and Philip McNiven. veterans and retired staff a private concert in their room. attended the program for The Dallas VAMC was the first VA performance for The Blanks. But as they visited with the vet­ erans and learned about their life and experiences in the military, it surely won’t be their last. Wright.

Houston VA Medical Center Opens New Post-Deployment Clinic for Returning Veterans Houston’s michael e. Debakey Va medical center recently opened a new Post-Deployment clinic to serve as a “Welcome cen­ ter” for veterans who served in operation enduring freedom and operation iraqi freedom. the Post-Deployment clinic is a “one- stop” center performing multi-disciplinary evaluations tailored to the individual’s physical, mental and social needs. assistance and information regarding non-medical Va benefits and community resources are also available. if the veteran cannot stay for the 90-minute comprehensive screening, the staff schedules more convenient appointments. in response to the unique physical and mental health needs of returning combat veterans, the medical center assembled a team of specialists to ensure smooth transition to Va medical care. the oef/oif support team meets with local reserve and National guard units before and after deployments to brief about available Va benefits.

34 VAnguard • Winter 2009/2010 HAVE YOUOUTLOOK HEARD

Group Burial Conducted at Dallas-Fort Worth National Cemetery More than 500 people turned out in the pouring rain on Sept. 13 for a group burial ceremony at Dallas-Fort Worth National Cemetery honoring seven military helicopter crash victims who perished in Iraq on Sept. 17, 2008. The deceased were National Guardsmen, members of Bravo Company, 2nd Battalion, 149th Aviation Regiment. They were aboard a CH-47 Chinook he­ licopter en route from Kuwait to Balad, Iraq, when the crash occurred. Most of the remains of the men had been identified and in­ terred elsewhere months ago, but after long analysis of the crash scene, further remains were found which could not be separated or identified. Those remains were interred in a single casket and marked with a monument located in Section 76 of the cemetery. roN eNNis/fort WortH star-telegram Four of the men were buried earlier in individual graves at na­ A National Guard member places a hand on the casket of his fallen tional cemeteries, including two at Dallas-Fort Worth, one at comrades. Fort Sam Houston National Cemetery in San Antonio, and one at Fort Sill National Cemetery in Elgin, Okla. It is highly unusual in VA cemeteries to inter and mark a veteran’s remains in more than one location.

North Chicago VA Medical Center Honors Former POWs Former POWs from U.S. conflicts gathered at the North Chicago VA Medical Center in September to honor and remember fallen comrades during their annual POW/MIA ceremony, which included their first-hand accounts as prisoners. “This event was different from previous POW/MIA ceremonies,” said John Stoffle, for- mer POW and event speaker. “Most depict the difficulties and suffering of these wars, but the events I described depicted the differences between Pacific-area and European POWs.” Stoffle was captured southwest of Berlin. “I think of death marches and poor camp conditions when I think of the war in the Pacific,” he said. “My experience was much different, in that my captors were more concerned with the war’s end and possible retribution.” Left: Former POWs (left to right) Don McCormick, John Stoffle, Chester Pestrak and Al mary WatermaN Fehrman salute the flag during the POW/MIA ceremony at the North Chicago VAMC.

VA Palo Alto Hosts Exhibit Honoring Hispanic Military Service to the Nation The VA Palo Alto Health Care System hosted the Hispanic Medal of Honor Society’s Legacy of Valor exhibit Oct. 8 and 9 in celebration of Hispanic Heritage Month. The exhibit honors Hispanic military service to the nation. It includes displays honoring Hispanic Medal of Honor recipients, Latino heroes such as Presi­ dential Medal of Freedom award winner Dr. Hector P. Garcia and former POW Everett Alvarez Jr., and the Aztec Eagles, an elite unit of pilots that flew combat missions during World War II, among others. Rick Leal, president of the Hispanic Medal of Honor So­ ciety, was on hand to give a presentation on the exhibit for staff and veterans in the facility’s auditorium. The exhibit’s two-day visit to VA Palo Alto was arranged by Thomas M. Turréy III, the facility’s Hispanic Heritage Program manager, who saw it on display at the National Council of La Raza’s annual conference last summer and contacted Leal about bringing it to VA Palo Alto. After leaving VA Palo Alto, the exhibit was displayed at San Francisco City Hall.

Right: The Legacy of Valor exhibit was displayed at VA Palo Alto Oct. 8 and 9 in celebration of Hispanic Heritage Month. curt camPbell

VAnguard • Winter 2009/2010 35 HONORS

Like Father, Like Son VA’s O’Leary to Serve The proverbial apple didn’t fall too far from as Journal Editor the tree in the case of Det. Mike Grieco, of Timothy J. O’Leary, M.D., the VA New York Harbor Healthcare Sys­ Ph.D., acting VA deputy tem, and his son, Mike Grieco Jr. The senior chief research and devel- Grieco is a career civil servant who spent 20 opment officer, has been years with New York City Corrections be- named editor-in-chief of the fore coming to VA. His son has served with the city’s fire department for four and a half Journal of Molecular Diag­ years. nostics. His term begins in Besides civil service, father and son also January 2010. share a passion for weightlifting, and recently Along with his leader- won gold medals at the World Police and Fire ship role in VA research, Games in Vancouver, Canada. Dad took the O’Leary is well known for gold in the age 50-55 class, and Junior gar- his work in molecular diag­ nered a gold medal in the 198-pound weight nostics. The field involves class. the study of genes and The World Police and Fire Games Fed- proteins within cells. Ad­ VA New York Harbor eration established the games in 1985 and vances in recent years have they are now an international sporting event, police detective Mike Grieco and his son, Mike offering police officers, firefighters, customs boosted health profession- Grieco Jr., won gold als’ ability to diagnose and officials and corrections officers an opportu- medals at the World Po- nity to showcase their athletic ability in more lice and Fire Games. monitor cancer and other than 60 sporting events. raymoND aalbue diseases. He has published more than 130 scientific papers and numerous book chapters. 2009 Environmental Services Department of the Year Winner Selected The Journal of Mo­ Va’s tennessee Valley Healthcare system was recently selected for the 2009 environmen­ lecular Diagnostics is the tal services Department of the year award by Health Facilities Management magazine and official publication of the the american society for Healthcare environmental services (asHes). the environmental Association for Molecular services Department of the year is designed to recognize the outstanding achievements Pathology, a not-for-profit of a leading-edge hospital environmental services/housekeeping team in maintaining the scientific society dedicated highest levels of performance in critical areas such as infection control and prevention, to advancing clinical mo­ patient safety initiatives, customer service, waste reduction and recycling initiatives, staff lecular laboratory medicine education/training and patient satisfaction. and translational research a panel of four judges selected the tennessee Valley Healthcare system based on its based on genomics and innovative programs and commitment to helping reduce hospital-associated infections. in proteomics. Co-published their comments, the judges recognized the health care system for its teamwork, continual by the American Society for training programs, initiatives to reduce hospital-associated infections, efforts to reduce Investigative Pathology, it medical waste, improve recycling and more. Health Facilities Management and asHes are is the top-ranked journal in part of the american Hospital association. its field.

Bronx VA Medical Center Director Wins AMSUS Federal Healthcare Executive Award Maryann Musumeci, director of the James J. Peters VA Medical Center in the Bronx, N.Y., was selected by the Association of Mili­ tary Surgeons of the United States as winner of the 2009 Outstanding Federal Healthcare Executive Award. The competitive award is presented to an individual senior health care executive officer in the U.S. Public Health Service, Department of Defense or VA who has made outstanding contributions to federal health care and has demonstrated superior leadership or executive management ability. AMSUS, originally founded in 1891 as a society for surgeons and physicians, is currently comprised of more than 9,000 pro­ fessionals serving in the full spectrum of health care disciplines, including the U.S. Public Health Service, VA, and DoD’s active, National Guard and reserve branches. Their official monthly journal, Military Medicine, features peer-reviewed scientific papers, case reports and editorials, including international submissions. Each fall, AMSUS sponsors a major educational conference for members, international delegates and others interested in the medical and health-related activities of the military and federal health agencies. Past award recipients from VA include Dr. Jonathan Perlin (2005) and Dr. Michael Kussman (2006), both former Under Secretaries for Health.

36 VAnguard • Winter 2009/2010 OUTLOOKHONORS

VA Maryland Health Care System Named One of Baltimore’s Best Places to Work The Baltimore Business Journal has named the VA Mary­ land Health Care System one of Baltimore’s Best Places to Work in 2009, the third such honor for VA Maryland. Competing with other businesses, hospitals, universities and financial institutions across the state, VA Maryland ranked second in this year’s competition for an organiza­ tion with 500 or more employees, and earned the unique distinction of being the only federal agency on the list. “As a federal agency, we don’t have the resources avail­ able in the private sector to enhance employee morale, but our overall mission, competitive salaries, generous benefits, employee recognition, strong leadership and cutting-edge technology have enabled us to attract and retain some of the most talented staff in the health care industry,” said Dennis H. Smith, VA Maryland director. In an anonymous online survey conducted by the terry toDesco Journal, employees were asked questions about job satisfac­ VA Maryland Health Care System Director Dennis H. Smith accepts tion, management style and trustworthiness, and their own the Baltimore’s Best Places to Work award. job performance. VA Maryland serves more than 52,000 veterans and employs approximately 3,000 clinical, technical, administrative and support personnel, providing a broad spectrum of care from two medical centers, a rehabilitation and extended care center and five outpatient clinics.

VA Pharmacies Get High Customer Satisfaction Scores in J.D. Power Survey j.D. Power and associates, a firm specializing in consumer surveys, has given Va pharmacies some of the highest customer satisfaction scores in a national sampling of pharmacy customers. j.D. Power surveyed about 12,000 pharmacy customers who use pharmacy retailers, including independent and mail-out pharmacies, chain drug stores, mass merchandisers and supermarkets. Va received an “among the best” ranking for the mail order category, the same overall ranking as kaiser Permanente Pharmacy and Prescriptions solutions. among the factors examined in the 2009 National Pharmacy study were pharmacy environment, price and value of prescription drugs, experience with online ordering and mail delivery, and experience with pharmacist and non-pharmacist staff. every veteran enrolled in the Va health care system is eligible to receive prescription medications, over-the-counter medications, and medical and surgical supplies. Va operates seven mail-out pharmacies, known officially as consolidated mail outpatient pharmacies, in charleston, s.c., Dallas, Hines, ill., leavenworth, kan., murfreesboro, tenn., chelmsford, mass., and tucson, ariz. these facilities support Va’s health care mission through advanced automated production tech­ nologies to dispense and mail prescriptions to eligible veterans. in 2008, Va provided approximately 126 million outpatient prescriptions to more than 4.4 million patients.

Four VA Facilities Make American Hospital Association’s List of 100 Most Wired Hospitals and Health Systems Four VA facilities made this year’s 100 Most Wired Hospitals and Health Systems listing in Hospitals & Health Networks magazine, published by the American Hospital Association. VA’s Northeast Region 4 in Brooklyn, N.Y., with 8,000 staffed beds in 36 hospitals, has made the list for the last eight years, the most appearances of any VA facility. With two years on the list, Fresno’s VA Central California Health Care System, with 114 beds, is a relative newcomer to the presti­ gious ranking. Both the 154-bed Richard L. Roudebush VA Medical Center in Indianapolis, and the 321-bed Washing­ ton, D.C., VA Medical Center have made the list for the past five years. The White River Junction VA Medical Center in Vermont was one of 25 hospitals chosen for the Most Wired–Small and Rural list. In the annual Hospitals & Health Networks’ Most Wired Survey and Benchmarking Study, facilities are graded on their use of information technology to achieve goals related to patient safety and quality, customer service, business pro­ cess improvement, workforce management and disaster readiness. This year, 556 hospitals and health systems nationwide completed the study, representing 1,314 hospitals.

VAnguard • Winter 2009/2010 37 HONORS

Omaha VA Medical Center Nurse D.C. VAMC Wins Honored for Exceptional Patient Care Organizational Dean Degner, an intensive care unit nurse at Achievement Award the VA Nebraska-Western Iowa Health Care The Washington, D.C., VA System’s Omaha medical center, is the first VA Medical Center is the 2009 recipient of The DAISY Award for Extraordinary winner of the Medallion of Nurses. The award, presented in collaboration Excellence, the highest honor with the American Organization of Nurse Execu­ presented for organizational tives, is part of the DAISY Foundation’s program achievement by the U.S. Sen­ to recognize the superhuman efforts nurses per­ ate Productivity and Quality form every day. Awards of Virginia. “We are proud to be among the hospi­ The SPQA uses the tals participating in The DAISY Award pro­ national Malcolm Baldrige gram. Nurses like Dean are heroes every day,” Award criteria to rate orga­ said Eileen Kingston, Omaha VA nurse execu­ nizations in all segments of tive. “It’s important that our nurses know their enterprise reflecting “visionary work is highly valued. The DAISY Foundation leadership, customer-driven provides a way for us to do that.” operations, value of employees

A retired Air Force major with 17 years of Will ackermaN and partners to the organiza­ military service, Degner has been a VA nurse tion, focus on results, and in­ Dean Degner receives The DAISY Award from since 1999. The nonprofit DAISY Foundation Bonnie Barnes, co-founder of the foundation that novation.” Not since 2006 has was established in 2000 in memory of J. Patrick sponsors it. the group’s judging committee Barnes, who died at the age of 33 from compli­ recognized an organization cations of an autoimmune disease. As of July, more than 4,500 nurses have received The DAISY with its highest achievement Award nationwide. For more information, visit www.daisyfoundation.org. award. The VAMC consistently Dental Director Receives N.C. Governor’s Volunteer Service Award scores high in patient satisfac­ Dr. Richard Chupkowski was named Cumberland County’s Outstanding Senior Citizen tion surveys, with nearly 85 Volunteer of the Year at the North Carolina Governor’s Volunteer Service Awards Ban­ percent of patients describing access to hospital services as quet recently. He also received a second-place award for the North Carolina Outstanding excellent. Its Patient Service Volunteer Medallion for Cumberland County. Center ensures all incoming Chupkowski began volunteering his profes­ calls are answered within 30 sional services to perform free dental extractions seconds. for The CARE Clinic patients in 1995. He soon The “paperless” hospital became the volunteer dental director and took over uses technology to improve responsibility for all dental aspects of patient care patient care. Its success is re­ at the nonprofit facility. flected in its award-winning Chupkowski is also an instructor for the Uni­ discharge summary program, versity of North Carolina School of Dentistry and designation as a “Most Wired” supervises dental residents at the Fayetteville VA hospital, and its telehealth initiatives. Medical Center. As a way to provide additional The D.C. VAMC was dental services to the clinic, Chupkowski began the first in the nation to put bringing his dental residents with him twice a EKGs on Blackberries, ensur­ month. The extra volunteers allow the facility to ing patients suffering chest courtesy of tHe care cliNic provide services to an additional 288 people a year pain get immediate, life-saving Dr. Richard Chupkowski in the community. treatment.

VA Mental Health Services Official Receives Top Award from American Psychological Association Dr. Antonette Zeiss, deputy chief consultant for mental health services with the Office of Patient Care Services in VA headquarters, has been named the recipient of the Retirement Research Fund Distinguished Contribution Award in Applied Gerontology from the American Psychological Association. Zeiss received the award at the APA annual conference, held last summer in Toronto, Canada. APA is a scientific and professional organization that represents psychology in the United States. With more than 150,000 members, APA is the largest association of psychologists worldwide. Its mission is to advance the application of psychological knowl­ edge to benefit society and improve people’s lives. The award Zeiss received is presented in honor of M. Powell Lawton to recognize those whose contributions include developing or implementing a program, practice, policy or treatment that has had or will have great potential to improve the lives of older people.

38 VAnguard • Winter 2009/2010 OUTLOOKHEROES

St. Louis VA Regional Office Helps Domestic Violence Victim Nurses Assist The widow of a World War II veteran With In-Flight walked into the St. Louis VA Regional Emergency Office with her new husband and was David mcgarry, a regis­ greeted by Public Interview Representa­ tered nurse at the West tive Laura Thomas-Jones. Palm beach (fla.) Va Thomas-Jones noticed that the medical center, and his elderly woman had bruises on her face wife mari, also a regis­ and head. That, coupled with the wom­ tered nurse, were on a an’s demeanor, led her to believe that flight returning home from a nursing conference the woman may have been the victim saNDra DaVeNPort of domestic violence. when a call came from Left to right: Laura Thomas-Jones, Dawn Dixon, Angela the crew asking any med­ Going on instinct, Thomas-Jones Clemoens and George Seper. separated the woman from her hus­ ical personnel on board to band and called Women Veterans Coordinator Angela Clemoens for assistance. The come forward. mcgarry two learned that the woman’s husband was physically abusing her and he brought her to and his wife immediately the VARO to change the address where her Dependency and Indemnity Compensation responded to the call for checks were mailed. He forced her to deposit her DIC check into his checking account, help. leaving her without any money. Thomas-Jones and Clemoens escorted the woman to the arriving at the front office of Public Contact Coach Dawn Dixon, where they knew she would be safe and her of the plane, they met up privacy would be protected. with a doctor and flight Thomas-Jones called local police to report the incident and Clemoens began calling personnel who took them local women’s shelters to find a safe place for the woman to stay. Dixon left messages at to a man suffering from the homes of the woman’s sons. Assistant Public Contact Coach George Seper distracted syncope, a brief loss the husband by asking him to complete some paperwork. The husband was kept oc­ of consciousness and cupied long enough for the woman to be safely secured and the proper authorities con­ posture caused by a tem­ tacted. porary decrease in blood The woman didn’t need to visit the VARO, which is three hours from her home, to flow to the brain. “He was change the address where her checks are mailed. She came to the VARO because it was unconscious, so we got the safest place she could think of to get help. him into a wheelchair and into the galley of the air­ plane, where we adminis­ VA Officers Break from tered oxygen and started Competition to Provide an iV. He had been vomit­ First Aid ing and had low pulse and Recently, several members blood pressure,” mari of the Salem (Va.) VA mcgarry said. Medical Center police force in addition to their were participating in an an­ traditional nursing train­ nual “Mud Run” competi­ ing, the mcgarrys also tion when they observed have in-air medical a female participant in training. “in 2002, we at­ medical distress. The team tended a conference for stopped their run to aid the in-flight emergencies,” woman until medical per­ David mcgarry explained. sonnel could arrive at the the training paid off, scene. and eventually the man For disregarding the tamara malek regained consciousness. competition to help a fellow Left to right: Detective Stanley Malek, Officer Russell Brockenbrough, “i’m so thankful that my Dispatcher Toney Clayton, Officer Brockenbrough’s son, and Officer citizen, Detective Stanley Benjamin Moody. training prepared me for Malek, Officer Russell this kind of situation,” (Carl) Brockenbrough, Officer Benjamin Moody and Dispatcher Paul (Toney) Clayton said mari mcgarry. received certificates of commendation.

VAnguard • Winter 2009/2010 39 68th Anniversary of Pearl Harbor marines stationed at the marine barracks in Washington, D.c., salute during the national anthem at a ceremony at the National World War ii memorial on the National mall marking the 68th anniversary of the japanese attack on Pearl Harbor. the ceremony began at 7:53 a.m., the time in Hawaii when the first bombs fell on Dec. 7, 1941.

robert turtil