Official Publication of the NATIONAL ASSOCIATION OF VA PHYSICIANS & DENTISTS

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For Information on NAVAPD email us at [email protected] Volume 37, Number 2

The Voice of VA Physicians and Dentists Since 1975 July 2015

NAVAPD Staff NAVAPD President Testifies to House VA Subcommittee Editorial Editor-in-Chief: n May 15, 2015, NAVAPD President Samu- cians in the VA feel their suggestions are unhelpful Samuel V. Spagnolo, MD Managing Editor: el V. Spagnolo testified before the United and unwanted,” he said. Larry H. Conway, RRT O States House of Representatives Veterans Affairs Subcommittee on Health at the Cannon “In many VAs, physicians and dentists are no long- Publishing Communications Director: House Office Building. The hearing, Overcoming er considered professionals and are simply called Larry H. Conway, RRT Barriers to ‘workers,’” he Consultant: More Efficient explained. Carol Blymire and Effective Operations VA Staffing, To see Dr. Website Administrator: focused on Spagnolo’s full Andrew Vines what progress testimony as Legal Counsel the VA has well as the full Robert Kirshner made in hiring hearing, go additional online to medical pro- c-span.org and Inside this issue: fessionals type “veterans since Con- affairs health President’s Corner 2 gress allocat- care staffing” VA Whislteblower ed $16 million into the search Cases Remain 2 to assist with field. Overwhelming this effort. As VA Planning to part of this NAVAPD and all Outsource Hepatitis C 3 discussion, the subcommittee members and wit- other witnesses submitted written testimony to Treatment nesses focused on issues that impede or slow hir- expand and support their verbal testimony. You VA Seeks Budget ing efforts, issues can read NAVAPD’s Flexibility from 4 that make retention written testimony Congress of these caregivers online at http:// New VA Under difficult, how the VA veterans.house.gov/ Secretary Sworn In 5 assesses how many witness-testimony/ physicians and other samuel-v-spagnolo. Studies Using MVP 5 medical professionals Data Announced are needed, and how One issue that got lots NAVAPD President 6 the productivity of of attention in discus- Addresses ASA these caregivers is sion and questions by Federal Funding assessed. both witnesses and Critical for Hepatitis 6 committee members C Treatment Dr. Spagnolo’s com- was the dysfunctional ments were largely state of the Human Legislative Update 7 about the ongoing Resources process in diminution and disen- the VA. It was revealed NAVAPD Mission and Principles/ 7 franchisement of phy- that hiring an individu- Officers and Board sicians in the VA, as Dr. Spagnolo (2nd from left) testifies al can take 6 to 12 well as the lack of months. ¤ Publication Policy 8 support staff who would allow physicians to be more efficient in seeing Veterans. “Most physi- Short Application Form 8 Page 2 NAVAPD News The President’s Corner Samuel V. Spagnolo, MD

ate hash out budget issues around the work. I know many of you are frustrat- Department of Veterans Affairs. ed. I know some of you are ready to leave your service and go to the private Regardless of what Congress does — sector. We hear you, and we will con- and we’re in regular communication tinue to work for you here in Washing- with Veterans Affairs Committee and ton to make sure your voices are heard. Health Subcommittee leadership in the House and Senate — what matters to We appreciate that you have renewed us is how that money is allocated by your membership and that you contin- the VA. I am sure you are as frustrated ue to recruit new members to as I am by the continued bad headlines NAVAPD. We are lean in staff and ex- in the news all across the country about penses, and all the dues you pay go to over-budget construction, misuse of supporting our time on Capitol Hill and ill Congress be able to pass funds, poor care, and still-long wait VA Central Office advocating for your a budget deal before the times. We hear from many of you, and needs and the needs of our veter- W fiscal year ends on Septem- pass along your concerns to the powers ans. Please keep reaching out to ber 30, or will we subsist on a series of that be. With the recent resignation of us. Please keep having conversations ongoing Continuing Resolutions as we the VA’s Inspector General, we can only in your facilities about what’s working have in the past? No one can be sure, hope things will improve. It will take and what’s not. but for the first time in a long time years to reverse the decades of spend- we’re seeing bipartisan collaboration ing abuse and overall mismanagement We are here for you, and we want to around biomedical research when it in many of the VA Medical Centers … hear your stories. It’s the only way we comes to NIH funding, and we can only but I am proud of all the NAVAPD mem- can work smarter and harder for you. I hope that kind of cooperation will ex- bers who continue to push through the hope you are taking a little time to en- tend to veterans’ issues when commit- bureaucracy every day to care for our joy the summer, and I thank you for tees and leaders in the House and Sen- nation’s veterans. I know it’s hard serving our nation’s veterans. ¤ VA Whistleblower Cases Remain “Overwhelming” Says OSC

arolyn Lerner, head of the inde- filed whistleblower retaliation com- created Office of Accountability Review, pendent Office of Special Coun- plaints, Lerner said, including a land- said the agency's responsibility to pro- C sel, says the number of whistle- mark settlement for three employees tect whistleblowers is an integral part of blower cases at the VA remains who suffered retaliation after filing its mission. "VA is fully committee to "overwhelming," a year after the care whistleblower complaints at the trou- correcting deficiencies in its processes delay scandal broke. Complaints of bled Phoenix VA hospital, the epicenter and programs, and to ensuring fair waste, fraud, abuse, and threats to the of the wait time scandal. treatment for whistleblowers who bring health and safety of veterans continue those deficiencies to light," Flanz said. to pour in. So many complaints have The numbers may point to an ongoing been filed that VA cases represent 40% problem, but could be viewed as part of An investigation by The Associated of all incoming cases investigated by a larger effort to restore accountability Press revealed the number of patients her agency, which has jurisdiction over at the VA, Lerner told the House VA sub- facing long waits has not declined. the entire federal government. committee. "The current, elevated Nearly 894,000 medical appointments numbers of VA whistleblower cases do at VA medical facilities from Aug. 1 to The counsel's office is examining about not necessarily mean there is more Feb. 28 failed to meet the VA's timeli- 110 pending claims of retaliation retaliation than before the scheduling ness goal of 30 days; nearly 232,000 against whistleblowers who filed com- and wait list problems came to light, or of those appointments involved a delay plaints involving patient health and that there are more threats to patient of longer than 60 days. safety, scheduling and understaffing, health and safety," Lerner said. Lerner said. The pending claims involve "Instead, these numbers may indicate Delays were not spread evenly through- VA facilities in 38 states and the Dis- greater awareness of whistleblower out the VA. Many were clustered at VA trict of Columbia. rights and greater employee confidence facilities in a handful of Southern in the systems designed to protect states, often in areas with a strong mili- Since last year, the special counsel's them." tary presence, a partly rural population office has secured either full or partial and patient growth that has easily out- relief for 45 VA employees who have Meghan Flanz, director of VA's newly paced the VA's sluggish planning pro- Volume 37, Number 2 Page 3

VA Planning to Outsource Hepatitis C Treatment

n another article in this issue, we letter to VA Secretary Robert McDonald a disaster for patients, providers and discuss how critical funding is to dismay at this unacceptable develop- VA." I the use of new therapy for Hepati- ment. tis C that appears to cure more than The VA had set aside nearly $700 mil- 90% of treated patient. Now it appears "... To halt hepatitis C treatment at VHA lion this year for HCV antiviral drugs. the VA is moving to outsource Hepatitis facilities now would be unconsciona- Department officials confirmed soaring C care for up to 180,000 veterans with ble," they wrote. "We can and must end patient loads and medication expenses this condition through the VA Choice the epidemic. Once we have treated have nearly wiped out that budget with Plan. The VA is taking these steps be- every veteran with hepatitis C, the several months to go in the federal cause the expense of the Hepatitis C costs will go away. ... Give us the am- fiscal year that ends Sept. 30. That's drugs has exhausted the funding set munition, and we will win this war." an estimated $400 million shortfall aside for drug therapies. In the end, with more dramatic costs expected, the total cost for all infected veterans The transition plan for so-called Hepati- beginning in October. could amount to billions of dollars. tis C Virus (HCV) patients was devel- oped by a working group chaired by A VA clinician who asked not to be The VA has spent weeks developing a Kenneth Berkowitz, acting executive named for fear of retaliation stressed dramatic and controversial transition director of VHA's National Center for that department leaders "haven't told as patient loads have surged and fund- Ethics in Health Care. In an April e-mail, anybody how it works. They've sent out ing has run out. However, there are a solution with no way to imple- many questions about this plan, These medications re- ment it." primary among them being whether this move is legal. How treatment portedly cost $1,000 Berger, of the Vietnam veterans is prioritized or withheld has also group, predicted major backlogs. triggered huge controversy. per pill retail, but still He said some states have no phy- sicians who are qualified to The program instructions indicate about $600 per dose treat hepatitis C and enrolled with that the veterans already receiving the Choice Plan. "Where the hell this treatment will be first priority. to the VA at a discount. are they going to send these pa- The sickest veterans generally will tients?" he asked. get the next top priority for treat- A typical treatment ment. However, patients who have The clinician added that VA leaders less than a year to live or who suf- regimen of 12 to 24 were warned months ago that fer "severe irreversible cognitive pharmaceutical funds were being impairment" will not be eligible for weeks costs $50,000 wiped out, but they did nothing treatment. That provision drew fire until the decision to move patients as setting up a rationing system. to $100,000. into a community-care program Tom Berger, executive director of a that has been underutilized and health council established by Vi- heavily criticized. etnam Veterans of America, criticized he told colleagues they needed to de- the VA for launching a "faulty plan" and velop an "ethical framework" in antici- In an official statement on blasted the idea of medical teams de- pation of a complete depletion of funds the hepatitis dilemma, VHA officials ciding which patients will be denied for drugs. "A fair and transparent plan said they remain "committed to ensur- antiviral remedies. that can be consistently applied is bet- ing America's veterans have access to ter than having no plan," he wrote. the health care and benefits they have "They've set up what I would call, in earned and deserve." They stressed Sarah Palin's words, 'death panels.' ... However, emails reveal that Dr. David that "no patients on current therapy will Maybe rationalization [sic] panels is a Ross, the VA's director of HIV, HCV and be stopped," but declined to clarify how better term," Berger said. public-health pathogens programs, many patients are being moved to pri- resigned from the working group. "I vate providers or how many will not be The plan also caused upset among cannot in good conscience continue to eligible for cure. experts inside the Veterans Health Ad- work on a plan for rationing care to ministration. Some disassociated veterans," he wrote. And in a separate Hepatitis C is a blood-borne virus that themselves from the plan and warned e-mail to top VA officials, Ross wrote, attacks the liver. According to the Cen- about ethical compromises. According "There is no doubt in my mind that ex- ters for Disease Control and Preven- to e-mails reported by The Arizona Re- clusively relying on Choice, rather than tion, about 3 million Americans are public, about 200 specialists sent a seeking supplemental funding, will be (Continued on page 4) Page 4 NAVAPD News

VA Outsourcing Hepatitis C Treatment— (con’t.)

(Continued from page 3) According to directives, those panels The instructions note that, "based on must follow strict protocols "to avoid the principles of equity and human dig- infected, though many have not been decision-making that is based on real nity," ineligible patients "should be pro- diagnosed. The disease is considered or perceived conflicts of interest, pref- vided all other appropriate medical epidemic among Vietnam-era veterans erential treatment or nepotism." An care and support." The VA clinician due to transfusions and blood contact appeals process also is being devised knowledgeable about the new program in combat or training. More than 60 for veterans who are denied the medi- said it is not clear whether the patient percent test positive, while 1 in 10 vet- cation. transfer to the Choice Plan is legal. The erans overall has the infection — a rate Choice Plan was developed to provide five times higher than the general pop- The VA has set up a detailed priority private care for veterans who could not ulation. Last year, about 3,000 veter- system to determine which patients get get timely treatment in more than ans died in VA care as a result of HCV the HCV cure first, and which are not 1,000 VA hospitals and clinics nation- infection, according to internal records. eligible. Veterans already receiving anti- wide. Program rules allow veterans to viral drugs are the No. 1 priority, fol- see private doctors if they live more Patients already receiving the antiviral lowed by those with severe conditions than 40 miles from a VA facility or can- therapy in veterans' facilities will con- such as cirrhosis of the liver, compro- not obtain an appointment there within tinue. The remainder will be contacted mised immune systems or B-cell lym- 30 days. by their VA doctors, told of the Choice phoma. Program and evaluated to determine The HCV patients apparently are being whether they meet eligibility for treat- Patients with a prognosis of living less enrolled in Choice based on a determi- ment. Decisions on who will be first in than 12 months will not be eligible for nation that, because there is no more line for treatment, and who will be de- the drugs. Veterans in a vegetative money to pay for drugs, they qualify nied the cure, are to be made by teams state or with advanced dementia also under the wait-time criteria. Depart- at Veterans Integrated Service Net- are excluded, along with those who ment officials did not directly respond works, regional offices also known as have hepatitis C strains resistant to when asked if the strategy is lawful. It VISNs. antiviral therapy. might be the only short-term answer. ¤

VA to Congress: Need “Budget Flexibility” to Operate Hospitals

n July 13, the Department of improve access, even more Veterans and practices, and requirements for Veterans Affairs (VA) urged Con- are coming to VA for care. coordination of care.” O gress to act expeditiously and approve its pending request for fiscal Deputy Secretary Gibson noted, “We “It is essential that Congress pass legis- year 2015 budget flexibility. The re- are currently referring Veterans who lation to provide the requested budget quest, formally transmitted on June 23, need Hepatitis C treatment to the flexibility by the end of July 2015,” Dep- seeks the transfer of funds from the uty Secretary Sloan Gibson wrote. Choice Program to continue VA's efforts “It is essential that Congress “This is necessary to replenish critical to increase Veterans' access to care pass legislation to provide operations funding that VA had to real- and life-saving pharmaceuticals. the requested budget flexibil- locate from other medical services pro- ity by the end of July 2015. If grams to sustain Care in the Communi- In his letter to Congress, VA Deputy ty, after those funds were depleted. If Secretary Sloan Gibson wrote, “In my these program funds are not these program funds are not restored, June 25, 2015 testimony, I described restored, VA will face shut- VA will face shutting down hospital op- the serious challenges to the VA budget ting down hospital operations erations during August 2015.” this Fiscal Year, which are the result of during August 2015.” our successful efforts to improve Veter- Nationally, VA completed more than ans’ access to health care and life- 56.2 million appointments between saving pharmaceuticals...Veterans are - Dep Sec Sloan Gibson June 1, 2014, and May 31, 2015 – 2.6 responding to these efforts...by coming million more appointments than were to VA for more care. Cjoice Program; however, this practice completed during the same time period is not the best model to provide care in 2013-2014. VA also made more than “Despite VA’s efforts, the Department is that meets both Veterans’ needs and three million authorizations for outside unable to keep pace with the extraordi- taxpayers’ interests because of the care. ¤ nary demands on our resources. As we increased costs, duplication of tests Volume 37, Number 2 Page 5

David Shulkin, M.D. Sworn in as New Under Secretary for Health

n July 7, Dr. David J. Shulkin tion of President at Morristown Medical and a Senior Fellow at the Health Re- took the oath of office as Under Center, Goryeb Children’s Hospital and search and Education Trust of the O Secretary for Health for the Atlantic Rehabilitation Institute, part of American Hospital Association. He Department of Veterans Affairs Atlantic Health System. Prior to joining earned his medical degree from the (VA). He was nominated by President Morristown Medical Center and Atlantic Medical College of Pennsylvania and Obama and confirmed by the Senate Health, Dr. Shulkin served as President completed his internship at Yale Univer- on June 23. Also sworn in was LaVerne and CEO of Beth Israel Medical Center sity School of Medicine. Horton Council as Assistant Secretary in New York, where he led a financial for Information and Technology and turnaround and rebuild of the $1.3 As Under Secretary for Health, Dr. Chief Information Officer. billion organization. Shulkin will direct a health care system with an annual discretionary budget of “Dr. Shulkin bring[s] stellar experience Dr. Shulkin also has served in numer- approximately $60 billion, delivering and exceptionally strong leadership to ous physician leadership roles at the care to more than 9 million enrolled [his] post,” said Secretary of Veterans University of Pennsylvania Health Sys- Veterans. The VA employs more than Affairs Robert A. McDonald. “[He] will tem, the Hospital of the University of 350,000 employees including over play [a] critical role in making VA a Pennsylvania, Temple University Hospi- 305,000 health care professionals and stronger organization for America’s tal and the Medical College of Pennsyl- support staff at more than 1,200 sites, Veterans, and I am looking forward to vania Hospital. He is a board-certified including hospitals, community based working with [him].” internist, a fellow of the American Col- outpatient clinics, nursing homes, dom- lege of Physicians, Professor of Medi- iciliaries and 300 Vet Centers. ¤ Dr. Shulkin comes to VA from the posi- cine at Mt. Sinai School of Medicine New Studies Using VA Million Veterans Program Data Announced

he VA has announced four new amount of data collected through MVP, man and Amy Justice at the VA Con- studies using genetic and other and we’re continuing to engage more necticut Healthcare System, and Dr. T data from VA’s Million Veteran Veterans in the program and building Henry Kranzler at the Philadelphia VA Program (MVP) to answer key questions its research infrastructure through Medical Center, will examine the genet- on heart disease, kidney disease, and studies like these,” said Dr. Timothy O’ ic risk factors for chronic use of alcohol, substance use. MVP has enrolled over Leary, VA’s chief research and develop- tobacco, and opioids—and the danger- 390,000 Veterans. It is the nation’s ment officer. ous use of all three together. largest database linking genetic, clini- cal, lifestyle and military exposure infor- The new studies, involving consortiums Pharmacogenomics of kidney disease— mation. Part of a beta test for data of VA researchers and university col- Dr. Adriana Hung of VA Tennessee Val- access, these studies are among the leagues, will explore specific questions ley Healthcare System will focus on first using MVP data to delve into press- related to chronic illnesses common how genes affect the risk and progres- ing questions on Veterans’ health. MVP among Veterans. They will also help sion of kidney disease. One goal is to -based studies on PTSD, schizophrenia establish new methods for securely examine how diabetics—who often de- and bipolar disorder are underway. linking MVP data with other sources of velop kidney problems—respond differ- health information, including non-VA ently to metformin, based on their ge- “MVP is making important discoveries sources such as the Centers for Medi- netic profile. The project will also look that will impact healthcare for Veterans caid and Medicare Services (CMS). The at the genetics of hypertension. and all Americans,” said VA Secretary new studies include the following: Bob McDonald. “We’re grateful to our Metabolic conditions—Dr. Philip Tsao at Veteran partners, whose altruism has Cardiovascular risk factors—Drs. Farooq the VA Palo Alto Health Care System made this possible.” Amin and Peter Wilson at the Atlanta VA and Dr. Kyong-Mi Chang at the Philadel- Medical Center, and Dr. Kelly Cho at phia VA Medical Center, leading a team The new research will specifically in- the Boston VA Health Care System, will from five VA regions and two universi- clude the understudied African Ameri- lead an effort probing the genes that ties, will explore the role of genetics in can and Hispanic Veteran populations influence how obesity and lipid levels obesity, diabetes, and abnormal lipid and ties into the broader national Preci- affect heart risk, and whether these levels, as drivers of heart disease. sion Medicine Initiative announced by genetic factors differ among African President Obama earlier this year. Americans and Hispanics. For more information about MVP and VA research in general, visit “There’s already been an impressive Multi-substance use—Drs. Daniel Feder- www.research.va.gov ¤ Page 6 NAVAPD News

President Spagnolo Addresses the ASA Legislative Conference

he America Society of Anesthesi- parties in determining the future of ologists recently held their Legis- health care. If we don’t educate Con- T lative Conference in Washington, gress and the Administration about DC. NAVAPD President was an invited what’s going on in our field, who will? speaker to the group on May 5, 2015. It’s up to us to educate and advocate The major focus of his comments was for what we need. the pending proposed change in the VA Nursing Handbook, which would allow Why do I say that? Political squabbling Certified Registered Nurse Anesthetists and one-upmanship has fractured the (CRNAs) to administer anesthesiology way business is done in Washington for without any formal oversight by Anes- Dr. Spagnolo also spoke about the many years now. thesiologists. need for increased advocacy for physi- cians and their expertise and role in However, in my recent meetings on the In the VA and outside the VA, CRNAs modern day healthcare, Hill – with both parties – it seems as have always been required to function though there are issues our leaders under the oversight of an Anesthesiolo- “Sadly, government, large hospitals can agree on. There’s no better time to gist. This would be a huge change in and insurers are now the controlling be outspoken about what you want, the degree of autonomy for CRNAs, and what you expect your congression- which worries many physicians. al delegations to do for you.”

The recent history of the relationship of Dr. Spagnolo also gave a brief overview physicians and nurses has been one of of NAVAPD, its mission and goals, and continual reduction of physician over- highlights of its accomplishments over sight of nurses and nurse practitioners. its 40-year history. “NAVAPD is the only Physicians consider this shift to near group that advocates for specifically VA total autonomy potentially dangerous. physicians and dentists.” ¤ Federal Funding Critical to Help Veterans Battle Hepatitis C

ope may be on the way for lation, and new data shows that cases cure rates close to 100 percent, the hundreds of thousands of vet- and fatalities continue to rise. reality is that without these federal H erans living with the hepatitis According to new data from the Depart- funds, many veterans will not be con- C virus. The U.S. House of Representa- ment of Veterans Affairs for the year nected with the testing and care they tives has passed a 2016 budget that 2013, more than 174,000 veterans need to win this battle. includes an additional $1.35 billion to using VA health care services are living increase hepatitis C screening and with chronic hepatitis C, which is the Despite the VA’s risk-based screening treatment for veterans – a population leading cause of catastrophic liver efforts which began in 1998, less than very much at risk for the virus, which is damage, cirrhosis, liver transplants and half of veterans in VA care have been now the nation’s deadliest blood-borne liver cancer – the fastest-rising cause tested for this potentially deadly dis- disease. of cancer-related deaths. And between ease. And across the country, Ameri- 2001 and 2013, annual all-cause cans living with hepatitis C are being As the Senate begins work on its budg- deaths among veterans with hepatitis C systematically denied access to new et proposal, NAVAPD calls on lawmak- increased nearly 400 percent. Even treatments – we need to take steps ers to follow the House’s lead and prior- more startling, the VA estimates that as now to ensure that veterans are not itize funding to get hepatitis C testing many as 42,000 enrollees may be in- among them. and treatment to our veterans. fected with hepatitis C without even realizing it. After veterans leave the battlefield, While hepatitis C is a growing epidemic hepatitis C can be one of the greatest across the country, the potential for It is critical to reverse this deadly trend, threats they face. For many, the dis- blood exposure in combat or medical but the federal government is needed ease is a direct result of their service to settings has made it even greater to provide the funds necessary to break our country, and we cannot let it claim among veterans. As we reported in the down barriers to testing and treatment. more lives. The funds being considered February issue, prevalence of hepatitis in the 2016 budget are a positive step C is very high among the veteran popu- While revolutionary new drugs offer toward addressing this deadly virus. ¤ Volume 37, Number 2 Page 7 Legislative Update by Kay Bulow

n addition to providing testimony completed Denver Medical Center. The 15 the HVAC will hold a hearing on S. before the House Veterans Affairs HVAC Health Affairs Subcommittee held 1994 “VA Accountability Act of 2015”. I Health Subcommittee, NAVAPD a hearing on a Congressional Budget President Sam Spagnolo has met with Office study to compare VHA health The House’s Energy and Commerce members of the House and Senate, key care costs to the private sector. The Committee has held multiple hearings legislative assistants and staff mem- SVAC held a hearing on the addition of on government efforts to combat the bers of both the House and Senate VHA to GAO’s High Risk List and a hear- problems of Opioid abuse and the Veterans Affairs Committees over the ing on VA Opioid Prescription Policy, House of Representatives is set to vote past few months. Practices and Procedures. on Friday, July 10 on HR 6 “21st Centu- ry Cures Initiative.” This legislation will The House (HVAC) & Senate Veterans The U.S. House of Representatives help deliver more cures and treatments Affairs Committee (SVAC) continue to passed HR 280 which authorizes the to patients more quickly; create an conduct oversight hearings on Veterans Secretary of Veterans Affairs to recoup “Innovation Fund” a dedicated and fully Affairs Department related issues. bonuses and awards paid to employees -offset research funding stream for five Both chambers conducted hearings of the VA and the bill is pending in the years for both NIH and FDA; and will regarding cost overruns incurred during Senate. Similar legislation S. 627 has streamline regulations and modernize construction of the new and still un- been introduced in the Senate. On July clinical trials. ¤

NAVAPD’s Mission and Principles Officers/Directors

Mission

AVAPD is dedicated to the principle that this nation’s veterans, as a result President: of their service to our country’s Armed Forces, have earned an entitlement Samuel V. Spagnolo, M.D. to quality health care to meet their needs as they become sick or injured. Washington, DC N The Department of Veterans Affairs (“VA”) is that agency of government obligated to honor the Nation’s contract with its deserved Veterans. Vice President: Cynthia L. Gibert, M.D. Washington, DC NAVAPD has as its highest priority the preservation and strengthening of the VA health care system, so that it stands ever ready to give our veterans quality medical Secretary: care equal to or better than that which can be obtained elsewhere in our society. Ronald J. Gurrera, M.D. Boston, MA Just as VA doctors care for those who have served, they also stand ready to treat the military and civilian casualties of future conflicts and non-military disasters. Treasurer and Director of VA health care facilities are a principal element in our national security and in our Dental Affairs: national defense, representing as they do a vast resource to back up the limited Joseph Abate, D.M.D. capabilities of our military hospitals. Salem, VA

Guiding Principles Directors: Pamela E. Karasik, M.D. NAVAPD shall function as the official professional organization of the VA physicians Washington, DC and dentists at all levels in the VA Health Care system, from the local health care facilities through VISNs to the national level. Robert T. Rubin, M.D. Los Angeles, CA NAVAPD shall cooperate to the maximum extent possible with official representatives of the VA, to the end that the best possible health care is provided Remberto Rodriguez, M.D. to veteran beneficiaries. Miami, FL

NAVAPD shall endeavor to ensure that qualified physicians and dentists are Stephen P. Rosenthal, M.D. Miami, FL. recruited into the VA Health Care system and retained therein.

Jill Wruble, D.O. NAVAPD shall support VA physician research, participate in activities of West Haven, CT professional organizations, continuing medical education and participation in equal partnership affiliation with medical schools. National Association of VA Physicians and Dentists P.O. Box 15418 Arlington, VA 22215

Phone: (866) 836-3520

NAVAPD News is a publication of the National Association of Veterans Affairs Physicians and Dentists. Opinions expressed in articles are those of the author(s) and not necessarily those of NAVAPD.

Pass Along to a Colleague Mail to: NAVAPD, P.O. Box 15418, Arlington, VA 22215 Full- Half- Resident Time Time Retired Fellow Lifetime $160 $100 $80 $45 $1500 NAVAPD is the only national organization protecting the interests of VA physicians and dentists. Since 1975, NAVAPD has been your advocate YES! and watchdog in Washington. NAVAPD will continue to focus on opportu- I want to join NAVAPD! 3 ways to pay: nities to improve pay and working conditions.

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