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January/February 2005 1

outlook

A Defining MomentEnd-of-Life Care

Foreign Medical Program

Veterans Construction Teams

January/February 2005

A Defining MomentEnd-of-Life Care

Foreign Medical Program

Veterans Construction Teams

VAnguard

2 January/February 2005

Features

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

Departments

3 Letters4 Management Matters5 Outlook22 Around Headquarters26 Introducing27 Medical Advances28 Have You Heard30 Honors and Awards32 Heroes

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VAnguardVA’s Employee MagazineJanuary/February 2005Vol. LI, No. 1

Printed on 50% recycled paper

Editor: Lisa RespessAssistant Editor: Matt BristolPhoto Editor: Robert TurtilPublished by the Office of Public Affairs (80D)

U.S. Department of Veterans Affairs810 Vermont Ave., N.W.Washington, D.C. 20420(202) 273-5746E-mail: [email protected]/opa/feature/vanguard/index.htm

On the coverMarine Cpl. Anthony Alegre, 21, works outwith physical therapist Doug Mitchell onthe Active Duty Rehabilitation Unit at theAugusta, Ga., VA Medical Center. Alegre,from Centerville, Ga., was wounded May29, 2004, during combat operations inRamadi, Iraq. He was admitted to the Au-gusta VAMC rehab unit in October 2004.photo by Ann Hamilton

http://www.va.gov/opa/feature/vanguard/index.htm

VAnguard


letters

Have a comment on something you’ve seen inVAnguard? We invite reader feedback. Send yourcomments to [email protected]. You can alsowrite to us at: VAnguard, Office of Public Affairs(80D), Department of Veterans Affairs, 810 Ver-mont Ave., N.W., Washington, D.C., 20420, or faxyour letter to (202) 273-6702. Include your name,title and VA facility. We won’t be able to publish ev-ery letter, but we’ll use representative ones. We mayneed to edit your letter for length or clarity.

A Day in the LifeJust received and read yourmost recent publication. Itwas great and very touchingreading and seeing the manypictures in the article “A Dayin the Life of VA” (Novem-ber/December issue).

Over the past year or so,VAnguard has significantlyimproved in quality and con-tent. Good job!

Pamela J. MonroeChief, Medical

Administration ServiceGainesville, Fla., VAMC

I enjoyed the recent issue ofVAnguard, but was saddenedby the lack of nursing repre-sentation in the “A Day inthe Life of VA” article.

The VA health care sys-tem is one of the largest em-ployers of advanced practicenurses, registered nurses andlicensed practical nurses. In-deed, within this network

alone, almost 500 certifiedregistered nurse anesthetists(CRNAs) provide anesthesiaservices for our veterans.

I can appreciate the dif-ficulty in picking photos forthe story but would hope formore than one photo. It isthe dedication of our nursingprofessionals, as well as manyothers working within VA,that make A Day in the Lifehappen.

Uwe KlemmCRNA

Indianapolis VAMC

I saw your very nice “A Dayin the Life of VA” article,but after looking through allthe pictures, for some un-known reason you forgot tomention probably the mostimportant part of our VAsystem, the VA police. Thereis not a single picture of a VApolice officer performing hisor her duties at any of our

hospitals around the nation.I believe that without

the security and protection oftheir lives and property pro-vided by the VA police, therest of the staff would not beable to perform their duties.It was very nice to see cooks,maintenance personnel,nurses, doctors, etc., butyour article forgot us.

We protect our facilities24 hours a day, seven days aweek. When others are sleep-ing we are on duty protectingstaff, patients and VA prop-erty around the clock. Maybesince you forgot us you canconsider an article about theVA police—our history, du-ties and commitment to VA.

Cyndia E. RamirezPolice Officer

San Juan, P.R., VAMC

Proud VR&E GraduateI would like to take a mo-ment to thank you sincerelyfor taking the time to honorthis country’s veterans bybringing the accomplish-ments of many of us to theforefront of the hearts andminds of those who supportus. I truly appreciated the ar-ticle published in VAnguardmagazine (“Working TowardRecovery,” September/Octo-ber issue).

I am proud to be agraduate of the VA’s rehabili-

tation program and will for-ever be an advocate. The pro-gram definitely made a dif-ference in my life. In myministry I see so manypeople who have been left totheir own devices and are notaware that the VA providessuch programs to help themsucceed in the civilian worldafter dealing with the trau-mas of war. It can truly be adifficult transition.

Raymond C. Hart Sr.Pastor

Washington, D.C.

If Disaster StrikesI read with interest the recentarticle on disaster prepared-ness and the Grab-and-Gokits available for purchasefrom the canteen (Septem-ber/October issue). I don’tknow if these two items areincluded in the kit or not:plastic whistle and chain, anda chemical snap and shakelight stick. The latter pro-vides a light source for about8 hours. If you need a con-tainer to hold these items,use a plastic wide-mouth wa-ter bottle, attach a “D” ringto the lid and secure it to abelt or belt loop.

Ted BennVHA Mail Manager

Health AdministrationCenterDenver

We Want to Hear from You

VAnguardmanagement matters


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

We have an obligation to recognize our veterans’needs for end-of-life care that is high quality andresponsive to their expressed wishes and needs.

Our nation’s veterans, ingrowing numbers, are facingone last hill to take underperilous conditions as theyapproach the end of their lifespans. That fact should notbe surprising, given thesimple arithmetic that all ofthose who were old enoughto join the armed forces in1941 are now past age 80.But somehow the magnitudeof our veterans’ needs forend-of-life care comes as asurprise to many who hearthe numbers for the firsttime.

And the sheer numbersare staggering. Eighteen hun-dred veterans die in thiscountry every day, two-thirdsof them from World War IIand most of the rest from theKorean and Vietnam eras. Infact, more than a quarter ofall deaths in this country in2005 will be veterans.

Their needs for high-quality end-of-life care de-mand a bold and determinedresponse from an appreciativenation. The Department ofVeterans Affairs, in concertwith dedicated staff in ourmedical centers across thecountry and in collaborationwith community providers, isnow leading the way.

Articles in this issue ofVAnguard report on VAprogress in establishing a suc-cessful and compassionateend-of-life care program, ourachievements introducinghospice and palliative careinto the fabric of the VAhealth care system, and VA’scommitment to ensuringthat veterans’ care preferencesare honored to the fullest ex-

tent possible at the end oftheir lives. I passionatelyshare that commitment, andI have been proud to partici-pate in the efforts of com-mitted VA staff to create acomprehensive and seamlesssystem of end-of-life carewithin VA.

VA is the nation’s largestintegrated health care system,caring for 6.8 million veter-ans. Clearly, we can’t directlyprovide all of the services ouraging and terminally ill veter-ans will need.

Working in concert withcommunity providers is es-

sential to ensuring that all ofour nation’s dying veteranshave the right care at theright time and in the rightplace, in accordance withtheir expressed preferences.And that is why the recentgrowth of partnerships be-tween VA medical centersand community hospices isso exciting to all of us at VACentral Office.

Opinion surveys showthat most Americans wouldrather be in their ownhomes, with their families, atthe end of their lives. Unfor-tunately, far too many endup dying in hospitals, even inintensive care units wherethey receive technologicallyintensive medical interven-tions instead of the emotion-ally and spiritually intensive

support of hospice care.To turn that trend

around, we need effectivehospice programs and pallia-tive care consultation teamsoperating in all VA medicalcenters. We also need theability to refer veterans tohome-based hospice pro-grams and, if necessary, topay for that care. We mustdo a better job of document-ing veterans’ care preferencesthrough mechanisms such asadvance directives. And weneed to raise the level of ex-pectation that veterans areentitled to hospice and pal-

liative care. If such care is notforthcoming, we want tohear about it.

Our mandate is tohonor each veteran’s prefer-ences for care at the end oflife, and we are translatingthat mandate into action. Forexample:■ Hospice and palliative careare now covered benefits forall enrolled veterans.■ VA policy requires hospiceand palliative care consultteam and/or inpatient unitsat every VA health care facil-ity.■ As standard practice, VAnow purchases comprehen-sive hospice services from thelocal communities it serves.■ VA managers are institu-tionalizing hospice and pal-liative care within our opera-

tions, and because care andeducation go hand-in-hand,we are creating an enduringnetwork of VA clinicians,educators and administratorsskilled in this burgeoninghealth care field.■ VA now includes homehospice care in the annualbudget submitted to Con-gress.■ Our Hospice-VeteranPartnership initiative withstate and national organiza-tions strengthens VA allianceswith our community part-ners to improve access toend-of-life care. While the

department does not directlyprovide comprehensive homehospice services, it is criticalto build solid working rela-tionships with the hospicecommunity in order to pro-vide these services to veteransunder our care. VA has estab-lished partnerships in a grow-ing number of states and weanticipate partnerships in allstates by the end of this fiscalyear.

Most of all, as the ar-ticles in this issue ofVAnguard reflect, we have anobligation to recognize ourveterans’ needs for end-of-lifecare that is high quality andresponsive to their expressedwishes and needs. A nationgrateful for their enormoussacrifices on our behalf cando no less.

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Honoring the Nation’s Veterans in PerpetuityJohn W. “Jack” NicholsonUnder Secretary for Memorial Affairs

America’s national cemeteries provide lasting, visibletributes to our veterans and ensure their legacy ofservice will burn brightly in the centuries to come.

Editor’s Note: Before depart-ing VA for the position of Sec-retary of the American BattleMonuments Commission,Nicholson offered some part-ing thoughts on the past,present and future of NCA.

Birl Britton was a veteran ofWorld War I who, in 1998,was awarded France’s highestdecoration, the Legion ofHonor, in commemorationof the 80th anniversary ofthe armistice that ended theGreat War. In his final years,this Army veteran was anursing home resident at theVA Palo Alto Health CareSystem in California. Follow-ing his death at age 108 onJan. 10, 2004, he was in-terred at San Joaquin ValleyNational Cemetery in centralCalifornia.

The oldest veteran to beinterred at a national cem-etery in 2004, Birl Britton isamong the many generationsof Americans who willinglyserved to ensure the free-doms that we all enjoy today.The National Cemetery Ad-ministration honors veteranslike him by providing a finalresting place that commemo-rates their service to our na-tion, and by treating veteransand their families with com-passion, dignity and respectin every interaction. NCA iscommitted to fulfilling thisnation’s promise of care andsupport for veterans in per-petuity.

The burial needs ofAmerica’s veterans are chang-ing and growing. Mirroringthe entire nation, more veter-ans have moved to the South

and the West. Our challengeis to ensure that burial spaceis located where it providesreasonable access to veteransand their families.

Five new national cem-eteries are under construc-tion, all offering the optionof columbarium as well ascasket interment. Six newstate veterans cemeteriesopened in the past year,funded under the State Cem-etery Grant Program. Withstate cemeteries providingburial options to increasingnumbers of veterans, ourpartnerships through thisprogram are more importantthan ever.

Looking to the future,NCA will fulfill the require-ments of the National Cem-etery Expansion Act of 2003,which directed establishment

of six additional new na-tional cemeteries in locationsspecific to the Act. These lo-cations are: Philadelphia; Co-lumbia/Greenville, S.C.;Jacksonville, Fla.; SarasotaCounty, Fla.; Birmingham,Ala.; and Bakersfield, Calif.

While annual inter-ments will peak in 2008,NCA’s inventory of gravesitesis cumulative and will con-tinue to increase every year.Additional resources will berequired to bring all of ournational cemeteries up to theshrine status appearance as

mandated by Congress.In 2003 and 2004,

NCA focused on quantifyingthe standards for appearanceand operations required toachieve National Shrine Sta-tus. This resulted in the pub-lication of updated “Opera-tional Standards and Mea-sures,” which then led to anambitious program of self-as-sessment. In this highly suc-cessful program, best prac-tices are identified for usethroughout the system, andproblem areas are addressedfor improvement.

Also in 2004, the first-ever NCA Training Centeropened in the vicinity ofJefferson Barracks NationalCemetery in St. Louis to pro-vide first-class training forcemetery directors, assistantdirectors, foremen and cem-

etery representatives, as wellas others on the NCA team.In addition to technical in-struction, the center teachesskills in helping veterans andtheir families cope withdeath and grieving, the roleof spirituality, and othertechniques related to servingveterans with genuine careand compassion.

These subjects help em-ployees embrace their workas a calling—not as just an-other job. In fact, if employ-ees lack this compassion,they are asked to consider

other types of work.The ways our employees

interact with veterans andfamily members in their timeof need, combined with theappearance of our cemeteries,are the most meaningfulmeasures of our mission ac-complishment. And, youmay ask, how is NCA doingwith these goals?

In the 2004 AmericanCustomer Satisfaction Indexsurvey, NCA received thehighest rating ever achievedby a federal agency. VA’scemetery system scored a sat-isfaction rating of 95 out of apossible 100 points. Thechallenge is to maintain—and even improve—that levelof service. NCA plans tomeet that challenge byachieving National ShrineStatus at every cemetery, and

by delivering impeccablycourteous and caring serviceto veterans and their familymembers every day.

In this century, as in thelast, our young men andwomen serve with distinctionin the armed forces to pre-serve America’s freedoms.Some give their lives in thatheroic cause. America’s na-tional cemeteries providelasting, visible tributes to ourveterans and ensure theirlegacy of service to our na-tion will burn brightly in thecenturies to come.

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Stephen Pavon served in theMarine Corps Air Wing from1963 to 1967, including a tour

in Vietnam. While on active convoyduty, he was injured twice, patchedup and sent back out. During the“times of turmoil” that followed hisdischarge, Pavon was a fireman, acollege student, and a hippie in Ber-keley, Calif. Later, he taught tran-scendental meditation, traveled theworld, and worked overseas as anengineer before finally landing as ahorse trainer on a ranch in Nevada.

Now Pavon, 57, is fighting an-other battle, one he will not win,against rectal cancer. He will spendhis final days at the VA Palo AltoHealth Care System in California,where Dr. James Hallenbeck, direc-tor of Palo Alto’s Palliative CareServices, and his team are building

and refining a new model of expert,compassionate, supportive care forveterans nearing the end of theirlives.

“I’ve never heard a ‘no’ here,”said Pavon. “The support is so com-plete that it allows me to be com-fortable and to live my final days incomfort. I get to personalize myroom. I can still maintain control ofmy heart, my mind, and my intelli-gence.”

When the 25-bed Palo AltoHospice Care Center was created in1979, it was at the vanguard of a na-tional hospice movement thatwould transform care for dyingpeople nationwide. Today, the cen-ter remains at the forefront of inno-vation. It received a 2001 Citationof Honor through the AmericanHospital Association’s Circle of Life

Awards for exemplary end-of-lifecare. It is also the hub site for a net-work of six interdisciplinary hospiceand palliative care fellowship train-ing programs within VA.

The unit’s staff includes psy-chologists, a half-time massagetherapist, and 25 volunteers, in ad-dition to the requisite hospice doc-tors, nurses, social worker and chap-lain. Families, who often travel to benear a loved one, may stay over-night on rollaway beds or in free fa-cilities on the hospital’s campus, saysHallenbeck, who, in addition to hisrole at the hospice care center is as-sistant professor of medicine atnearby Stanford University.

A Systemwide TransformationHospice care, whether it is pro-

vided in VA medical centers or in

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

Comfort andCompassion

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patients’ private residences bypartnering community hospice pro-grams, combines expert symptommanagement and pain relief withcompassionate attention to the psy-chological and spiritual dimensionsand family dynamics that arise whenconfronting a terminal illness. Qual-ity of life becomes paramount whenits quantity is limited. Hospice alsosupports grieving family members fora year or more after the patient’sdeath.

For the national VA health caresystem, recent advances in develop-ing, refining and expanding hospiceand palliative care, an approachaimed at bringing hospice’s holistic,comfort-oriented care philosophy toseriously ill patients earlier in theirdisease progression, are not merefrills. That is because an estimated1,800 veterans die every day in thiscountry, most of them members of

the Greatest Generation who wonWorld War II. Now in their 80s,they are nearing the end of theirnatural life spans. Veterans ac-counted for 28 percent of all deathsin the United States in 2004.

Through a national network ofstate and local Hospice-VeteranPartnerships, VA is sharing what it

has learned about such care with thecommunity agencies that providethe majority of hospice care to ter-minally ill veterans.

Hospice-Veteran Partnershipsare part of a systemwide transforma-tion aimed at honoring veterans’preferences for care at the end oflife, says Dr. Thomas Edes, who as

Right: Eileen Scheifer, a nurse on theVA Palo Alto Health Care System’s hos-pice unit, with a nurse trainee; below:An Interdisciplinary Hospice Teammeeting. Photos courtesy of JamesHallenbeck, M.D.

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Palliative care is a comprehensive approach to care in which the primarygoal of treatment is comfort rather than cure in a person with advanceddisease that is life-limiting and refractory to treatment. Palliative care pro-vides symptom management and emotional and spiritual support, guided byindividual preferences and generally provided by an interdisciplinary team.Palliative care can be a complement to conventional, disease-modifyingmedical therapies or it can be an alternative when such treatments are nolonger effective or not desired by the patient.

Hospice, the most intensive form of palliative care, is provided to seri-ously ill patients who have less than six months to live and who haveagreed to enroll in hospice services, rather than to pursue aggressive at-tempts for cure of their illness. Hospice focuses on comfort for both pa-tients and loved ones, not cure. VA defines hospice and palliative care as acontinuum of comfort-oriented and supportive services provided acrosssettings, including hospital, extended care facility, outpatient clinic and pri-vate residence.

Hospice and palliative care are covered services, authorized in VA’sMedical Benefits Package, on an equal priority with any other medical ser-vice. VA medical centers must provide or purchase hospice care when VAdetermines that an enrolled veteran needs it. VA medical centers must alsoprovide palliative care services through consultation teams that include aphysician, nurse, social worker and chaplain. Palliative care teams offerconsultation throughout a medical center, assisting with planning and guid-ance on managing a patient’s pain and other symptoms, especially whenthese are complex or difficult to control.

chief of Home and Community-Based Care is VA’s top administratoroverseeing this transformation. Inresponse to increasing and changingdemands for end-of-life services, VAhas issued a number of recent direc-tives mandating hospice and pallia-tive care.

“We now have a framework anda structure in place,” Edes says. “Allof the pieces are aligned. Hospice isnow a covered benefit for all en-rolled veterans, home hospice care isin the VA budget for the first time,and we have a national standard forpurchasing hospice care from com-munity providers. We can track hos-pice workload for resource allocationand planning, and we have a hos-pice point of contact at every VA fa-cility. We want to elevate expecta-tions and make it easy for veteransto access hospice and palliativecare.”

While the largely autonomouslocal VA medical centers are givenflexibility to address end-of-life careaccording to their veterans’ needs,national policy and standards stipu-late that each VA facility have thefollowing resources and services:■ a designated hospice contact per-son who is part of an integrated net-work for local and national commu-nications and information dissemi-nation;■ provision of needed hospice ser-vices in all settings;■ inpatient hospice beds or accessto them in the community;■ an interdisciplinary palliative careconsultation team;■ assistance with referrals to com-munity hospices in its service area;and■ tracking of hospice and palliativecare services provided to veterans inall settings.

In many cases, the local ap-proach may include a dedicated hos-pice unit, such as at the Palo AltoVAMC, based in either a hospital oran extended care facility. Palliative

Hospice and Palliative CareAre VA-Covered Benefits

care teams may consult on pain andsymptom management for outpa-tient clinics as well as throughoutthe hospital. VA’s own home-basedprimary care or specialized geriatricservices may also be involved in de-veloping end-of-life care programs.

“We will institutionalize, in thebest sense of that word, hospice andpalliative care in the largest inte-grated health system in the nation,proactively creating an end-of-lifecare system while implementing per-manent changes, making it an inte-gral part of the fabric of what VAis,” says Diane Jones, a palliativecare consultant in headquarters.That kind of integration has not yethappened in the private sector, she

notes, even though U.S. hospiceswill care for 900,000 dying patientsin 2004.

“We’re doing a lot of things tobolster that institutionalization … alot of program development, a lot ofaction. The challenge now is to cre-ate an enduring network of skilled,trained, committed professionals,”Edes adds. “It’s our privilege and ourresponsibility to ensure that veteransreceive comfort, support and care asthey face their final days and thatthey have a choice of where they re-ceive this care. Some don’t. I amconcerned that in the past far toomany veterans have suffered quietly,graciously accepting far less than theservices they rightly deserve.”

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Although much has been ac-complished in the last few years,more must be done to consolidateand sustain the gains at every level.VA’s newly established ability tomeasure and track the types of end-of-life care being provided in eachfacility—the workload—is a majorstep forward.

Changing the medical culturefrom top to bottom at each facility isanother significant challenge. VAleaders aim to create an environ-ment in which VAMC staff arecomfortable referring patients tohospice and palliative care andbringing up death and dying during

routine advance care planning con-versations with seriously ill veteransand their families.

“Is there a well-functioning pal-liative care team at every facility, aswe have mandated? Are those teamsadequately trained and staffed? Atthis point, probably not,” Edes con-cedes. “But we are raising expecta-tions at the national and local lev-els, so that a terminally ill veterancan go to any VA facility and obtainhospice care. If needed hospice careis not forthcoming, we want them tocontact us. And we now have cham-pions working in every VA facility,so we are getting closer to our tar-get.”

‘The Underlying Theme isComfort’

Stephen Pavon says he has en-countered the VA health care sys-tem twice in his life, and both expe-riences were positive. The first time,

five years ago, he was referred to aPTSD program at the nearby MenloPark VA Outpatient Clinic.

“That saved my life. The com-munication skills they gave mehelped me clean up my life,” he says.After five failed marriages and mul-tiple job changes, “I had turned iso-lation into a profession.”

More recently, Pavon was livingon his isolated Nevada ranch, wherea hospice team from Barton Memo-rial Hospital in South Lake Tahoe,Calif., visited and cared for him.When he could no longer manageliving alone, even with the help offriends, “they had a room waiting forme here on the VA hospice unit.”Before entering, Pavon wrapped uphis personal business, found a goodhome for his horse, gave away hisgolf clubs and conga drums, andpaid all of his bills—including a pre-paid cremation service.

When he came to the Palo Alto

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

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VA hospice unit, he expected tofind the same level of compassion-ate, spiritually oriented, medicallyexpert hospice care that he had re-ceived from Barton Hospice—andhe has. Sitting in his hospice room,wearing his black cowboy hat,Pavon reflects on a restless but full

With support from VA headquarters, the National Hospice and PalliativeCare Organization, the national Rallying Points office in Washington, D.C.,the Center for Advanced Illness Coordinated Care in Albany, N.Y., and otherend-of-life advocates, Hospice-Veteran Partnerships are now forming atstate and regional levels to increase access to appropriate end-of-life carefor veterans. They promote access by strengthening partnerships betweenVAMCs and their community partners, and by expanding their mutual knowl-edge base.

Some states are already well advanced in this dialogue, while othersare just starting to talk. A Hospice-Veteran Partnership “toolkit” developedby the VA Hospice and Palliative Care Initiative and published by RallyingPoints is full of suggestions on how to do this. Partnerships often are co-sponsored by state hospice organizations while bringing together commu-nity hospices, community end-of-life coalitions, veterans service and alumniorganizations, private service clubs, state Departments of Veterans Affairs,state veterans homes, the National Cemetery Administration, local militarytreatment facilities, and VA professionals at the medical center and VISNlevels.

“So much can be accomplished just by sitting around the table andtalking with each other,” says Kathleen Jacobs, Rallying Points Regional Re-source Center coordinator based at The Hospice of the Florida Suncoast inLargo. From there, coalitions typically assess unmet local needs, develop astrategic plan for how best to serve veterans in the area, and then share in-formation with veterans’ groups and the public. “Florida is a prototype ofwhat can be done through partnerships,” Jacobs says.

The Florida state group designed Hospice-Veteran Partnership com-memorative pins with a card that reads, “Thank you … for your military ser-vice to America by advancing the universal hope of freedom and liberty forall.” It distributed 20,000 of these pins in November 2003 to VA facilities,community hospices, veterans’ organizations, and public officials, as well asat a number of commemorative events.

“These events helped to bring greater awareness to end-of-life issuesand the need for advance care planning, without seeming morbid,” saysJoanne King, director of social work for Hospice of Volusia-Flagler in PortOrange and a member of the Hospice-Veteran Partnership of Florida. Thecoalition also co-sponsored a February 2004 statewide professional educa-tion teleconference on end-of-life care for veterans.

Hospice-Veteran PartnershipsPromote Access

life and on the cancer that has cometo dominate but not define his finaldays.

Mellow and sanguine about hisprospects, Pavon could be a spokes-person for the hospice philosophy.“The whole underlying theme hereis my comfort. I’m under 24-hour

care and they’ve got me covered. Ifsomething isn’t working, they comein and fix it and I’m back on theroad. Medically, they’re all up tosnuff. They know how to give methe tools I need and they don’t stopuntil I’m in my comfort zone,” hesays.

Pavon observes, “Sometimes,you find a simple word that explainsyou. I can relate my whole currentexistence, my spirituality, anything,to that concept of comfort.” Peopleare born into this world in need ofcomfort, he says. Sometimes, at theend, they need more help to main-tain a degree of comfort, and that’swhere hospice comes in.

In Pavon’s case, a percutaneousinfusion catheter (PIC) and portablepump deliver high doses of Dilaudid,a powerful synthetic form of mor-phine that keeps his pain under con-trol without sacrificing his lucidness.

“I’ve had great adventures.Sometimes I wish I’d stayed a fire-man—a nice, steady job,” Pavonsays. “But I traveled all over theworld. I was always trying to fit in—trying to find where I belonged.”

Epilogue: Stephen Pavon died onthe VA Palo Alto Health CareSystem’s hospice unit on May 26,2004, peacefully and comfortably.

Editor’s Note: VAnguard thanks theNational Hospice and Palliative CareOrganization for its cooperation in pro-ducing this article, which appears in a12-page monograph, “VA TransformsEnd-of-Life Care for Veterans,” byfreelance writer Larry Beresford. Themonograph is being distributed nation-ally to the organization’s members aswell as to VA facilities and state veter-ans homes. The publication can bedownloaded from NHPCO’s Web siteat www.nhpco.org/veterans. Limitedcopies of the publication are availableby contacting Chris Cody [email protected] or Pat Kelleyat [email protected].

http://www.nhpco.org/veterans

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With an extensive networkof medical centers andclinics throughout the

United States, VA offers substantialhealth care opportunities for veter-ans, but what do they do if they’retraveling or living overseas and findthemselves in need of medical atten-tion? Well, VA has that covered

too, under the Foreign Medical Pro-gram.

Managed by the VA HealthAdministration Center in Denver,the Foreign Medical Program givesveterans the ability to seek medicalcare related to their service-con-nected conditions in almost anycountry in the world, with VA pick-

ing up 100 percent of the medicalbill.

“The department establishedthe Foreign Medical Program to ful-fill its responsibilities to our veteranswho were temporarily or perma-nently living outside the UnitedStates,” said Ralph Charlip, directorof the Health Administration Cen-

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

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ter. “While it is not possible to havea VA medical facility in every coun-try or every city, through the FMP,service-connected veterans can stillobtain the medical and vocationalrehabilitation services they earnedwhile serving our country, no matterwhere they are.”

Here’s how theprogram works. Aveteran who cur-rently lives overseas,or plans to traveloverseas, sends a reg-istration form to theHealth Administra-tion Center, prefer-ably with a copy oftheir VA rating deci-sion. After processingthe form, the ForeignMedical Program of-fice sends the veterana letter confirmingenrollment in theprogram and outlin-ing the conditionsthat will be covered.If the veteran doesnot provide a copy oftheir rating decision,the Foreign MedicalProgram office willcontact the veteran’sVA regional office ofrecord to confirmtheir service-con-nected status.

A Growing ProgramA unique aspect

of the program is thatunlike disability com-pensation or VAmedical center treat-ment categories, per-centage of disabilityhas no bearing on the payment fortreatment; whether a veteran israted 1 percent or 70 percent for aservice-connected condition, pay-ment will be made to the providerin full for treatment related to that

specific condition.Once enrolled, if a veteran is

traveling or living overseas andneeds medical treatment related to aservice-connected condition, theysimply go to a health care providerand then send the bill to the For-eign Medical Program office in Den-

ver. The bill is translated, the ex-change rate for the foreign currencyis determined and the veteran is re-imbursed.

In Canada and the Philippines,however, the rules are different. Vet-

erans who seek treatment in Canadamust go through the White RiverJunction VA Medical Center in Ver-mont, and veterans traveling or liv-ing in the Philippines are expectedto go to the VA facilities in Manila.

“It is very important to remem-ber that the treatment must be re-

lated to theveteran’s service-connected condi-tion outlined inthe acceptance let-ter,” said TedBenn, plan admin-istrator for the For-eign Medical Pro-gram. “For in-stance, if a veteranis traveling inMexico and theprosthetic leg hereceived as a resultof a service-con-nected conditionbreaks and he fallsdown and getshurt, the ForeignMedical Programwill pay for the re-lated medical ex-penses. If the samevet becomes hospi-talized in Mexicofor food poisoning,the program willnot pay for it.

“Unfortu-nately, due to thefact that we aresuch a small pro-gram, the vast ma-jority of healthcare providersoverseas have notheard of the pro-gram, so the vet-

eran more often than not has to payfor the medical care up front out oftheir own pocket, then send us theclaim for reimbursement.”

Currently 12,446 veterans areregistered in the program and the

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Denver office has received claimsfrom 131 different countries aroundthe world, the most coming fromGermany, Panama and Costa Rica,respectively.

Although the beneficiary popu-lation has grown steadily since theprogram’s inception in 1973, com-pared with the number of veteransregistered for VA health care domes-tically, that number is minute.

“VBA has told us that there aremore than 15,000 veterans who liveoverseas and receive disability com-pensation,” explained Charlip.“We’ve registered just over 12,000,so we have at least another 3,000 togo. And that only accounts for thepeople living overseas. I imaginethat thousands of veterans traveloutside the United States every year.I expect to see continued growthfrom the traveling veteran commu-nity.

“We try to reach as many as wecan each year. As part of the HAC’soutreach effort, we try to inform

those veterans who travel about theprogram. In FY 2004, we visitedwith 648 members of veterans ser-vice organizations and more than1,100 state and federal veteran ser-vice officers and provided them withFMP information.”

Spreading the Word AbroadWord of mouth between veter-

ans living or traveling overseas hasalso been an effective avenue forgetting the eligible veteran popula-tion to sign up for the program. One

particularly well-organized group ofveterans in Mexico, led by Vietnamveteran and cancer patient DonAdams, has even had their experi-ences with the program documentedon several expatriate Web sites andpublications. Their enthusiasm forVA has grown considerably sinceenrolling in the program, as evi-denced by this letter Adams wroteto the Health Administration Cen-ter in January.

“It seems strange to be writing afan letter to a government entity buteveryone needs to know how muchmy wife and I appreciate everythingthat the employees of the ForeignMedical Program have done for us.

“We live in Mexico and arevery thankful for the services youprovide, but especially the easy ac-cess to the representatives who an-swer the phones in Denver. Eachtime I call I receive a polite, useful,and usable answer to my questions.

“And we and the Mexican doc-tors are both surprised and pleased

with the speed with which yourclaims people process my submis-sions and issue checks. Being able tofax my claims to you is both safe andfast, and one more indicator of thehigh degree of efficient service youprovide.

“I was diagnosed with a fastmoving small-cell cancer of the lung(in addition to my existing metasta-sized prostate cancer) and spentmonths traveling back and forth toTexas for treatment. The tumor keptgrowing and my prognosis was for a

quick death. After much discussionTeresa and I decided I should applyto the FMP and stay at home inAjijic for treatment until the end.

“As of today I have far exceededthe time the VA doctors believed Ihad left. My tumor is in full remis-sion and I’m stronger and healthierthan I’ve been for a long time. I’vemoved from the mountains of JaliscoState to a volcanic sand beach inColima State, and Teresa and I liter-ally have a new lease on life.

“Being able to receive treatmentin my home, with a doctor of mychoice, without tiring, expensive,and aggravating travel has been amajor contributor to my presentstate of remission. We cannot ad-equately express our thanks for notonly an excellent benefit for thoseof us who choose to live outside theU.S., but also the caring profession-alism of all of you who make theFMP work the way it was intendedto.

“We are both writers and haveposted articles on several Mexico-based English language Web sitesand are currently working on apiece for a U.S. newspaper withwide Mexico distribution. We’reconvinced that our good experiencewith the FMP is not unique and wewant to help spread the word aboutthis valuable program. Again,thanks to all of you.”

Veterans who would like tolearn more about the Foreign Medi-cal Program and how to enroll cango the Foreign Medical ProgramWeb site at www.va.gov/hac/fmp.They can also e-mail the HealthAdministration Center [email protected]; call FMPoffices at (303) 331-7590; or writeto: VA Health Administration Cen-ter, Foreign Medical Program, P.O.Box 65021, Denver, CO, 80206-9021, USA.

“While it is not possible to have a VA medicalfacility in every country, through the FMP,service-connected veterans can still obtainthe medical and vocational rehabilitationservices they earned while serving our coun-try, no matter where they are.”

By Glenn A. Johnson

http://www.va.gov/hac/fmp

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Employees of the VA Office of Inspector General have par-ticipated in the U.S. Marine Corps Reserve Toys for Tots pro-gram for the past six years. Most years they collected morethan 100 toys, and last year’s total was around 250. But thisyear’s donation of more than 350 toys for needy children inthe D.C. metropolitan area topped them all. Shirley Landes,left, chief of the Freedom of Information Act section, andAdrianne Mitchell, a management analyst, coordinated thetoy drive, and Secretary Principi was on hand when theypresented the gifts to the Marines at their holiday party.

Cold temperatures didn’t dampen the spirits of 16 veteransfrom the Alvin C. York campus of the Tennessee ValleyHealthcare System who got to ride on the VA float or carrythe banner in the Rutherford County Christmas paradethrough downtown Murfreesboro. The float, with its theme,“Thank a Veteran,” won first place for a business/industryentry, and drew lots of smiles, salutes and shouts of “Thankyou!” from the crowd. The float was made possible by dona-tions from the Employee Associations, Voluntary Service,and the Veterans Canteen Service, and by the after-hourswork of several employees.

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

MICHAEL L. MOORE

MOLLY REYNOLDS

DEBORAH F. EIRING

HolidayHeroes

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

ROBERT TURTIL

The Domiciliary Residents Advisory Council at the MountainHome, Tenn., VA Medical Center works all year to raisemoney for the Christmas party they throw in the domiciliary’srecreation hall for 30 needy children from the community.Local businesses help out with donations of food, toys andother items, and the residents buy each child a $20 Wal-Mart gift card. Domiciliary resident Charles E. Cable playedSanta at this year’s 11th annual party.Each year, all services and sections at the Overton Brooks

VA Medical Center in Shreveport, La., are invited to sponsora family for the holidays. Some choose a veteran and family,while others pick a family at the facility’s adopted school,Creswell Elementary. Thanks to the generosity of 25 ser-vices, the facility was able to brighten the holiday season formore than 30 families this year. Vin Joseph, president of themedical center’s Employee Association, George M. MooreJr., director, and Dock Voorhies, chief of Social Work Ser-vice, left to right, pose with boxes of food and gifts ready tobe delivered to the families.

JOHNSON CITY (TENN.) PRESS PHOTO

CECTRIA ASHLEY

VAnguardcover story


Defining moments are unex-pected and unrehearsed. Theytest our resolve and reveal our

character. For VA Secretary An-thony J. Principi, a defining momentcame in August 2003, when twoveterans of the wars in Iraq and Af-ghanistan got lost in the transitionfrom military to VA care.

Principi set the tone in a Sep-tember 2003 message to all employ-ees. “Let me make it clear that everymilitary man or woman wounded,injured or ill from training for orfighting our war on terror receivespriority service at VA. None ofthese heroes can ‘fall through thecracks,’” he wrote.

He established a Seamless Tran-sition Task Force in VA Central Of-fice and sent social workers and ben-efits counselors to military hospitalsacross the nation. Their job was tomeet up with recoveringservicemembers, introduce them toVA benefits, help them file claims,and facilitate their transfer to VAmedical facilities where they couldbe closer to their families.

The impact was immediate.Wounded troops and their militarycase managers now had face-to-facecontact with a VA representative.From their perspective, VA becamea warm smile and a caring touch.

The seamless transition programhas made a huge difference, accord-ing to Brian Austin, an assistant na-tional service director with the Dis-abled American Veterans in Wash-ington, D.C., who works with

Outgoing VA Secretary Anthony J. Principi cancount seamless transition among his successes.

Rather than take the easy roadby applying a quick fix based ontheir individual circumstances, heresolved to enact fundamentalchanges in how the departmentcares for those wounded in the lineof duty. His response reinvigorated aworkforce and may ultimately definehis term as VA Secretary.

wounded soldiers. He said the troopsare “ecstatic and overwhelmed thatsomeone is there to take care of

ANN HAMILTON

Marine Cpl. Anthony Alegre, 21, takeshis first steps since suffering a trau-matic brain injury on May 29, 2004, inRamadi, Iraq. He is assisted by physi-cal therapist Barry Dye, left, and occu-pational therapist Jason Vital on theActive Duty Rehab Unit at the Au-gusta, Ga., VA Medical Center. Theunit exemplifies the creativity of VAemployees who have embraced theseamless transition concept.

A Defining MomentA Defining Moment

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them and help submit their benefitspackets.”

It also helps VA, according tohis colleague Marc Burgess, whoheads up DAV’s transition serviceprogram. “It’s going to save the VA

a tremendous amount of man hoursdown the road” by reducing appealsand remands. “All injuries are beingdocumented before the discharge soa favorable decision can be renderedthe first time around,” he said.

Task Force EvolvesWhen Principi started the

Seamless Transition Task Force inthe summer of 2003, Americantroops had suffered about 2,500combat casualties in Iraq. By Jan. 7of this year, that figure had risen to10,252. As casualties mounted,Principi transformed the originaltask force into a permanent Seam-less Transition Coordination Officein VA headquarters.

A single office was necessary tokeep track of all the transition ac-tivities, according to one of the taskforce’s original co-chairs, Dr.Michael J. Kussman, who nowserves as acting deputy under secre-tary for health.

“There are so many joint activi-ties [between VA and DoD] and somany people involved, sometimesit’s hard to get your arms around itall,” he said. Kussman hopes thenew office will become the centralclearinghouse for all joint VA/DoDventures and serve as the primaryinterface with DoD.

By delegating responsibility toone office, the department will beable to coordinate transition activi-ties with a systematic, organized ap-proach. For example, when

wounded troops first started comingto VA hospitals, the emphasis wason a smooth admission and top-quality care. Little emphasis wasplaced on the environment of care.It soon became apparent, however,

that the environment would be amajor factor.

The current environment inmilitary hospitals borders on the sur-real. Politicians, movie stars andprofessional athletes regularly roamthe wards. There are news camerasand swarms of reporters. Troops getfree tickets to sporting events anddinners at fancy restaurants. Goodybags stocked with Red Bull energydrinks, DVDs, and the latest gamesfor Sony PlayStation and MicrosoftX-Box are handed out to them.They also have the support of theirpeers—other young soldiers who lostlimbs, eyesight or suffered disfiguringburns.

When they come to VA hospi-

tals, reality sets in. “It’s a major cul-tural transition for them. And wemight need to reevaluate the envi-ronment of care we provide thesepatients and their families,” saidKussman, noting that unlike typicalVA patients, these veterans may beaccompanied by young children oreven their own parents.

As the new Seamless TransitionCoordination Office continues toevolve, staff can look to the ideas ofVA employees across the country,many of whom have come up withunique ways of reaching out to ournewest generation of combat veter-ans. There have been open housesand health fairs, benefits seminarsand welcome home parades.VAnguard took a closer look at twoseamless transition activities thattruly reflect the flexibility and cre-ativity of the VA workforce.

Active Duty Rehab UnitMuch of the seamless transition

work involves greater cooperationbetween VA and the military. Thiscan lead to tough decisions aboutthe best use of resources. One ofthose decisions fell to Jim Trusley,director of the Augusta, Ga., VA

ROBERT TURTIL

Outgoing VA Secretary Anthony J. Principi addresses members of the original SeamlessTransition Task Force in his office. The task force, which was made up of employees fromthe Veterans Health Administration and Veterans Benefits Administration, has sinceevolved into a new office.

“These are the veterans of the future. Wewant to bring them in and let them knowthey’re welcome at the VA.”

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Medical Center, during a telephoneconversation with VISN 7 medicaldirector Carter Mecher, M.D., inNovember 2003.

The Army wanted VA rehabili-tation therapists to come to FortBenning in Columbus, Ga., to workwith soldiers wounded in Iraq. ButMecher reasoned it made moresense to send the troops to the VAhospital in Augusta, where rehabspecialists were already in place. Heasked if Trusley could set up a rehabunit for active-duty troops.

“I loved the idea,” Trusley laterexplained. “These are the veteransof the future. We want to bringthem in and let them know they’rewelcome at the VA.” But there wasa catch. He’d have to do it withinhis existing budget—there was noseed money.

Trusley turned to Rose Trincher,M.D., chief of spinal cord injury atthe hospital. “She’s a progressivethinker and I knew she could pull itoff,” he said. Trincher didn’t disap-point. By early February she hadcarved out enough space for a fewpatients. Her plan culminated inJune 2004 with the official dedica-tion of the new 30-bed inpatient re-habilitation unit.

The unit accepts patients fromall military branches. Most have suf-fered multiple traumatic injuries—amputations, burns, loss of eyesight,brain injuries, PTSD—according tothe unit’s director, Dr. DennisHollins. Their average age is 24.

In the beginning, Hollins wasn’tsure how the troops would like beingat the VA hospital or how the tradi-tional patients would respond to theactive-duty troops. His uncertaintysoon vanished, however. “The localveterans’ groups were so support-ive—they just embraced the idea,”he said. As for the soldiers, it’s justlike a military environment forthem, he explained, yet they haveaccess to all the VA services: neuro-surgery, mental health, blind rehab,

WILL TULLIS

ANN HAMILTON

Top: Alegre talks with Dr. Dennis Hollins, director of the Augusta VAMC’s Active Duty Re-hab Unit, and occupational therapist Becky Bonin; above: Helping servicemembers regainfunction and mobility is a priority on the unit. Here occupational therapist Lisa Dowling,right, works with patient Cleotha Williams, a member of the National Guard. Across thetable, therapist Jason Vital monitors the progress of Army reservist Ashley Brown.

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spinal cord injury, and physical andoccupational therapy.

The unit has treated 91 active-duty patients as of January. Of those,25 recovered well enough to returnto active duty.

Outreach IntensifiesOutreach has also been a major

element of seamless transition ac-tivities. For John Goldman, acting

director of the Tuscaloosa, Ala., VAMedical Center, that meant comingup with a plan to reach the 1,600reservists and National Guard mem-bers in his service area returningfrom combat tours in Iraq and Af-ghanistan.

Sure, he’d send each a personalletter welcoming them home and re-minding them of their VA benefits,but he knew he could do more.

“This is a very patriotic area andwe’re real proud of what our soldiersdid over there. We wanted to go totheir towns and let them know wewere there for them,” he said.

Goldman set up an outreachcommittee to figure out the best wayto reach these returning troops.Committee member Scott Martin, asocial worker, suggested that insteadof asking the soldiers to come to thehospital, outreach teams could visittheir armories during weekend drills.That way they’d have a captive au-dience. “I’m in the reserves myself,so I know how the system works,”Martin said.

On Nov. 6 and 7, 2004, theyput their plan into action. Martinand his teams visited four armoriesused by the Alabama NationalGuard’s 877th Engineer Battalion,which had more than 700 soldierswho served tours in Iraq. Thatweekend they helped about 200with enrollment and case manage-ment intervention.

In all, the outreach teams havebrought in more than 600 returningcombat veterans, more than a thirdof the soldiers who deployed fromtheir hospital’s 12-county servicearea. The entire effort is done on avoluntary basis, with team membersgiving up their weekends for themission. “Our teams really love whatthey do and it shows,” saidGoldman.

Moving OnSecretary Principi may be mov-

ing on, but his seamless transitioninitiative is here to stay. Perhaps thisis the true measure of a defining mo-ment: it transcends time and leavesa lasting impression. Principi oncenoted, “Our treatment of these new-est veterans over the comingmonths will define VA for their life-time and ours.” It also just might de-fine his term as VA Secretary.

Rather than waiting for returning troops to come to the VA hospital, teams from theTuscaloosa, Ala., VA Medical Center visited National Guard armories to meet with mem-bers of the 877th Engineer Battalion and welcome them home from Iraq. Jane Billings, di-rector of primary care (top), and Regina Toth, R.N., help soldiers with VA health care en-rollment and case management intervention.

ROY AVERETTE

ROY AVERETTE

By Matt Bristol

VAnguardfeature


VA lost the first member of its “family” in the war onterror—Sgt. Joseph O. Behnke, an employee of theManhattan division of the VA New York HarborHealthcare System. He was killed Dec. 4 when he wasthrown from a Humvee that crashed into a barrier whileescorting a convoynorth of Baghdad.

Behnke, 45, fromthe Park Slope sectionof Brooklyn, was as-signed to the ArmyReserve’s 258th FieldArtillery Regiment. Ini-tially sent to Iraq inApril 2004, he had justcompleted a two-weekleave for R&R when hereturned to Iraq shortlybefore his death.

According tofriends and family members, his heart went outto the barely clothed Iraqi children that he oftensaw begging for scraps of food. Wanting to dosomething to help, he collected clothing andtoys for the children of Iraq.

The son of a Navy man, Behnke joined theArmy at 17, serving in the 82nd Airborne Divi-sion from 1976 to 1980. Two years later, eager toserve again, he joined the National Guard, wherehe served for several years. After 9/11, compelledby patriotic zeal, he once again joined the Na-tional Guard.

He started working for VA in 1985 as a car-penter at the New York campus, progressivelymoving up to his last position as a maintenancemechanic.

“His love of country and family outshone all else,”said his brother-in-law Nelson Torres when asked howBehnke would be best remembered. Tributes by friendsand family members painted the life of Sgt. JosephBehnke as soldier, citizen, fellow employee, true friend,faithful husband, loving father and grandfather—a car-

VA loses a family member in thewar on terror.

In Memoriam: Joseph O. BehnkeIn Memoriam: Joseph O. Behnkeing person in all respects.

On Dec. 18, Secretary Principi, along with NewYork Harbor Healthcare System Director John J.Donnellan Jr. and Chief Chaplain Andrew Sioleti, wentto the Behnke residence in Brooklyn to personally offer

their condolences to the family.A memorial service honoring

Behnke was held at the New York cam-pus on Dec. 22, attended by the familyand hundreds of friends. The service alsowas attended by Acting Under Secretary

for Health Jonathan B. Perlin, M.D., who concluded hisremarks by saying, “May God rest the soul of JosephBehnke; may God send comfort to Joe’s family and to allwho mourn him; and may God continue to blessAmerica, this great country that Joe defended.”

Sgt. Joseph Behnke made the ultimate sacrifice forthe country he loved and honored with his service. Adevoted husband and family man, he leaves behind fivechildren, five grandchildren and his wife of 25 years,Miriam. He will be missed, but not forgotten.

By Peter Juliano

The Fort Hamilton Army Garrison Color Guard lowered the flag at the Man-hattan campus to half-staff in honor of Behnke; inset: Behnke serving inIraq with the Army Reserve’s 258th Field Artillery Regiment.

LEO MARINACCI

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A40-foot rappelling tower isone of a dozen constructionprojects underway at Fort

Devens, an Army Reserve trainingsite located about 40 miles west ofBoston. But the work isn’tbeing done by Army engi-neers. It’s being completedby military veterans, undera partnership between thefort and nearby Bedford,Mass., VA Medical Cen-ter.

The Veterans Con-struction Teams are oper-ated through the medicalcenter’s CompensatedWork Therapy program,which helps veterans re-turn to work while receiv-ing medical and mentalhealth services.

Veterans who join theconstruction teams un-dergo visible changes, ac-cording to the team’s di-rector Bernie Cournoyer,of the Bedford VAMC.They hone work-relatedskills such as problem-solving, decision-makingand interpersonal commu-nications while learningconstruction trades. Moreimportantly, they gain self-confidence by overcomingpersonal and career ob-stacles and achievingproject goals. “You can seetheir enthusiasm grow,both individually and as ateam,” said Cournoyer.

The relationship with FortDevens has developed into a valu-able and ongoing partnership, ac-cording to project manager Dave Di

Rienzo. He said there are currentlyabout 40 veterans working on roof-ing, fencing and interior renovationprojects at the fort. The rappellingtower is a particular source of pride

among team members. When com-pleted, it will be used by militarypersonnel, as well as local, state andother federal agencies.

Fort Devens commander Lt.

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

Col. Anthony Kanellis is supportiveof the Compensated Work Therapyprogram and veterans on the con-struction teams. “It’s the kind ofpartnership the Army finds most ad-

vantageous … and a smartway for Devens—and ulti-mately the Army—to havequality construction workat a good price,” he said.

The program’s ultimategoal is to help veterans getback on their feet. “That’swhat the Army is doing forthem,” said Cournoyer.“Homeless veterans aren’tmuch different from any ofus who served the country.They came home, and forwhatever reason, lost theirway for a while.” Most pro-gram “graduates” have goneon to compete for and winjobs with commercial firms.One even started his ownconstruction company.

Work therapy programsare in place at more than100 VA medical facilitiesnationwide. They work bestin partnership with otherfederal agencies, particu-larly the Department ofDefense. “The continuedcommitment of these orga-nizations sends a messageto those who served thecountry that they will notbe left behind,” saidCournoyer. He noted thatthe program’s success has

led VA medical centers in Texas,Oregon, New York, Ohio and Ken-tucky to explore the potential for es-tablishing their own veteran con-struction teams.

Lt. Col. Anthony Kanellis, Fort Devens Reserve Forces TrainingArea commander, and Bobby Griffis, Fort Devens Engineering Of-fice, review progress on a roofing project being completed bymembers of the Veterans Construction Team based at theBedford, Mass., VA Medical Center.

JUNE FORTE

VAnguardaround headquarters


Nicholson Takes the Helm as Secretary of Veterans Affairs

R. James “Jim” Nicholsonwas sworn in as Secretary ofVeterans Affairs on Feb. 1.President Bush nominatedhim to the position on Dec.9, and he was confirmed bythe Senate on Jan. 26.

During testimony at hisconfirmation hearing beforethe Senate Veterans’ AffairsCommittee on Jan. 24,Nicholson said a backgroundin the military helped pre-pare him for his new job.The West Point graduateserved eight years on activeduty, including combat dutyin Vietnam, and 22 years inthe Army Reserve.

“I have had the privilegeof wearing the uniform ofthe United States Army incombat,” he told the com-mittee, “so I have seen boththe horrors of war and theheroes of America makingthe greatest sacrifices of mili-tary service on behalf of theircomrades and our nation.

“One cannot leave abattlefield without havingprofound respect for thecourage and cool of all whohave served there,” he con-tinued. “Their example ofunwavering commitment totheir mission, no matter howdangerous and uncomfort-able, will always reverberatewith me, and readies me fora mission of service to thoseveterans.”

Nicholson emphasizedthat he will continue to workclosely with the Departmentof Defense to ensure a seam-less transition forservicemembers returningfrom the wars in Afghanistanand Iraq. “The manner inwhich the VA supports thetransition of today’sservicemembers into veter-ans, especially those who are

injured or became ill as a re-sult of their service in com-bat areas, will define the de-partment for them,” he said.

Nicholson praised hispredecessor as “a man whohas provided outstandingleadership and tireless dedica-

tion to the welfare of thisnation’s veterans.” Hepledged to build on the “ter-rific strides” VA made in

Top: “I marvel at America, that a boy from Struble, Iowa, may serve in the President’s Cabinet. Howcould this happen?” said Nicholson, as President Bush announced his nomination. “For me, it is be-cause of the opportunities that my country gave me as a cadet at West Point and as a soldier.” Above:Nicholson testifies at his confirmation hearing on Jan. 24.

WHITE HOUSE PHOTO

ROBERT TURTIL

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VA Secretary Anthony J.Principi said goodbye to em-ployees at a farewell cer-emony held Jan. 19 in head-quarters.

“I am privileged to callyou my colleagues,” he toldthe crowd gathered in thenew G.V. “Sonny” Mont-gomery Veterans ConferenceCenter. “The great progressin service we have made, theinitiatives we have begun, theawards and accolades wehave received, and the goodname we have perpetuatedspeak eloquently of yourcharacter, as it does the en-during character of our de-partment. The legacy I leaveis, in truth, your legacy—atestament to strength of pur-pose and commitment to ex-cellence.”

Bidding a Fond Farewell to Secretary Anthony J. Principi

Principi’s nomination byPresident Bush as Secretaryof Veterans Affairs was con-firmed by the Senate on Jan.23, 2001. His four-year termwas characterized by a reduc-tion in the benefits claimsbacklog and processingtimes; decreased waitingtimes for health care appoint-ments; record increases inhealth care funding; theCapital Asset Realignmentfor Enhanced Services, orCARES, plan to modernizethe VA health care system;and an unprecedented expan-sion of the national cemeterysystem.

Prior to being appointedVA Secretary, the combat-decorated Vietnam veteranheld a number of executive-level positions in the federal

government and business, in-cluding VA Deputy Secretaryduring the administration of

former President Bush. Hewas also a partner in a SanDiego law firm.

Clockwise from left: Principi shares a laugh with VA Deputy Sec-retary Gordon Mansfield at the farewell ceremony; the outgoingSecretary tries out his chair from the White House CabinetRoom. The chair was among several gifts he received duringthe ceremony; the new G.V. “Sonny” Montgomery Veterans Con-ference Center was filled to capacity for the Jan. 19 event.

health care, benefits deliveryand memorial affairs duringSecretary Principi’s tenure. “Iwill strive to move the de-partment to another level, bybuilding on all that has beenput in place and improvingupon those areas that remaina challenge,” he said.

He also told the com-mittee he would focus muchof his attention on VA’s230,000 employees. “I am

deeply committed to earningthe respect, trust and follow-ing of the men and womenof the VA who have madeservice to veterans their life’scalling. The VA workforcerepresents an enormous reser-voir of dedicated, committedtalent that must be put to itsbest possible use,” Nicholsonsaid.

“I will hold myself andmy leadership team account-

able for ensuring and har-nessing our employees’ bestefforts. It will be my job andmy privilege to lead and har-ness this awesome force oftalented people so that all ofus have the same focus: ourveterans. It is critical that wehonor’s America’s debt tothose who have served us sofaithfully.”

Nicholson most recentlyserved as U.S. ambassador to

the Vatican. Prior to that, hewas chairman of the Republi-can National Committeefrom 1997 to 2001. He hasalso been a housing devel-oper and lawyer in his homestate of Colorado.

The new Secretary, 66,is a native of Iowa. His olderbrother, Jack, served as VAUnder Secretary for Memo-rial Affairs from 2003 to2005.

EMERSON SANDERS

EMERSON SANDERSEMERSON SANDERS

VAnguardaround headquarters


The President signed a billon Dec. 3 that will improveVA’s ability to recruit and re-tain top-quality physicians,dentists and nurses.

“Thanks to this legisla-tion, we’ll have the flexibilityto adjust salaries for marketpressures and reward perfor-mance so VA can meet theneeds of a growing numberof patients,” said SecretaryPrincipi.

He said the current paysystem doesn’t adequatelyconsider regional differencesin pay among private-sectormedical specialists. As a re-sult, VA depends heavily oncontract medical specialists.These contracts often aremore expensive than thecosts of employing the samespecialists as VA physiciansand dentists.

Under the new law, theVA Health Care PersonnelEnhancement Act of 2004,beginning Jan. 8, 2006, VA’spay system for physicians

and dentists will consist ofthree elements—base pay lev-els matched to years of VAservice, regionally based mar-ket pay and performance pay.

No current employeeswill have their pay decreased.The new pay levels create abase pay for current employ-ees and future hires thatwon’t be decreased even ifmarket pay levels for theirspecialties go down. The“market” portion of pay lev-els will vary from time totime for new employees.

Determination of mar-ket pay for a physician ordentist will consider severalcriteria, including length ofexperience in the specialty,degree of need for certainspecialists at a facility, the la-bor market in the area, boardcertifications of the profes-sional and prior VA service.

Performance pay willclearly link a portion of eachphysician and dentist’s com-pensation to quality and per-

formance outcomes, reward-ing such things as quality ofcare, timeliness and patientsatisfaction.

“This new system re-tains the most positive fea-ture of the old—assurance ofregular salary increases withcontinued VA service—andadds rewards for performanceas well as market sensitivityso VA can maintain a com-petitive stance in serving vet-erans,” said VA Acting UnderSecretary for Health Dr.Jonathan Perlin.

“The current systemonly marginally considersmarket-rate salaries,” saidPerlin. “This will give facilityand regional executives theflexibility to meet their localneeds.”

VA officials said withina few years the added cost ofthe salary increases will actu-ally decline as higher-cost

VA has awarded a contract to Pricewater-houseCoopers to complete studies required by theCapital Asset Realignment for Enhanced Services,or CARES, plan. The $9.6 million contract callsfor completing studies at 18 sites throughout thecountry over a 13-month period.

Study recommendations, including those fromstakeholders, will be reviewed by VA’s Under Secre-tary for Health and the CARES ImplementationBoard, made up of senior VA officials, who willmake recommendations to the Secretary. The stud-ies will be completed by February 2006.

CARES is designed to provide greater access toquality care closer to where most veterans live. Itallows VA to expand outpatient services and pro-vide more of the care veterans want and use.

Law Gives VA Flexible Pay for Physicians, Schedules for Nurses

contracts for medical anddental care are eliminated.

The law also authorizesVA to offer registered nursesflexible work schedules inwhich longer workdays couldbe selected in exchange forfewer total working hours.Nurses would receive thesame pay. Congress will re-ceive VA certification annu-ally that facilities have poli-cies to prevent nurses in di-rect patient care from work-ing longer than 12 consecu-tive hours or more than 60hours in a week.

Additionally, the law al-lows VA to approve specialpay to the top nurse—nurseexecutive—at each VA medi-cal center. The added paywill range from $10,000 to$25,000 per year to bring theexecutives’ salaries closer tothat of their private-sectorcounterparts.

Contract Awarded to CompleteCARES Plan Studies at 18 sites

Legislation recently signed byPresident Bush makes homeownership more affordablefor many veterans.

Changes under the lawmean veterans will be able toget no-downpayment loansof up to $359,700. The pre-vious ceiling was $240,000.

VA-guaranteed homeloans are made by banks andmortgage companies to veter-ans, servicemembers and re-servists. With VA guarantee-ing part of the loan, veteranscan get a good interest ratewithout having to make a

downpayment.The changes took effect

Dec. 10 when the Presidentsigned into law the VeteransBenefits Improvement Act of2004. The law also allows forloan limits to keep pace withrising home values.

The new law allows VAto guarantee one-year adjust-able rate mortgages (ARMs)and it extends, through2008, VA’s “hybrid ARMprogram,” which allows vet-erans to lock in a favorableinterest rate for at least threeyears.

New Law Allows Higher Limitsin VA Home Loan Program

VAnguard


around headquarters

Popular television talk showhost Montel Williams ischairman of the 2005 Na-tional Salute to HospitalizedVeterans.

He will lead VA’s annualpatient recognition programinviting the public to visitand honor hospitalized veter-ans during National SaluteWeek, Feb. 13-19, and serveas national spokesperson fornearly 100,000 volunteersserving veterans at VA facili-ties across the nation.

Williams enlisted in theU.S. Marines in 1974 aftergraduating from high school.While attending the DesertWarfare Training Center atTwenty-nine Palms, Calif., hewas recommended for, andaccepted to, the Naval Acad-emy Preparatory School atNewport, R.I.

Williams went on to at-tend the U.S. Naval Acad-emy at Annapolis, graduatingin 1980 with a degree in gen-eral engineering and a minorin international security af-fairs. He was the first blackenlisted Marine to graduatefrom both the Naval Acad-

emy Prep School and U.S.Naval Academy.

While serving as super-vising cryptologic officer atFt. Meade, Md., Williamsdiscovered a gift for publicspeaking. He ultimately gaveup his naval commission topursue speaking full time,leaving the Navy with therank of lieutenant com-mander.

As a public speaker, Wil-liams encouraged thousandsof parents, educators andbusiness leaders to work to-gether to address issues af-fecting America’s youth.These efforts ultimately ledto the Montel WilliamsShow.

Now in its 14th season,the Montel Williams Showreceived the 1996 DaytimeEmmy Award for Outstand-ing Talk Show Host and hasalso been honored with Day-time Emmy nominations forOutstanding Talk Show in2001, and Outstanding TalkShow and Outstanding TalkShow Host in 2002.

In 1999, Williams wasdiagnosed with Multiple

Can you guess which federalagency rates the highestamong Americans when itcomes to satisfaction withgovernment services? It’s thesystem of 120 national cem-eteries run by VA. In fact,VA’s cemetery system recentlyreceived the highest ratingever achieved by a federalagency in a nationwide cus-tomer satisfaction survey.

“These results tell us ourcemetery employees are pro-viding the services veterans

Sclerosis (MS). He estab-lished The Montel WilliamsMS Foundation to furtherthe scientific study of MS,provide financial assistance to

VA National Cemeteries Score Highest in Satisfaction Survey

Talk Show Host Montel Williams Leads 2005 National Salute

select organizations and insti-tutions conducting research,raise national awareness, andeducate the public about thedisease.

and their families deserve,”said Secretary Principi.“Honoring our heroes in per-petuity and providing com-passionate service to theirfamilies are among VA’s high-est callings. Our cemeterystaffs have always met thatchallenge superbly.”

The survey was the2004 American CustomerSatisfaction Index, and VA’scemetery system scored a rat-ing of 95 on ACSI’s 100-point scale. That’s two points

higher than in 2001, the lasttime the cemetery system wasreviewed.

Scores of 80 or higheron this survey are consideredstrong; those near 90, excel-lent. The ACSI is producedthrough a partnership be-tween the University ofMichigan Business School,the American Society forQuality and the CFI Group,a consulting firm.

The survey polled nextof kin or others who had ar-

ranged for the interment of aloved one in a VA nationalcemetery within the past sixmonths to a year. More than2,800 people received thesurvey and nearly 500 re-sponded. A total of 93,000burials were conducted at VAnational cemeteries last year.

In addition, ACSI’s in-dex for “user trust” produceda rating of 97 out of a pos-sible 100 for the cemeterysystem. That score, two

Williams

continued on p. 26

VAnguardintroducing


Ray Dutra

An article in the September/October 2004 issue ofVAnguard highlighted therole of VA’s Vocational Reha-bilitation & Employmentprogram in helping disabledveterans rebuild their lives.One question the story didn’taddress, however, is why theprogram puts so much em-phasis on employment.

To answer that question,we turn to Navy veteran RayDutra, who has been in theprogram off and on since1987. Last year, he landedhis first job as an emergencyroom greeter at the Provi-dence, R.I., VA MedicalCenter and immediately dis-covered the therapeutic valueof work. The following is hisaccount of how a new jobhas given him a new outlookon life.

“I have worked in theE.R. for a little more than sixmonths alongside the paidmedical employees. In thattime I have blended my tasksof greeting incoming patientsand stocking shelves to thepoint that I feel part of themedical team, while my jobis not essential to the care ofthe veterans, per se.

“The day I received myidentity badge I had no ideawhat an impact the smallpiece of plastic would haveon my life. My badge speaksvolumes to hospital staff thatrecognize me as a volunteerand a part of the emergencyroom team. Doors to labora-

tories, departments, and vari-ous offices open to me; theoccupants welcome me withamiable camaraderie and Idare say equality. Workingwith the emergency roomstaff has been one of themost rewarding experiencesin my life.

“Like keys to the king-dom, my badge, a requiredidentity card on a clip to beshown at all times by everyhospital staff member, has al-lowed me to walk with un-sung heroes of America’smilitary. The warriors ofyesterday’s battles come tothe VA medical center indroves, seeking treatment ofpain of all types. I have beenboth staff and patient, and Iknow that no one under-stands a veteran more thananother veteran. That makesmy job as a greeter and hos-pital staff more importantthan I sometimes realize. It isimportant for vets to be withother vets for the simple rea-sons of sharing concerns andcommiserating together.

“As a volunteer, my con-tribution is only slightly re-munerated with a stipend,but the rewards are fargreater than I can say, beingunable to find words thatsurpass miraculous; the senseof well-being cannot be mea-sured. [Rising] from the dol-drums of clinical depressionto performing regular acts ofkindness and bringing happi-ness to more than deserving

heroes fills my sails with revi-talizing wind. It is a luckyperson who can find pride inwhat one does for a living. Iconsider myself a lucky man.

“My position as a volun-teer started by meeting a vo-cational rehabilitation coun-selor at the Department ofVeterans Affairs who enrolledme in the Veterans ResourceCenter (Compensated WorkTherapy program), a placewhere disabled veterans re-ceive counseling, guidance,and some work therapy. I al-most turned my back on thecenter when I thought I wasmore in control of my lifethan the people I met there.

“I was wrong in moreways than one. The men andwomen at the center aresome of the bravest people Ihave ever met. They taughtme that respect and honorshould not be held in reservefor those who seem worthyby their outward appearance.

“I know that I can’t es-cape all the demons that seekto take away my happiness,but I have found that I canslay many through the act ofserving others—the VAmedical center provides methat opportunity. In thinkingof others I have saved myself.

“Today the word ‘hero’has been bandied around agreat deal, but let us not for-get that once those heroescome home or get injuredand seek treatment, the VAhealth care system’s ‘heroes’will be there, ready to servethem.”

Editor’s Note: Ray Dutra hassince taken an assignment inthe hospital’s Supply, Process-ing and Distribution section.He “continues to do terrifi-cally wherever he is assigned,”according to James Turner,chief of the Veterans ResourceCenter.

Dutra

points above overall satisfac-tion, indicates that respon-dents are exceptionally will-ing to say positive thingsabout VA’s cemeteries.

The ACSI survey echoes

a recent VA survey thatshowed 97 percent of next ofkin were satisfied with theirexperience.

ACSI is the only uni-form measure of customer

satisfaction for governmentand industry in the UnitedStates. It produces satisfac-tion scores for seven eco-nomic sectors, 41 industries,200 private-sector companies

and some local governmentservices. ACSI allowsbenchmarking between thepublic and private sectorsand between one year’s re-sults and the next.

Cemeteries continued from p. 25

JAMES BURROWS

VAnguard


medical advances

Tablet-SplittingSaves MillionsThe VA health care systemsaved $46.5 million in 2003by having eligible patientssplit their tablets of a popu-lar cholesterol-lowering drug,researcher David Parra,PharmD, of the West PalmBeach, Fla., VA MedicalCenter, announced on Nov.10, 2004, during the Ameri-can Heart Association scien-tific meeting in New Or-leans.

Tablet-splitting savesmoney because many pillsare available in a higher dosefor the same price as thelower dose. By splittinghigher-dose tablets in half,patients can get their usualdose for about half the cost.

Parra also shared find-ings from a study thattracked 3,787 VA patients inFlorida, Puerto Rico andGeorgia who were takingsimvastatin, commerciallysold as Zocor, in 1999. Halfthe patients were convertedfrom whole to split tablets,maintaining the same dailydose, while the other halfcontinued on their wholetablets. Tablet splitters andinstructions were providedto those on the split tablets.

After 12 months, bothgroups dropped roughlyeight points from their LDL,or “bad,” cholesterol scores.No difference was seen inliver function, a commonmeasure of drug toxicity, orin the percentage of patientswho stuck to their prescrip-tion. Based on this and otherresearch, VA doctors andpharmacies are progressivelywidening the tablet-splittingprogram.

Splitting doesn’t workwith all medications, such astime-release tablets or thosewith a special coating. Statinsare good candidates for it be-

cause the dose doesn’t have tobe as exact as with someother drugs. The drugs, whilehugely popular, are relativelyexpensive. Parra offered theexample of one pharmacychain that sells 40mg and80mg tablets of simvastatinfor the same price, $147.79per one-month supply. Hesaid the annual savings forone patient on 40mg whosplits an 80mg tablet couldbe $850. “While this is a sig-nificant amount of money,patients should not take itupon themselves to startsplitting any medicationwithout first consulting theirhealth care provider,” cau-tioned Parra.

VA Care BeatsPrivate SectorA team of researchers foundveterans treated at VA medi-cal facilities received bettercare than non-VA patientsfor 26 conditions, rangingfrom depression to coronarycare. Researchers examinedthe medical records of nearly600 VA patients and about1,000 non-VA patients withsimilar health problems.They found VA patients re-ceived 67 percent of recom-mended care, compared to51 percent for the non-VApatients. For preventive care,such as pneumonia vaccina-tion and certain cancerscreenings, 64 percent of VApatients received the appro-priate care, compared to only44 percent in the private sec-tor.

Researchers attributedthe difference to technologi-cal innovations, such as VA’scomputerized patientrecords, and to policies hold-ing top managers account-able for standards in preven-tive care and the treatment oflong-term conditions. “Thisstudy confirms that VA’s

computerized patient recordsand our ongoing perfor-mance measurement of pa-tient care ensure that veter-ans receive the highest qual-ity health care,” said Dr.Jonathan Perlin, VA’s actingunder secretary for health.

The study was con-ducted by the RAND Cor-poration, an independentthink tank, in cooperationwith the University of Cali-fornia at Los Angeles and theUniversity of Michigan. Itwas published in the Annalsof Internal Medicine.

The Dirt on Anti-Bacterial SoapsAntibacterial soaps are nomore effective than regularsoaps at killing germs thatcause diarrhea and vomiting,according to a study on acutegastrointestinal illnesses pub-lished in the Dec. 2, 2004,issue of the New EnglandJournal of Medicine.

Researchers Daniel M.Musher, M.D., from theMichael E. DeBakey VAMedical Center in Houston,and Benjamin L. Musher,

M.D., from the University ofPennsylvania, conducted thestudy. They examined thebacterial, viral and protozoalcauses of gastrointestinal ill-nesses and recommended thebest ways to avoid gettingsick. “In nearly all instances,transmission of acute gas-trointestinal illness is due toorganisms that are presenttransiently on the hands,”the researchers noted.

Therefore, washing yourhands with soap and warmwater for 30 seconds is thebest way to avoid transmis-sion. “Hand washing reducesby about 95 percent thenumbers of bacteria or vi-ruses that are applied to thehands experimentally or thatare acquired exogenously un-der natural conditions, andhand washing clearly reducesthe spread of acute gas-trointestinal illness in day-care and family settings.”And don’t get fooled intopaying more for antibacterialsoaps. The researchers foundthese soaps do not preventacute gastrointestinal ill-nesses.

Tablet-splitting saves money, but patients shouldn’t do it without consultingtheir doctor, says researcher David Parra, of the West Palm Beach, Fla., VAMC.

GARY DALE

VAnguardhave you heard


Retiring worn-out flags

A familiar face at the bedside

The wife of a New Or-leans World War II veterancalled it a “Christmasmiracle.” New Orleans VARegional Office decision re-view officer Marlene Pittaricalled it just doing her job.Pittari read a newspaper ar-ticle about the couple’s inten-tion to publicly renew theirwedding vows to show thatlove conquers all, includingtheir financial and health

problems. The wife’s wed-ding ring had been stolen atgunpoint earlier in the yearand financial difficultiesarose after her husband’sstroke in 2001. The articlementioned that thehusband’s military recordshad been lost in the fire atthe National PersonnelRecords Center in St. Louisyears ago and that he washaving trouble establishing

service-connected disabilitywith VA. After reading thearticle, Pittari found theveteran’s case file, which waspending review, and got arating started right away. OnDec. 30, the regional officenotified the veteran and hiswife that he will receivemonthly payments at the100 percent disability rate, aswell as a sizeable retroactivepayment.

It took more than half acentury, but Army Staff Sgt.William H. “Shorty” Ross fi-nally received his PurpleHeart for wounds sufferedwhile bailing out of hisstricken B-17 during hiscrew’s sixth bombing missionover Nazi Germany in 1943.The aerial gunner was hit byshrapnel as his plane was at-tacked by German fighters

and ordered to bail out at12,000 feet. He was uncon-scious when he hit theground and hospitalized byGerman captors for 11 days.He was among the firstAmerican prisoners of warrepatriated in 1944 becauseof his medical condition.When he got home to Ohio,he made a point of contact-ing the families of fellowprisoners to give them mes-sages and reassurance. Cleve-land VA Regional OfficeVeterans Service Center man-ager Duane Honeycutt alsopresented Ross the newer butno less deserved Prisoner ofWar Medal during a specialVeterans Day ceremony.

New York VA RegionalOffice counseling psycholo-gist Art Bass couldn’t get thestory out of his mind. His

What to do with a worn-out U.S. flag? It’s a frequent ques-tion, for which the Aleda E. Lutz VA Medical Center andDAV Chapter 117 have just the right answer—a drop-offbox. Cong. Dale Kildee (D-Mich.) presided over dedicationof the medical center’s new Flag Retirement Drop-off Box,above, in which Saginaw, Mich., citizens and groups areinvited to deposit their worn-out flags. DAV members col-lect the flags and ensure their dignified disposal in accor-dance with flag etiquette.

Oscar-winning actor Denzel Washington visited spinalcord-injured patients at the Audie L. Murphy MemorialVeterans Hospital in San Antonio, Texas, on Dec. 17. Ac-companied by his wife Pauletta and three of their fourchildren, the actor also met with Eric Alva, a Marine in-jured in Operation Iraqi Freedom, and Wendall B. Rivers, aWorld War II POW. Lorraine J. Dawson, an Army veteranand patient at the hospital, was delighted when the actorstopped to chat with her during his visit. “He came straightto where I was when he walked in the room,” she said.“We had a long conversation. He even called over his wifeto meet me. He is so nice and easygoing.”

Washington, who has starred in a number of filmswith military themes, said the visit was a moving experi-ence for him and his family. “All we have to give is ourtime—to be here to listen and to hear whatever peoplehave to say, to encourage, and, as we’ve been doing allday, to say thank you.” His visit was arranged by RudiGresham, senior advisor to the Secretary.

Denzel Washington visits Marine Corps veteran Jose “Joe”Cepeda at San Antonio’s Spinal Cord Injury Center.

KATHY TATE

J.R. GARZA

VAnguard have you heard


A ‘very special’ volunteerA new American citizen

Hoofprints across Amarillo

son-in-law had told him ofan elderly couple in New Jer-sey he knew of whose homeof 52 years was being fore-closed on. The husband, aveteran, had suffered a num-ber of heart attacks and allthey were living on was So-cial Security. Bass called the

couple and learned that thehusband was captured duringthe Battle of the Bulge 60years ago and was a POW forsix months. He recalled a VAnews release announcing ex-pansion of benefits to formerPOWs and the Secretary’s de-cision to service-connect

former POWs for stroke andheart disease. He contacted alocal American Legion ser-vice officer for assistance incompleting the veteran’s ap-plication for disability com-pensation as a former POWand called the foreclosingbank to explain that forth-coming VA benefits wouldallow the couple to makenecessary payments to keeptheir home.

The congressionally-au-thorized Open World Pro-gram opened the Robert J.Dole VA Medical Center inWichita, Kan., to Russian

Nothing represents freedom like the power and grace of ahorse, and that’s just what’s on display at the Amarillo,Texas, VA Health Care System—a life-sized replica of anAmerican Quarter Horse. It’s part of a citywide public artproject celebrating the history and spirit of the QuarterHorse. With funding to purchase the horse donated by alocal businessman, a task force of VA volunteers and em-ployees came up with a design painted onto the fiberglassstructure by a local artist with a grandson serving in Iraq.The chestnut-colored horse, named “Freedom,” is blan-keted by a U.S. flag and features the VA seal surroundedby the seals of the five military branches. This labor oflove was placed near the center’s main entrance anddedicated on Veterans Day.

Marine Corps Cpl. Jason Poole is a patient on the VA PaloAlto, Calif., Health Care System’s traumatic brain injuryunit and, as of November, a citizen of the United States.Born in Bristol, England, Poole came to the United Statesas a boy and graduated from Cupertino High School nearPalo Alto. He enlisted in the U.S. Marine Corps and wassent to Iraq—not once, not twice, but three times. Tendays before he was due to come home from his third tour,a booby trap exploded and the young corporal was veryseriously injured.

When he arrived at Palo Alto, he couldn’t walk, couldbarely talk and breathed exclusively through a trache-otomy. Four weeks later at his citizenship swearing-in cer-emony, he talked non-stop, thrilled to have his family, girl-friend and friends there to congratulate him. Poole’smother, Trudy, and twin sister traveled from England to bewith him. “My son has come so, so far since his injury andmuch of that is due to the tireless and dedicated staff atthis hospital,” said Trudy Poole. Under Secretary of Home-land Security Eduardo Aguirre administered Poole’s oathof citizenship.

community health policyleaders who toured the facil-ity and learned about veter-ans health care. The groupwas particularly interested inthe center’s substance abuseprogram and astounded bythe swing-out concealed toi-lets in the center’s new Ur-gent Care area. Do they havesimilar equipment in Russia?“That’s a big nyet,” was thereply. Many Russian healthcare professionals and admin-istrators have developed sig-nificant partnerships withU.S. counterparts throughOpen World.

Marine Cpl. Jason Poole raises his right hand to be sworn in asan American citizen at the VA Palo Alto Health Care System.Poole, a native of England, was injured in Iraq.

CURT CAMPBELL

Pat Lewallen, a volunteer at the Amarillo VA Health Care Systemwho has a son who served in Iraq, poses with “Freedom.”

CAROLYN KINGHAM

VAnguardhonors and awards


The Central AlabamaVeterans Health Care Sys-tem won the Alabama Excel-lence Award, the top awardin a three-tier quality awardsprogram administered by theAlabama Productivity Cen-ter. The award is given forsuperior efforts in productiv-ity and quality as measuredby Alabama Quality AwardProgram examiners. The ex-aminers use a variety of qual-ity measurements includingon-site visits to assess afacility’s leadership and com-mitment to productivity. Lastyear CAVHCS won the sec-

ond-tier Progress TowardsExcellence Award.

The Jefferson Awards,sponsored by the AmericanInstitute for Public Service(AIPS), honors the unsungheroes who volunteer theirtime across America. Thisyear AIPS chose a VA Pitts-burgh Healthcare Systemvolunteer as one of 2004’s re-gional honorees. William“Mr. Bill” Vaupel has volun-teered at VA Pittsburgh for15 years, escorting patientsto medical procedures, clean-ing beds and stocking sup-plies. A veteran himself,

Vaupel is best known for hisability to put patients at easewith jokes, stories and a largedose of compassion.

Paula Pedene, public af-fairs officer at the Carl T.Hayden VA Medical Centerin Phoenix, Ariz., won theInnovation Award in Institu-tional Programs from thePublic Relations Society ofAmerica (PRSA), HealthAcademy Section. The awardhonored the Strategic PublicAffairs Plan she created forthe medical center. The planfocused on improving thehospital’s relationships withemployees, patients, volun-teers, congressional membersand the community. Theplan also earned PRSA’s pres-tigious Silver Anvil Award,the Phoenix PRSA Chapter’sCooper Anvil Award and theVA Under Secretary forHealth’s CommunicationsAward.

Biykem Bozkurt, M.D.,a physician at the Michael E.DeBakey VA Medical Centerin Houston and associateprofessor of medicine atBaylor College of Medicine,was awarded the W. ProctorHarvey Young Teacher Awardby the American College ofCardiology for her dedicationand excellence in teaching.Bozkurt teaches medical stu-dents and residents as well asspecialty fellowship trainees.

With the DestroyerDD-886 USS Orleck in thebackground, MaurilloGarcia-Maldonado, M.D.,Beaumont VA OutpatientClinic executive, received theHeritage Freedom Award at aceremony in Orange, Texas.Presented by the South EastTexas War Memorial Histori-cal Foundation in partner-ship with the Orange NavalReserve Center, the awardrecognized Garcia-Maldonado’s dedication to

veterans. The USS Orleck’skeel was laid in Orange onNov. 24, 1944, and after res-toration the destroyer will beopen to the public as a me-morial.

The VISN 2 HomelessTeam of Albany, N.Y., haswon Modern HealthcareMagazine’s 2004 Spirit of Ex-cellence Award for outstand-ing work by a homeless pro-gram. Their selection for the

Top honors in social work

Terry Harbert, left, chief of social work at the VA EasternKansas Health Care System, received the VHA SocialWork Pioneer Award, the most prestigious service awardfor a VA social worker. Among Harbert’s many achieve-ments during his VA career are implementing innovativeprograms, developing new models of service delivery andestablishing strong community/government partnerships toaid in patient recovery. Craig S. Howard, right, associatedirector of the VA Eastern Kansas Health Care System,presented the award.

Keith Armstrong, above,director of social workfor San Francisco VAMedical Center’s MentalHealth Service, receivedthe Excellence in Teach-ing Award from the Uni-versity of California, SanFrancisco, for his workwith psychiatry resi-dents. The award isvoted on by the psychi-atric medical residentsthemselves rather thanby experts or others inthe field. Armstrong re-ceived more votes thanpsychologists and psy-chiatrists who had alsobeen nominated.

Excellencein teaching

JAMES GLEISBERG

VAnguard honors and awards


award was based on improve-ments in providing access tohealth care and servicesthrough the Homeless Team’scontinuum of care program.The team credits the hardwork, dedication and com-mitment of team members,support from senior leader-ship, and community part-nerships that support theirefforts.

Sharon Rounds, M.D.,chief of pulmonary/criticalcare at the Providence, R.I.,VA Medical Center and pro-fessor of medicine at BrownUniversity, was elected presi-dent of the American Tho-racic Society. ATS, with morethan 13,500 members world-wide, is an independent edu-cational and scientific societywhich focuses on respiratoryand critical care medicine.The society’s members helpfight and prevent respiratorydisease around the globethrough research, education,patient care and advocacy.Rounds studies cell injuryand dysfunction, which areearly symptoms of acute lunginjury.

The VA MarylandHealth Care System receivedthe 2004 Grace HopperGovernment TechnologyLeadership Award, ScientificAdvancement category, forexceptional service to thepublic, mission accomplish-ment and cost effectiveness.Their submission, the MUE(Medication Use Evaluation)Initiative, was selected fromamong 260 applicants fromall branches of governmentby the Academy of Govern-ment Technology, consistingof 250 leading experts on thefederal government’s use oftechnology. The MUE Initia-tive, a software tool thathelps health care providerschoose and review their pa-tients’ medications wisely,

has been in place at the VAMaryland Health Care Sys-tem for more than threeyears and has been imple-mented for several medica-tions. Due to its success,plans are underway to extendit to other medications andto other VA facilitiesthroughout the country.

Mary E. Burkhardt, aprogram manager with theVA National Center for Pa-tient Safety in Ann Arbor,Mich., was named a Distin-guished Alumnus by WayneState University’s PharmacyAlumni Association. Sheholds a bachelor’s degree inpharmacy and a master’s inhospital pharmacy adminis-tration from the university.Burkhardt was one of thefirst pharmacists nationwideto work on patient safety is-sues on a full-time basis.

The Colegio deFarmacéuticos de PuertoRico (Puerto Rico Pharma-cists Association) has namedDr. Giselle Rivera, pharmacyclinical coordinator at theSan Juan VA Medical Cen-ter, as recipient of theAbigail Robles Award for2004. It is the organization’smost distinguished honor.Rivera is a leader in thepharmacy profession inPuerto Rico. She currentlysupervises 15 pharmacistsand coordinates the medicalcenter’s anticoagulationclinic.

Fred H. Rodriguez Jr.,M.D., director of pathologyat the New Orleans VAMedical Center, was recentlyinstalled as president-elect ofthe American Society forClinical Pathology. He hasserved the society in variouscapacities through the years,including as vice president,secretary, and on the boardof governors. Founded in1922, the society is the oldest

and largest nonprofit medicalspecialty organization for pa-thologists, medical technolo-gists and other laboratoryprofessionals.

Joy W. Hunter, dean ofthe VA Learning Universityin Washington, D.C., re-ceived an industry leadershipaward at the Learning inPractice Awards competitionsponsored by Chief LearningOfficer magazine. Hunterwon the bronze award in theLearning Innovation categoryfor her role in supportingtechnology-based trainingopportunities for VA em-ployees.

Robert H. Weiss, M.D.,a nephrologist with the VA

Northern California HealthCare System in Sacramento,received the Joan OettingerMemorial Award from theUniversity of CaliforniaDavis, School of Medicine.The award recognizes contri-butions to research in cancerdisease. Weiss investigatesgrowth control in cancer andatherosclerosis, a conditionthat causes lesions and limitsblood flow in arteries.

The Pharmacy Societyof Wisconsin selected LynnaeM. Mahaney, chief of phar-macy at the William S.Middleton Memorial Veter-ans Hospital in Madison,Wis., as Pharmacist of theYear.

Nick A. Kanas, M.D., below, associate chief of mentalhealth at the San Francisco VA Medical Center, wasawarded the prestigious Royer Award for San FranciscoBay-area physicians who have made significant contri-butions to the fields of psychiatry and neurology. Kanas,

who is also a professor ofpsychiatry at the Univer-sity of California, SanFrancisco, is the founderof the new field of spacepsychiatry.

He has worked withastronauts for more than35 years, studying the psy-chological effects ofspace travel, including as-sessing cultural factors increwmember and crew-to-ground interactions

during missions with the International Space Station.Kanas’ work has previously been recognized both in1999, when he won the Aerospace Medical Association’sRaymond F. Longacre Award, and in 2004, when his bookSpace Psychology and Psychiatry won the Life SciencesBook Award from the International Academy of Astro-nautics.

A new frontier in psychiatry

VAnguardheroes


A calm voice on the line

Cynthia Hall, above, telephone operator at the Mont-gomery campus of the Central Alabama Veterans HealthCare System, recently received a desperate cell phonecall from a veteran experiencing chest pains while driv-ing from Mississippi to Michigan. Hall contacted theCAVHCS Life Support Unit (LSU) and then forwardedtheir recommendation that the veteran stop at the near-est hospital. The veteran responded that the VAMC washis only choice because he didn’t have insurance. Hallthen asked the veteran to give her his cell number, a ve-hicle description, and his present location, and to re-main in contact with her.

The veteran soon indicated that he was closing inon the medical center’s proximity, but did not know howto reach its exact location. Hall notified CAVHCS policethat the stricken veteran was inbound, requesting theynotify the LSU and emergency treatment staff of his ar-rival. She then provided real-time directions that en-abled the veteran to drive up to the LSU entrance. Hall’scalm, hands-on involvement led to a successful conclu-sion to this desperate situation.

As VA police officer Johnnie Scott, above, made earlymorning rounds on Nov. 16 at the Ralph H. Johnson VAMedical Center in Charleston, S.C., his attention wasdrawn to a car with its door slightly open. “When Iopened the vehicle door I knew that this was a medicalsituation,” said Scott. He found the driver nearly uncon-scious, his left hand crumpled into a fist, his right clutch-ing a bottle labeled “Nitro Quick.” Scott realized that theman could be having a heart attack and called for anEMS response. He asked the driver if he needed themedication and the man nodded. Scott handed him a ni-tro tablet, enabling him to self-medicate.

The driver had indeed suffered a heart attack, buthas since returned home and is doing well thanks toScott and the VA medical team. “I just was glad to be inthe right place at the right time to help,” said Scott.

“I’m glad I didn’t parkin my usual space,” said VAsocial worker CynthiaHerndon. On Dec. 28,Herndon heard strangenoises as she walked to hercar in the Miami VA Medi-cal Center parking lot. Fol-lowing the “swooshingsounds,” she peered into a

manhole to find a manateemom and her year-old sonstuck in a three-and-a-half-foot wide drain. Herndonhoped the animals wouldsomehow free themselveswith that evening’s incomingtide. But when she arrivedthe next morning, the mana-tees were still there.

Herndon then called the Mi-ami Seaquarium and theFlorida Fish and WildlifeConservation Commissionfor assistance. It took aboutfour hours for the small armyof five professional animalrescuers, VA police and as-sorted hospital personnelequipped with two large con-struction cranes to rescue theanimals. After a quick veteri-nary checkup, the animalswere released into the MiamiRiver. Experts suspect that

momma manatee followedher wandering baby into thestorm drain on the Miamicampus through a nearbycreek. These endangeredmammals, also known as “seacows,” number only around3,200. They lack the properfins to move backwards, sothey were unable to escape.“I’m ecstatic and kind ofchoking on tears,” Herndonsaid. “I’m an advocate forvets and now for mammals,too.”

Right place and time to helpDAMON A. STEVENSON

CHRIS BAROODY

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