Veterans' Honor RoseVeterans' Honor RoseVeterans' Honor RoseVeterans' Honor RoseVeterans' Honor RoseNew Rose Dedicated to VeteransUnveiled This Month — page 9

VAnguard

Inside: Nurse Awards, 4 ✩ One VA Conferences, 7 ✩ Hispanic Executives Summit, 9

U.S. DEPARTMENT OF VETERANS AFFAIRS

MAY 1999

2 VAnguard

Published by the Office of Public Affairs (80D)

Department of Veterans Affairs810 Vermont Ave., N.W.Washington, D.C. 20420

(202) 273-5746E-mail: vanguard@mail.va.gov

www.va.gov/pubaff/OPAIndex.htm

CCCCCONTENTSONTENTSONTENTSONTENTSONTENTS

Editor: Lisa Respess

❏ VA Nurses 4-5Excellence awards, evolving roles

❏ Colorado Tragedy 6Denver VA facilities help community

❏ One VA Conferences 7Four planned this year

❏ Scissors Awards 8More VA teams honored

❏ Veterans’ Honor Rose 9New hybrid honors veterans’ sacrifices

❏ Stand Down 2000 11Outreach to more homeless vets planned

CCCCCOLUMNSOLUMNSOLUMNSOLUMNSOLUMNS

11111On The Cover:The Veterans’ Honor Hybrid

Tea Rose, developed by Jackson &Perkins Company at the requestof Under Secretary for Health Dr.Kenneth W. Kizer, debuts thismonth. The company donatedrose bushes for May 27th plantingceremonies at VHA facilitiesnationwide, and has pledged 10percent of the proceeds from thesale of the rose to VA medicalresearch. The Veterans’ Rose willbe available for sale exclusivelythrough the Jackson & Perkinscatalog.

13-16

Jim Mayer

VAnguard VA’s Employee Magazine

May 1999 Vol. XLV, No. 5

Printed on 50% recycled paper

INTRODUCINGAlthough Jim Mayer has been

Executive Director of Leadership VA(LVA) for only a year, he has beeninvolved with the program invarious capacities since it began 21years ago.

In 1978, while serving as execu-tive assistant to former VA Adminis-trator Max Cleland, he providedadministrative support to helplaunch Cleland’s vision of an internalexecutive development programmodeled on a similar program inCleland’s native Georgia, LeadershipAtlanta. In 1979, Mayer was selectedas a participant in the second LVAclass, and supported theprogram in lateryears by taking onvarious roles.

LVA providesleadership trainingto 70 competitivelyselected participantseach year throughfour intensive, week-long sessions held inBaltimore, Philadel-phia, Washington,D.C., andWilliamsburg, Va. It isthe only major VAprogram that trainsemployees from all organizationalelements together, and to date, morethan 1,300 senior employees havegraduated.

Open to GS-13s and above, theprogram is usually announced in thefall of each year. Competition for the70 slots is intense — approximately400 applications are received in atypical year. Mayer advises prospec-tive participants to keep in mind thatfew applicants get selected on theirfirst attempt, and those who havegiven a lot of time and attention tothe application are usually the oneswho are ultimately selected.

“Remember that the applicationtotally speaks for you,” Mayer says.“When we say it’s full and opencompetition, we mean it. Someapplicants have a perception offavoritism or unadvertised paths to

selection, but it is truly a self-nomi-nated, self-promoted process. Andthe more people who apply, thestronger the program gets.”

Downloading the applicationform from the VA Intranet at http://vaww.va.gov/forms/dotindex.asp, orthe Internet at http://www.va.gov/forms/dotindex.htm makes it easierto refine and update the application,Mayer says.

He also suggests that programcandidates seek advice from LVAalumni on how to strengthen theirapplications. “Among the alumni,there’s a genuine feeling of ‘I’ll pay

back what was invested inme,’ and they are alwaysavailable to help.”

Since taking over asdirector last April, Mayersays he has been makingsome changes to theprogram, while takingcare to keep intact theaspects participants havecome to expect from it.“There are certain time-tested, core and tradi-tional elements that wewant to maintain.”

He has been work-ing to bring in more univer-

sity and corporate leadership expertsas presenters to help participantslearn how to lead the many changesVA is undergoing. “VA is moving toa flatter, smaller, more team-orientedorganization,” he says, “so we needmore leaders and fewer supervisors.”

Mayer ‘s 20-year VA career hasincluded a variety of positions,mostly in VHA, and he is an activecommunity volunteer.

An Army veteran, he lost bothlegs below the knee in a land mineexplosion in Vietnam on April 25,1969. Each year on that date, hegathers friends and colleaguestogether for a celebration he calls“Alive Day.”

“I made myself a promise that if Ilived, I would have a party everyyear,” he says, and he has kept thatpromise for the past 30 years. ❑

May 1999 3

OutlookJoseph WoodringTruman Fellow, Office ofIntergovernmental Affairs

Partnership Helps VA MeetNeeds of Rural Veterans

W ith just seven months left in the 20th century, VA is continuing its efforts to ensure that field facilities

and the veterans they serve are readyto meet potential challenges broughton by the Year 2000 date change.

To that end, the Departmentrecently issued two new products: apatient-focused contingency plan-ning guide and an informational factsheet.

The Patient-Focused Year 2000Contingency Planning Guidebookprovides an easy-to-follow, nine-stepapproach to constructing a Year 2000contingency plan, complete withsample contingency plans for eachdepartment in a typical health-carefacility as well as an overall plan foran entire facility. Suggestions to

limit adverse impacts and risks alsoare provided with each sample.

The guidebook contains anextensive outline to assess, renovate,validate and prepare contingencyplans for medical devices; a compre-hensive assessment of potentialexternal threats, such as utility, trashand transportation systems failuresor outages; and provides guidelinesfor Year 2000 emergency prepared-ness training and drills.

In addition to helping VA’s ownfacilities get ready for the Year 2000changeover, the guidebook is ex-pected to be a valuable resource forother health-care facilities as well.As a public service, VA has made theguidebook available on the Internetat www.va.gov/year 2000. Onelarge health-care related organiza-

tion, Premier, Inc., has posted theguidebook on its Web site to help its1,700 member hospitals refine theirYear 2000 contingency plans.

The informational fact sheet, Y2KQuestions and Answers: Veterans andthe Year 2000, was developed andwidely distributed to veterans andother stakeholders nationwide toalleviate concerns about the potentialimpact on VA operations. Specificanswers are provided to questionssuch as: Will my benefits check bedelivered on schedule? Will myprescription drugs be available? andWill operations be interrupted at VAnational cemeteries?

VA met the Administration’sMarch 31 deadline to achieve 100percent Y2K compliance in allmission critical computer systems. ❑

New VA Products Address Y2K Challenges

The NationalRural Develop-ment Partner-ship (NRDP)’sMarch confer-ence marked amilestone forthe Partnershipand VA. It was

the first time VA was invited toattend the national meeting offederal, state and local governmentorganizations and interest groupsdedicated to meeting the needs ofrural communities.

Key VA officials spoke aboutVA’s current telehealth initiatives,homeless programs, community-based outpatient clinics, benefitsdelivery and other issues affectingveterans in rural communities.

Veterans’ interests are wellserved by the NRDP’s inclusive,broad-based approach to communityand economic development. Ap-proximately half of the 36 State RuralDevelopment Councils (SRDCs) haveat least one VA representative. Inaddition, VA IntergovernmentalAffairs (IGA) staff regularly attend

monthly National Rural Develop-ment Council meetings with repre-sentatives of some forty federalagencies, and state and local interestgroups interested in rural economicdevelopment.

VA partnering with State Coun-cils resulted in successfultelemedicine projects in Alaska andMaryland; teletechnology sharing inColorado, Montana and Texas;expanded veterans housing inKansas, Massachusetts, Missouri andSouth Dakota; and expanded health-care delivery in Kansas, Utah andWest Virginia.

The Department’s IGA Office iscurrently coordinating a NRDP RuralTelecommunications Policy WorkingGroup seeking to resolve nationaltelecommunications policy impedi-ments to ensure rural communitiesobtain high-speed, advanced tele-communications networks forInternet and telehealth use.

VA’s telehealth interests werewell represented during a recentFederal Communications Commis-sion (FCC) consultation. There,members from SRDCs, federal

agencies and national organizationsmet with key FCC officials to discussvarious national policy measuresenacted by the FCC that affect ruraleconomies, especially in the field ofhealth care and education. Rural VAmedical centers and community-based outpatient clinics should takeadvantage of the telecommunicationsdiscounts offered by the RuralHealth Care Program fortelemedicine use.

VA’s participation in the recentNRDP conference reflects theAdministration’s commitment to amore responsive and efficient federalgovernment and to broad inclusionof rural veterans in policy decisions.

Partnering with non-VA healthcare providers, other federal agen-cies, community organizations,businesses and state and localgovernment enables VA to improveservice delivery to veterans in ruralareas. Time and money are saved,and veterans’ needs are met. As newchallenges and changes emerge,VA’s outreach to the NRDP enablesrural veterans to vocalize theirconcerns, and we resolve to listen. ❑

4 VAnguard

T he Department honored itsmore than 55,000 nurses thismonth during NationalNurses Week, May 2-8. VA is

the largest single employer of nursesin the country, and many VA nursesare national leaders in professionaldevelopment, education and admin-istration.

Nurses havealways been at thecore of the VA healthcare system, but theirroles are evolvingand diversifying asVA continues totransform how healthcare is delivered toveterans.

Recipients of thisyear’s Secretary’sAwards for Excel-lence in Nursing andthe Advancement ofNursing Programswere honored in aceremony in Wash-ington, D.C., thismonth. They are: Linda B. Haas,registered nurse at the Seattle divi-sion of the VA Puget Sound HealthCare System; Dorothy Huebener,registered nurse at the St. Louis, Mo.,VA Medical Center; Janis Cole,licensed practical nurse (LPN) at theJackson, Miss., VA Medical Center;and Lois Capers, nursing assistant at

the New York campus of the VANew York Harbor HealthcareSystem. Richard A. Silver, directorof the Tampa, Fla., VA MedicalCenter, was honored as the recipientof the Secretary’s Award for theAdvancement of Nursing Programs.

An endocrine clinical specialist,Haas’ knowledge ofdiabetes mellitusand renal diseasemakes her theprimary consultantfor diabetes care notonly for the medicalcenter, but also thestate of Washington.In addition toconsulting with newpatients each month,she manages a panelof chronic diabeticpatients in theambulatory care andacute care settings.

As an associate professor atboth the University of Washing-ton School of Nursing and Seattle

Pacific University, her design of aninterdisciplinary teaching model fordiabetes education includes studentsfrom nursing, medicine and otherdisciplines. Haas also designed andimplemented the “Seattle Big Foot”diabetes teaching program, throughwhich more than 500 diabetics getfoot care, proper fitting of shoes and

VA currently employs morethan 2,500 advanced practicenurses (APNs), and they areplaying a key role in the trans-formation of the VA health caresystem from a hospital-basedsystem to a primary care,outpatient-based system.

VA’s APNs — nurse practi-tioners and clinical nursespecialists — are taking onbroad roles and responsibilitiesin such areas as home healthcare, women veterans programmanagement, education andadministration.

Their duties include educat-ing patients and family mem-bers, obtaining medical historiesfrom patients and performingphysical examinations. ManyAPNs have the authority to writeprescriptions for patients and toorder and interpret laboratoryand diagnostic procedures.

As primary care providers,APNs commonly work in VAoutpatient clinics, where theytypically have caseloads of 600-700 patients. They managechronic diseases such ascoronary artery disease, hyper-tension and arthritis, and alsotreat acute, episodic illnessessuch as flu, sprains and colds.

Many of VA’s womenveterans coordinators areAPNs, and some provideprimary care to other specialgroups such as older veteransor those with HIV infection,multiple sclerosis, psychiatricdisorders or cancer.

VA Nurses Heal from the Heartprosthetic appliances to preservetheir limbs.

Nationally certified as a diabeteseducator, Haas has authored morethan 45 publications and has servedas president of the State of Washing-ton Diabetes Association and Ameri-can Association of Diabetes Educa-tors.

Her colleagues describe her as anoutstanding clinician who demon-

Recipients of the Secretary’s Excellence in Nursing Awards were, from left: Linda Haas,Dorothy Huebener, Janis Cole and Lois Capers.

Richard A. Silver

Broader Roles andDuties for APNs

May 1999 5

strates each day the value of servingveterans and improving health care.

As a staff nurse, Huebenercoordinates care for radiationoncology patients. She is known forusing her broad clinical knowledgeto meet both the physical andemotional needs of patients.

As the pivotal force in bringingtogether the Radiation Oncologyteam at the medical center to worktoward improving patient satisfac-tion and use of resources, Huebenerwas instrumental in coordinatingseamless care between the St. LouisVAMC and referral facilities. Hercoordination efforts have resulted ina decrease in the number of inpatientdays before and during radiationtreatment.

Cole was recognized for con-tinually demonstrating that patientsare her primary focus by refusing tobe satisfied with the status quo andtaking the initiative to expand heractivities in ways that improvepatient care. Expanding her access topatient scheduling and initiatingindividualized medication flowrecords for clinic patients are ex-amples of her initiatives.

Cole improves her job-relatedskills through continuing educationand training, and she is currentlypursuing a degree in nursing.

Capers works on the Rehabilita-tion Medicine/Neurology Unit,where she is described as a self-directed worker who promotesteamwork in the unit and takes apositive approach toward changesthat may improve a process orsupport the unit’s goals.

She proposed and initiated asystem to ensure that hourly checksof patients are done on the off tours,which resulted in a decrease in thenumber of patient complaints and animprovement in patient satisfactionsurvey results. Capers is known forher commitment to improving thequality of care, and she frequentlyexpands her skills through continu-ing education.

Silver was honored with theSecretary’s Award for the Advance-ment of Nursing Programs forrecognizing the nursing program’sunique contribution across thecontinuum of care for veterans, andfor consistently supporting contem-porary and progressive nursingpractices.

He is credited with fostering

Nurses are not generally thought of as scientists, but Mary Deletter,Ph.D., a nurse at the Lexington, Ky., VAMC, is one of an increasingnumber of VA nurse researchers working to identify health care-relatedproblems and seeking solutions. She has been involved in a dozenresearch studies in the last 10 years and is currently working on threeprojects — two focusing on patients with chronic lung disease andanother on evaluating home health care services for veterans.

Deletter says nurse researchers do not look for cures for diseases orillnesses; rather, they search for ways to reduce symptoms and improvethe quality of life of patients with chronic health problems.

One of the goals of VA’s Nursing Service is to increase the numberof nurses with funded merit-review level research proposals. In fiscalyear 1998, more than 40 nurses were principal investigators in morethan 50 studies at VA facilities with total funding of $2.5 million. Manymore nurses participate in funded research but are not principal investi-gators.

Although VA has expanded the role of nurse researchers in recentyears, nurses were always eligible to apply for VA research funds if theirjobs allowed them time to conduct studies. In 1963, VA also became thefirst health-care provider in the nation to establish positions in hospitalsettings for nurse researchers with doctorate degrees.

But encouragement for more substantial research on nursing topicsbegan in 1995 when Nursing Service and the Office of Research andDevelopment created the Nursing Research Initiative (NRI) to increasethe role of nurses in medical, health services and rehabilitation research.

The goal of the NRI program is to bring the perspective of nurses tohigh-priority, VA mission-oriented subjects in independent research. Todate, 18 studies have been funded under this initiative, on topics such ascongestive heart failure, dementia, post-traumatic stress disorder,management of cancer pain, spinal cord injury and falls.

In 1998, Eileen Collins, Ph.D., a nurse at the Hines, Ill., VA MedicalCenter, became the first nurse to receive an award in the VA ResearchCareer Development Program. The Career Development Programprovides full salary for promising investigators who devote at least 75percent of their time to research, usually for three to five years.

Collins, a nurse scientist specializing in rehabilitation research, isstudying the effects of training in breathing and aerobic exercise onpeople with chronic obstructive pulmonary disease (COPD), a commoncondition among elderly veterans. She is evaluating the effectiveness ofa method of retraining breathing in coordination with various forms ofexercise to improve tolerance for exertion as well as quality of life.

growth of all nurses by providingthem opportunities to assumeincreased responsibility and account-ability at the facility, network andnational levels. He actively supportsinnovative programming, research-based practice and interdisciplinaryfunctioning for nurses in an environ-ment that promotes ethical stan-dards, caring and a spirit of inquiry.

Silver is described as a championof nurses whose support has contrib-uted to the national recognition ofTampa VAMC nursing projects.

Criteria for the Secretary’s Awardfor Excellence in Nursing include therecipient’s integration of current

standards of nursing practice intoclinical care, meeting performancestandards, interaction with co-workers to achieve excellence in care,and maintaining skills throughcontinuing education and inquiry.

The Secretary’s Award forAdvancement of Nursing Programsconsiders factors such as the incorpo-ration of contemporary nursingpractices into the facility’s existingnursing program, the involvement ofnursing as a clinical discipline at thefacility, and provision of supportservices such as personnel or tech-nology to enhance nursing’s contri-bution to health care. ❑

Expansion of Nurse Research

6 VAnguard

A mericans were riveted totheir television sets lastmonth as the horror of asuburban Denver high school

under siege by two teenage gunmenunfolded on their screens. In thewake of the tragedy at ColumbineHigh School in Littleton that left 15people dead, 23 hospitalized andcountless others in shock, employeesof Denver-area VA facilities pulledtogether to lend a collective helping

hand to the community.At the Denver VAMC, Public

Affairs Officer Joe Dean and AnitaUrdiales, team leader of the medicalcenter’s Mental Health Crisis Inter-vention Team, coordinated assistanceto the relief efforts.

As the news broke, medicalcenter staff quickly conducted aninternal bed status review to beprepared in case they were called onto receive some of the casualties.Eleven VAMC counselors who havespecial training in mental healthcrisis intervention and grief counsel-ing were dispatched to the scene incoordination with the Red CrossDisaster Team.

Working in shifts to help providesupport 24 hours a day, they mannedthe crisis hotline phones, workeddirectly in the park adjoining theschool at the crisis command center,and provided assistance at memori-als and church services. Nine VApolice officers and additional stafffrom the medical center also pro-vided security at the committal

services for two victims with supportfrom the Denver Special OperationsPolice Unit.

Dr. Rodney Haug of the DenverReadjustment Counseling Service(RCS) Regional Manager’s Officeprovided counseling coordination,arranging for an additional eightcounselors from that office and theDenver, Boulder and ColoradoSprings Vet Centers.

This team also worked long hoursto assist theRed Crossteam on thephone linesand at thecrisiscommandcenter. Theyworked intothe night tocover whenthe RedCross team’sshifts ended,and pro-vided acounselor totake calls on

a local radioshow thatwas receiv-

ing a large number of calls fromstudents who were in distress andneeded to talk. Team members alsostaffed two emergency counselingcenters established at local churches.

Tom Balsanek, director of theDenver NCA Area Office, LeonMurphy, director of the Fort Logan,Colo., National Cemetery, andcemetery staff worked to arrangecommittal services for two of thestudents killed at the school whowere the children of veterans. Theyworked directly with family repre-sentatives to ensure that their wisheswere accommodated.

With the media spotlight focusedintensely on all aspects of the trag-edy, Paul Sherbo and Elaine Buehlerof the Denver VA Regional Office ofPublic Affairs, and VISN 19 (Denver)Public Affairs Officer Jim Sandmanwere on hand to provide mediastrategy and coordination assistance.

They worked with the police andlocal and national media commandcenters to provide points of contactfor questions, coordinate distribution

of information on VA involvementand on the committal services, andarranged pooling of media coverageto minimize impact on the services.They also provided additional mediacoordination during the services.Denver Regional Counsel staffrounded out local support by provid-ing legal consultation and oversightto VA’s relief effort.

Although no VA employee lostan immediate family member in thetragedy, one Denver VAMC em-ployee was the godmother of one ofthe victims, and another has a childwho attends the school but wasabsent on the day of the shootings. ❑

Colorado School Tragedy Spurs VA Help

Two of the Columbine High School shooting victims were buried at FortLogan National Cemetery.

Although the tornadoes thatdevastated Oklahoma andKansas early this month did notdirectly affect operations at theOklahoma City VA MedicalCenter, about 50 employeesreported damage to their homes,ranging from blown-out windowsto complete destruction. Some ofthe twisters were among the mostpowerful ever recorded, anddamage was extensive.

Most of the casualties weresent to other area hospitals, butsome veterans were treated atthe VA medical center for minorinjuries and released. A numberof VAMC employees went towork in the community providingassistance in storm-ravagedareas, and the medical centeralso hosted a Federal EmergencyManagement Administration(FEMA) team.

The Oklahoma City VAMedical Center established atornado relief program to helpaffected employees. Donationsmay be sent to the OklahomaCity VA Medical Center TornadoRelief Fund (OOA), 921 N.E. 13th

Street, Oklahoma City, OK73104. You may also senddonations to the VA EmployeesDisaster Relief Fund, c/o VACentral Office Credit Union (831),810 Vermont Ave., N.W., Wash-ington, D.C., 20420. ❑

Tornado DevastationAffects VA Employees

May 1999 7

T he Department of Defense(DoD) has submitted toCongress a plan developedwith the input of VA and

veterans service organizations(VSOs) to improve the availabilityand delivery of military funeralhonors for veterans.

If approved, the plan wouldrequire the military to providefuneral honors at the burial of anyhonorably discharged veteran ifrequested by the next of kin. A teamof at least two representatives, one ofwhom will be a uniformed memberof the service branch the deceasedveteran served with, will conduct aflag-folding ceremony and presentthe flag to the family.

The plan also requires the playingof “Taps” at the funeral service,either by a bugler or a high-qualityaudio recording.

The Defense Department willimprove access to and coordinationof military funeral honors for fami-lies and funeral directors by estab-lishing a toll-free request numberand a Web site containing informa-tion on the benefit. The challenge of

providing military honors will bemet by DoD in part by working withlocal VSOs that are currently provid-ing military funeral honors and byexpanding the use of National Guardand Reserve forces.

VA joined with DoD to host ameeting last November in Washing-ton, D.C., to develop the plan to meetthis increasing challenge. Eighteenmilitary and veterans service organi-zations participated, along withsenior officials from two nationalfuneral directors associations andcongressional staff.

Current DoD policy requires themilitary to provide honors onlywithin the constraints of availableresources. But the policy, which hasnot been changed in nearly 15 years,is no longer adequate in an era ofincreasing veteran deaths and ashrinking military.

The number of veterans who dieeach year has increased by 18 percentsince 1989, while the size of theactive duty military has decreased by35 percent over the same period.

Reserves forces, which have longbeen used to help support requests

for military honors, have decreasedin size by 25 percent. Military baseclosures have added a geographicalchallenge for funeral honor guarddetails, according to DoD, becausethey often must travel greaterdistances than in the past to providefinal tributes for deceased veterans.

The military was asked to pro-vide funeral honors for 37,000deceased veterans last year, whichamounts to approximately ninepercent of eligible families. But withthe activation of the toll-free numberand Web site, as well as an antici-pated 36 percent increase in thedeath rate of veterans by 2008, DoDexpects demand to increase to 45percent, or more than 250,000 funeralservices per year.

If approved by Congress, the newpolicy will be implemented onJanuary 1, 2000. The plan wasdeveloped in response to a require-ment placed in the 1999 DefenseAuthorization Act after veterans’family members raised concernsabout the lack of available resourcesfor providing military funeralhonors. ❑

Military Funeral Honors Plan Goes to Congress

P hoenix, Ariz., will be the siteof the first of four regionalOne VA conferences July 13-15. More than 375 employees

are expected to attend from facilitiesand offices in 13 western statesrepresenting the three administra-tions and staff offices. They will form cross-organizationwork teams and participate inexercises to better understand how tocollaborate with colleagues fromother VA components as a unifiedteam.

The goal, according to planners,is to expose participants to successfulexperiences in improving customerservice through inter-organizationalinitiatives and then have the teamsdevelop action plans to implementOne VA initiatives at the local level.The three other conferences areplanned for Atlanta, Sept. 8-10,Pittsburgh, Nov. 3-5 and St. Louis,Dec. 7-9.

According to conference co-chairs

Gary Steinberg, Deputy AssistantSecretary for Planning and Evalua-tion, and Dr. Larry Blevins, Dean ofthe VA Learning University, theconferences represent an importantpart of a long-term transformationthat will see VA enter the 21st centuryproviding high-quality, seamlessservice to veterans.

Steinberg said he hopes theconferences will accelerate develop-ment of a One VA corporate cultureby helping VA employees see thevalue of initiating cooperativeactivities that go beyond theirfamiliar territorial boundaries.

The conferences will bring seniorleaders, middle managers and first-line employees together with unionrepresentatives and veterans serviceorganization members.

Steinberg expanded on theformat: “We plan to help participantssee what success looks like bysharing outstanding internal One VAaccomplishments from across the

country as well as the experiences oforganizations similar to VA in thepublic and private sectors that havetransformed their cultures.”

Following each conference, “newsstories” will be shared throughoutthe Department to inform all em-ployees about issues that wereaddressed and specific action plansdeveloped to enhance the delivery ofseamless service.

Many of the employees selectedto attend the conferences have jobsthat bring them in direct contact withveterans or work on quality im-provement teams. Exhibits andvideos will depict successful ven-tures among organizations that haveresulted in improved service toveterans and operational efficiencies.

Exhibits will be selected from the300 success stories submitted inresponse to an invitation fromSecretary of Veterans Affairs Togo D.West, Jr. ❑

First ‘One VA’ Conference Set for July in PhoenixThree Others Planned for Atlanta, Pittsburgh, and St. Louis

8 VAnguard

veterans homes are now participat-ing in the SPV program. The teamalso was selected to receive a Ham-mer Award for this initiative. Teammembers from VACO and VAmedical centers in Seattle/AmericanLake, Houston, Hines, Ill., andDenver were on hand to accept theawards from Deputy Secretary Goberat a ceremony last month in Wash-ington, D.C.

The St. Paul, Minn., VA Re-gional Office Information Centerreceived a Scissors Award forproviding telecommunicationssupport for VAROs serving 13Midwestern states, allowing tele-phone inquiries from veterans andtheir families to be answered moreefficiently.

Previously, a caller would receivea busy signal, which resulted in a“blocked call.” The St. Paul Informa-tion Center staff’s efforts, workingwith the affected VAROs, haveallowed more callers to reach VAand have their inquiries answered.

VA Podiatry Service received aScissors Award for adapting andreproducing for nationwide distribu-tion a monofilament device used toscreen a diabetic’s foot for areas thatlack sensation.

When a diebetic has lost feeling ina foot, the chances of infections,ulcerations and amputations in-crease. Podiatry Service staff identi-fied a monofilament device devel-oped by the Bureau of PrimaryHealth Care (Lower ExtremityAmputation Prevention Program),and obtained permission to modifyand reproduce it. About 22 percentof veterans have diabetes. Thedevice is now being used in 70 VAhealth-care facilities, and has savedthe government $60,000.

The ultimate benefit, however, isthat the devices are decreasing thenumber of amputations amongdiabetic veterans. At a recent“Heroes of Reinvention” awardsceremony in Cleveland, where VAPodiatry Service is based, the servicereceived both the Scissors Awardand a Hammer Award for thisinitiative.

The Hammer Award was sharedwith the Bureau of Primary HealthCare, designer of the monofilamentdevice. ❑

Center and VA Regional Officereceived a Scissors Award for a jointtelecommunications project thatsaved thousands of dollars andimproved customer service.

In 1997, the VAMC was complet-ing a facility upgrade, and the VAROneeded to update its antiquatedtelephone system. The VARO’sphone system would not allow callsto be transferred between the facility,the VAMC and the Baton RougeOutpatient Clinic. It also lackedauto-attendant, which would haveallowed quicker response to calls,and voice mail features.

Purchasing a new telephonesystem would have cost the VAROmore than $370,000 and upgradingthe existing system would have cost$150,000. But by teaming up withthe VAMC, the VARO became aremote tenant on the medical center’sphone system at a cost of $106,000.In addition to the cost savings, thejoint venture allows both facilities toimprove customer service. Previ-ously, callers had to hang up andredial a seven-digit number if theyhad contacted the wrong facility.Now, callers can easily be transferredbetween the VAMC, VARO andoutpatient clinic. The facilities alsorecently received a Hammer Awardfor this successful joint venture.

The Subsistence Prime Vendor(SPV) Management Team received aScissors Award for streamliningoperations of Nutrition and FoodService, Acquisition and MaterielManagement and Fiscal/FinancialManagement Services at VA facilitiesnationwide.

The team, composed of membersof the VACO staffs of Nutrition andFood Service and the Office ofAcquisition and Materiel Manage-ment as well as participating VAmedical centers, initiated a consoli-dated group food purchasing pro-gram that saves money, is moreefficient, and improves the quality ofpatient care.

By offering a wider food productselection at competitive marketprices, the new direct vendor deliv-ery system developed by this teamreduced food costs by 10 to 15percent nationwide and improvedmenu choices. A number of militaryhospitals and bases, as well as state

A s VA teams continue todevelop innovative initia-tives to cut red tape, stream-line operations and improve

customer service, they collect moreScissors Awards from DeputySecretary Hershel Gober for theirefforts. Here are recent winners ofthe VA Scissors Award:

Deputy Secretary Gober visitedthe Hampton, Va., VA MedicalCenter recently to present a ScissorsAward to a team of VA and Depart-ment of Defense (DoD) Tricareemployees for their efforts in devel-oping blanket purchase agreements(BPAs).

This group, originally formed toprovide more cost-efficient, high-quality laboratory reference testingservices for three VA medicalcenters in VISN 6 (Durham) and sixDoD medical treatment facilities inVirginia and North Carolina,subsequently turned its efforts toother aspects of laboratory services.

The group redefined the partici-pating federal hospital laboratoriesas a unified regional purchaser,using this combined purchasingpower to obtain maximum discountsfrom national vendors. The groupcontinues to execute VA/DoDcombined BPAs and saved morethan $1 million last year.

Two teams at the Lebanon, Pa.,VA Medical Center recently re-ceived Scissors Awards. The FoodService Department was honored forredesigning food service operations,incorporating technologicallyadvanced equipment, and rethink-ing workflow to achieve increasedefficiency while maintaining highquality patient meal service.

The VAMC’s Quality Manage-ment Section was recognized forstreamlining the process of review-ing medical records. Prior toimplementing the new process,fifteen different staff members wereresponsible for reviewing a portionof the same record. The new processresulted in the combination of theHealth Information ManagementSection and Quality ManagementSection working as one functionalunit to eliminate duplication ofeffort and improve data validity.

The New Orleans VA Medical

More VA Teams Collect Scissors Awards

May 1999 9

T he Department’s two-yearpartnership with the NationalAssociation of HispanicFederal Executives (NAHFE)

was underscored at the HispanicFederal Executives Summit IIconference held in Washington,D.C., recently. VA co-hosted the meeting ofHispanic executives andfederal human resourcesmanagers whose missionis to increase the numberof Hispanics in the topranks of the federalworkforce.

Hispanics continue tobe the most under-represented group incareer federal service,particularly at the topmanagement level, theSenior Executive Service.

More than 200 at-tended the two-daymeeting, which wasorganized and supportedby the VA Office of EqualEmployment Opportunity,directed by Acting DeputyAssistant Secretary EllisJones Hodges. The groupheard from a number of high-ranking officials, including keynotespeaker Togo D. West, Jr., Secretaryof Veterans Affairs, and Office ofPersonnel Management (OPM)Director Janice R. Lachance.

VA EEO staff guided participants

through a series of focus groupsessions designed to develop strate-gies to implement the nine Hispanicemployment initiatives undertakenby OPM in 1997 and shared withother federal agencies by thePresident’s Management Council.

Lachance emphasized the needfor the government to hire andpromote Hispanics, whom, she said,“continue to be the only under-represented group in the federalservice, representing 6.2 percent ofthe federal work force, compared to

11 percent of the civilian workforce.” She singled out the SocialSecurity Administration for its workin bringing the Hispanic representa-tion in its work force to 8.6 percentand “helping build a government

that looks like America.”Secretary West

acknowledged that VA had along way to go to bringHispanic representation inits work force up to civilianwork force levels, but hesaid progress was beingmade and new initiativeswere underway. He citedVA’s partnership with theHispanic Association ofColleges and Universities(HACU) as one source ofdiversity within VA man-agement.

“We are happyabout the growth in[HACU] interns in ourDepartment,” he said,“from a low single-digitnumber to more than 50this year.”

He also noted VAEEO staff outreach topotential Hispanic em-

ployees through job fairs, confer-ences, and mentoring.

Summit II recommendations goto the President’s ManagementCouncil for incorporation into theAdministration’s federal employ-ment strategy. ❑

A new rose dedicated toveterans will be planted atVA medical centers and vetcenters in special ceremonies

across the country on May 27 as thenation enters the Memorial Dayweekend.

The dark red Veterans’ HonorHybrid Tea Rose was developed byJackson & Perkins Company, theworld’s largest rose company, at thepersonal recommendation of UnderSecretary for Health Dr. Kenneth W.Kizer.

“I wanted to create a commemo-rative rose to signify the pride andgratitude that we as citizens of thiscountry have for our veterans,” Dr.Kizer said. “Without their sacrifices

VA Co-Hosts Hispanic Federal Executives Summit

New Veterans’ Rose Dedicated This Monthand beneficence, the freedoms thatAmericans and many other peopleenjoy today would not be possible.”

The company donated rosebushes to VA for the plantingceremonies and has pledged 10percent of the proceeds from the saleof the rose to VA medical research.VA’s medical research programsupports more than 7,000 investiga-tors working on more than 15,000projects.

Jackson & Perkins also will unveilthe new rose on May 27 at a cer-emony at Arlington National Cem-etery, where it will be planted in amemorial rose garden donated bythe Oregon-based mail order rosecompany.

The Veterans’ Honor rose isdescribed by the company as a“stunning dark red hybrid tea rose,with dark green, semi-glossy foliageand a light raspberry fragrance.”The rose bush will grow to a heightof about four feet and a width ofabout five feet. Its bloom opens to alarge flower with a high centeredbud.

Once planted on the grounds ofVA facilities nationwide, the peren-nial flower will serve as a living andlasting tribute to the nation’s veter-ans.

The rose will be available exclu-sively through the Jackson & Perkinscatalog. The company’s customerservice number is 1-800-872-7673. ❑

VA executives take at break at Summit II, a meeting of federalexecutives to develop methods and strategies to bring more Hispanicsinto the top levels of the federal workforce. From left: Ada Neale,associate director, VA Health Care System, Fresno, Calif.; Dr. AnnaDuran, management consultant; and Gabriel Perez, associate director,Honolulu VA Regional Office.

10 VAnguard

[Editor’s Note: Jamie MitchellMolitoris of Media, Pa., lost her fatherto cancer several months ago. Duringhis 11-month battle with the disease, herfather received his treatment from theVA Pittsburgh Healthcare System.Molitoris asked VAnguard to share withVA employees her story of thecompassionate, quality care her fatherreceived “as a way of recognizing thefine work of all of the VA healthcareproviders.” What follows are excerptsfrom that story, in her own words.]

O n January 31, 1998, my fatherwas diagnosed with radicalcancer that originated in theroot of his tongue. By the

time he sought medical help, thecancer was very far advanced. Herequired surgery that would entailthe removal of his tongue, esopha-gus, voice box and vocal chords.

As I sat in the doctor’s office andlistened to the doctor explain all ofthis, my stomach turned. Not onlywas I concerned about the basicquestions for Dad, but also, I wasconcerned with where the procedurewould take place. My father wasgoing to put his life in the hands ofpeople at a VA hospital.

VA hospitals have been in thenews repeatedly recently witharticles decrying care. This was myDAD and there was no way I wantedhim at a VA hospital. I wanted himsomewhere that he would receivequality, caring treatment. By thetime he sought treatment, it was toolate to shop around for hospitals.

From the getgo, I was encouragedby the amount of communicationthat went on. My brother and I weretrying to handle this long-distance,sometimes flying in for just a day ofmeetings. Ruth [Young], the [healthtechnician] coordinating Dad’s care,scheduled meetings when we couldbe there. Ruth always made us feelthat Dad was her only patient, yet avisit to the crowded Ear, Nose andThroat clinic proved that she wascaring for a lot of Dads and I wouldbet that they also felt like they wereher only patient.

Dad’s recovery from 14 hours ofsurgery was complicated [and]mandated heavy sedation andconstant monitoring. “Not to worry(her favorite expression),” said Ruth,

“he can stay in ICU as long as heneeds to, no insurance restrictionshere.” True enough, he needed twoweeks in ICU and there was neverpressure to move him.

In the next phase of his treatment,Dad required six weeks of radiation.Again I was panicked. Dad’s homein Bedford was 80 miles from Pitts-burgh where he was to receive theradiation and he did not have a car.Despite our constant nagging, Dadwould not “bother” my brother or Iby coming to stay with us andallowing us to help him through theradiation.

Again, “not to worry.” The

Oakland/Aspinwall VA providesrooms they call a “hoptel.” Patientscan stay there and come and go asthey please for the duration of theirtreatments. During his six weeks inthe hoptel, Dad came out of his shellmore than I had ever seen. Heplayed bingo every day, paintedstained glass for both friends in thehospital and family members, andbecame part of the VA community.At every turn, there was someonemy brother and I could call to findout about Dad’s care and Dad wasnever alone or lonely.

Thanks to the wonderful ex-tended care provided by VA and toDad’s fortitude, he was able to comehome and live on his own. “Howwill he communicate?” I wondered.Again, not to worry. He was pro-

vided with a Godsend device called aLightwriter. This little computerabout the size of a purse allowedDad to type in whatever he wantedto say. He then simply pushed abutton and the computer spoke forhim.

The true extent of the careprovided by the staff at the VAcenter in Aspinwall came toward theend of Dad’s life. The recurrence ofhis cancer was quick and horrible.When we couldn’t be at his bedsidethe nurses we spoke with daily werecalming and reassuring. Dad got to apoint where he couldn’t use hisLightwriter to communicate any-more so he wrote notes; sometimesjust scribbles, sometimes partiallycoherent fragments.

When he died, I went through histablet to try to understand how hefelt and thought as his head blew uplike a beach ball from fluid andtumor. Did he have any epiphanies?Any regrets? I found none of thattype of writing.

What I did find was remnants ofwhat looked like a particularlydifficult night: “TAKE ME TOBEDFORD” was followed by angryviolent scrawls. “I’M GOINGHOME” followed by more incompre-hensible scribbling. My heart wasbreaking as I read this until I got tothe bottom of the page. Very care-fully and lovingly was written: “Ienjoy taking care of you, and I wantyou to be safe. Please don’t get outof bed. If you need anything, pleasejust call and I’ll be right in.”

I had seen the way the nursesstroked my father’s swollen face; aface that I was sometimes afraid totouch. I had heard the way theytalked gently to him, calling him“buddy” and encouraging thefaintest of smiles when it truly wasdifficult to tell if he was smiling, butreading that carefully worded notesealed the deal. My father receivedthe best possible care and all in a VAhospital.

Does this piece settle my scorewith the VA hospital in Pittsburgh? Ithink not. How does one properlythank an organization for allowingher father to die with dignity ascomfortably as possible? To me thatis an impossible task. Now at least, Ifeel as though I’ve made an effort. ❑

Patient’s Daughter Shares Quality Care Story

Health Technician Ruth Young

May 1999 11

I n 2000, every state in thenation should have at leastone stand down for homelessveterans with VA participation.

Nearly 100,000 homeless veteranswill receive help as a result. That’sthe goal of Stand Down 2000, a VAdepartment-wide millenniumobservance.

Tipper Gore, wife of the VicePresident, has agreed to serve ashonorary spokesperson for StandDown 2000.

“We hope the Martin LutherKing, Jr., Birthday weekend in mid-January will serve as the focal pointfor holding many of the stand downsnext year,” said Pete Dougherty,director of VA’s Homeless VeteransPrograms Office, which will coordi-nate VA efforts nationwide.

The reason he sees the goal ofreaching 100,000 veterans at standdowns as reasonable is that a 1998poll of all VA medical centers

revealed that more than 43,000veterans and family members visited123 stand downs and benefits fairslast year. Those events were held injust 42 states and the District ofColumbia. An estimated 24,550volunteers, including VA employees,assisted at these events. And alreadyin 1999, more than 70 stand downsare scheduled. With the addedemphasis this year to stage standdowns in 2000, the number ofparticipants should greatly increase.

The concept of the three-day, ormultiple-day, stand down began in1988 when a group of Vietnamveterans believed that the highlyeffective military model of a standdown could be used to provide a safeand supportive environment forhomeless veterans. Stand downsprovide a means of bringing home-less veterans out of their “jungle.”

They draw homeless veteransliving under bridges or sleeping in

the woods and on the streets of citiesto places where they are welcomedby people committed to helpingthem.

Stand downs offer a safe havenby providing health care and medicalassessments, benefits assistance andother community-based assistance inone location at one time. Veteranscan receive medical evaluations andreferrals to VA medical treatmentfacilities, receive benefits counseling,hot meals, showers and haircuts.Stand downs often renew the spiritand give many the tools to makeinformed choices for the future.

VA staff and community orga-nizers estimate that 25-35 percent ofall veterans who attend stand downs(10,000-15,000) had not receivedmedical treatment or benefits assis-tance from VA previously, andreceived it as a result of participat-ing. ❑

Presidential Rank Awards Honor 19 VA Executives

Stand Down 2000 Aims to Reach More Homeless Vets

William T. Merriman

John J. Donnellan

Frederick L. Malphurs

Thomas A. Trujillo

V ice President Al Gorehonored 54 members of thefederal government’s SeniorExecutive Service (SES)

with the Presidential RankAward of DistinguishedExecutive last month.

Presented to no more thanone percent of career seniorexecutives, the award recog-nizes top federal executivesfor their extended exceptionalperformance in governmentresulting in more cost-

efficientservice to thepublic andvaluablecontributions inleading vitalfederal pro-grams.

Amongthose honoredwere four VAexecutives:

John J.Donnellan, director of the VA NewYork Harbor Healthcare System;Frederick L. Malphurs, VISN 2(Albany, N.Y.) director; William T.Merriman, Deputy Inspector Gen-eral; and Thomas A. Trujillo, former

VISN 18 (Phoenix) director (retired).In addition, 252 members of the

SES were honored with the Presiden-tial Rank Award ofMeritorious Executive,which is awarded to nomore than five percentof career senior execu-tives. The 15 VArecipients were:Vincent L. Barile,director of Operations

Support for theNational CemeteryAdministration; Joyce

E. Felder, Associate Deputy Assis-tant Secretary forHuman ResourcesManagement; GlenW. Grippen,Milwaukee VAMedical Centerdirector; Peter P.Henry, director ofthe VA Black HillsHealthcare Systemin Fort Meade, S.D.;Smith Jenkins, Jr.,VISN 22 (LongBeach, Calif.) director; Howard C.Lem, Assistant General Counsel,Group VI; James A. Maye, Roanoke,Va., VA Regional Office director;

Laura J. Miller, VISN 10 (Cincinnati)director; Richard F. Robinson,Fayetteville, Ark., VA MedicalCenter director; Robert W. Schultz,Deputy Assistant Secretary forAdministration; William L. Shelton,Associate Deputy Assistant Secretaryfor Financial Operations; Stanley R.Sinclair, Deputy for Management;Michael G. Sullivan, AssistantInspector General for Auditing;David M. Walls,Phoenix, Ariz.,VA RegionalOffice director;and Leo C.

Wurschmidt,Jackson, Miss.,VA RegionalOffice direc-tor.The Presiden-

tial Rankawards were established torecognize executives with careersof sustained accomplishment —those who have consistentlydemonstrated strength, leader-ship, integrity, industry and

personal conduct of a level that hasestablished and maintained a highdegree of public confidence andtrust. ❑

12 VAnguard

We launch a new recurringfeature in this month’s issue tohelp VA employees navigate theInternet/Intranet. It is designedto be a guide to helpful andinformative Web sites of interestto employees. VAnguard readersare invited to submit suggestions,including the Web site addressand a brief description of the site’scontents, to our e-mail address:vanguard@mail.va.gov.

■ Can’t recall what CHAMPVAstands for? Try the VA AcronymDatabase that has been added tothe VHA Intranet Reference pageat http://vaww.va.gov/med/reference/index.asp. More than500 acronyms are currentlyincluded. You can search byentering the beginning of theacronym (such as “V” for VA,VHA, VBA), and users are invitedto suggest new acronyms to add.

■ The Congressional Medal ofHonor (MOH) Society Web sitecontains a wealth of informationon the MOH, as well as a list ofliving and deceased MOH recipi-ents, citations for many, and ahistory of the MOH. The addressis: http://www.awod.com/

gallery/probono/cmhs.

■ Need to find out if a localWorld War I veteran is on the listof eligible recipients for theFrench Legion of Honor Award?Try the French Embassy Web siteat: http://www.info-france-usa.org/80ww1.

■ The Philadelphia VA RegionalOffice & Insurance Center’s Website has gone bilingual, and theresponse from Spanish-speakingvisitors has been positive. Theentire Web site was completelytranslated into Spanish late lastyear, and is registering more than1,500 hits per month. More than250 visitors have submittedquestions or requested assistancethrough the site. The address is:http://www.vaphilly.com.

T he newly formed Center ofExcellence for InformationTechnology (CEIT), spon-sored by the Government

Information Technology ServicesBoard, serves as a clearinghouse forbest information technology prac-tices in both the public and privatesectors and supports Vice PresidentAl Gore’s Access America Plan.

The CEIT grants awards to publicand private sector organizations thatdemonstrate the benefits of using thebest technology to improve govern-ment operations. Late last year, VA’sAustin Automation Center (AAC)applied for and won the CEIT award,along with 15 other organizations.

At the recent Virtual Governmentinformation technology conferenceheld in Washington, D.C., the AACwas officially recognized for itscontributions toward Web-enablingthe Master Veteran Record (MVR)system. Nationwide in scope, MVRprovides VA employees rapid accessto veteran status data, simplifies datacollection and eliminates duplication.

Before MVR, it was difficult touniformly access databases and sharedata across organizational lineswithin the Department. In somecases, when veterans sought assis-tance from VA offices, they often had

to contact multiple locations to getcomplete benefits information.Collaborating with nearly all ele-ments of the Department, VACentral Office and AAC staff mem-bers wrote and designed the system.

As the hub for MVR, the AACfacilitates the movement of dataamong systems and performstranslations to ensure that data isdelivered in a usable form. Gate-ways in each VA organizationprovide the linkage between thiscentral hub and the componentsystems.

VA identified MVR as an idealsystem for Web-enabling because ofits scope, its widespread and fre-quent use, the number of employeesinvolved and their need for quickaccess to large volumes of sometimesdisparate data.

Using a browser, authorizedemployees at VA health care facili-ties, benefits offices and nationalcemetery offices will have readyaccess to demographic data onveterans, allowing them to quicklyserve veterans. As one of the CEITaward winners, the AAC’s demowill be included in CEIT’s perma-nent display showcasing informationtechnology success stories. ❑

VAnguard Web WatcherVAnguard Web WatcherVAnguard Web WatcherVAnguard Web WatcherVAnguard Web WatcherAustin Automation Center WinsAward for Web-Enabling MVR System

Patient Safety Centers Established

T he Department is establishingfour Patient Safety Centers ofInquiry — the first of theirkind in the U.S. — and has

committed $6 million to support theinnovative centers over the nextthree years.

In addition to researching newknowledge on improving patientsafety, these centers will focus ondisseminating existing knowledgethat can be immediately used.

The four centers, which will workwith universities or other public andprivate partners, are: the VA PaloAlto, Calif., Health Care System;VA’s Health Care System of Ohio,Cincinnati; the New EnglandHealthcare System/White RiverJunction, Vt.; and the Tampa, Fla.,VA Medical Center.

Although the extent of the patient

safety problem has not been ad-equately measured, a variety ofstudies from the private sectorindicate that approximately five to 15percent of hospitalized patients areinjured during the course of theirmedical treatment. Some studieshave shown that such injuries affectmore than 30 percent of patients, andabout a quarter of these injuriesappear to be serious or fatal.

The goal of these centers will beto develop and share improvedmodels of care in such areas asmedication errors and adverse drugevents, wrong site surgery, transfu-sion reactions, restraint-relatedinjuries, falls and burns.

The centers were each awardedapproximately $500,000 per yearfollowing a nationwide competitionamong VA medical facilities. ❑

May 1999 13

MEDICALadvances

VA Study Finds No Link Between BloodTransfusions and Creutzfeldt-Jakob Disease

A study of more than 1,500 veterans who received bloodproducts from a donor who later died from Creutzfeldt-JakobDisease (CJD) — the human equivalent of “mad cow” disease— found no evidence that any of them contracted the disease.

The results are in line with other studies that have not founda documented case of CJD transmitted by blood or bloodproducts, adding to the mounting evidence that it may not betransmitted by blood. The study’s lead author, Dr. AbidRahman, an epidemiologist with VA’s Office of Public Health,presented the findings at a recent meeting of the Society forHealthcare Epidemiology of America in San Francisco.

Rahman and his VA colleagues examined medical recordsand death certificates of patients known to have received bloodproducts between 1991 and 1996 that were made from plasmaobtained from a donor who was later found to have died fromCJD.

In CJD, sponge-like holes form in the brain, which causeloss of muscle control, personality changes, dementia andeventually death. Virus-like proteins called prions are believedto be responsible. These prions are infectious, but scientistsbelieve they can also arise spontaneously from genetic muta-tions.

Creutzfeldt-Jakob Disease occurs in one person in a millionin the U.S. each year. Although the FDA banned bloodproducts from people with this disease in 1995, it can have along incubation period, so it may be years before the disease isdiscovered in someone who gave blood.

There have been documented cases of transmission topeople who received transplants of infected corneas or braintissue, and natural human growth hormone may also be asource of transmission.

Study Sheds Light on Use of EmergencyDepartments for Non-Urgent Care

Emergency department visits for non-urgent health condi-tions cost billions of dollars each year, placing financial andservice burdens on health-care organizations nationwide. Dr.Laura Petersen, a physician-health researcher at the HoustonVA Medical Center and assistant professor of medicine at theBaylor College of Medicine, led a study to examine the reasonspatients use emergency department services for non-urgentneeds. She found that one of the strongest predictors of non-urgent emergency department visits is the failure to have anestablished relationship with a primary care physician whowould treat minor illnesses and injuries.

“An ongoing relationship with a physician tends to promoteappropriate use of emergency facilities, regardless of insurancestatus, education level, ethnicity, or health status,” saidPetersen, whose results were published in the journal MedicalCare.

Petersen selected a cross-section of nearly 1,700 patientsfrom five urban teaching hospitals in the Northeast for thestudy. Patients presenting to the emergency department withchest pain, abdominal pain or asthma completed a survey,including information about their relationship with a regulardoctor. She controlled for potential variables that mightinfluence the results, including race, education, insurance andhealth status.

According to Petersen, keeping patients out of the emer-gency department when they don’t need it is more cost-effectiveand reduces crowding for those who really do need emergencycare.

VA Researcher Finds Primary Care DoctorsGetting More Involved in Mental Health Care

Limits placed on psychiatric visits by managed-care plansare leading primary care doctors to fill the gap for patients bybecoming more proficient in diagnosing depression, accordingto a study by Dr. John Williams, Jr., from the San Antonio VAMedical Center, and Dr. Allen Dietrich of Dartmouth Universitypublished in the Archives of Family Medicine.

Because many patients first experience depression with acluster of physical problems such as fatigue, headache anddisruptions in eating or sleeping patterns, general internists,family practitioners and obstetricians/gynecologists are well-positioned to monitor their patients’ psychological well-being,according to the researchers.

Among the challenges primary care physicians face inmeeting their patients’ needs for mental health care include lackof skill in diagnosing depression and time constraints thatprevent about half of them from adhering to the recommendedtwo-week follow-up of depressed patients.

Everyday Activities Can Stress Heartsof Cardiac Patients, Study Finds

Even routine activities such as gardening and driving canstress the hearts of people with heart disease, according to astudy by Fresno, Calif., VA Medical Center Chief of CardiologyDr. Prakash Deedwania.

Although they may not experience pain, only slight exertionor excitement can lead to the heart being deprived of theoxygen it needs. Deedwania’s team put continuous monitorson nearly 100 patients and asked them to go about their dailylives while keeping diaries in which they recorded how they felt,what they were doing and whether they experienced any chestpain.

The monitors tracked episodes of ischemia — blockages inthe arteries that restrict blood flow and sometimes causeoccurrences of chest pain known as angina. They found thatthe activities most likely to cause ischemia included driving,housework and yardwork.

They also found that patients with angina only felt the painonce for every five episodes of ischemia. Presenting thefindings at the annual meeting of the American Heart Associa-tion, Dr. Deedwania advised heart patients not to stop exerciseor normal activities, but recognize that some routine activitiesmay stress their hearts even if they are not feeling pain. Anappropriate exercise program, he said, will eventually reduceischemia. ❑

14 VAnguard

you heardHAVE

Emergency MedicalResponse Teams from theCentral Arkansas VeteransHealthcare System and theCentral Alabama VeteransHealthcare System joinedother federal, state and localagencies participating inQUAKE ’99, an exercisedesigned to test the ability oflocal emergency responseorganizations to work withstate and federal teamsduring a large-scale urbandisaster. The exercise, whichtook place in Blytheville andLittle Rock, Ark., simulated anearthquake measuring 6.8 onthe Richter scale. Massiveexplosions, destruction ofroads and property and lackof communication wereamong the devastating effectsof the simulated disaster.

Parking is never easy, butperhaps nowhere is that moretrue than in New York City.The Brooklyn campus of theVA New York HarborHealthcare System reorga-nized its parking plan toprovide more parking forpatients, employees andvolunteers, but had to placethe new patient parking areaat the far end of facilitygrounds. To alleviate theproblem this posed to lessambulatory patients, theBrooklyn “Key” Chapter of theAmerican Ex-POWs contrib-uted $7,000 to purchase a six-passenger golf cart. The golfcart is driven by volunteerswho transport patients andemployees alike to the mainentrances and back to theircars during the day. ThePolish Legion of AmericanVeterans purchased a golfcart to deal with a similarsituation at the health care

system’s St. Albans campus.The cart transports veterans,employees and visitors fromthe front gate of the facility tothe main entrances of boththe VA Primary and ExtendedCare Center and the NewYork State Veterans Home.

VHA’s VISN 15 (KansasCity, Mo.) has takentelemedical practice to a newlevel through innovativeefforts to employ the VISTAImage Project in conjunctionwith telemedicine technology.This VISN-wide imagingtransfer capability wasdemonstrated recently by Dr.Vincent L. Alvarez, VISN 15chief medical officer, as heconsulted from his KansasCity office simultaneously witha teleradiology interpretationcenter across town and asurgeon in Topeka while allviewed the same CAT scanimages via desktop comput-ers. The VISTA ImagingProject, developed by VA,integrates medical record textwith clinical diagnosticimages, including radiologyand non-radiology digitalimages, EKGs, scanneddocuments and videoconferencing. Dr. Alvarezreports that the availability ofdiagnostic images across thenetwork “significantly raisesthe standard of care within theVISN.”

The Office of PersonnelManagement (OPM) hasauthorized a special solicita-tion for cash donations fromfederal employees who wishto help Kosovar Albanianrefugees. The specialsolicitation period runsthrough August 31. TheCombined Federal Campaign

(CFC), the government’sannual charity drive, is theonly solicitation permitted inthe federal workplace and hasbeen around since 1961.OPM may grant exceptionsthat permit fundraising outsidethe CFC, and OPM DirectorJanice R. Lachance called theexodus of refugees fromKosovo an “appropriatecircumstance” for a specialsolicitation of funds fromfederal employees. Federalemployee donations can go toany of more than 50 chari-table organizations listed onthe Web site http://www.info.usaid.gov, oremployees can call 1-800-USAIDRELIEF for moreinformation.

The Houston VA MedicalCenter is marking its 50thanniversary throughout 1999with a slate of activitiescelebrating this milestone.One recent event was therededication of the facility’schapel and its symbolicstained glass windows. Theceremony featured represen-tatives of various religiousfaiths, and honored the manyindividuals and organizationsthat donated funds to restoreone of the chapel’s mosttreasured stained glasswindows, known as the“medicine” window.

Former Major LeagueBaseball star Tug McGrawrecently visited patients at theNew York VA Medical Center,and he also signed baseballsand photos for veterans andvisitors. McGraw’s visit waspart of the third annualHeroes to Heroes NationalTour, sponsored by MCI andthe Major League BaseballAssociation to honor andremember each veteran’sservice to the nation.

The Tampa, Fla., VAMedical Center recentlydedicated a new memorial

honoring the 13 Floridanatives who have received theCongressional Medal ofHonor. Made from Arizonasandstone, the memorialholds the names of the 13men, and is situated in aspecially designed land-scaped area. Four FloridaMedal of Honor recipientsattended the dedicationceremony, which was held onMedal of Honor Day, March25.

Staff from the Washing-ton, D.C., VA RegionalOffice provided benefitsinformation and claimsassistance to family membersof victims of the embassybombings in Kenya andTanzania, as well as thefamilies of military personnelkilled in action in Somaliamore than five years ago, at arecent State Departmentmeeting. Although VA initiallyprovided benefits assistanceto the families shortly after theincidents occurred as part ofthe Casualty AssistanceProgram, family members atthe meeting were interested inobtaining additional informa-tion on a variety of benefitsprograms available tosurvivors through VA.

Thirty employees from theManila VA Regional Officeand Outpatient Clinic in thePhilippines pitched in recentlyto help former PresidentJimmy Carter and Habitat forHumanity International buildlow-income housing for thepoor. They joined Ambassa-dor Thomas Hubbard andnearly 200 mission employeesto help build four houses inParanaque, a city nearManila. Habitat for Humanityis a U.S.-based nonprofitorganization that aims toalleviate the housing problemplaguing low-income familiesof the world through volunteerwork. ❑

May 1999 15

HONORSand awards

The Centralized DirectDeposit Unit in the SupportServices Division at theMuskogee, Okla., VARegional Office received theVanguard Award from theTreasury Department’s AustinRegional Financial Center(ARFC). This award ispresented annually to anorganization that has clearlydemonstrated leadership anda high level of cooperation ina project or initiative spon-sored by the TreasuryDepartment’s FinancialManagement Service. TheMuskogee unit was recog-nized for the success of itsefforts to convert veteransbenefits payments fromchecks to direct deposits.

Nick Maske, a volunteerat the Milwaukee VA MedicalCenter, has been namedOutstanding Youth Volunteerby the Daughters of theAmerican Revolution (DAR)Service for Veteran-PatientsCommittee. Given to a youthvolunteer between the ages of16 and 21 who is serving in aVA facility, the award recog-nizes outstanding or unusualachievement in caring forveteran patients. Maske, ahigh school senior, hasvolunteered at the VAMC fortheir past four summers andduring school holidays. Hismother, Terry, is a personnelassistant at the MilwaukeeVAMC. He accepted theaward at a reception inWashington, D.C., last month.

San Joaquin Valley, Calif.,National Cemetery ForemanTroy Hulsey was selected asthe National CemeteryAdministration’s Wage Grade(WG) Employee of the Year,

and Program Assistant MariaJones was named GeneralSchedule (GS) Employee ofthe Year. John O. Barger,cemetery caretaker at theFayetteville, Ark., NationalCemetery, was named WGEmployee of the Year in theSouthern Area, and BarryWoodin, gardner/pestcontroller at the Fort Custer,Mich., National Cemetery,received the award in theNortheastern Area. Bruce A.Schaffer, cemetery represen-tative at the Fayetteville, Ark.,National Cemetery, andPauline S. Suarez, programanalyst at the Quantico, Va.,National Cemetery, are GSEmployees of the Year in theSouthern and NortheasternAreas, respectively.

The Central ArkansasVeterans Healthcare Systemreceived first place in theLarge Government Agencycategory in the nationalConsumer Protection Weekconsumer education andoutreach contest. The facilitywas recognized for designingan educational program foremployees about consumercredit and credit fraud. Theaward will be presented at thismonth’s National ConsumerLeague’s Centennial Confer-ence in Washington, D.C.

Nine nurses from the VANorth Texas Health CareSystem were named to the1999 Great One HundredNurses, sponsored by theDallas-Fort Worth HospitalCouncil. This annual recogni-tion program honors 100nurses from the Dallas-FortWorth area who have madeoutstanding contributions tothe nursing profession and the

community. Honored were:Graciela Arredondo,Gregory Brown, CherylThomas-Green, M. AllisonGreen, Vicky Haynes,Carolyn K. McElroy,Frances Phillips, JacquelonHoward-Rodgers andValerie Speller.

Patrick J. Bastow, a staffdentist at the Canandaigua,N.Y., VA Medical Center,recently received the Excel-lence in Teaching by Part-Time Clinical Faculty Awardfrom the University of Roches-ter School of Medicine andDentistry. The award waspresented to him in recogni-tion of his dedication andselfless contribution to theschool’s dental educationprograms. Bastow’s entire23-year career has beenspent at the VAMC. He alsohas been a member of theUniversity of Rochester’steaching faculty for that periodof time.

Deborah Grady, M.D.,M.P.H., staff physician at theSan Francisco VA MedicalCenter, was one of fiveUniversity of California at SanFrancisco faculty to receivethe Chancellor’s Award for theAdvancement of Women.Grady is a national leader inhormone replacement therapyand mammography screen-ing, a mentor for womenmedical students, residents,fellows and junior faculty, andan advocate for improvedaccess to health care. Shealso established San Fran-cisco VAMC’s WomenVeterans ComprehensiveHealth Center in 1993, one ofsix such VA centers in thenation.

Robert W. McCarley,M.D., deputy chief of staff formental health services at theBrockton/West Roxbury,Mass., VA Medical Center,won the 1998 William S.

Middleton Award for hisachievements in research onsleep and the neurophysiol-ogy of behavior. He acceptedthe award last month at theannual meeting of theAmerican Federation forMedical Research. Recog-nized as a leading authorityon rapid eye movement(REM) sleep, McCarley hasmade major contributions tothe understanding of sleepand dreaming. His work hashelped set the stage for newapproaches to sleep abnor-malities, including sleepdisruptions in psychiatric andother disorders.

Laura F. McNicholas,M.D., Ph.D., Philadelphia VAMedical Center’s associatedirector of education for theVA/Penn Center on Studies ofAddiction, has received theUniversity of Pennsylvania’sDean’s Award for Excellencein Clinical Teaching at anAffiliated Hospital. The awardhonors commitment tomedical education andexcellence in clinical teachingby recognizing outstandingfaculty members fromaffiliated hospitals. Asassociate director of theFellowship Program in the VA/Penn Center on Studies ofAddiction, she is in charge ofrecruiting new fellows andmanaging the program.

VISN 3 (Bronx, N.Y.)Director James J. Farsettareceived the annual NationalAward for Excellence from theAmerican HospitalAssociation’s Section forFederal Hospitals. Farsettawas recognized for leadingthe network through improve-ments in quality, outreach andaccess for veterans despitesignificant budget reductions.The award was presentedrecently at the AmericanCollege of Health CareExecutives National Confer-ence in Chicago. ❑

16 VAnguard

HEROES✩ ✩ ✩ ✩ ✩

Sometimes it pays to havea physician in the family. Dr.Warren Browner, chief ofGeneral Internal Medicine atthe San Francisco VA MedicalCenter, arrived at the airportlate one night to pick up hisfather for a family get-together. While waiting toretrieve his father’s luggage atbaggage claim, Browner sawhim collapse to the floor.Determining that his fatherwas not breathing and did nothave a pulse, Browner quicklyasked a bystander to call 911and then began CPR. Hecontinued CPR for about 10minutes until the paramedicsarrived and took his father tothe hospital, where he laterunderwent successful cardiacbypass surgery.

✩ ✩ ✩ ✩ ✩

VISN 17 (Dallas) em-ployee Willie Breland and hiswife April volunteer their timeto provide free haircutting and

grooming services to thehomeless at the Fort WorthDay Resource Center.Breland, once homelesshimself, says he recalls thepsychological boost he gotwhen someone offered him ahaircut, and he finds itrewarding to do the same forothers.

✩ ✩ ✩ ✩ ✩

Dr. James LeClair, staffdentist at the San FranciscoVA Medical Center, receiveda phone call one weekendevening from one of hispatients. The 74-year-oldveteran said he was experi-encing dizziness and difficultybreathing. LeClair urged hispatient to call 911, but thepatient worried about the cost.When the veteran told LeClairthat he was unable to drivehimself to the emergencyroom, LeClair drove to thepatient’s home and personallytook him to the emergency

Secretary of Veterans Affairs Togo D.West, Jr. received the LamplighterAward for Public Service from theBlack Leadership Forum, Inc., inrecognition of his distinguished recordof leadership. Founded 21 years ago,the Black Leadership Forum, Inc., hasbeen a leading advocate for civil rights.Secretary West accepted the award atthe group’s annual awards gala inNew York City last month. With theSecretary are, from left: formerIllinois Senator Carol Mosley-Braun;Percy E. Sutton, Esq., Inner CityBroadcasting; and Daisy M. Wood,President, National Pan-HellenicCouncil.

room. Although the veteranwas diagnosed with a seriousheart ailment, he resisted theemergency room staff’s effortsto admit him to the hospital.When the emergency roomphysician informed LeClairthat the patient would soondie if he was not admitted,LeClair intervened andconvinced the patient to beadmitted. The veteran hassince recovered, and nowcredits his dentist with savinghis life.

✩ ✩ ✩ ✩ ✩

Employees of the VABoston Healthcare Systemcame to the aid of militarypatients whose plane had tobe diverted to Boston’s LoganAirport while en route fromEurope to Bethesda NavalHospital in Maryland. Duringthe flight, a three-week-oldinfant became critically ill andthe plane had to land inBoston. While the infant wasbeing transported to a nearbychildren’s hospital, a fuel leakthat needed to be repairedwas discovered on the plane.The 27 patients on board,along with their familymembers and attendants,were transferred to either theJamaica Plain or West

Roxbury campus, where theywere admitted, lodged andcared for until they couldcontinue to theirdestination. ❑

In the article on HammerAwards in the March issue,we incorrectly identified thelocation of the CentralizedDirect Deposit Unit, winner ofa Hammer Award for increas-ing the number of depositsfrom 46 to 78 percent, as theSeattle VA Regional Office.The Centralized DirectDeposit Unit is located at theMuskogee, Okla., VA Re-gional Office, and not Seattle.

The telephone numberlisted for Dr. David Ready inthe article on virtual realitytherapy for veterans withPTSD in the March issuecontains a typographical error.Dr. Ready can be reached atthe Atlanta VAMC at (404)321-6111, ext. 7082.

We inadvertently left an“s” off of the saving bondsWeb site address we includedin the April issue. For futurereference, the correct addressis: www.savingsbonds.gov.

Corrections