VAnguard

May/June 2004 1

outlook

EMS 50th AnniversaryBurial Records on the Web

OIF Vets at the Winter Sports Clinic

Special Report: CARES

May/June 2004

EMS 50th AnniversaryBurial Records on the Web

OIF Vets at the Winter Sports Clinic

Special Report: CARES

VAnguard

2 May/June 2004

Features

Keeping It Clean 6environmental management service celebrates 50th anniversaryBurial Records on the Web 10finding the gravesites of millions of veterans is now quicker and easierOIF Veterans Hit the Slopes 1122 participate in the 18th National Disabled Veterans Winter Sports ClinicSpecial Report: CARES 12building a VA health care system for the 21st century

Departments

Letters 3 Medical Advances 29Management Matters 4 Have You Heard 30Outlook 5 Honors and Awards 31Around Headquarters 24 Heroes 32Introducing 28

On the cover“I like keeping the hospital clean for theveterans,” says Willie Griggs, 47, floortechnician at the Atlanta VA Medical Cen-ter. “I hope somebody does the same forme one day.” Griggs is one of more than11,000 Environmental Management Ser-vice employees. Photo by Ann Hamilton

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VAnguardVA’s Employee Magazine

May/June 2004

Vol. L, No. 3

Printed on 50% recycled paper

Editor: Lisa Respess

Assistant Editor: Matt Bristol

Photo Editor: Robert Turtil

Published by the Office of Public Affairs (80D)

Department of Veterans Affairs

810 Vermont Ave., N.W.

Washington, D.C. 20420

(202) 273-5746

E-mail: vanguard@mail.va.gov

www.va.gov/pubaff/vanguard/index.htm

VAnguard

May/June 2004 3

letters

We Want to Hear from YouHave a comment on something you’ve seen in VAnguard?We invite reader feedback. Send your comments tovanguard@mail.va.gov. You can also write to us at:VAnguard, Office of Public Affairs (80D), Department ofVeterans Affairs, 810 Vermont Ave., N.W., Washington,D.C., 20420, or fax your letter to (202) 273-6702. In-clude your name, title and VA facility. We may need toedit your letter for length or clarity.

President Bush visited the Baltimore VAMC with Secretary Principi on April 27 to promote computerization of patient medical records, anadvancement pioneered by VA. During a town hall meeting, the President said he has set a goal that most Americans will have electronicmedical records within the next 10 years. “I want to thank the people who work here at this hospital for the VA,” said the President, herewith VA Maryland Health Care System Director Dennis Smith. “I appreciate your care for those who have worn the nation’s uniform.”

Presidential Visit

WWII RegistryThat is a very good article onthe WWII Memorial in theMarch/April issue ofVAnguard.

Please make your readersaware of the excellent Website (www.wwiimemorial.com)maintained by the memorialcommittee. It is a very infor-mative site and has oneunique feature: one can gointo the “WWII Registry”portion of the site, establishan account, and registerknown participants in theWWII effort, veterans as wellas civilians on the home

front. There are a lot ofWWII participants still outthere who have not been rec-ognized, and this is an excel-lent way to do so.

Perry KeetonReview Appraiser

Roanoke, Va., VARO

VA Executives inAfghanistanNathan Geraths is ourbrother and we received acopy of your VAnguardmagazine from him. Thewrite-up on him being inKabul, Afghanistan (“A Callto Serve,” March/April), was

wonderful. To know we havea family member who gavetime to assist the hospitalthere is unbelievable! We areso very proud of Nathan and

all those who made a differ-ence in their lives. God blessAmerica!

Nelson and Nancy GerathsPendleton, Ore.

RICHARD MILANICH

VAnguardmanagement matters

4 May/June 2004

Practice the ‘Three Rs’ of Environmental ResponsibilityWilliam H. CampbellAssistant Secretary for Management

Conservation is an individual responsibility, but in VA itis also a management responsibility. It means savingmoney as well as saving the environment.

In April, we celebrated EarthDay here at VA Central Of-fice and at VA facilitiesaround the country. EarthDay’s purpose embodies thepast, present and future. Welook at today’s deterioratingenvironment and dwindlingresources and back to the ne-glect, ignorance and limitedknowledge of the past. Wework hard in the present tolearn from our mistakes andapply those lessons to howwe conduct our lives today.

Conservation is an indi-vidual responsibility, but inVA it is also a managementresponsibility. It means sav-ing money as well as savingthe environment. VA manag-ers must factor conservationand environmental qualityconcerns into their day-to-day responsibilities. VA hasbeen a leader in buildingconservation into new facili-ties and refitting older oneswith energy-saving systems.But in an organization withthe range of facilities, opera-tions and professions that VAencompasses, the small, ev-eryday acts of aware manag-ers and employees also addup to big savings. That’s whywe should all practice the“Three-R” managementmantra every day.

Reduce – At a nickel akilowatt hour, turning offlights pays off. Conserve wa-ter by routinely reportingdripping faucets, leaky toiletsand other water wasters. En-courage native plant land-scaping (as is done in manyof our national cemeteries) toreduce the need to water. Ad-vocate and facilitate the use

of mass transit by employees,volunteers and veterans to re-duce fuel consumption. Re-place incandescent lightbulbs with fluorescent fix-tures that use 75 percent lessenergy and last longer. Pur-chase products with lesspackaging.

Reuse – Donate out-moded or unused items tocharity. Many VA facilitieswork closely with localschools and other organiza-tions in donating old com-puters and other equipment.This is not only a worthycommunity service, it re-

duces landfill needs and theamount of toxic material thatcould eventually find its wayinto groundwater. Managersshould also consider buyingdurable rather than dispos-able products.

Recycling – Recyclingused materials and buying re-cycled products should be aroutine practice. VA healthcare facilities have long prac-ticed recycling of X-ray filmsand other diagnostic prod-ucts, and today we can all getinvolved in recycling com-mon products such as tonercartridges, batteries, glass,aluminum cans and even pa-per. And we can make surethat paper we recycle comesback again when we buy re-cycled paper products.

When it comes to the

“Three Rs,” each VA em-ployee is an environmentalmanager. We can all contrib-ute whether we superviseothers or not. But we canalso take pride in VA pro-grams that are succeeding inkeeping us in the forefront oforganizations managed withthe environment in mind.

Last year, the Office ofAsset Enterprise Manage-ment led a revitalization ofVA’s energy conservation pro-gram. Soon thereafter, the of-fice published VA Directiveand Handbook 0055, VAEnergy Conservation Pro-

gram, which provides centraloversight and regional imple-mentation of energy conser-vation programs.

The Environmental Pro-tection Agency and Depart-ment of Energy recognized18 VA medical centers in2003 with Energy StarAwards for achieving energyefficiencies in the top 25 per-cent of their peers. And inSeptember, VHA acceptedthe prestigious EPA “Hospi-tals for a Healthy Environ-ment Program” championlevel award for safe environ-mental practices includingthe reduction and disposal ofmercury.

On the benefits side, theVA Insurance Center inPhiladelphia reached a majormilestone by going 100 per-

cent paperless in processingveterans’ insurance deathclaims. The elimination ofpaper and file folders saved$2 million a year, and claimsare reaching veterans 31 per-cent faster.

NCA is in the “Three-R” game, as well. It has re-vised pest management direc-tives to help national cem-eteries minimize both envi-ronmental risk and costs.Cemetery directors continuelandscape and maintenanceprograms that minimize wa-ter use.

VA headquarters is

working to set a good ex-ample. It recycles 40 percentof its waste stream, above the35 percent federal standard,and funnels its GSA recy-cling rebate into U.S. KidsChildcare, the headquarterschild development center.

VA will also be the firstfederal agency to participatein the Biobased Benefits Sur-vey. Teams will survey allproducts purchased at threeVA facilities for one year,then suggest biobased alter-natives along with their costand performance benefits.

VA’s commitment to ourenvironment and to the fu-ture is clear. It’s the way wedo business. Each of us has arole to play, from top linemanager to individual em-ployee.

VAnguard

May/June 2004 5

outlook

Celebrating the 60th Anniversary of the GI BillDaniel L. CooperUnder Secretary for Benefits

The GI Bill was responsible for assimilating more than16 million veterans into a peacetime economy, and itssocial impact is felt yet today.

This nation just dedicated agrand World War II Memo-rial honoring the men andwomen who won the waragainst tyranny 60 years ago.This year we also celebrateanother enduring monumentto the veterans of that warthat rests at the core of thebenefits programs adminis-tered by VA.

On June 22, 1944,President Franklin D.Roosevelt signed “TheServicemen’s ReadjustmentAct,” popularly known as theGI Bill of Rights. The GIBill was responsible for as-similating more than 16 mil-lion veterans into a peace-time economy, and its socialimpact is felt yet today.

Historians hail it as oneof the greatest pieces of so-cial legislation ever. Beforethe war, college andhomeownership were prov-inces of the few.

The GI Bill providededucation andhomeownership opportuni-ties to millions. Somedubbed it the “Magic Carpetto the Middle Class,” but itwasn’t magic. It simply har-nessed the drive and energyof veterans eager to get onwith their disrupted lives.

The success of ourWorld War II veterans inmaking the most of their GIBill benefits established thevalidity and structure of theVA programs and benefits weprovide veterans today. VAeducation, home loan guar-anty, and vocational benefitsprograms have given millionsmore veterans and activeduty personnel the opportu-

nity to work hard to buildcareers, buy homes, startbusinesses, and pursue theAmerican dream.

The history of the GIBill and succeeding veteransbenefits legislation is our VAhistory. Today, the GI Billlegacy lives on as VA homeloan guaranty and educationprograms continue to workfor our newest generation ofveterans.

The current VA educa-tion benefits program isknown as the MontgomeryGI Bill (MGIB). As well asproviding benefits for thosewho are serving or haveserved on active duty, it alsoprovides VA-administerededucation benefits for mem-

bers of the Selected Reserve.More than 1.2 million veter-ans and servicemembers andhalf a million reservists havereceived VA education ben-efits under the current pro-gram.

An unprecedented vari-ety of educational experi-ences now qualify for VAeducation benefit payments.In addition to traditional col-leges and technical schools,beneficiaries can use theirbenefits for flight, correspon-dence, apprenticeship andon-the-job training, or theycan receive MGIB benefits topay for licensing and certifi-cation tests needed to reach

their vocational or profes-sional goals.

Servicemembers cansupplement their military tu-ition assistance with MGIBbenefits to cover the totalcost of tuition and fees, andif they meet Defense Depart-ment transferability criteria,they can transfer part of theirbenefits to their dependents.

Congress has helped theMGIB keep up with the es-calating cost of education byincreasing the MGIB benefitrates by more than 80 per-cent since 2002. Legislationenacted in 2000 permits anactive duty servicemember tocontribute an additionalamount, up to $600, to re-ceive a higher basic monthly

benefit. Recently passed leg-islation allows payment forentrepreneurship courses tohelp veterans learn how tooperate a franchise.

VA and Congress alsocontinue to look for ways tohelp the GI Bill benefit re-spond to the needs of ourveterans when it comes tohomeownership.

The first VA home loanwas guaranteed for a retiredWorld War II Army captainnamed Miles Meyers, whobought a home in Washing-ton, D.C., on Nov. 17,1944. Since Meyers obtainedhis loan, approximately 17.5million additional veterans

and active dutyservicemembers have takenadvantage of the program.

Based on current law,most veterans and active dutyservicemembers who wish touse their benefit can buy ahome for up to $240,000without a down payment.

Loan funds amountingto about $830 billion havebeen made available to veter-ans, the vast majority ofwhom took advantage of theunique no down paymentfeature that the VA programoffers. Last year, the pro-gram had its third highestvolume of loans in the last50 years.

The GI Bill is recog-nized by political, business,

sociocultural and educationalleaders as a landmark pieceof legislation that has con-tributed to the developmentof the United States, itspeople and its leaders for 60years. VA’s obligation is tocontinue this importantlegacy by looking for newways to meet the needs ofthis country’s veterans, re-servists and servicemembers.

Please join VA in cel-ebrating the 60th anniversaryof this historic and monu-mental bill and in remember-ing this nation’s enduringcommitment to the men andwomen who serve this greatcountry in uniform.

VAnguardcover story

6 May/June 2004

EnvironmentalManagement Serviceemployees work quietlybehind the scenes atVA medical facilities,but their contributionscannot be overstated.June 24 is the service’s50th anniversary.

Choosing the most importantjob in a VA hospital is no easytask. The answer, it seems, de-

pends on whom you ask.Front office staff would no

doubt say it’s the director. Ask theER team and they’ll likely name aphysician. The chief nurse wouldprobably pick a nurse.

Few would ever think of pickingWillie Griggs, who cleans floors atthe Atlanta VA Medical Center. Forstarters, most people never see him.He works the midnight shift whilethe rest of the world sleeps. YetGriggs and his fellow floor techni-

cians, housekeeping aids and all theemployees of Environmental Man-agement Service play a vital role inthe day-to-day operation of VAmedical facilities nationwide.

Building healthy communitieswould be tough without them.They’re the ones who empty thetrash, disinfect the bathrooms, washthe sheets and keep the bugs out.They create safe working conditionsfor employees and an appropriatehealing environment for veterans.And yes, they may be among themost valuable players in a VA hospi-tal.

Cleaning HouseOne of their most visible func-

tions is keeping the place clean.“When a veteran first comes to themedical center and it looks cleanand appealing, well, that has a lot todo with their perception of the qual-ity of care,” explained Mike Morley,director of VA’s EnvironmentalManagement Service in Washing-ton, D.C.

That concept of a sparkling first

Above: Willie Griggs, floor technician atthe Atlanta VA Medical Center.

ANN HAMILTON

KeepingKeepingIt CleanIt Clean

VAnguard

May/June 2004 7

cover story

There are 11,463 EMS employees, according to April 2004 cost accountingfigures. Here’s a breakdown of who they are and what they do.■ 8,855 EMS staff work in sanitation operations as housekeeping aids, la-borers and various other positions.■ 979 work in laundry and dry cleaning operations.■ 516 work in linen and uniform distribution.■ 395 are EMS chiefs and administrative support personnel.■ 338 work in bed services and patient assistance programs.■ 196 work in interior design operations.■ 85 work in waste management.■ 53 work in grounds management operations as painters, gardeners andmechanics.■ 46 conduct integrated pest management operations.

impression dates back to 1954, whenVA’s chief medical director, Joel T.Boone, established a distinct house-keeping division at each VA medi-cal facility. A retired Navy admiral,Boone reportedly wanted VA hospi-tals looking “shipshape,” andthought the best way to maintaincleanliness was to consolidate re-sponsibility under a single com-mand.

Hospitals require a certain typeof clean. “It’s a little more scientificthan most people might think,” saidMorley. The goal isn’t so much tomake the floors shine, but to killgerms that could cause patients andstaff to get sick.

“We are the first line of defensein preventing cross-contamination,”said Ashley Newman, a retired AirForce master sergeant who cleansthe intensive care unit at the SouthTexas Veterans Health Care Systemin San Antonio. His defense relieson heavy use of the germicide Virex256. He uses it to wipe down theobvious culprits: doorknobs, IVpoles and remote controls. But healso uses it on the nightstand draw-ers, the curtains, “anywhere peopletouch,” he said. He even uses it towipe down his cleaning cart whenhe leaves a room.

One of Lori Tyler’s defenses isthe double bucket mop technique.Tyler, a housekeeper at the SiouxFalls, S.D., VA Medical Center, usesit when cleaning the supply, process-ing and distribution room. “That’swhere they sterilize and clean surgi-cal equipment,” she explained. Thedouble bucket method involves rins-ing the mop in one bucket to washoff the dirty water, and then rinsingit again in a second bucket filledwith clean water and disinfectant.She also changes the water, mophead and even the buckets every fewrooms.

It’s not an easy job, she admits,but she likes keeping busy and en-joys interacting with fellow veterans

she meets while doing her rounds.“Most are just amazed at the cleanli-ness and friendliness from all thestaff,” she said.

Taking Out the TrashAnother EMS function is to dis-

pose of hazardous medical waste in away that is “safe for the environ-ment and community,” according toDavid Roose, EMS chief at theSioux Falls VAMC.

In the old days, hospitals wouldincinerate used needles, surgicalwaste and other trash deemed toohazardous for the local landfill. Butwho wants to breathe the smokefrom that stuff? These days, employ-ees like Jerry Bender sterilizebiohazardous material at the SiouxFalls VA facility.

Housekeeping crews collect thewaste in 44-gallon drums and wheelit down to a 6-by-9 walk-in refrig-

Donald Culwell, laundry machine operator at the Kerrville, Texas, VA Medical Center.LUPE HERNANDEZ

EMS at a Glance

VAnguardcover story

8 May/June 2004

erator out by the loading dock,where it is stored at about 45 de-grees Fahrenheit. Bender takes overfrom there. He loads the barrelsonto his truck and moves them overto an industrial sanitizing machine.“The machine starts with a vacuumcycle, then injects steam until itreaches a temperature of at least 275degrees for at least 30 minutes,” heexplained. The process takes about45 minutes. Once complete, thetrash is safe enough for the landfill.

Bender estimates that he sani-tizes about 1,500 pounds of medicalwaste a week. Not all of it comesfrom the VA hospital. He saidthey’ve partnered with city and stateagencies to sterilize biohazardouswaste from throughout the area.“Medical waste processing and han-dling is a huge program here,” saidBender. “We generate revenue forthe hospital and make it safe for thecommunity.”

Keeping the Bugs OutPest control is another job un-

der EMS. Though many VA facili-ties contract out for total pest man-agement, some find it useful to havean in-house expert to monitor thecontractors and be available onshort notice to respond to certainsituations.

David Weber serves as the in-house expert at the Washington,D.C., VA Medical Center. He saidpest control isn’t something you justpick up on the job. It’s a regulatedindustry that requires specializedtraining and state licensing. Main-taining a pest-free hospital in an ur-ban environment goes beyond spray-ing for flies or ants. You have pi-geons and various other birds thatmake a mess of public areas. Thenthere are mice and other rodents at-tracted to food sources. “There are alot of aspects to pest control,” saidWeber.

Shannon Smith faces the fullrange of potential pests at the Perry

Point VA Medical Center, a 400-acre facility located at the base ofthe Chesapeake Bay in Maryland.They range from deer and feral catsto gnats and black snakes. But herphilosophy is simple: “If they don’tbother us, then we don’t botherthem,” she said.

Most of her work involves in-spections of various wards. “You lookfor cracks and crevices, open win-

dows without screens, spills or otherfood that can attract ants,” she said,referring to the department’s inte-grated pest management policy. “It’salso just trying to teach people howto reduce pests, because it’s really ateam effort.”

Enhancing the HealingEnvironment

Creating a healing environment

CHUCK REVELL

VAnguard

May/June 2004 9

cover story

goes beyond sanitation. There’s anaesthetic element, as well. That’swhere EMS interior designers comeinto play. More than 100 interiordesigners work at VA facilities na-tionwide. Together with architects,

engineers and nurses, they bringcontinuity and aesthetic appeal toVA hospitals.

“We look at how the environ-ment affects healing,” said MichaelMcCallian, an interior designer who

works at the Louis Stokes VA Medi-cal Center in Cleveland. He de-scribed various aspects of his job,such as selecting a noise-absorbingwall covering for patient suites orpicking a glare-reducing floor finishfor nursing homes. “Studies showdesign factors contribute to how fastpatients heal,” he said.

McCallian contrasts today’ssingle or double-person suites withthe old medical bays common to VAhospitals built in the 1940s and1950s. On those wards, patients hadno privacy and few family visits. Itwas loud and they had no controlover the lighting. “No one could getany sleep, no one felt comfortable—it was just unhealthy,” McCalliansaid.

Hospital design has come a longway since then. The trend towardprivate patient rooms was part of aneffort to humanize the healing envi-ronment, according to Mary Eliza-beth Boyd, an interior designer whoretired in April after a 35-year ca-reer with VA. She said VA has oneof the largest cadres of interior de-signers in the federal government.And that’s a good thing, becausehealth care design is more than justpicking colors. “It’s enabling patientsto find peace of mind by creatingconditions that enhance their physi-cal, spiritual and mental well-being,”she explained.

Overlooking EMSEMS employees do more than

keep the hospital shipshape. Theyrun the laundry, distribute linensand uniforms, and secure the per-sonal property of hospitalized veter-ans. It’s easy sometimes to overlooktheir contributions. But running ahospital would be tough withoutthem.

By Matt Bristol

Opposite: Charlotte L. Roberson collects and secures the personal belongings of hos-pitalized veterans at the Palo Alto VA Health Care System; top: hospital design hascome a long way since the medical bays of the ’40s and ’50s; above: Barbara Odum-Newberry delivers employee uniforms at the Palo Alto VA Health Care System.

CHUCK REVELL

Editor’s note: Chris Faldt contributedto this story.

VAnguardfeature

10 May/June 2004

On April 12, the NationalCemetery Administrationbrought the Nationwide

Gravesite Locator online, making3.2 million burial records availableto the public on the Internet. Thesite received more than 100,000 vis-its during its first 48 hours of avail-ability to the public.

These records—dating to theCivil War—include burials at VA’s120 national cemeteries, some stateveterans cemeteries, and those inArlington National Cemetery after1999.

“Placing our burial recordsonline allows the public to conductgenealogy searches for family mem-

bers or friends buried at any VA na-tional cemetery,” said Joe Nosari,NCA’s chief information officer.

Jim Woods, Webmaster for the489th Bomb Group (H), was one ofthe first beneficiaries of the newonline database. He maintains a sitededicated to the history of the groupand its planes and had accurate in-formation on all crewmembers ofone B-24 bomber, Heaven CanWait, with one exception: Sgt.Edwin P. Anderson. Anderson was acrewmember aboard the plane whenit was shot down during World WarII near Groesbeck, Holland, onSept. 18, 1944. Woods used the lo-cator to find the gravesite of Sgt.

Anderson in Keokuk National Cem-etery in Iowa and is updating theaircraft’s Web page, http://mywebpages.comcast.net/halesworth,to accurately reflect Anderson’s in-formation.

The Nationwide Gravesite Lo-cator Web page is located on NCA’sWeb site at www.cem.va.gov. A linkto the page can be found on the leftcolumn of the site. The locator al-lows users to conduct simple or ad-vanced searches using specific datafields, including last name, firstname, middle name, date of birth,date of death and cemetery. For allburials matching the criteria, thesearch engine returns the full name,dates of birth, death and interment,the veteran’s rank, period andbranch of service. The name of thecemetery, its address and phonenumber, and a link to its Web siteare also included.

Before the database was putonline, NCA interment recordswere only available to the public atindividual national cemeteries or bywriting to NCA headquarters. Theseoptions are still available to thosewithout Internet access.

The database is updated daily,and maintaining the records is anongoing process. In fiscal year 2003,NCA conducted close to 90,000burials and expects to conduct evenmore in fiscal year 2004. In addi-tion, last year state veterans cem-eteries conducted more than 18,000burials and Arlington NationalCemetery conducted 6,245 burials.

Burial Records on the Web

VA’s popular new gravesite navigator makes it quicker and easier for thepublic to find the final resting places of millions of veterans.

VAnguard

May/June 2004 11

feature

Charles Bartles lost an arm to aroadside bomb in Iraq, but thehigh school boxing champion

hasn’t lost his fighting spirit.The 26-year-old Army reservist

from Yankton, S.D., was riding inthe lead Humvee returning from amission when the bomb explodedon a road just north ofBaghdad on Oct. 23, 2003.The blast nearly severed hisright arm, which was lateramputated above the elbowin surgery. Another soldierwith his civil affairs unit waskilled in the attack, and athird was wounded.

A week later, Bartles ar-rived at Walter Reed ArmyMedical Center in Washing-ton, D.C., to begin his reha-bilitation. Six months afterthat, he was skiing the RockyMountains, one of 22 Opera-tion Iraqi Freedom veteransparticipating in the 18th Na-tional Disabled VeteransWinter Sports Clinic.

Sponsored by VA and theDisabled American Veterans,and hosted by the GrandJunction, Colo., VA MedicalCenter and the Rocky Moun-tain Network (VISN 19), theWinter Sports Clinic drewsome 325 disabled veterans toSnowmass Village in Aspen,Colo., April 4-9.

The OIF veterans came from 14states; the youngest among themwas 21, and the oldest was 36. Mostlearned about the Clinic while atWalter Reed, and their participationwas made possible through financialsupport from the Town of Snowmass

and a core group of its citizens.It all began with a conversation

between Neil Camas, Snowmass Vil-lage Resort Association’s nationalsales manager, and SandyTrombetta, national director of theClinic. Camas, a longtime Clinicadvocate, has been an instructor

with the event for 12 years. The ex-medevac pilot and disabled Viet-nam veteran knows firsthand theeffects of being newly injured, andhe wanted to find a way to bringsome Operation Iraqi Freedom vet-erans to this year’s Clinic.

Camas went about it on his

Iraqi Freedom Veterans Hit the Slopes

own at first, seeking support fromthe Elks and other fraternal organi-zations. Then he teamed up withSusan Hamley, marketing and spe-cial events director for the Town ofSnowmass. Hamley helped arrange amass mailing to the community andto homeowners, many of whom live

in other parts of the country.The money soon started

pouring in, most of it fromSnowmass Village residents,local shops, the Aspen SkiingCo. (SkiCo) and AlpineBank. The totals quickly sur-passed the initial goal of$7,000-8,000 to bring a fewveterans and their spouses orsignificant others to theClinic, and eventually topped$40,000.

“I could never have imag-ined the breadth of support ofthe town,” said Hamley. “I amso proud to live in a commu-nity with such a big heart.”

Their generosity allowedOIF veterans like DavidVidana, 25, a Marine Corpsveteran from Sun Valley, Ca-lif., to experience a unique re-habilitation program that hasbeen described by some par-ticipants as “miracles on amountainside.”

Vidana triedsnowboarding for the first

time in his life at the Winter SportsClinic. “It was better than I ever ex-pected because of the atmosphereand the attentiveness from the skiinstructors,” he said. “Just being heremakes me believe that people areable to do anything, regardless oftheir disability.”

22 participate in 18th National Disabled Veterans Winter Sports Clinicin Aspen, Colorado.

David Vidana, 25, of Sun Valley, Calif.

VAnguardCARES

12 May/June 2004

The CARES DecisionA Special Report

■ Health Care for the 21st Century- Secretary of Veterans Affairs Anthony J. Principi

■ CARES Decision Highlights

■ Behind the Scenes

■ Blueprint for Tomorrow

■ An Open Book

“Never before has such a comprehensive and strategic approach been taken toVA capital asset management.”

- Secretary Principi

VAnguard

May/June 2004 13

CARES

A Health Care System for the 21st CenturyAnthony J. PrincipiSecretary of Veterans Affairs

The VA health care system now stands at a crossroadsbetween the medical care of the past and the greatpossibilities of the future.

How we care for those whoserved, those currently serv-ing, and those yet to wearour nation’s uniform defineswho we are as a society andhow seriously we take Presi-dent Abraham Lincoln’scommitment “to care for himwho shall have borne thebattle.”

The CARES Decision Iannounced on May 7 willserve as VA’s road map forbringing our health caresystem’s facilities in line withthe needs of 21st centuryveterans. This decision com-mits us to providing greateraccess to quality care closerto where more veterans live.We pledge that our facilitieswill be modern and morefunctional.

VA entered the 21stcentury with a legacy infra-structure, most of which wasdesigned and built to pro-vide medical care as it waspracticed in the middle ofthe 20th century or, in somecases, as it was practiced be-fore World War I. VA facili-ties’ average age exceeds 50years, while those of success-ful private sector health careproviders average less than 10years.

Neither medical sciencenor the veteran population isstatic and unchanging. VAhealth care must be dynamicto provide veterans the accessand quality necessary to keepfaith with them and theAmerican people.

VA must adapt to themedical progress of the lasthalf-century. Today, most pa-tients see their physicians onan outpatient basis. Mentally

ill patients are no longer con-signed to remotely located,thousand-bed asylums for theremainder of their lives.

While the practice of VAmedicine has sometimes ledthese innovations, especiallyin the area of technology,where we are the world lead-ers in clinical information,electronic health records,digital radiology, and barcode medication administra-tion, to name a few, ourphysical infrastructure hasnot kept pace. The VA healthcare system now stands at acrossroads between the medi-cal care of the past and thegreat possibilities of the fu-ture.

Over the last half-cen-tury, millions of veterans, fol-

lowing the population migra-tion patterns of the nation,have moved to the South, theWest and the Southwest. Ac-cordingly, we must updateour facilities to reflectchanges in the practice ofmedicine and demographicsof the veteran population.

CARES does that. Neverbefore has such a compre-hensive and strategic ap-proach been taken to thedepartment’s capital assetmanagement.

The CARES Commis-sion report is a well-reasonedroad map to the 21st cen-tury. My CARES decisionuses the flexibility it provides

to maximize access to andquality of medical care forveterans and minimize anydisruption for our patients,employees and communities.

On May 20, I sent toCongress a five-year con-struction management planidentifying the first of 30major projects for advancedplanning and design we planto begin designing or build-ing in 2004 and 2005 at acost of $1 billion. Projectsdesigned this year and nextare scheduled for construc-tion in 2006 and 2007. I an-ticipate that CARES will callfor additional investments ofapproximately $1 billion ayear for at least the next fiveor six years.

Overall, the CARES

plan identifies more than100 major constructionprojects in 37 states, the Dis-trict of Columbia, andPuerto Rico, and many mi-nor construction projectsthroughout our system.

CARES will dramati-cally improve access to pri-mary care, especially for vet-erans living in rural areas, by73 to 80 percent.

In 2001, VA met inpa-tient care access guidelines inonly 28 of our 77 medicalcare catchment areas. Whenthe CARES process is com-plete, we will meet that stan-dard in 73 of our catchmentareas. We will also increase

the percentage of enrolleeswithin access guidelines forcomplex inpatient tertiarycare from 94 to 97 percent.

Investment in modern-ization, as well as moneysaved by vacating obsolete orredundant space, will pay offin resources committed tomedical care for our nation’sveterans rather than formaintaining vacant or obso-lete buildings. Implementa-tion of the CARES plan willreduce vacant space in theVeterans Health Administra-tion from 8.57 millionsquare feet to slightly lessthan 5 million, a reductionof 42.5 percent. The CARESplan will reduce the cost ofmaintaining vacant spaceover the period 2006 to 2022

from an estimated $3.4 bil-lion to $750 million and al-low VA to redirect thosefunds to provide more careto more veterans.

My decision to acceptthe CARES Commission re-port makes our commitmentto veterans clear. CARES isAmerica’s investment in ourveterans’ future. It is thelegacy of a grateful nation toforever serve the health careneeds of our aging heroes,the brave young men andwomen of Operations En-during and Iraqi Freedomand those who follow in theirfootsteps for generations tocome.

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14 May/June 2004

“The CARES program is an un-precedented initiative that movesthe VA health care system into the21st century.”— VFW National CommanderEdward S. Banas Sr.

“The Capital Asset Realignmentfor Enhanced Services, or CARES,plan represents a positive firststep toward providing for thehealth care needs of today’s andtomorrow’s veterans.”— DAV National Commander AlanW. Bowers

“Delivery of health care haschanged immensely over the past50 years, and it’s been evident theVA system had to undergo somesort of transformation if it was tokeep pace with the medical needsof our veterans.”— AMVETS National CommanderS. John Sisler

“When you take a look at the be-ginning of all this, when the draftnational plan came out last sum-mer, and then as the nationalCARES Commission met and hadfield hearings, and then you lookat this final decision, you find thatstakeholder input led to manygreat changes.” — American Le-gion National Commander JohnBrieden

Veterans ServiceOrganizationLeaders Respondto the CARESDecision ■ Construction of new medical centers in Orlando, Fla., and Las Vegas,

and a replacement hospital in Denver.

■ Replacement and major expansion of the Columbus, Ohio, VA Outpa-tient Clinic.

■ New bed towers in Tampa, Fla., and San Juan, Puerto Rico.

■ Open 156 new community-based outpatient clinics by 2012, about 50 inthe next two years.

■ Expansion of the downtown VA medical center in Cleveland to providecare now delivered at the nearby older Brecksville campus. Similar consoli-dations of the medical center divisions in Pittsburgh, and between medicalcenters in Gulfport and Biloxi, Miss.

■ Realign VA care provided in Canandaigua and Montrose, N.Y.,Livermore, Calif., Knoxville, Iowa, Butler, Pa., Saginaw, Mich., Ft. Wayne,Ind., and Kerrville, Texas. VA care continues, but type of care or mix ofspecialties subject to change.

■ Potential creation of four new—and expansion of five existing—spinalcord injury centers.

■ Open two new blind rehabilitation centers.

■ Increase sharing of health care sites with the Department of Defense.

■ Develop a “Veterans Rural Access Hospital” policy to determine how tobest provide care for veterans served by small and rural VA medical cen-ters.

■ Conduct studies recommended by the CARES Commission to determinebest way to provide acute inpatient care in metropolitan New York City,Boston, Montgomery, Ala., the Muskogee/Tulsa, Okla., area, and PoplarBluff, Mo., and Big Spring, Texas.

■ Gather additional information before determining best way to ensurecare for veterans now cared for at Waco, Texas, and Walla Walla, Wash.,VA medical centers.

■ No current facility patterns of care change until VA can provide care atalternative sites of comparable quality. No veteran loses services or experi-ences gaps in care during the CARES process.

Highlights of theSecretary’s

CARES Decision

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May/June 2004 15

CARES

“VVA also wants to applaud theefforts of the CARES Commission,chaired by Everett Alvarez, whichhas done a tremendous amount ofwork to meet its mandate, particu-larly with regards to expanding‘special needs’ services forblinded veterans and veteranssuffering from spinal cord inju-ries.”— Thomas H. Corey, NationalPresident of Vietnam Veterans ofAmerica

“PVA is pleased to see that VA’sdraft national CARES plan pro-vides for a much needed expan-sion of VA’s capacity to meet thegrowing demand for [spinal cordinjury] care. The four new SCIcenters proposed by the DNCPwill strongly enhance VA’s abilityto meet this growing medical caredemand. Additionally, these fournew proposed SCI centers willgreatly reduce travel distancesand waiting times currently expe-rienced by thousands of veteranswho depend on VA for their SCIhealth care needs.”— John Bollinger, PVA Deputy Ex-ecutive Director (Oct. 7, 2003, re-sponse to draft national CARESplan)

“I want to thank so many [veter-ans service organization] leaderswho are here today. …I want toexpress my deepest thanks fortheir support over the years andtheir advocacy in working with usto ensure that we do meet ourdebt to the nation’s veterans.”— Secretary of Veterans AffairsAnthony J. Principi at his May 7announcement of the CARES de-cision

■ greater access to quality care closer to where most veterans live. No vet-eran loses health care as a result of CARES, nor will there be gaps in healthcare services.

■ a blueprint for the future. It is a 20-year plan that will be phased in overtime and integrated into strategic and capital planning.

■ expanded outpatient services and more care veterans want and use. Un-der CARES, VA plans to open more than 150 new community-based out-patient clinics by 2012.

■ quality care and access to specialty services with the potential creation offour new—and expansion of five existing—spinal cord injury centers, twonew blind rehabilitation centers, and expansions throughout VA’s healthcare system.

■ the most comprehensive and strategic approach to capital asset manage-ment—how VA spends its money—in VA history.

■ expanded services, which include hiring more health care professionalsand buying more health care equipment.

■ that savings from CARES will stay in the region where the money issaved to further enhance health care services for veterans.

■ quality medical care for returning servicemembers, including NationalGuard members and reservists, with the addition of more clinics and spe-cialized care facilities.

■ focus on long overdue seismic and other patient and employee safetyissues.

■ VA/DoD sharing for the benefit of veterans and active-duty members.

■ greater opportunity for VA to seek enhanced-use leases—partnerships be-tween VA and private-sector organizations that enhance services, while re-ducing costs to VA.

■ savings from reduced expense of maintaining old, outmoded andunderused facilities.

CARESprovides ...

VAnguardCARES

16 May/June 2004

Our health care system is get-ting a new look for the 21stcentury. It’s no “Extreme

Makeover: Home Edition,” ABC’spopular home renovation realityshow, but it is a major facelift for anorganization built on the foundationof 1940s health care.

This makeover is CARES, andits goal is to align VA health careinfrastructure with the future needsof veterans.

Behind the scenes of “ExtremeMakeover: Home Edition” is a crewof about 100 carpenters, plumbers

and electricians who work day andnight to complete a project. Thesame goes for CARES. Hundreds,maybe thousands of VA employeesfrom across the country worked be-hind the scenes developing data-driven market plans. Here,VAnguard takes a closer look at asmall group of employees who, bysome accounts, became the back-bone of CARES.

Data CollectorsSpend a few minutes at the

VISN Support Service Center Web

site, http://vssc.med.va.gov, and itsfocus is immediately clear. The cen-ter collects reports from VA facilitiesand compiles them on the Web site,showing national trends and aver-ages. Looking for information onVA patient surveys? How aboutclinic wait times or workload sum-maries? It’s all there.

The center is actually a virtualorganization of 47 employees work-

VISN Support Service Center team collected data, helped the networksand assisted the national office.

Above: Steve Jones maps VA facilitiesin geographic regions.

MARK HALL

Behind the Scenesof VA’s MakeoverBehind the Scenesof VA’s Makeover

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May/June 2004 17

CARES

ing at various facilities around thecountry. They’re kind of like a con-sulting firm for the Veterans HealthAdministration. One of their keystrengths, according to Director JoniRubin, is data collection and analy-sis, which made them a natural fitfor CARES.

When CARES started to heatup in the summer of 2002, the ser-vice center put together a team ofconsultants—economists, accoun-tants, architects, statisticians, healthspecialists and IT pros—to work theissue full time. Deputy Director JillPowers, a former VA medical centerchief engineer, got the task of assem-bling the team. She issued a job an-nouncement across VHA for 12CARES positions.

Finding the right person for theright job is never easy. But whowould want a job that required 10 or11-hour workdays, tons of travel, noweekends, no vacation, no sick days,a looming deadline and a nationalspotlight? Interest was greater thanone might expect. Powers receivedmore than 35 applications in just afew weeks. Some of the applicantswere already part of the service cen-ter operation. Others were fromVISN offices and medical centersnationwide.

Louis DeNino, who has a Ph.D.in economics and works out ofHouston, Texas, was one of the firstto make the team. He applied be-cause he saw it as a tremendous op-portunity to use his background inplanning and economics at the na-tional level. Though he knew itwould be demanding, he neverimagined just how tough it wouldget. “I don’t think any of us did,”said DeNino, who was on the roadnearly every week helping coordi-nate plans for VISNs 17 (Dallas), 18(Phoenix) and 21 (San Francisco).

Network LiaisonsEach team member was respon-

sible for supporting several net-

works. One of their first tasks was tohelp interpret workload projectiondata provided by the NationalCARES Program Office and actu-arial firm Millman, USA.

The actuaries collected massiveamounts of data from the U.S. Cen-sus and used it to project VA healthcare usage for the next 20 years.How many veterans were expectedto enroll? What services would theyneed? Where would they live? Andso on. The final report containedmore than half a terabyte of data—

that’s about 510 gigabytes.Sorting though the data was the

easy part, according to Powers. Find-ing a way to turn the workload pro-jections into square footage and costrequirements got a bit tricky. “Thiswas the hardest work I’ve ever donein my life,” she said. “It wasn’t so

Clockwise from top: the CARES teamgets down to business; Jill Powers,deputy director of the VSSC and leaderof the CARES team; Mark Hall, left, andSteve Jones at the airport, where theyspent a lot of time as members of theCARES team; the CARES consultantsspent a lot of time away from theirfamilies. Rusty Lloyd is now back withhis: daughters Ashley (left) and Audrey(right), son Ryan and wife Nelda.

JIM SCHILLER

FAMILY PHOTO

COURTESY OF JILL POWERS

COURTESY OF JILL POWERS

VAnguardCARES

18 May/June 2004

much the hours, but the mentalchallenge of making it work.”

Much of that burden was sharedby VISN planners such as A.J.“Jean” Allen, from VISN 20, basedat the Vancouver Campus of thePortland, Ore., VA Medical Center.“We had to take the data and trans-late it into what would work for ournetwork,” said Allen, who workedwith a team of representatives fromeight VA medical facilities in hernetwork. She also had the assistanceof service center liaison KarenWeidner, Ph.D., who Allen creditswith being there “every step of theway.”

One of their objectives was toidentify gaps between projectedworkload and available capacity.Those that exceeded a specificthreshold were dubbed planning ini-tiatives. Those that leapt off thecharts warranted greater scrutiny.

Network 20 had their share ofplanning initiatives. They also hadthe distinction of having the mostfacilities scheduled for realignment.“They had some real challenges,”said Weidner, who also supportednetworks 19 (Denver) and 23 (Min-neapolis). “My role was to providethe data they needed to evaluate alltheir options and make the best de-cisions.”

Allen, the VISN 20 planner,said the final evaluation became anexercise in democracy, with inputfrom veterans, employees, commu-nity groups and congressional del-egates. “A lot of people got in-volved,” she said, “and that was soimportant for our network.”

Collaborating with HeadquartersThe team also worked closely

with the National CARES ProgramOffice in Washington, D.C., wherestrategic planner Jay Halpern andstaff were responsible for developingCARES policy. He said they col-laborated extensively with the ser-vice center to ensure their policies

could be implemented at the net-work level.

“We were very heavily depen-dent on the VSSC,” Halpern said.Working together was important, heexplained, because at the end of theday, “they were the ones who had togo out and help the VISNs developtheir market plans.”

Fred Malphurs, who served as aCARES special assistant to theDeputy Secretary and now directsthe North Florida/South GeorgiaVeterans Health System, said theteam was essential to CARES, par-ticularly in getting the processstarted. “They hit the ground run-ning, and we could not have done itwithout them.”

Once the networks submittedtheir plans, Powers and her team re-turned to Central Office to help re-view them. “Each VISN had aunique situation, but we needed tokeep the process uniform across thesystem. We needed to maintain astandardized approach,” said Powers.

Now that the CARES decisionis out, the service center is gearingup to help networks implementphases of the plan. “We’re ready togo,” Powers said.

Looking BackCARES may not be an extreme

makeover. But the behind thescenes effort required extreme mea-sures. Several team members charac-terize their two-year stint as thehardest work they’ve ever done. “Ittook a lot of energy,” said Weidner.

Sometimes, it wasn’t the hoursor the mental strain, but the disrup-tion to their personal lives. DebbieP. Wheeler, a strategic planner outof Richmond, Va., who worked withnetworks 1 (Boston) and 5 (Balti-more), said one of the toughestthings was being away from her 16-year-old son for weeks at a time.

Then there was the whole issueof the media. Wheeler found herselfdefending CARES to her family on

Thanksgiving Day. “The stories inthe media made it look like we weretrying to cut back on care, and thatjust isn’t true,” she said. “Most ofCARES is growth and improve-ments. I think every hospital hasconstruction projects coming out ofthis.”

Steve Jones, an engineer fromJackson, Miss., who supportedVISNs 8 (Bay Pines, Fla.), 16 (Jack-son, Miss.) and 22 (Long Beach, Ca-lif.), made the mistake of taking afew days off during CARES andheading to the Gulf of Mexico withhis family. It didn’t take long for hiscell phone to start ringing. Heended up spending a day in thecondo’s business office while his wifeand kids waited on the beach. “Weknew there was an end in sight, sowe could cope with it,” said Jones.

In spite of the personal sacri-fices, every team member inter-viewed felt it was worth the effort.“Changing demographics, changingneeds, aging facilities. I learned somuch over these past few years,”said Mark Hall, an architect fromDurham, N.C. DeNino, the econo-mist from Houston, said regardless ofhow hard he was pushed, he neverlost sight of the goal. “We’re restruc-turing the largest health care systemin the world to increase access forveterans. That was the most impor-tant outcome. That’s what made itall worthwhile.”

Rounding out the CARES teamare: Scot Dingman, an accountantfrom Albany, N.Y.; Chip Harvey, astatistician from Cary, N.C.; PatriciaGadbaw, a planner from Atlanta;Tom Salisbury, an IT specialist fromMica, Wash.; Troy Sherrill, IT spe-cialist from Durham, N.C.; JimmieTyus Jr., a planner from Tuscaloosa,Ala.; and Rusty Lloyd, who nowworks as chief financial officer forthe VA Nebraska/Western IowaHealth Care System.

By Matt Bristol

VAnguard

May/June 2004 19

CARES

In February 2003, the CARESCommission began the mostcomprehensive evaluation of

VA’s health care system ever con-ducted, an evaluation that would re-quire the independent panel of 16chartered by the Secretary to recom-mend critical change within VA.Their mission: to assess the UnderSecretary for Health’s Draft Na-tional CARES Plan. SecretaryPrincipi wanted the group to bring

an outside perspective to what hadbeen, up to that point, a largely in-ternal process.

The Secretary charged thegroup with providing specific, impar-tial and equitable recommendationsto meet the future demand for veter-ans’ health care services. But hedidn’t want their recommendationsto be based solely on data and analy-sis. The Secretary wanted the panelto consider the concerns and views

of veterans and others who would bedirectly affected by CARES.

Finding the Right PeopleTo lead the group, Secretary

Principi looked to Everett AlvarezJr., who served as VA deputy admin-istrator from 1982 to 1986. A distin-guished naval officer and govern-ment executive, Alvarez was thefirst American aviator shot downover North Vietnam. He was held asa POW for eight and a half years.

Alvarez agreed to chair thepanel. After reviewing the back-grounds of the nine members alreadyon board, he decided to build amore diverse commission that wouldnot only have strong representationfrom VA, but from the private sectorand major veterans service organiza-tions, as well. With a group ofpeople who were experts in their re-spective fields, Alvarez believed hecould complete the task in the timegiven by the Secretary. Many mem-bers were recommended, more thanhe could select. He decided to putthe emphasis on people with strongbackgrounds in health care.

One of those was Dr. LaytonMcCurdy, dean emeritus and profes-sor of psychiatry at the MedicalUniversity of South Carolina.Though McCurdy brought a greatdeal of academic and mental healthknowledge to the commission, he’dhad little experience with VA. Serv-ing on the panel has made him oneof VA’s strongest advocates.

“Prior to joining the commis-sion I had the opportunity to con-sult with VA as a psychiatrist, andmy impression of VA was OK,” saidMcCurdy. “But because of my directinvolvement as a commissioner, Ican tell you or anyone today that Ibelieve VA is the best health caresystem in this country.”

The 16 CARES commissioners dedicatedmore than a year of their lives to anintensive review of VA’s plan to realign its1950s health care infrastructure.

A Blueprintfor TomorrowA Blueprintfor Tomorrow

WARREN PARK

Above: CARES Commission memberslisten to testimony from a panel at thepublic hearing held in Pittsburgh.

VAnguardCARES

20 May/June 2004

Recently retired, former VA un-der secretary for benefits and medi-cal center director John Vogel wasselected as commission vice-chair.According to Alvarez, Vogel’s great-est strengths were knowledge of VApolicy and understanding of themany changes VA had recently un-dertaken. Not only is Vogel a vet-eran of the system as an executive,he’s an Army veteran who activelyuses VA as his health care providerof choice. “The American peoplehave a treasure, and it’s called theVA health care system,” said Vogelof why he prefers VA.

Reviewing the PlanLed by Alvarez and Vogel, the

commission began reviewing thedraft CARES plan with the ultimategoal of enhancing services, not sav-ing money.

They developed and applied sixfactors in their review of each indi-vidual proposal in the draft plan:impact on veterans’ access to healthcare; impact on health care qual-ity; veteran and stakeholder views;economic impact on the commu-

nity; impact on VA missions andgoals; and cost to the government.

The commissioners visited 81VA and Department of Defensemedical facilities and state veteranshomes, conducted 38 public hear-ings across the country, held 10 pub-lic meetings, and analyzed morethan 212,000 comments from veter-ans, their family members and stake-holders. At the public hearings, thecommission had the opportunity tohear from approximately 770 invitedlocal speakers, including VISN lead-ership, veterans service organiza-tions, state directors of veterans af-fairs, local labor organizations, medi-cal and nursing schools, alliedhealth professional affiliates, organi-zations with collaborative relation-ships, local elected officials, sevengovernors and 135 members of Con-gress.

Change is NecessaryThrough its meetings, visits and

hearings with individual veteransand stakeholders, the commissiondeveloped an understanding of thecomplexity of the issues confronting

VA and the significance of thechanges proposed in the draftCARES plan. The commissionagreed that change was necessary toprepare the system for a new veterandemographic reality and a rapidlyevolving approach to health care de-livery, including greater reliance ontechnology and specialty services, aswell as long-term care.

Vernice D. Ferguson, former as-sistant chief medical director fornursing programs in VA and formerchief of nursing for the ClinicalCenter at the National Institutes ofHealth, said that being a part of theCARES Commission has given hera whole new perspective on VA.

“I believe people have unclearnotions about this health care deliv-ery system and I have been verygratified as a result of being on thiscommission,” said Ferguson, who re-tired from the VA system in 1992after 12 years of service as a nurseexecutive. “VA is truly one of thebest kept secrets from the wholeworld and its employees are as dedi-cated and competent as ever.”

The commission conducted itswork in progressive stages: educa-tion, information gathering, and de-liberations. The group made it a pri-ority to understand and appreciatestakeholder interests by visitingmedical facilities, interacting withveterans and staff, inviting com-ments at public hearings, and re-viewing large amounts of informa-tion.

The commissioners divided intoteams to conduct site visits andhearings and held at least one hear-ing in each of the 20 VISNs in-cluded in the draft CARES plan.The overall objectives for these sitevisits were to gain a firsthand under-standing of the physical plants andthe management of VA capital as-sets; to hear informally from localveterans and stakeholders; and toprovide information about theirrole in the CARES process.

The stakeholder panel at the Charleston, S.C., CARES Commission hearing. From left: Dr.Larry Faulkner, dean of the school of medicine at the University of South Carolina in Co-lumbia; Capt. Greg Hall, of the Charleston Naval Hospital; Dr. Raymond Greenberg, presi-dent of the Medical University of South Carolina; Carl Hawkins, director of the ColumbiaVA Regional Office; and Charleston Mayor Joseph P. Riley.

JOHN C. BAROODY

VAnguard

May/June 2004 21

CARES

The group’s work will result ingreater access to quality health care,closer to where most veterans live,for today’s returning combat veter-ans as well as those from past con-flicts. It puts more health care re-sources into outpatient facilities,which veterans want and use.

Sister Patricia Vandenberg, with CARES Commission Chairman Everett Alvarez Jr., wasone of the health care experts who brought an “outside VA” perspective to the panel.

out the dedicated men and womenof the Department of Veterans Af-fairs throughout the country and fortheir hard work we are grateful,” saidAlvarez.

“We believe the CARES pro-cess advances VA’s efforts to ensurethe continued availability of qualityhealth care for the veterans itserves,” he continued. “This is aroad map for the next 20 years, ablueprint for tomorrow.”

The CARES commissionersdedicated more than a year of theirlives to the betterment of veterans’health care. Other members were:Charles Battaglia, former staff direc-tor of the Senate Committee onVeterans Affairs; Joseph E. Binard,M.D., former VA physician and spe-cialist in spinal cord injury treat-ment; Raymond Boland, formerWisconsin secretary of veterans af-fairs and president of the NationalAssociation of State Directors ofVeterans Affairs; Chad Colley,former national commander of theDisabled American Veterans and atriple amputee from the VietnamWar;

John Kendall, M.D., deanemeritus and professor of medicineemeritus at Oregon Health and Sci-ences University; RichardMcCormick, Ph.D., former directorof mental health care, VA HealthCare System of Ohio; Richard PellJr., former VA chief of staff; RobertA. “Bob” Ray, former American Le-gion Commander in Ohio; SisterPatricia Vandenberg, former presi-dent and chief executive officer ofHoly Cross Health System in SouthBend, Ind.; Jo Ann K. Webb, R.N.,director of federal relations for theAmerican Organization of NurseExecutives; Maj. Gen. Michael K.Wyrick, former deputy surgeon gen-eral, U.S. Air Force; and AlZamberlan, former VA health careregional director.

Road Map for the Next 20 YearsThrough CARES, VA is honor-

ing its commitment to provideworld-class health care for the menand women who have served thenation in uniform.

“This commission could nothave accomplished its mission with-

Sen. Charles Schumer (D-N.Y.) presents 60,000 signatures (petitions) demanding theCanandaigua, N.Y., VA Medical Center remain open, to Charles Battaglia, who chaired thehearing held there.

ROBERT TURTIL

By Jose S. Llamas

VAnguardCARES

22 May/June 2004

When most people hear thatchange is coming, theycringe and run the other

way. But when VA launched a mas-sive effort to overhaul its health caresystem to meet the needs oftomorrow’s veterans, employees roseto the occasion and answered thechallenge.

Change of this magnitudewould require hundreds of men andwomen across the nation to devotecountless hours to complex, diligentwork to achieve what many werecalling the most comprehensiveevaluation of the VA health caresystem ever conducted.

Learning from Past ExperienceThis was not the first time in

recent years that VA had taken alook at how it was using its capitalassets. In October 2000, the depart-ment began what would become thefirst phase of CARES, an assessmentof capital assets in VISN 12 (Chi-cago) conducted by a contractor.Based on lessons learned from thatpilot study, it was clear that in PhaseII, VA needed to improve how itcommunicated with stakeholders.

They needed to be involved inan active advisory capacity in devel-oping procedures and criteria forCARES. Doing this would not onlyallow VA to receive valuable per-spectives, it would also enhance un-

derstanding of, and build support for,the CARES process.

Stakeholders included veteransservice organizations, VA employ-ees, academic affiliates, Departmentof Defense sharing partners, congres-sional delegations, veterans andtheir families.

Coordinated CommunicationsFrom the beginning of Phase II,

VA made a firm commitment toconduct a coordinated communica-tions effort to provide timely, accu-rate and consistent informationabout the purpose and process ofCARES.

The National CARES ProgramOffice, the VHA Office of Commu-nications and VA’s Office of Con-gressional and Legislative Affairsworked together to establish an en-vironment of openness and coopera-tion with established goals of in-forming, promoting and encouragingmaximum participation from stake-holders.

As a result, more than 11 mil-lion people were contacted througha variety of outreach efforts, includ-ing e-mail, brochures, mass mailings,newsletters and briefings.

The national CARES officemonitored these outreach effortsthrough a Web-based recording sys-tem that allowed representativesfrom each of the 20 VISNs to input

their daily outreach efforts; acrossthe board, each VISN made a con-certed effort to inform their stake-holders of the CARES process.

“With this Web-based program,we were able to track, on a daily ba-sis if we wanted to, all outreach ef-forts going on in the field,” saidMaryAnne Bruno, a health systemsspecialist with the national CARESoffice. “I’m very pleased with theimprovement over the original pilot,and because of this program we wereable to provide our stakeholdersmonthly reports throughout the en-tire CARES process.”

The national CARES officeheld monthly group meetings withveterans service organizations, in-cluding the American Legion, Vet-erans of Foreign Wars, Blinded Vet-erans Association, Paralyzed Veter-ans Association, Disabled AmericanVeterans, Catholic War Veterans,Vietnam Veterans of America andnumerous others to brief them onthe process and progress of CARES.

These meetings involved com-prehensive discussions of the pri-mary statistical planning model, aswell as other CARES methodolo-gies. The VSOs played a key role inrecommending numerous changesthat were incorporated into themodel and in other enhancementsto the process. Their assistance wascritical to the successful communi-

An Open Book

The unprecedented level of involvement by stakeholders in the CARESprocess became one of its hallmarks.

VAnguard

May/June 2004 23

CARES

cations effort at the local level.Thirty-seven senators and 80

members of Congress were briefedon CARES, either directly orthrough key members of their staff,in their offices.

The national CARES office andthe Office of Academic Affiliationskept the American Association ofMedical Colleges informed andhelped prepare an AAMC presiden-tial memo for distribution to deans.

A memorandum of understand-ing between VA and AFGE was de-veloped to establish local union rep-resentation on all CARES planningcommittees, and extensive effortswere made at both VA Central Of-fice and in the field to keep employ-ees informed and up-to-date.

VHA and VA’s Office of PublicAffairs jointly conducted three in-tensive training conferences on

CARES communications, attendedby VISN and facility directors,among others. The national CARESoffice also sponsored three majorconferences and seminars specifi-cally designed to provide informa-tion to stakeholders.

The VHA Office of Communi-cations coordinated a weekly na-tional conference call to discuss cur-rent issues and various outreachtechniques with more than 70 par-ticipants.

Groundbreaking ResultsThe importance VA placed on

communication was instrumental inthe overall success of the completedDraft National CARES Plan, whichwas submitted to the CARES Com-mission on Aug. 4, 2003. Stake-holder involvement in the CARESprocess became one of its defining

characteristics. In fact, some havecalled CARES one of the most openplanning processes ever conductedin the federal government.

“My father’s a veteran and Itruly believe that he and all veteranswill benefit from what we’ve accom-plished,” said Bruno. “I think overallwe did a tremendous job with com-municating to everyone involvedand I would do it again if asked todo so.”

By Jose S. Llamas

At all 38 public hearings conducted by the CARES Commission, stakeholders were invited to submit comments on site. Here, GailMihlfried, left, and Sue Williams record comments at the hearing held in Pittsburgh. Both work for the VA Pittsburgh Health Care System.

WARREN PARK

CARES on the Web

For more information on CARES, orto download related documents,go to www.va.gov/CARES.

VAnguardaround headquarters

24 May/June 2004

Presidential Management Fellows Program Builds Momentum

ROBERT TURTIL

Jessica Byrnes, a PMF at the Pittsburgh VAMC, talks about her jobwith a prospective hire at the PMF job fair in Washington, D.C.

A program to recruit some ofthe brightest graduate stu-dents from universities acrossthe country is gaining mo-mentum in VA.

Word is out that thePresidential ManagementFellows program is a topsource of high-quality candi-dates eager to join the federalworkforce. About 20 differ-ent VA headquarters andfield offices turned out forthe program’s job fair April5-7 in Washington, D.C.

“It was a record year foragency interest,” said MaxCollier, VA’s PMF coordina-tor. He said interest in theprogram has grown steadilyover the past few years, with27 fellows joining VA lastyear, up from a handful in2001.

There is no questionthat PMFs make high-caliberemployees. All are graduatestudents or doctoral candi-dates who were nominatedfor the program by the deanof their university. They aregenerally at the top of theirclass academically, and haveenough drive and ambition

to kick-start any organiza-tion.

The Office of PersonnelManagement, which runs thePMF program, gave it afacelift last year. They startedby replacing the word “In-tern” with “Fellow” in theprogram’s name. Then theyexpanded the pool of finalistsfrom 700 to 1,000 and al-lowed federal agencies tocompete from among the en-tire pool rather than limitingthe hiring to 400 positions.They also added a senior fel-lows program for mid-careergraduate students.

Several VA offices havequietly gone about recruitingand hiring presidential fel-lows. The Philadelphia VARegional Office, for example,has a long history with theprogram. VBA headquartersin Washington, D.C., re-cently got in on the act, es-tablishing a structured pro-gram with training,mentoring, individual devel-opment plans and rotationopportunities, according tocoordinator MaureenMcKenna. They needed

structure, she said, to keepup with interest in the pro-gram. VBA currently hasseven fellows working inheadquarters. McKenna saidthey could have as many aseight additional hires result-ing from the spring job fair.

Representatives from thePittsburgh and PhiladelphiaVA medical centers showedup for the job fair. Bothbrought their current cadreof presidential fellows to giveprospective hires the scoopon what working for VA isreally like.

Jessica Byrnes, a PMF atthe Pittsburgh VA MedicalCenter since August 2003,described her experienceworking for the associate di-rector. “I’ve been given lotsof hands-on opportunitiesfrom the get-go,” saidByrnes, who helped write a$190 million constructionapplication for CARES.

She used to work onCapitol Hill for Sen. Chris-topher Dodd (D-Conn.)while attending graduateschool at George WashingtonUniversity. Once acceptedinto the PMF program, shewas drawn to VA because ofher interest in health policy.It’s a decision she doesn’t re-gret. “I really want to staywith the VA here in Pitts-burgh. They’ve got a wonder-ful leadership track and havegiven me so many opportu-nities,” she said.

Management at thePittsburgh VA is equallypleased to have her on board.“She brings a high level ofacademic knowledge and ea-gerness to learn,” said thehospital’s director, Michael E.Moreland. That eagernesscarried over to the job fair,where Byrnes helped recruit

three new PMFs to Pitts-burgh and two to the ButlerVAMC.

This was the third yearin a row at the job fair forthe Philadelphia VAMC.Their first hire, ArianaFunaro, completes the two-year program in August andhas accepted a career positionat the Lyons, N.J., VA Medi-cal Center. She chose VA be-cause she wanted to experi-ence the hands-on aspect ofhealth policy, or as she put it“to be able to see the veteransI’m working for.”

The PhiladelphiaVAMC has hired eight addi-tional fellows at the past twojob fairs as part of their suc-cession planning efforts.Their educational back-grounds range from publicpolicy and health care ad-ministration to social workand psychology. But they allshare several distinguishingtraits. “They are inquisitive,energetic, enthusiastic andvery results-oriented, with astrong emphasis on customerservice,” according to thehospital’s associate director,Margaret O’Shea Caplan.

One look at the top ofVA’s health care system showshow high Presidential Man-agement Fellows can climb.Laura Miller joined VA in1978 as part of the PMFprogram. Today, she’s in thetop management circle asdeputy under secretary forhealth operations and man-agement in Washington,D.C.

In all, the job fair mayhave resulted in as many as25 new hires for various VAfacilities and headquartersstaff offices. Visit www.pmi.opm.gov for more informa-tion on the program.

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May/June 2004 25

around headquarters

Presidential Rank Awardwinners are an elite group inthe federal government. Only1 percent of the approxi-mately 7,600 career membersof the Senior Executive Ser-vice receive the DistinguishedExecutive Rank Award eachyear, and just 5 percent ofthe career SES members re-ceive the Meritorious Execu-tive RankAward.

Winners arehonored for ex-ceptional long-term accom-plishments, andare chosenthrough a rigor-ous selectionprocess. They arenominated by

their agency heads,evaluated byboards of privatecitizens, and ap-proved by thePresident. Theevaluation criteriafocus on leadershipand results.

Distinguishedrank recipients re-

ceive a lump-sumpayment of 35 per-cent of their basepay; Meritoriousrank recipients re-ceive 20 percent ofbase pay. All recipi-ents receive a framedcertificate signed bythe President.

This year, threeVA executives re-

Public service is some-thing special for VA em-ployees like Jacki Wil-son, an Army veteranwho works in the mediaservices division of VACentral Office. For her it’smore than a job, it’s per-sonal. “It’s especially im-portant since my fatherpassed away last year atthe VA hospital. Theytook good care of him. Itmakes me appreciatewhat we do even more,”she said.

Wilson was amonga group of VA employees who showed their pride in public service by volunteering tostaff the VA exhibit on the National Mall in Washington, D.C., during Public ServiceRecognition Week, May 3-9. Each had their own reasons for volunteering, but allagreed that public service means giving back to the community.

ceived the Distin-guished RankAward. They are:James F. Farsetta,director, VISN 3(Bronx, N.Y.);ThomasLastowka, direc-tor, PhiladelphiaVA Re-gional Of-

fice & Insurance Cen-ter; and Laura Miller,assistant deputy undersecretary for health,VA Central Office.

Twenty VA ex-ecutives received theMeritorious RankAward. They are: Ri-chard J. Baltz, direc-tor, Jackson, Miss., VA Medi-cal Center; Sheila M. Cullen,

Executives Join Elite Group of Presidential Rank Award Winners

Showing Pride in Public Service on the Mall

director, San Francisco VAMedical Center; JohnDandridge Jr., director,VISN 9 (Nashville, Tenn.);Jim W. Delgado, director,Voluntary Service Office, VACentral Office; Robert J.Epley, VBA associate deputyunder secretary for policy

and programs,VA CentralOffice; Will-iam F. Feeley,director, VISN2 (Albany,N.Y.); NathanL. Geraths, di-rector, Madi-son, Wis., VAMedical Cen-ter; Brian

Heckert, director, Columbia,S.C., VA Medical Center;Ronald J. Henke, director,compensation & pension ser-vice, VA Central Office;Maureen Humphrys, direc-tor, Sheridan, Wyo., VAMedical Center;

Barry Jackson, formerdirector, New Orleans VARegional Office; John W.Klein, assistant general coun-sel, VA Central Office;Carlos B. Lott Jr., director,Cincinnati VA Medical Cen-ter; John Montgomery, direc-tor, Winston-Salem, N.C.,VA Regional Office; JamesW. Roseborough, director,Ann Arbor, Mich., VA Medi-cal Center;

Gary J. Rossio, director,San Diego VA Medical Cen-ter; Charleen R. Szabo, direc-tor, VISN 4 (Pittsburgh,Pa.); Linda F. Watson, direc-tor, VISN 7 (Atlanta); JamesA. Whitson, director, VBAEastern Area, Ann Arbor,Mich.; and Thomas J. Will-iams, assistant inspector gen-eral for investigations, VACentral Office.

VA employees staffed an exhibit during Public Service Recogni-tion Week.

ROBERT TURTIL

Farsetta

Lastowka

Miller

VAnguardaround headquarters

26 May/June 2004

Some 250 D.C.-area VA employees participated in the Walk toCure Diabetes, benefiting the Juvenile Diabetes ResearchFoundation, on May 16 in downtown Washington. Fifteen teamcaptains from throughout VA Central Office, the Washington,D.C., VA Medical Center and VA Regional Office recruited walk-ers for VA’s team. According to organizers, the VA team, Veter-ans for a Cure, had the largest turnout at the walk and raisedthousands of dollars for diabetes research.

Secretary Principi served as honorary chairperson for the event. He gave opening remarks (right) and led thecrowd in warm-ups, kicking off the 3.1-mile walk around the city. The D.C. VA Medical Center also staffed a diabetesinformation table at the event.

About 4,000 walkers participated in the D.C. event. The walkathon is held in more than 200 locations throughoutthe year. Nationally, more than 400,000 people participate.

VA Central Office kicked offits Earth Day celebrations onApril 14 with a program fea-turing speakers, musical en-tertainment, an award cer-emony and an Earth-friendlyproducts expo.

“The responsibility toprotect and preserve our en-vironment belongs to everyone of us,” said WilliamCampbell, VA’s Assistant Sec-retary for Management.“We’ve come a long waythrough pollution preven-tion, reduction efforts, recy-cling, and by purchasing en-vironmentally friendly prod-ucts. There is much morethat we need to do on behalfof our children and grand-children. And now that I’m agrandfather, it means a lotmore to me. You look at thefuture and say you’d like toleave it better for them thanyou found it.”

Campbell highlightedVA’s environmental effortsand successes over the pastyear and offered suggestions

on conservation efforts athome and in the office. Henoted that the recycling ofbottles, cans and newspapersin VACO subsidized U.S.Kids Childcare, nettingabout $3,800 in the firstquarter of 2004.

To illustrate Campbell’spoint, “The Butterflies,”youngsters from the childdevelopment center, offeredmusical entertainment, sing-ing, “It’s a Small World.”

The VA EnvironmentalExcellence Award was pre-sented to a VHA-Environ-mental Protection Agencyteam that initiated two inno-vative programs in the cat-egory of “Outreach and Edu-cation.” They involved me-dia-based environmentalcompliance training for se-nior managers and voluntaryenvironmental managementreviews.

Awards were presentedto VA’s Arnold Bierenbaum,Linda Martin, Jack Staudtand Marilyn Waggoner, and

to EPA’s Diane Lynne andGreg Snyder.

The final speaker wasDan Manternach of theBiobased Manufacturers As-sociation (BMA).Manternach praised VA’scommitment to a healthy en-vironment for agreeing to bethe first federal agency toparticipate in the BiobasedBenefits Survey. Teams will

survey all product purchasesat three VA facilities for oneyear. BMA will then suggestbiobased alternatives, show-ing the cost and performancebenefits of those productsand directing VA to sourcesfor product purchases.

The program concludedwith a vendor fair promotingthe purchase of environmen-tally friendly products.

VA Team Walks to RaiseThousands for Diabetes

Earth Day Observance Features Award Presentations, Expo

ROBERT TURTIL

Dan Manternach, of the Biobased Manufacturers Association, an-swers questions from VA purchase card holders at the vendor expo.

PRISCILLA KATES

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May/June 2004 27

around headquarters

All the good programs in theworld don’t mean a thingwithout good people. Thesaying applies to most orga-nizations, but is particularlyfitting for one dedicated tohealing the wounds of war.

Deputy Secretary Gor-don Mansfield paid tributeto some very good peopleduring the Secretary’s 2004Excellence in NursingAwards held May 10 in VACentral Office. “You serve astowering examples. You senda powerful message to veter-ans and their loved ones—that you care. Thank you forall you have done,” he said.

As a child, award recipi-ent Helen Noel, Ph.D.,dreamed of becoming anurse. Today she is an ad-vanced practice nurse at theWest Haven Campus of theVA Connecticut Health CareSystem and faculty memberat Sacred Heart and YaleUniversities.

Noel was honored forher role in implementing ahome telehealth program to

improve access and quality ofcare for high-risk patientsand those who can’t get tothe hospital. “Everything I’vedone has come from theheart,” she said. “It’s justoverwhelming to be recog-nized like this.”

From his signaturegreeting, “How can I helpyou, my friend?” to his can-do attitude, Philip Cotroneohas made a positive impres-sion on veterans and staff atthe Lebanon, Pa., VA Medi-cal Center. A retired AirForce sergeant, he joined theVA as a licensed practicalnurse in April 2001.

His boss knew he wasspecial from the start. Intheir first encounter, shewatched as he moved a mor-bidly obese paraplegic patientusing an assistive device thatothers said wouldn’t work.“Mr. Cotroneo spoke to thepatient in such a respectfulmanner that it brought tearsto my eyes,” wrote nursemanager Susan M. Brown,R.N., who nominated

Cotroneo for the award.Cotroneo was “a little embar-rassed” at being singled outfor a national honor. “Thereare a lot of good people atthe Lebanon VA. We aresuch a cohesive team,” hesaid.

Good people stand outin a crowd. Nursing assistantDebra Warren is no excep-tion. Many of her patients inthe hospice unit at the Day-ton, Ohio, VA Medical Cen-ter have special needs, soWarren tailors her care tomeet them. “It’s the littlethings you do that make adifference,” she said.

She crochets bed blan-kets for patients and says she

Nurse Awards: Paying Tribute to Some Heroes of Healing

VA InspectorGeneral RichardGriffin (left) re-ceived an honor-ary degree fromnorthernVirginia’sMarymount Uni-versity duringMay commence-ment ceremo-nies in Washing-ton, D.C., alongwith noted political commentator Mark Shields (secondfrom right).

Dr. James Bundschuh, Marymount president (sec-ond from left), cited Griffin, a 1984 Marymount MBAgraduate, for a distinguished career in public service withthe Secret Service and VA. Griffin asked the commence-ment audience to remember the words of WinstonChurchill, “We make a living by what we get; we make alife by what we give.” At right is Barry Fitzgerald, chair-man of Marymount’s Board of Trustees.

will continue until each hasone. During the holidays, shesang Christmas carols at theirbedsides. One patient whocan no longer speak or openhis eyes was moved to tearsby her soothing voice. “Itcalms them and lifts theirspirits,” said Warren, whohas worked at the DaytonVA since 2000.

Missing from the cer-emony was award recipientMary Withers, R.N., fromthe Central Texas VeteransHealth Care System in Waco,who gave birth to a baby girlon May 16. Nurse executiveKathleen Waters representedWithers at the ceremony.

Recipients of the 2004 Excellence in Nursing Awards with DeputySecretary Gordon Mansfield, center, and Chief Nurse Cathy Rick,R.N., far right. They are, left to right: Sandra K. Janzen, R.N.,Kathleen Waters (representing Mary Withers, R.N.), Debra Warren,George H. Gray Jr., Helen Noel, Ph.D., and Philip Cotroneo.

MICHAEL L. MOORE

IG Honored by Alma Mater

continued on page 28

VAnguardintroducing

28 May/June 2004

John Loosen

On Dec. 29, 1967, JohnLoosen lost his left leg to amortar round while servingwith the 101st Airborne Di-vision in Vietnam. Ninemonths after his injury,Loosen was at St. John’s Uni-versity in New York City,earning a degree in manage-ment. He graduated in 1971and went to work with theDisabled American Veteransas a national service officer.

Loosen joined VA as aveterans benefits officer atthe New York OutpatientClinic in 1975. He believedthe transition from DAV toVBA made him ideally suitedto serve veterans. While withDAV, he learned what dis-abled veterans were eligiblefor; at VBA, he was able todeliver those benefits.

Loosen often workedwith staff at the New Yorkprosthetics clinic, helpingveterans access services andhaving his own artificial legadjusted. Clinic personnelsuggested he put his personalexperience with prostheticsto good use by coming towork at the clinic. In 1978,he did just that.

He started out as a staffprosthetics representative,doing administrative work,providing equipment to pa-tients, assisting or coordinat-ing amputee, wheelchair andorthotic clinics, and manag-

ing automobile adaptiveequipment programs.

Loosen became the chiefof prosthetics service at theBrooklyn and St. Albans fa-cilities in 1982. He contin-ued seeing patients, but nowhe managed the clinic, super-vising a staff of seven.

In 1988 he accepted thechief ’s position at the Man-hattan VA Medical Center.Loosen managed the Pros-thetic Treatment Center,which incorporated prosthet-ics service, the prosthetic andorthotic laboratory, the resto-ration lab and the NationalFootwear Center, which pro-vided orthotic footwear forthe entire VA.

It was a huge leap in re-sponsibility, from a typicaltwo-person lab doing minoradjustment work to a staff of35 involved with completefabrications, distribution,and research and develop-ment. With this expertise, hewas often called upon totroubleshoot problems atnearby VA prosthetic facili-ties.

“We decided that in-stead of going up to theseother facilities all the time,why don’t we make thoseprosthetic services part ofNew York,” Loosen recalled.This was the first step inwhat he envisioned as an “in-tegrated prosthetics service.”

With the support ofManhattan VA MedicalCenter’s then-directorSanford M. Garfunkel, cre-ation of the VISN 3 Pros-thetics Network began in1996 and was completed twoyears later. It involvedmonths of negotiation be-tween management andunions at each facility.Loosen has since served asVISN 3 prosthetics chief. His60 employees at nine facili-ties in lower New York stateand New Jersey now serveapproximately 150,000 veter-ans a year.

The impact of this neworganization was profound—it increased the uniformity ofbenefits and continuity inthe quality of service pro-vided to veterans, with lesspolitical infighting and com-petition between facilities.Integration of VISN 3 pros-thetics became a model forthe rest of VA’s prostheticsservices, and reorganizationefforts throughout VA soonbegan. Final integration ofprosthetics clinics withinVISNs was completed in2002.

Loosen has been travel-ing throughout the country,meeting with soldiers whohave sustained major injuriesin Afghanistan and Iraq, andguiding them as they re-entercivilian life. But now he has

the added mission of recruit-ing others who can move be-yond their injuries to help anew generation of disabledveterans rebuild their lives.

He and others in pros-thetics service have been in-volved in a nationwide searchto bring 12 new faces intoVA’s prosthetics representa-tive ranks through its Pros-thetics Intern Program, a rig-orous two-year internship ad-ministered by the EmployeeEducation System and Tech-nical Career Field TrainingProgram.

John Loosen’s career wasborn of his own tragic expe-rience in Vietnam. Thirty-seven years later, after help-ing thousands of veteransovercome their disabilities, heis helping fill the needs ofthe newest generation of vet-erans who have lost limbs inservice to their country.By Robert Turtil

Loosen

“She’s not only compassion-ate and caring, but has awonderful mind for prob-lem-solving and research,”she said of Withers.

The award program also

recognizes health care execu-tives who advance nursingprograms. This year’s recipi-ents are George H. Gray Jr.,director of the Central Ar-kansas Veterans Healthcare

System in Little Rock, andSandra K. Janzen, R.N., asso-ciate chief of staff for nursingservice at the James A. HaleyVeterans Hospital in Tampa.For Gray and Janzen, nurses

are more than good people.They’re the backbone of VA.“I need their input whenmaking decisions,” said Gray,“because they are on thefront lines of health care.”

Nurses continued from p. 27

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May/June 2004 29

medical advances

The Skinny onLow-Carb DietsSeveral VA studies haveweighed in on the low-carbdiet craze. The findings aregenerally consistent withwhat most carb-counters willtell you: they lost weight andthey lost it fast. Which raisesthe question, is it the caloriesor the carbs that make us fat?

Last year researchers atthe Philadelphia VA MedicalCenter found obese patientswho followed diets low incarbohydrates lost slightlymore weight than those on alow-fat, calorie-restricted re-gime. Their findings werepublished in the May 2003issue of the New EnglandJournal of Medicine.

More recently, Peoplemagazine ran a Q&A withthe study’s lead author, LindaStern, M.D., in the May 31issue. In it, Stern touts someunexpected findings from thestudy. Not only did the low-carb dieters lose weight faster

than the low-calorie bunch,they also had lower levels oftriglycerides, the bad fats,and higher levels of HDL,good fats.

Stern also used the op-portunity to inject a littleperspective into the low-carbfrenzy. “There’s probably noperfect diet that’s going to fiteveryone. … A problem withour American diet is we eattoo much of everything. …The bottom line is, to loseweight we need to eat lessfood,” Stern told People.

Counting calories ismore important than watch-ing carbs, argued Lisa Dovey,a registered dietitian with theIndianapolis VA MedicalCenter, in the hospital’s em-ployee newsletter This &That. If the answer to losingweight were a low-carbohy-drate diet, weight manage-ment would have beenachieved in the 1970s whenthese diets were first intro-duced, she wrote.

Dovey warned there isno legal definition for claimsof low-carbohydrate foodmanufacturers. What is a netcarb, anyway? She pointedout that food science expertsstill rely on the total carbo-hydrate gram as a unit ofmeasurement, not the netcarb, which manufacturershave begun listing. “Weightmanagement is still a balanceof calories eaten versus thecalories burned. To loseweight this balance has to betipped toward the caloriesburned side. … Moderationis the key to healthy living,”concluded Dovey.

Laparoscopic HerniaSurgery Carries Risk forRecurrenceLife is full of tough choices.Some of the toughest arethose that affect your healthand well-being. For patients

seeking groin hernia surgery,a major decision just gottougher.

Researchers comparingrecurrence rates for groinhernia surgery patients foundthose who opted for the lesspainful laparoscopic proce-dure had double the risk forrecurrence of those who wentwith the tried and true openincision. The laparoscopicprocedure requires severaltiny incisions instead of onelong one, meaning less painand shorter recovery time.

The study findings werepublished in the April 29 is-sue of the New England Jour-nal of Medicine. Theyprompted lead researcherLeigh Neumayer, M.D., ofthe Salt Lake City VA Medi-cal Center and University ofUtah, to recommend thatfirst-timers go with the openrepair. “Men with a herniathat has never been repairedbefore should undergo anopen repair,” she said.

One exception to thefindings was if the surgeonhad extensive experience per-forming laparoscopic herniarepairs—more than 250 pro-cedures. They had about thesame recurrence rate as theopen incision group.

The study involvedtracking the success rates for1,696 male hernia patients at14 VA medical centers.About 700,000 Americansget hernia repairs each year.VA surgeons perform about10,000 hernia repairs annu-ally.

When to StopMammograms and PapSmears?Pap smears andmammograms are on the riseamong elderly women. Butare they really necessary? Notif you’re over age 70 and inpoor health, according to a

study conducted by research-ers at the San Francisco VAMedical Center.

The problem is thatthere are no clear guidelinesfor when to stop thesescreenings. But commonsense dictates that elderlywomen with life expectanciesof less than five years don’tneed Pap smears andmammograms. The moneyspent on these procedurescould be used to screen high-risk younger and middle-aged women who could actu-ally benefit from early detec-tion.

San Francisco VAMCresearchers analyzed datafrom 4,792 women age 70 orolder who took part in the2001 California Health In-terview Survey. The womenrated their overall health andfunctioning using a standardscale. The researchers foundwomen with the worst healthindicators continued to getscreened as much or morethan those considered thehealthiest.

The socioeconomic im-pact of over-screening is sig-nificant. A separate DukeUniversity study released in2003 estimated the cost ofPap smears andmammograms for womenover age 70 at more than$500 million annually.

“The good news is thatthe rates of screening mam-mography and Pap smearshave really increased inhealthy older women,” saidlead researcher Louise Walter,M.D., of the San FranciscoVAMC. “The problem isthat there is still a populationof very healthy older womenwho are not being screenedwho should be. And there’s apopulation of very sick eld-erly women who are gettingscreened when theyshouldn’t.”

ROBERT TURTIL

Is it the calories or the carbs that make usfat? VA experts weigh in on the debate.

VAnguardhave you heard

30 May/June 2004

Reaching out to OIF veterans

Help for nurses in Iraq

The Washington, D.C.,VA Medical Center held itsfirst Veterans Memorial GolfClassic on May 14 atAndrews Air Force Base justoutside Washington, D.C.The maiden tournament in-cluded 25 teams and morethan 20 sponsors who madeboth monetary and in-kinddonations. In all, they raisedabout $7,000 to support vet-erans through medical centergeneral post funds.

More than 200 formerprisoners of war attended theannual recognition luncheonApril 7 at the Dallas VAMedical Center. Retired AirForce Col. Kenneth Cordier,who was held captive formore than six years in NorthVietnam, served as master of

ceremonies. H. Ross Perotdelivered the keynote ad-dress. Perot first lobbied forthe release of AmericanPOWs in Vietnam in 1969.

A survey released April20 by the Industry AdvisoryCouncil E-governmentShared Interest Groupranked VA as one of eightgold standards in the federalgovernment for protectingthe privacy of medical pa-tients and benefits recipients.VA best practices include aninter-disciplinary privacycouncil, outreach to employ-ees, and ongoing training ini-tiatives. More than 200,000VA employees have com-pleted Web-based privacytraining, according to Bar-bara Symonds, director of

Nurses from the Battle Creek, Mich., VA Medical Cen-ter sent journals and textbooks to the public health teamof the 352nd Civil Affairs command as part of an effort toimprove training for nurses in Iraq. Together withKalamazoo Valley Community College and Western Michi-gan University’s Bronson School of Nursing, they shippedabout 700 pounds of materials to Iraq.

privacy service in the Officeof Information and Technol-ogy in VA Central Office.

For the fifth year in arow, VA’s annual perfor-mance report was rated oneof the top three in the federalgovernment by the MercatusCenter, an independent re-search arm of George MasonUniversity in Virginia. VA’sperformance report waspraised for linking perfor-mance measures to goals, ad-dressing major managementchallenges, and being easy toread. Check out the reporton the Internet atwww.va.gov/budget/report.

About 70 Central Ar-kansas Veterans HealthcareSystem employees and theirfamily members participatedin the United Way “Day ofCaring” April 17. They spentthe morning sprucing up

Jefferson Elementary Schoolin Little Rock by buildingand replanting flower gar-dens, trimming shrubs, andsodding and fencing an areato add an outdoor “Kinder-Garden” for teachers. Ac-cording to United Way, theywere the largest group to par-ticipate in this year’s event.

A new Fisher House iscoming to the Houston VAMedical Center.Groundbreaking for the new21-suite facility began inJanuary. This will be the sev-enth Fisher House donatedto VA by the Fisher HouseFoundation. The homes areused by families of veteransbeing treated at VA medicalfacilities for unexpected orlong-term illnesses. They arebuilt with private funds andthen turned over to VA tomanage and maintain.

Outreach to Iraqi Freedom veterans was the goal of theMilitary Appreciation and Resource Fair held April 17 atthe Armed Forces Reserve Center in Fargo, N.D. DavidGarland, business office manager at the Fargo VA Medi-cal Center, was among those who participated in theevent. Here, he explains medical benefits to Brett Gentile,a member of the 142nd Engineer Combat Battalion, whichreturned from a one-year tour in Iraq in early March.

Nurses (from left) Rebecca Garcia, Phillip Camera, RaeJones-Peters and Wendy Hamlin prepare to pack booksand journals collected to assist the nursing effort in Iraq.

TODD M. GREENMAN

MARGARET WHEELDEN

VAnguard honors and awards

May/June 2004 31

Nurse excellence in Salem

Alabama’s health care heroes

Margaret C.Hammond, M.D., chief ofspinal cord injury service atthe VA Puget Sound HealthCare System and professor ofrehabilitation medicine at theUniversity of Washington, re-ceived the 2004 A. EstinComarr Memorial award forDistinguished Clinical Ser-vice from the AmericanParaplegia Society.

Paul Brown, R.N., andNancy Thomas, Ph.D., ofthe Central Arkansas Veter-ans Healthcare System, re-ceived the 2004 Golden PenAward from the AmericanAssociation of OccupationalHealth Nursing for their ar-ticle “Exploring VariablesAmong Medical Center Em-ployees with Injuries.” Pub-lished in the association’sjournal in November 2003,the article highlights their re-search into the causes andprevention of workplace in-juries.

Donna Richardson, adietetic technician at theMichael E. DeBakey VAMedical Center in Houston,was named Registered Di-etetic Technician of the Yearfor 2004 for the state ofTexas. She received the awardduring the Texas DieteticAssociation’s annual confer-ence in Dallas on April 2.Richardson has been at themedical center for four yearsand works with spinal cordand mental health patients.

Dr. Margaret M.Baumann, associate chief ofstaff for geriatrics and ex-tended care at the Hines VAHospital near Chicago, wasone of five national recipientsof AMVETS’ “Silver Hel-met” award. She was recog-nized for her efforts in devel-oping new treatment and re-habilitation programs thathelp veterans return to pro-ductive lives. The award, a

unique silver replica of theWorld War II GI helmet, isone of the most prestigiousawards given by veterans or-ganizations and is known asthe “Veterans Oscar.”

The Massachusetts StateCouncil Knights of Colum-bus presented their 2004Lantern Award to PhilipSalois, chief chaplain for theVA Boston Healthcare Sys-tem. A decorated Vietnamveteran, Salois is founder andpresident of the NationalConference of Viet Nam Vet-eran Ministers and serves asnational chaplain to the Viet-nam Veterans of America.

Gary Bryson, a psy-chologist at the West HavenCampus of the VA Con-necticut Health Care Sys-tem, and David E.Cummings, M.D., a re-searcher at the VA PugetSound Health Care System,received Presidential EarlyCareer Awards for Scientistsand Engineers during aWhite House ceremony May4. It is the highest honor be-stowed by the U.S. govern-ment to professionals at theoutset of their research ca-reers.

Stephen A. Fausti,Ph.D., received theMagnuson Award, VA’s high-est award for rehabilitationinvestigators, in March at thenational meeting of theAmerican Academy of Audi-ology in Salt Lake City.Fausti directs VA’s NationalCenter for Rehabilitative Au-ditory Research at the Port-land VA Medical Center andis a professor at OregonHealth and Science Univer-sity.

The Electronic Pay-ments Association presentedthe 2004 Kevin O’Brien Au-tomated Clearing HouseQuality Award to the VHAChief Business Office for its

e-Payments Project (Third-Party EDI Lockbox). Theaward “recognizes VA’s pio-neering role in electronicpayment transactions,” ac-cording to Acting ChiefBusiness Officer KennethRuyle. Released in October2003 and deployed through-out VHA, e-Payments systemuses an automated clearing-house to receive paymentsand route them to recipients.For information, visitvaww1.va.gov/cbo and clickon Events, Highlights &Other News.

Dr. Frances Selsnick, asurgeon at the VA Sierra Ne-vada Health Care System inReno, was elected to mem-

bership of The Order of Dis-tinction for The Interna-tional Biographical Centre ofCambridge, England. Thishonor is limited to 400 per-sons worldwide and only onein 60 men and women con-sidered actually receive thecoveted invitation.

Keith B. Pierce, patientadvocate at the Washington,D.C., VA Medical Center,was elected to serve on the2004 board of directors forthe Society for HealthcareConsumer Advocacy, one of12 personal membershipgroups of the American Hos-pital Association. Pierce hasbeen a member of the societyfor 10 years.

Central Alabama Veterans Health Care System employ-ees Stacey Searcy, R.N., and Mark McGuire, an optom-etrist, were selected as two of 10 “Health Care Heroes”across Alabama in a competition sponsored by the Ala-bama Hospital Association. The two were honored at aluncheon held at the Alabama Activity Center in Mont-gomery May 12.

“I am extremely proud of these two employees forhelping show everyone how great our employees are,”said acting director Lea Wiggins. “Although we havebright and talented folks working here, you would behard-pressed to find two people more deserving of rec-ognition than Stacey and Mark.”

DAMON A. STEVENSON

VAnguardheroes

32 May/June 2004

Robber stopped in his tracks

Heidi Deeter, a veteransservice representative at theCleveland, Ohio, VA Re-gional Office, was screeningcases when she heard a coughand gagging noises. Shelooked across the cubicle tosee program support clerkBonnie Zinner in respiratorydistress. Deeter called out forhelp to Jim Swartz, a ratingspecialist with a nursingbackground. He performedthe Heimlich maneuver, andwith one attempt, dislodgedthe obstruction so Zinnercould breathe normally.

While driving to workon April 14, Debra Watkins,nurse manager for the ICUat the Dayton, Ohio, VAMedical Center, came uponan accident involving awoman who was trapped in aburning pickup truck.Watkins, along with anotherpasserby, quickly pulled thevictim from the vehicle. Lo-cal firefighters later said thatWatkins’s actions probablysaved the accident victim’slife. “People at the scene weregiving me updates on whatpart of the truck was blowing

Fabian Santos, canteen service chief with the VA GulfCoast Veterans Health Care System, interrupted acrime in progress at the retail store’s Gulfport, Miss.,division in early March. Hearing the screams of co-worker Sherry Branscum, Santos pursued the suspectto his getaway vehicle. Santos then called VA police,who immediately contacted city and county law en-forcement. Authorities apprehended the suspect, at-tributing the successful arrest to the quick response ofthe VA employees.

Investigators in two counties compared notes ofsimilar crimes and the suspect was subsequentlycharged with robberies in five Gulf Coast cities over atwo-month period. “We are just thankful he was notarmed,” said Branscum. “Things could have gone a lotworse.”

Denise Brown is a Disabled American Veterans volun-teer who makes the rounds serving coffee at the DornVA Medical Center in Columbia, S.C. On April 1, shewas collecting donations at the Fort Jackson Post Ex-change when she heard screams of “He’s choking!”Although she suffers from severe arthritis, Brown hur-ried toward the commo-tion and saw a womantrying to perform theHeimlich maneuver onher 27-month-old grand-son.

Brown, a veteranand former first-aidtrainer, realized that themaneuver was not beingdone properly for such asmall child, who was nowunconscious and notbreathing. Although it hadbeen many years, hermedical training kicked in.She began mouth-to-mouth resuscitation. “It didn’twork the first time,” she told the base newspaper,“but by the second time I tried, he started to cry.”Brown thought she was lucky that she was able tomove so well during the crisis, despite her debilitatingarthritis. Bystanders thought the boy, a relative of agraduating soldier-in-training, was the lucky one.

‘Coffee lady’ rescues child

up as I worked on the in-jured woman,” Watkins saidlater. A true hero and a dedi-cated VA employee, Watkinswent back home to changeclothes and then came towork.

Debbie Mason, clerk atthe Ukiah, Calif., Commu-nity-Based OutpatientClinic, was driving with hermother in hazardous, rainyconditions. They watched inhorror as a motorcyclist whohad just passed them misseda curve in the road ahead.The rider fell to the edge ofthe road as his bike sped

straight over the cliff. Masonpulled over to help, using her10 years of experience as amedic to perform a physicalassessment of the injuredman. While trying to keephim calm, Mason discoveredthat he was a veteran whohad been on the road for adangerously long period oftime without rest. Soon, anofficial with the CaliforniaDepartment of Forestry camealong and called 911 for anambulance and police. Ma-son later stopped by the hos-pital to check in on the in-jured veteran.Santos and Branscum

GARY MODICK

Brown

FORT JACKSON PHOTO