January 1998 1Inside: Salute Chair, 6 ✩ Pay for Applied Skills, 7 ✩ Togo West Nominated, 12

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2 VAnguard

Published by the Office of Public Affairs (80D)

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

(202) 273-5738/57357d000jka@mail.va.gov

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VAnguard VA’s Employee Magazine

January 1998 Vol. XLIV, No. 1

Printed on 50% recycled paper

Editor: Laurie TranterGraphics: Michael Nacincik

❏ Medical Advances 9

❏ Honors and Awards 10

❏ Have You Heard 11

❏ Heroes 12

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On The Cover:VA’s “What’s New” page

at http://www.va.gov/whnew_va.htm

INTRODUCINGVivian Higgins

❏ Centers of Excellence 436 programs highlighted

❏ Welfare to Work 6Implementation ahead of schedule

❏ New Inspector General 7Richard J. Griffin named

❏ Four Chaplains Award 8Chaplain Zimmerman receives medallion

❏ Togo West Nominated 12 President names West VA Secretary

If you try to locate Vivian Higginson one of her workdays, you’ll needa lot of energy, some creativity andeven a little luck. It is far easier tospot evidence of her work, becauseshe is a person of high impact.

Higgins is a registered nurse onthe Health Care for HomelessVeterans Program (HCHV) team atthe VA Pittsburgh HealthcareSystem, Highland Drive Division.

Co-worker and nurse RandyDickerson is quick to say that herwork is so valued the city of Pitts-burgh proclaimed a “Vivian HigginsDay” on May 15.

“Around herethat’s the sort ofthing usuallyreserved for theSteelers, Pen-guins andPirates,” hesaid.

Higgins isalso therecipient ofthe 1997Outstanding Service toHomeless Veterans award from theProviders, an organization of home-less, formerly homeless and socialservices workers. The group honoredher at the fourth annual Homelessand Crisis Services conference at theUniversity of Pittsburgh.

Higgins was recognized formaking a difference in the lives ofpeople like a 65-year-old veteran shefound in a shelter, who was de-pressed over the death of his wifewhom he had taken care of for 12years. He was having trouble gettinga job and didn’t care if he lived ornot.

Higgins got him into treatment,then placed him at a contract resi-dential facility for homeless veterans.He got a part-time job with a localtaxi service and is now a full-timesupervisor. He keeps in touch withthe center and Higgins.

As a nurse who has managed theHCHV Contract Residential Treat-

ment Program since it began inPittsburgh, Higgins’ work takesplace in shelters and on the streets,for the most part.

What motivates her to help anaverage of 15 homeless veterans aday? “Getting them into a warm, safeplace,” she said. “I see successes,men and women who, for whateverreason, were disconnected fromfamily, society and life. We helpthem reconnect and become produc-tive individuals who respect them-selves again.” Higgins knows no bounds when

it comes to serving theseveterans, accordingto the medicalcenter’s formercoordinator for theHCHV Program,Alice Martin. “She is out thereat 7 a.m. and oftenfinishing after 6 p.m.,literally saving thelives of the mostindigent and vulner-able veterans in our

health-care system,” she said. “Shehas been called on weekends andevenings to intervene in crises, andshe follows through to make sure theveteran receives adequate medicalattention.”

Higgins’ nursing career began in1964 at the Kankakee State Hospitalin Kankakee, Ill. She joined VA in1975 as a nurse in long-term psychia-try at the Danville, Ill., VAMC and,after a variety of nurse positions,went to Pittsburgh for more in 1980.

Higgins hopes to see more fundsallocated for residential treatmenthousing in the future — long-termfor people who are mentally ill withsubstance abuse so they can worktoward gainful employment. She alsotrains staff and student nurses inworking with chronically mentally illand homeless populations and hasconducted sensitivity training forlaw enforcement officers. ❏

January 1998 3

OutlookKenneth W. KizerUnder SecretaryFor Health

To Help Guide Change,VHA Adopts ‘Core Values’

Five core values — trust, respect, commitment,compassion and excellence — will be the compass that gives direction to VHA’s journey of change.

In the lastthree years, VHAhas undergoneprofoundchange: changein how we areorganized; inhow we providecare; in how wejudgeourselves;␣ and inhow we fund our

efforts.VHA is transforming from an

inpatient-focused, specialty-drivenorganization, which historicallyoffered a fragmented range ofservices, to one dedicated to provid-ing a coordinated continuum of caregrounded in ambulatory and pri-mary care.

Since late 1995, some 1,100 sites ofVA health-care delivery have beenreorganized into 22 veterans inte-grated service networks. During thistime this has resulted in measurableimprovements in access to care,quality of care, service satisfactionand cost-effectiveness.

Since September 1994, 42 percentof all VHA acute-care hospital beds— some 22,000 — have been closed.VHA treated more than 3.1 millionpatients last fiscal year, an all-timehigh, with 23,000 fewer staff thanthree years ago. Significantly, wetreated 19 percent more homelessveterans and 8 percent more psychi-atric and substance abuse patientslast year than in 1995.

VHA recorded 32.6 millionambulatory care visits last year, anincrease of 6.6 million, or 26 percent,compared to just three years ago.

We opened or will soon open 144new community-based outpatientclinics (CBOCs) with savingsachieved from our new approachesto care, and we expect to soon add 21more CBOCs. We recently intro-duced new telemedicine primarycare programs at 30 Vet Centers. Wehave also launched new initiatives toincrease care management, home

care, use of clinical guidelines andend of life care, to name a few.

This journey of change hasaccomplished much, but moreremains to be done. We have to findmore and better ways to enhancequality, increase access, reduce costs,and otherwise improve performance.The remaining two years of the 20thcentury present unparalleled chal-lenge and unprecedented opportu-nity.

Amidst the turmoil and uncer-tainty of profound change, we mustmaintain a clear sense of purposeand a clear understanding of what isimportant. It is critical that everyonein the organization understand whatwe stand for and what we value.That is why we developed a list of

VHA “core values.”We analyzed nearly 100 VA

facility and program value state-ments and surveyed nearly 24,000VHA employees. From this, itbecame clear that a number of corevalues are held by the majority ofVHA staff. In December, five VHAsystemwide core values were identi-fied.

These five values are: trust,respect, commitment, compassionand excellence.

These core values have not beenpreviously recognized by VHA at thenational level, and our organiza-tional behavior has not alwaysadequately reflected them. It must inthe future! These core values will bethe compass that gives direction toour journey of change. They willserve as a barometer for aligning ourmission, strategy, operations andstructure as we meet the future. Hereis a look at the meanings of these fivevalues:

“Trust” means having a highdegree of confidence in the honesty,integrity, reliability and sincere goodintent of those with whom we work,the services we provide, and thesystem we are part of. It is thefoundation for anycaregiver-patient relationship and isfundamental to all health care.

“Respect” means honoring andholding in high regard the dignityand worth of our patients and theirfamilies, our co-workers, and thesystem we work in. It means relatingto each other and providing servicesin a manner that demonstrates anunderstanding of and a sensitivityand concern for each person’sindividuality and importance.

“Commitment” means dedication

and a promise to work hard to do allthat we can to provide service to ourco-workers and our patients inaccordance with the highest prin-ciples and ethics governing theconduct of the health-care profes-sions and public service. It is apledge to assume personal responsi-bility for our individual and collec-tive actions.

“Compassion” means demon-strating empathy and caring in allthat we say and do. It means sharingin the emotions and feelings of ourco-workers, patients and theirfamilies.

And, finally, “excellence” meansbeing exceptionally good and of thehighest quality. It means being themost competent and the finest ineverything we do and continuallyimproving all that we do. Thesevalues will see us through. They areVHA! ❏

4 VAnguard

Top-Performing VA Programs Recognized

T he department has designated36 programs around thecountry as Clinical Programsof Excellence that provide

innovations in clinical approaches,service delivery and customerservice.

VA Under Secretary for HealthDr. Kenneth W. Kizer said, “Theseexceptional, high-performing clinicalprograms have been identified as thefinest in what they do comparedwith the best in American healthcare. They serve as models for theVA health-care system in measure-ment of clinical outcomes, as well asin education, training and research.”

Judged by peers in specializedclinical areas, the programs are ineight categories: cardiac surgery,renal dialysis, geriatrics, home-basedprimary care, health care for thehomeless, spinal cord injury, seriousmental illness and substance abuse.

A total of 87 programs werenominated and screened by clinicalrating panels based on factorsdesigned for each type of program.Criteria included excellence inclinical care outcomes, outstandingclinical care processes, exemplarycustomer service or patient satisfac-tion, efficient resource utilizationand, where applicable, the best inteaching and research.

Nominators were asked tocompare performance, outcomes andbenchmarks to other programs insideand outside the VA health-caresystem, using measurable criteriaaccepted by outside organizations.Designation as a Program of Excel-lence is for two years. Programs mayapply for recertification.

Examples of successful nomina-tions include:• The substance abuse treatmentprogram at the Boston VA MedicalCenter that, since its inception in1972, has expanded clinical servicesand established an enviable trackrecord for VA and non-VA researchsupport for substance abuse-relatedproblems. It attracts distinguishedinvestigators among its staff andfaculty and offers a wide range ofclinical services. Programs includeacute detoxification, psychopharma-cological treatments, chemicalsubstitution treatments, and voca-tional and transitional residency.

• The Spinal Cord Injury Service ofthe VA Puget Sound Health CareSystem serves Washington, Alaska,Montana, Idaho and Oregon in anintegrated program. Its patient-centered approach and rehabilitationmodel involve patients in definingtheir goals and treatment plans. Itboasts a high rate of returning thosewith spinal cord injury to indepen-dent living.• Among the accomplishments ofthe New Orleans, La., VA MedicalCenter’s health care for homelessveterans program was a reported 90percent improvement rate afterdischarge among veterans withalcohol problems, some 17 pointshigher than the VA national average.Three-fourths of these homelessveterans leave the program for astable residential setting, and morethan half are employed when theydepart the program.• The Dallas home-based primarycare program of the VA North TexasHealth Care System was recog-nized for innovations in its deliveryof primary care to veterans in theirhomes through an interdisciplinaryhospital team. Examples include anaggressive preventive medicineprogram, timely reviews of medica-tion profiles by a clinical pharmacist,and monthly calls that provideeducation and support-groupservices for patients and caregivers.• Both inpatient and outpatientservices are offered in the geriatricevaluation and management (GEM)program of the Little Rock, Ark., VAMedical Center. The programsupports about 280 admissions peryear in the inpatient GEM whileexpanding its outpatient services tocut clinic waiting times, reduce beddays of care, and increase customersatisfaction.• The Cardiothoracic SurgerySection at the VA Palo Alto, Calif.,Health Care System was recognizedfor better outcomes with patientsundergoing cardiac surgery. Theprogram has developed new ap-proaches to manage cardiac surgicaldiseases and earlier this year becamethe first VA medical facility toperform a new, minimally invasivemitral valve procedure.

Clinical ProgramsOf Excellence

Cardiac Surgery ProgramsBrockton/West Roxbury, Mass.New York, N.Y.Palo Alto, Calif.VA South Texas Health Care System

Renal DialysisVA Healthcare System of OhioDurham, N.C.Nashville, Tenn.VA Connecticut Health Care SystemVA North Texas Health Care SystemVA Pittsburgh Health Care SystemWest Los Angeles, Calif.

GeriatricsLittle Rock, Ark.Richmond, Va.

Home-Based Primary Care Pro-gramsAsheville, N.C.Birmingham, Ala.Miami, Fla.Tampa, Fla.VA Maryland Health Care SystemVA North Texas Health Care SystemVA Pittsburgh Health Care System

Health Care for Homeless VeteransCleveland, OhioLittle Rock, Ark.New Orleans, La.VA South Texas Health Care SystemWashington, D.C.West Los Angeles, Calif.

Spinal Cord InjuryTampa, Fla.VA Puget Sound Health Care System

Serious Mental IllnessesCleveland, OhioSheridan, Wyo.VA Connecticut Health Care SystemVA Network 5 (Linthicum, Md.)

Substance AbuseBoston, Mass.Cleveland, OhioMiami, Fla.Philadelphia, Pa. ❏

January 1998 5

It’s Out There for the Taking

Surfing VA’s Cyber Sites

T he department’s web sitesteach human resources em-ployees electronic reportwriting techniques, list

foreclosed properties for sale, letveterans e-mail questions and schoolofficials get on an e-mail list toreceive information from EducationService on future changes. They evenlet individual VA medical facilitiespromote their special programs andexpert clinicians to potential patients.

These topics and more are outthere — somewhere — on the WorldWide Web under http/www.va.gov,or on VA’s internal network atvaww. va.gov. Given the ease ofsetting up a web server, the numberof VA websites is growing rapidly.Under “Organization” alone, onVA’s external home page, you canfind 14 headquarters offices and insome cases be linked to their regionalunits. A department-wide team ofwebmasters, working with theInformation Management Service,writes and maintains web pages forVA offices.

Most field facilities are connectedto VA’s Integrated Data Communica-tion Utility (IDCU), which allowsthem to gain access to and buildinternal, intranet pages as well as toconnect to the Internet. The Office ofTelecommunications maintains theIDCU and also writes web pages forVA offices. Access to VA data onintranet is controlled.

A recent visit to the PAY VAHome Page showed that VA’sShared Service Center is preparing toautomate the procedures for recordkeeping on employees. Hospital staffcan test a pilot program for develop-ing report updates on individuals’educational credentials. This is aninternal, or intranet, web site only.

Links to local sitesOn the Internet, the Veterans

Benefits Administration’s EducationService has added e-mail links on itsmain web site to its four regionalprocessing offices. The links allowveterans to correspond directly aboutspecific claims.

VBA’s Internet Home Loan HomePage is accessed more than 4,000

times a month. The InternationalReal Estate Directory (IRED) on theInternet named it a “hot” real estatesite. Only about four percent of morethan 10,000 real estate-relatedInternet sites that IRED lists havereceived the “hot” rating. Find it atwww.va.gov/vas/loan. Visitors candownload to their computers a formrequesting VA to determine theireligibility for a loan.

A team at the Atlanta VA Re-gional Office, acting as administra-tors for multi-state loan guarantyoperations, created a web site forGeorgia and is developing sites forTennessee and Alabama. Atwww.vageorgia.com, veterans canfind forms and lists of properties forsale, results of bids, approvedbuilders and developments. In Octo-ber, the second month the site wasrunning, it received 71,000 hits. Somewere from public libraries, showingthat people who don’t own homecomputers can access the site free.

VBA’s Internet capacity currentlyallows responding to requests forassistance and posting of informationand forms. In the future, a secure siteis considered possible for acceptingapplications for benefits and updat-ing personal information.

The Veterans Health Administra-tion has an intranet web site, theVirtual Learning Center (VLC),where employees can submit “Les-sons Learned,” browse through thedescribed innovations of others andask colleagues for suggestions. Theaddress is vaww.va.gov/vlc.

VLC visitors can click on “Lessonof the Day” for the latest submission.People who want to share their how-to successes can click on “SubmitLesson,” prepare their text in Wordformat and import the lesson directlyinto the database. Looking for whatthe database holds on particular sub-

jects, a viewer selects “Search Les-sons” and fills in a box for date, title,author, VAMC/VISN or keyword.

“Ask Colleagues” sends anony-mous questions to VHA employeesnationwide. Readers can browse thequestions and offer responses. OnDec. 3, 1997, for example, someoneasked, “Does anyone have a strongviolence prevention in the workplaceprogram that others could adapt insupport of the performance measureon violence in the workplace?”

Facilities promote programsIn addition to VA medical center

web sites, numerous separateprograms at VAMCs and VAROs, aswell as outstationed national offices,proliferate under “Links,” followedby “WWW Servers.” For example, anew Alzheimer’s andNeurodegenerative Disorders Centerat the Oklahoma City VAMC pro-motes itself and provides biogra-phies of clinical staff members.

The same list of servers showseven an employee group with aninternal web site. The VA HispanicAssociation in Central Office isconstructing a section on careeropportunities. In “What’s Happen-ing,” it reports on meetings andother events affecting Hispanics.

VA-wide, more than a dozenemployees respond to hundreds ofveterans and other people everyweek who click on the graphic for“Putting Customers First” on VA’shome page. Visitors to this site havea menu of subject choices to getanswers to e-mail questions on a 1-Stop Customer Service Inquiry Page.Each subject block provides informa-tion and e-mail correspondence.Subjects in addition to VBA benefitprograms include: Cemeteries,Bosnia Home Page, Agent Orange,Persian Gulf Illness, Board of Veter-ans’ Appeals, Consumer Affairs,Inspector General Hotline and theCenters for both Minority andWomen Veterans. A block for the VAVoluntary Service allows someone toapply to be a volunteer. ❏

By Jo Schuda

6 VAnguard

The NationalSalute toHospitalizedVeterans thisyear will beled bychairmanDennis Franz,actor andfour-timeEmmy Awardnominee.

As Salutechairman, he will visit hospitalizedveterans the week of Feb. 14 andother times throughout the year.

He served in Vietnam.Franz is identifiable as detective

Andy Sipowicz on the televisionshow “NYPD Blue” and previouslyas Lt. Norman Buntz on the show

Dennis Franz Named Salute Chairman“Hill Street Blues.”

Franz’s interest in acting began inhigh school. He attended WrightJunior College in Chicago andSouthern Illinois University, wherehe earned his bachelor’s degree inspeech and theater.

After organizing several theatercompanies in Chicago, he joined theOrganic Theater Company thattoured the country and proved to bea turning point in his career. One ofits productions, “Bleacher Bums,”written by Franz and Joe Mantegna,won a local Emmy Award for itsPublic Broadcasting Service presen-tation.

In addition to guest starring inseveral television series and specials,Franz teamed with Bruce Willis in20th Century Fox’s 1990 film “Die

Hard 2, Die Harder.” Other filmcredits include: “The Package,”“Dressed to Kill,” “Popeye,” “BlowOut,” “Remember My Name,”“Perfect Couple,” “Body Double,”“Psycho II ” and “A Fine Mess.”

Franz is the voice of OfficerKlegghorn in Mighty Ducks, a“Disney Afternoon” animated series.He won his first daytime Emmynomination in the “Performer in anAnimated Program” category.

He won the “Lead Actor in aDrama Series” Emmy for the ‘93-’94and ‘95-’96 television seasons and thefirst Screen Actors Guild award forBest Actor in a Drama and BestEnsemble Acting in a Drama. Healso holds three “Best Actor” awardsfrom Viewers for Quality Televisionand a 1994 Golden Globe Award. ❏

VA leads the way as federalagencies continue searching for jobsfor former welfare recipients to meetPresident Clinton’s goal of 10,000federal hires by the year 2000.

By the end of September, VA hadachieved 75 percent of its welfare-to-work hiring commitment with 604new employees added to VA stafffrom welfare rolls.

“There has been an excellentresponse to this initiative at field andheadquarters levels,” Acting Secre-tary Hershel Gober said. “Ourcommitment to the final goal isunchanged. As we reach the target,we will also focus on keeping thesenew employees motivated andsuccessful so they stay with us forlong, productive careers.”

Most of VA’s new welfare-to-work hires came on board as fileclerks, laborers, food service employ-ees or laundry workers, said BarbaraPanther, team leader for the cus-tomer advisory group at VA CentralOffice.

She said success came throughcreative use of a variety of recruit-ment strategies involving VA-uniquehiring authorities, the worker traineeprogram and the Veterans’ Readjust-ment Act. She also said manyfacilities worked with state employ-

ment services and local agencies toprovide job-ready candidates.

Four VA organizations achievednotable success.

The National Cemetery Systemplaced 12 welfare-to-work jobseekers nationwide in cemeterycaretaker, clerk and laborer posi-tions. Most are veterans.

The Veterans Benefits Adminis-tration Records Management Centerin St. Louis accounted for 14 welfare-to-work hires, far exceeding its goal.

Dallas VA Medical Center, with28 hires, the most of any VA facility,started early and generated enthusi-asm for the recruitment effortthroughout the staff.

VA Canteen Service hired 46welfare-to-work candidates nation-wide. They are working in foodcourt/retail store customer servicejobs and being trained in transferableskills and work habits.

According to Panther, every VAwelfare-to-work hire is significant.“While we have to focus on thenumbers,” she said, “you can’t forgetthat each of these new hires is apersonal success story in the mak-ing.”

She recalled how VA and stateofficials worked together to provideeyeglasses to a West Virginia appli-

Welfare-to-Work Program a Successcant who otherwise could not havetaken a VA job. An Alabama facilityhired two sisters who impressedofficials during a volunteer workexperience program and used job-sharing to accommodate the sisters’family needs.

Not all the welfare-to-work hirescome to VA without prior trainingor experience.

The Pittsburgh VA RegionalOffice hired two college graduates totrain as benefits counselors. They areboth women veterans with priorwork experience who had foundthemselves on welfare.

“This program has the potentialto do great good,” said one new VAhire,“but it can also put pressures onpeople new to the workforce thatmay make them unsuccessful. Theyneed on-the-job support after beingon welfare so long.”

Panther noted that welfare-to-work recruitment and supportactivities continue in VA. Facilitiesare being surveyed to identifysuccessful tools and strategies thatcan be shared throughout the systemas “lessons learned.” A one-daytraining package, “Coaching theNew Workforce,” is being used tohelp supervisors and co-workersretain new employees. ❏

January 1998 7

Richard J. Griffin’s appoint-ment by President Clinton asVA’s Inspector General wasconfirmed by the Senate.

Before his confirmation,Griffin served as the DeputyDirector of the U.S. SecretService and was responsible forplanning and directing all ofthe Secret Service’s investiga-tive, protective and administra-tive programs. He also formu-lated and implemented opera-tional policies and proceduresthat ensured laws over whichthe Secret Service has jurisdic-tion were properly enforced.

Griffin received a B.A. ineconomics from Xavier Univer-sity in Cincinnati, Ohio, and anM.A. in business administrationfrom Marymount University inArlington, Va. He is also agraduate of the National WarCollege. ❏

T he New York and Detroit VARegional Offices are lookingforward to a final FederalRegister notice to appear later

this year announcing their proposedfive-year “pay for applied skills”demonstration project. It involvesreplacing the classification andGeneral Schedule pay systems with acompensation system that includespay for applied skills and variablepay. Emphasis will be on organiza-tional and team performance insteadof individual performance.

The project builds on the NewYork RO’s interim compensationsystem adopted three years ago thatfits skills-based pay into the GeneralSchedule System. At that time theRO redesigned its work processesinto self-directed work teams, whichwere recognized in 1994 with thefirst Hammer Award.

Realizing that the self-directedteam members needed to expandtheir knowledge and skills to providecustomers with “one-stop” shopping,the RO also formed an interimcompensation committee thatincluded union representatives.

The office created 26 “skillblocks,” and GS grades were defined

‘Pay for Applied Skills’ Test Approachingas collections of several different skillblocks. Every six months, employeescan request certification for the nextpay level based on skills acquiredand certified.

The “pay for applied skills”demonstration project will payemployees for individual skill blocksthey have acquired and used andthat have been certified. The range ofskills required for certification for askill block will be smaller than whatwill be required for a grade. The newsystem will compensate employeesfor learning a broader range of skills.

Unlike the current system, thedemonstration project will include“lump-sum blocks” in addition to theother skill blocks.

Lump-sum blocks consist of skillsrequired to perform short-term tasksor ones that only one or two teammembers need to perform in supportof the team.

The demonstration project’svariable pay component will rewardgroup performance based on theresults achieved as shown on theorganization’s balanced scorecard.The N.Y. RO developed balancedscorecard measures of customersatisfaction, speed, cost, accuracy

MedicalMusicalGroupPlaysKennedyCenter

and employee development as aGovernment Performance andResults Act pilot site. These samemeasures will be used by the Officeof Personnel Management (OPM) toevaluate the demonstration project.

The demonstration projectrequires OPM’s waiver of statutoryrestrictions to implement the flexibil-ity inherent in the project. ❏

About 225 musicians and singers who make up the VA NationalMedical Musical Group gave a performance November 8 at theKennedy Center in Washington, D.C. They came from 40 states tohonor veterans through music, with Dr. Victor S. Wahby directing.The program included the group giving an award to former Rep.G.V. ”Sonny” Montgomery for his service while chairman of theHouse Veterans’ Affairs Committee. After the concert the grouptraveled to Portugal and Spain. ❏

InspectorGeneral Named

8 VAnguard

Matthew A. Zimmerman, director of VA Chaplain Service, was selectedby The Chapel of Four Chaplains — a non-profit organization that encour-ages unity among Americans of all faiths — to receive its Legion of HonorGold Medallion.

The Chapel presents the award each year to someone whose service andleadership reflects the sacrificial spirit of four World War II U. S. Armychaplains who gave up their lifejackets to soldiers and drowned with theirsinking transport ship in 1943. The Chapel of Four Chaplains was establishedin Philadelphia in 1951 and dedicated by President Harry S. Truman “toteach Americans that as men can die heroically as brothers, so they shouldlive together in mutual faith and good will.”

Chaplain Zimmerman has served as director of VA’s National ChaplainCenter since 1994. He retired from the Army in 1994 as chief of chaplainswith the rank of major general. ❏

Zimmerman Receives ‘FourChaplains’ Gold Medallion

VA Deputy Secretary Hershel W.Gober was honored on Veterans Daywith the 1997 Heroes & HeritagePatriot Award for his leadership andsupport on behalf of Hispanicveterans.

Presented by Micky Ibarra,assistant to President Clinton anddirector of IntergovernmentalAffairs, the award was given at thethird annual Heroes & Heritageaward ceremony held at the Organi-zation of American States building inWashington, D.C.

Gober was cited for promotingcompassion and improved servicesand programs for the nation’s nearlyone million Hispanic veterans.

Heroes & Heritage is a nonprofit

Veterans Honor Deputy Secretary Goberorganization founded in 1995to pay tribute to the contribu-tions of Hispanic men andwomen who have served inuniform.

❄ ❄ ❄ ❄ ❄

Members of the ChosinFew presented a painting of afrozen landscape framed witha plaque honoring DeputySecretary Hershel Gober forhis efforts on behalf ofveterans who have cold-related injuries suffered inservice. The Chosin Few iscomprised of veterans of abloody

battle in sub-zero tempera-tures at theChosinReservoir inKorea in 1950.

In aCentral Officeceremony,they andother advo-cates ofexpanded VAbenefits forthese veteranspraisedGober’sleadershipthat led to

benefits and health care for veteranssuffering from the effects of coldexposure on not only feet but anybody part.

Gober accepted on behalf, hesaid, of all VA employees who haveworked to better understand thelong-term effects of cold injuries. Henoted that injuries caused by severecold affect not only those who servedin the Korean War but others whoserved in cold locations in WorldWar II. VA recently changed thecriteria for evaluating cold injuriesbased on current medical knowledgeof their long-term effects. Moreveterans will qualify for health careand compensation. ❏

Chaplain Zimmerman

The Cold Injury Committee of the Chosin Few with Deputy Secretary Gober

Micky Iberra, Deputy Secretary Gober

January 1998 9

Research Finds ClozapineEffective Against Schizophrenia

A large multi-center VA study isthe first long-term research to showthat the antipsychotic drugclozapine is effective in treatingpatients with severe schizophrenia.Study results, published in theSeptember 18 issue of The NewEngland Journal of Medicine, showed that clozapine improvedpatients’ overall quality of life, reduced hospital dependency,and is more cost-effective than other commonly prescribedmedications, such as haloperidol.

“In a chronic illness like schizophrenia, it is important toknow what the long-term effects of treatment and the resultantcosts are,” said lead author Dr. Robert Rosenheck, of the VAConnecticut Health Care System, West Haven Division. “What’sexciting about this study is that, for the first time, we haveevidence from a controlled trial that clozapine helps quality oflife, which hopefully will improve treatment compliance, therebypreventing relapses and reducing hospitalizations.”

Under the VA Cooperative Studies Program, Rosenheckand colleagues at 15 medical centers conducted a randomized,double-blinded study involving more than 400 patients withsevere schizophrenia. The researchers found that the clozapinegroup had fewer psychiatric hospital days than the haloperidolgroup, and the greater costs of clozapine treatment were offsetby the savings in inpatient care expenses.

They also found that clozapine was less likely than haloperi-dol to cause involuntary movements similar to those in patientswith Huntington’s chorea, Parkinson’s disease and some typesof cerebral palsy.

Study Offers New Hopefor Treating Chronic Pain

VA researchers have reported findings that offer hope for anentirely new approach against intractable pain. A team headedby Drs. Patrick W. Mantyh, of the Minneapolis VA MedicalCenter, and Ronald G. Wiley, of the Nashville VA MedicalCenter, targeted certain pain-associated nerve cells with apoison ferried into the spinal cord by a protein that nerves useto communicate with each other.

Their results in animal studies suggest that the newtechnique may eliminate nerves involved in transmitting severechronic pain signals, while nerves that transmit normal sensa-tions of pain and heat are left unaffected. The findings werereported in the October 10 issue of Science.

“Our results are very encouraging,” Wiley said. “This holdsout the promise that we may be able to use something like thisto treat pain for which our current treatments are inadequate.”Better treatments for chronic pain rest in part on the ability tosort out mechanisms that distinguish this kind of hammering,unremitting pain from the normal alarm pain sensations thatserve to protect people from injuries and burns, he noted.

The research team infused the spinal fluid around the spinalcords of rats with substance P, a small peptide that nerves useto communicate, and a toxin called saporin. The rats retainednormal responsiveness to mild stimuli such as touch or warmheat, but they failed to develop hypersensitivity to heat andtouch after the application to their foot pads of capsaicin—thechemical that makes chilies hot. This led the researchers to

conclude that substance P receptorsplay a pivotal role in the transmissionof highly harmful stimuli and thehypersensitivity present in chronicpain.

Smaller DefibrillatorControls Heart RateA patient at the Lexington, Ky., VA

Medical Center was the first person in the country to receive anexperimental electronic defibrillator that is 10 percent smallerthan currently available models. The new defibrillator, called theVentritex Angstrom MD and made by St. Jude Medical Inc., ofSt. Paul, Minn., is powered by a battery that lasts 8 to 10 years.Batteries on earlier models lasted about five years.

“It’s the smallest one available in the world right now,” saidDr. Andrea Natale, one of the doctors who implanted thedevice. “Since it is smaller, it causes less discomfort for thepatient and there is a reduced risk of long-term complications.”

Defibrillators automatically sense potentially dangerousrapid heartbeats and issues an electric shock to the heart. Thepatient who received the new device suffers from ventriculartachyarrhythmia, in which the heart’s lower chambers startbeating so rapidly they can no longer pump oxygen-carryingblood. Severe attacks can produce almost instant death. Dr.Fabio Leonelli, another VA physician supervising this case,said the new model also can distinguish non-life-threateningarrhythmias in the upper chambers from those in the lowerchambers of the heart, thus minimizing the shocks to thepatient.

“There is no way to predict when these episodes canoccur,” he said. “This device is always there, watching the heartbeat, ready to administer a shock whenever it is needed.”

AIDS Virus SurvivesDespite Drug Therapy

Although drug therapy can suppress the AIDS virus (HIV) tonearly undetectable levels in the bloodstream, VA researchersin San Diego have found that latent strains of the virus still hidein the immune system. Reporting in the November 14 issue ofScience, Drs. Douglas D. Richman, Joseph K. Wong andCelsa Spina and colleagues said they found latent virus inimmune system cells of six patients. The patients had nodetectable HIV in their blood after as much as two years oftreatment with a drug cocktail of AZT (zidovudine), lamivudineand the protease inhibitor indinavir.

“Clearly this has major implications for our prospects oferadicating HIV,” Richman said. “But we now know what weare contending with. Either we have to figure out how toeliminate this reservoir of virus or continue suppressive therapyindefinitely.”

Richman said HIV can hide inside CD4 lymphocytesbecause the viral genetic material is dormant until somethingsuch as an infectious agent stirs the immune system into action.The CD4 cells become an active part of the immune defense,but the HIV also awakens and causes the cells to manufacturemore virus. ❏

By Dan Bruneau & Pat ForsythResearch Communications Service

MEDICALadvances

10 VAnguard

HONORSand awards

Government ComputerNews honored nine VAemployees for excellence insystems development,management and implemen-tation. They include: StanleyR. Sinclair , deputy to theAssistant Secretary forManagement, for spear-heading strategic informa-tion technology goals;Raymond Poore , computerspecialist with the Informa-tion Technology (IT) SupportService, for developingnationwide standards thatassure unique identificationfor VA’s “new technology”file servers; Susan Boaz ,computer specialist with ITSupport Service, forproviding computer trainingto visually impaired employ-ees; Sandra Weisman ,associate deputy assistantsecretary for financial

management, for implement-ing VA’s first integrated coreaccounting system; SallyWallace , Veterans BenefitsAdministration’s year 2000project manager, for herwork on VBA’s date codeconversion effort; DavidBradley , VBA’s DataNetworks Division, forplanning and implementingtelecommunicationsinfrastructure improvementsacross VHA; W. KennethRuyle , director of theTuscaloosa, Ala., VAMedical Center and chief ofVeterans Integrated ServiceNetwork 7’s Mental HealthService Line, for his work onthe Computerized PatientRecord System; Richard V.Zucco , director of the ChiefInformation Officer Trainingand Education Office anddeputy director of training

and education in theDecision Support SystemProgram Office, for creatinga virtual training environ-ment for VHA employees;and Craig Davis ,telemedicine projectmanager at the Iron Moun-tain, Mich., VAMC, for hiswork on telepathologyservices.

Two VA investigatorswere among 60 youngresearchers to receive thesecond annual PresidentialEarly Career Awards forScientists and Engineers ata White House ceremony inNovember. The award is thehighest given by thePresident to outstandingscientists and engineersbeginning their careers.

The first VA recipient,Dr. Martin Gluck , is aphysician in the NeurologyService at the Bronx VAMedical Center. His majorresearch interests lie in themechanisms of mitochon-dria, parts of cells involvedin energy production. Hesees potential application ofinvestigation in this area tothe causes of Parkinson’s

disease and other neuro-logic disorders. He intendsto use his training as a basicresearch scientist to focuson the mechanisms ofneuronal damage inneurodegenerative diseaseand in stroke.

Dr. J. Michael Gaziano ,the other VA recipient, is aninternist in the MedicalService, cardiology section,at the Brockton/WestRoxbury VAMC. He is alsoassistant professor ofmedicine, Harvard MedicalSchool. His major researchinterests are in the causesand control of cardiovasculardisease.

Much of his researchhas focused on biochemicalmechanisms that underlierisks associated with variouslifestyle factors in thedevelopment of atheroscle-rotic disease. He hopes toestablish an independentlaboratory of cardiovascularepidemiology closelyassociated with clinicalactivities in preventivecardiology. ❏

Two more VA facilities honored with Vice President Gore’s Hammer Award include the Ann Arbor,Mich., VA Medical Center and the Indianapolis VA Medical Center.

The Ann Arbor VA Medical Center’s Cardiac Observation Unit won a Hammer Award for outpatientcardiac services. Diagnostic cardiac catheterization, implantable cardioverter defibrilator, permanentpacemaker implant and percutaneous transluminal coronary angioplasty are just a few of the proceduresnow being handled effectively and safely on an outpatient or short stay basis, saving substantial time,money and inconvenience for patients, insurors and health-care providers.

Besides improving customer service, the program saved about $200,000. The Unit provides post-procedure care, follow-up visits and telephone calls, and urgent care for patients who would otherwisehave gone to the emergency room, or not received care.

Surveying the patients and their families about their overall satisfaction produced a 92 percent rating ofexcellent. No one rated their experience as less then good.

The Indianapolis VA Medical Center received a Hammer for reinventing the process of discardingunneeded government property through “enhanced use.” Because recent changes in medical technologyand care delivery reduced the need for hospital beds from 659 to 219, the medical center was able to leaseabout 33 percent of its physical plant to the state. In exchange, the medical center received an estimated $11million from Indiana to provide state-of-the-art surgical and medical inpatient facilities. This enabled VA toreduce its recurring costs by $5 million annually and avoid additional facility capital improvement costs of$11.7 million. The arrangement permits the creation of satellite clinics.

The enhanced use team, including field and headquarters employees, implemented the project in ninemonths. ❏

Hammer Award Goes to Two Medical Centers

January 1998 11

you heardHAVE

The bowlers of the VAChicago Health Care System,VA Regional Office, andBenefits Delivery Network,Hines, will host a NationalBowling Tournament June5-7, 1998. All VA employeesand members of VA bowlingleagues are eligible tocompete in mixed doublesand a five-person team event.Pre-registration is required forboth events by April 1; forinformation write to: Tyrone E.Reese, committee person, P.O. Box 371, Hines, lll. 60141

A handbook on reason-able acccommodations isavailable from VA’s BlindRehabilitation Service’sCommittee on ReasonableAccommodations . Thehandbook offers an overviewof legislation and examples ofreasonable accommodationand case law. For a free copy,call Margie Donovan, VISTcoordinator, (415)750-6604,and request either large printor ASCII computer disk.

Applications are availablefor the 1998 Public Employ-ees Roundtable PublicService Excellence Awards .Selection factors include:measurable productivity orservice delivery improvement,increased cost effectivenessof governmental services andimprovement in Americans’quality of life. Winning

organizations will be honoredin May during Public ServiceRecognition Week. Requestnomination materials bycalling PER at (202)401-4344or by downloading from itswebsite at http:/www.patriot.net/users/permail.

Nearly 2,000 veterans andfamily members attended theSan Juan, Puerto Rico,Regional Office’s first “Feriade Beneficios” (benefits fair).The Sunday activity, inconjunction with NationalConsumers Week in October,enabled about 2,000 veteransand their families to spendtime with RO, vet center andnational cemetery employees,representatives of otherfederal agencies and vet-erans service organizations.

An exhibit at CentralOffice in November featuredphotographs of Earl J.Simmons , an Army veteranwho served in Korea andbecame a photographerthrough a rehabilitation plan ofself-employment at the Fargo,N.D., VAM&ROC. His photosof North American architec-ture and landscapes, whichhave been featured in manyCanadian and U.S. showsand galleries, were shown onVeterans Day at the CanadianEmbassy. Veterans Day isalso Canada’s annualRemembrance Day in honor

of thosewho servedin WWI.Simmons isa citizen ofbothcountries.His work willbe on perm-anent dis-play at theNew YorkRO’s newveteransmuseum.

The Tuscaloosa, Ala., VAMCand the Tuscaloosa commu-nity sponsored a workshop onrural homeless-ness in westAlabama to better understandthe needs of homelessveterans in remote and ruralareas and work towardsolutions. Keynote speakerwas Dr. Craig Burnette,national co-ordinator for theVA Community HomelessAssessment Local EducationNetworking Group(CHALENG). A formerlyhomeless veteran whorecovered through theVAMC’s Substance AbuseProgram and is now employedat themedicalcenter toldattendees,“Mosthomelessdon’t reallyneed yoursympathy,they needyourunder-standing.”

Thepodiatrysection oftheColum-bus, Ohio,VA Outpatient Clinic staffs afree clinic at a local homelessshelter housing many veter-ans. Dr. Ronald Halgado, VApodiatrist, organized theprogram offering primary footcare and foot screeningexams by po-diatric residents.At the same time, homelessveterans learn more about theoverall ser-vices of theoutpatient clinic.

VA has awarded threemajor contracts for construc-tion of national cemeteries.The first is a $17 millioncontract for the first phase ofa 982-acre national cem-etery near Joliet, Ill. , that willbe one of the largest in theNational Cemetery System.The second is a $12.7 millioncontract for the first phase of a638-acre Dallas-Fort WorthNational Cemetery . The thirdis an $11.6 million contractfor the first phase at a 373-acre Saratoga, N.Y., NationalCemetery .

In memory of Dr. GabrielO. Manasse , Under Secretaryfor Health Dr. Kenneth Kizerunveiled a portrait and plaqueat VA’s second annual cancersymposium in San Antonio inOctober. Dr. Manasse, apsychiatrist who died lastsummer, served as the chiefconsultant with VHA’s AcuteCare Strategic Health Caregroup from 1970 to 1997.The plaque describes Dr.Manasse as “a talented andcaring physician who treatedpatients, colleagues andfriends with dignity andrespect.”

The third annual DisabledAmerican Veterans CharityGolf Tournament , sponsoredby DAV Chapter 137 ofGarland, Texas, was held onVeterans Day. Tournamentproceeds will be used fortransportation and lodging forDallas-Fort Worth areaveterans who participate infour national veteransprograms: WheelchairGames, Winter Sports Clinic,Creative Arts Festival andGolden Age Games.

VA’s Office of Occupa-tional Safety and Health re-ceived a Centers for DiseaseControl grant for a nationalsatellite broadcast in Octoberon how to prevent and treattuberculosis. Approximately87 VA sites participated, and1,300 VA and privatehealthcare professionals willreceive continuing educationunits for the training. ❏

From left, Dr. Artie Shelton, VA consultant; EugeneBrickhouse, Assistant Secretary for HumanResources and Administration; and Joseph Pryor, VAMedia Services Division of Administration, whopainted the portrait.

From left, Earl Simmons and Marsha Munson,VBA counseling psychologist

12 VAnguard

HEROES✩ ✩ ✩ ✩ ✩

Togo D. West Jr. Named Acting VA Secretary

Enroute to work at a VAcommunity-based clinic, threemedical staff members of theClarksburg, W.Va., VAMCacted quickly to save anautomobile accident victim.Seeing that a car had collidedwith a truck and emergencyassistance had not arrived,they went to the aid of the cardriver, who was trapped in hisvehicle and had injuries,including to his head. Physi-cian assistant Steve Milliganand nurses Brenda Bennettand Rebecca Beets werecarpooling and Milligan, also afirefighter, had protective gearand a first-aid kit in his vehicle.He donned the gear andentered the wrecked car,

crawling through broken glassto reach the victim. Bennettand Beets used the first-aid kitand applied pressure dress-ings to the victim’s wounds.The three stayed with the manuntil emergency workersarrived and extracted himusing the jaws-of-life device.

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Three recent phone callsto VA facilities found employ-ees’ ingenuity and compas-sion in action. First, as DonReynolds , a pharmacytechnician at the Northamp-ton-Springfield, Mass.,Outpatient Clinic, was leavingfor lunch one day, he took a

phone call. It was a patientwho sounded upset andtalked about taking his ownlife. Reynolds kept the patienttalking until a member of thepsychology staff took over.Reynolds then called 911 andprovide enough informationfor police to find the veteranand take him to the medicalcenter.

At the Northern CaliforniaHealth Care System, MedicalAdministration Servicesecretary Alma Jamison gotan early morning call from apatient who was threateningto end his life. A coordinatedeffort by Jamison, programsupport assistant ShannonHill and Joyce Locke, R.N., atelephone advice nurse, keptthe patient from harminghimself. Police were calledand they transported thepatient to obtain medical care.Lastly, at the Waco, Texas,

VA Regional Office, MikeColby , a veterans benefitscounselor, answered a callfrom a despondent veteranwho threatened suicide. Colbykept him talking while anearby adjudicator, CorkyHolland , located SteveDonaldson , a counselor whocalled authorities in theveteran’s county. Colby keptthe conversation with theveteran going until thesheriff’s deputies reached theveteran and took him intoprotective custody untilreceiving treatment at theNorth Texas Veterans HealthCare System in Dallas. ❏

Correction: TheNovember/DecemberVAnguard mistakenlyidentified Jerry Bowen’salma mater. He is agraduate of ArkansasState University.

The President an-nounced December 2 theappointment of Togo D.West Jr. as Acting Secre-tary of Veterans Affairs;the appointment becameeffective January 2. Westwill be nominated asSecretary after the U.S.Senate reconvenes inJanuary.

West has served asSecretary of the Armysince 1993, after a lengthycareer in public service. Hewas called to activemilitary duty in theArmy’s Judge AdvocateGeneral Corps in 1969. Heserved in the Office of theJudge Advocate Generaland the Office of the

Assistant Secretary of theArmy for Manpower andReserve Affairs until 1973.In 1975 he joined theJustice Department asAssociate Deputy AttorneyGeneral. From 1977 to 1979he served as the GeneralCounsel for the Navy.From 1979 to 1980 heserved as the SpecialAssistant to the Secretaryof Defense and the DeputySecretary, and in January1980 was appointedGeneral Counsel of theDefense Department.

West practiced lawwith the firm of Covingtonand Burling in Washing-ton, D.C., from 1973 to1975 and again from 1976to 1977. In 1981 he joinedthe New York law firm ofPaterson, Belknap, Webb &Tyler as a managingpartner of its Washingtonoffice. In 1960 he accepted

a position as Senior VicePresident for GovernmentRelations of the NorthropCorporation.

West received a bach-elor of science degree inelectrical engineering fromHoward University in 1965and was commissioned asecond lieutenant in theU.S. Army Field ArtilleryCorps. In 1968 he earned adegree in law from thesame university, graduat-ing cum laude. Upongraduating from lawschool he served as a lawclerk in the U.S. DistrictCourt in New York.

For his military service,he was awarded theLegion of Merit and theMeritorious Service Medal,and for his public service,the Defense Medal forDistinguished PublicService. ❏

President Clinton greets West, left, and Deputy SecretaryGober at a Veterans Day breakfast in the White House.

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