September/October 1998 1

VAnguard

Inside: Health Care Enrollment, 5 ✩ D.C. Disaster Exercise, 6 ✩ Y2K Medical Warning, 12

U.S. DEPARTMENT OF VETERANS AFFAIRS

NCS 25th AnniversaryNCS 25th AnniversaryNCS 25th AnniversaryNCS 25th AnniversaryNCS 25th AnniversaryProud Past, Challenging Future— page 10-11

SEPTEMBER/OCTOBER 1998

2 VAnguard

Published by the Office of Public Affairs (80D)

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

(202) 273-5738/5735E-mail: vanguard@mail.va.gov

www.va.gov/pubaff/OPAIndex.htm

INTRODUCINGCCCCCONTENTSONTENTSONTENTSONTENTSONTENTS

NCS Silver Anniversary Employees

VAnguard VA’s Employee MagazineSeptember/October 1998

Vol. XLIV, No. 6Printed on 50% recycled paper

Editor: Chris ScheerGraphics: Michael Nacincik

❏ Beulah Cope Dies 4Served Spanish American War vets

❏ Rolling out Enrollment 5Communications plan launched

❏ VA Guides DC Exercise 6Disaster response expects rock n’ roll

❏ Blind Sculptor at VACO 7VA celebrates blind rehab program

❏ Red Tape Cutters 8-9Employees earn VA Scissors Awards

❏ NCS 25th Anniversary 10A proud past and a challenging future

❏ Y2K Medical Warning 12Dr. Kizer calls for industry cooperation

❏ PER Honors VA Effort 12Award to NY/NJ Homeless Program

❏ Nurses Share Values 20Process brings nurses together

CCCCCOLUMNSOLUMNSOLUMNSOLUMNSOLUMNSOn The Cover:

The dawn of a new day atCamp Nelson, Ky., NationalCemetery and dawn of a newmillennium for VA NationalCemetery System. NCS celebratesits 25th year as part of VA —1973 - 1998.

13-19

September 1998 marks the 25thanniversary of the establishment ofthe National Cemetery System (NCS)with the transfer of 82 nationalcemeteries from the Department ofthe Army to the Veterans Adminis-tration on September 1, 1973. Theanniversary’s theme, “Pride in OurPast, Focusing on the Future,”reflects the ongoing commitment ofNCS and its employees.

NCS employees are a dedicatedteam. Given the sensitivity of theirmission, they have an especiallydifficult responsibility. The griefover the loss of a member of one’sfamily is often devastating. Ofall the benefits a veteranmight receive fromVA, the one the familyis likely to recallmost vividly isthe last one —the final laying to rest oftheir loved one in a VA nationalcemetery.

Twenty-six current employeeshave served in NCS since its estab-lishment in 1973. The anniversaryreflections by two 25-year NCSemployees marks the NCS spirit:

“NCS employees take great pridein going the extra mile to helpveterans and their families duringtheir time of need. We have tremen-dous respect for our mission, whichhas remained essentially the samesince 1973. Over the years, I havebeen able to travel around thecountry and watch the cemeteriesgrow. My memories are of the facesof children and widows, family andfriends, who come together to sharea moment of sadness and great pride.I am truly honored to be a small partof these beautiful National Shrines!”Paul Graham, foreman, QuanticoNational Cemetery

“I consider myself blessed to haveworked with some great colleaguesover the past 25 years. I am veryfortunate in that respect. Occasion-ally, I run across the same peoplewho have been with VA for a long

time and they ask, ‘How do youwork for the same department for 25years? How do you stay there thatlong?’ It is because I love what wedo. We have a direct impact onveterans and their families, regard-less of whether I work at headquar-ters or at one of our cemeteries.Throughout my years, I have seen alot of people leave here…afterthey’re gone, they realize what theyare missing and fight to get backwhere they belong!” Gladys Partee,program specialist, Budget andPlanning Service, Washington D.C.

The following are NCS employ-ees who have served this

Nation with pride,dignity and compas-sion for over a

quarter century.We thank them

for their unwa-vering commitment and

dedication to veterans and theirfamilies throughout the years.

Headquarters: Elizabeth Combs,Gladys Partee.

Northeastern Area NationalCemeteries: Donald L. Monroe, Jr.,John H. Law, Jr. (Baltimore),Michael G. Gavin (Camp Butler),Eugene Lawrence, Arthur E. Primm,Robert G. Harwood, Paul C. Steiner(Long Island), William H. Jeffers(Rock Island), Paul H. Graham(Quantico).

Southeastern Area NationalCemeteries: James H. Bennett(Barrancas), Wayne K. Graham(Florence), John P. Malak (LittleRock).

Western Area National Cemeter-ies: Patrick G. Barnhart (Fort Logan),Donald Emond (Fort Snelling),Freddie A. Edwards (Golden Gate),William J. Inojos (Leavenworth),John E. Lockhart (Los Angeles),Alfred J. Jeremiah, Lawrence M.Kiyabu (National Memorial Cem-etery of the Pacific), Susano R. Leyba(Santa Fe), James R. Trimbo, FloydA. May , Gary J. Guthrie andLawrence H. Kase (Willamette). ❏

September/October 1998 3

OutlookRoger Rapp,Director, Field OperationsNational Cemetery System

For over twocenturies, thehistory of thisNation has beenfirst that of a newrepublic, strug-gling to establishits place in theworld commu-nity, and then anation upholding

its role as a world power and bastionof democracy. The devotion andcourage of those who wore theuniforms of the United States, andnow lay buried in our nationalcemeteries, greatly contributed tothat history, ensuring the continuedexistence of a nation governed by itspeople.

The current national cemeterysystem certainly was not pre-planned. It was born of necessityand grew by expediency. It wouldtake a Civil War, in which 600,000American servicemen lost their lives,to bring about the national cemeterysystem. For over 100 years theDepartment of the Army adminis-tered these and other establishedcemeteries; until 1973, when 82 of thethen 84 cemeteries were transferredto the Veterans Administration.

Combined with the 21 VAveterans cemeteries located athospitals and nursing homes, theoriginal VA National CemeterySystem comprised 103 cemeteries.Today, the National CemeterySystem (NCS) offers perpetualtestimony of the concern of a gratefulNation that the lives and services ofmembers of the armed forces will beappropriately recognized andcommemorated.

It is the purpose of NCS’s 25thanniversary to remember and honorall those who have served, both inwar and at home, in the military andin civilian life. To that end, I’d like tooffer my own testimony and per-sonal observations.

My Dad is a World War II Battleof the Bulge veteran. I remember in

the mid-1950s asking him the usualquestions kids ask about the war:Were you scared? Did you killanyone? I got the answers “Yes” and“I don’t know.” My Dad didn’t talkmuch. As an eight-year-old, I didn’tunderstand my Dad’s nightmares.Even then, World War II seemedlong ago. Today many veterans stilldon’t talk about those war timeexperiences.

Recently a PBS special on WorldWar II described how in 1940-41Churchill and Roosevelt’s leadershipalliance essentially saved the freeworld at its darkest hour. No longeryoung, I remember thinking thatWorld War II was not really that longago.

I believe as we get older, weappreciate the value of life evenmore and appreciate the sacrifices ofAmerica’s soldiers even more. Aswe get older, history and eventsseem closer in time, have moremeaning, have more impact as weunderstand what it takes to maintainour freedom and our lives.

On V.E. Day 1995, I invited myparents to attend the ceremony atFort Myer in our Nation’s Capital. Itmeant a lot to my father, a simpleman, a child of the depression, a highschool dropout, a retired factoryworker. My father sat with me in asection of mostly governmentexecutives and high-ranking militaryofficers.

When the time came for WorldWar II vets to stand and be recog-nized, my father was the onlycitizen-soldier to stand in oursection. During that long pause,generals and admirals turned andpointed to my dad and applauded.My father cried and an officer puther arm around him and patted himon the back.

My dad now feels comfortable totalk about the war because of that1995 experience. So why am I tellingyou all this? It’s because we needanniversaries like the NCS 25th thathelp us to remember, to value, toappreciate, to thank, to love and, forsome of us, to talk about thoseexperiences.

I have been with the NationalCemetery System 16 of my 26 yearsof service with VA. In that time Ihave seen many changes and havetruly come to appreciate the sacri-fices our Nation’s veterans and theirfamilies have made in defense of ourcountry. I have seen many facescome and go within VA, veteransand non-veterans, whose hard workand dedication represent the best ofwhat government and caring is allabout.

We have always been blessedwith countrymen willing to put theirpersonal concerns aside and givetheir all for America. We are blessedto have people like my dad, whofrom the beginning of this Nation topresent time have answered the callto arms — a call that has often led toloneliness, danger, injury and, forsome, death.

On NCS’s 25th anniversary, Iinvite each of you to visit a nationalcemetery and linger there on thehallowed ground of a nationalshrine; to visit the grave of a lovedone or friend. I urge you to read themarker inscriptions of those you donot know, of some young Americanwhose life was cut short by war.Imagine what they may have beenlike, the families and friends leftbehind and the stories left untold.Never forget what they did to defendus and keep our Nation free.

As we move into the next millen-nium — the National CemeterySystem’s next 25 years — let usalways remember our mission andthe good men and women whoserved so this country might live! ❏

This Hallowed Ground

... to care for him whoshall have borne the battle,and for his widow, and hisorphan...

President Abraham LincolnSecond Inaugural Address

4 VAnguard

Tireless Beulah Cope Dies at 97

B eulah Cope, 97, died in the100-year anniversary of thewar she had become identi-fied with. She was buried

July 15 in Arlington NationalCemetery.

Adjutant General of the UnitedSpanish War Veterans for the last 27years, Mrs. Cope died in her homeJuly 3 in Takoma Park, Md. TheSpanish American War ended Aug.12, 1898.

It was after she retired from acareer in the U.S. State Departmentin 1971 that she found a secondcareer assisting Spanish AmericanWar veterans. In recent years shewould leave her house, where shelived alone, drive her car to thesubway, and ride it to her smalloffice at Central Office. Her healthdeclined this year after she broke herhip in March.

As sole staff member of theUnited Spanish War Veterans andAffiliated Organizations, Mrs. Copespent the last years of her life helpingSpanish American War veterans andtheir families with pension and otherbenefit problems. Her uncle hadbeen a veteran of the war, but herdedication to veterans was based on

a deep commitment that went farbeyond family.

Born in Freeport, Ill., she livedher entire adult life in the Washing-ton, D.C., area. Her husband died in1938, and she never remarried.

Mrs. Cope actively participated inmany organizations honoringveterans of the Spanish AmericanWar. She served as president of the

District of Columbia of the NationalAuxiliary United Spanish WarVeterans from1946-47 and NationalFort Captain of the Daughters of ’98from1963-64.

Almost to the last day, Mrs. Copewas involved in organization work

and responding to queries about theSpanish American War and itsveterans. She was considered aprime source of information onSpanish American War veterans bythe news media.

Some 392,000 Americans servedduring in the Spanish American War.Begun Feb. 15, 1898, after the sinkingof the battleship Maine in Havanaharbor, the war ended six monthslater with Spain relinquishing Cuba,Puerto Rico, the Philippines andGuam.

VA designates the Spanish-American War era as runningthrough July 4, 1902, encompassingnot only the Cuban and Puerto Ricocampaigns but also the PhilippineInsurrection and the Boxer Rebellionexpedition into China.

Among Mrs. Cope’s last choreswas preparing the annual conventionof the veterans organization, held inJacksonville Beach, Fla., September18. Because the last of the SpanishAmerican War veterans is deceased,the attendance consisted of childrenand other relatives of the originalmembers. The official program wasdedicated to the memory of Mrs.Cope. ❏

S ince the VA Voluntary Service(VAVS) debuted its homepage in July 1997, 92individuals have volunteered

by computer to give their time toserve veterans.

Nearly evenly split between menand women, this group is highlyskilled and very enthusiastic. Asexpected, some have experience withcomputers, but the range of interestsis quite broad. A number are trainedmedical professionals, psychologists,paralegals, engineers, and physicaland vocational rehabilitation thera-pists. They are interested in caringfor ill, homeless, and otherwisedisadvantaged veterans in need ofassistance.

Volunteers are not just a medicalcenter phenomenon. A professionalcareer counselor offered her servicesto help veterans get jobs. Familiar

with the difficulty of getting up-to-date information to veterans inforeign countries, one man in Mexicooffered to help counsel veterans ontheir benefits. Another is interestedin helping veterans start their ownbusinesses. One manager contactedthe web site looking for ways hercompany can help veterans.

The VA’s Voluntary Service(VAVS) program places thousands ofpeople who give their time inappreciation of veterans’ service toour nation. VAVS volunteers havedonated 475 million hours of service.In FY 1997, all VAVS volunteerscontributed a total of 13,765,575hours, of which 12,565,977 hourswere from 109,716 regularly sched-uled volunteers. The FY 1997 totalVAVS volunteer hours equate to6,618 full-time employee equivalent(FTEE) positions. The current

monetary worth of the 13,765,575hours from all VAVS volunteers isover $189 million (using a privatesector valuation of a volunteer hourat $13.73). VAVS volunteers andtheir organizations annually contrib-ute an estimated $40 million in giftsand donations.

VAVS collects contact informa-tion from volunteers over theInternet at the VAVS web site athttp://www.va.gov/volunteer/form.htm. The Voluntary ServiceOffice (10C2) and InformationManagement Service (045A4) devel-oped the data entry form andimplemented it with softwaresupplied by Veterans BenefitsAdministration’s Education Serviceand hardware and software pro-vided by Veterans HealthAdministration’s Washington ChiefInformation Officer’s Field Office. ❏

VA Recruits Volunteers on the Web

Cope

September/October 1998 5

VHA ‘Rolls Out’ Health Care Enrollment

C ommunications and medicinejoined forces this summer asthe Veterans Health Administration (VHA) prepared for

the national rollout of VA’s newhealth-care enrollment program thatbegins October 1.

In addition to establishing theadministrative and informationalinfrastructure to implement thisradical change in eligibility determi-nation, VHA faced the daunting taskof informing millions of anxiousveterans. In order to receive VA care,they must apply for enrollment inwhat amounts to a new VA health-care plan.

A communications and outreachplan, developed by the VHA Officeof Communications with the supportof private-sector consultants and theVA Office of Public Affairs, is goinginto effect in early October at VAhealth-care facilities across thecountry. Its objective is to inform andreassure veterans, clearly outlineenrollment application proceduresand spell out the comprehensiveservices enrolled veterans willreceive from VA.

That plan stresses the “all healthcare is local” axiom by placingprimary responsibility for informingveterans with VHA networks and,particularly, medical centers. Infor-mational material —TV and radiotapes, news releases, consumerpamphlets — were created centrallywith the help of contracted adagencies and a variety of focusgroups. They were tested duringAugust in pilot rollouts in Spokane,Wash., and Lexington, Ky., wherelocal VA medical centers orches-trated media blitzes introducingenrollment. National VA spokesper-sons also helped in those markets.

Front-line employees and VAspokespersons at both test-marketfacilities received training in re-sponding to enrollment-relatedquestions, including televisiontraining. VA officials briefed veter-ans organizations and congressionalstaffs, and held town hall meetingsfor veterans in Spokane and Lexing-ton.

Among their selling points: VA’stoll-free number for enrollmentquestions, (877)222-VETS; the easy

access afforded veterans onceenrolled; and portability of healthcare, with the same health-carecoverage provided at VA’s 1,100medical access points.

An Enrollment Project Team,with representatives from VHA’sChief Information Officer and Officeof Policy and Planning, along withthe Office of Public Affairs, has donemuch of the outreach work so far.Participating with the team was theAustin Automation Center, whichmailed letters and a brochure tomore than three million veterans,and followed with more than onemillion letters to veterans to confirmtheir enrollment.

VHA contracted for a telephonecall service center on enrollment tohandle veterans’ questions. As ofSeptember 14, the center had re-ceived more than 76,000 calls.

Test market communicationssucceeded, said VHA Health Admin-istration Service Director KentSimonis, measured by the fact thatkey messages were received accu-rately by veterans and produced alarge volume of calls to the toll-freenumber. Twenty percent of calls tothe call center from Spokane andLexington were prompted by VA’sprint or broadcast announcements.

Now VA facilities — augmentedby national VA spokespersons andcommunications support personnel— are continuing the marketingefforts nationwide. ❏

As Oct. 1 approaches, veterans willbe wanting information. “They will likelyask, ‘Am I eligible? What for and whatwill it cost?’,” said VHA Director ofHealth Administration Service KentSimonis. They will come to the nearestVA source to get answers. He said thatVA medical center enrollment coordina-tors can provide detailed informationthat other VA staff may need.

There are consistent messages allVA spokespersons should convey, saidSimonis:• Most veterans must apply forenrollment; those with 50 percent orgreater service-connected disabilityratings are the exception.• Once enrolled, veterans will find theHealth Benefits Program offers easieraccess to care.• For the first time, enrolled veteranswill have access to the full range ofservices they need — includingpreventive care and outpatient services— not just those resulting from militaryservice. • The enrollment process is simpleand streamlined. The old 11-pagehealth-care application has beencondensed to a single page availablenationwide at any VA health-carelocation.• VA has established a web site toprovide veterans the most currentinformation (www.va.gov/health/elig).• Toll-free assistance: 877-222-VETS(877-222-8387). ❏

Handbooks and brochures for veterans and employees are part of the VA health-careenrollment communications campaign.

6 VAnguard

VA Experts Guide DC Disaster Exercise

A large metro area stadiumfilled with 60,000 young fansattending a rock concert is thetarget of terrorists bent on

disrupting the nation’s capital. Atoxic chemical is released in theirmidst. Chaos and pandemoniumensue.

The VA Medical Center inWashington, D.C., will join otherDistrict hospitals in receiving pa-tients from such a simulated terroristattack on September 22. The practiceexercise, in which many employeesfrom area emergency agencies willparticipate, simulates a chemicalweapons attack at a rock concert atWashington’s RFK Stadium.

Exercise participants, includingVA employees from the Office ofEmergency Medical Preparedness,will use the exercise to evaluate thecommunity’s emergency plans andresources. The exercise will focus onthe coordination of local emergencyemployees providing security,decontamination, treatment andevacuation of victims to local hospi-tals.

In addition to being one of adozen community hospitals accept-ing patients for treatment, theWashington VAMC, like other VAmedical centers around the country,stores the antidotes needed torespond to a chemical attack. A keyelement in the exercise is gettingtruckloads of these simulated drugs

to other hospitals in time to be of use.The “Rock’n Roll” exercise is

organized by the District Office ofEmergency Preparedness andinvolves employees of the Districtfire and police departments. A jointoperations center, a joint informationcenter and an emergency shelter willbe located at the National GuardArmory. The joint operations centerwill involve a number of city ele-ments, including the Health Depart-ment, Public Works, National Guardand the Office of the Mayor.

VA Deputy Director of Emer-gency Management Robert F. Elliotthelped develop the exercise scenario.He and VA area emergency manag-ers attached to his office will evalu-ate its success.

“Emergency planners andoperators at city, county, state andfederal levels must consider allavailable resources to mitigate theeffects of chemical, biological ornuclear weapons,” Elliott said.

He explained that local firstresponders bear the heaviestworkload during the first hoursfollowing a terrorist incident. That iswhy it is important to forge partner-ships among the first responders andtheir back-up departments andagencies in advance.

“Successful response depends onteamwork and a positive attitude oncollective responsibility,” Elliottnoted. “Keys to overcoming short-

falls in resources are joint planning,joint training and joint exercising.”

Every major metropolitan area inthe United States is a potential targetfor terrorist weapons of mass de-struction. In developing realisticscenarios, emergency planners andoperators and first responders mustdeal with communications andtransportation problems and poten-tial gridlock.

Elliott admitted that there are noeasy solutions in controlling massesof people under stress. Most indi-viduals caught in the aftershock of aweapons of mass destruction inci-dent will seek medical attention assoon as possible. Their survivalpaths will include all available exitsfrom confined spaces via cars, busesor other transportation systems.

Individuals who are contami-nated by hazardous chemicals willseek immediate relief throughdecontamination and appropriatemedical care. These victims may alsocause crush injuries and fatalities toother persons through mass stam-pedes.

Elliott stressed that because ofthe great risks associated withmass gatherings, it is crucial thatemergency planners and operatorsconstruct scenarios which matchlocal conditions and includefacilities where the public normallycongregates, like a crowdedstadium. ❏

A dvance word onthe movie “SavingPrivate Ryan” andits graphic por-

trayal of combat promptedextension of VA counselingservices beyond normalbusiness hours.

Because previousrealistic war movies hadtriggered emotionalresponses among veterans,VA decided to take specialprecautions when themovie opened nationallyJuly 10.

Some 125 employeesvolunteered to work VBA

phone units over theweekend to cover ex-tended hours. The phoneservice was also continuedthe following weekend.

“We had more volun-teers than we needed tocover the phones,” saidJimmy Wardle, the Veter-ans Benefits Administra-tion coordinator for theproject.

Volunteers includedabout 100 VBA employees,15 Vet Center counselorsand 10 other VHA employ-ees.

Counselors were

prepared to help veteransand family members copewith emotions brought onby the movie.

With the VA toll-freeassistance number openafter normal businesshours, calls were routed tocounselors standing by atseven regional officesthrough midnight Sunday.

The number of callsgenerated by the moviecaused the special phonelink to be extended anotherday, through midnightMonday, Pacific Time.

The seven regional

offices handling calls overthe weekend were Oak-land, St. Petersburg, St.Paul, San Diego, Philadel-phia, Chicago and Port-land, Ore. For Mondaynight, calls were routed tothe Oakland regionaloffice.

As a result of an alert tonews media and localveterans service organiza-tions, VA’s expandedservice was reported bynews agencies, televisionnetworks, and national andinternational newspapersand magazines. ❏

Weekend Duty for ‘Pvt. Ryan’ Counselors

September/October 1998 7

M ichael Naranjo forms clayheads with kids and veter-ans, and while the artworkis taking shape under his

direction, it’s easy to forget that theinstructor doesn’t see anythingtaking shape around him. A NativeAmerican Vietnam veteran blindedin combat in 1968, Naranjo helpssighted people develop creativitythat bridges emotional and develop-mental gaps and heals body andsoul.

Healing and developing werethemes of the July observance of the50th anniversary of the Blind Reha-bilitation Service in VA CentralOffice. Naranjo was a featured guestspeaker along with Tipper Gore, whopresented a congratulatory letterfrom the President to Secretary TogoD. West, Jr.

Executive Director of the BlindedVeterans Association Tom Miller,another graduate of a VA blindrehabilitation center, was master ofceremonies for the program. Blindedveterans from the national capitalarea and invited VA, Congressional

and blind rehabilitation officialsattended.

Naranjo — who completed theVA Western Blind RehabilitationCenter training program in PaloAlto, Calif. — held art workshops forveterans at the Washington, D.C., VAMedical Center and for veterans andstudents from a Very Special Artsprogram in Baltimore. At VA CentralOffice, he conducted another work-shop for young people and talked toemployees. Thirteen of his bronzesculptures were displayed in thelobby.

Naranjo describes his artwork as“touchable” and invited employeesto feel his sculptures. Childhoodmoments of seeing particular ani-mals while hunting and fishing nearhis New Mexico pueblo and nativeAmerican festival dances are thememories he draws on to createmany of his works in stone and wax.

“I always wanted to be a sculptor;I had to get there the hard way,” hesaid in his gallery talk to employees.He credited VA blind rehabilitationcenter staff for getting him a block of

Sculptor Lives VA Blind Rehabilitation Storywood, a mallet and chisel when hewanted to sculpt in the center’swoodworking shop during histraining.

VA blind rehabilitation programanniversary observances continuedin Chicago, where the artwork of 16graduates of the blind rehabilitationprogram were displayed at theconvention of the Blinded VeteransAssociation. That exhibit includedthe sculpture of an elephant, inspiredby an Indian tale that relates thedifferent impressions formed by sixblind men who touch the elephant’slegs, trunk, ear, tusk, tail and side.The elephant sculpture will befeatured as the display travels toseveral VA medical center blindrehabilitation programs later thisyear.

The Washington programs andtransportation of the elephant aresupported by: Pfizer, Inc.; theBlinded American Veterans Founda-tion; Help Hospitalized Veterans;Disabled War Veterans; and sustain-ing members of the Association ofMilitary Surgeons of the U.S. ❏

Tipper Gore, (left),wife of the VicePresident, discussesart and rehabilitationwith blind sculptorMichael Naranjo atVA Central Officeceremonies markingthe 50th anniversaryof the VA BlindRehabilitationprogram. With them(from left): Gail BerryWest, wife ofSecretary of VeteransAffairs Togo D. West,Jr., Deputy Secretaryof Veterans AffairsHershel W. Goberand Secretary West.

8 VAnguard

VA Scissors Awards To Red Tape Snippers

T he VA Scissors award, intro-duced by Deputy Secretary ofVeterans Affairs HershelGober, complements the

National Partnership in ReinventingGovernment’s Hammer award byrecognizing the outstanding accom-plishments of VA employee teams incutting red tape by finding better,less costly and more efficient ways ofserving veterans. Here are recentwinners of the VA Scissors award.

The Portland, Ore., VA MedicalCenter Home Infusion ProgramTeam helped the center become thefirst in VA to provide home infusionservices under contract. This rein-vention process resulted in de-creased lengths of stay, increasedpatient satisfaction, and an almost$1 million savings in bed days ofcare. Previously, the programrequired the community healthcoordinator to get three bids for theproposed therapy each time a patientrequired treatment. A cost estimatewas made and sent to the chief ofstaff for authorization. Now, bycontracting with a JCAHO-accred-ited national infusion company, thetherapy coordinator can arrangehome therapy with a simple tele-phone call.

The Battle Creek, Mich., VAMedical Center Destinators Teamredesigned transport of veteransbetween the Battle Creek and AnnArbor VA Medical Centers resultingin a 1997 cost savings of $202,299. Inprior years, although a contract wasnegotiated, private transport servicesran an average of $56,630 per month,and veterans endured long waitingtimes. Today, veterans ride inspecially equipped vans at timesconvenient to them. Outpatients arenow able to keep their appointmentsbecause veterans are not required tospend the entire day waiting forreturn transportation.

Based on employee feedback, theAlbany, N.Y., VA Medical CenterEmployee Training Team elimi-nated traditional classroom lecturetraining in favor of training fairs,saving $108,000 annually, increasingmorale, and decreasing staff time

away from work. The training faireducates employees on mandatorytopics including fire, chemical,radiation and electrical safety,utilities failure, infection control,workplace violence, patient rightsand safety, administration of bloodcomponents, emergency proceduresand ergonomics. It was so popularthat it will be expanded to includesuch topics as age-related competen-cies, latex sensitivities, informationmanagement and security.

The Mountain Home, Tenn., VAMedical Center Extended CarePerformance Improvement Teamdeveloped integrated, interdiscipli-nary assessment in extended care.Patients are now assisted by a teamof representatives from nursing,nutrition, social work, pharmacy,recreation, geriatric medicine,physical medicine, psychology,dental, and other specialties, includ-ing chaplain service. The changereduced the number of assessmentforms from 15 to two, and completelyeliminated 161 repeat questions.Although costs were reduced, theenhanced customer service is themost valued aspect of thisreengineering effort.

The Poplar Bluff, Mo., VAMedical Center Pharmacy Teamgreatly improved customer serviceby including a pharmacist as part ofthe outpatient clinic primary careteam. The staff addition meanspatients have direct contact with apharmacist and medications aremonitored to prevent duplication ofprescriptions. The results showprescription waiting time at PoplarBluff is less than half the nationalaverage, and costs have decreasedfrom an average of $15 per prescrip-tion to $13, saving $166,000 annually.

The Mountain Home, Tenn., VAMedical Center Home Oxygen Teamreinvented home oxygen services toimprove patient care and decreasecosts. A team representing pulmo-nary medicine, prosthetics, respira-tory therapy, nursing, pharmacy, andquality improvement studied allaspects of home oxygen servicesprovided to patients. Their recom-

mendations changed purchasing,specified responsibilities, and addeda tracking system and yearly evalua-tion process. As a result, the HomeCare Program scored 100, with norecommendations, in a Joint Com-mission on Accreditation of Hospi-tals survey. In addition, per patientcosts have decreased from $4,000 permonth, and satisfaction surveysindicate a 100 percent patient ap-proval rating.

The Des Moines VA RegionalOffice Iowa CommunicationsNetwork used fiber optics technol-ogy to provide video conferencingservices that have reduced customerwaiting times, speeded benefitsprocessing and saved money. TheVARO now routinely uses videoconferencing for hearings for veter-ans with the Board of Veterans’Appeals (BVA), personal interviewsfor veterans seeking vocationalrehabilitation and counseling,personal interviews for veteransrequesting special adaptive housinggrants, statewide program trainingfor contractors and lenders, and staffmeetings with outbased employees.Video conferencing at the VARO hasimproved service quality andtimeliness and reduced a backlog ofBVA hearings. Also, money spent ontravel, per diem and salaries hasbeen reduced.

John Dietrich of the Roanoke,Va., VA Regional Office, while withthe Baltimore VA Regional OfficeLoan Guaranty Division, changedthe way home sales listings reachcustomers by developing “fax ondemand.” Previously, monthlylistings were collected and thenmailed out, often reaching customerstoo late. In addition, printing costsreached $12,000 a year and wereincreasing. Using equipment pur-chased in 1995 for other purposes,Dietrich began offering sales listingsvia fax in 1996. Today, 3,000-pluscustomers receive timely informationvia “fax on demand” at no cost to theregional office. Customers call from afax machine, paying for the call andprinting themselves. The service isavailable 24 hours a day, and enablesthousands of customers to obtain

September/October 1998 9

information in a timely, efficient andcost-effective way.

The Boston VA Medical Centerand VA Regional Office formed ajoint Continuous Quality Improve-ment Team that employed qualityimprovement methodology tostreamline compensation andpension exams. Techniques includedbrainstorming, process mapping,cause/effect diagramming and flow-charting. Files are no longer lost dueto system errors in transferring filesbetween the regional office and theoutpatient clinic. Processing time forcases 180 days or older has beenreduced 55 percent, and the numberof insufficient exams dropped from30 to zero last year.

The VA Records ManagementCenter formed a partnership teamwith the St. Louis VA RegionalOffice, VBA Southern Area Office,and the National Personnel RecordsCenter to reduce the veterans recordretrieval backlog at the nationalcenter, which had reached 35,000 by1996. The team redesigned therecords retrieval process by institut-ing a historical data file to identifyduplicate requests, which amountedto 22 percent of daily requests. TheRecords Management Center and theNational Personnel Records Centernow work together to respond torequests within 24 hours of receipt,resulting in better service to VA andveterans.

The VA Office of Intergovern-mental Affairs (IGA) and StateRural Development Councils(SRDC) partnered to connect localeconomic development programswith corresponding federal and stateprograms to ensure the needs ofrural veterans were not beingoverlooked. VA, a charter member ofSRDC, contributed leadership,technical expertise and financialsupport. Partnerships include tele-medicine in Alaska and Maryland;tele-technology in Colorado, Mon-tana and Texas; housing in Kansas,Missouri and South Dakota; geo-graphic information-sharing inNebraska and Oregon; and health-care delivery in Kansas, Utah, WestVirginia and Wisconsin. IGA pro-motes these partnership activitiesand hosts Truman Scholar Fellows

who act as advocates for ruralveterans within VA.

The Leavenworth, Kan., VAMedical Center Surgical Ambula-tory Care Clinic Team reorganizedthe center’s entire surgical ambula-tory care process, from scheduling tofollow-up exams. Their changesreduced overbookings from 23 inl994 to 5 in 1996. Also, patientwaiting time decreased from 41minutes to 13, and the percent ofveterans reporting quality of care asvery good to excellent increasedfrom 60 percent in 1995 to 76 percentin 1996.

The Leavenworth, Kan., VAMedical Center Domiciliary After-care Program works to help home-less veterans make successfultransitions from hospital wards toindependent living. The aftercareprogram began in 1994 with 12patients and has now served nearly200. Community reintegrationassistance and classes prepareveterans for the day-to-day activitiesof living outside the hospital. Pa-tients receive instruction in budget-ing, paying rent, cooking andfollowing preventive medicineguidelines. The center providestransitional housing as well asprimary care, and staff make homevisits to the veterans, who also meetquarterly with members of theirtreatment team. The medical centeralso employs community resourcesto provide low-income housing forveterans returning to the community.Based on 28 patients in a two-yearperiod, savings on domiciliary carecompared to the aftercare programtotaled $814,875. Plans are underwayto open a second transitional house.

Mountain Home, Tenn., VAMedical Center Elective SurgeryTeam members recognized patientswere routed through an inefficientelective surgery process whichcaused delays and cancellations.Many patients were rushed throughsurgery, or were sent along withunfinished procedures. Underchanges instituted by the team,delays have decreased and patientsreport to and depart from a singleservice area with their medicationsand instructions in hand. Theseimprovements also have minimized

cancellations and kept costs down,and patients have consistentlyexpressed satisfaction with the newsystem.

The HR LINK$ Team in VACentral Office, the Austin, Texas,Automation Center and the Topeka,Kan., Shared Service Center auto-mated VA’s personnel and payrollfunctions, enabling employees toelectronically access and change theirpersonal records on line. Cutting outthe “middle man” in these transac-tions reduces paper, redundancy,misplaced documents and errors.

The Fee-Basis Program Team inVHA, the Office of Acquisition &Material Management, the Office ofSmall & Disadvantaged BusinessUtilization and the Austin, Texas,Automation Center automated thecollection of socioeconomic procure-ment data for VA’s fee-basis pro-gram.

The Electronic CertificationAutomated Processing Team at theBuffalo, N.Y., Muskogee, Okla.,Atlanta and St. Louis VBA regionalprocessing offices developed andimplemented an automated applica-tion for processing Chapter 30education re-enrollments, whichimproved service to veteransthrough more timely and accurateprocessing. ❏

Since the award

began in 1995,

200 Scissors

Awards have been

earned by

innovative

VA employees

10 VAnguard

National Cemetery SystemThe national cemeteries ofAmerica serve as constant re-minders that freedom isn’t free. Itwas paid for with the blood of oursons and daughters from Revolu-tionary War times to present day.

Our national cemeteries cameabout during the American CivilWar, when President Lincoln

signedinto lawanOmnibusAct onJuly 17,1862.This actled to theestablish-ment ofthe first 14

national cemeteries in 1862.Hundreds of thousands of bravesoldiers who died to preserve theUnion now rest with specialcommemoration of their service onthe field of battle.

Frontier: Following the war,America moved west to the PacificOcean. Soldiers in scatteredlonely outposts provided protec-tion and security for the massmovement westward. Theirservice made possible the comingof the railroad and the telegraph.The number of national cemeter-ies increased during this periodmarked by special efforts todevelop and beautify the hallowedgrounds. Simple, dignified,uniform headstones adopted in1873 now marked all new graves.

War with Spain: Americacame on the world scene whenthe Rough Riders charged up SanJuan Hill. Military commitments inareas beyond our shores broughtnew and increased intermentchallenges to national cemeteriesas veterans of the War with Spainwere given burial rights.

World War I: The “War to endall Wars” further expanded thesystem as all soldiers, sailors ormarines who died in service ordied after earning an honorabledischarge were offered burial inany national cemetery.

World War II: The greatestwar in the history of the worldbrought the American peopletogether as never before. Thetotal resources of the nation were

Pride in Our Past

Americans have been gathering on hallowed ground since the founding ofthis country — from the Old Hill Burying Ground in Massachusetts, theburial site of early Colonial families and Revolutionary War Soldiers, toTahoma National Cemetery in Washington State, VA’s newest nationalcemetery opened in 1997. The National Cemetery System (NCS) is an inte-gral part of this tradition to honor the memory of those who have served thisNation in time of need. This is NCS’s mission and has remained the samesince its establishment. Employees of NCS work amid reminders of ourNation’s past each and everyday. All they have to do is look out over thelandscape any day of the week, rain or shine, to see a constant reminder ofwhat sacrifice, honor and duty is all about. In a way, they are the keepers ofour national memory, the link between the past and the future.

NCS ESTABLISHED BY LAW The National Cemetery System (NCS) cameinto existence on September 1, 1973, as established by Public Law 93-43.Congress made this change to ensure that the honor of burial in a nationalcemetery would continue to be a benefit available to eligible veterans andtheir families. The law recognized that burial in a national cemetery is apermanent expression of the American people’s desire to recognize and payrespect to those who have honorably served in the United States ArmedForces. It declared that “all national and other veterans’ cemeteries in the(system) … shall be considered national shrines as a tribute to our gallantdead.”

SINCE 1973 NCS has increased the number of national cemeteries from 103to 115. Most of the original 103 were developed in response to the Civil War.The number of gravesites maintained has risen from 1.2 million to more than2.2 million and annual interments have doubled from 36,422 to 73,000. Morethan 6.3 million headstones and markers have been provided since 1973.Initiated in 1962 by President Kennedy, NCS’s Presidential Memorial Certifi-cate (PMC) program honoring veteran’s service has delivered more than 2.3million PMCs to veterans’ next of kin.

NCS HAS BEEN RECOGNIZED throughout its 25 year history for itsinnovation and quality customer service. Recently, NCS received two of theVice President’s Hammer Awards which are presented to teams of Federalemployees who have made significant contributions in support of reinvent-ing government processes. In 1998, NCS received a Hammer Award for itsSecond Inscription Program that has saved the Federal Government andtaxpayers over a million dollars. In 1995, NCS accepted a Hammer Awardfor its development of the Burial Operations Support System (BOSS) thatautomated the way NCS gathers, records and disseminates information aboutburials, grave locations, headstone and marker applications and variousreports.

The Robert W. Carey Quality Award recognizes organizations within VAthat have demonstrated a commitment to the principles of quality manage-ment resulting in organizational effectiveness, service delivery and customersatisfaction. In 1996, Calverton National Cemetery was the overall trophywinner. Other NCS Carey Award winners include: 1998 National CemeteriesCategory - Florida National Cemetery; 1998 Achievement Award - Jefferson BarracksNational Cemetery; 1997 National Cemeteries Category - Ft. Logan NationalCemetery; 1997 Achievement Award - National Memorial Cemetery of the Pacific;and, 1996 National Cemeteries Category - Riverside National Cemetery. Theseawards, combined with numerous VA Scissors Awards, represent NCS’scommitment to promote and recognize initiatives within VA that cut throughred tape, streamline operations and improve customer service.

September/October 1998 11

brought to bear in the cause offreedom. Gold stars appeared inwindows around the land, signify-ing the ultimate sacrifice. Eligibil-ity for burial in a national cem-etery was officially extended tospouses and dependent childrenof an eligible veteran.

Korea: The next 45 years ofthe American story saw thisnation in a polarized world. This“Cold War” had its flash pointsand Americans answered thosecalls. In 1950, the flash point wasKorea where the United Statesled a United Nations force indefense of South Korea and itspeople.

Vietnam: In the 1960s,American forces were committedto one of the longest and mostcomplex conflicts in our history,as America sought to containcommunist aggression in South-east Asia. In 1973, the NationalCemetery Act was signed intolaw, establishing the NationalCemetery System as part of VA.

Panama/Grenada: During the1980’s American forces re-sponded in freedom’s name inGrenada and Panama. As thecold war ended and the winds offreedom swept across a troubledworld, new threats to the worldcommunity of nations arose in theMiddle East. In 100 hours thethunder and lightning of DesertStorm liberated Kuwait from itsIraqi occupation.

Today: Our armed forces stillstand as a visible symbol offreedom around the world. Theyhave answered every call to armsin the name of liberty for morethan two hundred years and willcontinue to do so. The finalresting place for our fallen heroeswill continue to remind us of thetremendous cost paid for the life,liberty and the pursuit of happi-ness we all enjoy. ❏

25th Anniversary SaluteFocusing on the Future

NCS estimates that the annual number of veterans’ deaths will peak in theyear 2008 at 620,000, before gradually decreasing. In that same year, annualinterments will increase to 104,900, compared to 11,752 in 1973. The totalnumber of graves maintained is projected to increase to 3.1 million. How willNCS prepare for this?

FOUR NEW NATIONAL CEMETERIES By the year 1999, NCS plans toopen four new national cemeteries in Texas, New York, Illinois and Ohio.With a total of 119 national cemeteries, the system’s total acreage will in-crease to over 13,200, tripling the original total of 4,260 in 1973.

EXTEND THE SERVICE LIFE OF EXISTING CEMETERIES Approxi-mately, fifty percent of NCS land is undeveloped, providing the potential formore than 1.6 million additional gravesites. Thirty-nine projects have beenidentified for construction within the next five years to develop this acreage,including major construction projects at national cemeteries in Texas, Floridaand Arizona. Additional land acquisitions adjacent to existing nationalcemeteries are also under review.

COLUMBARIA AND IN-GROUND CREMATION SITES Approximatelyone-third of the interments at national cemeteries involve cremated remains.Recognizing the increased acceptance of cremation and that some cemeteryland is not suitable for casketed burials, NCS has significantly expanded bothin-ground and columbaria features. Ten national cemeteries presently havecolumbaria and NCS is evaluating other possible locations for the future. Allnew cemetery construction, and the majority of our gravesite developmentprojects, now include columbaria. In addition to columbaria, NCS designershave expanded the use of pre-placed, in-ground burial crypts that almostdouble the number of casketed burials per-acre of land.

ENCOURAGE STATES TO BUILD VETERANS CEMETERIES The StateCemetery Grants Program (SCGP), a 50-50 federal/state matching grantprogram established in 1978 to complement NCS, assists states in establish-ing, expanding, or improving state veterans’ cemeteries in areas not servedby a national cemetery. Since the first grant was awarded in 1980, VA hasprovided over 128 grants totaling more than $58 million to assist over 40veterans’ cemeteries in 23 states and Guam. In FY 1997, approximately 12,000veterans and eligible family members were buried in SCGP-supportedveterans cemeteries. To enhance the federal/state partnership, NCS hasproposed legislation to increase the ratio from 50 to 100 percent for the cost ofconstruction and to fund initial equipment costs.

THE GOVERNMENT HEADSTONE AND MARKER PROGRAM Memo-rial Programs Service (MPS) is a National Performance Review reinventionsite. To increase efficiency and reduce costs, MPS was decentralized and re-engineered. Some functions moved from VACO to NCS-owned sites inNashville, Tenn., Fort Leavenworth, Kan., and, Indiantown Gap, Pa. Sincethe Automated Marker Application System (AMAS) redesign in December1996, processing of headstone and markers has improved, while the develop-ment of the Burial Operations Support System (BOSS) has fully automatedthe administration of burial operations and reporting. All national cemeteriesand several state veterans cemeteries now have a direct link to AMAS/BOSS.

INFORMATION RESOURCE MANAGEMENT NCS is certified fully Year2000 compliant. The IRM staff has provided full Internet/Intranet accessibil-ity to its national cemeteries and has developed its own NCS Home Page. Anew touch screen information center (Kiosk) system has been designed toContinued on page 20

12 VAnguard

Dr. Kizer Warns of Y2K Instrument Glitches

D r. Kenneth Kizer, VA UnderSecretary for Health, hascalled for medical devicemanufacturers to step up

disclosures about their products andthe millennium bug threateningcomputers.

At a Washington news confer-ence, Dr. Kizer showed off a varietyof devices, including heart monitorsand blood pumps, that won’t recog-nize the new century and, as a result,may not function properly startingJan. 1, 2000.

Leading a coalition of providergroups, Dr. Kizer warned that with18 months left and tens of thousandsof medical devices in use, the sheernumber of manufacturers andproducts “makes it impossible forany entity to do the testing.” Ac-cording to Dr. Kizer, “We must relyon the manufacturer.”

Dr. Kizer was speaking for acoalition of health-care providers,including VA, the American MedicalAssociation, the American Hospital

Associa-tion andtheAmeri-canNursesAssocia-tion.

Thedevicemakers“need totakeimmedi-ateaction,”

said Dr. Kizer. “It’s going to taketime to address some of theseproblems. This isn’t information thatcan be made available on Dec. 31,1999.”

Dr. Kizer said VA has not yetreceived year 2000 complianceinformation from 30 percent of the1,600 manufacturers it has purchasedequipment from, even though it hassent them four letters.

Among the products Dr. Kizersingled out was a CT scanner.“Despite multiple inquiries, we don‘tknow if these are going to be compli-ant or not,” Dr. Kizer said, pointingto a photo of one of the $1.3 millionunits.

The coalition wants devicemanufacturers to make informationabout their products available tocustomers and the public no laterthan Jan. 31, 1999. The coalition alsocalled for the establishment of anational clearinghouse for informa-tion on problems with medicaldevices used in hospitals and homes.

The health-care industry dependson electronic medical devices con-trolled by microprocessors withembedded programs governingdates and times.

But because references to yearsare often kept as the last two digits ofa date in the 1900s, medical devicescould stop calculating new dates,and compute them instead as“1900”. ❏

T he VA New York/New JerseyVeterans Integrated ServiceNetwork Consortium onHomeless Veterans has

received the Public EmployeesRoundtable (PER) 1998 PublicService Excellence Award in thefederal category.

The Consortium for HomelessVeterans was recognized for excel-lence in providing a seamless con-tinuum of care for homeless veteransthrough innovative, cost-effectiveservice partnerships between VA andthe New York metropolitan areacommunity. It has become a nationalmodel for the planning, coordinationand integration of such programs.

“VA has made a commitment toexcellence in every aspect of healthcare. Helping homeless veterans isone of our highest priorities. We’reproud of the consortium and therecognition it has received,” saidKenneth W. Kizer, M.D., VA UnderSecretary for Health.

The award pays tribute to thehighest standards of excellence andinnovation in federal, state and local

government. By recognizing groupsrather than individuals, the awarddemonstrates the importance ofteamwork in public service.

VA estimates there may be asmany as 12,000 homeless veterans inNew York City, about one-third ofthe total number of homeless adults.During fiscal year 1997, outreachefforts by the consortium reached3,194 veterans who might nototherwise have sought treatment atVA.

Nearly 1,000 veterans wereplaced in either permanent or VA-supported housing, and 512 veteranswere housed in VA domiciliaries. Ofthe domiciliary residents, 62 percentwere housed when discharged fromthe program and 64 percent wereemployed when discharged.

Nationwide, VA estimates thatsome 250,000 homeless persons, orabout one-third of the adult home-less population living on the streetsor in shelters on any given night,have served their country in thearmed services. VA’s major home-less programs constitute the largest

integrated network of homelessassistance programs in the country,offering a wide array of services tohelp veterans recover fromhomelessness and live self-suffi-ciently and independently.

VA directed more than $92million to specialized homelessassistance programs in fiscal year1997, including grants and per diempayments to 23 public and non-profitgroups to assist homeless veterans in15 states and the District of Colum-bia. VA plans to spend more than$96 million on its specialized home-less assistance programs in fiscalyear 1998.

PER is a non-profit, non-partisancoalition of 38 management andprofessional associations represent-ing more than one million publicemployees and retirees. Its missionis to educate the public about wayspublic employees contribute to thequality of life in America, to enhanceexcellence and esprit de corps in thepublic sector, and to encourageinterest in public careers. ❏

National Honor for NY/NJ Homeless Program

Dr. Kizer at Year 2000 newsconference

September/October 1998 13

MEDICALadvances

Dementia Gene Found inHuman Chromosome

Researchers at the VA Health Care System at Puget Soundhave identified a gene that causes a form of dementia. Re-searchers found that nerve cell death was caused by mutationof a gene called Tau. Research showed that the mutated Tauproduced tangles of long string-like filaments identical to thosefound in the brains of Alzheimer’s patients.

Over the past 15 years, the research team has studied afamily whose members frequently develop what appears to beAlzheimer’s disease. The team later identified a second familyaffected by the same disorder and found the same Taumutation.

Dr. Thomas D. Bird, a team member, said: “Our finding mayhelp us learn more about a variety of brain disorders.” The newinformation also points to Tau as a potential target for newtreatment of Alzheimer’s.

Heart Patients ReceiveUnneeded Procedures

More than a quarter of the Americans who have heartattacks each year receive unnecessary procedures to reopentheir clogged arteries. A team of researchers at the Syracuse,NY, VA Medical Center says studies show between 400,000and 600,000 patients each year could avoid coronary angiogra-phy, the high-tech procedure in which a tube is threadedthrough an artery into the heart.

Dr. William Boden, chief of medicine at the VA facility, saidmany patients could also avoid angioplasty, in which theclogged arteries are stretched open with a balloon deviceinserted in the arteries. The VA research found that 462volunteers who had their heart arteries reopened with theballoon technique, or who had bypass surgery, were two-and-a-half times more likely to die within a month after their initialheart attack compared to the 458 patients whose doctors usedless invasive techniques. These techniques include giving clot-dissolving drugs and using exercise stress tests.

The study looked at patients with a type of heart attackknown as non-Q-wave myocardial infarction, which representsat least 55 percent of all heart attacks. Dr. Boden estimatedthat half of that 55 percent should not need aggressive treat-ment. Some patients, however, benefit from the more invasivetechniques, including angiography, angioplasty and bypasssurgery. Patients who need invasive treatment may developchest pain even after being put on drug therapy.

Sleep Disorders Cited asVillain in Study of Stroke Causes

Scientists are learning more about the harmful effects ofsleep disorders because of research at the Sepulveda,

Calif.,VA Medical Center. The studies show a chain reactionthat can cause stroke. When persons suffering from sleepapnea fall asleep, their tongue falls back into their throat,blocking their airway. As they struggle for breath, their bloodpressure rises. The rise in blood pressure damages the innerwalls of the carotid arteries lining the sides of the neck. Then,cholesterol and calcium stick to the injury sites and formcalcified plaques and block blood flow to the brain. The VAstudy used dental X-rays of 47 male veterans who sufferedfrom obstructive sleep apnea. The X-rays show a detailed viewof the neck, enabling scientists to detect whether calcifiedplaques had formed in the carotid arteries. Those X-rays werecompared to those of a healthy, age-matched control group of891 men. Twenty-one percent of the men in the study groupshowed calcified plaques blocking their carotid arteries. Butonly 2.5 percent of the control group had similar blockages.“Our results told us that the increased stroke risk was comingfrom the neck, not another part of the body,” says Dr. ArthurFriedlander, who chairs the department of dentistry at themedical center. “The calcium deposits are just the tip of theiceberg. The X-ray can’t show the true size of the plaque,which is also made up of fat, platelets and other soft tissue.”

New Treatment May RelievePatients with Back Pain

Thousands of veterans suffering from lower pack pain maybe able to avoid surgery, thanks to a new outpatient medicalprocedure being performed at the Columbia, S.C., VA MedicalCenter.

The new procedure, epiduroscopy, allows doctors to use aprobe to explore soft tissues in the lower back that do not showup on X-ray, CT or MRI scans. By providing a live, color imageof the area, it makes possible an accurate diagnosis of the low-back soft tissue.

A small incision is made to accommodate a miniaturefiberscope. The probe then explores the epidural space, thearea surrounding the spinal cord. The patient is conscious andassists by directing the doctor to the areas of pain.

Lowering Blood Pressure HelpsCut Heart Disease

A new study shows lowering diastolic blood pressurebeyond the currently recommended levels can help reduceheart attacks. In the VA Hypertension Optimal Treatment(HOT) study, the number of cardiovascular disease deaths washigher in patients targeted to 90 on blood pressure gauges than80 (90 mmHg versus 80 mmHg).

Dr. Fred A. Fass, with the Central Arkansas VA HealthcareSystem, participated as a researcher in the HOT study, whichfollowed 18,790 patients in 26 countries over a five-year period.More than double the patients in the study sustained a majorcardiovascular event with a diastolic blood pressure of 90 asopposed to those targeted to 80. The study also confirmed thatthe addition of aspirin is beneficial in reducing death and illnessin patients with well controlled hypertension. ❏

14 VAnguard

HONORSand awards

Three Fargo, N.D., VAMedical Center physiciansreceived awards from theUniversity of North DakotaSchool of Medicine andHealth Sciences: Dr. MarkIngebretson received the1998 Dean’s Special Recogni-tion Award for OutstandingVolunteer Faculty; Dr. KushalHanda , chief cardiologist,received the 1998 Outstand-ing Campus Preceptor Award;and Dr. William Newman ,chief endocrinologist, receivedthe 1998 Reverend Elmer andMin West Memorial FacilityAward.

The North ChicagoMedical Center’s IntensivePsychiatric CommunityCare Team and Police andSecurity Team were desig-nated finalists in the ChicagoFederal Executive Board’s1998 Federal EmployeeAwards Program for theirinnovative service to veteransand to the community.

The Memphis AreaFederal Executive Associationhonored these Memphis,Tenn., VA Medical Centeremployees for their publicservice contributions andprofessional excellence:Marlin D. Angell , medicaladministration officer,received the OutstandingManagerial/Executive Award;Almeda J. Williams , supervi-sory dietitian, received theOutstanding SupervisorAward; N. Timothy Smith ,computer specialist, receivedthe Outstanding SpecialistAward; Karen B.Whittington , biologicalsciences laboratory techni-cian, received the Outstand-

ing Technical/AssistantAward; Mary A. Sumler ,secretary, won the Outstand-ing Secretary Award; Mary A.Sorensen , program supportclerk, received the Outstand-ing Clerical Award; Mary AnnGiampapam , Constance K.Haan, John Riddle , andDaryl Weiman won theGroup/Team Award for TotalQuality Improvement; NancyAppling , Constance Haan ,and E. Van Thompson wonthe Group Award for Out-standing Public Service; andHerbert Alexander andEstell Leverston received theHeroism/Valor Award.

Gary J. Krump , assistantsecretary for Acquisition andMaterial Management, waselected as a fellow in theNational Contract Manage-ment Association for hiscontributions in the field offederal acquisitions andcontract management.

Two Little Rock VA MedicalCenter physicans wereselected as officers in theSouthwestern SurgicalCongress. Nicholas P. Lang,M.D., chief of surgical service,

is FirstVicePresi-dent, andJohn F.Eidt,M.D., avascularsurgeon,

is a State Councillor for theCongress.

Ivelysse Swan , staffassistant/associate director,New York VA Medical Center,was advanced to diplomat

status in the AmericanCollege of HealthcareExecutives for her commit-ment to continuing education,professional experience andparticipation in voluntaryhealth-care and communityaffairs.

Linda A. McVey , healthsystems specialist andconsultant for theNorthampton, Mass., MedicalCenter, was advanced todiplomat status in the Ameri-can College of HealthcareExecutives for her commit-ment to continuing education,professional experience andparticipation in voluntaryhealth-care and communityaffairs.

Robert E. Coy , recentlyretired VA general counsel/deputy general counsel, waspresented the ExceptionalService Award for his 40years of government service,38 of them with VA. This isthe Department’s highesthonor.

Washington GovernorGary Locke presented theGovernor’s Award for Serviceand Quality Improvement tothe VA Fort Lewis Team ,comprised of employees fromthe Seattle VA RegionalOffice, the VA Puget SoundHealth Care System, theWashington Department ofVeterans Affairs, the Ameri-can Legion and the Army.The award noted thatparticipants had “joinedtogether in a collaborativeeffort to improve the processof providing benefit informa-tion and responses” forseparating military personnelat Ft. Lewis and McChordAFB. Formerly, individualsleaving the Army or Air Forceat these facilities had to waitup to eight months for a VAclaim decision. The teamestablished processes todevelop and adjudicate theclaim while the service person

is still on active duty, with afinal VA decision issued 30days or less after actualseparation.

The Carl T. Hayden VAMedical Center , Phoenix,Ariz., is one of four winners ofthe John N. SturdivantNational Partnership Award.This is the first VA facility tobe so honored as an out-standing example of howlabor-management partner-ships are meeting theNational Partnership forReinventing Government’s(NPR) goal of a governmentthat “works better and costsless.”

The Friends of FisherHouse Foundation , Inc., hasbeen recognized as a Point ofLight by the Points of LightFoundation for voluntaryservice to the community.The Foundation builds andmaintains “comfort homes” atVA and military medicalcenters that offer temporarylodging to patients and theirfamilies. Hundreds of VAvolunteers are part of thenearly 3,000 volunteers thatraise funds, equip andoperate 26 “Fisher Houses.”

Karla Overland-Janssenof the Hot Springs, S.D., VAMedical Center, received theSouth Dakota PharmacistsAssociation Young Pharma-cist Award. She manages theoutpatient anti-coagulationclinic and is active in patienteducation.

Fort Meade, S.D., VAMedical Center’s SteveWilliams assumed thepresidency of the SouthDakota Academy of Physi-cians Assistants. A memberof the academy since 1981,he works in the center’snursing home care unit.

Robert W. McCarley,M.D., deputy chief of staff formental health at the Brockton/

Lang

September/October 1998 15

West Roxbury, Mass., VAMedical Center, received the1998 American PsychiatricAssociation Award forResearch at the group’sannual meeting in Toronto.Dr. McCarley’s researchinterests include the basicneurophysiology and neuro-pharmacology of sleep andwakefulness.

Meacham-Muhammed ,an infant teacher at theTuscaloosa, Ala., VA MedicalCenter Child Educare Center,received Childcare Online’sfirst Caregiver of the MonthAward. She was nominatedby the parent of a 13-month-old child who began receivingcare at the center when hewas eight weeks old. Theseven-year-old child carecenter was five years inplanning and has space for 44infants and toddlers, from sixweeks to kindergarten.

Lloyd E. Rader, Jr., M.D. ,chief of the outpatientpsychiatry residency trainingunit at the Little Rock, Ark.,VA Medical Center, wasnamed National Teacher ofthe Year for 1998 by theAssociation for AcademicPsychiatry. Rader also is anassociate professor at theUniversity of ArkansasMedical School and receivedthe school’s Red Sash Awardthis year in recognition of histeaching.

Melodee Mercer , head ofthe Philadelphia VARO&ICReader Focused Writing(RFW) program, receivedspecial thanks from theNational Partnership forReinventing Government forher rewriting “in plain lan-guage” of the new “Medicareand You” booklet. The HealthCare Finance Administrationwill release to booklet laterthis year to 33.5 millionMedicare beneficiaries. It willbe one of the first majorpublications issued after the

October 1 start of thePresident’s initiative directingthat all new governmentdocuments be written in plainlanguage.

Linda B. Haas, Ph.C.,R.N., endocrinology clinicalnurse at the Seattle VAMedical Center, was electedPresident for Health Care andEducation of the AmericanDiabetes Association. Shehas been an active DiabetesAssociation volunteer formany years and has servedthe association at state andnational levels. She is also aclinical assistant professor atthe University of WashingtonSchool of Nursing.

The Jacksonville, Fla., VetCenter honored DisabledAmerican Veterans (DAV)service officer Bob Padgettfor 16 years of volunteerservice to northeast Floridaveterans. Padgett beganworking at the Vet Center in1982 and has logged morethan 5,000 volunteer hours.He often works with troubledand destitute veterans afterhours. He is a past nationalcommander of the MilitaryOrder of the Purple Heart.

Charles J. Jones , St.Paul, Minn.,VA RegionalOffice vocational rehabilitationspecialist, was namedNational Veterans BusinessAdvocate of the Year by theU.S. Small Business Adminis-tration (SBA). More than 675veterans receive vocationalrehabilitation under Jone’ssupervision and he hassuccessfully assisted another177 into jobs or self-employ-ment. He has worked withstate small business develop-ment centers to help disabledveterans start a number ofsuccessful enterprises suchas a gunsmith service,trucking, farming, a restaurantand free-lance art business.

Anthony Winckowski ,

DSW, director of Social WorkGraduate and In-ServiceEducation at the West LosAngeles VA Medical Center,received the Heart of SocialWork Award at the annualconference of the Council onSocial Work Education. Theaward recognizes excellencein partnerships between socialwork schools and fieldinstructors of exceptional skilland expertise. This is the firsttime that the award recipientwas nominated jointly by threemajor social work schools.

VA Deputy Assistant Secre-tary for Equal OpportunityGerald K. Hinch , receivedthe Distinguished ServiceAward from the Federal AsianPacific American Council

(FAPAC)duringthatgroup’sCon-gres-sionalLun-cheon.

He was recognized for hismany contributions, includingcareer advancement work-shops conducted for FAPAC.

The VA Center forExcellence in FunctionalElectrical Stimulation (FES)in Cleveland was honored bybusiness, government andrehabilitation scientists thisyear for development of ahand-grasp neuroprosthesisknown as the FreehandSystem. The RehabilitationEngineering Society of NorthAmerica presented itsLeadership Award to FES forcontributions to the advance-ment of assistive technologyfor persons with disabilities.FES Director P. HulnterPeckham, Ph.D., received aspecial citation from theCommissioner of the Foodand Drug Administration for a“dedicated career to restoringmovement and independenceto those who are paralyzed.”

And FES received recognitionfrom Cleveland’s EnterpriseDevelopment, Inc., fordeveloping an idea resultingin measurable benefits tobusiness and society. FES ispart of the Cleveland Func-tional Electrical StimulationConsortium that includes theVA Medical Center, CaseWestern Reserve Universityand the MetroHealth MedicalCenter.

Gary J. Young, Ph.D. , ofthe VA Health ServicesResearch ManagementDecision and ResearchCenter at Boston VA MedicalCenter, was awarded the1998 Thompson Prize forYoung Investigators by theAssociation of UniversityPrograms in Health Adminis-tration. A frequent contributorto leading health careresearch and managementjournals, Young won the 1997Best Paper Award from theHealth Care AdministrationDivision of the Academy ofManagement.

Florida CongressmanMark Foley presented VAyouth volunteer FreddieEvans the Bronze MedalCongressional Award at WestPalm Beach, Fla., VA MedicalCenter. The award recog-nizes achievement of rigorousdevelopmental standards in

fourareas:voluntaryservice,personaldevelop-ment,physicalfitness

and expedition leadership.When notified of the award,Freddie wrote to Congress-man Foley and asked him to“come to the hospital and seewhat I do.” The Congressmantook him up on the invitation.Freddie took him on a tour ofthe center’s extended care fa-cility where he volunteers. ❏

Evans

Hinch

16 VAnguard

you heardHAVE

The Veterans BenefitsAdministration (VBA) hasinstalled a toll-free telephonenumber to enable veterans inOklahoma, New Mexico andWashington to call educationcounselors at the Muskogee,Okla., regional processingoffice (RPO) . Soon, callers to888-GI BILL 1 will haveaccess — through an auto-mated response system — toinformation specific to theireducation benefits status.

The Downtown Division ofthe Augusta, Ga., VAMCrecently opened an outpatient“mall,” which completes thefirst phase of an ambulatorycare renovation and addition.The completed project willprovide 14,000 sq. ft. of newspace and renovate 15,000sq. ft. of existing space for fiveprimary care team clinics. Thespace also will house sched-

uled admissions, compensa-tion and pension examina-tions and the office of specialprograms such as PersianGulf treatment.

The “Digi Drive” high-techcar driving system at theRichmond, Va., VAMC — anew concept that eliminatesthe steering wheel — is train-ing severely disabled veteranswho were only able to dreamabout driving. The systemuses a single joystick forsteering, braking and acceler-ating. Other equipment usesdigital touch pads andswitches. Trainees’ responsehas been overwhelminglypositive in spite of the re-quired 40 hours of instruction.

Private pilots will flyveteran patients to VAmedical centers under anagreement signed between

VA, the Disabled AmericanVeterans (DAV) and theNational 210 Owners Associa-tion (a pilots group). TheAssociation’s AmericanVeterans’ Medical AirliftService division will recruitqualified pilots and DAV willprovide ground transportationfrom patients’ homes toairports and back. Arrange-ments for the service aremade through VA chiefs ofstaff at treatment sites.

James Mayer , formerly inVA Central Office VoluntaryService, has been appointedexecutive director of Leader-ship VA, succeeding long-timedirector Dana Moore , who isnow director of operations,Office of the InspectorGeneral. Robert L. Jones ,former special assistant to theAssistant Secretary for Publicand Intergovernmental Affairs,is now deputy assistantsecretary of defense for POW/Missing Personnel Affairs inDoD.

VA has awarded a $11million contract to build thefirst phase of a Cleveland-area national cemetery . The60-acre initial phase willinclude nearly 16,000 full-casket gravesites and 3,000sites for cremated remains.The 274-acre site is 45 milessouth of Cleveland, nearRittman, Ohio. Burials willbegin in late 1999.

There is no bigger day forveterans and VA thanVeterans Day. Thoseplanning Veterans Dayobservances should check outweb site http://www.va.gov/pubaff/vetday98/vetsday.htm . The site wasadded to VA’s intra- andinternet home pages to assistVA employees, veteransservice organizations, schoolsand others interested inplanning Veterans Dayprograms for November 11.The site contains information

about the history of VeteransDay and Veterans Dayactivities planned in Washing-ton, D.C., and around thecountry. You will find informa-tion about the Veterans DayNational Committee, VeteransDay Regional Sites and theVeterans Day school informa-tion packet that can bedownload as a PDF file.There are links to otherVeterans Day informationpages, the Veterans DayPoster, Veterans DayPresidential Proclamation,State Directors of VeteransAffairs and related sites. TheVeterans Day web site alsoallows sharing of comments,questions or program materi-als with others.

The first medical supplytechnician certificate issued toa VA patient went to RalphNicander at the White City,Ore., Domiciliary. He com-pleted six months of on-jobsupply processing anddistribution (SPD) training,with academic work, toprepare him for employment.The SPD program developedwhen VA’s Acquisition andMateriel Management Serviceidentified a need for better VAservice and high employmentdemand in both governmentand private-sector health carein the region. Communityhospitals and a communitycollege facilitate the training.SPD assures aseptic condi-tions and consistent distribu-tion of medical/surgicalsupplies and equipment. Lastyear, White City’s employ-ment program served 365patients.

The Pittsburgh VARegional Office and the VAHealthcare System held aveterans forum earlier thisyear to commemorate ArmedForces Day and to reachunderemployed youngerminority veterans. VAminority veteran coordinatorschose Saturday for the event

Fort Meade, S.D., VA Medical Center staff take a buckboard wagontour of historic Fort Meade and help celebrate the fort’s 120th birthdayas a military post. The ride took them to a Cavalry Days military ball.Fort Meade is the first military post where the U.S. national anthemwas played, and was home to the 4th and 7th Cavalry Divisions. Ithas been home to the VA hospital since 1946.

September/October 1998 17

and held it in a predominantlyAfrican-American community.The forum included not onlyhealth screening for condi-tions prevalent among blackveterans but also a job fairwith employers and person-nel counselors.

The FY 1997 AnnualReport of the Secretary ofVeterans Affairs is availableon the intranet atvaww.va.gov/corpinfo. Asingle copy is also available atVA medical center libraries.Unlike past reports, it followsa format similar to VA’sStrategic Plan for 1998through 2003, reporting therelationship between re-sources and achievements.

A new “One-VA Em-ployee One-Stop” web siteoffers employees informationaimed at developing job skills,teamwork, a family-friendlyworkplace, mentoring,networking and diversity. Theintranet address is http://vaww.va.gov/1vaemployee .(On the Internet, changevaww to www.) Site creatorMichael A. Moore, of VA’sOffice of Policy and Planning,says employees can makesuggestions for site improve-ment by contacting any of themany “One-VA Champions”listed under “collaborativeeffort.” A few of the champi-ons include the VA AsianPacific American HeritageCouncil, VA Blacks inGovernment, the VA HispanicAssociation, and VA repre-sentatives to the President’sInteragency Council onWomen. Moore called thecollaborative web site a steptoward fulfilling needsidentified in the One-VAEmployee Survey. He chairsthe VA Minority Forum,another “champion” group.The Forum aims to drawtogether leaders and em-ployee volunteer groups forwomen, minorities and peoplewith disabilities to further the

goal of making VA anemployer of choice.

The Iowa City VAMC helda slogan contest for third,fourth and fifth grade studentsat Hamilton ElementarySchool in Hamilton, Ill., tohelp name a memorial wallerected at the hospital tohonor deceased veterans.The winning slogan, “TheUnforgettable Heroes” fromMikayla O’Brien, has beeninscribed on the wall. Ateacher at the school and hergrandmother had the idea forthe wall in memory of theelder woman’s husband, aWorld War II veteran. Recog-nition and saving bonds wentto the winner and tworunners- up at a schoolassembly. The program alsofeatured discussions aboutwho veterans are. HamiltonElementary School plans anannual essay contest to thankveterans each Veterans Day.

More than 1,000 veteransand family members havestayed at the Albany, N.Y.,VAMC Fisher House since itopened in 1994, but neverhas the comfort house hosteda more distinguished groupthan when six Medal of Honorrecipients toured the facility.Held in conjunction with theCongressional Medal ofHonor Society’s conventionnearby, the tour introduced

the recipients to the FisherHouse network of guesthouses that accommodatepeople visiting loved ones inVA hospitals.

Minneapolis VA MedicalCenter researchers HerbertNagasawa , Ph.D., and DonShoeman , Ph.D., entered acontest sponsored by acompany searching for thelongest running EppendorfMicro Centrifuge. They werepleasantly surprised whentheir research lab turned outto have it. Theirs was a 1968model, one-third the size ofthe new $3,000 model whichthe hospital received as aprize. The centrifuge sepa-rates blood components byspinning solutions at very highspeeds.

The deadline for changingfrom the Civil Service Retire-ment System (CSRS) to theFederal Employees Retire-ment System (FERS) isDecember 31. The SF 3109Election Form must be filledout and given to humanresources offices by that dateto make the change to FERS.Employees in organizationsparticipating as prototypesites in HRLink$ will notreceive a paper copy of theform, since they makechanges through the interac-tive phone system, a kiosk orby calling a service represen-

tative at 800-414-5272.VA has received authority

to grant voluntary earlyretirement until Sept. 30,1999 (an extension of a year).Management may choose touse the new authority inlocations where it wants tofacilitate reorganization anddownsizing and to ease theeffect of reductions in force.

A CD-ROM forAlzheimer’s caregivers is theresult of collaborationbetween the MinneapolisGeriatric Research Educa-tion Clinical Center(GRECC) and the VeteransHealth AdministrationEmployee Education System.The interactive multimediaapplication provides tailored,individualized instruction forthose who live with and carefor Alzheimer’s patients. Itincludes a caregiver-basedassessment that allows theuser to select information andstrategies most relevant totheir particular needs. Basedon the extensive clinical andcaregiver education of itsauthors, the program isprincipally aimed at develop-ing and strengthening theskills of family members inproviding daily care for aperson with dementia. Theunderlying principles havebeen used in numerousGRECC programs that havedecreased patients’ behav-ioral problems and helpedrelieve the stress forcaregivers. For more informa-tion, call the MinneapolisGRECC at (612) 725-2051, orFTS (700) 780-2051, or e-mailadelsonric@lrn.va.gov ormaddox.melitta@minneapolis.va.gov .

Planning a Veterans Dayobservance? Check theVeterans Day website on theVA home page at http://www.va.gov/pubaff/vetday98/vetsday.htm . ❏

Medal of Honor recipients visit the Albany VAMC Fisher Houseduring their convention.

18 VAnguard

HEROES✩ ✩ ✩ ✩ ✩

Birmingham VA MedicalCenter optometrist Patti Fuhr,OD, PhD, coordinated ahumanitarian eye-caremission to Brazil underauspices of the VolunteerOptometric Service toHumanity. During themission, Dr. Fuhr and fiveother volunteers visited aremote state with a populationof 250,000 served by only foureye-care providers. Sixtypercent of the population isunder 20 and the mean age ofdeath is 56, mainly due toparasitic infections. Thevolunteer team providedservices to as many people aspossible. Outlying tribes ofIndians from the Amazon rainforest trekked in for eye caredespite the threat of bandits.The volunteers treated morethan 1,200 people, providingexaminations, medicationsand recycled eyeglassesduring the one-week stay.Medications primarily were foreye infections and glaucoma.Lines were long and somehad to be turned away.

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Huntington, W. Va., VAMedical Center pharmacytechnician Margaret Hodgereceived a call from adistraught veteran who saidhe had run out of his medica-tion and was going to killhimself. Hodge kept theveteran occupied on thephone while getting theattention of pharmacist MikePerdue who contacted MentalHealth services for assis-tance. She assured theveteran that VA would get hismedicine to him. The patientwas taking Dilantin for Grand

Mal seizures and didn’t wantto go through another seizure.Hodge gained the veteran’sconfidence and said shewould personally deliver hisDilantin. After a 30-minuteconversation, Hodge andmental health workers wereconfident that the veteran wascalm or no longer suicidal.Hodge and her husband laterdrove to the veteran’s home,an hour from the medicalcenter, and delivered hisprescription.

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Two VA Western NewYork Healthcare Systempolice officers, MichaelMelerski and TimothyWagner , responded to a carfire on the main thoroughfarein front of the VA medicalcenter. They found the driverin the vehicle and used fireextinguishers to put out thefire while she was removedfrom the car. The twosecured the scene untilemergency response teamsarrived.

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While driving home fromwork, VA Hudson Valley,N.Y., Health Care Systemmedical administrativespecialist Sue Antonio wasfirst on the scene of a head-on car crash. She called 911with her cell phone andreported that the driver of onecar was unconscious, butalive. She kept the otherdriver, pinned in his car, calmand called his family at hisrequest. Antonio stayed on-scene until emergencyresponse teams arrived.

Iowa City VA MedicalCenter renal and infectiousdisease case managerSharon Gefaller, R.N. ,arrived at the scene of aserious van accident andimmediately began helpingparamedics. The van,carrying nine people hadoverturned into a ditch.Working in knee-deep water,Gefaller found severalseriously injured people still inthe van and helped stabilizethem until they could betransported to area hospitals.

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When Miami VA MedicalCenter Registered NurseBessie Garrett received theUnited Way Green FamilyFoundation American ValuesAward and a $5,000 check,she knew exactly what shewanted to do with the money.Last month, more than 50homeless children and theirmoms left on an all-expensepaid trip to Disney Worldthanks to Bessie and theGreen Family Foundation.Bessie is a special immunol-ogy nurse at the VA medicalcenter who works as acommunity volunteer toprovide basic health care andassistance to the homeless.“These children have beenhungry all of their life and arelooking after their moms,” shesaid. “It’s my dream to givethe kids their childhood beforeit is too late.”

Karen Hendry, R.N. , ofthe Biloxi/Gulfport, Miss., VAMedical Center, came upon acar accident while driving toher weekend military reservedrill. She had to crawl throughthe broken rear window toreach an injured front-seatpassenger. Persuading thedriver not to move thepassenger because ofpossible back and neckinjuries, she stayed in thewrecked car with the victimuntil an ambulance arrived.

The “Jaws of Life” had to beused to remove the injuredperson.

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A troubled World War IIveteran wrote a letter to thePresident to have his sus-pended VA pension rein-stated. The letter made itsway to Bert Compton ,customer service specialist inthe Nashville VA RegionalOffice’s Special Activity. Shequickly took care of theveteran’s immediate problemby obtaining some necessarytechnical information. But shedidn’t stop there. In reviewingthe veteran’s files, she noticedreferences to his war timeexperiences and how theyaffected him. Her supervisorencouraged her to developthe possibility of serviceconnection for the veteran.After determining that theveteran’s documented warexperiences possibly couldhave contributed to or causedthe PTSD-type symptoms henow displayed, Comptonphoned the veteran andpersuaded him to file forservice-connected disabilitycompensation. The veteranwas very suspicious andreluctant. He missed exami-nation appointments, butCompton persisted. Shearranged transportation forthe veteran with the Veteransof Foreign Wars and theveteran was finally awarded a50 percent service-connecteddisability rating for PTSD.

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Roseberg, Ore., VAMedical Center registerednurse Marilyn Eifert expectedanother routine call from aveteran, but as she listened tothe troubled voice on herphone, she realized she wasdealing with life and death.The veteran had a gun andthreatened to kill himself.Eifert engaged the veteran for

September/October 1998 19

half an hour, distracting himuntil police arrived at hishome. Things got tense whenthe veteran refused to let thepolice in. Still talking to himon the phone, Eifert remainedcalm and supportive until theveteran finally relented.

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Providence, R.I., VAMedical Center librarianCheryl Banick was taking herusual four-mile walk along thewaterfront in Warwick, R.I.,when a boy ran up beggingher to help his five-year-oldbrother. She followed him tohis brother who was bleedingprofusely from the mouth, apool of blood at his feet.Banick saw three people inthe vicinity and called them tohelp. None knew what to do,so she told them how to stopthe bleeding, keep the boybreathing, what to do in caseof vomiting, and how to applyice to the head. She thenflagged down a motorist andinstructed him to call 911 andreport the boy’s situation. Anambulance arrived a fewminutes later and Banickdirected traffic so the emer-gency response team couldget to the child. While all thiswas occurring, the boy’smother, who had gone to gether children ice cream, arrivedon the scene. As she ran toher son, she clutched herchest and fell to the ground.Banick directed rescueworkers to help her, as well.The boy and mother weretaken to a local hospital andsubsequently recovered. Oneof the rescue workers saidthat the boy had suffered avery serious injury and that ifBanick had not responded asshe did, the patient couldeasily have died.

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Cleveland VA MedicalCenter (Brecksville Division)registered nurse Barb Klatka

was snorkeling in the GrandCayman Islands during aMarch vacation when sheheard yells for help out on thewater. A fellow snorkeler fromher boat had suffered a heartattack while swimming. Hewas brought aboard the boatand Barb began CPRbreathing for the strickenman. Her emergencybreathing kept the victim aliveuntil the boat reach shore andan awaiting emergencyrescue team, but he later diedon his way to the hospital.

✩ ✩ ✩ ✩ ✩

Four Omaha VA MedicalCenter employees were partof a ten-person health-careteam that visited a smallvillage in central India earlierthis year and spent severalweeks providing care to theinhabitants. They were:David. M. Chacko , M.D.,Ph.D., and eye specialist wholed the team; husband-wifeoperating room techniciansLarry and Becky Rohe ; andoperating room nurse DeniseCuevas . The team performed215 eye procedures, 188 ofwhich were cataract removalswith lens implants. The tripwas financed with donationsfrom the Nebraska LionsClub, the Nebraska HealthSystem, pharmaceutical firms,friends and family.

✩ ✩ ✩ ✩ ✩

While on vacation toAlaska, Boise, Idaho, VAMedical Center registerednurse Mike Farruggia cameacross an auto accident innorthern British Columbia,near the Yukon border. A carhad veered off the highway,rolling several times. Thedriver was trapped inside.Farruggia directed theremoval of the driver from thecar. He determined that thedriver had a dislocatedshoulder and a number ofbroken ribs and had him

moved to a hotel a few milesaway and cared for him until amed-evac aircraft arrived.Ironically, the victim, a WorldWar II veteran on his way tovisit his son in Alaska, askedif there was a VA facilitynearby. Farruggia informedhim that there was no VAfacility in Canada but that hewas being cared for by a VAnurse.

✩ ✩ ✩ ✩ ✩

Giovani Rivera , a veteranworking at the Ponce, P.R.,VA Outpatient Clinic in thework-study program, wasrecognized by the clinicdirector and his veteransbenefits counselor for turningin to authorities an envelopecontaining $2,000 cash. VAofficials said that Riveraturned in the envelope withouthesitation and it was returnedto its owner, a fellow veteran.

✩ ✩ ✩ ✩ ✩

When North Chicago VAMedical Center police officersBruce Culver and JohnHoward responded to a firealarm in a campus outbuild-ing, they noticed smokecoming out a second-floorwindow. Hearing a faint voice,they entered the building andrescued a patient. Thepatient and officers weretreated for smoke inhalationand released in good condi-tion.

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John Syme was on hisway from his job at theFayetteville, N.C., VA MedicalCenter to a doctor’s appoint-ment when he came across awrecked sports utility vehicle.A crowd had already gath-ered; some were dousing thevehicle with fire extinguishers.As he walked to the wreck,Syme saw that the driver wasstill in the driver’s seat,unconscious and badly hurt.

People were afraid to moveher, fearing she had a brokenneck. Grass around thewrecked vehicle was begin-ning to burn and a power polethe car was wedged againstwas starting to flame. Thefront doors were jammed andSyme opened the back doorof the vehicle. He carefullybegan pulling the victim backover the fully reclined driver’sseat and out of the wreck.Others assisted and after theyremoved the victim, her carbegan to burn furiously. Thedriver suffered numerousinjuries, but is recovering.“The only reason she’saround today,” said herbusiness associate, “is thatsomeone was there for her.”

✩ ✩ ✩ ✩ ✩

It was a sweltering Texasafternoon at the Waco VARegional Office. Manage-ment analyst Carolyn Webbnoticed that a veteran doingcontract work in the director’soffice didn’t look well. Whenshe asked, he explained thathe had no air conditioning inhis apartment where thetemperature had reached 116degrees the previous evening.He said he was diabetic andhis blood sugar had droppedto a dangerous level. Carolyncalled a number of offices andagencies to assist the veteranbut was unsuccessful. Shethen went to her assistantdirector Larry Burks whocalled the local United Wayoffice which located a windowair conditioner donated by alocal businessman.

✩ ✩ ✩ ✩ ✩

While attending a porkexposition at the Iowa StateFair grounds in Des Moines,Knoxville VA Medical Centerpsychiatric nursing assistantKevin DeGoey rescued achild who was choking on alarge piece of pork with theHeimlich maneuver. ❏

20 VAnguard

Letter to the Editor: No ‘Robotic Pharmacists’ in VA!

I was disconcerted by the page 5 article (May/June 1998 Vanguard),“‘Robotic Pharmacists Cut Waiting Time for Veterans’ Prescriptions.” What isbeing implemented is an automated system for filling prescriptions, not a “roboticpharmacist.” I know that many pharmacists are harried by the title of the article.Its contents details the need to shorten waiting times for VA patients, and I fullysupport the concept and statement.

But pharmacists are no longer trained to count, label and pour prescriptions.Our education goes far beyond that. As a doctor of pharmacy, I came to VA dueto the available opportunities — opportunities to educate, manage patientmedication therapy, and provide medication-specific knowledge that only comesfrom a pharmacist.

Pharmacists are not in VA’s system to be replaced by robots, but to takeadvantage of the many needed opportunities that exist. When a robotic system isdeveloped to give patients their daily medication, will they be called “roboticnurses?” Were radiologists replaced by MRI scanners? The answer is no!Systems are added to adjunct the care that is provided, to improve outcomesand, yes, even to cut costs, but not to replace a viable, growing and valuableresource.

Marcus C. Raven, Pharm.D.Clinical Coordinator, Pharmacy ServicesVA Medical CenterFresno, Calif.

Nurse Executive Renita C. Johnson discusses the core values expressed on posters withnursing students of Mississippi Gulf Coast Community College.

A fter Nursing Service at Biloxi,Miss., VAMC split intoservice lines, Nurse ExecutiveRenita C. Johnson, R.N.,

M.S.N., sensed the need to bind morethan 500 nurses together in a processto establish a unifying mission. Lastfall she started consensus-buildingmeetings — structured with a“script” of poetry, songs and draw-ings contributed by Biloxi nurses.The result last spring was a celebra-tion of core professional valuesemblazoned on tee shirts duringNurse Appreciation Week.

Teams within service linesfocused on objectives supportingpatient-centered care. Team facilita-tors met with all nurses of the Biloxiand Gulfport Divisions of network 16and its outpatient clinics in Mobile,Ala., and Pensacola, Fla., to identifytheir core values for nursing care. Infocus and work groups, facilitatorshelped team members examinechange in their work, find out whatmotivated them as caregivers andexpress their individual professionalvalues.

Those values turned out to besimilar to the ones announced laterfor all of the Veterans Health Admin-istration by Under Secretary Dr.Kenneth Kizer — caring, trust,compassion, integrity, respect,credibility, communication andexcellence.

Biloxi VAMC Nurses Define Core Values

From these, the nurses derived aconceptual model for maintaininghigh standards of care. Johnson saidit also allowed them to take controlof the changes affecting their work.In early 1998 the teams published amission and vision statement, and in

May they shared their values with allemployees. Nurse MelanieCovacevich used the nursing staff’sdrawings and values to design a T-shirt displaying them. It’s beingworn throughout the Biloxi VAHealthcare System and community. ❏

From on page 11provide visitors with NCS, cemeteryand specific gravesite locationinformation.

COMPENSATED WORKTHERAPY PROGRAM In 1995, anNCS and VHA national agreementformalized a partnership betweenVA national cemeteries and VACompensated Work Therapy/Veterans Industries (CWT) program.National cemeteries are provided asupplemental work force whiledisabled veterans receive pay, regainwork habits and learn new skills.Since 1993, 22 partnerships have ledto more than 100 participants work-ing annually at national cemeteries. ❏

By Steven Westerfeld