[Congressional Record Volume 151, Number 100 (Thursday, July 21, 2005)]
[Extensions of Remarks]
[Pages E1559-E1561]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 RECOGNIZING THE 75TH ANNIVERSARY OF THE ESTABLISHMENT OF THE VETERANS 
                             ADMINISTRATION

                                 ______
                                 

                            HON. LANE EVANS

                              of illinois

                    in the house of representatives

                        Thursday, July 21, 2005

  Mr. EVANS. Mr. Speaker, today marks the 75th anniversary of the 
establishment of the Veterans Administration, what is now the 
Department of Veterans Affairs. Since the VA's inception, more than 33 
million Americans have become veterans, and 25 million veterans are 
alive today.
  When President Hoover declared the Veterans Administration to be 
``one of the most important functions of Government,'' he couldn't have 
been more right. It is one of our greatest callings and duties to 
provide care for those who sacrificed so much to preserve the liberties 
and freedoms we enjoy.
  The importance of this anniversary isn't just to mark the longevity 
of a federal agency, it is to honor and recognize the department's 
quality execution of its great and noble mission

[[Page E1560]]

``. . . to care for him who shall have borne the battle and for his 
widow and his orphan.''
  The Department of Veterans Affairs operates the largest integrated 
health care system in the country, maintaining 1,300 clinics, nursing 
homes, hospitals, and other medical sites, and it is a system which 
pioneers advances in medicine, such as telemedicine and prosthetics, 
which improves the lives of all Americans, not just veterans. In fact, 
three Nobel Prize in Medicine recipients were VA doctors.
  Indeed, in keeping true to its mission, the VA has provided benefits 
to many spouses and dependents of our Nation's veterans by providing 
housing loan assistance and education benefits; and, when a veteran's 
noble life comes to its end, the VA's mission does not end, as it 
provides burial assistance for families, operating 120 national 
cemeteries in the United States and Puerto Rico.
  It is our responsibility, Mr. Speaker, as representatives of this 
great Nation's veterans, to uphold our commitment to them; to provide 
for them and their families the best care available; and to do that, we 
must enable the Department of Veterans Affairs to endure and build upon 
its impressive legacy.
  Today a new generation is coming to understand the sacrifices that 
come with service. As they join the ranks of our Nation's veterans, our 
commitment to them cannot be any less than it has been to past 
generations, and to the veterans still with us that depend so greatly 
on the Department's care.
  And so, though we mark a great milestone in the Department of 
Veterans Affairs history, let us not forget that its mission continues 
and that its success is dependent on our dedication to its cause.
  Mr. Speaker, I would like to submit for the record an article from 
U.S. News and World Report, dated July 18 of this year, ``Military 
Might,'' that powerfully demonstrates the impact of today's Department 
of Veterans Affairs and the legacy it is building for future veterans.

               [U.S. News & World Report, July 18, 2005]

                             Military Might


           Today's VA hospitals are models of top-notch care

                       (By Christopher J. Gearon)

       Three summers ago, Augustin Martinez's skin was yellow. He 
     was in pain. And physicians at Kaiser Permanente, his usual 
     source of care, were baffled. The frustrated Martinez, a 
     retired Lockheed Martin engineer in San Jose, Calif., asked 
     his brother, a New York physician, for advice. After 
     consulting colleagues, his brother advised him to go to the 
     Department of Veterans Affairs hospital in nearby Palo Alto. 
     Martinez, a former Navy petty officer 2nd class, was entitled 
     to VA care (eligibility depends on several factors, including 
     date and length of military service, injury, and income). But 
     his brother's recommendation took him by surprise. Better 
     care at a VA hospital? But he went--and was quickly diagnosed 
     with pancreatic cancer by Sherry Wren, chief of general 
     surgery, who operated on him within days. He has relied on VA 
     hospitals and clinics ever since. ``They run a good ship,'' 
     says Martinez, now age 72.
       That they do, say healthcare experts. Routinely criticized 
     for decades for indifferent care, attacked by Oliver Stone in 
     Born on the Fourth of July, the VA health system has 
     performed major surgery on itself. The care provided to 5.2 
     million veterans by the nation's largest healthcare system 
     has improved so much that often it is the best around. And in 
     the new VA, patient safety is a particular priority. Before 
     making the first incision, for example, surgeons conduct a 
     five-step audit to be sure they don't cut into the wrong body 
     part or person. Doctors and nurses are unusually 
     conscientious about hand hygiene, to reduce infections caused 
     by carrying germs from one patient to another.
       Technology helps, as would be expected. Martinez is 
     particularly impressed by the computerization of patient 
     records. When he visits, his doctors and nurses instantly 
     call up his medical records, including test results (his 
     cholesterol is high and he suffers from asthma), CT scans, 
     and medications via laptop, which has become as ubiquitous a 
     tool at VA facilities as a stethoscope.
       Paper delay. But computerized records are more than a 
     convenience. If all patient information could be reviewed on 
     a computer screen and updated with each new test and 
     observation, studies suggest that many of the medical errors 
     that kill hospital patients would be prevented. Keeping 
     everything on paper has been shown to delay care, force 1 in 
     every 5 lab tests to be repeated, and cause unnecessary 
     hospitalizations. But switching to computerized records can 
     cost millions of dollars at a single hospital, so relatively 
     few medical centers outside the VA have changed over.
       ``The information is right at your fingertips, right at the 
     bedside, right when you're making decisions,'' Wren says. 
     Besides giving her a quick snapshot of a patient's progress, 
     the system automatically displays the latest and best studies 
     and guidelines for that patient's condition. The screen also 
     prompts her about preventive measures. If she calls up the 
     record of a diabetic patient, for example, she is reminded to 
     perform or schedule foot and eye exams, which diabetics must 
     have regularly to prevent amputation or blindness.
       Such prompting is largely why the VA vaccinates 92 percent 
     of patients ages 65 and older against pneumonia versus 29 
     percent 10 years ago, says Jonathan Perlin, the top doctor in 
     the Department of Veterans Affairs. Outside the VA, he says, 
     the rate averages below 55 percent. ``The increase not only 
     has saved the lives of 6,000 patients with emphysema,'' says 
     Perlin; ``we've halved hospitalizations for [patients with] 
     community-acquired pneumonia.''
       And the computerized system reduces medication errors, 
     blamed for thousands of deaths in hospitalized patients, by 
     flagging an order if there's a possible drug interaction, if 
     the dosage doesn't match a doctor's order, or if there is a 
     potential allergic reaction. Retired Army Sgt. Maj. Lance 
     Sweigart of Laurel, Md., takes six medications for arthritis, 
     high cholesterol, and depression. The 61-year-old Sweigart 
     says he has ``never gotten the wrong medication'' at VA 
     facilities in Baltimore.
       All drugs carry bar codes, as do patients' ID bracelets. 
     Both are scanned before a medication is administered to make 
     sure the drug and patient match and last-minute order changes 
     are caught. It's not yet sophisticated enough to offer the 
     appropriate dosage, but Isabel Sotomayor, a nurse at the VA 
     Medical Center in Washington, D.C., says the system snags one 
     or two potential errors every day during her medication 
     rounds.
       The impact of such changes is real, says Harvard School of 
     Public Health professor and renowned patient-safety advocate 
     Lucian Leape. ``Recent evidence shows [that care at the VA 
     system] is at least as good as, if not better,'' he says, 
     than care delivered elsewhere. In the 1990s, for example, the 
     VA began using a new way--since adopted by the American 
     College of Surgeons--to evaluate surgical quality. It enabled 
     VA surgeons to reduce postoperative deaths by 27 percent and 
     post-surgical complications by 45 percent. Recently published 
     studies have found that the VA rates much better than 
     Medicare fee-for-service providers in 11 basic measures of 
     quality, such as regular mammograms and counseling for 
     smokers. Late last year, the Annals of Internal Medicine 
     published a study showing that the VA had ``substantially 
     better quality of care'' than other providers in many of 
     nearly 350 indicators of quality, such as screening and 
     treating depression, diabetes, and hypertension.
       Overhauling a system of 157 hospitals, 134 nursing homes, 
     and 887 clinics is never finished. Recent reports by the 
     inspector general of the Department of Veterans Affairs have 
     highlighted such problems as cancellation of surgeries, 
     unexpected deaths, and radiology backups at VA facilities in 
     Florida. Surgeries have had to be canceled at some facilities 
     because surgical supplies were unavailable or improperly 
     sterilized. But John Daigh, who as assistant inspector 
     general for healthcare inspections is responsible for 
     exposing such flaws, says that VA top brass haven't retreated 
     into denial. They ``have stepped up to the plate and fixed 
     the problems'' that his investigators uncover.
       That, too, is evidence of a seismic shift, brought about 
     not by high-tech breakthroughs but by a fundamental change in 
     VA culture. A new emphasis, on patient safety and on a work 
     ethic that stresses constant examination of the processes and 
     procedures that go into caregiving, arrived in 1994 when 
     Kenneth Kizer, former director of California's Department of 
     Health Services, was tapped to run the VA health empire. His 
     mission, as he saw it, was to remake the unwieldy system into 
     one of the world's safest and finest. Kizer started holding 
     doctors, administrators, and managers directly accountable 
     for the quality of their patient care, linking, for example, 
     how many heart-attack patients received recommended beta 
     blockers and aspirin to job reviews. And the performance for 
     each facility was made public, which turned out to be a major 
     motivator. ``People competed like hell,'' says Kizer, now 
     president of the nonprofit National Quality Forum, which 
     develops national standards for assessing the quality of 
     healthcare.
       Kizer was immersed in studies of patient safety years 
     before the Institute of Medicine's jolting report in 1999 of 
     hospital errors that kill tens of thousands of patients. To 
     cultivate a ``culture of safety'' at the VA, he created a 
     National Center for Patient Safety, and to head it up he 
     brought in James Bagian, a former astronaut who had 
     investigated the space shuttle Challenger accident for NASA.
       Bagian's hire was ``one of the smartest things [Kizer] 
     did,'' says Leape. Both an engineer and physician, Bagian 
     brought to the VA unique skills and a zealous commitment to 
     safety. ``It was like being in two different worlds,'' Bagian 
     says of the move from NASA to the VA. ``One had a very 
     constructive and methodical approach to how we identify 
     problems, decide whether they are worth fixing and then 
     fix them versus one that was done much more like a cottage 
     industry, where decisions are based on what's my opinion 
     or how do I feel about it today, which is not how you 
     should run healthcare today.''
       Out loud. Bagian wanted people to report mistakes or close 
     calls in treating patients. Such intelligence was crucial if 
     safety was to be improved, because many errors happen because 
     of a flawed system rather than a careless individual--a chart 
     mix-up that could have ended in surgery on the wrong patient, 
     the incorrect medication given to a patient because it was 
     stored next to another one with nearly the same name. At 
     today's VA

[[Page E1561]]

     hospitals, patient safety teams identify every step that led 
     up to a blunder or close call to determine needed changes. 
     For example, the VA has instituted a process to ensure that 
     surgeons operate on the correct person or body part. One step 
     includes asking patients to say their full names and birth 
     dates out loud and to identify the body part to be cut.
       Bagian's greatest challenge was shifting the attitudes of 
     VA staffers. Few people reported a gaffe, for fear that they 
     or the person who made it would suffer. ``The VA had the most 
     punitive, hardest culture I had ever seen,'' says Kizer; he 
     and Bagian wanted to change the VA's punishment-oriented ways 
     to an open, nonpunitive environment. But the staff didn't 
     begin to respond until top managers showed they were serious. 
     In the new VA, for example, managers could be fired, fined, 
     and even jailed for retaliating against workers who file 
     mistake reports.
       Reports began coming in. More than 200,000 close-call and 
     error reports have been filed at the VA without anyone being 
     punished. ``Staff gets to have input about how to provide 
     better care,'' says Sotomayor, a VA nurse for 15 years. ``The 
     attitudes of people have changed.'' They take pride in the 
     results, such as a decline in patient falls and a pacemaker 
     redesigned by the manufacturer because of a close call. And 
     other hospitals have noticed. Jennifer Daley, chief medical 
     officer and senior vice president of clinical quality at 
     Tenet Healthcare Corp., is using the VA as a blueprint to 
     improve performance at the nation's second-largest for-profit 
     hospital operator.
       ``There is room for improvement,'' says Bagian. ``We're not 
     perfect, make no mistake about it.'' But now the drive to 
     enhance safety has become an accepted part of the VA. 
     Caregivers on the front lines turn in a steady flow of ideas, 
     such as requiring that doctors key in the full name rather 
     than the first few letters when ordering a prescription. That 
     minimizes the chance, say, that a patient who needs 
     clonidine, a blood-pressure medicine, will get clozapine, an 
     antipsychotic.
       Augustin Martinez simply appreciates that he took his 
     brother's advice. ``I was fortunate I was a veteran. 
     Otherwise, I don't know what else I would have done,'' 
     Martinez says. ``I don't think I would be here today.''


                   Small steps that made a difference

       These are a few of the changes the VA has put in place to 
     make patients safer.


                                 FALLS

       Problem: In older patients, falls were the top cause of 
     injury and the No. 1 cause of deaths resulting from injury.
       Solution: Bedside floor mats. Putting the bedside table, 
     call button, and light switch within easy patient reach. 
     Outfitting at-risk patients with hip protectors.
       Did it work? In a six-month trial at 31 VA facilities, 
     there were 62 percent fewer major injuries from falls.


                               INFECTIONS

       Problem: Infections caused by an antibiotic-resistant 
     strain of Staphylococcus aureus, largely spread by healthcare 
     workers' hands, were killing patients or making them very 
     ill.
       Solution: In 2001, the VA's Pittsburgh Healthcare System 
     mounted a hand hygiene campaign, raising awareness of the 
     need for disinfecting hands and for gloving and using gowns 
     and masks, and making sure such supplies were always at hand. 
     At the same time, infection monitoring was increased.
       Did it work? Such infections have been cut 85 percent in 
     the general surgical unit, 50 percent in the surgical ICU.


                             BLOOD THINNERS

       Problem: Delays in follow-up care for discharged patients 
     taking blood thinners such as warfarin, which can cause 
     bleeding complications if patients are not carefully 
     monitored.
       Solution: The VA Ann Arbor Healthcare System in Michigan 
     recently required doctors to ensure that these discharged 
     patients are seen within a week in one of its clinics. Their 
     blood levels and medication dosage can be checked, and they 
     can be counseled about diet, because certain foods interfere 
     with blood thinners.
       Did it work? It's too early for clinical results, but 
     reportedly all such patients have had follow-ups, lab tests, 
     and counseling within one week of discharge.

                          ____________________