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Witness Testimony of Sidney R. Steinberg, M.D., FACS, W.G. (Bill) Hefner Veterans Affairs Medical Center in Salisbury, North Carolina, Chief of Staff, Veterans Health Administration, U.S. Department of Veterans Affairs

Good morning Mr. Chairman and Members of the committee.  Thank you for giving me an opportunity to address your concerns regarding the quality of health care provided to our veterans at the W.G. Hefner Veterans Affairs Medical Center in Salisbury, North Carolina (Salisbury).  The focus of my remarks will be the improvements and expansion of healthcare at Salisbury.

Overview

The Medical Center in Salisbury provides quality health care to our veterans in our primary care clinics including Winston Salem and Charlotte across many specialties of medicine and surgery with our academic partner, Wake Forest University.  In recent years, Salisbury has made a concerted effort to improve the quality of our health care and to make access to care readily available.  We measure our improvements in these areas on a regular basis utilizing both internal and external tools. We track disease prevention, treatment outcomes, physician performance, educational processes and patients’ satisfaction surveys.  VA is committed to meet the needs of our veterans, whatever it takes. At Salisbury our commitment is total.

Improvements to Patient Care

Several years ago, with the help of our Veterans Integrated Service Network (VISN) leadership and a handful of dedicated clinicians, VA sought to make improvements at Salisbury, department by department.  VA leadership brought together the financial and manpower resources necessary to make these changes possible.  For example, the waiting list of veterans seeking a primary care appointment was a challenge.  The VISN came through with funding for recruitment of new employees.  As a result, every veteran on the wait list in 2003-2004 was enrolled in a primary care clinic, examined, and received his or her initial care needs.  VA was delighted to have members of Congress join the former Secretary and our Network Director to personally thank the dedicated staff who gave so much of themselves to achieve that goal.

Academic Affiliate and Specialty Care Services

To accommodate Specialty Care Services in the past, Salisbury relied upon the geographic partnership with the Asheville VA Medical Center. However, the addition of a large number of new patients made it apparent that Salisbury would need to develop its own specialty support system for our veterans.  To accomplish this task, VA established a new and stronger relationship with our Academic Affiliate, Wake Forest University School of Medicine in Winston Salem, North Carolina.  Meetings with the Dean of the Medical School and faculty leaders paved the way for the beginning of a new partnership to serve our patients with state of the art health care in many areas of need.  These efforts led to the establishment of resident physician training programs in a number of disciplines.  We now have 10 approved resident positions which include ophthalmology, urology, otolaryngology, psychiatry, medicine, infectious disease and dermatology. The superb eye clinic with its multispecialty support provided care to 27,000 patient visits in fiscal year (FY) 2006. Ten major eye operations are performed weekly by Wake Forest faculty and resident physicians.

VISN leadership continues to engage the Office of Academic Affairs on a regular basis to assist Salisbury in adding more resident positions in primary care, medicine and other specialties.  This year we have added a new affiliation agreement with Virginia Tech University and will work to incorporate their staff and residents in coming years to expand primary care. The real benefit of the residency program to our veterans is that they bring with them the highly skilled faculty members who are capable of providing state of the art care to our veterans.  The progress VA has made at Salisbury touches every veteran and employee at the Medical Center.  Our staff, our patients, our community leaders, and our medical school educators recognize the quality of these additions. These improvements in facility staffing and structure allowed us to see more than 400,000 out patients in FY 2006 as well as providing support for our Veterans Benefit Administration office in Winston Salem.

Mental Health

The Mental Health needs of our veterans are important to all of us and represent a program of excellence at Salisbury.  In this area of clinical expertise, we lead our VISN and have on our staff one of the world’s most prestigious investigators in the area of Traumatic Brain Injury. Through her efforts and those of her principal neuroscientist, there is collaboration with MIT, Harvard and the Department of Defense.  This team also serves as a key investigative and educational center for the Mental Illness Research, Education, and Clinical Center (MIRECC). This Center has a focus on post-deployment mental health.  Together with the other VA medical centers in VISN 6, this program strives to advance the study, education, and treatment of all mental health conditions resulting from war-time experience.  This investigative center leads VHA nationally in these efforts.  Our medical center’s research programs have generated a full Association for the Accreditation of Human Research Protection Programs accreditation through the year 2010.

Women’s Health Program

Our expanded Women’s Health program now serves our patients as well as those from the Asheville and Fayetteville VA Medical Centers.  The program is headed by a Gynecologist from the University of Virginia.  The new director of our Imaging Department came to us from the M.D. Anderson Cancer Center in Houston, with additional fellowship training at the University of North Carolina.  Her new colleagues in the department are from Duke University and Wake Forest, respectively. The Women’s Health Program is just moving this week into newly renovated space where additional special services are now provided.  A new bone densitometer, digital mammography and urodynamic devices are now available. A current NRM (Non Recurring Maintenance) project is now underway to provide more bed space for women veterans with private rooms and private baths.

Surgery Programs

We faced challenges in the quality of our program in 2003.  But we have turned the corner and now have a much improved surgical program.  The Salisbury Surgery Department is totally new and is headed by a chief from Vanderbilt University. A strong surgical program is essential to our veterans’ health needs and must be one of impeccable quality.  With the VISN’s busiest emergency department and increasing demands for care dictated by our 62,000 enrolled patients, our efforts were directed to making this department a solid high quality program. The support of our affiliate, Wake Forest University, is vital to this effort. As additional surgical staff and residents from Wake Forest join this effort, it will continue to gain in strength and expertise.  Our new construction project in Surgery will be completed in about 30 days and will provide the needed space and modernization required to meet the highest standards for operating room construction. Our new Chief is joined by a staff of surgeons from Johns Hopkins, the University of Maryland and the University of West Virginia.  Other key members of the Surgery and Anesthesia Staff came from Emory University, Duke University, the Cleveland Clinic, the Mayo Clinic and the University of Michigan.  We are recruiting for a new chief of Pathology, crucial to our post mortem evaluations and tissue studies.  Our Chief of Infectious Disease and our fellowship program have brought a fresh and important look to the evaluation, prevention and treatment of infectious diseases at our medical center.  Our large numbers of hepatitis and HIV patients are now receiving the care they must have to maintain their health and life.

Our approach to primary care was modified last year to provide more adequate care to our patients with more complex diseases.  At the Salisbury VAMC we have made a concerted effort to ensure that every patient now has been assigned to a primary care provider.  Our efforts in Primary Care were given a tremendous boost by the VISN’s support of a total renovation of all primary care clinic space to assure that each primary physician had at least two examination rooms per physician.  This space adjustment has made it possible to meet the demands of a higher patient volume.

Conclusion

Mr. Chairman, we acknowledge that Salisbury has faced problems with the quality of surgical processes in the past.  However, that’s behind us now, due to the hard work of the highly professional and dedicated staff at Salisbury.  We are proud of Salisbury and the patients we serve.  Through strong and meaningful leadership, our staff has turned the focus toward a future of excellence.  We will continue these efforts in our commitment to our nation’s finest, our veterans.

Mr. Chairman, this concludes my statement.  At this time I would be pleased to answer any questions that you may have.