STATEMENT OF
CHARLES B. SMITH, MD
CHIEF OF STAFF
VETERANS AFFAIRS PUGET SOUND HEALTH CARE SYSTEM
BEFORE A US SENATE VETERANS AFFAIRS' COMMITTEE HEARING

August 5, 1997

Senator Murray and other members:

Thank you for this opportunity today to update you on VA Puget Sound Health Care Systems' clinical programs for Persian Gulf War veterans. I am Dr. Charles Smith, Chief of Staff for the VA Puget Sound Health Care System. I am board-certified in internal medicine and infectious diseases. Seated with me today is Dr. Steven Hunt, a Persian Gulf Primary Care physician. Also, at the hearing today we have a team of health care providers and customer service staff who are here to assist our veterans and their families with specific concerns. I invite all the Persian Gulf Veterans here today to participate in our health promotion program and to register for a Persian Gulf Registry exam.

First, I want to assure you that the number one priority of the staff of our VA Healthcare System is to provide the veterans of Washington with the highest quality health care and services. We are a 617 bed, dual division, tertiary care veterans health care system that treats over 42,000 veterans annually. Of the 475,000 veterans in our service area, it is estimated that 20,000 are veterans of the Persian Gulf Era and 5,784 have received care from our healthcare system in the last twenty months.

Every veteran is evaluated for his/her individual health care needs and offered an array of VA services, including those unique to Persian Gulf service.

Persian Gulf specialty programs offered by VA Puget Sound Health Care System include the Persian Gulf Registry Exam, Persian Gulf primary care clinics, and Persian Gulf PTSD groups for men and women.

Leading our Persian Gulf Primary Care Team are two highly qualified and dedicated physicians. Dr. Tesfai Gabre-Kidan is board certified in Infectious Diseases and has particular interest and expertise in issues related to Persian Gulf veterans. Dr. Steven Hunt specializes in general medical problems with an emphasis on those with unclear etiology. Both individuals are nationally recognized for their work with Persian Gulf veterans. Recently, Dr. Hunt presented a talk on Physical Examination for Undiagnosed Illnesses at the VA National Persian Gulf conference and has given talks on related topics at meetings of the University of Washington Department of Occupational & Environmental Health. We are fortunate to have individuals of this caliber on our Persian Gulf Primary Care Team.

Our Persian Gulf programs are part of a comprehensive two-division veterans' health care system that serves the veterans of the Northwest by delivering the highest quality primary, secondary, and tertiary health care and services. Because some Persian Gulf War veterans' symptoms are complex, we often use specialty diagnostic and treatment services to treat those veterans' illnesses. This results in collaborative treatment of the veteran by our multi-specialty team, coordinated by the primary care provider.

Another important member of the Persian Gulf Support Team, is Coordinator, Deborah Strako. As a single point of contact, she works directly with veterans to assist them in receiving access to care and services.

Veterans who join the registry, established in 1992, receive an exam that includes x-rays and laboratory studies as prescribed by the national VA protocol for Persian Gulf veterans. The information is entered into the national registry, enabling VA to update veterans on research, health trends and compensation policies. To date, 1,175 have participated in our Persian Gulf Registry Exam Program. Our goal has been to schedule exams within 30 days of the request and we have consistently met that goal.

After completing the registry exam, our medical staff individually counsels veterans on the results, and when needed, refer them to specialty clinics like neurology, medicine, rehabilitation, surgery, urology, gastroenterology, or mental health.

As part of our commitment to providing Persian Gulf War veterans with valuable information and access to our services, we have dedicated significant resources to outreach programs.

Timothy B. Williams, Director, VA Puget Sound Health Care System, holds weekly meetings with veterans and veterans' service organizations to disseminate information on Persian Gulf programs.

Additionally, our Persian Gulf Support Team has participated in numerous programs in the community including a local Presidential Advisory Committee on Gulf War Veterans' Illnesses field hearing, and a Department of Defense outreach program.

VA Puget Sound Health Care System hosted a Persian Gulf program in 1995 with a panel of PGW experts including VA Under Secretary for Health, Dr. Kenneth Kizer, and the Director of VA's Environmental Agents Service, Dr. Frances Murphy.

The Puget Sound Persian Gulf program has also been reviewed by independent external organizations. The U.S. Congress mandated the Department of Veterans Affairs to enter into an agreement with the National Academy of Sciences to review the adequacy of the Persian Gulf Registry exam protocol and its implementation. The Academy's highly respected Institute of Medicine visited our Health Care System in April 1997 as part of this review. Three reviewers spent two days interviewing clinical and administrative staff working with Persian Gulf veterans, specialists who provide care for these veterans, and a Persian Gulf veteran to evaluate how well we are doing in this regard.

The written report from that visit is not yet available; however, we would like to share the verbal comments of the review team. They were extremely complimentary of the staff who provide care for these veteran-patients and were impressed by the consistent and comprehensive nature of the care provided (e.g., primary care, neurology, gastroenterology, and mental health services). The review team indicated that the Persian Gulf War veteran was also very complimentary and he expressed a high level of appreciation and satisfaction with his care.

Although we do not have separate customer satisfaction data for Persian Gulf veterans, these veterans are included in the National VA measures that show how our patients judge the care we provide. VA PSHCS achieved the designation as a site of excellence in six out of seven areas on the 1996 VA Outpatient Customer Satisfaction Survey. The six areas: access to care, continuity, coordination, emotional support, preference, and education, are measured by patient responses to several questions. Patients are randomly selected for survey and the questionnaire is validated for accuracy. To be a site of excellence, our scores needed to be two standard deviations better than the VA average. This is a highly significant achievement of which we are very proud.

The national VA quality review also shows we are among the best VA Health Care Systems in the country. Each month an independent reviewer inspects a random sample of medical records for selected quality indicators and reports the results on a chronic disease and prevention index. VA PSHCS had the highest VA scores in the country on the chronic disease index and the second highest in the country on the prevention index, validating our perceptions that we provide high quality health care.

As you can see our health care system provides quality care, however we continually strive to make it even better. It is in this environment that we are providing care to our Persian Gulf veterans.

Thank you for the opportunity to speak with you today about this important program. This concludes my prepared statement. I will be happy to answer any questions you may have at this time.