LVMAC News — Swinfard Talks on Downstream Effects of War

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Dr. Ronald W. Swinfard, M.D., President and CEO of the Lehigh Valley Health Network (LHVN) spoke to the Council at its business meeting on 19 October.  During the Vietnam War, he served in the Medical Service Corps as a Battalion Surgeon (a lieutenant position)  of an Aid Station (a platoon equivalent organization) in 195th  Brigade of the Americal Division (23rd Infantry Division), circa 1970.  After a short stint as a high school teacher, upon return from service and decommissioning, he embarked on a career as a doctor, first training in internal medicine and later dermatology as a specialty.  In 2003, Swinfard was hired by the Lehigh Valley Health Network as Chief Medical Officer (CMO) after serving at fifteen years at the Harry S. Truman VA Medical Center in Columbia, Missouri, eventually rising to the position of Section Chief for Dermatology.  He was also a key figure in the University of Missouri Hospital – Columbia.  In November of 2010, he was selected for his current position.  He stated that he is ever mindful of the sacrifice of others who gave their lives and because of them, believes we should celebrate our lives and make them useful in the service of others.

In his talk, “The Downstream Health Effects of War,” he observed that few doctors are veterans and hence a learning curve is often required when it comes to their care.  He noted that that LHVN sees a lot of veterans in their Emergency Rooms; and that while the organization has done some work with the local VA Clinic, it intends to do more on the behalf of our local veterans.

He went on to say that the VA system has done a pretty good job over the last few years and has ramped itself up.  As an example, its electronic medical records (EMR) system is more sophisticated than much of private medicines’, for it has a far more integrated system [though internal to its own networks], whereas most private healthcare systems have an un-integrated approach and hence difficulty in exchanging information, even regionally.  [This has an impact on the safety of patients under care and efficiency of properly directed service.  It should be noted also one problem existing with the VA is the electronic sharing of information with the healthcare organizations who serve the same patient, when the capability might exist.]  The VA has also been in a leader in post operative surgical care monitoring and evaluation.

Nevertheless, he noted that many Vietnam veterans remain cynical of the VA.  It is one reason the VA created storefront operations [VA Veterans Centers] to serve in the area of mental health [We have none in the Lehigh Valley].  In fact, what seems to worry most is the PTSD recovery of our veterans.  He can see the parallels of the situation in Vietnam with the current war zones, where one likewise encounters a “friends by day, enemies by night” situation.  Getting veterans to needed behavioral health care remains a major issue.  He mentioned that “while 18% of veterans seek out care for other medical issues, 80% seek care for diabetes and behavioral health ones.”

Therefore, going forward, he intends to reach out to other healthcare organizations in the area, and while the LVHN has no unique programs for veterans at this time, that might change as it becomes more involved in serving veterans.  They are in the process of developing strategic objectives in this area.  Meanwhile, he stated that they will serve any veteran, even those without insurance.  “No one will be turned away.”


 The emphasis of the last Veterans Affairs Committee meeting was on forming task forces for healthcare, homelessness, and employment in our community.  It is its belief, backed by the observations, the Lehigh Valley’s veterans in many ways are caught in a healthcare service desert between Wilkes-Barre, Lebanon, Lyons, and Philadelphia VA Medical Centers.  The presence of the Allentown VA Outpatient Clinic and the small Northampton VA Outpatient Clinic mask an important issue to those unaware of how the VA operates: the need for a convenient, full range of convenient services for working veterans entitled to federal health services. Homelessness among veterans also needs greater awareness.  Employment of returning veterans needs more concentrated attention.


Pat DiLuzio, our new Homelessness Subcommittee Chair, is in the process of revising our business plan and forming a task force to address veterans homelessness issues.  Ultimately a task force will be formed.  The first emphasis will be on awareness of homeless veterans and their needs. We are wondering if Wilkes-Barre VA Medical Center actually has a plan for the Lehigh Valley to eradicate veterans homelessness in another three and a half years — as the Secretary of the VA Shinseki national effort, his contribution to the U.S. Interagency Council on Homelessness’s “Opening Doors” plan.

Repeated requests to see the written plan in order that we might understand it and help in the Lehigh Valley have currently led nowhere. Regardless, the timing is good for getting the community more involved. Recently, the VA began transforming its efforts in the fight against homelessness.  It is changing from a program focus upon temporary, shelter-based services, to prevention, employment, permanent housing, and help to families and Veterans at risk of becoming homeless.  This will require more partnership efforts if the dream is to become a reality – much more than the Wilkes-Barre VA Medical Center has developed in the Lehigh Valley over the last two decades.  We need to ensure the Lehigh Valley is not forgotten.


Eric Johnson, our new Healthcare Subcommittee Chair, is on a schedule to convene a focus group in early November to identify the medical and mental health services currently available to veterans, whether offered by the VA or another source – the good, the bad, the gaps or problems with such services.  The ultimate goal is to develop an action plan with short, intermediate, and long-range tasks to improve access to and quality of care.

There will be an emphasis on improving coordination and cooperation between VA (both VHA and VBA) and local non-VA service providers to the benefit of veterans as patients or clients.


Dave Newton and his committee members will meet on the night of 20 October to kick off the planning for the second cycle of our job hunting training program.  Marketing is a key concern and developing the connections for jobs is another one.


Phil Hublitz and Dale Steventon reported the third PHWFF event of the year, which occurred on 8 October at Robin Hood Dell in the Lehigh Parkway, went off exceptionally well on bright and sunny day. Over 52 people attended, about 31 of these being veterans and their families – the balance being instructors. Seems Channel 39 is interested in doing a story on this program.  We extend kudos to our partner, Trout Unlimited – Hokendauqua, and can see why they were voted best chapter in the state for 2011.  Importantly, we are finally reaching the younger generation of veterans. It is apparent.  Persistence pays.  It has developed through a grassroots effort.  Government connections have not proven the key as first through – for the Lehigh Valley.


Veterans Sanctuary will need the community to step forward in new ways if it is going to be a success. The community has been amazing in helping get it up and running and meeting all the codes and licensing requirements, but now they have clients that they must turn away because there is no government source of funding for them to receive their care.  Hopefully, a coming meeting with the VA VISN-4 will improve the situation, but the root of the problem lies deeper.

Our state and federal governments have not worked together to work out a more realistic system of providing mental health care to returning veterans.  The present system is inadequate to the needs of most local communities such as ours.  “Big bucks” are spent and wasted because government is not recognizing that solving the problems of returning veterans does not lie in traditional investment in the VA  as much as investment into the community resources closest to them that can help.  Until government assumes a leading role, communities are left holding the bag to fund efforts such as Veterans Sanctuary through private funding.

The vision for Veterans Sanctuary included as early an intervention as possible – for it to be more than another program that treats veterans after they have been picked up in the criminal justice system.  We can do better by them.


The “family PTSD Booklet” should be out by the end of this month.  Had hoped to have copies by now, but the political campaign season has interfered with our printing contractor’s priorities.

Supporting the Homefront”, a family, psycho-educational program operated by Treatment Trends, which we are sponsoring, kicked off 27 September.  With the coming redeployments we expect it will eventually find its market.  While this program should prove a worthy addition to the arsenal of tools helping military families cope with this war, it will encounter the dual problems of: 1) state and federal acceptance of community-based alternatives to their own efforts; and 2) reaching those spouses, parents, and children who could most benefit. Persistence and dialogue will prove necessary.


In October, the District Attorney of Lehigh County announced his “Leaving No Veteran Behind” initiative, a program that has similarities to a veteran’s treatment court, but falls short.  We are thinking the Lehigh County judicial system remains resistant to the idea of specialty courts in general, a proven product, or they would be leading the charge.

Nevertheless, Lehigh County is joining a growing list of Pennsylvania counties who are at least trying to address the problem of those returning from war who sometimes get into trouble while dealing with inner demons and just need a little extra handling in consideration – and not to be cast away when duty is done.  At least 8 counties are implementing treatment courts and a further 10 are projected.

Sad to say, it needs to be a statewide movement organized by state government. The responsible caring for a returning veteran in need of help and having difficulties adjusting should not be an accident of where one lives.  Equally sad to say, we live in a state where there is little hope of that.  But worse still for us in the Lehigh Valley is while Lehigh County is trying to do something (albeit incompletely), Northampton County sits on its rump.


We will be talking with the National Guard, sometimes called the Department of Military and Veterans Affairs, about the State Department of Veterans Affairs legislation we are proposing through Senator Browne.

The Pennsylvania War Veterans Council has added an additional legislative priority to those I listed last time:  Increase DMV A budget to support opening of 120 beds at Southeast Veterans Center in FY 2013.  This amounts to approximately $1.2 M for about 88 employees.  As you might know, the state and federal government invested heavily in the renovation to bring it into compliance with new standards of care.  It would seem that our state government should not need prodding to finish the task — appropriating sufficient funds to operate it properly.  There’s a disconnect somewhere.

It has also now begun rank ordering its priorities, they are:

– Full funding of Act 66 VSO service officers
– A small games of chance bill (SB 369 and 444)
– Increase DMV A budget to support opening of 120 beds at Southeast Veterans Center in   FY 2013.
– Full funding of Pennsylvania’s DAV vans program
– Mark the driver’s license with a “veteran” indicator   (SB 165)
– Modify the real estate tax exemption program to include DIC and KIA dependents; change limit to Household Income rather than personal income (SB 572 and 385)

We’re still waiting to hear about Northampton County’s new county director of veterans affairs being hired.  We have heard other counties, to include Lehigh County and Warren in NJ, have picked up customers.  That is not exactly fair – for one set of taxpayers to pay for another’s.  It also demonstrates the problem with a county versus state service officer system in being able to respond to personnel turnovers in maintaining continuity of service. Northampton County needs to move along.


VA is encouraging family, friends and citizens in the community to “Make the Call” and help prevent and end homelessness among Veterans. Since March 2010, VA has offered a toll-free telephone number, staffed around the clock by trained professionals, to help homeless Veterans, their families and at-risk people.  The number is 877-4AID-VET (or 877-424-3838).



23 October 2011