One of the things I’ve been most
proud of working for the VA (Department of Veterans Affairs) is that our
veterans have access to the most cutting-edge technology in the world. There are many partnerships with research
entities like DARPA and Rory Cooper and his cadre of geniuses at Brown
University. Oftentimes when the most
advanced technology is released to the public, Prosthetics in the VA is the
only customer as Medicare and private insurance companies are slow to
respond. If it’s approved by the FDA,
the VA will provide it for veterans. A perfect example is the iBot, the
wheelchair that climbs stairs.
DEKA is a research and development
founded by Dean Kamen, who invented the Segway, while trying to create the
technology for this wheelchair that would raise the user to eye-level as well as help them maneuver up a flight of stairs. It became available on the market in 2005 at
a cost of $25,000. The VA was the main
customer as Medicare only covered 20% of the cost.
I refer to DEKA as a brain hive in New Hampshire. The people working there are so smart you can
hear a faint buzzing sound whenever you are in their midst. You may know them as the people who created the gleaming silver skeleton of the bad guy in Terminator 2.
I know all this as I visited their main
office when they were demonstrating their latest artificial arm
technology. My boss in DC, Fred Downs,
is an arm amputee. Even though there had
been many developments in technology for artificial limbs, it was mostly with
legs as arm amputees (especially from the Vietnam era) were less frequent, as
most of the time a battlefield explosion that would take someone’s arm would
also kill them. As the body armor
technology advanced, more and more arm amputees survived their injuries and the
technology needed to catch up to that of legs.
DEKA was doing phenomenal things
and had created an artificial arm that could be raised above shoulder level, a
task previously unachievable. It could also allow the user to grasp a bottle or can (without crushing it) and bring it to their lips to drink, another task we take for granted that was previously unavailable to the target audience. As Mr. Downs is a
very well-known gentleman-about-DC, serving as the National Director of
Prosthetics for the VA for more than 20 years and having written several novels
and appeared both before Congress and in many movies and TV shows, Mr. Kamen
asked him to demonstrate their latest achievement on an episode of 60 Minutes to be filmed at their offices
less than 30 minutes from my office at the VA.
How could I not attend?
During my time in New England, a
new Deputy had been hired in the Prosthetics office where I used to work; Dr.
Billie Jane Randolph. She had been one
of the important people who had seen my presentation about success we had been
experiencing in our region. She asked if
I would meet them in New Hampshire, so we could talk about possibly creating a program
based on my work. We converged on the
DEKA offices and were immediately told by the 60 Minutes producer that as we had not been cleared to appear on
camera, we had to ensure that we avoided being filmed. After 15 minutes of dodging a very busy cameraman,
we decided to withdraw to the employee kitchen to eat and get to know each
other.
Just like Jackie, I was immediately
enthralled as BJ and I clicked. She was
from the boonies of Kentucky but had risen through the ranks of the Army and
serving as George W Bush’s physical therapist in the White House. Armed with a PhD in Education, she was a
force of nature, so when she asked me to come to DC to create an
education-based review and audit program I was unable to say no. So, in February 2009, I temporarily returned
to my old job for what was to be a 90-day detail.
Once there, I jumped in with both
feet, creating an auditing tool, selecting and training team members from
across the agency and planning weekly visits to all 153 VA hospitals over the
course of three years. We had ranked each
facility’s Prosthetic Service based on our national metrics and started with
the lower performers as they needed the most assistance. Unlike other federal audits, ours was
education based, meaning if we found a deficiency, we would immediately halt
the audit and have a training session with all staff, followed by a meeting with
the leadership to show them how we had found the deficiencies and how to proactively
address them in the future.
As the end of the 90 days neared, I
was asked to extend another 30 days to lead the first two audits as a demonstration
of how they should be accomplished; Tuscaloosa, Alabama and Pittsburgh, Pennsylvania
were selected, and the training commenced.
Over the next two years, my detail was extended in 30-day increments
while our teams conducted audits at facilities, ranging from Alaska to Puerto
Rico, Hawaii to Maryland and many states in between. The plan was to complete an audit at every location,
but after we had completed our 53rd trip, we were asked to take a
step back, review our findings and develop a national conference, sharing what
we had learned, both areas of consistent concern as well as Best Practices. We used this conference in Boston to
highlight some of the best performing sites we had found, including San Diego
and Fresno, California as well as Boise, Idaho.
One of the locations I had
personally audited was Palo Alto, California, one of the largest and most
complex VAs in the country. It was one
of five Polytrauma Level One sites, which was the first stop in the VA for any
veteran discharged with a significant injury such as spinal cord injuries,
amputations, traumatic brain injuries and visual impairments. The five were in disparate parts of the
country to ensure proper triaging before being sent to their home
facility. Due to this designation and
the integral piece Prosthetics plays in returning veterans to as close to
normal function as is possible in their homes, these facilities (Richmond,
Virginia; Tampa, Florida; Minneapolis, Minnesota; San Antonio, Texas; and Palo
Alto) should have a stellar Prosthetic Service. While there is no such thing as a
perfect program, there were significant issues in Palo Alto and after my report
was shared with facility leadership, I promised I would find them the right
leader to take them to the level where they should be. I tried to find the person with the right mix
of subject matter expertise and leadership skills. I reached out to those I felt would be successful,
but most were unwilling to move for family or career reasons. I couldn’t fault them for that. I realized I knew of only one person who was both
the perfect fit and a gypsy at heart; me.
I asked me if I was interested and, lo and behold, I was.
In June 2011, I packed up my life and drove across our great land, almost literally from sea to shining sea with my best friend Christopher and a 2006 Dodge Charger crammed to capacity with clothes, books and other belongings I didn’t trust the movers to deliver unscathed.
If you had told me, even six months
before, that I would be living in California at any point in my future, I would
have thought you were crazy, yet here I was.
Welcome to Silicon Valley, home to 15-year-old millionaire tech nerds,
weirdly aggressive hippies, astonishingly over-priced tract homes and the trust
fund babies of Stanford, the only university I know of with Louis Vuitton and Tiffany’s
retail stores on its campus. How would I fit in?
