United States Senate
Committee on Veterans Affairs
Omaha, NE
August 20, 2009

Creighton University is a liberal arts university established in Omaha, NE in 1870.  Creighton provides comprehensive education in arts and sciences, law, and the health sciences of medicine, nursing, pharmacy and dentistry.  All of Creighton’s health science schools have mutually beneficial training and clinical care relationships with the Nebraska-Western Iowa VA Health Care System.
Creighton University School of Medicine has been associated with the Veterans Affairs Medical Center in Omaha essentially since its inception 60 years ago and is currently providing approximately 50% of the physician medical staffing at the Omaha VA site.  These Creighton School of Medicine faculty are full-time, part-time or contracted physicians at the VA and provide direct patient care in VA clinics, the inpatient hospital, or procedural areas and operating rooms coupled with administration of clinical services and the supervision and education of VA personnel.  Approximately 55 full-time medical, pathology, psychiatry, and surgery residents sponsored by Creighton and the VA are on duty in the Omaha VA every day and virtually all Creighton University residents receive at least a portion of their training at the VA.
Third and fourth year Creighton medical students also receive a portion of their education at the Omaha VA.  These students are supervised by the faculty and residents with whom they work.  In the VA Emergency Room, students have access to modern educational equipment and utilize simulation mannequins to learn in a controlled system how to respond to emergencies they may face in their future.  The VA provides a crucial component of the education of students in medicine, neurology, psychiatry and surgery and also introduces them to the diseases and issues of America’s returning combat heroes.  These invaluable lessons prepare them for the future care of all types of patients.
Creighton faculty engage in research at the Omaha VA Research facility and work to expand our knowledge of common diseases that affect Veterans including infectious diseases, diabetes mellitus, obesity, smoking and substance use diseases, and mental health disorders.
As I hope is readily apparent, these interactions offer great reciprocal value to both Creighton University School of Medicine and to the Nebraska-Western Iowa VA Health Care System.  While Creighton faculty members serve a vital role in the care of Veterans and research into their diseases, the VA provides the environment for education and research that benefits our medical students, residents, and faculty.  Creighton faculty bring the latest expertise in patient care and procedures to the VA to the benefit of the Veterans.
The interaction of Creighton faculty at the VA has led to improvements in patient safety and quality of care.  As an example, a Creighton faculty member is the lead physician for patient safety and ensures that identified safety problems are thoughtfully and promptly handled.  This includes weekly safety rounds in clinical areas to proactively identify potential problems and provide solutions in advance of unsafe events.
I had the opportunity to serve as the Chief of Staff of Nebraska-Western Iowa VA Health Care System for 8 years until January 3rd of this year.  While Nebraska-Western Iowa VA Health Care System has been remarkable in improving patient access both locally and regionally through the use of telemedicine, testing the concept of the medical home in its primary care clinics, and proactively reducing costs of care while at the same time enhancing patient safety and quality, there are clinical areas that can be further improved by additional funding.  The current physical plant was built at a time that inpatient care was essentially all that was provided and a much larger physical plant is needed today to deliver health care to our Veterans.  Larger operating rooms, more space for the services of pathology, radiology and mental health, a new heating and air handling system, additional educational facilities for both patient and student/resident education, and larger clinics and group rooms are needed.  These issues have been included in a proposal to the Department of Veteran Affairs to replace or enhance the current structure and the results of this request should be available soon.
Nebraska-Western Iowa Health Care System provides the care for our Veterans in a geographic area that measures 400 by 200 miles.  Additional funding should permit the development of more rural primary care clinics, further assessment of innovative healthcare delivery models such as the medical home, enhanced mental health and counseling services, and greater use of telemedicine to reach Veterans who would otherwise be required to travel long distances for their care.  Our aging Veterans population will require greater access to services in their later years such as assisted living and nursing home facilities, day care centers for senior Veterans, enhanced home care and assistance and not simply in the larger populated cities, added personnel and services to help them stay within their own homes in later life, and more hospice care sites for those who develop diseases that bring them to their final months.  Additional monies coupled with the health care engineering activities being carried out at Nebraska-Western Iowa should permit it to be the incubator to test new health care delivery techniques for Veterans that increase access, controls costs, and improves patient satisfaction.  Funding can also bring the VA the tools needed for screening and prevention of disease.  If we can continue to deliver the care and preventive services that our OEF/OIF war heroes deserve throughout their life and not just when they become sick, we will not only maintain their current health, we will prevent their chronic diseases and reduce the cost of care as they continue to age.  These are but a few opportunities as we continue to increase funding for Veteran’s care in Nebraska-Western Iowa.
I am grateful for the opportunity to speak to the importance of the VA to Creighton and of Creighton to the Omaha VA.  Thank you for your attention.

Respectfully submitted,

Rowen K. Zetterman, MD, MACP, MACG
Dean, Creighton University School of Medicine