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A special tribute.

May 3, 1991, marked a sorrowful day for the veteran community. On that date, Margaret Giannini, M.D., F.A.A.P., deputy assistant chief medical director for rehabilitation and prosthetics, Department of Veterans Affairs (VA), retired after ten years' service. Dr. Giannini enjoys a national and international reputation earned during her 43 years of working with the disabled.

During her years at VA, Dr. Giannini brought many programs and opportunities to our nation's disabled veterians. Prosthetics and sensory devices such as the Seattle Foot, the Seattle Ankle, cosmetic coverings, and endoskeletal improvements for amputees all are viable options for many people because of her efforts and dedication. Due to Dr. Giannini's hard work and expertise, the Vannini-Rizzoli Stabilizing Limb Orthosis--also known as The Boot-- (see "Mama's 'Magic' Boots," March 1991) is now available in the United States.

Computer-aided design/computer-aided machines (CAD/CAM) also are on the long list of programs and services Dr. Giannini has supported. The CAD/CAM automated system has significantly impacted the design and fabrication of orthopedic shoes as well as custom-molded shoes for diabetics. The clinical use of a unique body-powered, upper-extremity prosthetic arm has led to a more dynamic and functional device for amputee veterans.

Other programs Dr. Giannini was responsible for include:

* The creation and implementation of the Rehabilitation Research and Development Unit for Aging and the Functional Electrical Stimulation (FES) Center, which facilities walking and activities of daily living

* New bathroom fixtures designed especially for people who are elderly or disabled

* Digital hearing aids and the use of cochlear implants for those who are completely deaf

While at VA, Dr. Giannini received a number of awards and recognitions for her efforts. At the top of the list are those presented by President Ronald Reagan: the President's Award, in recognition for the Seattle Foot, and the President's Award for Employment of the Handicapped. She also received the coveted Silver Helmet from AMVETS, for humanitarianism.

On behalf of the membership, officers, and staff of PVA, I would like to extend this public commendation to Dr. Giannini for all of the support and assistance she has provided to our organization and our members. Although she is virtually irreplaceable at VA, it is comforting to know that she will contifnue her efforts for disabled people. We welcome the opportunity to work with Dr. Giannini on future research and projects.

A Giant Step

On April 23, PVA testified before the US Senate Committee on Veterans' Affairs (SCVA) regarding health care legislation for our nation's veterans. Specifically, PVA provided its views on Title II of Senate Bill 127, the Veterans' Benefits and Health Care Amendments of 1991. PVA was enthusiastic about this opportunity to extend input on issues and legislative proposals that greatly impact our members. The following reviews some of the highlights of our testimony. The committee concentrated on Parts A, B, and C (mental health, general health, and health care personnel, respectively).

Part A: Mental Health

An issue of significant concern to all veterans' advocates is the mental and psychological well-being of our nation's veterans. In 1988 the Department of Veterans Affair (VA) provided mental health care to 285,562 veterans. There were 4,061,288 outpatient visits (18.9% of all VA outpatient visits).

* Many veterans, particularly those of the Vietnam era, have posttraumatic stress disorder (PTSD) and other psychological complications resulting from combat stress. PTSD is not limited to Vietnam veterans. The VA Readjustment Counseling Program, which handles much of the assistance for PTSD patients, would not be overburdened by broadened eligibility criteria for PTSD assistance. Senate Bill 127 calls for mental health treatment for all veterans with PTSD. PVA wholeheartedly supports this section of the legislation.

* Mental illness research, education, and clinical centers (MIRECCs) have been proposed as centers for the study and treatment of mental illness. Patterned after currently existing geriatric research, education, and clinical centers (GRECCs), MIRECCs would provide research study in a particular area confronting the veteran population. An estimated $ 3.125 million will be required to establish five MIRECCs in the first year of operation, with $6.25 million required annually to maintain and operate these centers over the next three years.

Although PVA agrees with implementation of the MIRECC program, we are uncertain as to VA's ability to fund such a project. Currently VA is unable to fully implement the GRECC program as proposed, with only 50% of those projected facilities actually operating. It is vital that adequate funding be secured prior to the development of MIRECCs. Preemptive action to the contrary may result in establishing an obsolete program.

Part B: General Health

* Nonservice-connected disabled veterans currently do not receive prosthetic equipment and supplies. The proposed section will allow non-service-connected disabled veterans who fall into the "mandatory" care category and receive outpatient care to receive prosthetic equipment; this would prevent costly inpatient treatment. PVA support this measure as both preventative and cost-effective.

* An increase of the Home Improvement and Structural Alteration (HISA) Grant for SCI and other eligible disabled veterans has been a top PVA priority for years; the last evaluation of HISA costs was implemented in 1976. Congress must make necessary adjustments to grant allocations for home modifications by disabled veterans without exorbitant personal costs.

PVA has recommended that the HISA grant be increased by 50%, to $5,000 for service-connected veterans and $1,200 for nonservice-connected veterans. PVA has assured SCVA that we will lend whatever assistance is necessary for passage of this much-needed revision.

* A provision in S. 127 calls for establishing a Transitional Housing Fund, which will assist nonprofit entities in meeting the costs of establishing programs to assist homeless veterans and those suffering from substance abuse or mental illness. This program, when coupled with regional outreach service programs and other extended services, can begin to alleviate the great problem of homeless veterans.

* Recently medical technology has developed accepted methods of reestablishing procreative possibilities for service-connected disabled veterans. For years, however, advances in this area have been blocked by members of Congress and lobbying groups who oppose the concept of in vitro fertilization. PVA will continue its fight for authorized in vitro fertilization and support other efforts to assist people seeking fertility assistance from VA.

Part C: Health Care Personnel

Pay enhancements, collective-bargaining protection, child-care services, and increased standards of practice all are substantial steps to providing greater services and benefits to ensure quality in VA health care via its employees.

The many issues in this bill outline a giant step for providing greater benefits and services to our nation's veterans. Legislation addressing issues and concerns for our veteran community will be met head on with all the energy and ammunition PVA has to offer. We will win our fight for veterans' rights and quality health care throughout the VA system. Although our battle may not be easy, given the unlimited number of interests vying for limited budgetary outlays, PVA will keep our veterans high on Congress's list of priorities.
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Title Annotation:Dr. Margaret Giannini
Author:McCoy, Victor, Sr.
Publication:PN - Paraplegia News
Article Type:column
Date:Jun 1, 1991
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