By Frank DeLoache

Salisbury Post

It’s not easy building an Indy racing car on a 1953 Chevy chassis. But that’s what Dr. Sidney R. Steinberg and the staff at the Hefner VA Medical Center are attempting to do.

On a rear wing of Building 2, the main structure drivers notice as they cruise by the Brenner Avenue complex, Dr. Charles P. Graham stands in the middle of a half-finished room, his arms spread wide.

Just like Dorothy in “Oz,” when he came to Salisbury from Kansas, he found “operating rooms destined for the Smithsonian.”

They were half the size of the unfinished room he’s standing in now and couldn’t possibly accommodate the modern equipment required by today’s surgeons.

Now they’re gone. Workers have gutted that entire wing — to the brick and steel foundations — and are installing three modern surgery suites. They’re still not large operating rooms by today’s standards — two are 400 square feet and the one in the center is 600 — but they will have the equipment necessary to perform sophisticated procedures never dreamed of here only a few years ago.

And Graham confidently points out the fourth-story window where he says construction crews will eventually erect a new tower featuring state of the art, 800-square-foot surgery suites.

Only a decade ago, the Hefner VA was still a “huge psychiatric hospital” that was losing medical positions to larger, more modern facilities in Durham, Richmond and Asheville.

Not now.

“We’re metamorphasizing into a real hospital,” Graham says.

Becoming dominant

Steinberg, one of the architect’s of this giant transformation, now serves as the Hefner VA’s interim director, since Director Donald Moore moved to a VA center in Phoenix in November.

A soft-spoken, bespectacled man, Steinberg says he’s not a candidate for the full-time director’s job. His love is working with patients and other doctors, he says.

Right now, he’s concerned about the budget for the current year stalled in Congress. The VA is operating at last year’s budget levels even though it can’t delay salary increases but doesn’t have the money to move forward on approved programs.

But in the end, that’s a temporary problem. The foundation required to transform the Hefner VA has been laid already, and Salisbury is now managing one of the fastest growing veterans’ medical centers in the country.

In the fiscal year that ended Sept. 30, the Hefner VA and its satellite clinics in Charlotte and Winston-Salem saw the list of patients exceed 60,000, more than double the number just five years ago. The Hefner VA recorded more than 400,000 out-patient visits between Oct. 1, 2005 and Sept. 30, 2006.

Those numbers make the Salisbury center the largest in the Mid-Atlantic Health Care Network, including seven other facilities in North Carolina and Virginia and one in West Virginia.

“It’s difficult for other facilities which have dominated in the past to realize that we are now dominant in our region,” Steinberg says, a hint of pride in his voice.

Charlotte is the engine driving that growth, he adds. The proportion of patients considered “elderly” has actually decreased. The average patient age is now in his mid 40s, requiring a full range of medical services.

Adding specialists

And Steinberg quietly reels off a list of specialists who are lifting the Hefner VA to star status:

* Dr. Robin Hurley, the VA’s acting chief of staff and associate chief of staff for mental health, is an expert on traumatic brain injury, including many of the explosive types of injuries soldiers are sustaining in Iraq.

* Dr. Katherine H. Taber, a Ph.D specializing in neurophysiology.

Taber, a research scientist, is working with Hurley, the medical expert, and a professor at Harvard on a new textbook called “The Windows of the Brain.” The book will likely serve as the leading source for the study of brain injury in medical schools in the future, Steinberg said.

* Complimenting Hurley and Taber’s work on the brain is a group of radiologists that Steinberg labels “brilliant.”

Drs. Corinne Deurdulian, David A. Pacholke and Djenaba Bradford-Kennedy are experts on imaging, and the Hefner VA has added “very sophisticated imaging equipment” they need in their work.

Likewise, Dr. Naomi K. Unterreiner is regarded as a leader in using new digital equipment in breast imaging and mamography, Steinberg said.

Her work is particularly important to the growing number of women veterans coming to the Salisbury center and its satellites for service.

* Surgeon Dr. David W. Crist, from Johns Hopkins University, is an expert in pancreatic surgery.

* Dr. Susan Jensen is a board-certified specialist in physical rehabilitation, another important service to veterans.

* Dr. Charles A. deComarmond, an assistant professor of infectious diseases at Wake Forest University, is an expert on hepatitis C, which soldiers contract when they come into contact with blood and which is becoming increasingly more common in the general population.

DeComarmond also is leading the Hefner VA’s HIV treatment program, which Steinberg says is “large but not expanding rapidly.”

“Our treatment results are pretty darn good,” he adds.

* Dr. Joseph B. Sutter, a Ph.D and researcher, came from Brigham Young University to the University North Carolina at Charlotte and is using the Hefner VA to train students in the management of hospitals and other large businesses.

As the Hefner VA’s associate chief of staff for research and education, Sutter has forged a strong link with UNC-Charlotte.

Steinberg hopes to expand that cooperation by recruiting UNC-Charlotte nursing students to train at the VA’s new Charlotte clinic when it opens in early 2008.

* Dr. Joseph L. Jorizzo, also from Wake Forest, is an expert in dermatology and treatment of skin disorders.

* Dr. Gary Bullard, a Duke University graduate, came from NorthEast Medical Center in Concord and has established a program to diagnose and treat sleep disorders and the underlying heart problems that can accompany long-term sleep problems.

An integral part of the Hefner VA’s growth has been its association with the medical school at Wake Forest University. Many of the VA’s medical staff, including Steinberg, are members of medical school faculty, and faculty based in Winston-Salem often spend a day or two each week treating patients in Salisbury.

Residents from Wake Forest’s medical school also train in a number of specialties at the Hefner VA.

Steinberg also is working with Virginia Tech, which has opened a new medical school in Blacksburg, Va., to train primary care physicians to serve in the Carolinas and Virginia portions of Appalachia.

Already, five to 10 Virginia Tech students visit the Hefner VA for a month at a time as part of the graduate training. The students are staying in the series of brick apartment houses that line the Statesville Boulevard side of the Hefner campus.

No longer leaving

High on Steinberg’s list of superlatives is the Hefner VA’s ophthalmology and optometry services.

Not the least

When Dr. Gary Mancil joined the VA staff in Salisbury 12 years ago, he was the only staff eye doctor.

Today, he directs a staff of 12 doctors.

When he first came to Salisbury, Mancil said the Hefner facility had to refer patients with more complicated eye problems to other VA centers in North Carolina.

Today, the Hefner VA has the largest eye program — serving 16,000 individual veterans a year — of any of the eight hospitals in the VA’s Mid-Atlantic Health Care Network. The centers in Durham and Richmond, Va., would be the next largest, with slightly more than 10,000 patients.

The Hefner VA recently opened a new ophthalmology suite with sophisticated laser surgery that can help older veterans who are legally blind.

The center’s staff offers programs to manage and treat glaucoma and macular degeneration.

Mancil talks as Optometry Technician Shirley White instructs Kris S. Pettigrew, executive assistant to the VA director who was volunteering as a patient, to rest his forehead against an ocularcoherent tomographer. It’s a machine that scans the layers of the retina at the back of the eye at a microscopic level.

When visitors came through the eye unit recently, workers hadn’t even had time to set up a new machine that takes pictures of the cornea at the front of the eye.

Until these machines were developed, doctors used to monitor eyesight by injecting dye in the blood vessels of the eye. Now, they don’t need to.

Whereas years ago, the Hefner VA sometimes had to send patients to the Wake Forest medical school in Winston-Salem, now Wake Forest specialists in glaucoma and retinal diseases come to Salisbury regularly.

And eye resident physicians from Wake Forest come to the Hefner VA for training.

All that activity is important to Salisbury itself, says Carol Waters, the Hefner VA’s public affairs officer. The medical center now boasts more than 1,500 employees and a budget exceeding $200 million.

“All of the growth at the Hefner VA is important … because it infuses jobs and 21st century health care technology into the community,” Waters says.

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Contact Frank DeLoache at 704-797-4245 or fdeloache@salisburypost.com.