integrating acupuncture at the portland va hospital erika fayina marie 2012

80 Pages·2012·0.93 MB·English

INTEGRATING ACUPUNCTURE
AT THE PORTLAND VA HOSPITAL

ERIKA FAYINA MARIE

2012

INTEGRATING ACUPUNCTURE
AT THE PORTLAND VA HOSPITAL

© 2011-2012
Erika Fayina Marie
All Rights Reserved
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ABSTRACT

This thesis contains a proposal written for the purpose of creating a community clinic
shift of National College of Natural Medicine (NCNM) acupuncture interns at the
Portland VA Hospital. The introduction shares the history behind the proposal, lessons
learned in the attempt at implementing the proposal, and reasons why the proposal is
being offered as a thesis. The proposal itself includes valuable information and
references regarding the emergence of complementary and alternative medicine as a
popular, efficacious, medically recognized, and federally-mandated component of
modern health care. The focus of included research is on the increasing usage of
acupuncture in the military as well as veteran health care settings, particularly for pain
and symptoms of post-traumatic stress disorder. The proposal offers a plan for an intern
acupuncture shift supervised in dual capacity role by a medical doctor with hospital
credentials and acupuncture training as well as a licensed acupuncturist recognized by
acupuncture and Oriental medicine accrediting bodies. Appendices offer further support
for the implementation of the proposal and are included as part of a complete example of
a proposal for intern-provided acupuncture in a leading, integrated hospital setting.
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DEDICATION

This thesis is dedicated to the mysterious force of existence, the Source, the
overwhelming spiral of beauty and perfection, to which I am forever grateful.
To all who have served, serve, or may serve the veteran community, thank you for your
dedication, compassion, and skill. So many veterans suffer from the empty despair of
disillusionment and betrayal. With the services and care you provide, may they know
they are loved and find a way to come to peace with existence and their place in this
world.
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TABLE OF CONTENTS

INTRODUCTION ........................................................................................................................... 1
PROPOSAL TO THE PORTLAND VA HOSPITAL EDUCATION DEPARTMENT ................. 8
I. PURPOSE ................................................................................................................................ 9
II. OVERVIEW OF ACUPUNCTURE AS A MEDICAL TREATMENT ............................... 10
Acupuncture in Oriental Medicine ......................................................................................... 10
Acupuncture as a Safe, Legal, and Regulated Therapy ......................................................... 11
Evaluating Acupuncture Research ......................................................................................... 13
Acupuncture: Multiple Perspectives on Mechanism of Action ............................................. 16
Acupuncture as a Popular Treatment Choice ......................................................................... 18
Acupuncture as a Cost-Effective Treatment for Complex, Chronic Conditions .................... 20
Federal Initiatives for Integrative Health Care ...................................................................... 23
PTSD: A complex, chronic disorder ..................................................................................... 24
Efficacy of Acupuncture for PTSD and Associated Symptoms ............................................ 27
Acupuncture in the Armed Forces and Conventional Medicine ............................................ 32
Acupuncture, CAM, and the Veterans Administration .......................................................... 34
The Benefits of Integrative Health Care ................................................................................ 37
III. STATEMENT OF EXPECTATION ................................................................................... 39
PERSONNEL ........................................................................................................................ 39
RESOURCES ........................................................................................................................ 42
V. PROPOSAL IMPLEMENTATION AND INTEGRATION .............................................. 45
VI. STATUS AND NEXT STEPS ........................................................................................... 48
VII. APPENDICES .................................................................................................................... 50
A. NCNM: A Leader in Natural Medicine Education ......................................................... 50
B. NCNM’S Curricula & Clinical Internship ....................................................................... 52
C. Example Curriculum for Master of Science in Oriental Medicine Degree, 2011 ............ 54
CONCLUSION .............................................................................................................................. 59
NOTES ........................................................................................................................................... 60
REFERENCES .............................................................................................................................. 68
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INTRODUCTION

In January 2011, as a third year student in the Master of Science of Oriental
Medicine (MSOM) Program at National College of Natural Medicine (NCNM), I met
with Dr. Laurie Regan, Dean of the Classical Chinese Medicine program, to discuss the
possibility of creating a community clinic shift at the local Portland, Oregon VA hospital.
As a West Point graduate and Post-911 Army veteran, I had experienced a small share of
physical and mental-emotional trauma. Yet, in just a couple years, through the use of
meditation, Reiki, acupuncture, qigong, and nutrition, I had also experienced and
witnessed considerable healing in myself and other veteran friends. I wanted to help the
veteran community that was struggling with issues like post-traumatic stress disorder and
chronic pain and was curious about the feasibility of creating a NCNM student-intern
community clinic shift for veterans at the Portland VA hospital. With the Dean’s
permission, I volunteered to investigate the potentiality and steps to NCNM and VA
institutional partnership.
At first, it seemed as though our project – the Portland Veterans Acupuncture
Initiative (PVAI) – was riding an unseen current to quick fruition. Our intention was to
establish an acupuncture program as an intern shift through the VA Education Office,
much like the hospital’s other medical residencies. In this way, the VA hospital would
gain the benefit of having acupuncture as a treatment option at little to no cost to itself.
The program would also serve to strengthen the hospital’s ties to the community and
provide a valuable experience to the NCNM interns. When all of these potentialities
were combined with the relief individual veterans suffering from pain and PTSD could
receive from acupuncture, our project seemed truly promising.
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While a few VA employees expressed hesitation due to the unconventional nature
of acupuncture, the majority of hospital employees, physicians, nurses, and veterans
expressed positive support for the idea of offering acupuncture as an adjunct therapy at
the hospital. As I worked to determine the steps to VA partnership I visited PVAP, the
Portland Veterans Acupuncture Project, a local non-profit organization that receives
referrals from several Portland VA hospital primary care physicians and psychologists in
the absence of onsite VA acupuncture. At PVAP, I met Dr. Diane Miller, MD, one of
PVAPs founding members, a Medical Acupuncturist, and an anesthesiologist at the
Portland VA Hospital. When I told her of NCNM’s intention to offer an intern
acupuncture shift to the VA hospital at no cost to the hospital, Diane offered to be intern
supervisor, stating that it would fit under her hospital research duties and responsibilities.
At that moment, we realized in addition to being a valuable service to veterans, the
project could also be used to advance the body of acupuncture and integrative medicine
research.
The Accreditation Commission for Acupuncture and Oriental Medicine
(ACAOM) requires supervision of interns by a licensed acupuncturist (LAc) for
accreditation purposes. With Dr. Miller accepting the role of VA credentialed supervisor,
we needed to select a licensed acupuncturist from the NCNM faculty to co-supervise the
shift. We considered the qualities of an ideal NCNM faculty supervisor and discovered
that Dr. Roger Batchelor, DAOM, LAc, had several qualities to recommend him. First,
he had worked as an acupuncturist for Central City Concern for ten years, an organization
dedicated to serving and finding solutions for Portland’s homeless population. During
his employment, he gained a great deal of experience treating veterans struggling with
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pain and post-traumatic stress. Second, Dr. Batchelor had earned a clinical Doctorate in
Acupuncture and Oriental Medicine (DAOM). In a conservative setting like a veterans’
hospital, his doctoral degree could help to open doors. Third, his personal bearing and
character of friendliness, compassion, and strength would inspire trust and confidence
amongst veteran service members. Amongst a faculty of extraordinarily talented intern
supervisors, Dr. Batchelor’s particular skillset made him a natural choice for what we
knew would be a delicate position.
By mid-March 2011, I had finished the proposal for the Portland Veterans
Acupuncture Initiative, including a research-laden overview of acupuncture and its
current status and usage in the medical, military, and veteran community. Meanwhile,
Dr. Diane Miller had obtained the legal paperwork necessary to create an Inter-
Institutional Agreement between NCNM and the Portland VA hospital. By the end of
March, we submitted our proposal with the Inter-Institutional Agreement to the Portland
VA hospital Chief of Staff (CoS) through the hospital’s VA Education Office, as per their
directive and protocol. We received the Chief of Staff’s signature and official approval
of the Inter-Institutional Agreement in June 2011 and Dr. Miller began working on
getting security clearance paperwork for Dr. Batchelor and the interns. In less than 6
months, we had found our way through a complicated bureaucracy and were looking
forward to starting our first rotation in September 2011.
Suddenly, however, the tide supporting our project turned from our favor. As
weeks went by, we learned that several higher-level hospital administrators were
expressing concern and resistance to the idea of hosting an acupuncture shift proposed by
an “outsider.” We quickly changed the proposed location of our shift from the Portland
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VA Mental Health Clinic to the Portland VA Women Veterans Health Clinic, also
located on the Portland VA Hospital campus, as its leadership was much more eager to
receive us. By July 2011, we had submitted our security clearance paperwork for VA
hospital background checks and ID badges and were awaiting final approval from the
Chief of Staff for our new location.
In September, however, hospital administrators expressed to Dr. Miller concern
over the cost of offering acupuncture, stating that they had a federal mandate for
integrative care but no funding to provide it. Additionally, they had strong concerns
about the project being too popular. They worried that other clinics and departments
would have patients that desired acupuncture and worried that we would not be able to
handle all the patients. In sum, the hospital administrators’ major concerns were about
cost and being overwhelmed by patient demand for acupuncture.
Dr. Miller responded to the hospital’s concerns on our behalf, assuring
administrators that hospital costs would be negligible. We adapted our proposal to
provide our own acupuncture supplies and to utilize only the space, chairs, tables, and
Sharps containers already available. Our preliminary canvassing had shown us that we
could anticipate seeing 8-10 patients at the Women Veterans Health Clinic per week to
start. With a team of four interns and one four-hour shift per week, we would have the
capability of treating 30-40 patients per week. We could clearly meet initial demand.
Additionally, in the case of growing or excessive demand, we could schedule a second
shift per week, which would allow us to see 80 patients per week. If demand required us
to begin a waitlist, not an uncommon phenomenon in the specialty clinics of the VA