Daniel Federman, MD
Vice Chair, Veterans Affairs
Allergy and Immunology
The Section of Allergy and Immunology has one faculty member, Christina Price, MD, who provides services through e-consults, telehealth, and in-person consultations. Drug allergies are addressed, and varied services that include management of immune deficiency in immunoglobulin infusions as well as allergen immunotherapy are provided. The section’s areas of excellence include clinical research in adults with immune deficiency.
The section includes 11 full-time and nine part-time faculty, with an additional 12 advanced practice registered nurses. VACHS has a long tradition of cardiac surgery and interventional cardiology (coronary and peripheral artery angioplasty), with a large referral region (eastern New York, western Massachusetts, and Rhode Island) and a track record of excellent outcomes. In expanding the portfolio of advanced cardiac therapies, the VA central office has approved West Haven as a site for left atrial appendage occlusion (LAAO) procedures, and conducted a site visit for potential approval of transcatheter aortic valve replacement (TAVR).
To serve a growing population of older and more medically complex patients with heart disease, VACHS has had a busy clinic for patients needing nonsurgical valve procedures for the past five years. The clinic is run conjointly with cardiac surgery to provide convenience and improve coordination of care for this cohort of patients. The volume of patients and the complexity of the cardiac diagnoses has reached the point of having a contracted physician from Yale New Haven Hospital’s Structural Heart and Valve Disease Program seeing patients in this clinic. An advanced practice provider has also been hired. LAAO procedures are expected to begin in early 2023, with the completion of the TAVR demonstration simulation in early 2023 as the last step in approval of the TAVR program. What began pre-COVID as a small opportunity to partner with the Hudson Valley VA has now blossomed into a large and ever-expanding virtual care program. In June 2019, S. Elissa Altin, MD, responded to the appeal of a podiatrist who was frustrated by sending many of her patients with foot wounds on long bus trips to the Bronx VA to see a vascular surgeon. Altin travelled to Hudson Valley, taught a technician to use a vascular Doppler, and set up a live camera joint clinic so that she could examine a patient’s foot wounds from her office in Connecticut. This experience led to a busy clinic that provided a convenient local experience for the patient and the treating provider. This model of care has benefitted the health care system and stimulated considerable nationwide interest during the COVID pandemic. Altin’s innovation quickly led to other ideas about extending VACHS physician expertise to other relatively underserved VA facilities. Altin’s remote vascular clinic now serves both Hudson Valley and Central Western Massachusetts.
In collaboration with the VA Clinical Resource Hub program, a program for remote cardiac electrophysiology care for patients with pacemakers and automated implantable cardioverter-defibrillators (AICDs) has been launched at the Manchester, New Hampshire, VA. Using telemedicine, expert physicians and APRNs from West Haven are able to remotely monitor device function, adjust device parameters, and optimize care for about 130 cardiac patients in Manchester who would otherwise be referred to community physicians. This innovative program is unique to New England, and serves to keep care within the VA system; improve care coordination; and reduce cost. Ideally, this program will be replicated for cardiac device patients in western Massachusetts within the next year.
New programs in preventive cardiology and coronary physiology have been a section highlight over the last year. The prevention program has expanded care and intervention to those patients at highest risk of heart disease, partnering with Health Psychology and Endocrinology (lipid and diabetes management) to devise a comprehensive care model. Over the last year, approximately 100 patients have gone through an extensive screening/counseling program and/or cardiac rehab. The program also has a nascent academic arm, generating four abstracts and manuscripts in the last 12 months.
In coronary physiology, Samit Shah, MD, PhD, is the principal investigator for a multicenter study to understand the common clinical problem of patients with typical chest pain but without obstructive atherosclerosis—also known as ischemia with no obstructive coronary artery disease (INOCA). Using a protocol developed and refined in the West Haven VA catheterization labs, Shah is now running the Discover INOCA registry, using invasive methods to characterize dysfunctional aspects of coronary physiology in this challenging group of patients. Robert Soufer, MD, who has devoted his career to understanding the relationship between mental stress and heart disease, is applying these same invasive methods to understand changes in coronary physiology during mental stress—a program unique to VACHS catheterization laboratory.
VACHS Endocrinology is staffed by six faculty members (with a total of 2.5 FTE) who provide endocrine care for veterans in outpatient clinics in West Haven and Newington, and supervise endocrinology fellows in their longitudinal clinic. Two faculty members, Section Chief Varman Samuel, MD, PhD; and Daniel F. Vatner, MD, PhD, have their own independent labs. Ana Luisa Perdigoto, MD, PhD, and Diana Athonvarangkul, MD/PhD, are junior investigators. Lisa Parikh, MD, and Grace Lee, MD, bring clinical expertise in endocrine subspecialties (e.g., obesity medicine, transgender care, and bone and thyroid diseases) to ensure outstanding health care for veterans and a comprehensive educational experience for trainees. Taken together, faculty members in this section produced 16 publications in FY2021/22. Samuel is currently serving on the VA’s Clinical Practice Guidelines Committee for Diabetes.
The section recruited Athonvarangkul this year to replace Barbara Gulanski, MD, MPH, who retired from VACHS after more than 20 years of dedicated service and leadership. Parikh and Vatner expanded their clinical expertise to develop specific roles in obesity medicine and clinical lipidology. With support from the VA, these roles could be added to the Clinical Resource Hub to make VACHS a regional center for these endocrine subspecialties.
Gastroenterology / Liver
Fourteen faculty members in digestive diseases work, teach, and train fellows and residents at VACHS. Led by chief Tamar Taddei, MD, this group published 88 peer-reviewed original research studies, eight editorials, and six separate society guidelines, along with 10 funded grants during FY2022. Two are high profile VA Cooperative Study Program grants focused on colorectal cancer screening (Petr Protiva, MD, MPH, is the local site investigator) and hepatocellular carcinoma (Taddei is study co-chair). Several faculty members serve as associate editors of high-impact publications: Guadalupe Garcia-Tsao, MD, The New England Journal of Medicine; Wajahat Mehal, PhD, MD, Journal of Hepatology; Taddei, American Journal of Gastroenterology; Protiva, BMJ Open Gastroenterology; and Gyanprakash Ketwaroo, MD, AGA GI & Hepatology News. These clinicians and researchers have received significant recognition for their careers and service: Garcia-Tsao received the 2021 Distinguished Scientific Achievement Award from the American Liver Foundation. Simona Jakab, MD, and Taddei serve on the VA National GI and Hepatology Program’s Hepatology Field Advisory Board. Jakab directs a nationwide lecture series for the VA Specialty Care Access Network; and Joseph Lim, MD, directs the VACHS Liver Update conference. Mehal and Jonathan Dranoff, MD, serve as regular members of NIH NIDDK study sections. Garcia-Tsao serves as a member of the AASLD Foundation Board. Loren Laine, MD, serves as chair of the NIH-funded Fecal Microbiota Transplantation National Registry Steering Committee and of the Digestive Disease Week Council. Taddei was elected treasurer of the AASLD, a position she assumed in January 2023.
Two junior faculty have joined the section: Amy Ogurick, MD, director of GI Clinics and GME site director for the Digestive Diseases Fellowship Program; and Louise Wang, MD, recipient of a five-year VA Career Development Award for the study of pancreatic cancer risk.
The section comprises 34 primary care, 11 hospital medicine experts, and four researchers, led by section chief Lori Bastian, MD, MPH.
Eight section faculty members were promoted to new roles this year at the VA Connecticut Healthcare System. They are:
- Seonaid Hay, MD, associate chief of staff for Education
- Cindy McNamara, MD, associate program director for Internal Residency, traditional track
- Jeffrey Kravetz, MD, chief of Primary Care
- Rebecca Brienza, MD, MPH, chief of Primary Care, Firm A/COE
- Juliette Spelman, MD, chief of Primary Care, Firm B
- Matthew Zegarek, MD, associate chief of Primary Care, Firm A/COE
- Christopher Ruser, MD, associate chief of Medicine
- Jin Xu, MD, chief of Medical Consultative Services
This year, the VA Health Services Research & Development postdoctoral fellowship was up for renewal. Led by Bastian, the programmatic funding request was successful. In addition, Caroline Falker, MD, was given a mobile medical unit to expand care for VACHS’s Homeless Patient Aligned Care Team.
In collaboration with the Harvey and Kate Cushing Professor of Medicine (Infectious Diseases) Saad Omer, MBBS, MPH, PhD, a working group of section members focused on combating vaccine hesitancy. The team of Spelman, Bastian, Ruser, and Kravetz developed electronic medical record-based tools capitalizing on VA data to reach unvaccinated veterans. They incorporated evidence-based language to assist with documentation and linking to easy vaccination options. Their efforts were published in the Journal of General Internal Medicine, one of the 25 publications from section faculty members this year.
Kravetz led a multidisciplinary workgroup with primary care, emergency medicine, and pharmacy personnel to create an outpatient remdesivir infusion clinic and then triage oral medications for treatment of COVID-19. Minhee Sung, MD, was awarded two new grants related to her work with veterans with opioid use disorder and the use of buprenorphine.
Hematology / Medical Oncology
Seven faculty members care for patients with cancer and hematologic disorders at VACHS. The section has a robust clinical trials program and is a popular rotation for fellows and residents.
The VACT Hematology/Medical Oncology clinical trials program is highly active within the National Cancer Institute’s (NCI) National Clinical Trials Network (NCTN), and continues to be the top enrolling site for NCTN studies across the Department of Veterans Affairs. Michal Rose, MD, is also the lead oncologist for the VA New England Healthcare System (VISN 1) clinical trials network and the SWOG cancer research network storefront.
VACHS is a hub site for the Lung Precision Oncology Program, a partnership between the National Oncology Program Office and the Office of Research and Development to optimize lung cancer care. The primary co-investigators are Hilary Cain, MD, and Rose. This grant has enabled the lung cancer clinical trials portfolio to expand, and has allowed the Section of Hematology/Oncology to mentor other New England VAs as they build their own clinical trials program.
Over the past year, hematology/oncology faculty were recognized for their excellence. Herta Chao, MD, PhD, is the PI on three federal grants: NAVIGATE (NCI and VA Interagency Group to Accelerate Trials Enrollment); a VA Merit award; and an R01 to study the impact of androgen deprivation therapy on cognitive function in men with prostate cancer. Edward Perry Jr., MD, gave the keynote address at the Association of VA Hematologists/ Oncologists annual meeting. In addition, Perry was accepted into the Yale Master of Health Science-Medical Education Pathway degree program. He received a Department of Internal Medicine education grant to support his project developing a novel opioid pain management curriculum for oncology fellows. Alexander Pine, MD, PhD, was awarded a Frederick A. DeLuca pilot grant to study proteins and cytokines in patients with antiphospholipid syndrome.
Talib Dosani, MD, was appointed to the national VA guidelines committee for hematologic malignancies.
This team has grown to 11 hospitalists who cover 100 percent of the inpatient medicine service as of 2021, and is led by Chief Craig Gunderson, MD. Most of the team spends over six months of the year with learners through teaching courses like the Medical Coach Educator course; as clerkship directors for YSM Internal Medicine or PA student rotations; or as mentors for the VA Chief Resident in Quality and Safety (CRQS) program. New educational roles have been added this year: Benjamin Cherry, MD, became clerkship director for the YSM subinternship rotations; Shaili Gupta, MBBS, was named associate program director (APD) for diversity, equity, and inclusion; and Benjamin Rodwin, MD, is the new associate program director for preliminary residents.
During the past year, members of the Hospital Medicine team published 20 articles, five as senior authors and 10 original research manuscripts. Gupta, Gunderson, and Naseema Merchant, MBBS, were each invited to give poster or oral presentations and/or talks at national conferences.
Gunderson and Jurgen Holleck, MD, were principal investigators on large clinical trials that concluded in September 2022. Gunderson is the PI on the “Variation in Management of Hospitalized Patients with Alcohol Withdrawal: A Multicenter Retrospective Cohort Study.” Holleck’s trial, “Risk of Serious Adverse Gastrointestinal Events Associated with Use of Potassium Binders,” was run through the VA HSR&D SWIFT review.
Gunderson was named the new associate chief of staff, Hospital Operations, for VACHS for 2021–2022.
The section is led by Chief Richard Sutton, MD/PhD, who has been on medical leave; Louise- Marie Dembry, MD, MS, MBA, has served as acting chief in his absence. The ID team has eight physician members: Rupak Datta, MD/PhD, MPH; Dembry; Brinda Emu, MD; Ann Fisher, MD; Sheela Shenoi, MD, MPH; Sandra Springer, MD; Sutton; and Joseph Vinetz, MD. In addition, the section has one full-time physician assistant (PA) and several adjunct physicians.
The team runs the inpatient ID consultation service on the VACHS West Haven campus, along with two outpatient consultation clinics per week and two HIV clinics (which include one ID fellow HIV continuity clinic). There is one combined ID/HIV clinic per week at the VACHS Newington campus staffed by Springer, and an additional Newington HIV clinic staffed by the HIV PA. Moreover, the consultation service fulfills all the e-consults for the West Haven facility, and occasionally other sites within VISN1 that don’t have an ID consultant. The consultation service and clinics serve as a training site for Yale ID fellows; they provide an opportunity for the fellows to maintain care continuity between inpatient and outpatient settings, and treat infectious diseases in unique veteran populations (e.g., Community Living Center, residential mental health).
The VACHS Hospital Epidemiology/Infection Prevention and Antimicrobial Stewardship programs are directed and run by section physicians. Dembry is chief of Hospital Epidemiology/Infection Prevention; Fisher is the associate hospital epidemiologist; and Datta is the part-time assistant hospital epidemiologist. The Infection Prevention Program covers inpatient and outpatient services (including community-based outpatient clinics across Connecticut), the Community Living Center, and other residential programs. Fisher and Datta direct the VACHS Antimicrobial Stewardship program. Both programs offer training and research opportunities for ID fellows in their second and third fellowship years.
Sutton, Vinetz, Springer, Emu, and Shenoi have basic, translational, and clinical science laboratories at Yale School of Medicine in which they investigate various aspects of infectious diseases. Some of these laboratories are at least partly VA-funded.
Two section faculty were awarded honors related to their VA work this year. Springer received the Avant-Garde Award for HIV/AIDS and substance use disorder research, a focus of her VA-based research. Datta was awarded the Society for Healthcare Epidemiology of America (SHEA) Epi Project Competition grant to study antibiotic stewardship within VA home-based primary care.
Led by Susan T. Crowley, MD, MBA, the Kidney Medicine section has nine clinicians who provide consultations for inpatients around the clock at the West Haven facility, and maintain clinics for patients who received kidney transplants, have hypertension, or require dialysis in an outpatient setting. In addition, the clinicians train patients and their caregivers on peritoneal dialysis. The team runs clinics in person or via telemedicine in both West Haven and Newington. In conjunction with VA Boston HCS, Justin Belcher, MD, PhD; Robert Safirstein, MD; and John Chang, MD, operate three national telenephrology clinics currently serving underserved veterans across New Hampshire, Oklahoma, and eastern Colorado. Patients in Montana and Wyoming will be added later this year. The section also completes hundreds of clinical e-consults annually in addition to a dedicated e-consult clinic for nephrology-restricted medication renewals.
To continue the advancement of health equity, the section, pathology, and lab medicine were leaders in the early adoption and implementation of the race-free CKD-EPI 2021 eGFR equation across the VHA, which was enacted in January 2022. Namrata Krishnan, MBBS, serves as the section’s vice chief of diversity, equity, and inclusion, and cares for patients at the VA. The section has earned national attention, with Crowley receiving the 2022 David M. Hume Award, the highest award from the National Kidney Foundation; and Mark Perazella, MD, receiving the 2022 Robert G. Narins Award from the American Society of Nephrology for education in October 2022. Crowley serves as executive director of the Veterans Health Administration Kidney Medicine (Nephrology) Program. David Geller, MD/PhD, is the medical director of both the VA New England Dialysis and the VA CT Dialysis Programs.
Members of the section are presently conducting two large clinical trials. The National Institute of Diabetes and Digestive and Kidney Diseases funded HOPE Study is a trial of innovative nonpharmacologic and pharmacologic treatment of chronic pain in people who require maintenance hemodialysis. Crowley is the VA Consortium co-PI, and Belcher is the site PI. The Incremental Hemodialysis for Veterans with incident ESRD (IncHVets) Study tests the efficacy of patient-centered hemodialysis initiation strategy through a multisite trial. Geller and Crowley are co-site PIs.
The Occupational Environmental Medicine section is led by Chief Brian Linde, MD, MPH, and has three physician members: Efia James, MD, MPH; Richard Smith, MD; and Linde. In addition, the section has one full-time physician associate (PA) and one registered nurse.
The team runs the Employee Occupational Health service as well as the Occupational and Environmental Medicine consultation service. The Employee Occupational Health service is responsible for the management of all administrative medical exams (including new employee onboarding), medical surveillance, and work injuries. In addition, the service continues to work very closely with Hospital Epidemiology/ Infection Prevention on COVID-19 response. The Occupational and Environmental Medicine consultation service, which addresses clinical questions related to health effects of military/occupational/environmental exposures, is preparing to expand the service following passage and signature into law of the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act in August 2022. The PACT Act addresses health care, presumption of service connection, research, resources, and other matters related to veterans who were exposed to toxic substances during military service.
Treating veterans with histories of toxic exposures is now one of the six top-level VHA priorities.
Linde recently served on the National Academies of Science, Engineering, and Medicine’s Committee on Guidance on PFAS Testing and Health Outcomes. PFAS testing refers to analyzing drinking water for contaminants known as per- and polyfluoroalkyl substances. The committee’s report is available on the National Academies website. Linde is also the associate program director for the Yale Occupational and Environmental Medicine fellowship training program.
James serves as lead physician of Employee Occupational Health for VISN1 (the New England Region of VHA) and the lead environmental health physician for VA Connecticut. She is also a member of the National VHA Change Advisory Board for Employee Occupational Health, and serves as a delegate to the New England College of Occupational and Environmental Medicine within the American College of Occupational and Environmental Medicine’s legislative branch. James has delivered many exciting education initiatives, teaching medical, physician associate, and nursing students on clinical rotations; she most recently collaborated with Addiction Medicine on the highly successful Pain, Opioids, and Worker Wellness CME Workshop. The service was also pleased to recruit Richard Smith, MD, this fall. Smith completed his residency training with the Yale Internal Medicine Primary Care Residency Program and his fellowship training with the Yale Occupational and Environmental Medicine Program. During his fellowship training, Smith worked with the Connecticut Department of Public Health on its campaign to raise awareness about contaminants in well water. He also collaborated with the Post-COVID Recovery Program at the Winchester Center for Lung Disease studying patients’ return to work following COVID infection. He has also been a critical partner with the Yale Occupational and Environmental Medicine Program in immunological surveillance of worker populations throughout the COVID-19 pandemic.
Pulmonary, Critical Care and Sleep Medicine
Section Chief Hilary Cain, MD, continues to serve as co-lead PI for the Lung Precision Oncology Program (LPOP) with Michal Rose, MD (hematology/oncology VA chief). The VA’s goal is to become a model of excellence for precision oncology. Priorities include increasing access to lung cancer screening, clinical trials, and biomarker testing. The award was a joint application between pulmonology and oncology (PIs Cain and Rose) and provides support for a clinical core (clinical coordinator, Kathryn Lerz, APRN) and research core (research coordinator, technician) for up to five years.
Lauren Cohn, MD, directs the Biologics and Advanced Therapeutics in Airway Diseases in Pulmonary. All asthmatic veterans being considered for biologic therapy by a pulmonary provider are referred for evaluation using the e-consult process. Faculty and fellows are educated about severe asthma, therapeutic options, and the safety and monitoring of biologics for asthma; and this oversight ensures the appropriate use of therapies. Oversight of the asthma biologics program ensures that pulmonologists work closely with the clinical pharmacists and nursing staff to educate veterans about various therapeutic options and indications, and to review protocols for drug delivery and monitoring.
Charles Dela Cruz, MD, PhD, was recently awarded a VA Merit award for analyzing the role of innate immune mediated pathways in driving lung inflammation, injury, and fibrosis during smoking exposure; in viral influenza infection; and in patients with COPD. He also continues to be supported by the U.S. Department of Defense for his work on pulmonary infections. Edward Manning, MD, PhD, received multiple honors, most recently a two-year VISN1 Career Development Award. Other awards include a three-year $600,000 grant from the Additional Ventures Single Ventricle Research Fund mechanism; a National Institute on Aging Butler-Williams Scholar Award; Yale Pepper Center grant recipient and scholar; and the RCCN/AFAR Measuring Biologic Aging Workshop travel award.
Kathleen Akgün, MD, MS, VA Medical ICU director, continues as a core leader for emerging areas of health services research in the Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center. She also collaborates closely with Amy Justice, MD, PhD, (Section of General Medicine) and the Veterans Aging Cohort Study as well as with Shelli Feder, PhD, APRN (Yale School of Nursing.) Akgün is completing her final year as chair of the Ethics and Conflict of Interest Committee for the American Thoracic Society, and has mentored learners and strengthened relationships with clinical and research leaders to advocate for equitable and accessible pulmonary care.
Over the past year, several of the rheumatology section faculty members have continued to work to expand clinical services for veterans and educational programs for trainees from Yale and the University of Connecticut (UConn). In particular, they continue to provide outstanding educational training for Yale and UConn rheumatology fellows in musculoskeletal ultrasound. Carmen Pagan, MD, obtained USSONAR Musculoskeletal Ultrasound certification in June 2022, and opened an ultrasound/procedures clinic in West Haven in the summer of 2022.
Section Chief Evelyn Hsieh, MD, PhD, and Lisa Suter, MD, have been recognized nationally to serve as chairpersons for committees and subcommittees of the American College of Rheumatology (ACR), Suter as co-chair of the Quality Measures subcommittee, and Hsieh as chair of the Global Engagement Special Committee and co-chair of the Strategic Planning Task Force. In addition, Suter is a member of the American Academy of Orthopedic Surgeons Patient-Reported Outcomes Task Force.
The section has continued to be productive in research both at the VA and beyond, with new NIH funding obtained within the past year for VA-related projects.
Hsieh, together with Julie Womack, PhD, from the Yale School of Nursing, obtained a R01 supplement for their project titled “Use of Optical Character Recognition (OCR) to Enable Al/ML-Readiness of Data from Dual-Energy X-ray Absorptiometry (DXA) Images.” Hsieh also received a supplement from CMB for “Creation of a Global Health Pre-Departure Orientation Program for CMB GHLDP Fellows.”