Transcripts For CSPAN Veterans Affairs Secretary Robert Wilkie Testifies Before House... 20240712

Subcommittee on the agencys response to the coronavirus pandemic. Careecretary updated the provided during the pandemic and talked about some of the challenges moving forward. This is 2. 5 hours. A military briefing for a full year. When my dad was the artillery commander, they asked the second airborne to come visit. He was troubled. So i have touched royalty. Secretary wilkie is here for important testimony. Do i have the mic on . I can officially call the subcommittee on military construction, Veterans Affairs, and related agencies to order. I would like to welcome secretary wilkie, who is our witness this morning, joining us. Since this is our first hearing with some numbers participating remotely, i would like to begin by offering a brief explanation of how it will work, in order to benefit both members and the public. First, this hearing room has been configured to maintain the recommended six foot social distancing between members, witnesses, and other individuals in the room necessary to operate the hearing, which we have kept to a minimum. Some members have elected to use secure videoconferencing which allows them to participate remotely. For those on videoconference, once you start speaking, there will be a slight display delay before you are on the main screen as i am now. We ask that members participating virtually remain on mute until it is your turn to ask westerns. Please are member to meet yourself at the conclusion of your question. Should you seek additional time, please unmute yourself so i may recognize you, just like if you were in the room and you want to get the chairs attention. You would turn your mic on and ask for attention. For those participating remotely, your voice will actually activate your appearing on the screen across the room, you do notw that move to the screen until you actually begin speaking. I remind all members that the witnesses fiveminute rule still applies. If there is a technical issue, we will move to the next member until it is resolved and you will retain the balance of your time. You will notice a clock on the bottom of your screen that will show how much time is remaining. At one minute remaining, the clock will turn yellow. At 30 seconds remaining, i will gently tap gavel to remind members their time is always expired. When your time has expired, the clock will turn red and i will begin to recognize the next member. We will follow the speaking order set forth in the house rules, beginning with the chair and Ranking Member. Members will be recognized in order of seniority, and members not present as the meeting is called order. This is a meeting in response to the covid19 pandemic. We Welcome Department of Veterans Affairs secretary robert wilkie, who is joined by the under secretary for benefits of the Veterans Benefits administration, the assistant secretary for management and seek financial officer, and the chief consultant the Deputy Deputy under secretary for health area thank you for being here today. I cannot underscore enough the importance of this hearing as we strive to take care of our veterans and do everything in our power to keep Frontline Health care workers safe. This hearing is an important opportunity to provide oversight of the almost 1 billion congress has appropriated to v. A. In emergency funding in the familys first Coronavirus Response act, and the cares act, to assist v. A. In combating the pandemic. The book of the funding is for direct patient care, and it is our duty to oversee that funding to ensure the v. A. Is administering and veterans are receiving the utmost and highest quality of care, especially during these unprecedented times. With that money, we expect v. A. To provide enough personal protective equipment, or ppe, to every person working in a v. A. Facility, and to patients when necessary. As soon as one covidpositive patient walks through the door, every v. A. Employee is at risk of contracting the virus whether they are directly treating the patient in the covid19 board or not. I understand a shortage of supplies and unstable supply chain issues contributed to the implementation of austerity measures providing ppe, but only providing ppe to frontline v. A. Health care workers, particularly only those who were treating directly covid19 patients, was unacceptable, especially given the amount of interaction other v. A. Employees have with patients who may or may not display symptoms of the virus. We all know and are well aware that we do not have to be symptomatic in order to be carrying the virus. I am glad that v. A. Has started to make steps in the right direction after unrelenting backlash from congress on the irresponsible ppe policy, and has since updated it to provide one mask for every employee, regardless of direct patient interaction or not, and i appreciate it the opportunity, mr. Secretary, to talk with you throughout the crisis, express our concerns, and get back from you on how we could be helpful to you in making sure we could write that ship. Right that ship. I am still hearing concerns at the field level that the policy is not being implanted consistently, so many veterans and employees are still left unprotected. The v. A. Must make sure it is communicating effectively. It is not enough to issue guidance to v. A. Employees. V. A. Must ensure that such guidance is being adhered to and implement it consistently. Further, v. A. Must do everything in its power to meet conventional cdc standards in ppe usage. Any austerity or contingency measure in place on ppe usage leaves veterans and healthcare workers vulnerable to infection. This is especially egregious when the president has implanted full authority to fix the problem of a lack of supplies by fully invoking the defense production act, so american businesses can completely fill the gap in the supply chain for these vital resources, which is the defense production acts purpose. V. A. Would no longer have to compete for care supplies like it currently does, and could revert back to professional practices rather than austerity measures in administering ppe. Further exacerbating the problem, scarce resources create the right conditions for price gouging, which Many Companies are taking advantage of. A propublic a couple of weeks ago shed light on the issue of small, inexperienced contractors charging exorbitant prices for scarce ppe. V. A. Is willing to pay the price because of how desperate the situation was. I understand these are unprecedented times, but we need to protect our veterans and frontline workers who are putting their lives at risk to combat this deadly virus, will still protecting taxpayer dollars to do so. Within the Funding Congress appropriated, we want to make sure v. A. Is providing adequate testing to veterans and to its employees. I cannot stress enough the importance of testing, as it will be the only way we can get a handle on how the virus is spreading, and where. We need adequate testing to make americans feel safe. We do not have a consistent, comprehensive testing policy at v. A. Right now, and this must change. This is especially important as vmas the to reopen facilities around the country beyond emergency care. V. A. Has already begun reopening at 20 facilities and plans to open additional facilities and start to resume more services in a phased process. We need to make sure we have sound policies in place so we do not fight these fights and the virus as we move forward. When veterans are at v. A. Hospitals, we need to make sure they are treated with the utmost quality of care. More and more information is coming out about how ineffective and potentially deadly the antimalarial drug hydroxychloroquine is for covidpositive patients. What is astounding to me is v. A. Is still insisting on providing this drug to veterans, yet v. A. Cannot effectively communicate circumstances in which the drug is administered. I hope that changes today. We clearly have a lot of ground to cover today. Thank you for being here this morning, and i look forward to your testimony. I would like to yield to Ranking Member carter for his Opening Statements. There may be a delay before he is displayed on the main screen. Hello from round rock, texas. Chairman, thank you for this hearing today. To let you know that right now it is 67 degrees outside in the lone star state. Temperatures will be up around 85 today. Which is kind of cool for us. I am glad to be here today. I never thought i would be able to go to a hearing sitting in my home, telecommunicating. This is quite a step. It is a big step for the appropriations committee, and the house of representatives, and a first step, so i am proud to be part of it. Chairwoman,tion the the Ranking Member, doing this and working very hard to get this done right. I think all of them and congratulate them for their work. As a member who cannot attend , i guessing in person this is the best im going to be able to do, and i am grateful for it. As we continue with their oversight of the department of Veterans Affairs and the response to covid19, and these supplemental funding provided two months ago, secretary wilkie, thank you for being here to talk about the v. A. s response to covid19. In many ways, the v. A. Has been at the forefront of americas response and has been a leader in caring those affected by the pandemic. Decisive action to protect residents in Community Living centers and other special care facilities spared many veterans serious injury or illness, and possible death. Aa. Has also stepped up for individuals to work with civilians to provide urgent needs for medicine in every corner of the United States. , not many would have believed that a large, decentralized National Healthcare system could so quickly and effectively respond, but the v. A. Did, never losing focus on their first mission, which is care for the veterans. Such as its problems maintaining supplies of personal protective equipment for its employees, and questionable contracting procedures, and we will discuss these issues today. We will also discuss supplemental funding provided by the cares act, and whether there is a need for additional funding or any followup package that. Ay be coming in teacher years i want to thank the committees Technology Staff for their help and very diligent work. We are holding this hearing because of what we have learned, and i personally thank you. Again for my time, and i yelled back. Thank you, judge carter. I appreciate your kind words and join you in thanking our appropriations staff, as well as the Technology Staff and the house recording studio. Outside of the rules committee, this is the first with outside witness hearings, hybrid hearings, where we have some members participating remotely and some in person. There was lots of her personal, dress rehearsals, that went into this, to make sure everything was going to go smoothly. I thank all of the members for their cooperation. That is the spirit of this committee. It always has been. It is deeply appreciated so we can continue to do the work that is so important for us to do. Thank you for your thoughtful remarks. I would like to yield to the full Committee Chair for her opening remarks. There might be a slight label or she appears on the screen. Madam chair, you are recognized. Think thank chairwoman Wasserman Schultz and Ranking Member carter for holding this very important hearing. And i welcome secretary wilkie and our other distinguished officials, and i thank our Committee Staff for navigating this new way of conducting business. Discussionegin our on the heels of memorial day, we would be remiss not to mention our recent quarrels recent of nazir the removal and some of our cemeteries. All the predecessors may have allowed them, today, we need to do the right thing and remove these offensive symbols from the solemn ground where our brave warriors rest. During this horrible corona responsibility to the men and women who have served our country has never been more vital. This administrations lack of mismanagementnd has led to needless death and suffering, and much fear among their families, and the Health Care Professionals who care for them. To date, there have been more ofn 13,000 13,500 cases covid19 diagnoses throughout v. A. Health care facilities. Tragic deaths, 241 have occurred in new york. Is even more tragic in state run Veterans Homes, where our most vulnerable veterans have been denied the highest quality of care. Responsibility to oversee and ensure the facilities are meeting gay standards of care, and v. A. Should have stepped in sooner to help. Months, evahree Health Care Workers have risked their lives and the lives of patients because of a shortage of personal protective equipment. V. A. Ack of urgency by the to address this need has likely contributed to additional sickness and death. Hope that we are all on the workpage, and that we can fix this issue, which is so outrageous. Veterans have suffered because of disruptions to routine physical and Mental Health care visits. Many patients stressed the burden of homelessness, unemployment, and uncertainty. When veterans most need the v. A. To be ahead of the curve, it is falling behind. We need to understand what went can understand and identify what needs to be done to avoid the shameful treatment of veterans in the future. So thank you. I look forward to your statement, and i do look forward to answers to our questions. Thank you. Rep. Wassermanschultz thank you, madam chair. Mr. Secretary, as always, your full statement will be entered into the record, and you are recognized to summarize earmarks for five minutes. Sec. Wilkie thank you very much and i want to thank you also for your availability to me throughout this. I value that relationship, and i think it is incredibly important to the department. We are fighting a war that very few people in america would have predicted just a few months ago. Our doctors, nurses, and staff are routinely putting their lives on the line and sacrificing time with their families to care for veterans, most of whom are older and therefore more vulnerable to this virus. 31 of our Staff Members have passed away, and as you know, we have lost hundreds of veterans to this disease. But the news is not all grim. From the start, v. A. Took an aggressive posture to protect our patients from covid19, and our staff has worked tirelessly to carry it out, with great success. Here is where we stand. We have diagnosed 11,500 veterans with the virus, but over 9000 of them have fully recovered. That is 76 . Treating 1500only veterans for the virus, out of the over 9. 2 million veterans in our system. We are stocked with supplies. On average, vha has a minimum of two weeks supply on hand of each gloves, eye protection, masks, gowns, sanitizer. We are staffed in part because of the changes we have made in our hiring process. In the last five weeks, we have hired more than 10,000 medic 3000 nurses. Ing and as i discussed with the chair yesterday, i intend to keep these processes in place. If i need to come for a legislative fix, i will be doing so, after consultation with you. Our infection rate among v. A. Staff, i can argue, is the lowest in any Health Care System in the country. It is either at half of 1 or lower. And i credit the steps we took early on to protect those on the front lines with these incredibly low numbers. We were the first Health Care System and the First Federal agency to activate our emergency procedures. We did so in january, establishing 19 Emergency Operations centers was the country. We did begin to manage our supplies of ppe, and as i have discussing with the chair, our supply chain was disrupted with this National Emergency, and we have changed to meet that emergency. In some ways, we have stressed the system, which i think will be better for the future. Haveealth services expanded exponentially. In a normal month, we would conduct 40,000 Mental Health televisits. We are now at 900,000. We are reaching areas of the country that we never thought we would reach, particularly in tribal and rural america. Changer, game particularly when it comes to Mental Health. In april, we began working our Fourth Mission in earnest, taking in nonveterans in hotspots, deploying v. A. Staff to Nursing Homes and state Veterans Homes that needed our expertise, an issue i know some of you will want to talk about today. Addition, we have our Veterans Benefits administration reaching out to more than 400,000 veterans, continuing to talk about our response and answer questions about their benefits during the crisis. Our National Cemetery administration has taken steps to assure that loved ones are erred [indiscernible] sec. Wilkie madam chair rep. Wassermanschultz madam chair, you need to mute your line. Secretary, you can resume. Sec. Wilkie that our veterans rep. Nterred in a wassermanschultz mr. Secretary, you can interred in a rep. Wassermanschultz mr. Secretary, you can proceed. We have a technical issue. Sec. Wilkie i was privileged to address several veterans of the coNational Cemetery on memorial day. As i was looking down the hill, i saw veterans families gathering on that day to pay respects to their loved ones. Our cemeteries have never closed. Our hospitals have never closed. Believe that our people have turned v. A. Into a learning organization that was able to turn on a dime in this froms and transform itself an institution that many of us have known and some of us have looked askance at for many years. Cannot thank them enough for their agility. I cannot thank them enough for putting themselves in harms way to serve their fellow americans. And i thank you, madam chair, for allowing me to speak. Thankassermanschultz you, mr. Secretary. Now, i would like to begin my five minutes of questions. Mr. Secretary, i want to start off this hearing discussing the issue of personal protective equipment or ppe, which i noted has been a huge issue for the v. A. As of yesterday, v. A. Has a 39 day supply of loves, a 333 day supply of face shields, at 267 day supply of n95 mask, 244 supply day supply of surgical masks. This is a significant improvement from earlier days combating the pandemic, when the v. A. Had 18 days or less of all supplies, leading to v. A. Invoking austerity is yours on employee ppe. As ppe guidance, availability returns to normal, Healthcare Facilities should promptly resume standard practices. The v. A. Has significantly higher amounts of ppe. Does the v. A. Plan to issue less stringent guidance to the field to protect veterans and Health Care Workers, and would you clarify for the records what v. A. s guidance is guarding who will receive ppe, and under what circumstances, including veterans, Frontline Health care workers, and other employees in v. A. Facilities . Sec. Wilkie i will let the practitioner give you the chapter and verse on what the medical needs are. I will say that our hospitals have never run out of mint, but in response to this emergency, as you and i discussed yesterday, we are putting in place plans and operations so that we do not have to adjust to a disruption in the supply chain. I have given instructions to begin the establishment of depots across the country to and otherto house ppe medical equipment, so that if this does rebound mr. Wassermanschultz secretary, i want to be mindful of my time constraints. Specifically, with more availability of ppe, do you have plans . The last time you reissued guidance was may 1. Do you have plans to issue additional stringent guidance to the field so we can better protect veterans and Health Care Workers . Sec. Wilkie we will as we resume operations. Rep. Wassermanschultz how many days of supplies will be a need on hand before you are comfortable with reducing austerity measures . Chair, want to emphasize that our workforce is our strongest asset. We have a workforce that runs toward a challenge, and it is goal to assure they are safe. We have moved to universal masking throughout the pandemic. Because of early planning in january, our forces had what they need throughout the entirety of the response. Those on the front lines have n95 masks. Those in facilities have a mask a day. And every visitor to our facility, even the caregiver of a veteran accompanying a veteran to a tickle appointment i amwassermanschultz specifically asking about the austerity measures. I understand there are issues. But the whistleblower anonymous complaints i have been getting have indicated that they are required to reuse repeatedly those masks, to have to lay them in the sun to sanitize them. What are the current criteria in terms of mask issuance and ppe issuance so that reuse policy is not required . Dr. Macdonald thank you. We are at universal masking right now. In reference to the austerity measures, this was in line with cdc guidance at the beginning of april as the Global Supply chain was in a state of uncertainty and the virus was surging. We were certainly had two weeks of supplies on hand. But we were not certain of was our ability to resupply. We made a strategic decision for a very brief time to make sure that our supplies would reach until we could be resupplied. At each point and each day across that time, our employees had what they needed and had n95 masks and a full set of personal protective equipment they needed to care for patients. Sec. Wilkie i would add right now we sadly have 500 employees who are infected. The reason that number is stark ofthat that is 500 out 330,000. So the measures that we put in place, arguably emergency measures, were designed in an emergency to take care of those who were the most immediately vulnerable. I have been able to expand the use of ppe as the emergency has changed. But i would also argue that the entire nation has been learning this onthefly. And as you and i have discussed, for the first time in the history of v. A. , we did have to share resources with the city of new york, the state of new york, the city of los angeles. We followed cdc guidelines. He followed them to the letter. We follow the same guidelines that you would find in Georgetown Medical center or in nyu. And i think the results have shown that we have done an excellent job, better than any Health Care System in the country, and keeping these numbers as low as we have. Rep. Wassermanschultz ok, i am sure that other members will get into the ppe issue further. With the committees indulgence, im going to ask an additional strip and will certainly recognize judge carter for longer than five minutes. Too want to take a moment enter the following into the myself,a letter from judge carter, chairwoman lowy, and Ranking Member granger, to you, secretary wilkie, regarding the gravestones that have been discovered that are at the sam houston v. A. Cemetery in utah excuse me, in houston, and the v. A. Cemetery in utah as well. Swastika ase nazi well as inscriptions honoring hitlers on them. Consent tounanimous enter all of the following into the record, a statement from the Southern Poverty Law Center that urges you to recognize the offensive nature of those inscriptions and statements, and to remove them. A statement from benign Birth International that also asks you Brith International that also asks you to remove those and replace them with more appropriate information about the deceased. A statement from the Antidefamation League asking the same, and a statement from the American Jewish Committee Asking the same. This is deeply troubling, to learn that several v. A. Cemeteries contain graves of german prisoners of war that feature swastikas on the headstones, as well as inscriptions that honor adolf hitler. These groups sit alongside men and women who fought for our ideals that run counter to everything the nazi ideology represents. I understand the cemeteries were not under the jurisdiction of the v. A. At the time these headstones were installed. Now that they are under v. A. Jurisdiction, there is no excuse to continue to maintain these headstones instead of replacing them. The agency has claimed in its public response that you will not these headstones because the National Historic preservation act of 1956 requires federal agencies to protect Historic Resources. In fact, what the Historic Preservation act refers to as Historic Resources are defined as sites worthy of inclusion on the National Register of historic places, in case you were wondering, the criteria generally does not consider individual gravesites eligible except in cases of historical figures of outstanding importance. German soldiers who took up arms against the United States do not meet this criteria. Relyingrs that this is on a gross misreading of a law that was enacted to preserve and protect historical sites and neighborhood so we do not erase our nations history in the name of development. It is not a pointed excuse to avoid addressing past mistakes. Mr. Secretary, i really felt her tond by the fail understand why you have this for used to remove and replace gravestones with nazi insignia. Is that the kind of stewardship that contributes to the inspiration and benefits of future generations, as the law states . If it is not, as you and i both know it is not, how can you claim the v. A. Is unable to replace these headstones simply because of Historic Preservation tumor sec. Wilkie madam chair, if you dont mind, i want to take a moment of personal privilege on this. You and i, in the last two years of our relationship, have exchanged beaches with you that i have given in israel, that i war given to jewish veterans. I made a point in my first speech at v. A. With the jewish war veterans. As you know, my son, in his senior year in high school spent that year working at the holocaust museum. This is a subject, the oldest hatred, which i am very passionate about. To jan fisher yad means remember in 7 00 a. M. Antisemitism its rearing its head over europe and we have seen it in some places in this country. I happen to agree with the president of haifa university, who was quoted in the wall street journal article that the last thing we need to do is not remind americans of the horrors of antisemitism and the horrors of the nazi cult. To looksked my people at various ways to address this. That makingthink sure that when people visit our cemeteries, they are educated of the horror is an incredibly important thing to do. Erasing these headstones removes them from memory, and as we continue to study the holocaust, the last thing any holocaust scholar wants to do is erase that memory. I think we can find a way to put this in a Historical Context. That is my view, that we cannot it. E the horror and ignore we have to continue to hammer it. My view is that we need to look at historical interpretations that i am very happy to put up. Thatld also note in Historical Preservation act, in section 106, these cemeteries, which we inherited from the army, are on the National Register of historic places. I would happily engage in a very long process right now in order in i would have to engage a very long process in order to erase. Rep. Wassermanschultz now, if you look at the wording of what you just cited, section 106, that you are currently hiding behind, it says it is the policy of the federal government to administer federally owned Historic Property in a spirit of stewardship. That does not restrict v. A. From taking a serious look at whether these are appropriate today in their current form. Onfact, v. A. s own materials this issue acknowledge that the law does not prevent you from removing them. The law merely sets forth a consultation process for taking action. V. A. Could begin that section 106 process right now, and start the process of removing the headstones. V. A. Also acknowledges that engravings on headstones can send messages about our values. For example, on v. A. s own website respecting the various emblems of beliefs that can be believed, it says v. A. Will not inscribe an bloom that would have an adverse impact on the solemnity of cemeteries honoring those who served the nation. I would argue that the swastika as well as the inscriptions these headstones feature, honoring hepler, absolutely have adverse impact in honoring those who served. We do not erase history by replacing these headstones and with more appropriate inscriptions. I am certainly not suggesting removing the dead who live beneath headstones, but i urge you to immediately begin the section 106 process and replace these inappropriate and insensitive headstones. There are far more individuals across the world that think that that is absolutely essential when we look through the lens of modern times, and i hope you are not suggesting that replacing these few offensive headstones with neutral replacements, done in a respectful way, would be an unreasonable step to take in the name of sensitivity. You have soldiers who fought and died, who were killed by the nazis, whom they are lying next to and whose loved ones need walk past inscriptions in American Veterans cemeteries that honor hitlers and have a nazi swastika. Swastika is prohibited in germany from being displayed. Is not a reminder to prevent hatred. It is seen as something to be snuffed out. And there are certainly ways that you can put the gravestones in an appropriate Historical Context that do not lie above the graves of these dead. Sec. Wilkie let me respond. Rep. Wassermanschultz i urge you and ask that you begin the section 106 process. Will you do that . Sec. Wilkie i will certainly review everything. I will just finish with a statement that was issued in 2018 by the American Council on Historic Preservation, which governs these matters. It is essential for decisionmakers to directly confront historys difficult chapters, consult broadly with the public to ascertain contemporary community views, and consider a range of management alternatives to promote Public Education regarding all aspects, positive and negative, of the nations history. But i am just saying is that as someone who cares deeply about this, and you know i do rep. Wassermanschultz i do. Sec. Wilkie i do want to do it in a way that still reminds americans of the horror. And because of the times in which we live, where we have seen antisemitism reach our shores, i want to make sure that v. A. Is doing the best we can to educate and remind people why those veterans in that cemetery fought against that horror from 1941 to 1945. I just want my meaning clear about what i am thinking. Rep. Wassermanschultz secretary, i dont want to prolong this and i am certainly not questioning your personal commitment to upholding religious pluralism, and fighting against antisemitism. Commitmentw is not a to begin the section 106 process, and i can assure you that this is not the last time we are going to deal with this. This is going to be dealt with one way or the other. I really would urge you to make sure that we can set aside those 1940s and from the put them in context historically. There are other places in the cemeteries to do that, without having them appear sec. Wilkie and that may be the rep. Wassermanschultz reclaiming my time, mr. Secretary. Without having them appear before grave of nazi pows, and coming families of those soldiers that were killed by nazis walk past them when they visit. Sec. Wilkie i will conclude by saying i dont think were that far off, because i do think that putting those in context in the cemeteries, as you just mentioned, is the way forward. It is just i have got to i will take a look and see what we can do, because we have the same goal in mind, and as you know rep. Wassermanschultz i appreciate that. Sec. Wilkie i am very passionate about that issue. Rep. Wassermanschultz i am as well and i hope we reach the same conclusion that they are not an appropriate context now. Thank you to the committee. Judge carter, you are recognized for as long as you want to, basically. [laughter]. Hank you very much judge carter, you are recognized. Rep. Carter thank you, madam chairman. Thank you for recognizing me. Secretary wilkie, welcome. Before i go through some of the questioning here, lets go back to the subject matter at hand. I love history and i read history, and i read my hobby is reading history. In trying to consider what andably happened in 19 43 1944, when these things were it is hard to conceive in the 21st century why they would be that way, with all we know about the horrors of to people in those concentration camps. But if you will study your history, you will realize that we had rumors of these rings at the governmental level. But they were not subject to 24 news that, like we do have. The average american and the , he may not even have a concept of what was going on in germany at that time. About how thents attitudes change after we actually discovered the concentration camps our soldiers became even more of a human in their battle when they witnessed the horror they were fighting against. Maybe the people that erected the stones did not realize how much it would affect the jewish who are allmericans horrified by what went on with germany at that time. So i think that you should replace the stones with just a regular stone. Still say they were german prisoner of or, but that is it, and take all of those nazi symbols off. In so many words, preserve those tombstones for historys purpose a Historical Commission can preserve them in some other way but i do not think they should be displayed daily to the american public, because what we now know happened and are aware we are offended by things like that. In this particular context, i think we should definitely do it, and i think it is the right thing to do. Sec. Wilkie yes, sir. We are in the same place. My only concern is one from a passionate view, to make sure that when we do this, we are still reminding people of that horror and why those soldiers fought, and that we educate, because the last thing there is a museum down the street that will not let people forget. It is to never forget. And because of my feelings on this issue, i want to make sure that if it is done, it is done so that we still allow people to reflect, to contemplate, and to say also, never again. Rep. Carter it is important to every member of this committee, the appropriations committee. You will note that both the chairman and Ranking Member of the full committee have endorsed our letter, and we expect it to be done. Moving on, the cares act provides you with 19. 6 billion to respond to the covid19. As of last week, less than 2 billion of that money has been obligated i would like to know how much has been allocated, and should we be concerned about the low rate of obligation . Sec. Wilkie i will let john retask a, our chief financial officer, answer that. Madam chair, is that all right . Rep. Wassermanschultz yes, but before he answers, there is one vote that begins now, but we are voting in a group, so i am going to continue with the hearing. Members who have to go vote during their rupe should do so and come back to the hearing. Halski, you are recognized. Does it seem low . We do not have a president to compare. We are crating a baseline today. We are finding many things out. I thank the committee for the funds they provided. Some expenses were less. Some were more. We were putting some workers into hotels so they did not need to go home, things like that. We will know more in six months. I think we are absolutely adequately funded. One thing i would say is that we could make better use of this with additional flexibility. By that i mean maybe some Additional Limited transfer authority. There are a couple of areas where we probably did not think through what we needed, money for overtime and educational system upgrades, and for additional workload. We are providing updated obligation reports weekly. We are going to see how this goes. There is nothing to compare it to know if it is low or high. In some cases, materials and supplies were not available when we wanted to buy them. We have to go through the federal procurement process. Not everything is realtime. I think we will see this go substantially, especially as we resupply ourselves and have stock on hand. Rep. Carter the industry should is considering a supplement to funding package if needed. How much more would you estimate the v. A. Would need an additional supplemental package if one went forward . How much more does v. A. Estimate will be the need to address the current covid situation . What if the infection spike in the fall, as some are predict . If you were on the subcommittee, how would you balance the low obligation rate of the cares act funding with your estimate of future needs . Thank you, sir. With respect to additional supplemental funding, from what i see now, we are adequately funded. I do not know the future with respect to spikes, but we are from a medical perspective adequately funded. For Additional Needs, the one area i could see potentially Additional Needs we are working with our facilities folks to see about accelerating reconfiguration of some of our facilities from multipatient rooms to single patient rooms. That was something we already knew. Accelerating that that made a big difference. That is probably the only area. I will tell you what we need more than money at this point is probably additional flexibility, as i mentioned, to move some of the cares money around, and some additional legislative provisions. We have one that is very important right now. It is sort of related, but not exactly. We need authority to keep paying Community Care bills. We call that obligate and pay. We have a legal ruling that we are probably not in compliance with the preterm and law. If we dont get that authorization, we are going to be short about 5 million in Community Care. But it is a matter of an accounting issue and a legal issue as opposed to a honey rep. Carter i yelled back. As opposed to a money issue. Rep. Carter i yield back. I do notermanschultz see chairwoman lowey on video. She still with us . Chairwoman, your video is turned off. Back to thecome , and mr. Bishop and mr. Case have gone to vote. You are recognized for fiveminute for your questions. Rep. Pingree thank you, madam chair. Thank you, secretary wilkie, for being with us here today. And for the work you are doing to take care of our veterans. Thank you to all of your staff, who we know are extremely dedicated to our veterans, and are challenged every day, working in the Health Care Field , and our hearts go out to the families of those veterans who have lost their lives to covid19. Im going to take a little bit of a different tack, but i know we are talking about all the issues related to the situations that people are struggling with, with covid19. One of them is around Food Insecurity. There is such a longstanding Food Insecurity crisis among our veteran population. Over a quarter of iraq and Afghanistan War veterans have struggled to put it on the table, which is about double the national rate. It is also related to Adverse Health outcomes, which we know are an indicator for those people who are really struggling with this particular disease. And we know that Food Insecurity is exacerbated during this crisis. We have all seen the long lines at banks, and the challenges many families are facing. Our veterans are particularly vulnerable. The pandemic has also put an extreme burden on some of these disadvantaged populations, including those with Underlying Health conditions. Data shows that veterans have higher rates of multiple chronic disease related conditions like heart disease, hypertension, and diabetes. My concerns are around both are we assessing Food Insecurity with our veterans and are we improving access to healthy food. It is more of a longterm problem. One of the challenge we have seen during the covid19 crisis is it shows some of the underlying issues that people are facing, whether it is around the Underlying Health conditions or just basically getting food at any moment in time, but today in particular. Can you give us a little update about how the v. A. Is tracking Food Insecurity during this pandemic to mark and also, do you have data right now on obesity and dietrelated diseases within the Veterans Community . Sec. Wilkie thank you. Im going to answer the first part by saying the chair of the subcommittee actually answered our most immediate Food Security needs in your emergency package. You up to the amount of money for per diem costs, which we have instructed those receiving them to use for, amongst other things, their food. Think, has helped more people than you probably knew when you entered into that, so i the chair and i thank the committee for that. I will give you a statistic. Hometown of new orleans, of those who passed the virus, 51 had diabetes. We have an aggressive education and Outreach Program on food and on health, related to food choices. I will let dr. Mcdonald go into the particulars, but this is the subcommittee that recognize that problem, and we have certainly made up ground, particularly in the homeless community, on this. There is a National Emphasis on population health, and that is our priority within v. A. I thank you for pointing out the social factors impact affecting veterans, including Food Insecurity. As we are focused on homelessness, there are factors in their health. Chronic conditions are part of it, but where they live, how they live, is a huge part of their ability to succeed in combating this virus and across this time. Im proud to say that of the first billion in medical funding that you have graciously given us in the cares act, more than 20 of that, 205 million, has gone toward our Homeless Veterans and toward programs that help outreach to veterans and make sure that putins ready issues, housing, rapid rehousing for them and their families are addressed. I thank you also for calling attention to diabetes and chronic condition specifically. It is important that we are engaging through our team and outreach to all of those patients we know are vulnerable. Toare taking specific action protect those populations that we know are significantly affected are at higher risk of covid19. As one example, we have conducted outreach to those veterans who have registered acted. As being of affected. I know this outreach is occurring as i myself am receiving it. That outreach is important as we engage veterans and let them know that v. A. Is here for them across this time, not just for medical conditions, but for the entirety and holistic approach to their life. Rep. Pingree it would be great in the future to see more data and more of an update once all the funding that has been allocated has been spent. I particularly appreciate it breaks anyones heart to think of someone who served their country going homeless. Those who are homeless are the most vulnerable with this disease. I yield back, madam chair. You are recognized for five minutes. Chairwoman, first and foremost i want to associate myself with the chairwoman lowerys initial comments about symbolism in our most hallowed grounds and the need to remove that. I appreciate the chairwoman of our subcommittee leading the charge on seeing that happen. To the leadership of the committee and the staff, i feel we have been doing more conversations since covid19 than we were before. I think that shows the commitment to the american people. Secretary wilkie, it is a pleasure to be with you and one of the things i would like to highlight some of the south texas veterans Health Care System in san antonio. Didnt experience the shortage of ppe our private sector colleagues and academic affiliates saw. To folksed donate ppe within the community to make sure the community was in response. They have been leading in the video connect system that was already in use before covid19 and they are now a leader in the number of v. A. Video connect episodes of care. Is, how douestions we ensure that for the foreseeable future, we are able to continue this level of support to our activities in a code we have the facilities and the spaces that, where you can have the exam rooms to do telemedicine . How will make we make sure existing facilities can deal with these amazing numbers . Sec. Wilkie the people at aday diephy are wonderful au murphy are wonderful. I will give you a couple statistics i gave at the beginning in april. They provided 1. 2 Mental Health million Mental Health telephone visits. That is an astounding number. And iessed the system believe we will go back. Part of the change has been the distribution of thousands and thousands of tablets, particularly in rural and native america. Firstthe ribbon on the v. A. Private sector telehealth clinic at a walmart in asheboro, North Carolina. I expect walmart will be expanding that across the country. Particularly as walmart has a footprint in most of rural america. Is the wavedicine of the future, particularly in Mental Health. A stagewe are now at where we are not going to revert back to the old ways. This committee, the subcommittee recognized that by funding our outreach. I will ask the practitioner if she has anything to say. Dr. Macdonald i will simply add way we part of the design facilities even now, telehealth is included in those plans and the beauty of the authority you have given us with the option to provide telehealth anywhere to anyone, where a veteran is able to be at home in their living room, and the practitioners are able to deliver that care from anywhere they may be serving, that gives us the flexibility to use space and optimize the in person care that is necessary. Having telehealth facilities as are needed in our v. A. Medical centers, but delivering most of the care direct to a veterans living room and meet the more they are and keep them safe. Thank you for your attention to this. We will keep focus on this. A colleague of mine have been talking about the issue of sepsis, something that is a leading cause of death within v. A. Facilities and we know Covid Patients are susceptible. I know 10 v. A. Centers are already using a new, more accurate sepsis testing system and this is more important than ever. How are we expanding that across our systems . Sureacdonald sir, as im you are aware, sepsis is a complex constellation of symptoms. There have been several definitions of this over the past 20 years. What it takes is recognizing clinically what we call gestalt, looking at the numbers, observing how sick is this person, identifying this early so you can ask, you can hydrate the person, get them the antibiotics they need. Several of our facilities are exploring an automated way to synchronize that data and alert clinicians that this might be sepsis. Then, for them to make a more immediate clinical decision to engage the patient. We have extensive and consistent protocols across our system for this. We have excellent data to show we are effective in managing this. These advancements in Technology May take us one step further and that will be important in the setting of covid where we know this is a complication of the illness. Rep. Hurd thank you, chairwoman. Thank you. I would like to recognize mr. Cartwright. Forgive me, im sorry. I recognize mr. Case for five minutes. Mr. Secretary, greetings from the pacific where you are remembered fondly for the being the first v. A. Secretary to visit some of our communities. Thank you for not only trying to understand but trying to feel the remote nests the veterans feel. I wanted to follow up, and i want to commend your team throughout the pacific. They have done a nice job through covid19 not only in taking care of veterans but in in directing with local Health Care Facilities and providers. May i also mention you are getting a new director . Admiral robinson, former Surgeon General of the navy, will be coming out in the next few weeks and he is an outstanding public servant. Rep. Case excellent. We appreciate that. I think it is a good model of interaction with the civilian community in the pacific, where we have an interreliance. Along those lines, my question goes back to testing and ppe. I think the question i have come of comes from discussions with your team, hawaii and the pacific from a Public Health perspective have done better than much of the rest of the country. That has come at the expense of our economy, because we shut down tourism to get those low numbers. We have a tremendous economic issue where we are one of the worst in the country. From the testing side of it, the doingn is, while we were a pretty good job on the Public Health side, the testing and ppe were out allocated elsewhere to include as i understand it the v. A. Communities, so it was considered an integral part of. Hat Broader Community as scarce supplies were allocated. The concern is that if we did see a surge, or if there came a time when because we recovered larger numbers of cases and as the military started to move around more, we have one of the Largest Military communities in the country and largest veterans communities, we would see that served and start to detect a greater concern over the scarcity of test kits and ppe. So the question, and this interacts with the civilian Community Side where you see a patchwork in terms of how the nonVeterans Health care communityand veterans utilizes for the delivery of services in our other places in our country. Goals in inconsistent terms of the use of testing. Some require all testing to come into any kind of a procedure. Some take a little more of a nuanced approach. The bottom line is, that is using testing and ppe, which gets into scarce supply throughout the system. With whatn has to do does, what is the ability of the Veterans Administration to deliver test kits and supplies, to ensure testing and ppe to its facilities in hawaii and the pacific . Especially if we see a surge two you have an independent source . To you have a way of assuring that you are doing that in a Surge Capacity regardless of what the rest of our community is doing . Sir, yes. Ald we are proud to say that due to early engagement with multiple different vendors and proactive planning, we have an adequate testing supply at this point. 140 five of our facilities have Rapid Testing and many of those actually have multiple types available of testing, rapid and typical antigen testing that returns in about two days. We are able to cross level supplies for testing across the country and we proactively work on pieces that are more challenging in the Global Supply chain, including nasal swabs and the transport media that is necessary to move the specimens to the test site. , as imhave a model sure you are aware in your area, that helps us more rapidly process those tests and make toe results are delivered facilities and clinicians so they can make decisions as soon as possible and keep that care going for patients. Rep. Case enqueue. Thank you very it i would be remiss if i did and opportunity to emphasize the importance of the aloha project in hawaii, our outpatient v. A. Multiple , two yearshreeyear too long project area three. Ears fully funded, ready to go i have had this discussion with you and other the a folks in hearings and offline. V. A. Folks in hearings and offline. It seems to be hung up. The issue seems to be ombs inability to understand that in hawaii we have higher health. Are, higher land care costs and therefore, that has to be taken into account in terms of the lease award. The fact that hawaii does tend to have higher land lease costs should not disadvantage our veterans. This is a desperately needed facility. I would put in the covid19 context, it was needed before covid19 but it is definitely needed after and it is part of Overall Economic regeneration for hawaii, which is one of the most devastated economically. It seems to be that it is on its last few months, but that is what we said last year so i would ask for your personal attention getting this over the finish line, getting that lease awarded so we can cut through whatever is going on between gsa and omb and v. A. And make the award and get the project underway. Sec. Wilkie i agree with you, sir. I said in a country like this, particularly with the veterans population, one size does not fit all. The solution that favors North Carolina doesnt make any sense on an island. They have heard me. I will go back to them and see if i can, as you say, push it across the finish line. I agree with you and i agree about the needs, the particular needs of the Veterans Community on the islands. Rep. Case thank you very much. Mr. Rutherford . Reppo rutherford reppo ford rford rep. Ruther on behalf of the veterans in our home state of florida, i would like to say thank you for the service. I would like to talk about access to care. Mentioned you since the covid19 that since the covid19, we have seen 100,000 telemedicine encounters and quite frankly, i am a little concerned about that because i hear people talk about telemedicine as medicine that is good enough. Fact, i had an individual that spoke to me about his yearly physical, a retired veteran who in the past would , and wouldod workup go in and the doctor would go over those results him with him and this year, his physical was a five minute phone call. No bloodwork, because he was in a low risk population. , and thisole purpose goes to the Underlying Health concerns that have been highlighted as you mentioned focusr, by covid19, the on health and finding issues before they become serious issues, that is what that physical is for. So my question is, can you tell me first of all, define for me what atelemedicine telemedicine encounter is. In the private world, i think it will be even more concerning cms payingther it is for that or insurance companies, exactly what is the definition of that . A five minute phone call . Is that they telemedicine a telemedicine encounter . . Ow do you define that are there areas where you think it is not effective . I would think if we are going to have a phone conversation for a doctor to simply go over bloodwork with me, to tell me where i am high and low and what may need to be followed, i think that is reasonable. Physical to devolve into just a five minute phone call, i question whether that is the best use of telemedicine. Sec. Wilkie i will answer what has happened in the last three months, then i will let dr. Macdonald the practitioner give you the details. We were the first Health Care System in the country to stop routine visits. We had to do that. As the chair has pointed out on numerous occasions, not only in this setting but in phone calls, i was making sure that we were preserving our people and preserving our equipment. So those routine visits did stop in terms of facetoface, but we made up for that in telemedicine and counters. We had to do that to protect patients and to protect our staff. I would say the wave of the future for telemedicine is not in what you just described, it is really an Mental Health. It is allowing people to address these deep issues in the comfort of their home or they can visit the library or wherever they feel comfortable to talk to our Mental Health professionals. That is where we have seen the biggest explosion. I will let dr. Macdonald answer the rest of the question. Dr. Macdonald to emphasize what the secretary said, you are right that there is care, alums in person. That belongs in person. That meaning of the patient and provided that provider relationship, the privilege of that encounter, is why i went into medicine. The that is important to us. That can actually be delivered effectively by telemedicine. To your question about physicals, we are actually going above and beyond in conducting outreach to veterans, not causing them to wait for a physical anymore, but making sure we know their concerns in advance. We are emphasizing the ability to do that through a phone call them at to coach them through the clickable link to set up a adeo and conduct the visit in more frequent, high touch way that meets their concerns before they have to wait for that annual visit. To the question of the five minute encounter, i would offer that sometimes, that is the right answer for the person. But telehealth means we can still have that meaningful, deep discussion and spend the time that is necessary to address their concerns. That is how we are approaching it. We train staff on that so there is really meaning on both sides of the virtual encounter. Rep. Rutherford if i could ask one last question, this deals with access. In 2016 quickly, mr. Rutherford, if you can. Rep. Rutherford in 2016, the v. A. Authorized three of the four advanced practicing nursing fields to go to full Practice Authority. But you did not include the certified registered nurse and nothing and as the cysts in hecists. Anest i heard there is a lot of access crnaselayed because the are not available. Can you address that . And is there any consideration to giving them full Practice Authority . Sec. Wilkie madam chair, may i yes, mr. Secretary. Sec. Wilkie the serna program was done carefully. S withvided our crnaa Practice Authority in the states that had offered Practice Authority. I believe we have only hired 18 additional crnas but those were the parameters of the practice and we did that because we needed so many hands on deck for the Emergency Rooms and the covid wards. We are finding covid19 patients, as im sure you have heard from your constituents come are difficult patients to ventilate. This can take up to 90 minutes of a very skilled, experienced time. The v. A. Has been a leader in teambased care and anesthesia have long been vital members of those teams. We moved in alignment with industry and the pandemic to make sure they have full Practice Authority in those states where that is already occurring. To the earlier point by the secretary, that gives us a better ability to recruit and retain those essential providers for our teams. We have seen a Response Rate to offers for rns at 80 of those offers we extend. Before we extend the Practice Authority, it was only 8. 7 . We need these members of our teams and we need that level of agility to respond effectively and deliver the access you mentioned originally. Rep. Rutherford thank you. Thank you, mr. Rutherford. Low hase chairwoman returned. I saw her for a moment and now i didnt. Chairwoman, you are recognized for five minutes. Much. Owey thank you very think of your thank your thank you for your comments. The symbols on the tombstones go to the heart of many people who visit, and i thank you very, very much. I want to thank the secretary for your thoughtful presentation. I do want to follow up with a couple questions. First of all, i want to get an understanding from you what is happening with the hydroxychloroquine. Im concerned that the v. A. Administered hydroxychloroquine, which was unproven for treatment 1300vid19, to more than veterans, despite a lack of evidence of its effectiveness. We know now that patients who are prescribed this drug are more likely to die than those who received standard treatment. What was the rationale for administering this drug to vulnerable veterans, and were they fully aware of the risk before receiving it . Has the president s reckless endorsement lead to an increase in veterans requesting the drug . Can you explain to me what is happening . Sec. Wilkie let me talk about period of time we are in. This is a new disease. And even though i am not a medical person, im a military person, i understand there has to be help. Be hope. Has to you cant look at a patient and. Ay you cant have hope i relied on the vote of this congress on the right to try. The right to try that was endorsed by the president with his signature. This congress was clear in saying that if people of sound mind ask to be given experimental treatments because that may be the last thing that separates them from life and death that we do that. The other option was to do nothing. Learning this in real time and we have followed fda guidelines on this. Chartk i gave the chair a. We have brought down the use of this. It peaked when it in the rest of the country. In april. I will ask unanimous consent to enter the chart that is labeled hydroxychloroquine timeline and utilization into the record. Sec. Wilkie the use of this, madam chair, peaked when it peaked in the rest of the country. Asstarted ratcheting it down we went more to remdesivir and we went to the convalescent plasma. Last week we only used it three times. Talked to dr. Fauci yesterday as you know, i serve on the National Coronavirus task force. He said to me that we still have to leave the door open because with all of these studies, there still has not been randomized controlled trials. That said, it is our doctors and practitioners that are working with our patients. These are people dedicated to the preservation of life. Go in thisning as we crisis. I would also add that the rest of the world is all over the map. France banned it, then the government of india says it is essential for them to provider people with it to protect them from the virus. So again, we are, we have ratcheted down as we brought and ireatments online, expect that trend to continue in the future. But our mission was to preserve and protect life. For youry thank you commitment. However, i would hope that the v. A. Would respond to the science that is clearly coming than someauci, rather Wishful Thinking coming from the president. But lets move onto another question. It is very disappointing to me that the v. A. Was using that did nott dr. Fauci endorse. I have known dr. Fauci on the committee forever. Almost 30 years. I would listen to him rather than the president when looking for scientific information. I would like to get to the Mental Health issue, because we poseshat social isolation dangers for the general population, but particularly to the veterans who have suffered with mental illness. Can you tell me what the v. A. Is doing to continue connections with at risk veterans during this time of stayathome orders, and are you anticipating an increase in Mental Health services when this pandemic subsides . The wilkie we have changed way we do business when it comes to Mental Health care. And i think that is the silver. Ining from this crisis over 40we have sent out million individual communications, not just to families and caregivers. We are unique as a Health Care System in that like the military, when someone joins the family joins. We have expanded our footprint in mental telehealth. I think to the benefit not only of the veterans today, but the vet the benefit of veterans in the future. Madam chair, i will be releasing , inaugurating our prevent Task Force Recommendations on Mental Health and Suicide Prevention on june 14. That will be the First National roadmap that will fall in line with the question you just asked about the way of the future when it comes to Mental Health. I think we will be the first Large Health Care organization to have a National Conversation to invoke a National Conversation on Mental Health and how we treat it. That will include a roadmap on homelessness and it will include a roadmap on addiction. That is in line with your thinking and i know that is the thinking of the chair. Madam chair, i believe my time is up. Im not sure what timing we are using. Rep. Wassermanschultz your time is expired. Rep. Lowey thank you very much, madam chair. Rep. Wassermanschultz we will do a second round so there will be another opportunity. Thank you so much. Before we moved to the next question i will note for the yesterday. Fauci said on hydroxychloroquine that the Scientific Data is, and i quote, the Scientific Data is quite evident now about the lack of efficacy. He has made it clear where he is on the effectiveness sec. Wilkie . Fight sec. Wilkie i talked to him after he made that statement. At a time when we are most seriousof the Health Pandemic in over a century, the Central Alabama veterans Health Care System still has multiple leadership and staff positions that are unfilled. Currently, there is no permanent director. There is a pending start date for chief of staff. There is no permanent deputy there are anf and additional six service chief openings with no permanent staff. Unacceptable that cavetts still has so many senior staff openings. Understand how you, mr. Secretary, can expect to bring about positive change for our veterans care and the management of the v. A. Employees when you have no permanent leadership to bring about this change. It is especially concerning that after the previous director left in september of 2019, we still do not have a fulltime director and it is a must june. Almost june. We know Central Alabama v. A. Has. Uch improvement to make the right attention at the highest level of the department of Veterans Affairs is warranted, which is not effectively happening now. Office continues to have difficulties in getting answers vits to the simplest questions. In preparation for this hearing, my Office Reached out to the v. A. Staff in washington and directly had questions about staffing vacancies. My Washington Office received a fairly prompt response while my District Office has yet to receive an answer from cavett and made that request 13 days ago. While i appreciate the Response Time of the ba staff in washington, the staffing vacancies data was readily available because it had been included in a report provided to congress on may 14. That report specific to cavetts was required by law due to language that thankfully, the chairwoman and i pushed to include in the appropriations bill last year. The members of the committee, we have to put language into law to get the v. A. To communicate with me specific to cavetts. As i said repeatedly, it has been difficult if not impossible to get prompt responses from your office. Apparently the only way we are able to get you to provide information is if the committee requires you by law or if you are scheduled to testify before the committee, the information is nicely delivered right before a hearing. My office has been left mostly in the dark as it relates to covid19 and updates from cavett. Began, kevindemic has held only to Congressional Staff briefings, both in april. That seems to be woefully in adequate, especially when it is my understanding that birmingham, for those of you not familiar with alabama, it is an hour and a half north of , the birmingham, alabama v. A. Has been providing congressional covid19 briefings every two weeks. Hear wouldraged to be holding the first congressional covid19 briefing in over a month. That was fleeting, because that briefing was just postponed yesterday. It was not postponed for a week or two weeks. It was postponed for an entire month, meaning it will be two months in total since we heard on covid19. Madam chair, i know you and our colleagues on the committee have continuously heard my please. And you have pushed to improve the overall care for our veterans in central and south east alabama. Please know that i will continue to push for answers and actual improvement until my last day serving in congress. Mr. Secretary, my wishes, and my hope, not for me but for the veterans i serve, is that we wont continue to talk about how improve we hope this will improve but you will demonstrate to those veterans the actions, real improvements will demonstrate your commitment. I will give you an opportunity to respond to my comments. I am pass the time. May i . Rep. Wassermanschultz you can respond. Say one of i will the first visits i made as secretary was to montgomery and tuskegee. I paid attention to it. We changed leadership. I believe the folks in montgomery and tuskegee have provided the entire state of alabama with important services. We have placed many of our employees in Central Alabama at the bill nichols state Veterans Home. Veterans who were in deep crisis. The staffing issues you are understandut, and i the value of permanence but those positions are occupied. I have the same issue in my office. I have an acting deputy and enacting chief of staff. That doesnt mean the work is not being done. We are in the midst of revamping our hr program at v. A. I agree with you the first time you raise this issue that it was not adequate for the entire country and not adequate for Central Alabama and my family as you know lives in north alabama. It is a state i am in a lot. We are doing everything we can to make those positions permanent. We have new leadership, as you know, both in atlanta and in montgomery. I think that the services have improved across that area. I will continue to focus on it because i am very familiar with the area, and i have heard you , the secretary in generals focus has been to personally move on the leadership issues in your district. , i wish iould say could snap my fingers and they would all be fixed, but i think it is in a better place than it was when you first raised the issue. I would just say to you, mr. Secretary, where there have been some improvements, the situation is still very dire. I want nothing more than to celebrate improvements and care for our veterans. We have a long way to go. It feels like every time we have this conversation, that i am the only one that feels a sense of urgency here and i just want to see more passion and urgency from your office and dedication to dealing with, we are still one of the worst v. A. s in the country and i have been banging my fist for years on this issue. I want toin, celebrate whatever improvements there are to celebrate, but just know that we have a very long way to go. Im sure mr. Bishop could comment on that, as well. I yield back. Thank you, gentlelady. Let me welcome you, mr. Secretary. Let me thank you for all of the efforts that you and the team at the v. A. Have undertaken to continue services to our veterans under these extreme pandemic conditions as well as your efforts to keep the Service Providers and our veterans safe during the crosses the crisis. Join andtto and associate myself with ms. Robys remarks. She represents alabama and i represent west georgia aspect of s and we have serious concerns. Her voice is not the only voice that has been raised with those concerns. The delays that have been caused i covid19 have caused delays in your systems and your plans across the country and i assume the delays also have come in response to the questions that i raised last time we spoke center that is a to be constructed in columbus, georgia. And at this point, i am very, very frustrated that after almost a decade, we are still waiting, and of course after the relett was let, it was and the site was selected for a second time is a site that has no public transportation, it is away from the longestablished medical campuses that have specialists for our veterans, and of course, it is not very convenient at all. As i indicated the last time we spoke, and the time before that, we have yet to receive a satisfactory answer as to what went into that decision and whether the proposed location can be changed and can be made more accessible. This has been a process that has been ongoing now for almost a decade. I would like you to comment on that, and of course, i have a second line of questions with thatd to the impact covid19 has had, which caused you to pause all of your in person conversation and examinations. I understand that was to keep the veterans and the physicians safe during the pandemic. But some of the exams have been completed using the Telehealth Technology and our final review goes through, i think you call it the acceptable Clinical Evidence initiative. I understand you are exploring new exam delivery models like that tell a hybrid model, and the extension of authority to intention examination providers clinical licenses to cross state lines. I would like you to tell me what additional tools you need from congress to assure a timely exam. With the pause of the exams over the past two months, what course of action you will take to address the ballooning backlog and what other technical changes the v. A. Is looking at in addressing the coverage for elderly patients and other vulnerable populations to ensure the safety of the patient and the provider. Please address the columbus, georgia issue first. Sec. Wilkie i will, then i will let dr. Lawrence answer the other. What is happening in columbus is not acceptable. The same that i have issue and mr. Mccarthys district in bakers bill bakersfield, california. We are taking a look at the way we acquire and build properties. Is a 19th century system stuck in the 21st century. It is doubly important in your district, because i think happy and of this year, georgia will have the fifth highest number of veterans of any state in the country. Push andl continue to will get you another report as soon as i leave. I agree, it is unacceptable. We tend takehen these masks off, i promise to come see with my eyes and be with you to look at that site. Dr. Lawrence in terms of the cmp exams, we appreciate your question. We follow the lead of the hospitals. They stopped doing these on april 2 for obvious reasons of safety. We told our contractors to stop on april 3. We did some telemedicine, but you are right come of the failure to meet in person, you can only do those things i just described and you described for a limited number of the total. The failure to do in person compensation and exams sets us back so we cant process claims. We are partially awarding claims, warning some of the claims we have but this is a big deal. We are working with the vendors to get ready to reopen, following the v. A. Plan. What do we need yet a we have a request before you to do two things, allow doctors to do these exams to practice across state lines, and allow nondoctors, nurse practitioners, to do some of these. We think with that will expand our capacity, which will bring down the backlog. I know you are concerned about the backlog. This morning it was 100 14,000. In november it was 64,000. We know how to drive it down. We are not proud of this. We want to open up, get the exams and get back to the low number. Rep. Bishop thank you. I think my time has expired. I recognize mr. Cartwright. , mr. Cartwright thank you secretary, for coming today. I listened to your Opening Statement and you said that we have, we have lost hundreds of veteran patients to this fact,19 disease and in that is what you wrote in your written Opening Statement, as well, am i correct . Sec. Wilkie yes, sir. I have right when what i have is 1100 v. A. Patient deaths in my statistic. Sec. Wilkie it is 700. It is 700 . Ight sec. Wilkie i can get you the exact number. Many have fully recovered. Right now, we have a total of 1500 veterans in 170 hospitals. I got that. Ght we are doing oversight and this committee is here to be helpful to veterans and families and everybody isd understandably frightened of this disease and their Health Prospects during the pandemic. Has been some debate, and i wanted to bring it up with you, about how much authority the v. A. Has over staterun Veterans Homes. We are proud, i am from scranton and we have the veteran center that has had no deaths. Zero. It is a staterun Veterans Home in scranton. That has not been the case all over the country. We have to talk about this. State runut whether Veterans Homes that received federal payments and are subject to federal inspections, mr. Secretary, you took the stance that the protection of veterans from infectious spread in state homes should be left to the states. My question is, did that work well . My understanding is that there are hundreds of veterans across the country who have died from covid19 in state run Veterans Homes. Am i correct . Sec. Wilkie that is true and we account for many of those in our numbers that i will give you. Rep. Cartwright here is where i am going with that. Mica stronger, more comprehensive, united policy, maybe when it takes into account where our victories have been, a stronger,ton unified response for the 50 states, would that work better for the state home veteran residence where lives were lost . It is onee i think of the most important questions that will come up. If you would indulge me for a minute, i will talk about the two separate systems and why congress did what it did and what we do. How about 30ht seconds. Sec. Wilkie congress was clear in separating us from state Veterans Homes in terms of management and operation control. It said it several times in the statute. We provide surveys just as the joint commission does for the 6700 hospitals around the country. I will give you the example of massachusetts. In massachusetts, we delivered a report to the commonwealth of , 52achusetts on january 31 pages with seven recommendations including infection control. Is themonwealth certifying authority for that home. We do provide those recommendations. When this hit, i began calling governors. I called your governor, call the governor of massachusetts, new jersey, said what do you need from the v. A. . We can provide that bridge between states and you. In your neighboring state, we have come in and taken control of 2 Nursing Homes. I think there needs to be a onate, a more clear debate, what the final federal responsibility is for those state Veterans Homes. Rep. Cartwright i have to move on. I want to talk about testing of v. A. Employees, mr. Secretary. There is a vha directive 1047 issued april 21 of this year dealing with the all hazards Emergency Cash Program and has an appendix, it is an opinion from the office of general counsel, subsection f of the ,pinions is pursuant to statute v. A. Has the authority to provide certain Health Services to its employees and that includes that v. A. Has the authority to provide medical countermeasures to employees. Already provides key immunizations to its own employees who are not veterans, and who are not eligible for routine health care from the vha. Do you agree with the general counsel statement of authority that this type of medical countermeasure is both appropriate and legal . Congressmen, we do. We have testing for employees. Rep. Cartwright do you agree testing via a employees who are regularly exposed to covid19 patients would provide a next infection spread prevention benefit . Dr. Macdonald we move in lockstep with the science and cdc guidelines. Rep. Cartwright thank you. To prevent patient threatening conditions as described in the general counsels opinion, does the v. A. Currently offer testing to its nonveteran employees who are routinely exposed to covid19 patients . Dr. Macdonald we do. Employees who are symptomatic or who request a test are able to get one through us or through their outside help insurance should they have that. Rep. Cartwright im glad you said that. Here is why i asked. Im from northeastern pennsylvania. We have ava Medical Center there. That testing was not offered in , it wasnt, so far offered in april or so far in may at the wilkesbarre v. A. Medical center. Employees, including those caring for covid19 patients, have been required to seek testing elsewhere if they were in veterans themselves, so eligible to register with the medical comprehensive care. Here is my question. Were either of you aware of that going on at the wilkesbarre v. A. . Sec. Wilkie i was not aware what was going on. I will take a look at that. Rep. Cartwright we need to talk about that and i will have more questions in the next round. I yield back. Thank you. I would like to recognize the gentlelady ms. Wellstones secretary come i want to thank you and your team. I am going to start off a little bit where chairwoman Wasserman Schultz started on the question about ppe. If i have any time i would like to go into testing a little bit, as well. You may recall secretary wilkie, when you were here on march 4, talking about your budget request, i ask you about the v. A. Ability to respond to the coronavirus. That is going back to march 4. At that time, here is what you answered to my question about your preparation. We train for epidemics. We began moving on supply chain and preparation really before this became a national issue. That was your quote to me on that date. You assured us at that time the v. A. Was uniquely prepared among Government Agencies to respond to the coronavirus, and you testified your agency had been, quote, augmenting the supply chain,. Those were the assurances march 4. Fast forward a little bit to stone, the dr. Executive in charge of the Veterans Health administration, describe your system was facing severe shortages. With some of your hospitals near austerity levels of personal protective equipment. Again, you talked about your training for epidemics. You began preparation early, yet it was about a month later that your hospitals faced this dire situation. What the disconnect was in that very short amount of time between what you told us as subcommittee, and what dr. Stone talked about a short time later. There isnt a disconnect. What happened in between the time i testified and the time dr. Stone delivered those remarks was that a National Emergency was declared. Made forsions that we independent supply chain and disrupted. As we no longer had access to that as things flowed into the national stockpile. That equipment was spread across the country. Willtioned earlier, and i do this really fast, im looking at ways to prevent that from happening again. In the event that this thing boomerangs back on us in the fall. But that is what happened. Dr. Ink in the rest of stones remarks, he probably beyond twont fall weeks of supplies in any of our hospitals, we never ran out because we have the ability to do what they call the navy cross deck. They are huge swaths of the country where the virus is not impacted. If you look at the canadian mexico,idaho to new there are very few patients. We were able to move supplies from those areas into areas that were hotspots, particularly in the northern part of your state, where we also opened up our hospital to civilians. So do you have what you need now . You talk a little bit about your level of supplies but you mentioned in your response to me about, should this, we have a second wave, that kicks off, how you also mentioned the supply chain. Talk about if the numbers do , andup to a greater level the supply chain issue you mentioned in your own opening remarks, how is this all coming together and how, what assurances can you give us, the Veterans Committee employees that you will be ready . Sec. Wilkie we are marshaling resources and storing them up. At a greater pace than we had back in february, which is right before i testified. Ceose been also talking to of large corporations to make sure that as the National Emergency subsites, we start getting large numbers of equipment for them, everything from masks to gowns. That is the plan. I am establishing depp owes across the country, an old military model. I have to be honest him of the chair knows this, i said right ther i testified and National Emergency was declared that we werent working in optimal conditions. And we had to compensate for that. Thank the lord we have had a very, very low incident of infection amongst our employees. Right now, all the 330,000 employees we have, there are 500 active infections. But we dont want to face another situation where i come and tell the chair that it is not optimal. I think i have been very clear in stating that, that we dont want to go through that again. Rep. Bustos i yield back. My time is expired. Rep. Wassermanschultz mr. Ryan , you are recognized for five minutes. Rep. Ryan always good to be with you, mr. Secretary. Thank you for your work. We pass along our regards to the men and women at the v. A. On the front lines. Firsteciate, let me associate myself with the chairs remarks from her comments and we appreciate you addressing that issue to the best of your ability. I appreciate your remarks around telemedicine. There are some tectonic shifts happening in the economy right now, and in some of our institutions, and i think it is a telemedicine, there will be huge shift. So we want to continue a conversation with you about how we continue to build out telemedicine with regard to the v. A. And in addition to what ms. Stos was saying, i represent youngstown, ohio. We have additive manufacturing. There is an mo you win the works with the v. A. And america makes with regard to 3d printing ppe into the future. I hope we can get that worked out as quickly as possible so when there is a second or third wave, we have already done the lead the legwork in the groundwork to tap in to tap into the Maker Movement in the United States, which could be very helpful in this regard. Number two, two quick questions. Number one, one is about the dbqs. So i know that the v. A. Reversed policy on processes relating to the applications with disability benefits and the questionnaires. Ohio, and ik in think across the country, thought this simplified the process for veterans to obtain sufficient medical evidence, and the implementation of these forms are a key part of the reduction of the backlog of bsos see many of the this as a step backwards. Can you walk me through your logic on this situation and why you did it you why you did it . Sec. Wilkie i think there is a lot of confusion about this. We welcome all evidence from any medical provider that supports a veteran client. That could come in any form. Wereublic facing dbqs victims of fraud and misleading information that forprofit vendors were taking advantage of our veterans. By virtue of their public face, we couldnt keep up with the changes. We had to go through the omb process. It was designed during a time when we were very much paperbased. It essentially has been overcome by events. Any veteran can provide any medical information. The dbq is in some ways becoming irrelevant for this situation and was a real source of fraud that we were working on. Were you working with the bso . absolutely. It is perplexing that after the fact, after we worked with them, they understood the situation. It troubles us to see what has happened with this. Again, the public facing nature of it prevented us from being able to change it as things were changing, but again, they are all aware, they have access to our systems as you know with being able to see veterans records. We welcome all information from their private providers. That has never been the issue. It has been this form that has been its been causing additional problems. Whatever i can do to get everybody on the same page. Sure, i welcome that. Like many members of congress, we rely on our boots on the ground, in the foxhole every single day. I just want to make sure that their voice is being heard in this process. One final quick question, mr. Secretary, if you could, with regard to the disability benefit applications, a lot of the older good, i likey that. I wish i could do that. [laughter] they find it difficult to use the technology. And they are really comfortable with going to the offices and kind of getting the eyeball to and thesewo eyeball, offices have been closed. What is the process the officers are going to do to reengage the vets we may not be connected with them right now. Sure. Again, were going to follow their lead in terms of the two step process to reopen, least risky to most risky. Were going to follow that process. In addition, were working closely with the states and counties as they reopen because they can serve veterans, too. We want multiple ways of access. Finally, some veterans will not leave their home regardless of what we do. We regularly advertise this number. Looking colors. Canhey can call us and we take their application over the phone. We will i would say i have actually been amazed at embracing of many of the telehealth changes by older veterans. I am a computer neanderthal myself. Encounters. So many 8055. They have these arent young veterans doing this. They are working. Thank you, madam chair. Thank you, mr. Ryan. Mr. Secretary, i believe we have a few members that want to ask a cigarette of questions. I will begin by asking you about testing. Thats one of the biggest question marks, nationwide, we have is our capacity and access testing, the confusion around it, the inconsistency of criteria available at testing sites. So i want to have you walk asleep, walk us through, what are the capabilities . Do you provide consistent access to testing across v. A. Facilities . Who is eligible to receive a test under what conditions . What are we doing as far as criteria to test v. A. Employees . Can they get tested even if they are not showing symptoms . I think the clerk needs to reset our clock here. How many facilities have Rapid Testing available on site . What is the turnaround time for those test . Overall, the theme of my questions are that the feedback i am getting from vs those criteria andsting accessibility and availability of it is quite inconsistent. Madam chair, im happy to say we do have adequate testing in v. A. We have tested more than 125,000 veterans, just over 11,000 of whom have been positive. Most of those, as the secretary referenced earlier, have 76 , and were than are happy to see that high rate of recovery. Most of our veterans are also able to be monitored at home. And we are seeing a trend, as we have made Testing Available and as we are able to catch this illness early, that gives veterans and their families and those they encounter a better chance at being able to fight this and being able to succeed in conquering it. We also have Testing Available for employees. Any employee who is symptomatic, who is they have been exposed or requests the test is able to receive that. Wequestion of Rapid Testing, do have that in 145 facilities. We are aware that there are specific tests that have been under consideration by the fda for needing higher accuracy. Im proud to say that inis in v. A. Early relying on those under question. We have multiple forms of testing and we see those results in a couple of hours. For the standard tests, and about two days. In about two days. Im really, for the entire time, gotten reports that we do not have consistent access to testing, based on the same criteria all the way across the v. A. Are you confident and can you go back and provide me with assurance and documentation that in every one, we have a uniform access to testing, clear criteria across the board that both veterans and employees can understand, and are you promoting, and that you are promoting that access to testing . Madam chair, we would be happy to provide that, and yes. For those listening today, we would so appreciate helping us carry the message that if there is a veteran concerned about the symptoms they have, the v. A. Is here for them. We have more than adequate testing supply. We can conduct up to 60,000 a week and we welcome them to come and see us. I just think the messaging needs to be consistent across all so there is a clear understanding about that. Speaking of clear messaging and understanding, i mentioned yesterday in our conversation on the phone i had a virtual roundtable and have been speaking with various Veterans Service organizations on an ongoing basis. And i was concerned that acrosstheboard, they raised issues with the disheartening lack of communication from the v. A. And consultation with the vs those at the time vsos at the time. I know you are having regular conversations, but their concern is they arent being consulted, merely informed. This, obviously, quite a difference between consultation and feedback, when you really want to be able that they explained to you what works best for veterans. Thats been an ongoing issue with the v. A. We are having troubles, often getting information from you and from your team, it took over a updateor us to get the on your use of hydroxychloroquine and the instructions that are being sent out to v. A. s across the country. That you are in a covid19 pandemic environment, but the secretary of defense, who is also a member of the task force and is quite busy, was dealing with the militarys response, press conferences, and was able to communicate more consistently and effectively. How can you make sure that you have a consistency of the guidance and policies that are communicated, consult with your constituent groups, particularly the vsos, and can you commit to more regularly about the communication with the public and the committee . Im going to say thats an interesting observation. I sat down with cbs news. Thats different. I know youve done interviews. I raised these concerns yesterday. About 160 representatives on michael, which lasted over my call, which lasted over an hour, and i mentioned i talked to you. And i urged them to use the form and forum and to use the time to raise the concerns you raised with me. Ill be brutally honest with you. I cant guess, but i asked them to send, to talk. I cant read minds. I dont mean to sound harsh, but i took your concerns yesterday and asked exactly what you just said. Mr. Secretary, just to make sure you understand, youre requiring them to submit questions to you a week in advance before you talk to them. Its a lot more intimidating on a group of 160 other organizations communicate with you to be the one or two that raise the issue as someone who is on the call every week with 233 other of my colleagues, its not the easiest format right now to raise concerns. I can assure you i had a very large group represented and have been so, they may not have wanted to tell you to your face, but i can assure you thing,me ask one other you mentioned the secretary of defense. Having been the undersecretary and assistant secretary, theres a dedicated press corps at the department of defense. There are hundreds of them. We dont have that. Can it the best that i given the fact that the major publications, newspapers in this country dont have anybody dedicated to v. A. Its sort of a catch as catch can, which is why i have done so much radio and television across the spectrum. The particularly, those but particularly, those venues that you would agree most people in the republican side, or conservatives i recognize you have done tv interviews. That is different than making yourself available and publicly communicating from platform with a weekly or biweekly press conference to provide update, and also to engage in backandforth with more than just one reporter at a time, and then also the concern im certain you are not questioning that i heard this feedback, and others have as well, making sure that you consult, which is different than informing the vs so they have an opportunity to give you feedback and feel like they can inform your decision. Its a different approach than you have been taking. I agree with your observation to the extent that it is a twoway street. Yes, it is a twoway street. Right now they feel it is only going one way. Can you commit you will make yourself more publicly available rather than one reporter at a time, to more broadly update the public about the ongoing response of the v. A. To the covid19 pandemic . Dont think any v. A. Secretary has had that luxury just because of the layout and the way we are covered. Thats why ive had to turn to however you might find an opportunity to do that, im sure that because we have you are the largest Health Care System in the country that there would be response by the press to hearing from you about the impact of the virus i know you dont want to continue this, but i will also say i have made myself available from the most visible platform in the country, the White House Press room. Right, but not consistently. I dont think any of us have and not consistently. To as manymitted venues as i can. Publicly,ce to you, is that perhaps you could do so on a more broadbased basis and ensure that the vsos will have the opportunity to provide you feedback that they can give you before decisions have been made. I want them to provide feedback. Ok, i am glad you can confirm that publicly. And if you could give that it them a form to do so a forum to do so without submitting a question in advance i agree with you. Logistically, thats almost impossible given the conditions we have now. But i will return to the normal process of having the leaders in, and i dont know why it is necessary to ask them to give you questions a week in advance. You can certainly there were 160 on the phone yesterday. Right, i understand. Making sure that questions come up between the week before youre on the phone with them i am doing it is happening in real time all the time. I am doing what i can as much as i can. And i agree with you that more information is better. Ok, well, i would ask for you to go back and review how you might be able to ensure, in more realtime prior to your decisions are concluded, that youre are getting the kind of feedback for the Constituency Group that your present. Carter, who is still with us. Your recognized provide minutes you are recognized for five minutes. Am i ready . Its on black. You are recognized for five minutes. Do you have additional questions . I have one little conversation id like to have and i thank you for the second run. Second round. Stone authorized [indiscernible] states which permitted it are allowed it. It was to be temporary authority. Know [indiscernible] aneard some stories about anesthesiologist at the v. A. , and this is important to me [indiscernible] i heard everything i wanted to hear about the incubation process. The chemical used in the process, in my case, is a murder weapon. [indiscernible] adult gag reflex. I guess maybe i know too much about anesthesiology because of that case. Have adultrtunate to comt asthma, on asthma e on in my testes. I have to worry about breathing when i come out. Should an emergency arise, they are going to provide me what i need. Nurses aree the wonderful people, but they are [indiscernible] our parents,ow they are going into a situation [indiscernible] so id like to know when that will be and what message did the da use to determine the full Practice Authority . Was it more than anecdotal . Ill answer the second portion. We were in emergency situation. The original estimates i give to the chair in the first conversation we had, after the emergency was declared, was that we would probably be looking at 200,000 infected veterans. Peopleed to find as many as quickly as we could for emergency purposes. Thankfully, weve been able to hire over 10,000 people in the last five weeks. On the nursing emphasis, because of the immediacy of the ventilator issue, we needed as many people who were skilled in the operation of those ventilators as we could find. Earnest in used this those states that you pointed out, the states that authorize them to a full range of practice. It was an emergency situation. I dont know when that emergency will of the, will update come will abate, but that was the parameter. I will let the doctor finish. To emphasize the secretarys points, this was in line with the industry and the pandemic. 17 by law and 12 by executive order. Thats 29 states, and about 200 million americans living in errors areas served in full Practice Authority. Longr team, and we have been a leader in teambased e as vitaleeded thes elements of our team to help give us the agility we need to serve veterans well and well across the country, and this is an element of necessary recruitment that we need for readiness now and readiness if there indeed is a future wave of this in the fall. So, do you expect when do thisxpect youll rescind temporary order that you expected to make people . Andhis is temporary, sir, it actually automatically expires with the end of the National Emergency. At that point, we would like to come back and have a conversation about the way forward. That is actually a part of the order that it will end after the National Emergency. With the end of the National Emergency, yes, sir. Thank you for the information. Thank you, judge carter. And our last member to ask questions in the second round will be miss bustos. Your recognized. Thank you, madam chair. We have mostly a rural district in the central, western, northern part of the state of illinois, and we have a great goodwill in the city of peoria. And what theyve conveyed to me is that while youre leveraging your virtual outreach, especially during this pandemic, mr. Secretary, he went over those numbers of how youve grown the telehealth capabilities. What we are learning is that we have many veterans, especially in rural areas, we dont have highspeed internet. But also many dont even have smartphones or any kind of digital device that would lend itself to have that telehealth interaction reconnection make eye contact virtually. Willondering, and i know hurt this question so i didnt get to this, but i understand you said you have a program to lend tablets to veterans. Can you talk about how you will institutionalize that . To the veterans in our area who dont have smartphones or tablets, what can i go home and tell them about this system that you have and how you institutionalize that in the v. A. . Yes, maam. It is part of our general outreach to expand our footprint into rural america. Theeen distributing chair and committee and subcommittee provided money for that. Were sending this tablets out to veterans who are in these rural areas. If they dont have one, please because we will do our best to get one out to them. Call the v. A. Medical center that they use and we will work to that. Ill have to get back with you on the training because i dont know all of the ins and outs, but it is part of a comprehensive Rural Outreach that we have. So, for your veterans, please call us and we will get. Ok, so no question on the supplies. You have the supplies you need to get those out . You have funding . We are constantly expanding the number of tablets that we purchase. Ok. Very good. Anything else to add to that . To follow under the secretary, maam, yes, this is part of the comprehensive rural health strategy. Those tablets come equipped with Internet Access so that these are readymade devices to enable veterans to succeed in their care and engage with us. Additionally, under the secretarys leadership, weve engaged with a number of publicprivate partnerships, including the Rural Broadband association, to bring telehealth sites to rural areas and also offset the otherwise would be cost of engaging in telehealth visits. So tmobile, sprint, tracfone, verizon actually waived the data fees when veterans are engaging with us. Additionally, the in person part of the provision is important. Telehealth. They also sent providers to engage veterans where they are as a necessary piece of this. Thats supplemented by our Community Care engagement and availability in the series. Do you see any impediments to this Rural Health Program as we have this conversation is getting the tablets out, whether theres training that can take place or any issues with that, but any impediments as we have this conversation . We dont see any. As a secretary we dont see any. The secretary said, we this started before but we expended it now. Apple inankful for order to get this situation done. Thats great. Got a minute left so im going to squeeze this question in. You mentioned your search hiring about 10,000 employees. Can you talk about what kind of employees . Mental health . What is the layout, geographic . Can you go into of what those 10,000 employees are doing their jobs, where they are, etc. . We have cut many cutters cut many corners. We eliminated many of the bureaucratic barriers to hiring those 10,000. About 3000 are nurses. 700 or doctors. We told them if they wanted to join us, they could stay in their home regions. So i dont have the breakdown across the country, but its a significant number. Do you have any . Yes, and i just want to emphasize, mr. Secretary said we hired more than 11,000. Week, andt was nurses we are very proud to have brought on thousands of nurses. Hundreds of doctors, as the secretary mentioned, respiratory therapists. These highpriority roles that we need to deliver health care and a teambased way that we know is so effective, and for the chronic conditions many veterans face. We are planning to continue that aggressive hiring as we move forward through the summer and into the fall to maintain our readiness stance and make sure we are ready for what comes. Very good. My time is up. I yelled back. Thank you very much i yield back. Thank you very much. Thank you. That concludes our questions. Thank you for appearing at todays hearing. We clearly have covered a lot of ground and we have a lot to do in front of us to continue the response to protect our veterans and the employees that work for the v. A. Against the coronavirus. I look forward to continuing to work with you all to do that, to continuing our ongoing conversations, which have been incredibly helpful and informative, and have given us a real opportunity to have the giveandtake necessary in the midst of an ongoing crisis. Thank you and on behalf of our committee, please extend our appreciation to all of those that are working so hard to protect our veterans. With that, the subcommittee is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2020] Governors Jared Polis colorado, Gretchen Whitmer of michigan and asa of arkansas testified on how other states are responding to the pandemic. Watch tuesday at 11 30 a. M. Eastern on cspan. Watch cspans daily unfiltered coverage of the governments response to the coronavirus pandemic with briefings from the white house, congress and governors from across the country. Plus, join in the conversation on our live callin Program Washington journal. If you missed any of our live coverage, watch online ondemand. Night on the communicators, the former fcc commissioner talks about ways to reduce hate speech and extremism online. When they find terrorist, they will tag so that others dont copy it. There is now much greater cooperation even then we had a few years ago. There is still a tremendous amount that needs to be done. Watch the communicators monday night at 8 00 eastern on cspan2. Took offacex dragon from cape canaveral, florida taking american nationals to space from american soil for the first time in nearly 10 years. Here is a look at the launch carrying bob behnken and doug hurley to the International Space station. Falcon 9 is in started. Down. Agon is in count under one minute now. The flight termination system has been armed. Dragon spacex, go for