Transcripts For CSPAN Veterans Affairs Hospital Delays 20140515

Thank you all for coming. I want to thank our panelists for what is going to be a very important hearing. The rules will be that i will make some opening remarks, senator burr, the Ranking Member will make opening remarks, members will have three minutes, and i will keep people to three minutes because it will be a long hearing it, and that we will go to secretary shinseki, and the undersecretary. Excellent second panel and a very good third panel as well. It will be a long hearing, and we will get through it. Let me begin by just making a few basic points. Serious allegations have v. A. Personnelt in phoenix and other locations. I take these allegations seriously, as i know every member of the committee does, which is why i have supported an thependent investigation of v. A. Inspector general, and they are in phoenix doing a thorough investigation, and my hope is the report will be done as soon as possible. What i have stated and i will repeat right now, is that as soon as that report is done, this committee will hold hearings to see what we learned from that report, and how we go forward, as soon as we possibly can after their investigation is completed. I think there is no member of this committee who disagrees, and nobody in the United States, that this country has a moral obligation to provide the best quality care possible to those that have put their lives on the line to defend this nation, and i believe that every member of this committee will do everything that we can to get to the truth of these allegations, but if we are going to do our job in a proper and responsible way, we need to get the facts judgment, ando one of the concerns i have, to be honest, is there has been a little bit of a rush to judgment. The happened in phoenix truth is, we do not know, but were going to find out. That me say a word about v. A. Health care in general, which is what this hearing is about. What we want to know about v. A. Health care is what is going well, what is not going well, and in terms of what is not going well, how do we improve that . Today, we must understand that when we talk about v. A. Health care, we are talking about the largest integrated Health Care System in the United States of america. Has 150 Medical Centers, over 800 communitybased outreach clinics, and 300 vet centers. Every year, the v. A. Is serving 6. 5 million veterans. Tenant today, tomorrow, and week, every single day, v. A. Veterans, and what does that mean . Here is my point. If senator burr and i would run around and visit every v. A. Medical center, we would suspect say i have would good health care, i was treated curiously, i like my doctor, and then you would find people that say i did not like my doctor. The point that i want to make is when you are dealing with 200,000 people, and if you did better than any other Health Institution in the world, there would be thousands of people every single day that would say i do not like what im getting, and we have to put all of that in the context of the size of v. A. Does v. A. In general provide quality care to veterans . Simple question. The answer is some people think that it provides very good quality care. The American Customer Satisfaction index ranks Customer Satisfaction among the best in the country, and if you talk to veterans generally speaking, in vermont, not 100 they say we get good health care, are the problems, absolutely, and we will talk about those problems. Servicealing with ected injuries said this v. A. Is a model provider that has led the way in various areas of biomedical research, specializing is, graduate training for all health professions, and the use of technology to improve health care. Say suchn to expertise cannot adequately be replicated in the private sector. Of the paralyzed veterans of america will testify the simple truth is v. A. Service is the best care for veterans, and they are incredible resources that cannot be duplicated in the private sector. Today, the representative for all 50 states will tell us the state of v. A. In our nation is strong here at strong. Further, and i know this is not fit in a 12second soundbite this point has to be made there is no question in my mind that v. A. Health care has problems, Serious Problems, but that the rest of health care in america is wonderful. That is not the world we live in. Let me give you one example because it is important to put v. A. Health care in context. Article,fic american september 20, 2013, less than how manygo, states, die from medical mistakes in u. S. Hospitals . An updated estimate says it could be 200 and 10,000 210,000 a year. Hospital errors that caused death are now the third leading cause of death in america behind cancer and heart disease. What does that mean, has death been reported through medical errors in the v. A. . The answer is yes, and everyone of those deaths is a shame, but it is not just v. A. It is the. Leading cause of death in american hospitals. That is an issue we have to settle. Having said that, there is no doubt in my mind there are Serious Problems facing v. A. Health care, and we have to do everything that we can to address those problems. Let me just discuss a few. Does the v. A. Have adequate staffing . When we talk about patient wait times, which is a major concern in certain parts of the country, and its issue came up in phoenix land town meeting was held by the American Legion, wait times came up, and is the v. A. Adequately staffed . Do we have enough doctors and nurses in various parts of the country . I do not of the answer to that, and that i want to find out. Further, is the v. A. Doing its job in allocating the resources to where the staff is needed most . There are some places in the isted states where v. A. Load going down, but your people are coming in, and other places where it is increasing are we allocating resources appropriately . Lets are member, in the midst of all of that, we are dealing with 200,000 men and women that have come back from iraq and ptsd, not anith easy problem to address. The weight measure was way change to 14 days. Is that appropriate . Can there, did that with the level of staffing that they have . \ we have to discuss that. What happens to those that are not able to bring patients and within the 14day period . Some possible that in cases Unrealistic Expectations have created a situation where some staff is in fact, cooking the books . I want to look at that. With that, i look for to hearing to get at the root at some the Health Care Problems facing the v. A. And i want to give the microphone to Ranking Member senator burr. To wreck, mr. Chairman, thank you for calling this hearing. Thank you, mr. Chairman, thank you for calling this hearing, and secretary shinseki, thank you for being here today. We have a sacred obligation to ensure that those that have fought for this nation receive the highest quality of services from the department of Veterans Affairs. Now, the chairmans opening remarks he was correct. We are not here to analyze a pole that was taken about the look att we are here to the investigations that have already taken place and addressed certain deficiencies ystem that veterans s no action was taken on, or at least not corrective action. In fiscal year 2013, v. A. Reported that 93 of specialty and primary care appointments, and 95 of health care opponents are made within 14 days of the desired date. At first glance, the numbers appear to demonstrate veterans are receiving the care they want when they wanted, however we know this is not the case. I think if v. A. Had asked hard questions regarding the statistics, we would not be here today discussing recent allegations surrounding many and i stress many v. A. Facilities. More specifically, we are here to discuss when Senior Leadership became aware that local v. A. Employees were manipulating wait times to show that veterans do not wait at all for care. It seems that everyday there are new allegations regarding inappropriate scheduling practices, ranging from zeroing out patient wait times, to scheduling patients in clinics that do not even exist, and even to booking multiple patients for a single appointment. The recent allegations were not only reported by the media, but have even been substantiated by the general accounting office, the Inspector Generals office, and the office of the medical inspector. Here are a few examples the gao released a report on scheduling oversight in december, 2012, and has testified multiple times on this issue. Several ig reports have been issued regarding delays in care and scheduling the regulators including irregularities, including reports in texas in 2012, and up to the most egregious report in september, 2013, at the columbia v. A. Medical center. Two publicly released documents related to whistleblower allegations that jackson, v. A. Medical center, and a four jackson immunity based outpatient communitybased outpatient clinics. Other reports that have been released, v. A. Senior leadership, including the secretary, should have been aware that the a was facing a National Scheduling crisis. Leadership has either failed to connect the dots, or failed to address this ongoing crisis, which has resulted in patient harm and patient death. The question that we must answer they is even with all of Information Available to the secretary starting over one year and a half ago, and specific instances of patient harm and death directly related to care, why were the National Audits and statements of concern from the v. A. Only made this month . I yield back. Thank you, senator burr. Senator murray . Thank you. Im glad you called this hearing. When it comes to caring for nations heroes, we cannot accept anything less than excellence. The government made a promise and one of the most one of the ways we uphold that is making sure veterans can access the health care that they need and deserve. Why the department generally offers highQuality Health care and does many things as well as or better than the private sector, i am very frustrated to be here once again talking about some deeply disturbing issues and allegations. It is extremely disappointing that the department has repeatedly failed to address wait times for health care, so i was encouraged when you announced a nationwide review of access to care, and i am pleased that the president is sending one of his key advisers, robert neighbors, to assist in overseeing that radio. His perspective from outside of that department will make the review more credible and effective, but announcing this review is just a first step. These recent allegations are not new issues. They are deep, systemwide problems, and they grow more concerning everyday. When the Inspector Generals report is issued and the access review report is given, i expect the department to take them very seriously, and to take all appropriate steps to amend their recommendations. There are also cases where the facts are in right now. There are problems that we know exist, and there is no reason for the department to wait until the phoenix report comes back before acting on the larger problem. The gao reported on the a failures with wait times as will at least as far back as the year 2000. Last congress did a great deal of work around wait times, particular for Mental Health care. Inspector general at the these problems in 2005, 2007, and again in 2012. Each time they found schedulers across the country were not policy. G v. A. They also found in 2012 that v. A. Has no reliable or accurate way of knowing if they are providing timely access to Mental Health care, but now the ig recommendations are still open, and the department has not limited legislation that i offered to improve the situation. Clearly, the problem has gone on far too long. It is unfortunate that these leadership failures have dramatically shaken many confidence in the system. Secretary shinseki, i continue to believe that you take this seriously and want to do the right thing, but we have come to the point where we need more than good intentions what we need is Decisive Action to restore veterans confidence in the v. A. , create a culture of transparency and accountability, and change the systemwide, yearslong problem. This needs to be a wakeup call for the department. The lack of transparency and accountability is inexcusable and cannot continue on. The practices of intimidation and coverups have to change starting today. Giving bonuses for hospital directors for running a system that places priority on gaming the system and keeping the numbers down rather than provide care for veterans has to come to an end, but to my mr. Secretary, it can not and with just dealing with a few bad actors, or putting a and fill of employees on leave. Handful of employees on leave. You must lead the department in a place where we prioritize the candidates receive about anything else. The culture at the v. A. Must allow people to admit where there are problems, and ask for help from the hospital leadership, or from you. This is the time to make real changes. Thank you, mr. Chairman. Thank you, mrs. Murray. Mr. Isaacson. The would like to have openingr. Boozmans statement be included in the record and we wish a speedy recovery. Should have a rush to accountability. Durham,ore phoenix, fort collins, the others that have come to matter, we already known and the v. A. Has already admitted to 23 deaths that took place in part at least due to delays in consult. Seven were in my area. Four were at the va hospital in atlanta, georgia, all Mental Health issues. Was in my state for a two and a half hour hearing on the atlanta situation, and we knew and determine then there were problems with the delays that caused an open period of time where in fact they took their lives because of a failure to get the service that they should have gotten. Sincee had 50 ig reports 2013, and in those reports we have found repeatedly over and over again where there has been a gaming of the system, where the system is more important than the patient. I think our veterans, and you, secretary shinseki, deserve better from the members of the v. A. Health system. I told you yesterday on the phone when you were generous enough to call, i think the veterans and yourself have been mr. By the Senior Management of the v. A. We need accountability. What is going on is not a mystery anymore. We will find out more from the ig port, but i hope we get report, but i hope we get accountability in the chain of command where you are held responsible for your response ability, mistakes are not tolerated, one mistake might be tolerated, but the second mistake on the same decision should never be tolerated. You for for thank being here today, and on behalf of the state of georgia, and United States, lets get this right, make sure no veterans die because of failure to the system of the system. Senator isakson. Enator blumenthal thank you for holding this hearing that i hope will be bipartisan and as nonpolitical as it possibly could be. , secretaryk you shinseki, for your service to our nation. Over many years you have served and sacrificed for this nation, and i deeply respect and thank you for all you have given to the United States of america, including in your six years as secretary of the v. A. , and i know you are determined, as the president is determined, to unravel and convio unveil any wrongdoing and restore trust in the v. A. Health care system. I agree with the chairman that we should avoid a rush to judgment, but we have more than allegations at this point. We have evidence, solid evidence of wrongdoing within the v. A. System, and it is more than an of wrongdoing, and it is a pattern and practice, apparently, of manipulating lists and gaining the system, in effect, cooking the books, creating false records, which is not just an impropriety, or misconduct, it is potentially a criminal act. It is a pattern, as the chart submitted by the American Legion as addendum c shows. There is a pattern across the country, in more than 10 states, of this misconduct occurring. History. On, there is a the gao has reported, your own Inspector General has reported these kinds of problems in the past. So, there is a need now for more than just investigation. There is a need for action to restore trust and confidence, to assure accountability and our nations and veterans deserve the best medical care, nothing less with the situation now presenting serious, pressing, unanswered allegations and uncertainty is foundrable, and i have that the resources now at the disposal of the Inspector General are sufficient to meet this challenge. I think there is a need for more than just the kind of appointment the president has made to oversee the department of Veterans Affairs, there is a need for resources going to the Inspector General, and possibly involvement of other agencies from the federal government because the resources currently available simply might be insufficient. In addition, there are 300,000 job openings across the country in the v. A. , they are listed on thatobs. Gov and i urge issues relevant to medical care the field immediately, and that actions be taken to restore, not only the transparency and accountability that we all expect from the v. A. , but also to deal with the disability claims, backlogs that continue to plague the v. A. The question now is what does the evidence show . Is it criminal, or simply civil . And that judgment needs to be made as soon as possible. Thank you, mr. Chairman. Thank you, senator blumenthal. Enator heller thank you, mr. Chairman, and thank you for taking time to be with us today, and for the veterans in the room with us and those watching the hearing, thank you for your service. What has come to light about the v. A. In recent months has proven to congress, the president , and the american people, is that there is a problem with accountability at all levels within the Veterans Ministry should. That nevadalem veterans are facing, and it is not something that is new, and in fact it is something i have raised repeatedly with the v. A. To no avail. I think it is long overdue for this committee to exert oversight and hold leadership within the v. A. Accountable. Last week i sent a letter to senator shinseki asking for immediate answers about the lack of accountability on the local level, and whether the v. A. Leadership finally plans to do something about it. I look forward to receiving a timely response and action on the concerns that i highlighted. As nevadas presented on this committee, i believe it is also my role and response ability to get answers for nevadas veterans for the problems they are facing with benefit. They have complained of access excess weight times in emergency rooms, which in itself is too small to meet demand. There was anago, inspection of a blind female veteran that waited five hours in the emergency room and two weeks later died. The ig also found that one quarter of the veterans in the emergency room wait over six hours before receiving care. Veteranore, a las vegas wrote me a letter recently and said he had to find care elsewhere because the wait time for an appointment at the v. A. Was longer than two months. , i wantese concerns assurance that all of nevadas v. A. Medical centers and clinics will be fully audited, and that i will receive and be able to review the results immediately. As the cochair of the v. A. Backlog working group, i am concerned with the claims backlog in nevada. Although the secretary promised me that would be changes, nevada veterans are still waiting the longest, at 355 days on average, for the claims to be processed. When my office requested the status of claims, it was unresponsive. It is unacceptable that veteran officials would limit any ability to get answers for the veterans. Despite my repeated requests, these ongoing issues have not been resolved. Ifsome point i have to ask these problems in nevada are the demonstration of failed leadership at the time. At the top. It is failing to care for those that sacrifice on our behalf. Promises to change and do better for veterans have not produced results. I want changes, not empty, says. If the v. A. Continues on this course, i think it is time to alternately looked to the top 40 changes. Thank you top for these changes. Thank you, mr. Chairman. Thank you. Enator hirono to her, mr. Chairman for holding this hearing and i certainly echoed the q i mr. Chairman, for holding this hearing. I certainly echoed the concerns of my colleagues and the need for structural and systemwide changes. Healthcare system is a promise that we made to americas veterans that we will take care of them in return for their service and sacrifice. The close to 10 million veterans that access care through the v. A. Systems need to trust that they are receiving high quality care when they need it, and i do note that 10 million veterans signed up for the healthcare huge here that is greater than the population of a number of states, including the state of hawaii. When we fail to provide proper care for our veterans, we not only fail them, but their families as well, and these families have also sacrifice for our nations security, and provide essential care and support for our veterans. While the immediate focus might be on the phoenix case and similar allegations regarding a hospitals,ther v. A. It is important to see what is happening systematically at the v. A. To provide veterans highquality care, so we must look at the totality of the v. A. System to see what is working and what is not. I look forward to hearing from the panel about exactly what the challenges and problems are, what actions have been taken, need to be taken to serve our veterans better. While the v. A. Inspector general is investigating and secretary shinseki has called for a national facetoface audit of the v. A. Of the system, my hope is that this first of a number of hearings by this committee will identify other changes that should be of limited. I look forward to hearing from you, and again, as a secretary, and the other v. A. Officials, on your plans to resolve the underlying issues and restore confidence in the veterans community, and, very poorly, to listen very importantly, to this and to what the Veterans Committee has to say about the changes that need to be made. Thank you, senator hirono said senator moran senator hirono. Senator moran. Thank you. Becauseew minutes late i had conversations with kansas veterans again the morning. It is a moving experience each and every time to have that opportunity to visit with our world war ii veterans, and, again, the conversation is the v. A. Is failing them, please make certain that that does not continue. Thousands of veterans across the country, and hundreds in kansas visit with me on an annual basis to tell me they are suffering because of circumstances they find the department of Veterans Affairs. They will tell me that the sacrifices that they encountered, if they were willing to say this humble sentence, why can we not have a service that weird and deserved . They earned and deserve the service, and the department is not providing the veterans will we have committed to do. A sad story is that many veterans across the country and certainly in kansas, have lost hope in the department of Veterans Affairs, and believe things are not going to get any better. Your announcement of a facetoface review across the system, mr. Secretary, i find lacking in what needs to be done. The reality is we have had review after review, Inspector General report after Inspector General report, questions by this committee and the House Veterans Affairs committee, that i cansulted, as far as tell, you know action by the department of Veterans Affairs. The idea that you can conduct a systemwide as you indicate in your opening testimony, review of the v. A. Using 200 and 20 mr. Secretary, we have 1700 v. A. Points of access to care, and you indicate this will provide a full understanding of the v. A. s scheduling policy and continuing management of access to care. I do not see a review of looking at 153 medical facilities with 220 employees as capable of managing the system, so it looks to be more damage control than solving the problem. I actually think we do not have the need for more information, although that is always welcome. What we need is action based upon the information that has already been provided to the department of Veterans Affairs. I served 18 years on the Veterans Affairs committee. I work with nine secretaries of Veterans Affairs, and what is seemingly true to me today is that the quality of service, the timeliness of that service is diminishing, not increasing, and that was not true until recently. We have a significant number of veterans that we serve today, but, mr. Secretary, we can anticipate more as our military men and women retire from service in afghanistan and iraq. We have an aging world war ii veterans population. If we cannot care for the veterans, how can we expect the department of Veterans Affairs to care for those as the numbers and seriousness increases . I look forward to hearing what you have to say today, and i welcome the conversation, but in my view an additional review by your department is not the answer, but the answer is action that changes the system that you are leading and the culture and nature of the folks that are your boys. I look forward employees. I look forward to your testimony. Thank you. Thank you,n senator moran. Senator begich. To eye for holding this hearing and the opportunity to have a conversation about thank you for holding the hearing in the opportunity to have a conversation about the v. A. Rifice and sucking secretary shinseki, immediately after the phoenix story broke, i sent a question letter quickly because i was outraged, but after a few weeks it has become a systematic issue come as you have indicated through your own conversations. It is an issue that is occurring in other v. A. Clinics. Has 77,000e that veterans, the highest per capita in the nation, it is impactful, determining where they get the care. We have been fortunate to create access to our Health Care Services that has been able to cut the wait time out and get Better Service throughout the state, but when we look at veterans, may they be in alaska today, tomorrow they might be in arizona, North Carolina. The service that is being delivered is critical to figuring out the systematic problem. What i agree with my colleagues that we have report after report after report, always indicating systematic problems that we need to correct. So, i am going to be anxious for your commentary, as well as others, on how we will fix this once and for all. I know you have been burdened in some cases because we have had to wars and the v. A. Started be funded aggressively in the last three or four years after we have started to wind down in iraq and afghanistan, which draws a lot of pressure, so i need to understand how that has impacted some of the work of the v. A. Also, as you look at issues and examine what we need to be doing, i want to know from your perspective, what are the things that we are doing through more regulation, or more laws, that are creating more hurdles and red tape . Are there things we should be eliminating to create a more streamlined process . I want to know that. To not have the service delivered at the highest level to our veterans is a disservice. They earned it. They fought for our country, served for our country, and we need to make sure we do everything we can to make sure the service is delivered as high a level as possible. This will be contentious. No question about it. I hope tomorrow we move to increase the performance and capacity of the v. A. , and thank you for being here that i will tell you that i was outraged, but im anxious here. I will tell you that i was outraged, but im interested in your from you. There is more work to be done but it thank you, mr. Thank you don. Thank you, mr. Chairman. Thank you, mr. Begich. Thank you for having his panel. As an elected official, the most meaningful issue i can fund is sending men and women in harms way. We have the second highest per capita veterans in our state. It is a personal issue for me and it is why i am proud to serve on this committee. I am encouraged that folks in washington are suddenly interested in access to health care for veterans. In most cases, it is long overdue. Before i got here, the v. A. Did not have mandatory funding, and they did not have forward funding. Given my Close Association with veterans issues, im approached by veterans every time i go home, and that is almost every weekend, and the overwhelming majority of those folks are appreciative of the care of v. A. In montana, and when they have issues and concerns, they are not bashful, as veterans are not, about telling me about it, and when i get back to my office on monday, i work with those concerns, often with you to. Aren the allegations i hear very troubling. If any of these allegations in phoenix or elsewhere turn out to be true, swift and appropriate action needs to happen if the issues are systemic, we need to make fundamental changes happen. If the issues us at comic systemic, we need to make changes quickly and heads need to roll. We do need the facts. I hope we get those today. If we are truly interested in honoring our veterans by doing them right, the facts will drive an honest conversation about access to health care for our veterans. Us talk about ways we can address shortfalls. Lets talk about ways we can improve Transportation Options for veterans, or expanding telemedicine initiatives. Lets talk about partnerships with local providers and providing the v. A. With resources it needs to address these patient workloads. Lets have these conversation so that we can provide veterans justmeaningful items, not talking points. Veterans deserve our best. They have sacrificed much. Lets demonstrate our best by having a productive, instructive, truthful conversation about what needs to be done to fix the problems are out there in our v. A. Thank you, senator tester. Senator mccain of arizona is not a member of this committee, but given the serious allegations raised in phoenix, senator mccain asked to come before the committee, and we welcome him today. Thank you, mr. Chairman. He went for the opportunity to make a brief statement, particularly given that many of the serious allegations discussed today involve the treatment of veterans in my home state of arizona. Since our nations founding, americans have been fighting in faraway bases to make this dangerous world safer for the rest of us. They have been brave, you have sacrificed, and suffered. They bear wounds and losses they will never completely recover from and we can never fully compensate them for, but we can care for the injuries they suffered on our behalf and for the physical and emotional recovery from the battles they fought to protect us. Decent care for our veterans is the most solemn obligation a nation incurs, and we will be judged by god and history how well we discharge hours. It is why i am deeply troubled the recent allegations of gross mismanagement, fraud, and neglect at a growing number of Veterans Administration medical Centers Across the country. It has been more than a month since allegations that some 40 veterans died while waiting for care at the phoenix v. A. Were first made public. To date, the Obama Administration has failed to spot and in an effective manner an effective in manner. This has created a crisis of confidence toward the v. A. , the very agency that was established to care for them. For my hosted in phoenix, the families of four veterans who passed away in the last two double your months stood before a crowded room to tell their stories. With tears in their eyes they described how their loss loved ones suffer because they were not provided the care they need and deserve. They recalled countless unanswered phone calls, ignored messages, and list wait times, mounds of bureaucratic red tape, while their loved ones suffer debilitating and ultimately fatal conditions. No one should be treated this way in a country as great as ours, but treating those to whom callously, sot so ungracefully, is unconscionable, and we should all be ashamed. Since the initial reports in arizona last month, weve seen this scandal go nationwide, servicing in at least 10 states across america. The quotation seki has ordered a nationwide secretary shinseki hazarded the nationwide audit. Several employees have been placed on administrative leave, and the v. A. Office of Inspector General is inspecting the phoenix v. A. My fellow veterans cannot wait the many months it might take to complete the report. They need answers, accountability, and leadership from this administration and congress now. Is sufferingv. A. From systemic problems in its culture that requires strongminded leadership and accountability to address. At the same time, commerce must provide v. A. Administrators with greater ability to hire and fire those charged with caring for our veterans and most importantly we must give veterans greater possibility and how to get quality care in a timely manner rather than continue to rely on a department that appears riddled with systemic columns in delivering care. We care for those problems in delivering care. How we care for those that deliver for us is the most important test of the nations character. Today we are failing the test. We must do better tomorrow, much better. For the 9 million American Veterans enrolled in the v. A. Today, and for the families whose tragic stories we heard last week in phoenix and are greeting breeding their toses, it is time to live up lincolns injunction. It is time for answers, accountability, and leadership from this administration, and i look forward to hearing from secretary shinseki. I thank you mr. Chairman, and Ranking Member burr, and the members of this committee. Thank you, senator mccain. I would like to now welcome retired u. S. Army general eric shinseki, secretary of Veterans Affairs, to the first panel. As most people know, secretary shinseki is a graduate of west point, served as a chief of staff for the army from 1999 to 2003, retired in 2003 after a near 40year career in the u. S. Army. Following the september 11, 2001, terrorist attacks against our country, secretary shinseki led the army during operations iraqi freedom and serve simultaneously as commander general, nato land forces in central europe, and commander of the natoled stabilization force, bosnia and herzegovina, a fewt to note few of the many awards the distinguished metal, the barn star medal, and the purple heart. Mr. Secretary, thank you very much for being with us today. Secretary shinseki is accompanied by dr. Robert petzel , who is the undersecretary for health. Mr. Secretary, your repaired remarks will be submitted for the record. What i would like to do now is if both of you could rise and take the oath . Or affirmemnly swear that the testimony that you are about to give before the Senate Committee on Veterans Affairs will be the truth, the whole truth, and nothing but the truth, so help you god . Thank you very much. Please be seated. Mr. Secretary and dr. Petzel, the floor is yours. Youhairman sanders, thank very much for that more than generous introduction. To you and Ranking Member burr, and the members of this committee, thank you for this opportunity to discuss the state of v. A. I have been taking oaths most of my life, mr. Chairman, so whenever i appear before this committee, whether i am sworn or not, you have my best answers based on what i know, and as truthful a presentation as i can make. I deeply appreciate your support , and unwavering support for nations veterans. That has been true for five years that i have worked with members of this committee. Chairman, i would also like to recognize that in the room here are others with whom i have worked with very closely for five years, developing good dialogue, good collaboration. They have been very helpful in shaping what we thought was a priority in the department of Veterans Affairs, and it has been a good, strong relationship, and i thank them for their partnership, and i know some of them will be testifying before you today. In those cases where we have not always seen eye to eye, we have managed to find Common Ground on behalf of veterans, and i expect we will do that again. We had v. A. Are committed to consist of providing our veterans the highquality care, timely benefits, and safe facilities necessary to improve their health and wellbeing. This commitment mandates a continuous effort to improve quality and safety. Americas veterans deserve nothing less. Meet highy and Safety Standards and veterans should feel safe in using v. A. That said, in health care, as you point out, there are always areas in need of improvement. Any allegation about patient care or employee misconduct are taken seriously, and based on the background that you just described, that i followed most of my life, for 38 years in uniform, and i now have this great privilege of being able to care for people i went to war with many years ago, and people that i have sent to war, and people that raised me in the profession when i was a anygster, any allegation, adverse incidents like this, makes me mad as hell. I could use stronger language here, mr. Chairman, but in deference to the committee, i wont. At the same time, it also saddens me because i understand that out of those adverse events a veteran and a veterans family is dealing in the aftermath, and i always try to put myself in their shoes. In response to allegations about manipulations of appointments, i amuling, and phoenix, committed to taking all actions necessary to identify exactly what the issues are, to fix them, and who strengthens healths trust in v. A. Care. The office of Inspector General, ismany of you went up, it conducting it, review. If any of these allegations are true at phoenix and elsewhere we have invited the ig to come and look at issues that surface if any allegations are true, they are completely unacceptable to me, to veterans, and i will tell you the vast majority of vha communities that come to work every day to do the best for those veterans. If any of those are substantiated by the Inspector General, we will act, and i thank senator murrays encouragement to do something different, and senator, i will. Important,t however, to allow the specter general to complete the review and provide results. Secondly, i have directed v. A. To complete a nationwide access review of all other Health Care Facilities to ensure full compliance with our scheduling policy, and as we have begun that, we already received reports where question, is under and we have asked the ig in a number of those cases to also take a look. Third i have asked for and received the assistance from president obama. The president has agreed to let his deputy chief of staff for s assist us inbor our review of allegations and honey other issues we might find and any other issues we might find in these reviews. Rob is a fresh set of eyes, the son of a veteran, and a proven performer that brings experience to this task, and i welcome his experience. Known rob nabors family for many years. We served together for many years, i know his mom and dad very well, and i welcome the assistance of rob nabors. It is important to remember that millionucted roughly 85 outpatient appointment clinics last year. Are over 1700 points of care, including 150 Medical Centers, 820 communitybased outpatient clinics, 332 veteran 104ers, 140 living centers, rehabilitation Treatment Programs, and 70 mobile vet centers. His is a demonstration of concern by this department this is illustration of concern by this department, trying to make sure that every veteran, no matter where they live in this country, and even in our overseas locations, have an equal opportunity to have access to Quality Health care. As the chairman has noted, vha conducts approximately 336,000 appointments every day. Employees00 vha provide Exceptional Care to the 600 million veterans. V. A. Meets and exceeds that is in very many areas. We always endeavor to be fully transparent, fostering a culture that rate avoids repeating errors. Every facility is accredited by the joint commission, the independent organization that ensures the quality of u. S. Health care through comprehensive evaluations. In 2012, the joint commission recognized 19 v. A. Hospitals as among its top performers, and last year that number increased to 32. Additionally, as the chairman has pointed out, the most recent American Customer Satisfaction index ranks v. A. Customer satisfaction among the best in the nation, equal to or better than the rankings for private sector hospitals. An overwhelming 96 of veterans who use v. A. Health care. Today indicated they would use us again the next time they anded inpatient care, 96 , 95 for outpatient care. I want them to continue to have that level of trust. Veterans deserve to have full faith in their v. A. Vha is committed to full disclosure when any adverse event occurs. V. A. Will continue to aggressively develop and sustain reliable systems and train employees to detect and prevent health care incidents before they happen. I have detailed some of our many Significant Health care a competence a competence over the past five years in my written testimony accomplishments over the past five years in my written testimony. I appreciate our employees, our partners, as indicated, in this room, community stakeholders, many of whom we deal with on a daily basis, and our dedicated v. A. Volunteers. I deeply respect the Important Role that congress and the members of this committee play in serving our veterans, and i look forward to continuing our work with congress to better serve them all, and again, mr. Chairman, thank you for the opportunity to appear here today. Thank you are much, for your testimony thank you very much for your testimony. Mr. Secretary, i am going to start with a simple question, and then i will ask some harder questions, and you or dr. Petzel could answer. Simple question the v. A. Hospital system is the largest integrated Health Care System and an end states of america with 6. 5 million veterans accessing it every single day. ,r. Shinseki, and dr. Petzel what are the strengths, what are the problems in your judgment . Is it a good system . Mr. Chairman, it is a good system, and it is comparable to any other Health Care System in the country. In some areas, and in some specific occasions we exceed even those good systems. For five years now, we have focused on three major goals for v. A. , all of them focused on doing better by veterans, which is what the president asked me today when i came here. The first was to increase access. I think we have been successful at us. We have enrolled 2 million more veterans into v. A. Health care. Here,k there is a net somewhere around 1. 4 million, 1. 5 million, who are net overall increases, but over the past five years, we have enrolled 2 million more veterans. The second focus was to go after this thing called the backlog. We have had this discussion for a number of years now, but we did not simply go after the backlog just simply to and what was then, five years ago, a set of claims. Hadlso acknowledged that we not done very well by veterans of previous conflicts. So, even as we committed to and in ending the backlog in 2015, we also went and tried to bring justice to those who have never had an opportunity to submit a claim. I called on the good people in the Veterans Benefits administration to take this on, and they did, and i promised them we would give them a new tool called the Veterans Benefits management system, and in three years we feel this new cut you to do a 2008 thats you do in 2008 benefits . We have 11,000 people who process claims. I want to pick up on some of the legitimate points made by democrats and republicans. Everyonelegation understands when you treat 230,000 people a day, is a for any institution that size. Heres a major criticism i hear and others, that this is not new news, that this is not new news. That these concerns did not arise yesterday, did not arise in phoenix, but in fact there have been reports by the Inspector General, the gao, on numerous occasions about problems having to do with waitingng and with lists. Could you address how it could happen that year after year these reports were made and have not been acted upon significantly . It is important to look at the gao and the ig reports and what they intend to do, and they come in and give us some sense of where we could be doing better, and we get in there and we address those issues and take corrective action and in essence close out the report. It does not mean that we have solved every issue. It does mean that we have taken care of addressing those issues him a and then when they come back, there may be another set of issues to deal with. sdo understand senator murray suggestion that we should take a comprehensive look at this. What youre hearing from a number of senators and myself the criticism is that year after year reports have made talking about these problems and that problems continue to exist. Can you give us some assurance of what happens tomorrow, where do we go from here so we do not have this hearing next year or two years from now . The audit weat have created is intended to do. While the Inspector General is looking at phoenix for evidence andmployee misconduct evidence that 40 veterans may have perished awaiting scheduling, the ig is going to get to the bottom of that. What we are attempting to do is a dress the senators question is to take a look at ourselves and not wait for the igs outcomes. Already we have begun to see evidence that people are coming forward and saying, i think there is an issue here, which i encourage. And if what we are after there were performance issues in the past, if they are continuing today are people cooking the books . Is that a problem in the Health Care System . I am not aware in other than a number of isolated cases where there is evidence of that. The fact that there is evidence in a couple of cases behooves us to take a look, and that is why we have structured this audit so set of clinicians are not going to inspect their own areas. Have offset them so that and we will get a comprehensive good look. I apologize. My time has expired. Welcome. These questions are for you and i will go as quickly as i can. Mr. Secretary, were you wear that on october 20 5, 2013, the office of special counsel nggressive the v. A. Conduct a investigation into it an outpatient clinic, and since then the media has reported on an email of june 19, 2013, that explains how to game the to avoid on being on the bad boy list. I became aware of that screenshot, i believe, is what it was, of an employee who was suggesting there are ways to game. I put that employee on administrative leave. That was last friday. It is my understanding onto 21, 2013, v. A. Received a rough port from the office of medical inspector regarding understaffing issues at the jackson center, and that report described multiple patients andduling problem, scheduling patients for a clinic that does not have any assigned providers. On september 17, 2013, the office of special counsel submitted a letter to the president of the United States on which the v. A. Was copied, describing the findings of that june 21 office of medical inspector report on the Fourth Jackson Medical Center, including the practice of double booking patients and the use of clanks. Clinics . To remember reading that report . I cannot say. There is a december 23 report the medicale of inspector regarding the Medical Center in fort collins clinic that found that several medical support assistants businessdical centers Office Training includes teaching them to make the desired date the actual appointment and if the clinic needed to cancel appointments they were instructed to choose the desired date to within 14 days of the new appointment. You read that report . The report has come to my attention recently. Staff submitted a response to the office of special counsel, which included report on fort collins. In that letter, it was stated was not provided any specific veterans cases affected by these practices, they cannot substantiate the failure to train staff resulting in injured Public Health or safety. Were you aware of what your chief of staff worked . Wrote . I was. Are you aware of the report need improvement which was andicly released in 2013, then on december 11, 2012, to that same report module former chief of staff sent a letter to the gao which stated v. A. Generally agrees with with the conclusions and agrees with limitations to the department. Do you remember that letter, that report, and your chief of staffs response . In general i remember that report. Issuesknew there were related to scheduling and wait 2013,as early as june 21, at jackson, december 20 three at ft. Collins as well as numerous reports related to excessive weight times in january 2012, october 2012 in cleveland, september 2013, columbia, south carolina, and to subvert 2012 him at the gao report with questions the reliability of the reported weight time performance measures, which brings us to today and phoenix. On may 1 you probably stated that you had removed a person as the medical director. He stated then have that was to ensure the integrity of the current investigation. On may 5, there was a Conference Call with all directors, all medical directors, and the chief ther largea ranthe group to discuss the audits in large communityaced outpatient clinics. Hen i called the doctor, made the statement that the removal was political and the chief has done nothing wrong. If you are asking us to wait until the investigation is over, apply for the people who work you, and all the people ive described to you and that investigation going on, why should this committee or any veteran in america believe that change is going to happen as a result of what we are going through . I was not aware of the phone call you refer to, and i will look into it. My removalt tell you placing her on administrative leave was at the request of the ig. On thehe lead comprehensive review. I do not get out ahead of him. He requested it. I put the director and other individuals on administrative leave. I thank you, mr. Chairman. Thank you, senator. Senator murray . Secretary, as i said, the announcement that the president is sending one of his top advisers to assist in the review is good news. Im confident he will make sure this review is comprehensive and accurate. It is critical that this review is effective, because at a hearing of this committee that i called in november of 2011, i whetherdoctor facilities were gaming the system and not fully reporting wait times, and she told me she was unaware of any facility doing that and audits were being done to make sure that is not happening. There were a number of allegations that wait times are in the oversight organizations have reported on it for years are at the department so far has been unable to provide me even the most a sick information on how this nationwide review is going to be conducted or what it will look like, and i hope that is about to change. I want you to explain how this review is going to be conducted. Let me call on the dr. To give you the details. Thank you, mr. Secretary. There are several phases to what we do. This week we are auditing with the inperson teams and an Anonymous Survey the First Tranche of the facilities, 151 centers. Starting next week we will work our way down to more of the other sites. Gathering information, and i think the anonymous nature of the questioner is important, information about whether or not people have felt forced to do things that were inappropriate and lacking trust and integrity in the scheduling system. The second heart is and is the second part is an assessment that a number of people have mentioned as to whether or not we have our resources deployed appropriately, whether or not we have the appropriate amount of resources, and just as importantly whether or not we are using those resources in the best way at each one of our sites. Everybody needs to remember that million,000 85 outpatient visits every year. 95 of those visits are with established patients, and those are commerce within how want the details of this is going to occur so we get good information. We will focus on the new patient and the scheduling system that we have for these patients, and all the other Access Points besides our clinics and her Medical Centers that we have got available for new patients. First is the review to see how the scheduling system is being done. Second, look at whether we have i would like to get the details on that, and i do not want to use all my time, but it is important we know how that is going to be use and that real change will occur. I want to ask the secretary, the deputy undersecretary told me at a hearing in my 12 that the meaning is so prevalent as soon as new directives are put out they are torn apart to find about how to get around the apartment. The stability from an employee said the exact same thing. At that same hearing linda if we have seen scheduling practices that result in gaming the system to make performance metrics look better, at the end of the day, over the past seven years, they need a culture change. To get that culture change i think they really need to hold the facility directors accountable for how well the data is actually being captured. That was more than two years ago. Practice at the v. A. Seems to be to hide the truth in order to look good. That has got to change once and for all, and i want to know how you are going to get your medical directors and Network Leaders to tell you whether it is through this survey or in the future when they have a problem and we will work with you to address it, rather than pursuing these secret lists and playing games with the sweet times. Senator, if there is anything that gets me angrier than just hearing allegations is to hear you tell me that we have folks that cannot be truthful because they think the system does not allow it. Trust is an important aspect of everything we do here, and has been in my previous life as well. In order to do that, we have to be transparent and we have to hold people accountable. Say to you is we are going to get into this, and it is important for me to assure veterans, to regain their trust, whatever has been compromised here, that when they come to v. A. They come to a good, safe, caring system and that they will be care for. And for all the employees that are listening in today, i expect our employees to provide the highest quality care, safest care we can provide, given all the comments about how tough it iis in the Health Care Industry and provide access to benefits as quickly as we can. That is our mission. We only have one mission, to take care of these veterans, and not these veterans. I am one of them. Employees at the v. A. Our veterans. We have a vested interest here to get this right. Absolutely critical. This review will not work if the people who are telling you the information do not tell you the truth. I agree. Thank you, senator murray. Senator isaacson . For both of you gentlemen, do you remember or do you know william . I do. Do you . I do. April 20 6, 2010, he said a memo to all the directors entitled inappropriate scheduling practices. Has come two begins it to my attention that to improve scores on axis measures, sometimes referred to as gaming strategies. Paragraph three, and this is the key of the question, and the key of the issue, for your liststance attached is a this practices identified by a working group chartered with the system redesign office. Be cautioned that since 2008 additional modified gaming strategies may have emerged, so do not consider this list a full disruption of all current possibilities or other inappropriate scheduling practices that need to be addressed. These practices will not be tolerated. Are you familiar with that memorandum . I was not i am not. I am familiar with that memorandum, yes. If it is not going to be tolerated, and for over four years ago, you had eight pages of known practices for gaming the system, what action if any i do not think any took place did the v. A. Take to respond to the memorandum that to see to it that hospital directors followed their orders . We have worked very hard to root out these inappropriate uses of the scheduling system and these abuses. We have been working continuously to try to identify where those sites are and what we need to do to prevent that from happening. It is absolutely inexcusable. The schedulers response validity is to nature that that program is administered with integrity. What do you do when you uncover one . What do you do to hold them accountable . The individuals are held accountable. I cannot give you an example of specifically, but if someone were found to be manipulating the scheduling system, they would be disciplined. Would they lose their job . I do not know whether that is the appropriate level of punishment or not. We can probably give you a little better answer to this, because youre focused on scheduling. In 2012, we involuntarily removed 3000 employees for either poor performance or misconduct. In 2013, another 3000 employees were involuntarily removed, and among them there were some Senior Executives as well. Are those removals reassignment within the v. A. Health care system . Some may be reassignment. Others were departures. Some retirement, and others by in effect being let loose by v. A. Well, i have read this entire memorandum, and there is no gray area. It is not we think this is happening. It is we know this is happening, and there may be other ways of gaming the system. It talks about it is done specifically for the purpose of improving scores on assorted axis measures, which i guess means the way in which their performance is evaluated. Is that correct . Im going to take your direction here i would assume that that i would assume the assistance redesign office group you know what the system redesign offices . Doctor . Yes, the group that is weponsible for ensuring that are designing the work within our clinics and operations in the most effective and efficient way, and they have been given at theytime at that time were given responsibility for keeping track of access. And it says that the listing of inappropriate scheduling practices was identified by the working group, so you have a group within the Veterans Administration that identified on the 26th of august, 2010, various and numerous practices where numbers were being manipulated for the purpose of better outcomes, i presume, in terms of how those people would be rated. It would seem to me there should have been a systematic practice where the chain of command would see to it that was not tolerated as the memo said, and was an ability to be had, including the loss of a job. Did agree with you, and we institute that appropriate level of accountability. I will find out. I do not know whether anybody was physically disciplined route that issue. This has been an important thing to us for at least the last four years, and we have tried to root out those places where the scheduling system was being used inappropriately. I know my time is up, but let me say two things. One is for the sake of the and cavity of the Veterans Administration, you need to find out if there is an accountability system to respond to this memorandum from 26 of august. I would ask for consent to cement this memorandum for the record. Without objection. Senator blumenthal . Thank you. Again, thank you to you and the other veterans who are here who are listening for their interest and involvement in this issue. Secretary shinseki, can you tell me how quickly we will have some preliminary results to both the review and the ig investigation . The Inspector General has his own timetable, and i do not have insight into what that is. On our audit, were taking care of hosting a large facilities this week. There will be some followup next week, perhaps in about three weeks we will have then able to us of all the data, do a good analysis, and then respond in detail the way that guest can you commit within three weeks you ever report for us . I think we should be able to do that, but that is preliminary reyna. I do not know what data is being assembled. We will shoot for three weeks. I apologize for interrupting, but our time is limited. As part of your management youponsibility, dont believe and i certainly believe that there is a responsibility from the ig to complete this report as quickly as possible, in a matter of days and weeks, not months . I agree that it would be helpful for the ig to complete his report as quickly and you gave the ig deadline . Im not able to do that. The ig is an independent reviewer here, and once i turn this over to him, i am primarily supporting his needs here. Raise the elephant in the room. Isnt there evidence here of criminal wrongdoing, that is, falsifying records, false statements to the federal government . That is a crime should become a yes. Would it not be appropriate for assistance from another igncy given that the resources are so limited that the task is so challenging and the need for results is a powerful . I will work with the ig to make that available to him, if that is his request. L, may i suggest respectfully, mr. Secretary, that it is your responsibility to make that judgment about the and withoutes, rushing to judgment, to reach the conclusions to involve appropriate criminal investigative agencies, if there is sufficient evidence of criminality, and in my judgment, there is more than sufficient reason to involve other investigative agencies here and like of his evidence in light of this evidence, of potential false statements to the federal government, and the need for timeliness and promptness in results to restore trust and confidence . What im hearing from my colleagues is the background about the systematic failures and the need for also Greater Transparency and accountability, so let me ask my next question the discussion i have had on resources, and repeated them with the ig to make sure again, every discussion of whether you have ienpouough resources, each New Discovery adds to that workload, and i would have that discussion with him again. Let me ask, will you change thatManagement Team given the background here shows systematic failings over a period of years, not just months . Senator, i do not want to get ahead of myself or head of the ig here. I want to see the results. I want to see the results of the audit. And if changes are required, i will take those actions. Give this evidence that we have seen already is as powerful as it seems to be, wouldnt changing your Management Team be appropriate . Perhaps. Im still wait for results for the audit. Thank you. Thank you. Thank you. Mr. Secretary, i point out in my Opening Statement about the ig investigation about the treatment of a blind female wasran in the way she treated in the emergency room in a v. A. Hospital in las vegas. Have you had an opportunity to see the results of those investigations . Yeah, senator, i have had an opportunity to review that investigation, yes. What was the conclusion . Without revealing details about the individual, it was that she did wait too long and that there were others that waited too long in the emergency room. It did not have any estimation of the inspector and impact on the eventual course of her illness, but it was it appropriate that a blind vector and would have to wait that long in our merchants room. Thanks for the answer. Mr. Secretary much do you agree . I do agree. I dont think any veteran, whatever the condition, should have to wait that long in any of our facilities, emergency room or click. Have you received complaints about wait times for any other facility in nevada . Im not aware of another facility in nevada. Doctor . Im not aware of it either. I do not know the results of our either reno or the las vegas hospital, but i have not heard anything. Will all the hospitals and clinics have facetoface audits . Yes, they will. Will the v. A. Conduct more thorough audits later with the ig . If we find that there are instances where there might been inappropriate or no activity, we will certainly enjoy and en join the ig to come. That might be difficult to predict. Are you talking about a continuing series of audits based on what we find, if there is a widespread issue here, we will have a set of proposals of sustaining looks to make sure we have rooted out the kind of behaviors that we are talking about. Either alleged or in fact. Thefter conducting investigations, will you make that available to myself or my staff . Yes. To any member of the nevada delegation . Yes. Obviously with the issues with what is going on in phoenix, the waiting room, the time waits that we are seeing across the country and in my state of nevada, and of course the disability claims backlogs we are seeing three times longer in the state of nevada, than what it should be, do you believe you are ultimately responsible for all this . I am. You and i had this discussion yesterday. I think i need to provide you data that would be a little more current than three times the National Average on weights of backlog claims. Perhaps too at one time. I am told that those numbers are down. Todays members have 355 days. That is the average grade would you explain to me after knowing all thais information why you should not resign . I will tell you, senator, i came here to make things better for veterans. That was my appointment by the president. Every day i start out with the to provide as much care and benefits for the people i went to war with and the people that i spent a good portion of my life doing. This is not a job. I am here to accomplish a mission that i think they andically deserve and need can tell you over the past five years we have done a lot to make things better. We are not done yet. And i intend to continue this mission until i have satisfied told byhat goal or i am the commander in chief that my time has and serve. Thank you for being here today. Thank you, mr. Chairman. The testimony states that the core mission is to provide holly health care. Is providing Health Care Still the v. A. s core mission, or have the goals shifted over time as they have expanded to providing other vet benefits . Passedthat congress has the v. A. To provide job training housing assistance, education assistance, reduced sharessness, so can you your thoughts about what is the core mission now, and with all these other tasks that you now have, programs that you now one, are you able to focus your core mission of providing Quality Health care to our vets . Yeah. Providing quality, safe, Accessible Health care for our veterans who have earned them is a core mission. But in order to provide that kind of health care, they still have to access the system, and that means we have to do a good job dealing with this ability claims. If we are not able to process those claims, the opportunity to Access Health care is something less. For the current generation it is automatic they have five years of health care from v. A. For that group, that generation of veterans, it is a little different than others. So disability claims becomes an issue here, because that then it renders the opportunity to take advantage of health care benefits. I would say homelessness is also part of our supportability. Five years ago we talked about it were ass as though thing out there. What we have learned in five years because we have focused on it is depression, major factors that lead to homelessness, depression, insomnia, pain, substance abuse, Substance Use disorders im sorry to interrupt, but my time is rapidly expiring. The point of my question is that all of these areas that we have asked you to address with regard to our veterans, education needs, homeless issues, all of that, whether that is making it yourharder for you to meet core mission, and that may be a rhetorical question. Let me just move onto to another area. As we look at the potential need to making systemic changes gs v. A. Operates, i note i testimony where he says theres is no National Process to establish what are deemed essential positions to the delivery of health care. Theres no standard organizational chart for a fev. A. Hospital or clinic. It is difficult to determine what clinics are doing. Would you consider these areas to be a potential systemic changes that we should be looking at making to the v. A. . I think that is a good inside here, and we will take a look at that. Part of our challenge is the complexity of the v. A. Health care system. We have a series of hospitals that go from the very largest and most sophisticated, apprehensive kind of health care, organ transplants, brain surgery. 1bs, allem these distinguishing between the level of care that can be provided there. It is a compass system, but standardizing the terms within that framework would be helpful. This question may be one for dr. Petzel to respond to. We have heard that ca has used bonuses to reduce wait times. Are these clinic bonuses . Individual compensations that have occurred . Staff you hold the accountable to ensure that these incentives are earned in an appropriate manner . What do you have in in place . Iswhat you are referred to the performance awards that are given at the end of the year in executive has a performance contract that has many elements, one of which, a subset of which may relate to access. It could be stated in the variety of Different Things, has access improved, and the percentage of improvement. Review of them would state the absolute. Most of them are statements of what has been the improvements. It is part of a much more comprehensive evaluation for seniors. Itd if you do not ourages thank you. Thank you, mr. Chairman. Thanks for holding this important hearing, and i hope it is the first of many hearings. Secretary, as you know i occupied a cabinet post for part of my career. There are some cabinet posts by nature, kind of a lightning rod. If you are going to be the attorney general or the secretary of state, you are going to get fired at every day. It is just part of the job description. The v. A. , on the other hand, in my judgment, does not fit into that category. And the other thing about the v. A. Is that because of the Ranking Member and chair and those who preceded them preceded them, it is a pretty nonpartisan committee. We do not talk about republican and democrat stuff. We sai talk about how we improve the lives of veterans. I have always applauded that. I think you need more of that in washington, not less. The other thing i would mention is that there has been tough budget cycles. We know that, and yet you yourself have come to this Committee Many times and said us are resourcing appropriately and generously under the circumstances we thank you for that. We applaud you for that. We are going to look at this stuff, and i go, what the heck . Mr. Secretary, one of the submissions we got from the was a map. Gion have they share that with you, or has that come to your attention . I may have seen a copy of that last evening. This map is entitled epidemic , and itmismanagement goes down to burlington vermont, pittsburgh, North Carolina, columbia, south carolina, augusta georgia, atlanta, jackson, chicago, st. Louis, austin, san antonio, cheyenne, fort collins, phoenix, just place after place after place where the American Legion it has thrown up their hands and said, my goodness, what the heck is going on here . Do you dispute what they are saying in this map . Do you think they are saying something here that is not true . Im not aware of the basis for that map, but i accept that there are places, this is here, where we have had adverse events, and i would also point out that i do not know if in all, but in a good number, majority of those events, do were self hey identify them initiated within the Veterans Administration, Veterans Health administration. Figure out what happened, get to the root causes, and then be transparent, tell people what happened. Here is where i am getting with this. Have comearings i to, or would talk about waiting listss, disability claims, it is one thing after another. Hearingalk out of the like i have been given an explanation, so i will quiet down and let you go back to work. The change that is necessary, and what worries me about this and what worries me about what we are dealing with here is that it is systemic, it is cultural, is thise have just adopted mode of operation as the way of doing business. Do you share my concern . Do you feel that the v. A. Culture is such that every rule this,t out, even after you say, ok, folks, from now, we d, doing to do a. , b, c, you feel that people say, how do we game that . And am sure someplace Large Organization you are always going to have Something Like that. But this is part of the reason why i engage the Veterans Service organizations on a near monthly basis. If there are any straight shooters here, it will be them in terms of being direct with the secretary. This is why i have spent time traveling the country, going to our facilities, talking to them about what is important, and engaging veterans in those locations as well. The voices that are most important to me are the voices of the veterans i encounter out there. I will say there is an occasional concern that is voiced to me, and i will bring it back and go to work on it, but i have not received that systemic look that is being described. There is a distinction between a medical mistake and the relation, and manipulation, or cooking the books. In the case of a medical mistake, i want people to stand up and Say Something is wrong here. Something is not working or we made a mistake or i made a mistake. To do that you have to have the confidence and honesty on the part of the workforce, and in many of those examples cited on that map, that is what initiated our concern. Many relation we will get to the bottom of men appear later we will get to the bottom of. At this point, i would like the senators are. Yet questions do you have questions . Thank you. I wanted to catch that first vote as we were getting ready. Again, i want to thank you very much for being here. You have for the work done in alaska, but let me just say that some of the comments i want to follow up on that other members have had, let me first start with one. And i am struggling here. Let me be frank with you, mr. Secretary. We havegood work done in alaska, and we are supposed to be able to a composting that made it improvement in delivering services for veterans. And to remind folks, having 37,000 veterans is a huge amount in alaska. The bigger issue as i have listened to the senators note of the memo and regarding identification of the issues that talked about scheduling and other issues, we talked about trust a little bit earlier. That is important. That we have trust with delivery of services and we trust the people who are delivering services to the v. A. I will tell you from my time as mayor, if you have people that have been identified to have manipulated records, we would fire them. Because we have lost trust. If they are cheating, they are not trustworthy. If you just transfer them to another part of the government, it is perpetuating what they have done, maybe in a different feel. My question is, and i know you talked about the 2000 people, you have moved tomorrows dismissed them a retard but i want to know on this issue, have you ever fired anybody on this issue when you find out that they are not they manipulated records . To me it is the fundamental question, because if it is just shifted around, we are not changing the system to improve it. I do want an answer, because this to me is a fundamental issue. As a former mayor, we would fire them. They would be gone. I would have to give you an answer that looked across those specific reasons that we released 3000 people, senator. Manipulation is very specific. This is something for me more recent. Ofhout getting ahead decisions, i would say manipulation of data, of the truth is serious with me. Would you fire them . I would do everything i can that is not a question. There is a process here, senator. Let me cannot get ahead of it so in the end i have it reversed because of predetermination. Document, it last , thet remember the memo report identified people that have been doing some manipulation. Reportstion is from that. Was anybody fired from that itivity question mark would say if there was any manipulation that identified individuals, i would expect to have seen their names, and a list of 3000, and i cannot tell you that today. Can you get it to the record for that . I will do that. Let me ask the doctor. Not have specific information, but we can try to resurrect whether or not that has occurred. To i want try to say we saw that problem when i first came in in alaska. We had backlogs, scheduling issues, a lot of things. We went after it. We went after it jointly. With a program, which is going to run out of money at the end of this fiscal year. There are bright of things to go after. We can fix this problem. We saw challenges, and the Biggest Challenges is weve is if we do not hold people accountable, we will never solve this problem. Sometimes you have to have some heads roll in order to get the system to shape up, because sometimes they know this is going to get transferred, i will still get paid. What is the real penalty . We are not in disagreement here. Great. I just wanted to prove that clearly. Let me again say, mr. Chairman, i know this is just one of many opportunities we will have. Youre waiting for the report. That will give us more opportunity. Reporteful that ig when it comes out there will be immediate action based on the report menotti further study of the report. Ig says here are the problems, we need to get after it, because if we do not, the v. A. In this country and in alaska will be the ones who lose out. You recognize that the veterans will be on the back end of this. Thank you, senator begi ch. Senator . Thank you. Mr. Secretary, your testimony, you said i invited an independent investigation by the office of Inspector General to conduct a comprehensive review if there are any ideations, allegations. If they are substantiated by the responsible and timely action will be taken. How do you define response will and timely action . There is a process to be able to implement those findings. Decisions regarding those substantiated findings. I will tell you i will be aggressive and assistance i can make it. There is a process here that is not entirely under my control. I am sure you are aware of the ig report regarding the mismanagement of inpatient Mental Health care at the atlanta the Medical Center that was released april 17 of last year. I am sure you are were at the report regarding the unexpected patient deaths and the substance Treatment Program in the miami v. A. Health care center, because that was released on march 27, 2014. He willgs testimony give later, it is both miami and tlanta standards of kept safe. E would assume you would find miami and atlantic as unacceptable, and if you will, tell me what we have done in a responsible and timely manner to remediate that problem . In atlanta, thereve been seven disciplinary actions, including the retirement or removal of three senior officials. And miami . Miami and still is in proces. S we will do this as quickly as we are able to do. Thank you. Thank you. Two questions. Number one, you have heard Serious Problems about waiting times at various locations around the country. I think dr. Petzel informed us the last few years we have seen two million additional veterans come into the system. Million new patients have arrived since 2009, with a net increase of 1. 4 million. I would the suspect that some of the patients are coming in with some Serious Problems in terms of ptsd, . Yes, sir. Let me ask you a civil question. To what degree does the v. A. Not have the resources to address that increase in patients . In a lot of patients coming in certain parts of this country, and are we seeing we think this is you do not have the resources . What is the answer . Uh ability ton, the provide appropriate access to these group of veterans depends on several things rate one is the people. Do we have enough people. Are we using these people effectively. Are we using all the other things available to us, telehealth, febasis program, etc. One of the things we are going to do is we are to look at this place that are having access difficulties as a result of this and make a determination as to whether or not we have adequate resources there. Do, but wenow is we need to look carefully at those places where we are having access issues, to see if it is a resource problem. That may conclude, and may i add, this is not a once and done or whenever we have a crisis we do. This is an ongoing set of looks at ourselves. Our patient load. Grows each year complexity of the issues, as you describe. This is an ongoing assessment that we tried to get into the budget process so there is an orderly decisionmaking. At me thank you for being here. Let me thank you for being here. I would like to call up our second panel. The v. A. Is a little bit different than other agencies, because while there while it serves all the people in our country, it has a very special constituency. People who have put their lives on the line to serve our country. Representatives from many of the major organizations. Thank you very much for being here. Are all interested to hear about your experiences with ca Health Care Services. You know more about it because your people access the system every day. I look forward to hearing your suggestions and your criticisms of how v. A. Can do better. I would like to remind each of you to keep your oral presentations to five minutes, and of course, your false statement will be printed in the record of the hearing. Our guests today are daniel r, the National Legislative director for the disabled American Veterans, the chief policy officer for the iraq and afghanistan v america, the president of student veterans of america, the beauty director of National Legislative Service Veterans of foreign wars, and the executive tractor for policy and Governmental Affairs of the Vietnam Veterans of america. I want to thank all of you for your Honorable Military Service and for being with us today. Commander, we will begin with you, please. Good afternoon. Yesterday we learned of a veteran in vermont who died while trying to get Mental Health care from his local v. A. His wife complained he would have to wait for hours just to be bounced around to different counselors. The American Legion expressed our concern about his very issue for the House Veterans Affairs committee at the beginning of april and again before this committee at the end of april. Our testimony is a matter of public record. Members of this committee, on behalf of the 2. 5 million members of the American Legion, plus another million of uxiliary, thank you for allowing me to share my views. Two days ago i was in phoenix. I hosted a Veterans Hall meeting which lasted almost four hours. 200. S attended by over 60 two spoke passionately about scheduling issues and other concerns at the hospital. I will be happy to sit to scuff the details of that meeting during the question and answer time if you want to hear more about the session. Im here today to help you understand why the American Legion believes the v. A. Needs to address deficiencies and let you know the American Legion fully supports the department of Veterans Affairs. We supported the creation of the Veterans Administration in 1930 and fought hard to get v. A. Elevated to cabinet level in 1989. We donate hundreds of thousands of hours each year to the v. A. Along with billions of dollars and have scores of claims representatives. We have fund a Brain Research center in the center and are representing 750,000 veterans as they file their claims. The allege of the secret waiting list in phoenix that are now being investigated along with the 40 or more patient deaths have rocked the veterans community. We understand six additional v. A. Locations have been identified in wait time manipulation. The allegations in phoenix were not the only reason the American Legion decided to call for leadership change at the v. A. They were the final straw in leadership failures that include, construction delays and cost overruns, patient deaths, atient infections due to unacceptable waiting times. Failure to create a joint health care record for used by the department of defense and department of Veterans Affairs and refusal to answer to nquiries and disclose relevant truths. Senator mccast cull is concerned at the st. Louis v. A. And wants to get to the bottom of it. The list continues to grow. When are things going to get better. A day cannot pass without problems and diss with delays and quality of care challenges. While we wait for things to get better, hundreds of thousands of veterans are waiting for decisions on initial disability claim or appeal which prevents them from receiving treatment. While we wait, Service Members are falling through the cracks due to the inability to create a single interoperative medical record. While we wait, officials in v. A. s central are preventing them from being transparent. While we wait, veteran suicides continue to plague our nation at 22 per day with no Clear Strategy on proactively addressing suicides. I would like to thank you for this opportunity to speak with you today and welcome your questions. Thank you. Chairman sanders, Ranking Member burr, thank you for inviting us to testify about the state of v. A. Health care. D. A. V. Remains concerned about allegations that v. A. Employees or management took actions to skew the picture at some v. A. Facilities. We support the Ongoing Investigation by the Inspector General and will demand full accountability for anyone found to have violated the laws or failed to follow and enforce v. A. Rules and regulations. We also support secretary shinsekis initiative to audit all v. A. Facilities to determine whether similar problems are occurring, however we strongly recommend the v. A. Include outside Third Party Experts to increase its objectivity and correct and help regain the full trust of veterans and the american people. Mr. Chairman, no Health Care System is perfect and medicine is far from an exact science, veterans have earned the right to expect the v. A. Health care system to provide high quality medical care. While it may be weeks or months before the investigations and audits are completed, we continue to have confidence that the v. A. Led by secretary shinseki can and will correct any problems identified or uncovered. This secretary has a track record of directly and honestly confronting problems and working with stakeholders to correct them. Mr. Chairman, we continue to believe that v. A. Provides high Quality Health care for the vast majority of veterans treated each year and veterans are now and will be better served in the future by a robust v. A. Health care system than any other mad ell of care. The real challenge facing v. A. And the root cause of the problems being reported today have to do with access to care rather than the quality of care delivered. For the past decade, d. A. V. And our partners and the independent budget have pointed out budget shortfalls in construction budgets. In the prior 10 v. A. Budgets, funding for medical care provided by congress was more than 5 billion less than what we recommended. For f. Y. 2015, the recommendation is 2 billion more than than v. A. Requested. You did call for an increase of 1. 6 billion for f. Y. 2015, but based on available information today, it appears your Senate Colleagues will not significantly increase the administrations inadequate request just as the house already failed to do. Similarly over the past decade funding requested by v. A. For construction and the amount appropriated by congress has been more than 9 billion less than the recommendations. For f. Y. 2015, the v. A. Budget request is 2. 5 billion less than the recommendation, which was based upon v. A. s own analysis. We agree with your views and estimates for the past two years where you stated that the Administration Budgets request for crux has been and i quote clearly insufficient to meet the identified end needs, but unfortunately Congress Took no action to increase construction funding. Finally, v. A. Needs to better utilize its purchase care authority. A. V. Believes whenever a veteran is not able to get care, v. A. Must take responsibility to find alternative means to provide and coordinate such care. However, since each dollar used to pay for nonev. A. Care that is less to hire new employees to treat veterans. V. A. Must provide accurate estimates of the additional funding required and Congress Must appropriate those dollars. Even with sufficient funding, ow will nonv. A. Care be coordinated . There qualified providers in each community. Giving a veteran a plastic card and wishing them good luck is no substitute for a fully coordinated health care. Looking at v. A. And putting it into proper perspective the entire system of health care, we continue to have confidence that veterans are well served by seeking their care by v. A. We remain confident that working with stakeholders and congress can, will and must address these challenges. American veterans deserve nothing less. Tom tarantino. On behalf of iraq and afghanistan veterans of america, i thank you for this opportunity to share our views and recommendations regarding the current state of health care with the v. A. We have been a leader working on behalf of veterans and families to ensure that v. A. Meets the needs of our community. It has been confronted with challenges and many have been overcome but still too many remain. Serious allegations of misconduct have arisen from several medical facilities indicating that records are being doctored to falsely portray wait times. Long wait times are alleged to be the result of 40 deaths while waiting for care at the phoenix medical facility and since phoenix more allegations of misconduct at other facilities from coast to coast are painting a similar picture. These nepts are not new nor are they apparently unique. It is time for new pressures of accountability and oversight. Our members are outraged and want to know that they are being addressed and personnel are being held accountable. V. A. Needs to deliver quality care in a timely manner. We expect them to comply subpoenas. Full and swift compliance will be a good first step in not only figuring out what happened in phoenix and how misconduct will be addressed and just like the secretary we are awaiting the results of the Inspector Generals investigation of alleged misconduct in phoenix but we cant sit around while the investigation is under way. Applaud the full audit of 1700 points but we expect action in weeks, not months. We support encourage concurrent investigations that are clearly independent of v. A. Veterans need to see the secretary step out in this issue and lead we want a proactive secretary. Controlling the public message is critical and if the secretary cannot do it, veterans will continue to lose faith in the v. A. System. Accountability is a fundamental preliminary necessary for any organization. Mismanaged care that such a thing is missing from all levels at v. A. Secretary shinseki has started to emerge publicly and address these allegations, but we need to be clear that shortterm reactive mers will not get rid of the problems. V. A. Has a long way to go to earn back the confidence of millions of veterans shaken by this growing controversy. Although recently exposed by whistleblowers, long wait times at v. A. Are nothing new. The g. A. O. Has conducted studies and their findings center around lack of oversight, inadequate training, in other words, weak leadership. Long wait times are one thing. They can be solved with a combination of people, time and resources. They are solveable as long as good leaders have the tools and information they need to fix it. That does not seem to be the case. Instead of leaders coming forward, they appear to be fixing the books. This is indicative of a culture of failed oversight and no accountability. Theons were highlighted and worst thing that can happen is he sense that the v. A. Is so inefficient that veterans lose faith. The right answer to this is not to cover up problems but to solve them or keep them from happening in the first place. This isnt just a matter of communication. Its a matter of lives. Estimated of 22 veterans who die by suicide, 17 have not sought the care at the v. A. It is absolutely critical that veterans who need care feel encouraged to seek it. In order to improve care, legislation such as the Suicide Prevention for American Veterans and the v. A. Management accountability act should be enacted into law immediately. Our membership and the veteran communities needs to be assured that despite these issues the v. A. Is there to serve them and any charges of misconduct will be addressed and swiftly corrected. We need to ensure we need the full scope of mismanagement and coverup. This is why we are proud to work with you to protect whistle plorse. V. A. Employees can come forward. Mr. Chairman, we appreciate the opportunity to offer our views on this critically important and urgent topic. We look forward to work with you to improve the lives of veterans and their families. Carl blake is next. Chairman sanders and Ranking Member members, on behalf of paralyzed veterans of america i thank you for the opportunity to testify on the state of the department of veteran affairs. No group of veterans understands the full scope of care provided by the v. A. Better than our members, members who have incurred a spinal chord injury. Let me begin by saying that we are deeply disappointed by the number of reports from around the country that suggest that Veterans Health care is being compromised. There are serious access problems in the v. A. I would like to associate myself to the comments made by senator isakson and senator begich. When cases are found, serious and appropriate action should be taken. If that means people have to be fired, so be it. Thats what has to happen. However, we believe that a thorough analysis to understand the depth of the situation across the system should be completed before any final decisions about the v. A. Leadership are made. At this time, p. V. A. Stands behind secretary shinseki and he is committed to fixing these problems and should be afforded the opportunity to get it right. The narrative that has been created by the media does not necessarily reflect what is happening inside the walls of the v. A. Health care system. Committee wants to gauge what is going on and how the quality of care is being delivered, i would ask you to spend a day Walking Around inside the local hospital talking to veterans and discussing their health care experiences, not sitting in front of a preselected panel of veterans to support sweeping jenlizations and to stoke public outrage. The fact is that the v. A. Health Care Services are excellent. Patient satisfaction Services Support that assertion. The primary complaint we hear all of the time from veterans is how long they had to wait to be seen for an initial appointment or to receive care. At its core, this is an access problem, not a quality of care problem. These are not the same thing. And to be clear, sending veterans outside of the v. A. To get private care is not the solution to this problem. It might be part of a solution, it is not the solution. Particularly for veterans who rely on the v. A. s specialized services. The fact is there are not Comparable Services to blinded care, amputee care and the wide weert variety of care. A snapshot of the v. A. Spinal chord system injury of care. We identified serious staffing shortages that exist, particularly on the Nurse Staffing side. The site visits that we have conducted with our medical Services Team were nearly three decades provide us unique authority to affirm those problems. Those staffing shortages severely limit access to the system while placing the delivery of health care to veterans at risk. Insufficient staffing and by extension insufficient capacity is ultimately a reflection of insufficient resources that this administration and previous administrations have requested for health care and insufficient resources that congress has ultimately provided. He independent budget has made recommendations to adequately fund v. A. Health care for 28 years. For the last several years, congress has ignored our recommendations and we are now discussing how could this have all happened. I would agree with you who indicated what the heck is going on when he looks at this and considers the budgets that have been requested. The great irony of this hearing today is the discussion about is the o. I. G. Adequately funded to do these investigations . Is the v. A. Health care system adequately funded to deliver timely quality care . I would suggest the answer to that question is no. Veterans get the absolute best health care when they need it not when it is convenient. P. V. A. Members and all veterans will not stand for anything less. I thank you again, mr. Chairman. I would be happy to answer any uestions you might have. Student veterans of america, mr. Robinson. Thank you for inviting student veterans of america to submit our testimony on the state of v. A. Health care. S the advocate for students of higher education, we are sharing our perspective with you today. I would like to address the veterans for whom we are gathered today. We have student veterans of america honor the service of your loved ones and stand with you seeking answers. Student veterans of america is a network of over 1,000 chapters on as many campuses coose all 50 states and three countries. They comprise veterans with the majority having served after 9 11. Paramount to their success is the ability to remain healthy and utilize the Health Care System provided by the department of Veterans Affairs. In this testimony, we speak on student level issues of health and wellbeing with our main focus being on higher education. As the g. I. Bill makes up a major portion of the benefits, we believe it is essential to consider education and the role it plays in the life of veterans who may be receiving health care. As a former commander in the army with service spanning three decades and current leader of a Large Organization, understand how difficult it is to be responsible for many locations and work forces. I also understand the position of older and younger veterans as i have served along side, have led and have been taught by both. Many of these friends and former leaders of mine ensure they are made abreast of the issues they face while accessing care. Some veterans are student veterans are as diverse of our nation and progressing of degrees. Likewise, our members have millions of experiences with the v. A. And other large institutions integral to their success on a daily basis. They are allowing the v. A. For their livelihood, health care and future success of themselves and their families. This support system for student veterans may be understood by looking at three levels of support which we term the three pillars. We encourage this committee to focus on these three pillars. Pillar one, institutions. Institutional support for student veterans is an important aspect of maintaining a strong pipeline of successful veteran candidates. Pillar two, individuals. Establishing an environment for the student veteran to interact with the institution and the community as a determining factor of wellbeing. Pillar three, communities. Established Network Across university offices, Academic Networks and Career Services enables the student veteran to make the transition from the campus to a fulfilling career. It is the firm belief of s. V. A. That the v. A. Has overhauled the benefits process and that the same level of production should be sought within all components of the department. Over the last five years, secretary shinseki has led the v. A. As it brought g. I. Bill processing times down. And in the at the same time, v. A. Has paid out more than 40 billion in tuition and benefits o 2. 1 million veterans and families since 9 11. We recognize the v. A. Has a long way to go. It is our sincere hope that the secretary is able to achieve the kinds of outcomes across the department that he has accomplished for student veterans with the implementation of its benefits programs. As v. A. Believes that secretary shinseki is dedicated to American Veterans more than ever. The v. A. Has seen substantial improvements over the years. While the recent allegations are disturbing indeed, we would encourage the secretary to take swift action when the facts become clear. This would demonstrate his continued commitment to veterans who utilize the v. A. System. We thank the chairman and Ranking Member and the Committee Members for your time, attention and devotion to this cause. As always, we welcome your feedback and your questions. Thank you very much. Ryan gallucci, Deputy Director of the National Legislative service, v. F. W. Thank you, mr. Chairman. I wish i didnt have to be here today, but on behalf of the 1. 2 million veterans, i thank you for the opportunity to share the v. F. W. s concerns. Simply put, v. F. W. Members are outraged that the Health Care System that i use may be doing harm to my fellow veterans. What is more frustrating, nearly a month after these allegations, we still do not have the facts. We dont know who the veterans may have died in phoenix. And veterans wait for care or paid for it out of pocket. Regardless of what comes out in phoenix, wyoming, atlanta, chicago, spokane or elsewhere, v. F. W. Knows that veterans have died while waiting. So what happened . The v. A. Tells us the situation is improving but to the veterans affected, this is not good enough. Over the last month, we see the v. A. May not be living up to its obligations to provide the best care. Veterans deserve the truth, not about wait times and investigations. The v. F. W. Has been frustrated at the situation, and we have been reticent to condemn individuals without the facts. Whistleblowers first brought problems in phoenix to the attention of v. A. And congress as early in 2010. Cnn broke the story. Why are we still waiting . The v. F. W. Told the veterans to call our help line to voice their concerns and connect with some of our Service Officers to help. While some said they were satisfied, most painted a picture of a v. A. Health care system that is overburdened and overresourced and sometimes paranoid. In North Carolina, a veteran told me he can see his primary doctor once a year and sought health care elsewhere. A small sample of the hundreds of concerns, and the outpouring of concern was alarming. What is causing this failure, lack of resources, personnel or leadership . The v. F. W. Will conduct town Hall Meetings talking to finalizes, we will invite you. Veterans and families are losing confidence in the system that is designed to support them and care for their needs. If one veteran is not receiving the care he or she needs, it is one too many. We demand answers and we want those responsible held accountable in all levels of leadership. With this in mind the v. F. W. It believes it may be time to commission a review. We hope v. A. Would not deny care, but there have to be reasons why it is so long to be delivered. The culture may be focused to fit funding at every level. If this is the case, the culture must change. Leadership at every level must have the confidence that if they have a need, they can ask for it to be addressed. We know capacity is an issue. The partners on the independent budget highlighted the need to increase budget capacity. Utilization was at 80 . 2010, 122 . 119 . That affects v. A. s ability to deliver care. When there is a lack of resources, they make tradeoffs. The v. A. Health care system was commissioned to those who bled for our nation. The stewards of this system have been entrusted with a system that cannot fail. It is failing, it is their duty to fix it and hold employees accountable ffment they are unwilling to perform the mission, it is their duty to ask for help or step aside. In addressing any failures, we must resist any suggestion that it is a fundamental failure in favor of an alternative model. It relieves v. A. Of its responsibility. Last year, the president met with John Hamilton and promised he would not leave. There was a letter sent to the president. We learned last night that the president shares the concerns of the v. F. W. We ask the president to live up to its word and congress to do the same. We cannot wait for the system to slowly improve. This demands immediate action. The mission is far too important and users of this system, we will not allow it to fail. This concludes my testimony and im happy to answer any questions that you or the committee may have. Rick weidman is the executive director for policy and Government Affairs of Vietnam Veterans of america. Thank you for the opportunity to be here today. Let me say one thing that has troubled us for a long time and that is is the lack of truthfulness on the part of some people in senior grades at v. A. , both in shading the truth and hearings on the hill, but also reporting up. And there is something that baffles all of us from the v. S. O. If i lie to our National President , im toast. Im out of here and fired and youre gone, pal. I agree with that decision. You cant run an organization and certainly not a medical organization where people do not tell the truth to their superiors, because otherwise if they dont have good information, they cant manage properly. I will say it is our firm contention that the majority of people who use v. A. Get good to excellent care. The problem has to do with access and with poor quality assurance. It is very uneven. Are not fact is there off clinicians and it is a national gouse to walter read. It is a question of too many clinical needs. And what happens, distortion in the system and breakdown of the sequencing of care and that is what was wrong with the care. Thats whats wrong with the care at v. A. There are not enough clinicians and getting people the care exactly when they need it is not happening. The question is are there enough resources and we have to say we dont know. What we have been saying for five years is when the budgets started to go up, largest increase in the Health Care Budget for v. A. Since the end of world war ii, that too many middlemiddle people where positions were being created. Congress gave that huge increase to v. A. To hire more direct service providers, more doctors, more nurse practitioners, more clinicians and counselors, et cetera. But it ended up that in some places the resources deployed. It may be there has to be a supplemental, but we would urge that the review and facility by facility review with everybody who is not directly involved inpatient care, you have to justify that position and why and how it adds to the overall enterprise of delivering quality care to veterans in a timely manner in a place where they can access it. Part of that problem with resources is we have said it ever they started using the formula, it is a civilian formula and does not take into account, what they use to estimate the amount of resources that they would need. Nd we have exposures to things but chemicals and on and on. What it means is that when at v. A. Hospitals, the average presentations are things wrong with an individual is five to seven per individual. The formula was built on a middle class p. P. O. s and h. M. O. s and they had one to three average presentations of things wrong with them. Which means that the burn rate of resources at v. A. Is much higher. Thats particularly true as old guys from vietnam age and become from re aged and uncles korea and fathers from world war ii. Presentations per individual of o. I. F. , o. E. F. Veterans is over a dozen for each individual that comes through. So the point is, we need to reprogram some money. Pass the have management accountability on this side of the hill and reprogram money and frankly go for a supplemental if that turns out that its needed. In the meantime, we would urge everybody, every hospital, something we have been urging is screened screen everybody at the hospital for the five major and v. A. Has yet to do one of these screenings on a mass basis and do it for the five major killers. Ung cancer, prostate cancer, Colorectal Cancer and Bladder Cancer and heart conditions. If you screen everybody, then you dont have the kind of situation that developed in phoenix. I thank you very much. In general, we all are aware and no one here dispute that there are Serious Problems and serious allegations, but some of you have said that the quality of care at the v. A. That your members are receiving are good to excellent. Are you agreeing. Is the quality of care, is it adequate or is it not . We know there are all exceptions out there. We would agree with your assessment, mr. Chairman. The overall quality of care after they get into the system and actually get into the hospitals and clinics are very good. Yes, mr. Chairman, our members believe the same thing, quality of care when they get in is excellent. We find their experience with the v. A. While a bit negative, their actual individual care is incredibly positive. Thats also including the use of their g. I. Bill. Mr. Blake . My comments spoke for themselves, senator. I would agree with my colleagues once the system has been accessed that quality is good. I would agree that the issue lies within access. To expand on this a little, one of the things i wanted to point out. I said i use v. A. And i was there last week. Sometimes the person you get on the other end of the phone may not understand policies or proper procedures. When i see my clinicians, they offer me topnotch care. Generally good to excellent. The problem has to do with Case Management and access to the system. Let me ask another question, and we all recognize, everybody up at your table and everybody here, that anybody who is lying in the v. A. , anybody cooking the books in the v. A. , unacceptable. There is not much debate. But i want to ask what seems to be a problem not all over the country but in many parts of the country and all of you referred to it is access. Once people get into the system, the quality of care is pretty good. The problem is access. We have heard, mr. Blake talk about the independent budget, which is the budget done by a number of veteran organizations assessing what they believe the needs of the v. A. Are. I support that budget. Bottom line is, do you believe the v. A. Needs more funding in order to deal with the access issue, make sure that people all over the country can get into the system in a timely manner . I believe it is underfunded and there should be reallocation of funds within the system. Good point. And others can speak to that. I think clearly the problem rests with a lot of the management efficiencies that the administrations have tried to put into the budget. A recent g. A. O. Report of 2012 indicated v. A. Reduced their budget by 2. 5 billion which were not realized and which are impacting the resources. So this has gone on in previous administrations and that needs to be stopped. Thats like gaming the system. The v. A. Is underfunded but throwing money at the problem doesnt help, unless you have clear lines of accountability and reform for the things that are not working. I would agree with mr. Tarantino. You cant throw money at the problem if its not done smartly. There were a lot of people hired and werent hired where the need is. Our own written testimony points out serious staffing shortages. Clearly people are not being hired there where there is a demonstrated need. You could do reallocation of resources but there is even more need for additional resources. Colleagues th two to my right that the v. A. Is underfunded but first there should be infrastructure and systemic reviews and issues addresses addressed and after that, where the funds will be allocated, they should be funded. I would agree with our independent budget partners that we support the numbers and we believe the v. A. In its current form. You guys are part of the independent budget . Yes. And i would echo the concerns about resource utilization and proper distribution of resources. In my written testimony spoke about v. A. s capacity. Construction facilities. If we dont have the space, where are these clinicians supposed to practice . We have seen that with Mental Health hiring. Where are they going to see their patients . Allocation of resources but i would associate, particularly not the Major Construction but remodeling and adding to existing facilities. You have to have a place to actually deliver the care. But it is we are underfunded and dont have enough clinicians. Thats how they game the system. They are under pressure not to admit there are not enough docs. I wanted to ask one brief question, which is important. When you deal with the public system, like the v. A. , every problem sometimes makes the front pages. There are studies that 200,000 people are dying out there in hospitals. On the other hand, the advantage of a public system is that citizens of the country and representing millions of veterans which you guys do, you have input into the process. Let me ask you this question. My understanding is that the secretary kind of meets with representatives of the organizations fairly frequently, that he wants to hear your input. Is that true . Yes, it is. We have a sitdown breakfast with him once a month to discuss the issues. I assume everybody thinks thats a sensible idea . Yes. Input from the veterans organizations, of course. Yes, our executive director meets with both the secretary and the under secretaries on a regular basis. That is not true for us. We had our first meeting with the secretary at v. A. Headquarters last week. So you have not been meeting on a regular basis . No. Our executive director meets with him on a monthly basis. Yes, we met with the secretary on a regular basis. We meet with the secretary thank you, mr. Chairman. The v. F. W. Leadership meets with the secretary and his deputies. National level. Not on progress attic things. Only place in v. A. That is sticking to the president s executive order on consultation of stakeholders before decisions are made is the under secretary for benefits, because it doesnt happen in many other areas, and if it did, the decisions would be better. I have gone way over my time. You will have equal time. Thats the prerogative of the chair. Following up on the tone of the discussion, im going to make a statement and i would like you to tell me whether you agree with the statement or not. The question before us today is not the quality of health care delivered to veterans by the v. A. , the question is access to quality of care. Would you agree with that, commander . We do agree with that, but there are pockets within it, like a skin cancer, if you get the small pockets out, the overall system will live. If you dont take care of that, the system will die. Yes. D. A. V. Agrees with that and i would like to point out a task force back in 2003 that president bush established to look at health care pointed out at that time that there was a mismatch of funding and demand and if something wasnt done about that, access was going to be affected and thats what were seeing now. We would agree with that statement. Yes, definitely access. Our concerns would be access especially in rural areas. We would agree with that, but access that can reach into care delivery, one of the concerns we received from a veteran in nevada, he was diagnosed with skin cancer. But because a doctor had left the v. A. Medical center, they wouldnt be able to schedule him for a proper consultation until that person was replaced. Which is an access problem. Yes. It reaches into quality of care. Capacity is one of the problems for access. It is primarily access and an additional thing v. A. Is not in the medical system addressing the wounds and injuries of war and taking a military history and using it in the diagnosis and treatment. The reason im taking this track, i dont want us to leave this hearing with a mixed message. If there is a problem in quality of health care, we need to talk about that. But if theres not except in isolated cases, we need to talk about what is the problem, which is capacity problem number one but it appears to be an attitude National Problem where there is a motivation to make the numbers look good than to give health care to the veteran. Anybody disagree with that statement . I think there have been concerns raised that the performance accountability system promotes Something Like that. So access is controlled in order to make performance look better. And capacity is a function of appropriations, i understand that. But its also a function of the management of the system internally within the v. A. I dont ever recall, and i could be wrong, mr. Chairman, us receiving a report from the Veterans Administration on any study its done to improve its access to capacity or improve capacity so we improve access. We have talked about time to get a determination on a disability or how long it takes to get into a v. A. Center when it seems like we ought to have a thorough, thorough examination of the capacity situation in terms of the v. A. , and then you have to look at the issues you addressed, mr. Blake. I know you are not for any private delivery of service. You want veterans hospitals to operate. But the option of having that access could help solve the capacity problem, particularly on a specialty like determine tolling, melanoma. So is that an idea that is not replacing the v. A. Health care system but having veterans having options to access in the private Health Care System . I think veterans have even now and they are improving on it. Pccc is an example. If we are going to move in that direction, there needs to be coordinated care. That doesnt work for veterans with specialized care needs like blinded care or amputation because those types of services dont really exist in the private sector at least not in the way our members come to expect it. Privatized where care plays a role or contract for services plays a role. One thing i would suggest that, is that what veterans want . Veterans want into the v. A. So why would we create an option where they would go somewhere else . They want into the v. A. , they cant get into the v. A. We are not sure that allowing them to go outside is addressing what their immediate desire is. Except wants and needs are two Different Things and the need is the most important and if it gets them the service they need in a timely fashion even though it may not be in a v. A. Hospital because of the particular problem, better than having them wait so long and have a lifethreatening situation come about. I agree with that. All of your testimony was outstanding. I appreciate it. And im going to leave this hearing with a clear message for the veterans of georgia, we need to solve the access and scheduling problems and we need to do it now and we need the v. A. Needs to go internally and have accountability mechanism all the way down because i think the Senior Leadership is disserving the american veteran. We know what the needs are and i hope we will take this hearing and move forward and solve this problem and hold everyone accountable accountable and have an attitude of solving problems rather than masking problems. Senator begich. Im going to follow up on the senators questions. We have had a similar problem and i thank many of you because you had concerns about what im about to talk about, but you were good in helping figuring this out. We have a large american native population in alaska. We have an indian Health Care System which was not very, very good. In alaska, the tribes took it over. And now deliver, we consider the best health care in this country, in my opinion and i think in many others opinions. C. M. S. Has had some of the best health care in the country and because we dont have a veterans hospital, we are trying to figure out a system to create better care, access is what its about. If you are living in nome, alaska and come into anchorage into the clinics, you could spend lots of money. We have 800 veterans in nome, squea that are native and nonnative and built a new facility for Indian Health services. It is given the check to the Tribal Consortium that then delivers health care because of the work you did with our office, we now have access to veterans. They have a choice. Can get the health care in their home or village and tell you story after story that has become very valuable or go to the clinic or go to seattle to the hospital. There was an access issue. Because the care that the v. A. Offers, we have great professionals. They work hard. I think they are overworked for the amount of time they have and not enough staffing. But the issue was we found a solution protecting the importance of v. A. Health care, which is veterans want to be part of the v. A. Health care system. They earned it and fought for it, its a benefit of theirs. But in alaska, we had an access issue. We couldnt afford to have a veteran waiting to catch the next plane when there is a hospital next door. We figured this out. And we have a model, which when you walk into the Indian Health care service, the odds of you getting a sameday appointment is 75 or better. And the question you brought up the amount of ailments is different than the model. The model, same situation, problem, too many ailments, one individual. When you come in, seen by a health provider, doctor, dentist, they meet with you as a team and resolve issues collectively rather than individually and the care and quality is superb. We have been pushing on the v. A. To look at the model. And also sameday access to be able to schedule a routine appointment and to wait weeks or months is outrageous. And so, maybe im its more i know many of you i point carl out because he and i had good gates on this. Veterans call me and tell me thank you, not that they are not going to go to the v. A. , they are going to go to the v. A. They have a choice. So i guess i would like you have heard my comments, i would hearing your in comments. The model is all about access. Any comments from folks . Senator, thanks for that question because it happens i was in alaska last month and they they want to expand what they are doing in that area and in a strip mall. But they also are looking for additional space. And v. A. Spent three years trying to get a lease worked up and they are frustrated. They want to do additional things. But i agree with your assessment as far as accessibility. East coast is different. As i travel to the western states, i think it is something we should build upon. It has a brand new hospital that will partner, which is unbelievable care. Any other comments on that . I know my times almost up. The only thing i would like to say, right now we have 27 points of access that are on hold because we cant get the funding and thats important that we move forward on that. Going back to the Clinton Administration when they put a lot of construction on hold to determine where they wanted to build, v. A. Has been underfunded in Construction Since the Clinton Administration. So we need to do something about that also. More moran. I appreciate you being here. Let me raise a topic about the assessment thats going on, facetoface review across our country. One of my Congressional Colleagues had a conversation with v. A. Personnel in jackson, mississippi after the assessment presumably took place and this is a bit of a paraphrase of his or her report back from what they heard about this assessment. We asked about their facetoface review. The team came in on monday and interviewed some clerks and superviseors and didnt find any evidence of scheduling issues. No veterans were interviewed. What struck this person was the this nt superficiality of socalled audit. It did not come through the electronic reports and is not indicative of a thorough review. We are going to have one more review that is to be completed within two weeks, with 1700 facilities across the country. So in part my concern is the quality of the review. It appears to me this is more of damage control to what people do when there are allegations of mismanagement, improper conduct, you have another review. And so my concern is how credible will the review be based upon the amount of time and resources thats being devoted to itment but perhaps more troubling to me is how many more reports, allegations, i. G. , g. A. O. , congressional hearings do we have to have before there is a different approach or attitude at the v. A. To solve the problem . And so i guess i dont disagree with an audit across the country, but what is this really going to accomplish . Will we be here six months from now which the v. A. Has a plan in place to transform itself so the access issues that you all described are not the same ones that we heard today, we heard last week, we heard last month, we heard last year . The phoenix situation seems to have brought National Attention to this problem, but i cant imagine that there is anyone at the table who believes that the phoenix situation is really what is the problem. Its a symptom of a much broader problem that has been ignored for a long time. Let mander, and here, me add this, i understand that the testimony of the secretary this morning in response to the senator from North Carolina in which he outlined, he, the senator, outlined a long list of audits and reviews, g. A. O. Reports, Inspector General audits and the secretary indicated that he was unaware of those audits and reports and hadnt and therefore hadnt been used in any conclusions that i assume would be made at the v. A. There was an i. G. Report included in that list that said the unexpected death report could be avoided if the v. A. Focused on its core mission to deliver Quality Health care. It is difficult to implement v. H. A. Directives when there are no standard descriptions or organizational structures. The i. G. Believes its time to review the organizational structure and business rules of v. H. A. How can that be an i. G. Report that a secretary of Veterans Affairs would be unaware of . Its directly related to the management, organization of the department of Veterans Affairs. If there is one in here in my commentary and what is what assurance do you have that when this facetoface review is done that something will be different in the direction that the v. A. Is taking in regard to creating Higher Quality of care for veterans and making certain that they have access . Commander. Senator, thats quite a task. With the i. G. Audit, yes. In the findings, once they come out, i think this committee needs to establish a along with v. A. , milestones so as to rectify these issues as they go through. But as you noted in your report, each hospital is different. And even when a director changes, a hospital doing excellent, then could possibly slip below the standard. So its going to be an ongoing challenge and we would hope that the secretary and the v. A. Would move forward as soon as possible with the changes necessary to give us the Quality Health care that all veterans deserve. My time is soon to expire. I dont know if the chairman is allowing you to answer my question. You have indicated that you have or senior staff have ongoing conversations with the secretary or high level individuals at the department ofsecretary or highl individuals at the department of Veterans Affairs. The question i would ask, does that result in a change in approach style management attitude at the v. A. That results in Higher Quality care for our veterans. Iq for the opportunity to issue a statement and to ask the question. Thank you. Panel forthank the their testimony, their vision. Ive and their i want to thank you for staying for this part of the hearing and express my apologies. I got tied up in a committee. I will followup with you in private. It is good to be asking questions about this. We agree access is the issue. It is the issu