Transcripts For CSPAN Veterans Affairs Hospital Delays 20140518

Of their inalennable aalienable right to get 30rate mortgage. Think feelings like that are zapping some of the current momentum. Anymore. O crisis wondering about the begin is the major constituencies agency,ederal finance wall street, the banking industry, fair housing advocates are there others that i accompliced . Homeowners. Basically, the federal Housing Finance agency is a very agency. Mel watt is very powerful because he doesnt answer to a board or commission or the president. Hes an independent regulator. The policies that he sets governing the mortgages that and freddie mac affect about 2 3 of american mortgages. Thats how many mortgages are freddieby fannie and now in the market. So if he puts in place a policy that might change Mortgage Rates or might mean you cant get a bigger or smaller loan, thats going to affect people who are to buy a house. Its difficult for the public to react to his speech. Other constituencies have voices. How good they react to the things he laid out this week . Think people were generally impressed with the thoughtfulness of the speech. Were areas as he said today, he didnt go into. Beenme people may have disappointed by that people have hopes that hes going to do more to help particularly on the left to help troubled borrowers. I think the interesting question congress cant get to an answer which increasingly wont whilehey barack obama is president youre looking at over the next two Years Congress isnt going do anything. These companies are out there. They have employees theres a of uncertainty there. Tot is mel watt going to do end the conservatorship . And freddie in a position for whatever comes next . He made clear he doesnt feel he should substitute his judgment if theyre not going decide. But at some point this gets harder to run. These are company thats dont capital. So i think the big question here view his mandate to run this conservatorship especially in the absence of being able to decide on that longterm question. And for now hes made it very he only wants to talk about what these companies can to stabilize a Housing Market thats a little bit fragile. But a couple of years out if these companies are still in limbo, he may need to be talking their future and making decisions about whether to them and how theyre going to proceed. The last question. Say thatecifically without changing the construct, footprint reduce the was private capital into the Housing Marketplace. He did set up a framework that that . Encourage fannie and freddie have done theyre kind of wonky in thesertgage world but mortgage derivative sales where aret now fannie and freddie mortgage guarantors. They dont make mortgages. They buy loans them sell them ofk to investors in the form securities. They provide guarantees to those investors if borrowers default. A deep andeated liquid market for mortgages in the country. But fannie and freddie take all the credit risk on those loans right now. So they have begun to sell those mortgages, really derivatives, that where do notand fled did i guarantee the risk. You can see the Companies Wind up those sales so that private standing ahead of fannie and freddie. Thats probably the most significant way in which were at reducing the taxpayer footprint here. Thats it for our time. Your you very much for questions for director watt this week. Thank you. Thank you. This past week glenn guest on was a washington journal. He talked about his latest book thet edward snowedden and disclosure of n. S. A. Surveillance. Watch the interview today 2 00 eastern on cspan. Can now take cspan with you wherever you go with our radio app for your smartphone or tab let. Listen to all three cspan tv channels, cspan radio, anytime. Theres a schedule of each of tune inorks so you can when you want. Play pod casts of recent shows programs liketure afterwards, communicators, q a. Whereveran with you you go. Download your free app online android orhone, blackberry. Next, Veterans Affairs secretary Eric Shinseki senateing before the Veterans Affairs committee about the level of fair being provided to veterans at v. A. Facilities around the country. The issues addressed, the recent allegations of misconduct whereasenix va center many as 40 veterans may have died while waiting for treatment. Joined byshinseki was Veterans Affairs undersecretary whohealth dr. Robert petsel redesigned a day after this resigned from the va a day after this hearing. Thank you all for coming. Thank you all for coming. I want to thank our panelists is going to be a very important hearing. , the rankingr 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. Veterans deserve to have full faith in their v. A. Ch 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 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 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. Mr. 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 we have enrolled 2 million more veterans into v. A. Health care. I think there is a net here, 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. We also acknowledged that we had not done very well by veterans of previous conflicts. So, even as we committed to and 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 automation tool how did we used to do 2008 benefits . On paper. We have 11,000 people who process claims. I want to pick up on some points i think are legitimate made by democrats and republicans. When you treat 230,000 people a day, mistakes are going to be made. Criticism thator i hear from other senators. This is not new news. These concerns did not arise yesterday. Reports on numerous occasions about problems having to do with scheduling and with waiting lists. Could you address how it could happen that year after year these reports were made and have not been acted upon . Is important to look at the reports. They give us some sense of where we could be doing better. We get in there and we address those issues. We take corrective action. We close out the report. It does not mean that we solve every issue. It means that we have taken care of addressing those issues. There may be another set of issues to deal with. I do understand senator murrays suggestion. Hearing is that Everybody Knows problems will arise tomorrow. That is not the criticism. The criticism is that year after year reports are made talking about these problems and the problems continue to exist. Can you give us some assurance of what happens tomorrow . Audit iss what the intended to do. Evidence that 40 veterans may have perished awaiting scheduling. We are going to get to the bottom of that. Senatorso address the broader questions. Not wait for the igs outcomes. Coming forward and saying i think there is an issue here. I encourage that. That is what we are after here. There were performance issues in stopast. We want to put a to them. Are peoplejudgment cooking the books . Is that a problem . Aware other than a number of isolated cases where there is evidence of that. We have structured this audit so that a set of clinicians are not going to inspect their own areas. We have offset them. We will get a comprehensive look. My time has long expired. Thank you, mr. Chairman. These questions are for you and i will go as quickly as i cam can. That the office conduct an investigation . Since then the media has reported about mr. Freemans in 2013 that explains how to game the system were you i of this question mark became aware of that screenshot of an employee who was suggesting there were ways to game it. I put that employee on administrative leave. That was last friday. 21, 2013, there was chronic understaffing issues at the jackson v. A. Medical center. Schedulinged many scheduling patients for a clinic does not have providers. These are called ghost clinics. Counselce of special submitted a letter to the president of the United States on which the v. A. Was courtesy copy it. Including the practice of double booking patients and the use of ghost clinics. The you remember reading that report . And resaving that . There was a report by the office of the medical inspector regarding the Cheyenne Medical center in cheyenne. The Business Training including teaching them to make a desired date the actual appointment and if they needed to change they. Ould change it within 14 days did you read the report . That is come to my attention. On february 25, your chief of staff submitted a response. 23s included the december office of the medical inspector report. I was not provided any specific veterans cases affected by these practices. Failure toave the properly train staff. Were you aware of what your chief of staff wrote . I was. Of the report . Re january 2013. D in your former chief of staff sent a letter to the gao that stated the v. A. Generally agrees with. He conclusions and concurs dear member that letter . I do. You knew that there were specific issues relating to scheduling and wait times. Which brings us to today. You publicly stated that you had removed the medical director. You stated then that that was to ensure the integrity of the investigation. Cally 5, a conference happened with a large group. They discussed the audits of the a centers the a centers. Thatetzel made the station the removal was political. She has done nothing wrong. If youre asking us to wait until the investigation is over, doesnt the same apply to people who work for you . From all i have described to you, and the current investigation going on, why should this committee believe that change is going to happen as result of what we are going through . Aware of the phone call you referred to. I will look into it. Removal of the director and placing her on administrative leave was at the request of the ig. Lead in this comprehensive review. I dont get out ahead of them. Put threeed it and i people on administered leave. Thank you, mr. Chairman. Senator murray. Announcement,n my the president is sending one of his top advisers to assist. This is good news. I am sure he will help make this review conference of inaccurate. It is critical to this review is effective because of this committee, i asked the v. A. Director of metal Health Operations whether facilities were gaming the system and not flowing recording wait times. She told me she was unaware of any facilities doing that. They were doing audits to make sure it was not happening. The oversight organizations have reported on it for years. Department has been unable to provide me with the most basic information on how this review is going to be conducted or what it will look like. I hope that is about to change. I want you to explain how this review is going to be conducted. Call and dr. Petzel to give you details. Thank you. There will be several phases to what we do. Auditing in are person teams. Next week, we are going to work our way down to all of the other sites of care. We are gathering information. The anonymous nature of the questionnaire is important. Might have felt forced that were inappropriate and lacking trust and integrity in the scheduling. The second part of this is an assessment as a number of people of mentioned. Resources applaud spent a pergola. Whether or not we are using those resources in the best way and each of our sites. Everybody needs to remember that we do 85,000 85 million outpatient visits every year. 95 of those visits are with a established patients. Those are all accomplished. Details of how this is going to occur so we get good information. We will focus on the new patient and the scheduling and all thewe have other Access Points besides our clinics. The first is the review. I dont want to use all my time. We want to know the real change occurs. I only have a minute and a half left. I was told in 2012 that gaming is so prevalent that as soon as new directives are put out, they are torn apart to find how to get around the requirements. A Mental Health employee said the exact same thing. At that same. Hearing, if we have seen scheduling practices that result needming the system, they a culture change. To get that culture change i think they need to hold the facility directors accountable for how well the data is actually being captured. That was two years ago. The standard practices of the v. A. Seem to be the to hide the truth in order to look good. That has to team once and for all. I want to know how youre going to get your medical directors to tell you whether it is through this survey or in the future when they have a problem and will work with you to address it rather than pursuing these secret lists and playing games with the wait times. It makes me angry that we have people because they cant be truthful because the system does not allow. Trust is an important aspect of everything we do. It has been in my previous life as well. We have to hold people accountable. To you is we are going to get in the this. It is important for me and for veterans to regain their trust. When they come to the v. A. They come to a good safe carrying assist him. They will be cared for. For all the employees listening in, i expect our employees to provide the highest quality care and the safest care we can provide. We want to provide access to benefit as quickly as we can. We only have one mission. We are taking care of these veterans. I am one of them. 100,000 of our employees are veterans. We have a vested interest to get this right. Not work ifew will those people who are telling you the information do not tell you the truth. I agree. Senator isaacson. For both of you gentlemen, dear member do you remember . Of april, he sent out a memo to all of the Division Directors in the v. A. Begins, it is come to my attention that to improve scores certain facilities have adopted the use of inappropriate scheduling practices. The whole paragraph because this is the key to the question. There is an eight page attachment to this. This is a listing of the inappropriate scheduling practices identified by working groups chartered by the system redesign office. Since 2008, additional new or modified any strategies may have emerged. Do not consider this a full description of current possibilities of inappropriate scheduling practices. These practices will not be tolerated. Are you from there with that . Not. Am i am familiar with it. If it is not going to the tolerated and you have eight pages of known practices, what action did the v. A. Due to respond to this memorandum . Hard to rootvery of these inappropriate uses the scheduling system and these abuses. We have been looking continuously to identify where those sites are and what we need to do to prevent them from happening. It is inexcusable. The schedulers responsibility is to be sure that that program is administered with integrity. What do you do to help them accountable . The individuals are held accountable. I cant give you an example specifically. If someone were found to be manipulating and appropriately the scheduling system they would be disciplined. Would they lose their job . I dont know if that is the appropriate level of punishment or not. We can give you a better answer to this. 2012, can tell you as in we involuntarily moved 3000 employees for poor performance or misconduct. Employeesnother 3000 were involuntarily removed. There were some Senior Executives as well. Are they reassigned within the v. A. . Some maybe reassigned. Others were departures. Some by retirement and others by being let loose and let go by the a. Memorandum. Ad this 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 how it is done for improving scores on access measures. Theirs the way in which performance is evaluating as an employee. Is that correct . Im going to take your direction. I would assume. If the redesign office had a multidivision working group, do you know what the redesign offices . Yes. For is a group as possible ensuring that we are designing the work within our Clinics Operations in the most active and inefficient efficient way. They were given a responsibility for monitoring access. It says you had a group within the Veterans Administration that identified in 2010 numerous practices were numbers are being manipulated for the purposes of Better Outcomes in terms of how those people would be rated. It seems to me that shouldve been a systematic practice with the chain of command would see to it that was not tolerated as the memo says. I absolutely agree with you. We did institute that appropriate level of accountability. I will find out. I do not know if anybody was specifically disciplined about met issue. This is been a very difficult issue an important issue to us. We have tried to root out those places where the scheduling system was being used inappropriately. I know my time is up. For the sake of the integrity of Veterans Administration, you need to find out if there is an accountability system to respond to this memorandum. I would like to ask consent to submit this for the record. Without objection. Senator blumenthal. Thank you to you and the veterans who are here and listening for their interest and involvement. Can you tell me how quickly we tol have preliminary results these investigations . The Inspector General has his own timetable. Know insights into what that is. Audit, we are taking care of most of the large facilities this week. There will be some followup next week. We have been able to assemble all of the data and do a good analysis. In three weeks will you have a report for us . I think we should be able to do that. That is per limoneira right now. I dont know what data is being assembled right now. We will shoot for three weeks. I apologize for interrupting. Our time is limited. Responsibility, dont you believe there is a responsibility to complete this report as quickly as possible . I agree. It would be helpful for the ig to complete his report as quickly as possible. Can you give the ig a deadline . I am not able to do that. It is an independent reviewer. Once i turn this over to him, i am supporting him very of let me raise the elephant in the room. Is there evidence here of criminal wrongdoing that is falsifying records to the federal government . That is a crime. The appropriate to ask from the fbi help . The igs resources are so limited. The task is so challenging. The need for results is so powerful. Ig toill work with the make that available to him if that is his request. Respectfullyest that it is your responsibility to make that judgment about the and without rushing to judgment or reaching any conclusions to involve appropriate criminal investigative agencies if there is evidence of criminality. In my judgment, there is more than sufficient reason to involve other investigative agencies in light of the evidence. 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 here. There is a need for Greater Transparency and accountability. But mass my next question. Discussionad this repeatedly with the ig to make sure. Every discussion about having enough resources is based on what is underway. Each New Discovery as to that workload. I will have the discussion with him again. Will you change your Management Team given that the shows systematic failings over a. Of of years and not just months. I dont want to get ahead of myself or the ig. I want to see the results. I would assume the results of the audit. If changes are required, i will take those options. If 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 waiting for the results of the audit. Thank you very much, mr. Chairman. Senator heller. I pointed out in my statement about the ig investigation about the treatment of a blind female veteran. Have you had an opportunity to see the results of that investigation . I have had an opportunity to review that investigation. What was the conclusion . Detailsut revealing about the individual, she did way too long. There were others that waited too long. An impact on the course of her illness. It was inappropriate that a blind a veteran should have to wait that long in our emergency room. Mark you agree, question at of thing any veteran should have to wait that long. The the case at any of our facilities. Have you heard complaints about weight times . I am not aware of another facility in nevada. I am not aware of it either. I dont know the results of our vegas to reno or the las hospital. Will they have facetoface audits westmark . Yes they will. Where the be more thorough audits later with the ig . If we find that there were instances where there might have been inappropriate criminal activity we will join the ig. That is difficult to protect him what we find. Are you talking about continuing series of audits . Based on what we find if there is wide spread issues, we will set up a program of sustaining looks to make sure that we have the behaviors we are talking about. After conducting those investigations will you make that available to me and my staff . Yes. Back, the waiting room and the time awaits the we are seeing across the country and in claimsand the disability backlog so we are seeing than what it should be, do you believe that the youre ultimately responsible for all this. I am. We had this discussion yesterday. With dataprovide you that is more accurate. That may have been true at one time. I am told that those numbers are down. Todays numbers are 355 days. That is still three times longer. Would you explain to me why you should not resign . I came here to make things better for veterans. That was my appointment by the president. Everyday i start out with the caret to provide as much and benefits of the people i want to war with and the people that spent a good portion of my life with. This is not a job. That i thinkion they critically is irv and need. I can tell you over the past five years we have done a lot to make rings better. Were not done yet. I intend to continue this mission until i am satisfied. Thank you for being here today. Thank you. Mr. Griffin states that the v. A. s core mission is to provide Quality Health care. Is that still the core mission . Have the goals shifted over time as they have expanded into providing other benefits to veterans is where . Added congress has Housing Assistance and job training. Share those thoughts on the core mission now. Tasksll of these other are you ablehave, to focus on your core mission . This is a core mission. It are provide that kind of health care, they still have to access the system. That means we have to do a good job of dealing with disability claims. If when it able to process those , it is automatic that they have five years of health care from the a. Generation is different than others. Claims becomes an issue here. Opportunity. The homelessness is part of our responsibility. Five years ago we talked about homelessness as though it were a thing out there. Depression is a major factor that leads to homelessness. Pain, substance abuse. My time is rapidly expiring. Areas, whether that is making it much more difficult for you to meet your core mission. Let me move on to another area. As you look at the needs for making systemic changes to all theway the v. A. Operates, ig says there is no National Process to establish essential positions to the delivery of health care. Theres nor standard organizational chart for va hospitals and clinics. It is difficult to determine what is better than others. Are these potentially systemic changes that we should be looking at making to the v. A. . I think that is good insight. We will take a look at that. Part of our challenge is the complexity of the v. A. System. We have a series of hospitals that go from the most sophisticated kind of health transplants,n brain surgery. E call them it is a comic system. Inndardizing the definitions that framework would be helpful and sensible. Thank you mr. Chairman. I hope this is the first of many hearings. As you know, i occupied a cabinet post for part of my career. Posts that are a lightning rod. If youre going to be the attorney general or the secretary of state, youre going to get fired at every day. It is just part of the job description. Hand doesn the other not fit into that category. It is a pretty nonpartisan committee. We dont talk about republican and democrat stuff. We talk about how we improve the lives of veterans. It i have always a plot of that. I think we need more of that an. 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