Transcripts For CSPAN Washington This Week 20140920

Continuing to review the document and make sure that weve got it correct. The fact that it went to the Department Without the statement its a process until the last day that we sign a final report. It came up in the reason you dont put draft report out because they are subject to interpretation and they are not final and shortly after the draft came up here it was reported in the press but heres proof that somebody in the va changed it. That is not proof that just means you dont understand the process and i can show six days before the initial draft is released we were having discussions internally that if we dont declare that delay was the cause of death, we need to say so. It took a couple more drafts before it was concluded that on may 14 in the hearing where the original 17 names that we received came up i was asked if we had a chance to review those. It doesnt demonstrate the causality in a persons death. That is three and a half months before this final report. So there should have been no taking that it doesnt demonstrate the causality and i think the last statement for the record that i would hope everybody would read is that as doctor day already referred to bears that out. They have to write an acceptable response to convince us that they got it and they were going to fix it. We have made a commitment to the congress to publish that report in august. We had to cut off some work in order to be about the business of writing the report and that is why theyve gotten 3526 urology patients that would be the subject of the future review i was able to read in detail each one but it does seem to me evidence of poor care. Is it possible that those families are being notified of what happened. Those family members can pursue litigation and the va could be found culpable is that right . Thats correct. Those patients called by the auditors and healthcare inspectors so they were on the list and couldnt get an appointment timely. Some of the cases from the list were part of what we were looking at. Our methodology section laid that out. These are the 28 cases that we identify. To know why someone died is very difficult. So when you get down to an individual who commits suicide on a certain day after a certain event. The event wouldnt have occurred and in the world that feature to be able to prove we have a hard time going there. So the second group of patients that we report on. Its also important to understand that the charge is to respond to the congress, congress, to the secretary got to the under secretary of health and comments to them on the quality of medical care that is provided. So what i usually do is we look at an issue and the issues are all different and the question of this one was there a direct relationship between disappointment and got. Once we determined that there was in fact agents that have poor quality of care, we then always switch to the systemic issues that we can address. When you go to the issue of exactly who committed the va or the patient or the other hospital down the street or the nursing home what exactly do they contribute to this event or to this poor outcome that is a matter for the courts. The veterans were injured or harms and work with the va as partners to try to get this fixed. There may have been tampering of the software its different from the real numbers of waiting. How is it that the appointments could be overridden to zero out the previous employment come and do you believe that the audit controls were deliberately disabled . Yes i think there was one of two methodologies used. They show that it was there was a small number and not correct and they had a second list where they disabled the reporting function and went into the reporting software so that it would end give an accurate number of say over 200. The data shows from the inception of the list it never gives the right number. At the time is broke and out and it was 55 days. The wait was six months to get through to the 3,500. At the wait the wait was somewhere between one and a half to two years. We know they are taking a look into it and hopefully they will be able to find the forensic evidence to support that claim. A question for mr. Griffith. The language that was included in the final report regarding the come close that case of death has no relation at all to any measure of medicine. As a matter of common sense the va doesnt schedule appointments early enough to carry a disease that is highly likely that it is a potentially fatal condition that would suffer from the conditions. Does that make sense to you and do you agree with that statement . If your care is delayed comment you are very likely going to be harmed. When we started this review it seemed that with what we would find over and over again and we looked at these cases and we didnt find that so we said why didnt we find that and i think there are two of the cases in here where in fact they could say they saved a life, found a patient and a waiting list who had diabetes and critical heart care and intervened to make sure that they lived. Its also clear that the veterans have access to other sources of care beyond the va. So much nurture respect thinking about the question i think that people must have been extremely diligent where they knew the trains to and from time to try to make sure that horrible people that care. Does this apply when the report reported that veterans die while waiting for care in South Carolina and georgia . The poor quality of care was divided. Can you answer the question was the same measure applied when they died while waiting for care in South Carolina or georgia what is your answer to that . It is usually a fact pattern on exactly what happened. Im not sure exactly what report you are referring to. But usually it is a different fact pattern if we determine the quality was provided then we try to look at the system and try to get the va to do the right thing which is effective quality of care. So the report that you were discussing in the delay because of delay it colonoscopy. The same applies to you to in the columbia case in the report. In colombia they found that they have delay the colonoscopy is in a Large Population of veterans and as a result as you would expect a large number of veterans developed colon cancer that probably would have been prevented had the colonoscopy being done. The va had already taken the process to notify. Why did this happen, how is this possible and what we determined is that the va doesnt have a way to ensure that nurses and clinics if that job is critical to the clinic, refilling that position is given to the hospital where administrators decide whether or not they are going to fill the nurse position or teaching position or research position. The fact patterns were quite different. Thank you. I apologize we have had a rollcall and i would like you to have an opportunity to ask questions before we recess to go to the vote. Thank you mr. Chairman. Like its been mentioned before i am eagerly awaiting the results of the investigation that the other facilities in Southern Nevada is home to the newest va hospital many people think it is the best they have the largest medical system and im getting asked by a member of my constituents are the same number is happening here in phoenix because once you hear Something Like that and of course it makes you worry and begin to think that there are problems. Ive talked to isabel once a week to be reassured that they arent but still i just want to encourage you to finish up because not only do we not want to solve any problems you might find that i think that is a big problem of restoring trust is to get that done and move on with it. Also, you put forth the 24 recommendations and as i look at them i think there are enough and that relates specifically to phoenix, but the rest of them look at the systemic problem. Youve given those to the va. This is a big dose, a large order that you are calling for. Are you confident that the va has the facilities and the means and the intent and the ability to carry out those recommendations and solve these problems so this does not happen again . It would be the first to admit that they need additional clinical space. They need additional clinicians and a new scheduling process. They need a methodology by which they can remotely monitor what the wait times are in las vegas or any other place in the country where they have a medical center. I think they are aware of all these things and the new secretary and his team that he is assembling our dead serious about addressing those things. We do follow up on the recommendations and we have suspended states when things are supposed to be completed and we certainly follow very aggressively on these 24 recommendations and we had internal discussions about how we might scope a future project to go out and verify that everything is working according to plan. We follow up on those on a quarterly basis. I share your enthusiasm for the new secretary and i believe he is committed to the changing the attitude of the va and making these specific reforms. Do you think the bill that bill that we just passed, the compromise bill will be useful in addressing some of these 24 recommendations . Im not totally reversed on the bill. Thereve been a number of of what is later changes to assist the department in accomplishing their mission but i would like to take that for the record if i may. [no audio] the committee would like weve made an agreement that we would like to not entered into the record until weve had an opportunity to look at any other information that may need to be redacted. Yount mind sharing it with so that we are not putting something into the record that personallyse identifiable information or illnesses or diseases or anything of that nature. Thats fine. If reductions you see were done by our privacy officer to make sure that we do not have any names and their names in their. Because we havent had a chance to look at it, we agreed to thepartisan fashion reductions. You brought up an interesting point. A process and a civil process if in fact causation is found because of deaths as a result of the way times. Is it your understanding that there is now currently an ongoing criminal investigation by the Arizona Attorney general, the fbi and the department of justice . There is an ongoing criminal investigation. It involves the criminal investigators from the igs office, the fbi, the u. S. Attorneys office in phoenix. So, there is a process and case causation is found. Criminal behavior is determined through a quick are you aware of any cases that have followed filed under the claims act as a result of deaths because of wait times . Guest im not aware of any. That doesnt mean that there might not have been won. We checked on the 45 case reviews and we did not find any filed. Thank you. I want to thank you for being here and for coming forward. Ive expressed in the past that i appreciate your courage because all of us on this committee are united. That veterans get the medical care and access to that care that they really care about. Thats why i introduced the whistleblower protection act. I wish that had been in place for you. Hopefully that will make things better for future whistleblowers. Part of that act is a National Hotline that patients and workers within the ba system can call ava system can call. V. A. System can call. This committee is committed to access to care for our veterans. As you know, there was a bipartisan, Bicameral Conference Committee that was appointed in the summer. We met together and we passed the veterans access choice and accountability act of 2014. One of the primary pieces of t is the new toys card choice cards that will allow veterans to schedule an appointment to actually go to a local provider. I was concerned when you said you did not know of some of these people on the waitlist new that they had a choice to go to an outside provider. Do you think the use of a choice card which is going to go out in november to our veterans, giving them that option will help improve that . Option ofd the walking into ava Primary Care Clinic to get care. At this point, if you were not enrolled in the ba, the ba would not pay for their care anywhere else. The idea of getting care access is wonderful. Earlier wassaid that while these veterans said had a choice, they dont have a choice. Many americans dont have insurance. If they get sick, they opted not to go to a position. I dont know about other members here, but i would be have i would have a hard time paying for a visit. They kept going to the er because that was the only way to get there severely worsening symptoms taken care of. Onlye equivalent of putting up the fire, but never doing anything to prevent the fire starting. With thepe is that choice card, that will make a difference. Veterans in my area who are 40 miles away from the facility. Have 12 native american tribes. They will be able to go to their local Health Services facility to get their veterans care. A huge piece of reform was encouraging a partnership between the v. A. And the inhouse services. I thank you for your testimony in helping to guide this committee to do meaningful reform and we will keep an eye on it. Thank you very much. Mr. Kaufman. I can provide the ig emails. They will be reviewed by our privacy officer to make sure that no ones identity is left in their that shouldnt be. , the you are aware department of justice has already declined to prosecute 17 cases of possible criminal violations by ba employees v. A. Employees. The are some of the Reasons Department of justice has provided for not wanting to prosecute . Some of the reasons include that it was not determined that criminal behavior occurred. , they had the cases more rigorous prosecute of standards for the cases that would rise to the level of getting prosecution as opposed to administrative action. Fact thatem, the someone manipulated the data, but there wasnt proof of a death as a result caused them not to prosecute. Some of them said this has been a systemic problem in the department for a number of years that has been allowed to perpetuate itself. Thatbility to demonstrate someone knowingly and willingly committed a criminal offense was too difficult. Thatre you surprised at response . I think that we work with these prosecutors everyday last year, we arrested over 500 individuals. We arrested 94 employees last year. That they cant prosecute every case that they get. Frankly, our investigators would like every case that they investigate to be prosecuted. But thats not the real world. Based on the demands on the department of justice and the court system determinations are made by the department of justice in that respect. We have to live with them. Passed an amendment on an appropriations bill to put more money into the line item for the department of justice for the specific purpose of prosecuting these cases. Dont you think, oh when you maybe the systemic fact that it was a cultural of corruption, maybe its ok. Somebody does something manipulates records for the purpose of financial gain, isnt that a criminal offense . Shouldnt there be an example set by somebody being prosecuted somewhere in the system . I agree. Im not saying that there wont be, either. There havent been any at this point. You would expect that the cases with the least amount of evidence and the least amount of manipulation, if you will, or coconspiracy would be the ones set aside earliest because the additional cases will require more work. We are working feverishly on those cases because we know its important to get through all 93 of them. As we finish them, if there will criminalssed prosecution, i know that apartment is anxious to get this report so they can take appropriate administered of action. Tell me, are you surprised there were not promote prosecutions . Not at this point. The fbi still investigating. There is still retaliation against whistleblowers. There would be no reason to prosecute. It does seem like the department of justice is looking the other way. Because the situation is embarrassing to the administration. Thank you. I want to thank all of you for your work towards veterans. The situation in phoenix and elsewhere that provided even one metric of substandard care is unacceptable. I know someone heavily on the ig to provide another set of eyes and provide that unvarnished view of what was going on. Lets be very clear. Whats being implied is that the integrity of this office was influenced by the ba by the v. A. Did anybody ask you to change the report to make them look better . No. Is a normal Standard Operating Procedure form of the draft reports to be done . It is. A report of 170 pages with 24 recommendations. A case beforeeen where your methodology has been questioned to the point where you were called in front of congress to defend the methodology . No. Understanding that it is predicated on the interpretation of you were asked for the original draft . That is correct. With that being said, i want to be very clear. The report you issued is very damning to the ba the v. A. The department of justice and making sure that everyone willing to there has to be a route and an avenue for people are held accountable. From my understanding, that is in the process. The fbi and the department of justice are looking at. The investigation is ongoing in phoenix and other places. In our first recommendation in that report, refer to the names of the 45 veterans in our case reviews to the department for them to conduct appropriate reviews to determine if there was medical negligence and that. Here ought to be redrafts does the ba oig prosecute v. A. Oig prosecute cases . Traction on a get federal violation. Does this report and the way it was handled strike you how long have you been with the oig . 13. 5 years. , investigation have you been a part of roughly . Done about 520 arrests every year for the last six years. Thats about an average year. And the methodology, the folks who work for you is there anything strikingly different about this one . A very large undertaking and it was a combination of criminal. Nvestigators it was a joint project where they had ownership of the medical care in the case reviews. The audit staff have the responsibility to try to identify all of these people who were not on an electronic waitlist to a number of different sources. Her staff did that. To try to pull the different disciplines together and to get everybody on the same page as far as what makes sense there might be some language that makes sense to david that might not make any sense to they are still obviously there is still the belief that we have not gotten to the bottom of this. , i want toeing said use my remaining time. My immediate concern right now is on those 24 recommendations. Are they moving in the proper direction . Youve had people testifying before that v. A. Did not apply your recommendations. I can tell you this. A lot of the wait times issues were previously identified in our interim report. I know the department started addressing those immediately and in the updated report when we identified an additional 1800 veterans that were not on the list but were in a drawer or not properly being managed, we immediately gave those 1800 names to the people in phoenix so they can make sure those veterans who had not gotten care got it as quickly as possible. This is very subjective. You are at the heart of this matter and you have a better insight than anyone. Does it like cultural changes are beginning to change the hold accountability . The change will come as we complete more investigations and people realize that there is a price to be paid. I was asking for my testimony to be made public. I would not agree with that statement. I would say no. There is lots of investigations, but there has been no substantial change. I yield back, mr. Chairman. Thank you, mr. Chairman. Today thatd earlier you did not conclusively examine all the medical records to determine a patient death related to delays in care. Yet, and the report, your colleagues said the igs report in august concluded it could not conclusively assert that long wait times caused the deaths of these veterans. Can you explain to me and the , how canwatching today that you canto us determine no link between wait times and thats if you did not examine all the records . Let me clarify. 34 to the chairmans point, we did not examine all the records of patients on the list who said they wanted care at v. A. If they never made it through the maze and got an appointment. If there was no record for me to review given the Electronic Medical record was our main source, i cannot review those cases. All the cases we were able to review came from a whole variety of lists. Most of which had to do with waiting lists that we found that phoenix. Veryose cases, we did thoroughly review those cases. In those cases where we determined that there was harm delayed care cost arm, we published those. In those cases where we found improper care, we published those. Have 28 cases where we thought people were on a waiting list and were harmed as a result. An additional 17 cases where we thought the standard of care was not met. We published those cases. Not trying to say to people who could not get there through the barriers im not trained to excuse anything at v. A. Im trying to answer a fact. On these people, on the cases we look at, did we see a Significant Impact on their care because they were on a waiting list . Thats what we found thats what we published. That our review necessarily needs to be determined. I put the scenarios out there hoping the citizens would read these cases and would understand the complexity that these veterans present. And understand the difficulty they have. Understand the fragility of these cases so that when they dont get care in a timely fashion, horrible things are likely to happen. Each person that can read these cases and decide whether a person who might have unfortunately committed suicide do they think that was related to timeliness . I offered the opinion of my office, which has the ability to see lots of data. Its not in the summaries intentionally. A lot of the data is unnecessary for the basic pattern. These families have a right to privacy so we try to be very careful about what we decide to publish. That peoplessue would like more data about these cases, i understand it. Think the v. A. Needs to ensure that veterans have access to care thats done appropriately. In that way, the v. A. Can deliver proper care. If you had a chance to go back and reinvestigate these cases, would you do it differently today . No, i would not. The way we did it is the way weve done this for many years. Its very thorough and it produces a fair result. I wishwish we had we had not been tied to this issue of timeliness. Explain the impact of the waitlist on quality care. Its a totally madeup standard based on the circumstances of the complaint of this case. If i could have picked Something Different to look at, we would have come up with a different test. Thank you, mr. Chairman. I healed back. I yield back. Thank you, mr. Chairman. Do you know if there is a parallel fbi investigation going on at this moment . There is a joint investigation involving my people and the fbi. Investigating the same issues . Asking the same questions . They are doing it together. If there is an interview happening, there is an oig criminal investigation and fbi presence. The question related to the closing out of 12 cases and still 93 ongoing, you mentioned they were closed out because they met the wereria and the questions answered. You talked about Additional Information that was not necessarily related that you called together. Can you talk about the Additional Information . Can you give me some examples . Let me clarify that point for you. When we did some of our 93 investigations. The 12 that weve given to the department we did not do a phoenix level review of everyone. It would take 10 years. We looked at where we received allegations, either through our hotline or any number of sources of a specific infraction going on there. In summons and says some instances, with more specific language than others. We investigate those. If the result doesnt rise to the level of the u. S. Attorneys to approve criminal prosecution am my that investigative package within the scope of the review that was done is given to the department. Its incumbent on the department and its their job to review that information and say, ok, maybe someone decided this doesnt rise to the level of criminal prosecution. However, we think disciplinary action which can range from counseling to firing needs to be taken in this case. In order to prove that come which they will have to do, they will look at the piece of the investigation we did or did they y determined they have to interview someone else to support their administrative action. If that were to result in some new information that we were not aware of, it could cause us to reopen our investigation. Its up to the department to take those administrative actions. Thats why, when there is no criminal prosecution forthcoming on a specific case, we hand over our reports and transcripts to the v. A. And they can take administrative action based on those. If in putting together their review for the purpose of administrative action and somehow they come up with some information that wasnt available the department has to propose the action, whether it be removal or something less than that. It could cause us to say that we are going to go back and look into this further. Thats just the way the process is. I wanted to followup on the questioning ask specifically if you believe there are adequate resources to continue and complete the ongoing investigations at the remaining sites. That some of those investigations are much more than the magnitude of the review we are doing in phoenix. We are progressing on the remaining 81. Every week, there is another handful we are able to bring to closure. The answer is, yes, we have the resources. I must say that this is not the only investigation that our people are involved with. Number ofary, the threat cases that have come to us on v. A. Facilities, the number of assault cases, 86 drug arrests since january some of these matters that are already we prosecutor mode could not drop that case in take on a new case when its gone through the judicial process. Thank you. I yield back. Deaths. Were 293 is that correct . Guest there were 290 three deaths we reviewed. That is correct. How many of those were crossreferenced with medical documents . All of them. I think there were 28 on the list. Andhonestly trying to learn you have educated at least me on some things. Dr. Day, you said, because they were on the near list, they were not in the system, so there was no medical record for your review. A the near list included large number of patients. Of the patients we reviewed from the near list, we would not be able to review a patient if we did not have a medical record. If you were on the near list, we dont have a record. We excluded you from the review. In our methodology section, we can only look at cases that actually come to the v. A. I understand. I keep going back to this. How can you say you conclusively were able to say these individuals did not get timely care . They are now dead. Im talking about the cases we were able to review. I understand that. If there were cases you have just said you can review. Cant review. There are cases that were part of this investigation that you apparently couldnt review because there was no radical dutch medical record for you to look at. Of the 293 deaths, did everyone of them get crossreferenced with some type of medical record . The total number of people on the near list is a big number. The 293 deaths. Im just turned to be clear. The 293 deaths were all among patients from whatever list they were on that had a medical record that we could review. Im going to agree with you. There would be people on a near list who did not have a medical record who we cannot review. They were not part of the chart because its not possible for me to review them. There were 293 deaths we reviewed intensively paired the 293 number is a data point. The 293 number is from the 3409 patients. Is a number that has limited meeting in the sense that its drawn from a population that you dont know the Disease Burden of. I cant tell you whether to 93 is too high or too low because the reason for death could be normal causes. Einar stand. I apologize. Im trying to find out because, in a staff briefing, staff was told that, in some instances, all that could be done was a match of Social Security numbers and looking at a death list. There was no way for some of those individuals to be crossreferenced. That would be a misunderstanding of what was said. I would not comment on patients we havent been able to review the record for. But they were on the list. Sectionr methodologies im really trying to be clear. I cant report on cases who i have no information on. I concur. Thats where the cross wires are coming from. Its very hard for me to accept a statement and a document if you havent been able to look at every single medical record. Thank you very much for clarifying that. Thank you, mr. Chairman. Im still confused of where you the 3000 to find cases. You have medical records for all those cases . Yes, sir. In page 34 and on, you identify numerous other categories of veterans that. Ould total well over 9000 either not unlike chronic waiting lists or on the near list or 600 printouts. Decide 9121 get reduced to 3400 an9 . The report talks about there were many lists in phoenix. Lists from different sources and different points in time. If you are talking about cases that were part of the appendix, which were v. A. s cleanup action, those cases were not part of the most of those cases i do not believe its in the appendix. Page 34 question two identifies 9100 11 veterans. 9000 veterans. How did you decide not to look at 5600 some cases of veterans . We looked at those lists that were collected during the timeframe of when we started our review up until about june 1. I would have to go through and work through the data set we of the 3562 names on a list of which 293 have died and which 743 had a physician review them. An electronice on waiting list, did you look at them and review their cases are not . We did. Everybody we were able to determine was on any of these waiting lists of any variety described in this report i just gave you another 5600 you put in the report. Why you didnt look at those on the near list did you not look at any on the near list . Ifyou asked him to get you were on the near list, you never got care. If you died waiting for care because there is a failure in the system, they dont show up as a death . Thats correct. Isnt that the crux of the problem . Thousands and thousands of veterans are waiting for care in your report says we dont count them because they died before we got the records. We are not going to go back and look at different sources. 9021 and itswn pretty unclear to me to get that. Can you provide information of how you decided to exclude the 5600 . The day before you released your final report to congress, the ber in the news outlets some say no delays caused patient deaths. No deaths related to long waits. You think these are accurate or are they misleading headlines . I have seen plenty of misleading headlines in the last two weeks. The ones i read to you . Are they misleading . Thats part of the story here. If someone links something before the scheduled release date of a report and if it quoted our reports, it should not have been leaked its not true. Is that headline misleading . Could you read it to me again . No deaths related to long waits. Is that misleading . That is an accurate representation of arcing motion. Of our conclusion. No depths. How about no link . Those are not my words. Im asking for your thought on them. Im not worried about anything. Thats just the reality. You can get on google to show the amount of coverage that was put on the statement that there and there was no ifs, ands or buts about it. It doesnt take a lot of research to find that. Im still not for sure apparently, those headlines are ok. I did not say they are ok. Headlines are sensational to get a person to read a story. Cases this 5600 veterans that apparently were not reviewed. I look forward to the determination of why you decided not to review those cases. Reviewe was nothing to if they did not get in the door. He was reviewing medical records. If they did not get an appointment, they didnt have any records to review. You say there is no causality and they failed to to get in the door that would because audi. That would be causality. We dont know how they died. Neither do you. I think by the criteria you have described to us that you are using to reach your conclusions, i understand where youre coming from. Legalisticer narrow interpretation of data. I understand it and i think you made that very clear today. I except within those constraints would you concluded. Common sense tells me from the cases ive seen in this district that there is a causeandeffect relationship between care that up beingtest that ends care that is denied that ends up in veterans dying. Ive used this example before. With all due respect to the family nick, who had been trying to get health care was unable to for untreated ptsd. After not being able to and attending one of my town halls stood up and said i also have not been able to get in. He was driving home and his mom related the story to me that he was driving home that night with her and said some of these guys are much older than i am and have been trying to get in for years and cannot. I dont know what i have to look forward to. She cited that lack of hope as one of the main reasons that he took his life five days after that meeting. Takeow 22 veterans a day their own lives in this country. I have to think there is a connection between denied care and these tragic instances of suicide. I dont know if it meets the strict legal criteria you are using, but it makes a lot of sense to me to draw the connection and the conclusion. Thats what is prompting so many of us to try to improve the level of access and quality of care. Your conclusions here you make some bold statements. You talk about a breakdown of the ethics system within vha. Which i take to be a comment on the largest issue i see that we have a problem with which is not funding and resources or number of doctors, but the cultural aspect of vha. The lack of accountability, premium placed on performance bonuses and not an excellence of care, not on response ability, not on Patient Outcomes for the veterans. I looked at your recommendations related to ethics on page 74 of your report. Hey were pretty narrow i think good recommendations come all of them, but fairly narrow. Are there other recommendations i may have missed that more fundamentally addressed the issue of culture within vha . I would love to know what those are and how the secretary is going to respond to those recommendations. Mr. Griffin . The original draft report had four or five recommendations speaking to affects. They were narrowly constructed. They were combined into one Global Ethics recommendation. Secretary previously was the chief ethics officer at p g. I suspect we are going to see ethics placed at a level where it should be. We did not find that in our review in phoenix where there was a request for an ethical review. Not all the recommendations were followed that we put forward by the person who submitted them. There was a reorganization in the chiefremoved medical ethics officer from the intercircle inner circle of the highest tier of management in vha and was relegated to a lower level which removed that person from a seat at the table with the most senior people. I suspect we will see a change in that. Ethics what had been from the medical ethics perspective is something that will be expanded beyond vha to other areas of the department. Read every page of this report. Im currently reading it. I need to do that. I have read through the essex session ethics section. I have not seen specific recommendations on accountability,. People losing their jobs we have heard the most egregious instances of dereliction of duty and fraud and learned those people are still on the job. I cannot argue with anything you said about the new secretary. I had a chance to meet with him yesterday. I am looking forward to his leadership. I think we need to institutionalize these cultural changes. You were asked earlier about anything in the july compromise bill that you think would help change the situation. I think the ability to fire Senior Executives, get the deadwood and fraudulent actors out of the way quickly so we can bring up those who are the best and brightest and have the outcome of the veteran first and foremost in mind is what we need to do. I am not seeing that still throughout the system, including where i have the honor of serving veterans. I realize i am out of time. I appreciate the chairmans indulgence. Thank you. I will approach this a little differently. When you are in training, you present cases to staff and they critique your care of cases. I had a chance to review many of the cases and draw the that iton that you did, had no effect on the outcome of those patients is outrageous. You would have lost both limbs. If you try to convince me or a staff member i think the question i pose to you in one of these cases is if this were your family member, by case 29 that had congestive heart failure, if this was your dad, would you be happy with the explanation you just gave of his death . Would you accept that . My suspicion is no because you know if your dad have gotten testing and the defibrillator the outcome would have been different. That is why we put these devices into prevent sudden cardiac death. Case number seven, this one the v. A. Got lucky on. A guy in his mid60s come in to see a doctor with chest pain and has nothing done for seven months. All you can say is you got lucky because he could have died of coronary disease. He had a bypass operation. It was nothing the v. A. Did. I can insure you and most private facilities, if this guy had come in the emergency room e this, he would have had hypertension, mid60s, chest pain you cannot wave a bigger red flag. What does this guy get . They control his Blood Pressure and send him out. They are really lucky. Case 31, a man with an elevated psa. I am sensitive to that. I have had one before. It is worrying when you are a veteran with an elevated psa. It looks like this veteran got ignored for a while. Would he have died . I think you can say, and what i would like to do is have this looked at by the institute of medicine, some other outside source to see if they draw the same conclusion because i dont draw the same conclusions you did. You are right. You cant absolutely say this veteran, that missing this appointment or whatever, but it is the culture i see. You miss one appointment, that probably did not cause her death. I got that. The culture, i dont understand it. You dont follow up. People are dropped through the cracks. Ct stands reordered, nobody gets a followup. I want you to comment. You have been a political director for 19 years per gao agree or disagree with what i said . For 19 years. Do you agree or disagree with what i said . Lets talk about case seven. What really happened is quite different. He had been waiting 12 months for the pointless the v. A. When he presented in january having chest pain several times a week. An ekg was done. Was suggestive of a prior Myocardial Infarction in a patient having chest pains. He was given an appointment in october from january, only because they spotted it in june did i get him in sooner. At that time, he was having daily chest pains. Showed he had an injection fraction of 35 . 50 is normal. My analysis is he had a heart attack in the 12 months waiting. He further extended that. Fortunately, we were able to get him urgently cathed and bypassed. He saved his life but lost 30 of his heart function. The report referred to that as a favorable outcome. I guess if you dont go to a funeral, it is a favorable outcome. I can tell you that had been my anybody, your would not have been happy with the care you got. I looked at this one veteran at how did that one veteran get their care and would this pass muster we have to pass in the private sector to get paid by medicare. Of course it would not. I am embarrassed by this. When i read a lot of these cases, it was embarrassing. Dr. Mitchell, do you want to comment . I would like to go on the record against the entire oig. When you have a patient who is unstable site catcher clete and if youhiatrically, discharge and he will commit suicide unless something intervenes. In this case, nothing did and he committed suicide. Patient number 40 was demonstrating unstable behavior as an inpatient. The psychiatrist had the option to stop his discharge. If you discharge an unstable patient who has a history of hurting himself and suicidal ideation, he will commit suicide. The only question to be asked is when. This is National Suicide prevention month. The v. A. Has a Wonderful Program on the power of one, which means one person, one question can stop a suicide. This gentleman, both gentlemen should have had the power of one being the department of ea this is inappropriate medical care for a psychiatric patient. On behalf of every Mental Health provider in the United States i will say if you discharge an unstable psychiatric patient verbalizing suicidal ideation, he will commit suicide unless something happens to intervene. Miss brown . Thank you, mr. Chairman. In my 22 years on this committee, i have never heard anything from the Inspector General that would make me believe the office of the Inspector General has worked with the v. A. To soften the findings. Me people seem to think because i make an allegation that is a criminal firede and i should be without any due process. Can you explain that to me . Thinking about the 93 reviewed cases. Allegations. D many we received 34,000 allegations in the last nine months to our hotline. That is why we have investigators, auditors, and doctors and other clinicians. When we get an allegation if we have Resources Available and it rises to a level where we feel compelled to take it, that is where we go out and do our reviews and either conclude this allegation is correct or it is not. As we haveuch time accomplished that, and allegation is an allegation. It seems as if everybody seems to think every veteran is eligible to participate in the v. A. That is not accurate. I know the former secretary opened it up to millions of additional veterans. Can you explain that . Everyone that, was in the department of defense, not necessarily eligible to participate with the v. A. I know we have expanded that net. But to a large extent, it was not. Day served our country in the army. He was an army doctor for more than 20 years. He is wellversed on coverage available to retirees in addition to veterans, so let me ask him to speak to the options available. I am not sure i can address it factually except to say that you are correct, not all veterans are eligible for care in the v. A. The v. A. Was set up to take care of the indigent and those disabled in combat or otherwise. The inclusion recently of all veterans who return from the wars has certainly spend it eligibility for v. A. 8s wereegory allowed to join, veterans but not financially disqualified from previous groups, that has significantly increased the number of people. The gates to get in and not have changed over time. That is all i know right now. But we have expended that area. Which i applaud. But in expanding it, it created as far as problems processing them through the system. I recently spoke to a veterans group. They indicated it was a horrible experience. I said, what was the horrible experience . When you got in to see the doctor . The personn i went, at the desk was on the phone and did not stop and take care of me. I understand we have downgraded the intake person so that veteran is not necessarily getting the right kind of experience that could have offices if youer dont have a person that is the first contact, not a person at a certain level for the intake. Yes, maam. I guess i was asking a question as to how could we improve the system as far as system, feeling the once that person got in with the doctor everything was fine. It is just getting that person into the system. I think a couple of things. The system by which you make appointments, the Communications Systems are quite complex between v. A. In phoenix we found many patients who traveled to phoenix parttime, snowbirds, had a difficult time getting into care. They were blocked out of the primary care group set up. Their access was diminished. I think you have to look at what you mean by access to care as a system. You have to implement the systems that make it work, mostly computer systems. You have to incentivize everyone who works in the v. A. To have a customer focused, friendly, polite attitude. Issues are of those part of what i believe the current secretary understands and what i believe he will work on. Thank you. I yield back the balance of my time. Mr. Jolly, youre recognized. I have questions about the analytical model behind your statements. It goes to what mr. Work said mr. Orourke said. That the report did not substantively influence your statements. The office is in my district. I hear constituent concerns, complaints, and governments about the i. G. The way other members dont. I know words matter. Your statement that you cannot conclusively assert the lack of timely care caused the death of veterans certainly is an accurate statement based on your analytical model. Can you also conclusively assert wheat lists did not contribute to the deaths of veterans . Did you say that in the report . Not . Let me go through this. This is very important. This is why not. We put in the stories of all these people we thought did not get proper care. It was my assumption that by reading this stories these stories, you could understand where the weights were and drive to your own conclusions. You made a powerful statement based on inadequate local analytical model not requesting on the other side of the equation. For six months, we have been investigating the deaths of veterans. I. G. Words matter. We challenge a pointy words all the time. Wrongof times, they are and misleading. We expect the i. G. Not to be. The statement you made that you cannot conclusively assert that led to deaths is a substantive statement that addresses work we have done for six months. Yet you did not assert you cannot conclusively assert it did not, right . You can say it did not cause. Would you be willing to say wait lists contributed to the deaths . Would you be willing to say the wait lists contributed to the deaths . Yes. Title of the first 20 cases are cases where we thought haitians were harmed because of the wait list we thought patients were harmed because of the wait list. The issue is caused. , whatrect relationship kind of relationship you want. That is where the difficulty is. I understand. That put you down the road they that gets interesting. You said you have no ability to yourmine the cause of death then asked at the beginning, what is the point of the study if you are not able to make a determination . Suggests youthat cannot draw conversation creates a great question that undermines most of what is in the report. If you say contributed to, that should be the headline. If you are an american person that in april learned there were 40 deaths, we can play with semantics but it was a knowledge by the i. G. s office the wait lists contributed to the deaths of veterans. That is an accurate statement. That is an accurate statement. Mr. Griffin, would you agree that the wait list contributed to the death of veterans . I think a careful reading of our report would show in some cases we say they might have lived longer. They could have had a better quality of life at the end and so on. Is that true or not . Would you agree the wait lists contributed to the death of veterans . Yes or no. Words mean something. I would say it may have contributed to their deaths. Cannot say conclusively caused it. You cannot say conclusively it it not contribute. You are not willing to say contributed, is that right . That is not right. The report says it may have contributed. Youre undermining confidence we have in the i. G. But not answering that question. Did it contribute to the deaths of veterans . Yes or no . It could have. That is your answer and i know dr. Davis agreed with you. I do not think he disagreed. He answered differently. In law, the facts speak for themselves in cases of negligence and deaths. We know people were on the waiting list. We know they died of conditions for which they were awaiting treatment. We know your office mate criminal referrals related to that. Willingiate dr. Day is to say wait lists contributed to the death of veterans. That is not the story that has come out as a result of the i. G. Report. I yield back. I appreciate you letting me sit in on this committee. Ofad the opportunity and joy representing a large offered area of phoenix and have had a number of folks that have been affected by the v. A. In my office. We have set down over coffee. His is a difficult subject from the accounting and math world, we want to say this is binary, yes and no as the discussion we were just having. The reality is when we deal with people, health is not necessarily binary, yes or no. Some of this is really tough. A few months ago, the sitdown coffee with the widow, you think of yourself as a tough guy and youre driving home and cannot get that lump out of your throat and youre trying not to cry and you have not cried since you were a child. So hopefully everyone here understands the emotional impact. Now we have worked through the mechanics of what this report says and the fixes. How do we never, ever have these types of hearings and experiences, and id never sit down with a widow that breaks my heart ever again . For mr. Griffin, maybe it is the through theing report, the word significant is rolled through a number of times. Was it a significant causation, a significant factor in the death . Questions within the of the right and left, a times we say how many times we say significant. It can have a wide interpretation. Was that how you meant to write it . There is a wide path of causation . Our political staff did those reviews. I would ask dr. Daigh to answer your question. Dr. Daigh, im trying to be really fairminded and not let my emotions drive my questions. Am i being fairminded. I think so. First of all, it takes a great deal of effort for the people that work for me to write these stories with no emotion. When they readd these stories is an emotional layout of fact. If we start from a universe of patients all delayed in getting it is reasonable to assume they are all harmed by the fact undelayed care. I want to touch on observation. Mr. Griffin, i will write you a note of this, the fact you knew there were 800 articles. I. G. Facts. Promise me you are not tracking the press articles and say we are up or down. That is our world. That is not never should be the auditors world. It bothers me you knew there had been 800 some articles. Two quick things. Tell me what you learned from the hotline. Did you ever map out a pattern thatvision or specialty there was something wrong . Something came up repeatedly . Let me respond to the 800 articles briefly. It took about 60 seconds to determine that. The fact you had any curiosity at all it was not curiosity. We were being challenged for the fact we alluded to the original allegation of 40 deaths. That is what got reported over and over again. You work for ultimately the taxpayers, the agency, not the media. The media should never influence the professionalism of what you do. Doctor, sorry, you were moving up to the microphone. Would you repeat the question . Any patterns from the hotline . I would say the pattern we was essentially people denied care because they were on a waitlist. The hotline cases were usually more clear in the delay or impact, for us the timing of not getting care and able to see the impact on the waitlist than on the long list of cases we look through a people delayed trying to determine whether there was impact. The urology clinic was one area where we saw a pattern. The other pattern was people had a difficult time getting into primary care. If you are already impaneled in you hadcare at phoenix, at least one access to get consults or move through the system. If you were not in the primary care panel, you had a very difficult time navigating the system. I would say those are two examples. Mr. Chairman, thank you for your patience. For all of you, i have written questions i will shoot your way. Doctor . Thank you, mr. Chairman. I guess the question the chairman brought up in the thing that concerns me the most about this is this is really bad stuff that happened to our veterans. Outlined, it was read through the cases, 40 cases, the case summaries. I know they are incomplete. But to see how our veterans have suffered subject to delays in care most evident from these short excerpts, you know, your not t that delay did the causation with the death, i understand that argument. The delays that occurred here would be unacceptable in my someone, if you refer to a shortterm followup and due to a screwup of scheduling, a twoday followup did not occur for months. This is just unacceptable. I think you all agree on that. Is that right . The title about the first 28 cases, clinically significant delays. I completely agree with you. Wish we hadnt i worded better was this idea that delay caused death. That upsets me about this is somehow the media has taken that there is no problem or not a big problem. This is a huge problem that has to be addressed. Hopefully with the changes happening now with the new secretary and hopefully a new culture that will happen. Weall just want to be sure have an Inspector General we can rely on to be inspecting v. A. Endently of the a coercion, enforcement, or discussion. That is the gist of what i get from this hearing. Mr. Griffin, do you want to comment . I do. We dont have an Inspector General right now in our office. It is a president ial appointment. It has been vacant since january 1. Everybody who worked on this report is a career federal employee. We dont pick sides. Rigor of our interim report issued on may 28 led to very large change in the department, including the most Senior Leadership. I think the 24 recommendations in this report the dress the address the issues we found. The notion somehow we would have issued either of these reports if we were complicit with the department is no stop just does not wash with me. I missed some of the hearing because i had to do another thing. Has anybody been prosecuted . People have been referred to the department of justice for prosecution. There are ongoing investigations. No one has been prosecuted yet. Have you heard from the department of justice . We have. The assistant attorney general for the Criminal Division sent guidance to all the u. S. Attorneys offices laying out for them his view of what the potential charges could be based on his knowledge of the manipulation of records, potential destruction of records, and so on. That was sent to every u. S. Attorneys office in the country. We are working in partnership with the fbi on the ongoing phoenix investigation and in number of other locations. Believe me, we have no desire to see people escape who deserve criminal charges. As i mentioned earlier, we arrested 94 v. A. Employees last year on charges unrelated to waiting times. We are not bashful about arresting people when they break the law. You dont know the timeline on when this will be done . I think as we complete the investigations, it will be a rolling process. It is not like there is a date certain when all 93 will be closed. But every week, we will make progress. Are you doing more referrals . Did you do any referrals to the Justice Department in the last week . I think we had a new case last week in minnesota. Whenever we open a case that has criminal potential, the attorney general guidelines require us to notify the fbi so we are not duplicating efforts. Thank you for your indulgence, mr. Chairman. The secretary has been waiting for over an hour to appear. Forpreciate your indulgence waking through the vote. Waiting through the vote. I have learned a lot in this hearing. Idea the oig would go back and forth with drafts to the v. A. I was under the impression it was a single draft that went to them to be checked for factual corrections that needed to be made. I would ask that you provide the committee copies of the drafts done. The fact remains that from the there was no inclusion of the statement that has caused me concern. It took away the entire focus from all of the work your office have done. So much so that it was leaked, just that part. I think it even cause you to move up the release of the final report because it exonerated the department. It did not exonerate the department. I dont think anybody here thinks it did. I dont think it did, mr. Chairman. I dont believe it exonerated them. Here is the question i still need to ask before we close. In your testimony, you gave the impression the committee suggested the appropriate standard to be used to determine causality of death is to unequivocally prove, i think that was a, you made, that a delay in care caused death. Citedg the document you as an exhibit in your testimony, it states a Committee Staff member sought specific information in order for this committee to approve delays were related to prove delays were related to death. Met i need for you to tell is, do you believe caused and related mean the same thing . I think in the context of this document, attachment b for those who would like to review it, attachment b to our statement. It reads in order to unequivocally prove these deaths , all 40, are related to delays in care. It says all 40. We were in pursuit of all 40. You did not finish. It says a comma, oversight needs access to the v. A. System to pull up the veteran files or request them from the a from the v. A. To unequivocally prove for the committee. Not you. Does the committee have the clinicians to make that determination . I dont know that. In your testimony you are saying we put that burden on you. That burden was not placed on you. We said that about ourselves. Whether we have the clinicians to do it or not is not relevant. The fact is you were saying we said that. My question is, is caused and related, do they mean the same thing . Youre saying they do. Saying unequivocally prove is an extremely High Standard and not the standard dr. Daighs before using. We did not ask for that. Correct . Your memo sent to us on april 9 after the hearing said in order to unequivocally prove these deaths, all 40, remember they were potential deaths. As it continued on, it was declarative that there were 40. That all 40 are related to delays in care. The committee. A burdenivocal was not placed on you. It was placed on us. We placed it on ourselves. Yes, you did. It was not placed on you. You alluded to that. I did because this was sent down here on an email by your staff saying here are most of the documents, meaning documents that surfaced in the april 9 hearing. This document comes down with 17 names. It says we are going to unequivocally prove all 40 well, there are only 17 names. I am sorry. Youre trying to say we set a higher standard for you to prove we did not set that standard. Is that correct . I will let the document speaks for itself. , yout you made testimony are testifying to the fact we set that bar for you to meet. In order tosays, unequivocally prove these deaths, all 40, are related to delays in care, the committee needs access s this we werefrom trying to set a standard you could not meet. I think dr. Daigh said something about a standard that could not be met. We are having communication issues. I understand that. I would be pleased to answer for the record the other suggestions that came from the committee as to how this should be done, including one sent to us as the ink was drying on the final report. Which had we modified, would have been a violation of government accounting standards. Again, i am talking specifically about something you have included. You are saying this was a directive to you to meet a standard you could not meet. Unequipped call unequivocal. Is that true or not . The document says so staff can look at this. That is fine. Why was this sent to us if staff wanted to look at these things . It could have asked the department for these records. Asked. , we were being in some circles it says we were ordered to expand our investigation to look into the issue. Not from this committee. If you have proof i am telling you what has been reported. Your googling again. No. You can make all the fun you want of that. That is a reality. The basis for this was the allegation of 40 specific deaths. We could not find the trigger for those 40. Instead, we looked at 3409. Deaths. Und 293 there were 293 dead out of that number. You now have a statement that and then iuld not am through. Conclusively whether these deaths were related to delays in care. That was inserted after the first draft. Correct . That is correct. We have been down this road. There were multiple drafts. In the 2, 1 of our staff tracking changes indicated if we cannot conclude this, we should say so. Eventually, that is what we got to. Say noyou conclusively deaths occurred because of delays in care . No, we dont know. Bornethe causality thing out in the testimony for the record from the witness not here who is the president of the National Association of medical examiners. I dont know who requested this. Got it right. People are entitled to their own opinion. We appreciate your testimony. You have a job to do. We appreciate the job you do. We have a job to do as well. I appreciate the Committee Members for their questions. You are now excused. You have been watching the first portion of the House Veterans Affairs Committee Meeting of this week looking at the Inspector Generals report on the phoenix v. A. System. It included testimony from the acting Inspector General, richard griffin, and others in the i. G. Office, and a couple of whistleblowers. The hearing from the past wednesday will continue in a few minutes on cspan. We are going to go to phone calls to get your comments on what you have been seeing so far and what changes you think should be made at the v. A. The numbers are on your screen. We will take those calls in a moment. Coming up this afternoon, testimony at the House Veterans Affairs committee from the v. A. Secretary Robert Mcdonald. Earlier this month, he held a news conference. Before we take your calls, we will show you a short portion with the secretary talking about his vision for the culture at the Veterans Affairs department. When i was going around, it seemed to me employees thought of the hierarchy of v. A. As a pyramid. Everybodysecretary, would rise when i entered the room. Everybody would call me sir. It was very formal. As a result, i got the impression employees thought the secretary, like the ceo of a company, was on the apex of the pyramid and the veterans were on the bottom of the pyramid. I dont like that idea. One of the things i am trying to do is create a nonhierarchical veterantion where the is on top. The organization we are trying to create looks like this. The veteran is on top. All those people who work against the veteran and work with the veteran every day are the ones that need support in the organization. I, the secretary, m on the bottom am on the bottom trying to help those people in the organization. While i am asking you to call me by my first name, im asking everybody in v. A. To do that, i need to create a more open culture where every employee feels comfortable telling the secretary what is wrong in the organization and how we can improve. The v. A. Secretary Robert Mcdonald from earlier this month talking about his vision for the culture at the Veterans Affairs department. We will see testimony from the v. A. Secretary in a few minutes at the House Veterans Affairs committee. First, some phone calls from you, your comments on what you have seen today and what changes you think should be made at the v. A. We will start with david in iowa on the line for democrats. If they had an investigation about these wait why did they not do an investigation on the wait times . What did they do to resolve the problem of the wait times . I did not see any report of them telling anything that improved on the wait times or anybody being fired for altering books. In a story in the arizona republic, the representative said she received a lot of promises but not many answers during a meeting with secretary bob mcdonald thursday, the day after the contentious hearing about the glade care delayed care. Told mcdonnell she was frustrated by the slow pace of reform in the phoenix system which earlier this year became the epicenter of a National Scandal over a wait times and the manipulation of data by administrators to obtain pay bonuses. She says she urged mcdonald to take a number of steps, fire top administrators, higher new administrators to run the facility, open and auxiliary clinic, complete the hiring of 1000 new medical personnel to improve staffing. Her request echoed recommendations by a couple of senators, mccain and blake. Robert mcdonald told the congresswoman he would provide timetables next week for the likely completion of each of the actions. Said that in a teleconference after the meeting. That from the arizona republic. Changes should be made at the v. A. . Caller it has to be a complete change. The ba program the v. A. Program should be on the they have exposed their lives for the country. When they come back with some need, you find people completely inhuman. That is where it needs to be cleaned up. The whole system, the whole thing. Otherwise, it is going to continue. In corpus christi, the v. A. Clinics are so nasty. It seems like they hire the scum of the earth. That is not taken very well by my son and soninlaw because they are veterans and they are being mistreated in different places and parts of the v. A. Clinics. That is not fair. You have to hire people that are human. Thanks for calling. California, on the line for republicans, what are your thoughts . Caller i am a physician. I ran my own office for a number of years. I know what office should look like. When i went to the v. A. , it seemed relatively ok. By law medicare could not pay the v. A. For my care. I am on medicare. I was billed for my care. I am not billed when i see a private doctor. I dont understand the need for medicare to be unable to pay the v. A. For his care, number one. Number two, i had an issue with a refill on my medications. I called the lab. They were unable i am sorry. I called the people responsible for my prescriptions. They said they could not handle them and i had to go to the doctor. The doctor was a resident from the university of california working at the v. A. In over two weeks, he never responded to my calls. I called back several times. Never got an answer. I was a resident or fellow in my specialty. I think the v. A. Does not carefully watch their doctors close enough. Thanks for calling. We are showing you from wednesday the House Veterans Affairs committee looking into the Inspector Generals report on the phoenix the as phoenix v. A. Health care system, getting your thoughts on what you have seen so far and what you think ought to change at the department. Shelley is on the line for independents from kansas city. What do you think . Caller i work for the department of defense audit agency. My husband is a veteran. He was at phoenix at one time with blood clots. They told him they could not see him or take xrays of his legs or anything because the people admitted to presentence over people in the emergency room. They told him he could not take xrays of his legs until monday when they had enough opening in the appointments. From listening to the cspan interviews, they are saying their internal Audit Committee has rules for government auditing. That is good and well but it is still an internal audit, which makes it irrelevant and worthless. They need to have an external , army ofncy like gao aa performudits, or vc the external audit of the Veterans Administration because notnternal audit is independent because they are an internal agency and report to the v. A. They do not report to an external committee or agency. Their audit results are worthless. Thanks very much. Story in the Washington Post v. A. Doctors saying the report was a whitewash, referring to testimony by dr. , a former clinic director for the v. A. Said the report appears to be designed to minimize the scandal and protect perpetrators rather than provide the truth. At best, this report is able whitewash he told the committee. At its worst, it is a feeble attempt at eight cover up. It invents unrealistic standards of proof and makes misleading statements. That is from dr. Samuel foote who testified at the hearing. Secretary,r from the Robert Mcdonald, in a few moments as we continue showing you wednesdays hearing from the House Veterans Affairs committee. Right now, back to the calls. Maryland, go ahead. Caller i want to be as short as i can because it is a long story. My husband was in one in salisbury, maryland. All he needed was a tooth extraction to be able to swallow. He stayed for 50 days with no water or food and no medicine except a medicine Pain Medicine because they said they could not give him any of it because of infection. He is buried in a veterans cemetery. You need to look into the health care report. There is a section that says doctors can get paid for putting elderly people in pallets of care palliative care. That is what he was put in. He was older but he did not need to die. An oral surgeon said so. In the to get him put Veterans Hospital in baltimore. Could. Verything i marilyn just put a law in in 2007 like the health care law. It has taken a lawyer for me to get my husband better care. Interrupt, your husband clearly had serious issues at the v. A. What should change . I know the changes people are talking about. There is no need to go back into them. If youre going to let veterans younto private hospitals, need to be looking into the health care and see to it these patients that they can get treated like this. Thank you for the call. We will move on and get a couple of other calls. Trevor in austin, a democrat, what changes should happen at the v. A. . Caller i dont see any changes happening because it has to do with funding. Our veterans are not being taken care of the way they should. I have an actual veteran from the war in iraq. The problem is money. Greed of do with the the american people. Thanks for the call. Susan, pittsburgh, independent caller. Caller i think it starts at the top. I was looking at the acting Inspector General. I think we need to get an Inspector General. Why do we not have one . It has been nine months we have been without one. I think mr. Griffin has to go. I got lost in the words and detailing of everything. He never could come to a decision about what to do. I did try to do some work at the v. A. Because i am a social worker. They did not want me. They were not interested. They tried to push me out. Protecting. As self start at the top and get the person in place that needs to be there. Dr. Daigh is fantastic. Maybe he would set this up. What about veteran review boards at each of the hospitals . Someone that can help them maneuver this large bureaucracy and have some real power in what goes on in the veterans community. That is all i have to say. Thank you for hearing me. Thank you, susan. We will see what veteran Affairs Secretary Robert Mcdonald has to say as we go back to wednesdays hearing of the House Veterans Affairs committee and testimony by the v. A. Secretary on cspan. We areur next panel, going to hear from the honorable Robert Mcdonald, secretary for the department of Veterans Affairs. The secretary secretary, we apologize for keeping you waiting for so long. Clancy,companied by dr. Interim undersecretary. Your entire statement will be made part of the hearing record. We would like to say welcome to you. We look forward to working with you in the future. You are now recognized for your opening statement. Thank you, chairman miller. I look forward to working with you and the committee to improve the department of Veterans Affairs to provide the kind of care our veterans deserve. And members of the committee, thank you for the opportunity to discuss the response to the recent report on phoenix. Offer my personal apologies to all veterans who experienced unacceptable delays in receiving care. It is clear we failed in that respect. Regardless of the fact the report on phoenix could not conclusively tie deaths to to fixingam committed this problem and providing highquality care veterans have earned and deserve. That is how we will regain Veterans Trust and the trust of the american people. The final oig report on phoenix has been issued. We have concurred with all 24 of the recommendations. Three have already been remediated. We are well underway to remediating many of the remaining 21 because we began work when the interim report was issued in may. We have proposed the removal of three Senior Leaders in phoenix. We eagerly await the results of the department of justice investigations. Nationally, there are over 100 ongoing investigations of v. A. Facilities by the oig, department of justice, office of special counsel, and others. In each case, we look forward to receiving results so we can take appropriate disciplinary actions when the investigations are complete. We are grateful for the committees leadership in establishing the recently passed veterans access choice and accountability act of 2014. This law streamlines the removal of Senior Executives and the appeals process if misconduct is found. However, it does not eliminate the appeals process to guarantee v. A. Decisions will be upheld on repeal on appeal. It applies only to Senior Executives, who are less than half of. 5 of v. A. s employees. Actionstaken many other in phoenix and the surrounding areas to improve veterans access to care including putting in place a strong acting leadership team. These are good people with proven track records of serving veterans and solving problems. Increasing phoenix staffing by 162 personnel and implementing aggressive recruitment and hiring processes to speed recruiting, reaching out to veterans identified as being on unofficial lists or the wait list, and completing over 146,000 appointments in three months. As of september 5, there were only from may through august, phoenix made almost 15,000 referrals for nonv. A. Care