.nd we have exposures to things but chemicals and on and on. what it means is that when at v.a. hospitals, the average presentations are things wrong with an individual is five to seven per individual. the formula was built on a middle class p.p.o.'s and h.m.o.'s and they had one to three average presentations of things wrong with them. which means that the burn rate of resources at v.a. is much higher. that's particularly true as old guys from vietnam age and become from re aged and uncles korea and fathers from world war ii. presentations per individual of o.i.f., o.e.f. veterans is over a dozen for each individual that comes through. so the point is, we need to reprogram some money. pass the have management accountability on this side of the hill and reprogram money and frankly go for a supplemental if that turns out that it's needed. in the meantime, we would urge everybody, every hospital, something we have been urging is screened -- screen everybody at the hospital for the five major and v.a. has yet to do one of these screenings on a mass basis and do it for the five major killers. ung cancer, prostate cancer, colorectal cancer and bladder cancer and heart conditions. if you screen everybody, then you don't have the kind of situation that developed in phoenix. i thank you very much. >> in general, we all are aware and no one here dispute that there are serious problems and serious allegations, but some of you have said that the quality of care at the v.a. that your members are receiving are good to excellent. are you agreeing. is the quality of care, is it adequate or is it not? we know there are all exceptions out there. >> we would agree with your assessment, mr. chairman. the overall quality of care after they get into the system and actually get into the hospitals and clinics are very good. >> yes, mr. chairman, our members believe the same thing, quality of care when they get in is excellent. >> we find their experience with the v.a. while a bit negative, their actual individual care is incredibly positive. that's also including the use of their g.i. bill. >> mr. blake? >> my comments spoke for themselves, senator. >> i would agree with my colleagues once the system has been accessed that quality is good. >> i would agree that the issue lies within access. to expand on this a little, one of the things i wanted to point out. i said i use v.a. and i was there last week. sometimes the person you get on the other end of the phone may not understand policies or proper procedures. when i see my clinicians, they offer me top-notch care. >> generally good to excellent. the problem has to do with case management and access to the system. >> let me ask another question, and we all recognize, everybody up -- at your table and everybody here, that anybody who is lying in the v.a., anybody cooking the books in the v.a., unacceptable. there is not much debate. but i want to ask what seems to be a problem not all over the country but in many parts of the country and all of you referred to it is access. once people get into the system, the quality of care is pretty good. the problem is access. we have heard, mr. blake talk about the independent budget, which is the budget done by a number of veteran organizations assessing what they believe the needs of the v.a. are. i support that budget. bottom line is, do you believe the v.a. needs more funding in order to deal with the access issue, make sure that people all over the country can get into the system in a timely manner? >> i believe it is underfunded and there should be reallocation of funds within the system. >> good point. and others can speak to that. >> i think clearly the problem rests with a lot of the management efficiencies that the administrations have tried to put into the budget. a recent g.a.o. report of 2012 indicated v.a. reduced their budget by $2.5 billion which were not realized and which are impacting the resources. so this has gone on in previous administrations and that needs to be stopped. that's like gaming the system. >> the v.a. is underfunded but throwing money at the problem doesn't help, unless you have clear lines of accountability and reform for the things that are not working. >> i would agree with mr. tarantino. you can't throw money at the problem if it's not done smartly. there were a lot of people hired and weren't hired where the need is. our own written testimony points out serious staffing shortages. clearly people are not being hired there where there is a demonstrated need. you could do reallocation of resources but there is even more need for additional resources. colleagues th two to my right that the v.a. is underfunded but first there should be infrastructure and systemic reviews and issues addresses -- addressed and after that, where the funds will be allocated, they should be funded. >> i would agree with our independent budget partners that we support the numbers and we believe the v.a. in its current form. >> you guys are part of the independent budget? >> yes. and i would echo the concerns about resource utilization and proper distribution of resources. in my written testimony spoke about v.a.'s capacity. construction facilities. if we don't have the space, where are these clinicians supposed to practice? we have seen that with mental health hiring. where are they going to see their patients? >> allocation of resources but i would associate, particularly -- not the major construction but remodeling and adding to existing facilities. you have to have a place to actually deliver the care. but it is -- we are underfunded and don't have enough clinicians. that's how they game the system. they are under pressure not to admit there are not enough docs. >> i wanted to ask one brief question, which is important. when you deal with the public system, like the v.a., every problem sometimes makes the front pages. there are studies that 200,000 people are dying out there in hospitals. on the other hand, the advantage of a public system is that citizens of the country and representing millions of veterans which you guys do, you have input into the process. let me ask you this question. my understanding is that the secretary kind of meets with representatives of the organizations fairly frequently, that he wants to hear your input. is that true? >> yes, it is. we have a sit-down breakfast with him once a month to discuss the issues. >> i assume everybody thinks that's a sensible idea? >> yes. input from the veterans' organizations, of course. >> yes, our executive director meets with both the secretary and the under secretaries on a regular basis. >> that is not true for us. we had our first meeting with the secretary at v.a. headquarters last week. >> so you have not been meeting on a regular basis? >> no. >> our executive director meets with him on a monthly basis. >> yes, we met with the secretary on a regular basis. >> we meet with the secretary -- >> thank you, mr. chairman. the v.f.w. leadership meets with the secretary and his deputies. national level. not on progress attic things. only place in v.a. that is sticking to the president's executive order on consultation of stakeholders before decisions are made is the under secretary for benefits, because it doesn't happen in many other areas, and if it did, the decisions would be better. >> i have gone way over my time. you will have equal time. >> that's the prerogative of the chair. >> following up on the tone of the discussion, i'm going to make a statement and i would like you to tell me whether you agree with the statement or not. the question before us today is not the quality of health care delivered to veterans by the v.a., the question is access to quality of care. would you agree with that, commander? >> we do agree with that, but there are pockets within it, like a skin cancer, if you get the small pockets out, the overall system will live. if you don't take care of that, the system will die. >> yes. d.a.v. agrees with that and i would like to point out a task force back in 2003 that president bush established to look at health care pointed out at that time that there was a mismatch of funding and demand and if something wasn't done about that, access was going to be affected and that's what we're seeing now. >> we would agree with that statement. >> yes, definitely access. >> our concerns would be access especially in rural areas. >> we would agree with that, but access that can reach into care delivery, one of the concerns we received from a veteran in nevada, he was diagnosed with skin cancer. but because a doctor had left the v.a. medical center, they wouldn't be able to schedule him for a proper consultation until that person was replaced. >> which is an access problem. >> yes. it reaches into quality of care. >> capacity is one of the problems for access. >> it is primarily access and an additional thing v.a. is not in the medical system addressing the wounds and injuries of war and taking a military history and using it in the diagnosis and treatment. >> the reason i'm taking this track, i don't want us to leave this hearing with a mixed message. if there is a problem in quality of health care, we need to talk about that. but if there's not except in isolated cases, we need to talk about what is the problem, which is capacity problem number one but it appears to be an attitude national problem where there is a motivation to make the numbers look good than to give health care to the veteran. anybody disagree with that statement? >> i think there have been concerns raised that the performance accountability system promotes something like that. so access is controlled in order to make performance look better. >> and capacity is a function of appropriations, i understand that. but it's also a function of the management of the system internally within the v.a. i don't ever recall, and i could be wrong, mr. chairman, us receiving a report from the veterans administration on any study its done to improve its access to capacity or improve capacity so we improve access. we have talked about time to get a determination on a disability or how long it takes to get into a v.a. center when it seems like we ought to have a thorough, thorough examination of the capacity situation in terms of the v.a., and then you have to look at the issues you addressed, mr. blake. i know you are not for any private delivery of service. you want veterans hospitals to operate. but the option of having that access could help solve the capacity problem, particularly on a specialty like determine tolling, melanoma. so is that an idea that is not replacing the v.a. health care system but having veterans having options to access in the private health care system? >> i think veterans have even now and they are improving on it. pccc is an example. if we are going to move in that direction, there needs to be coordinated care. that doesn't work for veterans with specialized care needs like blinded care or amputation because those types of services don't really exist in the private sector at least not in the way our members come to expect it. privatized where care plays a role or contract for services plays a role. one thing i would suggest that, is that what veterans want? veterans want into the v.a. so why would we create an option where they would go somewhere else? they want into the v.a., they can't get into the v.a. we are not sure that allowing them to go outside is addressing what their immediate desire is. >> except wants and needs are two different things and the need is the most important and if it gets them the service they need in a timely fashion even though it may not be in a v.a. hospital because of the particular problem, better than having them wait so long and have a life-threatening situation come about. >> i agree with that. >> all of your testimony was outstanding. i appreciate it. and i'm going to leave this hearing with a clear message for the veterans of georgia, we need to solve the access and scheduling problems and we need to do it now and we need -- the v.a. needs to go internally and have accountability mechanism all the way down because i think the senior leadership is disserving the american veteran. we know what the needs are and i hope we will take this hearing and move forward and solve this problem and hold everyone accountable accountable and have an attitude of solving problems rather than masking problems. >> senator begich. >> i'm going to follow up on the senator's questions. we have had a similar problem and i thank many of you because you had concerns about what i'm about to talk about, but you were good in helping figuring this out. we have a large american native population in alaska. we have an indian health care system which was not very, very good. in alaska, the tribes took it over. and now deliver, we consider the best health care in this country, in my opinion and i think in many other's opinions. c.m.s. has had some of the best health care in the country and because we don't have a veterans hospital, we are trying to figure out a system to create better care, access is what it's about. if you are living in nome, alaska and come into anchorage into the clinics, you could spend lots of money. we have 800 veterans in nome, squea that are native and nonnative and built a new facility for indian health services. it is given the check to the tribal consortium that then delivers health care because of the work you did with our office, we now have access to veterans. they have a choice. can get the health care in their home or village and tell you story after story that has become very valuable or go to the clinic or go to seattle to the hospital. there was an access issue. because the care that the v.a. offers, we have great professionals. they work hard. i think they are overworked for the amount of time they have and not enough staffing. but the issue was we found a solution protecting the importance of v.a. health care, which is veterans want to be part of the v.a. health care system. they earned it and fought for it, it's a benefit of theirs. but in alaska, we had an access issue. we couldn't afford to have a veteran waiting to catch the next plane when there is a hospital next door. we figured this out. and we have a model, which when you walk into the indian health care service, the odds of you getting a same-day appointment is 75% or better. and the question you brought up the amount of ailments is different than the model. the model, same situation, problem, too many ailments, one individual. when you come in, seen by a health provider, doctor, dentist, they meet with you as a team and resolve issues collectively rather than individually and the care and quality is superb. we have been pushing on the v.a. to look at the model. and also same-day access to be able to schedule a routine appointment and to wait weeks or months is outrageous. and so, maybe i'm -- it's more -- i know many of you -- i point carl out because he and i had good gates on this. veterans call me and tell me thank you, not that they are not going to go to the v.a., they are going to go to the v.a. they have a choice. so i guess i would like -- you have heard my comments, i would hearing your in comments. the model is all about access. any comments from folks? >> senator, thanks for that question because it happens i was in alaska last month and they they want to expand what they are doing in that area and in a strip mall. but they also are looking for additional space. and v.a. spent three years trying to get a lease worked up and they are frustrated. they want to do additional things. but i agree with your assessment as far as accessibility. east coast is different. as i travel to the western states, i think it is something we should build upon. >> it has a brand new hospital that will partner, which is unbelievable care. any other comments on that? i know my time's almost up. >> the only thing i would like to say, right now we have 27 points of access that are on hold because we can't get the funding and that's important that we move forward on that. going back to the clinton administration when they put a lot of construction on hold to determine where they wanted to build, v.a. has been underfunded in construction since the clinton administration. so we need to do something about that also. more -- moran. >> i appreciate you being here. let me raise a topic about the assessment that's going on, face-to-face review across our country. one of my congressional colleagues had a conversation with v.a. personnel in jackson, mississippi after the assessment presumably took place and this is a bit of a paraphrase of his or her report back from what they heard about this assessment. we asked about their face-to-face review. the team came in on monday and interviewed some clerks and superviseors and didn't find any evidence of scheduling issues. no veterans were interviewed. what struck this person was the this nt superficiality of so-called audit. it did not come through the electronic reports and is not indicative of a thorough review. we are going to have one more review that is to be completed within two weeks, with 1700 facilities across the country. so in part my concern is the quality of the review. it appears to me this is more of damage control to what people do when there are allegations of mismanagement, improper conduct, you have another review. and so my concern is how credible will the review be based upon the amount of time and resources that's being devoted to itment but perhaps more troubling to me is how many more reports, allegations, i.g., g.a.o., congressional hearings do we have to have before there is a different approach or attitude at the v.a. to solve the problem? and so i guess i don't disagree with an audit across the country, but what is this really going to accomplish? will we be here six months from now which the v.a. has a plan in place to transform itself so the access issues that you all described are not the same ones that we heard today, we heard last week, we heard last month, we heard last year? the phoenix situation seems to have brought national attention to this problem, but i can't imagine that there is anyone at the table who believes that the phoenix situation is really what is the problem. it's a symptom of a much broader problem that has been ignored for a long time. let mander, -- and here, me add this, i understand that the testimony of the secretary this morning in response to the senator from north carolina in which he outlined, he, the senator, outlined a long list of audits and reviews, g.a.o. reports, inspector general audits and the secretary indicated that he was unaware of those audits and reports and hadn't -- and therefore hadn't been used in any conclusions that i assume would be made at the v.a. there was an i.g. report included in that list that said the unexpected death report could be avoided if the v.a. focused on its core mission to deliver quality health care. it is difficult to implement v.h.a. directives when there are no standard descriptions or organizational structures. the i.g. believes it's time to review the organizational structure and business rules of v.h.a. how can that be an i.g. report that a secretary of veterans affairs would be unaware of? it's directly related to the management, organization of the department of veterans affairs. if there is one in here in my commentary and what is what assurance do you have that when this face-to-face review is done that something will be different in the direction that the v.a. is taking in regard to creating higher quality of care for veterans and making certain that they have access? commander. >> senator, that's quite a task. with the i.g. audit, yes. in the findings, once they come out, i think this committee needs to establish a along with v.a., milestones so as to rectify these issues as they go through. but as you noted in your report, each hospital is different. and even when a director changes, a hospital doing excellent, then could possibly slip below the standard. so it's going to be an ongoing challenge and we would hope that the secretary and the v.a. would move forward as soon as possible with the changes necessary to give us the quality health care that all veterans deserve. >> my time is soon to expire. i don't know if the chairman is allowing you to answer my question. you have indicated that you have or senior staff have ongoing conversations with the secretary or high level individuals at the department ofsecretary or high-l individuals at the department of veterans affairs. the question i would ask, does that result in a change in approach style management attitude at the v.a. that results in higher quality care for our veterans. iq for the opportunity to issue a statement and to ask the question. >> thank you. panel forthank the their testimony, their vision.ive and their i want to thank you for staying for this part of the hearing and express my apologies. i got tied up in a committee. i will follow-up with you in private. it is good to be asking questions about this. we agree access is the issue. it is the issue. we have had everything talked about from dollars to construction to milestones to all sorts of stuff. helpful. i'm going to ask you, each one of you, because you represent veterans in this country that are being served by the v.a., i think you have an understanding of what the challenges are out there. you tell me what you would do first to fix the v.a. and what you would do second. i am assuming there will be 3, 4, 5 more down the line. is it money? is it the resources they have the need to be allocated different? do we need to put a focus on hiring professionals? you cannot say do all of them. we want to hold folks accountable. if you can give me your priorities of what we need to do, it could be helpful. assessment is the first thing that needs to happen. speakhave heard the v.a. , they have enough money. they do not have the accurate numbers. system,are gaming the how many actual visits are they going to have a year? instead of having 85 million, will of the 150 million? you cannot assess a money value to that until you make an assessment as to what the problem is. >> want to get the assessment, you follow that assessment as a blueprint to fixing the v.a. does anyone else have anything to add? >> i have a list of four things i would like to talk about. first is resources. as our budget partners have talked about, it may not be a numbers game, it may be an allocation of resources. >> what are you telling us to do? recommend taking the recommendations on how to properly fund v.a., things like capital infrastructure. andnd would be training outreach for your gatekeepers. the people that mandy call maners -- the people who the call centers. consistency across the board. your experience at one center is very similar to your experience at another center. finally, another i want to talk about his accountability. we have had a lot of talk about accountability. the secretary said 3000 employees were sanctioned in some way, whether that was termination, retirement, or transfer or devotion, what have you. there is a problem -- and having conversation over recent weeks, their art two things that we know. reprimanding or firing an employee is a difficult process. has significant eeo and other legal protections. it can take a long time to take punitive action. second, when there is a vacancy in the federal government, not v.a. exclusive, it can take between six months to a year to fill that. when you have an underperforming employee, you have to make -- do you make the trade-off decision -- i have an underperforming employee. is it better to serve -- have them on the books serving some veterans or terminate them and have a vacuum of care for six months or possibly longer? bring us around to another discussion about how we can work with the department. this could apply to all agencies and government. reduce the red tape for hiring. it takes too long to get that done. thent to ask about accountability portion. myountability is, from perspective, really easy to talk about. sometimes, it is very difficult to put your finger on where the problem is, who is the problem, and quite frankly, how you deal with it. example --n -- for the argument could be made that because we have hired all of these middle management folks, you made a good point on that -- we should not be doing that. these should be on the ground folks. we have hired these middle-management folks to make sure the folks on the ground are doing the job. how do you deal with accountability? do you contract it out? what do you do? secretary orw the is everybody else held harmless? introduced by mr. miller on the house side is a good start. people said do you favor the bill that strips people at the the a of protections, but there is a reasonable point in between mr. miller's bill as it currently is and what we have now. they cannot fire people. they say they can't, but they cannot. the lady from kansas city, they removed her as a director, but kept monday morning, we her here at government expense and flew her back every three years, paying her $180,000. they need flexibility. >> thank you. thank you, mr. chairman. to everybody who is here, this has been extremely helpful. i think we are going to find that the access issue which you consistently say is the problem, is going to be easier to identify than resolve. i think about a va hospital needs five specialists. they are probably going to recruit from the area around and compete with private doctors, hospitals, and that is true, whether it is a doctor, a nurse, or the medical technician, whatever it is. building that capacity, even would be af money challenge. i think we agree to that. let me ask you a question. i also agree, we are waiting for a hospital in omaha. i am beginning to wonder if it will happen in my lifetime. i am a fairly young man. i am not too old. the moneyd get all of all at once, which would be hard to accomplish, how much construction can you get up and going on and on? let me ask you a question about access. let's say we're thinking about this and we have all of this population that is needing more access, not less. be a non-arab people, a whole group of people and we are aging. we are the baby boomers and we need more access, not less. open to anmembers be idea that said something like they say iy call, need to see a health care professional because i have a spot on my leg that does not look right. i think it might be cancer. want to see you just as quick as we can, but that will be four months or six months or whatever. would your members be open to an idea that says, if you cannot or in within two weeks, three weeks, or whatever the appropriate timeline is, you can seek private care. you can go to your local doctor or specialist or whatever. the government will pay the cost we will cover that because we do not want you to wait. we believe that is the best way be the with access to quickest and most effective way. the other thing i mentioned is in states like mine, we are a western state, the state of nebraska. rural veterans is difficult and especially difficult in some areas like mental health and specialized care. >> what is your thought about that? --the v.a. utilizes medicine. even though there is only a utilizingy can -- by -- >> i appreciate that, how would your members react if i said look, we are not going to make you wait anymore. if the v.a. cannot meet your needs within a certain period of time, we will allow you, if you choose, to seek private care. if you want to wait, you can. >> we would not be opposed to that because we want the best health care fast as possible, ve to put ao hal feett on that because they -- the fee-based will be higher. >> i get that, but we are saying we want the best care. >> that is the point. if you are not willing to give the a the resources it needs to allow for access in the facility, you're going to need to give them more resources i sending veterans out to the community. ba has the authority, i do not think they use it enough, for purchase care. out, if a veteran cannot be seen in a certain timeframe, they should be able to get that care by a private doctor that needs to coordinate the care, but we need to be careful that we do not start increasing the money going out to private doctors and taking away the v.a. possibility to hire internally because all we are doing is robbing peter to pay paul. we will have less money to do it on the private sector. >> i am out of time. here's my point. if it results in better care, isn't that what we are trying to achieve? i hope i can have a discussion. >> can i address that? it is my understanding that the is envisioned to address part of the problem that you outlined specifically. that is what we want. we want coordinated care. the key is the continuity of care and ensuring that the v.a. is ultimately responsible for that veteran so they know what the veteran his roots -- is receiving. in the it is moving direction of addressing the concerns you are raising. >> senator blumenthal. >> i want to thank all of the leaders who are here today for your presence today, but also relentlessss and work on behalf of the veterans of america. your leadership has made a big not only in the performance and outcomes in the veteran's administration, but in countless communities and other areas across the country. my thanks to you. my questions are simple. me,of you would agree with i believe, that the asestigation should hard-hitting, aggressive, thorough, and prompt as possible. the resourceses ive agencies,stigat they ought to be called on as well. would you agree? >> i do, senator. >> we not only agree, but our national president road to the eternal -- attorney general of arizona last week and the u.s. attorney for the district of arizona, asking them to launch criminal investigations into reckless endangerment, possibly resulting in loss of life. earlier, were not here let me just tell you that i urge that the secretary of the v.a. shockingly -- strongly consider and recommend he involved the department of justice because there is ample evidence and i emphasize evidence, not just allegations of criminal tongdoing to warrant the fbi review this situation, as they do, my. the reason is simple. not only the evidence, but also the inspector general lacks the jurisdiction authority, the resources, and the expertise to do a prompt and effective criminal investigation. only the fbi can provide the resources, expertise, and and the department of justice includes the attorney in everya and the ones in state that may be affected here. we share a determination. i believe the secretary of the v.a. shares this as well, to get to the bottom, to provide relief to anyone denied access. i think that is a determination that unites us in this room and accountability means changing the team if necessary. there may, at some point, be a need to consider those changes as well. my thanks for being here. my time is limited. i think the chairman. >> thank you, senator blumenthal. i apologize if this question has been asked, but senator murray asked earlier as to what a face to face audit should involve. i would like to ask you and perhaps we can start with mr. bellinger, what needs to happen in a face to face audit to elicit the kind of information we need to address the challenges and problems that v.a. hospitals and clinics? i.t. has to start with first. they have to look at the process of the books as far as what actually occurs and they have to go through the administration and the employees and also get input from the stakeholders and the veterans. >> did that happened the last time? there have been audits before. when those audits were conducted, where the stakeholders included? >> i do not have that information. >> to the rest of you have any do the rest of you have any information that will help us? >> often, we are not included. if you ask the veterans, they say, we got hurt, we got wounded. the veterans will tell you how to fix the facility. >> would you agree that any face to face audit should include -- this is probably a rhetorical question. input from the veterans organizations as well as veterans at the particular facility. and iould agree with that would also, as we pointed out, recommend there be an independent third-party expert involved. it would alleviate a lot of the questions that were raised about the audit. i think it would help everyone be assured that these audits were being done properly and everything was being looked at. >> what do you mean by an independent third-party? >> i do not have the expertise to determine are the people cooking the books, are veterans theyng timely care, are spending sufficient time or too much time with the doctors? there needs to be someone who is an expert in time management and accessing medical care that can be there to make a determination , are they asking the right questions and are the answers sufficient to address this problem. suggest also, if they are going to do a thorough audit, it would take more than a couple of weeks. a thorough audit would be an examination of the entire system. that might involve clinicians, nurses, whatever that may be. audit that is going on right now is what senator moran suggest happens, that is disheartening. that is not going to solve any problems as far as we are concerned. it might get to the bottom of a problem, a shallow depth problem at a local facility, but i don't know if it will solve the deeper rooted problems. >> i would envision that an assessment of the entire v.a. health care system was involved not just in this process that has been described to us, but it would be an ongoing kind of assessment. i hope that will be the case. the secretary is still here and to heart he is taking the suggestions and comments you are providing. secretary, ine regards to all that we have been discussing, whether you think this is taking away from the v.a.'s core mission of providing health care for the veterans. does anybody care to respond? as aere is no such thing homeless veteran. there are veterans whose problems have been so acute and not address that they have ended up without homes. if other services come through, people do not end up on the street. each one is a failure. it does not mean people set out to fail, but we have failed those folks coming home somehow. the vfw believes the resources the v.a. can provide should never come at a trade-off. the obligations to provide holistic services to the assistance,ployment but also health care has to remain a cornerstone. when veterans transition off of active duty, there are a litany of transitional resources that need to be made available to them. -- to deliverhe most of those. seeould never want to trade-offs made on how we deliver other benefits. , other --t injecting will suffer. >> senator moran did not talk about audits, i just one of the theesses to know that was assessment of chairman miller, from the house committee. jackson. i am not sure how many facilities he is covering. that was his assessment of the audit process. not that i do not love you guys, but we're going to try to get the next panel and before we get into a series of votes. thank you. >> thank you. let me just say this. thank you for what you do everyday representing veterans. most importantly, we all know that we are not going to create the great health care system without your active participation. we need you. thank you for being here. keep up the good work. >> let me introduce our third panel. 'spresenting the v.a. independent inspector general office is its acting inspector general and he is accompanied by feday.n from the national association of state directions of the veteran affairs, we have clyde. from the government haventability office, we debra draper. finally, joining us today, senior research fellow. thank you for being here. mr. griffin, you may begin. >> mr. chairman, members of the committee, thank you for the opportunity to provide testimony at this hearing. i would like to provide an overview of our ongoing review at the unix health care center. the aig has assembled a multidisciplinary team, comprised of auditors, health care inspectors, board-certified -- to address these allegations. our team toted focus on two questions. where the facilities electronic waitlist or parsley amended the names of veterans waiting for care, and if so, at whose direction. number two, whether the depths ofany of these -- the deaths any of these veterans were related to delaying care. this, we the bottom of have an exhaustive review underway that includes seven parts. number one, interviewing staff with knowledge of patient scheduling practices and schedulingncluding clerks, supervisors, patient care providers, management staff , and whistleblowers who have stepped forward to report allegations of wrongdoing. number two, collecting and analyzing reports and documents from information technology systems related to patient scheduling and enrollment. medicalhree, reviewing records of patients who may be related to delays in care. number four, reviewing .erformance ratings number five, reviewing past and newly received complaints to the as well as those complaints shared with us by members of congress and by the media. reviewing other prior reports to these allegations, including reports from veteran health administration offices of the medical inspector. finally, number seven, reviewing massive amounts of e-mail and other documentation pertinent to this review. to facilitate our work on may 1, place thesecretary to phoenix director, associate director, and another individual on administrative leave. this was done because of the gravity of the allegations and , some whocooperation have expressed concern about talking to the team. techie -- thee secretary agreed to my request. we have the resources and talent to complete a thorough review. we are using our top audit examine all of the scheduling related records. board-certified physicians will ,e reviewing medical records treatment and harm that may have happened. forensic experts are assisting the team. we are working with federal prosecutors from the united states attorney's office from the district of arizona and a public integrity section from the department of justice here in washington. we will determine any conduct that merits criminal prosecution. since the phoenix story broke, we have received additional reports of manipulated waiting even at other facilities, through the hotline, members of congress and the media. these reviews are being conducted by other staff to enable the team working on the phoenix review to complete efforts on their project. we expect these reviews will give us insight into the extent scheduling -- in other facilities. while much has been done, much more remains ahead. review is theis top priority and maximum resources, dedicated to bring about its timely conclusion, we intend to bring you and other and areof the congress ready to publish our reports. we project finishing the project of publishing the report in august of this year. inc. you -- thank you for holding this hearing and we would be pleased to answer any questions. >> thank you very much. >> my name is clive marsh. i am the president of the state directors of veterans affairs. present in the news of state directors from all 50 states. agencies,vernmental we -- the processing of claims. we provide over half of all of the long-term care in our state nursing homes. state health care is strong. the v.a. has medical centers in the majority of major cities in america. community -- expanded our community base in recent years. the vha has moved out of the box, taken advantage of technology to provide tele-help, and have also taken steps to provide transportation for those veterans in rural areas to make their appointments. customer satisfaction has been trending higher. the v.a. may not get everything perfect every time, however on a national level, we are one of the leading health care providers in the country and providing good, quality health care. those of us in the health delivery business or v.a., we strive to get it right and we work on that every single day. experience, we are on the same page. endorse the resignation along with his top administration officials. they will be needed to follow actions to swiftly correct any procedural issues that may be identified. and is not ine the interest of our veterans to make premature decisions. the u.s. department of veteran affairs is transforming a pre-world war ii claims process into a paperless system that has reduced compensation and claims backlog by 44% as reduced veteran's homelessness by 24% and has enrolled more than 2 million veterans in the health care system since 2009, receiving some of the highest quality care ratings in decades. to supportinged vha and the health care system. at the local level, state directors are in constant coordination with the medical center directions -- center directors. attention to confirming those individuals who have been nominated to fear -- to fill vacant leadership positions. it is imperative that the a -- that the v.a. and vha received .he necessary support those folks will be coming as a result of the war and military drawdown. the bottom line is, the v.a. may require more in terms of the budget. doctors,need more nurses, technicians, clinicians, and even facility expansions or operations. we look forward to participating as copartners or facilitators. we remain dedicated and committed to doing our part. believe that v.a. leaders will transform into a technology-based and veteran centered. have the director of health care. collects i appreciate the opportunity to discuss access to care problems in v.a.. for over a decade, gao and thats have reported medical centers do not provide timely care. in some cases, these delays have resulted in harm to veterans. across our work on access, several common themes have emerged. policies andguous processes, subject to interpretation, resulting in variation in confusion at the local level. antiquated software systems that do not facilitate good practices. ofaining, and use unreliable data for monitoring. they did not always record the desired appointment date, the date the veteran or provider wants the veteran to be seen. this is due to lack of clarity in the scheduling policies and how to record the desired date. byituation made nor -- worse the large number staff that could schedule appointments. during our site visits, more than half of the schedulers we observed did not record the desired date correctly, which may have resulted in a shorter wait times and veterans experienced. some staff said they changed the dates so that they aligned with the v.a.'s goals. we found follow-up appointments being scheduled without ever talking to the veteran, who would then receive notification of their appointment through the mail. in addition, we found scheduling systems electronic waitlist was not used to track new patients. they put these patients at risk for delayed care were not receiving care at all. ofalso found the completion required training was not always done, although officials stressed its importance. additionally, we found a number of other factors that negatively impacted these usually processed area for example, officials described the software system used for scheduling as antiquated, error-prone, and cumbersome. turnovershortages in of scheduling staff, provider staffing shortages, i telephone call volumes without sufficient staff to answer the calls. takecommended the v.a. actions to improve the reliability of its way time theures, and sure consistent implementation of a scheduling policy, allocate scheduling resources based on need, and improve telephone access for medical departments. the v.a. concurred with our recommendations and told us he were taking steps to address them. we are pleased that actions are being taken, but more progress is needed to ensure timely access to care. work examiningng v.a.'s management, which is a type of medical plan. the preliminary work has identified a number of problems, including delays in care, or care not being provided all comment at each of the five medical centers included in our review. console data, systemwide closure of 1.5 million consoles older than 90 days with no documentation as to why they were close. we expect to publish our findings this summer. as the demand for the health care continues to escalate, it is imperative that v.a. addresses this. since 2005, the number of patients served by v.a. has increased nearly 20% and the number of annual outpatient medical appointments has increased by approximately 45%. in light of this, the failure of the v.a. to address the access to care problems, including the accurate tracking and reporting of wait times and specialty care consults will worsen. this concludes my opening remarks. i am happy to answer any questions. >> thank you very much, mr. eber. >> thank you for giving me this opportunity. different than the other panelists. i am not a veteran. i am not affiliated with the v.a. in any way. i am not affiliated with veteran service organizations. bookhere because i wrote a anywhere: whyare v.a. care would be better for anyone." for my book came from losing my wife robin to breast cancer. in oneas treated prestigious corner of the american health care system in washington, d.c. suffice it to say, what i saw during the six months between her diagnosis and demise caused me to become radically interested in the questions of medical quality and safety. died, theyer robin instituted a report that has been alluded to already, showing that there are 98,000 people that are killed by medical errors. that is equivalent to a jumbo jet falling out of the sky, killing everybody on board every third day. the chairman has alluded to other estimates, showing that as many as a quarter of a million people are killed by various forms of overtreatment, under treatment, maltreatment. i set out to find out who is doing a better job. i was surprised to find, after healthng literature on care quality and talking to many experts and veterans and such, that the da health care system, by many metrics out performs the rest of the u.s. health-care system as a whole. i seem to have come to a broad consensus, is he a health care -- v.a. quality health care is very high quality health care. the problem is access. robind have welcomed being treated in a hospital that had an inspector general. would that not have been wonderful? ifld it have been wonderful two committees of congress exercised oversight of that hospital? would it have been great if there were various broad-based effective citizen organizations akin to the american legion that erplied scrutiny to that corn of the american health care system. i also would want to draw attention to the fact that we have a problem with someone times ormetric on wait some other metric that the v.a. applies, that is because there is a metric. health-careof the system, there are no quality metrics that are exercised, let alone wait times. it took me 2.5 years to find a primary care physician who is still taking patients. mammogram momor a enough for her tumor to grow from this size to the size areas many people in the united states live in places where there is a queue primary care shortages. we have a problem with access. times, so much of what we are doing is trying to has aine whether somebody service related disability or not. hearing allou are of this -- losing your hearing -- we have this tremendous administrative machine that adjudicates that kind of question. how much smarter when we be if we opened the v.a. to all veterans, thank you for your service, come in. thank you. >> thank you. all the testimony was excellent. thank you. a few questions. let me reiterate. we chatted on the phone. do you have the necessary theurces to undertake investigation that needs to be done regarding phoenix. >> yes, we do. have 120 medical clinicians, who for a number of years are doing reviews of the a medical centers. and --.doctor the reason the system was set up the way it was is so you have people with knowledge of the department. that is why we're the right group to do this review. >> when you told us a few moments ago that you do not -- isyou can do this there anyway you can give us a preliminary review? many members would like to get a sense of what you found out there. progresses,view part of this review could lead to criminal charges and we do not want to do anything to jeopardize the ultimate outcome. >> what we have been reading in the media, at least 40 u.s. veterans waiting for appointments at the phoenix veteran affairs health-care system. many were placed on a secret waiting list. at this point, can you tell us how may people you have identified who have died while waiting on a secret waiting list. >> i cannot give you that number. the number that has been wildly pressd -- quoted in the does not represent the total number of veterans we are looking at. that was one list created by the facility. we need to do an analysis of recordst, both death --. there are also other people who have come through the congress, who have come to the media, who have come through our hotline. , none ofultiple lists them identical. we are going through the basis of going through those lists and the initial list that we were given, we have gone through and there were only 17 names on that list. our review to date, we want to have more than one set of eyes look at all of the records. those 17, we did not conclude that delay caused death. be on ae thing to waiting list, is another thing to conclude that as a result of being on a waiting list that is the cause of death. it is dependent upon what your illness might have been at the beginning. >> you have not identified anyone that has died as a result of being on the waiting list as of this point. this is complicated stuff. >> we have been provided names of people who are on various lists and it is true that those veterans whose names were on the list have died. we have looked at a substantial number of cases and we have been looking at those cases to determine that yes, there was a delay in care, as has been expressed. quality standards were not met. -- we have found that some patient harm. to draw a conclusion between patient harm and death has so far been a tenuous connection. to records we have looked at date are mostly v.a.'s medical records. to the extent that a patient died, we are in the process of getting death certificates, autopsy reports, if they were in another hospital, there are procedures we need to go through to get the rest of those records. we may need to interview people who are knowledgeable about the events surrounding the death. it is a serious problem. we won't work through that. >> thank you. the conclusion states unreliable ait time has resulted between positive way time. this is v.a. report that you are talking about was the report presented to the v.a. in december 2012. it became a public document in january 2013. what i have said so far about your comments are on record. the secretary of the v.a. was --ommended to take action to the reliability of wait time measures. the sector of the v.a. under the secretary of the director felt to take action to consistently and accurately implement the scheduling policy. for the two recommendations, v.a. specified in their comments that these recommendations had a ofgeted completion date november 1, 2013. let me ask you -- based upon the knowledge you have today, has this process at the v.a. been completed as it relates to those two actions in your report from december 2012? >> and has not been fully completed. >> is this an ongoing communication? to be quite frank, it has been almost a year and a half. we would have expected more progress to be made. >> do you or your predecessor, and thank you for serving in that capacity. you are a standup guy. we have great confidence in what you and your team will do, can produce, and accuracy of it in the reliability of it. please share that with the folks who are working so hard. >> do you or did your predecessor have a scheduled meeting with the secretary? meetings with the entire leadership team every two weeks. my predecessor went to one, i went to the other one. we had occasional meetings with the secretary at different times during the year. >> how many meetings have you had since the issue of phoenix arose. had one meeting that was unconnected to the review. it was a budget related meeting. we had a second meeting when i went over to request certain individuals be put on administrative leave. >> from a standpoint of the who is handling that? of theng the course administrative leave discussion, not un-similar to the -- we are going to be looking at. i put someone in administrative leave that i thought was completely appropriate. we are independent. we cannot be told to not do something or to do something because it would violate our independence. a report that completes, when phoenix is finished, if it happens like every other work, will you or your staff sit down with the secretary and brief him on the findings? we issue probably 300 reports a year. not all of them would rise to the level. at the assistant inspector general level, dr. jay meets with the bha senior staff to discuss these things. we just heard about the process of getting closure and reports. there is an ongoing follow-up process. >> how many years have you been in the v.a.? >> about 13 out of the last 16 years. >> how many times have you set awn -- sat down with secretary and brief them? i would say, a report of this magnitude, maybe a couple of times a year. depending on -- there are 300 reports. i would say at most, quarterly. >> on a reporter multiple? >> on a report. the doors open. it is just the issues are resolved. meetingave requested a -- have you ever had one ray meeting was not made available to you? >> no. >> thank you. i want to thank you for your testimony. you said you have 120 medical investigators. are there more investigators than that? have about 615 personnel in the ig organization. david andm work for they are health-care inspectors. they are doctors, nurses, psychologists, clinicians. we have about 150 criminal investigators. we have people in 39 cities around the country. we have over 200 auditors. >> how many people are working on this investigation. 185 people have touched this investigation. >> for how many weeks? >> this is the third week. >> you anticipate a final by august? >> correct. anticipate a preliminary report before that? >> to the extent that it will not impact the outcome of the work to include the fact that we are working with two different groups from the department of justice, looking at a possible criminal violation. about seniortalk management staff, including the secretary and the v.a.. asked those folks for information? >> no, we have not. we did ask them for a list that they suggested to us that they had of veterans who died on an electronic list. >> this is where want to get to. have they been open? have they been transparent? what is the other word i am trying to think of? helpful in your investigation. >> they have. resources, buted we do not want to give anyone the impression that our independence was being questioned. we have not received any resources nor do i intend to. >> up to this point, being fully transparent with what you need, would you so it's not a new issue. and i'm confident when we finish our work in phoenix it will be the same outcome as these previous reports. >> ok. that is all, mr. chairman. i would just say we look forward to the investigation. i know you need the time >> we are going to nail this thing. it in the end, we will have a good heart for you. -- rx for you. product for you. >> i will try to summarize weekly. the process by itch you have assurance that is acted upon. what is the follow-through and a result of gao reports? >> the report we issued was released in january. we did a follow-up. they issue a status. we do have that. we provide a testimony for the have threettee we arctic updates with the ba on the status. >> you testified about this report. is vba-8 reports successful and useful. they are successful in implementing the proposals you >> with rick -- regard to the report, how are you able to determine whether its recommendations are followed through? >> if they can satisfy -- us with that there is a new policy and here's how we are going to thatit work, we may close at that time. more often if we don't have a comfort level, we will send eight team back and go to the same facilities and look and see if the fixes are in place. >> what is your sense if you have information, since the department of veterans affairs following the rhythm recommendations -- following the recommendations and implementing them? >> the answer is mixed frequently be policies look good but are not followed. it it is an accountability question for the field managers. when they do not follow it, something needs to happen. thing i think you have nothing to do with would be the office of the inspector. one of the things we have determined is they are not made public and submitted to congress . we don't know the result of those types of audits and reviews. i am pursuing legislation to change that so we can see with that report says. and keep ise the think there is a whole set of other reports that there is no ability for us to gauge whether a recommendation is followed or not. -- facilities in kansas? >> are criminal investigators -- our criminal investigators have had rapid response to new allegations. days, theyer of two went to 50 medical centers to see if what was being allegedly .s occurring >> i was referring to over the last to your or so. ofre have been allegations v.a.mstances within the and my state. our effort to find out what is going on, what response the department has taken as a result of the stories out there. we have never received a response from anyone in the department here in washington. ba.fficials who work at the -- va. i do not know whether any of those circumstances are being investigated i you. reportsajority of our -- somee member criminal reports take longer. you may or may not see -- >> i apologize for interrupting. there are 95 senators fading -- waiting for us to vote. this was a great panel and i appreciate the wonderful testimony. the hearing is adjourned. >> for over 35 years, c-span brings public affairs events from washington directly to you, putting you in the room in briefings, conferences, and offering gavel-to-gavel coverage of the u.s. house. all as a public service of private industry. there c-span, crated by cable tv industry and brought to you by your cable or satellite provider. watch us. like us on facebook. the loss on twitter. -- follow us on twitter. >> in a few minutes, the fcc considered new rules for the internet. and in an hour, we will re-air the hearing. the testimony from the head of the ba, eric shinseki. >> several live events including a speech by hillary clinton to the new america foundation. you can see that at 11:30 a.m.. defense andgal education fund marks the 60th anniversary of the brown versus board of education decision. that found that state laws establishing separate public schools for 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[applause] >> my name is margaret flowers. century,st injury -- the internet is our free speech. it was created with our public [indiscernible] [applause] free.p the internet [indiscernible] >> ok, we now have -- >> [indiscernible] >> for the may 2014 meeting of the federal medications commission, let me begin with a couple of housekeeping items. first of all, we have a particularly full agenda today, and so for the benefit of my colleagues, we will be taking a break between the third and fourth items of about 10 minutes. we will be coming back quickly for that. i just want to say at the outset insofar as before the meeting began, there was some activity here. the purpose of what we are doing here today on the open internet is to make sure that we hear from everyone and that we start a process that fully opens the doors for comment by the american people. we are going to move through that process today, and disruption does not help adding to the point where the american people can provide input to the process. we look forward to a full and complete discussion of all of these issues. and that is the important thing that we are beginning today. so, madam secretary, will you please introduce our agenda for the morning? >> thank you. good morning to you and good morning, commissioners. four items. first, you will consider a notice of proposed rulemaking addressing the d.c. court of appeals remand a portion of the 2010 open internet order and proposing enforceable rules to protect and promote the open internet. second, you will consider an order that provided limited expansion to the class of wireless microphone users eligible for a license. third, you will consider an order that adopts key policies and rules for the broadcast television spectrum incentive auction, laying the groundwork for an unprecedented market-driven process for repurpose of spectrum for mobile broadband use in promoting competition and innovation. last on your agenda, you will consider a report and order that modifies the commission's policies and adopt rules regarding the aggregation of the spectrum for mobile wireless services through initial licensing and secondary market transactions to preserve and promote competition. this is your agenda for today. the first item will be presented by the wireline bureau. the chief of the bureau will be the introduction. >> good morning, mr. chairman and commissioners. we present for your consideration an item seeking broad public comment on the best way to protect and promote the internet. the commission has emphasized for almost a decade the importance of open internet protections. but following the court of appeal's decision earlier this year, there are no legally enforceable rules insuring internet openness. to remedy this absence, the item before you proposes rules to protect and promote internet as an open platform for innovation, competition, economic growth, and free expression, as well as being a driver of broadband investment and deployment. i would like to thank our colleagues in the consumer and governmental affairs bureau and the wireless bureau, as well as the office of engineering and technology for their significant contributions to this item. with me at the table are roger sherman of the wireless bureau. stephanie from the office of general counsel. matt and kristine of the wireline bureau. i would like to acknowledge carol simpson of the wireline bureau for her efforts on this item. kristine will now present the item for your consideration. >> good morning. >> to notice we proposed a six comment on that framework of internet rules that would affect consumers identified in the 2010 order and fosters innovation. the goal of this notice is to find the best approach to protecting and promoting internet openness. there are six key elements to this notice. first, in order to fulfill the objectives of the 2010 open internet order, the notice proposes to retain the scope of the 2010 rules. it seeks comment on whether to revisit the scope of the 2010 rule, including with respect to the differential treatment with regard to mobile and fixed for broadband internet access. second, the notice tentatively concludes that the commission should enhance the transparency rule that was upheld by the d.c. circuit to ensure that consumers and providers and the internet community at large has the information that they need to understand the services that they are receiving an offer to monitor practices that could undermine the open internet. third, the notice proposes adopting a tax of the 2010 no blocking rule that the rule prohibits broadband providers from providing edge providers of a minimum level of access to the broadband providers' subscribers. this would provide an important foundation in the efforts to protect and preserve internet openness. fourth, for contact not prohibited by that no blocking rule, the notice reposes a rule that would require broadband providers to adhere to an enforceable legal standard of commercially reasonable practices. the notice asks how internet can be prohibited under this standard and whether certain practices like paid prioritization should be barred altogether. for any practices that are not prohibited outright, the notice proposes a number of factors that the commission can consider when determining whether the conduct in question would harm internet openness. fifth, the notice proposes a multifaceted dispute resolution process to enforce the open internet world. this enforcement mechanism is intended to provide legal certainty, decision-making, and effective access for users from providers and broadband networks alike. for instance, the notice proposes to establish the role of an ombudsman person who would act as a watchdog that would represent the interests of consumers, startups, and other small entities. the notice proposes these enforcement mechanisms include the self-initiated investigation and formal complaints and formal complaint processes adopted in the 2010 open internet order. sixth and finally, the notice proposes to rely on section 706 of the telecommunications act of 1996 as the source of authority for adopting the rules that will protect the open internet. it seeks comment on the best source of authority for production of internet openness, whether section 706, title 2, or another source of legal authority, such as title 3 for wireless services. with respect to the possibility of proceeding under title 2, the notice seeks comment on whether and how the commission should exercise its authority under section 10 of the act or section 332c1 for wireless services, to forbear from specific title 2 obligations that would flow from the classification of service. the bureau recommends adoption of this item and requests editorial privileges. thank you. >> thank you and all the bureau. let's get comments from the bench. commissioner? >> thank you, mr. chairman, when my mother called about public policy concerns, i knew there was a problem. in my 16 years as a public servant, emily clyburn has never called me about an issue under consideration, not during my time serving on the south carolina public service commission, not during my tenure here at the commission, nor as a chairwoman, never. but all that changed for me and us on monday, april 28. indulge me for a moment. my mother is a very organized, intuitive, and intelligent woman. she was a medical librarian who earned a master's degree while working full time and raising three very interesting girls. she is smart, thoughtful, and engaged, and she is a natural researcher. so when she picked up the phone to call me about this issue am i knew for sure something was just not right. she gave voice to three basic questions, which as of today's date her message remains on my telephone -- what is this net neutrality issue? can providers do what they want to do? and if it already passed? like any good daughter with an independent streak, i will directly answer my mother's questions in my own time and in my own way. [laughter] but her inquiry truly echoes the calls, letters, e-mails i received from thousands of consumers, investors, startups, health care providers and educators, and others across this nation who are equally concerned and confused. all of this demonstrates how fundamental the internet has become for all of us. so why are we here at exactly what is net neutrality or open internet? let me start from a place where i believe most of us can agree, that a free and open exchange of ideas is critical to a democratic society. consumers with the ability to visit whatever website and access any lawful content of their choice can interact with their choice can interact with the government, apply for job, or even monitor their household devices, educators having the possibility to access the best digital learning tools for themselves, and students in health care treating patients with the latest technology, all of this occurring without the services or content being discriminated against or blocked, all content being treated equally. small startups on a shoestring with novel ideas, having the ability to reach millions of people and competing on a footing with those established carriers and their considerable budgets, innovation abounds with new applications, technologies, and services. at its core, an open internet means consumers, not a company, not the government, determine winners and losers. it is a free market at its best. all of us, however, does not nor will it ever occur organically. without rules governing an open internet, it is possible that companies and broadband providers could independently determine whether they want to discriminate or blocked content, pick favorites, charge higher fees, or distort the market. i have been listening to concerns, not just for my mother, but from thousands of consumers and interested parties. startups this year, they want a chance to succeed if access is controlled by corporations rather than by a competitive playing field. investors who say they will be reticent to admit to companies because they are concerned their new service will not be able to reach consumers in the marketplace because of high costs or differential treatment. educators, even where there is high capacity connection at their school, feel their students may not be able to take advantage of the best and digital learning. health care professionals worrying the images they need to view will load too slowly and patients will be unable to benefit from the latest technologies and specialized care made possible through remote monitoring, and i'm hearing from everyday people who say that we need to maintain the openness of the internet and that this openness enables today's discourse to be viewed by thousands and offers them the ability to interact directly with policymakers and engage in robust exchanges like we are experiencing today. in fact, let me say how impressed i was when i spoke to some of you clear this week. you came from washington, north carolina, new york, virginia, on your own dime, to voice how important this issue is to you. average consumers should have the same access to the internet as those with deep pockets. there are dozens of examples across the globe where we have seen firsthand the dangers to society when people are not allowed to choose. government locking access to content and stifling free speech and public discourse, countries including some in europe where providers have degraded content and apps are being blocked from certain mobile devices. problems have occurred at home, particularly with regard to apps on mobile devices, even though providers in the united states have been subject to net neutrality principles and rules with the threat of enforcement for over a decade. to mom and all of you, this is an issue about promoting our democratic values of free speech, competition, economic growth, and civic engagement. the second question she posed was, can providers do what they want? the short answer is yes. as of january, we have no rules to prevent discrimination or blocking. this is actually a significant change because the fcc has had policies in place dating back to 2004 when the commission unanimously adopted four principles of an open internet and internet policy statement. these principles became the rules of the road with the potential for enforcement. in 2010, commission formally adopted rules to promote an open internet by preventing blocking and unreasonable discrimination. when the commission approved these rules, i explained why i would have done something differently. for instance, i would have applied the same rules to both fixed and mobile broadband, inhibited paid prioritization, limited any exceptions to the rules, and i am on record as preferring a legal structure. the 2010 rules are a compromise. yes, mom, i do compromise at times. in january of 2014, the d.c. circuit disagreed with our legal framework, and here we are again. so i say again that the court decision means that today we have no unreasonable discrimination or no blocking rules on the books, so nothing prevents providers from acting in small ways that go largely undetected. and nothing prevents them from acting in larger ways to discriminate against or even lock certain content. to be fair, providers have stated that they intend for the time being not to do so and have publicly committed to retain their current policies of openness. but for me, the issue comes down to whether broadband providers should have the ability to determine on their own whether the internet is free and open or whether we should have basic clear rules of the road in place to ensure that this occurs as we have had for the last decade. and this may be surprising to some. but i have chosen to view the court decision in a positive light, for it has given us a unique opportunity to take a fresh look and evaluate our policies in light of the developments that have occurred in the market over the past four years, including the increased use of wi-fi, deployment of lte, and the increased use of broadband on mobile devices, to name a few. this enables us to issue a clarion call for the public or they can once again help us answer that most important question of how to protect and maintain a free and open internet. that ability officially begins for everyone today. the third question, and judging by the headline and subsequent reactions, my mother is in good company here? has it passed? no, it has not, but let me explain. some accounts have reported that the chairman's initial proposal is what we are voting on and have conflated proposed rules with final rules. neither is accurate. for those of you who practice in this space can i ask that you bear with me for a few minutes. when the chairman circulates an item, it is indeed a reflection of his vision. my office then evaluates the proposals, listens to any concerned voice by interested parties, including consumers, and considers whether we have concerns, and if so, what changes we want to request so that we can move to a position of support. this item was no different. it is true, i too had significant concerns about the initial proposal, but after interactions among staff, my office and the chairman's office, and the chairman, this item has changed considerably over the last few weeks, and i appreciate the chairman for incorporating my many requests

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