.. including veterans and native americans. this is an hour and 40 minutes.

>> we will call the order of this hearing on efficiency and effectiveness in the workforce. this morning's hearing is entitled developing the workforce and building partnerships that i look forward to hearing from our witnesses about efforts made by the federal health care workforce to address the needs of rural american including veterans and native americans. they will discuss some of the challenges of this task including efforts to recruit and retain quality health care workforce and he will be will highlight opportunities for collaboration and cost-sharing and stronger partnerships between agencies and local providers. -- is work closely with the veterans a native american population. i'm aware of the challenges in rural and frontier areas

accessing quality health care. in a timely manner. to address these challenges will require multifaceted approach between to invest in technology telemedicine and bring health care health care closer to home. went to expand the number of mobile clinics and vet centers and improve transportation options for folks that are forced to travel significant distances to receive the health care that they need. but we also need to address tonic health care workforce shortages rural communities and agencies like the va and indian health services. far too often we have seen of facilities that vital as we can't recruit enough bensahel professors to an area or scene veterans burdened for care because of nursing shortages of a particular facility. this is not a va's specific album. it's a rural international problem. we need government agencies to aggressively and effectively work together to ensure they are working in cooperation and not in competition. this collaboration shouldn't

only be happening between federal agencies. it should be happening at the state level and it needs to be happening in more rural areas. in these communities the federal health care workforce needs to leverage with limited resources it has and empower local partners to more effectively increase access to care. just because a veteran lives in a place like montana doesn't make him or her less deserving of a timely and quality health care. we have some great witnesses with us here today and as we discussed these critical issues in more detail i look forward to hearing from each of them. i will now turn it over to ranking member portman for his opening statement. >> thank you mr. chairman and thank you for having the hearing today on an incredibly important issue for montana and ohio and across the country. it's an important topic and i think the testimony we are going to get today will shed light on these issues facing rural health care in particular and thanks for the witnesses for being

here. this panel in the coming panels. one of the most important functions are federal government must fulfill as the care for veterans and we need memorial day to think about that. they are out there defending us in the mission continues when they get home and we have to make sure we are there with them. there are few health care problems right now facing veterans in rural communities including the lack of sufficient health care providers who need to travel as the chairman said and significant distances to seek care in many cases. like her urban veterans are rural veterans returning from iraq and afghanistan are coping every day with with the visible and invisible wounds of war but unfortunately for them and the rural areas health care is not readily available. i would like to discuss these topics in the context of traumatic brain injury because it's often referred to as a signature wound unfortunately from the wars of iraq and afghanistan.

over 10 and 66,000 servicemembers have suffered traumatic brain injuries are tbi's from 2000 to 2012. at the same time the sierras research service has estimated 100,000 servicemembers who have served since 2000 suffer from post-traumatic stress so it's one thing to fail to get our rural veterans treatment for an orthopedic issue or help may be on a diabetes management program but often it's another thing entirely to present the full scope of treatment needed for veterans suffering from tbi or post-traumatic stress. i know our witnesses recognize the scope of the problem and each of the department has departments has embarked on a number of initiatives to address those problems and i look forward to hearing more about that today. i will say i'm concerned that we are making internal adjustments in small steps forward where is the size of the problem is bigger than that. it's daunting and the longer we take to address it the worse

it's going to become. our treatments are now providing for our veterans are not as effective as they could be and i think the pilot projects and assessments are important but we have a big problem that we need to address and that is what we'll talk about today. tragically we are losing rare till 22 veterans a day to suicide. the fundamental changes are needed to occur from the way fee interacts with our veterans to provide care and we will talk about that. when i'm back home in ohio i regularly talk to our veterans about their interactions with the va and some are very positive. some of the stories i hear from rural veterans are slightly similar to what the chairman hears in montana long drives and longer drives in montana probably. expensive drive sometimes to get the treatment they need. and coordinated appointments varying customer service. when a tbi patient may find it difficult to remember his or her appointments may find it difficult to find directions for the people have to drive a

couple of hours to an appointment and when he shows up a little late after driving through blizzard and has to reschedule his appointment for weeks later we are not setting that person up for success. unfortunately the stories i have heard are not isolated and i know in montana some of the same stories are out there. we have got to leverage the resources of our nation for the men and women who have given so much to us. we have providers who stand ready to support this population with over 6 million rural veterans and giving the opportunity to do so. connecting our rural veterans with the right treatment is something like to be focused on we will talk about that today. thanks to our witnesses and i look forward to the testimony today in discussing these issues. >> thank you senator portman and i would like to say thank you for your opening statement and as we kick off the first hearing of the sub committee i want to say i look forward to working with you to help improve issues whether it's health care or something else and it is the pride taste subject so i look forward to working with you to

get-somethings done. i would like to welcome our first panel of witnesses who have spent years in public service working to increase access to health care for rural americans and have dealt extensively with the challenges of her trading entertaining a quality health care workforce. for as well as lex introduced dr. robert sub on the undersecretary of health for the department of veterans affairs. he has served in that capacity since this february 182000. he oversees the health care needs of 8 million veterans currently enrolled in the veterans health administration the nation's largest integrated health care system. vha employs over 272,000 staff members and 1700 sites across this country. last year the va treated 6 million patients during 80 million outpatient visits and 692,000 patient admissions. welcome dr. petzel. it's great to see you and we look forward to your testimony and look forward to getting it back in montana.

next we have dr. roubideaux who is the director of indian health services ihs that the u.s. department of health and human services. she has served in that capacity since 2009. ihs provides confer health of health and service over system for approximately 2.2 american indians alaska natives from 566 federally recognized tribes in some 35 states and they serve a critical role in my state of montana. it's good to see you again and we look forward to your testimony. last but certainly not least least we have tom morris the associate administrator for the office of rural health policy and the health resources and services administration otherwise known as hrsa an agency within the u.s. department of health and human services. it's a critical research and policy resource on rural health issues and administers a number of critical programs and enhances the delivery of rural health care.

his office works closely with local partners to increase access and to build capacity within those communities. tom also happens to serve on the veterans health advisory committee. welcome tom. it's good to have you here. there she is. we just got going. before we go to dr. petzold for his opening statement -- you can have an opening statement if you would like. okay. we will start with dr. petzel. you will have five minutes for your oral testimony. know that your full written testimony will be made a part of the record so with that dr. petzel you may proceed. >> chairman tester ranking member portman and members of the subcommittee thank you for the opportunity to speak with you today about recruits retains and deploy a quality health so

they can access the health care they have earned and deserve. they be as committed to providing veterans with quality timely and accessible health care is close to their home as possible. veterans mental health is a top priority for the va and apart of president barack obama's executive order to improve access to mental-health services for veterans servicemembers and military families the va has made significant progress to increase the mental health workforce to meet the needs of veterans. as of may 14, 2013 the va has hired 1367 new mental health providers. in addition to that we have hired 2063 mental health providers to fill existing vacancies over the past 10 months the va has hired almost 4000 additional mental health providers. in addition to that we have begun hiring a new group of

people called peer specialists and today 261 of them have been hired. we are aware of the challenge is to recruit and retain a quality health care workforce and are implementing creative recruitment strategies to ensure access to care for all veterans. these efforts to increase the awareness of employment opportunities include national advertisements television commercials public service announcements and to meet the mental health needs of veterans and their families the va has began to hold facility based mental health summits with the purpose of building and expanding coalitions with community providers organizations in the communities and federal and state agencies. the va is dedicated to improving access to quality health care for rural veterans by developing innovative practices to support the unique needs of veterans residing in geographically remote areas. the va has used a number of programs including project a.r.c.h., patient-centered care

cortisi three in order to provide eligible veterans with coordinated and timely access to care through a network of nonva medical providers who meet to be a quality standards. the va will continue to implement new ways to broaden the axis two approaches to bringing care to veterans. especially in rural in geographic areas where can it can be difficult to recruit health care professionals and where travel distances are excessive. the va is a national leader in telehealth-based care. fiscal year 2012 dh today provided care to half a million patients through video clinical conferencing forward technology telehealth and tell a whole health. this number is set to rise to 830,000 in 2013. specialty care acts such as network extensions for community

health outcomes or echo is one initiative that the deed a.j. is using to ensure the liberty of the specialty care services to improve access to specialist. scan of go leverages telehealth to allow health care specialist from a regional center to offer expert at rice to providers in rural health care settings. another initiative is -- this -- this offers on-line access to va health care through the va health care system and designed to give them greater control over their health and wellness. features of the system include the ability to communicate with providers, refill prescriptions and to access their electronic medical records. va optimizes the delivery of treatments by using technologies and tools such as mobile applications. these mobile applications can help with the veterans resilience and to manage their daily challenges. the award-winning ptsd coach

mobile app provides an opportunity to better understand and manage the symptoms associated with ptsd. pe coach a prolonged exposure therapy coaches a mobile application for patients to use with their therapist during prolonged therapy as a treatment companion. the va maintains partnerships and continuously seeks to foster relationships with government and nongovernment organizations to bring value to veterans and expand access for the care they have earned and deserve. the va has a strong history of collaborating with mental health clinics including federally qualified centers. these locally developed community partnerships provide mental health services to veterans and areas where direct access to va health care is limited by geography or workload. in response to president barack obama's executive order the va

working closely with the department of health and human services initiated 15 pilot projects to evaluate how these partnerships can help bring mental health services to the areas that are experiencing difficulty in providing direct care. we are committed to building an accessible system that is responsive to the needs of america's veterans. the va continues to implement its rural work for strategy to recruit locally and utilize the necessary resources including collaboration, technology and partnerships to achieve these goals. i think the subcommittee for the opportunity to appear before you to discuss this important issue and i'm prepared to answer any questions you may have. >> thank you for your testimony dr. petzel and we will move to dr. roubideaux. >> thank you chairman tester ranking member portman and others of the subcommittee. my name is desiree roubideaux and i'm pleased to provide testimony in the effort to

develop and support the federal health care workforce. it plays a critical role in supporting the overall mission of the page as as a rural health care system addressing the population was significant disparities in health and access to care. i h.s. share similar challenges faced by rural communities across the nation. many of our ihs facilities are in rural in remote locations where recruitment and retention of employees especially health care providers present unique challenges. i h.s. vacancy rates for health professionals has improved over the past few years but they still remain an issue. for example dental vacancies were greater than 30% but increase the focus on recruitment and retention to reduce those vacancies to approximate 10% however continued efforts to improve recruitment and support are critical. over the past few years i h.s. has improved and contributed to

better support and strengthen ihs workforce since many of our reforms are based on input and recommendations from our employees and their stakeholders. ihs also supports programs such as the american indians and medicine and psychology and the american indians nursing program which helped develop student interest in health provisions and encourage them to return to their communities and work for ihs in the future. the ihs health profession scholarship program is a key strategy for the agency in developing the future alaskan native workforce. the ihs loan repayment program is one of our most effective recruitment and retention tools for the recruitment of a variety of positions in our workforce. ihs has worked to strike the recruitment and retention strategies for gathering input from our workforce and stakeholders to better understand the needs of our workforce. another important strategy to improve recruitment and retention is to improve the work

pace environment at ihs to better support our workforce. ihs has made improvements and background checks the hiring process and credentialing and privileging of providers to ensure that we have a quality federal workforce. ihs has also worked to make their salaries more competitive with the private sector which is especially important for help with additional improvement. ihs has leverage many partnerships to help develop and support its federal workforce with other federal agencies academic institutions and tribal committees. our partnership with the health resources and services administration has helped us recruit more health professionals who work in ihs through the national service corps scholarship and loan repayment program through their partnership at the va has helped us improve coordination of care for american alaskan native vitamins -- veterans third 2010 memorandum of understanding in her 2012 va ihs national reimbursement agreement.

those are helping our workforce to improve access to quality health care for american indian and alaskan native veterans. our partnership with academic institutions are extremely important to our recruitment and retention effort because of the link it provides to students in new graduates. one of our most powerful recruitment and retention strategies is our partnership with their communities. as more of our federal workforce feels at home and supported by the communities the likelihood that they will become a long-term member of that community will increase. in summary the federal workforce is central to the core mission of the indian health service and delivery of accessible and quality health care services to the american indian and alaskan native indian comanches. while there is much more do we appreciate the opportunity to testify to further discuss opportunities for improvement. mr. chairman this concludes my testimony and i'm happy to answer questions. >> thank you dr. roubideaux. we appreciate appreciate your testimony we will go to

mr. morris. >> mr. chairman and ranking member portman and members of the committee thank you for the opportunity to testify today on behalf of the department of human health and services the services of about the rural policy. for 25 years the office created by congress has served as a focal point for rural activities within hhs and charged with advising the secretary and impact of hhs policy and regulations programs in rural amenities. this includes an ongoing focus on issues related to the training recruitment and retention of health care professionals in rural communities. we also administer several grant programs related to the capacity building from community ace pilot programs to state programs to focus on improving quality and financial performance and smaller offices. we welcome the opportunity to discuss ways to help rural communities attract and retain health care providers. this is for hrsa and the

administration. they're nearly 59 people living in rural areas and that represents 15% of population spread across 80% of the landmass in the united states. the rural health care center system is focused on chronic disease management and relies on providers like small rural hospital eisen federally qualified hospitals as well as solar providers. the office of policy from several initiatives to focus on building up that rural capacity. this ranges from our work with the state offices of rural health which would provide grants to as well as her work with the state rural grant program and the small hospital grant graham which works to improve quality and financial performance in small rural hospitals. hhs's investment in rural amenities goes far beyond the programs. for example administrators at the national service corps which offers a lifeline to rural munizzi support loan repayment and scholarships for health care providers. almost half of those providers are in rural areas.

training programs and primary care behavioral health dentistry in nursing play a key role in training the next generation and we are have we focused on investing in community-based training for physicianphysician s whether through her health center programs in which 15 of the grantees serve rural minister for work supporting the 23 tracks across the country. studies indicate 70% of graduates of these rural training track stay in rural practice and we are focused on increasing student interest in this program and working with communities to start rural training tracks. rural areas benefit greatly from the hhs and state j. one visa waiver program which -- and communities who need them most. it works with essays the national rural recruitment and retention network and conscience in rural areas and passers. we have long supported grants to link urban specialist with rural

communities in need need and yet we are seeing for grant programs and emerging technologies such as e. emergency care as well as telehome monitoring. telehealth technology plays a key role in extending the reach of mental health work orders particularly in areas where psychiatrists and psychologists are often scarce. we also currently our funding for telehealttelehealt h pilot that includes montana and alaska to link ware veterans to telehealth and health information exchange to enhance their care. also working with a range of federal partners through their rural council to train workers need to operate and maintain the south information technology systems whether we are talking electronic health health records telemedicine or health exchange. we expect this to be a key job growth area as these technologies continue to be deployed in health care. thank you again for providing the opportunity for share the mission with you today and the efforts we have underway to focus on rural workforce challenges. i'm pleased to respond to your questions.

>> thank you mr. morris for your testimony. it's around 10:30 there will be a vote called and what we are going to do is we will decorate it out so we are not going to adjourn. we will stagger out and then rob comes back he can do otherwise and if we both have to be gone we will kick it over to senator baggage or senator heitkamp. thank you. seven minutes on the clock please. dr. subeleven, the va has made a commitment to higher 1600 new mental health care professionals health clinicians i guess we will call them and i think about 300 support staff and correct me if my numbers are wrong. where are we at those hirings both for the clinicians and for the support staff? >> the numbers are correct mr. chairman. the clinical providers we have

two ways that we look at this. one is the actual positions that were identified that up and filled as of the 14th of may we have filled about 1356 of that 1600 clinical mental health providers. another way that we look at this is every quarter we are able to assess the number of clinical providers providing direct care that we actually have on board. we went back and look to what we had on board in may of 2012 and we began this effort. now i have the most recent data from march of 2013 and that indicates that we have got an additional 1556 people on board providing mental health care than we did back in may. so we believe that we are well on our way to meeting that

whole. we have basically hired almost all within a few short of the administrative -- >> what are the totals? >> that total mental health that we have and i want to make sure i get this number correct but i believe the total mental health we have on board providing direct patient care is about 18,600. that would include psychiatrists, psychologists, mental health nurse, clinical health specialist nurses, psychiatric social workers, masters trained counselors and pastors trained family therapist. >> as you well know on montana and i think this could be said for all of rural/frontier america. we have suffered with mental health shortages for years so unless we are getting a healthy portion of new hires which you have indicated we have is unable

to make up the browned -- ground with ptsd and tbi and the issues that we haven't seen. we will just call them the unseen and veterans coming back for more. you talked about where we are today. in the future are there long-term efforts for assessment and if so is there long-term efforts for recruitment to go with those assessments as we move forward to help bring in more of our young folks and to the eye of rural america? >> first of all mr. chairman their ongoing recruitment efforts and these will continue because we have continuing developing vacancies. i'm pleased pleased to say the vacancy rate has actually dropped from slightly over 13% amongst clinical mental health providers to a little bit below 11%. that is a significant number when you're talking about almost

20,000 mental health professionals. we are assessing and we'll assess actually continuously whether or not we are meeting the access standards that we have described and if we discovered that we are not able to do that because we did not have the personnel available we will continue to add to the mental health workforce. but i think it would be useful if i could take one minute to describe the other thing that we are doing that are relatively new efforts. most important of which is the use of telehealth and telemental health to deal with the shortage of psychiatrists which we and everybody has difficulty recruiting into rural areas and i know you are very familiar with that. we have set up regional centers of psychiatry that communicate with community-based outpatient clinics and provide consultation

and therapy by telemental health from remote areas such as spokane washington where we are having difficulty recruiting psychiatrists into one of the centers in an urban area where we are able to recruit psychiatrists. we have more difficulty recruiting psychiatrists in new york or minneapominneapo lease or houston or san francisco. these regional centers are proving to be very effective. the telemental health therapy is very well received by veterans. they like the idea that they don't have to travel great distances. they are not frustrated by a 45 minute drive even across town in an urban area. that is going to be a major effort in the next two years to help us provide the psychiatric services in remote areas. >> thank you. and thank you for your work. dr. roubideaux i want to talk about some of the challenges that may be unique to indian

country as you seek to recruit and retain quality health care folks. time and again we hear administrators who must ring and folks from outside of the area's primate cared doctors and specialists and nurses. these are highly-skilled and high-paying job in indian country. i had a group of eighth-graders in my office yesterday and one of the questions they asked me was how do we get more doctors and nurses from crow country and the crow hospital? these are 12, 13-year-old kids who understand what's going on. we talked about the challenges of recruiting in indian country. >> our challenges are significant and we certainly would like to recruit more individuals from our tribal communities to work in our facilities and the health professionals. the challenges of social

economic activities and then they have to travel far away for their education sometimes they don't come back. our health programs help us recruit and retain american indian and alaska natives to work in our system. the indian preference law helps us a lot because i would say approximately three-quarters of our employees right now are alaska natives. the place where we have difficulty recruiting american and alaska natives in some of the health professions that require training at a distance from the indian reservations and recruiting them is a challenge better loan repayment programs really help with that. >> i'm going to take it over to senator -- now. >> thank you mr. chairman. dr. petzel i wanted to ask a little about the va providers and rural veterans.

i know we talked about that despite hiring 1500 new physicians in the last year on the mental health site. beyond capacity issues were sometimes you do have to use a fee service what is the threshold? how far do the required veteran to go to seek services? how do you define geographic accessibility which i know is one of your criteria? >> thank you senator portman. we have definitions of distances. 60 miles would be an example and time, 60 minutes to services. those are not really used in a great since when we are evaluating whether someone should read cnas recall ever

cared for in the community. much of it has to do with convenience of them or inconvenience of them being able to travel. if you have an 81-year-old gentleman who lives even 60 miles from a medical center, it is a burden to ask that individual to travel for a routine clinic appointment. some individuals who are much closer but have it travel in an urban area, that can be a daunting task for somebody who is 81 years old. so we tried to do two things. number one and option is providing the care and a local community and we have got two pilots that are running right now looking at that option. another one that we are doing using in increasing numbers is what we call telehome health. a video camera in the patient's home, instruments to monitor the patient's weight, ekg, blood

pressure and regular context with their primary care provider at the clinic or their medical center. it has proven very effective in taking care of patients with multiple chronic diseases and providing them with the opportunity to not travel to a clinic. we reduce emergency room visits by 40% where we have done this and studied it as we have reduced clinic visits by 30% and we have reduced hospitalizations by almost a third by providing this care in the home with constant communication. >> for mental health treatment, is that as effective as it is for other types that we talked earlier, the fact that trends with ptsd or tbi so maybe for someone who is again recovering from a procedure or somebody on

dialysis. maybe you worked through some of these issues. using some of the telemedicine you're talking about but how does it work with mental health? is it a challenge? >> telemental health is remarkably well accepted. it began in the va on the rosebud indian reservation in south dakota almost 10 years ago now. it's a study. treating ptsd by telemental health by a researcher at the university of colorado proved to be very successful and was really the impetus for spreading telemental health around the country. the acceptance rate by this and the satisfaction rate by this is over 90% for the patient. i will tell you and anecdotes very quickly. ann has to travel 45 minute ticket to his psychiatrist who works in one of the medical centers there and he described

why -- life on the video camera the experience, 45 minutes through traffic. he's frustrated gummies angry and he is not the same kind of person that is normally is by the time he shows up for that appointment. when he does the telemental health therapy sitting in his own homecoming home, his comfortable and he hasn't driven across urban traffic. he is relaxed and he is an entirely different person. the therapy session as a dramatic way better effect. it works. it works very well and we are going to be exploiting this to the maximum over the next several years. >> do you think that using nonva providers for mental health and tbi is something that you are doing adequately? i noticed in the data you provided the committee that 2% mental health patients receive

nonva health each year. they use nondod mental health providers for tricare recipients on a regular basis. what is your policy and only allowing 2% of our veterans to seek treatment by many providers is appropriate? >> i think that should be expanded senator. i have no doubt that 2% is not as much as is needed and as could be and we are in fact doing the nonva care arrangement called pc three is going to have entered the mental health component and we will be expanding it. the issues are making sure that those nonva providers are docile with ptsd particularly dramatic brain injury and depression, the things that we see as a result of combat. we are expanding and we intend to expand -- expand our use of

nonva providers. the pilot that we are doing with the federally qualified health centers and i will give an example, we have committed to piloting and 15 locations how this works when we have contract for the federally qualified health care provider. those are up and running 15 of them in five more will be added relatively shortly. i have no doubt that the network is going to expand. >> i noticed that many providers in 2010 it does show an increase from 2007 to 2009 and a decrease in 2010 from 2009. are you suggesting your data for 2011, 2012 and 13 will show an increased? >> certainly senator 12 will show an increase. i don't know what 11 looks like let's 12 should certainly show an increase. >> telehealth are telemedicine, you gave us important information in your testimony and i appreciate that. by your own account you are

seeing over a million mental health patients a year now. clearly a lot more for veterans need the service. if we assume these patients are disbursed like the veteran population as a whole that is at least 300,000 patients in rural areas. and likely just as many are seeking treatment through these health programs that are telemedicine, telemental health programs. how many patients do you think connected? >> that is a very good question. presently it's about 83,000 patients that we have delivered telemental health services too. >> and how many of those 83,000 go to one of your community outpatient-based centers to get that service? >> almost all of them would be going to some location where we have telemental health services.

there are few but not many that we have as the gentleman described in new jersey where we have set this up in their home. >> is that a pilot program you think should be expanded? >> it is not a pilot. it's in its embassy and we think it will be. they are better therapy sessions when we see them in the context of their home. see anything we can do to help you expand the capacity? >> i think that, you think we have the resources senator. we have the money to buy the equipment and the price has wronged dramatically and it's basically just a webcam now, a high-quality webcam on the computer. the think we need help with around the country all of us do is psychiatrist, there are not enough psychiatrists in this

country to meet the country's mental health needs much less meet the needs of rural veterans, people that are being treated by the indian health service. that is probably one of our largest issues. >> thank you mr. petzel. i appreciate your testimony and senator begich. >> thank you very much and got her petzel thank you very much for your work and trips to alaska and other work your agency is done especially around the work with indian health services and delivering health care services to rural veterans especially in areas of alaska where it's very difficult as you know to get access. i want to ask a general question but first i want to commend you for moving forward. i know our tribes have been very motivated and hopefully i have given them the task after period

of time to be working with us on any issues that may come up to make sure we continue that process so i veteran no matter where they lived in rural alaska will have access to care it not worry about having to fly all the way to anchorage or seattle depending on the service they need. can you just give me a quick update on how that is working and how you feel the success of that is? >> thank you senator begich. i wanted to mention that i had dinner last night with catherine gottlieb and i mentioned that we were having a hearing and she said to send your regards. >> thank you. >> we have had great success i think in working with south-central and the other tribes in alaska. the contract that we have for sharing services with south-central has been very effective in providing specialty services. we also have some instances were where in more remote areas veteran patients are being seen in tribal facilities obviating

the need to travel back to indian affair or a -- so the number ,-com,-com ma and the second issue the number of people that are having to travel out of seattle for services has shrunk dramatically and i would say with very few exceptions we want to eliminate that need in the not-too-distant future. there are some ordinary things such as bone marrow transplants which seattle is the obvious place to go but otherwise our goal is to not have veterans in alaska traveling out of alaska in order to receive care. and i think we are making progress. >> fantastic. let me ask on the mental health issue, i appreciate the rate of tory change made to eliminate co-pays on whom providers and

mental health providers. you know this so it's repeating the obvious that we have been on the forefront of telehealth from health care to mental health to delivery of just about everything you can imagine to telehealth. do you have, let's say i am an alaskan who need services to telemedicine and my doctor is in idaho. does that doctormacdoctormac k in telemedicine have to be licensed in alaska? >> the short answer is no. we have first of all in the va i think as every federal health care entity you need to have a license in a state. you do not have to have a license in in the state and which are practicing. the licensure issue is really not a problem.

the problem if it arises is not the credentialing which is what licensing is. if the privileging. you need to have that individual have the right kind of privileges in the right kinds of organizations so if a doctor in boise was doing specialty care for somebody at the anchorage facility they would have to be privileged in anchorage and in boise. we are working to try and smooth out this process. credentialing is not an issue. >> thank you for splitting the two issues. i knew there was an issue here. is there anything we need to do? i know we did some stuff with dod on there and. senator kelly ayotte and i did an authorization a couple of years ago to fix that problem. there were a few more issues they had to make sure no matter

where in active military member would go they could get their mental health services delivered from whatever doctor they had any time. is there anything legislatively we need need to do? the senator begich i don't know. the privileging issue is something that has do with the regulating bodies, the joint commission. the joint commission requires that the individual, the privileged at the point where they are delivering the care. there is no law and there's not even a federal regulation that has anything to do with privileging. is the requirement and we have been working with them to find ways to make it easier to have people privileged various places but right now privilege inning is the right of the medical center or the clinic that is delivering the care. >> very good. let me again say thank you for all the work that you guys have

done in regards to getting what i call the heroes card, the delivery for health care for veterans to matter where they lived and the services they have burned so thank you for that. >> i would like to comment on the fact that the working with the ihs in alaska has just been wonderful. it's been a very good example of federal collaboration. >> thank you. they are great group. let me ask dr. roubideaux if i can and dr. petzel thank you very much for that. as you know, we have a significant problem and i want to echo what dr. petzel said. our indian health services drive the task and a covered health care. we have the top in the country when it comes to delivering the most harsh climates, conditions and situations so i agree that we have incredible -- that we are making headway.

one of the issues and you have heard me talk about this before and that is the consistent problem of staffing. how do you make sure that if you haven't vacancy rate of 30% in some of europe's categories as you describe but the bigger issues, we have as you know nau is completed and a beautiful facility. they can deliver the services the federal government contracted with them to do. you have got about 53 million last year in the cr nationwide. just the one in fairbanks will have 8 million of that. how are we going to solve this because it's one thing to have a clinic in an urban area but you get someone hired in arra area like alaska you can't do it the

day they are open. it doesn't make any sense. how are we going to solve this because this is obviously unacceptable. we have invested lots of money these facilities and then we don't staff them. what is the answer here because these arra areas. >> the answer is for us to work together on the appropriations that will help us get the staffing packages and i'm pleased to report that the president's budget for 2014 in terms of new and replacement facilities including joint venture facilities and federal facilities in alaska helps us catch up. it's been difficult over the past few years but force and there are collaboration working with the tribes our proposal for $77 million in the staffing helps us catch up. >> but is that enough?

>> that is enough to catch up with the need for the facilities plan to be opened in 2014 so right now we are doing our 2015 budget formulation and trying to estimate which ones will be open then as well. >> let me ask one more question and then i have got to go vote. this one is the massive facility. they have the top four available. the va has a clinic down the street at that capacity. it doesn't have full service but it's a clinic. the clinic that the va has takes the space, the beautiful space. it's all federal money. >> the great thing about -- >> is that a good idea of? >> yes because mou allows us to do that through the sharing of facility and staff so we have started to do that and we hope to do more. >> we would be delighted if that kind of an arrangement worked

for both parties. >> we want to work with you specifically on that. thank you, i have to go vote. >> thank you mr. chairman and thank you to all the members of the panel. i want to point out the two senators whose names were in the testimony were senator conrad and senator -- vote from north dakota and both deeply concerned over a long period of time about the issue of her help delivery. whether its veterans are native americans or just mom and dad on the farm. this is a critical issue for us and the critical infrastructure issue for the development and the continued viability of rural america. i thank the chairman for bringing this very important issue to the forefront and i have bought these for more questions than what i have time.

i would ask for an opportunity to commit additional questions going forward. but i want to first make a point. we have heard every bit of your testimony across-the-board talking about telemedicine, talking about the need to do things a little differently. expand your capacity by using the technology. our uke so convinced that the technology is available in indian country are rural america, the kinds of things you think you can do in washington d.c., do you really believe you can do it at home? nd? is there the infrastructure back home, the amount of technology and have you looked at those issues going forward when you're promoting telemedicine as a solution? >> senator i will take a crack at that first. 10 years ago but technology was clunky. it required special telephone lines that were often difficult

to get into in terms of remote areas. that whole technology landscape is changing dramatically. number one we can now use a high-resolution web camera to provide the same kind of fidelity of image etc.. >> out mean to interrupt but is that true in every remote location in the united states? >> we can put that technology in a place and we can then use the internet. >> what happens if the internet is intermittent and dial-up? see if it's dial-up, we have not run into those kinds of difficulties in really anyplace. we have been to rosebud and providing services of this nature on pine ridge. we are going to be providing those services in devils lake in north dakota and every place we have used it has been number one reliable but i think are

importantly it is very well accepted by the patients. patient. when they see that as an alternative to driving 100 miles to fargo they will take it in a minute and they like it and they get good care with it. i am convinced that this is going to be the wave of the future. >> mr. morris i would like to hear your response for that. your umbrella is a little broader. >> i think there are some challenges in terms of -- is there enough capacity and we can get back to you for the record. i know there has been some analysis of where their broadband gaps. the fcc is has done revisions to its universal service program for rural health care that we think is going to be key to that

last mile and expanded capacity for those areas and that was announced within the last couple of months. in addition to that, some of these recovery through the department of commerce and agriculture help close some of that gap but there it areas that are not accessible. >> i don't think there's any doubt that there is still a digital divide in the country and that is my point. we are going to solve it with telemedicine and then not have the highway that is going to take you there. and so i am chairing on the ag committee the rural development subcommittee and this is an area that goes beyond telemedicine but this is obviously an absolute critical component of rural development in my opinion. i have a question for dr. roubideaux as well. obviously senator begich and the

work that has been done in alaska is very intriguing to us in north dakota. we think we have remote locations. we think that we have a great deal of difficulty and i would tell you that where you hear a lot from him in terms of indian health service that is not what i hear in my state. what i hear is intermittent services. i hear clinic shutting down because they don't have the capacity and don't have the staff to even open up on a friday. that overflow goes to other hospitals and so i am very concerned about the long-term commitment and appreciation that you have about the concerned that native americans of my state have about the quality of their health care. >> i want to reassure you that we are absolutely committed to providing health care services to the best of our ability to american indian and alaska natives and you're absolutely right. there are differences among areas.

it tends to track around the difference between the proportion of more direct service program versus more trebly manage programs and there is flexibility in travel management better helping alaska do some really innovative wings. we still have the federal trust responds ability and our commitment to the direct service program in north dakota and throughout the regions in the country. we are still working very hard to try to have improvement in those programs. >> not to prolong it but i will tell you this. there are concerns about innovation especially in the mental health areas within the indian health service because it doesn't fit with what people may see as traditional models and i would like to have a longer conversation with you about that going into the future. we need to be innovative in indian country in order to provide these services and continue to develop the work force and the technical

expertise of anyone who wants to offer their services but particularly the programs that we have two train indian doctors and indian nurses. if i could indulge one additional question. i am very interested in looking at modeling the health program that senator begich has been able to get a pilot on. i'm very interested in modeling that in north dakota and particularly as it relates to native american veterans. i think anyone who understands indian country knows that many native americans in terms of the percentage of their population this serve has doubled, tripled in the armed services. when they come home to have access to indian health and access to veterans but neither one seems to work for them so we don't want people who have

entitled to veterans services to have to get on a bus and drive 10 hours and literally weighed in fargo another eight hours while the other patients on the bus get their services. as somebody who understands chemotherapy that is not a healthy thing to do to people. we really believe that north dakota would be a great additional site for modeling a hero's health card in the lower 48. >> we would be delighted -- be delighted to talk with you about that. >> terrific. ..

>> that collaboration was continued, and i think it's taken time for us to understand the unique challenges the va has and how that intersection takes place between the va providers and private providers, but i think the fact remains so often veterans return from the previous two wars, especially, coming back to the towns, seeing care from the local providers and going to the va for specialized care. the challenge, but also i think

the opportunity, is how we can both, the private sector, and va, dually care for the pairkts. part involved as we share patient information that you need the privacy and security challenges of the va's fire wall, but there's progress made there through the initiative with blue button, a form of health information exchange, and we have a veterans' pilot program right now. one of the grantees in your state in montana and alaska and virginia, in which we put money to put health equipment in hospitals and clinics, reach out to the va so that, for instance, a veteran might be able to get the ptsd treatment from a va provider without leaving their home community even if there's not a veterans' clinic in that location, so that program is really still in its infancy, and we are recompeting it now for another three year of grants,

and we hope it's a pilot so those who care for veterans reach out to the va and their regions and care for the patients effectively as possible, and then we're in conversations with the va office of rural health looking at a number of pilot sites, focusing on health information exchange so that as veterans sees cares in both places, patient information, the medical records are back and forth between both groups. >> very good. i would be remiss if i didn't ask this question that senator alluded to. it's a collaborate between, and i expect you both to say it's working great, but what are the challenges you faced with the collaborations that you've done together, and that's the first question to each of you, and the second question is do you have all policy flexibility you need to be able to do collaboration?

basically, in many, many cases, you serve the same group of people, and so if you can talk about what the challenges have been and then talk about if, in fact, from a policy standpoint if you have the plexability you need, whoever wants to go first, go ahead. >> >> well, we appreciate the partnership with the va and willingness to dig in and deal with challenges we face. we are two different systems and two authorities and we have to work through issues. there's the need and distances that are really challenging us as we work together, but i've been requiring my directors and ceos to work with the va over two years and meet with them, and that's actually going really well. we're starting to have the conversations we need to have through some of the challenging issues, and the -- so that relates to the policy issues, and i think the reimbursement agreement was a great opportunity for us to understand each other's authorities and

understand some of the innovative ways we could collaborate and innovative things we could do. i appreciate the partnership with the va because they are willing to dig in at some of the hardest challenges we are facing. >> from your perspective? >> i would say in terms of washington and here, the collaboration's excellent. the attitude, the desire to make this work for both of us, the desire, particularly from our perspective to serve veterans wherever they might be is unparalleled. the issue for me is generally how this is executed locally. you know, on both sides. i'm not saying it's either the va or the ihs or the tribes, but it works better in some areas than it does in others. alaska, i think, is an example of where it works wonderfulfully. we have sharing agreements from every tribal organization in alaska. we have reimbursement pilots in

almost all of the states. in other parts of the country, we're -- we have difficulty with our people getting together with ihs people, and i think that my responsibility is to be sure that the attitude that we have in washington is transmitted down to the level where the work is being done, but i would also agree that it is, as i would look at it, working very well. we have a number of places around the country where we do do sharing. clinics are located from the va perspective on tribal grounds. the reimbursement agreement, i think, was a huge step forward. ten pilots piloting that reimbursement agreement to work out the kings in terms of charges and how bills a paid and how patients move back and forth. there's always room for improvement, mr. chairman, and that's, in my mind, at the local

level where we need to be sure that people do everything they can do to develop the cooperative relationships in places like devil's lake, places like the reservation and billings clinic, ect.. >> right, okay. thank you, all, very much. do you have any further questions? okay. i just wanted to thank you all for your testimony and thank you all for your -- the question-answer session we had. the record will be open for 15 days. if there's additional question, and i know there will be because i have some myself and others will do or additional comments to be put in the record, you can do that over the next 15 days. thank you, all, for your service, and thank you for being here this morning. now we'll go to the second panel. if you would come up, and we'll get the name tags changed.

>> i'd like to welcome the second panel of witnesses who both work tirelessl yrks over the years to improve health outcomes and increase care to more folks. we have, first of all, mr. matt cons, from the great state of montana, remits the best of montana. he graduated from west point, served with distinction, army infantry officer, spurred by personal loss, recognized by president obama. currently, he practices law, serves as executive director of the national alliance on mental health from montana. matt took on the role to support, educate, and advocate from all suffering from mental illness and their families. he's done a tremendous job in

that capacity, and i'm proud of the work, and the work of the national alliance on mental illness, welcome, matt. next, ralph is the national policy director of the wounded warriors project, heading up research and policy development on health benefits, and economic empowerment issues for the wounded warriors project. he formally served as general council at the department of veteran affairs and veteran of the united states army. thank you for your service, and welcome ralph. each of you will have five minutes for oral testimony, know that your entire written testimony will be made a part of the record, so we'll start with you, matt, with your opening testimony. >> thank you, sir. good morning, chairman tester, ranking member portman, and members of the committee. i'm really honored to be here to testify. as you mentioned, i came into the army line of work the hard

wayment like most of us do, but i'm really honored to try to help out as much people as possible, especially our rural vets. i'd like to start out by just saying what the view from montana is. it's -- as you know, it's a very big state with 147,000 square miles, just over a million people with roughly six people per square mile. we've got the -- one of the nation's highest per capita rates of military service, and we're home to over 108,000 veterans which is about 16.2% of the population. our indian health services needs, we have 12 tribes and seven reservations with over 66,000 montanaians of native american heritage. the scarcity of mental health

professionals in montana's pretty hard to comprehend, and really is a major difficulty for our families, but the best way to describe it is we have one psychiatrist between billings and bismarck, north dakota, a stretch of 400 miles on the interstate, which is roughly the distance between boston and dc. one psychiatrist to cover all that area. there are fill-ins by psychiatric nurses and tele psychiatry, but one warm body. i think the other thing that needs to be mentioned because it underlies everything in montana is the oil development in the eastern montana and western north dakota is over taxed with pretty much all infrastructure

issues, but especially mental health department, and it's taking what was a crisis and turning it into something really, really terrifying. i just wanted to give some quick, like, realities of what happens in montana, especially with our vets to show how interlinked all of these different agencies are. for instance, if there's a veteran in darby, montana who goes into crisis, probably be moved 16 miles to hamilton to stay at western montana's private in-patient crisis center. after being there for a day or two, he'll then be transported to helena where the va's in-patient unit is. it's a hundred miles. we'll eventually return to his home community where he'll be treated either by the va through

telepsychiatry, or by the private health contractor, and that's just how it looks from us. some of the things that i think that are really good that are happening in montana is that the contracting system with the private providers is absolutely essential. the psychiatric nursing program at montana state is really helping us to fill the needs, and tel epsychiatry hit almost a critical mass in montana, especially with the cms grant for 7.7 million for montana and wyoming. pure services is developing well, and i guess that one of the things i want to see more is a residency program. i think that we talk about how

bad we need psychiatrists, but the fact is every state that needs psychiatrists also needs a residency program, and if they are able to do some of these things, they are able to provide the services through telemedicine, maybe there's a way to structure those residency programs a little bit more flexibly as well. also, the loan repayment programs. our nation really relies on our in-patient psychiatrists, and how they should be taking care of and loan repayments a little bit different than out-patient psychiatrists. thank you, senator tester, and i'm willing to answer any questions. >> thank you, matt, i appreciate your testimony. next we have ralph. >> chairman tester, thank you for inviting wounded warrior project to testify this morning.

with our mission of honoring and empowering those wounded in iraq and afghanistan, the mental health of our returning veterans is among the highest priorities. i'm honored to be here with matt. despite extensive federal efforts, and i want to emphasize "extensive federal efforts," there's wide gaps in meeting the mental health needs of this generation of warriors. let me highlight one critical concern. many who served in iraq and afghanistan remain reluctant to receive mental health care. research indicates half of those who need care are not getting it, and a high percentage of those who elect to pursue care drop out prematurely. much more progress is needed to reverse the trends in our views. many factors play a role in the process, but in some cases, it's also appears to be a function of family issues, and while current law, law that you helped end act

directs the aid provided mental health services to immediate family members, va has not implemented that provision. to your focus this morning, mr. chairman, excuse me, nowhere are the gaps in meeting warriors' mental health needs greater than in rural america. as discussed earlier, va facilities must be able to provide veterans' needed health care, and if they cannot because of lack of on-site staff or geographical inaccessibility, other options must be used like telehealth or contract arrangements. those in remote areas often encounter local va reluctance or even resistance in offering community-based care. with limited exceptions, we see only modest via use of arrangements to overcome access gaps, and as indicated with 55% of the u.s. counties, all rural,

having no practicing mental health clinicians and situations as matt described in montana, va policy in contract care is hardly a comprehensive answer, and with the draw down of forces in afghanistan, the access challenge will only grow. we do see promise in programs mentioned this morning, va's telemental health capability has seen exponential growth, and we see room for va to greatly expand use of mental health to engage more warriors that is reflected in other's testimony. a second important effort was sparked by the directive in the president's executive order of last august. the va hire and train 800 veterans to serve as peer-to-peer counselors. we see that as a model for winning warriors, trust in entering into mental health treatment and staying in treatment, and we also see it as

having potential in rural areas. one concern is that the initiative is not really targeting the veterans where the need is greatest in our view. vet centers, as you know, incorporate a peer-to-peer model, and we see that as a key aspect of the success of that program and are pleased, again, at the acknowledgement that that's a program that needs to expand. finally, let me suggest that many oaf warriors with ptsd and other mental health conditions are struggling to readjust to a new normal, to uncertainties about finances, career, education, and employment. no single va program necessarily addresses that full range of issues that many young warriors face. few, if any of the va programs are embedded in veteran's' community, and yet va and community has a distinct role to play. for some, as we see it,

community reintegration takes a community-wide effort, and we see a role here for va, but as of yet, no real partnerships. the programs are generally not focused or integrated with the adjacent community, and while va has broad authority to enter into partnership with community providers and congress just last year in the nbaa, strongly encourage that, we don't see much happening in that front. finally, we believe they should work and provide menial health services wounded warriors including training to clinicians and military culture and the combat experience. simply vaccine more providers or access to providers who don't really understand the experience veterans have been through or ptsd a not, itself, a real answer. we look forward to working with

the subcommittee on the important issues discussed this morning, and thank you for consideration of our views. happy to answer questions. >> thank you, both, for your system. i appreciate it very much. i'm going to start with you, ralph, on what you just last said because i think it's an issue that i heard from the veterans themselves, and that's the training of the clinicians, making sure that when veterans who is -- has issues, goes and sees a clinician that they actually have an understanding of what got that person to the point where they are at. how do we best -- i mean, how do we best do this? i mean, it seems to me there's several steps involved, and, by the way, correct me if i'm wrong, but, i mean, first you have to build the partnership, and then you've got to make sure that the folks who are dealing with the veterans understand what the veterans' been through.

how, i mean, how's the best way to move forward with that? from a va perspective. i think you're spot on, quite frankly. >> well, mr. chairman, i think you've really put your finger on the important point or emphasized an important point, and that is that the treatment process begins with developing a relationship of trust, and i think essential to that is that the veteran perceive that provider understands his or her problems, understands where he or she has been, and i don't -- you know, va has done heroic job of training its clinicians on evidence-based therapies. i don't purport to be an educator or, you know, have insight on the best way of training, but i don't see the equivalent focus on helping

ensure that those providers really understand veterans, and i do see, you know, even as va has expanded, has filled many vacancies, hired 1300-plus from the veterans perspective, when they encounter a clinician who they perceive doesn't understand them, they leave. >> yeah, i agree with that, and that's the worst possible outcome quite frankly as far as is cure goes. matt, despite significant investments that have. made to address the complex wounds of war, we continue to see, and you deal with this firsthand, high rates of depression, divorce, domestic abuse, up acceptably high number of service members as already pointed out today who commit

suicide every day. it is overwhelming, and at times, it's hard to tell whether we are making significant progress or what's going on out there. we have to ensure the va is able to identify and treat these folks with their issues in a meaningful way, and we have to ensure they are appropriately staffed in a rural area like billings, bismarck, 400 miles away. we have to train staff. sometimes there's not staff to train in certain areas. there's not the mental health professionals there, and so to ensure that -- to ensure that we have, you know, accessible folks there now, as an advocate, you've been personally involved with this epidemic. you've seen the investments that have been made. you talked about telemedicine. are there other things out there that are working besides telemed

sip, and is telemedicine working well? >> sir, i think to telemedicine is working well. it's great, wonderful thing, and as a travel veteran's rep program are the first to bring it to montana, and it is valuable. there's no question. i think that one of the other things i thought was really good was, as you know well, the va really struggled, the staff, its in-patient facility in helena, and, i mean, it just sat open, and they couldn't run it due to lack of psychiatrists, and i think the way they were able to change their staffing structure to use it with one in-patient psychiatrist, one out party and a couple nurse practitioners, like, that willingness to adapt

what happens on the ground in montana, we don't have three in-patient psychiatrists to run a facility like that, and the va learned. it took them awhile, but one of the other things that i think is, like, the peer support is critical and important, and it also provides much needed jobs for veterans that struggle with the issues, but the retention of the coups lores, i think, in some ways is the bigger issue than actually whether or not they served, and i know many vellet rans that i have talked to just say it's a matter of changing bodies in front of them, and if they open up their soul and describe their combat needs, describe all of their issues going on with them, then the perp's gone, i mean, like i talked to one vet that works

across the street, had three counselors in a year, and i think while we have to focus on getting the perfect right training and everything -- >> multifaceted, yep. what's the issue on retention? i mean, why are they leaving? is it salary? what is it? quality of life? burning out, getting out of business? why are they leaving? why are we seeing the turnover? >> it's hard to tee, sir. it's different for all of them, but what shocks me is how in the box and how con trained they are. i mean, the limits they are given to work with, i think they are heavily worked, overworked, working with peer specialists but also, like they don't even have business cards sometimes, and, i mean, no voice mail for

some of the coups lores, and how do you -- >> right. ralph, do you have anything on what is working, what is not working? just that, what's working; what's not? >> well, i've seen that same telemental health demonstration he eluded to, and i agree with that assessment and agree as well with matt's perspective on retention issue, which i think is not limited to counselors. i do think that we attempted a year and a half ago to survey mental health clinicians, and i do to not suggest it was a scientific survey, but disturbing to see results that suggested serious morale programs. it was a period of understaffing so i acknowledge that as well, but many spoke of the system as

top-down, failing to appreciate to build the trust relationship of imposeing performance rimes -- requirements highly based on based practices, exposure therapies, while having solid evidence based were not appealing to the veterans. many of the vellet -- veterans could not handle, you know, the dealing on a weekly basis with reexposure to the trauma they experienced, and, yet, the -- that was the directive from on high, and so, again, the va has done, i understand, a survey on its own last september on clinician attitudes. it would be helpful to see the results of that study, that survey, helpful to understand

the factors that drive the 10%, you know, vacancy data the doctor cited, and i think a system that honored clinicians from those on up would be a successful one. >> i'm going to ask you guys a question that i was going to ask the doctor, but i didn't want to keep him here all day long, but i think you can answer it maybe in a better way than he could because you drive the bus at the other end of the experience here. marriage family therapists, they are -- they make up 40% of the overall mental health practice work force, and in the va, they make up less than 1%. is there a reason for that? i mean, is there, other than the fact that, i mean, is there a reason on the ground that these

folks, are they less desirable to be counselors or not, is is there something out there i'm missing other than -- can you help me with this? >> there may be a reason for that, but it's not a valid one. we need them. >> okay. >> ralph, do you have anything to add to that? >> i don't disagree. >> okay, good. i want to talk about the gaps you talked about, ralph, in your testimony, and there are some real inhibiting things that are in our society about people who have mental health treatment, there's attachment, and not issues, but because the employer might not want them to begin with. what can we do to minimize the stigma? to be able so the folks are more likely to go in and get help

when they need it because it's curable. we know it's curable. it can be fixed. what can -- is there anything we can do about it? i mean, it's -- >> well, i do think there are, you know, there's been a 20-year or longer effort to address stigma, i think, you know, organizations, you know, have playeded an important part in that, and i think so there's evidence that suggests that veterans themselves, warriors of this generation are still distrustful of mental health care. it's not solely a stigma issue, and i think the peer-to-peer counselors, you know, play an enormously important part in, you know, belying those views, and drawing warriors into treatment and sustain them in treatment. i think, you know, again, matt's

point that we have to honor those warrior employees, make them feel they are an important part of the team and make their working conditions appropriate, but i do think the infrastructure, the policies are in place to close those gaps. >> okay. >> matt, do you have anything to add to that? >> sir, i have two, i guess, two things. one is i think we need to take the magic out of what this is through research. i mean, really big rob with the lack of understanding or stigma is based on lack of understanding, and we don't understand the brain well enough, and especially these patterns with the dsm's changing and everything, the best clinicians really struggle to identify what a person has in i think because we don't have valid scientific instruments to

measure whether or not they have conditions, they are measured by behavior health surveys that just leads to a level of mistrust, and people don't have a way of saying, okay, my neurocircuitry is disrupted, so i get help for this. you know, like, it's -- >> i understand. >> anything that e we could do improve that. the other thing, i think, we have a lot of different antistigma efforts, but they don't highlight people who have ptsd and depression in the past. we don't read about or see antistigma things that talk about winston churchill's depression, that talk about lincoln's depression. some of the greatest americans struggled with these conditions, and why don't we bring them up? so i would love to see a little bit more of that. >> okay. good. >> i want that talk about

partnerships, particularly between the va and wounded warrior project, and there may be partnerships between them and the va i'm unaware of or maybe there's opportunity for partnerships that we can make them aware of. i have been aware of and quite frankly been out on programs like healing waters in montana, and you mentioned a project in your testimony, and which is maybe classified in the peer-to-peer program. i don't -- >> it's separate. it has a strong element of peer-to-peer. >> yeah. our guess is if you shed light on programs like that, their effectiveness, and if -- and how, you know, how we might be able to expand on other programs. there's programs out there working with animals, horses in particular, dog, and just kind

of talk about opportunities out there to collaborate on pure activities related to the outdoors to relieve stress. >> well, if i could follow-up, mr. chairman, project odyssey is one of 18 different programs that our organization operates. it's a program that takes warriors out and retreat-like settings, could be to montana for, you know, an outdoor activity or, you know, mountains in vermont, wherever, but takes them out in groups, has a trained, you know, has a therapist with them, and focuses on building peer-to-peer relationships to confront, you know, in some cases for the first time, their post-traumatic stress disorder or other combat-related health conditions, and it has been very successful in, you know, helping veterans confront issues and get into treatment to overcome the

stigma and barriers and it's a program that we've run for a number of years run in collaboration with va and vet center program, and to our disappointment, va pulled out of it in about 2010. the suggestion was they lacked the authority or felt they lacked authority to continue. since then, congress last year enacted legislation making it crystal clear that authority exists, and we hope that leads to reconstitution of that partnership. that has not happened yet. >> matt, do you have anything to add? >> yes, sir. i got my favorite program for this, totally bias because i was involved in helped starting it, my sister, dr. janet cheryl, and a veteran from mizzuola started it up, and what it is is they

take -- it was based on taking veterans river boarding, and it was a six week program, and engages them in a extremely high adrenaline activity, and tied in with coups -- counseling afterwards, and the level of success from that program is just astonishing, and the veteran participation in not only joining it, but got involved in it, but they took it over themselves, and they ran it, and it really is amazing, and it is done in partnership with the verett center, and you know it's a model that could be expanded to other sports and stuff, but what's neat in comparison to the other ones is it's not a retreat. it gets -- it taking them in their community and in a sport or something they can do afterwards, and it gets them

involved with a group of men and women that they eventually form bonds and friendships with and introduced them to civilians like the rafting guide that helped start it. it was the first civilian that some boned with, and they were republicked him because he takes a little tiny raft on the river and really is remarkable, but i have not seen any efforts from the top to expand that beyond montana. >> last question. this is going to be quick for you, ralph. who funds your project odyssey now? >> we -- we get donations typically small donations from around the country. >> all private sector? >> all private, we don't take federal money. >> all right. thank you very much, i want to thank you again for your testimony this afternoon, or this morning. i very much appreciate it. i think overall this hearing has underscored some of the

important progress that i think we've made, but it also highlighted some additional efforts that we need to make, and i look forward to working with ranking member portman and our witnesses here today on these issues to make sure we address the health care need of the citizens and they are met at regard, i just want tolive. thank you two fellows for being here again this morning, appreciate your work. this hearing record remains open for 15 days for additional comments or questions that may be submitted to the record, and with that, the hearing is adjourned. [inaudible conversations]

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>> the most fundamental difference it seems to me between left and right is both look at the economic ladder, and those op the left seek to reach down and physically move people up the economic ladder, and that is almost always driven by noble intention, and yet it never, ever, ever works. the only way anyone is ever climbed the economic ladder is to pull himself or herself up one rung at a time. >> nearly all of you will experience failure, some of you crushing failure that you'll recover from, and, yes, learn from, and, yes, be all the better for it because once you had a failure, that's the only good option to take something from it. of course, very few of you will

never recover from your failures, and statisticically speaking between two and five of you will spend some part of your life in prison. [laughter] >> every spring, c-span visits college and university campuses across the country, and for the next two weekends, stories and advice for a new graduating class. friday night at 8 eastern with senator al franken and ted cruz, congressman james and baldwin, and saturday, 8:30, conk paul ryan, nancy pelosi, and peter king, senator elizabeth warren, flores, and senator mark warner. president obama's nominee for commerce secretary testified thursday before the senate commerce committee. a long time fund raiser for the president chairman of the credit bureau and heir to the hyatt hotel fortune. for two years, he served on the president's economic recovery advisory board.

the hearing is just over two hours. [inaudible conversations] [inaudible conversations] [inaudible conversations]

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[background sounds] [inaudible conversations] >> good morning. because we are confronted here by two incredibly important and busy senators facing us, it would never occur to us to do what we ought to do which is to give our statements first and make you wait. what we're going to do, if it's all right with you, ask each of you to give your statements; then we'll give our statement, and then we'll move on.

senator durbin. >> chairman rockefeller and senator thune, thank you, as well as other members of the committee for allowing senator kirk and i to come here today to introduce the nominee that the president offered to this committee and to congress for the important position of secretary of commerce. i know that you are leaning in our direction, mr. chairman, because of your wonderful illinois-born wife, and your connections to our great state, and we thank you for that. >> actually, it's not that. it's that you're in the leadership, and i don't want to mess around with you. [laughter] >> that would be a first. [laughter] >> she's here with her family, whom she'll introduce, i'm sure, when the time is right for that. what you see when you consider is not only decades of business, intern nearly, and civic

experience which make her a strong candidate for this position, but also a warm, compassionate person who really gave back to the community in illinois and across the nation. she's built five businesses from scratch, served on boards, and effective leader of major corporations, ranks as one of the most influential women in corporate america, and that is quite an achievement when you consider glass ceilings and other obstacles that women face. her lifetime of experience is the current role of founder and chairman of partners and realty group, and is on the board, and they previously served on the boards of william wrigley, jr. company, and the lasalle bank corporation. the mission is to work with businesses, universities, and communities to promote job creation and economic growth.

her business experience is only enhanced by her service to the community in illinois and across the country. she's led initiatives that improve education and help connect people with job opportunities. she leads skills, and a national programs to help others to prepare worker for the 21st century jobs and find employment. in addition to education, she's a supporter of the arts. she's a member of the american academy of arts and sciences, a trustee of the kennedy center, and former chairman of the board in chicago ment president obama appointed her to the president's council for jobs and competitiveness, and served on the economic recovery board. you just might think in the presence of serving so many charities and boards and managing so many businesses she's a busy person. well, she is, but for fun, she trains for and competes in iron man distance triathlons in her

spare time, senator thune. i know you do that yourself. penny's business know-how and intelligence make her an excellent candidate for secretary of commerce. her humor, warmth, and humanity underscore those qualifications. she'll serve the nation as we compete in the global market place and continue to get our economy back to work. her contributions to the business world and especially to the state of illinois are truly appreciated. it's my pleasure on behalf of myself and senator kirk to introduce to the committee, and i fully support the nomination and look forward to working with her as she becomes president obama's secretary of commerce. >> thank you, senator durbin. senator kirk, do you have any remarks? >> i do, mr. chairman. i just wanted to say that i'm very enthusiastic for penny's nomination. i have see her as a voice for business that the president will have to heed, that let me point

out a few things that senator durbin mentioned. she started a new business from the ground up called classic residents by hyatt employing 3500 americans that she has a letter for you i want to submit to the record by the former chairman. fdic, william issac, i think that will help you, and just to say to my republican -- >> the letter will be included. >> i will be whipping each one of you on behalf of penny's nomination coming up when the vote comes hoping this voice for business is the next commerce secretary. >> great. all right. now you two distinguishedded senators have a choice, you can listen to senator rockefeller or mr. thune --

>> we're afraid we have to go, mr. chairman. [laughter] we so appreciate that offer. >> yeah. [laughter] >> thank you very much. >> now, senator thune and i will give our opening remarks, and then what we're going to do is what we did yesterday, and that is other colleagues on both sides will not give opening remarks, but all questions, questioning period will go for seven minutes, so you can kind of do quite a lot with that. all right? that all right with you, sir? >> yes, sir, mr. chairman. >> thank you. >> yes, sir. >> i would like to call this nomination hearing to order. it's app important one. we are meeting today to meet a distinguished nominee to be the

next secretary of commerce. we have not had a secretary of commerce for awhile, and to be brash, we have not had a strong secretary of commerce in quite awhile. her nomination comes at an important time during the nation's economic recovery. while we have the lowest levels of unemployment in four years, that's find, but still too many people are out of work in my state and senator thunes, and all our states, and budget cuts in march create a new drag on the economy. our nominee understands these challenges, she's a businesswoman. she follows the world about her very closely. in fact, your decades of experience in the private sector, in my judgment, investing and managing numerous companies have given you the skills to manage a large department, and that's what you will get, a very large department, by forkated in many sections, not all communicating with each other in need of good, tough leadership. you come from the business community, and you understand

their needs, but your long track record as a civic leaders serves you well in the position should you be confirm. as many already know, and has been said, you served on the president's council on jobs and competitiveness, and the president's economic advisory board. you served for the future project, did not know that, and i'm pleased by that, because it's fostered partnerships between 40 employers and 200 community colleges across the country. each of the experiences will be important to your task as commerce should you be confirmed. the commerce secretary is in charge of 12 different bureaus, joy. over 47,000 -- 40,000 employees, 40,000 employees, but to do the job well, you have to reach far beyond the people under your direct management. the department of commerce serving very different

constituencies that touch all corner of our country, remarkably different. you know, the arctic ocean to all kinds of fish to telecommunications and everything. you will need to appreciate the immediate financial struggles facing fisherman, not in west virginia, but in the northeast and in the southwest, which is often tricky sometimes competition. at the same time, you're going to be managing and conserving the nation's fisheries for all of us for the future. you will need to find ways to improve the resilience of our coastal communities who face increasing threats from storms and sea level rise. sea level is rising. some don't believe that. i do. you have to work directly with businesses and communities partnering with them and creating jobs and expand opportunities. collaboration between the public

and private sectors is one of the centerpieces of the department's work whether it is the creation of cyber security standards, which we do some in this committee, whether it's the creation of those standards or the development of manufacturing hubs for small and medium sized businesses, the private sector has to rely on and trust the commerce department's work. this trust is crucial to the long term competitiveness of the united states. we will be depending on you to continue this collaboration and strengthen it where necessary. one crucial area of public-private collaboration is development of the wireless economy. the commerce committee closely follows the department's efforts in this area, expanding the spectrum for available wireless services in relieving so-called

spectrum crunch is vie -- vital to jobs and growth in the years to come. at the same time, smart spectrum policy includes protecting vital federal operations. not all federal operations want to give up spectrum. you'll be running into the department's defense on that, and good luck. i expect the department works in close cooperation with federal agencies and public sector to open up more spectrum to meet our burgeoning spectrum needs, and you can't create it. you can't create it. finally, the department manages our nation's severe storm warning system and weather satellites. there's been a troubled area for us, especially with satellites. the terrible tragedy in oklahoma is a stark reminder to us that the vital role that the national weather service plays is an extreme weather event. in conditions like oklahoma earlier this week, minutes

matter. i'm convinced that that is the devastation was, the timely emergency warnings issued by the national weather service probably saved some lives. even as it faces budget cuts imposed by the sequester, not something we expected, but it's something that we have. we expect the to come to a grand bargain. we have not, so sequester is part of the lives of all of us. we need a new weather-ready nation initiative to improve communications during severe weather events and to build community resilience in the face of increasing vulnerable to extreme weather. you had a very, very full, hard charging life, highly successful life. i am one who profoundly believes in public service. you, obviously, do because of

all of the boards you belong to that deal with youth training and jobs and all of that, so i look forward to your testimony and hearing from my colleagues, especially my ranking colleague, senator thune. >> thank you, mr. chairman, and thank you for holding this hearing today on the nomination to be the next secretary of commerce, and i want to welcome her to the committee. she has an extended background in the private sector, and look forward to hearing how she'll apply positive results at the department of commerce and the nation's economy, should she be confirmed. the department of commerce is tasked with promoting business, facilitating job creation and spurring economic growth. the nation's unemployment rate at 7.5%. december of 2007, the unemployment rate measured 5%, peaking at 10% in october of 2009. clearly, much work remains to be done to get the unemployment rate back to pre-recession levels, particularly when you factor in the 21.9 million americans who are unemployed or

under employed. despite positive reports and other areas of the economy, job growth is slow, and so far in 2013, monthly job growth lags behind averages experienced last year. we in congress must make jobs and the economy our top priority, and that means we have to strive to do what we can to unleash the great american spirit, we move needless regulation, and reduce tax rates for bidses of all sizes, crafted policies that spur the private sector to take risks, create job, and we must seek to restrain government's inclination to intervene in the market place. in other words, we should be -- we should let the free market choose winners # and cluesers rather than have the government do so. that's why it's important to have a secretary of commerce who has a strong records of accomplishment in creating jobs in the private sector, someone who knows the challenges and how to overcome barriers the private sector faces in creating jobs. ..

>> we are making more federal spectrum available for

commercial use as you mentioned, mr. chairman. the commerce department is uniquely situated. to play a role in this matter, particularly in national publications and information administration. should she be confirmed from i would ask that she focus some of her time and energy arguing this issue. especially with respect to bring up the 755 to 700 megahertz band. i hope we can resolve this issue because if we are successful, it would unite a great deal of economic activity across the country. including funding a nations network and ease the debt by bringing billions of dollars into the treasury from the auction of this valuable spectrum of the private sector. finally, i would note that there are some concerns that have been raised about penny pritzker's qualifications, as well as the bank a lot of 2,002,001. i have been in communication with her on these matters and i would appreciate her working with us after the hearing to answer all of the questions that we have before you report her nomination.

i hope that penny pritzker will be a strong voice for lowering regulatory burdens, lowering tax rates, especially on businesses large and small, and for more job creation in the private sector. on a personal level, pritzker to my wish to thank you for serviceware country. although i don't think we will see eye to eye on every issue, it is important we have individuals with experience who are willing to put to work for the submission. thank you for holding this hearing, mr. chairman. i look forward to hearing the testimony of ms. pritzker. >> thank you, senator schumer. mr. monk and the floor is yours. >> ranking members and members of the committee. i am honored to be considered for secretary of the united states department of commerce. with me today is my husband to, my rock and my best friend, doctor brian traubert. as well as my son and daughter.

over the past few weeks, i have had the privilege to meet with many of you to discuss the department. and how we can work together to give entrepreneurs and businesses the tools that they need to create jobs and keep our economy growing. thank you for your valuable time and insights and perspective. american entrepreneurship is at the heart of my family's history. my great grandfather came to the united states from russia, dirt poor, at the age of 10. he taught himself english, worked several jobs, and earned his law degree at night and opened a law practice at the age of 30 or so. what is it healthy to work with his work with him at a motel on weekends. i would play on his adding machine to his office and help out actions of her property.

as an entrepreneur and a business person, he has been our inspiration. my father died when i was just 13 years old. in high school, my interest in business grew and i turned to my grandfather. on his 80th birthday, my mother said that i could give him anything that i wanted as a gift. so i decided to write him a note on green stationery. inside i asked him why he only talk to boys about family business. when i was interested in business like they were. he said to me that penny, you were born recently and i was born in 1896. how much of this and other young women are interested in business when he gave me a book on accounting and tommy the basics that summer and i was hooked. i attended college at harvard and received my mba and law degree simultaneously from stanford. then i began working with my

grandfather, my uncle, my cousin's in the family business. in the 27 year since then, i've worked as a number, both starting businesses from scratch and growing existing business and. it has not always been easy. i have learned on my successes and also my failures. for example, my first startup involve residential communities for seniors. the initial team consist of consists of me, a secretary, and a lawyer. like most entrepreneurs, i found the first few years to be terrifying. particularly when the early '90s recession hit. i help myself to a high standard. he was even suggesting to my uncle that he fire me if i could turn things around the cleanup. through hard work, we survived and grew and the company remained successful even to this day, employing thousands of people. since then, i have been involved

in sectors ranging from the hospitality and manufacturing units, to real estate in the financial services industry and more. i have founded or cofounded five companies, which have created thousands of jobs throughout the country. i have also sat on five corporate boards. my role has been both local and national in scope. at the local level i have served as chair of the museum of contemporary art, as a member of the chicago board of education. also as cofounder of my family foundation, which enriches the lives of chicago's children through education and health and fitness and art and culture. on a broader level i have served on the board for foreign relations, stanford and harvard universities, the kennedy center for the performing arts and others. over the past few years, i have served on the council for jobs and competitiveness and the

president economic recovery advisory board. oath of which have helped destabilize our economy and help support job growth. flowing from this i launched skills for america's future. this initiative promotes partnerships between employers and community colleges to address the skills mismatch. in our first local model, launched last september, we have already secured commitments from companies to hire a thousand unemployed chicagoans. if confirmed, i intend to leverage the sum of these experiences as an entrepreneur, a business leader, and a citizen deeply committed to american competitiveness in my service as the commerce secretary. i should note that i have had first-hand experience with the commerce department over the years. for example, the census bureau was the foundation for the

decisions that i made and i have described this earlier. moreover, i know that thousands of businesses get the information, tools, and support that they need from the commerce department each year. this includes patents for new products. support for small manufacturers. help for exporters who want to break into new markets. assistance for entrepreneurs from underserved communities. support for fisheries and coastal economies. dissemination of timely and accurate weather forecasts, and much more. overall, my vision is that the commerce department will continue to use all its assets to protect and promote and anticipate what america needs to be competitive and innovative in the 21st century. if confirmed, i intended to serve as an access and visible part of the present economic team. i will bring both concerns and

ideas from the business community to the forefront. i envision the commerce department maintaining its governmentwide leadership in areas such as manufacturing, attracting business investments, innovation, and exporting. your partnership will be crucial. we actively seek your input and your advice, and your expertise. i believe very strongly that we must ensure that american entrepreneurs can continue to pursue and achieve their dreams. as my family has had that opportunity over the past century. and given the honor to serve my country, i will work every day to support these entrepreneurs as they create jobs. as they build our nation's prosperity. i will continue to uphold the core values and deep sense of

patriotism that has been passed down to me. finally, let me say that if confirmed, i look forward to working with a dedicated service of the commerce department. thank you, i look forward to your questions. >> thank you. it relates to cybersecurity. it is sort of embarrassing, i think, for the congress. because for four years now, all of the defense and intelligence people have declared it the greatest national threat. the greatest national threat to our security. not al qaeda, not cybersecurity, coming from computers. we made computers and now we use them and they are threatened. so we are trying to put together a cybersecurity bill. there are three committees that have jurisdiction and we are one of them. the department obviously played

a very key role with a wide range of cybersecurity efforts. including international standards. you will be conducting technical research and working with businesses to improve risk management. in fact, we are currently leading the effort with the approval of all parties so far. not many people know this, but it is incredible the brains that they have over there and the experience that they have. it is extraordinary. leaving effort to develop his cybersecurity framework was to protect our most critical infrastructures are you from cyberattack. that is a tricky subject of critical infrastructure. if confirmed, what priority would you give to the department of cybersecurity?

and how will you bring a full range of the department's capabilities to the bureau and the national treasury administration to the forefront? >> senator, thank you for that question. i understand the threat of cybersecurity. one of the businesses that i have been involved in is experiencing 3.8 billion cyberincidents a month. that is three times what it was three years ago. the complexity of those incidents is 50 times greater than it was three years ago. so i fully appreciate what we are up against here. if i am confirmed, i will work closely with our ita and the full commerce department to make sure that we do help develop a cyberframework as we have in touch with as well as a close working relationship with the

business sector to make sure that we are addressing the cybersecurity. >> thank you. i had a very good talk with the chairman of the appropriate committee handling cybersecurity in the house. we have had lots of conflict over here about what is voluntarily the standard and you have to meet a certain standard and all of those kinds of things. as he spoke, i said every word that you decide to me, i agree with. i have never met him before. but i think for the first time, i think that we see a real opportunity of getting a bipartisan cybersecurity bill. it will be a miracle if we do it. as i say, it's the greatest national threat. i'll ask one more question.

i have a fascination for forensic science and i'm finding that some of my fascination is with great. but the more studies that go on is very important in this. that our system is badly in need of renewal. but there are a lot of people who are in prison who shouldn't be in prison, a lot of people who should be in prison, because forensics, which through, you know, tv programs, we take it as absolute. saying that he or she is guilty. but it's not quite that easy that we are discovering that now. so getting forensics right is of enormous importance and a conference. what you see is your role in supporting us is that collaborates with the department of justice to increase the reliability of forensic science?

>> senator, forensic science is something that i know firsthand in this the state of illinois. i was involved with making sure that we used all the dna kits and that they were actually evaluated and that had significant implications on various aspects of our justice system. there are consequences of using forensic science. if i am confirmed, i will use this to work with the entire commerce department to make sure that we bring for the best science and we are working closely with the department of justice to bring that forward as quickly as possible. >> it is stunning, isn't it? that for a couple of decades we thought it was an absolute science. you look through the microscope, you saw what you saw. and then you made your judgment for now. it just does not work that way.

it is not talked about much in public discussion. but we are getting frantic science where it needs to be, up-to-date. it is of enormous importance. i appreciate your answer. >> thank you, mr. chairman. this is part of justifiable public outrage against conservative organizations, it underscores how critical it is for government leaders to scrupulously honor the public trust. my question is what, if anything, and he pledges committee regarding your commitment to safeguard the trust that would be bestowed upon you as the cabinet secretary. >> senator, i think that it is important that i bring my core values to the table if i am confirmed as secretary of commerce. for me, being known as someone who is trustworthy, someone of high integrity and high ethics that is what i strive to be.

so i hope that i can set the tone if i am confirmed. trusting that taxpayers in all that they can have, the work of the commerce department is something you have full faith in. >> we have all watched this week and those who were struck by that deadly and devastating tornado. at the same time, we can be grateful that the warnings and alerts issued by the national weather service helped to save lives. and you have learned first-hand, or i guess you will learn, every department agencies making tough choices in the face of necessary budget cuts. so it does require proper planning and privatization. it is no longer an option to do that. can we have your commitment that if confirmed, you will ensure that budget cuts are made in

ways that prioritize funding for the public safety missions like the delivery of timely warnings for severe weather? >> senator from the work of the national weather service is vital, as we know. frankly to lives and most importantly to the lives of americans. we have seen this we have seen it in hurricane sandy and the flood we have been experiencing in the midwest. they remind us of the critical mission of saving lives. if i am confirmed, i will work with the national weather service to make sure that the impacts of our budget do not impact the critical mission that the national weather service provides. >> key pledge to us as well that you will work with this committee to find efficiencies in ways to stretch taxpayer dollars further when it comes to various responsibilities of the commerce department? >> senator, in my 27 years in business i have had to learn to stretch dollars and that is

something that i have experienced. i think that the first thing that is required to put in place is good leadership throughout the organization. something that shares the same approach and then work with that leadership to be able to identify ways that the commerce department can be as effective, but more efficient. >> as i mentioned in my opening remarks, some have criticized the administration kneeing antibusiness. in 2010, the chairman of the business roundtable said that administration was fostering an increasingly hostile environment for investment job creation if confirmed, he would bring a track record of entrepreneurial activity for private sectors as well as service on the president's job counsel to the position of secretary. if confirmed, what we do to foster a pro-business attitude within the administration and maybe providing examples of

actions and strategies that you have used successfully to create jobs in the private sector. >> senator, when the president asked me if i was interested in taking this position, we discussed very clearly his desire that if i was confirmed in his possession, a bridge between the administration and the business community, a role that he saw it if i can play that is part of his economic team, that he felt that and that is something i look forward working very hard on. i started a senior living company that employs about 3500 people today. i started a real estate investment firm that today employs, you know, dozens of people. i have started a number of businesses might as well as growing businesses. and i have grown the number of employees. frankly, when i think about my job as a business person,

looking at me most nervous was to try to make the best decisions that i knew that i could because i knew how many lives were impacted by those positions. the ability to not just be business leader but a top trader is something i have been very proud of and something that will bring for experienced if i am confirmed as this role to be the secretary of commerce two with regard to the failure banks in 2001, the bank was one of the early leaders of subprime lending. some have defended you have no active management role for seven years prior to the bank failure. according to a report issued either fdic, concerns were raised by the office about the banks mortgage banking practices when you are were still chair of the bank's board. others have said that you have the banks audit committee until

its failure. could you tell us the world you have played a leading up to the superior bank failure in 2001? >> senator, things were giving me the opportunity to tell the story. so my uncle and a friend of his bottoming in 1989. it was a failed bank. i was never involved in management. i was chairman of the board from 1991 until 1994 when the primary purpose or activity of the bank was to clean up the balance sheet of the bank, which had a lot of problem loans. i stepped down as chairman of the bank and the bank maintained its own separate thing before they fail. regulators concluded with certain assets on the balance sheet, but they were overvalued after a change in accounting rules. with a holding company one looks like the balance sheet and the financial statements. we deal with all the subsidiaries of the holding company.

unfortunately, when the problems arose, my uncle recently passed away. i stepped in on behalf of the ownership of the 50% ownership of my family to try and salvage the situation. unfortunately, those negotiations failed and the bank failed. then, shortly thereafter, i went to the fbi the, voluntarily. the family only owns 50% of the bank. i voluntarily went to the fdic and said that this is post-9/11, and as i said, i come from a family that is very patriotic. and i said we head of the fdic from this country has been very good for family and we need to make the situation right. we like negotiated. my family voluntarily agreed to pay $450 million and i was not on the audit committee. that is something that is not

right. it was the right thing for us to do. both were the depositors and for us as a family. >> a quick follow-up if i might. okay, so ultimately there were a number of banks and depositors that have claimed that they lost over $100,000 in savings, including one that deposited her entire retirement account before it fell. my question is two parts. what you have to say to those depositors lost significant sums of money because of this venture. and what lessons did you learn from your experience that will inform your role as secretary of commerce if confirmed? >> senator, i regret the failure of superior bank. it was simply not an outcome for situation and i feel very badly about it.

the lessons i have learned are about good government structure. including transparency and having a solid government. >> okay, thank you, mr. chairman. >> thank you, senator. >> thank you, mr. chairman. >> thank you, senator. >> would hope that we will come -- this committee will recommend you and you will be able to serve. you have a deep down in business. you will be needed in the administration. and you will help this economy recover and focus again on greater job creation. to that end, i would like to raise a couple of quick question. the first of the areas that falls within the department part of that was management that

residents laid out, a very ambitious thing to have 500 megahertz available. i would like for you to think about how we can make sure how we can keep everything on track. one of our challenges is to make sure that our federal entities are little more responsive in terms of spectrum sharing and trying to make sure that we take full opportunity and i would like you to speak to that issue to light. >> i speak to your belief to try to find the 500 megahertz of spectrum. it is my understanding that we have found, from the government side, about 100 megahertz of spectrum that has been made

available. the questions include we have to look harder at the various opportunities. this is something that is high on the priority and we will continue to look and see how we can find more spectrum that can be made available for commercial use. including the explosion of the wireless world that we are living in. >> i would not ask you to speak to this today. take a bigger block and we have to take what we can while we can move forward on that. another area that we will have oversight over is the trade

office. we are all concerned about the increased amount of litigation. unfortunately my old industries, we basically have patent arsenals that could be better utilized in terms of innovative and breakthrough technology rather than building of arsenals to be litigation worse. i don't know if you want to have some general comments about what we can do to try to make sure that we get better ideas into the marketplace and try to decrease why think is a dramatic increase, much of it not geared

at innovation protection, but really just about transferring wealth between large entities. >> senator, i share your concern about that. in terms of innovation, as an entrepreneur i know how important it is to be able to have the time to market. the legislation that you all passed in terms of patent reform is extremely important in that way. in helping the patent office become more and more efficient. in terms of the large amount of litigation that seems to be emanating from various nonproducing organizations that is a very big challenge, and that i need to look into more. especially if i could confirm something more. >> two other quick areas. this is an editorial comment more so than specific questions.

but the commerce department has a wide array of programs and i firmly believe that this is an agency that is right for program consolidations and review. we need to think smarter or in i personally believe that we ought to give the president and future president the ability to do executive reorganization. my hope would be that you will come in with a fresh look at a wide variety of programs within the commerce department. looking from where they are, look at where we can get better bang for the buck. again, i would like to editorialize and highlight one area that we have worked on and have them opportunity in a brief conversation about. we do a very bad job in this

country supporting in sourcing of jobs into america. most of that development is done in the state and local level. in trying to get this administration to actually look at how we might support state and local development levels to bring jobs back into america for a host of reasons. jobs that have been outsourced in the past two years and companies are looking at bringing manufacturing and other reductions on select this country especially because of the rule areas. my hope is, as my time ticked down, the you will look at streamlining all of these efforts and program obligations within the commerce department to work with me and other members. this is bipartisan legislation that i have gotten with the congressman in the house. about how we can do a better job in the federal level two support to support in sourcing of jobs back in this country. >> senator, i think this is a great opportunity, particularly as energy costs fall into the

united states and we have a terrific labor force and a great patent protection. i think this is something i look forward to working with on a. >> and you, mr. chairman. >> one of my colleagues tommy about a few things. we are trying to do everything we can to push things back. what i suggest on my side is that we cut our seven minutes down to five minutes. >> the other side of the aisle have seven minutes. >> senator fisher. >> thank you, so much. thank you so much. i'll try to help out here. senator thune ask you about

efficiency. when we had the pleasure of meeting and having a good conversation, i also brought up about looking at streamlining and efficiency and i had asked if you have any examples. have you had were thought of any examples, maybe in different program areas where you would look to find some efficiencies? >> senator, i commit that i'm interested in focusing on the good i have to confess that i have been tied up, having the pleasure of meeting you in all your colleagues and i have not been able to dig in yet. but i do look forward if i'm confirmed to have the opportunity to do that. >> that will be great. thank you. also, we have the manufacturing sector here in this country that has faced challenges. i believe that we have to level

the international playing field if we are going to ensure that our manufacturing sector is competitive. i think we have to look at regulations. we have to look at trade. would you agree that? >> senator, i agree completely. leveling the playing field, making sure that our good american companies are able to play globally is extremely important. >> would you commit to looking at the regulatory policies? >> i believe especially the trade policies that we have in this country so that we can ensure that we have a more level playing field. >> senator, i will spend a lot of time focusing on trade and regulation. >> thank you. i believe that trade is vital not just for manufacturing, but

for ever closer products as well. and i see that is a definite area for growth and job creation. i appreciate your focus on that. >> the senator was asking me about spectrum. as you know from our discussion, it's an important issue for the country that we have to look at for the spectrum. there has been some discussion on how accurate the cost estimates have been with regards to the spectrum. i believe the department of defense in the past has estimated it will cost $4.6 billion to clear the 7055 to 1,850,000,000,000 of debt. and others estimate it will cost 18 billion. how are we going to have more accurate estimates with that?

bc anyway forward? >> senator i must confess that i'm not exactly familiar with that particular band. but i think that is something that i know that the ntia is very focused on. we are working to make sure that we are getting the best estimates of the cost of rework to share the spectrum or remove the spectrum. i realize the importance of trying to make more spectrum available for commercial use. and i endorse that endeavor. if confirmed, i will push the organization to make sure that we do this carefully. that includes all the information that is accurate. >> thank you very much, and i look forward to working with you in the future be met thank you, senator. cnet thank you, mr. chair. >> is that all? [laughter]

>> [inaudible] >> we are always prepared work in a bipartisan fashion. i enjoyed our conversations last couple of days and we have hit on a couple of topics that are very important to the future of america. one being trade. we have had a robust conversation, which is an important part to be considered concurrency issues to backdoor in, parts of our free trade agreement that hartigan passed, one issue that comes to my mind and heart is the issues that we face in south carolina. i believe that south carolina is a part of the solution from a manufacturing base. if we do not continue to make things that is tangible, we have a very long road ahead of us. myself and i felt that

mr. warner will be working on the subcommittee of competitiveness and innovation, hoping we'll that we will have many opportunities work with you if confirmed. including the fact that you can make this as good as possible. we are continuing to expand in the charleston market and we have the accent highest concentration with companies like michelin, bridgestone firestone, continental, those coming to her for state as well, as well as expanding mess. especially as you have jobs come back to america. look no further than this. my question is we would like to further promote the u.s. industry. >> senator, i support your

enthusiasm over american manufacturing. my family has been in this business for over 50 years. as you know, you are well aware that innovation comes from being close to the factory floor grade i think it's something like 72% of the dollars are from the manufacturing sector and 90 to end a from the sector as well. so bringing jobs back to united states is a high priority if i am confirmed as secretary of commerce and you know, i think that we sent in a very competitive position. we are competitive with our labor force and our great rule

of law and our patent system, i think it gives us an enormous opportunity to really grow and encourage companies to put a plant in the united states. if i am confirmed, that is what i work very hard to advocate for. >> the second question really helps us bridge the gap and create opportunities as of late storability to enforce our trade. the enforcement of our trade laws is one of the common challenges we have faced protection of our pharmaceutical companies, intellectual property, to proper classification of imported goods, how do you prioritize enforcement of our trade laws? in we have both incoming

challenges some of our trade laws as well as export challenges. but i think that the commerce department, if i am confirmed, it should focus on both. we cannot just afford to focus on one and not the other to need to create a level playing field for american corporations globally. >> this is a great opportunity, one of the things we have done is to use the synergy of economic, realizing that america's greatest port is charleston and gives us an opportunity to track the industry. revealing the structure needs and the transportation needs, whether it is transit or the port of charleston or other port. it's coming through the panama canal coming in 2015, 2016, they

will provide a robust opportunity for us move forward on meeting expectations of doubling exports of the next two years. >> senator, i agree with the economic synergy. if you think about it, only 1% of american corporations actually exports today. 58% of export one country. so we could work both in terms of supporting infrastructure creation but also at the commerce department, if i am confirmed, working with those companies. what if they were to export, what if they have two countries or three countries and think of the job creation opportunities associated with that. i think that's a great opportunity for commerce department. i am confirmed, i will focus on that. >> thank you, senator.

>> thank you, mr. chairman. i'm i am glad to welcome you to the committee. and welcome welcome to what you bring to the commerce department. and the acting secretary has done an admiral job under difficult circumstances and i think this important department needs somebody who is confirmed and in charge and ready to take hold. i am hopeful that we are going to see this happen here pretty quickly. this is the issue that i have been pretty involved and because we have had several companies with attorneys or someone else, they were not in compliance with trade laws. they did a sanction against them. somehow these same products keep

coming from someone else in a different box. the commerce department has as a matter of stated policy said it will not address the vision of beauty through these shipments. including whatever else you need to address this problem. i hope he will look into this and find out why that would be the stated policy of the commerce department. maybe they thought they would have too many things to keep track of. but this is a problem that many members of the senate and work with you to help solve. >> senator, i am familiar with this problem. but i am not familiar with the statement from the commerce department. if i'm confirmed, that would be something i would look into it back okay. let's go back to another thing that mr. scott mention, manufacturing some of the

advantages that we have. if you talk a little bit about the energy potential in the country today, and how that may have an impact on manufacturing. >> one of the most significant and puts the cost of manufacturing today's energy costs. given that the falling cost of energy in our country has enormous opportunity for chemical companies and others ,-com,-com ma we want them to place their plants in the united states and that is something that i would work very much to encourage and enforce and support. manufacturing jobs are good jobs. jobs that we want to grow in this country. this includes the importance of being close to the manufacturing floor, something that improves innovation. >> i think that there is no more

logical advocate for good, cost-based energy policies and the secretary of commerce. i'm glad that you are headed in that direction in your thinking as well. the rule of law, another thing i would like to mention, is travel. something that you know a lot about. the senator and senator and i have been very involved on these travel issues. when i was still in the house we created something that was called brand usa. and i think that it has great potential but clearly needs someone in the department paying attention to be sure that everything they do is justified. they are the low hanging fruit for the economy. again, you probably know more about that than anybody in this room. we were cents a pound for travel is to the economy, particularly

foreign travel, would you like to thinking about that? >> senator, i appreciate your about that. unfortunately, the has lost market share in the long haul. that is something that we need to regain. i was on the president's jobs council, spearheaded the effort to reduce wait times, which were ridiculous with some of the most major countries who wanted to come and visit and travel throughout the united states. we will were able to point out to the state department that if you are a foreign traveler coming to the united states, we have to be interviewed for a visa. so the interviewers bring around a half-million dollars each. so we would be able to increase travel and you are well aware, senator, those are good for the

travel industry and it creates good jobs. the average traveler in the united states, it's about $6000. so for every family of five that were to come to disney world, you know, that is 30,000 dollars and that is potentially the creation of a new job in this country. it's really terrific opportunity. i think brand usa is a really exciting opportunity. i believe that half of the money comes from the private sector and have comes from the government. especially to promote travel to the united states. that is something that we should be out promoting. we are good at this. it is something that is a great source of exports, as well as a trigger job creator. >> foreign travelers stay longer than domestic travelers come and , they spend more, and when they leave, they almost like it

better than what they did them when they came. this has positive reverberations. again, in this job, all the impact of this throughout the economy, i look forward to working with you on that, assuming you are confirmed. >> thank you, senator. >> thank you very much, mr. chairman. i know that they will be even happier they visit branson, missouri. i enjoyed our meeting and working with you. the senator and i have worked extensively and i appreciate the knowledge. i think you know this is a huge opportunity for our country to gain jobs. tens of thousands of jobs for every point that we gain back with the international tourism market. we are finally headed in the right direction. when we talk, i spoke about

this, particularly someone with your background. not just the things under it agency, but i suggest the top 15 exporting industry and figuring out that they all have some things in common and they also each have individual things that can help. medical devices, fda, things that they are working on. i'm wondering if you could comment on that. >> on that i would take it seriously, one of the main reasons that i'm really interested in this job and was interested in this job, i think the president the president hopes that i could bring her experience i have had with my

ability to relate to businesses, as you said, there are many in the industry, and the ability to work on helping our company, not just to export, but to gain technical knowledge so they can continue to innovate or get access to this more quickly so that the market is reduced. those are areas that i look forward to having the opportunity to focus on. >> you mention exports, and i didn't a part of this is the foreign commercial service. i hope that you will be committed to continuing not heard we would love to see it expanded for our small and medium-sized businesses that can't afford to have their own trade export on morocco, but can do a lot of business there. i think we have a good thing

going, and it's really one of the best things that we can invest in. so i hope you will continue to expand that to help those small end medium-sized businesses. >> i completely agree with you. i think the this is one of the great assets of the commerce department. among many great assets. and if i am confirmed, i would look forward to working with to encourage their growth and of their continued outreach, not only with small and medium-sized businesses, but all american businesses. >> so my colleagues asked about manufacturing. we had three women in business as witnesses. that is the reason, as pointed out, there a lot of room for women to grow across manufacturing, women only hold 70%, only 12% of the executive offices, and only 6% of ceos. many go on the front line and workers -- the share of women

workers has been declining even though we are standing up for hiring right now since 1990 and is now 27%. the lowest level since 1971. as you know, we have job openings that have a 5.4% unemployment rate in these manufacturers are trying to get women to support these arguments. this is no longer your grandpa's manufacturing or any more. and then we have the overall business, what has been successful in business and how we get more women into the boardroom and running companies. >> the two things i would like to comment about. one is that i sent i spend significant time on the skills mismatch in a country. making sure that americans are well trained for the jobs that are open in terms of making sure that we have more women in

manufacturing. it starts with encouraging more women to get a stem education. i have been very much a proponent of that. we have seen much greater mentorship occurring, which is a significant part of how we can end up with more women in leadership in manufacturing. including mentorship and education. >> i look forward working with you on that. >> one quick question. the commerce department and the economics and statistics have provided critical information about the social and economic needs of communities. most people aren't aware that is misleaders heavily rely on these demographics so they can do business. it is a tool for market valuation and i just want to get your commitment because i know that these kind of surveys can be under attack at times.

understanding that they go to very good use to help the american economy. >> senator, i am well aware of the importance of the data that is collected. because some of the businesses i have found, senior living business, for example, totally relies upon the kind of demographic and income data that is collected in those surveys. where we locate our property so that they can be successful. because no one was on the property that is not successful. it depends upon a critical data. so i have an enormous appreciation for that work and i will continue, if i am confirmed, to make sure that that is a vector data collection. you thank you. thank you for the commitment earlier to continue this. we have one company that has so many patents, they have a patent for every employee. very important for us and we want to continue that.

so i think you. >> thank you. >> thank you. senator kyl,. >> thank you, mr. chairman. thank you, ranking member. it is good to see you again and welcome. welcome to the committee and congratulations on your nomination. thank you and your family for your willingness to serve. obviously, we are confident that the breadth and depth of your experience will be a tremendous added bonus to the commerce department at this important time. we will be taking over as department at a critical time for our department. and i hope you'll use all of your experiences to create jobs and expand economic opportunities in the nation. my conversation the other day, and you are an impressive resume know that you are well prepared to we the department, which is encouraging. it is important to us in

massachusetts because we have some challenges right now. it will surprise no one that i now wish to engage you on the fishing industry. as you know, it is 300 years strong. these businesses are important to us. they are also struggling. because of changes in the economy. right now, fishermen are living under a cut of the number of fish that they can catch. and it is in peril to the very existence of the industry. and as i mentioned to you, there are challenges, some of which are man-made. some that we believe that they haven't had a good partner in the commerce department in recent years. and i talked to you about the need to have a much more

comprehensive and thoughtful and inclusive plan for fishing industry to help save this industry and bridge a gap towards a brighter future. so i would like to ask this time if you're willing to make a commitment to work with those of us who represent the great fishing industry and with these two plans for a brighter future and address the realities we are facing right now and help us find our way forward collaboratively. we believe that that has been missing. >> senator, i have great respect for the fishermen. all over our country, and particularly those in the northeast. fishermen are entrepreneurs, and i have an affinity for entrepreneurship. there are many fishermen in family businesses and heaven knows i come out of the family business organization. i appreciate the challenges that

the fishermen are facing in the northeast. and if i am confirmed as the secretary of commerce, no one needs to improve its relationship with the fishermen and the citizens. this includes better communication with noaa and better trust. so that if decisions are being made, we can understand and that there is an understanding of what is exactly the data.

>> if i could just talk about how you are a business leader yourself, and you mention your current business and you know the importance of this issue. one of the issues that we grapple with in congress is what is the best way to move forward constructively, particularly around the issue of information of the private and public sector. it seems to be a particular sticking point. what is your viewpoint on that particular issue as a business owner and as someone who is going to be charged with leading the commerce department. >> senator, i believe it is important for you to begin a dialogue with the business community and explain what is at stake. each business understands what is at stake for them individually. especially in terms of our