to get the root of some of the health care problems facing the va, and with that i want to give the mic to ranking member burr. >> thank you, mr. chairman. thank you for calling this hearing. secretary shinseki, welcome, and to all the other witnesses today, thank you for your willingness to be here with us. the issue before the committee today is the state of the va healthcare system. we have a sacred obligation to ensure those who have fought for this nation receive the highest quality of services from the department of veterans' affairs.

now, the chairman's opening remarks, he was correct. we are not here to analyze a poll that was taken about the va. but we are here rather to look at the investigations that have already taken place, and addressed certain deficiencies within the veterans system that no action was taken on, or at least not corrective action. in fiscal year 2013, the reported 93% of specialty primary-care appointments and 95% of mental health appointments were made within 14 days of the patients or providers desired date. at first glance, these numbers appear to demonstrate that veterans are receiving the care they want and when they want it. however, we know this is not the case. i think if va had asked hard questions regarding these statistics, we would not be here

today discussing recent allegations surrounding many va facilities. more specifically, we are here to discuss when senior leadership in the department became aware that local va employees were manipulating wait times to show that veterans do not wait at all for care. it seems that every day there are new allegations regarding inappropriate scheduling practices ranging from zeroing out patient wait times, to scheduling patients in clinics that do not even exist, and even to booking multiple patients for a single appointment. the recent allegations were not only reported by the media, but in some cases have even been substantiated by the gao, ig, and the office of the medical inspector. here are a few examples. the gao released a report on the reliability of reported

outpatient medical appointment wait times and scheduling oversight in december 2012 and has testified multiple times on this issue. several ig reports have been issued regarding delays in care and scheduling irregularities, including reports on temple, tx, in january 2012, and up to the most recent and egregious report in september 2013 at the columbia va medical center. two publicly released office of the medical inspector reports related to whistleblowers' allegations at the jackson va medical center and the fort collins community based outpatient clinic. even more troubling is that, with the numerous gao, ig, and office of the medical inspector reports that have been released, va senior leadership, including the secretary, should have been aware that va was facing a national scheduling crisis. va's leadership has either failed to connect the dots or

failed to address this ongoing crisis, which has resulted in patient harm and even death. the question we must answer today is, even with all of the information available to the secretary, starting over a year and a half ago, and specific instances of patient harm and death directly related to delays in care, why were the national audits and statements of concern from va only made this month? i thank the chair, and i yield back. >> thank you. senator murray. >> thank you very much, mr. chairman. i'm glad you called this hearing. like most americans i believe when it comes to caring for our nation's heroes we cannot accept anything less than excellence. the government made a promise to the men and women to answer the call of duty and was most important ways we uphold that is by making sure our veterans can access the health care they need

and deserve. while the department generally offers a very high quality health care and does many things as well as or better than the private sector, i am very frustrated to be here once again talking about some deeply disturbing issues and allegations. it's extremely disappointing that the department has repeatedly failed to address wait times for health care. so i was encouraged when you announced a nationwide review of access to care and i'm pleased the president is sending one of his key advisers, rob nabors, to assist in overseeing and evaluating that review. is perspective from outside the department will make this review more credible and more effective, but announcing this review is just a first step. these recent allegations are not new issues. they are deep systemwide problems and they grow more concerned every day. when the ig's report is issued and when the access review report is given, i expect the department to take them very safely and to take all appropriate steps to implement

their recommendations. there are also cases where the facts are in right now. there are problems we know exist and there is no reason for the department to wait until the phoenix report comes back before acting on the larger problem. the gao reported on p.a.s failures with wait times at least as far back as the year 2000. last congress we did a great deal of work around wait times, particularly for mental health care. inspector general looked at these problems in 2005, 2007 and again in 2012. each time they found schedulers across the country were not following va policy. they also found in 2012 that va has no reliable or accurate way of knowing if they're providing timely access to mental health care. but now the ig recommendations are still open and the department still has not implemented legislation i offered to improve the situation.

clearly this problem has gone on far too long. it is unfortunate that these leadership failures have dramatically shaken many veterans confidence in the system. secretary shinseki, i continue to believe that you take this seriously and want to do the right thing. we've come to the point where we need more than good intentions. what we need now is decisive action to restore veterans confidence in the va, create a culture of transparency and accountability, and to change the systemwide years long problems. this needs to be a wakeup call for the department. the lack of transparency and accountability is inexcusable and cannot continue on. the practices of intimidation and cover ups has to change starting today. giving bonuses to hospital directors were running a system that places priority on gaming the system and keeping their numbers down rather than provide care for veterans has to come to

an end. but mr. secretary, it can't end with just dealing with a few bad actors are putting a handful of your employees on leave. it has to go further and lead to systemwide change. you must lead the department to a place where we prioritize the care our veterans receive about everything else. the culture at the va must allow people to admit where there are problems, and ask for help from hospital leadership, or from you. this is the time to make real changes. thank you, mr. chairman. >> thank you, senator murray. senator isakson. >> thank you for calling the string. i'd like to ask unanimous consent a complete statement of senator john bowden beginning to the record speed without objection. >> also our best wishes for a speedy recovery. to ask unanimous consent that all members opening statements be included in the record? >> without question. >> secretary shinseki, thank you for being here.

the chairman has said we should not rush to judgment and that's always true but we should have a rush to accountability. even before phoenix, before durham, before some of the others, fort collins to the others that come to america and we've known that he has admitted to at least 23 deaths that took place in part because of delays in g.i. consults. seven were in my area. two in north florida, three in a custom georgia, for in a letter to george of all mental health issues. dr. petzel was in my state on august 22 of last year for a two in our hearing on the alleged situation. we knew it and determined it was problems with delays in setting up limits for mental health patients that cause an open period of time where, in fact, they took their life because of failed to get services they should've gotten. so while we need to complete the ig's report and find out everything within the rocker with a ig reports since 2013 and in this report we find repeatedly over and over again

what has been making the system, where the system is more important than the patient. i think our veterans and a thank you, secretary shinseki, deserve better from the members of the veterans administration and the va health system. i told you yesterday on the phone when you're generous enough to call and we had a long discussion i think that veterans and yourself have been missed served by senior management of the va. we need accountability, what's going on and he is not industry anymore. we will find out more from the ig's report but i would hope we get and accountability in the chain of command at the va as in the canada of the chain of command of the nine states that force. were you held accountable for your responsibility, states are not tolerated in one mistake might be tolerated but a second mistake on the same decision should never be tolerated. i thank you for being here today on behalf of all the veterans in georgia and in the united states of america. let's get this right. let's hope the system accountable. let's make sure no veterans guys because of failure because of the system, to get the care they need when they need it.

i yield back. >> thank you, senator isakson. senator blumenthal. >> thank you, mr. chairman. and thank you very, very much for holding this hearing which i hope and belief will be bipartisan and as nonpolitical as possible can be. let me thank you, secretary shinseki, for your service to our nation. over many years you have served and sacrificed for this nation, and i deeply respect and thank you for all you've given to the united states of america, including in your six years as secretary of the va. i know you're determined as the president is determined to unravel and reveal any wrongdoing and to restore trust and confidence in the va health care system. i agree with the chairman that we should avoid a rush to judgment, but we have more than allegations at this point. we have evidence, solid evidence of wrongdoing within the va

system, and it is more than an isolated system of wrongdoing, and it's a pattern and practice apparently of manipulating lists and gaming the system. in effect cooking the books creating false records, which is not just an impropriety or misconduct, it is potentially a criminal act. it is a pattern as the chart submitted by the american legion as a tendency shows. there is a pattern across the country in more than 10 states of this misconduct occurring. in addition, there is a history, the jail has reported your own inspector general has reported these kind of problems in the past. so there is a need now for more than just for investigation.

there's a need for action to restore trust and confidence, to assure accountability and transparency, our nation's veterans deserve the best medical care, nothing less. the situation now presenting serious, pressing, unanswered allegations and uncertainty is intolerable, and i have very severe and grave doubts that the resources now at the disposal of inspector general are sufficient to meet this challenge. i think there is a need for more than just the kind of appointment the president has made to oversee the department of veterans affairs, there's a need for resources going to inspector general and possibly involvement of other investigative agencies from the federal government because the resources currently available to the inspector general simply may be insufficient. in addition there are 3000 job openings across the country in the va.

they are listed on u.s.a. jobs.gov. i urge that positions relevant to access to medical care be filled immediately. and that action be taken to restore not only the transparency and accountability that we all expect from the va but also to do with the disability claims backlog that continues to plague the va. the question now is what is the evidence show? isn't criminal or simply civil? and that judgment has to be made as soon as possible. thank you, mr. chairman their. >> thank you, senator blumenthal. senator heller. >> thank you, mr. chairman. and ranking member burr bowling this ring today. i want to thank secretary, dr. petzel for also been you, the other witnesses. thank you for taking time to be here with us and also the veterans in the room with us,

those who may be watching this hearing, thank you for your service. what has come to light about the va in recent months has proven to congress, the veterans and to the american people that there's a real problem with accountability at all levels within the veterans administration. poor management and care from the va is a problem in nevada. veterans are facing and is not something that is new and effective something that is raise repeatedly. i believe it's long overdue for this committee to exert its oversight and leadership within the va and accountable. just last week us in a letter to secretary shinseki, asking for immediate answers about the lack of accountability on the local level and whether the va leadership finally plans to do something about it. i look forward to receiving a timely response and action on the concerns that i highlighted. as a that is represented on this committee i believe it's also my roll and responsible to get answers for nevada's veterans of the problems they're facing with va care and benefits.

in las vegas veterans have complained of excess weight times in the emergency room, which in itself is too small to meet demand. just a

i want changes. i do not want empty promises. if the va continues on this course i think it's time to look to the top for these changes. thank you, mr. chairman. >> thank you, senator heller. senator hirono. >> thank you, chairman sanders for providing this forum for us to drill down at the root of the

many issues facing veterans hospitals and finding solutions to these problems. i certainly a good the sentiments of my colleagues in expressing concerns regarding the va culture of the lack of enough accountability, the probable need for structural and systemwide changes. the veterans health care system is a promise that we made to america's veterans that we will take care of them and read -- in return for their service and sacrifice. close to 10 million veterans have access to care through the va system need to trust that they are receiving high quality care when they need it. and i do know 10 million veterans signed up for the health care system is huge. that is greater than the population of a number of states, including the state of hawaii. when we failed to provide proper care for our veterans we not only failed them but their families as well, and these

families have also sacrificed for our nation security and provide essential care and support for our veterans. while they -- while the immediate focus rebuild the phoenix case and simmer allegations regarding a number of other va hospitals, it is important to see what is happening systematically at the va to provide veterans high quality care. so we must look at the totality of the va system to see what is working and what is not. i look forward to hearing from the panel about exactly what the challenges and problems are, what actions have been taken, need to be taken to third our veterans better. while the va inspector general is investigating and secretary shinseki, has called for a national face-to-face audit of the va health system, my hope is a number of hearings by this committee will identify other changes that should be implemented. i look forward to hearing from you once again, mr. secretary,

and the other va officials on your plans to resolve the underlying issues and restore confidence in the veterans community and very importantly, to listen to what the veterans community has to say about the changes that need to be made. >> thank you, senator hirono. >> thank you for conducting this evening. mr. secretary, good morning. i arrived a few minutes late because i just returned from the world war ii memorial were a kansas on a flight was there, had conversations with the kansas veterans begins this morning. it's a moving experience each and every time to have the opportunity to visit with our world war ii veterans. and again of the conversation was the va is failing them. these make a certain, senator moran, that doesn't continue. thousands of veterans but hundreds of veterans in kansas visit with me on an ongoing basis and they tell me they're struggling and suffering stories

because of circumstances they find at the department of veterans affairs. they would tell me that the sacrifices they encountered if they were willing to save this less than doubled since, they would say why can't we have a service we earned and deserved what they earned and deserved that service. him sad story is that many veterans across the country and certainly in kansas i speak of lost hope in the department of veterans affairs department of veterans affairs and just believe that things are never going to get any better. your announcement of a face-to-face review across the system, mr. secretary, i find lacking in what needs to be done. the reality is that we have had review after review, inspector general report after inspector general report, questions by this committee and the house veterans' affairs committee that has resulted in a force like and

to any action by the department of veterans affairs. the idea do you can conduct a systemwide, as you indicate in your opening testimony, review of the va using 220 va employees and visiting one of 53 medical facilities, mr. secretary in 1700 va points of access to care, and you indicate in your testimony this will provide a full understanding of va scheduling policy and continued integrity in managing patient access to care. i don't see a review that last two weeks using 220 employees to look at 153 medical facilities as capable of providing that information. so i would suggest it seems to be more damage control than it does to be solving the problem. i think we don't have the need for more information, although that's always welcome. what we need is action based upon information that is already been provided to the department of veterans affairs. i served 18 years on the committee. i've worked with my secretaries of veterans affairs.

and what isn't seemingly true to me today is that the quality of service, the time in us of that service is diminishing, not increasinincreasin g, and that wasn't true until recently. we have a significant number of veterans that we serve today but mr. secretary we can anticipate more as are military men and women retire from service in afghanistan and iraq. we have an aging world war ii veteran population. if we can't care for the veterans were trying to care for today, how do expect the department of veterans affairs to care for those as the numbers and seriousness of the condition increased? so mr. secretary, i look forward to hearing what you have to say today. i welcome the conversation but in my view an additional review by your department is not the answer. the answer is action by the department of veterans affairs that changes a system that you are leading and changes the culture and nature of the folks that are your employees. i look forward to your testimony. i look forward to make certain we keep argument to those who

serve our country. thank you. >> senator begich? >> thank you very much, mr. chairman for holding this meeting, ranking member burr for offering an opportunity of this discussion, oversight of the va and issues that are surrounding the schedule but also many other issues that the va faces. let me first say to our two panelists, thank you for your service to this country in both way have done. secretary shinseki, immediately after the phoenix story broke, i sent a letter very quickly, outrage, unbelievable what is hearing but now after a few weeks it's now become a systematic issue that i've now seen others as you've indicated to your own conversations i've had with you. it seems an issue that is occurring in other va clinics. i will say from a state that is 77,000 veterans, the highest per capita in the nation, it is impactful in determining whether you get the care. we've been fortunate to be very frank with you the work we've

gotten with the va to give the great access to our health care services that has been able to cut some of that we can out but get better service throughout the state. but we would look at the veterans, maybe in alaska today, the more they might be in north carolina. so the service that's being delivered is critical that we figure out the systematic problem and i do agree with my colleagues that we have report after report after report, i've been here a little over five years and i've seen is gao reports and other reports always indicate systematic problems that we need to correct. i am going to be anxious for your commentary as well as others on how we're going to fix this once and for all. i know you've been burdened in some cases because we've had two wars, and the va started aggressively in the last three or four years after we've started to wind down in iraq and afghanistan which is cause a lot of pressure. so i need to understand how that has impacted so the work of the va.

also as you look at the issues and gives and what we need to be doing, i want to know from your perspective what are the things we're doing through more regulation or more loss of data grading more hurdles and red tape? is the stuff we should be eliminating to great a more streamlined process? i want to know that. but do not have the surface delivered at the highest level for veterans is a disservice. they earned it. they fought for this country. they served our country. we need to do everything we can to make sure the service is delivered at the highest possible level. so today will be a little contentious, no question about it. i hope tomorrow and you take what we've learned today and move to increase the capacity and increase the performance of the va. i thank you both for being here but i will tell you i was outraged and unbelievable what i've seen over the last few weeks but am anxious to work with you to get our veterans the best care possible as we started

aggressively in alaska is a unique arrangement with the indian health care services and the va which is because delivering better care than ever before. but more work to be done. thank you, mr. chairman. >> senator tester. >> thank you, senator sanders, and trying to end ranking member burr for this thing. i want to thank the witnesses for being here, this panel and the next he. the most meaningful and most difficult decision i can find is a men and women into harm's way. montana's -- with the second highest per capita of veterans in our state. it's a very personal issue for me and it's what i'm proud to serve on this committee. i am encouraged that folks in washington are suddenly interested in access to health of our veterans. in most cases it is long overdue. before i got fear that he didn't even have mandatory funding. they didn't have forward funny. this is a topic many of us been trying to address, and given my close association with the veterans issues i'm approach by veterans every time i go home,

and that's almost every weekend. overwhelming majority of those folks are appreciative of the care of va in montana. when the issues and concerns they are not bashful, as veterans are not, about telling me about it. when i get back in office on monday i work on those concerns, often with you. the allegations that they here and the allegations i am hearing now are very troubling. if any of these allegations in phoenix or elsewhere turnout to be true, swift and appropriate action needs to happen if the issues are systemic, we need to make some fundamental changes that we need to make them now. if the issues are about employees misconduct and competence, specific heads should roll. in order to move forward effectively and smartly we do need the facts. i hope we get those today. if we are truly interesting in on our veterans by doing them right, the facts will drive a productive conversation about access to health care for our veterans. let's talk about the ways we can

address the va medical work for shortfalls, particularly in rural areas. let's talk at ways we can improve chess notation options for veterans or expanding telemedicine initiatives. let's talk about buildings and partnerships between the local providers and providing the va with the resource it needs to address its patient workload. let's have these conversations so we can provide veterans with meaningful access, not just political talking points. veterans deserve our best to they have sacrificed much. let's demonstrate our best by having a productive, constructive, truthful conversation about what needs to be done to fix the problems that are out there in our va. thank you, mr. chairman. >> thank you, senator tester. senator mccain of arizona is not a member of this committee, but given that there is is allegations that it and raise the treatment in phoenix, sentiment became requested it, before the committee and we welcome them today. today. >> i think you mr. mcgurk of what you think of adapting for the opportunity to make a brief statement this morning,

particularly given that many of the series allegations that will be discussed at today's hearing involved the treatment of veterans in my home state of arizona. since our nation's founding, americans have been fighting in faraway places to make this dangerous world safer for the rest of us. they have been brave, sacrificed and suffered. they their wounds from more losses they will never completely recover from. we can never fully compensate them for. what we can cover the injuries they suffered on our behalf and for their physical and emotional recovery from the battles they thought to protect us. decent care for our veterans is the most solemn obligation a nation and curse, and we will be judged by god, and history how well we discharge ours. that's what i'm deeply troubled by the recent allegations of gross mismanagement, fraud and neglect at a growing number of veterans administration medical centers across the country. it's been more than a month since allegations that some 40

veterans died while waiting for care at the phoenix va were first made public. to date the obama administration has failed to respond in an effective manner. this it has created in our veterans community a crisis of confidence toward the va. the very agency that was established to care for them. at a town hall need forum i posted in phoenix last week, the families of for veterans who passed away in recent months stood before a crowded room to tell their stories. with tears in their eyes they described how their loved ones suffered. because they were not provided the care they needed and deserved. they recalled countless unanswered phone calls and ignored messages, endless wait times, mountains of bureaucratic red tape while there loved ones suffered debilitating and ultimately fatal conditions. no one should be treated this

way in a country as great as ours, but treating those to whom we owe the most so callously, so ungracefully, is unconscionable. and we should all be ashamed. since the initial reports in arizona last month we've seen this scandal go nationwide surfacing in at least 10 states across america. sectors and check has ordered and manage -- audit, several employees have been placed on administrative leave and the va office of inspector general is investigating the phoenix va. i respect the role of inspector general but my fellow veterans can't wait many months it may take to complete its report. they need answers can accountability and leadership from this administration, and congress now. clearly the va is suffering from systemic problems in its culture that requires strong reform minded leadership and accountability to address. the same time congress must

provide va administrators with great ability to hire and fire those charged with caring for our veterans. most importantly we must give veterans greater flexibility in how they get quality care in a timely manner rather than continue to rely on a department that appears riddled with systemic problems in delivering care. how we care for those who risked everything for us is the most important test of a nation's character. today, we are failing that test. we must do better tomorrow, much better. for the 9 million american veterans enrolled in the va today and for the families whose tragic stories we heard last week in phoenix who i know are still grieving the losses, it's time whether the to lincoln's injunction which serves as the va's model today, to care for him who shall have borne the battle and for his widow, his orphan. as i said, it's time for answers, accountability and leadership from this administration and i look forward to hearing from

secretary shinseki. i thank you mr. chairman, and i thank ranking member burr and the members of this committee. >> thank you, senator mccain. i would like to now welcome retired u.s. army general eric k. shinseki and the secretary of veterans affairs to the first panel. as i think most people know, secretary shinseki is a graduate of west point, served as the chief of staff of the army from 1999-2003. he retired from active duty in 2003 after nearly a 40 year career in the u.s. army. following the september in love with, 2001, terrorist attacks against the couch, secretary shinseki led the army during operation enduring freedom and iraqi freedom. he praises serve simultaneously as commander in general, nice

its army europe, seventh army, commanding general nato-led forces central europe and command of the nato-led stabilization force bosnia-herzegovina. and i want to also note a few of the many wars that secretary shinseki received during his -- awards. the legion of merit with oak leaf clusters, the barnstormed medal with the device with two oak leaf clusters and the purple heart with oak leaf clusters. mr. secretary, thank you very much for being with us today. secretary shinseki is accompanied by dr. robert petzel who's the undersecretary for health. esther secretary, your prepared remarks will be submitted for the record. what i would like to do now is if both of you could rise and take the oath. i would ask that do you solemnly swear or affirm that the testimony you are about to give before the senate committee on

veterans affairs will be the truth, the whole truth, and nothing but the truth, so help you god? think it very much. please be seated. mr. secretary and dr. petzel, the floor is yours. >> chairman sanders, thank you very much for that more than generous introduction. to you and ranking member burr and the members of this committee, thank you for this opportunity to discuss the state of va health care. i have been taking owes most of my life, mr. chairman, so when i ever -- whenever i appear before this committee, whether i'm sort are not, you have my best answers based on what i know, as truthful a presentation as i can make. i deeply appreciate your support and unwavering support for our nation's veterans. that's been true for five years now that i've worked with members of this committee.

mr. chairman, i would also like to recognize in the room here are others with whom i have worked very closely for five years, developing good dialogue, good collaboration. they have been very helpful in shaping what we thought was a priority in the department of veterans affairs. and it's been a good, strong relationship. and i thank them for their partnership and i know some of them will be testifying before you today. in those cases where we haven't always seen eye to eye, we have always managed to find common ground on behalf of veterans, and i expect we will do that again. we added the art committed to providing our veterans the high quality care, timely benefits, and safe facilities necessary to improve their health and well being. this commitment mandates a continuous effort to improve quality and safety america's

veterans deserve nothing less than our quality and safety meet high standards and bette veteras should feel safe in using va health care. that said, in health care, mr. chairman, as you point out, there are always areas in need of improvement. any allegations about patient care or employee misconduct are taken seriously, and based on the background you just described that i followed most of my life for 38 years in uniform, and i am now have a great privilege of being able to care for people i went to war with many years ago, and people i have sent to war, and people who raised me in the profession when i was a youngster, any allegations, any adverse incident like this makes me, makes me mad as hell. i could use stronger language

are, mr. chairman, but in deference to the committee i won't. but at the same time it also saddens me because i understand that out of those adverse events, a veteran and a veterans family is dealing in the aftermath, and i always try to put myself in their shoes. in response to allegations about manipulation of appointments scheduling in phoenix, i am committed to taking all actions necessary to identify exactly what the issues are, to fix them, and to strengthen the veterans trust in va health care. first, the office of inspector general as many of you pointed out is now conducting a thorough in time to review. if any of these allegations are true with regard to scheduling at phoenix and elsewhere, is where we've invited the ig to come in and look at issues that surfaced. if any allegations are true,

they are completely unacceptable to me, to veterans, and i will tell you the vast majority of dedicated va employee to come to work every day to do their work -- best for those veterans but if any of our substantial by the inspector general we will act, and i take senator murray's encouragement here to do something different, and senator, i will. >> it is important, however, to allow the inspector general to complete his duty, which is to conduct an objective review and provide us the results. second, i directed the hk as some of you have noted -- vha to complete a nationwide access review of all other health care facilities to ensure full compliance with our scheduling policy. and as we become that we've already received reports where

compliance is under question, and we have asked the ig in a number of those cases to also take a look. third, i've asked for and received the assistance from the president obama. the president has agreed to let his death the chief of staff for policy, robin neighbors, assist us in our review of these allegations come at any of issues we may find a during these reviews we start to scheduling but we will go where ever the reviews because. rob is a fresh set of eyes, the son of a veteran in these improved performer who brings brought a significant management experience to this task and i welcome his assistance. i have known his family for a long time. rob's dad and i served together for many years. i know his mom and dad well and i welcome the assistance of rob nabors. even as we take these proactive measure to support remember that vha conduct and approximately

85 million outpatient clinics, appointments last year. as a large integrated health care system, vha operates as has been noted over 1700 points of care, including 150 medical centers, 820 committee based outpatient clinics, 300 veterans centers, 135 community living centers, 104 rehabilitation treatment programs, and 70 mobile veterans centers attempting to reach the most remote of our veterans. this is a demonstration of concern by this department, trying to make sure that every veteran that matter where they live in this country, and even our overseas locations, have an equal opportunity to have access to quality health care. as the chairman has noted, vha conducts approximately 136,000

appointments everyday. over 300,000 vha employers provide exceptional care to the 6.5 million veterans and other beneficiaries annually. va health care is comparable meeting or exceeding standard in many areas. we always endeavor to be fully transparent. fostering a culture that if i which airs in order to avoid repeating them. every va medical facility is accredited by the joint commission, the independent organization that ensures that the quality that u.s. health care through comprehensive evaluations. in 2012, the joint commission recognized 19 va hospitals as among its top performers, lester that number increased to 32. additionally as the chairman has pointed out, the most recent american customer satisfaction index ranks va customer satisfaction among the best in

the nation, equal to or better than the ratings for private sector hospitals. and overwhelming 96% of veterans who use va health care today indicated they would use us against the next time they need inpatient care. 96%, and 95% for outpatient care. i want them to continue to have that level of trust. veterans deserve to have full faith in their va. the age is committed to a process of full and open disclosure to veterans and their families whenever any adverse event occurs. we participate in multiple external independent reviews every year to ensure the safety and quality of health care. they va will continue to aggressively develop and sustain reliable systems and train employees to detect and prevent health care incidents before they happen. i have detailed some of our many significant health care accomplishments the hk over the

past five years in my written testimony. i appreciate the hard work and dedication of va employees, our partners from the veteran service organizations as i indicated in this room, committee stakeholders, many of whom we deal with on a daily basis. and are dedicated va volunteers. i deeply respect the important role that congress and the members of this committee play in serving our veterans and and i look forward to continue our work with congress to better serve them all. and again, mr. chairman, thank you for the opportunity to have you here today. >> thank you very much for your testimony. i'm going to start off with a simple question of going to ask some harder questions. and you or dr. petzel can answer. very simple question. they va health care system is the largest integrated health care system in the united states of america, 6.5 million of veterans access it every single

day. mr. shinseki or dr. petzel come what are the strengths of the va health care system? what are the problems in your judgment? is a good system? >> mr. chairman, it's a good system, and is comparable to any other health care system in the country. in some areas and some specific occasions we exceed even those good systems. for five years now we focused on three major goals for va. all of us focused on doing better by veterans which is what the president asked me to do when i came here. the first was to increase access. i think we've been successful at this. we've enrolled 2 million more veterans into va health care.

i think there's a net here, somewhere around 1.4 million, 1.5 million who are net overall increases. but over five years we've enrolled 2 million more of veterans. the second focus was to go after this thing called the backlog. we've had this discussion for a number of years now, but we didn't send ago after the backlog just two and what was then, five years ago, a set of claims. we also acknowledged that we hadn't done very well by veterans of previous conflicts. and that even as we committed to ending the backlog in 2015, we also went and tried to bring justice to those who have never had an opportunity to submit a claim. i called on the good people in the veterans benefits administration to take this on, and they did it and i promised them we would give them the

benefits management system in three years we feel this new automation tool that makes -- >> how did we used to do them in 2008 benefits? >> all paper. if you want to go faster, mr. chairman, you have to hire more people. we ha have done that over many years. i think we have, i don't know, 11,000 people to process claims, which is -- >> what i want to do now, mr. senator, is pick up on some of the points, i think legitimate points made by democrats and republicans. and the major allegation, i think everybody here understands that when you treat 230,000 people a day in this mistakes are going to be made. that's true of any institution of that size. here's the major criticism i hear from senator burr, senator burr, senator begich and others, that this is not new news. that this is not new news.

that these concerns did not arise yesterday. they did not arise in phoenix, but, in fact, there have been reports by the inspector general, by the general accounting office on numerous occasions about problems having to do with scheduling and with waiting lists. could you address how it could happen that year after year, these reports were made and there has not been significant action? >> i think it's important to your to look at the gao and the ig reports and what they intend to do. and they come in and give us some sense of where we could to being -- doing better than ever get in there and we address those issues and take corrective action. and in essence close out the report. it doesn't mean that we have solved every issue. it does mean that we have taken

care of addressing those issues. and then when they come back there may be another set of issues to deal with. i do understand senator murray's suggestion that we are to take a company that looked -- >> i think what you're hearing from a number of senators, and for myself, is that everybody knows problems will arise to more. that's a criticism. the criticism is that year after year reports have been made talking about these problems, and the problems continue to exist. can you give us some assurance of what happens tomorrow? where do we go from here so we don't have this hearing next year or two years from the? >> i think that's what the audit that we've created is intended to do. so while the inspector general is looking at phoenix for evidence of employee misconduct, and evidence that 40 veterans

may have perished awaiting scheduling, the ig is going to get to the bottom of that. what we are attempting to do is to address the senators broader question is to take a look at ourselves and not wait for the ig's outcomes. and already we've begun to see some evidence that people are coming forward and saying hey, i think there is an issue. which i encourage. that's what we are after. and if there were performance issues of the past, if they are continuing today, we want to put a stop -- >> i have gone over my time. in your judgment based on what you know, our people quote unquote cooking the books? is that infected problem within the health care system? >> i am not aware other than a number of isolated cases where there is evidence of that.

but the fact that there is evidence in a couple of cases behooves us to go and take a thorough look. that's why we have structured of this audit so that a set of clinicians are not going to inspect their own areas. we have offset them so that we will get a comprehensive, a good look. >> i apologize but my time has long expired. senator burr. >> thank you, mr. chairman. mr. secretary, again welcome to these questions are for you and i will try to go as quickly as i can for the time constraints. mr. secretary, were you aware that on october 25, 2013, the office of special counsel requested that the conduct an investigation into the allegations of inappropriate scheduling at the fort collins community outpatient clinic? and since then the media has reported about mr. freeman's e-mail of june 19, 2013 that

explains how to game the system to avoid being on the bad boy list? were you aware of those? >> senator, i became aware of that screenshot, i believe is what it was, screenshot of an employee who was suggesting that our ways to game. i put unemployed and administratively. that was last friday. >> it's my understanding that on june 21, 2013, va received a report from received a report found office of medical inspector regarding chronic understaffing issues at the issues at the jackson the medical center, and the report described multiple patients scheduling problems including scheduling to patients for the same appointment slot and schedule patients for clinic that does not have any a signed providers. often referred to as ghost clinics. and on september 17, 2013, the office of special counsel submitted a letter to the

president of the united states on which the va was courtesy copied describing the findings of that june 21 office of medical inspector report on the fort jackson medical center, including the practice of double booking patients and the use of ghost clinics. do you remember reading that report and receiving that copied letter to the president? >> i can't say that i remember it today. >> there was a december 23, 2013 report by the office of the medical inspector regarding the cheyenne medical center in fort collins clinic that found that several medical support assistance reported and i quote, medical center to business office training included teaching them to make the desired date the actual appointment, and if the clinic needed to cancel appointments they were instructed to change the desired date to within 14 days of the new appointment.

did you read that report? >> the report has come to my attention here recently. >> okay. on paper 25th, 2014, your chief of staff submitted a response to the office of special counsel which concluded at december 23, audie 13, office of the medical inspector report on fort collins. and in that letter he states and i quote, however as always my, office of medical investigation, was not provided any specific veterans cases affected by this practice, they cannot substantiate the failure to properly train staff resulted in danger to public health or safety. were you aware of which are chief of staff wrote? >> i was. >> okay, mr. secretary, we aware that the gao report entitled the health care, reliability of reported outpatient medical

appointment wait times and schedule oversight need improvement, which was publicly released in january 2013 and then on december 11, 2012, to that same report, your former chief of staff john gingrich said a letter to the gao which stated and i quote, the a general agrees with the gao conclusions and concurs with gao recommendations to the department. do you remember that letter, that report, and your chief of staff response? >> in general i do remember that report. >> mr. secretary, you knew that there were specific issues relating to scheduling and wait times as early as june 21, 2013 at a jackson, december in fort collins as well as numerous ig reports went to excessive wait times in january 2012 in temple texas, september 20 vote in spokane, washington, october 2012 enclave in ohio, september 2013 in columbia, south carolina, and december 2012 a gao report which

questions the validity and reliability of the re- ported away time performance measures which brings us to today. and phoenix. on may 1 you publicly stated that you had removed ms. heldman as the medical director. and you stated then that that was to ensure the integrity of the igc current investigation. on may 5 dr. petzel conducted a conference call with all directors, all medical directors and the chief of staff's, a rather large group, to discuss the ongoing face-to-face audits of all these centers in large community-based outpatient clinics. i have been told by sources that were on that call that critical dr. petzel make a statement that the removal of ms. helmand was i quote political and that she is done nothing wrong. if you are asking us to wait until the investigation is over, doesn't the same apply to people

who work for you? and mr. secretary, from all i described to you and the current investigation that's currently going on, why shouldn't this committee or any veteran in america believe that change is going to happen as a result of what we are going through? >> i was not aware of the phone call you refer to, and i will look into it. i would just tell you that my removal of the director, placing her on administrative leave, was at the request of the ig. he is the lead in this comprehensive review. i don't get out ahead of him. he requested it, and i put the director and two other individuals on administrative leave. >> i thank you, mr. chairman. >> thank you, senator burr. senator murray.

>> secretary shinseki, as i said in my opening announcement that the president is in one of his top advisers to assist in this nationwide review is good news but i'm confident mr. neighbors will make sure the that this review is companies have an accurate. it is critical that this review is defective because at a hearing of this committee that i called in november of 2011 i asked the director of mental health operations whether facilities were gaming the system and not fully reporting wait times, and she told me she was unaware of any facility doing that and that vha was doing audits to make sure it wasn't happening. that as you know that an overwhelming number of allegations systemwide that wait times are being doctored. in the oversight organizations have reported on it for years. the department so far has been unable to provide an even the most basic information on how this nationwide review is going to be conducted or what it will look like. ..

particularly important about whether people have felt forced to do things that were inappropriate and acting the integrity of the scheduling system. the second part of this is an assessment as the number of people have measured as to

whether or not we have resources deployed appropriately and whether we have the appropriate amount of resources and whether we are using those resources in the best way in each one of the sites. >> everyone needs to remember that we do 85 million outpatient visits every year. 95% of those visits are with established patients. it's been mac i want the details of how this is going to occur so that we get different information. second would be to look at

whether or not to. they told me at a hearing in 2012 that aiming is so prevalent as soon as the directives are took apart the find a way out of the requirement. testimony from the mental health employees had the same thing. at the same hearing from the ig office told us and i quote if we have seen scheduling practices that resulted in the system to make performance tricks book better at the end of the day over the past seven years they need a culture change and to get that culture change they need to hold the facility directors accountable for how well the data is actually being captured. that was more than two years ago and the standard practice seems

to be to hide the truth to look good. that has to change once and for all and i want to know how you're going to get your medical directors leaders to tell you whether it is through this survey or in the future when they have a problem and we will work with you to address it rather than pursue these games in the wait times. >> if there is anything yet rather than just hearing allegations it is to hear you tell me we have folks that cannot be truthful because they think the system doesn't allow it. trust is an important aspect of everything that we do and it has been in my previous life as we well. what i will say to you is we are going to get into this.

we ensure that veterans to gain their trust and whatever has been compromised that they come to the va, they come to a good caring system and that they will be cared for. and for all of the employees that are listening hayek specked the highest quality care given all of the comments about how tough it is and the healthcare industry. and provide access of the benefits as quickly as we can. we only have one mission. let's take care of these veterans. i am one of them. 100,000 of our employees at the va are veterans and we have a vested interest. >> it will not work if the people telling you information

do not tell you the truth. do you remember or know william? >> i do. >> on the 26th of april, 2010 he sent out a memo to all of the direct using the va entitled an appropriate scheduling practices. it's come to my attention in order to improve the scores on the measures certain facilities adopted the use of scheduling part is sometimes referred to as gaming strategies. i'm going to read the whole paragraph because this is the key to the question. for your assistance and this is an eight page attachment. there's a listinthere is a liste scheduling practices identified by the working group chartered

by the system redesign office. additional or modified strategies may have emerged who do not consider this a full description of all of the current possibilities for scheduling practices that need to be addressed. are you familiar with that memorandum? >> i am not. >> i am familiar yes. >> if it is not going to be tolerated and over four years ago you had eight pages for gaming the system, what action if any data they do to respond to the memorandum to see to it to the hospital director directs followed the orders? >> we have worked very hard to rule out the inappropriate uses of the scheduling system. we have been working continuously to try to identify

where those sites are and what we need to do to prevent that from happening. it's inexcusable. the scheduler's responsibility is to be sure that program is administered with integrity. >> certainly you have uncovered one. what did you do to them accountable? >> the individuals as you mentioned i can't give you an example specifically that if someone were found to be manipulating the system, they would be disciplined. >> i don't know if that is appropriate or not. >> we can give you a little better answer because you are focused on scheduling. what i can tell you is the 2012 we removed 3,000 employees for either poor performance or misconduct. in 2013 another 3,000 employees.

some may be reassignments and others were the departures of my retirement and others by in effect being let loose. i go into this entire memorandum and there is no gray area. we know this is happening and there may be other ways of gaming the system and it talks about it specifically for improving the scores on the measures which i guess means the way in which the performance is evaluated as an employee is that correct? >> i would assume if the system

redesign office had a multi-working group, do you know what the system redesign in office is? >> that is the group that is responsible for ensuring that we are designing the work within the clinics and operations in the most effective and efficient way, and they've been given at that time responsibility for monitoring and keeping track of access. >> you had a group that identified him 26th of august, 2010 the various and numerous practices where numbers were being manipulated for better outcomes i presume in terms of how those people will be rated

they would see to it is and tolerated and it was an accountability to be had including the loss of a job. >> the dead institute that appropriate level of accountability. i don't know whether anybody was disciplined around that issue but this has been an important thing to us for at least the last four years and we try to rule out the places where it was being used. >> i know my time is up. for the sake of the integrity of the veterans administration you need to find out if there's an accountability system to respond and what it was in the second i would ask consent to submit this for the record. >> senator blumenthal? >> again thank you to do and the

other veterans who are here and listening for their rest and involvement in this issue. secretary can you tell me how quickly we will have some preliminary results to the review into the investigation? >> the inspector general has his own timetable and i don't have insights into what that is. we are taking care of most of the large facilities perhaps in about three weeks we will have been able to assemble all of the data and do a good analysis and then respond in details can you commit that you will have a report for us? i don't know what the data is being assembled but we will

shoot for three weeks. >> as you know all of our time is limited. as a part of the management responsibility, don't you believe that the fix and i certainly believe there is a responsibility to complete this report as quickly as possible within a matter of days and weeks and not months. >> it would be helpful to complete the report as quickly -- can you give a deadline? >> they are an independent reviewer and once i turn this over to him and supporting the nature is a very criminal wrongdoing that is falsifying records and statements for the government? that is a crime.

wouldn't it be appropriate to ask for assistance from the federal investigation or some other agency given that the resources are so limited that to the task is so challenging and the need for results is so powerful? i will work to make that available to him if that is the request. >> may i suggest respectfully that it's your responsibility to make that judgment and to include appropriate federal criminal investigative and there's more than sufficient the is more than sufficient reason to involve other agencies here in light of the evidence in the

false statements to the federal government what i am hearing from my colleague is the background about the systematic failures and the need for the greater transparency and accountability so let me ask my next question. >> every discussion is based on what is underway. each discovery adds to that workload and we will have that discussion again. will you change your team given that the background here shows

systematic failing over a paragraph of years and not just once? i don't want to get ahead of myself or dig i want to see the results and if the changes are acquired either will take those actions. >> what is changing the team be appropriate? >> i am still waiting for the results of the audit. >> thank you anyway that she was treated at the emergency room in

las vegas have you had an opportunity to see the results of that investigation? >> i've had an opportunity s. the >> without revealing details about the individual it was she did way too long and there were others that waited too long. it didn't happen in the estimation of the inspector the impact of the course for illness, but it was inappropriate to that of a service connected a blind veteran should have to wait for that long in our emergency rooms. >> mr. secretary, do you agree? >> i do agree. i don't think any government should have to wait for that long in any of our facilities whether it is an emergency room or clinic. >> have you received complaints about waiting times for any

other city in nevada? was that i am not aware of another facility in nevada. >> i'm not aware of it either. i don't know the results of the visit. >> 12 hospitals and clinics? >> yesterday well do they have more with dig? >> if we find there would have been inappropriate activity than wan appropriate activitythen wee ig to come. that is difficult to predict. >> are you talking about a continuing series of products? >> i think based on what we find is a long-term systemic issue we

will set up a program of sustaining looks that way are talking about. >> can you make that available to myself and my staff? any member in the application? >> with what is going on in phoenix and the time wasted that we are seeing across the country and of course in nevada, and of course the disability claims backlog that we were seeing three times longer than what it should be do you think that you've are ultimately responsible for all of us? it would be three times the national average on the claims.

perhaps it is true at one time but those numbers are down. >> affair 355 days. that is still longer than the national average. would you explain after knowing this information why you should not reassign? >> i told you senator i can't even think of things better. that was my appointment by the president every day i start with the intent to provide as much care and benefits for the people who. i think it is wit critically dee and need and i can tell you over

the past five years we have done things to make things better. we are not done yet and i intend to continue this mission until either that goal or the commander in chief has been served. >> thank you for being here today mr. chairman. >> in this testimony he states the mission is to provide quality healthcare is providing quality healthcare still the core mission or have the goals shifted over time as they have extended and to provide other benefits as well and of course i know the congress passed the job training, housing assistance, education assistance, reduced homelessness.

can you share your thoughts about what is the mission and with all of these other tasks are you able to focus on your mission of providing quality healthcare to our vast? >> the safe and accessible healthcare for the veterans who have earned their is the core mission is to provide healthcare they still have access to the system and that means we have to do a good job at dealing with disability claims if we are not able to process those claims have the opportunity to access health care is something less for the current generation so

for that group that generation is a little different than others. so the disability claims become an issue because it renders the opportunity to take advantage of healthcare benefits. >> i would say it is also part of our responsibility. five years ago we talked about homelessness as though it were a thing out there because we focused on ending as a major factor that lead to homelessne homelessness. depression, insomnia, pain, substance abuse. >> i'm sorry to interrupt you but my time is expiring. all of these areas that we have asked you to address and the

homeless issues and all of that. is that to me to the core mission and that may be a rhetoricarhetoricalrhetorical qy move on to another area. as we look at the potential need for making the systemic changes to how the va operates, and i know tnote through the testimony on page eight where he says there'there is no natural proceo establish the positions to the delivery of healthcare. there is no standard organizational chart for the hospitals and clinics so it is very hard to determine. would you consider these two areas to be potential systemic changes that we should be looking at making?

>> i think that is a good insight and we will take a look at that. part of our challenges the complexity of the system. we have hospitals that go from the largest and the most sophisticated comprehensive healthcare. almost distinguishing between the level of care that can be provided. it is a complex system, but i think standardizing the definitions of what in that framework would be helpful. >> thank you mr. chairman for holding this hearing and i hope it is the first of many hearings. you know, mr. secretary, as you know, i occupied a cabinet post

for part of my career there are some that are kind of a lightning round. if you are going to be the attorney general or the secretary of state, you're going to get fired every day. it's part of the job descripti description. on the other hand my judgment doesn't fit into that category. and the other thing about the va is because of the ranking member and those that preceded them it is pretty nonpartisan. we don't sit around talking about republican democrats. we talked about how do we improve the lives of the veterans that have served our country and i've always applauded about and i think that we need more of that not less. but if there have been tough

budget cycles yet view your self have come to the committee many times it is said that you are resourcing this appropriately and generously under the circumstances and we thank you for that and applaud you for that. mr. secretary one of the submissions we get is a map. have we shared that with you or has that come to your attention? >> i think i may have seen a copy of that. >> it is entitled epidemic mismanagement and it goes down vermont, pittsburgh, north carolina, columbia south carolina augusta georgia, jackson, chicago, st. louis, san antonio, fort collins, phoenix,

just place after place where they have thrown up their hands and said what is going on here. do you dispute what they are seeing >> i'm not aware of the basics but i accept that there are places here where we have had adverse events and i don't know if all but a good number may be a majority were self identified and initiated within the veterans administration or the veterans health ministration which then allows us to investigate and figure out what happened in than t then to be

transparent and tell people what happened. >> so many hearings where we've talked about the waiting list into the disability claims i walk out of the hearing like i've been given an explanation so i will quiet down and let you go back down to work. i don't see the change necessary and what worries me about this and what we are dealing with is that it is the stomach. it's cultural. people have adopted this operation as the way of doing business is. do you fear that the culture is even after this you say okay

folks from now on we are going to do eight, the, c. and d.. do you feel people say how do we gain that? how do we get around that? i'm sure some plays in an organization they will have something like that. >> but this is part of the reason why i engaged the veterans service organizations on a monthly basis. are there any straight shooters here in terms of being direct this is why i spent a good bit of time traveling the country coming to the facilities and talking about what's important and engaging in those locations as well. the voices most important to be aware of those i encounter out there and there is an occasional

concern and i always bring it back and go to work but i i haven't received a systemic look at is being described. there is a distinction between a medical mistake and manipulations. in the case of a medical mistake, i want people to stand up and say something is wrong here we made a mistake or i made a mistake. we have to have a confidence and honesty on the part of the workforce. and in many of them succeed bowlethose exceedinggoals on tht initiated the concern that. >> at this point i would like to bring up -- do you have

questions? >> thank you mr. chairman and i just wanted to catch the first vote. i want to thank you for being here and for the work that we have done but some of the comments i want to follow up on and they will be very frank with you mr. secretary, again the good work we have done to go after some of these issues to accomplish some things that have been an improvement for the veterans and to remind folks. to listen to the note of the memo regarding the identification of the issues

that talked about scheduling and other issues we talked about trust with the delivery of services in the va. but i will talk you from my time as the mayor if you have people that have been identified, to have manipulated records from the city site we would fire th them. if they are cheating they are not trustworthy. if you transfer them to another part of the government, then it's perpetuating a what they have done. they are dismissed, retired. i want to know on this issue have you ever fired anybody on this issue when you find out

that they are not -- they manipulated the records? because to me it is a fundamental question. we are not changing the system to improve it. if you can't answer that now i do want an answer because to me this is a fundamental issue. >> i would have to give you an answer that looks at the specific reasons that we released. without getting ahead of the decisions, i would say that the manipulation of data is serious. >> would you fire? >> i would do anything i can. >> that's not the question.

there's a process, let me not to get ahead of it. so in the end i have a reversal because -- >> let me ask you this in the last -- clearly that report identifies people that have been doing some manipulation manipule question is from that report was anyone fired for that activity? >> i would say ther if there way manipulation that identified individuals i would expect to see their names on that list of 3,000 that's what i can tell you today. >> can you go on the record for that? >> let me ask if he has anything

better. >> i don't have any specific information, but we can go back and try to resurrect whether or not that has occurred. >> we solve this problem when we first came in we had backlogs on claims and scheduling issues and a lot of things but we went after it to figure out how to do this. we went after it with the program that has money at the end of the fiscal here and there is a variety of things, so i know that we can fix this problem, but we still have challenges and i think the biggest challenge is if we don't hold people accountable for actions, that they've manipulated or drafted the records to make it look better we will never solve this problem and sometimes you have to have their heads roll in order to get the system to shape up or they

know line still on leave and get paid. what is the penalty? >> we are not on disagreement. >> i just wanted to hear that. i know we are waiting on the report that will give more opportunity and i am hoping that when it comes out that there will be an immediate action based on the report by further study. they say we need to get after it. in this country and then i'll ask it will be the ones that lose out at the end of the day. >> of those will be the last questions from the members. >> mr. secretary and your testimony you said and i quote i

invited an independent investigator to conduct a thorough and timely review if any of the allegations are true they are completely unacceptable to the employees if they are abstaining to make a substantiated for what you definewould youdefine the respod timely action? there is a process to be able to implement those findings will. the decision regarding those i would tell you it would be a aggressive and swift as i can think there's a process tha thas that is not under my control the va medical center was released april 17 of last year because senator isakson went to

personally address it and i'm sure you are aware that the report regarded the unexpected deaths and the substance abuse and the rehabilitation program in miami va healthcare center because that was released on march 27, 2014. in the testimony, it saves both money and he in atlanta as the reports indicate the steps to ensure they were kept safe while under the control were not taken and the managers didn't show the hospital staff was performing their jobs. i would assume that you would find miami and atlanta acceptable and if you tell me what we have done in a respectable manner to remediate that problem. >> there have been seven disciplinary actions including the removal of three senior

officials and miami is still in the process. but we will do this as quickly as we are able to do. >> we have heard about the waiting times in the various countries and i think that the doctor informed us of the last few years we have seen 2 million additional veterans coming into the system is that correct? >> some of them are coming in with cvs problems in terms of ptsd. let me ask you a simple question to what degree does the va not

have the resources to address that increasing the patient's? a lot of them are coming into certain parts of the country if we see this because you simply don't have the resources. >> the ability as i said earlier to provide appropriate access to the group of veterans depends on several things. one is the people, do we have enough people in our reusing these people effectively and number three are we using all of the other things available to us? we are looking as a result of the audit to make a determination if we have adequate resources there and my

thought is we need to look closely at the place is having access issues. whenever we have a crisis and this is an ongoing set. the patient growth each year the complexity of issues as you described so this is an ongoing assessment that we try to get in the budget process. i would like to call the second panel.

>> is more from the hearing on veterans health care. this panel includes leaders of the organizations. they testified that the quality of the veterans health care is strong but access to care is a problem along with funding and accountability.

>> a >> of the va is different than other agencies because while we serve and represent all of the people in the country we have a very special constituency and that is the men and women that put their lives on the line to defend their country. there are people that utilize the everyday. and today we are very pleased to have their representatives for many of the major veterans organizations here with us and i think them all very much for being here. we are all interested to hear about your experiences. you know more about it will. i look forward to hearing your suggestions and criticisms. i would like to remind each of you to keep your presentation to five minutes into the statement

will be printed in the record of the hearing will. our guests today are daniel who is the commander of the american legion, joseph, the national legislative correct or for the disabled american stearns, carl blake of the paralyzed veterans of america dwayne robinson of the student of veterans of america, ryan, deputy director of national legislative service veterans of foreign wars in the united states and rick white for the department of veterans. i want to thank all of you for your honorable military service and being with us today with. commander dellinger. >> yesterday we learned of someone who died trying to get health care from the va.

his wife complained he would have to wait for hours to be bounced around different counselors. they expressed their concern about this issue before the house veterans affairs committee at the beginning of april, and again before this committee at the end of april. our testimony as a matter of public record. chairman sanders, ranking member burr and the distinguished members of the committee. on behalf of the two and a half million plus another million of the auxiliary family members, thank you for holding this hearing and inviting me to share the views of the largest veterans service organization in the nation. today itoday's ago i was in phox arizona. we were in the veterans hall meeting with almost four hours but by over 262 spoke passionately about scheduling issues and various other concerns at the hospital. i will be happy to discuss the details of the meeting during the question and answer period if you would like to hear more about the information gathering

sessions. so, i am here to help you understand why the american legion believes that the va needs to address the deficiency and also let you know that the american legion fully supports the department of veterans affairs. we support the creation of the administration in 1930 to get an elevated to cabinet level in 1989. we donated hundreds of thousands of hours each year along with millions of dollars and have scores of claims are presented as. make no mistake about it the american legion believes in the va. the allegation that seems to the department of veterans affairs medical center now being investigated along with 40 or more patients have rocked the veteran community. in addition we now understand at least six have been identified in the weeks time that

reputation. they were not the only reason that they decided to call for the leadership change at the va. for the colonoscopy an and until equipment and unreasonable times between resulting in patient deaths and abandonment of efforts to create a unified interoperable joint health care record used by both o the department of defense and the department of veterans affairs. the refusal is her congressional inquiries before congress. we heard the senator is concerned enough about mismanagement and mental health at the st. louis began the drivt of the letter with senator blunt to get to the bottom of it. when nothing is going to get the

better it seems that they can't pass when the reports of the problems and difficulties they face with the amazing quality of care challenges. while we wait for things to get better, hundreds of thousands are waiting for the decision on their initial disability claim or appeal. while we wait for the transitioning service members falling through the tracks to create a single operative medical record. while we wait, the officials prevent hospitals from being transparent while we waited they continue to plague the nation at 22 per day with no strategy from the va on proactively addressing suicides. again i would like to thank you for this opportunity to speak with you today and welcome your questions. >> thank you for inviting me to

testify today about the state of the health care we remain concerned that the allegations of the employees that are management that actions for the true picture of access problems. we support the ongoing investigation by the inspector general and we bough we will bel accountability for anyone found to have violated the law or failed to follow and enforce the rules and regulations. we also support the secretary should psyche to honor them to determinthan todetermine whether problems are occurring. however we strongly recommend the va outside third party experts to increase its objectivity, and credibility and help to gain the full trust of the veterans and the american people who while the medicine is far from an exact science, they've earned the right to

expect the healthcar health-caro provide high-quality medical care. while it may be weeks or months before the investigation is an audit, we continue to have confidence that it will. the secretary has a track record of directly honestly confronting problems and working with stakeholders to correct them. we continue to believe that they have high-quality healthcare for the vast majority of the veterans treated each year and the veterans are now and will be better served in the future by the robust health care system than any other model of care. the challenge in the root cause of the problems being reported today have to do with access to care rather than the quality of care delivered. over the past decade the

partners in th into the indepent budget have pointed out funding shortfalls in the medical care into the construction budget. funding for medical care provided by congress was more than $5.5 billion less than the recommended. they recommended over $2 billion more. i would point out that you called for an increase of $1.6 billion for fy 2015 but based on available information today, it appears that your colleagues will not increase the administration's inadequate request for the funding request in the amount has been more than $9 billion for less than the

recommendations. for fy 2015, the budget request is $2.5 billion less in the recommendation which was based upon their own analysis we agree with your estimates and letters the past few years where you stated that the administration budget request for construction has been and i quote clearly insufficient to meet the identified needs and that congress took no action to increase construction funding. finally, the va needs to utilize its purchase authorities and believes that whenever they are able to receive care directly from within the established timeframe, they must have take responsibility to find alternative means to provide and coordinate such care. however if it was gekas and each

dollar was 1 dollar less than available. are the congress must appropriate those dollars to hell it not be coordinated with care and are there sufficient qualified providers available in the community simply giving the veteran a plastic card wishing them good luck in the private sector for the fully coordinated system of health care. mr. chairman, looking today putting it in the proper perspective the entire system of healthcare that we continue to have confidence of the veterans that are served by seeking their care from the va. we remain confident that secretary chin zaki working with stakeholders in congress will come it can and must address

these entities are nothing less. >> thank you for will. >> chairman, ranking member of the committee on behalf of iraq and afghanistan i think you for the opportunity to share views and recommendations regarding the current state of health care with the va. nearly a decade we've been a tireless leader working on behalf of the families to ensure they meet the needs of the community after spending 13 years it's been confronted with significant challenges and timely care and services. many have been overcome that are far too many remain. in the past few weeks the allegations of misconduct have arisen from several facilities indicating records are being intentionally doctored to portray the patient wait times as reasonable satisfactory. long wait times are alleged to be the result of 40 deaths of the veterans that perished while waiting for care at the medical

facility alone. unfortunately these incidences are not new nor apparently unique. it's time for reform and measures of accountability. our members are outraged and expect meaningful evidence of long-standing inefficiencies are being appropriately addressed and personnel are being held accountable. they must be assured they can deliver care in a timely matter. the issue on the house committee on veterans affairs in full compliance in the subpoena would be a good first step not only figuring out what happened in phoenix but demonstrating how the applications would be addressed and other facilities. like the secretary, we are also awaiting the results of the inspector general's results in phoenix. but we can't sit around while the investigation is underway.

we applaud the 1720s however we expect to. veterans need to see the secretary step out in front of the issue. we want a proactive secretary not a reactive one. controlling the messages critical into the secretary cannot do it they will continue to lose faith in the system. accountability is a fundamental principle necessary for any organization to properly function, yet the incident of mismanaged care indicates such a thing as missing from all levels at the va. secretary should psyche started to emerge publicly and address the allegations but not eradicate the problems to lose faith in the system to earn back the confidence of the veterans shaken by the controversy.

they are actually nothing new. they conducted numerous studies touching on scheduling efficiencies and they are finding things continue like that of oversight and inadequate training and ambiguous policy procedures in other words, leadership. essentially they are in management and proces process ay can fault the combination of peoplpeople into time and resous in the effective business practices. they are solvable as long as they have the tools they need to fix it. that isn't the case. instead of the leaders coming forward they appear to be fixing the book. this is of the culture of the failed oversight and no accountability. reasons for highlighting the mismanagement are not done lightly. the worst that can happen is the sense that the va is so efficient that they lose faith in the system to take care of the needs.

the right answer isn't to cover up problems wa but to keep them from happening in the first place. it's a matter of lives and the estimated veterans who die by suicide per day 17 have not sought care at the va despite the problems seeking the care works. it's critical that they need care and feel encouraged to seek it. it should be enacted into law immediately for her. it will be addressed and swiftly corrected. we also need to ensure the full scope of mismanagement and covered up at the system. this is why they are proud to

work with th the project on government oversight to protect the whistleblowers. they can come forward confidentially by going to the oversight.org. we can appreciate the opportunity to offer our views on the important topic and we look forward to continuing to work with you and your committee endorsed after improved the lives of the veterans. thank you for your time and attention. >> of is a would like to thank you for the opportunity to testify on the state of healthcare delivered no group of veterans understands the scope of the care provided better than the members. they have a spinal cord injury or dysfunction. members are the highest percentage users. let me begin by saying they are deeply disappointed by the

number from around the country that suggest it ha is being compromised. they are undoubtedly serious access problems in the va have i would like to associate myself with comments made re: gaming the system and for all intensive purposes shooting the standard. if that is going on and where they are found going on the mysterious and appropriate actions should be taken if that means people have to be fired, so be it. .. completed before any final decisions about the v.a. leadership are made. at this time, p.v.a. stands behind secretary shinseki and he is committed to fixing these problems and should be afforded the opportunity to get it right. the narrative that has been created by the media does not necessarily reflect what is happening inside the walls of the v.a. healtca