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. health care system.

committee wants to gauge what is going on and how the quality of care is being delivered, i would ask you to spend a day walking around inside the local hospital talking to veterans and discussing their health care experiences, not sitting in front of a pre-selected panel of veterans to support sweeping jenlizations and to stoke public outrage. the fact is that the v.a. health care services are excellent. patient satisfaction services support that assertion. the primary complaint we hear all of the time from veterans is how long they had to wait to be seen for an initial appointment or to receive care. at its core, this is an access problem, not a quality of care problem. these are not the same thing. and to be clear, sending veterans outside of the v.a. to get private care is not the solution to this problem. it might be part of a solution, it is not the solution.

particularly for veterans who ly on it might be part of a solution. it is not the solution. particularly for veterans to rely on the special ed services. the fact is there are not comparable services to the va sci service, blaney care, amputee care and the widespread of specialized care va provides in the private sector. everett statement provides a snapshot of the spinal cord injury system of care and clearly identified serious staffing shortages that exist in the sci service, particularly understaffing side. the site visits we've conducted with ethical services teams for nearly three decades provide us the unique authority those problems. unfortunately those staffing shortages severely limit access to the system will also play in health care delivery for veterans at risk. insufficient staffing and by extension insufficient capacity is ultimately a reflection of

efficient resources that this assertion in previous administrations are requested for health care commit sufficient resources commerce is ultimately provided. the independent budget co-authored by pba, tac in the vfw has made recommendations to adequately fund health care for 28 years. for the last several years, congress has essentially her recommendation. and now here we are discussing, how could this have all happened? i would agree with senator johanns who indicated what the heck is going on when he looks at this and considers the budget that have been requested. as suggested in the great irony of the hearing today's discussion about is the oig adequately funded to do these investigations? is the va health care system adequately funded to deliver timely quality care? i would suggest the answer to

that question is no. until the congress and administration commit to providing truly sufficient reserves is to hire adequate staff and establish real capacity. the problems around the country will only get worse. the administration and congress both bear the response ability of these problems. veterans pay the cost sometimes with their lives of inaction resulting from partisan occurring and political gridlock. political interests do not come -- do not come before the needs of the men and women who have served and sacrificed for this country. we call on this committee, congress has a hole in the investigation to redouble your efforts to ensure veterans get the best health care provided when they need it, not when it's convenient. pba members in all veterans will not stand for anything less. i thank you again, mr. chairman.

i'd be happy to answer any questions you might have. >> thank you very much. dwayne robinson as the president and ceo of veterans of america. beatnik chairman sanders, ranking member bird and ranking member -- members of the company. thank you for many students veterans of america to submit her testimony. as a near advocate for student debtors in higher education is their privilege to share on the ground it with you today. i would like to begin by addressing family members of the veterans for who we are gathered today. and stand with you seeking answers. student veterans of america is a network of over 1,000 chapters on as many campuses coose all 50 states and three countries. they comprise veterans with the majority having served after 9/11. paramount to their success is the ability to remain healthy

and utilize the health care system provided by the department of veterans affairs. in this testimony, we speak on student level issues of health and well-being with our main focus being on higher education. as the g.i. bill makes up a major portion of the benefits, we believe it is essential to consider education and the role it plays in the life of veterans who may be receiving health care. as a former commander in the army with service spanning three decades and current leader of a large organization, understand how difficult it is to be responsible for many locations and work forces. i also understand the position of older and younger veterans as i have served along side, have led and have been taught by both. many of these friends and former leaders of mine ensure they are made abreast of the issues they face while accessing care. some veterans are student

veterans are as diverse of our nation and progressing of degrees. likewise, our members have millions of experiences with the v.a. and other large institutions integral to their success on a daily basis. they are allowing the v.a. for their livelihood, health care and future success of themselves and their families. this support system for student veterans may be understood by looking at three levels of support which we term the three pillars. we encourage this committee to focus on these three pillars. pillar one, institutions. institutional support for student veterans is an important aspect of maintaining a strong pipeline of successful veteran candidates. pillar two, individuals. establishing an environment for the student veteran to interact with the institution and the community as a determining

factor of well-being. pillar three, communities. established network across university offices, academic networks and career services enables the student veteran to make the transition from the campus to a fulfilling career. it is the firm belief of s.v.a. that the v.a. has overhauled the benefits process and that the same level of production should be sought within all components of the department. over the last five years, secretary shinseki has led the v.a. as it brought g.i. bill processing times down. and in the at the same time, v.a. has paid out more than $40 billion in tuition and benefits o 2.1 million veterans and families since 9/11. we recognize the v.a. has a long

way to go. it is our sincere hope that the secretary is able to achieve the kinds of outcomes across the department that he has accomplished for student veterans with the implementation of its benefits programs. as v.a. believes that secretary shinseki is dedicated to american veterans more than ever. the v.a. has seen substantial improvements over the years. while the recent allegations are disturbing indeed, we would encourage the secretary to take swift action when the facts become clear. this would demonstrate his continued commitment to veterans who utilize the v.a. system. we thank the chairman and ranking member and the committee members for your time, attention and devotion to this cause. as always, we welcome your feedback and your questions. >> thank you very much. ryan gallucci, deputy director of the national legislative service, v.f.w.

>> thank you, mr. chairman. i wish i didn't have to be here today, but on behalf of the 1.2 million veterans, i thank you for the opportunity to share the v.f.w.'s concerns. simply put, v.f.w. members are outraged that the health care system that i use may be doing harm to my fellow veterans. what is more frustrating, nearly a month after these allegations, we still do not have the facts. we don't know who the veterans may have died in phoenix. and veterans wait for care or paid for it out of pocket. regardless of what comes out in phoenix, wyoming, atlanta, chicago, spokane or elsewhere, v.f.w. knows that veterans have died while waiting. so what happened? the v.a. tells us the situation is improving but to the veterans affected, this is not good enough. over the last month, we see the

v.a. may not be living up to its obligations to provide the best care. veterans deserve the truth, not about wait times and investigations. the v.f.w. has been frustrated at the situation, and we have been reticent to condemn individuals without the facts. whistleblowers first brought problems in phoenix to the attention of v.a. and congress as early in 2010. cnn broke the story. why are we still waiting? the v.f.w. told the veterans to call our help line to voice their concerns and connect with some of our service officers to help. while some said they were satisfied, most painted a picture of a v.a. health care system that is overburdened and overresourced and sometimes that is overburdened, underresourced and many times paranoid. interim, north carolina, direct veteran told me he can see his

primary care doctor once a year and not health care ulcer after 10 years of misdiagnoses. what we've heard over the last week is a small sample of hundreds of concerns for veterans coast-to-coast, but the outpouring of concern is alarming and seemingly systemic truths about his causing the failure? is the lack of resources, personnel, leadership? the vfw plans to conduct town hall meetings talking to veterans face to face once location we will invite the committee to attend. as a veteran who uses va care, i worry the recent allegations are causing veterans to lose confidence in the system that is designed to support them and care their needs. if one veteran is not receiving the care he or she needs coming this one too many. vfw members demand answers about one is responsible for any wrongdoing held accountable at all levels of leadership until the fullest extent of the law. with this in mind come in the vfw believes it may be time to issue a review of care.

we hope the va would never intentionally deny care to veterans, either have to be reasons why takes a lot to be delivered. they were the current culture may be focused on making funding fit at every level as my colleagues from paralyzed veterans of america outline. the culture must change. readership must have the confidence that if they have a need to has to be addressed. when a capacity is an issue. the vfw and other partners on the independent budget have for years highlighted in needs and in 2004, utilization was at 80%. in 2010, 122%. still unacceptably high. that is undoubtedly affects the care. plus when there's a lack of resources, there's a tendency to make trade-offs whether through delaying carotene in the schedule to satisfy quotas. the health care system is commissioned to care for those who serve template for a nation. men and women chosen as jurors of the system have been entrusted with a mission that cannot fail. it is their duty to fix it.

it is her duty to hold underperforming accountable. most important if there are going to perform the mission, it is their right duty to ask groper satisfied. in addressing any failures we must reduce any suggestion vha is a fundamental failure that should be dismantled in favor of an alternative model. this only relieves va of its responsibility. last year the president met with an vfw commander chief john hamilton and promised he would not leave these promise to his successor. last week the commander-in-chief sent a letter to the president reiterating the concerns. we learned last night the president shares the concerns of the vfw. today we ask not only for the president to live up to his word but implore congress to do the same. we cannot sit on our handsomely for the system to slowly improve. the situation unfolding across the country demands immediate, decisive action. the mission of va health care is far too important veterans advocates and users of the system, we will not allow it to

fail. mr. chairman, this was my testimony i am happy to answer any questions. >> thank you, mr. gallucci. rick weidman is the director of policy affairs of vietnam veterans for america. >> thank you for the opportunity to be here today. what they minister about us for a long time and that is the lack of truthfulness on the part of some people in senior grades at ea, posted shading the truth and hearings on the hill, but also reporting up and do something that households all of us. it highlights her national president, john rowan, i'm toast. i am out of here. i am fired and you are gone, pal. i agree with that decision. you can't run an organization and certainly not a medical organization where people do not tell the truth to their

superiors because otherwise if they don't have good information, they can't manage properly. i will say it is her from contention the majority of people who use va get good to excellent care. the problem has to do with access in poor quality assurance. it is very uneven. the plain read. it is a question of too many clinical needs. and what happens, distortion in the system and breakdown of the sequencing of care and that is what was wrong with the care. that's what's wrong with the care at v.a. there are not enough clinicians and getting people the care exactly when they need it is not happening. the question is are there enough resources and we have to say we

don't know. what we have been saying for five years is when the budgets started to go up, largest increase in the health care budget for v.a. since the end of world war ii, that too many middle-middle people where positions were being creat ngress g too many mental mental people positions are being created. congress gave back huge increase to va to hire more direct service providers. more.yours, more nurse practitioners, more clinicians and counselors, saturday. but it had made a there are in some places the resources deployed all wrong. it may be that there is a supplemental, but we would urge the review that goes on position by position and facility by facility review with everybody who's not directly involved in patient care would have to justify that position and why

and how it adds to the overall enterprise of delivering quality care to veterans in a timely manner and a place for they can access it. part of the problem with resources as we said ever since the target using the formula is a civilian formula. it does not take into account what they used to estimate the amount of resources they would need. we have exposures to you that from my lips to god's ear, the civilian population will never be exposed to. chemicals and on and on. when va hospitals, the average presentations are things wrong its five to seven per individual. gnomon formula was built on a

middle-class ppos and hmos and they had one to three average presentations at several times. what that means is the birthright of resources that va is much higher. that is particularly true as us old guys from vietnam age have become even more aged and articles from korea and fathers from world war ii, but it's also true that the young people coming home today. presentations of oif, oef, all in the veterans is over a dozen for each individual that comes through. the point is you need to reprogram some money. we need to have passed pick a management accountability act on this side of the hill and go for supplemental if it turns out it

is needed. in the meantime we urge everybody, every hospital, something with encouraging a screen everybody at the hospital for the five major killers, lung cancer alliance the last couple of years, va has yet to do one of these screenings and do it for the five major killers. lung cancer, there, colorectal cancer, bladder cancer and for her conditions. if you screen everybody then it is not -- you don't have the kind of situation. i thank you very much, mr. chairman. >> kennebec very much, mr. weidman. thank you for your excellent testimony. when you start off with a fairly simple question. if it was mr. blake, mr. weidman and others talk in general we

all are aware that there are serious problems and serious allegations. but some of you have said the quality of care at the va pitcher members are receiving a good to excellent. do you agree with that? is the quality of care that your members are receiving, is it adequate? we all know there are exceptions out there. let me hear the answer briefly if i could. commander dellinger. >> we would agree with your assessment, mr. chairman. the overall care after the hospitals and clinics aren't very good. >> mr. chairman, our members believe the same thing. the quality of care would make it and it's excellent. >> mr. tarantino. >> we survey numbers and find their experience with va while a bit negative, their actual individual cares incredibly positive.

but that is also including the use of their g.i. bill. >> my comments spoke for themselves, senator. >> yes, i would agree with my colleagues that once the system has an access that quality is good. >> mr. gallucci. >> are degree via she realized that access. one of the things i want to point out as i said i use va and i do. i there last week. what happens is sometimes the person on the other end of the phone may not understand policies, may not understand proper procedures. clinicians from a top-notch care. that is what we heard from veterans responded to the inquiry last week. >> generally good to excellent. the problem has to do with case management and access to the system. >> let me ask another question. we all recognize, everybody at

your table and everybody here, that anybody who was lying, cooking the books totally, absolutely unacceptable. we demand accountability. people lined should be fired. i don't think there's much debate. but i want to ask what seems to be a problem not over the country, that in many parts of the country and all the basically referred to access. what i'm hearing you say is let's be looking into the system, the quality of care is pretty good. problem is access. we have heard mr. blake talk about the independent budget, which is the budget done by a number of veterans organizations assessing what they believe the needs of the va are. i support the budget. bottom line is do you believe the va needs more funding in order to do with the access issue, make sure that people all over the country can get into the system in a timely manner?

commander. >> i do believe it is underfunded. i also believe there should be reallocation of funds as an assistant. >> at point. others can speak to that as well. >> yes, mr. chairman, clearly the problem rests with the management efficiencies that the administration to try to put into the budget. a recent gao report in february 2012 indicated ba reduced their budget by $2.5 billion based on management efficient he is, which were not realized in which our impact the resources. this has gone on in previous administrations and needs to be stopped. that is like gaming the system. >> mr. tarantino. >> the va is underfunded. throwing money at the problem doesn't help a must have clear lines of accountability and reform for the things that are not working. >> i would agree with mr. tarantino.

mr. weidman point out a lot of people are hired. ireland written testimony points out serious staffing shortages and the entire service. clearly people are not being hired there or there is a demonstrated need. you can be reallocation of resources that we believe by extension its even more need for additional resources. >> i agree with my two colleagues to marry if they just come in the va is underfunded. however, i would say first there should be infrastructure and systemic reviews and issues addressed and after that, after we are intelligent on where the funds will be allocated, then they should be funded via thank you. >> i would agree with her independent budget partners that we support the numbers they believe the va in its current form is underfunded. >> you guys are part of the

independent budget, are you not quick >> i would echo concerns of everyone at the table about resource utilization improper distribution. i written testimony spoke peace capacity. this has to do with construction facilities. if we don't have the space, where these clinicians supposed to crack this? within a problem with mental health hiring. they hire more practitioners, but were they going going to see patient? >> mr. weidman. >> the allocation of resources, but in addition i would associate particularly not the measure can direction, very modeling and adding to existing facilities you got to have a place to actually deliver the care. but we are underfunded in don't have enough clinicians. as for the games the system. not because they are bad people. they are under pressure not to admit. >> i would take a little more time. >> just wanted to ask one brief

question. when you do a public system, like the va, every problem sometimes make front pages. i mentioned earlier thersites at their 200, 300,000 people. usually don't have hearings like this and tv cameras talking about it. on the other hand, the advantage of the public system is the citizens of the country representing millions of veterans, you have input into the process. to me ask you this question. i don't know what the answer is. i understand if the secretary made to it representatives of the organization fairly frequently. is that true? >> yes, it is, mr. chairman. we had a sitdown breakfast at 10 approximately once a month to discuss the issues. >> i assume everybody thinks that's a sensible idea. >> yes. input from the veteran

organizations of course. >> yes, executive director misa at the secretary and the undersecretaries on a regular basis. >> that is not true for us. we had our first day with the secretary at the va headquarters last week and that was the last time. >> you have not been made on regular basis basis quick >> no. >> or executive director meets on a monthly basis. >> yes, meet with the secretary and a regular basis. >> me weep with the secretary -- >> thank you, mr. chairman. the vfw does meet with the secretary of regular basis in african leaders meet with deputies on a regular basis as well. >> mr. weidman. >> it is on a regular basis. the only place in va that is sticking to the president's executive order or consultation with stakeholders before decisions are made as an

undersecretary for benefits. it doesn't happen in many other areas. if you did, decisions would be better. >> mr. isakson, i've gone way over my time. >> thank you, mr. chairman. that is the prerogative of the chair and my dad. >> is the prerogative of the acting ranking member. >> following up on the tone of the discussion, i am going to make a statement like each one of its tell me whether you agree with the statement or not. the question before us today is not the quality of health care delivered to veterans by the va. the question is access to the quality of care. would you agree with that, commander? >> senator, we do agree with that, but there's also pockets if you don't take care of that, the system will die. >> yes. d.a.v. agrees with that and i would like to point out a task

force back in 2003 that president bush established to look at health care pointed out at that time that there was a mismatch of funding and demand and if something wasn't done about that, access was going to be affected and that's what we're seeing now. >> we would agree with that statement. >> yes, definitely access. >> our concerns would be access especially in rural areas. >> we would agree with that, but access that can reach into care delivery, one of the concerns we received from a veteran in nevada, he was diagnosed with skin cancer. but because a doctor had left the v.a. medical center, they wouldn't be able to schedule him for a proper consultation until that person was replaced. >> which is an access problem. >> yes. it reaches into quality of care.

>> capacity is one of the problems for access. >> it is primarily access and an additional thing v.a. is not in the medical system addressing the wounds and injuries of war and taking a military history and using it in the diagnosis and treatment. >> the reason i'm taking this track, i don't want us to leave this hearing with a mixed message. if there is a problem in quality of health care, we need to talk about that. but if there's not except in isolated cases, we need to talk about what is the problem, which is capacity problem number one but it appears to be an attitude national problem where there is a motivation to make the numbers look good than to give health care to the veteran. anybody disagree with that statement? >> i think there have been concerns raised that the

syrfnce accotability anybody disagree with that statement quick >> i think there've been concerns raised that maybe the performance promote something like that, so access is controlled in order to make the performance with better. >> capacity is a function of appropriations. i understand that. it's also a function of the management of the system internally within the va. i don't ever recall and i could be wrong, mr. chairman, as receiving a report from the veterans administration on any study it is done to improve access to capacity will improve its capacity so we improve access. we've always talked about the time it takes to get a determination of disability or how long it takes to get into a va center is another right libby case when it means that we ought to have a thorough examination of the capacity situation in terms of the va. and then it got to take a look at the issues you address. i know you're not for any private delivery service.

you want the veterans hospitals to operate, but the option of having that access could help solve the capacity problem. particularly when i selected specialty like dermatology, like melanoma, like most surgeries, something like that. is that an idea that is not replacing the va health care system, but having veterans have options to access the private health care system? were that were? >> veterans have options even now when they are approving. the pcc see is improving on that. if his or some other direction there needs to be coordinated care. my point was that doesn't particularly work for veterans for specialized care needs like sei or blind interpretation those services don't really exist in the air. at least not in the way our members have come to expect it. we certainly could see where

privatized care plays a role or contracted for services with coordinated care plays a role. one thing i would suggest that as a solution suggest that the veterans want. so problem we see right now shows that are in want into the va. i would recruit an option where they would go somewhere else. they can't get into the va. so we are not sure that i'd have to go outside is addressing what their immediate desire is >> except wants and needs are two different things in the need is the most important initiatives that the service they need in a timely fashion, even though it might not be in a va hospital because of the particular problem, it's better than waiting so long to have a life-threatening condition, though. >> out of correct with a plaque, senator. >> are your testimony was outstanding. i appreciate all of it very much. i'm going to leave this hearing with the clear message from the

veterans of georgia. we need to solve the access and scheduling problem and we need to do it now. the va needs to go it and secretary shin shinseki and i talked about this. the senior leadership third of the american veterans. we've know what the problem or for some. at times i think we know what the needs are and i hope we take this hearing and affording solve those problems will hold everybody accountable accountable and have a solution to solving problems rather than asking problems. thank you, mr. chairman. >> thank you am a singer isaac said. senator begich i think is next. >> mr. chairman, i want to follow the mr. isakson's problems. i will kind of put this on my first want to thank many of you because you had concerns about what i'm about to talk about, but you are really good at helping us figure this out. that is we have a huge american

indian population in alaska. 150 plus thousand. we have a health service system, which was not very good to be frank, many, many years ago. in alaska, the tribes took it over and now we considered the best health care in this country in my opinion and many others opinion. cms has had some of the best health care in the country. because we don't have a veterans hospital, many of us had conversations over the last two years. we try and figure out a system to create better care access is really what it's about. if you live in alaska and you want to come into anchorage to the clinic, you can spend 1500, $2000 that are very expensive for veterans. we have 800 veterans living in alaska that are both native and non-native. but to print a hospital there was stimulus money, which are very proud of. $170 million facility which is

run by health care in alaska. it is given a check to the tribal consortium and delivers health care for our tribes. because of the work you out there with our office, we now access their veterans. 800 veterans have a choice now. they go to any health care services, get the help care near their home or village. i can tell you story after story that is not very valuable. or they go to the clinic for seattle to the hospital. it was an access issue. the care the va offers them a thank you all said we agree professionals they are. they work hard. there's not enough staffing to go through the list. the issue as we found a solution protecting the importance of va health care, which is veterans want to be part of the va health care system. they earn it, five for it. it is the benefit of tears. alaska we had an access issue. we cannot afford to wait to

catch them explain when there's a hospital right next-door. so we figured this out only have a new cap, which when you walk into the indian health care services company either be getting a same-day appointment is probably 75% or better. and when you come in, the question you brought up is the amount of elements summoned comes in with this different than the model designed years ago. too many elements for one individual. now when you come in, eye doctor, dentist, full health care, they resolve issues collectively rather than individually in the care quality is superb. you know, we've been pushing on the va to look at the model because that is how we've got to deal with all the illness of the individual had also same-day access to be a lot of scheduling routine appointment is outrageous.

and so, maybe it's more of a statement, but i'd be interested in miniview where can i point carl e. and i did some debate on this. i veterans now who call me and tell me thank you. not that they are not going to always go to the va, but now a situation they live in the village or small community can go across street and they have a choice. so i guess you've heard my comments here. i'd be interested in the new car model in the u.k., a very unique delivery system. it is all about access. any comments from folks? >> senator, thank you further question because it just so happens i was in alaska last month. i was in kenai. >> beautiful new hospital. they want to expand that they are doing in that area and mayor in a strip mall, but they also are looking for additional

space. va spent three years trying to get these works to and are frustrated. they want to do additional things. i agree with your assessment as far as accessibility. east coast is something different. as they go through the western states, i see more services and i think it is something we should build upon. >> enoch has a brand-new hospital -- beautiful hospital, which is unbelievable care. thank you. any other comments on that? i know my time is almost dead. >> right now we have 27 points of access on hold as we can get the funding and that is important that we move forward on that. i went back to the click administration, when they put a lot of construction on the old under care to determine what they want to build coming va has been underfunded and instructions and the clinton administration. we need to do something about

that also. >> thank you, mr. chairman. >> thank you, senator begich. senator moran. >> thank you, mr. chairman. secretary shinseki, thank you are remaining for the testimony. i appreciate you being here. when there is a topic about the assessment going on, the face-to-face review across the country. one of my congressional colleagues have a conversation with va personnel in jackson mississippi after the assessment presumably took place. this is a bit of a paraphrase of his or her report or what they heard about the effect that. we ask about their face-to-face review. they stated the team came in on monday and reviewed quirks and supervisors may didn't find any evidence of scheduling issues. no veterans were interviewed. what struck this person with the apparent superficiality of the so-called audit, a day at most

is that they did not come through the electronic system or audit any reports is not indicative of a thorough review. that's what i try to reason my opening statement is one more review that is to be completed within two weeks. we have 1700 facilities across the country. so in part, my concern is the quality of review that appears this is more damage control. it's what people do when there's allegations of mismanagement, improper conduct. you have another review. so my concern is how credible will the review be paced upon the amount of time and resources devoted to it. more troubling to me is how many reports, allegations, ig, gao, congressional hearings do we have to have before there's a different approach or attitude to solve the problem. i guess i don't agree with the

out across the country. will we be here six months from now on which the va has a plan in place to transform itself so these access issues that you will describe are not the same ones we heard today. we heard last week, last month, last year. the phoenix situations into a brought national attention to this problem. i can imagine there's anyone at the table who believes the phoenix situations is the problem. sense of a much broader problem that has been at board for a long time. commander and here let me add this. i understand the testimony of the secretary this morning and respond to the senator from north carolina in which he outlines. he decider outlined a long list of audits and reviews, gao

reports come inspector general audit and the secretary indicated that he was unaware of those audits and reports and therefore had been used in any conclusions that if they would be made at the va. there was an ig report in that list but said the unexpected death report to be avoided at the va focused on its core mission to deliver quality health care because no to va medical centers are alike. it is difficult to implement vha direct his when there's no descriptions or organizational structures. the ig police have time to review the structure and business roles of vha. how can that be an ig report that a secretary of veterans affairs would be unaware of? this directly related to the management, organization of the department of veterans affairs. my question if there is one here in my commentary is what

assurance can we have or what assurance do you have that when this face-to-face review is done by something will be different in the direction the va is taken in regard to higher-quality care for veterans in making certain they have access. commander? >> senator, that is quite a task. with the ig audit coming yes. the findings once they come out, this committee needs to establish, along with va milestones as to wreck if i these issues as they go through. as he noted in your report, each hospital is different. a hospital is doing an excellent and could possibly slip below the standard. it's an ongoing challenge and we hope the secretary in the va would move forward as soon as

possible with the changes necessary to give us a quality health care that all veterans deserve. >> china soon to expire. i would add you almost ought indicate you have ongoing conversations with the secretary for high-level individuals of veterans affairs. the question i would ask is does that result in a change, management, attitude at the va that results in higher quality care for veterans like >> mr. chairman, thank you for the opportunity to issue a statement and ask questions. >> senator tester. >> thank you, mr. chairman. i want to thank the panel for their testimony, their event vision. i also want to take secretary shin seki -- shinseki for same. we will follow up with you in

private. it is good to be asking questions about fifth or sixth on the list because we carry accesses the issue. we've have everything talked about from dollars to allocation to construction to milestones to manpower to all sorts of stuff and it all is good and it all is helpful. i'm going to ask each one of you folks because you represent veterans in this country that are being served by the va. you have an understanding of what the challenges are out there. you're not secretary to va, not president of the united states. you are above all of them. tell me what you do first to fix the va and what you do second and i'm sure there's three, r., five more down the line. is it money?

if the resources they have to need to be allocated different? we need to put a focus on hiring professionals and you can't say all of them because we want to hold folks accountable. if you could give priorities for what we need to do, i think it could be helpful. >> senator, the assessment is the first thing that needs to happen. as we've heard the va speak about they have enough money, but they don't have the accurate numbers. if they are gaming the system, how many actual visits are they going to have a year instead of 85 million, is that 150? you can't access ssa money value until you make the assessment about the provenance. >> i assume is to get the assessment committee follow that as a blueprint to fix the va.

is anybody else have anything really to add to that? >> senator, thank you for asking the question. i have a list of four things i want to talk about. first is resources at the vfw and budget partners to talk about. it may not be a numbers game. it may be allocation of resources. >> what are you telling us to do? >> we recommend taking recommendations on how to properly fund va and things like capital infrastructure and the baseline budget. second would be training and outreach for gatekeepers, the people who man the call centers nva facilities and outreach to veterans that they know what to expect when they call va. consistency across the board so your experience at one va center is very similar to experience at another va center. finally, one of chomping at the bit to talk about his accountability. the secretary said 3000 employees were sanctioned in

some way, whether that was termination, retirement or demotion, what have you. there is a problem and having conversations over recent weeks internally with vfw advocates and veterans, there's two things we know. first of all, reprimanded or fired an employee in the federal government is a difficult legal process a significant eeo. you can take a long time to take punitive action against an employee. second, when there's a vacancy in the federal government, this is not be exclusive. it could take between six months in the year to fill them. if you have an underperforming employee, you have to then they can really ask him a question, you make the trade-off decision. is it better to keep them on the at least serving some veterans or terminating them and having that vacuum of care for six months to a year or possibly longer?

>> that might bring us around to another discussion about how we can work with the department. by the way, this would reduce the red tape for hiring because it takes far too long to get that done. i want to just ask a little bit about the accountability portion because accountability is from my dad really easy to talk about, but sometimes very difficult to figure finger on where the problem is, who is the problem and quite frankly how you deal with it. any ideas, for example, the argument could be made that because we tired of these middle-management folks and you guys made a good point on that, this is crazy, you should be on the ground. we've heard middle-management folks to make sure folks on the ground are doing the job. how do you deal with

accountability? you contracted out? what do you do? or doesn't strictly follow the secretary's fee and everybody else is held harmless? >> go ahead. >> i think the bill introduced in the house side is a good start and people say you favor that bill, which strips ses people at the va of any protections whatsoever. but there is a reasonable points in between mr. miller's bill as it currently is and what we have now because they can't fire ses people. i remember the lady from kansas city a few years ago they removed her, but every monday morning, capture here and every year spanner $180,000. they need flexibility. >> thank you. thank you, mr. chairman.

>> thank you, senator tester. senator johanns. >> thank you, mr. chairman. to everybody here, this has been extremely helpful. we are going to find the access issue, which you will consistently say is the problem is easier to identify and to solve. you know, what's a va hospital needs by specialists. they are probably going to recruit from the area to compete with private doctors practices. they will compete with hospitals and that is true whether it's the doctor, the nurse for the medical type mission, whatever it is. so building that capacity, even with lots of money would be a challenge. i think we all agree to that. so let me ask you a question because i also agree we are waiting for us on omaha. i am beginning to wonder if it

will happen during the lifetime and i am a fairly young and. i am not too old. even if we could get all the money all at once, which would be very hard to accomplish, how much construction can you get up and going? so let me ask you a question about access. let's say we are thinking about this with on all of this population is needing more access, not less. vietnam era people. it's a whole group of people and we are e.g. in. we are the baby boomers and we need more access, not less. would your members be open to an idea that the company might face. they call. they say i need to see a health care professional because i've got a spot on my leg that will

look right. i think it might be cancer. and they say well, we went to see you as quick as we can, but that will be four-month for six months or whatever. would your members be open to an idea that says look, if you can't get in in two weeks or three weeks or whatever the appropriate timeline is, you can seek private care. you can go to your local doctor or specialist or whatever. the government will pay the cost of that and we will cover that because we don't want me to wait and we believe that is the best way to deal with access, the quickest way, the most effect device. and the other thing i mentioned in asking you this question is in states like mine, we are western state. the state of nebraska, access

for rural veteran is especially difficult and it is especially difficult in some areas like mental health and specialized care. commander, what is your thought about that? >> well, you know, the va right now utilizes telemedicine. so even though there is only nurse there, they can by utilizing tele- health -- >> i appreciate that. how was your members reacted they said look, we're not going to make you wait anymore. if the va can't feature needs within a certain period of time, we will allow you, if you choose, to seek private care. if you want to it, you can way. >> we would be opposed to that because we want the best health care as fast as possible, also have to put a caveat, but it can't have been exceedingly

because then there goes the entire budget that is fee-based, which is higher in the reverse is the ability the va. >> i get that. we are all same best care. >> that is the exact point if you are not willing to give va the resources it needs to allow for access to the facility, you need to give them more resources by sending veterans out to the community. ba has the authority. i don't think to use it enough for purchase care. again, as i pointed out, if a veteran can't be seen in a cert timeframe him and he should get the care by a private doctor, but we need to be careful we don't start increasing the money going out to private top errors and taking away the va's ability to higher internally because all we are doing is robbing peter to pay paul and if they don't have

the money to do it now, less money to do it on the private sector. >> amount of time, but here's my point again. if it results in better care, isn't that what we are trying to achieve? i hope someday i can have a discussion. >> thank you, mr. chairman. >> senator, can i address that? it is my understanding the pccc, patient centered coordinate care, is sort of envision to address part of the problem you outline specifically. that is what we want. we want for medicare because the key is the continuity of care in assuring the va is ultimately responsible for the veteran sitting on the spectrum of what the veteran is receiving. i think maybe pccc has been in the direction of addressing concerns you are raising. >> thank you, mr. chairman. >> thank you had senator blumenthal. >> thank you, mr. chairman. i want to thank all of the leaders who are here today for

the president today, but also your tireless and relentless work on behalf of the veterans of america and truly your leadership has made a big difference not only in the performance and outcomes from the veterans administration, but in countless communities and other carriers across the country. ..e asestigation should hard-hitting, aggressive, thorough, and prompt as possible. the resourceses ive agencies,stigat they ought to be called on as well. would you agree? >> i do, senator.

>> we not only agree, but our national president road to the eternal -- attorney general of arizona last week and the u.s. attorney for the district of arizona, asking them to launch criminal investigations into reckless endangerment, possibly resulting in loss of life. earlier, were not here let me just tell you that i urge that the secretary of the v.a. shockingly -- strongly consider and recommend he involved the department of justice because there is ample evidence and i emphasize evidence, not just allegations of criminal tongdoing to warrant the fbi review this situation, as they do, my.

the reason is simple. not only the evidence, but also the inspector general lacks the jurisdiction authority, the resources, and the expertise to do a prompt and effective criminal investigation. only the fbi can provide the resources, expertise, and and the department of justice includes the attorney in everya and the ones in state that may be affected here. we share a determination. i believe the secretary of the v.a. shares this as well, to get to the bottom, to provide relief to anyone denied access. i think that is a determination that unites us in this room and accountability means changing the team if necessary. there may, at

some point, be a need to consider those changes as well. my thanks for being here. my time is limited. i think the chairman. >> thank you, senator blumenthal. i apologize if this question has been asked, but senator murray asked earlier as to what a face to face audit should involve. i would like to ask you and perhaps we can start with mr. bellinger, what needs to happen in a face to face audit to elicit the kind of information we need to address the challenges and problems that v.a. hospitals and clinics? i.t. has to start with first. they have to look at the process of the books as far as what actually occurs and they have to

go through the administration and the employees and also get input from the stakeholders and the veterans. >> did that happened the last time? there have been audits before. when those audits were conducted, where the stakeholders included? >> i do not have that information. >> to the rest of you have any do the rest of you have any information that will help us? >> often, we are not included. if you ask the veterans, they say, we got hurt, we got wounded. the veterans will tell you how to fix the facility. >> would you agree that any face to face audit should include --

this is probably a rhetorical question. input from the veterans organizations as well as veterans at the particular facility. and iould agree with that would also, as we pointed out, recommend there be an independent third-party expert involved. it would alleviate a lot of the questions that were raised about the audit. i think it would help everyone be assured that these audits were being done properly and everything was being looked at. >> what do you mean by an independent third-party? >> i do not have the expertise to determine are the people cooking the books, are veterans theyng timely care, are spending sufficient time or too much time with the doctors? there needs to be someone who is an expert in time management and accessing medical care that can

be there to make a determination , are they asking the right questions and are the answers sufficient to address this problem. suggest also, if they are going to do a thorough audit, it would take more than a couple of weeks. a thorough audit would be an examination of the entire system. that might involve clinicians, nurses, whatever that may be. audit that is going on right now is what senator moran suggest happens, that is disheartening. that is not going to solve any problems as far as we are concerned. it might get to the bottom of a problem, a shallow depth problem at a local facility, but i don't know if it will solve the deeper rooted problems. >> i would envision that an

assessment of the entire v.a. health care system was involved not just in this process that has been described to us, but it would be an ongoing kind of assessment. i hope that will be the case. the secretary is still here and to heart he is taking the suggestions and comments you are providing. secretary, ine regards to all that we have been discussing, whether you think this is taking away from the v.a.'s core mission of providing health care for the veterans. does anybody care to respond? as aere is no such thing homeless veteran. there are veterans whose problems have been so acute and

not address that they have ended up without homes. if other services come through, people do not end up on the street. each one is a failure. it does not mean people set out to fail, but we have failed those folks coming home somehow. the vfw believes the resources the v.a. can provide should never come at a trade-off. the obligations to provide holistic services to the assistance,ployment but also health care has to remain a cornerstone. when veterans transition off of active duty, there are a litany of transitional resources that need to be made available to them. -- to deliverhe most of those. seeould never want to trade-offs made on how we deliver other benefits. , other --t injecting

will suffer. >> senator moran did not talk about audits, i just one of the theesses to know that was assessment of chairman miller, from the house committee. jackson. i am not sure how many facilities he is covering. that was his assessment of the audit process. not that i do not love you guys, but we're going to try to get the next panel and before we get into a series of votes. thank you. >> thank you. >> thank you, senator. let me just say this. thank you for what you do every day representing veterans. most importantly, i think we all know that we are not going to create a great health care system we need without your active participation.

we need you. thank you very much for being here, and keep up the good work. >> the last part of the hearing features testimony from the inspector general richard griffin who talked about specific details of the audit of the phoenix va center and other facilities around the country. g.a.o. health care director deborah draper also provided recommendations for improving the va health care system. >> okay. let me introduce our third panel . representing the va independent inspector general office is it acting inspector general richard griffin, and he is accompanied

by dr. john d. is a day, and system suspect -- inspector general perry from the national association of state directors of veterans affairs we have its president retired rear admiral w. clyde marsh. from the government accountability office, the gao, we have the director of health care deborah draper. finally, joining us today is philip forman, senior research fellow at the new america foundation. thank you all very much for being here. mr. griffin, you may begin. may. >> mr. chairman >> mr. chairman, ranking member, members of the committee, thank you for the opporunity to provide testimony at this hearing. i would like to provide an overview of our ongoing review at the phoenix health care the aig has assembled a

multidisciplinary team, comprised of auditors, health care inspectors, board-certified -- to address these allegations. our team toted focus on two questions. where the facilities electronic waitlist or parsley amended the names of veterans waiting for care, and if so, at whose direction. number two, whether the depths ofany of these -- the deaths any of these veterans were related to delaying care. this, we the bottom of have an exhaustive review underway that includes seven parts. number one, interviewing staff with knowledge of patient scheduling practices and schedulingncluding clerks, supervisors, patient

care providers, management staff , and whistleblowers who have stepped forward to report allegations of wrongdoing. number two, collecting and analyzing reports and documents from information technology systems related to patient scheduling and enrollment. medicalhree, reviewing records of patients who may be related to delays in care. number four, reviewing .erformance ratings number five, reviewing past and newly received complaints to the as well as those complaints shared with us by members of congress and by the media. reviewing other prior reports to these

allegations, including reports from veteran health administration offices of the medical inspector. finally, number seven, reviewing massive amounts of e-mail and other documentation pertinent to this review. to facilitate our work on may 1, place thesecretary to phoenix director, associate director, and another individual on administrative leave. this was done because of the gravity of the allegations and , some whocooperation have expressed concern about talking to the team. techie -- thee secretary agreed to my request. we have the resources and talent to complete a thorough review.

we are using our top audit examine all of the scheduling related records. board-certified physicians will ,e reviewing medical records treatment and harm that may have happened. forensic experts are assisting the team. we are working with federal prosecutors from the united states attorney's office from the district of arizona and a public integrity section from the department of justice here in washington. we will determine any conduct

that merits criminal prosecution. since the phoenix story broke, we have received additional reports of manipulated waiting even at other facilities, through the hotline, members of congress and the media. these reviews are being conducted by other staff to enable the team working on the phoenix review to complete efforts on their project. we expect these reviews will give us insight into the extent scheduling -- in other facilities. while much has been done, much more remains ahead.

review is theis top priority and maximum resources, dedicated to bring about its timely conclusion, we intend to bring you and other and areof the congress ready to publish our reports. we project finishing the project of publishing the report in august of this year. inc. you -- thank you for holding this hearing and we would be pleased to answer any questions. >> thank you very much. >> my name is clive marsh. i am the president of the state directors of veterans affairs. present in the news of

state directors from all 50 states. agencies,vernmental we -- the processing of claims. we provide over half of all of the long-term care in our state nursing homes. state health care is strong. the v.a. has medical centers in the majority of major cities in america. community -- expanded our community base in recent years. the vha has moved out of the box, taken advantage of technology to provide tele-help, and have also taken steps to provide transportation for those veterans in rural

areas to make their appointments. customer satisfaction has been trending higher. the v.a. may not get everything perfect every time, however on a national level, we are one of the leading health care providers in the country and providing good, quality health care. those of us in the health delivery business or v.a., we strive to get it right and we work on that every single day. experience, we are on the same page. endorse the resignation along with his top administration officials.

they will be needed to follow actions to swiftly correct any procedural issues that may be identified. and is not ine the interest of our veterans to make premature decisions. the u.s. department of veteran affairs is transforming a pre-world war ii claims process into a paperless system that has reduced compensation and claims backlog by 44% as reduced veteran's homelessness by 24% and has enrolled more than 2 million veterans in the health care system since 2009, receiving some of the highest quality care ratings in decades. to supportinged

vha and the health care system. at the local level, state directors are in constant coordination with the medical center directions -- center directors. attention to confirming those individuals who have been nominated to fear -- to fill vacant leadership positions. it is imperative that the a -- that the v.a. and vha received .he necessary support those folks will be coming as a result of the war and military drawdown. the bottom line is, the v.a. may require more in terms of the budget.

doctors,need more nurses, technicians, clinicians, and even facility expansions or operations. we look forward to participating as copartners or facilitators. we remain dedicated and committed to doing our part. believe that v.a. leaders will transform into a technology-based and veteran centered. have the director of

health care. collects i appreciate the opportunity to discuss access to care problems in v.a.. for over a decade, gao and thats have reported medical centers do not provide timely care. in some cases, these delays have resulted in harm to veterans. across our work on access, several common themes have emerged. policies andguous processes, subject to interpretation, resulting in variation in confusion at the local level. antiquated software systems that do not facilitate good practices. ofaining, and use

unreliable data for monitoring. they did not always record the desired appointment date, the date the veteran or provider wants the veteran to be seen. this is due to lack of clarity in the scheduling policies and how to record the desired date. byituation made nor -- worse the large number staff that could schedule appointments. during our site visits, more than half of the schedulers we observed did not record the desired date correctly, which may have resulted in a shorter wait times and veterans experienced. some staff said they changed the dates so that they aligned with the v.a.'s goals.

we found follow-up appointments being scheduled without ever talking to the veteran, who would then receive notification of their appointment through the mail. in addition, we found scheduling systems electronic waitlist was not used to track new patients. they put these patients at risk for delayed care were not receiving care at all. ofalso found the completion required training was not always done, although officials stressed its importance. additionally, we found a number of other factors that negatively impacted these usually processed area for example, officials described the software system used for scheduling as antiquated, error-prone, and cumbersome. turnovershortages in of scheduling staff, provider staffing shortages, i telephone call volumes without sufficient staff to answer the calls. takecommended the v.a. actions to improve the reliability of its way time theures, and sure

consistent implementation of a scheduling policy, allocate scheduling resources based on need, and improve telephone access for medical departments. the v.a. concurred with our recommendations and told us he were taking steps to address them. we are pleased that actions are being taken, but more progress is needed to ensure timely access to care. work examiningng v.a.'s management, which is a type of medical plan. the preliminary work has identified a number of problems, including delays in care, or care not being provided all comment at each of the five medical centers included in our review. console data, systemwide closure of 1.5 million consoles older than 90 days with no documentation as to why they were close. we expect to publish our findings this summer. as the demand for the health care continues to escalate, it

is imperative that v.a. addresses this. since 2005, the number of patients served by v.a. has increased nearly 20% and the number of annual outpatient medical appointments has increased by approximately 45%. in light of this, the failure of the v.a. to address the access to care problems, including the accurate tracking and reporting of wait times and specialty care consults will worsen. this concludes my opening remarks. i am happy to answer any questions. >> thank you very much, mr. eber. >> thank you for giving me this opportunity. different than the other panelists. i am not a veteran.

i am not affiliated with the v.a. in any way. i am not affiliated with veteran service organizations. bookhere because i wrote a anywhere: whyare v.a. care would be better for anyone." for my book came from losing my wife robin to breast cancer. in oneas treated prestigious corner of the american health care system in washington, d.c. suffice it to say, what i saw during the six months between her diagnosis and demise caused me to become radically interested in the questions of medical quality and safety. died, theyer robin

instituted a report that has been alluded to already, showing that there are 98,000 people that are killed by medical errors. that is equivalent to a jumbo jet falling out of the sky, killing everybody on board every third day. the chairman has alluded to other estimates, showing that as many as a quarter of a million people are killed by various forms of overtreatment, under treatment, maltreatment. i set out to find out who is doing a better job. i was surprised to find, after healthng literature on

care quality and talking to many experts and veterans and such, that the da health care system, by many metrics out performs the rest of the u.s. health-care system as a whole. i seem to have come to a broad consensus, is he a health care -- v ...a. quality health care is very high quality health care. the problem is access. robind have welcomed being treated in a hospital that had an inspector general. would that not have been wonderful? ifld it have been wonderful two committees of congress exercised oversight of that hospital? would it have been great if there were various broad-based effective citizen organizations akin to the american legion that erplied scrutiny to that corn

of the american health care system. i also would want to draw attention to the fact that we have a problem with someone times ormetric on wait some other metric that the v.a. applies, that is because there is a metric. health-careof the system, there are no quality metrics that are exercised, let alone wait times. it took me 2.5 years to find a primary care physician who is still taking patients. mammogram momor a enough for her tumor to grow from this size to the size areas many people in the united states live in places where there is a queue primary care shortages.

we have a problem with access. times, so much of what we are doing is trying to has aine whether somebody service related disability or not. hearing allou are of this -- losing your hearing -- we have this tremendous administrative machine that adjudicates that kind of question. how much smarter when we be if we opened the v.a. to all veterans, thank you for your service, come in. thank you. >> thank you. all the testimony was excellent. thank you.

a few questions. let me reiterate. we chatted on the phone. do you have the necessary theurces to undertake investigation that needs to be done regarding phoenix. >> yes, we do. have 120 medical clinicians, who for a number of years are doing reviews of the a medical centers. and --.doctor the reason the system was set up the way it was is so you have people with knowledge of the department. that is why we're the right group to do this review.

>> when you told us a few moments ago that you do not -- isyou can do this there anyway you can give us a preliminary review? many members would like to get a sense of what you found out there. progresses,view part of this review could lead to criminal charges and we do not want to do anything to jeopardize the ultimate outcome. >> what we have been reading in

the media, at least 40 u.s. veterans waiting for appointments at the phoenix veteran affairs health-care system. many were placed on a secret waiting list. at this point, can you tell us how may people you have identified who have died while waiting on a secret waiting list. >> i cannot give you that number. the number that has been wildly pressd -- quoted in the does not represent the total number of veterans we are looking at. that was one list created by the facility. we need to do an analysis of recordst, both death --. there are also other people who have come through the congress, who have come to the media, who have come through our hotline. , none ofultiple lists

them identical. we are going through the basis of going through those lists and the initial list that we were given, we have gone through and there were only 17 names on that list. our review to date, we want to have more than one set of eyes look at all of the records. those 17, we did not conclude that delay caused death. be on ae thing to waiting list, is another thing to conclude that as a result of being on a waiting list that is the cause of death. it is dependent upon what your illness might have been at the beginning. >> you have not identified anyone that has died as a result of being on the waiting list as of this point.

this is complicated stuff. >> we have been provided names of people who are on various lists and it is true that those veterans whose names were on the list have died. we have looked at a substantial number of cases and we have been looking at those cases to determine that yes, there was a delay in care, as has been expressed. quality standards were not met. -- we have found that some patient harm. to draw a conclusion between patient harm and death has so far been a tenuous connection.

to records we have looked at date are mostly v.a.'s medical records. to the extent that a patient died, we are in the process of getting death certificates, autopsy reports, if they were in another hospital, there are procedures we need to go through to get the rest of those records. we may need to interview people who are knowledgeable about the events surrounding the death. it is a serious problem. we won't work through that. >> thank you. the conclusion states unreliable

ait time has resulted between positive way time. this is v.a. report that you are talking about was the report presented to the v.a. in december 2012. it became a public document in january 2013. what i have said so far about your comments are on record. the secretary of the v.a. was --ommended to take action to the reliability of wait time measures. the sector of the v.a. under the secretary of the director felt to take action to consistently and accurately implement the scheduling policy. for the two recommendations,

v.a. specified in their comments that these recommendations had a ofgeted completion date november 1, 2013. let me ask you -- based upon the knowledge you have today, has this process at the v.a. been completed as it relates to those two actions in your report from december 2012? >> and has not been fully completed. >> is this an ongoing communication? to be quite frank, it has been almost a year and a half. we would have expected more progress to be made. >> do you or your predecessor, and thank you for serving in that capacity. you are a standup guy. we have great confidence in what

you and your team will do, can produce, and accuracy of it in the reliability of it. please share that with the folks who are working so hard. >> do you or did your predecessor have a scheduled meeting with the secretary? meetings with the entire leadership team every two weeks. my predecessor went to one, i went to the other one. we had occasional meetings with the secretary at different times during the year. >> how many meetings have you had since the issue of phoenix arose. had one meeting that was unconnected to the review. it was a budget related meeting. we had a second meeting when i went over to request certain individuals be put on administrative leave.

>> from a standpoint of the who is handling that? of theng the course administrative leave discussion, not un-similar to the -- we are going to be looking at. i put someone in administrative leave that i thought was completely appropriate. we are independent. we cannot be told to not do something or to do something because it would violate our independence. a report that completes, when phoenix is finished, if it happens like every other work, will you or your staff sit down with the

secretary and brief him on the findings? we issue probably 300 reports a year. not all of them would rise to the level. at the assistant inspector general level, dr. jay meets with the bha senior staff to discuss these things. we just heard about the process of getting closure and reports. there is an ongoing follow-up process. >> how many years have you been in the v.a.? >> about 13 out of the last 16 years. >> how many times have you set awn -- sat down with secretary and brief them? i would say, a report of this

magnitude, maybe a couple of times a year. depending on -- there are 300 reports. i would say at most, quarterly. >> on a reporter multiple? >> on a report. the doors open. it is just the issues are resolved. meetingave requested a -- have you ever had one ray meeting was not made available to you? >> no. >> thank you. i want to thank you for your testimony. you said you have 120 medical investigators. are there more investigators than that? have about 615 personnel in the ig organization.

david andm work for they are health-care inspectors. they are doctors, nurses, psychologists, clinicians. we have about 150 criminal investigators. we have people in 39 cities around the country. we have over 200 auditors. >> how many people are working on this investigation. 185 people have touched this investigation. >> for how many weeks? >> this is the third week. >> you anticipate a final by august? >> correct. anticipate a preliminary report before that? >> to the extent that it will not impact the outcome of the work to include the fact that we are working with two different groups from the department of justice, looking at a possible

criminal violation. about seniortalk management staff, including the secretary and the v.a.. asked those folks for information? >> no, we have not. we did ask them for a list that they suggested to us that they had of veterans who died on an electronic list. >> this is where want to get to. have they been open? have they been transparent? what is the other word i am trying to think of? helpful in your investigation. >> they have. resources, buted we do not want to give anyone the impression that our independence was being questioned. we have not received any resources nor do i intend to.

>> up to this point, being fully transparent with what you need, would you >> we found that waiting times were not accurately being reported. most recently in mental health where it was reported that at the 95% level, we looked at the exact same data and concluded it was 49%. so it's not a new issue, and i'm confident that when we finish our work in phoenix, it'll be the same outcome as these previous reports. >> okay.

that is all, mr. chairman. i would just say we look forward to the investigation. i know you need the time to do it right. of course, in the society we live in, this case is already being litigated and convicted every day in the news media by some, and so it will be great to get the facts out there so that we can help the va do their job better to serve the veterans who have served this country so well. thank you all for being -- >> understood. and the only thing i can say about the rush is we are not going to rush to judgment at the sacrifice of quality. i know you're not suggesting that. we're going to nail this thing, and at the end we'll have a good product for you. >> yeah. and at the sacrifice from people who are innocent. thank you. >> sure. >> thank you. senator moran. >> mr. chairman, i understand there's only a minute or so left in the vote that's been called, so i'll try to summarize very quickly. ms. draper, and then i'll follow up with mr. griffin, the gao

reports what is the process by which you have assurance that your report is acted on by the department of veterans affairs? what's the follow through, and what has been the results of gao reports at the va? >> yes. we have, for this particular, for the report that we issued it was publicly released in january of 2013. we did a follow up with -- they issue a 60-day letter on status of the recommendation, so we do have that. and then we provided congressional testimony for the house committee in april, so we followed up with va to get an update on where the recommendations were. so we have periodic updates with va on the status of the recommendations. >> you testified earlier about this particular report and its current status. about other gao reports, do you have a sense that the va is successful, useful, that your report is useful and they're successful in implementing the proposals that you suggest? >> it varies. i think that we have quite a number of open recommendations at the va at this time across gao. >> mr. griffin, in regard to the

ig's report, what -- how are you able to determine whether or not your report and its suggestions, its recommendations are followed through by the department of veterans affairs? >> well, we do it in two different ways. in some instances we will review -- if we say you need a new policy on staffing or you need a new policy on waiting times or you need to train the schedulers and you need to create a methodology where you can audit the scheduling process to make sure someone's not cooking the books, if they can satisfy us that here's the new policy and here's how we're going to make this work, we may close that at that time. more often if we don't have a comfort level, we will send a team back six months later and go to the same fundamentals and look and see -- same facilities and hook and see if the fixes are in place.

>> what's your sense in your time as acting or if you have information about your predecessor, what's your sense of the department of veterans affairs following the recommendations and implementing them following an ig report? >> i think it's a, the answer is mixed. i think frequently policies emanate from washington. the policies look good on paper, but they're not always followed by the managers in the field. so it's an accountability question for the field managers, and when they don't follow it, something needs to happen. >> one of the things that i don't think you have anything to do with but is an important component of the investigation would be the office of medical inspector reports. and one of the things that we've discovered is that those are not made public and not submitted to congress. and so we don't know the results of those types of audits, investigations or reviews.

and i'm pursuing legislation to change that so we can see what that report says. we can excise the names and keep the confidentiality of patients straight. but i think there's a whole set of other reports that there is no ability for us to gauge whether or not a recommendation is followed. let me just ask in conclusion, mr. griffin, are there ig reports, let me say it this way, are there ig investigations ongoing that involve facilities in kansas? >> i'd like to take that for the record. i know that we have in the past week and a half our criminal investigators who are locatedigt around the country have had a rapid response to ten new allegations, and in a matter oft two days over the previousthe weekend they went to 50 medical centers unannounced in order to

see if what was being alleged was occurring at thosese facilities. so -- >> i'd be happy to know that.s. i actually was referring to more not necessarily a current investigation beginning as a result of the current as circumstance, but over the last year or so. and the reason i ask the question is that there have been allegations of incidents, circumstances, consequences ates within the va in my state, andi our effort to find out what's going on, what response has the department taken as a result of at least these stories that are out there. we've never received a response from anyone at the department of veterans affairs either here in washington with the secretary and his testimony or with kansa officials, individuals who work at the va within our state. and i did not know, do not know whether or not any of thoseow circumstances that are at least having a conversation are beinga investigated by you. with me,ou'dow up that'd be --w >> i will. the majority of our audit andma health carejo reports go to the

member whose district that facility's located in. some of the criminal reports that take longer because of the judicial process and privacy issues involved with criminal cases you may or may not see quickly. . >> i apologize for interrupting. i think there are 95 senators waiting for us to vote. his was a great panel. and i very much appreciate the wonderful testimony. the hearing is adjourned. >> adriel bettelheim is senior editor with cq roll call. the house returns monday after being away for a weeklong break, and one of the key items on the agenda is defense authorization legislation. can we dig into some of the main items in the bill and how immigration could factor into the floor debate on defense? >> guest: well, this defense

policy bill is one of the biggest, most sprawling measures to hit either chamber. and it takes up a plethora of issues from military suicides to this year russian rocket motors that the u.s. space program depends on. immigration, oddly enough, is going to factor into it. there is an effort in the house by the ranking democrat on the armed services committee, adam smith, to include language in this bill that would give permanent legal status to undocumented immigrants in the military. and we've seen this kind of language pop up before in senate debates over defense policy. and it's going to be up to the republican-controlled house rules committee to decide whether to declare this amendment in order. and they may very well decide to do that and have a nice big floor fight over immigration in an election year. but even if it does make it into the bill, the republican-controlled house is likely to defeat this language. that doesn't mean that it won't

pop up when the senate takes up its defense authorization bill which is also being marked up. so it's interesting intersection of national security and the immigration debate coming back. >> members are also scheduled to debate the third appropriations bill to fund commerce, justice and science government programs. can you tell us about that bill and whether the gun issue that the appropriations committee dealt with might come up in floor debate? >> yes. this is a bill that provides a little bit over $51 billion in discretionary funding, and texas republican john carter included some language in this bill that would bar a program that would require gun dealers along the southern border to report to the justice department when they sell shotguns and rifles, or more than a few of them, to a single purchaser. it appears designed to stamp out an obama administration effort that the white house says will reduce violence along the southern border and might

eliminate or weed out straw purchasers of these type of weapons. but carter and others who are critics of the policy say it's a back door attempt at federal gun registration. so this will become part of this huge bill that, as you say, covers multiple agencies, and we'll see if it triggers floor debate now that it's out of appropriations. >> host: the house is also set to consider two bills in response to two items that have come center stage in the news, the kidnapping of nigerian schoolgirls and recent problems at the veterans administration. can you tell us more about those? >> guest: yeah. the kidnapping of the nearly 300 schoolgirls is becoming a major concern on the hill. there was a senate foreign relations hearing on thursday that took up whether the nigerian military is in a position to respond and whether the several dozen u.s. officials on the ground can do very much. there's also this question of whether a u.s. prohibition on

military assistance to foreign militaries where there are human rights problems helps or hinders this effort. so you're hearing now lawmakers on both sides increasingly calling for perhaps military involvement. john mccain saying there should be special op toes forces that go and -- ops forces that go and help the girls. so we're expecting to hear more of that and watch congress sort of follow the developments. >> host: in the senate your article titled "senate tax cut vote: republicans filibuster $85 billion bill" was the way debate ended last week on a tax extenders bill. what are both parties looking to do to move the bill toward final passage? >> >> guest: actually over the weekend there was some informal discussions about an amendment deal. this bill deals with tax extenders, some 55 temporary deductions and favorite provisions that expired at the end of 2013. and what it would do is another

short-term extension. the problem is that the senate democratic leadership is putting a very tight control on the amendment process. harry reid, the majority leader, fears that if he allows republican amendments, there will be a very realistic effort to strip out the medical device tax from the health care overhaul which a fair number of democrats as well as most republicans favor repealing. so because he's not allowing republicans enough input, the republicans, they need five republicans to make this work and to advance the bill, they're holding out. so we're watching senate finance chairman ron wyden, his ranking republican orrin hatch, see if they can work out an amendment deal, if they'll entertain the possibility of republican amendments before a cloture vote and just whether this thing falls victim to more procedural fighting. >> host: adriel bettelheim is senior editor with cq roll call. their web site is cqrollcall.com.

adriel, thanks for your time. >> guest: nice to be with you. >> a spokesman for house majority leader eric cantor confirmed to reporters this evening that amendments to the defense bill dealing with immigration will not be permitted. you can watch our live coverage of the house on c-span monday at noon eastern. >> you can now take c-span with you wherever you go with our free c-span radio app for your smartphone or tablet. listen to all three c-span tv channels or c-span radio anytime, and there's a schedule of each of our networks so you can tune in when you want. play podcasts of recent shows from our signature programs like "after words," "the communicators" and "q&a." take c-span with you wherever you go. download your free app online for your iphone, android or blackberry. >> coming up tonight on c-span2,

the brookings institution hosts a discussion about maintaining and improving u.s. infrastructure. then from washington journal, a discussion about the u.s. housing market. internet caucus looks at yesterday's fcc decision on open internet rules. >> today the brookings institution hosted a discussion about infrastructure spending and how to fund the maintenance of american roads, bridges and public transportation. the first speaker was congressman john delainey who's put forward a bill to fund the highway trust fund with changes to the tax code. he's introduced by bruce katz of the brookings institution. this is two hours. >> good morning, everyone. my name is bruce katz, i'm vice president at the brookings institution, founding director of the metropolitan policy program here. i want to w