most troubled location based with what i character-based as leadership failure, mismanagement, chronic underinvestment and get a person after person raised their hand and talk about the things they were doing, the things they had to overcome in order to be able to take care of their veterans. ..

and that was what prompted my direction to say we are going to overhaul the standard performance contract for medical center direct recent visitor directors because we are not going to have a contract with their result is aligned with the patient outcome. i think is going to take some of those kinds of structural changes as well to ensure we get people focused. the last thing i would say is this. you know, we are so focused on wait times. as we think about how we teach timeliness of that is in the future, the centerpiece of that is a much more robust focus on patient satisfaction. i think that helps us resent her back on the veteran we are serving in notley cannot wait times in the 700 other metrics

that we've got people. >> those types of responses should be the driving force to whether someone gets a bonus or how they are compensated. >> yes. >> the spec or general reply to us at it is led to more layers of administrative aspect rather than actual care and that really is a concern. i had a meeting this morning with several members measuring productivity and efficient be with some of the doctors here. i think you're going the right direction, but there's still something's missing. you evaluate the rbu, but there's a lot more that goes into that for us to be efficient. this comes with $17 million. for example, if you have an old physical plant come you got to take a look at how much you were at ending for productivity to be used in a plant. you may be better closing that entire facility and putting everything in the community.

but we are not measuring not. those are the things we have to measure as well because when you talk about outburst in cost, maybe it doesn't cost more if the physical plant is costing you so much more. those are business decisions and that's got to be the approach. we can't assume where we are is the best place to be always. i will continue to work with that group in with you and hopefully we continue these types of changes that i appreciate. with that, i am out of time and i yield back. >> thank you very much. ms. bradley, your recognizer five minutes. >> thank you, mr. chairman. i appreciated very much. thank you, mr. secretary. the way i understand your proposal of the $17.6 billion is predominately for additional personnel, professionals and some money for i.t.

i said they agreed that in terms of facilities and personnel there is a need. mike c. c. bach in oxnard, california, as you stated in your testimony is one that has had double-digit increases each year over the last couple years. not much has been done over the last couple of years i will add. i think what i have learned through all of the hearings we have had, that they care for veterans once they get in the system is pretty good. it is accessing a system where we have seen is truly broken. when i see the iec proposal tear, a concern me. it is a red flag for me. you did mention off-the-shelf products that you are lucky not in the technology or the kidnap. but we've got to fix the excess

part of that spirit i don't want to invest more money into a broken system. i want to invest money into new technology and innovation and getting the va and to a 21st century, much like the private sector is, the school is that they have to access the health care system. so if you could comment on that, please. >> first of all, i would say the majority of the i.t. resources as i am the proposal here are associated with the activation of the facilities. so it is the i.t. infrastructure we need as we activate facilities on additional clinical staff. there's a number of the underway to really take us into the 21st century here. part of it is purchase of the commercial scheduling system, which is not included here. it is already provided within the core funding. but there are other things we were talking earlier about in

operability for purchase karen there are technology investment that are included here, associated with that. anything else to add quick >> a couple items relative to i.t. we have a capital request in there and we are requesting a certain amount, i think 12 to 13 million feet pearly space, but we had to out it that with i.t. should make it useful to connect to pcs, cables, networks, telecoms, et cetera. that's part of it. so that is built-in to it. it is not just all brought development work. it is what you need to make use of the space you get and connect the staff you are hiring. you need i.t. to make that happen. that is part of the request. >> mr. secretary, in terms of office shelf solutions, what is the timeframe and not? what not? letter with the kidnap? >> there are actually three or four different initiatives, parallel initiatives upfront.

with already let a contract to deal with some of the most challenging aspects of the current system and we are expecting us to begin to be fielded within the next six to 12 tons. the timeline for the purchase of the commercial off-the-shelf system is still a bit up in the air based upon the contract and approach we are going to have to pursue there. i think 2016 is probably the best case scenario for the introduction of that pretty early system. and so, that is one of the reasons we are going ahead to make the investment in the fixes to the existing system so we don't wait two years to have the improved functionality. >> very quickly come in your opening comments as well he talked about the vba and the improvements they are. we also learned in our hearing that we've had a 2000% increase in the appeals with regards to

benefit. when you are back together, to me is a positive terms believing we made the improvement if you could just briefly comment on that. >> sure, would be glad to. there has been the flavor sharp focus on the disability claims. i perceived out walking in the door the morning of my third day at the va. i was at the white house talking about the backlog in this laser sharp focus on the disability claims backlog we have not been as focused as we need to be on appeals and on our fiduciary claims. that is what we are really talking about, particularly with appeals for the majority, 91st and at the appeals and process said in vba. we've allocated additional resource is to congress in support to the board of appeals, which is helping us amusing to allergy to make it more efficient. but we have worked to do on the

vba site. >> thank you. mr. huelskamp, you're recognized for five minutes. >> thank you, mr. chairman. thank you for your continued leadership in so many issues than the opportunity to question the acting secretary. i want to bring your attention first to a very famous publication life magazine may may 22nd i presume you are somewhat familiar with this publication and also the photos that gained much attention across the country began may may 1970 in which the va was found to have abused the trust and neglected our veterans. mr. gibson, i think we stood here today and not his thing topic. how are we going to restore the trust of our american veterans and the american people? what i have heard me so far today has been that we give you

another 17.6 billion somehow will restore that trust. i don't think that does it for my constituents, search enough for my veterans. i have some very specific questions i would like to ask of you. first of all, have all secret waiting list been eliminated and identified? >> to the best of my knowledge, yes they have. >> have you identified, mr. matkovsky, but i understand his 18 different schemes internally. you're absolutely everyone of those we must have been identified? >> i don't know what the 18 number comes from. >> it comes from a memo in 2010 from your department. >> the i.t. to know for any location and i am not privy to what you're saying. that is why i say to the best of my knowledge they been uncovered. but until we complete those reviews and come back and issues

reports i can't tell you that. >> how do we restore the trust if we don't know the extent? >> i think you start where you are. >> you start by spending money? >> no companies start by articulating expectations about how we are going to operate. you start by getting veterans of getting veterans of the weightless and interconnects. you start by fixing the chronic scheduling problems that exist within the organization. >> how do we know we are achieving progress? >> i'm sure you are aware of numerous employees from the va have become before this committee and identified big data presented to this committee and you come in here today again and present data and say we're make you progress. had we restore the trust that we can actually believe the data you are presenting to the committee? >> i will tell you when i direct all the visitors to go out and spend time in each of their

clinics and engage with their schedulers, you know, people have, people have asked me gee, that doesn't sound like much of the checks and balance. the real motivation behind that direction was for them to be out there on the ground and take ownership or the quality of health care being delivered, including the timeliness. >> whistleblowers here are saying that is not changed. >> we are coming behind that with an independent audit. comprehensive audit of scheduling practices across the organization because we need to restore the trust. >> has anyone lost their jobs for retaliating? now, there's not. there's two whistleblower retaliation that have come from the office of special counsel. tuesday morning i will have investigators on the ground pursuing those. >> how many ongoing investigations are currently underway for investigating these retaliation complaints? >> the number changed 70 or some pain. >> will hear about two or the

other 68 are ongoing? >> these are ongoing. i am waiting for the office of special counsel to provide me the results of their investigation. >> what are you doing about it? let me describe whistleblower. maybe you didn't hear that. we didn't you know what here that says we have the right to whistle blow. and then we are faced with retaliation. this is still going on today. >> i have no doubt that it is. i can articulate over and over again the expectation that we will not retaliate that behavior. until i have a set of facts that i can act on, i can't take the personnel action. and so, nobody is more anxious than i am to have that opportunity. that is why in fact this morning i checked again. have we got anything from the office of special counsel? the answer was yes, we just got

tuesday morning the investigators on the ground. >> in the last meeting i requested information of contacts between a whistleblower here that have contacted what the chief of staff to the president. i don't believe we received the information. your department can look into that. you have access. you just need to call mr. neighbors. that hasn't been looked into. that hasn't been responded to. these are very serious allegations, mr. secretary. to come in and say we are going to restore the trust what we have address this problem, give a $17 billion. >> it's not somebody else's job. it is my job. i just can't take action until i get to read olds from the oig or the office of special counsel. one or the other. >> have you issued any statement to the va system about whistleblowers? >> yes. >> could you provide that to the committee?

>> yes. >> thank you so much, mr. chairman and mr. secretary for your hard work. before i begin come i want to recognize a friend of all of ours, nancy brown on the national president of the american league auxiliary here in a route today visiting us for my district california and is by you know it's a long track. thank you for being here and thank you for all your hard work. [applause] you know, recently my office has really done an incredible, detailed, thorough investigation of the different issues that face our veterans. not only when i started off last summer when we held community forum, stakeholder is, research, but also stakeholder interviews. we underwent added light of this

crises. we have a veterans advisory board that is just top notch. we conducted surveys. we've done more interviews than hot multiple meetings with the va administration. and we recently conduct of this informal survey of veterans in my district to assess the satisfaction to the va health care. our approach means a world of a difference to our veterans and we approach this with the spirit of problem solving. we approach this with the spirit of partnerships for solutions. we approach this with the spirit of honoring our veterans, with a relentless determination to serve and put them above anything else. and we found and i'm going to give you some information and we understand there's some selection so i take these numbers, but nevertheless they tell a story. we found the vast majority of my

district veterans are responded that they waited more than 60 days. of course these are individuals upset and willing to can that this survey. when asked what issues were preventing them from obtaining timely care, about one third said they cited a shortage of, which is adequate concerns raised by secretary gibson in the dso's represented here today. even more troubling when asked what could be improved to better provide timely care, the vast majority again said people who care. and we've heard that on multiple occasions. so, we also heard that there is this culture where the va system believes that perhaps it is about them and we need to change that culture to make it a more

high-performance, veteran center culture. the va access to honor, respect and give dignity and care for our veterans who have put their lives at risk. the veterans do not exist to serve the va health care's stone. that is very import for that said in an to penetrate every level of the va health care system. now, my question to you is what is the plan for a systemwide cultural change that will create a culture of high-performance veterans centered system? >> to you as you look at organizational change, cultural change in the organization, the critical ingredient in all of my experiences leadership.

part of that has to do with articulating a big patient and then holding people accountable for behavior like those expectations. we are working hard to do the first part. we are working hard to get ready to do the second part that we are anxious to the second part as well because quickly you, that is where we begin to get real traction. i would also tell you on the leadership part, i agree with you completely. i think there is a fundamental shift in culture that has to have been. one of the things that i talk about an awful lot in turn only is ownership. really at all levels. we're talking about leaders not at the top of organization, but all levels taking ownership for issues of veterans. some instances could be a leader taking ownership for a greeters

less than cordial welcome of a veteran. it could be more fundamental in terms of the leader taking ownership for the steps they need to be taken to get x-ray machines repaired in operating room as i've ran into in phoenix. it's really about taking ownership and understanding my job, as i said earlier, my job is to create the conditions for them to successfully take care of it. >> i believe that is very important. at least a cultural accountability that we absolutely need. however, we need a veteran center culture. so what are you being held accountable for? what are the tools you'll use it to make sure that our eyes aren't necessarily on the spreadsheet, but always on the veterans themselves and that can be done with veterans advisory boards. that can be done with tying

promotions to veteran satisfaction. that can be done in a lot of different ways that focus on all of our eyes, oliver accountability, everything we do, everything we strive for an exist, even in our high-performance is always answer the question through the lens of the veteran. thank you. i yield back my time. >> thank you very much, dr. ruiz. karo cook, you recognize. >> thank you very much, mr. secretary. i appreciate you being here. we are talking about trust and confidence. i will be very honest with you. i've lost a lot of trust income events in the va. you know, when i was in a platoon, i felt very, very

confident with the troops that i had, company commander, trust and confidence all the way up there. i'm trying to, you know, not let the events of the past influence my judgment. about three months ago i called one of the va's. i'm not going to call as congressman cook. i'm not going to call as colonel cook. i just said hey, this is paul cook. i am on final bear. i want to get an appointment. i could even get past the switchboard, okay? i called the va, the regional office and told them about that. but there is part of me that wanted to go to war, if you will. but there is part of me that my office, we do a great job with veteran. i didn't want to endanger other cases on file.

so anyways ,-com,-com ma i said to myself, what are you going to do? so i said, here is what is going to happen. i am going to walk into a va and i am going to try and get an appointment. i am going to get my i.d. card. i just want to give them a driver's-side. they will look at it. but it will have a social security number on their and what i want to know. what all questions should i have answered right then and there so i could go forward with the process because if i think those questions are working, i'm going to spread batter every veteran. according to the va, make sure

you have law, blah ,-com,-com ma blah. you ask these questions because i'm going to answer those questions. we have a problem we have to address. here we go again. >> in any va you should ask only one question, am i enrolled? if you are enrolled, you should be getting care. the second question after that would be if you are not enrolled, the second question would be i would like to roll, how do i do that quite >> i'm enrolled or that go with that. >> that the one question. i'm enrolled another to get an appointment. >> the next one quick >> i would like to see my primary care provider, that provider, that's it. you shouldn't be asking any other questions. >> so two or three questions? >> yes, sir. >> a couple of questions of the ig. you might not be out of answer.

how many of the ig visit are on their? >> i'm sorry, how many ig visit? >> are unannounced. >> i would say the large majority. >> okay, so they don't know when it didn't -- >> oftentimes they respond to a hotline to a hotline call or something like that. >> i mentioned this before about the principle. the thing about managing by walking around. you know, you don't like to do that when you have evidence that there's something going on i found a live mortar and plays with a safety pin off. on the livable. and yet, when you come in like that, particularly if you're worried about a darkness they

should based upon the statistics going out there, i don't know. i am kind of excited about you being here. i still don't understand granularity and it's the third time i've heard it into committees in the last two days. it took me a long while to understand a stroke while i am by custer lobectomy for now you throw that way. i am just a marine, but i'm glad we are going to start over again and we are focused on it and dr. rhee's, it is about the culture of the military. i yield back. >> thank you very much. mr. o'rourke come you recognize her five minutes. >> thank you, mr. chairman. mr. secretary, let me begin by thanking you not only for being here, but for the amazing job you have done in under two months as the act and secretary. you have been incredibly

responsive and transparent. u.s. focused on issues of accountability and i believe you have defined a vision for excellent, even in the first two minutes of your opening statement. my hope is that as we have a new secretary for the va at the you will still be part of this work in nation at the very highest level, continuing that very aggressive and vicious push towards excellence and accountability in changing the culture that all of us have been working on and talking about incendiaries now. let me quickly switch to el paso and i realized this is parochial, but i hope it has some implications for others with similar situations in their districts and for the system as a whole. he visited 13 facilities. i believe el paso was one of

them. the american legion also set up a command center affair with the last month. that shows us that you are taking the issue seriously and would have a problem in el paso. the ranking resolve from the vha reported in a show that out of 151 one facilities, were dead last, absolute worst for established veteran and new veterans access to mental health and second-worst for a specialty. even some of your comments he made while in el paso talked about problems with the capacity of the facility we have, the quality of the facility we have. i would love for you right now to say i am going to help you with a full service veteran hospital. i won't ask you to make a commitment and have the power to implement. i will ask you where you work with me to ensure we can increase capacity that we can

improve the level and quality of access to care in el paso and similarly underserved facilities. >> i absolutely will. el paso is one of those locations that has grown almost 20% over the last three years. it is located as we know in a medically unders are to market and so we've got challenges there is a good place to space it relates scope of services we are providing organically in that particular location. and challenges and summons those which you have cultists within trying to attach conditions. >> if you don't mind come i told you friday is going to call a psychologist trying to recruit to el paso. when i was sworn in in january january 2013 and the wii at 19.5 vacancies and mental health in el paso. as of last month made 19.5 vacancies. i've been making recruitment calls. i spoke to a wonderful

psychologist yesterday, a leader in ptsd terror. i learned that because we are clinic, she will be a gs 13 most likely. that will be the pay scale if she were coming to the hospital should be a gs 14. i can't blame anyone on what they will earn given the fact they are coming into and historically underserved area. another piece of the case i will need a full-service vha house on el paso. quickly switching gears, the chairman and ranking member convenes the week before last of survivors of servicemembers who have taken their lives as they transition into civilian life and we talked about ptsd and many to do a better job of taking care of service members when they come back. the parents of daniel summers, dr. and mrs. summers also

provided a potential solution or at least a suggestion and that was kind of picking up unfitting doctor rose that how we communicate, could the vha become a center of excellence for war related ptsd, tbi, muscular skeletal entries and exposure to toxins like asian origins are his numbers were exposed to in the gulf war and have community care for all others. i am not endorsing the idea, but have to give your thoughts and perhaps mr. matkovsky sponsor the chairman's permissions and so close to running out of time. >> i think the first part of the question should be become a center of excellence around this practice areas i would tell you either are or should that those

are instances where we need to have the knowledge and expertise but also exceptional capacity to meet the needs of servicemembers there. how that fits into a revised model of va care delivery, i don't know that i'm ready to give you a few i'm not. clearly in this particular area, as they learn from our friends at pva, oftentimes the va has over the decades developed deep specialties and are absolutely vital and these are great examples of today's areas. >> as i yield that come i ask we continue to work together choose explore this concept. perhaps the va cannot be everything to all veterans and maybe we should focus on winners of excellence. with that, i yield back. >> thank you, mr. trent three. >> thank you, mr. chairman. secretary gipson, it and honor to meet you. thank you for being here.

i want to take a second and let you know why i am stymied by this request for $17 billion because i want to take you back to how this started on the committee. i am from the state of indiana. we have 6.2 million hoosiers in the state of indiana. we have half a million veterans out of 6.2 million people. our state is passionate. and they are freedom fighters. we love the military. we embrace the va in the state of indiana. we had the fourth largest national guard in the nation. that little tiny state in the midwest behind california and texas. we are patriots in our state. so i am passionate about this issue because i believe when our little state of half a million people answered a call and heard a promise from this government. i've sat here for 18 months as a freshman on this committee and i still have for you today the original questions i asked

because we never got an answer from the va. all he wanted to know -- all he wanted to know was what was the status of my state? what is happening? i've gotten several hospitals in my state. i have a hot bill that not even a fully functioning hospital. they don't even have an icu. you'll be looked at the yard shipped across the street with private facility of taxpayers pay for both. i went through two weeks ago that had probably two thirds. and they've never been called by the va to impose the nation by check. they showed up on the list of 122 original audits that the va had additional questions from and the ceo told me he's never heard a word. nobody's ever checked with them. there's been no check. nobody's been fired. there's no harassing whistleblowers. we don't know the status of our state. we can't get good answers to the questions we started with. and i guess the question i want

to ask you but i'm also mortified to your ear if there to your your answer is when will we we know the status of our state. mr. matkovsky has been here before. i'm sure i have asked those questions today one. >> please don't tell me is that to the ig and everybody script ticket serious and anonymous. >> monday when it next week myself in one or two of our peers will be conducting in our briefings here to the committees in the senate and the house of the state delegations will be sending that data out to the field as well. so what we provide to you, we provide to the facilities the networks themselves. >> yet, that is a huge concern. that goes back to representative brownley. we have sat in here on i.t. and will never forget the gentleman in charge sitting before the microphone. your i.t. according to the

hearings has been a disaster. there's been many breaches. veterans information in the gentleman sat there and i said to him, do you have enough money to do what you need to do to protect her va and our veterans and a big assistance you need? yes, ma'am. we find out during the subsequent hearing in the $17 request that we have allocated long before i got here. this consistent the estates late allocated all the money the i.t. department has asked for. and then we find that a revelation one of these hearings that they are scheduling software that sent them a shocking revelations i've heard. a few months ago i said where are the billions of dollars? where do they go on this giant ea? they obviously weren't addressing i.t. when you come to rest and ask for $17 million in no one can

answer the question of why we use antiquated equipment, the i.t. at the va is a disaster. what is the answer to the question of how can we possibly trust you now, even for another billing for i.t. when all of that money has been unaccounted for in the revelation underwrote i think that a shocking than the american taxpayers deserve an answer as to where did the money go and how can they trust you with another 17 million or one alien in i.t. after? either of you. >> i was listening for a questionnaire. >> my question is how can the american people trust you for more money? >> i'd be glad to give you a laydown of the brick i.t. does on an annual basis. the projects undertaken, the system is maintained and developed in the functionality delivered. >> mr. chairman, if i can watch one final question.

the information we heard that day from the guy in charge of i.t. was correct. they could not have possibly been correct information where people are taking a nose they were using outdated scheduler software when he simply sat there to the bad boy made no money. were compliant, we are fine, thank you very much. the information he gave us wasn't true, correct? >> i think he gave you an honest answer. i think what you heard was the result of an organization managing to a budget as opposed to an organization mangy requirements. one of the things we need this especially system built into her budget for 2015 and 20 eckstein. >> with all due respect, it was built into the budget for years that we were funding it and we were trusting of its use for the the records. >> is a highly reported has

developed an effort that occurred back years ago where the va invested a substantial amount of money in a scheduling system and wasn't able to deliver. i would tell you in the year since that time starting in 2010 when the va developed the project management accountability system and i would prefer to you in to you and i'll make sure we get your copy of of the recent gao report to look at severin major difference departments and the progress their functions have done particularly national development, the way we go about delivering software. va was the only one of the seven department to pass the grade with gao. >> the other question is the guy in charge of i.t. that got a bonus for the lack of adequate resources you have. i want to know if you guys give him a bonus. i appreciate it for the record. >> form is walorski's record, were to have an oversight

hearing this week in regards to i.t. we were not able to do it because the person who is responsible for i.t. is out of the country on a long planned family vacation and so we canceled in hopes that he will be able to attend. mr. walsh, you recognize. >> thank you, mr. chairman. mr. secretary, thank you. i for one and grateful at the foot of the station still produces citizens like yourself. i've had the privilege of working with you in other capacities in commitment is unquestioned. when you started out, i agree with you on this. this is on her record as opportunities to make lasting. what we do within the last weeks and months will have decades of moment locations. its important to get it right, not just a tad. i've been navigating what is missing is the natural veterans strategy very similar to the quadrennial defense review that said the priority think it's a transition because in a minute i will ask you about your commander's intent and the transition is that goes to the

next commander as we all know and how that will work. what i am hearing in what you hear it or not is this nation is committed to getting this right. they are committed to providing resources, but they ask every dollar be spent in a wise manner. trying to strike out, i want to clarify when we talk about the private sector. let's be clear, eight out of 10 businesses fail the private sector. don't take the eight where you get your information. the oversimplification of the government is going to do it right you get into these ideological difference is, that class and takes us away from the mission of best practices in tanks out there. i would ask you this i would like to get your take on. i had the privilege of representing the number one hospital nation, the mayo clinic. i've watched in want to and understand how mayo had done this to one of the things mayo has been focused on is the patient first.

systems analysis to the very beginning over 100 years ago on what they've done. these things have performance excellence drives that they do. interestingly enough it starts on the flowchart with leadership in advance of the elves. and so my question is in mayo they have a quality academy and all those things. they are asking basically. many of you don't know this, mayo was founded on medicines that they are deeply ingrained in the battlefield msn and then partnerships with you. they are asking now what they can do. my question is when undersecretary hickey was sitting here, when they come back to where this is from, what are you suggesting there what can be done in vha two can see the six sigma type of performance so we now forgive me the money how it's going to be

applied. >> interestingly enough we did a review of the practices and access practices, we invited folks for me is to come brief us. when we looked about her safety practices, we invited engineers to come. i would agree with you they are a model organization. one of the things we need to look at. i agree that we should look at it as a system and look at our entire health care system. not just focusing on a metric here or there but concepts like beat veteran centric and how do we measure, how do we assess that? over the next couple months we'll take a look at some of our product to the work we've done. we've briefed dr. winthrop on it. bring us some folks on the outside and help us doing initiatives here and there, but looking up at the factors would look like if we change state, assessed with real conditions on

the ground. real positions. can we deploy, test it, measure companies the principles? for the long-term sustainability come in vha in va, but especially vha used to have academy were really great of a sort of let betty roda may have to bring them back in built leaders by focusing the training on them, building them over time and investing in them. >> at so you want to hear. i think this is an opportunity to build that hybrid. you do it here. the core mission of the va needs remain intact. there certainly positive lessons that they are, mayo in others. we heard last week from a panel that offered great suggestions. one from indiana said he looks out the window and the five hospitals. he does on any given day there is only 79% of capacity. the think outside of the 21.

>> i was in st. louis on tuesday and had the opportunity to visit our training academy on the cemetery side of the business and cited as an internal best guess -- >> we need to import into vha because we don't have the kind of talent development and succession planning inside vha that you would find. >> i think it's important you bring that back up again. the older members will remember this. out of arlington and others in the focus but i'm not in the turnaround that's been there with a verifiable turnaround we can do this. but if we miss this opportunity or does he use to rise to the occasion, then shame on all of us. i yield back. >> thank you very much. mr. runyon, you're recognized for five minutes. thank you, mr. chairman. i would probably throw out a couple of verbal questions and maybe some and analogies to set

the table. the one you probably won't have her. but i just want to throw it out there and see if you can respond to why someone would even ask it. is va too big to fail? that is something we have dealt with in other sectors in the last decade. i think it is a legitimate question. and when we talk about trust and processes, how are we going to get their? as representatives lauretta said earlier and you followed up and during mr. huelskamp's question about process. your quote was on the personal fact your company need a set of facts to act on. that could be done in the budgetary process. i'll use the analogy. go back to your high school college days. your girlfriend broke up with you. you made at the next day, but

you didn't ask her to marry you that day. the legitimate process he is gaining trust over time. and to go to bat an eyelid at she brought up the fact to manage requirements. their seven, eight numbers on the committee listserv on armed services and mr. walls brought it quadrennial defense review. most of the committee believes the dod does the same thing. they keep the requirements to keep the budget. they don't let the whole thing up to congress and allow us to say at some point we are going to have to prioritize what we're going to do because there's only so much, but we have to know without you. would we deal with a crisis like this and i asked the question to undersecretary hickey last week. when we are attacking some pain and leaving the chairman and attacking something like this, the claims backlog.

that's a category. now when you do your is to say we need this much money to solve this problem, rico in all the the way back into everything from the change on a daily basis. i do it by the biannual basis to eliminate all of the claims whether it's death benefits, whether it's burials, whether it's education, you know, pension, all that kind of stuff. is that even possible to move the overlay of what we are making definition of putting claims in piles to say do you have an idea of even what the number is because you have alluded to it on several haitian aspects. in an overall claims because we continue to say were only going

to ask because we put this overlay on it. what is the overall pick picture? what is the requirement to eliminate this once and for all? i don't think these questions get asked are answered on a regular basis. >> you are talking about on the clean side, on the benefit side. >> just boil the whole thing down. lusciously claims. every single one of them sitting on a desk and are a somewhere, what is that number and mother sat system number that goes to eliminate? i mean, a lot of times i know he talked a lot about modeling the knowledge that. well, you are using shelters and layers to actually put those numbers that come out of those models. what is the big picture? is the crisis bigger than we are

realizing the bigger than we thought it was a year ago. but can we at some point push this back and say they've got to look at this and realize this is a bigger problem and we need to dive in with. >> i think is a really to the claims side of the benefits -- the benefits side of the business if you will and the health care side of the business. part of what you are seen in vba has done this for some period of time, this regular weekly publication and detailed information not just about the disability claim, but also now detail information about all of the claims so that people have that complete picture. the same thing on wait times. you know, up until six weeks ago we were pushing detailed ways time information on every single location. care quality of patient safety information every single location. we create that kind of openness

and transparency so people can understand the magnitude of the problem. i figured since 6041 veterans that have appointments that are more than 30 days from when they wanted to see. >> i know my time is running out. i've experienced in my four years in congress as you build trust and building up one step of time. we don't have a problem if you come in here intact when this $10 million at a time. i don't think they would. actually get it right and have the last set of facts that we can act on this he said he is so with that, i yield back, chairman. >> thank you, mr. runyon. it is said to come you're recognized for five minutes. >> thank you, mr. chairman. thank you undersecretary for being with us in taking on this extraordinary staff. i want to echo the comments of my colleagues. i think you'll find this is one

of the rare bipartisan committees on capitol hill right now when we strive to work together. and then if a kiss on the issue you mentioned, ms. bradley in the work on ethics and accountability because but my concern is while i wholeheartedly believe we need to do every possible to to ensure that our veterans get the care they deserve, i had a hard time addressing the funding request before we get into how the va is going to fix this underlying systemic issue of integrity and in particular, the testimony we have heard here about this chemo of people receiving bonuses based upon many deleted data, frankly lack of truthfulness if you call it honesty and integrity that not

only to veterans, that the american taxpayer deserves. so if you could address before we get into the additional fun being, how do you tend to that level is at haggerty throughout the system and what will be the actions taken for defeat and failure to abide by basic, basic issues of integrity. >> yes, ma'am. when the president told me that he was going to have me be the acting secretary i said don't expect me to behave like activists in front of the job title. i've tried not to do that consistently. we have moved out on every front that we can conceivably move out

on. it's been a process of working not sequentially on tackling different issues, but working across a much broader front of the same time. so working to get veterans off of the witless, working to fix scheduling issues and simultaneously working to the processes that we can hold people accountable for willful misconduct and management negligence when it arises. as we would do this process i perceive the need for additional expertise, which is why went and recruited lee probably the secretary haeckel strong support to come over to the department nurtured to the department of veterans affairs. we have built underneath her a cross functional team of senior leaders from across the organization. part of the challenge we go through right now is just what it takes and the federal government to pursue personnel actions and to have them done in

a way that you at least hope is going to stand up to an appeal. the other challenge we are working through right now is really the recalibration of the department yardstick if you will, the behavior that looks like this, which in the past might not have had any accountability action associated at all may in the future he deemed appropriate for removal of federal service or for a very extended period of suspension. so what we've done and as i mentioned earlier have gotten the first of these cases and from the ig are now exercising not process. following due process, but also managing or the reset that has to happen, the recalibration to ensure appropriate accountability actions. >> if there's anything we can do

in our capacity in congress. i know including passing a bill to give you the authority to literally fire employees because they did that is the only thing that is going to bring this integrity back. i want to save for the record i had a tremendous honor this week. my constituent, sergeant ryan pitts received the presidential medal of honor and i was there for the ceremony which he and his wife amy and chad look at the white house and then again as he was in debt to into the pentagon. i was very interested in his comments this morning on national television when asked about his own care at the va that the care he has received new hampshire has been a very high quality. but i want to say for the record that every veteran deserves that

care and my time is coming up, but i want to say i hope you will pursue best practices because they think we have some exemplary care at new hampshire and i would like to see that throughout the country. thank you and i yield back. >> thank you very much, ms. ms. kuster. i apologize some numbers has to particular conference meeting in the visitor center, which is at 12:00 noon. we tried every way we could do was available for everybody. i'm going to turn over to mr. bilirakis and recognition for his statements. thank you for your service, candor and i look forward to continuing to work with you.

the >> thank you, mr. chairman. i appreciate that. i will recognize myself for five nights. mr. secretary, again thank you are your service to our country. mr. secretary, are you aware of an event that occurred monday for a florida facility were a marine, a veteran was actually waiting for three hours for care, did not receive that care and then he was subsequently locked into a facility during closing time, so it was an advert obviously. i mean, what are we going to do with this accountability? are you investigating this? the people responsible, it is streeters be held accountable? >> all i know about it is what i read in the clippings this morning. it will be an object of intensive review to understand

what happened and ensure nothing like that happens again. >> okay, can you report back to me with regard to that? it is outrageous as far as i'm concerned. the next question, you have directed that an independent external audit of va scheduling practices be performed. what to expect the audit to reveal the va's own audit? has a contract been awarded and how long do you anticipate this to go on? i have a couple other questions. >> the contract has not been awarded yet, which is why i'm not in a position to reveal the entity we are working with. i believe once it is announced, the reaction will be that they must be pretty serious about make sure it is done right. quite frankly, i hope it doesn't tell us anything we don't already know. i hope it confirms what we now have in place or scheduling practices aligned with our

needs. but i think to some of the earlier questions asked about the need for some verification, how do you believe we're publishing we time data every two weeks. is it valid data? namibia chooses to look at the scheduling is, have a rigorous independent review, determined that they are sound practices aligned with our policy in their first guy credible data for external consumption of us for our own internal actions. >> what is the expected cost of the audit? >> i don't have a number for you. >> again with regard to the bonuses, have any bonus is then rescinded to willful misconduct for negligence management? can you answer that question? >> i will give you the best dance or as i know it.

there were some bonuses rescinded recently that were rescinded with administrative error. the law allows us to do that. we are the areas sub team learned after the end of the performance. and after the performance contract is officially the performance beneficiary approved we don't have the ability to go back and change performance evaluation. we do have the ability to go and reduce ballot and take better action would be to difficult actions upon some subsequent information that affected performance during our performance. >> okay, last question. i understand implemented a hiring freeze for the vha sentra lot is in the business offices

with the exception of a so-called critical position to be approved by you and a case-by-case manner. what would you consider it critical position for vha central office of business offices? >> i will say for example, if my memory serves me right, for a vacant direct your positions. if we were where we have the right person identified to step into one of those key leadership roles, then i would be prepared to grant an exception for that personnel. >> have you granted an exception? >> i have not for that purpose. one employee granted an exception for where he has been made an offer in a dirty begun to relocate. in that instance i.d. granted except it. this is focused on the roughly 3000 people that comprise the headquarters leadership as well as the central office.

there's other staff associated with those areas such as call centers. we have thousands of people that work with call centers in dha and this would not be position because they are providing subject to the hiring freeze because they provide direct service to veterans. ..

>> i also think the chairman and the acting secretary for your time here today. i know that we all honor and appreciate your service at the u.s. which was a turnaround in the american success story and i want to thank you for that. we saw that in philadelphia with the organization they are and of course we all hope that you can bring that enthusiasm and success back to the organization at the va. it needs your leadership and echoes the comments of some of

my previous colleagues. the va has the health administration, the benefits administration and the third is the cemetery administration. as said in the past it's not been without its issues but coming from pennsylvania, we have a new national cemetery, the washington crossing cemetery, beautifully being developed serving very well in the constituents and the greater region, so the veteran community, the families of the military into the bigger communities is left with a very positive view of the veterans administration because of the cemetery administration in the community. not so much with the benefits administration. mr. secretary i'm sure you are

familiar with the hearing we had last week into the early hours of the morning there was a dedicated employee who parenthetically as a whistleblower for her work for providing direct outstanding direct support going to the middle managers pointing out flaws in the system and she's pointed out the backlog delays and duplicate payments and the shredding of documents and for that, she has been sort of divide and set aside and made a victim herself when really the administration and the management of the philadelphia va should be embracing her. and i know that you were in philadelphia a couple weeks ago. my staff appreciated your time in going there but based on what you saw in philadelphia and what you heard and what you now know, i would ask what are the plans and action steps to turnaround

the philadelphia office which would apply to many of the others across the country. >> it's a great question, congressman. i think we are back to the earlier point of leadership. we have one of our most capable experienced senior leaders that is in the process of relocating to take over the troubled location. and i would start in the wake of her arrival to see steady improvement. i have as i go out to visit medical centers i've make a point of visiting offices in the community is coming and there are a number of those that i visited fairly recently that not that long ago. we find that as we get new leadership on the ground the right kind of leadership we see

a very strong recovery improvement and that's what i'm looking for in philadelphia and expecting to find a location for us. >> it's changing leadership there needs to be a changing culture and there's been a lot of discussion in the $17.8 million. how many billion dollars does it take to fix a broken culture in the va? >> i would say as i was eluting to earlier, this is not a one stage effort. this is not something that we feel like veterans expect us to tackle some of these problems in sequence because if we did, we would be three years before we got veterans of the waitlist the way they need to be gotten off the waitlist. so, there are things we are doing to get veterans of the waitlist to fix scheduling practices to address cultural issues to enforce accountability, and along with that part of that is identifying and quantifying resources we

believe we need over the next several years to be able to meet the timely -- >> in my remaining time here i just want to get into this issue of the goal to eliminate the backlog. i don't see it in your written testimony that you testified here you have an inten antenna e the backlog eliminated by 2015. that is an audacious goals and one i heard to find based upon our own investigations where you have middle managers essentially cooking the books to the point where they can produce reports and send them up the chain of command to see based upon these metrics we've met the goal but it is a hollow victory which is no victory at all because we may look like we met the goal and we may celebrate meeting the goal but there would be hundreds of thousands waiting to be served. how to address that? we heard general shin seki say we will amaze the veteran homelessness by 2015.

how are we doing on that goal? we make steady progress and that is one particular goal but it doesn't necessarily lend itself to the most frequent measurement. but there is steady progress being made reducing the number of the veterans on the street and i would've told you and the say it again right now we will eliminate the disability backlog in 2015. we are on track to do that notwithstanding the challenges in our regional offices we have work to do. >> thank you mr. fitzpatrick. if there are no further questions, you are now all excused and i will invite the second panel for witnesses to the table please. on the second panel we have ms. bernard jones the veterans affairs director for the

american legion. welcome. the deputy director of the national legislative service for veterans in the united states. welcome. the acting associate director for the governmen government rer paralyzed veterans of america. welcome. the national legislative director for disabled american veterans welcome. mr. rick white and executive director of the government affairs for the veterans of america. and mr. alex nicholson who is the director for the iraq and afghanistan veterans of america. welcome. thank you all for joining us this morning and for your patience. your complete statements will be made a part of the hearing

record. if you're ready you are now recognized for five minutes. >> i wonder how many people in this room was that their last $40 a longshot chance to make sense of the va. mr. vice chair and ranking member on the half of the 2.4 million members of the american legion, thank you for your diligence and oversight during this crisis. the american legion spent the last six weeks setting up crisis centers. he'd seen over 2,000 veterans. i've been at each one of the crisis centers and i can't argue firsthand that it's bad. and i'm deeply saddened. the american legion is sad. we've listened to veterans and widows and children who buy one until the stories of broken promises, team come in this treatment, delays and even that. many of them are full of hurt and anger, confusion and uncertainty and just want to be

heard. we've told the story many times but they have fallen on deaf ears. during the town hall meetings the american legion listens because of what the veterans and family members have to say is important. we spent the last $40 to get to the crisis center because he literally had nothing left. 70-years-old reduced to sometimes sleeping in public bathrooms because the va couldn't get the claim correct. she came to us in tears. we were able to put her in front of the va and get them fixed on the spot in the crisis center. and in el paso texas in the first three days with 74 veterans we had $462,000 on the spot for the veterans who are entitled to money.

i wrote in office a letter that included the veteran more than 80 years for the psychiatric appointment. we have the veterans taking their own lives 20 to veterans at a hearing america. and it is the area but a veteran has to wait eight years for an appointment? we saw in the north carolina a veteran that had been working for 14 years after he left the crisis center he said i can't believe that it took me 90 minutes to fix i've been working on for 14 years. that's what we've been doing. five cities and we have to have a dozen more scheduled. we are making an extra effort. we are whistleblowers talked toe committee about the boxes of mail in pennsylvania. you can identify that, she said it just takes extra effort thatt they don't allow you to make the

effort. if an employee wants to make an effort to help the veterans that employees shouldn't have her car vandalized. we need to promote that kind of employee. i hope the va is listening. how about you take the whistleblowers and stand up and say that's not the right way to treat veterans and put them in leadership positions so they can be simple for the people that work for them. you can make room for them by getting rid of the ones that covered up veterans waiting for cares if he could make extra money every year or overstate accuracy to look good. i want to be perfectly clear this is not about tearing down the va. it's about saving the va. the american legion wants a good va for all veterans. abraham lincoln said to care we should have borne the battle. i didn't read the part that says that small and void if it affects your bonus. top veterans in every city is a

place that belongs to them. they want doctors and medical professionals understand their service and needs. when the american legion says they have a problem o problem wh accessing accuracy and leadership we don't want to throw out the va. we want to make it what it should be and make it with the veterans deserve. the man i told you about in colorado has been let down by the system that was supposed to care for him. he felt broken and he spent his last $40 on a cab ride to get to the american legion crisis center. all of his possessions. he arrived at the crisis center after waiting for us to open. the next day we were able to get him in front of the va and he was placed in a housing program and received the services he needed. the chairman of the veterans affairs rehabilitation for the american legion gave that gentle man back his $40 because the american legion truly believed

no veteran should have to pay for services they've already paid for by virtue of their own service. we served the 2,000 veterans in the crisis centers and life-changing decisions have been made. we appreciate the support and collaborations in the va. those employees came into the crisis center and worked with veterans and they did a great job. this is what happens when we come together to do what we know is right and as the have been honored to help, the question remains why does it have to come to this point in the first place? >> thank you so much for that testimony. now we both recognize you for five minutes or. the allegations made against the va are outrageous and the members are rightfully outraged

and they worry the loss of trust among the veterans of the potential to be more harmful than some of the propriety that we've seen. when the scandal broke they worked quite quickly to intervene on behalf of the veterans and we advertise our helpline where veterans can turn for assistance or share their experience as we also conduct a town halls and verdict surveys around the country and over the first two months of the outreach we receive 1,500 comments most of which were negative. they then worked with the leadership to help resolve more than 200 critical issues. next we sorted through the status to identify the trends and makes recommendations to fix the system. as we seek to resolve the issues we must be careful not to dismantle the va or abdicate the responsibility to care for veterans. the va is far too important since many services cannot be duplicated. my full comments are submitted for the record and i will share concerns and scheduling and accountability. the major issue facing the healthcare system is timely access. even veterans that really

experience is still share concerns over unreasonable wait times. to date the vfw outdated appointments technology is scheduled for the access issue. they know that its antiquated system allows the patients to split through the cracks and makes it impossible to manage the workload. this is why the system i is ripe with fraud and manipulation and the veteran care suffers. one veteran who contacted assured his problems in the salt lake city va system. at first they said it would take six months to see primary care and they told him it would be another six months. later when they called the va he was informed he was this an old andisabled andhadn't been seen a year. we have to do better than this. it's why congress must provide the resources necessary to acquire a modern sustainable scheduling system. next they acknowledge the va must leverage its authority however, the va must have the responsibility to properly coordinate and deliver care

otherwise veterans .-full-stop or. earlier this week i spoke with a caregiver in missouri who recounted a nightmare not receiving care. the veteran needed a seemingly routine surgery but they were backlogged and have to send him out for the procedure. we are followed with a bureaucratic mess. after they provided the operation he was discharged and told the hospital had no further possibility meaning the veteran and his caregiver had to drive directly to the va to receive proper vacation and the need for recovery. now they understand that the va may have been suited to provide both that this wasn't communicated prior to the procedure. moreover the caregiver reported that the facility was inflexible in providing basic assistance to a veteran who was in pain while still in their care. this is a prime example while outsourcing isn't a catchall solution. most outsource care when they cannot deliver in a timely manner. absolutely. however they must continue to serve as a guarantor of such carcare and they must ensure tht

the va record al with proteins e networks can make responsible, timely health care decisions. finally, we all know that accountability is a major problem for the va and that goes nonexecutive employees. secrecy into the low morale seemed to be symptoms of a culture that focus on internal processes rather than patients. they told the vfw the resources are stretched too thin that they are afraid to speak up and as we heard today they penalize when they do. the va has to focus on the patient's first by changing the mindset. this demand strong leadership and whistleblower protections. they also worry that the current bureaucracy overdetermination replacement. since the va acknowledges it can take up to be here to fill the vacancies if they cannot hire the top talent, we cannot expect the va to fire employees. they canno cannot fight your bad employees we cannot expect them to deliver quality care to the veterans who need it. thankfully not everything they hear about the care has been

that. nearly 40% who contacted us praised the va. just this week several sort out our professional staff at the national convention to share how the doctors saved their lives. others offered a perspective on how the system had improved over the years. we believe the system can work that they cannot work without the congress taking action. the international convention members also passed to the stern resolution calling to pass the access and accountability act. both chambers already agreed to peace would help the veterans receive timely care which is why the members insist the congress absolutely cannot go into the recess without passing the bill. when the scandal broke every legislator in washington agreed this was a national imperative to. however some ^-caret more about the cost than waiting for care. we have an opportunity here. an opportunity to show veterans and those in harms way that the nation will live up to its promise to care for those that defend. we have to get this right and restore trust and confidence in the va system and the vfw will

do whatever it can to make that happen. members of the committee this concludes my testimony and i'm happy to answer any questions you may have. >> i nohave. >> i now recognize mr. blank for five minutes. >> members of the committee on behalf of the paralyzed veterans of america i would like to thank you for testifying today. it is frustrating and disappointing to see things that have beethe thingsthat have beet the system in the last several months. the members and veterans with spinal cord injury and dysfunction are the highest percentage users of the system in the veteran population. they have experienced the long delay and scheduling gimmicks that have been disclosed. i'm a regular user of the va and it has happened to me as a regular user of the va. however, we are fortunate because 30 years ago they developed an agreement to allow

us to do annual visits to fully understand what goes on in the system of care and to make sure the adequate staffing and resources are devoted to that system. the sad reality is the veterans that try to access the larger health care system do not have that luxury. the fact is we are all responsible to these problems. they should have a great examination of the concerns by encouraging congress and the senior leadership to examine the basis of the problems as we saw. the administration should have been fully honest about the resources and the staffing needed to make actual demand on the system not manipulating the statistics but to make things look better than they obviously were. finally the congress should have listened to what we should say as advocates and as we have been saying for years. these problems can be traced all the way back to 2003 when the va had to begin denying enrollment

to eligible veterans seeking care because they didn' it didne capacity or the resources. unfortunately instead of taking the meaningful steps then we allowed the va to close the door to some people and that simply has gotten worse and so here we are today talking about this problem. in a meeting recently an in memr of congress told several of us in the community we thought we were getting enough resources. that is a ridiculous statement. this is the firm no one is listening to what we know and particularly the co-authors of the independent budget have to say because we've been pointing to these problems in both of the recommendations for 28 years. in fact for four years now, we have not once had the opportunity to present in front of the va appropriations subcommittee to outline our concerns. for years now. i will not dispute the fact that the va healthcare system has been given large sums of money

in recent years and that the va has done a poor job of managing and spending those resources. those are facts. but that doesn't automatically mean that additional resources are not needed now. we believe they absolutely are. whether it is to address the conditions made by the va or the administration or the white house or whoever made that recommendation. or to address legislation to conference committee is currently wrangling over right now. unfortunately, the discussion is more towards using the private health care to resolve these problems. instead of re- strengthening the va from within. sending veterans out into the private marketplace may alleviate the pressures on the access right now. but that is not the answer to the long-term problem. the va has provided come and get some numbers of congress say that is unacceptable or not part of this debate. when will it be part of this debate because i am not convinced it will ever be part

of the debate. as the congress not interested in fixing the va from within? i hear all of the discussions and i couldn't agree with anyone more. the culture needs to be fixed. i use the va so i know what the culture is like that i wil but l you i prefer to go to my dr.. the question was asked at the committee week contracting most surfaces and not specialized care or the care that is unique to the va. but the question ignores the fact that primary care is not a generic function particularly when it comes to veterans. even the representative and the american hospital association sat right there and admitted they would need time to understand the nature of the veteran position. before it could begin to meet the demand. meanwhile one of the other representatives that stuff right here in this seat said we had long-standing concerns about the rate of reimbursement. are we not concerned when the people that it seems we are

going to turn to to help us address these access problems will readily admit they do not understand them as patients and they are worried about how much they are going to get paid? the motivation of the mission is not the mission of the va. to be clear, we find it unacceptable that tens of thousands of veterans waited for far too long for care and in many cases are still waiting to be seen or have never been seen. not a single veteran should have to wait for care when it is needed and it is incumbent upon this committee and all of us at this table and the folks sitting behind me to get this right because it will matter in the long run to millions of veterans. so it's time for the rhetoric to stop. thank you again mr. chairman and i would be happy to answer any questions that you may have. >> i appreciate it. now you are recognized for five minutes.

>> thank you vice chair and members of the committee. thank you for inviting me to testify today. when the obligations of the secret waiting list came to light we were outraged. but like you we wanted to wait for all of the facts until making the final conclusion. today there is no longer any doubt that the problems uncovered by this committee invalidated by the va are real and must be corrected. over a decade ago, they faced similar crisis. in may of 2003 the presidential task force appointed by president bush reported the following come and i would quote from his book as of july, 2003 at least 236,000 veterans were waiting six months or more for the first appointment and initial follow-up as a clear indication of the lack of

sufficient capacity or a minimum a lack of adequate resources to provide required care. they concluded there was a mismatch in the va between the demand for access and available funding. the secretary sat at this table and stated i asked for $1.2 billion more than i received. one year later after stating an equivocally that the va budget for fy 2005 and 2006 were sufficient, the secretary nicholson admitted the va needed an additional $975 million in 05 and $2 billion more in 06.

even when they accurately indicate the needs, omb passed back a lower number in the final budget. that's why the partners testified over the past decades the va medical care and construction budgets were inadequate. and in the prior ten years, the funding provided for medical care was more than $7.8 billion less than what they recommended. for next year we predict it will be $2 billion less than is needed. here's what the congressional budget office said in a recent report, and i quote under the current law for 2015, on the base line projections for 2016, the appropriations for health care are not projected to keep the pace with growth in the patient population or the growth in the per capita spending for health care.

the wait times will tend to increase. in addition, over the ten years of the funding appropriated for the construction. that is based on the va internal analysis. they wrote those that cannot remember the past are condemned to repeat it." the question is will we learn from the mistakes of the past. the resource is provided as a settled issue. why would they vote for under 26 to zero and the senate voted 93 to three for the legislation to

expand the veterans access to healthcare that the cbo estimated could cost $30 billion for two years of cover and after $54 billion annually after that. if there was already enough money. the secretary testified about the progress made over the past two months adding more clinic hours. if he is the temporary staffing resources and secretary gibson also justified in order to continue this expanded access initiative for this year and the next three years. unlike the proposals in the conference committee, the va proposal would have an immediate impact by continuing the va expanded access initiative and its purchased care while

building up internal capacity for the future. for these reasons we support the supplemental request approach. mr. chairman, the dav has for decades said prem illegal funding provided was inadequate to meet the future health care needs for veterans. sadly, history has proven us correct. it's up to the congress and the administration to take the steps necessary to end the mismatch and provided the va with the resources that the needs and work with them to strengthen the va healthcare system. so the emerald veterans receive high-quality, timely and convenient medical care. that concludes my testimony and i would be happy to answer questions. thank you. >> you are recognized for five minutes. >> thank you very much, congressman and mr. vice chairman. we are a simple bunch and our legislative agenda for the 112 congress an in the 113th congres

consists of only four things. number one, fix the va. what we meant by that is nothing in terms of adding to accomplishing the mission. secondly, that there would be true accountability. when people lie they get fired. it highlighted the national president of mind host and i absolutely agree with that decision. you can't run an office where people systematically do not tell the truth. the third thing is they have adequate resources. and i have to agree with my colleagues here as we have been saying for a long time they don't have adequate resources. and last, addressing toxic blooms which hasn't really been adequately done for any generation. it wasn't done for those exposed to radiation at the end of world war ii were during the 50s and it wasn't true of the vietnam veterans with agent orange and

other toxic exposures or the gulf war veterans that were exposed to levels of gas but in fact do have long-term consequences and they have not addressed t that of young folks today. it's something that needs to change in the system in the way that the va approaches their mission of veterans hold care. it's not a genital healthcare system that happens to be for veterans. it's got to be a military exposure. whether that would be all of the things that people talk about here earlier today in terms of spinal cord injury, visual and at the end baird and blind services, prospects and on and on. certainly if talks to these exposures and that's why we had such highavesuch high cancer ra. i noticed that somebody put it out on the table a little card for the american academy of

nurses. and where they get this from, the information in this, they are disseminating it to their members. why? because the va is not talking to the private sector medicine about the wounds and the illnesses and conditions that stem from the military service based on the branch of service, when did you serve, where did you serve and what was your military occupational specialty. and in fact it should be because 70% were 60 to 70% of the veterans don't go anywhere near the va hospital. and more of them would and do today than 20 years ago because the care is better once you get in but we still don't have the adequate resources and most importantly we don't have the right kind of attitude. the plantation mentality of we are going to tell them what they need help out asking the veterans what do you need? what do you think? here's the problem can we solve

this together? not just the national level, but the working level and most importantly we believe the va medical center level. all too often, people have it all backwards. one example the white house mandated that everybody would be with somebody with mental health last month in october so they were supposed to meet with the stakeholders in the community including all bso and they set the agenda and work together on the summit. that isn't what happened. they had a predetermined message and they invited a couple of people and told us what we ought to think. that is not a summit or a part worship and once we changed this at the local level, then we will start to turn it around. i will say that under the acting secretary, there is a fresh thought going through vermont

that hasn't gotten out of the field yeto thefield yet but it'h so people are doing what they should have been doing all along. not that we call the shots from the other sequels arthe others t they ask our opinions. as an example of the scheduling system. some people weren't going to ask our opinion. and thus secretary committee acting secretary made them listen because we know what it's like because it is our folks that go through the nonsense. and if you want to change the va coming you change that particular part of it. forcing the va to listen to the stakeholders and do the patient centered care you've got to respect the individual veteran and the veterans organizations and other stakeholders. we said that the outlet in 2003 was no good.

why? because of the formula that is designed for the middle class people that can afford those. that's not who uses the va. the average number of presentations at the time was five to seven presentations were things going with veterans coming into the hospitals and today among the youngest is 14 presentations. but the formula figures one to three presentations. now it doesn't take a rocket scientist, even i can figure out you are going to fall further and further behind if you use that to estimate what it's going to be. we need to jump back and go to o the case based on the needs of the people in the area. the last thing i want to comment on and as an appendix to today people have been saying where are we going to find the medical professionals? and a number of people

particularly have been working on a program called grow our own and it stays on the medics program and not just the former medics who become physician assistants but why not send them to school? even if they are smart enough to go to medical school and they get back to years for every year they are in school then you are growing your own. it's veterans who served and who are committed to the system from the heart outward and we will have enough people for the future. i would submit that to the committee and thank you for the opportunity to appear today and for your indulgence. >> thank you for your testimony. now we will recognize mr. nicholson for five minutes. >> vice chair, ranking member and members of the committee on behalf of iraq and afghanistan veterans of america we appreciate the opportunity to share our views and recommendations on what changes and reforms should be made to

the department of veterans affairs and the indication of collaboration with veteran service advocacy organizations. in the recent months, revelations about extensive patient wait times in the reputation of data and a systematic lack of accountability and even preventable that are in deficit was in the va system have undermined the trust of the american public in the va and add a particular impact on the trust and the confidence of the members of the system. why would his true that many of the members have expressed general satisfaction with the delivery of healthcare they receive from the va many have also expressed serious frustrations with the general access to and direct communication with the va system. we are pleased to see some recent changes in the dha and cursor in the areas of accountability, the adoption of the best technologies and the increased pasadena to deal with future needs. congress has acted swiftly in the area of accountability to

the scheduling scandal by passing the va management accountability act. we are pleased to see th the position move forward with the members want to ensure that the secretary actually uses it once it is signed into law. we would welcome an extension of the similar authority to title 38 as well as with appropriate due process protections of course as a part of that. we would also like to see the va is not only the more user-friendly technological platforms especially those that are better in facin veteran face believe the organization needs to face the shift in the way that it looks at its tech genies and how it goes about acquiring and were designing the systems. compared to the private sector interfaces the members use the web-based platforms and portals are a junk to many of the veterans. finally the members want to see an increase in the capacity to deliver critical services to veterans especially in the realm

of mental health care. the shortage of psychologists, psychiatrists, counselors and social workers and other mental health professionals and service support staff asked because we remedied. some of these and other reforms and actions are actions that ea could have pursued partially all along. unfortunately the level of communication, cooperation and collaboration with the new generation organizations over the past five years have been severely lacking. prior to the outbreak of the scandal the current scandal the secretary of veterans affairs coming up with them directly on one occasion during his entire tenure of secretary. much like the va attitude towards the committee is the prior regime within the va didn't like what they were hearing from the nonprofit partners with those partners refuse to throw the party line, they were shut out from the top-level access and tightly. the va interim leadership however has been much more communicative with the iava and

other vso's groups and the liaison brought on by the va immediately prior to the access crisis has done a phenomenal job in working to repair the relationships between the va and the nation's largest commiseration of iraq and afghanistan veterans and families. in addition to the above we want to take the opportunity to let the members know that today right after national press club is releasing the results of its 2014 member survey. the policy positions are driven by the survey and the data this year overwhelmingly rebuild its suicide mental health care access. most are available today at iava.org and led by the office we would be happy to preview and the staff on the detailed 2014 findings in the very near future. we appreciate the opportunity to

share our views on the topic to improve the lives of the veterans moving forward. strategy for your testimony and i will recognize myself for questions for five minutes. >> first question for the panel. mr. robert mcdonald has been nominated by the president to be the next secretary. i'm sure we all agree that he's got his hands full to restore the trust and the va. what is your opinion of the president's choice to add mr. mcdonald through the agency cafor the department as the secretary of the va does the lack of experience in the healthcare system concern you. they are ready to assist anyone

at the point of the acting secretary. whatever the choice is the american legion has a history and has bestowed by the previous secretaries and the region continues to stand by and let mr. mcdonald note that we are here to assist them with whatever he needs. the lack of experience in the legion has been around since 1919, and we are going to be here to help as we have always done. >> have you had any contact with mr. mcdonald? >> i have not, sir. >> was a piece of advice do you have or what area you would like him to focus on the most? >> transparency. >> it doesn't happen again so we know what the va needs. so, we can advocate for those needs we would like for the secretary whoever that may be to let us know what is needed and to be transparent so as long as we know we are working with, we

can work towards making sure the veterans are taken care of and they receive quality service. >> mr. gallucci housing question. >> thank you. the vfw has been supportive of the selection of mr. mcdonald, the nomination for the position of the va secretary. i think it's time to do something a little different. we think the expertise has the opportunity to change the mindset of the va system. this goes not just the old care. the secretary is responsible for coordinating the programs that millions of veterans rely on whether it is post-9/11 g.i. bill, the disability compensation, the home loan program and to think the corporate mindset might be beneficial for the system. to one of your other questions about what do we think they should focus on from vfw perspective it would be the business process. from what we have seen and heard from our veterans w who know the

system hasn't been agent centric when it should be and that is the va healthcare system specifically that by improving the streamlining the way decisions are made in the system we can improve the delivery of the services from the veterans. having said in a confirmation hearing on tuesday it was very encouraged by the things the nominee have to say he certainly addressed the concerns raised by ms. jone jones of transparency d number of times gone and i'm sure that while he may not have said it to you all yet one of the first things people tell you is he will give all of you his cell phone number and expect you to call him and he will call out all hours of the night since he seems to be willing to be actively engaged with the committee. so hopefully that will fit the transparency. i think the first parody ought to be culture. i think the bad actors, that attitude into the data processes

ultimately stem from the culture that is sad. i think the acting secretary gibson has done a good job of trying to change that, but you can't change that overnight. i think the kennedys that we are debating right now proves the question was asked about the challenges and certainly the secretary gibson made it clear that the challenge of firing people is a tough one. i won't argue with this. somebody did something illegal, wrong or immoral or forever, wh, somehow, someway harmful health care delivery for veterans committee should be fired. the congress put in place federal rules that makes the difficult process. so they think it should be changed then so be it and i know the committee is looking at the legislation that will address that issue but it's going to take mr. mcdonald seemed to be committed to changing the culture and i think that will be first in his mind. >> again, give me your opinion of the secretary or the -- whats piece of advice would you give?

>> i was a confirmation hearing and i was impressed with his responses to the committee's questions as well as the remarks. i just hope that he can accomplish most of what he said. in my mind, the one important thing that he said was transparency commander that i think more than anything else we need to see in the va. i don't know that we will ever see it accomplished. but i think it is a goal that their secretary should try to achieve so that we know what's going on and what needs to be done. >> what should i secretary focus on? >> what people have already sa said. i forget how many hundred communication through the central office of the va and communication. they are in the business of constructing an obfuscation and most of those folks need to be assisted in finding another way to contribute to the good in the

world. and we need to her three people. it was for the committee and what it does is things that ought to be on the web suddenly become a freedom of information act and they drag out for months. an example is just asking for the job descriptions of major positions within the va. and which happen to be last year it took five months to get the thing. thing. i'd already gotten it another way. but in one of them they said they didn't have because it was available in vermont avenue and that was the job description for the director to the national center for ptsd. you don't have a job description? how could that be? and it wasn't but you had some attorney that could be put to use enabling veterans to get their claims approved as opposed to messing around with

bureaucratic junk and should be the litmus test certainly for everybody. it's how much do they and how much do they contribute to accomplishing the mission. and at the vha all of those metal people, almost all of them needed to go away. because they just get in the way of the measure. >> does it trouble you that he lacks the healthcare experience? >> it doesn't necessarily. he has a phenomenal business background and like mentioned in the business process for the va certainly needs to focus on. they are supportive of mr. mcdonald and we were not consulted by the white house on the selection process of the nomination. but he was sort o of ran out of the blue pic for us so we had to do learning and we are still in the process as everyone else i believe. but we are generally supportive and would agree the accountability and transparency are top priorities but also upgrades oswald. >> thank you very much.

when he came in and 82 the veterans organization was so mad that everybody was chewing on males. and he came in with no experience and took over, restore competence in what they were doing and straightened out a whole lot of problems including assisting veterans for the first time soon is possible with a business background to be one heck of an administrator today we call it the secretary. >> i sealed back mr. charan. >> i apologize to the panel and we were having a conference committee. i will be meeting with mr. walters suffered three timeo gain some insight from his time as the administrator. >> thank you very much

mr. chairman. before i ask my questions i do want to commend the secretary gibson for still being here. it shows that your commitment to listen to the vso's this is the first time i've ever seen a secretary sit through a whole mother panel. you are taking your job very seriously as well. and hopefully we will see action as well. for each of the panelists the congress continues to ask th tha with the need for services and you heard my comments earlier about the secretary that really showed the disconnect between what the needs were and what the administration asked for. my question is to each of you to keep it short that would be great. do we need to do an independent audit to properly plan the

budget? my biggest concern has always been -- and i made it clear over the years i don't care how big of an increase is in the va budget but it are we taking care of the needs of our veterans? and as you heard the secretary mentioned earlier, it's always been budget driven and not outcome driven. so i guess we will start with mr. mickelson first. we have an independent audit plan the budget? >> the first thing to come to mind is i is anyway we already . we have the independent budget which many are play a very prominent role in putting together. i know karl is sort of our community budgetary expert and we defer to him on a lot of these issues. it's certainly helpful but please keep in mind we don't have to reinvent the will. please use resources that already exist and give a credible way to those as well. >> the va has reached out to some places like the mayo clinic but nobody has really reached out in a systematic way to all

in our society. one thing we do know the issue of the veterans people will step up from the industry, from the sector, the medical center. cosector etc. and we need to do that in an organized way and including organized labor in a way that makes sense in order to get where we need to get in terms of designing a system that actually can estimate the needs and put it together in a way that people are held accountable as it moves back down the chain. >> i would disagree with my colleague with what he said earlier about the actuarial model. when we were still pushing for mandatory funding for va health care we went in a number of times to talk to the budget people. and at that time they told us that the model which was based on the civilian models was revised to be specific veterans

use. i belief if there was transparency in the process and we could see what they were putting into the model and what comes out without the omb having a shot at it that we would be better off and know exactly what the needs are because that's all we want to know is what the va needs. i don't care about building and fire for anyone. i want a veterans to be taken care of and knowing that what's important is that their needs are met. first i don't want the distinction of being recognized as the community budget expert. from the perspective of the independent budget i would say the difference between what we do and the administration does come and the secretary gibson had this on the head of the management and budget versus the need we take what information we have available to us, look at what the need is and find out what we believe the cost is. we don't take a budget number and try to smash the services down into the available budget that's given. that's what the va is required to do.

you asked about the independent audit and when we asked for the appropriations this is one of the ideas we wrestled with was having a tide of independent audit on the va budget of the best we came up with the legislation i think was the geo responsibility. not that that's going to get us where we want but that's the idea so i think we agree with with the notion is and we would like to see it enhanced perhaps. >> i think the vfw agrees and we testified when the senate hosted a hearing when the scandal broke back in may the problem is we have assessed with the workload could be or what their problems are but as we have learned with the scheduling system and software that is decades old and the va bite her own admission has no accurate measure of the times or of the waiting lists to the housing veterans waiting for initial appointments based on the independent review that was recently conducted. so i think right now even being able to evaluate the need is very difficult.

.. enough resources, and of everything for the veterans to be taken care. they will have to suffer. >> think you, mr. chairman. i appreciate the ladies and gentleman that are here today. i want to thank