allowing to perpetuate itself. and to demonstrate some one knowingly and willingly >> were you surprised at the response? >> working with these prosecutors everyday, last year we arrested over 500 individuals. rearrested 94 employees last year. frankly our investigators would like every case to be prosecuted but that is not the real world.

in the determinations are made by that department to justice. so to pass the amendment on the appropriations bill for the specific purpose to prosecute these cases. but to talk about systemic there was the culture of corruption baby that purses those cases it was so k? -- space or somebody manipulates the records the purpose of financial gain is said that a criminal offense shouldn't that be an example set somewhere in the system? >> i agree.uk there has not been any at

this point you would expect the cases with least amount of evidence or manipulation or:conspiracy would be the ones to be set aside your earliest because the additional cases require more work than we are working feverishly with those because it is important to get through all 93. as we finish them i know the department is anxious to get the reports to take administrative action. >> are you surprised there are not criminal prosecutions? >> not at this point because the fbi is still investigating. >> i am not surprised.

>> it does seem like the department of justice is looking the other way. because the situation is embarrassing to the administration. >> thanks to all of you for your work to veterans&p that provided even one veteran substandard care of a bite to go back with the long history with the o.i.g. office someone in my unit i count on heavily as another set of eyes so what is implied the integrity of chiapas was influenced by the v.a.. did anyone at the v.a. bascule to change the report to make it look better? >> no. >> is is standard operating

procedure for multiple drafts to be done? >> especially 170 pages. >> what about that methodology being questioned ? >> this is the first time. >> is it your understanding is predicated to ask for the original draft? >> correct. >> to be very clear that report is very damaging to the v.a.. the department of justice to make sure dr. mitchell and dr. foote there has to be an avenue where people are held accountable. that is in the process.mj is that correct?

>> the investigation is ongoing. but also the very first recommendation referred the names of the of veterans in the case reviews for them to conduct appropriate reviews of there was medical negligence. >> does it prosecute cases? >> we take them to the prosecutors if we cannot get that traction. >> does this report strike you, how long have you been with o.i.g.? rick 13 years. >> investigations? >> we have done about 520

every yearn8 for the last six years but that is average. >> is there anything strikingly different about this one? >> it was an undertaking of the criminal investigation. a joint project where dr. daigh people. so the staff had the responsibility to identify those that were not on the electronic wait list. to try to pull the three

different disciplines together everybody on the same page with what makes sense. >> guy would argue it makes sense to dr. foote and dr. mitchell. but with that being said with my remaining time that would be investigated but my immediate concern is to you feel in your professional judgment they move in the proper direction? to you feel at this and it is early. >> it is utterly. the a lot of the of late -- wait time issues better is a the report to identify an

additional 1800 veterans that were not properly managed. to give those names to people in phoenix to make sure they got it as quickly as possible.á7 >> yes or no. does it feel like cultural changes are changing the accountability? >> does a complete more investigations. >>. >> for my testimony to be made public. >> no.

>> i yield back. >> dr. daigh and, you cannot conclusively examine all the medical records to determine the release of thema final report of the long wait times causes the death of the veterans. how can it say to us synthetically that no link the wait times if you did them and examine all the records? >> 200-0409 records were evaluated. the service point looking at their records of the

patients on the near system if they never made it through the maze. with that electronic medical record that all the cases we're able to review those ted to do with of waiting list. they did very thoroughly review the cases it predetermined delayed care. and those where there were improper care prepublished those. and as a result they were harmed. an additional 17 cases where standard of care was not met

republished those. i am not trying to say to people who through frustration could not make it through the barriers. i am not excusing anything but answering tough fact are these people on the cases that we've looked atñu, did we see a significant impact of their care? that is what we found and that is what we published. i further say i don't believe that further review needs to be determined but i put the scenarios out there hoping you would read the case is to understand the complexity and understand the difficulty and the fragility of the cases. but when they don't get care in a timely fashion horrible things are likely to have

been then each person could decide do they think that was related to make their own decision. to offer the opinion of my office to see lots of data is the necessary. these families have a right to privacy so we be careful about what we publish with respect to fax of the case if people would like more data ijñ understand. but the v.a. needs to be sure to have access to care is that time and way to develop proper care. >> if you had a chance to go

back and reevaluate what could you do it different today? >> no. that is so we have done this for many years it is very thorough. but i would wish it was not tied to the issue of timing isfor the impact of the old way to list and quality of care. that is a native standard -- a maid at standard we would have come up with something different so that is what we had to address >> i yield back. >> mr. chairman, is there a parallel fbi investigation going on right now? >> a joint investigation

involving my people and the fbi. >> investigating the same issues in asking the same questions? >> there is an interview happening there is fbi and it o.i.g. president. >> so answering a the question related to the closing out of those 12 cases of the 93 ongoing you mentioned there were closed because they met the criteria and questions were answered buy you talk about additional information that was not necessarily related4s. can you talk about the additional information? can you give examples? >> i will clarify. we did some of the 93

investigations of what we gave to the department department, agreed did not join phoenix level review of every one of those facilities. it would take 10 years. free did look at where there were allegations from any number of sources that were specific infractions going on. some have more specific language than others. . .

we handover reports and transcripts except drop to the

va, and they can take administration action. >> so there is not additional information or a list of additional information that was uncovered that had not been already investigated? >> i am just saying that together, their review for purposes of administrative action, somehow they come up with some information that was not available. in that apartment, they have to propose the action whether it be removal or something less than that, it could cause us to say that we are going to go back and put -- look into this further. as is the weather processes. >> zero one the follow-up on the questioning and asked very specifically if you believe there are adequate resources to continue and to complete the

ongoing investigations. >> some of those investigations are much more narrow in scope than the magnitude of the review we are doing in phoenix. we are progressing. every week there is another handful that were able to bring to closure. so the answer is, yes, we have the resources, but i must say that this is not the only investigation that our people are involved in. since january the number of threats cases that have come to us at va facilities, progress, so some of these matters that are already in the prosecuting mode, i mean, we prosecuted at

director for 64 counts of corruption and certainly could not drop that case in order to, you know, take on a new case when it is going through the judicial process. >> thank you, and i yield back. >> there were 293 deaths. is that correct? >> 293 deaths that we reviewed. that is correct. >> how many of those were cross reference the medical documents? >> all of them. >> i think there were 28 that were on the list. i am trying -- again, i am honestly trying to learn, mr. griffin. and you have educated at least me as the chairman today on some things. you said because they were on the list that they were not in the system so there was no medical record to review, and you were not able to do that. >> let me please clarify.

the list included a large number of patients. of the patients that we reviewed from the list we would not be able to review a patient if we did not have the medical records. if you were on the list and do not have a record then we excluded you from the review. so in our methodology section we can only look at cases that actually come to the va. >> and i understand. but how can you -- i keep going back to, how do you say you conclusively were able to say these individuals did not get timely care? they are now dead. >> i am talking about the case is that we were able to review. >> i have a stand that, but there were cases that you just said you can review. all i am trying to figure out is, there are cases that were part of this investigation that

you apparently could not review because there was no medical record for you look at. and so my question is, again, of the 293 deaths, he did every one of them get cross referenced with some type of medical record ? >> the total number of people on the list is a big number. >> 293 had. >> but what i am trying -- i'm just trying to clarify. the 293 deaths were all among patients from whenever list there on that had a medical record that we could review. so i am going to agree with you. there would be people who would be on the list to did not have a medical record that we could not review. therefore they were not part of the chart because it is not possible to review. so all of the deaths, 2903 that we reviewed, that number is a

datapoint. that number is 3409 patient, 293 were dead. but that number is a number that has limited meaning in the sense that it is drawn from a population that you do not know the disease burden of the laws i cannot tell you whether it is too high or too low because the reason for death could be normal causes. >> i understand. i apologize, but i am still trying to find out because and a staff briefing, staff was told that in some instances all that could be done was a match of social security numbers, looking ahead list. so there was no way for some of those individuals to be cross referenced for the medical record. that is correct. >> i think that would be a misunderstanding of what was said. i would not support that we have

not been able to review the record. >> but they were on the list, correct? >> again, and our methodology section we said we excluded. i am really trying to be clear. i cannot report on cases that i have no information on. >> and i concur. i think that is why the crossed wires are coming. it is very hard for meanwhile to sit -- accept the statement and a document as we have been discussing if you have not been able to look at every single medical record. thank you for clarifying. >> thank you, mr. chairman. i appreciate that line of questions. still, i am confused. 3,409 veterans. >> medical records for all those cases. >> yes, sir. >> but in pages 34 and on in the reports you identify numerous

other categories of veterans that would total well over 9,000. either not on the electronic wedding less or not or on the new list. printouts are scheduled appointment consults to the backlog. how did you decide that 9121 is reduced to 3,409? six. >> well, the report dr. upper in phoenix there were many. the report talked about some different sources and points. so if you are talking about cases that were a part, which were the va clinic action, those cases were not part of the -- most of those cases were not part. >> excuse me. page 34. question to identifies 9,121

veterans. they may not be cumulative. my question is how did you decide not to look at 9,600 some cases of veterans, you decided not to review their case. >> well, we looked at those with a collection date of within the timeframe of the start of our review up until about june 1. i would have to go through and it looked through that date is set that we have of the actually 3,562 names on a last, 3409 unique individuals of which 293 have died in 743 had a position review them. >> if they were on an electronic wedding listed you look at them and review the patients are not? >> we did. everybody that we were able to

determine on any of these waiting less of any variety described in this report. >> i just give you another 5,602 put in the report. why did you not look at -- those on the list at 3500. did you not look at any? >> if you were on the list and for asking for a veteran to get into the va system it never made it into the system. >> if you died waiting for care because there was a failure in the system does not show up? >> that's correct. >> well. >> isn't that the crux of the problem? thousands and thousands and thousands of veterans are waiting for care that we don't count them because they died before we get their records. we're not going to go back and look at other sources. it is unclear to me.

if you could provide information to the committee, how you decided to exclude. that would be helpful. one of the questions, the day before you release your final report to congress and number of news outlets were carrying reports. he looked closely at headlines uncounted resources. delays caused patient deaths. no links found between deaths and care delays and no deaths due to long waits. are these accurate or just for headlines? >> i have seen plenty of misleading headlines in the past two weeks. >> the ones i read -- >> okay. >> the ones i read to you -- [inaudible conversations] >> that is part of the story here. if someone leaks something before the schedule released a report, and if it quoted our

report, it should not have been leaked. >> is that report headline misleading? >> could you read it to me again? >> absolutely. i am sure you have seen it before. no death. is that misleading? >> that is an accurate representation of our conclusion that we could not assert a cause of death being associated with the waiting times. >> how about a link? >> those are not my words. earth. >> i am asking you for your thought. you were worried about 800 headlines. >> are not worried about anything. that is just a reality to show the amount of coverage that was put on this statement and that there were no ifs, ands, or buts

about it. that does not take a lot of research. >> i am still not for sure. those headlines are okay, misleading. >> i did not say that there are okay. the headlines are sensational to get people to read a story. >> sensational that there are 5600 veterans cases that apparently were not reviewed. you have them in the report. i look forward to the determination of why you decided not to review those cases because i fear there are more veterans that have died. >> there was nothing to review if they did not kid in the door. he was reviewing medical records. if they did not get an appointment they did not have records to review. >> said there is no causality and they fail to get in the door and i because we did not deliver care, i would say that is causality interested in it would be misleading. >> we do not know how or why they died, an ordeal. >> mr. o'rourke. >> thank you, mr. chairman. and i will say that mr. griffin

and dr. richard griffin, by that criteria you have described your using to reach your conclusion i understand where you're coming from. i think that it is a rather narrow legalistic interpretation of data. i understand and think you made it very clear. i accept within those constraints would you conclude. common sense tells me from cases i have seen in my district that there is a cause and effect relationship between care that is delayed and is up being care that is denied that affects the veterans that spirit i use the example before with all due respect to the families. they have shared their story with me. it is for a purpose. you know, vic the mego have been trying to get health care and was unable to for entreated ptsd after attending -- after not being able to and attending one of my town halls where veteran

actor veterans set up and said have also not been able to get income he was driving, and is not related the story to me that he was driving home that night. some of these guys are much older than i am and have been trying for years to get in and cannot. i do not know what i have to look forward to. and she cited that lack of hope as one of the main reasons that he then took his life five days after that meeting. we know in this country 22 veteran's day sadly take their own lives, and i have got to think that there's a connection between the way deferred and ultimately denied guarantees very tragic instances of suicide now, do not know if it meets the strict and legal criteria that you are using, but it makes a lot of sense to me to draw that connection and conclusion. i think that is what is causing so many of us to try to hamper the level of access and the quality of care. i do not think that you would disagree with that. conclusions, you make some very bold statements. you talk about a breakdown in

the ethics system within vha, which i take to be a comment on the largest issue that i have seen that we have a problem with, which is not funding and resources a number of doctors but the cultural aspect, the lack of accountability, a premium placed on performance bonuses and not excellence of care, not responsibility, and not on patient outcomes for the veterans that purportedly the vh a serve. look to your recommendations related to ethics on page 74 of your report. they were pretty narrow. i think it recommendations all, but fairly narrow. are there other recommendations i may have messed that more fundamentally address an issue of culture within vha? would love to know what those are and how the secretary -- i will ask him when he is here, how he will respond to the recommendations.

>> mr. griffin. >> the original draft report had four or five recommendations speaking to ethics. they were very narrowly constructed, so they were combined into one global ethics recommendation. the secretary previously was the chief ethics officer at p&g, the chief compliance officer at p&g. i suspect that we are going to see ethics placed at a level where it should be. we did not find that in our review in phoenix when there was a request for an ethical review and not all of the recommendations were found and put forward by the person who submitted them. there was a reorganization of cha which removed the chief

medical ethics officer from the inner circle of the highest tier of management in vha and was relegated to a lower level which removed that person from a seat at the table with the most senior people. i suspect we will see a change in that. and that think what had been ethics just from the medical ethics perspective is something that will be expanded beyond vha to other areas in the apartment. and i had not read every single page in the report. i am currently reading it. i need to, but what i have not seen, and i have read through the ethics section, what i have not seen as specific recommendations on accountability, people losing their jobs. we heard the most egregious instances of dereliction of duty, abuse, fraud, and later learned that those people are still on the job. i cannot argue with anything you

said that the incoming secretary or the new secretary perry had a chance to meet with him yesterday and am looking forward to his lead. i think that we need to institutionalize these changes. you were asked a question earlier by one of my colleagues. anything in that july compromise bill that you think would help change this situation, i think the ability to fire senior executives, get the dead wood and the fraudulent actors out of the way quickly so that we can bring out those who are the best and brightest and have the outcome of the veteran first and foremost in mind is what we really need to do, and i am not seeing that still throughout the system, including in the public system where had the honor of serving veterans. i realize i am out of time and appreciate the chairman for his indulgence. >> thank you, chairman. i will approach this a little differently. dr. john daigh and it dr. samuel

foote and dr. katherine mitchell know what i will be talking about. for those of you who do not know, when you are in training you present cases to staff and they critique your care of the cases. i had a chance to review many of these cases and to draw the conclusion, dr. john daigh, and maybe it is the criteria, it had no affect on the outcome of the patients, that is outrageous. you would have lost both lambs if you try to convince the staff member when i was a staff member. think the question i posed to you in one of these cases, if this were your family member, yours, just like case number 29 that had congestive heart failure, your dad, would you be happy with the explanation you just gave of his death? secondly, would you accept that? my suspicion is no because you know that if your dad had gotten his allergy testing and a defibrillator the outcome may have been different which is why we put these devices and to

prevent sudden cardiac death. case number seven, this one the va just got lucky on. a guy in his mid-60s comes in to see a doctor with chest pain and has nothing down for seven months. i mean, all you can say is, you got lucky because he very well could have died of coronary disease. it was certainly nothing the va did to help them prevent. one of the reasons -- and i can assure you that in most private facilities if this guy had come in the emergency room like this you would have had hypertension mid-60's chest pain, you cannot wave of more red flag than that. what to see it? they control his blood pressure and send them out and are really, really lucky. the case 31, a man with an elevated psa -- i have little sensitivity to that. it is worrisome when you're a

veteran. it looks to me like he just sort of got ignored. would he have died? i think that you can say. what i would like to do is have these criteria are have this looked at by the chief of medicine or some other outside source to see if they draw the same conclusion. i certainly do not draw the same conclusion as you did. you're right. you can't absolutely say that this veteran missing disappointment or whenever. but it is the culture that i see polygamous one appointment, that probably did not cause her death. i doubt that, but the culture, i just don't understand it or you do not follow up, people are dropped through the cracks, ct scans reordered, nobody gives a follow-up. and dr. samuel foote, want to stop, but i want you to comment.

>> my point was before about how the case was somewhat downplayed . what really happened was quite different. he had been waiting 12 months for an appointment with the va when he presented in january with chest pain, having just been several times a week. in the case he was done and the ig referred to it as an abnormality. suggested price of anterior myocardial function. he was given an appointment in october from january only because they spotted it in june. at that point he was having daily chest pain and now had que waves. >> the answer. >> absolutely. and echocardiograms showed that he had 35 percent. fifty is normal. interior wall abnormality. my analysis is he had a heart attack.

in the 12 months while he was waiting he extended that and fortunately we were able to get him bypassed. so the data saved his life that lost 30 percent of his heart function. and they refer to that as a favorable outcome. >> i guess if you don't go to the have committed to of the funeral is a favorable outcome. if it had been me or anyone else sitting at that day as you would not be happy with the care you got. i look at this one veteran at a time and evaluate not as a system but have that one veteran get their care and woody pass mustard that we have to pass in the private sector to get paid by medicare? of course it would not. and i am embarrassed by this. i read a lot of these cases. was embarrassing. dr. mitchell, would you like to comment? >> i would like to go on the record against the entire oic. and you have a patient to is unstable psychiatrically

verbalizing suicidal ideation second case number 39, if you discharge him home he will commit suicide unless something intervenes. in this case nothing did and he committed suicide. the gentleman in case number 40 was demonstrating psychiatrically unstable behavior as an inpatient. a psychiatrist at the option to stop this discharge. if you discharge a psychiatrically unstable patient with a history of hurting himself, a history of suicidal ideation, he will commit suicide. the only question that should be asked is when. this is national suicide prevention month the va has a wonderful program on the power of one which means that one person, when questioned in stop suicide. this settlement should have had the power of one to one being the department of the va. totally inappropriate medical care for a psychiatric patient, and on behalf of every mental provider in the united states i

will say that if you discharge an unstable psychiatric patient who is verbalizing suicidal ideation is he will commit suicide unless something happens to intervene. >> i think the chairman and yield back. >> mr. brown. >> thank you, mr. chairman. mr. griffin, in my 22 years in this committee i have never heard anything that would make me believe that the office of the inspector general has worked with the va to soften the findings, nothing, nothing. but i think it seems to me that people seem to think that because i make an allegation that that is a criminal offense and therefore i should be fired without any due process, can you explain that to me? and i am thinking about the ongoing review cases.

>> right. we received 90 allegations. in the last 12 months we got 34,000 allegations through our hotline. okay? that is why we have investigators and auditors and other conditions, so when we get an allegation, if we have the resources available and it rises to a level where we feel compelled to take it, we go out and do our reviews and nighter conclude, yes, this delegation is correct or, no, it is not. but until such time as we have accomplished that an allegation is an allegation. >> this seems as if everyone seems to think that every veteran is eligible to participate in the va. and that is not accurate. i know the secretary opened it

up to a million additional veterans. can you explain that? in other words, every one that was in the department of defense but not necessarily eligible to participate with the va. now, i know that we have expanded that, but to a large extent it was not. >> dr. john daigh served our country in the army, an army doctor for more than 20 years. he is well versed on coverage available to retirees in addition to veterans to muscle let me ask him to speak to the options are available. >> i am not sure that i can address it factually except to say that you are correct that not all veterans are eligible for care at the va. and generally i believe it is set up to take care of the indigent and those who are

disabled in combat or otherwise. so the inclusion recently of all veterans who return from the war has certainly expanded the eligibility. and then when category aides were allowed to join, people were veterans but not financially disqualified from premium groups, that has significantly increase the number of people. that is about all i know about it right now. we have expanded that area. which i applaud, but in expanding it it created additional problems as far as processing and through the system. i recently spoke to a veterans group of indicated that it was such a horrible experience. what was a horrible experience? when i went for my appointment

of a person's that were done for on the phone and did not stop and take care of me. i understand we downgraded the intake so that veterans when they come and are not necessarily getting the right kinds of experience that could have happened in offices if you do not have a person that is the first contact, not a person at a certain level for the intake. >> yes, ma'am. >> well, i guess i was asking the question, how can we improve the system as far as veterans feeling that the system, once that person got in with the doctor everything was fine. getting that person into the system. >> a couple of things. one, the systems by which to make appointments and consoles, the communications systems are actually quite complex.

in phoenix we saw, for example, that many patients to travel to phoenix part-time have a very difficult time getting care and were blocked out of the primary care group. their access was diminished. i think that you have to look at what you mean by access to care and the system that makes it work, mostly computer systems. and i think that you also have to compare a customer focused, friendly, polite,. [inaudible question] help you, i can't help you too much attitude. so i think all of those issues, part of what i believe the current secretary understands and i believe he will try to work on them. >> thank you and i yield back the balance of my time. >> you are recognized. >> thank you, mr. chairman. mr. griffin, i have questions about the analytical model binder statements. and it goes to what mr. o'rourke

said. it matters not to me if va and lost this report. take you at your word to say that it did not subsequently influence your statements. the ig office has faced charges in my district. believe it or not i your constituents' concerns are complex command complement's the way may be other members did not. what i know is words matter, and so your statement that you cannot conclusively assert that the lack of timely care across the death of veterans certainly is an accurate statement based upon your analytical model. can you also conclusively assert that waitlist did not contribute ? >> no. >> and did you say that in the report? was that reflected in the report cannot conclusively assert and why not. this is important.

all these people who we thought did not get proper care by reading these stories we could understand where their rates were. >> a very powerful statement based on a non analytical model that has not been reflected on the other side. the reason that matters is because for six was we have been investigating the deaths of veterans. we challenge words all the time. the statement he made that you cannot conclusively asserted led to this is a sensitive statement and yet you did not assert that you cannot conclusively asserted didn't. so you can say it did not cause.

would you be willing to say the weightless contributed to deaths ? >> the first 28 -- >> would you be willing to say the willis contributed to the deaths? >> yes. >> you would? >> in fact from the title of the first 28 cases were cases where we thought that patients are harmed because of the waitlist. >> did it contribute to their deaths connected the waitlist contribute to the deaths of a trust? >> yes. no problem with that. the issue is caused. >> of course. >> a direct relationship the difficulty is here. you have no ability to determine the cause of death. at the very beginning, what is the point of the setting. if you're not able to make a determination, then the analysis to suggest that it cannot draw a causation creates a great

question that actually undermines most of what is an airport whereas if you say it contributed to that should be the headline. we talked a lot about that. there were 40 deaths. we can play with semantics all we want. it was a novelist that the wait list contributed to the deaths of veterans. that is an accurate statement correct? >> that's an accurate statement. >> would you agree with that, mr. griffin, that the west attributed to the deaths of veterans? >> in our report a careful reading would show that in some of those cases we say that they might have lived longer. they could have had a better quality of life at the end and so want. >> sir, -- >> is that true or not? >> would you agree that waitlists contributed to the deaths of veterans? it is a yes or no. yes or no. >> yes, college to police and

blacks -- >> their death. we cannot. >> that is not right. >> the oic. a very simple question. did it contribute to the debts of veterans, yes or no? >> it could have. >> okay. that is our answer. >> i don't think he disagreed. >> he answered it very differently. listen, i am going to conclude with this. you know that your offices make criminal referrals related.

and so i appreciate, dr. john daigh, you are at least willing to say that waitlists contributed to the death of veterans because that is not the story that has come out as a result of the ig report. thank you and i yield back. >> thank you very much. >> thank you, mr. chairman. i appreciate you letting me sit in on this committee. i have the opportunity and the joy of actually representing a large area phoenix. and had a number of folks that, shall we say, have been affected by the va in my office who sat down with me over coffee. and this is one of those difficult subjects because for those of us from the accounting rules we want to say is a binary , yes, no? and the discussion we were just having, and the reality, whenever we deal with people,

people, human beings are not necessarily by neri, yes or no. but some of this is tough. i mean a few months ago to sit down and have coffee with the widow and do-it-yourself as a tough guy condo with lots of this. you can't get a lot of your throat. you have not crisis your child. everyone understands the emotional impact. now we were through the mechanics of what does this report really say fifth and what are the fix is? how do we never ever ever have these types of hearings and these sorts of experiences and not ever sit down with the widow? it breaks my heart.

very quickly, when going through the report the word significant is rolled through a number of times, significant causation, a significant factor in the deaths . you do see within the questions both the right and the last year how many times we say significant could have a wide interpretation. is that how you meant to write it? was that the goal? look, there is a wide path year of causation. >> our clinical staff did those reviews. i would ask dr. de to answer your question. >> i am trying to be really fair minded year and not let my emotions drive my question. and my being fair minded? >> i think so. i think first of of it takes a great deal of effort for the people that work for me to write

these stories with no emotion. and so when people read these stories, you do not see the outrage that we feel. so if we start from the universe of patients it is reasonable that they are all harmed by the fact that they did not get care. >> and you sort of nudge up to something i want to touch on, and observation. i was disturbed. i will write you a note of this. the fact you knew that there were 800 articles. ig. fact, fact, fact. promise me that you are not tracking press articles. no, we are up, down. they did not do this nicely. that is our world. it is not, never, ever, ever

should be the auditors world spirit it bothered me that you knew there were 800 some articles. two quick things. tell me what you have learned from the hot line? did not line ever -- did you ever back on a pattern or division or specialty that there was something wrong, something came up the repeatedly that could be mr. griffin. >> let me just respond to the 800 articles very briefly. it took about 60 seconds to determine. >> a share thank you have any curiosity going. >> we were being challenged for the fact that we alluded to it the original allegation. and that is what -- >> and again, you work for ultimately us, the taxpayers, the agency, not the media. the media should never influence the professionalism of what you

do. so you were moving into the microphone? >> would you repeat the question, sir? >> any patterns from the hot line. >> i would say that the pattern that we saw in the cases was not that -- essentially people who were denied care because they -- the hotline cases were usually a little more clear in the bel-air the impact. the timing of not getting care and then being able to see impact was clear on a hot line cases than it was an ally of the cases we looked through were people who were delayed try to determine whether there was an impact. >> mr. chairman -- >> the urology group, the neurology clinic was one area. >> or use of that? >> that pattern. the other pattern was that people had a very difficult time getting in the primary care. if you're already into primary care, phoenix, you had at least

one access to get counsel to move your way through the system. if you were not in the primary care panel then you had a very difficult time navigating the system. i would say those would be to examples. >> forgive me, mr. chairman, thank you for your patience. for all of you i actually have some written questions that i will shoot your way. >> thank you, mr. chairman. i guess the question that comes up -- the chairman brought it up, and it concerns me the most. there is really bad stuff that is happens to our veterans, and they care that was outlined -- i read through those cases that we have here. i don't know, like 40 cases, case summaries. i know they are incomplete, but, you know, just to see how our veterans have suffered subject

to delays in care was most evident from these short excerpts here, but you know, your argument that the delay was causation of death, and i understand that argument. ..

>> >>55 with the changes happening and the forum said playfully a new culture that will happen. we just want to secure that we can rely on it independently of vague coercion or enforcement's. that is the gist of what is this hearing. mr. griffin? >> i do. we don't have a general right now in our office.

it has been vacant since june refers. everybody who votes on the report is a career federal employee. interim report went to a very large changes in thel#kltp)tment including most of the leadership i think the 24 recommendations of this report addressed the issues that were found. and the notion that somehow we would have issued either of these reports that this does not wash with me. >> i missed some of the hearing today.

but the justice for.@cy prosecution? nothing has happened in viet? >> not yet. >> had you heard from the department of justice? >> we have. the assistant attorney general for the criminal division from all u.s. attorneys offices shows the potential charges based of manipulation of records and potential disruption of record sent to every u.s. attorney's office in the country. we are working a partnership with the fbi and the of the knicks investigation and a number of other locations. believe me, we have no desire to see people escape criminal counts. wepj arresteduáemñ 94 v.a.

employees not related to wait times we're not bashful >> so you don't know the time line? >> i think as we complete the investigations, it will be a process. not a date certain all 93 are closed but every week we will make additional progress. >> did you do any referrals? >> i think we had a new case this week. whenever we open the case with criminal potential, the attorney general guidelines require us to notify the fbi and. >> des secretary has been waiting over an hour. i appreciate your indulgence for waiting through the vote.

i have learned a lot. at this hearing today and i had no idea -- batf that o.i.g. would go back and forth with the draft through the v.a. i was under the impression a single draftkf&wñ checked for factual correction said needed to be made. i would ask that you provide the committee copies of the drafts that were done. the fact remains the very first draft there was no inclusion of the statement that caused me concern because it took away the entire focus of all the work that your office designed. so much so it was leaked leaked, just that bar prior to a and it even caused you

to move up the release of the file reports because it exonerated the department. but it didn't. little think anybody here thinks that it did. >> sorry to interrupt the don't believe it exonerated them. >> but here is the question that i still need to ask before we close. in your testimony you gave the impression the committee suggested the appropriate standard to be used is to determine causality of death is to unequivocally prove, i think that was the comment that you made, a delay in care cause death. and in reading the document that you in fact, cited as an exhibit in your testimony that at committee staff member sought specific

information for this committee to prove delays were related to death. tell me is do you believe cause and related mean the exact same thing? >> a stink in the context of this document, those who would like to review it is attachment letter be reads in order to unequivocally prove that these deaths meeting all 40 are related to delays in care, and 17 names but we were in pursuit of the 40. >> you did not finish. there is oversight investigation gave access to computerized patient records

of veteran files or to request from the v.a. >> unequivocally prove. >> for the committee. not you. the committee. >> does the committee have the clinicians to make that determination? >> i don't know. in your testimony you say that we put that burden on you. that burden was not placed on you. we said that about ourselves if we have the clinicians to do that or not is irrelevant. the fact is that you said that we said that and my question is cause it really did mean the same thing? >> i say to unequivocally prove is the extremely high standard. not the standard that dr. daigh people were using. >> we did not ask for that.

>> your memo sent to wes april 9 after the hearing said the order to unequivocally prove that these deaths, all 40 comment that it was declared if there were 40 comment that all 40 related to delays of care. >> meaning of that committee. the unequivocal was not placed on you as a burden it was on us9-. you alluded to that. >> i did. because it was sent from an e-mail from your staff to save your most of the documents that surfaced from the april 9 hearing and this document found 17 names and that allest 40.

>> again. i am sorry but you say we had set a higher standard. we did not set that standard. is that correct? >> the document stands and speaks for itself. >> but you testified to the fact that we said that was the bar for you to me to. it clearly says to unequivocally prove that these deaths are related to delays in care, meaning a the committee bayou took from this that we wereócopñ trying to set a standard that you could not meet. i think dr. daigh said something about a standard that could not be met but again we have communication

issues and i understand that >> i would be pleased to answeter@u the record the other suggestions that came from the committee including one said to us as the ink was dry dock the final report at had we modified the violation of the standards. >> again. i talk specifically about something you included. directive to you to meet a standard you could

>> >> but you could not? then i am through. you could not conclusively

whether these deaths were related to delays in care? that was inserted after the first draft. correct? >> that is correct. we have been down this road. there are multiple draft. july 26 and 1 of our staff as tracking changes on the report you can see indicated if we can not include this you should say so and that is what we got. >> you can conclusively say note death occurred because the delay of care? >> no. we don't know. it is causality that is borne out in the testimony for the record. the witness is not here today the president of the national association of medical examiners. he says we got a right.

people are entitled to their own opinion. >> we appreciate your testimony. you have a job to do and we appreciate that job. we have a job to do as well and thanks to the committee members for your questions. you are now excused.

[inaudible conversations] >> with the next panel we will hear from the honorable secretary for the department of veterans affairs. first of all, we apologize for keeping you waiting for so long he is accompanied by the interim undersecretary

for health that the veterans health administration. your entire statement will be made a part of the hearing record. we'll come to you and the committee and we look forward to working with you in the future and you're recognized for your opening statement. >> i'll look forward to work with you and the rest of the committee to improve the department of veterans affairs for the care our veterans deserve. to members of the committee thinks for this opportunity to discuss these response to the recent v.a. o.i.g. report on phoenix my apologies to all veterans to experienced unacceptable delays it is clear we failed in that respect regard this the report on the knicks cannot conclusively tied to the delays.

to provide timely high quality care that veterans have come to deserve. to be traded just of the people of a final o.i.g. report has been issued we have confirmed all 24 of the recommendations three of them have already been read mediated weirder way to really beating their remaining 21 because we began work with the interim report was issued in may. we have proposed the removal of three senior leaders in phoenix we will re wait -- wait for the department of justice but nationally over 100 ongoing investigation of v.a. facilities by the office at i.g. head office of special counsel and we will receive the results to take appropriate

disciplinary action when the investigation is complete. when we have the evidence. we are thankful for a the recently passed veterans access choice and accountability act of 2014. it streamlines the senior executives the process. it does not make the appeal process guaranteed the decisions are upheld on appeal or to allow them to have directives without evidence or cause. it applies only to senior executives who are less than one-half of 1% of the v.a. employees. we have taken many actions to reprove veterans access to care include putting in place a strong leadership team. good people with proven track records and increase

staffing by to see four-speed recruiting. those on be an official list or the of wait list for its 146,000 appointments in three months. as of september 5th there is only 10 veterans, though waitlist. had paid not refer patients to a non v.a. care. bay made almost 50,000 referrals for non the

>> >> going forward more than

personnel actions to create a culture were all employees understand how they're daily work supports our mission and values and strategies and requires supervisors to provide daily feedback to every subordinate for what is going well to identify what improvements are necessary moving forward on several fronts to discuss the initiatives with the chairman and ranking members and many members here. last week we announced the beginning of the road to veterans day focusing on the next 60 days to rebuild the trust with veterans and the american people to improve service delivery to set the course for long-term excellence. we released of blueprint for excellence and general clancy on my left and a

former undersecretary for health now the chief medical officer at one of the largest medical providers in the country has four broad themes and attend a central strategy is to simultaneously improve the importance that the health care now the transition from sick care to health care and develop transparent and accountable and business management processes. and with timely access to care. as part of that effort to oppose increases for eligible physicians. with more competitive salariesví&ñ here better position to retract and hire more health care providers to tree to the veterans and in a position for those at a high-level.

you will judge the success against a single metric that is veterans' outcomes. we don't want them to meet a standard vat to be recognized as the standard to provide health care and benefits. we could fix the problems that we face and utilize the opportunity to transform the v.a. to better serve veterans. members of the committee thinks for your unwavering support and i look forward to implement the of lot to make things better for all of america's veterans. we are prepared to take your questions. >> thanks for your testimony. i have a number of questions in here that are designed to to rip and punch but i will not do that. this committee is committed to be a full and complete partner with you as you work

towards repairing the damage that has been done to v.a. over a number of years. not just recently but a number of years. what we want to know and you have only been there 50 days. the you have the tools that you need or do you find that you need more? we talked about this last week that we need to help legislatively so you can make that changes necessary to deliver the of benefits to the veterans? >> thank you. we have gone through to look at the legislation that governs our department. we put together some proposals that is currently at the omb and we would like to share those with you

within the next few weeks as we get them back. we have a lot of tools that are disposable - - disposal. it is a great show of bipartisanship for veterans but i think there will be things we could use help with the and we will continue the conversation so we can identify those legislative means. >> you will probably hear from both sides that it appears that nobody has been fired yet. i know the wheels have begun but we are at 110 days and is it that hard in the federal system or v.a. to fire someone who has been caught red handed? >> coming come the private sector running said

$84 billion global company coming issa misperception to think even in the private sector you what can one day you fire someone. that is not sustainable accountability. if you do a good job managing the individual you should have daily feedback that there is a relationship that the action could be taken quickly with due process. but in our case of around 65% of employees are union members and our ability to separate them from their job depends on the specific union contracts we have been our facilities. of the revision and that you all made and it does shorten the appeals time for the

service employees and we welcome that but there is still a process. in phoenix, we have to executive service people that of the proposed action against we give a report every week. yesterday that had 19 separate disciplinary actions and we will work with you to track that to keep you up-to-date as we learn information. we need to get these done and that was pleased to hear they think we can get them done relatively quickly. >> thanks very much mr. chairman. mr. secretary, and thanks for being here today. i am very pleased so far

with your leadership style. not only had you visited with employees at the v.a. that has not been done but to your willingness to reach out not only to members of congress but also the of organizations to get the reports and the insight into how we cam provide better services for veterans. i appreciate that. and there is a turbulent time right now but it is also an opportunity to really change that cultural structure within the department also to think big of the national strategy and where we go with the department of veterans administration. thank you for your willingness to step up to

the plate. let's get that 24 recommendations with the i.g. report how long will it take to complete those? >> we have put that in our report and it is by the end of 2015 budget is over time depending house as to make or how bigl=1x the change. we meet every week to get those three mediations done. i have separately asked the i.g. for all reports i would like to go back to look at the history to understand what we need to do on the things that have not been mediated because my into standing is there is quite a few things. believe me i have run a public company and onto different audit committees i like what the i.g. doesn't

need their help and the work that they do improves thept organization. as i have gone to these sites may have been 21 different operations over my first 50 days. i tell people i want every employee to be a whistle-blower helping us to change the v.a. -- i.g.. welcome the criticismft i even made the mistake about might cellphone number publicly it is in "the washington post" is online and i answered 150 phone calls so far. >> speaking about the whistle-blower that is still a concern talking to some employees on whether or not they are protected. when will the office be

certified on the whistle-blower protection? >> i and and secretary a gibson have demanded from the very beginning that whistleblowers are protected and will have to get back with a specific date. but talk about changing culture that as the leader your behavior is looked at as a demonstration of a new culture. when i cite those 21 different sites i ask to meet for the whistle-blowers and for them to be in the town hall meetings. we cannot do this alone. we have to get every employee in the 10 and working together so veterans benefit to. >> a lot of focus is from

the next bet but of those shortcomings said integrity type of issues. >> as we talked, part of the problem is a silent organization. we have been brought together without any idea to integrate the organization. there were nine different geographical maps that means no decision nobody represents at and a lower level than the secretary. we simply have to get that fixed. that long term effort on the road to veterans day but i want to get to a point where our organization is so simple for the veteran to understand they can plug in any way and we will be

there. whether a smart phone or paper work for world were to we will be there. i want them to think of it as there is everyone to say this is my v.a. and i am proud of it. >> my time is expired. thanks again for your0g leadership and willingness to do this. i am optimistic and hopeful that is our style of that this change will continue in a positive direction. >> and thing q. mr. secretary to be here today. there is a lot of things to talk about that we try to get to the details surrounding the inspector general report that has just come out. you heard the testimony of the inspector general

earlier today that while the waiting list in the next contributed to some or all not caused their death in dave made a difference of contributing and causing the death. but is it misleading for some of those press headlines to have them like node death related to long wait? or another that said no link between death and bettering care delays? >> i am acting as if every shortage of care or a shortage of access to care is important to. someone said think about this one veteran at a time. i am a veteran i do have injuries from my time in the service. my father in law of was a

prisoner of war. he has posttraumatic stress and shot down world war ii. we got him to the v.a. we did not know the problem of my old cold sufferers from agent orange it is very personal so we act every shortage is important and we will fix it with your help. >> but are those headlines accurate? >> i will tell you as if every veteran deserves the care they need and i will provide it. >> would do you think about the fact that someone in the inspector general's office would week to the press - - week to the press before it was released to ther1 public? to you have any concern? >> i don't know anything about that. >> is it a violation of v.a.

ethics to release something before the public release? >> i don't know. >> would you look into this? >> certainly we have have leaks all over the of press. i read about one this morning. the important thing is to create a culture that is open and transparent that works on veterans' issues. every single issue. and every three hours i spent waiting to testify are time i am not in the field of working for the veterans were they are being cared for. >> i hear from veterans of the time they are amazed that no one in phoenix has been fired or the

unacceptable waiting list. >> i said we have proposed two employees in phoenix. >> bid to fetter on paid leave? >> that is the rule of law of you would fight to change that. >> we did. >> you did so with effects the appeal only. >> the two that are on paid leave that is the extent? >> i thank you heard mr. griffin say the fbi and other sources are there right now. and you also have received a report from the every week that says the people we are disciplining yesterday's report has 19 people we will track that weekly and update weekly and make sure we discuss with you whenever you like to discuss about that report. >> now the people are

declined for criminal prosecutions? >> that is mr. griffin. these of the people we administration please feel should be called out and brought to task for what they did which is the important part to change the culture as the i.g. hold people accountable' or they will not change the culture. >> i want you to take action. >> i am doing everything the of thought -- the law allows me. >> we're here to help you. >> but talk about working together with other legislative remedies. >> first of all, welcome and in the future we will have the common courtesy that to

have them waiting. but then when you came back at the veterans day is my birthday but what do you mean the? >> is really about getting those first 90 days as suggested to make as many changes as we can as quickly as we can to improvew service for veterans. we have three strategies. one is rebuilding trust the other of lawrence about what is going wrong. stakeholders, compiling analyst of the changes. but having teenagers but the

organization was not communicating. we need to get employees involved to make the changes they're the closest. but that will form a cheese jake plan and we will improve access. >> that they want you to think of this budget it does not have to be andg they give this is now with improves.

i don't think every complaint is us against them. >> exactly. that is the culture we have to create. i can understand this moment of time those that were retaliated against, are skeptical as to whether i mean what i say or fight can deliver. the only remedy is to get out to demonstrate and put in place a new leadership team which will lead in the culture we believe for the lowest level making the biggest changes. >> highlight their motto. it will improve the situation and we will do what we said to deliver assistance to the veterans you can be proud of.

think you for your service and commitment we have members that would want to talk to you.áq i yield back. >> but to be delayed were keying and testifying. >> said chairman is correct. >> but now to follow-up follow-up, thank you for joining us today. when i did not hear but what level does the v.a. have a collaborative process that it is altered with the recommendation of change i don't know. before my time.

>> but that is what the inspector general had. >> beginning of the classification and. >> bet to see we are on trackq

>> >> but we still hear the stories. >> i have heard from many

whistle-blowers i asked to speak to whistle-blowers to call me on my cell phone. and then i say publicly within the department in 21 different sites i welcome the whistle blowing in people criticizing the operation i love the employees who want to get involved on the reengineering teams to help reengineer the process that they criticize. there is no lack of clarity. i may have missed us site or not talk to a particular person or an activity that arrived before i did but the communications i have done and two videos that one out to every employee, and many letters one of which is the discussion of sustainable accountability with the idea

how do we get daily feedback going? and i have met with leadership four times. >> i wanted you to restate that and there are some between your level that have not got the message. >> tell them to call me. >> you have the people to do that. they ask if this is still but other places think v.a. is doing a poor job to meet the needs of veterans. >> i have worked this is in nevada and. >> and that is the bill. give the veterans choice. it can be implemented.

but in my district veterans go to four different businesses or maybe more than 300 miles. even after the said trial period is over to say we could do a better shot. >> look through the lens of a veteran. we bled to do. if we don't have discipline or capacity thin we should. >> this is not the pasadena distance but getting permission to go. they're willing to do that.

i don't know if you have lived in a rural area. >> give us their name. >> but the folks out there would like that choice. that is being offered by the v.a. >> thinks mr. chairman and mr. secretary. i hope we have a chance to talk again soon. some say like the phoenix v.a. has many layers below the secretary level. how can you be shrewd to tell you the truth and you can count on people getting accurate decoration.

it will require a change of culture. and with those large organizations they know that is the most difficult things to do but with those set first thing was to ask every employee to regents -- to the values of those organizations. whom he and to even talk about their mission iraq out of the values the second thing is to do demonstrate you want an open coaster. but we say how he but most with the ceo on by them but

every single day and dash miss and to the people of that we shed. because we're not but we no longer bird travel with the entourage may be just the issue this is not. remember i am at the bottom of the pyramid. [laughter] >> i sympathize. i wish you could do something about that.

i would appreciate it. >> we talked with ranking member about this in his office. veterans should not be published to have the barrier between dod. the veterans should not be punished for nine different maps of the organization structure. this is what we have to simplify. we have 14 different web sites the required different user names and passwords. i don't know about you but i hate keeping track. you should be able to plug into the v.a. with the easiest way to get your care. that is what we're working on. >> ranking member of the economic opportunity. we had.

and they could show that there is not petty kin is very personal we cannot allow people to. >> because the it the word to use steadied tomb have more medical professionals. >> dell was talking to the dean. >> that wasn't in the university of san diego it is critical to have those deck -- taxersri+2.

but this is the broader community. it will help the rural areas as well as others. >> it is very important as we talked with the congress will amend the a day to develop a new school at the un no paid to work forever

by to offer that is something to partner with you. >> thank you. >> dr.? >> thank you chairman. first of all, mr. secretary thinks for taking the job. thinks for your service. >> ice said during then every time he asks florida the day you flow of that charge. >> for how anybody jumps of a perfectly good airplane.

[laughter] wide you do that? one of the things i asked the secretary is deal having enough money to carry out your mission? >> >> that is a question for the budgets that we provide the resources the american people want the veterans taken care of. i know to work with him on the residencies slots i would like to personally offer you to visit my v.a.. it is one of five medical schools on the v.a. campus so our medical students actually go to the v.a. campus every day for their

education and also the public hospital. it is a very good model may be as we look at these shortages and doctors are a creature of habit it is a great way to get doctors to state to make a career as dr. foote did as the career v.a. dr. i built have questions other than take you for taking the job. you have a background. he will be a great secretary. >> thank you. 70 percent of doctors have worked through the tea to solve that are those and we

all benefit. >> i will selflessly promote >> it is one of the five but his challenge for us to seek demographically moving to the rural areas more than their urban areas. this situation is only exacerbated. we need to get ahold of it. >> 10% of my district is veterans. >> click get that primary-care school definitely on the list. i just want to thank you for your additional residence

because we recognize the private sector with recruiting and hiring. >> long term it is a great matt said. >> then it will provide benefits floor in the v.a. >> mr. chairman, thinks mr. secretary for being here and i enjoyed my meeting with you last week and i appreciate it very much. i told them. i have not met with nine and her sense ofeo urgency is to make veterans first put one

of those issues that were with right now is says hiram and getting no information from that point will -- v.a. as you set out a plan for change within the v.a. that we will all collectively as members of this committee at the bottom of the of organization and the veterans, we can all collectively agree on the direction of the of organization. . .

and from talking to the chairman, the communications has been the challenge for us. and, frankly, some of the communications that come to my desk i have rewritten myself because i'm not happy with our ownership of the