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 office.

the chairman and i talked about trying to re-organize communications. this week, we got rob neighbors to agree to come over to va, and he is going to be our leader of communications. so, under rob we're going to have a congressional communications, communications with the vsos, external and internal communication. i want it integrated so we're saying the same message. that's not in an attempt to centralize. we talked about decentralizing so you can go to the subject matter expert and get the answer and it doesn't necessarily immediate to be cleared with one tip of the funnel. i think what has happened in the past is the organization has done that, they've made everything go through one person, and when you do that, it obviously backs things up. and everybody should be capable enough to be able to answer, and

i could ask your indulgence, you have to realize if you got a wrong answer, it may be temporary or may be incommence, but the person -- incompetence but the person is not trying to deceive you. we'll try clear mischunks. >> i'm a strong believer in data-driven decisionmaking itch think the data is extremely, extremely important. i would -- the two cents would be in terms of the dat presented to you, is trust but verify. i don't think i have, necessarily, the confidence that the data that has been presented to us i don't have the confidence there, in some ways want to just clean the table and start all over again in terms of data collection. i know there's some good datas that there is also, but -- >> the point is they're getting the right values and the right mission in place, and making sure people look at

everythingstep two is getting the right leaders in place, and we're in the process of doing that. step three is getting the right culture in place, and then the right strategies. right now we have a group of strategies that, frankly, no one is working against. there's in a desk drawer somewhere. my test is, can i go to the lowest level employee, or in my case the highest level employee, and do they know how their work every day is tying back to caring for veterans? if they don't, stop the work. i had somebody bring to me a binder full of information the other day. i said, what's this for? and one binder was a series of reports. i said i've already seen this information. let's stop doing it. and so that got rid of a whole bunch of work. another binder was testimony i gave at the senate hearing. why do i need to see my own testimony? let's stop doing that. so we have to stop a bunch of things, and then redeploy all of that effort against caring for veterans. >> thank you. my time has expired, but thank you, and i look forward to working with you, and i yield

back. >> thank you,. >> thank you, mr. chairman. mr. secretary, it's a pleasure to be with you today, and i do thank you publicly for taking on this task. i benefit from living in the city of cincinnati, where procter & gamble is located and all the great things you brought to our community has benefited with so many people. as you take on this job there's so many things to consider. it's a mondemental task but not one you're unfamiliar with and why so many of us for a while have been talking about needing an outside influence, someone from private sector, because we're talking about acquisitions, costs versus productivity, changing a culture, assuring quality and care as well as access to care, all these things that go into being successful. i think if there's anyone that can create a brand, it's someone who has been at procter & gamble, and you build trust with

that, and that's the key. so, if you can build trust in the va brand in the same way you have done tide, i think we'll be in good shape, and i appreciate your openness and the able to work with you every day. thank you. >> i look forward working with you. i appreciate the fact of the commitment of all the members of this committee, which really means a lot to all of us at the va. >> mr. titus. >> thank you, mr. chairman. mr. secretary, thank you for being here. there's a lot of enthusiasm when you were appointed, and i think anybody who has heard you testify today will certainly have that feeling reinforced and erase any doubts you're the man for the job. so we appreciate it. thank you for coming by to see me. it meant a lot you had already taken time to visit nevada, both our service center in reno that has had so many problems, and the new hospital. shows you're really personally

vested in that, and we appreciate it. it's been nice to hear my kole degrees talk about our -- colleagues talk about our boil create more residence yes in hospitals, and we want to be shower they you dent go to big hospitals but good to the places where they are needed. i know, mr. bato works on there, and there are areas that are underserve and that was the real accident. so we want to be sure they do that. also, we're very supportive of your notion of re-organizing, not just middle management but also the geographic regions because las vegas is in several different areas that don't really make much sense. and finally, maybe you can share with the committee, and for the record, some of the things you told me about the new emphasis on women veterans. they're our silent veterans. they have had serious problems,

one in four hospitals doesn't have a gynecologist. i know that's a new priority of yours, which i'm very supportive of and want to work with you on. maybe put on the record some of the things you're doing there. >> yes, ma'am. thank you very much. we look forward to working with you. i noe know that apportioning the residencies is important. we'll work with you on that. we have to go to where the puck is going to go rather than where it's been so we have to get after that and we'll work with you on that so we're making the decision together. relative to women veterans, this is critically important. right now we have 11% of veterans are women, but the percentage in the army -- in the armed forces is much, much higher, so obviously it's going to increase over time. many of our facilities were built in the 1950s when we were a virtually single gender army, and so when you think about the kinds of equipment we have, when you think about the kind of doctors we have, you're

right, we need to hire more ob/gyns. we have to get ahead of this because it's quickly becoming an issue for us already. one of the things that we have also done is many people see the mission of va as articulated in abraham lincoln's second inaugural address where he said, for him who have born the battle, his widow and his orphan. and we changed that you. look at our mission, in our 90-day plan, we say better serve and care for those who have born the battle for their families and survivors. while that seems like modest change in words, it's meant a lot to our female veterans to know we're looking out for them and thinking about them, and we have to get ahead of the things we need to do so that we're able to meet the capacity, maybe dr. clancy can talk more before the this. this is of particular -- area of

interest to her. >> i would agree with everything the secretary just said, and it is a very high priority for us. it has changed a lot in recent years. we're not going to slow down until every single facility has got a top-notch women's health coordinator. all of our health coordinators across the system dot reinforcement of the training to get to make sure we're meeting those needs and it will remain a high priority. so thank you for thundershower unioned support. we can see where the numbers are going, as the sect just noted. >> mr. jolly. >> thank you, mr. chairman. mr. secretary. welcome. we haven't had an opportunity to meet. i echo my colleagues' meshes. thank you for serve. >> i look forward to getting together with you soon. >> my predecessor was here for 43 years, and one of your predecessor's said, please don't take this job, you can never change the va. i know the challenge you face.

i appreciate your comments today. i want to express a little with of concern and give you an opportunity to revisit your exchange with my colleague, when he asked about whether you believed that wait list contributed to the deathed of veterans. i understand that's a hard question for you ask, but if we're talking about changing the culture, it's a very important one. you have spoken of a lot of organizational changes, but as you step in to this role, do you believe that the negligence of the va has contributed to the deaths of veterans over the past several years? >> again, think it's very simple. there are veterans who haven't had access. there are veterans who haven't gotten proper care itch don't need to go any further than that. that says they're a problem. that says i got to get it done. -- >> i mean this very respectfully. i got a little heated in the last exchange and shouldn't have. what -- >> what value there is in having this discussion?

>> that speaks the cultural change of the department. i understand the administrative changes and the organizational changes and it's needed. deputy, gibson, when he was acting, that and apologized to the congress and the american people for the failures of the department and what it led to for veterans. you got an exchange with mr. lambborn just did now as well that doesn't show an acknowledgement. to me that's not a cultural change. that's going backwards. i understand nobody wants this on their fingertips. you weren't there. i get that. but in terms of the culture you bring to the top leadership post at the va, do you believe with conviction that the wait list problem contributed to the deaths of veterans or do you not. >> sir in my opening statement, said i apologize on behalf of myself and the veterans administration, veterans affairs department. i have said that in every testimony i've given. i've said that when i've gone out to town hall meetings, when

i talked to veterans. i own this. it's not because i wasn't there. i own this. i wouldn't have taken this job if i thought that somehow i could not own this. i own this, and i'm committing to you i'm going to fix it. i don't know that you can ask for a bigger commitment than that. >> well, i mean, it's a very simple question. i'm just asking you to acknowledge that wait list and the negligence of the va contributed to the deaths of veterans we have had hearings on for six months. that's all. >> i'm acknowledging, i'm acknowledging, that i own it, that they didn't get the proper care, and that we need to improve. >> okay. well -- >> and that not getting proper care has adverse>b effects. >> i very respectfully will take that as an answer. don't think it's a complete answer. don't think it's an acknowledgment of a cultural change that you continue to espouse, but i understand what are why you need to guard your words carefully in a public hearing and in front of the press, and hopefully privately you would acknowledge the

negligence at the va led to deathed of veterans. >> let again say i own this problem, and one of the thing mistac west point classmate i thought did so will, a great leader, he opened it and is helping authorization own and i am, too. we have to own it. if we don't, we can't change. >> i appreciate that. i look forward to working with you. thank you for serving. i appreciate it. >> mr. kirkpatrick. >> thank you, mr. chairman. mr. secretary, first of all, thank you for taking the job, and then thank you for visiting the phoenix facilities a your first stop after you were confirmed. that really gave a message to our veterans in arizona, that you care and you're paying attention. i want to focus on conditionability, because our committee has heard from people who say, they're getting excellent care at the va, and that the employees at the va care about veterans, many of them are veterans.

but i'm sure that you're familiar with the business motto, if you will, that an organization is only as good as its weakest link. and we know that there are weak links in the va. i just want to get your thoughts about how you ensure that there's continuing accountability, and i just want to tell you some of the ideas that we have heard, and then if you could comment on them. one is rolling audits, review bay neutral party, mr. micheaux has an idea about setting up a blue ribbon committee that would develop a strategy for the va. i have a veteran in flagstaff who talks to me frequently about the idea of a volunteer board of veterans, who really don't have sort of the sounding board and a way to solve this. i have introduced my whistleblower protection act,

which includes an anonymous hotline for patients and employees to report things. would you just give us your thoughts about that. >> well, i think accountability is a huge issue. and it's got to be a big part of the cultural change. one over things we have done is talk a lot about it. talk about this concept that i messenger inside my prepared remarks, sustainable accountability. it's not just about firing people. it's about giving day-to-day feedback mitchell -- my standard is an individual would never need to be fired unless it was regime yous activity because you're providing day-to-day feedback. shoot be the standard. relative to external groups, we -- deputy sac gibson, when he was interim secretary, hired jonathan pearlland to join news developing the blueprint for

excellence for the hospital network. that was an attempt to bring outside benchmarking into va. we're very much in favor of that. the new bill provides for a commission which we will help stand up. there also is -- i'm to rejuvenate some of the 23 different standing committees we have which are supposed to help the secretary. there are 23 of them. one could argue maybe that's too many. but there are 23 of them. they're supposed to be helping the secretary. i want to reenergy those and get the right people on them. one of them, dr. clancy and i are in+t the process of hiring w doctors and nurses and clinicianses to help us to join that. so, we want to do exactly what you're saying, but the most important thing for me is we have to get every single employee in the organization to feel accountable nor outcomes of the veteran. rather than worrying about the internal workings of va. >> let me just mention one over to the more troubling things our

committee heard and that is bonuses and that people who perform poorly still get their bonus and there's this sense of a bonus is an entitlement to the employees. what is your plan to address that? can you give us your idea about that problem, and what is the -- a good use of bonuses. >> first of all, deputy secretary gibson, when he was interim secretary, took the immediate step of rescinding the bonusesbb for 2014. second of all, he took the 14-day metric out of people's performance plans, because that was helping to cause people to behave in the wrong way, based on outcome for veterans. third thing is i've gone back and i've reviewed what can we do about bonuses? in private sector there's something called a claw-back providing, so that if an individual receives a bonus and you later discover, because we have 100 investigations going

on -- you can claw back past bonuses in order to do that. many audit commitees, chive served on, have put rules in place to do that. the government right now, there's not a potential for clawback because apparently when the law was written, the law was wherein in such a way that when the political parties changed, you didn't want to allow in the new political party to claw back from the past political party. i've got to get into this in more detail but that's the way i understand it right now. but that's the practice in the private sector. >> thank you, mr. secretary. we look forward to working with you. >> look forward to it, too. >> mr. secretary, there's been a fill filed, hr5094 and allows you to do just that, should we be allowed to pass that through the house and senate. mr. o'rourke. you're recognized. >> thank you, mr. chairman. mr. secretary, i want to join my colleagues in thanking you for your service and taking on this very difficult but not

impossible task of bringing the va back up to writ should be. i want to thank you for meeting with me and just from that meeting, and some of the issues we discussed and your followup to those items, including anid e-mail today from dr. clancy, i think that speaks very well of your ownership of these issues, your attitude of accountability, and some of things we'll have to look forward to on the bigger issues confronting the va. i also appreciate your commitment in our meeting to ensure that el paso, which is currently, would argue, one of the worst if not the worst, operations in the va, becomes the model. i think you have no greater opportunity to demonstrate straight turn around than in el paso. i want to make a large point about the system and get your response. following what we learned about el paso, despite our assurances from the va to the contrary, that we were seeing people within 14 days, learned that

fully a third of veterans couldn't get in to a mental health care appointment. the average wait time was 71 days. the average appointment was cancelled at least once on average or rescheduled at least once. when we had the vha audit in the spring, we learn we were the worst for established many health care appointments, worst in terms of being able to see a doctor or provider. fourth worst for new patients, second worse for specialty, on and on. so we that that attention and focus. va committed $5.2 million in additional funds. the acting secretary, sloan gibson, visited the virginia. we had our chairman, chairman miller, visit the va in el paso. we had mr. -- visit the va. we had primary care teams, mental healthcare teams you send there, and yet when i win there two weeks ago and i ongo by just to talk to"? veterans and see hw things are going.

met a number number of people, got excellent care, and a number of people who had complication or issues. one was very glaring, gentleman who said, i was given an appointment today, and that was months back i scheduled it. i called yesterday to confirm my appointment with dr. b -- a mental healthcare provider. they said, yes, we have you there to see dr. b at 1:00 this morning. the gentleman shows up -- i don't know how hard it was for him to travel there but the gets to the va, shows up 00 for his 1:00 to be informed that dr. b no longer works at the va and hasn't for a month. thought with all the attention i have been bringing to this issue this for us to fail this veteran that badly is indicative of some deeper, larger issue, and i think of the 20ig reports since 2005 that we have had about schedule problems within the va,

that all of, congress and administration, have known about, and yet we haven't resolved those issues. tell me, to mr. jolly and others, who brought up this point, answer that concern that we have about culture. as we did in el paso, we can throw money and attention it's it, personnel and flexibility in how you fire and hire people. there's a deeper cultural issue how will you address that in a minute and a half. >> s assad, cultural change is very difficult to achieve. but it starts with the mission and the values. and i would wonder in an organization, have they really committed themselves to the mission and values if an individual can be signed if for an april opinionment with a doctor that doesn't:d exist. frankly, in a situation like this, let us know, we'll go back and check and get back to you find out what happened in the specific instance. any specific an neck dolts -- anecdotes you can provide

because it allows to us see what went wrong and fix it. it also starts with behavior. i have to get to el paso. third i think there's a big issue in the openness or lack of openness in this organization. i mean, how could you have a situation where employees were lying to one most honorable men i've ever known in my life, in general shinseki. why would that exist? why would that happen? why were we having -- have meetings where union leadership was not involved or weren't invited. why have people feeling their only recourse is to be a whistleblower. that's why i demanded town hall meetings and some feedba3)z got was, we can't hold a town hall meetingment it will be counterproductive. that's exactly why we have to do

them. we have open the culture up and get communication move and have ownership have people feeling responsible. the end the only thing that matters this veteran. this is going to take time but we'll build it into our strategies. an organization start wiz mission and value and we're underway there. we got to look at our leadership and see do we have the leadership create the new culture. if the leader is i unwilling to embrace the culture, they shouldn't go on the journey with us. do we have the right strategies in place to make this happen across, and we're taking a look at that. do at the have the right system? place? and then the last do we have the right high performance culture where people flow to the work and people work on veterans issues. it's going to take time. it's going to take time. but i really do believe we can do it.

>> as i yield back to the chair let me just offer my assistance if you are missing legislative authority to do any of the things you're talking about doing to turn around and improve the culture at the va, i hope you'll comp to us as quickly as you know that. we will be your partner in offering the legislation and getting it passed. >> thank you very much. >> thank you. >> thank you, chairman, and thank you, mr. secretary, again, for assuming this sacred frustrate awesome responsibility.3@ -- sacred trust and awesome responsibility. restoring the trust is one of the first things, and i also want to say you scored big points with my chief of staff who is a minnesota hockey player, with your reference, as a football coach i talk about pursuit angles but it's the same thing, where do we anticipate. i applaud other members for -- i've been saying for a long time i never understood as a military person myself why there was no equivalent of the defense review. second hagel has that --

secretary hagel has that. i looked at the 1997 one under then-secretary coen, here safer than during the cold war but threats are more likely to happen and they anticipated where the threats would come from once the european threat was gone. that allowed to us start tailoring the force. the va did not do that. and here we are trying to figure out we're going to add a whole bunch of veterans from iraq and afghanistan. so i encourage you, whatever that form looks like, mr. michaud and other ares are doing this, this would help give you that guiding document and it would force us to go back on a periodic basis to get that done. i encourage you to do that. then i say you're at a unique perspective. let's think big. let's break through the

barriers. let's crush this thing, and it is going to be hard to change culture. i would say, if not you, who? if not us, who, then? is this ever going to happen. if the country believes this is important, is a know they do. if a awful us in this room think it's important, let's get there. i'd be bed to hear you thoughts. we have to break down there is false construct of government versus the private sector. we work together best. if the private sector can deliver and we can work in conjunction, quit that argument that is it a dead end, us versus them. how do we speed collaboration? i represent the mayo clinic, great medical institution but in a rural area that has roots in combat medicine. how can you bring your experience from p & g to bridge that and break down this ridiculous us versus them argument on the care of our veterans? >> well, we're going to embrace it in our strategies.

we believe we can't do this by ourselves and that we have to partner. we have to partner with medical schools, as we have already talked. we have to partner in the private sector. we have to partner with members of congress, and so the important thing for us will be to figure out everybody's role, and to create a system which takes advantage of that. give you an example. i was in las vegas in -- congresswoman titus' district, and we're very close to nellis air force base, and the doctors there can't keep up their medical proficiency without seeing va patients. they don't get broad enough piece of work doing only flight physicals for pilots al nellis. so it's great. we have the dod doctors come over to the va. they serve our client -- clientele. the doctors love andxd it we le it. so one thing i did was to get a map of all the federal

facilities in the country. now most of the private facilities because we had a healthcare business at procter & gamble. and to toe figure out what's the right combination, if we don't have the ob/gyns we can borrow them from someone else, where -- or developed indian health services is another example in rural areas. indian health services have some terrific facilities. these are the things we want to do and our strategic work is to figure out the right combination of these things and then we'll be local. the details will be in each locale, trying to figure out the right combination because it will probably be different. >> i would echo mr. o'rourke, whatever the thing -- some of these things are rick and deep and tough. i understand that. but let us i want to give an example now colleagues where i, too have been frustrated with the flow of information but i recognize the incredible work that gets done at times. if this is a glimmer of the

potential, last week in minneapolis, we -- whistleblower press was reporting a story. we were in contact with them. this happened on faze nighty& ad by monday there were people on the ground attempting to address on this there was real sense of collaboration with both the public, the veterans, the member of congress, all of us working together, where was the gap, how do we fix it? so i'd have to say i'm seeing that and i very much appreciate that i was seen as a partner, trying to fix it, as was the press, as was the whistleblower is in case, and we'll see what goes forward. i'm with you, mr. secretary. can he are we can't be afraid to point out our failings. we cannot be afraid to continue to move forward. >> no, sir. if any member of the committee senses they're being treated as an adversary, i'd like know that. we need partner with you make these changes. >> i appreciate it. i yield back. thank you, mr. chairman. >> thank you very much, mr. secretary, for being here. we are very appreciative, as has

been said over and over again, you would be willing to stand in the gap for those who need leadership, and again we would reiterate that it our desire to stand with you as a full partner in serving those who have worn the uniform of this country. mr. michaud, do you have a closing statement? >> i want to thank mr. sac for coming here and i agree with everything that chairman miller just said. so thank you very much for your service. look forward to strong partnership. >> thank you. i look forward to working with yaw all and i know every person in va does as well. >> thank you, mr. secretary. >> robert mcdonald has directed all facilities hold town hall meetings by the end of september to improve communication with veterans nationwide. on friday, we covered the town hall meeting at the phoenix va medical center. that will be available on our

networks and our web site later this week. b. >> now, chiefs of staff nor veterans health administration and phoenix va answer questions about changes the ig report, whistleblower retaliation and manipulation of data. this is an hour. >> thank you very much. as the third and final panel comes to the witness table and we're setting up the name plates. i'll tell you who we're going to hear from. dr. lisa thomas, have to of staff to the veterans health administration.

dr. thomas accompanied by dr. darren deering, chief of fax of the phoenix va healthcare system. if you would, i'd ask you to stand. i was going to try to catch you before you sat down. raise you right hand. due you solemnly swear under penalty of personalry the testimony your about to provide this truth, the whole truth, and not but the truth? thank you. let the record show that both wilts respond ned the affirmative. secretary mcdonald has already provided an openings statement. on behalf of the department of veterans affairs. so, we will move directly into a round of questions.

>> dr. thomas, in march 2013 the oni committee reviewed@7rq wait time and healthcare delays in august a, georgia, columbia south carolina, and dallas, texas. two months later, may, the va waived the fy2013 annual requirement for facility director to certify compliance with va policy. further reducing accountable over wait time. data, and scheduling practices. are you familiar with that? >> yes, sir, i am. >> did you approve or recommend the waiver of the requirement? >> no, i did not. >> so, you knew the waiver was given. >> after the fact. >> after the fact. and what action did you take after the fact? recognizing there was a real problem. >> in the spring of this year, is when we realized we really

missed the boatcm in the vha, tt the situations regarding delays in care were more of a systemic issue rather than looking at each case individually. and in the spring of this year, when we went back and researched it, the memo you reference that would issued in 2010 was prior to my tenure as the chief of staff, so i went back and looked at that. it was an immediate -- it was hard not to real a's we had this memo, talking about our scheduling problems and the gaming of the system, and we looked at that and in relationship to automatic ol' of the other issues -- all of the issues in the country and realized, albeit to late, we had a systemic issue. we should have taken a whole listic approach rather than looking at each incident in isolation.

>> who got the original inspectionor general report on phoenix and we have the one that va released. i assume you're aware that there was a crucial change in language made in the executive summary that said that the fission whose allegations this committee had carefully verified could not tell the inspectionor general the 40 names of the veterans who had died. i think this gave a false impression right up front that the whole matter was untrue. so, my question to you is, did you have any idea that language like this was going to be inserted in the ig's report? >> no, i did not.oa >> your.

>> according to your fiscal year 2013 performance review, -- by the way, 500 out of 500. is what you received on your review. perfect. one of your responsibilities as veteran halve administration chief of staff is being able to identify critical oig reports that could produce negative media attention, and ensure talking points and communication plans are developed before the final report was released to increase the department's responsiveness. so, could you give the committee a little idea as to how that works? >> absolutely. first i'd like to say we sincerely apologize to all the veterans. no veteran should have to wait for care, and it's unacceptable to us. we did get the ig report and

several drafts, and each draft stage of getting a draft it was our responsibility to make sure we were putting together an accurate communication plan so that we can then communicate to all of our stakeholders what the ig found, and more importantly, what we were going to do to fix this. we focused on more of the edits and looking at what we're going to do in the actual plan and the actual recordment we have management review service and they're responsible for looking at that and making sure all the correct subject matter experts look at that3i report and if there's anything factually they think needs to be correct, they provide that information. and what we also do is making sure that all the subject matter experts come together to identify what is the corrective action that it needed so we can immediate the needs of veterans. the communications folks that toronto me were doing that every iteration, and so each iteration of the report we were trying to highlight for them what was the difference from the last report

to the next report. so they could accurately and very efficiently get a communication plan together. one of those changes was change from 28 recommendations to 24. the consolidation of a number of the individual recommendations regarding ethics were rolled into one. highlighting those for them makes its easier for them to be more responsive to have a document that is pulled together so we can communicate to all of our veterans, the public, and the stakeholders, exactly what was and what we're going to do to fix it. >> want to ask you to pause right there members, we need to move to the floor. we have less than five minutes to get to the vote. we'll be back as soon as we can. [inaudible conversations]

[inaudible conversations] >> committee will resumetç its hearing. again, we apologize to the witnesses. that will be our final interruption. of the day. dr. deering, thank you for attending. i would like to know if you reached tout any of the whistle-blowers about resolve aring their cases, and if so, how many have you work with? >> i have not personally reached out to the whistle-blowers at the phoenix va about their specific cases. >> would that be something that ordinarily would do or somebody else do that? >> i believe someone else is working with them on their cases. >> in a normal course -- i mean, i understand that phoenix is somewhat of an anomaly.

normally would you be the one that would reach out to whistle-blowers? >> ly. i've had other employee who have brought up concerns wind the organization, and i work with them closely to address those. i had an employee just about two weeks ago sent me a message on my personal cell phone saying she had concerns she would like to discuss. she didn't feel safe talking about them at work, and i met her off campus to discuss the issues. >> has anybody prevented you from talking with whistle blowers or advised you not to talk to them. >> no, i'm not been advised not. >> of the 293 deaths that were identified by the office of inspector general, how many required institutional disclosures? >> i don't have that information because i have not reviewed those 293 cases specifically. i'd have to cross those to see how much would requirelç institutional disclosures. we're in the process of review thing 45 cases outlined in the

inspector general's report to see which of those would require institutional dischose sure. >> you're the chief of staff of minneapolis healthcare system and you don't know if there were sin stational disclosures -- institutional disclosures. >> i have not been provided the specific names open 239 veterans. i hack obtain the name skis don't know if those happen to be on the same list. >> let's go this way. how many institutional disclosures have been made in phoenix in the last two years? >> in the last two years, i can get that pick number but it's around six or seven institutional disclosures have been conducted. >> the number again? >> somewhere around six or seven. >> did you order oig report case number 7 schedule an appointment with primary care consult to be

removed from his chart? >> can you repeat that question for me? i'm sorry. >> report case number 7, which is in the oig report, there was a schedule and aain't aye opinionment with primary care but was removed from a chart. my question is, did you remove this from his chart or, if you didn't, who did? >> i do not recall instructing anyone to remove a consult from someone's chart. but specifically the case number 7, i don't have that patient's demographics. i have to go back and look at  that and get back to you. >> who at phoenix can remove those kind of records or can wipe a chart clean? >> consults typically aren't removed. they're discontinued or cancelled or completed. even if they're discontinued or cancelled they would still stay in the veteran's chart and show

they were -- >> it was a primary care appointment taken off of number 7's chart. so, again, i'm just trying to get to the bottom and find out exactly what happened. dr. -- report health in and patient safety issues to leadership and was fired. i'm sure you're aware of his firing. and i guess was fired by miss hellman. did she ask or require you to do a board on the doctor? >> specifically regarding -- lutam, i don't recall him bringing patient safety concern to my attention. regard his>f(bkt termination, a summary review board was convened to look at his case specifically and make a recommendation to the medical center director. >> but you did conduct the board

on him. >> i did not conduct a board. i convened a board and it was >> can i ask you -- it's a personal question but it's simple. after all that's happened at the phoenix va medical facility, how is it you're still employed there? >> sir, i think that's a fair question. if i may, i grew up in the va. my father, who was a veteran and passed away in october, received all of his care through the va healthcare system, and i have memories from being a child growing in waiting rooms where we would often show up and wait all day for an appointment and often be turned away at the end of the day not being seen. i came to work at the va after

training there as a medical student, intern resident. dr. foote was my attending when i was a resident. i am committed to this mission. i worked one year in the private sector and i ran back to the va when i had the opportunity. i have committed my career and personal life to trying item proffer the va. the phoenix va certainly is not perfect, and i've said that before. i don't think any healthcare system is perfect. we certainly have made mistakes. we're learning from them and rear moving forward. a good example is after the interim report came out from the inspector general, i helped lead the initiative to get all the patients on unofficial lists in for care, contact them and get them in a short duration of time. i'm very committed to this commission the cause and have spent a large part of my life, as a killed gripping or trainee or student or as a provider in the -- as a child or trainee or student as a provider in the system.

i brief in this system -- i believe in this system. >> mr. michaud. >> thank you. mr. were you aware of the report in january of 2012 and may 2013 that found that the phoenix healthcare system was using unauthorized scheduling practices and not complying with vhas scheduling policies? >> i was not aware of the report until it was cited in the media. then we asked for a copy of it. >> is it your job to ensure that phoenix comply with the vhas policies? >> i think it's all of our job in central office to make sure we have a system that has policies in place that the field can understand, so they can implement, and we do need to improve our oversight to ensure the field is following policy. that's one of the things that both dr. clancy and the secretary are looking to change as part of the change in the culture, to make sure we have

the appropriate oversight in central office and the auditing function to make sure things happen the way they're owes supposed to do. >> can you complain what your job is. >> i conclude. as the chief of staff the best explanation is i'm really a service a function as an adviser to the undersecretary, but i'm really like acknowledge air traffic controller. don't fly planes. responsible for making sure the plane attacked or lands. i'm there to make sure all the planes are flying on time, going in the right direction, which is set by the vision of the secretary and the undersecretary for health. so i need have a broad understanding of everything that's going on wind vha. unfortunate that mind mime knock a subject matter expert. i cannot know -- >> you're looking at the planes as they take off and land properly, since phoenix, arizona, was not complying with vha policy, not complying with

it, set a path for them to follow, they did not follow it. so who is responsible at v ah a? the undersecretary or your job as chief of staff or is your job as chief of staff to be a -- to make sure the sect understands what is going on in the office? >> i thick it's all of our responsibility in central office. if i could, sir, if you would allow me, when the first panel was here you asked a very important question and you said, really, what we need to know is what happened, why did it happen, and how do we move forward and how do we hold accountantable. what happened is we have an overly scheduling system. we have an undo focus on performance metrics and they're related to the wait, 14-day wait

time me metric has been removed. we have capacity issues, and the choice act which was recently passed is going to help us do that. we are going to hire 9600 clinicians -- >> okay. i guess the big concern i have, yes, we have to find out what happened, and how to solve the problem. i if you were part of the problem in the undersecretary's office that knew that phoenix, arizona, and other facilities were not complying with policies that were set by the department, i guess it is your responsibility, and that's a big concern i have and other committee members have, is if you have been part of the problem, how aim going to feel comfortable you're not going to still be part of the problem? >> sir, unfuneral, we did not know -- unfortunately we did noted flow of the problem inside phoenix until the spring, and we did not know of the previous reports that the network had commissioned, and saw they had a problem, and i'm not sure where

that system broke down, why we didn't know. but i do know that with the change in culture that the secretary has set forth for us, we are going remedy that issue. >> did you see a problem with the understand secretary and sect shinseki as far as not moving no the same direct or was there undercutting occurring between they? >> i was very rarely in the same meetings as the two gentlemen. i only knew what heard the secretary say in meetings i was in and what the undersecretary would say when he would come back from meeting with the secretary. i was not privy to the permanent conversations. >> my last question, moving forward, is, is there -- as a vha chief of staff, what have you done to make sure that scheduling problem does not continue to occur? >> we have two very major

initiatives we have taken on. the first is the access audit which you have been briefed on. that was very important for us to understand if that's was isolated instances around the country or if we had a more systemmish issue, and sadly we know today it was more systemic. so we then launched into the accelerating access to care so we quiet -- anyone who was waiting more than 30 days, we contacted and reached out to every single one of them and overfeared the tome come in for care earl 'er or refer them to the community for care. for those who we no contact we made three attempts by phone, sent a all right and also working with partners to try to see if we can locate those veterans. so we're take those extra steps to make sure we can identify who they are so we can bring them in for the needed care. >> the last question, i know i'm over time, mr. chairman. do think of that there's too

much aton autonomy back at the business level and that's part of the problem as far as following the directive from the secretary or undersecretary of health. >> any personal pin is we are not well standardized. people talk about centralization, that's the wrong conversation. i think we need to have standardized system of health care that we can consistently provide quality health care to all of the veterans, whether they're in the large cities or the in the rural areas. >> thank you. thank you, mr. chairman. >> thank you, mr. chairman. now on committee but trying to understand and what is being reported in the numbers can be very difficult at times. i will note there's at least 41 individuals that you did not reach on the outreach campaign that reported deceased, and i will note for the committee, think that's part of the records that did not get reviewed by the oig, where at least those 43.

one thing i want to bring attention to that is disturbing to me, dr. thomas and dr. deering we have student rosters, e-mails on va purchases approved by the business, and va sponsored training using a book called "how to lie with statistics," and the author explains his book is a primer in the way to use statistics to deceive, and a well wrapped statistic is better than big lie because it cannot be pinned on you. one technique in this book -- this is a technique that are talk in a course for va employees -- but i think it might have been used here before the committee, and july 11th, a chart provided to us by i believe dr. deering's office that led the committee to suggest we have a problem with not enough employees, and if you

look at the blue you say garnishesness, look at the increase in the number of -- my goodness, look at the increase in the number of visits and needs of patients, and the green line is the number of -- when you put the two child supports together you find out they're on different scales. they're about flat, actually. there's about equal growth if you pull the numbers out there. i look at that and average american looks at that and says, my gosh, we didn't spend enough money are money or didn't have enough employee. it's clear, you pull it down, look at what your employees are learning from the book in the courses and my question is this, probably dr. deering or dr. thomas. who orchestrated what appears to be a purposeful intent to deceive veterans, congress, and the american people? dr. deering? >> well, regarding the book, that -- from what i recall that was actually a sponsored training for coaching sessions.

i wasn't involve with purchasing that book. the graph you're showing on the screen is part of our congressional briefing to our local delegates. there was no intent there to mislead anyone. we were trying to basically outline the framework of how we got to where we were in phoenix as part of mr. michaud's -- >> why would you do two different scales and put that together? it's misleading. if you use the same scale, the growth in the ftes and the number of visits is about the same. >> i appreciate that feedback. the intent was not to mislead. the -- >> what this intent to show there? >> the intent to show here is that we have had continued growth in the outpatient setting on number of visits coming into our facility over the last several years, and when you look at the increase in the fte, it has gone up a little bit, but the key opinion here was back in fy10, my personal belief is we

still dud -- did not have enough personnel. we were in the process of trying to hire staff. >> why would your employees be learning from a book about how to lie with statistics? >> sir, i can't speak to that. that's a title of a book. i don't -- >> there's employees from your office that are learning from this course. you've never seen this book before? >> i've seen the book but never read it. >> where did you see the book. >> when the coaching session happened. this was quite a long time ago. >> what is a coaching session? you're coaching them to use the book to mislead? >> no, not at all, sir. not at all. >> describe what would you use a become like that's which demonstrates how to misuse statistics -- i have a background in this, part modify ph.d -- misuse statistics to mislead folks. why would you be coaching folks

with this book? >> i can't speak to that. i doesn't coordinate that training session, sir. i don't know if they were trying to teach people how to notice when statistics are not being used appropriately -- >> actually, says how to lie. >> don't know if the content of the book is teaching people2h hw to notice when people are being honest with statistics or to teach people how to lie with statistics. i don't know what the intent of the book is without reading it. >> this is from your office. very misleading, and it's difficult as a policymaker to get to the bottom of the facts of the matter and we just had a hearing earlier a few hours ago, but trying to figure out exactly how many folks were on waiting lists and the numbers are confusing coming out of the oig. this would suggest that, gosh darn it, there's been enormous growth-but there has not. it is a scheduling problem, and we have hard that again and again from the oig and from your

office, and i think that's very misleading. mr. chairman i want to make certain -- i'll say dish appreciate the time, mr. chairman -- -- it's so difficult to follow what the numbers actually are, and we have gone so far as to say the numbers don't matter anymore because it's driving bonuses, and i think both of you have significant bonuses. dr. thomas you have had bonuses for how many years in a row. >> i do not know. i i can provide the information. >> mine show five or six or seven gliese a row, and always doing very well. so with that, mr. chairman, let's be very careful with what we see unless it matches up wita real. can you fix this chart to put it on the same scale so we can compare apples and apples. >> i i can do that. >> thank you, mr. chairman. /. >> thank you, mr. chairman. dr. thomas and dr. deering, the commitee has a lot of whys, and since the problem has been brought to our attention, and as

was said, we want to get to the facts -- and it's not that we want to harass you but we need to understand the whys in order to help craft some policy that makes sense. for instance, one of my puzzling whys has been this memo of 20 that outlined all the scheduling problems, and i just would -- out of curiosity like to know if either of you or both of you maybe saw that memo and what happened next? ...

>> >> until the of crisis surfacedshqg setback obviously there is the problem in communication in terms of the checklist of things to be done and improved. i appreciate you try to it to divide scheduling i were given an area that i tell you that the district will help you identify those veterans especially in the tribal areas.

those are those areas that are difficult to reach but they are willing to assist and we know them personally. >> battery will try to connect those. of how they grew up in the town of 400 people. and within the 60 miles of the home to give them care in st. louis that the of the a leveraged that type of care and i am more than happy to talk after words. >> i yield back the balance of my time. >> you said you started in

2012? were you a director of a medical facility? >> i was chief to responsible of the care of the patient. >> but not of the medical facility? >> and restarted working on improving access to the veterans one of the things we have learnt is the car about time to do it ministry did patient care so we started to go through the process from the "frontline"

staff of the clinics but some providers were working very hard seeing a lot of patience and some providers would block off parts of their clinical time. that is not fair to the veterans. and so we need to clean up those profiles for the providers and some of felt they did not want to continue the journey and they've left. but the helps with the veterans. >> are you aware of the hold placed in the phoenix records? >> yes. >> can be deleted or moved or evade unavailable any emails related to the

scandal? you are under oath. >> i have not. >> i have not. >> dr. thomas, a report this morning on cbs news a whistleblower in the central office to soften in the report from phoenix of want to paraphrase that the v.a. was aureate about the i.g. report that why -- therefore it would soften the blow. but i question to you are you aware of any employee of the central office to change

their report that questions the it i.g. about any length? >> i am happy you ask that question it is very important. >> yes or no. >> it is more complex. >> yes or no? did you ask for any changes since the average? i know the process. i appreciate you doing that under oath. what was your reaction? >> the process is from a the i.g. we draft our response

for what needs to go along with that. and i do remember that the second or third a paragraph was confusing i am not sure what but then in the final draft we had five action plans but then every time we submitted we have a draft. and then to that final approach. >> what was it? >> one talked about the cases but to talk about the

various levels so many patients this or that. but exactly what that said i don't know. >> changes? >> there were someone every iteration. >> i am understand i should have vast dr. daigh when he was your but you go back and forth and i know the i.g. produced a report over factual issues by a understand there was of back-and-forth conversation. i assume you? >> no.

i don't know. i did not have communication >> the secretary said he was not of party to that conversation. >> but my question is you have no idea who was involved but your review specifically talks about the negative impact so you tell me you have no communication at all? you have a perfect performance evaluation. what did that involve? bamako was not involved at all with any conversations

or of the report was involved taking the report that they submitted for a the correct issues at hand. >> so at what point that were not in the original you tell me why that would need to be? >> i have no idea. >> in the report? then the othermp9÷ the conclusively said to say that it didn't cause death. >> only the final draft to respond to. >> the final draft?

>> i am not even in sure how many. >> i personally only saw three. >> think you for appearing under oath. >>. >> thank you, mr. chairman. in terms of dr. thomas to make any amendments they were i a hard copy. >> as with all reports there provided to us hard copy and zero or e-mail. and then to be used for official purposes.

with phase organization. >> sorry to interrupt you we answered part of that already. to ask for changes that you received? was there that e-mail distribution list? >> it went out to win number of people who have that document. the other individuals?myyy >> it is provided on e-mail to put into the action plan. i have concerns of the committee i really do.

>> i ask the secretary. it was not me. but you tell me you have no idea on the v.a. side? to know who made the changes? >> no. >> made one other person there received a copy of the draft. >> i would have to go back to look at my e-mail. it is on there i recall. and here is the hard copy there was limited distribution because it was said to allow high visibility case but the people reviewing the draft interoffice? can you identify another

office? >> so a side of the organization. >> public-relations? >> absolutely. those documents working on a the communications even to work on that plan. >> but to your knowledge has this report been leaked before? >> no. >> is someone found out to be leaking a document what is the punishment? >> absolutely they should be held accountable.

>> we would have to go through a chart to find out if there were prior disciplinary action. if they had committed prior acts. i want to ask specific questions dr. deering to understand the knicks. but the report identified 1800 individuals were you aware there was the near system list? >> i was not until the concerns brought up on april april 9th so we try to see what was going on. >> were there names on that list? >> some time late april 2 were three weeks from what i

recall. >> another thing with the urology consoles, when did you become aware of the scheduling request? when did you find out? >> about the same time as the engineer report. >> what did you do about that? vinik is that your responsibility to take care of this. >> the third level is a little different and dr. dr. thomas as the chief of staff responsible for ignitions in the clinical side bet that process paul's more under the business side i cannot speak to what happened to those employees

but we started to educate the staff to schedule patients. >> actually it is with the scheduling practices this may hit the fan but this has been going on. those routes their publicly for years. i am not sure of the numbers with the committee with the documents and files it could be three or 5,000. thank you for the time. i yield back. >> dr. thomas we have all been concerned about the antiquated i t system. and you say that overly complex system but i would

like to know what that entails and being the first component to a the problem of that is the of policy is the system 182 no pay but also because of what of this system to have multiple monitors. to do an interim updates but just recently trying to get off the shelf for the scheduling. >> you have any idea see you

can bring that back into the first century? >> i should know that. but i cannot think about that. >> i yield back the balance of my time. >> you said you looked at three draft reports. did you provide the input directly or through another staff person the ada to change that report? >> i did not. >> with your chief of staff with the level of publicity received why is there not all five reports?

>> i filled the history when i saw them. when i looked at with in box then three of the finals. >> but the changes you like to see to the endgame? >> but rebroadcast all quite surprised. >> bedmate 78 change since that was the hair style. you said you worked at the va you would kill us the

first 30 days? >> the most amazing thing is you have to be here. >> i was interested. >> schaede and have no faith in the health care system if they need the health care if a new health care. but if you have the chief of staff this time. >> we were trying to do giveback. >> then i talk to myself for hours and day delay to go straight to myself.

>> who did you talk with? >> a think, i know there are multiple meetings with communications stuff@>b like those set was given the news and we were waiting to see what it would say to take immediate action but we're not providing quality care. we have to get our act together and pyxis. >> secretary a shinseki and his staff. i am sure almost everyone

spee mexico's tried to mislead or hide. >> i am sure you did not discuss the report with the 300 employees. >>. >> but i have one final question dr. thomas, who do you believe commissioned this7s report? >> i believe the v.a. report

was started from the phone calls about phoenix then after the april 9 hearing, the the i.g. was directed to do so. >> by hugh? >> i believe congress charged them with investigating the issue. i could be wrong. >> you are correct. >> okay. >> so my question is, how could you file a report before congress? >> final draft? >> final report. >> college the draft your report how did you see the final copy of whenever it was?

if you saw the final draft use of the final report. how did you see that before congress? >> i know it was publicly released august 26. i dunno when you got there we have to respond before it is published that is how i saw it. >> okay. it says ben it your testimony there of this was happening. correct? >> be more specific in the thing was happening? >> manipulation of data, the scheduling, problems, comment any issues with delays of and care. >> that you can't to work

2007 is to make you are aware intel april 2016. >> i think from the i.g.? >> you are telling me you were aware of the end of the problems intel after the hearing? >> al is trying to get this situation to arise -- arise says the isolated event rather than taking fashion holistic and comprehensive approach. >> sova begin your testimony is you are not aware. >> i was not aware of the extent of the problem.

>> we would love to have that to create a national plan. breast they do respond so of the recommendations sphere in fifth day they already know what they willyí agree to. this is the first time that i can rebar that v.a. is doing some of the things they have in the past. certified. >> but i would not agree with the relationship with the i.g. >> i will retract that statement. i s understand. i berndt today you get that and you make changes.

do you not? >> is. >> but to make those recommendations thatabut we appreciate the link you had to be here today. >> thank you mr. sharon and but we need to put his efforts to care rid of a half.

>> members seven like each of you to call to touche. we've reached out to her car shirting press it is that all would be -- but that would be set to appear.

>> the historical, educational shows are very, very informative and very, very highly educational and in pliable to society today. group doesn't know but what these structures had on them how the ancestors will shape things on this country. >>.

>> we detonate dash-7 line dash but this program. but including the examination of war. all of it. is good programming.l

>> good afternoon when the editor for bloomberg at the news desk in vice president

of uh national press club it is the leading organization for journalist committed to programs such as this. and we foster a free press rolled wide. for more information visit our web site. on behalf of the members worldwide and would like to welcome our speaker and all attending today's lunch. we have working journalist that our club members. applause may be from members of the general public not necessarily evidence of a lack of a journalistic objectivity. with like to welcome public radio and c-span audiences using fatah #put after issa

speech we will have question and answer period as time commits. i each perfect to stay with him daily. but until everybody has been introduced we have palaces and fitzgerald reporter for the center of public integrity. in an end to the west to views remain tries to al site for her as fox business. >> editor at "scientific american". >> but a guest of our speaker and cbs cheese --

and speaking over the speaker we have john welch account to. but the cbs health strategy officer and general consol. we have the reporter of modern health care. and reporter at bloomberg and a former editor at hr magazine. of round of applause but there is no smoking at the national press club.

[laughter] [applause] enter now you cannot buy them at cbs. [applause] the second-largest retail pharmacy chain voluntarily gave up $2 trillion of the announced it would stop selling tobacco products. cvs uses them as contradicting the up plans to expand in the health care business. cvs waistband in-store minute clicks. >> recently which change his name as the shift in direction. racine's to be reacting favorably but just the day

they announced they would go tobacco free. neighbor down a little but today they were trading at the highest level this year the man in charge is our speaker today, the company sees no. the first person and hisdv family to attend college and graduated from the pharmacy school at the university of pittsburgh in 1978 and it took a job as the assistant manager and pharmacists at a peoples drug store. by 1980, a regional manager for the chain and that is when it was acquired by cvs. then to drive sales and profits and acquisitions and job growth. it was long held cvs is part

of the solution of the bog down health care system. and larry joins us today to improving sprig giving a warm press club both from. good evening everyone in. >> i will have an impact on an employee is and conservatives. i think's. >> to redress to put it i will show you how that'd

devolving with the integrated health care and lou of this stuff of sale.t@ rule on with polemist said one - - two was a significant force - - her it doesn't matter how hot it is but all along the way we try to stay true to create value and constantly innovating to me. >> i am sure you know, what is best. they have. >> but does that benefit the

judge? >> ranging from small employers and government sponsored medicare. it has flavors and medicaid. >> also more than 900 medical clinics and most practitioners are seeing 21 million patients. finally specialty privacy one of the fastest growing areas of health care which is the leading national provider we tweet to more than in -- treat more than 20,000 patients per month or at the ambulatory site. so those patients better managing multiple or complex disease we offer according to case management servicesck coming 17 specialized programs to focus on whole patient care. a few see how it is a combination of assets, with

fact gaf for the patients. >> but they have their mission and vision and at cvs we call it our purpose to work hard. and all along the way to. >> and to help care dash and >> some of the regiment changes but barely touched. >> what about the consumers.

>> that the product will increase from 17% to more than 19% of 2023. but it is still spending fan growing expander than that average economic growth. other real world translation is if it becomes more challenging >> i will purchase with employer funded. >> but health care companies have worked hard to bring innovation to the market

with the quality of care and many. >> with her being so short and not needing medications is a large part óa0-i3 i am eligible for medicare every day. but for the use of medications. speaking up to a from said a word inveigle the heaviest night. that accounts for in a row is three.

>> but why would they do that unnecessary cost? >> there are a lot of factors contributing to health care spending and no question we must me and can do more to slow the cost. first is the affordable care act when fully implemented to see more than 30 million insured americans by that insurance places or medicaid and health plans as well as the government will play the important role. at the same time the major

threat of the affordable care at focused on access also to innovate with the dilemma. no health plan with this base payment model that operates but this is beginning to change. into the patient since shared medical but they're not focusing on the quality improvement and cost efficiently. but the inmate is something that he's left with the whole school rappers and promises. >> we called the retail nation that consumers.

>> click at the growth but to foot directly directly into the eyes. at the same time the consumer directed health plans also driving consumers to be more involved to take more fiscal responsibility for their health care choices and cost. finally this transition to a digital society. we all experience it has transformed how we live and how businesses behavior and consumers act within the day to day lives. although this has been slow were in health care significative and lasting changes under way. the reality is this innovation is not optional. many believe the health care industry will change more in

the next 10 years than in the past 50. pay will began. >> but one and maybe important. but many of those things that we get to you give a solution. >> but people thought about receives -- pharmacies we know it is much more to and that. there on the front lines of health care to deliver a better outcome more efficient -- were frequently and cvs health has many reproaches but the ultimate goal is to once again help people with their path to better health. the way we do this looks very different from how we serve customers in the past.

one of the greatest assets we have is our life and there were people. we're in a weak position to help. for many years that a gallup poll has consistently ranked in the top three of the trusted professionals. with the bride age of counseling and intervention we could address the issue from earlier. >> just as prescribed. >> if you go back to look at half of all americans suffer from a the diseases. >> because one added three patients.

>> by a prescribed by my a smith mac we are still is. >> there is a huge opportunity at the same tie with over cost. we have the policy adviser to help grants to help people manage a crisis. to help them stampers private medication to prevent complications and these touch points enraged by counseling and in-store counseling and consultation

for the more complex cases. research is showing it is working. if we left that interventions with people with diabetes they were effective not just increasing adherence better return on investment. for every dollar spent there was $3 and to dave wallace -- fallacy's people range from five eighties. >> there is one that offers trustee and flexibility how do they access specialty dedications? what is a specialty medication? prescription their peace pork complex conditions like hepatitis c or retaliate arthritis but in addition to be peering costly oftentimes a requires.

>> and pick up the prescriptions at any pharmacy. but it makes it easier for people to get on and stay on with there be. another to access to care with the influx of new the injured people and of growing shortage of primary-care physicians. that clinic continues to stand and. >> that is a lot of rain.

but we are fully accredited by the joint commission. we except every insurance plan including government programs seven days a week >> we see it as complementary

and helpful to the health care system overall. finally the focus on digital innovation to use customers' with both retell - - two even transfer them to retail a and fair challenge. a and said he and giving people close to a rise in the of the -- the liberation you put down then to add for surely more branch. >> you could see have a businesslike so you want to

have a job at mcdonald's but making 42 million adults 480,000 people died each year for the bow and he has pulmonary diseases but there is $2 billion of tobacco sales to be continued.

our colleagues and customers what the conservatives are saying about. >> you are in a better position that include jean of goods and are rise. >> there was long term opportunities with debate and discussion with unified management team with the board of directors we've tried to be equipped:a rare and from his comes back we want to hear but to discuss

the bill being of the patients and the -- the questions from before. [applause] with a leading health organizations including the campaign for tobacco free kids the american lung association, said the robert johnson foundation, a and these organizations and any others have rallied adding to the course of why the pharmacy should be tobacco free. but countless statements for consumers and celebrities and political leaders, no question that national conversation about tobacco is so late night. we tacked an and.

>> talking to a 38 folie paid but they stopped nursing campaign for it rose to and a hand but they online hundred meet susan but they had 26,000 and an.

but to help them stay motivated and prevent storage costs is free to go broke we perry chemical. >> is the day we announce the new homes and also a fundamental shift about who we are and what we do. for that purpose it helps people on their past to better hh.