testimony. -- thank you doctor. fuson next? okay. our thanks to the witnesses. dr. clancy, according to ngo report, va deviated from recommending guidelines and most all of the 30 cases reviewed by not assessing antidepressant treatment properly. ..

and it was hard to get people back in or whether we weren't just on the ball. that is very important future. >> dr. clancy, we found veterans who died of drug toxicity reported hallucinations and subsequently died by suicide and reported homicidal thoughts. are these improved outcomes you are referring to? >> no, they are not mr. chairman. >> in response to the report ba noted it would conduct reviews and develop a plan to determine and address the fact is contributing to coding variances. this was to be completed by march 2015. has this been completed?

>> it is in progress. we are not completed yet. i will also add in addition to that i have been meeting inspired by it by the gao report and at their feet back with dr. kudler and others to figure out the veterans we think are struggling the most with mental health disorders that we should be targeting to make sure that they are getting the best possible care. >> thank you. when do you think that report will be done? >> i will have to double check on what we committed to having the recommendations done. >> our ba has stated it would examine associations between treatment practices and indicators of recovery or adverse outcomes for veterans treated with antidepressants. the target date of completion was also march 2015. has this been completed?

>> i believe it has. i have to double check my notes there. >> can you get a copy of the? >> yes absolutely. >> roughly 63% of the behavioral health autopsies reviewed by gao critical data was missing. is this inaccurate reporting based on the confidence or is it to intentionally keep central office in the dark? >> i have no reason whatsoever to suspect it is to keep central office in the dark. as i understand, the program was transitioned from her cause analyses at individual facilities to a centralized repository two years ago. as you might expect, training reviewers and people doing interviews and collect data to collect the data consistently and accurately took some time and frankly senator ration to make sure we were getting it

right. do you want to add to that? >> at the time the gao is conducting the study the behavior of health autopsy program was just the launch. the forms were new and in need of refinement. as has the training of the suicide prevention coordinators commit 300 across the country at 100 facilities who filled them out. there were questions about what data goes where and how do you count this or where do you go with that. that has now been addressed their trading and updating of manuals. we now review all of these at the central and national level. we've also created software through another system to make sure we are accurately looking at these from multiple perspectives. this is continuously improving has regressed a great deal and we will continue to work on it. >> the subcommittee has requested the behavioral health

autopsies for numerous veteran who have died by suicide and in all cases except one kalish l. holmes, ba has stated the information is confidential, privileged et cetera so it cannot be released to us. if this is true, why was the report for ms. holmes released to the committee? >> i would have to take the question for the record. i would say in general the behavioral health autopsy report i think the ranking member custer describes this more clearly than i could. this is quality assurance for you want the most forthright input in observations. if people think this is disclosed we will not get input that forthright. >> i think we are very concerned about the fate of our veterans in this subcommittee and the

committee as a whole has a responsibility for your operation and we came to the oversight operation in making policy that is best for our veterans if you don't fulfill your obligation and submit the information when requested to the congress. wiki member custer. >> thank you mr. chairman. thank you to all of our witnesses and dr. maffucci, i appreciate you being here and sharing the experience of the veterans returning from 14 years of conflict in the injuries are much more complex. the good news is people are surviving. the difficulty is they have chronic lifelong issues. i want to focus in on how we move forward. i share the concerns expressed about the data and making sure

we are getting at the heart of the issue here. but i am very dead. i mentioned i had a median and some cutting-edge research and i will talk to the chair about ringing witnesses to share that. in particular, the opioid safety initiative and a couple of different things in whichever is the appropriate witness, one is getting at the heart of what is causing the pain. my husband has chronic pain in many, many years of back pain and various medications and come to find out what he needed was a hip replacement. and now we live pain free with yoga and stretching and exercise. so i would like to find out what is being done to get at the crux of what is causing the pain. secondly setting a goal of reducing opioid use and working with practitioners to bring down the opioid use and particularly

emphasizing patient education close monitoring. they talked about actual drug testing because in our area selling its opioids on the market would have been sometime since people will not use the medication and so and they can determine that through frequent drug testing, which as you imagine is not popular with the patient. and alternative medicine acupuncture. i mentioned yoga, massage exercise. if you could comment on the opioid may share how far has the god, how widely has it been? what can we do to help move the award? >> thank you. the several terrific questions. i will start and then turned to mr. valentino. like the case of depression where the clinical practice guideline was developed with colleagues in the department of defense on the management of

chronic pain that was published in 2010. as at september this year it will be updated with the frequency you want to update the guidelines and we will be having input from veterans and family members. the guideline does include drug testing periodically. we have mentioned probably too quickly in my opening statement and a series of steps the umbrella i would refer to as the opioid safety initiative made data prescribing patterns at the network level the facility level and most recently at the individual clinician level available so clinicians can see what has the patient ban on overtime, what other tracks are they on and so forth. getting to the root of the problem is incredibly important. i'd be happy to submit for the

record to brief anyone anytime about the exciting research we have an process because it is very important. there's a lot we need to learn into areas. one is what are the predictors of federated or anyone who is likely to use opioids for a short time to go down the path of using them on a regular basis because if we knew dad would target a lot of efforts. which veterans are most likely to respond to alternative treatments to nonnarcotic medications and so forth. as i said we have some research going on in that area and a lot more to learn. mike, do you want to add to that? >> yes thank you. the opioid safety programs is just shy of two years old. we've have to build it from the ground up and asked dr. clancy

mentioned it has been very iterative. initially we focus on data collection, aggregation to identify potential outlier visions. we asked for a corrective action plan. the next iteration was to continue to focus on business but drill down to va facilities which we did identify outliers and ask for corrective action plans. we know this is working because 17 medical centers identified have now fallen off the list. we are poised right now it would build the tools and we are validating man to drill down to the individual provider level. someone may show up at the show up as a data outlier, but maybe a pain management specialist. maybe they treat cancer pain. maybe other situations you would expect it. we have to make sure we get it right so there's confidence in the tool. we have good results.

i will go through some of the metrics. since we began we have 110000 fewer patients receiving any kind of opioid short-term or long-term. 34,000 fewer patients receiving opioids and benzodiazepines together, which is a known risk. 75000 more patients have had a drug scheme on long-term opioids because that is definitely an opportunity for diversion and we want to make sure patients are taking it. we have 92000 fewer patients on long-term opioids arp, which we define as longer than 90 days. we also have begun to look at the totality of the opioid wording. there are many opioid drugs, but you have to boil those down to a common denominator, morphine equivalent daily doses.

>> mr. valentino my time is out. i'm interested in what you have to say but the colleagues made their turn as well. we can take that on the record. >> let's see if they cannot run the clock out on some of these answers. >> alumni to thank the chairman for bringing the important issue to light. unfortunately it comes to lay for one of the colorado springs families. i would like to tell you the story of noah, a former marine who served with honor in iraq in 2009 and afghanistan in 2011. i want is his last name, but his parents have offered the use of this picture. so if i could just show you those pictures. after leaving the marine corps noah began work on a business degree at the university of colorado at colorado springs and started his own online business based out of colorado springs. noah comes from a military family, his dad having honorably

served 23 years. noah chose to put off college that he considered the great nation. unfortunately, his parents are appalled by the care their son didn't received from the va. they believe their son would be alive had he received better care. noah was diagnosed with ptsd and received a 50% disability due to ptsd. on april 2nd this year he went to the colorado springs va clinic were medical notes from his visit state he had suicidal thoughts or suicidal ideation specifically. noah was prescribed a psychotropic drug venlafaxine and sent on his way. we don't know at this time with this time but this did or didn't do, but we do know he was not referred for suicide prevention. he was not offered counseling and there was no follow-up from the va. he went missing that evening at may 4th and was found dead from an apparent suicide

may 12th at this year a month ago. as you can imagine his family is devastated. they are asking a lot of serious questions. dr. clancy would like to ask you several questions on their behalf. why was their son who had been given -- to have been documented with having suicidal thoughts or ideation and not referred to suicide prevention? why wasn't there a follow-up from the va and why wasn't he offered counseling? >> i will look into this personally, mr. congressman. that is heartbreaking. i can't imagine, but i know it is horrendous but his family is going through. the picture was worth many many words, someone who did so much for this country and i will look into that and get back to answer the family.

>> with one of the other witnesses have any response to my questions, to the families questions? >> as a psychiatrist, someone was treated veterans and clinics for 30 years it is hard to understand the report we are given in the seem to be the facts available to look into it. my first thought if i want to make sure the family has been reached out to direct late and we have a chance to collect the information. the system can be cold and inhuman, but we need to have a sit down and understand everything that happened from their point of view questions they have which may torture them and we will work with them to do that. >> thank you, both. mr. chairman thank you for the hearing an ideal back my time. >> mr. o'rourke, texas. >> thank you. dr. clancy come a question to which i would like to receive a

direct answer. we are touting reduced prescriptions of opioids as though a success in itself. i would like to know the consequences. i better insist show up to the town hall meetings say their prescriptions were cut off without notice, without ripping down. how many of those no longer receiving prescriptions from the va are using heroin or other street ducks. dashed street drugs? >> with the information we have it is something we work on constantly. >> visages hopefully feedback for you from el paso. others are prescriptions are required to renew prescriptions after her monthly visit with their prescriber. they are unable to get the appointment in the passages in the prescriber said they cannot get the prescription renewed syndicate without her something

they without her something they shouldn't have said they buy in the without her son danish inhabited by in the street and at a minimum they are suffering and in some cases i would connect that to suicide specie in el paso. i would also like to give you the following feedback. as i shared with you when i met with the one monday, the may 15th access report from the va shows el paso is ranked 157th out of 158 for mental health care access. we have 115 mental health care physicians are approved for el paso. on the 87 of those are filled within a 24% rate. your predecessor winwood relay anecdotal information is hearing from veterans told me we were seeing everybody in 14 days. more than one third of veterans could not get a mental health care appointment. not in 14 days, not of months not ever. we are serving the veterans again to alan receiving responses back has not improved in the year we have had leadership there.

they should be for you a five alarm fire. i have met with the widows and mothers of suicides in el paso far too often and i continue to do that and i just did the last time i was home in el paso. i see no for whatever reason they are able to solve it as a priority it should be. i'm glad to hear good things are happening but everything i do with the veterans they serve in el paso. you know we have a proposal from the community to address this. i want your commitment because the va leadership in action and resources to do the right thing. i will do whatever it takes to work with you and your team and the secretary to get this implemented. this is a crisis that is deadly repercussions for the veterans who serve in el paso. we didn't take it seriously over

the last year because our statistics and they can see and position relative to mental health access is worse than it was a year ago. and what commitment you will work to resolve this crisis for you, urgent for you and we will turn this around. >> you have my full unwavering commitment. we are bringing out various members of the el paso community to work with asp and i want to thank you for your supportive employees during what was a different kind of tragedy at the el paso facility several ago. something that cut to the heart of clinicians across the country are particularly those serving veterans in el paso. you have my full commitment. >> thank you. i yield back. >> that is not enough. [inaudible]

>> you are out of order. you are out of order. thank you. dr. benishek, michigan. >> thank you, mr. chairman. i want to associate myself with the comments of mr. o. work for one thing and that is i have seen this as well but the goal seems to be cutting down the amount of psychotics and the same circumstances happening in my district where people have prescriptions cut off with no alternative treatment. it has been a real problem. a couple of specifics i want to get to after about and that is something dr. kudler said something dr. williamson said. there is not that much follow-up on the behavior of health autopsy program.

remind me what you said in your testimony. >> we were talking about oversight. very little oversight of the program at a local or national level to see whether there was accurate and complete. >> you said you are doing oversight. mr. williamson said you are not. what is exactly going on? >> the differences the two years that passed i'm not questioning the report at all. i find the report helpful as a spur to do more. at this point we're making a difference. >> show me the results of the oversight done in the last two years. did you get back to me in a reasonable period of time, like a month? >> that is not quite the way it is. there is still to respond recommendations on oversight. i don't think va has completed yet. it is not a two or three-year lag at all.

there have been changes made. there is now a box checked on the behavioral autopsy report that indicates oversight has been done. that is one of the things. they are revising guidelines are making progress. but it's not been completed to our understanding. >> i'm not going to give you another chance sorry. dr. clancy you said something in your testimony that was very important to me and that is this seems so simple, but the fact is people who have an idea they want to hurt themselves have to hang up and dial another 800 number when they call in to the va. he spontaneously said you'll have that six to hit a key and make that work.

what i want to know is why in. can you give me at eight so i can call the number and see if it's actually working? >> absolutely. by november, december. one of the things we've been working closely with the veterans crisis line. we want to make sure we don't overstress the system. >> i just want to have a date so if it is not there by november december. i completely agree with the guy who stood up your in the back and was out of order and that it is great to keep hearing you are going to all the work but from where i said the actual accomplishment of the job does not seem to be happening. i will be back to talk to you in january and hopefully i've got people calling me all the time.

>> i will be checking. >> i yield back the remainder of my time. >> thank you dr. benishek. >> thank you to the chairman. thank you for being here. i would like to add on the osi implemented in minneapolis and we followed this closely since october 2013 and i would associate with them. we saw dramatic increase in calls to our office after his implemented which is probably somewhat expected. i think the lack of being mayor are the year candidate. this issue of mental health parity, mental health treatment certainly is societal wide. a small first step on clay hunt is going to be the broader issue

than on the opiate issue this nation has vacillated back and forth from our prescribing too under describing of finding this is the research gets there. so i hear that. i guess my concern in the frustration and you hear authentic frustration for veterans, whether it be here or all the time. this pain management pain is a tough one. i only say this but it is important for context. i represent the mayo clinic area so these are folks dealing with this on a very big issue. i was proud in 2081 of the first girls i was able to move through was the military pay act and the veterans pay out. out of that came the pain directive 29053. we put together the iom staff care pain model, which is the old standard. is that correct?

i won't go through all of it that is here, but what i would say if it had a five-year span on it. i wanted to go further but this is the nature of how we do legislation. it expired in 2014 before it was fully implemented. it did not get reauthorized, but when we were on this issue dr. clancy, you responded march 30 at the va doesn't need us to do it. you can put it in yourself. i set that is wonderful. let's do it. i followed up with a written letter and i don't expect to be a high maintenance person but i have heard nothing on my specific question. the frustration and this was seven years ago we were dealing with pain management. seven years ago we implemented best practices. seven years ago it was implemented and not -- expired in a fully implemented. i hate this exchange is that we continue to have.

i hate the pattern of communication we now have because it does not go well for veterans. it does not fit. in fact, it's very irritating. i wanted to start a process that i understand the challenge of the issue. i understand the deep societal issues on the positives remake of the pluses and minuses. the frustration was more and that this might not have been the fix, but why did we do it? >> it has been done. it is still being reviewed internally. i will be honest in saying this is a gao highlighted in our high risk list and we've got to do better at the process and updating of our policies and directives. the pain directive has been updated. the >> who does that? >> we are going to tell you as soon as we reviewed it in house consensus and haven't missed any details.

i apologize i haven't seen your letter but i will make sure you receive it before the day is over. >> i don't expect to be high priority. this is one of the issues. our job is has to do this. we had a great coalition working with your talented people on this. we got it good piece of legislation and were left to the no man's land where we don't know what to think. i don't like going out and hammering on you. this is stuff. there's some things i encourage my colleagues to look at this. the ranking members intuitively clicking into this. the things you hear from dr. dr. benishek aromatherapy. if we make it sop they would be there. i encourage you in many cases if you are doing something right, let us know and talk about it.

communicate with us. css partners in helping veterans to the frustration you hear here and out in our districts is reduced. we look forward to the follow-up and i yield back. >> thank you, mr. walz. >> thank you, mr. chairman. just a couple things. one data collection you draw or produce inadequate data. you trot inadequate results of the results might not be accurate at all. it is extremely important health care to get the data. we have a solution based on many patients today from this patients to die. when you put bsn you get esi. that is what is happening right here.

i'm been a little crude, but that is absolutely but it looks like you've done. mr. williamson pointed out that when you've got half of the template incomplete or inaccurate from the drawback conclusions. so i think until you get the data right, you'll never know. dr. clancy, you are bright. what works for one patient might not work for another. the ranking member has pointed out alternative theory piece and what works and dr. murphy whom i am sure you know continually complains about the od and has a patient's table and when they are separated from the military and they go to the va, there's a different formulary there so they then stop what is taking forever and they are now on something else. that is something that needs to be addressed. he was very adamant about that. he sees it a lot since he is still in clinical practice.

i see with dr. benishek want to associate myself. the outburst you heard was frustration that i tried to get in there and couldn't. mr. a work has every right to be frustrated finance people outlined up outside the office talking about not being able to get in the va. when the shareware that is frustration. i've been here six years and change on the committee. we've increased the budget 74%. it is not money. it is management. it is not the amount of money. there is plenty of money to spend. i don't understand why the system isn't functioning better. any comments on that? mr. williamson, you pointed out in your testimony poor oversight that nor accountability. what happens to someone when they find out they are just not following. and outcomes. you mentioned all of those

things. mr. williamson. >> so your question is to record at oversight? >> yes sir. >> there's a lot of reasons that doesn't happen. a lot of times the va does not have the data, real, accurate and complete data to do that thing. i don't think there's any willful motive on va's power. i think it is just a lot of times at the local level not that accountability that a supervisor is holding his or her employee accountable for doing their job correctly. >> that seems basic to doing your job to me. that is not rocket science. you are not doing your job. so what happens when you don't do your job. do you lose your job? what happens? >> i am not sure i have the right one to ask a period in an idealistic world i would think

you would. we are held accountable for the quality of the work we do and what we don't do about we get feedback. first of all we have expectations and feedback and corrective action after the and that is very business 101. >> dr. roe, to you and your colleagues, we share your frustration and i want to salute my colleague dr. kudler who is working with others. yes people who don't do their job should be held accountabaccountab le. we've given them resources and capacity to do the job. you cannot hold people accountable if there is no ability. >> mr. work pointed out there's twentysomething jobs available 24 people that need a job in el paso, texas and there's money to fund it. one of the positions filled? >> we've tried a lot of variety of ways to recruit people. mr. o'rourke came in with a

group of partners from the community and i am very much looking forward and he asked my full commitment to looking up at to see. >> the va is making it hard for veterans to lead the system and go to private practitioners. as we find that sometimes it is just so hard with the rules to get out it takes forever to someone to get an appointment. my time has expired. how long does it take to change a phone number? or does it take six months. i know how frustrated i get when a punch to for this come at three for that. makes you want to throw my phone away. how hard is that when someone is contemplating suicide to have a solid two where they go straight to a person? >> we want to make sure we don't overstress the people taking the calls, one of whom recently took a real nice. as you can imagine that is a very stressful job. that is the reason we are

testing first and will then rule it out. >> it may be stressful and am very sorry for the family, but is stressful on the other end. that is why they make the call. >> we want to make sure when you hit the one number or whatever that number will be ,-com,-com ma that it connects you directly to a counselor. the only thing worse than not having it is doing it then. the issue of transitioning service members over to va continue on the drugs they were getting in the service. we've gone over this with dr. woodson at the defense. >> i will have them checked. >> i would be happy to follow up as well. >> ms. rice in new york.

>> distress from the operators comes from the fact they know they don't have support from cnn giving callers the help they need. i'd like to take a minute to recognize the work done in my home state that covers the bronx and manhattan. they specifically reject the prescribed first come i diagnosed later treatment facility that is all too with doctored by the va. they have taken what should be a revolutionary approach. i understand that.there's when a patient comes and present the real pain. that's the first round of reaction. using alternatives acupuncture

and exercises to relieve pain. what we've seen is veterans who undergo treatments without the harmful effects of addictive narcotics. the va's outstanding approach should become the norm at all va facilities nationwide. my question has to do is what is the version to alternative forms of treatment like meditation acupuncture and exercise? >> first of all, share your enthusiasm for what vision three is doing and i've spoken to that spokesman is wonderful. we have many thousands of veterans using alternative forms of therapy said there is no aversion whatsoever. veterans who are already getting opiate and some of whom come to us from active duty on the same medications the path forward is going to be different. it's not starting from day one.

i love what they are doing in new york and i've spoken with many veterans and have actually begun to think about how we might use their stories to help those struggling to get off opioid and try alternatives. many veterans who take opioids would like not to but they like to wake up and it all be okay. the journey dares not that we see. >> the system here and you know works. one of my colleagues told the story about no and clearly he was prescribed drugs. he was not given any follow-up, any alternative any therapy, anything like that. the doctor in charge of the asn three she stated -- she said to be an ob is this to be trapped in a cycle of poor function in

poor pain control. i am imploring you. they get it right there. just export to the rest of the country. one other thing i want to talk about his fate though i happen to be a proud cosponsor of put forth by our colleague from wisconsin h.r. 1628 -com,-com ma the veterans pain management improvement act which would establish a management board within each of the isn to handle treatment plans for patients with complex theme. it would incorporate family members into the decision-making process for a veteran course of treatment. has the vha taken the ideas in this bill under a price that? >> yes i told him he had made personal support, which may be different than the department supporter. i can't think of anyone -- any

reason we would not support that fully. it was inspired that updating the clinical practice guideline wanted to make sure we had input in doing just that. i told him that. as heartbreaking as some of the experiences that the veterans are at the experiences of families to raise their hands and that i'm worried about my son, daughter, spouse whatever. >> it's not even a service person issue. i don't think we want to be a nation that says to our brave men and women who come back so damaged and so injured that we are going to do our best to keep you in a catatonic state for the rest of your life as a pain management error p. that cannot be where we come down on this. i am begging you to do everything you can to look at what they are doing and

supported through the rest of the country. it is not rocket science. >> if i was going to some of the hearing that the veterans health administration they would simply be drugs are a shortcut. there are shortcuts to doing the right thing and the therapies required to treat veterans both mentally and physically in terms of pain management and those suffering from depressive disorders and that is disconcerting. and it is unfair and hurtful to the men and women have made tremendous sacrifices for the country in uniform. one question i have is how many physiologist for rehabilitation physicians as a veteran of frustration have dr. clancy?

>> i would have to take that for the record mr. chairman. >> i've got the number at about 40. therein lies the problem. those are the people of central when it comes to pain management. we are shortchanging not because the easy thing to do is to drag somebody. drug them not to feel pain. drug to get them up in the morning so they can go to sleep at night. when we look at the suicide rates of our veterans that is reflective of what the veteran administration is doing in terms of having drug reliant therapy as a shortcut for doing the right thing. dr. maffucci. are you bettering yourself? >> i am not. i'm under a scientist by training and prior work for the pentagon on behavioral health

issues that army suicide prevention task force and other programs. >> i want to thank you for her work on behalf of amanda marvin who served. do you believe in over prescription of is a shortcut? >> i think this is a really complex question to ask. if you look at the history of a clinician education, medications have always been at the forefront particularly with pain management. as a nurse scientist, i can tell you the research is young in understanding how pain manifests in individuals. every individual experiences it differently. because of that we don't have a lot of great treatment options. however, having said that there is a lot of research coming out right now that really supports the idea of integrated management of pain using

alternative and complementary medicine. there's an spinal cord stimulation is a new technology out there and i va has a veteran who is addicted to opioids, was a chronic pain sufferer and was able to get off of the drugs through spinal cord stimulation and alternative practices, lives a much better life now as a result. these are all new technologies. doctors don't know about them. they are not using them. clinician education is so so critical to redefining how commissions look at pain management. >> you would agree drug should not be the first course of action. they should be the last course of action. >> absolutely. drugs are one option as many. they might seem necessary, but they shouldn't be the end-all

be-all. they should be part of a comprehensive plan. >> mr. williamson, how would you view the principles of the treatment weather for psychotherapy or pain management from what we see here in terms of testimony it seems to be kind of the first and preferred of trade minister of therapy. >> i'm not a clinician and i'm not qualified to answer that. we are going to be looking at the operations, va operations relative to the program later this year. i will be much more educated after that. >> .it's not comforting. dr. kudler, what do you think? >> are really glad you asked that question.

the bottom line -- the bottom line is this. whether it is pain or depression, it takes an integrated approach as dr. maffucci was saying. different patients started different places. patients that can't talk about this. i won't talk about this medication will make it possible. in the paint case there are people who absolutely need not to go where they need to go into opioids or come off of them, but this is all that ever worked for me. we me. when you discover the patient is, what about rudeness. with my patients have said look of a lot of different tools. talk therapies and medication. this is the good and bad about each of them. don't make sense to you and we can do both at most cases we end up doing both. >> dr. clancy, in an oig report from 2013 it was recommended va insured facilities take action

to improve post discharge follow-up from mental health patients particularly those identified as high risk for suicide. what is done to ensure the process is followed? >> a few years ago va put out as a performance measure the veterans must be seen in person or at least by phone in the first seven days after live in a hospital based on statistics that show the most vulnerable time or a suicide attempt or admission for suicide activity. we have been monitoring this. we are not perfect, but i can't give you the number now. i can provide it later. we have the automatic work for people on the take of miles further. i wish i could give the exact number right now.

>> from over here in this committee, it is a world apart and for what we are hearing in this committee were true, we wouldn't be here today having the discussion. >> mr. chairman fma we are not saying everything is fine and i acknowledge that it the outset. but i did want to tell you is we are committed to getting it right. we have a lot to improve on and we welcome your support and help. >> hard to get it right if you are not acknowledging the depth of the problem. ranking member kuster. >> thank you, mr. chairman. thank you to our panel for coming forward in all the comments from the committee. i just want to follow up on where we go from here in terms of sharing best practices. we have now heard dr. maffucci. i appreciate your commentary and expertise in this area in the team from the va.

i've talked about some examples in white river junction. either they get shared in the research under way. how do we move forward with this the more veterans will be served by this. in the clinician education. we have to change the parameters started to go to answers that some of the clinicians have. where do we go from here with this and how can this committee best top of that didn't continue to work with the va to make sure we are serving these veterans all across the country. i will bring el paso. obviously one of the challenges is that this involves a very case management intensive approach. you are right the worse case scenario is cancel somebody's medication without follow-up

because as we all know that is why people turn to. how do we get this right hand how do we get it right across the board in the va in what is the follow-up? >> what am i suggest is you i suggested to abydos.org received and we give you a follow-up. you pick the frequency, a couple months, three months. i didn't get a chance to say before to congressman to work that i do have people monitoring for this abrupt discontinuation of medications and i'm really worried about it when people change providers. if we send a message that says they want fewer veterans on opioids, it is much easier when someone changes providers to say no. that is absolutely not acceptable and no definition of success here. i want to be very very clear on this point. some of these challenges are areas for u.s. medicine is struggling in general.

chronic pain in particular and for mental health we've had to blaze trails. there is no clear-cut blood test that one can do with the blood sugar, blood pressure whatever to check on the diagnosis or assessment. it depends on the use of standardized questions. in some cases and this we're working hard on right now. we are changing how we schedule appointments and simplify so it is much easier to get veterans and for the follow-up assessment. you should hold us accountable and i would look forward to showing you where we've been and where we are going. in no way do i not want to say we have problems to solve. we do. wait on them and we are stepping up to the and look forward to your support. where you can help us help you to work with us on reducing stigma. this remains a huge problem and also sending a sense you are supporting efforts to get better care for clinicians -- for

veterans, one of our challenges is a lot of young people are not choosing to go into these fields and that is the ultimate recruitment problem that this -- we have terrific incentives thanks to the clay junta not thanks to the veterans choice act and so forth and those are great tools, but someone has to make the decision to go down the path. >> thank you very much. >> thank you, ranking member kuster. i want to express again turning over documents. your failure to do so makes things very difficult. >> dr. clancy, thank you for addressing the el paso issue to make sure you're not those who are going to be coming off opiates. the feedback stands directly from veterans is apparently not happening in el paso. we both must conclude for every

veteran who takes the time to come to a town hall meeting despite what they are going through to tell their congressman they are having this problem in front of 200 other veterans in this admitting they receive a theist and are now doing without, they were a person represent that it given up and say why should i bother. we've got a problem in el paso in terms of ramping people down or finding an alternate ere pet care with their cessation of opiates. i would like you to respond to something they've heard the secretary say and read about in the press that he's got 28000 positions to fill in the vha. something undersecretary sloan gibson reiterated through mexico, for weeks ago. when the ranking member and other members were in your command and control center on the eighth floor a few weeks

back, we heard the number was not 28000. it is 50,000 positions to be filled. could you confirm the number and tell me how you are prioritizing hires and obviously if we have a crisis in mental health we have a problem if you're prioritizing mental health is a chance to tell the committee and the public at large. >> so i did not hear the number 50,000 so i have to check on that and get back to you directly. the easiest way to say that the 300,000 employees sorting out normal turnover somewhere around 7% or 8% across all disciplines from areas we are trying to fill is a little bit challenging. we have identified five areas that are the highest priority physicians, nurses, mental health professionals physicians assistant and i'm blocking on the fifth one. mental health professionals is

clearly on that list. in fact we have been way ahead of the curve compared to the rest of the country in terms of hiring mental health professionals from multiple disciplines. they work as teams in primary care as well as mental health clinics and so forth trained to do everything to make it almost impossible to seek assistance in getting appeared if you do get care from one of our facilities we have a long way to go. i was simply commenting on the overall pipeline problem. the other area where we do a lot now but could do much more is in tell them until health. big spring texas which isn't that far from you and texas terms, they tried hard to recruit psychiatrists and recently recruited one from the who is not moving. the individual is provided all virtual care. we are working to figure out how to make the business process

work as smoothly as possible. many veterans preferred that. they find it less confrontational. >> is a yield multi-and i conclude you asked for additional briefing are hearing to follow web. i hope when you come back, you come back with a plan for el paso or in the underserved community and say we are paying psychiatrists and psychologists and therapists and social workers and counselors x. i will pay them at plus 20% to get them to el paso for the underserved community and retain them once they are there because you have a huge problem with retention as well. that is a suggestion. for some other plan that treats this as the crisis that it is versus making this a priority. we are going to do this, that heard the other. i need dollars on the table specific offers deals to get

the psychiatrists for mental health professionals they are the first place and keep them there after. i hope to hear specifics. mr. chair and ranking member thank you for holding this hearing. really import. >> ranking member kuster. >> thank you, mr. chairman. i want to follow up for my colleagues that we will do a follow-up hearing not only on the types of pain management and techniques that do seem to be working but didn't take a particular i would like to include tele mental health and maybe even do a short demonstration. just for you that might be an alternative in a crisis situation that you have. i want to make sure we stay on top of days so our colleague can get through. >> thank you, ranking member kuster. you are now excuse. today we have had a chance to

hear about problems that exist within the department of veteran affairs with regard to prescription management and veteran suicide. this hearing was necessary to accomplish a number of items to demonstrate the lack of care and follow-up for veterans prescribed medications for mental disorders, to demonstrate inaccuracies and discrepancies in the data collected by va regarding veteran suicide and those diagnosed with mental disorders and to allow the va to inform the senate committee what plans to do to improve his glaring deficiencies in order to ensure veterans are receiving the care they deserve. i ask unanimous consent that all members have five legislative days to revise and extend remarks and include extraneous materials. without objection so ordered. i like to once again thank all of our witnesses and audience numbers for joining in today's conversation. without, this hearing is

adjourned. [inaudible conversations] [inaudible conversations] ..

>> and this morning c-span to taking you live to the national press club in washington, d.c. for remarks by academy nominated actor and veterans activist gary sinise. it will be talked about his advocacy for disabled veterans and the work of his foundation. john hughes as the president of the national press club and he is making introductions right now. >> gary, chairman of the press club speakers committee, the washington bureau chief for the buffalo news and a former national press club president. skipping over our speaker for a moment melissa, director of communications for fedex and the

speakers committee member who organized today's event. thank you, melissa. paul, national security correspondent for u.s. news and world reports. andrea mckernan, reporter with the u.s. a -- uw u.s.a. tv and a "usa today" contributor, and starting thursday a military service dog racer. robert, director of political research at cnn. dave, communication and legislative fellow covering veterans issues are representative mike honda. [applause] i also want to welcome our c-span and public radio audiences, and you can follow the action today on twitter use

the hashtag npc lunch. even though this is a breakfast, use hashtag npc lunch. now, gary sinise has devoted great energy to raising support and awareness for america's service members, and their families. it was here at the national press club in 2011 that he announced the launch of the gary sinise foundation. the foundations nation is to boost troop morale and to help old resources and self-reliance for service men and women who are in transition. the foundation's projects include providing custom smart homes for the severely wounded. but even before the foundation, he used his celebrity status in support of u.s. military personnel. this band has performed around the world raising millions of

dollars to benefit the nation's veterans. the band of course is called the lt. dan band. it is named for his academy award nominated role as wounded vietnam war veteran lieutenant dan in the movie forrest gump. you might know sinise for other roles as well. he spent nearly a decade playing detective mac taylor in the tv program csi new york. it also had roles in movies such as apollo 13 "the green mile," but it's his role as servicemember advocate he seems to enjoy best. sinise serves as spokesman for the medal of honor museum. he is the patron of the g.i. film festival highlights movies that positively portray veterans and the military. he has cohosted the national memorial day concert for a

decade, and is certainly a familiar face in washington in that regard. and sinise as recipient of the presidential citizens medal, the second highest civilian honor for deeds performed for the nation's servicemembers. tonight, the national association of broadcasters education foundation will award him its highest individual honor, the service to american leadership award. ladies and gentlemen, please join me in giving a warm national press club welcome to mr. gary sinise. [applause] >> thank you. thank you.

thank you very much. it's good to be back. i want my to what to say something. the last time i was here there was a big sort of wooden medallion here on the back, and about halfway through my speech it fell down. [laughter] so i'm glad it's not here. i'd like to thank the members of the national press club. john, thank you very much for the invitation to speak today. it's a great honor for me to return to speak since i think first and opportunity in 2007 as national spokesperson for the american veterans disabled for life memorial, which after 16 your effort was finally dedicated and open to the public on october 5 last year. the second time addressing the members of the press club was in support of the documentary film brothers at war. and a third time, as john said, four years ago when we first launched the gary sinise

foundation. i guess i haven't burned any bridges here at the press club yet. keep asking me back, thank you. i'd like to speak a little today about how far the gary sinise foundation has come in those four years with the work the foundation is doing and what the future looks like as we continue to grow. and i like to emphasize how important it is to have nonprofits in the military support space as our military servicemen and women continue to confront the dark forces of this world on many fronts with long and varied of the deployments. but first i'd i'd like to note a few people but here today. one of our board members bobby seale. thank you for coming, bob. i appreciate you being here sir. [applause] i had a very distinguished guest

that john introduced them a friend of mine who's here with us today. general james livingston was awarded the united states highest military decoration, the medal of honor for heroic actions in 1968 during the vietnam war. and on that fateful day, captain livingston and about 800 fellow marines ran up against a north vietnamese company of 10,000 strong enemy combatants. 10,000. against 800 marines. what captain livingston says was a fair fight. [laughter] during the ensuing fight captain livingston was wounded three times through heavy fire, and despite his when she coordinated attacks to destroy over 100 mutually supporting enemy bunkers repelled a savage

enemy counterattack and refused to be evacuated from the field until he was assured of the safety of his men. and he would serve two combat tours in vietnam. he was presented the medal of honor on may 14, 1970, by president richard nixon. rise in the ranks he retired from the marine corps as a major general. general livingston's philosophy on leadership is to lead from the front. he said if i'm willing to do it, then i can ask you to do it or he never had a marine under his command, then say to them, i don't want to do this. following his example they all did their job and whatever he asked of them come and performed superbly. that is true and inspiring leadership. general livingston, thank you, sir, for being here. [applause]

>> we are truly grateful for everything you have given in service to our nation. and i know we have several veterans here today so i want to personally say thank you to all of our veterans for being here and for stepping forward to serve our country. it has been said that the training of america will always be the land of the free, as long as it is the home of the brave. the veterans here today ensure we live in a free country because they were willing to take the fight to the enemy and keep the enemy from coming to our shores. a community, a city a country,

can only flourish as the people of the peace in their everyday lives to enjoy their life and liberty, and have the opportunity to pursue their happiness. in doing so they make their communities flourish with commerce and trade, and create an environment where each child's dream has the hope to be realized. we have seen a nation born of these ideals comment from generation to generation it has shown itself to be the greatest, strongest and most prosperous nation on earth your the envy of the world. today we have an all-volunteer force that wears the uniform and our collective home, the united states of america, is kept safe by the men and women of the united states military willing to serve and sacrifice so much of our way of life is secure. and with these sacrifices being made each and every day there comes a much-needed.

that is why today more than ever it is so important to a successful nonprofits in the military support space. as government alone cannot possibly build all of the needs. over the years there have been so many experiences that have led me to realize that we must be there for our men and women in uniform to make sure that they are taking care of before during and after the battle. after the tragic events of september 11, 2001, wanted to do something to support those who are going in harm's way in response to those attacks, i begin to volunteer for the uso. going on handshake tours and entertainment tours with my plan to let our military know that they were appreciated, that we were thinking of them come and that their service and sacrifice did not go unnoticed.

during the thanksgiving holiday inn 2009, i was visiting bagram air force base in afghanistan, and general mike skipper roddy who was the director of operations for united states central command providing oversight to all military operations throughout the centcom area of responsibility including iraq and afghanistan he came to me and he informed me that there would be an angel flight early the following morning for a fallen special forces soldier was been killed in action. the general invited me to the ceremony would use military would load the casket of our fallen american heroes on a plane to repatriate his remains back to america. what my eyes saw and what my heart felt that they has always stayed with me. i watched hundreds of american

servicemen and women from all branches, most of them including myself never knew this soldier personally but they gathered in formation in his honor to pay their respects at all for a farewell salute to a brave fellow american soldier. the mood was somber. the casket draped with an american flag, was carried by eight members of his unit moving slowly and solemnly onto the plane as the formation was commanded to give their final salute to an american who gave his last full measure of devotion for his country. indeed a sight to behold. members of his unit was the day before were fighting by his side placed his casket on the bed of the c-17 kneeled down around it and offered their final prayers

and farewells to their brother. than the rest of the formation followed suit rank by rank traveling up the ramp of the c-17 to pay their respects. it was my sobering honor to be by the general site as we entered the plane and meltdown beside the casket. i was flooded with emotion for this young man and his family, the painful and sobering reminder of the cost of freedom. so in looking back on my own journey working with veterans groups in the chicago area in the '80s supporting our wounded for the disabled american veterans association in the '90s and the post-nine 9/11 as i begin to understand the full weight of our servicemen and women carried with them into battle and oftentimes bring home with them when they return from long deployments i begin supporting

many military charities and participating in as many support concert and fund-raising events as i could to raise awareness, spirits, and support them. in 2011 i brought all my endeavors together to serve our veterans under one umbrella launching the gary sinise foundation. in just four years with the generosity and support of the american people we've been able to start

health 1200 veterans and their

families through their times of urgent need. 162 children and family members of the fallen 156 veterans, 944 wounded. the first responders outreach, gary sinise foundation has provided support to train 45 firefighters and in black force call about after the devastating fires there. support the families of the hotshot in prescott arizona, after 19 firefighters were lost in the deadly firestorm. donated to lt. dan band's to the fdny fire family foundation sent -- transport to medical facilities. and we've awarded six grants to police fire and ems services. other programs include our arts and entertainment outreach taking veterans to theater around the country for a free meal and performance.

and as part of our educational outreach we have end of world war ii program, the most recent partnership with the national world war ii museum in new orleans. gary sinise foundation has helped finance a historian who has to date recorded 35 world war ii veterans, stories, oral histories, preserved on video in the museum archives preserving america's history and their legacy. we will also include a trip next week for 50 world war ii veterans from california to see this magnificent museum built in their honor. so we have come a long way in four short years that we are impacting the lives of her veterans and active duty across the nation to it is truly the most rewarding mission i've had in my life to strengthen members of our military. one of the hardest things to come to terms with when you endeavor to a life of service is

the enormity of the need that exists today. it has to be upon us and our communities to close that gap and meet that need. with all of your artsy inefficiency and the difficult challenge is currently being reported within the va, it is important that the our successful nonprofits in the military support space that we engage common courage and as far as many communities within this country as possible to address the needs of local veterans. so i applaud all the military nonprofits that are here today doing the good work. during the conflicts in afghanistan and iraq would have seen remarkable advances in field medicine and care. while this may reduce the number of casualties, many more have returned home injured or seriously wounded. as we have now been at war for the past 14 years, roughly 50,000 military personnel currently live among us bearing the severe wounds of war both

physically and mentally. their struggles can affect the entire household, and ongoing treatment can quickly become ruinously expensive. we have become aware of the startling shortfalls in daycare these men and women often face. with the media, they have provided troubling glimpses at health related complications that veterans experience in seeking care the bigger picture is alarming. survey data suggest 71% of americans do not understand what combat veterans endure, and 84% of veterans polled said the public is little awareness of the challenges they face in life after combat. this suggests an urgent need to supplement existing support and raise public consciousness on a grassroots level. and emotional drama is at epidemic proportions.

from 2002-2012, 103,972 cases of post-traumatic stress were reported. according to a report from the department of veterans affairs an average of 22 american veterans continue to take their lives every day. physical injuries often compounded the emotional damage. in the same 2002-2012 time spent, 1715 out of injury amputations were performed. beyond the personal struggles loss of limb and/or physical disintegration, place a tremendous stress on veterans families loved ones often must take on the role of caregivers, and post-traumatic stress can affect the entire family. maintaining access to ongoing health care support system is a

daunting task. reentry society and find employment is especially difficult. more than half of all veterans report feeling disconnected from their communities. better sense of disconnect is a solvable problem -- their sense of disconnect -- raising awareness will help where help is needed within individual communities are important first steps. local citizens in every community need to connect with these veterans and their families to provide support however possible. as citizens who benefit from what they do for us it is our duty, very simply put every neighborhood in every community and every town and city and in every state sought out their local veterans and offered their hand, we would greatly reduce the problem and most likely

have the problem solved. it is a dangerous and unpredictable world. we need to keep our military strong and ready to face the evils of this world that would seek to destroy our way of life. they are our freedom providers and they and their families need our help. and as we all know, we all too often take our freedom for granted. i recent return to my third trip to korea performing for our troops, and a third visit to the dmz, a strange very strange and sad place. this time while there something happened that didn't have it in my previous trips. as we came out of the building and approached the borderline two north korean guards came

right up to the borders and to take pictures of our group. i was two feet away and could look directly into the eyes of these guards. haunting and very sad eyes. they know nothing but worship of the supreme leader, and are slaves to their master. or hats there's no place on earth where one can feel a palpable difference between freedom and slavery more than standing on the border between north and south korea. the north koreans know nothing nothing of freedom. for three generations they have been oppressed a dictatorship indoctrinated by a regime that

has enslaved and and sealed them off from the rest of the world. the north koreans have a military that is there to suppress them and take their freedoms away. but with the united states by their side, like all of us here in the u.s. the south koreans have a military that's very purpose is to protect their freedoms and provide life liberty, and the ability for every man, woman and child to pursue their happiness. education is the key to making sure our generation and future generations know the high cost of freedom and what our military men and women sacrifice to endure, and endured in providing it, as it is gracious and we must never take it for granted. not everyone in this world gets to live eyed we do. is there any doubt there are evil forces in this world that given the opportunity we do

anything within their power to destroy what we as americans all western nations have grown so accustomed to? freedom, liberty, and the pursuit of happiness. like our brave heroes of world war ii whether only two possible outcomes in the world at that time, tyranny or freedom our defenders today stand as guardians of all the we hold dear against another evil that the heads and crucifies christians come enslaved and oppressed as women and children, and punishes anyone who does not submit to their twisted view of the world. on october 22, 1962 addressing the nuclear threat posed by the soviet union and the u.s. response to missiles in cuba president john f. kennedy said, the path we have chosen for the present is full of hazards, as

all paths are but it is the one most consistent with our character and courage as a nation, and our commitments around the world. the cost of freedom is always high, and americans have always paid it. and one half that we shall never choose is the path of surrender or submission. today, we face many threats to peace and security of the world. indeed, full of hazards of the present, and we're thankful to the american men and women who are willing to do the dangerous work necessary to ensure that we remain free and secure. still, with a disconnect between the average american and its military, i believe education educating our citizens and our youth as to what a military men and women and/oand/o r in combat with long deployments away from

family and friends is in order. so that we better understand why it is critically important to support them and take care of them. this is what i want to talk to you today about the importance of the medal of honor museum, the effort to build a national museum in mount pleasant, south carolina. now, in retirement general based in is very passionate is a very busy man. among other things he is a member of the board of directors of the medal of honor museum foundation. in addition he along with seven other medal of honor recipient -- student in which we do all museum exhibits and programs to ensure they are consistent with the mission of the congressional medal of honor society a society is the brotherhood of the 79 living battle of honor recipients. education can come in many

forms. one way is through memorials and museums where the stories of those who served have a permanent place to have their voices heard. since the first medal of honor was awarded by president abraham lincoln on march 25, 1863, more than 25 million men and women have served during our nation's conflicts. fewer than 3500 of them less than 22% have received the medal of honor. those who wear the medal represent america's bravest and best. album of service and sacrifice in defense of our nation. their stories offer lessons for us all in how to live our lives with honor integrity and character. my own issue with the medal of honor society and foundation goes back to 2007. i have been humbled and blessed to serve on the foundations

presidents advisory group, and now through the invitation of general livingstone, on the board of directors as a national spokesperson for the medal of honor museum effort. it's been my privilege and great honor to get to know many of the recipients of the medal of honor personally, and to hear their stories, to be among america's bravest, to listen to them and interact with them has been a blessing and a true education. they have all shown me a quiet strength and modesty. and they all say that they were the medal of honor not for themselves but for all those who fought so bravely alongside them and did not make it home. that we would remember them and their sacrifice. more than 18% from 646 of the medals awarded since 1863, have been presented posthumously but from the civil war into world war ii out of 2418 medals

awarded, just 3% 83 were presented posthumously. from world war ii to the present, however, more than 60% of medals have been awarded posthumously. 58% in world war ii 73.8% in the korean war 62.9% in the vietnam war and 43.7% in the wars in iraq and afghanistan. within the last few decades the defense department has reviewed records of a number of potential medal of honor recipients who have been passed over in the past because of their race, religion or ethnicity. as a result of these reviews a number of african-americans, hispanic, japanese and jewish servicemen have received long overdue recognition as medal of honor recipients. medal of honor recipients hail from every walk and every station in life.

they reflect the ethnic cultural, economic, religious and educational diversity that is a hallmark of the american experience. all 50 states the district of columbia, puerto rico, guam, more than half a dozen nations are represented. mode and 20% of recipients were born outside of the united states. today as i mentioned there are 79 living recipients. fewer than at any time since the civil war when the medal was first awarded. the oldest recipient of world war ii is 94. the youngest, a veteran of the war in afghanistan is 25 their and their average age is 71 years old. the medal of honor is the nation's highest award for valor in combat, the only military medal that is worn around the neck.

it's recipient are the only individuals whom the president salutes as a matter of custom. it is awarded by the president in the name of congress to a member of the armed forces who distinguishes himself conspicuously by gallantry and intrepidity at the risk of his life above and beyond the call of duty. while engaged in an action against the united states. so the medal of honor museum is in the works. why? to preserve the stories of medal of honor recipients presenting them to new generations sorely in need of true heroes to look up to and emulate to help visitors understand what it means to preserve service above self and the meaning of the price of freedom. the future site of the museum is located at patriots point in mount pleasant, south carolina, on the eastern shore of charleston harbor directly across from the u.s. as

yorktown. throughout the museum visitors love multiple opportunities to meet and interact and learn from the recipients through films videos and dynamic elements and in depth explorations of personal stories and experiences that will honor and promote the ideals and values associated with the metal. two galleries will be devoted the congressional medal of society character development in citizens honors programs to educate our america's youth and citizenry. as one teacher recently commented on the character development program saying, our children want to change the world on so many levels. the medal of honor curriculum offers of them the tools and opportunity to do just that now and in the future. aydin, education is the key to helping the youth of america

understand and be inspired by the valve and selfless acts of courage that those who earned the medal have so valiantly portrayed in the most harrowing circumstances. i am honored to serve on the board of directors come as national spokesperson for this worthy and important project and encourage you to seek out more information like going to the medal of honor museum website moh museum.org. for the gary sinise foundation effort you can learn more at gary sinise foundation.org. james michener in his book the bridges of tokyo rights movement of the heroes who fought in the korean conflict ended in the book's final scene and admiral stands on the darkened bridge that is carrier waiting for pilots he knows will never return from their mission. as he waits he asks in the

silent darkness, where did we get such men? today, as i stand in the presence of general livingstone, and all our veterans here today i ask again where did we find such men and women who are willing to go into harm's way to keep us free? the answer is very simple. we find them where we've always found them come in our villages and towns, on our city streets and in our shops and on our farms. america's families defend us all. one generation fighting for america's future, one generation conspiring the next so that i didn't a young would rise out of the communities that would dare to stand and face those who would do us harm and say boldly and with conviction, not on my watch. and to those who stand guard deserving to know there is a

grateful nation standing behind them, and who may from time to time question whether their service will go unnoticed, or who would ask will our sacrifices the sacrifices of our fallen, are wounded our military families, be forgotten? i say and i encourage all our fellow americans to say not on my watch. thank you. [applause] >> and >> thank you very much.

each generation of war has prompted lessons learned. ptsd awareness out of world war ii and korea, and separate in troop support from war support coming out of vietnam. what do you think we should learn from the veterans of the wars in iraq and afghanistan? >> there's much to learn. thankfully, and i will say this i haven't vietnam veterans in my family so i'm very motivated by what i learnt in the vietnam veterans in my family years ago back in the late '70s and early '80s. when they came home from war. and a big catalyst for me today in supporting iraq and afghanistan veterans in trying to assure that they have the services they need, they are shown the appreciation that they

deserve our from what happened to our vietnam veterans. and the shocking reality, the shameful way they were treated when they came home from war and the services that they needed that they didn't get. we have much to learn. we have come as i said, there's a major epidemic within the military community of those suffering from post-traumatic stress. thankfully there are a lot of services within the va that are being provided but also within the military nonprofit support space. i think part of my feeling about this is that, you know, with the thousands of military charities that are out there, military nonprofits that are filling these gaps in trying to provide services like service dogs, for example, these dogs are very important to mental health,

thankfully there are those military nonprofits. because we all know that the challenges the va has come some wonderful people working within the va, but it's a challenging environment for our veterans. thankfully there are these military nonprofits out there that are trying to address needs on multiple fronts. the caps organization is here today, bonnie carroll who is providing a great service to the families of our fallen. there's a post-traumatic stress involved with their for our iraq -- afghanistan comes that they go through. thankfully there are services out there that are being provided, and i encourage anyone who is seeking service or seeking help from the iraq and afghanistan committee to continue passing on the information of where these services are provided. there's a lot to learn from

from those who served in past wars and certainly those who are serving now. we can never do enough for those who are serving our nation. there's a lot more to be done and we can always try to do a little bit more. >> with nearly a decade of war winding down how do you see the mission of your foundation changing as fewer and fewer combat veterans, out of the armed forces? and with the war is winding down, do you worry that it's going to become more difficult to get the american people and the political system to appreciate and properly serve that trained? >> it already is a more difficult. our servicemembers continue to be deployed in harm's way yet they're off the front pages for the residual effects of these wars will last for decades as they continue to last from previous wars.

we still have challenging environments within the pattern community from all wars, don't we? you know i've never been to combat and i know many of our veterans here have. it never leaves you, never goes away. you can certainly move beyond it, but the more we can keep consciousness and keep people aware of what's happening within our military community, the more services will continue to be provided. i think this is where the challenge becomes greatest as we do draw down, as we do leave the battle space and leave the front pages, is about as i said, the residual effects of these wars will last for decades and we need these services to be provided continually. that's what somebody like me can come in and be useful, you know? i can talk to the press club

where, and express myself and get a public platform around the country to try to keep this awareness up and help us meet military charities as i possibly can because they need is enormous but there are lots of unmet needs out there and will continue to face these challenges. so keeping awareness of is important, it's primary. thanks to you for having me here today to be able to keep awareness up and to talk to members of the press club about this what you can do is help you know keep this in the consciousness of the american people. we are tired of war. we have been at war for 14 years, and yet our military continues to serve, continue to challenges. our military hospitals continue to serve those who have been injured years ago. i mean, i know people the gone through rehabilitation for years and will continue to do that.

we have, whatever families here, luis and claudia are here today. we're going to be doing a whole building project for deweese and claudia there at the hospital every single day. god bless you for serving our country. thank you for being here today and we can never do enough for you and what you have done, luis. [applause] >> this question is is for those not familiar with the story please tell why you took on the leadership of this noble cause. but to broaden out you talked about after 9/11 getting involved. was about after nine 9/11 that it stepped up, or did you really have this passion even years before growing up? talk about your own evolution to where you are today is such a devoted servant to this effort. >> as i said, it begins with the

family members, begins with family members on my side of the family, world war i veteran, my grandfather served driving in and maintenance in france on the frontline in france. two uncles in world war ii my dad served in the navy on my wife's side of the family, her two brothers served in vietnam. i learned much from them. it's really the vietnam side of the family that opened my eyes in the late '70s and early '80s, because by the time i was old enough to absorb things as a young teenager family members on my site of the family, they were well beyond their service. so i don't remember my grandfather ever talking about world war i. i don't remember my uncle talking about world war ii until i started to a lot of this work and that i would take it everywhere i went and just getting talking. as a matter of fact, he would spend memorial day here with me at the concert every year. he unfortunately passed away at

90 years old this past october, as did my brother-in-law jack, who is a combat medic in vietnam, and state in the army for 22 years. i learned so much from him, so much from the veterans from my wife's two brothers. they've really got me thinking. so i got involved with vietnam veterans groups back in the '80s in the chicago area, supporting them. so 10 years later i had of this opportunity to audition to play a vietnam veteran, forrest gump i really wanted to do having veterans coming out and being involved with vietnam veterans in the chicago area. luckily i got the part of a big and association with the disabled american veterans association. as i said that relationship goes back 20 years. and then after september 11 when we were attacked it just felt this is this is were i could employ my service to helping those who serve and those going out in response to those

devastating attacks. and so i volunteered for the u.s. out and started visiting our troops, and you know so this is a decades old and it all came together for years ago when i created the gary sinise foundation, launched it right at the press club. and now, you know my objective here is to have this foundation be here long after i'm gone serving and honoring the needs of our military and veteran community. like i said i don't think we can ever do enough for our freedom providers. and this is a dangerous 21st century and we will be facing a lot of challenges and the military will be called upon to me many times in the coming decades. >> the "washington post" recently ran a story headlined military tributes at baseball games, true honors or hollow gestures? how would you answer that question? and also talk about the change from come after vietnam today in

the appreciation and recognition that veterans receive from what they want to do. what really driven that change primarily, do you think? >> i don't, you know, i can't respond to the baseball game thing. i don't sports think i really don't know anything about that. but i think we learned some hard lessons from vietnam and general that they spend state in the military for 33 years. i know -- general livingston stayed in the military for 33 years. my brother-in-law jack who stayed in a military 22 years after vietnam it was a good place for him to be. but for my other brother-in-law, my wife's brother uncle was a helicopter pilot in vietnam he got out after his tour and it was very very challenging for him. to try to blend in and forget

jenna, to pretend he wasn't a vietnam veteran, which at that time so many went into vietnam had to do. said it was a challenging time, and our nation triggered our veterans in a shameful manner and does a difficult time for our country and certainly a difficult time for our veterans. it was a hard time for the army i know, very difficult time for our marines. but we learned and i think the reason you see over 40,000 military nonprofits out there today, there are over 40,000 have popped up in the last 14 years, and i think one of those one of the reasons is because people are aware of what happened in the late '60s and early '70s, and it's '70s when our vietnam veterans were treated poorly. and like me many of them wanted to dive in to try to prevent that from happening to our active duty service members in iraq and afghanistan. education, as i was in sync am

is such a critically important part of letting our young people understand why it's important to support this .1% of our population that served in military, in the military. it's a very, very small percentage of over 300 million people are serving in uniform defending our country. a lot of people, a lot of young people come if they don't have a personal connection like i do do some who serve in the military there's a disconnect. there's a serious disconnect between the average american citizen and its military. so keeping awareness up on education, that's why i'm supporting the medal of honor foundation using. this museum project will act as a beacon of education for what service and selflessness and character is all about. we want our young people to

understand something greater than themselves, a service. and that doesn't mean it always applies to war and the warfighter. but the legacy of the medal of honor is about so much more than that, isn't it? that's why disney didn't project is important. that's why i'm i am supporting it. that's what i encourage you to go to moh museum.org to learn more about it. we have a national world war i museum in new orleans honoring the service of our world war ii veterans and educating our young people as to what happened when freedom and tyranny were the only choice in the world and i think this month of honor museum would be a great education for people. >> we just have a few minutes left, before i ask you a question or two about hollywood, i just have some housekeeping. the national press club is the world's leading professional organization for journalists

and we fight for a free press worldwide. for more information on the club visit our website at press.org come and to donate to our nonprofit journalism institute visit press.org/institute. i would remind you about some upcoming programs. on thursday archbishop joseph kurz, president of the u.s. conference of catholic bishops come and cardinal donald, archbishop of washington will discuss pope francis encyclical on the environment. on june 20 for the next two saturdays after that, our journalism institute will hold a series of training sessions on cybersecurity. and on july 8, washington capitals coach will address the national press club luncheon. i would now like to present gary sinise with our traditional national press club mug.

[applause] >> wow thanks. spent those of course are very special, valuable gifts, edging out before i believe. so you're working on the set. in the time remaining, i wanted to ask you, you know, you mentioned about you can use your celebrity status to promote these causes. and, of course, you keep working on the end of your career as well, and you've got a new series upcoming. could tell us a little bit about this new tv series of you are beginning? >> oh, yeah the job. [laughter] oh, yeah, the day job, well csi new york went off the air in february of 2013. so since then i've been pouring all my energy into the military support veterans support

foundation, building the foundation. traveling around the country in the world raising awareness and that kind of thing. but i was approached by cbs about doing a pilot for a new spinoff series of the show criminal minds. so we shot the pilot and it was an episode of a criminal minds the series where the introduce a new team of the international division of the fbi and the behavioral analysis unit. so that will come and they picked us up some going back to work july 27 we start shooting in california and we will explore the international division, as i said, so every week we will be in a different country chasing bad guys and trying to protect americans. [applause]

>> and in preparation for this role, you are doing some work at here as well? >> yes. tomorrow i'm actually going out to the fbi and i will be visiting, getting some briefings out there meeting cepeda, doing some research for the port excited to go out to the fbi tomorrow and this will be my first time there. i'm very much looking forward to it. one of our technical advisors is taking me there. is an fbi guy who moonlight as a writer. >> ladies and gentlemen, please join me in getting a round of applause to our speaker today. [applause] >> thank you for having me. thank you. [applause]

>> i would also like to thank the press club staff concluded that the journalism institute and broadcast center for organizing today's event. if you would like a copy of today's program or to learn more about the national press club, again you can go to our website, press.org come and again i want to thank all of that service organizations that have joined us today for this breakfast. it made it extra special and we of the national press club are grateful for all of the work that you do. and thank you so much. we are adjourned. [applause] [inaudible conversations] and if you missed any of the remarks by gary sinise at the press club you can find them online in our video library c-span.org. as we take you live to the floor of the u.s. senate lawmakers are about to gavel in. more work expected on the 2016

defense department programs and policies a bill which contained $612 billion for the pentagon for a vote expected at 11:30 eastern time on anti-torture amendment with more amendments to be considered in the afternoon. senators will break at 12:30 p.m. for their weekly party lunches and returned at 2:15 p.m. you are watching live coverage of the senate here on c-span2. the chaplain: let us pray. sovereign lord, your kingdom cannot be shaken. thank you for inviting us to ask and receive to seek and to find, and knock for doors to be open.