more opportunity to -- >> a stable afghanistan is a good, strong, stable possibility? >> i don't think it's going to become canada, but it has the opportunity to create for itself a functional nation state. but a lot of that will be dependent upon our commitment to helping them get there. >> the comments of senator marco rubio, taking questions from marinkalb. we'll continue the conversation tomorrow morning here on the washington journal which you can listen to on cspan radio, ed o'keefe will be talking about the postal service bill. also a conversation with two members of congress the chair of the house armed services kmerks as he talks about the defense department bill and joe courtney, democrat from connecticut on to talk about other issues, the student loan debate on capitol hill.

join us tomorrow morning at 7:00 a.m. eastern time, 4:00 for those of you on the west coasoh and thank you for joining us on this wednesday. i hope you enjoy the rest of your evening. next on cspan 3, a senate veteran's affairs hearing on mental health. then a memorial service at the capitol for congressman donald payne. and the senate commerce committee looks at how online video and new technologies are changing the media landscape. today the senate veteran's affairs committee held a hearing on veterans' access to mental health care, a report by the va inspector general found that veterans have to wait for nearly two months to get an appointment with a mental health provider.

>> this hearing will come to order. i would like for all of you to -- access to mental health care services. today's hearing built upon two hearings held last year. at each of the previous hearings, the committee heard from the va how accessible mental health care services were. this was inconsistent with what we heard from veterans and the va mental health care providers. so last year, following the july hearing, i asked the department to survey its own mental health care providers to get a better assessment of the situation. the results, as we all know were less than satisfactory.

could not schedule an appointment in their own clinic -- over 40% could not schedule an established payment within 14 days of their desired appointment and 70% reported inadequate staffing or space to meet the mental health care needs. the second hearing held in november looked at the discrepancy between what the va was helding us and what the providers were saying. we heard from a va provider and a mental health expert. at last november's hearing, i announced that i would be asking va's office of inspector general to investigate the true availability of mental health care services at va facilities. i want to thank the ig for their tremendous efforts in addressing such an enormous request. the findings of this first phase

of the investigation are substantial and troubling. we have heard frequently about how long it takes for veterans to get into treatment and i'm glad the ig has brought those concerns to light. the ig will also discuss an entirely different and more useful way of understanding access to care. this model would give more reliable bat t data and reduce rampant gaming that we have seen so far. the i zbrks has lost found that the existing scheduling system is hopelessly insufficient and needs to be replaced. va has struggled with developing a new scheduling system. i understand va is working to get a replacement system in place. i would like the department's commitment that they will work to get this done right and get it done soon. the ig findings also show some serious addition kr

serious discrepancies. 95 first of veterans received mental health evaluations within 14 days, in reality, it was only about 50%. vha data reported that after the evaluation was completed, 95% of veterans received a treatment appointment within 14 days, in reality it was only 64%. for those in treatment, 12% were scheduled beyond a 14-day follow-up appointment window will providers telling the ig that they were delaying follow-up for months, not because of the veteran's needs, but because their schedules were too full. va is failing to mite it's own mandates for timeliless and at the same time making the data look like they're complying. the va can and will do much better. vast week va announced the addition of 1,600 mental providers and late last year, the va announced an increase in

staffing levels at the veteran's crisis line. but as we will see today, the hard work remains in front of us at a time when veterans are dying by suicide at an alarming rate. we know that the sooner a veteran can get a mental health care appointment after they request it, the more likely they are to followthrough with care. we can't afford to leave them discouraged when trying to access care and when in care, we must be getting veterans their next appointments within a clinically -- while i commend va for the decision to hire another 1,600 mental health providers, there is still no reliable staffing model to determine were these individuals are needed. without that model, va needs to explain how they will know where to place these additional providers. there are other challenges with getting the best providers into the system. i understand that nationally

there are short amgs of menl health providers and it's even harder for va because they cannot always pay the highest salaries in the community. there are still a large number of vacancies in va's mental health ranks, i want to hear from the department how they will fill the existing gaps and ensure the new positions they have announced do not become 1,600 empty offices. ultimately, what really matters is how long it takes for a veteran to start that first treatment session. what really matters is not abandoning that veteran. i recently saw andrea sawyer whose husband lloyd suffers form ptsd and depression, andrea bravely testified before this committee last july about the tremendous difficulties she and her husband faced in getting him into care. lloyd still faces challenges. but he's now getting the care he needs. that is what matters. we cannot let our veterans down, especially when they have shown the courage to stand up and ask for help.

i look forward to hearing from va, how they intend to address the issues the ig has found. now more than ever is the time for action and for va to show effective leadership. let the hearing today serve as an unequivocal call for action, the department must get this right. in closing, i do want to be clear that while we have discussed a number of problems with the system at large, none of this reflects poorly on va's providers. i believe i can speak for all of us in thanking va's many mental health providers for the incredible job they do do. but make no mistake, these individuals are incredibly dedicated to their profession. they choose to work harder than their peers, all for less lucrative -- to all the va's

psychologists, psychiatrists and social providers and all the administrative staff that support them, thank you and keep up the good work. and with that i'll turn it over to senator brown who's standing in for senator byrd today. >> good to be back on the committ committee. i'm still serving, i see and hear of these types of situations regularly. $5.9 billion that's the increase that va got. out of that, do you think we could hire some more people to address these very real concerns? $5.9 billion and to read some of the things that we have been reading about the suicidal veteran calling for help gone unanswered, one more person killing themselves, and the veteran's mental health care is delayed, put out by "the washington post," actually yesterday talking about how the

system is being gained by the va and not actually scheduling and following through with scheduling and providing a good opportunity for these soldiers to get the care and coverage that they need. it's minds boggling. i understand the delay, i understand that there are problems, i understand that claims go for over a year. but for somebody to call and say i'm thinking about killing myself. well, not right at this moment, but yesterday i thought about hanging myself. i want to continue to look into mental health services, your insights on this committee help perform the oversight to ensure the veterans get the services they need and that's a good thing. as you know, one of the several hearings regarding members of the jury health services provided by the va this is another one and last year i remember we did learn about the various mental health services that were needed and quite

frankly land lacking and i will say that today's hearing will focus on evaluating the availability of these services and assessing the care that's delivered. the testimony we hear today will be from va's inspector general and the va mental health officer nick ftorentino. i want to thank you for your testimony and -- i got to tell you, it's unacceptable, as i said for somebody who still serves and sees and speaks regularly with people who are affected by these very serious ailments. and the gaming of the system has to stop and the ig found in their audit that the veterans are not given the opportunity to actually offer a desired date for their next appointment, they were simply told when and where to show up, and no consideration or compassion to address the very real concerns that they

have, and schedule system is not the only problem with delivering mental health care, even though the va has increased the staffing by 48% between 2006 and 2010. both the va and the ig says there's a -- it's no surprise that just one week after this hearing, the va announced they're hiring an additional 1,91 1,900 mental health staffers. we have people's living depend on these di decisions that we're making. it's a good step as i said, but how long will it take to actually fill these positions and what happens to that soldier who calls as has been happening with jacojacob mann and others.

it's a great example of the community coming forward and addressing needs not currently being met and in the end simply hires more staff will not cure all the issues, but it will certainly take a combination of changes, developing better performance methods and i concur with you that the individual people that are there, are doing oweman's work. $5.5 million should go a long way to address those issues. i'm going up stairs and then i'll be right back down. then i look forward to everybody's testimony, thank

you. >> at this time i would like to introduce the first panel. representing the va is mr. bill schoenhard, he is accompanied did antoinette seiss and dr. mary schoene. from the office of inspector general, we have dr. david day, assistant inspector general for health care inspections, accompanied by dr. michael shepherd, senior position in the ig's air force of health care inspections. also from the office of inspector general, we have ms. linda halladahalladay. and next we will hear from nick torintino, he is a navy veteran of the iraq war and a former mental health administrator in the va and then welt will hear

from retired united states marine corps major general thopgs jones. >> we have a lot of answers we need from you, so please begin. >> thank you. chairman murray. we appreciate the opportunity today to address the access to quality of mental health care services to our nation's veterans. and we appreciate so much discussion of a topic that is integral to the well-being and full living out of a fulfilled life of our nation's veterans. mental health is integral to the overall well-being and physical health of a veteran. it's important that if there's underlying depression, problem drinking, substance abuse or other mental ailment that this be diagnosed to ensure that those who have served our

country have the fundamental -- physical health aspects of medication management, staying employed and the rest which is so important to the quality of life of a veteran who has served this country. it is the sacred mission of va that this very integral part of our care is well delivered. i appreciate so much regarding your comments of the 25,000 providers who work so hard every day to treat our nation's veterans in this important mission. in the statement, i have outlined three areas of improvement and concern, but i would like to make first mention that we appreciate so much your leadership, the committee's review, and the inspector general's review.

this is an important aspect of care and we appreciate all of the assistance and we will be working very closely with the inspector general as we go forward with their report as it relates to the first recommendation that i would like to address and that is if we agree with the inspector general that our appointment measurement testimony should be revised to include a combination of measures that better capture the overall efforts throughout a course of treatment for a veteran, while maintaining flexibility to accommodate a veteran's unique condition and phase of treatment. we must also continue our efforts to strengthen mental health integration into our primary care, in order to ensure in the primary care settings that we are assessing mental health needs of our nation's veterans and also be able to address the stigma that's often

associated with this that can be discussed in a primary care setting. second point i would like to make as announced by secretary shinseke said last week, we are increasing staff to increase both the access of menl health care, by hiring 1,900 additional staff, more than 1,600 are actual clinicians. we have 25,000 mental health employees in our system. and it's also a design to increase our staffing of our crisis line, which is so integral to the identification and treatment of people who are in crisis, as ranking member brown spoke of so eloquently. and it's also an important aspect of increase in that we

will be adding additional examiners for compensation and pension examinations. that's an important transition from active duty to veteran's status for those who are currently on active duty and for those who present with new conditions, we have a solemn responsibility to ensure that we increase our staff to ensure that we can handle this volume in a timely fashion and that we can do this in a way that doesn't erode our capacity to serve our existing patients. i want to emphasize, that this additional staffing will be continued to be evaluating the assessed data and refine the staffing model. we are currently piloting this in three divisions and this is a work in progress that will be continually improved as part of our comprehensive approach to

children our facilities have the resources to ensure that we accomplish this mission. and veterans have access to the most effective methods for ptsd and other mental health ailments, we are making more of it widespread and improving our training for those who are receiving care and delivering care of evidence-based treatments. we're shifting from a more traditional approach to one with newer treatments and we acknowledge that we have not always communicated these changes as clearly as we might to our nation's veterans. so we're rebubbling our efforts to improve communication, not only to our providers, but to your veterans, to ensure that these evidence-based therapies are implemented in a way that can be supported by the veteran and fully educated and trained

personnel to ensure that is delivered. in summary, we thank you again for your encouragement, for your support. this is an important part of care that is fundamental to the well-being of our nation's veterans. we look forward to answering your questions and those of the committee. >> thank you very much. ms. halladay? do you want to testify? >> madam chairman, members of the committee--thank you for mental health occasion services. we conducted the review at the request of the committee, the va secretary and the house veterans' affairs committee. today i will discuss our efforts to determine how accurately the vha determines wait times in va facilities. dr. day, the assistant inspector

general will address whether the wait times data va collects is an accurate depiction of the veteran's abilities to access those services. we are accompanied today by dr. michael shepherd, a senior physician in the office of health care inspections and mr. larry rinkermeyer. our review found that inaccuracies in data and inconsistent scheduling pracces -- needed to fully assess current capacity, resource distribution and productivity across the va system. if va's fiscal year 2011 in the performance accountability report, vha reported 95% of veterans received -- we concluded that that 14-day reported measure has no real value as an access to care

measure. because the ig measured how long it took to conduct the evaluation, not how long the patient to receive that evaluation. we calculated the days between the first contact of the veteran for mental health and the completion of their treatment. we see that the va only complete 54% within 14 days, of either the veteran's request, on average it took vha 60 days to provide the full evaluation. once the vha -- schedules the patient for an appointment to begin tree. in fiscal year 2011, we determined that vha completed approximately 168,000 or 54% new

patient appointments for treatment within 14 days of their desired date. that's apprimatel94,000 or 36%. vha data showed that 95% received timely care. we also projected that vha completed approximately $8.8 million or 88% for follow-up for treatment in 14 days nachlt's approximately 1.2 million or 12% of the appointments nationwide exceeded 14 days, in contrast, va reported 98% received timely care for treatment. we based our analysis on the dates documented in vha's medical records. however we have concerns regarding the integrity of the data information because providers told us they used the desired date of care based on their schedule availability. i want to point out that we

reported concerns with vha's calculated wait time data in our audits of outpatient scheduling procedures in 2005, and outpatient wait times in 2007. during both audits, we found schedulers were entering an incorrect desire date. and our current practice -- for new patient appointments, the schedulers frequently stated they used the next vablg appointment slot as the desired date of appointment for new patients. this practice greatly distorts the actual waiting time for appointments. to illustrate, vrksz arksz received approximately 211,000 new patients received their appoint onto on the -- vl ha,'s data would show a 0-day wait time. based on discussions with

medical center staff and our review of the zeta, we contend it is not plausible to have that many appointments scheduled on the exact day of the patient's desire. offer the rest of my time to dr. day who will provide the overall oi zbrks conclusion. o'. >> ranking chairman, members of the committee, it's an honor to testify before you today. i, my staff in the -- daily basis deal with clinical square issues in va and we know that both the employees and the leadership in va strive to provide the highest quality health care. in fact, with respect to quality metrics, i believe va leads the nation with respect to both the use of data and the pub case li of that data on the website.

when it comes to matrix of care reports, those are flawed. a group will be put together to try to resolve the issue and get the access to care metrics in line. i plan to talk about some of the access to care metrics in the private sector, but i think what i would like to make are two different statements after hearing your opening statement. the first would be, i think the va as a number of missions. they have a mission to provide health care. they have a mission to do research, they have a mission to training people who will work in the health care industry. they have a mission to be available in times of natural disasters. i think as individuals in those hospitals decide how they're

going to spend their time, those missions are generally accepted as being equal. there's not a waiting that says the primary mission is the delivery of health care and we will address those assets first as professionals schedule their time or allocate their time. so i think when we have a crisis like we have, a prioritization of mission, again, stated clearly from top to bottom would allow individuals across the system to rethink how they're spending their time. the second issue i think that's important is to set a standard of productivity, i realize that health care can't be numbers driven. i realize it's a personal interaction between a patient and a provider, but at the same time, there has to be some method to determine that you're getting enough work or productivity from the people that are working for you. and so i think although va has

worked on these issues for a while, i think that there just has to be a clear measurable and in my view productivity standard that is easily relate bable to work done in the private sector by a similar provider. so that one can decide whether the money spent is actually being effectively used. i think the other issues that i brought forward are in terms of the kind of access to care standards we could use. >> madam chairman, senator brown, members of the committee. as a combat veteran i'm honored