what problems would you foresee if the va were to adopt the d.o.d.'s definition of prosthetic? >> thank you for the question. i believe the concern that we would have is many of our veterans whom we serve have come to expect a certain degree of their own choice to be honored in the system. and frankly the expectation that a physician doesn't have to defend his or her prescription through an administrative process. my concern would be that the degree of vigilance to ensure that those elements in our system are not lost is what i would worry about, that it would work 90% of the time. i would be concerned as we try to constrain the definition of prosthetic or definition is because we have a broad system that is geographically distributed. my concern would be that we restrict the ability to source specifically what is for the

benefit for a veteran either through a physician prescription or through the veterans choice. >> i get that. i understand what the purpose of 8123 is. but to cut through the red tape, supposed to make sure that nothing is in the way of getting what the person needs. biologics don't seem to fit that definition. that's clearly something that a doctor is going to use like something off the shelf. how a doctor applies that is highly individualized and specific to the patient. what i'm getting at is the d.o.d. has a definition that seems to be fairly comprehensive and meets what most people would want. y'all have a definition that seems to be much broader than that and allows for slippage. i want to make sure nothing we do or recommend puts a red tape barrier between the provider and

the veteran, the person who needs the benefit of the device of the technology that we are trying to make available to them. at the same time we have an obligation to make sure we are not having a loosy goosy definition that we are cutting all kinds of corners and not applying best practices when it comes to make sure we are getting value for the taxpayer. >> when we compared our definitions at the committee's request we compared with other entities. there are commercial entities that use a definition of prosthetics that is comparable to our definition. >> sure there would be folks that would conform to yours. that's not the -- >> the other thing that i wanted to mention. as we are committing this transition process and we are

trying to commit that process as carefully as possible but we are committed to completing it within this fiscal year, there is nothing in the use of a source justification that precludes us from engaging in a price negotiation, a contracting officer is authorized within the va. it is our expectation that price negotiation even when source is under limited or restrictive competition that the price reasonableness determination would still continue. that is our mechanism that we are trying to use to balance the flexibility granted to source a physician prescription or veteran's choice with reform. >> i understand your position. one last question. you heard from representatives at the provider community and d.o.d., vaoig. anything you heard that needs to

be amplified in order to give us a fuller appreciation of the issue? anything you think needs to be said that has gone unsaid? >> well, yes. i don't think we heard from the veteran community today. and hearing from their concerns. this is not a process or a rule that we invoke to make our life easier. this is a process that is in place to serve our clients. >> i understand that. >> that would be it, sir. >> i appreciatet that. how about clarification from what you heard from other folks? >> one point is what we are talk about in the transition process is over 50% of the prosthetics. and i think that is clarification we wanted to make sure was understood. as the warrants transition from prosthetics community to procurement that is well over 55% of the procurement action in dollars. the next thing that i would

indicate is that part of what our challenge is to ensure that we have available prosthetics timely for veterans. this notion of timely has to be true across the entire system. >> thank you. my time is expired. thank you. >> i thank the gentleman for yielding. i do have follow on questions. what you are saying here today is the exact opposite of what the deputy secretary's letter said in regards to the application of 8123. why is that? >> sorry, i do not believe it's the exact opposite. i think that with respect to the specific acquisitions that were noted we were asked a specific question about whether or not we had to seek waiver approval. we cited 8123 as a source justification that would allow

us to obvee ate the need for the waiver. i do want to emphasize one thing that what we are doing here today is not something we have just embarked on over the last couple of months. the transition in prosthetics to the procurement community is something that mr. doyle and dr. beck began last august and we have been working on it. this is not a new transition for us, either. >> okay. what policies and processes does the va have in place for its purchasing officials to determine when and when not to use the far in purchasing prosthetics? >> well, we have mentioned a few policies that we have. we have a few policies that actually identify the conditions under which we would apply the 8123 source authority that remains. we also have the var which makes

references. we are updating our policies to ensure that they are current. we have recent directives out to the field in form of memorandum requesting that unless explicitly specified by a physician prescription for biologics it is to be followed. >> why does the va not document purchases made under section 8123? >> i can tell you that on a moving forward basis all of our procurements that would use 8123 as a source justification will be tempilated and will contain the basis of justification within them. they will also be within the system. they will be our procurement

contracting officers will actually initiate and conclude those purchase action within ecms and would be documented. >> that would be helpful because for the last 30 years they haven't been documented. the fact that you are going to do it moving forward will certainly be helpful. does the va have records or can it audit under section 8123? >> on a point forward basis we expect our procurement officials to use ecms as a contract writing system and contain all of their procurement actions and documentation within them. the justification for limited scope competition must be documented and there must be a justification contained in the contract file. that would be an auditable item. we expect the ability to audit any action that contained a less than full and open competition

contained within our ecms system. >> does the va need section 8123 to acquire prosthetics? >> we believe section 8123 allows us to preserve intact the physician's prescription from their professional opinion and the veterans choice and not subject it to a second guess, a request for strengthening the definition or justification. we believe it codifies that for us and allows a standard base frs the justification for the prescription or veteran choice. >> how and when did the va's definition of prosthetics come into use? >> i believe this one over time. we have in our specific policy documents we have explicit

definition of the prosthetics items that are contained in that definition. >> when was the last time that policy and definition was updated? >> i have to defer to dr. beck on this one. sorry. >> our handbook is from 2001. we have an internal initiative now and are working on updating our regulations. >> 11 years. wow. does the va employ vha directive 2003-037 titled prosthetics simplified acquisition procedures training in prosthetics acquisition? >> yes, we do, sir. >> that directive expired on july 31st, 2008. >> that is correct. the directive that is expired unless explicitly rescinded

remains in force until one of those actions comes about. >> there we go again. not doing things for 30 years. working off of expired directives. 11 years between reviewing documents. that is part of what has gotten us into this mess now. wouldn't you agree? >> i would say that we do need -- >> you wouldn't run a business that way. >> i would say we need to strengthen some of our policies now. i would say that the definition, however, 11 years for the definition of a prosthetic i don't know that in and of itself is problematic. >> when can this committee expect to see the full detailed plan on reorganizing your prosthetics purchasing process? >> we are right now and i will ask mr. doyle to elaborate a little bit on this for us. we are in the midst as we

testified earlier in the process of transitioning. that process was documented in a plan that was approved by the senior procurement executive september of last year. we committed to pilot test that. we did not want to production change this. so we tested and we are now in the process orphcompleting that transition process. our target date is july 1st. we have additional time built in to ensure that we don't take any unnecessary risks. >> let me reask my question because it sounds like you have gone into the execution phase of the plan. when can this committee expect to see the full detailed plan of reorganizing your prosthetics purchasing process? >> we will provide that to the committee. >> let me ask it one more time. when? >> i will go back and work on it. as soon as we can.

we have been executing this plan? >> a week, two weeks? >> i will dmiet two weeks. >> great. i think those are all my questions. let me go back for a final round. >> thank you. thank you for being here today. i think we have a better understanding of where you are coming from and you have a better understanding of our concerns. i would like to thank dr. beck and mr. doyle for your service to our country. you have an idea of what we are concerned about. we need to make progress on this to make sure you have the flexibility to do what you need to do and make sure we are not going to have any unnecessary waste in this. it hurts the folks we are trying to help ultimately. >> i thank you for your comments because i, too, sense your desire to do the right things. and we're all focused on the

same issue here. i know the questioning at times appears potentially confrontational. that's because we have a responsibility here on the subcommittee to make sure that we are asking the right questions. we don't always get the answers that we want. i certainly sense the sincerity in what you are trying to do and i appreciate that. i want to say thanks to the panel and you are also now excused. the va's sweeping definition for prosthetics opens the door for confusion. i think we have heard that today, such an inclusive definition means small policy changes can have impacts on areas that would not otherwise be impacted under a traditional definition. it is also clear that actions by the va's purchasing agents have

reduced the chances for getting the best value while some guidance and regulations already existed that would have helped ensure best value even those were ignored time and time again. the committee looks forward to receiving details on changes before it moves forward. once again a partnership between the va and committee can further assure that veterans continue to receive the best care possible. with that this hearing is now adjourned. thank you.

all this week we are featuring american history tv with a look tonight at america's civil rights policy. starting at 8:00 p.m. eastern we will hear from historians and former presidential administration officials as they discuss the changes in policy from fdr to today. all this week on c-span 3.

spend the weekend in ouichita, kansas with book tv and american history tv. saturday at noon eastern literary life on c-span 2. wings on american presidents and black entrepreneurs. and dennis farny on the founding of beach craft. also browse the rare book collection at watermark west's rare books. sunday on american history tv experience early plains life at the old cow town museum, the early days of flight. and two participants from the kansas civil rights movement. in 1958 they sat down for service. once a month c-span local content vehicles explore the history and literary life of cities across america. this weekend from ouichita, kansas. well, i believe in every

book i write. go there. go to green bay to find out what it is like in the winter when vince lombardi is coaching there. go live in hope, arkansas to find out what it is like for bill clinton. i have never been to vietnam before. how can i write about it without going to the battlefield. >> in his book david wrote about two major turning points in the vietnam war, one in vietnam and the other here in the u.s. watch his 2003 interview online. over the past four years he has been traveling and researching his newest book, "barack obama the story." he will take your phone calls on the 17th live on book tv. earlier this month the combatting terrorism center at west point released some of the documents ceased during the navy seal team raid that resulted in

the killing of osama bin laden a year ago. an analysis was given looking at the past and future of al qaeda. according to nelly lahoud's report, bin laden was no longer in control of the organization in 2010. welcome. my name is brian fishman. i'm a terrorism research fellow here at the new america foundation. and i really, i really have a unique pleasure today to host nelly lahoud from the combatting terrorism center up at west point. nelly is one of those people that when you get a chance to talk to her about al qaeda, or politics in the middle east, you never walk away with a feeling that you haven't learned something. and i hope that we have that experience here today. it's also a real pleasure for me to, to host somebody from the combatting terrorism center at west point which is a place where i worked for four years. i still have an affiliation as a fellow there.

it's really a unique institution. their primary mission is educating cadets yet they have taken on this role as an organization that does cutting-edge research on terrorism in general and on al qaeda in particular. and i think that there's often misconceptions what the combatting terrorism center is. i whsh i was up there and i'm sure it still happens people would come up for a -- they would be looking for a tour or something like that thinking there's some kind of command center with flat screen tvs all over the place and flashy information. and really what you find are a group of very smart, dedicated researchers and academics that spend their days the way dedicated researchers and academics do all over the world, which is trying to understand our problems through hard work. nelly is a great representative of that organization and what it tries to achieve. so it's nice to have her here

today. nelly is a senior associate at the ctc. she also teaches in the department of social sciences at west point. and she's also and oil point this out and we'll talk about this a little bit later the author of a great book," jihadi's path to destruction." i liked it so much i assigned it to my class and i would encourage to you take a look at it. without further ado oil turn this over to nelly. she's going talk for 15 or 20 minutes and then we'll have a q and a. i hope you'll engaging that. the one rule about q and as, please stand up, state your name, explain your affiliation, and then ask a great question and be part of the conversation. so, nelly, please. >> first, many thanks for all of you who are interested in coming here today and particular thanks

to the new america foundation and particularly to brian on behalf of the ctc and the authors of this report. i would like to note that the findings of the report represent the a -- analysis. the views are my own views solely. oil start my presentation with an important qualification, followed by a sound bite if you like about the most compelling story of the documents and proceed to give an overview of some of the main findings of the report. in the overview, i focused on al qaeda under the leadership of bin laden and its relationship with regional jihadi groups and the relationship with iran and pakistan. of course i would be happy to delve into more details during the q and a about other aspects of the documents.

the important qualification has to do with the fact that the report is a study of only 17 documents captured from osama bin laden's compound. they consist of electronic letters or draft letters totalling only 175 pages in the original arabic. in view of the thin view of the documents it would be irresponsible that they reveal information about al qaeda. the documents are valuable and demand a reassessment of what's been dubbed as al qaeda central and its affiliates. this brings me to the sound bite which is bin laden's frustration with regional jihadi groups and inability to exercise control over their actions and public statements is the most compelling story to be told on the basis of the 17 declassified documents. why is this a compelling story? well that's because it's been

assumed al qaeda was able to rebuild across pakistan's northwest frontier following throwses it suffered after the immediate aftermath after the u.s.-led military campaign in 2001 and also been able to act as an organization. the intelligence community labelled this revived entity as al qaeda central both in reference to the geographical center of the core senior leaders who were to the report bin laden and seek his approval for major decisions and to indicate that there was at least a relationship between this al qaeda central and regional jihadi groups that have been dubbed among other names as affiliates. according to this argument, al qaeda central gives strategic guidance to its regional affiliates and assumed the affiliates are largely in compliance with al qaeda central. the documents show that the framing of an al qaeda central as an organization in control of regional affiliates reflect a

conceptual construction by outsiders rather than the reality of insiders. some of the affiliates sought bin laden's symbolic blessing when it came to matters that are symbolic such as declaring an islamic state and want ad formal union to acquire the al qaeda brand. on the operational front, however the tone in several letters authored by bin laden makes it clear that he was struggling to exercise even a minimal influence over them. he is burdened by their mistakes committed by them and he disapproves of their operations, especially those operations that resulted in the unnecessary death of muslim civilians. their mistakes he worried distorted the image of the jihadis in the eyes of the public, separating them from their popular bases. the documents do not show bin laden to be in charge of the jihadi landscape rather in 2010 bin laden is seeking to find

ways to centralize and oversee the regional groups. so that there is something called al qaeda central came as a new boost to bin laden and i'm not joke. in his blueprint for centralization is in fact inspired by what he read about al qaeda central and the media and i'm quoting him. the expression of al qaeda central is a technical term used in the media to distinguish between al qaeda and afghanistan and pakistan and al qaeda and the rest of the region. i do not object to using it initially to clarify the objective of the centralization endeavor. end of quotation. as to those that have been called the affiliates, they have not just been a problem for al qaeda in terms of harming its image but also caused internal debates among the senior leadership. three different position within al qaeda can be discerned on the subject. there are those who one may term the principal, represented by a

leader to disassociate themselves from groups whose leaders have not consulted al qaeda and yet still act the same. there are others represented by an anonymous author urging the opposite believing the inclusion of regional jihadi groups in the fold contributes to al qaeda's growth and expansion. bin laden stems have represented a third position. he wanted to maintain communication through his own pen or that of idea with brothers every where. at least to urge restraint and provided vice even if it fell on deaf ears but without franchising the brand. the groups got some meaningful understanding relationship of the its almost jake state of iraq, al qaeda, pakistan and taliban. with respect to the islamic state of iraq the documents

confirm what we knew before namely it's admission into al qaeda by bin laden the only group he admitted proved to be a liability not an asset to al qaeda. an anonymous author describes the leader of iraq to be extremists and their speeches to be repulsive and lacking wisdom. somewhat revealing is bin laden's concern is what many consider is bin laden's success story. he was anxious that they were attempting to complete more ambitious actions than capable of sustaining. it appears its leader had sent a letter either to bin laden or to al qaeda in which he wrote if you ever want some