captions copyright national cable satellite corp. 2008 to have my daughter ask my wife why can't daddy come and walk with us. with va moving ahead on changing procurement practice, wounded warriors need this committee's help. prosthetic limb is not a mass produced widget, they are specialized medical equipment that should be prescribed by a clinician and promptly delivered to the veteran. they urge the va to stop implementation of the change in prosthetic conferment. beyond this concern war zone injuries that result in amputations are often complex and can prove difficult for later prosthetic fittings. it's apparent the paradigm shift promised some years ago is far from complete and more progress is needed to realize va's vision

for an amputee's vision of care. we have real concerns about the direction of this program which appears to have lost the kind of focused advocacy it once enjoyed and fallen victim to a bureaucratization that has lost sight of its customer, the veteran. today it seems intent on tossing out veteran procurement. tomorrow we fear centralized funding of prosthetics will be tossed out and we may wind up where as jim mentioned earlier, where we were to years ago where the fourth quarter meant that all the money for hospital's budget had been spent and you couldn't get a new limb or wheelchair until the next fiscal quarter. our goal is improved prosthetics service. to that end we offer a number of recommendations in our full statement. in closing let me highlight a few areas in which the committee can mach a profound difference, ensure through ongoing oversight that va's vision of an amputee system of care is realized.

second, press va to reestablish and reenergize robust steering committee of experts to oversee and provide guidance on the direction and operation of va's prosthetics and orthotics program and finally it is essential va reestablish itself as a leader in prosthetics research and care and maintain that position as a commitment to our wounded warriors. that concludes my testimony. thank you and i welcome any questions. >> thank you very much. miss brudeau, you may proceed. >> thank you. chairwoman berkle, ranking member micaud and members of the sub committee thank you for allowing us to testify concerning prosthetic services of the department of veterans affairs ensuring our veterans receive state-of-the-art devices in a timely member is important. in recent months the va office of the inspector general

released numerous reports on sensory aids psas, inventory management, acqui significance of prosthetic limbs and prosthetic limb care. pva believes the internal audits and investigations identified many improvements and we support the recommendations. these recommendations provide not only an opportunity to improve upon the prosthetic services for veterans with amputations but for all veterans that utilize va prosthetic services. the oig's evaluations and assessments are taking place during a critical turning point for va prosthetics. the veterans health organization directly impacts the delivery of process of delivery to veterans. today i'll limit my remarks to this reorganization. under the current changes prosthetics will no longer be solely responsible for the purchases of items. they are implementing psas and the office of procurement and

logistics making prosthetic purchases. while the va reports that this change will result in increased oversight and review of prosthetic orders, pva is concerned the dual purchasing track has potential to create delays in the delivery of items to veterans. the further concern is that the new system will lead to less va accountability for veterans during the ordering and delivery processes, when an order for prosthetics is placed at any point before the item is delivered, veterans and national services on behalf of the veteran is able to contact a psas order. with the office of procurement and logistics handling prosthetic purchases it is unclear which will serve as a point of contact to provide timely assistance of questions or concerns that may arise. pva reached out to psas leadership on several occasions to identify the status of the reorganization and appreciates the opportunity to provide

input. while we have been informed that the dual purchase system was piloted in three networks beginning january 2012 and will be further implemented in additional areas in july 2012 we're not aware how the va intends to make sure veterans are aware of the changes. they encourage the leadership to consult with veterans and their families as well as stakeholders who regularly work with the prosthetic offices. pva further recommends the va regularly update the committee with the findings compiled as a result of the pilots implemented in january 2012 as well as future findings as plans move forward. lastly, the office of procurement and logistics is governed by va policies of va acquisition. such policies are noent address the purchasing of various items within va. pva would like to make certain the change to the office of

procurement and logistics managing the cost of prosthetics does not lead to a standardization of items such as artificial limbs, specialized wheelchairs and surgical implants. pva strongly urgeness the va to continue to abide by va policy that adheres to title 38, united states code section 8123 a statute that enables the va to meet the unique prosthetic needs of veterans without contract bulk purchasing. veterans must have access to prosthetics that best fit their individual needs. for many years psas has done a good job ensuring the number one consideration ordering prosthetics is quality, the ability to meet the medical and personal needs of veterans. the va must make certain that the issuance and delivery of prosthetics continues to be provided based on the uniqueness of veterans and to help maximize their quality of life. again, pva thanks this committee for their attention to this important issue and encourages

continued oversight. i'm happy to take any questions from the committee. >> thank you all very much. i'll yield myself five minutes for questions. mr. oros, in your opening statement you mentioned the four very important tenets of trust, access, trust, experience and positive outcomes. as you look at the va prosthetic care, do you think that encompasses those four tenets that you laid out for us this morning? >> i think it can but it's somewhat dependent on the veteran's ability to advocate for themselves. i think the outcome piece frankly we're missing almost across the board both inside and outside the system. >> can you give us insights, how do we change that? how do we make the outcomes more positi positive? how do we make sure the four tenets are -- >> i think specifically with

outcomes, there are validated instruments, tests that could be undertaken when prosthetic limbs are prescribed, so are we truly getting, i'm going to use the word the most bang for your buck when it comes to prescribing a particular pros tetic leg or foot or a particular prosthetic need. there are not research dollars allocated to studying comparative effectiveness when it comes to orthotics and prosthetics. in absence of that we'll sort of it continue to use our experience and best judgment as to what we think are the best components for a veteran without any necessarily evidence to support that. >> do you have any information or knowledge as to why there hasn't been that kind of research done and like you say compilation of data about the outcomes? >> my suspicion is we're really just too small of a profession.

if it's not industry driven, then it has to, frankly has to come from the federal government, and i can't explain beyond that. >> thank you. mr. pruden in your testimony you talked about va prosthetics research has lagged in recent years. now, mr. oros talked about outcomes but i think you're talking more generally in terms of the research. what impact, and i shouldn't speak for you, i should let you say what research you were referring to and then if you could, after you tell us that piece, what impact has that had on veterans in the services that they need? >> the va has stepped up a number of capacities in the past few years, but as mr. mayor pointed out earlier, dod has taken the lead on the, you know, development of the deca arm, and all these advanced technology

things. in years past, va has been, one of its key roles and one of the reasons it exists is to provide specialized medical equipment for our combat wounded, for our veterans, and va really needs to have the capacity and the focus on research for durable medical economy when dod and global war on terror dollars go away, and this also ties into the discussion about the centers of excellence at walter reed, brook army medical center and so forth. when these dollars go away those dod facilities will certainly scale back their capacity both for rehabilitation and for research, and what we're calling for is for va through the amputee system of care and enhancements and research to be prepared to meet the needs as dod scales back. >> thank you. ms. predoux i'm extremely concerned with regard to your

comments about the filing system being outdated and the backlog that it creates. could you comment on that for us? >> yes n my written statement with the filing system, it refers to medical records within one va medical center and if, for instance, a veteran were to relocate for example our director actually of benefits relocated to this area from san diego, and it took quite a bit of time for the medical records to be transferred from san diego to d.c. because there's not one central system in which all of the medical centers are able to locate and view the records of a veteran and as the panel before us testified it's not just a wait time, it's a matter of being able to be comfortable and actually be mobile. >> that was going to be my follow-up question. so when those records are not able to be transferred expeditiously or timely at least, that means the veteran then does not have -- >> the records not being able to

be transferred for the medical provider to see them and they're not able to get what is needed, it could be a chair, it could be a repair, those type of items. >> thank you all very much. i would now yield five minutes to the ranking member, mr. michaud. >> thank you very much, madam chair. i'll start with mr. oros. mr. mayor from the first panel actually recommended the committee ask the va to freeze the pending reorganization until a full scale program to evaluate a new strategic plan can be achieved, and i know sounds like the wounded warrior project agrees with that assessment. do you agree with that as well, and we'll start each of the panelists can answer that question. and why. >> i guess i'm not entirely familiar with the differentiation between what mr. mayer is asking to be done and

the current system. >> do you think we should ask the va to freeze the organization, to bring everything in-house? >> absolutely, absolutely. >> i'm happy to provide a comment on that. with regard to the reorganization, all of our concerns are provided in our written statement, but until i think that we can answer that, it would be great to be able to know the results and how things worked in the pilots that were implemented in january. it is my understanding that within those pilots different, the re-org was implemented in different ways, in different visions so it would be interesting to see how veterans were affected and the delivery of items, the timeliness, those issues, and access. >> the different pilot programs, the diverse, the way they

implement it. >> i think it's minor. it's administration of certain policies, handed off items that need to be handed off to pl and o versus psas, that's my understanding. >> why should the va undertake research and comparative prosthetics outcomes? why couldn't this be done by other agencies such as the department of defense or the national institute of health? we'll start with -- okay, anyone who wishes to answer that. >> i would say that dod's mission is to rehabilitate troops to their maximum potential for rehabilitation and return them to the line or send them on for further care. va's job is for the longstanding lifelong care, once they leave the service. those are different goals, so dod's focus is on acute care,

and acute rehabilitation. va's should be on long-term outcomes and long-term care for our warriors and certainly, if possible, should be done in partnership with nih and dod, but va should be taking the point on long-term care for our amputees. >> all the panelists agree with that? >> i concur with that, i think that's essential for va because of the paradigm shift that did occur with dod maintaining disabled veterans for so much longer and providing this up front amputee care, but as they transition into va that's certainly the lifelong care and they are focused on effective care and good outcomes so that would certainly be within their portfolio. >> i guess this would be for mr. oros or anyone else who might want to answer it. there has been some discussion about the cost in the private sector versus the va.

has anyone done an analysis of what the cost is within the department of defense? >> we haven't, but i think the comments that mr. oros made were really pertinent. the first thing we thought when we saw the ig report and the difference between the two cost comparisons was, you know, not factors in a number of other things, you know, maybe that was just material, so we'd certainly like to see a better analysis of that. >> and may i say that $2.2 million, while it seems like a lot of money, for us to allow our most severely injured, the ones who will utilize devices that cost more than $3,000 are blind, are wheelchair-bound, are prosthetic-using warriors to bear the burden of cost savings at $2 million, even assuming all those savings could be realized, i think is unconscionable, and

that's where i stand on that. >> a point well taken and i agree with your point. we'll be asking the ig and va as far as how did they come up with those cost comparisons, because sometimes they're not comparing apples to apples, which will give you that deviation, but as well as dod, it would seem to me that the costs should be similar to the va as far as you know the va and dod costs are the same, then probably the methodologies is correct. if it's not, i'd be interested in seeing that as well, so i yield back. thank you, madam. >> thank you. i now yield to the gentleman, mr., from mr., mr. billeracas. >> thank you, madam chair. i thank the panel for their entire testimony today.

my first question is for mr. pruden. first of all thank you for your service to our country. same subject, you mentioned in your testimony your concerns about the va's plan changes in the prosthetics acquisition process. will you elaborate on the real world implications that this will have on our veterans, specifically from the time a prosthetic is ordered, how long does it typically take to arrive under the va's current process and what time frame would you anticipate under the new proposed acquisition process, and then what are the quality of life and health issues that could arise from these delays? >> thank you for the question, sir. under the current system, there are safeguards in place to ensure the va is being fiscally responsible and it can take a month, two months, some of this is predicated on the clinical

needs of the patient and availability of the product in their area, which is appropriate. our real concerns is that with the new system it would be supposition but it may take months and months longer to get purchase orders for needed equipment and the veteran should not have to wait and the clinicians hands should not be tied if they feel that a device is appropriate and going to provide the best care for a warrior, they should be able to prescribe that device. i have had the opportunity to speak with over a dozen va:itions and prosthetists currently serving in former chiefs of prosthetics and every single one of them said they share our concerns about the ability to remain timely and potential delays in veterans receiving needed prosthetic devices under this new system. dr. beck will come up in a few minutes and she'll say that one of the things that we're going to consider is if a device is

generally available and interchangeable, then it will fall under the federal acquisition regulations. who is determining what is generally available and interchangeable? it's going to be somebody in acquisition, not a physician, not a clinician who has the patient's best interests at heart, and that's our real concern. the va was given wide discretion by congress to provide prosthetic and assistive devices without consideration of applicable federal acquisition regulations years ago because congress recognized this very special and unique role in prosthetics for providing care for our warriors, and unfortunately this seems to be a step in the opposite direction. >> thank you. again, maybe for the entire panel, let's address this specifically. what are the quality of life and health issues that could arise from these delays, if anybody would like to self on that?

>> i'll say it again that i have personally experienced this through the natural and appropriate delays that occur from the time i break a prosthetic foot to the time i need a new one but my quality of life is hindered. my ability to go on walks with my kids, my ability to do some aspects of my job are directly hindered and i can tell you story after story about warriors i've worked with who have been stuck in wheelchairs, who have gained weight and had subsequent health issues due to an inability to get up on their prosthetic limbs. buddy of mine, gatlin mixen, double amputee, lost both of his legs in iraq and a clinician who worked with him was able to use discretion and latitude to get him the appropriate devices in a timely manner recently and that same physician told me i'm concerned if this goes through i would not have been able to do this for gatlin. he wouldn't have been able to

stretch and go outside to take care of this veteran and that's the last thing we want to see happen. the mantra in hearings from the past several years within psas has been take care of the veteran first and foremost. that is our end goal, ensure they receive the devices they need, and it is concerning to see us stepping back from that. >> yes, sir. what about maybe mental health issues as a result of these delays? anyone want to comment on that? >> i think from da's perspective we have a number of members and people we work with on our staff in washington, d.c., and local area that are prosthetic users that have been long-term users and certainly when something goes wrong, whether they have to have a revision of their stump, whether there's a broken foot or some sort of issue with their prosthetic appliance, it's absolutely critical, and you can just see it in them how frustrated they are, not to be able to ambulate, to be able to

do the things they're used to doing. if there's a delay in getting those items fixed, and getting to their prosthetist of their choosing often-times, the person that's worked with them over years and years, so i think that it definitely can impact on their mental health, and you know, they want to be functioning in the best, all that they can. >> thank you. anyone else? >> my colleagues have discussed quality of life and mental health, quality of care is also an issue. oftentimes when there are delays, there are sometimes quick fixes and other times they could be larger issues, but veterans are able to step in, figure out what the issues are and kind of interrupt that process that could extend the delay. when it comes to acquisitions as it stands it's not an office that sees many veterans or veterans can call and see what's going on or their representative can call, so with regard to the

reform and moving over to acquisitions, systems must be put in place that will allow veterans to know the exact process in which the order will be going, so that when there is a delay, they can call and say there's been a delay, what is the problem, and then hopefully the problem can be fixed. >> very good. thank you, madam chair. i yield back. >> thank you. i now recognize the gentleman from florida, mr. sterns. >> thank you, madam chair. let me welcome the panel and mr. pruden, i understand you went to the university of florida? >> yes, sir, go gators. >> go gators. it's my honor to represent the university of florida here in congress and so i'm delighted that i could come over here in time. i have two other committees at the same time but i wanted to especially be here to welcome you personally and to thank you for your service and just admire your ability and leadership here in testifying and presenting to the american people some of the problems for the wounded

warriors. i think what i'm asking is sort of an overview. i understand you're one of the first improvised explosive devices ied casualties of "operation iraqi freedom." is that perhaps true? >> yes, sir. >> you're also testified before the oversight subcommittee on seamless transition issues in 2010. >> yes, sir. >> have you discussed any of your concerns raised in your testimony with the va clinicians or other va officials? >> i certainly have, sir. i've had the opportunity to speak with numerous current va physicians and prosthetic chiefs, several candid off the record discussions and all of them had real concerns about this process, and about us moving forward in changing our procurement requirements and potentially tying the hands of our clinicians and hampering the delivery time for our veterans.

>> i guess particularly the members here on the va subcommittee, which i've served for 24 years, i guess with a growing population of wounded veterans, do you feel confident that the transition that we're making will not encounter greater delays perhaps in our veterans receiving the care they need and the prosthetics they need? >> sir, i certainly feel that that is a real danger and that's why we've, we're asking the committee to stop the implementation of this until either we are assured there are safeguards in place that won't cause this to happen or just find another way to define savings. the ig report that was cited several times here today in no means, nowhere in the report does it call for the use of federal acquisition personnel in procuring these assistive devices. it asks for stricter cost controls and certain control

measures and certainly we are all for fiscal responsibility and for, you know, saving taxpayer money but not on the backs of our most owe veseverel injured. >> i look at some of the statistics my staff provided as of march there were 1,288 service members experienced major limb loss. of that number, 359 lost more than one limb and that's just this past month. the walter reed medical center received two quadruple amputees. this is sort of mind-boggling to think there's that many. do you think that, with that number -- sthu we organihould wl these people together in an en masse type of grouping to work with them in a focused way

rather than sort of in a broad way? i mean is there something since we can identify these people, we know the problems they're going to have and the enormous challenges they have, shouldn't we try to single out these folks and try to have a very special program? >> sir, i think that it would be appropriate, and what you're hitting on is that it is a real challenge and actually the number i got this morning is i think 1,458 new amputees from iraq and afghanistan, and it is a challenge. i had the honor of being on a 27-member expert panel that made some recommendations about the amputee system of care, and va to their credit has implemented that amputee system of care in large measure, but it's not there yet. it hasn't met all its stated objectives and certainly we want to encourage the committee to provide oversight and support as needed for prosthetic and

sensory related services to continue that program of enhancing care for our warriors. dr. beck, dr. miller, as jim said, these are professionals. they're doing a good job, but certainly there is need for oversight and we certainly don't want to see penny pinching curtail all the advances that have been made in the past 20 years. >> madam chair, i would think that the committee might just think about this in terms of since we can define who these people are we should give advantage in the job market for these people, either through tax credits or tell the employer, if you hire one of these people, you're going to get advanced depreciation on your capital assets or you're probably going to get write-offs or incentives for them to hire these people so that all of these people will get a job, because in the end, the challenge that they have mentally and physically is so