lead on the, you know, development of the decka arm and all these advanced technology things. in years past, va has been one of its key roles, when 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 medical equipment, when dod and global war on terror dollars go away. this all ties into the discussion about the centers of excellence at walter reed, brook army medical center and so forth. when the dollars go away, the dod facilities will scale back their capacity both for rehabilitation and research. we're calling for va to be prepared to meet the needs as dod scales back.

>> thank you. i'm extremely concerned with regards to your comments about the filing system being outdated and the backlog that it creates. could you comment on that for us? >> yes, in my written statement with the filing system, it refers to medical records within one ical center, and if, for instance, a veteran were to relocate -- for example, our director actually benefits, relocated from this area to san diego. and it took quite a bit of time for the medical records to be transferred from san diego to d.c. simply because there's not one central system in which all the medical centers are able to locate and actually view the medical 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 the records are not able

to be transferred expeditiously or timely, at least, that means the veteran then does not have -- >> the veteran -- the record is 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. >> thank you very much, madame chair. i'll start with mr. ores. mr. mayer from the first panel recommended to freeze the pending reorganization until a full-scale program to evaluate a new strategic plan can be achieved. i know it sounds like the wounded warrior project agrees with that assessment. do you agree with that as well? or we'll start -- each of the panels 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 reorganization, 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 reorg 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. >> how the different pilot programs, they diverse, the way they implement it, is the diversity great or is it minor in the different -- >> i think it's minor. it's an administration of certain policies and how they handed off items that needed to be handed off to plno versus psas. that's my understanding. >> why should the va undertake research in comparative prosthetics outcomes? why couldn't this be done by other agencies such as the department of defense or the national institute of health? start with bill. anyone who wishes to answer that. >> i would say that the dod's mission is to rehabilitate troops to their maximum potential for rehabilitation and either 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 should be on long-term outcomes and long-term care for our warriors and certainly if possible, it should be done in partnership with nih and dod. but va should be taking the point on long-term care for amputees. >> do all the panelists agree with that? >> i would concur with that. i think that's absolutely essential for va, just because of the paradigm shift that did occur within dod, maintaining veterans, disabled veterans for so much longer. and providing this upfront amputee care. as they transition into va, that's certainly the lifetime care and they're focused on effective care and good outcomes. that would certainly be within their portfolio. >> i guess this would be for mr.

ores or anyone else who might want to answer it. there's 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. ores made were really pert ninenpertinent. the first thing we thought when we saw the ig report and the difference between the two cost comparisons was, you know, not factoring in a number of other things. you know, maybe that was just materials so we'd certainly like to see a better analysis of that. >> may i say $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, our blind, our wheelchair bound, prosthetic using orders, to bear the cost

savings at $2 million, to assume the savings could be realized i think is unconscionable, and that's where i stand on that. >> point well taken. i agree with your point. we'll be asking the ig and the va as far as how did they come up with their costs comparisons? because sometimes they're not comparing apples to apples. which would give you that deviation. but as well as dod. it would seem to me that the cost 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, then i'd be interested in seeing that as well. i see i've run out of time, so i'll yield back. thank you. >> thank you. i now yield to the gentleman from florida. >> thank you, madame chair. i appreciate very much.

i thank the whole, the entire panel for their testimony today. my first question is for mr. pruden. first of all, thank you for your service to our country. you mentioned your testimony, again, the same subject, you mention ed in your testimony th concerns about the planned changes in the va's prosthetic 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 alive under the va's current process, and what timeframe 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? >> thanks for the question, sir. i -- under the current system,

there are safe guards in place to ensure 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 the area. which is appropriate. our real concerns is with the new system it would be supposition, but it may take months and months longer to put it -- to get purchase orders for needed equipment and the veterans should not have to wait. and the clinicians' hands should not be tied. if they feel a device is appropriate and going to provide the best care for a warrior, they should be able to prescribe that device. i've had the opportunity to speak with over a dozen va clinicians and ly serving and f. 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 sththat of the things 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 is going to be somebody in acquisition, not a physician, not a clinician who has the patient's best interest at heart. that's our real concern. the va was given wide discretion by congress to provide prosthetic and assisted devices without consideration of applicable federal acquisition regulations years ago because congress recognized this very special, 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 testify on that. >> well, i'll state, again, that i have personally experienced this. through the natural and inappropriate 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. i can tell you story after story about warriors that i've worked with who have been stuck in wheelchairs, who have gained weight, had subsequent health issues due to an inability to get up on their prosthetic limbs. a buddy of mine, a bilateral above the knee amputee who lost both his legs in iraq, and a clinician that worked with him was able to use some discretion, some latitude, to get him the appropriate devices in timely manner recently. and that same physician told me, i'm really concerned if this goes through, i would not have

been able to do that for him. he would still be in his wheelchair today because he wouldn't have been able to stretch and go outside to take care of this veteran. that's the last thing we want to see happen. the mantra in hearings from the past several years within psas have been take care of the veteran first and foremost. that's our end goal. ensure they receive the devices they need. and it is concerning to see us stepping back from that. >> yes. what about maybe mental health issues as a result of these delays? anyone want to comment on that? >> yeah. i think from dav's perspective, certainly we have a number of members and people we work with on our staff, you know, in washington, d.c., and local area that are prosthetic users that have been longtime users and certainly when something goes wrong, whether they have to have a revision of their stump, whether, you know, there's a broken foot, or some sort of issue with their prosthetic appliance, it's absolutely

critical and you can see it in how frustrated they are to not 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 oftentimes. the person that's worked with them over years and years. it definitely can impact on their mental health, and, you know, they want to be functioning, you know, 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, fig wrure out what the issues a 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 generally sees many veterans. 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, madame chair. i appreciate. i yield back. >> thank you. i now recognize the gentleman from florida, mr. sterns. >> thank you, madame chair. let me welcome the panel. mr. pruden, i understand you went to university of florida. that's good. >> go gators. >> go gators. it's my honor to represent the university of florida in congress. i'm delighted i could come over here in time. i have two other committees at the same time. i wanted to especially be here to welcome you personally and 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 of the wounded warriors. i think what i'm asking is sort of an overview. i understand you're one of the first improvised explo ploeplos devices ied casualties of operation iraqi freedom. is that, perhaps, true? >> yes, sir. >> yeah. you 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-record discussions. and all of them had real concerns about this process and about us moving forward in

changing our procurement requirements and potentially tieing 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 the 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 this -- that is a real danger. and that's why we're asking the committee to stop the implementation of this until either we are assured there are safe guards in place that won't cause this to happen or just find another way to find 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 assisted devices. it asks for stricter cost controls and certain control measures. certainly we're all for fiscal responsibility and for, you know, saving taxpayer money, but not on the backs of our most severely injured. >> i look at some of the statistics my staff provided and it says as of march, there were 1,288 service members experiencing, experienced major limb loss. of that number, 359 lost more than one limb. that just this past one. the walter reed national naval med ical center received two quadruple amputees. this is sort of mind-boggling to think that there's that many. do you think that with that number, the -- should we organize all these people

together in an unmassed 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 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 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, you know, penny pinching curtail all the advances that have been made in the past 20 years. >> madame chair, i would think that the committee might just think about this in terms, since we can't define who these people are, we should give advantage in the job market for these people either through tax credits for tell the employer if you hire one of these people, you're going to get advanced depreciation on your capital assets or you're possibly going to get write-offs or incentives for them to hire these people so that all these people get a job.

because in the end, the challenge that they have mentally and physically is so enormous. it can be overcome if they have a job that they feel they have strong self-esteem and they're self-sufficient and independent. and they need this job more than anything else. would you agree with that? >> i think that's an excellent idea. and in principle, i certainly agree with it. yes, sir. >> yeah. and so, and, in fact, those employers that hire these people should be singled out with merit and recognized somehow in their cooperation with the designation that they're hiring these roughly 1,300, 1,400 people. so across america, everywhere i go, person can look and say, that's a company that's doing a great service for our veterans and for this nation. captain, i want to thank you for your service, for your sacrifice. it's truly a pleasure for me to

represent you and the folks in gainesville. thank you. >> captain, i was going to cut you some slack until i found out you went to the university of florida. you and i are probably going to have to go head to head. all kidding aside, after this is over, i want to talk to you about something i want to do privately with wounded warriors. >> we, sir. >> i think what i've heard from, certainly with the prosthesis and limb loss is the very individualed care th eed care a needs and relationship they have with their provider is very important and may go on a lifetime, either in private practice or with the va. i'd like to have all you's comments about -- i can understand this saving taxpayer money. captain, i could not agree more. we're not going to balance this budget on the back of people that lost limbs in service to this country. whether it's going to be a private prosthesis or va, wherever they need to go, they

need to get the best care wherever it is. i think we need to see -- we're measuring apples to apples, too. i don't think $3,000 probably looks at the cost of the light bill, the water bill. if you really dig down into it, my bet is it's just the actual cost of the prosthesis. the materials and putting it together. which that's not anywhere near the cost, if you've ever run a business, to the overhead of your person doing it's insurance. everything that goes into running a business. what i heard you say, i completely agree with, captain pruden, about we could set this back if we do what the va is going to do and delay and what was said by mr. myer right before you about it's not just -- it's not just an inconvenience, it's, like you said, you can't go out and walk your daughter or whatever it may be that -- whatever function you may have. the other thing i would argue a little bit -- i wouldn't argue,

but just comment to congressman sterns, what i see with a lot of these wounded warriors, they want to go back to just regular life. they use this prosthesis not to have advantages but to do what they were able to do before they went in the military. am i wrong on that or not? >> i think, too, that that's -- and the employment issue is obviously important for many veterans but it all comes down to, again, their ability to be able to do what they want to do, to regain their function, to live, you know, to have a quality of life. and that onlies down to the care that they're going to get, the lifelong care that they're going to get at va and maintaining their prosthetic items and getting them in a timely manner. >> just a brief example. i had been here probably six months in congress. this is only my second term. and had been to walter reed and was walking down the steps. spanky, you remember him, he's a major, he lost his -- i didn't know he was an amputee until i saw him go down the steps.

he had returned to duty and was carrying on exactly like he always had. when i saw him, then we sat down and had a talk about that. that was amazing to me he was able to do that. for months i saw him walk in and out of here and didn't know he was an amputee. i think that's the kind of return to duty that people want. when they've lost an extremitex some obviously are more horrific than others. i believe that's the goal of every wounded warrior is to be able to go back to what they did and assume the life they had before they signed on, took the pledge. i appreciate you all's testimony, and certainly every one of you service to our nation. i will now call our next panel. >> thank you.

>> thank you, all. joining us on our third panel, audits and evaluations for offices of inspector general. ig for the u.s. department of veterans affairs. miss halladay is accommodated by nicholas dahl, director of bedford office of audits and evaluations for the ig. kent, director of atlanta office for audits and evaluations for ig. joined by john daye, assistant inspector general, accompanied by dr. yang, a physician for the office of health care inspections. thank you all for being here today and to share your expertise. we'll begin with you. >> okay. representative roe, ranking

member, and members of the subcommittee. thank you for the opportunity to discuss the results of our two recent reports on vha's management and acquisition of prosthetic limbs and supply inventories. we conducted our work at the request of the house veterans affairs. today we'll discuss our efforts to evaluate va's capabilities to deliver state of the art prosthetic limb care and manage prosthetic supply inventories in its medical centers. in our first report -- and the cost paid for prosthetic limbs. we've identified opportunities for vha to improve payment controls to avoid overpaying for tr thetic limbs and approve contract negotiations to obtain the best value for prosthetic limbs purchased from contract vendors. with regard to the cost

comparisons in our report, addressing va fabricating the prosthetic limbs or processing these limbs via contract, our report concluded va lacked information to make -- whether in should continue with the use o the labs or rely on contracts to provide these limbs. in no way did we address cutting the quality of the requirements to purchase a limb. this was the -- the focus was on the contract administration piece. and the contract administration piece is that va entered into are t contracts with vendors to provide limbs at certain prices. what we looked at was that the invoices were coming in. they lacked an adequate review process prior to certification

for payment. in which case resulted in overpayments. that's a contract administration issue. i want to be very clear, we did not say cut the quality of a prosthetic limb for any of these veterans. clearly it's an opportunity to if you can fix this control, you can then reprogram the funds saved to provide more prosthetics care for veterans. the overpayments for prosthetic limbs were a systemic issue. in 21 veteran integrated service networks. and that's where we identified over payments in 23% of all the transactions paid in 2010. the overpayments generally occurred because invoices received from vendors, they lacked adequate review. as a result, the vendor invoices were just processed with charges in excess of the prices in the

vendor contracts. we reported vha would continue to overpay prosthetic limbs for about $8.6 million over the next four years if it did not take action to strengthen these controls. we also found that vision contracting officers were not always negotiating to obtain a better discount rate with vendors. without negotiations for the best discount rates obtainable, vha cannot be assured it receives the best value for the funds it spends to buy prosthetic limbs. we noted that taking action to ensure contracting officers consistently negotiate better discount rates in no way compromises the quality of the prosthetic limbs va buys. we also found and made a very clear point in our report that the vha guidance states the prosthetic service should periodically conduct