>> really? >> yes i do. it's good quality care. i die dr. clancy -- >> doctor here's the problem. >> our system compares favorable with the private-sector in terms of quality of care and patient satisfaction. we're challenged right now. we're challenged because of data integrity and we need to re-earn the confidence of the public, of the congress, and of your veterans. we're working to do that, sir. >> you're just glossing this sufficient over. >> i'm not glossing over. >> you ought to be and you're part of the problem. i just don't see you as part of the solution. i don't see you able to get us out of this ditch, and we are in a ditch and you're in denial that we're in the ditch. >> congressman, i'm not denying at all that we have a significant problem. if you want to call it a ditch, i will not disagree with you. >> we just had testimony -- >> we do have a way forward. i think we do have plans. i think we do need to

reestablish our integrity. i think we can do that, and i think we can salvage a system which does provide good care, and we can make that system provide timely access. >> i am stunned that you would call this, with all the information that's come out, and i don't think we're at the bottom of all this yet, that you would call this a good system. i think it's absolutely stunning. and i think that the veterans administration is the most mismanaged agency of the federal government, and i think that it is not -- has not been there to serve those who have served this country, but the leadership of the va has been there to serve themselves, and we've had testimony from this committee about all the bonuses, all the bonuses, despite the incredible bureaucratic incompetence and cultural exception. that's all you seem to be capable of doing is writing checks to yourself.

mr. chairman, i yield back. >> mr. kirk ps. kirkpatrick, yo recognized for five minutes. >> thank you, mr. chairman, and i want to thank you and mr. mishu for continuing to have these hearings. i don't feel like we've gotten to the bottom of this. mr. lynch, you've been here a number of times, and toipt foi focus on the scheduling delays. that's the problem we're trying to get to the bottom of. the committee heard there are five reasons for scheduling delays, that there was an unexpected surge of new patients. there was not enough funding, obsolete facilities and obsolete technology, a lack of patient extenders in personnel, a lack of consistent policy across the system. but that just further describes a problem. and my question is, why?

why did the va not anticipate a surge in new patients? we know that we have an aging population. why did the va not have funding when we've given them all the funding they've requested. we're starting to think as a committee that this is a systemic problem, but we're still not getting to the bottom of the why. can you answer that for me? >> i think part of the reason may be relatively self-evident. we were not getting good data from the system. we didn't have a good measure of those patients that were waiting -- >> but why? why? we're just -- >> i think we know why. i think we've acknowledged that the system was not honest. we were not getting the information we needed. we had performance measures that were misguided, and we need to reform that so we have accurate

information, and we can resource our system appropriately based on demand and capacity. i think we have the tools to do that. i think we have the information to do that. we need to assure that our data is accurate. we are working very hard to do that. we are making demands on both our visiting directors and medical directors to make sure the practices in their clinic are according to policy. we acknowledge that we are probably going to have to have an independent third party confirm that information is accurate. because at the moment, we have to verify to you, we have to justify to the american public that our information is real and accurate, and we can provide timely care, and we can give the information that we need to assess the capacity. >> i appreciate your answer, but i still feel like we're not getting to the bottom of this. and let me just say, why is the

va so slow? why are they so slow in responding to mr. waltz's office? why have they been so slow in responding to this committee? just why, why, why? is it because there aren't enough -- >> it is not correct. i think we do have to work with this committee, and we do have to work with congress if we're going to build a better va system. and we do need to give you the information that you need. >> dr. lynch, let me ask one other -- is it a system that can innovate? >> yes. i think it is a system that can innovate. and i think we have shown that we can innovate in the past. particularly in response to crisis. if you rolook back in the mid-1980s, there were concerns about surgical care in the va. the va acquired a risk assessment model that has now become the model in the private sector. in the 1990s, the va was

criticized and the va noin vain with the electronic health record. i think we have an opportunity here in va to respond to this crisis with an innovative model of staffing, of assessing demand and capacity that can become a standard for the industry as well. >> please do it. i yield back my time. >> well, if i could just add one thing to what you just said. i think all your questions are critically important, but right now we are focused 100% on trying to get veterans into this system and using all the tools available at our disposal. there will be time for the why questions and the much tougher analytical questions that all of you are asking about how do we fine-tune capacity and demand, but right now the number of veterans waiting is an emergency, and that gets the highest priority. that does not mean anything else is off the radar screen. and i just have to say in response to the innovation

question, i did have the pleasure and opportunity of visiting 1, which happens to encompass the state of maine, and some of the innovations they've employed up there is really terrific. i think our challenge is figuring out how to spread it and see the successes we've seen in surgery and other areas. >> thank you, dr. clancy. >> dr. winthrop, you're recognized for five minutes. >> thank you, mr. chairman. as we sit here and talk about all this, i think a lot of times as people are watching, it almost seems like we're talking about patients as though they're monopoly pieces. when mr. walsh brings up the point of the possibility of getting surgery within 48 hours but it's six weeks until they can get their pre-op work done at the va, it's disappointing that that surgeon can't make something happen sooner or that there is nowhere to go, that these types of things aren't corrected. i'm sure these have gone on for years. there's a lot of things we're

hearing tonight, and you share our concerns. when did you start? when i got here i went to the general three times saying i would be willing to go into the clinics, to go into the ors. i come from private practice. i trained from a va, and to discuss why it is so much slower, why there are so many fewer patients being seen. never got a response, never got action on that. you talk about rvus, and for people at home, they probably don't know what those are. relative value units. a new patient has a higher value than an established patient. a short procedure has fewer value units than a long procedure, those types of things. so when people hear that, they know what we're talking about. when did you start looking at the rvus? >> the rvus, i believe, became part of our evaluation process after the oig report in late 2012. >> so just in the last couple

years. and that's been around for a while as some type of measure. but my question is, are you measuring how many rvus per patient, per day, per month, per provider, per facility, per visit? >> yes, sir, we are. sg >> well, that would be nice, because if you could pick one visit and give me that information tomorrow, i would appreciate seeing how you go about doing that. i would be very curious. and dr. benechek brought up a very good point when he said how much are you spending for rvu? so if you take all this money you're spending on these patients and tally up how many rvus that have been built up, how much are you spending per rvu? because i can tell you medicare knows how much they spend per rvu because it's already established. so your budget is out there. you're measuring rvu but not how much you're spending per rvu, and i think that's key. and i also think it's key that you look at how many patients a doctor is seeing each day or a facility is seeing each day.

there's more than one way to measure these types of things. in our practice, if one doctor is seeing 60 patients and a similar doctor is seeing 30, we're talking to the one with 30 and see how we can help them get that up and continue the quality that they have to have. but when you're comparing to yourself, i don't think you're getting anywhere, and that's part of the problem. so my next question is, when you talk about doing these evaluations of profficiency, who is doing this? if it's someone in the va system their whole life, they don't know what they're measuring, they don't compare to successful, healthy health care systems. so who is doing this currently? >> right now it's being done by dr. carter mecher and eileen mor moran. >> are they in the private sector? have they been in academia? where have they been in their careers that makes them qualified to do this? >> i don't know dr. mecher's history. i know he's met with the

physicians on this committee, so i think you have talked with him. i think he does have a good handle and a good understanding of the rvu system and productivity. i think he has some very innovative concepts of how we can use that to resource our system and to look at right-sizing the number of physicians and the capacity that we have. >> and that's helpful, but i would definitely look at someone who has had great success in these areas and they exist throughout our country, without a doubt. >> we are speaking to kaiser and a continue of leaders from private sector systems, and if you had other suggestions, we would be all ears. >> and those are good suggestions, and i would also suggest that you encourage the president and the senate to confirm someone who has some administrative experience in the private sector in these areas. i think it would be a great benefit to our veterans and to our country. and lastly, i do want to point out that the cincinnati va, and

i represent that area, has been flagged. i have asked for why they were flagged and have not received my notification yet as to why. certainly somebody knows why, so i hope we get that very quickly as well. i look forward to seeing one of those reports on the rvus as well. i yield back. thank you. >> ms. custer, you're recognized for five minutes. >> thank you very much, mr. chairman, and thank you, dr. lynch and dr. clancy for being with us this evening. i think what all of us are trying to do is be helpful. i think our chair opened the hearing asking how can congress help you? and our challenge is that this whole process feels like a rubik's cube. every time we think we've got a peace and order and we think we understand what the problem is, is it not enough physicians, then we offer to help on that, but maybe that's not the problem, it's a space problem. if it's not a space problem, it's the support staff and the list goes on and on.

i'm very fortunate to have experience with the d.a. in new hampshire. my father-in-law got very excellent care within that system, but obviously the concern that we have is that that be replicated for every veteran around the country. so the focus of my comments is, how do we ensure access to high quality care at a cost that the taxpayers can afford for every veteran? i spent 25 years in the private sector on policy issues. i know this isn't easy, this conundrum of high quality care, access and cost. sometimes a wobbly three-legged stool. but in your case, it seems that the problems of scheduling and wait time data has called into question the whole basis for your staffing and capacity calculations. and i think, dr. lynch, you just mentioned this. you're trying to match supply

and demand, but you don't have an accurate picture on the demand side, and so trying to determine what the staffing model would be is of limited use. and when you tell us the average is a physician seeing 10 patients a day, does that include the data that we've heard in this committee of 50% no-shows? is that actually a physician that has 20 slots per day but only 10 patients walk through the door? and we want to help you with this. we want to get the policy right. we have legislation that we're offering this week. it will be bipartisan, that's about getting residents involves, give you greater capacity. we would be happy to help talk about what the state issues, but how can you help us with where to start helping you? >> congresswoman, i think we can

start by trying to give you the information that you ask for. and i apologize if you have not seen that. we have provided a briefing to members of this committee on the productivity model that we have. i acknowledge that until we can assure the accuracy of our scheduling data, that information is going to be flawed. although i am confident that i think we do have reasonable information on productivity, and we can begin to use the productivity information to begin to look at what we need in the way of additional staffing to increase the efficiency of physicians, or, in those practices that are very efficient, who we may need in the way of additional physicians. so i think we have a start. but i think we need to gather more data. i think we need to have accurate data on access before we can come to a final answer. >> and then if we could add dr.

benechek's analysis about the cost in-house and outside the va, because it's difficult for us to make that recommendation as to how to make these adjustments. you know, we want veterans to be seen in a timely way, but it's not unlimited, you know, the funds that can be put toward this. if it is less expensive within the va, then let's expand your capacity. if it's less expensive outside the va, then let's use private facilities, but we're not able to measure this at this point. >> no, but i think that all of the information that you've heard and we look forward to briefing you more on, on the productivity and staffing, will be a huge puzzle piece here that will be foundational to getting to this second order question after the emergency of addressing people waiting in line right now about what kinds of resources do we need.

and the issue that dr. lynch brought up a couple of times about maker by decision at the very local level, because that's where it needs to happen, the answer to that is not going to be thumbs up, thumbs down all the way. it's probably going to be make in some areas primary care, for example, and buy in some other specialty areas and so forth. and a lot of that will be a very dynamic relationship with community capacity and so forth. >> my time is up, but i do have a specific question i'd like to get to later about women being served in the va, because i think that's a unique situation as well and problematic at best. so thank you, mr. chair. i yield back. >> you're recognized for five minutes. >> thank you. i'd like to ask a question about the va staffing and productivity standards. the ig that was here a couple weeks ago made an interesting kind of assessment. he pretty much said be careful what you wish for to our

committee and this issue of va care. i did some investigation in my state. i learned there are a number of va hospitals, including the one in fort wayne, indiana, va medical center, that are not functioningal fu aling at full . they're turning patients away due to lack of physicians or facilities. the va facility is closed. the er is now using criteria over what patients they'll accept and those they will turn away based on their facilities. by paying for non-va care in addition to operating half-empty hospitals, va appears to be paying for two systems of care. so do you know how many va hospitals fit this description? >> i don't. >> could you give me that number? i found the fort wayne one pretty quickly. >> i think there are facilities that are struggling. they are older facilities. not always like fort wayne where they're in larger communities. sometimes they're in smaller

communities. the population that they support is small and oftentimes it's difficult for them to support an icu. those are difficult decisions, but we need to look at our facilities where they are and we need to ensure that we're using them optimally. >> i guess my follow-up question would be what the ig warned us about, which is, who is looking at those numbers to figure out -- for example, in fort wayne, those numbers for pre-basis care are skyrocketing every year. once i looked at that and found out there's no icu and they're using criteria of who they can take and who they can't take, they may have to send somebody across the street for a risk-based procedure because there's no icu. who looks at those numbers? is that statewide or that specific hospital looks at those skyrocketing numbers, and who makes the assessment are we paying for two facilities or are we paying for one? >> part of the challenge we have is that based on the volume in some of our facilities, we

cannot support an icu. not because we can't afford it, because we don't have the patient volume to maintain competence. and so there's a balance. and oftentimes it's felt that because of the volume and because of the competence, it is better to send these patients into the private sector. i understand your concern, and we do need to look at where our costs are going and how we're using our facilities. >> we do need to look at or is somebody actively looking at this now that all this information is really coming to us from the inspector general. is somebody ongoing looking at that to see this cost benefit analysis to see what are we paying for? are we paying for two systems, or is that something you're going to look at in the future? >> i don't know whether we have an active exercise in place, but we certainly do need to have one moving forward. >> i just got a note from a constituent that says there must be some kind of cnn program on tonight and that there's a new

revelation. it says records of dead veterans were changed or physically altered, some in recent weeks, to hide how many people died while waiting for care at the phoenix hospital. a whistle blower pointed to a new problem in the va scandal. records were removed so it would not show that patients died while waiting for care. you've been to the phoenix hospital four times. are you aware of this revelation? >> i am not aware of the revelation. i am aware that the ig is looking very carefully at all the deaths that have occurred. i don't know of any attempts to hide deaths, congresswoman. >> and my follow-up question, because i imagine this will be big news this morning or big news tonight when all the constituents are watching the news. to echo the comments of the committee, it's so hard to take the information seriously that you give us tonight when there are these ongoing investigations

by new whistle blowers that they're taking stickers off of files and removing names still. while we've been doing these hearings a couple months and americans are literally wondering when is this going to stop? this looks like a new revelation tonight. under all the scrutiny, all the lights, all the spirit of full disclosure, phoenix is still doing this kind of stuff? and you guys have had them under a microscope and you've physically been there four times, and this is new? >> congresswoman, i don't know the details of the accusation. >> could you provide that to us when we're probably going -- i think the details are up, but could you provide a va answer to that in a timely manner? >> i will certainly try, as i understand it. >> thank you, mr. chairman. i yield back my time. >> mr. roarke, you're recognized for five minutes. >> thank you, mr. chairman. dr. lynch, you mentioned earlier that $312 million has been made available to accelerate access to care for veterans who have been unable to receive it thus

far. where did that money come from? >> the money was recovered from funds that were not being used across va. i believe there was some activation moneys that was repurposed to cover the accelerated care initiative. >> and what are activation moneys? >> activation moneys are sometimes moneys that are used for new projects. i don't know the details, but i would assume that it was felt that the moneys were not absolutely necessary at this time and could be repurposed to address the immediate concern, which was the provision of timely care to veterans. >> will you or the va be coming back to congress to recover those moneys after we get through this crisis? >> i don't think that's our intention, congressman. >> okay. >> i think our immediate attention is to provide timely access to care, and at the moment, we're trying to use the

funds that we have. >> what i'm trying to get at, and i agree with you that should be our focus, and i appreciate dr. clancy saying that earlier that the number one priority before us is to connect veterans who need care to the providers who can give it to them. but i do want to get to the chairman's question and one my colleague, ms. kuster, brought up, which is, what likely will you be asking for from congress? i think this is a time where the american people and their representatives here would be very open to request from the va to say to get to the level of care that we have promised to our veterans, we need x. and, you know, you say that you have provided 312 million. is there more to be found among those funds from which you've taken it so far? will there be more needed in the coming days? we're really only weeks out from the revelations, and as miss walorski pointed out and others, myself included in our districts, we're still finding new gaps and shortfalls that

need to be met. so i'm thinking -- and you may not have a number in mind, but wouldn't you say that you're likely going to come back to congress to request additional funds? >> i can't answer that question right now. i can tell you that we are beginning to look at the resources, particularly personnel resources that we need, to increase our capacity and will be working with the congress to develop a proposal that would allow us to hire more personnel to provide that care. i know that we're looking carefully at the money we're spending on fee basis services. we have been able to find some central money to send those patients out. facilities and networks have also been able to identify moneys as well. it's anticipated that we will probably increase va funding on fee basis care from about 4.8

billion to about 5.4 billion this year. >> and i'd also ask you to -- and you essentially committed to this earlier in previous answers, but pay special attention to the providers that we have within the va system today and retaining them there. when i met with providers in el paso a couple months ago, morale couldn't have been lower, and a lot of it had to do with the amount they are being paid, meeting with colleagues to work with d.o.d. which paid more, to work in the private sector which paid more. in some cases they were single parents. these were nurses, nurse practitioners, providers of all kinds. and i've just got to think as you're repurposing these funds and perhaps asking more from congress, i think it's really important that we ensure that we are attracting the absolute best within the va system that we're actually then able to retain them. one primary health provider told

a prescribing for mental health patients and seeing the mental case load that's coming in here. he said he didn't feel good about it at all, it's not right, but he wasn't going to let that person go untreated even though he's not trained to treat them for these problems. that raises a lot of questions and issues in itself, but it gets back to the resources for providers. i have a number of other questions specific to el paso, but we'll continue to reach out to you in between these hearings and after these hearings to follow up. i appreciate your responsiveness so far, and i do ask dr. clancy and dr. lynch and the leadership, as we get through this immediate crisis, if we lose this opportunity to address the real systemic, structural, cultural problems within the va, you know, i think that we will be right back here again in another couple years, five years, ten years having this very same discussion. so while addressing care and connecting veterans to care is

important, let's smmake sure we don't stop there. we need to address the culture and the operations in the system. thank you for your cooperation on this. mr. chair, i yield back. >> you're recognized for five minutes. >> thank you, mr. chairman. dr. lynch, i want to give credit where credit is due. i recently hosted in my congressional district what i call the va intake day and invited the community to come in and talk about their care, their complement, their concerns at both baker pines and haley. we had a lot of people come in to simply defend the va health care that they receive. the other thing i want to compliment you on is secretary gibson said a few weeks ago that they are in the process of contacting 95,000 people on the waiting list. i actually heard from people in my district who were contacted by phone. one was told your dermatology appointment is four months away, and if you'd like, we can move

that up and see you. i want to compliment the department for that, yourself, the secretary as well. i'll also tell you just as a matter of a metric, we gave a questionnaire to folks. and for those of the 200 who filled out surveys, of those who had sought to go outside the system for non-va care, 50% rated that experience in trying to get the va to feed them out as poor or very poor, expressing a lot of frustrations with the ability to get outside the system. i recognize those were some quick metrics we got. they mentioned behavioral health and mental health. i met a patient who committed suicide while he was waiting for services. they directed the department to competitively contract with non-va providers in certain communities where there was a need for additional mental and behavioral health capacity as

well as where there was also a non-va infrastructure that could actually provide that. are you aware of that direction, and can you update us on whether or not that has been pursued or is in the process of being implemented? >> i know that the va has been actively working with the community. they have been holding almost on a yearly basis mental health care summits to inform the community of opportunities to participate in the care of veterans. so i think we are moving aggressively to involve the community where they are available in the care of veterans if it's necessary. >> i understand that reflects a spirit. but the department was directed by the congress. congress determines the budget, congress makes directions when it comes to how that money is to be spent. and in the 14 bill, congress directed the department -- didn't ask -- directed the

department to have a demonstration project to competitively contract out in certain communities at the choosing of the va, mental and behavioral health, non-va care to do a demonstration project to relieve capacity in certain areas. i guess, particularly given the position you have, are you aware of that in the 14 budg'14 budge? >> yes, i am aware of that. >> has anything been done to implement that? >> yes, it has. >> what has been done? >> we have developed demonstration projects, i believe, at five or six of our facilities to involve the community in veteran care. and we are evaluating the results. that is in process, yes. >> okay. i would very parochially tell you how wonderful the pines health system is and we have the best beaches in the world. to the extent tampa fits that profile, i would encourage you

to look at it. well, two last questions. one, for non-va care right now, those who ask to go outside, i understand that folks who need a specialty care service that's not available from within the va are likely the most candidates. what about for the va patients who simply aren't satisfied with the quality of care and ask to see a different primary care physician outside the system? has that ever accommodated to va care? >> i think the va would attempt to find the patient another provider within va if he was unsatisfied with his current provider. >> is there any -- and i understand there is some statutory guidelines. any feasibility of going outside the va? >> in rare instances, tif the patient is very unhappy, and i'm speaking from personal experience, as chief of staff i had authorized patients to receive care outside the va. >> and my last question, and ms.

walorski just shared the story that's breaking, and i understand it's breaking, you had the opportunity to review it, but i did have a very specific question. because the ig talked about criminal investigations or investigating allegations that rose to a criminal level. we've had several hearings thus far. were you, dr. lynch, personally aware that this was a matter of being investigated, that the word deceased and the label deceased had been or was being removed from files? did you have actual awareness of that, that that was being investigated? >> this is the first i've heard of it. >> so you weren't aware that it was being investigated? >> no, i was not. >> thank you very much. i appreciate it. yield back. >> you're recognized for five minutes. >> thank you, mr. chairman. i'd like to go back to the point that miss kuster was making at the end of her comments. we're talking about evaluating the capacity of the va to care for veteran patients. i want to look specifically at the va's capacity to serve our

female veterans. they're often referred to as the hidden veterans or the silent veterans because they're less likely to seek service because it's not very accommodating and the statistics that have just come out in an ap story certainly show that. with regard to capacity, last year the va served 390,000 female vets, and yet a quarter of the va hospitals do not have a full-time gynecologist on staff. a quarter. with regard to quality, half of the women veterans received medications through the va health care system that could cause birth defects, despite the fact that many are of child-bearing age and the majority were not on contraception. this is much higher than what would occur in the private practice. with regard to care coordination, the va-oig has said that 50% of female veterans didn't receive the results of their normal breast cancer exam

within the required two weeks, which is your own policy. and even more disturbingly, 45% of those results never made it into the electronic health record data system. i find these statistics to be as bad, if not worse, than some of the others we've been talking about just generally speaking, and they indicate that the issues of access to quality care and proper coordination of care may be even worse for our female veterans than they are for the general population. now, i understand you have some plan to ensure that there is a designated female provider, women's provider, in each facility, so i'd like to ask you what's your timeline for achieving that goal? whether y when are you going to start doing some training on va providers for health concerns like drugs that can cause birth defects, and just what is your plan for looking at the female population, because that's a

group of veterans that is going to increase in number? >> you're absolutely right, congresswoman, and i thank you for your questions. we were concerned by some of the findings reported in this story as well. about 80% of our facilities do have a designated women's health provider, and in some of the other facilities, there has been a challenge identifying someone to do that, so we are looking into training some existing staff, for example, some of the current primary care clinicians to be able to meet that role. i should just point out this is not something that we just came up with on the spur of the moment for women. i mean, this is an area where we've had other similar sorts of training experience training people with specialized expertise, for example, when there is a particular problem that's much more common in one facility. we figured out how to bring specialist expertise to prthe primary care facility. we're going to try to do the same thing so we can get up to

100% as soon as possible. the issue on mammograms, as i understand it, in terms of the timely follow-up particularly for abnormal findings has been the focus of some substantial improvement efforts, and we can get you more details on that. the other thing i would just point out in terms of women's health is that obviously women have issues that relate to their unique needs and issues as women as well as all the other stuff that human beings get, whether that's heart disease, lung disease and so forth. vha is the only system in this country that actually routinely reports publicly and transparently about how we do for women and men. that is not true for any other payers in this country. and, in fact, the disparaties are minimal, if not different,

between women and men. i'm talking heart disease and so forth. the issue of gynecological care is one that's improved substantially, but clearly we have more room to go. >> i don't think that's accurate. i'm glad it's been improving, but a recent opinion by the american college of ob-gyn says there is an urgent need to continue training providers in this area, and you mentioned that you've done some work with the reporting back, especially of abnormal results, and it says that they are typically informed within three days and "typically" is in quotation marks. you don't really show why the improvements have been adopted or what specific progress has been made in this area. it's kind of hit or miss, like so many of the things that we've been hearing about. so i am concerned that you are just going to train primary

caregivers to be experts on women's health. maybe that's an interim measure, but it's certainly not the same as having somebody who is qualified in that field. and again, i go back to these clinics that exist, say, in rural nevada where it's very hard to find somebody who is an expert or even in our urban centers like las vegas where we lack providers, and this is something that we need to address, even if you send them out into the community and then you don't track their results out in the private sector, or if you send them out and there are no providers in the private sector, we really have just kind of traded the devil for the witch. we haven't solved the problem. >> i very much appreciate that, congresswoman. i want to be clear about one thing. i wasn't suggesting we would be sending primary care providers to camp for three weeks and then they would be ob-gn yryns by an stretch of the imagination. this was more serving in the

coordinating role and providing some basic services but also making sure people got services they needed in a timely fashion. and i would just say our top consultant in mental health, urgency would be her middle name, but i would be happy to get back with you with the model more specifically. >> thank you. i yield back. >> i'm certainly glad it's not three weeks. it took me 40 years and three years experience to get to og-gyn camp, so i'm glad to hear you can't do it in three weeks. look, we want to, as a group here, and i think you hear from both sides of the aisle. we want to be able to go from good to great. and to be able to do that, though, we have to have information that's accurate and timely. and i looked at the memo the day we were sent on the rvus. i know this isn't a big thing, but i think it's a symptom of what goes on in the va. if you look at a law that was passed in 2002, it looks -- it

appears to me when you look at the evaluation that the ig did with these five medical centers in boston, houston, indianapolis, philadelphia and looked at the staffing levels we're talking about for specialty care services, it's taken 12 years and we still don't know what they are. i mean, this law was passed in 2002, and it's 2014, and we're still talking about we don't know what our staffing needs are. well, that's not complicated. i can tell you haven't spent 30 years doing what i did. it's not hard to figure out what your staffing needs are. if you can't get anybody in to see a coardiologist, you need a cardiologist. you don't need another study to figure that out. and i don't understand, again, the accountability. when this didn't happen for 12 years, and then last friday we found out that 80% of the people in senior levels at the va got

rewarded for doing a great job. and yet we completely ignored this metric. it doesn't appear there is any penalty whatsoever for not following the law. am i wrong? i mean, why wasn't this done? >> congressman, i can't speak to what happened before i got here. i can speak to the fact that following the ig report, that was taken -- the recommendations were taken seriously. we are a year ahead of time in meeting those recommendations. by the end of this year, we will have productivity standards for all specialties in va, and we will be able to use those moving forward to make decisions about where we need to supplement support for physicians or to provide additional support. >> let me ask the question again. is there any accountability at all? because this 12 years went by. this information should have been available to you all so you could use to prevent what just happened.

i'm going to go on to a couple other things. mr. o'rourke brought this up and i agree with this. the backlog is not going to be a big deal. we can fix that one very quickly, i think. and today i got a call from memphis, tennessee, a physician down there put together in three days with the university of tennessee system, with the methodist hospital. they'll see any veteran, primary care or spebcialty care, including oncology, in 72 hours. so the backlog is very simple to solve. a much more difficult decision is the culture of the va where we go 12 years and don't follow what the law is. where we reward people at senior levels for doing i don't know what. maybe some of them did a really good job, but others clearly did not, because we see the failings right now. let me just give you a brief example. i went to my eye doctor today right here in washington, i had a little retina problem.

the doctor said he had been trying to get to the va here, the retina specialist, to help out. he had a patient that was supposed to see a doctor in january of this year with a retina problem at the va. it snowed that day, the doctor couldn't get in, so they made the next appointment in june. that's this month. well, when the retina guy finally saw him, they rushed him over to the retina specialist because the guy had an unattached retina for five months that didn't get treated. this physician i talked to in memphis had a fellow who took eight months to get to an oncologist in the va. they recommended a biopsy. that took four months. the man has cancer they probably can't treat now. we cannot have a system that treats our veterans this way. we have private physicians who want to help. they want their veterans like me and dr. winthrop and others who -- this young man right here, i should show you this

when we get through here, dr. lynch, i want you to see this because they want to help. i think they're there to help, i think their intentions are right. i think your intentions are right. i truly believe that, you want to make things better for veterans. but we do have that second one. that first one, the backlog, we can take care of that. in six months we can get it fixed. that second one, though, that culture in the va, is going to be much, much harder and it's going to take a lot of work and honesty and transparency so we can help you go from good to great. i yield back, mr. chairman. >> thank you very much, doctor. mr. mis hrhmisho? >> thank you. when you think of the costs in putting out services from the va, do you also consider the savings? we heard from the ots program. we're able to save the va about $600,000 during that pilot

program for mileage. do you consider the cost savings as well or just the costs compared to others? >> i think when we look at how we manage excess demand, we need to determine whether we can provide that service more economically within the va, or whether it's better for us to buy that in the community. i think that's an important decision. we do know the community costs. we can calculate. we do have the information to determine what it would cost us to hire those physicians and to provide care in the va. and i think if we can do it more economically and at less cost in the community, then that would be an appropriate thing to do. >> but considering all the factors, it might cost within the va for a certain specialty care. costs might cost more outside, that same specialty care, but when you look at the savings,

it's more cost-efficient to do it outside versus inside. so do you look at the whole cost? >> yes, sir, i think we do. and we will. >> my second question is, of the three key elements of capacity, supply for clinical providers, amount of services providers can deliver, bauden it infrastructure, of these three, which one proposes the greatest challenges to the va? >> i would say based on our aging infrastructure, our greatest challenges are providing the physicians adequate space to see patients and giving them the support they need to see patients efficiently. it's hard to separate. i think i.t. is a challenge as well, but i think we do have an electronic medical record. it's not a perfect record. it's in the process of evolution and improvement, but i think our greatest challenge is our support for our physicians and the space for them to provide care in an efficient fashion.

>> my last question is, when you look at the wait lists, i know some facilities have an automated system where they call in, it's automated depending on how long it takes them to get through the menu. they might hang up and say the heck with it, i'm not going to bother. are they counted into that wait list, and if so, how can you track them? >> people call in to the va for a number of reasons, so it's going to be difficult to know what they're calling in for. we do measure, however, abandon abandonment rates, and we do measure the timeliness of our telephone system. we're working to improve those so that won't be a problem. >> thank you, mr. chairman. >> dr. winthrop? >> so i'm a little confused by

interoperability of records. can you tell me what they were trying to explain about interoperability? >> this is an area where you're both right. they've put in place in incentivizing providers to input records and the like. not to actually buy the stuff but to use it to improve quality of care. that second stage of meaningful use actually requires that providers be able to share some information with other providers. so you're right, that meaningful use is actually a path to getting us to a place where we can share all the information. i think it's fair to say that many providers are finding this challenging, so dr. benechek is also correct when he says, give me a break, because when you think about uploading all information from one to another, that's actually much, much

steeper and likely a bit far off. but i think your original assertion that, in fact, the centers put in place by the vhah all of that. >> i understand having spoken -- quoting them, the information is all there. it seems common sense to me that records are integrated. that that enhances the integrated care within the system. so within the v.a. system, doctors can pass this information around. >> absolutely. yes. >> so the concern that was raised in these hearings was the lack of interoperability with d.o.d. the millions of dollars that we've not been able to spend in a way that we have interoperability. we listen to situations and cases where service members and

veterans, their health care was greatly compromised. and so i've been listening to these hearings and understanding that the challenge with being able to move into opening great opportunities for our veterans to use, access non-v.a. care, is this interoperability challenge. so that's why, you know, i was raising the question. so it would seem to me that if we want to move more in this direction, that we're going to have to encourage private -- private physicians and care groups to be able to communicate with the v.a.'s record system. >> yes. so i think your other question or statement was that if this were written into the pc-3 contracts, that providers who had met the meaningful use requirements and so forth would

get preference or to the extent that they could contract with such providers that would be a good thing in terms of coordinating care is a very fabulous idea. so we'll take that back as well. >> thank you. >> ms. brownley? ms. tice. >> i have a quick follow-up. i want to go back to fy-'14 appropriations question i asked you for a point of clarity. i understand you mentioned the v.a. is in the process of working with outside providers. is that just a general statement? are you suggesting that the demonstrational project congressionally directed in the fy-'14 budget is being implement zbld it is being implemented, congressman. can i get you the information on the sites where that's being provided at this time? >> you certainly could. there are about six or seven of us that actually wrote a letter to the secretary on may 7th

asking for an update on the imp lemation. i know you got a lot of letters coming your way now. it is a matter of concern. it was done with some specifici specificity. even the criteria were put in the congressional report as to how the centers were to be evaluated. so i just want to make sure we're talking apples and apples here. this is the fy-'14 -- >> let me work with our office of mental health operations. >> that would be great. >> get you the information that you need and make sure that we are talking apples and apples. >> sure. i'll leave a copy of the letter. it was may 7th. there's seven of us that signed it. i'll put it in your hand when we leave tonight. appreciate a response. >> thank you very much. >> thank you. >> mr. kirkpatrick, you're recognized five minutes. >> thank you. dr. lynch, i just have two questions. is there a complaint system within the vha, something like a hotline that a veteran can call and someone gets back to them about their complaint? >> dr. clancy, do you want to take that? >> yes. every facility has a patient advocate. and, in fact, they get

complaints. they get all kinds of calls. that is actually tracked in terms of time to resolution and so forth. that all of the patient advocates now come under an office of patient centered care and cultural transformation. so we have begun working with them a bit from the quality and safety side to try to figure out how could we learn more from what they're hearing. because we're noticing that a number of private sector organizations are taking to heart just how important and useful it can be to learn from the patients themselves. >> is that information looked at nationally, nationwide? it doesn't just stay at the local facility? >> yes. there is a national database. >> my second question is, are you consulting with the vsos on how to engage innovation in the system when it comes to scheduling these appointments?

>> we have not been communicating directly with the vsos. i think we certainly have been looking at ways that the vsos can help us understand how the veterans are perceiving our care and the timeliness of that care. i think there's a huge opportunity there. >> i agree. and, you know, chairman miller, i think it might be good to have a hearing where we hear from the vsos about their suggestions about how to fix this problem. i yield back. thank you so much. >> thank you very much, ms. kirk jb patrick. we do have one hearing that will be coming up in several weeks. it will be specifically geared towards the vsos. it's at that particular hearing that we will invite the secretary to be here to hear their recommendations as well. dr. reese? ms. kuster? mr. o rourke? >> thank you, mr. chairman. thank you both for being here and listening to the testimony i appreciate where you're at.

i've said het here almost in th exact same seat for 7 1/2 years. just like you with the vsos and the v.a. as partners and advocates to get this right for veterans. i'm going to come back to -- i oftentimes in those years preface i'm your staunchest supporter but i'll be your hardest critics when i need to be. dr. roe brought this up. mr. o rourke and i brought it up with several others. this is the time to think fundamental change. this is the time to think big. i found it interesting that you focused, dr. clancy, on the triage, which of course needs to be done with these veterans right now. and called what we were talking about a second order question. i would argue that you had addressed that earlier, we would have never had phoenix. we would have never had those things. i'm going to ask you, are both of you clinically credentialed. >> i'm not currently -- not clinically credentialed at this time. i certainly have been for the last -- >> can you see patients? >> i cannot see patients, no. >> dr. clancy?

>> i haven't. i haven't for a number of years. i've actually looked into what would be required. >> but you're both doctors? >> yes. >> and we don't have enough doctors. so i'm going to say what vietnam veterans of america made this suggestion to you. the question was that you haven't contracted them. this is what they said you needed to do to fix this in phoenix. all vhs staff with clinical credentials and training who are not directly direct service providers need to see patients four days a week. get out of the administrative office and go see patients. if you're serious about this triage, i would think you would be turning over every stone to find positions already in the system. the reason i'm bringing this up, it may not seem like a fair question, but the ability to call fundamental cultural change a second order question, we'll get to it when we get this down, you can multitask. get that done. that is, of course, a priority. but not addressing this? we're going to come back here again. that is more of a statement. believe me, it pains me that

we're at this point. it pains me all the good work we do gets erased by this. but it once again confirms to me this is cultural. it's leadership. it's structural. and it runs deep. i yield back. >> thank you very much, mr. walz. following up with your line of questioning, how many physicians are there in the system who don't see patients? that are in administrative roles? >> i don't know, mr. chairman. >> would you find that out for us? >> yes, sir. >> thank you very much. in your testimony, you mentioned that -- or an answer to a question that somebody had about how much money was being spent to help solve the backlog problem, i think the number that you used was about $312 million being made available for your access initiative. you mentioned the funds were centrally located. can you give me an idea where the funds were supposed to be spent? >> i will get that information for you. >> is the 312 million part of

the planned $450 million carryover that the department had already budge ed for 2015? >> i can't answer that, mr. chairman. i will get the information for you. >> i can answer it. >> it is. >> it is. and i guess the big question is, almost half a billion dollars st sitting there in the bank. why do we have a backlog the size of the one we've got? how did we get here? i don't think anybody even to this day knows how the culture became so corrupt that people would falsify records and in some cases, i believe, criminally, that we would cause veterans to wait months and years. look, that's $500 million for carryover this year. we've had a couple of years just recently that have been a billion dollars carried over.

and i don't think the public understands. people are running around saying, more money, more people, more money, more people. $500 million sitting there that could have solved this. and nobody within the central office or the department was blowing the whistle, saying we needed to spend that -- it's almost as if they were trying to keep it for a nest egg. for next year. because if you carry it over, it goes into the base budget. we've got to fund it again. that's how the bureaucracy grows. with that, thank you so much for being here. we appreciate both of you members. thank you for attending. this hearing is adjourned.

and we're live on capitol hill this morning as homeland security secretary jeh johnson and other government agency representatives are witnesses as the homeland security committee examines what the u.s. should do about the influx of unaccompanied, undocumented children coming across the southern border. congressman michael mccaul of texas chairs the committee. bennie thompson is ranking member. as this hearing convenes we'd like to hear what you think about this issue. offer your thoughts a t your facebook page or tweet us using #cspanchat. this is live coverage on c-span 3. we expect this to get under way in just a moment.

security will come to order. the committee is meeting today to examine the current crisis at the border regarding unaccompanied children. i now recognize myself for an opening statement. today on the southwest border we are facing an escalating refugee crisis. parents are handing over their young children by the thousands to cartels who are profiting by smuggling these kids to the united states. many are under the age of 10. including some barely old enough to walk. these children with no parents, relatives or legal guardians risk a perilous and sometimes fatal journey riding buses and trains from central america via mexico. as a father of five, it's unimaginable to me that what would compel a parent to risk the lives of their children on such a dangerous passage. not to mention the risk of sexual assault, exploitations

and the potential to be trafficked. when they arrive at the border, the children are simply turning themselves into the nearest border patrol agent. however, patrol stations are not set up to handle this massive and growing number of detainees. let alone children. shelters have been established like the one at lackland air force base in san antonio. we've all seen the photos of hundreds of children piled on top of each other, and the flow shows no signs of abating. every member of this committee including myself is gravely concerned about the safety of children, no matter where they come from. since october, 52,000, 52,000 unaccompanied minors have crossed into the united states from mexico. nearly two-thirds of those cross through the rio grande valley in texas. cdp estimates that next year

more than 150,000 unaccompanied children may attempt to cross our borders. this is a crisis. it's a crisis that's been in the making for years. one that we should have seen coming. but few concrete actions have been taken. the department of homeland security and the united states government as a whole has been slow to act, turning a blind eye to the warning signs. the tragic fact is these children are making a dangerous journey based on misinformation and the false promise of amnesty. the first step is for the administration to acknowledge the cause of this problem. no one questions the fact that there are horrible economic conditions and violence in central america. but these conditions are not new. what is new is the series of executive actions by the administration to grant immigration benefits to children outside the purview of the law. the relaxed enforcement posture

along with talk of comprehensive immigration reform. it is beyond dispute that such a narrative shapes behavior and encourages people to come to our country illegally. in fact, newspapers in el salvador and honduras seem to be encouraging youth to head to the united states based on these policies. in recent internal dhs surveys, these childrenry ve reveal that than 70% believe they are going to stay in the country. this administration should send an unambiguous message that those arriving will be promptly sent home. i, for one, do not want to see another child harmed because we have not clearly articulated the realities on the ground consistent with current law. yesterday i was glad to see secretary johnson's letter. an open letter to the parents of children crossing our southwest

border, notifying them that there are no free passes into the united states. this is a good start. but a lot more needs to be done. in addition to a robust and effective public service campaign, we should also engage with the government of mexico to step up their efforts to secure their southern border. i call on the president of mexico and his interior minister to do just that. i'm very concerned that this recent surge is weakening our border security efforts here at home. border patrol agents and officers who are looking after these children are being taken away from their main duty, their mission of tracking down drug and weapon smugglers as well as criminal aliens. operation control of the rio grande valley, the busiest sector in the nation, may be suffering. and cartels will no doubt exploit this situation. recently the state of texas announced that it would surge border security operations along

the border to fill a void left by the federal government. securing the border is a responsibility of the federal government. states should not need to protect what is in the federal government's role under our constitution. the president needs to immediately send the national guard to the southwest border to deal with this crisis. we need to find solutions to this crisis, and soon. and while secretary johnson has largely inherited the current situation, i look forward to hearing now how he is planning to respond to this emergency. again, i want to thank the witnesses for being here today on such short notice. the chair now recognizes the ranking member. >> thank you, mr. chairman. i want to thank you also for holding today's hearing. i want to thank the witnesses also for their testimony. on a daily basis, waves of children ranging from toddlers to teenagers are fleeing

violence, oppression and economic desperation from guatemala, honduras and el salvador. many of them sent by their families. they are simply looking for a safe haven. as an intense and significant humanitarian crisis develops, we are finding it to be complex. it is irresponsible to attribute this crisis to one u.s. policy, or for that matter, one u.s. president. despite the demagoguing by many, this crisis is not just an immigration matter, nor is it just a foreign policy matter. this crisis is not exclusive to the united states. much of the western hemisphere is reeling with this crisis. according to the united nations, these children are streaming into mexico, panama, nicaragua and belize as well as canada and the united states. from our perspective, we seem to

be barraged on a daily basis by troubling images of vulnerable children, many still clutching their dolls and teddy bears, crossing the border into the united states and being immediately apprehended by border patrol officers. this fiscal year alone, the border patrol officers have apprehended and detained over 50,000 unaccompanied children at the southwestern border. the number of kids arriving at our border without their parents seems to grow by the day. the influx of these kids has certainly strained border patrol resources. but the men and women of the border patrol have risen to the challenge. in 2008, then president george bush signed a william we believe force trafficking victims authorization act. t( law recognizes that special kay is demanded when dealing with the young and vulnerable. under these laws, the border patrol is required to take

unaccompanied children who are not from mexico into custody, screen them and transfer them to the department of health and human services office of refuge resettlement. i would note for the record that during this challenging time, f even though border patrol has had to ramp up activities in the rio grande valley, the agency's effectiveness rate has improved. for those out there who are looking for simple answers, to lay the blame on president obama's policy on action for childhood arrivals or even the senate-passed comprehensive immigration reform legislation, i would note that neither would apply to these kids. hence the assertion that the recent surge on unaccompanied children is due to lack of immigration enforcement does not pass the smell test. in a time of crisis such as this, mr. chairman, we need to get our priorities in line and find both near-term and long-term ways to address this

situation. on june 2nd, the president tapped secretary johnson to establish a unified coordinating group to ensure federal unity of effort to address this situation. in turn, secretary johnson appointed fema's administrator fugate to be the fellow coordinating official and lead those efforts throughout the executive branch. looking out to the long term, we need to do more to turn the tide on this crisis by, among other things, fostering greater stability among our neighbors and dissuading families from taking such action. over the weekend, secretary johnson issued a public service announcement in various central american countries, debunking the myth about u.s. immigration policy, and informing the parents about the danger of traveling from central america to the united states. today i want to hear from the department about the response and their work with other fellow agencies, including the

departments of health and human services, defense and state in addressing this crisis. we need to organize all our fellow agencies involved, not just dhs, to effectively address the sudden surge. looking beyond dhs, there are questions to ask about hhs's resources for that matter. states' engagement through regional security initiatives such as the central american regional security initiative, do these programs have enough funding and personnel to be effective? i recognize that the panel assembled today may not be in a position to answer this question, but it is a question i will be pursuing. dehumanizing and labeling these kids and their parents will not yield a solution. labeling this as an administration failure will not address what is actually going on in el salvador, honduras and guatemala that would cause a parent to hand over their son or

daughter to a smuggler, or send that child through a perilous trek through central american and mexico to the united states. at this time, mr. chairman, we can use our platform to rise to the occasion and be helpful. or we can engage in political grandstanding at the peril of young lives. it is my hope that this committee, with its strong history of bipartisanship, can choose the former and be a model for effective leadership on this matter. with that, mr. chairman, i yield back. >> i thank the ranking member for his constructive comments. other members are reminded that opening statements may be submitted for the record. we're pleased to be here today to have a distinguished panel of witnesses before us today. first, the secretary, jeh johnson, of homeland security was sworn on in december the 23rd, 2013, as the fourth secretary of the department of homeland security.

prior to joining dhs he served as general counsel for the department of defense where he served as part of the senior management team and led more than 10,000 military and civilian lawyers across the department. as general counsel of the department of defense, secretary johnson oversaw the development of the legal aspects of many of the nations counterterrorism policies and spearheaded reforms to the military commission systems at guantanamo bay. you and i talked privately. you have traveled many times down to my home state of texas and seen this crisis firsthand. we thank you for doing that. he is accompanied today, this morning, by mr. greg fugate, the administrator of the federal emergency management agency. and mr. ronald vitiello, deputy chief of the united states border patrol. mr. fugate and mr. vitiello will not be offering opening statements. they're here to answer any questions members may have.

secretary has submitted a written statement. on behalf of those witnesses which will appear in the record. the chair now recognizes the secretary for five minutes for his opening statement. >> thank you, chairman. you have my prepared statement. i will deliver an abbreviated version of it. mr. chairman, ranking member thompson, members of this committee, i thank you for the opportunity to testify today about our efforts to address the recent rise of unaccompanied children and others crossing our border in the rio grande valley. with me today to answer questions are craig fugate, the administrator of fema, and deputy chief ron vietillo of the u.s. border patrol. to be clear we face an urgent situation in the rio grande valley. last fiscal year, cdp apprehended more than 24,000 unaccompanied children at the border. by mid-june of this year, that number has doubled to more than 52,000. those from guatemala --

guatemala, el salvador, honduras make up three-quarters of that migration. on friday, i traveled to south texas for the fourth time in six months in office. this time to lead an interagency team to oversee our efforts there. while there, we met with officials at mcgown and lackland to review the situation and hear directly from those on the ground what their needs are. while there, i spent time talking with the children again. it is a vivid reminder that this is a humanitarian issue as much as it is a matter of border security. we're talking about large numbers of children. without their parents. who have arrived at our border hungry, thirsty, exhausted, scared and vulnerable. how we treat the children in particular is a reflection of our laws and our values. therefore, to address this situation, our strategy is

three-fold. first, process the increased tide of unaccompanied children through the system as quickly as possible. two, stem the increased tide of illegal migration into the rio grande valley. three, do these things in a manner consistent with our laws and values as americans. so here's what we're doing. first, on may 12th, i declared a level four condition of readiness within dhs. which is a determination that the full capacity of cbp and i.c.e. to deal with the situation is full and we need to draw upon additional resources across all of dhs. i appointed deputy chief vitiello to my left to coordinate this effort within dhs. second, on june 1st, president obama, consistent with the homeland security act, directed me to establish a unified coordination group to bring to bear the assets of the entire federal government on this situation. this group includes dhs and all

of its components. the department of health and human services, defense, justice, state and gsa. i, in turn, designated fema administrator fugate to my right to serve as the federal coordinating official for the u.s. government-wide response. third, we have established added capacity to deal with the processing and housing of the children. we are creating additional capacity in places. and we are considering others. fourth, dhs and hhs are increasing spanish speaking case management staff. increasing staff handling incoming calls from parents or guardians, raising awareness of the parent hotline provided by fema and operated by hhs. surging staff to manage the intake of cbp referrals to track shelter bed capacity and facilitate shelter designations. here i must note from personal observation that our border patrol and other cbp personnel,

as well as personnel from hhs, i.c.e., fema and the coast guard are doing a remarkable job in difficult circumstances. all of these dedicated men and women deserve our recognition, support and gratitude. fifth, dhs is building additional detention capability for adults who cross the border illegally in the rio grande valley with their children. for this purpose, dhs is establishing a temporary facility for adults and children on the federal law enforcement training center's campus in artegia, new mexico. the establishment of this temporary facility will help cbp process those encountered at the border and allow i.c.e. to increase its capacity to house and expedite the removal of adults with children in a manner that complies with federal law. artegia is one of several facilities dhs is considering to increase our capacity, to hold and expedite the removal of the

increasing number of adults with children illegally crossing the southwest border. sixth, dhs has brought on more transportation assets to assist in the effort. the coast guard is loaning air assets to help transport the children. i.c.e. is leasing additional charter aircraft. seven, throughout the rgb sector we are conducting public health screening for all those who come into our facilities of contagious diseases or other possible public health concerns. both dhs and hhs are ensuring that children's nutritional and hygienic needs are met while in our custody. that children are provided regular meals and access to drinks and snacks throughout the day. that they receive constant supervision. and that children who exhibit signs of illness or disease are given proper medical care. we have also made clear that all individuals will be treated with

dignity and respect and any instances of mistreatment reported to us will be investigated. eighth, working through fema's national response coordination center, we are coordinating with voluntary and faith-based organizations to help us manage the influx of unaccompanied children crossing the border. the american red cross is providing blankets and other supplies. and through their restoring family links program is coordinating calls between children in the care of dhs and families anxious about their well-being. ninth, to stem the tide of children seeking to enter the united states, we have also been in contact with senior government officials of guatemala, el salvador, honduras and mexico to address our shared border security interest. the underlying conditions in central america that are promoting the mass exodus, and how we can work together to assure faster, secure removal and repatriation. last week, president obama spoke

with mexican president pena net toe about the situation as has secretary kerry. this past friday vice president biden also visited guatemala to meet with regional leaders to address the influx of unaccompanied children and families from central america. and the underlying security and economic issues that are causing this migration. the vice president announced that the u.s. will be providing a range of new assistants to the region, including $9.6 million n( additional funding for central american governments to receive and reintegrate their repay treeuated citizens. and a new $40 million u.s. agency for international development program in guatemala over five years to improve citizen security. an additional $161.5 million will be provided this year to the central american regional security initiative to further enable central american countries to respond to the nation's most pressing security and government -- government

challenges. i will travel to guatemala on july 8 and 9. the government of el salvador has sent additional personnel from its consulate in the u.s. to south texas to help expedite re-pay treeuation to its country. tenth, dhs together with doj has added personnel and resources to the investigation, prosecution and dismantling of the smuggling organizations that are facilitating border crossings into the rio grande valley. 11th, we are initiating and intensifying our public affairs campaigns. in spanish, with radio, print and tv post to communicate the dangers of sending unaccompanied children on the long journey from central america to the united states. and the dangers of putting children into the hands of criminal smuggling organizations. as the chairman noted, i have personally issued an open letter to the parents of those who are sending their children from central america to the u.s.,

which has been distributed broadly in spanish and english to highlight the dangers of the journey and to emphasize there are no free passes or permissos at the other end. we are stressing that the deferred action for childhood arrivals or daca program, does not apply to children who arrive now or in the future in the united states. and that could be considered for daca individuals must have continually resided in the united states since june 2007. seven years ago. we're making clear that the earned path to citizenship contemplated by the senate bill passed last year will not apply to individuals who cross the border now or in the future. only to those who have been in this country for the last year and a half. 12th, given the influx of unaccompanied children in the rio grande valley, we have increased cbp staffing and detailed 115 additional experienced agents from less

active sectors to augment operations there. i'm considering sending 150 more border patrol agents based on my review of operations there this past week. 13th, in early may i directed the development of a southern border and approaches campaign plan effort that is putting together a strategic framework to further enhance security for our southern border. finally, we will continue to work closely with congress on this problem and keep you informed. dhs is updating members and staff on the situation in conference calls twice a week. and we're facilitating site visits to border patrol facilities in texas and arizona for a number of members and their staff. i have directed my staff to be forthright in bringing to me every conceivable, lawful option for consideration to address this problem. in cooperation with the other agencies of our government that are dedicating resources to the

effort, with the support of congress, and in cooperation with the governments of mexico and central america, i believe we will stem this tide. thank you. >> thank you, secretary. chair now recognizes himself for questions. let me say, first, i commend you for your immediate response to this crisis. but we do have a crisis on the border. it's in our backyard. and it's affecting my state particularly probably the greatest. and when i see our military bases now turning into refugee camps here in the united states, i think that's something i never thought we would see in the united states. i talked with senior officials and border patrol down in the rio grande valley sector. we have 250 -- over 250 children being apprehended every day down there. and i think the saddest thing about this whole story is the exploitation of these children.

i think as you recently mentioned in your open letter, you said that it's dangerous to send a child on the long journey from central america to the united states in the hands of smugglers. many children are traumatized, psychologically abused by their journey. or worse, beaten, starved, sexually assaulted or sold into the sex trade. they are exposed to psychological abuse at the hands of the criminals. you know, we see these publications down in central america saying, if you come into the united states, you can stay. now, whether that's a misinterpretation of our policies, i think there's a lot of confusion out there. and i personally believe that this administration's policies have contributed to this problem and have encouraged more people to come. when i talk to law enforcement, whether it's border sheriffs or cbp on border, they believe that

this problem will continue until we provide a deterrence. a strong message that if you do come, you cannot stay. and so secretary johnson, what are you doing in that respect? what deterrence are we providing to stop this? because if we don't provide that deterrence, this problem will not stop. >> i agree, first of all. we need to stem the tide. these gentlemen here to my left and right are leading our herculean effort to deal with the current capacity, but we've got to stem the tide. i believe among the things that i listed here that what is critical is we correct the record. we straighten the misperceptions. the smuggling organizations are creating a misinformation campaign that there's a permissos or free pass. i've even heard that you have to get here by may 2014 in order to get your free pass.

so the smuggling organizations have an incentive to induce these kids to -- to have their families pay money to smuggle them up here. so their putting out misinformation, which we're trying to correct through our public awareness campaign. but we're also building, as i mentioned, increased detention capability for adults who bring their kids into the country to expedite their removal and return back to their home nations. the other thing that we in the department of justice are very focused on right now is going after the networks of smuggling organizations. through their financial transactions, through prosecuting the personnel, we've surged doj and criminal investigators into texas for that purpose. but i agree, chairman, we need to stem the tide. >> and i think that -- that -- i know in 2006 we had a brazilian crisis. and we provided mandatory detention. and it worked. so i think -- i think the administration needs to look at that. i think the national guard -- i

know d.o.d. doesn't like that option. but i think if they could help with the influx and allow border patrol to do their job on the border, i think that would be helpful as well. in the limited time i have, i want to focus on what i think could be a very good solution to this problem. in addition to deterrence. you and i have talked about this issue. and it has to do with mexico. and mexico's cooperation with the united states. they are allowing this to happen in their country. the drug cartels are exploiting these children as they come through mexico. we know mexico's southern border is completely wide open. i know we have offered assistance to mexico that to date i don't know whether that has been accepted. but my information is that it has not been. i would like to commit my efforts to work with you to get that problem solved. because i think as you look at these children, they're all coming from central america.

if we can close the southern border of mexico, that stops 99% of our problems here. so if -- if, mr. secretary, if you would -- wouldn't mind commenting on that issue. >> well, first, as i mentioned in my opening comment, i want to hear every legally available option for consideration. whether it's from my own staff, whether it's from the interagency, or whether it's from members of congress. or former government officials who write op-eds. i want to hear every available option. clearly, the key -- a key to this is what the government of mexico can do. i agree with your assessment, mr. chairman. we need to engage the senior most officials and we've begun that in president to president discussions. i've had discussions with my counterpart. i think that mexican -- the mexican southern border, our shared border security interest,

is the key. i also think that engagement with the government of guatemala is the key which is why i'm going there personally next month. so -- but no doubt, we've got -- this is a critical way to stem the tide. >> all right. i encourage you. i think you're right. central america as well. with the secretary of state, state department has a role to deal with central america in this crisis coming out of there. with that, chair now recognizes the ranking member. >> thank you, mr. secretary. how often have you had a discussion with secretary kerry or burwell on this situation? what i'm looking for is, right now the microscope's on you. but there are some other players in this effort also. are you having discussions with -- with other officials of the cabinet?

>> yeah. oh, yes, definitely. on june 1st, as i noted, the president established a -- a government-wide effort pursuant to the homeland security act to deal with this and set up a unified coordination group, which i oversee. administrator fugate is in charge of it, which brings to bear the resources and assets of not only dhs, but hhs, doj, department of defense. and so we have an effort which fema, day-to-day, craig and his staff day to day coordinate and support. in addition to that, we're in routine -- i'm in routine conversation with my cabinet counterparts about this issue. i'm having a meeting with my cabinet counterparts right after this testimony, as a matter of fact. last friday i brought a group of interagency colleagues down to mcgowan and langley myself.

not langley. lackland myself to see the situation. so we're in good consultation with all these other agencies. >> yeah. just trying to make sure that there's an understanding that it's not just jeh johnson who's responsible for this issue. but there are other players also who actually we need to have conversation with. one of the conversations that i think would be important is under existing law, how long would the children be in custody of dhs before they're passed off to hhs? >> under existing law, we are required to transfer the child within 72 hours to hhs. from the point at which we identify the child as an unaccompanied minor. i know that the provision in the law says there's an exception for extraordinary circumstances. but in general the legal

requirement is 72 hours. >> and i guess my question to administrator fugate is, have you been able to coordinate the resources so that 72 hour pass on is working? >> at this time, with the number of children coming in, we're not meeting the 72 hours. but since june 1st, we've added over 3,000 beds to the health and human services office of refugee resettlement. including the three military bases that previously were referenced. in addition to that, we wanted to get these kids as quickly as we could from the detention facilities to a bed, even if we could not get them to hhs's custody. so custom and border protection has built out one processing center. another one is coming online in mid-july. so at this point, we have not reached the 72 hours. but we're building more capacity to get children in beds. but also health and human

services is stepping up placement for the longer-term care of these children. our other hope is, is that the quicker we can place children long term, either reunited with legal guardians or parents or with foster families while they await further proceedings, the fewer beds that will be required. we have increased capacity. but the number of children coming in have increased as well. and we have not reached the 72-hour mark. >> and i guess the follow-up to that is, in your coordinating role, do you feel that the resources necessary to be successful have been made available to you? >> yes, sir. the challenges again in building out facilities and bringing on additional foster care facilities, these are licensed facilities. it is diligent work by a lot of federal agencies to get this work, and it is time consuming. that's why we looked at some intermediate steps to increase bed capacity within custom and border protection. but you do have, i believe,

additional requests that have been identified from omb that there will be additional resources required in the next year. we continue to work within our authorities and within the budgets we currently have. >> mr. vietello, can you tell us whether or not the border patrol as it's presently staffed can meet this influx of young people coming across the border? >> as is typical, the men and the women of the border patrol have stepped up to this task. i think you heard the secretary describe that we were there on friday. we watched the hard, diligent, heroic work they are doing to make the best of the situation. it's our -- it's my assessment and what we heard from the leadership on the ground down there, the agents that are involved in this crisis, we are adequately staffed and even better staffed than we were this time last year. so we are concerned as this goes

on about staffing levels and our ability to do the other patrol border functions. but the reports that we got on friday, i'm very comfortable that they have the resources that are available and they're using them in an adequate way to protect the border. this isn't a security problem in the sense that this population, both the family units and the children, are not trying to evade apprehension at the border. they're essentially coming in an area that's -- that's well known by us, well patrolled by us. they're not evading arrest. and the other locations along the border were adequately or -- we are better staffed or the same staffing that we had last year. so there is some risk involved here, but the reports that we heard on friday don't concern me. >> thank you. i yield back. >> chairman recognizes gentleman from new york, mr. king. >> thank you, mr. chairman. secretary johnson, let me thank

you for your testimony today. before we get into this issue thank you for what you've done as far as counterterrorism efforts. i want to personally thank you for that. it's greatly appreciated. on this issue, let me get to the question that the chairman is raising regarding deterrence. in your statement you say that you want to emphasize there are no free passes. i understand what you mean by that, but if you're parents in central america, in effect this can look like a free pass. you're making the situation more humanitarian. you're making more facilities available. as mr. fugate said, you're providing support to families. all which is understandable. that's our obligation as human beings. on the other hand, if you're a family in guatemala or el salvador this in a way is a free pass. it's a better life than they're getting in south america. i don't understand how that's going to restore what's happening. and on the issue of diplomatic engagements, it would appear that as the chairman said the southern border of mexico is the

key here. do we have any realistic hope that mexico is going to be cooperative on that? also you mentioned going into the coyotes? what's the time frame on that? as a practical matter we've been trying to do that for years. is there any reason to think the homeland security or doj can expedite that or be more effective? i'm not reflecting on you. i'm just saying we've been doing this for as long as i can remember, going after the coyotes. they're still there. i guess what is the deterrence? because the more you take what is proper humanitarian action, the more you're making it, to me, more accessible and more hospitab hospitable, and it seems to be almost a catch-22. unless we can step up diplomatic efforts regarding the southern border of mexico. and going after the coyotes. >> well, a couple of things. first, i'm convinced that the principal reason these kids --

from everything i've heard, everything i've seen, and from my own conversations with these kids, the principal reason they're leaving is the push factor from the countries they're living. the conditions in honduras, for example, are horrible. it's the murder capital of the world. there is -- there is this misinformation out there that there is a permissos. that's what we're hear ing. free pass. you get a piece of paper that says, welcome to the united states. you're free. that's not the case. when you're apprehended at the border, irregardless of age, you're a priority for removal. they're giving a notice to appear in a deportation proceeding. the way the law works, the 2008 law, we are required to give that child to hhs. and hhs is required to act in the best interest of the child, which most often means placing that child with a parent who is here in the united states. but there is a pending

deportation proceeding against the child. now, in terms of -- but that's not a free pass. in terms of -- >> but if i were a parent in guatemala, wouldn't i sooee tha as being a free pass? a 5-year-old child getting an order to show up in immigration court, are you going to actually deport that child? to me, it is a free pass. from their perspective. >> congressman, i don't see it as a free pass, particularly given the danger of migrating over 1,000 miles through mexico into the united states. especially now in the months of july and august that we're facing. a lot of these kids stow away on top of freight trains. which is exceedingly dangerous. i spoke to one kid who was about 12 or 13 who spent days, climbed on top of a freight train. a boxcar. and these kids, sometimes they fall off because they fall asleep. they can't hold on any longer. it's exceedingly dangerous. >> i'm not saying it is a free pass. i'm saying how do we change

their minds, not think it's a free pass, considering the poverty we're under. also if i could ask you on that, is the situation any worse in honduras today than it was two years ago or three years ago? any tougher economically or gangwise in these countries than it was several years ago before we had this mass influx? >> i know it's been bad for a while. i know it's been bad for a while. if you're asking me to explain why the influx over the last cup of months all of the sudden -- >> if you could, yeah, sure. >> i'm not sure i have the answer to that question. i do believe that the smuggling organizations are putting out a lot of disinformation about the conditions, the legal conditions here in the united states to induce this activity. and i agree with you, congressman, that we have to put in place, and i think we're doing this, a number of deterrent factors. increased housing to detain parents, adults who come to this country with their children, expedited removals, and the public relations campaign. and one of the things that i'm

doing in addition to everything else we've done on the public relations front is i'm talking to the u.s. conference of catholic bishops about how they can help. and i've had very good conversations. and i think that they will. because they realize that the dangers of a parent sending a child for this type of migration. >> thank you for your service. yield back, mr. chairman. >> thank the gentleman. chair now recognizes the gentle lady from texas, ms. jackson-lee. >> let me thank both the chairman and the ranking member for the spirit of this hearing. and the combined recognition that this is a humanitarian crisis way beyond our imagination, we might use hindsight, mr. secretary, and look at this and say why did we not see it. i think the variables of the world would argue that the world

remains in crisis in many areas, and it makes it very difficult, even when individuals are your neighbors, to be able to spot crises maybe before they begin to show themselves. so i am grateful for the response of the border patrol and the agencies and the president who is recognized that we have come. let me first of all acknowledge that this should not be political grandstanding. and i would commend some of my colleagues to read -- i'll hold up this article that says "why 90,000 children flooding our border is not an immigration story." in a survey of 404 by the united nations, they found that 58% of these children were forcibly displaced. and to a degree it warranted international protection. meaning that if the united states breached its

responsibility, and i know some adhere to the u.n. i do. i respect it as an international organization. we would be breaching many of its conventions that we have adhered to. so we're doing the right thing. i think it's important that i ask unanimous consent to put this in the record. an article dated june 16th, 2014. >> without objection. >> i also want to hold up what we're talking about. we're talking about a little baby holding a bottle. maybe not even carried by his own family. we're talking about children who are not in the taj mahal, but are desperate. and may be internally displaced or chased off by the violence of their countries. and we're trying to respond to it. i think that is very important. i think it's also important to note that the wilbur force act was signed in 2008 by president bush. this is the one about unaccompanied children that were supposed to be handled by hhs.

it was legislation that originated in a judiciary committee. i remember it very well. and the idea was for 20 children or 100 children to be handled by it was not an open door policy. it was never, if you will, amnesty. then i want to put into the record june 15, 2012 statement by i.c.e., accused of being the open-door policies june 15, 2012. come to the united states under the age of 16 and continuously resided in the united states for five years. what child can imagine that they would fit under daca? it is clearly an issue of devastating human smuggling and human trafficking, something my colleague, my chairwoman mrs. miller, myself have looked at

and included this language even in our authorization bills some few weeks ago. so i ask these questions as long as we can keep the facts. it is not an issue of the wilbur force bill. it is a question of detention facilities, as well the need for diplomatic interaction as we've done with the crisis and the leaders of guatemala, el salvador and honduras. they are in crisis. they are violent. i ask you about creating more processing centers, and as well, the senate passed about a 2 billion out of their labor hhs, is this what you need, about $2 billion to $3 billion to make sure we can respond to this? i also ask if someone would address the question, and i thank the border patrol for the work they've done, the

suggestions that there have been some form of abuse. i think we should not run away from challenges that have been made regarding the treatment of these children. i think we should be open. we want to make sure they have facilities. i appreciate your response to those questions. >> congresswoman, i will answer quickly and ask my colleagues if they would like to supplement. in general in response to your question, we need to identify and create more processing space, more shelter space for hhs, before they place the kids and more detention space for adults which children. we do not have a lot of detention space for family units. so as a deterrent and simply deal with the sheer numbers, we need to create more detention space for adults who bring their children. that's one of our principle goals as part of this process. i ask administrator fugate or chief patelo if they have

anything they want to add? >> no. >> i would add on the claims of abuse, my chief, the commissioner and secretary have been very direct and we are all focused on that issue. there is no room for abusive detainees in custody, specifically children. will be fully cooperative in all manner getting to the bottom of those allegations. >> i'm glad to hear you say that publicly and openly, we are not running away from it, we are investigating and care about these children and will address this in the way the united states has always done in a humanitarian crisis. >> the lady's time expired. the secretary has to leave 12k:30. i will strictly enforce the five-minute rule. gentleman from alabama mr. rogers is recognized. >> thank you. do you believe we had control of our border, our southern border? >> he recognized when i took office we had some real issues

in the rio grande valley sector, in particular, with those coming from guatemala, el salvador and honduras. >> any areas of the border we had a fence we had children coming across? for example, southern part of california. >> this has not been a big phenomenon in southern california or arizona. >> any place we had a fence, have we had 5-year-old children coming across the border? >> not in very large numbers. it's got a lot to do with the fact south texas is so closely located to central america, too. that's the migration path. >> the rio grande valley, if we had the same fencing we have along the southern border of california, do you believe these children would be coming across the border in numbers they are coming across or anything close to it? >> it's hard to answer because you are talking about the rio grande river, which is a very -- >> i've been there. i know what i'm talking about. we don't have a fence down there. if we did, we wouldn't have 5-year-old children coming

across. this congress in 2006, because i was here. we authorized and appropriated the money for 700 miles of fencing. we've gotten most of that. that was done in 2009. we haven't had any more since then. this is what we get for it. let me ask this. i've been down to the large detention facility. i've seen the folks we detain be debriefed, cleaned up, put on a bus and sent back. why aren't we doing that with these children? >> first of all it's being used as a processing center for the unaccompanied children. they are leaving and going to hhs custody for shelter and then placement. >> why aren't we putting them on a bus like we normally do and sent them back down to guatemala. >> because the law requires i turn them over to hhs, sir. >> the law required obamacare to be kicked in two years ago. that hasn't stopped the administration before. it's a humanitarian crisis.

it's a national security crisis for our country. i don't know why these children are being treated differently. you talked about wanting to talk to the guatemalan government. what you need to do is ask the guatemalan government where they want these kids dropped off when the buses bring them back down there. what are we doing other then taking them and putting them in a facility here which makes it more likely we'll keep them here for months and years. what are we doing to get them turned home? >> we are creating additional detention space for adults who bring their children. i want to consider any option for stemming this tide, sir. the law requires, the law that was created in 2008, requires that we turn these kids over, they're unaccompanied to the department of health and human services within 72 hours, generally. that's what we do. they are turned over with a notice to appear that is effectively a deportation proceeding commenced against them.

the law requires i turn them over to hhs. >> do you believe these are exegent circumstances? >> yes. >> do you believe the president should issue an executive order to deal with this crisis? >> i'm not sure i can comment on that. of what nature? >> to supersede the law. this is not the first time -- >> last time i -- >> i don't know why he can't do it with these children. >> last time i looked an executive order can't supersede the law. >> that's what i thought. right now we have a crisis. i don't see this administration doing anything about it other than trying to house the children. i understand the humanitarian basis for that, but we need to send a signal to these other countries that it's not going to work. you can't send your children up here and let them stay. we'll turn them right back and give them right back to you. that's what i'm looking for you as a way to do this. that's a clear signal to these

parents not to send these children in the future. tell me what you can do other than give them to hhs. nothing. have you called the national guard out? or asked for it? >> like i said, i would like to consider every option presented. i went through in my prepared testimony the 12 or 13 steps we've taken to deal with the crisis, which includes building more detention space. >> the speaker of the house last week called on the president to mobilize the national guard to give relief to the border control and fema in this crisis. why can't you call on the president to do that? >> sir, if you're asking me if i can take an unaccompanied child, turn him around in the border and send him back to guatemala, i don't believe the law would permit us to do that. >> thank you, mr. chairman. >> recognizes mr. higgins from new york. >> thank you, mr. secretary.

we had an incident in buffalo regarding facilities for undocumented and unaccompanied children in grand island, new york. a local developer offered to gsa a property that the local developer doesn't own and either represented that the property was vacant and developable or federal agents assumed that the property was vacant and unavailable. that offer of property made its way from gsa to hhs, and finally to the department of homeland security where 3-d hs agents showed up at the property unannounced, and upon their arrival, they realized the property wasn't vacant. wasn't available. and found it to be a 236-room functioning hotel and spa. now, it would seem to me that

someone that represents they own a property and knows anything about it and offers that property to the federal government for use under this program, some due diligence would have had to have occurred to verify either the assumptions another to refute the misrepresentations that were made. are you familiar with this? can you offer any -- >> i've been informed that somebody within dhs looked at a hotel in upstate new york, and we were quickly informed that it's an up-and-running, functioning, occupied hotel. it's not a viable candidate for this situation. >> i think this misses the point. my real concern is that again, a local devop