intolerant of whistle blowers. so far in this fiscal year, nearly half of the matters transferred to agency heads, seven out of 15 involved the va. according to the osc, it currently has 67 active investigations into retaliation complaints from va employees and has received 25 new whistle blower retaliation cases from va employees since june 1st of 2014. a recent new york times article stated that within the va there was a culture of silence and intimidati intimidation. acting secretary gibson recently stated that he was deeply disappointed not only in the substantiation of allegations raised by the whistle blowers but also in the failures within the department to take whistle

blowers complaints seriously. within vha, the problem of intimidation, retaliation may be magnified by what some consider a protective culture of the medical profession. it is often thought to be against the code to point out colleague's mistakes or where a nurse or a tendant is told it is appropriate to question a physician or surgeon. the natural tendency is to close ranks, to not die that problems exist or mirs stestakes were ma. so after we listen to the testimony before us this evening from the whistle blowers, the office of special counsel and the va will -- anything change after we hear what the whistle blowers have to say and how do we fix this culture and encourage all va employees to step forward to identify

problems and work to address the problems. changing a culture is not easy. it cannot be done legislatively or 33inthrowing additional resos at it. talk is cheap. real solutions are hard to find. it is clear to me that the va as it is structured today is fundamentally incapable of making real changes in the culture. i note that acting secretary gibson announced today that he was taking steps to reinstruct the office of medical inspector by creating a strong internal audit function which will ensure issues of the quality care and patient safety remains at the forefront. this is an improvement but it raises additional questions regarding how these restructures will be better enable omi to undertake investigations resulting from whistle blowers complaints forward by the osc or

have the authority to ensure that -- medical actions will be taken to the appropriate components of the va. time and time again as the june letter from osc demonstrates the va found fault by determining that these grave errors did not effect the health and safety of veterans. anyone reading the specifics of any of these cases will mind that this harmless error conclusion as stated by the osc is said to be inadequate. this has prevented the va from acknowledging the severity of the systematic problems and from taking the necessary steps to provide quality care to veterans. we all seem to have some goals this evening. we all want the va employees to

feel comfortable raising problems and having them addressed without fear that raising their voices will mean the end of their careers. the va has stated that it wants to make fundamental changes in its culture so the work force intimidation, retaliation is unacceptable. talk is cheap. real change is difficult. i would propose that the very first order of business at the va is to take accountability seriously. if any va employee is shown to have intimidated or retaliated against another va employee than that employee should be fired. the va should have zero tolerance for policies that would harm whistle blowers and intimidate whistle blowers or retaliate against them. as i see it, effective leadership and real accountability is the only way to begin the process of institutional changes.

i hope tonight is the beginning of that change. with that, i yield back to balance my time. >> thank you very much to the ranking member. i would ask that all members would waive their opening statements as is the custom of this committee. thanks to the witness that's are here at the witness table tonight. our first panel that we're going to hear from is dr. joesa matthe matthews. dr. christian head, associate director, chief of staff, legal and quality assurance at the greater los angeles va health care system, dr. catherine mitchell, medical director for the iraq and afghanistan post deployment center at the phoenix va health care system. this time i'd like to introduce our colleague dr. price to briefly introduce his constituent who within the fourth witness on the panel this evening. >> thank you mr. chairman. i want to thank you and you the ranking member for allowing me to offer this introduction.

this is a remarkably important topic. i commend the committee for the work that you've done as a physician, i worked at the va hospital in atlanta for a number of years during my training. i know how important it is to have honest and real information for our veterans to honor their service which is why i'm so very pleased to welcome scott davis who will be on the panel today. s a resident of my district. a graduate of more house college. his father served in vietnam. he is a program specialist at the va eligibility center in atlanta. he's been in contact with my office for a number of months outlining his concerns. he's come forward with the allegations and concerns that he has in a very brave and courageous manner putting his career and representation on the line. i have no doubt that his testimony will help shine a light on the situation at hand. we must know the facts on the ground at full before we can truly begin to fix the situation at the va. i welcome mr. davis. i thank you for allowing me to

join you for this introduction. >> i would ask the witnesses if you would please rise. raise your right hand. do you solemnly swear under the penalty of perjury that the testimony you're about to provide is the truth, the whole truth and nothing but the truth? thank you please be seated. all of your complete written statements will be entered into the record. dr. matthews, you're now recognized for five minutes. >> honorable chairman and distinguished members of the committee i am honored to appear before you today while serving at the chief of psychiatry at the department of va affairs in missouri. i just want to very briefly outline the goals i had when i took this position as the chief of psychiatry leaving my full

time faculty position at washington university. i had very simply wanted to create the very best care possible with the resources that i had. very soon i realized that the metrics i had -- that the va was putting out was not reflecting what i was actually seeing. i made it a point that i review any veteran complaints. the majority i had was their inability to obtain care, the long wait times and having difficulty contacting to schedule an appointment. how busy are we really at the outpatient clinic, the answer i got was not very good. i got the answer in a i verified that the psychiatrists were only spending approximately 3.5 hours in direct patient care. i could not account for the rest

of their time. i verified this. i put this data transpareappare where as psychiatrist could challenge me and i did not get one valid question. so i knew the data was accurate. i discussed this with the chief of staff. i wanted to change this. there were two things that i wanted change. one was that the veteran has easy access to care timely access to care. the second was that no veteran would be turned away if they come to the clinic. i had a very sad veteran complaint before a disabled veteran who had requested his friend to drive because he does not drive. he drove approximately an hour and a half to come to the clinic. he had two requests. he wanted to see his provider earlier because he was not doing well and he wanted his medications refilled.

unfortunately the veteran had either of these requests meant. he was sent away with another appointment 48 days later. his medications were not refilled. just before this meeting, i checked and he has not followed up or come back to the clinic since last may. his description of that event includes how disappointed and how upset he is at the va for not providing him care. so that was the context of how i started out. i discovered that the physician time was not being utilized properly. there was long wait times. one of the metric that's very important especially in mental health is engagement and care or the drop out rate. i found that 60% of the veterans were not coming back for their visits in the outpatient setting. so there was 60% attrition rate. there were only four pieces of information that i needed to

provide very good care. one was the wait time. the second was the utilization of expertise or what amount of time does a physician actually expend in direct patient care. the third was their attention and care. how many veterans actually follow-up with care or dropping out of care. the fourth metric that was not existent was the veteran satisfaction with care like chairman miller talked about. these surveys not being complete and may not be reflective of all places. i talked to some donors that i knew from washington university. i pledged $60,000 over two years to institute a real time veteran survey. i had had educational contracts for ipads and my intent is why the veteran is waiting in the waiting area to be seen would be

able to complete this questionnaire using touch screens which would be automatically compiled. i would have information on whether a particular clinic or a particular health care professional that i need to focus on. so this last bit was very concerning to the staff. shortly after i made these disclosures including two avoidable deaths that i wanted root cause analysis and inpatient suicide attempt which was completely covered up. i did not go along with that. so very shortly i was put on detail. i was told that there was an administrative investigation and that i was put to compensation and pension evaluations. now, i took this job also -- it was dealing with veterans. i had filed the complaint with osc. while they were processing my complaints i took this very seriously to see whether they

had compensable mental disorders related to the service. what i found here, in many instances, the veteran was not even heard properly. i had doubts whether the prior evaluation report was the same veteran or not. this was a serious concern. i actually started looking at their ids to make sure this was not some other person. the problem here was that the veteran did not have enough time to explain their situation. it was a hurried conveyer belt like system where i was specifically told that i was sending too much time with the veteran. that i should hurry-up and see the veteran and check a few boxes in my evaluation because it's meant for some rater somewhere to rate the disability. that's not how i saw my job. that's not the right way to do it. three things need to be accomplished in these evaluations because these are disability evaluations.

you have to make sure that the veteran is heard properly. the second thing is that i review the prior records properly to make sure that i capture a full history. the third is to make sure that my report reflects some of the inkconsistencies and i can spea to it. now, there were few egregious errors that were there. that really bothered me. as i was retailed under primary care. i vote to the chief of primary care recently about these examples about why, you know, this was really unfair to the veteran and how it affected the life of the veteran and just two weeks ago on the 26th of june, i'm detailed now to another place. so from my perspective, i have always put the veteran's

interest first. i have disclosed the wrong doings that i found promptly to the chief of staff and to the chief of mental health with the expectation that they would address it and what i found was that nothing has really changed. as late as june, just two weeks ago, the response to my finding about these evaluations that were not done properly was to just detail me elsewhere. so this seems to be an ongoing practice. when it's detailed, i don't have any responsibility as a chief of psychiatry. that's the position i accepted. two people who i worked rally hard on recruiting both excellent psychiatrists, they declined to join the va after i disclosed that i'm no longer the

chief. i've been removed. so there is a sense of mission that's lacking. i'm really hoping that this committee with its powers will take aggressive actions to really make sure that this retaliation stops and that the people responsible are held accountable because really with the data being so cooked up and so unbelievable, it's extremely important that, you know, why we work on data integrity to make sure the data reflects reality. it's extremely important that people step forward and are able to speak the truth and talk about what's really happening at the patient interaction level. i think i'm really hoping that this committee would do that. i'm really honored that i have this opportunity to be able to answer questions and to be here. >> thank you dr. matthews. we'll have an opportunity, each of us to ask questions and get into specifics a little bit

later on. next i'd like to recognize dr. hedd for five minutes. >> thank you for inviting me to testify today. i'm honored, congressman. i think it's a very important topic, our veterans. we shouldn't lose focus of that. associate director chief of staff at the los angeles va hospital. i'm very proud of my position. i can't think of a better job. retaliation is alive and well especially within the va administration. my first encounter was a number of years ago. i was subpoenaed by the inspector general to investigate time card fraud involving two surgeons in my area. i was among close to do 30 individuals who gave testimony. that during that testimony, i said i feared retaliation. i outlined how i felt they would

retaliate against me. every aspect i outlined came true. the person who did the deposition was inspector solomon from the inspector general's office. she promised i'd be protected interest the state and federal government. three months after they came out with the final results, one of the individuals paid back a year salary to the federal government and resigned. another individual who they recommended immediate termination was allowed to stay in your supervisory role. there was an end of the year party. at that party this slide was shown. i know. that actually is me. i'm much younger back then. i'm flipping the bird saying if all else fails.

in front of 300 individuals, i was labeled the rat. i was voted the person who ratted out the person. the slide that followed this was so heinous that i can't show or discuss it today. i could discuss it under subpoena. that person by the way is still in the supervisory role at the va. no apology. nothing. i somehow survived that athat. retaliation has been relentless. the problem my retaliators have that i think the va and the veterans deserve far better no matter what happens to me, i think the focus still should be on the veterans of this country. i somehow survived that process and again, i was retaliated against later when i gave my

opinion on the investigation of a physician who was wrongly terminated. i was asked to change my testimony, my salary, i stopped getting paid for two weeks and because of a number of other factors, my house went into foreclosure. i didn't lose my house but the harm it causes. the family members of federal workers who are being retaliated against cannot be measured. i have two young girls who i would be proud if they decided to join the ared forces or even work for the va. i think the va has the potential to be one of the mifinest institutions in the world. the pharmacy cannot be matched. it's very efficient. there are many things that are efficient within our system. what we should ask ourselves is when someone came up with the idea of seeing a veteran in 14

days. that seemed like a good idea. what we should be request heing is if we made a mistake and somehow overloaded the system, how come people's names disappeared off lists. how come hundreds of thousands of veterans electronically no longer existed. that should be the question. retaliation exists because there's a culture. this culture of retaliation that's really the cancer to the veteran administration of the most physicians and nurses and people working in the hospital are disgusted. morale is extremely low. people care. when i heard some of the testimony i heard from the phoenix va, it was gut wrenching. i couldn't sleep.

i believe there's a lot of people within the va system that feel the same way. there exists a cancer within leadership. a few individuals that perpetuate this idea that we should be silent. that we shouldn't stand up and do the right thing and be hop honest. everyone makes mistake. when you make mistakes and try to conceal it, that is really the question we'd be asking. who are these individuals who would alter data and hide the truth and prevent patient care? i have been receiving text messages all day from veterans saying be careful dr. head, we don't want to lose you as a surgeon. be careful something might happen to you. if you get labeled as a whistle blower, oh, my god, they will take you out. i'm not afraid to be taken out. i do hope if i am taken out someone will take care of my family but i think people need

to speak up. we shouldn't be isolated and i. you notice every time there's a whistle blower there's urlsuall an e-mail that follows this person didn't get the raise they wanted or bonus so they can be suspect or this person didn't do this. they always defame. they isolate. usually they transfer you to another position. why? >> because they are slowing building a case if they don't have one already to say that you're crazy. that you're not being truthful. i would hope -- i apologize for running over, i would hope that -- i've given you close to 176 -- 276 pages, i think, of evidence and a number of other statements of other individuals that would be helpful in trying to improve the system.

i would hope especially the press, i challenge you also to be a real reporter and also report the truth but also -- not to insult the reporters but also the congressmen and women, this is very important that we try to focus on what's really important here. that's the veterans of this country. thank you. >> thank you very much for your courage dr. head. dr. mitchell, you're recognized for five minutes. >> good evening. i'm deeply honored by the committee's invitation to testify tonight. as a phoenix va employee i have suffered retaliation for years for routinely reporting health and safety concerns. my written testimony shows the retaliation. in addition, section four and five of my written testimony outlines specific tactics that the va uses to suppress whistle blowing and also to retaliate against anyone who speaks up

within its ranks even without whistle blowing. they are routinely intimidated any employee that brings forth information that is contrary to the image that they want to reject. approximately ten days after the national va received my report, i was placed on administrative lead for a month. i provided limited amounts of patient information in order to support my allegation of the suicide trends and the facilities inappropriate response to them. eventually i received a written counsel saying i violated a specific policy but i cannot find out the name of the policy i violated. this is relatively minor retaliation considering what happened during any last three years as medical director.

>> during that time we were grossly under staffed in address there was sufficient staff room to do basic items such as wash rooms, telephones, deliver patients. as a result doctors were routinely pulled away from patient care in order to do extra duties. the deficiencies became office. the actual number of mistakes as well as nurses sky rocketed. symptoms such as heart attack, blood infections and other serious medical issues were missed by inexperienced triage nurses. i started reporting the case s f mistakes to the facility chain of command. in the process of reporting hundreds of these. approximately 20% of the er nurses would retaliate against me. they would stop doing my orders for patients.

they would refuse to answer questions in the nurses station. they would not give me verbal reports on patients that were placed in rooms. administration was made aware of this but yet declined to stop this behavior that was interfering with my treatment of patients and they would never institute the comprehensive standardized nurse triage training that we need to in order to prevent future mistakes. this is not to say they were id idle. they ban me from reporting any cases in the risk management department. i was forced to work two years of unlimited scheduled shifts to fill in holes because hr was too slow at credentialing emergency physicians to fill in. eventually things reached a critical mass. i told the new director that the

er was too dangerous on an hour-to-hour basis and we should be closed. unfortunately the administrative's response was to haul me into a meeting and tell me that the only problem in the er was my lack of communication skills. the nursing back lash that was reported would in the be straegted. eventually i was unvoluntarily transferred based on critical need to an empty medical clinic. it only howuses a social work program. i do very useful work but that's not what i intended what i started reporting concerns. the veterans care presented to the er have survived campaigns, dessert storm, croatia, fallu h

fallujah, it is a bitter irony to me that i as a physician could not guarantee their health and safety in the middle of phoenix. the va needs to embrace the core values on its website. in the process, it's very important that employees of any pay grade who truly care about veterans and their well fair and that they be protected. they were often places in the unthinkable position of being forced to follow orders unless permanently lose their livelihoods in the future. most importantly, the ability to positive positively influence the care and safety of any veteran should not be are considered a democrat or republican chance or even a

american problem. it is a human issue. it has ethical implications for all of us. thank you for your time. >> thank you very much, doctor. mr. davis you're not recognized for five minutes. >> thank you mr. chairman. i'd like to thank you the committee for providing a platform so that the voices of va whistle blowers can be heard. i urge the committee to take prompt action as time is running out. everyday, a window of opportunity discloses on a veteran to receive quality health care because of the inaction of senior va officials. some veterans even face the burden of being billed for care their service has earned them e. as noted in the office of serve sis counsel report, va leadership has repeatedly failed to the concerns of whistle blowers with with patient care at pa.

despite the best efforts of truly committed employees at the veteran health administration who have risked their careers to stand up for veterans. management at all levels have ignored them for simply exposing the truth. some of the critical issues reported by whistle blowers include, mismanaging critical veteran health programs and wasting millions of dollars on an affordable care act. the possibility purging of nearly 10,000 records. a back log of over 200,000 pending health application sz. nearly 40,000 unprocessed applications discovered in january of 2013. these were primary applications from returning service members from afghanistan.

the harassment i've experienced from top levels of management include, my whistle blower complaint to white house chief of staff was leaked to my manager sherry williams who stated that she was contacting me on behalf of secretary gibson and mr. neighbors. neither have responded to this fact. think employee reports were illegally altered. i was illegally placed on a permanent work detail. i was placed on involuntary administrative lead curiously at the same time the oi investigation was taking place in atlanta by acting director greg beckor. unfortunately my experience is

not unique at va. darren owens has experienced the same retaliation for reporting medical errors and patient neglect as well as misconduct by senior police officials. our local 5/18 union president is routinely harassed as a direct consequence of assisting me and other federal employees with with retaliatory action by members of management. mr. owens, mrs. owens, ms. ivory, are all veterans. fact, over 50% of the staff that works are disabled veterans. in 2010, allegations surfaces that applications for health care were being shredded under the direction of the deputy director and former associate director, and her team, kimberly

hues saw two,000 apl2,000 apoli that did not appear as new enrollments in the system. it was abruptly closed and she was also subject to harassment and intimidation. the whittle blower statements i have provided to the committee were also provided to the oig. they are more relevant to the committee than many may realize. i urge additional review of the whittle blower statements. in addition to providing specific examples of to the committee. i hope it provides insight to three key issues. reckless waste of federal funds and causing back log of

enrollment applications for the purpose of achieving goals. why there is resistance to implementing proper and effective reporting sift exes an the need to remove ineffective managers and the critical need for the va management accountability ability act to be fully implemented. thank you for this opportunity. i look forward to your questions. >> thank you very much, mr. davis. if you would, explain a little b bit further, the information you provided to rob neighbors who was detailed from the white house over to va that led to adverse employment actions being taken against you. >> yes, i contacted mr. neighbors about four weeks ago for the point of contact for the white house i wanted him to be aware of what was going on in our house.

a lot of attention is placed on scheduling but it's important to know that if you're not enrolled you're not going to be placed in the schedule. i wanted him to know with the shortcomings of the system that we have spent millions of dollars on and yet we're back at square 1. i also reached out to him to encourage senior citizens who are veterans to enroll in va. that was problematic because as you know if you enroll in va, you can only use the pharmacy at va. you have to use your va doctor. many of our most vulnerable veterans could be confused and end up being stuck in the doughnut role in the back log. i also contacted mr. neighbors about the continued miss

management of va programs managed by the chief business office under the direction of them. after sending out information to mr. neighbors, i did not receive a response. i subsequently contacts the dep hit chief of staff anita brekconridge. i also did not receive response. this surprised me that ms. williams would do this because she's a former oig official. to this date no action has been taken. this goes to the very hard of the question whether or not va should be allowed to police itself and whether or not an outside agency should be brought in to fully conduct an investigation to the actions taken at va. i did receive an e-mail from the

white house counsel directing me to contact the special counsel. if that was the official position at the white house there would be no need for anyone to contact ms. williams about my complaint. >> you also in your testimony, you describe the possibility purging of over 10,000 veteran health records at the health eligibility center that there's a back log of 600,000 pending benefit applications and 40,000 unprocessed applications discovered that span three years? >> absolutely. currently, we have over 600,000 pending applications. these are are applications that have been applied for by veterans, turned into va and for whatever reason we could not take that application to a final determination. this back log has reached the number of 600,000. what we should have done instead

of hiring 40 people to address the affordable care act in a belief is that we're going to have a serge of people because of a buddy letter marketing campaign where the veteran was encourages to pass on information about enrolling into va health care to a veteran. the information for a veteran to take action was on the second page of the letter. 1650 were only applications we could actually do something with. this was discovered in january 2014 with regard to the 40,000. this is important to the committee. i want to share something that was in a report from 2013. increasing online application sm submissions versus paper has a positive direct impact on

providing timely access to health care. data reveals applications submitted in person are processed with higher emergency while online applications linger in a less visible cue. how could this happen? >> it's they linger. >> even though the it department paid licensing fees for over $40,000 for us to have a system for managing the queue. this was only put into play until after the 40,000 applications which were lingering in the queue was discovered. that is something that is shameful. >> thank you mr. davis. members, i have one more question i'd like to ask dr. head. >> you talked about the retaliation against you. i want to specifically talk about dr. wang who i read that

the oig concluded that dr. wang had in fact committed time card fraud. is that correct? >> yes. the official report lay person. the information i received was that they had recommended immediate termination of her and this other individual through other chief of staff and counsel they had said that they had found significant fraud time card fraud. >> so she's been terminated. >> she has not been terminated. she's maintained in a supervisory role. >> can you explain a little bit about how that has occurred? >> i have no idea how she was able to maintain her position. >> but va did not follow the inspector general's recommendations? >> they elected not to follow

the inspector general's recommendation. she has been left in her division chief position. she was my supervisor. i filed numerous complaints. they moved me from that office under her chain of command to the chief of staff which in my opinion was an excellent opportunity. i rose in the ranks. became head of legal and quality assurance. i became an expert in system analysis and quality assurance which i think will help the veteran even more ironically now from being retaliated against. that's just how i was brought up. find a way. >> thank you doctor. >> thank you very much mr. chairman. as you all know whistle blowers often risk your career in order to bring problems to light.

what would you recommend that we do as far as to change the rules or laws government-wide to actually protect the whistle blowers. i will start with dr. matthews and work down if there's anything we should do to strengthen the whistle blowers protection act. >> that's an excellent question. one of the things that i experienced was that i was immediately removed from my position. so under the guise of an administrative investigation with the specific guide to cut off the databases to get accurate data. one of the things could be that if there is this sort of an investigation, that, you know, the person continues rather than be detailed. if the person has to be

detailed. perhaps there should be a review by tears to see if that is even warranted or not. >> there seems to be no time limit to these kinds of detail. this is the second time i've been detailed. just recently i've been detailed again. >> these are not the jobs that we wanted to do. we would do it to the best of our abilities. having that protection, the osc have some sort of time limit to review these complaints would be very beneficial. having a process like how you mentioned, if a supervisor is indeed to have found retaliated to have some very tangible consequences so that person would be very important. right now, i think at least in the st. louis v.a., they do not

think that this is a serious issue. like two weeks ago i was called in a a meeting with the chiefoff chief where the outpatient psychiat psychiatry, the person i worked with very closely to implement my changes was also called into that meeting. at that meeting, i was specifically told that the chain of command must be respected at all times. that if i had any issue or if he had any issue that we should report it first to our supervisor and move up the next level and next level. so -- >> could you finish up because i'm running out of time. >> we have three others. >> so i think your recommendation for having very quick and serious consequences to retaliation would be very important. >> thank you. dr. head. >> yes. i think there needs to be greater repercussions for

retaliation. we have laws deferred to as shield and sword laws. sword laws meaning if i retaliate against someone there are laws saying retaliation is against the law. they can warn the person don't retaliate but they can continue to retaliate against the person which will have a direct or indirect effect on the care of a veteran. endangering the veteran only because their care giver or nurse or doctor is being retaliated against. shield law means that as long as you have sword law, repercussions for retaliation but you have a shield law where you can made take action. there could be immediate repercussions for any retaliations against a whistle blower. you tell the chief of staff. if this person gets retaliated against, we're going to hold you accountable for this until we figure out what's going on here. we have a shield law that was

enacted in the state of california but that's something that should be considered by congress. ultimately you la dress it one way or another because retaliation in the health place is different than a factory. you retaliate against physicians or surgeon or nurses, you will have direct effects on the health of a veteran. >> certainly the oig needs to put in writing that providing limited patient information to support allegations in a complaint is not a violation of hipaa. this isn't. certainly there are employees charged all over the nation for it. in addition peer reviews need to be part of the prohibited actions. they have a predetermination that this physician is not

properly functioning even though there is certainly no level of his functioning and they can permanently sabotage a physician's ability to get employed not only inside the va or to the public sector. whenever you're subject of a peer review you evhave to repor that for the rest of your life. physicians ftruly face losing their livelihood. you need whistle blowers who are physicians. people who are trained to identify the high risk problems. >> dr. davis. >> thank you. i don't know if a new law would really change anything honestly at va if you don't have accountability. i think there's some structural changes that need to take place. one being a centralized human resource office that actually has operational authority. currently when i went through my

situation of retaliation, i spoke with the representative from the va hr office. they told me they are only a policy body that they could contact the hr office where i work and maybe make some recommendations and see what they could negotiate. that's problematic because -- in va unlike a corporation or a normal health care system, every division or the hospital itself has its own hr department which becomes the secret police force for the managers who harass employees. that's problematic and what needs to change. i think a operational change for a centralized human resource department would also like and make bad managers pay their own legal fees. currently, he managers, even if they are found guilty of wrong doing, well, the bill goes to the taxpayer. currently we have managers in our office that have several

different complaints for harassment. it's not a big deal to them. regional counsel will take care of it. that's the issue that would change people's behavior is if you hit them in their pocket. >> you're recognized for five minutes. >> thank you for having this hearing. i want to thank all of you for being here. you're showing a lot of braverly and courage. i know you're doing it for our brett veterans. dr. mitchell, you've been at the phoenix va for 16 years, do you believe the lack of response to safety issues you've brought up over the years have threatened the health and even the life of veterans in phoenix? >> yes anything that impairs the delivery of care threatens the lives of patients. certainly in the er i can recall specific deaths that occurred in the er. as a resident, i also trained

through the phoenix da. there are were at least two patients that died because they could not get their cardiac cath. when i was a nurse there, there were tremendous problems with patient care. there weren't -- there weren't enough nurses to turn patients. i could remember certification inspections that to this day still haunt me because administration would charting but would not authorize staff to feed patients or turn patients. >> doctor, did these problems catch the hospital and the administrators by surprise or had they been warned that there

were pending problems if something didn't change? >> i'm aware of problems throughout the facility without necessi necessarily having access to upper administration. i know that people communicate these concerns as best they can. what happens is any concern you bring up you have to present to your supervisor in a politically correct manner because if you don't, you will be retaliated against. either you'll be harassed at the moment you're giving the information. your proficiencies will drop. something bad will occur. that's best that management not know your name because if they do, it makes you an automatic target. there's not to say there are all supervisors that way. >> good. that's good to hear. the interim oig report which brought out some of the issues that we were seeing you believe

don't go far enough if i understand your testimony correctly. do you think there were flaws with the methodology and that it could have even been more revealing of problems out there? >> yeah. there's a saying that has had a to do with it. what they did was take out a segment of patients and said this is the average wait time. it was divided by clinics. some of the clinics had short waiting times. the list ran from january 2013 to april of 2014. some clinics had very short waiting timings. the waiting times started at 477. they didn't get down to the 110s or 120s until page eight or nine. i have no idea which patients they picked. it would have certainly been more accurate that at the

clinics we had this many waiting from zero to 30 days . as a result, you don't think the report revealed nearly as much of the problems as it could have. >> no, i told them about the mental health waiting delays. the huge problem with that. i thoeld them about the mapatie issues but didn't go into that. >> i want to thank you all for your service to veterans and being here today. >> thank you mr. chairman. >> dr. matthews, are you familiar with the federal classification of employees whether it's ses or title 38. are you aware of that? >> yes. >> in your capacity as a former -- as chief of psychiatry, was that a title 38 position, do you know. >> yes. it's a title 38 position. >> okay. dr. head, in your position, were

you title 38 position or something below title 38. >> title 38. i'm still employed -- >> i understand. okay. and dr. mitchell. >> i'm title 38 employee and i've been employed as a physician throughout my va career. >> dr. davis. >> i'm general service employee gee so o . >> one of the things i'm grap e grappling with is the ability to fire employees guilty of wrong doing more, typically whistle blowers come from the lower ranks of employment but there's a debate about whether or not we should extend this sort of standard to title 38 employees. so in my mind i'm going through this contradiction of well,

there is a sense among some members that we want to make it easier to fire people at certain levels of service but that might seem to run against the idea that we need to protect people who speak up. dr. matthews, do you have any thoughts on this? we have whistle blower protection but how do you feel about it making it easier to fire title 38 employees? >> well, i think, you know, when veterans lives are at issue here, i think that you should be able to be fired. any person in direct patient care right now enjoys almost a lifetime tenure where they are completely protected from the consequences of their actions. i think that's not good for providing a safe work environment for the veterans or safe health environment or work environment for the physicians and other people who come forward. i do not think that the chief of

staff or the chief of mental health who just threatened me two weeks ago has any concern about their position being threatened in my manner. so i think that kind of protection should end. at the same time, i also would want us to consider that a work place is only as good as the employees there. i'm hoping that we take a look at what the sally structure is especially for hard filled positions. >> dr. matthews, excuse me. but wouldn't that ability to have fired you have eliminated your ability to even voice any dissent or act as awhistle blower. >> well, that already exists. they already professionally assassinated me in that i'm no longer the chief of psychiatry. in fact, the way i found out that there was this

administrative investigation stuff going on was when one of the psychiatrists i recruited called me concerned that you're fired? i hear you're fired. so professionally it's a bad statement for the va, me having trouble with the va is -- >> but would you have been worse off having your voice completely eliminated by you being fired because they had the ability to do so. you at least are able to be here and voice your concern. so it's far from where we need to be in order to have feedback from people at the mid level and lower level to say what's wrong. that's in our rate to be middle, to lower level employees to speak up without fear of being retaliated. but is whistle blower protection enough? do we need to have some sense of

due process? some members would like to see it eliminated so it's easier to fire people. i see a tension here. i mean, i think you might even recognize, i too would be like to be able to fire people and not have them have complete tenure but i don't know how we solve this. >> i think one way i with with suggest is to put ourselves in the veteran's position. would i want to obtain care or would i want my son to obtain care where poorly performing nurses or physicians cannot be fired. i think i would not want to go to this hospital. i think this would accept resolve the tension are we providing the veterans or employees. >> also the legislation that we've passed in the house does not reach down to this level of

title 38 level employee. only the top 450. >> thanks for holding this hearing. i wanted to thank you, the people that are testifying tonight -- testifying tonight. thank you for your courage. you mentioned this vha could be the best health care system in the world. how do we get there? >> i believe with leadership. there are certain parliameeople leadership that have been there 18 years. if they are a great leader it is great. but if they are not we need to find ways to bring unloin leadership. if you a good leader you are identified as a good leader and

you can be part of the team that shows leadership and maybe if you are not you should be put in another part of the federal government or retire. but leadership is clearly the key. our surgical team at the west la facility could be matched against any facility in the world. my wife is a cardiolgist and she could work anywhere in the country. she married me and loves her jobs and obsesses over it and always works to save the veteran. there is lot of people like that. we need leadership. the leadership will take the va to that next level. i think it is not resources. we all care about the veterans and you are giving and we will give anything to serve the veterans. we will do anything it takes to

make the situation right and serve the veterans. i have no doubt with the right leadership is brought to bear we can solve this problem. >> our next question, and this is for the entire panel, in the previous fiscal year all senior executives service employees received a fully successful performance and last year they received a fullly successful performance that totaled to $2.8 million in performance awards. yes or no, did you believe this is an accurate assessment and all eligible senior employees perform in a successful capacity and higher >> no. >> dr. head? >> no. >> mr. davis? >> absolutely not. >> dr. mitchell? >> no.

>> thank you. next question is for dr. matthews. three your own work during your time at the st. louis va you identified that on average ps h psychiatrist were seeing veterans for 3.5 hours a day in an eight hour day. when you contacted others do you know if they were tracking the information prior to your investigation? >> i don't not know if they were tracking it. i know our va doesn't track it and many don't track it because the chiefs wanted to know the answers as well. i got e-mails from other chiefs wanting me to forward the

respon responses. and there was a new chief that had the same set of question asking what number should be reasonable. >> thank you. next question for dr. matthews. your findings discovered that 60% of veterans were dropping out of mental health care after one or two visits and during town meetings they tell me the same thing. do you think it is the type of treatment? should there be alternatives to that treatment? >> my goal was to make the va mental health clinic a welcoming place with easy access to care. the majority of the veteran complaints that i reviewed had to do with long wait times, not being able to seek care and that demoralized them from care and some of the young veterans i saw

in my new capacity or the previous compassion evaluation i came across barriers to care and veterans that were in the specialized forces and in just one instance i will mention here is this veteran was doing so poorly that his roommate was a veteran and he had taken off a day of work though that he can take this veteran and get him care. so they come to the va and it takes 3-4 hours to find out whether this person is eligible for care or not and then they determine this person is eligible for care. this veteran comes to the ptsd clinic and isn't seen by a health care provider. he is told we will contact you after a meeting to determine what we can do for you.

i was doing evaluations and i had access to the records and i looked at whether there was a record of this veteran going to the clinic and where didn't find any record. but there is a subsiquent letter saying we learned you were interested in obtaining care at our facility and call these numbers to squabblichedule an appointment. this is for a veteran who sacrificed a lot, the military recognized he had ptsd, he took a day off his low-paying job to obtain care and no record of this person being at the va and the contact wasn't made.

i asked him if he could go to the va to obtain care and he said no, i wasn't treated with respect and he didn't want to get care there. so that is one bad example i can say about how the access to care and the attitude of not being a welcoming place and putting up barriers that prevents people from coming back. there is a lot of complaints in my capacity as a chief. how we interface with the veteran and care we provide i think is critical in maintaining patients and care. >> thank you for your testimony. >> mr. bradley, you are recognized for five minutes -- ms. -- >> thank you, mr. chairman and thank you for holding the hearing and thank you for being here.

your testimony is important. we appreciate it very much. i believe that all of you by virtue of being here and having gone through what you have gone through you have as our veterans served our country with honor. thank you for that service. i want to ask dr. mitchell and dr. davis because both of you -- well dr. mitchell you went through a formal process with the oig and somehow that information leaked out and it wasn't private and mr. davis you reached out to the whitehouse and obviously there were, based on your testimony, leaks as well. i was wondering if the two of you could comment on if you know how the leaks occurred and were you promised prescribe privacy?

>> senator mccain submitted with an outside request and also that my name be kept private. i don't know who leaked my name just know it was leaked. i don't know if there is any consequence to whomever leaked my name. the second thing is i don't know if the oig actually investigated. what happened was there is no official report although certainly the website has complete discretion has to what reports it puts on the website and i have been told they are unfavor to ses service and don't go on there. someone forwarded me a complaint that is unfavorable and can't be found on the website. i have no idea what occurred and i cannot get a report of it. >> have you tried to find out? >> i had senator mccain's office

checking and they are stone hp walling them. >> and mr. davis? >> i can tell you at 4:30 p.m. i was informed that the acting chief business operator responded saying ms. williams wasn't authorized to speak on their behalf but which she didn't provide, which is mo important, is who told her in the first place and that is the problem with the va. a complete lack of accou accountability. and when people know they can n engage in behavior without consequences something husband to change. >> i represent ventura california and my veterans use your facility in west los angeles. i am wondering what it is going

to be like when you return back to west la? >> i do fear retaliation but i know this was the right thing to do. and i think my veterans support me. >> did you believe by virtue of what you have been through and now being here do you think everything that happened and what we have learned about what is going on in the va across the country do you feel a difference when you go back to west los angeles than you do a few months ago? >> more importantly, i have enlighted congress, i believe and they have an opportunity to look very factual. i think that will be helpful to look at the facts.

as far as going back to my job, i could afford not to work, but i want to work and serve the veterans. dr. mitchell and i were chatting and we both want to retire within the va administration. >> i think i am just trying to drill down to see if there has been any shift or change over the course of the last month or two in the culture because you feel it every single day and culture -- changing culture is a ha hard thing to do. do you feel a shift? >> i think there has been awa awareness. they are very much aware they are coming tonight. and very much aware i will stand up for myself and the veterans and that i will not cower down. i am human. i have my frailties and this is

wearing on me. i wish i could go to work and dedicate all of my energy to working with veterans but instead the reality is i do worry about retaliation on a daily bases. i am looking over my shoulder and wondering about peer reviews. and i have been immune to some of the retalitory efforts. if you could do one thing for me you would relieve the obstructions of this retaliation and allow me to serve the veterans and work without the fear of retaliation. that would be a great gift. >> thank you to all of you and my time is up and i yield back. >> dr. matthews, i was a young doctor once and returning from southeast asia and full of vigor and i was stationed in virginia

and there were 2,000 women that needed pap smears. when i left there were 2,000 women on the list and i ran into an enertia and you have hit the nail on the head. it is the backlog we can take care of. number two changing the culture of the va is difficult and that is more critical downstream from years. what you did at the va was recognized a problem. saw you long wait times and wanted to make sure the patients in need got there. i have seen those patients in my office. you said how much work are we actually doing and when you evaluated it you found out your colleagues were seeing basically six patients a day. there is no private practice in the world doing anything that

can stay afloat seeing six patients a day. increase productivity and wait time and 60% of people that sought out care, and we know there is a shortage of your specialty in the va and in the country quite frankly, wouldn't come back. i found that amazing to me they found the environment so unhospit unhospitalable they refused to come back. and how we are all being evaluated with accountable care and were you satisfied with your visit, a fair question, and you hit the nail on the head a minute ago when you said what if you were the veteran? would you want to be in a place where less qualified people or people that didn't have your best interest would you want to see them? and i want to ask all of you how does retaliation within the va

affect patient care? if you are retaliated against and go back to the six patients a day and that means 60% of the veterans are not getting care they need? am i right? >> that is the case. being in pension evaluation i know of one veteran who committed suicide while waiting for the call back to get care. so, you know, unfortunately it went back to where it was and we really don't have a real time veteran satisfaction metric and i think that is important because we don't real know other than the surveys which are incomplete and are administered not correctly. mostly the clinic itself hands out the service to the veterans and they fill it out. you tell them it is private but -- >> i think you could draw across primary care, specialty care and

find out if it is a staffing issue and more people or just need to be more efficient while at work. i want to ask mr. davis what happened to the 40,000 veterans that were cue queued up. >> they were eventually processed. but here lies the problem of the carelessness in va management and that is why i go back to the point of make them pay for it. the problems with the queue would have been addressed. again, va was paying for licensing and maintenance fees for the a new system that could have resolved that issue. it wasn't resolved or addressed until after the 40,000. i will give you an example of the attitude by management. a report from 2013 talked about

the backlog. it talks about the slow processing of online applications. you are a physician. can anyone imagine an application for health care that you can write in your health, drive to a va medical center, wait in line, turn it into someone at the counter, waiting for someone to process it faster than the online process. if this was a private corporation we would be run out of town. now i have submitted a document of a fact finding report that dealt with waste and mismanagement and it addresses the issue at our office that the contract was so poorly mismanaged that the $5 million contract wouldn't withstand scrutiny if done in the third party audit. look at it in the contract situation. it is the same wreckless reck

less attitude. they don't assume responsibility for the actions with wasting the resources. >> and one other thing, which is a statement not an answer, but in the briefing it said the st. louis va medical centers reports to va central office that it's productivity was the highest in the nation. how in the world can we believe anything in this committee? i get asked how do you know about this and if we get this information how would we know? thank you, mr. chairman. >> mr. kirkpatrick you are recognized. >> thank you, mr. chairman. i would like to start by thanking our whistle blowers having to courage come forward when you witnessed wrongdoing.

i asked you to come testify and i know you risked your career to report wrongdoing and suffered repeated retaliation from administrators who refused to do the right thing. by bravely stepping forward dr. mitchell and dr. foot made us aware of the va problems in phoenix that led to tdata on th wait time. without whistle blowers we were motable to identify many of the problems and now because of them we can work to fix them. half of the retaliation cases involve the va. the bullying of patients and va employees that report wrongdoing must stop now. i sent a letter to acting

secretary gibson last month asking him to remind all va employees as their rights as whistle blowers. it isn't enough they are informed of their rights the va must deliver a culture of zero tolerance for whistle blower retaliation at all levels of its organization. employees shouldn't be afraid of ruining careers or loosing jobs for speaking up when something is wrong. patients shouldn't fear they would be denied care because they feel something is wrong. ... ...

whistleblowers are necessary. my question is for all of our witnesses. if you could name one thing that the va could do it immediately

to change the culture of silencing whistleblowers, what would it be and we will start with you doctor mathews. >> if i had one wish it would be that data integrity is there. and we have demonstrated over and over again they will make a number that comes up with lies like doctor mitchell said i will paraphrase a person that will go beyond life that are transparent and accurate and buy another major university that has a higher degree of integrity and people who are found with these numbers are punished because it has real-life consequences. these are not just a game they are playing. >> not to cut you off but i have

about 45 seconds. >> when people know they've done something wrong and they've been shown they've done something wrong but they are allowed to maintain the position sometimes you get raises and bonuses you are sending a signal throughout the entire va -- >> we are going to go quickly to doctor mitchell [inaudible] they sent out the nano. ithey are waiting to see what happens the body that is good to be responsible for enforcing whistleblower protection and va cannot be a part.

>> thank you all very much if mr. chairman for the expectation. >> thank you mr. chairman for your service to the veterans and also the courage and joining us tonight to share your stories. doctor mitchell cohen as you know, the va has had several internal investigations now. we have had reviews by the medical inspectors and we've actually had it couple of high-profile resignations. in response to that we have begun to make changes and make actions. based on what you've seen so far will any of the changes and activities the va has been involved in in the last three or four weeks to get measurable difference?

>> no. although they've tacked the basic object into the scheduling nothing has changed for me. the retaliation is still in place and the chain of command authorized the return counseling for violating the policy they don't have to tell me what partt policy i violated is still in place and interpreted the contract to mean i could be forced to work on limited schedule shifts for two years without any compensation is still impact. we haven't addressed what happens when we bring all the steps in and you've already got your overload. you say that your pay was stopped. were you ever told why it was

stopped? with administrative error? when we attended the attorney initial proof of the presence, they paid me. it took me a couple months to do that but. they really give me no explanation. >> the federal government would do something like that. in the legislative fix to some of the things we are talking about let me ask you this. is there any legislation we can do to fix the culture of the va?

what can we do to face that if anything. >> i think there has to be some fear of accountability. certain individuals feel they can act, that either the system is too slow to respond or maybe it's never response. they know they are absolutely wrong. most individuals cannot withstand that kind of punishment. >> is there anything that you would add to that?

when you see the pattern behaving as we look at people's timecards and if we see people on the timecards we know something is wrong. if you see the same va manager constantly being represented by the general counsel's office, then at some point you need to let the coverage. think about it like car insurance. if i keep banging my car into other cars i'm going to get dropped off the policy. if the va official continues to put the agency at risk of that occasion and liability, then the coverage elapses outspokenness situation. first would be the integrity should be there because once the data.

the newspapers can report on it. to take away that responsibility over the va of the managing the data without having the lifetime tenure positions. >> thank you doctor mathews. i yield back to you >> thank you doctor reese. >> thank you mr. chairman for being here. often times we are put in the position where we are the last stop for the patients. we have to fight the system to do what's right for the patients because it is not right and i appreciate all of your efforts and advocating despite the

consequence is that you put on ourselves. regardless of your specialty. that is what i referred to as a high-quality veterans entered culture of responsibility and accountability in our va system that we need to transform into. we are not there yet and we need to ensure that we apply the mechanism, the process and e. valuations within the system that will lead to the veteran centered institution. there is a form of the ceremony that we do that and ensures that we address these atrocities and that is the ground of morbidity and mortality rounds. do we have those?

>> not for the emergency room. >> it is more traditionally in surgery that we have the equipment for the internal medicine also for emergencies. >> i think all specialties should have been in emergency medicine, practices throughout the country also have been where they review things that went wrong, mortality is, people that have died from other causes of those. if there were any lapses of the systematic failure that led to those problems. >> they were presented to the risk management and i often will hear things either through the court process or a week or two

after and the then agree just activities presented by the chiethechief of staff directorse ceo. >> there should definitely be metrics based on the morbidity and mortality to determine if there was a staffing issue or medical error or any lack of process heat were following integrity and practice or lack of judgment etc.. and that would give information as to what needs to happen, and that information should be directly linked to the ceo and the link to make the changes that are necessary. the other way to ensure systematic and transparent open way to evaluate certain practices so we don't have to rely on the whistleblowers are through the chart reviews and a spontaneous random audits. does any of that exist in your practices.

the people that regret those issues if there is complications that were reported but is only as strong as the ability to actually report the incident. the instance that i reported a net can go several years down the road when it comes to the root of the top process is too late at that point. i agree that the mortality is very evident when somebody dies

that should be investigated in to determine if there was any wrong during the care for this veteran. i believe that part of the solution. the leadership and the idea of taking the responsibility away from those that would have to do the self evaluations from those supervisors and placing it in another location that has more of the advocacy is a very good idea and wish that i yield back my time. thank you all for your courage to come out and stand for the veterans. mr. davis i want to put this out there because i know you just talked about it and ms. kirkpatrick ran out of time, but a statement tha the statemee

earlier, came the va police itself and if not, who? >> i don't think the va can police itself. i would look at media organization like the government accountability office, maybe finally setting up some sort of oversight panel of health care professionals. one of the things i would tell you that the va employees talk about is during the financial crisis there was talk about bringing people like elizabeth warren during the talk about the national security issues they talk about bringing back the doctor. when we had the crisis in the va, we present deputy chief of staff and there is no disrespe disrespect. in the largest health organization it goes to how people look at the va. one of the reasons why i aged up to the white house is because i

was trying to find the person who could answer questions with all of this issue. we had a form of everything that you could imagine in this town but not one for the veterans and i think that is the issue there has to be an outside source to say as to chairman, members of congress, mr. speaker, mr. president it's not going to work in terms of the context of giving the secretary about where right to fire people in november of 2013 the memo was released by the assistant secretary for human resource stating that they were not to go to the secretary's office about the complaints because it abstracts the final decision of the disputes. if that is the approach they take even if we change the law we still wouldn't get the information to the right people

to hold them accountable. there has to be something in the wall to become the policing organization over the va and it simply isn't going to come from them. >> this leads to my next question. and i've asked doctor mathews to follow up. he said in one of his statements that he doesn't necessarily know that it gets above the st. louis regional central office could you shed some light on that. >> i can tell you the only reason my case got where it was because i didn't go through the agreement process because that is the way of trapping the employee in filing the complai complaint. when that didn't work i went to

my congressman and we had to put something in place. me and my supervisors get along in a normal process. if it is about the patient's care of human beings or people that served in iraq and afghanistan, that needs to be fast tracked into brought to the forefront. when she was conducting the investigation of the applicati application, once the directors of the stop there was no recourse for her and so we have to find something in place to allow them to go to the forefront based upon the severity and the critical nature that they represent. >> and with my remainder of time do you have a central office that sees this as an issue because it seems like there' tha disconnect. >> there is a disconnect and i really don't believe any of the

data. we have to have integrity and how we are basically talking about ways to make that happen and that the abuse at this time maybe for a perco of time we need to have an external agency that has higher integrity than the va looking into the data complaints and then seeing what needs to have interest in what can wait. and unfortunately, the va demonstrated over and over again that they are not able to police themselves. they are not able to come up with honest negative information. and again, it is not an automatic exercise. it really hurts the lives of our veterans. >> you're recognized for five minutes. >> thank you mr. chair to the courage and in coming forward we appreciate it and understand the risk that you are taking. just know that we are your

witness if there is anything that happens to you, please be in touch with our offices. i would like to follow up on the question. in the private sector in the healthcare field we have a process of quality assurance that sounds like a b. what you're doing in your root cause analysis. but to get at the issues that an act the public safety and issues of veterans but also some of the staffing issues that you have raised in your testimony, is there any type of process within the va for sharing best practices or four determining what our effective mechanisms? the type of problems that you are describing, perhaps we are fortunate not to have to va facilities in manchester new hampshire and vermont and some

very high levels of competence and access. what is the concept of sharing best practices and how would you go about improving on that? >> in 2012, november of 2012, i noticed a spike increased number of veterans presenting these.

in the 50 pages there are slow diagrams, standard operating procedures that kind of naked basic idiot proof that when you have certain patients that come in that you should have guidelines and when the patients should be screened and received treatment if they have cancer it would be presented in the multidisciplinary teams we could expedite. surgery is possible. for whatever reason this was not happening in the number of patients that i saw and so i encourage us to adopt some of those. >> did you have any success? >> i had some but i think one veteran who doesn't receive the screening necessary is too many in my opinion. and so i thought that we should have more -- those types of ideas should always be floating within the va to have procedures

so we don't miss the veterans. no veteran should be left behind. >> and is there any cross us for quality improvement? do you have any procedures or protocols within the va system that you could bring forward for these types of standards and procedures? >> that is what i would like to do. but because of the other activities that had to be involved in -- >> have you had any experience in them? >> there is a whole quality assurance division and certainly i was on the e-mail group for the physicians of the directors and we shared ideas. what we need is a best practice of how to overcome bad management because we all knew he are suffering from short staffing and other issues, the promise with nurse triage and other things. we just couldn't get anyone in the facility to listen to us that had the power to make the change.

>> in the short staffing word you told her that that was a fiscal issue that you couldn't hire people or was it a timing attack in terms of getting the professionals credentialed? >> it varies depending on the week. we are having a high giving free is where there's not enough applicants which is often the case. a lot of times there are fantastic applicants but the process of credentialing takes eight or nine months and we already found another job. >> i have little time left but i just want to say that having reviewed your testimony and the various lawsuits i'm extremely concerned about the issue of the racial bias in your record, and i just want to commend you on your courage and on your professionalism and admire the strength it takes for you to get up and go to work every single day so thank you for coming here today. >> thank you very much. >> thank you mr. chair.

>> you are recognized for five minutes. >> thank you mr. chairman. thank you all for your very powerful testimony that you presented here today. i was a va doctor for a long time myself and i feel there's a great deal of difficulty communicating in the leadership and i think doctor mitchell, you mentioned the tool that when you find problems in the va as a physician, you try to tell somebody up the ladder the problem is to improve care and there is no one that seems to get something done. talk to your chief of surgery or psychiatry and do talk to the chief of staff. is that chief of staff and advocate for the physician or do they have an advocate for the

administration? my concern is that the physicians don't have enough access to the management to make changes that have a recognized need to be done. how can we do that better? at me asme ask all of you that. in my particular case i was the chief of psychiatry going to the chief of staff and it seems like they don't exist or like you said it's not giving the right urgency or the right priority -- >> does the chief of staff have somebody they can talk to up higher on the latest? that seems to be the place that it stops from my experience working there. is that the problem you think? what is your opinion about that?

>> one person's chief of staff came to my defense and they were severely punished and pushed out. i think there are good people in the chief of staff and in the country. there's close to 12 chief of staff members. some of them know that retaliation is a problem and others are part of it. >> what do you think of that? >> we certainly run through several and generally the advocate we have an option of going above but i will refer you back to the facility director. every physician has the ability to go to the local union office and say they want to organize. there are some physician groups that have done that got in the members of understanding to stop the overload of the physician panels and things like that. but they have to organize themselves in whatever way they want to approach that whether it is through the union or by

themselves been through management. everyone is afraid to do anything because the risk of retaliation is so real and that is the loss of your livelihood act best in your ability to be employed anywhere in the vicinity of the va. >> can you tell me more about this and explain it to me again? >> a legitimate review is when someone questions the ability of the physician -- >> dais where we would typically do that and in my hospital setting -- >> but this is someone that has -- everyone can make a mistake and things can be overlooked. but here review is when you're afraid that they are not practicing up to the standard of care that he would hold a large section of cases and have them reviewed to see if they are truly significant deficits for the person's ability to practice medicine. that is only supposed to be done in extreme cases where there

truly is legitimate concern that this person is not up to the standard as far as practiced. the review is where you have the ability to call the review teacher review of the physician cases. if you can't find anything that they have done wrong that significant, then what you can do is put a subjective finding. they have the ability to interact with people or something very big and subjective. what happens is that in the medical community to peer reviews are only done if there are red flags. that is the reason why it's important that if you were ever in the review you would have to report on the license or job application. most people that don't work in the va don't realize that they are done as punitive actions in the va in order to sabotage the physician's credibility. it's also incredibly demeaning for the physician to go through the peer review practice because

they were practicing professionally. psychologically it is so stressful but most would quit. >> but if it is done by other physicians on the staff with you. >> usually it is the administrator they all get together and say -- >> but he is not a physician? it isn't the peer review? >> it doesn't mean that they have the ethics. >> i guess i'm out of time. thank you doctor. you are recognized for five minutes. >> thank you mr. chairman. and i will associate myself with my colleagues. thank you all for the work that you are doing. you understand that the nature of this is not just the personal damage that is done to you but as each of you have stated so eloquently with the passion it hurts our veterans. that is what is at stake to you here so i appreciate that. there is no veteran strategy.

when i ask what the strategy was, they give me the goal they are going to get to. it doesn't surprise me. they are not sure to send and who to go with. it doesn't work that way. i've been asking for the review just like we have so that we can resource it correctly and we can have the things in place to make the corrections but that is lacking. i can tell each of you we are coming to this how-to we get this. i will tell you doctor matthews i am not putting my veterans health care or reputation on the data so when people ask me how are the local facilities doing, i.e. m. worried. months ago we got the audit and had some of our facilities and they sat right there and those of you sitting behind their honey you can be sure that we want an answer and we will ask you again tonight whether it is

her field or not. why don't we know what happened at rochester. can somebody speak to that and say? tonight we get the general counsel. they all blame to you in the other hearings come as amount you get the answer tonight but i would suggest this. and i know that the work we are doing. i would submit to all of us here the watchdog on this in the outside agency to look at this is here. it's us. we are given the constitutional right to do it. when i go home and asked about this and i should be held accountable. but we don't know where to get it and i would suggest this committee is the most nonpartisan in many cases. to fix the problems for the veterans because that is what we do but it's been historically understaffed. i would like to send staff to tell me what is happening in st. louis, with happening in los angeles and come back to report so i get it from the horses mouth because right now i cannot trust where it is coming from so

that is my soapbox to each of you and we all feel very strongly that we have to come up with a solution. we have to have accountability. we had the constitutional power and need to give the authority to do this and added to the good staffers that are there so they can get out there and ask the questions. and i would suggest were put forward each of you maybe i am a little pollyanna -ish on this but i am a high school teacher. this is bullying. this is what it amounts to. there's been a lot of research done. here's what happens if the increased productivity, loss off litigation, commitment, satisfaction, transfers, adverse impact from the patient customer satisfaction. we know all about that. but the question i have is that we can say to the va can go down this has never happened in the private sector. this is about people and accountability. what we need to figure out from a national strategy, putting in place the accountability pieces that have the elected people

that have the power into the resources because there are wonderful people. you work with them every day providing great care. one question for you. you said over 16 years that the care has improved at phoenix. how do you simultaneously and prove the care where this has existed? is that the quality of the people that are coming there to work? >> you have an incredible force for change and the majority of the employees are veterans themselves and family members of the veterans. they get incredibly good care whether it is direct or indirect care and so despite the fact that there is a nod in your stomach when they try to get in the car and go to work and despite the fact during the day they try to get -- >> that's happening because when my veterans say they care to the da if you can get past that -- i would ask each of you have given two different va hospitals? does minneapolis look like los angeles? >> i've only been to phoenix. and we get tons of good care.

the problem is with health care needs when you ignore them a veteran pollster the cracks and that has devastating consequences to their health so what we are focusing on is the hundreds of thousands of cases where there has been bad care giving and we shouldn't lose sight of the fact we have millions of instances of care and that's the reason because they make it worth saving. >> our youn young residents and graduates of our medical institutions while they still choose to continue to go to the va like you did because my fear is we drive them away and make it so unattractive. >> i wouldn't recommend in the current state of the people get a job at the va physician until there is a guarantee that with the retaliation we will be protected. that the pay would be commensurate that there is a professional working environment. everyone just -- i'm really prouproud -- >> that is a nightmare scenario because we know what the numbers look like and we have got to get this figured out.

i yield back. thank you. >> you are recognized for five minutes. >> thank you mr. chairman. i appreciate the witness is coming and visiting tonight and sharing your story. and i'm particularly troubled by the comment suggested recommendation that the folks look for employment elsewhere until these problems were fixed. doctor mitchell one thing that i would ask them each name that appears by the senior staff but ignored your plea is violated your confidentiality knowingly injured veterans or place them at risk for do you know if any of these have been punished or censored by the va? we will start with you. >> i don't know. but cooking up the numbers it is basically sending all the wrong messages that it doesn't matter. care is optional. you protect it and come up with the numbers. it is so corrosive. going back to the point i

started the washington university residence in the va, and i have one resident who was very good but wanted to join and two other people that i knew in the community that were excellent psychiatrists trained in very good places and they came and were interviewed, but they didn't want to work in these situations where they wanted to join because i wanted to build a good mental health clinic there. and then it was inconceivable that they just removed me from the position. so, this is very corrosive and demoralizing. a lot of the ethical people work there as well because they have to leave or they have to just keep quiet or suffocate internally. in the mistreatment and violations in your treatment and choose to remain silent.

>> i know that for a fact that is the case. >> what would you recommend in all of the members of the committee have probably heard from the constituents since this broke open and we have been looking at this for a number of years what would you recommend it to the whistleblowers that had the knowledge and the concern that share the doubts about how you would be treated, which they do. i have had three or four whistleblowers show up unannounced for a surprise visit to the facility somehow was able to get in and started to uncover things but what do i tell the whistleblowers this is what we see happen but we cannot tell you our name because we are afraid we are going to lose our job. what should i tell them? panic at this point you could give me dvd that -- them my name. that is what is happening. i had multiple phone calls from those across the country.

it's because they were forbidden to document the force. there are several in that there are many issues. i contacted jeff miller or representative miller's office and got a phone number of someone that said that they would maintain the confidentiality and investigate. and at this point i would tell them that is a problem above my pay grade. >> i have had several company derrick pulley and i share the testimony with the committee and i read some of the statements in the record and i would say though that i know that our failure with the administrative process either the house i would be more than happy to take the whistleblower complaints to the public. might have grabbed his communications i was able to