as noted in the office of special counsel report va leadership has repeatedly failed to respond to the concerns raised by whistle blowers concerning patient care at va. despite the best efforts of truly committed employees at the hec and the veteran health administration who have risked their careers to stand up for veterans, management at all levels have ignored them or retaliated against them for simply exposing the truth. some of the critical issues reported by whistle blowers at the hec include mismanaging critical veteran health programs and wasting millions of dollars on an affordable care act direct mail campaign. the possible purging and deletion of over 10,000 veteran health records at the health eligibility center. a back log of over 600,000

pending health applications. nearly 40,000 unprocessed applications discovered in january of 2013. these were primarily applications from returning service members from iraq and afghanist afghanistan. the ewrath that i've experience include my whistle-blower complaint to white house deputy chief of staff was leaked to my manager sherry williams who stated in writing that she was contacting me on behalf of acting sent gibson and mr. rob neighbors. neither mr. gibson nor mr. neighbors have responded to this fact. my employment records were illegally altered by cbo manager joyce deet terse. i was illegally placed on a permanent work detail by phillip mccofsky.

i was placed on involuntary administrative leave curiously at the same time the oig investigation was taking place in atlanta by acting hec director greg becker. unfortunately, my experience is not unique at va. darren and irene owens who work at the atlanta va medical center have experienced the same retaliation for reporting medical errors and patient neglect as well as misconduct by senior va police officials. our local 518 president daf any ivory is routinely harassed of assisting me and other disabled employees with retaliatory action by members of management. mr. owens, mrs. owens, miss ivory are all veterans. in fact, over 50% of the staff that works at the hec are disabled veterans.

in 2010 allegations surfaced that applications for va health care were being shredded at the hec under the direction of the hec director and deputy director. miss kimberly hughes, former associate director for informatics and her team began to investigate this allegation. her team discovered nearly 2,000 applications that were reported as being processed that did not appear as new enrollments in the enrollment system. miss hughes' investigation was abruptly closed by the hec director's office. she was also subject to harassment and intimidation because she dared to advocate for veterans. the whistle-blower statements i have provided to the committee were also provided to the oig and i'm more relevant than many may realize. i urge the review of those whistle-blower statements. in addition to providing

specific examples to the committee, i hope my testimony provides some insight to three key issues va management fails to address. reckless waist of va funds and the sole purpose of achieving va performance goals. why there is resistance to having proper reporting systems and the source of the resistance by dr. draper during her testimony and the need to remove ineffective managers and the critical need for the va management accountability 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 bit further the information you provided to rob neighbors who was detailed from

the white house to the va that led to adverse employment actions being taken against you. >> yes, i contacted mr. neighbors about four weeks ago. at the point of contact for the white house i wanted him to be aware of what was going on in our office. a lot of attention has been placed on scheduling, but it's important to understand if you do -- if you're not enrolled, you're not going to be placed on the schedule. i wanted him to know about shortcomings with the enrollment system, a system that many of you have talked about. we have spent millions of dollars on and yet we're still back at square one with these va systems. i also reached out to him about a medicare part d marketing initiative by va to encourage senior citizens who are veterans to drop their subsequent companion medicare insurance and enroll in va's. 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 were not aware of that and could be confused and cancel their supplemental medical insurance and end up being stuck in the donut hole in the back log. i also contacted mr. neighbors about the continued mismanagement of va health programs managed by the hec and the chief business office under the direction of mr. phillip mccofsky and lynn hare gren. after sending out information to mr. neighbors i did not receive a response. i subsequently contacted the office of deputy chief of staff anita breckenridge. i also did not receive a response until after receiving notification from miss sherry williams that she was contacting me on behalf of the acting secretary and mr. ross neighbors. it surprised me miss williams would do this because she is a former oig official. to this day no action has been taken to reprimand miss williams

for her behavior. this goes to the very heart of the question whether or not va should be allowed to police themselves and whether or not an outside agency should be brought in to conduct an investigation into the actions taken at va. i did receive an e-mail from the white house office of white house counsel directing me to contact the office of special counsel. well, if that was the official position from the white house, there would have been no need for anyone to contact miss williams about my complaint. >> you also in your testimony -- you describe the possible purging of over 10,000 shaen health records at the veteran 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 applications that have

been applied for by a veteran, turned in to va and for whatever reason we could not take that application to a final determinati determination. this back log has reached 600,000. what we should have done is instead of hiring 40 people to deal with the affordable health care act, the veteran was encouraged to pass on information to a fellow veteran. unfortunately, the information for the veteran to take the action was on the second page of the letter, therefore, we ended up getting 80,000 duplicate applications of which only about 1650 were actually 578 cases that we could actually do something with. in terms of the 40,000, this was discovered in january of 2013

and this is important to the committee because i want to share something that i forwarded to the committee from 2013. increasing online application submissions versus paper and improving turn around times for eligibility decisions have a positive direct impact on providing timely access to health care. data reveals applications submitted in person are processed with higher urgency while online applications linger in a less visible cue. to answer your question how could this happen? because the applications linger in a less visible cue. even though the i.t. department had paid licensing fees for over $40,000 for us to have a new system for managing the cue, a system referred to as bisflo. it was only put in place until after the 40,000 applications that were lingering in the cue for some cases nearly three years was discovered.

that is something that is shameful. >> thank you, mr. davis. members, i have one question i'd like to ask dr. head. dr. head, you talked about the retaliation against you, and i just -- i want to specifically talk about dr. wang who i read that the oig conclude that had dr. wang had, in fact, committed time card fraud, is that correct? >> yes. the official report was not released to the layperson. 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 term nated. she has maintained a supervisory zbloel 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 recommendations. she has been left in her division chief position. she was my supervisor. i filed a complaint. numerous complaints. they removed 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 and have become, i think, one of the -- 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, dr. mr. michaud. >> thank you very much, mr. chairman. as you all know, whistle blowers, you 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 help protect the whistle blowers? i'll start with dr. matthews and work down if there's anything we should do to strengthen the whistle-blower protection act? >> that's a very -- that's an excellent question and one of the things that i experienced is that i was immediately removed from my position under the guise of an administrative investigation with the specific directive to not contact any other psychiatrists that i was mapping and they cut off my access to the databases, some of

which i had set up myself, to get accurate data. so one of the things is if there is this sort of investigation, the person continues rather than being detailed and if the person has to be detailed, perhaps there should be a review by peers to see whether, you know, 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. as dr. mitchell mentioned, these are not the jobs that we wanted to do, not that we would not do it. we would do it to the best of our abilities. so having that protection. having the osc have some sort of time limit to review these complaints would be very beneficial. having a process for like you rightly mentioned, if a

supervisor is indeed found to have retaliated, to have some very tangible consequences to that person would be very, very important. right now i think at least in the st. louis va they do not think that this is a serious issue. like i said, like two weeks ago i was called into a meeting with the chief of staff where the chief of the out-patient psychiatry, the person i worked with very closely to implement my changes was also called into that meeting, and in that meeting i was specifically told that the chain of command must be respected at all times, that if i had any issues or if dr. ethis had any issue that we should report it first to our supervisor and move up to the next level and the next level. >> could you finish up? because i'm running out of time. we have three others. >> yes. so, you know, i think you are --

your recommendation for having quick and serious consequences to retaliation would be important. >> thank you. dr. head? >> yes. i think there needs to be greater repercussion for retaliation. we have shield laws and sword laws. retaliation is against the law and they can warn the person, don't retaliate. they can continue to retaliate which ultimately will have a direct or indirect affect on the veterans only because their caregiver or doctor or nurse is being retaliated against. sword law -- shield law means that not only do you have a sword law, repercussion for retaliation. you have a shield law where you can immediately take action and there can be immediate repercussions for any type of

retaliation against a whistle-blower. you tell a chief of staff, you say, look, this person gets retaliated against, pushed out of a job or anything, we're going to hold you accountable for this until we figure out what's going on here. and we have that -- a shield law enacted in the state of california but that's something that should be considered by congress. ultimately you will address it one way or another because retaliation in the health place is different than a factory. you retaliate against a physician, surgeon, nurse practitioner, nurse, you're going to have direct repercussions one way or another to the health and well-being of a veteran. >> thank you. dr. mitchell? >> i'm not sure all of -- i'm sorry. i'm not sure all of it needs to be legislated but 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. it isn't but certainly there are

employees charged all over the nation for it. in addition, sham peer reviews need to be part of the personnel action. that's where they drum up reasons to evaluate cases. and then they can permanently sabotage a physician's ability to get employed not only inside the va but in the private sector. whenever you're subjected to a peer review you have to report that. sham peer reviews are done specifically to sabotage the credibility of a physician. physicians truly face losing their livelihood, their ability to be employed again as a physician. you need whistle blowers that are physicians, people that are trained to identify the high risk problems. >> dr. david? >> yes, thank you. i don't know if a new law would

really change anything honestly at va if you don't have accountabili accountability. i think there are some structural changes that need to take place. one being a centralized human resources office that has authority. currently when i went through my situation of retaliation i spoke with the representative from the va hr office. they told me they're only a policy body. they could contact the hr office where i worked and maybe make some recommendations and see what they could negotiate. that's problematic because in va, unlike a corporation with a normal health care system, every division has its own hr department which becomes the secret police force for the managers who harass employees and that's problematic. that's what needs to change. i think a centralized human resources department would help. bad managers should pay their

own legal fees. currently they have no fear because the bill is going to be passed onto the taxpayer. even if they lose a case or they find wrong -- they're guilty of wrongdoing, the bill just goes onto the taxpayer. currently we have managers in our office that have several different complaints for harassment. it's not a big deal for them. regional counsel will take care of it. the office of general counsel will take care of it. >> you're recognized for five minutes. >> thank you, mr. chairman, for having this hearing. i want to thank you all for being here. you're showing a lot of bravery and courage. you're putting it all on the line to do this. i know you're doing it for our veterans. dr. mitchell, i'd like to ask you, you've been at the phoenix va for 16 years. do you believe that the lack of response to safety issues that you've brought up over the years have threatened the health and even the life of veterans in

phoenix? >> yes. anything that impairs the efficiency of the delivery of care threatens the lives of patients. certainly in the er i can recall three specific deaths. i trained as a resident at the phoenix va. there were two patients that died because they were delayed in getting the card yacht caths. they only did them monday through friday, not on weekends. the veterans had to wait because there wasn't time to get them done on friday. they died on sunday. when i was a nurse there there were tremendous problems with patient care and there weren't sufficient nurses to turn patients in the adequate number of time. we had patients developing huge bed sores. i can remember jhaco certifications that still haunt me because administration would authorize overtime for charting because the jhaco would look at charting but would not authorize

time to turn staff or to feed patients. we used to volunteer our time because we couldn't get it done. >> doctor, did these problems catch the hospital and administration by surprise or had they been warned? >> i'm aware of problems throughout the facility without necessarily having access to upper administration. i know that people communicate these concerns as best they have. any concern you have to present to your supervisor in a politically correct manner because if you don't, you'll be retaliated against. you'll be harassed at the moment you give the information, your proficiencies will happen. it's best that management not know your name. if they do, it makes you an automatic target. it's not to say all supervisors

are that way. there are some incredibly ethical super voo izors. >> that's good to hear. the interim oig report which brought out issues that we're seeing better as a result you believe didn't go far enough if i understand your testimony correctly. >> correct. >> do you think that there were flaws with the methodology and that it could have even been more revealing of problems out there? >> yes. there's a saying that has to do with lies, damn lies and statistics and what they did was they took out a segment of patients and said, well, this is the average wait time. the near list that they were looking at was divided by clinics. some of the clinics had relatively short waiting times. the near list ran from january 2013 to april 24th of 2014. some clinics had very short waiting times. the downtown phoenix clinics were all aggregated or an aggregate of some and the waiting times started at 477, they didn't hit down to the

110s, 120s until page eight or page nine. because some of the wait times were zero or one days or two days, i have no idea which patients they picked. it would have been certainly more accurate to say at the phoenix va clinics we had this many patients waiting 0 to 30, this many from -- >> so 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 problems with that. other people told them that. i told them about the patient safety issues. >> thank you. once again, i want to thank you all for your service to veterans and for being here today. mr. chairman, i yield back. >> thank you. you're recognized for five minutes, mr. takano. >> thank you, mr. chairman. dr. matthews are you familiar with the federal classifications of employees, title 38?

are you aware of that system? >> yes. >> in your capacity as a -- as chief of psychiatry, was that a title 38 position? >> yes, title 38 position. >> doctor, had your -- you're a physician where i formerly were, was that a title 38 position or something below title 38? >> title 38. i'm still employed. >> you're still employed. >> i'm a title 38 employee and i've been employed as a physician throughout my va career here. >> okay. dr. davis? mr. davis? >> no, i'm just a general service employee. >> general service employee. >> one of the things i'm grappling with is the proposal to fire va employees believed of wrongdoing.

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. in my mind i'm going through this contradiction of well there is a sense amongst some members that we want to make it easier to fire some people at certain levels of service but that might seem to run against the idea that we need to also protect people who speak up. dr. matthews, do you have any thoughts on this? you have whistle-blower protection but how do you feel about it making it easier for us to fire title 38 employees? >> i think when veterans life and health is at issue here i think that you should be able to be fired. any person in direct patient care right now enjoys lifetime tenure where they're protected

from their actions and consequences of their actions and that's not good for providing a safe work environment for the veterans or health 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 whatsoever. that kind of protection should end. at the same time i want us to consider that a workplace is only as good as the employees there and i'm hoping we're looking at the salary structure in the hard to fill positions so that you can have less protections. >> doctor, excuse me. if they were to have fired you would have absolutely eliminated your ability to voice any

dissent or act as a whistle-blower? >> well, that already exists. they've already politically assassinated me. i'm no longer chief of psychiatry. they've spread that. in fact, the way i found out that there was this administrative investigation stuff going onwas one of the psychiatrists i recruited called me saying, are you fired? i hear that you're fired. so professionally -- and it's a bad statement of the va that me having trouble with the va is -- >> would you have been better off -- worse off having you completely eliminated, voice completely eliminated by you being summarily fired because they had the ability to do so? you at least are able to be here and advice your concerns. it's far from where we need to be to have feedback from the mid

level and lower level to say what's going wrong. that's our interest, right? to have lower level employees be able to speak up without fear of being retaliated but is whistle-blower protection enough? do we need to have some sense of due process which some of the members would like to see eliminated so it's easier to fire people. i see the tension here. you might even recognize it. i, too, would like to fire people and not have them have complete tenure and they feel insulated. >> right. >> but i don't know how we solve this. >> i think one way we can solve this is put ourselves or our loved one in the veteran position. would i want to obtain care or would i want my son to obtain care where physicians cannot be fired? i would not want to go to that hospital so i think that would help perhaps resolve this tension about who are we

protecting, are we protecting the veterans or the va employees. >> i understand. mr. chairman, i yield back. >> thank you very much. also, the legislation that we have passed in the house does not reach down to this level of a cs or title 38 employee, only senior level, the top 450. . mr. bilirakus, you're recognized. >> thank you for holding this hearing. thank you so much for your courage. i really appreciate it. dr. head, i o know i don't have a lot of time. you mentioned in your testimony that this potentially could be -- the vha could be the best health care system in the world. how do we get there? >> i believe with leadership. there are certain people in leadership that have been there for 18, 20 years and if they're

a great leader, fabulous. if they're not, it's very disruptive to the system. we need to find ways to bring in leadership on a continuing basis, maybe term -- i don't know if this is the answer, term limits. if you're a good leader you're identified and perhaps you can be part of the team that brings on new direction. if you're not such a good leader, maybe you should be integrated into other parts of the federal government or retire. leadership is clearly the key. our surgical team at the west la va could be matched against anyone in the world. my wife is much smarter than i. she could work anywhere in the country. somehow she agreed to marry me and dedicated her life to serving vaebs. she loves her job. she obsesses over it. she's always worried about trying to save another veteran. i commend that.

there's lots of people like that within our system. we need leadership. the leadership will take the va to the next level. i think it's not resources. we all care about the veteran and you're very giving. we'll do anything to serve our veterans. it's not resources. we'll do anything to make the situation right and serve veterans. i have no doubt that if the right leadership is brought to bear in this problem, we can solve this problem. >> thank you. our next question, this is for the entire panel, in the previous fiscal years all senior executive service employees all receive a fully successful performance, last year they receive a fully successful performance which totals 2.8 million in performance awards. yes or no, we'll start with dr. matthews, yes or no, do you believe that this is an accurate

assessment and that all senior employees perform in a fully successful capacity at hire? >> no. >> no. okay. how about dr. head? >> no. >> okay. mr. davis? >> based on what we now know in the public record, absolutely not. >> dr. mitchell? >> no. >> thank you. next question is for dr. matthews. through your own investigative work during your time at the st. louis va you identified that on average, you spoke to this in your testimony, on average psychiatrists were seeing six veterans per day which accounted for 3 1/2 hours in an eight-hour workday. when you contacted other psychiatry chiefs regarding actual time spent in direct patient care by psychiatrists seeing veterans, do you know if they had been tracking this information prior to your inquiry? >> no, i do not know if they

were tracking it. i know our va does not track it and many other vas do not track it. a lot of the chiefs wanted to know the answers as well. i got a lot of information, why don't you forward the responses to me as well. just recently there was another new chief of psychiatry who had the same question that was sent out to everybody saying, what is a reasonable expectation, what number should be reasonable? >> thank you. dr. matthews, your findings discovered 60% of veterans were dropping out of mental health care after one or two visits. i have town meetings, i have veterans advisory councils, they tell me the same thing. did you believe it was directly connected to the experience they had while seeking treatment with the va? is it the type of treatment? should there be alternatives to that treatment?

if you could please. >> sure. my goal was to make the va mental health clinic a very welcoming place with very easy access to care. the majority of the veteran complaints that i reviewed had to do with long wait times, not being able to come to seek their ca care. that really demoralized them from obtaining care. the previous capacity of the compensation and pension evaluator, i came across some really horrendous barriers to care for veterans who had tremendous amount of combat exposure. they were in some of the specialized forces and here just one instance i will mention here -- >> please do. >> -- this veteran was doing so poorly that his roommate who's also a veteran had taken off a day of work so he can take him to get him care. so they come to the va and it takes three or four hours to find out whether this person is

even eligible for care or not. they made determine, yes, this person is eligible tore care. this veteran comes for the ptsd clinic and is not seen by a health care provider, is told that we will contact you next week after a meeting to determine what we going to do for it. now i was doing compensation and pension evaluation so i had access to the records. i was looking at whether this is -- whether there's a record of this veteran actually going to the clinic or not and i did not find any record but there is a subsequent notation saying -- a form letter sent to the veteran saying we learned that you were interested in obtaining care at our facility, please call these numbers to schedule an appointment. so this is what a veteran who has served our country and sacrificed a lot who even the military recognized had ptsd,

was -- had taken a day off of his low paying job to obtain care. there was no record of this person being at the va and the contact was not made. when i evaluated him i asked this person that, you know, would you consider coming to the va to obtain care and this veteran was very clear in saying, no, i'm not going to obtain care here. i was not treated with respect and, you know, he didn't want to come to get care there. so that's one really bad example that i can say about the access to care and the whole attitude of it not being a welcoming place. barriers, that really prevents people from coming back. there are a lot of such complaints that i heard in my capacity as the chief. so, yes, the answer is yes. how we are interfacing with the veteran, what kind of access we are providing and what kind of care environment we are

providing i think is critical in maintaining patient care. >> thank you very much. i appreciate it. thank you all for your testimony. >> thank you, mr. brownlee. you're recognized for five minutes. >> thank you, mr. chairman. thank you for holding this hearing and thank you to all of you for being here. your testimony is extremely important and we appreciate it very much. i believe all of you by virtue of being here and having gone through what you have gone through, you have also as our veterans served our country honorably. thank you for that service. i just wanted to ask dr. mitchell and mr. davis, both of you went through a -- well, dr. mitchell, you went through a formalized process, a confidential process with the oig and somehow that information leaked out, it was not

confidential. mr. davis, you reached out to the white house and obviously there were -- based on your testimony there were leaks as well. i was wondering if the two of you could just comment on do you know how those leaks occurred? were you promised confidentiality? >> yes, senator mccain's office submitted my complaint. the local oig didn't do very good investigations and the second was that my name be kept confidential. i don't know who liked my name, i know it was leaked. i don't even know if there's any consequence to whomever leaked my name. the second thing is i don't even know if the oig actually investigated. what happened was there is no official report although certainly the website, the oig has complete discretion as to which reports it puts on the

website. anecdotally i've been told those unfavorable to s.e.s. do not go on there. i have no idea what occurred. i can't even get a report of it. >> have you tried to find out though? >> i had senator mccain's office checking and they're stonewalling him. >> thank you. mr. davis? >> i can tell you that as late as about 4:30 p.m. this evening i was informed by my union president that stephanie martin said that miss williams, the person who said she was responding on behalf of secretary gibson and mr. neighbors, was not officially authorized to speak on their behalf. what she didn't provide, which would probably be more important, is who told her in the first place. and i think that's the problem with va. a complete lack of accountability.

and when people know that they can engage in belaf i don't remember without consequences, something's got to change. >> thank you. dr. head, i represent ventura county in california so my veterans use your facility in west los angeles so i'm wondering after being here this evening with us what it's going to be like for you when you return back to west l.a. what will the environment be? >> i'm not sure. i do fear retaliation, but i also know this is the right thing to do. more importantly, i think my veterans that i care for support me. >> and do you believe by virtue of what you have been through and now being here, do you think that that has -- and everything that has happened and what we have learned about what is going on in the va across the country, i mean, do you feel a difference when you go back to west los

angeles than did you a few months ago? >> well, i think more importantly i have enlightened congress and they have an opportunity to look very factual. all i ask is that you look at the facts and unveil the facts and i think that in itself will be helpful. as far as going back to my job, i can afford not to work, but i want to work and i want to serve the veterans. when i first came, dr. mitchell and i were chatting and we both -- we both want to retire within the va administration. >> yeah. i think i'm just trying to drill down a little bit to see if there's 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 is, you know, changing culture is really a hard thing to do, but i'm just do you remember ewes to know if there's been -- you know, do you

feel a shift? >> i think there's been awareness. they're very much aware that i was coming here tonight and i think they're very much aware that i will stand up for myself and the veterans, that i will not cower down. i'm human. i have my frailities and this is wearing on me. i wish i could go to work and dedicate all my energy caring for veterans and to make processes that will improve the care of veterans but instead the reality is i do worry about retaliation on a daily basis. i'm always looking over my shoulder. i'm always wondering about, you know, peer reviews. fortunately i'm head of peer reviews so i've been immune to some of those retaliatory efforts. i am worried. i'm tired. if you could do one thing for me tonight, you would relieve the obstructions of this retaliation and allow me to serve the veterans and allow me to work without the fear of retaliation.

that would be a great gift. >> thank you, dr. head. again, thank you be to all of you and my time is up. and i yield back. >> thank you. dr. row, you're recognized for five minutes. >> thank you, mr. chairman. dr. matthews, i was a young doctor once and i remember returning from southeast asia and i was full of vim and vigor. i was stationed at fort eustis virginia. there were 2,000 women that needed pap smears. i was going to solve that. when i left there were 2,000 people that needed pap smears. i ran into inertia. i admire what you did. you touched on two important things. you all have hit the nail on the head. it's the back log which we can easily take care of. we can do that. number two, changing the culture of the va is going to be much more difficult. that's much more critical downstream years from now but what you did when you got to the va in psychiatry, you recognized a problem.

you saw long wait times for patients. you wanted to make sure those patients in need got there. i have seen those patients in my office. two, you said, how much work are we actually doing? and when you evaluated it you found out that your colleagues were seeing basically six patients a day. there's no private practice doing anything that can stay afloat seeing six patients a day. you wanted to increase pro duct difficult and shorten the wait times. what i found astonishing, 60% of our veterans who sought out care, these are folks with ptsd that desperately need this care, we know there's a shortage of your specialty in the va and the country wouldn't come back. i found that absolutely amazing to me that they found the environment so unhospitable to them that they refused to come back. then very simply how we're all being evaluated.

were you satisfied with your visit? a very fair question. you hit the nail right 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 who didn't seem to have your interests at heart. i want to ask all of you, dr. head and dr. mitchell, too, just very briefly, how does retaliation within the va affect patient care? i think we all know that because if you're retaliated against you go back to the six patients a day, 60% of those veterans that need care and you'd get them, am i right? >> that's unfortunately the case. being in compensation and pension evaluation, i know one veteran who committed suicide while waiting for the call back to get care. so, you know, it unfortunately went back to where it was. we really don't have a real veteran time satisfaction

metric. i think that's very important. we do not really know other than the surveys which are incomplete and which are administered not correctly. you know, mostly the clinic itself hands out new service to the veterans to hand out and they collect it. although you tell them it's confidential, i don't think anyone -- >> i think you could take what you did and go across primary care and find out the staffing need, do we need more people to work or do we need to be more efficient at work while we're there? i want to ask mr. davis a question. it dawned on me a minute ago. what happened to the 40,000 veterans that were cued am? what happened tow them? >> well, the 40,000 veterans that were discovered, they were eventually processed. i think here lies the problem of the callous and carelessness of va management. that goes to my point of making them pay for it. the problems with the cue as it was referred to could have been addressed. again, va was paying for them to

institute a new work flow management system. it wasn't resolved or addressed until after the 40,000. now what's interesting, i'll give you the example of the lax si days sick call attitude. the report i read in 2013, it talks about the back log. it talks about the slow processing of online applications. you're a physician. can you imagine writing it at your house, drive to a va medical facility. wait in line, turn it in, wait for them to process it is actually faster in 2014 than the online process? if this was a private corporation, we'd be run out of town. now let's put that in the context. i have submitted to the committee a document, a fact finding report, a marketing contract. waste and mismanagement.

it addresses the issue that the contract was so poorly mismanaged that the $5 million contract would not withstand scrutiny if it was subject to a third party audit. i ask you to look at this in the process of the enrollment system, in the context of the work flow management contract, about $2 million. it's the same sort of reckless attitude. they don't assume responsibility for their actions when it comes to retaliation and they don't assume responsibility for their actions when it comes with wasting the resources given to them to provide services to veterans. >> i want one other thing. it's a statement, not an answer. in our briefing today it said officially the st. louis va medical center is reporting to va central office that its productivity was among the highest in the nation. when that sort of thing happens, how in the world can we believe anything that's in front of this committee? i get asked at home why do you know about this? i say we get this kind of information. how would we know about it? when the people give this information, they're not giving us factual information.

thank you, mr. chairman. i yield back. >> thank you, very much. ms. kirkpatrick, you're recognized for five minutes. >> thank you, mr. chairman. i'd like to start by thanking our whistle blowers for having the courage to come forward when you witnessed wrongdoing. i would particularly like to recognize dr. kathryn mitchell. i asked you to come and testify before our committee. i know that you've risked your career to report wrongdoing and suffered repeated retaliation from administrators who refuse to do the right thing so thank you. by bravely stepping forward dr. mitchell and dr. foote made congress, the i.g. and others aware of the problem in the va. unfortunately, without whistle blowers we were unable to identify many of the problems in the va. because of whistle blowers, we

can now work to fix them. it is unacceptable and reprehensible that almost half of the office of special counsel's whistle-blower retaliation cases involve the va. the 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 of their rights as whistle-blowers. however, it is not enough that employees are informed of their rights. the va must still develop a culture of zero tolerance for whistle-blower retaliation at all levels of its organization. employees should not be afraid of losing their jobs or ruining their careers for speaking up when something is wrong. patients should not be afraid that they will be denied care because they think something is wrong. the va must stop using the

harmless error defense to downplay wrongdoing. this finding by the va office of the medical inspector in most cases was baseless and an excuse for administrators to do nothing but patients were put at risk. this is why i'm introducing a bill this week to give further productions to va whistle-blowers. employees and patients should be able to report wrongdoing directly to the office of the va's secretary so they do not have to face retaliation from the same administrators that refused to act. the office will investigate complaints of whistle-blower retaliation and ensure that whistle-blowers' rights are protected. while all va employees should work to serve veterans, the sad reality is that the va has a corrosive culture and a history of retaliating those who speak to break the code of silence. until the va is able to instill

transparency throughout its ranks and develop a culture focused on caring for veterans, i believe additional protections for va whistle-blowers are necessary. my question is for all of our witnesses, if you could name one thing that the va could do immediately to change its culture of silencing whistle-blowers, what would it be, and start with you, dr. mathews? >> if i had one wish, that would be that data integrity is there. we have demonstrated over and over again that they will make up numbers, they will come up with blatant lies, like dr. mitchell said, i'll paraphrase the great person from missouri, mark twain, lies and statistics. so that would be my one wish, to have meaningful metrics that are transparent and accurate and are vouched for by another organization, perhaps a major

university that has a higher degree of integrity and people who are found cooking these numbers are punished because it has real life consequences for veterans. these are not just some game that they are playing. people -- >> not to cut you off but i want to hear -- i'm sorry to run out of my fine. i have about 45 seconds. >> i believe accountability. when people or supervisor knowingly have done something wrong but they're allowed to maintain a position, sometimes even get raises and bonuses, that should be unacceptable. you're sending a signal throughout the entire va that -- >> thank you. i'm sorry, i'm going to go quickly to dr. mitchell and then mr. davis. >> i think most whistle-blowers want to make sure that they're willing to put their careers on the line but they want to make sure if there is retaliation it will be investigated immediately. right now they sent out the memo that said all the places you

could go if you felt you were being retaliated against. those haven't worked in the 16 years i have been there. no one i know of thinks they'll work and they're waiting to see what will happen. >> mr. davis -- thank you. mr. davis? >> i think the body that's going to be responsible for enforcing whistle-blower protection and va cannot be a part of va. i can tell you that whistle-blowers who shared information with me to take to the committee are scared to cooperate with the oig. >> thank you all. i have run out of my time, but thank you all very much. thank you, mr. chairman, for the extra time. >> thank you. mr. flores, you're recognized for five minutes. >> i thank each of you for your service to our veterans, also for our courage in joining us here tonight to share your stories. dr. mitchell, as you know, the va has had several internal investigations now. we've had reviews by the medical inspector. we've had oig inspections or reviews. we've actually had a couple high profile resignations.

so in response to that the va has begun to make some changes and take some actions to try to deal with the news that's come out. my question is this, based on what you have seen so far, will any of the changes and activities that the va has been involved in the last three or four weeks really make a measurable difference in the care for our veterans? >> no. right now what's happening is that although they've checked into -- looked into the appointment scheduling, nothing has changed for me. the chain of command that refused to investigate nursing retaliation is still in place. the chain of command that authorized a written counseling for violating a policy and then said they don't have to tell me what policy i violated is still in place. the chain of command that interpreted the 247 federal contract to mean that i could be forced to work unlimited scheduled shifts for two years without any compensation is still intact. you've only addressed the scheduling issue. you certainly haven't addressed what's happening when you bring all those vets in and you've

already got your physicians overloaded. >> okay. that's the answer i was afraid i was going to get. dr. head, i think you passed over something pretty quickly in your testimony. you said your pay was stopped for a while. did you say that? >> yes. >> were you ever told why it was stopped? was it blamed on administrative error for what? >> i was accused of time card fra fraud, and they said they weren't going to pay me. and when i obtained an attorney and showed proof of my presence, they paid me, but it took a number of months to do that, and, you know, i interpreted that as clear retaliation. it was a very painful time when that occurred, and they really gave me no clear explanation. >> that's truly amazing that the

federal government would do something like that. mr. ri chamichaud asked a quest about legislative fixes. is there any legislation we can do to fix the culture at the va? i think what each of you said clearly in your testimony, we have a real cultural issue -- >> i think there has to be some fear of accountability. currently evidently certain individuals feel they can act with impunity, that either the system is too slow to respond or maybe it never responds, but they fear they can engage in these activities and know that they have government attorneys to represent them on the taxpayers' dollar to protect them in these little fights, and sometimes they know they're

absolutely wrong and they have a protracted battle on purpose because they know most individuals can't withstand that type of punishment. >> i see. and, mr. davis, anything you could add to that? >> i would echo what i said earlier. you have to spread the accountability. it's one thing to have a va manager go through an initial lawsuit or some sort of claim of retaliation and be represented by an attorney. but when you see a pattern behaving just as when we look at people's time cards, if you see people constantly taking friday off, you know something is probably wrong. if you see the same va manager constantly being represented by the general counsel's office, then at some point you need to less that 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. so if the va official continues to put the agency at risk of litigation and liability, then the coverage should lapse as well in that situation. >> dr. mitchell?

>> i would agree with the others on the panel in the interest of time. >> and dr. mathews, you can go until the light turns red. >> okay. i'll be more mindful. if i had two wishes, the first would be that the data integrity should be there because once the data is transparent and accurate, i think, you know, our lawmakers can act on it, the veteran service organizations can act on it, the newspapers can report on it. now, if they just cook up data, there's no way to even find out that there is a problem so that would be number one. and the second thing -- and at least for a short while to take away that responsibility away from the va of managing the data and the second is i agree with everybody else about accountability and not having lifetime tenured positions. >> thank you, dr. mathews. i yield back, mr. chairman. >> thank you. >> thank you, mr. chairman. thank you all for being here. i'm an emergency medicine physician and often times we're put in a position where we are

the last stop for our patients. the gatekeepers and also in the front lines and taking care of our patients, and i understand that we have to sometimes fight the system very hard in order to do what's right for our patients because if not us, then who? and i appreciate all of your efforts in advocating for your patients despite the consequences and the risks that you put on yourselves regardless of your specialty or of your responsibilities in the hospital, and that's admirable and that's what i refer to as a high quality veteran centered culture of responsibility and accountability in our va system that we need to transform into. we're not there yet, and we need to make sure that we apply the mechanisms, the processes, and the evaluations within the system that will lead to a veteran centered institution. now, having said that, in the

private sector and in our training as physicians, there's a form of ceremony that we do that ensures that we address these atrocities, and that's the m&m rounds, morbidity and mortality rounds. do you have those, dr. head and dr. mitchell? >> not for the emergency room. i know that they exist in surgery service. >> do you have one, dr. head? >> yes, we do. it's more traditionally in surgery, but we have an equivalent for internal medicine also for emergency. >> i think all specialties should have them, emergency medicine practices throughout the country also have them where they review things that went wrong, mortalities, people that have died and what were the causes of those. do you have the coo of the hospital or administrator sitting in to listen in to determine if there was any lapses of any systematic

failures that led to those problems? dr. head? >> traditionally there are several layers. we have a risk management committee, then it's presented to risk management. i often will hear things either through the tort process or a week or two after it's been presented, and then egregious activities presented by our chief of staff directly to the ceo. >> there should definitely be metrics based on those morbidity and mortality results and classifications to determine if it was a staffing issue, medical error, any lapse of processes or following an integrity in practice, et cetera. that will give information on what needs to be happen and that will be directly linked to the coos and the administrator's ability to make changes as necessary. the other way to ensure an open

way to evaluate certain practices so we don't have to rely on whistle-blowers are through chart reviews and spontaneous or random audits. do any of that exist in your practices? >> there were -- i was the person that would look at the issue that is would come up because the physicians would give me all their cases. i asked them to do that so i would be the only one that would be retaliated against by the nursing staff. i do know there is a process of looking at suicides in our facility, but the chain of command over that area refuses to release that information. that was not even available to the suicide prevention team members when i asked them. >> and the m&m process is only as strong as the people who self-report those issues. if there is a complication that's not reported, it can become invisible. and the other thing, too, is another strong part of our component of our institution's root cause analysis, but that's only as strong as the ability to

actually report an incident. if an incident is not reported, then it can go invisible, and usually i will catch it later, several years down the road when it's coming to the tail end of the tort process. it's too late at that point. >> yeah. i agree, and i think that mortality is very evident when somebody dies, that should be investigated and determined if there was any wrong during that care for that veteran. i believe that part of the solution, i'm very encouraged on miss kirkpatricks efforts and advocacy with the phoenix va and i appreciate her leadership, and i believe that the idea of taking the responsibility away from those that will have to do self-evaluations, from those supervisors and placing it in another location that has more of the advocacy role is a very good idea. with that i yield back my time. >> thank you very much, doctor.

mr. runyan, you're recognized for five years. >> thank you, mr. chairman, and thank you all for your courage to come out and stand up for our veterans. mr. davis, i want to put this out there because i know dr. rue wiz just talked about it and miss kirkpatrick had ran out of time. a statement you made earlier, can the va police itself and if not, who? >> thank you. i don't think va can police itself. it's kind of like a scholarly journal. you don't peer review yourself. i would look at maybe an organization like the government accountability office, maybe finding -- setting up some sort of oversight panel of health care professionals. one of the things i will tell you that va employees talk about is during the financial crisis, there was talk about bringing people like elizabeth warren. during the talk about national security issues, they talked about bringing back dr. gates. when we had the crisis in va, we were sent the deputy chief of

staff, and it's no disrespect to mr. nabors, but where is the medical leader that's going to come rescue health issues at the nation's largest health organization and i think that's the issue. it goes to the issue of how people look at va. one of the reasons why i reached out to the white house was because i was trying to find the person who could answer questions and resolve this issue. we have almost a czar for almost everything you can imagine in this town, but not one for veterans, and i think that's the issue. there has to be an outside source to say, mr. chairman, members of congress, mr. speaker, mr. president, i have noticed this information, this information came to me. it's not going to work. in terms of the context of giving the secretary the right to fire people, in november 2013 a memo was released by the assistant secretary for human resources stating that employees were not to go to the

secretary's office about complaints because it obstructs the final decision of disputes, but he still will accept confidential e-mails. well, if that's the approach they take, even if we change the law, we still would not get the information to the right people to hold the 400 and something odd people accountable. there has to be some change in the law to allow outside institutions to become the policing organization over va. it's simply not going to come from within. >> which kind of leads to my next question, and i'll ask mr. davis first and if there's any time left i'll ask dr. mathews to follow up because dr. mathews said in one of his statements that he doesn't necessarily know it gets above the st. louis regional into maybe the central office. can you shed some light on that? >> i can shed light on that. i will tell you the only reason why my case got to where it was is because i didn't go through the elongated grievance process

because that's a way of trapping the employee and constantly filing complaint, filing complaint, appeal process after appeal process. what i decided to do was to go to the person at the top, the principal executive in our organization, and i sent the information to him. when that didn't work, i sent it directly to the secretary. when that didn't work, i went to my congressman. so i think we have to put something in place which would allow va employees to fast track the grievance process, and it depends on the variation. if it's something, me and my supervisor doesn't get along, that can go through a normal process. if it's about lost applications for people who have served in iraq and afghanistan, that needs to be fast tracked. in miss hughes' case when she was conducting the investigation of the 2,000 missing applications, once the director said stop, there was no recourse for her. so i think we've got to find something to put in place to allow these complaints to kind of go to the forefront based upon the severity and the

critical nature that they represent. >> and with my remaining time, dr. mathews, you made the statement. do you have a sense of central office sees this is an issue? because it seems like there's a disconnect. >> well, there is a disconnect, and, you know, i really don't believe any of the data that the va puts out, unfortunately, and, you know, we have to have data integrity and we're basically talking about ways to make that happen, and at least at this time maybe for a temporary period of time we need to have an external agency that has highhigh er integrity than the va looking into the complaints and triaging what can happen first and what can wait. unfortunately, the va has demonstrated over and over again that they're not able to police themselves. they're not able to come up with honest negative information, and it, again, is not an academic

exercise. it really hurts the lives of our veterans. >> thank you. chairman, i yield back. >> thank you. miss kuster, you're recognized for five minutes. >> thank you, mr. chair, and thank you to all of you in your courage to coming forward. we appreciate it and we understand the risk you're taking, and just know that we're your witness if there is anything that happens to you, please be in touch with our offices. i would like to follow up on dr. ruiz's questions to dr. head and dr. mitchell. in the private sector in the health care field we have a process of quality assurance that sounds like maybe what you're doing in your root cause analysis, but to get at the issues that impact patient safety and the safety of veterans, but also some of the staffing issues, dr. mitchell, that you raised in your testimony. is there any type of process

within the va for sharing best practices or for determining what are effective mechanisms, the types of problems you're describing we perhaps are fortunate not to have. i've toured our va facilities in manchester, new hampshire, and white river juncture, vermont, and found very high level of competence and access and quality of care, so i'm wondering what is the practice of sharing best practices and how would you go about improving upon that? >> well, in 2012, november of 2012, i noticed a spike, an increased number of veterans who were presented with advanced cancer, and once i did a little research, i found they were in the system, but for whatever reason they weren't either receiving a screen, like a

colonoscopy, or there wasn't really follow-up, and that troubled me. so i sent the e-mail to the director at 1:30 in the morning saying we should follow the practices that are well established in the community and the standard of care within the national institute of health and it's around 50 pages. there are flow diagrams, standard operating procedures to make it idiot proof that when you have certain patients that come in that you have guidelines of when the patient should be screened, when they should receive treatment, if they have cancer, they need to be presented a multidisciplinary team so we can expedite therapy. most therapy of multimodality, chemotherapy, radiation therapy, surgery, if possible. for whatever reason this was not happening in the number of patients i saw, and so i encouraged us to adopt some of those things. >> did you have any success with that? >> well, i had some success, but

i think one veteran who is in the system who doesn't receive the screenings necessary is too many, in my opinion. so i thought we should have more -- those type of ideas should always be flowing within the va to have procedures so we don't miss the veterans. so veteran should be left behind. >> and is there any process for quality improvement? is there any -- do you have any procedures or protocols within the va system that you could bring forward these types of standards and procedures? >> that's what i'd like to do, but, you know -- >> apparently that does not exist. >> -- i can't do it because of the other activities i have had to be involved in. >> dr. mitchell, have you had any experience with this? >> there is a whole quality assurance division in our va, and certainly i was on an e-mail group for er physicians, the directors, and we shared ideas. the problem is what we need is a

best practice of how to overcome bad management because we all knew what -- we were all suffering from short staffing. we're all suffering from other issues, problems with nurse triage, other things. we just couldn't get anyone in our facility to listen to us that had the power to make the change. >> and with the short staffing, were you told that that was a fiscal issue, that you couldn't hire people, or is it an issue of timing in terms of getting professionals credentialed? >> the reason varies depending on the week. it can be because we're short, there's a hiring freeze, it can be because there's not enough good applicants. a lot of time there's fantastic applicants but the process of credentialing them takes eight or nine months in which case they've already found another job. >> just briefly and i have very little time left but i want to say, dr. head, having reviewed your testimony and the various

lawsuits and i'm extremely concerned about the issue of racial bias in your record, and i just want to commend you on your courage and your professionalism and admire the strength that it takes for you to just get up and go to work every single day. so thank you for coming here today. appreciate it. >> that's quite a compliment. thank you very much. >> thank you, mr. chair. >> thank you. dr. benishek, you're recognized for five minutes. >> thank you, mr. chairman. i want to thank you all for your very, very powerful testimony that you presented here today. you know, i was a va doctor for a long time myself, and, you know, i really feel there's a great deal of difficulty in communicating with leadership, and i think dr. mitchell, you sort of mentioned it, too. when you find problems in the va as a physician, you try to tell somebody up the ladder what the problem is in order to improve care, there's no one that seems to be able to get something

done. i mean, you talk to your chief of surgery or the chief of psychiat psychiatry, the chief of the er, and then you talk to the chief of staff. is the chief of staff usually an advocate for the physician or are they an advocate for the administration or who do you go to then? my concern is that physicians don't have enough access to management to make changes that they recognize need to be done. can you -- how can we do that better? let me ask all of you how to do that. dr. mathews, why don't you start. >> in my particular case, you know, i was the chief of psychiatry and i was going to the chief of staff, and it seems like, you know, these things don't register. like you said. it's not given the right urgency or the right priority. >> does the chief of staff have somebody that they can talk to

up higher on the list? that seems to be the place it seems to stop from my experience working there. >> yeah. >> is that the problem do you think? >> well, you know, i really do not know what the chief -- >> dr. head, what's your opinion about that? >> well, you know, one person's chief of staff came to my defense and this person was severely punished and pushed out. so i do think there are good people on chief of staff. in our hospital, we have one of the largest vas in the country, there's close to 12 chief of staff members. you know, some of them know that retaliation is a problem. >> right. >> and others are part of it. >> dr. mitchell, what do you think about that? >> my experience with chief of staff, and we certainly run through several at the phoenix va, a generally they advocate for themselves. we have the option of going above, but often they 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 that have gotten memos of understandings to stop the overload of physician panels and that but the physicians have to organize themselves however they want to approach that. the problem is everyone is too afraid to do anything because the risk of retaliation is so real and that's the loss of your livelihood at best. at worst it's the loss of your career and your ability to be employed anywhere within the vicinity of that va. >> can you tell me more about this sham peer review thing? >> normally a legitimate peer review is where someone has questioned the ability of a physician to meet -- >> i'm familiar with an m&m. that's where we would typically do that in my hospital setting. >> it's more than just an m&m. this is someone who has -- everyone can make a mistake and

things can be overlooked. a peer review is where you are so afraid this person is not practicing up to the standard of care that you pull a large section of cases and have his peers review them to see if there are truly significant deficits in 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 physician is not up to standard as far as practice. sham peer review is where you have the ability to call a review, a major review of a physician's cases. if you can't find anything that they've done wrong that's significant, then what you can do is put kind of subjective findings, well, this physician, you know, doesn't necessarily practice with the most professional ability to interact with people or something very vague, very subjective. what happens is that in the medical community, peer reviews are only done if there are huge red flags. that's the reason why it's important that if you are ever the subject of a peer review, tough report it on a license or

a job application. most people that don't work in the va don't realize peer reviews are done as punitive actions in the va in order to sabotage a physician's credibility. it's also incredibly demeaning and debasing for a physician to go through a peer review practice because they are practicing professionally. psychologically it's so stressful, most physicians would quit. >> but it's done by other physicians. >> usually it's the administrator and friends of the administrator. >> there's not a fashion you're saying? >> no, it's physicians. just because someone has an m.d. doesn't mean they have ethics. >> i guess i'm out of time. >> thank you, doctor. mr. walz, you're recognized for five minutes. >> thank you, mr. chairman. again, i will associate myself with my colleagues. thank you all for the work

you're doing because you understand that the corrosive nature of this is not just the personal damage that's done to you but as each of you have so clearly stated and eloquently and with passion have stated, it hurts our veterans. that's at stake here, too. mr. davis you summed up what i have been beating this drum for years. there is no national veterans strategy. when ski them, they give me a goal they're going to get there, there's no strategy to get there. it doesn't stris me when you call the white house they don't know who to send. i have been questioning for a vets review like we do in dod so we can have a strategy, resource it correctly, and have the things to place to make the corrections but that is lacking. i would go further on this and i could tell each of you that we're coming to this how do we get this. i'm with dr. mathews. i am not putting my veterans health care or the reputation on the data i receive. when people ask me how are the local facilities doing? i'm worried to tell them. i said, well, the data they've

given us is showing this. i'm somebody who has been here and here we sit, and my colleagues will tell you this, months ago we got flagged after the audit, and we had some of our facilities flagged, and they sat right there and those of you sitting in the va behind there, you can be sure we want an answer and we'll ask you again tonight whether it's your field or not, why don't we know what happened at rochester? why is it flagged? why is it flagged? can somebody speak to that? can somebody say? tonight we get general counsel. they all blamed you in all the other hearings. now you get the answer tonight but i would suggest this and not to point at you because i know the good work that's going on. i would submit to all of us here the watch dog on this and the outside agency to look at this is here, is us. we're give the constitutional right to do it. when i go home, i'm asked about this, and i should be held accountable of where this is asking but we don't know where to get it and i would suggest that this committee is the most nonpartisan in many cases.

the staff that sits up here, i can go to either one, the majority or minority, and get answers to fix problems for veterans because that's what they do but it has been historically understaffed. i would like to send this staff out there to tell me what's happening in st. louis, what's happening in los angeles so i get it from the horse's mouth. right now i can't trust the data. that's my soapbox to each of you. we all feel very strongly but we have to come up with a solution. we have to have an accountability. we have the constitutional power. we need to get some authority to be able to do it. we have to add to these good staffers up here so they can get out there and ask the questions and start doing this, and i would suggest or put forward to each of you, maybe i'm a little pollyanna-ish but it's beyond the pale. i'm a high school teacher. this is bullying. you talk about horizontal violence. there's been a lot of research done on this. increased turnover, lost productivity, loss of motivation, lots of lateral transfers, lawsuits, and adverse

impact on patient's customer satisfaction. we know all that, that research is out there. the question i have is we can say it's the va, go down this never happened in the private sector, it happens in the private sector too. it's about people and accountability. what we need to figure out, national strategy, put in place the accountability pieces, have the elected people who get here by the public's will who want to get this right and then have the resources and the power to make sure it happens because there's wonderful people. you work with them every day, providing great care. one question to you, dr. mitchell. you said over 16 years the care has improved at phoenix. the care of veterans. how do you simultaneously improve care while this corrosive culture has existed. is that just the quality of the people coming there to work? >> you have an incredible force to change in your employees. the majority of employees are veterans themselves, family members of veterans. they give incredibly good care. so despite the fact there's a knot in their stomach when they try to get in their car to go to work, despite the fact they know

their supervisors are going to harass them -- >> so that's really happening. when somebody says the care at the va, once you get in -- i would ask each of you have been in different va hospitals? does minneapolis look like l.a.? >> i have only been in phoenix and we give tons of really good care. the problem is with health care needs, when you ignore them, a veteran falls through the cracks and that has devastating consequences to their health. we're focusing on the hundreds of thousands of cases where there's been bad care given. we shouldn't lose sight of the fact we've given millions of instances of quality care and that's the reason the va's worth saving. >> our young graduates of our medical institutions, will they still choose to continue to go to the va and give careers ? my fear is we make it so unattractive, so poison that we can't. >> i wouldn't recommend in the current state that people get a

job at the va as a physician physical there's some guarantee that whistle-blower retaliation will be protected, that the pay will be commensurate with what's in the community, that there's a professional work environment. everyone just -- i'm really proud to be a va -- >> that's a nightmare scenario because we know what the numbers look like. we know the care our veterans are going to need and we have to get this figured out. i yed back. thank you, chairman. >> mr. huelskamp, you're recognized for five minutes. >> thank you, mr. chairman. i appreciate the witnesses coming and visiting with us tonight and sharing your story and i'm particularly troubled by the last comment, the suggestion, recommendation that folks look for employment elsewhere until these problems are fixed, dr. mitchell. one thing i would ask for each of you, each named senior staff who ignored your pleas, violated your confidentiality, knowingly injured veterans or placed them at risk. do you know if any of these have been punished or censored by the

va? start with you. >> no, i do not know, and, you know, with the whistle-blower retaliation and cooking up numbers, it's basically sending all the wrong messages that it doesn't matter, care is optional. we'll protect you, we'll come up with the numbers. it's so corrosive and going back to the point of mr. walz, i started washington university residents rotating through the va, and i had one resident who was very good who wanted to join who did not and i had two other people i knew in the community who were excellent psychiatrists trained at very good places, and they came and interviewed but, you know, they couldn't. they didn't want to work in these situations where they were wanting to join because i wanted to build a good mental health clinic there. and then it's inconceivable they just removed me from that position. so this is a very corrosive -- it's very demoralizing. a lot of the ethical people who

work there as well because they see either they have to leave or they have to just keep quiet and suffocate it internally. there are no other choices there. >> so there's no doubt in your mind other employees see the mistreatment, the violations, and see your treatment and choose to remain silent. >> i absolutely know that for a fact that that's the case. >> what would you recommend, and all members of the committee have probably heard from constituents since this scandal really broke open and the committee has been looking at this for a number of years, but what would you recommend to whistle-blowers that have knowledge, have this concern that share your doubts about how they will be treated? what should they do? who should they turn to? i have had three to four whistle-blowers that showed up unannounced to a surprise visit for a facility. somehow was able to get in and started to uncover things but what do i tell whistle-blowers when they say congressman, this is what we've seen happen, but

we're not going to tell you our name because we're afraid we're going to lose our job? what should i tell them? >> at this point you could give them my name and i'm report it since i've already got a target on my back. it doesn't matter. actually, that's what's happening. i have had multiple phone calls from physicians from vas across the country. there's a va facility that's bed sore free not because they don't have bed sores but because the physicians and the nurses were forbidden to document bed sores. there's several -- there are many, many, many issues. i have certainly contacted jeff miller -- representative miller's office and gotten a phone number of someone who said they would maintain the confidentiality and investigate, and at this point i would tell whistle-blowers to go to the congressman or see mr. miller, and that's a problem above my pay grade. >> yeah, and that's what's happening in our office. mr. davis? >> i would say i have hadself whistle-blowers come to me directly and i have shared their testimony with the committee and i have actually read some of

their statements into the record. and i, too, would say those i know are familiar with the administrative process side of the house, i would be more than happy to touk their complaint to the public. that's our ability to do what they can. my background is communications so i was able to navigate through the press process a little quicker than most whistle-blowers. and i think that's the key thing. it doesn't take everyone to do the same thing. some people may be comfortable at just going to the ig. some may be comfortable going to their representative or senator. some may be comfortable going to the press. but there's different levels of whistle blowing. you don't have to go as far as we did. i think we're something -- in some cases the exception, but i think there are different ways you can get the information out, and there are different people who want to report. there are interest groups, civil groups, there are veteran service organizations who would be more than happy to get the information. they have direct connection with many of the leaders in congress. there are different ways you can get the information out but i will tell you this, you feel much better when you say

something versus holding it in. >> and i have no doubt there are va employees that are as concerned as you are listening tonight or seeing the comments and i might add they're probably -- there's folks out there probably tearing all four of you down for having the courage and bravery to show up. but recognize if you're listening, step forward, and my office will be there to carry that water for brave employees like yourself. so i appreciate your commitment, mr. chairman -- >> i want to make a clarification. even though i said i would not recommend getting a job at the va, i actually am not looking for a job elsewhere. the va is really important work. i would tell those people they would be working with great people, but they have to have a true understanding of the administrative culture and where it stands today and then make the decision. >> dr. mitchell, there is no doubt in my mind your commitment to our veterans, so thank you. and mr. chairman, i yield back. >> mr. o'rourke, you're recognized for five minutes. >> thank you, mr. chairman. to follow up on mr. huelskamp's statement, dr. mitchell, i

couldn't help wondering during your testimony and in the answer to many of the questions that were asked of you as you detailed the ostracism that you endured, being shunted aside when you made problems for management, ending up in a position now where you say you're doing good but it wasn't the position you signed up for, and then i know you just clarified it but earlier saying you would recommend to somebody who is thinking about working for the va not now, not until we get accountability and oversight and protection for whistle-blowers, i couldn't help wondering why you stayed. >> i stayed for a couple reasons. one, the work is incredibly fulfilling and important. i went back to medical school specifically to be a va physician because i saw there was a great need. everyone who works at the va knows there are limitations. we're a federal department. there are limitations. the veterans are so grateful for the quality of care. you will see such a wide variety

of people at the va and certainly disease states from a physician standpoint it's interesting. my background is geriatrics. it was a playing field for geriatric. er was geriatric urgent medicine at its best. it's very interesting, very fulfilling. i don't always feel so resilient though as a physician there. i'm definitely tenacious. i will give myself that, but sometimes it's really hard. there is that knot in the center of your stomach driving in where you just don't want to show up because as much as you love the veterans the administration wears you down, and you begin to doubt your own professional abilities. >> just from your answer to my question and what you said earlier and really for everyone on the panel, i mean, we keep asking about culture which is the most important issue, but probably the most difficult task before us as a country in terms of turning around the va, but you really represent the culture i think we're looking for and

that we want to see throughout the system, not just at the provider level, at management, at the secretary level, on through this committee and, again, as a country. so i want to thank you for that and thank you for the example that you provide. but i also want to follow up on another comment you made. you mentioned surviving 16 years of this and these problems didn't just occur, you know, under this administration or the administration prior to that, but they're long standing, and i remember, i have been here for a year and a half, and one of the first hearings i attended was a joint hearing with the senate va committee where we heard from the veterans service organizations, and i remember a commander coming before us and saying, you know, this is my -- i don't know what the exact number was. this is the 32nd time i have appeared here. i have been coming up for decades and i have been saying the same things over and over again. so you said this is a system

worth saving, but my question to you is, is it salvageable? >> oh, yes. you have got thousands and thousands of employees that are dedicated to the veterans and the welfare of the veterans. i am really discouraged when i hear people say that va is too big to change. you have an entire group of people that are ready for a revolution, and they want this. they want a productive health care system delivering good care. the horizontal violence has to stop. that was one of the implications of whistle-blower retaliation is that it affects care because you don't speak up to say what the problems are because you're afraid of the repercussions. the corollary to that is -- it's a pressure cooker. you begin to pick on each other, gossiping, bullying, exclusive cliques at work. we kind of feed on each other because we don't know -- we're under so much pressure and that needs to stop, too. >> yeah. i wanted to, and you all -- each

of you have given us some ideas and direction on how we can make those changes but i do wonder how we're going to be able to do it after so many years and so many fundamental systemic problems. dr. mathews brings up the issue of not being able to trust the integrity of the data which has become obvious to all of us. i commend your efforts to measure those things that are important to patient care and outcomes at the facility in which you work. in el paso we have seen similar attrition rates of over 40% of veterans seeking mental health who can't get an appointment just give up and stop trying. we can only right now because we don't have the full story wonder at the outcomes. mr. flores and i and mr. jolly and others on the committee introduced the ask veterans act which would not rely on the va to tell us how the va is doing but ask veterans to do what you were trying to measure in your facility. so let me just conclude by thanking you all for what you're doing. i hope the recommendations you

gave us lead to some of the cultural changes we know are essential to turning the va around. so thank you. mr. chair, i yield back. >> thank you, sir. mr. coffman, you're recognized for five minutes. >> thank you for stepping forward as wrihistle-blowers. i believe the rank and file are employees that truly care about serving the needs of our nation's veterans and without the whistle-blowers such as yourself who have had the courage to step forward, we would never know the problems that exist within the veterans administration because none of the problems have ever been identified -- self-identified by the leadership within the veterans administration. they have always been -- we've always been aware of them simply by whistle-blowers coming forward and sharing with us the reality of what is occurring on the ground within the veterans

administration, particularly the veterans health administration. mr. davis, one thing i think when we became aware of -- started becoming aware of the magnitude of the crisis, it was concerning the patient wait times, and the fraudulent changes in terms of those records often fueled by a drive for bonuses. but what you're saying is actually the problem was much deeper than simply patient wait types, that they were also denying people inside the system. is that correct? >> they were actually -- >> to get in the system. >> they were neglecting the applications, and i think that is where i think we have to look at, you can only get the appointment if you're enrolled. >> okay. >> and so we have systemic problems in the enrollment system, and to give you some context, you may hear this from the next panel, the office where

i work, the health eligibility center, is about to start what they're calling a command center. this is something that they're going to probably send to va leadership, perhaps even this committee. but i want you to understand that real change will only come from real solutions at va. currently this is part of what i call the gimmicks that go on at va. we announce something, give it a new name and we send it out making the public and the leadership on the hill think there's a change but i will tell you when you look at this document, the communication training people perform communication training every day. that's not anything new. the enrollment people perform the enrollment tasks, the call center people perform the call center tasks. this is not going to change anything. the strategy is to take people from the fifth floor and put them in a room on the second floor. this is what constitutes responding to veteran concerns at va, and so i think what has to happen, what i would encourage the committee to do is follow something i do think works in business and that is make people sign off on the reports they turn into the congress.

i can tell you what's disappointing to me as a citizen and a va employee is to watch leader after leader in the va sit in these chairs and say i don't know, i'll get back to you, so-and-so was supposed to do that, general counsel won't let me. that to me is just inefficient. if you're going to be in a leadership position, you just need to lead. and so making people sign off on quarterly reports to say that i own the data that i turn in, i own the enrollment records that we turn in, i doubt very many people in this room knew there was a 600,000 pending backlog at va. or that last year 40,000 applications, 18,000 or more from iraq and afghanistan veterans, if people would have known that, something could have happened. if those reports had to be signed off on by people like miss harbin, people in positions formally held by dr. jesse, dr. petzel. the first time you go to make something public, they tell you where is your proof?

where is the document? most people are not going to sign a document i'm deleting applications. i failed to process applications. but this is the type of conversation you get when you go and talk -- >> let me put it this way. if you all could comment on this, is it -- the va -- the veterans administration is so dysfunctional right now in terms of its leadership, in terms of the culture as well so, i mean, having a new secretary come in, the culture is still there. i mean, i hope that the new secretary can make the appropriate changes but it's going to be difficult. do you all believe that there should be an entity really outside of the veterans administration for which a whistle-blower reports to. mr. davis and then let me go down to the rest -- the physicians here. >> i would absolutely say yes. it's imperative. you really want real change in a true whistle-blower environment where people will come forward, you have to take the policing power outside of va. >> dr. mitchell? >> i would agree. no one trusts the va to habitnd

their own problems. >> dr. head. >> agree. >> dr. -- >> i completely agree. va doesn't acknowledge the problem exists. it's absurd to expect they would want to fix it. their position is there is no problem and we have the numbers to prove it. >> mr. chairman, thank you. i yield back. >> miss titus, you're recognized for five minutes. >> thank you, mr. chairman. thank you for being here. i realize there is a pattern that leads us to a conclusion we need to go outside the va, but aren't we at a point where there's a real opportunity to make a change because about nine of the top positions, including the secretary, are vacant right now? so if we can bring in a new leadership team and impress upon them the need for this accountability which we have heard repeated in every hearing, whether it's on the backlog or the bonuses or whistle-blowers, that this is the message that maybe we're at a point where we

can start to make that difference? i'm sorry that mr. mcdonald can't come in here and hear what we are hearing. i know that sloan gibson is scheduled to come, but, mr. chairman, we need to get the new secretary in here as soon as we can because he needs to hear the kind of things we're hearing so we can move this in a new direction. i would ask you all, you're located kind of near my district in las vegas. we have a new hospital. i met with some emergency room doctors there. they were scared to come. they aren't as brave as you all are. they feared some retaliation. you travel in small circles. have you had any contact with people at the las vegas hospital or familiar with any whistle-blower problems there? dr. head or dr. mitchell? >> the individuals who have contacted me are from across the country but not from las vegas. >> no, i haven't. we've had a significant number of our staff actually relocate

in las vegas when you were building your now hospital but i haven't heard of any whistle-blower problems. >> i'm glad to hear that. one other thing i wanted to ask you, dr. head, you mentioned the first response to a whistle-blower is to try to impugn their integrity, and one of the examples you mentioned is that they often say, well, you're just a disgruntled employee because you didn't get the bonus that you wanted. i just wonder, could you talk about maybe the possible nexus between bonuses and whistle blowing? are people getting paid to be quiet? >> well, i have no evidence of people getting paid to be quiet, but i do think, you know, there is a teb den si to try to generate a motive for why someone is coming forward and telling the truth or reporting wrongdoing. and it's often associated with somehow personal gain from a whistle-blower, but i'll tell you, there is no personal gain

for being a whistle-blower. even when you go through long litigation and you ultimately win, you know, there's no financial incentive whatsoever. >> right. >> believe me. >> oh, i'm sure of that. i was thinking of just the opposite, that you keep people kind of tamped down and not speaking up if you give them regular bonuses and that keeps that culture of silence that you mentioned. >> i think you'll see that the bonuses are usually among the chief of staff or higher ups who are receiving those bonuses. you're not necessarily receiving bonuses at the level of some of these whistle-blowers. >> dr. mathews or dr. mitchell? >> in my experience in the st. louis va, i had productivity data or had data for every psychiatrist as to the number of patients being seen, and i know that there is only one psychiatrist perhaps who did not get the full performance pay which is what would be considered a bonus, and that's

me. i got 50%, and actually for the wrong reason they were correct because i only could accomplish probably less than 50% of what i set out to do, but it sends a very wrong message that the way to go about in the va is to just keep quiet, just do what you want to do, and you will not get into trouble for not working. you know, the only reason i think one can get in trouble is by identifying problems and coming forward. so that has to change. and i think, you know, it's a complex issue if you call it culture, but i think the fix to it can be very simple. and demanding data integrity and holding people accountable. once that starts to happen and once some senior positions, not people who resign who, again, have high integrity that they resign, people resign because they have integrity, but the people who don't care, and those people need to be fired. so that it sends the message

that this is not -- this cannot be tolerated anymore. so, you know, i would say that you're right. the people who get bonuses are the ones who just keep quiet and keep doing what they're doing. >> dr. mitchell? >> there's a difference between performance measure bonus and proficiency bonus. performance measure bonus is what you get if your facility met the performance bonuses. most of us who are eligible for those are frustrated because the facility never has the resources to meet the performance measure so there's a bonus per se but it's no -- he want to be rewarded for the work we do on our proficiencies. our proficiencies are how we perform through the year on our own personal merits and those are subjective. our administrators if they like us can rate us high. if they don't like us they can rate us low and don't have to give a reason. most people stay quiet for survival in the va system at least in my level. i don't know what's in the ses

service. >> thank you, mr. chairman. >> dr. wenstrup, you're recognized for five minutes. >> thank you, mr. chairman. and i thank all of you for being here tonight, and as i sit here and listen to your testimony, one of the things that comes to my mind is somewhere along the line through oyour parents or somewhere, someone taught you about doing the right thing and about being able to look in the mirror at the end of the day and knowing you're doing the right thing and i applaud you for that and know that you're respected by those that matter and those that don't, they have their own issues. and i appreciate that. you know, i served in iraq as a doctor, and we had something that you mentioned tonight, a sense of mission. we had a shared sense of mission and everyone was on the same page. we were a reserve ewe thit. we all come from private

practice. there's no room for slacking and the patients were the first priority and you work through the night if you have to, and you take shifts sleeping and there's an esprit de corps, and wouldn't you love to be able to practice in an environment like that every day and the people i'm talking about, these are our veterans, the ones that provided that type of service and they provided for the others that are our veterans today. and it's really sad for me to hear that there is a need for an agency with a higher integrity than the va which was said tonight. that the people in the va would be willing to accept that they need someone to watch over them because of their lack of integrity, and we brought up mortality and morbidity and peer review. what i'm used to in my hospital is you had people from the same specialty reviewing charts and people that know the -- are familiar with the procedures you're talking about, the problems that maybe exist, and you do that to try and make

things better, and if someone is really failing, then they have to go because the reputation is on the line and it's not there to be punitive but to make to m better as far as care. so my question is, besides whistleblowing is there any chance for provider input such as we have too much administrative responsibility? we don't get to see patients. such as, i need another clinical assistant in here. i need a pa or medical assistant? then i can see five times more patients. or do you have the opportunity to say, so and so is really a poor performer in the clinic and it's slowing my time down with my patients. i don't get to see as many. is that available to you? i'll start with you, dr. mitchell. >> in that particular form, that's not available. there are certainly in section four and five, especially four, i talk about the retaliation tactics against providers. one of them is failing to fill

the ancillary services so the provider's clinical time is stretched incredibly thin. they overload the provider's patient panels so they can no way get through them. you're not talking -- we're not at the level to be able to communicate equally with our administration. we're far below. and anyone that speaks up is retaliated against. we don't have that freedom to speak freely an advocate for patients and ourselves. >> as you said before just because you have md after your name doesn't mean you have that ethics but in those situations, it may be another doctor but they are saying you don't need this or we're not listening to you. would that be correct? >> yes, that would be correct. and for a variety of reasons. certainly a legitimate reason like there's a -- congress hasn't passed funding or something like that, we can't hire anyone, that's legitimate, but there are decisions that are made, at least as far as we can tell on the rank and file made for the benefit of the administrators not for the

facility or the veteran. >> any other input? >> you know, i think it's mixed. i've seen extraordinary efforts to move mountains to -- for instance, build a new lab in our institution that was definitely needed. >> by providers? >> by providers. providers said they would no longer practice their craft in the area they felt. and they were responsible for that. it took a certain amount of recept uf leadership, and it also look very stern providers who as a group spoke up and said, this is not right. and so i did think the response was appropriate in that instance but other times, i think resources are placed in areas where there's too many resources and things. and so, again, you know, it involves leadership.

>> to quickly add, i was trying to institute a time map thoef available time of a physician and what's being provided. that along with veterans satisfaction. we have those two accurate measures we can know which facility is overloaded. if a physician's time, they are putting in more than, say, 50 hours or whatever, and still if there's a wait time and the veterans satisfaction is not there then the answer is more resources. in the mental health, the situation was that the physicians, the psychiatrist that i was monitoring or responsible for were working less than 50% of the time. so the solution there is more accountability and more efficiency. it's not more resources. and we can only know that if we have real data that we can believe. >> thank you very much. i appreciate it. i yield back. >> thank you, mr. chairman. and i am grateful as well that you are all four here. it's interesting that you said

something, mr. davis, that i find that i relate to and i can see it even again tonight. and you hear members of the committee as well. i've been here 18 months as well and the typical pattern of how this issue with the investigation of the va and looking out for veterans and making sure they get the health care we promised them when they fought for our liberty and freedom. and typically a panel comes in and you reference this. and tells us, unbelievably shocking stories that, and back to your comment, that are so shocking and so disappointing to me as an american, horribly ds appointing to me as representing veterans in my district, 54,000 of them in indiana. horribly disappointing. nothing celebratory about it. i think every time i come to these hearings i want the panel to say we've turned a corner. we've drilled down, rooted out the bad actors, hit the reset button and we have a bright future and can promise our fellow americans we have a bright future. again tonight, you know, we're going to sit here and the

representative alluded to this. you're going to walk out of here. there's going to be another va panel. there's been dozens. they are going to come in and give twous answers. either that you aren't telling the truth or they don't have the answers to all the questions we're going to ask based on your testimony. and that's going to happen again tonight. it doesn't happen tonight, i'll be absolutely shocked. but there are dozens and dozens of high ranking members of the va that come in here sfld really absolutely said nothing. my question to all of you but specifically dr. mitchell. the phoenix facility has been at the apex of this whole kickuf of this urgent reaction time. and one of the things that's floored me is the lack of urgency on the part of the va that there's a five-alarm fire and nobody is rushing to put it out. i'm thinking, if i was in the phoenix va, and i was responsible for any of the stuff that's been going on in the phoenix va that the minute this hit the fan nationally, i would be looking and trying to figure this out double time and make sure that my facility is the

standard and that we've raised the standard. and that we've reset the record and are an example for the rest of the country. in the three months this has been under the scrutiny of the american people and the american people have stood up and said they'll not tolerate this. this committee said we'll not tolerate this either. we'll drill this down and root out the bad actors to where we can provide the best health care to our veterans. have you seen anything in the last three months that says, wow, what a turn around. they got the message. people have been fired. they've removed these people. there's a ton of accountability and transparency. have you seen that the last three months in phoenix? any kind of turn around? >> the turn around has to do with scheduling. and consults. because of backlogs i've been reduced. i've nut a consult with a patient and they've gotten a call from the va during my appointment with the appointment time for the consult. they've certainly done tremendous work getting the veterans processed. the problem is they only fix the problem that was in the media. they haven't fixed the patient care problems, the hidden mental

health delays, although they're workac that for the psychiatry department. there are still administrators there who refuse to reduce nursing retaliation directly impeding care for ill patients in the emergency room. there was a meeting where five or six of the full-time physicians told the chain of command this and they said flat out we will not investigate the backlash against dr. mitchell. >> we had the inspector general in here a couple weeks who who said the issue of rooting out corruption at the administrate uf level is not going to stop. it's still going on. you're corroborating it's actively going on against you. until somebody goes to prison and people are fired that there's actually tangible action taken. number one, that's the american people can see. number two, the veterans to restore some kind of faith n integrity in that same where they are going for health care. so your colleagues you work with as well feel like their backs are covered. how long do you see if it took a national urgency to move the

scheduling issue and it took a resilience an the part of the chairman and the ranking member to really go after this issue and try to reset it. how long do you see, even if we keep pressure up, even if the new va secretary comes in. if we don't root out the corruption, new va secretary won't be any more successful than shinseki was. how long is it going to take to turn this around if we keep up the same amount of pressure? >> i'm not sure i'm in the best position to judge that. i know the media paid attention to the scheduling issues and all of a sudden, i get consults completed within ten minutes. the media needs to pay attention to the lack of ethics issue and maybe we'll get that turned around. >> i want to say that i think we've got to do two things. i think first of all, we do need a separate group to look at va. as you alluded to, when the new secretary comes in, he or she, whoever finally gets aproofed by the senate, zill to deal with the health care issue first.

they'll probably not have time to become the chief of police for va and also make the health care reforms. you'll need some assistance. even if it's a sunshine law where this operating authority only acts for a period of years until you get va under control. the next thing you have to look at, look at performance standards. they may have some legitimate reasons for their challenges in terms of the leadership group. in our organization, our primary function is to enroll veterans into health care. we stirred that away to the project and this is not about the politics of the law. this is about va having a public affairs division here in d.c., a national veteran outreach office here in d.c., a health system communication office here in d.c., and that project was sent down to atlanta for the sole purpose of a senior executive meeting a performance goal. had nothing to do with our core business. i go back to the previous point i make. why you need an outside agency to look at

we have, again, for delta dental yet we could put these in a post office, a grocery store to say if you had a pending application in va through years 2000 and 2014, contact such and such number. the same effort we put