undersecretary for health for administrative operations. and your prepared remarks will be submitted for the record. secretary gibson, senator tester, you've already made your statement, okay. secretary gibson, please begin. things and get straight to business. as has been recounted we have serious problems. here is how i see the issues, first and foremost veterans are waiting to long to care. and second, scheduling acts were widespread. and third an environment exist where many staff members are afraid to raise concerns or offer suggestions for fear of retaliation. forth, a vast number of vocal points for staff are not focused

on the veterans we are here to serve. fifth, the va has failed to hold people accountable. and last we lack physicians, space, staff, information technology and perchase care funding to meet the current demand for timely health care. furthermore we don't have the capacity to quantify the staffing because we have not built resources from the bottom up. we have instead managed to a budget number. as a consequence of all of the failures the trust that is the foundation of all we do, the trust of the veterans we serve and the trust of the american people and their elected representatives has eroded. we will have to earn that trust back through deliberate and decisive action and by creating an open, transparent approach to

deal with veterans. to begin restoring trust we focused on six key priorities. get veterans off the wait list and into clinics. fix systemic scheduling problems, address cultural issues, hold people accountable, establish regular and ongoing disclosures of information, and finally quantify the resources needed to consistently deliver timely, high quality health care. here is what we are doing now. vha reached out to over 160,000 veterans to get them off wait list and into clinics and made over 543,000 referrals for veterans to receive care in the private sector. 91,000 more in the period a year a ago. and i would point out for each referral on average they result

in seven visits to a clinician. vha facilities are adding more clinic hours, aggressively recruiting to fill spots, deploying mobile medical units. we are moving to augment and improve our scheduling system and buying a commercial off the shelf state of the art scheduling system. i have directed people to conduct monthly in-person inspections to identify any related obsticals to timely care for veterans. over 1100 to date have been conducted. we are putting in place an ex ternal audit of scheduling across the entire system and building a robust situation to

measure patient satisfaction which i believe will be central to measurement processes in the future. i have visited 10 va centers to hear from the field on the action to get the veterans off the wait list and into the clinic. i leave later today for two locations in new mexico. they are eliminating any motives for scheduling practice and over 13,000 performance plans were amended in the process. where willful misconduct is documented action will be taken and this always applies to whistle blower retaliation. hiring is a first step to ensure we are all working to support those delivering care to

veterans. vha dispatched teams to provide direct assistance to facilities requiring the most improvement including a large team on the ground right now in phoenix. all vha senior executivexecutiv for 2014 have been suspended. vha is expeneding the use of private sector health care to improve access. i sent a message to 341,000 to veterans and reiterated that whistle blowers will be protected and we will not tolerate retaliation against whistle blowers. i named dr. carry for the secretary of health and she will spear head the immediate access for veteran care and restore the

trust. a former health secretary is on leave of absence from chief medical officer and president of clinical services for hospital corporation of america has begun his two month stint as senior secretary advisor. he will help bridge the gap until there is a confirmed secretary for health. dr. jerry cox is serving as interim of medical am specter. a navy office for 30 years and the former assistant inspector of the navvy for medical matters. he will ensure a strong internal audit function. as we complete reviews and fact finding, we are beginning to initiate personal allegations to

those who were doing wrong. ms. bradley is a formal general council at va and a senior member of the general coun council team at the department of defense and had direct responsibility for the ethics portfolio. let me address the need of additional resources. i believe the greatest risk for the veterans over the immediate and long-term is additional resources are provided not to remedy the historic shortfall of va capacity. such an out come would leave va more poorly positioned. we have been working with the office of budget for several weeks to request refunding. while the amounts under the

consideration are large under the context of scope and represent moderate expenditures. they are non-reoccurring and wouldn't be reflected in long-term rates. resources to meet the demand for fiscal year 2014-2017 total $17.6 billion. these funds address only the current shot short falls in staff, space, technology. we are taking the action to own the problems we face. the president, congress, veterans, the american people, vso's and va staff all understand the need for change.

we must, all of us, seize this opportunity. we can turn these challenges into the the greatest opportunity for improvement in the history of this department. i believe in as little as two years the conversation can change. that va can be the trusted provider of choice tr hilary clinton and benefits. if we are successful who wins? the growing number of veterans that turn to va for health care each year. the 700,000 veterans who are currently diagnosed with ptsd. the million iraq veterans that turned to the va since 2002. and the average veterans who turns to the va who is older, sicker and poorer than average patients in the private sector. these are the veterans who win when va becomes the trusted provider of care and benefits.

that is what and where we want to be in the shortest time possible. our ability to get there depends on our will to seize the opportunity, challenge the status quo, and drive status change. the vast majority of whom i believe care about the mission and want to do the right thing and work hard to take care of the veterans. i appreciate your partners, community stakeholders and volunteers. i respect the role the members of the committee play in serving veterans and i am grateful to you for long-term support. i am prepared to take your questions. >> well, mr. acting secretary, thank you much for not dealing with nisities and dealing with

realities. i understand we are talking in a broad sense about two very serious problem areas. number one, i trust every member of the committee understand we have an immediate crisis. that we have hundreds of thousands of veterans on wait list and those folks must get the medical care they need in a timely manner and am i pleased to see you have acted aggressively in that area. but if i understand you correctly the second point you made it is important to put out the current fire unless we effectively deal with the long-term capacity issues facing the va we will be back here year after year with similar type problems. you mentioned the number. and i want you to get into some detail. what are we talking about? how many in phoenix, other areas of the country there are long waiting periods. the goal of this committee is to

end those waiting periods so veterans get quality care in a timely manner. let's start off with personal. how many doctors, how many nurses, how many other types of medical personal do you need to achieve that goal? be as specific as you can and how much is that going to cost? >> mr. chairman, of the 17.6 billion approximately $10 mill billion is allocated for purchase care and hiring additional staff. the blend of that will change over time as we ramp up that capacity and we are successful in hiring people. >> is it fair to say that to the degree that we stregthen the va we become less dependented on expensive care? >> it is absolutey true.

>> continue. i interrupted you. >> that $10 billion is allocated in a portion to purchase care probably more on the front end than the back end as we are successful in hiring. our ability to develop highly refined bottom up estimates of physician requirements is limited. our best estimates at this time is that this would -- closing this gap requires hiring 10,000 additional clinical staff. those are divided among primary care, specialty care, and mental health care. of the 10,000, roughly 1500 are physicians and others are nurses and nurse practitioners and other direct patient support staff. >> you talked about space. >> yes, sir.

>> i trust you are not talking about building some las vegas-type expensive building. what is the relationship between space and the emergency that we currently have in terms of waiting periods. >> i will tell you, mr. chairman, in every medical center i visited except one and that is augusta, the number one problem is space. fayetteville, north carolina is growing at 7.8% annual rate and when it takes five years to get a building on the ground it doesn't make long to fall behind. so where we are today as a department is we are behind in the in terms of the space required today to serve patients. there are $6 billion in the $17.6 billion that is designed for infrastructure.

>> do you have those projects? >> there are -- i will ask phillip to go into some details. there are 77 lease projects for outpatient clinics that would add about 2 million square feet and 4 million appoiappointment and minor construction and occurring maintenance that would add 4 million additional outpatient visit slots there. >> we have heard time and time again that the dysfunctional for the appointments at the va is due to an outdated computer situation. can you say a word on how you will deal with that?

>> there are four parallel issues. 11 existing defects in the system being patched as we speak. there are four different interfaces in the process of making it easier for schedulers to access and provide the opportunity for veterans to access the schedule. on the 11th of july we led a contract for the existing system that will remedy maybe many of the most problems we make it hard to deal with and parallel with all of that we are pursuing the acquisition of a off the shelf state of the art system that is probably two years down the road in terms of having that functionality in place which is why we are pursuing. >> let me conclude. if we don't have the resources at the va to address the issues

with the ptsd folks, space issues, what happens in years to come? >> the wait times just get longe longer. we don't meet any standard of quality health care. i have committed to the president, veterans, the staff at va -- i will not hold back for asking for resources because we have not been managing to requirements as department. this would never happen in the private sector. you would fail as a business if you did this. i am not holding back now and won't in the future. but i told these folks that worked on the number i don't want a penny in there we can't justify. not one cent. >> senator burr. >> mr. chairman, thank you. and secretary gibson, i commend

you, again. you have sort of made us go back and ask about numbers because it hasn't been that long ago we wrote off $127 million for the new software to do scheduling and then there is the $14 billion in the construction and maintenance account that means projects are on a 7-10 year timeline. so it is good to see one that va has a sense of urgency and that omb is recognizing the reality of the set of needs. i have a set of questions for you but i want to send them to you and ask you to respond and i would ask for all members to have an opportunity. >> without objection. >> i want to focus on data integrity.

... the little rock va regional office, we are concerned how quickly the number of regional offices with allegations is growing. they removed all provisional rated claims from its pending in inventory. this process misrepresented the

actual workload of pending claims and progress toward eliminating the overall claim backlog. the office of inspector general team sent to philadelphia regional office determined that there were significant opportunities for regional offices to manipulate and in put incorrect dates of claims in the electronic record data integrity related to timeliness of claims processing. then there is this exchange that took place you remarked in your opening statement they have self reported a decrease in the national backlog by more than 50% since march 2013. do you trust those numbers? at this point, i would say, no. we have a lot of work ahead of us to address the allegations that we just received which all

seem to focus on data integrity and need to be looked at carefully. i do not want to say a trust in. in the end of the hearing, one of the things you said in your opening, and that struck me was that some of the success may be comprised by data integrity issues. anything that the secretary has said tonight that alleviates those concerns that he raised in your opening statement simply responding know. also, on the issue of whether the quality metrics are reliable , the general accounting office provided this testimony, and prior work we documented shortcomings in va quality assurance activities and more recently concerns have been raised about the lack of transparency related to changes in the agency's national accuracy rate for disability claims. in several basic areas they are

not following general statistical procedures. that looseness in their methodology translates to numbers that are inaccurate and and helpful in terms of looking at trends over time in terms of performance accuracy and/or comparing relative performance. that is not good metrics. simply, the inspector general's office testified that they continue to identify a high rate of errors and regional offices processing claims decisions. now, undersecretary hickey was the one that testified from the va. and despite her testimony, which was preceded by the inspector general, the gao, the va put out a press release the very next day entitled va takes action to ensure data integrity of disability claims in which said va touts it as reduce the

backlog, the number of days it takes to process claims and has improved their rate to over 90 percent. now, listen, you said that you have to regain the trust of the committee. i think we agree with you. let me ask you, how smart was that press release? did you sign off on that press release? how can numbers that were refuted by the people that were actually doing the investigations of va facilities, how can they reviewed the numbers and the next day that va come out with the same numbers and talk to them? >> senator, i think, as you have noted, trust is the foundation of everything that we do. where there are questions about data integrity i think we have got to look deeply. there are a number of issues that have been raised.

i could sit and go through and take an item or two, but the fundamental issue remains. they're is -- there are questions about whether or not we have good data integrity. just as we are undertaking independent reviews, we need to take those. >> so this has been under way. much of it initiated by members of this committee with the inspector general, the general accounting office. you have acknowledged the shortcomings on the fee age a side. this is fresh, this week. and still that press release of stress is that the va will continue to publish these performance data is on its website. >> senator, i would tell you that i come into this organization and look at the transformation over the last two

to three years and a fine anybody to show me any major part of the federal government anywhere that is transformed that much in that amount of time. i think it is amazing looking at it from a private sector perspective, much less in the context of the federal government agency. there is room to improve. we have got to restore trust. the 100 percent provisional ratings were pulled out. my recollection a round numbers, it's about 12,000. that may not be exactly right, but the backlog is down 350,000. so i get it. we need to make sure that the data integrity is there, but i am not going to pull back from standing by that department and the good work that has been done we cannot have back and forth between ing. we have to embrace the findings.

>> i appreciate the chairman's lenience. i am not sure you are embracing those findings. it concerns me because these are veterans that are waiting for their determination is to be made and in some cases it involves overpayments. and it just strikes me -- and now realize this is a vha hearing. it strikes me that we could have testimony like we had on monday night and turn around and put out a press release stating the same numbers the next day when every one of the investigators found that those numbers could not be trusted. this is an area of great concern big, if not bigger because the budget is the biggest budget.

>> thank you, mr. chairman. the va has removed the wait time criteria from the performance contracts. i do understand the need to be wary of creating incentives for people to gain -- game the numbers, but we have a serious accountability problem. how will you hold a network and medical center directors accountable for wait times if it is not in a performance contract ? >> i think the first that we have to do is get to integrity in the data. so the idea behind polling that at this stage of the game was to eliminate any questionable motivation. >> understood. >> i think as we move forward what we are going to find is that average wait times are a very poor gauge firm timeliness of care for a large, integrated health system.

you don't really find that in that private sector. it is one of the reasons we are boosting our patient satisfaction measurement activities because i think patient satisfaction is going to become central. the veteran needs to be seen today, we have failed that veteran. >> you are looking for different ways -- >> i think we will be looking at different ways to evaluate timeliness of care, a combination of patient satisfaction, veterans waiting too long and seeing that number coming down steadily. and then as we have the system could ability to do things like you see in the private sector, metrics like the third next available appointment which gives you some gauge of the capacity of the system to be able to handle that veteran as they come in. today at least we are able to look at same day appointments. roughly in the primary care area we see about 100,000 veterans on the same day basis every single

month in primary care. that's coming to me, suggests that there is capacity being maintained to take care of that veteran who cannot wait 14 days or 21 days or 30 days. >> okay. health care from the private sector does play a critical role in making sure that veterans get the care in a timely fashion. there are drawbacks to the care that the va has been trying to overcome like not being able to get medical records returned to the department and a little ability to see the quality of care. if congress were to expand the authority for 90 for health care, what steps would be necessary? >> i will ask philippe to jump in here in a moment. one of the biggest challenges we have with purchase care in the community is maintaining continuity of care for the veteran. the ability to get information, medical information, medical record information back and forth is a vital part of this.

ensuring the quality of care. i would tell you if the floodgates open it will present the department with challenges, but the fact remains we are right now referring out roughly a quarter of a million referrals' every month to purchase care. as i mentioned before, every one of those referrals on average will result in roughly seven appointments. that is an awful lot of activity. last year 15 million visits to non va providers over the course of the year added to the 85 million outpatient clinic visits. 100 million outpatient visits per year that we are managing. it is already a very large number and a challenge for us. but if we open the floodgates it would be an even bigger challenge. >> senator, the one thing i would add is purchasing care in the community does not absolves loss of the requirement and responsibility to coordinate care in addition to the assurance that we can send --

both send and receive clinical data. there is just the hands-on coordination required to make sure an appointment has occurred, the veteran knows where to go, the family is involved, all the rest of that. for a look at the cost of care alone, we are missing a big responsibility. >> we look at how we do this and expand, we have to look at those issues and get them right or we will create a bigger problem for the future. finally, va has had a lot of difficulty hiring providers for a number of reasons including the that is lower than the private sector and a long, as you mentioned, cumbersome hiring process and hiring in shortage areas in health care anyway. because we know there is a national shortage as well. now va does a lot of training for doctors and nurses and works closely with a lot of universities. what more can that va do to help build the health care workforce necessary to meet the needs of

the department and our country? >> that is a great question, ma'am live. one of the significant opportunities where we can work collaboratively. maybe tuition payment programs or reimbursement programs, ways that we can encourage that. we rely heavily upon our academic affiliations as a source for new conditions. we are doing things from my compensation standpoint as well where we have flexibility to appeal to meet the local markets . >> that is part of the reason for a backlog as well. we cannot ignore that side of it >> yes, ma'am. >> thank you very much, mr. chairman. >> thank you, senator murray. >> following up with a question about referrals and the private sector, i wrote this down from your statement. he said 543,000 referrals for private care. what percentage of those would

you guess or mental health referrals? fifth. >> i'm sorry. i could hasten a guess, but i will take that one for the record. >> the reason i ask that question is to my got into the atlantic va in august of last year when we had two suicides and a drug overdose. when we dug -- they were using a community based provider. va with see the patient, refer them to the community-based provider with no follow-up. and in that time when the person was determined to be at risk, in two cases they took their own life because they did not get timely service. i think there was an interesting observation about coordinated care. as we expand private options and veterans' health care, which we may or may not do. i hope we do. care coordination will be one of

the secrets to making that work, not just in reducing wait times but the quality of care -- or increasing the quality of care for veterans, particularly with the number of mental health people coming forward. that will be an ongoing process, one that will have to be coordinated and monitored. >> the memorandum. >> in may when secretary shinseki and dr. peters were here and ask them both the question had they seen it. dr. peters said he had and the secretary said he had not. i think both of them told me the truth. i don't think he ever saw it because i think the senior leaders did not let him. i think -- my experience is it lies at the highest levels of the veterans administration that insulated leaders from the problems. why else would a memorandum

written four years ago that we are discovering now and 2014 not have been acted on? the last sentence of the third paragraph says these practices will not be tolerated. it does not say look at this when you get a chance and delineates each of the programs. you are an interim director, secretary. you will be handing off this presumably to of mr. macdonald. what are you doing to put in place the type of affirmation transfer and conduits that will see to it he does not become a rookie victim of what a distinguished general was in terms of mr. shinseki. >> i will let my old friend -- are will not let my friend become a rookie victim of anything. >> let me interrupt. i am not being tried when i ask this question. >> i understand. >> for four years va has indicated its leader. >> i will tell you from my personal perspective i have learned to never have all my

information filtered through a couple of people. so from the first day that i got to va asserted reaching down the organization to get additional information. i think your sense is an accurate one. historically they have operated in an insular organization. part of what we have been doing is dismantling a lot of those barriers. since my first day as acting secretary, every single morning at 9:00 a.m. we have something called access stand up. senior leaders from across vha and the department up in our integrated operations center and bore into data are round access to care. this status, what are we doing, many contacts, appointments, the wait times, the status on many of these different initiatives i

have alluded to in my opening statement. it is just part of what we're putting in place. this young guy right here -- and as said before if i was half as smart as philippi would be darn smart. he has been doing an awful lot of the work to put in place the kind of management system the you're talking about some of the and not just relying on by chance the information filters out that we have dashboards in place to help us identify whether -- where there is scheduling malpractice from a productivity opportunities for us so bring more productivity out of a particular clinic, that we are able to identify those things and in tandem requiring medical center directors to get out in their clinics so that they take direct ownership for the consequences. the first sentence in a memo that provided that direction was , medical center directors are directly accountable for their quality of care and the timeliness of care delivered.

that was the first sentence. that is part of ensuring that we have that kind of accountability and, frankly, is part of the culture change. it. >> my time is up, but with that endorsement i have to ask this question. you are not leaving when secretary stone leaves, are you? >> i am not going anywhere either. >> i am talking about -- make sure he is at the right hand. >> there are a lot of good people building a lot of good tools. one of the things we have a team working on now is to take that memo and actually developed tools that allow us to mind gated to look for those patterns. give us -- as we are looking at art timeliness data secretary gibson has directed us to go look at and integrity score against it and read it. are there certain questions? if they persist have an audit.

>> thank you both very much. >> thank you. and you are right. there are a lot of good people at the va and a lot of them delivering damn good health care on the ground. when need more of them and to get rid of the bad apples. you said you have a concern about purchase care trumping va capacity. i assume that is during this conference committee and other times. we will put more emphasis on purchase care and not enough emphasis on va capacity. have you been able to do any sort of cost analysis? is it more expensive, less expensive? >> there are instances where we have taken what we would consider to be the mix of patients and the types of services we provide and compare them to private sector models. sometimes we do it for

community-based outpatient clinics. as a general rule it tends to be more expensive. there are two different types of contract options. they both have their problems. i come from a state where quite frankly the frontier in a lot of areas of private care mayor may not solve the problem, but it looks attractive. if it breaks the budget of the va and we don't get better health care in the private sector, which both of those are up for debate can age can be a problem. that is why i agree with your capacity issue. want to talk about an issue called project -- project march. it has worked well, not been perfect, but worked well. can i get any assurance that it will not be prematurely shut down before it is reauthorize? >> the discussion that we had the other day was exactly to that issue. my commitment is, to the extent i have the authority -- there is some question, but we will not

end a program that is providing access to veterans until we have their robust replacement in place so that there is no lapse in care for the veterans being served. that is my commitment. >> that is good. i think the project definitely works and it allows you to have control of those medical issues moving forward, which is a big concern. can i ask you, what do you say to folks that say the va work shortages are a myth and the real problem is medical personnel is just not working hard or fast enough? >> i will start and probably pass it to philip for a wrapup. i think when you looked -- i mentioned earlier in my opening remarks, older, sicker, people were. when you look at the typical va patient. when you start talking panel sizes, specialty care, you have

to take into account the very different patient population that the va is dealing with. the number of primary care patients that a commission sees at va is in all likelihood going to be different than what you see in the private sector. secondly, there are oftentimes factors, for example space. we talked about that earlier. i think the average in the private sector for primary care is to and have treatment runs for a primary care provider. and i do not know that we have good data on what that looks like a cross va but i strongly suspect we do not have those resources. in the case of specialty care, one of the places we are significantly under a leveraged addressed and these numbers in this request is on average one support person for every specialty care provider. that compares to a goal or target of three and a half to

one. we are under leveraging specialty care providers and as a result they are not seeing as many patients as they ought to be able to. we get these differences. i am convinced we will see productivity enhancement, but it means we have investments to make to be able to deliver. >> that meets the needs of the veterans that to not have access to the va? what i am saying is, i was told, for instance, va montana has 22 slots. productivity can probably take care of some of those. maybe, maybe not. but my point is that if we are 22 short, it becomes an issue of if they would be happy. >> take a moment and summarized

the process we have been going through. >> we did accelerating care. we pushed up productivity data. i may touch on panel size a little bit. but we sometimes miss the comparative patient population when we do that. we are looking at productivity, comparing it internally. hi, productive facilities, looking at how they get there. part of it is smart use of support staff and part of it is just monitoring productivity. some can be covered internally and some will require additional resources. we ask every facility to look at productivity numbers. we use that as the basis to a accelerate care. >> thank you very much.

>> chairman, thank you very much . you have used the word trust. i never asked for a cabinet secretary's resignation. this is the first. we were indicating that there was the problem with the culture , a systemic problems. it was my sense that all of that was true. i was somewhat comforted in the position, but actually very concerned by what i heard the secretary say on the day he announced his departure which was something to the point that he had been surrounded by people whose views he trusted that he should not have.

the scenes that we were right. if the secretary cannot trust the people that he or she must deal with on a day to day basis. i want my comments to be brought and not provincial. appreciate the senator from montana, but i want to use that as an example of why i have had difficulty in trust and the department of veterans affairs. i don't mean this in a personal way or to suggest that i am personally offended. handicapped by the sense that i have had fact that the

department of veterans affairs does not trust us, does not share information, is not honest , and most importantly has rarely responded to issues raised. again, this is not a personal concern of mine. it is not that i am personally offended, but when a veteran in kansas' brings an issue to me and i raise it, i think we should be able to expect an on asphalt, fair, and timely response which has not occurred. my ability to trust the department of veterans affairs has been significantly handicapped. an example of that is this program. it says if you live long distances from i va hospital outpatient facility you can access at home by the veterans department giving you the ability to do that paying for the service. that is a pilot program. five across the country i kept

asking how what was going. is it working? how are veterans -- are they letting it? is the technology work? we get virtually no answers. finally, at a hearing with secretary shinseki -- this program is about to end. its three-year pilot program is coming to a conclusion, although we are pleased to know you have the authority to extend it. secretary shinseki in march of this year indicated to me and would have an answer to my question by sunset, his words. never had an answer yet. then in march -- and incidently one of the things i have learned since then is that in the spring of 2012 year after the pilot program got started the wichita va is interested in promoting this program to rural veterans

and were instructed by dca you cannot recruit and market. my concern is we have created a program that someone at the department of veterans affairs is not like so they are out and about trying to make certain they prove it does not work. for someone at the va to tell folks in kansas, don't market this, don't encourage veterans to participate suggests that they wanted a failure. i become more suspicious as i learned this. on march 26 of this year a national program director directed the five pilot programs to notify veterans the program was going to a conclusion. at the same time -- in fact, in april, a week or so later, a senior staff at the va the shores my staff and committee staff that we are continuing to assess the program. subsequently we learn the memo

has gone out. ten days later, to weeks that we are assured. that makes me suspicious five about the inability to get the report promised by the secretary of veterans affairs by sunset i wonder what is going on in march. then june of this year we discovered there was an e-mail ready to be sent terminating the program. i, including some on this committee and ask that not to be the case. we are told just-in-time. this and russian -- send button was not pushed. a series of things have caused us have great doubts about who is telling us what, what the truth this. in a more fundamental way, programs authorized by congress, then they'd be easily undermine

to my personality not apparently like the suggestion we have made, not a suggestion, the law we have passed finally, our telephone conversation. i appreciate you reiterating what you just said, but that is the circumstance of find myself and as someone who is a supporter of veterans and they're for a supporter of the department of veterans affairs whose mission it is to take care of veterans across our country in state. >> just a quick comment i alluded in my opening remarks to an openness and transparency. i think that is central to maintaining trust and the position we are in right now of reestablishing trust. this is one of the central cultural issues that we must deal with as an organization. i would tell you that there is -- i used the word insular earlier to describes the

particular vha, as i find it, coming into the department. i think that is the case. over the last six weeks i have been pushing information out the door as fast and hard as i can. i prod behind-the-scenes for responses to congress, and we have got a lot of work to do in that regard to earn the trust back. >> is, sir. >> okay. thank you. senator. >> thank you. we know there are capacity issues at the va, and i would like some clarification on comments or statements you made. did you say that based upon your assessment of the capacity issues that you would need 10,000 additional staff? at think you were talking about -- >> that is correct. >> over two and a half billion that you would be requesting. >> that is correct. yes, ma'am. i know that sounds like a huge

number. there are 300,000 people in vha alone. >> so additional staff -- and i know you broke it down to how many doctors and within the specialties. so is that for the emergency situation we have now, or is this an assessment that reflects your long-term staffing needs? >> there was a reference made in one of the opening statements earlier about the findings of the field audit. the number one cause for scheduling difficulties was that there were not sufficient providers lots to be able to schedule patients into. so what we're talking about here -- my comment earlier -- we have not historically manage requirements. we have managed to a budget number. basically we took a budget number and did what folks thought they could do, and the veterans on the being the shock absorber in that process. >> meanwhile, if you look at

your true needs you're saying that you would need to hire 10,000 additional staff. >> yes, ma'am. >> that would of course depend upon the appropriations that we provide. >> yes, ma'am. >> if you were to have the appropriations to hire 10,000 people, how long do you think it would take for 10,000 people to be hired? one of the things i did hear about the hiring in va is that it takes a long time to hire a doctor. i hope that in your review you are also looking at your hiring process is because it should not take a long time, whatever that means. that is one question. and then, to hire 10,000, do you have any sense of how long this would take should you get the money from us? >> a couple of comments. one, every single medical center i visit i hear from rank-and-file staff that it takes too long to hire.

staffing practices is one of our areas of concentration. my guess is there are some things we will find is just a function of being in the federal government, regulation and statute we must follow. my guess is we will find a large portion of that is self-inflicted, and we have got to clear that stuff away so that we can hire more expeditiously. second, round numbers to i would say in vha we probably hire 30,000 people every year anyway. nine of 10,000 sows like a huge number. it's about 3 percent of staff, maybe a little less. but recognize that some of these are in places like primary care positions and mental health providers. we know, and you all know that those are tough to find. so it will take time for us to be able to hire. quite frankly, the other problem even if we could go out and hire them all tomorrow, we don't have a place to put them all. in some instances we will have

to deal with space issues in tandem with this. we may be able to do -- there are provisions in here for what are called the emergency leases. i authorize some of these when i go out to the field where someone has found clinics based that is local that can be occupied quickly. 10,000 square feet, something like that. >> i don't mean to interrupt you, but my time is running out. >> yes, ma'am. >> you are addressing the length of time it takes. if you are hiring 30,000 people every year, there are probably some retention issues that you also probably ought to be addressing. >> 10% turnover. >> well. >> it is relatively low. >> you mentioned that in response to a question when the ig has findings from embracing those findings. since the problems and challenges that the va has a

longstanding, i wonder whether you have a process or someone in that va who provides a response to the ig findings. should you be providing a report to congress to respond to the ig finding so that we also can provide the kind of oversight that we should provide as to what is happening at va? >> there are responses. unless i am mistaken, i believe those responses are shared. is that correct? >> yes. >> so there are responses. what i would tell you is that i don't believe that those have always done the visibility and detention. some of the examples surrounding the office of the medical inspector in those reports, quite frankly, i don't think those are getting the attention they deserve. as we look at overhauling processes, part of what we have to do is make sure the issues that need to be elevated of the way to the office of the secretary are, in fact, being

elevated. where someone says we have taken care of this issue, we know what has been done and confirm that. >> mr. chairman, just one more item. i was told by the veterans i have been talking with, many of them live in rural areas. i was told that even if they got vouchers to go out to get private care that the doctors on the big island would not take veterans, so we would not help them. have you heard that concern? >> i would tell you, there are issues of around primary-care close-knit community contract that we have got was two different national providers for specialty care, and we do find instances where -- i think we have room for improvement. a new program just launched earlier this year, and i cannot think we are executing it as well as it needs to be. there are discussions going on this week, today with the leaders of those two programs to make sure that we address those issues.

i get that feed back from staff and from veterans as well when i am out of a field. >> the main thing is you are addressing that issue. >> yes, ma'am. >> thank you. >> thank you, senator. >> mr. chairman, thank you. mr. secretary, in your requests for of lot more money one of the things that you mentioned was the facilities and the idea behind that is some of these may improve productivity and hopefully that results in better services to veterans, that sort of thing. you mentioned that there were eight facilities that would be construction projects. how did you pick those? i know of a list of there. if you have a need for a facility, new hospitals, making its way of the list, do you just

pick the top eight? if you want to toss it over to philip matkowsky, that is fine, too. >> i am guard to toss this one, if i could, please. >> this is -- we have a backlog of major construction projects. this is the major construction, not a minor distraction or nonrecurring maintenance. they're is a prioritized ranking system that has rated safety and security as the highest. seismic corrections where we have deficiencies if there were an earthquake the building would crumble, those have to be fixed. there are a number of those. we also have long-standing space shortages. every single one of our facilities as a space shortage in terms of meeting patient need visa not abstract numbers. there is not enough space. the vast majority of the va projects are sinless, louisville , american lake, san francisco, palo alto, west l.a., long beach. for the most part they high

prioritized items because of structural deficiency. some to have patient care for additional space >> with this top aide be the same topic as the list of 20-some projects that are out there waiting to make their way ? >> it is from that list. yes, sir. >> with a match if i took that list and matched it with what you just describe for me? >> if you talking about the 26 or 27 major leases? >> not leases. >> i think you're talking about the historical projects that were ranked. it would match, and it would match against that list for the most part. yes. >> for the most part. what is the most part missing here? >> for the most part, just to give you a direct answer, the ability to complete a project given the size of the required funding it would fit in whereas somewhere else that might only

be 20 percent of that project. that is what i mean. >> at the committee hearing in may 1 of the things i talked about and other members did, too, the expanded use of non va care to deal with the urgent treatment issues. you know, this is not an academic issue. it never was. it very definitely is not today because we know that people died on the va waiting list. we know that throughout the system the list was gained intentionally and dishonestly. to the detriment of veterans. now, there are a lot of ways of handling that. mr. secretary, let me be candid with you. i have sat on this committee now nearly six years. other members of hot water.

this committee has been, i think, very, very generous to the va. and i kind of find it remarkable republicans, democrats, liberals, conservatives, when general shinseki came in and it was kind of like, what do you need, general? and it was almost like we would salute when he said what he needed an out the door he would go with more money. how was the promise of reducing better. >> here is my concern. this sounds so similar to what we have heard over the years, i need more money. i need to be bigger, faster, grander, a bigger bureaucracy, hire more people and on and on and on. i think what you need personally is competition i think if someone were biting at your backside because they were providing better care, faster

care, honest waiting lists people would go, holy smokes. if we don't put our act together we will lose out on this. if we don't see more patients touring the day we will lose out on this. let me ask you, what am i missing here? >> i think -- i do not know what you are missing. and know that millions of veterans turned to va for their health care. as a number of folks have mentioned, an awful lot of veterans continue to believe they get great care, access to care is a challenge for many, particularly for new patients, but they're is a lot of great care being delivered every single day. >> i am out of time. you know, i hear this, but at the end of the day these veterans fight for our freedoms. why don't they have the freedom

to make their own choice about their health care? maybe they say, by golly, i love the va. i will stay with the va until the day that i died. maybe they say, that hospital 20 minutes down the road for i am at is just simply a better situation for me than the hospital that is 250 miles from our am at with a long waiting list. i am totally out of time, and i do not want to impose on the chairman's patients, but i just think that you guys need competition. kaj feel very, very strongly about that. if you cannot clean up your act then, guess what, you lose a help. that is what i think you need. i don't think you need more billions and billions of dollars so thank you. >> thanks you, senator. >> you will have a modest amount

of additional time. >> thank you very much, mr. chairman. thank you both for being here. i appreciate it. you know, it is amazing to me. i have been here not just about six years, but i am looking at a 2003 report, improve health care delivery for our national veterans. are you familiar with this report? if not you should read it when i turn to one page year, part of your point, although enrollment veterans have access said health care they see long waiting times for appointments with health care providers and continue to be problematic for a significant number of veterans as of january 2003. at least 236,000 veterans were on a waiting list six months or more for their first appointment , a clear indication of lack of sufficient capacity or at a minimum a lack of adequate resources to provide

required care. this is not new. it is just they did not get the funding years ago, and now we are playing catch-up because you have also had almost one-and-a-half million net new va patients. we did not do it. i was not here. somehow people missed this report. i do not know. for the record, mr. chairman, it is like somehow suddenly it is all a new problem. it just occurred yesterday. no. it is right here in this report. because they were not funded properly it build up. they knew that patients were added to the list from afghanistan and iraq wars. maybe people missed that. again not know. pretty simple. third page of the report. not complicated. down under a different administration. so i want to put that to the record because the issues you are bringing a par relevant. joy think it is a lot of money? yes. is the money will reserve --

well deserved for our veterans? absolutely. the problem we will have is hiring 10,000 people, i agree, you have a hiring system that is great. but to get mental health providers and primary-care doctors, every private hospital in this country is behind the curve getting doctors. nurses are backed up. we do not have the capacity to fill it. so i want to make this clear because i think there are a lot of good bumper stickers being talked about today, i get it. but this is a systematic bomb that has been around for a decade or more and yet it is now suddenly and thanks to the fiasco's and others who have come forward and say, look, we have been fighting for this for years. i will tell you -- and i know my chairman gets aggravated -- not aggravated, but he knows i will bring it up all the time. we have talked about this. we saw this problem when i came into office in of nine.

we said, what are we doing? we know the private sector. all of us get a doctor. it is hard enough to get our appointments. at a veterans to the system and got it up more? we looked at our current system of federal tax dollars and how they're being used. health services delivered by tribes in alaska. qualified clinics, federally funded. what do we do? we maximize resources at our fingertips today. what is our wait time in alaska, the northwest region? is one of the lowest in the country because we now have access. as a matter of fact, an anchorage when you use a qualified federal clinic there and/or the south central clinic -- and again, you have to be on the list, up, get through the system and get on the list, for non major medical it is in day care that is pretty significant. that is competition that actually works with the tax

dollars we are all paying. we shall let out to the private sector. we do closer to care program, as you know, which uses private sector, but that does not mean it is the panacea that every veteran will get care overnight. we have to look at the systematic problems. and now you and i talked about this idea and we are doing in alaska. we have some logistic problems, billing problems, scheduling issues and how to make sure that the records are transferred properly between federal agencies and so forth. i know we will figure this out. but doesn't that seem like something we should be expanding and looking at around the country? i mean, federally qualified clinics, the one reason you have certain pay levels for doctors is so you have a controlled cost unit. now, it does mean that we will use private sector resources, as we are in alaska along with

federally qualified. >> and our indian health services, otherwise known as we call the new model. don't you think this is a model that we could go after? i mean, again, i did not mean to get so aggravated about this. it is aggravated when people tell me this is a new-found problem . go ahead. sorry. there is my rant. there was a question there. [laughter] >> i will try to address it, sir very quickly, the model in anchorage, the director -- actually, he was a trailblazer for us establishing a number of trouble agreements with local alaskan tribes, 26 of them now. a phenomenal work that he did. he literally extended the network of community providers into a seamlessly integrated system up there that allowed us

to avoid folks having to travel long distances. the norm before used to be folks flying down to washington state, if you recall. so remarkable work by the director. some of that has actually become sort of a pattern we have used elsewhere in the country with local drives and i ags, signing the agreement to extend health care services. most importantly with the tribes , the dakotas and oklahoma and across the country. we have trouble agreements in place where we can reimburse for care. it is not perfectly seamless, but it is something that has really taken root for us. >> and you do need new rules. >> no, we did not. we have certain authorities entitled 38 that we use. >> you can do that also with federally qualified funding? >> we can under sharing authority and in alaska we are doing that. one just went from private to a federally qualified connected to libertarian sort, alaska because there is no veteran care down

there which is a great example of how you can do this with existing rules. let me ask you, having the va you lice -- i sent a letter to general shinseki on this regarding positions, they use for their medical delivery system and seeing if the va can do the same thing. it is in the bill. in other words, the health care core. you tell me if your regulations allow you -- i know we talked about this briefly. i don't know if you had time to check on that. this is over 5,000 medical professionals sitting there ready to go. >> you're talking about the national health services. >> i'm sorry, national health services. >> we would have to look at credential in an privileging issues that would allow us to grant privileged and share those authorities to tree in our system as well. i would have to take that back and look at it. >> can you do that for me?

>> i will. >> the last thing, senator murray talked about reimbursements for doctors in the sense of serving our va system. i have a bill on mental health providers psychiatric care, a huge gap. have you had a chance to look at that, and if not, can you give us feedback on that at an appropriate time? >> if you would yield to me for a second. >> absolutely. >> the issues being raised are important and has to do with how we not raid other facilities and steel doctors and psychiatrists but develop more. the issues are that you have a house education assistance program which coming a, needs to be reauthorize, and it, the companies to be significantly increased. right now the maximum is only $60,000. that is what you're talking about. >> exactly. it is up to 100,000.

you want to try to -- have you had a chance to read the bill and do you support the concept? >> we support the concept. we have to look at the funding requirements associated with it, but the practice is something that would allow us to recruit and retain highly qualified staff. >> very good. >> mr. chairman, i have other questions i will submit for the record. i appreciate your allowing me to ask questions. it's frustrating when i see a report like this and people think it is a new-found problem, and it has been around for over ten years. we just have to get after it. it is going to take years to change it. >> thank you. you will have additional time as well because he did not make an opening remark. >> what i will do is just submit a opening remarks for the record it that way i will go back to my five minutes and keeping this timely. >> one of the few senators who once less time. >> if i go over please don't cut me off. having said that, thank you very much for holding this hearing,

the chairman and ranking member. at risk of irritating you, you know will be talking about statistics. i certainly appreciate a rescheduling of a hearing on the backlog information. i will talk about that in a minute. i am looking at the latest autistics. i want to thank both of you for being here. but i am looking at the latest average days of completion. i bring this up because reno has the worst va regional office in the country. i have been hitting on this and hitting on this, and i think it is a management problem. and i think the rank-and-file are at fault. i am hoping and have called for changes in that particular office, but the average date to complete a pending crime is about 340 days. have been harping on this for five years. they are making progress.

they have reduced it ten days in five years. and you have to imagine, it is pretty frustrating. i am frustrated for every veteran and a state of nevada that truly needs the help and benefits and health care that they deserve. on top of that we had an inspector general report, 51 percent of the possibility claims that or reviewed were inaccurate. i have to tell you, i appreciate your opening statement, your openness, and i think that is important. transparency is important. senator casey and i have -- tea had similar problems in pennsylvania, our staff worked hard. became up with this claims backlog of working group.

i you familiar with the information in this? >> i would tell you i am aware of it. it would be a stretch to say i'm familiar. >> fortunately i will be able to meet with the nominee tomorrow and get an opportunity for and to also address or take a look at it. i think it is very clear. it does address some of those problems. begin news is there are co-sponsors of this legislation it would go a long way so that in ten years we don't have an improvement and in less than a year we can see, perhaps, a much greater improvement. ..

then have resulted in domains. we had challenges on the procurement side of that as i think your staff has been briefed over the years and right now we are working

as well as why someone would have wound up on a further review list. it's taken us a while to do that and i want to apologize for him out of time.

>> i want to make sure we don't miss the follow-up and anticipate that you would bet many can't -- do we have been a timeline? >> the question there as somebody mentioned earlier the ig said over 70 different locations. do they want to do any additional review? they have created teams to go into all of those where the ig isn't in those are scheduled to be completed by think by mid-august is the completion time but in the meantime we are going to provide briefings on what the findings were. >> thank you very much. i'm going to be in reynaud in august. i have to go out there and speak. we will get you the dates. the dates when i'm going to be here and i will visit. >> thank you very much. >> lastly we appreciate the opportunity to provide technical input on the leasing issue. i think we furnish some of that information to the staff

mr. chairman that would help us be very helpful to us to be able to move forward. >> thank you. senator blumenthal you have eight minutes minutes and there will minutes and there will be uploaded as i understand it is 12:20. >> thank you very much mr. chairman. i really proceed you're holding this hearing and your leadership along with ranking member her and thank you mr. gibson -- mr. gibson and mr. matkovsky for your service to our nation. i think you folks are in a typical if not impossible position because you are temporarily before us without the head of an agency and my hope is that there will soon be a secretary of the va but right now in effect there is an empty desk where the buck should stop and i think that situation has to be remedied as soon as possible and that's on us, not

on you. leadership has to include an overhaul top to bottom of the people who run the agency. very simply my view is that there has to be accountability for what's been done in the past but also a change in leadership which you are commendably seeking as well top to bottom. my experience over the last few months has been that their failure of the accurate and some of what it is saying to the public is actually aggravating its credibility and trust problems. senator burr raised one incident earlier with the press release that he mentioned. i have found that there simply have been no answers to some of the questions that i have posed in letters to the agency.

letters asking for site-specific information about the audits that were performed. the va officials locally and the audits seem to confirm that there have been no problems in connection with these delays and destruction of documents and manipulation of waiting lists and yet we found a recent pattern released by the va that in fact wait times have increased over the may to july waiting times have tripled. what's the meaning of that data? i ask not only for the site-specific information from the audit that was performed as a result of general shinseki's order but also an explanation of those wait times and i have yet to receive responses from agencies that are really complete and satisfactory in

writing to the questions that i have posed. now i understand you have a lot going on but i would suggest that kind of responsiveness and providing information is part of the mission that's all the more important work. it has always existed. i would like a commitment from you that the agency will respond to my inquiries in writing as soon as you are able to do so and that you will respond in the future to the increase that i pose. >> two quick comments comments. first of all the answers we absolutely will. it might even be more effective for us to arrange a briefing. also as philip mentioned a

second ago briefing material around the audits is being provided. the opportunity and there are other comments that we have been pushing information out the door as fast as hard as we can over the last six weeks. that openness and transparency into your very point is an essential part of earning back trust. the last thing i told the president of the united states when he tapped me to be the acting secretary. if anybody is saying any behavior out of me that look like i was serving as a caretaker please let me know what it was so that i can try to explain what made you were looking at. >> i welcome that comment comments and i 2 it and support it. can you tell us anything about the ongoing inquiry internally, what its status as and when you are expected to be completed and second about the department of justice investigation? i called for a criminal

investigation by the department of justice with great reluctance and regret but i do think that the criminal responsibility has to be applied if there was obstruction of justice, destruction of documents, fraud and reporting because those crimes even with an agency as important as the va or perhaps especially because of its very important issue has to be implemented where necessary. >> as i mentioned earlier to the fact that the ig has reviews underway at 70 some locations across the organization. i should explain here before the ig goes into in a location to do any kind of review for any purpose they informed the fbi. at any point during the course of their review in wrongdoing does routinely get referred to the department of justice.

in fact there is a criminal investigation division of va's ig. so routinely there are criminal investigations to be undertaken and completed and prosecutions that occur as a result of ig investigation so it's a routine matter. i would tell you of the 70 some odd locations that the ig has been reviewing at the end of june i got the first set of reports on the first location and so we have been working more than a thousand pages of transcripts of sworn testimony. it turned out that we actually needed some additional information so we dispatched it, an official fact-finding group to go to that particular location. we have reviewed hundreds if not thousands of e-mail traffic and i expect by the end of this week to have proposed personnel actions on my desk for a number

of individuals and that one particular location. there is nobody wants to see this process move faster -- move forward faster than i do. it is painstaking and i would say the other general category here of issues have to do with the referrals coming from the office of special counsel. i've met directly with carol lin lerner. we are expecting a substantial number of those to come to us very quickly and we have agreed on some expedited processes that we will work through to ensure that the whistleblowers are properly protected and then to launch the appropriate personnel actions in the wake of that. >> my time is about to expire so i apologize, i'm not going to have more questions in this setting. i would like to follow-up on the department of justice investigation. i know you can't really comment in this setting about it and most important about protection for whistleblowers, i think one of the unexplored areas here has

been the potential for retaliation. i would like to know for them in the course of a future briefing what has been done to protect them but just one last comment. there is nothing routine about what happened here. you said that routinely the fbi is involved. there's nothing routine about what happened here and the fbi should be fully engaged and the department of justice. >> senator boozman you also have additional time. >> thank you senators and ranking member burr for having this important meeting. i want to thank you all for being here. i know that you are working very hard to try and resolve these things rate i also want to commend you mr. gibson for getting out to the places that are really struggling and also the places that are doing well, trying to figure out best practices and again why others

are struggling so much. it's important in the situation and bring him on as adviser i think i was a very good move. in regard to your request as far as additional personnel and things like that, is that based on current practice or is that based on reforms in the future that have significantly change things? both of you. >> sir the methodology we use is largely framed in the current context. senator boozman will be looked at is looking at the current volume and looking at our current delays of care forecasting through the years and trying to attenuate them year-on-year. so it's not a subsequent reform. it's in our current context. >> i had the opportunity to serve with tom a great coach from nebraska and people used to talk to him about when and he said we would never talk about

win. what we talked about was doing little things and one of the little things that has to be done and i'm a little bit concerned because you said it would take two years probably and va that's probably more like four or five. that's one of the little things that if you don't get that done tomorrow my understanding is that you don't call people the day before and tell them they have an appointment. you can catch a no-show right significantly just by doing that and then taking somebody that's on a backlog and sticking them into those slots. that's just common sense practice. it's done through the country with anybody in the private sector. so you have to get this under control and there's no reason not to do that in a rampant situation particularly targeting the areas that are having problems. your facilities that are doing okay right now by whatever standards you are measuring but it does seem like you would put that into place right away.

>> you may have missed the comments earlier. they were actually four different major initiatives underway. one has to do with fixing existing issues. there are 11 of those fixes that are in the process right now. there are four separate applications under development to make it easier for schedules -- schedulers to interface with the system as well is to give veterans the ability to directly request schedules. there is a contract that is argument led that will make major modifications to existing schedule on the 11th of july. we expect that to bear fruit in the may through august time period of next year to do with some of the toughest, some of the most difficult issues associated with the existing schedule. all of that is unparalleled while we are working to acquire a commercial author. >> is very good over-the-counter system right now in place that

major medical centers are using without any problem at all? >> that's the basis of medical practice. >> can i answer this one? i would agree with you sir. i think you have two comments. one of them is the underlying system and i think there was a reference made to a prior system effort. i don't think we are looking to go build something from scratch this time. >> no, i would hope not. that's something that people have been doing for years and i'm an optometrist by training and again that is the basis of your practice, your schedule. you mentioned that one assistant specialist and i would write down the pa system and i think he said to in-app for whatever. that might even be a little bit low but what is -- what i would like to know is what is the relationship if you take a major va medical center and a look at total staffing, you look at the staffing that it takes to support that medical center.

what is the comparison with a major private entity as far as numbers? >> i don't have the exact percentages but if you look at the overhead rate at the va or the indirect rate in the va for support staff is considerably lower in each one of our major areas are merrily and specialty medical health. >> as far as the total numbers, i'm talking about administration the whole bit. >> i'm looking at the fuel cost not looking at everything else for blended overhead rate. i think we could come up with something that would look at a blended regency where the charges come in but in terms of what we have in our facilities, the labor share is lower in the va or support than it is private. >> not as dollars by people. >> in terms of people it's lower in the va benefits in the private sector. what you may be asking as well would be could reconstruct a

blended rate that looked at the overall cost factors? we could. we have not done that. >> i would like to see that. the other thing is that right now if you go to your medicare doctor and the view our veteran and you get -- you have a physical and the medicare doctor decides that you need high blood pressure medicine and in then you go to the va. instead of filling a prescription which is a pretty good deal for the veteran, they have to have a physical in order for that to be done. why is back? is there any logical reason for that at all? how many slots with that free up if you made that one change? how much money would that save? >> i'm not a clinician so i cannot and i learned way described by that's the case that there are certain reasons why that would be appropriate and why that does make sense that i will tell you that we are looking late things to audiology

and where that could be bypassed the primary care step as an additional item billing to look at that carefully. i think folks are looking at that now. audiology optometry ophthalmology and maybe some pharmacy. not all pharmacy, we need to be careful that we are looking at that. >> i can see the scheduled drugs and things like that the to make it neck's no sense at all that the guy that is license and taking medicare dollars another entity that is licensed by the government, why a prescription can be filled for diabetes, high blood pressure? the vast majority of stuff that comes across. could you look and see? >> we will look at that but just one point would be not to overcorrect in that direction.

we do have folks looking at the pattern between primary care and the pattern between primary and pharmacy. >> would the main overcorrect? >> to not be vigilant for pharmacy fill requests coming from the private sector. that's the only thing that i mean. just to make sure we are determining the appropriateness of prescriptions filled. the descriptions you have givens seem pretty straightforward. >> there's a large percentage of veterans served by both va and medicare and so part of this is understanding what the second and third order effects are of the change you are talking about. clearly one of the impacts would a primary care slot you've got it. >> it would decrease the backlog. >> pardon? >> it probably would decrease

the backlog if you have primaries. thank you. >> we have reached the end of what i think has been an important and productive heari hearing. mr. acting secretary i want to thank you very much for stepping in clearly unexpectedly and for your very important position. thank you very much for the work you are doing and mr. matkovsky thank you for your doing and we look forward to working within a days, weeks or months to come. thank you very much. the hearing is adjourned. scree

delays. that's followed by question time in the british house of commons. next, a hearing on the justice department's investigation into alleged irs targeting of conservative groups. this hearing of the house oversight subcommittee on regulatory affairs is about three hours. the committee will come to order. we're going to welcome our guests and we'll get to our witness here in just a few minutes.

subcommittee's hearing continues the committee's ongoing oversight of the irs's targeting of conservative tax-exempt groups. may 10th, 2013, lois lerner apologized for the irs responding to a question at an obscure tax event. four days later, eric holder called the targeting outrageous and unacceptable, vowed that the justice department would begin a criminal investigation. that was may of last year. here we are now, 14 months later, and we've heard virtually nothing from the administration about this criminal investigation. all we have heard is members on both sides of the aisle calling for concerns. barbara boxer is playing a leading role in the investigation. miss bosserman is a substantial contributor to the president, now it's her job to investigate the targeting of people who opposed the president's policies.

the attorney general then comes out and says, miss bosserman's not alone, she's working with the public integrity section and federal bureau of investigation. the fbi and public integrity section met with lois lerner to determine how to bring prosecution against the same groups that were targeted by the irs. these are serious apparent conflicts of interest, but the justice department just wants us to look the other way. no big deal they say. we have unnamed law enforcement sources who leaked to the "wall street journal" that no criminal charges were going to be filed in the irs targeting investigation. then you have the president of the united states going on national television and saying there's not a smidgen of corruption in the internal revenue service. if that's not prejudging the investigation, i don't know what is. the house passed a resolution calling on the attorney general to appoint a special prosecutor. 26 democrats, i stress that, 26

democrats joined every single republican in the house of representatives in approving this measure. but the administration still won't do anything. they still won't appoint a special prosecutor. my question is this, what more will it take for the administration to appoint a special counsel. then we find out just last month that the irs lost two years of e-mails from lois lerner due to a hard drive crash. mr. cole's testimony says the justice department is investigating. that, of course, is good. someone in the administration recognizes that there's something rotten with missing e-mails. but more must be done. we have serious concerns about the administration's investigation, and serious questions for our witness today. we need to hold all wrongdoers accountable for targeting of americans for exercising their first amendment rights to speak out in a political fashion. and that's why this hearing is so important.

and with that, i would yield to mr. cummings. >> thank you very much, mr. chairman. >> for an opening statement. >> i welcome to the hearing deputy attorney cole. the republicans claimed the white house directed the irs to target conservative groups. but now that we have conducted our investigation, we know the truth. there's no evidence to suggest that the white house played any role in directing or developing the search terms identified by the inspector general as, quote, inappropriate, end of quote, or any other aus expect of how irs employees processed these applications. we have now conducted, ladies and gentlemen, 42 interviews.

these were witnesses that were called by the republicans. and they make it very clear that in of the office in cincinnati, they developed these criteria on its own. we also know from his supervisor, who described himself as a conservative republican, quote, that he did this not for political reasons, but because he was trying to treat similar cases consistently. not one of the witnesses we interviewed, including senior officials at the irs, the treasury department and the justice department identified any white house role in this process. our investigation also confirmed the findings of the inspector general, who was appointed by

republicans, who stated that the irs employees reported that they were, quote, not influenced by any individual or organization outside the irs, end of quote. the inspector general has testified repeatedly before congress that he has identified no evidence of any white house role for political motivation. so now the republicans have a different argument. although they're still trying to somehow link this to the white house. now they claim the targeting of a conservative group is a massive governmentwide conspiracy involving the president, the irs, the securities and exchange commission, the federal election commission and numerous other agencies, all coordinated in response to the supreme court's decision in citizens united. they claim that the justice department is a key player in the conspiracy.

the they've accused the department in engaging in criminal -- they accused the justice department of the united states of america of engaging in criminal activity by obstructing the committee. they claim the department is delaying or even closing down its own investigation for political reasons. and they claim that the appointment of a special counsel is needed. mr. chairman, i stand prepared to submit the accusations against the department of justice. as well as specific responses showing why each one is unsubstantiated. and i ask unanimous consent this memo be entered into the official record. >> without objection. >> let me address one of these allegations. last month chairman issa and chairman jordan sent a letter that the department conspired

with taxpayer information in order to criminally prosecute conservative groups for their political speech. here is what that letter said. quote, the irs transmitted 21 disks containing over 1.1 million pages of nonprofit tax return information, including confidential taxpayer information protected by federal law to the federal bureau of investigation in october of 2010, end of quote. their letter then accuses the department of working with the irs to, quote, assemble a massive database of nonprofit groups, end of quote, which they called an illicit and comprehensive registry. these accusations are complete nonsense. there's no illicit registry. there's no singling out of conservative groups. the vast majority of information was available to the general public. and this information was never used for any investigation or

prosecution. in 2010 the irs provided form 990 not only from conservative groups, but from all groups regardless of political affiliation. and it wasn't until earlier this year more than three years later that the department discovered that a very limited amount of confidential taxpayer information was stored on those disks. this was an inadvertent error that affected only 33 of 12,000 forms on those disks. that's half of 1%. the bottom line as i close is that these disks were never even reviewed by the fbi or used as part of any investigational prosecution. on may 29th, the department wrote a letter to the committee stating as follows. quote, the fbi advises that upon receipt of the disks, reporting an index, which is set forth in one of the disks, into a spread sheet, but did nothing further with the disks, and to the best of our knowledge, the

information obtained on the disk was never utilized for any vettive purpose, end of quote. that's from the fbi. where is the so-called illicit registry. the fact is it simply does not exist. this is not the basis of a white house scandal. this is the latest example of republicans desperately searching for one, and then using any excuse they can to manipulate the facts until they no longer have any resemblance to the truth. our committee has now held ten hearings on the issue. and the irs has spent more than $18 million responding to congressional investigations. it is time to stop wasting millions of taxpayer dollars, and start focusing on reforms to help our government work more effectively, and efficiently for the american people. with that, i yield back. >> i would also ask for unanimous consent to enter into the record a couple of e-mails

from 2010 from mr. pilger in the justice department. e-mails to lois lerner. and i'll just quote. thanks, lois, the fbi says raw format is best because they can put this into their systems. again, the point that ranking member was just talking about, 1.1 million pages, 21 disks of information. the fbi got an exact format they wanted, had this information for four years. i'm aware of the testimony from the justice department that they did not use this information. but what i also know is they had it for four years and it did contain 6103 confidential taxpayer information. i ask that we enter this in the record as well. >> i would ask that mr. cole, since we want to be effective and efficient and not be caught up in distraction and dysfunction, that when he answers his questions, that he be allowed to answer what you

just stated. i want to hear the answer to that, too, all right? >> i do, too. i hope he does answer and say it's not an yog gn investigation. that's why we've got him here. >> very well. >> thank you. >> anybody else wish to make an opening statement? mr. cartwright? the gentle lady is recognized. >> thank you, mr. chairman. i'm reading this on behalf of mr. cartwright. on may 14, 2013, inspector general russell george released a report stating irs employees used inappropriate criteria to screen out tax-exempt status. republican and democratic members including myself condemn the irs mismanagement identified in the inspector general's report. the concern expressed by some members had even begun to investigate, chairman issa went on national television and declared the irs was involved in the targeting of the president's

political enemies. the inspector general has repeatedly refuted this base lot allegation. he reported that senior leaders at the irs said the criteria were not influenced by any organization outside the irs. then on may 17th, 2013, the inspector general was asked before a ways and means committee, quote, did you find any evidence of political motivation in the selection of tax exemption applicants? his response, he responded, quoit, we did not, sir. after interviewing 42 employees in the irs, treasury department and doj and receiving more than 680,000 pages of documents, the committee has not found any evidence of white house involvement, or political bias. despite these facts, republicans continue to invent partisan election season conspiracy theories. one of the latest allegations is that the supreme court's decision into the citizens united prompted president obama, democratic members of congress, and the irs, doj and other

agencies to launch a governmentwide effort of targeting conservative groups. it severely undermines our campaign laws allowing dollars to drown out the voices of average americans, republican attempts to characterize these concerns as evidence of political pressure for agencies to target conservative groups lack merit. these preposterous accusations have also been contradicted by the committee's own investigation. we already know that the inappropriate criteria started with irs employees in cincinnati. the inspector general's report said, and i quote, that they developed and implemented inappropriate criteria. the irs screening group in cincinnati confirmed this fact in a committee interview. he explained his employees first came up with inappropriate search terms, not for political reason, but to promote consistency. he proved his point by telling us that he is a conservative republican. former irs commissioner