huge portion of the republican party base saying they supported impeaching the president. i think a lot of people in this town laugh that off. i think it is -- i would not discount that possibility. i think that speaker boehner by going down the path of this lawsuit has opened the door to republicans possibly considering impeachable at some point in the future, and i think that the president acting on immigration reform will certainly up the likelihood that they would contemplate impeachment at some point. >> you can watch that entire event with dan pfeiffer online at c-span.org. and on this weekend's news makers, we'll hear more about the unaccompanied minors entering the u.s. with customs and border protection commissioner gill kerlikowske. he talks about what his agency is doing to address the issue and the proposals in congress as a potential solution.

that interview is sat 10:00 a.m. and 6:00 p.m. eastern on c-span. michele flournoy is our guest on this week's q & a. >> in government, you're dealing with the daily tyranny of the inbox. you're focused on the crisis of the day. part of my responsibility as undersecretary of defense was representing the secretary of defense on the so-called deputies committee, which is sort of the senior level group that's working through the issues, developing options for the principals and the president. a lot of crisis management focus. when you're in a think tank, your real utility is not trying to second guess the policymaker on the issues of the day but help to do some work to raise their day, help them look over the horizon to see what are the issues that i'm going to confront a year from now, five years from now, ten years from now, and how do i think more strategically about america's role in the world?

>> former undersecretary of defense and co-founder of the center for national american security, michele flournoy on the creation of cnas, its mission, and current defense policy issues. saturday night on c-span's q & a. next month on book tv' in depth, former republican congressman from texas and presidential candidate ron paul. he's written more than a dozen books on politics and history with his latest "the school revolution" on america's education system. join the conversation as he takes your calls, e-mails and tweets, live for three hours, sunday august 3rd at noon eastern and tune in next month for author, historian and activist mary francis barry. in october, supreme court experts discuss court sessions both past and present. best selling author and historian is our guest in november, and in december, american enterprise institute president and noted musician arthur brooks, in depth on

c-span2's book tv, television for serious readers. next, acting veterans affairs secretary sloan gibson testifies before the house veterans affairs committee about what the v.a. is doing to improve veterans health care. one of the topics includes an additional $17.6 billion that was requested last week. acting secretary gibson began heading the v.a. in early june after the resignation of eric shinseki. his likely replacement, robert mcdonald was unanimously approved by the senate veterans affaired committee the day before. a final confirmation hearing is likely in the senate next week.

good morning. welcome, everybody, to today's oversight hearing entitled restoring trust. i want to ask unanimous consent also that representative michael fitzpatrick from the state of pennsylvania be allowed to join us at the dis today and participate in today's hearing. without objection, so ordered. the committee is going to examine this morning what steps we need to take to help the department of veterans affairs to get back on track to meet its core mission. a mission to provide quality health care to our veterans. since the beginning of june, this committee has held almost a dozen full committee oversight hearings, some of them, as you well know, have gone way into the night and some into the

early morning hours. we want to do a stop to bottom review of v.a. and to delve into how we are now situated in a crisis at the department of veterans uz fairs. and while i hope to focus on the major themes we've covered and to receive updates from v.a. this morning, on the topics that we have talked about over the last few weeks, i can promise the department and the committee members here that we, as we move forward, to help mend the broken v.a. system, the oversight done by this committee is going to continue. mr. secretary, in your written statement, you state that the status quo in our working relationship must change. and that the department will continue to work openly with congress and provide information in a timely manner. first y agree that our relationship between v.a. and this committee must change. we must go back to the way business used to be handled for

decades. when members and staff could communicate directly with v.a. senior leaders about routine business we conduct with the department. using the phrase continue to work openly is in my opinion not a reflection of the current reality that we find ourselves in. members of this committee, other members of congress and our staffs, are still being stonewalled to this day and you will hear several questions that relate to that information. for example, the day after our july 14th vba hearing, our colleague, mr. jolly, personally spoke to cary witty, the director of the st. petersburg regional office regarding a firing of a man. he had raised very serious concerned about retaliatory action and mismanagement at the st. pete ro, and it's incumbent upon this committee to investigate those allegations. but instead of being open and honest about the process, about mr. soto's removal, v.a. has

equivocated, stonewalled, changed its story, and obstructed members of this committee in what appears to be an attempt to cover up, and i say what appears to be an attempt to cover up v.a.'s retaliation about mr. soto. we're prepared to subpoena the documents if that's what it takes. we've got to get compliant with the multiple requests we've made to the department. i could not agree with you more the department needs to earn back the trust of veterans, their families thrk veterans service organizations, members of congress, and the american people through deliberate, decisive, and truthful actions. recent scandals that have tarnished trust in the v.a. are a reflection of a broken system that didn't just happen overnight, nor can it be fixed overnight. upon stepping up as the acting secretary, you stated that there has to be change. and there has to be accountability.

but i have yet to see where the department has drawn the line and brought those people who have caused this crisis to justice. we have shown through many of our hearings that one contributing factor to the current crisis is that v.a. has clearly lost sight of its core mission. and that extra funding didn't go to improvements in patient care but toward ancillary pet projects and an ever growing bureaucracy. according to an article by former undersecretary of health, dr. ken kaiser in the new england journal of medicine, vha's central office staff has grown from about 800 in the late 1990s to nearly 11,000 in 2012. this further illustrates v.a.'s shift of focus to building a bureaucracy as opposed to fulfilling its duty to providing quality patient care. and as i said before, the

problems that exist today will not be fixed overnight. and it cannot be fixed by simply throwing money at those problems. to date, the v.a. has been given every resource requested by the administration. every year, during our budget oversight hearings, members of this committee and dr. roe in particular, has asked if the secretary had enough to do his job, and every time, we as a committee were told unequivocally, yes. this is why last week acting secretary said that an additional $17.6 billion was needed to insure that v.a. is available to deliver high-quality and timely health care to our veterans. and when he did that, it raised some very obvious questions. where did the number come from? what assumptions underlie this request, and how were they made?

what effort was made to look within existing resources at the department to meet these new sources or resource needs? i know many of my colleagues would agree after multiple oversight hearings, outside investigations, countless accounts being made by whistleblowers, v.a.'s numbers simply cannot be trusted. v.a.'s determination that 10,000 additional medical staff is needed is also surprising when the secretary's own written statement states, and i quote, v.a. doesn't have the refined capacity to accurately quantify its staffing requirements, end quote. if they don't have the ability to accurately predict staffing needs, then how do we know that 10,000 more bodies is what is needed to solve the problem? i would also remind members that we don't have any type of grasp

on how the department is going to spend the new funding they have requested. the president's 2015 budget request, 1300 pages. you've all seen it. it's in your office. 1300 pages. the request from the department, the first request from the department, i had been saying, was a three-page request. and that request actually is a single page. this is all we got. i hope all of you got a copy of this because this is how they, in fact, justified their request. and i asked the secretary on the telephone earlier this week if he would delve into and give us a more complete review of what they requested, and i was told that we would get a much more detailed request. we got two pages.

that's all we've got. two pages. entitled working estimate as of july 22nd of 2014. for $17.6 billion. now, yes, the number has been refined to about $13.5 billion now, but still. two pages for $13.5 billion? our veterans deserve the best, but throwing money at the department into a system that has never been denied a dime will not automatically fix the perverse culture that has encompassed the department. v.a. can no longer consider itself a sacred cow that is not subject to rules of good government and ethical behavior. veterans are sacred. v.a. is not. ultimately, we're talking about a system that has a long road

ahead of it before it can get back to an organization deserving of our veterans and the sacrifices that they have made. i hope that today we receive a needed insight from our veterans service organizations. they and their members are on the ground. they need to be partners as v.a. tries to rebuild the trust that is lost. i hope that together we can bring about true change to this broken system and a change -- and a change that will fix the corrosive culture that has encompassed the department of veterans affairs for far too long. with that, i yield to the ranking member for his opening statement. >> thank you very much, mr. chairman. good morning. i want to thank you, mr. chairman, for holding today's hearing and for leading our rigorous oversight over these past few months. it's been a long road getting here. the hearings that we have held over the past two months have

yielded difficult, disturbing, but ultimately important information. with each hearing we've heard of a different aspect of the department of veterans affairs that just isn't working. we heard about some challenges like the claims backlog and technology issues which we have been confronted for quite some time now. we learned of others like how the v.a. treats whistleblowers and the reality of the data v.a. reports. the v.a. is a good product. when veterans get to see a v.a. doctor, they like the care they get. when veterans get the eligibility rating and stats receiving v.a. benefits, they find the benefits to be useful and helpful, but the business model for producing and delivering and supporting the v.a. product is fundamentally broken. we have heard this time and again over the course of these

hearings. there is a clear cultural problem at the department of veterans administration. there are scheduling failures and technology problems. inconsistent office practices lead to a backlog that appears to be at the expense of other services. the department of veterans administration is a sprawling agency that offers critical services to millions of our veterans. it's clear to me that we need a business-minded approach to reform the agency. more of the same isn't going to solve the underlying problems. tweaks and band-aids around the margins aren't going to sustain the system. we need a new model, a new approach, and a new way of thinking about and looking at the department. we need immediate short-term fixes, but we also need a long-term vision and a new approach to the business of the department of veterans administration. and i would like to thank you, secretary gibson, for joining us

today and for your efforts over the last few months. you have stepped up to the plate at the most challenging moment in the department of veterans affairs history, and you owned the problem of the organization. that has been experienced over the last several years, and i thank you for your increased effort to communicate with us on the hill. our dedication to the nation's veterans and exhibiting the courage to be the face of the department of veterans administration during these very difficult times. i would also like to thank bob mcdonald who i hope will soon be confirmed as the next v.a. secretary. i'm looking forward to talking with mr. mcdonald about his vision for reforming the department of veterans administration, both in the short term as well as in the long term. like mr. gibson, mr. mcdonald is exhibiting extraordinary courage and commitment for taking on this role at this very important

time. i also would like to thank the veterans service organization for joining us today. you have been strong and relentless advocates for the well being of our veterans. you have done an excellent job in holding all of us in congress, in the department accountable. you are a key stakeholder in this whole debate of the department of veterans affairs. you need to be active, engaged in the process of long term reforms for the department of veterans administration. so i want to thank all of the vsos as well for your continued effort you have been doing and keeping an eye on what is happening with the department, and for joining us today. once again, mr. chairman, i want to thank you for having this very important hearing. with that, i yield back the balance of my time. >> thank you very much. to my friend mr. michaud. i want to recognize some participants in the audience with us from the american league boys nation, who joined us here today. welcome to all of you, and

thanks for being here. we're glad to have you with us. [ applause ] this morning we're going to hear from the honorable sloan gibs gibson. to you, sir, we owe a great debt of gratitude for stepping in as number two and then stepping up as my ranking member has said, during a very trying time for the department, and we appreciate you being here. he's accompanied by mr. danny pummel, deputy undersecretary for benefits at the department of veterans affairs and philip matkovsky, assistant director undersecretary for health and the administrative operations at the department of veterans affairs. as always, your complete written statement, mr. secretary, will be made a part of the hearing record and with that, you are recognized for your opening statement. >> thank you, mr. chairman. i'll get straight to business.

concerning v.a. health care, we have serious issues. here's how i see the problems. first, veterans are waiting too long for care. second, scheduling improprieties were widespread, including deliberate acts to falsify scheduling data. third, an environment exists where many staff members are afraid to raise concerns for fear of retaliation. fourth, metrics became the focal point for some staff instead of focusing on the veterans we're here to serve. fifth, v.a. has failed to hold people accountable for wrongdoing and negligence. and last, we lack sufficient resources to meet the current demand for timely, high-quality health care. as a consequence of these failures, the trust of the veterans we serve, the american people, and their elected representatives has eroded. we have to earn that trust back

through decisive action. and by greater transparency in dealing with all of our stakeholders. to begin restoring trust, we have focused on six key priorities. get veterans off wait lists and into clinics. fix systemic scheduling problems. insure that veterans are the focus of all we do, in a culture where leaders insure accountability, where transparency is the norm, and where employees live our v.a. values every day. hold people accountable where willful misconduct or negligence are documented. establish regular and ongoing disclosure of information. and finally, quantify the resources needed to consistently deliver timely, high-quality health care. here's what we're doing now. vha has reached out to over 173,000 veterans to get them off wait lists and into clinics.

we're adding more clinic hours, recruiting to fill vacancies, deploying medical mobile units, expanding resources and expanding the use of private sector care. in the last two months, between mid-may to mid-july, we've made over 570,000 referrals for veterans to receive care in the private sector. that's up more than 107,000 over the comparable period a year ago. each of those referrals will, on average, result in seven actual appointments and visits. so that produces an increase of more than 700,000 appointments and visits for varin the community above last year, just associated with the increase in referrals over a two-month period. vha is posting regular twice-monthly data updates to keep veterans informed about progress we're making in access.

as part of the effort to improve transparency, i recognize, mr. chairman, we have more work to do in providing complete and timely responses to congressional inquiries and requests. you all are keeping us very busy in that regard right now. we're moving to improve our existing scheduling system and simultaneously pursuing the purchase of a modern commercial off the shelf system. i have directed medical center and visiting directors to conduct monthly in-person visits to clinics to look at scheduling and look at scheduling problems. to date, over 1500 of these visits have been completed. we're putting in place a comprehensive external audit of scheduling practices across vha and we're building a more robust system for measuring patient satisfaction. i have personally visited 13 v.a. medical centers in the last six weeks to hear directly from the field how we're getting

veterans off wait lists and into clinics. the 14-day access measure has been removed from over 13,000 individual performance plans. where willful misconduct, negligence or whistleblower retaliation is documented, appropriate personnel actions will be taken. i have frozen vha's central office and headquarters hiring. vha has dispatched teams to provide direct assistance to facilities requiring the most improvement, including a large team on the ground in phoenix right now. in addition, we've taken action on all of the recommendations made in the ig's may interim report on phoenix. all vha senior executive performance awards for fiscal year 2014 have been suspended. additionally, i have directed a fundamental revision of all medical center and visit center objections to insure they're aligned with patient outcomes. i have repeatedly taken a firm

stand on the subject of whistleblower retaliation. in messages to the entire workphose and in numerous face-to-face meetings with employees and leaders i have made it clear that we will not retaliate tolerate retaliation against whistleblowers, i committed to caroline learner that we will achieve compliance with the satisfaction program, and she and i have agreed to streamline the process by which we work together to insure appropriate whistleblower protection. we have also established internal processes to insure appropriate personnel actions are taken where retaliation has been documented. i've made a number of leadership changes, including naming dr. carolyn clancy interim undersecretary for health. new to v.a., she is spearheading our immediate efforts to acc accelerate veterans' access to care.

dr. jonathan purlin has begun his assignment as senior adviser to the secretary. he comes to us on loan from the hospital corporation of america where he is the chief medical officer and the president of clinical services. he's also chairman elect of the american hospital association. dr. purlin brings a wealth of knowledge and experience to help us bridge the period until we have a confirmed new undersecretary for health, a position dr. purlin himself once held. as part of the restructure of vha's office of the medical inspector, we call that omi internally, dr. jerry cox has been appointed to serve as interim director. a career navy medical officer and a former assistant inspector general of the navy for medical matters, dr. cox will help insure omi provides a strong internal audit function helping to insure the high standards of care quality and patient safety. as we complete reviews and investigations, we're beginning to initiate personnel actions to

hold those accountable who committed wrongdoing or were negligent. to support this critical work, ms. lee bradley has begun an assignment. she is a former general counsel at v.a. and most recently at the department of defense where she has direct responsibility for their ethics portfolio. shifting gears, an area of resources. i believe that the greatest risk to veterans over the intermediate to long term is additional resources are provided only to support increased purchases of care in the community. and not to materially remedy the shortfall in internal v.a. capacity. such an outcome would leave v.a. even more poorly positioned to meet future demand. today, v.a.'s clinical staff and space capacity are strained. between 2009 and 2013, the number of unique veterans we treat annually has increased by over half a million and the

typical veteran we treat today has on average nine major diagnoses. in just the last three years, 40 veterans health care facilities have experienced double digit growth in the number of patients who come through their doors. as an example, at the fayetteville, north carolina, v.a. center, which i visited several weeks ago, the number of patients being treated has grown 22% in the last three years. resources required to meet current demand covering the remainder of fiscal year '14 through fiscal year '17 total over $17 billion. while the amount is large, it represents a moderate percentage increase in annual expenditures. these funds would address clinical staff, space, information technology, and information technology necessary to provide timely, high-quality care. let me briefly address benefits. since arriving at v.a., i have been very impressed with vba's

ongoing transformation. i doubt that any major part of the federal government has transformed so much in the past two to three years. and i believe that because of this transformation, we're on track to eliminate the disability claims backlog in 2015. having said that, veterans still wait too long to have their claims decided. and our quality is still not up to our own standard. a portion of our request for additional resources will be invested to accelerate accurate and timely claims decisions for veterans. in closing, we understand the seriousness of the problems we face. we own them. we are taking decisive action to begin to resolve them. the president, congress, veterans, vsos, the american people, and va staff all understand the need for change. we must, all of us, seize this opportunity. we can turn these challenges

into the greatest opportunity for improvement i believe in the history of the department. furthermore, i think that in as little as two years, the conversation can change, that v.a. can be the trusted provider for veterans health care and for benefits. our ability to do that depends on our willingness to seize the opportunity, challenge the status quo, and drive positive change. i deeply respect the important role that congress and the members of this committee play in serving veterans. i'm grateful for your long-term support, and we'll work hard to earn your trust. we cannot succeed without the collaboration and support of veterans service organizations. i have conducted some 20 meetings and calls in the last two months with vso leaders and other stakeholders to solicit their ideas for improving access and trust, and i look forward to hearing the testimony on the panel that follows. and last, i appreciate the hard work and dedication of v.a.

employees. the vast majority of whom i continue to believe care deeply about our mission, want oo do the right thing, and work hard every day to care for veterans. because of their work today, thursday, today, hundreds of thousands of veterans will receive great care in facilities all the way from maine to manila. and in the midst of this crisis, it's all too easy for us to forget that simple fact. mr. chairman, i am prepared to take your questions. >> thank you very much. mr. secretary, and it's an honor to have an opportunity to work with you, call you a friend. we've got some questions that we're going to ask today, and both sides will have some pretty probing questions. and i think we appreciate the actions that have been taken at the department to move the veterans off wait lists and i think probably the one of the significant questions that needs to be asked right now is how many veterans currently are on waiting lists over 30 days for

appointments? >> do you want to take the wait list question? and i'll address the broader issue. >> sure, veterans on the ewl or electronic wait list number about 40,000 nationwide today, down from 57,000 may 15th. >> the new enrollee appointment request list, which was another focal point for this overall effort, started at roughly 64,000. it is currently sitting on what's really going to be a permanent level of about 2,000 because there's flow in and out just about every single day. when you look at the number of veterans that are waiting that are scheduled but waiting longer than 30 days for their appointments, it's about 640,000. total. we see the number of veterans waiting longer than 90 days as we release information each two

weeks. we see that coming down steadily but not precipitously, not fast enough. >> if we can talk a little bit about the funding request that you alluded to in your opening statement, is this a formal request being made by the president? or is it an emergency request, a supplemental que aal request? >> what i'm trying to do is articulate the requirement as best as i can possibly articulate it. from my perspective, it's a formal request for funding. >> from the administration? >> that's my understanding, yes, sir. >> is anybody aware of how the supplemental request was made by the white house in regards to the process, crisis that exists on the border right now? $3.4 billion. >> i am not aware of the method by which it was completed. >> it was a supplemental request from the white house, so i'm trying to figure out, because everybody keeps dancing around

the word request, even yesterday, an undersecretary did here on the hill, and i'm trying to find out what are we -- you know, it's a desire, but ordinarily, it would come through the white house. so walk me through the -- how did this come up right now? what was the impetus that began you looking at the need. we already have $35 billion on the table, and so now during negotiations on a conference committee report, you have injected $17.6 billion. >> i think as we launched into now over two months ago, we launched into an effort to accelerate care for those veterans waiting the longest, we undertook simultaneously a process of evaluating the adequate resources in the field in order to be able to meet that standard of consistent,

high-quality health care, timely, high-quality health care. as we work through that process, using the information systems that we have available to us, we developed an initial set of requirements and began working with the office of management and budget. as my testimony last week to the senate became closer and closer, nearer and nearer, there was an increased effort there to try to get that process to closure so that during that testimony as well as his testimony, i would be able to present that statement of requirement. >> so the memo that you gave to senator sanders on the 16th of july says per your request, attached for your information, is a summary for additional resource needs through 2017. so was it senator sanders' request, a combination, or yours? >> senator sanders requested the

information, the information -- the requirement that's being communicated here, and if you will, the request, is our request. >> you come from a banking background. if somebody came in to your bank with three pieces of paper and asked for a million dollars, would you give them a million dollars? >> the honest answer there is it probably would depend on who the borrower was, but i understand your point. the committee needs additional information. >> and we have set a goal of trying to wrap up the conference committee by the end of next week before we leave so that we can get something to the president for his signature. and we got three pieces of paper to justify a request that senator sanders clearly wants put into the scope of the case is making it very, very

difficult for us to be able to do our job if all we get are sheets of paper that basically says they are working documents. at some point, they have to say this is the document. with that, mr. michaud, you're recognized. >> thank you very much, mr. chairman. once again, i want to thank you, mr. secretary, for being here. you stated in your statement that v.a. doesn't have the resources that it needs. in your view, what led to this lack of resources, number one. and when was this underresourcing identified? and my third question is, what did the department actually requested in their budget? the reason i ask that question is, when i first became a member of this committee, when i was first elected, we had secretary principi sitting where you were sitting and we asked him, as he was defending the president's budget, and the question was, can you deliver the services for our veterans with iraq and afghanistan and the current?

his response was that he requested additional $1.2 billion, did not receive it, but he'll make due with his budget, so i would be interested in knowing what your actual request was when you originally submitted your budget. >> first of all, as i have come into the department five months and six days ago, i formed opinions about what i see and what i hear. my general sense is that what we have done historically is we have managed to a budget number as opposed to managing to requirements, which is what you do in the private sector. and i think as a result of that, what's happened is we have sort of muddled our way along and not been able to meet the standard of care that veterans deserve, because we did not manage to requirements. the exercise that we have gone through and frankly continue to

go through as we work to insure that we're ringing all the productivity that we can out of the existing resources, is really about managing to requirements. i would tell you that process as i mentioned in response to the chairman's question, has really been under way for about the last two months. i have been in places acting now for seven weeks. and so we're working through that process. these are not -- in the private sector, this would be a routine part of the business. you would be managing to requirements. you would be continuously exercising productivity tools and over a period of years, you would be building the organizational capacity to insure you have the responsive resources to meet existing demand. that's simply not the way the department has historically been run. we have managed to a budget number instead. i can't answer your question as to what the specific budget request was in relation to what

was actually finally approved, but we'll take that one for the record and get you an answer. >> i appreciate that, and i appreciate your comment because that was my same response to secretary principi at the time, was i don't care how big of a budget increase you received. i want to know, are you taking care of the veterans? the outcome is so critical, and over the years, through several secretaries, i have sat here and listened to, i believe that they have always operated the department based upon the budget they had, not what they needed to take care of our veterans, and hopefully, that will change. >> well, if i may interrupt, sir, i committed to the president. i committed to employees at v.a., and most importantly, i have committed to veterans. i will not hold back. if i think resources are required, i'm going to ask for them. and i have told the internal

staff, don't you ask for one penny more than you can justify. you know, i'm not looking here for some kind of a blank check, but i'm not going to sit here, in my meetings with individual employees, as they raise issues about the needs that they have and the resources that they lack, you know, i have come to understand what my job is. my title may be acting secretary, but my job is to create the conditions for them to successfully meet the needs of the veterans that they serve. and that's what i'm obligated to do when i come here and sit in this seat. >> i appreciate that. do you think the business operating model that the v.a. currently operates is sustainable in the long term and getting to what chairman miller had mentioned, when you look at the fact that at the business level has exploded with management, and i think that the v.a. definitely has to be reorganized, and you know, in a better format. do you think the current business model is sustainable in the long term?

>> my sense is that there are -- my sense is there are opportunities for us to structure differently. i don't like bureaucracy, but i understand in an organization as large as this one, you've got to have some of it. the challenge is making it work for the people that are serving veterans day in and day out, and i dont think we're doing that very well. so i think there are opportunities. there has been concentration at the vizzen level and at the v.a. central office level. part of that, i would tell you, i think was positively done as part of taking and consolidating support activities either at that level or at the v.a. central office level where they can be performed more efficiently and effectively than scattered in 150 different locations, but that doesn't mean we've got it exactly right. there's still work to do. >> thank you, thank you, mr. chairman. >> mr. lam born, you're recognized for five minutes. >> thank you, mr. chairman.

thank you, secretary gibson for being here today. i want to follow up on something that was brought up earlier by chairman miller. very important issue that i would like to get more information on. it has to do with where you said in your statement, we don't have the refined capacity to accurately quantify our staffing requirements, and yet in your $17.6 billion resource requirement, you are requesting $8.2 billion for about 10,000 primary and specialty care physicians and other clinical staff. given that you said that the department is unable to quantify its staffing needs, how can a number like that even be arrived at? >> i'm going to let philip met kauvsky, who is intimately

involved in this, we have not been working to solve to requirements. i think earlier today, some of the staff participates and i think congressman win strm may have participated in a briefing we delivered about our opthemology specialty. inside the model when you look at some of the productivity tools we're rolling out, you get a good microcosm of what ultimately is going to give us the kind of granularity, you're going to find as we exercise the model, there are some locations that have enough staff. there are some other locations that may need some additional support resources, either some a additional support staff or space, and there are places where you look and say we have enough providers here, and it's going through that kind of bottom-uf, highly granular process that is going to give us the precise answer. we're working and doing that right now, but in the meantime, as we go out in the field, as i go out in the field and as we

look at top-down requirements it's clear to us that we don't have the resources we need. >> the one thing i will indicate is we try to use a bottom-up approach which is looking at veterans waiting longer than 30 days for care and processing that. we made certain assumptions about improving efficiency over the years and that thrust gave us the definition of the count of appointments we needed to accelerate and cost in the model, and we worked with the assumption in year one, we're going to do mostly of purchasing of care in the private sector because of staffing issues that would take time and then we would blend it over time and sustain it using internal staff, but the way we came about that is estimating the number of veterans and their appointments that wouldn't be delivered in a timely manner and costing that and turning it into the $8.2 billion. >> it sounds like it's a work in progress. and as you both are saying. so i question how specific you

can actually be. but a follow-up question is, are there a lot of slots that are sitting empty right now that you haven't been able to find someone to fill? either a doctor or other health care professional? >> i would say yes, there are thousands of vacant positions. all across vha, roughly 28,000 vacant positions. and in some instances, those aren't all being actively recruited to fill. i would tell you as part of accelerating care, we have been pushing on clinical staff and direct support staff to accelerate some of the hiring. >> my follow-up question there is if you have 28,000 minus x open slots, and you add 10,000 or so more open slots, are you ever going to even be able to fill those slots under current requirements? the current productivity requirements you have, which i understand from testimony is

different than in the private sector. >> organizations will always have some measure of organ ic vacancy rates. you'll have turnover in the staff, but what it allows us to do the raise to floor so that the floor of the fully incumbered positions grows with additional staff brought in, so i think there will be staff that leave the organization, people leave, they retire, they move on to other jobs. there will be a vacacy rate. right now, it's about 10%. and that sort of reflects the turnover rate. as turnovers occur, you have a certain vacancy rate. the other thing we're looking at at the same time is looking at our physician management practices. rather than hiring to vacancy, hiring to the requirement, which may require in certain places that we have fully incumbered staff as opposed to where we are today. to your point, i think the additional staff allows us to raise the floor of the onboard fte. >> thank you, mr. chairman. i yield back. >> thank you very much.

was mr. brown here? mr. brown, you're recognized for five minutes. >> thank you, mr. chairman, and i want you to know i was here before the chairman. i have been on this committee for 22 years, in fact, when i came, jesse brown was the secretary, and his motto was putting veterans first. and i have been through all of the secretaries. and you know, some of them left a lot to be desired, and some -- but the point of the matter is that i understand that v.a. has changed over the period of time. and at one time, we were serving a certain kind of veteran. now, we have expanded to the veterans. i don't want to say they're sicker. their conditions are different because of the war. they have come back with different ailments.

how can you plan for that? because they want their services at the v.a. i want to make sure that the v.a. is there for them. and it's a lot more complicated than what we're saying. because like you said, they have ten additional things as opposed to at one time, it was a lot more simple than it is now. >> we have an actuarial model to forecast. part of that looks at the past practice and forecasts into the future. that's part of it. the other part, i think, though, is to start introducing more bottom-up planning and having our field give us, if you will, the statement of requirements. so if this is the number of veterans that you think you can serve, i also think that and i neglected to mention this for congressman lamborn's question, if we improve performance, that is, if we are better at

providing high-quality and timely care, that's going to affect veterans coming to the v.a. they will come to us more if they can get care more timely. so having a bottom-up planning approach and working with our medical center leadership and our network leadership to give us a bottom up operating plan of what their financial requirement is in the out years will also help us be better prepared to adjust for where we're succeeding and when we succeed. >> and someone said that we've given the v.a. everything they have requested. now, i guess institutional memory should be important because i remember in 2007 and 2008, it was the first time the veterans were able to get the budget that they requested for budgeting. that was under president barack obama. i know i'm the only one that remembers that, but you know, it's important to remember how you got where you are. as we move forward. you need to remember that many

of us talk the talk, but we didn't walk the walk or roll the roll, so i think the walk or roe role. i think that's important for us to remember how we got where we are. and v.a., yes, we're having problems but we're not to the point that we need to destroy the system, and i feel very strongly about that, and i don't want to be the only one saying that the v.a. shouldn't -- i mean, i think we should work with community partners and community stakeholders and how do you feel about that? we have teaching hospitals that we should partner with. we could share equipment, but i still want v.a. to be in charge. >> yes, ma'am. as i travel around and visit v.a. medical -- >> you just returned foreign policy grainsville? >> yes, ma'am. and after medical center after medical center i'm impressed with the academic affiliations

we have with local partners in the communities and all the benefits, all the many benefits, the extraordinary care that's being allowed to be made available for veterans, the expert staff, clinical staff that we're able to recruit in part because of those -- because of those strong affiliations. it's one of our opportunities to continue to pursue. >> thank you very much and thank you for your service. >> yes, ma'am. >> i yeel the balance of my time, sir. >> you got 42 seconds. dr. rowe, you are recognized. >> thanks very much, mr. chairman and thank you, mr. secretary for being here today and thank you for your service in this tough time. i agree with your opening statement. i've said this in the very beginning. one of the problems the v.a. has that it did have was lost of trust, and i think ms. brown brought up the point a minute ago that a previous secretary and i've said this the very beginning, what the mow toe should be of the v.a. is we work for the veterans.

i don't wok for the v.a. i work for the veterans. that cultural change will help. one of the things i'm just not sure about having more people is going to solve the problem because when i came on this committee five and a half years ago, there were quarter of a million people that work for the v.a., 250,000 people and the number i saw in your testimony is 341,000. that's more people that work for the v.a. than any city in my district. it's huge, and i'm just not convinced in getting bigger is going to solve the problem. i think getting better will solve the problem and getting more efficient will solve the problem, but i don't think getting larger may make the problem worse. i honestly believe that. and when you see an office go from 800 people to 11,000 that's mind boggling to me, that that many more people could be needed when you don't have that many more employees. so i think -- i think you are looking internally. i truly believe that.

a question i have is you mentioned accountability, has anyone been held accountable yet and terminated? >> there were three actions that were announced dealing with phoenix back about two months ago. there's an additional individual that's been placed -- an executive manager who has been placed on a leave of absence. >> has anybody that doesn't have a job that had a job? >> there is -- >> it's called being fired. >> i understand what being fired means and i'm learning the hard way how you do that in the federal government. and so -- >> tougher. >> it starts when -- when you create this massive base of information that's documented. we just got -- i got the end of june, i got the first results from the ig, finally released on one location. a thousand pages of transcripts of sworn testimony and in the midst of all of that, there

still wasn't all the information needed so we had to dispatch additional investigators to go take additional testimony. we reviewed all of that. we pull email traffic, and then we go through the process of i have to delegate authority for a proposing official and a deciding official and they have to review all the information. there are two things going on right now in the accountability space. >> let me interrupt you because my time is short. you've just made my point. when you were in the private sector, did you have to go through a thousand pages and do all this to fire somebody? >> no. >> the answer is no, you didn't. so creating more inefficiencies in there, i think more people making this bigger, before we trim it down and make it better is not the right direction, and i want to -- very briefly, i don't have a lot of time left, but we're going to have to try to have make decisions, big decisions in the next week or so that involve a lot of money, the taxpayer's money and it's $17 billi

billion. i've asked every time do you have enough money to carry out your mission. how will i know that this is enough money? because i've voted for every single budget. that's one of things i'm never apologize for up here is to spend money on our receipt -- veterans. i absolutely would never do that. we would not have this country the way that it is, the way i enjoy and grown up if it were not for the veterans of this nation. that's not an issue, but i don't want to take the money that hard working people including veterans go out and pay taxes and not spend it wisely. so can you tell me how this $17 billion and that's 17,000 million dollars, where i'm from, that's a lot of money. >> a lot of money where i'm from too. >> how is it going to be spent and can i know is that it will

be spent wisely and would it be better to not take some of that money, but to veterans who want to, if a veteran says i would like to go see my doctor outside, just let that veteran do that, would that not be cheaper, the infrastructure is already out there, the hospital is already out there. we had those folks out there a week and a half ago today who expressed the desire to do that, and they had the capacity to do that. would it be more easier and more efficient to just do that? >> one of points made earlier was the fact that veterans are pleased with the care they go, once you get it, it's hard to get it. >> i agree they are pleased with the care they get in the private sector for the most part. >> the other thing that's been interesting to me is we've been working down these lists and we call veterans who have been waiting out for care, we ask them do you want us to refer you to community? sometimes the answer is yes.

but oftentimes the answer is no. i want to wait. >> i had a sergeant in my office this week. but he call the v.a. to cancel his appointment. he was open hold for two hours. two hours. he walk around his office doing his job, and then later, when he was -- when he had an appointment, you all have done something, i'll tell you at that because he said he got eight different phone calls from eight diven people about his appointment. now, is that efficient or is that inefficient? >> it doesn't sound very efficient to me, sir. >> i yield back. >> thank you very much. >> mr. secretary, is there a storage of doctors at the v.a. and if so, what areas are the shortages in? >> i would say the short direct answer is, yes, there are shortages and there are shortages in primary care and specialty care and mental health all three. >> mental health is a big

percentage of the shortage. i heard there's a problem referring people to specialists. what are the v.a.'s most successful recruitment tools and does the v.a. need stronger tools for recruitment? >> i think we have a number of very strong improvement tools. one of the areas where we have done a lot of work is in surgery. the surgery program has actually made significant use of infomatics to look at practice, process and to identify deficiencies. that program runs nationally and is able to actually support both at the regional level, recruitment -- one of the areas that had come up before, would we look to have a tuition reimbursement and other kinds of authorities like that provided and i think looking at costs, those are valuable, and i think

we need to look at extending those. >> recruitment is -- that kind of recruitment, tuition reimbursement, presupposes that there's a supply that's adequate to recruit from. we know that doctors are more likely to stay in practice in a place where they completed graduate and medical school education. gmes seem like one of the best recruitment tools the hospitals have. is the v.a. ewing gmes effectively. >> i think we are. where we have developed a strong academic affiliate, we have a good pipeline of quality providers who want to work in the v.a. they understand our mission. they love our mission and they come to work for us. >> would you welcome funding to expand the v.a.'s gme program. i know the v.a. has normally been 10 to 12% of graduate

school education, with medicare and medicaid have been taking 98%. we've been frozen since 1996. i think that is contributing to a storage of doctors generally. >> i have to look at that. conceptually, he would support t but i need to look at the details. >> do you think if we were to increase the number of graduate medical school education slots at the v.a. >> i think so. >> would the current fee basis system, has the lack of interoperable between the electronic records between the v.a. and non-v.a. been a problem? >> is the requirement that we have, we have the responsibility

to maintain continuity and coordination of care. it has, congressman takano. i think in some of our contract options, we have the ability to exchange electronic data. that's written into the contract. >> here's the thing. i think manufacture -- many of us support the idea of non-v.a. access, given our emergency situation, both public and private, we support that. a lot of us on the democratic side. but the concern about the solution that's the focal point of the funding, is the continuity? >> we are looking alt one of major contracts we have today to look at further making the data that we share back and forth computable. today it is not computable. when we have individual authorizations for fee care, it

will come sometimes in paper and we scan it. >> so we need more interoperability to make outsourcing for feasible. the interim ig said in the long run the best efficiencies for the v.a. are going to be own its own doctors and to keep care within its system. no system really, whether you are private or public, wants to outsource of out network care. there's usually a huge charge to go out of network. i think the v.a. has same sort of situation. in this emergency situation, we want to make sure that there is couldnntinuity of care. >> we think in terms of extraordinary geography, technology and demand. clearly in a period rhine of extraordinary demand that we're dealing with as we accelerate

care to veterans waiting too long. extraordinary geography, there's going to be communities where we can't justify building. we're going to have to provide timely and appropriate care for those veterans. there are going to be occasions where very highly specialized procedures that we're going to want to refer them out. >> we want to maybe set the parameters so it really is possible and really does work. >> correct. >> mr. chairman, i yield back. >> thank you very much, mr. florez. >> in your testimony, you said, quote, we will work hard to earn your trust, unquote, we being the v.a. and your trust being the trust of congress. your background and my background are fairly similar. we are both c level organizations in private sector organizations. you as chief financial officer and me as chief financial and executive officer. in those positions, we were

reporting to boards and was responsible for the organizations. let's say you are the ceo of a organization that has caused funding levels to be higher than were actually used, and those funds were reprogrammed to other purposes without letting the board know, and then you have a resource management system that accordingly to your own system is not accurate so in light of that what do you think the board's reaction would be if you go to it and say i need a whole bunch more money, and i'm only going to give you three pages to explain it? so that's so the first part of the question. the second part is wouldn't it have been much more wise to come

and say we need a small amount and we're going to many could back to you in a few months and show you what a great job we did with this small amount and then say in light of that we would like to make a larger request because we're on the the right track? so that's my first question. >> well, i think the sense is that we needed to provide, as the conference committee was considering other appropriations, we needed to provide our best estimate of the requirements to meet the current demand. >> you turned those requirements into a request. and i don't think that was wise. i think it would have been a lot smarter to koom back to us say this is the down payment we need and if we are successful in turning this around and putting veterans health care first, then we're going to come back for you and ask for x, y, z, but you asked for the whole enchilada at

one time. that's caused a lot of folks to look at that. let's go into a little bit more granular information. in the health care model that the v.a. uses, it's call the enrolling health care projection model. that takes into consideration a number of components, projected number of enrollees, workload, unit costs for providing the services, in fiscal 11 and 12 the v.a. used that for the sources for health care budget estimates. in 2014, it expanded the use to develop cost estimates beyond that. over the years, gao has identify many problems with that since it's not a very trustworthy product so that's an issue, and

now the administration is asking $17.6 billion, which is an unwise thing to ask. here are my questions, you can answer these supplementally hoel before the end of the day. number one was the chcpm used to clear out the current background lock from the v.a., why did the ehcph failed to effect the demand on the system, and is there a way it can be adjusted to incorporate wait times? should we continue to advance appropriate v.a. health care funding if clearly the method used to predict the funding needed to far in advance is not working? as i said earlier in my testimony, the v.a. overestimated and then used the funds for other purposes without talking to congress or its board, so the model just goes

all over the place. now you are saying that it needs $16 -- $17.6 billion. did you use that? >> indirectly. we used unit costs that were derived from the model but we look at appointment wait time and used the data that we had for veterans waiting for care greater than 30 days. that's different from the model. >> everything else was starting -- >> looking at the data that we had at the time. >> do you know why the ehcpm failed to pringt these estimates in the past? >> i don't know that it did fail to predict it. i would have to go look at the details -- >> the facts say it did fail. get back to us on that as well as my third question. i yield back. >> thank you, very much. ms. titus, you are recognized for five minutes. ms. titus, you are recognized. >> excuse me, mr. chairman.

well, i think we all agree that the purpose of these hearings and of your proposed reforms is to increase service to our veterans and to their families. these are services that they have deserved and i thank you, mr. secretary, for being here and all that you propose to make that happen. we have heard of all the many problems and if these problems exist generally for veterans, i think that problems are perhaps even worse for our lgbt and women veterans and that's where i would like to address my concerns. i will ask you, mr. secretary, do you believe that veterans and their spouses should have equal access to federal benefits through the v.a. regardless of their current state of residency? >> yes, ma'am, i do. >> well, i thank you for that answer and i ask you this because last month the v.a. announced that your agency has exhausted all avenues in the

wake of the decision by the supreme court in windsor versus the u.s. that struck down doma for giving benefits to our lgbt veterans. unless congress acts, those veterans who live in states who don't recognize their marriages would be denied access to their earned benefits, is that correct? >> that's correct, yes, ma'am. >> that's most unfortunate. because of that, i recognize that need and after the supreme court decision, i introduced hr 2529, that's a very simple bill that would correct that language problem in the statute. we had a hearing on that last march. nobody came forward to oppose it. we had vsos speaking in favor of it. nobody is working against it and i will ask you would you support our efforts here in congress to make that change so all our veterans who have all worn the

uniform, senkd the united states, could have access to those benefits? >> ma'am, i'm not familiar with the legislation specifically, but my own policy decisions at the department have been to provide equal benefits to all veterans to the maximum extent permitted by the law. >> and i thank you for that and our veterans do too. i'm sure. as for women, i would like to ask you about that. some of the recent reports have highlighted some very disturbing statistics about the low quality of care that our women veterans face and they are less likely to seek out care. they are often called our silent veterans. but when they do, we've found that the v.a. served 390,000 female vets last year, yet nearly one in four of the v.a. hospitals does not have a permanent gynecologist on staff, and one out of every two female veterans receive medication that could -- was determined could have caused birth defects, even

though they are at an age where they might want to have children. these are unacceptable statistics and they really address the question of quality of care. i sent a letter along with 50 of my colleague here in the house asking that this be addressed. i know you've been busy. i haven't heard back from you, but i wonder if you could speak to that this morning. >> well, i owe you an answer, first of all. apologies and we'll get you one. we are quite frankly playing catch up. the growth rate for women rad kael outstrips the overall number of veterans coming to the v.a. for care. we are doing things -- training existing providers, hiring additional providers, as well as -- i know what a big deal it is every time we're able to cut

the ribbon on a women's medical center, i always get invited. so it's a really big deal. we're playing catch up and we've got work to do that. >> i appreciate that. i thank you for your answers because sometimes we're looking at this in the big picture and we forget there are certain veterans who are perhaps being overlooked and i want our improvement of services to go for all of our veterans because they have all served and sacrifice the as have their families so thank you very much. i yield back. >> thank you very much, ms. titus. it looks like dr. benachec. >> thank you your story of coming in the interim like this and trying to pick up the pieces of a system that's obviously been under a lot of stress is

admirable and i appreciate what you are doing. i have a couple of quick questions. >> yes, sir. >> that i hope you'll be able to help me with. first of all, ij want to address the personal issue. you know the cbok in traverse city michigan has been scheduled to be increased in size for years. the money is in your department and all it needs is a signature to make that happen. my district has been waiting for this for years and the money has been appropriated and it's in the budget, but, you know, we've been trying to get this to happen for a long time, so i hope you can fix that. >> we'll dig into that one. >> well, i've been trying to get this to happen for a long time. >> i got to tell you when i'm out in the feel, i run in all kinds of instances where -- before i leave the room. >> i appreciate that you are out there yourself seeing what's

happening on the ground because, you know, my problem with management is that when somebody is sitting back behind their desk and lynning to their subordinates tell them how things are, that's when trouble happens and i think that's what happened in the past frankly here. now the question that we brought up and some of the members brought it up earlier what does the secretary need to do his job? you mentioned how difficult it is to remove people. so what would your recommendations be to -- what powers should the secretary have that he doesn't have now to make sure that change happens? >> that's not -- it's not an easy question to answer. i've said repeatedly, i will use whatever authority i've got and use it to the maximum extent that i can to hold people accountable. there are different proposals out there about granting additional authority to the secretary and if those -- and if those are provided, then we'll use them.

we recognize that to the extent that those are targeted solely at the department of veterans affairs, that has an impact over time. >> you are explaining a lot. but you are not giving me an answer. what do you need to make this happen better? >> you know, somebody asked a question earlier is that how it work in the private sector? i tell you, let's work like we do in the private sector, but that ignores a century of -- >> let's make a step forward. what would be the number one thing that you would recommend to make it easier for the secretary to do his job and promote accountability and action? >> well, i think the flexibility to expedite personnel actions, that would be a big deal. >> let me ask another question, and that is we're trying to get the patients off waiting lists and into the private sector. so, you know, my experience with

the v.a. is it's very difficult to make that happen because there's like so much paperwork that the veterans have to go through. what have you done in this emergency situation to make it easier for that veteran actually to get out into the private sector and make it happen and the guys get paid and it all is happening quickly? now, what have you actually done to make this happen? >> it's a good question. congressman benishek, one of things we've done. we've created these new tools. it helps us to oomt the documentation of the referral so that it occurs a little bit faster but what it also allows us to do for the first time we get to look at that referral through all of its stages and we get to manage to it, so we get to look at when was the referral created, when was it authorized, did we sit on it too long before rewe authorized. when was the schedule scheduled,

how much time passed? when was it delivered, and when was it returned. we still have work to do. >> what exactly are you doing to get these people off the waiting list and into the private sector? >> it's phone calls to veterans asking them if they would like to be seen in the private sector, if they would and we can coordinate with pc 3. we're using the pc 3 partners. >> it's not in place for the most part. >> not fully, but where it is, pc 3 will coordinate the appointments for us. if they know a provider, they will work with their own provider, if they don't, we will work with providers we have a relationship with. it's a scripted process. we still have a lot of work to do to get that done wrong. we need to look at that process from a veterans perspective, is it easy to understand and follow through. we have work to do that.

>> thank you. dr. reese, you are recognized. excuse me, ms. kirkpatrick, you are recognized for five minutes. >> thank you, mr. chairman. secretary, thank you for being here today. on monday i was out on the navajo nation in my district and talking with lots of folks. many of them live in areas with no cell phone coverage and broad band coverage. i know one of your goals is to expand telemedicine. in your budget, do you have money for expanding broad band infrastructure in those areas where we have veterans who have no access? >> i think it's one of the things we'll have to look at. in the supplemental requests we did have additional support for it to include hardware and band width for expanded care but i think we need to look at that specifically. i don't want to give you a false

answer. >> i would love to be part of that conversation as we continue on because it's going to be so critical to getting them the care they need. my other question is is for the secretary. i mean, you know, the inspector general's reports have been very valuable to this committee in trying to unravel the problems at the v.a. and come up with real solutions and just would like to know what you have done, what you have put in place since the interim report from the inspector general in may. >> there were a series of recommendations and findings in the report. many of them had to do with looking at the 1,700 veterans that they had turned up in their process. we have reached out to every single one of them. appointments for a thousand veterans have been scheduled as

a result of that particular process. there were recommendations in the report about producing the new enrollee appointment request report. producing that at the medical level and producing that out. that's happening. the near list has gone from 64,000, it was 2,100 the last time i looked, which is going to be the bottom of that. phillip, other items that i'm not remembering, it seems like there were one or two others. >> yeah. each one of them became a specific action plan. we've worked on them. we've i think closed them. we've implemented their recommendations in the interim. >> i've got it. there was also a recommendation regarding reviewing wait lists nationwide which obviously we do. we're producing them and publing

them. we've vig rosily produced every single one of them. >> i visited with a doctor at flagstaff medical center and they had entered into a contract with the v.a. to treat local veterans and they are very happy and pleased to do that. with that, i yield back. thank you, mr. chairman. >> thank you very much. dr. winstrop, you are recognized. >> thank you mr. chairman and mr. secretary for being here today and for your many years of service to our country in many ways. let's take the assumption that the goal of the v.a. is to see all those that are eligible for care as soon as possible and provide quality care. and that i think should be the assumption there. but what i find is that the motivational factors that are really need to accomplish this that and achieve that on a regular basis and comply with human nature don't really exist. in other words, the incentives

aren't necessarily there that would exist in the private sector, et cetera. and i'm curious how su propose in this mass bureaucracy that we're dealing with, how do we create an environment where truly seeing the veteran patient is an asset rather than a liability to the system. >> interesting way to frame the issue. as i mentioned in my opening statement, i -- i continue to believe when i go out to the field, it was in phoenix several weeks ago and visited with a roomful of employees, and you know, that is clearly our most troubled location, faced with what i have characterized as leadership failure,

mismanagement and yet person and person raised their habed hand and talked about the things they had to overcome in order to be able to take care of their veterans. i still find everywhere i go the vast majority of people care deeply about the veterans that we're serving and i would tell you if we didn't have that, i wouldn't have anything to reach in and grab hold of. being able to reach in there and grab ahold of the fact that they care, they want to do the right thing is the absolute -- is a critical, critical element of what we're doing. i would tell you other structural things and i alluded to it in my opening statement. i've got situations where quality of care at a medical center is declining and medical center directors are getting top box scores on their evaluations, and that was what prompted my direction to say we're going to overhaul the standard

performance contract for medical center directors and visiting directors because we're not going to have a contract where their result isn't aligned with the patient outcomes that we're delivering. i think it's going to take some of those kind of structural changes as well to ensure we got people focused on veterans. the last thing on this point, we're so focused on wait times and we think about how we gauge timeliness of access in the future, i think the centerpiece of that is going to be a much more robust focus on patient satisfaction. i think that helps us recenter back on the veteran that we're serving and not looking at wait times and the 700 other metrics that we got people trying to -- >> and those type of responses should be the driving force to whether someone gets a bonus or how they are compensated. >> yes. >> and inspector general complied to us as money over the last decade has increased, it led to more layers of

administrative aspects rather than actual care and that really is a concern. as you know, i had a meeting this morning with several members on measuring productivity and efficiency which we have done a couple of times with some of the doctors here. i think we're going in the right direction. i think there are some things missing, when you evaluate on rvus, what we're able to look at is how much we're paying the doctor per rvu. for example, if you have an old physical plant, you've got to take a look at how much you are spending for productivity in rvus in a plant that's costing you out of this world. you may be better closing that entire facility and putting everything in the community in that particular spot. we're not measuring that. those are the type of things we have to measure as well. when you talk about outsourcing and saying it costs, maybe it doesn't cost more if your physical plant is costing you so much more. those are business decisions and

that's got to be the approach. we can't assume that where we are is the best place to be always. so i'm going to continue to work with that group and with you, and hopefully we can see these types of changes and i appreciate with that i'm out of time and i yield back. thank you. >> thank you, ms. brownley you are recognized for five months. >> mr. secretary, the way i understand your proposal of the $17.6 billion is predominantly for additional space, additional personnel, professionals, and some money for i.t., and i certainly agree that in term of facilities and personnel, there's a need. my cboc in ox nard, california has you stated in your testimony

has had double digit increases each year in the last couple of years. and not much has been done over the last couple of years, i will add. i think what i have learned through all of the hearings that we've had that the care for veterans, once they get in the system, is pretty good. it's accessing the system is where we have seen it's truly broken. when i see the i.t. proposal, it kerps me. you did american off the shelf products that you are looking at. off the shelf technology that you are looking at. i really want to know, we got to fix the access part of this and i don't want to vest more money into a broken system. i want to invest money into new technologies and innovation and getting the v.a. into the 21st century much like the private sector is and the tools that they have to access a health

care system. so if you can just comment on that, please. >> first of all, i will say the majority of the i.t. resources as i understand the proposal here are associated with the activation of the facilities, so it's the i.t. infrom a structure that we need as we activate facilities and bring on additional clinical staff. there are a number of things under way to really take us into the 21st century here. part of it is the purchase of the commercial off the shelf scheduling system which is not included here. it's already provided within the core funding. there are other thing we were talking earlier about, interoperablity for purchase care. anything else to add, phillip? >> i would add a couple of items relative to i.t. part of it is we have a capital request in there.

we're requesting 12 to 13 million square feet for lease space, but we have to outfit to i.t. to make it useful, pc's, networks, telecomes. so that's built into it. it's not all just raw development work. it's what you need to make use of the space you get and to actually connect the staff you are hiring. you need i.t. to make that happen. so that's part of the request. >> so mr. secretary, then, in terms of off the shelf solutions that you are speaking of, what's the time frame in that? what are we looking at? >> sure. there are actually three or four different initiatives kind of parallel initiatives on the scheduling front. we have already let a contract to deal with some of the motion challenging aspects of the current system, and we're expecting those to begin to be fielded within the next six to twelve months. the timeline for the purchase of the commercial off the shelf

system is still a bit up in the air based upon the contracting approach that we're going to have to pursue there, but i think 2016 is probably the best case scenario for the introduction of that particular system. does that sound right, phillip? and so that's one of reasons we're going ahead to make the investments and fixes to the existing system so we don't wait two years to have that improved functionality. >> thank you. and very quickly in your opening comments as well, you talk about the vba and the improvements there. we also learned in our hearings that we've had a 2,000% increase in the appeals with regards to benefits, so when you add that together, to me, it gives me pause in terms of believing that we've made the improvement and if you could just briefly comment on that. >> sure, glad to. there has been this laser sharp focus on the disability claims

backlog. i perceive that walking in the door the morning of my third day at v.a. i was over at the white house talking about the backlog and vbms. so this laser sharp focus on the backlog, we've not been focused as we needed to do on nonrating claims and on appeals and on our fiduciary claims and that's what we're really talking about doing here, particularly with appeals, where the majority, 90% of the number of appeals that are in process sit in vba. we've allocated additional resources, thank you very much to congress's support to the board of veterans appeals which is helping us and we using some technology there to make them more efficient but we have work to do in the vba side to be able to provide more timely decisions. >> thank you. i yield back. >> mr. hulscamp you are recognized. >> i appreciate the opportunity to question the acting secretary

and i want to bring attention first to a very famous publication, life magazine, may 22nd, 1970, i presume you are somewhat familiar with this publication, and also the photo that gained much attention across the country of again, may, 1970, in which the v.a. was found to have abused the trust and neglected our veterans, and mr. gibson, i think we sit here today and that's the same topic. how are we going to restore the trust to our american veterans and to the american people and what i've heard from you today so far has been that we will spend, give you another $17.6 billion, somehow that will restore that trust and i don't think that does that for my constituents, certainly not for mir veterans and i know there are some very specific questions i would like to ask you.

first of all, have all secret waiting lists been eliminated and identified? >> to the best of my knowledge, yes, they have. >> you've identified at least -- identified those on the electronic waiting lists but my understanding there were 18 different schemes identified internally, you are absolutely certain that every one of those waiting lists have been identified. >> i don't know where that 18 comes from. >> that comes from the oig report. it came from your department. >> the ig is in 80 locations right now and i'm not privy so what they are fighting. that's why i say to the best of my knowledge, they have been uncovered. but until the reviews have been done, i can't tell you. >> how do we restore that trust if we don't know the extent of the problem? >> i think you start where you are. >> you start by spending money. >> no, you start where you are. you start by articulating expectations, but how we're going to operate.

you start by getting veterans off of wait lists and into clinics. you start by fixing the chronic scheduling problems that exist within the organization. >> how do we know we're achieving progress? what we've heard and i'm sure you are aware of numerous employees from the v.a. have come before this committee and identified fake data presented to this committee, and you come in here and present da it and say how we're making progress? how do we restore trust that we can actually believe the da that we're presenting to the committee? >> i will tell you when i directed all the medical center directors and visiting directors to go out and spend time in each of their clinic and engage with their schedulers, people have asked me, gee, that doesn't sound much like of a check and balance u.s. because they are in the inside. the real moesks behind that direction was for them to be out there on the ground and to take ownership for the quality of health care that's being delivered, including the timeliness of the health care -- >> the whistle blowers that i

hear from, i'm shot on time -- i'm short on time. we're saying that hasn't changed. >> we're coming behind that with a comprehensive audit from all the organizations. we need to restore that trust. >> has anyone lost their job for retaliating -- >> no, there is not. there are two whistle-blower referrals that have come from the office of special counsel. tuesday morning, i will have investigators on the ground pursuing those. >> how many ongoing investigations are currently under way for investigating these retaliation complaints? >> the number is 70 or something. the number is huge. >> we're going to hear about two and the other 68 are still ongoing. >> these are ongoing at the office of special counsel. i'm waiting for the office of special counsel to provide me the results of their investigation. i can't -- >> what are you doing about it? what we heard from whistle

blowers -- let me describe what we heard from whistle blowers. they said we get an email once a year that says we have a right to whistle blow and then we are faced retaliation. i'm hearing this still going on today. >> i have no doubt that it is. i can articulate over and over again the expectation that we're not going to tolerate that behavior but until i've got a set of facts that i can act on, i can't take the action. i can't take the personnel action. and so nobody is more anxious than i am to have that opportunity. that's why in fact this morning i checked again, have we gotten anything from the office of special counsel, the answer was yes, we just got two. tuesday morning, we'll have investigators on the ground. >> i requested in the last meeting, following the last meeting, information of contacts between the whistle-blower here that have contacted the chief of staff of the presidents. i don't believe we received that information. your department can look into that.

you have access to the information. you just need to call mr. nabors, that hasn't been looked into or responded to. these are very serious allegations, mr. secretary. i presume we're going to have a new second in a couple of weekends, but to come in and say we're going to restore the trust but we haven't addressed the whistle-blower problems because that's somebody else's jobs -- >> no, it's not. it's my job. ij can't action until i've got the results of the investigation. >> from the iog. >> or the office of special counsel. one or the other. >> have you issued any new statements to the v.a. system the information about whistle blowers? >> yes. >> thank you, mr. chairman, thank you secretary for your hard work. before i begin, i want to recognize a friend of all of ours, nancy brown park -- she's the national president of american legion women's

auxilia auxiliary, she's visiting. thank you for being here and thank you for all your hard work. [ applause ] >> recently, my office has really done an incredible, detailed, thorough investigation of the different issues that face our veterans, not only when i started office last summer, when we held community forums, stakeholder analysis, research, but also key stakeholder interviews, we underwent that again in light of this crisis. we have a veterans advisory board that is just top notch. we conducted surveys. we did more interviews and had multiple meetings with the v.a.

and v.a. administration. and we recently conducted this envelope survey of veterans in my district to assess their satisfaction with v.a. health care. our world means a world of difference to our veterans. we approach this with the spirit of partnerships with solutions. and we found, i'm going to give you some information, we understand there's some selection bias here. nevertheless, they tell a story. we found that the vast major of my district veterans who responded said they waited more than 60 days. of course, these are individuals who are upset and who are willing to conduct this survey.

more troubling, when asked what could be improved to better provide timely care, the vast majority again said, people who care. and we've heard that on multiple occasions. we also heard there's a culture where the v.a. system believes that perhaps it's about them. we need to change that culture to make at this more high performance veteran centered culture. the v.a. exists to honor, respect, and give dignity and care for our veterans who have put their lives at risk.

the veterans do not exist to serve the v.a. health care system. that is very important for that sentiment to penetrate every level of the v.a. health care system. now my question to you is what is the plan for a systemwide cultural change that will create a culture of high performance veteran centered system? >> i think as you look at culture change in an organization, the critical ingredient in all of my experience is leadership. part of that has to do with arctic lighting expectations and holding people accountable for their behavior. we're working hard to could the first part. we're working hard to get ready to do the second part, and we're

anxious to do the second part as well because quite frankly i think that's where we begin to get real traction. i would also tell you on the leadership part, i agree with you completely. i think we need -- there is a fundamental shift in culture that has to happen. one of the things that i talk about an awful lot internally is ownership really at all levels and we're talking about leaders not at top of the organization, but at all levels. taking ownership for issues that are getting in way in caring for veterans.

it's really about taking ownership and understanding that, you know, my job as i said earlier, my job is to create the conditions for them to successfully take care of veterans. >> i believe that is very important. that leads to a culture of accountability which we absolutely need. however, we need a veteran centered culture. so what are you being held accountable for? what are the snushlized -- institutionalized things being done? it can be done in a lot of different ways that focuses all of our eyes, our accountability, everything we do, strive for and exist even in our high

performance, is always answer the questions through the lens of the veterans. >> agree. >> thank you. i yield back my time. >> thank you very much, mr. ruiz. colonel cook, you are recognized, sir are for five minutes. >> thank you, mr. secretary. i appreciate you being here. we're talking about trust and confidence and i will be very honest with you. i've lost a lot of trust and confidence in the v.a. you know, when i was in a platoon, i felt very confident with the troops that i had, the company, the company commander, trust and confidence, battalion, all the way up there, and i'm trying to, you know, not let the events of the past influence my

judgment many about three months ago, i called one of the v.a.s. i'm not going to call as congressman cook. i'm not going to call as colonel cook. i said hey, this is paul cook. i'm on file in there. i just want -- i want to get an appointment. i couldn't even past the switchboard. okay? called the v.a., the regional office and told them about that. but i didn't -- there's part of me that wanted to go to war, if you will, but there's part of me that my office, they do a great job handling the veterans and i didn't want to endanger other cases that are on file. so anyway, i said to myself, okay, cook, what are you going to do? you are a dumb marine. so i said all right, here's what's going to happen. i'm going to walk into a v.a. and i'm going to try and get an

appointment. i'm going to bring my i.d. card. i probably will not show them first. ij want to give them my drivers license. they are going to look at it. right away they are going to see i'm older than dirt. but it will have my social security number on there, and what i want to know from you guys, if you can, what five questions should i have answered right then and there so i can go forward with the process? because if i think those questions are working, i'm going to spread that through every veteran that, hey, you go in the v.a., make sure you have blah, blah, blah, blah, and you ask these questions. because i'm going to say if they can't answer those questions, then we have a problem and we have to address it and i'll come back to you and here we go again. sorry. it's a long question, i guess.

>> i think to get care in a v.a., you should ask one question. am i enrolled? if you are enrolled, you should be getting care. the second questions would be what kind of care you would want. if you are not enrolled, the second question, how do i do that? i would like to get an appointment. >> just the next one. >> i would like to see the primary care provider, this provider, that's it. you shouldn't be asking any other questions. >> so two questions. >> or three questions. >> yes, sir. okay. i got acouple of questions. ig. how many of the ig visits are unannounced? >> i'm sorry, how many ig visits? >> are unannounced. >> i would say the large

majority. they don't know in advance that they are -- okay. >> oftentimes they are responding to a hot line call or something like that. i don't even know where the ig's -- >> i mentioned this before about the principle. this thing about managing by walking around. sometimes you walk into a battalion or what have you, you don't like to do that, when you have evidence that there's something going on with a unit. i walk in one time. i found a live mortar in place with the safety pin off. unbelievable, and yet when you come in like that, particularly if you are worried about an organization, based upon the statistics that have gone out there, so i don't know. i'm kind of excited about you being here. you answered your question. i still don't understand gra granul

granularity, and it's the third time i've heard it in committee the last two days. it took me a while to understand pseudomonas, and other bacteria. we're focused on it. it's about that culture of the military and we can never forget that. thank you. i yield back. >> thank you very much. mr. owe rork you are recognized for five minutes. >> thank you, mr. chairman. let me begin for thank youing for being here and amazing done you've done in two months as the acting secretary. you've been incredibly responsive, you've been transparent, and i believe you have defined a vision for excellence even in the first two minutes of your opening statement and my hope is that as we have a new secretary for the

v.a., that you will still be part of this organization at the very highest level, continuing that very aggressive, ambitious push toward excellence and accountability and changing this culture that all of us have been working on and talking about for so many months and in some cases years now. let me quickly switch to el paso and i rls it's -- real lies it's parochial. you visited 15 facilities. el paso was one of them. a command center was set up there within the last month. that shows us that you are taking this issue seriously, but it also shows us that we have a problem in el paso. the access rankings that we saw from the vha showed in june

showed out of 151 facilities, we were dead last, absolute worse for establish veterans for mental health care appointments, and second worse for speciality care. you in your some of your comments while you were in el paso talked about problems with the capacity of the facility that we have, the quality of the facility that we have. i would love for you right now to set about the timeo i'm going to help you with a full service veterans hospital. i'm not going to ask you to make a commitment that you cannot follow through on. will you work with me to ensure we can uncrease capacity and improve the quality and care in el paso and similarly poorly performing facilities in this country? >> i absolutely will.

el paso has grown almost 20% in the last three years. it's located in a medically under served market. we've got challenges as it relates to space and scope of services that we're providing organically in that particular location. and challenges in some instances in which you've helped us with in terms of attracting clinicians to work there. >> i told you friday i was going to call a psychologist who we were trying to recruit to el paso. when i was sworn in january of 2013, we had 19 1/2 vacancies, in el paso. as of last month, it's the same. i've been making recruitment calls. i spoke to a wonderful psychologist yesterday. a leader in pstd care. i learned because we are a clin being she will be a gs 13 most likely. that would be the pay scale. if they were coming to a hospital, she would be a gs 14.

i cannot blame her or anyone who would make a decision based on what they will be able to earn in a position given the fact that they are coming into a historically under served area. it's another piece of the case i'm making that we need a full service hospital in el paso. the chairman and ranking member raised a great panel last week. we talked about pstd and the need to do a better job of taking care of these service members when they come back, and the parents of daniel summers, dr. and mrs. summers also provided a potential solution or at least a suggestion for us to explore and that was in kind of picking up on something that dr. rowe said how we communicate with community care and private care, could the vha become a

similar of excellence for war-related injuries for survivors of ptsd, of tbi, of muscular skeletal injuries, and have community care for all other services? i'm not endorsing the idea, but i would love to get your thoughts and perhaps mr. matkovsky's thoughts. >> the first part question, should we become a center of excellence around a lot of those practice areas, i would tell you we either are or should be. those are instances where we need to have deep knowledge and expertise, but also exceptional capacity to be able to meet the needs of service members there. how that fits into a revised model of v.a. care delivery, you know, i don't know that i'm

ready to give you a view on that, but clearly in those particular areas and as i learned from my friends at pba, the things that v.a. has developed deep specialties are absolutely vital to our veterans. >> as i yield back, i ask that we continue to work together to explore this concept. perhaps the v.a. cannot be everything to all veterans and maybe we should focus on centers of excellence. with that, i yield back to the chair. >> thank you, mr. o' rourk. thank you, mr. chairman. i want to take a second and let you know why i'm stymied by this request for $17 billion because ij want to take you back how this started on the committee. i'm from the state of indiana. we have 6.2 million hoos yers

that live in the state of indiana. we have a half a million veterans out of 6.2 million people. our state is passionate and they are freedom fighters. we love the military. we embrace the v.a. in the state of indiana. we have the fourth largest national guard in the nation, a little state in the midwest, behind california and texas. we love -- we are patriots in our state, so i am passionate about this issue because i believe that when our little state, a half a million people answer the call and they heard a promise from this government, and i've sat here for 18 months with all of my fellow freshman on this committee and i still have for you today the original questions i asked when these hearings began because we've never got an answer from the v.a. and all we wanted to know, all i wanted to know was what is the status of my state? what's happening? with the clinics in my state. i've gone to several hospitals in my state. i have a hospital that's not even a fully functioning hospital. they don't even have an icu, so

if you are a have the ran that comes in, you are going to be looked at in the er and shipped across the street to a private facility and taxpayers are paying for blood. i went to another facility that this 2/3 beds empty. they showed up on the list of 122 original audits that the v.a. had additional questions from and the ceo personally told me he's never heard a word. nobody has ever checked with him. there's been no check. nobody has been fired. they are still harassing whistle blowers. there's been no checks. we don't know the status of our states. we can't get the answers to the questions that we started with, and i guess the question i want to ask you, but i'm almost mortified to hear your answer is when will we know the status of our states? i've asked those questions from day one, i'm sure. when are we going to hear the status of our states and please

don't tell up to counsel general and it's up to aig and everybody is cryptic and anonymous. >> myself and one of my fears will be conducting eight-hour briefings to one of the committees. we'll be sending that data out to the field as well. what we provide to you we provide to the facilities and the networks themselves. >> perfect. >> so monday and wednesday. >> yea! because that's been a huge concern. my second question goes back to representative brownley's. we sat here on many hearings on i.t. and your i.t., according to the hearings that we've had has been a disaster. there's been many breaches. the gentleman that was in charge of i.t. sat there and i said to him do you have enough money to do what you need to do to protect our va and to protect our veterans and to upgrade the systems that you need?

yes, ma'am. we find out during a subsequent hearing that -- and $17 billion request, that we have allocated long before i got here, this committee has consistently faithfully allocated all the money the v.a. i.t. department has asked for and then we find out a revelation in one of these hearings that they are using 1985 scheduling software. that's one of the most shocking revelations that i heard. where the billions of dollars, where did they go in this giant v.a.? they obviously weren't addressing i.t. and when you come to us and ask for $17 billion and nobody can answer the question why we're using antiquated equipment, the i.t. at the v.a. is a disaster, what is the answer to the question of how can we possibly trust you now even for another billion just for i.t. when all that money has