.. the department can and must be a force for that which is right. i hope that i have done honor to the faith that you have placed in me, mr. president, and to the legacy of all those who have served before me. i would also like to thank the vice president who i have known for so many years and in whom i have found great wisdom, unwavering support and a shared vision of what america, and should, be. i want to recognize my good friend, valerie jarrett, whom i have been fortunate to work with from the beginning of what started as an improbable

idealistic effort by a young senator from illinois who we were both right to believe would achieve greatness. i have had the opportunity to serve in your distinguished cabinet and worked with a white house chief of staff -- white house staff ably led by denis mcdonough. den has done much to make real the promise of our democracy. and each of the men and women i have come to know will be life-long friends. whatever my accomplishments, they could not have been achieved without the love, support and guidance of two people who are not with me here today, my parents nurtured and my accomplished brother william and made us believe in the value of individual effort and the greatness of this nation. my time in public service, which now comes to an end, would not have been possible without the sacrifices, too often unfair,

made by the best three kids a father could ask for. thank you maya, thank you brooke, and thank you clay. and finally, i want to thank the woman who sacrificed the most and allowed me to follow my dreams. she's the foundation of all that our family is and the basis of all that i have become. my wife sharon is the unsung hero and she is my life partner. thank you for all that you have done. i love you. in the months ahead i will leave the department of justice but i will never -- i will never leave the work. i will continue to serve and try to find ways to make our nation even more true to its founding ideals. i want to thankt dedicated public servants who formed the backbone of the united states department of justice for their tireless work over the past six years, the efforts they will continue, and for the progress that they made and that will

outlast us all. i want to thank you all for joining me on a journey that now moves into another direction but that will always be guided by the pursuit of justice and aimed at the north star. thank you.

that was yesterday's announcement at the white house with president obama and attorney general eric hold he with the president officially announcing that mr. holder will step down after six years as the nation's top law enforcement official. this morning he is set to lead off today's meeting of the congressional black caucus legislative conference. this is live coverage. a live picture from the washington convention center. it should get under way it in just a couple of moments here on c-span3. while we wait for this to start, earlier today we spoke with a reporter looking at the attorney general's resignation yesterday. >> miss johnson, you broke the story. how did you get the news that eric holder was resigning? >> i don't want to go too far behind the curtain, peter, but it's fair to say i've covered eric holder and his inner circle

for many years now, since he was the deputy attorney general in the clinton administration, and i remember his confirmation hearings to be attorney general, even from the very earliest days of this administration. he was a polarizing figure and a target for republicans. i remember the day in february 2009 when he re-entered the justice department as attorney general. an employee there who had been fatigued by some of the scandals in the bush administration greeted him with wild applause. of course, some of that early glow faded given the controversies on his plate as attorney general, but it's been a pretty remarkable 5 1/2 years or so of tenure. >> carrie johnson, was this unexpected? >> eric holder's been signaling for months and months now that he did not intend to serve a full two interprets as attorney general. he pointed out that one of his former bosses, janet reno, the

attorney general in the clinton years, did so and he thought that was a marathon enterprise. he did not want to serve a full eight years. of course, peter, the timing here is delicate because you don't want to leave with less than a year in the administration to leave the white house with the political problem of replacing you before an election. so holder figured now was the right time. he says he's going to stay until the senate confirms his successor which of course sets up a big battle between democrats and republicans on capitol hill over the timing of that decision. a battle that they started to engage as early as yesterday afternoon with charles grassley, the leading republican on the senate judiciary committee saying we don't want to have any confirmation hearing for a potential ag nominee during a lame duck session where pat tri leahy, the democrat who runs the committee saying this is too important to wait and we should try to handle this situation in the lame duck, if at all

possible. >> so what's your prediction? is it going to be lame duck or we going to wait for the new congress? >> what i was hearing from high levels in the administration yesterday was they hope this decision on a hold arer replacement will be ready within days or weeks, not months. but i don't think they've decided fully yesterday on a strategy. of course they've known, peter, since labor day weekend when holder and president obama at the white house had a long conversation about this that holder actually was going to go this year. so they have had some prior notice. they have a list, although the public list, of replacements is a relatively long one. i think the realist is much shorter. they're weighing now a number of factors such as who could be confirmed in a lame duck versus whether the senate shifts to republican control and that situation and calculation becomes more difficult in early 2015. >> so who's the front-runner, in your view? >> well, i think among the

leading candidates are people who are known quantities to the obama white house. they include don verile, the current solicitor general, the top representative to the supreme court. he's handled a number of difficult situations for this administration, including state secrets cases and very high-profile national security litigation. former white house counsel kathy remler who recently returned to private law practice but has been a star in the obama white house. and tom perez, the current labor secretary, peter, who previously ran the justice department civil rights division earlier in this administration. the civil rights division that represents a major part of eric holder's legacy. >> does this create a lame duck situation though for eric holder that he really is in a position now of not making decisions since he's already announced his resignation, or is he still

effective as attorney general? >> that's a great question. his aides labored yesterday afternoon to demonstrate that he is as engaged now as he has been over the past five years and they are teeing up a number of major announcements for the coming weeks, including a revision to the justice department's guidelines for the use of racial profiling in federal investigations, expanding categories beyond race to include sexual orientation and ethnicity and religion in some cases. those have been long awaited for more than five years. peter, we are also expecting more developments on holder's efforts to become smarter on crime, to produce lengthy prison sentences for non-violent criminals and to make sure that prosecutors are not using the threat of lengthy prison terms to defendants pleading guilty and waiving their constitutional

rights to trial. i expect more developments there. and potentially some news on long-running civil rights investigations, although it seems like it would be too soon for doj to conclude their investigation of what happened in ferguson, missouri, earlier this year. >> carrie johnson, of npr, who broke the news on eric holder's resignation. thanks for being with us. >> my pleasure. thank you. in a moment we'll hear from the attorney general this morning as he speaks at the congressional black caucuses legislative conference here in washington, d.c. it's taking place at the washington convention center. we will have more from the cdc this afternoon with a discussion with minorities and law enforcement. that's set to start at 3:00 p.m. eastern here on c-span3. now also, right now on c-span2, live coverage of the family research council's annual values voters summit. that will be live until noon eastern with speeches by senators ted cruz and rand paul. congresswoman michele bachmann and then in the afternoon session, which gets under way at

2:00 p.m. eastern, former senator rick santorum, sarah palin and rush limbaugh. all of that live on c-span2.

good morning. thank you all so much for being here. we know it is early on a friday morning, but we want to start. we know that we are going to be joined by many of the people but we want to get started to respect your time. first off, i'm congresswoman

marsha fudge. this is the brain trust that i am honored to host today. this has been hosted by mel watt for almost 20 years. now that he's the head of fhfa, i am filling in for him today so let's give mel watt a hand for all that he's done over all these years. we have some students here this morning, some of the very first people who were standing in line. i want to recognize the students from kitt d.c. prep school and middle school. as well as cesar chavez public charter school for public policy. cesar chavez. thank you all for joining me at this annual a. leon higginbotham voting rights brain trust. nearly half a century after the

voting rights act, we still must fight to ensure everyone has the right to a free an fair vote. today you will hear about some of the challenges we face, including suppressive state legislation and supreme court decisions like shelby v. holder. in my home state of ohio the republican-led assembly attempted to limit early voting. we know that early voting contributed significantly to the election of president obama in 2008 and his re-election in 2012. according to a report by the lawyers committee on civil rights, approximately 78% of all early voting balance lots in the country were cast by african-americans. ultimately, conservatives in ohio were not successful in restricting the amount of early voting days, largely because of the advocacy of local and state officials and the efforts of organizations like the naacp and

the advancement project. earlier this month a federal judge ruled in naacpv.hustead that the legislation violated the voting rights act of 1965. to those of you watching live stream or following global grind's live tweets and to all of you here in washington, d.c., we must combat ill-advised conservative-led state legislation by encouraging every eligible person you know to vote. every seat in the house of representatives and more than -- and the control of the senate are at stake in this election. we cannot let those who try to suppress our voices win. i cannot stress enough how important this november election is and that is why i will personally be traveling across the country to galvanize our voter days and education them on issues impacting their lives. you can do your part. frederick douglas said you power concedes nothing without demand.

it never did, and it never will. find out just what people will quietly submit to and you have the exact measure of the justice and wrong which will be imposed upon them. it is my pleasure, and my honor, to have the united states attorney general, eric holder, as our featured speaker this morning. attorney general holder has a long and distinguished career in law. he has been nominated to positions by three different presidents. in 1988, president reagan nominated him as an associate justice of the superior court of the district of columbia. in 1997, president clinton named him to be the first african-american to serve as a deputy attorney general. and lastly, he was nominated by president barack obama as the 82nd attorney general of the united states. attorney general holder is a champion for social justice, often taking heat for his

efforts to preserve the sanctity and protect the security rights and interest of all americans. please join me in welcoming united states attorney general eric holder. thank you. thank you. and good morning. thank you, congresswoman fudge, for those kind words. thank you all, not only for that warm welcome, but thank you all for your steadfast friendship over the years. we have a lot of members of the cdc here, people who have been

friends in times good and bad, who have been great partners on the many critical challenges that we have all faced together. and i want to thank them for their tireless efforts today and every day on behalf of those whom the law protects and empowers. i've been privileged to work with many of you throughout my tenure as attorney general which has not ended. okay? let's just make that clear. it has not ended. i woke up today and i was still the attorney general of the united states. i am deeply proud of all that we have achieved together. although my time at the justice department will draw to a close in the coming months, once my successor has been nominated and confirmed, i want you to know that my commitment to this work -- my commitment to this work -- will never waver.

in the meantime there remains i think a great deal that needs to be done. i have no intention of letting up. i have no intention of slowing down. i am honored to discuss our ongoing efforts with you once again today. i am proud as ever to stand with sole. dedicated public servants devoted advocates, and passionate leaders of our ongoing fight for equal rights and for equal justice. i particularly would like to thank the congressional black caucus foundation for organizing this important event and for your decades of selves in our struggle to secure the civil rights of everyone, everyone, in this country.ves in our struggle to secure the civil rights of everyone, everyone, in this country.rves in our struggle to secure the civil rights of everyone, everyone, in this country. many years ago during my first days here in washington, d.c., i had the opportunity to attend my first congressional black caucus dinner with my aunt. i tell you how long ago it was in the sense that i didn't have my own place.

didn't own a television set. i didn't -- i had to sleep on beds that she had. i was a young lawyer. that was a long time ago. the president was not lincoln for those of how were thinking that. it wasn't that long ago. but my experience at that first dinner was, in many ways, a foundational experience for me. and in the years since then, i have been consistently inspired by the caucuses' leadership over the years from education to health care, to economic development, and our efforts to address racial disparities and to reform injustices, you've advocating for understanding and to build a more just society. as you know, this year marks the 50th anniversary of the landmark civil rights act of 1964 which president lyndon johnson signed into law to codify, vital and long overdue protections for all

americans. in the decades since then, thanks to leaders like you, our nation has made remarkable, once unimaginable progress, in expanding opportunity, overturning legal discrimination and expanding access to the ballot box for every eligible citizen. now all of this progress, all of this progress is laudable and all of it is worth celebrating. yet there can be no question that as we gather here today in washington, d.c. in 2014, there is a great deal of work that remains to be done. not only to defend those advances, but to expand on the progress of our forbearers and to continue the march that they so courageously began. over the past six years, my colleagues and i have proven that at every level of today's united states department of justice and at every part of the barack obama administration, we are firmly committed to doing our part.

as part of the smart on crime initiative that i launched just over a year ago, we have implemented important reforms and evidence-based strategies to make america's criminal justice system both more fair and more effective. with the national initiative for building community trust and justice which i announced earlier this month, we are striving to eliminate mistrust and to build strong relationships between law enforcement officers and the communities that they serve. diffusing tensions just under the surface on too many cities and towns across our great country that too often give rise to tragic events like those that captured our national attention like those last month in ferguson, missouri. beyond these efforts, as part of president obama's my brother's keeper initiative we are working together to address persistent opportunity gaps faced by boys and young men of color and to ensure that all young people can

reach their full potential. in fact, i can announce today that we stand poised to take this work to a new level and to complement our data-driven approach under smart on crime and my brother's keeper by launching a new smart on juvenile justice initiative which will promote system wide reform and bolster our efforts to end racial and ethnic disparities. under this new initiative, three states -- georgia, hawaii and kentucky -- are work ing with te pew charitable trust public safety project to provide diversion alternatives, community based options and other reforms aimed at reducing recidivism, decreasing correctional spending, and improving public safety. all while reducing the number of youth who come into contact with

the criminal justice system. now to support this work, i'm pleased to announce that our office of juvenile justice and delinquency prevention is awarding funding to the crime and justice institute to provide training and technical assistance that will help these three states implement important policy changes. in addition, we are awarding more than $1 million to the w. haywood burns institute and the development services group to reduce racial and ethnic disparities throughout our juvenile ju juvenile justice system. it is time to focus on our juvenile justice system. with a third set of smart on juvenile justice apart we are concentrating on training for juvenile justice prosecutors to acquaint them with the very latest information on forensic science, adolescent development, neuro sciences and the prosecution of sexual assault

cases. now these are, i think, promising new steps that will help to advance this very important work, and in many cases work that is life changing, work in our juvenile justice arena. these efforts go to the heart of who we are and who we aspire to be, both as a nation and as a people. but as this group has, i think, rightly recognized over the years, and as you re-affirmed today by convening this very, very critical forum, few of the challenges that we face as a country are more fundamental, more complex, or more urgent than the need to preserve what president johnson once called the most basic right to which every american is entitled -- the right to vote. as you're discussing through the unrelenting -- as you are discussing through the unrelenting efforts of the justice department civil rights division under the leadership of acting assistant attorney

general from whom you'll hear later in the afternoon, my colleagues and i are acting aggressively to ensure that every american, that every american, can exercise his or her right to participate in the democratic process. unencumbered by unnecessary restrictions that discourage, that discriminate, or that disenfranchise in the name of a problem that doesn't exist. we are advancing this fight, as we speak, along a number of fronts and communities across the nation. this work has been a top priority since the moment i took office near ll lly six years ag these efforts i think show significant promise. for instance, just this week a federal appeals court in cincinnati held that plaintiffs challenging the state of ohio's changes to its in. hearn early voting rules likely will be able to prove that those changes are unconstitutional. this outcome was a milestone in the effort to protect voting rights even after the supreme court's deeply misguided, flawed

and unwise decision in shelby county. the justice department filed an amicus brief supporting those who brought this challenge under section 2 of the voting rights act. the appeals court ruling means that early voting can begin in ohio on tuesday just as it had in prior election cycles. separately in wisconsin, we are carefully monitoring a challenge to that state's voter identification law. although we were disappointed by the 7th circuit's actions two weeks ago to lift the stay and allow the law to go into effect, we look forward to reviewing the court's reasoning when it issues an opinion. in texas we are currently awaiting a ruling on the department's challenge to certain of the states' redistricting maps which were found by federal court to be

drawn with discriminatory intent. closing arguments concluded on monday in our challenge to the texas voter i.d. law which our experts found likely to disenfranchise hundreds of thousands of eligible voters who lack the requisite identification. finally, just yesterday in a case that's pending in north carolina, the 4th circuit heard oral arguments in a challenge to that state's voter i.d. measure. we joined several groups last year in challenging that law, and although we did not prevail at the preliminary injunction phase, we believe that the evidence at trial next summer will show a violation of the voting rights act. of course, these are only the most recent and the most visible actions that the justice department has taken to protect the voting rights of every eligible american.

earlier this week the department helped secure a victory in a case brought to ensure that the voting rights of alaska natives obtaining an order that effectively overhauls the entire election system to make sure that all information is translated into native languages that every village in the region is covered, and that official election pamphlets will be translated in writing. now this landmark result is emblematic of our continuing broad-based commitment to stand for expanded access and against disenfranchisement whenever and wherever it plays out. as we look forward to the future of this work and seek new ways to advance this struggle, the justice department will remain determined to use every tool at our disposal to secure the rights of every citizen. we will continue this fight until all americans have equal access to the ballot box, no matter who they are and no matter where they live. we will continue our efforts

until all americans share the same opportunities for engagement in the democratic process. and we will continue to look to groups like the cbc for leadership to advance the voting rights act amenities and to continue your efforts until all americans can make their voices heard in the halls of the federal government. and when i talk about all who want to be heard in the halls of the federal government, i am including the more are than 600,000 taxpayers who, like me, like me, live in the district of columbia and still -- 600,000 taxpayers who, like me, live in the district of columbia and still have no voting representation in congress. we pay our taxes. we die in the army. we have a great representative and we do not have voting rights. it is long passed time for every

citizen to be afforded his or her responsibilities as well as our full rights. in the months ahead, as we prepare for the upcoming elections, leaders from the civil rights divisions voting section will be coordinating with civil rights organizations, u.s. attorneys, and others to dispatch federal election monitors to polling places around the country just as we do during every election season. we're not stopping because of shelby county. our people will be in the field. we will never waver and never rest in our determination to improve the integrity of this vital process. despite the myriad challenges that lie before us and a long march that still stretches out ahead, i'm really confident that with the passionate advocates in this room, with the lasting education of justice department

officials across america and with the advocacy and engagement of public servants like all of you together we will carry on the fight for equality. we will build upon the progress that has led us to this moment and we will extend the legacy and the proud record of achievement that has been encrusted to each of us by generations that have gone before. this is the imperative that has driven me over the last six years and that will continue to shape our steps forward. i want to thank you all once again for your partnership and for your leadership of these important efforts and i look forward are to everything that we will do together and everything that we will achieve together in the months and years ahead, no matter what might path will be, no matter where i will be. this promising journey will continue. our cause is just. our mission is clear. our history propels us.

so let us act together to make our nation, to make our union, more perfect. thank you. >> outgoing attorney general eric holder. we will have more from the cbc this afternoon with a discussion on minorities and law enforcement. that's set to start at 3:00 p.m. eastern here on c-span3. also, president obama will address a cbc dinner tomorrow night. check c-span.org for coverage. we're live this morning from the family research council's annual values voters summit. it's happening here in washington, d.c. coverages continues until noon eastern. among the speakers, senators ted cruz and rand paul and congressman michele bachmann and the afternoon session starts at 2:00 p.m. with former senator rick santorum, sarah palin and rush limbaugh. all of that live on c-span2. during campaign 2014 we're

covering 100 debates for the control of congress. we are covering this afternoon one for oregon's governor. here's a preview. >> in oregon the democratic governor is facing another debate with husband republican challenging. chris lehman is on the phone. he's following the race for public broadcasting. thanks for being with us. >> you're welcome. >> how would you size up the race? what does the governor bring to the campaign and tell us a little bit about dennis richardson? >> both of these candidates are political veterans in oregon. john kitzhoffer was elected twice in the '90s as governor after a long career in the state legislature. he was term limited, then came back and won a third term in 2010, now going for a fourth term. nobody has ever done that in oregon before. is he a former er doctor and

long-time democratic politician in oregon. he has been running recently as a centrist candidate and tried to talk about his ability to reach out to republicans and come together to find agreements on issues, including education and health care. he's been criticized for his handling or perhaps lack of oversight with the state's health insurance exchange which had a troubled rollout. generally speaking he has fairly solid democratic credentials and expects to do quite well in the upcoming election. dennis richardson is a long-time state representative from southern oregon and a republican. those are two marks against him politically speaking, number one that he's from outside the most populated area of the state. and number two, that he is a republican. no republican has been elected governor of oregon since 1982. that was the last time that happened. there are no republicans holding any state wide office currently

in oregon. obviously richardson, as a republican, and as somebody who is not very well known on the state level despite his terms in the state house, he has an uphill battle ahead of him. >> we have been tracking some of the ads in this race. has it been particularly negative from your standpoint? >> this has not been an overly negative campaign so far. of course there's still over a month to go. i say that in part comparing it to our u.s. senate race which has gotten fairly nasty. the governor's race so far -- first of all, there really haven't been a lot of ods at this point. i think we can expect to see a lot more in the coming months. both of these candidates are very good at talking policy and them have a tendency to do it in a sort of walkie kind of way. put them together in the same room, both of them will probably

try a zinger or two, but they're probably going to stick fairly closely to the issues and have a fairly civil discussion of them. >> oregon is unique because it's the one state that has mail-in voting. so explain for the rest of the current how that works and what that means in terms of overall voter turnout. >> you might think of it as permanent absentee balloting in the sense that everybody gets their ballot delivered to them through the mail. and so you have about three weeks or so from the time you get your ballot until the time that you have to turn it in. and so you can fill it out in the comfort of your dining room or whatever. you can mail it back in or if you don't want to pay for a stamp, you can drop it off at some local elections office. you know, it's fairly easy. you don't have to request the ballot be sent to you. you just automatically -- it just automatically comes to you and there are no voting booths

on election day. in fact, we almost don't even refer to election day as much as we call it the deadline to cast a ballot in oregon because your vote counts just as much whether you send your ballot back in the very first day you get it or whether you wait until the end. one thing you have to be careful of is that postmarks do not count so if you put your ballot in the mail on election day, it's not going to be counted because obviously it won't arrive at the elections office until at the very earliest the day after the election. so you do have to watch for that if you're getting close to the end, you're recommended not to trust the postal service to deliver it in a day or two but instead to drive it down to the elections office, which quite a lot of people do. >> bottom line, what is the race all about? what's the race for the governor's claim to seek a fourth term, what's he telling voters and the claim by dennis richardson who i know in your story pointed out he's hoping the public is tired of the

governor. >> it is certainly true that the unemployment rate has lowered since the time that the governor came into office four years ago and he says he's got the experience to carry the state forward for another four years. he does acknowledge that the rollout of the health insurance exchange wasn't the most brightest moment for the state, but he says that despite the website that never did work properly, some people -- a lot of people in fact that did manage to sign up for health insurance that didn't have it before and through pen and paper and other methods. and he says that was the result of some of his policies. dennis richardson says, well, we could have done things a little bit better. he points out the $250 million or so taxpayer money that went towards this website that didn't

really work. that website is cover oregon. it is the subject of some lawsuits right now between oregon and its technology vendor oracle. i think dennis richardson is portraying himself as a more involved hands-on governor. he says he would actually live at the governor's mansion. that's something that the current gopher doesn't do most of the time right now. he just portrays himself as a more pragmatic problem solver type of person who, by the way, is also a social conservative which is something that's probably going to cost him some votes in the more populated and liberal parts of the state. >> chris lehman joins us from salem oregon with northwest news network in oregon public broadcasting. thank you very much for being with us. >> sure. you're welcome. again, you can see the jjurj debate today at 2:00 p.m. eastern on our companion network, c-span.

this weekend on the c-span networks, tonight in prime time on c-span, the values voter summit. featured speakers include texas senator ted cruz and kentucky senator rand paul. saturday night at 8:00 p.m. eastern, a national town hall on the critical and historic impact of voting. and sunday evening at 8:00 on q&a, "washington post" columnist sally quinn. tonight on c-span2, just before 9:30, daniel green and william mullen, two "operation iraqi freedom" veterans talk about their experiences in iraq, isis and the use of american force. and saturday night at 10:00 on book tv's "afterwords," pulitzer prize winning reporter matt richtel. sunday, the ninth annual brooklyn book festival. tonight at 8:00, on c-span3,

former chiefs of staff and advisors talk about the relationship with the commander in chief and how he makes important decisions. saturday night at 10:00 p.m. eastern, author jonathan white on the role of the union army in abraham lincoln's 1864 re-election. sunday afternoon at 8:00 p.m. eastern, author annette dunlap explores the he have been lugs of first ladies' fashion. follow our television schedule at c-span.org. call us at 202-626-3400 and let us know what you think about the programs we share. last week the house veterans affairs committee held a hearing analyzing the findings of the inspector general's final report on the phoenix va health care system. the investigation identified 40 patients who died while awaiting

appointments in phoenix but found there was no conclusive link between delays in care and veteran deaths. t representative jeff miller of florida chairs this committee hearing. good afternoon. this hearing will come to order. i thank everybody for attending this hearing which will examine t the oig report on the phoenix issue. i would also like to ask unanimous consent. he's not here yet but that our

colleague from arizona be allowed to join us here to address this issue. without objection, so ordered. also, members, we do have a series of votes that will start at 1:00. i apologize for that. this hearing was moved from its original scheduled time because of the joint session of congress to hear the president of the ukraine. what we will do is immediately after the final vote move back as quickly as you can. we will resume the hearing as quickly as we possibly can so that we will not keep the witnesses waiting any longer than absolutely necessary. on the 26th of august, the va office of inspector general released its final report on the phoenix va health care system which vaulted to national attempt after our hearing on april 9th. oig confirmed that inappropriate scheduling practices are a

nationwide systemic problem and found that access barriers adversely affected the quality of care for veterans at the phoenix va medical center. based on the large number of va employees who were found to have used scheduling practices contrary to veterans health administration policy, the oig has opened investigations, as i understand it, at 93 va medical facilities and have found over 3,400 veterans who may have experienced delays in care from wait list manipulation at the phoenix va medical center alone. the oig concluded by providing the va with 24 recommendations for improvement to avoid these problems from reoccurring. these recommendations should be implemented immediately and this committee will work tirelessly to ensure that they are in fact implemented. mr. griffin, i commend you, sir,

and your team for your work and continued oversight on these issues in the past and in the months ahead. with that said, and as we have discussed, i am discouraged and concerned the manner with which the oig report, the final report, was released, along with the statements contained notably prior to the release of the report. selective information was leaked to the media, apparently by a sos source internal to va which i believe pupsly misled the public that there was no evidence at phoenix linking delays in care with veteran deaths. as the days progressed and people actually read the report, that falsehood actually became obvious. what the oig actually reported and what will be the subject of much discussion today is the

statement by the oig, "we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans." what's most concerning to me about this statement is the fact that no one who dies while waiting for care would have delay in care listed as the cause of death since a delay in care is not a medical condition. following the release of this report which found pervasive problems at the facility regarding delays in care and poor quality of care, committee staff was briefed by the oig regarding its findings and how specific language was chosen throughout the entire drafting process. prior to this meeting we requested that the oig provide us with the draft report in the form it was originally provided to va three weeks before the release of the final report. after initially expressing

reservations, the oig providing us with the draft. what we found was that the statement that i just quoted was not in the draft report at all. another discrepancy we found between the draft and final reports arose with statements to the effect that one of the whistle blowers here today did not provide a list of 40 veterans who had died while on a waiting list at the phoenix va medical center. first the oig stated in the briefing to the committee staff that va inquired why such a statement was not in the report. and the oig ultimately chose to include it. further, additional information provided by the oig to our committee staff shows that based on numerous lists provided by all sources throughout the investigation, the oig in fact accounted for 44 deaths on the electronic wait list alone, and an astonishing 293 total veteran

deaths on all of the lists provided for multiple sources throughout this review. to be clear, it is not, nor was not, my intention to offend the inspector general and the hard working people within the agency that he employs. however, i think i would be remiss in my duty to conduct oversight of the department of veterans affairs if i did not ask these questions. i would also like to point out that no one within the department or any other federal government employee, including members of this committee, is beyond having their record scrutinized. as such, the committee will continue to ask the questions that need to be asked in order to perform our constitutional duties. it is absolutely imperative that the oig's independence and integrity in its investigation be preserved. full and transparent hearings like this one will help ensure that that remarns the case. with that i now turn to the

ranking member for his opening statement. >> thank you very much, mr. chairman, for having this very important hearing. i would like to thank all the panelists for coming today as well. today's hearings opportunity to examine the va inspector general's final report on the patient wait times and scheduling practices within the phoenix va health care system. this report did not state a direct casual relationship between long patient wait times and veteran deaths. for some, that is a major concern, and accusations of undue influence by the va on the inspector general's report will be discussed at length today. what the ig did find is that the cases included in this report clearly shows that there were serious laps in v.a.'s follow-up, coordination, quality, and continuity of care for our veterans. they also concluded that the

inappropriate scheduling practices demonstrated in phoenix are a nationwide systematic problem. i do not need any more evidence or analysis. there is no doubt in my mind that veterans were harmed by the scheduling practices and culture at the phoenix facility and across the nation. the bottom line is this behavior, and its detrimental effect on veterans, is simply not acceptable. my heart goes out to the families of the veterans who did not receive the health care they deserved in phoenix and around the country. rest assured, we will understand what went wrong, fix it, and hold those responsible for these failures accountable. as such, my questions to the va today is straightforward, what went wrong, what are you doing to fix the problem, how will you ensure that this never happens again, and how are you holding those responsible accountable?

i applaud secretary mcdonald for taking forceful action to begin address the systematic failures demonstrated in phoenix. we need serious, deep and broad reform, the kind of change that may be uncomfortable for some in v.a., but so desperately needed by america's veterans. i believe that such reform must be guided by a higher-level national veterans strategy that outlines a clear vision of what america owes its veterans, and a set of tangible outcomes that every component of american society can align and work towards. earlier this week, i sent a letter to president obama asking him to establish a working group to engage all relevant members of the society in drafting this national veterans strategy. r(t&háhp &hc% we must develop a well-defined

idea of how the entire country government, industry, non-profits, foundations, communities and individuals will meet this obligation to our veterans. v.a. needs to become a veteran-focused, customer service organization. it needs to be realigned to become an integrated organization. it should do what it does best, and partner for the rest. it needs to be the government model for honesty, integrity, and discipline. we need to complete our investigation of these problems, and provide oversight on the solutions. i look forward to today's additional testimony about what happened in phoenix, and how the v.a. is working to ensure that it never happens again. so once again, mr. chairman, i want to thank you for having this hearing. i yield back the balance of my time. >> thank you very much. i would ask that all members waive their opening statements as customary in this committee. thank you to the witnesses that

are here at the table, and those who agreed to set behind the principles. today we're going to hear testimony from acting inspector general richard griffin who is accompanied by dr. john daigh jr. assistant inspector general for health care inspections. mrs. linda holliday, assistant inspector general for audits and evaluation. maureen regan, counsel for the inspector general and larry rinkmyer, director of the kansas city office of audits for the office of inspector general. we are also going here from doctor samuel foote, former va physician at phoenix the health care system, and doctor catherine mitchell, current whistleblower and medical director for the iraq and afghanistan post-deployment center at the phoenix va health care system. i would ask the witnesses now to please stand so that we may swear you in. if you would, raise your right hands. do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth and nothing but the truth?

thank you. you may be seated and let the record reflect that all of the witnesses affirmed that they would, in fact, tell the truth, the whole truth and nothing but the truth. all of your complete written statements will be made a part of this hearing record, and mr. griffin, you are now recognized for five minutes. >> mr. chairman, ranking member michaud, and members of the committee, thank you for the opportunity to discuss the results of inspector general's extensive work at the phoenix v.a. health care system. our august 26, 2014, report expands upon information previously provided in our may may 2014 interim report, and includes the results of the reviews of the oig clinical staff of patient medical records. we initiated our review in response to allegations first

reported to the oig hotline on october 24, 2013, from dr. foote, who alleged gross mismanagement of v.a. resources, criminal misconduct by v.a. senior hospital leadership, systemic patient safety issues, and possible wrongful deaths at phoenix. the transcript of our interview with dr. foote has been provided to the committee, and i request that it be included in the record. >> without objection. >> we would like to thank all the individuals who brought forward your allegations about issues occurring at phoenix and other v.a. medical facilities, to the attention of the ig, the congress, and the nation. on august 19, 2014, the chairman of the subcommittee on oversight and investigation sent a letter to the ig requesting the original copy of our draft

report prior to v.a.'s comments, and adopted changes to the report. on september 2 a committee staff member at a summit request for a written copy of the original unaltered a draft as first provided to va on behalf of the chairman. concerns seem to come from our inclusion of the following sentence at a subsequent draft report that was not in the first draft report we submitted to v.a. the sentence reads as follows. while the case reviews in this report documents poor quality of care, we are unable to conclusively assert that the absence of timely care caused the death of these veterans. this sentence was inserted for clarity to summarize the results

of our clinical case reviews that were performed by our board-certified physicians, whose curricula vitae are an attachment to our testimony. it replaced the sentence, the death of a veteran on a wait list does not demonstrate causality, which appeared in a prior draft, not the first draft that was requested but in a subsequent draft. this change was made by the oig strictly on our own initiative. neither the language nor the concept was suggested by anyone at v.a. to any of my people. in the course of our many internal reviews of the content of our draft report, on july 22, almost a full week before the draft was sent to the department, one of our senior

executives wrote this question. this is key, gentlemen and ladies. and i quote, did we identify any deaths attributed to significant delays? this is on july 22nd. if we can't attribute any deaths to the wait list problems, we should say so and explain why. after all, the exact wording in the draft report was, were the deaths of any of these veterans related to delays in care? this type of deliberation to ensure clarity continued, as it should, after the initial draft was sent to the department. in the last six years we have issued more than 1700 reports. this same review and comment

process has been used effectively throughout oig's history to provide the v.a. secretary and members of congress with independent, unbiased, fact-based program reviews to correct identified deficiencies and improve v.a. programs. these reports have served as the basis for 67 congressional oversight hearings, including 48 hearings before this committee. during these same six years our work has been recognized by the ig community with 25 awards for excellence. we are scrupulous about our independence and take pride in the performance of our mission to ensure veterans receive the care, support and recognition they have earned through service to our country. the v.a. secretary has acknowledged the department is in the midst of a serious

crisis, and has concurred with all 24 recommendations, and has submitted acceptable corrective action plans. a recent report cannot capture the personal disappointment, frustration, and loss of faith that veterans and their family members have with the health care system that often could not respond to their physical and mental needs in a timely manner. although we did not apply the standards of determining medical negligence during our review, our findings and conclusions in no way reflect the rights of a veteran, or his or her family, from filing a complaint under the federal tort claims act with v.a.. decisions regarding v.a.'s potential liability in these matters lies with the v.a., the department of justice, the

judicial system, under the federal tort claims act. mr. chairman, this concludes our statement. we'll be happy to answer any questions you or other members of the committee may have. >> thank you very much. mr. griffin, dr. foote, you're recognized for your opening statement for five minutes. >> i started my internal medicine training in 1981 at the combined v.a. program. i finished in 1984 and became board certified in internal medicine. i went to work full time in east mesa, arizona as an emergency physician and returned to the v.a. in 1990 the same year i earned my boards in emergency medicine. i ran the v.a.'s emergency department from 1990 to 1998, i was a medical service teaching attendant from '91 to 2003. i became an outpatient clinic direct in december of 1994, a position which i held in my retirement in december 2013. while i have views on many

aspects of what has come to be known as the v.a. scandal i would like to use this statement to comment on what i view as the foot dragging, downplaying and frankly inadequacy of the inspector general's office. this continues in the rot issued august 26th, 2014, which i fear is designed to minimize the scandal and protect its perpetrators rather than provide the truth along with closure to the many veterans and families that have been affected by it. all the employees receive mandatory training on their duty to report waste, fraud and abuse to the inspector general, whose job it is to investigate these allegations. i first did this in february of 2011, which resulted in an then director gabriel perez being placed on leave within two weeks of the ig receiving my letter and a few months later his resignation in lieu of termination. i sent a second letter to the ig in 2013 where i made allegations against brad curry for creating a hostile workplace.

engaging in personnel actions and discrimination against certain classes of employees. as far as i could tell the ig never investigated this complaint. and it appears that they turned it over to the veterans integrated service network director susan bauers who was both hellmann's superior. susan bowers could not take action against him without running the risk that the entire waiting list scandal would be exposed. in late october 2013 i sent a third letter to the ig informing them of a secret waiting list where ten patients had died while waiting for appointments. i include allegations of the prohibited actions by senior staff. further more i advised them of a second hidden backlog of patients contained in the schedule and appointment with primary consult list and an unknown number of veterans had perished on it. i also detailed other methods that were used in use to lower the apparent backlog for new

patients, and i implored the i.t. to come to phoenix to investigate all of the above. i get a response from the office on december 3rd, 2013 to join a conference call with them on december 6th. the team came up to investigate the week of december 16th through the 20th. at that time, i and others told them about the unaddressed scheduling appointment consults and showed them the northwest electronic holding clinic which was being used as were prior holding clinics to mask the true demand for return patient appointments. we updated them on the secret electronic waiting list summary report showing that 22 patients had been removed from it because they had died. we only had the names of two of the deceased because none of the employees who were working with me had the electronic keys to print the names of the deceased. we asked the i.t. inspectors if they could do it but they responded that they could not. the last e-mail response i had from them was on december 21st,

2013 when i received an out-of-the office until tuesday december 31st, 2013 reply. i had offered to fax or mail the names we had at the time but they were unable to give me a working fax number or address to mail it to. facts and standard mail but not unencrypted e-mail are considered appropriate methods to transmit hipaa sensitive materials. i went four more e-mails in early january asking if they would like me to fax or mail the patients names but i got no response. i also got no response when i advised them that several more veterans have died. finally february 2, 2014 out of frustration with a lack of action by the ig even though we were informing them of more and more deaths i sent out ig letter number four with copies to everyone who i could think of that might be able to help. the only response that i got from the ig was a confirmation that they had received my letter. a friend suggested i contact the house veterans affairs committee and there i found the help i needed. during this process i was advised by several people that

i could get the ig's office to investigate my allegations was to make them public, which reluctantly i did. in my opinion, this is a conspiracy. possibly criminal perpetrated by senior phoenix leaders. of the many scandal effects from the performance made by the top administrators with supposedly waiting time goals to the harassment of employees trying to rectify the situation, to the destruction of documents and electronic records to the very real harm done to the health of thousands of veterans unable to receive timely medical care, nothing is more scandalous than the fact, the fact that 293 veterans died in phoenix. yet even now, right here in this report, the inspector general tries to minimize the damage done and the culpability of those involved by stating that none of the deaths can be conclusively tied to treatment delays. i've read the report many times and several things bother me about it. throughout the case reports, the authors appeared to downplay the

facts and minimized the harm. this was absolutely true in cases six and seven, where i have direct knowledge. after reading these two cases it leaves me wondering what really happened in all the rest. for example, in case number 29, how could anyone conclude that the death was not related to the delay when a patient who needs an implanted defibrillator to avoid sudden death did not get one in time. and why was the cardiac death case excluded from the ig review? in addition, a critical element to proving this was a conspiracy was the potential tampering with the reporting softball where of the electronic waiting list from the beginning, the ig's own data showed that there was a difference between the numbers reported to washington, and what the numbers actually were on the secret electronic waiting list. the ig clearly minimized the significance of this crucial point, treating it as a trivial clerical error, and touting how quickly the ig department

corrected it. rather than exploring who tampered wit in the first place. adding it up the ig report states 4,900 veterans were waiting for new patient appointsments at the phoenix v.a. 3,500 were not on any official list, and 1,400 were on the not reporting secret electronic waiting list. 23 of these veterans are now deceased. this slastly exceeding my original allegations that up to 40 veterans may have died while waiting for care. the ig says it is not charged with determining criminal conduct. true. but neither is it charged with producing reports designed to downplay potential criminal conduct designed to defuse and discourage potential criminal investigations or to diminish the quite appropriate public outrage. at its best this report is a whitewash. at its worst, it is a feeble attempt at a cover-up. the report deliberately uses confusing language and math, invents new unrealistic standards of proof, ignores why

the electronic waiting list was not reporting accurate data and makes misleading statements. in addition the attempts to minimize bad outcomes by protecting the v.a. officials respondible for the scandal just reinforces the v.a.'s long-standing culture of sifrkleing the wagons to delay, deny and let the claimed story or patient die that the veterans community had to suffer with for years. >> dr. foote i apologize, you've gone three minutes over the five. i would like to say that the rest of your testimony will be entered into the record. i apologize. but i let you go a little bit longer than what we all had agreed to. can you wrap it up in the next 20 seconds? >> yeah. >> secretary mcdonald said he was going to try to increase the transparency of the agency and that would not tolerate with the -- retaliation. apparently some senior washington administrators did not get that memo. this report failed miserably in those areas with the transparency equivalent to a lead lined four foot thick concrete wall.

>> thank you very much doctor. dr. mitchell you're recognized for five minutes. >> i'm deeply honored by the committee's invitation to testify today. the oig was unable to conclusively assert that the absence of timely quality care caused vet vans deaths. as a physician reading the report i disagreed. specifically in the memo of five cases i believe there was a very strong actual or potential causal relationship between delayed care or improper care, and veteran death. in addition health care delays contributed to the quality of life for five other veterans who were terminally ill and shortened the lifespan of one of them. in looking at the report, there are four cases where there is no cause of death listed and it's unclear to me how a causal relationship may or may not exist if there is no cause of death given. it's unclear if 19 veterans who were on the electronic waiting list were aware of the self-referral process to the primary care clinic. if they were not aware of this process then they reasonably believed that waiting on the

waiting list was the only way to get medical care, even if their symptoms were worsening. in two cases the oig gave evidence that the veterans accused -- or had acute instability of their chronic medical disease that required repeated visits to the e.r. and hospitalization. i believe that those likely -- those delays likely contributed to their deaths, but again, the oig did not give a cause of death for those two veterans. in terms of mental health treatment there were eight veterans on the electronic waiting list waiting for a primary care who apparently just wanted a mental health referral. two of those veterans committed suicide before they got the appointment. it's unclear if anyone told them that the mental health process is a self-referral process and they could have done so any regular base day and initiated mental health care. in case number 29 there was a veteran that needed a life-saving medical device implanted under his skin that would immediately shock his heart into a normal rithd up if his heart stopped.

the community standard would have been to implant this device immediately. at the v.a., he waited for four months and still did not have happened. unfortunately, the veteran heart did stop and without the device he had to wait precious minutes for the paramedics arrived to restart it. he was revived but unfortunately the family had to withdraw life support three days later. the oig stated that this device, might, quote might have forestalled death, end quote. it's very apparent that it would have fore -- i'm sorry, it would have forestalled death, because the implantable device is exactly what is used to treat the lethal heart rhythm that he had. he died from complications of prolonged heart stoppage without the device that could have restarted his heart in seconds. he was denied access to specialty care. in case 39 a veteran with multiple risk factors for suicide came to the e.r. with intense emotional stressors, including being homeless. he was put on psychiatric meds to stabilize him, but he was discharged back to the streets. he committed suicide 24 hours later. the community standard would have been to admit this unstable

veteran. the oig admitted that it would have been quote a more appropriate management plan, end quote, to admit this patient but did not draw a connection between inappropriate mental health discharge from the e.r. and death from suicide within 24 hours. case number 31, he died of metastatic prostate cancer that was not treated during the seven month period that the v.a. failed to act on the abnormal lab. while the metastatic prostate cancer could not have been cured earlier detection would have started the treatment that would have slowed down the progression of his disease significantly and slowed the painful spread of cancer to his bones. because of unavailable urology appointments and missed labs this veteran was denied timely access to specialty care that would have forestalled his death by months if not longer. in case 36 this veteran didn't receive timely quality care for evaluation of unrelenting severe pain that clearly served as the impetus for his suicide. in case 40, there is a premature discharge from a psychiatric ward for an unstable patient with multiple suicide risk

fatters that enabled the death from suicide 48 hours later. there are many other cases that i reviewed in my written testimony. i did not discern a difference between death on the electronic waiting list, and death waiting for appropriate medical care for those who were already in the system. death is death and there is no way to get those veterans back. the purpose of my testimony is not to undermine the v.a. or the oig. the purpose is to get the v.a. to examine its practices, and in order to improve the quality of health care for veterans. they have to repair the cracks in the system so no more veterans slip through. thank you very much for your time. >> thank you everybody for your testimony. mr. griffin, in the information that you provided to the committee or your office has provided to show that 28 veterans died while on the near list or the new enrollie

appointment request, essentially meaning they died while waiting to get their foot in the door at v.a. and since these veterans were not yet in the v.a. system, your staff briefed us that the oig used social security records which only show that the individual had died, not how they died. is that correct? >> i would say that we sought a lot of additional information from social security. we sought to find death records from the coroner's office. we explored who might have been getting treatment under medicare programs but as far as the specifics on those deaths i would refer to dr. daigh. >> dr. daigh, could you ask that question? >> good morning. the determination of death was by and large made from the medical records and the death certificate was mostly how we were able to identify "a," that a patient clearly had died. the record was correct, and by

reading both medical records, and the and in several cases the records of their care at local hospitals. >> if you're on the near list is there a medical record? >> no, patients on the near list would have tried to -- and may not be seen at the v.a. you're absolutely right. anyone who is on the near list that did not make it through the wickets at phoenix to be seen and does not have a medical record, i can't look at. so those folks, i'm not able to examine. they don't have a record. if i have no contact with them. >> if that is true then how can you conclusively or otherwise whether these deaths were related to delays in care. >> well, in the cases that we identified that we were able to actually review -- >> wait. the report says, conclusively says this is where we have some problems. >> right. >> dr. griffin. is that, there were people that

were looked at in the report, and your report says conclusively that there's no link to delays in care and death. yet there are individuals that you were not able to go back and look definitively at their medical records to determine what the cause of death was, or if there was a delay in care. is that correct? >> in the reports we are trying to address the patients that we identified who had a delay in care, and then subsequently received the poor quality care as a result. >> but if you were on the near list. >> correct. >> is that a delay in care? if you did not get into the system, is that a delay? >> yes. >> okay then how can you conclusively say that none of the delays were a cause of death?

>> well, we were referring to the patients that we were able to look at. >> you didn't look at all of them? >> no, i'm not saying that -- i provided your staff with a breakout.>> i sorry dr. daigh, u able to look conclusively at all of those that were on wait lists? >> i'm only able to look at those -- i looked at 3 -- >> yes or no, were you able to conclusively look at all of the people that were on wait lists? >> no. if you -- >> i want to direct you to an e-mail from dr. deering found on page 38 of your report regarding a veteran who died waiting for care. it's already been talked about this morning and in a staff briefing on the 4th. you stated that the veteran was seen by a urologist within three days of presenting to the e.r. so his case was not included in the 45 case reviews in the report. however, we have received notification from the oig

yesterday stating that a mistake had been made and that this veteran was actually not seen after he was presented at the e.r., and after informing us of this delay, the oig still says that this delay in care did not contribute to his death. could you explain to me how the oig came to this conclusion? >> so the patient in question has bladder cancer, and had bladder cancer for many years. he arrived at the v.a. and was seen in the emergency room initially, and received a very reasonable emergency room evaluation. among his chief plants were that he had blood in his urine. he also had chronic -- he had rheumatoid arthritis and some other disabilities, including amputation of a leg. as a result of that visit, his urine was looked at, and he had

microscopic hematuria. he also did need to see a rheumatologist and he did not have a primary care provider. so the e.r. physician asked that this gentleman have several consults. asked for a surgery consult, rheumatology consult and a urology consult and a primary care consult. the records, and this is the source of the confusion, v.a. records state that he had an appointment made for urology to be held on 10-22-13. it says that the patient called and requested a rescheduling of that appointment which was then rescheduled for 11-06. he no-showed for that appointment. so in our discussions, some people would say the patient had an appointment to see the urology and didn't keep his appointment. >> but -- >> but -- >> but -- >> my clarification -- >> let me ask the question real quick and i'll let you finish.

i apologize. nobody here in this room has any faith in any of the appointments and scheduling that was going on at that time, so i have no belief that what may have been written was in fact true. >> i understand that. >> please continue. >> so what i'm saying is that this gentleman then died, by what appears to be by image, metastatic cancer where he had metastasis to his brain and he also i believe had cancer in his lung. so the assertion that having seen a primary care provider in the six or eight weeks between the emergency room visit and when he died, i don't believe that that primary care provider would have -- that visit would have changed his death. and i refer you to page 75 or 76 of the testimony that we provided from the transcript -- >> if i may also interrupt. >> sure. >> the testimony was given to us

as the hearing had already started. we haven't even had a chance to look at it. we just got it handed to us. >> yes, sir. i'm just saying -- >> in the hallway after the gavel dropped. >> well, sir, i'm just saying that on -- >> -- and it was sent up to make sure the truth was on the record, having seen other witnesses' testimony and needing to make sure that the committee was fully aware that we had a taped transcript of our interview, and people should take a hard look at that transcript. >> i appreciate it very much. but your staff told us there was a formatting problem getting it to the committee and that's why we just got it. >> are you referring to the transcript of the interview of dr. foote? >> that's what i'm referring to. any other transcripts i need to

be aware of? >> i believe we sent all the rest of the information out 48 hours in advance. >> let me ask you, mr. griffin, dr. foote's original allegation was up to 40 veterans may, may have died while awaiting care at phoenix. and i think everybody knew that he was referring to patients on the electronic wait list, and the schedule. an apainment with primary care consults, so it was all-conclusive. so between those two sources, you've now found 83 patients, more than double what the original allegation was. so i have a couple of questions and then i will turn it over to mr. michaud. but why was that information not included in the executive summary that the v.a., not you but the v.a. leaked early?

but you did find room in it to include that we, quote, pursued this allegation, but the whistle-blower did not provide us with a list of 40 patient names, end quote? >> i believe that you as the chairman received the same hotline that we did. it stated that there were 22 who had died on the electronic wait list. and there were 18 who died on the consult list. so, in our pursuit of finding out what happened here, which was an exhaustive pursuit, which is still ongoing as you know, because of the urology issues that we discovered, the obvious first question in our interview with dr. foote was, give us the 40 names. we want to go after the records of these 40 people and ensure that we don't miss any of these 40, because it was so definitive.

now you were very careful in the hearing on april 9 to say potentially 40. as time passed it became declarative by some that 40 died. others said there were at least 40. so that spawned 800 media reports that 40 veterans died while waiting for care in phoenix. that was the story as of the april 9th hearing. to not address that with the amount of coverage and the millions of readers who would have read that would have been derelict on our part. so we didn't look at 40. we looked at 3,409 records to make sure we didn't miss any. >> so it was important that you draw the fact that dr. foote did not provide you the 40 names. that was very important. >> what was important was in the april 9th hearing in this

room -- >> no i'm talking about the final report. not the april 9th hearing now, i'm talking -- >> that was not -- that was not something that was inserted in the final report. there were multiple drafts which is a very important point that doesn't seem to be getting any traction. we were asked to provide the first unaltered draft report, and that's what we provided. it's the first time -- >> let me -- >> thinking about what we asked for. okay. please provide committee with the original draft copy. all right. you may have that original meant the very first -- that meant an unaltered copy and i had an e-mail that went to your staff that has original, and then in parentheses beside it it says, unaltered. in other words don't adult rate it in any way, weant the original draft. >> we received two requests from

the committee. one from you and one from chairman kaufmann. one of them said, unaltered. and the other said something different. but there wasn't any confusion that you wanted the very first initial draft report. it's just unknown -- >> sir, let me read this e-mail to you. you've gotten a third one that came from the staff director of the iog, the oni subcommittee, to joann moffet, dear joann, chairman miller would like to know if the oig is going to provide the committee with a written copy of the original, paren, unaltered graft copy of the phoenix report as first provided to v.a. if so, when? >> i guess i don't see what the difference is. you asked for the first initial draft report and we provided it. >> did you ever indicate

to the committee or to the staff that there was more than one draft? >> we did not. we provided what the committee asked for. and we also explained that in the last six years, no committee has ever requested a copy of our draft report. because -- >> well, shame on them, sir. >> no, no. that's the way it is in the ig community. >> well here's the way it works here. we want all of the information. we don't want you to use semantics about which copy of the draft we asked for. we asked for the draft that you gave to the v.a. so v.a. could make their determination as to whether or not that draft was factual or not. that was the intent. you knew that's what it was. that -- just wait a minute. my time, not yours. >> okay. >> you knew what the request was, what we were trying to get is how does that -- get inserted from the draft to the final.

and now we have testimony from dr. daigh that, in fact, they did not conclusively look at all the causes of death. so i still make the statement and then i'm going to yield. to mr. michaud and i apologize to the members. we've all got to be honest and open with each other about what's going on, and whether or not any other committee has ever asked for a draft report, shame on them. whether or not the oig has ever sat at a table with anybody other than people from the oig office, tough. this committee is going to get the truth about all of the facts mr. michaud? >> mr. michaud, may i response? this is the crux of the whole allegation. >> yes, the gentleman will want to respond. >> we were asked to provide the initial, because you didn't want one that had been through two or

three iterations. you wanted the very first draft report. that was clear to us. you can deny that all you want -- >> can you show me anywhere that it shows we asked for the first draft. >> i would refer to the attachments to our report where all of this is spelled out in writing. >> no, can you tell me where we asked for the first draft report? let me find the e-mail, and i will respond to your question. >> mr. michaud, you're now recognized -- >> here it is. it showed a lack of aware dnc -- >> now recognized. you're out of order. >> do you want the truth? >> sir, you're out of order. >> mr. griffin, on the records, if i understand you correctly,

you didn't provide the first draft of the report, but there might have been other additional crafts out there? >> that's correct. >> so the draft you provided was the first draft. >> that was requested. >> okay. but there was other drafts since the first one that came out is that correct? >> it was a draft -- it is a deliberative process. in order for us to get concurrence from the department, we have to put a draft in front of them. if we have factual errors in that draft that they can convince us were fact yule errors, then it would be incumbent upon us to make whatever edits are required so that at the end of the process the report in its final issuance speaks the truth on all issues. >> so, when the ig does its reporting, you could conceivably get some information, whether

it's from a whistle-blower, whether it's from the department, that might not be factual, and once you get information that you determine actually to be factual, that's when you change the report before it gets -- >> that's correct. there were some minimal changes on one of the case reviews we had the blood pressure numbers that were taken at two different times were reversed. to me that is not a substantive change. obviously we had them wrong. when it was reviewed we put them back so we put them back the way they should have been. but that is not a substantive change. >> okay. you mentioned dr. foote alleged 40 veterans. did you ever receive the list of names of those that were on that list? >> no and i would refer you to the transcript of our interview which addresses that very clearly. it was even

suggested that perhaps some of them might have been run over by a bus that he didn't know what the cause of death was. >> did he not give you a definitive -- i haven't read that transcript yet. >> no, understood. and i apologize for it arriving late but it does need to be read by everybody who has a serious interest in this matter because it was a taped transcript of the interview. >> can i respond to that interview? >> no. i still have some other questions. my other question is, of the 93 ongoing reviews, how many have been closed out, and when do you believe that the rest will be completed? mr. griffin? >> at this point we have 12 that we have turned over to the department that i wouldn't say were closed because we would anticipate administrative action

being taken. they're closed from the standpoint that we have completed the work that would have addressed the specific allegations that we were looking at. now in the department, in their proceedings to make determinations concerning administrative action, if they come across additional information that was not part of our focus, we may have to do additional work on those. but we've turned over 12 so far. the others are not being worked with any intent of, okay, a week from tomorrow the other 81 are going to be all published. we will turn these over to the department. those that do not get accepted for any criminal action we will promptly turn those over to the department so that they can take administrative action. >> thank you. dr. mitchell, in your testimony you mentioned how good the phoenix v.a. pain management team is but that they lack the staff to supply the services to

phoenix veterans. how did phoenix v.a. communicate their staffing needs to the director? was it ever communicated? and if so, what was done, if anything? >> i don't have any direct knowledge of the communication between the pain management team, and the senior administration to get additional staffing. what i do have is direct knowledge from many, many providers who find their panels filled with patients who are on high-dose, long-term nash cotics and the patients need additional close monitoring and follow-up. what's happening is those providers don't have enough time to be able to get those patients in for sufficient appointments to be able to review that. in addition, in the community patients that are on long-term narcotics are referred to a pain management specialist to titrate the

ongoing education and monitor for side effects. unfortunately the staffing does not allow for that. >> thank you. my times arun out, mr. chairman. >> in lamborn. >> thank you, mr. chairman. and thank you for having this very important hearing. dr. mitchell, briefly, on page 15 of your written testimony, you pulled out case number 35 from the ig report as a special circumstance, and please explain why you did so in this particular case? >> i want to make it clear that i did not have access to the records that the oig went through. however, anecdotally i was told that this was the same patient which i was familiar with, and the details are the same with one glaring omission. in the oig report, the history starts with the patient presented with the e.r. -- to the e.r. with his family, seeking mental health care. he was evaluated, he declined admission, he was discharged home, he committed suicide the next day. what wasn't in the report and i believe this is the same case and if it's not it should be

reported anyway, he was having problems with depression and called his parents and they brought him to the walk-in mental health care clinic. however because he had not been enrolled in phoenix v.a. he was diverted from there to the eligibility and enrollment clinic where apparently he waited for hours. by the time he was enrolled in the system he went back to the mental health clinic and it was too late in the day for him to be seen. so then he and his family were diverted to the e.r. where again they waited for a lengthy amount of time before they were seen by a psychiatric nurse to evaluate. by that time, the people that were involved said the patient was very tired, he wanted to go home, he declined discharge, he was subsequently discharged at that point with to have follow-up the next day in the same clinic that wouldn't see him earlier. >> thank you for that clarification. mr. griffin, when you shared your draft report with the v.a. before release, did the v.a. propose any changes or ask any questions regarding what was in or not in the report?

>> they did. they requested that we remove several of the case reviews that appeared at the beginning of the report. we refused to remove them. they suggested that we flip-flop the blood pressure numbers that were out of order. of course we changed that. there were two other minor things, one involving a date that was inconsequential to the outcome of the case review. so we fixed that. there were a couple of verb tenses changed in a recommendation that in no way whatsoever affected the intent of the recommendation, so those were changed. none of the case reviews were substantively changed and the secretary agreed to implement all 24 of our recommendations. >> how often do departments ask

for changes before the release to the public? >> i suspect that there's probably never been a report where there wasn't some minor change in that request. >> i want to talk more about -- >> the reason being that they have to implement what we have found, and what they are concurring with, and so they're going to scrutinize those things and make sure that they're in total agreement, and also, look for those minuscule types of errors that will make the correctly report more accurate. >> when the language stating that you could not conclusively assert that there was a connection, do you know who leaked that to the press before the report was made public? >> no. i have no idea who leaked that. that was in the report.'xú the report had a date certain for being published.

it should not have been leaked. but the fact is, it didn't change anything in the report. >> was it someone in your office that leaked it? >> absolutely not. >> okay. and i didn't think so. the word conclusively is not a medical term of art, as far as i know. and as a lawyer i know it's not a legal term of art. on a scale of 1 to 100, where does that fall on the spectrum? >> it's a reflection of the professional judgment of the board certified physicians there've been a number of suggestions as to how we should do this and we have received one from the committee saying that we should unequivocally prove that delays caused deaths. we received that on april 9th. what does unequivocally proved mean? we did a review of the quality of care that these 3,409

veterans received. that's what we do in all of our health care reviews. that's what their charter calls for when they were created. >> but there could be a connection less than conclusive? >> i think in some of them we -- we said it might have improved the course, but to say definitively that this person would not have died if they had gotten in sooner, was a bridge too far for our clinicians. i'll let dr. daigh expand on that. >> the basic problem with this is that it's very difficult to know why somebody actually died. i'm not clairvoyant. i'd ask you to read, also, the testimony submitted by dr. davis where he supported the methodology we used in our report. that would be death certificates, plus a review of the chart. in the case that was discussed previously case 29 where individual died, after failing to get an implantable heart

device quickly. in that report, you said, and i will read exactly what we said, we indicated that -- we indicated that he should have -- he should have gotten the device more timely. he died. i don't know exactly why he died. you'd like to think that he died because he had an arrhythmia to his heart and if that device had worked maybe it would have saved his life. but i don't know that that's why he died. there are circumstances around the weekend of his death that are not included in this report. and the reason that he came to our attention is that he was on a wait list for a clinic. he wasn't on a wait list for a cardiology clinic. secondly he's not in the group of patients initially where we called those who were on a wait list who received delayed care.

he's on a wait list of patients who we said got substandard case. we found cases where the care did not meet veterans quality of care. so this gentleman was delayed in getting care between phoenix and tucson. so he's in a part of the draft where i think he belongs. i cannot assert why he died. and that's why we have -- >> okay doctor thank you. my time is way over. i yield back. >> mr. takano. >> thank you, mr. chairman. thank you to all the witnesses who are appearing before the committee today. mr. griffin, i did read through much of the material last night. i have to say i homing -- i'm trying to understand what the controversy is. i understand charges have been made by the majority impugning your integrity. i understand it means -- doesn't mean you were forced to change lack or persuaded to change language. that is the heart of the allegations. could you help me understand

from your point of view what is the charge? i think the public needs to understand that. and what is your response? >> my response is that there is a lack of understanding of the processing of draft reports. and it's understandable, because it's the first time anyone's gotten one. when we send an initial draft report over there, that does not mean that my senior staff and others -- other members of our team aren't continuing to review that document, and make sure that we've got it correct. the fact that it went to the department without the statement isn't proof of anything. it's an ongoing process until the last day when we sign out that final report. and over the course of five different drafts, there were

minor changes made for purposes of clarity. the minute that the draft report came up here, and the reason that you don't put draft reports out, is because they're subject to interpretation, and they're not final, and shortly after the draft came up here, it was reported in the press. but here's proof that somebody in v.a. changed it. that's not proof. that just means that you don't understand the process. and i can show as i mentioned in my oral, six days before the initial draft was released we were having discussions internally that if we don't declare that delay was the cause of death, we need to say so. now it took a couple more drafts before the causality line was included, but i would point out

on may 15th, in a senate hearing, where the question of the original 17 names that we received came up, i was asked if we had a chance to review those. i said yes, we had reviewed them. and that being on a wait list for care does not demonstrate causality in a person's death. that's three and a half months before this final report. so there should have been no note taking that it does not demonstrate causality that you're waiting. and i think the last statement for the record that i would hope everybody will read because the witness won't be here is dr. daigh already referred to bears that out. and bears out our methodology. someone might ask, well why, why did you send it over there if it wasn't ready? because we have to put it in front of the department. we knew the department had 24 recommendations that they had to write an acceptable response

that convinced us that they got it and they were going to fix it. we knew they would need time to do that. we had made a commitment to the congress to publish that report in august. as a result, we had to cut off some work in order to be about the business of writing the report. and that's why dr. daigh's staff has got 3,526 urology patients that will be the subject of a future review. >> dr. daigh, those 45 or some-odd cases that we included, i was able to read each in detail and frankly, to understand each one but they didn't seem to me evidence of poor care, of bad continuity of care. is it for those families -- those family members are being notified of what happened, those family members can pursue

litigation, i imagine, and the v.a. could be found culpable in some of those instances. is that right? >> that's correct. so let me offer this comment. the universe of patients that we sat about to review in this review were primarily those patients called for wait lists identified by whistle-blowers, by our auditors, by our health care inspectors. so we were looking at people who were on a list, and then did not get an appointment timely. that's the universe we starting with. in fact some of the cases from the near list were part of what we were looking at. if you weren't seen at the v.a. then i couldn't see you. my records don't allow me to take a look at whether you tried to get to the v.a. or didn't try to get to the v.a. and our methodology second we lay that out. so from those cases we were looking for people who had a delay in care, and had a clinical impact on that delay. and those are the 28 cases that

we identify in the process, six of whom have died. to know why someone died is very difficult. and so when you get down to an individual commits suicide on a certain day after a certain event, you might like to say that event had something to do with the suicide. but in the world where we try to be able to prove and have data to support what we're saying we have a hard time going there. so the second group of patients we report on are those that we found had a poor quality of care. the other point that is important to understand is my charge to the congress, to the secretary, and to the undersecretary of health, and comment to them on the quality of medical care and the issues

are different. and the question we took to be was there a direct relationship between a missed appointment, and for what the media was talking about, was he forced to address that in some way. and so once we determined that there was, in fact, patients that had poor quality of care, we then always switched to -- >> what are the systemic issues at this v.a. that we can address that try to get the v.a. to change their practices to make this never happen again? when you go to the issue of exactly who committed the tort, exactly what does the v.a. or the patient or the other hospital down the street or the nursing home, what exactly did they contribute to this death or this poor outcome, that's a matter for the courts. and that's a matter for v.a.'s internal processes. so i get to the point of poor

quality of care, and then i always shift and focus on what can i do to work with v.a. to make sure we fix it. and again, in the last written testimony i outlined 10 or 12 or 15 reports where veterans were injured or harmed, and we worked with v.a. as partners to try to get this fixed. >> thank you my time has run out. >> mr. chairman? >> question for dr. foote. in your testimony you indicate that there may have been tampering of ewl software and that the numbers reported to central office differed from the real numbers of veterans waiting. how is it that the ewl appointments could be overridden to zero out previous appointments?

and do you believe audit controls were disabled? >> yes. there were two methodologies used. either there was a list of 100 or 200 which the ig scrap showed it was a small number or not correct, and they had a second list where they disabled the reporting function or they went in and tampered with the reporting software so that it would not give an accurate number of, say, over 200. certainly the ig's data shows from the inception of that list it never gave the right number. the doctor said the waiting list time was 55 days. well, on the actual nonrofting electronic waiting list there were 1,400 to 1,600 and the wait was six months. if you threw in the 3,500 that were scattered around on a schedule appointment consults, on loose papers, the wait was probably more on -- somewhere

between 1 1/2 to 2 years. i've reported this to the ig and also to the fbi and i know they're taking a look into it, and hopefully they will be able to find the forensic computer evidence to support that claim. >> thank you. question for mr. griffin. the language that was included in the oig final report regarding the conclusive case of death has not relation at all to any accepted standard of measure in medicine. as a matter of common sense, if va doesn't schedule appointments early enough to treat a disease, it is highly likely that veterans with potentially fatal conditions will needlessly suffer from conditions and possibly die. the question -- does that make sense to you, and do you agree with that statement? >> so i agree with your statement. the premise of if your care is

delayed then you're very likely going to be harmed. and when we started this review it seemed to me that that would be what we would find over and over and over again. and we looked at these cases and we didn't find that. so we said, well, why didn't we find that? i think there are two of dr. foote's cases in here where in fact he can go home and say he saved a life. he found a patient that was in a waiting list or in a pile who had diabetes and another one that had critical heart care and he intervened to make sure that they lived. it's also clear that veterans have access to other emergency rooms and other sources of care beyond the va. so in retrospect, thinking about this question, i think that people must have been extremely diligent at phoenix where they knew the trains didn't run on time, to try to make sure that vulnerable people got care. i can only report the news. this is what i found. >> okay. let me ask you this. was this measure applied when the oig report reported that veterans died while waiting for care in south carolina and

georgia? >> again, i normally go to the point where we determine that poor quality of care was provided. >> can you apps that question? >> i'm sorry? >> was this same measure applied while it was reported that veterans die in south carolina and georgia? what is your answer to that? >> sir, it's usually a fact pattern-based decision on exactly what happened. i'm not sure exactly which report you're referring to. but, sir, it's usually -- each report is usually a different fact pattern. if we determine the poor quality of care was provided then we try to look at systemic issues and try to get va to do the right thing with respect to quality of care. >> so the report discussing the delay of colonoscopies. >> yes, sir. >> can you answer that question? would the same standard apply? >> in the columbia case --

>> -- the report. >> i don't think -- i can't -- the same standard wasn't applied because the fact pattern was entirely different. in columbia, va had found that they had delayed colonoscopies in a large population of veterans and as a result, as you would expect, a large number of veterans developed colon cancer that probably would have been prevented had the colonoscopy been done. and the va admitted some of those patients had died. and va had already undertaken the process to notify those patients. what my report was looking at was why did this happen, how is this possible. and what we determined was that va does not have a way to ensure that nurses in clinics that need -- if a nurse leafs clinic and that job is critical to the performance of that clinic, refilling that position is goichb a board within the hospital wre&$ administrators decide whether or not they're going to fill the nurse position

or a teaching position or a research position. so, again, we focused on what can va do to make sure this doesn't happen. and so, yes, the same standard wasn't applied because the fact patterns were quite different. >> all right. thank you. thank you, mr. chairman. i yield back. >> mr. chairman, if -- >> i apologize. we've had a vote called, and i'd like miss titus to have an opportunity to have her questions before we recess to go to the vote. miss titus, you're recognized. >> thank you, mr. chairman. mr. griffin, like it's been mentioned before with many of my colleagues, i'm eagerly awaiting the results of the investigations at the other vha facilities. southern nevada is home to the newest va hospital. many people think it's the best, it's state of the art, and we also have a large medical system there. now, i've been asked by a number of my constituents are the same problems happening here as in phoenix, because once you hear something like that, then of course it makes you worry and begin to think that there are

problems. i've talked to isabelle duff once a week practically to be reassured that they aren't. but still i want to encourage you to finish up because not only do we want to solve any problems you might find but i think that's a big part of restoring trust in the va is to get that done and move on with it. also, you put forth 24 recommendations and as i look at it i think there are 11 that relate specifically to phoenix, which that's in florida, but the other -- the rest of them look at the systemic problems. now, you've given those to the va, saying you recommend that they do this. this is a big dose, a large order that you're calling for. are you confident that the va has the facilities, the means, the intent, the ability to carry out those recommendations and solve these problems so this does not happen again? >> i would agree with your assessment that at present they don't have the facilities.

i think va would be the first to admit that they need additional clinical space, they need additional clinicians, they need a new scheduling process, they need a methodology by which they can remotely monitor what wait times are in las vegas or any other place in the country where they have a medical center. i think they're aware of all those things, and i believe the new secretary and his team that he's assembling are dead serious about addressing those things. we do follow up on our recommendations. we have suspend states for when things are supposed to be completed, and we will certainly follow up very aggressively on these 24 recommendations. and we also have already had some initial internal discussions about how wegh