i care acronym. we've used that as a leadership exercise to talk to employees about the values, about the mission. the second thing we've tried to do is tried to demonstrate we want a very open culture. we've talked about the positive aspects of whistleblowing. we've talked about the positive aspects of criticism. i've used a couple diagrams. most people think of an organization like this and the customers on the bottom and the ceo is on top. but i turn that on its head. this is a va we want. we want the veterans on top. those people next to the veterans every single day, the doctors, the nurses, the schedulers, the clinicians, those are the people that we should honor and make sure are paid properly and are rewarded. then the ceo or secretary is on bottom. the leadership's job is to make sure these people can properly care for veterans. this is a different kind of culture. to demonstrate that, i've cut down the size of the secretary

office. i no longer travel with an entourage that maybe once existed. and we're simply trying to make very visible that this is a different dullture. >> are you sort of like the pope? you know, travel in a little tiny car. >> i'm much less than that. remember, i'm on the bottom of the pyramid. i'm flying coach. >> i have to say, i sympathize with my colleague. i wish you could do something about that. fix that. i'd certainly appreciate it. >> we talked with ranking member michelle in his office about this. again, the veteran should not be published -- or punished for having a barrier between va and dod. the veterans should not be punished for having nine different maps of organization structure. you know, these are things that we've got to simplify so that every -- i'll give you another example. we have 14 different websites that require different user

names and passwords. i don't know about you, but i hate keeping track of user names and passwords for all these website. you should be able to plug in the va in the easiest way and then get your care. and that's what we're working on. >> you know, i'm the ranking member of the economic opportunity committee. i have a lot of concerns about the educational benefits. i know you've been maybe paying attention to what's been going on in the for-profit college sector. making sure that there's not undue predatory behavior. >> i got my mba using the g.i. bill. my dad and father-in-law went to college using the g.i. bill. again, it's very personal. we cannot allow people to take advantage of our veterans. it's really that simple. i'm thrilled with the work that was done in the new bill. i've told the chairman that. because you've expanded our

ability to get doctors and nurses reimbursement for their study if they work for the va. we need more medical professionals. so that was a really big win for us. i've been out to duke university medical school. i was talking to the dean of pennsylvania university medical school, upenn. just two days ago i was in san diego with the dean of uc san diego. these relationships for us are critical, and getting those doctors, nurses, particularly mental health professionals in the va, is very important. >> i want you not to forget i just wrote you a letter asking you for a plan on how we would use the medical residencies. that's a huge thing on the medicare, medicaid budgets. we've been frozen in terms of the supply of doctors. really, we don't have a supply problem with the med students. we have a problem matching them to residencies. i'm looking forward to your

ideas on how this will help the broader community. of course, the primary function is the va. i think it will help the rural areas as well as impacted areas. >> it's very important. in fact, we talked with congresswoman titus yesterday. we're working to develop a medical school at unlv. we want them to work at the university of las vegas hospital. these are important things. we're going to have to work together to get more medical schools contributing more graduates for our rural areas. so i would offer that as something we would like to partner with you on. >> i certainly would love to work with you on a plan like that. thank you. >> dr. roe. >> thank you, chairman. first of all, mr. secretary, i thank you for taking the job. >> yes, sir. thank you. >> thank you for your service to our country. and i certainly appreciate that. i think i said during these long

hearings we went through, if you ask someone at the va who they work for, they'd say the va. the right answer was, i work for the veteran. you got that right when you flipped that chart upside down. i also appreciate the fact that you just said you know the front of the airplane gets air before the back of the airplane does so you can save a little money there. >> i used to jump out of them. i would not recommend that. >> well, i've done that a time or two and questioned my sanity about why would anybody jump out of a perfectly good airplane. >> particularly a doctor. >> exactly. why would you do that? i think one of the things that -- a question i ask our secretary every year when we come in with budget is, do you have enough money to carry out your mission? two, do you have adequate staff to carry out your mission? i think that's a question you may not have time to answer right now, but that's a question you'll get next year when we go through the budgets. we want to be sure that we provide the resources to take care of our veterans. i can tell you, the american people want their veterans taken

care of. i know they've worked on the residency slots. i'd like to offer you the opportunity to visit east tennessee to our va. let me tell you why. it's one of five medical schools. it's now a 30-year-old school. it's on a va campus. it actually was started with the teague cranston bill. our medical students go to the va campus every day for their education, and they go to the va hospital along with the public hospitals. it's a very good model. maybe as we look at these shortages of physicians and know that doctors are creatures of habit, we stay where we are, like most people like to if you're comfortable. and it's a great way to get doctors to stay and make a career at the va as dr. foot did. he was a career va doctor. so i don't really have any questions other than just to thank you for taking the job. >> yes, sir. >> you come from a great

company. you have a great background. you've run a big organization before. so i think you're going to be a great secretary. >> thank you, sir. i would just say -- i know the chairman knows this, but 70% of the doctors in the united states have worked for the va at one time or another. the best operations we have, at least in my 50-day review so far, are those connected with medical schools, whether it be our palo alto facility, our durham facility with duke, our philadelphia facility with penn. we want to do more of that. it's really a great way. we all benefit. >> i'm going to selflessly promote my school. >> and east tennessee, of course. >> yeah, it's one of the five top primary care putting primary care doctors in rural areas. >> we need that badly. >> it's one of the things mr. tacano was talking about. getting people out to rural areas. rural america is where i live.

it is a challenge for us. >> and our veterans, just so you know, demographically are moving to more rural areas than they are urban areas. this situation will only get exacerbated. so we need to get ahead of it. >> i think 10% of my district are veterans. so big number there. >> i will just say it's a very strong primary care school, as i recall, as well. and definitely on the list for a visit. we just want to thank you for the additional residency slots. we realize we're in tight competition with the private sector in terms of recruiting and hiring. but we think we've got the best mission. >> i think long term it's a great method to do. just thinking 10, 20, 30 years when nobody is even going to know who we were it's going to provide benefits for the veterans. i yield back. >> thank you. >> thank you, mr. chairman. thank you, mr. secretary, for being here. i certainly enjoyed my meeting

with you last week and appreciate it very, very much. i went back to my district and told my veterans you should have hope. i met with you, and i really appreciate your can-do and will-do leadership style and approach, particularly your sense of urgency around reforming and changing and making that cultural change, making veterans first within the va organization. so i am very, very much encouraged. i think one of the -- you know, one of the more global issues i think i wanted to raise with you in this hearing is in the time i have served on this committee, it has been extremely, extremely frustrating getting information from the va. and i hope, and my dream, is that as you move forward and set

out a plan for change within the va that we+9bz will all collect have -- collectively, we as members of the this committee, you at the bottom of your organization, and the members and vsos most importantly that we can all collectively agree on direction of the organization is going. then set the appropriate outcome measures we're looking for so we can again collectively monitor and watch and evaluate the progress as we move forward. so for me, that is, you know, a very essential thing. it's really the only way we can tell the american people that we're on track and we're making progress. so if you could just comment. >> yes, ma'am. as we talked, i want to be your partner. that's why i'm sharing with everyone our road to veterans' day plan for the next 90 days.

as we're renewing our strategic plan, which we're starting as a leadership team this friday doing, we will share that with you as well. i know from my confirmation hearing and from talking to the chairman that communications has been a challenge for us. and frankly, some of the communications have come to my desk i've rewritten myself because i've been totally unhappy with our ownership for the problem, our ownership for the issue. the chairman and i talked about trying to reorganize communications. this week we got rob neighbors to agree to come over to va. he's going to be our leader of communications. so under rob we're going to have congressional communications, communications with the vsos, external communications, internal communications. so we'

saying the same message. but that's not an attempt to centralize. in fact, what we talked with the chairman about was decentralizing so that you can go to the subject matter expert and get the answer, and it doesn't necessarily need to be cleared with one tip of a funnel. i think what's happened in the past is the organization has done that. they've made everything go through one person. and when you do that, it obviously backs things up. everybody should be capable enough to be able to answer. of course, i would ask your indulgence that you would have to realize if you got a wrong answer, it may be temporary or may be incompetence, but the person's not trying to deceive you. we'll work together to make sure we clear up any miscommunications. >> thank you for that. and i am, you know, a strong believer in data-driven decision making. i think the data is extremely, extremely important.

my two cents would be in terms of the data that will be presented to you is trust but verify. i don't think i have necessarily the confidence that the data that has been presented to us and don't have the confidence there. in some ways want to just clean the table and start all over again in terms of the data collection. i know -- i'm sure there's some good data that is there also. >> well, step one is getting the right values and the right mission in place and making sure people look through that lens. step two is getting the right leaders in place. we're in the process of that. step three is getting the right culture in place. then we got to get the right strategies. right now we have a group of strategies that frankly no one's working against. they're in a desk drawer somewhere. but my test is, can i go to the lowest-level employee, or in my case the highest-level employee, and do they know how their work every day is tying back to caring for veterans? if they don't, stop the work.

i had somebody bring to me a binder full of information the other day. i said, well, what's this for? one binder was a series of reports. i said, i've already seen all this information. let's stop doing it. so that got rid of a whole bunch of work. another binder was testimony i gave at the senate hearing. why do i need to see my own testimony? let's stop doing that. so we've got to stop a bunch of things. then redeploy all of that effort against caring for veterans. >> thank you. my time has expired. but thank you and i look forward to working with you. i yield back. >> thank you. doctor, you're recognized. >> thank you, mr. chairman. mr. secretary, pleasure to be with you today. i do thank you publicly for taking on this task. i benefit from living in the city of cincinnati, where proctor & gamble is located and all the great things you have brought to our community has benefitted so many people. as you take on this job, there's so many things to consider.

i know it's a monumental task, but it's not one you're unfamiliar with and why so many of us for a while have been talking about needing an outside influence, someone from private sector. because we're talking about acquisitions cost versus productivity, changing a culture, assuring quality of care and access to care. all these things that go into being successful. i just want to say i think if there's anyone that can create a brand, it's someone who's been at proctor & gamble. not only that, you build trust with that. that's going to be the key. if you can build trust in the va brand in the same way you've done tide, i think we'll be in good shape. i appreciate your openness and the ability to work with you every day. thank you. >> i look forward to working with you. i appreciate the fact of the commitment of all the members of this committee, which really means a lot to all of us at the va. >> ms. titus.

>> thank you, mr. chairman. mr. secretary, thank you for being here. there's a lot of enthusiasm when you were appointed. i think anybody who's heard you testify today will certainly have that feeling reinforced and erase any doubts that you are the man for the job. so we appreciate it. also, thank you for coming by to see me. it meant a lot you had already taken time to visit nevada, both our service center in reno that's had so many problems and the new hospital. it shows that you're really personally vested in that. we appreciate it. also, it's been nice to hear all my colleagues talk about our bill to create more residencies in the hospitals. i would just point out again as we talked about in our meeting that we want to be sure those residencies don't just go to the big hospitals that already exist but really go to the places where they are needed.

i know there are areas that are underserved and that was the real intent. we want to be sure they do that. also, we're very supportive of your notion of reorganizing, not just middle management, but also the geographic regions because las vegas is in several different areas that don't make much sense. finally, maybe you could share with the committee and for the record some of the things you told me about the new emphasis on women veterans, because they're our silent veterans. they've had serious problems. one in four hospitals doesn't have a gynecologist. i know that's a new priority of yours, which i'm very supportive of and want to work with you on. maybe just put on the record some of the things you're doing there. >> yes, ma'am. thank you very much. we look forward to working with you. i know that portions those additional residencies will be very important, and we'll work with you on that. i've played hockey. we've got to go where the puck's going to go rather than where

it's been. so we've got to get after that. we will work with you on that, so we're making a decision together. relative to women veterans, to me this is critically important. right now we have about 11% veterans are women, but of course the percentage in the army -- or in the armed forces is much, much higher. so obviously it's going to increase over time. many of our facilities were built in the 1950s when we were virtually a single-gender army. so when you think about the kinds of equipment we have, when you think about the kind of doctors we have, you're right. we need to hire more ob/gyns. we've got to get ahead of this because it's quickly becoming an issue for us already. one of the things that we've also done is many people see the mission of va as articulated in abraham lincoln's second inaugural address where he said, for him who have born the battle, for his widow, and

orphan. we've changed that. we've paraphrased it. if you look at our mission, the way we call it out here on our 90-day plan, we say, you know, better serve and care for those who have born the battle, for their families and their survivors. while that seems like a modest change in words, it's meant a lot to our female veterans to know that we're looking out for them and we're thinking about them. we've got to get ahead of the things we need to do so that we're able to meet the capacity. maybe dr. clancy can talk more about this because i know it's a particular area of interest to her. >> i would agree with everything the secretary just said. it is a very high priority for us. it has changed a lot in recent years, but we're not going to slow down until every single facility has a top-notch women's health coordinator. all of our health coordinators across the system just got reinforcement of all the training they get to make sure we're meeting those needs. it will remain a high priority.

thank you for your continued support because we can see where the numbers are going as the secretary just noted. >> mr. jolly. >> thank you, mr. chairman, mr. secretary. welcome. we haven't had an opportunity to meet. i echo my colleagues' comments. thank you for serving. >> thank you. i look forward to getting together with you soon. >> my predecessor was here for 43 years. one of your predecessors, once nominated, he said, please don't take this job, you're not going to be able to change the va. i'll never forget that as a young staffer in that meeting. i know the challenge that you face. i appreciate your comments today. i want to express a little bit of concern and maybe give you an opportunity to revisit your exchange with my colleague, when he asked about whether you believe that wait lists contributed to the deaths of veterans. i understand that's a hard question for you to ask, but if we're talking about changing the culture, it's a very important one. because you've spoken a lot of organizational changes, but as

you step into this role, do you believe that the negligence of the va has contributed to the deaths of veterans over the past several years? >> again, i think it's very simple. there are veterans who haven't had access. there are veterans who haven't gotten proper care. i don't really need to go any further than that. that says there's a problem. that says i got to get it done. i'm focusing on veterans. >> i mean this very respectfully. i got a little heated in the last exchange. i shouldn't have. >> what value is there in having this discussion? >> because that actually speaks to the cultural change of the department. i understand the organizational changes and it's needed. deputy secretary sloane gibson, when he was ak acting, sat there and apologized to the congress and the american people for the tail yours of the dmt and what it led to for veterans. you got an exchange that doesn't

show an acknowledgment. to me, that's not a cultural change. that's going backwards. i understand nobody wants this on their fingertips. you weren't there. i get that. i'm not holding you accountable. but in terms of the culture you bring to the top leadership post at the va, do you believe with conviction that the wait list problem contributed to the deaths of veterans is or do you not? >> sir, in my opening statement, i said i apologized on behalf of myself and the veterans affairs department. i've said that in every testimony i've given. i've said that when i've gone out to town hall meetings when i've talked to veterans. i own this. it's not because i wasn't there. i own this. i wouldn't have taken this job if i thought that somehow i could not own this. i own this. and i'm committing to you that i'm going to fix it. i don't know that you can ask for a bigger commitment than that. >> well, i mean, it's a very simple question. i'm just asking you to acknowledge that the wait list and the negligence of the va contributed to the deaths of veterans who we've had hearings

on for six months. that's all. >> and i'm acknowledging that i own it, that they didn't get the proper care, and that we need to improve. >> okay. well -- >> and that not getting proper care has adverse effects. >> and i very respectfully will take that as an answer. i don't think it's a complete answer. i don't think it's an acknowledgment of a cultural change you continue to espouse, but i understand why you need to guard your words carefully in front of a public hearing and the press and hopefully privately you acknowledge the negligence of the va has led to the deaths of veterans. >> let me again say, i own this problem. one of the things my west point classmate i thought did so well, and he was a great leader as the interim secretary, is he owned it and he's helping the organization own it. i am too. we have to own it. if we don't own it, as you've said, we can't change. >> and i appreciate that. i look forward to working with you. thank you.

thank you for serving. >> mrs. kirkpatrick. >> mr. secretary, first of all, thank you for taking the job. thank you for visiting the phoenix facility as your first stop after you were confirmed. that really gave a message to our veterans in arizona that you care and you're paying attention. now, i want top focus on accountability because our committee has heard from people who say they're getting excellent care at the va and that the employees at the va care about veterans, many of them are veterans. but i'm sure you're familiar with the business motto, if you will, that an organization is only as good as its weakest link. and we know that there are weak links in the va. and i just want to get your thoughts about how you ensure that there's continuing accountability. i just want to tell you some of the ideas that we've heard. and if you could comment on

them. one is rolling audits, review by a neutral party, an idea about setting up a blue ribbon committee that would develop a strategy for the va. i have a veteran in flagstaff who talks with me frequently about the idea of a volunteer board of veterans who really don't have any connection with the administration at all but are sort of a soundingboard and a way to solve this. i have introduced my whistleblower protection act, which includes an anonymous hotline for patients and employees to report things. just give us your thoughts about that. >> well, i think accountability is a huge issue. it's got to be a big part of the cultural change. one of the things is we talked about this concept i mentioned in my prepared remarks, sustainable accountability.

it's not just about firing people. it's about giving day-to-day feedback. my standard is that an individual would never need to be fired unless it was an egregious activity because you're providing day-to-day feedback so that person should never be surprised. that should be the standard. relative to external groups, we -- deputy secretary gibson hired jonathan purlin who was the chief medical office to join us in developing the blueprint for excellence for the hospital ne network. that was an attempt to bring outside benchmarking into va. we're very much in favor of that. the new bill provides for a commission which we will help stand up. there also is -- i'm trying to rejuvenate some of the 23 different standing committees we have, which are supposed to help the secretary. there are 23 of them. one could argue maybe that's too

many. but there are 23 of them that are supposed to be helping the secretary. i want to re-energize those and get the right people on them. one of them, dr. clancy and i are in the process of hiring new doctors and nurses and clinicians to help us to join that. we want to do exactly what you're saying, but the most important thing for me is we've got to get every single employee to feel accountable for the outcomes of that veteran rather than worrying about the internal workings of va. >> let me mention one of the more troubling things that our committee has heard. that's bonuses. people who perform poorly still get their bonus and there's this sense of a bonus is an entitlement to the employees. what's your plan to address that? give us your idea about that problem. and what's a good use of bonuses? >> right. first of all, secretary gibson

took the immediate step of rescinding the bonuses for 2014. second of all, he took the 14-day metric out of people's performance plans. because that was helping to cause people to behave in the wrong way based on the outcome for veterans. third thing is i've gone back and i've reviewed, what can we do about bonuses? in private sector, there's something called a clawback provision. if an individual receives a bonus and you later discover, because we have 100 investigations going on, you can claw back past bonuses in order to do that. many audit committees which i've served on have put rules in place to do that. in the government right now, there's not a potential for claw back because apparently when the law was written, the law was written in such a way that when the political parties changed, you didn't want to allow the new political party to claw back

from the past political party. that's the way i understand it right now. but that's the practice in the private sector >> thank you, mr. secretary. we look forward to working with you. >> i look forward to, too. thank you. >> mr. secretary, i would tell you there's a bill that's been filed, hr-5094. it allows you to do just that, should we be allowed to pass that through the full house and on to the senator. mr. o'rourke. >> thank you. i want to join my colleagues and thank you for taking on this service and this difficult but not impossible task of bringing the va back up to where it should be. i want to thank you for meeting with me. and just from that meeting and some of the issues we discussed in your follow up to those items, including an e-mail today from dr. clancy, i think that speaks very well of your ownership of these issues, your attitude of accountability and some of the things that we will have to look forward to on the

bigger issues confronting the va. i also appreciate your commitment in our meeting to ensure that el paso, which is currently, i would argue, one of the worst if not the worst operations in the va, becomes the model. you have no greater opportunity to demonstrate turn around than you do in el paso. i wanted to use the example in el paso to make a larger point about the system and get your response. following what we learned about el paso, despite our assurances from the va to the country that we were seeing people within 14 days, we learned that fully one-third of veterans couldn't get in to see a mental health care appointment. the average wait time was 71 days. that average appointment when scheduled was canceled at least once on average or rescheduled at least once. when we had the vha audit in the spring, we learned we were the worst for established mental health care, worst in terms of being able to see a doctor or provider. fourth worst for new patients.

second worst for specialty care. on and on and on. we had that attention, that focus. va committed $5.2 million in additional funds. the acting secretary, sloane gibson, visited the va. we had our chairman, chairman miller, visit the va in el paso. we had primary care teams, mental health care teams that you sent down there. yet, when i went there two weeks ago -- and i often go by just to talk to veterans and see how things are doing, i met a number of people who said, hey, i got excellent care, wonderful treatment, thumbs up, you guys are doing a great job and a number of people who had complications or issues and we tried to help them. one was glaring to me. it was a gentleman who said, you know, i was given an appointment today, and that was months back that i scheduled it. i called yesterday to confirm my appointment with dr. b. this is a mental health care provider. they said, yes, we have you there to see dr. b at 1:00 tomorrow.

the gentleman shows up, and i don't know how hard it was for him to travel there, but he gets to the va, shows up for his 1:00 appointment to be informed that dr. b no longer works at the va and hasn't worked there for a month. i thought, with all the of the attention that i have been bringing to this issue, that the va has been bringing to this issue, for us to fail this veteran that badly is indicative of some deeper, larger issue. and i think of the 20 ig reports since 2005 that we've had about scheduling problems within the va that all of us, congress and administration, have known about. and yet, we haven't resolved those issues. tell me -- answer that concern we have about culture. as we did in el paso throw money and attention at it, personnel, flexibility, and how you fire and hire people, but i think there's a deeper cultural issue. how will you address that in a minute and a half? >> as i said, cultural changes

is very difficult to achieve. but it starts with the mission and the values. and i would wonder in an organization, have they really committed themselves to the mission and values if an individual can be signed up for an appointment with a doctor that doesn't exist. frankly, in a situation like this, let us know. we'll go back and check and get back to you and find out what happened in the specific instance. any specific anecdotes you can provide us are very helpful because it allows us to go back and understand what really went wrong and correct it in the future. so it starts with the mission. secondly, it starts with leadership behavior. that's why i've gotten out to as many places as i have. i have to get to el paso. third, i think there's a big issue in the openness or lack of openness in this organization. i mean, how could you have a situation where employees were lying to one of the most honorable men i've ever known in

my life in general shinseki? why would that exist? why would that happen? why would we have meetings where union leadership wasn't involved or weren't invited? why would we have people feeling their only recourse was to be a legal whistleblower? that's why i demanded town hall meetings. when i demanded them, some of the feedback was, well, we can't hold a town hall meeting, it will be counterproductive, it will be violent, whatever. that's exactly why we have to do them. we've got to open the culture up. we've got to get communication moving. we've got to get ownership for the problems. and we've got to get people feeling responsible. because in the end, the only thing that matters is the veteran. this is going to take time. but we're going to build it into our strategies. when i think of a high-performance organization, it starts with mission and values. i think we've got that. we're under way there. we got to look at our leadership and see, do we have the leadership to create this new culture? if a leader is unwilling to

embrace this new culture, then they shouldn't go on the journey with us. do we have the right strategies in place in order to perpetrate this culture, to make it happen? we're taking a look at that. do we have the right systems in place? the system would be so that if you asked me, how could this happen in the scheduling system that this doctor doesn't even work there gets made an appointment. then the last is, do we have the right high-performance culture where people flow to the work and people work on veterans issues? it's going to take time. it's going to take time, but i really do believe we can do it. >> as i yield back to the chair, let me just offer my assistance. if you are missing legislative authority to do anything that you're talking about doing to turn around and improve the culture at the va, i hope you will come to us as quickly as you know that. we'll be your partner in offering that legislation and getting it passed. so thank you again. >> thank you very much. >> thank you, mr. chair. >> mr. waltz. >> thank you, mr. chairman. thank you, mr. secretary, again,

for assuming this sacred trust and awesome responsibility. i'm grateful you're there. i think restoring that trust is one of the first and paramount things. i also want to say you scored big points with my chief of staff, who is a minnesota hockey player with your reference. i often as a football coach talk about pursuit angles. it's the same thing. where do we need to anticipate? and i've been saying and i applaud other members, i never understood as a military person myself why there was no equivalent of the quadrennial defense review. secretary hagel as that at his dispense. i went back and looked at the 1997 one under then-secretary cohen talking about we are dramatically safer than during the cold war, but wild card threats are more than likely to happen. and they started anding where those threats would come from once the full-out eastern european threat was gone. that allowed us to start tailoring the force to be prepared to responds to those things. the va does not have that.

the va did not do that. here we are trying to figure out that we're going to add a whole bunch of veterans from iraq and afghanistan. so i would encourage you whatever that form looks like, this is something that would help you enchulture ate this need to get you there. it would force us to go back on a periodic basis to get that done. so i would encourage you to do that. then i would say you're at a unique perspective here. this is time, as i've been saying. let's think big. let's break through the barri s barriers. it is going to be hard to change culture. it is going to be difficult. but here's what i would say. if not you, who? if not us, who then? if not now, when, is this ever going to happen? if the country believes this is important, as i know they do, if all of us in this room believe it's important, let's get there. i think something you can bring, and i would be interested to hear your thoughts, mr. secretary, we have got to break down this false constructive government versus the private

sector. we work together best. this is service of veterans. if the private sector can deliver, if we can work in conjunction, if you can do it, quit that argument that is a dead end that it's trying to find us versus them. this is our veterans trying to get it right. so i would ask you, how do we speed collaboration? i represent the mayo clinic, a great medical institution but also in a rural area that has roots in combat medicine. how can you bring your experience from p&g to bridge that and break down this ridiculous us versus them argument on the care of our veterans? >> well, we're going to embrace it in our strategies. we believe that we can't do this by ourselves and we have to partner. we have to partner with medical schools, as we've already talked. we have to partner in the private sector. we have to partner with members of congress. and so the important thing for us will be to figure out everybody's role and to create a system which takes advantage of that. i'll give you an example. i was in las vegas in congresswoman titus' district.

there we're very close to nulles air force base. the doctors can't keep up their medical proficiency without seeing va patients. they just don't get enough, a broad enough piece of work doing only flight physicals for pilots. so it's great. we have the dod doctors come over to the va. they serve our clientele. the doctors love it. we love it. so one of the things i did in preparation for this -- not this hearing but for this role, was to get a map of all the federal facilities in the country. i know most of the private facilities because we had a health care business at proctor & gamble. and to figure out what's the right combination? if we don't have those ob/gyns that carolyn and i talked about it, we can borrow them from someone else. indian health service is another

one. they have terrific facilities. these are the kinds of things we want to do in our strategic work, what's the right combination of these things. inherently, we'll be local. the details will be in each locale trying to figure out what the right combination is because it will probably be different. >> if there's something we can do, whether it's credentialing or whatever the things -- i know some of these things are difficult and deep and tough. i understand that. but let us get there. i want to the give an example to my colleagues where i, too, have been frustrated with some of the flow of information, but i recognize the incredible work that gets done at times. if this is a glimmer of the potential, last week in minneapolis the press was reporting a story. we've been working with them. this happened on a friday night. by monday there were people out there on the ground addressing or attempting to address on this. and there was a real sense of collaboration with both the public, the veterans, the member of congress. all of us are working together. where was the gap? where can we fill the gap? and how do we fix it? i have to say, i'm seeing that. i very much appreciate that i was seen as a partner trying to

fix this as was the press, as was the whistleblower in this case. and we'll see what goes forward. i'm with you, mr. secretary. we can't be afraid to point out our failings. we cannot be afraid to continue to move forward. >> no, sir. and if any member of the committee ever senses that they're being treated as an adversary, i would like to know that. we know that we need to partner with you to make these changes. >> i appreciate it. i yield back. thank you, mr. chairman. >> thank you very much, mr. secretary, for being here. we are very appreciative as has been said over and over again that you'd be willing to stand in the gap for those who need leadership. again, we would reiterate that it is our desire to stand with you as a full partner in serving those who have worn the uniform of this country. do you have a closing -- >> no. i, too, want to thank mr.

secretary for coming. i agree with everything chairman miller has just said. thank you for your service. look forward to a strong partnership. >> thank you. i look forward to working with you as well. >> thank you, mr. secretary. more now from this hearing on the phoenix va facility with the vha chief of staff and the phoenix va chief of staff. they take questions from committee members about changes to the inspector general's report. whistleblower retaliation and manipulation of data. you can read the report on our website, c-span.org, when accessing the hearing. >> thank you very much. the third and final panel comes to the witness table. we are setting up the name plates. i will tell you who we're going to hear from. dr. lisa thomas, chief of staff

of the veterans health administration. dr. thomas is accompanied by dr. darren deering, chief of staff of the phoenix va health care system. if you would, i'd ask you to stand. i was going to try and catch you before you sat down. raise your right hand. do you solemnly swear under penalty of perjury that the testimony you are about to proride is the troourt, the whole truth, and nothing but the truth? thank you. let the record show that both witnesses responded in the affirmative. secretary mcdonald has already provided an opening statement on behalf of the department of veterans affairs. so we will move directly into a round of questions. dr. thomas, on march 14th of

2013, the oni committee revealed wait time and health care delays in augustaugusta, georgia, colu south carolina, and dallas, texas. two months later, may, the va waived the fy-2013 annual requirement for facility director to certify compliance with va policy, further reducing accountability over wait time, data integrity, and scheduling practices. are you familiar with that? >> yes, sir, i am. >> did you approve or recommend the waiver or requirement? >> no, i did not. >> so you knew the waiver was given. >> after the fact. . >> after the fact. and what action did you take after the fact, recognizing that there was a real problem? >>.

>> in the spring of this year is when we realized that we really missed the boat in vha, that the situations regardsing delays and care were more of a systemic issue rather than looking at each case individually. in the spring of this year when we went back and researched it, the memo you referenced that was issued in 2010 was prior to my tenure as chief of staff. so i went back and looked at that. it was in the media. it was hard not to realize that we had this memo talking about our scheduling problems and the gaming of the system. and we looked at that in relationship to all of the other issues that were going on around the country and realized, albeit too late, that we had a systemic issue. we should have taken a holistic approach to looking at it rather than each individual incident in isolation.

>> we've got the original inspector general report on phoenix. and we have the one that va released. iz assume you're aware there was a crucial change in language made in the executive summary that said the physician whose allegations this committee had carefully verified could not tell the inspector general the 40 names of the veterans who had died. i think this gave a false impression right up front that the whole matter was untrue. so my question to you is, did you have any idea that language like this was going to be inserted in the ig's report? >> no, i did not. >> your -- let me see if i can finds it real quick.

according to your fiscal year 2013 performance review, by the way, 500 out of 500 is what you received on your review. perfect. one of your responsibilities as veteran administration chief of staff is being able to identify critical oig reports that could produce negative media attention and ensure talking points in communication plans are developed before the final report was released to increase the department's responsiveness. so could you give the committee a little idea as to how that works? >> absolutely. sir, first, what i'd like to say is we sincerely apologize to all the veterans. no veteran should ever have to wait for care. and it's unacceptable to us. we did get the ig report and

several drafts. at each draft stage of getting a draft, it was our responsibility to make sure that we were putting together an accurate communication plan so we can then communicate to all of our stakeholders what the ig found but more importantly what we were doing to do to fix it. we really focus on more the edits and looking at what we're going to do in the action plan than the actual oig report. as dr. clancy said, we have a management review service. they are responsible for looking at that and making sure that all the correct sungt matter experts look at that report and if there's anything factually they think needs to be corrected, they provide that information. what we also do is making sure that all the subject matter experts come together to identify what is the corrective action that's needed. so that we can meet the needs of veterans. the communications folks that report to me were doing that every iteration. so each iteration of the report we were trying to highlight for

them what was the difference from the last report to the next report so that they could accurately and very efficiently get a communication plan together. one of those changes was the change from 28 recommendations to 24. the consolidation of a number of the individual recommendations regarding ethics were rolled into one. highlighting those makes it easier for them to be more responsive to have a document that's pulled together so we can communicate to all of our veterans, the public, and stakeholders exactly what was found and what we're going to do to fix it. >> okay. i'm going to ask you to pause right there. members, we need to move to the floor. we have less than five minutes to get to the vote. we'll be back as soon as we can.

committee will resume its hearing. again, we apologize to the witnesses. that will be our final interruption of the day. dr. deering, thank you for attending. i would like to know if you've reached out to any of the whistle bloblowers about resolv their cases and if so, how many have you worked with. >> i have not personally reached out to the whistleblowers at the phoenix v.a. about their specific cases. >> would that be something that you ordinarily would do? >> i believe someone else is working with them on their cases. >> but in the normal course -- i

understand phoenix is somewhat of an anomaly. normally would you be the one that would reach out to whistleblowers? >> certainly. i've had other employees who have brought up concerns within the organization and i work with them closely to address those. i had an employee just about two weeks ago sent me a message on my personal cell phone saying she had concerns she'd like to discuss. and i met her off campus to discuss those issues. >> has anybody prevented you from talking with whistleblowers or advised you not to talk to them? >> i've not been advised not to. >> of the 293 deaths that were identify by the office of inspector general, how many required institutional disclosures? >> i don't have that information because i have not reviewed those cases specifically. i'd have to crosswalk those to see how many would require institutional disclosures. we are in the process of

reviewing the 45 cases that were outlined in the inspector general's report to see which of those would require institutional does his cloisclo necessary. >> you're the chief of staff and you don't know if there were institutional disclosures? >> i haven't been provided the specific names of those 293 veterans, sir. i can pan the list of names of who we have conducted initial disclosures on and i don't know if those happen to be on that same list. >> well, let's go this way. how many institutional disclosures have been made at phoenix in the last two years? >> in the last two years, and i can get that specific numbers, but it's around six or seven institutional disclosures have been conducted. >> say the number again. >> somewhere around section or seven. >> did you order oig report case number seven's schedule an appointment with primary care

consult to be removed from his chart? >> can you repeat that question? i'm sorry. >> report case number seven, which was in the oig report, there was a schedule an appointment with primary care, but it was removed from a chart. and my question is, did you remove this there his chart or, if you didn't, who did? >> i do not recall instructing anyone to remove a consult from someone's chart. but specifically to case number seven, i don't have that patient's demographics. i'd have to go back and look at that and get back for you with that information. >> who at fphoenix can remove those kind of records or wipe a chart clean? >> consults typically aren't removed. they're discontinued or canceled or completed. socontinued

or canceled, they would still stay in the chart. >> there was a primary care appointment taken off of number seven's chart. so i'm trying to find out exactly what happened. dr. huton reported health and patient safety issues to leadership and was fired. i'm sure you're aware of his firing. and i guess was fired by ms. helman. did she ask or require you to do a board on dr. hutan? >> specifically regarding him, i don't recall him bringing patient safety concerns to my attention. regarding his termination, a summary review board was convened to look at his case specifically and make a recommendation to the medical

center director. >> but you did conduct the board on him? >> i did not conduct a board. i convened a board and it was ran by another physician. >> can i ask you a personal question, but i think it's pretty simple. after all that's happened at the phoenix v.a. medical facility, how is it that you're still employed there? >> sir, i think that's a fair question. and if i may, i grew up in the v.a.. my father who was a veteran passed away in october, received all of his care through the v.a. health care system. and i have memories from being a child growing up in waiting rooms where we'd often show up and wait all day for an appointment and often be turned away at the end of the day not being seen.

i came to work at the v.a. after training there as a medical student, as an intern and recent department. dr. foot oig was my resident. i ran back to the v.a. when i had the opportunity. i've committed my whole career and a lot of my personal life to trying to improve the v.a.. the phoenix v.a. certainly is not perfect and i've said that before. i don't think any health care system is perfect. we certainly have made mistakes. we're learning from them and we're moving forward. and a good example is after the interim report came out, i helped lead the initiative to get all those patients that were on unofficial lists in for care, contact them and get them in in a short duration of time. i'm very committed to this mission and to the cause and have spent a large part of my life either as a child growing up or trainee or student or provider in the system.

i believe in the system. >> thank you very much, mr. chairman. dr. thomas, were you aware of visi vision oig report that found that the phoenix health care system was using unauthorized s practices? >> i was not aware until it was cited in the media and then we asked for a copy of it. >> is it your job to ensure phoenix comply with the vha policies? >> i think it's all of our job in central office to make sure that we have a system that has policies in place that the peeled can understand, that they can implement. and we do need to improve our oversight. that is one of the things both

dr. clachb cincy and the secrete looking to change to make sure that we have the appropriate oversight and auditing function. >> can you explain to the committee what your job is? >> i can. as chief of staff, i think that the best explanation i can think of is i'm really -- i serve the function as adviser to the undersecretary whoever that may be, but i'm like an air traffic controller. i don't get to fly any planes. i'm the one who is there to make sure all the planes are flying on time, going in the right direction, which is set by the visn and sent and undersecretary for health. so i need to have a broad understanding of everything that is going on with that vha, but that means i'm not a subject matter expert. >> so if you're looking at the planes as they take off and land

properly, since phoenix arizona was not complying with vha policy, you set a path for them to follow. they did not follow it. so who is responsible at vha? is it the undersecretary or your job as chief of staff? or is your job as chief of staff to be -- to make sure the secretary understands what's going on in the visn office? >> i think it's all of our responsibility in central office. if you would allow me, i think when the first panel was here, you asked a very important question. and you said really what we need to know is what happened, why did it happen, how do we move forward and how do we hold people accountable. and i think that is really key. and what did happen was that we have an overly complex scheduling system and process which we are in the process of fixing. we also have an undue focus on performance metrics.

as you'll hear the secretary say, all of the performance metrics are related to the 14 day wait time met fricke has been removed. we do have capacity issues and the choice act recently passed will help us do that.removed. we do have capacity issues and the choice act recently passed will help us do that. we will hire 9600 clinicians -- >> since my time is running out, yes, we have to find out what happened and how we solve the problem, but if you were part of the problem that knew that phoenix, arizona and other facilities were not complying with policies that were set by the department, i guess it is your responsibility. and that's a big concern i know i have and other committee members have. if you've been part of the problem, how am i going to feel comfortable that you won't still be part of the problem some. >> sir, unfortunately, we did not know of the problems in phoenix until the spring.

we did not know of the previous reports. and i'm not sure where that system broke down. but i do know with a change in culture that the secretary has set forth, we will remedy that issue. >> did you see a problem with the undersecretary and secretary as far as not moving in the same direction or is there undercutting occurring between the two? >> i was very rarely in the same meetings as the two gentlemen. i only knew what i heard the secretary say inings that i was in and what the undersecretary would say after he came back from the meetings. >> my last question moving forward, is there a -- as vha chief of staff, what have you done to make sure that scheduling problems do not continue to occur?

>> we have two very major initiatives that we've taken on. the first was the and you had eithe audit which i know you've been briefed on. that was very important for us to understand if this was isolated instances or if we a more systemic issue. sadly we know it was more systemic. so we then launched into make sure we could put resources to all of the veterans waiting for care. anyone waiting more than 30 days, we contacted, we reached out to every single one of them and offered them to come in for care earlier or refer them to the community for care. to those that we could not contact, we made three attempts by phone, we sent a letter and we're also working with partners to try to see if we can locate those veterans. so we're taking those extra steps to make sure we can identify who they are so we can bring them in for the needed care. >> and last question, i know i'm a little over time, but do you

think that there is too much autonomy back at the visn level and that's part of the problem as far as following the directive from the secretary or yupd secreta yubd secretary of health? >> my personal problem is we are not well centralized. i think we need a standardized system of health care that we can consistently provide quality health care to all of the veterans whether in the large cities or the rural areas. >> thank you, mr. chairman. >> mr. huelskamp, you're recognized. >> thank you. i know -- maybe it's just me, but trying to understand what is being reported in the numbers can be very difficult at times. i will note there is at least 41 individuals that you did not reach in the outreach campaign that is reported as deceased. and i will note for the committee i think that's part of the records that did not get

reviewed by the oig. one thing i want to bring attention to that is disturbing to me, dr. thomas and dr. deering, we have student rosters including employees there dr. deering's office, v.a. sponsored training using a book called how to lie with statistics. and the author explains that his book is a primer in ways to use statistics to deceive and a well wrapped statistic is better than the big lie because it misleads yet it cannot be pinned on you. one of the techniques described in the book, and these are taught in a doucourse for v.a. employees, july 11, this was a chart provided to us by i believe folks out of phoenix that led the committee to

suggest that we have a problem with not enough employees. and if you look at the blue, you say, oh, my goodness, look at the increase in the number of visits and needs of patients and the green line is the number of afts increased. but when you put the two together, you'll find out they are on different scales. actually they're about flat. there is about equal growth. but average american looks at that and say we at the present time spend enough money or didn't have enough employees there. but i think it's clear that you pull it down, you look at what employees are learning from, but who orchestrated what appears to be a purposeful intent to deceive veterans, congress and the american people? dr. deering. >> well, regarding the book, from what i recall, that was actually a visn sponsored

training for coaching sessions. i wasn't involved with purchasing that book. the graph that you're showing on the screen is part of our do congressional briefing to our local delegates. there was no intent there to mislead anyone. we were trying to basically outline the framework of how we got to where we were in phoenix as part of -- >> why would you do two different scales and put those together is this together? if you use the same scale, they're about the same. >> i appreciate that feedback. the intent was not to mislead. >> what is an intent to show there? >> the intent to show here is that we have had continued growth in the outpatient setting on the number of visits coming into our facility over the last several years and when you look at the increase in the fte, it has gone up a little bit. but the key point here was back

in fy 10, high personal belief, we still did not have enough personn personnel. >> why would your employees be learning from a book about how to lie with statistics? >> sir, i can't speak to that. that's a title of a book i don't -- >> employ heees i believe from r office are learning from this course. you haven't seen the book? >> i've seen the book. i haven't read it. >> are you aware your employees are using it? >> i can't say that. >> where did you see the book? >> when the coaching session was happening. >> you're coaching them to use this book, to mislead? >> no, not at all, sir. >> describe why would you use a book like this which again demonstrates how one can misuse statistics, and i have a background in this, this is part of my ph.d., misuse statistics

to mislead folks. why would you be coaching folks with this book? >> i can't speak to that because i didn't coordinate that training session. i don't know if they were trying to teach people how to notice when statistics are not being used appropriately -- >> actually, it says how to lie. >> so i don't know if the kept content is teaching people how to notice when people being honest or teaching people to lie with statistics. >> this is your chart coming there your office and i think it's very misleading. and it's difficult as a policy maker to get to the bottom of the facts of the matter. we just had a hearing earlier a few hours ago, you might have been here, trying to figure out exactly how many folks were on a waiting list. and the numbers are very confusing coming out of the oig. but this would suggest that fwosh dagosh darn it, there has been enormous growth, but there has not. it's a scheduling rob.

and we've heard that again and again. i will say and i appreciate the time, mr. chairman, it's so difficult to follow what the numbers actually are and we've gone so far as to say the numbers don't matter anymore because it's driving bonuses. and i think both of you have pretty significant bonuses. you've had bonuses for how many years? >> i don't know. i'll be happy to provide you with that. >> i think mine show five or six or seven years in a row and always doing very well. so with that, i would share will with the rest of the committee. let's be very careful with what we see unless it matches up with reality. you can fix up this chart to put it on the same scale? >> sure. we'll do that for you. >> thank you. ms. kirkpatrick. >> thank you. dr. thomas and dr. deering, as you can see, the committee has a lot of whys.

and since this problem has been brought to our attention. and as dr. huelskamp said, we want to get to the facts. not because we want to harass you, but but we need to understand the whys in order to help craft some policy that makes sense. for instance one of my puzzling whys has been this memo of 2010 that outlined all the scheduling problems. and i'd like to know if either of you or both of you maybe saw that memo and what happened next. >> i can answer first, congresswoman. that memo was signed and distributed prior to my tenure. it was in i believe april of 2010 when that memo was signed and i started in my position in 2011. i did not have awareness of it until we realized that we were having in the spring of this year that we were having significant issues away our

system and started putting the pieces together. >> and my answer is similar. i came in to this position in 2012. prior to that, i worked as inpatient hospitalist. i ran the inpatient side of the hospital and country work with the outpatient side very much. so i wasn't familiar with that memo and i didn't become aware of it until this crisis surfaced. >> that's troubling to us, but at least helpful to know because obviously there is a problem in communication in terms of checklists of things that need to be done and improved. i appreciate that you're trying to identify the vets who need care who have been waiting for scheduling. i represent a very large rural district and i want to tell you that the vsos in my district are willing to help you identify

those veterans especially on tribal land. we have vast areas where it's difficult to reach veteran, but they have reiterated over and over again that they are willing to assist. a lot of them know them personally. we just want to make sure that they get access to care. >> and i'm very happy to work with them, as well. we were talking about rural health. i true grew up in a town of 400 people. my father had melanoma and there was not a term toll guest within probably 60 miles of our home and the local v.a. was able to leverage tele dermatology to get him care. and this was years ago that the v.a. leveraged that type of a tool. so there are resources. i'm more than happy to talk with you afterwards. >> i appreciate that the vso will be happy to hear that. i yield back the balance of my time. >> prior to your current role,

had you ever been a clinic director or -- of a medical facility? >> no. i was the chief of the hospitalist service at our facility and was responsible for the care of the inpatient side of the house. >> so never a clinic director or service chief of a medical facility? >> no, sir. >> thank you. were you aware that scheduling manipulation of any kind was occurring at phoenix before really i guess april 9 when it hit? >> when i became chief of staff in 2012, we started working on improving access to the veterans and one of the things that we had learned in that process is that some of our am because laer to care clinics had carved out time in their day to do administrative work instead of patient care. so we systemically started going

through that process to standardize the expectations for front line staff in the clinics. i don't know if i would call it manipulation, but there was certainly some providers who were working very hard seeing a lot of patients and there were some providers who had managed to block out parts of their clinical time to not see as many patients. and i don't think that's fair to our veterans. so the expectations was that we would standardize that across the health care system and clean those profiles up for our providers. and unfortunately or fortunately in the process, some of those providers felt that they didn't want to continue the journey with us and they left. and others continued to feel like things were being rectified and made more fair and it helped to improve appointment availability for our veterans. >> are you both aware of the litigation hold that was placed on the phoenix records? >> yes. >> remember that you're both under oath. have any of you -- either of you deleted, removed or made unavailable any e-mails related

to the scandal in the phoenix area, any communication at all? >> i have not. >> i have not. >> dr. thomas, there was a news report this morning on credits n cbs new, i don't know if you were able to see it, citing a whistleblower in the central office who talked about how v.a. officials sought to soften the inspector general's report. he said v.a. was worried the report would damn the organization, which it did, therefore it was important for v.a. on introduce language that softened the blow. so my question to you is, did you ask or are you aware of any employee in the central office

who asked the ig to change the report or questioned the ig about any language, verbiage in the report? there has been a hang up on specific words and i get that. and -- well, i'll let you answer that first. yes or no. >> thank you very much. it's a very important question. what the ig found -- >> that would be a yes or no. >> it is a more complex situation than that, sir. >> my question to you is yes or no, did you ask for any changes in the verbiage -- i know the -- >> i did not. >> thank you very much. and i appreciate you doing that under oath. how it you find out that the verbiage had been changed and what was your reaction when you heard it?you find out that the verbiage had been changed and what was your reaction when you heard it? >>nkzf as i mentioned, the pro is it a standard process that we use and we get draft reports. we then begin to draft our response in terms of an action

plan as well as any communication product such as fact sheets and communication plans that need to go along with that. one of the iterations of the report, in fact i do remember the very first report made no mention at all of the 40 deaths. the second or third iteration, a paragraph arose in that new draft, it was a little bit confusing. i'm not really sure exactly what it was communicating. and then the final draft that we got, and we were already working our final action plans and every time we submitted something, another draft came in. so we would say what is different in this draft so that we can then address it and update our data. in the last draft that we received, it did have the sentence. >> so what was the language that was confusing? >> there was a paragraph in one of the drafts that talked about the number of cases. it mentioned something about the -- i don't remember off the top of my head exactly what it said. but it talked about the various

levels of concern, so many patients this, so many patients that. i'm sure you'll see those copies and see exactly what it says, but -- >> so the changes were made in about the third iteration? >> there were changes on every iteration. >> we're talking about two specific changes. it's my understanding, and i should have asked this of dr. day when he was here, but that it's given to -- again, i learned today that there are numerous iterations that go back and forth. i thought the ig produced a report, gave it to v.a.. v.a. reviewed it for acfactual issues and then a final report came out. now i understand that there was a back and forth conversation between the office of inspector general and i assume you? >> no, sir. >> who?

>> i'm sorry? >> who? >> i don't know. i just know that i did not have any communication -- >> the secretary said in his testimony that he was not a party to the conversation. so as the chief of staff of veteran health administration, you have no idea who was involve some had. >> i had no direct contact with the ig whatsoever. >> that wasn't my question. you have no idea who was involved? part of your bonus and your review specifically talks about oig reports and the negative impact that they may have. so you're telling me you had no communication at all? >> that's correct. >> yet you got a -- but you got a perfect performance evaluation and double digit be nonus, yet weren't involved at all? >> what do you mean? i wasn't involved in any direct conversations with the ig about

changing any portion of the report. what i was involved with was taking the reports that they submitted to us and making sure that we had a good action plan to correct the issues at hand and to have a communications plan that clearly communicated to members of congress and the public -- >> your action plan. at what point when apparently there were two statements in the report that were not in the original, one was that dr. foote did not give the 40 names, which can you tell me why that would need to be -- >> i have no idea. >> just trying to figure out why that would need to be in a report. and then the other about cop cl conclusively which they also couldn't say that it didn't cause death. so what point did it you leayouu learn that was in the report? >> when we saw the final draft.

>> so it wasn't the third iteration. >> i'm not clear how many iterations there were. i personally saw three. >> i think oig said there were five. >> i personally saw three. >> so you did see three. >> uh-huh. >> very good. thank you for appearing under oath and answering these questions. >> mr. huelskamp. >> thank you, mr. chairman. as i understand the answer to your last question in terms of dr. thomas, you saw the iterations, but weren't able to make any amendments. they were just sent to you via e-mail or hard copy? here's what is out there? can you describe that a little further? >> as with all oig reports, they're provided to us either in hard copy and/or on e-mail. and they're stamped with instructions to guard it and that it is only to be used for official purposes.

when we receive that, we then worki?pwith it. as dr. clancy said, an organization within vha is responsible for -- >> is there a distribution -- sorry to interrupt. you answered part of that already. if i i understood, you have no idea who asked for changes but you received thosed a d ed adap. was there an e-mail distribution list? >> it went out to a number of people. >> can you identify a few other folks that were receiving that did you want that needed to? >> i'm sorry, i didn't hear the question. >> the other individuals that needed to see the document. i guess yours was view only. you made no suggestions to amend it. but somebody else did. dwl not sl >> not view only. it's provided on e-mail so that if we needed to cut and paste some words to be able to put in the action plan, we didn't have to retype it. i understand the concerns of the committee. i really do -- >> my question is who was making the changes? we still don't know. i asked the secretary.

that's not me. you seem to be the one at the level. and you saw the iterations. you're telling me you have no idea from the v.a. side who suggested changes? >> i do not. >> do you know who would know who made the changes? >> i do not. >> do you know who was on the disthere distribution list? you can name one other person? >> i would have to go back and look at my e-mail to see who was on there. here's who we sent it to and here is who is getting a hard copy. we wanted to limit the e-mail because it was high visibility case. >> what happened with the leak and i can appreciate that concern. the folks reviewing the draft, were they all in your office? >> no. >> you can identify another office? >> there were members from

management review service, members from the operations side of the organization. i'm sure the field probably -- >> public relations, did they get a chance to review that? >> absolutely. our communications office that reports to me needs those documents. they received each iteration because as i said, they needed to start working on the communications plan. we needed to work efficiently and we couldn't wait until something was published and then start working on a communications plan. >> has a report like this ever been leaked before to your knowledge? >> there are lots of things that are leaked. >> to your knowledge, has a report like this been leaked before? do you have any policies against -- >> absolutely. >> if someone is found out to be leaking the document or authorizing that, what is the punishment? >> i think absolutely that they should be held accountable. >> what is the punishment? >> we would have to work with

our hr experts to find out. it depends upon that individual if they had prior disciplinary action because we have progressive can it discipline. so if they have committed prior acts, the discipline that would be proposed for them would be stronger than if it was a first time owe fence. >> dr. deering, i want to ask you some specific questions. again trying to understand what was going on at phoenix if i might. the oig report identified, for example, 1800 individuals on near. did you know before before wenk there was a near list? >> i was not up tntil april 9. >> when did you find out there were 1800 names on that list? >> it was sometime late april. probably about intwo, three wee

from what i recall after the disclosure of the information from chairman miller. >> the other thing -- there are a lot of things in here. urology consults, 600 printouts. when did you become aware that some member of your staff was printing out a schedule request and sticking it in a folder? when did you find out that was going on? >> about the same time i found out about the near report. >> what did you to once you discovered that was occurring? and is it your responsibility to take care of this? >> my role as chief of staff at a facility level is a little bit different than dr. thomas. at the facility level, chief of staff is responsible for the fish oiphysicians and clinical the house. the scheduling process falls under the business side of the house. so those were not my employees. i can't really speak to what happened with those employees. but i know they quickly put a

stop to that process and started educating staff about those employees about the correct process. >> there's actually ten years of oig reports of these scheduling practices. so there was no quick stoppage to it. there might have been about this one once it hit the fan, but that is a real concern, as well, that this has been -- those reports were out there in public for years before you took the job. so just curious what had happened with those. i'm not sure what the number was stated earlier as unreviewed documents and files. and it could have been anywhere from 3,000 to 4,000 to 5,000. very unclear from the oig report. so thank you for the time. i yield back. >> ms. kirkpatrick. >> thank you. dr. thomas, we've all been concerned about the antiquated i.t. system. and you've stated that it's in

the process of being fixed. what does that entail, what you're looking at, just give me an update on that process. >> absolutely. i think there are two components to that. the first is our policy. we need to have a clear policy that is easily understood by all of our employees that they can follow. the second com poe thept would be i.t. system. i know just recently we did a call out to the field to make it easier and offered them dual screens because of the i.t. system that they're currently using, it would make it easier for them to do their job to have multiple monitors. we're doing interim updates and fixes to our current scheduling system while we do a more long term solution which we've had an industry day lately and -- just recently and trying to get off the shelf solution for our !cbtr"ur+árp+e any idea of your time line for that when you think you'll be able to get an

off the shelf system and really bring it back into the 21th century? >> i should know that. i sit in the daily briefings we have on this topic and we brief the schedule once a week, but i can't think off the top of my head. i'll be happy to get that. >> thank you. i yield back. >> dr. thomas, you said you looked at three of the draft reports. did you provide any input to the ig either directly or through another staff person to the ig as far as changes in that report? >> i did not. >> you're chief of staff and particularly with this case, the level of publicity it's received, why did you not look at all five of the reports? >> i don't think i had awareness of all five of them. in preparation for this hearing,

obviously i went back and looked through the history of what i saw and when i saw it and when i looked at my in-box and what i reviewed, i i could see the interim report and three drafts of the final. >> so you made no comment to then else at v.a. as far as the report and changes you'd like to see in to v.a. employees? >> we had plenty of conversations about the report. i think that when the first draft came out, we were all quite surprised that there was no mention of the 40 deaths. but we -- i personally -- made no attempt whatsoever to intervene or change that. it seemed quite odd since that was what was in the news as the ig had mentioned all over the news and we personally have asked questions of our neighbors and our families, you work for the v.a., did you kill 40t's no important part.

the most important part was we had delays in care. i personally was interested that the report should address the 40 deaths because my concern was that veterans would not have faith in their health care system and they need to be able to come to us for care if they needed health care. >> and when you had mentioned -- pd you said we. the part that concerns me, you're the chief of staff so this case that's got a lot of news and we do have to move forward, but we're trying to get back to where the -- will the disconnect. and when you mentioned we, who is the we? >> i said we and then i corrected myself and said i because i'm under oath and i can only speak to myself. >> but who did you talk with

within the department? >> i think there were -- i know there were multiple meetings within vha, with leadership, with communications staff, with the congressional folks both within vha and -- it was a topic. it was in the news. and we were waiting with bated breath to get the report to see what did it say because we did take immediate action right after the interim report. and we wanted to know where else are we falling short where we're not providing quality care to veterans. we need to get our act together and fix it. we wanted the report for see what else do we need to put in place. >> is that we dr. petzel, secretary shinseki or we some staff below you? >> i think collectively everybody in the department. we have over 300,000 employees in vha and i'm sure almost every single one of them gets up every day to make a difference for veterans just as i do.

and we don't come to work to try and mislead or hide or -- >> i realize you have that many employees. but when you said we discussed the report, i'm sure you didn't discuss that report with the 300,000 employees. so i'm just trying to narrow down who the we that you're talking about. and i know being the chief of staff, that that's your job. but that is a very important job. and you set the tone as well as the undersecretary. so i do have a concern with some of your answers today. but with that, i yield back. >> i have one final question. dr. thomas, who do you believe commissioned this oig report? >> i believe that the oig report was initially started because of

a hotline call out from a physician from phoenix. and that after the april 9 hearing, that the ig was directed to do so. >> by who? >> i believe congress charged them with investigating the issue. my belief. i could be wrong. >> oh, you're correct. >> okay. >> and so my question is, how is it you got the final report before congress got it? >> the final draft? >> final report. >> i did not get the final report. >> call it a draft, call it a report. how did you get -- how did you see the final copy, whatever it was, how -- you saw -- it if you saw the final draft, you saw the

final report. how did you see it before congress? >> i'm sorry, i don't know when congress got it. i know the report was publicly released on i believe august 26. and we see the final draft because we have to respond to it before it's published. >> well, it's been your testimony both of you that neither one of you knew any of this was happening, is that correct? >> can you be more specific in your question? any of what was happening? >> oh, i don't know. manipulation of data, problems with scheduling, any issues within delays in care. you weren't aware of any? >> in the spring. >> but you came to work in july of 1'11? >> 2011. >> so you weren't aware of any delays in care until april 9 of

2014? >> as i said when i started this hearing, sir, i think vha missed the boat. we were -- >> i'm talking about you. you personally. >> from the ig -- >> i'm talking about you personally. >> and i am a member of vha and -- >> you're telling me you were aware of none of the problems until the hearing on april 9? >> what i'm trying to explain is that as the situation arises, we were looking at that as an isolated event as we were each of the ig reports rather than taking a holistic approach and a more comprehensive approach and looking at them together. >> so again, your testimony is you were not aware of any of the scheduling problems and delays in care until april 9? >> i was not aware of the extent of the problem. >> what does that mean? >> as i said, each time an ig report was issued, we would look at it, respond to it, and create

an action plan for any of the national reports. >> the interesting thing what v.a. usually does, they do respond to it. it's interesting that they accept every recommendation. now i see how it works. if the ig and v.a. with working hand in glove backwards and forwards, they already know what they're going to agree to. this is the first time that i can remember that v.a. actually is doing some of the things that they have in the past certified that they have been done. >> sir, respectfully i would not agree with our characterization with oig. >> i understand and i will retract that statement. but you did i learned today you get drafts, you respond, you make changes. it goes back to -- do you not?

>> i think it's a very important distinction to make between the i fwch ig report and the action plan. >> i'm not talking about the action plan. the ig report. the ig makes 23 recommendations in this report. >> 24. >> 24 recommendations. three have already been done. and i guess what i'm saying is congratulations to v.a. for the first time that i can recall for actually moving on the recommendations, not just certifying them and then we find out months and years later that they haven't been done. but we appreciate you being here. we do apologize for the length that you had to be here today. but thank you very much. and ms. kirkpatrick. >> thank you. i just want to thank our staffs. we started this at noon and so it's been a long day. but we need to put in this kind of effort to get it right for our veterans. so i just wanted to say i really appreciate everybody's effort. >> thank you very much.

and also members i'd like to let each of you know that sharon helman was also minvited to appear and we reached out to her attorney and we never received a response to the invitation that was issued. but she in fact was invited to appear. and with that, this hearing is adjourned.

this campaign season, we are covering more than 100 house, senate and governors races from around the country. last night in nebraska's second congressional district, we carried a debate between republican lee terry and democrat brad ashford. here is some of their exchange. >> hindsight is 20/20 and what one could say i think is that had we left troops on the borders with syria, we could have maintained some training mission and some support mission on the border with syria theoretically, and in and around baghdad and other parts of iraq. that train has left the station at this point. and i don't see -- i really don't see us coming back into iraq with that kind of force now or in the future. >> well, i agree that hindsight is 20/20.

the reality is that the laissez-faire policy of the president of not helping with the establishment of the document are or pulling military out too quickly so they weren't trained, when the government started in essence punishing segments of their society,are o out too quickly so they weren't trained, when the government started in essence punishing segments of their society, all of that we should have been much more involved to prevent that from halvinf i happening and we have had isil. i did want to say as i support the president on his strikes. i think that's the right thing to do. we have to do it. it's in our national security interests to do that. but we have to make sure that this government and their military, they're the ones and kurds should be armed, as well. they're good fighters. i think the boots on the ground in iraq should remain iraqi boots. >> okay. you did recently vote against arming the syrian rebels.

can you explain your position on th that? >> yeah. thank you for letting me do that. i was the ol only one that vote against that. that was to arm the syrian army and train them. i've seen too many instances where we trained a group of people and then as we're training them, they turn their weapons on us. and syria is one of those places where it's really difficult to find that you just because they're fighting assad doesn't mean they're our friends. so i worried that they would just turn on the united states whenever they would get the chance and we would have trained them to do that. >> mr. ashford, do you agree? >> here's what i think about this. it's impossible for me to know about the vote because i didn't see -- i wasn't briefed. i don't know about the intricacies about that congressional decision. but what i do believe, and i don't understand this, maybe lee

can explain it, how congress could have left washington after four days coming back from the summer vacation and had a vote on training syrian moderate rebels without a thorough discussion and debate. and think those questions need to be asked and i think the authority needs to be discussed and debated. what authority do we have in making this move. so i would say stay in washington, debate at least for a couple days. there was only four days of congressional meeting after the summer recess. it should have been debated at least over the weekend after that vote. >> mr. terry, you get a chance to respond. >> and there were several days of discussion and the process was the president asked for congress to make the authority that the president said he wanted it in the continuing rez loou resolution and we had a deadline. that's the answer. real clear politics rates

this race as to up. y toss up. you can see the full debate and other election related programming on our website cspan.org. c-span campaign 2014 debate coverage continues. today at 2:00, the oregon governors debate between the incumbent and dennis richard son. and sunday, iowa u.s. senate debate. c-span campaign 2014, more than 100 debates for the control of congress. tonight at 8:00 p.m., how presidents make decisions with former white house chiefs of staffs and advisers to former presidents ronald reagan, bill clinton, george w. bush and

president obama. and just before 10:00, the presidents and cia with intelligence expert melvin g goodman. that's on american history tv on c-span3. the future of the european union. experts from the european parliament presented a report on the ramifications of dissolving the eu. the wilson center hosted will this event. >> good afternoon. i'm christian ostermann. it's a great pleasure to welcome all of you on this beautiful late august day here in washington. i'm thrilled to see a good

number -- a good turnout on such a beautiful day here, a good turnout for the eu and europe. we're delighted to host this event on mapping the cost of non-europe 2014 to 2019 with our colleagues and friends here at the european parliament liaison office with the u.s. congress and delighted to welcome all of you. for those of you who are -- most of you are probably familiar with the wilson center. for those of you who aren't, especially those of you watching on c-span, let me just remind you that the wilson center chartered by the u.s. congress as the official memorial to

president woodrow wilson is the nation's key non-partisan policy forum for tackling global issues through independent research and open dialogue to inform actionable ideas for congress to administer and to broader policy community. the center's global europe program addresses vital issues affecting europe relations, europe's relations with the rest of the world through our scholars and residents, seminars, international conferences and publications. these program activities cover european energy security, europe's role in setting global standards relating to governance and human rights. i'm delighted to welcome today's panelists to this presentation. claus welle and anthony teasdale. let me introduce both of them.

they are behind this important new study that we will talk about today on mapping the cost of non-europe. really, a study showing immense research on the benefits of integration of european integration, trying to put this in very real, specific practical terms. and with that setting from the european parliament's side, trying to set a policy agenda for europe. let me just say a brief word about our two speakers. then i will turn it over to them to talk about the report. klaus welle has been the secretary-general of the european parliament since 2009. prior to that, he has held a number of positions within the european parliament including the head of the cabinet of the president of the european parliament, director general for

international policies and the secretary-general of the european people's party and the european union of christian democrats. he was also head of the european and foreign policy department of the christian democratic union, union central office in germany. he is a native of germany. and received a degree in economics from the university in germany as well as grants from the foundation of the german people and a foundation which gave me a grant when i was studying in germany. anthony teasdale is the in-house research center and think tank of the european parliament. he was educated at oxford university and has worked as political adviser and civil

servant in london and brussels. he has held positions in the foreign and commonwealth office and treasury as well as the general secretary at both the secretary of the council of minsters and the parliament. he worked for successive presidents of the parliament. he speaks and has published widely on european and political and institutional issues. he is coauthor of the penguin companion of the union published in the fourth edition in september of 2012. i would like to thank john luc from the european parliament liaison office for working with us on this event.

it hean a wonderful partnership we have with your office. let me add that if you are using social media, you can use the hash tag displayed on the walls. there it is. having said that, i would like to ask you to quietly switch off. it manufactures with the microphones here. last but not least i would like to thank my colleagues who really have helped bring this program about and put it into play. with that, i will turn it over to you.

they will follow-up and we will open it up to you for questions. we have two very distinguished speakers. >> yes, thank you very much. and thank you also for your interest in something that might at first glance appear to be a rather technical issue. mapping the cost of not europe, but i can assure you that it's absolutely not. you have all received a study. this study can be consumed. for those who have little time, those who are ready to those of

you after the enthusiastic will find references in here which were about 600 pages. you have the chance to study about 6,000 pages. just to say this is kind of consumer tip of the iceberg of work which was conducted intensively over the last 2 1/2 years, trying to find out what the potential benefits of our european integration. of course in the union maybe in the past years, we have more discussing about what are the burdens and the cost of european integration and the debate was, was it costly or very costly or terribly costly. this is the contribution to

something else. given that i started slowly to become a veteran in this business, i of course remember the report from the 80s which was the basis for&+d# the inte market. we tried to revise the method with the time wars that there might be benefit in replacing nowadays eight sets of national regulation. the question was, was it true at the time, can it be updated and still informative for what we are doing today?

this is something we consider impact assessment. those interested in better regulation might be familiar with the impact assessment, but normally we are checking the impact of proposed legislation or regulation. that's the impact. as a formal economist, what we are interested in is the cost of different arrangements and we have to look at the cost of regulation and non-reg uling certain area. nonregulation can be equally expensive. we have at the latest learned with the financial crisis, large parts of financial markets were under regulated.

the bill of under regulation was quite heavy. we are insisting that in a good car, you of course want to have a break on the process. every good car has a brake and every good car has a gas pedal. it has to be complimented with the cost of non-europe and nonregulation and the cost of non-legislation. what could be the benefits of this exercise?

to start with, this has the potential to build a renewed pragmatic consensus behind european integration. why is this? because if it is true that there hundreds of billions of euros out there and potential gains through integration, then it would be very strange to not use that potential. so wherever you come from, from a more ideological point of view on european integration if there enormous benefits out there, then it's much more easy to establish that consensus behind integration in that area. the second argument is something that is even more topical. we are currently all of us in the united states, but probably

more so in europe. we are looking for potentials of growth. we are also aware that the possibilities to create growth through state spending are increasingly limited. we have all reached that level of the fringes that are still being sustainable. if cannot get growth, you have to use the possibilities. if there possibilities out there to create growth basically through reform and integration, that should be something where people should be interested to find about. our current estimates and a personal guarantee that it is prudent, the estimate are that in the area that we have studied

the potential of growth from about 1,000 billion euros a year. that's not neglectible. skeptics say it's not 1,000 billion, but only 700 billion euro a year. if it's only 400 or 200 billion, that's something that can't be neglected. it is a kind of compass reinvigorating growth through the growth without doubt. there is a third i would like to make. we are now having the principal applicable in the union for quite sometime. the problems always are the principal that it's difficult to

say when is it being violated. the subsyd areaity principal means you should only deal with issues at a higher level of governance when this cannot be done at the lower level of governance. you should deal with issues on the local level. only if you can't do it there. you go to the region and then you go to the national level and you go to the european level. that can only achieve the full potential. how do you decide this? this cost of non-europe is one possibility to quantify the subsidiary principal. here the argument is being made that what is