immigration/naturalization service could waive two laws. nepa which concerns environmental assessment and the endangered species act. those two waivers, that waiver authority in many observers' mind was insufficient. the i.n.s. was required to deploy essentially complete a triple layered fencing project in san diego. and over the course of nine years, that project wasn't completed because of impediments caused by other environmental laws. congress responded to that pursuant to the real i.d. act by providing dhs with very broad waiver authority to waive all legal requirements that may impede the expeditious construction of barriers and roads. not a specified place like san diego but anywhere along the u.s. border. >> did it work? >> that -- that waiver authority was exercised in five instances

in, i believe, five in between 2005 and 2008 and that certainly assisted border patrol in expeditiously constructioning hundreds of miles of fence along the southwest border. there were legal challenges brought to halt certain border projects. but when dhs would show waiver authority, the courts would dismiss those challenges. i will note it is not absolute. besides the constitutional limitations, you cannot waive the constitution. another thing is that it refers specifically to the construction of barriers and roads. there is certainly some question as to whether it would apply to tactical infrastructure that is not a barrier or a road. like sensors or cameras. dhs when it has exercised waiver

authority to border projects, it has often mentioned things like radio towers and cameras in addition to the fence. but whether waiver authority could be used exclusively for a say, a project to install towers or sensors along a particular stretch of the border dhs has never done that and that would raise a question, is that a barrier? >> okay. chief, why don't you finish out and i'll turn it back over to the ranking member? >> so i think we've used fencing. and it's been part of border deployments for my entire career. in the images that you're showing here in the top left, the landing mat, you know that was designed, procured and developed by -- mostly by border patrol agents. a lot of the national guard deployments we've used over the years along the southwest border to build that fencing. effective for a short-term, you know, surge operations when you're adding other things that technology, et cetera. it did us very well.

the fencing that was brought to us by the changes in the act and the mandate to do 700 miles or more of the other images that you show there, and then the vehicle barrier also represented there is strategically placed in locations where it's very difficult to get to the border afoot. and so necessary to have a -- it's not necessary to have a pedestrian fence in places where it's -- the infrastructure doesn't support people walking toward the border. and so all of them have contributed to higher levels of security. i think on the other side of the equation, it's a lot more expensive than we expected when we started. and it was much more difficult. i was in texas as the chief of the rio grande valley in 2007 through '10. and so when i arrived on duty there in 2009 -- 2007 we helped validate and set a requirement for fencing. as i recall, about 75 miles. most of that fencing was built.

and it has made a difference. but it wasn't without lots of -- excuse me? most of it is in place, yes. most of it is in place. oh, it absolutely has made a difference. yes, it has. but it wasn't without lots of challenges. difficulty with hydrology and flood control in south texas and lots of concerns about people who own that land. and we're still in court about condemnation, et cetera. that's part of the history. that's part of the lessons learned as we went through that whole project. >> thank you, senator carper. >> thanks so much. i had to leave the room for a moment. right in the middle of asking a question. i was asking a good question. and i asked them, rather than talk about what is working so we can do more of that i asked them to tell us about what is not working so we can do less of that. and he's still thinking about it.

and ron here was about to get into it and i had to slip out of the room. so you want to pick up where we left off? >> so, as i was saying, i was agreeing with both of my colleagues. some of the lessons we've learned with trying to fit technology in without the proper kind of awareness with all of the capabilities or lack of capabilities. one of the lessons we've learned is as we move into this new version of our technology lay do you we have and are using field input for all of the installations. >> give us some examples of that. >> we have this process, capability gap analysis. and those in business are familiar with gap analysis. as a border patrol agent it's something well known in this environment. it allows us to go to the field and do surveys and walk the ground and understand what threats are faced at a station level. right, so the agents on the ground who are challenged day-to-day. and patrolling the border. where are the biggest problems and what kinds of technologies that they have or think are

available will help them solve those problems. so we do that in a station by station look. that's rolled up into a sector picture. and rolled up into the headquarters. we're in the process of baselining the data. we've got about 3/4 of the workforce and the station level data coming to us. and we'll use that to help inform the plans that we've already made with otia. and for unmet needs, the things in the inventory the things that work now being installed in places like arizona will give us a hint of where to go next. what might be coming available that we can help do research on the dhs side. >> what country does your family come from? >> vietnam? >> i knew it. north or south? whereabouts? >> the south. >> great to see you. i served a little time over there. >> thank you for serving. >> loved doing it. it was an honor. >> thank you for keeping me safe

and free all those years. >> thank you. you're welcome. same question. >> yes, sir. same question. give us an example or two. >> yes, sir. from an s and t standpoint i would say the biggest challenge always has been how do we transition from an r & d effort into acquisition. and it's a challenge, it's not unique to just dhs. dod has the same challenge. it's been in existence a lot longer than dhs, as well. >> have you seen some instances where folks have overcome that challenge? is there anything to learn from that? >> yes, sir. when i say it's a challenge it doesn't mean that nothing transitioned. of course we have transitioned a lot of things in dhs as well as elsewhere. what i'm trying to say is it's a challenge in a sense that that in the way the budget is structured. for example, i'll give you a very specific example. my division has been working close hand in hand and we

co-fund a lot of technologies that i just talked in my opening remarks. these are undergoing operational assessment right now. so for the resource allocation plan cycle which is for fq '17 and '21 our two organizations sat down and tried to put in the budget on my side, the technology cost to complete the development of technologies we think would be ready in that time frame and deliver that in time. and otia's cost is the acquisition and maintenance of that. but we both do it because we know it's the right thing to do. but i, frankly doubt that the budget request that was put in will get approved. it's just because the way the structure -- the budget is struchd. being an operational department, cbp have many urgent needs.

and if otia come up and ask for a budget for a possible technology that may or may not be successful three years from now, it doesn't come as a very strong argument against other very urgent needs. so the problem of what we call wedging the budget, if we don't do that, then, of course, there's no smooth transition even if i'm successful to deliver a technology in fy '18 if by that time we get to that point and pass all the assessment and let's say obp ask mark, yeah, we want that technology. we want that technology. and if mark doesn't have it in his plan at that time, then he would have to scrounge for money. because we cannot wedge the budget. >> okay. >> so that's the problem that does impact most of us who are trying to bring a very innovative technology into acquisition. >> all right, thank you. where do you work? you don't work at gao, do you? >> i am -- >> you probably never thought of the idea of what doesn't work, have you?

>> so i think two points, senator, coming from gao's work on border security and acquisitions more broadly. one is, determining what the user needs are up front before moving forward with deploying technology. and it's important and we've reported on this as it relates to the surveillance technologies in arizona. for cbp to better document the underlying analysis and justification for what it's deploying, you know, where it's deploying it, and in what quantities. so we think that's important, and then the second piece of that is to conduct robust testing of what's being deployed to ensure that you're identifying any risks as early on in the process as possible so that cbp's best positioned to be able to address those risks before moving toward full procurement and full deployment.

so i think those are two key themes emerging from our work. >> okay. good. thanks. any ideas? i bet you do. >> i should begin by saying i'm an attorney, not a policy analyst, so i simply defer to my co-panelists on that issue. i'd also be happy to put you in touch if necessary of any of the border security experts. i could make an observation, though, and this is more in terms of the legislative role. and that's simply that a central issue for congress has been what is the appropriate level of discretion? and what is the appropriate level of guidance that should be proffered to dhs through the legislation. and issues of border security. and sometimes congress has been specific, sometimes very general. sometimes it's re-evaluated where it's provided a general authority and later imposed a specific requirement. or other times, it has had specific requirements that it has later deemed to be too onerous and provided a more

general framework for dhs. to operate with. so the two observations would be, number one, the appropriate level of discretion in guidance may be different in congress' view depending on the particular issue related to border security. and number two, it is not necessarily guaranteed that just because congress believes that a particular moment a certain level of discretion should be given or specific amount of guidance should be given that they cannot change it at a later date. >> okay. that was good. it was very helpful. i'll close with this thought. i usually get a better result in the end if i'm trying to figure out how to do something by asking a lot of other people. what do you think? what do you think? and at the end of the day, we probably end up coming up with a better idea. and we also, even if we don't use their idea, i think people feel good about having been asked.

did i ever give you a chance to briefly comment? i know you tried to at the beginning and you swung and missed. >> second chance, sir. >> real beliefly, please. >> one thing i think we struggled with in the past, when we procure new assets, make sure they're provisioned properly. that's been an issue for us in the past and it's one thing we don't want to continue in the future. we want to make sure that affects our readiness. that's key. >> makes a lot of sense. thank you. >> senator langford. >> thank you. let me ask a couple of general question and i'm going to drive down some specifics, as well. let me ask you. do you need more people? do you need more technology? i understand it's a little bit of both. but if you're going to weigh up between the two, what are you needing more than others? >> so you absolutely have to have the right mix depending on the terrain, depending on the activity, threats, et cetera. right now, i think our challenge is finishing what we started on the technology piece. i think that would do more for us. if you're just looking at the border environment, at the immediate border, the technology

would be my priority would be our priority for the agency. >> the type of technology most of the agencies met with the -- we met with an agency yesterday that have 207 computer systems in their agency and they don't all talk to each other. it's just kind of grown up organically over the years. at some point you realize it costs more to maintain these different systems rather than centralize into one system. how many types of helicopters are we using? for instance? >> that would be my area, sir. goodness. have to count the numbers. hueys, astars black hawks, ac 120s, about five. >> would it help us, are there one or two of the platforms more effective than others that as we determined efficiency, effectiveness for what we're trying to accomplish with it. maintain the parts, maintenance of five different types of aircraft on that. has its own unique dynamic and cost on it.

>> the direction would be to go to two aircraft, a light enforcement helicopter and medium lift helicopter. >> what would it take to get there? >> procurements of new helicopters to replace the ones that are the odd types. >> is that something we need to help with or is that something you are all in process with right now? >> part of it we're in process with, some of them we can't entirely deal with the budgets we have. >> okay. you mean you can't retire the old ones or replace those that need to be replaced. >> can't replace all of them. some of it we can, some of it we can't. >> okay. >> so other technologies that are out that we have multiple platforms of. is there a need to be able to shrink down to one or two types that are more effective that have been tried and tested. we've had five types that are tried and tested now we need to zero into a couple? are there any efficiencies of scale we can gather from that? >> yes. actually, we sort of went the other way with the ground-based technology. because what we had was this very large, very expensive system which was overkill for a lot of areas. it made sense to have us have a multiple number of these

technologies from small to large. the way that we're handling that is we're designing a strategy where we can centralize our workforce that does maintenance on those so we can take advantage of the economy of scale to workforce. that's a work in progress. it does continue, though, to be a concern. if we have multiple kinds of radars, cameras, downstream, we may want to make the cameras the same on different systems. but that will be a plan going forward. >> okay. tell me a time period on that. we try to make those decisions. again, the more people we have on maintenance, the fewer people we have -- on patrol, lack of a better term. >> we don't use border patrol to do the maintenance, first of all. >> dollars. >> that's correct. and by the way, i know this is counter intuitive the cost of the systems has gone down because we are sustaining lower-cost systems. that doesn't mean we can't drive efficiencies as we go forward and drive those costs further down. so far this has been a good trend. i think the way we deal with

more combination is in what we call technology refresh. as systems age in three, five seven years what you replace those with you look for commonality. what's that we would be look at. >> what are we detecting that we can't address, ground systems, aerial systems, what percentage we cannot address, then, actually get someone to them in a manner to actually interdict? >> the fixed in mobile technology does really well on ground targets. people crossing the border afoot or vehicles. we have -- the assets brought by vader on the uas has been very good at that. i think our biggest challenge collectively with air and marine in mark's shop is this low slow radar detection for small what they call ultralight aircraft.

that's been a challenge for us. we've tried a couple of different systems, had some success, but not as far along as we'd like to be. the other big challenge based on terrain and conditions is tunnel detection. >> actually headed to my next question. where are we technology wise being able to pick that up? >> we have a system that we've borrowed from d.o.d. and done some testing with and had some success with. but the terrain varies so much along the southwest border that it's been very difficult to find a box or a machine, if you will, that will give us the kind of fidelity that you would like to see the kinds of things we get with aircraft or fixed towers, mobile scopes, et cetera. >> okay. what kind of interchange with ideas do we have with d.o.d. and other folks to swap what we've learned, what we've gained, how is that working? are there impediments to that we can help correct as far as communication? are you finding any walls of separation? >> we have a great and

increasing relationship with d.o.d. at all levels. from secretary down to the colonel and lieutenant colonel running. i have an office that does that, and ms. duwong has an office that does that. we are plugged in with the technology that they do. we have all kinds of programs to bring that into our environment and check it out and test it, and in some cases use it to support operations. very extensive. >> one thing i would comment is we do have extensive collaboration. d.o.d. has taken lately to wanting us to buy the systems from them. so before excess military systems were passed over to us for use in homeland security, now we're having to purchase those. >> okay. are you getting walmart prices or saks 5th avenue prices? >> it's not sa ks 5th avenue. they do what they can, but there's been a big process of charges on the dod side. >> one other thing on the aircraft, the aerostat and how that's working. our blimp, am i using the right term on that? >> so first half to specify, two

aerostat systems. the system i work with is tar system, high altitude 15,000 feet detects aircraft very well. needs to be recapitalized, it's an older system. and there's also -- i'll let mark talk about the lower altitude systems. >> all right, the lower altitude systems, the ones we've borrowed from d.o.d. that they used in iraq and afghanistan. those we call tactical aerostats. five of them flying in texas. they are relatively expensive. we are leasing them from d.o.d. but they've been extraordinarily effective there. now we're in the process of deciding at that cost how often should we use them? that's where that's -- >> this is the cost, actually, the item itself or sustaining it? >> it's the operations and maintenance and sustainment of it. we are basically leasing the d.o.d. crews that operate those. we have been able to get d.o.d. to transfer us four of the small ones as well as the towers. right now we are leasing systems and paying for operations and support.

>> and one more thing to wrap up, if i may. i want to come back to a percentage that i talked about before. percentage of people in just a guess that we can detect but we're not actually interdicting. >> so one of the suite of measures that we collect is called effectiveness. and effectiveness is designed to get out how many people across the border last night and how many were apprehended. and so the data we collect, again, as anne talked about and this is an estimate. but the data for last year shows that we're in the 75 to 78% range on effectiveness across the southwest border. >> those are individuals that we saw, that we were able to actually pickup. >> the observations through aircraft, an individual agent, or through what we call sign, footprints in the desert, if you will. you wrap those all up, and we try to do a 24 by 7 estimate of that activity across the southwest border. and also, that effectiveness ratio counts for the people who came in, people apprehended as as well as the ones that ran back, what we call turnbacks.

>> okay. >> thank you. >> thanks, senator. that is, you know, in terms of testimony before the committee, there's discrepancy there. and maybe that's the discrepancy. if you are looking at desections and looking at how many people you detected versus how many you apprehended, it's 75%. but you're not detecting everybody, which is one of the reasons i asked the question about some level of understanding of what situational awareness is. is there any sense of what percent you're not detecting? >> we're also attempting at the departmental level, they're also attempting to look at the probability of apprehension, which would start to estimate the actual flow that would give you a scientific estimate, but still an estimate about the number of people who are crossing. we're in the technology and the deployment support realtime information. you can be very confident in specific zones where there's enough agents and there's enough technology to show you what's happening in realtime and record

the responses in realtime and the effect. the effectiveness in those locations is very well documented. again, not scientific. sometimes you don't see the people cross in realtime. you can use that camera data, you can use the agent data and wrap those shift by shift, day by day and start to look at trends across. in the places where we don't have that kind of deployment, we're using this change detection technology. for instance, something that hangs off of the uas, that can fly the border take a digital snapshot, if you will, and an interval later, maybe an hour, maybe a shift maybe a day, and look at that land again and you can start to recognize change based on the way the pixels look in the picture. and that can tell you and verify when you don't have threat or don't have crossings. and it'll give you a lead to find out if there's change in the specific areas to go and investigate what it is. and so that has been very useful for us in these locations where we believe based on the people who live there or based on our

own activity levels there's not a lot of traffic. and we've been able to validate some of those locations don't see cross border elicit traffic. >> again, i'll definitely acknowledge, this is very difficult to wrap your arms around in terms of what the data is, what the information is, what the truth is. but, you know, we started this series of hearings on border security, certainly dhs pointed to a number of apprehensions down, which is a quasi metric for, you know, how effective we are at securing our border. but at the same time, we started our first panel. people on the border themselves. and to a person, they are very emphatic making the point that the border is not secure. and another pretty interesting metric, i think depressing metric. and we had general mccaffrey here in his testimony before us he said there are only interdicting 5 to 10% of illegal drugs. there's a pretty big discrepancy. 75% apprehension rate of people coming into this country

illegally, only 5% to 10% interdiction rate of drugs. so, you know, as i grapple with that, plus you know border patrol agents talking somewhere between people on the ground, 30% to 40%. i realize this is very difficult to grapple with but i take a look at that interdiction rate of drugs as pretty indicative of how really not secure our border is. can you comment on that in terms of how that all relates? >> i think as we get better with these deployments, as we start to fill out the arizona technology plan, as we start to move into the other locations, the next for us is south texas, we'll get better in all categories. we'll get more effective at the immediate encounters on the border and we'll get more effective at the drug interdictions. looking at the worldwide estimate of production, which is an estimate, and looking at our seizure data there's a wide discrepancy. but there is -- if it's out

there and our agents get wind of it, if they can follow it and track it down and make an interdiction they're going to do that. same for the air and marine. same for the state and locals. there's a lot of help out there. >> but do you dispute that estimate in the 5% to 10% range? do you think it's higher? >> i can't dispute it. i'm not familiar with how they do worldwide production. the aggregate of all the drugs that are produced. i assume we're in a small percentage of interdictions that are actually made. >> reason i really point that out is again, as we really explore this problem, i'm from a manufacturing background and our ranking member always talks about root cause as well. if i were to really put a finger on the root cause of our insecure border it's really our insatiable appetite for drugs. and the drug cartels that have spawned, the destruction of public institutions in central america that that has created, this is a huge problem. and the drug cartels aligning themselves with international criminal organizations, potentially aligning themselves with terrorists. this is an enormous problem,

which is why we're spending so much time on it. commissioner alice, i really do owe you the ability to just respond to the office of the inspector general's report on the drone program. i know when we were down there at mcallen you were pretty emphatic you did not agree with that. i just want to give you the opportunity to give you some perspective on that inspector general report. >> part of our discussion this afternoon has been on the whole issue of situational awareness or what we will call domain awareness. and i think that was one of the key things missing from the inspector general's report. the predator uas system helps with domain awareness, has sensors on it i never had before, we've never had in cvp before, that work over land and over water to detect movements of craft and also personnel. and they seem to have missed that for some reason. we had 18,000 detections in the tucson sector alone the year they did that report, 2013. so that's a pretty substantial

detection rate for the technology. i think the other part of it is they did not consider the actual value of the system in terms of seizing contraband. i just mentioned we just finished a deployment in el salvador that netted us $370 million in contraband. that's pretty impressive considering for this half of a year that we just completed with the predator system it's got $370 million of seizures. for the year they did the report we had a 444% return on investment. versus their flight hour calculation, the cost per hour versus what we returned in contraband. so i think it's been a very successful system for us overall and i look forward to better performance out of it in the future. >> and i think one of the biggest problems cited in the inspector general's report really was just hours of operation and just the inability to get it up as often as possible to drive that cost per operational hour down. can you speak to that at all? >> i do think this is an area we need to still work in. it's not achieving the number of hours i wanted to achieve per year.

there is -- part of that has to do with the weather. but that's not all of it. there's other factors in there too. we need to build out in the system in terms of personnel, maintenance, satellites, those kinds of things we're working on. we want to hit 6,000 hours every year. i'd like to get it up more towards 9,000. i'm not looking for the numbers they put out, 23,000 hours frankly as i mentioned to you guys down at corpus, the systems will wear out in a few years flying at those kinds of rates and not be available. so chief atell very quickly, because this is detection and you're in charge of apprehension. so you speak a little bit to the uav program and how useful that's going to be and what are the drawbacks and what are the advantages? >> so i take the general's description about vader. this is something we had never tried before. and there were people projecting on to it something we weren't even sure it was capable of doing. it turned out to be a very useful system and we now are on our way to procure more of them. so we think it's going to be part of the future. it's obviously something that makes the uas much more capable. already a robust system with

eoir, et cetera but having the vader and being able to see moving targets in realtime is going to help us and has. we've learned a lot with it in tucson. we're starting to experiment, if you will, and use operational tests in south texas and we look forward to its success there as well. >> thank you. and again, we saw a pretty amazing demonstration of that too when we were down there. senator carper. >> that was good to hear. very encouraging. maybe we can talk about effective budget cuts. ron, if you and alsis -- alice would respond to this. it's my understanding. somewhere around $39 billion, maybe a shade over that. this amount is $350 million a year below the appropriation, almost $2 billion below what the president requested for 2016. and let me ask each of you if you can take a moment these

potential budget cuts will impact your work and the folks that you work with to secure our borders. >> i think it's going to -- it's obviously potential. i don't know exactly where they'll fall out. but first area of concern in the flight hours area, we would like to maintain ourselves flying the 95,000 to 100,000 hour area which is what we're projecting here in the coming years. if we're cut back, obviously, then that is going to suboptimize our force. we're really situated aircraftwise and peoplewise to operate at those levels. if we don't we're not being as efficient or effective as we can be. a second part is i have very limited procurements. the only current procurement we're buying is an enforcement aircraft at two per year. >> what kind of aircraft? >> multirole enforcement aircraft. built up here at gaithersburg -- i'm sorry. not in gaithersburg. hagerstown.

>> king air? >> it's a king air. it's a beech king air. that's our only procurement. if that would for some reason stop because of money more than likely that line would close. >> okay. >> obviously i'll leave it to the chief and general alice to talk about the operational impact but in acquisition systems there's also a huge impact. first of all, we can't buy as much. oftentimes that means we cut back on contracts. for example, what that can mean is i have an arrangement with a industry. the arrangement is an up to but not necessarily all the way up to and you can imagine what industry does. they project based on that and take some chances on the early part of it. if i cut some of that down stream effort out they don't get the return on the investment. now i have a tough relationship with them. the other thing that happens is the competitions become winner takes all. they get down and dirty and nasty. they increase protests. it delays the process. that also has a huge effect. it also affects their ability

and their interest in investing in what they call independent research and development which is investment we all need to provide for the future. and going to ms. duong's point, it makes it difficult to do this long-term wedge planning for the next system that allows us to have a smooth transition including with industry from the s & t arena into the acquisition arena. >> okay. chief? >> senator, it remains to be seen where those cuts are. we're obviously very concerned. this gives us a chance -- gives me a chance anyway to amend my answer about what not to do. one of the challenges we have in -- >> we don't get a lot of second chances in life, do we, guys? >> appreciate that. >> good to get one. >> so, one of the challenges we have in cbp is that corporately at cbp as a component we have over 70% of the budget is applied to salaries. that's people in the field. almost everybody that is employed in cbp, that's 65,000-plus.

big mission support group here and smaller numbers in each of the field locations. but within the border patrol specifically, enormous amount of money provided by you all and the taxpayer. but 93% of it goes to salary. so it becomes very difficult to decide what things you need to make that workforce capable that you cannot do with specific levels of cuts. that's our challenge. 93% labor. 7% to do everything else we have to do. all the cars and all the radios and all the phones and all of the equipment that agents need to be capable. that becomes a very difficult challenge for us. >> okay. thanks. different subject. life cycle costs. and this would be you, miss gambler, miss duong and if we have time for some of these guys as well. but i think congress -- not just congress, others as well, but we're often better about buying new technologies than we are at paying to get the full value of those investments. it doesn't make a lot of sense. for example, we talked a little about this already.

by advanced surveillance technologies if we're not prepared to pay for their ongoing atmosphere costs to keep them running well and at full capacity and make sure we have the right people trained to do that stuff. could each of you comment, starting with you, miss gambler, on whether this is a challenge for the department in terms of border security investments and what advice do you have for us, for congress, on how to improve matters? >> with regard to the arizona technology plan, we -- when we did our report last year on that plan, we did assess the cost estimates that cbp had in place for the plan and some of the highest cost programs under the plan and found that cbp could take some additional actions to ensure that those life cycle cost estimates better meet best practices. a key area we reported on was the need for cbp to verify and validate its cost estimates against independent estimates to make sure that those estimates would be fully reliable and

credible. and we made recommendations to cbp in that area to ensure that their life cycle cost estimates more fully meet best practices, and we understand that -- and mr. borkowski may be able to speak to this more, that they are in the process of updating the life cycle cost estimates for some of the technology programs under the plan going forward. >> okay. thank you. miss duong? >> from the standpoint of technology that we in s & t are developing, we make sure that we do a good job at estimating a life cycle cost before we submit that information to mr. borkowski, for example, for potential acquisition. it's a process we keep improving. as you know, before we start a project we already consult with operating component in estimating the return on investment. and when i say return on investment it's on their

investment not my r & d investment. so we estimate that if we pursue this particular technology, let's say we could find ten more tunnels per year, what does that mean in terms -- and we estimate throughout that -- it would cost x dollars to buy a new tunnel detection system that we're developing does that mean it would break even in two years, five years, ten years? so at first it's just an estimate. and as we move further into the development of the solution, then we try to come up with a better and better estimate, and in the end when we get to operational assessment that's when we try to come up with a much better return on investment and estimate to help cbp make the decision. so it's not just about oh, look, what great this capability could do, what great things this capability could do for you, but if you were to buy one or three or five systems, and we estimate it would help you find five or ten more tunnels, just be

conservative, per year then what does that mean in terms of cost saving? we try to do that from an s & t standpoint to help them make the right decision. the other part is about acquisition programs. as you know s & t, it's not in our responsibility to do acquisition. that's otia's responsibility. however, the department does employ us as an adviser and we try to make investments to help acquisition programs better understand the implication of the maintenance cost. the tale of anything. just like you pointed out, senator, a lot of time the acquisition cost is actually the lowest cost. but it's the easiest one that everybody look at. so s & t always say that we want to be able to spend millions in order to save billions or hundreds of millions for mark.

so it's always a goal that we strive to achieve. and the department has become more and more -- has become more and more -- in recognition of our role, and i'm glad to say that s & t has become a trusted adviser for the adopt along that line. >> well, my time's expired. we're going to have one more round so i can let these guys answer that question or not? >> no. i've got a couple more questions also. >> good, good. great. chief atell i've got a couple questions. i want to go over the inspector general's report that came out today about the lack of the department collecting data on prosecutorial discretion. deferred action on childhood arrivals. in the report it says as of september 30th, 2014 cbp's office of border patrol reported it had released 650 dock-eligible individuals. so you are keeping track of that? in what organized fashion are

you tracking that? >> in cbp specifically in the border patrol when we process someone who is encountered by an agent and we refer them to either deportation proceedings or in the case of unaccompanied children to the hhs system and then all of the encounters that we make are documented in a system, the enforcement system. so if it's appropriate, fingerprints biographical data, photos, et cetera. >> but if you're apprehending somebody illegally crossing the border, how could they qualify under doca? >> they won. -- would not. >> but you released 650 under that. >> i don't know that that's a cbp number. i have not seen the report. we've had very few encounters with doca eligible individuals in our context. >> yeah. you've -- according to this report you released 650 i.c.e.

released about 1250. your percentage is quite low. how could anybody qualify under doca coming into this country illegally? >> we do have environments we operate in such as checkpoints or people at the border who haven't crossed the orderer and they're encountered by our agent and they have eligibility under the standard. not everybody we come in contact with obviously has crossed the border. >> i believe the department has agreed with the recommendations of the office of the inspector general to collect more data. have you already been contacted in terms of the kind of data they're look for as it relates to process cuorial discretion? >> specifically to that i have not seen that. we are always looking for ways to identify where there are gaps in the system. so the issue with unaccompanied children last year, we struggled mightily with understanding how our data connected with data that i.c.e.

keeps as it relates to detention and further on to removal proceedings within the justice department. that's been a struggle for us for a couple of years. >> do you deal much with just the prioritization of who we're going to try and remove? i know the aliens pose a danger to national security. those that violated immigration control. aliens, fugitives, otherwise. is that something you deal with or you apprehend them and somebody else deals with those criteria? >> so all the agents -- there's a training regimen for everyone to understand what the priorities are as it relates to the memorandum. but obviously, most of the work we do, over 190-some thousand arrests or apprehensions made so far this year, those are all recent border entrants. so they fall well within the priorities for action. >> those priorities really don't affect you as much as they obviously affect i.c.e. or other -- criminal justice or hhs? >> correct. >> you did mention border patrol agents, the numbers. i just want to get your assessment. i know the texas department of public safety engaged in "operation strong safety."

and they surged a lot of manpower to the border. i just want to get your evaluation, how effective that was. because we talked about technology. different detection systems, fencing, that type of thing. in the end we need manpower. and so just give me your "operation strong safety" worked -- i believe in mcallen, texas. is that all texas borders or is that -- >> it's mostly south texas. i've actually seen directly the deployments in the rio grande valley. and obviously as an operator i'm going to tell you that more boots on the ground is always better. is it the most efficient way and those kinds of things? that's -- that really would be for the state to tell you how effective their deployments have been. but i know we've worked closely with them. most of our deployments especially in south texas are near the river, and having the department of public safety, they have some capabilities in rural enforcement and on the river, et cetera but most of that deployment is related to hard top, on the highways. and they've been an asset for us with regard to helping chase smugglers, et cetera.

>> operation strong safety, is that continuing? >> as far as i know, it is. >> have you measured at all? do you have kind of a before and after now? >> i can look at all of the data that we've developed. i'm not sure -- obviously, locally we're aware of their contributions directly. but again, it's a situation where there are more boots on the ground, et cetera, in that particular location. and in their deployments they help us in the areas where we know traffic is going to eventually try to make it if it's made it past us. >> we were down there, particularly the sunday the extra day i stayed down there, you see their presence. i mean, i would never try speeding around the rio grande valley. i would really be interested in any kind of analysis your agency, your department can do in terms of what was the apprehension rate, what was the detection rate prior to the "operation strong safety" and what is it now? i think it's just a really good test case of additional manpower

and we can kind of measure how much we've increased the manpower because of that. >> we have seen -- you know, obviously, in the prior testimony that you've mentioned we've seen lower levels of activity across the southwest border. that does include where strong safety is deployed. what's their contribution, what's the contribution of the other assets that we've been able to procure and send to the agents for use and their capability there, that's the part that we struggle with. that's what you hear about data. that's what you want us to do better at. >> so again, please look at that. i mean, it's -- and -- because we also found out with the aerostats for example, the areas where those things were deployed it shut down the illegal crossings but they just went some place else. >> that's often the case. i think what i've heard from the agents on the ground that are the benefit of that capability, they went from not having, you know, high altitude persistent surveillance situational

awareness, if you will to having a very capable system. we're advantaged in the sense we don't have to use agents to monitor those sensors and run those systems. that's a contract. the other side of that coin is it's very expensive to do. >> the other side too is when the wind's blowing and they're down let's face it, i would cross when the wind's blowing. >> correct. that's why we're very in favor of the ift deployments, the refresh and the additional rvss, the cameras and sensors, the fixed and mobile technology. we know those capabilities work. we've got a long history with some of it. we know that those -- that's part of the future and you won't be subject to the vagaries of the weather. >> thank you. i was trying to be shorter but i've got so many questions. senator carper. >> so many questions. so little time. i'd like to ask chief, if you and mr. borkowski and mr. alice will just go back to my last question about life cycle. just do a minute, no more than a

minute apiece. but could you just comment on whether this is a challenge for the department in terms of border security investments and what advice if any do you have for us on how to improve on this. >> yeah, i think we have -- this is the data question. this is refining the assets that are available and recognizing what life cycle costs. as an operator what we try to do is say this is the requirement, this is the problem we're trying to solve and we leave it to the acquisition professionals to understand what's out there, how much does it cost. and i think we've gotten really good at learning from the acquisition folks how to establish requirements and then recognizing that life cycle, what we call o & m, operations and maintenance, is crucial for us to understand before we make the final decisions on deployments. >> thanks. mr. borkowski? >> senator, we've got some pretty good processes that have grown in the department that put some discipline to check the affordability which proves whether or not we can pay for o & m. but there's a continuing problem, and i'll just be frank that when i challenge people they blame it on congress. let me tell you what that is. >> no. >> they do.

i'm not sure that's true, but i'll tell you what they say. what happens is we buy more technology. you would expect that the operations and maintenance costs would go up. so what our budget plan is -- let's suppose i have $100 and start with $80 to buy it and $20 to operate it. over time as i spend that $80 after i've built all of my technology, maybe i'm down to zero and i've moved all of that money from buying to operating and maintaining. what happens is the budget people don't look at that as a total of 100. they look at it as money to buy and money to operate. they see the money to buy going down and they say that's great, we love you, you've saved money. that's not really true but that's what they say. but we hate you for operation and maintenance because that's gone up and you need to make it flat. that's the real problem we tend to have with operation and maintenance, is getting people to understand that if you buy more stuff you need to operate and maintain it. we have to look at the totality of the budget, not the individual pieces. >> thank you. mr. alice. >> senator langford asked kind

of a key question about numbers of different types of airplanes. as we -- we commute compute life cycles across each of your platforms. but if you think about the big picture, five different kinds of airplanes, that means five different pilot training programs, five different maintenance supply chains, five different maintenance training programs, those kinds of things. so one efficiency we need to keep working on on life cycles is these numbers of different platforms. >> good. excellent. it's my understanding cbp is doing an extensive gap analysis. for border security that involves identifying what else is needed to better secure our southwestern border with mexico. could you just take a minute and give us a preview of what might be in that gap analysis? and when do you think it might be done? how could it be used? >> so describing the process, what we've tried to do in the capability gap analysis, is gone to the field, asked them what

their challenges are, where they have specific things they would like to solve with technology, with additional kinds of deployments or other innovative ways to solve problems at the or other innovative ways to solve problems at the immediate border and in specific zones, specific stations, specific sectors. so what we've done is gone to the workforce and i explained to them what the process is and then have gone out and taken surveys and gotten from the agents who patrol the border who are there and gotten their ideas about what is required. now, what we try to do is take that data that information at the station level roll it up to the sector of the 20 sectors out there and then that will be fed up to us at the headquarters. right now we're in a situation where the training is out for the bulk of the workforce, like 95, 98% of it. and then we've got about 70% of their ideas and their innovations about how to go forward with specifically on the

technology side. we have 70% of the data in. once we get all of the data, we'll start to have conversations both with oti and find out if there is technology available, is technology the best available resource for solving the problem as stated. and then we'll be able to it ter rate that process, what the future looks like with the success of other things and try to fit a program together that says this is how many of these things that you need and then you can go down specifically into the locations and say, you know, for instance the agents need you know, the brush cleared or they need additional rvss. that's the kind of capability we look to have once the gap with the first federation is in as we move forward. >> and last -- thank you for that. and the last thing i wanted to touch on briefly is when we think of force multipliers, it's

important, sometimes, i think, in terms of being able to better ensure that our borders are not so porous is to i use a needle in the haystack analogy. and say the needles are folks trying to get into our country could be human factors, drug traffickers, people trying to flee a held labor shous situation at home. but there are a couple other ways to find those needleless in the haystack and one of those is to make the haystack smaller. another way is to have better equipment to detect the needles. and maybe another way would make the needle bigger. and i think to some extent if we do immigration reform, do it smart, we can actually make some

progress in -- on this front. if we do a better job with intelligence. i think one of the reasons we do well on the northern borders is the great relationship we have with the canadians and sharing of intelligence and joint operations. the other thing i keep coming back to and chairman and i talked about this a fair amount we talked with chairman kelly about it and that is to figure out how to convince a lot of people who live in honduras guatemala and el salvador. somehow figure out how we can make them less likely to want to flee their country to come up here. do y'all have any thoughts on any of this before we close? i'd welcome that. mr. garcia, briefly, any thoughts? just very briefly. you may not have. that's fine. okay. yeah. it's okay. >> i would add, on the

unaccompanied children issue and there are a couple of reports that will be issued in summer including looking at u.s. programs in central american countries to address some of those issues as well as a report looking at screening care and custody of the children when they are -- when they come to the u.s. and so we'll have some work on that this summer. that will help inform some of those points. >> we'll welcome that. thanks. >> senator, i know the focus of this hearing is not about cargo. >> i'm going to ask you to be very brief. >> i would point out, when we talk about needle in the haystack, that problem is exacerbated at the points of entry because we know travel is increasing by 5% at least per year. so the strategy of reducing the size of the haystack is indeed one of the main strategies that snt is pursing technology for.

>> okay. excellence. thanks. chief? >> we reiterate your comments in relation to canada. that relationship is a very good one. the local law enforcement and the federal law enforcement as well as our partners in canada that makes a big difference. we're increasingly having those kinds of conversations in mexico and as we get more smart about how the unity of effort and the joint task forces roll out it will give us another opportunity to use the whole of government approach at the southwest border and as mexico -- our relationship with them matures, it will be a benefit to all of us. >> thank you. any brief comments before we close? >> i like the needle in the haystack technology. if it deters it it can reduce the haystack but we also agree technology is not necessarily the best way to get there. >> thanks. >> briefly joint task forces help intelligence investigation koord coordination is key and then i think working with mexico is

going to help us. >> great. thanks so much. great panel. i appreciate it. >> senator carper, i think one of the advantages of me not making long, opening statements i'll make a closing one because i've got a comment. if you want to reduce the haystack what you should do is try and reduce, maybe eliminate the illegal immigration. one chart we have been putting up here is a history of unaccompanied children coming from central america and prior to deferred action on arrivals we were somewhere around 3 or 4,000 per year. and then you know, we issued those memorandum in 2012 and that number jumps 10000. the next year, 20000. the following year, 51000. i know it's come down a little bit but it's still way above historic levels. so i think we have to again looking at the reality of the situation, what causes these things and we need to reduce those incentives. i've always been very supportive

of the functioning guest worker program. you know, 8.1 million of those individuals here in this country illegally are working. it's a rational decision. when you have so -- wages so much lower in central america and mexico than they are here in the united states, it's a rational economic choice particularly when the reality of the situation is regardless of what the memorandums say or says, if you get into america, people are staying, particularly if you're a minor. so i think we really need to take a look at our policy and, you know, i want to solve the problem. i think realistically we're for the going to have comprehensive -- we don't really do comprehensive really well. what i've asked the secretary what i'd hopefully ask my ranking member is work with me. let's identify those incentives and reduce them and let's start approaching this in a step-by-step basis. i come from a manufacturing background. you don't solve problems just

like that. i'm perfectly willing to engage in continuous improvement. let's take the step-by-step incremental improvements. if all of you would be willing to work with this community to identify those incentives and steps, maybe that small little piece of legislation we reported one out of our committee yesterday or last week in the business meeting just along cbp on federal lands in arizona. you know, i'd like to do it across the board probably some resistance there so how about we look at arizona and see if that would actually work. i really do hope that the administration, the department, your individual agencies will work with us. let's identify those and, you know take a step-by-step approach and improve border security. with that, the hearing record will remain open for 15 days. i forgot i have to thank all of you folks. again, thank you very much for your thoughtful testimony for sitting here and answering, you

know, in a very thoughtful manner. we really do appreciate it. i know how much time and effort goes into this. the hearing record will remain open for 15 days until may 28th at 5:00 p.m. for submission of statements and questions. this hearing is adjourned.

tonight on c-span 3, veterans affairs staffing and then the white house news briefing and then recent data security breaches at banks and retailers. a hearing today looked at staffing shortages at veterans affairs hospitals. witnesses representing va doctors and nurses talked about the need for more medical professionals. this house veterans affairs subcommittee hearing is two

hours. this subcommittee will come to order. before we begin, i would like to ask for unanimous consent for my friend and colleague from pennsylvania to sit in on today's hearings. without objection, so ordered. thank you for joining us today for today's subcommittee hearing, overcoming barriers to more efficient and effective va staffing. as a physician who worked at fee for service at the iran mountain va department of veterans affairs medical center for about 20 years i know how privileged it can be to care for veterans on a daily basis. regardless of how fulfilling va

employment often is, the department's ability to effectively and efficiently recruit and retain qualified medical professionals it to treat veterans is seriously fractured. for example, in my district at the outpatient clinic, it has not had a physician on staff for at least two years. va has attributed that to the difficulty of recruiting physicians in rural areas. and while i understand that difficulty i think va's overtly over hiring bureaucratic process contributes to the inability to recruit a position for years running. the sioux st. marie was unable to post a position directly. instead, they are filtered through a human resource office in milwaukee wisconsin, several

hours away in another state. and my understanding, all job postings are run through this one office in milwaukee. despite repeated assurances that the department was actively recruiting for the position in sioux st. marie, i have not seen an advertisement except for a blurb on that hospital website leaving me to wonder whether they know what it is supposed to look like. as important as effective recruitment is, retention of employees is critical. according to the 2014 best places to work survey the number of va employees resigning has risen every year since 2009. it's not hard to see why.

the survey results ranked 18 of 19 large agencies overall. 18 of 19 in effective leadership. 19 of the 19 in pay with the department's overall score last year being the lowest va has received since the report was first published in 2003, when a va center is inadequately staffed or make as decision to leave the va, our veterans lose out. the growing physician shortage is causing the marketplace to be more and more competitive with the association of american medical colleges projecting a 91,000 physician shortfall by 2025 if the va is going to keep pace with the private sector in recruiting and retaining the high quality providers that our veterans deserve, immediate action must be taken to improve

retention of existing staff and ensure that qualified candidates for new or vacant positions are quickly identified, recruited, hired and brought aboard. critical to that and to all va's plans regarding the delivery and quality of care is making sure those on the front lines providing direct patient care are not only involved, but leading the efforts to make the va health care system stronger. to that end, i'm proud to have representatives from the national association of va physicians and dentists. the va physician dentist association and the nurses association physicians of va on our witness panel today. they input you as well as the rest of our witnesses will provide about the daily reality you and your members face at va facilities across the country every day is invaluable. i thank you and all of our witnesses for being here this morning. and i now yield to the ranking member for any opening statement

she may have. >> thank you, mr. chairman, and thank you for calling this hearing today on va staffing. section 301 of the veterans access care and accountability act signed by the president last year mandated the va shall submit a report assessing the staffing of each medical facility of the department. this hearing will assess how they are doing in staffing around the country in respect to the care of our veterans. in its report, the va cites the need for an additional approximately 10,000 full-time employees to supplement the approximate 180,000 employees that currently work in veterans health care. i'm looking to find out from the va how both numbers were arrived at. one issue is that last year secretary mcdonald quoted a

number of 28,000 positions needed to fully staff va health care. now we are down to just over 10,000. the staffing report concurs with the inspector general's report listing the top five occupations that are most critical. medical officer, nurse, physician assistant, physical therapist and psychologist. one occupation not listed because it's not technically health care related is human resources. these are the people that hire and fire and generally keep a facility fully staffed. i'm interested in hearing how the vha will be streamlining the hiring process and getting more people to work in a reasonable time frame to treat our veterans. veterans in my congressional district face barriers to access and care due to va issues.

ventura county is home to more than 47,000 veterans and our local cboc struggles with staff retention. there are high turnover rates for physicians and medical support staff. the primary care team is down to just one physician, two nurse practitioners and one physician assistant. we are concerned that veterans are not using important wrap-around services because there's no primary care social worker on staff. over the past five years the number of veterans seeking mental health care at the cboc has doubled and the va has been working hard to meet the growing demand, but we still seem to be in a place where we're not fully staffed. i know staffing issues facing ventura can county are ones that can be found across the va

system. i look forward to hearing how the va is using the funding to increase the department's workforce and high demand occupations so that the nation's veterans have timely access to the high quality professional care that the va is known for. thank you, mr. chairman, and i yield back the balance of my time. >> thank you. joining on our first panel is joan clifford, immediate past present of the nurses organization of veteran affairs. dr. samuel spagnola. the president of veteran affairs physician assistant association. jeff morris, the director of communications and external affairs for the american board of physician specialties. and dr. nicol salvo from the american podiatric medical association. miss clifford.

we allow everybody five minutes. so should be a little light there when it goes red. that means you're up. thanks. >> hi. thank you. chairman, ranking member, and members of the sub committee, on behalf of the nearly 3,000 members of the nurses organization of veteran affairs, i would like to thank you for the opportunity to testify on today's important and timely subject, va staffing. as the department of veterans affairs undergoes system wide reorganization to include many challenges of implementing the veterans access choice and accountability act, staffing must be at the forefront of the evaluation. i'm deputy nurse executive at the va boston health care system and i'm here as the immediate past president of nova. nova is a professional organization for registered nurses employed by the va.

the focus is veteran issues. we're uniquely qualified to share views to efficiently and effectively recruit and retain qualified health care professionals to treat our veteran patients. as va nurses we are in the medical centers and at the bedside every day. we have identified retention and recruitment of health care professionals as a critically important issue in providing the best care anywhere for our veterans, and we would like to offer the following observations. nova believes that the underlying issues reside in the lack of a strong instruct for human resources. insufficient nursing education opportunities and the complex application system. namely usa jobs that va uses for hiring staff. we are facing a shortage of corporate experience. insufficient hr staffing to support the multiple priorities required for health care professionals. the complex hiring process with systems that do not interface lead to extended weights for job offers. as times this results in candidates accepting non va jobs and puts va back in hunt for

qualified candidates. resulting in unnecessary recruitment delays contribute to delays in hiring personnel. reclassification and downgrades of some occupations, such as surgical technicians, who are brought in and recently downgraded to gs-5 are making it impossible to competitively retain and recruit. a lack of knowledge on how to maximize the law has resulted in inconsistent application of the law, an obstacle to hiring and retention. nova asks it be increased in order to remain competitive. ensuring an infrastructure to sustain programs that produce nursing graduates who honor and respect the programs is vital. the office of veteran affairs has limited funds.

potentially impacting the recruitment of future hires who flock to these programs. the nurse practitioner residency program is a pilot and will require continued funding for educational infrastructure. nova believes it's a good investment as hiring nurse practitioners will increase access and give access to veterans nationwide. ongoing support for tuition reimbursement alone tuition programs will help nurses with the cost of education if they work for va and support for va nursing partnerships is needed. an area of concern is the use of advanced practice nurses, which at this time is subject to state laws in which the facility is located. vha is advocating full practice authority, which would result in all advanced practice registered nurses employed by the va to be

able to function to the full extent of their education, license sur and training regardless of the state in which they live and work. legislation has been introduced, hr-1247. the improving veterans access to care act of 2015, which is the model already practiced by the department of defense, indian health service, and public health service systems. nova, together with other national nursing organizations, are calling on congress to support the legislation, which would begin to address critical needs within va facilities by improving wait times and access of care to all veterans. va employs over 90,000 nursing personnel, which is about a third of the health care workforce. nova believes there's no greater time to have representatives from the office of nursing services at the table at va organized the way it provides care and services to america's heroes. improvements and careful review, increased training and use of the locality pay law, revising the cap on the rn pay schedule to eliminate compression as well as establishing a more user friendly application process and

supporting human resources across the nation will go a long way towards correcting the challenges we face with staffing. nova once again thank you for the opportunity to testify and i would be pleased to answer any questions from the committee. >> thank you very much, miss clifford. doctor spagnola, please go ahead. >> mr. chairman, we have submitted a written testimony. i will ask that that be entered into the record. i will try to keep my few comments here fairly brief. thank you for having us here, and thank the the distinguished members of the committee for having us here. we certainly appreciate it. i am here as practicing physician with more than four decades where the va, and i'm here also as the president of the national association of va physicians in dennis, usually referred to as nava.

the national association of va physicians in dennis is a 501-c 4 nonprofit organization dedicated to improving the quality of patient care in the va health care system and ensuring the doctor-patient relationship is maintained and strengthened. i appear today in pursuit of that purpose. this year it is nava's celebration of it is 40th year. nava believes the key means of enhancing care of veterans is by employing the best physicians in dennis. we believe it's essential for physicians to be involved in decisions requiring delivery and quality of health care. during my many years with the va i have witnessed many changes in the va. some good. some not so good. i've had the opportunity to meet nearly all of the secretaries of the va over the last 40 years get to know some of them fairly

well and a few i have seen as patients. i believe all of these individuals have been good people and all with the best intentions. i'm sure secretary mcdonald who i have also met with also has good intentions. not withstanding the good intentions of these people, however, the role of the physician within the system as a leader of medical care has greatly diminished over the same period. today most physicians in dennis feel like their opinions are neither helpful nor requested. at many centers physicians in dennis no longer are even considered professionals. but referred to simply as workers. these observations come from our members. va docs in dennis. men and women who want to help improve veterans care. in the late 1960s and '70s nearly all va medical centers were led by directors who were physicians. today, very few centers have

physician directors. the position now called the va undersecretary of health was known as the chief medical director. at that time there was a direct line from the chief of staff at the medical center to the chief medical director. issues of the quality of medical care were raised and addressed by medical professionals. today, chiefs of staff report to a clinical specialist at the centers. in more recent times, there's also been a strong movement to eliminate the need even to have a physician in the role of undersecretary of health. i ask, would it be wise or even possible to run the defense department without generals and admirals in leadership positions? we are not saying that there is no role for nonphysicians in the administration of hospitals or medical care. we are saying, however, that medical judgment should be base on years of education and patient care.

physicians are being loaded with with additional duties more appropriate. such as typing, follow-up calls, patient perception and preparation. similarly, it's not cost saving nor efficient to have physicians routinely escort them from waiting rooms to exam rooms and having them help the patients get undressed. there's a growing trend to add nonphysicians and a growing concern that a veteran may never be seen or treated by a physician while in the va health care system. veterans are seen by non-m.d. doctors without realizing they have not seen a medical doctor. we believe this is dangerous for patients, and their families, and it may also raise ethical issues. the va is currently considering a change in the nursing handbook. there will no longer be physician oversight for the process of sedation and providing operating room anesthesia by certified

registered nurse. the proposed change provides no guarantee this will provide safer patient care. additionally, lpns with little or no psychiatric experience are taking the place of psychiatrists during intake and assessments. taking care of patients and providing excellent care has a lot to do with providing basics and using a lot of common sense. for example, when patients are asked what is important to them, you will hear simple, straightforward commonsense questions, such as will i be admitted quickly? is the room clean? is there a bathroom in the room? does the call button work? and does someone answer and arrive quickly when i need them? does everyone speak so i can understand them? if i need help to eat will there be somebody there to help me? do my doctors and nurses spend time and explain things so i can understand what is happening?

unfortunately, patient surveys indicate that none of the above questions are being answered very well in the va. although the crisis last year in va did focus on access to care, this is but one small piece of the total package. getting timely initial access is of little value if it takes months to get your hip replaced or have lung cancer removed or a colonoscopy screening because there may not be sufficient physicians or add quit access to the operating room. timely access must be assured throughout the course of care, not just on the initial visit. va is referred to as a health care system. at best, it's a collective of hospitals and other medical facilities operating under a common umbrella. the operation of standards at every facility appear to be different. there must be unification and simplification of process across the organization to achieve an order of efficiency and common outcomes. when you've seen one va you've

only seen one va. in this regard we have seen no recent operational structural changes in the va. implemented in local facilities perhaps because the facility leaders have not understood that the changes are mandatory. >> doctor you'll have to make -- clean up your time here. >> i'm one sentence left. >> okay. good. >> hearings like this are important and helpful and the va appreciates the opportunity to be here today. we want to help fix the medical care problem. the unfortunate truth, however, it's far easier to throw money at the situation than it is to fix it. thank you, mr. chairman. >> thank you doctor. mr. morris? you have five minutes to come across with your testimony. >> ranking mean north bradley

and distinguished members of the subcommittee, we thank you for examining the issue of overcoming barriers to more efficient and effective va staffing. veterans should never be short-changed in their medical care. what many do not know is that physician politics along with existing discriminatory and monday nop poe lie zags is keeping excellent physicians out. what is indefensible, they are not denied because of their training, education or experience. these highly skilled physicians are being denied employment solely because of their choice in board certification. this discrimination is going on within the administration. a veteran himself, was a green beret and member of special forces and was picked to lead the treatment of 400 of our special forces. he wanted to work at the va. he applied for seven positions

and was never even called back for an interview. this was not due to his training. the doctor graduated from the university of alabama medical school and is a fellow of the american academy of radiology. the doctor is also an attorney in hospital administration with a focus on waste, fraud and abuse. the only barrier that prevented him from working at a va was his choice insert if in certification. he chose avps. because of that choice, he's denied the opportunity to take of his fellow veterans. we're asking to cease the discrimination. behind the discrimination is that most people do not understand what board certification is. it's a choice. and an indicator that a practitioner has demonstrated their skills in their chosen facility.

there's three agencies. there's the american board of physician specialties and the largest of the three is made up of 24 individual specialty bodies making everybody believe that they are all different entities. this structure has hidden the monday nop monopoly that has been established. it's the only one of the three to have received an independent of a firm mags of the high standards of the exams through an exhaustive review process. since 1994, avps has approached the department regarding these discriminatory staffing issues. each time they respond that they have no mans to recognize anyone else. in 2011, they returned to the administration to stop the discrimination and further explain that we were part of the

current standard of certification. they refuse to see the issues. all of these discussions led by former secretaries of health along with dr. karen sanders, all board certified by the very same organization keeping avps and other highly skilled physicians out. what is most confusing is under the gi bill, avps has been reviewed and approved but yet they stated to us that it does not mean they have to accept it. the va reimburses for board certification but will not recognize it for hiring or promotion. the board certificateion is not a rermt requirement. according to usa jobs there are over 1,000 physician positions which discriminate limiting the ability to fill much needed positions. only few hospitals recognize

avps and have hired them to fill their needs. the kansas city va is an example of providing a higher level of care. some, also, have hired these avps positions but there's a hostile work environment and openly discriminates against them. many are not here today because they fear retribution or loss of their jobs. avp wishes to contribute to solutions to ensure that veterans receive the highest quality of career. a director from the office of the secretary of va needs to have policies in place that clearly defines board certification. job listings we also ask that a quarter reporting structure be developed and the denial and hiring of physicians in all applicant boards being identified and having identified individuals accountable for this oversight all done in a similar manner as corporations are to

ensure minority hiring and this will provide local hospitals accountable. thank you again for this opportunity. the avps looks forward to working with you to improve hiring practices and end the discrimination. most importantly, our veterans health safety and care must be placed before physician politics and the eeggos of a few. it's what they deserve. >> thank you mr. morris. mr. silva, you're up next. >> on behalf of the association, we appreciate the invitation to provide this testimony before you today. the p.a. relationship has a unique relationship with the veterans. it came into existence in the 1960s due to the shortage of primary care physicians in the united states. the va was the first employer of

the p.a. and is the largest single employer of p.a.s in this country. these p.a.s provide cost-effective high-quality health care working in hundreds of medical centers and outpatient clinics. about a quarter of all primary care patients are treated and seen by pa. approximately 32% of those pas are veterans, including myself. i'm a former navy hospital corpsman. the oig report of january of 2015, conducted a determination with the large staffing shortages as required by the veterans choice act. oig determined the pas were the third critical on the list. according to the workforce succession planning of 2015, next year 37% of pas are eligible to retire. this workforce will result in approximately loss of 1.15

million veteran eligible patient care appointments. next year the highest total loss rate of 10%, more than any of the other top ten occupations deemed difficult to recruit and retain. utilizing the va provisions of the veteran choices act of 2015, the va reports no current plans for recruiting for new p.a. positions and for retaining an optimal p.a. workforce. they are setting goals to hire only physicians and nurses as they interpret the law as to not including the p.a. workforce. some facilities are not posting for vas at all under the veterans choice act. of the total postings nationallily there are only 83 postings. this eliminating 50% of eligible applicants. when they do not post for pas they send a message that p.a.s and p.a. veterans should not and cannot apply, even though military pas have higher experience of care. the discrepancy in salary

benefits and education debt programs continues to be a recruiting and retention barrier. there are three types of providers within the va that provide direct patient care. physicians, physician assistants and nurse practitioners. by virtue of being a nurse, mandated under the yearly rn low kalt low kalt pay scale. pas fall under specialty races. however, this is not mandated yearly. some have not performed a special salary survey for 11 years. 88 va facilities report they cannot hire vas because they cannot compete with the private pay secretary. sector. the secretary can convert to covered physicians and pay them pursuant to public law. however, the va has refused to review these steps to solve the problems for p.a.s.

the recommendation is congress should legislate a mandate to include p.a.s and the nurse locality basis testimony. for the education debt reduction program, va pas is at the discretion of the hiring facility and is not standardized across the p.a. system. during 2013, only 44 physician assistants have received $319,000 in scholarships. compared to 705 registered nurses seeking to become nurse practitioners, receiving scholarship awards totalling over $12 million. the recommendation is that the va must announce and applicants are away of the education debt reduction loan forgiveness. moving through the process for accountability nationally since this is not a facility fund but a va-funded program. next is the independent care technician the itc program also known as the grow your own

program. oif returning veterans to include scholarships, the mandate that the va should appoint p.a. ict director to coordinate the assistance necessary to be a liaison so these corpsmen and medics can become p.a.s. in conclusion, as you strive to assure that veterans received timely access to quality health care and demand more accountability into the va health care system we urge the committee to review the role of the p.a. profession and take immediate steps to address the current problems on a national level and not leave it to the oig report that shows the p.a. position moving up the list. the p.a. profession was born from the military and we need to continue that special relationship. on behalf of the entire membership of the veterans

affairs physician assistant association, i really appreciate this opportunity to testify here before you today and ask for your help in supporting the nation's veterans. >> thank you, mrs. silva. >> yes. >> dr. salvo. >> ranking member brownly and members of the subcommittee, i welcome and appreciate the opportunity to testify on behalf of the american poed at trick medical association. i commend the subcommittee to effectively and efficient low recruit and retain qualified medical professionals and improve access to quality health care in the v.a. i can neb andam a practicing podiatrist and before you representing apma and the podiatric medical

profession. i bring with me firsthand experience and knowledge of hiring practices within va and knowledge of the widespread disparity between podiatric physicians and other physicians. when the qualifications for podiatry were adopted in the 1960s, i was not yet born. back then, residencies were few and not required. today, there are mandated standardized comprehensive three-year medicine and surgery residencies to satisfy all of our graduates. each requiring completion of a broad curriculum, equitable to medical residency training.

today's podiatrists serve in leadership roles in those institutions. many of my colleagues have full admitting privileges. the competency skill and scope of today's podiatric physicians has certainly grown from the podiatrists that practiced before i was born. because of this, cms recognizes the physicians and tri-care recognizes as licensed independent practitioners. that's twu today's podiatrist. veterans plagued by psycho social issues are ailing have co-morbid disease compared to their nonveteran counterparts. these patients increase the burden of diabetic foot ulcers and amputations and it's documented in my testimony, almost 2 million veterans are at

risk of amputation. this is my patient population. the veteran population is far more complex to treat than patients in the private sector as a whole. one of our major missions is am tu precipitation prevention and limb salvation. as part of the team we manage patients within our scope of practice and we assume the same clinical, surge jal and administrative responsibilities as any other unsupervised and medical specialty. despite this equality and work responsibility, there exists a marked disparity and pay and recognition as podiatrists in the va. the majority of the new hires will separate from the va within five years.

i am speaking to you from personal experience as i am one of the majority. i entered the va without board certification with less than five years of experience. i gained my experience earned my board certification and then separated from the va to take a leadership position with my parent organization. while i will forever remain loyal to the veterans, which is why i still voluntarily treat patients at my local facility without compensation i testify to the profound disparity. legislative proposals to amend title 38 in the physician and dentist pay ban for the last ten years and these proposals have been denied every single year. as were several requests for an internal fix despite written letters of support from the former undersecretary of health, robert petzel, m.d. five years ago this was made a

top priority. since then we have alerted to the va our knowledge of this issue and secretary petzel recently received acknowledgement of the need of a legislative solution to address this issue. in closing, i would like to state that oftentimes we find that the simplest solution is the best. i come before this committee today to respectfully request that congress help the va and it is patients by passing legislation to recognize podiatric physicians in the pay band. we believe that simply changing the law to recognize podiatry, both for the advancements that we have made to our profession and for the contribution that we make for our veteran population will improve the problems. mr. chairman and members of the subcommittee, thank you for this opportunity. this concludes my testimony and

i'm available for questions. >> thank you dr. salvo. i appreciate it. i'll yield myself five minutes for questions. boy, there's a lot of questions that i could get answered here today from many of you. i think i'll start with miss clifford, though, because i think you brought up something that is permanent here. how long does the average hiring process take? how long is that time and talk more about the difficulty in getting people because they take a job somewhere else while the process is ongoing. >> it's pretty variable. it can go anywhere from two to six months in some places. it's a complex process. it has to get posted on usa jobs and put in the proper format to be posted on that and then we

wait and get the certification of who has applied for that position and then they have to go through all of these other processes that we have such as equip, which is the background check. >> the least amount of time is two months? >> i think two months would be considered a good hire, a quick hire. >> i know in the private sector if you apply for a job it doesn't take two months. they get hired in the private sector at the local hospital, i mean in my experience, do you have any experience with numbers on the private sector? >> i don't have any numbers but i do know that that's what we have from some of our candidates and it will come to the point where they say we have another job offer, how quickly can you tell me whether or not i can have it? because they probably haven't even given notice to their other job so it's another month before we get them in the door. >> dr. spagnola can you comment

on that on the physician side of things? i know there's a lot of trouble with the qualifications or making sure that the person's background is right and getting that right but how does that process work in the va from your experience? >> i would echo what you just heard. it takes sometimes a year to recruit a physician. i've heard them taking even longer. i also run the respiratory care department and it's usually a year before we can hire a therapist to get through all the processes and finally get them in working with hr is near impossible. >> so this is all done through the hr department and physician hires as well? >> it's more than just the hr. you have to get approved by different committees and chairman and hospital directors and then goes back and forth. it just takes forever.

>> dr. salvo, at the va i worked at, the podiatrist was the busiest in the surgery clinic. he had a hard time keeping up there long enough to do all of the work that he had to do. what's the difference? the payment? are they not paid as physicians then? can you explain that to me a little more? >> podiatry is on a different pay scale. unofficially, i am aware that the pay scale ranges anywhere from 60 to $100,000 less from other va medical and surgical specialties depending on what the specialty is. >> that would sort of explain why it doesn't recruit, right? mr. silva, do you have anything

to add on that recruitment and difficulty in hiring question? >> i would agree it does take a long time, it takes about six weeks on the private sector max where the va system it could take up to six months. >> could you expand a little bit about your -- you know my concern when i worked at the va was the fact that doctors weren't involved with making the decisions in the departments that actually involved how the patient care is delivered. they were sort of told what to do by the administration and then left to do that. can you expand on that thought? do you agree with my thinking there and what should be done about it? >> well yeah. we need to empower the physicians in the facilities i think if you took people in every va facility, you took a dozen people who really knew what was going on, you could find out very quickly what was

working and what wasn't working. you need to empower some of the nurses and the physicians that get some real input on how to become more efficient and how to provide better care. that could be done very quickly. >> thank you. i'm out of time and i'll yield to miss brownley. >> thank you, mr. chairman. i know that the secretary of the v.a. is really trying to make transformation at the va and i've heard him and others from the va testify that we need to shift the va from a rural-based organization to a principle-based organization and it sounds to me, based on the longevity of hiring people within the va it is the rules that are -- because there are so many -- is what slows the whole

process down that we would be better off following the practices of private industry in terms of hiring. is that a fair assessment for nurses? >> i would say so. it's very complex, lots of steps in the process from the human resources side and that is what causes -- >> so for the nurses, it's unlike the physicians, the problems are predominantly within the human resources department and their rules hiring doctors you go through human resources but have to go outside of human resources as well? yes and yes? >> i'm not sure i understand the question about going outside. so dr. spagnola testified that for longevity, in terms of hiring physicians it's within the human resources department but they also have to go outside of the human resources and i presume be interviewed by other

physicians or other departments and i'm just wondering, for nurses, is the whole hiring process within the human resources department? >> the nurses -- the nurse manages, the supervisors look at who they want to hire and then done by human resources. >> and the same for physicians? >> i can't tell you how many human resource officers i've seen go by in 40 years. but every new director that came to our facility in the last 40 years has said my number one priority is to fix hr. it's never been fixed. >> mr. spagnola, your testimony was shocking when you said sometimes veterans have medical appointments for care and leave not knowing that they did not see a physician or medical expert of any kind.

that's pretty shocking testimony to me. and then when i hear some of the obstacles around a physician assistant and the shortage there, it's -- i'm not sure what to say except we have a lot of improvements to make. but do you think that's a common occurrence where a veteran comes for an appointment for medical services and never sees a physician? >> was the question do i think it's common? >> yes. >> i think it's quite common. >> and how do you think -- you also said in your testimony that physicians are doing nonphysician care like typing and filing and helping patients change their clothes and reception -- patient reception, et cetera, how did that happen? how did those responsibilities become the responsibilities of the physician? is it just because of the shortage of people in the

operation or are these specific responsibilities of a physician? >> i don't know for specifically how that has occurred over the years but i can tell you that when i was the chief of staff a number of years ago i used to say to our hospital director when he would come in and yell at me and say our docs are not seeing enough patients, there was nobody in the clinics to assist the patient. they have one exam room. they have to get the patient, they have to help get the patient undressed, they have to see the patient and they be they have to write a note usually on the computer nowadays, they have to help the patient get dressed and then escort the patient out of the room. how many times can do you that when you have no other help? you have nobody to help input date data into the computer, you have no one to request drugs into the

computer. you're basically doing the physician, the secretary the receptionist. it's very difficult to be efficient. not that the physicians don't want to be efficient. receptionist and it's very difficult to be efficient, not that the physicians don't want to be efficient, they would love to be efficient but the system doesn't permit it. when you talk to administrators, they just glaze over. it's -- it gets physicians extraordinarily frustrated. they would love to see more patients, everybody would love to see more patients. >> thank you, doctor, my time is up and i yield back. >> you're recognized for five minutes. >> thank you, mr. chairman. and you really threw me off and i realize i've been a doctor longer than alive but i expect you have the same angst as i did. a couple of things to go over quickly, i have to catch an airplane but number one, you very clearly pointed out the loss of professionalism.

in my practice, i had an assistant, had a nurse with me and three examining rooms. i can really see a lot of patients very efficiently and very well. you cannot see patients in that -- it's impossible. you can't make it more productive when you have six jobs. and i think that very loss of professionalism has occurred and another thing that has occurred in the va, we have fewer providers as hospital administrators. if you've been in the trenches working, you understand exactly how that clinic works. i understand exactly how your clinic works or doesn't. so i think that's one of the issues we've got to deal with. and i think another question i have quickly is how -- what is the retention problem? when you hire people there's a huge turnover in nursing and medical side. what do you all see? why is this? is it working conditions or pay? why is that? >> i'll take a stab at that. they come to work with great

enthusiasm, good people, they get put into these situations after six months or a year they are frustrated and depressed and tired and nobody listens and they leave. so your turnover rates, i don't know what they are nationally but am primary care some places have turnover rates of 100% every year. it's frustration primarily frustration i would say. and go ahead -- >> again, it's dependent on different facilities to your point that people all come in with the best of intentions, but if you happen to be in an area that has a difficult time recruiting and trying to do overtime and lots of shift changes and people get frustrated and burned out and leave. in facilities they are able to maintain that people stay because they stay for the mission. >> two other quick questions,

one is for mr. morris's standpoint, is there a barrier if you have a different -- i'm certified by the american board but are there barriers out there for other board certifications that you see that help reduce staffing? is that a real issue that you brought up or not? i guess dr. spagnolio can answer -- and the second -- let me fill the second one out so you can answer it. the veterans choice act which we spent a lot of time on getting passed provided $5 billion to increase staffing for the va. is that money being used that way? that's my two questions. >> if your question is on the veterans choice act, whether they are utilizing it -- >> yes, sir. >> i don't know how much they are utilizing it to be honest with you. i don't know if -- i know we've tried to have a few people go somewhere else, one had an

artificial heart and it was a nightmare to get that done. because the facility that they were to go to had no experience with that. i can't tell you how it is across the va. from what i hear it's not very efficient. so if it's going to work, it's going to be efficient. i would like to see within the va more efficiencies and getting these procedures done more quickly. some physicians have no -- their access to the operating room is one or two days a week. >> that second was less physicians, as mr. morris pointed out, being boarding by somebody, is that a barrier to hiring people? >> yes. >> is it a legitimate barrier? >> i think it's a legitimate barrier in some situations. >> okay. any other comments on that? did any of you, dr. salvo, have

you seen that? >> in my capacity as a woc appointment within the va, i have had to deal almost nothing with veterans choice act personally. it's purely administrative by other departments. >> i did want to say with the veterans choice act it has been interpreted to not include physician assistance by some facilities. if you want to talk about increasing recruitment, the jobs aren't even posted, physician assistants aren't able to apply for those jobs. that's not going to increase access for care for veterans. >> it isn't really hard to figure out your needs when you just call the people scheduling the appointments and find out you have a six-month wait. it ain't rocket science. i've been doing it for four decades and you find out and all of you there know, if you have a long waiting list for patients to come in, you need to hire people to take care of waiting lists or make the shop more efficient. it's not complicated. i did it for years. and i mean, the way i learned if i needed advice, i would go to church and somebody say i can't get an appointment for six

months. figure hey, maybe we better hire another practitioner and we did. and that's what i see there. my time is expired, mr. chairman, thank you for indulging me. >> thank you. >> you're recognized for five minutes. >> thank you, mr. chairman. i want to thank everyone on the panel for being here in your commitment to improving the va and serving our veterans gives me an opportunity to remember and think those who serve nk those who serve ank those who serve nk those who serve ank those who serve veterans -- that's the district i have the honor of serving and dr. salvo, your story of continuing to treat veterans without compensation reminds me of people i met at the va who are providers there and could be working in the private sector at much greater pay and probably much less frustration and yet choose to work at the va because they want to serve veterans and

do a wonderful job. i hear that from the veterans that they treat and serve directly, that it's really hard to get in and there's a lot of frustration with the bureaucracy, but once you are seen by a provider, typically the experience is excellent. and i think that's something that i've heard my colleagues on the committee share as well. two things stick out to me in terms of the larger picture. one is we heard the deputy secretary say this day before yesterday sloan gibson, that there are 28,000 unfilled positions at the va today. just the hiring challenge there is just monumental, staggering, i don't know how you get over it and it hasn't improved in a year. and the other is wait times also have not improved in a year. 15 or $16 billion authorized and appropriated this summer,

program went live in new york and dr. spagnolio, you're not sure if you've seen significant change in access or treatment. we know from a hearing earlier this week that we thought that $10 billion of that were going to be obligated sometime in the early part of fy 16 which could take you to maybe december or january. the next six months and only $500 million has been obligated. so you all have each offered important suggestions to improve the delivery of care and hiring and speed at which we bring people on board and i'm glad dr. lynch is here to listen to all of this. i know he's taking note of this and will incorporate these, i hope, into the operations at the va, but i'm also looking for some kind of big break through in what we're doing. i don't know that with these 28,000 outstanding hires with wait times that haven't improved

despite the notoriety around the crisis in phoenix and all of the attention we've spent and new legislation that we thought would fix it, i don't know this model works, nor should we expect it to work. one of you said it's not going to be a matter of resources, we can't throw more money at this and expect -- we can hire people a lot more quickly. i've heard the same stories, we had a psychologist hired from georgia recruited by the va in el paso and he said sure, i'd like to do this job, sign me up and it took three months to bring him on. they recruited him and it took three months. in the that time they said there were several other offers and thought of taking them. but i wanted to serve an underserved area. i realize i've chewed up most of the time i had but i want to offer the last minute and a half to anyone who might have a big breakthrough idea on how we change what is obviously a system that doesn't work.

ms. clifford -- >> i don't know if it's a breakthrough idea, but if we don't address the human resource piece of it -- it's not the staff doing the work there killing themselves trying to help us get these people in. but the task ahead of them is so overwhelming, i don't know what the retention rates are but i would think they are not very good because they turn over quickly because it takes a lot of time to get them trained. they don't stay long enough to get trained and go to other jobs, either in other parts of the government or out of human resources all together. we don't address that area because they are the bread and butter of getting people in. >> that's an open question for me to each of you, i'm sure my colleagues on the committee would be interested in hearing your answer. we won't have a time to get to each of you today. but i speak for myself, very interested in a different way forward. i just think more of the same we've seen from the last year