bear with me for a few minutes. when the chairman circulates an item, it is indeed a reflection of his vision. my office then evaluates the proposals, listens to any concerned voice by interested parties, including consumers, and considers whether we have concerns, and if so, what changes we want to request so that we can move to a position of support. this item was no different. it is true, i too had significant concerns about the initial proposal, but after interactions among staff, my office and the chairman's office, and the chairman, this item has changed considerably over the last few weeks, and i appreciate the chairman for incorporating my many requests

to do so. though i still may have preferred to make a portion of the draft more neutral, what we are voting on today asks about a number of alternatives which will allow for a well-rounded record to develop on how best to protect the public interest. second, today, we are voting only on proposed rules, not final rules. this item is an official call inviting interested parties comment to discuss pros and cons of various approaches and to have a robust dialogue about the best path forward. when the chairman hits the gavel after the vote is cast on this item this morning, it will signal a start of 120 unique days of opportunity, each of you have, in shaping and influencing direction of one of the world's most incredible platforms. the feedback up to now has been nothing short of astounding. but the real calls to action begin after this vote is taken. comments are due on july 15, and there's ample time to evaluate any of the proposals and provide

meaningful feedback. you have spoken, and i am listening. your power will never be underestimated. i sincerely hope that your passion continues. as i have said to those i met outside of the fcc headquarters, this is now your opportunity to make your point on the record. you have the whole ear of the fcc. the eyes of the world are on all of us. i will do all that i can independently and with the chairman to identify ways to

encourage more interactive dialogue with all stakeholders, town halls, workshops, social media, because i know with a robust record this commission will be able to move quickly and get to the finish line with rules that are clear and enforceable. so, mom, i hope that answers most of your questions. and i sincerely hope you will not be compelled to ask me any more significant policy questions for another 16 years. in all seriousness, i want to thank the dedicated staff from the office of general counsel, including jonathan and stephanie, as well as the wireline competition and telecommunications bureau for their work on this significant item, and i want to thank my wireline legal advisor rebecca for her expert work on this item, and, rebecca, yes, you may take tomorrow off. thank you, mr. chairman. >> thank you, commissioner, both for your significant contributions to this item as well as to explaining to your mother and everyone how this process works.

commissioner? >> thank you. i support an open internet, but i would have done this differently. i would've taken time before proceeding to understand the future, because the future of the internet is the future of everything. there is nothing in our commercial and civic lives that will be untouched by its influence or unmoved by its power. i would have taken time for more input, because i think as public servants we have a duty to acknowledge and respond to the great tide of public commentary that followed in the wake of the chairman's proposal. even now, the phone calls continue, the e-mails pour in, and the web itself is ablaze with commentary on how this commission should proceed. it is no wonder.

our internet economy is the envy of the world. we invented it. the broadband beneath us and the airwaves all around us deliver its collective might to our homes and businesses in communities across the country. the applications economy began here on our shores. it produced this dynamic engine of entrepreneurship and experimentation is a foundation of openness. sustaining what has made us innovative and creative should not be a choice. it should be an obligation. as we proceed, we are also obligated to protect what has made the internet the most dynamic platform for free speech ever invented. it is our modern town square. it is our printing press. it is our shared platform for opportunity. online, we are sovereign.

we can choose, create, and consume content unimpeded by that prefaces of our broadband providers. sustaining this freedom is essential. so as we proceed, we almost keep in mind the principles of fairness and protection from discrimination, that have informed every proceeding involving the internet that has been before this agency. these are the essential values in our communications laws. they are the ones we have honored in the past. they must guide us in the future. so going forward, we must honor transparency, ban blocking, and prevent unreasonable termination. you cannot have a two-tiered internet. so i support network ecology. i believe the process that got us to this rulemaking today is flawed. i would have preferred a delay.

i think we moved too fast to be fair. so i concur. but i want to acknowledge that the chairman has made significant adjustments to the text of the rulemaking we adopt here today. he has expanded its scope and put all options on the table. our effort now covers law and policy, section 706, and title 2. if passed, this prologue, the future of this proceeding, the future of network neutrality and the internet is still being written. i'm hopeful we can write it together, and i am mindful that we must get it right. >> thank you, commissioner. commissioner?

>> thank you. a few years ago google's ceo was quoted as saying the internet is the first thing humanity has made that humanity does not understand. if this is so, then every american who cares about the future of the internet should be wary about five unelected officials deciding its fate. after the u.s. court of appeals here in washington struck down the agency's latest attempts to regulate broadband providers practices, i recommended that the fcc seek guidance from congress. instead of plowing ahead, yet again on its own. in my view, recent events have only confirmed the wisdom of that approach. let's start by acknowledging the obvious. the chairman's proposal has sparked a vigorous public debate. but we should not let that debate obscure important common

ground, namely, a bipartisan consensus in favor of a free and open internet. indeed, this consensus reaches back at least a decade. in 2004, then fcc chairman michael powell outlined four principles of internet freedom -- the freedom to access lawful content, the freedom to use applications, the freedom to attach personal devices to the network, and the freedom to obtain service plan information. one year later, the fcc unanimously endorsed these principles when it adopted the internet policy statements. respectful of these, these freedoms have propelled the internet's tremendous growth over the last decade. it has shielded online competitors from anti-competitive practices. it has fostered long-term investment in broadband infrastructure. it has made the internet and unprecedented platform for civic engagement, commerce, entertainment, and more. and it has made the united

states the epicenter of online innovation. i support the four internet freedoms, and i am committed to protecting them going forward. it is not news that people of good faith disagree when it comes to the best way to maintain a free and open internet. or as i think of it, how best to preserve the four internet freedoms for consumers. some would like to regulate broadband providers as utilities under title 2 of the communications act. this regulation would scrap the clinton-era decision to let the internet grow and thrive free from price inflation and other obligations applicable to telephone carriers. there are others, and i am one of them, who believe that president clinton and congress got it right in the

telecommunications act of 1996 when they declared the policy of the united states to be preserving the vibrant and competitive free market that presently exists for the internet, unfettered by federal or states' regulations. i think we should recognize the benefits made possible by the regulatory regime that has been in place for the most art of the last decade. after all, nobody thinks of plain old telephone service or utilities as cutting edge. but everyone recognizes that the internet has potential, and that is because governments did not set the bounds early on. today's items strikes yet a third approach, a lawyerly proposal of a minimal level of access role, and not too much discrimination rules. it allows for paid prioritization under unspecified circumstances. to date, people outside this building have asked me to support this proposal. i remind you of an observation that there is nothing in the middle you wrote that yellow

stripes and dead armadillos. i think less than the future of the internet depends on how we resolve this disagreement. what we do in this proceeding will imperil or preserve internet freedom. it will promote or deter broadband infrastructure investment throughout our nation. it will brighten or hamper the future of innovation within the networks. it will determine whether control of the internet will reside with the u.s. government or with the private sector. it will impact whether consumers are connected by smart networks or dumb pipes. and it will advance or undermine american advocacy for an internet free from government control. my view of the dispute is not for us to decide. instead, it should be resolved

at the people's elected representatives, those who choose the directions of government, and those whom the american people can hold directly accountable for that choice. therefore, i am disappointed that today rather than turning to congress we have chosen to take matters into her own hands. it is all the more disappointing because we have been down this road before. our prior attempts ended in court. even with the newfangled tools that the fcc will conjure up out of the legal grab bag, i'm skeptical that the third time will be the charm. for these reasons, along with others that are detailed in my written statement, i respectively dissent. nevertheless, if we are going to a suitable role of many legislatures and punch the commission into this morass, we need to use a better process going forward. i agree with my colleague that we have rushed headlong into this rulemaking by holding this

vote today. and when there is any bipartisan agreement on net neutrality, that is something. we have seen what happens when the american people feel excluded from the fcc's deliberations. on several recent issues, many say that the commission has spent too much time speaking at the american people and not enough time listening to them. we need to give the public a full and fair opportunity to participate in this process. and we must ensure that our decisions are built and based on a robust record. so what is the way forward? here is one suggestion. just as we commissioned a series of economic studies and passed media ownership proceedings, we should ask economists to study the impact of our proposed regulations and alternative approaches on the internet ecosystem.

to ensure that we get a wide range of perspectives, each commissioner should pick two authors to ensure accuracy. each study should be peer reviewed. and to ensure public oversight, we should host a series of hearings where commissioners can question the authors of the studies and the authors of these studies could discuss their differences. surely, the future of the internet is no less important than media ownership. but we should not limit ourselves to economic studies. we should also engage computer scientists, technologists, and other technical experts to tell us how they see the internet's infrastructure evolving. they should be subject to peer review and public hearings. alternately, any decisions we make on internet regulation should be based on sound economics and engineering, and an accurate understanding of how networks actually function.

they should be informed by the judicious and successful regulatory approach embraced by both democrats and republicans in recent years. and they should avoid embroiling everyone in yet another years-long legal waiting game. in short, getting the future of the internet right is more important than getting this done right now. going forward, i hope that we will not rush headlong into enacting bad rules. we are not confronted with a crisis that requires immediate action. if we are going to usurp congress' role and make fundamental choices for the american people, we must do better than the process that led us here today. i respectfully dissent. >> commissioner o'rielly? >> thank you. it should come as no surprise that i cannot support today's notice. as i said before, the premise for imposing net neutrality

rules is fundamentally flawed and rests on a faulty foundation of the believed statutory authority. i have serious concerns that this item will create damaging uncertainty and head the commission down a slippery slope. the notice proposes to grant the net neutrality rules in section 706 of the telecommunications act of 1996. i have expressed my views that congress never intended section 706 to be an affirmative grant of authority to the commission to regulate the internet. at most, it could be used to trigger to regulation. the notice does not stop there. it takes comments to ensure additional language in section 706 and events just using section 230-b to broaden the scope of the usurp authority. this is absurd. now the commission is trying to cast a wider net of authority. service providers could become ensnarled in its future.

the notice explores years of investment by reclassifying access as a title 2 service. the commission examined applying monopoly era telephone rules to modern broadband services solely to impose unnecessary and effective net neutrality regulations. courts can recognize that they may legally reverse course as long as it explains the reasons for changing its position. i am concerned about real-0 world impact that such a decision could have on the communications industry and the economy as a whole. the current framework has provided a climate of certainty and stability for broadband investment and internet information. i also worry about the credibility of an agency that consistently fails to meet statutory deadlines to eliminate all rules by supposing obsolete provisions.

the notice just because location could be accompanied by substantial forbearance from the title 2 requirements, the need to forbear from a significant number of provisions in title 2, for that title 2 is an inappropriate framework for today's technologies. indeed, title 2 includes arcane provisions. the idea that the commission can impose just the right amount of title 2 on broadband providers is giving commission more credit than it ever deserves. additionally, before taking any action on any issue, the commission should have a specific evidence that there is a market failure. the notice does not examine the broadband market, much less identify any failures. a true and accurate review of the broadband market which must include wireless broadband which show how dynamic it is. the notice fails to make the case that there is an actual problem resulting in real harm to consumers.

the notice identifies at most two additional examples of alleged harm, and in one instance the condition conceived it did not find a violation. in an attempt of a problem, the notice points to suppose it had conduct occurring outside the united states without explaining how it is relevant to a very different u.s. broadband market and regulatory structure. having come up empty handed, the notice proceeds to explore hypothetical concerns. at the top of the list is prioritization. even ardent supporters of net neutrality recognized that some amount of traffic prioritization or differentiation must be allowed or even encouraged. voice must the prioritized over e-mails, video over data,. prioritization is not a bad word, a necessary component of a reasonable network management. the notice is skeptical of paid participation.

companies that do business over the internet, including some of the strong supporters of net neutrality, pay for a variety of services to ensure the best possible experience. they have been doing it for years. fears that paid prioritization will be a great disservice for other users, relegating them to a slow internet, have been disproven. because there has been no evidence of actual harm, they are not tailored, but vague and unclear. the notice allows providers could seek a binding staff guidance or prospective reviews of their practices. but that is very troubling when legitimate committees are put into the position of having to ask the government every time they need to make a business decision in order to avoid litigation. it is more telling -- the notice devotes several pages to a wish list of disclosures,

requirements, and certifications. they will impose new burdens and carry real costs, they may not ever wind up having meaningful ends to use. what will be the average consumer do with the information on packet corruption and jitter the approach to cost-benefit analysis cannot continue, and i intend to spend time in the proving this important fraction. proposed net utility rules and legal theories will stifle innovation and investment by private sector can provide no help to consumers, and thrust the commission into a place it should not be. i respectfully dissent. >> [indiscernible]

>> please. we are trying to move ahead. >> [indiscernible] >> we are trying to move ahead. [applause] >> i strongly support an open internet. this agency supports an open internet. although you have seen today that the ability to a sure and open internet is a matter of dispute. there is one internet. not a fast internet. not a slow internet. one internet.

attention is being paid to this topic throughout the country, here in this room, is proof positive as to why the open and free exchange of information must be protect did. thank you to all of the thousands who have e-mailed me personally about this. thank you to those who feel so strongly about this, that they have been living in tents outside the building, and i enjoyed our meetings. one could only conclude that the founding fathers must be looking down and smiling at how the republic that they created is carrying out the ideals that they established. by releasing this item today,

those who have been expressing themselves will now be able to see what we are actually proposing. they have been heard. we look forward to further input, and i say thank you for your passionate caring about this very important issue. but today we take another step. this is been a decade-long effort to preserve and protect the open internet. those previous efforts were blocked twice by court challenges who sell internet connections to consumers. today this agency moves to surmount that opposition and to stand up for consumers in an

open internet. there has been talk up here about freedoms, about whether or not there has been market failures. the d.c. circuit in its opinion on the 2010 decision of this commission made an interesting observation that i would like to quote. there is little dispute that broadband providers have a technological ability to distinguish between and discriminate against certain types of internet traffic. the court found there have been examples of abuses from individual cases to mobile carriers denying access to apps for banking or voice or video.

so this notice of proposed rulemaking starts an important process where it ends, we will learn during the process. that is why am grateful for the attention this has received. we start with a premise -- protecting the open internet is important for both consumers and economic growth. we are dedicated to protecting and preserving an open internet. and as commissioner clyburn much more eloquently pointed out, what we are dealing with today is a proposal, not a final rule. with this notice we are asking for specific comment on

different approaches to o'connor's same goal -- an open internet. nothing in this proposal authorizes paid prioritization, despite what has been incorrectly stated today. the potential for there to be some kind of an "fast lane," available to only a few, has many concerned. personally, i don't like the idea that the internet could become divided into haves and have-nots, and i will work to see that that does not happen. in this item we specifically ask whether and how to prevent the kind of paid prioritization that could result in "fast lanes." two weeks ago, i told the

american convention of -- the convention of america's cable broadband providers something that is worth repeating here. "if someone acts to divide the internet between haves and have-nots, we will use every power at our disposal to stop it." i will take no backseat to anyone that privileging some network users, in a manner that squeezes out smaller voices, is unacceptable. today, we have proposed how to stop that from happening, including consideration of the applicable it he of title ii. there is one internet. it must be fast. it must be robust, and it must be open.

the speed and quality of the connection the consumer purchases must be unaffected by what content he or she is using. and there has to be a level playing field of opportunity for new ideas. small companies and startups must be able to affect the ugly reach consumers with innovative products and services and they must be did against harmful conduct by broadband providers. the prospect of a gatekeeper choosing winners and losers on the internet is unacceptable. let's stop for a minute and look at how the internet works at the retail level. the consumer accesses the internet using conductivity that

they have her just from an internet service provider. that on activity should be open and in violet. it is the simple purchase of a pathway. i believe it would be commercially unreasonable, and therefore not her metadata under this proposal, for the isp not to deliver the contracted for open pathway. but let's consider specifically what that means. i want to get rules that work like this. if the network operators slowed the speed below that which the consumer bought, it would be commercially unreasonable and therefore prohibited. if the network operator blocked access to lawful content, it would violate our no blocking rule and be commercially

unreasonable and therefore doubly prohibited. when content provided by a firm such as netflix reaches the consumer's network provider, it would be commercially unreasonable to charge the content provider to use the bandwidth for which the consumer had already paid and therefore prohibited. when a consumer buys specified capacity from a network divider, he or she is buying open capacity, not capacity the network provider can prioritize for their own profit purposes. prioritization that deprives the consumer of what the consumer has paid for would be commercially unreasonable, and therefore prohibited. simply put, when a consumer buys a specified bandwidth, it is commercially unreasonable, and thus a violation of this proposal, to deny them the full connectivity, the full benefits

that connection enables. also included in this proposal are two new powers for those who use the internet and for the commission. expanded transparency will require networks to inform on themselves. i call it the "rat out rule." the proposal expands existing transparency rules to require that networks disclose any practices that could change a consumers or a content provider's relationship with the network. i thus anticipate that, if a network ever planned to take an action that would affect the content providers access there would be time for the fcc to consider petitions to review such an action.

recognizing that internet entrepreneurs and consumers should not have to hire a lawyer to call the commission's attention to a grievance, and on ombudsperson would be created within the fcc to receive their complaints and, where warranted, investigate and represent their case. a separate and apart from this connectivity is the question of interconnection between the consumer's network provider in the various networks that deliver to that isp. that is a different matter that is better addressed separately. today's proposal is all about what happens on the broadband providers network and how the consumers connection to the

internet may not be interfered with or otherwise compromised. the situation in which the commission finds it self is inherited from the actions of re-vs commissions over the last decade. the d c circuit's ruling in january of this year upheld our determination that we need rules to protect internet openness, and upheld our authority under sections of an hundred hundred six to adopt such rules, even while it found the portions of the 2010 or net order were beyond the scope of our authority. in response, i probably stated

that we would reinstate rules that achieve the goals of the 2010 order using section 706-based roadmap laid out the court. that is what we are proposing to do today. section 706 is one of two personal methods proposed to accomplish the goals of an open internet. today we are seeking input on both sections 706 and title ii of the communications act. we have established a lengthy comment and reply period to allow everyone the opportunity for debate. mr. clyburn, observation of personal point. i would like to make a personal point as an entrepreneur and venture capitalist. i know the importance of openness firsthand. as an entrepreneur, i have had drawbacks and services shut out of closed cable networks.

as a vc, i have invested in companies that wouldn't have been able to innovates if the network weren't open. i have hands-on experience with the importance of network openness. i will not allow the national asset of an open internet to be compromised. i understand this issue in my bones. i've got scars from when my companies were denied access in the pre-internet days. the consideration we are beginning today is not about

whether the internet must be open but about how and when we will have rules in place to assure an open internet. my preference has been to follow the roadmap laid out by the d c circuit in the believe that it was the fastest and best way to get protections in place. i have also indicated rick heatedly that i am open to using title ii. this rulemaking begins the process by putting forth a proposal, asking important and specific questions, and opening the discussion to all americans. we look forward to the feedback on all of these approaches. and now we will proceed to a vote.

all those in favor say i. opposed. the eyes have it. the order is adopted. the request for editorial privileges is granted. now, before we move on to our next item, i would like to note that the order will be slightly different for the next two items. we will first hear presentations from the fcc staff for the next two items followed by statements from the bench on both items. after that, we will proceed to individual votes on the two items. madame secretary, will you please announce our next item, and to the bureau and all caps staff who have worked so we just adopted, our hearty and heartfelt thank you. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] the wonderful thing about the

gold coast is that it is so underappreciated. it gives us a lot to write about. new york, chicago, they are also mll known in new york is the e capital. on the gulf coast, we think of that from texas to the florida there is a pan-golf sensibility where we have a live oaks,ironment, sandy soil, salt in the air, the nourishing and supplying us with wonderful seafood, estuaries and rivers wonderfully rich in tradition and culture. there have been memoirs in and around these things for hundreds of years so it's an toraordinarily rich subject take. and of course, along comes the

oil spill in 2010 where all of a sudden we are at center stage in people are beginning to look up the gulf coast in think about what it's like there, what moves them. we did not know we got so much of our oil and gas from them, the board. we were tuned in to how important the gulf is. >> learn about the rich history and literary life of mobile, alabama. saturday at 5:00 p.m. eastern on c-span 2 and sunday at 2:00 on c-span 3. >> in a few moments, thursday's hearing on the state of veteran health care with testimony from affairs secretary ericsson seki. the senate veterans committee continues the hearing with comments from veterans groups. then a third panel that includes

the acting inspector of the veterans department. on the next "washington journal," discussing the state of the housing market. then senior editor of telecommunication reports on the vote approving the net neutrality proposal and what it means for consumers. , looking a government report that analyzes the gross to mr. product for 22 industry sectors plus your phone calls, tweets. comments, and live at 7:00 a.m. eastern on c-span. >> convergence. you'd use that word throughout your book. what does it mean?

convergence of left-right agreement on darius things that is being pushed down on the corporate grip of both parties and their leaders. example, with public opinion. it does not matter red state or blue state. they are upset with the patriot and it's a big convergence. especially the wall street bailout type where no crooks were prosecuted or put in jail. they want a crackdown on corporate crime. pushing around all over the world and into the country and the comeback traumatize wasting

trillions of dollars. all these people around the world see crumbling public works. america needs repair. >> ralph nader on creating left-right alliances sunday night at 8:00 on c-span "human day." q&a." > hearing from ericsson shinseki including allegations that patients were waiting for care. others included representatives from the veteran organizations and the acting and after general. this is four hours.

>> thank you all for coming. i want to thank our panelists for what is going to be a very important hearing. the rules will be that i will make some opening remarks, senator burr, the ranking member will make opening remarks, members will have three minutes, and i will keep people to three minutes because it will be a long hearing it, and that we will go to secretary shinseki, and the undersecretary. excellent second panel and a very good third panel as well. it will be a long hearing, and we will get through it. let me begin by just making a

few basic points. serious allegations have v.a. personnelt in phoenix and other locations. i take these allegations seriously, as i know every member of the committee does, which is why i have supported an thependent investigation of v.a. inspector general, and they are in phoenix doing a thorough investigation, and my hope is the report will be done as soon as possible. what i have stated and i will repeat right now, is that as soon as that report is done, this committee will hold hearings to see what we learned from that report, and how we go forward, as soon as we possibly

can after their investigation is completed. i think there is no member of this committee who disagrees, and nobody in the united states, that this country has a moral obligation to provide the best quality care possible to those that have put their lives on the line to defend this nation, and i believe that every member of this committee will do everything that we can to get to the truth of these allegations, but if we are going to do our job in a proper and responsible way, we need to get the facts judgment, ando one of the concerns i have, to be honest, is there has been a little bit of a rush to judgment. the happened in phoenix -- truth is, we do not know, but we're going to find out. that me say a word about v.a.

health care in general, which is what this hearing is about. what we want to know about v.a. health care is what is going well, what is not going well, and in terms of what is not going well, how do we improve that? today, we must understand that when we talk about v.a. health care, we are talking about the largest integrated health care system in the united states of america. has 150 medical centers, over 800 community-based outreach clinics, and 300 vet centers. every year, the v.a. is serving 6.5 million veterans. tenant -- today, tomorrow, and week, every single day, v.a. veterans, and what does that mean? here is my point. if senator burr and i would run

around and visit every v.a. medical center, we would suspect say i have would good health care, i was treated curiously, i like my doctor, and then you would find people that say i did not like my doctor. the point that i want to make is when you are dealing with 200,000 people, and if you did better than any other health institution in the world, there would be thousands of people every single day that would say i do not like what i'm getting, and we have to put all of that in the context of the size of v.a. does v.a. in general provide quality care to veterans? simple question. the answer is some people think that it provides very good quality care. the american customer satisfaction index ranks customer satisfaction among the best in the country, and if you

talk to veterans generally speaking, in vermont, not 100% -- they say we get good health care, are the problems, absolutely, and we will talk about those problems. servicealing with --"ected injuries said this v.a. is a model provider that has led the way in various areas of biomedical research, specializing is, graduate training for all health professions, and the use of technology to improve health care." say "suchn to expertise cannot adequately be replicated in the private sector . of the paralyzed veterans of america will testify "the simple truth is v.a. service is the

best care for veterans, and they are incredible resources that cannot be duplicated in the private sector." today, the representative for all 50 states will tell us " the state of v.a. in our nation is strong here at -- strong." further, and i know this is not fit in a 12-second soundbite -- this point has to be made -- there is no question in my mind that v.a. health care has problems, serious problems, but that the rest of health care in america is wonderful. that is not the world we live in. let me give you one example because it is important to put v.a. health care in context. article,fic american

september 20, 2013, less than "how manygo, states, die from medical mistakes in u.s. hospitals? an updated estimate says it could be 200 and 10,000 -- 210,000 a year. hospital errors that caused death are now the third leading cause of death in america behind cancer and heart disease." what does that mean, has death been reported through medical errors in the v.a.? the answer is yes, and everyone of those deaths is a shame, but it is not just v.a.. it is the. leading cause of death in american hospitals. that is an issue we have to settle. having said that, there is no doubt in my mind there are

serious problems facing v.a. health care, and we have to do everything that we can to address those problems. let me just discuss a few. does the v.a. have adequate staffing? when we talk about patient wait times, which is a major concern in certain parts of the country, and its issue came up in phoenix land town meeting was held by the american legion, wait times came up, and is the v.a. adequately staffed? do we have enough doctors and nurses in various parts of the country? i do not of the answer to that, and that i want to find out. further, is the v.a. doing its job in allocating the resources to where the staff is needed most? there are some places in the isted states where v.a. load going down, but your people are coming in, and other places where it is increasing -- are we allocating resources appropriately?

let's are member, in the midst of all of that, we are dealing with 200,000 men and women that have come back from iraq and ptsd, not anith easy problem to address. the weight measure was way -- change to 14 days. is that appropriate? can there, did that with the level of staffing that they have? \ we have to discuss that. what happens to those that are not able to bring patients and within the 14-day period? some possible that in cases unrealistic expectations have created a situation where some staff is in fact, cooking the books?i want to look at that. with that, i look for to hearing to get at the root at some the health care problems facing the v.a. and i want to give the microphone to ranking member senator burr.

>> to wreck, mr. chairman, thank you for calling this hearing. -- thank you, mr. chairman, thank you for calling this hearing, and secretary shinseki, thank you for being here today. we have a sacred obligation to ensure that those that have fought for this nation receive the highest quality of services from the department of veterans affairs. now, the chairman's opening remarks -- he was correct. we are not here to analyze a pole that was taken about the look att we are here to the investigations that have already taken place and addressed certain deficiencies ystem that veterans' s no action was taken on, or at least not corrective action. in fiscal year 2013, v.a.

reported that 93% of specialty and primary care appointments, and 95% of health care opponents are made within 14 days of the desired date. at first glance, the numbers appear to demonstrate veterans are receiving the care they want when they wanted, however we know this is not the case. i think if v.a. had asked hard questions regarding the statistics, we would not be here today discussing recent allegations surrounding many -- and i stress many --v.a. facilities. more specifically, we are here to discuss when senior leadership became aware that local v.a. employees were manipulating wait times to show that veterans do not wait at all for care. it seems that everyday there are new allegations regarding inappropriate scheduling practices, ranging from zeroing out patient wait times, to

scheduling patients in clinics that do not even exist, and even to booking multiple patients for a single appointment. the recent allegations were not only reported by the media, but have even been substantiated by the general accounting office, the inspector general's office, and the office of the medical inspector. here are a few examples -- the gao released a report on scheduling oversight in december, 2012, and has testified multiple times on this issue. several ig reports have been issued regarding delays in care and scheduling the regulators including -- irregularities, including reports in texas in 2012, and up to the most egregious report in september, 2013, at the columbia v.a. medical center. two publicly released documents

related to whistleblower allegations that jackson, v.a. medical center, and a four jackson immunity based outpatient -- community-based outpatient clinics. other reports that have been released, v.a. senior leadership, including the secretary, should have been aware that the a was facing a national scheduling crisis. leadership has either failed to connect the dots, or failed to address this ongoing crisis, which has resulted in patient harm and patient death. the question that we must answer they is even with all of information available to the secretary starting over one year and a half ago, and specific instances of patient harm and death directly related to care, why were the national audits and statements of concern from the v.a. only made this month? i yield back.

>> thank you, senator burr. senator murray? >> thank you. i'm glad you called this hearing. when it comes to caring for nations heroes, we cannot accept anything less than excellence. the government made a promise and one of the most -- one of the ways we uphold that is making sure veterans can access the health care that they need and deserve. why the department generally offers high-quality health care and does many things as well as or better than the private sector, i am very frustrated to be here once again talking about some deeply disturbing issues and allegations. it is extremely disappointing that the department has repeatedly failed to address wait times for health care, so i was encouraged when you announced a nationwide review of access to care, and i am pleased that the president is sending one of his key advisers, robert neighbors, to assist in overseeing that radio. his perspective from outside of that department will make the

review more credible and effective, but announcing this review is just a first step. these recent allegations are not new issues. they are deep, systemwide problems, and they grow more concerning everyday. when the inspector general's report is issued and the access review report is given, i expect the department to take them very seriously, and to take all appropriate steps to amend their recommendations. there are also cases where the facts are in right now. there are problems that we know exist, and there is no reason for the department to wait until the phoenix report comes back before acting on the larger problem. the gao reported on the a failures with wait times as will -- at least as far back as the year 2000. last congress did a great deal of work around wait times, particular for mental health care. inspector general at the these problems in 2005, 2007, and again in 2012.

each time they found schedulers across the country were not policy.g v.a. they also found in 2012 that v.a. has no reliable or accurate way of knowing if they are providing timely access to mental health care, but now the ig recommendations are still open, and the department has not limited legislation that i offered to improve the situation. clearly, the problem has gone on far too long. it is unfortunate that these leadership failures have dramatically shaken many confidence in the system. secretary shinseki, i continue to believe that you take this seriously and want to do the right thing, but we have come to the point where we need more than good intentions -- what we need is decisive action to restore veterans' confidence in the v.a., create a culture of transparency and accountability, and change the systemwide,

years-long problem. this needs to be a wake-up call for the department. the lack of transparency and accountability is inexcusable and cannot continue on. the practices of intimidation and coverups have to change starting today. giving bonuses for hospital directors for running a system that places priority on gaming the system and keeping the numbers down rather than provide care for veterans has to come to an end, but to my mr. secretary, it can not and with just dealing with a few bad actors, or putting a and fill of employees on leave. -- handful of employees on leave. you must lead the department in a place where we prioritize the candidates receive about anything else. the culture at the v.a. must allow people to admit where there are problems, and ask for help from the hospital leadership, or from you. this is the time to make real changes. thank you, mr. chairman.

>> thank you, mrs. murray. mr. isaacson. the would like to have openingr. boozman's statement be included in the record and we wish a speedy recovery. should have a rush to accountability. durham,ore phoenix, fort collins, the others that have come to matter, we already known and the v.a. has already admitted to 23 deaths that took place in part at least due to delays in consult. seven were in my area. four were at the va hospital in atlanta, georgia, all mental health issues. was in my state for a

two and a half hour hearing on the atlanta situation, and we knew and determine then there were problems with the delays that caused an open period of time where in fact they took their lives because of a failure to get the service that they should have gotten. sincee had 50 ig reports 2013, and in those reports we have found repeatedly over and over again where there has been a gaming of the system, where the system is more important than the patient. i think our veterans, and you, secretary shinseki, deserve better from the members of the v.a. health system. i told you yesterday on the phone when you were generous enough to call, i think the veterans and yourself have been mr. by the senior management of the v.a. we need accountability. what is going on is not a mystery anymore. we will find out more from the ig port, but i hope we get -- report, but i hope we get

accountability in the chain of command where you are held responsible for your response ability, mistakes are not tolerated, one mistake might be tolerated, but the second mistake on the same decision should never be tolerated. you for for -- thank being here today, and on behalf of the state of georgia, and united states, let's get this right, make sure no veterans die because of failure to the system -- of the system. senator isakson. .enator blumenthal >> thank you for holding this hearing that i hope will be bipartisan and as nonpolitical as it possibly could be. , secretaryk you shinseki, for your service to our nation. over many years you have served and sacrificed for this nation, and i deeply respect and thank you for all you have given to the united states of america, including in your six years as secretary of the v.a., and i

know you are determined, as the president is determined, to unravel and convio -- unveil any wrongdoing and restore trust in the v.a. health care system. i agree with the chairman that we should avoid a rush to judgment, but we have more than allegations at this point. we have evidence, solid evidence of wrongdoing within the v.a. system, and it is more than an of wrongdoing, and it is a pattern and practice, apparently, of manipulating lists and gaining the system, in effect, cooking the books, creating false records, which is not just an impropriety, or misconduct, it is potentially a criminal act. it is a pattern, as the chart submitted by the american legion as addendum c shows. there is a pattern across the

country, in more than 10 states, of this misconduct occurring. history.on, there is a the gao has reported, your own inspector general has reported these kinds of problems in the past. so, there is a need now for more than just investigation. there is a need for action to restore trust and confidence, to assure accountability and our nation's and veterans deserve the best medical care, nothing less with the situation now presenting serious, pressing, unanswered allegations and uncertainty is foundrable, and i have that the resources now at the disposal of the inspector general are sufficient to meet this challenge. i think there is a need for more than just the kind of

appointment the president has made to oversee the department of veterans affairs, there is a need for resources going to the inspector general, and possibly involvement of other agencies from the federal government because the resources currently available simply might be insufficient. in addition, there are 300,000 job openings across the country in the v.a., they are listed on thatobs.gov and i urge issues relevant to medical care the field immediately, and that actions be taken to restore, not only the transparency and accountability that we all expect from the v.a., but also to deal with the disability claims, backlogs that continue to plague the v.a. the question now is what does the evidence show? is it criminal, or simply civil?

and that judgment needs to be made as soon as possible. thank you, mr. chairman. >> thank you, senator blumenthal. .enator heller >> thank you, mr. chairman, and thank you for taking time to be with us today, and for the veterans in the room with us and those watching the hearing, thank you for your service. what has come to light about the v.a. in recent months has proven to congress, the president, and the american people, is that there is a problem with accountability at all levels within the veterans ministry should. that nevadalem veterans are facing, and it is not something that is new, and in fact it is something i have raised repeatedly with the v.a. to no avail. i think it is long overdue for this committee to exert oversight and hold leadership within the v.a. accountable. last week i sent a letter to senator shinseki asking for

immediate answers about the lack of accountability on the local level, and whether the v.a. leadership finally plans to do something about it. i look forward to receiving a timely response and action on the concerns that i highlighted. as nevada's presented on this committee, i believe it is also my role and response ability to get answers for nevada's veterans for the problems they are facing with benefit. they have complained of access -- excess weight times in emergency rooms, which in itself is too small to meet demand. there was anago, inspection of a blind female veteran that waited five hours in the emergency room and two weeks later died. the ig also found that one quarter of the veterans in the emergency room wait over six hours before receiving care. veteranore, a las vegas wrote me a letter recently and said he had to find care elsewhere because the wait time for an appointment at the v.a.

was longer than two months. , i wantese concerns assurance that all of nevada's v.a. medical centers and clinics will be fully audited, and that i will receive and be able to review the results immediately. as the cochair of the v.a. backlog working group, i am concerned with the claims backlog in nevada. although the secretary promised me that would be changes, nevada veterans are still waiting the longest, at 355 days on average, for the claims to be processed. when my office requested the status of claims, it was unresponsive. it is unacceptable that veteran officials would limit any ability to get answers for the veterans. despite my repeated requests, these ongoing issues have not been resolved. ifsome point i have to ask these problems in nevada are the demonstration of failed leadership at the time. -- at the top. it is failing to care for those

that sacrifice on our behalf. promises to change and do better for veterans have not produced results. i want changes, not empty, says. if the v.a. continues on this course, i think it is time to alternately looked to the top 40 changes. thank you -- top for these changes. thank you, mr. chairman. >> thank you. .enator hirono >> to her, mr. chairman for holding this hearing and i certainly echoed the -- q i mr. chairman, for holding this hearing. i certainly echoed the concerns of my colleagues and the need for structural and systemwide changes. health-care system is a promise that we made to america's veterans that we will take care of them in return for their service and sacrifice. the close to 10 million veterans that access care through the v.a. systems need to trust that

they are receiving high quality care when they need it, and i do note that 10 million veterans signed up for the health-care huge here that is greater than the population of a number of states, including the state of hawaii. when we fail to provide proper care for our veterans, we not only fail them, but their families as well, and these families have also sacrifice for our nation's security, and provide essential care and support for our veterans. while the immediate focus might be on the phoenix case and similar allegations regarding a hospitals,ther v.a. it is important to see what is happening systematically at the v.a. to provide veterans high-quality care, so we must look at the totality of the v.a. system to see what is working and what is not. i look forward to hearing from the panel about exactly what the challenges and problems are, what actions have been taken, need to be taken to serve our

veterans better. while the v.a. inspector general is investigating and secretary shinseki has called for a national face-to-face audit of the v.a. of the system, my hope is that this first of a number of hearings by this committee will identify other changes that should be of limited. i look forward to hearing from you, and again, as a secretary, and the other v.a. officials, on your plans to resolve the underlying issues and restore confidence in the veterans community, and, very poorly, to listen -- very importantly, to this and to what the veterans committee has to say about the changes that need to be made. >> thank you, senator hirono said senator moran -- senator hirono. senator moran. >> thank you. becauseew minutes late

i had conversations with kansas veterans again the morning. it is a moving experience each and every time to have that opportunity to visit with our world war ii veterans, and, again, the conversation is the v.a. is failing them, please make certain that that does not continue. thousands of veterans across the country, and hundreds in kansas visit with me on an annual basis to tell me they are suffering because of circumstances they find the department of veterans affairs. they will tell me that the sacrifices that they encountered, if they were willing to say this humble sentence, "why can we not have a service that weird and deserved?" they earned and deserve the service, and the department is not providing the veterans will we have committed to do. a sad story is that many veterans across the country and certainly in kansas, have lost

hope in the department of veterans affairs, and believe things are not going to get any better. your announcement of a face-to-face review across the system, mr. secretary, i find lacking in what needs to be done. the reality is we have had review after review, inspector general report after inspector general report, questions by this committee and the house veterans affairs committee, that i cansulted, as far as tell, you know action by the department of veterans affairs. the idea that you can conduct a systemwide -- as you indicate in your opening testimony, review of the v.a. using 200 and 20 -- mr. secretary, we have 1700 v.a. points of access to care, and you indicate this will provide a full understanding of the v.a.'s scheduling policy and continuing management of access to care. i do not see a review of looking at 153 medical facilities with

220 employees as capable of managing the system, so it looks to be more damage control than solving the problem. i actually think we do not have the need for more information, although that is always welcome. what we need is action based upon the information that has already been provided to the department of veterans affairs. i served 18 years on the veterans affairs committee. i work with nine secretaries of veterans affairs, and what is seemingly true to me today is that the quality of service, the timeliness of that service is diminishing, not increasing, and that was not true until recently. we have a significant number of veterans that we serve today, but, mr. secretary, we can anticipate more as our military men and women retire from service in afghanistan and iraq. we have an aging world war ii veterans population. if we cannot care for the veterans, how can we expect the department of veterans affairs to care for those as the numbers

and seriousness increases? i look forward to hearing what you have to say today, and i welcome the conversation, but in my view an additional review by your department is not the answer, but the answer is action that changes the system that you are leading and the culture and nature of the folks that are your boys. i look forward -- employees. i look forward to your testimony. thank you. >> thank you,n -- senator moran. senator begich. >> to eye for holding this hearing and the opportunity to have a conversation about -- thank you for holding the hearing in the opportunity to have a conversation about the v.a.. --rifice and sucking secretary shinseki, immediately after the phoenix story broke, i sent a question -- letter

quickly because i was outraged, but after a few weeks it has become a systematic issue come as you have indicated through your own conversations. it is an issue that is occurring in other v.a. clinics. has 77,000e that veterans, the highest per capita in the nation, it is impactful, determining where they get the care. we have been fortunate to create access to our health care services that has been able to cut the wait time out and get better service throughout the state, but when we look at veterans, may they be in alaska today, tomorrow they might be in arizona, north carolina. the service that is being delivered is critical to figuring out the systematic problem. what i agree with my colleagues that we have report after report after report, always indicating systematic problems that we need to correct. so, i am going to be anxious for

your commentary, as well as others, on how we will fix this once and for all. i know you have been burdened in some cases because we have had to wars and the v.a. started be funded aggressively in the last three or four years after we have started to wind down in iraq and afghanistan, which draws a lot of pressure, so i need to understand how that has impacted some of the work of the v.a.. also, as you look at issues and examine what we need to be doing, i want to know from your perspective, what are the things that we are doing through more regulation, or more laws, that are creating more hurdles and red tape? are there things we should be eliminating to create a more streamlined process? i want to know that. to not have the service delivered at the highest level to our veterans is a disservice. they earned it. they fought for our country, served for our country, and we need to make sure we do

everything we can to make sure the service is delivered as high a level as possible. this will be contentious. no question about it. i hope tomorrow we move to increase the performance and capacity of the v.a., and thank you for being here that i will tell you that i was outraged, but i'm anxious -- here. i will tell you that i was outraged, but i'm interested in your from you. there is more work to be done but it thank you, mr. -- thank you -- don. thank you, mr. chairman. >> thank you, mr. begich. >> thank you for having his panel. as an elected official, the most meaningful issue i can fund is sending men and women in harms way. we have the second highest per capita veterans in our state.

it is a personal issue for me and it is why i am proud to serve on this committee. i am encouraged that folks in washington are suddenly interested in access to health care for veterans. in most cases, it is long overdue. before i got here, the v.a. did not have mandatory funding, and they did not have forward funding. given my close association with veterans issues, i'm approached by veterans every time i go home, and that is almost every weekend, and the overwhelming majority of those folks are appreciative of the care of v.a. in montana, and when they have issues and concerns, they are not bashful, as veterans are not, about telling me about it, and when i get back to my office on monday, i work with those concerns, often with you to. aren the allegations i hear very troubling. if any of these allegations in phoenix or elsewhere turn out to be true, swift and appropriate action needs to happen if the issues are systemic, we need to

make fundamental changes -- happen. if the issues us at comic -- systemic, we need to make changes quickly and heads need to roll. we do need the facts. i hope we get those today. if we are truly interested in honoring our veterans by doing them right, the facts will drive an honest conversation about access to health care for our veterans. us talk about ways we can address shortfalls. let's talk about ways we can improve transportation options for veterans, or expanding telemedicine initiatives. let's talk about partnerships with local providers and providing the v.a. with resources it needs to address these patient workloads. let's have these conversation so that we can provide veterans justmeaningful items, not talking points. veterans deserve our best. they have sacrificed much. let's demonstrate our best by having a productive, instructive, truthful

conversation about what needs to be done to fix the problems are out there in our v.a.. >> thank you, senator tester. senator mccain of arizona is not a member of this committee, but given the serious allegations raised in phoenix, senator mccain asked to come before the committee, and we welcome him today. >> thank you, mr. chairman. he went for the opportunity to make a brief statement, particularly given that many of the serious allegations discussed today involve the treatment of veterans in my home state of arizona. since our nation's founding, americans have been fighting in faraway bases to make this dangerous world safer for the rest of us. they have been brave, you have sacrificed, and suffered. they bear wounds and losses they will never completely recover from and we can never fully compensate them for, but we can care for the injuries they suffered on our behalf and for the physical and emotional recovery from the battles they

fought to protect us. decent care for our veterans is the most solemn obligation a nation incurs, and we will be judged by god and history how well we discharge hours. it is why i am deeply troubled the recent allegations of gross mismanagement, fraud, and neglect at a growing number of veterans administration medical centers across the country. it has been more than a month since allegations that some 40 veterans died while waiting for care at the phoenix v.a. were first made public. to date, the obama administration has failed to spot and in an effective manner an effective in manner. this has created a crisis of confidence toward the v.a., the very agency that was established to care for them. for my hosted in phoenix, the families of four veterans who passed away in the

last two double your months stood before a crowded room to tell their stories. with tears in their eyes they described how their loss -- loved ones suffer because they were not provided the care they need and deserve. they recalled countless unanswered phone calls, ignored messages, and list wait times, mounds of bureaucratic red tape, while their loved ones suffer debilitating and ultimately fatal conditions. no one should be treated this way in a country as great as ours, but treating those to whom callously, sot so ungracefully, is unconscionable, and we should all be ashamed. since the initial reports in arizona last month, we've seen this scandal go nationwide, servicing in at least 10 states across america. the quotation seki has ordered a nationwide -- secretary shinseki hazarded the nationwide audit. several employees have been placed on administrative leave, and the v.a. office of inspector

general is inspecting the phoenix v.a.. my fellow veterans cannot wait the many months it might take to complete the report. they need answers, accountability, and leadership from this administration and congress now. is sufferingv.a. from systemic problems in its culture that requires strong-minded leadership and accountability to address. at the same time, commerce must provide v.a. administrators with greater ability to hire and fire those charged with caring for our veterans and most importantly we must give veterans greater possibility and how to get quality care in a timely manner rather than continue to rely on a department that appears riddled with systemic columns in delivering care. -- we care for those problems in delivering care. how we care for those that deliver for us is the most important test of the nation's character. today we are failing the test. we must do better tomorrow, much

better. for the 9 million american veterans enrolled in the v.a. today, and for the families whose tragic stories we heard last week in phoenix and are greeting -- breeding their toses, it is time to live up lincoln's injunction. it is time for answers, accountability, and leadership from this administration, and i look forward to hearing from secretary shinseki. i thank you mr. chairman, and ranking member burr, and the members of this committee. >> thank you, senator mccain. i would like to now welcome retired u.s. army general eric shinseki, secretary of veterans affairs, to the first panel. as most people know, secretary shinseki is a graduate of west point, served as a chief of staff for the army from 1999 to

2003, retired in 2003 after a near 40-year career in the u.s. army. following the september 11, 2001, terrorist attacks against our country, secretary shinseki led the army during operations iraqi freedom and serve simultaneously as commander general, nato land forces in central europe, and commander of the nato-led stabilization force, bosnia and herzegovina, -- a fewt to note few of the many awards -- the distinguished metal, the barn star medal, and the purple heart. mr. secretary, thank you very much for being with us today. secretary shinseki is accompanied by dr. robert petzel

, who is the undersecretary for health. mr. secretary, your repaired remarks will be submitted for the record. what i would like to do now is if both of you could rise and take the oath? or affirmemnly swear that the testimony that you are about to give before the senate committee on veterans affairs will be the truth, the whole truth, and nothing but the truth, so help you god? thank you very much. please be seated. mr. secretary and dr. petzel, the floor is yours. youhairman sanders, thank very much for that more than generous introduction. to you and ranking member burr, and the members of this committee, thank you for this opportunity to discuss the state of v.a.. i have been taking oaths most of my life, mr. chairman, so

whenever i appear before this committee, whether i am sworn or not, you have my best answers based on what i know, and as truthful a presentation as i can make. i deeply appreciate your support , and unwavering support for nation's veterans. that has been true for five years that i have worked with members of this committee. chairman, i would also like to recognize that in the room here are others with whom i have worked with very closely for five years, developing good dialogue, good collaboration. they have been very helpful in shaping what we thought was a priority in the department of veterans affairs, and it has been a good, strong relationship, and i thank them for their partnership, and i know some of them will be testifying before you today.

in those cases where we have not always seen eye to eye, we have managed to find common ground on behalf of veterans, and i expect we will do that again. we had v.a. are committed to consist of providing our veterans the high-quality care, timely benefits, and safe facilities necessary to improve their health and well-being. this commitment mandates a continuous effort to improve quality and safety. america's veterans deserve nothing less. meet highy and safety standards and veterans should feel safe in using v.a.. that said, in health care, as you point out, there are always areas in need of improvement. any allegation about patient care or employee misconduct are taken seriously, and based on the background that you just described, that i followed most of my life, for 38 years in uniform, and i now have this

great privilege of being able to care for people i went to war with many years ago, and people that i have sent to war, and people that raised me in the profession when i was a anygster, any allegation, adverse incidents like this, makes me mad as hell. i could use stronger language here, mr. chairman, but in deference to the committee, i won't. at the same time, it also saddens me because i understand that out of those adverse events a veteran and a veterans family is dealing in the aftermath, and i always try to put myself in their shoes. in response to allegations about manipulations of appointments, i amuling, and phoenix, committed to taking all actions necessary to identify exactly what the issues are, to fix

them, and who strengthens healths' trust in v.a. care. the office of inspector general, ismany of you went up, it conducting it, review. if any of these allegations are true at phoenix and elsewhere we have invited the ig to come and look at issues that surface -- if any allegations are true, they are completely unacceptable to me, to veterans, and i will tell you the vast majority of vha communities that come to work every day to do the best for those veterans. if any of those are substantiated by the inspector general, we will act, and i thank senator murray's encouragement to do something different, and senator, i will. -- important,t:

however, to allow the specter general to complete the review and provide results. secondly, i have directed v.a. to complete a nationwide access review of all other health care facilities to ensure full compliance with our scheduling policy, and as we have begun that, we already received reports where question, is under and we have asked the ig in a number of those cases to also take a look. third i have asked for and received the assistance from president obama. the president has agreed to let his deputy chief of staff for s assist us inbor our review of allegations and honey other issues we might find -- and any other issues we might find in these reviews. rob is a fresh set of eyes, the son of a veteran, and a proven performer that brings experience

to this task, and i welcome his experience. known rob nabors' family for many years. we served together for many years, i know his mom and dad very well, and i welcome the assistance of rob nabors. it is important to remember that millionucted roughly 85 outpatient appointment clinics last year. are over 1700 points of care, including 150 medical centers, 820 community-based outpatient clinics, 332 veteran 104ers, 140 living centers, rehabilitation treatment programs, and 70 mobile vet centers.

his is a demonstration of concern by this department -- this is illustration of concern by this department, trying to make sure that every veteran, no matter where they live in this country, and even in our overseas locations, have an equal opportunity to have access to quality health care. as the chairman has noted, vha conducts approximately 336,000 appointments every day. employees00 vha provide exceptional care to the 600 million -- veterans. v.a. meets and exceeds that is in very -- many areas. we always endeavor to be fully transparent, fostering a culture that rate -- avoids repeating errors. every facility is accredited by the joint commission, the

independent organization that ensures the quality of u.s. health care through comprehensive evaluations. in 2012, the joint commission recognized 19 v.a. hospitals as among its top performers, and last year that number increased to 32. additionally, as the chairman has pointed out, the most recent american customer satisfaction index ranks v.a. customer satisfaction among the best in the nation, equal to or better than the rankings for private sector hospitals. an overwhelming 96% of veterans who use v.a. health care. today indicated they would use us again the next time they anded in-patient care, 96%, 95% for outpatient care. i want them to continue to have that level of trust. veterans deserve to have full faith in their v.a. vha is committed to full

disclosure when any adverse event occurs. v.a. will continue to aggressively develop and sustain reliable systems and train employees to detect and prevent health care incidents before they happen. i have detailed some of our many significant health care a competence -- a competence over the past five years in my written testimony -- accomplishments over the past five years in my written testimony. i appreciate our employees, our partners, as indicated, in this room, community stakeholders, many of whom we deal with on a daily basis, and our dedicated v.a. volunteers. i deeply respect the important role that congress and the members of this committee play in serving our veterans, and i look forward to continuing our work with congress to better serve them all, and again, mr. chairman, thank you for the

opportunity to appear here today. >> thank you are much, for your testimony -- thank you very much for your testimony. mr. secretary, i am going to start with a simple question, and then i will ask some harder questions, and you or dr. petzel could answer. simple question -- the v.a. hospital system is the largest integrated health care system and an end states of america with 6.5 million veterans accessing it every single day. ,r. shinseki, and dr. petzel what are the strengths, what are the problems in your judgment? is it a good system? >> mr. chairman, it is a good system, and it is comparable to any other health care system in the country. in some areas, and in some specific occasions we exceed even those good systems. for five years now, we have

focused on three major goals for v.a., all of them focused on doing better by veterans, which is what the president asked me today when i came here. the first was to increase access. i think we have been successful at us. we have enrolled 2 million more veterans into v.a. health care. here,k there is a net somewhere around 1.4 million, 1.5 million, who are net overall increases, but over the past five years, we have enrolled 2 million more veterans. the second focus was to go after this thing called the backlog. we have had this discussion for a number of years now, but we did not simply go after the backlog just simply to and what was then, five years ago, a set of claims. hadlso acknowledged that we

not done very well by veterans of previous conflicts. so, even as we committed to and in -- ending the backlog in 2015, we also went and tried to bring justice to those who have never had an opportunity to submit a claim. i called on the good people in the veterans benefits administration to take this on, and they did, and i promised them we would give them a new tool called the veterans benefits management system, and in three years we feel this new cut you to do a 2008 that's -- you do in 2008 benefits? >> we have 11,000 people who process claims. >> i want to pick up on some of the legitimate points made by

democrats and republicans. -- everyonelegation understands when you treat 230,000 people a day, is a -- for any institution that size. here's a major criticism i hear and others, that this is not new news, that this is not new news. that these concerns did not arise yesterday, did not arise in phoenix, but in fact there have been reports by the inspector general, the gao, on numerous occasions about problems having to do with waitingng and with lists. could you address how it could happen that year after year these reports were made and have not been acted upon significantly? >> it is important to look at the gao and the ig reports and

what they intend to do, and they come in and give us some sense of where we could be doing better, and we get in there and we address those issues and take corrective action and in essence close out the report. it does not mean that we have solved every issue. it does mean that we have taken care of addressing those issues him a and then when they come back, there may be another set of issues to deal with. 'sdo understand senator murray suggestion that we should take a comprehensive look at this. >> what you're hearing from a number of senators and myself -- the criticism is that year after year reports have made talking about these problems and that problems continue to exist.

can you give us some assurance of what happens tomorrow, where do we go from here so we do not have this hearing next year or two years from now? the audit weat have created is intended to do. while the inspector general is looking at phoenix for evidence andmployee misconduct evidence that 40 veterans may have perished awaiting scheduling, the ig is going to get to the bottom of that. what we are attempting to do is a dress the senator's question is to take a look at ourselves and not wait for the ig's outcomes. already we have begun to see evidence that people are coming forward and saying, i think there is an issue here, which i encourage. and if what we are after there were performance issues in the past, if they are continuing

today >> >> are people cooking the books? is that a problem in the health care system? >> i am not aware in other than a number of isolated cases where there is evidence of that. the fact that there is evidence in a couple of cases behooves us to take a look, and that is why we have structured this audit so set of clinicians are not going to inspect their own areas. --have offset them so that and we will get a comprehensive good look. -- i apologize. my time has expired. >> welcome. these questions are for you and i will go as quickly as i can.

mr. secretary, were you wear that on october 20 5, 2013, the office of special counsel nggressive the v.a. conduct a investigation into it an outpatient clinic, and since then the media has reported on an e-mail of june 19, 2013, that explains how to game the -- to avoid on being on the bad boy list. >> i became aware of that screenshot, i believe, is what it was, of an employee who was suggesting there are ways to game. i put that employee on administrative leave. that was last friday. >> it is my understanding onto 21, 2013, v.a. received a rough port from the office of medical inspector regarding

understaffing issues at the jackson center, and that report described multiple patients' andduling problem, scheduling patients for a clinic that does not have any assigned providers. on september 17, 2013, the office of special counsel submitted a letter to the president of the united states on which the v.a. was copied, describing the findings of that june 21 office of medical inspector report on the fourth jackson medical center, including the practice of double booking patients and the use of clanks. -- clinics? >> to remember reading that report? >> i cannot say. >> there is a december 23 report the medicale of

inspector regarding the -- medical center in fort collins clinic that found that several medical support assistants businessdical center's office training includes teaching them to make the desired date the actual appointment and if the clinic needed to cancel appointments they were instructed to choose the desired date to within 14 days of the new appointment. you read that report? > >> the report has come to my attention recently. staff submitted a response to the office of special counsel, which included report on fort collins. in that letter, it was stated was not provided any specific veterans' cases

affected by these practices, they cannot substantiate the failure to train staff resulting in injured public health or safety. were you aware of what your chief of staff worked? -- wrote? >> i was. >> are you aware of the report need improvement which was andicly released in 2013, then on december 11, 2012, to that same report module former chief of staff sent a letter to the gao which stated v.a. generally agrees with with the conclusions and agrees with limitations to the department. do you remember that letter, that report, and your chief of staff's response? >> in general i remember that report. issuesknew there were

related to scheduling and wait 2013,as early as june 21, at jackson, december 20 three at ft. collins as well as numerous reports related to excessive weight times in january 2012, october 2012 in cleveland, september 2013, columbia, south carolina, and to subvert 2012 him at the gao report with questions the reliability of the reported weight time performance measures, which brings us to today and phoenix. on may 1 you probably stated that you had removed a person as the medical director. he stated then have that was to ensure the integrity of the current investigation. on may 5, there was a conference call with all directors, all medical directors, and the chief ther largea ranthe

group to discuss the audits in large community-aced outpatient clinics. hen i called the doctor, made the statement that the removal was political and the chief has done nothing wrong. if you are asking us to wait until the investigation is over, apply for the people who work you, and all the people i've described to you and that investigation going on, why should this committee or any veteran in america believe that change is going to happen as a result of what we are going through? >> i was not aware of the phone call you refer to, and i will look into it. my removalt tell you placing her on administrative leave was at the request of the ig.

on thehe lead comprehensive review. i do not get out ahead of him. he requested it. i put the director and other individuals on administrative leave. >> i thank you, mr. chairman. >> thank you, senator. senator murray? >> secretary, as i said, the announcement that the president is sending one of his top advisers to assist in the review is good news. i'm confident he will make sure this review is comprehensive and accurate. it is critical that this review is effective, because at a hearing of this committee that i called in november of 2011, i whetherdoctor facilities were gaming the system and not fully reporting wait times, and she told me she was unaware of any facility doing that and audits were being

done to make sure that is not happening. there were a number of allegations that wait times are in the oversight organizations have reported on it for years are at the department so far has been unable to provide me even the most a sick information on how this nationwide review is going to be conducted or what it will look like, and i hope that is about to change. i want you to explain how this review is going to be conducted. >> let me call on the dr. to give you the details. >> thank you, mr. secretary. there are several phases to what we do. this week we are auditing with the in-person teams and an anonymous survey the first tranche of the facilities, 151 centers. starting next week we will work our way down to more of the other sites.

gathering information, and i think the anonymous nature of the questioner is important, information about whether or not people have felt forced to do things that were inappropriate and lacking trust and integrity in the scheduling system. the second heart is and is -- the second part is an assessment that a number of people have mentioned as to whether or not we have our resources deployed appropriately, whether or not we have the appropriate amount of resources, and just as importantly whether or not we are using those resources in the best way at each one of our sites. everybody needs to remember that million,000 -- 85 outpatient visits every year. 95% of those visits are with established patients, and those are commerce within -- how want the details of

this is going to occur so we get good information. >> we will focus on the new patient and the scheduling system that we have for these patients, and all the other access points besides our clinics and her medical centers that we have got available for new patients. first is the review to see how the scheduling system is being done. second, look at whether we have -- >> i would like to get the details on that, and i do not want to use all my time, but it is important we know how that is going to be use and that real change will occur. i want to ask the secretary, the deputy undersecretary told me at a hearing in my 12 that the meaning is so prevalent as soon as new directives are put out they are torn apart to find about how to get around the apartment. the stability from an employee said the exact same thing. at that same hearing linda if we have seen

scheduling practices that result in gaming the system to make performance metrics look better, at the end of the day, over the past seven years, they need a culture change. to get that culture change i think they really need to hold the facility directors accountable for how well the data is actually being captured. that was more than two years ago. practice at the v.a. seems to be to hide the truth in order to look good. that has got to change once and for all, and i want to know how you are going to get your medical directors and network leaders to tell you whether it is through this survey or in the future when they have a problem and we will work with you to address it, rather than pursuing these secret lists and playing games with the sweet times. senator, if there is anything that gets me angrier than just hearing allegations is to hear you tell me that we have folks

that cannot be truthful because they think the system does not allow it. trust is an important aspect of everything we do here, and has been in my previous life as well. in order to do that, we have to be transparent and we have to hold people accountable. say to you is we are going to get into this, and it is important for me to assure veterans, to regain their trust, whatever has been compromised here, that when they come to v.a. they come to a good, safe, caring system and that they will be care for. and for all the employees that are listening in today, i expect our employees to provide the highest quality care, safest care we can provide, given all the comments about how tough it iis in the health care industry and provide access to

benefits as quickly as we can. that is our mission. we only have one mission, to take care of these veterans, and not these veterans. i am one of them. employees at the v.a. our veterans. we have a vested interest here to get this right. absolutely critical. this review will not work if the people who are telling you the information do not tell you the truth. >> i agree. >> thank you, senator murray. senator isaacson? >> for both of you gentlemen, do you remember or do you know william --? >> i do. >> do you? >> i do. april 20 6, 2010, he said a memo to all the directors entitled inappropriate scheduling practices. has come two begins it to my attention that to improve scores on axis measures,

sometimes referred to as gaming strategies. paragraph three, and this is the key of the question, and the key of the issue, for your liststance attached is a this practices identified by a working group chartered with the system redesign office. be cautioned that since 2008 additional modified gaming strategies may have emerged, so do not consider this list a full disruption of all current possibilities or other inappropriate scheduling practices that need to be addressed. these practices will not be tolerated. are you familiar with that memorandum? >> i was not -- i am not. >> i am familiar with that memorandum, yes. >> if it is not going to be tolerated, and for over four years ago, you had eight pages of known practices for gaming the sm,