continues with the assistant defense secretary for international security affairs. " live everyjournal day at 7:00 a.m. eastern. you >> if you go back and you look at coolidge, he was a concerted of hero. his tax was a gold standard tax rate. 25% was what he got. -- foughtke crazy like crazy. that was an epic battle. you look at what they said about coolidge and how cold he was. they were probably also from families that endorsed a different policies. some of them had a different model. coolidge was seen as pretty and

cold and not giving out favors. he was from new england. did not talk a lot. waved his arms a lot. temperamental, a temperament. he was a shy person. it also was a political or biscuit if he did not talk a lot, people would stop talking. a president or political leader is constantly up aborted with a request. his silence was his way of not giving in to special interest. shlaes on taxes, depression a presidents on "in tv.h" on c-span 2's book , last night's hearing

before the house veterans affairs committee looking into problems with veterans health care in phoenix. this is four hours. >> i want to welcome everyone to our hearing.

tonight we are going to discuss va's continued lack of compliance with the subpoena for documents that this committee issued on may 8. unanimous consent that the representative jackson be allowed to join as. she said she would be late. i would like to ask for unanimous consent. hearing no objections -- that va office inspected -- issued a report that confirmed appointments scheduling and it --ation to substantiated that confirmed appointments had scheduling manipulation. also indicated it has expanded its investigation and

its open cases regarding 42 va medical centers. they found inappropriate scheduling actresses are systemic throughout the va. their interim findings make it all the more urgent for va to come clean and fully compliant with our subpoena. that involved in. i will not stand for a department cover of. -- cover-up. it is absolutely essential to receive the documents that we have requested from the department of veterans affairs. the scope of the may 8 subpoena -- wasy narrow and will sufficiently tailored to provide reasonable time to produce the documents in full. it simply demanded production by may 19 that all written correspondence sent and received by certain va officials between

regarding all 8 of the disappeared or altered waiting lists. my staff was told the committee would only receive a partial response on the original due date and that va would produce additional comments on a rolling basis thereafter. if this committee were to access the va unilateral rewriting of subpoena terms, it were -- would perpetuate va's belief that selective compliance with committee request is acceptable and would allow va to continue its perceived mission to prevent this committee from doing its job. last night, we received from them what they purport to be the last of the three sets of documents that they are going to produce for this committee. that va has claimed that they have search 27 different record

custodians and they have produced over 5500 pages of documents. , given their pattern of stonewalling committee requests, i'm not at all convinced that they have conducted a thorough and comprehensive search for responsive records. i know va is withholding documents related to at least three for a living communications by claiming attorney-client privilege. however, va bill to produce the privilege demanded by the subpoena or provide any explanation whatsoever which is necessary for us to consider whether we will accept the assertion of the privilege. this committee deserves a complete explanation of the interim destruction at phoenix and for its general failure to respond to ongoing request elated to delays in care.

several toi invited explain va's incomplete record production to the committee. they did not come. dr. lynch was in phoenix. on may 22, we prepared three additional subpoenas. we compel them to appear before us. yet they again the client to attend this evening's hearing. expect va to be forthcoming, but it takes repeated request and threat of compulsion to get va to bring their people here. i look forward to hearing what he had to say. membernize the ranking in any statement he would like to make and then we will proceed with questions.

thank you. we find ourselves in a very difficult position. there's a push of materials that came overnight. those materials and the release of interim report today does not provide answers we saw, but rather raise additional .estaurants i share your frustration and passion for getting to the bottom of this issue. we have been bipartisan on so many things within this committee. i'm hopeful we can continue that even as the situation gets increasingly difficult and emotionally charged. i'm not completely satisfied with the va's response to our

inquiries and the compliance with the subpoena. daysfeel over the past few there has been a shift over increasing responsiveness and trying to work harder to satisfy our requirement. the key take away for me tonight costbe hearing the va the -- request. clear -- i am not happy. not fully satisfied with the responses we have seen. we do expect answers. we will get to the bottom of this and uncover the truth and ensure a solution is implemented and it never allow something like this to happen again. andxpect accountability full accountability for every individual for every

who would cause such harm. i would shortly urge the ig to diligently and swiftly provide a soprehensive, final report we can take action and hold people accountable. we all share the same goal of ensuring that our veterans receive the highest quality care and treatment possible. they deserve nothing less. i believe that we rise above politics and emotion and act pragmatically to chew the best outcome for our veterans. you must take our sponsor build he seriously and one that will yield results. i look forward to an opportunity to get some stuff to did answers from the va this evening. i yield back. >> thank you. prior to beginning the questions, i would like to ask for unanimous consent that the

ranking member and myself be allowed to have 15 minutes each for questioning followed by five members and if necessary, we will have a second round of questioning as well. hearing the objections, so ordered. half,nch, mr. mooney, mr. thank you for attending. if you would, please stand and raise your right hand. do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth, nothing but the truth so help you god? thank you. please be seated. office of the va

inspector general issued a report identifying multiple lists other than the electronic waiting list in multiple scheduling practices that is not in compliance with policy. did you identify the same issues during your review or did you just merely take the word of those in charge that everything was fine? if you could turn the mic on please. made three visits to phoenix to date. after which i reviewed my findings with committee staffers. it was an initial visit. we had little information to go on at the time.

we thought we had identified an intermediate work product that identify veteran appointments that had been counseled for the purpose of rescheduling those veterans. it was my impression that it had been destroyed when the purpose was over. i also made it clear to the committee staffers that this was a process that we were going to continue our review. i returned about a week and a half later with two additional .taff and a scheduling effort we are trying to understand the process of scheduling that had

late 2012.on since i will be happy to outline that process for you beginning in november of -- beginning in october of 2012. it had been scheduled more than three months in the future and they identified more appropriate slots to see them sooner. >> i apologize. we will be able to have long-winded comments. you said you told the staff that it was your impression and that the list was destroyed. is that what you are saying today? >> that is what i in saying. >> you were in the room at the time. did mr. lynch say it was his impression that the list was destroyed? you are under oath. >> i believe that is what he

said. >> you believe or you know? >> i believe that is what he said from my memory. >> you didn't take any notes? >> i took notes. i don't have those in front of me today. >> let me ask you a question -- if you took notes at that meeting, why haven't those notes been provided to this committee as part of the subpoena for all records talking about the destruction of the list, including notes, phone calls, and memos? >> i turn over all of my documents to the general counsel. >> does anybody at the table know why those notes have not and delivered? your mic is not on. is a legalthis issue, my understanding is that

documents,t of the they began responding to the subpoena and dedicating significant sources to that effort. melet me interrupt -- excuse . let me interrupt you and redo the definition in the subpoena. the term document means any written record or graphic matter of any nature whatsoever ,egardless of how recorded whether classified or unclassified, whether original or a copy, including, but not limited to the following memorandum, construction, working papers, records, notes, letters, notices, ella grabs, in other words, -- telegrams, in other words, everything. why have we not received all of the documents in question in the

subpoena even though we got a letter from the general counsel late last night that said the v.a. was done? i understand the general counsel has held a small number of documents for attorney client privilege. there is an ongoing discussion related to those documents. >> are the records from a briefing part of the protected notes that the general counsel is claiming attorney-client religion about. --i would differ attorney-client privilege about? >> i would defer you to them. complied with the terms of the subpoena? >> it is my understanding that va has provided the committee with relevant information. >> can you say anything without reading your prepared notes? counsel would be

the appropriate party to ask. >> and we did asked the office of general counsel to come and brief members last week. they declined. he said he declined because he didn't want to brief members. he wanted to brief the staff. it's is not a single person sitting here in this room that voted for the subpoena. the members did. until va understands that we are deadly serious, you can expect us to be over your shoulder every single day. while i have your attention, can you please explain to me why we in fact have 110 outstanding requests for information, some dealing with this issue specifically? why have you not told this committee yet who was augusta, georgia,

and kalinga, south carolina were nine veterans died because they were on a waiting list for colonoscopies? , the office -- >> ma'am. died.-- veterans get us the answers, please. >> i understand that. i will look -- >> that is what you said three months ago good this has been going on since january. since january. in case you don't know it, we put on our website every week what we asked for. nothing changes from week to week. we have an oversight responsibility in this congress. we cannot do our job

appropriately if you do not provide us information that we request. there was a "misunderstanding" in the first brief. they issued substantiated, inappropriate scheduling. they said it was systemic throughout. do you believe you have that credibility now necessary to identify and fix the problems? i used the term "misunderstanding" with perfect -- respect to the references made to a secret list. i did not make any qualifications are statements as to whether i thought the actions occurring were appropriate. >> it is your contention there was no secret list? >> very or were a number of

documents. three were identified by the ig today. one of which we identified earlier. working documents used to provide information about patients or addition -- for the rescheduling of patients. i did not inc. they were secret list. i think they easily could have been misunderstood as being secret list. we discussed this last week as well. dr. lunch came back from phoenix and asked to brief the four corners in which a matter of hours we were able to have the four corners come together at the staff and in that, you said -- what gave you the impression that the list had been destroyed. had been conveyed to me secondhand by one of the members to have been with us on the

first visit that the center was using a document to record the names of veterans who had been counseled. appointments had been counseled -- canceled so they could be rescheduled. veterans had been rescheduled and the list was no longer required. it was destroyed. it did contain patient identifiable information. the staff is tell me it was described as a transitional document as they were transitioning from paper over to the electronic waiting list. was a list of stored before after the committee requested a person mission order for all documents. >> it was my impression that those lists were destroyed before your presentation order. i was trying to explain before you asked me to be briefed that

this was occurring between october and november of nt 12. at the time -- november of 2012. we learned during the course of the second visit that the transfer and the use of this document were occurring during the course of rescheduling patients because they were trying to provide care more probably because they were trying to consolidate the profiles to make it clinic management more efficient. it automatically generates a list of patients who were counseled so that it could be used to be scheduled patients. once the rescheduling has occurred on the list is no longer necessary.

it is my understanding this .ccurred >> why do we not know that when we first asked about it? >> because i had only come back from the first visit. it wasn't until we spent a week there working through the entire process that we understood exactly what had been going on. letterve written a asking for that specific information good has it been responded to? it was never responded to, hence the subpoena. we are trying to get answers. no one is giving they answers to us. that is why we are here tonight. let me be real quick before time runs out. received.to an e-mail an employee in los angeles

reported up the chain of command that wait times in the los angeles va medical center was being manipulated. the response was that employee was simply a disgruntled employee. in a related e-mail, a senior official substantiated that there appears to be inappropriate actions by the supervisor in los angeles. would you comment for the committees the half on what is going on in los angeles. amthe only concerns that i aware of related to los angeles were concerns expressed by an employee regarding the cancellation of radiology orders which were felt to be's ale and no longer appropriate. understanding based on discussions with the chief of staff as well as the chief of radiology that this is done after a careful review and that

a were notified at the time of cancellation in case they needed to reschedule the appointment our request. >> so every single veteran was contacted. you had one of their orders canceled. >> that is what i was told. >> let me give you a little hint. truth. not tell you the you are relying solely on the management of these facilities to tell you the truth, you will not get it. you will not get it. the complaint is not in radiology. it is exactly what we are seeing all over the country. i would suspect that you better have someone go to los angeles quickly before they start destroying secret lists.

>> if you share the documentation with me, i would be happy to follow up. you know my equipment -- you know my commitment. >> thank you very much. dr. lynch, but date did you first become aware that there were allegations of problems in phoenix? >> april 9, 2014. what date did you travel to phoenix to investigate? >> i made the first visit to phoenix i believe on april 17. it was a thursday before easter.

i was there through easter until tuesday of the following week. that -- what was the date you returned back to d.c.? >> april 23. i believe i came down to discuss the initial findings for the committee staff. >> under whose direction did you fly to phoenix? >> a doctor had asked me to go to phoenix. you travel to phoenix with? >> myself. my wife joined me for the weekend. can you please explain your role in the initial investigation in phoenix as well as the role for individuals that you are with? my initial role in phoenix

was to try to get an understanding of what had happened and to get a sense for how the congressional delegation as well as the veteran services re viewingon we validations. i brought with me to individuals. one was a doctor and another a toeduling expert itself identify what they had about deaths that had occurred at the facility and what review process they had put in to look at those deaths. we for the put in place a process to match those deaths against potential delays in care whether theyee

were related. withu said that you talked -- go down withs did me, along with the scheduler. they spent their time talking with folks in the scheduling office and with providers to get an understanding of their management model. >> i thought you answered my question of who you traveled to phoenix. >> i'm sorry. i flew by myself. they join me there. >> when did you first become aware that the phoenix facility had used an xl spreadsheet in regards to patient scheduling? >> dr. davies had indicated to me that he had heard that had been use of an excel spreadsheet to transfer information about canceled patience to allow

rescheduling of those patients. i'll say subsequently we found that it was found to be incorrect when we went back a second week at work or the process more completely. >> and what date was that on? >> the second visit occurred on the week of may 5-9. 5 andved on monday, may left on saturday, may 10. >> and during what time was the spreadsheet used? >> i no longer think it was a spreadsheet. we now believe it was an generatedte product of when you cancel it nation, it generates a document that says these are the patients that you canceled. it provides information about their social security number, the date of their appointment, and the time of their ointment

so you could use the information to be scheduled the patient. >> the date that mr. davies .nformed you of i guess -- you know, a spreadsheet. >> this is a process. we were learning. we wanted to be sure we understood the process. i believe he informed me that or 22nd.ril 21 stafformed the committee that the spreadsheet was destroyed at some point. when was it destroyed and who authorized it? >> my understanding was that it was destroyed when the patient had been rescheduled. it would have probably been in late 2012 through mid-2013.

>> it is my understanding that a paper weight list may constitute a number of items including spreadsheets, word documents, podost-it notes -- notes. were you aware of any other items that might be used in phoenix? >> during the course of our second week there, we did identify the additional documents. they were also referenced by the inspector general's report today. they were the request to schedule and consult that was generated from the emergency department. schedule that a was generated from the va phoenix help line impatiens

called in asking for an appointment. >> who authorized the destruction of the list? >> i'm not sure who authorized the destruction. i think it was felt once the purpose of the list of the document had been completed, the patients and treat had been added onto the electronic weight list or the patient had been scheduled and that it was appropriate to destroy the document because it contained patient identifiable information and could potentially have adverse consequences if it was not destroyed. >> is a common policy that it be destroyed? >> to my understanding, it is a federal mandate that we cannot personals of identifiable information once they have served their useful purpose. >> if you identify other items that are used as a paper weight

list, what were they and when were they used? only three documents that i have identified was the intermediate work products electronicy the va health record, the names, social security numbers of patients whose appointments were counseled -- canceled. is to mylist that knowledge and electronic document that is generated by va in response to the request for appointment. used tore documents store request from the emergency department and the documents used to transfer information about patients requesting appointments when they called going back to when you first became aware of the problems with phoenix, can to detail what steps

investigate and respond to these allegations? >> the steps included the following -- number one, i was asked to go back so we could develop an understanding of what scheduling processes where going on. at the same time during the week of the fifth, a second team arrived from va central office. their focus was to take the information that we had gathered and develop recommendations and provide those to the facilities to improve their efficiency. the week after i left, there was a second team that arrived here you they were working with the clinic to look at their processes and ensure that the clinic was functioning in an efficient fashion so we were not missing valuable resources that could be used to provide care to veterans. >> who was part of the second team? >> congressman, i do not recall

at this time. >> who was initially in charge of the va's response? methe va response was led by while i was in phoenix. and by another who was adding together the supporting documentation in washington that the teams were using to improve the processes in place. >> is working groups were formed to address the allegations in phoenix, under whose authority where they formed and on what date? cannot tell you under whose authority they were formed. come intos began to play probably late in the first week of may. we began to develop a way forward.

>> what was your initial assignment when you were first asked to go to phoenix? >> my initial assignment was to go down and understand what was going on and understand the climate that was present within the organization. also to try to identify what information they did have about that been my -- deaths might have occurred in their facility. >> are you surprised with the interim report released? i shared the. information that we found. it does not surprise me with the reported. we have shared that information with the ig. >> nothing in there was a surprise? had not looked at

the numbers of patients who were on this list. that was a surprise. havething else we identified during the course of our visit. >> thank you. in looking at the document the va has produced in response to the committee subpoena, are you aware that the response includes any documents or e-mails dated prior to april 24, 2014? respondingoena was to whether there was illegal action. i would not have knowledge of that. >> ok. can you explain the difficulties that you face answering the questions posed by the committee weeks ago? of "weeks in terms

ago" with regard to -- >> when was the spreadsheet that was mentioned by dr. lynch destroyed? >> dr. lynch didn't provide a response to the committee may 1 letter regarding his statement. the office of inspector general's investigation was ongoing, as well as his own investigation was ongoing. at the time, misunderstanding is there were no facts upon which to respond to the committee's request in the letter. my understanding is he stuck to the facts in the letter. when this unique to the va you talk about the attorneys? are these difficulties common among all agencies? or is this just va for the -- just the va? >> i'm not sure.

>> the concern i have is the committee asked a very basic question. very narrow questions that wouldn't interfere with the inspector general's report. we thought it was something we should be able to get without any problem. there seems to be an ongoing delay in getting information to the committee. certainwe ask for information, the standard response is pecan cap that because -- is we cannot get that because of legal counsel. bet appears to unresponsiveness from the department were very basic questions that we originally asked for be issued the subpoena. ,> in the case of the subpoena we have a number of staff in the office of general counsel. i know that they worked weeks to provide the documents in response on a rolling asus.

basis. >> why didn't you tell us about the ig investigation? instead of you ignoring us? why did you not tell us? notefore, you could respond. i believe my right -- -- i'm notn is we sure. >> thank you. >> he was in arizona at the same time we were there. we did talk with them to ensure we were not in their way. yes. >> yes. >> thank you. before you question what is, i must call for the resignation of secretary shinseki.

i was waiting for permission to be gathered to make my judgment. based on the inspector general report that came out today, our veterans in phoenix and maybe other cities have not been treated fairly. this report states "our review and a growing number of va medical facilities has confirmed inappropriate scheduling actresses are systemic -- practices are systemic throughout va." the tragic possibility of veterans who died while on the waiting list have died because of the waiting list is still open. it will hopefully answer this in their final report. even if they do not know in advance of these wrong doings, these violation should not have happened on his watch. i believe success in the military does not automatically

translate to success in the policy and political realms. you have a concrete example of the failure of iraq proceed and a failure of leadership. --ding hasn't been an issue you have a concrete example of failure of policies a failure of leadership. funding hasn't been an issue. it was a failure. -- these veterans be on waiting lists. they should be seen immediately. many veterans are on a secret waiting list in phoenix with the average wait time of four months for a visit. we know a similar story is emerging elsewhere. i are thousands of veterans ofting -- why are thousands veterans waiting months when there's a system in place to treat these men and women in the private sector?

if care is not available at the va, they can go to any private hospital or clinic and get immediate care. why is that not being done? >> congressman, that is being done. there are plans in place to contact every one of those veterans by a close of business on friday. their need for care will be assessed and they will be offered services if appropriate. across vha, there's also a process in place that began approximately a week or so ago. each ofcess is asking the facilities to look at their weight list to identify those patients who are waiting for care and to contact those veterans and to offer them services if that is what they request. >> i'm glad you did not say that you are waiting for more money from congress.

the money has been given to you. the money is there that money has carried over each of the last five years. $1.1 billion. even this year, we anticipate half $1 billion being carried over. money is not an issue. >> care is an issue. you need to assure if they had been waiting, we identify them and we provide care in the community if necessary. type ofld view the disaster relief that veterans are entitled to and the money is there. i recently spoke with the directors of va health care facilities in colorado and asked them about whether there are waiting list in colorado. they assured me it wasn't to their knowledge. when the information comes out, a report like this that there are

systemic problems throughout the country, we have problems getting the documents that we want. trust has eroded. what can we say to veterans to restore that trust? i think we have a real problem with broken trust. >> we are here this evening in bestfaith to answer the course of action. we pledge to work with you to get you what you need. >> thank you. i yield back. >> thank you. >> think you, mr. chairman. i have been on this committee for 22 years. before i begin, i am going to put on the record a letter that i am sending to the governor of the state of florida. standing and

indicating that he is suing the that he isfact sending people to the various va facilities around the state of florida and he wants to take a look at the record. grandstanding i have seen since i have been in congress. absolutelyave nothing to do with the va. we have over 4 million people oft need medical expansion health care. they are not getting the quality health care that they need. anything about the lawsuit and whether or not governor rick scott has sent people to the various va facilities throughout florida? i'm certain it has never

happened in the history of the united states of america. brown, isswoman haven't heard of anything like instances. these i would be happy to take your request to the general counsel and intergovernmental -- endure -- partners. >> speaking of partners, i personally went to california. i reported to this committee that we had 400 units that we have built that were standing still for two years and no veterans were in these brand-new facilities. angeles. in los we're not talking about problems that just started at va.

it has been problems for years. clear -- veterans were given the runaround from the va system. there were millions additional veterans brought in. he have a responsibility to make sure that they are taking care of. i can tell you we are doing fine in florida. in orlandoew bill soon, i hope. i have been working on it. we have a wrapper around in gainesville. we have new cemeteries in florida. veteransalmost 600,000 a year in florida.

went and i say i talked to various groups and not one single complaint. we are doing our job. that is what this committee is supposed to do. make sure that the va is doing what we commit to veterans. let's forget the grandstanding. i see a lot of it. we do have money for the veterans. for years, it was just talk. it was just talk. -- when wepresident have a democratic house and senate, we got the largest va increase in the budget in the history of the united states. we do have the money. we have got to know we're not just talking the talk, but walking the walk.

is there any additional information that you want to give me about the overall problems with the va around the country? i know florida is not included. congresswoman. i want to make sure that i choose my words carefully. i have thought about this for a long time. let me begin by saying that i think it is absolutely critical that the va maintains its focus on its mission to serve veterans and its core business to provide for primary health care for our veterans. it is important to the member that we have a good system. i think it is worth stating. the quantity of hair care -- health care -- we provided health care to over 2 million new veterans.

our performance measures however have become our goals. numbers,e our access but we undermined the integrity of our data. we were told that the scheduling system was challenged, but discounted the reports and patient concerns as exceptions and not the rule. we could and should have challenged those assumptions. this was an insidious process. it is not apparent will happening. i think having said that, there is a way forward. we must charge our medical center directors and network erectors to assess the integrity of organizations -- network directors to assess the integrity of organizations. we can assign resources appropriately. we will also need to ensure a

relationship with congress. this will be essential. in thefaced criticism past and is better for it. in the 1940's, omar bradley and others remodeled the be a system and involved academic artist and established a research presence. in the mid-80's, there was questions about the quality of surgical care. they developed a risk adjusted care model that has been adopted by the care sector and is being used to assess mortality across the country here in the mid-90's, or were concerns about va care and emphasize outpatient care and began to implement the use of electronic health records has been used by health care across this country. we have a good health care system. we have a good foundation. he have challenges.

i recognize that. working together, we can solve those problems and once again provide evidence of an excellent health care for our veterans. >> thank you for the additional time. >> thank you. could you give me the documents and i'll ask for anonymous content it be entered into the record? askedt objection, i also for consent for another to be joining. without objection. >> thank you. i appreciate it. thank you for your strong leadership in this area. i will jump right into the questioning in the interest of time instead of making a statement. in the correspondence sent to it was confirmed that the interim way to list was maintained and destroyed, which

are told the house and senate in april 2014. is that correct? >> that is my understanding. >> how and when did you become aware? >> i first became aware of the reference -- i would correct the concept that this was an interim way to list. this was a work product generated by the vista itself,ng system that that it was not a waitlist, but a work product. >> what about the retention recordsegarding patient ? do you know the current policy? >> i do not have the policy

available. disposal authority is obtained from the archive states.the united the next question for the entire panel -- what was the reason for the destruction of said documents? i would like to hear from the panel. >> i will start. >> it is my understanding that there were intermediate work products. when their usefulness had been served, it it was appropriate to dispose of it. >> yes. ini have not been involved that investigation, nor was i present at the staff briefing. i defer to dr. lynch.

>> doctor? the records of patient incellation are preserved the overall record system. this was used as a process to ensure they knew who canceled so they could get rescheduled. >> were were these documents destroyed? and mayime in late 2012 2013. >> did anyone from the va or some --rty conduct >> i don't have knowledge of that. >> how long was interim list in existence?

>> are you aware of any documents currently in use? just like this "interim list"? >> to my knowledge, there were to transfers used request for care from the emergency department, as well as request from the va. i believe there was reference within the ig report should i believe that the ig also referenced information into the electronic waitlist. is is within the va possible for the management and maintenance of va policies for record retention? is anyone on the panel know? >> i do not know. we will have to take that for the record. >> anyone else know? can you please get back to me.

do you believe whoever it might be, he or she, or be held accountable and penalized under va controlling who can answer that question for me? >> congressman -- >> anyone else on the panel? >> thank you very much, plch. chairman. e it mr. i yield back. >> thank you, mr. chairman. you know, the v. sambings a huge and complex organization of many, many facilities. under h a bureaucracy is siege, people often run for cover. post l an incident in

apartheid south africa when they were looking for accountability, there was something called the truth commission to encourage people to tell the truth. i was reminded of this by this "new york times" op ed piece by dr. sam foot, the retired v.a. physician who blew the whistle in the medical center and he suggested an alternative to the secretary's approach to the internal audits. he was skeptical that they were doing with to work and produce good data. he believes that the government accountability office should conduct a survey of care providers and other health professionals at vambings a. hospitals to find out what they think the new and returning waiting patient times are and then give the hospital administrators a one-week amnesty period to record report their waiting times.

such an agencies is under i think we welcome help from any government agency in informing problems and helping us come to solution. whether that's the best option, i don't know. but we have certainly valued the reports from the g.a.o. and the .i.g. in the past. >> could you comment? >> thank you. we value collaboration and working to provide our veterans

the best care. >> i work hard every day to do my job and provide the information that the committee needs. >> i took note of this mainly because it was the whistle lower helms who suggested -- himself that suggested we try another approach in terms of trying to get accurate information from the -- v.a. employees. is congress going to get a list of the scheduling practices similar to those at the phoenix v.a. hospital? i for one would like to know if the hospital that serves my area is using the same practices? >> i believe v. sambings conducting a nationwide audit. i don't believe there is any intention not to share that with congress when it is completed.

>> i appreciate that. again, this audit is the very issue that i am sort of raising about how do we get a good audit? that concludes my question. yield back. >> dr. row you are recognized. > i am a veteran and physician and i trained at a va, some of my training was at a va. it is disturbing to me that we have created this uncertainty among our veterans in the country. i think we have lost a lot of trust and i want to ask do you agree with the interim report that the i.g. just produced that we have today? do you agree with the findings? >> i do. >> and we have a situation where you say 1,700 veterans are going

to get care. why in the world do we have to have hearing after hearing after hearing. we are here on a wednesday night about 1700 veterans. why wasn't this just done? let me just read this to you right here. the length of time these 1,700 veterans wait for appointments are added to the electronic weight list will never be captured in any wait time data because the staff had not yet scheduled their appointment or added them to the electronic waiting list. it is the ultimate catch 22. let me also ask you, here are people out here. this is what troubles me most. look. i get being overworked, having more work than you can do and patients than you can take care of. i have got that. i understand that completely. what i do not understand is creating a list right here that has people waiting until they can get on another list to show they can get an appointment and

then someone gets a bonus, benefits when veterans are suffering. is that what happened? i think it is. >> as i mentioned earlier -- >> is that what happened? >> i think we elevated a performance measure to a goal. i think people lost sight of the real goal of v.a., which is treating veterans. they goon focus on achieving a 14-day -- achieving care within 14 days. >> i agree with you. would you say those particular goals right there that the v.a. set up and obviously you had people playing games with it, hurt veterans. >> congressman, they were flawed measures and it should not have happened. >> it should not have happened. do you think it is happening around the country in other va centers? >> i think the evidence

suggested this could be a systemic process. we need to focus and we need to get the veterans seen in timely fashion. >> what i don't understand as a veteran and a doctor and a practitioner, how you can look at yourself in the mirror and not throw up knowing you have people out there. i can't go to v.a.. i make too much money. i'm ok with that. i have good insurance. i see some of these people out there. they live in my communities. they can't get in and they are desperate to get in and someone who is making $180,000 a year gets a bonus for not taking care of the veterans. i don't get that. >> congressman, what has appened is unacceptable. but i have to go beyond that because i have to figure out how to fix the system and that is my goal and purpose.

to understand the problem and ensure it doesn't happen again. >> i certainly dr. lynch, thank you for that. the next question i have is to to the panel. it is not necessarily you i'm directing it at. why would any information we ask for be withheld? that chris an uncertainty among us here. if you don't give us the information, i'm thinking there is something they are trying to hide. why don't you just turn over the documents? they are what they are. just tell the truth. is there a reason? i can't understand why there wouldn't be one thing they ask for that they don't have right in front of them right now in my mind i'm thinking right now they are hiding something from me and i have no reason to believe you're not. >> congressman, our goal is to be open and transparent. >> the documents are not coming in. excuse me, respectfully. if that were the goal, the

chairman would have all the documents he asked for. >> respectfully, sir, the office of general council responded to the subpoena in accordance with the subpoena document. and we continue to work with staff on the few documents under iscussion as well. >> my time is expired. maybe we can get a second round. >> thank you, mr. chairman. i would appreciate all of you being here to answer the committee's questions this evening. mr. chairman, i share your frustration. i'm very troubled by the slow pace of the v.a.'s response to this crisis. what has and in phoenix and what clearly is happening at the other facilities across this country is in my opinion unforgivable. we need decisive action now. well-stated and good intentions

just won't pass the muster. as the ranking member stated in his opening remarks, we must have accountability wherever it leads us. i sincerely believe that everyone in this room wants to ensure that our veterans receive the best possible care in a timely manner. but we will only achieve that goal when we have honest and open lines of communication from the v.a.. our veterans deserve nothing less. and from the top down and the bottom up, the v.a. needs to level with this committee. needs to level with our veterans across the country and needs to level with the american people about what has happened and how we are doing with to fixette. hiding the truth is absolutely unforgivable. and the damages are compounded when we don't act quickly and decisively to all of the facts so we can then act upon them.

we need the truth and need v.a. to be proactive, not reactive, and we need the truth now. i just wanted to make that statement. i will ask my first question to dr. lynch. the chairman asked a question about the greater west los angeles facility and you answered some of his questions. i wanted to follow up on that. given the fact that we are going to have a nationwide audit, i want to know the progress of those audits as -- particularly as it relates to the west l.a. i want to d i'm also know the steps that were taken in phoenix with regards to destroying the work product, destroying the documents after patients were inputted into the electronic system. is that still occurring?

is that still a practice that is occurring in -- i know not in phoenix, but in other locations across the country and how are we actually handling, you know, patients right now? who are waiting to be seen. talked about the 1,700 veterans phoenix, but what about veterans across the country who are waiting -- waiting for ppointments as well? >> congresswoman, let me try to take your questions in order. the audit that has been going on by v.h.a. across our system began a week ago. the first phase was focused on medical centers and community-based outpatient clinics serving greater than 10,000 patients. it is my understanding that the review at greater los angeles has already occurred.

i have not seen those results yet. the secretary's insistence, that review has been extended to all v.a. care facilities. i believe that second phase has been in place last week and this week. regarding other veterans across v.h.a. a process has been in place. medical centers, all medical centers have been asked to have patients who have been placed on a wait list, patients who are waiting for care, they are charged to submit that list to v.a. and they are then going to be asked to review their resources. can we provide care internally? if we can't, the plan is to contact those veterans, offer them care, if we can in v.a., if we can't, offer them care outside of v.a.. >> houk do you they -- how long

do you think that is going to take? >> i don't know the time. i can't tell you exactly how long it is going to take but the plan is it should be done quickly. we appreciate your concern that we should not have veterans waiting. >> how much time are you going to spend assessing the situation before we would the other parts of the -- >> i believe the plan is it should be completed in a week or less. so we can begin assessing our resources and contacting veterans. >> ok. thank you. the other question i had and maybe this is for the assistant secretary -- i apologize. i yield back. hopefully i'll have another chance. >> mr. flores you're recognized. >> thank you, chairman. and thank you, panel. when the v.a.o.i.g. went to phoenix to look at what was

actually happening there, they did what auditors do, they took a statistical sample of files to see what was reported and what was actual. the sample set was 226 veterans in this particular case. the original report from the phoenix v.a. facility was that these 226 veterans waited an average of 24 days for their first primary care appointment and only 43% waited more than 14 days. when the i.g. did their study of what actually happened on those cases they discovered they waited an average of 115 days with 84% waiting more than 15 days. based on what they found in that sample, you have to extrapolate that and assume that all of the

appointment process is as broken as those 226 are. who is responsible for reporting fraudulent numbers to the v.a. central office? when you look at a v.h.a. facility, who in that facility is responsible for reporting those numbers up the chain so to speak? >> mr. congressman, i believe the responsibility for reports from the facility lie with the medical center director and with the network director. >> ok. i think you touched on this a minute ago. what is the driver that causes them to engage in that activity? one thing i learned from today based on another article that came out is that 50% of v.h.a. executive performance reviews are based upon wait times. is that one of the primary

drivers that is causing this misbehavior to occur? >> mr. chairman, i don't know to what percent for the medical center directors -- the wait times measures contributed to their bonus. i don't have that information. i will reinforce what i said earlier. i think that while well intended we had a performance measure that became a goal and that created the potential that that information could be misused. >> the last time i saw an example of this was enron. where the bonus system drove behavior and we all know what happened at enron. i'm not suggesting that the v.a. is enron, but it is something that i think we need to look at this terms of flawed bonus system and driving bad behavior. that leads us to the next question. we just said -- we just heard testimony so far in this hearing

that veterans really don't have to wait because there is a fee for service program where the v.a. will send them out to private sector doctors. if that is the case, the v.a. can do this, why then do we still have the long waiting list? is that because they are not really allowed to go out for a fee for service? >> i think that we had tried prior to the information that we had received, we had felt that our core business was the delivery of primary care. we had tried to keep that one v.a. in retrospect, i think that was not a wise move. i think we did have the potential that patients were waiting and we should have provided fee-based services while we were trying to improve the processes so that we could provide that care in house. ok. there is a publication that i don't read very often called "the daily beast." they had a report that ran about

11:00 last night. it said texas v.a. ran like a crime syndicate. president obama planned to address allegations of corruptions but before the president could deliver on his pledge, the scandal spread even further. new whistle blower testimony implicates the hospital in intersection widespread wrongdoing in what appears to be systemic fraud. the facility they are talking about here is a facility in temple, texas. are you aware of any similar issues that occurred in phoenix as having occurred in temple? >> i'm not aware at this time. >> ok. i would urge you to read this particular offer. they post pictures of the email chains that make it look like there was a cover-up. one doctor would cancel appointments and they would have to be rescheduled. thank you. i yield back.

>> ms. titus. you're recognized for five minutes. >> thank you for holding this meeting late to accommodate us who had to fly back from the west coast. we appreciate that. like my colleagues, i too want to get to the bottom of this waiting list problem in phoenix and across the country and many of my questions have been answered. the i.g. is not going to release, as i understand it, the names of the other facilities that are being investigated primarily to protect the whistle blowers. i've asked that nevada be added to that list because i want to be sure that the veterans there are getting the kind of services they deserve and there are not any secret waiting lists. i want to ask kind of a different line of questions because i think they go to the point of priorities. and i think priorities are kind of some of the problem that we are facing here as we look at the waiting list issue. dr. lynch, you mentioned that you went to, phoenix to check into the acquisitions that 40

and that was the -- accusations that 40, that people had died as a result of this secret waiting list. you went on to note that you went on thursday, april 17. you spent the easter weekend there with your wife and then you were joined by two staffers on monday april 20 to begin working on the issue and then in your words, understanding the climate. i would just ask you, doctor, to tell me how you could have possibly thought it was appropriate to turn such a capitol hill critical, serious mission into a personal holiday? don't you just get that? that you postponing looking into something that should have been looked into right away? and also tell me then, how i can explain your actions to veterans who are worried about getting an appointment for possibly a life colonoscopy, not a tee

time. >> congresswoman, i do not play golf, to begin with. i take my job seriously. it was easter weekend. i thought it was appropriate that my wife could join me. i spent thursday and friday working at the v.a. i spent monday and tuesday working at the v.a. there was nothing i could do over the weekend. i went back to get more information, congresswoman. think i took the issues in feaks very seriously. phoenix very seriously. i think what we found was shared and confirmed by the inspector general. i think because of what i did in phoenix, we were able to get people on the ground to begin the process of making recommendations for change. so i'm sorry you misinterpreted my intentions. my intentions are to help veterans to assure they get good care and understand where our system is failing. >> that is our intention too. we feel like we need to work 24

hours a day, seven days a week to make this happen. not taking holidays off. but i appreciate that and i yield back. >> thank you very much. you're recognized for five minutes. >> thank you, mr. chairman. mr. lynch, i just want to make sure this is clear. you believe phoenix is an isolated incident or you believe this entire problem is a systemic issue? >> i believe the inspector general has made it clear this is a systemic issue, congressman. >> this is something that goes back to 2005. we have had investigations over and over and asked for many different -- 18 reports have been identified coming back. you said in your testimony of october and november of 2012, there was a report that came back, we were working on this in 013. you talked about a glitch in the system. this doesn't seem to be a faulty

computer system that we're dealing with here. >> congressman, i think i made it clear that it is important that we need to keep our eye on what is the mission of v.a. i think that we have elevated performance measures to goals. i don't think that is a glitch. i think that is a mistake. and i think that is something that needs to be corrected. i think we need to use performance measures for what they should be used for. management tools to identify where we have demand. where we don't have capacity and how we're going the use our resources. >> sir, i don't think anything is clear at this point. that's why you see so much frustration. the only thing that is clear now is that there are 40 brave soldiers that served their country proudly that died while waiting on a list. that is the only thing that is clear. what is unclear is how much further this goes. how many other v.a. centers? how many other veterans are waiting? and we expect answers. that's all we're looking for

ere. so you started audits now, beyond phoenix. 42 audits have been started? >> i'm sorry, sir? >> 42 audits have been started now? >> no, sir. we have reviewed i believe all of our 150 medical centers and additionally, our major k box and now are in the process of reviewing all of our healthcare facilities. >> how many have been completed thus far? >> i don't have that number but certainly well over 200. your intent is not to share that with congress? >> i don't believe said that. >> well, let me ask you then. is it your intent to share it with congress? >> i don't know why we would not share it with congress. >> it is my understanding that palt palo alto in any area has already conducted their audit. i sent a letter on may 19 asking for not only an audit but a

review. now i'm told by the palo alto unit that it is -- it has been completed but we are unable to receive that information. i'll make sure you get a copy of this letter as well. every member of this committee and of congress is going to be looking at their local v.a. centers wanting to know the truth of what's happening in their communities. >> i'm sure they are. hat is proper and right. >> we have a nonv.a. fee care program. we have implemented a program which used community providers to provide care. >> i will share this with you in but i know of doctors my area that have asked to help

out our veteran population. there is no reason. there is money in the system. there is waiting lists. why we wouldn't be utilizing more doctors to fulfill those claims. >> and we are going to be doing hat. >> mr. chairman, i'll present one of these letters for the record and provide mr. lynch the other one pism yield back. >> without objection, mr. kirkpatrick, you're recognized. >> thank you. we all know there is a problem here and i appreciate you making it a priority to fix it and come up with solutions. m the only yeaan on this committee. i've been hearing from ots lots of veterans in arizona. i called for a stm-wide audit. i want this fixed in arizona so

that we can get the veterans the care that they want and they need in a timely way and that's what i'm hearing you say. i really think listening to our veterans is key to resolving this issue. so my first question is when you did your assessment at the phoenix v.a., did that include talking to the veterans who had experienced these delays? >> did not talk to any veterans during the course of that visit. i had subsequently received a phone call from one veteran who has had troubles with access and i am working with him to assure that gets the care needs. >> my i just suggest that we include our veterans maybe a little more in this process? i share somewhat the concern that he expressed about how do we know we're getting accurate information and i sometimes think getting it from a couple of sources helps with that process. i'm certainly hearing from a lot of -- >> i don't disagree with you. i think the veteran is our

customer. i think we can learn a lot by talking to the veteran in the experience they have. >> and what the record shows in term turnovers wait time. you have identified the 1,700 patients who'll be contacted by friday. can you tell us a little bit more what contact means? does that mean an email or phone call? what does contact mean by friday? >> we are going to be using the central business offers call center out of topeka, kansas. we will make an attempt to contact by telephone every veteran that is on that list. if we cannot contact them, we will be sending them a registered or certified letter to assure that we have gotten in touch with them. that we have determined what their care needs are and we have arranged for those care needs as necessary. >> you know, i respect a large rural district. a lot of places don't have

access to broadband and a lot of places don't have mail delivery. i'm concerned that the rural veterans that i'm hearing from are not going to be contacted in a timely way and maybe i can work with you about some suggestions. i i know the v.s.o.'s would like to be very involved in this process and sometimes they are the point of contact in these rural communities and offer that as a suggestion. >> thank you. at this point, we are open to any suggestions that improve our process and help us contact the veterans. >> now, my second question goes back to original purpose of this hearing. which was responding to our subpoena. so during your first visit to phoenix, which was april 17-23, did you receive or spend any interim work product that in any way referenced the destruction or deletion of an alternative patient wait list? >> to the best of my knowledge

come i don't believe -- congresswoman i don't believe i communicated any of that via email. i believe i communicated it to v.a. central office when i came back and i believe i communicated it to the committee staff the following day. >> ok. thank you. and i yield back, mr. chairman. >> thank you very much. mr. runyon, you're recognized for five minutes. >> thank you, mr. chairman. something i read in the o.i.g. report today touches on this credibility issue. and i want to ask you a couple of questions about it. and first, i'm going to paraphrase it. it's the last paragraph of page four. where it says certain auto controls within vista were not enabled. does limited v.h.a. and o.i.g. ability to determine whether or not any malicious manipulation of this data had occurred? to ensure proper oversight ability is not compromised. and the i.g. asked that it be turned back on. are they turned back on as of this day throughout the country?

>> i don't know, congressman. >> do you know what those switches were -- the controls would have been? >> i read the report at 12:30 and not familiar with the auto controls. i can assure you i will find out. i will understand them. they will be activated at the request of the i.g. >> following up on those questions, as part of your proprietary software do they have to be turned off or come out of the box in the on position? as someone asked to do that? >> i don't know. >> i would love to know that answer. >> those are questions we need to ask. i will extend it and will indicate that not only do we need to understand whether that was occurring in phoenix and whether it's been corrected. we need to understand whether that was occurring elsewhere in our system as well. >> it not only compromises our ability to do our oversight job but your internal ability to do your own thing. >> congressman, we are

attempting to put in place audit tools and if there's anything that makes those audit tools more effective, we are going to be assured -- we're going to assure that they are functioning. >> going back to mr. huff, your notes were given to the general counsel. they were not destroyed, correct? >> correct, congressman. >> thank you. >> mr. chairman, i yield back. >> thank you very much, mr. reese. >> you're recognized for five minutes. >> thank you, mr. chairman. for holding this hearing. i am deeply disturbed and furious about the recent reports of forged record keeping. and veterans having the quality of their care negatively impacted due to long waiting times at v.a. facilities. the veterans in my district and across the nation deserve better. to begin the healing process of this broken trust, the v.a. must answer to this committee and more importantly, to the

veterans who served our country. any v.a. leader or whoever knew about this breach of public trust and did nothing should be held accountable or resign. i'm an emergency medicine doctor and know first hand that delays for much needed care can harm the patient. so let's take care of our patients. and this is the prescription to begin that process and what should be your priority right now. first, do the right thing and immediately ensure that no other forged waiting list exists anywhere else. second, give our veterans the care they need as soon as possible and without delay. no more harm to our veterans. third, conduct this systemwide, honest and transparent investigation and hold those found to be dishonest and negligent accountable and help those who serve our veterans

with excellence and distinction. higher -- hire and train new employees who will show our veterans the respect and honor that they deserve. as a physician, public servant, and more importantly, as an american, i'm committed to ensuring that all veterans receive the medical care they have earned and need when they need it. and that those responsible are held responsible. and as a public servant and advocate for veterans, i have written a letter to director stan johnson who oversees the luoma linda v.a. helt care system to obtain additional information on how long veterans are waiting for care in my region. can you assure me that the luoma linda v.a. helt care system in my district is included in a systemwide, honest and transparent investigation to ensure the veterans in my district are getting the care that they have earned and need? >> to the best of my knowledge,

congressman, loma linda has been included in that process. >> and from your expectations and performance metrics, can you comment? on whether or not we have any waiting list there? >> i cannot comment, congressman, at this time. i have not looked specifically at the data from loma linda. >> ok. i look forward to working with you to ensure that the veterans in my district and everywhere else will get the care that they need when they need it and we can lower the waiting time so that this never happens again to any of our veterans. >> i cannot disagree with it, congressman. >> thank you very much. and i yield back my time. >> thank you, doctor. dr. benishek, you're recognized for five minutes. >> thank you, mr. chairman. >> dr. lynch, what's the name of the person who destroyed the waiting lists? >> first of all, i don't believe they were waiting lists. >> well, who destroyed the documents under question here?

the name of the person? >> they were schedulers who were working on the process of -- >> do you know their names? >> no, i don't. >> could we find out their names? >> i don't know whether we can or not, congressman. >> to me, you talk about the motive for this. and the motive is that we're trying to do this right. by complying with the rules and superfluous lists and danger of loss of getting their information. but that may not be the motive. the motive may be they're complying with some -- somebody above who wants the waiting list to be short. so i think it's important that we identify the people that actually did the destruction of these things. ms. mooney, what's the name of the general counsel that recommended that we don't have them -- the items here we don't have? >> our general counsel will guynn is working with the committee on -- >> will dunn is the name of the gentleman that says this is a matter of privilege? his name is will dunn, is that

what you're saying? >> our general counsel is will gunn. >> thank you. have any -- dr. lynch, who is your immediate supervisor? >> my immediate supervisor is at the moment dr. robert jesse. we do not have a deputy undersecretary for health for operations and management. >> have you had any conversation with or any communication at all with dr. jesse about your testimony here today? prior to the -- >> i met with him briefly this afternoon so that i understood exactly what our way forward was following the release of the i.g. report. >> deaf any recommendation for your testimony?

were going and how we were going to -- >> do you have any documentation of your conversation? >> no, i don't. >> ms. mooney who is your immediate supervisor? >> sloan gibson. >> did you have any discussion with sloan gibson about your testimony here today? >> brief, in passing, in the morning. >> no documentation of any of that communication? >> no, sir. >> mr. huff, who's your immediate supervisor? > mr. mark hone. >> ok. did he have any conversation with mr. hone about your testimony here today? >> yes, sir. >> and what was the nature of that conversation or communication? >> to provide clear, accurate, and honest responses to your questions. >> you know, it's very troubling to me that we talk about accountability and making sure we know the facts here. but when you don't know the name of the people that actually did the destruction it seems like that would be the first thing when you went to phoenix you'd find out who did it. >> so congressman, my goal in going to phoenix was to understand the process. i knew that the inspector general was there. they were there to assess intent and to identify if there was responsibility or accountability for -- >> without names of people, how does that occur?

how does -- don't you ask the person why did you destroy this evidence? these lists? why did you do it? >> these -- i did not speak to any of the schedulers -- >> did anyone on your staff do that? >> pardon? >> did anybody on your staff? you found out about it through a member of your staff -- >> i don't know whether the staff had spoken directly with the schedulers who may have been involved in -- >> what was the name of that staff member again? >> pardon? >> the name of the staff -- >> i was there with dr. mike davies. >> did mr. davies talk with anybody at the phoenix staff that may have actually done the destruction? >> i don't know, congressman. >> i just don't understand how you can conduct an investigation about the alleged destruction of documents and not actually talk to anybody or know the name of anybody who actually did the destruction. or their -- >> that was the i.g.'s function. they were there -- >> i thought you went there to figure out what was going on. >> i was there tounds the process. and >> wouldn't identifying the person who did the destruction of the documents?

>> i did not -- >> didn't you have any interest in doing it? >> i didn't think that was necessary at the time. >> it seems to be the first thing you should ask and maybe i'm simple minded. but there's question about destruction of documents. and you don't even know who did it or their motive? >> i believe i understood the motive at the time. >> but your contention is that the motive was just and within the realm of the v.a. and protecting the patient's records. i'm suggesting to you that there's a possibility that there's motivation within the v.a. that encourages people to shorten waiting lists so that they get bonuses. you understand my concern about that? >> i understand your concern. >> wouldn't that be something that you might be concerned about, that you might question the people that were doing the destruction if they had any communication with their supervisors that they might be pressured to do things that would allow their supervisors to get bonuses? >> that is a discussion the i.g. is having. >> why wouldn't you have that discussion? >> because my goal, congressman, was to understand

the process so that we could -- >> you can't understand the process if you don't understand who did it and their motivation. i yield back my time. >> thank you, mr. custer, you're recognized for five minutes. >> thank you very much, mr. chairman. and thank you to our witnesses for appearing here this late in the evening. i share the horror, frankly, of the allegations coming from the v.a. facilities around the country. including the v.a. phoenix facility on the long patient wait times. and more importantly, the alleged misreporting of those patient wait times. and what's been referred to in the report is gaming of scheduling. needless to say, i think this -- not a partisan issue. but we find this completely unacceptable. and i appreciate your attempt to determine what was wrong and who's responsible and how to move forward. the question that i have is as

you've raised a number of times in your testimony, dr. lynch, a question of integrity. and a question of accountability. because obviously the interim g. report indicates mass stemic problems with long patient wait times. and inaccurate reporting. and this gaming that's been going on. my question is this has been going on apparently since 2005. i assume well before you were in your current position, well before secretary shinseki was in his current position. but in recent months, has secretary shinseki in his role as leader of the v.a. been aware of these stemic problems -- systemic problems? and why were these issues not immediately addressed given this long line of i.g. reports

over the past 10 years? >> congresswoman, i think to a certain extent we failed to challenge our assumptions. we believed our numbers. we felt the i.g. reports and patient complains were exceptions and not rules. i acknowledge that in retrospect that should not have happened. i would also indicate that during this time, there were people who were trying very hard with the best of intentions to identify methods by which we could monitor veteran access to v.a. care. it has been a challenge. we have tried multiple different models. it has been a challenge for the private sector. there isn't a right answer here. we were trying to find a solution. i believe we probably

incorrectly assumed we had a solution. it has become painfully obvious that we had set our system up to give us incorrect information. and we need to assure that doesn't happen again. >> and in terms of my question about secretary shinseki's role, was he involved in this? >> the secretary has been aware. nd i can assure you has been asking questions and directing activities to assure that we move to a quick resolution of this problem. >> and with regard, i want to go back to one of the documents in the report that's department of veterans affairs memmedum able 26, 2010. it's one of the atafments. appendix e. and flfs a gaming strategy that concerns me as a way to combat missed opportunity rates. some medical centers cancel

appointments for patients not checked in 10 to 15 minutes prior to their scheduled appointment time. some of the stories that we've heard about are veterans who think they have an appointment. they go to the appointment. and they're told they don't have an appointment. even if they have a card with an appointment. it seems to me that this is -- has become an issue that gets ex-aser baited and then these people are not being seen in a timely way in terms of the continuity of care. have you had reports from physicians that their frustration trying to treat our veterans in a timely, compassionate and high quality way? >> i have not had individual complaints from physicians. i have been a v.a. physician before i took this position. i valued my encounters with veterans. i hope that i had provided good care. i share your concerns about any

mechanism that games our system. not only because it hurts a veteran but because it doesn't give us the information we need to make our system better. >> thank you very much. i yield back my two seconds. >> mr. heel's camp you're recognized for five minutes. >> the first question i have for ms. mooney. i believe you articulated the assertion of attorney-client privilege and have referenced that numerous times. would you identify for the committee who is the client that you're asking for that privilege. >> i would just defer that to the office of general counsel. >> has that been identified for the committee, exactly the client that the attorney-client privilege is being asserted by the office of general counsel? >> attorney-client privilege -- >> there has to be a client clearly. who is the client?

who is refusing to provide information to this committee and to the american public about this issue? >> mr. hules camp, i know that the office of general counsel is working with the committee staff on that. >> so you do not know know? do you know who the client is -- >> i'm not with the office of general counsel. >> if the gentleman would yield. >> yes, sir. >> all we know is that it is one of the eight people who has in fact been subpoenaed. that is, we haven't been given a name yet. but to answer your question, it is one of the eight people. >> thank you, mr. chairman. my understanding of that privilege, we get the privilege of knowing who the client is. that should have been noted in the original refusal to provide the information. i would like to return to mr. -- or dr. lynch as well. and returning to your trip to phoenix and you are apparently not surprised by the o.i.g. report. >> no, congressman, i'm not. >> and what actions have you taken in the five weeks since

that report if you can describe those -- or since your visit? >> not sure -- well, maybe it is five weeks. we have had two teams in phoenix since my visit. one working with the scheduling team. the other working with the clinics to improve their care delivery process. >> have they identified the 1,700 individuals that were revealed in the o.i.g. report? >> did not identify the 1,700, congressman. >> you've described the -- obviously electronic waiting list which is not secret. you've referenced numerous times about the interim or intermediate list. how many names were on that interim intermediate list? >> i don't know, congressman, because i suspect there were multiple lists as patients were canceled. the list of the patients that were canceled were printed out and the patients were rescheduled. >> and these were all destroyed? >> to my knowledge, they were

destroyed, congressman. >> so no idea. how many names were on the destroyed interim waiting list? >> they were not available for me to reveal. >> did you observe that? >> pardon? >> did you see the list? >> i did not. >> how did you know it existed? >> i've seen an example of what the list looked like. >> how did you know it compisted? >> because the people we talked to told us that -- >> did you visit with the director of the phoenix clinic about the list? >> i did not. we visited with folks in their scheduling office. >> who made the decision to take away her bonus? >> i'm sorry? >> wasn't her bonus removed after your visit or rescinded? >> that was i believe within the last week. that was not my decision. that was the secretary's decision. >> it was rescinded? >> yes. >> but you did not visit at all with the director of the clinic when you went to do your investigation? >> there are multiple clinics. >> yes or no, did you visit with the director of the clinic? >> actually, i did. >> tell us the conversation.

>> we talked to him about his process of trying to improve the availability -- >> did you discuss the destruction of the interim waiting list? >> no, i did not. >> did you know about it when you visited with the director? >> i did. >> and chose not to bring it up. why? >> because it did not appear to be in his area of responsibility. his area of responsibility was the clinic -- >> which just happens to be the waiting list -- >> pardon? >> two other, three other lists, thank goodness we have those. i.o.g. -- o.i.g. found those. that's the near tracking report, the screen shot paper printouts, the scheduled appointment consult and how we identified 1,700 veterans who were denied care. i would say this was a secret we were lucky i guess that we found those. do those type of lists exist throughout the entire v.a. system? >> i don't know. >> you're the expert in the

process. you don't know if there's a near tracking system in other clinics? >> the near list is available to every medical center. >> so every medical center could have the near list with potentially another secret waiting list? >> the near list is not secret. but they could have -- >> how did you not know about the list? if it's not secret? >> i'm sorry? >> they identified 1,100 veterans sitting on this list who were denied care. some of them might not be alive today because you waited 35 days and did nothing. as far as changing that. i yield back, mr. chairman. >> mr. a rourke you're recognized for five minutes -- mr. o'roarke you're recognized for five minutes. >> i would like to begin my remarks by sharing the frustration expressed so far by the committee members and also members of the panel. but also making clear that my frustration at least does not extend to the providers. i think about the providers at the el paso v.h.a., many of

whom, doctors, nurse practitioners, nurses, psychologists, therapists, counselors, could be working in the private sector for more money and could be working with the department of defense for more money. could, within the v.a. system, be working at other v.h.a. facilities other than el paso for more money. and they're working to serve the veterans in our community that i have the honor of representing because they want to help them. and in many cases they themselves are veterans. so i think that message is too often lost in our justified criticism of the management of v.a. leadership here in washington, d.c. at v.a. leadership within the -- and at some of the local v.h.a.'s. when i hold town hall meetings in el paso and i hold one every single month and i hold a most of the concerns are about wait times. and flew in the face of the

information the data that i was receiving from the el paso v.h.a. which showed that our wait times were on par with national levels and were very close to the targets set by the v.a. what we decided to do is hire somebody to go and do what many people here suggested and talk to the veterans and not just listen to them at these town hall meetings but conduct a scientific survey in el paso and we surveyed 692 veterans with an error margin of plus or inus 3.8%. primary mental health care times was wildly different from what our veterans were erroring. in december of 2013, v.a. reported that 70% of new el paso v.a. patients saw a mental health provider in 14 days. our survey showed that 36.5% of power respondents did not even get an appointment at all.

ompletely dropped oust system. 42% of our respondents completely put off getting mental health care because of the difficulty in obtaining an appointment. i don't need to draw the connection but i will. that when we delay care we're often denying care and at a time when we're seeing on average 22 veterans. taking their own lives every single day. life and death situation in phoenix and life and death in el paso and across the country. as much as i would like to get to the bottom of what happened in phoenix, and know who destroyed which records and who made what decisions, i think this is a problem that is much larger than just phoenix. much larger than just el paso. we see similar problems there as well. so as the chairman has asked and others have asked, i'm asking you to look into the specific issues in el paso. we'll provide you all the data. that we collected.

i would also like you to look into allegation that is we've heard in el paso, confirmed by the o.i.g.'s report that appointments are set for veterans who request an appointment. but the veteran is never informed that that appointment has been set. and so when the veteran does not show up for that appointment that he did not know about because no one informed him, it shows up on the veteran's record that he declined to come in or failed to show up. and does not harm the v.a.'s record in terms of performance on wait times. we've heard that anecdotally oftentimes in el paso and seeing it in the i.g. report and hope you look into it as part of your systemwide audit. >> congressman, we are. and i would be happy to meet with you personally to get the information that you have. that you've obtained from the veterans. >> thank you. >> i would value looking at that. >> and i think that's why phoenix resonates throughout this country. beyond the tragedy of apparently 40 veterans losing their lives because of gross negligence within that

facility. it seems to confirm what so many of us are hearing every single day in our district. so i appreciate your tenacity in pursuing the facts and reporting those back to this committee. and lastly, excuse me, for ms. mooney, on the 29th of april, congressman pete galarragao and myself sent a letter to the secretary asking specifically about the el paso v.a. and whether similar practices were conducted there. and a very simple question about whether a secret wait list was maintained there. we have still not received a response to our letter. when can we expect a response? >> i know the results of the nationwide audit are -- will be forthcoming. and those results will be shared with the congress and we look forward to answering your response. and all the members' responses about individual facilities at that time in the very near future. >> mr. chair, i yield back. >> thank you, mr. kaufman, you're recognized for five minutes. >> thank you, mr. chairman.

dr. lynch, the office of inspector general indicated that it had received allegations of retaliation against whistleblowers in phoenix. what is v.a. doing to make sure it does not gauge in such prohibited personnel practices? >> i'm sorry. i'm not quite sure i understand the question. i did not see the allegations regarding retaliation. i believe the i.g. will probably give us a complete report about any of those concerns. and it would be my expectation that if there was inappropriate retaliation it will be addressed. >> what was the name of the doctor that -- the retired doctor from the phoenix hospital that was a whistleblower? what was his name? >> dr. foote. >> dr. foote. how was your meeting with dr. foote? how did it go? >> i did not meet with dr. foote. >> you did not meet with dr. foote. did you ask for a meeting with dr. foote? >> i did not. >> why didn't you ask for a meeting? here is somebody that clearly was at the center of the storm, you're there to understand what the process was. and yet you didn't request a

meeting with dr. foote. >> i at the time was concerned that it might interfere with the i.g.'s investigation. >> i think that your concern was it might interfere with the truth. and i got to tell you, how far this problem goes. because the fingerprints of you all that are at this panel today are all over this problem. because i can tell you you are not being forthright in your testimony. and i think the model for the veterans administration, and let me tell you, there are a lot of good young men and women -- of all ages that work for the veterans administration. the rank and file. and they are -- some of them are the whistleblowers. because without them, we would have no idea what's going on. because the leadership of the v.a. and the tragedy here is that the impression that you give, all

you today, is that you are here to serve yourselves and that haven and women made extraordinary sacrifices country. nothing will change in the until weadministration and not justership from the very top, general of you have toll fine something else to do to doe you're not here your job. i yield back. you.ank mr. walsh. >> thank you. so many of my closings have to this issue of trust, it's fundamental in any inationship, especially true this, the v.a. and congress working in concert together. and i think being on this committee over the years and atching this there's been cautiousness that maybe as some