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 nature of anythe

bureaucracy. the interchange with mr. denim and dr. lynch was interesting. mr. denim was talking about the audit that was beg done and he deputy underistant secretary if we were going to get that list and theres with a and a cautiousness. i know your hearts are in the right place. rob race is holding you back. i can't imagine a world, dr. lynch, where you would let someone in a bureaucracy not get thatenim or myself information, why you wouldn't have again out on a limb and theyi'll get it and if don't like it, too bad. and that mentality gets us to today, because what we're all trying to do is solve this problem to provide timely quality care for our veterans. and everyone gets that, the you, us.ind me, but the problem is no competent leader is going to formulate a

course of action with all perfect tin en data and i was that the naive impression our oversight response is when spp i for a very narrow was under the impression this is what this would look like. say from go back and this date to this date, print there mighthought be a bunch of interns taking e-mails, or other things that were perfect tin andt those would be here this committee would decide what was important. but i was mistaken, because now i already know the answer. the answer is going to be you should ask the general counsel team of lawyers saying this is going to go, this isattorney-client privilege, there something over there putting something the executive privilege stacks? know that?ou

>> congressman, i don't know the answer. i can let you know they have met with this committee, with this committee's staff, with this chairman, on a number of occasions to share what i know about v.a. and v.h.a. health care. relationship with congress, i for one am looking -- strong -- we've known each other for quite some time and worked together. are you under the impression that this relationship has been strained for a while between congress and the v.a.? >> congressman, this is not our be strained.t our intent is to be open, collaborative and work closely with you. >> have you everrer from anyone panel about a strain? yes,s, i've heard that, and many of you talked to us about issues that you face and worked to get you information as quickly as we can. we understanda

the constraints, we worked for two and a half weeks, the office provideal counsel, to the committee with a response. that unrealistic? pileect you would send a of stuff over here and the staffers would sort through and decide what needed to be done was that a naive assumption? passivelythat not aggressively. is that naive in terms of subpoenas? >> congressman, i know had this was run out of the office of general counsel, so i would them.to i was not part of that process and i don't think anyone on the panel -- >> many of us on this committee have proven ourselves of what we and to trust, but i something but feel has not been given to me. and that may be false, but the impression was there. i would have loved to see

say over my dead boat will you not get that report. >> i have no doubt that this will get that report. i just do not have responsibility for it. i have no doubt -- >> the person who is responsible is not here, so we may have to bring them in. >> on the audit -- >> what was the job of the liaison, who do we talk to? just skip over and you go directly to general counsel? congressman, in a subpoena that is a legal matter. we work with members of this staffs.e and their >> we tried to do it without a subpoena. >> thank you very much, mr. walsh and dr. lynch you're minutes.d for five >> thank you very much, mr. chairman. as a physician, i have serious concerns obviously like the rest of this committee. why were so many patients

canceled? were canceled in an effort to reschedule them more timely, first of all. >> to have them seen sooner? >> to have them seen sooner. and rescheduled -- >> were they all new patients or of them followup? >> historically in phoenix, as i understand it, the managemention, the used to miss hellman, had a mod wrel they had not employed the wait list, they had simply sended patients when ever there was an appointment, could be six months out, could be seven out.s with the new team there was a desire to identify appointment they did.ch they then went out, identified these patients who had been scheduled three, four or five months in advance, canceled broughtpointments and them into a new appointment slot. >> do doctors weigh in on the

sit of rescheduling -- do they say no that patient is sick, they need to get in here right away? because in my private practice someone,rescheduling movingre that we were them up, but if they needed to wewould do that, but also would discuss on a patient by patient basis, this patient away,to be seen right they cab wait. does that ever happen, or is the doctor out of this situation? cannot tell you whether the doctors were involved in the rescheduling process that phoenix.in >> so we don't mow if doctors in toeral in the v.a. are able weigh in on the risk associated with a patient waiting longer a procedure, because we're talking about peep waiting for byes --s could delayed.

i live it does happen. i believe that physicians can identify --lts and >> can, or do that? i imagine they can, i would hope access to the patients' records much does this take place? do. believe they >> because in private practice a hospital or clinic is not going to let a lot of patients sit on a waiting list, they're going to get them in to be seen, because that existence depend on and that's a different model than exists at the v.a. currently. so what dr. row alluded to to get is there a drive patients to fee based care come from the problems that have is thatecently or something that's been embraced with energy and the othery i have is are those receiving sendes penalize if they them to fee based care? >> i do not believe they are patients if they send to fee based care. believe they --

>> part of performance is really productive as well as results of taking care of patients. one or thing to say when i comes to the opposite general counsel. turning everything over and you have nothing you're concerned about that we should bee out about, you should very upset that they have not toned this information over us, you should be screaming inside of saying i defer to them. you should fire them. you should stand up for yourself overay i turned everything and here it is so you can evaluate it. do you have any comment on that a personal note? don you feel that you're being let down? because people are asking you here tonight where is this information. you say you've turned it over they're saying holding, does not that bother you? the've turned over information. i haven't turned over the information that they've gone

my e-mail files. >> does that bother you that us? haven't submitted it to >> sir, i haven't reviewed the e-mail files. you. it doesn't bother apparently. >> we are committed at v.a. to being collaborative and responsive. >> our veterans in the time in that are love responded to the needs immediately, they dropped everything and did it immediately. same.d hope you'd do the mr. chairman, i yield back. >> thank you very much, doctor. we willittee rules continue with membership and then we'll go to miss jackson lee. mr. cook, colonel of the united states marine corps retired, recognized for five minutes. >> thank you, mr. chairman. this whole issue is very disturbing it's ironic, this was gave a loty, we all of speeches. kind of turned into memorial day

slash veterans day because this was the up in one issue when you talk to the military and the veterans. they want to know what's going on, what's happening. my unit, he wanted to talk about m16. and i told him, i said it a piece of crap, i doesn't fire the things at that 1967.nd that was most of you people welcome back even born then. but he was 80 something years old, he was taking notes and then suddenly after that there ofe all kinds investigations, changes to the

system, to change it so that no else would die, because of a weapons failure. beingat weapon is still used today. in the u.s. military, the longest weapon. what if general bradley were last five-star general we had, kind of ironic, invasion, 6thandy of june. there's a't feel that chain of command or a sense of urgency. going to goho is down there and correct these and i know you had a busy weekend. there, youare dying got to work through the weekend, 7-day 24-hour day, it's a a week, there's got to be a sense of urgency. and i'm come away from this hearing that the lawyers run everything.

be certaino decisions made right away to change some of these policies, whether certain people have to whether they don't get bonuses. there's a lot of great people that work for the v.a., most of them are military frustrated.probably what i'm getting up to is, you aboutwe're going to talk this and this committee will make a report. you, ins going to ask the chain of command who is going to do this, this and this. from thise away hearing tonight and i get the feeling that no one is in the v.a. right now is in a position to do that, there is in trust to the people i talked about. they want action and they want it now. if certain people like, if i did something wrong, if people

fired probably court martialed. thethat's the nature of business. we owe that to the veterans, to military, and we owe that to all the people that are working so hard in the v.a. administration. we have to straighten out this problem right now. we can have subpoenas and i haven't else and heard that. i'd like to see the president go and to the v.a. hospital meet with the vens. like to who ever possible to go down there right now and talk them. everybody.ents of very, very frustrated. i'm in a know,

position to make a difference anything.t do i can't get across to you or the ofle, and it's a feeling frustration. if i was smarter than most people i'd say okay you got to this, this, this and this. think you need certain people have got to be these policies, have got to be changed almost overnight. can't accept excuses or the fact that the lawyers are handling it. sorry, i should ask questions, but that's been something that's bugging me and i apologize. thank you. second.back my one >> colonel, thank you for your service to this country, we are as part ofhave you our committee. for the record, there are close to 700 attorneys at the .epartment of veterans affairs

>> thank you, mr. chairman. i sit here and i englishe a word 'the language that can describe how frustrated i am and that's an understatement. for 18 months and listen toed to the same kind of tonight ande heard we've sat here for 2 hours and 15 minutes, we've had 20 some ofple question the three you, and i know now two and a half hours later what you don't know. you actually traveled to arizona and you didn't meet with anybody anything to do with this directly. it was easter weekend, we plan.tand that you didn't meet with anybody that was directly involved from all the testimony of these 20 right here. if i was in your shoes, i would country this as a five-alarm fire and you're rushing to the keen and you're bringing mutual aid because the house is on fire and nobody is going to survive.

to theit here and listen three of you and i'm thinking to myself the question i leave here and probably my colleagues what do you know? is that people died. so i guess the question i want on behalf of the families, that probably aren't but we'veom tonight, heardfrom some of them, i ago, heeone three weeks couldn't a colonoscopy, people died. we're asking all the same questions. but if you have an opportunity, i'm going to give you an opportunity because you all three are sitting here, what do mr. lynch? say, to the families of these people that lost veterans, what do you on behalf of the v.a.? here's your opportunity. on behalf ofman, myself, first of all, i take

time that any veteran has been harmed because of something the v.a. has done wrong. >> dr. lynch, does the buck stop deaths? on these do you accept responsibility for what happened, are you responsible? >> congresswoman -- >> yes or no. does the buck stop with you, dr. lynch? >> i don't know whether it does, i consider myself responsible. >> ms. moody, does the buck stop with you? can you look into the eye of these families and say i accept this responsibility? >> congresswoman, i am the daughter of an atomic veteran. >> yes or no, are you responsible? >> yes, i am responsible for ensuring that our focus at this i'm sorry, mr. cook, that we didn't make this perfectly clear to you, our caring for ourn veterans. we want -- >> this is my time, i have a limited type. i've sat here for 18 months as a freshman. i've gotten very few answers

i've posed to you or anybody else. i'm still waiting on questions questions -- mr. huff, do you share this responsibility, does the buck stop with you? >> congresswoman owe. >> yes or no. buck -- >> a civil servant and also a veteran. a supervisor. i'm a staff level federal employee and i do the best job i can. ther. huff, does responsibility lie with secretary shinseki, do you still believe in his lowership ability to stand up to a five-alarm fire? where in the world is the urgency? i can sense the urgency of this committee, democrats and republicans, because our nation has totally lost its trust, it's responsibility to sit here and continue to maintain oversight. out where theind buck stops. i've asked for secretary when thes resignation american legion report came out.

different people asking the question, does the buck stop with you, do you this responsibility, are you ready to accept this responsibility? the either eyes of the american people and say you say tonight? i know what you don't know. what do you know that you can tell the american people that learn in two and a half hours of a committee meeting? focusgresswoman, our remains on caring for these veterans. we -- finish? >> no, because i have five minutes. miss moody if that has been the how could dr. lynch go to to anybody not talk involved that had anything directly to do with this and unexplained deaths, there's an i.g. report that has have and you all seem to turned the facts to a general counsel and we know less more questions tonight than i had when i walked

in here. because we learned what you my question is, and it's going to have to go you know?, what do >> we know that the facts of report are utterly werehensible, that is what know. and we owe a debt to all our served. who every one of them. ?> are you responsible what are you going to do with that responsibility? yourou going to stay in position, are you going to apologize, are you going to resign? in my going to stay position and fight for veterans and fight for this congress that i love. together, and really meaning it, working together, for the good of our veterans, what the public expects. and that's what i'm committed to do. >> the public got, and 40 veterans died, this is what the got.c >> we understand that and we view that report as totally the the report as totally reprehensible.

inexcusable. expired.s .hank you, ms. mooney ms. mr. jackson lee, five minutes. >> thank you for the courtesy, for the thank you service that you're doing for the american people and for all the veterans. probably not one of us that could not count our in world war ii, there for me, others, extended family members, neighbors, faith there's notothers, a place we can go that we do not touch a veteran or a veteran touch us, or a soldier. and as well it is not a place can go where we're not grateful. thanks overwhelming and i you for allowing me to sit here. i'm from texas, and there are facilities including those in my area of 32,000

in the 18th congressional district alone. this into theead record, with my colleagues who are on this committee have probably immersed themselves in. but i just want to have these words, this is about the practices reported in phoenix, we're finding that inappropriate scheduling systemic problem nationwide. then just to read this paragraph, schedules go into the scheduling program, find an open veteran if, ask the that appointment would be one,table, scheme number back out of the scheduling open date, this makes the wait time of an established patient zero days. question is where is the focus now with this report that this is systemic, this is nationwide, and i've there is aay that nationwide audit.

is, while we're having a nationwide audit and many of us have sent letters, i i should ask the question first. i have send a letter about the v.a. hospital in the 18th congressional district in houston texas. of soon will members congress, individually, there could be 435, could be 535 letters, be able to get our responses to know the cries is in our own neighborhood? we get that response? >> hopefully as soon as it's available, congresswoman. are looking to brief the congress as soon as it's available. ourut if we are sending letters and we want to know about our immediate cries is in our own neighborhood, how soon get that response? i didn't realize there were 700 lawyers. >> congresswoman, it will be forthcoming very soon. i know the results of the awe it being compiled now and we look for to having them out to

you. individual hospital reports, is that how it's coming? >> yes. there you separating request from members from your general audit, if a member sends letter can they get an answer immediately? >> i think we are looking to audit at nationwide at one time. that is my understanding. disturbs me only because when we are in our districts we are hearing individual outcries time. i want to agree with many havers who have see we very fine providers in the v.a. system and we should pay tribute to them. i know debakey hospital has a as doine staff who cares others. but i also know that when i travel around i have individuals airport, an individual who said they waited elderly months for an veteran for service. and when you go and get directly from these hospitals, they have completely

different numbers. my concern is what numbers are we to believe in and a crisis we have with it being a nationwide system. wethere no way to have what orld call task forces special ops to target into places besigh having an awe it to go interest hospitals and fix problems quickly? of sorts? >> congresswoman, we have right now at the same time that the on, facilities identifying patients on the wait list. we are identifying those facilities that are challenged in terms of clinic efficiency. ofare looking at ways providing care to veterans in a timely fashion using nonv.a. helping thosebe facilities that need assistance the providing more efficient processes. simultaneously with the audit. >> let me just finish on this because i appreciate the passion you all are public

please get an we stated outcry from the veteransp of the affairs department, standing up, responsibility, speaking not to us as members of congress, but speaking to these preparedthat we are and ready, one, to criminally havecute those who may been in a coverup, i'm not and secondtch hunt, arely, standing up and saying we are pained by what is happening of the united states of america we will not this task we finish on your behalf and save your lives and provide you with care. that? hear >> congresswoman, we will not rest and we have not rested. not rest until we provide veterans with care. >> congresswoman, we have been working to identify and understand the problem across and toire system initiate solutions so that we

can eliminate way times and get care when they need it as soon as possible. >> i thank the chairman for his and the ranking member for your courtesy. >> thank you. >> i appreciate the understanding and courtesy of chair. ofpologize, i've missed some this. areas that have already been gone over, just point me to the report. that the department and this congress can ultimately reforms.long-term those are long-term institutes al reforms, though. is what's happening right now to clear the way list. by lynch, you mentioned that friday everybody at arizona will be contacted and in your words, needed, be referred out. my understanding and the ploaz correct me if i'm wrong in the first place, and secondly i'll give you my

question. understanding is that's the current policy. that if a veteran it's determined a veteran need to go outside the system that can actually occur now. if the veteran requests care we will refer him him.we speak with >> well north korea practice, no, and i will tell you i've sat with my own hospital administrator in my district, and i understand in practice the required whenre that let ran requests to go outside the system, it's task.ly not an easy >> there will not be hurdles, congressman, we are committed to getting veterans who are on the wait list care as appropriately and efficiently and as soon as they need it. theo my question is, current policy is already if it's needed, nonv.a. care is available. saying now that the standard for this friday deadline is if it's needed a can go out, how is that any different, other than you're

just suggesting that the department is going to try harder? and secondly how is that need evaluated? is that a medical evaluation? a that's going to be conversation with the veteran, if there is need for a medical will have a call center medical professional or provider or nurse professional to discuss the patient's care and to determine his need. of >> is the standard of review going to be any more relaxed than it currently is? >> congressman, it's my understanding that we are going get these veterans care in community. to me, andsurprising i have talked about this every step of the way, i don't think issue. a political i think the congress and the administration can get to the long-term institutional reforms. my concern is that the

department currently has the heardity, you've probably it a dozen times tonight, the second has the ability to refer out.e you're asking us to trust that administration executing the same exact policy that if needed policy that was is somehowplace going to have a different rut in the next 48 hours. this, if so,ll you i will be the first one to go to and comeof the house compliment the administration. you this far we have not seen new perhaps, emergency measures, new personnel. really your only indication tonight is that you're just going to try harder at the call but apply theas same standard that already exists. >> congressman, let me go ally further, if i may. with respect to phoenix, we have hiring ofproved the 12 more physicians, three of

shortly.l be online we have approved and we have newght on board a number of concerners to increase the oficiency of the management scheduling and the wait list. locall be moving providers to phoenix as well as mobile medical care centers to improve capacity and to, tall resources to provide that care. we are taking steps to increase services in phoenix. if we can provide care to have beenho identified by the i.g. in phoenix in a timely fashion, we will. if we cannot do that they will be sent to the community for care. indicated other facilities as well would be undergoing a similar? is collecting,a. has asked each of our facilities to identify patients who are currently on their wait list, who are waiting for care, to

the us that list so we know numbers. we are going to assess if we can locally.hat care if we cannot we will move that into the community. the response.e i would just express my concern this.e record and it's it's the very same medical physicians, medical staff that have already determine that these patients go outside the system that we're now asking to reconsider whether they do. dramatic shift in the administrative judgment that you expect everyone of your medical providers to exercise in this new 48 hour period, i still have great concern that it's not going to solve it. but i very much appreciate the are being taken and i hope i are successful. i yield back. much.nk you very everybody obviously continues to interest intened talking with our witnesses. we've had numerous requests for

a second round. chair will give a second round of questions, but with that i ask unanimous con send we have a five-minute recess and we will reconvene in five minutes. >> dr. lynch, i'm going to read from the april 9 hearing, and thecally i asked you, does v.a. have every legal authority

veteransto pay for a care whose care is delayed to receive care outside of the v.a. system. your response, to my knowledge, sir, yes. i followed up. correct to say that failure to deliver care in a timely fashion is simply a of poor loweredship at v.a.? your response, i think that stretch, sir. i think that our system strives v.h.a.t patients within because we think we do provide good care. we think we provide quality care. could you please expand on that now that you have had several reflect. >> congressman, i still think we have a good system. think we have evidence that we deliver good care. in verybviously difficult times right now. that we haveified significant failures to provide care. we need to address that.

i think we have a way forward. i think we have the tools to do that. i think it's going to require the collaborative relationship with congress and with your committee. i've think, sir, demonstrated in the past i'm willing to work with your committee to try to identify problems and to look to solutions. >> thawsm for your response. do you think, though, that this a failure of leadership or what has it's been? >> i think that there is the have lost truewe north. i think we need to focus on our mission, treating veterans, providing health care. to focus oured performance measures on giving tothe tools that we need provide timely care, mr. congressman. much.nk you very the letter we received from mr. gun dated may 27 basically says that these were the

remainder of the documents of the 27n our search custodians, in other words the general counsel believes that they have complied with the subpoena. miss mooney works you thrufer a message back back to the general counsel that the committee says v.a. has not complied with the subpoena. would you do that for us? >> yes, sir. >> mr. mooney, on september 13 requestedhe committee the current status of all v.a. that havee facilities an point wait time backlog. to date we have received information on only two of hundreds of v.a. medical facilities. despite this request being over eight months late. aen can we expect to receive response? work toessman, we will get you that request as expeditiously as possible. >> eight more months?

>> no, sir, we look to having awe it andngs of the getting the responses quickly as possible. know the circumstances of this particular request. to get that and back.ake that >> the committee sends a letter every week to the secretary, single outtabling request. on january 6, 2014, v.a. was request for information regarding gastrointestinal each v.a.lays for health care facilities. received noe response. when will we receive a response? i'll haveult delays to, i will get that information for you as to when we can it.ide >> on january 14, 2014, a to v.a. askingd for a copy of a report that

contained information on consult across v.a. medical facilities, and for complete information from 2005 to present. considering that this request is late, when will we receive a pons from you? will,gressman, i mr. chairman, i will work to get you the information and look request that immediately as one of the priorities of the committee. >> miss mooney toshes date have provided any information to the committee staff to explain when the alternate phoenix wait destroyed? on april 29, april 28 and 29, asked mr. huff, no response. the stafflittle 30 called and asked you, no response. 1st i wrote a letter the second, no response. hence the subpoena on may 8. pretty simple. there was a list, a list was

destroyed, we asked when was it have not and you still provided an answer despite elapsing.onth of time >> thank you very much, mr. chairman. mr. lynch, getting back to lists, and your response mr. jolly's questions about thator service, is procedural for the phoenix, arizona facility or throughout the v.a. in general? >> no, congressman. as we evaluate the wait list from all of our facilities we be determining how basis effectively why fee services to reduce and eliminate those wait lists. >> throughout the system? system.ghout the >> i'm very glad to hear that. look atrn is if you some of the other problems the v.a. will be facing with

care needs for our world war ii veterans and well as therans, as drawdown occurs over in afghanistan, there's going to be a huge need for services from the v.a. the v.a. cannot provide all you do havees and to look at fee based services. 40% of ourat veterans live in rural areas, that i think we definitely have to look at that problem there. my question to miss mooney, i know you talked about you can questions because it's a general counsel, but as earlier we only went the subpoena route when we could not get the information in the was veryce that specific to phoenix. i know the v.a., river time we ask for information you talk about the long list of questions

that we're asking, and we try to job a lot easier when sloane gibson was before this the deputy secretary, we talked to him about the fact to help speed up the process we asked that the v.a. or membersttee staff of congress if they want to talk to subject matter experts that we can do that, so that way you will not have to respond to a letter from us. yet that seems to still be a problem. we are trying to work with you, but there has been a disconnect between what this committee needs to do our job for what the v.a. is willing to give us. that we can't speed up the process by allowing subject matter perts to work directly with the committee staff when asked rather than having to go through ucla is when you lookem at the frustration that we see a committee. hopefully we'll be able to

those concerns and problems that we have within the system. and i'll ask you once again, would you allow the subject experts to talk to committee staff would you having ocla?get approval through >> congressman, i think as you know, dr. lynch came to the brief the committee and the committee staff and to engage in conversation with them. i understand, i understand the the point ofn wanting us to reaffirm, again, did not provide -- i mean the, yes, v.a. deciding to come to us. examples where legislators asked the subject matter expert whether or not could come brief us on certain issues, they said they but they haveo, to go through ocla to get ocla's

permission. >> no, i would respectfully suggest it is not permission. to coordinate -- >> well, we have an e-mail and miss share it with you, mooney, from the subject matter expert saying that that is the v.a.y of the we can address that, i brought sloane gibson's attention, i've talked to the secretary a factr of times about the that the relationship 2010 the department and this committee is extremely strained because we are not able to get the information that we need to. we try the beginning of my some of theth out requests as far as going directly to the subject matter expert. worked. not so hopefully we'll be able to it that working the way should be working to build trust and open line communication. mr. huff, i want to thank you

for your service. know that that you just happened to be in a met with you'rech and that's why appearing here today, i want to thank you for your service. i know you are not in a position you have to make these decisions. it's above your pay grade. thank you forto your willingness to come this onning to talk to us here this committee and i do abovetand that these are your pay grade. so thank you for coming forward and answering the questions that were put to you this evening and thank you for your service. back.hat i yield >> thank you. inspectorinterim general's report i want to ask you about a couple things on executive 4 of the summary there's this statement. we are not reporting the resultings of our clinical in this interim report on

delay of appointment resulted in a a delay in diagnosis or treep particularly for those veterans who died while on a wait list. the assessments require analysis of v.a. and nonv.a. medical andrds, death certificates autopsy results. we have made requests to appropriate state agencies and issued subpoenas to obtain records.edical do you know,oenas has the i.g.'s office issued to nonv.a. agencies concerning deaths of people on a waiting list? congressman.ow, >> do you happen to know, have v.a. aboutted the v.a. medical records, death certificates or autopsies? sure they have. >> do you know the specifics? >> i don't know the specifics. they are carrying out

that part of the investigation? >> congressman, to the best of knowledge, the i.g. is taking this very seriously. honest attempt to understand the deaths and to determine whether or not they were related to the delay or not. i think that's a critical question. and i think it's such a critical question that they are doing this very carefully, that want type.right the first >> absolutely. when will they be done? >> i don't know. >> let me change subject because limbed and ask about recommendation number 3 in the report. you agree with it. it says, we recommend the v.a. secretary initiate a nationwide veterans on way lists and ensure that veerns veterans are seen in an appropriate time clinical condition. >> i agree with it. and it has been implemented. >> okay. my question then is this.

. >> we are looking cavally and employees no anonymously report and identify been they there have secret wait lists or where they have been told to do things that of our policy. them immediate treatment especially if they've gettingtoo long without treatment, using fee bases, will that be used elsewhere in the or is that exclusive to phoenix?

>> no, sir, it is not exclusive phoenix. if the facilities cannot provide timely care to patients on the we will be using fee bases to provide that care. that, blood to hear because i have almost 100,000 district in my district in coach we're getting a lot of concerned phone calls, as you can imagine. i would urge you, especially isause the projection 450 million, almost half a billion, is going to be rolled until next year. let's use that money. let's consider this a disaster veterans. >> congressman, we have to reestablish credibility in v.a. this is critical. we take this very seriously. no veteran should be harmed care.e of delay and we need to reobviously this problem, we have a good health care system. assure that veterans have access to that health care

system. nationwidel this review be done? >> i believe it's going to be completed in the next week or so. there was a new round, the secretary requested that all evaluated, not just the larger facilities. so i don't know the exact date conclusion. >> well, i agree with the intention behind that. have the concern, can we rely on their self you when some of these people are hiding information, will they be up front with you? >> i think, congressman, that it audit, i think i have the i.g. assisting us, think we have the resources to identify where there are in our system. we have to do that. we have to restore the credibility. >> thank you, and mr. chairman i yield back. >> mr. brown, five minutes. you.ank let me thank all three of you

for your service, thank you very much. because i think it's very important that we have veterans in the veterans administration that's committed to veterans and by the way, many veterans work in the v.a. system? >> about a third of our employees are veterans, and i'm very proud that half of my work force in ocla are veterans. family membersre of veterans as well. we all care very deeply about mission. >> thank you. the fee for service, there's been a lot of discussions about service and we've had that available. lot of the reason why a veterans don't want the fee for service is they want their care and they've come to the committee over and over and us that they want the services in the v.a. and in fact, i know being on for 22 years i know it's not a lot of

dotitutional memory, but i have a little bit here, and on january 16, 2003, the bush administration just stopped faking the -- taking the v.a. requests for services. june, 2009, secretary shinseki just opened it up and victim veterans -- vietnam veterans come in. so that was millions and millions didn't have tot prove their individual case, which is with a was needed. it also was a great, a break to the system. to take it a step further. how can we work with the community, because i don't think to hire thousands of new people. thecan we work with community groups that are already doing it, one of the health, a lot of the need is not just that they

are homeless, they need care.hensive how can we work closely with community to provide the veterans with with they need? list, it'sst a making sure that they get the off the list.need >> congresswoman, the v.a. has been holding summits for are the years now to the best of my knowledge, where we providers innity understanding what our mental health needs are and engaging participating in the mental health care of our veterans. >> do you want to speak to that? would just echo, many of you saw the senate hearing had ourk where we veteran service organizations make statementings, that the beste truth is v.a. is the health care provider for veterans. in fact, v.a. specialized incomparable resources, they can't be duplicated in the private sector, that's from carl blake the paralyzed veterans of

america. in am vets they said the same not there out one of the premiere health care systems in the world in our haste to fix these problems or achieve political goals. commander dellinger of the noted thatgion private care can help get money more quickly, but we have to put caveat on that if it exant happen exceedingly, because there's goes the buyer budget which isfee based going to be higher in the private sector. know for myself, congresswoman, for loved ones that i've had who have sought the community, while bright and well intended, did the same transformative v.a.,hat they received in that was life changing for them, family.our entire >> and i agree with you, and been lots of accusations based on whether or how many people have died in

the system. those are allegations that are investigated. i just really have a problem when i listen to the television or the scandal, the scandal. for been a scandal for v.a. years and finally we are getting the servicesand that we need. the budget,arded someone says why do you turn this money back. no. doing it like the other agency used to do it. you got to spend it by the end year or else, and you just buy gadgets. we have that money for next year. so we can continue to work with make sure that they get the services that they need. speak to that? because that was something i think that was very important. >> the gentle lady's time is two seconds from expiring. >> okay.

>> gentle lady's time is expired. mr. chairman. i appreciate it. to dr. lynch, define timely care. because you said the vets were waiting list, they've had to wait a long perfect of time that they'll be able to go to receive thee care. define, what's your definition -- >> right now somebody goes on waiting list if we cannot provide care within 90 days of request. ideally we would like to provide more timely. outside -- time.days is a long with regard to the records, are yearware that the fiscal 2013 the department was found to be at high risk regarding record obligations by the

national archives record administration, are you aware of that? congressman.aware, >> if you're not aware, does anyone else on the panel, miss aware of that? >> i'm sorry, the question again? >> the department was defined as, they were found to be high risk regarding records management obligations, are you aware of that? sir., >> can you please provide me, pleasep and miss mooney, provide the committee with sinces the v.a. has taken this finding to correct the records management processes. you can provide that information to me and maybe to the chairman of the committee, the entire they wish? >> we'll do our best, congressman. >> please do. much.you very with regard to the list again, how and when did you become the list?

>> i initially became aware of was in phoenix holy thursday. actually, i take that back. easter.monday following we were talking, i was talking davies and he indicated that his conversations with the staff in scheduling had was aned that there intermediate work product that provide theed to names of veterans. >> did he create the list? the list? create >> the doctor you're speaking of. >> no, the list was created by the v.a.'s health information system. when an appointment is canceled, cancellationat process, the list of the patients who are canceled is provided and is printed out so that it can be used to assure thoughs that patients are rescheduled.

>> okay. after the list was created, who notes on the or contents and what did those notes or comments state? thereon't know whether are any notes or comments on the list. was the listeople circulated to, do you have any idea? >> i don't know. you get that information to us? >> i can try. >> please do. if we cansk feehan is identify that, i can't promise you that information much. get it to us to because i think it's very relevant. mr. chairman, i yield back. >> i know you get whip sawed back and forth by different members who feel urgent, this urgency to get answers. you state ms. moony that you think the audit might be complete within weeks, a week or two.

>> yes. >> my question to you may seem a little per verse, but how can you get the audit done so quickly given the scale of the department? that a realistic turnaround time for you? >> congressman, maybe i'll try to answer that based on what i know about the audits. v.a. has mobilized resources from across our system. we have asked each of the networks and facilities to provide volunteers to do these audits to go out and evaluate hospitals so that we can get this audit completed in a timely fashion. >> again, i go back to the issue of how good this information is that you're getting from people. public officials have called for criminal investigations or turning this over to the justice department.

are people going to lawyer up, clam up? is that going to slow down the ability to get information out of people? >> i am sure that there are people who are concerned. i think that the i.g. is also our partner in this. they have also been evaluating facilities particularly those with concerns. they have authorities that we don't have to obtain the information we need to assure that we establish the integrity of our system. >> it seemed as if you did things were he turning to goals -- i forget what you said -- that you put goals ahead of everything else. i forget the term. >> i think what i said is that we need to focus on our primary goal and responsibility, and that is assuring timely care to

veterans. that is giving veterans access to our system and providing quality care. >> i thought there was a line of questioning was really enlightening when he brought up the case of enron that maybe the incentives that were built into the management of the v.a. and health system were induced some of the results that we have seen today. >> congressman, i think that's possible. i think that's what happens when measures become goals. >> well, in the situation we're in now, i'm kind of concerned less about the rewards or the incentives that might have led us to this point. i'm concerned about the amount of time it's going to take to get a good accurate audit and that maybe the punitive atmosphere may also impede that. that's where i'm really going with my line of questioning. human ense that is

instinct going to cause us to see ab audit that is maybe less than whole? >> i can tell you, congressman, that we have discord system failures as part of our audit. i don't think that our audit is going to be a whitewash. i think we are identifying some of the same concerns that the i.g. has identified. >> real quickly. is there a shortage of providers? is that within the system in these particular areas where we've seen failure? is that a large part of what the problem is? >> there are some facilities where there are a shortage of providers. i think to the point i think there are things that we can do to provide the efficiency of our providers. i think he would agree with me that we can provide services more efficient so they can see more patients.

there can be simplor solutions than hiring physicians. there could be hiring support so that physicians can see more patients providing them additional rooms so they can work more efficiently. i think it's not just the provider. it's the support we give the provider so they can work efficiently. >> this fee for service, i applaud your effort to simultaneously try to get these 1700 people seen by providers. but i'm more worried about the systemic consequences of that. are fee for services sufficient for physicians in the private sector to take on these patients? >> there are some communities where we do not have sufficient fee providers and we're going to have to look at how we address capacity issues at our v.a. facilities so that we can see those patients in a timely fashion. it's a complicated process. we have to assess how efficiently we're working, how

efficiently we're allowing our physicians to work, and what's available in the community. >> thank you. i'm sorry for going over. >> thank you. >> mr. chairman, i do want to say that the mountain home facility in johnson city, tennessee, there have been a lot of letters to the editor recently all been positive. there are a lot of positive things that go on with the v.a. secondly i want to remember asking the secretary every time i've been here do you have the resources you need to do to take care of america's veterans? and the answer is yes every time. so something is wrock. the question i have very quick -- wrong. in phoenix, what happened? and i can tell you flatly how to make the doctors more efficient. right now we've got physicians in the v.a. system that are clerks. they have to call and schedule their own appointments. they have to do all the data entry. they have to do all those things. that slows you down enormously

when you have to do that. you could hire somebody just to put the information in the health record and about double the capacity or 50% increase in any physician because it slowed me down about that much when i got the records. i can tell you in two seconds how to make that happen. but in phoenix specifically when you have people calling in -- i understand when more people called into my office that we couldn't see we needed more providers because we were as efficient as we could possibly be. and right now, i mean -- and you made the comment and in my hometown in orthopedic surgery the doctors are operating were in private practice and got toward the end of their careers and got tired of fooling with all the stuff that's going on and went to the v.a. they're very fine physicians but they were very fine physician it is day before. and i think i heard dr. lynch just say that in 90 days if you didn't get taken care of we'll get you out into the private

sector. are you saying today that if i'm a veteran with a bad knee and it's not fixed within 90 days we can get that veteran out into the private sector and get that fixed? because it's not happening right now. >> it depends on eligible but i think we have the options to do things -- >> i think you said in 90 days. a veteran doesn't have an appointment taken care of. i'm going to go back home and when a veteran comes up to me and said itch assurances from the v.a. that you can get your knee or hip fixed in 90 days. because we can do that in the private sector. >> within the limits of eligibility we hope to get that done. >> well, no. that's not what you said a minute ago. you said we're going to do that. i think i heard you say that >> congressman, we are going to get that done within the limits -- >> so what happens this summer? august when i go home during

the august recess and the veterans are not getting taken care of? they're having to wait six months or a year, 18 months, to get a hip or knee replacement? >> then i hope you let me know so i can look into it. >> that's not what you said. >> i'm saying if that hasn't happened i want to know about it so i can identify the problem and fix it. because it should have taken place. >> well, what was the problem in phoenix? i understand all the lists. what was the reason these veterans couldn't get in? nobody even said that tonight after two hours. >> congressman, i think part of the reason was capacity. and their ability to see patients in their system. it appears that they needed more physicians. we're providing more physicians. there was probably an inefficient process of handling patient requests. i don't think they had enough personnel in their scheduling

area to get patients on the wait list and to get them scheduled. >> when, if at the v.a. -- let's say any system in the country. if those -- and it's been sort of dancing around a little bit here tonight. but if a v.a. system is sending out into the private sector a fair amount of people, how does that affect the bonus of the people running the business and the local medical center? in other words, we know that scheduling time, we've learned that's one thing. but is that something else that affects their bonus? if i send this veteran out to get care promptly, then it will hurt me financially. is that true? >> i don't know, congressman. >> what metrics are used to determine what bonus is provided for v.a. director? it varies by network. the network director makes the decision. >> each network decides how the bonuses are handed out? >> they're going to establish

based on their facilities. >> can you get me the criteria for how that, for how someone is paid a performance bonus in the v.a. system. >> congressman, we'll try to get that for you. >> will you get it for me? >> yes, sir. > thank you. >> dr. lynch, you've said you went to phoenix for six days and mostly what you did there was try to stay out of the way of the i.g. you didn't talk to any doctors, didn't talk to any veterans, didn't talk to any wherbles but you whirbles but did learn about the procedure. we've learned about goals, metrics. i'm not sure what all that means but most of the focus has been on the past. i'm more curious about the future. if you put in reforms and all these problems, you hire more personnel, bring more doctors,

improve accessibility, get rid of all these scheduling schemes, how are you going to know if they're work sng are you going to come with a new set of metrics? are you going to do a whole bunch of more audits? are you going to do anecdotal evidence from interviews? how do we know we're going to make progress? >> i think first of all, congresswoman, the key is to assure that we have the right goals. if we hold people responsible for the right goals, how many patients are you getting into your system? how satisfy -- satisfied are they with your system? then the performance measures become tools. if you try to game those you lose. if you don't know who is on your wait list and get those patients in and increase the number of patients you're treating, then you lose. we have to set up a system where we know what our priorities and goals are and our metrics are focused on giving us the information that assures that we can achieve

those goals provide increasing care to veterans and quality care to veterans with increasing satisfaction. >> but hasn't that been the goal of the v.a. all along? how is that a different new goal? >> i think where the difference occurred is that in some cases -- i think in some cases our performance measures became the goal. and we need to get away from that. we need to use our performance metrics as tools and we need to focus on our core mission, our core values which are treating veterans and providing quality services so that we get good patient satisfaction. >> are you going to have some milestones along the way so we'll know that progress is being made? we don't have to wait like two years from now until another crisis comes and then we go sorry those metrics didn't work out so well we've got to get some new net rirks? >> i think we have the tools right now that allow us to monitor the system, to know

about access, to know about consult delays. we need to assure that we have integrity in our data systems, that we're getting acrass information so that we can use those tools to provide assistance to facilities when we see that there are delays. when there is increasing demand. >> if you have those tools right now, why aren't you using them verage the tools have been implemented over the last year. we have been putting those in place. right now in certain cases the information we're getting has been compromise bid the data that's being entered into our system. we need to assure that we do clean up the system. we understand where people are not giving us accurate information, and that we instill in our system a sense of integrity. it begins at the medical center, it begins with the vissites. we have to respect the fact the data is important because we can't treat appropriately and timely otherwise. >> you're going to have these systems in place at all the

facilities? and if you discover problems say at the las vegas hops are you going to bring in these new personnel, schedulers, doctors, to do all these major changes at every facility where there's a problem? >> hopefully, if we can begin to identify the problems before they become major issues, we can work with the facilities to identify where they may need additional resources or where they may have to institute efficiencies either in scheduling or in their clinics to provide greater capacity. i think we can use these tools in one of two ways. we can use them to make decisions whether or not we should be buying the care in the community or whether we should be hiring providers and making that care internally. we can use these measures to ask critical questions. are your clinics effectively managed? are you using your personnel effectively? there are a number of ways that

once we have this accurate information i think -- and we can get beyond the wait list that we have now, we can get to a steady state situation where we can identify delays before they become significant and institute actions to assure that they don't become major issues and there aren't delays that result in patient harm. >> thank you. >> i have sort of a philosophical issue i've been dealing with and it goes back to early 2011 shortly after i was sworn in. my very first dealing with the v.a. was when i was trying to help a world war ii veteran that was trying to get hearing aids and he had been delayed in getting these hearing aids somewhere in the neighborhood of two years. finally the way i was able to help this gentleman is i threatened to take my personal funds and buy this gentleman a hearing aid but then put out a press release that i did it and the v.a. said we don't want to

be embarrassed. there are a lot of great people in the v.a. and dr. lynch i think you're on point maybe the v.a. has lost its north star a little bit or some people within it. not all of it. i think it's got thousands of employees do a great job but i think we've got some that have et a bad culture corrupt them. so we have a system where poor performance is not punished. and if you cook the books you can wind up with a bonus out of that. and the outcome was lots, thousands of veterans are waiting for health care and some of them died while they were waiting. this brings into focus, how good is a federal government bureaucracy? this is the same federal government that's spent hundreds of millions of dollars on a health care website that didn't work for months. i think we as americans need to

say what is -- what do we want to do here? if our goal is to take care of veterans then i think we as congress need to try to think about other models to do this versus using a huge bureaucracy. i mean, again, if our goal is to take care of veterans we need to think outside the box and how to do this. this ought to be a wakeup call. we've got an agency committed to taking care of veterans but what's going to happen when we have a federal system under obamacare that's going to have to take care of millions of americans and use a federal structure? this is a wakeup call all americans need to think about. dr. lynch i have a question. there were three employees placed on leave in phoenix as a result of the i.g. report that came out today. do you have any idea of the background behind the folks put on leave? i mean why and what happens next with these folks?

testimony e in his -- and i'm trying to think. i believe it was before the senate veterans affairs committee, the inspector general indicated that the employees were placed on leave so that they would not compromise the investigation by their presence. >> ok. mr. chairman, i have no further questions. >> thank you. >> i would like to call our attention to appendix d of the interim report which we got today, the oig oversight report on wait times. we've had 18 reports on patient wait times in eight years from 2005 to 2013 and now is the time so we know there is a problem we know what the problem is and now is the time to fix it. i want to go then to --

>> common, i think we've gotten the message. we know we have a problem. we know we need to fix it. >> but dr. lynch what i do not want to see is in eight more years 18 more reports and we're still dealing with the same problem. >> i don't want to see that, either. i think we have a good health care system. i think we have a health care system that veterans value. and it's our responsibility to assure that we fix this problem and get them timely access. and don't allow it to destroy this system. the v.a. offers many unique advantages to veterans. we have to assure they get those advantages. i think it's a solveable problem. i think the v.a. has solved problems in the past and has been better for the criticism we've received and with the collaboration of congress has come up with models which have actually been exemplary and been adopted by the private sector. >> i want to call your

attention to appendix e which is the april 26, 2010 letter about the inappropriate scheduling practices. dr. lynch, when did you find out about that let center and when you did what did you do about it? >> i found out about the letter i believe when it was presented on nbc news approximately two weeks ago. two or three weeks ago. i had not seen it prior to that. it had been issued before i arrived in central office. >> ms. moony when did you first see that april 26, 2010 letter? >> probably sometime in 2010. >> and what did you do about it when you saw it? >> i think with that we were all concerned and v.h.a. looked into it. there was an obvious reason why the memo was written. >> i am extremely concerned

about that answer. this is clearly was sent to all of the directors and the central office in 2010, and nothing was done about it. how can that be? >> congressman, i wasn't there at the time. i can't answer that question. i only became aware of that memo and that letter within the last several weeks. >> let me just say this. let's make sure that this doesn't happen again. and mr. chairman, and ranking member, i think it's incumbent on this committee to continue our oversight responsibilities until this gets fixed. it is not acceptable that we have 18 reports in eight years and we're still deal with the same problem. and our veterans are not getting the care they need. with that, i yield back. >> if i may ask one question. you said dr. davies.

did he accompany you on your trip to phoenix? >> he was in phoenix. >> was he part of your investigation? >> he was part of the initial visit that we made. when i returned a week or so later, i had a different team with me that was specifically focused on looking at the scheduling process. >> his job now is? >> his job is in systems redesign and working with our access and performance measures. >> so he is in the same position today that he was in 2010? because i'm looking at the memo from william schoenhard. and it says for questions please contact director davies. this is the same person on this memo? >> it is. >> thank you. >> i'm going to ask the same questions.

there are audits ongoing right now in the v.a. centers in each of our districts today. is there any reason the v.a. would not share that information with members of this committee with members of the house and members of the senate on specifically what's happening in their v.a. center? >> we look forward to sharing that information with members of congress. related to -- >> so are you committing that the v.a. will be sharing that either public or private briefings with every member that is requesting one? >> i know, congressman, that we will be briefing members of congress and their staffs on the results of the audit, absolutely. already the gentleman yield? >> yes. >> is it true that senator doiben has already received a briefing on chib? -- chicago? >> no. i don't think so on the results. i don't know. i don't know. >> you're the undersecretary for taufs of congressional affairs and you wouldn't know

if senator doiben already received a briefing on chicago? >> here is what i know. i know facilities have not -- not to my knowledge or understanding. now, what facilities -- we will be briefing out facilities as we go. >> i only make the request because i've read about it in the media and so i would find it very disingenuous if the united states senate senator has already been briefed on a facility in his state and members of the house of representatives are asking for the exact same thing and we can't -- and i apologize. i yield back to the gentleman. >> i look forward to that information as well. as well i've heard for the palo audit is already complete. so i would expect that i have an immediate briefing this week. i will be calling your office later this week if i've not received a briefing before we head back home. >> i look forward to it. >> i want to talk about a

couple of different case that is came up here. james pert was a marine who fought in vietnam from 1968 to 1970. in his early 60's he is partially disabled. his exposure to agent orange and ptsd left him with several problems. he was told the wait list to see a v.a. doctor was six to eight months long. is there any reason that somebody would have to wait six to eight months? >> no one should have to wait six to eight months. >> i would agree with you on that. is there any way possible that in phoenix or any other v.a. system that somebody would be told by a doctor that it would be a six to nine month wait? >> congressman, i would hope not but i don't know the specifics of the case. >> we've been hearing a lot tonight about trying and hoping. trying and hoping is not solving this problem. is there any problem with somebody moving to phoenix from a separate area that they would

be denied service because they came from an outside area? >> congressman, one of the areas that v.a. does need to work on is how we transfer patients across our system. it's not a seamless transfer as it should be. we are working on processes to make that better. ideally if a veteran is being treated by the v.a. and moves to phoenix, we should be able to coordinate that transfer so that he doesn't have to become a new patient in phoenix. >> thomas green was a 71-year-old navy veteran from brooklyn new york. he was proud of his service and when he fell ill he went to the phoenix part a. his condition was rated as urgent but he was unable to secure an appointment. is there any reason that somebody would come to the emergency room at v.a., see a doctor, be rated as urgent, and then sent home for several months? >> congressman, i don't have an explanation for that.

>> is there anywhere in the v.a. system where somebody comes into an emergency room under an urgent condition and they are sent home? >> they should not. >> and what is the wait time the standard wait time for an urgent claim? >> i deally, if the patient was considered to be urgent, it would depend on what the urgency was but certainly should be seen within seven days. and if it was truly urgent the patient should be admitted to the hospital. >> should be doesn't always solve the problem. after seven days is there not a tickler file or buzzer that goes off, red light that says oh my gosh this guy was urgent and it's been seven days? maybe somebody should follow up. is there no system like that today? > in phoenix i don't know. >> he was admitted initially because of a blood in his urination. it says there were no tests that were done. is there any possible way that

somebody could come into an emergency with -- room with urinating blood and no test be done? >> i would find it unusual but i don't know the specifics of the case. it is my expectation. >> his family called several times over and over again. would there be record of those phone calls guest: i don't know with a, congressman. >> you don't know if there would be records? somebody calls a v.a. center and we don't document whether or not they called and what the issue was? >> congressman, i don't know where he called. i don't know the specifics of -- ideally, if he contacted the call center there should be a record that that call was made. >> mr. chairman i would ask for your indulgence. i will be real quick on my last couple pertaining to this one issue. >> you'll be quick on your last question. >> they waited from september to november.

he died on november 30th. is there any reason why somebody who is waiting on a list urgent or unurgent if they're waiting on a list that they wouldn't -- the v.a. would not be notified that somebody passed away? >> i think it would depend on where he passed away. the v.a. now in phoenix does have an arrangement with maricopa county. they do receive a list of all patients who died in the county so that they can look at whether or not there were any veterans that were in that list. >> and the v.a. called a week later. that's a good reason to make sure that we know so that you're not upsetting the family that much further after they've waiting several months to get a phone call from v.a. after their father passed away. i will just add that the comments to his family were i've got to go to the v.a.

that's where servicemen go. that is where we go. you serve your country you want to go to the v.a. i want a world class system for our v.a. but i don't want to see any more lives lost in the process. >> i don't either, congressman. one of the mornt things you have made a commitment to this evening is to restore trust. some good news that we received from the el paso vha is in march of this year veterans seeking new mental health care appointments waited zero days which seems remarkable and is exciting, except for everything that we're discussing today and our inability to trust twha we're hearing. i already said earlier that we took it upon ourselves to conduct a scientific survey to find out what the facts were and how long veterans were really waiting in el paso.

could the v.a. not employ that same method and in phoenix, el paso, everywhere that your auditting results right now, could there not be just this one-time daut but ongoing a continuing survey of the veterans treating them as customers, finding out about the quality of their experience and verifying their wait time as they experienced it against what the v.a. said they waited? >> congressman, one of the options we have been discussing internally is whether or not we could partner with the veterans service organizations and use their members as an opportunity to identify the kind of service we're providing and where they're experiencing delays. i think there is an opportunity there that clearly needs to be explored further. >> i hope you will do that. another thing that struck me was you were talking about a failure within the v.a. that resulted from elevating a performance measure into a goal.

which could possibly have led to the scandal in phoenix and other perhaps other failures and other parts of the v.a. if the current performance measures are not working what are some recommendations that you have for how we measure performance at our v.h.a. system? >> don't get me wrong. i think we need to have performance measures. i think they need to be tools that help us understand our system. and i can we need to focus on our primary goal which is are we seeing veterans? is our system growing? are we providing quality care? when those become the goals of the system, then you cannot game performance measures. performance measures become a tool. if you ignore them then you're actually hurting yourself because you're not growing your system like you're supposed to. and as a director or an administer you will fail. >> i also appreciate your

commitment to do more to listen to providers and try to make their jobs better and make the processes that they undertake more efficient. when we met with providers in el paso we heard stories about a doctor having to write a prescription to a veteran to be picked up by a van to be taken to a bus station to be taken by that bus to albuquerque because don't have a full service hospital in el paso. which further depresses his morale and ability to see the patients which he wants to take care of. so i appreciate the commitment that you made there as well. >> if i can just comment briefly. i think v.a. has a real opportunity as an educational institution to be able to recruit physicians who are familiar with our process and our electronic medical records. we have to assure during the

course of that training that we have a system that is physician friendly. we have to identify those things that are not physician friendly that interfere with physician effectiveness so that we can effectively recruit those people who are training in our system, who are familiar with our system. it is a huge opportunity. >> when i was running for this office in 2011, 2012, i met veteran after veteran who told me that they couldn't get in to see a health care provider for the entire year and this is at the beginning of 2012. they said all appointments have been booked. it's very hard for me to believe but it has since been confirmed by the data we've been able to obtain. when i got into office we found 20 full-time equivalent vake sis. we've been working with the local v.a. to staff those up. but when we get somebody and recruit them and bring them to el paso it's very difficult to retain them. they don't make as much within that system as they do within the d.o.d., as in the private sector. do you have enough resources

from congress to hire and retain the providers that you need to provide the coverage and the care that our veterans have earned? >> if we don't, i will be the first one to come back and let this committee. >> so you're saying you do today? >> i'm saying i don't have visibility right now on what we're going to need to staff our system appropriately so we can see veterans in a timely fashion. once i know that, once i know what our needs are, i can assure you that i will advocate to assure that we have the necessary resources to hire those physicians. >> thank you. >> mr. chairman, if i could follow up on a few questions i ask in my previous round the first. i appreciate my colleague from arizona referencing 19 reports. there are also 16 g.a.o. reports. this is nearly a decade. this is nearly a decade of excuses.

and i don't know if dr. lynch was there ms. moony was there mr. huff was there i'm sure he wasn't. but what i hear today is there's no accountability from any of these. let's start all over again. so 35 reports tn years later almost a decade later we're still here trying to get answers to the same questions asked in 2005. but what i want to ask you today is a question i asked in march of 2013. i think dr. lynch was at that hearing. as far as the issue of accountability and holding your employees responsible for misconduct and gaming the system, that was back in 2005. i requested a list of those who have been punished, censored, lost their bonuses. that has not been provided. i've been waiting since march 14 of 2013. when can i expect that report from your office? >> congressman, i don't know where that report is. i would have to defer to ms.

moony. >> i'm sorry? what was the date again? >> march 14, 2013. there was reference to gaming the system and i asked questions of who would be punished? how would that be treated? meanwhile the bonuses continue. you realize the information we have -- information from a website source. we can't get it from your age sifment but at phoenix, an $843,000 worth of bonuses. so was over a two-year period. what we haven't received yet is the listing of those who lost their bonuses for failure to the system. who are we going to hold accountable? it's easy for you to stand up here and say the buck kind of stops here or maybe it doesn't at all. but who made the decision? the director in phoenix. maybe there's -- >> my question is when will we get the report answered?

>> i'll work to get an answer to your question. >> how soon will i get an answer? again, march 14, 2013. still waiting to know how the secretary of the v.a. is going to hold employees accountable and responsible for what i think are criminal violations? >> i will work to get that information for you. >> the last thing. trying to identify how many waiting lists are at all v.a. facilities. and if i understood dr. lynch, every facility has a near tracking report. is that correct? >> every facility receives a near report. which is an enroll yes request. >> and every v.a. facility has a schedule and appointment consult as well? >> that may be unique to facilities. that is probably not universal across v.a.

that is a tool which can be used. >> and the o.i.g. also referenced at the phoenix v.a. screen shot paper printouts which are not reports, but there are 400 veterans hiding in that system. nd again, the cloirk to oig is these folks hidden in these secret waiting list that is could be at any clinic were and are continued to be at risk of being lost or forgotten. as a result these veterans may never obtain the appointment. so if i understood correctly from the report and your testimony is these secret waiting lists could be at every v.a. facility in the country. is that correct? >> i don't think they were secret. i think they were -- >> how did you not find them? you were there. >> i did find them. >> how many were on the list? you told me you didn't look at this list. >> i told you we didn't document the numbers. i told you we were aware of the process. >> why didn't you report to the press and to mr. shinseki and

the president of the united states that there were 1100 veterans waiting for care on that list? did you tell anybody above you? you waited 35 days. 35 days that you say you cared about them. they waited on a list languishing. what about the 1100 veterans? you knew about these veterans that were waiting for care? >> i wish i have had identified the number and we could have move forward more quickly. >> did you do anything to get care for them? some of them might have been on the list that died. >> we identified the processes and we put people -- yes or no? did you do anything for those veterans? >> i put in place an understanding of the process which allowed us to -- >> they are still waiting for care. i think that's your afpblets i yield back. hearing tonight is members of congress who are doing what they should do they're channeling the mubble

american public. many heard this. it's on people's minds. which shows you their commitment to getting this right is there and finding solutions and i appreciate that statement that this is about establishing and maintaining the good parts and the important parts and the critical parts of a world-class health care system. and trying to reestablish that sense of trust so they're channeling that. it's also incumbent upon us to understand how things work. how the system works and understand the positions you're in and where you're at. i think it's important to point out there's people that failed our veterans horribly, there's people who failed the secretary in this. i do think it's important and i would note mr. huff's not a political appointee. he's a civilian civil servant and a veteran and i'm not certain why you're here but i appreciate you coming here, i appreciate you standing and being willing to answer the questions. i think as we go through this painting with the broad

generalized brush is not going to be helpful. but this desire to hold accountable, it's not personal in terms of personally trying to damage someone. it's personal about the care for those veterans and it's personal about this belief. if someone can not be held accountable for such egregious dare licks of their duty, how can we expect for it to get better? so i hope -- i would ask and i think the statement that's coming through on this is, yes, we need the data. yes, we don't need to jump to conclusions, yes people deserve due process. veterans on the list and people that are setting here or elsewhere trying to get that right. i would suggest or put forward in seeing this, i think one of the things we're going to find out in this is that why it's a large system there are distinct differences. i would put forward to you as we went out several weeks ago to the minneapolis v.a. i went with the leaders of our

veterans service organizations. and as director briefed us we did the audit. they produced the numbers. and then i asked them and told them we're going to produce this for the press and a courageous decision was made by the direct tor go ahead and release that data and put it out there. and so what you had happen was that you had this audit, you had the vso who by the way hold offices inside that medical center, the legion sets in that office. and so these leaders on a weekly basis meet with the director. they are the consumer advisory board that meets with the director. so many of them were saying i don't know and we will still find out but yoverage we could be surprised but there was a collaboration and a cooperation. and it was released to the press. guess what happened. a belief amongst the press and an outpouring of people saying well yeah they're failing on that. audiology is too long. of that will meteorology has gotten better.

primary care is good here but not good here. but we had an honest accounting. and people said now we know where things are at. let's find solutions. by not getting that data, by not having that collaboration, by not having that cooperation, by not pulling in your partners who want to help you, it creates the frustrations you're hearing. so i can't go back and up again i will not allow people to paint this system with a generalized brush because i know the high quality of care. i know veterans' lives are depending on it being open. but i also will not sit back and allow you or anyone else to let this system disintegrate because we're unwilling to answer some of these questions. what was asked about the bonuses is not unreasonable. and i don't know why -- and i get it -- everyone deserves their due process. but there's such a desire on this, this ends up looking like you're protecting the bad actors. and it can't be healthy for

you. it can't be. and the question that got asked is i know -- i'm an enlisted guy. we know where this is going. you're being a team player but they're pulling you down. they're pulling the system down. the bad actors are doing this. we've got to hammer this. we've got to hammer it now. we can't wait this long. we know what's out there. i just am baffled that some people have not stood up and said we were doing it wrong. i'm going. this is why it is. that's not about a pound of flesh for the sake of firing somebody. it's about that we got to have some healing. it's almost that way. so it's a statement. i want to make clear mr. huff, you did not deserve to be treated in that way. none of you do in this case but it doesn't mean that someone is not going to have to say, it's me. let's go forward. and let's get this. because dr. lynch you summed it up. toot -- it is too important of a mission to fail. >> i do believe that the v.a.

is better for a lot of thing that is veterans need. it's a better place for them to be, where they're around those that have similar ailments, similar problems, whether it's reaction from agent orange, tbi, pts, i know we have a great providers. i heard an expression a couple weeks ago that i think is probably true. if you you've seen one v.a., you've seen one v.a. and they're all very different. and that's a problem that we have within our system. dr. lynch i know you've been a provider. have you ever been in private practice? >> i've been in academic practice. >> and that's the same thing i asked someone else at one point. we have a lot of people never in private practice, which is a different model which is driving to see more patients as we alluded to before. and to do it efficiently. and that you wouldn't let people wait because you need to get them into your practice. that's how you keep your doors

open. dr. row referred to adding a doctor because we know we're already efficient. and i think we need to look at. when i got here -- i'm a new member, i want to be part of the solution. and i met with general shinseki about three times and offered every time to go into v.a.'s, to go into hospitals and the o.r.s the clinics and say how can we do things better? i've been a provider in d.o.d., another government-run system, if you will and there's a lot of thing that is have been referred to tonight where you're doing stuff a physician shouldn't have to be doing because it takes away from actually seeing patients. and again, it gets to that problem of actually getting patients into the door. the i.g. referred last week if we put more money we solve more bureaucracy not more care being given. that's a problem we need to address. one of my questions is are we really looking at physician-driven policies?

are we getting bureaucrats driving the policies or physicians driving the policies? i have two partners many n my private practice they go to the v.a. once, twice a month. i do two surgeries in the time in my private practice i do six to eight. that's a problem we've got to face and we're hearing more and more stories like that. so are we letting the physicians drive the policy or bureaucrats driving the policies? >> i hope we're seeing more physicians in leadership roles. i made that decision three or four years ago that i thought it was a good move. to get further education, to learn more about management. and to try to be a physician who provides physicians input into management. i think it is important. i think you make good points. i think our physician ks work more efficiently. i think in fact it is much easier to hire support personnel than it is to hire a physician. >> exactly it is. and that's your physician

extenders allow you to do more. >> and i don't think we've taken advantage of that model in v.a. as effectively as we can. >> you want to talk about the concern of this committee. there's four doctors on this committee. bipartisanship. and we met separately with dr. jesse and with dr. edgar waled to discuss how we're evaluating efficiency and nowhere in there was like how many patients on average is a certain specialist seing in an eight-hour period. well then what are you measuring? i understand you're looking at quality and cost. but if you're not looking at numbers -- in our private practice if one doctors is seeing 60 patients and another is 30 we're taking a look at that situation and how we can make it better. there's noth

we would like to see some justification or precedent set in this situation. is that possible to get a legal memo on that? >> i'll take your request to general counsel, sir.

>> thank you. i yield back. >> i think there's an assistant general counsel in the room. could we get an answer from that individual? there's nobody here from -- could you come sorry sir could you step forward and identify yourself? richard epol et. general counsel for legal policy. >> would you ask your question again? >> [inaudible] general counsel to conclude that withheld documents are privileged? and that memo can be redacted. we would just like to see some justification of precedent here. >> yes. we will do that. >> thank you. >> and sir while you're here

can you find out why mr. huff's notes were not delivered to the committee as requested in the subpoena? >> yes. i'll check into that. >> thank you, sir, very much. >> i just have a quick question for dr. lynch and ms. moony. based on data in the inspector general report do you believe there's a need for criminal investigation? >> i think the inspector general will make that recommendation. i believe based on their findings they have the ability to initiate a criminal investigation if they think it's appropriate. >> and you concur with their findings? >> we work with the i.g. i respect their opinions. i respect their reports. and i think if they feel there is criminal cause then we need to respect that judgment and let the process follow through. >> and ms. moony? >> i concur with dr. lynch. >> i yield back my time. >> i want to associate my

remarks with those of mr. wolf. i think you're hearing tonight a frustration of the members here because we do have an article 1 authority to ask the questions. but our frustration is rooted in the fact that while we conduct the necessary oversight as part of our article 1 responsibility we continue to hear of a wait list and know that there are wait lists. and we are held accountable for that from our constituents. it's kind of a remarkable process that our constituents hold us responsible for a wait list created by the administration. and that's probably fair. because we have to excute our responsibility. we have the privilege of living outside the beltway and working inside the beltway so we do hear stories from within our own community that are

personal. we hear of delays and in medical care. i had a gold star mom who came up to me memorial day she believes that her son took his life because of a lack of timely mental health care. and that's a real story within our community. that is the frustration because while we have to provide the oversight and get to the bottom of it all of this is occurring while there's still a wait list. and so my message is very sirm -- simple and i mean it constructively. we need to clear the wait list now. we will get to the bottom of how we got here. but the american people, the people in my community are more concerned with the fact that a wait list exists than how we got here. and ultimately that's a responsibility and a fix that we have to rely on the administration for. and we have to rely on the president for his leadership. and i am asking for his

leadership on this. it is not political. when he spoke last week he spoke of the investigations into how we got here. he spoke of sending mr. neighbors there to arizona. and all that is right and well but he didn't speak to clearing the wait list. and on behalf of all of us and on behalf of the administration, i think we need tangible measures to restore the crisis and confidence of the american people right now that's been created by the notion of a wait list. that there's untimely care being provide bid the v.a. that's the issue that we need to hear addressed. dr. lynch i'm pleased to hear that there is a plan in place over the next 48 hours to get to the bottom of it. but i think the american people need to know that. and my only question really is will you take back to the secretary and frankly to the ppt of the united states a plea from this member of congress to please hold a

for you. >> i don't mean this politically but this does need to go to the president of the united states and here's why. when he held his press conference he took credit for having made reforming the v.a. a top priority when he ran for senate. and again when he ran for the president last week in his press conference he took credit

for the reforms that he is responsible for. if he is going to take credit for those reforms he needs to lead on this issue. it's not political. he needs to lead on this issue. i'm asking for his leadership on this issue. and i can tell you people within my district and i know communities across the country are asking for that leadership. and i for one will rally behind him the moment i see him because it's not a partisan issue. i yield back. thank you. >> thank you. and a final question. you're recognized. five minutes. >> thank you and i want to thank you and the ranking member for putting together this important hearing. i'm sorry that i missed a portion of it. i had an amendment on the floor on veteran treatment courts and was trying to deal with that. but i want to echo what mr. jolly just said. i think i also my constituents and my veterans and my community also are saying they're not so concerned about how we got there right at this moment.

but they want to resolve this issue in terms of getting a timely response and making sure that their health care needs both physical and melts needs re taken -- meltsd -- mental health care needs are taken care of. i think the one question that i wanted to conclude on is that i'm happy that we're going to do a sort of national audit. i want to understand what that includes. does it include like the oxnard sea bock in my district? does it go down to that level? and -- >> it is my understanding that the audit has now been extended to all v.a. health care facilities. >> very good. and then if the v.a. could provide us with a time line of every single facility and when this audit is going to take place and when it will be

completed and what are the results of that so that we have a time line that we can report back to our districts obbut that we can also monitor and watch to make sure that we're covering every single if a stilt across the country. phoenix has brought a lot to our attention but i'm concerned about so many other facilities across the country and if i could get your commitment today that you will provide us with that information i would be very appreciative. >> i will do my best to get you that information. i think it is available. i think our process has been well tracked. and i think we should be able to basically show you when each facility was audited and when the report is finished to give you information about the dauts at each of our facilities. >> a follow-up question.

as far as performance and the difference -- >> the network directors established the performance standards. fordeputy under secretary health and operations management establishes the performance managers -- measures. >> are they different? some performance measures that are standardized across the system. there is flexibility to introduce standards that may relate particularly to the network or facility. >> i wish you would look at that. what concerns me is if different networks have different performance measures, i don't know why they would be different. my big concern -en