>> it's always the same. they isolate and usually transferred to another position. why? because they are slowly building a case to say that you are crazy. they you are not being truthful. and i apologize for running over. i would hope that i have given -- 270se to 176 pages six pages, i think, of evidence. a number of other statements and individuals that would be helpful trying to improve the system. i would hope, especially the press, i challenge you to be a real reporter and actually

report the truth. not to insult the reporters. and also the congressmen and women. tois important that we try focus on what is really important here. that is the veterans of this country. thank you. >> as an employee, i have routinely suffered retaliations. talks about the devastating effects on patient care. in sections four and five of my written testimony, and outline specific packages to suppress whistleblowing and also to retaliate against anyone that speaks up within its ranks even without whistleblowing. the v.a., in my opinion, has routinely intimidated any

employee that has brought forth information contrary to the public opinion the v.a. wishes to project. after they receive my report, i was placed on administrative leave for one month. i was investigated for misconduct because i provided limited amounts of information in order to support my allegations of the suicide andds and the facilities appropriate response -- inappropriate response to them. counseling stating i have violated a policy but do this day they will not tell me what i violated. this is minor realitation given the last three years. during that time we were

under-staffed and there wasn't staff to wash beds, answer telephones, deliver patients and transport labs. doctors and nurses were pulled away from direct patient care to perform these duties. when the number of patient visits increased to the er the deficiencies became obvious. the number of mistakes skyrocketed. strokes, heart attack, blood issues were missed by inexperienced nurses or seasoned nurses who were overwhelmed by the flood of patients hitting the er. i started pointing the mistakes to the facilities chain of command. 20% of the nurses retaliated against me and refused to answer

my request or give me verbal requestion. the administration was made of this but wouldn't intervene to stop it. they ignored by request for additional er resources and staff and they would not increase the training to prevent the future mistakes and care being need make. they did ban me from reporting cases to the risk management department. my proficiencies dropped each year. i was forced to work two years of unlimited shifts because hr was too slow to fill-in with emergency nurses. things reached critical mass when the new oncoming medical director arrived i told her the er was too dangerous to remain open and we should be closed unless additional support should

be given. the administration's response was to hall me into a meeting and tell me the only problem in my er was my lack of communication skills. the nursing backlash that was reported would never be investigated. eventually i was transferred based on critical need to an empty medical clinic. i assume the medical director position of a clinic that only houses a social work program. i do useful work but it isn't intended what i wanted. d-day campaigns and ted offenses and counter offenses, desert storms and it is a bitter irony to me that as i a physician couldn't guarantee their health

and safety in a middle of phoenix. the va needs to embrace its core values if advertises on its website. it is very important that employees of any pay grade who true care about veterans and their welfare and that they be protected. they were often placed in the unthinkable position in being forced to follow ordered or les lose their livelihood. and the ability to positively influence the safety and care of any veteran shouldn't be considered a democratic rer republican stance or pro-union stance. the advocate for any patient is a human issue.

thank you your time. >> mr. davis you are recognized for five minutes. >> thank you, mr. chairman. i would like to thank the committee so the platform of va whistle blowers can be heard. every day a window of opportunities closes on a veteran to receive medical care. some burdens face the burden of being build were care their service has earned them. as noted in the office of special council report va leadership has failed to respond to the concerns raised by whistle blowers about patient care at va. despite the best efforts of truly committed employees at the hec and health administration who have risked their careers to stand up for veterans,

management at all levels have ignored them or retaliated against them for simply exposing the truth. some of the critical issues reported to senior va officials by whistle blowers include mismanaging critical program and wasting millions on a direct mail campaign. the possible purging and deletion of 10,000 health record and a backlog of 600,000 pending health applications. nearly 40,000 unprocessed applications discovered in january of 2013. these were applications from returning service members from iraq and afghanistan. the harassment i experienced at the hec from top levels of

management include my whistle blower complaint to rob neighbors was leaked to my manager who stated she was contacted me on behalf of mr. gibson and mr. neighbors and neither of them have responded to this fact. my employment records were illegally altered and i was illegally placed on a permanent work detail by the acting chief business officer stephanie martin. the was placed on involunitary administrative leave by acting hec director greg becker. unfortunately, my experience is not unique at va. darren and eileen owens who work at the atlanta va medical center have experienced the same

retaliation for reporting medical errors and patient neglect as well as misconduct by senior va police officials. our local 518 union president is routinely harassed as a direct consequence of assisting me and other employees with retaliation by members of management. mr. owens, mr. owens, ms. ivory are all veterans and in fact 50% of the staff at hec are disabled veterans. and allegations surfaced that applications for veteran's health care were being shredded under the director of kimberly h hues. they discovered this allegation and discovered 2,000

applications didn't appear as new enrollments. the investigation was closed by the office and she was also subject to harassment and intimidati intimidation because she dared to advocate for veterans. the statements i provided to the committee were provided to the oig and i urge additional review of those statements. in addition to providing whistle blower harassment i hope it provides insight to key three issues va management fails to address. wreckless waste ofunds and causing backlog for the sole purpose of achieving goals. why is there resistance to

implementing effective reporting system and the source of resistance as addressed by dr. draper and her testimony. and the need to remove managers and the critical need for the accou accountability act to be implemented. >> mr. davis, if you would, explain a little further the information you provided to rob neighbors who was detailed from the whitehouse over to the va that led to adver employment actions being taken against you. >> i contacted mr. neighbors about four weeks ago as the point of contact for the whitehouse i wanted him to be aware of what was going on in our whitehouse. there is a lot of attention on scheduling but i wanted him to

know about shortcomings with the enrollment system. a system we have spent millions on but are still back at square one with the va systems. i reached out about a medicare part d marketing initiative to encourage senior citizens who are veterans to drop their insurance and enroll in va and then you have to use the pharmacy and their doctors. many of the most vulnerable veterans were not aware of that and could get stuck in the donut hole of the back log. and i contacted him about the mismanagement of the programs.

after sending out that information to mr. neighbors where didn't receive a response. i contacted anita breckenridge and then no response. but sherry williams did contact me on behalf of the secretary and mr. neighbors. ms. williams is a former aig representative and nothing has been done about her behavior. and this brings up the question should the va be able to police themselves and not receive action? i did receive an e-mail from the whitehouse counsel directing me to contact the office of special

council. there would have been no need for anyone to contact mr. williams about my complaint. >> in your testimony you describe the possible purging of over 10,000 veteran health records at the health eligibility center and that there is a backlog of 600,000 spending applications and 40,000 unprocessed applications discovered that span three years. >> absolutely. currently we have over 600,000 pending applications. these are applications that have been applied for by a veteran, turned into va and for whatever reason we could not take the application to a final determination. this backlog has reached the number of 600,000. instead of hiring 40 people to address the affordable care act and the belief we would have this surge of people because of

a buddy letter marketing campaign where the veteran was encouraged to pass on information about enrolling into va health care to a fellow veteran. well unfortunately the information for the veteran to take the action was on the second page of the let skter so got 80,000 duplicate applications. in terms of the 40,000 this was discovered in january of 2013. and this is important to the committee because i want to share something that was in a report that i forwarded to the committee from 2013. increasing online applications versus paper and improving turnaround times has a positive direct impact on providing timely access to health care. idatey reveals that applications submitted in person are processed with higher urgency

and online linger in a less visible cue. even the the it department paid licensing fees of over $40,000 to have a system managing the cue, that system was put into place after the 40,000 applications that were lingering in the cue for some cases nearly years was discovered. that is shameful. >> i have a question for dr. head. you talked about the retaliation against you and i want to specifically talk about dr. wang who i read it was concluded he

committed time card fraud. is that correct? >> the official report was not released to the lay person. the information received was that they had recommended immediate termination of her and this other individual through other chief of staff and council they had said they had found significant fraud. time card fraud. >> so she has been terminated? >> she hasn't been terminated. she has maintained a supervisor role. >> can you explain how that occurred? >> i have no idea how she was able to maintain position. >> va didn't follow the inspector general's recommendation? >> they decided not to follow the recommendations.

i followed complaints and they moved me under her chain of command to the chief of staff, which in my opinion, was a great opportunity and i rose in the ranks and became head of legal and quality assurance and an e pe expert in system analysis and assurance. but that was how i was brought up: find a way. >> thank you, dr. thank you, mr. chairman. whistle blowers often risk their careers in order to bring problems to light as you know. what would you recommend that we do as far as to change the rules or laws of government wide to

actually help protect the whistle blowers. is there anything we should do do strengthen the whistle blower's protectio act. >> that is a great question. one thing i experienced was i was immediately removed from my position. under the guidelines and administrative investigation with the specific directive not to contact any of the psychologist i was managing and cut off the databases and some of those i set-up. so one thing is if there is an investigation the person continues rather than be detailed and if the person has to be detailed perhaps there should be a review by peers to see if that is warranted or not.

there seems to be no time limit to the details and this is the second time i have been detailed. just recently i was detailed again. i dr. mitchell mentioned they are not the jobs we would not want to do. we will do them to the best of our abilities but having that protection and a time limit to review these complaints would be beneficial and having a process for, you know, like you mentioned, if a supervisor is found to have retaliated and have tangible consequences to that person would be important. right now, i think in the st. louis va, they do not think this is a serious issue. like i said, like two weeks ago, i was called into a meeting with

the chief of staff where the chief -- the outpatient -- the person i worked with closely to implement changes was called into the that meeting and in that meeting i was specifically told the chain of command must be respected at all times and if i had issues or dr. isa had issues we should report it up to super vise and then the next level. >> can you finish up? i am running out of time. >> i think you recommendation for having quick and serious consequences to retaliation would be important. >> thank you. >> i think the needs to be greater reprecushions for

retaliation. we have sword laws and that means if i retaliate against someone it is against the law. and they can warn the person not to do it but they will continue and that will have a direct or indirect effect on their of the veteran because the caregiver or doctor or nurse is being retaliated against. the reprecussion for retaliation and there can be charges against any retaliation against a whistle blower. you tell the chief of staff this person is retaliated against and we are going to hold you accountable here until we figure out what is going on. we have a shield law that was enacted in the state of california but that is something that should be considered by congress because ultimately you

will address it in one way or another. retaliation health place is different. you retaliate against physician or surgeon you will have direct reprecu reprecu reprecushians. >> i am not sure it all needs to be legislative but it should be in writing that supporting allegations in a complaint isn't a violation of hipa. it isn't but there are employees charged all over the nation. and they need to drum up the reason to examine the physician case and have a pre-determination this physician isn't functioning and they can sabotage the physician's ability

to get employed inside the va and inside the private sector. whenever you are subjected to a peer review you have to report being a subject of a peer review for the rest of your life. these reviews are done to sabotage the credibility of a physician. physicians face loosing their ability to be applied again. you need whistle blowers who have physicians. people trained to identify the high risk problems. >> dr. davis? >> thank you. i don't know if a new law would really change anything at the va if you don't have accountability. i think there are structural changes that need to take place. one being a centralized human resource office that has operatio operational authority. i talked to the representative from the va/hr office and they

said they are only a policy body and they can contact the hr office where i work and maybe make recommendations and now negotiate. every va hospital has their human resource department and that is problematic and needs to change. so operational changes for a centralized human resource office would help. but you need to make bad managers pay their own legal fees. managers that engage in harassment have no fear because the bill is passed on to the taxpayer. currently we have a manager in our office that has several complaints to harasharassment a

isn't a big deal to them. that is the issue i think would change if you hit them in the back pocket. >> thank you for having the hearing and thank you for being here. you are showing bravery and courage and putting it on the line to do this. i know you are doing it were your veterans. dr. mitchell, i would like to ask you you have been at the phoenix va for 16 years. did you believe the lack of response to the safety issues you brought up have threatened the health and life of veterans in phoenix? >> yes, anything that threatens the delivery of care threatens the life of patients. in the er i can recall three specific deaths and several more that occurred in the er. there were two patients that died because they were delayed in getting their cardi'ac

catheter. they had to wait because there wasn't time to get it done on friday and they died on sunday. when i was a nurse there were problems with patient care. there were not sufficient cares to turn patients and we had patients with develop huge bed scores. i can remember the certification inspections that still haunt be because administration authorizing overtime for staffing but not to turn or feed patients. we used to volunteer quite a bit because we could not leave the team short staffed. >> was the administration warned of pending problems if something didn't change? >> i am aware of problems throughout the facility without

necessarily having access to upper administration. i know that people communicate these concerns as best as they can. any concern you bring up you have to present to your sup supervisor in a politically direct manner because if you don't something bad will occur. it is best management not know your name because if they do it makes you a target and that is not to say all supervisors are that way. there are ethical ones at the facility i work at. >> that is good to hear. the interim report that brought out the issues we are seeing better as a result you believe didn't go far enough if i understand your testimony correctly. do you think there were flaws with the methodolgy and it could

reveal more problems out there? >> there is a saying that has to do with lies and statistics and what they did was they took out a segment of patients and said this is the average wage time. the list they were looking at was divided by a clinic and some of the clinics have short waiting times. the list ran from january 2013 to april of 2014. some clinics had short wayiitin times. the downtown times started at 477 and they didn't get to the 110 or 120s until page 8-9. because some of the wait times were 0 or 1-2 days i have no idea which patients they picked. it would have been more accurate it is we had this many patients

wa waiting and this many. >> you don't think the report revealed as much of the problems as it could have? >> no, i told them about the mental health waiting delay ath huge problems and others told them about that and the safety patient issues. it didn't go into that. >> thank you and i want to thank you for your service to the veterans and being here today. >> mr. conner you are recognized for five minutes. >> thank you, mr. chairman. dr. matthews, are you familiar with the federal classification of employees? >> yes. >> in your capacity as a former chief of psychiatry was that a title 38 position? >> yes. >> in your position, was that a title 38 position were you formally were or below?

>> title 38. i am still employed -- >> okay. and dr. mitchell? >> i am a title 38 employees and have been employed as a physician throughout my va career. >> and mr davis? >> i am just a general service employee. >> one of the things i am grappling with the proposal making it easy to fire employees. there is a debate on if we should extend this to title 38 employ employe employees. there is a sense something some members we want to make it

easier to fire people but that run against the idea of protecting people that speak up. dr. matthews do you have any thoughts on this? we have the whistle blower protect protection but how do you feel about making it easier to file tigtle 38 employees? >> i think you should be able to be fired when veteran's lifes -- lives -- are at issue. they get a life long tenure and are not going to get in trouble for their action and that is not providing a safe health environment for the veterans or the health environment for the physicians. i don't think the chief of staff or mental health who threatened me two weeks ago has any

concerned about their position being threatened. so i think that protection should end. i would want us to consider a workplace is only as good as the employees there and i am hoping that we take a look at what the salary structure is especially for hard to fill positions so we can have less protection. >> but wouldn't that ability to fired you absolutely have eliminated your ability to voice decent or act as a whistle blower? >> that already exist. they already professionally assa assassinated me. i am no longer the chief of p c psychiatry and the way i found out this administration investigation was going on is

when one of the psychiatrist called me saying i heard you were fired. so it is a bad statement that me having trouble with the va -- >> would you have been worse off having your voice eliminated by being fired because they had the ability to do so? you are at least able to be here and voice your concerns there. it is far from where we need to be in order to have feedback from people at the mid level and lower levels to say what is wrong. that is our interest to have lower level employees be able to speak up without fear of being retaliated. but is the whistle blower protection enough? do we need a sense of due process which some members would like to see eliminated so it is

easy to fire people. i, too, would like people to be fired and not have complete tenure but i don't know how we solve this. >> one way i can suggest is put ourselves in the veteran position. would i want to obtain care or want my son to obtain care at a system where poorly performing nurses and physical physicians can't be fired. i would not want to go to that hospital. so that would help solve are we proteching the employees or the veterans. >> thank you very much. the legislation passed in the house also doesn't reach down to this level of a title 38 employee. only senior level, the top 450.

>> thanks for holding this hearing. i want to thank the testimony and the people testimonying -- testifying tonight. thank you for your courage. you mentioned this vha could be the best health care system in the world. how do we get there? >> i believe with leadership. there are certain parliameeople leadership that have been there 18 years. if they are a great leader it is great. but if they are not we need to find ways to bring unloin leadership. if you a good leader you are identified as a good leader and you can be part of the team that

shows leadership and maybe if you are not you should be put in another part of the federal government or retire. but leadership is clearly the key. our surgical team at the west la facility could be matched against any facility in the world. my wife is a cardiolgist and she could work anywhere in the country. she married me and loves her jobs and obsesses over it and always works to save the veteran. there is lot of people like that. we need leadership. the leadership will take the va to that next level. i think it is not resources. we all care about the veterans and you are giving and we will give anything to serve the veterans. we will do anything it takes to make the situation right and serve the veterans.

i have no doubt with the right leadership is brought to bear we can solve this problem. >> our next question, and this is for the entire panel, in the previous fiscal year all senior executives service employees received a fully successful performance and last year they received a fullly successful performance that totaled to $2.8 million in performance awards. yes or no, did you believe this is an accurate assessment and all eligible senior employees perform in a successful capacity and higher >> no. >> dr. head? >> no. >> mr. davis? >> absolutely not. >> dr. mitchell? >> no. >> thank you. next question is for dr.

matthews. three your own work during your time at the st. louis va you identified that on average ps h psychiatrist were seeing veterans for 3.5 hours a day in an eight hour day. when you contacted others do you know if they were tracking the information prior to your investigation? >> i don't not know if they were tracking it. i know our va doesn't track it and many don't track it because the chiefs wanted to know the answers as well. i got e-mails from other chiefs wanting me to forward the respon responses.

and there was a new chief that had the same set of question asking what number should be reasonable. >> thank you. next question for dr. matthews. your findings discovered that 60% of veterans were dropping out of mental health care after one or two visits and during town meetings they tell me the same thing. do you think it is the type of treatment? should there be alternatives to that treatment? >> my goal was to make the va mental health clinic a welcoming place with easy access to care. the majority of the veteran complaints that i reviewed had to do with long wait times, not being able to seek care and that demoralized them from care and some of the young veterans i saw in my new capacity or the

previous compassion evaluation i came across barriers to care and veterans that were in the specialized forces and in just one instance i will mention here is this veteran was doing so poorly that his roommate was a veteran and he had taken off a day of work though that he can take this veteran and get him care. so they come to the va and it takes 3-4 hours to find out whether this person is eligible for care or not and then they determine this person is eligible for care. this veteran comes to the ptsd clinic and isn't seen by a health care provider. he is told we will contact you after a meeting to determine what we can do for you.

i was doing evaluations and i had access to the records and i looked at whether there was a record of this veteran going to the clinic and where didn't find any record. but there is a subsiquent letter saying we learned you were interested in obtaining care at our facility and call these numbers to squabblichedule an appointment. this is for a veteran who sacrificed a lot, the military recognized he had ptsd, he took a day off his low-paying job to obtain care and no record of this person being at the va and the contact wasn't made. i asked him if he could go to

the va to obtain care and he said no, i wasn't treated with respect and he didn't want to get care there. so that is one bad example i can say about how the access to care and the attitude of not being a welcoming place and putting up barriers that prevents people from coming back. there is a lot of complaints in my capacity as a chief. how we interface with the veteran and care we provide i think is critical in maintaining patients and care. >> thank you for your testimony. >> mr. bradley, you are recognized for five minutes -- ms. -- >> thank you, mr. chairman and thank you for holding the hearing and thank you for being here. your testimony is important. we appreciate it very much.

i believe that all of you by virtue of being here and having gone through what you have gone through you have as our veterans served our country with honor. thank you for that service. i want to ask dr. mitchell and dr. davis because both of you -- well dr. mitchell you went through a formal process with the oig and somehow that information leaked out and it wasn't private and mr. davis you reached out to the whitehouse and obviously there were, based on your testimony, leaks as well. i was wondering if the two of you could comment on if you know how the leaks occurred and were you promised prescribe privacy?

>> senator mccain submitted with an outside request and also that my name be kept private. i don't know who leaked my name just know it was leaked. i don't know if there is any consequence to whomever leaked my name. the second thing is i don't know if the oig actually investigated. what happened was there is no official report although certainly the website has complete discretion has to what reports it puts on the website and i have been told they are unfavor to ses service and don't go on there. someone forwarded me a complaint that is unfavorable and can't be found on the website. i have no idea what occurred and i cannot get a report of it. >> have you tried to find out? >> i had senator mccain's office checking and they are stone hp

walling them. >> and mr. davis? >> i can tell you at 4:30 p.m. i was informed that the acting chief business operator responded saying ms. williams wasn't authorized to speak on their behalf but which she didn't provide, which is mo important, is who told her in the first place and that is the problem with the va. a complete lack of accou accountability. and when people know they can n engage in behavior without consequences something husband to change. >> i represent ventura california and my veterans use your facility in west los angeles. i am wondering what it is going

to be like when you return back to west la? >> i do fear retaliation but i know this was the right thing to do. and i think my veterans support me. >> did you believe by virtue of what you have been through and now being here do you think everything that happened and what we have learned about what is going on in the va across the country do you feel a difference when you go back to west los angeles than you do a few months ago? >> more importantly, i have enlighted congress, i believe and they have an opportunity to look very factual. i think that will be helpful to look at the facts. as far as going back to my job,

i could afford not to work, but i want to work and serve the veterans. dr. mitchell and i were chatting and we both want to retire within the va administration. >> i think i am just trying to drill down to see if there has been any shift or change over the course of the last month or two in the culture because you feel it every single day and culture -- changing culture is a ha hard thing to do. do you feel a shift? >> i think there has been awa awareness. they are very much aware they are coming tonight. and very much aware i will stand up for myself and the veterans and that i will not cower down. i am human. i have my frailties and this is wearing on me.

i wish i could go to work and dedicate all of my energy to working with veterans but instead the reality is i do worry about retaliation on a daily bases. i am looking over my shoulder and wondering about peer reviews. and i have been immune to some of the retalitory efforts. if you could do one thing for me you would relieve the obstructions of this retaliation and allow me to serve the veterans and work without the fear of retaliation. that would be a great gift. >> thank you to all of you and my time is up and i yield back. >> dr. matthews, i was a young doctor once and returning from southeast asia and full of vigor and i was stationed in virginia and there were 2,000 women that

needed pap smears. when i left there were 2,000 women on the list and i ran into an enertia and you have hit the nail on the head. it is the backlog we can take care of. number two changing the culture of the va is difficult and that is more critical downstream from years. what you did at the va was recognized a problem. saw you long wait times and wanted to make sure the patients in need got there. i have seen those patients in my office. you said how much work are we actually doing and when you evaluated it you found out your colleagues were seeing basically six patients a day. there is no private practice in the world doing anything that can stay afloat seeing six

patients a day. increase productivity and wait time and 60% of people that sought out care, and we know there is a shortage of your specialty in the va and in the country quite frankly, wouldn't come back. i found that amazing to me they found the environment so unhospit unhospitalable they refused to come back. and how we are all being evaluated with accountable care and were you satisfied with your visit, a fair question, and you hit the nail on the head a minute ago when you said what if you were the veteran? would you want to be in a place where less qualified people or people that didn't have your best interest would you want to see them? and i want to ask all of you how does retaliation within the va

affect patient care? if you are retaliated against and go back to the six patients a day and that means 60% of the veterans are not getting care they need? am i right? >> that is the case. being in pension evaluation i know of one veteran who committed suicide while waiting for the call back to get care. so, you know, unfortunately it went back to where it was and we really don't have a real time veteran satisfaction metric and i think that is important because we don't real know other than the surveys which are incomplete and are administered not correctly. mostly the clinic itself hands out the service to the veterans and they fill it out. you tell them it is private but -- >> i think you could draw across primary care, specialty care and

find out if it is a staffing issue and more people or just need to be more efficient while at work. i want to ask mr. davis what happened to the 40,000 veterans that were cue queued up. >> they were eventually processed. but here lies the problem of the carelessness in va management and that is why i go back to the point of make them pay for it. the problems with the queue would have been addressed. again, va was paying for licensing and maintenance fees for the a new system that could have resolved that issue. it wasn't resolved or addressed until after the 40,000. i will give you an example of the attitude by management. a report from 2013 talked about the backlog.

it talks about the slow processing of online applications. you are a physician. can anyone imagine an application for health care that you can write in your health, drive to a va medical center, wait in line, turn it into someone at the counter, waiting for someone to process it faster than the online process. if this was a private corporation we would be run out of town. now i have submitted a document of a fact finding report that dealt with waste and mismanagement and it addresses the issue at our office that the contract was so poorly mismanaged that the $5 million contract wouldn't withstand scrutiny if done in the third party audit. look at it in the contract situation. it is the same wreckless reck

less attitude. they don't assume responsibility for the actions with wasting the resources. >> and one other thing, which is a statement not an answer, but in the briefing it said the st. louis va medical centers reports to va central office that it's productivity was the highest in the nation. how in the world can we believe anything in this committee? i get asked how do you know about this and if we get this information how would we know? thank you, mr. chairman. >> mr. kirkpatrick you are recognized. >> thank you, mr. chairman. i would like to start by thanking our whistle blowers having to courage come forward when you witnessed wrongdoing. i asked you to come testify and

i know you risked your career to report wrongdoing and suffered repeated retaliation from administrators who refused to do the right thing. by bravely stepping forward dr. mitchell and dr. foot made us aware of the va problems in phoenix that led to tdata on th wait time. without whistle blowers we were motable to identify many of the problems and now because of them we can work to fix them. half of the retaliation cases involve the va. the bullying of patients and va employees that report wrongdoing must stop now. i sent a letter to acting

secretary gibson last month asking him to remind all va employees as their rights as whistle blowers. it isn't enough they are informed of their rights the va must deliver a culture of zero tolerance for whistle blower retaliation at all levels of its organization. employees shouldn't be afraid of ruining careers or loosing jobs for speaking up when something is wrong. patients shouldn't fear they would be denied care because they feel something is wrong. ... ...

u who speak to break the code of silence. whistleblowers are necessary. my question is for all of our witnesses. if you could name one thing that the va if you could to change the culture of silencing istleblowers, what

would it be and we will start with you doctor mathews. >> if i had one wish it would be that data integrity is there. and we have demonstrated over and over again they will make a number that comes up with lies like doctor mitchell said i will paraphrase a person that will go beyond life that are transparent and accurate and buy another major university that has a higher degree of integrity and people who are found with these numbers are punished because it has real-life consequences. these are not just a game they are playing. >> not to cut you off but i have

about 45 seconds. >> when people know they've done something wrong and they've been shown they've done something wrong but they are allowed to maintain the position sometimes you get raises and bonuses you are sending a signal throughout the entire va -- >> we are going to go quickly to doctor mitchell [inaudible] they sent out the nano. ithey are waiting to see what happens the body that is good to be responsible for enforcing whistleblower protection and va cannot be a part.

>> thank you all very much if mr. chairman for the expectation. >> thank you mr. chairman for your service to the veterans and also the courage and joining us tonight to share your stories. doctor mitchell cohen as you know, the va has had several internal investigations now. we have had reviews by the medical inspectors and we've actually had it couple of high-profile resignations. in response to that we have begun to make changes and make actions. based on what you've seen so far will any of the changes and activities the va has been involved in in the last three or four weeks to get measurable difference?

>> no. although they've tacked the basic object into the scheduling nothing has changed for me. the retaliation is still in place and the chain of command authorized the return counseling for violating the policy they don't have to tell me what partt policy i violated is still in place and interpreted the contract to mean i could be forced to work on limited schedule shifts for two years without any compensation is still impact. we haven't addressed what happens when we bring all the steps in and you've already got your overload. you say that your pay was stopped. were you ever told why it was

stopped? with administrative error? when we attended the attorney initial proof of the presence, they paid me. it took me a couple months to do that but. they really give me no explanation. >> the federal government would do something like that. in the legislative fix to some of the things we are talking about let me ask you this. is there any legislation we can do to fix the culture of the va?

what can we do to face that if anything. >> i think there has to be some fear of accountability. certain individuals feel they can act, that either the system is too slow to respond or maybe it's never response. they know they are absolutely wrong. most individuals cannot withstand that kind of punishment. >> is there anything that you would add to that?

when you see the pattern behaving as we look at people's timecards and if we see people on the timecards we know something is wrong. if you see the same va manager constantly being represented by the general counsel's office, then at some point you need to let the coverage. think about it like car insurance. if i keep banging my car into other cars i'm going to get dropped off the policy. if the va official continues to put the agency at risk of that occasion and liability, then the coverage elapses outspokenness situation. first would be the integrity should be there because once the data.

the newspapers can report on it. to take away that responsibility over the va of the managing the data without having the lifetime tenure positions. >> thank you doctor mathews. i yield back to you >> thank you doctor reese. >> thank you mr. chairman for being here. often times we are put in the position where we are the last stop for the patients. we have to fight the system to do what's right for the patients because it is not right and i appreciate all of your efforts and advocating despite the

consequence is that you put on ourselves. regardless of your specialty. that is what i referred to as a high-quality veterans entered culture of responsibility and accountability in our va system that we need to transform into. we are not there yet and we need to ensure that we apply the mechanism, the process and e. valuations within the system that will lead to the veteran centered institution. there is a form of the ceremony that we do that and ensures that we address these atrocities and that is the ground of morbidity and mortality rounds. do we have those?

>> not for the emergency room. >> it is more traditionally in surgery that we have the equipment for the internal medicine also for emergencies. >> i think all specialties should have been in emergency medicine, practices throughout the country also have been where they review things that went wrong, mortality is, people that have died from other causes of those. if there were any lapses of the systematic failure that led to those problems. >> they were presented to the risk management and i often will hear things either through the court process or a week or two after and the then agree just

activities presented by the chiethechief of staff directorse ceo. >> there should definitely be metrics based on the morbidity and mortality to determine if there was a staffing issue or medical error or any lack of process heat were following integrity and practice or lack of judgment etc.. and that would give information as to what needs to happen, and that information should be directly linked to the ceo and the link to make the changes that are necessary. the other way to ensure systematic and transparent open way to evaluate certain practices so we don't have to rely on the whistleblowers are through the chart reviews and a spontaneous random audits. does any of that exist in your practices.

the people that regret those issues if there is complications that were reported but is only as strong as the ability to actually report the incident. the instance that i reported a net can go several years down the road when it comes to the root of the top process is too late at that point. i agree that the mortality is very evident when somebody dies that should be investigated in

to determine if there was any wrong during the care for this veteran. i believe that part of the solution. the leadership and the idea of taking the responsibility away from those that would have to do the self evaluations from those supervisors and placing it in another location that has more of the advocacy is a very good idea and wish that i yield back my time. thank you all for your courage to come out and stand for the veterans. mr. davis i want to put this out there because i know you just talked about it and ms. kirkpatrick ran out of time, but a statement tha the statemee earlier, came the va police itself and if not, who?

>> i don't think the va can police itself. i would look at media organization like the government accountability office, maybe finally setting up some sort of oversight panel of health care professionals. one of the things i would tell you that the va employees talk about is during the financial crisis there was talk about bringing people like elizabeth warren during the talk about the national security issues they talk about bringing back the doctor. when we had the crisis in the va, we present deputy chief of staff and there is no disrespe disrespect. in the largest health organization it goes to how people look at the va. one of the reasons why i aged up to the white house is because i was trying to find the person who could answer questions with

all of this issue. we had a form of everything that you could imagine in this town but not one for the veterans and i think that is the issue there has to be an outside source to say as to chairman, members of congress, mr. speaker, mr. president it's not going to work in terms of the context of giving the secretary about where right to fire people in november of 2013 the memo was released by the assistant secretary for human resource stating that they were not to go to the secretary's office about the complaints because it abstracts the final decision of the disputes. if that is the approach they take even if we change the law we still wouldn't get the information to the right people to hold them accountable.

there has to be something in the wall to become the policing organization over the va and it simply isn't going to come from them. >> this leads to my next question. and i've asked doctor mathews to follow up. he said in one of his statements that he doesn't necessarily know that it gets above the st. louis regional central office could you shed some light on that. >> i can tell you the only reason my case got where it was because i didn't go through the agreement process because that is the way of trapping the employee in filing the complai complaint. when that didn't work i went to my congressman and we had to put something in place.

me and my supervisors get along in a normal process. if it is about the patient's care of human beings or people that served in iraq and afghanistan, that needs to be fast tracked into brought to the forefront. when she was conducting the investigation of the applicati application, once the directors of the stop there was no recourse for her and so we have to find something in place to allow them to go to the forefront based upon the severity and the critical nature that they represent. >> and with my remainder of time do you have a central office that sees this as an issue because it seems like there' tha disconnect. >> there is a disconnect and i really don't believe any of the

data. we have to have integrity and how we are basically talking about ways to make that happen and that the abuse at this time maybe for a perco of time we need to have an external agency that has higher integrity than the va looking into the data complaints and then seeing what needs to have interest in what can wait. and unfortunately, the va demonstrated over and over again that they are not able to police themselves. they are not able to come up with honest negative information. and again, it is not an automatic exercise. it really hurts the lives of our veterans. >> you're recognized for five minutes. >> thank you mr. chair to the courage and in coming forward we appreciate it and understand the risk that you are taking. just know that we are your

witness if there is anything that happens to you, please be in touch with our offices. i would like to follow up on the question. in the private sector in the healthcare field we have a process of quality assurance that sounds like a b. what you're doing in your root cause analysis. but to get at the issues that an act the public safety and issues of veterans but also some of the staffing issues that you have raised in your testimony, is there any type of process within the va for sharing best practices or four determining what our effective mechanisms? the type of problems that you are describing, perhaps we are fortunate not to have to va facilities in manchester new hampshire and vermont and some very high levels of competence

and access. what is the concept of sharing best practices and how would you go about improving on that? >> in 2012, november of 2012, i noticed a spike increased number of veterans presenting these. in the 50 pages there are slow

diagrams, standard operating procedures that kind of naked basic idiot proof that when you have certain patients that come in that you should have guidelines and when the patients should be screened and received treatment if they have cancer it would be presented in the multidisciplinary teams we could expedite. surgery is possible. for whatever reason this was not happening in the number of patients that i saw and so i encourage us to adopt some of those. >> did you have any success? >> i had some but i think one veteran who doesn't receive the screening necessary is too many in my opinion. and so i thought that we should have more -- those types of ideas should always be floating within the va to have procedures so we don't miss the veterans.

no veteran should be left behind. >> and is there any cross us for quality improvement? do you have any procedures or protocols within the va system that you could bring forward for these types of standards and procedures? >> that is what i would like to do. but because of the other activities that had to be involved in -- >> have you had any experience in them? >> there is a whole quality assurance division and certainly i was on the e-mail group for the physicians of the directors and we shared ideas. what we need is a best practice of how to overcome bad management because we all knew he are suffering from short staffing and other issues, the promise with nurse triage and other things. we just couldn't get anyone in the facility to listen to us that had the power to make the change. >> in the short staffing word

you told her that that was a fiscal issue that you couldn't hire people or was it a timing attack in terms of getting the professionals credentialed? >> it varies depending on the week. we are having a high giving free is where there's not enough applicants which is often the case. a lot of times there are fantastic applicants but the process of credentialing takes eight or nine months and we already found another job. >> i have little time left but i just want to say that having reviewed your testimony and the various lawsuits i'm extremely concerned about the issue of the racial bias in your record, and i just want to commend you on your courage and on your professionalism and admire the strength it takes for you to get up and go to work every single day so thank you for coming here today. >> thank you very much. >> thank you mr. chair. >> you are recognized for five

minutes. >> thank you mr. chairman. thank you all for your very powerful testimony that you presented here today. i was a va doctor for a long time myself and i feel there's a great deal of difficulty communicating in the leadership and i think doctor mitchell, you mentioned the tool that when you find problems in the va as a physician, you try to tell somebody up the ladder the problem is to improve care and there is no one that seems to get something done. talk to your chief of surgery or psychiatry and do talk to the chief of staff. is that chief of staff and advocate for the physician or do they have an advocate for the administration?

my concern is that the physicians don't have enough access to the management to make changes that have a recognized need to be done. how can we do that better? at me asme ask all of you that. in my particular case i was the chief of psychiatry going to the chief of staff and it seems like they don't exist or like you said it's not giving the right urgency or the right priority -- >> does the chief of staff have somebody they can talk to up higher on the latest? that seems to be the place that it stops from my experience working there. is that the problem you think? what is your opinion about that? >> one person's chief of staff

came to my defense and they were severely punished and pushed out. i think there are good people in the chief of staff and in the country. there's close to 12 chief of staff members. some of them know that retaliation is a problem and others are part of it. >> what do you think of that? >> we certainly run through several and generally the advocate we have an option of going above but i will refer you back to the facility director. every physician has the ability to go to the local union office and say they want to organize. there are some physician groups that have done that got in the members of understanding to stop the overload of the physician panels and things like that. but they have to organize themselves in whatever way they want to approach that whether it is through the union or by themselves been through

management. everyone is afraid to do anything because the risk of retaliation is so real and that is the loss of your livelihood act best in your ability to be employed anywhere in the vicinity of the va. >> can you tell me more about this and explain it to me again? >> a legitimate review is when someone questions the ability of the physician -- >> dais where we would typically do that and in my hospital setting -- >> but this is someone that has -- everyone can make a mistake and things can be overlooked. but here review is when you're afraid that they are not practicing up to the standard of care that he would hold a large section of cases and have them reviewed to see if they are truly significant deficits for the person's ability to practice medicine. that is only supposed to be done in extreme cases where there truly is legitimate concern that

this person is not up to the standard as far as practiced. the review is where you have the ability to call the review teacher review of the physician cases. if you can't find anything that they have done wrong that significant, then what you can do is put a subjective finding. they have the ability to interact with people or something very big and subjective. what happens is that in the medical community to peer reviews are only done if there are red flags. that is the reason why it's important that if you were ever in the review you would have to report on the license or job application. most people that don't work in the va don't realize that they are done as punitive actions in the va in order to sabotage the physician's credibility. it's also incredibly demeaning for the physician to go through the peer review practice because they were practicing

professionally. psychologically it is so stressful but most would quit. >> but if it is done by other physicians on the staff with you. >> usually it is the administrator they all get together and say -- >> but he is not a physician? it isn't the peer review? >> it doesn't mean that they have the ethics. >> i guess i'm out of time. thank you doctor. you are recognized for five minutes. >> thank you mr. chairman. and i will associate myself with my colleagues. thank you all for the work that you are doing. you understand that the nature of this is not just the personal damage that is done to you but as each of you have stated so eloquently with the passion it hurts our veterans. that is what is at stake to you here so i appreciate that. there is no veteran strategy. when i ask what the strategy

was, they give me the goal they are going to get to. it doesn't surprise me. they are not sure to send and who to go with. it doesn't work that way. i've been asking for the review just like we have so that we can resource it correctly and we can have the things in place to make the corrections but that is lacking. i can tell each of you we are coming to this how-to we get this. i will tell you doctor matthews i am not putting my veterans health care or reputation on the data so when people ask me how are the local facilities doing, i.e. m. worried. months ago we got the audit and had some of our facilities and they sat right there and those of you sitting behind their honey you can be sure that we want an answer and we will ask you again tonight whether it is her field or not.

why don't we know what happened at rochester. can somebody speak to that and say? tonight we get the general counsel. they all blame to you in the other hearings come as amount you get the answer tonight but i would suggest this. and i know that the work we are doing. i would submit to all of us here the watchdog on this in the outside agency to look at this is here. it's us. we are given the constitutional right to do it. when i go home and asked about this and i should be held accountable. but we don't know where to get it and i would suggest this committee is the most nonpartisan in many cases. to fix the problems for the veterans because that is what we do but it's been historically understaffed. i would like to send staff to tell me what is happening in st. louis, with happening in los angeles and come back to report so i get it from the horses mouth because right now i cannot trust where it is coming from so that is my soapbox to each of

you and we all feel very strongly that we have to come up with a solution. we have to have accountability. we had the constitutional power and need to give the authority to do this and added to the good staffers that are there so they can get out there and ask the questions. and i would suggest were put forward each of you maybe i am a little pollyanna -ish on this but i am a high school teacher. this is bullying. this is what it amounts to. there's been a lot of research done. here's what happens if the increased productivity, loss off litigation, commitment, satisfaction, transfers, adverse impact from the patient customer satisfaction. we know all about that. but the question i have is that we can say to the va can go down this has never happened in the private sector. this is about people and accountability. what we need to figure out from a national strategy, putting in place the accountability pieces that have the elected people

that have the power into the resources because there are wonderful people. you work with them every day providing great care. one question for you. you said over 16 years that the care has improved at phoenix. how do you simultaneously and prove the care where this has existed? is that the quality of the people that are coming there to work? >> you have an incredible force for change and the majority of the employees are veterans themselves and family members of the veterans. they get incredibly good care whether it is direct or indirect care and so despite the fact that there is a nod in your stomach when they try to get in the car and go to work and despite the fact during the day they try to get -- >> that's happening because when my veterans say they care to the da if you can get past that -- i would ask each of you have given two different va hospitals? does minneapolis look like los angeles? >> i've only been to phoenix. and we get tons of good care.

the problem is with health care needs when you ignore them a veteran pollster the cracks and that has devastating consequences to their health so what we are focusing on is the hundreds of thousands of cases where there has been bad care giving and we shouldn't lose sight of the fact we have millions of instances of care and that's the reason because they make it worth saving. >> our youn young residents and graduates of our medical institutions while they still choose to continue to go to the va like you did because my fear is we drive them away and make it so unattractive. >> i wouldn't recommend in the current state of the people get a job at the va physician until there is a guarantee that with the retaliation we will be protected. that the pay would be commensurate that there is a professional working environment. everyone just -- i'm really prouproud -- >> that is a nightmare scenario because we know what the numbers look like and we have got to get this figured out. i yield back.

thank you. >> you are recognized for five minutes. >> thank you mr. chairman. i appreciate the witness is coming and visiting tonight and sharing your story. and i'm particularly troubled by the comment suggested recommendation that the folks look for employment elsewhere until these problems were fixed. doctor mitchell one thing that i would ask them each name that appears by the senior staff but ignored your plea is violated your confidentiality knowingly injured veterans or place them at risk for do you know if any of these have been punished or censored by the va? we will start with you. >> i don't know. but cooking up the numbers it is basically sending all the wrong messages that it doesn't matter. care is optional. you protect it and come up with the numbers. it is so corrosive. going back to the point i started the washington

university residence in the va, and i have one resident who was very good but wanted to join and two other people that i knew in the community that were excellent psychiatrists trained in very good places and they came and were interviewed, but they didn't want to work in these situations where they wanted to join because i wanted to build a good mental health clinic there. and then it was inconceivable that they just removed me from the position. so, this is very corrosive and demoralizing. a lot of the ethical people work there as well because they have to leave or they have to just keep quiet or suffocate internally. in the mistreatment and violations in your treatment and choose to remain silent.

>> i know that for a fact that is the case. >> what would you recommend in all of the members of the committee have probably heard from the constituents since this broke open and we have been looking at this for a number of years what would you recommend it to the whistleblowers that had the knowledge and the concern that share the doubts about how you would be treated, which they do. i have had three or four whistleblowers show up unannounced for a surprise visit to the facility somehow was able to get in and started to uncover things but what do i tell the whistleblowers this is what we see happen but we cannot tell you our name because we are afraid we are going to lose our job. what should i tell them? panic at this point you could give me dvd that -- them my name. that is what is happening. i had multiple phone calls from those across the country.

it's because they were forbidden to document the force. there are several in that there are many issues. i contacted jeff miller or representative miller's office and got a phone number of someone that said that they would maintain the confidentiality and investigate. and at this point i would tell them that is a problem above my pay grade. >> i have had several company derrick pulley and i share the testimony with the committee and i read some of the statements in the record and i would say though that i know that our failure with the administrative process either the house i would be more than happy to take the whistleblower complaints to the public. might have grabbed his communications i was able to navigate quicker than most and that is the key thing.

it doesn't take everyone to do the same thing. some people might be comfortable just going through the ig and the sun it covetable going to the representative or senator and some light be comfortable going to the press. but there are different levels. you don't have to go as far as we did. in some cases there is an exception that there are different ways that you can get the information out and different people that want to. there's the civil groups, veterans service organizations that would be more than happy to get the information they have direct connections with other leaders in congress. there are different ways that i would tell you this. you feel better when you say something versus holding it in. >> i have no doubt there are employees listening tonight and seeing the comments and i might add that they are probably out there during all of you down for having the courage to show up. but step forward and model this

other office to carry that water for the brave employee like thet was also the appreciate the commitment. >> if i could make a clarification even though i said i wouldn't recommend getting a job at the va i am not looking for a job elsewhere. they have the culture where it stands today. >> there is no doubt in my mind that you are a veteran committed. >> thank you. you are recognized for five minutes. >> thank you mr. chairman. to follow up on that statement, i couldn't help but wondering during your testimony and in the answer to the questions that were asked of you as you detailed the ostracism that you were being shunted aside when you made problems for the management ending up in the position now that you are doing good but it isn't a position

that you signed up for and then i know that you clarified it a earlier saying that you would recommend to somebody thinking about working for the va not now, not until we get accountability and oversight protection for the whistleblowers i couldn't help but wonder why you stayed. >> the work is fulfilling and important. i went back to medical school to be a va physician because i felt there was a great need. everyone knows there are limitations. we are a federal department. the veterans are so grateful for the quality of care. you will see such a wide variety of people at the va and from the physician standpoint to interesting. in the geriatrics i have a playing field in fact it was urgent medicine at its best it's interesting and fulfilling. i don't always feel so resilient as a physician.

i am tenacious i get myself gif that but sometimes there is that's not in the center of your stomach when you just don't want to show up because as much as you love the veterans committee administration really wears you down and you begin to doubt your own professional ability. >> and they answer what you said earlier and for everyone on the panel, we keep asking about the culture that is the most important issue but probably the most difficult task before us as a country turning around but you represent a culture that i think we are looking for and that we want to see throughout the system not just that the provider level at the management and the secretary level on through this committee and as a country so i want to thank you for that and for the example that you provided. but i also want to follow up on another commente comment that y.

you mentioned surviving 16 years of this and these problems didn't just occur under this administration i've been here for a year and a half it is a joint hearing in the committee where we heard from the veterans service organizations and i remember the commander coming before us saying i don't know the number was with a 32nd time that i've appeared and have been coming up for decades and i've been saying the same things over and over again. so, you said that this is a system worth saving but my question to you is is it's salvageable? >> you've got thousands of employees that are dedicated to the veterans and the welfare of the veterans. i'm discouraged when i hear people say the va is too big to change. you have an entire group of people that are ready for the revolution.

and they want this. they want a productive healthcare system delivering good care. the horizontal violence has to stop. that was one of the implications of the whistleblower retaliation is that it affects care because you don't speak up to save the problems are because you are afraid of the repercussions. the corollary to that is that you begin to -- it is a pressure cooker and you pick up to each other gossip, bullying, exclusive we kind of see it on each other because we don't know they are under so much pressure and that needs to stop, to. >> you have given us ideas on that but i do wonder how we are going to be able to do that after so many years and so many fundamental systemic problems doctor matthews brings up the issue of not being able to trust the integrity of the data that has become obvious to all of us and i commend your efforts to measure those things that are

important to the patient care and outcomes in the facility that you worked. we've been trying to do that and in el paso we have seen similar rates of the veterans seeking mental health who cannot get an appointment, just give up and stop trying and we can only write now because we don't have the full story wonder at the outcomes. we introduced the ask veterans act which would integrate wyoming's ea to tell us how they are doing that to ask them what you were trying to measure indoor facility. let me just conclude by thanking you all for what you are doing and we hope the recommendations that you gave us might lead to some of the cultural changes that we all know are essential to turning the va around. >> thank you. mr. kaufman you're recognized for five minutes. >> thank you all for stepping forward as whistleblowers. i believe the rank-and-file in the veterans administration are

in fact employees that care about serving the needs of the nation's veterans and without whistleblowers such as yourself who have had a courage to step forward, we would never know the problems that exist in the veterans administration because none of those problems have ever been self identified by their leadership in the administration. they have always been aware of them simply by the whistleblowers coming forward and sharing with us the reality of what is occurring on the ground with the veterans health administration. one thing i think when we became aware of the magnitude and the crisis was concerning the patient wait times, and the fraudulent changes in terms of

those records often fueled by the drive for bonuses. that's what you're saying is actually the problem was much deeper than simply patient wait times, that they were also denying people inside the system is that correct? >> they didn't get into collecting the applications that i think this is where we have to look at you can only get the appointment if you are enrolled and so we have systemic problems in the enrollment system and to give you some context you may hear this from the next panel the office that helps build of this center is about to start with a call for command center. this is something that they will assume to be the leadership or perhaps the committee that i want you to understand the change will only come from real solutions at the va. currently this is what i call the gimmicks that go on at the va.

we send about making the public and the leadership on the hill. but i will tell you when you look at this document to the communication train people perform the communication training every day. that isn't anything new. the call-center people perform the call center task. this is not going to change anything. the strategy is to take people on the fifth floor and put them in the second floor. this is what constitutes responding to the veteran concerned that the va. following something that works in the business that is the people sign off on the reports they turn into the congress. i can tell you what disappointing to me as a citizen at a va employee is to watch leader after leader sitting in the chairs and say i don't know. i will get back to you. so and so was supposed to do that. the general council won't let me. that is inefficient and if you are going to be in a leadership position you need to leave for making people sign off on a

quarterly report to say that i own the data that i turn and, i owned the enrollment, you doubt very many people in this room there was a 600,000 pending backlog in the va from the iraq and afghanistan veterans of people would have known that was going to happen if the reports have to be signed off on by people in the positions that were held formerly by the doctor this is where the change comes from another you have to document. one of the problems that we have is the first time that you go to make something public they tell you where is your proof, where is the document? most people will not sign the document. i forget to process the applications but this is the kind of conversation where you ggo in to talk -- >> let me put it this way. if you all could comment on th this. the veterans administration is so dysfunctional )-right-paren in terms of its leadership and

in terms of the culture as well. so having the new secretary come in they are still there. i hope the secretary ca can take the appropriate change but it's going to be difficult. should there be an entity outside of the veterans administration for what they report and let me go down to the rest of the physicians here. >> it is inherited if you really want the new change in the whistleblower environment where people come forward you have to take the policing power outside of the va. >> i agree no one trusts them to handle their own problems that we have reported it to them. >> i agree. if we acknowledge the problem these are expected to fix it. the position is that there is no problem. we have the numbers to prove it.

>> thank you for being here. i realize that we need to go outside the va that is under the point that we have to make the change because of nine of the positions including the secretary are vacant right now so if we can bring in a new leadership team and impress upon them the need for the accountability that we have heard repeated every hearing whether it is on the backlog or bonuses or the whistleblowers this is the message that maybe we are at a point where we can start to make a difference. i'm sorry that mr. mcdonald can't come in here and hear what we are hearing. i know sloan gibson is scheduled to come that we need to get the new secretary and as soon as we can because he needs to hear the kind of thing so that we can move this in a new direction.

we have a new hospital. i met with some of the emergency room doctors at my invitation they were scared to come. they are not as brave as you all are and they want to be sure that they knew that i invited them because they feared retaliation. you travel in small circles. have you had any contact with people at the hospital were for me or any whistleblower proble problems. we have had a significant number of the staff to relocate but i haven't had a whistle blower problem. >> i'm glad to hear that. one of the things i wanted to ask you, you mentioned that the first sponsor to the whistleblower is to try to impugn their integrity. one of the reasons you mentioned is that you often say they are just a disgruntled employee because you didn't get the bonus

that you wanted. can you talk about the nexus between the bonuses and whistleblowing. are people getting paid to be quiet? >> i don't know that people are getting paid to be quiet, but i do think that there is a tendency to try to generate the motive for why someone is coming forward to when the truth and reporting wrongdoing. and it's often associated with somehow personal gains for the whistleblowers but i tell you there is no personal gains of being a whistleblower even as you go through the litigation you ultimately when, you know, there is no financial incentive whatsoever. >> i'm sure of that. i'm thinking of just the opposite you keep people pat down and not speaking up if you give them regular bonuses and it

keeps that culture of silence that you mentioned. >> the bonuses are among the chief of staff and higher-ups. >> doctor mathews or doctor mitchell? >> my experience in the st. louis va have productivity data for every psychiatrist as to the number of patients being seen. and i know that there is only one who perhaps didn't get the full performance based for what could consider to be the bonus and that's me because actually for their own reasons they were correct. you could accomplish what i set out to do but just do what you want to do it you will not get

into trouble for not working. the only reason i think one can get in trouble is by identifying problems and then coming forward. so that has to change. and i think it is a complex issue with the college culture, that the fix can be very simple and demanding the data and holding people accountable. you know, that once that starts to happen and some senior positions, not people that redesigned again, they have high integrity that they re-sign because they have integrity, but the people who don't care, those people need to b be fired be fit it sends a message that this is not -- this cannot be tolerated anymore. so i would say that your right to the people that get the bonuses are the ones that keep quiet and keep doing what they are doing. >> doctor mitchell? >> the difference between the performance bonus, the performance measure though this is what you get if they've got the performance.

most o of us that are eligible e quite frustrated because the facility never ha have the resources to make the performance measures. so there is a bonus just nowhere near where we want to be reworded for the work we do in the proficiency that they are actually how he would perform through the year on our own personal merit and those are subjected. if the administrators like us they can rate as high or low and they don't have to give a reason why. most say quiet not because there is any benefit one way or the other at least at my level. >> thank you mr. chairman. >> you're recognized for five minutes. >> as i sit here and listen to your testimony one of the things that comes to my mind is somewhere along the line through your parents were somewhere,

someone taught you about doing the right thing. and about being able to look in the mirror at the end of the day and know that you are doing the right thing and i applaud you for that. and know that you are respected by those that matter. and those that don't have their own issues and i appreciate that. i served in iraq as a doctor, and we have something that you mentioned tonight with a sense of mission. we have a shared sense of mission and everyone was on the same page. in the reserve unit we come from private practice. there is no reason for slacking and the patients were the first priority and you work through the night if you have to. and you take shifts sleeping. wouldn't you love to be able to practice in the environments like that every day? they've provided for the others that are veterans today.

and it is really sad for me to hear that there is a need for an agency with a higher integrity than the va. which was said tonight. that's the people would be willing to accept that they need someone to watch over them because of their lack of integrity and we've brought up the mortality and wha when did e and the peer review. i needs to is you had people from the same specialty reviewing the charts and people that know they are familiar with the procedures that you're talking about and you do that to try to make things better and if someone is feeling that they have to go because the reputation is on the line. it's not fair to be punitive but to make everything better as far as care. so my question as far as whistleblowing is there any chance for the providers and put such as have too much

administrative responsibility we don't get to see the patients, such as i need another clinical assistant in here i need a medical assistance then i can see by times more patients or do you have the opportunity to say so and so is a poor performer in the clinic and it's slowing my time down with my patients and i don't get to see as many. is that available? and i will start with you, doctor mitchell. >> in a particular form is not available. in section four and five i talk about the retaliation tactics against providers and one of them is failing the ancillary service so the providers are stretched thin and there's another they overloaded the patient panels that there is no way that they can link through. we are not at the level to be able to communicate equally with our administration. we are far below. and anyone that speaks out is retaliated against the don't

have the freedom to speak freely and advocate for the patients in ourselves. >> .. >> i think it's mixed. i've seen extraordinary efforts to move mountains to, for instance, build a new catsdz lab in our institution that was definitely needed.

>> yes, by the providers. basically the provider side they that they would no longer practice this in >> it involves leadership. i was trying to institute the time provided. that is along with veteran satisfaction. we can know which facility is lower. the if