i want to thank all of you for your courage and being here today. i appreciate what you said about once a diagnosis is made and medication is prescribed staying on that medication. i really want to know how often our veterans have to refill those prescriptions and i would just like to hear from each of you what you have learned about that experience. are they given a 30-day supply, they have to go constantly back, sergeant, can we start with you and work our way down the panel. >> yes, ma'am. so at our facility in washington state, medications are given on a 30-day supply. there is an option for mail refills. the system is pretty con fusing and i formally mess it up pretty well so my wife has to manage that for me for the most part. you have to be able to put in a request three weeks before you need it and i usually forget until i'm about to run out.

so then i'm off my meds for a long period of time which is never good. as far as the other medication issues that have been discussed, continuity of medications from one facility to the next, i'm in the southern part of washington state and people who are coming up from portland, oregon, which is about an hour away are on medications that are not transferable to the v.a. facility where i'm at and so they have to start all over as a guinea pig as what was discussed earlier trying medications that they may have already tried in the past to get to the point where they're able to approve a nonformulated medication that they had at another facility and the transition from d.o.d. to v.a. care, it took about four years for the d.o.d. to balance about nine medications for myself and when we transitioned to v.a. care, many of those medications were not on the form larry. we had to go back to ma guinea pig phase again and we ended up on 14 in order to utilize the medications available through

the v.a. there are many issues as we're talking about that. >> that's just unbelievable. any other families want to -- >> brian was never put on any medication. they diagnosed that he had depression, p.t.s., but never put on any medication. he was put on medication for his back when he was thrown from the humvee, naprosyn and muscle relaxer. that was just temporary, but they never even prescribed scheming out three times a week with nightmares and having your brothers wake you up and then telling the therapist how embarrassing that was, i think you need to be on some medication. >> agreed. >> these medications are so subtle and they're so particular to the individual, it's just mind boggling that there is not an easy way to identify and work with the individual vet to determine exactly what that cocktail, if you will, looks like and then

be able to without -- to just seamlessly transfer that to wherever that vet is. these people are young and they're on the move. they're all over the place. >> right. >> so that -- those barriers just need to be taken down. >> dr. and mrs. somers. >> yes, thank you. and thank you, representative kirkpatrick, for being such a support and a help for us. there is multiple issues that have to do with the medications. just the fact that the form larries are not the same is a huge issue. it just doesn't affect veterans at the v.a. system. there are veterans who are retired from the military who see both -- who see physicians both at the v.a. and the d.o.d. so they are seeing people at both different medical centers and they cannot be on similar medications from one to the

other because the formlaries are not the same. the problem is not only does the v.a. use 99% generics, but they use the cheapest generics. so daniel who had not only ptsd and t.b.i., but full-blown gulf war syndrome which included irritable bowel had only certain medications that he could tolerate. so maybe the chemical in the medication is the the same, but the bonding agent is different. maybe he is on a medication that he only has to take once or twice a day, but the v.a. gets a better price, so now he has to take it three or four times a day. and the change in the medication changes everything. so, i mean, the issues, the ssues are just huge. it's not only that -- and the other thing that we have heard and from unimpeachable sources

is that v.a.'s vary, as we heard, with their pharmacy policies. there are some v.a.s where you can go and you can get a brand name medication with no problem, other v.a.'s that essentially it's impossible to get a brand name medication. so, i mean, that just brings up the huge issue that we have as to why there is so much variation in the entire system, why we can't have more uniformity within the v.a. system as a whole. >> thank you, dr. somers. my time is up and thank you. let me: cued by saying your testimony is heartbreaking. i can barely hold back my tears. i thank you for being here. >> thank you. mr. runyon, you are recognized for five minutes. >> thank you, chairman, and thank all of you for sharing your stories and truly being great americans and great patriots because your stories

are going to help people in the future. thank you for all that. a couple points and i think dr. somers was just talking about it. i think we see it all day. we talked about this in the hearing the other night, it almost seems like the v.a. is that there is no overwhelming mission from the flexibility from below. we're admitting there is a structural breakdown in how you're actually going to conduct business and that's really where we're at, whether you're talking v.h.a. or v.b.a. it's the same issue. we have yet -- i think next week we're digging into some of the v.b.a. issues also. it's a culture. and one other point and then i'll ask one question and ms. somers was talking about it and

dr. roe also validated it, when you talk about community and you talk about support networks, these men and women are spending more time away from that the health care facility than they are in the health care facility. so friends, family members, classmates, buddies all have to be part of the healing process. we're not doing that. i know the term wholistic has come up a few times. i think sergeant mentioned it a couple times. it's part of the healing process. there is no silver bullet to cure somebody. you got to be able to help them in many different ways. that being said and the v.a.'s testimony, they mention suicide prevention coordinators are supposedly placed at all v.a. medical centers and the large clinics. they're supposed to follow up with veterans that are at high risk. were any of your sons ever

contacted in that first month after they were designated high risk by a v.a. suicide prevention coordinator? >> we're not aware of that, the fact that they didn't even know where he lived would bear proof of that. >> that's one of the issues that we're dealing with, also, and that goes into the whole support network issue is that -- and we have spoken to so many, so many families in the same situation is that daniel was married and that basically shut us out of the equation. that's where if we had the opportunity, if we could do some changes in this misinterpreted hipaa regulation where we could have been more in touch with his therapists and they would have felt free to talk to us where we feel we could have been more help. since he was married, it was as if we didn't exist. >> i think that's an important

point is that, like when brian was injured in the tank plosion, i was notified, it was 3:00 in the morning and they called me from fort hood saying he was injured, where they had taken him, he is back with his unit, you know. but yet you diagnose somebody with ptsd and t.b.i. which could be life threatening injuries and nobody knives you. i mean, that just doesn't make sense to me. >> anyone else? >> your point or question of being flagged as a high risk, this is something that came up that really baffled us, i guess. when clay was transitioning or moving to houston and starting to go to the v.a. in houston, his records apparently from what i was told, those records

were not seamlessly electronically sent. they did not have his records from l.a. and that's where the bulk of his time was once he had gotten out of the marines. so as i look back through those medical records, as i said, there were at least two or three times in there that it's talked about and he talks and admits to having had suicidal thoughts. so i assume that he was flagged, would have been flagged as a high risk. i mean, it says on the medical record, high risk highlighted. when he comes to houston v.a., nobody knows he is a high risk. the psychiatrists didn't have anything other than clay saying this is what my past history has been and this is the medication i have been on. so that's a great point as to when are they flagged as a high

risk. do any family members know that? the only way i ever knew that anybody called him a high risk was when i got his medical records and poured over them after he had died. >> thank you, chairman, i yield back. >> you are recognized for five minutes. >> thank you, mr. chairman. i want to join my colleagues in thanking all of you for being here and sharing your stories and certainly through your stories about your sons, it ertainly to me, i feel their patriotism through your stories and their overall most insincerest commitment in service to our country. so thank you for being here. i wanted to ask the sergeant a question and so in your service

when you were in theater, was there any support system in ace for you to go to get any kind of, you know, mental health support while you were there. hearing brian's story, it was very gut wrenching to hear it, and just to wonder if brian had a place to go to, while he was in theater, how helpful that might have been in terms of his time there and his transition coming home. >> ma'am, thank you. when i deployed in 2003, it was right after the initial surge, it was a completely different war theater, we really didn't have anything set and established at that time. so to answer the question, no, there wasn't anything. however, again, i work with

many, many veterans currently and active duty members and i have been told in recently deployments in afghanistan that after major events take place, there is sometimes availability to have a type of a crisis debrief. it is somewhat available. it's not streamlined. it's not across the board, but it has been implemented on some level. >> if i may, the problem is that we know that there is an effort in the d.o.d. to destigmatize mental health issues, but if you are in theater, i would -- i would venture to guess that it's going to be incredibly rare for somebody to take advantage of that because all of a sudden they're going to be taken

off-duty and the whole idea to destigmatize it is to say, ok, you come in for treatment, but once you're better, then you'll be able to rejoin your unit or you'll be able to regain your security clearance, but while you're under treatment, you're not with your unit and you have lost your security clearance. so i mean, the issue is a huge issue. and we know from people that we ve spoken to that the people at the top are aware of this and they're trying to deal with it, but there is just so much you can do on a boots on the ground level. >> well, if i may, so there are two separate levels here. there is a crisis response much like a team that can go out and basically say, hey, this is what happened, these are the normal reactions to this type of a situation. if you experience this, find somebody to talk to. so more of an education and

immediate response. at effort has been available as stated, most military servicemembers and veterans as i stated earlier in my testimony are not going to say, gee, that was a horrible experience. i should talk to somebody before i have issues. they're going to wait until it becomes a crisis point in life and debilitating in nature before they seek treatment. >> i just feel like if it is part of the culture being in theater that there is constant dialogue that is going on, that that would have to be helpful to the men and women who are there. >> brian did tell me one time when they were on the 15-month tour, there was at one time that they lost four people in one mission and when he was out very low morale was after that. these were people that were

high up, sergeants and l.t. and all that. so they sent someone in and when the soldiers would go in and talk with them, he asked the same question, was it sort of like a movie? that just insulted them almost. it's just like why would you ask such a silly question. so they all shut down. i think by not processing those thoughts, then you're going to internalize them so they're never dealt with. i think even before they're in theater, i think in basic training, they should be taught ptsd and when they're deployed and report on each other for their own good and in transitioning home. i don't think we can say it enough. that's my opinion on it. >> thank you, thank you. i think it just confirms that women to our men and go to serve and to go to war. we don't prepare them very well to transition back. dr. sovereign mers, you --

somers, you talked about the barriers to hipaa, we have talked about the family involvement piece. you mentioned also modern technology. i yield back, i apologize. >> thank you very much. you are recognized for five minutes. >> thank you, mr. chairman. i just want to say thanks to the moms and dads and sergeants for your riveting testimony. i look forward to asking the v.a. some follow-up questions and yield back, mr. chairman. >> thank you very much. mr. custer, you're recognized for five minutes. >> thank you, mr. chairman, and thank you to all of the families for being with us today. i think for many of us sitting here today, the pain is to recognize your commitment to give meaning to your sons' lives, i'm the mother of two sons, 22 and 25. i can't fathom what you're going through, but i want you to know that we will do our

part to give meaning to their lives and it just makes me feel that personally i'm becoming more and more anti-war, pro veteran. i think our country is, had those priorities misplaced getting us into conflict, but not being focused on the cause, societal cost to our country and to the population, these extraordinary young men and the going to at they held haiti and making a difference right here. i want to focus in because i think from your experience you can really help the v.a. and the d.o.d. to understand what could make a difference and i want to commend you all with your -- the specificity of your recommendations. but in particular, i have been trying to understand best

practices and whether there is any effort within the v.a. where there are practices that are known, group therapy, for example, or the type of medications that are helpful. have any of you in any of your discussions, whether within the v.a. or since then, the experience that you have had meeting with people, have any of you come across any effort to share best practices with the transition, particularly ound p.t.s. and t.b.i. and just the trauma, how we can help people coming back from this level of trauma. i don't know, maybe we can start with the sergeant if you're aware of any types of programs that are effective? >> thank you, ma'am. there are great things that are effective, but the problem is, even though we can group veterans together in a large

sum and combat veterans in another category, it's hard to label one program as effective for all. so many find group therapy programming very successful. many find combat veterans support groups very helpful. some find one-on-one peer mentoring very effective and helpful. this is why when we're talking about evidence-based therapies, the best practices of the v.a. pushing cbt, cpt, these things can be deemed as best practices, but many veterans aren't ready to go through such intensive therapy. they would rather pace themselves. so while it can be very effective at squashing the problem, i can't really say that there is one thing that's straight across the board going to work for everybody. that's why i stress the

importance of a team that works together to bring together what's best for each individual veteran in a veteran-centered care rather than a systematic care that the veteran has to adhere to. >> so you're look at more of an individualized approach, but a team approach and i think ms. portwine, you mentioned that others on the team may see something in the care. >> yes. >> i also want to visit this issue of hipaa because i'm an attorney, i have worked 25 years in health care. there is definitely a waiver process and this happens in private sector medicine. are any of you aware and through your review of the records after the fact, have any of you experienced the v.a. asking the patient at any point in their service for a waiver

to identify people that they would be willing to have their medical records shared with? >> i know we had specific -- daniel ended up going outside the v.a. because his psychiatrist retired and they said we don't have anybody for you to see. at the time he was having suicidal ideation, so his mother-in-law who was a private sector psychiatrist had him to somebody in the community. we asked him can we be a part of what was happening. he said he would ask her. my guess is he never asked her and we never got the feedback. it was just embarrassing is probably the closest word we can come to for him to have to share that information. >> sure, i understand. i can speak to that a little bit as well going through clay's medical roads from houston from the v.a., there

was a form in that assessment and there is a question that says do you want us to or will you allow us to, i think it said do you want your family to be contacted regarding your care and he had checked no. and as difficult as that was to read, i know, you know, i know him and i can't even imagine and i really, i just can't even so ne -- these people are strong in the first place to raise their hands and say i'll go and they go to war and they have these injuries and especially with the mental injuries, it's so difficult to feel that you're a burden on other people and i know clay felt that, even though he knew how much he was loved unconditionally, any of us would do anything to help him,

but he was 28 years old. he had been a marine scout sniper. you just want to be able to take care of yourself and get the medical care you need. so it didn't surprise me to see that, but there was a question of would you allow your family. >> thank you, my time is up so i'm sorry to interrupt you, thank you, mr. chair, i yield back. >> thank you, mr. kaufman, you're recognized for five minutes. >> thank you, mr. chairman. i think, first of all, thank you so much for the service of your sons and, sergeant, in your case, your own service. my heart goes out to you for your losses as a veteran myself. a question that i have is, i mean, do you think certainly, sergeant, in your case, and

then for the parents in the ases of your sons that was the v.a. overmedicating them in lieu of giving them therapy? sergeant, why don't i start with you and then i'll work this way. >> sir, thank you for that question. this is really a culture that begins with d.o.d. and extends into the v.a. it is an issue that we deal with on a daily basis as we provide support and service to veterans and active duty members where i'm at in my local area. the part of what i do through the ministry that i'm in is providing support groups through the chaplain's channels, so i deal with this very closely on both sides. medication is no longer being used as a tool to subdue the symptoms while we work on the deeper issues. >> what does the v.a. do? >> the v.a. specifically utilizes medication to control and keep them, suppress the

symptoms without working on the deeper issues. >> thank you. >> brian was never put on any medication, only for his back. >> yes, clay was on quite a bit of medication and as i said, he termed that he felt like a guinea pig just constantly being given something different. >> do you think that they chose medications in lieu of therapy? >> sure. >> one-on-one therapy? >> yes. the only one-on-one therapy that he spoke of that seemed to be effective at a certain point in l.a., he went to a vet center and had a counselor there that he really liked and felt that he finally had found somebody he could talk with. >> from daniel's point of view, i think part of his problem was that he also had gulf war

syndrome which manifested with so many physical symptoms, so, yes, he had a 24-inch by 24-inch drawer full of pill bottles. i think it was because he was having such incredible interactions between the different drugs that he was taking for pts and the gulf war syndrome. >> daniel was not being seen by a v.a. psychiatrist after, six months after he was home just because he never got the postcard that he was supposed to get to assign him another rovider. >> how much of the stress or the factors leading to suicide do you think might have been related to the fact that, i mean, i can tell you having been to iraq, i mean first iraq

war and then the second that when you come home, there is a huge, sort of a guess maybe separation anxiety that you are with, you develop these interdependent bonds and this team around you and all of a sudden it is just gone. it is just gone. people fall into very dark and deep depressions sometimes. i think it's easier for those that come back and then they have a long period of active duty with the same people that they served with and i am wondering if you can comment, we'll start with this side of the table. >> um, this is a problem certainly with national guard. daniel was a member of california national guard with the military intelligence. they are routinely separated from their main unit and assigned to other units. daniel went to iraq with an m.p. unit out of texas. so he was already not with the unit that he trained with.

he went to iraq. when he came back, his wife had moved to arizona to be with her parents so california national guard deployed with texas and ended up in arizona. so he had no support group whatsoever close by. it would have been phone call and email. >> this is a known issue. reserves and national guard, it's a huge issue. not to take away, of course, from regular servicemembers in all branches of the service, but it's a much bigger issue for those who do not have the opportunity to come back to a defined facility and spend time like you said with the people that they were deployed with. >> great question, the bonds that these men and women form in combat are just incredible. so it's very difficult for them to leave service and come back to their communities. clay probably stayed in -- he

really struggled about going home to texas or staying in california. i think one of the reasons he stayed there for a while his close friends were staying and continuing. one of the tragedies with clay was he moved back to texas and wanted to consider going into working for the fire department, a paramedic, that sort of thing. he was having struggles with that. after he died, we found out that actuallyhis group were in the greater houston area. one of them in particular had gone through -- he was a year ahead of him going into the fire department. it could help, just the knowledge that those people are there would have helped. inre is a big break there leaving service and going back to the community. >> when brian went first, he was

with first cav, a deployment that was supposed to be 12 months, and they extended it to 15. of course, he was very tight with all those brothers, and they are still very connected online and text and everything. when he was in college, then when he was called back the second time, his unit was already home for the year, so he was put with the louisiana national guard and he had no idea. those were completely new people. you can imagine, when you are already damaged and you wake up screaming three times a night and have anxiety and panic attacks. it is very difficult. with thee did bond people. he was very social. but it was not the same type of time he had with the first group. >> it has been stated well. to highlight on that, the battle

buddy system is so culturally ingrained in the military community. you really become a family unit with those around you that you serve with. and separating from that, especially the wounded as they transitiond into a battalion, separated from the family unit. even though they are with other service members, it is different. then they transition out and begin to isolate themselves after that loss. it is a difficult thing. that is why programs such as the v.a.'s navigator program are so essential. we should look at that and look at the way it has been implemented and improve upon that. servicemembers and veterans connect best with other veterans, especially those who have shared experiences. they can help each other navigate through the difficulties they experienced in this system. >> thank you. mr. o'rourke, for five minutes.

>> thank you. i would like to join my colleagues in thanking you and telling you that what you have shared with us today is so powerful. yourant renschler, story, the story of brian and clay and daniel, i hope will force us and the administration and this country to treat this issue with the respect it deserves, with the attention it deserves, and to get the results our veterans deserve. beyond the power of the stories, which are just -- it's hard to put into words, the effect they are having on me and my colleagues on this committee. you have also come to the table with solutions and proposals to improve the system. i love the idea that we think about the v.a. restricting responsibilities to becoming a

center of excellence for war related injuries. i have not thought about that for, -- before, and i would love to hear from other organizations. but i love your thinking about a big idea to transform a system that is obviously not working today and has not worked for a very long time, from everything i have learned so far. this idea of an interdisciplinary approach to taking care of veterans, i would like to know more about that. it makes a lot of sense, given your earlier testimony. the buddy to buddy system you brought up, identifying a support network when service members are still in listed, are all excellent ideas. i would like to ask you, i have received so much more value from this testimony today than i ever have from a representative of the v.a. including the reasons why we should be focused on this, the ideas, suggestions how to fix it.

i would like to ask each of you, if there was some formal process to involve you in fixing bva -- the v.a., would you like to participate? any ideas,f you have because so many good ones have come through so far, i would love to give you the opportunity to share with that. maybe we can start with dr. somers. >> whatever efforts, and resubmit it as part of our -- we submitted as part of our testimony 15 pages of problems and potential solutions. so there are a lot of really good people who can be very beneficial to try to help the system. we just don't have the time to get into specifics right now. but to answer your question, sure, we would like to be involved if at all possible. >> absolutely.

we would be happy to do whatever we can to help. i wanted kind shift the focus of little bit off of us as parents who have lost sons and lost children. words can't describe that. but i said here and look at sergeant renschler and listen to his story, and we are surrounded by veterans behind us. iava of them from the group. if there is any silver lining, it is that we have become friends with so many of these young veterans who have enriched our lives. i don't know where i would be without them. i mean that sincerely. they have enriched our lives so much. so whatever we can do -- we can't do anything to bring back clay or brian or daniel. but what we can do is do

something to make life better for sergeant renschler and all the veterans behind us and across the country. all veterans. not just iraq and afghanistan, but all of them. we should not have to be reminded of that. and yet we seem to have to be reminded that we need to do better. so we are happy to do whatever we can to help. >> thank you. anytime, anyplace. we are available. us, andthe process for for everyone at this table, is to have the opportunity to go beyond personal losses and address the veteran community as a whole, and do whatever we can to take care of them. , to be inortunity this community here and be able to talk and be heard by people who hopefully have, i believe,

certainly have the heart and hopefully have the ability to make some things happen. the v.a. is very complicated. it is a huge animal. i know there's a lot of things that need to be dealt with. there's a lot of really good stuff there, and some big problems. if we can just focus on the individuals, focus on them as care, whatn their they need today, and then build and modify the system based on that, that will take us a long way. the focus needs to be these veterans, totally. thank you. my time has expired, but ms. ,ortwine and sergeant renschler could you briefly indicate if you would like to be involved in perhaps a more formal way to include your experiences? >> it would be an honor for me

to help make a change, for veterans, to pay it forward. >> thank you. >> certainly, anytime, anyplace. i would not only bring my own battlefield perspective, but that of all the veterans i work with. and i can only offer that much. thank you. >> thank you, mr. chair. >> mr. cook, you are recognized for five minutes, sir. >> thank you, mr. chair. i want to thank the group for being here. i know this is really tough. sergeant, for your input. this is tough to listen to. it is even tougher for you guys. the comment about the parents not knowing, i'm not surprised. , after my second purple heart i did not want my parents to know what was going on. this is going to be the problem that i think all of you sharing

that common denominator -- you know, everybody goes through these experiences will have huge psychological problems, but who are they going to share them with? are they going to share them , or ahey psychiatrist psychologist who does not understand the military culture, the veteran cuure? they will not open up. you need that connection, and i think the sergeant made a great point. your comments about the wounded italian,rogram or the when someone -- batallion, when someone has a problem, they go into the system. i want to get your feelings -- and maybe i am going down the wrong road -- when someone has a

problem they need an ombudsman, somebody who is going to look out for their interests. that if they are in a particular hospital, they can go to the administrator. they can go to anybody and say, wait a minute. an immediate situation, general quarters, and we have to have a meeting right now or somebody will die on your watch. can you comment more on that? it's pretty much what you were talking about, but it's a buddy -- buddy to buddy. but to cut through the red tape with people who understand the severity of the problem. >> yes, sir. tos is a crucial element, have someone to come alongside the severely injured, cut through the red tape, and get treatment now.

this is something i experienced firsthand. i shared it with folks in the wounded warrior project recently. i had a veteran who attempted suicide. we had to remove him from his residence and we got him to a physician. i understood he never accessed care at aba facility -- v.a. facility. he was denied treatment and told he could be seen in three months, after telling someone he attempted suicide the night before. i went down and met with that veteran, and we walked in and i said, this is an unexceptional answer -- unacceptable answer. we got the department head to say, i will take him today. that saved that veteran's life, but there are thousands more a day getting the no and not that extra answer because they don't have somebody to advocate for them. i'm not saying that to to my own horn. -- toot my own horn.

i am saying, if we had more people advocating for these veterans we would be able to save a lot of lives and get better care. >> i went to camp lejeune. myaw the folks, including the tune sergeant 47 years ago. we talked about the infantry unit. you never forget the marines you lost. 13 may, 1967, horrible day. you never forget their names. just like you will never forget. but what you have to do is try to make the system better. and right now i think it is broken. in terms of not capturing those individuals and those thoughts, it is down to the point where they're going to do something bad. and if we don't correct it now, it is our fault. is a systems issue within the v.a. our feeling is everybody who

works in the v.a. should have only one purpose in mind, to advocate for the veterans. if the person who sits in the corporate office, the person who cleans and empties the wastebaskets at night, that is the only thought they should never have. ombudsman,ept of the somebody who is responsible or who is that advocate for that person in trouble -- >> we agree there needs to be an ombudsman. we know about the navigator program. that's a great program. we know they are doing a much better job of that in san diego. but it is not only the ombudsman. not only the navigator. it is every single -- --that there should be a standard operating procedure for every house will -- hospital. i yield back. >> thank you.

>> let me thank each and everyone of you. let me just tell you, recently i with the marines. they would be very proud of your sons. thank you very much for your service. i have to say, we are talking about the v.a., but this is not just the v.a., it is dod. v.a.-dod, because the dod sends people over and over and over again to combat, and it is not transitional when they come back. it is a bigger problem. and to sit here and just say it is the v.a., that is just not true. it's just not true. and we need to deal with the problem. we have been fighting a war with reservists,

and we have sent them over and over again, and they did not have the support they need. i have gone out when they were deployed, and they don't have what all the other military branches have. we are not doing the wars the way we need to. the system is fragmented. so as we develop a comprehensive system, let's get everybody in the room. let's deal with the system the way we need to deal with that. -- the v.a. and dod, we insist that they negotiate the prices of the drugs to keep costs down. now, what is wrong with the way we are doing that? because in the regular market, it is illegal for the secretary to negotiate the price of the drugs, which i think is dumb.

>> there is no problem negotiating the price of the drug. the problem is, the drugs are not the same. lexapro,for example, you would want the dod formulary as opposed to the v.a. formulary. no doubt about it. i know firsthand that you can basically get anything you need with relatively little hassle. >> i thought the v.a. was the one doing a lot of the urge, not the -- research, not the dod. >> the research has nothing to do with anything. the only thing that has to do with it is the drug you are provided with year -- prescribed by your provider. that was one of daniels issues. there is a fear of doing research because of the fda and schedule one medications and things like that. the problem is, the formularies are not the same.

you have patients, not only veterans being discharged, but retired military who are being seen at a dod hospital and a v.a. medical center, and they are eligible to be seen at both. they are under medication restrictions because the formularies are different. that is the big issue. we need to make it a single formulary. bottom line. >> ok. >> excuse me -- in addition to that, if a person is doing really, really well on a drug, they should be able to stay on that drug. >> the doctor tends to override it -- >> it can have major effects on their body. >> absolutely. but the doctor can override that. --what she says is different it is a generic, but as i said before, it is a different formulation of the generic.

especially as was said, that is what is so important, to have these groups of the multi-specialty groups, the interdisciplinary committees or whatever they are that are going to communicate among themselves. >> i definitely think that is something we can work on. ms. portwine, i think you made an excellent -- important point. your son, you realize, was having serious problems, and yet he was redeployed. >> yes. >> he was not given medication. it should have been a timeout at that point. >> even on the form, you could see it said no go. that was crossed through and coordinator,ped a i forget what they call them, put go. >> that is dod. >> that tells me they had hesitation in sending him to begin with. >> that was dod. thank you very much.

what i'm saying, it's a lot of work that needs to go on, and not just v.a. thank you again for your service. >> thank you very much. ms. will -- for five minutes. >> i can assure you that this is how things change in this country. when brave men and women stepped forward and say to a concerned body like this of republicans and democrats, sitting here listening to your story. i can't pretend to imagine how tough it is to sit here and relive this. i think i can safely say that we are committed to bringing right to all of this wrong. and everyone one of you has hit the nail on the head by saying, everyone of you has said that the story is about the individual veterans. i have only been on this committee for 18 months, but the last three months the chairman and ranking member have led an

intensive investigation into what the heck happened to the v.a. from the day it started to the mission today, and every layer of this onion we peel back comes to the same issue -- nobody is advocating for the veteran. when we talk about systemic ,roblems and the culture itself the secretary is removed and a bunch of people are removed and we are trying to help america reset a button, because americans believe in our veterans. they send us here to fight for our veterans. i want to applaud your efforts. you have made such a huge difference here today. this is how laws change. us is how policy becomes correct. this is how we move forward in this country. we do it together. unfortunately, sometimes it the disaster we have had in the bureaucratic system of the v.a. i have 54,000 veterans in my district. every time i described them, i talk about, i have 54,000

veterans and their families in my district. and i want to apply your effort on two huge issues that i think we can address in this congress and we can help move forward. one, the support network. i know you know how many constituents have called our office in indiana. the wife or the husband is in tears, and they are begging for hipaaouse, the v.a. says prohibits me from letting you get involved. i have gotten personally involved in some cases in my district, calling the regional director and trying to advocate. the answer is still no. i asked, do you subscribe to a different mission than we do? the answer is no, hipaa overrides. to be able to be that bridge between somebody who is dying and the system. i applaud that effort. i am going to make sure we do

everything we can to get that part of the law changed, because we can bring advocates into the lives of these struggling men and women. for the spouses trying to hold families together, we can do that, too. i want to thank you for your commitment on the issue of keeping the focus where it belongs. i think some day, i don't think this is a quick turnaround, but you have brought transparency and accountability of another layer of what america needed to hear. while we are trying to share your grief and find solutions to move forward, you had an opportunity to talk to the american people today. i guarantee you every single person who you are and influence to -- i will hear from a constituents today and say, i relate to that mom and dad father and my fellow serviceman. this is a tribute today. this is how government works,

and we have a commitment to make sure we restore, not your sons, but certainly the america they have been fighting for. certainly our trust, their trust in us as a government that asks them to fight for freedom and liberty, our finest heroes in this nation, and continue to root out the bad actors and bad policies in the v.a. i want to applaud your efforts and thank you so very much for helping us reset an organization that started out as a great, noble effort and really has run into a bureaucracy that has run amok. you have our commitment -- my commitment, certainly -- that none of what you experienced will be in vain., i yield back my time. >> i would like to yield my first minute to my colleague, mr. peters, who represents ms. somers. >> thank you. i want to start by thanking the chairman and the committee for allowing me to be a guest. we are not members of the

committee, but there is not any place we would rather be this morning. it takes a lot of courage to do what you are doing, and i want to say thank you for that. also to let you know, beyond the power of your stories, it is the education you provide that only you can provide. these are insights that only you have. it has been very valuable to us. while we are new here, we can tell you that from time to time you see testimony that will make a difference. that is what has happened today. you can feel confident those brothers and sisters will be heavily affected and helped by the time you put in and the effort you put in today. i also want to thank howard and jean somers for your leadership, for the time you put in on behalf of daniel, and the education you have given me. i look forward to continuing to work with you to make these issues, to resolve these issues and make things right with the veterans that the v.a. sees. >> thank you.

>> again, thank you all for being here. i am sorry i never got the chance to know daniel or brian. i did have the privilege and honor to know clay, and not only know him, but work with him on veterans issues. the profound loss is felt by everyone who came into contact with him. someone so strong -- you are not going to notice it. these are very special individuals. you and i have become friends over the years. we were in st. paul a few weeks ago working with the wood for your project. i applaud you. this is a committee of heartfelt folks who want to get this right. i would just mention, and i think all of you get this, at this point, the frustration we all feel, solutions and results are all that matter. i am done with it, as you all are. i am done with the talk. i'm done with the pilot programs. i understand we need to do something, but there are

suggestions that are concrete. 2007, in on january 3, had the honor of being elected to congress. on the ninth of january, i started a bill. , thef our colleagues suicide prevention act. it said the secretary of veterans affairs should carry at a conference a program designed to reduce suicide among veterans. education for compassion. recognizing risk factors. proper protocols for responding to crisis situations. screening of veterans. tracking of veterans. designation of suicide prevention counselors. and on and on and on. they did not do it. it was in law. we passed it. we gave the speeches, had the signing ceremony and went home and said, we made a difference. and it's the very same things. said.ike joshua's parents you,i would ask of all of

the v.a. is the second-largest governmental agency behind dod. yet we have one of the smallest committees. we have committees that i don't even know what they do that have 80 staff. we can get lip service, or we can get serious. if thisave this, or crisis passes, our veterans will be coming back. there are veterans sitting behind me -- they have seen this movie before. here is what is different. i think there is no doubt in my mind that the american public wants to get this right, and they are entrusting us as their representatives to get this right. the commitment from the members of this committee, it is different, different from the seven years i have been here, different in how we are focusing, different amongst the advocacy. and we cannot let this pass. so what i would tell you, ms. portwine, and some of you doing this, you mentioned chairman miller and representative duckworth and myself along with

a bunch of folks will be out there this afternoon. we will introduce 2182. here is what i will say is different. this was a well-intentioned bill. but look to your right -- these are the folks who helped write the bill. susan was in the office. joshua is there. the somers suggestions are incorporated. this is the silver lining. you get tired of hearing that. there is no silver lining when your son is not coming home, but you have asked for a solution. i would ask each of you as 2182 starts to move and senator walsh does it in the senate, let's together make sure it does not end up as the joshua act. the secretary had this authority. the american people said, do this, and we did not do it. so i would only say to each of you, as my colleague mr. o'rourke said, this is how democracy can work best. this is how we can incorporate people in it. this idea of wringing our hands, who could have anticipated this

-- this was started in 2007. and here we sit in 2014. so keep the faith. but again, i would say this, the cameras, the tv, what is there, whatever, none of it means a damn thing if we don't get results this time. here is the thing. meetot going to get to brian, i'm not going to get to meet daniel, i'm not going to see clay again, but i want to see josh, i want to see the rest of them. we have the right guys here. we have the right commitment from the public. the right people behind you, writing good legislation. now it will be, can we do it? >> thank you. dr. bennett scheck -- benishek? five minutes. >> thank you. i would like to thank you for your courage to be here today. please know that your efforts today will make a difference at

the v.a. i really want to thank you. , i want to. somers thank you for the 15-page primer. it had some really good ideas, and i really appreciate you all taking the effort with a document like that. , yound mrs. selke mentioned, and i was disturbed by the comment that you found the environment of the houston v.a. was stressful. could you elaborate on that? what specifically lead to that conclusion? have you been there since? hasn't changed? -- has it changed? >> i went by myself that they, and have not been back since. for whatever reason, i felt compelled to go and get his medical records. i wanted to see them. , for 10 weeks with

the care, so there were not a lot. you drive to the facility, it is huge, as they all are huge. there were so many people milling around out front. big crowds. lots of people that i don't know if they were there waiting for appointments or if they just don't have anywhere else to go and they hang out there. you go inside and i likened it to an airport terminal anyway. -- in a way. you go in and it is a hub. very busy. lots of people milling around. lines, the cashier lines look like in an airport where you line up to get your tickets or something. it was very stressful for me. of course, i was in grief mode, but not the post-traumatic stress mode. i just could not imagine, i could not visualize clay going in. i could understand why when he

left the day he called and said, i can't go back there. no one was that the information desk. you go to the front door, they were on a break or something. no one was there. i finally found someone who could direct me to where the medical records are. i went and retrieved those. before i left, i just remember standing there for a few minutes and imagining, if i were a veteran, if this were clay -- >> how do you negotiate this? you mentioned another thing. your son had voiced concerns about the care he was receiving. is there this of the concerns he raised? >> i'm not sure i remember. >> let me ask sergeant renschler a question. you wrote that the combat veterans in particular often approach mental health care as ly.itantly or distrustful

change thesuggest we dynamics of that veterans who need mental health care feel more comfortable accessing the care? >> thank you. it starts with what she was just sharing. haveat our facility. we one in seattle. seattle is a large hospital building, not very user-friendly. brain, i have a traumatic injury that i have overcome fairly well, but i get lost and confused in that place real bad, and there's not a lot of friendly people there to direct me. i get better customer service at best buy, quite frankly. a little bit of care training would go a long way in the v.a. medical centers. my other medical center closest to me is a campus with many buildings. the building numbers don't even make sense. i will be in 81 and i'm told to go to building 3, which is right

next-door, and building 61 is across the campus. the numbers make no sense. the facility is confusing. not a lot of people to help guide and navigate a very confusing situation. so for one, just recognizing who the audience of a veteran is and making the environment conducive to healing would be a start. another one would be, as i discussed earlier, and i keep bringing it back, the interdisciplinary team. it takes report -- rapport, developing a relationship and rapport with a veteran to get him to go beyond service level issues with a physician. especially in, the infantry culture, a sick call was very encouraged. if you went to sciick call you were a wuss and pretty much got

crap for it the rest of the day. we don't go to sick hall unless something is debilitating in nature. that sticks with you the rest of your life. as i am muscling through ridiculous pain, my wife will eventually say, when will you get some help? it is the mentality of socket up and drive on. that is what they are doing with mental health issues. that is when they -- why when they get there is a crisis and needs to be treated as such. there is a twofold answer. number one, the v.a. needs to recognize there will be a lot of crises, and come back in three months is not acceptable. come back in 14 days to intake so you can get treated in three months, still not acceptable. instead, to have a team to say, welcome, this is your place, this is your team, these are the people caring for you, this is what we will do for you, and provide better customer service, for one, but for two develop a

relationship of trust and rapport so i know i can confide in these people to provide the quality care that i know they should. i hope that answers. >> thank you very much. i am out of time. >> mr. titus, for five minutes -- mrs. titus, for five minutes. >> thank you for being here. this is tragic and heart wrenching. i hope you can take some comfort in knowing what powerful advocates you are. you have told your stories so eloquently, so orderly, so thoroughly, that it really will help us to move forward. i have just been noting some things we need to address. we are at a point where we really can make a difference. so in addition to the things you have suggested, i want this committee and the people in the room and -- i ask you for your help on this, for us to address some other things that i think are also related to the problem.

first, you are obviously very loving families. you are there for your children, but many of our veterans don't have families like that. there are many homeless veterans, sleeping on the streets. they don't know where to go. they don't have somebody they can turn to. so we need to figure out a way, how we can address the problem for those that are in -- vetera, as well as those like your children. i want to not overlook that. a second thing is the bso -- vso's are there to provide services to veterans, and when they don't have the ability to bond like they do while in the military, they cannot be there 24/7 like your band of brothers and sisters can, but they are there, and maybe we need to look at ways we can help them to do more outreach and better fill the gap for when people come

out. we have also heard horror stories about the medicine and all the different drugs. i think we have begun to hear that medical marijuana is a possible way to address ptsd. let's not leave that off the table as we move forward. even something as simple as the notion of companion dogs. that something you hear, that many vets if they have a pet that helps them get through some of these troubled times. let's keep that on the agenda. you mentioned about being a firefighter. let's remember that when veterans come back, they don't just need health care, both mental and physical, but they need to be able to transition into civilian life with easy access to education so that some of their training counts toward college credits or employment, retraining and having jobs that have something to look forward to, that takes a little of the burden off.

those are all things we need to look at, the big picture. and i just thank you very much for committing to continue to go down this path with us. i would ask you, too, don't leave anything off the table. anything you can think of, no matter what it might be, now is the time for us to address it. i don't know if you want to comment. i don't want to put you through more questions. >> i have one comment. >> that door is open. >> i know the v.a. has the emergency crisis line. i work for an insurance company -- we have what we call nurse line. any time, a member can call, 24/seven. why do we have to wait until it is a crisis to have somebody to talk. when they are starting to feel depressed would be a great time for a nurse to assess and triage what the person needs.

can it wait until tomorrow? what do they need? i think that by waiting until it is a crisis, you are more down the slippery slope. we are fairlyadd, new at the whole political thing. but i came across something called the independent budget, which if i am interpreting it correctly the vso's put together for congress. i would ask that next time that comes to you, that you really look at that closely. because these are your veterans talking to you. >> i would like to ask quickly -- one of the things that clay said over the years that sticks wrong, hend it is would say over and over, i have .o grovel for my benefits

and i just think we need to wake up as a country. our veterans should not have to grovel for anything. and it should not be so difficult to get the care they need. at all. thank you very much. thank you, mr. chairman. i cannot thank you enough for being here today. the sacrifices you have made. i pray that the sacrifices that you and your entire family made will make us a better nation at the end of the day. i think most who sign up to serve have that intention, that they will make this a better nation at the end of the day. i am a physician and also a reservist. i served in iraq for a year. that has led me to want to be here today. one of the things that i know is a doctor, and i'm sure that dr. somers can relate, when you have

patients, regardless of their problems, there is a level of anxiety because they have something wrong. whether it is musculoskeletal or mental. it doesn't really matter. something is wrong, and there is anxiety. and it makes it even more difficult and heightens the anxiety when you have all these administrative problems. i know you started to deal with that in private practice. when the prescription you think is best, they are not allowed to have. those types of things just increase the patient problem. trying to take care of the patient. we really are here, i will say, not to complain but to come up with solutions. so your input today is extremely valuable. one of the things i see, if a doctor is credentialed with one v.a., he should be credentialed at every da anothers him to go to

v.a. if there is a deficit. if your prescription is good at one v.a., it should be good at another v.a. you can call and get the prescription filled, and when you cannot, think of the anxiety that comes with that. these are things we can fix. these are things we have got to fix. i will also contend, it is a big difference being in uniform and out of uniform as far as care. as a reservist, i can remember being with the family for 15 all of a sudden i am the last one left at the airport, going home. when i get home they say, you have 90 days to go back to work. i say, that's not going to work. i am getting my house in order and going back to work. you have to have something to go to. when you are just wallowing -- i think we need to engage. engage on what you are doing when you go home, and have the v.a. be part of it as well.

we have got to blend these two systems together. we have to engage in the post-deployment activity. when i have been in uniform, i have had the opportunity to serve in preventative medicine, in particular in suicide prevention. we get a lot of training in uniform of what to look for. have the battle buddy. the types of symptoms you are looking for. sometimes when the decision is made that you are going to take your life, that there is a columnist -- calmness. look for somebody giving away their stamp collection or coin collection because they have made up their mind. for they spend more time with the family because they have made this decision. those are things we get in uniform. we don't get them afterwards. guard and reserve in particular, you just go home. i have seen at fort lewis, families engaged with programs. but that doesn't happen the same way with guard and reserve. it is a different animal. more than anything else, what i

want to do, when you talk about solutions we can all be trained to look for symptoms and look for signs. but how do we go about preventing the very ideation of taking one's life? what are we doing that creates a situation where someone comes up with the ideation that this is the best way to go? that is the type of input we need. that, to me, is really preventative medicine. i hope to get through it. our suicide rate is going up in our civilian population as well. we have a national problem here, not just a military problem. again, i applaud all your input. it is extremely helpful to us. and as you have seen, this is a determined group here that wants to make a difference in the history of our nation as we move forward. and we are glad to have you as a part of it. so your input is always welcome, and thank you for your commitment.

i yield back. check your mic. there you go. >> thank you for allowing me to participate in today's hearing. a special thanks to my colleague from arizona, ms. kirkpatrick. i want to thank all of today's panelists for joining us. in particular, thank you to daniel's parents for being here. we worked together quite closely, and learning of daniel's suicide -- it is an honor and privilege to be here today. unfortunately, daniel's story and the other young men who committed suicide, it is all too familiar in our country. 22 veterans a day are still committing suicide, even after we have heard the tragedies of young men who lost their lives

here, and the brothers across this country. as we heard from mr. walz, congress has addressed this issue before, has passed legislation before, has said they will fix it before, and yet the problem has not gotten better. it has gotten worse. i have heard a lot of testimony today about ideas to reform the system to make it better. the hipaa issue is one the community would agree needs to get addressed. i am interested in the pilot program sergeant renschler are dissipated and. my question to dr. and jean somers would be about daniel. his experience at the phoenix v.a. was one of lack of concern, lack of care, lack of follow-through, and a discombobulated system that did not allow veterans to get the care they needed. one of the struggles daniel faced was with individuals who served in classified service, he was unable to participate in

group therapy because he was not able to share the experiences he experienced while and service. and yet at the phoenix v.a. he was unceremoniously put into group therapy, and when requested private therapy he was not able to get that care. as we know, he took his own life as a result of being unable to get that care. medical model in the private community has provided an opportunity to get patients better care and allow civilians to get the care they need in one home that is centered directly on their needs. while the private program in washington was ended because of, i don't understand why -- they say they did not have enough money for it, which i think is outrageous and a horrible reason to stop providing care that we know is effective and appropriate. my question for dr. ng and isers -- and jean somers

whether you believe a medical home model could be helpful to veterans like daniel. we know many 9/11 -- post-9/11 veterans experience: occurring disorders -- co-occurring disorders. what a medical home model have worked better for daniel than what he faced? >> absolutely. as daniel's your will bowel syndrome worsened -- irritable bowel syndrome worsened, he didn't feel he could leave the house. i cannot imagine that embarrassment. howard mentioned, at the time phoenix had the speed traps set up on major highways from his home to the phoenix v.a. so he had to find a way to get off the highway so the flashing lights would not affect him.

so absolutely. i can see it would have been very helpful to him just to have the privacy kit though they -- capability. >> i completely agree. i think not only the medical home model, but will we talked about, the ability within the system for the different people. because of his ibs and tbi and ptsd, you are being treated, as we learned here, the term being "in silos." you have to get out of the silos and combine resources, combine knowledge. we have heard a program such as was mentioned that are very successful, where people can have problems -- you have an optometrist in there who says, it sounds like it is not this,

but this, something you might not have thought of. the medical home model, the ability to create panels of care, anything like that would be overwhelmingly positive. >> thank you. i do want to take a moment to thank mr. benishek for cosponsoring legislation we drafted with the somers to address service members who served in classified settings and need appropriate care when they return. i want to thank the committee for supporting just a part of the solution to this issue. >> thank you very much. >> i really appreciate it. i appreciate the panel testifying and appreciate your courage. i want to ask about alternatives to medication. i want to ask the entire panel which alternatives you believe the v.a. could consider in addressing the mental health issue. i realize you have to have some

medication. in most cases, prescribed. but i'm familiar with the recreational therapy. the chairman and myself participated in a field hearing on recreational therapy, equine therapy. in my district we have the quantum leap farms. they travel all over the country. do wonders, igs understand from talking to veterans. just to name a few. can you maybe elaborate a little with regard to alternative to medication for mental health therapy, ptsd, tbi, what have you? >> brian had a brother who came back, and he had ptsd and he had a friend that was doing some gardening. he started working gardening with him. pretty soon, they realized they really liked it.

so they decided to make it bigger. and then they thought, let's take these vegetables and take them to market and see if they can sell them. now they have a huge area, and they do this. i have heard of veterans going on farms where there are not a lot of loud noises and flashing lights and sound issues that they have with ptsd. so those are two others. >> thank you . anyone else? >> we could put together an extensive list of what veterans used to cope with these things outside of medications. motorcycle riding, bike riding, equine therapy, service animals. the list could go on and on. i would rather stress the importance of the fact that there is no one solution. until the v.a. can get to implementing best practices

system-wide and taylor -- tailor-fitting to each individual veteran's needs and using known best practices that exist out there, until we can do that we cannot fix anything. we will put policy -- we can put policy in place that you have to give access to these treatments, but it is the implementation of the policy that is a major issue here. the list is extensive. >> thank you very much. one size does not fit all. >> i would like to weigh in on that. , ahear a lot of the excuses lot of the excuses we heard at phoenix is that it has to be evidence-based treatment. how do you get innovative therapy if everything has to be evidence-based before they will use it? i think they need to open up

their minds a little bit and think outside the box. heard,have third -- everything has to be individualized. i have heard of gardening before as being very therapeutic for people. i think they need to get out of the mentality that this is all we can do, we have these blinders on. >> thank you very much. bottom line, we need to listen to the that -- vets. >> it is a community, a lifestyle sort of approach. the v.a. needs to do what the v.a. needs to do the best way the v.a. can do it, but the v.a. cannot do everything. clay kind of put together his own therapy program. with thevolved community. with the team doing disaster relief programs.

with ride to recovery, riding bikes. that was great for him, to be able to heal. it was also great for him to be there to help his brothers and sisters heal. the problem, for whatever reason when a person decides to take their life, they have given up hope. so what do you do about that? clay could do everything. he could go on these missions, could do bike rides, but what got him was being alone in his apartment, by himself, hopeless. , matters ofestions faith, but it is a community approach. people need to come to governments and volunteer organizations, partner. no one organization, not even the government, can do it all.

everybody needs to realize that, come together, and take care of these folks. >> thank you so very much. i yield back. >> recognized for five minutes. >> thank you. i want to associate myself with the comments of mr. bilirakis and ms. titus about alternative therapies. i think we know they work. i appreciate your comment about evidence-based. i'm not a doctor, but i have seen evidence non-drug therapies work. it should be good enough for the v.a. i want to talk about the v.a. acknowledgment of non-drug therapies, and your experience with that. understanding every case is going to be different. i was at a v.a. intake day where we have 300 people coming through in my district. one man brought a backpack that he turned upside down and dumped out surplus medications, dozens and dozens and dozens of bottles of them. a start -- sergeant, you

referred to your cocktail going from 11 drugs to 14. ms. selke, you have expressed concerns about ambien. ms. somers, you expressed concerns about generics and otherwise. do you lack confidence in the way the v.a. administers pharmaceuticals? not the merits of the pharmaceuticals, but the pharmaceuticals administered and directed by the v.a.? >> i will speak to that. i spoke earlier about the disability -- difficulty of clay getting a prescription refilled. what has been said before, in the private world if i go to a doctor and they determine i need a drug for my low thyroid issue, i go and get it, and i stay on it as long as i am retested and that is shown to be effective. i don't understand why the dod and v.a. have two different

and theutical programs, veteran has to suffer the consequences when you separate from the service and moved to v.a. you cannot swap them out. it makes no sense to me. i do understand why one system would not work for both. why not whatever works for dear as far as pharmaceutical medications or anything, why does the v.a. have to be different? it sounds like it is a cost factor and they went to the cheaper route. we have people dying everyday because we switched. is a matter ofis personal impression, not clinical. ofconcern having heard each your stories that simply because of the patient and a million volume of patients, we raise

concern about personalized care and it seems to me that is clearly lacking. i do not know what your impressions would be if you can speak to that. also, simply whether or not alternative therapies -- your son had that discussed perhaps or sergeant in your counseling, the ability to get alternative therapy. i say that based on the personal experience. i had a man in my office to set up the therapy works. that was good enough for me but it wasn't good enough for the v.a. any discussions about alternative therapies, availability? your opinions. sir? >> within the medical center, they had at one point of time available trauma patients who suffered from conditions. we were able to access

recreational therapy and i was put on a six-month waiting list. when the six months came up, they lost the therapist. i never had a chance engaging them because it was downgraded when they determined my dramatic brain injury had reached a plateau of recovery and probably would not get better. that is a really be separate -- that is completely separate. it really helps -- >> the availability. >> the availability is not there. it is private communities. >> ms. somers? >> i would agree. it was easy for him. he got a piano and a guitar. that was his therapy. they haveego v.a.,

parted -- pottery classes. and a guitar program. >> it is not just medication. the psychological treatment that are out there that only using two of them when there are so many other potentials. the older thing we mentioned was ecstasy/lsb fd for pain. phobiasof our national against these particular chemicals, we are making it very difficult to do trials with these potential benefits. >> thank you very much. i yield back. >> thank you. we think the witnesses for dissipating whether or not you know it, you're been at that table for three hours. we are very thankful you have

been willing to share your stories with us. with that, thank you very much and you may be excused. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> tomorrow on washington journal, the american civil liberties union discusses the class action lawsuit that group has filed on behalf of thousands of children who have crossed of the u.s.-mexico border and could be deported. looks at the concept of religious liberty and how it is being debated in u.s. courts and the legislative branch. urban talksclark

about efforts to increase security at the airports. plus, your form -- phone calls and facebook comments and tweets. it is live every day at 7 a.m. eastern. governorsal association continues its annual summer meeting in nashville. we regular -- we will hear discussion about health care reform with the tennessee governor and vermont governor. that is tomorrow at 10 a.m. eastern. will be livesion tomorrow. they will talk about education and job training ideas tomorrow on c-span. know want to- i do get metaphysical about this.

to be theod sport national pastime of a democratic nation because democracy is about compromise. you do not get everything you want and baseball is like that. there is a lot of losing in baseball. every team that goes to spring training knows it is going to win 60 games, lose 60 games. you play a whole season to start out. you win a 10 at of 20 games, you are by definition mediocre. 20 games, you have a good chance of playing in october. >> the latest book on baseball and wrigley field and the recent controversy surrounding one of his columns sunday night at eight eastern and pacific on c-span skew and -- c-span's q and a. >> the first year of operation.

the house is out for the rest of the week returning on monday at noon for speeches and 2:00 p.m. for legislative work. house leaders kevin mccarthy and steny hoyer came to the floor to discuss next week's agenda. here is a look. pro tempore: without objection. mr. hoyer: thank you very much, mr. speaker. 'm pleased to now yield to i suppose the majority leader-elect. a few weeks from now. but we'll be doing the colloquies and i appreciate his stance. we had the opportunity to have lunch. i'm hopeful we can have a very productive rich: as i'm sure this house and -- relationship as i'm sure the house and the country hopes. i'm pleased to yield to the majority lead hrn elect. mr. mccarthy: i thank the gentleman for yielding. i look forward to a very strong working relationship with you. mr. speaker, on monday the house will meet at 12:00er to morning hour and 2:00 prime minister for legislative

business. votes will be postponed until 6:0 p.m. on tuesday and wednesday the house will meet at 10:00 a.m. for morning hour and noon for legislative business. on thursday the house will meet at 9:00 a.m. for legislative business, last votes of the week are expected no later than 3:00 p.m. on friday, no votes are expected. mr. speaker, the house will consider a few suspensions next week, complete list of which will be announced by close of business today. in addition, the house will consider h.r. 5016, the fiscal year 2015 financial service and general government appropriations act sponsored by chairman crenshaw. members are advised that the debate on the bill and amendments will begin monday night after the 6:30 p.m. vote series. members are further advised that it is possible that we will have an additional vote series monday night on amendments to the financial service appropriations bill.

for the remainder of the week, the house will consider a package of five tax bills from ways and means that will help foster charitable giving. these five bills that will be included are h.r. 2807, the conservation easement intendtific act of 2013, authored by representative gerlach. h.r. 4619, making the rule allowing certain tax-free distributions from individual retirement accounts for charitable purposes permanent, authored by representative schock. h.r. 4719, which will permanently extend and expand the charitable deduction for contributions of food inventory authored by representative reid. h.r. 3134, the charitable giving extension act authored by representative kelly and h.r. 4691, modifying the tax rate for excise tax on investment income for private foundations authorized --

authored by representative paulsen. the house will also likely consider the highway extension bill to ensure that the vital transportation projects continue during the busy summer construction season. and, finally, members are advised that the house may also consider an extension of the terrorism risk insurance act. i thank the gentleman and yield back. mr. hoyer: i thank the gentleman for his information. i would ask him, we have now completed six appropriation bills, the gentleman has announced we'll have a seventh appropriation bill, financial services, on the floor next week. does the gentleman anticipate doing the balance of the appropriation bills the remaining -- bills, the remaining five bills, before the september 30 end of the fiscal year? i yield to my friend. mr. mccarthy: i thank the gentleman for yielding. as the gentleman noted, as of last night the house has now acted on six appropriations bills, which is halfway through. and as i mentioned in the

schedule announcement for the next week, the house will begin consideration of the seventh bill, the financial services appropriation act, starting on monday evening. and that's as much as i see for the next week. but as we move forward to the july calendar, i will keep you notified as we continue through. i yield back. mr. hoyer: i thank the gentleman. hopefully, i know he has the expectation, i hope that we would be asked to pass the appropriation bills individually, in a manner that we've considered the previous bills on this floor. i note that the labor health bill has not been marked up in subcommittee and would simply ask him if, in light of the fact that that has not moved through subcommittee yet, would that be one of the bills that he would anticipate bringing to the floor before september 30? i yield to my friend. mr. mccarthy: i thank the gentleman for yielding. i do not anticipate that bill coming up next week, but as we look towards the remainder of the july schedule, we will certainly notify the members for the consideration of the

house. mr. hoyer: i thank the gentleman. of course from our perspective and i'm sure from his, very, very important piece of legislation. the highway bill that is coming to the floor, we know that that is critically important. it passed out of committee i think on a voice vote, although as the gentleman knows, there was substantial disdepreement on the length of term of that -- disagreement on the length of term of that. we're disappointed that we haven't given a longer term or either done a short-term so we could do a long-term bill, giving confidence to contractors and jurisdictions around the country. but we find ourselves in a situation now where there are more than 100,000 transportation projects that could be delayed. so we look forward to working to not only move this process forward in the short-term, but we would like to and would urge , notwithstanding the fact it appears it's going to be a

longer term, until may of next year, that we continue to focus on a long-term, confidence-building, we believe economy-growing effort at a longer term re-authorization of a highway program. the gentleman doesn't need to comment on that. i just wanted to make that comment to him. unless he wanted to say something on that. mr. mccarthy: if the gentleman will yield. i thank the gentleman for yielding. i do want to thank the gentleman and the other side of the aisle because as you did note, it did pass out of ways and means on a voice vote unanimously. we are committed, we want to bring the bill to the floor. fill the hole that we are committed to looking long-term, as many of the ideas that we have brought forth in the past. and we look forward to working with you on working on the highway bill. i yield back. mr. hoyer: i thank the gentleman. we passed, as the gentleman repeated and that

extended -- it was not an extension from that standpoint, but the tax credit for vestments and equipment, depreciation allowance, we palsed that today. that was -- passed that today. that was a $287 billion cost. i would call the gentleman's attention, as i have with mr. cantor, we are still concerned on this side of the aisle, i know the gentleman knows this, that the unemployment insurance bill that lapsed in december of 13 is still -- has still not been funded. there's some three million people who have fallen off that. d part of your new responsibilities, you will be focused on scheduling legislation. i would urge the majority leader to consider very seriously bringing that unemployment bill to the floor for a vote. we believe that it does have the votes on this house floor and we believe that the three

million, and it's growing by thousands per month, who have run out of unemployment insurance, it's slowing our economy, but also obviously from their perspective giving them no support to support themselves and to help support their families. so i would urge the gentleman to look again at the unemployment insurance status. originally proposed to be retroactive, even if we look at it prospectively, we would hope that the majority leader would look at that and consider whether we may move forward on that on this house floor. i yield to my friend. mr. mccarthy: i thank the gentleman for yielding. i thank him for his input. as i said earlier, in next week's schedule, i do not anticipate that coming up next week. but as we look towards the rest of july, i will keep all members posted. mr. hoyer: i appreciate not only keeping us posted but the focusing on that to see whether we might do that.

tria, the gentleman has announced that tria is going to be under consideration. we believe this is a very important piece of legislation. it however passed out of committee on a party-line vote, as the gentleman knows. and there are still concerns that need to be addressed and i would hope that we could work on those before it comes to the floor. does the gentleman know whether that will come under a rule and whether or not that rule will amendment an open process? mr. mccarthy: i thank for yielding and bringing up this issue. as i mentioned, the schedule announcement for next week, members should be prepared for a possible consideration of the terrorism risk insurance act. but once the timing is finalized, the rules committee will announce the hearing on the measure to determine the process by which the bill will be brought before the floor. i yield back. mr. hoyer: i thank the gentleman. as the gentleman knows, we only have 12 days remaining until the august break, of

legislative days that we'll be in session. and only 22 days before the end of the scheduled session, prior to the election. the scheduled date is october 2 for us to adjourn. we believe this legislation is critical, again, for the economy, for confidence in the marketplace, to be passed. and so we would hope that to facilitate that, we could pass it through this body in a boip way, which would make it he's -- boip way which would make -- bipartisan way which would make it easier for the senate to facilitate pass and get that bill president. so i look -- bill to the president. so i look forward to working with the gentleman to see if we might overcome the partisan vote that came out and replace that with a bipartisan vote, make some accommodations on both sides to accomplish that objectivive. and i appreciate his being willing to work on that. last -- next to last, the export-import

next to last the export-import bank, i know there's work being done. i know the gentleman indicated it's not ready at least for passage. but we know -- this expires at the end of the year. we are very concerned about the adverse impact it will have. could the gentleman give me any information on where he thinks that consideration of that bill may be at this point in time? mr. mccarthy: would the gentleman yield? mr. hoyer: i yield. mr. mccarthy: do i not anticipate that coming up -- i do not anticipate that coming up next week. we will certainly notify the members if that will be considered on the house. million hoyer: again, i -- mr. hoyer: i did understand it's not coming up next week. the reason i mention time, we have so few days, legislative days left, we are going to need to plan to address some of these issues that i think are going to be very important to our

economic growth. i know the gentleman's very concerned about that. we are very concerned about it. on our side. his members are very concerned about that. we believe that that export-import bank is a -- an economic growth, economic confidence building measure. we would hope we could address that. there are also, as the gentleman knows, 41 house republicans who signed the letter urging that be passed and indicating their support of it, which we believe every democrat on this side will vote for that. that's almost 200 people. with the 41. clearly makes a majority of this house. we think it could be passed on this floor, and we think it would have a very positive effect on the economy. we would urge the gentleman to consider very carefully with his colleagues whether or not we can move forward on that. lastly, i would say to the gentleman, we are all very

concerned about children coming to the border. concerned about the process of making sure that this humanitarian crisis is dealt with in a constructive, positive way for the children. but also in way that gives clear notice that america cannot have borders which are simply opened but must be able to authorize people to come in to this country. not have them come in in an unauthorized fashion. in that respect, one of the problems, i don't know whether the gentleman had the opportunity to see the "wall street journal" editorial today, but they made it very clear that one of the problems is that because the system is broken, because we have not passed comprehensive immigration reform, and the gentleman, of course, based upon where he lives, obviously is very -- probably one of our more knowledgeable members on this issue, but the "wall street journal" observes that one of the problems is that people cannot come across the border

and then return in a fashion which will provide for work here by them and also for them not only coming here but then leaving without an expectation they'll never be able to visit or work again. either family members or for the purposes of work. we continue to believe that the passage of comprehensive immigration reform would be a ameliorate the present crisis we see at our borders. and we continue to hope that comprehensive immigration reform will also be an item on the agenda. although we have 22 days left between now and our october 2 projected adjournment, the expectation, i think, of all of is we will come back in a postelection session, so-called lame duck session.

either before that, in the next 22 days, or in the session after the election, we believe it is critically important to address the immigration issue. the gentleman and i have had an opportunity to discuss this over the last couple of months. i know he's very knowledgeable about this issue and sensitive to this issue and i would hope we could work together to see whether or not we could put a bipartisan bill on the floor sooner rather than later. i yield to my friend. mr. mccarthy: i thank the gentleman for yielding and i appreciate you bringing up the crisis at the border. many of the members in this house on both sides have been down to the border personally to see the crisis. i think that's foreign for all elected officials to go see. -- that's important for all elected officials to go see. we have a task force working on this. i know the president put for the the supplemental -- put forth the supplement. do i not anticipate that coming

up next week, but as we look toward the remainder of july i look forward to working with the gentleman on that and other issues. mr. hoyer: i thank the gentleman for that response and hope that the supplemental, because it deals with a humanitarian crisis, would not be a partisan issue. we obviously need to deal with the immediate problem. i was talking about the longer term problem, but i appreciate the gentleman's observation with reference to the supplemental. i'm a supporter of that supplemental. obviously appropriations committee needs to review it with respect to the proper levels of funding, but there is no doubt that we, right now, have inadequate resources to deal with the humanitarian crisis that confronts us immediately. those funds are necessary. i'm pleased that the gentleman brought it up and i look forward to working with him on it. unless the gentleman wants to make further comment, i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. for what purpose does the gentleman from california seek recognition? mr. mccarthy: mr. speaker, i ask

unanimous consent that when the house adjourns today, it adjourn to meet on monday, july 14, 2014, when it shall convene at noon for morning hour debate and >> remarks earlier today on the house floor. the chamber returns on monday for speeches. for more on next week's agenda, we spoke with a capitol hill reporter. the month ofrough july, getting closer to the august recess, the house comes back for a full week next week starting with reauthorizing the highway bill, the ways and means republicans are tweeting about the debate. they say we just approved it to fund the highways and a bipartisan way so we can make improvements to our roads and bridges. we are joined by lauren french, a reporter for politico. how similar or dissimilar is it

to the senate bill? >> you have republicans in the house backing it. it is a temporary extension of the highway bill. about eight to nine months of extensions for those funds. uc nancy pelosi, the minority leader, say it is putting america in a rut. it is just a temporary extension and suddenly a permanent solution to the funding crisis. it worked out between the senate and the house version. was extendedsion until next may so you're going to continue to see that -- besides hammering out their differences even though the house is scheduled to vote next week. >> you were writing about the rules committee next wednesday on the lawsuit on president obama. here is the headline. session look like? >> you will see both sides

hashing out the argument about why they can or cannot sue the president over overreach of executive action. the democrats are putting in high profile witnesses. they are going to argue the democrats that this suit has no standing. the house republicans should not be allowed to go forward. dou have two note constitutional experts for the republicans. school professor and a professor down in florida. they are going to make the argument about why the house does have standing to sue the president over his executive actions on the employer mandate in obamacare. >> they do turn their way through the 2013 spending bills. what is ahead for next week? >> the irs appropriations, that is going to come up. it is going to be a chance for house republicans to punish the irs for that controversy as well

as some of the other controversies the agency has gotten itself in. decreased funding is ahead for the irs. >> senator john cornyn and the headline says -- this was part of the statement that senator cornyn made when president obama was down in texas meeting with governor perry. the president requested money from congress. when will they hold a hearing on that? >> you have republicans saying they are not thrilled with that amount. the chairman think the number is way too high and a number of republican soul is of they are go through a rush to and fun to that request as is. their going to go through the normal appropriations and look to see what has already been allocated, what needs to be allocated immediately, and what needs to be allocated next year. even if the figure is right or

whether it is too high. that is going to be a huge source of debate between democrats and republicans. week, the the democratic leaders unveiled the response of the supreme court hobby lobby decision. this is the tweet from senator reid that says next week babel vote next week to ensure that it will not interfere with women's access to preventative care. >> it will overrule the supreme court's decision in the hobby lobby case which said religious exemptions do not need to provide some forms of birth control under their insurance to women. that would override the case and make it so these for-profit orinesses have to provide account for birth control action in their health care plans. >> a lot to cover in the coming week. lauren french, for politico. she is also on twitter. thank you for the update.

the american civil liberties union discusses the class-action lawsuit that group has filed on behalf of thousands of children who have crossed of the u.s.-mexico border and could be deported. and a smith -- hannah smith looks of the concept of religious liberty in how it is being debated. rban talks, clark u about efforts to increase security at overseas airports with direct flights to the u.s. plus, your phone calls, facebook comments, and tweets. it is live saturday and every day at 7 a.m. eastern on c-span. following washington journal, enough -- the national governors association continues its summer meeting in nashville. we will hear a discussion on health care reform with tennessee governor and the vermont governor. that event is tomorrow at 10 a.m. eastern.

later in the day, a special session with mary fallin and mr. hickenlooper. they will talk about job training and education ideas. that starts at 11:45 a.m. >> tune in this weekend for the harlem book fair. saturday ate starts 11:45 eastern on c-span2. by ed royce on foreign policy issues, including afghanistan and iran. this is held earlier at the "christian science monitor." >> thank you for