heartbreaking stories to share. heteenage girl told us how s she had fled her home when her uncle had been murdered in front of her house. sadly, this is not an anonymous -- not an anomaly. they and their families are being preyed upon by smugglers. the situation of this magnitude requires us to work across the law and to care for these children that honor our values. federal law says that hhs' role is to feed, shelter, and provide medical care for these children until we are able to place them in a safe and suitable setting with a family member or sponsor while they will await immigration proceedings. as the number of children have grown, our resources have been stretched thin. in fiscal year 2011, an estimated 65,000 unaccompanied children came into our care. to 13,600 and

2012 and almost 25,000 in 2013. as of july 6, over 50,000 children have been apprehended and placed in our care in fy 14. to address the associated challenges, a two-pronged strategy has been put together. one is to drive down the length of time the children remain in shelters. the other is to expand our shelter capacity. when it comes to time, the children that are in our care, we have made significant progress. since 2011 when it took 75 days to reduce that time to 35 and are continuing to make progress to move in more quickly. about 1700 beds and since january, and we have also opened a temporary shelters with three military races across the country. while temporary solutions were necessary in the short term, makeshift solutions do not make long-term fiscal sense.

morerary shelters cost than the permanent shelters. as we move forward, the reality is that we don't have enough beds and we don't have sufficient resources to continue to add beds to ensure that the children are not staying in the holding facilities at the border. that is why the president has made the request that we were discussing today, and we believe this investment will allow our department to bring on the additional capacity that we need. the gravity of the situation calls for a robust and compassionate approach that reaches across governments and empowers us to enforce the law. thank you, and i welcome your questions. let me just summarize it with

some less formal observations about this request. first of all, i believe we can this recentstem tide of the migration into the rio grande valley sector. the request that we have made billion is indeed a lot of money for the taxpayer. i think senator shelby asked the right question -- what will it address? what am i being asked to pay for? from my perspective, this request has the right focus on deterrence, added attention and removal, and removal more quickly than we have done in the past. from my perspective, the supplemental seeks $1.1 billion for immigration and customs 870 $9 million of which goes to adding the adults whoapacity

bring their children, family units as we refer to them. we have already begun the process of increased detention totality at new mexico, where i'm going tomorrow. we need money to build additional family unit capacities. to i.c.e. foroes working with the three central american countries from which this migration is coming, to expand their own resources. with respect to the customs and 430 $3protection agency, million is requested, $364 million of which is for added border patrol agent overtime and the like. ier capacity. -- for their capacity. as doj would point out, $45 million goes to more judge teams and an increased caseload 75,000 cases a year.

the deputy attorney general and i have already agreed that with this added capacity, the recent influx should be the priority. the state department is seeking $300 million, $295 million of which is for re-repatriation and reintegration into society. members of the committee, doing nothing is not an option. at our current burn rate, within the department of homeland c.e. will run out of money in mid-august. given the added transportation and enforcement costs, customs and border patrol will run out of money by mid-september. and given the situation we face. the one additional point i would like to add is the transfer authority that we have requested within the department of homeland security and between hhs and dhs in our view is

theical based upon possibility of evolving circumstances. i would also like to point out fromwe are not starting standing still. we have already done a number of things to address the recent influx. with respect to the adult population that is part of this recent migration, already dramatically reduce the expedited removal time, the turnaround time from something like 33 days to four days with the respect to the adult population. i personally witnessed when i was on guatemala two days ago, an airplane of adults coming back who were being repatriated to water mullah -- to water guatemala. with regard to the family units, i have already noted that we have built a federal law enforcement training center in new mexico into a dissension

center for family units. to highlightorrow that fact, and we need to build more. with regard to the unaccompanied obviously ais is major challenge with a humanitarian component to it. along that personally with secretary burwell, we have spent considerable time ourselves with the children, and we are bound and determined to do the right thing, but we are and we must request added resources to move these cases quickly. along with the department of justice. there is a public relations and awareness campaign, which the first lady of what a mullah herself along with his govern, ment has spearheaded. this is the first lady of water molecules he -- the first lady guatemala's awareness

campaign. asky have established a t force commanding mexicans i am pleased to note announce on monday that they intend to add to their border security along their southern border, so considerable progress has already been made in this regard to stem this tide among other things, but the supplemental is in our judgment an absolute necessity to address the situation. thank you. >> thank you. ambassador sherman? chair,m chair, vice members of the committee, thank you for this opportunity to testify before you on the president supplemental budget request. my colleague, secretary of health and human services, the secretary, security, have described well the situation that is underway. the challenge, i would like to address briefly the foreign policy and the larger diplomatic

challenges we face. i would like to start by making broad statements about the migration crisis that we are facing at this point. first, migration by unaccompanied children assign new phenomenon along our southwest border. however, what we are facing now in terms of its size and composition is. it is unprecedented and unique in terms of its drivers, and we believe that solution. it is unprecedented and unique first because the majority -- it had been a mexican phenomenon. it is no longer. what we're seeing is a dramatic increase in the number of central american children, and point of view, this means something is driving them out of central america this is the central american driven progress. second, while the motives behind migration are mixed and while many of those coming to the united states are driven by an traditional factors such as economic opportunity, it is

evident from interviews with them both by our customs and border patrol officials and by ngo's that work along the frontier that much of the migration underlying is violence . in other words, there is a significant push factor to this migration. the third point is that the migration is regional, and while much of it is directed toward the united states because of theting migrant networks in united states and the attraction of our country, the impact of this migration is being felt throughout the region. on u.n. high commission put an asylum request a neighboring countries, which means that when children decide either cannot make it to the united states or that are not want to run the, if they feel they have to leave, they do and they are going elsewhere in region. we believe that a diplomatic approach and a follower -- and a approach has toeport

involve the source and the transit countries, but also those affected by migration. in the process of working up the and looking request again at our broader central american strategy, we follow-up with a five-step or five-part strategy that we are in the first step is establishing a common understanding of what is happening and why between the united states, the three source countries, guatemala, honduras, el salvador, and the major transit country, mexico. the second step is manufacturing a compai that highlights the dangers ofgn campaign thatng a highlights the dangers of immigration. the second is to interject migrants. fourth is enhancing the capacity of guatemala, honduras, and el salvador to receive and

reintegrate, repatriated migrants to break the cycle of migrations and destroy further efforts of migration. the fifth step is addressing the underlying causes of migration of unaccompanied children by focusing additional resources on economic and social development and enhancing our citizens security programs to reduce violence, attack criminal gang structures, and reach out to at-risk youth. this strategy is a cooperative effort defined by collaboration between the united states, mexico, guatemala, honduras, and el salvador. it is a new approach to address migration issues that reflect the growing ties in, interest -- growing ties and a common interests. as we look at the supplemental that belongs to the foreign to the community, department of state and to our partners in dhs and the , wertment of justice decided that we would allocate $300 million in two fashions, $5 million on public diplomacy

messaging, and 205 million dollars on economic support fund broadly divided between the prosperity government and security. i am happy to discuss why we do this and how it is we propose to use this money. as noted by my colleagues, we believe this request is reasonable and necessary. it builds on work we are already doing in central america, takes advantage of existing expertise and experience and eggs -- and closelyto work with us on an issue of compelling human drama and national interest. this request will also allow us to build the newest comprehensive and collaborative approach with central america and mexico, the problems that have an immediate manifestation of migration but underlie the larger development and security challenges facing our closest neighbors. by working to meet the challenge of illegal migration of unaccompanied children to the united states, we will be advancing broader interest in the region and giving substance

to our vision of an america where democracy and market deliver economic and social development. this is an investment worth making, and i thank you for the opportunity to discuss this with you and i look forward to your questions. our thank you. afternoon, matt -- >> thank you. >> good afternoon. he was for the opportunity for allowing me to speak with you today about the justice department's role in the situation on the southern border. the deputy attorney general cannot be here today because he is traveling at the border. i will be concentrating my test my today on the executive office for immigration review, which is the largest component of the doj portion of the supplemental, and it is what i have. doingr is responsible for civil proceedings and that the board of immigration appeals.

overall, there are now 200 43 immigration judges in 59 courts around the country. many of our courts are located along the southern border and looting san diego, texas, el .aso some are actually located in reasons.cations for hashighest priority uir been detained aliens, and the agency has focused on the primary of those cases which involve individuals that dhs have apprehended and charged removal for of criminal convictions that make them are mobile. the current situation along the

texas border is pumping us to reset priorities as we along with our federal partners respond to the president's director to focus additional resources on the border, particularly on those as the secretary said who entered the border in recent weeks. from now on, the following four types of cases will be the highest priority for the immigration court. detained cases will continue to be a top priority, but we will be adding those involving unaccompanied children, adults who arrive with children who are detained, and adults who arrived with children or not detained and are released. this means that these cases will go to the front of the line for adjudication, and immigration judges will be reallocated to make sure that these cases are heard probably ahead of others. while there aren't already a number of immigration judges assigned to the regular detained prioritization of the rest of the cases means we will make additional judges available from the not detained dockets

and make sure those cases are heard probably. unaccompaniede children and adults who arrive with children. this will have large consequences for the broader immigration court case load. case is not considered a priority will take longer to adjudicate, in some cases considerably longer, however, given the seriousness of the situation on the border, it is the appropriate response for our agency. regardless of the changes for priorities that we are making, our overriding its bulls will remain at every factor is considered, every application of law is correct, and all persons appearing in our courts will receive due process of law. ,n order to meet this mission uir must be provided with the ability to properly staff with judges and staff to efficiently process cases. in 2010, we begin an aggressive hiring effort to address the significant rise in caseloads. it was met with considerable success.

unfortunately, funding constraints have resulted in hiring freezes, increasing the pendingf cases adjudication and extending core dockets far into the future. this year's appropriation act included funds enabling the department to lift the hiring freeze and we began an aggressive hiring effort to fill more than 200 vacant positions nationwide including at least 30 new immigration judges, and the president has presented his request for fy 15, which also includes a good increase for our agency and would add more than another additional 30 judges or more. i would like to highlight for the rest of my time the president's request for $71 million resented yesterday for the supplemental doj funding to address the border situation. this request includes $64 million to be directly appropriated to doj and $7 million to be transferred to doj from funding appropriated to the state department. of the $64 million appropriated to the justice department, uir would be allocated $38.7 million

to support the judge teams and $6.7 million for equipment and technology to maximize our flexibility and ensure that our judges are available when we need them and where we need them. in addition, the request includes $2.5 million for successful orientation programs for children in immigration proceedings. in addition, the request includes just over $1 million for doj's office of litigation to support the excessive workload increase and finally $7 million will be transferred from the state department to support a wide range of doj programs designed to build law enforcement capacity and central america to combat transnational crime. i ask your support for the president's request. >> i'm going to thank the witnesses for their testimony and now we will go to questions. you can see the enormous interest of the community, that we have 24 of our 30 senators who are members of this committee that are participating.

it will be let off by myself and senator shelby, followed by senators tester and alexander, murray and collins. that is the first hour. i can go to the second hour, but we are going to move right along here. i would like to go to the secretary johnson, and i really ask my colleagues in the committee to turn to page two, the second paragraph. says is without the supplemental funding in august, mr. secretary, you elaborate what will happen if we do not pass the supplemental, photograph my colleagues to look at it, but i would go to you, secretary burwell. $3.7 billion, $1.8 billion is in hhs. if we do not pass the supplemental by august, what

will happen -- and you gave a compelling narrative about the situation of the children, but what is it that you need $1.8 billion to buy? america'ss what middle class are asking. we are worried about these children, but back home they are worried about their children. could you tell us why this is urgent, what you need the 1.8 -- 1.8 billionr dollars? >> the money for hhs is generally for the care of children, and we generally refer to that as that's and 84% as for beds and 12% for other services and 2% in terms of administration cost over time. when we say a bad, what we mean in the full care for the child, and i assume we are going to talk about that throughout the hearing today. in terms of whether that is the fact that all those children receive a wellness exam, and that is important to the public health of our nation.

it is important to the public health of those children. each of those children also receive mental health interviews . as we have talked to, these children have been in -- some of them -- very tragic situations, and we need to make sure that as we place those children, we consider those types of things. the child is in our care. in addition, we are not putting an additional burden on the communities where the child is in our care. when the child is in our care, we actually do many the health examinations as part of our system where the child is. providingn, we are educational components for those children. they are not any system, so the cost for us in terms of the overarching cost is really about the care. servicesre for legal and certain health services. so the child actually have a situation that requires medical basicion that is beyond

child welfare, that the physician and other medical attendants can take care of. we paid for that care. the federal government pays for that care. in addition are the costs that we are talking about when we say the legal costs. the type of assistance that we for thehat we pay children when they come in to receive materials and sometimes better dump i video and sometimes those are done in person, and they received two types of information. one, the children come to understand and know their rights and protections that they have as part of this process. the second thing is the children are actually taught and it is explained what the immigration proceedings at the will face will be. for some of the children, we do additional supplemental group education sessions where they can ask questions, and overtime for certain children that have special needs, that is what the money is for. theo what happened this

state department should be encouraging people not to come, is not enough money for going after the gangs, the meet the border control, and then they come to you while the legal status is being determined. bill beforeass this this -- so if we do not pass his bill before the august bill, what happened? continue in the current trajectory that we saw in may-june, what happened in may and june is the number of children they came through dhs exceeded the number of beds that we had available at hhs. and what that means is those .hildren are at the border those children are in detention in holding pens until we can move them. currentay on the

trajectory and we are trying to speed our process, there are three variables -- the number of kids, the number of beds, the speed at which hhs can move the children. we are working on that speed is much as we can, but we need to do this in a safe and secure way, and what it is about is in august, if we continue on the may-june trajectory, the ability for hhs to bring on bed so that we no longer have more coming in than i can process at hhs and our teams can on a daily basis, they will be backed up at the border. >> what happens to you at the border? >> senator, because of the recent spike in migration, we have had to search within i.c.e. transportation costs and the cost of building increased attention capability. to be honest, i.c.e. had very

few beds for family unit attention capability, and we have had to build more to deal with this, to send people back quicker. the border patrol has been working overtime, so we have incurred those overtime costs as well as somebody cost of caring for all of the children. as i said earlier, at the current burn rate, i.c.e. is going to run out of money in mid-august, and we project cdp is going to run out of money in mid-september if there is no supplemental. we're going to have to go to some dramatic am a harsh form of reprogramming, which i am sure the committee is familiar with, some vital homeland security programs that i'm sure members of this committee care a lot about, so -- or risk anti-deficiency act violations, which is intolerable to me. expired, with my time the failure to act does not save

money for the taxpayer. what is essentially does is back up the ability of these children to be in a safe and secure surrounding. they will be primarily at the border with border patrol agents agents who are dedicated people who were never children.ouse they have overcrowding, poor sanitation, a variety of things there, so that will be the choke points, and you have to start reprogramming money from other homeland security's. is that correct? >> yes, ma'am. >> again, please go to page two of the testimony of secretary johnson. thank you. i will turn to senator shelby. before i do, i want to say one thing. i've seen now into action the people of caring for the children.

i have seen what your border patrol people are doing. i just really want to thank all the men and women who work , and theovernment faith-based organizations on the border and others reaching out for you for the way they are really trying to meet this in a way that is humane, legal, but ultimately we need to prevent these children are continuingly exploited by the traffickers. >> thank you. secretary johnson, is the protection reauthorization act of 2008, which you are very -- iiar with -- is that know that was a well-meaning piece of legislation, you know, because we are against human trafficking, adult, children, everything. problemhat part of the in detaining and processing these children now?

we have had reports that probably we need to change that law in some ways, amanda that law as we talk about more money. do you want to address that? >> it became law in 2008 and requires that when we identify a child as an unaccompanied child, i am required to give a child over to the department of health and human services, and they act in the best interest of the child. talking about unaccompanied children who do not have with them an adult to make decisions on their behalf, so i believe that the intentions behind the law, the spirit of reflect very worthwhile principles and reflect our american values, frankly. and this is that --

not part of this particular request -- i do believe that some type of added discretion on my part would be helpful to address this particular situation, and so right now what treatingn mind is migrants, unaccompanied migrants from the three central american as being from contiguous countries. right now we have the discretion to offer an unaccompanied child from a contiguous country, i.e. mexico, the ability to accept voluntary return. acceptf them do voluntary return. we want the flexibility in this to have thattion discretion to offer somebody from a central american -- >> if we allow to get that discretion, you think that would help you? >> yes, sir. >> thank you.

director, the administration announced on wednesday that in immigration proceedings, unaccompanied alien children will not be given priority over adults. we have seen no explanation of how resources will be allocated to achieve this end. at the moment, it's my understanding that the docket for detained person takes priority over other cases. if it is a docket for , childrened persons youhatever where the -- if don't shift resources to where the problem is, how do you prioritize these cases? following up on this, how many asldren are being detained opposed to non-detained status? senator, to answer your

question about how you address this without more resources -- we don't. the setting of the new priorities that now include unaccompanied children is to be able to shift immigration judge in immigration court resources away from the non-detained dockets, which are a big portion to then akets, company children. the unaccompanied children for the most part are not detained. arevast majority of them released by hhs and put in the care of a custodian, often a family member. >> is it most of the times a family member? >> that's correct. , ands, 55% are parents

getting us up to another 30% will be other family members such as relatives, sisters, brothers, aunts, uncles. >> for people who are , and they are put out with their family or to church or somebody that would take them that is responsible, what is the lag time -- say you did it today until there is an adjudicated hearing of whether they would be allowed to stay or go home? >> are you talking about for unaccompanied children? >> no. >> on detained children, and then detained. >> unaccompanied children for the most part are not detained. are asking is a lag time between the time it comes to the court system and the time there is a hearing. significantly from court to court. some courts can take a few weeks.

the point of setting these priorities is to make sure these cases are now heard much more promptly than they have been. they will go to the front of the line for adjudication. speak, what percentage of children meet the adjudication process, are sent home? what percentage stay in the u.s. currently? with thet familiar numbers as to how many children are actually sent home. that is a dhs priority or function. [indiscernible] the actual numbers of how many are sent home, i would differ to secretary johnson. >> secretary johnson, do most of the children after adjudication stay in this country? >> up until the recent

situation, the average pace at which unaccompanied children were deported was something like 1800 a year. >> and how many stayed? thousands? >> eventually if there is a final order of deportation and they have gone through the process, they should be returned to their home countries. we have done that at a rate of about 1800 a year. part of this request is so that we can accelerate that process so that more are returned, given the current situation. >> i'm going to start with you, jeh johnson. 433 million are slated to go through custom and border control. where is the other 70 million going? >> good question. you can give back to me on that.

will they be permanent? >> for overtime and related cost in terms of the actual numbers of hired personnel, i would have to get back to you on that. >> if we are able to get that situation solved, we need to visit about whether those agents need to be permanent or not. a lot of that cost is embedded in border patrol caring for the kids. ,> that requires bodies permanent bodies to care for the kids. thate baseball, a.u.o., if bill were to pass, would it help this money go further? >> if the a.u.o. bill that i --w that you have sponsored long-term, overtime cost would go down and it would be a more stable environment. >> it would contribute to make

this money go further? >> yes, i believe that. how many courts exist right now in the southern border? >> along the southern border, we have about six. three detained and three non-detained. >> how many additional courts will this supplemental be able to give you? allow supplemental will us to hire additional immigration judges. those immigration judges, because the situation will result in caseloads rising throughout the country, will be sent to some along the border, but many in courts far from the border. kids willy additional this allow you to process? >> i don't have an answer for that, senator. a large number,

perhaps most of the vast majority of the individuals that dhs has them apprehended will end up in our courts. until we start seeing those cases, we don't have a good handle on the actual number of minors coming to our courts. we know it will be substantial. you with this,lp but how can you come to us with a budget request if you don't know how many courts or how it is going to speed up this process? everyone of you talked about speeding up the process. how can you give us a budget request if you don't know how it will speed the process up? i want to be helpful and vote for this. the assumption underlying the request from doj that will be addeding and additional caseload of 55,000 to 75,000 cases a

year, correct? overall. >> and how many are they handling right now a year? >> right now the pending caseload is 275,000. >> how many kids are coming into the border every day? the totalays, apprehensions of the kids unaccompanied is about 250,000 -- 250. it is down to 250 a day. >> we will be able to make significant inroads into these kids as far as moving them through the process if this money gets to the department of justice. correct? on the tv programs, i hear senators and house members talk about how when these kids are process they never end up back in court. is that true, and does this money help that not occur? >> let me correct the numbers.

375,000 hazes pending in our court right now. -- cases pending in our court right now. there is a significant number of unaccompanied juveniles that don't end up in immigration court. the current rate is 46%. note that should there are significant consequences for somebody who gives notice for a hearing before an immigration judge and does not show up. that immigration judge has to issue an order of removal that is enforceable, whether it is an adult or child. >> will any of these dollars help with the abstention rate? go to thellars will legal orientation program for custodians. that is a program that is successful in cutting the in absentia rate. >> thank you very much, madam chair. right,re exactly senator.

fordo they know what to ask , unless they can honestly say how many cases are coming? --you are not talking to dhs let's go to senator alexander. he has been waiting. >> i thank the witnesses for coming. is an extraordinary problem an extraordinary amount of money. with all respect, it is an incomplete plan for dealing with the problem. it is not a new problem. we have known about this for a couple of years. government, itf is the president's job to lay out a specific land for what we should do about it. we don't job to say, like that, we are going to change this, and respond to that. this is not a complete land to me. what is missing are three things. 320 we need to secure the miles of border in the rio grande valley where the majority

of the children are coming. surges an unprecedented of illegal immigrants, unaccompanied children. we need an extraordinary response. the quickest way to deal with it and to send a message back to those three countries is, those children are coming home. we need to make it as clear as we can that what will happen to these children if they come to our country is they will be treated with respect and humanely and sent home, taken home as soon as we responsibly and safely can do it. number three, we need to know from the president what changes 2008 lawto make in the that apparently is the source of a good deal of the problem. monday that he has some changes he wanted to make. are,ed to know what those if we are being asked to spend that kind of money. number one, to secure the

border. we want an extraordinary response to an extraordinary problem? why don't we consider using the national guard? president obama has done that once. president bush did it in 2006. i was one of the former governors who urged him to do it. we have been commander in chief's. -- chiefs. in both cases, it had the desired effect of the government accountability office. if the president were to use the national guard for this 300 plus miles of the border, that would send a clear signal in those countries who those parents or those smugglers or whoever is responsible for this that the children are coming home, and the border is closed to them. that would be the first thing. that would be one thing we could do to make the extraordinary response. the second would be to make it clear that the children are

coming home safely, but quickly as we possibly can. the third thing to do would be this law in 2008. none of us are for human trafficking. the amendments in 2008 seem to have created unintended consequences, and contributed to the problem. the president said he wanted to make changes in the law, but now we have not heard exactly what those changes are. we have heard from mr. johnson the one of those changes might be to give him more discretion so that a child from one of those three countries could voluntarily be sent home. let me start with this question. secretary johnson, if in the past president bush and president obama used the national guard in a specific instance and used it effectively, why wouldn't that be a good tool?

to send a message that those children if they come here will be sent home as quickly and safely as we can. senator alexander, any time you deploy an armed force, you should do so with a clear plan and a clear objective and clear rules of engagement. unlike the situation we faced in 2006, 2007, this migration is also urging into one very specific area, the rio grande valley. we know where they are going. unlike the previous rise in migration we faced in 2006, 2007, this population wants to be apprehended. the are not seeking to evade law enforcement or the national guard. simply building and added presence on the southwest border on the rio grande itself will not necessarily stem this tide. >> by that logic, we should just

open the border. >> no, not at all, senator. what i do believe we should do is consider all lawful options, all lawful and humanitarian options. i have continually asked my staff -- i want to hear every conceivable option. evolves, is the national guard a possibility? title 32nal guard in status is hugely expensive by the department of defense. we have searched a lot of resources already. i want to consider all lawful options. some use of the national guard off the table for consideration, as the situation evolves. i do agree with you that we need to turn this population around. we have dramatically reduce the

repatriation removal time for the adults who are part of this population. we are building detention capability for the family units who are part of this population and turning that around. i'm going to new mexico tomorrow to make a point of that so people see that they are coming back, and with regard to the unaccompanied children, you have heard from the department of justice that that process can take as long as over a year. we need to dramatically reduce that, because we have to show that if you do not qualify for some form of humanitarian relief under our laws, you must be sent home. >> my time is up, but i hope somewhere in the discussion that mr. johnson or one of the witnesses will tell us exactly what the president wants us to do about changing the 2008 law so the children can be sent home more quickly and as safely as possible. thank you. we have heard this in other

quarters. i would bring out that the state department -- this goes after, where do you need to be muscular? the deterrence has got to come out of the state department trade -- department. using theh johnson authorities of the department of homeland security, working with our fbi to be going after the cartels that are actually doing massive ad campaigns to recruit them. having guys with guns at the border, i'm not sure would do it, as going right to these countries and having the deterrence. >> what the guard did under president bush was not substitute for the guards at the border. it took over some of the responsibilities and permitted the customs people and other people to spend their time doing the things they were trained to do.

>> there has to be real deterrence and going after the really bad, despicable guys. senator udall, and then senator rand, murray. the testimony of all of the witnesses. secretary johnson, thank you for visiting. as you noted in your testimony, artesia is the first facility you have stood up independent for women with children. when you visit it, i would like you to think in terms of what are going to be the additional burdens on this small community. you will see a facility that is running a law-enforcement facility on the same campus. it is a very small facility. they are now expecting and predicting 670 women and

children in a very short period of time. i included in the dhs appropriations markup last week added language directing dhs to consult transparently with state and local governments and avoid imposing costs on local communities for these types of temporary facilities. question is prior to dhs making a decision to use this training center for family detention, did you consult with state and local officials? >> i believe we did. that is a standing instruction of mine to my staff before we go to decision to someplace for increased detention for processing, we should consult with state and government. >> is there a process to have an ongoing briefing with state and local officials in place of

things that occur, changes in mission -- >> yes. i have personally spoken to the aboutof mcallen, texas the situation in the surrounding community. i have met with the governor of arizona. suspect i will be meeting with officials in new mexico tomorrow when i go there. if it's not on my agenda, i will build it into my agenda. >> i'm sure the mayor of artesia would very much like to meet with you and talk with you. his description was that he heard on one day that there was a rumor and two days later the he hady was open, and very little information, concrete information he could tell his constituents in the community about. the communities with detention centers like artesia are very concerned about incurring costs and strains on their infrastructure and other resources. ,rtesia, the mayor told me

increased bus and vehicle traffic is creating traffic problems near the entrance of this law enforcement training center. the city does not have the funds to install necessary traffic signals. his police have had to respond to incidents at the detention center. i don't believe local communities should bear the cost of the crisis in our border. is there any funding in the supplemental request to help offset any costs the new detention centers impose on state and local governments? >> not directly. i don't believe that there is. i do agree that we should endeavor to minimize the burden ,n the surrounding communities and that we should be mindful of the burden that is being imposed in places like texas and mexico, arizona, southern california.

i want to work with local mayors, sheriffs to better enable us to do that. >> i would just add with regard of helping local communities, as mr. shelby reflected, the cost is large because we the federal government when the children are with hhs take on the majority, the vast majority of anything that the children have so we are not burdening the community when we are there. in that sense, we understand the number one -- i understand the number is very large. the reason it is large is because we take care of the children from beginning to end. >> secretary burwell, you used in your testimony the statement, no additional burdens on the community. that is what i'm asking for, secretary johnson. haveieve that if you don't it in the supplemental, it's not

going to happen. i think you are in a position of really having an incomplete plan before us, because you're going to rush to set up these facilities. you're not going to anticipate the needs, and there's going to be a real problem there. what is the cost of operating the family detention center for a year, and in the absence of a supplemental, where is that funding going to come from? >> the cost of running the detention facility we set up in artesia, i don't have offhand. i can get you that. not doing anything is not an option. it will require us to simply run out of money. it will make some dramatic reprogramming steps. you understand that your have said that already. where is the funding coming from right now to set up the facility that will house 607 -- >> coming tomorrow, our existing

budget. >> it is being taken away from what? >> it is being taken away from other aspects of immigration and customs enforcement. >> thank you. thank you, madam chairman. secretary johnson, i think all of us can agree that we are facing a humanitarian crisis of the first magnitude. needed to may well be deal with the consequences of this crisis. address thenot causes of the problem. that is what is troubling to me. evidencetrary to the to think that some 57,000 would undertake an

extremely dangerous journey to reach our borders if their parents did not think that they would be allowed to stay here once they arrived. administration has appointed to changes made in our 2008 as an laws in partial explanation for the surge in the number of unaccompanied children. i think many of us would agree that does need to be revised. it does not explain the surge. if you will look at the chart that i distributed, the surge in did notanied children begin following the passage of the 2008 law.

the numbers actually declined between fiscal year 2010 and fiscal year 2011. the wave of children arriving here clearly began in 2012. we need to look at what happened that year. 15 of 2012, president anda took unilateral action announced his deferred action for childhood arrivals policy. that i thinklear the president's action was motivated by compassion. but it seems clear to me that it sent the wrong message to those parents in central america. what happenses when the president unilaterally decides to issue an executive order affecting immigration without securing the border.

the number of children more than doubled between fiscal year 2011 and fiscal year 2013. yet until just recently, the president did not even speak out to warn their parents and to tell them that the journey would be horrendously dangerous for their children, and that they would be sent home. we know that many of these children have been abused or harmed on their way here. evident,wave became two years ago the president took no action at that time to try to stem the tide. we know it will take a long time before all of these children have hearings that could lead to their being sent home if they show up at all for the education. -- adjudication.

what specifically is the administration doing to propose changes in the laws or regulations right now so that these children can be safely and immediately put on planes and returned to their parents? wouldn't such an action send the strongest possible message to the people of central america that they should not allow their children to go with these smugglers and come here? i know this from personal conversations -- i have spoken to dozens of these kids. i know from talking to border patrol officers who have spoken to these kids -- the first thing they say when you ask them why do you come here, it has to

with the conditions in the three central american countries. that a gangld me was going to kill me. or, my brother was killed. it is always initially that. clearly, they know that if they come to the united states, our laws require certain things. that we transfer them to the department of health and human services. that theo the case criminal smuggling organizations are creating considerable misinformation about the state of our laws and so forth. in order to induce the family 5000, theyay 3000, tell them things like, you will get a free pass and it will expire at the end of june or the end of may. i have been saying this publicly now for weeks. it is being repeated in central america, in the press, that the

deferred action program established two years ago is for children who have been in this country for seven years, since june 2007. it is simply wrong to say that if you come here today, tomorrow or yesterday, you are going to benefit from it. i said that yesterday in a press conference, i believe. we are dealing with criminal smuggling organizations to induce payments of money will put out considerable disinformation about this. you have asked about changes in law. i believe and i agree that people in central america need to see illegal migrants coming back. the children accompanied by their parents, the children, and the unaccompanied adults. we are already dramatically reducing the time it takes for

that to happen. we are asking for the additional resources. to turn these people around quicker, including the children. and inasking for that terms of the change in law, as i said a moment ago, we are asking -- and this will be in a separate submission -- for the ability to treat unaccompanied kids from the central american countries in the same way we would somebody from a contiguous country so that we have the ability to offer them voluntary return, which the kids for mexico do accept. -- from mexico do accept. >> senator murray. >> thank you for holding this hearing today. everybody in this room are at least in agreement that will we are seeing along the nation's southwest border is simply unacceptable. mentioned, the

numbers of young people and children crossing our border often by themselves and almost always with nothing beyond the clothes on their backs is really staggering. we areyone here knows, not just talking about a few individual cases. we are talking about tens of thousands of young, often unaccompanied minors entering the united states. i want to be clear about the circumstances these children are facing. arecircumstances that causing them to cross a continent by foot and seek safety here in the united states. these are not people coming here to get a free ride. these are children. many of them seven or eight years old. they are fleeing terrible violence in their home countries. they are being sent here often by desperate mothers and fathers who have had to look them in the eyes and literally tell them to run for their lives. as a mother and grandmother, i cannot imagine what that food -- what that would feel like.

we have to be clear about what this is. this is a refugee crisis we are seeing along our southern border. ofamericans, we think refugee crises as situations that happened far away to somebody else. we need to open our eyes that this is something that is happening in our country, and it is happening right now. affect theot only americans who live on our southern border. this affects every single american community. we have heard in my home state over the last few weeks in washington that we are seeing headlines and press reports that some of these children may be just a fewilities miles from downtown seattle. all of us, regardless of what state we are in, need to take this situation seriously. i am particularly concerned about the condition and care of the young women and girls who are being detained along our border. so many of them faced unbelievable hardship in their

home countries. i'm hearing that many of them have endured physical abuse, sexual abuse, violence, human trafficking, and a lot of them have fled in hopes of avoiding those kinds of fates. it is important that we talked about the resources the administration needs to have to fight organized crime on the border. onave also focused myself giving the administration the resources they need to protect these children, and to treat them humanely while they're being detained. we are talking about things like food and water and diapers. it also means we have to be prepared to protect these children and young people, particularly the young women and girls tom a from having to once again face that same kind of violence, abuse, human trafficking that they are running away from in their home countries. some of these kids will be sent back to their home countries, but we cannot ignore the legitimate cries for help from refugee children. we often ask our friends around the world to support refugees

fleeing violence. it is our turn in this country. we have to accept that as part of this. focused on fighting organized crime on our borders, reducing legal -- illegal immigration, but we cannot lose sight of our responsibilities to provide these children with the most basic legal information and guidance. we have to make sure they have valid claims for asylum, and someone is there to help them pursue that. more than a year ago, we all know, republicans and democrats in the senate voted to pass overheads of immigration reform. -- comprehensive immigration reform. the houseagedy that has not taken this up. that is one of the ways we can fix this long-term comprehensive strategy. is the administration pursuing costly detention of families instead of relying on more cost-efficient and

effective alternatives to detention? senator, i believe that in order to deal with the current situation, that it -- and i agree with the comments of the senators here -- we have to return people, and we have to show others in central america that we are returning people. that is how to deal with the existing situation. in order to do that quickly, we are building detention capability for adults who bring their children here. we did not have much of that type of detention capability until very recently. returning the adults around faster, and we are turning the adults -- we need to turn the adults with children around faster in order to send people home. is the administration making

sure that each of the children who are detained can pursue asylum and have legal representation from a qualified attorney, receiving fair hearings? >> it is part of our standard procedure to make sure that people are informed of their rights in this type of situation. >> with regard to when the children come to hhs, a number of things happen. first, the children are informed of their rights. of thee informed immigration proceedings. for those children who are identified -- usually they are identified at dhs if they have a potential different status. happens in terms of the issue of asylum for the child, appropriate steps are taken to connect that child with someone who can help them with the process. with the children, we continue to try and in some cases under 2000 at over 1000 cases we

actually do connect them sometimes with pro bono and other legal services when there are extreme circumstances. as you pointed out, there are children who have extreme circumstances with regard to things that have happened to them along the way, and they need special types of help and support. >> don't lose sight of that in all of this. >> when we think about the numbers, 14% of the money that is for healthfor and legal services that are beyond the basic service that we provide for all children, because there are some children who have extreme needs, whether those are legal or health. >> thank you very much. >> i'm going to turn to the senator. many senators have had to leave because of airplane demands. i want to protect the rights of every single senator. if any senator had to leave, i'm

going to make sure the record is open, that they may submit their questions in writing and ask the departments to respond in two weeks. it has been a long hearing, and i want to make sure everybody has the ability to do that. you are uncompromising in your fairness towards the members. i appreciate that. let me say to the witnesses, thanks for being here. this morning i was driving into work and i was listening to npr. you might be shocked by that. this very well spoken gentleman -- i wish i would have gotten his name -- came on and talked about his travels through ,entral america very recently his interviews, the families he had talked to. it was very extensive and informative.

isically, what he was saying at the risk of paraphrasing his , or the, the coyotes smugglers or cartel or whenever it is, go to these families and promise everything. we will get your kids to the border. they will be received by the united states of america. they will be taken into custody. they will be eventually reunited with family members. the chances of ever being deported and sent back home are slim to none. then they rip the families off. $3000, $7,000.or all the way up to the border, the abuse these children. they starve these children. they rape these children.

and they take them through hell on earth, all with the promise that here, the united states government will take care of them. i have listened carefully to your testimony here today. i believe you are proving their case. no reflection on you, madam secretary. you have to deal with the law that was given to you in 2008. i took the opportunity to review that law. .ere is what is resulting you tell me, mr. secretary, that 1800 get deported. those are pretty darn good eyes. chances are you are not going to get deported. 46% don't show up. your comments about, if you don't show up, you are in really big trouble with us. when we catch up with you, you

are going home. we have 12 million people here in the united states that have those circumstances. madam secretary, i read through the law and took the time to look at the 2008 law. look at what you do. it is no reflection on the job you are doing. it is what you have to do under the law that congress gave to you in december of 2008. for theirsponsible care and custody. you have to do an immediate age determination. you have to establish policies and programs as to how you are going to care for these unaccompanied minors. you have to make sure that when you are ready for placement, that they are safe and secure. that, you have got to do literally assessments of the family, the home, the environment to determine whether

they are going to be safely placed. you have to make sure there is access to ongoing information. you have to do legal orientation presentations. you have to give information about access to counsel. . child advocates can enter into this. it just goes on and on and on. i don't doubt that this was well-intentioned. i was not here at the time. it strikes me as the kind of law that came along, and people bought into it. i have not checked the vote record on this. i bet it passed with a bipartisan amount of support. is, if the coyotes are promising these families that these kids are going to get to the united states and they are going to be received into custody, they're going to be cared for, isn't your testimony today establishing without a

shadow of a doubt that that is in fact exactly precisely what you're going to do when those kids are in your custody? >> i think the question of the is anching plan overarching plan and we are one piece of the plan. we are the part that when a child gets here, how we treat the child -- that is a reflection of us and our nation and our values -- what we are saying and asking for in the supplemental is the support to make the coyotes promise -- coy otes' promise not true. how we do that is by speeding the time with which people go back here it -- back. the numbers are not high, and my colleague secretary johnson has said, that is our objective. that 1800 number we all believe is not the right number to send the signal that is appropriate to deter.

what we want to do is make the coyotes promise -- coyotes' promise not correct. when the child is here and in our care -- 20% of these 11.dren this year are under how we believe we should treat -- i agree. i'm glad you read the law and can hear from our conversations and the back-and-forth. the requirements are treating the child appropriately and making sure they are safe. to get to the root of what you are reflecting in terms of these coyotes, smugglers, these people who are taking many families down and inappropriate path is, we have to make sure we are sending a deterrent signal. >> i will wrap up. i'm completely out of time. i don't see anything in what you

are requesting here that is going to impact the story they are telling down there, and what is causing these kids to come to the united states. they are coming here believing that if they can just get in your custody, they are not going to go home. thank you, madam chair. >> that was some of the testimony to the senate appropriations committee on thursday on the white house's request for emergency funding to deal with children who are crossing the border illegally from central america into the u.s. we will take your calls and hear what you think about the u.s. response. make sure to mute your tv so we can hear you properly. we will take a look at an article about the house probably taking of action soon. this is from reuters, reporting

that the chair of the u.s. house appropriations committee says the obama border security request is too high. that is chairman harold rogers. he says a large portion of the funds that could be handled through the normal spending bills process for funny 15, and his committee could have a better estimate this week. the obama administration says that border security agencies could run out of money this summer if that request is not approved. we will turn to your phone calls now. calling from baltimore, maryland we have elliott. what do you think about the u.s. response so far? my name is harriet. i wonder why we are being held responsible for this. it is the responsibility of the parents and the people in those countries that are sending their children here. >> what do you want the u.s. to do? money from uske

to take care of somebody else's children. i want them to turn them around when they get to that border and send them back where they came from. theme not responsible from -- for them. their parents are responsible. i'm sick and tired of this country talking about being humanitarians to everybody, except the people in this country. johnson, hear from jeh speaking and saying he was going to do just that. do you think he's taking the right course of action? caller: if he's going to have them come here and it's going to cost us while they're here, no. send them right back. don't bring them into the country. >> we are going to turn to lloyd on the line for republicans. where are you calling from? caller: san francisco. >> what do you think? what should we be doing about these kids coming across the border? caller: put them on a plane when

they walk over and send them right back and tell their government, you take care of this. why is america always responsible for everybody else? we already have 12 million immigrants over here, illegally. we have not even taken care of them yet. and now we are going to take on thousands? no. they need to go straight back and send a clear message to let everybody know we are not taking on anymore. we already have 12 million that we have to worry about right now. we have got to secure our borders. i don't know what is wrong with president obama. he doesn't understand, we have to secure the borders first and stop this overflow coming in by the thousands. >> let's take a look at what the white house has posted on its website. this is a request for emergency funding. you can take a look at it in great detail. billionhe $3.7

requested, most of that money would go to health and human services for children in detention centers in the u.s. the rest of the money to the department of homeland security. some of that border protection the colors have been mentioning. and money for more judges to process these cases more quickly. back to your phone calls. have got donald on the line from wisconsin for independents. what do you think? societies today are a lot different than they were 20 years ago. i feel sorry for everyone killed, but i would get after mexico and have them take care of their southern border. it is smaller than ours. and stop giving mexico money until they do this.

that would cut down on probably 50% to 60%. we don't need the national guard . we can have the militia called up. that can come from all the states, and they can accumulate on the border, get sworn in and help the border patrol, texas rangers. you have got to feel sorry for them, but we give money to all these countries, millions and millions of dollars every year. all it does is filter into somebody's pocket. it does not get to the people. >> on the republican line, we have lewis. go ahead. i believe in human [indiscernible] too. we have all these illegal immigrants over here too.

i don't think we need any more. we have got children right here in the united states going hungry. needsk the united states to take those children at the border and send them right act -- back, and let those countries over there and know that we are no free lunch over here. >> taking your calls on unaccompanied immigrant children crossing the border into the u.s. onshington post" reports some of the politics here at home. the border crisis scrambling the politics of immigration all his see. republicans and some democrats accusing president obama of being insufficiently engaged in this issue. until now, the politics of immigration have been seen as a no lose proposition for president obama and the democrats. the democrats now deeply divided over what should be done. arizona --he line in

sorry, rogers, arkansas. caller: the current administration's response is inadequate. this constitutes an invasion. i wonder how they would feel if we emptied out our prisons and sent them to the borders and force them across the borders to invade their country. furtherdo you think steps, the u.s. in terms of what it is doing now and steps on the other side of the border? caller: steps on the other side of the border need to come in the form of an economic embargo. we need to stop sending money in the form of aid. it's kind of curious how they list honduras as being one of the nations that is a chief contributor, and because of the criminal activity in honduras and mexico with the drug lords and cartels, but the very first people to flee the country in

search of prosperity is the able-bodied man. >> kathy is on the line for republicans. what do you think about this issue at the border? caller: i understand the democrats and obama are talking about the senate bill that was passed. ideas oflicans have first securing the border. that is what was supposed to happen after reagan gave amnesty in the 1980's and it never did. there is border money in the bill that was passed by the senate. the millions of dollars to set up border security is only to be spent at the discretion of the homeland security chief. likehappens is if a bill that is ever passed through the house and signed into law, that discretion will be put on the back earner -- burner. for what ever reason, the border will not be secured. that is why that senate bill is no good. we do need to secure the borders. if they were secure, how would

the children be getting in any way? obama has made it so that the border security people are told to stay back by a mile or so away from the border. that is how these children with adults -- most of them have adults. only a small portion are by themselves as children. present, then you can process them and send them right back. it is only the unaccompanied children that must be kept, and that is all because of the bill passed in the 1980's for child trafficking, which i can understand. the ones that have adults with them, they should just be processed. obama has given the directive here,f anybody here -- is the law is they should be processed and sent back. he is just giving them a slip of paper and saying, come back and you will have your official the partition -- deportation

criminal. if they don't have a criminal background, they are being released into society. >> let's take a look at what is happening on capitol hill. a tweet on some of the response from texas.ponse president obama met last week with texas governor rick perry, and he talked about the president's response this morning on fox news sunday. here is what he had to say. [video clip] >> i appreciate the time the president gave me. it was important for him to take time and to listen to what is really going on at the border. i do think he should just go to the border himself and take a look at this, just like some of his democrat colleagues and a number of us on the republican side won him to. as i look at that piece of

legislation, it is a very large amount of money. as you analyze it, very little of it is for border security. until he gets realistic about the problem and how you deal with the problem -- and it is a border security issue. we have a track record of five plus years of him disregarding what is going on in the border. here is his opportunity to truly read. don't blame this on anyone. and leader, lay out a plan, i will suggest you -- the president does not have to have this big amount of money. he can pick up the phone today, call the dod and direct them to have the national guard troops on the border. >> you don't support the bill and will not be encouraging her delegation to pass this? >> you have distilled the correct answer. >> taking your calls on the republican line, patricia in

georgia. what do you think about this issue going on at the border? i'm calling on the democratic line. >> i'm sorry. go ahead. caller: it is a multi-complex problem. the first thing we do need to do and i did vote for the president the law.s is to revise i understand the humanitarian capacity that this country takes towards people who have been violated within our country. the human trafficking and , itence prevention law gives the cartel the incentive to scam the parents in their countries so that the parents the childrenthat are not going to be violated, but they are going to come to america because we have some very progressive laws on providing services to children.

>> any idea of how to prevent that from happening, the cartels taking advantage? all, the moneyf should go towards border patrol. ly, we do not need to build more detention centers. that means we are taking the children in. once they are in our countries, the laws apply. thirdly, to prove the cartels wrong. they are promising that the parent will do it safely. to ensure that they are allowed thatour country come actually do violate those children. that is to ensure they come in

under that law. >> getting through the border and needs to be fiercely independent. i was drilling to go and volunteer my health. president obama needs to go and see. this is president obama's plan to deal with an accompanyied who are minors. you can read more at nationaljo

urnal.com. chris christie says it is a symptom of washington on immigration reform. martin o'malley says he cannot send children back to that. they are potential rivals and 2016. back to your calls. thoughts about the border crisis? >> i don't understand how everybody is looking at these children and saying we're just going to send you back. they are children. heartod human with a good oft sees a child in need food, a loving shoulder, and how can you turn that down? what kind of people are you? i opened my door to as many whether it iscan africa, mexico, china.

how can you do that? what kind of society are we? and everybody in this country. i in native american and mexican. that is what this country is derived on. youthe rest of you, how can turn around and say that these children should be turned at the border and not giving refuge? cannot believe a society where you put a dollar in front of a human life. what has the society become? ashamed to call myself a member of the united states of america if we turn our backs. last call on the republican line. share your thoughts with us. >> i am so glad i am behind. i am so glad i am behind you. i was in western kansas and the

dodge city area. by legalrwhelmed people. skechers the 19 $90 million on. give them their a free education. we pay for their milk in there. there's. we given babysitting. what is happening to the american citizens. we have to leave because we cannot afford our taxes. >> what you want to see happen in? i want to sit back. i want to stay in my home. you want to see my home. i would like to keep my home. i cannot afford my taxes. we have too many people in our citizens and not even

like going to school. and $99 million school. phone lines will be open tomorrow. we will start off with ron johnson and more on the latest efforts to ease the border crisis. we will also be hearing from stephanie armour about people who signed up for health care. they have not gotten coverage is what is in the system. audrey elaine and discussed the role of the highway trust fund and whether it'll give us money by the end of the summer. this is on washington journal starting at 7:30 a.m. eastern time. >> and the past, education was limited down the street. now for high school students there is this burning -- a

bundle of digital learning experience. some are informal. the resources that students and parents find online. it is becoming important that states make sure that every family have access to a variety of online learning and that they remain open to those possibilities. to >> and future learning monday night at 8:00 eastern. >> the house veterans affairs committee: this is to examine the level of care that veterans are having for mental health for granted like posttraumatic stress disorder. some of the members are from family members who committed suicide while singing the mental health treatment. this is three hours.

>> if i could get everybody to take their seats, please. this hearing will come to order. i would like to ask consent for our colleagues to sit at the dais and participate. i would like to welcome everybody to the full oversight committee hearing entitled service should not lead to suicide. following an investigation which uncovered harm at v.a. facilities all across this nation, this committee has held a series of full oversight hearings over the last several weeks to evaluate the systemic

access and integrity failures that have consumed the of the a health care system. perhaps none of these hearings have been presenting the all too human face of the failure so much as today's hearings today will do. recently the committee heard from a veteran who had attempted to receive mental health care at a community-based clinic in pennsylvania. the veteran was told that he would be unable to get an appointment for six months.

when that employee left them, another v.a. employee leaned in to tell this veteran that if he just told her he was thinking of killing himself, she would be able to get him an appointment much sooner, in just three months instead of six. that veteran was not considering suicide. but what about those veterans who are? how many of the tens of thousands of veterans that v.a. has now admitted have been left on waiting lists for weeks, months, and even years for care were seeking mental health care appointments?

how many are suicidal or edging toward suicide as a result of the inability to get the care that they earned? despite significant increases in v.a.'s budget and staff in recent years, the suicide rate among veteran patients has remained more or less stable since 1999, with approximately 22 veterans committing suicide every day. most recent v.a. data has shown over the last three years rates of suicide have increased by nearly 40% among male veterans under 30 who use ca health care services, and by more than 70% of male veterans between the ages of 18 and 20 four who use v.a. health care. this morning we are going to hear testimony from three families, the somers, the selkes, and the portwines. they will tell us about their

sons, daniel, clay, and brian, three operation iraqi freedom veterans who sought care following combat. each of them faced a barrier in their struggle to get help. each of these young men eventually succumbed to suicide. in a note he left in hand, daniel summers wrote that he felt that his government had abandoned him and referenced coming home to face a system of dehumanization, neglect, and indifference. the v.a. owed daniel and clay and brian so much more than that. with that, i yield to our ranking member for his opening statement. >> thank you very much, mr. chairman, for holding this very important hearing.

we have had many discussions and debate about how to deliver the best health care services to our nation's veterans and how to ensure accountability within the leadership ranks of the department of veterans affairs. during the course of these recent hearings and discussions, we have touched on a number of important issues, but one we have not touched upon too much yet has been access to mental health care and suicide prevention services for our veterans. that is why this hearing today is so important. i would like to thank all of the panelists were joining us today, particularly i want to thank the family members joining us who have lost a loved one. i know they are speaking about a loss of a loved one, and it can be an incredibly difficult and exhausting experience.

but in this case, i think we have to listen to your stories, identify what went wrong, and we can take action to ensure that those failures are not repeated again. i want to thank you very, very much for joining us today to share your stories. 18 to 22 veterans commit suicide each day. that is 18 to 22 brave and women who our system has let down. it is totally unacceptable. when a veteran is experiencing oppression or other early warning signs, that may indicate mental health issues or even suicide, that must be treated like immediate medical crises, because that is exactly what it is. veterans in that position should never be forced to wait months on end for medical consult because quite frankly that is time that they may not have. we have taken steps to help put in place programs and initiatives aimed at early detection him and we have significantly increased our funding.

the department of veterans affairs spending on mental health has doubled since 2007. it is not working as well as we would have hoped, and we have to figure out why and how we can correct these problems. our veterans are the ones paying the price for this dysfunction. a 2012 i.g. report found that vha data on whether it was providing timely access to medical services is totally unreliable. a gao report from that year not only confirmed that disturbing finding about, but also said that inconsistent and limitation of vha scheduling policies made it difficult, if not impossible, to get patients the help that they need when they need it.

that is why we have to look at this situation. that is a problem that we have seen repeatedly as we dig into the v.a.'s dysfunction and enough is enough. our veterans and their families deserve a v.a. that delivers timely health services, covers a spectrum of need from ptsd to counseling for family members, to urgent round-the-clock response to a veteran in need. a recent oig report found that in one facility patients waited up to 432 days, well over a year, for care. once again, we are finding that our veterans deserve much better than what the care that they are receiving. in all of the areas we must address, we have to look at it comprehensively, and fixing mental health services is one of the most important areas. i look forward to our discussion we begin today as we look forward to try to solve some of the problems with a dysfunctional department that we are seeing over the last several months. i want to thank you, mr.

chairman, for having this important hearing and for the panelists for coming today to tell your story. i yield back the balance of my time. >> thank you very much, mr. ranking member. we are humbled and honored to be joined by our first panel of witnesses this morning, family members of the three veterans who sadly and tragically lost their lives to suicide, and i am sure that i speak for each of my colleagues when i say that each of you have our deepest sympathies to you for your loss. i am both grateful and at the same time angry that you have to be here to share your stories of your sons with each of us. so if you could approach the witness table, please, joining us is dr. howard and jean somers, susan and richard selke, the parents of clay hunt, and

peggy portwine, the mother of brian portwine. we are also honored to have josh renschler. thank you for your service. >> mr. chairman, we are grateful for this opportunity to testify today. we are especially pleased to see arizona representative ann kirkpatrick and another representative who have been great allies to us in our efforts to advance reforms in the v.a. based on experiences of our son. >> as many of you know, our journey started on june 10, 2013, when daniel took his own life following his return from his second deployment in iraq.

at that time, he suffered from posttraumatic stress disorder, a traumatic brain injury, and gulf war syndrome. daniel spent nearly six years trying to access the vha health benefits systems before finally collapsing under the weight of his own despair. we have attached the story of daniel so much to our testimony, which provides details of his efforts, and we hope you will read it if you have not already done so. today it is our objective to begin the process which will ultimately provide hope and care to the 22 veterans today who are presently ending their lives. >> over a year ago and four days after daniel's death, feeling fortunate that we at least had a letter from him, howard and i -- howard is a urologist -- spent time with daniel's wife and his mother, a psychiatrist, and together we are uniquely qualified to prepare a report.

we have shown that document with several of you over the last year, and it is attached to our testimony. the purpose of the report remains the same as when we wrote it -- to improve access to first-rate health care at the v.a., to make the v.a. accountable to veterans it was created to serve, and make every v.a. employee and advocate for each veteran. >> at the start, daniel was turned away from the v.a. due to his national guard in active ready reserve status. upon initially accessing the v.a. system, he was essentially

denied therapy. he had innumerable problems with v.a. staff being uncaring, insensitive, and adversarial. literally no one at the facility advocated for him. administrators frequently cited hipaa for not being able to use modern technology. >> the appointment system is at best inadequate. it impedes access and lacks basic documentation. the v.a. information-technology infrastructure is antiquated and prevents related agencies from sharing critical information.

there is a desperate need for compatibility between computer systems within the vha, the vba, and dod. there was no succession planning. >> no procedures in place for handoffs, no contracts in place for -- and a refusal to outsource anyone or anything. at the time daniel was at the phoenix v.a., there was no pain management clinic to help him with his chronic and acute fibromyalgia pain. there were few coordinated goals, policies, and procedures. the fact that the formularies are separate and different makes no sense, since many dod patients who are stabilized on a particular medication regimen us readjust it when they go to the v.a. >> there was no way for daniel to obtain the status of its benefits claim.

there was no vha, vba interfacing, no procedures, no interest of communication between disability termination and vocational rehabilitation. this report is offered in the spirit of a call to action and reflects the experiences of daniel with v.a. program services beginning in the fall of 2007 until his death last june, through our eyes. >> our concern was that the impediments that daniel and counted were symptomatic of deeper and water issues in the v.a. potentially affecting the experiences of a much broader population of service members and veterans. unfortunately, this has been proven true come as evidenced by recent revelations. many of the reforms outlined in our report will require additional funding for the v.a. with that new funding should come greater scrutiny and a demand for better, measurable results.

there is an alternative to attending to the existing broken system. we believe congress should seriously consider fundamentally revamping the mission of the v.a. health system. the new model we envision, the v.a. would transition to a center of excellence, specifically for war-related injuries, by the more routine care provided to the system would be open to private-sector service providers much like tri-care. that approach would compel the current model to self improve and compete for veterans businesses. this would allow all veterans to seek the best care available allowing the v.a. to focus resources and expertise on a treatment of traumatic injuries suffered in modern warfare. >> we thank you for your time, and we would be happy to discuss our regulations and suggestions.

we hope that the systemic issues raised here for will provide a platform to bring together lawmakers, veterans, and private-sector medical professionals and administrators for comprehensive review and reform of the entire v.a. process. and if the v.a. committee or congress as a whole makes a decision to involve other stakeholders in a more formal reform process, we would be honored to be among those chosen to represent the views of affected families. thank you. >> thank you. >> thank you. >> distinguished members of the committee, thank you for the opportunity to speak with you today about this critically important topic of mental health care access at the v.a., suicide among veterans, about the story and experience of our son clay. my name is susan selke, and i'm here today as the mother of clay hunt, a combat veteran who died by suicide in march 2011 at the age of 28. clay enlisted in the marine corps in may 2005 and served in the infantry. in 2007, he was deployed to iraq. shortly after arriving in iraq,

he was shot by a bullet that barely missed his head. after he returned in california to recuperate, clay began experiencing symptoms of posttraumatic stress, including panic attacks and was diagnosed later that year. following recuperation from gunshot wounds, he graduated from the marine corps scout sniper school in march of 2008. a few weeks after graduation, he deployed again to afghanistan. in his experience during his deployment to iraq, he experienced the loss of fellow marines during his second deployment. he received a 30% disability grading from the v.a. for his pts. clay appealed the rating only to be met with significant bureaucratic barriers, including the v.a. losing his files. 18 months later, and five weeks

after his death, his appeal finally went through and the v.a. rated clay's pts 100%. he exclusively used the v.a. for his medical care after separation. afterward, he lived in the los angeles area and received care at the v.a. medical center in l.a. he constantly voiced concern about the care he was receiving as well as the treatment he received, which consisted of medication. he received counseling only as far as a brief discussion regarding whether the medications he was prescribed was working. if not, he would be given a new medication. he used to say, i am a guinea pig for drugs. i would have side effects and they put on something else. in late 2010, he moved to grand

junctions, colorado, where he also used the v.a. there, and then finally to houston. the houston v.a. would not refill their prescriptions that clay received from the grand junction v.a., because they said prescriptions were not transferable, and a new assessment would have to be done before his medications could be re-prescribed. he had only two appointments in 2011 and neither was with a psychiatrist. it was not until march 15 that clay was able to see a psychiatrist at the houston v.a. medical center. after that appointment, clay called me on his way home and said, mom, i cannot go back there. the v.a. is way too stressful. i will have to find a better center. two weeks after his appointment, after the site had shifted at the houston v.a. medical center, clay took his life. after his death, i went to the houston v.a. medical center to retrieve his medical records,

and i encountered an environment that was highly stressful. large crowds, no one was at the information desk, and i had to flag down a nurse to ask directions to the medical records area. i cannot imagine how anyone even with mental health injuries could successfully access care in such a stressful setting without exacerbating their symptoms. clay was open about having pts and survivor's guilt. he worked hard to move forward and found healing by helping people, including participating in humanitarian work in haiti and chile after the devastating earthquakes. he also started a public service advertising campaign aimed at easing transition for fellow veterans, and he helped wounded warriors in biking events. he participated in iraq and afghanistan veterans of americans annual storm on the

hill to advocate for legislation to improve the lives of veterans and families. his story details the urgency in addressing this issue. despite his proactive approach to seeking care to address his injuries, the v.a. system did not adequately address his needs. today we continue to hear about both individual and systemic failures by the v.a. to provide adequate care and address the needs of veterans. not one more veteran should have to go through what clay went through with the v.a. after returning home. not one more parent should have to testify before a congressional committee to compel v.a. to fulfill its responsibilities to those who have served and sacrificed. mr. chairman, i understand you are introducing the suicide prevention for american veterans act. the reforms directed by this legislation will do critical work to help the v.a. serve and treat veterans suffering from mental injuries during war.

had the v.a. been doing this all along, it may have saved his life. we appreciate you hearing her story and our recommendations about how we suggest the v.a. will properly care for america's veterans. thank you. >> thank you for your testimony this morning. you're recognized for five minutes. >> thank you, mr. chairman, distinguished committee members. my son brian gave 100% to every

task he performed. his military service was no exception. by the time he was 19, he was awarded the purple heart and the army commendation medal. i am before you today to share brian's store. at 17 he enlisted in the army after his training in infantry. he was deployed to baghdad where he patrolled in sadr city. it was an extremely daunting service. this occurred before the surge of troops. during this tour, he lost 11 brothers. while serving in iraq in 2006, his tank was struck and flames quickly engulfed the tank, and the men fought for their lives as the driver was unable to hydraulically lower the ramp. they scramble to the flames, ,manually lower the ramp, and exited with injuries. ryan suffered a concussion along with lacerations to his face and legs and bone fragments. this was his first experience with traumatic brain injury. on yet another mission, brian and his first sergeant were in a humvee when his sergeant signaled to brian to switch seats with him. they switched seats.

20 minutes later an ied hit the humvee, killing the sergeant and throwing brian from the vehicle. besides these incidents, he experienced six other explosions during his 15-month deployment. i asked, isn't this enough to warrant a thorough evaluation and further testing? the powers that be apparently thought of sending brian to walter reed hospital, but did not. aren't his experiences with the physical and mental injuries enough to possibly exempt him for another deployment? apparently, the v.a. felt his care was spiffy enough to stamp a "no" on his form, but then it was crossed out and written "go." how why this decision was made is beyond me. after the first deployment, he

was ecstatic to be home. he enrolled in college and worked in the admissions counseling office. he created videos to share resources with students, hosted events, and helped students with employment around their school schedules. brian suffered with short-term memory loss. he would have to write everything on his computer, his iphone, or his calendar. many times his friends told me when he was out within he would say, where are we going again? i have scrambled brains from iraq. to help cope, he posted all his appointments on his computer, his calendar, and his phone. in 2010, the military recalled brian before the college year ended. he immediately dropped his classes, ones that he excelled in, and when i asked him why, he said, mom, there's no point. you keep your mind in a completely different place. i have no idea what is coming.

during the second deployment, brian did not e-mail or from phone to any family or friends. little did we know how he was struggling with anxiety attacks, panic attacks, traveling the same roads as the first tour. he knew the statement of admitting ptsd as most soldiers do. so he just manned up and moved on. i will be turning from the second deployment. he was evaluated and diagnosed with depression and anxiety. at this time i would like to refer to the documents that you received, brian's medical documents. depression and anxiety. at this time i'd like you to refer to the documents you received, brian's document that brian couldn't remember the questions asked from the therapist during the interview. he had extensive back pain, he couldn't sleep, he felt profound

guilt, he suffered from low self-esteem, and as a result, he was a risk for suicide. nonetheless, he was immediately discharged and told to follow up. how in the world you can ask someone who can't remember the questions asked to follow up with the va is beyond me. brian deteeriorated quickly fro december 2010 to may 27, 2011 when he took his life. he couldn't stand how he would be angry, depressed, anxious but he didn't know how to cope. it took a toll on his relationships. if the d.o.d. and va assessed brian for suicide risk, it was their duty to treat him, but they did nothing. he applied for disability but was unable to wait. brian's unit has lost three others besides himself to suicide since the 2006 to 2008

tour. as you know, suicide surpassed combat fatalities for the first time in history. it's a very slippery slope from ptsd and tbi to death, something our va should realize. our soldiers never hesitated in their mission to protect, serve and sacrifice for our country. now it's time for the va to prove their commitment to our soldiers. i never knew of brian's pts, tbi or suicide risk. i think he felt if i can survive two tours of iraq, i can survive anything. i think it's a life-threatening situation like this and it should be shared with the family so we are able to help. the va needs to work with the service organizations, including the families in the plan for care. i'm requesting, i'm begging this committee to pass act 2182, the

save act. this has been a most devastating wore in history war in history in terms of suicide. our nation continues to suffer every day. we continue to lose 22 brians a day. i promise mid son at his funeral that i would stop this injustice. these are quality young men who potentially had so much to offer society. please pass this act 2182 and support any legislation that gives our soldiers the timely and loving care that they deserve. thank you. >> thank you, ms. portwine. sergeant wrenchler, you're recognized for your statement. >> chairman miller, ranking member michaud, members of the committee, i appreciate the opportunity to discuss va mental health care, and i certainly want to acknowledge the loss and

the courage of these family membe members, ensuring that this wasn't in vain, and i struggle with the severity of the stories. as an infantryman who lost so many in the iraq war and injured and struggled with the loss of suicide from chronic pain and other injuries, i just thank you all for being here. my experience with the va health care system began in 2008. sorry. >> it's okay, you've got plenty of time. >> after i was medically retired from the army due to severe injuries from a mortar blast in iraq -- excuse me. i've been a patient but i'm also

an advocate for other warriors who are struggling with deployment-related traumas. for a period of about 12 months, i did receive excellent mental health care at a va facility. it provided easy one-stop access through deployment health models staffed by mental health, pharmacy and social work providers. unfortunately, though, hospital administrators decided this well-staffed interdisciplinary care was too costly. now veterans at the facility go through a personal intake assessment process and have to find their way around a stra sprawling facility pto access te care that they need.wandering ty is enough stress in itself.

they will seldom open up and discuss private issues with a clinician they've never met. they're more likely to describe surface level issues, like difficulty sleeping. it takes time to build a trust to talk about the deeper issues. and not every clinician is skilled at winning the trust or insightful enough to sense when there is deeper problems. working with a team increases the likelihood of someone to see something that others may have missed. this is implications for suicide prevention as well. veterans will rarely volunteer to clinicians that they're contemplating suicide. and there aren't necessarily obvious signs that a veteran is a suicide risk. one thing is for sure, we won't prevent suicides by doctors mechanically going down a mandatory list asking questions like, have you contemplated suicidal thoughts lately or harming others? sometimes there is red flags an astute clinician can spot, like

the breakup of a relationship or other major life events that can lead a person to take a desperate act. in a treatment system where i get sent to building 3 for neurologist for chronic back pain, building 61, to see a psychiatrist for sleep problems and building 81 to see a social worker for relationship issues, no one is getting the full picture. so it is likely that no one is going to see if my life is spinning recklessly out of control. as an integrated health care system, the va can provide the kind of care i once received from an interdisciplinary health team. there the team members shared observations and can see potential problems before they became explosive. so i think that the most important step that the va can take to prevent suicide is to dramatically improve its mental health care delivery. access is certainly an issue, but we have to ask ourselves, access to what? access to mental health care isn't enough unless that care is effective.

for example, providers who work with combat veterans need to understand the warrior mentality, and they may have to work hard to win that veteran's trust. if a clinician lacks that wareness or has too many patients to give each enough time, veterans will get frustrated and drop out of treatment. veterans that aren't ready for therapy will drop out of the multiweek treatment programs even though they're hailed as evidence-based therapy. the bottom line is that the va care must be veteran centered. that has to mean recognizing each veteran's unique situation, and individual treatment preferences and building a flexible system to meet the veterans needs and preferences. not the other way around. the warriors that i'm describing don't come at a treatment for pt ptsd or anxiety because the text books say they should. most don't come in until they

have reached a crisis point in their lives. certainly a veteran in distress who finally asks for help for combat incurred mental health condition needs to get into treatment immediately. but we won't solve that problem by establishing an arbitrary requirement like a 14-day rule. it doesn't help a warrior at the end of his rope to get assessed within 14 days but not begin treatment within three months. this is the way that the va is currently implemented such policies. they have added additional steps to get into treatment, so that you can see someone within 14 days, they added a second intake process, so now you intake to intake to finally get the treatment you need. i know that some believe the way to solve the veteran problem is to expand veterans access to nonva care. i really personally doubt that's any kind of silver bullet solution. the two big concerns with that is, first detailed in my full statement, many reports and studies point to a national shortage of mental health

providers within the community. secondly, there is real quality of care issues here. va could certainly benefit from a greater use of purchase care, where and when it is available, and when it can be effective. but it wouldn't help veterans just to be seen by providers who aren't equipped to provide effective care. whether because of lack of training and treating combat-related ptsd or cultural competence or any other reason. again, it is not just a matter of access, but access to what. it has to be effective treatment. i do believe that there are va facilities that are providing veterans with timely access to effective patient centered care, but it is not system wide. for my perspective, the starting point for va leadership at all levels is to adopt the principle that providing timely, effective mental health care for those with service-incurred mental health conditions must be a top priority. the va achieve that with its efforts to combat veteran

homelessness recently. that tells me the va can have a real impact when the direction and priorities are clear. when artificial performance requirements don't create distortions, and when clinicians have latitude to provide good care. improving mental health care definitely requires the comprehensive approach. one part of that approach in my view should be to institute the kind of interdisciplinary team-based model i described earlier, but the core of any approach has to center on the veteran and that patient's need'needs and preferences. we need a system that serves the veteran, not one that requires the veteran to accommodate the system. i hope that this hearing brings us a step closer to that kind of va care system. and i thank you for the time and i would be happy to answer any further questions that you may have. >> thank you very much, sergeant. thank you, again, to all the witnesses. sergeant, if i could go back to

you since you were the most recent person to testify, you talked about the interdisciplinary care team that you had for 12 months. and then after that, you alluded to the fact that the hospital director or somebody said that it cost too much to do it that way. i think we would all benefit from you elaborating a little bit about how that occurred and what did you transfer to what type of a care? >> yes, sir. in 2008 until 2009, the va rolled out, i believe, four different deployment health care models nationwide. the deployment health care model that i speak of was one that was rolled out washington state for the american lake va medical center. and it was put together by dr. steve hunt with the va. and this model provided one wing of a hospital floor in which an

interdisciplinary care team for deployment health post 9/11 veterans exclusively that had a pharmacist, social workers, psychiatrist, psychologist, and primary care on one team and weekly they would meet to discuss the case load of that team. and the wait times were short for care. the quality of care was up. the management of our medications were the best that we had seen within the va. however, after 12 months, the team began to dissipate and what i was told and have been told since by dr. steve hunt and others within the va is that this was a temporarily funded program and it was too costly to provide this level of care to exclusively post 9/11 va -- or veterans within the va center when a facility director has to provide care for all veterans to set aside the amount of funding that it required to provide this

level of care for only one portion of that population was not practical. >> mr. and mrs. somers, i would like for you to elaborate, if you would, a little bit on the fact that you talked about daniel having enumerable problems with va staff being uncaring, insensitive and adversarial. saying literally no one at the facility advocated for him. could you give us any specific examples or are they generic examples? >> absolutely. probably the most -- i don't make it through this, howard will finish. probably the most egregious event was when daniel presented to their er -- >> it took daniel a lot to go to the va facility and some of the

things that had been mentioned here were part and parcel of the fact. even along the highway in phoenix, there were speed traps on the highway, and when the lights flashed, that would give him flashbacks, even if he wasn't the one speeding. if he was going by on the highway at the time. so it was very difficult for him to drive down to the va. it is busy. but he presented there in crisis. he presented to one of the departments, to the mental health department. he said he needed to be admitted to the hospital. this is something that we have been told by his wife, who as jean mentioned, has a bs in nursing and his mother-in-law who is a psychiatrist. and he told them this on multiple occasions. so he was told that the mental health department they had no beds, and he was told by the same department that there were no beds in the emergency department.

so this brings up another few issues, but the fact is that he went into the corner, he was -- he laid down on the floor, he was crying. there was no effort made to see if he could be admitted to another facility, there are two major medical centers within a mile and a half of the phoenix va. the vision issue is another issue that we need to discuss at some point. but he was told that you can stay here and when you feel better, you can drive yourself home. that is just an example of the lack of advocacy, the lack of compassion, that we know that

not only daniel has encountered through the va system, we have met other veterans, specifically in oklahoma city, who had very, very similar circumstances at different vas. >> do you know if he ever spoke to any va official about how he was treated? >> we do not. the other problem, of course, is that these visits are never -- the appointment system is so antiquated that things are not even documented. there is no way to go back into the system and to document a contact in the system. so no -- as far as we're aware daniel did not speak to anybody at the va about this. it is just something he wouldn't do. he just wouldn't do. there was a feeling of, i tried and this is just another example of what the pressures that are brought to bear. we brought not only the vha, but the vba issues into account and

these are just things that altogether just became overwhelming. >> my belief is that he still had that military mentality, you know, this is what an authority told you, i have to accept it. i cannot go above and beyond. i just need to accept what they're telling me. >> thank you. mr. michaud. >> thank you very much, mr. chairman. i want to thank the panel for coming today to talk about your stories and your family and really appreciate it, i know it can't be easy. so dr. somers, my question is, can you go into further detail on about why you think it is important to encourage every veteran suffering with pts and other combat-related mental health issues to supply a list of points of contact and get a

hipaa waiver? >> interesting that you should say hipaa because once somebody says hipaa, that sort of stops the conversation. we have been trying to deal with this issue because it takes a village, a large village, to not only treat but to recognize and to approach our veterans who might be in crisis. we feel it is critically important to expand what we call the support network, and actually at this point a hipaa change would be wonderful. we really -- we ran a medical practice and jean can tell you that what we have come to learn that what hipaa really says isn't what -- isn't how -- isn't how it is practiced. people are afraid of hipaa, so they take the regulation, that is actually there, and they take

it to the nth degree and really you do have some options under hipaa, especially if you feel that somebody is a threat to himself or to his family or to the community where you can reach out to family members, or a caregiver in a situation like that. but we feel it is absolutely critical to identify prior to deployment, certainly during deployment, and after deployment what we call the support network, so that these people can be educated as to what experiences their loved one or maybe not even a loved one, maybe it is a high school football coach or maybe it is your, you know, math teacher or maybe it is your best friend from the second grade, but so these people can be educated as to what the experiences might have been, what the signs and symptoms of crisis might be, and educate it to the fact that you don't take no for an answer.

and if you see that somebody is in trouble, that you can direct them to the proper treatment, to the proper authority, to the proper medical facility. and that's not actually something that you have to worry about with hipaa. so that's one way that we feel that hipaa doesn't even come into the equation, hipaa would come into the equation when you're in treatment. and we really feel that if you're in treatment, and there is an issue, then the therapist should certainly take the opportunity to contact the closest people to the patient. >> thank you. my second question relates to hipaa. i heard a case where even though it is the department of veterans administration, where vha employees could not talk of vba employees and they used the excuse of hipaa. have you heard that -- have you

had that problem? with your son? >> we haven't heard that was a hipaa issue. we felt it was a total communication breakdown issue, the fact there was -- the computer systems weren't compatible within the va system itself, and the fact that as far as we know phoenix still uses a postcard system for appointments, and nobody could document the fact that postcards were even sent. and we know for a fact that after daniel died, and the suicide prevention coordinator contacted his widow, and they were talking and they were going to send her some information as to what kind of counseling facilities were available for her, and she asked where are you going to send it, they, in their system, had an address that was four years old. and he had been involved with the vba and with the vha over

that entire period of time. >> my time is quickly running out. mr. and mrs. selke, how long had clay been taking medication for his pts and how long has he -- was he denied medication through the va? >> he began taking medication in 2007, when he was back at twenty nine palms recuperating from the gunshot wound in iraq. my understanding is that he, again, received medication that he needed when he was active duty. his care seemed to be good and he felt comfortable with it. when he transitioned to va care, he was never denied medication. what happened when he moved to houston, he was told that they could not refill his prescription, that had been -- that followed him from the l.a.

va and in grand junction, colorado, for a short time, he was having to start over as a new patient and i was -- had this reinforced yesterday in a meeting, but it was -- that was one of his major frustrations. and that i've heard from fellow veterans of his that when they go some -- to another facility, they have to go back through everything, all the recounting everything. and it -- that seems ridiculous to have to have that type of redundant system. when he was told in houston that he -- that they could not refill his prescription, he was told, you need to call the va that prescribed it, wrote the prescription earlier and see if they will refill it for you. he was leaving the country. he was going to haiti for a couple of weeks and he needed to have enough medication while he

was gone. and clay was proactive enough and was able to do that. he just was determined and he said, okay, and he took care of it and he did get it from the grand junction va. when he came back from haiti, and went to his appointment in february, that was with a psychologist, a clinical psychologist, and my understanding was he was never -- he was not given a new prescription until he saw the psychiatrist on march 15th. so his first appointment was january 6th, second appointment february 10th or 11th, and finally march 15th, sees a psychiatrist. also part of that issue was when he was active duty, lexapro was found to be the drug that worked best for him. name brand drug, no generic, but they -- he had been on paxsill,

on zoloft, a variety of drugs. lexapro seemed to work the best with the least side effects. when he came out of active duty and into the va system, apparently generic drugs are the drugs of choice and he was given, i believe it is the generic for salexa, which is close, but not the same thing. at that time there was not a generic for lexapro. when he arrived at the houston va, and asked for a refill, and then he also somewhere in those first couple of appointments said that he would like to go back on lexapro, as that worked better for him, with less side effects, when he met with the psychiatrist, he said, okay, i understand from your background that that's worked before, and he did give him a prescription for lexapro. so clay leaves on march 15th, the psychiatrist office, goes

downstairs to the pharmacy at the va, to fill his prescriptions. and he spent two hours in the pharmacy, he was called up to the pharmacy desk to pick up his prescriptions, and given the ambien for sleep, and given -- told they could not give him lexapro, they don't stock it because it is not a generic, that it will have to be mailed to him. so it was mailed to him, sometime within the next week, i think they told him a week to ten days that he would get this. a couple of issues there, if you know about antidepressant, anti-anxieties medications, you can't -- you can't stop them cold. you can't wait for it to come in the mail, and then expect that it is going to work quickly, it takes a while for these to work. they have to stay built up in your system.

he was extremely frustrated. he called me as i said in my testimony on the way home and said i just can't go back there. the doctor at the houston va, i have spoken with him several times since clay's death, he's been very forth coming. i appreciate very much the information that he's given me. something in our last conversation which was just a couple of weeks ago that i had not heard before, i have been concerned about ambien, there have been just a lot of conversations among parents and spouses and family members of veterans who are dhave died of suicide and they have been on m ambien for sleep problems. whether there is a connection or not, i don't know. but it was a high number that are given that when they have sleep problems and sleep problems are common, huge problem with post traumatic

stress. the doctor, the other day, in talking about specifically ambien and sleep medications, he said, well, actually, ambien would not be the best drug for the type of sleep problems, and i believe the term is hyperarousal, but i'm not 100% sure on that, for the type of sleep problems that come from post traumatic stress. the nightmares and flashbacks and that sort of thing. there is another drug that starts with a p, i don't have it with me, like prazasin and he said that is the drug that actually works best for that type of sleep difficulty. and i was so stunned that i couldn't ask the question, well, why didn't you prescribe that drug for him as opposed to ambien that he was given over and over different times before.

so that haunts -- that's something that haunted us for three years, because in that two-week window, something went wrong. clay had moved back home, he had just returned from haiti, doing volunteer work, which gave him great -- just great hope, that was great therapy for him. he had started a job. he had bought a truck the friday before. he called me and asked me to meet him and he bought a truck for work. and by thursday the next week he was dead. we were with him over the weekend on that saturday. the whole family at various points during the day, saw him. he had lunch with his dad. he had -- we went to a movie. richard and i went to a movie with him that evening. i could -- i just -- i just couldn't believe it, that within five days he was dead.

so we know he suffered post traumatic stress, we know he was treated for it, he was very open about it, sought help, and that two-week window is just a mystery that haunts us. and we have done everything we can to try to find out answers. >> mr. lamborn for five minutes. >> i want to thank you all for being here. you've given so much. i thank you i know the committee thanks you. and the country thanks you. i want to ask about the role of families in treatment and therapy. i have a constituent who came to me and her husband was stationed with the tenth special forces at fort carson, colorado, where i represent. and he took his life. andan advocate for a program that has a holistic approach that involves families, whether parents or spouses.

and i would like to ask any one of you who has insight as to whether there should be more of a role for families in the treatment programs that are offered through the va. or is there a lack there? >> we certainly, during the time that daniel was with the va, certainly feel that there is a -- there was a lack. and, again, we feel it has a lot to do with fear of repercussions under the hipaa law. and also a total misunderstanding of what the law currently is. and i would like to take your point further and say that it shouldn't just be family, i think we would all like to say we did not have dysfunctional families, but there are dysfunctional families out there and so we started using the term support network. a lot of young men and women undoubt ledly join the service get away from families. that doesn't mean they don't have a support network. we would like to get away from

the whole blood kinship and say it is a support network. i think it goes without saying, i recently read a report by national association mental illness that there is no question that family involvement is beneficial. there is just no question. it becomes more of an issue, i believe, and it is why howard an i have been trying to work with the dod to get them to identify a support network, because certainly in daniel's case, daniel was a geek. but he was at his absolute healthiest, mentally and physically after he joined the army. and he went through basic training. he was in great shape. if they have could have identified right then and said, daniel, give us a support network for you, who would you write down, you know? he had really, really good friends, we hope we would have

been on it, his wife would have been on it, his mother-in-law probably would have been on it, his brother-in-law. it would have been so helpful to have that list then. because when he got back home, he wasn't capable of that anymore. i like to say, you know, not from a legal standpoint, but he had diminished capacity. he was not making correct decisions. >> okay, okay. anyone else? mr. selke? >> thank you. our experience, like most -- probably a lot of families is we didn't know what pts was. we had no idea. clay was, again, very open about it. told us he was destinationed with it. told us he was on medication, seeking counseling. but we didn't know the ramifications of that. and like most of our warriors, they're strong. and so he was, you know, put on

a real good act. had we known the extent of even what he talked to his counselors about, the idea that the somers have approached about regardless of the hipaa, you know, legalities of that, for -- if in fact somebody has that conversation with their -- that counselor, somebody outside of that counselor and the patient needs to know that the patient could identify somebody who would then be able to be aware of what is going on, and to say, you know, this person needs help. clay, looking back, there was all kinds of things going on in his life. there were just red flags. and we didn't know. and there is a lot of literature out there, there is a lot of information. i believe that any family who

has an individual involved in the military, after they had come back, or really anytime, they should probably just assume that there may be some sort of pts involved there. the suicide deal, clay actually had a conversation with susan and said, hey, mom, i thought about it, but i would never do that to you all. he actually addressed the issue and lied about it to us. and so the family plays a huge part in really being advocates for the individual and being able to just watch and watch for signs and then maybe be able to do something about it. >> in conclusion, i would have to say, the va needs to learn best practices and have programs available that include families. everywhere. >> if i could add something to that, going back through clay's medical records, for whatever reason, when he died, i

immediately wanted his medical records. i wanted to read everything i could and try to grasp what was going on. he had apparently as early as november or december of 2009 spoken to someone in the va in the l.a. va about suicidal thoughts, that's on one of his reports, at the end of 2009. he had separated from the marines at the end of april of 2009. i knew nothing of that. we didn't learn until the fall of 2010 when he told us, he said, i have struggled with this thought, but i could never do that to you all. i just can't. and i don't think -- i think in his mind he believed i'm thinking these thoughts, but i

could never do that. as far as we know there were two times during the fall of 2010 that he did have enough serious suicidal thoughts that he did reach out, one time he called and talked with me, and another time he spoke with a close friend, and then after that second time he shared with me, you know, that -- or with all of us. so we knew in 2010 at the end of the year, we knew he had struggled with suicidal thoughts. and we also knew that he was on medication and we're assuming that with post traumatic stress and suicidal thoughts and that that the va knew best how to take care of him. i begged him, please, let's go to private care. we will pay for it. we know great psychiatrists, counselors in houston, let's do

that. he would not do that. he was adamant. he said, i have served in the marine corps for four years, my medical care is to come from the va, they owe that to me, i don't want to go to private care. i want to talk to someone who has either been in war or knows about war and post traumatic stress and the things that i have seen and done in are war. i don't want to go to private care. and that was just his personal feeling. we have heard that from other veterans as well. that's as difficult as the system is, that's their comfort zone. and they need to be feel they can be taken care of. >> my hearts go out to you. >> mr. takano, you're recognized for five minutes. >> thank you, mr. chairman. it is very difficult to listen to your story.

i'm very touched by them. so i definitely want to thank all of the families for being here today. so, let me ask this question of miss selke, i believe a lot of veterans have that same feeling and therefore i do believe that we have to, it is incumbent upon us to make sure that we get it right at every facility, because veterans are expecting that. they don't want to see this be be a burden to their families financially. i am very much open to making it easier for nonva care to be available. and with that i want to ask dr. somers, you are also a medical doctor, dr. sommer esom? >> i'm a urologist. >> you're from the phoenix area. >> i practice in phoenix. we currently live in san diego. >> in san diego.

i'm from riverside, north of san diego, as you know. i went to visit my own va, in loma linda. they're able to -- they get -- they're able to get veterans to see a family practitioner in 24 hours if need be. i'm not so sure about mental health care or psychiatrists. they indicated to me there is a shortage of psychiatrists. and i recently visited a new kaiser facility and i asked him if there was a -- what shortages he was experiencing. can you tell me if there are general shortages in your area of these kind of practitioners? >> there is a shortage of mental health professionals nationwide.

and there are many issues that go into it. certainly reimbursement is one. we know one of the people that daniel had been seeing because -- and this is another issue of continuity of care, he was forced to go outside the va system, just because he couldn't be seen in phoenix. there was just no availability, no mental health available. and i think you have to divide psychiatry and psychology. for these people suffering from ptsd, it is the psychologist and the psychiatric social workers who are providing most of the care as opposed to the psychiatrist themselves. but psychiatry and psychology are incredibly important and what happens is if we try to recruit into the va, the community is losing that mental

health component. and it is a huge issue. it is an issue that has to be addressed by our medical schools, by society in general. but it is not just an issue here and there. >> here is the thing. dina titus and i represent a bill that would increase the number of residencies at va hospitals. i expect a number of those -- if we approve it, a number of those residents would stay, but also something would go into the community as well. >> right. >> my thing is even if we do approve -- make it more easy, easier for vets to use, that areas like mine, they're still going to have trouble finding that care, you know, in the community. >> they will. and they'll have trouble even if you have people in the community, you'll have trouble finding people in the community aware of military culture and

who are aware of the issues that veterans face, and, again, that's just brings up a whole other issue, whole other series of issues. >> i wish i had more time. maybe i could get your information through my staff, because i'm trying to understand also your criticism of the vista medical records. there is also an issue of the -- >> be trying to with the pc-3 program and with the other issues that are being promulgated now, there has to be communication between the va and the providers who are seen the veterans being referred out. so huge, huge issues that have to be addressed. >> i think i understand your point of view as well about your doubts about radically restructuring, that we got to try to get it right in the va facilities because of that

expectation that miss selke -- and the selke's son had, that they -- that was their comfort zone. so we got to do both things at once, make sure that every va center has excellent mental health care and try to provide some options. >> yes, sir. my concern with the bill that just increases the number of practitioners at a hospital, we're not solving the issue with effectiveness of care. so it really has to be a systematic approach to solve the efficacy of what care is being provided as well as the numbers to accommodate the sheer overwhelming amount of veterans that are trying to access that already broken system. i just wanted to add that, sir. >> thank you. mr. chairman? >> dr. roe, you're recognized for five minutes. >> thank you, mr. chairman. and i thank, as a father of three, and a veteran, i

appreciate your courage to come here today and speak. it is a really heart warming and i know this is very difficult for you to do. and it has been difficult to sit and listen to the testimony. there are a good number of veterans sitting up here. i'm a veteran of vietnam era. and just want to thank you for that. and in being here. i can tell you this past weekend, i returned to something very joyous for me. it was a reunion of a bunch of young boys growing up in the '60s, who were all eagle scouts. and all but one was there, of our friends, he didn't make it out of vietnam. so i can tell you that this loss that you have, that you're sharing with us, is very, very helpful, that loss will go with you as it does for my friend of almost 50 years. so thank you for your courage to be here. i know it is very difficult. and sergeant renschler, you

bring up a great point, all of you have today, and the coordinated effort you brought forward, that team approach i think was very good. and i certainly do understand what the va was saying, if this works for the oif, oef veterans, it should work for all veterans. the majority that they're serving are veterans of my age. i think this needs to be expanded if that method that you put forward, it looks like it worked extremely well, should be looked at. and dr. and mrs. somers brings up an incredible point. dr. somers, you probably dealt with, as i did, some primary care in your practice when you were in urology. you don't just get to be a urologist, your patients get to know you and share a lot of things with you. and dealing with this is very complicated. as you all have pointed out, and miss selke so eloquently pointed

out, is that it -- this approach of caring for people with pts or chronic mental illness is extremely difficult. dr. somers and i could go in operating room and remove a tumor. that's easy. this is much more difficult to do. and those signs and symptoms are very difficult to spot because miss selke, you saw your son, when he was actually, you thought, doing very well, that week before he passed, and i think as a doctor, that's been one of the things that troubled me all of my career, is trying to figure out when you have a patient that would take their life, it is why did this happen, and many times that week or two before, things seem to be going well. you think things are going better. i think dr. somers, you and your wife brought up something that is extremely important, that a good friend is probably as important as a good doctor, good person to lean on. and i think you have to do what sergeant renschler was talking about to have this very sophisticated team together for

people in need, but you also just need someone, it may not be a family member, like you pointed, it could be a coach or pastor or whom ever it might be in your life, it could be a family member, i think putting all that together is a real challenge. i will hear later from the va about what they plan to do. but any further thoughts along that line would be helpful, if anybody would like to share some of the -- your thoughts about what we could do. >> i think it is important for the transition program. i know before that brian went to iraq the first tour, he went to california where they have a base where they teach them all, like, they make it like an iraqi town. so they learn how to control crowds, take buildings and all that. but had th but when they come back, it is boom, you're there for a week and then out in the community. there is no transition. why can't they use those centers they use to send them where they

could have psychiatrists, psychologists, and look at them, give them assignments, see if anybody has poor concentration, poor memory, you know, and use these resources that we have, you know, say, okay, now you need to go do laundry, give them a list of things to do see if they're able to do that, and, you know, observe them, we can't just take them like cattle and put them up through a bunch of questions and then let them go in the community where they don't have their brothers to confide in. when they come back, they have put their life on the line to trust these other brothers, they would die for them. they come home, they don't have anybody they're going to trust that much. and nobody that has been in war is going to understand so they don't open up. the most people that open up to is their brothers. michigan has a program called buddy to buddy. that they put together one veteran, you know, that has been home with the veteran. so that if they have any

problems, that are going to open up to that person much more than they are a therapist. or have group therapy, let the veterans talk among themselves. they could, you know, have a group of ten veterans and then have group therapy and maybe they could confide in each other. because it is going to take a while to build up trust with a therapist, if you do. >> totally agree, thank you very much for your courage of being here today, mr. chairman. i yield back. >> mr. brownly, you're recognized. apologize, mrs. kirkpatrick, you're recognized. >> i appreciate what you said about once a diagnosis is made, and medication is prescribed, staying on that, on that medication. and i'm really want to know how often our veterans have to refill the prescriptions, and i would like to hear from each of you what you've learned about

that experience, are you given a 30-day supply, they have to go back constantly back, or on sergeant, we can start with you and then 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 confusing and i normally mess it up pretty well, so my wife has to manage that for me for 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 and 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 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 transferrable to the va

facility where i'm at. so they have to start all over as a guinea pig is what was discussed earlier, try medications they may have already tried in the past to get to the point where they're able to approve a nonformulary medication. it took four years for the dod to balance nine medications for myself, and when we transitioned to va care, many of those medications were not on the f m formulary and we had to go back through the guinea pig phase again and we ended up with 14. there are many issues as we talk about that. >> that is just unbelievable. any other families want to -- >> brian was never put on medication. they diagnosed he had depression, pts, but never put on any medication, he was put on medication for his back when he was thrown from the humvee,

naparcin and muscle relaxer and that was temporary, but they never even prescribed, screaming 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 is just mind boggling that there is not an easy way to identify and work with the individual vet, determine exactly what that cocktail, if you will, looks like. and then be be able to without -- to just seamlessly transfer that to wherever that bed is. these people are young and they're on the move. and, you know, they're all over the place. and so that -- those barriers 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 formularies are not the same is a huge issue. and it doesn't just affect veterans at the va system. there are veterans who are retired from the military who see both -- who see physicians both at the va and the dod. so they are seeing people at both different medical centers and they cannot be on similar medications from one to the other because the formularies are not the same. the problem is that not only does the va use 99% generics, but they use the cheapest generics. so daniel, who had not only ptsd and tbi, but full blown gulf war syndrome, which included

irritable bowel, had only certain medications he could tolerate. maybe the chemical in the medication is the same, but the bonding agent is different. maybe he's on a medication he only has to take once or twice a day, but the va 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 issues are just huge. it is not only that -- and the other thing that we have heard, and from unimpeachable sources, is that vas vary as we heard with their pharmacy policies. there are some vas where you can go and get a brand name medication with no problem, other vas that essentially it is impossible to get a brand name medication. so, i mean, that brings up this huge issue that we have is why there is so much variation in

the entire system. why we can't have more uniformity within the va system as a whole. >> thank you. thank you, dr. somers. my time is up, thank you. >> sorry. >> let me just conclude by saying your testimony is heart breaking. and i can barely hold back my tears and i thank you for being here. i yield back. >> thank you, mr. runyan, you're recognized for five minutes. >> thank you, mr. chairman. and i 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 and thank you for all that. a couple of points and i think dr. somers was talking about it, and i think we see it all day. we talked about this in the hearing the other night. it almost seems like the va is so fragmented, that there is no

overwhelming mission from the top with flexibility below. that's -- and i think there is a structural breakdown on how you're actually going to conduct business. and that's really where we're at, whether you're talking vha or vba. it is the same issue. and we have yet to -- i think next week we're digging into some of the vba issues also. it's a culture. and one other point, and then i'll ask one question, and it -- and miss somers was talking about it and dr. roe also validated it, when you talk about community and talk about support networks, these men and women are spending more time away from the health care facility than they are in the health care facility. so friends, family members, you know, classmates, buddies, all have to be part of the healing process. not doing that.

and i know the term wholistic has come up a few times. i think the sergeant mentioned it a couple of times. it is 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, in the va's testimony, they mentioned suicide prevention coordinators are supposedly placed at all va medical centers and the large clinics. they're supposed to follow up with veterans at high risk. were any of your sons ever contacted in that first month after they were designated high risk by a va suicide prevention coordinator? >> we're not aware of that. the fact 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. and 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 therapist and they would have felt free to talk to us, where we feel that we could have been more help. but since he was married, it was as if we didn't exist. >> i think that's important point is, like, when brian was injured in the tank explosion, i was notified, 3:00 in the morning an they called me from fort hood saying he was injured, where they had taken him, he's back with his unit, but yet you diagnose somebody with ptsd and

tbi which can be life threatening injuries and nobody notifies you. 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 started to go to the va 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 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 va, nobody knows he's a high risk. the psychiatrist didn't have anything other than clay saying, this is what my past history has been, and this is the medication i've been on. so that's a great point is 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. >> miss brownley, you're 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 certainly, to me, i feel their patriotism through your stories and their overall most sincere risk commitment and service to our country. so thank you for being here. i wanted to ask sergeant renschler a question. and so in your service, when you were in theater, was there any support system in place for you to go to get any kind of, you know, mental health support while you were there. hearing brian's story, it was re gut wrenching to hear it, and, you know, just to wonder if

brian had a place to go to, why 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 was 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, in active duty members and i have been told in recent deployments in afghanistan that after major events take place, there is sometimes availability to have a type of crisis

debrief. it is somewhat available. it is not -- it is not streamlined, 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 dod to destigmatize mental health issues. but if you're in theater, i would venture to guess that it is 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, okay, you come in for treatment, but then 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 lost your security clearance. so i mean the issue is a huge

issue. and we know from people that we have 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 is two separate levels here. there is a crisis response, muc type of a situation. if you experience this, find somebody to talk to. more of an education and immediate response. that has been available as stated, most military service members 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 are going to wait for it

become a crisis point before they seek treatment. >> i just feel like if it was part of the culture being in theater that there is kind of constant dialogue that is going on, that that would have to be helpful to the men and women who are are there. >> brian did tell me one time when they were on the 15-month tour there was at one time they lost four people in one mission. when he was out there, the morale was very low after that because these were people high up, sergeants and lt and 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 was like, why would you ask such a silly question, so they all shut down. i think by not processing those thoughts you are going to

internalize them so they are never dealt with. i think even before they are in theater, i think in basic training they should be taught ptsd and while they are 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 we prepare our men and women to go to serve and to go to war. we don't prepare them very well to transition back. dr. somers, you talked about hipa and the barriers to hipa. you mentioned also modern technology? am i? i yield back. i apologize. >> thank you very much.

>> thanks to the moms and dads and sergeants for your testimony. i will look forward to asking the va question. i yield back. >> thank you very much. >> thank you, mr. chairman and thank you to all the families being with us today. 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 are going through. i want you to know we will do our part to give meaning to their lives. it makes me feel, personally, i'm becoming more and more anti-war/pro-veteran. i think our country had those priorities misplaced getting us into conflict, but not