providing the worst levels of care. >> shelby, north carolina, good morning. this is gerald. you are on the air with lou celli, the legislative director for the american legion. caller: thank you for taking me call. host: you bet line caller: my daughter has a very simple, helpful absolutely shwould sharply volunteer for no pay if the va would make sure that she doesn't have to pay her malpractice, also make sure that whatever the recommendation is that it be actually doable. the president even with my condition, i cannot get into a va facility. i have been in va facilities over the years. some are good. some are terrible. at the present time in new york and mur feesboro, tennessee, there is no doctor to be seen

the reason so who sees me, i can't see a cardiologist because the cardiologist isn't already there. i go to a private cardiologist at a considerable expense. if someone would take a few minutes and go to a va. you would find there are no two alike. getting in the first part is the hardest part if you can see a real doctor, at a time chances are the veterans administration will be more than helpful. >> you are a world war two veteran how would you say that the va service, the healthcare service has improved or gotten worse over your years as at veteran? >> when i first got out of the service, i was diagnosed with tb. i went to sunmount. they were wonderful, couldn't do enough. tb at that time was a death sentence. so i have formed feelings for

those people at the sun mound facility. if asked a question, some nigerian would hand you a piece of paper. i am a fphi beta capa. i never got an answer. when i preferred to york in tennessee, i have been very happy with the people there. they just don't have enough people of the right skills we need doctors that are not tasked with treating people and being the moved by some trial lawyer. >> we appreciate your service and call. to address his issue of the specialists not being there, doctors not being there at the facility he wants to use for gerald and the veterans on the line, thank you for your service. we wouldn't be where we are today had we not had the dedicated service from the veterans of this nation. and to speak directly to his

suggestion we are expecting bob mcdonald to look at some out-of-the box findings, rotations throughout the night if need be. also, ideas such as gerald suggested, maybe having doctors who are willing to volunteer but make sure their liability is covered where it's not costing them financially to volunteer their services. these are the things we are completeing the new va secretary to look at. >> in his confirmation hearing, a quick look at what he had to say. >> in the midst of all of these problems, in the midst of a dysfunctional u.s. congress, in the midst of bitter partisanship,f. >> thank you chairman sanders, i think it's a good question and it's a question my family and i have talked a lot about.

i desperately want this job because i think i can make a difference. i think my entire career, whether it was starting at westpoint, being in the secondary born division, being at the proctor & gamble company, one est most admired companies in the world for 33 years has prepared me for this task. as i said in my prepared remarks, i think there is no higher calling, and this is an opportunity for me to make a difference in the lives of veterans who i care deeply about. if not me, who? >> it's coming back to you taking over an organization that's pretty dog-gone big. what would he have to do first? >> some of the work he did while he was at proctor & gamble was develop new markets. >> that requires understanding metrics, being able to evaluate what works and what doesn't. those are the skills we are going to be looking for, for him to deploy when he gets to the department of veteran affairs. s we are looking forward to working closely with secretary mcdonald, looking forward to

have him boots on the ground, hit the ground running. >> to be clear, he has not been cleared by the whole senate. the vet transcommittee cleared him last week. do you know if he is going to vote on him in the coming week? what's your sense of that? >> we believe that they will call probably before they go on and reses but we don't control that. >> susan is next, in hinkston, illinois. hello. >> i want to say when i hear john boehner say he is working diligently in trying to tell the public, i think it's a joke. we are not that stupid. i don't understand why veterans shouldn't have any problems at all after, you know, 100 years of war and using our military i can't believe. it seems to me like they have always kind of been treated bad. i have all of the compassion in the world for israel and what's going on over there but when i hear that they need money from us for their iron dome, i can't stand it. every penny should be going to

our veterans first and for 100 years or whatever, it seems to me like the veterans have never been treated very good and they should have been -- the american legion, unions and the people in the and the workers should be number 1 on the list and it's so obvious they haven't been for, you know, years, years and years and i don't understand it if you are a young person and you swath the republicans and see what's happening, they try to fool everyone with working diligently, they care about veterans, actually, it is like they are stuck in the 1820s, thinking everybody is really, you know, kind of dense and don't understand. i think the american public know a lot more than the republicans think they know and they just are trying to brainwash people. i feel sorry for the man from tennessee who thinks obama is evil because it just proves that, you know, i was a

republican, too, but it's too embarrassing now. and every republican i know, they just seem so brainwashed. >> susan, we remind you to call in on the line that best reflects your view but to the point in terms of forgetting about the veterans, when wars happen, how much thought is given ahead of time to what our needs will be for veterans? >> that's a fantastic question. you know, there have been studies that have come out and there have been recommendations that say, look. if we are going to go in to some kind of armed conflict where we are going to deploy u.s. troops, there should be a fund set up meal that starts growing interest to support veterans when they come back. congress has not really seen fit to do that just yet. >> might not be a bad idea. >> todd is in covington, georgia. on our democrats line. hello ry caller: the main think is going on is progressives are busy with these illegal people in cities, getting them in their cities.

if you want to get in the va, come across the border, tell them you are a hamas guy. we just invest $50 million in hamas. tell him you are hamas, you got beat up by a jew and chased by a co2 and they will send nancy pelosi to take to you nancy's house to get you fixed up. >> we have some comments by e-mail, victory e-mailed us, he asked: congress should issue choice cards until they can fix the va. many veterans are dying, waiting for care from the va. do you agree? and i am not sure exactly what he means by choi"choice cards". >> in the legislation, there is a catch phrase that's been tossed around that stems from when senator mccain was running o for office, he believed veterans should have choice cards to avoid va care and to go into the civilian economy and get the care they need. while we support the vet transby

being able to see doctors that are availability whether they are at the va or not. the choice card is complicated because we don't want to privatize va. it's a cost issue. it's a quality of care issue. it's an understanding of veterans needs issue. so we don't endorse the overall concept of a choice card being given forever but we endorse veterans getting the care they needed to. >> more of an interim solution? >> exactly. >> to follow up to another comment by e-mail. this one is from otis who says, as a veteran, i recognize there are many veterans who truly need the support of va facility but there are a lot who are just milking the system, too. i would like to see the veterans properly screened to make sure they are not just adding unnecessary burden to the system. is that an issue with the system? >> that's a complicated question because now we are talking about

integrity and we are also talking about the backlog. with the difficulty and the barriers that are currently set up to get veterans the care they need, there are probably more veterans needing care not getting it than veterans who don't need care that are getting it. >> michael who is in willsboro, pennsylvania, who is a veteran on our independent line. hello there. caller: good morning, c-span. i would like to say i am a vet nan veteran and i go to a meeting once a month. we used to go twice a month, but the va cut it down. one. mainly problems i see every time we go to a meeting, they have a new psychiatrist, associationologist who handles the group. a lot of the guys aren't going to open up to something the first time. you've got to have somebody that's there for at least five or six months. >> uh-huh.

>> i have been going for three years. you don't get rapport to somebody if you have to explain yourself every month. basically that's what i have to say. >> when you are going to these counseling sessions, michael, you sometimes encounter somebody who is brand new at that position, you are dealing with, i assume, your personal information and how your feelings or he emotions? ets. >> that's correct. i am a not going to tell somebody every month, why i am there, how i feel, how my month has been. i liked it a lot better when we had two weeks because you bond with the the people in the group because they are the ones who understand you. >> in terms of personnel, is this an issue? >> michael's concern is exactly the reason that the american legion advocated for two years of opening up this conferenced bill for veterans to be able to go outside of the va originally,

we were looking at six months but one of the things we were concerned about was the could not newty of care michael is looki looking for. we didn't want to send patients who are looking for some he emotional support from their physician and six months later rip them away. that was one of the years the two-year time leip was discussed. >> lou celli is a 22 year veteran of the u.s. army. where did you service? >> in german, in the united states. i retired as a master sergeant. a did a number of different jobs. i am proud of my service and proud of every moment i served. >> how long have you been with the american legion? >> two years now. i retired in 2002. i ran a small business and helped veterans start and grow their own businesses through a non-profit for about 10 years and i came to the american leakageon about two years ago. >> one more call from louis, colorado, joe on the republican line. >> yes. >> jo, go ahead.

>> yes. you know, i think we need to forget about republicans and democrats when it comes to our vet transwe have a company called mentors of america, l.l.c. i have been trying to get veterans vbeed, be employers, not employees because people don't understand that thighs boys are leaders and future leaders, but i find we need to call it what it is. they are discriminated against because people don't understand what they went to. i have tried to get colorado certified with vee and catherine williams never calls us back. we are discriminating dpenls our veterans. >> joe, the shorthand? >> disabled business enterprise

that's something the american legion has looked at. we want to make sure our veterans have the most advanceages available to them when they come back from that periods of service and spend, maybe like mean, 10, 15, 20, 25 years in the military, they don't have a rolodex. they are not integrated into the community as well as they could be. there are programs out there designed to give them a level playing field a disabled antrolith prize, the veterans we have worked with have not been that interested in because it looks as a veteran as being disabled, in some cases, it gives the wrong impression. we want to empower veterans through specialty programs that will give them a level playing field and make up for some of the time they were gone. >> lou celli joining us to talk

about va healthcare bil and the relationship between hamas and the arab countries in the region. though cunningham has the details on a news story that says that 10 million people have gotten coverage under the health care law. times"geles investigative reporter talks about the problems with a defense system that was designed to protect the u.s. from missile attacks. you can join the conversation on facebook or twitter. "washington journal" live at 7:00 on c-span. next, a house hearing with acting house veterans affairs secretary sloan gibson. then "q&a."

questions and comments on washington journal. on thursday, the house veterans affairs committee talking about assessing health care. witnesses included sloan gibson, wouldnounced that the va need an additional $17.6 billion years.e next few the senate committee voted to unanimously confirm robert mcdonald as the secretary of veterans affairs. portion of the house hearing is two and a half hours.

good morning. welcome, everybody, to trust. i want to ask unanimous consent also that representative michael fitzpatrick from the state of pennsylvania be allowed to join us at the dis today and participate in today's hearing. without objection, so ordered. the committee is going to examine this morning what steps we need to take to help the department of veterans affairs to get back on track to meet its core mission. a mission to provide quality health care to our veterans. since the beginning of june, this committee has held almost a dozen full committee oversight hearings, some of them, as you well know, have gone way into the night and some into the

early morning hours. we want to do a stop to bottom review of v.a. and to delve into how we are now situated in a crisis at the department of veterans uz fairs. and while i hope to focus on the major themes we've covered and to receive updates from v.a. this morning, on the topics that we have talked about over the last few weeks, i can promise the department and the committee members here that we, as we move forward, to help mend the broken v.a. system, the oversight done by this committee is going to continue. mr. secretary, in your written statement, you state that the status quo in our working relationship must change. and that the department will continue to work openly with congress and provide information in a timely manner. first y agree that our relationship between v.a. and this committee must change. we must go back to the way

business used to be handled for decades. when members and staff could communicate directly with v.a. senior leaders about routine business we conduct with the department. using the phrase continue to work openly is in my opinion not a reflection of the current reality that we find ourselves in. members of this committee, other members of congress and our staffs, are still being stonewalled to this day and you will hear several questions that relate to that information. for example, the day after our july 14th vba hearing, our colleague, mr. jolly, personally spoke to cary witty, the director of the st. petersburg regional office regarding a firing of a man. he had raised very serious concerned about retaliatory action and mismanagement at the st. pete ro, and it's incumbent upon this committee to investigate those allegations. but instead of being open and honest about the process, about

mr. soto's removal, v.a. has equivocated, stonewalled, changed its story, and obstructed members of this committee in what appears to be an attempt to cover up, and i say what appears to be an attempt to cover up v.a.'s retaliation about mr. soto. we're prepared to subpoena the documents if that's what it takes. we've got to get compliant with the multiple requests we've made to the department. i could not agree with you more the department needs to earn back the trust of veterans, their families thrk veterans service organizations, members of congress, and the american people through deliberate, decisive, and truthful actions. recent scandals that have tarnished trust in the v.a. are a reflection of a broken system that didn't just happen overnight, nor can it be fixed overnight. upon stepping up as the acting secretary, you stated that there has to be change. and there has to be

accountability. but i have yet to see where the department has drawn the line and brought those people who have caused this crisis to justice. we have shown through many of our hearings that one contributing factor to the current crisis is that v.a. has clearly lost sight of its core mission. and that extra funding didn't go to improvements in patient care but toward ancillary pet projects and an ever growing bureaucracy. according to an article by former undersecretary of health, dr. ken kaiser in the new england journal of medicine, vha's central office staff has grown from about 800 in the late 1990s to nearly 11,000 in 2012. this further illustrates v.a.'s shift of focus to building a bureaucracy as opposed to fulfilling its duty to providing quality patient care.

and as i said before, the problems that exist today will not be fixed overnight. and it cannot be fixed by simply throwing money at those problems. to date, the v.a. has been given every resource requested by the administration. every year, during our budget oversight hearings, members of this committee and dr. roe in particular, has asked if the secretary had enough to do his job, and every time, we as a committee were told unequivocally, yes. this is why last week acting secretary said that an additional $17.6 billion was needed to insure that v.a. is available to deliver high-quality and timely health care to our veterans. and when he did that, it raised some very obvious questions. where did the number come from? what assumptions underlie this

request, and how were they made? what effort was made to look within existing resources at the department to meet these new sources or resource needs? i know many of my colleagues would agree after multiple oversight hearings, outside investigations, countless accounts being made by whistleblowers, v.a.'s numbers simply cannot be trusted. v.a.'s determination that 10,000 additional medical staff is needed is also surprising when the secretary's own written statement states, and i quote, v.a. doesn't have the refined capacity to accurately quantify its staffing requirements, end quote. if they don't have the ability to accurately predict staffing needs, then how do we know that 10,000 more bodies is what is needed to solve the problem? i would also remind members that

we don't have any type of grasp on how the department is going to spend the new funding they have requested. the president's 2015 budget request, 1300 pages. you've all seen it. it's in your office. 1300 pages. the request from the department, the first request from the department, i had been saying, was a three-page request. and that request actually is a single page. this is all we got. i hope all of you got a copy of this because this is how they, in fact, justified their request. and i asked the secretary on the telephone earlier this week if he would delve into and give us a more complete review of what they requested, and i was told that we would get a much more detailed request.

we got two pages. that's all we've got. two pages. entitled working estimate as of july 22nd of 2014. for $17.6 billion. now, yes, the number has been refined to about $13.5 billion now, but still. two pages for $13.5 billion? our veterans deserve the best, but throwing money at the department into a system that has never been denied a dime will not automatically fix the perverse culture that has encompassed the department. v.a. can no longer consider itself a sacred cow that is not subject to rules of good government and ethical behavior. veterans are sacred. v.a. is not. ultimately, we're talking about

a system that has a long road ahead of it before it can get back to an organization deserving of our veterans and the sacrifices that they have made. i hope that today we receive a needed insight from our veterans service organizations. they and their members are on the ground. they need to be partners as v.a. tries to rebuild the trust that is lost. i hope that together we can bring about true change to this broken system and a change -- and a change that will fix the corrosive culture that has encompassed the department of veterans affairs for far too long. with that, i yield to the ranking member for his opening statement. >> thank you very much, mr. chairman. good morning. i want to thank you, mr. chairman, for holding today's hearing and for leading our rigorous oversight over these past few months. it's been a long road getting here. the hearings that we have held

over the past two months have yielded difficult, disturbing, but ultimately important information. with each hearing we've heard of a different aspect of the department of veterans affairs that just isn't working. we heard about some challenges like the claims backlog and technology issues which we have been confronted for quite some time now. we learned of others like how the v.a. treats whistleblowers and the reality of the data v.a. reports. the v.a. is a good product. when veterans get to see a v.a. doctor, they like the care they get. when veterans get the eligibility rating and stats receiving v.a. benefits, they find the benefits to be useful and helpful, but the business model for producing and delivering and supporting the v.a. product is fundamentally broken. we have heard this time and again over the course of these

hearings. there is a clear cultural problem at the department of veterans administration. there are scheduling failures and technology problems. inconsistent office practices lead to a backlog that appears to be at the expense of other services. the department of veterans administration is a sprawling agency that offers critical services to millions of our veterans. it's clear to me that we need a business-minded approach to reform the agency. more of the same isn't going to solve the underlying problems. tweaks and band-aids around the margins aren't going to sustain the system. we need a new model, a new approach, and a new way of thinking about and looking at the department. we need immediate short-term fixes, but we also need a long-term vision and a new approach to the business of the department of veterans administration. and i would like to thank you, secretary gibson, for joining us

today and for your efforts over the last few months. you have stepped up to the plate at the most challenging moment in the department of veterans affairs history, and you owned the problem of the organization. that has been experienced over the last several years, and i thank you for your increased effort to communicate with us on the hill. our dedication to the nation's veterans and exhibiting the courage to be the face of the department of veterans administration during these very difficult times. i would also like to thank bob mcdonald who i hope will soon be confirmed as the next v.a. secretary. i'm looking forward to talking with mr. mcdonald about his vision for reforming the department of veterans administration, both in the short term as well as in the long term. like mr. gibson, mr. mcdonald is exhibiting extraordinary courage and commitment for taking on

this role at this very important time. i also would like to thank the veterans service organization for joining us today. you have been strong and relentless advocates for the well being of our veterans. you have done an excellent job in holding all of us in congress, in the department accountable. you are a key stakeholder in this whole debate of the department of veterans affairs. you need to be active, engaged in the process of long term reforms for the department of veterans administration. so i want to thank all of the vsos as well for your continued effort you have been doing and keeping an eye on what is happening with the department, and for joining us today. once again, mr. chairman, i want to thank you for having this very important hearing. with that, i yield back the balance of my time. >> thank you very much. to my friend mr. michaud. i want to recognize some participants in the audience with us from the american league boys nation, who joined us here

today. welcome to all of you, and thanks for being here. we're glad to have you with us. [ applause ] this morning we're going to hear from the honorable sloan gibs gibson. to you, sir, we owe a great debt of gratitude for stepping in as number two and then stepping up as my ranking member has said, during a very trying time for the department, and we appreciate you being here. he's accompanied by mr. danny pummel, deputy undersecretary for benefits at the department of veterans affairs and philip matkovsky, assistant director undersecretary for health and the administrative operations at the department of veterans affairs. as always, your complete written statement, mr. secretary, will be made a part of the hearing record and with that, you are recognized for your opening statement. >> thank you, mr. chairman.

i'll get straight to business. concerning v.a. health care, we have serious issues. here's how i see the problems. first, veterans are waiting too long for care. second, scheduling improprieties were widespread, including deliberate acts to falsify scheduling data. third, an environment exists where many staff members are afraid to raise concerns for fear of retaliation. fourth, metrics became the focal point for some staff instead of focusing on the veterans we're here to serve. fifth, v.a. has failed to hold people accountable for wrongdoing and negligence. and last, we lack sufficient resources to meet the current demand for timely, high-quality health care. as a consequence of these failures, the trust of the veterans we serve, the american people, and their elected representatives has eroded.

we have to earn that trust back through decisive action. and by greater transparency in dealing with all of our stakeholders. to begin restoring trust, we have focused on six key priorities. get veterans off wait lists and into clinics. fix systemic scheduling problems. insure that veterans are the focus of all we do, in a culture where leaders insure accountability, where transparency is the norm, and where employees live our v.a. values every day. hold people accountable where willful misconduct or negligence are documented. establish regular and ongoing disclosure of information. and finally, quantify the resources needed to consistently deliver timely, high-quality health care. here's what we're doing now. vha has reached out to over 173,000 veterans to get them off

wait lists and into clinics. we're adding more clinic hours, recruiting to fill vacancies, deploying medical mobile units, expanding resources and expanding the use of private sector care. in the last two months, between mid-may to mid-july, we've made over 570,000 referrals for veterans to receive care in the private sector. that's up more than 107,000 over the comparable period a year ago. each of those referrals will, on average, result in seven actual appointments and visits. so that produces an increase of more than 700,000 appointments and visits for varin the community above last year, just associated with the increase in referrals over a two-month period. vha is posting regular twice-monthly data updates to keep veterans informed about progress we're making in access.

as part of the effort to improve transparency, i recognize, mr. chairman, we have more work to do in providing complete and timely responses to congressional inquiries and requests. you all are keeping us very busy in that regard right now. we're moving to improve our existing scheduling system and simultaneously pursuing the purchase of a modern commercial off the shelf system. i have directed medical center and visiting directors to conduct monthly in-person visits to clinics to look at scheduling and look at scheduling problems. to date, over 1500 of these visits have been completed. we're putting in place a comprehensive external audit of scheduling practices across vha and we're building a more robust system for measuring patient satisfaction. i have personally visited 13 v.a. medical centers in the last six weeks to hear directly from the field how we're getting

veterans off wait lists and into clinics. the 14-day access measure has been removed from over 13,000 individual performance plans. where willful misconduct, negligence or whistleblower retaliation is documented, appropriate personnel actions will be taken. i have frozen vha's central office and headquarters hiring. vha has dispatched teams to provide direct assistance to facilities requiring the most improvement, including a large team on the ground in phoenix right now. in addition, we've taken action on all of the recommendations made in the ig's may interim report on phoenix. all vha senior executive performance awards for fiscal year 2014 have been suspended. additionally, i have directed a fundamental revision of all medical center and visit center objections to insure they're aligned with patient outcomes. i have repeatedly taken a firm

stand on the subject of whistleblower retaliation. in messages to the entire workphose and in numerous face-to-face meetings with employees and leaders i have made it clear that we will not retaliate tolerate retaliation against whistleblowers, i committed to caroline learner that we will achieve compliance with the satisfaction program, and she and i have agreed to streamline the process by which we work together to insure appropriate whistleblower protection. we have also established internal processes to insure appropriate personnel actions are taken where retaliation has been documented. i've made a number of leadership changes, including naming dr. carolyn clancy interim undersecretary for health. new to v.a., she is spearheading our immediate efforts to acc accelerate veterans' access to care.

dr. jonathan purlin has begun his assignment as senior adviser to the secretary. he comes to us on loan from the hospital corporation of america where he is the chief medical officer and the president of clinical services. he's also chairman elect of the american hospital association. dr. purlin brings a wealth of knowledge and experience to help us bridge the period until we have a confirmed new undersecretary for health, a position dr. purlin himself once held. as part of the restructure of vha's office of the medical inspector, we call that omi internally, dr. jerry cox has been appointed to serve as interim director. a career navy medical officer and a former assistant inspector general of the navy for medical matters, dr. cox will help insure omi provides a strong internal audit function helping to insure the high standards of care quality and patient safety. as we complete reviews and investigations, we're beginning

to initiate personnel actions to hold those accountable who committed wrongdoing or were negligent. to support this critical work, ms. lee bradley has begun an assignment. she is a former general counsel at v.a. and most recently at the department of defense where she has direct responsibility for their ethics portfolio. shifting gears, an area of resources. i believe that the greatest risk to veterans over the intermediate to long term is additional resources are provided only to support increased purchases of care in the community. and not to materially remedy the shortfall in internal v.a. capacity. such an outcome would leave v.a. even more poorly positioned to meet future demand. today, v.a.'s clinical staff and space capacity are strained. between 2009 and 2013, the number of unique veterans we treat annually has increased by

over half a million and the typical veteran we treat today has on average nine major diagnoses. in just the last three years, 40 veterans health care facilities have experienced double digit growth in the number of patients who come through their doors. as an example, at the fayetteville, north carolina, v.a. center, which i visited several weeks ago, the number of patients being treated has grown 22% in the last three years. resources required to meet current demand covering the remainder of fiscal year '14 through fiscal year '17 total over $17 billion. while the amount is large, it represents a moderate percentage increase in annual expenditures. these funds would address clinical staff, space, information technology, and information technology necessary to provide timely, high-quality care. let me briefly address benefits. since arriving at v.a., i have

been very impressed with vba's ongoing transformation. i doubt that any major part of the federal government has transformed so much in the past two to three years. and i believe that because of this transformation, we're on track to eliminate the disability claims backlog in 2015. having said that, veterans still wait too long to have their claims decided. and our quality is still not up to our own standard. a portion of our request for additional resources will be invested to accelerate accurate and timely claims decisions for veterans. in closing, we understand the seriousness of the problems we face. we own them. we are taking decisive action to begin to resolve them. the president, congress, veterans, vsos, the american people, and va staff all understand the need for change. we must, all of us, seize this opportunity.

we can turn these challenges into the greatest opportunity for improvement i believe in the history of the department. furthermore, i think that in as little as two years, the conversation can change, that v.a. can be the trusted provider for veterans health care and for benefits. our ability to do that depends on our willingness to seize the opportunity, challenge the status quo, and drive positive change. i deeply respect the important role that congress and the members of this committee play in serving veterans. i'm grateful for your long-term support, and we'll work hard to earn your trust. we cannot succeed without the collaboration and support of veterans service organizations. i have conducted some 20 meetings and calls in the last two months with vso leaders and other stakeholders to solicit their ideas for improving access and trust, and i look forward to hearing the testimony on the panel that follows. and last, i appreciate the hard

work and dedication of v.a. employees. the vast majority of whom i continue to believe care deeply about our mission, want oo do the right thing, and work hard every day to care for veterans. because of their work today, thursday, today, hundreds of thousands of veterans will receive great care in facilities all the way from maine to manila. and in the midst of this crisis, it's all too easy for us to forget that simple fact. mr. chairman, i am prepared to take your questions. >> thank you very much. mr. secretary, and it's an honor to have an opportunity to work with you, call you a friend. we've got some questions that we're going to ask today, and both sides will have some pretty probing questions. and i think we appreciate the actions that have been taken at the department to move the veterans off wait lists and i think probably the one of the significant questions that needs to be asked right now is how many veterans currently are on

waiting lists over 30 days for appointments? >> do you want to take the wait list question? and i'll address the broader issue. >> sure, veterans on the ewl or electronic wait list number about 40,000 nationwide today, down from 57,000 may 15th. >> the new enrollee appointment request list, which was another focal point for this overall effort, started at roughly 64,000. it is currently sitting on what's really going to be a permanent level of about 2,000 because there's flow in and out just about every single day. when you look at the number of veterans that are waiting that are scheduled but waiting longer than 30 days for their appointments, it's about 640,000. total. we see the number of veterans waiting longer than 90 days as we release information each two

weeks. we see that coming down steadily but not precipitously, not fast enough. >> if we can talk a little bit about the funding request that you alluded to in your opening statement, is this a formal request being made by the president? or is it an emergency request, a supplemental que aal request? >> what i'm trying to do is articulate the requirement as best as i can possibly articulate it. from my perspective, it's a formal request for funding. >> from the administration? >> that's my understanding, yes, sir. >> is anybody aware of how the supplemental request was made by the white house in regards to the process, crisis that exists on the border right now? $3.4 billion. >> i am not aware of the method by which it was completed. >> it was a supplemental request from the white house, so i'm trying to figure out, because

everybody keeps dancing around the word request, even yesterday, an undersecretary did here on the hill, and i'm trying to find out what are we -- you know, it's a desire, but ordinarily, it would come through the white house. so walk me through the -- how did this come up right now? what was the impetus that began you looking at the need. we already have $35 billion on the table, and so now during negotiations on a conference committee report, you have injected $17.6 billion. >> i think as we launched into now over two months ago, we launched into an effort to accelerate care for those veterans waiting the longest, we undertook simultaneously a process of evaluating the adequate resources in the field in order to be able to meet that

standard of consistent, high-quality health care, timely, high-quality health care. as we work through that process, using the information systems that we have available to us, we developed an initial set of requirements and began working with the office of management and budget. as my testimony last week to the senate became closer and closer, nearer and nearer, there was an increased effort there to try to get that process to closure so that during that testimony as well as his testimony, i would be able to present that statement of requirement. >> so the memo that you gave to senator sanders on the 16th of july says per your request, attached for your information, is a summary for additional resource needs through 2017. so was it senator sanders' request, a combination, or yours? >> senator sanders requested the

information, the information -- the requirement that's being communicated here, and if you will, the request, is our request. >> you come from a banking background. if somebody came in to your bank with three pieces of paper and asked for a million dollars, would you give them a million dollars? >> the honest answer there is it probably would depend on who the borrower was, but i understand your point. the committee needs additional information. >> and we have set a goal of trying to wrap up the conference committee by the end of next week before we leave so that we can get something to the president for his signature. and we got three pieces of paper to justify a request that senator sanders clearly wants put into the scope of the case

is making it very, very difficult for us to be able to do our job if all we get are sheets of paper that basically says they are working documents. at some point, they have to say this is the document. with that, mr. michaud, you're recognized. >> thank you very much, mr. chairman. once again, i want to thank you, mr. secretary, for being here. you stated in your statement that v.a. doesn't have the resources that it needs. in your view, what led to this lack of resources, number one. and when was this underresourcing identified? and my third question is, what did the department actually requested in their budget? the reason i ask that question is, when i first became a member of this committee, when i was first elected, we had secretary principi sitting where you were sitting and we asked him, as he was defending the president's budget, and the question was, can you deliver the services for our veterans with iraq and

afghanistan and the current? his response was that he requested additional $1.2 billion, did not receive it, but he'll make due with his budget, so i would be interested in knowing what your actual request was when you originally submitted your budget. >> first of all, as i have come into the department five months and six days ago, i formed opinions about what i see and what i hear. my general sense is that what we have done historically is we have managed to a budget number as opposed to managing to requirements, which is what you do in the private sector. and i think as a result of that, what's happened is we have sort of muddled our way along and not been able to meet the standard of care that veterans deserve, because we did not manage to requirements. the exercise that we have gone through and frankly continue to

go through as we work to insure that we're ringing all the productivity that we can out of the existing resources, is really about managing to requirements. i would tell you that process as i mentioned in response to the chairman's question, has really been under way for about the last two months. i have been in places acting now for seven weeks. and so we're working through that process. these are not -- in the private sector, this would be a routine part of the business. you would be managing to requirements. you would be continuously exercising productivity tools and over a period of years, you would be building the organizational capacity to insure you have the responsive resources to meet existing demand. that's simply not the way the department has historically been run. we have managed to a budget number instead. i can't answer your question as to what the specific budget

request was in relation to what was actually finally approved, but we'll take that one for the record and get you an answer. >> i appreciate that, and i appreciate your comment because that was my same response to secretary principi at the time, was i don't care how big of a budget increase you received. i want to know, are you taking care of the veterans? the outcome is so critical, and over the years, through several secretaries, i have sat here and listened to, i believe that they have always operated the department based upon the budget they had, not what they needed to take care of our veterans, and hopefully, that will change. >> well, if i may interrupt, sir, i committed to the president. i committed to employees at v.a., and most importantly, i have committed to veterans. i will not hold back. if i think resources are required, i'm going to ask for them.

and i have told the internal staff, don't you ask for one penny more than you can justify. you know, i'm not looking here for some kind of a blank check, but i'm not going to sit here, in my meetings with individual employees, as they raise issues about the needs that they have and the resources that they lack, you know, i have come to understand what my job is. my title may be acting secretary, but my job is to create the conditions for them to successfully meet the needs of the veterans that they serve. and that's what i'm obligated to do when i come here and sit in this seat. >> i appreciate that. do you think the business operating model that the v.a. currently operates is sustainable in the long term and getting to what chairman miller had mentioned, when you look at the fact that at the business level has exploded with management, and i think that the v.a. definitely has to be reorganized, and you know, in a better format. do you think the current business model is sustainable in

the long term? >> my sense is that there are -- my sense is there are opportunities for us to structure differently. i don't like bureaucracy, but i understand in an organization as large as this one, you've got to have some of it. the challenge is making it work for the people that are serving veterans day in and day out, and i dont think we're doing that very well. so i think there are opportunities. there has been concentration at the vizzen level and at the v.a. central office level. part of that, i would tell you, i think was positively done as part of taking and consolidating support activities either at that level or at the v.a. central office level where they can be performed more efficiently and effectively than scattered in 150 different locations, but that doesn't mean we've got it exactly right. there's still work to do. >> thank you, thank you, mr. chairman. >> mr. lam born, you're recognized for five minutes.

>> thank you, mr. chairman. thank you, secretary gibson for being here today. i want to follow up on something that was brought up earlier by chairman miller. very important issue that i would like to get more information on. it has to do with where you said in your statement, we don't have the refined capacity to accurately quantify our staffing requirements, and yet in your $17.6 billion resource requirement, you are requesting $8.2 billion for about 10,000 primary and specialty care physicians and other clinical staff. given that you said that the department is unable to quantify its staffing needs, how can a number like that even be arrived at? >> i'm going to let philip met kauvsky, who is intimately

involved in this, we have not been working to solve to requirements. i think earlier today, some of the staff participates and i think congressman win strm may have participated in a briefing we delivered about our opthemology specialty. inside the model when you look at some of the productivity tools we're rolling out, you get a good microcosm of what ultimately is going to give us the kind of granularity, you're going to find as we exercise the model, there are some locations that have enough staff. there are some other locations that may need some additional support resources, either some a additional support staff or space, and there are places where you look and say we have enough providers here, and it's going through that kind of bottom-uf, highly granular process that is going to give us the precise answer. we're working and doing that right now, but in the meantime, as we go out in the field, as i

go out in the field and as we look at top-down requirements it's clear to us that we don't have the resources we need. >> the one thing i will indicate is we try to use a bottom-up approach which is looking at veterans waiting longer than 30 days for care and processing that. we made certain assumptions about improving efficiency over the years and that thrust gave us the definition of the count of appointments we needed to accelerate and cost in the model, and we worked with the assumption in year one, we're going to do mostly of purchasing of care in the private sector because of staffing issues that would take time and then we would blend it over time and sustain it using internal staff, but the way we came about that is estimating the number of veterans and their appointments that wouldn't be delivered in a timely manner and costing that and turning it into the $8.2 billion. >> it sounds like it's a work in progress. and as you both are saying. so i question how specific you

can actually be. but a follow-up question is, are there a lot of slots that are sitting empty right now that you haven't been able to find someone to fill? either a doctor or other health care professional? >> i would say yes, there are thousands of vacant positions. all across vha, roughly 28,000 vacant positions. and in some instances, those aren't all being actively recruited to fill. i would tell you as part of accelerating care, we have been pushing on clinical staff and direct support staff to accelerate some of the hiring. >> my follow-up question there is if you have 28,000 minus x open slots, and you add 10,000 or so more open slots, are you ever going to even be able to fill those slots under current requirements? the current productivity requirements you have, which i understand from testimony is

different than in the private sector. >> organizations will always have some measure of organ ic vacancy rates. you'll have turnover in the staff, but what it allows us to do the raise to floor so that the floor of the fully incumbered positions grows with additional staff brought in, so i think there will be staff that leave the organization, people leave, they retire, they move on to other jobs. there will be a vacacy rate. right now, it's about 10%. and that sort of reflects the turnover rate. as turnovers occur, you have a certain vacancy rate. the other thing we're looking at at the same time is looking at our physician management practices. rather than hiring to vacancy, hiring to the requirement, which may require in certain places that we have fully incumbered staff as opposed to where we are today. to your point, i think the additional staff allows us to raise the floor of the onboard fte. >> thank you, mr. chairman. i yield back.

>> thank you very much. was mr. brown here? mr. brown, you're recognized for five minutes. >> thank you, mr. chairman, and i want you to know i was here before the chairman. i have been on this committee for 22 years, in fact, when i came, jesse brown was the secretary, and his motto was putting veterans first. and i have been through all of the secretaries. and you know, some of them left a lot to be desired, and some -- but the point of the matter is that i understand that v.a. has changed over the period of time. and at one time, we were serving a certain kind of veteran. now, we have expanded to the veterans. i don't want to say they're sicker. their conditions are different because of the war. they have come back with different ailments.

how can you plan for that? because they want their services at the v.a. i want to make sure that the v.a. is there for them. and it's a lot more complicated than what we're saying. because like you said, they have ten additional things as opposed to at one time, it was a lot more simple than it is now. >> we have an actuarial model to forecast. part of that looks at the past practice and forecasts into the future. that's part of it. the other part, i think, though, is to start introducing more bottom-up planning and having our field give us, if you will, the statement of requirements. so if this is the number of veterans that you think you can serve, i also think that and i neglected to mention this for congressman lamborn's question, if we