unanimous vote as we did. senator sanders talks about 93-3. >> he is always trying to one up me. [laughter] >> as they go through the process, there will be an educational process. obviously some of our members will be more educated than others. day, the end of the whether you are a conservative republican or a progressive, people understand that this issue should and must go beyond politics. people who put their lives on their line, comeback with a whole lot of problems -- it would be an absolute disgrace to this country if we did not address that. i think there will be widespread support. do youhe process -- when expect the conference committee, and would chamber do you expect to go first?

>> we want to get this done as quickly as possible. i think it would be appropriate to say that we would like to have everything done by the end of the day. in regard to the conference community signing off on the report. and the mechanism as to who goes first is not as critical. as other pieces. thell step out and say house will probably go first, but that hasn't been decided. is it isportant thing done as quickly as possible. that your view is that congress is dysfunctional, nothing getting done-- >> did i say that? >> you did. going just from last week, it was a pretty tense moment at the end of last week. when you give us a sense of what

it took to get here? it could be instructive. congress is so divided right now. we have to work through these things. at the end of the day, what is important -- am i understood? are you understood? this is the veterans of the united states. we have an obligation to do it. >> there has not been one time that senator sanders nor our staff have continued to communicate. hey out the media made of what took place last week. we continue to negotiate even if that today was unfolding. we were communicating. >> ok, one or two more questions. >> their members of the pennsylvania delegation who have

been seeking to have some measures put in. about if that was part of the conversation and what happened? >> it was not part of this conference report, however we both agree that some of the issues, specifically in pittsburgh and other places around the country, will not resolved we must try to the veil of secrecy that caused the issue to crop up in the third. -- in pittsburgh. >> this is not the end, this is the beginning. we are dealing now with the crisis situation, and i think we are going to work through it. there is a lot more work to be done. we have got to keep going. thank you all very much.

>> president obama signed the veterans health-care bill into law on thursday, august 7, at fort belvoir. members from both parties attended the ceremony as well as current veterans affairs secretary, robert mcdonald. this is about 15 minutes. a biglso want to say thanks to america's new secretary of veterans affairs, bob mcdonald. [applause] some of you may know bob headed up one of the biggest, most successful companies in the world. but he also was a west point grad. who serveder

valiantly on behalf of his country. this was a labor of love for him and he hit the ground running. he is turning out clinics and hospitals around the country. for exceptingbob, discharge in this challenge and making sure we are doing right. [applause] i'm really proud of him. i want to thank all the members of congress who are here today, and i especially want to thank those who led the fight to give bob and the v.a. more of the resources and flexibility they need to make sure every veteran has the benefits they have earned. senator bernie sanders-- [applause] senator richard burr, represented in mike michaud, representative jeff miller. give them a round of applause, thank you. [applause] we are all grateful to our

outstanding veteran service organizations and all the work that they do on behalf of our veterans and their families. thank you very much to all the veterans service organizations. i want to thank general buchanan and all of you who served here at fort belvoir for nearly a century. this space has helped keep america strong and secure. seven years ago, troops from were the 29th infantry, some of the first to storm omaha beach. in recent years, many of you have deployed to iraq and afghanistan. you have risk your lives on multiple tours to defend our nation. as a country, we have a sacred obligation to serve you as well as you served us. an obligation that doesn't and duty. your tour we honor that commitment.

at v.a. hospitals across america andu have got doctors nurses who are delivering world-class care to america's that are in. -- veterans. families are profamily grateful for the good over the last few months, we have discovered some misconduct. veterans waiting on care they needed, long wait times being covered up on the books. this is wrong. this is outrageous. and working together, we set out to fix it time a do right i our veterans -- we set out to fix it, do right by our veterans, no matter how long it took. we have held those responsible for misconduct. some have been relieved of their duties. the investigation is ongoing. we have reached out to

veterans, making sure we're are getting them off wait lists and into clinics inside the v.a. system. we are instituting a critical altar of accountability. and rebuilding our leadership teams, starting at the top with secretary mcdonald. his first act -- he has directed all v.a. facilities to hold town halls to hear directly from veterans they serve, to make sure we are hearing honest assessments about what is going on. in a few minutes, we will take another step. i will sign into law a bipartisan bill -- that does not happen often -- passed by congress. [applause] it is a good deal.

this bill covers a lot of ground. from standing survivor benefits to educational opportunities, to improving care for veterans struggling with traumatic brain injury and victims of sexual assault. but i want to focus on the ways this bill will help ensure veterans have access to care. first of all, this will give the v.a. more of the resources it needs. it will help the v.a. hire more doctors and nurses, staff more clinics. as a new generation of americans returned home from war and transitions to civilian life, we have to make sure the v.a. system can keep pace with that new demand. keeping in mind i have increased funding for the v.a. since i came into office by extraordinary amounts. but we also have extraordinary numbers of veterans coming home. so, the demand, even though we

have increased the v.a. budget, is still higher than the resources that we have got. this bill helps to address that. second, for veterans who can't get timely care through the v.a., this bill will help them get the care they need somewhere else. this is particularly important for veterans and more remote areas, rural areas. if you live more than 40 miles from a v.a. facility or v.a. doctors cannot see you within a reasonable amount of time, you will have a chance to see a doctor outside the v.a. system. and we are giving the v.a. secretary to hold more people accountable. we are giving bob the authorities so he can move quickly to remove executives who fail to meet the standard of competence the american people demand. if you engage in unethical practice, if you cover up a serious problem, you should be fired, period. it should not be that difficult.

[applause] and if you blow the whistle on an unethical practice or bring a problem to the attention of higher-ups, you should be thanked. you should be protected for doing the right thing. you should not be ignored. you should not be ignored. you certainly shouldn't be punished. to care for him or her who shall have borne the battle. that is the heart of the v.a.'s motto. this bill i am about to sign will help us achieve it. at but let's be clear. this cannot be the end of our effort. implementing will take time. it will require focus on the part of all of us. even as we focus on urgent reforms we need at the v.a. right now, particularly around wait lists, we cannot forget our

long-term service goals for our veterans. the good news is we have cut the disability claims backlog by more than half. but let's now eliminate the backlog. let's get rid of it. [applause] the good news is, we have poured major resources into health care. the good news is, we have helped get thousands of homeless veterans off the street, made an unprecedented effort to end veterans homelessness. we have zero tolerance for that. but we have more work to do in cities and towns across america to get more veterans into the homes they deserve. we have helped more than a million veterans and spouses go to college under the post-9/11 g.i. bill. but now we have to help even

more of them earn her education and ensure they are getting a good bargain in the schools they enroll in. we have rallied companies to hire hundreds of thousands of veterans and their spouses. that is the good news. with the help of jill biden and michelle obama -- two pretty capable women -- [laughter] they know what they are doing and no one says no to them, including me. but we have to help veterans it new careers in this economy. america has to do right under all of those who serve under our proud flag. congress needs to do so, also. i urge them to approve my nominee for the secretary of policy in the v.a., joel schwartz. my nominee for cfo, jill tierney. each of them have been waiting months for a yes or no vote.

they are ready to get to work. it is not that hard. it continues to be this hard to get someone confirms who was well qualified. nobody says they are not. it is just -- the senate does not seem to move very fast. as soon as the senate gets back in september, they should act to put these outstanding public servants in place. our veterans do not have time for politics. they need these public servants on the job right now. [applause] let me wrap up by saying -- two months ago, i had the chance to spend time with some of america's oldest veterans. some of you may have seen on television the celebration, the commemoration of those incredible days, the 70th anniversary of d-day.

this was my second visit to democracy's beachhead. this was the second time i have gone as president. it is a place where it is impossible not to be moved by the courage and sacrifice of free men and women who volunteered to lay down their lives for people they had never met. ideals they cannot live without. that is why they're willing to do these things. and some of these folks that you met, they were lying about their age -- they were 16. landing either at the beach or sometimes behind the lines. the casualty rates were unbelievable. being there brought back memories of my own grandfather who marched in patton's army and then came home and like so many veterans of his generation, went to school, got married, raised families. he eventually helped to raise me.

and on that visit to normandy, i brought some up today's service members with me. because i wanted to introduce them to the veterans of d-day and show the veterans of d-day that their legacy is in good hands. that there is a direct line between the sacrifices then and the sacrifices folks have made in remote places today. because in more than a decade of war, today's men and women in uniform, all of you, you have met every mission we have asked of you. today our troops continue to serve and risk their lives in afghanistan. it continues to be a difficult and dangerous mission, as we were tragically reminded again this week in the attack that injured a number of our coalition troops and took the life of major general harold greene. our thoughts and prayers are with the families. four months from now, our

mission in afghanistan will be complete and this war will come to an honorable end. in years to come, many from this generation will step out of uniform. whether this country properly repays their heroism, their patriotism, their sacrifice, that is in our hands. i am committing to seeing we fulfill that commitment. the men and women of this generation, this 9/11 generation of service members, are the community leaders we need for our time -- community leaders, business leaders, and i hope leaders in politics as well. from the greatest generation to the 9/11 generation, america's heroes have been called to serve. i have no greater honor than to serve as your commander-in-chief.

as long as i hold this office, we are going to spend each and every day working to do right by you and your families. i am grateful to you. god bless you. god bless america. with that, i am going to sign this bill. thank you very much. [applause] >> highlights from congressional hearings on veterans health care. we begin with members of the during anommittee investigation of the phoenix va system. that is to douche and has been accused of keeping a secret week

institution has been accused of keeping a secret week list. -- wait list. >> what is the a doing to make sure it does not engage in prohibited practices? >> i'm not sure i understand the question. i did not see the allegations. i believe they will probably give us a complete report. it would be my expectation that if there was inappropriate retaliation, it will be addressed. >> what was the name of the doctor that was the whistleblower? how was your meeting with him? >> i did not meet with him. >> did you ask for a meeting with dr. foot? >> i did not. that clearlyody

was at the center of the storm. you are there to understand the process. you did not request a meeting. mightas concerned it interfere with the investigation. >> i think you're concern was it might interfere with the truth. i can tell you, you are not being forthright. there are a lot of people that work for the administration. some of them are the whistleblowers. without them, we would have no idea what was going on. v.a.eadership of the simply is not there. here is the

impression you give, all three of you today, you are here to , not the men and women who have made sacrifices defending this country. until we haveare leadership. not just from the very top, but all of you. you are not sure to do your job. i yield back. >> you are recognize for five minutes. >> so many of my colleagues have a alluded to the issue of trust. and for the nature veterans. working in concert together. a cautiousness

that may be the nature of any bureaucracy. a bunkermoved toward mentality. the thealking about audit that was being done. he asked the deputy if we were going to get the list. i know your hearts are in the right place. bureaucracy is holding you back. i cannot imagine a scenario where we would let some of the bureaucracy get some of that information. what you would not have said, i will get it and if they don't like it, too bad. that gets where we are today. what we're trying to do is solve everybody gets that.

the problem is no competent formulate aing to course of action with all .ertinent data impression this is what this would look like. i thought there would have been interns taking stacks of e-mails. those would be here. this committee would decide what was important. i was mistaken. i ready know the answer. be -- isr is going to there a team of lawyers saying, is thereoing to go something putting something in executive privilege is there an

executive privilege of these anybody know the answer? >> i have met with this committee and staff the chairman. on a number of occasions to vare what i know about health. i'm looking for a collaborative relationship. >> we have known each other for quite some time. impressioner the that this relationship has been strained for a while? the between congress and the v.a.? our intent.ot that we work closely with you. many of you talked to us about youes and we work to get

information as quickly as we can. we understand the constraints we work for two and a half weeks. to provide the committee with a response. >> i expected you would send a pile of stuff at any staffers would sort through and decide what needed to be done. was that a naïve assertion? say that not leading or passive aggressively. >> i was not part of that process. >> many have proved what we want to do. i can't help but feel something has not been given to me. the impression was there.

, overd have loved to see my dead body. >> i have no doubt they will get this report and do not have responsibility for it irks the person who is here is not -- responsible is not here. job -- who do we talk to? should we just get over you and go directly to general counsel? >> in a subpoena, that is a legal matter. we try to do without a subpoena. >> thank you very much. you are recognized. and aa veteran, physician, i have serious concerns like the rest the

committee. let me ask you a few questions. >> they were canceled in an effort to reschedule. >> were they all new patients? in phoenix, as, i understand it, the administration and management model whereed a they had not employed the list. they had scheduled patients when there was an appointment. it could have been six months out or seven months out. with the new team, there was a desire to identify appointment slots. they identified the patients who 3, 4, fiveheduled

months in advance. canceled the appointments. brought them into a new appointment. in on theors weigh meeting see? do they say, that patient is very sick? areor any reason we rescheduling someone, it is rare that we are moving him up. -- them up. we would discuss on a patient by patient basis, this patient needs to be seen right away. they cannot wait to read that that ever happen? tell you whether the doctors were involved in the rescheduling process. >> we don't know if doctors in the va are able to weigh in on the risk of patients waiting longer for the procedure. we are talking about people waiting for colonoscopies. they were delayed. to weigh in and

say, this patient needs to be in here right now? >> i believe it does happen. physicians -- >> can or do? >> i hope to have access to the patients records. >> the hospital or clinic is not going to let patients set on a waitlist. r existence depends on that. doesthe doctor alluded to, the drive to get to care derived from problems that have arisen? are thosequestion is, receiving bonuses penalized if they send the more patients in? >> i do not believe they are penalized if they send more patients to feed basis care.

we have been putting in place the tools that have allowed the use of feed basis care. access of performance is and productivity as well as results. when it comes to the general nothing to you have be concerned about, you should be upset. you should be screaming and of reciting that you do for your review should fire them stand up for them. any comments on that on a personal level? people are asking where is the information. you said you turned it over. >> i't that bother you?

have turned over the information. they have old my e-mail files. it bother you they have ?ot submitted it to us it doesn't bother you. >> we are committed to being .ollaborative and responsible >> veterans responded to needs immediately. i hope you would do the same. >> thank you. per committee rules, we will continue with never ship. , you are recognized for five minutes. this whole issue is disturbing. it is ironic that this is memorial day.

this was the number one issue when we would talk to the military. they wanted to know what was going on. mentioned omar bradley. i was a second lieutenant in vietnam that met him. .e got shot up said, he wanted to talk about the m-16. i said it does not fire right. was 1967. he was 80 something years old suddenly, after that, there were

all kinds of investigations. would die because of . weapons failure what if general bradley were here right now? it is ironic that next week, the normandy invasion, sixth of june, i don't feel there is a chain of command or a sense of urgency. my feeling is, who is going to go down and correct these things? i know you had a busy weekend. people are dying. you have to work through the weekend. it is a 24-hour day. there has to be a sense of urgency.

i'm coming away from the hearing that the lawyers run everything. there has to be certain toisions made right away change some of these policies. whether certain people have to be fired or they don't get bonuses, a lot of great people out there. most of them are military. they are probably frustrated. what i am getting up to his i think right now, we are going to talk about this in the committee. i was going to ask you, the chain of command and who is going to do this, i come away from the hearing and get the bea is in one in the a position to do anything. there is no trust or confidence. they want action. they want it now.

didain people, if i something wrong and people died, i would be died, and probably court-martialed. we owe that to the veterans and the military. all the people working so hard. we had to straighten out the problem right now. we can have subpoenas and everything else. i haven't heard that. i would like to see the president to go down to the va hospital and meet with the veterans. if it were possible to go down there right now and talk to them, investigate and take statements of everybody. we have all done it before. i am very frustrated.

i am frustrated that i am a position to make a difference, and i cannot do anything. itan't get across to you -- is a feeling of frustration. if i was smarter than most people here, i would say, you have to do this and this. right now, you need to discipline -- the discipline to go down there. certain people have to be relieved or fired. the policies have got to be changed overnight. excuses for the fact that the lawyers are handling it. but thatask questions, is something that has been bugging me. thank you. i yield back. colonel, thank you for your service to this country. we are honored to have you.

>> there are 700 attorneys at the department of veterans affairs. mrs. walorski, you are recognized. >> i sit here and i don't think there is a word in the english language that can describe how frustrated i am. i have sat here for 18 months and listened to the same kind of answers i have heard tonight. and we have sat over 2:15 and 22 people questioned the three of you. and i know now 2 1/2 hours later what you don't know. you actually traveled to arizona and didn't meet with anybody that had anything to do with weekend. we understand that plan, you didn't meet with anybody who was directly from all the testimony in these 20 people right here. if i was in your shoes. i would describe this as a five-alarm fire and rushing to the scene and bringing mutual

aid because the house is on fire and nobody's going to survive and i listen to the three of you and the question i leave with tonight, what do you know? what we know is that people died . i guess the question i want to ask is on behalf of the families that probably aren't in this room tonight, but we have heard from some of them and i heard from barry that had a death warrant that was no fault of his wn because he couldn't get a colonoscopy. we are asking all the same questions. if you have the opportunity, i'm going to give you the opportunity and this is carried live, what do you want to say, mr. lynch, to the families of these people that lost veterans, what do you want to say on behalf of the v.a. >> congresswoman, on behalf of

myself, first of all, i take personally any time that a veteran has been harmed because of something the v.a. has done wrong. >> does the buck stop with you on these deaths? do you accept the bulk of the responsibility for what's happened? are you responsible? >> congresswoman -- >> yes or no, does the buck stop with you? >> i don't know whether it does but i consider myself. >> does the buck with you, do you feel responsible can you look in the eyes of these families and say i accept this responsibility? >> i am the daughter of an atomic veteran. >> yes or no, are you responsible >> i'm responsible that ensuring and i'm sorry, mr. cook, that we didn't make this clear to you, our focus remains on caring for our veterans. >> this is my time that i have, limited time, i have sat here 18

months as a freshman and ever question i posed to you or anybody else, i'm still waiting on questions about the. mr. huff. does the buck start with you? yes or no. >> i'm a officer who is a civil veer vant and veteran. i'm not a supervisor but a stf-level federal employee. >> does the responsibility with secretary shinseki, do you believe in his leadership ability? where in the world is the urgency? i can sense the urgency of this committee because our nation has totally lost its trust and it's our responsibility to sit here and maintain oversight and we can't find out where the buck

starts. i asked for secretary shinseki's resignation when the america legion report came out. you heard several different people ask questions, do you accept responsibility? are you ready to accept this responsibility and look in the eyes of the american people and our veterans and say what? what do you say tonight? i know what you don't know. what do you know that you can tell the american people that they can learn in 2.5 hours. >> our focus remains on carring r caring for this. >> can i finish? >> no. i have five minutes. how could dr. lynch go to arizona and not talk to anybody involved, that had anything directly to do with this and 40 unexplained deaths and i.g. reports that have facts and you all have turned the facts to a general counsel and we know less

tonight -- i have more questions tonight than i have had when i walked in here because we learned what you don't know. my question is, what do you know? >> we know the facts of that report are utterly republic rens i believe, that is what we know. and we owe a debt to all of our veterans who served. every one of them. >> are you responsible? do you accept that responsibility? what are you going to do? are you going to stay in your position? >> i'm going to stay in my position and fight for veterans and fight for this congress that i love, working together and really meaning it. working together for the good of our veterans. that's what the public expects and that what i'm committed to do. >> and 40 veterans died. this is what the public got. >> and we understand that and we review that report as the facts

of that report as totally republic rens i believe. >> the gentlelady's time has expired. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> making changes to the veterans' health care system and includes $10 billion allowing veterans to get treatment outside the v.a. if they live 40 miles away or facing long wait times. hiring more v.a. doctors and nurses and 27 new leases for v.a. facilities. president obama signed the veterans' health kay bill into law on august 7. this series of hearings included testimony from families with service members who have committed suicide. they told congress about problems, conflicts with v.a. staff. prescription drug problems and other issues.

this portion of that hearing is about 35 minutes. >> 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 or -- 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. here 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 he 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 .a. rated clay's pts 100%. he exclusively used the v.a. for his medical care after eparation. 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. e 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 enter. 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 ecords 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 nd 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 ife. 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 eployment. 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 n. 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. he could not remember the questions asked by the therapist during the interview. he had extensive back pain. he could not sleep. he was a risk for suicide. nonetheless, he was immediately discharged and told to follow up. how in the world you could ask someone who cannot remember the questions asked to follow up with the v.a. is beyond me. rian deteriorated quickly from december 2010 to may 27, 2011, when he took his life. he could not stand how he would be angry and depressed, anxious, but he did not know how to cope. it took a toll on his

relationships. if the dod and v.a. assessed brian for suicide risk, it was their duty to treat him, but he received nothing. he applied for disability, but as unable to wait. brian has lost three others to suicide since the 2008 tour. suicide has surpassed combat fatalities for the first time in history. it is a very slippery slope from ptsd and pti to death, something our v.a. should realize. our soldiers never hesitated in that mission to protect our country. now it is time for the v.a. to prove their commitment our oldiers. i think he felt if i could survive two tours i could

urvive anything. i think a life-threatening situation like this should be shared with the family, so we are able to help. the v.a. needs to work with the service organizations, including the families, and the plan for are. i am requesting, i am pleased for this committee to pass act 2182, the save act. this has been a most devastating war in history in terms of suicide. our whole nation continues to suffer, and every day we ontinue to lose 22 brians. i promise that i would stop this injustice. these are quality young men who potentially have so much to offer society. please pass the act and support in the legislation that gives soldiers the timely and loving care that they deserve. thank you.

>> thank you, mrs. portwine. sergeant, you're recognized for your statement. >> chairman, ranking member, members of the committee, i appreciate the opportunity to discuss the mental health care, and i want to acknowledge the loss and the courage of these family members ensuring that they were not in vain. nd i struggle with the similar stories. as an infantryman who lost so many in the iraq war and injured and struggled with the thoughts of suicide, from overwhelming chronic pain and injuries, i just thank you all for being ere. my experience with the v.a. health care system began in 2008. sorry.

>> that is ok. you have plenty of time. >> after i was medically retired from the army due to severe injuries from a mortar blast in raq -- excuse me. i have been a patient, but i am also an advocate for other warriors who are struggling with employment-related traumas. for time of about 12 months, i did receive excellent mental health care out of v.a. facilities. you provided easy one-stop access to deployment health models staffed by medical, mental health, pharmacy, and social work providers. unfortunately, hospital administrators decided that this well-staffed interdisciplinary care was unsatisfactory.

i had to find myself around a sprawling facility to access the care i needed. for many, navigating around is anxiety producing itself. some drop out of care altogether. there's lessons to be learned here. veterans with mental health issues will not discuss painful and private issues with a clinician they have never met. they're more likely to describe surface-level issues, like difficulties sleeping. it takes time to build the trust to talk about the deeper issues. but every clinician is skilled at winning the trust or insightful enough to sense when there are deeper problems. working with the team increases the hood of someone who see something that others may have missed. this is applications for suicide prevention as well. veterans will rarely say they are contemplating suicide.

there are not necessarily obvious signs that a veteran is suicide risk. one thing is for sure, we will not prevent suicides by doctors from mechanically going down a mandatory list asking questions like, have you contemplated suicidal thoughts lately or harming others? sometimes there is red flags and an astute clinician can spot them, like a breakup of a relationship. n the treatment system where i get sent, building 61, to see a psychiatrist to see about sleep problems, no one was getting the full pitcher. it is likely no one is going to see if my life is spinning out of control. as an integrated health care system, the v.a. can provide the kind of care that i once received from a health team.

there the team member shares observations and could see problems before they became explosive. i think the most important step is the v.a. can take to prevent suicide is to improve its mental health care delivery. access is an issue, but we have to ask ourselves, access to what? access to mental health care is not enough unless that care is effective. providers who work with combat veterans need to understand the warrior mentality and they may have to work to win trust. if a clinician lacks that awareness or has too many patients give it each enough time, veterans will get frustrated and drop out. veterans who are not ready for intense exposure based there be will drop out of these multi-week treatment rograms. bottom line is that the care must be veteran centered.

that has to mean recognizing each veteran's unique situation and preferences in building a flexible system to meet the needs and preferences and not the other way around. the warriors do not come in for anxiety because when the textbooks say they should. most do not come into treatment until they have reached a crisis oint in their lives. a veteran who finally asks for help for combat-incurred total health conditions needs to get into treatment immediately. we will not solve that problem by establishing an arbitrary requirement like a 14-day ule. it is not helping warrior to get assessed within 14 days, but not actually begin treatment within three months. this is the way that the v.a. is currently lamenting such policies. they have added additional steps to get into treatment, so that you can see someone within 14 days.

i have added a second intake process, so now you can take to finally get the treatment you eed. i know that some believe the way to solve the veteran problem is to expand access to non-v.a. care. i doubt that is any silver bullet solution. the big concerns with that is 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. v.a. could benefit from a greater use of purchased care, where and when it is available from and when it can be effective. it would not help veterans just to be seen by providers who are not equipped to provide effective care. whether because of lack of training in treating combat-related ptsd or cultural confidence or other reasons. it is not a matter of access, but access to what? it has to be effective treatment. i believe there are facilities

that are providing veterans with timely access to effective patient-centered care, but it is not systemwide. from my perspective the starting point for leadership at all levels is to adopt the principle of providing timely, effective mental health care for those with service-incurred conditions must be a top priority. the v.a. achieved that with veterans to combat homelessness recently. that tells me that the v.a. can have an impact it when artificial performance requirements to not create distortions and when clinicians have managed to provide the care, improving mental health care requires a comprehensive approach. one part is should need to institute the team-based model i described earlier. the core of any approach has to sit on the veteran and that patient needs and preferences.

we need a system that serves the veteran, not one that requires the veteran to accommodate the system. hope that this hearing brings us a step closer to that kind of v.a. care system. i thank you for your time and will be happy to ask questions that you may have. > thank you, sergeant. sergeant, if i could go back to you since you were the most recent person to testify, you alked about this interdisciplinary care team that you had for 12 months, and then after that, you added to the fact that the hospital director or somebody said that it would cost too much to do it that way. i think we would all benefit from it elaborating a little bit about how that occurred and what did you transfer to, what type of care. > yes.

in 2008 until 2009, the v.a. rolled out i believe four different health care models nationwide. the deployment health care model i speak of was one that was rolled out in washington state for the american lake v.a. medical center, and it was put together by dr. steve hunt with the v.a. his model provided one wing of a hospital floor in which an interdisciplinary care team for deployment for post-9/11 veterans exclusively. they had a pharmacist, psychiatrist, and others on one team, and one day they would discuss the caseload of that eam. the wait times were short. the quality of care was up. the management of her medications were the best and we had seen within the v.a. 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 v.a. is that that was a temporarily funded program and it was too costly to provide this level of care to exclusively post-9/11 v.a. war veterans within the v.a. 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 the population was not practical. >> mr. and mrs. somers, i would like for you to elaborate if you would just a little bit on the fact that you talked about daniel having innumerable problems with v.a. staff being uncaring and adversarial, saying no one at the facility advocated for him. could you give us any specific examples, or generic xamples?

>> absolutely. probably the most -- if i do not make it through this, howard will finish -- the most egregious event was when daniel presented to their e.r. -- >> it took daniel a lot to go to the v.a. facilities, and some of the things that have been mentioned here were part and parcel of the fact. 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 was not the one speeding. if he was going by on the highway at the time, it was difficult for him to drive down to the v.a. it is busy. he presented there in risis. he presented there to one of the departments, to the mental health department. he said he needs to be admitted to the hospital.

this is something that we have been told by his wife, who has a degree in nursing, and his mother-in-law, who was 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 come up with fact was he went into the corner, he lay down on the floor, he was rying. there is 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 f the phoenix v.a. another issue that we need to discuss at some point.

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 ot only daniel has encountered to the v.a. system. we have met other veterans, specifically in oklahoma city, who had very, very similar circumstances at different v.a.'s. >> you know if he ever spoke to any v.a. official about how he was treated? > we do not. the other problem is that these visits are never -- the appointment system is so antiquated that things are not even documented. there's no way to go back into the system and to document the

contact in the system. so as far as we are aware, daniel did not speak to anybody at the v.a. about this. it is just something he would not do. he just would not do. it was a feeling of i tried -- and this is just another example of what the pressures that are brought to bear. he brought not only the vha, but the vba issues into account, and these are things that altogether just became overwhelming. >> my belief is he still had the military mentality, you know, this is what somebody in authority told you, i have to accept it, i cannot go above and beyond, i just need to accept what they are telling me. >> thank you.

michael lynch talks about the situation at the border and his documentary on illegal immigration. and christine gorm and on the publications report on the 40-year on cancer. "washington journal" is live every morning. and you can join the conversation on facebook and twitter. >> the national business group on health releases its annual survey on what large businesses are doing with the health care coverage. that's live at 10:00 a.m. eastern here on c-span. >> friday at 8:00 p.m. eastern, history tour looking at the civil war. "the ay at 6:30 p.m., communicators." sunday, political commentator, author and former presidential

candidate, pat buchanan. books on hillary clinton, barack obama and edward snowden. and sunday morning at 10:30. we tour casper, wyoming. the negro league's kansas city monarches. saturday on the civil war, the depiction of the war and movies. an interview with president herbert hoover and let us know about the programs you are watching. call us or email us at comments@ cspanch.org. >> c pan's coverage of veterans' health care continues. in july, they heard from a panel of whistleblowers and one official from phoenix, dr.

katherine mitchell who told her that the v. her that the v.a. put her on administrative leave. others testified about retaliation they experienced after trying to fix problems within the v.a. health system. >> i took this position and leaving my full-time position. i had very simply wanted to create the very best care possible with the resources i had and very soon i realized

that the things i had that the v.a. was putting out was not reflecting what i was seeing. i reviewed every veteran complaint and the majority of the complaints i had had to do with their inability to obtain care at a reasonable time. long wait times, having difficulty even contacting the clinic to schedule an appointment. i started out with the simple question how busy are we at the outpatient clinic. and the answer i got was not very good. i got the answer that i verified that the psychiatrists were only spending approximately 3.5 hours indirect patient care. i could not account for the rest of their time. i verified this. i put this data transparently as a prospective data where any

psychiatrist could challenge me and i did not get one valid question. so i knew the data was accurate and i discussed this with the chief of staff and i wanted to change this. there were two things i wanted change. one was that the veteran has easy access to timely access to care and second was no veteran would be turned away from the clinic. i had a very sad veteran complaint from the disabled veteran who requested his friend to drive because he does not drive. he drove approximately an hour and a half to come to the clinic. he wanted to see his provider earlier because he was not doing well and wanted his medications refilled. unfortunately that veteran had neither of these requests met and sent with another appoint 489 days later.

and before this meeting, that veteran has not come back to the clinic since last may. his description of that event includes how disappointed and how upset he's at at the v.a. for not providing him care. that was the context of how i started out. i discovered that the physician time was not being utilized properly. there was long wait times and one of the metrics that is very important is engagement in care or the dropout rate. what i found there was 7 -- 60% of the veterans were not coming their visits. four pieces of information that i needed to provide very good care. one was the wait time to care and second was utilization of expertise and what amount of time does a physician spend

indirect patient care and how many veterans actually follow up with care are dropping out of care and fourth metric that was not existent is the veteran's satisfaction with care. chairman miller talked about surveys not being complete and may not be reflective in all places. i wanted the survey to be a complete set. i talked to son donors and they pledged $60,000 over two years and veteran satisfaction survey and i had the contract with educational contract for ipad and logged in people to valid questioners and my intent is while the veteran is waiting in the waiting area to be seen were able to complete the questionnaire using touch screens, which would be automatically compiled and i would have information on whether a particular clinic or a

particular health care professional i need to focus on. this last bit was very concerning to the staff. and shortly after i made these disclosures, that i wanted root cause analysis on and inpatient suicide attempt while the joint commission was reviewing the hospital which was completely covered up. and did not go along with that. so very shortly i was put on detail and i was told there would be an administrative investigation and i was put to doing pension and compensation evaluations. i took this job -- it was dealing with veterans. i filed the complaint and while they were processing my complaint, i took this very seriously to evaluate the veterans about they had mental disorders related to their service. and what i found again here is in many instances, the veteran

was not even heard properly. i had doubts whether the prior evaluation report was the same veteran or not. and this was serious and i started to look at their i.d.'s again to make sure this was not some other person and the problem was that the veteran did not have enough time to explain their situation. it was a hurried conveyor-like system and i was told i was spending too much time with the veteran and hurry up and see the veteran and check a few boxes in my evaluation because it is for someone later to rate the disability. hat is not how i saw my job. three competencies to be accomplished in these he valuation because these are disability evaluation. you have to make sure the veteran is heard properly and i reviewed the prior records properly to make sure i capture a full history and the third is

to make sure my report reflects some of the inconsistencies in the record and i speak to it so the very next person, if on it becomes an appeal issue can determine how i made my decision. there were few egregious errors that were there. and that really bothered me and as i was in detail under primary care. i go to the chief of primary care recently about these examples about why this was really unfair to the veteran and how it affected the life of the veteran and just two weeks ago on the 26th of june, i'm detailed now to another place. so from my perspective, i have always put the veterans' interests first. and i have disclosed the wrong doings that i found promptly to

the chief of staff and to the chief of mental health with the expectation that they would address it. and what i found is that nothing has really changed. as late of june, just two weeks ago, the response to my finding about these evaluations that were not done properly was to just detail me elsewhere. this seems to be an ongoing practice. when it's detailed, i don't have any responsibility of the chief of sigh ki try. that is the position i accepted. two people i worked hard on recruiting, one trained at hopkins and one at harvard. they deliped to join the v.a. after disclosed that i'm no longer the chief. i been removed. there is a sense of mission that's lacking and i'm really hoping that this committee with its powers will take aggressive

actions to really make sure that this retaliation stops. and that the people responsible are held accountable because really, the data being so cooked up and so unbelievable, it's extremely important that while we work on data integrity to reflect the reality and people step forward and speak the truth and talk about what is happening at the patient interaction level and i think that i'm really hoping that this committee would do that. and i'm really honored that i have this opportunity to be able to answer questions and to be here. >> thank you, dr. matthews, we will ask questions and get into specifics later on. i would like to recognize dr. head for five minutes. >> thank you for inviting me to testify today.

i'm honored, congressman and i think it's very important topic, our veterans and we shouldn't lose focus of that. i work out of the west los angeles v.a. hospital and i can't think of a better job than serving our veterans. retaliation is alive and well across our country especially within the v.a. administration. my first encounter was a number of years ago. i was subpoenaed by the inspector general to investigate time card fraud involving two surgeons in my area. i was among close to 30 individuals who gave testimony. i gave honest and true testimony and during that testimony, i feared retaliation and i outlined how i felt they would retaliate against me. every aspect i outlined came true. the person who did the eposition was inspectors

solomon from the inspector general's office and she promised i would be protected. three months after they came out with the final results, one of the individuals paid back a year's salary to the government and resigned and another person was allowed to stay in the supervisory role. at the end of the year party because we are affiliated with a university that is nearby. at the party, this slide was shown. that is me, i'm much younger back then and i had hair. it says i'm flipping the bird. in front of close to 300 individuals, i was labeled a rat. i was labeled a rat that ratted out this person. the slide that followed this, i can't even show it.

i could discuss it under subpoena. that person right now is in a supervisory role at the v.a. no apology. nothing. i somehow survived that. retaliation has been relentless. the problem my retall yators have i think the v.a. and the veterans deserve far better. no matter what happens to me, the focus should be on the veterans in this country. i somehow survived that process and again i was retaliated again later when i gave my opinion on the investigation of a physician who was wrongly terminated. i was asked to change my testimony. i stopped getting paid for two weeks and because of another

factor, my house went into foreclosure. i didn't lose my house. the e harm it causes family members of federal workers who are being retaliated against cannot be measured. i have two young girls who i would be proud if they decided to join the armed forces or even work for the v.a. i think the v.a. has the potential to be one of the finest institutions in the world. we have seen certain aspects of the pharmacy cannot be matched. one of the best in the world. very efficient. there are many different things that are efficient within our system. but what we should ask ourselves, when came up with the idea of seeing a veteran 14 days, that sounded like a good idea, veterans should be seen promptly. we should be questioning is if we made a mistake and somehow

overloaded the system, how come people's names disappeared off lists? how come hundreds of thousands of veterans electronicically no longer existed? that should be the question. retaliation exists because there is a culture. this culture of retaliation that's really the cancer to the veterans administration. st physicians and nurses and people who work there are disgusted. morale is extremely low. people ask me, did that happen here? people care. when i heard some of the testimony i heard from the oenix v.a., it was gut-wrenching, i couldn't sleep. and i believe there are a lot of people within the v.a. system that feel the same way. exists cancer that

perpetrates this idea that we should be silent and not stand up and do the right thing and be honest. everyone makes mistakes but when you make a mistake and try to con seal it. who are these individuals who would alter data and hide the truth and prevent patient care? i have been receiving text messages from veterans saying, be careful dr. head, we don't want to lose you as a surgeon. if you get labeled ace a whistleblower, oh my god, they'll take you out. i'm not afraid to be taken out. i do hope if i'm taken out, someone will be taking care of my family. people need to speak up. and we shouldn't be isolated. and the level of defamation.

every time there is a whistleblower, there is an email, this person is not getting a bonus and this person didn't get the raise they wanted so they could be suspect or this person didn't do this. they defame and isolate and they will transfer you to another position. they'll say you're crazy and not being truthful. i hope, i apologize for running over but i would hope that -- i've given you close to 176 pages, 276 pages, i think, of evidence and a number of other statements from other individuals that will be help nfl trying to improve the system. i would hope, and especially the press, i challenge you also torblings be a real reporter and actually report the truth, balls i would -- not to insult the

reporters, but also the congressmen and congresswomen, this is important that we try to focus on the -- on what's really important here, and that's veterans of the country. thank you. >> thank you very much for your courage, dr. head. dr. mitchell you're recognized. >> good evening. 'm deeply honored by the committee's invitation to testify tonight. i have been retaliated against for reporting concerns. my written testimony outlines that and section 4 and 5 of my written testimony shows tactics the v.a. uses to suppress whistle blowing and to retaliate against anyone who speaks up within its ranks even without whistle blowing. the v.a. has routinely hue

mailuated anyone who brings forth any information that's contrary to the image they want to project. i prouth up life threatening issues in the v. ample system. approximately 10 days after the v.a. received my reporting i was placed on administrative live because iinvestigated had provided limited information out patients to back up my claims about suicide rates. i was told i violated a policy but my human rights director still has not been able to tell e what law i violated. there was insufficient ancillary staffing to wash beds or answer

telephones, deliver patients, trapt labs. as a result doctors and nurses were routinely pull aid way from direct patient care to perform these extra duties. when the number of patient visits increased greatly to our e.r. the deficiencies became obvious. the actual number of mistakes as well as near misses in our nursing triage skyrocketed. simp toms like stroke, heart attack, pneumonia and other serious medical issues were routinely mised by inexperienced treeage nours by seasoned triage nurses overwhelmed by the floofed patients hitting the e.r. i started reporting the cases of actual mistirkse near misses to the chain of command. in the process of reporting hundreds of these, approximately 20% of e.r. nurses would retaliate against me. they would stop doing my orders for patients they would refuse to answer question, they would not give me verbal reports on patients placed in rooms. administration was made awear of

this yet declined to intervene and stop this behavior that was obviously interfering with my care of patients they ignored my repeated requests for additional resources and would never institute the comprehensive standardized nurse triage trains we needed to prevent future mistakes in care being made in our e.r. this is not to say they were idle. they did ban me from report anything cases to risk management department, my proficiencies dropped, i was forced to work two years unlimited shifts because h.r. was too slow at credentials emergency room physicians to fill in. eventually things reached critical mas when the new oncoming director arrived i told her the e.r. was too dangerous on an hour-to-hour basis to remain open. unfortunately, the administration's response was to haul me into a meet wng about a

week and a half and tell me the only problem in the e.r. was my lack of communication skills. the nursing backlash that was reported would never be investigated. eventually i was involuntarily transferred based on critical need to an empty medical clinic. i assume the medical director of the clinic that only houses a social work program and that's where i remain today. i do very useful work but it's certainly not what i intended when i started reporting patient safety and concerns. the veterans needing care that present to the e.r. have survived campaigns like d-day, iwo jima, teltoives -- offensive, kosovo, cree arab ark the battle of fa hugea and dismal years in hellmund process. it is a bitter irony to me that i as a physician couldn't guarantee their health and safety in a v.a. facility in

thed my of cosmopolitan phoenix. he v.a. needs to embrace the values they state on their website. it's important that employees of any pay grade who truly care about veterans and their welfare , that they be protected. they were often placed in the unthinkable position of being forced to follow orders or else permanently lose their livelihoods and ability to help any veteran in the future. most importantly, the ability to positively influence the patient care and safety of any veteran should not be considered a democratic or republican stance, a pro-union or anti-union choice or eavep uniquely american problem. the ability to freely advocate for the health and safety of any patient is a human issue and it has ethical implications for all of us. thank you for your time. >> thank you very much, doctor.

mr. davis yourself recognized for five -- mr. davis, you're recognized for five minutes. >> thank you, mr. chairman. i'd like to thank the committee for providing a platform so that the choices of v.a. whistleblowers can be heard. i urge the committee to take prompt action as time is running out. every day, a window of opportunity closes on a veteran to receive quality health care tpwhifes inaction of senior v.a. officials. some veterans, even -- some vet raps even face the burden of being killed for care their service has owned -- has earned them. as noted in the office of special counsel report, v.a. leadership has repeatedly failed to respond to the concerns raised by whistleblowers about patient care at v.a. despite the best efforts of truly committed employees -- employees at the a.t.c. and the veteran health administration who have risked their careers to stand up for veterans, management at all levels have ignored them or retaliated

against them for simply exposing the truth. some of the critical issues reported to senior v.a. officials by whistleblowers at the a.t.c. include mismanaging critical veteran health programs and wasting millions of dollars on an affordable care act direct mail campaign. the possible purging and deletion of over 10,000 veteran health records at the health eligibility center. a backlog of over 600,000 pending health applications. nearly 40,000 unprosessed applications discovered in january of 2013. these were primarily applications from returning service members from iraq and afghanistan. the harassment i have experianed include t.c. -- h.e.c. my complaint to deputy chief of

staff was leaked to my manager, sherry williams who stated in writing that she was contacting me on behalf of acting secretary gibson and mr. rob nabes. neither mr. gibson nor mr. nabes have responded to this fact. my employment records were illegally altered by work force management director joyce deeters. i was illegally placed on permanent work detail. i was placed on involuntary administrative leave, curiously at the same time the o.i.g. investigation was taking place in atlanta by acting h.e.c. director greg becker. unfortunately, my experience is not unique at v.a. daren and eileen owens, who work at the atlanta v.a. medical center have experienced the same retaliation for reporting medical errors and patient

neglect, as well as misconduct by senior v.a. police officials. our local 518 union president, daphne ivory is routinely harassed as a direct consequence of assisting me and other disabled federal employees with retaliatory action by members of anagement. and over 50%. owen of the staff at the h.e.c. are disabled veterans. scralgations were uncovered that applications for v.a. benefits were being shredded under were ly hughes and her -- being shredded.

this was being investigated. ms. hughes' investigation was abruptly closed by the h.e.c. director's ausms she was also subjected to harassment and -- director's office. she was also subjected to harassment and discrim face because she dared to advocate for veterans. the whistleblower statements i provided to the committee were provided to the o.i.g. and are more relevant to the committee than many may realize. i urge additional review of the statements. in addition to providing specific examples of whistleblower harassment to the committee, i hope my testimony provides some insight into three key issues in v. -- three issues v.a. management fails to address. reckless waste of federal funds and causing greater backlog of enrollment applications for the sole purpose of achieving performance goals. why there is resistance to implementing proper and effective processing and reporting systems and the source of the resistance as addressed

previously by dr. draper during her testimony and the need to remove ineffective managers and the critical need for the v.a. management accountability act to be fully implemented. thank you for this opportunity. i look forward to your questions. >> thank you very much, mr. davis. if you would, explain a little bit further the information you who ded to rock neighbors, was deta -- detailed from the white house over to v.a. that led to adverse employment actions being taken against you. >> i contact police department neighbors about four weeks ago. at the point of contact for the white house, i wanted him to be aware of -- aware of what was going on in our office. a lot of attention has been placed on scheduling but it's important to understand, you're not enrolled, you're not going to be placed on a schedule. i wanted him to know about shortcomings with the enrollment system, a system that many of

you have talked about. we have spent millions of dollars on. and yet we are still back at square one with these v.a. system systems. i also reached out to him about a medicare part d marketing initiative by v.a. to en-- to encourage senior citizen whors veterans to drop their subsequent -- citizens who are veterans to drop their subsequent insurance and enroll in v.a. that was problematic because as you know if you enroll in v.a., you can only use the pharmacy at v.a. you have to use your v.a. doctor. many of our most vulnerable veterans were not aware of that and could be confused and cancel supplemental medicare insurance and end up being stuck in the doughnut hole in the backlog. i also contacted mr. neighbors about the continued mismanagement of v.a. health problems managed by the h.e.c. and the chief business office under the direction of mr. phillip mccroskey and lynn

harvin. i did not receive a response. i suns quently contacted the office of deputy chief of staff anita breckenridge. i also did not receive a response. until after receiving notification from ms. sherry williams that she was contacting me on behalf of the acting secretary and mr. neighbors. this surprised me that ms. williams would do this because she's a former o.i.g. official. to this date new york action has been taken to reprimand ms. williams for her behavior. this goes to the very heart of the question whether or not v.a. should be allowed to police itself and whether or not an outside agency should be brought in to fully conduct an investigation to the actions taken at v.a. the last thing i will say that i did receive an email from the white house office of white house counsel directing me to contact the office of special counsel. that was the official position from the white house, there would have been no need for anyone to contact ms. williams

about my complaint. >> you also in your testimony, you describe the possible purging of over 10,000 veteran health records at the health eligible center, that there's a backlog of 600,000 pending benefit applications, and 40,000 unprosessed applications discovered that span three years? >> absolutely. currently, we have over 600,000 pending applications. these are applications that have been applied for by a veteran, turned in to v.a. and for whatever reason we could not take that application to a final determination. this backlog has reached, again, the numb of 600,000. what we should have done, instead of hiring 40 people to address the affordable care act in a belief that we're going to have this surge of people because of a buddy letter marketing campaign, where the

veteran was encouraged to pass on information about enrolling into v.a. health care to a fellow veteran. unfortunately, the information for the veteran to take the action was on the second page of the letter. therefore we ended up getting 80,000 dupely cat applications of which only about 1,650 were actually applications we could do something with. in terms of the 40,000, this was discovered in january of 2013. this is important to the committee because i want to share something that was in a report that i forwarded to the committee from 2013. increasing online application submissions vs. paper, improving turnaround times for eligible decisions has a positive direct impact on providing timely access to health care. data reveals applications submitting in person are processed with higher urgency while online applications ling

for the a less visible queue. to answer your question, how could this happen? because these applications ling for the a less visible queue. even though the i.t. department paid licensing fees of over $40,000 for us to have a new system for managing the queue, a system referred to as bizflow, that was only put into place for implementation after the 40,000 applications that were lingering in the queue, in some cases for nearly three year was discovered. that is something that is shameful. >> thank you, mr. davis. members i was one more question i'd like to ask dr. head. you talked about the retaliation against you and i just -- i want to specifically talk about a doctor wang. o i read that the o.i.g. concluded that dr. wang had in fact committed time card fraud,

is that correct? >> yes. >> they had recommended termination of her and other individuals through chief of staff. they had found significant fraud. time card fraud. >> so she's been terminated. >> she has not been terminated. she's maintained in a supervisory role. >> can you explain a little bit about how that has occurred. >> i have no idea. >> but they didn't flole the inspector general's recommendations? >> no, he's been left -- she's been left in her position. she was my supervisor. i filed a complaint, numerous complaints, they moved me from

that office under her chain of command to the chief of staff, which in my opinion was an excellent opportunity. i rose in the ranks, became head of legal and quality assurance, and i've become, i think, one -- an expert in system analysis and quality assurance, which i think will help the veteran even more, ironically, now, from being retaliated against. that's just how i was brought up. find a way. >> thank you, doctor. mr. michaud. >> thank you, mr. chairman. as you all know, whistleblowers are, you often risk your career in order to bring problems to light. what would you recommend that we do as far as to change the rules or laws, government-wide, to actually help protect the

whistleblowers and i'll start with dr. matthews and work down. if there's anything we should do to strengthen whistleblower protection act. >> that's an excellent question. and one of the things that i experiences -- experienced was that i was immediately removed from my position. so under the guise of an administrative investigation with the specific directive to not contact any other psychiatrists that i was managing and to cut -- and they cut off my access to databases, some of which i set up myself to get accurate data. one of the things could be that if there is an invest, that, you know, the person continues rather than be detailed and if the person has to be detailed perhaps there should be a review by peers to see whether, you know, that's even warranted or not. there seems to be no time limit to these kinds of detail.

this is the second time i've been detailed just -- been detailed. just recently i've been detailed again. so as dr. mitchell mentioned, these are not the jobs that we wanted to do. not that we would not do it, we would do it to the best of our abilities. so having that protection, having the o.s.c. have some sort of time limit to review these complaints would be very beneficial. having a process for, you know, like you mentioned, if a supervisor is found to have retaliated, to have some very tangible consequences to that person would be very, very important. right now, i think, at least in the st. louis v.a., they do not think that is -- that this is a serious issue. two weeks ago, i was called into a meeting with the chief of staff where the chief of -- the

chief of outpatient psychiatry, the person i worked with very closely to implement my changes was called into the meeting. in that meeting, i was specifically told that the chain of command must be respected at all times. that if i had any issue or if dr. ephes had an issue, we should report to our supervisor and then move to the next level and the next level -- >> could you finish up. i'm running out of time. >> so i think your -- your recommendation for having very quick and serious consequences to retaliation would be very important. >> ok, thank you. >> i think there needs to be greater repercussions for retaliation. we have laws referred to as shield laws and sword laws. a sword law means that if i retaliate against someone, there's a federal law that says

retaliation is against the law. and they can warn the person, don't retaliate but they can continue to retaliate against the person which ultimately will have the direct or indirect effect on the care of the veteran, endangering the veteran only because the caregiver or doctor or nurse is being retaliated against. shield law means that not only do you have a sword law, repercussions for retaliation but off shield law where you can immediately take action and it could be immediate repercussions for any type of retaliation against a whistle blower. in other words, if you tell a chief of staff, look, this person gets retalluated against, pushed out of a job or anything, we're going to hold you accountable for this until we figure out what's going on here. we have that, we have a shield law that was enacted in the state of california but that's something that should be considered by congress. ultimately you will address it, one way or another. because retaliation in the

health place is different than a factory. you retaliate against a physician or surgeon or nurse practitioner or nurse, you're going to have direct repercussions, one way or another, to the health and well being of a veteran. >> dr. mitchell. >> i'm not sure all of it needs to be legislated. but certainly the o.i.g. needs to put in writing that providing limited patient information to support allegations in a complaint is not a violation of hipaa. it isn't. but certainly there are employees charged all over the nation for it. in addition, sham peer reviews need to be part of prohibited personnel actions. they drum up a reason to examine the physician's cases, they have a predetermination that this physician is not properly functioning even though there's no problem with this level of functions and they can permanently sabotage a physician's ability to get employees not only inside the v.a. but in the private sector.

whenever you're subjected to a peer ve rue -- review, you have to report being subject to peer review for the rest of your professional life, on every job application and every license renewal. they're done to sabotage the credibility of a physician. physicians truly face losing their livelihood, their ability to be employed again as a physician. you need whistleblowers that are physicians, people that are trained, to identify the high-risk problems. >> dr. davis. >> thank you. i don't know if a new law would really change anything, honestly, at v.a. if you don't have accountability. i think there's some structural changes that need to take place, one being a centralized human resource office that actually has operational authority. currently when i went through my situation of retaliation, i spoke with the representative from the v.a. h.r. office. they told me they're only a policy body.

that they could contact the h.r. office where i worked and maybe make some recommendations and see what they could negotiate. that's problematic. because in v.a., unlike a corporation or a normal health care system, every division or the hospital itself has its own h.r. department which becomes the secret police force for the managers who are -- who harass employees. and that's problematic. that's what needs to change. an operational change to a centralized human resource office would also help but also i think you need to start making bad managers pay their own legal fees. currently managers who engage in harassment have no fear because the bill is going to be passed on to the taxpayer and even if they lose the case or they're found guilty of wrongdoing, the bill goes to the taxpayer. currently we have managers in our office that have several different complaints for harassment. it's not a big deal to them. regional counsel will take care of it. the office of general counsel will take care of it. that's the issue that really

would change people's behavior, if you hit them in their pocket. >> congress passed a -- passed a new bill before the august recess, making changes to the health care system. it includes $10 billion for a new program to allow veterans to get treatment outside of the v.a. if they live 40 miles away from a facility or are facing long wait times. there's $5 billion for hire manager v.a. doctors and nurses. 27 leases for new facilities. and it makes it easier to fire senior v.a. executives. president obama signed the veterans' health care bill into law on august 7. tonight's special presentation on veterans' health care hearings continues with testimony from veterans' service organizations. they discuss long-standing problems at the veterans' health care system, offering ideas for reducing wait times. this event took place a few days before house and senate negotiators announced they'd come to an agreement on a rhett

van -- veterans' health care bill. it's about 34 minutes. >> i wonder how many people in this room would bet their last $40 on a listening shot chance to make some sense of the v.a.? mr. vice chairman, ranking member michaud on behalf of the national commander and the 2.4 million member os they have american legion, thank you for your diligence and oversight in this crisis. the american legion has spent the last six weeks in five cities heading up crisis centers. -- crepters. i have been at each of those crisis centers. i can tell you firsthand that it's bad and i'm deeply saddened. we've listened to veterans, widows and children who one by one told store roifs broken promises, pain, mistreatment, delays, and yes, even death. many of them full of hurt, anger, confusion and uncertainty, just want to be heard. but they told story miss times

but their pleas have fall on o-- fallen on deaf ears. the american legion listened because what those veterans and family members have to say is important. we want to help. it's woven into the fabric of who we are as an organization. i'm going to tell you about a man in fort collins, colorado who spent his last $40 on a cab ride to get to the american leon crisis center because he literally had nothing left. i met a widow in phoenix, arizona, 70 years old, redeuced to sometimes sleeping in public bathrooms because the v.a. couldn't get her d.i.c. claim correct. she came to us in tears. we were able to put her in front of the v.a. and get those errors fixed on the spot in our crisis center. in el paso, texas, within the first three days, e74 veterans we recovered $462,000 on he spot -- on the spot for those veterans who were entitled to those moneys.

i read a letter from the office of special counsel about v.a. and the harmless errors that included a veteran waiting more than eight years for a psychiatric appointment. eight years. we have veterans taking their own lives, 22 we saw a veteran working on his claim. he left the crisis center and said that he could not believe that it took 90 minutes to fix what he had been working on for 14 years. that is what we have been doing. we have half a dozen scheduled and we are making extra effort.

if the employee wants to make an veteran, they the should not have the car vandalized. you need to promote the employee. i hope they are listening. how about you take the whistleblowers -- the people with the guts to say that that is not the right way to treat put them ind leadership positions. by can make a room for them removing the ones who covered up veterans waiting for care or overstated accuracy. i want to be clear that this is not about tearing down the pa. this is about saving the v.a.. we want a good v.a. for all veterans. abraham lincoln said to care for him -- i did not read the part that said that that is no one

void if it affects your bonus. they want doctors and medical professionals who understand that their service -- understand their service and their needs. when they say the heaven issue with access in leadership, we want to help restore it and make it what it should be. make it what veterans deserve. you about and colorado was left, the system. he was broke and fell broken. he spent his last $40 to get to a crisis center. all of his possessions were on his back. he arrived at the crisis center after it closed. he had to wait for it to open. we got him in front of the v.a. and the gentleman was put in a housing program to receive services he really needed. our chairman was so affected

that he gave that gentleman back his $40. the american legion believes that no veteran should have to pay for services that they have already paid for with their service. 2000 veteransver to the crisis center. appreciate the support and collaboration of the v.a. employees who came into the crisis centers to work with veterans. this is what happens when we all come together to do what we know is right. while we have been honored to help, the question remains why it had to come to this point in the first place. thank you for listening. >> thank you so much for that testimony. gallucci.ognize mr. >> thank you. on behalf of the veterans of foreign wars, i appreciate getting a chance to testify.

the allegations made against the v.a. and our members are outraged. we worry that a lost of trust could be more harmful than impropriety that we have seen. we have worked quickly to intervene on behalf of veterans. we have advertised our help line. veterans can turn for assistance. over the first two months of our outreach, we have received comments and most of them were negative. we worked with leadership to help resolve 200 critical issues. we sorted through and made specific recommendations to fit's the system. we must be careful not to dismantle or abdicate the v.a.. and many ofportant the services cannot be provided civilian-side. today, i will share concerns.

the major concern is timely access. those who have positive reviews shared concerns. outdated technology is central to the issue. we know that in and acquitted system allows the patient to slip through the cracks. the scheduling system is rife with fraud and manipulation. vfweteran who contacted the shared their problems transferring in. at first, they said it would take six months. after six months, it was another six months. six months later, he was informed that he was not enrolled because he had not been seen in over a year. we have to do better than this. congress provided the resources for this. the vfw acknowledges that we must leverage the authority.

we must have the ability to coordinate and deliver non-v.a. care. earlier this week, i spoke with a veteran caregiver. the veteran and his caregiver had to drive to receive medication. the vfw understand that the v.a. may be best suited to provide both. this was not communicated to the veteran. moreover, it was reported that the facility was not flexible. the veteran was clearly in pain. this is why outsourcing the care is not a catchall. must the v.a. outsource when they cannot deliver in a timely manner? absolutely.

ensure thatt referral teams and private networks make responsible and timely health care decisions. we all know accountability is an issue the v.a. and it goes beyond. is the and a low morale byproduct of culture. veterans tell the vfw that resources are stretched then and employees are afraid to speak up . they are penalized when they do. the v.a. has to focus on patients for changing the mindset. the vfw worries that the bureaucracy incentivizes poor performance over filling vacancies. if we cannot hire top talent, we fire thepect to employees. if v.a. cannot fire bad in ways, we cannot deliver timely and audie care.

-- quality care. thankfully, not everything is bad. nearly 40% of veterans praised the v.a.. out theveterans sought staff to talk about how the v.a. save their lives and others thered perspective on how system has improved. we believe it can work. members passed a stern passed the access and accountability act. that they donsist not going to the august research -- recess without passing this bill. legislature --y backed off, caring more about cost. we have an opportunity. we have an opportunity to show our veterans that our nation will live up to the promise.

we have to get this right. we have to restore trust and confidence in the system and we will do whatever it takes to make that happen. this concludes my testimony and i am happy to answer any questions you may have. >> we recognize mr. blake. >> thank you. i appreciate the opportunity to testify. it is frustrating to see the things that have been reported in the last several months. not a thing we have heard is surprising. highest are the percentage users in the population and i can promise you that our members have experienced long delays and appointment gimmicks that have been disclosed. i am a regular user of this and it has happened to me as a regular user.

30 years ago, they developed an to do annual visits to figure out what is going on. there was an issue of adequate staffing and resources devoted to that system. the sad reality is that the veterans who try to access the larger system to not have that luxury. the fact is that we are all responsible for these problems beenhere should have greater examinations of our concerns. examining the face of these problems as we saw them. in the meanwhile, the administration should have been honest about the resources and staffing needed to meet the demand on the system. not manipulating demand data and statistics to make ends the better than they were. finally, congress should have listened to what we said and what we have been saying for years.

the problems can be traced back to 2003. the v.a. denied enrollment to veterans because they do not have the capacity or resources. instead of taking meaningful resources, we allowed the v.a. to close their doors and it has gotten worse. here we are today. we are talking about this problem. thatess told many of us they were giving us a lot of resources. that is ridiculous. affirms that nobody is listening to what we have to say. we have been pointing to these problems in the budget and policy recommendations for 28 years. for four years, we have not had a chance to resent in front of the committee to outline concerns. for years. dispute the fact that

the v.a. has been given large sums of money. the v.a. has done a poor job managing and spending those resources. those are facts. that does not automatically mean that additional resources are not needed. we believe that they are. whether to address the recommendations made or whoever made the recommendations. or, addressing the legislation that the conference committee is wrangling over right now. the conversation is towards private health care. sending veterans out into the private marketplace may alleviate serious pressures on access right now. that is not the answer to the long-term problem. some members of congress have laughed it off as unacceptable

and not part of the bay. when will it be part of the debate? i am not committed ever will. this congress not really interested in fixing the v.a.? i hear all the discussions and i could not agree with any more. i used the v.a.. -- use the v.a. i prefer to go to my doctor. the discussion was about the possibility. ignores the fact that primary care is not a function when it comes to veterans. the representatives from the association sat right there and it made it that they would need time to understand the nature of the veteran and patient population before meeting demand. meanwhile, one of the other representatives said that they have a concern about the rates

of reimbursement. are we not concerned that the people we think we are going to turn to to address access problems, will readily admit that they do not accept veterans as patients question mark -- patients? the missionn is not of the ba. to be clear, we find it unacceptable that tens of thousands of veterans have waited for too long for care and, in many cases, are still waiting to be seen or never have. not a single veteran should have to wait for care when it is needed and it is incumbent upon the committee and all of us at the table to get this right. it will matter in the long run to millions of veterans. so, it is time for the rhetoric to stop. thank you. i will be happy to answer any questions you may have.

call on -- mr. >> thank you. the allegations of secret waiting list came to light and we were outraged. we wanted to wait for all the facts before reaching conclusions. there is no longer any doubt that the problems uncovered by this committee and validated by the oig are real and must be corrected. over one decade ago, the v.a. faced a similar crisis. forceidential task reported the following. i will quote from the book. july in 2003, at least 236,000 veterans were waiting six months or more for

appointments or follow-ups. indication of a lack of sufficient capacity and a lack of adequate resources to provide the root -- the required care. they concluded that there was a mismatch between demand and available funding. earlier, at a out hearing here in february 2004, the secretary sat at this table i asked forthat -- more than i received. one year later, after stating unequivocally that the budget for 2005 and 2006 were sufficient, the secretary admitted that the v.a. needed an for 2005l $975 million

and in additional 2000 -- 2 billion more for 2006. even when they accurately indicate their needs. the lower number is in the final budget and that is why our theners have testified that budgets were not adequate and, in the prior 10 years, the funding provided was more than $7.8 billion less than what was recommended. next year, we predict it will be less than needed. the congressional budget office and what they said in a recent support -- report. the cbo baseline prediction for 2016, the appropriations for health care are not projected to keep pace with growth in the patient population or in per

capita spending for health care. the waiting times will have to increase. in addition, over the 10 years that funding is appropriated for construction being less than what is needed, that is based on the internal analysis. in 1905, an, philosopher wrote that those who cannot remember the past are condemned to repeat it. will we learns, from the mistakes of the past? over aview, the debate mismatch in the v.a. health care and the resources provided is a settled issue. why would the house vote 426-0 in the senate vote 93-3 four

legislation to expand veteran access to health care that the cbo estimated could cost $30 billion for two years of 54 billiond up to annually after that if there was enough money. the secretary testified about the progress made over the past months, adding more clinic hours, filling physician vacancies, and using temporary staffing resources. secretary gibson also testified that, in order to continue the expanded access initiative for this year and the next three, the v.a. will need supplemental resources totaling $17.6 billion. unlike the proposals in the conference committee, the proposal would have an immediate -- andattitude who

continue the expanded access care. it will build up added capacity. we support the supplemental approach. we have said that the funding is inadequate to meet the needs of veterans. has proven us correct and it is up to congress and the administration to take the steps necessary to end the mismatch, provide the resources the v.a. needs, and work to strengthen the health care system. veterans receive high quality and convenient medical care. that concludes my testimony and i will be happy to have questions. >> you are recognized for five minutes. >> thank you. we are simple.

agenda consisted of only four things. number one is to fix the v.a.. is nothing that goes to counting -- a couple should the mission. second was true accountability. i i lie, i am toast and agree. you cannot run an outfit where people do not tell the truth. the third thing is that they have adequate resources. i have to agree with my colleagues here. we have been saying that they do not have adequate resources. and, lastly, on the agenda, addressing the toxic wounds. it has not been done for those exposed to ionizing radiation at the end of world war ii or the 1950's.

it was not true as leader -- vietnam veterans with agent orange and other toxic exposure. it is not true of gulf war veterans who were exposed to low levels of sarin gas. they have not addressed that. it is something that needs to change in the system. not an add-on. change the way in which the v.a. approaches this mission of veteran health care. it is not a general health care system that happens to be for vets. it has to be based on military exposures. whether that is all the things that were talked about earlier today, in terms of spinal cord injury and prosthetics. on and on and on. certainly, toxic exposure. that is why we have such high cancer rates. i noticed that somebody put it

on the table, a little card from an amended -- the american academy of nursing. the information in this, they are disseminated to us -- to their members. why? because the v.a. is not talking about the private sector medicine. illnesses and conditions stem from service. did you serve? what was your military occupation? it should. or 60-70% of veterans do not go anywhere near a v.a. hot it'll. -- hospital. the care is better when you get it.-- when you get we do not have adequate resources and we do not have the right kind of attitude. the mentality of telling the veterans what they need, no. how about asking what they need.

what do you think? how do we solve this. not just at a national level. most importantly, we believe, at the medical center. all too often, people have it backwards. i will use an example. thathite house mandated everybody does a summit on mental health and they did. they were supposed to meet with the community and set the agenda to work together and have a summit. that is not what happened. they had a predetermined message. we ought to what think. that is not a summit. that is not a partnership. when we change that at a local level, then, we will turn around. i will say that, under the acting secretary, there are wind

s of fresh thought coming through vermont. it has not gotten to the field. it is coming through. people are doing what they should have been doing all along. they asked our opinion. on the scheduling system. some would not ask our opinion and the acting secretary made them listen. we know what is like and it is our people who go through the nonsense. if you want to change the v.a., you change that part of it. forcing the v.a. to listen to the stakeholder and do patient-center care or veteran-centric care. you have to respect the veteran and the organizations. and, other stakeholders. touch on resources for a second.

we have said, from the outset, that the formula imposed in 2003 was no good. why? it is a civilian formula that is hmos.ed for ppos and that is not who uses the v.a.. the average number of presentations at that time was 5-7 presentations. veterans would come into v.a. hospitals and, today, among the youngest veterans, it is 14 presentations. figures 1-3 presentations. it does not take a rocket scientist -- even i can figure out -- that you will fall further and further behind if you use this to estimate. we need to jump and go to a realistic funding based on the needs of the people in the area. the last thing i want to comment saying, when are we

going to find the medical professionals. ,articularly within the af ge they have been working on a program called grow our own. -- why not send them to school? even if they are smart enough to go to medical school and they get back to years for every year they're in school. you are growing your own. you are committed to the system and it is from the heart outward. we will have enough people for the future. so, i commend that to the committee and i thank you for the opportunity to appear here today. thank you for your indulgence. i see that i am over. >> we will recognize mr. nicholson. veterans, weof the appreciate the opportunity to

share our view and recommendations. in recent months, the revelations of extensive patient wait times and lack of accountability was in the v.a. deaths -- was in the system. it has undermined the trust of the american public and had an impact in the system. while it is true that many members have expressed satisfaction with the health , manyhey have received have expressed frustration with the general access to and direct communication with the system. we are pleased to see recent the vha and we are eager to see more changes in the area of accountability. the adoption of best technologies and increase

capacity. congress has asked it -- acted swiftly. we are pleased to see this legislation move forward. we want to ensure that the secretary actually uses it when signed up. there is appropriate due process protections, of course, as a part of that. i would like to see the v.a. adopt more and newer user-friendly programs. organizationat the needs to begin a shift in the way that it looks at technology needs and how they go about of wiring or designing the systems -- of wiring or designing this cquiring or designing the systems. the portals are a joke to a lot of veterans.

increase ine an capacity to deliver services to veterans in the realm of malta health care -- mental health care. mental health professionals and services must be quickly remedied. pursued all along. the v.a.'s level of communication, cooperation, and collaboration with new generations of organization over the past five years has been severely lacking. prior to the outbreak of the v.a. scandal, the current scandal, the former secretary of veterans affairs had met with us on one occasion in 10 years. much like the attitude towards this committee, it is the -- if the prior regime in the v.a. did not like what they were hearing from nonprofit orders were they refuse to toe the party line, they were shut out entirely. interim eater ship has been much more communicative with i ava and other vs owes an

veteran advocate groups. they have done a phenomenal job in irking to repair the relationship between v.a. and the nation's largest organization of iraq and afghanistan veterans and their families. in addition, we want to take the opportunity to let the committee know that right now, the isional press club, iava releasing its member survey. arepolicy of priorities driven by the annual member survey and the data this year overwhelmingly revealed that suicide and mental health care access at the v.a. are the top challenges facing this generation of veterans. more information about the results of our member survey are g andable today at iava.or our staff and research team would be happy to brief you and your staff on her detailed finding in the near future. journale next "watching

-- "washington journal," eleanor smeal. and then filmmaker dennis michael lynch talks about the situation at the border and his documentary on illegal immigration. later, christine gorman on the publication's report, "march on malignancy: march on the 40 year war on cancer." "washington journal" is live at 7:00 a.m. eastern on c-span. the center for strategic and international studies hosted discussion wednesday on the trade relationships between south korea, japan, and the u.s.. you can see that live at 12:30 p.m. eastern here on c-span.

>> tonight, c-span is bringing you highlights from congressional hearings on problems with the veterans' health care system. the senate in late july unanimously concerned -- confirmed a to head the v.a.. he appeared before the senate veterans affairs committee be of -- before his confirmation. he graduated from west point and achieved the rank of captain. this portion of his confirmation hearing is about an hour. appreciate the confidence of president obama in this nomination and i am fully committed to for filling this me, for filling

president lincoln's promise to care for him who show up to battle and for his widows and orphans. and by serving and honoring the men and women who are america's veterans. organizationate an that lives by install use. over the next several weeks, i have had an opportunity to meet you individually, and i deeply commit -- appreciate the committee's concern and unwavering support for our veterans and for the mission of the dependent of veterans affairs. i've listened carefully to your concerns and advice and i benefited from your counsel. as explained by senators brown and portman, my life's purpose has been to improve the lives of others. my time at west point and as an airborne ranger captain in the 82nd airborne division instilled in me a lifelong sense of duty to country.

my values are steeped in my experience at west point and in the military. those values have allowed me to be an effective leader at the procter & gamble company and those values are what i will bring to the management of v.a. i am still guided by that west point prayer which encourages us to choose the harder right rather than the easier wrong. for me, taking care of veterans is very personal. i come from and care deeply for military families. my father served in the army air corps after world war ii. my wife's father was shot down over europe and survived harsh treatment as a pow. her uncle was exposed to agent orange in vietnam and still receives care from the v.a. and my nephew right now is in the air force flying missions over the middle east. my 33 years with proctor and gamble taught me the importance

of effective management, strong leadership and being responsive , to the needs of customers. when i joined the company, we recorded $10 billion in sales. today that businesses over eight times larger with $84 billion with almost double the number of employees and the brands are present in nearly every country of the world. i helped lead this transformation. i am a forward-looking leader who spent my business career expanding p&g to serve new and underserved customers. that is the experience needed to modernize the v.a. as i met with members of this committee in the past few weeks. you told me the depth of crisis of that the department of veterans affairs. while there is much that is going well, there have been systematic failures that suggests that some in the organization have lost track of the mission and core values. the department's problems with access, transparency, and accountability are all well

documented. there is a lot of work to do to transform the department. it will not be easy but it is essential and it can be achieved. the seriousness of this moment demands action. and if confirmed, i pledge to the committee and to our nation's veterans to take a series of immediate actions over the first 90 days to deliver the needed reforms our veterans deserve. i will put the veteran at the center of everything that we do consistent with our mission. if confirmed, on day one, i will lay out my leadership vision to all employees. my charge will be to provide veterans the care they have earned in the most effective way possible. i will ask v.a. employees to join me in reconfirming our commitment to v.a.'s mission and core values. i also plan to ask all employees to bring forward any information, any concerns, any problems that exist so that i,

as a leader, will know the whole picture of what is going wrong and what we can improve. if confirmed, it will be important to incentivize this process and reward those that constructively come forward to solve problems. i am looking forward to gaining valuable input and insights from its employees as well as veterans and other stakeholders. if confirmed, i will also renew the department's strategic plan and ensure it is properly deployed so that every individual in the organization knows how their work every single day ties back to the strategic plan and to the mission of caring for veterans. by getting out in the field and talking with veterans and employees, i will learn much about the organization as possible. i will be able to determine the processes that will need to be reorganized or streamlined. in order to regain the trust of the american people and most importantly veterans, we must ensure every employee has an

action plan in their annual performance review that rolls up to the strategic plan and the mission for the department. the majority of the employees of the v.a. are dedicated to the mission and the values of the organization. but those employees who have violated the trust of the nation and of veterans must be and will be held accountable. if confirmed, i plan to improve the communication between the field structure and the central office, between the employees and the leadership. i also plan to travel extensively over the first several months to hear directly from employees, veterans, and other stakeholders. i plan to establish a board of physicians to advise the secretary on best practices for delivering timely and quality health care. if confirmed, i will focus on reorganizing the department to more efficiently and more effectively use our resources to get care that the veterans deserve and have earned.

the department must improve his forecasting and develop a strategy for meeting increased demands. at the same time i believe the , department will need to expand the use of digital technology to free human resources that can be applied more to the care of veterans. i plan to take advantage of the scale to improve productivity and the flow of more people to the work. it is clear the v.a. must be more efficient and productive. the department needs to demonstrate they can manage a complex facilities portfolio, it can create with the department of defense an integrated record system, it can regularly and accurately produce key data for decision makers and oversight entities. most importantly, provide the veterans the highest-quality and cost-effective benefits possible. all of these things are possible. they are possible through some of the steps i have outlined. if confirmed, i will work to

transform the department of veterans affairs. i will continue to partner with you and all the department stakeholders. v.a. has made great strides in serving veterans thanks to the commitment of many dedicated employees and the hard work with our partners and advocates in the community. but, the v.a. is in crisis. the veterans are in need. there is much to do. i can think of no higher calling, no higher calling than to serve our veterans who have so selflessly served all of us. with your support, i am confident we will succeed at the department of veterans affairs. thank you and i look forward to your questions. >> thank you very much for your testimony. in a sense i think you have , answered my first question. but i am going to ask it again.

you don't need this job. i don't think you're at the age in your career where you need to move up the ladder. you don't need anything more to your resume. you have done pretty well. in the midst of all of these problems and a dysfunction u.s. congress and bitter partisanship, why do you want this job? >> thank you, chairman sanders. i think it is a good question. it is 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 west point, being in the 82nd airborne division, being at the procter & gamble company, one of the most admired companies in the world for 33 years has prepared me. 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 so deeply about. if not me, who? >> thank you for that response. one of the issues we are struggling with is v.a. health care. i look at this different than some of my colleagues who think health care is just fantastic and it is just the v.a. that is having problems. the other point i want to make is not just the size of the v.a. 6.5 million come in every year. inevitable problems are going to occur. the fact that because the v.a. is a public entity and, appropriately so, there is a lot more public attention to the problems facing the v.a. in the paper today, johns

hopkins university hospital paid $190 million to more than 7,000 women for inappropriate behavior on the part of a physician. that was in the "washington post." if that happened at the v.a., there would be dozens hearings, articles for months to come all , kinds of investigations. john hopkins university is a great hospital. problems happen. a couple of weeks ago, in montana, there is a lacking of 20 physicians. just in the small state of antenna. i know that in vermont, we lack them. in phoenix, god knows how many they lacked. in a nation in which 40 million people have no health insurance, in a nation where we spent almost twice as much per capita on health care than any other nation, in a nation where 45,000 people died because they don't get health care, how are you going to help us get the

physicians that we need, the nurses we need so that when people attempt to get into the v.a., they get in in a timely manner and they get high-quality health care? how do you do that within a dysfunctional health care system nationally? >> chairman sanders, first of all, we will start with us giving you very transparent projections as to what we think the demand is and how many resources we will need. we will have to build those from the bottom up and i promise you i will be, if confirmed, open, transparent with you as to what we think the need is. we will have to restore the reputation of the v.a. if anything, this crisis may have damaged the reputation of a great organization. we will have to restore that and we do that by acting quickly to make sure every veteran in need gets the care they deserve.

they can tell our positive stories for us. we will have to do recruiting. third, at proctor and gamble, we talked about this, we promote from within. i left the army as a captain. i went to the proctor and gamble company. bottom i started at the and i worked my way up. we spent a lot of time on college campuses recruiting. last year, we had over a million applicants for fewer than 5,000 jobs because people want those jobs. it is a company they want to work for. v.a. is a health care system that people want to work for. what i need to do is help recruit the very best people for that system. >> will you go to the medical schools of this country and the nursing schools in order to bring bright young people into that system so that our veterans get quality health care? >> we talked about the important role of leadership and changing culture. the fastest way for a leader to change the culture is through their own behavior.

if recruiting is important, which i believe it is because we have a shortage. we also have a time where the v.a. is in crisis. i think the leader has to play a role in recruiting those doctors and nurses. >> my last question deals with technology. there is no question or debate that the v.a. has very outdated technology in terms of scheduling appointments and other areas. what can you do to utilize the best technology to make the v.a. a more efficient and cost-effective entity? >> i think technology is a real enabler. it is a high-leverage activity. it would allow us to release some people and some resources and flow them to the mission which is to care for veterans.

my undergraduate degree is in engineering. i studied computer science at west point, both hardware and software. i wrote an assembly program for the honeywell computer at west point. at procter & gamble, i committed that we would become the most digitized company in the world. creating molecules digitally and shipping to our customers using digital technology. i think the same thing needs to be true for v.a. we need to use technology to free up people and take care of veterans. i plan to do that. >> thank you. >> welcome, mr. mcdonald. we are truly grateful to you and your family for this. i want to start with a couple of housekeeping questions. as ranking member, part of my role is to conduct oversight with regard to v.a. activities. this often leads me or my staff

to request information, statistics, or other materials from the v.a. if confirmed will you ensure , that my staff and i will be provided with the requested information in a timely fashion? >> senator burr, you and i talked when we were together, you will have my cell phone number. every member of the committee will have my number. i would expect if we are not in -- if we are not meeting your needs, you will call me. when you run a large corporation globally, you have a cell phone that is on 24 hours a day, seven days a week. it gets called. if you have concerns, i want to know about them and react to them. >> i thank you for that. if confirmed will you be , proactive in alerting this committee, including both sides of the aisle, about significant issues involving the v.a.? >> yes, sir. i believe no leader can do a job this big by themselves. i need your help if confirmed. >> he has deep concerns that the veterans needs are not being

met. i think he chairs the new york hospital. he told me this morning the medical staff is the same medical staff that we use at the v.a. facility. that we actually leverage the hospital staff to staff the v.a. is that a model we could expand around the country and leverage for any shortages that exist? is that a possibility? >> from what i know, that is relatively common. i know that -- i think from what i read, two thirds of health care professionals in the united states have at least trained in the v.a. that would certainly be something we would want to look at, particularly in a case where capacity is constrained and we need help. >> i have been told that in

2011, v.a. began an initiative called the harmony project. this was to explore the pros and cons of further integrating emerging operations of the v.a. and the department of defense health care systems. i believe this effort resulted in a report suggesting the agencies could improve access and continuity of care while saving billions of dollars annually, but it is unclear to me whether the v.a. ever discussed the findings of that project with the department of defense and whether any action was ever taken on that report. i do not expect you to know anything about the harmony project. can i get your commitment that you will go back and ask was there a harmony project, that you will review it, and then you will provide the committee with a copy of the conclusions of that project? >> yes, sir, i was certainly like to learn about. demonstrating my own commitment

to the importance of the department of defense and veterans affairs working together, i had the opportunity to meet with secretary hagel. we had a great meeting. we both committed to a partnership, a partnership that acting secretary gibson had also had it with secretary hagel. we both agree that it should not be the veterans fault or the service members fault that there was a scene in the united states government between the department of veterans affairs and department of defense. that should be absolutely seamless for those who have taken the oath and became veterans. i pledge and i know secretary hagel does the same to make that as seamless as possible. >> if i could get your commitment, excuse me, to report back to congress or the committee if what or any interactions taking place between the v.a. and the department of defense about the concepts highlighted in the harmony project.

>> i am not familiar with the project, but we will take a look at it and get back to you on what we think about the different items in the harmony report. >> i appreciate that. i look forward to expediting your nomination. i thank the chair. >> thank you senator burr. >> thank you mr. chairman. mr. mcdonald, i was really troubled to hear secretary shinseki say he felt like he was misled by directors and other senior leaders. the department, they cannot function at the secretary is not given honest information from the field and taking appropriate action. if you are confirmed how are you , going to create a better team and build trust and transparency? >> i think that is an excellent question. on day one, what i have to do is meet as many employees as i can. i have to understand how they

think about their role in the department. one of the things i pointed out is i think we have a pretty good strategic plan. when i looked at the strategic plan on the internet -- i am only looking at publicly available information. the behavior of every employee in the department is not consistent with that strategic plan. we have to develop a way to make sure the department -- the behavior of every employee and their expectations and their performance each year ties back to the strategic plan. >> do think that was happening? >> i do not want to judge but at the procter & gamble company, what we work hard to do is to take the strategic plan and make sure every blow ranking and every employee in the entire company, if you roll up their behavior, it will be based on the strategic plan. >> i agree with that, too. what secretary shinseki was saying he was misled about

people that were not telling him the truth. how do you build that trust so to give you the information that you can -- >> i have to be out there with the people in the field and we have to have the leaders who are vigilant, making sure that trust is real. it is unconscionable to me that you have an organization where one of the stated values, one of the stated values -- the first stated value is integrity, yet you have people lying. you have people tolerating it. the west point honor code says we do not lie, cheat, steal and we do not tolerate people who do. you don't want people in your community lying. we have to get into this and understand it. >> i appreciate that commitment. i have talked with prior v.a.

leaders about concerns with some of the facilities. the v.a.'s access, many of those facilities for some further investigation. the most recent wait time and quality data released shows shortcomings at washington medical facilities. i have raised real concerns about what is happening with the spokane medical center, including whether staffing and budget shortfalls are hurting health care for veterans. if you are confirmed, how were you going to confirm oversight of these facilities and make sure the resources are getting to the places where it is needed? >> i think that is part of the forecasting and projecting that i was talking about in conjunction with the strategic plan. what i heard from secretary gibson last week during his testimony was that the v.a. had not done a bottoms up forecast before. he was having some trouble

getting that done. we got to do a better job of that. we got to be very open and transparent with all of you and all of our constituents as to what we are forecasting. we have to put the systems in place that can make sure our veterans are getting the appropriate care. we have to be able to have doctors and nurses and physicians on the ground to be able to do that. i think digital technology will play a role because it will help us -- i know we have at the v.a. -- the v.a. is known for a very good electronic medical records. if we can get a scheduling system that is equally world class, there is no reason we can't, i think we can use that to help better care for the veterans. >> you talk a lot about health care. i did want to ask you about the veterans transition into civilian life. many of them are using their g.i. education benefit.

back in 2012, i passed legislation to make sure they had something available to them so they can have resources available to them. schools may provide inaccurate or incomplete information to prospective student veterans and that veterans themselves want independent, objective advice when it came to making their education decisions. i know you are not in there yet but one of the things i hope you focus on is making sure the veterans make good choices when they use those education dollars. >> i will certainly focus on that. i myself am a beneficiary of the g.i. bill. i did my graduate degree using the g.i. bill. my father was a g.i. bill user as well. it is a very important part of this country. we need to make sure it is robust.

>> thank you very much. my time is up. >> thank you, senator murray. senator isaacson. >> in your 90-day plan, you're going to travel the v.a. system and meet with providers within the v.a. and veterans and stakeholders. when that is over, will you report back to was what you found and what you were going to do to correct what is wrong? >> i would love to do that because my ideas are laid out in my opening statement are based out on publicly available information. as i learn more, that will be modified. i would love to report back to you as to what i saw and he -- and how i would modify the indicated actions going forward. >> your answer is really perfect because all the discoveries we have made beginning with phoenix and other facilities in the country have been information that is not publicly available. we had to dig it out. it took whistleblowers to bring

it forward to us which reflects the culture within the v.a. system right now which is a insular protective culture. , you have to open up. there are only two motivators in running a business -- one is fear and the other is reward. the reward is not necessarily compensation. it is the fact you are doing a good job. i hope you will give us a game plan and make it public and make it is the fact you are doing a good job. i hope you will give us a game plan and make it public and make the employees know you are not just passing through. we are going to insist on accountability. >> i cannot agree with you more. for in organization to succeed, it has to learn. for an organization to learn, people have to admit when things go wrong. we try to do the same thing at procter & gamble company. if something goes wrong or right, you need to learn from it and share it through the organization so it does not happen again.

in this culture, you're not getting bad news, you are not correcting mistakes. everything becomes a one-off. that is why we are seeing so many reports and it seems like there was a bit from a different location somewhere in the country. we have to create a learning organization. >> in your testimony, you mentioned creating a position advisory board. did you contemplate those physician becoming only the a physicians or do you have outside physicians? >> my initial thought was to get the very best medical talent in the world. and i have been very heartened by the number of people who come forward to me and said they would like to participate and like to help. i think the greatest thing about this nomination at this moment in time is the original question about the mission about caring for veterans. there is an unusual coming together of everyone in this

country to take care of those veterans. i have got a lot of offers already. i will like to the very best medical minds we could find inside the v.a. and outside. >> i think you have discovered what i have found in my travels over the past six months dealing with this issue and that is a lot of people want help. there is a lot of help out there. there is an example in atlanta today and one of the finest centers in the world and recognizing. they tried to get the v.a. to cooperate. they finally cracked into it last year and now they are taking voluntarily in raising the money to do it. taking spinal cord injury patients. i think the more we open the door and make the v.a. accessible to the private sector providers, those people -- many of them are veterans -- the better the v.a. will be because there is support from the

outside. >> it is a great institution. it is lead innovation in so many areas and does so many unique things that i do not think can be done as well by the private sector. nevertheless, any organization like the v.a. needs the benchmark itself consistently against activities elsewhere to become better. the procter & gamble company, we benchmark ourselves against the very best companies in the world in order to make ourselves better. i think we would need to do that as well if i am confirmed. >> thank you for your service to the country and thank you for the willingness to take this job. >> thank you, mr. chairman. i want to thank you, bob, for willing to take this job. i don't know what you thought about what you will do on your first day. you mention your testimony about the 90 days. what is on the very top of your list?

>> the very top of my list is getting the leadership and the entire organization together and sharing with them what i plan to do. and how important to me the mission and the values of the organization are and how on acceptable it is to behave in a way that is inconsistent with the mission and the values. that is what i will do on day one. >> i know you talked about leading by example. is there anything you can do to restore trust by the veterans to the v.a. again? >> i have already made calls to the veterans service organizations. i have talked to other veterans. what i would like to do as i travel is to get together with the veteran service organizations and veterans

around the country and listen to their concerns. i want to do that as a veteran. i want to do that as one of them. i do not want to do that as a secretary with an entourage. >> good. i want to talk about perception. you said you have gone health care from the v.a. in the past, is that correct? >> my family has, i have not personally. >> it still applies. has your perception of ea changed over the last 30 some years? >> my father-in-law before he passed away suffered tremendous treatment as a pow. he loved the v.a. he loved going to meet with his fellow pows. he very much benefited from that. my uncle who suffered from agent orange and still is under the

care of the v.a. speaks very highly of the v.a. his personal experiences have been all been positive. >> since you became a nominee, has anything changed from your perception of the v.a. in the last month or three weeks? >> when you run a large organization, there are always things that go wrong. the people i have met seem very dedicated to the mission and the core values. what we have to do is figure out who was not. >> right. the big issue that most people are talking about is access because once it goes to the door, 90% of them think -- there is another issue and that is mental health. the injuries coming out of iraq and afghanistan deal with -- the majority deal with ptsd.

we have a shortage of providers. there is also a big shortage in the private sector. how are you going to solve that problem because it is a problem that will not go away. you will have a better success rate if you get to them early. >> i agree with your comment. it is a great comment which is we do have an issue on mental health, not just in the v.a., but in the country. we have to find ways to meet this need. it is one of the most pressing needs that we have within the v.a. and one of the most pressing needs within the country. i think partnerships may be one way to look at it. certainly, talking -- this is a longer-term solution -- talking to people interested in careers. this is a great career for someone to be able to make a difference in the life of another person through effective mental health is fantastic.

we do need more. we do need more. >> last question -- we have a conference committee going on right now. and major cost to those bills deals with outsourcing health care to the private sector. it costs more money. sloan gibson says it costs more to give the private sector than what the v.a. can provide. it is an emergent situation, i believe. that aside, what is your number one priority coming out of that conference committee? >> again, i am dealing with publicly available information. having known sloan gibson for over 40 years, having gone to west point together and serve together and in the military, i trust what he has to say. i think he has talked about the resourcing needs that we have.

that is all about access. >> thank you. i appreciate your time. >> thank you. senator heller. >> thank you. mr. mcdonald, thank you for being here. i don't think there was any secret to my priorities on this committee. the backlog. especially in light of the fact that i has the worst backlog in the country. the v.a. continues to provide is a very rosy picture of how it has reduced the claims backlog. i want to assure you that this depiction is false. last monday, a report was released about how the claims initiative led to inaccurate processing in part of them feeling pressure to complete claims.

i want to go nationwide and then a little locally. nationwide, 32% of the claims reviewed had errors. some claims were denied without waiting for evidence needed to decide. some claims were filed without a final decision. some claims without a final decision were counted as closed. my question is -- do you think is responsible for the v.a. to count as progress in light of this report? >> i think we need to improve the claims backlog. i read the report which you shared with me. i am thankful for that but i am also embarrassed for the organization that you had to go to that. we have to get ahead of this claims backlog and we have to find a way to get it down and get it down quickly so that the veterans are getting the care they deserve.

>> if i can get a commitment from you that you will review the entire claims process, whether management has tried to manipulate these numbers. >> absolutely. one of the things i am trained in is total quality where it is a technique taught by a doctor where you take a look at a work process and you work to find out where the constraints are and you streamline that process. given the challenges with the claims process and the backlog, that will be one of my first jobs is to take a look at that. >> there was an ig report recently of the va hospital in reno. that inspection found that 51% of the claims reviewed were inaccurate and that management had contributed to inaccuracies and other problems. many months ago, i was promised by your predecessor or would be

predecessor that there would be changes. i personally have called for new leadership. would you review the management of each regional offices including that of reno? >> certainly, i will. one of the first tasks of the leader, i think i wrote this in my submission, is to get the right people on the bus and get them on the right seat on the bus. i do not care for the fortune 500 ceo you talk to, it took them too long. it always tasted too long to get the right leadership team in place but it is the first priority. >> i think you just answered my question. you are willing to make leadership changes when they are necessary? >> i have done that throughout my careers, beginning in the u.s. army. >> ok. thank you, mr. chairman. >> senator brown.

>> we have heard of my colleagues refer to me around the country. very critical of the v.a. we have seen some of this criticism directed at v.a. employees generally. i think it is important -- i know you will be dealing with very serious morale issues. we had terrible morality shoes at the dayton v.a. i just want to always point out that 30% of the v.a. employees are veterans and close to 100% of the employees chose to serve veterans. how important morale is and how important it is that we recognize most of the employees are doing a good job.let me ask a couple of questions. your predecessor, he did three things that he was working on

that want to ask if you plan to continue. he identified an self-imposed a plan for ending the backlog. we have seen major improvements. he worked hard in reducing veterans homelessness, and highlighting one of the v.a's that were considered some of the best in the country in meeting unique needs of women's veterans. want to ask you of what you know if you plan to continue his efforts on those three broad issues. >> i do, senator brown. in fact, i was reviewing the strategic plan. i noticed the agency priority goals are two of the three things you mentioned. i know that one of the chronic groups of homelessness is women. absolutely, we will continue

work on those three areas you targeted. >> the v.a. conducts of appointment each year. 6.5 million veterans, 80 million appointments. some of those are conducted by private providers. i hear it from these groups about delays and payments for the services. sometimes they go for as long as a year. i want to ask you to commit to dealing with payment and working on this issue on behalf of veterans affecting those health-care people and institutions outside of the v.a. >> yes. prompt payment. >> last is one is on a further field we talked about in my office on your first visit. that is legislation that i have

worked on called the significant event tracker where a number of soldiers in combat will get head injuries -- the marine or ranger may say he got his bell rung. it is not recorded anywhere. a soldier gets four or five of these and a space of a year or a space of two or three years of duty. six years later, his behavior changes. his kids notice it. he has no documentation of it. it makes it hard to diagnose it because they do not have the records. it makes it more difficult for the v.a. when this soldier or veteran filed for disability. often times, it is difficult to put together what happened. therefore, increasing the backlog, delaying it when the v.a. does have the information. whether this legislation passes or not, would you commit to working with the department of defense so they keep that her records on these so-called

invisible minor injuries, injuries that have a long-term effect on that soldier? >> i think that is a really important idea. secretary hagel and i discussed that. i think if anything this really shows why we need a v.a. because the v.a. and the dod working together can do this and they are going to be on the forefront of innovation on mental health as it deals with these significant events that occur. we have to do that but we have to find a way to do it. it will be all new and innovative. it'll be something that has never been done before but it has to be done. >> the burden rests with dod more. you urging dod to do it just like trying to eliminate what you call a wall between the soldier and the v.a. and how that is so important to smooth that over.

>> we will own the outcome. understanding that outcome and being able to trace that back to the significant events that occurred that created the head injury is going to be critical. i think it is very important that we work hard on that. >> thank you. >> thank you. again, thank you so much for being here, mr. mcdonald. is a pretty extensive interview with whatever the subject from the press. at the end of the interview, is there anything that i left out, is there any question i have not asked. i usually reply not. i think you are at that point right now. i just want to say i am very impressed with the answers you have given. i do not think it is feared to

get to specific since you're in the position that you were just getting your feet wet. you talked about process, your approach to how he will solve problems -- i think it is excellent. i want to mention a couple of things that i think is important. just mention a couple of things that are on my mind. one of them is the fact that right now when a better and goes to his medicare doctor, he gets a prescription and in order to get that filled at the v.a. which is a pretty good deal for the veteran, he has to go see a va doctor which makes no sense. i would like you to think about that in the future. scheduling is a huge problem. you mentioned getting some of

the providers, getting the best providers and visiting with them. certainly, the administrative people would be good to do along the same lines. that really is the backbone of health care and whatever you are looking at. suicide, prescription drug prescribing -- i think there is too much of that. not prescription drug that the schedule drugs. we put tremendous pressure on the v.a. to get rid of their backlogs and specifically, these things. in treating our veterans that have issues. there has been a lot of pressure to get that solved and eliminate the backlog. the easiest thing is to prescribe a drug rather than working on the problem. again, the prescription drug abuse. there is so much of the stuff on

the street that when i am visiting with my sheriffs, i talk about veterans regarding that and selling that to supplement their income. the other thing that i would like a commitment from you is one of the things that really frustrates the committee and as you are seeing -- the committee is a bipartisan entity when it comes to the veterans, congress works very well together whether it is in the senate or the house. republicans and democrats. one of the most frustrating things is trying to get information and not being able to get that information in a timely way, to be stonewalled. i think you find the committee really does want to help you as we go forward. i would like you to commit that when we do ask for things that that is honored. this is -- we have oversight, recognizing that fact.

and that you will try -- i know you would try to have a good relationship between the committees, but i think that is probably one of the most important things and most frustrating things we had. >> it is certainly my intention to be responsive to whatever questions or demand you may have. i realize the role you have an oversight and are realize that you have people in your state who have needs. it is going to be our responsibility to try to help you meet those needs. i will plan to, if confirmed, to give every member of the committee my cell phone number. i will expect you to use it and call me when you have a concern. we will try to do that together. >> thank you, mr. chairman. >> thank you. i think you were p