the problem is no competent leader is going to formulate a course of action with all pertinent data. i was under the 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 already know the answer. the answer is going to be -- is there a team of lawyers saying, this is going to go is there 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 share what i know about va health. i'm looking for a collaborative relationship. >> we have known each other for quite some time. are you under the impression that this relationship has been strained for a while? the between congress and the v.a.? >> that is not our intent. that we work closely with you. many of you talked to us about issues and we work to get you 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 assumption? i 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. i would have loved to see, over my dead body.

>> i have no doubt they will get this report but i do not have responsibility for it. >> the person who is responsible is not here. what is the 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. >> as a veteran, and a as a 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? >> historically, in phoenix, as i understand it, the administration and management prior had used a model where 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 had been scheduled 3, 4, five months in advance. canceled the appointments. brought them into a new appointment. >> do doctors weigh in on the

meeting see? do they say, that patient is very sick? if for any reason we are rescheduling someone, it is rare that we are moving them up. we would discuss on a patient by patient basis, this patient needs to be seen right away. they cannot wait, did that that ever happen? >> i cannot 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.

do doctors get to weigh in and say, this patient needs to be in here right now? >> i believe it does happen. i believe 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. mayor -- their existence depends on that. what the doctor alluded to, does the drive to get to care derive from problems that have arisen? the other question is, are those 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. >> part of performance is access

and productivity as well as results. when it comes to the general counsel and you have nothing to be concerned about, you should be upset. you should be screaming and yelling instead of reciting that you defer 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. doesn't that bother you? >> i have turned over the information.

they have pulled my e-mail files. >> does it bother you they have not submitted it to us? it doesn't bother you. >> we are committed to being collaborative 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. mr. cook, 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. somebody mentioned omar bradley. i was a second lieutenant in vietnam that met him. we got shot up. my unit he said, he wanted to talk about the m-16. i said it does not fire right. that was 1967. he was 80 something years old suddenly, after that, there were all kinds of investigations.

no one else would die because of a 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 decisions made right away to 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 feeling no one in the va is in a position to do anything. there is no trust or confidence. they want action. they want it now. certain people, if i did something wrong and people died,

i would be fired, 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. i can't get across to you -- it 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. we can't accept excuses for the fact that the lawyers are handling it. i should ask questions, but that 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 close to 700 attorneys.

lish language that can describe how frustrated 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

billed congress passed the new allowing veterans to get treatment outside the v.a. if they live 40 miles away from a facility. more is $5 billion for v.a. doctors and nurses. president obama signed the veteran health-care bill into law august 7. the series of house veterans affairs hearings this year included testimonies from family members of service members who have committed suicide. they talked about problems with long wait times, complications with staff. this portion of that hearing is 35 minutes.

>> as many of you know, our journey started on june 10, 2013, when daniel at that time, he suffered from 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 >> coming up, the recent supreme court decision. lynch talksmichael about the situation on the border and his document tree on illegal immigration --

documentary on the illegal immigration. in the 40 year war on cancer. washington journal is live every morning. you can join the conversation on facebook and twitter. next tuesday, c-span focuses on the general motors recall. we'll hear from mary barra who testified on capitol hill. and the manager of the victims compensation program. next tuesday. huron c-span. here on c-span. >> history two tour looking at the civil war. the communicators this

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continues. affairs committee heard from a panel of whistleblowers. including one person who said the v.a. placed her on in the straight of leave after trying to raise concerns. others testified about retaliation. minutes.bout 40 honorable chairman and distinguished members, i am honored to appear before you to speak about my experiences while serving in the capacity of the chief of psychiatry with the department of veteran affairs in st. louis. , i want tocity briefly outline the goals i had when i took this position as the chief of psychiatry.

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. the bill makes it easier to fire senior v.a. executives. theident obama signed veterans health care bill into 7. on august tonight's special presentation care hearingsalth 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 just a few days before house and senate negotiators announced they had come to an agreement on a veterans health care bill. it's about 34 minutes. thank you for your oversight during this crisis. the northwestern legion has last six weeks setting up crisis centers. over 2,000 veterans. i've been at each one of those crisis centers and i can tell it is bad.nd that i'm deeply saddened. the american legion is saddened. we've listened to veterans and

widows and children who one by one told their stories of broken promises, pain, mistreatment, delays, and yes even death. many of them are full of hurt, anger, confusion and uncertainty want to be heard. yet they told their stories many have, but their pleas fallen on deaf ears. dur these town hall meet ttion listened because what most veterans and family members have to say is important help. want to it's part of the fabric of who organization. i'm going to tell you about a man in fort collins, colorado spend his last $40 on a cab ride to get to an american crisis center because he literally had nothing left. arizona, 70 phoenix years old, reduced to sleeping in public bathrooms. tears.e to us in

we were able to get those fixed on the spot in our crisis center. paso, texas within the first three days with 74 recovered $462,000 on the spot for those veterans were en tighted to those monies. i read a letter from the office about v.a.counsel and the harmless eras that included a veteran waiting more aan it a years for psychiatric appointment. eight years. veterans taking their own lives 22 veterans a day here america, and it's a harmless to waitat a veteran hat it a years for an appointment? we saw in north carolina a veteran who had been working on claim for 14 years. as he left the crisis center, he said i can't believe it took me what i've beenix years. on for 14 that's what we've been doing. five cities, and we have a half scheduled. we're making the extra effort,

that's what it takes. heard a whifl -- blower talk about -- if an employee wants to make extra effort to help veterans at v.a., that employee shouldn't have to subject to harassment. you need to row meet that kind of employee. i hope the v.a. is listening. how about if you take the whistle blowers, the people who have the guts to stand exup say that's not the right way to treat veterans and put them in so they canositions be an example of the people who work for them. can you make some room for them getting rid of the ones who covered up veterans waiting for care so that could earn extra every year. i want to be perfectly clear, about, this is not tearing down the v.a., it's about saving the v.a. the american legion wants a good v.a. for all veterans.

abraham lincoln said to care for who shall have born the battle for his widow and orphan. part that sayshe that's null and void if it affects your bonus. veterans in every city who want a v.a. that belongs to them, they want medicaland professionals who understand their service and understand their needs. legion saysrican the v.a. has a problem with access and leadership, we don't throw out the v.a. we want to make it what it be for veterans, make it what veterans deserve. the man i told but in colorado thewithin let down by system. the system was supposed to care for him. he was broke, he felt broken, he spent his last $40 on a americanto get to the legion crisis center. all his possessions in a knapsack. crisis centerthe after it closed that day, so he had to sleep at a gas station waiting for us to open. morning we were able to

get him in front of the v.a. and that gentleman was placed in a received theam and services that rereally needed. affairsrman of veterans rehabilitation for the american leenl on was so affected that he back his $40tleman because the american legion that no veteran should have to pay have alreadythey paid for by virtue of their own service. over 2,000 veterans at these crisis centers and life changing decisions have been made. support ande the collaboration of the v.a., those v.a. employees came to the and worked with veterans and they did a great job. this is what happens when we together and do what we know is right. and we as an organization have honored to help. the question still remains, why to thisave to come point in the first place. thank you for listening. >> thank you so much for that testimony. now we'll recognize mr. galucci for five minutes. you, mr. vice chierm.

members of the committee, on ofalf of the veterans foreign wars, thank you for the opportunity to testify. the allegations made against v.a. are outrage us and our rightfully outraged. plus the v.f.w. worries that the loss of trust among veterans has to are more harm l than some of the impropriety seen. help line,ed our where veterans could turn for assistance or share their experiences. ofalso conducted a series town halls and surveys around the country and over the first two months of our outreach received more than $1,500 comments, most of which were negative. we then tried to help resolve critical issues, next we sorted the data to make specific recommendations to fix the system. seek to resolve these issues we must be careful not to or abdicatee v.a.

the v.a. of its responsibility. cannot bes services duplicate civilian side. my full comments are submitted for the record. the major issue facing the v.a. health care system is timely access. even veterans who relay positive experiences to the v.f.w. still unreasonables over wait times. the v.f.w. outdated appointment scheduling technology is central to the access issue. antiquatedthat its system allows patients to slip through the cracks ask makes it manage thessible to workload, this is why it's ripe with fraud and manipulation. veteran who contacted the v.p.w. -- utah. his problems in he was told six months, then another six month. six month later he was informed he was disenrolled since he had not been seen in more than a year. to do better than this. this is why congress must

provide the v.a. with the to acquire aessary modern scheduling and system.ent another veteran needed a seemingly routine knee surgery, v.a. was backlogged. what followed was a bureaucratic mess. after the outside provider the operation the veteran was quickly discharged and told that the hospital had no further responsibility, veteran and his care giver had to drive directly to proper. to receive medication and prosthetics needed for recovery. the v.a. may have been best suited to provide both, but this was not communicated to the veteran prior to the procedure. moreover the care giver reported that the nonv.a. facility was inflexible in providing basic assistance to a veteran who was

clearly in pain while still in their care. this is why outsourced care is not a solution. v.a. must continue to serve as anddwarn for of such care congress must ensure that v.a. referral teams and private responsible make timely health care decisions. we all know accountability is a major problem for the v.a. low morale seem to be symptoms of a system that on internal processes rather than patients. their resources are stretched but employees are afraid to speak up, and worst, penalized when they do. patientsto focus on first by changing this mind set. this demands strong executive strong whistle blower protections. thev.f.w. also worries that --rent bureaucracy

if v.a. cannot hire good talent, they cannot fire bad employees, they can't fire bad employees, they can't deliver timely quality care to those who need it. thankfully not everything the v.f.w. hears has been bad. nearly 40% praised the v.a. this week several veterans staff to share how v.a. doctors had saved their lives. offered perspective on how the system has improved over the years. the system cannot work without congress taking action. passed a members also stern resolution calling to pass the v.a. access and act.ntability both chambers have agreed these will help veterans receive care, which is why congress cannot go into the august recess without passing when the scandal broke, every legislator in washington agreed that this was national imperative, but some have recently backed off, caring

more about cost than the care.ns waiting for we have an opportunity here to show our veterans and those that serving in harm's way our nation will live up to its promise to care for those who defend it. right. to get this we have to restore trust and confidence in the v.a. system do whateverw. will it takes to make that happen. mr. chairman, members of the committee, this conclude my and i'm happy to answer any questions you may have. >> thank you. forw recognize mr. blake five minutes much. >> thank you, vice chairman, members of the committee. of paralyzed veterans of america i'd like to thank you for the opportunity to testify today. it is frustrating and disappointing to see the things that have been reported about in v.a. health care system the last several months. yet not a thing we have heard is .urprising veterans with spinal cord injury and dysfunction are the highest the v.a.e users of health care system in the veteran population. i can promise you that our have experienced the

scheduling game takes have been disclosed. i am i regular user of the v.a., happened to me as a regular user of the very much a. fortunate because epva30 years ago developed an to allow with the v.a. us to do site visit to fully understand the -- sad reality is those who try to access the larger system do not have that luxury. the fact is we are all responsible form these problems. veteran service organizations should have promoted great byerstanding of our concerns urging congress and senior leadership to examine the face it.hese problems as we saw meanwhile the administration should have been fully honest about the resources and staffing needed to meet actual demand on the system, not ma nip iting demand data and statistics to

make things look better than they were. finally congress should have listened to what we have to say as advocates and as we've been for years. these problems can be traced the v.a. had when to begin denying enrollment to eligible veterans who are because it did not have the capacity or the resources then. unfortunately, instead of taking meaningful steps then, we allowed the v.a. to just close nowdoors to some people and it's gotten worse. so here we are today talking about this problem. recently, a member of congress told several of us in the community we thought we were giving the v.a. enough resources. statement.idiculous this just affirms that no one is listening to what we at the theo. and particularly coauthors of the inbudget have beenbecause we have dealing with these problems for years much in fact for four

have not once had the opportunity to formally present before the subcommittee to concerns.r thatl not dispute the fact the v.a. health care system has been given sums of money in the v.a.ars, and that has done a poor job of managing and spending those resources. facts.re but that does not automatically mean that additional resources now.ot needed we believe they absolutely are, whether to address the recommendations made by the v.a. or the administration or the white house or who ever made the recommendation. or to address the legislation that the conference committee is righttly wrangling over now. unfortunately the discussion has turned more towards using private health care to resolve these problems, instead of restrengthening the v.a. from within. veterans out into the private marketplace may alleviate the serious pressures now.cess right but that is not the answer to

the long-term problem. provided its appraisal and yet some members of congress have laughed that unacceptable or not part of this debate. when will it be part of this debate? because i'm not convinced it will ever be part of this debate. reallyress not interested in fixing the v.a. from within? i hear all the discussionculture with anyone't agree more. the culture needs to be fixed. know what v.a., so i the culture of the v.a. is like, but i can tell you i prefer to v.a. doctor. the question was asked of this committee hearing last week about the possibility of v.a. contracting out for most services, not specialized care theare that's unique to v.a., but that question ignores the fact that primary care is not a generic function, comes torly when it veterans. even the representative from the associationpital sat right there and admitted that they would need time to nature of the

veteran patient population before it can begin to meet demand. meanwhile one of the other representatives a sat right in we have longd standing concerns about the rates of reimbursement. when thet concerned people that it seems that we are going to turn to to help us access problems will readily admit that they fully do not understand veterans and that they're worried about how much they're going to get paid? not ourtivations are motivations. their mission is not the mission of the v.a. clear, p. v.a. find it wholly unacceptable that tens of veterans have waited far too long for care, and in many cases are still or have neverseen been seen. not a single veteran should have to wait for care when it is needed, and it is incumbent upon this committee, all of us at this table, and the folks sitting behind me to get this right, because it will matter in long run to millions of

veterans. so it's time for the rhetoric to stop. thank you again, mr. chairman. i'd be happy to answer any have.ons that you may >> thank you, i appreciate it. mr. valenti,n you're recognized for five minutes. >> thank you, vice chair and the committee. thank you for inviting me to testify today. when the allegations of secret lists came to light, we were outraged. but like you, we wanted to wait all the facts before reaching final conclusions. anyy there is no longer doubt that the serious problems uncovered by this committee and validated by v.a.'s o.i.g. are corrected.st be over a decade ago, v.a. faced crisis. in may, 2003, a presidential force or p. fvment f. appointed by president bush and i'llthe following, quote from this book, as of

least 236,000 veterans were waiting six months more for first appointments or initial followup. clear indication of lack of sufficient capacity or at a minimum a lack of adequate to provide required care.