-- >> and security was a part of that. >> yes, sir. and that's just the point i was going to make before i handed it over to general mattice who will correct everything i say because he commanded out there at they literally had their heads handed to them because they were not strong enough to handle the fight. made a huges amd e difference in providing the security that allowed the tribes to say, you got our backs. now we can turn on al qaeda, who has made himself hated. security and steps towards good governance have to go together. thehairman, governing in age of diversity is difficult

anywhere in the world, whether you be iran "newsmakers" -- in see thein scotland, you challenges. had enoughce we troops there to prove that we had their back, at that point, we got them kind of working together. how well together? out,the arab spring broke one of my cia officers was briefing me and said note the one city you do not see people demonstrated in the streets was one of those bad days from cairo to damascus, and there was iraq , baghdad, they were not demonstrated because they felt they had a role to play in their own government. eventually when the american troops pulled out, the american ambassador becoming a hostage in his own embassy without the cia

platforms from the country to keep the ambassador informed and the u.s. military working with the iraqi military well enough d training isle perishable, but the nato training mission doing its job. they no longer had the awareness stalin-esque pa his senior officers. it was the first sign of stress. >> which would not have happened if we were there. >> yes, sir. we play teh ball --the ball where it lies now, sir. it will be more difficult to gain their trust the second time along these lines. we lost a lot. possible, and i think general allen is the right person to bring this forward. i think the administration has done the right thing by bringing him in. >> we have a few minutes. we will not be able to meet after 1:00.

>> we have the ukrainian president. first thing, this is a difficult book for congress. i'm very happy that congress voted because i think we are in severe conflict. it is important to stand behind the commander in chief. is notmander-in-chief just making these decisions off the top of his head. we have the best military and intelligence advising him. what happened, the administration has been keeping in touch with us on the intelligence committee. i cannot talk about the other committees. weakuld have looked very to the rest of the world -- we are going to be the quarterback. there are issues and resources we have that no one else has. and i think we can make a difference. this threat, we have had other issues. sometimes you try to find a threat. people do not listen. i think the americans understand how serious this isis or isl thil threat is.

when we try on this committee, we get facts and try to persuade our members of congress why we want to vote for something or not and give them the facts. i think that is important. one of the questions i continue to have, where people have anxiety was where we had the coalition, the arab coalition was extremely important. planal, you had to militarily just like general austin does now. what do you see, what can we arabt from the saudis, and countries as far as their commitment to boots on the ground? eventually, you're going to have something have -- have to have something like that. the moderate -- what am i saying? the moderate syrians, the opposition. i get that question even today. i'm trying to find a way to answer it the right way.

oint, aboutirst p what we can expect in terms of boots on the ground, it will be more difficult if the americans declare we will not do it. right away, you have to wonder why the most powerful nation said, we won't put boots ont the ground. table,ng it off the you're showing a moderated response that could cause them to moderate. the idea that we step back, they will step forward is not been proven in history. >the more we are willing to brig these boots on the ground, perhaps we less we have to put them there. >> you have to do what you have to do. the american people are war weary. they do not want another conflict. i think part of what they concerned is the infantry going i in in a long conflict. we do what we have to do, but we

are not going to go in the way we did with iraq and afghanistan. >> sir, it is. it is not either we go in with what hundred 50,000 troops are rico one with none -- or we go in with none. if a battalion of marines brought off of ships for a m onth to do a surround annihilation -- i think we should reserve the right to use that. as far as the resistance inside syria, it will become a force to be reckoned with. it depends on how much resource and, training, and equipping we get it over the next year. it is not going to be something that turns the tide anytime in the next six weeks. this is a long-term effort we are in. countries,t the arab

as far as their commitment on the ground or what they need to do? they have to take care of their area, and we can coordinate and we can help with with air power, but what you expect from the saudi arabias and the jordans? >> it will depend a lot on what we are willing to commit ourselves and the threat at home. obviously, in lebanon there will not be much. they have their hands full. in jordan, they will have again a pretty healthy threat in their own country. they are on the front lines. same thing for saudi arabia. but when you look at countries like the united arab emirates and others, they will be there us, but i think they will look very closely at the level of commitment by the americans. are we demonstrating a decisive form of leadership or are we demonstrating evidence? if they make that decision, many

of their decisions will follow. >> i have a lot of respect for all three of you for coming here. thank you all for your service. jointpologize -- once the session starts, we are to close all proceedings. it is either really lucky or you have got the short end of the straw. i want to thank all of you for your discussion today. it is so difficult and can be confusing to the american people, clear messages are going to be incredibly important, especially understanding what the threat relalally is. dr. rand, thank you for your service. he also served on the senate intelligence committee. we cannot say that upfront because we thought with a friendly rivalry, that would not be appropriate. but thank you for your service to your country. investor cro -- ambassador crocker. but the mob, you got out, they got you back in. i'm a fan of your work and your

courage for putting the diplomacy front on every difficult conflict we have. general, your service is really without president and we thank you for your service. and this candid conversation is important as we move forward. i hope you all will continue to find your voice. on the other side of government service so that we can all get this right youthat, i want to thank very much. i look forward to talking to you all real soon. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute]

>> coming up on c-span, the house veterans affairs committee examines the ig report. after that, john boehner talking about the economy. and live at 7:00 a.m., "washington journal" looks at the legislation aimed at the fight against superbugs and the acceleration of new medications. former secretary of state hillary clinton will speak at the democratic national committee's women's leadership forum. with live coverage on c-span today at 12:05 p.m. 2:00, john kerry will chair a debate at the un security council on the situation in iraq . live on c-span. >> the 2015 student cam video competition is underway. opened all middle and high school students to create a documentary on the theme "the three branches and you."

has affected you or your community. there are 200 cash prizes totaling $100,000. for how to get started, go to studentcam.org. on, wednesday, the house veterans affairs committee held a hearing to examine the findings of the inspector general's final report on the phoenix v.a. health care system. next, a portion of the hearing featuring testimony from the ig and whistleblower sam foote, the former phoenix v.a. medical direction. or. this is an hour and 20 minutes.

>> i would also like to ask unanimous consent, he is not here yet but that our colleagues david schweikert from arizona be allowed to join us here to address this issue. without objection, so ordered. also members we do have a series of votes that will start at 1:00. i apologize for that. this hearing was moved from its original schedule time because of the joint session of congress to hear the president of the ukraine. what we will do is immediately after the final vote move back as quickly as you can. we will resume the hearing as quickly as we possibly can so that we will not keep the witnesses waiting any longer

than absolutely necessary. on the 26th of august, the v.a. office of inspector general released its final report of the phoenix v.a. health care system which defaulted to national attention after hearing on april the ninth. the oig confirmed that an appropriate scheduling practices are a nationwide systemic problem and found that access barriers adversely affected the quality of care for veterans at the phoenix v.a. medical center. based on the large number of v.a. employees who were found to have used scheduling practices contrary to veterans health administration policy the oig has opened investigations as i understand it at 93 v.a. medical facilities and have found over 3400 veterans who may have experienced delays in care from weightless manipulation at the

phoenix v.a. medical center alone. oig concluded by providing the v.a. with 24 recommendations for improvement to avoid these problems from reoccurring. these recommendations should be implemented immediately. this committee will work tirelessly to ensure that they are in fact implemented. mr. griffin i commend you sir and your team for your work and continued oversight on these issues in the past and in the months ahead. with that said and as we have discussed, i am discouraged and concerned with the manner in which the oig report, the final report, was released along with the statements contained within it. notably, prior to the release of the report selected information was leaked to the media apparently biosource internal to v.a. which i believe

purposefully let the public -- misled the public that there was no evidence that phoenix linking delays in care with veteran deaths. as the days progressed, and people actually read the report that falsehood actually became obvious. what the oig actually reported and what would be the subject of much discussion today is the statement by the oig quote we are unable to conclusively assert that the absence of timely quality care cause the deaths of these veterans end quote. what is most concerning to me about this statement is the fact that no one who dies while waiting for care would have to lay in care listed as the cause of death since a delay in care is not a medical condition. following the release of this report which found perv.a.sive problems at the facility regarding delays in care in poor

quality of care committee staff was briefed by the oig regarding its findings and how specific language was chosen throughout the entire drafting process. prior to the meeting we requested oig provide us with the draft report in the format was originally provided to v.a. three weeks before the release of the final report. after initially expressing reservations the oig provided us with the draft. what we found was that the statement that i just quoted was not in the draft report at all. another discrepancy was found between the draft and the final reports arose the statements to the effect that one of the whistleblowers here today did not provide a list of 40 veterans who had died while on a waiting list at the phoenix v.a. medical center. first, oig stated in a briefing to the committee staff that v.a. inquired why such a statement was not in the report.

and the oig ultimately chose to include it. further, additional information provided by the oig to our committee staff shows that based on numerous lists provided by all sources throughout the investigation oig in fact accounted for 44 deaths on the electronic waitlist alone and in an astonishing 293 total veteran deaths on all of the lists provided from multiple sources throughout this review. to be clear, it is not nor was it not my intention to offend the inspector general and the hard-working people within the agency however i think i would be remiss in my duty to conduct oversight of the department of veterans affairs if i did not ask these questions. i would also like to point out that no one within the department or any other federal government employee including members of this committee is

beyond having their records scrutinized. as such the committee will continue to ask the questions that need to be asked in order to reform our constitutional duties. it's absolutely imported that the oig's integrity and investigation be preserved. full and transparent hearings like this will help ensure that remains the case. with that i now turn to the ranking member mr. mitchell for his opening statement. >> thank you mr. chairman for having this important hearing and i would like to thank the panel is for coming today as well. today's hearing provides the opportunity to examine the v.a. inspector general's final report on the patient wait times and scheduling practices within the phoenix v.a. health care system. this report did not state directly as show relationship between the long patient wait times and veterans deaths. for some that is a major concern and acquisition of undue influence by the v.a. on the

inspector general's report will be discussed at length today. what the ig did find is that the cases included in this report clearly shows that there are serious lapse in v.a.'s follow-up, coordination, quality and continuance of care for our veterans. they also concluded that the inappropriate scheduling practices demonstrated in phoenix are a nationwide systematic problem. i do not need any more evidence or analysis that there is no doubt in my mind that veterans were harmed by the scheduling practices and culture at the phoenix facility and across the nation. bottom line is this behavior in a detrimental effect is simply not acceptable. my heart goes out to the families of veterans who did not receive the health care they deserved in phoenix and around the country.

rest assured that we will understand what went wrong, fix it and hold those responsible for these failures accountable. as such, my question to the v.a. today is straightforward. what went wrong, what are you doing to fix the problems, how will you ensure that this never happens again and how are you holding those responsible accountable? i applaud secretary mcdonald were taking forceful action to begin to address the systematic failures demonstrated in phoenix. we need serious deep and broad reform, that kind of change that may be uncomfortable for some that v.a. but so desperately needed by america's veterans. i believe that such must be guided by a national veterans strategy that outlines a clear vision of what america owes its veterans in a set of tangible outcomes that every component of american society can a line and

work towards. earlier this week i sent a letter to president obama asking him to establish a working group to engage all relev.a.nt members of the society in drafting the national veteran strategy. we know from experience that v.a. cannot do it alone. we must develop a well-defined idea on how the entire country, government, industry, non-profits, foundations, communities and individuals meet this obligation to our veterans. v.a. needs to become a veteran focused, customer service organization. needs to be realigned to become the integrated organization. it should do what it does best and partner for the rest. needs to be the government model for honesty, integrity and discipline. we need to complete our investigation of these problems

and provide oversight on the solutions. i look forward to today's additional testimony about what happened in phoenix and how the v.a. is working to ensure that it never happens again. once again mr. chairman i want to thank you for having this hearing and i yield back the balance of my time. >> thank you very much and i would ask that all members waved their opening statements as customary in this hearing and yankee to those who agree to sit behind the principles. today we are going to hear testimony from acting inspector richard j. griffin was accompanied by dr. john day jr. assistant inspector general for health care inspections miss brenda holiday assistant inspector general for audits and evaluation and maureen reagan concert for the inspector and the director of the office of inspector general. we will also hear from dr. samuel foote former position at the v.a. health care system and

dr. catherine mitchell current whistleblower and medical director for the iraq and afghanistan post-deployment center at the phoenix v.a. health care system. i would ask the witnesses now to please stand so we may swear you in. if you would raise your right hand. do you solemnly swear under penalty of perjury the testimony you are about to provide us the truth the whole truth and nothing but the truth? thank you. you may be seated. let the record reflect that all of the witnesses affirm that they would in fact tell the truth, the whole truth truth and nothing but the truth. all of your complete written statements will be made a part of this hearing record and mr. griffin you are now recognized for five minutes. >> mr. chairman, ranking member michaud and members of the committee thank you for the opportunity to discuss the results of inspector general's extensive work at the phoenix v.a. health care system.

our august 26, 2014 report expands upon information previously provided in our may 2014 interim report and includes the results of the reviews of the oig clinical staff of patient medical records. we initiated our review in response to allegations first reported through the oig hotline on october 24, 2013 from dr. foote who alleged gross mismanagement of v.a. resources, criminal misconduct iba senior hospital leadership, systemic patient safety issues and possible wrongful deaths at phoenix. the transcript of our interview with dr. foote has been provided to the committee and i request that it be included in the record. >> without objection. >> we would like to thank all the individuals who brought forward their allegations about

issues occurring in phoenix and other v.a. medical facilities to the attention of the ig, the congress and the nation. on august 19, 2014 the chairman of the subcommittee on oversight and investigation sent a letter to the ig requesting the original copy of our draft report prior to v.a.'s comments and adopted changes to the report. on september 2, the committee staff member made a similar request for a written copy of the original unaltered draft s. -- as first provided to v.a. and the chairman. concerns seem to come from our inclusion the following sentence in a subsequent draft report

that was not in the first draft report submitted to v.a.. the sentence reads as follows. while the case reviews in this report document poor quality of care we are unable to conclusively assert that the absence of timely care caused the death of these veterans. this sentence was inserted for clarity to summarize the results of our clinical case reviews that were performed by our board-certified physicians whose curricula are an attachment to the testimony. it replaced the sentence, the death of a veteran on a wait list does not demonstrate causality. which appeared in a prior draft, not the first draft that was requested but in a subsequent draft. this change was made by the oig strictly on our own initiative.

neither the language nor the concept was suggested by any of my people. in the course of our many internal reviews of the content of our draft report, on july 22, almost a full week before the draft was sent to the department, one of our senior executives wrote this question. this is key gentlemen and ladies. and i quote did we identify any deaths attributed to significant delays? this is on july 22. if we can't attribute any deaths to the wait list problems we should say so and explain why. after all, the exact wording in the draft report was, where the deaths of many of these veterans related to delays in care?

this type of deliberation to ensure clarity continued as it should after the initial draft was sent to the department. in the last six years we have issued more than 1700 reports. this same review and comment process has been used effectively throughout the oig history to provide the v.a. secretary and members of congress with an independent, unbiased, fact-based program reviews to correct and identified deficiencies and improve v.a. programs. these reports has served as a basis for 67 congressional oversight hearings including 48 hearings before this committee. during the same six years, our work has been recognized by the ig community with 25 awards or excellence.

we are scrupulous about her independence and take pride in the performance of her mission to ensure veterans receive the care, support and recognition they have earned through service to our country. the v.a. secretary has acknowledged the department is in the midst of a serious crisis and has concurred with all 24 recommendations and has submitted acceptable corrective action plans. a recent report cannot capture the personal disappointment, frustration and loss of faith with veterans and their family members have with a health care system that often did not respond to their physical and mental needs in a timely manner. although we did not apply the standards of determining medical negligence during our review, our findings and conclusions in

no way reflect the rights of a veteran or his or her family from filing a complaint under the federal tort claims act with v.a. decisions regarding b.a.s potential liability in these matters lies with the v.a., the department of justice, thieves -- the judicial system and the federal tort claims act. mr. chairman this concludes her statement and i'd be happy to answer any questions you or any members of the committee may have. >> thank you very much mr. griffin. dr. foote you are recognized for your opening statement for five minutes. >> i started my internal medicine training in 1981 at the phoenix v.a. prevented a finish in 1984 and became board-certified in internal medicine. i went to work full-time as an emergency visit should then

return to the v.a. 1990 the same year i earned my boards and medicine could i ran the v.a. department for not from 199219 1990-198 and a pair of service teaching attendant for 91 to 2003 and i became an outpatient director in december of 1994 they but they physicians -- position which i held since my retirement. while i have views on many aspects come to be known as the v.a. scandal i would like to use the statement to comment on what i view as the foot-dragging downplaying an inadequacy of the inspector general's office. this continues in a report issued august 262014 which i i fearst 26, 2014, which is designed to minimize the scandal and protect its perpetrators rather than to provide the truth along with closer to veterans and families would have been affected by it. all the employees has received training on a duty to report waste fraud and abuse. to the inspector general whose job is to investigate these

allegations. they resulted in director gabriel perez being placed on leave within two weeks of the ig receiving my letter and a few months later his recognition -- resignation in lieu of termination rates in the second letter in april of 2013 brin made allegations against the chief of services brad curry for creating a hostile workplace. engaging in personal actions and discrimination against certain classes and employees. as far as i can tell the ig never investigated these complaints and it appears they turned over to the veterans integrated service network director susan bowers who was their superior. susan bowers could not take action against him without running the risk the entire waiting with scandal would -- in late october 2013-the third letter to the ig informing them of the existence of a secret waiting list for 10 patients on the list had died while waiting

for appointments. i also included additional allegations of prohibitive personal actions by senior staff. furthermore i advised him of a second hidden backlog of patients contained in the schedule appointment with lists and an unknown number of veterans had pierced on. i also detailed other methods that were used, and used to lower the apparent backlog for new patients and i imported the ig to come to phoenix to investigate all of the above. i got a response from the san diego ig office in december 3, 2015 to join a conference call with them on december 6. their team investigated the week of december 16 through the 20th. at that time i and others told them about the unaddressed scheduling appointments complex and show them the electronic holding clinic which is being used as to mask the true demand for return patient wednesday reinstated them on the secret waiting with summary report showing 22 patients have been

removed because they had died. we only had the names of two to seize seize because none of employers working with me have the electronic keys to print the names of the deceased. we asked the ig inspectors they could do it but they responded that they could not. the last e-mail response that i have from there were some december 21st, 2013 when i received it a reply. i offered to facts or mail the names we had at the time but they were unable to give me a working facts number or an address to mail it to. i send for more e-mails in early january again asking if they would like me to facts or mail a patient's names but i got no response. i also got no response from my advisor to several veterans had died. finally on february 2nd, 2014

out of frustration with lack of action by the ig even though we were informing them of more desai standout ig letter number forward copies to everyone i could think of that might be able to help. the only response i got from the ig was a confirmation that they had received my letter. a friend suggested i contact the house veterans affairs committee and there i found the help i needed. during this process i was advised by several people the only way to get the ig office to investigate my allegations was to make them public which reluctantly i did. in my opinion this was a conspiracy possibly criminal perpetrated by senior phoenix leaders. of the many scandals from the performance top administrators supposedly wait time goals to the harassment of employees trying to rectify the situation to the destruction of documents and electronic records to the very real harm done to the health of thousands of veterans nothing is more scandalous than the fact that 293 veterans died in phoenix. even now right here in this report the inspector general

tries to minimize the damage done the culpability of those involved by stating none of that death can be conclusively tied to treatment delays. i have read the report many times in several things bother me about it. throughout the case reports the office appeared to have downplayed past. this is true in cases six and seven where i have direct knowledge that after reading these two cases it leaves me wondering what really happened in all the rest. for example in case number 29 how could anyone conclude that the death was not related to the delay when a patient who needs an implanted defibrillator to avoid sudden death did not get one in time and why was the cardiac death case excluded from the ig review? in addition a critical element to proving this was a conspiracy was a potential tampering with the reporting software of the list.

from the beginning of the igs own data showed there was a difference between the numbers reported to washington and what the numbers actually were on the secret electronic waiting list. the ig clearly minimize the significance of this crucial point treating it as a trivial clerical error and touting how quickly that idc department corrected it rather than exploring who tampered with that in the first place. adding it up the ig report states 4900 veterans are waiting for new patient appointments at the phoenix v.a.. 3500 were not on any official list and 104,400 romba in not reporting secret electronic waiting list. 293 of these veterans are now deceased. this vastly exceeds my original allegations that up to 40 veterans may have died while waiting for care. the ig says it is not charged with determining criminal conduct. true but neither so charged with

reports designed to downplay potential criminal conduct designed to defuse and discourage potential criminal investigations or diminish the quite appropriate public outreach. at its best this report is a whitewash. at its worst is a feeble feeble attempt at a cover-up. the report liberal uses confusing language and math and that's new unrealistic standards ignores what electronic list was not reporting accurate data and makes misleading statements. in addition the attempt to minimize bad bad outcomes like outplaying damaging information and thereby protecting the v.a. officials who are responsible for the scandal reinforces the long-standing culture of circling the wagons to delay tonight and let the claim story or patient either the veterans community has had to suffer with for years. >> dr. foote, i apologize. you have gone three minutes over the five. i would like to say the rest of your testimony will be entered into the record. i apologize that i let you go a

little bit longer than what we all had agreed to. can you wrap it up in the next 20 seconds? >> secretary mcdonald said he was going to increase transparency of agency and would not tolerate whistleblower retaliation. families on the administrators did not get the memo. this report fails miserably in those areas and is the transparency equiv.a.lent to a four-foot thick concrete wall. >> thank you very much dr. mitchell you are recognized for five minutes. >> i am honored by the committee's invitation just by today. the oig was unable to assert the absence of timely quality care. as a physician reading the report i disagreed specifically in the minimum of five cases i believe there was a very strong potential causal relationship between delayed care or improper care and veteran death. in addition health care delays contributed to the quality of life and for five other veterans who were terminally ill and shorten the lifespan of one of them.

in looking at the report there are four cases where there is no cause of death listed. some clear to me how a causal relationship may or may not exist if there is no cause of death given. it's unclear if 19 veterans who are on the electronic waiting lists were aware of the self referral process to the primary care clinics. if they were not aware of this process then they reasonably believed that waiting on the waiting list was the only way to get medical care even if their symptoms were worsening. cases, the veterans had acute instability that required visits to the er and hospitalization. i believe those delays likely contributed to their deaths, but aain, the oig did not give cause of death. in terms of mental health treatment, there were 8 veterans on the waiting list waiting for care who wanted a referral.

suicide before they got the appointment. it is unclear if the -- if anyone told him that the referral process is a self referral process and they could have done so and initiated mental health care. in case number 29, there was a veteran that needed a life-saving medical device that would shock the heart into a normal heartbeat. he waited four months and did not have an appointment. his heart did stop. and without the device had to wait precious minutes for the paramedics to restart but unfortunately the family had to withdraw life support and three days later it may have forestalled death. but it would have because it is exactly what is used to treat the heart rhythm he died from complications of prolonging to heart stoppage in was denied

access to specialty care. and in case number 39 coming to the e.r. was dresser's including homeless he was put on medications to stabilize the discharge back to the streets and committed suicide. community standard would be to admit the veteran and said it would be more appropriate management plan but did not draw a connection from the e r a and death and suicide within 24 hours. and one doubt pluses not treated for prostate cancer over seven months earlier detection would start the treatment to slow down the progression significantly a. and then was denied timely access to forestall his death five months if not under.

number 36 there was not timely quality care for unrelenting pain ended with multiple suicide risk factors that had just suicide 48 hours later mania other cases i reviewed i could not discern a difference between on the medical waiting list were those of the system but a death is the death. the purpose is to get the of the gate to let the practices they have to repair the system so no more slips through. thank you for your time.

>> thank you to everybody for your testimony. mr. griffin in the information you provided to the committee that 28 veterans died while on the list is essentially meaning they died while waiting to get the foot in the door in since they were not in the system that briefed us that which showedds that the individual died but not how. correct? >> and to find death records from the coroner's office in hugh may be getting treatment under the medicare program but that goes to the doctor's

statement can you answer the question? >> that determination from looking at the medical records. clearly the patient had died and in several cases the care of their local hospital. >> it is a tremendous problem patients on the list so you are absolutely right anybody on the lists that did not make it to be seen in a dozen have medical record that i cannot look castle -- i cannot look at.

those folks i am not able to revoew/ iew. >> how we able to analyze whether these deaths were related to delays in care? wait. says, conclusively says, this is where we have some problems. there were people looked as if noone the report and it says conclusively that there is no link to delays of care of death but there are individuals to go back to look definitively at the medical records but there was a delay of care is that correct? >> we try to address the patient that we identified with the delay in care and subsequently received for quality care.

>> but if you were on that list to not getting into the system is that the delay? >> yes. you say that none of those delays were a cause of death? >> we were talking about the patients we looked at. i provided your staff with the breakout. >> were you abele to look conclusively at all of those on the wait list? >> i can only will get those , 3,000. >> yes or no? >> could you conclusively look? >> no.

>> i want to direct you to an e-mail on page 38 of your report regarding a veteran while waiting for care. and in a staff briefing you stated that he was seen by a urologist within three days of presenting to the e are so his sopresenting to the e.r., his case was not included in the report however to receive notification as he was not presented was not seem. and then that contributes to his death could you explain to me out oic came to this conclusion? >> the patient had bladder cancer for many years. he arrived at the v.a. and was

seen in the emergency room evaluation in. among the chief complaints were blunted his urine and also ande had blood in his urine remove to '08 arthritis with disabilities including amputations of the leg. as a result he was looked at and did need to see rheumatologist and did that have a primary care provider. the er physician and from that consults and primary-care consoles. the records and this is the first of the confusion but v.a. records said said he had an appointment for ecology put the patient call to request a rescheduling of that appointment which was rescheduled for november 6, 2013 and was a no

show. so some would say he had an appointment and did not keep that. >> right. let me ask a question. i will the you finish. nobody here in this room has any faith in any of the appointments scheduling going on at that time so i have no belief that what may have been written was true. >> -- understand. then he died by metastatic cancer with to had cancer of his brain and his long and so having seen a primary care provider retrieve that emergency visit and when he died i don't believe

that primary-care provider would have changed his death. refer you to page 75 of the testimony provided the testimony as a the hearing already started. it was just handed to us. >> yes, sir. >> in the hallway after the gavel dropped. >> well, sir i'm just saying that on -- >> and it was set up to make truth was of the record having seen other witnesses' testimony it was fully aware of the taped transcript of our

interview and people should take a hard look at that transcript i >> i appreciate it very much by your staff told us there was a formatting problem and that is why we just got that. >> are you referring to that transcript? of the interview of dr. foote? any other transcripts and i need to be aware of? >> i believe we send the information 48 hours in advance. >> the original allegation was that 40 veterans may have died while awaiting care and it think everybody knew he was referring to patients on the electronically list to schedule an appointment with

primary-care consult so between those touche sources you now -- between those two sources, you now have 83 patients patients, more than double the original allocation. so i have a couple of questions. why was that information not included in the executive summary that the v.a. leaked but you had time to see that we pursued this allegation that the whistleblower did not provide with a list of 40 patient names. >> i believe that you as the chairman received the same hot line that there were 22 who died of electronically last and 18 who died on the consulate's list.

in our pursuit of finding a what happened which wusses exhaustive exhaustives an is ongoingch because of the urology issues with the obvious first question and was give us the for the games we want to go after the records of these 40 people to make share we don't miss any. but the you -- but we were careful to say potentially 40 but as time passed it was declared if that four days some said at least four days so that spawned 800 media reports that 40 veterans died waiting and that was the story. to not address that with the amount of coverage than those readers that would've been

derelict on our part to so rule of that those 3400 records. >> it was important you draw the fact that he did not gave you the for the names? >> in the april 9 hearing. >> i am talking about the of final report. >> that was not inserted into the final report there were multiple drafts it doesn't seem to be getting traction grasped to provide the first of an altered report that its will be provided. >> i am asking what we ask for. we provide with the original draft copy maybe you thought the first of an altered copy and i

have an e-mail that went to your staff that has original and then in parentheses is says unaltered . draft. the original >> we have one for new once said of an altered the other said something different but there was no confusion you wanted the very first initial draft. >> let me read that e-mail. the third came from the staff director from the oig subcommittee to joanne moffett chairman of the right to know if

the oig will provide the committee with a written copy the us an altered draft report as provided to issa v.a.. if so, when? >> i guess i don't see what the difference is. you asked for the first initial draft report that we provided. >> did you ever indicate to the committee or the staff there was more than one draft? >> we did not. we provided what the committee asked for and explained in the past six years nobody has ever ask for a copy. >> shame on him, sir. we don't want you to use semantics of which copy of the

draft we asked for. we asked for the draft that you gave to the v.a. so they can make their determination whether or not that was or not a and you knew that is what it was. that is my time. what the request of was. testimony that they did not look at all the causes of death. and i apologize to the members we have to be honest and open about what is going on and whether or not it ended in another committee asks for a draft report shave on then if -- shame on them.

this committee will get the truth about all of the facts. >> this is the crux of whole allegation. we were asked to provide the initial not one that had been through 2 or 3 iterations but the very first draft report you candy night that all you wants to mickey and you show me - >> and you show me anywhere in says the first draft. >> show me where we ask for the first draft report.

>> do you have that e-mail, david? let me find the e-mail, and i will respond to your question. awareness --ack of >> you are out of order. >> do you want the truth? >> sir, you are out of order. on the reports come if i understand correctly, you did provide the first draft of the report, but there might have been other additional drafts, so the draft you provided was the first draft that was requested, but there was other drafts since the first one i came out. is that correct? >> it is a draft. it is a deliberative process. in order for us to get concurrence, we have to put a

draft in front of them. if we have factual errors in that draft that they can convince us were factual errors, then it would be incumbent upon us to make whatever edits are required so that the end of the process, the report in its final onuance, speaks the truth all issues. itso when the ig does reporting, you could conceivably get some information, whether it is from a whistleblower, from a department, that might not be factual, and once you get information that is determined to be factual, that is when you changed the report before it gets -- correct, and there were some minimal changes. and one of the reviews we had blood pressure numbers taken in two different times that were reversed. to me, that is not a substantive thing.

when they were reviewed, it was pointed out, so we put them back to where it should've been, but that is not a substantive change. footu mentioned, dr. alleged 40 veterans. did you ever receive the list of names of those that were on that list? >> no, and i would refer you to the transcript of our interview, which addresses that very clearly. it was even suggested that perhaps some of them might have been run over by a bus. and that he did not know what the cause of death was. you -- i did not give have not read that transcript yet. >> understood, and i apologize, but it does need to be read by everybody who has a serious interest in this matter because it was a taped transcript of the interview -- >> can i respond to that, please?

>> no. i still have questions. of the 93 ongoing reviews am a have a been closed out, and when do you believe the rest will be closed, mr. griffin? >> at this point, we have 12 of those that we have turned over to the department that i would not say is closed because we would anticipate administrative .ction being taken their close from the standpoint that we have completed the work that one of a dressed the specific allegations that we were looking at. the department in their proceedings to make determinations concerning administrative action, if they come across additional information that was not part of do focus, we may have to additional work on those, but we turned over 12 so far. -- they are not being

worked with any intent of ok, a week from tomorrow, the other 81 are going to be all publish. we will turn these over to the department, those that do not get accepted for any criminal action, we will promptly turn those over to the department so they can take administrative action. >> thank you. dr. mitchell, in your testimony you mentioned how good the phoenix the a pain management -- the phoenix v.a. pain management team is. how did the phoenix v.a. communicate their staffing needs to the director? was it ever communicated, and if so, what was done -- if anything? >> i do not have direct knowledge of the medication between the pain and management team and the senior administration and additional staffing. what i do have is direct knowledge from many, many providers who find panels filled with patience who are on

high-dose long-term narcotics and the patients need additional close monitoring and follow-up. what is happening as those providers to not have enough time to be able to get those patients and for sufficient appointments to be able to review that. in addition in the community, patients that are on long-term narcotics are referred to a pain management specialist for ongoing education and a monitor for side effects. unfortunately, the staffing at the phoenix v.a. did not allow for that. >> thank you. i see my time has run out, mr. chairman. .> mr. lamborn >> thank you, mr. chairman, and thank you for having this briefing. you pulled out case number 35 from the ig report as a special circumstance, and please explain while you did so in this case. accessd not have

to the records the ig went through, but the details are the same with one glaring omission. in the oig reports, the history starts with the patient presented to the er with the family seeking mental health care. he was evaluated, he declined, he committed suicide the next day after he was discharged home. what was not in the reports, and this should be the same case -- if it is not, it should be reported anyway, his parents said he had problems with depression, he called his parents, they brought him to be walking mental health care clinic. however, since he had not been ,nrolled in the phoenix thv.a. he was severed into the enrollment clinic where he waited for hours. by the time he was enrolled in a system, he was back to the mental health clinic, and it was too late for him to be seen, so he and the family were diverted to the er, where again they waited for a lengthy a lot of

time before they were seen by a psychiatric nurse to evaluate. by that time, the people involved that the patient was very to come he wanted to go home, he declined discharged. he was subsequently discharged to have follow-up the next day in the same clinic that would not see him earlier. >> ok, thank you for that clarification. mr. griffin, when you shared your draft report with the v.a. before release, did the v.a. propose any changes or as any questions regarding what was in or not in the report? >> they did. they requested that we remove several of the case reviews that appear at the beginning of the report. we refused to remove them. they suggested that we flip-flop the blood pressure numbers that were out of order. of course we changed that. there were two other minor things, one involving a date that was inconsequential to the outcome of the case review, so we fixed that.

there were a couple of verb in as changed recommendation a in no way whatsoever affected the intent of the recommendation, so those were changed. of the case reviews were substantively changed, and the secretary agreed to implement all 24 of our recommendations. >> and how often do departments ask for changes before they are released to the public? >> i suspect there has probably never been a report where there was not some minor change in that request. the reason being that they have to implement what we have found and what they are concurring with, so they are going to scrutinize those things and make sure that they are in total agreement, and they will also look for those miniscule types of errors that will report more

accurately. the language stated that you could not conclusively assert that there was a connection. do you know who leaked that to the press before the report was made public? >> no, i have no idea who leaked that. that was in the report. the report had a date certain for being published. it should not have been leaked, but the fact is it did not change anything in the report. >> was it someone in your august your office that leaked it? >> absolutely not. >> i did not think so. the word conclusively is not a medical term, and as a lawyer, i know it is not a legal term of hours. on a scale of one to 100, where does that fall on the spectrum?

. we receive that on april 9. what is o unequivocally proving? we did a review of the quality of care that these veterans received. that is what we do in all of our health care reviews. that is what their charter calls for when they were created -- >> but there could be a conclusion less than conclusive? it might have improved the course, but to say definitively that this person would not have died if they had gotten in sooner was a bridge too far for our clinicians, and i will let dr. day expand on that.

the basic problem with this is it is very difficult to know why somebody actually died. i am not clairvoyant. i would ask you to read also the testimony submitted by dr. davis where he supported the testimony we have in a report, and that would be the death certificate plus the review of the chart. in the case discussed previous he, case 29 where an individual died after failing to get on heart device quickly come in that report, we said, and i will read exactly what we indicated that oh, indicated thatth he should have gotten the device more timely. he died. i don't know exactly why he died. we would like to think that he died because he had an

arrhythmia to his heart and if that device had worked maybe it would have saved his life, but i do not know that that is when he died. there are circumstances around the weekend of his death that are not included in this report, and the reason he came to our attention is because he was on a wait list for an interim clinic. he was not a wait list for a cardiology clinic. secondly, he is not in the group of patients initially where we call those who were on a wait list to receive delayed care. he is on a list of patients who got substandard care, who in reviewing these cases, we found cases where the care did not receive quality of care, so this gentleman was delayed in getting care between phoenix and tucson. so in the part of the draft belongs, --k he or, my time is up.

>> thank you. mr. takano. >> thank you. i did read through the material last night. i'm trying to understand what the controversy is. i understand a charge has been made by the majority impugning your integrity. you were forced to change language or persuaded to change language. that is the heart of the allegation. can you help me understand from your point of view what is the charge and what is your response? >> my response is there is a lack of understanding of the processing of draft reports, and that is understandable because it is the first time anyone has gotten one. initial draftn report over there, that does not

mean that my senior staff and other members of our team are not continuing to review that document and make sure that we have got it correct. the fact that it went to the department without that proof of is not anything. it is an ongoing process until the last day when we sign out that final report, and over the course of five different drafts, there were minor changes made for purposes of clarity. the minute that draft report came up here, and the reason you don't put draft report out, is because they are subject to interpretation and they are not final. shortly after the draft came up here and was reported in the press that here is proof that somebody in v.a. changed it -- that is not proof.

that just means that you do not understand the process, and i can show, as i mentioned in my oral, six days before the initial draft was released, we were having discussions internally that we don't declare that delay was cause of death. we need to say so. ftstook a couple more dra before the causality line was included, but i would point out on may 15 in a senate hearing where the question of the original 17 names that we received came up, i was asked if we had a chance to review those. i said yes, we had reviewed them and that being on a wait list for care does not demonstrate causality in a person's death. that is three and a half months before this final report, so there should have been notes taken that it is not demonstrate

causality that you wait. i think the last statement for the record that i hope everybody would read because the witness will not be here, as dr. daigh already referred to, bears that out and bears out our methodology. someone might ask well, why did you send it over there if it was not ready? because we have to put it in front of the department. we knew that the department had 24 recommendations that they had an acceptable response that convinced us that they got it and they were going to fix it. we knew they would be time to fido that. we had made a commitment to congress to publish that report in august. as a result, we had to cut off somewhere in order to be about the business of writing the report, and that is why dr. 6aigh's staff has got 352 urology patients that will be the subject of a review.

>> dr. daigh, though subjects that we include, they did seem to me evidence of poor care, of bad continuity of care. is it possible for those -- that those family members are being notified of what happened? pursueamily members can litigation, i imagine. could be found culpable in some of those instances. is that right? >> that is correct. let me offer this comment. we setitations that about to review in this review were primarily those patients cold from wait lists -- culled identified bys inspectors, so we were looking at people on a list to did not appointments

timely. some of the cases were part of what we were looking at. if you were not seen at the v.a. , then i could not see you. my records do not let me take a look at whether you try to get to the v.a. or did not try to get to the v.a. our methodology section, we lay that out. in those cases, we were looking for people who had a delay in care and had a clinical impact on that delay. those are the 28 cases that we identify in the front, six of whom had died. someone died is very difficult, and so when you get individual commits suicide on a certain date after a certain events, you might like to say that event had something to do with the suicide, or you might like to believe that but for going to the psychiatrist or , but in the doctor world where we try to be able to prove and have data to support

what we are saying, we have a hard time going there, so the second group of patients we report on are those that we found had a poor quality of care. the other points that i think is important to understand is that is to respond to the congress, to the secretary, and to the undersecretary of health and comment to them on the quality of medical care the v.a. provides. what i usually do is we look at an issue, and the issues are all different, and the question in this one was -- we took to be -- was there a direct relationship between a missed appointment and death? that is sort of what the media was talking about. we were forced to address that in some way. once we determined that there was in fact patients that had we thenlity of care, always switch to well, what are the systemic issues at this v.a. that we can address to try to

get v.a. to change their practices to make this never happen again? when you go to the issue of who it, what the patient or the hospital down the street or the nursing room, what exactly did they contribute to this death or this poor outcome? that is a matter for the courts, and that is a matter for v.a.'s internal processes, so when i get to the point of poor quality of care, and then i always shift and focus on what can i do to work with v.a. to make sure we fix it? in a last written testimony to my outlined 10 or 12 or 15 reports where veterans were injured or harmed, and we worked with v.a. as partners to try to get this fixed. >> thank you. my time has run out. thank you, mr. chairman. >> thank you. >> mr. chairman?

>> a question for dr. foot. and your testimony, you indicate that there may have been a wl software, and that the numbers report to central office if her from the role numbers of veterans waiting. ewl is it that the appointments could be rewritten, and you believe that audit controls were deliberately disabled? yes. scrap shows it was a small number not correct, and they had a second list where they disabled the reporting function or they went in and tampered with the reporting software so that it would not number of say,e over 200. certainly the ig's data shows

that from the exception of that list, never gave the right number. one had said the waiting time was 55 days. on the actual not reporting, there were 1400 to 1600, and the wait was in six months. if you through any 3500 that were scattered around on the schedule appointment consults on loose papers, the weight was probably more between one and a half to two years. i reported this to the ig. i also reported this to the fbi, and i know they are taking a look into it and hopefully they will be able to find the forensic and computer evidence to support that claim. >> thank you. a question for mr. griffin. elaine was included in the oig final report regarding the case of death has no relation at all to any accepted state or the measure and medicine. as a matter of common sense, if

v.a. does not schedule up women's early enough to treat a disease, it is highly likely that veterans with fatal conditions will suffer from conditions and possibly suffer or.. -- or die. does that make sense to you, and do you agree with that statement? >> i agree with your statement. the premise is if your care is delayed, you are very likely going to be harmed, and when we started this review, it seemed to me that that would be what we would find over and over again, and we looked at these cases and we did not find that, so we said well, why did we not find that? 'sere are two of dr. foote cases in here where he can say he save a life. he found patients in a waiting list or in a pile, one had diabetes and one had a critical heart care, and he intervened to

make sure that they live. it is also clear that veterans have access to other emergency rooms and other sources of care beyond the v.a. in retrospect thinking about this question, people must have been extremely diligent at phoenix where they knew the trains to not run on time to try to make sure that vulnerable people got care. i can only report the news. this is what i found. >> was this measure applied when the oig report of the veterans died well while waiting for care in south carolina and georgia? i will say that i normally go to the point where we determine that poor quality of care was provided -- >> can you answer that question? applied same measure when the oig reported that veterans died while waiting for care in south carolina or georgia? what is your answer to that question? usually a fact pattern-based decision on exactly what happened. i'm not sure exactly which report you are referring to, but

usually in each report is a different fact pattern. if we determined that poor quality of care was provided, then we try to look at systemic issues and try to get v.a. to do the right thing with respect to quality of care. >> so the report discussing the delay and colonoscopies -- can you answer that question? same standard apply? >> in the columbia case -- >> in the report. >> the same standard was not apply because a fact pattern was different. in colombia, v.a. had found that they had delayed colonoscopies in a large population of veterans, and as a result, as you would expect, a large number of veterans developed: cancer that probably would have been prevented had the colonoscopy been done, andy v.a. admitted that some of those patients had

died. what my report was looking at was -- why did this happen? why is this possible? what we determine is that v.a. does not have a way to ensure that nurses in clinics that -- if a nurse leaves a clinic in that job is critical to the performance of the clinic, refilling the opposition is given to a board with of a hospital where administrators decide whether or not they're going to fill the nurse position or a teaching position or a research position, so again, we focused on what can v.a. do to make sure this does not happen? not the same standard was apply because the fact patterns were quite different. >> thank you. thank you, mr. chairman. i yield back. >> mr. chairman? >> i apologize. we have had a vote call, and i would like ms. titus to have the chance to ask her questions. missed titus, your recognize.

>> thank you, mr. chairman. like my colleagues, i am eagerly awaiting the results of the facilities. southern nevada is home to the newest the a hospital. many people think it is the best and we also have a large medical system there. i have been asked by a number of my constituents -- are the same problems happening here as in in phoenix because once you hear that, people think there are problems. i talk once a week to be reassured that they are not, but still i want to encourage you to finish up because not only do we want to solve any problems you might find, but i think that is a big heart of restoring trust in the v.a. as we get that done and move on with it. also, you put forth 24 recommendations, and as i looked at them, i think there are 11 that relate specifically to phoenix, which that is important, but the other, the rest of them look at the systemic problems.

you have given those to the v.a. , said that you recommend that they do this. this is a large order that you are calling for. are you confident that the v.a. has the facilities, the means, carrytent, the ability to out those recommendations and solve these problems so this does not happen again? i would agree with your assessment that at present they do not have the facilities. i think v.a. would be the first to admit that they need additional clinical space. they need additional clinicians. they need a new scheduling process. they need a methodology by which they can remotely monitor what waits times are in las vegas or any other place in the country where they have a medical center. i think they are aware of all those things, and i believe the new secretary and his team that

he is assembling are dead serious about addressing those things. we do follow-up on our recommendations. we have suspense state for when things are supposed to be completed, and we certainly will follow-up very aggressively on these 24 recommendations. ,e also have had some initial internal discussions about how we might scope a future project to go out and verify that in fact everything is working according to the plan. >> that is good to know. don't make recommendations that sit on the shelf. >> no, we follow up on a quarterly basis. >> i share your enthusiasm for the new secretary. i believe he is committed to both changing the attitude of specificand making the reforms. do you think the bill that we just passed, the compromise

bill, will be useful in addressing some of these 24 recommendations? i am afraid i am not totally versed on the bill. a numberere have been of legislative changes made in order to assist of the department in accomplishing their mission, but i would like to take that for the record if i may. thank you. >> i yield back, mr. chairman. >> thank you very much. members, we do need to pause. i apologize to the witnesses. we think it may be about 30 minutes for us to go and do that. we will give you a heads up when we are going to start back, and his hearing is in recess until immediately following the third boat. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> next, house speaker john weiner talks about his plan to grow the economy and jobs. he was the speaker thursday at the american enterprise institute and took questions

from the audience. this is half an hour. >> good afternoon, ladies and gentlemen. i am delighted to welcome you all here today for this important address from the speaker of the house, john weiner. it is a distinct honor to introduce my friend, john boehner. as most of you know, he is the 61st speaker of the house. when he was first elected in 1990, he had little idea what his trajectory was going to lead to, i daresay. he served as the house minority leader, the house majority leader, the chairman of the chairman oftee and the workforce, the chairman of the house public and congress and on and on. he is known not just as someone who holds leadership positions but who is authentically a good and courageous and fair leader.

today he is here to discuss a five-point plan for the congress to reset america's economy. please join me in welcoming speaker john boehner. [applause] >> good afternoon, everyone and let me just say how happy i am to be back at aei. i last spoke here shortly before i became speaker and it's a job i love but looking back a at job , a job i never thought i would have. when i got first elected to congress i thought i will probably do this for 10 years and go back and run my business or do something else but i'm still here and still on the journey for the same reason that many of you are. each of us was fortunate that we had a chance to succeed, chance to realize our potential and our work isn't finished until we have passed the same chance on

to our kids and theirs. and i have got some ideas about how to do that, and today i would like to share those with you. let me start by picking up where i left off when i was here nearly four years ago. that day i talked about how we would run the house differently, differently than the republicans had run it in the past and how democrats were running it then. today i can report that the people's houses more open and more transparent than ever. for the first time legislative data is posted online in xml and in bulk. the house proceedings and committee hearings are all streamed on line. you can even bring your ipad to the house floor, which was prohibited in the past. earmarks used to crash our coffers at the rate of 10,000 at a time and they have been eliminated. the cost of the house has been reduced by 13.8%, and we have

considered at least 33 bills under an open process. i consider that my predecessor had no bills on the floor under that open process. so we are on the right track. much of the credit goes to the people in the institutions that would do all the heavy lifting. all this without delivery and what my friend called the 21st century citizen directed government. one that is smaller, less costly , and more accountable to the people we serve. that is why despite being a minority party here in washington, republicans have gotten some really important things done. we have cut total federal spending two years in a row, which hasn't happened since the korean war. we have completed a major trade agreement with columbia and panama and south korea, made it easier to pay for college by tying student loan rates to the markets instead of some fluke improved our job

training system so that more people can gain high-quality skills that advance our economy. we are protected 99% of the american people from an increase in their taxes. now there's a lot more that we can do, and our focus continues to be on what we call better solutions. solutions to get people back to work, lower costs at home, and restore opportunity for all americans. to that end we have passed now over 380 bills that are pending in the united states senate. 380 -- almost all of them done on a bipartisan basis. dozens of those would improve our economy and improve the prospects for jobs in our country, and as we speak the house is considering a big energy bill and with good reason. there's an energy boom going on in america. oil and gas production is soaring everywhere from colorado

to north dakota to texas louisiana, to eastern ohio, pennsylvania, west virginia, too, and the boom is driving real economic growth. youngstown is an example. unemployment today is half of what it was just four years ago. it's a big deal. except americans aren't hearing a whole lot about it because it's happening entirely on state and private lands. and the federal government really is not involved in this at all. we take this approach to the national level by doing things like approving the keystone pipeline, opening more of our federal lands for oil and gas exploration, and if we really want to get our economy humming that would do it. but let's not stop there. i want to think beyond just moving the numbers a little bit. in my view america's energy boom presents a once in a generation opportunity to reset our economic foundation from from

the bottom up, and here's what i mean. north america is on track to be energy independent in the next few years. that's going to mean more growth , but it's also going to mean lower prices, energy prices in north america. we are already paying anywhere to 50% less than our big competitors around the world, industrial competitors especially the europeans. this disparity is going to grow and as it grows more manufacturers are going to work at moving their facilities here. it's actually already underway, and if you are an energy dependent industry you are going to have no choice but to move your operations here because you can't produce anything without energy, and you can't produce anything without electricity. and so they are going to be doing this, and our job is to make sure we continue to look at moving their facilities here. the problem is washington's

approach is always top down and the bureaucracy is so lumbering that the government is keeping us from where i think we need to be. now just look at the state of things and where we are today. flat wages, higher prices, a six -year slog to regain the jobs lost during the recession and millions continue to ask the question -- where are the jobs? so we can do this the washington way and move dirt around and see what happens or we can lay a solid foundation for economic growth and mobility. not picking one over the others but to do all what we can to reap the benefits of this bill. -- of this boom. bring these good-paying jobs home, get our workers off the sidelines, build a culture of hard work and responsibility around them, and make america the place to work, save, and invest.

it can be done, and there are five things that i think that need to happen in order to bring this about. you know the first is to fix our tax code. we have heard a lot lately about corporate inversions and inversions are just symptoms, visible symptoms of a much deeper problem. our tax code is terrible. nobody understands it not even , the irs. it will pay accountants hundreds of dollars so they can try to lower their tax bills and they have had to because over the years thousands of changes have been made to the tax code. and mostly for the benefit of those who are well connected. all this talk about inversions is making the problem smaller. it is like fussing over a did it when the road is loaded with potholes. let's fix the whole code -- corporate side and personal side. make it pro-growth, make it pro family, and bring down the rates for every american and clear out the loopholes allowing people to

do taxes on two sheets of paper. 95% of the american people do their taxes on two pieces of paper. i could feel the blood pressure going down in the room already. [laughter] so we do this. we get one of the biggest reasons that jobs are moving overseas, and we make it easier for families to do anything from building a house to save for college for their kids. secondly, we have got to solve our spending problems. for 50 of the last 60 years we have spent more than we have brought in. this is where people get on me about comparing apples-to-oranges, but hear me out. now would you do this in your own home? of course you wouldn't. you would never get by with it. can anybody run a business this way? absolutely not. well guess what? we can't do it as a country either because it's bad for our economy, to stealing from our

kids and their grandkids, robbing them of the benefits they will never see, leaving them with burdens that are nearly impossible to repay. the question isn't what's driving this debt, it's too. -- it's who. baby boomers like me are retiring at the rate of 10,000 a day. 70,000 this week, 3.5 million this year, and this is going to go on for another 20 years. our entitlement programs were designed for almost all of this retiring at the same time and they certainly weren't designed for the fact that most of us are going to live well beyond 80. those programs are important to tens of millions of americans you can't throw them out, and you don't want to throw them out, but they need to be fixed and put on a sustainable path , and we can in fact do that. thirdly, we have to reform our legal system. we let anybody in america sue

anybody they want for any damn reason they want. this is crazy, and we all pay for it in everything that we buy. the costs are staggering. we spend more per person on litigation like 2.5 times more the average industrial country around the world. they don't just show up in higher premiums but literally in the cost of everything we buy. it's inefficient, it makes america less competitive. there has got to be a better way. i'm all for taking care of people have been injured and making sure they have access to the system, but there ought to be reasonable standards and reasonable limits on compensation. fourthly a regulatory system. , the way the federal government hands down regulations is coercive, combative, and frankly it's very expensive. you take the dodd-frank was as

as an example with a 849 pages and $21.8 billion for compliance costs. the interesting thing about this is the dodd-frank was passed to get rid of too big to fail. not only is it failed to do that, the compliance costs are indiscriminately giving small community banks and credit unions and for the banks and credit unions small business loans and family loans. but now you have more and certainly in more money going into compliance and what happens with the cost of borrowing goes up and access to credit goes down. it's the last thing that main street needs right now. other countries have a more collaborative process for deciding what is the problem, a more collaborative process for how to address that problem and problem, and the result is you have fewer regulations, but the ones that you do have are a more meaningful and don't necessarily drive up the cost of doing business in that country. even if we did these four things i don't think we are going to

maximize our potential out of this energy bill. the fifth issue is simple. we have got to find a way to educate more of america's kids. aside from arthur brooks, you are not going to need more of a glass half full guy than me, but some of these figures are really rather depressing. last year one out of every five high school students didn't graduate with their peers. one out of five. among those who did graduate one in five need remedial education before they can start college. according to the nation's report card, only 38% of 12th-graders performed at or above proficiency in reading. only 26% performed at or above proficiency in math. we are simply not educating enough of america's kids. no child left

behind did was require every child to adopt standards and make assessments. frankly it's there so we can track whether kids are learning. that's the good news. the bad news is too many children still are learning. many are not learning because they are sentenced to attend a struggling school. that is why one of the things we have done is create the first federally funded private school choice initiative in america, the d.c. scholarship program. i will tell you what -- it's exceeding beyond anyone's highest expectations. 97% of these kids graduate from high school. 92% approval rating from the parents, so why wouldn't we go ahead and start expanding the program to the rest of the country? let's give more kids and their parents a better chance to find schools. we all know we are going to have

a growing economy, we are going to need workers. we can't have workers that don't get the basics of a decent education in america. here is the whole point. if we were doing these five things in a meaningful way and along with this coming energy boom that is right here in front of us, we could reset for these next iteration and beyond provide a reliable stream of , good-paying jobs, more stability and security all the way through retirement, and more opportunities for americans to get ahead not just to get by. there are many reasons do that than not one more important than the rest. when fall comes around, i am reminded how in the first and second world war, many cities and universities built their memorial stadiums in honor of the following. one of the classics is the navy marine corps memorial stadium in annapolis. if you have never been there , on the façade surrounding the

football field the great battles are listed, guadalcanal, midway, sicily, and iwo jima and the story goes a few decades ago , a william and mary player looked at the names and said man these guys have a tough schedule. [laughter] let me tell you, america has a tough schedule in front of it , and we can avoid it nor should we try. we are not just obligated to lead. we are called to lead. and we are driven to serve in the same spirit which our parents, grandparents built those living memorials with humility and desire to do something that outlasts us. for what lies ahead we need a the world need a strong america means a strong economy, one in which our people can strive to fulfill their

god-given potential and show us there is no greater enterprise and free enterprise and we will never settle for a safe route. we will lead for freedom in every sense of that word. today i have tried to lay out a path that speaks to both parts and frankly to all americans because i trust them, i know they can do anything, and i know their labors will justify our faith. thank you all for being here today. [applause] >> thank you, mr. speaker. we can take a few questions from the audience. looking forward to hearing yours. aeis start with this scholar derek scissors. >> thank you. mr. speaker, i really appreciate the foresight you were showing in taking this energy boom and how we can maximize the rare and valuable thing.

of course i -- and i'm afraid i will get into trouble with my boss -- i am a glass half-empty guy and not a glass half-full guy. i am worrying about the forces in the city that are going to prevent us from realizing the gains you are talking about, which are so valuable. can you talk a little bit how to overcome the obstacles and sustain the progress so not just for five years but 15, 20, 25? >> frankly the state regulates fracking and while the epa continues to try to stick their nose into this they really can't find a reason to do so. when you look at where the congress is, i don't think the congress is going to get in the middle of this. this will create good-paying jobs. we look at eastern ohio where we have got this big oil and gas line they have been developing over the last three or four years. it's a big deal.

you have to understand this was the heart of the so-called rust belt. this is where it started, and what is happening there, the development and all the good jobs, it's like manna falling from heaven. i don't think the congress on either side of the aisle wants us to go away. what i didn't spend much time talking about was how much oil and gas we have in the mountain west on federal lands in the continental shelf. we have an abundance of oil and gas reserves that can help fuel our economy for hundreds of years. this is a lot different than what was being preached 20 or 30 years ago. let's make sure we use it in a way to maximize the potential for our entire country for a long time. >> let's go next to joe lawler from the "washington examiner."

>> thank you, mr. speaker. i want to ask you about two things you didn't mention. one is immigration reform and how the obama administration says immigration reform is a key part of spurring growth over the next few years. do you agree with that? and also with the housing market faltering resolving the status of fannie mae and freddie mac -- for republicans? >> i gave a version of this speech a year ago and somebody said hey, you have got to have a fifth point. i gave it some thought over the months and i thought legal reform needs to be part of this. there can be a lot of other pieces to this. yeah, i think immigration reform would help our economy but you need to secure the borders

first. we have a mess and i think everyone knows we have a mess. our legal system is broken and our borders are secure and then we have the problem of those that are here without documents. we are a nation of immigrants. the sooner we do it the better off the country will be. when it comes to the housing market, i don't know what's going to happen to fannie and freddie, but i don't think it's going to have any sizable impact on what happens in the housing market. >> give us your name and your affiliation, please. >> thank you. my name is roberta stanley, and i am a k-12 public advocate. i happen to be from the state of the great michigan. the chairman put together a tax reform plan unfortunately with max baucus about a premature exit. did you have a chance to go over that, and do you think it had substance that you would like to support? >> when you look at the

proposal, i have got my questions about, but it has been out there since march, and i am shocked at how little i have heard about it. there are some quarters that we have criticism about this issue or that issue, but for a plan to overhaul our tax system completely, i would have thought i would have heard more complaints, so i think it is a good starting point. the next chairman may start someplace else, but you were not going to get this done by keep talking about it. at some point, you have got to lay out your ideas in writing and let people comment and have the people engaged in this. we are republicans. we actually think you should read the bill before you vote on it. [laughter] >> we are going to come over to the side here, the friend here right in the middle. andy name is barbara dello, i am a nurse. a large part of the

comment, so i want to hear about comments i heard in d.c. one is to a large degree obamacare and one is there people on both sides of the aisle is the focus on the economic burden of health care. are you still committed to protecting the elderly? i know you are one of the great people on this. do you have a strategy the politicians and american people support? >> i think the essence of this is medicare. when it comes to medicare this -- let's just be honest. this program is not sustainable in its current form. our kids and grandkids do not have enough money to pay for all the medicare we are going to consume over the next 30 years, so what are we going to do about? there are small steps we could take and you can combine parts a and b. you could change the pre-insurance program.

a lot of things that could be done, but i can tell you, sticking your head in the sand doing nothing is a prescription for disaster. >> let's bring the mic back here to the middle. >> thank you. my name is michelle, i am with the jewish council for public affairs. a few weeks ago or month ago i heard a speech by your colleague, representative rydan, talking -- representative ryan talking about poverty. i am interested to get your perspective extending the earned income tax credit for childless adults and tax form. >> paul is doing some very good work on the issues of policy. we have record number of americans not working, but we have a record number of americans stuck if you will. it is our obligation to help

provide the tools for them to use to bring into mainstream america society. i think this idea that has been born over the last -- maybe out of the economy over the last couple of years back, you know, i really don't have to work. you know, i really don't want to do this. i think i would rather just sit around. this is a very sick a deal for for our country. i grew up with 11 brothers and sisters and my dad had a bar and , if you wanted something you worked for it. i had some kind of a job whether throwing newspapers or cutting grass. tend to the bar with those characters who walked in every day. trust me -- i did all. i do think his idea on the earned income tax credit has an awful lot of merit.

the other issue i thought about this criminal justice reform a lot. i was in the state house when every state was in the mandatory decided weut we would not trust the judges anymore. we need a real, honest conversation about this. >> we have time for one more. we give it to steve. no, right here, yes, sir. >> steve luckett. i work and study right here in the city, mr. speaker. about 500 of your closest friends for a discussion giving a survey there are lot of students in the audience today , so could you give a view of the international waterfront

your view of syria and the , ukraine? and a bonus question. >> he wants me to give two or three more speeches. [laughter] >> is president putin making a good case for man of the year, or is he soon is beating out roger goodell? [laughter] aboutave a speech vladimir putin and the soviet union and about 2011. i'm sure you can find it at speaker.gov. it is probably somewhere in the archives, but if you read it, you will find everything i said is exactly what he has done. the message today from president poroshenko was straightforward. america, we need your help. we cannot do this by ourselves. and they can't. the president worked with the europeans and put some sanctions in place, but the sanctions are

not going to bring freedom and security to ukraine. they need weapons. they need advisors. i think he made the case today if not now then when. and if not there, where? >> coming up next on c-span, your calls and comments live on "washington journal." then just afternoon eastern, former secretary of state hillary clinton speaking to the dnc women's leadership forum. of cvs p.m., the ceo larry merlot at the national press club, and at 2:00, secretary of state john kerry discussing the situation in iraq at the u.n. security council. coming up in 45 minutes on "washington journal," congressman phil gingrey of georgia and gene green of texas.

they discuss their bipartisan legislation to fight jug resistant -- drug-resistant germs. host: congress is leaving town until after the november elections. the government is funded through september 11. $500 million going to arm the syrian rebels. here is your chance to weigh in undone,ess and was left elections, politics, etc. the numbers are on your screen. host: