actionstaken many other in phoenix and the surrounding areas to improve veterans' access to care including putting in place a strong acting leadership team. these are good people with proven track records of serving veterans and solving problems. increasing phoenix staffing by 162 personnel and implementing aggressive recruitment and hiring processes to speed recruiting, reaching out to veterans identified as being on unofficial lists or the wait list, and completing over 146,000 appointments in three months. as of september 5, there were only from may through august, phoenix made almost 15,000 referrals for non-v.a. care.

we have secured contracts to utilize primary care positions from within the community and the future. i have spoken to veterans. congress and service organizations, and other stakeholders. during those visits, i have found v.a. employees to be overwhelmingly dedicated to serving veterans and driven by our strong v.a. institutional values of integrity, commitment, advocacy, respect, and held in this acronym, i care. we will continue to work with stakeholders to ensure accountability. there are over 100 ongoing investigations at v.a. facilities. by the department of justice, the office of special counsel, case, we willage

take the appropriate disciplinary actions when all the facts and evidence are known. but we will not wait to provide veterans the care they have already earned. going forward, we will focus on sustainable accountability. more than just adverse personnel actions, this means creating a culture where all employees understand how their daily work supports our mission, our values, our strategies jury didn't require supervisors to provide daily feedback to every subordinate, to recognize what is going well and identify where improvements are necessary. i have discussed these major initiatives with the chairmen and ranking members of the veteran affairs committee and with many of the members here. the week we announced beginning of our road to veterans day, focusing on the next 60 days. we are focusing on three strategies.

rebuilding trust with americans, improving service delivery, and setting the course for long-term excellence and reform. this week we released our blueprint for excellence. dr. carolyn clancy on my left and dr. jonathan, the former under secretary health, and now the chief medical officer at hca, one of the largest medical providers in the country, helped us lay out this blueprint. themes, 10 essential strategies, to help us simultaneously import the performance -- improve the performance at v.a. health care now, develop a positive culture, transition from sick care to health care, and develop efficient, transparent, accountable, agile business and management processes. and to increase timely access to care, we are recruiting to hire more clinicians. as part of that effort, i have proposed increase in the minimum and maximum rates of annual pay

for eligible v.a. positions, with more competitive salaries. better position to retain those who are performing at a high level. allill judge the success of of our efforts against a single metric, and that is veterans outcomes. we don't want to be a to meet a standard. we want v.a. recognized as the standard in providing health care and benefits. i know we can fix the problems we face. i know we can utilize this opportunity to transform v.a. to better serve veterans. mr. chairman, members of the committee, asked for your unwavering support for veterans. i look forward to working with you and implementing the law and in making things better for all of america's veterans. dr. clancy and i are prepared to take your questions. >> thank you, mr. secretary. questions iner of

here that are designed to rip and punch and do all kinds of things, and i'm not going to do that. this committee is committed to being a full and complete partner with you as you work damage repairing the that has been tend to v.a. over a number of years, not just recently but over a number of years. i think what we want to know is -- and you only been there 50 do you have the tools that you need? are you finding that you need more? we talked about this at breakfast last week, that we need to help you with legislatively so that you can make the changes that are necessary to deliver the benefits to the veterans that have earned them.

>> mr. chairman, thank you. we have gone through and look at the legislation that governs our departments, and we have put together some proposals which are currently with the office of management and budget. we would enjoy the opportunity to be able to share those with you within the next few weeks as we get them back from the office of management and budget. we have a lot of tools at our disposal. i thank you for the act that you all passed. it was a great show of bipartisanship for our veterans. i think there are going to be things that we could use help with, and i know we will continue the conversation so that we can work together to identify those legislative needs. >> i think you are probably going to hear from both sides that it appears that nobody has been fired yet. i know that the wheels have begun, but some points -- we are

at 110 days. is it that hard in the federal system or in v.a. to fire somebody who has been caught red-handed doing something? >> well, coming from the private sector, having run and $84 allion global company, it is misperception to think that even in the private sector you walk in one day and you fire someone. failure of sustainable accountability. if you're doing a good job managing an individual, you are giving them daily feedback. shouldily feedback result in a relationship that when something goes awry, the action can be taken quickly but with the due process allowed. in our particular case, around 65% of our employees are union members and our ability to separate them from their jobs

depends upon the specific union contracts that we have in our facilities. made in the you all new act does shorten the appeal time for senior executive service employees, and we welcome that. but there still is a due process. as you know in phoenix, we have got two senior executive service people who we have proposed action against. we give you a report every week. the report we gave you yesterday has 19 separate disciplinary actions on it. we are going to work with you to continue to track it and keep it up to date as we learn new information. we need to get this investigation done, and i was pleased to hear that the inspector general thinks we can get them done relatively quickly.

>> thank you very much, mr. chairman. i want to thank you for being here today. that i'm very pleased with what i've seen so far with your leadership style and the fact that not only have you taken the time to visit with employees at the v.a., which hasn't been done in the last five years, but your willingness to reach out not only to members of congress but also the veterans service organization to get their input and insight into how we can provide better services for our veterans -- i really do appreciate that. , the v.a. isd going through some turbulent times right now, but it is also a time for opportunity, to really change the cultural structure within the department

and its employees, but also a time to really think big on a national strategy in where we should be going as far as the department of veterans affairs and. i mentioned about the 24 recommendations. how long do you think it will take you to complete all of those recommendations? have actually put that in our reports, and i think it is by the end of 2016, 2015. it is over time, and it depends on how systemic the change is. week ineeting every trying to get those remediation's done. for alltely have asked passed ig reports that have not been remediated. i would like to go back and look at the history and understand what we need to do on the things

that have not been remediated trade my understanding is there is quite a few things. having run a public company, having been on two audit committees, two different board of directors, i like what i.g. does and we all need the i.g.'s help. the work they do is critically important. been in nine different cities, 21 different operations of the v.a. over my first 50 days. i tell people that i want every employee to be a whistleblower. i want every employee helping us change the i.g. i welcome the criticism that anyone has. the mistakeps made of giving out my cell phone number publicly. it has been published online. it is in the "washington post." calls answered 150 phone

so far. >> thank you. speaking about the whistleblower, i know that is still a concern, talking to some v.a. employees. but whether or not they will be protected if they come forward -- when will the v.a. be certified by the office of special counsel section 2302- c on the whistleblower protection? i and deputy secretary gibson in the interim have amended -- demanded from the very beginning the whistleblowers be protected or it i will have to get back to you with a specific eight on that. one of the things i have tried as a leader, your behavior is looked at as a demonstration of a new culture. when i go to those 21 different sites, i talk about -- i asked to meet with the whistleblowers. i ask for the whistleblowers to be in a town hall meetings.

i ask for the union leadership to be in these meetings. we can't do this alone. we have to get every employee working together so our veterans benefits. a lot of the focus has been on vha. do you have any plans to look at the national cemetery administration for similar leadership shortcomings and integrity type of issues? >> yes, sir. as you and i talked, part of our problem in v.a. is we are a silo to organization. we have been brought together over the years without really any idea to integrating the organization.

i want to get to a point where our organization is so simple for the veteran to understand that they can plug into our organization anyway they want. for any a smart phone iraq veteran, we will be there. if it is paperwork for a world war ii veteran, we will be there. i want them to think of the v.a. as their v.a. i want every veteran in the country to say, this is my v.a. and i'm proud of it. >> my time has expired. thank you once again for your leadership, your willingness to do this. i'm very optimistic and very hopeful that with your leadership style, this change will continue in a positive direction. i want to wish you the best of luck. >> it will take the partnership of all of us. >> thank you. >> thank you for being here

today. we really appreciate hearing from you. there's a lot of things we could talk about, but the need at the moment is to try to get to the bottom of what the details are surrounding this inspector general's report that has just come out. you may have heard the testimony of the inspector general earlier today that while the waiting list in phoenix contributed to some or all of the 40 deaths of , it did notphoenix cause their deaths. they made a distinction between contributing to their deaths and causing their deaths. that, was it misleading for some of the press headlines after a leak was made to have headlines like no deaths related to long waits, which was one, or another which said no links found between deaths and veterans' care delays? i am reacting as if

every shortage of care, every isrtage of access to care incredibly important. you have to think about this one veteran at a time. i am a veteran. i do have injuries for my time in the service. my father-in-law was a prisoner of war. he had posttraumatic stress. he was shot down in world war ii. until we got him to the v.a., we did not know what the problem was. my uncle suffers from agent or judge -- agent orange. we are acting as if every shortage is absolutely important, and we are going to fix it. >> are those headlines accurate? >> i am telling you, i'm going to act as if every veteran deserves the care they need, and i'm going to provided to them. that's why i'm acting. >> what do you think about the fact that someone in the inspector general leaked to the

sentence outrtant of the report before it was released to the public? do you have any concern about that? >> i don't know anything about that. violation of v.a. ethics or rules or regulations or law to release something before public release? >> i don't know. >> are you going to look into this? lots ofinly we have had leaks all over the place. i read about the doctor's testimony in the newspaper this morning. the important thing is to create a culture. we have got to create a culture that is open and transparent and that works on veterans' issues. >> i agree -- waiting tos i spend testify is ours i am not

spending working on veterans' issues in the field. >> let me pursue something you were talking to the chairman about. i hear from veterans all the time that they are amazed that no one in phoenix has been fired for the on except the waiting list in phoenix -- unacceptable waiting list in phoenix. >> we have proposed disciplinary action against two of the employees in phoenix. that is currently underway. that is the rule of law. if you would like to change the law -- >> we did change the law. >> you change the law so it affects the appeal only. >> the two that are on paid leave, is that extent of what we're going to look at as far as any kind of -- >> i think you heard mr. griffin say that the fbi and other investigate sources are in phoenix right now. you also have received a report from me every week that tells you the people who we are disciplining.

the report you gave you yesterday has 19 people on it. we will track that report weekly. we will update it weekly. we will make sure that we discuss with you whatever you would like to discuss about that report. there those the people that department of justice declined to do criminal prosecutions of? >> i'm not familiar with those people. that is with mr. griffin. these are the people that we administratively feel should be called out and brought to task for what they did, which is an important part of changing the culture. you have to hold people accountable or they will not change the culture. >> that is why i want you to take some action, because that is part -- >> i am taking all the action the law allows me to take. >> we are here to help you. >> i know you are. we look forward to working with

you on that. >> let's get it done. i yield back. >> welcome to the veterans committee. i hope the future that we will have the common courtesy not to have the secretary waiting, even if we need to stand down one committee to bring you in. i want you out there. thank you for your service you are doing. i mentioned when you came to my office, the first secretary -- his motto was putting veterans first. i like that. yours is, road to veterans day. what exactly do you mean? >> for me, the road to veterans day is about using the first 90 the chairman and ranking member suggested to make as many changes as we can as quickly as we can to improve our service for veterans.

we have three strategies. one is about rebuilding trust. the effort and doing to get around, to talk about people, all stakeholders, veterans themselves -- we are compiling a list of the changes that need to be made. at the same time, we are forming teams of employees from within the department. part of the issue before was the organization was closed and wasn't communicating from bottom to top and top to bottom. we need to get employees involved in making these changes. they are the ones closest to serving the veterans. we're in the process of putting that together. that will form a strategic land. -- plan. we will improve access. we will go ahead and get down the number of benefits in the backlog that we have. it is all designed so that in the end, the veteran will know how to plug into v.a. and think of this as their v.a.. that's really what we want. >> one of the problems i keep ising with the whistleblower

that it always seems like it is negative, but i don't think feedback has to be negative. i think it should be a way that employees can come forward and say, this is how the system can improve. i don't think every complaint should be viewed as us against them. >> that's exactly right. that is a culture we have to create. i can understand that in this moment in time, whistleblowers who have been retaliated against ie skeptical as to whether mean what i say and whether i can deliver what i say. the only remedy to that is to get out, talk to people, demonstrated through our behavior, but in place a new leadership team which will believe in the culture that we believe in, and open culture that needs the people at the lowest level of the organization making the biggest changes because that is how we improve our work. motto, one team,

one fight. if we are all fighting to improve the situation for the veterans, we will do what we have said we will do for 75 years. thank you very much for your service and your commitment. i'm sure you have a lot of team members that are willing to work with you. thank you and i yield back the balance of my time. >> thank you, ms. brown. i can assure you while the secretary was delayed in coming in testifying, he was working. and saw hime room meeting with individuals. >> that's correct. >> i want to follow-up on a couple of questions. thank you for joining us today. maybe this question is for dr. clancy as well. what i did not hear in the testimony and from the last panel was at what level the v.a. in the collaborative process

which the report is altered, and the recommendations for changes. at what level did that actually take place? .> not at my level before my time, too. we have an office that reports to the undersecretary -- reports to the principal deputy undersecretary for health that routinely interfaces with the inspector general, with the government accountability office and so forth. getting clarification on recommendations. frankly, tracks to see that we are on track with recommendations that we have agreed with and so forth. as you heard from the inspector general previously, the issue of looking at a draft report and draft recommendations. they are asking for factual information to make sure it is accurate. >> what office is that?

could you provide that? >> management review services. dr. rasmussen. >> i appreciate that. apparently that created some concerns about that and did not know what level that was. that had not come out earlier. i had a line of questions with oig that perhaps there were 5600 veterans that escaped review in that process. other areas -- whistleblowers. last week we heard more harrowing stories from whistleblowers of retaliation, intimidation, richard bijan. -- retribution.

can you describe and show a waiter commitment is? -- show me what your commitment is? this is on your watch. >> i have spoken to many whistleblowers in the organization myself. when i go to a location, i asked to speak to whistleblowers. i have had many of them call me on my cell phone and i have had conversations with them. as i have said publicly within the department and as i have said in every town hall i have held in the last 50 days, in 21 different sites, i welcome whistleblowing. i welcome people criticizing the operation. i welcome employees who want to get involved on some of these reengineering teams we are putting together so they can help reengineer the process they are criticizing. i don't think there's any lack of clarity. i may have missed a site. i may not have talked to a particular person.

but with the communications i have done, which have been two videos that have gone out to every employee -- many letters, one of which you might be interested in, is a discussion of sustainable accountability in this whole idea of how do we get daily feedback going and how do we get the organization working together. i met with union leadership four times. >> thanks for that. i wanted you to restate that. there are some folks between your level going down who have not got the message. you have all the people to do that. the subcommittee announced this is still going on. in rural areas of the country, the v.a. is doing a poor job of meeting the needs of our veterans. >> i have been out to nevada.

we are working very hard on telehealth. >> let me give you a better option, and that is in the bill, and that is v.a. choice. giving the veterans a choice. it can be implemented. i understand our current law, there were options here that were not used. in my district, i have veterans that go to four different buildings, more than 300 miles. i have the employees say, too bad. get in the car and drive. we need to make certain they have local options. even after this trial period is over, i would like to continue to see efforts at the v.a. to say, we can do a better job and provide that access closer to home, which is important for the veteran but more important for the family and the local community. >> if you look at these issues through the lens of the veteran, the answer becomes very clear. we want to get care to veterans.

if distance is an issue, if capacity is an issue, then we should help that veteran get the care in the private sector. >> the issue is not capacity. the issue is not distance. the issue is getting permission from the v.a. to go to the local hospital. i encourage you to look into that. >> please give us their name and we will work on it. >> there are a lot of folks out there that would like that choice, and we need to see that choice being offered by the v.a. thank you. >> thank you. mr. secretary, welcome. we will get together soon. >> yes, thank you. secretary, some of these -- the phoenix v.a. waitlist scandal happened many layers below the secretary level.

how can you be sure that the leadership teams that are near you are going to be able to tell you the truth or be able to get , and that you can count on people getting you accurate information? >> it's going to require a change in culture. have experience running large organizations know that is probably the most difficult thing to do. with the purpose, values, and principles, which are the bedrock of any organization. the first thing i did is i ask for every employee to recommit themselves to the mission of caring for veterans and to the values of the organization represented in the eye care -- i care acronym. we have used that as a leadership exercise to talk with their employees about the mission, the values. we have tried to demonstrate that we want a very open culture. we talked about the positive

aspects of whistleblowing. the talk about the positive aspects of criticism. i have used a couple of diagrams. people think of an organization like this, and the customer is on the bottom and the ceo is on top. i turn that on its head and i said, this is the v.a. we want. we want the veterans on top and those people who are next to the veterans every single day, the doctors, nurses, schedulers, clinicians -- those are the people we should honor and make sure our paid harper lee and rewarded. -- properly and rewarded. the secretary is the bottom. this is a different culture. to demonstrate that, and have cut down the size of the secretary office. i no longer travel with the entourage that maybe once existed. we are simply trying to make a very visible that this is a different culture. travel of like the pope,

in a tiny car? .> i'm much less than that remember, i'm at the bottom of the pyramid. i fly coach. >> i sympathize with my colleague hoss accounts. -- colleague's accounts. memberalked with ranking michelle and his office. the veteran should not be punished for having a barrier between v.a. and dod. the veteran should not be punished for having nine different maps of organization structure. these are things we have got to simplify so that -- we have 14 different websites that require different usernames and passwords. but it know about you, hate keeping track of usernames and passwords for all these websites. you should be able to plug in the v.a. in the easiest way and get your care. that is what we are working on. and the ranking member of the

economic opportunity committee, member of theking economic opportunity committee, and i have a lot of concerns about the educational benefits. the for-profit college structure, and making sure there is not undo predatory savior -- undue for the tory behavior -- predatory behavior. >> it is very personal. we cannot allow people to take advantage of our veterans. it's really that simple. thatthrilled with the work was done in the new bill. i have told the chairman that. you have expended our ability to get doctors and nurses reimbursement for their study. we need more medical professionals. that was a really big win for us. i have been out to duke

university. i was talking to the dean of pennsylvania university medical school. two days ago, i was in san diego with the dean of uc san diego. these relationships for us are critical, and getting those doctors, nurses, mental health professionals in the v.a. is very important. >> i just wrote you a letter asking you for a plan on how we would use the medical residencies. on the a huge thing medicare-medicaid budgets. we have been frozen in terms of the supply of doctors. we have a supply problem with the med students. we have a problem matching them to residencies. i'm looking forward to your ideas and how this will help the broader community. the primary function is the v.a. it would help the rural areas, as well as impacted areas. it's very important.

we talk with congresswoman titus the other day about this. we are working to develop a medical school at unlv. we want residents to work for the v.a. at the las vegas hospital. these are critically important things. we will have to work together to get more medical schools contributing more graduates for our rural areas. i would offer that is something we would like to partner with you on. doctor? >> thank you, chairman. secretary, thank you for taking the job. >> thank you. >> thank you for your service to our country. i certainly appreciate that. i have said during these long hearings we went through that if you ask someone at the v.a. who they work for, they would say the v.a. the right answer was, i work for the veteran. you got that right when you flipped that chart upside down. i appreciate the fact that you just said you know the front of the airplane gets there only

slightly before the back of the airplane. >> i use to jump out of them. i would not recommend that. ori have done that a time two, and then questioned my sanity about why anybody would jump out of a perfectly good airplane. >> particularly a doctor. >> yeah, why would you do that? a question i was asked, our secretary would come in every year with budget -- do you have enough money to carry out your mission? do you have adequate staff to carry out their mission? that is a question you may not have time to answer right now. that is a question you will get next year when we go to the budgets. we want to be sure we provide the resources to take care of our veterans. the american people want the veterans taken care of. him mark -- we worked with on that, on the residency slots. i would like to personally offer you an opportunity [indiscernible]

let me tell you why. it is one of five medical schools. it actually was started with a team kristen bell. our medical students go to the v.a. campus every day. it's a very good model. maybe as we look at these shortages of physicians and we know doctors are creature of habit him a we stay where we are -- it's a great way to get doctors to stay and make a career at the v.a. he was a career v.a. dr.. -- doctor. i don't have any questions other than to thank you from taking the job. i'm from a great company. you have a great background. you run a big organization. i think you will be a great secretary. >> thank you, sir. 70% of doctors in the united states have worked for the v.a.

at one time or another. the best operations we have, at least in my 50 day review so far, are those connected with medical schools, whether it be our palo alto facility was stanford, our durham facility with duke, our philadelphia facility with penn. we want to do more of that. it's a great way, and we all benefit. >> i am going to selflessly promote -- >> in east tennessee, of course. >> is one of the top five primary care of putting doctors in rural areas. >> we need that. >> it is one of the things he was talking about, getting people out to rural areas, which is real. it is a challenge for us. are veterans are moving more to rural areas than urban areas. this situation will only get exacerbated. >> 10% of my district are

veterans. big number there. >> it's a strong primary care school, if i recall, and definitely on the list for a visit here and -- visit. we want to thank you and here -- everyone here. we think we have got the best mission. >> long-term, it's a great method to do. thinking 10, 20, 30 years when no one even is going to know who we were, it will provide that for the v.a. and for the veterans. i yield back. >> thank you. >> thank you, mr. chairman. thank you, mr. secretary, for being here. i certainly enjoyed my meeting with you last week and appreciated her a much. much.reciate it very i went back to the veterans in my district and said, you should have hope. i met with you and appreciate your can't-do and will-do

leadership style -- can-do and style, anddership sense of urgency around reforming and changing and making that cultural change, making veterans first within the ba organization. -- v.a. organization. one of the more global issues i want to raise with you in this hearing is in the time i have served on this committee, this has been extremely frustrating getting information from the v.a. and i hope, and my dream is that as you move forward and set up a v.a.,or change within the that we will all collectively -- we as members of this committee -- you at the bottom of your organization, and certainly the veterans -- we all can

collectively agree on the direction of the organization is going, and then set the appropriate outcome measures that we are looking for so that we can collectively monitor and watch and evaluate the progress as we move forward. is a very essential thing. it is really the only way that we can tell the american people that we are on track and we're are making progress. if you could just comment -- >> yes, ma'am. i want to be your partner, and that is why i'm sharing with everyone our road to veterans day plan for the next 90 days. strategicrenewing our land, which we are starting as a leadership team this friday doing, we will share it with you as well. i know from my confirmation hearing and from talking to the that communications has

been a challenge for us. frankly, some of the communications that have come to my desk i have rewritten myself because they have been totally -- i have been totally unhappy with our ownership for the problem. the chairman and i talked about trying to reorganize communications. got rob nabors to agree to come over to v.a. he is going to be our leader of communications. under rob, we will have a congressional communications with the vs so -- vso's. i wanted integrated so we are saying the same message, but that is not an attempt to centralize. what we talked with the chairman about is decentralizing so that you can go to the subject matter expert and get the answer, and it does not necessarily need to be cleared with one tip of a

funnel. i think what has happened in the past is the organization has done that. they have made everything go through one person. when you do that, it obviously back things up. everybody should be capable of enough to be able to answer. i would ask your indulgence, that you have to realize that if you got a wrong answer, it may be temporary or it may be incompetence, but the person is not trying to deceive you. you will work together to make sure we clear up any miscommunications -- we will work together to make sure we clear up any miscommunications. >> i am a strong believer in data-driven decisions. my two sense would be in terms of the data that will be presented to you is trust but verify. i don't think i have the confidence that the data that has been presented to us at

don't have the confidence there, and in some ways want to clean the table and start over again in terms of the data collection. i'm sure there is some good eta -- data that is there also. >> the point is they're getting the right values and mission in place, and making sure everyone looks at the lens of the vete ran. step three is getting the right culture in place. then we have got to get the right strategies. right now we have a group of onetegies that frankly no is working against. they are in a desk drawer somewhere. my test is, can i go to the lowest level employee or the highest level employee, and do they know how their work every day is tying back to caring for veterans? if they don't, stop the work. i had somebody bring to me a binder full of information the other day. i said, what is this for? one binder was a series of reports. i said, i have already seen this

information. let's stop doing it. another binder was testimony i gave at the senate hearing. why do i need to see my own testimony? we have got to stop a bunch of things, and then redeploy all of that effort against caring for veterans. >> thank you. my time has expired. i look forward to working with you. >> thank you, mr. chairman. mr. secretary, it's a pleasure to be with you today. i thank you publicly for taking on this task. in theit from living city of cincinnati, where procter & gamble is located and all the great things you have brought to our community with procter & gamble has benefited so many people. as you take on this job, there are so many things to consider. unfamiliarne you are with, and why so many of us for a while have been talking about needing an outside influence. we are talking about

acquisition, cost versus productivity, changing a culture , ensuring quality care and access to care. all these things that go into being successful. if there is anyone that can create a brand, it is someone who has been a procter & gamble. not only that you build trust with that and that will be the key. if you can build trust in the v.a. brand in the same way you have done tide, we will be in good shape. i appreciate your openness and ability to work with you every day. thank you. >> i look forward to working with you, and i appreciate the fact of the commitment of all the members of this committee which means a lot to all of us at the v.a. thank you, mr. chairman. thank you for being here. there is a lot of enthusiasm when you were appointed, and i think anybody who has heard you testify today will certainly have that feeling reinforced and

erase any doubts that you are the man for the job. we appreciated. thank you for coming by to see me. it meant a lot that you had already taken time to visit nevada, both our service center in reno that has so many problems, and the new hospital. it shows that you are really personally vested in that, and we appreciated. it has been nice to hear all my colleagues talk about our bill to create more residencies in the hospitals. out again as we talked about in our meeting that we want to be sure that those residencies don't just owe to the big hospitals that already exist, but really go to the places where they are needed. there are areas that are underserved, and that was the real intent. we want to be sure they do that. also, we are very supportive of your note of -- motive of reorganizing the geographic regions.

las vegas is in several different areas that just don't really make much sense. with the could share committee and for the record some of the things you told me about the new emphasis on women they are because silent veterans. they have had serious problems. one in four hospitals does not have a gynecologist. that is a new priority of yours, which i'm very supportive of. maybe just put on the record some of the things you are doing their. >> yes, ma'am. thank you very much. we look forward to working with you. i know that apportioning those additional residencies will be very important. theave got to go to where puck is going to go, rather than where it has been. we have got to get after that. we will work with you on that so we are making a decision together. relative to women veterans, this is critically important. right now we have about 11% of

veterans are women, but the percentage in the army or in the armed forces is much, much higher. it is going to increase over time. many of our facilities were built in the 1950's, when we were virtually a single gender army. when you think about the kinds of equipment we have, when you think about the kind of doctors we have, you are right, we need to hire more ob/gyn's. we have got to get ahead of this. it is quickly becoming an issue for us already. one of the things we have also done is many people see the mission of v.a. as articulated in abraham lincoln's second inaugural address where he said, for him who are born in the battle, for his widow, and his orphan. we have changed that. we have paraphrased it. if you look at our mission, the way we call it out here in our 90 day plan we say -- better serving care for those who have theirthe battle, for

survivors. while this seems like a modest change in words, it has meant a lot to our female veterans to know we are looking out for them or we are thinking about them. we've got to get ahead of the things we need to do so that we are able to meet the capacity. maybe dr. clancy can talk more about this. i know it is a particular area of interest to her. >> i would agree with everything a secretary just said. it is a very high priority for us. it has changed a lot in recent years. we are not going to slow down until every single facility has got a top-notch women's health coordinator. coordinatorsalth across the system just got reinforcement of all the training they get to make sure we are meeting those needs. it will remain a high priority. thank you for your continued support. we can see where the numbers are going, as the secretary just noted. take you, mr. -- >> thank you, mr. chairman.

i echo my colleague's comments. thank you for serving. >> thank you. >> my predecessor was here for 43 years and one of your assessors canceled and said, don't take this job. you will not be able to change the v.a. i will never forget that. i know the challenge you face. concern andpress maybe give you an opportunity to revisit your exchange with my colleague when he asked about whether you believe that the waitlist contributed to the deaths of veterans. i understand that is a hard question for you to ask. if we are talking about changing the culture, it is an important one. you have spoken a lot of organizational changes, but as you step in to this role, do you believe that the negligence of the v.a. haskin to be did to the deaths of veterans over the past several years? >> it's very simple. there are veterans who have not

had access. there are veterans who have not gotten proper care. i don't need to go any further than that. >> there is a problem. [indiscernible] >> i got a little heated in the last exchange. i should not have. [indiscernible] >> what value is there in having this discussion? >> that speaks to the cultural change at the department. i understand the administrative changes and organizational changes and i think it is needed. gibson, when he was acting, sat there and apologize to the congress and the american people for the failures of the department and what it led to for veterans. you got in an exchange with mr. lamborn. to me, that is not a cultural exchange. that is going backwards. nobody wants this on their fingertips. you were not there. i get that. i'm not holding you accountable. in terms of the culture you bring to the top leadership post at the v.a., do you believe with

conviction that the waitlist problem contributed to the deaths of veterans or do you not? i in my opening statement said i apologize on behalf of myself and the veterans administration. i have said that in every testimony i have given. i have said that when i have gone out to town hall meetings, when i have talked to veterans. i own this. it is not because i wasn't there. i own this. i would not have taken this job if i thought that somehow i could not own this. i own this. i am committing to you that i am going to fix it. i don't know that you can ask for a bigger commitment than that. >> it's a very simple question. i'm asking you to acknowledge that the waitlist and the negligence of the v.a. contributed to the deaths of veterans that we have had hearings on for six months. that ii'm acknowledging own it, that they did not get the proper care, and that we need to improve. >> ok. well -- >> and not getting proper care has adverse effects. >> i very respectfully will take

that as an answer. i don't think it is a complete answer. i don't think it is a technology that of a cultural change that you continue to espouse, but i understand why you need to guard your words carefully in a public hearing and in front of the press. hopefully privately you can acknowledge that the negligence of the v.a. has led to the deaths of veterans. >> let me again say that i own this problem. my west point classmate -- he is a great leader. it, and he is helping the organization own it, and i am too. if we don't own it, we can't change it. >> i appreciate that and look forward to working with you. >> mr. kirkpatrick? >> mr. secretary, thank you for taking the job. thank you for visiting the phoenix facility as your first stop after you were confirmed.

that really gave a message to our veterans in arizona that you care and you are paying attention. i want to focus on accountability. our committee has heard from people who say, they are getting excellent care at the v.a., and the employees at the v.a. care about veterans. many of them are veterans. i'm sure you are familiar with that anness model organization is only as good as its weakest link. we know there are weak links in the v.a. i want to get your thoughts about how you ensure there is continuing accountability. i want to tell you some of the ideas we have heard. if you could comment on them. one is rolling audits. review by a neutral party. of setting up a blue-ribbon committee that would develop a strategy for the v.a. flagstaffeteran in

who talks with me frequently about the idea of a volunteer board of veterans who really don't have any connection with the administration at all, but serve as a sounding board and a way to solve this. i have introduced my whistleblower protection act, which includes an anonymous hotline for patients and employees to report things. would you give us your thoughts about that? >> i think accountability is a huge issue. it has got to be a big part of the cultural change. one of the things we have done is we have talked a lot about it or it -- it. we talked about this concept that i mentioned in my prepared marks -- remarks. it is about giving day-to-day feedback. my standard is that an individual would never need to be fired unless it was an egregious activity, because you are providing day-to-day feedback, so that person should never be surprised.

that should be the standard. ,elative to external groups secretary gibson hired jonathan perlin, who was the chief medical officer that joined us in developing the blueprint for excellence for the hospital network. that was to bring outside benchmarking into v.a. we are very much in favor of that. the new bill provides for a commission which we will help stand up. rejuvenate some of the 23 different standing committees we have, which are supposed to help the secretary. there are 23 of them. one could argue maybe that is too many. there are 23 of them. i want to re-energize those, and get the right people on them. dr. clancy and i are in the process of hiring new doctors and nurses and clinicians to help us.

we want to do exactly what you are saying. the most important thing for me is we have got to get every single employee in the organization to feel accountable for the outcomes of that veteran. rather than worrying about the internal workings of v.a. >> let me mention one of the more troubling things our committee has heard, and that is bonuses. poorly stillrform get their bonus, and there is this sense of a bonus is an entitlement to the employees. what is your plan to address that? what is a good use of bonuses? tookputy secretary gibson the immediate step of resending the bonuses for 2014 -- rescinding the bonuses for 2014. he took the 14 day metric out of people's performance plans. that was helping to cause people

to behave in the wrong way based on [indiscernible] and reviewedack what can we do about bonuses. in the private sector, there is something called the clawback provision. if an individual receives a --us and you later discover you can clawback past bonuses to do that trade many audit committees which i have served on have put rules in place to do that. in the government right now, there's not a potential for clawback because apparently when the law was written, the law was written in such a way that when the political parties changed, you did not want to allow the new political party to claw back from the past political party. i have got to get into this in more detail. that's the way i understand it right now. that's the practice in the private sector. >> thank you, mr. secretary. we look forward to working with you. >> mr. secretary, there is a bill that has been filed, and it

allows you to do just that should we be allowed to pass that through the full house and onto the senate. mr. o'rourke, you are recognized. >> i want to join my colleagues in thanking you for your task of bringing the v.a. back to where it should be. a lot of thank you for meeting with me. meeting and the issues we discussed and your follow-up to those items, including an e-mail to dr. clancy. it speaks very well of your ownership of these issues, your attitude of accountability, and some of the things that we will have to look forward to on the bigger issues confronting the v.a. i appreciate your commitment in our meeting to ensure that el paso which is one of the worst, if not the worst operations in the v.a., becomes the model.

you have no greater opportunity to present turnaround. show the example in el paso and get your response. following what we learned in el paso, despite the assurances to the contrary, we learned that veterans cannot see medical care. the average appointment was scheduled and canceled at least once. only have the audit in the spring, we learned we were the worst in terms of seeing a doctor or provider. second-worst for specialty care. we have that attention. had $5.2 million in additional funds. of visit theairman v.a. in el paso.

we had another visit the v.a. we have primary care teams come up mental health care teams. yet, when i went there two ten go by andi of greet the veterans of the parking lot -- i met a number of people who said they had excellent care, one treatment, thumbs up. one was very glaring to me. a gentleman who said i was given an appointment today and that was months back that i scheduled it. i called yesterday to confirm the appointment. this was a mental health provider. we have yet 1:00 tomorrow. the gentleman shows up and i don't know how hard it was printed travel there buddy gets to the v.a., shows up for his appointment to be informed that the doctor no longer works there and hasn't worked there for a month.

with all of the attention i've been bringing to this issue, for us to fail does better in that badly is indicative of a deeper, larger issue. the 20 ig reports ansince 2005, all of us, the administration and congress have known about it and yet we have not resolve these issues. to mr. jolly and others who brought up this point -- answer that concern we have about culture. we threw in el paso, money into the fund. there is a deeper cultural issue. how do you address that? in a minute and a half? >> cultural changes is very difficult to achieve. it starts with the mission and the values.

it starts with the mission. . secondly it starts with behavior. i have to get to el paso. inhink there is a big issue the openness or lack of openness and the organization. how can you have a situation where employees were lying to one of the most honorable man i have ever known in my life in general shinseki? why would that exist? why would that happen? would we have meetings where union leadership was not involved or were not invited?

why would we have people feeling the other owner recourse was to be illegal whistleblower? hall meetingswn and we did that, some of the feedback is that we cannot hold a town hall meeting. it would be counterproductive, violent, whenever. that is exactly why we have to do that. we need to have communication moving. me to get ownership for the problems and get people feeling responsible because in the end, the only thing that matters is the veterans. this will take time and we will build into our strategies. what i think about a high-performance organization, it starts with mission and values. we need to look at the leadership and see if we have the leadership to create this new culture. as a leader is unwilling to embrace this new culture, they should not go on the journey with us. to we have the right strategies order to make itein happen? do we have the right systems in place?

a system so that if you ask me how this can happen -- the scheduling system. do we have the right high-performance culture where people work on veterans issues? it will take time. i really do believe we can do it. >> let me just offer my -- if you are missing legislative authority to do anything that you are talking about doing to turn around and improve the culture of the v.a., hope you will come to us as quickly as you know that. we will be your partner and offer that legislation and get it passed. >> thank you. >> thank you, chairman and mr. secretary for assuming the sacred trust an awesome response ability. i am grateful you are there. i think restoring that trust is one of the first and paramount things. you scored big points with my chief of staff who was a minnesota hockey player with your reference.

coaches talk about pursuit angles but it is the same thing. where do we need to anticipate? i have been saying for a long time i never understood as a military person myself why there was no equivalent of the defense review? secretary hagel -- i was thinking about this. i went back and look at the 1997 100 then secretary cohen. we are dramatically safer than the cold war but wildcard threats are able to happen. once the eastern european thought was gone, we begin to be able to prepare for those things. the v.a. does not have that. here we are trying to figure out and adding a whole bunch of veterans from iraq and afghanistan. i would encourage you whatever that form looks like, this is something that would help you

with this need to get that there and give you that guiding document. it would force us to go back a periodic basis to get that done. i would encourage you to do that and i would say you are at a unique perspective. let's do the reforms. let's break the barriers. let's crush this thing. it is hard to change culture but here is what i would say. if not you, who? if not now, when is this ever going to happen? if the country thinks this is important, if all of us believe this is important, let us get there. i would be interested in hearing your thoughts. this falsebreak down construct of government versus the private sector. if the private sector can deliver and work in conjunction, quit that argument. that it is us versus them. this is our veterans try to get it right. how do we speed collaboration?

a great medical institution but also in a rural area. how can you ring your experience &g to break down this ridiculous us versus them on the care of our veterans? embracell strategies. we have to partner with medical schools as we have already talked. we have the partner in the private sector. we have to part with members of congress. the important thing is to figure out everybody's role and to create a system which takes advantage of that. i will give you an example. i was in las vegas -- congresswoman titus's district. we were very close to nellis air force base. the doctor cannot keep up the medical proficiency without seeming v.a. patients. they don't get a bottom left prie -- a broad enough piece

of work to see pilots at nellis. it is great. we have the d.o.b. doctors coming to the v.a.. the doctors at nellis love it. one of the things i did in preparation for this -- not this hearing but for the role -- to get a map of all the federal facilities in the country. i know most of the private facilities because we have a health care business at procter and gamble. figuring out what is the right combination where we don't have those ob/gyn's that we talked about, we can borrow them from someone else or dod. indian health service has some terrific facilities. these other kinds of things we want to do what our strategic work -- to figure out what is the right combination of these things. we will be local. trying to figure out what the right combination is. is there something we can do

whether it is credentialing or whatever it is? some of these things are difficult and tough. i and her stand that -- i understand that. i have been frustrated with the flow of information. i recognize the incredible work that has been done. if this is the glimmer of the potential last week in minneapolis -- a whistleblower. we have in working with them. this happened on a friday night and on monday there were people on the ground addressing this issue. there was a real sense of collaboration with both the public, the veterans, congress, all of us working together. work and we fill the gap and how can we fix it? i am seeing that and i fear it much appreciate i see that as a partner trying to fix it as was the press, as was the whistleblower in this case. we will see what goes forward. we cannot be afraid to point out our failings. we cannot be afraid to work to move forward.

>> if any member of the committee senses they are being treated as an adversary, i was like to know that because we need to partner with you to make these changes. >> thank you, chairman. >> thank you very much, mr. secretary, for being here. thate very appreciative you would be willing to stand in who needor those leadership. we reiterate it is our desire to stand with you as a full partner in serving those who have worn the uniform of this country. do you have a closing? >> i want to thank mr. secretary for coming in working with you. i agree with everything sherman milledge a set. thank you very much for your service. >> i look forward to working with you all. i know every person in the v.a. does as well. >> thank you, mr. secretary.

>> the hearing continues now with the phoenix v.a. health care system's chief of staff who was joined by the chief of staff of the veterans health-care administration. the testimony adjustable under one hour -- the testimony is just under one hour. >> thank you very much. this is the third and final panel. we are setting up the nameplates. that will tell you who we are going to your from. dr. leavitt -- dr. lisa thomas from the health administration. dr.thomas is accompanied by darren deering, chief of staff of the phoenix v.a. health care system. if you would, i would ask you to stand. i was trying to catch you before you sat down. raise your right hand. do you solemnly swear under penalty of perjury that the testimony that you are about to provide is the truth, whole

truth and nothing but the truth? thank you. let the record show that both witnesses responded in the affirmative. secretary mcdonald has already provided an opening statement. on behalf of the department of veterans affairs. a will move directly into round of questions. -2013 up a silly director to certify compliance with the v.a. policy further reducing

accountability overweight time data and integrity and scheduling practices. are you familiar with that? >> yes, sir, im. am. >> did you approve the waiver? >> no, i did not. you knew the waiver was given. >> after the fact. >> what action did you take after the fact? recognizing there was a real problem. >> in the spring of this year, we realize we really missed the boat. the situations regarding care were more of a systemic issue rather than looking at each case individually. in the spring of this year when we went back to the memo your referenced, it was prior to my tenure of chief of staff.

i went back and looked at that. it was hard not to realize that we had this memo talking about our scheduling problems and the gaming of the system. we looked at that and the relationships to all of the other issues that were going on around the country. we realized too late that we had a systemic issue. we should've taken a holistic approach at looking at it rather than looking at each individual one. >> we have the original inspector general report on phoenix. we have the one that be a released -- the v.a. released. there was a crucial change in the language in the executive summary that said the physician whose allegations this committee

did not tell the inspector general the 40 names of the veterans who have died. this gave a false impression right up front about the whole matter was untrue. so, my question to you is do you have any idea that language like this was going to be inserted in the ig report? >> i did not. let me see if i can find it real quick. according to your fiscal year 2013 performance review, by the 500 is what you received on your review. perfect. one of your responsibilities as a veteran health administration chief of staff is being able to reports critical oig

that can produce negative media attention and ensure talking points in communication plans are developed before the final report was released to increase the department's responsibilities. can you give the committee a little idea as to how that works? >> absolutely. i would like to say that we sincerely apologize for all of the veterans. know better and should ever have to wait for care. it is unacceptable for us. we did get the ig report and several drafts and in each draft phase, it was our responsibility to make sure we have accurate communication plan so we can communicate to all of our people what we will do to fix it. we focused more on the looking at what we are going to do on the action plan than the actual ig report.

we have a server that is responsible for looking at that and making sure everyone looks at the report and if there is anything factual that needs to be corrected, they provide that information. what we also do is making sure all the experts come together to identify what is the corrective action that is needed so that we can meet the needs of veterans. the communication folks that report to me were doing that every iteration. each iteration of the report we were trying to highlight for them what was the difference from the last report to the next report so they can accurately and very efficiently get a communication plan together. one of the changes was the change from 20 recommendations. the consolidation of individual recommendations regarding ethics. highlighting those makes it easier for them to be more responsive to have a document put together so we can

communicate to all of the veterans and the public and stakeholders exactly what was found. >> i ask you to pause. members, we need to move to the floor. we have less than five minutes to get to the vote. we will be back as soon as we can. >> committee will resume its hearing. we apologize to the witnesses. that will be our final interruption of the day. dr. deering, thank you for attending. i would like to know if you're

reached out to any of the whistleblowers about resolving their cases and if so, how many have you done? >> i have not cursorily reached out to any of the whistleblowers at the phoenix v.a. about their specific cases. >> would that be something that you ordinarily would do or what somebody else do that? >> i believe someone else is working with them on their cases. >> in a normal course -- i understand phoenix is somewhat of an anomaly. normally, would you be the one that would reach out to whistleblowers or? >> certainly, i have that other employees well brought up concerns. i work with him closely to address those. had an employee about two weeks ago send me a message on my personal cell phone saying she has concerns that she would like to discuss. to didn't feel safe talking them about work and i met her

off campus to discuss those issues. >> have as -- has anybody advise you not to talk to whistleblowers? >> i have not. that the 290 three deaths have been identified by the office of the inspector general, how many needed disclosures? don't have that information because i have not reviewed those cases specifically. how manyave to see would require additional disclosures. we are in the process of reviewing the 45 cases that was outlined in the report to see which of those would require additional disclosure is necessary. >> you are the chief of staff of staff of the phoenix health care system and you don't know if there are institutional disclosures? the haven't been provided specific names of those 293 veterans, sir. that list of names and we have conducted disclosures

on. i don't know what those happen to be on the same list. >> let's go this way. how many institutional disclosures have been made at phoenix in the last two years? >> in the last two years, it is around six or seven disclosures that have been conducted. >> say that number again. >> around six or seven. >> did you order oig report case number seven scheduling an appointment with primary care counsel to be removed from his chart? question? repeat that >> report case number seven which was in the report. there was a scheduling appointment with primary care but it was removed from a chart. my question is did you remove this from his chart or if you did not, who did? instructingrecall

anybody to remove a consult from somebody's chart. specifically, case number seven, i don't have that patient demographic. i would have to look at that. >> who at phoenix can remove those kind of records or wipe a chart clean? >> consult typically are not removed. their discontinued or canceled or completed. even if they are discontinued or canceled, they would still stay in the veterans chart and it would show they are discontinued. wasrimary care appointment taken off of number seven chart. again, i am trying to get to the bottom and find out exactly what happened. utam?ayer h reported health and safety issues to leadership and was fired. i am sure you are aware of his firing. -- did shes fired by

ask or require you to do a board on the doctor? i regarding the doctor, don't recall them bringing safety concerns to my attention. regarding his termination, a summary review board was convened to look at his case specifically and make a recommendation to the director. but, you did conduct the board on him? >> i did not conduct the board. i convened the board and was ran by another physician. >> can i ask you a personal question but i think it is pretty simple after all that has happened at the phoenix v.a. medical facility? how is it that you are still employed there?

>> sir, that is a fair question. may, i grew up in the v.a. my father who was a veteran passed away in october and received all of his care through the v.a. health care system. i have memories from being a child growing up in waiting rooms where we would often show up and wait all day for an appointment and often be turned away. v.a. afterork at the training there is a medical student, an intern resident. dr. foot was my attending . i worked one year in the private sector and i came back to the ba when i had the opportunity. i have committed my whole career and a lot of my personal life to trying to improve the v.a. the phoenix v.a. is certainly not perfect and i said that before. i don't think any health care system is perfect. we certainly have made mistakes.

we are learning from them and moving forward. a good example of the interim report came out from the inspector general. we helped lead the initiative to help those patients get into care and contact them and get them in. i am very committed to this mission and to the cause. i've spent a large part of my life either as a child growing up or as a trainee or student or as a provider in the system. i believe in the system. thank you very much, mr. chairman. aware ofs, were you the 18 director report of january a 2012 and again in may of 2013 that found the phoenix health care system was using unauthorized scheduling practices and not complying with vha's scheduling policies? of what was aware

cited in the media and we asked for a copy of it. >> is it your job to ensure that phoenix complies with the vha's policies? >> i think it is all of our jobs to make sure we have a system that has policies in place that we can implement. we need to improve our oversight to ensure that it is following policy. that is one of the things that we are looking to change as part of a changing culture to make sure we have the appropriate oversight in central office to make sure that things are happening the way they should. >> can you explain to the committee what your job is? >> i can. beste chief of staff, the pixelation i can think of is i am focused on being the adviser on the undersecretary. i am like an air traffic controller. fly anyget the

plans, i am not responsible for them taking off or landing -- i make sure all of the plants are flying on time going in the right direction. i need to have a broad understanding of everything that is going on. ifortunately, that means cannot control all of the areas and know in detail. >> looking at the planes as they --e off and land possibly phoenix, arizona was not compliant with vha policy. not complying with it. you set a path for them to follow and did not follow it. who is responsible at vha? the undersecretary or your job as chief of staff or is your job as chief of staff to be a -- to make sure the secretary understands what is going on? >> i think it is all of our

responsibility in central office. if i could, i think when the first panel was here you asked a very important question and you said what we do know is what happened, why did it happen, how do we move forward and how do we hold people accountable? that is really key. what did happen is we have an overly complex scheduling system and process which we are in the process of fixing. we have an undue performance on metrics. all of the performance metrics are related to the 14 day weight metric has been removed. we have capacity issues. the choice act which was recently passed will have us do that. we will hire 9600. >> since my time is running out, my big concern i have -- yes, we are going to find out how to solve the problem but if you are part of the problem and you knew that phoenix, arizona and other facilities were not complying with policy that was set by the

department -- that is a big concern i have. other committee members have is if you have been part of the problem, how my going to feel comfortable that you are not being part of the problem? >> unfortunately, we don't know the problems until the spring. we do not know of the previous commissionedwas and saw they had a problem. i am not sure where that system broke down, why we did not know. i know the change in culture, the secretary has set forth that, we will remedy it. >> did you see a problem with the undersecretary and the secretary as moving in the same direction or was there undercutting occurring between the two? >> i was very rarely in the same meetings with the two gentlemen.

i'll he knew what i heard the secretary say in with the undersecretary say what he would say. i was not privy to those personal conversations. >> my last question moving as the vha chief of staff, what have you done to make sure scheduling problems do not continue to occur? very majortwo initiatives we have taken on. the first one would be the access audit. that was very important for us to understand if this was an isolated instances around the country. if we had more persuasive -- pervasive and systemic issues and that is what we know now. theaunched into accelerating access for care to make sure we can put resources for all the veterans that are

waiting for care, anybody that is waiting more than 30 days. after he reached out to every single one of them and offer them to come into care earlier or refer them to community for care. those who we cannot contact, we made three attempts by phone, we sent a letter and work with our nurse to try to locate those veterans. we are taking those extra steps so we can identify so we can bring them in for needed care. >> i know i am a little overtime, mr. chairman. do you think that there is too much autonomy in the business level and that is part of the problem as far as following the directive from the secretary or undersecretary? >> my opinion is that we are not well standardized. pop -- a lot of people talk about centralization. we can consistently provide quality health care and all of the veterans whether they are in

the large cities or areas. >> your recognize. >> maybe it is just me but trying to understand what is being reported can be very difficult at times. there are 41 individuals that receive.- you did not the records that get reviewed by the report. is wes disturbing to me have student rosters including employees from the office. andils on purchases training using a book called " how to lie with consistency. it misleads yet cannot depend on

you. one of the techniques described in this book -- technically are caught for being employees. i think it might've been used here. this is a chart provided to us by dr. deering's office that led we committee to suggest that have a be a problem with not enough employees. if you look at the blue, look at the increase in the number of patients theeds of green line is the number of -- when you put the two charts together, they are in different scales. they're about even. the averageat and

american looks at it and says we have not enough money were not enough employees. .ook at this graphic you look at what your employees are learning from and the book my question is who were traded what to beast that's what appears to be a purposeful way to deceive? , from whatg the book i recall, that was actually coaching sessions. i was uninvolved with purchasing that book. the graph is part of our congressional briefing to the local delegates. there was no intent to mislead anyone. we were trying to outline the framework how we got to where we were in phoenix. >> why would you do two different scales and put them together? that is very misleading because of the use the same scale, the

growth in the number changes. >> the intent was not to mislead. >> what is the intent to show? >> the intent is that we have had a continued growth in the outpatient setting in a number of patients coming into our facility. when you look at the increase, it has gone up a little bit. back in 2010, my personal belief is that we did not have enough personnel to meet the needs. we were in the process of hiring. >> why would your employees be learning from a book about how to lie? book.t is a title of a i don't -- >> there are employees from your office that are learning from this course. you have never seen this book before? >> i have seen it, i have not read it.

>> heavy senior employees? -- have you seen your employees? when did you see the book? >> i saw during the coaching happened. >> you are using this book to mislead? >> not at all, sir. >> describe why would you would use a book like this that would demonstrate how you can misuse statistics and other backgrounds? misuse statistics to mislead folks? can you describe why you would be coaching folks? >> i did not coordinate that training session. i don't know if they were trying to teach people how to notice when statistics are not being used appropriately. i don't know what the content of that book is teaching people how to notice when people are being honest or if it is teaching people how to lie with statistics. i don't know what the intent of that book is.

>> visits from your office. this is very misleading. it is difficult as a policy maker to get the facts of the matter. we heard a few alere's ago that's a few hours ago, we were trying to figure out how many folks ron the waiting list. the numbers were very confusing. there has been enormous growth. there has not. it is a scheduling problem and we have heard that again and again from the oig and from your office. i think that is very misleading. i appreciate the time. of followo difficult what the numbers are actually our. are. the numbers don't matter anymore because it is driving bonuses. how many times have you had bonuses?

[indiscernible] let's be very careful with what we see unless it matches up with reality. can you fix this chart to put it scale? same >> thank you. dr. thomas and dr. deering, the sinceee has a lot of -- this problem has been brought to our attention, we want to get to the facts. it is not that we want to harass you but we need to understand the whys in order to help craft a policy that makes sense. issues hasuzzling been the memo of 2010 that outlined all of the scheduling problems. do either ofity,

you are both of them you saw that memo and what happened next? first,n answer congresswoman. that memo was distributed prior to my tenure. that was in april of 2010 when the memo was sent. i started in 2011. i did not have awareness of it until we realized we were having ese issues around our system and started to do research and pulling the pieces together. >> thank you for that honest answer. dr. deering? >> my answer is very similar. i came into this position in 2012. prior to that, i worked as a n.mmunication i did not become aware of the memo until this crisis surfaced. >> at least that is helpful to

know because there is a problem in can indication in terms of checklists of things that need to be done to improve. i appreciate you are trying to identify the veterans that need care. i represent a large rural district in arizona. the vso's in my district are very willing to help you identify those veterans, especially on tribal land. we have vast areas where it is very difficult to reach veterans but they have reiterated to me over and over again that they are willing to assist a lo. we want to make sure they did get access to care. >> i am very happy to work with them as well to try to connect those veterans to care. we were talking earlier about rural health. the v.a. save my father's life -- he had melanoma.

there was not a dermatologist within 60 miles of our home. le toocal v.a. was ab get him care in st. louis and this was in 1992 or 1993. the v.a. leverage that type of tool to give care to my father. i am more than happy to talk to you afterwards. >> i appreciate that. i yield back the balance of my time. >> prior to your current role, you see started in 2012. have you ever been a clinic director at a medical facility? >> a director of a medical facility? no. i was chief of the hospital service at the facility and was responsible for the care of patients. >> you have never been a clinic director or service chief of the medical to sit -- facility? >> no. >> were you aware of scheduling manipulation of any kind was

occurring before able nine when it hit? >> when a mccain chief of staff in 2012, we started working on improving access to the veterans. one of the things that we learned in that process was some carved outics had time in their day to do it ministry at work instead of patient care. we systematically started going through that process to standardize the expectations for frontline staff and the clinic. i don't know if i would call the manipulation but there were some providers working very hard seeing a lot of patience and some providers who had managed to block out parts of the clinical time to not see as many patients. i do not think that is fair to our veterans. the expectation to standardize that and go through to clean those profiles for the providers. unfortunately or fortunately in

the process, some of those providers felt they did not want to continue the journey with us and they left. others continued to feel like things were being left aside and made more fair in the process. and help to improve the appointment availability for the veterans. >> are you aware of the litigation that was placed on the phoenix records? remember, you are both under .have either of you deleted or removed any e-mail related to the scandal in the phoenix area? any communication at all? >> i have not. >> i have not. >> dr. thomas, there was a news report this morning on cbs news. are know if you are able to see it. citing a whistleblower in the central office who talked about

how v.a. officials sought to soften the inspector general of phoenix report. i want to paraphrase with a whistleblower said. the report would damage the organization which it did which is in for -- important for them to deliver information to soften the blow. did you ask or are you aware of any employee in the central i tog who asked the change the report are questioned about any language in the report? there are hangups on specific words and i get that. i will let you answer that first. yes or no? >> i am happy you asked that question. what the ig found. >> that would be a yes or no. >> it is more complex than that. >> my question to you is -- yes

or no -- did you ask for any changes in the verbiage? >> i did not. >> thank you very much and i appreciate doing that under oath. had you find out the burbage had been changed and what was your reaction? is a process we use with oig and we get draft reports. we begin to draft a response in terms of an action plan as well as the communication plan dated to go along with that. one of the iterations of the report -- i remember the very first report made no mention at all of the 40 deaths. the second or third iterations -- a paragraph arose on the new draft. it was a little confusing. i not sure what it was communicating. in the final draft -- we were

already working on our final action plan. we would go back and say what is different in this draft so we can then address it and update our data. the last draft we received did have the sense in the final report. >> what was the language that was confusing? >> there was a paragraph in one of the drafts that talks about the number of cases. --mentioned something about i don't remember off the top of my head exactly what it said -- he talked about the various concern. so many patients this, some indications that. i'm sure you will see those copies and see exactly what it says but i don't know. >> the changes were made in about the third iteration? >> there were changes in every iteration of the draft. >> we are talking about two specific changes. my understanding and i should've

asked this of dr. day when he was here. today there are numerous iterations that go back and forth. produced ahe ig report, gave it to the v.a., the and a final dash -- the v.a. reviewed it. aam to stand there was back-and-forth conversation between the office of the inspector general and i assume you. >> no, sir. >> who? >> i do not know. >> the secretary said in his testimony that he was not a party to the conversation. as the chief of staff of veteran health administration, you have no idea? >> i had no direct contact with the ig. >> that is not my question. my question is u.n. no idea who was involved -- part of your bonus and your of you specifically talks about oig reports and the negative impact

they may have and the life they may show. you are telling me you had no communication at all? >> that is correct. >> yet, you have a perfect performance evaluation and a double-digit bonus. you are not involved at all? mean?t do you i was not involved in many direct conversations with the ig about changing any portion of the report. i was involved with taking the report they submitted to us and making sure that we had a good action plan to correct the issues at hand and have a communications plan that clearly communicated to the members of congress -- action plan -- at one point, apparently there were two statements answer to the report. one was that dr. foot did not give the 40 names.

can you tell me why that would need to be -- >> i have no idea. >> i am trying to figure out why that would be in the report. the other was about conclusively cannot wish they have now said -- they can also say it did not cause death. at what point did you learn that was in the report? >> when we saw the final draft. >> the final draft? ok. it was in the third iteration? >> i am not clear how many iterations there were but i remer i saw three. >> they said there was five. >> i personally just saw three. >> thank you for appearing under oath and answering these questions. >> thank you, mr. chairman. if i had to stand the answer to your last question in terms of

dr. thomas. use all the iterations but were not able to make any amendment. they were just sent to you via e-mail or hard copy. can you describe that for me? reports, they are provided with is either on hard copy or on e-mail. they are stamped with instructions to guard it and use it for official purposes. when we receive that, we work with it. we have an organization within vha that is responsible -- >> sorry to interrupt. you answered part of that already. eyeing us then you have no idea who asked for changes that you received those adaptations. was there an e-mail distribution list or a blind copy to you? >> it went out to a number of people. >> can you identify a few other

folks that received the document? >> i don't understand the question. >> can you talk about the other individuals that receive the document? >> not view only. it is provided on e-mail. if we needed to cut and paste some words to be able to put into the action plan, we do not have to retype it. i missed in the concerns of the committee -- i understand the concerns of the committee. >> i asked the secretary. you seem to be the the one at the level. you saw the iterations. you have no idea who suggested changes. do you know who would suggest changes? >> i don't know. >> can you name one other person who received a copy of the draft? >> i would have to go back and look at my e-mail to see who was on there.

there was a listing on the e-mail saying who is who we sent it to and who is getting a hard copy because they wanted to limit the distribution on e-mail. it was such a high visibility case and many people will be interested in seeing several other drafts. >> i appreciate that concern. draft,ks reviewing the were they on your office? >> no. >> can you identify another office? thehere were a member from operations side of the organization. i am sure of that. >> public relations, did they get a chance to review it? >> absolutely. the committee cases office that reports to me receives each iteration because they need to start working on the communications plan. we need to work very efficiently. we cannot wait for it to publish

and have them work on the report. . >> has a report like this been leaked like this to your knowledge? >> there are a lot of things that are leaked. >> do you have any policies against a leak? >> absolutely. >> if somebody is leaking or authorizing that -- what is the punishment? >> absolutely, they should be held accountable. >> what is the punishment? >> i have to work with our hr experts to find that out. if the individual had prior disciplinary actions because we have progressive actions. if they have committed prior acts, the discipline that would be impose would be stronger if it was a first-time offense. >> dr. deering, i want to ask you specific questions. i am trying to understand what was going on in phoenix. the oig report identified, for

example, 1800 individuals. did you know there were any folks -- were you aware there was a list? >> i was not until chairman miller dropped the concerns up on april 9 and we started to see what was going on. >> when did you find out there were 1800 names on the list? >> it was sometime in late april. disclosure after the of the information from chairman miller. inthere are a lot of things here. --n did you become aware some member of staff was printing out a scheduling request and sticking it into a folder. when did you find that out? >> the same time i found out about the report.

>> what did you do about it then when you discovered that was occurring? was in it your responsibility to take care of this or somebody else's job? >> my role of the chief of staff is different from dr. thomas. at the facility level, the chief of staff is responsible for the clinical side of the house. the scheduling process you are referring to falls under the business side of the house. those were not my employees. i cannot speak to what happened with those employees, but i do know they quickly put a stop to that process and started educating staff about the correct process to schedule patients. >> there were 10 years of oig reports of scheduling practice. there was no quick stoppage to it. that is a real concern as well. those reports were out there in public for years before you took the job. i'm curious what happened to those.

i'm not sure about the numbers earlier in the committee. reviewed the documents and files and could be anywhere between three years of the report. thank you for your time. >> thank you, mr. chairman. dr. thomas, we have all the concerned about the antiquated it system. you stated that it isn't overly complex scheduling system. you're in the process of fixing that. i would like to know what that entails, what you are looking at and give me an update on that. collects absolutely -- >> absolutely. the first component is policy. we need to have a clear policy that is easily understood by all of our employees that they can follow. the second component would be the system to allow us to do that. weo know that just recently

made it easier for our schedulers and offered each one of them dual screens because of the i.t. system they are using which make it easier for them to do their jobs to have multiple monitors. andre doing interim updates fixes to work current scheduling system while we do a more long-term solution which would have an industry day lately and trying to get off the shelf solutions for our scheduling concerns. >> do you have any idea for your timeline for that? when you can get an off-the-shelf system and bring it back into the 21st century? >> i should know that. we briefed the schedule once a week but i cannot think of it off the top of my head. >> thank you. >> dr. thomas, you said you looked at three of the draft reports. any input to the

ig directly or through another staff person >> i did not. >> with this particular case, the level of publicity it has received, why did you not look at all sides of the reports? >> i don't think i had awareness. in preparation for them obviously i went back and looked through the history of what i saw and when i saw it, in my inbox, what i had reviewed. i could see the interim reports and the draft. >> so you made no comment to anyone else at v.a. as far as the report and changes you would like to see to v.a. employees? >> we had plenty of conversations about the report. t