taxes, spending we disagree on that, and there have even been people in this body that disagree that any violator of the fair labor standards act should get a contract but i certainly hope that those people who are repeated let me repeat, repeated and willful violators should be excluded, at least for five years. and i yield back the time that i don't have. the chair: for what purpose does the gentleman from new jersey rise? mr. frelinghuysen: i rise to claim time in opposition. the chair: five minutes in opposition. mr. frelinghuysen: mr. chairman, we all agree that bad actors who deny workers basic protections, including wage and overtime pay, shouldn't be rewarded with government contracts. funded by taxpayer dollars. but this amendment is unnecessary. there is a suspension in department process already in place under the current law. if an employer has a history of bad behavior including willful and repeated violations of lfla -- flfa, federal agencies know

about it and have the authority to deny that employer federal contracts. . a report by the nonpartisan government accountability office found that litigation stemming from such claims continues to be a significant problem. these aren't all bad actors. often they're employers trying to do the right thing but are simply tripped up by an overly complex regulatory system. mr. chairman this amendment was voted down in the transportation h.u.d., transportation justice, and veterans affairs committee and likewise it should be on this floor. i urge a no vote and yield back the balance of the time. the chair: the question is on the amendment offered by the gentleman from minnesota. those in favor say aye. those opposed, no. in the opinion of the chair, the

noes have it. mr. ellison: i ask for a recorded vote. the chair: pursuant to clause 6 of rule 18 further proceedings on the amendment offered by the gentleman from minnesota will be postponed. for what purpose does the gentleman from missouri seek recognition? >> thank you, mr. chairman. i have an amendment at the desk. the chair: the clerk will report the amendment. the clerk: amendment offered by mr. smith of missouri. at thed on the bill before the short title insert the following. section, none of the funds appropriated or otherwise made available in this act may be used to provide for defense counsel for any individual described in section 8101-c. the chair: pursuant to house resolution 303 the gentleman from missouri and a member opposed each will control five minutes. the gentleman from missouri. mr. smith: my amendment would prohibit funds from being used to provide defense counsel so foreign terrorists detained at guantanamo bay. simply put, mr. chairman, our tax dollars should not be going

to defend foreign terrorists. hard working taxpayers should not foot the legal bill of noncitizen terrorists who plotted to kill innocent americans. i recently visited guantanamo bay and learned firsthand of the outrageous amount of time these detainees spent with their taxpayer funded counsel. i've asked the department of defense to provide me with the exact amount they have spent on legal services for detainees but i have received no response. i'm sure millions have been spent defending these foreign terrorists. legal resources should be prioritized for american service members. the pool of judge advocates that represent those at guantanamo is a stand-alone unit, they're only to act as defense attorneys for suspected terrorists. meanwhile there's another pool

for american service members. why should they be used to defend foreign trysts when they could be used to defend our men and women in uniform. i'm confident most americans would agrow this could be better spent in the department of defense perhaps by making sure our service members are provided legal counsel ahead of noncitizen terrorists. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from indiana. mr. visclosky: rise to claim time in opposition to the gentleman's amendment. the chair: the gentleman is recognized for five minutes in opposition. mr. visclosky: mr. chairman, i rise in strong opposition to the gentleman's amendment. we have a constitution in this country. it contains language talking about the right to be assisted by counsel. and there are many other provisions relative to the

protection of individual human beings from the state. we're a very large country with approximately two million people in the military. i think one of the great foundational issues in the united states is to protect any human being from that incredible amount of power so that you avoid abuse. we've seen enough instances of abuse because of allegations of terrorists, many of whom are very real, mean, despicable people. but to now say that no one should have protection to make sure that that incredible power of the state is used justly and

wisely is absolutely wrong. we have had any number of members, our colleagues here yesterday and today on this bill offering amendments because they believe the department of nrbling made a mistake on uniforms for airmen. the department of defense made mistakes as far as whether or not we should move helicopters from one base to another. we've made mistakes as far as how we should have life-saving rescue missions for various aspects of the department of defense positioned throughout our great country. what if, god forbid, all these allegations that the department of state may make mistakes from time to time would actually have an impact on a human being whoever they are, and that in the last instance we don't give

them one iota of protection that we give to murderers and rapists and burglars and arsonnists in this country. i think it is absolutely wrong for the gentleman to offer this amendment. i reserve the balance of my time. the chair: the gentleman reserves. mr. smith: this amendment is clear. if you don't want american tax dollars to be used to defend terrorists who plotted to kill americans, vote yes. i yield back the balance of my time. the chair: the gentleman yields. the chair: did the gentleman yield back his time? -- >> did the gentleman yield back his time? mr. visclosky: we should be talking about the protection of human life and to make sure that that life, no matter whose life

it is is protected from the arbitrary use of power. and i again strongly oppose the gentleman's amendment that i think is just contrary to the foundational principles of the united states of america. we don't torture people. we protect people's lives in the united states. and now to withdraw any protection from them is absolutely wrong. i yield back my time. the chair: the question is on the amendment offered by the gentleman from missouri. those in favor say aye. those opposed, no. in the opinion of the chair the ayes have it. mr. visclosky: i ask for a recorded vote. the chair: pursuant to clause 6 of rule 18 further proceed option the amendment offered by the gentleman from missouri will be postponed.

>> mr. chairman i have an amendment at the desk. the chair: for what purpose does the gentlewoman from texas rise? ms. jackson lee: i have an amendment at the desk. the chair: the clerk will real port the amendment. ms. jackson lee: amendment number 177. the chair: clerk will report the amendment. the clerk: amendment offered by ms. jackson lee of texas. at the end of the bill, before the short title insert the

following, section, none of the funds made available by this act may be used in contravention of the authority of the president pursuant to article 2, section 2 of the constitution. the chair: pursuant to house rule 303, the gentlewoman from texas and a member opposed each will control five minutes. the gentlewoman from texas. ms. jackson lee: responsibilities of the president, thank you very much mr. chairman, and the responsibilities of the defense department continue in this new climate to grow. this has been a long journey in the defense appropriations process and amendments on the floor and i'd like to at this hour thank the chairman and the ranking member of the defense appropriations committee for their patience and as well their participation in the list of amendments that we've had the opportunity to present. i'm a member of the homeland security committee and therefore

see a lot of the new approaches -- i'd be happy to yield. mr. frelinghuysen: the committee would be delighted to accept your amendment. ms. jackson lee: i'm delighted and i will finish my sentence and yelled book. i thank the committee for accepting my amendment. i look forward to working with them on this issue. i yield back my time. the chair: the question is on the amendment offered by the gentlewoman from texas. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the amendment is adopt. for what purpose does the gentleman from new hampshire seek recognition? >> i have an amendment at the desk. the chair: the clerk will read the amendment.

the clerk: amendment offered by mr. guinta of new hampshire. at the obed they have bill before the short title add the following new section. section, none of the funds made available by this act may be used to propose, plan for, or execute a new or additional base realignment and closure brack, round. -- brac, round. the chair: pursuant to house resolution 303, the gentleman from new hampshire and a member opposed each will control five minutes. mr. guinta: i rise today to offer my amendment to the defense appropriations bill to prevent any funds from being used to conduct a new round of military base closures through a process known as base realignment and closure or brac. while president owhat ma continues to discuss another round of brac as another way to reduce defense spend, we know all too well the nellingtive impact this has on closing military bases for our communities, our states, our

national security and our military preparedness. for more than 200 year, the fort smith able shipyard has provided thousands of granite staters with jobs and continued millions in revenue for the united states navy. today, the shipyard has roughly 100 naval officers and personnel assigned to the facility. in addition, it employs ralphly 4,700 civilian -- sievian employees and offers an active apprentice engineer program in the area surrounding the facility. this is measure just helpful to our local economy and our military readiness. it is absolutely necessary to new hampshire. it's one of only four ship yards remaining in the country. each of these facile hi ties has a mission to overhaul, repair and modernize our nation's submarine fleet. these services are vital to maintaining fleet readiness. i urge my colleagues to vote yes to show our unwavering support

for our men and women in arms. thank you and i reserve the balance of my time. the chair: for what purpose does the gentleman from indiana rise? mr. visclosky: i rise to claim time in opposition to the amendment. the chair: the gentleman is given phi minutes in opposition. mr. visclosky: while i claim time in opposition i wouldn't express it that i would oppose his amendment but i do want to express some very serious concerns. the concern i have is that we do need to begin to think about future budgets for the department of defense. and as i mentioned repeatedly tonight we're going to have to start making some hard decisions and changes are going to have to be made and cuts are going to have to be made. i'm very concerned about congress' continued failure to confront the challenges we face at the department of defense and simply saying no, no, no and that we shouldn't even consider

any possible changes. the department of defense has continuously proposed significant initiatives to provide for future flexibility to meet our national security strategy. congress has said no no, no. i simply do not think we should foreclose any options to consider in order to possibly, god forbid save money in the out years. . a background is a reasonable approach that employs congress the abblets to say yes or no -- the ability to say yes or no. i would make the observation again that we have got to stop saying no to everything that the department of defense considers. in this case, i'm not even aware there's a proposal for a brac. let's say no anyway. i think we have to stop doing it. i yield back my time. the chair: the gentleman yields back the balance of his time. the gentleman from new

hampshire. mr. guinta: i certainly appreciate the gentleman's concerns. while i certainly hope that there is no background, there are concerns expressed by members relative to the president's comments in this area in terms of reducing defense spending. we gone through sequestration. i have seen first-hand the concerns expressed by the members and the civilian employees at the ship yard. they are the best and the brightest in the business. i feel very strongly that this is important to new hampshire and important to the defense of our nation. so i certainly share the concern and welcome the opportunity to look at the defense department to try to find efficient sis and effectiveness to make sure that our men and women are properly prepared, but i feel that a brac realignment would be inappropriate at this time and i would hope that the members would support this amendment and i reserve the balance of my time. the chair: the gentleman from

indiana has yielded back so -- mr. guinta: i'd like to thank the chairman, frellen hughesen, and the rest -- frellen hughesen, and the rest -- freelien hughesen, and the restth -- frelinghuysen, and rest of the committee for their hard work. i yield back. the chair: those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the amendment is adopted. for what purpose does the gentleman from kentucky rise? >> mr. chairman, i have an amendment at the desk. the chair: the clerk will read the amendment.

did the gentleman bring his amendment to the desk? the clerk: amendment offered by mr. massie of kentucky. at the end of the bill, before the short title, insert the following new section. section, a except as provided in subsection b, none of the funds made available by this act may be used by an officer or employee of the united states collection of foreign intelligence information acquired under section 702 of the foreign intelligence -- mr. massie: mr. chairman. the chair: the gentleman from kentucky. massachusetts meats i ask unanimous consent -- mr. massie: i ask unanimous consent to dispense with the reading of the amendment. the chair: without objection, the read something dispensed with. pursuant to house resolution 303, the gentleman from kentucky and a member opposed each will control five minutes.

the gentleman from kentucky. mr. massie: mr. chairman, the american people don't want to be spied on by their own government. our founding fathers included the fourth amendment for a reason, to require probable cause and a warrant before the government and government agents can snoop on anyone. during the 113th congress, the house of representatives passed the bipartisan amendment i am offering today by a 293-123 vote. this year our bipartisan group is reuniting once again to shut down unconstitutional surveillance that does not meet the expectations of our constituents or the standards required by our constitution. our amendment shuts one form of backdoor surveillance by prohibiting warrantless searches of government databases for information that pertains to u.s. citizens. the director of national intelligence has confirmed that the government searches vast amounts of data, including the content of emails and telephone

calls without individualized suspicion or probable cause. at this time i will submit for the record the director from the -- for the record from the director of national intelligence. the chair: the gentleman's request will be covered under general leave. mr. massie: the director of the f.b.i. has also confirmed that he uses the information to build criminal cases against u.s. persons. but the director of national intelligence and the f.b.i. are not above the fourth amendment and this practice should end. this time i would like to yield 1 1/2 minutes to my colleague from california, ms. lofgren. the chair: the gentlewoman is recognized. ms. lofgren: i thank the gentleman for yielding. in support of the massie-lofgren amendment. the declassified fisa court decision has indicated that substantially more warrantless communications are are collected through 702 than 215. we had a bill up to --

recently, the u.s.a. freedom act, that alleged that we would stop bulk collection, with you be-- but we didn't. during the markup of that bill in the judiciary committee we offered this amendment and everyone on the committee, including the chairman of the committee, said they were for this provision, but it wasn't the right time. well this is the right time. and that's why we have this broad support. it's the massie-lofgren-sensenbrenner-co nyers-poe-gabbert-jordan-o'rour ke, it's broad, it's bipartisan, it's supported by groups like the american civil liberties union as well as the campaign for liberty the demand progress as well as freedom works. this has broad bipartisan support and the american people deserve this. that when we have an interest in querying the 702 database for american citizens, get a

wrnt. that's what the fourth amendment -- warrant. that's what the fourth amendment requires. finally, this closes the opportunity to require back doors on technology. as has been mentioned earlier by technologists, to do that, just opens a door wide open for the bad guys and the hackers to break in. so i thank the gentleman for yielding and yield back. the chair: the gentleman from kentucky. mr. massie: mr. chairman as my colleague stated, our amendment also prohibits the n.s.a. and the c.i.a. from placing back doors into commercial products. this is important because in december of 2013 it was reported that a u.s. security company had received $10 million from the n.s.a. to use a flawed encryption method. our government should strengthen technology that protects our privacy, not take advantage of it. at this time i'd like to reserve the balance of my time. the chair: the gentleman

reserves the balance of his time. for what purpose does the gentleman from new jersey rise? mr. frelinghuysen: mr. chairman, i rise to claim time in opposition. the chair: the gentleman is recognized for five minutes in opposition. mr. frelinghuysen: marpe, i rise to claim time -- mr. chairman, i rise to claim time in opposition to this amendment. this amendment restricts the use of section 702 of fisa which is not currently up for re-authorization. the law does not sunset until december of 2017. any reform to this authority should be fully vetted by the authorizing committees, not inappropriately attached to our spending bill. this amendment would impose greater restrictions on the intelligence community's ability to protect national security and create an impediment to our government's ability to locate threat information already in our government's possession. such an impediment would potentially put american lives at risk of another terrorist attack. the house recently passed h.r. 3361, the u.s. freedom act,

with overwhelmingly bipartisan support. it was signed into law last week. this amendment would -- seeks to relitigate an issue fully litigated in the drafting of that legislation. a similar amendment was offered and rejected by the house judiciary committee during its markup of that bill. the u.s. freedom act does include two reforms related to section 702 collection. these were reforms properly considered during the authorization process, not slapped on an appropriations bill without consideration and deliberation. the first limits the government's use of information about u.s. persons that is obtained under section 702, that the fisa court later determines to be unlawful. the second provision requires the director of national intelligence to report the number of u.s. person queries under section 702.

under current law, a person can only be the target of an intelligence gathering under fisa pursuant to an individualized court order based upon probable cause. the intelligence community is allowed to query communications illegally collected from foreigners for information about a u.s. person so long as the query itself has foreign intelligence value. there is no difference from jish criminal law. if the government has -- judicial criminal law. if the government has an illegal wiretap on a drug dealer's cell phone and record as conversation where a second drug dealer talks about committing a murder, police can use that phone call as evidence against the second drug dealer in the murder trial. what matters is that the initial wiretap or the initial targeting of the foreign terrorist was legal. colleagues, this is an issue critical to our national security and it is complicated.

any changes to 702 should be fully evaluated and voted on using the authorization committee process which is the appropriate channel for considered review and debate on this critical issue. url unfortunately this emmed -- unfortunately this amendment has haas not benefited from the work of the authorization -- has not benefited from the work of the authorization processance would potentially put american -- and would -- process and would potentially put american lives at risk for a greater terrorist attack. that's not a risk i'm willing to take. for this reason and many others i strongly oppose this amendment, urge my colleagues to do the same and i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from kentucky. mr. massie: mr. chairman, how much time do i have remaining? the chair: one minute and 30 seconds. mr. massie: at this time i yield 45 seconds to my colleague from california. ms. lofgren: i thank the gentleman for yielding. the unclassified fisa court reported that the 702 search

had in fact scooped up vast amounts of wholly domestic information. how does this work? the upstream communications are tapped into by the n.s.a. and in the digital world your digital information, your domestic information is stored throughout the united states -- throughout the world. it's scooped up and it's used, the f.b.i. has indicated it's used, and the d.n.i. has indicated it's used for wholly domestic purposes without a warrant routinely. thousands, tens of thousands of times. it is in violation of the fourth amendment. it must stop. and i thank the gentleman for yielding and i'd just say on the judiciary committee, every member of the committee who declined to support this amendment said they were for the amendment and said we should offer it to the d.o.d. appropriations bill. i yield back. the chair: the gentleman from kentucky.

mr. massie: it's been said here tonight that this is not the time or the place to address these problems with 702. but, look, we have a constitutional crisis and this was an excuse we were given in the judiciary committee when my colleague tried to get the amendment allowed there. it was the same excuse i was given in the rules committee when we had an opportunity to address this. and i would maintain that 2017, two years from now, is too long to go in this constitutional crisis situation, where we recognize something that illegal and/or unconstitutional is occurring, yet we don't do anything about it. so this is the time to do something about it, this is the place to do something about it. i urge my colleagues to vote for this amendment and i yield back the balance of my time. the chair: the question is on the amendment offered by the gentleman from kentucky. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it.

mr. massie: mr. chairman. the chair: the gentleman from kentucky. mr. massie: i request a recorded vote, the yeas and nays. the chair: pursuant to clause 6 of rule 18, further proceedings on the amendment offered by the gentleman from kentucky will be postponed. for what purpose does the gentlewoman from north carolina seek recognition? >> mr. chairman, i have an amendment the desk. the chair: the clerk will read the amendment. the clerk: amendment offered by mrs. ellmers of north carolina. at the of the of the bill, before the short title, insert the following, section, none of the funds appropriated or otherwise made available by this act may be used to deactivate the 440th air wing -- airlift wing or to move the personnel or aircraft of the 440th airlift wing or to otherwise degrade the capabilities of the 440th airlift wing. mr. frelinghuysen: mr.

chairman. the chair: for what purpose does the gentleman from -- mr. frelinghuysen: i reserve a point of order on the gentlewoman's amendment. the chair: a point of order is reserved. pursuant to house resolution 303, the gentlewoman from north carolina and a member owes posed each will control -- opposed each will control five minutes. the chair recognizes the gentlewoman from north carolina. evplevpl mr. chairman, i -- mrs. ellmers: mr. chairman, i rise today to continue my fight against the air force's misguided decision to shutter the 440th airlift wing. as i have stated time and time again, removal of the 440th airlift wing injects avoidable and unreasonable risks to our military readiness. given the instability and uncertainty in the middle east and around the world, i find it baffling that the air force has chosen to close such an efficient airlift wing that provides critical training to special operations forces and units such as the 82nd airborne's global response force. i fail to

i fail to see the true cost savings or any benefits related to this shortsighted proposal and i will continue to work with my colleagues to pursue every option possible to flevpbt closure. furthermore, i find it troubling that the air force has hollowed out the wing before this. i will continue to work with my north carolina colleagues to prevent its closure. i reserve. the chair: the gentlewoman reserves. for what purpose does the gentleman from new jersey rise? mr. frelinghuysen: continue to reserve my point of order. the chair: the gentlewoman from north carolina.

mrs. ellmers: mr. chairman, i believe this is a necessary effort that we need to preserve the 440th airlift wing because it is vital and unique -- because of its vital and unique training mission it has at fort bragg with our paratroopers. our paratroopers have to be packed and ready at any moment for their global response force. i have paratroopers who live day-to-day ready to leave at a moment's notice, within hours, around the world and i believe that this, again is a shortsighted myopic decision on the part of the air force and i believe we need to be protected. i reserve. the chair: the gentlewoman reserves. mr. frelinghuysen: i insist on my point of order. the chair: the gentleman is recognized for the point of order. mr. frelinghuysen: i make a point of order against the amendment buzz it proposes to change existing law and constitutes legislation in an

appropriations bill and therefore violates clause 2 of rule 21. the rule states, in pertinent part, the amendment to a general appropriations bill should not be made tissue shall not be ined or fer changing existing law. the amendment requires a new determination. i ask for a ruling from the chair. the chair: does any other member wish to be heard? if not, the chair will rule. the chair finds that this amendment includes language requiring a new determination. by the relevant federal official of the -- of which actions would degrade given capabilities. the amendment therefore

constitutes legislation in violation of clause 2 of rule 21. the point of order is austinned -- is sustained and the amendment is not in order. ms. ill mers: i hope that the gentleman will help in this effort and i would like to thank his staff as well for all their effort and i will continue on this fight with my colleague to maintain the 440th. thank you, mr. chairman, i yield back. the chair: the gentlewoman yields back. for what purpose does the gentleman from california seek recognition? >> i have an amendment at the desk.

the chair: the clerk will read the amendment. the clerk: amendment offered by mr. rohrabacher of california. at the end of the bill before the short title add the following, section none of the funds made available in this act may be used to provide assistance to pakistan. the chair: pursuant to house resolution 303, the gentleman from california and a member opposed each will control five minutes. the gentleman from california. mr. rohrabacher: i rise in support of my amendment to h.r. 2685 which would prevent any funds in this bill from being provided to pakistan. over the last 15 years, the united states has provided pakistan with over $25 billion. the vast majority of which has gone to their military and security services. with this money, which we are giving them at a time when we are borrowing hundreds of billions of dollars pakistan is using it to subsidize

terrorists. some of whom are targeting americans. and just as bad, our largess enables pakistan to repress its own citizens. our military aid is being used to murder and brutalize the baluch and other peoples who are citizens of pakistan. the baluch people are being slaughtered as part of a campaign by pakistan in partnership with china to steal the natural resources of the people. with our money, the paks are in fact murdering and repressing their own people and they are ingressing upon their neighbors in afghanistan and india.

they are also as we have heard a much hyped cooperation against terrorism and i would suggest to my colleagues that this is a charade. this is the same pakistan establishment that gave shelter to osama bin leaden for years osama bin laden, the mass murderer of americans on 9/11 and the establishment of pakistan gave him shelter and gave him a place to hide all those years. making a fool out of us as we provided them money. in case there's any doubt that they knew about osama bin laden hiding next door, they rubbed our nose in their air gabs and hostility when they arrested dr. afriti, the pakistani doctor, who helped us find osama bin laden and bring him to justice. and as we talk tonight, dr.

afriti still painfully languishes in a pakistani dungeon while dr. a -- dungeon. while dr. afriti is imprisoned pakistanis should not get one cent of aid from our country. this is an insult to us and an insult to the victims of 9/11 that we are even considering giving money to the country which hid osama bin laden from us. much less giving them borrowed money. borrowed money perhaps from china. so now we see we borrow money from china, give toyota pakistan, with then gives it to china in exchange, of course, china is getting the natural resources of pakistan of the baluch people and they are in fact getting a facility in qatar. our tide pakistan does not make us safer or the world more peaceful.

they see it, the pakistanis and other enemies of ours, see it as a weakness on our part this payoff, we hope, of course, will bring more peace and pay the pakistanis off. no, it emboldens the pack stn iowa establishment in their criminal vibles against their own people and their destabilizing violence against afghanistan and india. let us note, if we want to have a peaceful situation in afghanistan someday, we cannot keep subsidizing the i.s.i. and military in pakistan which is primarily responsible for that mayhem that's going on in afghanistan. the people in afghanistan know that. and our own specialists know that. we're just hoping if we pay people off things will settle down. it hasn't accomplished that mission. we've emboldened our enemies by being stupid, by giving money to a country like pakistan which

obviously hates our guts. they hide the man who murdered thousands of people on 9/11 and then suggest they didn't know it and then arrest the person who helped us find that murderer. now -- i ask my colleagues to join me in prohibiting any more of this -- of our money, especial libor rowed money as we are borrowing it today from going to these people or committing in pakistan. that leadership that are committing crimes against us. the chair: the gentleman's time has expired. does anyone seek time in opposition? the question is on the amendment offered by the gentleman from california. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. the amendment is not adopted.

for what purpose does the gentleman from florida seek recognition? >> mr. chairman, i have an amendment at the desk. the clerk: the clerk will read the amendment. the clerk: amendment offered by mr. nugent of florida. at the end of the bill before the short title inset the following, section, none of the funds made available by this act may be used to require conventionally armed air launch cruise missiles, a.g.m.-86-c-d. the chair: pursuant to house resolution 303rks the member from florida and a member opposed each will control five minutes. the gentleman from florida. mr. nugent: i offer a simple amendment that would help keep america's strategic forces strong and robust. my ealt would make sure that the urs air force keeps the air launch cruise missile in their arsenal. that's agm-86 and it's variants c and d.

replacement missile, which i agree needs to happen, the long-range standoff weapon has faced continuous problems. at this point the replacement missile remains years and years away from feeling. i'd like to applaud chairman frelinghuysen and the committee for taking action in light of the numerous setback and delays of this program by appropriately rephasing funds in the underlying bill. with such development uncertainty i'm disappointed to say that further delays are almost guaranteed. in this high threat veerment with heightened russian aggression, their violations of the i.n.f. treaty which are now public and hostile chinese adventurism in the south pacific, we need to ensure this nation's defense is without a gap. we can't afford to take these weapons out of the arsenal at this current moment until a replacement is up and operational. it is critically we maintain our existing

inventory and with that, i reserve the balance of my time. the chair: the gentleman reserves. mr. nugent: i yield. the chair: the gentleman from new jersey. mr. frelinghuysen: i thank the gentleman for yielding. we admire his strong commitment and advocacy for this program. we're prepared to accept his amendment with the understanding that we need to study and discuss it with the air force to understand its full impact. mr. nugent: i appreciate the chairman doing that and would love to work with him. yield back my time. the chair: the question is on the amendment offer wid the gentleman from florida. those in favor say aye. those opposed, no. in the opinion of the chair the ayes have it. the amendment is agreed to.

for what purpose does the gentleman from virginia seek recognition? >> i have an amendment at the desk. the chair: the clerk will report the amendment. the clerk: amendment offered by mr. forbes of virginia. at the end of the bill before the short title insert the following. mr. forbes: i move that the we waive reading of the amendment. the chair: without objection pursuant to house resolution 303, the gentleman from virginia and a member opposed each will control five minutes. the gentleman from virginia. mr. forbes: mr. chairman this is the second part of a two-part amendment that deals with the deterrence fund. we began this four weeks ago

when the armed services committee put in this fund. we at that particular point in time transferred $1.4 billion to the fund, in addition to that we gave authorities for additional moneys to be transferred by the department of defense. four weeks ago we had 375 members who -- who voted in favor of that provision when it was challenge thond efloor. a few hours ago we had 321 member who was supported that. all of the same individuals are supporting this fund that did so earlier. i could repeat all of that but we've already done that so i would wrust say all the arguments we had earlier and all the people who supported it then continue to support it now and i hope the will of the house will prevail and that the amendment will be accepted and if not, i hope it will be adopted by the house. with that, i reserve the balance of my time.

the chair: the gentleman reserves. the chair: the gentleman reserves the balance of his time. does any member seek time in opposition? the gentleman from virginia. mr. forbes: mr. chairman, with that i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the question is on the amendment offered by the gentleman from virginia. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the amendment is agreed to. for what purpose does the gentleman from new jersey seek recognition? mr. frelinghuysen: mr. chairman, i move that the house do now rise. the committee do now rise. the chair: the question is on the motion that the committee rise. those in favor say aye. those opposed, no.

the ayes have it. the motion is adopted. accordingly, the committee rises. the speaker pro tempore: mr. chairman. the chair: mr. speaker, the committee of the whole house on the state of the union, having had under consideration house resolution directs me to report that it has come to no resolution thereon. the speaker pro tempore: the chair of the committee of the whole house on the state of the union reports that the committee has had under consideration h.r. 2685 and has come to no resolution thereon. the chair announces the speaker's appointment, pursuant to 22 u.s. code 1928-a and the order of the house of january 6, 2015, of the following

members on the part of the house to united states group of the nato parliamentary assembly. the clerk: mr. larson of connecticut, mr. david scott of georgia, ms. frankel of florida and mr. connolly of virginia. the speaker pro tempore: for what purpose does the gentleman from new jersey rise? mr. frelinghuysen: mr. chairman, i move that the house now adjourn. the speaker pro tempore: the question son the motion to adjourn -- is on the motion to adjourn. those in favor say aye. those opposed, no. the ayes have it. the motion is adopted. accordingly, the house stands adjourned until 10:00 a.m. today for morning hour debate.

funding to skirt budget caps put into place by the 2011 budget control at -- but to control

act. >> republican leaders are in favor of that. what has been the reaction to the $38 billion from democratic leaders? >> democratic leaders oppose using the war fund in this way because it is a one-year emergency war fund and they basically want republicans to lift the spending cap. and put the $38 billion in the base budget. >> what does that war funding cover? >> it was created after 9/11 to pay for the global war on terror, but its use has expanded to cover lots of things. some things that are not more related and also to cover

contingencies in europe such as the u.s. response to russian efforts in ukraine. >> in your article on the hill.com, your writing about the white house opposition to that initial -- to additional 38 billion. what else does the white house not like about this measure? kristina: the bill would restrict transfers of gitmo detainees to the u.s.. it also modified -- it does not allow any money to that. another thing the white house opposes is that the bill would restrict any military base closures and also restrict the retirement of the a-10 and other weapons systems. >> the hill tweeted earlier today that obama is to spend -- is to send hundreds more

divisors to iraq. >> urgency for the debate in congress. that has been largely avoided. both republicans and democrats say they want authorization for the use of force against isis. but the sending of additional forces were certainly -- will certainly add urgency and you will have 2016 presidential candidates having to state their position. >> the 16 defense spending bill is coming up under an open rule. >> i think you are likely to see democrats propose amendments to strip the bill of the restrictions on gitmo transfers and also, you may see an amendment trying to force an aumf.

that is happening in the senate so you might see henhouse as well. >> word is that the house is set to finish that by the end of the week. what about the senate? kristina: the senate is expected to work on their version next week but senate democrats are expected to block consideration of that bill until senate republicans begin a discussion of lifting the spending caps. >> christine a long -- kristina wong covers defense issues for the hill. >> the new congressional directory is a handy guide to the new congress, with color photos of every center in-house number plus bios and contact information. plus, district maps, a full. map of congressional hill. order your copy today.

it is $13.95 plus shooting and handling through the c-span online store at c-span.org. >> researchers have found that recent veterans have a suicide rate 50% higher than the general population. in a recent hearing, officials testified about the problem and the treatments available to patients. this hearing is one hour and 45 minutes. >> good morning. this hearing will come to order.

i want to welcome everyone to today's hearing titled prescription mismanagement and the risk of veteran suicide. before beginning, i would like to ask unanimous consent the statement from the american legion be entered into the hearing record. no objection so ordered. this hearing will examine the relationship between veterans prescribe prescribed medication and the increaset suicide rate among veterans. in a report issued in november of 2014, a hearing on veterans disorders it the extend they

were prescribed medicine the extent of proper care and whether va monitored that care and the information required to collect on veterans suicides. it is now clear that va is not even aware of the population of veterans with major depressive disorder due to inappropriate coding by va physicians. as a result, va cannot determine if veterans are receiving care consistent with the clinical practice guidelines. these treatments are vital and are designed to provide the maximum relief from the debilitating symptoms associated with mental health. it is imperative our veterans receive the proper care and follow up by receiving mental

health care. especially when they are being prescribe prescribe prescribed various medications. what is also becoming clear is that va is receiving and reporting inaccurate and inconsistent data regarding veterans suicide. this severely impacts and limits the department's ability to accurate accurately evaluate the efforts and identify trends in veterans' suicide. not only did the committee conduct a hearing in 2010 on this same issue but since then there is countless media stories of veterans being over med medicatted. the proper follow up and monitoring and the all too common result of suicide.

>> we will hear stories here today highlighting the problems occurring within the va for years and continuing today with regard to treatment of veterans with mental health. with mental health concerns and adequate programs and more importantly the actions taken to insure veterans who are prescribed countless medication receive proper follow-up. va has approximately 10 different programs dealing with prescription medication and suicide prevention issues. but it does not appear that any

of these programs interact with one another. no one is talking to anyone else. how can we insure that the veterans are getting the proper care, the proper follow-up, and the proper advice if the right hand doesn't know what the left hand is doing. i think it is more appropriate to say based on the statistics from the goa report and in numerous media stories the va is throwing out a bunch of different ideas and programs hoping one of them will stick. and they can claim they have solved the problem. this is unacceptable. we need to know what va is doing to change this pattern and what is it doing to improve protection of veterans. what is a real way forward?

who will be held accountable for mistakes that have been made and cost veterans their lives? who will stand up and take responsibility for making a change? it is time to answers. it is time for change. with that i yield the ranking member kuster for any opening remarks she may have. >> thank you mr. chairman. good morning to the panel and thank you for being with us. we are addressing an issue affecting veterans and over a hundred million adults. the statistics on veterans experiencing chronic pate is staggering. 50% of all veterans receiving care at av medical facilities experience chronic pain with half a million veterans managing

pain with prescribed opioids. as a nation and in my district throughout the northeast we face what can be described as an opioid abuse epidemic. the centers for disease control and prevention has termed opioid abuse the worst drug diction in the country's history killing more people than heroin and crock crack cocaine. we must remember veterans experience chronic pain suffer from meant health disorders like pdfs and traumatic brain injuries. it is important to have mechanisms to monitor the safe use of opioids for manage veterans' pain. i am concerned of self medication and addiction being

prescribed opioids for pain management. we know the va has struggled to monitor the precriptions and the patients. i am concerned a deadly mix of opioid use, mental health disorder and lack of oversight is contributing to the high rate of veteran suicide. the newest drug enforcement regulations that require veterans to see a doctor monthly creates a burden on veterans having issues getting there leaving them in pain and giving them withdraw symptoms. this hearing provides us with the opportunity to begin to seriously examine whether the benefits of managing the veterans pain with opioids is

outweighed by the risks and the va's struggling to properly monitor the use. i would like to hear from our witnesses how we can better address safe and effective treatment of veterans while insuring care management is not forgotten. i would like to discuss whether a high level of informed consent is needed to insure veterans and their families understand the risk and side effects before choosing to manage passenger with opioids and whether the va is properly coordinating mental health and suicide prevention programs with va clinicians responsible for monitoring the opioid use. i am interested in alternative pain management and whether, as i get to my comments later, i will talk about what is happening at the white river junction da in bringing down the rate of opioid prescriptions and how we can help get ourselves

out of this problem, out of this cycle, and address the veterans to serve their needs without putting them and their families at risk. and finally, i would like to discuss what is being done to reduce long-term opioid use and treat the underlying conditions causing chronic pain so that veterans are able to live a better quality of life. thank you, mr. chairman and i yield back the balance of my time. >> thank you, ranking member kuster. i will introduce our witnesses in one moment. but i ask that the witnesses stand and raise their right hand. scribed do you swear under a penalty of perjury your testimony you are about to provide is the truth, the whole truth and nothing but the truth? please be seated. i am like to recognize jeff miller chairman of the veteran

committee. >> thank you, mr. chairman and ranking member and thank you subcommittee all the work you have done over the years. if i might, i want to ask ms. clancy a couple questions. i believe you have been made aware i am going to be asking a couple questions all be it a little out of order. i want to talk specifically about bradley stone. we know he was seen by his va doctor before committed murders and dying of suicide. he was on many, many prescription drugs and had alerted the va as i understand

it to mental health and physical difficulties in the weeks leading up to the incident. but it appears that the va said he showed no signs of suicidal or homicidal ideations. i would like to know how the va >> people would ask the veterans a series of questions about thoughts of harming themselves and so forth to get assessment of suicide risk. my conclusion if the clinician said would be the veteran gave negative responses to those

questions. >> on the 24th of april of this year i asked the department if it would confirm whether or not they had provided the full committee with all of the files related to bradley stone. to date i have not received a response. so again i ask you has the va provided this committee with all of the files on bradley stone? >> i had been told that va had provided the committee with the files with some redactions and provided an in-camera review. the redactions were about social security numbers and some information that was about sensitive details about the living family members of bradley stone and offered to discuss that with the committee and camera. >> and again as i have stated in every single letter sent to the

department requesting information, an in-camera review is not acceptable. that is not at all acceptable. and the staff is informed you and the department, that i would ask a particular question. i ask you, again has all of the information -- and i would go back to -- i sent the secretary a letter on april 24th, where i referred to ms. diana ruben's director of the regional office on april 22nd saying the philadelphia regional office provided everything related to mr. stone's file and her response was unevequivalent and yes. i am taking from your comment today everything that she provided to the central office the central office has now provided to this committee?

>> since i am under oath i am going to be very careful. i cannot speak for what diana ruben is telling you. i have been informed by our lawyers that we have provided the committee with the records, and the redactions i mentioned, social security numbers and sensitive details about the living family members of ms. stone. >> for the record, mr. chairman and dr. clancy i know va has withhold hundreds of pages related to the bradley stone file. and so with that i would say that we have requested all of the documents every way we know how. so i will ask you one more time. can i expect the department to deliver the complete records by the end of this week? >> i will take that back and i will verify what i have been

told. we have given this committee everything except for redactions i noted earlier. >> i can assure you it is missing >> i will bring that message back. >> we expect the behavioral health autopsy and an in-camera review is not acceptable and i ask will you commit that all of the documents i have requested will be provided by the end of the week? >> the behavioral health autopsy is a unique feature of watt we do at va health care for veterans. rather than having a private, limited to the people at the facility root cause analysis or deep dive of what happened when a veteran takes his or her own life this is something we centralized so we can learn across the system what factors

precipitated the suicide, and what we could have done better and it involves a conversation with the family none who have been told we would be sharing their details with members of the committee. we think it will have a chilling affect on family members sharing sensitive details and are uncomfortable sharing that behavioral health autopsy. >> thank you for sharing that. we are the legislative branch and you are the executive branch. we have oversight over the department and unre-redacted information if you chose to withhold he will subpoena it. >> can i expect the documents?

>> i will take it back. >> i would like to add on a positive note. i was in cincinnati and dayton the day before. i want to thank you for the good job being done at the facilities there. there has been a great change and i enjoyed the opportunity to spend a couple hours with the people in cincinnati. we do focus on a lot of the negative and the press likes to focus on that as well. but i want to commend you on some of the great things. i would hope some of the good things specifically at cincinnati would be shared throughout the dha and the rest of the department. thank you very much. >> if i might for one second first, thank you very much for that. i know how hard those people work. cincinnati is the hub of expertise in intensive care for our system and they provide

remote -- >> i had a chance to view it. >> it is great. thank you very much. >> mr. chairman, one point, dr. clancy the va has turned over behavioral autopsy to this committee before. so so, ranking member kuster? >> as a health care attorney who worked in this area for a long period of time in the realm of quality asurrance what this is about is it is intends for physicians to grow and learn from the experiences. and i am concerned at the impression that the might be left with the veterans and family members, particularly the family members who have been through the trauma of a suicide this information would be treated private because these

hearings are televised. i don't want to have a chilling affect on families sharing the most personal aspects. we have a stigma around mental health and people seeking treatment and i would be concerned if we left the impression today that we are in somewhere digging into private affairs. if there is information about living family members that is not relevant it could be extremely personal and i guess i just don't understand why we could not do that in a private setting or in a redacted way? why this committee would be trying to determine -- and i am speaking if you believe there is documents that haven't been provided that is a separate matter -- but under our statutes

in the state private information in the quality asurance process is private and not to be shared and the purpose of that is so people come forward. >> thank you very much. i appreciated the expertise you bring to the committee and subcommittee. you can rest assured we are trying to hold people accountable. we are not trying to release information that is personally identifible. this is a suicide and a murder. we have gotten this information before from other incidents.

this one is particularly grevious because of the murders that took place. we are given oversight of the executive branch and we are not bound by hippa laws. this is not political. we are trying to get to the bottom of a very tragic event. we are trying to partner with the va as well. and right now, they are not being as open as they should be. there are documents that are clearly missing from the file. documents that i believe are damning and would put the va in

a negative light. i understand that. you cannot remove the documents from the file because it makes you look bad and that is what we are trying to get at. i thank every member of the subcommittee for the job you have been doing. i thank you for the good work. >> i ask other members wave the opening remarks. hearing no objection, so ordered. i would like to introduce our panel with that. on the panel, we have dr. carolyn clancy. michael valintino. dr. harlot -- herald cutter and

randall williamson and the research director for the iraq and afghanistan veterans of america. dr. clancy you are recognized for five minutes. >> good morning, chairman coffman, ranking member and members of the subcommittee. one of the most important priorties is at the va is keeping veterans from harm at all times. i am deeply saddened by the tragic outcome involving a veterans veterans. to families here or watching woo who have lost a loved one i want to appreciate my sorrow.

we will honor by learning from your cases and improving care. we acknowledge we have more work to do reduce opioid use, meet the increasing demands for mental health and prevent suicides and we have taken significant actions to improve these areas in order to better serve veterans. as ranking member kuster said chronic pain is a national problem affecting a third of the nation's adults population and half of veterans from recent conflicts. as a result a number of veterans and americans rely on opioids for pain control. they can be effective for a while until the side effects become quite worisome and mixed with other drugs they can have additional adverse unintended affects. we have adapted a number of

initiatives to enact our goal of pain manages management and making the number of opioids visual. starting july 1, we will expand on an approach called academic detailing which consist of one-on-one coaching for every single clinician prescriber in our system. in addition to information about effective use of medications, this approach also works for clinicians to have a difficult conversation with veterans to help them try other alternatives for pain management and so forth. i think it is important to note many of the veterans we serve come to us transitioning from

military service on opioids and abrupt discontinuation is not possible or appropriate. we have to continue to taper the doses. we have seen some successes and those with the least amount of problems have tended to do better better than those experiencing more severe pain. suicide among veterans is complex and tragic. those of us who have lost a loved one to suicide know the deep and lasting pain. we worked with scientific partners to understand suicide among the veterans receiving va care and all veterans across the nation. we know the treatment works. we have identified many positive outcomes for veterans receiving our care. for example, the rate of repeat attempts at suicide among veterans who have attempted to

take their own lives has declined for veterans enrolled in the system. between 1999-2010 the suicide rate among middle age males fell by 31% using our system at the time the suicide rate for middle age men who are not veterans or using our system rose. the rate of suicide among women veterans is higher than other women in the general public but women veterans who use our system are less likely to die from suicide when compared to other women veterans. our research allowed us to estimate 22 veterans die by suicide every day. what is less well known is 17 of the 22 do not receive treatment for care within the va system. i worry that some of the 17 are

seen in the system and fearful of raising mental health concerns because of stigma or privacy. suicide prevention has to extend to veterans that don't seek our help. we have increased targeted outreach efforts to veterans in communities throughout the country and made it easier for anyone to call the veterans crisis line. you will not have to hang up and call a line. you can hit a number on the phone and that will transfer you. i want to express appreciation for the clay hunt act and the passage that will expand our capabilities to help veterans so thank you for that. the importance of mental health treatments, i don't think, can be overstated.

about 20 years ago in this country we did not recognize how important a challenge mental health care is for all-americans. at va we have embraced the problems that veterans from returning conflict brought to us whether that is various mental health problems post traumatic stress traumatic brain injuries and so forth. we have had to blaze trails doing so. we have had to go ahead in the health where utileization of mental health has been controlled over the years. that meant we have had to work with public and private science partners to build the basic science, the data, and the population health expertise. we have learned a lot made significant gains, and seen the successes of treating mental health problems. but we have so much to do to

dispel the stigma of mental health issues. it wasn't that long ago that cancer inspired that whispering and people didn't talk about it outloud because of fear and misinformation. we hope with your hope and the help of many partners soon we will be able to eliminate that fear associated with seeking mental health care. we are focused on creating an atmosphere of trust and privacy. we are committed to improving our existing programs, taking every action to create new opportunities and most importantly improving the quality of life for veterans. we are compassioniately committing to serving those who served. we are honored to have this privilege and are prepared to work with you until we get this right. thank you. >> mr. williamson you are recognized for five minutes. >> good morning mr. chairman

miller and ranking member kuster. i am pleased to be here to discuss our november 2014 report on vha's effort to monitor major depressive disorder who were prescribed one or more anti depressants. this is a mental health associated with severe depression and reduced quality of life. i will focus on certain aspect of the suicide prevention problem. i will discuss the mdd, the rate of anti depressants prescribed, and the

data collected. 10% of the veterans receiving hillary clinton were diagnosed with mdd and 94% of them were prescribed one or more anti depressants. the estimated of veterans with mdd may be low because we found vamc's didn't always correctly report and record confirmed mdd diagnoses among veterans. we reviewed a sample of veterans with mdd prescribed one or more anti depressants and found they didn't receive care for three important recommendations in the clinical guidelines that was established to guide clinicians in treating mdd. for example, although the cpg recommends a veterans depressive

systems be assessed using a standard tool at 4-6 weeks after initiation of anti depressant treatment, we found for 26-30 veterans in the sample the va clinician clinicians didn't use this tool or within a specified time frame. not mandatory for clinicians but the recommendations are based on evidence-based data from clinical trials and research and meant to enhance the outcomes for veterans with mdd. and moreover there is not a process to monitor the extent that the clinicians deviate from the recommendations. with little if any, visibility over whether the care provided is consistent with the cpg the va is able to insure that deviations are identified and

evaluated and whether appropriate actions are taken to mitigate potential risk to veterans. finally we found demographic and clinical data collected on veterans suicide to better inform the suicide prevention program were often incomplete and inaccurate. as part of the behavioral health autopsy program bv is what i will refer to it it creates the number of visit and last va contact. we examined 63 report and found 2/3rds contained inaccurate and incomplete information. this is made worse because the reports are not reviewed at any level within vha for accuracy

completeness and consistency. this lack of data doesn't allow us to learn from previous suicides and diminishes efforts to develop programs that reduce veteran suicide. the va made good progress in addressing the six recommendations to improve weaknesses we noted in our report. in the six months since the report was issued one recommendation has been fully implemented and several others are very close to being implemented. this work illustrates a continuing pattern of vha's non-compliance of policy and procedure and inaccurate data and poor oversight. this is among the same factors to include vha on the high risk. until a culture is instilled that holds staff and managers

accountable for affectively performing their responsibilities and overseeing outcomes and achieving a recognized standard of excellence they will continue to fall short of providing the highest quality of care to veterans. this concludes my opening remarks. >> thank you, mr. williamson for your remarks. doctor, you where recognized for five minutes. >> chairman ranking member and the subcommittee on behalf of the veterans for america, thank you for letting us share our views on medicine and potential risk of suicide. iada launched combat suicide prevention and celebrated the clay hunt act into law.

this was a first step on a long road to address the challenges of combat and suicide among service members and veterans. the issue we are here to talk about is complex because it is two topics. providing care for veterans seeking relief from chronic pain, mental injuries and other conditions and recognizing the potential for misuse and abuse of the powerful drugs. these drugs are powerful, but they can be extremely effective for a veteran. chronic pain affects approximately a hundred million adults and this number is growing. given the physical demands on the troop we have seen a similar trend among service men and veterans. over 60% of the iraq and afghanistan veterans seek care for muscular care element and this is the most common category for disability.

nearly 60% seek care for mental injury. the members survey reported experiencing chronic pain as a result of their service. 1-5 reported using prescription opioids and 1-3 using anti-anxiety or anti-depression medicine. medical advancements allowed for higher survival rates from injury but increases the impact of nerve and skeletal damage. treatment of pain can be complex because other conditions like depression, anxiety, pdfs or tbi, may limit treatment options. for clinicians assessing pain and devising a strategy to be difficult particularly given knowledge in this field is still growing. primary care physicians who say the bulk of patients report they

feel underprepared to treat the patients due to lack of training this included va providers surveyed in 2013. untreated pain can put an individual at higher risk of suicide. yet we know that prescription medications are result in strong addictions and provide a means for suicide attempts. half of non-fatal suicide attempts results from overdose or intentional poisoning. this highlights the challenges that clinicians face when treating patients with complex injuries and demonstrates the importance of integrated pain management management. the va published an evidence-based guidelines opioid safety initiative and introducing a pain management system but more remains to be done. with approximately 22 veterans

dying by suicide every day and more attempting suicide reducing instances of overmedication and limiting access to powerful prescription medications must be included in a comprehensive approach to addressing this issue. a recent study showed patients receiving opioid therapy are at an increased risk of attempting suicide, following the guidelines reduced this. they showed the critical need not only for these guidelines but implementation of the guidelines. va's 2009 director on pain management expired in october of 2013. it expired in date and remains active but updating hasn't been prioritized. we urge the va to prioritize and fully implement this at all facilities. we would like to focus on the

risk of men minimizing the risk of overdosing on prescription take back. an important change to dea regulation expanded operations for drug drop off sights giving the va the ability to have drug take back programs in the hospital and this is critical to limiting the chance of abuse of powerful drugs but no action has been taken. while the va is working to fully implement its roll in prescription monitoring drug program full implementation remains to be scene and we urge the va to prioritize this as well. too often we hear stories of veterans who are prescribed anti psychotic drugs or opioids with little follow up. and we hear stories in pain and

doctors not considering the request for stronger medication to manage the pain. these are tough challenges and we are committed to working with the va and congress to address them. again, thank you for the opportunity to offer our views on this important topic we look forward to continuing to work with each of you, your staff and this committee in this critical year ahead. thank you for your time and attention. >> thank you, doctor. i appreciate your testimony. who is next? okay. thanks to the witnesses. dr. clancy according to a jo report va deviated from the guidelines in most of the 30 cases reviewed by not assessing anti depressant treatment

properly. is the policy ignored or lack of oversight by leadership in your opinion? >> first, i want to say we regard the recommendations, feedback is important, a gift if you will to help us get better. i am not sure that any guidelines written on planet earth should be followed a hundred percent of the time. many doctors think of them as tools not rules because there will be patients with unique circumstances that don't fit perfectly. in terms of the follow-up assessment, i think that is important and we need to do a better job. we will be looking to see whether that is a feature of the fact that we were having access problems and it was hard to get people back in or when we were not on the ball. -- whether -- that is an important feature. >> we found veterans dying from drug toxicity reported

hallucinating and reported suicidal thoughts. are these the improved outcomes you are referring to? >> no, they are not. >> the va noted it would conduct chart reviews and develop a plan to determine and address the factors contributing to coding variances. this was to be completed -- are you still working on that? >> it is in progress. in addition i have been meeting inspired by the report and other feedback from the mental health leaders in our system to figure out who are the veterans we think are struggling the most with mental health disorders, that we should be targeting two make sure they are getting the best possible care. >> thank you. who do you think that report is -- when -- going to be done?

>> i will double check on when we committed to having the recommendations done. >> the va stated it would examine associations between treatment practices and indicators of recovery or adverse outcomes for veterans being treated with anti depressants. the target date of completion was march 2015. has this been completed? >> i believe it has. i would have to double check my notes. >> can you get a copy of it? >> absolutely. i will submit that. >> 63% of the behavioral health autopsy reviewed critical data was missing. is this inaccurate reporting based on not being competent or is it to keep the central office in the dark? >> i have no reason whatsoever

it is to keep the central office in the dark. i understand the program was transitioned from the root cause to a central repostory and training reviewers and people doing the interviews collecting the data to collect the data consistently and accurately took time. and frankly iterations to make sure we were getting it right. do you want to add to that? >> at the time the goa was conducting the study the behavioral health autopsy program was being lunchaunched. it has been refined and the cordinators, 300 of them, who fill them out have been taught more as well. there were questions and they have been addressed through the training and we are reviewing

all of these centrally and nationally. we created software to another suicide prevention center so we can accurately look at them for perspective. this progressed a great deal since the original report and we will continue to work on it. >> the committee has requested the behavioral autopsy for numerous veterans and in all cases except one holmes, va stated this information is private private, why was the report to ms. holmes released but not others? >> i would have to take that question for the record. i would say in general the behavior health autopsy reports,

i think the ranking member kuster described this more clearly than i could, this is quality asurasurance and if people think this is going to be disclosed disclosed we will not get information that is forthright. >> we are concerned about the veterans and the committee has oversight responsibility for your operation and we cannot do that oversight operation and making policy that is best for the veterans if you don't fulfill your obligation and submit that information when requested to the congress. >> ranking member kuster? >> thank you.

i appreciate you being here and the veterans returning from the 14 years in conflict. the injuries are complex but the good news is people are surviving but the difficulty is chronic life long issues. i want to focus on how we move forward -- i share concerns about the data and making sure we are getting at the heart of the issue here -- but i am interested, i had a meeting with the team at the white river junction facility and there is cutting-edge research and i am i will talk to the chair about sharing this. but the opioid safety initiative. and a couple different things and whichever is the appropriate witness. one is getting at the heart of what is causing the pain. my husband has various years of

backpain and they found out he needed a back replacement and lives pain-free with yoga and exercise now. i would like to find out what is being done to get at the crux of what is causing the pain. and secondally setting a goal of reducing the use and worker with practitioners of bringing down the use and emphasizing education, close monitoring, they talked about actual drug testing because in our area, selling the opioids on the market, people will not use the medication themselves and they can determine that through frequent drug testing, which is not poplar with the patients as you can imagine and then alternative medicine -- yoga,

massage, exercise -- if you comment on the opioid safety initiative. is it in use? what can we do to move that forward? >> those are all terrific questions. i will start and turn to mr. valintino. we have have a clinical practice guidelines on the management of chronic pain and as of september this year it will be updated. we will be having input from the veterans and family members. the guideline does include urine drug testing periodically and we have, as i mentioned too quickly probably in my opening statement, made a series of steps under the umbrella of the

opioid safety initiative and made data of the prescription patterns available and visible so that clinicians can see what this patient has been on over time, what other drugs they are on, and so forth. getting to the root of the problem, i think is incredibly important and i would be happy to submit and brief anyone any time about the exciting research we have in process. i think it is very important. i think there is a lot we need to learn in two areas. one is what are they predictors of veterans, or anyone who is likely to use opioids for a short time and go down the path of using them on a regular bases? if we knew then that is who we would target a lot of effort. the second is which veterans are most likely to respond to treatment of non-narcotic

information and so forth. as i said we have some research going on in that area and a lot more to turn. mike, you want to add to that? >> yes, thank you. so the opioid safety program is just shy of two years old. and we have had to build it from the ground up and as dr. clancy mentioned we focused on data to identify outliar problems. the next iteration was to continue to drill down on the va facilities and identified outli outlyers. we are poised at the moment and built the tools and are validating them to accuracy to

drill down to the individual provider and patient level. this is very complex. someone may show up at as out layer or maybe they treat cancer pain or pain specialist. we have to get it right so there is confidence in the tool. we have had good results. i will go through some of the metrics. since beginning, we have fewer than 11,000 patients receiving opioid. 34,000 using opioid and benzo together. 75,000 patients had a urine drug screen who were on long term opioid use because that is definitely an opportunity for diversion and we want to make sure it patients are taking it. we have 92,000 patients on

long-term opioid use which is longer than 90 days. we looked at the total opioid burden. there are many opioid drugs but you have to boil them down to a common denominator. morphine equivalent. >> i am sorry, my time is up. i am interested in what you have to say but my colleagues need a chance. >> let's see if we cannot run the clock out on the answers. >> i would like to thank the chairman for bringing this important issue to light. unfortunately, it comes too late for one of my colorado springs families. i would like to tell you the story of noah. a former marine who served in iraq with honor in 2009 and afghanistan in 2011. i am not use his last name but his parents offered the use of

his picture. so if i could just show you noah's picture. after leaving the marine core miller began work on a business degree at the university of colorado at colorado springs and started his own online business based out of colorado springs. noah comes from a military family. his dad having honorably served for 23 years. noah put off college so he could serve the great nation. his parents are appalled by the care their son didn't receive from the va. they believe their son would be alive had he received better care. noah was diagnosed with ptsd and received a 50 percent dispability. he went to the va carolyin clancy -- clinic and the notes

state suicidal ideas. he was prescribed a psycho tropic drug and sent on his way. we don't know at the time what the drug did or didn't do. he wasn't referred for suicide prevention he wasn't offered counseling and there was no follow-up from the va. he went missing the evening of may 4th and found dead from an apparent suicide may 12th of this year. a months -- a months ago. his family is devastated. i would like to ask questions on their behalf. why was their son who was document documented with having suicidal thoughts not referred to suicide prevention? why wasn't there a follow-up from the va? and why wasn't he offered counseling? >> i will look into this

personally, mr. congressman. that is heart breaking. i cannot even imagine what this -- i cannot imagine but i know it is horrendous what his family is going through. the picture was worth many many words. someone who did so much for the country. i will look into this. >> reporter: any other witnesses have response to the family's questions? >> you know as somebody who has treated veterans clinics for 30 years. it is hard to understand the report given and these were the facts available. my first thought is i want to make sure this family was reached out directly and we have a chance to collect this information. we created a system and the

system can be cold and inhuman but we need to sit down with them and understand everything that happened from their point of view questions they have and we will work with them to do that. >> okay. thank you, both. mr. chairman thank you for having the hearing. i yield back my time. >> mr. o'rourke texas. >> the question i would like a quick direct answer to is we are touting reduced prescriptions of opioids as though perhaps that in itself is success. what i would like to know is the consequences? i have veterans showing up to my town hall meetings saying the precription were cut off without notice and ramping down. how many of those no longer receiving prescription from the va are using heroin or other street drugs? >> we can't know that with the information we have. it is something we worry about

constantly. >> let me tell you another problem. this is hopefully helpful feedback from el paso. others who have prepscriptions are required to renew them after a month but are unable to get an appointment so can't get it renewed so they go without or something they buy on the street. at a minimum they are suffering and i would connect that suffering to suicides we see in el paso. i would like to give you the follow feedback as well. as i shared with you when i met with you on monday the may 15th access reports shows el paso is ranked 157-158 for mental health access. we have 115 mental health physicians approved for el paso and only 87 are filled leaving 24% vacancy rate.

your predecessor, when relaying information i was hearing from veterans told me we are seeing everybody in 14 days. we found 1/3 of the veterans couldn't ever get an appointment. that information has not improved in the year we had new leadership there. this should be for you a 5-alarm fire. i have met with the widows and mothers of suicides in el paso far too often. i am continuing to do that. and just did the last time i was hope in el paso. as you know for whatever reason, the va is unable to solve this issue and treat it as a priority it should be. so i am glad to hear good things are happening in other parts of the country but everything i do is through the prism of the veterans i serve in el paso.

we have a proposal to address this. i want your commitment we will work with this. the community is coming forward. i will do whatever it takes to work with you, your team and the secretary to get this implemented but this is a crisis with deadly reprecussions for the vess veterans. we didn't take it seriously because the statistics and vacancy regarding mental health is worse than last year. i want your commitment to resolve this that is a crisis and we will turn this around. >> you have my full unwavering commitment. we were impressed with you reaching out and bringing in members from the el paso community to work with us. i want to thank you for your support of our employees during what was a different kind of tragedy at the el paso facility several months ago.

something that cut to the heart of clinicians across the country bought particularly those serving veterans in el paso. you have my full commitment. thank you >> thank you. i yield back. [inaudible talking] >> dr. benishek, michigan. >> i want to associate with the comments of mr. o'rourke. the goal is cutting back on narcotics and the same circumstances happened in my district with people getting

their prescription cut off with no alternative treatment to figure it out. there are a couple specifics i want to get to and that is something something that was set. there is not that much fallollow up n this. remind me what you said in your testimony, mr. williamson? >> we were talking about oversight oversight, very little oversight, to see if the information is accurate and complete. >> you said you are doing oversight. mr. williamson said you are not. what is going on? >> the difference is the two years passed since the report was written. i am not questions the report and find it helpful. but we are making a difference

in this. >> can you show me the report? can you get that to me within a reasonable period of time? >> to respond to recommendations on oversight, i don't think the va completed them. it isn't a two or three lag. there has been changes made. there is a box checked on the behavioral autopsy report that oversight has been done. >> that is all there is? >> that is one of the things. they are revising guidelines and making progress. but it hasn't been completed to my understanding. >> i am not give you