dr. lynch and dr. clancy for coming here this evening. we understand that the accelerated access to care initiative is designed to ensure access to care by enhancing resources within va facilities and also, sending veterans promptly to community-based care and nonva care when needed care is not readily available at the va facility. what is the role of pc 3's in va accelerating access to care initiative? >> pc3, as it develops, will be another model that we can use to have vi provide care in the community. pc three is in the process of being stood up. some sights have a greater available of pc 3 services than others. it is, however, an option that we can use to identify community providers who are willing to provide care and to meet certain conditions of the contract which specify the care will be provided within 30 days. that we will receive reports in a timely fashion. so pc 3 is an enhanced method of providing care in the community. that gives benefit to the va because it assures timeliness a

dr. lynch states and testimony that by the end of september 2014, all vha physicians will have productivity standards in place. i'm skeptical of the usefulness of the standards due to the current crisis. they are unlikely to hear from the v.a. how they are capacity any time line so when this will be done. most importantly, any resources that may be needed to ensure that v.a. is fully fulfilling the primary mission of providing health care to our nation's veterans. mr. chairman, i know that the vast majority of apartment employees are hard-working and dedicated to caring for our veterans. for that, i applaud them. we still have a responsibility and duty to take care of all of our veterans. i look forward to hearing from the v.a. tonight. i want to thank you for coming. for that -- with that, i yield back. >> thank you very much. we are honored to be joined this evening by dr. thomas lynch, the assistant secretary -- deputy undersecretary for health. he is accompanied by dr. carolyn clancy. we ap

dr. lynch, in the last two weeks number of veterans in my district in colorado springs have contacted my office asking for help while trying to see a doctor has more than doubled. one veteran described how he was referred to get a biopsy done on his thyroid to determine whether or not he had cancer only to be told he couldn't be seen for two months. i can't imagine having to wait for two months to even just get a test done when you have a possible cancerous growth. tell me what options are available to denver medical center to experiod dit a biopsy appointment in particular especially based on medical necessity and if there's a possibility of a life threatening condition? >> congressman, based on what you're telling me, if services cannot be provided in less than 30 days, that is an unacceptable waiting time. and the denver va facility should be able to identify a community provider to offer those services. >> that would be the fee basis approach that we've talked about. >> that's the use of no

dr. lynchstates and testimony that by the end of september 2014, all vha physicians will have productivity standards in place. i'm skeptical of the usefulness of the standards due to the current crisis. they are unlikely to hear from the v.a. how they are capacity any time line so when this will be done. most importantly, any resources that may be needed to ensure that v.a. is fully fulfilling the primary mission of providing health care to our nation's veterans. mr. chairman, i know that the vast majority of apartment employees are hard-working and dedicated to caring for our veterans. for that, i applaud them. we still have a responsibility and duty to take care of all of our veterans. i look forward to hearing from the v.a. tonight. i want to thank you for coming. with that, i yield back. >> thank you very much. we are honored to be joined this evening by dr. thomas lynch, the assistant deputy undersecretary for health. he is accompanied by dr. carolyn clancy. we appreciate you both for bein

dr. lynch was in phoenix. we prepared three additional subpoenas for dr. lynch, ms. mooney, and mr. huff to compel them to put up here before us if they decided to -- to compel them to appear before us if they decided to decline the invitation. unfortunately it takes repeated requests and threats of compulsion to get the v.a. to bring their people here. i look forward to hearing what they have to say. i now recognize the ranking member for any statement he would like to make and then we will proceed with questioning. >> thank you very much mr. chairman. tonight we find ourselves in a very difficult position. i do appreciate the witnesses appearing before us this evening and for the additional production push of materials that came overnight. unfortunately, as you heard from the chairman, those materials and the release of the interim i.t. report today did not provide the answers we saw but rather just grazed additional -- raised additional questions. i share your passion for getting to the bott

dr. lynch, i just have two questions. is there a complaint system within the vha, something like a hotline that a veteran can call and someone gets back to them about their complaint? >> dr. clancy, do you want to take that? >> yes. every facility has a patient advocate. and, in fact, they get complaints. they get all kinds of calls. that is actually tracked in terms of time to resolution and so forth. that all of the patient advocates now come under an office of patient centered care and cultural transformation. so we have begun working with them a bit from the quality and safety side to try to figure out how could we learn more from what they're hearing. because we're noticing that a number of private sector organizations are taking to heart just how important and useful it can be to learn from the patients themselves. >> is that information looked at nationally, nationwide? it doesn't just stay at the local facility? >> yes. there is a national database. >> my second question is, are you consulting with the vsos on how

dr. lynch, you mentioned earlier that $312 million has been made available to be accelerate access to care for veteran who have been unable to receive it thus far. where did that money come from? >> the money was recovered from funds that were not being used across va. i believe that there was some activation monies that was repurposed to cover the accelerated care initiative. >> what are activation moneys? >> sometimes monies that are used for new projects. i don't know the details but i would assume that it was felt that it the monies were not absolutely necessary at this time and could be repurposed to address the immediate concern, which was the provision of timely care to veterans. >> and will you or the va be coming back to congress to recover those monies after we get through this crisis? >> i don't think that's our intention, congressman. >> okay. >> i think our immediate attention is to provide timely access to care and at the moment, we're trying to use the funds that we have. >> what

dr. thomas lynch, the assistant deputy undersecretary for health, for clinical operation and he's accompanied by dr. carolyn clancy, the assistant deputy undersecretary for health for quality, safety and value. we appreciate you both for being here tonight and dr. lynch, we appreciate you coming for your return engagement for an evening function. you're recognized for your opening statement. >> good evening, chairman miller, ranking member michelle and members of the committee. thank you for the opportunity to discuss the provision of timely, accessible and quality care for veterans. i'm accompanied today by dr. carolyn clancy, assistant deputy undersecretary for health, quality safety and value. at the outset, let me address the significant issue that's been the focus of the committee, the va, and the american public. that is, the issue of wait times. no veteran should ever have to wait an unreasonable amount of time to receive the care that they have earned through their service and their sacrifice. america's veterans should know they will receive the highest quality health care from va. wh

if we did not have the metrics that dr. lynch said here, numerous times a couple weeks ago and said these metrics are forcing us to play these games, is that a possibility? >> i think it is part of that. they go hand-in-hand. first of all, i think setting an unrealistic performance metric and dying rewards or incentives to the meeting -- again, this is not even an outcome measure. this is an activity measure. tying rewards are incentives to the attainment of that activity was a mistake. not understanding the capacity of our system when we set that was a mistake then. there are reasons we don't schedule two years in advance, quite frankly. just you don't want to hold up the entire set of appointments lots with the appointments that are so far out that they might end up getting met. there are technical reasons you would not do that, before the most part this is a and culture question. we have found in some of our networks where staff for using the same outmoded technologies and policy. i bring that up because i think you kind of to

dr. lynch, i want to go back to the fy 149 appropriations question i asked you for a point of clarity. i understand you mentioned the va is in the process process of working with outside providers. is that just a general statement or are you suggesting that the demonstration project kong depressionally directed in the fy '149 budget is currently being implemented? >> it is being implemented, congressman. can i get you information on the sites where that is being provided at this time? >> yeah, you certainly could. there are about six or seven of us that wrote a letter to the secretary on may 7th asking for an update on the implementation. i know you've got a lot of letters coming your way right now. but it is a matter of concern because it was done with such specificity. even the criteria were put in the congressional report as to how the centers were to be evaluated. so i just want to make sure we're talking apples and apples here that this is the fy 14. >> let me work with our was office of m

and if we didn't have the metrics that dr. lynch sat here numerous times a couple weeks ago and said these metrics are forcing us to play these games, is that a possibility? >> i think it is part of it. i think that they go hand in hand. but first of all, i think setting an unrealistic performance metric, tying rewards or incentives to -- again, this isn't even an outcome measure. this is an activity measure. times, rewards or incentives to the attainment of an activity was a mistake. not understanding the capacity of our system when we set that was a mistake. there are reasons why we don't schedule two years in advance, quite frankly. just -- you don't want to hold up the entire set of appointment slots with appointments that are so far out that they might end up getting missed. there are technical reasons you wouldn't do that. for the most part this is a leadership and culture question. we have found in some of our networks where staff are using the same outmoded technology as the other staff, and scheduling with integrity. >> i b

it does add some light onto the issue, but i will also tell you this, we were told by dr. lynch two weeks ago because every member of this committee has been asking for the data from their facilities, and we were told that we would receive it once the report was final. the report is final. i got a call today that my local media got it before i've got it. i just don't understand why people in the va won't follow through with their commitment. now, you don't need to respond to that, but that's a statement. i yield back. >> thank you, mr. chairman. i appreciate that. i did want to read from an e-mail that was handed to me by i guess an acting director, and for members of the committee i did not know this. if the director and the assistant director are on vacation or on a management conference at least in wichita va facility, the acting director is the chief nurse, but handed me an e-mail that said please immediately stand down on any further communications with stakeholders, delegation members, and others regarding the access audit, wait list, and accelerating care initiatives, and

it does add some light onto the issue, but i will also tell you this, we were told by dr. lynch two weeks ago because every member of this committee has been asking for the data from their facilities, and we were told that we would receive it once the report was final. the report is final. i got a call today that my local media got it before i've got it. i just don't understand why people in the va won't follow through with their commitment. now, you don't need to respond to that, but that's a statement. i yield back. >> thank you, mr. chairman. i appreciate that. i did want to read from an e-mail that was handed to me by i guess an acting director, and for members of the committee i did not know this. if the director and the assistant director are on vacation or on a management conference at least in wichita va facility, the acting director is the chief nurse, but handed me an e-mail that said please immediately stand down on any further communications with stakeholders, delegation members, and others regarding the access audit, wait list, and accelerating care initiatives, and

if we did not have the metrics that dr. lynch said here, numerous times a couple weeks ago and said these metrics are forcing us to play these games, is that a possibility? >> i think it is part of that. they go hand-in-hand. first of all, i think setting an unrealistic performance metric and dying rewards or incentives to the meeting -- again, this is not even an outcome measure. this is an activity measure. tying rewards are incentives to the attainment of that activity was a mistake. not understanding the capacity of our system when we set that was a mistake then. there are reasons we don't schedule two years in advance, quite frankly. just you don't want to hold up the entire set of appointments lots with the appointments that are so far out that they might end up getting met. there are technical reasons you would not do that, before the most part this is a and culture question. we have found in some of our networks where staff for using the same outmoded technologies and policy. i bring that up because i think you kind of to

dr. thomas lynch. >> i value the v.a. system greatly. system. >> it is not a good system. how can you say -- >> i think it is a good system. >> really? >> yes, i do. >> not if you're a veteran, it's not a good system. >> this happening as the office of special counsel sends a scathing letter to the president blasting the v.a. for ignoring whistle-blower warnings. the letter says phoenix v.a. officials failure to act is part of a troubling pattern nationwide. acting secretary sloan gibson ordering review of the system to handle whistle-blower complaints. >>> house democrats want you to pay the legal fees for illegal immigrant children. this measure is led by new york representative jeffreys. democrats introducing a bill that would give illegal minors taxpayer-funded lawyers. they claim nearly half of the thousands of children crossing the border have legitimate reasons for being here even though they came here illegally. it's estimated that 90,000 illegal minors will try to cross the border into our country this year alone. >> a veteran c

lynch pin to what happened in libya. >>> hillary clinton on the book tour, but cautious optimism about the hunt for facts. >>> and dr.rilling on capitol hill about his support for sketchy weight products. why his doctor's orders are being inspected. this is "way too early." >>> hey, there, everybody. i'm thomas roberts. it's wednesday, june 18th, and welcome to "way too early," the show with premature vacation brain. the floor crew can attest to my vacation brain in full affect. and leading the a-block. the deadly attack in benghazi, and one of the suspected ring leaders is now in u.s. custody. u.s. special forces carried out a raid over the weekend. about two dozen military agents were involved after months of planning, ahmed abu khattala was taken to new york to be questioned. he is suspected of being linked to the militant group. and he is facing trial in the united states and could be put

say private lynch suffered a head injury and broken bones in her leg and back when her truck flipped. she was unconscious when iraqi soldiers and the fedayeen brought her to the hospital. drdi said it was clear in the emergency room jessica had neither bullet nor stab wounds. >> with respect to the circumstances of sergeant bergdahl's capture by the taliban, we obviously have not been interrogating sergeant bergdahl. he's recovering from five years of captivity. with the taliban. he's having to undergo a whole battery of tests and he's going to have to undergo a significant transition back into a life he has not even met with his family yet, which indicates the degree to which we take this transition process seriously. something that we learned from the vietnam era. but let me just make a very simple point here, and that is regardless of the circumstances, whatever those circumstances may turn out to be, we still get an american soldier back after being held in captivity, period, full stop. we don't condition that. >> private jessica lynch was the first american p.o.w. rescued after world war ii. the initial story that the pentagon told about jessica lynch about her actio