dr. mitchell? >> asking for my testimony to be made public, i would not agree with that statement and say no. >> i would say no. there's lots of investigations but there has been no substantive change. >> very good. i yield back. thank you, mr. chairman. >> thank you very much. ms. walorski. >> thank you, mr. chairman. dr. daigh, you had said earlier today i believe to chairman note that you did not exclusively examine all the medical records to determine if patient has led to delays in care. yet in the report your colleaguecolleagues released ite the igs the report in august completed that it could not assert that long wait times caused the death of these veterans. can you explain to me and families are watching today who have been going through this how can the va emphatically say to us that you can determine no link between wait times and death if he didn't examine all the records? >> let me clarify. we examined 3409 records. to the chairman's point, we did not examine all the records of patient

dr. mitchell, i want to thank you for being here and for coming forward. i'd expressed to you in the past that i appreciate your courage because all of us on this committee really are united with you in our care for veterans and making sure that they get the medical care and access to that care that they really care about. and that's why i introduced the whistle-blower protection act. wish that had been in place for you, but hopefully that'll make things better for future whistle-blowers. and part of that act is a national hotline that patients and workers within the va system can call and that information would go directly to the secretary in hopes that there wouldn't be any kind of retaliation. but as i mentioned, this committee really is committed to access to care for our veterans, and as you know there was a bipartisan bicameral conference committee that was appointed in the summer. we met together and we passed the veterans access choice and accountability act of 2014. and one of the primary pieces of that is a new choice card that will allow veteran

dr. mitchell. but with that being said with my remaining time that would be investigated but my immediate concern is to you feel in your professional judgment they move in the proper direction? to you feel at this and it is early. >> it is utterly. the a lot of the of late -- wait time issues better is a the report to identify an additional 1800 veterans that were not properly managed. to give those names to people in phoenix to make sure they got it as quickly as possible.á7 >> yes or no. does it feel like cultural changes are changing the accountability? >> does a complete more investigations. >>. >> for my testimony to be made public. >> no. >> i yield back. >> dr. daigh and, you cannot conclusively examine all the medical records to determine the release of thema final report of the long wait times causes the death of the veterans. how can it say to us synthetically that no link the wait times if you did them and examine all the records? >> 200-0409 records were evaluated. the service point loo

dr. mitchell in your testimony talking about that paid management team with the lack of services how did they communicate their staffing needs to the director? was never communicated and what was done if anything? >> 1/2 direct knowledge between the senior administration that what i do have is direct knowledge from many providers who find that panel's rob long term narcotics in the patient's need additional close monitoring and follow-up but providers still have enough time to get those patients in for sufficient appoint ince to review that. that those the from long-term narcotics refer to the pate and management specialists. >> my time has run out of. >> ag for having this important hearing. briefly on page 15 of your written testimony you have case number 35 baba i.g. report as the special circumstance and please explain why. >> i did not have access to this a record set they went through but i was told was the same patient that i was familiar with them the details are the same. with the i.g. report is starts he presented to the year with his family seeking health care and evaluated ca

dr. mitchell you talked about how good the team is but how did the phoenix v.a.ut their staffing needs? what was done if anything? >> i'll have a communication between the pain management team but what i do have is direct knowledge from those who were on a long-term dosage of narcotics and they needed additional mentoring or follow-up but they needed to review that. in the community that patients that are in their long term referred to a pain management specialist and monitored for side effects. unfortunately that was not followed up. >> thank you for having this important hearing. just briefly on page 15 dr. mitchell you pulled out case number 35 from the the ig report as the special circumstance and explained that. >> i did not add access to the records of o.i.g. but typically i was told the of patients that i was familiar with but in the o.i.g. report he was seeking mental health care and evaluated and declined admission and discharging committed suicide the next day. what was not in the report that he actually had problems with depression he called his parent

dr. mitchell, in your testimony you mentioned how good the phoenix v.a.pain management team is but that they lack the staff to supply the services to phoenix veterans. how did phoenix v.a. communicate their staffing needs to the director? was it ever communicated? and if so, what was done, if anything? >> i don't have any direct knowledge of the communication between the pain management team, and the senior administration to get additional staffing. what i do have is direct knowledge from many, many providers who find their panels filled with patients who are on high-dose, long-term nash cotics and the patients need additional close monitoring and follow-up. what's happening is those providers don't have enough time to be able to get those patients in for sufficient appointments to be able to review that. in addition, in the community patients that are on long-term narcotics are referred to a pain management specialist to titrate the ongoing education and monitor for side effects. unfortunately the staffing does not allow for that. >> thank you. my times

dr. mitchell, in your testimony you mentioned how good the phoenix the a pain management -- the phoenix v.a. pain management team is. how did the phoenix v.a. communicate their staffing needs to the director? was it ever communicated, and if so, what was done -- if anything? >> i do not have direct knowledge of the medication between the pain and management team and the senior administration and additional staffing. what i do have is direct knowledge from many, many providers who find panels filled with patience who are on high-dose long-term narcotics and the patients need additional close monitoring and follow-up. what is happening as those providers to not have enough time to be able to get those patients and for sufficient appointments to be able to review that. in addition in the community, patients that are on long-term narcotics are referred to a pain management specialist for ongoing education and a monitor for side effects. unfortunately, the staffing at the phoenix v.a. did not allow for that. >> thank you. i see my time has run out, mr. chairman. .> mr. lamborn >> thank you, mr.

dr. mitchell called a whitewash with this one statement in their and then you have other statements werenot only other va facilities that would seem to indicate that many within the va think that this scandal was overblown. you know based on the e-mail that was sent on your behalf, do you think that our congressional reps who have representatives here, do you think they got out in front of the media and over blew the scandal? thank you think that they misled and lied because it would seem from this e-mail that you are implying that. do you believe that? >> no, i believe the ig report found really important issues and challenges for the phoenix va and we are working on fixing them and looking for. >> why are the staff members here trying to undermine the congressional representatives? just so you all know there is another investigation of this fine facility at the hip of violation. why do staff members here try to undermine our congressional representatives? won't answer its? okay, got it. might as well just talked to the wall. have a good evening. [applause] >> yes sir, how are you doing

dr. mitchell, do you want to comment? >> i would like to go on the record against the entire oig. when you have a patient who is unstable site catcher clete and if youhiatrically, discharge and he will commit suicide unless something intervenes. in this case, nothing did and he committed suicide. patient number 40 was demonstrating unstable behavior as an inpatient. the psychiatrist had the option to stop his discharge. if you discharge an unstable patient who has a history of hurting himself and suicidal ideation, he will commit suicide. the only question to be asked is when. this is national suicide prevention month. the v.a. has a wonderful program on the power of one, which means one person, one question can stop a suicide. this gentleman, both gentlemen should have had the power of one being the department of ea this is inappropriate medical care for a psychiatric patient. on behalf of every mental health provider in the united states i will say if you discharge an unstable psychiatric patient verbalizing suicidal ideation, he will commit suicide unless something happens to i

dr. mitchell called a whitewash with this one statement in their and then you have other statements were not only other va facilities that would seem to indicate that many within the va think that this scandal was overblown. you know based on the e-mail that was sent on your behalf, do you think that our congressional reps who have representatives here, do you think they got out in front of the media and over blew the scandal? do you think that they misled and lied because it would seem from this e-mail that you are implying that. do you believe that? >> no, i believe the ig report found really important issues and challenges for the phoenix va and we are working on fixing them and looking for. >> why are the staff members here trying to undermine the congressional representatives? just so you all know there is another investigation of this fine facility at the hippa violation. why do staff members here try to undermine our congressional representatives? won't answer it? okay, got it. might as well just talked to the wall. have a good evening. [applause] >> yes sir, how are you doing. wi

dr. kurtis from u.s. naval academy mitchellquestion has to do with the missiles that fail within the -- >> within? >> within the vicinity of the reactor. and -- >> what? nothing hit the reactor. >> well, i read that some fell within the vicinity, and i'm wondering, is this an escalation of target selection on the part -- >> yes, definitely. not only that, have been going up, but nothing would surprise me. this was expected. >> thank you, sir. >> charles perkins, aipac. two quick things. there's been a lot of discussion about how to prevent the next round, how to stop the smuggling, how dependent are ham -- is hamas now on internal ability to manufacture inside gaza versus stopping outside sources, and secondly, although it's not directly on our topic figure past years you have given us a comprehensive look at the irann ballistic missiles program which is retaliated what was going nongaza. there's -- going on in gaza. and i wonder if you could spend very brief time talking about where the iranian ballistic missile system is goin