dr. vas brought her three children to stay with the lopez family. lopez remembers noticing that baby isis had a number of unusual marks or bites on her head, which her mother acknowledged. >> dr. vas said they were flea bites, and i've never seen flea bites like that. maybe around here, here, on her foreheadnd se oner nk. they were black. >> thompson: people at work later recalled his concern about the baby's condition. >> there was one episode where she had woken up, and she was crying and she was, like, gasping for air while she was crying. >> thompson: the lopezes were also concerned about the color of her stool. >> it had turned black. it was a tarry, almost sticky substance, and it was really hard to clean her, you know. >> thompson: ernie lopez said he asked dr. vas for a note to take isis to the doctor just before she went out of town. >> i ran out the door and i asked her... i said we need a note, just in case something happens. and she said, "isis will be fine." >> okay, i need you t

today i will discuss our efforts to determine how accurately the vha determines wait times in va facilities. dr. day, the assistant inspector general will address whether the wait times data va collects is an accurate depiction of the veteran's abilities to access those services. we are accompanied today by dr. michael shepherd, a senior physician in the office of health care inspections and mr. larry rinkermeyer. our review found that inaccuracies in data and inconsistent scheduling practices -- needed to fully assess current capacity, resource distribution and productivity across the va system. if va's fiscal year 2011 in the performance accountability report, vha reported 95% of veterans received -- we concluded that that 14-day reported measure has no real value as an access to care measure. because the ig measured how long it took to conduct the evaluation, not how long the patient to receive that evaluation. we calculated the days between the first contact of the veteran for mental health and the completion of their treatment. we see that the va only complete 54% within 14 days, of either

in december va polled their facilities and they found that there were 1,500 open mental health positions. is that accurate? >> let me turn to dr. petzel. >> would you repeat that number? >> in december of 2011 the va polled their facilities and found there were 1,500 mental health slots that were unfilled. >> out of 20,500 that's true, yes. >> okay. i just wanted to make sure the information i had was correct. mr. secretary, i want to thank you for something unrelated to this budget hearing. march 31st in north carolina we will have the first in the country welcome home vietnam vets day. an all-day event. and i want to thank you for the va's cooperation at making sure that the va presence is there to make sure that we are able to catch those who have fallen through the cracks, work with those who have problems, and have a va mobile presence there as we will from d.o.d. and a lot of private sector entities that are working on employment placement. i think this is a very special event that's long overdue and hopefully it will be the first of a total of 50 that are held around this country. and i thank you for the va's participat

dr. dave, let me turn to you. as you well know, it's hard enough to get veterans into the va system to receive mental health care, once a veteran does take a step to reach out for health, we need to knock down every potential barrier to care. clearly the report your team produced shows a huge gap between the time that the va says it takes to get mental health care and the reality of how long it takes them to get seen at facilities across their country. va has concurred with all of your recommendations, but i think it's clear we all have some real concerns. some of these issues have been problems for years. so can you address a question of what you think it would take to get the va to get this right this time. >> i think to begin with, the veteran population is zurlsed across the country and the va is not evenly dispersed across the country. those veterans that go to fixed facilities to receive their care, the va is probably trying to address the current plan for 1600 people, i haven't seen the details of the plan, so i don't know. i think the first issue is to realize that you have a problem where you have facili

institute, community anti-drug coalitions of america, alexandria, va; jordan burnham, mental health advocate, active minds inc., washington, dc; dr. wendy greene, assistant director of trauma and critical care and program developer, screening, brief interventions and referral to treatment program, howard university hospital, washington, dc. fran, what is the definition of behavioral health, and how do we distinguish between prevention, early intervention, and treatment within that definition? the definition for behavioral health for samhsa is we are taking the substance abuse and mental health prevention, intervention, and treatment programs, and we are encasing it within the disorder realm. so substance abuse, prevention, intervention, and treatment are exactly the same, same levels, and so is mental health. we are finding that mental health properties for prevention, especially, are very similar to the properties of substance abuse, and treatment is different in one respect, but the intervention to get people into treatment is very similar. it is similar, but there are differences between the treatment aspect of substance use d

va. it's all hands on deck. lastly, and i have a bunch of questions written out by -- the metrics that are use d, it may have been you, dr. dave about those being flawed. i don't know if this is the same thing or not, but the report i read means they were kind of jimmying the numbers to make it look like people were getting treatment in a timely manner when they weren't? >> i think that the problem is, that the schedulers were inconsistently operating by business resume that said you should schedule the appointment according to the date that was desired. and the desired date. what is the desired date, the date the patient wants, the doctor wants? in the to and fro of scheduling, i think va created a metric, the rules for which are not supportable in a systematic way. you look at the data set, it's not usable from my point of view. so i think that is in large measure part of the problem with the access measures across the system. we also hear reports of gaming, and people trying to game the system. i don't have evidence that i can give to you of gaming, but i can certainly say the data set, we don't think accurately refle

va is mr. bill schoenhard, he is companied today by dr. ann to net zeiss, chief consultant to the office of meant l health services, and dr. mary schohn at the department of veterans affairs. we have dr. david daigh accompanied by dr. michael shepherd, senior physician in the ig's office of health care inspections. also from the office of inspector general, we have ms. linda halliday, audits and evaluations accompanied by dr. larry reinkemeyer, and next we will hear from nick tolentino, officer in the va, and finally we will hear from the executive direct every of outdoor odyssey, major general thomas jones. mr. schoenhard, we will begin with your testimony. we have a lot of answers we need from you so, please, begin. >> thank you. chairman murray, we appreciate the opportunity today to address the access to quality of mental health care services to our nation's veterans. and we appreciate so much discussion of a topic that is integral to the well being and full living out of a fullfilled life of our nation's veterans. mental health is int

dr. scohn, at this committee's mental health committee meeting, you said you were not aware of not fully reporting waiting times. you heard the testimony about the manchester va regularly using loopholes to meet their mental health measures at the expense of veterans. now that you've listened to his testimony, i want to ask you the same question that i asked you in november. do you believe that va facilities are gaming the system and not fully reporting wait times? >> senator, i would say that we have zero tolerance for that, and we are going to continue our audits and reviews to ensure with additional training of scheduling practices, that this is not occurring. this is certainly not a practice that can be condoned. >> well, you heard mr. torentino, he talked about the manchester va increasing their mental health work load numbers in order to get additional resources, despite not having enough staff to support that growth. the quality over quantity that i believe you stated. and the result is, veterans not getting the care they need. i'm really shocked that the va allowed providers to be put in that kind of dilemma where they have to chose following directio

dr. day spoke of earlier in terms of our four-part mission, one of the great assets having been in the private sector for many years before coming to va is that many mental health providers, including hundreds of trainees currently today get part of their training in va. and have the opportunity to experience this going-forward. we need to better link with these trainees and ensure that we have a warm handoff for employment when they finish this. >> that's one issue. how you arrived at your staffing plan is really unclear to me. >> i'm sorry. >> the new 1600 mental health providers that you allocated. the information that we got from the department yesterday on where that was going to go isn't supported by any concrete facts or evidence. in fact, yesterday the vision 20 director told us that she learned about the new positions only a couple days ago, didn't know if it was sufficient, and didn't know how the department even reached those numbers. i want to ask you, how did you arrive at that number, 1600, and how is it going to be effectively placed across the country? >> i'm sorry, i misunderstood the question, i'm going to ask mr. sc

dr. schoenhard i appreciate the va stepping up to this today. i appreciate them accepting the ig report. i really appreciate the ig for all the work you did and intense amount of time. a large number of your resources focus on this, of course our other witnesses, thank you very much for being here today. but i want to make it very clear, this is not something we will have a hearing on and leave and go do something else tomorrow. this has to be taken care. we owe it to these men and women. i don't want to continue to hear that anybody is gaming the system. i want to know that the action plan that is being put in place, make sure the hiring that you have announced is actually taking place. if there are berries to the, we want to know about it. and i want to know how you decided which business were going to get the practitioners you've outlined, and i want to know from on the ground there is a real connection to the va here at central office. and this isn't just another hearing here in washington, d.c. and action on the ground continues to be the a

dr. dave? >> madam chairman, members of the committee, i already testified before you today. on a daily basis we deal with clinical care issues in the va. we know that the employees and leadership at the va strive to provide the highest quality of care to its veterans. with respect to quality metrics, i think the va leave the nation regarding use of data and publication of data on the web site. with respect to access to care, i believe it is a different story. i think those metrics are flawed. as the report indicates, he has put together a group to try to resolve the issue so that they do accurately reflect the business process at the va. a plan to address the access to care metrics in the private sector, but i think what i would like to make are two different statements after hearing the opening statement. the first would be that i think that the va has a number of missions. a mission to provide health care. the mission to do research. a mission to treat individuals who will work in the united states and elsewhere in health care industry. the other mission is to be available in times of natural disaster. i think that as individuals ou