and it just strikes me, and i realize this was a vha hearing. it strikes me that you could have testimony like we had on monday night and yet turn around and put out a press release still stating the same numbers the next day when every one of the investigators found that those numbers couldn't be trusted. so i'll work with you. it's an area of great concern. it's as big if not bigger problem than the vha because the budget is the biggest budget at the v.a. i thank the chair. >> senator murray. >> thank you, mr. chairman. secretary, the v.a. has removed the wait time criteria from the performance contracts of network and medical center directors, and i do understand the need to be wary of creating incentives for people to game the numbers, but we also have a serious accountability problem. how will you still hold a network and a medical center director accountable for wait times if it's not in their performance contract? >> i think the first step that we've got to do is get the integrity in the data. and so the idea behind pulling that out at th

all across vha, roughly 28,000 vacant positions. and in some instances, those aren't all being actively recruited to fill. i would tell you as part of accelerating care, we have been pushing on clinical staff and direct support staff to accelerate some of the hiring. >> my follow-up question there is if you have 28,000 minus x open slots, and you add 10,000 or so more open slots, are you ever going to even be able to fill those slots under current requirements? the current productivity requirements you have, which i understand from testimony is different than in the private sector. >> organizations will always have some measure of organ ic vacancy rates. you'll have turnover in the staff, but what it allows us to do the raise to floor so that the floor of the fully incumbered positions grows with additional staff brought in, so i think there will be staff that leave the organization, people leave, they retire, they move on to other jobs. there will be a vacacy rate. right now, it's about 10%. and that sort of reflects the turnover r

vha is expanding her use of private sector health care to improve access. i sent a message to all printed 41,000 va employees and have reiterated during every single visit to va facilities the whistleblowers will be protected. i've conducted over a dozen meetings and calls with senior representatives and vso's and stakeholder groups to solicit their ideas for improving access and restoring trust. i've named dr. carolyn clancy and from secretary for health. she will spearhead our immediate efforts to accelerate veterans access to care and restore the trust of veterans. dr. jonathan perlin former undersecretary for health that va currently on leave of absence from his duties as chief medical officer and president of clinical services for hospital corp. of america has begun his two month assignment as the a senior adviser to the secretary. dr. proven expertise judgment and professional guys will help bridge the gap until va has a confirmed undersecretary of health. dr. jerry jerry cox is jerry cox has agreed to serve as interim director for office of medical i

and yet in that time, the el paso vha and the national vha was telling me that things were under control, and as recently as may 9 of this year, the director of vha told me that there was zero days wait time on average for a veteran seeking mental health care access in el paso. what i take that to mean is no veteran waited more than 14 days to do that. the discrepancies between what we were hearing from people like mr. damico and the va were so great that as i told this committee before, we initiated our own survey of mental health care wait times. found the average wait time was 71 days. found that, as dr. matthews told us earlier this week, more than 14% of veterans stopped trying to seek mental health care because it was too frustrating, and 36%, one-third, couldn't get an appointment at all. is to i want to ask y so i want to ask you, if you had known the average wait time was 70 days, or as the va found last month, 60 days, but certainly more than 14, we have the worst wait times for access to mental health care for new veterans, the worst as of june. what would you have done differ

all across vha, roughly 28,000 vacant positions. and in some instances, those aren't all being actively recruited to fill. i would tell you as part of accelerating care, we have been pushing on clinical staff and direct support staff to accelerate some of the hiring. >> my follow-up question there is if you have 28,000 minus x open slots, and you add 10,000 or so more open slots, are you ever going to even be able to fill those slots under current requirements? the current productivity requirements you have, which i understand from testimony is different than in the private sector. >> organizations will always have some measure of organ ic vacancy rates. you'll have turnover in the staff, but what it allows us to do the raise to floor so that the floor of the fully incumbered positions grows with additional staff brought in, so i think there will be staff that leave the organization, people leave, they retire, they move on to other jobs. there will be a vacacy rate. right now, it's about 10%. and that sort of reflects the turnover r

what would you consider a critical position for a vha central office and visiting offices? >> for example, we currently have four vacant visin director positions and if we were where we had the right person identified to step into that those key leadership roles, i would be prepared to grant an exception for that personnel action. >> have you granted an exception so far? >> i have not for that purpose. there is one employee i granted an exception for, where he had already been given an offer and he agreed to an offer, and had already started to relocate. i did that. this is roughly 3,000 people that surprised the vzn central office relationship. there are other staff that are associated with those particular areas, such as call centers. we have thousands of people that work in our call centers in vha and those would not be positions because they are providing -- that would be subject to the hiring freeze because they are providing direct service to veterans. >> how long will the hiring freeze be in effect? >> don't know. >> you can't anticipate how long, huh? >> you know, t

the bigger question, as i see it, what is vha's mission? vha's mission to deal with all reintegration problems? and i would say probably not. and because so much is trying to stream through vha to deal with reintegration issues outside of health care, it's created a strain on the system and has diluted its primary mission of providing outstanding health care, including mental health services. >> thank you. getting back to the v.a., i noted in your opening remarks, v.a. spending on mental health is approaching $7 billion, double the amount in 2007. what is the v.a.'s -- what is v.a. using as a measure of success of this investment in mental health services? >> thank you, congressman. there is no single measure that we can point to that is going to satisfactorily answer that question. what we have heard today, over the last few weeks, points to the fact that v.a. has a lot more to do. at the end of the day, what matters most is whether or not we have met the needs day, what matters most is whether or not we have met the needs for individual v

for the long-term sustainability come in vha in va, but especially vha used to have academy were really great of a sort of let betty roda may have to bring them back in built leaders by focusing the training on them, building them over time and investing in them. >> at so you want to hear. i think this is an opportunity to build that hybrid. you do it here. the core mission of the va needs remain intact. there certainly positive lessons that they are, mayo in others. we heard last week from a panel that offered great suggestions. one from indiana said he looks out the window and the five hospitals. he does on any given day there is only 79% of capacity. the think outside of the 21. >> i was in st. louis on tuesday and had the opportunity to visit our training academy on the cemetery side of the business and cited as an internal best guess -- >> we need to import into vha because we don't have the kind of talent development and succession planning inside vha that you would find. >> i think it's important you bring that back up again. the older members will remember this. out of arlington

the bigger question, as i see it, what is vha's mission? vha's mission to deal with all reintegration problems? and i would say probably not. and because so much is trying to stream through vha to deal with reintegration issues outside of health care, it's created a strain on the system and has diluted its primary mission of providing outstanding health care, including mental health services. >> thank you. getting back to the v.a., i noted in your opening remarks, v.a. spending on mental health is approaching $7 billion, double the amount in 2007. what is the v.a.'s -- what is v.a. using as a measure of success of this investment in mental health services? >> thank you, congressman. there is no single measure that we can point to that is going to satisfactorily answer that question. what we have heard today, over the last few weeks, points to the fact that v.a. has a lot more to do. at the end of the day, what matters most is whether or not we have met the needs day, what matters most is whether or not we have met the needs for individual v

all vha senior executivexecutiv for 2014 have been suspended. vha is expeneding the use of private sector health care to improve access. i sent a message to 341,000 to veterans and reiterated that whistle blowers will be protected and we will not tolerate retaliation against whistle blowers. i named dr. carry for the secretary of health and she will spear head the immediate access for veteran care and restore the trust. a former health secretary is on leave of absence from chief medical officer and president of clinical services for hospital corporation of america has begun his two month stint as senior secretary advisor. he will help bridge the gap until there is a confirmed secretary for health. dr. jerry cox is serving as interim of medical am specter. a navy office for 30 years and the former assistant inspector of the navvy for medical matters. he will ensure a strong internal audit function. as we complete reviews and fact finding, we are beginning to initiate personal allegations to those who were doing wrong. ms. bradley is a formal gene

there was no vha, vba interfacing, nor procedures.nterest of communication between disability termination and vocational rehabilitation. this report is offered in the spirit of a call to action, and reflects the experiences of dana services program beginning in the fall of 2007 until his death last june, through our eyes. theur concern was that impediments that daniel and counted were symptomatic of deeper and water issues in the v.a. potentially affecting the experiences of a much broader population of service members and veterans. unfortunately, this has been proven true come as evidenced by recent revelations. many of the reforms outlined in our report will require additional funding for the v.a. with that new funding, should come greater scrutiny and a demand for better, measurable results. there is an alternative to attending through. the existing broken system. we believe congress should seriously consider fundamentally revamping the mission of the v.a. health system. the new model we envision, the da would transition to a cente

second, round numbers to i would say in vha we probably hire 30,000 people every year anyway. nine of 10,000 sows like a huge number. it's about 3 percent of staff, maybe a little less. but recognize that some of these are in places like primary care positions and mental health providers. we know, and you all know that those are tough to find. so it will take time for us to be able to hire. quite frankly, the other problem even if we could go out and hire them all tomorrow, we don't have a place to put them all. in some instances we will have to deal with space issues in tandem with this. we may be able to do -- there are provisions in here for what are called the emergency leases. i authorize some of these when i go out to the field where someone has found clinics based that is local that can be occupied quickly. 10,000 square feet, something like that. >> i don't mean to interrupt you, but my time is running out. >> yes, ma'am. >> you are addressing the length of time it takes. if you are hiring 30,000 people every year, there are probably some retention issues that you also

what would you consider a critical position for a vha central office and visiting offices? >> for example, we currently have four vacant visin director positions and if we were where we had the right person identified to step into that those key leadership roles, i would be prepared to grant an exception for that personnel action. >> have you granted an exception so far? >> i have not for that purpose. there is one employee i granted an exception for, where he had already been given an offer and he agreed to an offer, and had already started to relocate. i did that. this is roughly 3,000 people that surprised the vzn central office relationship. there are other staff that are associated with those particular areas, such as call centers. we have thousands of people that work in our call centers in vha and those would not be positions because they are providing -- that would be subject to the hiring freeze because they are providing direct service to veterans. >> how long will the hiring freeze be in effect? >> don't know. >> you can't anticipate how long, huh? >> you know, t

all across the vha roughly 28,000. and in some instances, those are not all being actively recruited to fill and i would tell you we have been pushing particularly on the clinical staff to accelerate some of that. if you have 28,000 open spots and you have 10,000 or so more open spots are you ever even going to be able to fill those spots under current requiremen requirements? the current productivity requirements you have but i understand in the testimony is different and in the private sector. >> organizations will always have a measure of organic vacancy if you have turnover in the staff but what it allows us to do is raise the floor so that the floor into the fully encumbered positions grows with additional staff brought in. so, i think there will be staff that leave the organization and if they retire and move on to other jobs there will be a vacancy rate. the rate now is about 10% and the reflect to her turnover rate. so as that occurs you have a certain vacancy rate. the other thing we are looking at her with th

and that's really where we're at, whether you're talking vha or vba. it is the same issue. and we have yet to -- i think next week we're digging into some of the vba issues also. it's a culture. and one other point, and then i'll ask one question, and it -- and miss somers was talking about it and dr. roe also validated it, when you talk about community and talk about support networks, these men and women are spending more time away from the health care facility than they are in the health care facility. so friends, family members, you know, classmates, buddies, all have to be part of the healing process. not doing that. and i know the term wholistic has come up a few times. i think the sergeant mentioned it a couple of times. it is part of the healing process. there is no silver bullet to cure somebody. you got to be able to help them in many different ways. that being said, in the va's testimony, they mentioned suicide prevention coordinators are supposedly placed at all va medical centers and the large clinics. they're supposed to follow up with veterans at high risk. we

we brought the vha and the vba issues into account. these are just things that all together just became overwhelming. >> my belief is he still had the mentality of the military where this is what someone of authority told me and i have the accept it and i cannot go above and beyond. >> thank you. >> i want to thank the panel for coming again today to talk about your stories and your family and really appreciate it. i know it can't be easy. my question dr. somers is can you go into further detail about why you think it is important to encourage every veteran serving with ptsd to supply a list of points of contact and get a hippa waver? >> interesting you should say hippa because once that is said someone stops the conversation. we have been trying to deal with this issues because it takes a village, a large village, to not only treat but to recognize and to approach our veterans who might be in crises. we feel it is critically important to expand what we call the support network. at this point, actually a hippa change would be wonderful

and yet in that time, the el paso vha and the national vha was telling me that things were under control, and as recently as may 9 of this year, the director of vha told me that there was zero days wait time on average for a veteran seeking mental health care access in el paso. what i take that to mean is no veteran waited more than 14 days to do that. the discrepancies between what we were hearing from people like mr. damico and the va were so great that as i told this committee before, we initiated our own survey of mental health care wait times. found the average wait time was 71 days. found that, as dr. matthews told us earlier this week, more than 14% of veterans stopped trying to seek mental health care because it was too frustrating, and 36%, one-third, couldn't get an appointment at all. is to i want to ask y so i want to ask you, if you had known the average wait time was 70 days, or as the va found last month, 60 days, but certainly more than 14, we have the worst wait times for access to mental health care for new veterans, the worst as of june. what would you have done differ

there was no vha, vba appointment interfacing nor proactive procedures. there was no communication between disability determination and vocational rehabilitation. this report is offered in the spirit of a call to action and reflects the experiences of daniel with va program services beginning in the fall of 2007 until his death last june through our eyes. >> as seen through our eyes. our concern then was that the impediments and deficiencies were a sign of deeper and broader issues within the va not serving a broad number of veterans. unfortunately, it has proven true after dramatic revelations of recent announcements. they will provide funding with the va, but with that new funding should come greater scrutiny and a demand for better measurable results. >> there is, however, an alternative to attempting to repair the existing broken system. we believe congress should seriously consider fundamentally revamping the mission of the va health system. in the new model we envision, the va would transition into a center of excellence specifically for war-related

the workload at the vha alone is enormous. some 85 million appointments a year and some 25 million consultations. as ceo of procter & gamble, bob oversaw more than 120,000 employees with operations around the world, selling products in more than 180 countries and more than 2 million stores reaching 5 billion customers. in other words, he knows the key is staying focused on the people you are trying to serve. he's renowned for his operational excellence and started his career in the field and worked his way up, serving at virtually every level of procter & gamble. he understands grand plans are not enough and what matters is the operations you put in place and getting the job done. bob is an expert at making organizations better. in his career, he's taken over struggling business units. he knows how to roll up his sleeves and get to work. putting an end to it doesn't work, adopting best practices that do, restructuring, introducing innovations in making operations more effect. in short, he is about delivering better results. he

. >> the vha reached out to over 650 and made 543,000 referials for veterans to get service. this is in the last two- month period. >> reporter: he said there are more clinic hours and looking to buy a state-of-the-art scheduling system. he asked congress for help. and he's hiring more people. >> you would need 10,000 additional staff? i think you were talking about some 17.6 billion that you are requesting? >> yes, ma'am, i know it sounds like's huge number. >> reporter: the price tag concerns those on the committee who poured hundreds of millions in the va and it was not well spent. others warn it is no quick fix. >> i commend you for what you have done, but over the course of the years is a horrendous blemish on the va's relationship. >> reporter: president obama nominated robert mcdonald, former head of proctor and gamble to take over the va. the senate will hear from mcdonald next tuesday. >> thank you, molly. >>> new strategy to try to dig up the e-mails from the woman in the heart of the irs scandal. the house adopting a resolution to direct the nsa to turn over any e-

last year, this congress for this year appropriated $55 billion for vha. the veterans health administration. of that $55 billion, most members would be shocked to know that 48% goes to direct patient care. we're talking about $27 billion of appropriated money goes to the delivery of health care to our nation's veterans. 52% goes to administration and other programs that emanate out of the vha budget. of that $27 billion, that's doctors and nurses, it's the delivery of care to all of our 8.4 million veterans who cbo has scored enrolled and active. now, it brings us to the house bill and the senate bill. the house bill was scored at $35 billion a year. and if fully implemented after the two-year period scored it $50 billion. the house scored it $44 billion. basic difference of timing on the wait times from 14 days to 30 days. now, i ask my colleagues around this table, is the cbo product that they've produced reflective of anything sane? that the scoring of a bill that offers limited choice if one of two things is triggered in the house side, gone past the 3

and that's really where we're at, whether you're talking vha or vba. it is the same issue. and we have yet to -- i think next week we're digging into some of the vba issues also. it's a culture. and one other point, and then i'll ask one question, and it -- and miss somers was talking about it and dr. roe also validated it, when you talk about community and talk about support networks, these men and women are spending more time away from the health care facility than they are in the health care facility. so friends, family members, you know, classmates, buddies, all have to be part of the healing process. not doing that. and i know the term wholistic has come up a few times. i think the sergeant mentioned it a couple of times. it is part of the healing process. there is no silver bullet to cure somebody. you got to be able to help them in many different ways. that being said, in the va's testimony, they mentioned suicide prevention coordinators are supposedly placed at all va medical centers and the large clinics. they're supposed to follow up with veterans at high risk. we

the employee then stated in the letter, quote, if vha is replaced by vba and 14 days is replaced by zero claims over 125 days and 98% accuracy, these excerpts from the report apply equally to the vba, end quote. to determine the scope of this statement at the end of last week, the committee asked afge to inquire whether employees nationally agreed or disagreed with this sentiment. and in less than two days, fast responses were received from 18 regional offices. not one regional office employee responded in disagreement. in fact, 16 ros agreed on equivocally. let that sink in. vba is still running guns blazing on this questionable path without a real plan, without a real change. so let's begin tonight by reminding everyone again of vba's real mission. and it is, quote, to provide benefits and services to veterans and their families and a responsive, timely, and compassionate manner, end quote. you've seen the perverse consequence of the mixed metric goals within the veteran health administration. and tonight we're going to look at vba's targets. and we will hear what's being done to push

we talked about the vha a lot.i wanted to ask you and the other panelist have you felt any sense of change coming down from the top around the work environment? how we want to improve, encourage, and serve the veterans and be a veteran-centered operation. >> have you felt that change in culture in your department? >> no. >> mr. robinson? >> i have a new director now. so i am not going to lump all of the directors in one pool because i don't like to paint with that kind of brush. she is new. we have been able to get along and together. >> up until that point? can you answer up until that point? >> up until that point no. it was awful. employees suffered. and the reason it disturbed me that the va chain of command knew and allowed it to be. >> thank you, mr. robinson. and ms. ruell, have you felt any change recently? >> no. actually i believe things are getting worse. i took it upon myself to help employees that were targeted by manageme management. they are terrified to stand up for themselves and they i don't want

similar to the vha paper waiting list our memos were on all paper. so if you wanted to find out how many memos were done in philadelphia, you would have to go to the file room and find the claims and memos if they are still there. map-d isn't a program that the managers are not familiar with and e-mailing they do everything day. they e-mail us list non-stop. i think they understand the bottom portion and they failed to do anything to control it. i think it was to hide it. >> thank you. >> thank you very much, mr. chairman. the first few questions are a quick yes or no and starting with mr. soto and going down the panel. did you believe that production is being driven over quality? >> absolutely. >> yes. >> definitely. >> and did you believe that non rating workload is being provided enough resources to be done in a timely and accurate manner? >> no. >> definitely no. >> no. >> and do you believe that vbms is making va more efficient than when you dealt with paper? >> at the present time i would say it is debatable. >> i say it is no because all the w

we've talked a lot about the vha. i wanted to ask you and the other panelists, have you felt any sense of change coming down from the top around the work environment, how we want to improve, how we want to encourage our employees, how we must serve our veterans, we must be a veteran-centered operation? have you felt any of that change in culture in your department? >> no. >> mr. robinson? >> i have a new director now, so i'm not going to lump all the directors in one pool because i don't like to paint with that kind of brush. she's new. we have been able to get along and work together, but it's -- >> up until that point then? can you answer up until the point of -- >> up until that point, no, it was -- it was awful, okay. employees suffered, and the reason it disturbs me that the va chain of command knew it and allowed it to be. >> thank you, mr. robinson. and, miss ruell, have you felt of recent any change? >> no. actually i believe things are getting worse. i took it upon myself to help employees that are targeted b

it is because i feel partially responsible and in that time the el paso vha in the national dha were telling me things were under control and as recently as may 9 of this year the director of vha told me there was zero days way time on average for a veteran seeking mental health care access in el paso and when i take that to mean is no veteran waited more than 14 days to do that. the discrepancies between what we are hearing from people like mr. d'amico and the va were so great that as i have told this committee before we initiated our own survey of meth mouth health weights and on the average was 71 days. like dr. matthews told us earlier this week 40% of veterans stopped trying to seek mental health care because it was too frustrating and fully 36%, one third could not get appointments at all. and so i want to ask you if you had known that the average wait time was 71 days or as your own vha bought it -- audit found 60 days but much longer than 14 days, if you knew as we know now that we have the worst way times in the country for access to mental-health care for veterans, the wors

the vha formerly with in their transformation efforts. i presume that means the v.a.'s transformation. fromjust curious to know your old position, how you thought you were doing with the transformation of the aj? of any of those things? >> i was not aware. i think most people in the organization at senior levels were unaware. i think that is part of the problem. my job as transformation lead for the organization, we have omitted a program and expanded our health program. those are the things i was working on. i was a medical center director for 12 years. i have a lot of operational experience. i thinknto her point, training and education is very important. people have to know the right standard of conduct is. the second point i would make is once they know it makes it easier for us to hold people accountable. you can't say i didn't know. think that program has the potential to have a very positive impact. >> doctorow, you are recognized for five minutes. of things tot patients that require one thing that is very important. that is called trust. washave said the v.a. gr

just as vha attempted to do by cooking the books on schedule times in our vacations involving disease the va office of inspector general will testify to the potential over $1.3 billion in improper payments. all claims that were two years old or older to be created within 60 days introduced a scheme called provisional ratings. this was another hard and fast deadline dictated by central office and vba promise don't worry, would you will get them done right. they won't be going out the door without service treatment records without medical exams if that's necessary. so what was found at the regional office? guidance that read and i quote the new vba exam request will have a negative impact on our ability to meet the goal that has been mandated by her leadership" map. so vba employees were directed to move forward even if a medical exam was necessary to decide these aging claims. contained in the guidance and i ask you to look at the screen and members you should have this at your desk, i quote from an e-mail where it says i understand this may be difficult to do. it may appear to go agai

we talked about the vha a lot. i wanted to ask you and the other panelist have you felt any sense of change coming down from the top around the work environment? how we want to improve, encourage, and serve the veterans and be a veteran-centered operation. >> have you felt that change in culture in your department? >> no. >> mr. robinson? >> i have a new director now. so i am not going to lump all of the directors in one pool because i don't like to paint with that kind of brush. she is new. we have been able to get along and together. >> up until that point? can you answer up until that point? >> up until that point no. it was awful. employees suffered. and the reason it disturbed me that the va chain of command knew and allowed it to be. >> thank you, mr. robinson. and ms. ruell, have you felt any change recently? >> no. actually i believe things are getting worse. i took it upon myself to help employees that were targeted by manageme management. they are terrified to stand up for themselves and they i don't want

within vha, the problem of intimidation, retaliation may be magnified by what some consider a protective culture of the medical profession. it is often thought to be against the code to point out colleague's mistakes or where a nurse or a tendant is told it is appropriate to question a physician or surgeon. the natural tendency is to close ranks, to not die that problems exist or mirs stestakes were ma. so after we listen to the testimony before us this evening from the whistle blowers, the office of special counsel and the va will -- anything change after we hear what the whistle blowers have to say and how do we fix this culture and encourage all va employees to step forward to identify problems and work to address the problems. changing a culture is not easy. it cannot be done legislatively or 33inthrowing additional resos at it. talk is cheap. real solutions are hard to find. it is clear to me that the va as it is structured today is fundamentally incapable of making real changes in the culture. i note that acting secretary gibson announced today that he was taking steps to reinstruc

vha facilities are adding more clinic hours, aggressively recruiting to fill physician vacancies, using temporary staffing resources, and expanding the use of private sector care. we're moving rapidly to augment and improve our existing schedule system while simultaneously pursuing the purchase of a commercial off the shelf state of the art scheduling system. i've directed medical center and visiting directors to conduct monthly inspections in person of their clinics to assess the state of scheduling practices and to identify any related obstacles to timely care for veterans. to date over 1100 of these visits have been conducted. we're putting in place a comprehensive external audit of scheduling practices across the entire vha system. we're building a more robust continuous system for measuring patient satisfaction, which i believe will be central to our measurement processes in the future. i've personally visited 10 va medical centers in the last six weeks, to hear directly from the field on the actions being taken to get veterans off wait lists and into clinics. i leave later today f

this goes back years, and that's because the leaders in v.a., in particular vha the health care side, they've been in leadership, some before i was even born. >> the people that run the place, a lot of them are lifers. the bonus system seems to be at the crux of a lot of this. that to get those bonuses, a lot of managers, a lot of workers, went through hoops to justify the numbers, to make the numbers. am i right about that? >> i think a lot of managers did it to make the numbers to get the bonus. but also look at the influence of government. people in government don't do just what they do for bonuses. they also do it to empire build. the more you hit your numbers, the more you can expand your department. in our department where we work, we brought in about four or five new gs-15 positions. these are $130,000 to $150,000 a year positions. yet we have not done anything to bring in workers who can bring down the workload. that's what a veteran wants. he or she wants their health care application processed. they don't need another executive to stand around looking at other people do the

there are 300,000 people in vha alone. >> so is that 10,000 additional staff -- and i know you broke it down to how many doctors et cetera. so is that both for the emergency situation we have now or is this an assessment that reflects your long term staffing needs? >> there was a reference made in one of the opening statements earlier about the findings of the field audit and e number one cause for scheduling difficulties was that there weren't sufficient provider slots to be able to schedule patients into. so what we're talking about here my comment earlier that we have not historicically managed requirements. we've managed to a budget number. so basically we took a budget number and then we did what folks thought they could do and the veterans wound up being the shock absorber in that process. >> so meanwhile what your needs are, you would need to hire 10,000 additional staff. >> yes, ma'am. >> and that would of course depend on the appropriation that is we provide. >> yes, ma'am. >> so if you were to have the appropriations to hire 10,000 people, what would -- how long do you thin

is how much do they and how much do they contribute to accomplishing the mission, and vha, all those middle, middle people -- almost all of them -- need to go away because they just get in the way of the mission. >> mr. nicholson, last question. again, does it trouble you that mr. mcdonald lacks health care management experience? >> it does not necessarily. he has a phenomenal business background and, like i think ryan mentioned, business processes is certainly something the v.a. needs to focus op. we were not consulted on the selection process of the nomination, but he was sort of an out of the blue pick for us, so we had to do a lot of catching up and learning about him and are still in the process of that as is everyone else, but we're generally supportive of him. we would agree that accountability and transparency are top priorities but tech upgrades as well. >> i yield back. >> mr. bilirakis, could i add one thing? earlier i noticed in the audience the honorable harry walters, and when he came in in '82, the veterans administration was so mad that everybody was chewing on nails.

>> actually, the vha is spending $60 billion. that's how much they get.0% in the last seven years, with only a 20% increase in patients. so there's been a lot of money thrown -- >> i don't think money is an issue but just allowing someone to come in there and just do the job. i almost think you could have patton going in there but if his arms are tied, can't do anything and nothing happens. >> the house and senate agreed on these three items with the exception of quibbling about the money. how much money, when in what format, with what going of granularity. some said the va just sort of pulled this number out of a hat. >> what about vouchers, they're not getting the care they need, walk across the street -- >> if say even if congress passed the vouchered today it will take months to evict wait that. congress needs to send m-mccon dub mr. mcdonald with marching orders, tens -- >> what if he went in there and i'm going to start firing people right now. >> think mr. mcdonald is an adroit manager who we be able to get things done even in the absence of those

. >> we're putting place a comprehensive external audit of scheduling practices across the entire vhauing system for measuring patient satisfaction which i believe will be central to our measurement processes in the future. >> but all of this comes way too late for some veterans' families. they are complaining of long wait times not just to see a doctor, but even worse, to receive critical surgeries like removing a tumor. here is cnn senior medical correspondent elizabeth cohen. >> reporter: sergeant terry mitchell, radio operator in vietnam withstood fire deep in the jungle, exposed to agent orange, survived all of it and then his wife believes his life was cut short by delays in care here at the va. >> reporter: what do you call this place? >> va hell because you are in hell when you get here. >> reporter: here's what she means. august 8, 2012, a va pathologist finds a growth on terry mitchell's neck is concerning for cancer and recommends complete excision. in other words, operate and get it out. but vicky mitchell says her husband then got bounced around from doctor to doctor. med

should be tapping the best health care minds that we have in this country to go step-by-step through the vha season and write us a blueprint for the lean, smart, 21st century v.a. that serves our veterans. this reform should be a direct facility to the private sector. there is much we need to know. we need to know why past attempts have failed and why outside the traditional v.a. system emerge, we need to ensure the v.a. will properly collect the resources owed to them. not continue to leave money on the table. i'm just not confident that we will get the information we need and the goals accomplished if we don't look outside of the v.a. to proven leader ins the health care injury. before we get to planning on the future, immediate steps need to be taken. i believe we can do this in a responsible, effective way. our veterans have been through enough. the language is written to wait 14 days before they're eligible to look for private sector care, then we haven't done our job here. if the authority we grant the v.a. looks really similar to the authority that they already have but choose not to

vha has reached out to over 703,000 veterans to get them off of witless and in the clinics to playing a mobile medical units using temporary staffing resources and expanding the use of private sector care. in the last two months between may and may to mid july and we have made over 570,000 referrals for veterans to receive care in the private sector. that is up more than 700,000 to over the comparable time the year ago. each of those referrals will on average results and seven actual apartments and visits. an increase of more than 700,000 of lemons and visits for care in the community last year just associated with the referrals over to once. the ag is posting a regular twice monthly updates to keep veterans of born about progress we are making and accents. as part of the effort to improve transparency, i recognize, mr. chairman, that we have more work to do in providing complete and timely responses to a special inquiry. we are moving to improve our existing scheduling system and simultaneously pursuing a purchase of a moderate commercial off-the-shelf system. i have directed medical

you mentioned this vha could be the best health care system in the world. how do we get there? >> i believe with leadership. there are certain parliameeople leadership that have been there 18 years. if they are a great leader it is great. but if they are not we need to find ways to bring unloin leadership. if you a good leader you are identified as a good leader and you can be part of the team that shows leadership and maybe if you are not you should be put in another part of the federal government or retire. but leadership is clearly the key. our surgical team at the west la facility could be matched against any facility in the world. my wife is a cardiolgist and she could work anywhere in the country. she married me and loves her jobs and obsesses over it and always works to save the veteran. there is lot of people like that. we need leadership. the leadership will take the va to that next level. i think it is not resources. we all care about the veterans and you are giving and we will give anything to serve the veterans. we will do anything it takes to make the situation rig

management failing injures, lack of communication is a problem at all levels of the vha, and v.a. needs more provider, more space and modern i.t. systems, as we continue to work in the conference commit year, i hope an agreement will be reached so we can send it to the president and start making the changes needed at the v.a. so veterans get into care. the compromise will be the important first step, as more problems are found, we will need to take additional steps. we cannot lose sight of many other pressing issues. too many veterans still die by suicide each day. sexual assault survivors still need help. the v.a. has to continue to make progress toward the commendable, even more challenging goals of eliminating homelessness and reducing we've been working on this, as you know, for a very long time. now hundreds of veterans in that area will be able to access the long-term care that they need. as i have said repeatedly here in this, when the nails goes to war, it also commits to taking care of the veterans. their needs are a cost of war, and we will provide for them no matter wha

kim kaiser in "the new england journal of medicine" vha central office staff has grown from about 800n the late 1990s to nearly 1,102,012. this further illustrates va shift the focus to building a bureaucracy as opposed to fulfilling its duty to providing quality care. as i said before the problems that exist today will not be fixed overnight. it cannot be fixed by simply throwing money at those problems. to date the va has been given every resource requested by the administration. every year during our budget oversight hearings members of this committee dr. row in particular has asked if the secretary had enough to do his job and every time time we have the committee were told unequivocally, yes. this is why the last week acting secretary said that an additional $17.6 billion was needed to ensure that va is available to deliver high-quality and timely health care to our veterans and when he did that he raised very obvious questions. where did the number come from? the substance to underlie this request and how were they made? what effort was made to look within existing resources in