[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS FOR 2016
__________
Wednesday, March 4, 2016.
DEPARTMENT OF VETERANS AFFAIRS
WITNESS
ROBERT A. McDONALD, SECRETARY, DEPARTMENT OF VETERANS AFFAIRS
ACCOMPANIED BY:
DR. CAROLYN M. CLANCY, INTERIM UNDER SECRETARY
FOR HEALTH
ALLISON A. HICKEY, UNDER SECRETARY FOR BENEFITS
STEPHEN W. WARREN, EXECUTIVE IN CHARGE FOR
INFORMATION AND TECHNOLOGY
HELEN TIERNEY, EXECUTIVE IN CHARGE FOR THE
OFFICE OF MANAGEMENT AND CHIEF FINANCIAL OFFICER
GLENN R. POWERS, DEPUTY UNDER SECRETARY FOR
FIELD PROGRAMS
Chairman Opening Statement
Mr. Dent [presiding]. Good morning.
I would like to bring to order this hearing for Veterans
Affairs--for the MILCON V.A. Subcommittee. Thank you all for
attending.
And today, I am very pleased to welcome Secretary Robert A.
McDonald, Secretary of the Department of Veterans Affairs, for
his first appearance before this subcommittee, defending his
fiscal year 2016 budget request.
Mr. Secretary, we know you have a lot of important material
you want to present to us today, and subcommittee members have
a lot of questions for you and I know competing hearings as
well. So we would appreciate you being willing to keep your
opening remarks to within 10 minutes.
I will also keep my opening remarks to a minimum.
Secretary Bob, you come before us at a challenging time for
the V.A. You are trying to recover from the wait list scandal
and implement the complex new Choice legislation.
And you are trying to bring about a transformation of the
agency to make it more veteran-service-centric and certainly
more customer-friendly, and we appreciate those very good and
sincere efforts.
You are also defending an enormous budget increase in your
discretionary budget of about $5.1 billion, or a 7.8 percent
increase, which is financed by offsets in the President's
budget that Congress, frankly, is unlikely to accept.
I have to be frank with you, Mr. Secretary. Any increases
are going to be extremely difficult to fund under the
constraints we have, and all departments are going to be
affected under the BCA, the Budget Control Act, with a
government-wide increase in the non-defense discretionary cap
of $1.1 billion. We can't make room for a $5.1 billion increase
without taking a machete to important programs in other
subcommittees. I suspect the chairman may agree with me on that
point.
We fully appreciate the complex mission you have at the
V.A. and share your dedication to making it work better. You
have a lot of great employees out there, and when I visit
facilities, I am always extraordinarily impressed by your
medical team and all the allied health professionals.
The subcommittee welcomes the opportunity to learn about
your vision for addressing the V.A.'s problems and reforming
the agency so that we are sure we are giving veterans who want
to use the V.A. the services they deserve.
Mr. Bishop is not here at the moment.
I am going to quickly yield to the chairman and then to the
ranking member of the full committee for their opening
statements.
Full Committee Chairman Opening Statement
Mr. Rogers. Thank you, Mr. Chairman, and congratulations,
by the way, on assuming this chair.
Mr. Dent. Thank you.
Mr. Rogers. This is your first hearing?
Mr. Dent. Third hearing.
Mr. Rogers. Third hearing? Well, Okay. You are off to a
good start.
Anyway, congratulations to you, and best wishes.
Mr. Secretary, we are glad to have you here.
You have ranked some very impressive credentials to this
job from the private sector, and we are looking for great
things from you and your staff. You've got your headaches,
you've got your problems, but I feel like you are the man for
the job. We congratulate and welcome you to this subcommittee
for your first time.
The V.A. is charged with carrying out an essential
responsibility of the U.S. government, and that is ensuring the
health and well-being of our nation's vets, who selflessly
serve with dignity and honor.
This charge brings a host of challenges: providing our
veterans with timely access to quality health care, ensuring
that they receive appropriate compensation for disabilities,
and fighting the persistent problems of veterans' homelessness
and substance abuse.
Just last summer, we were made aware of gross mismanagement
and negligence on the part of this department. Veterans were
kept on wait lists for months, awaiting health care services
and treatments that they have been guaranteed by their
government and deservedly so.
We can all agree that treating our veterans this way is
unacceptable, and I commend you for your willingness to face
these serious issues head on and the actions you have taken to
right the ship.
Among the changes you have made to the V.A. care model is
the implementation of the Veterans Choice program. The Choice
program has offered thousands of veterans the opportunity to
get off lengthy wait lists and seek treatment outside of the
V.A. health care system.
We are beginning to see progress on the wait lists, and
veterans now have access to health care facilities closer to
their homes. But even with this progress, more work remains.
Many veterans who should qualify for the Choice program
have been denied access by the V.A. These veterans either live
more than 40 miles from a V.A. facility or must drive distances
in excess of 40 miles to reach one due to geographical
impediments.
This department must take steps to ensure that the 40-mile
rule and qualifying exceptions are applied evenly and in a
timely manner.
While we continue to hone and improve new programs, such as
Veterans Choice, it is critical that V.A. does not lose sight
of important modernization initiatives that Congress has been
promoting for years.
One such initiative is digitizing V.A.'s medical records.
Mr. Secretary, your budget includes $141 million for
scanning files and medical records into digital format, which
is the same as your fiscal 2015 allocation.
For 2015, the committee provided an additional $40 million
for three specific purposes--regional-office staffing,
digitized scanning and the centralized-mail initiative--yet you
have only allocated $10 million of that for scanning and
centralized mail.
Eliminating the need to locate and transfer paper records
will streamline the claim and benefit process tremendously. We
need a strong commitment from the department to make this a
reality.
I have visited one such center and noticed the huge bundles
in a file, bound maybe this thick--paper, that is shipped all
around the country trying to find its place.
You are digitizing those records, which means you can
electronically, instantaneously access that file without having
to ship it from Burbank, California. So I really hope that we
can see more of this.
Another initiative Congress has been emphasizing for some
time now is the implementation of the electronic health-record
system that is interoperable with the DOD system.
Your budget requests $233 million for the V.A. electronic
health record and sets aside $50 million of that for achieving
the interoperable capacity.
I appreciate your commitment to that initiative in the
budget and the work you have done to stand up a framework that
will allow your record system to work with DOD's. And you have
all heard me talk about this one instance a few years ago. A
vet from my district was injured by a bomb in Iraq, and he lost
one eye. The other eye was severely injured.
Then he was discharged, and the eye begins to act up. So he
goes to the V.A. hospital in Lexington, and V.A. declines to
treat him. They were afraid to operate not knowing what had
happened in the DOD hospital in Germany, and they couldn't get
the records.
So he lost his other eye simply because of the incapability
of these two bureaucratic agencies to work together. That is
going to stop, and you are making a really good start, and I
appreciate that very much.
I continue to be concerned that until DOD awards a contract
to produce its record and V.A. shows demonstrable progress with
modernization of its record, we can't be sure that this goal
will be achieved in the near term.
I can't emphasize strongly enough the importance of
achieving interoperability with DOD's electronic health-record
system. If these two systems can't talk to each other, which I
find incomprehensible, we continue to run the risk of service
members receiving inadequate care and undergoing inadvisable
procedures.
We need more than words on this critical issue; we need
results. In fact, we are demanding results.
We had a meeting less than a year ago with the Secretary of
Defense, and the Secretary of V.A., and we talked about this
extensively. Both sides agreed to work it out. But both sides
are protecting their own turf.
And so you will find language in your appropriations that
puts you under the gun on this, and we are going to do the same
with the DOD, which we have been doing for several years.
And finally, let me stress to you the seriousness of the
problem of prescription-drug abuse among our vets.
We have all seen in the news the V.A. hospital in Tomah,
Wisconsin that some are referring to as ``Candy Land.'' We now
know that officials there have been overprescribing opioids and
possibly even contributing to the abuse of these drugs by our
veterans.
I am pleased to see that the V.A. Office of Inspector
General is investigating that case. It is my hope that this
investigation will lead to safer practices among those treating
patients suffering from drug addiction.
This committee is also interested to know what other
actions the department is taking, regarding these disturbing
developments in Wisconsin, and I hope you touch on that today.
As part of your opioid-safety initiative, it is important
that the V.A. continue to pursue alternative remedies to
prescription opioids and consider new technology such as abuse-
deterrent drug formulations and tamper-resistant packaging.
It is also critical that we continue to invest in tried and
true models like veterans treatment courts. These courts which
require regular court appearances, drug testing and treatment
sessions are integral to helping our veterans find a way
forward and out of addiction.
This committee stands ready and willing to tackle these
issues with you head on, and we hope that your department will
remain a committed partner in the fight against prescription
drugs, which the Center for Disease Control now says is a
national epidemic.
We look forward to learning how you plan to offer more
timely and accessible health care to our vets and fulfill the
promise that both Congress and the V.A. have made to serve
them.
Thank you.
I have to go to another couple of hearings. I am going to
miss part of your testimony, which I regret.
Mr. Chairman, thank you.
Mr. Dent. Thank you, Mr. Chairman.
I want to second your statement, particularly the issue of
the interoperability between the V.A. and the DOD health
record. It is very important. It is a priority, I think, for
all of us.
At this time, I would like to recognize distinguished
ranking member, Mrs. Lowey.
Full Committee Ranking Member Opening Statement
Mrs. Lowey. I too would like to thank my friend, Chairman
Dent. Congratulations.
And unfortunately, Ranking Member Bishop, who has worked on
these issues for a long time, I know he has worked with you, he
couldn't be here today.
But this is a very important hearing, and I would like to
welcome Secretary McDonald and your assistants and all of our
distinguished guests this afternoon.
As the subcommittee reviews the fiscal year 2016
President's budget request, we have the tough mission and
responsibility to ensure the funding of the Department of
Veterans Affairs adequately addresses some very serious issues.
The number of current veterans and those transitioning into
the V.A. health care system is staggering. We must ensure that
we have the right programs and services these men and women
deserve for their service to our nation. We made certain
promises to our veterans. We are obligated to deliver.
In your short time, Mr. Secretary, your efforts have led to
reductions in the claims backlog, accountability in your
workforce and initiation of several new programs to meet the
growing demand and concern of all veterans.
Specifically, I applaud the use of technology in the V.A.
to further automate the claims submission and approval process,
which I understand has reduced the overall wait time by 138
days for a decision.
And I just want to say, the chairman and I have been so
frustrated. We have had four hearings. A couple of public
hearings, a couple of closed door hearings. It is beyond me,
frankly, that you can't get this done. And I know you are
working towards that end. I won't put up pictures of all the
old files that were kept in boxes. But it is such a disservice
to the men and women who served our country with such
distinction. Frankly, I still can't understand that the people
who send our young men and women in harm's way, our government,
can't get this done. But I am glad you are working on it, I am
glad there is progress.
It is amazing to me, in the private sector, you leave a
job, you take the chip, bring your health care information to
the next employer, and we are still going through boxes. But
thank you for the progress that has been made.
And I look forward to the day, Mr. Chairman, and Mr. Big
Chairman, when we can hear ``mission accomplished,'' and that
it would be completed. Because we know there is so much more
work to be done.
At last count, by the way, the claims backlog was still
around 214,000. And then there are more claims that are
continuously added into the system.
I hope you move this process forward expeditiously.
I am also very concerned about the amount of qualified
medical personnel necessary to address the increasing number of
veterans in serious issues like mental illness, post traumatic
stress disorder, traumatic brain injury, and suicide
prevention, especially in remote areas where there are limited
or no V.A. facilities.
I know we are in a fiscally uncertain environment. The
Budget Control Act remains. There may be some impact to certain
services in programs where veterans are a top priority. And
while there is cause to celebrate some successes, we can and
must do better. We are committed to working with you going
forward.
And I think it is important, Mr. Chairman, and I know the
chairman is struggling with the numbers, and we don't know
exactly the numbers that we are dealing with but I think it is
important when the numbers are released and we get an analysis
of what those numbers will do to the whole process.
So, Mr. Secretary, again, welcome. I, too, want to
apologize, because we have about four hearings today. But I
look forward to continuing to talk with you, working with you.
And I just want to say in closing and expedite that process--I
am glad to know that you have new facilities for records, but I
still can't understand why it is taking so long.
Thank you very much for the progress you have made and
thank you for your service.
Mr. Dent. Thank you, Mrs. Lowey, for your comments.
At this time, Mr. Secretary, your full statement will be
included in the official record. After you introduce those who
are accompanying you today, please feel free to begin.
And members are reminded that we will be operating on a 5-
minute rule for questions. So, with that, Secretary Bob.
Secretary's Opening Statement
Mr. McDonald. Thank you. Thank you, Mr. Chairman.
I have with me today Under Secretary Hickey and Under
Secretary Clancy, who will join me, as well as our CFO, Helen
Tierney and Steph Warren, who runs our I.T. operation. And
hopefully, we will get a chance to get into detail on some of
the issues that you all raised, like the electronic health
record.
Chairman Rogers, Chairman Dent, Ranking Member Lowey,
Ranking Member Bishop, members of the subcommittee, thanks for
the opportunity to discuss the 2016 budget and 2017 Advanced
Appropriations request.
I appreciate the opportunity to speak with many of you
prior to this hearing. We deeply appreciate Congress' and the
President's steadfast support for veterans, their families, and
survivors, as well as the assistance of veterans service
organizations.
As V.A. emerges from one of the most serious crises the
department has ever experienced, we have before us a critical
opportunity to improve care for veterans, and to build a more
effective system. With your support, the V.A. intends to take
full advantage of this opportunity.
Members of this Committee and VSOs share my goal to make
the V.A. a model agency with respect to customer experience, an
example for other government agencies. With efficient and
effective operations, we look to be comparable to the top
private sector businesses.
The cost of fulfilling our obligations to veterans rose
over time because veterans' demands for services and benefits
continue to increase as wars end.
In 2014, 22 percent of Vietnam veterans were receiving
service-connected disability benefits. That is four decades
after the war ended. We expect the percentage will continue to
increase. And it is worth remembering that today, almost 150
years after the Civil War, V.A. is still providing benefits to
the child of a Civil War veteran.
We still have troops in both Afghanistan and Iraq. Yet, in
the last decade, we have already seen dramatic increases for
demand for benefits and care.
From 1960 to 2000, the percentage of veterans receiving
V.A. compensation was stable at about 8.5 percent. But in just
14 years, since 2001, the percentage dramatically increased to
19 percent, more than double.
Simultaneously, the number of claims and medical issues in
claims has soared. In 2009, VBA completed almost 980,000
claims. In 2017, we project we will complete over 1.4 million
claims. That is a 47 percent increase.
But there has been more dramatic growth in the number of
medical issues in every single claim; 2.7 million in 2009 and a
projected 5.9 million in 2017. That is a 115 percent increase
over just 8 years.
These increases were accompanied by a dramatic rise in the
average degree of veterans' disability compensation. For 45
years, from 1950 to 1995, the average period of disability was
30 percent. Since 2000, the average period of disability has
risen to 47.7 percent.
So, while it is true that the total number of veterans is
declining, the number of those seeking care and benefits is
increasing dramatically. Fueled by more than a decade of war,
Agent Orange-related claims, an unlimited claims appeal
process, increased medical claims issues, far greater survival
rates for those wounded on the battlefield, more sophisticated
methods for identifying and treating veterans' medical issues,
and importantly, the demographic shifts--our veterans are
aging, veterans' demands for services and benefits exceeded
V.A.'s capacity to meet them. It is important that Congress and
the American people understand why that is happening.
The most important consideration is that American veterans
are aging and retiring. Just 40 years ago, only 2.2 million
veterans were 65 years old or older. That is 7.5 percent of the
population. In 2017, we expect 9.8 million veterans will be 65
years or older. That is 46 percent of all veterans.
We now serve an older population with a greater demand for
care, more chronic conditions, less able to afford private
sector care. Currently, 11 million of the 22 million veterans
in this country are registered, enrolled, or use at least one
V.A. benefit or service. More are demanding V.A. services and
care than ever before.
Requirements for women veterans and mental health care have
increased dramatically. Over 635,000 women veterans are now
enrolled for health care. And over 400,000 actively use V.A.
That is double the number in the year 2000.
Annual increases in women veterans seeking care, about 9
percent. And this trend will continue.
Our women veteran call center now connects with over
100,000 women veterans per year.
In 2014, over 1.4 million veterans with a mental health
diagnosis entered VHA. And we had 19.6 million mental health
outpatient encounters. That is an increase of 64 percent and 72
percent, respectively, since only 2005.
Since its inception in 2007, our veterans' crisis line has
answered over 1.6 million calls, and assisted in over 45,000
rescues. As veterans witness the positive changes V.A. is
making, and as the military downsizes, the number of veterans
choosing V.A. services will continue to rise. It should, and
they have earned it.
We are listening hard to what veterans, Congress, employees
and veterans service organizations are telling us. What we hear
drives us to a historic department-wide transformation,
changing V.A.'s culture and making veterans the center of
everything we do.
We call it MyVA, and it entails many organizational reforms
to better unify the department's efforts on behalf of veterans.
MyVA focuses on five objectives to revolutionize culture and
reorient V.A. on veterans' outcomes, rather than internal
metrics.
First is improving the veteran experience so that every
veteran has a seamless, integrated and responsive customer
service experience every single time.
Second, improving the employee experience by eliminating
barriers to customer service and focusing on our people and our
culture so that we can better serve veterans.
Third, improving our internal support services.
Fourth, establishing a culture of continuous improvement to
identify and correct problems faster and replicate solutions at
all facilities.
And last, enhancing strategic partnerships. The American
people, many partners want to join us in this effort, and we
welcome them inside the tent.
MyVA is reorganizing the department geographically and
that's the first substantial step in achieving this goal. In
the past, V.A. had nine disjointed geographic organizational
structures, one for each one of our nine lines of business. Our
new unified organizational framework has one national
structure, which is five regions.
This aligns V.A.'s disparate organizational boundaries into
a single framework. This facilitates internal coordination and
collaboration among our business lines, creates opportunities
for local level integration, and promotes effective customer
service. Veterans will see one V.A. rather than individual
disconnected organizations.
Last, MyVA is also about ensuring sound stewardship of
taxpayer dollars. We will integrate management improvement
systems, such as Lean Six Sigma, across operations to ensure we
balance veteran-centric service with operational efficiency.
But we need the help of Congress. V.A. cannot be a sound
steward of the taxpayers' resources with the asset portfolio we
carry. No business would carry such a portfolio, and veterans
deserve better.
It is time to close V.A.'s old substandard and
underutilized infrastructure. Nine hundred V.A. facilities are
over 90 years old, and more than 1,300 are over 70 years old.
V.A. currently has 336 buildings that are vacant, or less than
50 percent occupied.
That is 10.5 million square feet of excess space costing an
estimated $24 million annually to maintain. These funds could
be used to hire roughly 200 registered nurses for a year, pay
for 144,000 primary care visits for veterans, or support 41,900
days of nursing home care for veterans in community living
centers.
We need your support to do the right thing. MyVA reforms
will take time, but over the long term they will enable us to
better provide veterans with services and benefits they have
earned, and that our nation has promised them.
Our 2016 budget will allow us to continue transforming to
meet the intent of MyVA. It requests $168.8 billion; a $73.5
billion in discretionary funds, and $95.3 billion in mandatory
funds for benefit programs. The discretionary request is an
increase of $5.2 billion, or 7.5 percent above the 2015 enacted
level, providing resources to continue serving the growing
number of veterans seeking care and benefits.
The budget will increase access to medical care and
benefits for veterans. It will address infrastructure
challenges, including major and minor construction,
modernization and renovation. It will end the backlog of
claims, and it will end veteran homelessness in calendar year
2015. It will fund medical and prosthetics research, and it
will address important I.T. infrastructure and modernization.
The resources required in the 2016 budget request are in
addition to those Congress provided last year in the Veterans
Choice Act. V.A. has implemented the Act. We want to be
successful, and we will be expanding our outreach, and
providing more information to veterans with a nationwide
public-service announcement, which we will share with you the
link so that you can see it.
But we don't know at this time how many veterans will use
the provisions of the Act to seek non-V.A. care, or how much
that care will cost. There is a high degree of uncertainty, as
there is in any free marketplace with choice. Our current
estimates of demand range from a low of about $4 billion for
Choice Act, to a high of about $13 billion over a 3-year
program.
We will need flexibility within our budget to ensure that
we have the right resources at the right place, at the right
time, to provide veterans the timely care they need, regardless
of where they choose to get that care. As an example of this
flexibility, we are currently exploring options to review the
40-mile provision of the Choice Act to get more veterans the
care that they want.
I look forward to working with this committee, with other
members of Congress, with veteran stakeholders, on this
critical issue. We meet today at a historically important time
for V.A. and our nation. Today marks the 150th anniversary of
President Lincoln's solemn promise to care for those ``who
shall have borne the battle,'' and for their families and their
survivors.
That is V.A.'s primary mission, the noblest mission
supporting the greatest clients of any agency in the country.
Mr. Chairman, members of the committee, thanks again for your
support for veterans, for working with us on these budget
requests, and for making things better for all veterans. We
look forward to your questions, sir.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
THE CHOICE ACT
Mr. Dent. Thank you, Mr. Secretary. Mr. Secretary, I have
to begin with an issue I view as critical to the future of the
V.A., and we have discussed this. And I know this view is
shared with members of the subcommittee.
The Choice Act, as you know, is bifurcated, reflecting the
different views of the members of the House and Senate
authorizing committees at the time. On the one hand, the Choice
Act sets up a system for non-V.A. care to be provided in
situations where distance or wait time prevent access to direct
V.A. health care.
But it also finances a hiring of almost 10,000 new V.A.
medical staff, and more than 200 facility leases and
construction projects in an effort to strengthen capacity for
direct V.A. care. This is a rhetorical question, but is this
bifurcated system sustainable in the long term? Can we afford
to build up the V.A. system with its aging infrastructure, at
the same time as we develop non-V.A. care alternatives?
I personally think that non-V.A. care is a great and
underutilized alternative, particularly in the aftermath of
what happened in Phoenix and elsewhere around the country. Many
veterans have high-quality, non-V.A. facilities in their
neighborhoods, but aren't able to use them, and instead have to
travel great distances for V.A. care.
Let me be clear, I understand and support the need for the
V.A. to provide specialty services in areas like polytrauma
injury, PTSD, TBI, Agent Orange, behavioral health, and other
areas. But why shouldn't we rely on high-quality, private-
sector providers for more routine, non-service-related care?
That is really my question. And for you, Mr. Secretary,
given where I live and many members live, we have some world-
class facilities that just really cannot be utilized by many of
our nation's veterans who deserve the best.
Mr. McDonald. Mr. Chairman, we share your vision for hybrid
or integrated system of the future, an integrated system of
V.A. care and non-V.A. care. Looking at it from the veterans'
perspective, we want the veteran to get the care they need,
wherever it is most convenient and that care is available.
Outside care is something the V.A. has been about for quite
a while. In fact, over the last year, our non-V.A. care
appointments have increased about 48 percent. So that is a
large increase. That is even before the Choice Act.
With the Choice Act, we now have the ability, as you said,
if you are outside 40 miles, if you are beyond 30 days of
getting more people access to outside care. It is very early in
the days of the Choice Act. The last cards were mailed in
January. We started in November.
We set up the program in a period of months. And so we are
not yet certain how many veterans will take advantage of the
Choice Act. And we would like to continue opening the aperture
of the Choice Act so more veterans can take advantage of it.
We are now getting in contact with all veterans to make
sure they are aware of it, since many of the cards were sent
out over the holidays, and may have been lost. We are also
airing a public service ad, which is on our web-site, and we
would be happy to share that ad with you. And we are doing
everything we can to get more providers into the system.
But so far, we have not seen the full impact of the Choice
Act. And we want to work with you on redefining it in order to
get more people into it.
Mr. Dent. In my observation, is many veterans are aware of
the program, but for whatever reasons, they are not eligible;
either they don't meet the 40-mile requirement, or a scheduling
issue. But as a quick follow up, would the idea of a mix, or
integration of the V.A. in private sector, could that help us
to address the facility challenges that you so clearly
articulated in your testimony? Would this help us predict where
veterans will be geographically in order to build the
facilities years in advance?
Mr. McDonald. We think it will. If you look over our recent
past, we have been leasing more facilities and creating more
community-based outpatient clinics than we have the big, large
hospitals. That is a trend in the medical industry. And it is
one that we think is appropriate in order to get care out to
where the veterans actually live.
RESTRUCTURING V.A. HEALTH CARE
Mr. Dent. And I would also mention, too, last week a group,
Concerned Veterans for America, released a report called
``Fixing Veterans Health Care.'' The report prescribes a major
restructuring of the V.A. health care.
Among its proposals, this bipartisan task force recommends
that future veterans be required to enter a new V.A. insurance
system with varying levels of coverage. Currently-enrolled
veterans would be able to continue using V.A. health
facilities, or shift to subsidized care to private providers.
It also calls for the closure of inefficient V.A. medical
facilities similar to your testimony. Mr. Secretary, I know you
issued a statement rejecting the report saying that, ``Although
there is an important role for non-V.A. care in supplementing
V.A. health care, reform cannot be achieved by dismantling the
V.A. system or preventing veterans from receiving V.A. care.''
I am certainly not endorsing the report in its entirety,
but I do think it could jumpstart a healthy debate about how to
more efficiently and cost-effectively provide care to veterans.
I would be curious about your thoughts.
Mr. McDonald. Well, as you said in the statement that I
issued, we felt that many of the proposals advocated
contracting out this sacred mission that we have for care for
those who have borne the battle. We think there is an important
role for outside care, as I have said. We think there will be a
hybrid system, an integrated system in the future, to
supplement V.A.'s own care.
But we don't think that diminishes or obscures the
importance of V.A.'s health care system. We think reforming
V.A. health care can't be achieved by dismantling it and
preventing it, or preventing veterans from receiving the
specialized care and services that can be provided by V.A.
Our goal continues to be to provide that care for veterans,
and we are happy to meet with anyone to discuss any ideas. We
believe every idea is on the table. But we are going to look at
it through the lens of what is best for veterans.
Mr. Dent. Thank you. My time is expired. I would like to
recognize the very distinguished ranking member.
Mr. Bishop. Thank you very much, Mr. Chairman. At this
time, Mr. Farr, he is ranking member of the Agriculture
Subcommittee, and he has a hearing that he needs to be in
presently. So I am going to yield to him, and allow him to go
first.
Mr. Farr. Thank you very much for yielding, Mr. Bishop. And
thank you, Mr. Chairman. Thank you very much, Mr. Secretary,
for coming here. And thank you for your service. You know, the
most frequently asked question in Congress is ``why don't we
run government like a business?''
I don't think anybody has come before this committee with
more business background than you have; CEO and President of
Procter & Gamble, which was awarded the best company for
developing leader talent. The list goes on and on.
Also, I think your training in the military in the 82nd
Airborne and in jungle warfare is going to be very helpful. You
are coming before a Congress, which has just told you that
despite this incredible testimony with probably more reform and
suggestion in it than any opening statement I have ever heard
from a secretary in any department, that you are not going to
get the money you are after.
I hope, Mr. Chairman, when we finally get these numbers,
and we are taking the Veterans' budget and cutting and
squeezing and trimming it, we can bring the Secretary back and
have a real, transparent discussion on what those cuts are
going to mean and what is going to happen as a result. Mr.
Secretary, you put in here how we can fix the things that are
broken, you also indicate that you are going to need money to
do that. It can't all be done just by savings. For example, I
think your idea of a ``BRAC for veterans facilities'' may be
worth looking into but endeavors like that cost money.
Also I want to tell you that I appreciate you going out and
seeing cemeteries, as you have. A week from Friday, I am
dedicating the California Central Coast Veterans Cemetery in my
district. Your department has been very helpful in its creation
and I wanted to thank those in your department who worked in
that.
HEALTH CARE ACCREDITATION
You indicated in one of the Chairman's questions about some
sort of combined professional network involving the public and
private sector that could help provide more mental health
practitioners. I am very concerned that because of PTSD TBI,
and other mental health issues, our veterans in California are
suffering unnecessarily due to a shortage of appropriate
doctors. I know that Congresswoman Barbara Lee is very
concerned about this, too. We can't find marriage and family
therapists to work for the V.A. because the V.A. has an
accreditation issue in California. I really want you to go back
and find out what initiated the ruling on this issue. We can't
hire marriage and family therapists in the V.A. unless they
have graduated from institutions that have specific
accreditation curriculum.
California has 95 percent of certified marriage and family
therapists who cannot qualify to work for the V.A. They went to
Stanford, they went to Berkeley. I mean, this is nuts. I can't
believe that they can't take steps to correct that.
We are opening the first jointly designed DOD/V.A. clinic
on the Monterey peninsula, next year and we are having a heck
of a problem trying to hire a psychiatrist to come there. You
are having even a harder time getting marriage and family
therapists. A lot of them in the community would love to go
work for the V.A. I hope that you will check what steps the
V.A. is taking in providing and maintaining a significant
number of mental health practitioners.
When can you accept the credentialing of California
marriage and family therapists as part of that professional
core that you want to increase?
Let me also ask you to look into the backlog with the board
of appeals. Mr. Secretary, the amount of money you are
committing to that is going to be cut, in these reductions the
chair is talking about. He is not the only chair--every chair
of every appropriations committee is giving the warning, Mr.
Secretary. What we do here is, we have all these nice hearings
on what the President has proposed. Then we get the numbers
from the Budget Committee. And then we go behind closed doors,
and cut the hell out of everything. Then we adopt it without
any public transparency. I hope this year will change that, and
that we have subsequent hearings once we get the numbers,
saying ``this is what you are asking'', ``this is what you are
going to get.''
What are the consequences? Because that is what we are
supposed to relay to our constituents. So, if you could look
into the marriage and family counseling and the backlog on the
board of appeals, I would appreciate it.
LOCAL COMMUNITY SUPPORT
Lastly, let me just ask, if local law enforcement officers
are coming to me and they say that the V.A. needs to assist
local law enforcement officers and VSOs in dealing with
suicidal veterans who should they contact to help these people
that they know from the local community are in harms' way?
There is no kind of crisis core in the V.A. who can go out with
law enforcement and intervene in these crises with veterans,
who have real problems. I would like to see if we could develop
that enterprise. Thank you.
Mr. Dent. Would you like to respond quickly, Mr. Secretary?
Mr. McDonald. Yes, sir.
First of all, relative to our employment initiative, we are
recruiting. This week I was at the University of Delaware
School of Nursing, and it was my 13th medical school trying to
recruit people. So we do desperately need people.
We talked about the issue in California. I would ask Dr.
Clancy to do a deep dive on that. Maybe let her report on that.
Dr. Clancy. So, thank you, Mr. Secretary. Congressman, we
have a group taking a very hard look at this again. You have
the facts exactly right, in terms of our initial interest in
hiring marriage and family therapists who have graduated from
an accredited program by a commission with a very long name,
because we wanted to make sure that we had people with the best
skills to meet the needs of veterans, which can be fairly
complex. My understanding is that some of the newer programs
have actually sought that accreditation. But we would be happy
to follow up in terms of looking at other opportunities for us
to bring this cadre of folks in to help veterans.
Mr. McDonald. Relative to the peace organizations, we do
have a national peace organization, well trained to deal with
veterans, particularly those with traumatic brain injury. It is
their role to reach out to the community, connect with the
community, make sure that the local community is aligned.
Mr. Farr. What they need when the crisis occurs, is to have
somebody they can call who knows the veterans. Local law
enforcement can't always talk them out of a situation.
Mr. McDonald. Absolutely. We will follow up on that. We are
working very hard to strengthen our security organization,
particularly in light of what happened in El Paso, and this
will be one of the things we build into it.
Mr. Farr. Thank you.
Mr. Dent. Thank you. At this time, I would like to
recognize Mr. Jolly, of Florida.
Mr. Jolly. Thank you, Mr. Chairman. Mr. Secretary, thank
you for being here this morning.
I have a couple quick questions, specifically on
appropriations matters.
CLAIMS BACKLOG
You and I spoke about the backlog in benefits; it is a
priority of mine. And I think the next story after the V.A. is
going to be the VBA if we don't solve the backlog.
Your budget requests $85 million, for 770 new FTEs, as well
as $230 million additional for I.T., sorry, an addtional $85
million. Mr. Secretary, do you believe that will have a
demonstrable impact on clearing the backlog, or are we just
keeping up, as best we can?
Mr. McDonald. I think we will have a demonstrable impact.
And, as we talked, the number of claims is going up. The number
of issues per claim is going up. We have committed to ending
the backlog by 2015 and then keeping it down. I would draw your
attention to the pictures in my written testimony of the
Winston Salem VBA office, where on one picture, you see all the
files that Chairman Rogers was talking about. The other
picture, you see no files. Because everything has been
digitized.
We have done all we can with digitization, with mandatory
overtime. Now, we need more people.
Mr. Jolly. And ending the backlog is defined how?
Mr. McDonald. 125 days.
Ms. Hickey. So, I just wanted to let you know, Congressman,
that actually, we are well on target to end the disability
rating claims back on the 125 days. We are--right now, we have
reduced that backlog from 611,000 down to 214,000--almost
400,000 that are no longer in backlog.
We also have at the same time increased the quality of our
claims. Well over 90 percent on the medical issues level and 96
percent on--90 percent claim level, 96 percent at the medical
issue level. We will do that. But your question is about the
current budget.
The current budget is focused on the appeals, non-rating
and fiduciary requirements. Those are all direct results of
doing 1.32 million claims.
OFFICE OF INSPECTOR GENERAL'S FY 2016 BUDGET REQUEST
Mr. Jolly. Well, I understand. And I appreciate your
attention to this. Quite frankly, it was something that I would
support; this is an issue of significant concern. Very quickly,
on the OIG budget, what is the increase in the OIG budget?
Mr. McDonald. The increase that was in the----
Mr. Jolly. Request.
Mr. McDonald [continuing]. The real request--we have had
subsequent conversations with the OIG--is $15 million. We
support that request.
[Clerk's note: The official request is $355,000 above FY
2015.]
Mr. Jolly. What percentage is that?
Mr. McDonald. I don't know exactly.
Mr. Jolly. Is the increase in the OIG budget comparable to
the 7.5 percent increase in the overall VA discretionary
request? Is it less?
Mr. McDonald. We will do the math and get back to you. It
is $15 million. We have a lot of investigations going on and we
need to get through them, get them over with.
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COMMUNITY MENTAL HEALTH PARTNERSHIP
Mr. Jolly. Another appropriations question--fisal year
2014, there was a request for the department to pursue
community mental health partnerships. To use excess capacity in
major metro areas to provide non-V.A. mental health services.
Has there been any movement on that?
Mr. McDonald. There has been a significant movement. In
fact, I will let Carolyn talk about it. I wanted to mention
something you and I had talked about earlier--strategic
partnerships. Home-Base, in Boston where I visited, funded by
the Boston Red Sox. Serving veterans with TBI, with PTSD. We
are very supportive of activity. We want to create more of this
strategic partnership.
Dr. Clancy. So, we do actually actively partner with a
number of practitioners in the private sector to help serve the
needs of veterans. And the good news is, we just learned that
we have figured out how to make sure that they have easy access
to our continuing education materials. Rather than our kind of
shipping them in paper, now they can actually get online
directly and get their continuing education credits, which I
think only strengthens them.
Mr. Jolly. The 2014 bill directive actually provides for a
demonstration project. Is there anything--have you actually
defined a demonstration project in this? Or are you just using
non-V.A. providers when you need them?
Dr. Clancy. I think that we have done some of both, but I
am going to have to follow up with you on that one.
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FALSE NOTIFICATION OF DEATH
Mr. Jolly. And then one last thing just for the record. You
and I spoke about this. I appreciate your attention to it. But
I do want it to be on the record. We have had several cases of
veterans and veteran beneficiaries, who have been notified
falsely of their own death.
I understand from the V.A.'s perspective that it results
from the Social Security Administration sending over a notice.
We know it is disruptive to the veteran. The V.A. has always
resolved it, but it is a disruption that takes a month or 2 to
solve. So I would appreciate your continued attention.
Mr. McDonald. We actually talked this morning after our
discussion, and we are going to go big into the Social Security
Administration and find out what is going on. Because we have
to take responsibility for that. The veterans are ours.
It is devastating.
Mr. Jolly. Thank you for that. I appreciate it. Thank you,
Mr. Chairman.
Mr. Dent. Thank you, Mr. Jolly. That reminds me of the old
George Bernard Shaw statement that ``the rumors of my death
have been greatly exaggerated.'' Something we certainly don't
want to have happen. Mr. Bishop.
VETERANS CLAIM INTAKE PROGRAM
Mr. Bishop. Thank you very much, Mr. Secretary, Dr. Clancy,
and the other panel members. Your fiscal year 2016 budget
request includes $140.8 million for the Veterans Claim Intake
Program, which is a continuation of a scanning program that
began scanning in September of 2012.
I have a couple of questions about this. First, how many
scanning contracts does the V.A. have for that program? And
second, how many documents are scanned per month, and what
happens to the documents after they are scanned? And then once
the document has been scanned, how long does it take to get the
completed package to a claims processor?
Mr. McDonald. Let me let Allison answer that, but I just
want to say that the scanning process is absolutely essential.
It allows us to digitize the claim, which allows us to have a
national workflow. We can move those claims anywhere in the
country that has time and effort to get it done. It is one of
the things that has led to the reduction, the backlog. Allison?
Ms. Hickey. So Mr. Ranking Member, first of all, one
contract. It is a performance-based contract, so we have two
large companies that participate in it. And they are rewarded
for doing better. So there is a performance competition base
there.
Four sites, one of which is in Newnan, Georgia, another in
Kentucky, a third in Wisconsin, and a fourth in Iowa. We have
successfully scanned more than 1.3 billion images since the
start, at 99 percent quality. And that has effectively allowed
us to reduce our paper inventory down to a remaining 25,000
claims out of the 477,000 in the inventory.
So we are 95 percent paperless right now. And we do all of
our claims works now in the digital environment, minus those
25,000 we are trying to get out. The companies have done a very
good job of building quality assurance into this. We have
mandated that for the contract. They have four to five layers
of quality assurance to ensure the reliability.
But to the point of what happens to the paper? We are
paying a lot of money for the contractors to hold the paper
while they are waiting on the DOD decision, because these are
DOD records. We are working actively with DOD to the Benefits
Executive Committee to make that decision. We will be involving
our veteran service organizations in that final decision on
what is the proper disposition of those records.
I will tell you that I have today, sitting in regional
offices across the country, half a million cubic feet of paper
we are no longer using or touching. We are waiting on the
simple disposition decision on what to do with those paper
records. Because we are doing most of our business through the
electronic digital environment; in fact, more than a million
claims, and more than 2 million rating decisions.
Mr. Bishop. Thank you. So when do you think that decision
will come?
Ms. Hickey. So Congressman, I am going to try to talk a
little quieter. I apologize. My good Irish voice carries loud.
So we are working literally right now on a decision with
DOD. They are newly incentivized to move faster on this issue,
because they are now storing paper from what they are scanning
in their central cells for the services to bring us the records
across from HAIMS.
So we are literally right now, as we are working, I suspect
sometime this year we will have a final decision. When we do,
that will, as I expect, require resources to move us into that
environment of proper disposition of those records. And that is
not in the current budget right now.
V.A. AND DOD INTEROPERABILITY
Mr. Bishop. All right. I recently read that VistA is no
longer in contention to use by DOD for the electronic health
records, which is not surprising, because it was clear that DOD
historically has wanted nothing to do with VistA. What steps
are being taken to make sure that whatever system that DOD
chooses, this will be able to share information with it?
I know that this is well before your time, Mr. Secretary.
But as you know, the veterans department and DOD were directed
to develop an electronic health record system. And can you tell
us why it has been so difficult to achieve?
Mr. McDonald. Ranking Member Bishop, I have said many times
since I came in this job that we shouldn't punish veterans or
servicemembers by having boundaries between organizations that
get in the way of their care.
So we take it very seriously that we have got to integrate
with DOD on the electronic health record. It is one of the
first things I looked at. And I have been to our sites, San
Antonio, for example, where we run a hospital with DOD, and we
have V.A. and DOD doctors looking at the same medical
information on the screen.
So I would like Steph Warren, if I could, to do a little
bit of a deep dive on this, to bring the committee up to speed.
And we would be happy to come over and do demonstrations for
you in your office for your staff.
Mr. Warren. So to hit your point about interoperability,
top question was with whatever system DOD purchases, is
interoperability guaranteed?
DOD, no matter what system is bought, the requirement to
maintain the interoperability that we have accomplished will
continue. So we talked in prior hearings about a tool called
Janus, which today, allows us to look at the DOD record and the
V.A. record in the same screen simultaneously. So that
interoperability, the ability to see the record in the care
setting is happening today.
Mr. Bishop. May I just interrupt you for a second? Didn't
we in Congress, both the authorizers and the appropriators,
direct DOD and V.A. to use one system, as opposed to two
systems?
Mr. Warren. So the interoperability in terms of the
information sharing and doing, we are doing that using the same
services. Both of the departments approximately 2 years ago--
and I believe we had a joint hearing. I think it was the
largest hearing I had ever been in, with 50-plus members.
We talked through how the mission differs between V.A. and
DOD and drove DOD to a decision in terms of buying an end-to-
end system with a logistics tail, and that we would continue to
work with the VistA system, which is a veteran-centric
solution, and keep evolving it forward.
Mr. Bishop. It is my understanding, though, that the system
that you are using prohibits the manipulation of the data. So
basically, it is viewing only. So it is not really
interoperable, because, you know, a doctor at V.A. can't
manipulate the information there, so that is not very helpful
in what we are trying to get to. And we really instructed both
DOD and V.A. to have one seamless system.
And of course, this was before the Secretary's tenure, both
departments seemed to have backed off from that and just said,
``Well, we wanted interoperability.''
But it just makes no sense to me. And I have continued to
really labor over the question of why it is that DOD and V.A.
want to have stovepipe systems that is just going to allow them
to view it.
Mr. Warren. If I could, the viewer is to show the ability
to view the data. There is a key point that we need to make
sure we lay out there.
If you look at the DOD side with respect to care, the
majority of their care takes place outside of their health care
delivery system--it will also take care of--it will be given
outside of whatever their new system is.
On the V.A. side, with the third-party care we have been
giving, as well as what the Choice Act will be doing, a large
amount of our care will also be outside of that health care
system. Our biggest challenge is how do you move the data
between different systems? How do you present it up in a care
setting?
Janus shows that you can do it. The data gets translated so
it is the same. All Janus did was to show that you could do it,
yes, in a read-only. Right now, the enterprise health
management program, which is--in San Diego, moves it to the
next step, which is the ability to go in--
Mr. Bishop. Why couldn't both departments have one system?
And if you have outside care, have the outside providers
certify it to utilize and to enter that system with secured
access so that only people who are authorized can enter the
system? But if you have one system, everybody is going to
access. It is simple.
Mr. Warren. Sir, I wish it was that simple. When we talk
about health care delivery, the viewer is how the clinicians
interact with the data. But the systems we are talking about
are more than just the viewing of the data. It is the pharmacy
system, it is the immunization system, it is all of the other--
--
Mr. Bishop. I understand that.
Mr. Warren [continuing]. A medical center.
Mr. Bishop. I understand that.
Mr. Warren. So buying one big system that does all that
stuff, if you go look at the national health service in the
U.K., they showed that one system could not do all that stuff
across all those different places.
And so what is key is how do you make sure the data moves
between the systems, not just V.A. and DOD--in a way that
clinical care can take place. And I believe that is the path we
are on, and we have been able to show that we can accomplish--
but glad to come and sit down more, walk you through and show
you how those systems are working together, and how the data is
formed.
Mr. Bishop. I am just not convinced that the technology
can't be fashioned to accomplish that. But my time is up, and I
will come back a little later.
Mr. Dent. Thank you. Thank you, Mr. Ranking Member. And I
am sure there will be more questions on that particular topic.
Mr. Rooney.
Mr. Rooney. Thank you, Mr. Chairman.
I appreciate, Mr. Secretary, our visit yesterday. And I
appreciate the spirit of the other testimony that we have
heard. You know, it is okay if you speak too loud, especially
with issues that frustrate not only members of this committee,
your agency, as well as the veterans and the people that we
serve. Certainly, South Central Florida has its share of
retirees and veterans.
One of the things that I was most impressed with, Mr.
Secretary, when we visited was the kind of background that you
have, and the business acumen that you bring to the table. And
I think that when people read your resume and get to know you,
not to say that previous secretaries haven't been able to
accomplish what they set out to do, but the fact of the matter
is, we are still talking about a lot of the same things that we
have been talking about since I got to Congress 6 years ago.
You know, as Mr. Bishop alludes to, one of the big
frustrations for me, as a veteran myself, is when you join the
Army and things are kind of prescribed for you, and you are
sort of told where to stand, what to say and what to do, and
then when you get out of the Army, and you kind of hear this,
``Well, you know, the orders for the prescriptions aren't
exactly the same,'' or, ``We are just getting around to our
computer systems being able to communicate and understand each
other,'' that is the kind of thing that when you join the Army,
or you join one of the other branches, you assume are already
taken care of. And when you find out that they are not, I think
that that is the most frustrating thing.
FRUSTRATIONS AND FUTURE INNOVATION
So my question revolves around your background and some of
the things and the frustrations that we have heard. You don't
have a lot of time in this job, I assume. And what time you
have here with being a former CEO of a major company, what do
you honestly think that you are going to be able to accomplish
for veterans? What kind of innovation?
I have a question, drafted out here for me about VSOs and
our local counties that want to be able to be more active in
screening, and things like that, at the county level. Maybe
that is part of it. And you talked yesterday about, you know,
consolidation of some of the people that are doing the same
job. And that is all great.
But I think that you as a spokesman, getting out there and
showing the kind of frustration that we have heard, the
American people were responding to me like, ``I like that guy.
I agree with him. He is a CEO. He is not,'' you know, no
disrespect again to former secretaries, but what can you--what
has been your biggest frustration? What kind of innovation do
you think you will be able to bring to the table so 6 years
from now, this committee isn't still talking about these same
things, like prescription orders aren't marrying up, and
computers aren't talking to each other? So if you could talk to
that, I would appreciate it.
Mr. McDonald. First of all, Congressman Rooney, thank you
for the question, and thank you for your service. Everything we
put together, we are not looking at as a time-bound exercise.
But I would hope that everything we have talked to you about in
terms of MyVA, the reorganization we are talking about, I think
we can certainly get done over the next couple of years.
My biggest frustration from the very beginning was the lack
of focus on the veteran. It was a sense that we were an
organization, as I went around--and I have been to over 100
sites now of V.A.--employees were telling me they felt like
they were prisoners of a system that they couldn't change.
The single message I am giving employees every time I go
somewhere and I do a town-hall meeting is, ``No, this is your
V.A., too, and you can change it.''
I have embraced union leadership, 65 percent of our
employees are union members. This leadership team, this group
of employees, is going to change the V.A., is going to put the
veteran at the center of everything we do.
My first national press conference, which I think was in
September, I gave out my cell phone number nationally. It is
available on the Internet. And I would like members of Congress
to do the same.
And I get calls every single day from veterans. And I like
that, because I am able to figure out what is going on. We
stood up a team of people to help me with it, but I like to
answer the phone.
I did that deliberately, because I wanted to demonstrate to
everybody during a time of crisis, it is normal organization
dynamic, and normal human dynamic, that people turn inward, and
in a sense become more bureaucratic, and worry about their own
survival.
What we need to do is turn outward, care about veterans,
embrace veterans. And I see those changes happening right now.
I hear it on my phone at night when I am able to answer the
calls. And I get a lot of letters. And we respond to every
single one of them. That is a big change.
Ms. Hickey. So, Congressman, first thing I will ask you as
a veteran, if you have your eBenefit account, if you don't, I
would like to come over and help you get it. But you don't need
me to, because we have built a complete online capability from
a veteran at 2:00 in the morning, if you are reading a long
bill, and you decide you want to file a claim, you can go
online, you can file your claim online.
You can upload your own medical evidence online, and your
three-and-one computer, turn it into a PDF and give it to us.
You can find out the status of your claim online. And it all
goes now into the VBMS system where the digitization has
occurred that was spoken about earlier. And the decisions can
be projected to you when they come out online.
All that has been built in the last 3 or 4 years while we
have been transforming VBA. While I will fly on the airplane
while we were building it--sorry, former airmen as well, so I
am going to use that analogy. So we have fundamentally changed
VBA already, but we are not done yet.
There are a lot of things in this budget that we need to
fundamentally change three other parts of a benefit allowance
to a veteran. And I will tell you straight up, appeals. Appeals
are wired in law, worse than tax code.
There are two opportunities for you to help us with
appeals. One is change the law, and there doesn't seem to be a
lot of appetite for it. But I have submitted all the
legislative proposals.
And the second is you have got to give me a whole lot more
people to do that work. I have got no other way to do that
better. Law or people, authorizers or appropriators. I don't
care. What I care about is veterans getting a better answer.
Mr. Rooney. Thank you.
Mr. Dent. Thank you. I just want to point out for the
record, I made that particular quote about the rumors of my
death being greatly exaggerated. I attributed it to George
Bernard Shaw. I believe it was Mark Twain. So with that, I
recognize Mr. Price.
Mr. Price. Thank you, Mr. Chairman. Mr. Secretary, I want
to welcome you and your colleagues to the committee. We
appreciate the energy and determination you have brought to the
V.A. in a short period of time.
And I appreciate the background you bring to this; the
business background, the military background, and I should say
also the educational background, because I am well aware of the
value you have rendered to Duke University's Fuqua School of
Business, as one of their major advisers.
A lot of handwringing today, as there always is, about the
constraints we are operating under. Maybe we need to remind
ourselves that these are not written in stone. They are the
results of very explicit political failings.
The Budget Control Act still hovers over us, and haunts the
work of this subcommittee with its centerpiece of
sequestration. Sequestration, however, is self-inflicted
damage. It was not supposed to occur. It is the result of a
very specific failure to address the main drivers of the
deficit; tax expenditures and entitlement spending.
This body, having failed to address those, has fallen back
again and again on appropriated spending. So we need to do more
than just decry this, we need to change it, need to take
specific steps to overcome it, that really would mean a
comprehensive budget deal that deals with the main drivers of
the deficit.
But if we can't get that, we at least need another year-
long budget deal, a la Ryan-Murray, to get us off of
sequestration and with some numbers we can work with here. And
this applies of course to this subcommittee, and probably even
more to other subcommittees.
So the resource constraints are serious here. And yet, a
lot of the problems that you have identified call for
additional resources, particularly personnel resources. And
that is what I want to ask you about very specifically.
We are all aware of the unacceptable wait times for primary
care, mental health, patients at various facilities in my
district, around the country. We know that this is linked in
part--this is what I want to ask you to assess--linked in part
to a lack of primary and mental health care providers in the
system, particularly at more rural locations.
So I want to give you a chance to address that problem
system-wide. Is the lack of manpower, womanpower, a primary
obstacle to achieving acceptable wait times, and adequate care
in general? I know you visited a lot of medical schools,
including Duke University, I would say. Glad you came there.
You spoke to medical students about coming to work for the V.A.
HEALTH CARE STAFFING AND RECRUITMENT
How did you do? How are you doing? What can you do to
recruit the best and brightest young people in the medical
field? Where are the most serious shortages? What specialties,
what areas of practice?
And then how much is this a matter of compensation? What
else is going on here? What is your assessment, having looked
at this, I know, very carefully? What is it going to take
besides an adequate appropriation to solve the problem?
Mr. McDonald. Thank you, Congressman Price. Great
questions. Staffing is a big issue for us. Roughly, we are
short about 4,000 physicians and about 10,000 nurses.
I have been to roughly over a dozen medical schools. Duke
University was the first medical school I visited. And we are
competing against some of the for-profit systems in the country
to attract the best and brightest doctors and nurses we can
find.
One of the first things I did as Secretary was to raise the
salary bands of our doctors in order to pay them competitively.
That has helped our recruiting effort. And if I look over the
last nine months, we have hired roughly 900 doctors, net-new.
So in other words, we have had some leave. Our retention
rate is very good. We have had some leave. But we have got
roughly 900 more new doctors. And that is good. We have hired
over 1,000 nurses.
So that has been very helpful. But while getting the
providers is helpful, and paying them competitively is helpful,
the other thing I am up against is just in a sense the aura
that exists in this country that V.A. is somehow a terrible
place to work. And I am pleased that the Chairmen and Ranking
Members of our two committees, House and Senate, Veterans
Affairs committees, have come to V.A. We have town-hall
meetings, national town-hall meetings, so that the members of
the committee could express themselves to the employees about
how much they respect what they are doing, and how important it
is.
The other barrier we face is the infrastructure. We have
11.5 percent roughly female veterans right now. It is going to
grow to 20 percent. And our buildings are over 50 years old.
They were built at a time when you had one gender of bathroom,
where you didn't have space for women's clinics. And one of the
things we know about women veterans is they prefer to enter the
building and exit the building in a different place than the
men. So we are in the process of trying to retrofit those
entries. But that is why our construction budget is so
important.
One last example, and I will end, is part of the problem in
Phoenix that we talked about was providers, was the doctors and
nurses. When I went there, we needed 1,000 new people the day I
was there. That was right after I was confirmed.
But one of the problems that didn't get much publicity, is
we only had one clinical room for each doctor. And the average
doctor has three clinical rooms; one where the patient is
getting ready, one where the patient is being examined, one
where the patient is getting ready to leave. So this is a
fundamental issue.
Last point is, I talk a lot about V.A. being the canary in
the coal mine for American medicine. Our shortage of primary
care physicians, our shortage of mental health professionals,
is a national shortage. And that is why I go to the medical
schools, is to try to increase the throughput, and increase the
residency, so we can get a greater number of mental health
professionals and family care physicians.
Dr. Clancy. Just a couple of other points, because I know
that you expressed a particular interest in rural health care.
One of the areas I think where we are doing very well is in
virtual care, particularly telemental health, which frankly,
makes it very--much, much easier for some veterans who don't
always find any complex facility all that easy to navigate, and
so forth.
We are doing enough of it that we are starting to talk now
about whether we actually need to train and hire people who are
virtualists. There are companies that do this now. We could
actually have an internal group that does that.
The other part--and I just want to thank you and your
colleagues for--is the loan reduction program. We now have, for
the first time, the opportunity to pay the lenders back
directly. What we have been doing before, if you think about
how indebted many of these students emerge from post-graduate
training with, is when they paid, then we reimbursed.
So if they fell behind, they didn't get the reimbursement.
You can see where this gets into a kind of vicious cycle. Now
we can pay the lender back. So not only can we offer that to
new people coming in, we can actually help some of our own--it
is both a recruitment and a retention tool, which I think is
going to be phenomenal.
And ultimately, the mission is what really attracts people.
You ask, though, what is the hardest? I would say primary care
and mental health. Both, as you probably are aware, are not
incredibly well-paid specialty areas. Both were in stiff
competition with the private sector.
You probably saw the report yesterday from the Association
of American Medical Colleges I think saying we are short 90,000
physicians or something along those lines. But that is what we
are working at.
The point about spaces, we actually do have a tool now to
assess productivity so that in addition to broad messages about
we need space, people, and so forth, we can actually help
facilities figure out what is the rate limiter for them. Is it
really more the space, the people, and so forth?
Mrs. Roby. Thank you, Mr. Chairman, and thank you for being
here. I do want to echo the sentiment of my colleague, that we
appreciate the time that you have taken to meet with us prior
to today's hearing.
But I think a couple of the points that were discussed are
worth mentioning again for the benefit of those that are in
this hearing room today, and for the American people, and for
my constituents in Alabama, too, who have suffered. These
veterans have suffered horribly at the hands of bad actors.
Mr. Chairman, Central Alabama V.A. Health System is one of
the worst in the country. We had one of the first directors
actually removed under the new law that we passed because his
behavior and the decisions that he made and the culture he
created was so disastrous and horrible, that he was actually
removed.
And you of course know all of this. And you are keenly
aware of the situation. I appreciate Sloan Gibson, Deputy
Secretary, for his presence in Alabama consistently working
with my staff to provide us updates.
As I told you, Mr. Secretary, last evening, that I am
looking forward to the day when I can stand with you behind the
podium and celebrate the successes of the V.A. But we are not
there, and you know that.
ACCESS TO CARE--THE CHOICE ACT
And there is still a real distrust, because the numbers
that we were presented as it relates to access to care, were so
false and wrong. So we will continue to work with you on that.
I do think, as you mentioned, that you are dealing with a
huge bureaucracy, and feeling your way through it, that there
are some real solid ideas here that you have heard from the
chairman and others throughout this as it relates to access to
care. And we know the V.A. does a lot more than just that. But
for right now, we have a lot of sick veterans that need access
to care.
And for me, in light of what took place in Southeast
Alabama, I really want the focus to be down there on how do we
get more veterans access to good-quality care in a timely
fashion, and both with Choice--the Choice cards and with PC3,
Patient-Centered Community Care, which is a huge priority to
me. We have wonderful private medical facilities in Southeast
Alabama, where these veterans could access care immediately,
rather than having to go to Atlanta, or some other facility.
So I want to continue to be helpful in any way that I can,
to push these programs, that this committee could be helpful in
ensuring that we allow veterans to have access to outside
providers. And then we have all these aging facilities that
need repair how do we figure out a way to find the cost savings
in bricks and mortars, and use that money for our veterans to
access care?
So I know these are all priorities of yours, because I have
heard you say that. The one thing that I did want you to
elaborate on is the authority to reallocate the Choice funding,
as you have stated, that you have been mischaracterized on what
your ideas are.
One thing I am concerned about is that Congress gave the VA
$15 billion for Choice. And you were saying that there is
uncertainty right now in knowing how much access veterans and
how many veterans will utilize the Choice program.
So if we could just talk about that in a little bit more
detail, because I really think that this is a huge part of the
solution to getting towards this hybrid system that would allow
our veterans to have good-quality health care.
Mr. McDonald. I was--one of my surprises when I came back
to government was the inflexibility of being able to serve
customers. I am used to the private sector. I am used to, if a
customer wants to buy Tide, we have Tide for them. If they want
to buy Dash or whatever, we have Dash for them.
The inflexibility of moving money from one line item to the
other, despite the fact that the consumer, the veteran, has a
choice, doesn't make much sense to me. It is analogous to
having two checking accounts at home; one is for gasoline, one
is for food. And you can't move money between the two. The
price of gasoline falls in half, and you are hungry, you want
to buy food. But you can't do that.
Because of the Choice program, we have given the veterans a
choice. You, the Congress, have defined by law the benefits
that veterans get. I am trained to execute and provide those
benefits, but yet, you control both the benefits they get, and
you control the money I have to spend to deliver those
benefits. I am kind of a prisoner of the system.
All I was saying with the request for flexibility was--and
I am happy to come back with you at the appropriate time--as
these programs, as we begin to integrate these programs with
the only intention of serving veterans, let's make sure we have
a discussion that we have the money in the right place, and
that we have enough money in the right place, that we can
provide the veterans the care that the laws that we pass said
they deserve.
I just want to make sure we have that conversation, because
I can't predict the free market with 100 percent certainty.
40 MILES RULE
Mrs. Roby. Sure, I appreciate that. Mr. Chairman, one quick
thing about the 40-mile rule. I am concerned that the
definition is not clear about the distance driving, or as the
crow flies. What do we need to do to modify language so that we
ensure that it truly is for those that are 40 miles away.
Mr. McDonald. When the law was passed, and the way the
Congressional Budget Office scored it, it was 40 miles
geodesic, meaning as the crow flies. We have been given
enthusiastic support by both of our authorizing committees to
take another look at that 40-mile criteria.
We are in the process of doing the review right now. We are
going to come back to the Congress with a reinterpretation in
an effort to open the aperture. We have had roughly a half a
million calls to our call center about the Choice Act. But
only--that has resulted in only about 30,000 appointments or
so. And about half of those are because of 40 miles, about half
of those are because of 30 days, the 30-day limit.
That is just not a big enough take rate. So we are trying
to do a better job marketing. We are contacting veterans. We
are also running a public-service ad I talked about. We want to
see how far we can push it.
At the same time, we want to, as quickly as possible,
redefine that 40-mile limit, which is the biggest barrier, and
come back to members of Congress with that reinterpretation.
Mrs. Roby. Okay, great. Thank you. I yield back. Thank you,
Mr. Chairman.
Dr. Clancy. Can I just add one thing? Congresswoman, I just
wanted to thank you for your commitment to, and persistent
attention to the Central Alabama facility. So today, our top
analytics team is visiting with them, both helping them
understand their data, which I think has been a big, big change
for us, this relentless focus on how we are doing, and also how
to deploy tools that we have built, so that they can identify
some of the problems that occurred there at a much earlier
stage. So just wanted you to know that.
Mr. Dent. I would like to recognize Ms. Lee at this time.
Ms. Lee. Thank you very much, Mr. Chairman. Good to see
you, Mr. Secretary, Dr. Clancy, Secretary Hickey.
Now, I tell you, a couple of things--I have to preface the
question and statement. First of all, I am the daughter of a
veteran. My dad died several years ago. So as the daughter of a
veteran, I know the V.A. system very personally. And I just
want to say to the three of you that I think you made a lot of
progress. I have had to deal with the V.A. on a personal basis.
OAKLAND REGIONAL OFFICE CLAIMS BACKLOG
But not enough yet. And I have a lot of concerns, very
grave concerns regarding the funds that have already been spent
on updating our veterans claims backlog. Again--and I think
Secretary Hickey--we have met several times with the California
Delegation as it relates to the Oakland V.A. Regional Office,
which is in my district.
And we have seen money appropriated to fix the backlog. But
it still remains--and veterans still, who deserve their
benefits, they are still dying before they can receive their
benefits.
And I want to read to you just a brief excerpt from--now
this was February 25, 2014, just recently, CBS News report.
Okay, and I want to make sure that this is accurate or not. I
hope it is not.
``Last week, the V.A. Inspector General confirmed that
because of poor recordkeeping in Oakland, veterans did not
receive benefits to which they may have been entitled. How many
veterans is not known, because thousands of records were
missing when inspectors arrived. The V.A. declined CBS News'
repeated interview request, but it did admit to widespread
problems in the handling of claims, but blamed that on the
transition from a mail basis to the new electronic system. The
V.A. said in a statement, `Electronic claims processing
transformed mail management for compensation claims greatly
minimizing any risk of delays due to loss and misplaced mail.'
''
Now, there have been several whistleblowers, of course, out
of Oakland. And in this report that CBS presented February
25th, there was one individual who said that the V.A. took the
files, put them--told them to put them in a file and stuff them
away.
There were 13,000 veterans begging for help. When this
employee raised her concerns, she said she was taken off the
project, and then this past summer, they found a cart of these
same claims, and they were ignored again.
Can you explain this to me? Is this accurate or not? And
what is taking place with the Oakland V.A. office in the
backlog?
Ms. Hickey. So I don't know what station Mr. Paul Harvey
used to talk about. But there is a much bigger rest of the
story that I would love to be able to present to you.
First of all, the 13,184 pieces of paper they found were
duplicate copies of an informal claim. It isn't even a real
claim yet. It is a duplicate copy of an informal claim. They
were in an old process that used to be done in VBA long before
I got here. They used to make copies of things to keep track of
them.
And so those were the 13,184 pieces of paper put in the
drawer. At the same time, those same 13,184 veterans came in
with their formal original claim. We worked those all as they
were coming in. They were not set aside.
Those 13,000 copies were sitting in a drawer. The originals
were being worked by the employees, the hardworking employees
in the Oakland Regional Office, or as you well know, because we
have talked about this, many other hardworking employees across
the nation who we brokered out, or sent out that work. So no,
no veteran was waiting on those 13,184 while they were sitting
in a drawer. That was a copy.
Second thing I would share with you is we did not misplace
any of those 13,184. They were in that drawer. We brought in--
we actually, by the way, discovered, because I sent in a help
team to help Oakland. And when we found them, the employee did
exactly the right thing; raise the issue and said, ``There are
13,184 in there. We need to do something.''
They told us about it. I called the I.G. and said, ``Full
transparency. I want you to get in there and make sure what is
going on with those 13,184,'' and they did.
We set up special teams that took every one of those copies
against the original file that we work--we had already worked.
And we matched every single one twice, a full 100 percent
review of every single one against those copies of those
informal claims to make sure we had it right.
At the end of the day, we completed those two complete
looks last September, on the 5th of September, and we found in
the process of reviewing, there were about 403 to be exact,
where we said, ``You know what, we probably could have made a
better decision on those 403 claims than we did when we worked
them.''
And so we made some adjustments. All of them are complete.
None were missing. No malfeasance in that whole effort. No
intention to hide anything. We just had those 13,000 copies
over there.
That practice has been discontinued. That practice was not
a practice by the new director who was out there, who is doing
a terrific job. And today, Oakland, by the way, backlog is down
70 percent from when we were visiting when it was so bad in
that same 2012-2013 time frame. They are doing much better.
Their quality is up substantially. All the investments you
helped us do to make them better are seeing good fruit.
Ms. Lee. I appreciate that. But then maybe you need to call
CBS and clarify this, because this report is all over the
place. Also, in it, it indicates that the V.A., the Inspector
General, mind you, confirmed that because of poor
recordkeeping, and Oakland veterans did not receive benefits to
which they had been entitled, and this is the I.G. quote. So
you need to clarify that I think, because if in fact that is
not the case, you know, we need to know that. The I.G. needs to
know that.
Ms. Hickey. I think the I.G. has worked very hard on this.
And I really appreciate their effort. They are looking at lots
of things with us right now. And I think their point is well
taken.
As you well know, we weren't doing a very good records-
keeping job during that whole time where we were not in great
shape in Oakland. I think that is exactly what they are
pointing out to us, and the fact that we had a drawer of copies
is still inappropriate, and not good recordkeeping.
We have resolved that. We have fixed that. So I think in
this case, the I.G. was right. We shouldn't have had those
copies just sitting out there in a drawer somewhere. We should
have properly disposed of them when we were complete with the
claim.
Ms. Lee. So do we know how many veterans should have been--
should have received their benefits that did not receive their
benefits?
Ms. Hickey. Of the 13,184, all of them got their claims
worked as we received them. When we did the reviews, we found
about 400 where we went, ``You know, we could have made a
better decision there.'' But that is the 400 I am talking
about.
Ms. Lee. Okay.
Ms. Hickey. They had received a decision already, and they
had received benefits already. We were able to up their
benefits.
Ms. Lee. Okay. Thank you, Mr. Chairman.
Mr. Dent. Mr. Fortenberry.
Mr. Fortenberry. Thank you, Mr. Chairman. Mr. Secretary,
good morning. Welcome. Thank you all for your testimony this
morning. I think it should point out, in light of all of the
challenges and difficulties you are facing, Nebraska, by
certain measures, has had one of the best outcomes for service
to veterans, particularly in terms of the measure of process,
time for processing claims.
I think we were one of the states that actually took on
additional caseloads when other systems were under such severe
stress. So I am proud of that. It doesn't diminish, though, the
need obviously to continue to work aggressively across the
nation. But to the degree that we have served as a valuable
template, service delivery, we are happy to be in that
position.
Mr. Secretary, I really do appreciate your freshness of
approach, and your creative commitment to trying to rethink
some of the architecture in order to get us all to the goal
that we share; the highest and best quality of care for our
veterans.
ENHANCED STRATEGIC PARTNERSHIPS
In that regard, I want to bring up a specific example from
home. Omaha has a difficulty with our hospital, as you are
quite aware. Over the years, based upon a priority list, which
is not necessarily the list of funding priorities, but is
listed as a priority, which is to me, a peculiarity.
Nonetheless, it has floated from 30 down now to 10, 19, all
over the place.
The broader point being to--maybe that is based on
analytics, maybe that is based on more subjective criteria. I
just don't know. The broader point, though, is enhanced
strategic partnerships are the way forward. It is the model for
the 21st century of veterans care.
If, as you are--have been invited, and as I know you are
working to commit to coming to Omaha when you do, you will be
warmly received by creative community partners who are ready
and capable to think about, again, an enhanced strategy that
looks at a new model by which we can build out a potential new
facility, if that is what is necessarily decided upon, as long
as we have the flexibility for creative financing, or using
existing structures that could be rehabilitated, or partnering
with the excellent medical facilities through the University of
Nebraska Medical Center, a great medical center, another five
facilities that are already there.
A quick anecdote, I have had the American Legion of
Veterans of Foreign Wars in my office this week. And the
committee has heard me talk about something, and you have as
well, called ``Veteran Certified Facility.''
And what I think this does is give us the ability to carry
forward this important legacy of having the V.A. in charge of
veterans health care, but maybe embedding that within other
systems, as long as we have oversight authority over us, so
that the quality of care is delivered. But it gets us out of
this problem of putting money under the mattress for years,
sometimes decades at a time, in order to build out a facility,
because we simply have been doing it that way for the last 100
years.
The next 100 years, though, we can take that money that we
do have, leverage it in strategic partnerships, and assure the
veteran is getting the highest possible care, still while being
under our authority. That is the new model and the way forward.
I willingly commit our community to be your model template in
this regard. I think--I don't think that is an overextension of
the desires of the community that I represent.
But I would like to work with you, whether it means new
legislative authority, or exercising the current authorities
you have, or creating and enhancing those strategic
partnerships, and labeling something like a veterans certified
facility. I would like you to respond to that, please.
Mr. McDonald. Well, we agree with your comments. In fact,
of the five objectives of MyVA, I think maybe perhaps one of
the biggest ideas, other than being veteran-centric, is
strategic partnerships. We are working very hard to establish
strategic partnerships.
And when I say that, I include the community. And I would
just point to the example of we have a problem with
homelessness. We are trying to drive down homelessness to zero,
virtual homelessness of veterans to zero by the end of this
calendar year. Yet, we have had a lawsuit going on in Los
Angeles for 4 years that stopped us from doing what we needed
to do to use 380 acres that we had there for homeless veterans.
I got involved through a friend in Omaha. I found out who
the law--who was behind the lawsuit.
We brought the community together, including the mayor and
everyone else, and members of Congress. And we have come up
with a solution and a memorandum of understanding, and a plan
forward to eliminate homelessness. So, I want to do the same
thing in Omaha.
Mr. Fortenberry. Perfect, Mr. Secretary, we need to get out
of this trap of this priority list, which has, again, a model
submitted a long time ago, but is not enhancing the opportunity
to leverage the strategic partners and actually give the
service that veterans need and in a quicker fashion.
We have got to eliminate this construct, because we are
just carrying forward--as Sam Farr was saying earlier--we carry
forward in time legacy systems--in Appropriations, somebody
gets trapped into whether or not we are going to plus up the
same system or cut it back, rather than creating new
architecture that actually makes sense in terms of service
delivery.
Does that mean my time is up? I didn't realize I talked
that long.
Thank you, Mr. Chairman.
Mr. Dent. Thank you, and you did.
At this time I would like to recognize the gentleman from
Ohio, Mr. Joyce.
Mr. Joyce. Thank you, Mr. Chairman. You had just answered
some of the questions I had and while I was listening to this
discourse of other questions that were asked, I would like to
follow up on the distinguished gentleman from Florida, Mr.
Rooney's question about bringing your extensive business
experience to the Department of Veterans Affairs.
What can Congress do to help you?
Mr. McDonald. I think the biggest thing Congress could do
is provide me the flexibility a business leader has to get the
job done. Let's agree on what the task is. And then let's have
the flexibility to get it done.
Budget line items, where money can't be moved in a free
market economy. You know, arguably, the V.A. is the largest
business in government. We are the second largest department in
government. We are the largest health care system in
government. At one time--and this goes back to the
congressman's recent comment--many of the things that we do are
archaic versus today. Today, veterans have choice. They never
had choice before. Yet, our laws and our budgetary processes
are all about an inflexible system, an inside system.
So, no criticism here. I just think we need to move forward
and move toward the end game, which is going to be strategic
partnerships. It is going to be a combination inside V.A. care
and outside care. But we have to have the budget to do that. We
have to have the flexibility to do that. And all of us focus on
the task of providing the care to veterans.
Mr. Joyce. I appreciate that and following up on his
questions, too, it would seem to me from my visits that we have
legacy systems that are putting band-aids on a system from the
1970s.
Would it make more sense to start a system that is 2017 and
start working towards that one and eventually discard the
legacy system? Wouldn't there be some cost benefit to that?
Mr. McDonald. One--that is a great point. One of the things
that we are doing--and this is particularly through the health
system--as you have heard from Alison's comments about the
benefits, she and her team have done a great job bringing this,
modernizing this, digitizing this, and getting this going.
Admittedly, we have more work to do yet, but we are on the
way.
BLUEPRINT FOR EXCELLENCE
In the health care system, we have got some more
fundamental work to do. Under Alison, under Carolyn's
leadership, we put together something called the Blueprint for
Excellence, which is a 10-strategy plan of returning the health
care system to preeminence in the country. That plan talks
about strategic partnerships. It talks about a hybrid system.
That is the vision that we have.
As we continue to work, we will get more and more concrete
on what that vision looks like. And I think that your point is
exactly right. Rather than trying to take an operating room
which needs to be 50 percent bigger, and trying to do that,
maybe we go to an operating room in a university that we have
an affiliation with. We have got great affiliations with the
best medical schools in the country.
So, there is a lot that can be done. And we are going to be
making that vision more and more concrete over time.
Mr. Joyce. And I wish we would continue to discuss the ways
we can help you get to where you need to go. Because it is
important, and Madam Under Secretary, you brought up where you
had a strong Irish voice--keep it up.
VETERANS COURTS
I know the frustration as a D.A. of 25 years, then you get
to Washington, D.C. and it operates completely different and
you wonder where you are sometimes. But there are ways to
streamline the process, and it seems, we're in trouble because
of the antiquated system and that is just not acceptable. And
the other thing--you had answered it in the last question too--
as D.A.s, and I know with friends who are doing the same thing,
I tell you it breaks your heart when you have to exercise
prosecutorial discretion because veterans do something so they
can get put in a place where they receive three squares and a
roof over their head.
It is wrong and I know you have many programs to address
that. But whatever we can do to make sure not one veteran is
homeless, please be loud, be clear, and let us get that help to
you.
Mr. McDonald. You are absolutely right. Incarceration for a
veteran is a ticket to homelessness. And so, veterans courts--
it was mentioned earlier in one of the members' testimony--
veterans courts are a great way to deal with this. We are big
advocates of veterans courts, we support veterans courts.
I spoke at the Harvard Business--Harvard Law School about
veterans courts. And we want to do everything we can to put
veterans courts in place in every state. Because if we keep
veterans out of jail, we will keep them out of being homeless.
It is a great point.
Mr. Joyce. Thank you very much for your time here today.
I yield back.
Mr. Dent. Thank you for respecting the time on that.
That ends round one of the questioning; we will move into
round two.
V.A. AND DOD INTEROPERABILITY
I want to try to conclude this hearing by lunchtime, by
noon, again. So, Mr. Secretary, following up on Mr. Bishop's
comments, and also Chairman Rogers about the interoperability
to help work through the records.
Obviously you haven't been here for the frustrating
experience of watching DOD and V.A. develop a single integrated
health record then spend years and hundreds of millions of
dollars on it, only to throw in the towel and go down two
separate tracks.
DOD will soon award a contract for a new electronic health
record. The V.A. is working to modernize its existing VistA
health records. Both departments are sort of committed to
making their records interoperable with the private riders that
both active service members and veterans use.
I also want you to know that members of the House
Appropriations Committee--we are strongly in favor of the
integrated health record. And we are determined that the two
records be interoperable. Just want to--again, hear your
assurances that this is going to happen.
And, moreover, I want to talk a little bit about the money
side of this. Congress provided $344 million for the V.A.,
electronic health record for fiscal year 2015. And despite all
the increases elsewhere in the budget, you are requesting $111
million less than for 2016.
You indicate that less funding is required because the
transition from moving from a single to two interoperable
records took longer than anticipated leaving carryover 2015
funds. And that less 2016 funding better aligns with program
requirements and workload capacity. The Committee certainly
does not want to provide you with funding that you cannot use,
but what does that say about your progress in modernizing
VistA?
Will you still meet your deadline of reaching final
operating capacity for VistA evolution by 2018?
Mr. McDonald. We are totally committed to maintain and
making modern and useful our electronic health record. This has
become even more important than it was before, because, as
Steph alluded to earlier, we now have private sector doctors
using our record.
I went to the American Medical Association Convention last
summer in Dallas. And I talked a lot about how do I get every
doctor in this country using our health record.
Our record is open source, which means it is free. Our
record is crowd-sourced innovation, which means if a doctor
uses our record and has an idea to improve it, we want that
idea.
I think there is a real opportunity here to make our
records the world class record it can be. And so it needs to go
forward to the private sector doctor and then go backward in
DOD. So the interoperability is actually essential in both
directions.
Mr. Warren. Sir, to your question about the reduction in
the 2016 request:
It did take us longer when we moved from how we were doing
a single record to how we are going to go forward, recognizing
the sharing of information with third-party providers. So
instead of asking for dollars in 2016 that we could not spend,
we felt it was more appropriate to basically work off of the
funds we carried over in 2014; the resources we received in
2015. And that is why there was a reduction in 2016.
We are still on track to make the interoperability
commitments. In fact, that sharing of information, and again,
Janus is just one piece of it--on track to meet that. And you
will see a robust request for 2017 and 2018, as we pick back up
the effort, again, work through the transition of reduction in
2016 because we could not spend those resources. And in 2017
you will see a robust request coming in.
Mr. Dent. Thank you.
SUICIDE AND MENTAL ILLNESS
Mr. Secretary, the recent Academy Award given to the
documentary profiling the V.A. crisis hotline brought a fresh
public spotlight on the tragic problem of suicide and mental
illness and behavioral health among veterans that the V.A. has
been battling for many years. In response to the problem over
the years, the V.A. has increased its number of mental health
practitioners, incorporated mental health services into primary
care to reduce stigma, conducted research on effective
treatments for service-related mental health issues and
supported numerous outreach and prevention campaigns.
Can you tell us what additional steps the V.A. plans to
take to battle suicide and serious mental illness within the
veteran population? I know that you plan to hire more than
2,100 mental health staff through the Choice Act funding by the
end of 2016, as an example.
Mr. McDonald. The Clay Hunt Act was also helpful, and we
are very thankful to members of Congress for the Clay Hunt Act.
Because, as Carolyn said earlier, being able to repay student
loans is an incentive to get more mental health professionals.
And that allowed for a $30,000 repayment of student loans. It
also allowed for more residencies, as I recall. And residencies
becomes an issue.
Medical schools will tell you, they can produce more
graduates. But without the residencies, it doesn't help. So,
that is very helpful.
To me, the biggest thing we have got to do is outreach. We
have got to find the veterans who are, for whatever reason,
resistant to seeking that care. And I am very hopeful that with
the ``American Sniper,'' being such a successful movie and with
our Academy Award that we won for our ``dial 1'' documentary,
that this is going to create more visibility in the general
public and help Americans realize that if they see someone--a
veteran who may need help, to let somebody know about it.
We have a toll-free number that can be called, and we want
to increase our outreach, both from veterans and from the
general public and from family members, so that we can get in
touch with these individuals, because we know if we get them
into our system, that we can effectively treat them.
Dr. Clancy. So one other point I would just make, Mr.
Chairman, we take every suicide very, very seriously and almost
personally, and in fact, we do what we call a behavioral health
autopsy. That is to say, each case gets a very in-depth review,
and the team has put together a database.
What they are doing now is trying to identify how we might
use all of the data from our electronic health records and
other sources to identify those at highest risk and target the
outreach that the secretary just mentioned.
We think that there are going to be some early signals that
we can be able to do that. It is a very, very difficult
challenge but one that we are not letting up on.
CHOICE ACT
Mr. Dent. Very, very quickly--just quickly back to the
Choice Act, Mr. Secretary, you are no doubt aware of the
initial report on the Choice program the VFW organization
released yesterday.
The group surveyed their membership to judge how many
qualified and were able to use Choice, although the VFW report
acknowledges that the V.A. didn't have much time to get the
program running, that the V.A. has been working hard to improve
it. The results of that they reported were disappointing.
VFW says that only 20 percent of veterans who live more
than 40 miles from the nearest facility or who had to wait more
than 30 days for an appointment were offered the Choice option.
Almost all those surveyed who were not offered Choice said
they were interested in obtaining non-V.A. care.
Don't the VFW findings contradict your statements that not
many veterans seem to be interested in using Choice to obtain
non-V.A. care? My sense is many are very interested, just
simply not eligible.
Mr. McDonald. No, as I said, we would like to do more with
the Choice program, and we want to make sure every eligible
veteran is able to take advantage of it.
I appreciate the VFW running that research. We sent out
cards starting in November. The last cards went out in January.
That research started in December, so--and was completed
recently.
So it is going to take time, but we are redoubling our
efforts, as I said earlier, to make sure every veteran knows of
their qualifications for the Choice program and every veteran
can take advantage of it.
We appreciate the VFW running the research.
Mr. Dent. Thank you.
At this time, I yield to Mr. Bishop.
Mr. Bishop. Thank you very much, Mr. Chairman.
I want to turn to some parochial issues.
GAS TO ELECTRICITY CONVERSION
I have heard that some V.A. hospitals are looking at
converting their energy supply to gas from electricity and
understand that the Atlanta V.A. is studying a possible
conversion.
Apparently, any type of conversion could cost a significant
amount of money in capital cost. What is the thought process
and analysis of this decision?
Mr. McDonald. I am not aware of that specific situation,
Ranking Member Bishop, but I know from my private sector
experience, I have converted different plants from natural gas
to electricity and back and forth, or use co-generation. So I
am assuming that the study would have to show a rate of return
on that investment if we are going to make the capital
investment.
I can assure you that, as the Secretary, I would not make
that investment if there weren't an acceptable rate of return
from the American people. But we will have to dig into that
specific example.
Thank you.
Mr. Bishop. Thank you.
MARTIN ARMY COMMUNITY HOSPITAL AND V.A. CLINIC
During our last conversation, you mentioned that there has
been 18,000 square feet of space at Martin Army Community
Hospital that would be allocated for a V.A. clinic. There was
to be an initial allocation, as I understand it, of 10,000
square feet followed by 8,000 square feet a month later.
As you know, this is something that I have been asking for
years, a co-location with DOD and V.A. clinics. Can you provide
me an update as to the status of the transition?
Mr. McDonald. That is as much as I know is what you just
said. We are in the process of making transition.
And again, I think this is a good example of another
strategic partnership, and that is a partnership with DOD. And
we appreciate your comments and the fact that you have been
looking for this.
Caroline, I don't know if you have an update beyond that.
Dr. Clancy. I understand that it is all on track, and there
will be sort of a grand opening in May, but you better believe
we will be letting you know about that.
Mr. Bishop. Thank you. Thank you. Thank you.
V.A. CLINIC SELECTION, NORTH COLUMBUS, GEORGIA
Finally, we talked at length about the selection of a V.A.
clinic in North Columbus, Georgia and the questions of the
process utilizing the selection of the site.
Have you been able to find out anything in regard to the
property selection there, and if it is truly the best location
that will service the veterans in the Columbus, Georgia,--
Alabama and surrounding areas?
Mr. McDonald. We did look into that. After we talked, we
did look into that process. And frankly, I think that we could
have done a better job involving your staff and you in that
process of selecting that location.
The location is selected. We do think it is a good
location, and if we were to change the location, my
understanding is it would significantly delay us.
And as a result, we think it is best to move forward, but
we do think that the process could have been improved of
including your staff and you in the process of that.
Mr. Bishop. It is my understanding that there is no public
transportation that will go to that site and that there are
very few veterans that actually live in that area, that the
central city location would provide much greater access with
public transportation and that there are facilities there that
are already constructed as a part of the Columbus regional
medical complex.
So I am trying to understand how they came to the
conclusion that that was the best location.
Dr. Clancy. I believe that transportation is going to be
arranged for those veterans who would need transportation
from--particularly if they are at that other complex and need
to get out to our facility.
I believe that there was a problem with putting this
facility downtown, but I will follow up with you on that.
Mr. Bishop. Yes. Yes, I don't know what the problem was,
other than that the specifications when they put the request
for a proposal out excluded that particular geography where
there was a tremendous medical complex in existence that had
excess space.
It was already wired for all kinds of emergency
transportation, for specialty services and the like.
Mr. Dent. I recognize Mr. Jolly.
Mr. Jolly. Thank you, Mr. Chairman.
VACANT FACILITIES AND OBSTACLES
I just have one question I didn't get to last time. Mr.
Secretary, you made a very reasonable argument and request
regarding vacant facilities and one of the ways we could be
helpful would be to remove the obstacles that stand in your way
of closing facilities.
What are those obstacles on the congressional side? Are
they merely political? Are they statutory? Are they tied to
funding?
Mr. McDonald. I will have to get back to you on the
details. My understanding is they are generally political,
and--
Mr. Jolly. I don't know who would stand by that one
facility that you sent a picture of. I think you should able to
close that one, right?
Mr. McDonald. Yes. That--that garage?
We obviously picked that picture on purpose.
Helen, do you have any--what do we need help on here? Is it
statutory or--thank you for asking.
Ms. Tierney. Sir, it is a combination of different things.
We do have facilities such as that one that is designated
as a historical facility, which, once that happens, we are not
able to move forward.
And then it is a lot of political concern when we look to
close a facility, so we need something like a BRAC process that
would be fair, that a board would evaluate our facilities, and
Congress would agree with those closures based on their
ranking.
Mr. Jolly. But do you have the authority to close vacant
facilities? Let's stick with vacant facilities, not reducing
the footprint of maybe existing facilities.
And I ask just because if it is political, then the
category of vacant facilities, I think would be the low-hanging
fruit with the least amount of political opposition.
Do you have the legal authority to close vacant facilities?
Ms. Tierney. So each case tends to be a little bit
different. Sometimes that facility is on a complex, and we
don't have enough construction money to tear it down.
An option when we start to do that process, one of the
historical organizations gets involved--so yes, we would
probably need an agreement that everybody was going to agree to
close certain facilities.
Mr. Jolly. Thank you.
Mr. Dent. Can we submit for the record what your
authorities are? That would be very helpful.
[Clerk's note: The requested material was not provided by
publication deadline.]
I recognize Mr. Fortenberry.
Mr. Fortenberry. This was related to the line of
questioning I wanted to undertake.
But first of all, let me make a quick recommendation, if
there is some viable mechanism whereby you can creatively
dispose of excess inventory and capacity working with
communities, do not call it BRAC. [Laughter.]
Don't do that, because this is a positive thing. We are
trying to make you more efficient and effective, not close
stuff in communities, and that means transitioning this vacant
property, underutilized property.
By the way, the V.A. clinic in Lincoln, Nebraska, where I
live, has a similar dilemma, a very old, stately facility that
needs to be preserved--enhanced and preserved, and there is
development agreements that have tried to be worked, and it is
completely stuck.
And meanwhile, what is happening? The V.A. is carrying
excess capacity, taking money away from your primary mission,
the community is not being as well served, because there are
other development opportunities there, and we are losing the
opportunity to rehabilitate and preserve historic structures.
So, I will think of--I will come up with an acronym if you
want, but don't say BRAC.
Ms. Tierney. Sorry. We have a legislative request that we
have submitted to give us enhanced use lease authority. Right
now, our authority was limited to only supportive housing for
homeless veterans. We would like to extend that back to the
authority we used to have so we could bring in a broader range
of people to use those beautiful historic facilities.
Mr. Fortenberry. Well, perhaps, Mr. Secretary, this is the
heart of the problem that we have all been talking around with
our lofty ideals and strategic partnerships. The mechanism for
this--one of them, anyway, to create a financing mechanism--
could be this enhanced leasing authority, where private bill
would lease back, or however you want to structure it.
You said it--``We used to have the authority.'' You no
longer do. What happened?
Mr. McDonald. I think part of it was around the issues in
Los Angeles that I mentioned earlier. The Los Angeles campus
had a rental car facility, a laundry facility, and a whole
bunch of other things. And as a result of that, the enhanced
use lease authority got restricted. I think we are beyond that
now. We have solved the problem in Los Angeles. This would be
helpful.
The other thing that would be helpful--and we have done a
lot of study on this--is, with the strategic partnerships, we
also have the ability to create mechanisms where we could
receive funds from private sector to help veterans. And we have
looked at that authority, as well.
Mr. Fortenberry. Well, I think what would be helpful--and
you alluded to this earlier--is if we can quantify what you
need in terms--across multiple platforms, what we have talked
about, in terms of enhanced authority that is going to give us
creative opportunity to have the private sector either
contribute, or be involved in the financing. So, we could just
get going here. There is no reason for all of this holdup. It
is just that we are carrying legacy infrastructure of previous
ideas as to how to do things. Not a condemnation of the past.
We had to do it that way. But we don't have to do it that way
going forward.
So, I think as an outcome here--tangible outcome--can you
get back to us with the list after the evaluation is done, what
specific legislative authorities you need? Or if it is a matter
of just cross-agency communication, as we talked about with the
OMB----
Mr. McDonald. Right.
Mr. Fortenberry [continuing]. Who has some stress regarding
enhanced leases or private bill with private build leased-
backed arrangements--that would be very helpful.
Mr. McDonald. We will do that.
Mr. Fortenberry. If you could do that quickly, that would
be----
Mr. McDonald. We will do that. We will do it very soon.
Mr. Fortenberry. All right. Thank you, Mr. Secretary.
Mr. Dent. Thank you. That concludes the second round.
But before we depart, I want to ask one quick question and
then will submit the balance of my questions for the record.
Mr. Secretary, your predecessor set goals of ending the
disabilities claims backlog of defining backlog as taking
longer than 125 days per claim. And achieving a 98 percent
accuracy in completing claims by 2015.
Your budget document states that you will meet the
timeliness standard--outside observers are a little more
skeptical. It appears that trend in backlog reduction has
declined in the last 8 months.
Your budget documents are silent about whether you will be
able to meet the 98 percent accuracy goal by the end of the
year. Why has that goal proved more elusive to you and what
steps, like training, are necessary for you to achieve your
quality goal?
Mr. McDonald. On that particular goal, we have done a deep
dive on the statistics of that goal. And statistically, it is
virtually impossible to achieve it. Statistically, if you have
two probabilities--let's say one is .5 percent, the other is .5
percent--together, they are .25 percent. If you add another
one, you know--and the probabability keeps going down the more
elements you add.
We did a deep dive on this, and there are so many elements
to achieving a perfect claim resolution that it would be
impossible to get to 98 percent.
Allison, any detail you want to add?
Ms. Hickey. The only thing else I would add is that I have
met now repeatedly with commercial industry experts and chief
claims officers from across the nation who do similar work. And
when I describe to them the level of quality we have already
attained, and then I say to them, ``How would you get
further?'', they say to me, the return on investment would be
so huge to get further that they actually believe--and when I
asked them about their numbers, I am actually ahead of most of
them in terms of the quality that they do. They didn't say just
have a process on the back side for which--a working appeals
process with good law around it--have a process on the back
side for which you address those points of disagreement.
I think it is important to also note there is no
correlation today between quality and appeal. We have done that
study and that analysis. In fact, some of our best stations had
the highest number of appeals.
So, what I would tell you is that we are really optimizing
the system right now at that 96 percent medical issue quality.
Which, by the way, is a 5.5 million issues we have done this
year, and will go up again next year. So, we are actually doing
pretty well against that at the individual medical issue level.
We have--and I thank you for the resources--significantly
improved our training programs, our challenge programs. And we
even have sort of remediation now--programs which you assisted
us with. We also have consistency studies we are doing every
day. We have quality review team people in the regional office
who are providing just in time assessment of errors.
We have almost seven or eight layers of quality assurance
now that I would actually say probably supersedes what even
industry does in this area.
Mr. Dent. Thank you for that.
This concludes our hearing. I want to thank all of you
today--the secretary and staff for appearing here.
And this hearing is adjourned.
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Thursday, March 19, 2015.
OVERSIGHT HEARING--DEPARTMENT OF VETERANS AFFAIRS, OFFICE OF THE
INSPECTOR GENERAL
WITNESSES
MR. RICHARD J. GRIFFIN, DEPUTY INSPECTOR GENERAL, DEPARTMENT OF
VETERANS AFFAIRS
DR. JOHN D. DAIGH, JR., CPA, ASSISTANT INSPECTOR GENERAL FOR HEALTHCARE
INSPECTION, DEPARTMENT OF VETERANS AFFAIRS
Mr. Dent [presiding]. We will bring this meeting to order.
Good morning.
We would like to welcome Mr. Richard Griffin, the deputy
inspector general for the Veterans Administration, to discuss
his office's oversight efforts at the Veterans Administration.
This is probably one of the most active periods in recent
memory for your office, Mr. Griffin, with your audits of
whistleblower allegations and the wait list scandal reports
that you are required to make to Congress by the Choice Act.
You have also had to respond to recent charges that your office
has fallen a little bit short on transparency by failing to
release some investigative reports.
Members of the subcommittee will no doubt have many
questions about the many areas of your oversight, and we
understand that you have a previous engagement that requires
you to leave at 11:30 this morning, and we will do our best to
honor that. But with all the issues, from the wait list scandal
to the construction challenges issue at Denver and so many
other issues, I look forward to just getting right into this
testimony.
At this time I would like to ask our ranking member, Mr.
Bishop, if he has any opening remarks that he would like to
make?
Ranking Member Bishop Opening Statement
Mr. Bishop. Thank you very much, Mr. Chairman, for
yielding.
I believe that the inspector general plays a vital role in
ensuring the programs that are implemented actually work and
that the funding is spent wisely. The I.G. last year, I think,
was tasked with the difficult work of investigating the scandal
in Phoenix, about which we were all appalled.
In response to this investigation, which uncovered numerous
issues, Congress moved forward on historic legislation,
including the Veterans Choice Act, that would improve access to
health care for veterans across the nation, which was signed
into law in August. While this is an essential first step in
addressing the systemic issues that are facing the Department
of Veterans Affairs, there is still a lot of work to be done.
And as we move forward, it is critical that the inspector
general have the necessary resources to conduct aggressive
oversight to ensure that veterans are able to receive the
health care that they need when they need it. It is vital that
we change the culture that has been so infested within the V.A.
and to make sure that it doesn't resurface.
No matter what steps the V.A. takes to address the
challenges that it faces, it will not be able to move forward
if we don't have proper oversight. So I commend you for the
work that has been done over the last several months, but there
is a lot yet to be done to repair the trust that has really
been broken with our veterans and with the American people for
the veterans--the V.A. system.
So I look forward, Mr. Chairman and members of the
subcommittee, to working with the department to eliminate the
issues that are raised by the I.G.
And I thank you, and I will yield back.
Mr. Dent. Thank you.
So, Mr. Griffin, your full statement will be entered into
the record. Please introduce Mr. Daigh, who is with you at the
witness table, and please summarize your testimony for us. And
I know we are going to be interrupted by votes at some point,
so we are going to try to move along as quickly as we can.
Mr. Griffin. Thank you.
Mr. Chairman, Ranking Member Bishop, and Members of the
Subcommittee, thank you for the opportunity to discuss the work
of the V.A. Office of Inspector General.
In fiscal year 2014, our office issued 310 reports, we
closed 880 investigations, we made 539 arrests, and we
identified $2.3 billion in monetary benefits for a return on
investment of $22 for every dollar in I.G. funding. In the
first 5 months of fiscal year 2015 alone, the I.G. has
recovered in fines, penalties, restitution, and civil
judgments, actual money returned to the U.S. government
equivalent to 91 percent of our enacted appropriations.
Recoveries since fiscal year 2011 are even more remarkable,
with $3.1 billion in recoveries, which represents actual cash
recoveries of $5.50 for every dollar spent on the I.G.'s
operations.
In the past 6 years we have issued more than 1,700 reports,
made more than 3,000 arrests, and provided testimony at 69
congressional hearings. We conducted 400 briefings for Members
of Congress and staff and responded to more than 1,300 written
requests from various members of the House and the Senate.
This level of productivity and information-sharing with
Congress is among the very highest in the I.G. community.
During the past 6 years, our work has been recognized by the
Council of Inspector General for Integrity and Efficiency with
25 awards for excellence.
The national attention sparked by reporting on waiting
times and patient deaths at the Phoenix Health Care System has
resulted in a dramatic increase in the number of contacts to
the OIG hotline.
In fiscal year 2014 the OIG hotline received nearly 40,000
contacts, a 45 percent increase over fiscal year 2013. We saw a
similar increase in the number of inquiries from the Members of
Congress, with over 200, reflecting a 38 percent increase in
congressional requests. We expect that these upward trends will
continue.
Recent attention to opioid prescription practices at the
Tomah VAMC has generated interest in the OIG's practice of
administrative closures. Let me be clear that our work at Tomah
was painstaking and comprehensive.
OIG physicians reviewed the clinical practice of providers
to include quality assurance data and patient medical charts.
We contacted the V.A. Police, the Drug Enforcement Agency, the
Tomah and Milwaukee Municipal Police, to determine if there was
evidence of narcotic abuse at the Tomah VAMC. OIG investigators
were involved in an attempt to find appropriate or illegal
behavior on the part of providers or patients.
Current and former Tomah pharmacists were interviewed. OIG
staff reviewed the e-mails and other files from 17 employees at
the Tomah VAMC.
At the end of a 2.5-year review we concluded that narcotic-
prescribing practices of some Tomah staff were at the outer
boundary of acceptable narcotic prescribing, and we were unable
to find evidence that illegal activity was occurring. While the
decision was made to close the review without a public report,
we did, in fact, brief the Tomah and the network director who
oversees Tomah, along with VHA central office personnel.
In January of this year I directed a review of
administrative closures for fiscal year 2014 to determine
whether any adjustments were to be made to our internal
policies. We found that 42 percent of the administrative
closures were not substantiated, 54 percent were closed because
when we arrived, the facility had already taken sufficient
action that resolved the issues, and 4 percent involved tort
claims.
I also directed a review of our decision-making practices
on closing reviews administratively and instituted a new policy
requiring coordination of administrative closures within the
immediate Office of the Inspector General, the Office of the
Counselor to the Inspector General, and our Release of
Information Office. This process will ensure consistency in
decision-making regarding when and how public release of
related documents is handled.
This week we began publishing administrative closure
reports on the OIG Web site. Additional reports will be
published pursuant to the Freedom of Information Act as we
complete the process of reviewing and redacting sensitive
information.
For fiscal year 2015 the OIG is funded at $126.4 million.
The President's budget proposed $126.7 million for fiscal year
2016, a three-tenths of 1 percent increase, which will require
a reduction of 10 full-time employees.
Without additional resources, we cannot meet the demands of
increased congressional and other hotline contacts. It will be
practically impossible to maintain our schedule for cyclical
inspections of V.A. medical centers, outpatient clinics, VBA
regional offices, and other national reviews.
Our investigative staff is also stretched to the breaking
point by the rise in threats and assaults, fiduciary fraud,
drug diversion, identity theft, and service-disabled veteran-
owned small business fraud. We believe an increase of $15
million over the fiscal year 2015 enacted level will enable us
to surpass our performance in terms of productivity, quality,
and timeliness, and help meet the unprecedented increase in our
workload.
Mr. Chairman, we appreciate the committee's continued
interest and support, which has included the addition of $5
million above the President's request during the last 2 fiscal
years.
This concludes our statement, and we would be happy to
answer any questions you or any other Member may have.
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WAITING LIST SCANDAL
Mr. Dent. Thank you, Mr. Griffin.
And I will get to the Tomah issue in a moment, but I just
wanted to first start with the waiting list scandal.
Your office was obviously thrust into the epicenter of the
wait list scandal last year. Your testimony indicates that you
have undertaken 98 audits responding to allegations of
scheduling manipulation and that so far you have referred 44
audits to the department's Office of Accountability Review for
administrative action. You are still working at the other 54
sites.
Should we conclude from the 44 completed audits that
scheduling manipulation was endemic to all the hospitals you
visited? And are the violations you identified matters of
breaking the law or administrative malfeasance, and has the
Department of Justice been willing to take any of these cases
you have identified?
Mr. Griffin. I can't tell you as I sit here if 100 percent
of the facilities were manipulating wait times, but I can tell
you it was certainly widespread throughout the system. We have
presented these cases to the U.S. Attorney's Office; 33 of the
cases that were presented have been declined for prosecution,
with the suggestion that they be referred to the department for
administrative action, which is, of course, what we would do
anyway.
We have eight that are still pending with DOJ and, of
course, you know, each individual U.S. Attorney's Office has
their own caseload and their own decision matrix as to what
they accept for prosecution and what they don't, but certainly
any time that we had evidence of criminality we presented these
cases.
Mr. Dent. There are conflicting media reports in the wake
of President Obama's visit to the Phoenix hospital. One of the
whistleblowers said that progress was being made and that
terrific strides had been made in on-time appointments; another
one of the whistleblowers dismissed any notion of progress and
said that the V.A. was still gaming the system of appointment
delays.
What conclusions have you made about the pace of the
progress from your most recent audits?
Mr. Griffin. We issued an interim report on Phoenix urology
issues within the last 30 days. It is something that came to
our attention when we were in Phoenix initially. We had to set
it aside because we wanted to get the waiting times report out
the door.
We found some 750 veterans that were waiting for urology
care for extended periods of time that appeared to be
unaccounted for in the system.
So there are issues. It took a long time for the system,
system-wide, to get into the state that we found it in, and I
think it is going to take a long time to get it all
straightened out.
OMI AND OIG DIFFERENCES
Mr. Dent. And I would like to also just follow up on the
last comment on Phoenix. After the Phoenix wait list scandal
the V.A. took steps to reorganize and strengthen the Veterans
Health Administration's Office of Medical Inspector, OMI,
including creating an audit capacity for that office.
What does the OMI do that is different from the OIG? Do the
two groups often have the same cases?
Mr. Griffin. We have a statutory requirement to oversee the
work of the OMI, so we would never do duplicate work because we
would tell them--if they were going to initiate something we
already were working. They are in regular contact with Dr.
Daigh's office. It is not unlike our relationship with GAO. If
we are doing an audit on a certain subject it would make no
sense, so----
Mr. Dent. So it is not redundant?
Mr. Griffin. Previously, as a medical inspector, they were
the under secretary's early warning mechanism. If there was
something that he wanted them to go look at before it became a
national crisis, he could dispatch his medical inspectors prior
to it coming to anybody's attention, just based on one of his
directors hopefully saying, ``I think we need someone to come
out and take a look at this.'' The audit aspect is a new twist
for them.
TOMAH ISSUE
Mr. Dent. I would like to quickly move to the Tomah issue,
if we could. Your office has obviously been investigating the
Tomah, Wisconsin V.A. hospital case of over-prescription of
opioid drugs, which gained a lot of national attention. And
your office has faced some criticism for concluding that
doctors' prescription policies were within the scope of
practice.
Last week the department released its preliminary clinical
findings on Tomah and reported that the V.A. team found unsafe
clinical practices at Tomah in such areas as pain management
and psychiatric care. The department also noted that the Tomah
hospital had double the national average in the simultaneous
use of benzodiazepines and opioids, a practice which is
discouraged by official V.A. policy. These findings seem to
indicate a significant problem.
I guess the question is, why did the I.G. conclude that
prescribing behavior was in the scope of practice, or you said
they perhaps pushed an outer boundary?
And then finally your office also had received some
negative publicity recently. It was a USA Today story on March
the 8th related to the Tomah case because you administratively
closed the case without publicly releasing the report and
response.
You talked about it in your testimony, but on Tuesday you
established a new policy that administrative closures would be
decided centrally. Out of the 140 reports that have not been
released, you have released five with sensitive information
redacted and your staff is reviewing the other 135.
NEW CENTRAL POLICY ON RELEASING REPORTS
Can you tell us what the new central policy would be on
releasing those reports? Are reports, even those with
confidential information and unsubstantiated allegations, being
released with appropriate redaction? Is there no standard
policy government-wide for I.G.s to follow about the
circumstances in which I.G.s must release the reports from
their investigations and their audits?
I kind of gave you three issues there: Tomah, the most
recent issue of the disclosure of the reports, and a standard
for I.G.s generally.
Mr. Griffin. Regarding the recent publication by Dr.
Clancy, our work there covered a point in time from 2011 to
2013, and during that time we looked at the specific patients
and the specific medical records that were in play at that
time. We are back in Tomah now looking at some of the new
allegations involving new patients, and we have another
investigation ongoing there. For it to be misunderstood that a
current review somehow has application to the work that Dr.
Daigh's team did isn't exactly the way it should be described.
Your second question on administrative closures.
I can tell you that other I.G.s do administrative closures
and that based on the numbers that I mentioned to you--we have
40,000 hotline requests, most of them with multiple issues they
want us to look at. If we start looking at something and we are
10 percent into the review and we realize this is a dry well,
it would make no sense for us to use our limited resources to
pursue something when we have been convinced early on that it
is either unsubstantiated or because perhaps the whistleblower
or the person who raised the issue raised it through the chain
of command--sometimes that happens, too--and it was taken to
heart locally and fixes were put in place prior to our team
even getting there.
For us to continue to do work and issue an extensive report
with the additional requirements on our personnel and cost and
efficiency would be a poor utilization of our resources. In the
past we administratively closed such reviews.
Frankly, we are doing these now because of some
misunderstanding as to whether we were hiding something.
Anybody that reads these as they come out--and I think we have
got 13 out this week--will see that if you were in our position
you would make the same decision.
Mr. Dent. Thank you, and I would like to yield this time to
our distinguished ranking member, Mr. Bishop?
Mr. Bishop. Thank you, Mr. Chairman.
Ms. Lee has got some exigencies, and so I am going to, if
the chair would allow me to yield to Ms. Lee and let her go
ahead of me out of turn?
Ms. Lee. Thank you very much. I want to thank the gentleman
for yielding.
UNPROCESSED INFORMAL CLAIMS
We have the Budget Committee coming up, and I really
appreciate being able to ask you these questions.
So thank you, Mr. Bishop, very much.
Good morning. Good to see you.
And first, let me just thank you for responding to report
language that this committee placed--I think it was the year
before last with regard to the Oakland Regional Office. We
indicated that there had been 13,000--over 13,000 unprocessed
informal claims, and Under Secretary Hickey, in her testimony,
indicated that these were actually duplicate claims, but that
that still was unacceptable.
There was some recommendations based on the report that you
gave us that we presented back to you that I believe it was Ms.
Boor--Julianna Boor--worked with us on. And let me just--there
are three recommendations, and I wanted to get a sense of what
you think needs to happen next.
We recommended that the Oakland V.A. Regional Office
director complete and take appropriate action on the remaining,
I think it was 537 informal claims; secondly, that the Oakland
regional director implement a plan to provide training to staff
on proper procedures for a process in informal claims and
assess the effectiveness of the training; thirdly, that the
Oakland V.A. Regional Office director implement a plan to
ensure oversight of those staff assigned to process the
informal claims.
I think you know that Oakland has been one of the worst,
and you have made a lot of progress, so I want to thank you for
that. But also, getting to 2015 goal of no disability claim
being more than 125 days old, I can't for the life of me figure
out how that is going to happen, given what is taking place and
what has taken place in processing in Oakland.
So are you going to continue to investigate, continue to
monitor? How do we make sure that we reach the goal of 2015?
Mr. Griffin. I think that was a stretch goal when it was
articulated. I think there has been extreme emphasis placed on
processing claims, and a lot of other collateral duties that
VBA has have fallen by the wayside.
And we were in a meeting about this subject and the answer
was, ``We don't have enough staff.''
And I said, ``Well, we are making millions of dollars in
improper payments that could be used to hire staff and get
adequately staffed so things can be done right.'' I came away
from the meeting believing that there was going to be a request
for that.
They are up against it, there is no question. The increase
in demand since 9/11 for the post-9/11 veterans has them and
VHA drowning in demand. And as you know, they have been under a
fair amount of pressure to try and get this backlog cleaned up.
I would applaud their effort, but I am afraid that in part
what has happened is some of the backlog is getting moved
around and not getting resolved. Some of it is going to----
Ms. Lee. That is what we are seeing there.
Mr. Griffin [continuing]. It is going to wind up at the
Board of Veterans Appeals or it is going to be temporarily
taken off the table, which was part of another initiative they
have on the 2-year-old claims, but then it has to come back to
be finalized later on.
So there are a lot of issues. You are right, Oakland was
not one of their high achievers.
Ms. Lee. One of the lowest----
Mr. Griffin. Exactly. But thanks to some funding we got
through this committee a few years ago, we created that
inspection program. And we get to every regional office once
every 3 years so we can look at the more difficult claims and
see if they are doing them correctly or not, or are they making
improper payments, and so on.
So we know they had problems with Oakland. With the 13,000
you alluded to, as you know, they didn't even have sufficient
records as to be able to go back after the fact and confirm
that they fixed those 13,000, so more work needs to be done, no
question.
Ms. Lee. Okay. So is there a plan to go back to determine
if those 13,000 were fixed? And then do you think that the goal
of the claims being no more than 125 days old by 2015 can be
attained or not?
Mr. Griffin. I don't believe that will happen, but we all
hope it could happen. But, like I said, I think it is a stretch
goal.
Ms. Lee. Okay.
Well, Mr. Chairman, I would hope we could figure out a way
to help make sure that goal is achievable since that is the
goal, because these veterans deserve better that what is taking
place now.
So thank you very much.
Mr. Griffin. Thank you.
Mr. Dent. Thank you, Ms. Lee, and thank you for your
service on the Budget Committee. I know you are a little busy
today. Hope you got a little sleep.
At this time I would like to recognize Mr. Jolly for 5
minutes?
Mr. Jolly. Thank you, Mr. Chairman.
And, Mr. Griffin, Dr. Daigh, thank you for being here.
We are coming off one of the worst scandals of the last few
years within the V.A., where your office uncovered widespread
abuse, manipulation of wait lists. You are the independent
inspector.
This is the Appropriations Committee, though, not the
Authorizing Committee. The President's budget proposes overall
an increase of around 7 percent for the department, but for
your department and the inspector general's department only 0.3
percent.
Your testimony says that you will have to reduce your
personnel by 10 full-time employees under the President's
proposed budget. Is that correct?
Mr. Griffin. Yes, that is correct.
Mr. Jolly. Last year you issued 310 reports, 888--or 880
investigations, 70-something arrests, recovered $2.3 billion.
You were responsible for, frankly, uncovering some of the
greatest concerns of the American people. And the President's
budget proposal requires you to cut staff if enacted at this
level. Is that correct?
Mr. Griffin. That is correct.
Mr. Jolly. In your oral testimony you reference if it was
up to you you would be requesting an additional $15 million?
Mr. Griffin. That is correct.
Mr. Jolly. And what would that enable you to do? If at $126
million you are laying off 10 people, then at $141 what does
that do for your operations?
Mr. Griffin. Thank you.
We have got a 45 percent increase in hotlines. We have got
an intake unit that processes those. But when there are serious
violations that need to be either investigated or need a
medical review by Dr. Daigh's staff or need an audit, the
intake unit farms those out to the people that hit the street
and do the actual work.
So what we would do is we would hire 75 additional
personnel. Some of them would be in the intake unit, but some
of them would work for Dr. Daigh, some would work in our
criminal investigative unit, and some in the audit staff.
It would also allow us to not have to lose the 10 that you
have already described.
Mr. Jolly. And I would point this out to the committee. You
know, I asked the secretary when he appeared before us what the
President's budget proposal included for OIG, and I am not sure
we got a clear answer that day, and I am not sure if it was
obfuscation or perhaps he just didn't know.
CHOICE ACT
Is there an issue related to anything in the Choice Act? In
past testimony, as I have seen over the past several weeks from
the department, both on the Hill and publicly, there has been
reference to the fact that perhaps your office did receive
additional money sometime towards the end of last year that
justifies this increase?
Mr. Jolly. Justifies this lack of increase.
Mr. Griffin. Thanks to this committee, we have received $5
million above the President's budget the last 2 years. The way
the omnibus worked out last year, it was like ships passing in
the night as far as the pass-back from OMB and the
appropriation for 2015 occurring.
I believe that somebody saw that $5 million and concluded
that, well, they already got their $5 million in 2015. But we
used that $5 million to add staff to try and put our finger in
the dike to stay afloat here. And based on the growth in
demands, 45 percent growth, we already had to stop doing some
of the cyclical reviews that we think are very important so we
are not just showing up at hospitals when somebody pulls the
fire alarm. You need to have a routine inspection process.
So there was a memo that came out from the Office of
Management saying that there may be either a supplemental or--a
reapportionment of some of the Choice Act money. Now, my
reading of what the reaction has been to that idea suggests
that that wasn't going to happen, but I felt compelled, if
there was going to be a supplemental, based on us having to
lose people, to make a serious and sincere request for
additional staffing because we are going under.
Mr. Jolly. So to be very clear, your position is that
nothing that has occurred, from the omnibus to the Choice Act,
any additional resources, there is nothing that has alleviated
your need for additional money? This would be a real cut.
Mr. Griffin. Absolutely.
Mr. Jolly. If this President's budget is enacted at this
level, this is a real cut of 10 employees to your office?
Mr. Griffin. That is right. And we could use twice as much
as that, but I don't want to be greedy. I am serious. There are
other I.G.s that have 1,600 FTE and we have 650.
Mr. Jolly. Thank you.
Mr. Griffin. And we are the second-largest agency in the
government.
Mr. Jolly. Thank you very much.
Mr. Chairman, thank you.
Mr. Dent. Thank you.
I would like to, at this time recognize the distinguished
ranking member, Mr. Bishop?
Mr. Bishop. Thank you very much, Mr. Chairman.
CLAIMS BACKLOG
Let me go back to your budget document for a moment to try
to follow up on an earlier statement that you made about the
backlog. I think an OIG review found that the VBA's 2013
special initiative to expeditiously complete disability claims
pending more than 2 years was not effective, and the
initiatives allow use of additional ratings to process claims
while awaiting receipt of requested supporting evidence was
less effective in quickly providing benefits to veterans than
were the existing rating procedures.
And you said although the complete provisional claims still
required a subsequent final rating decision, they were omitted
from the VBA's inventory of pending cases, understating VBA's
total workload and its progress in eliminating the claims
backlog. So basically, what I would like to get clarification
on is whether or not when you take--when you eliminated the
pending cases, did that increase the--did that distort the
number of claims that were still unresolved and still pending?
Mr. Griffin. Yes, it did. I mean, they took those
provisional ratings off the table even when there might have
been one or two of the several claims that had been filed that
had not yet been completed, and they weren't included in the
count.
BUDGET REQUEST
Mr. Bishop. Which is really troubling to us, because, you
know, we are really, really struggling to get a handle and to
hold the agency accountable on the numbers. It just seems like
the numbers are ambulatory, they just move all over the place.
And we have to have some real metrics so that we can track
and we can hold the agency accountable so we can exercise our
oversight duties.
Let me ask you something about your budget request now. You
mentioned that the return on investment was five-to-one, I
think, in your testimony, in terms of recovery.
The budget document seemed to suggest it was three-to-one,
so that was--that kind of jumped out at me. But I find it
interesting that the funding level is flat, because you
actually do provide a return on investment of significantly
more than has to be expended.
Can you explain the different ways that the money is
recovered and how it should be invested back into V.A.? And if
it were reinvested and you are generating that kind of return,
why is it that you are not able to utilize that for additional
FTEs in order to carry out your responsibilities?
Because, I mean, you are definitely a great asset to the
taxpayer and to the agency. You are conserving resources and
recovering resources.
Mr. Griffin. Thank you, Mr. Bishop. I don't know where the
three-to-one number comes from. Is that in the department's
documents?
Mr. Bishop. Yes. It is in the budget----
Mr. Griffin. In fiscal year 2014 our return on investment,
which is a number that all I.Gs use, was 22-to-1, and that
number reflects monetary benefits, money that could have been
put to better use. It is mostly money that is identified in our
audits that was either improperly spent or wasted.
The recoveries result from our----
Mr. Bishop. I think it was the recoveries that were three-
to-one.
Mr. Griffin. Recoveries for the last 5 years were five-to-
one, and that was on criminal cases, that is when there is a
quitam filed and the government recovers monies that were
wrongfully obtained by private sector contractors.
Now, some of that money, to the extent that we can
demonstrate that V.A. procured a certain dollar value in drugs
that were wrongly identified or were off-market labeling or
what have you, V.A., once we can demonstrate through our work,
``This is the amount of this drug V.A. purchased,'' then V.A.
gets their share of the penalty money.
A lot of our fines and recoveries are in criminal cases.
That money goes to the U.S. government--mostly to the U.S.
Treasury, sometimes to asset forfeiture funds. But at the end
of the day, it is all money returned to the same U.S.
government on behalf of the taxpayers.
Mr. Bishop. I guess my question is you are struggling for a
lack of resources. You don't have enough FTEs. You are
generating significant recoveries.
Do you have the flexibility, or does the Secretary have the
flexibility, to utilize some of these recovery resources to
supplement your FTEs, or do you need to come to us for
additional authorities to do that?
Mr. Griffin. I think that due to the independence of the
I.Gs, you don't want to give the impression that we are
beholden to the secretary to provide our funds. So that is why
there is a separate line item in the budget. And when we don't
get what we request, there is a narrative portion that we are
supposed to tell the Congress, ``This is how much we asked for
and this is how much we were given.''
Mr. Bishop. So from the recoveries, though, does it come
back to you or does it go back to the department?
Mr. Griffin. No. No. It is for the good of the whole, but
not to the I.G.
Mr. Bishop. The whole department of the----
Mr. Griffin. No. Some goes to V.A., some goes to the
Treasury Department.
Mr. Bishop. Thank you, Mr. Chairman.
Mr. Dent. Thanks.
Before I recognize Mr. Rooney I just want to say we are in
votes. I think there are about 9 minutes left in the vote.
IDENTITY THEFT
We will have Mr. Rooney proceed and then when he is
finished we will recess briefly. It is only two votes, so we
will vote on the two then come right back.
So with that, I would like to recognize Mr. Rooney, for 5
minutes?
Mr. Rooney. Thank you, Mr. Chairman.
My question is pretty brief and kind of specific to
Florida, but I think it might reflect a larger issue which
deals with patients at V.A.s and identity theft. We had an
issue down in Tampa recently, at the James Haley V.A. Hospital
where this guy, Willie Streater, was a contractor, and he was
in charge of shredding some documents.
Well, he didn't shred them, he sold them and the people
that bought them, I guess, had filed fraudulent tax claims and
got over $1 million for that. But it is not just that, it is
benefits, it is being able to open lines of credit, health care
fraud, all the things that we know are associated with identity
theft.
And so I guess my questions are, why do we still use Social
Security numbers with regard to patients at the V.A.? Number
two, would electronic records help this issue? And finally, why
do we outsource with the V.A. the way that we do, especially
when there is opportunity for people with felony criminal
records to be, you know, employed by our taxpayer dollars?
Mr. Griffin. Identity theft is a huge problem. In the last
3 or 4 years it has been a growing area for our criminal
investigative staff.
We have sent alerts to the department about the seriousness
of this issue, and in the case that you referred to, how easy
it is for somebody to gain access to a sufficient amount of
information to be able to file a fraudulent tax return.
Frankly, Florida, unfortunately, is one of the leading
areas where people have really made a career out of identity
theft and the tax business. We have participated in task forces
with the IRS and others to try to combat this. And as I said,
we tried to alert the department on how critical it is that
they guard this personal identity information.
Certainly if it is electronic you won't have to worry about
somebody getting access in the case you referred to for
shredding purposes, but it doesn't preclude somebody who has
access to that electronic data to also do things with it,
because each account that you can provide the person with on
the outside has got a dollar value that would be shocking, and
it is a really serious problem.
And then when the actual veteran tries to apply for his
benefits the IRS says, ``Well, no. You already got your
refund.''
``Well, no I didn't,'' and that can take a long time for
all of that to get resolved.
Mr. Rooney. What are your thoughts on the whole Social
Security number issue, as opposed to using some other kind of
identifying----
Mr. Griffin. I think it would be a good idea not to use
them. When we have to use them in order to identify medical
records for our work, typically we will just get the last four
digits of the Social Security number along with the name and we
feel confident that we have got the right person and the right
record.
But clearly the Social Security number is one of the key
numbers that the identity theft people like to get.
Mr. Rooney. Thank you, Mr. Chairman. Yield back.
Mr. Dent. Mrs. Roby, I was going to suggest maybe we go
vote now, unless you want--do you have quick questions? Maybe
we can do them quickly, or we can vote and come back.
Let's go ahead. I recognize you for 5 minutes. Then we can
run downstairs----
V.A. WHISTLEBLOWERS
Mrs. Roby. Thank you for being here today. Certainly
timely.
I brought a visual aid--the front page of the Montgomery
Advertiser--telling the story two individuals who were
whistleblowers at the Central Alabama V.A.
These two individuals couldn't take it anymore. They had to
come forward. We protected their identities.
If it weren't for these two individuals, we would not know
even a fraction of what we know of the gross malfeasance that
has been taking place at Central Alabama V.A.
For those of you in the room that aren't familiar,
everything from thousands of unread x-rays to a V.A. employee
taking a veteran to a crack house. My office would not have
been able to expose this culture and what is happening to our
veterans in Alabama but for these courageous individuals who
have stepped forward knowing that--in that particular
environment--retaliation is a very real thing. Because of their
frustration they finally exposed themselves because of what has
been happening to our veterans.
There was a second report today--news report today that
demonstrates that this is happening all over the country with
V.A. employees who consider themselves whistleblowers, that
they, too, are being retaliated against. There are 120 active
investigations into allegations of retaliation at the V.A., and
so I would want you, as you are here to defend your budget
request, to--this is my opportunity to hold you accountable as
to what you are doing as it relates to these very problematic
and disturbing instances where at the end of the day the people
who are suffering the most are our veterans.
And if we can't get it right by them in this country, I am
not really sure what we can get right. So I would just ask you
today to address this--why this is happening and why these
individuals are not being protected properly.
Mr. Griffin. I agree with you that our veterans deserve the
best. I mentioned in my oral testimony that our contacts with
our hotline are up 45 percent. We received 13,000 more contacts
last year than the previous year.
We are very pleased to hear from whistleblowers. Dr.
Daigh's team has been doing work down in Central Alabama. Our
criminal investigative team continues to have open work in
Central Alabama.
I don't know how much Dr. Daigh can talk about the
specifics of what he is looking at down there, but we are
responding to these things and we do take our job very
seriously. And it is a tsunami of work, and we are trying to
get through it as quickly as we can.
David, I don't know if there is anything you can----
Dr. Daigh. No, I would be glad to comment.
I think that without whistleblowers government can't
function correctly, so we are absolutely on the same page
there. And I think that we need a mechanism for whistleblowers
to come forward to lay out their allegations in as clear a
fashion as possible. And then we need to be able to go look at
those allegations as factually as we can, so that we have clear
allegations and we have clear facts to either support or refute
them.
And I think sometimes--and then we need a management at
V.A. that, when presented with facts, will aggressively
respond.
Mrs. Roby. Can I interrupt you for a second? It would be
great if we could package it up that nicely.
Dr. Daigh. Right.
Mrs. Roby. But the way that this happened is the director
at CAVHCS lied to me and then I went seeking information. And
these two courageous individuals told me the truth, and now
they have been subject to an investigation for telling their
member of Congress the truth.
So it wasn't like they came forward and said, ``I would
like to sit down and talk to somebody about what is going on at
Central Alabama.'' They read a news article where the director
there lied to me and couldn't sit back and just take it.
And so I hear what you are saying. It would be great if it
was that simple, but it is not.
Dr. Daigh. So in real life what happens--when we get
allegations and we think that people in V.A. are lying, that
management is not doing what they are supposed to be doing or
not handling things correctly, then I walk down the hall and I
talk to the head of investigations. And then the criminal
investigation unit will go and address those issues, to the
extent to determine whether we can put forward or collect the
data required to make the case we need to make.
So we are not shy about switching quickly between an
allegation in my office, an allegation that would best be
handled by audit, or an allegation that would best be handled
by the investigators. That happens all the time.
Typically, what happens if the investigators start down the
road and there is some health care aspect to it then they are
the leaders. I append either a physician or a nurse or social
worker, depending on what is required to support their
understanding of the data, and often reading the medical chart
or interpreting some of the hospital data requires someone who
does that for a living. And we work together as a team.
Mrs. Roby. I am making my chairman nervous because the red
light is flashing and the time has run out on our votes, but I
just want a real commitment from you guys that you are
committed to ensuring that these individuals, not just at
Central Alabama but all over the country, that we take this
very seriously and do all that we can through your office and
others to ensure that this is not being covered up, that these
individuals are recognized for their courage.
Mr. Griffin. Could I just say that we do work very closely
with the Office of Special Counsel that has statutory authority
for whistleblowers, and I believe the director is gone, isn't
he?
Mrs. Roby. Yes, he is.
Thank you.
Sorry, Mr. Chairman.
Mr. Dent. No. They were important questions.
With zero on the clock 217 members have not yet voted, so
what we will do is we will recess this meeting to the call of
the chair, but I suspect we will just be back within 10
minutes, and respectful of your time, as well.
So thank you. This meeting is in recess to the call of the
chair.
[Recess.]
Mr. Dent. We would like to bring to order this recessed
meeting of the Subcommittee on Military Construction and V.A.
We are going to move into our second round of questions right
now.
STANDARDIZED AUDIT REPORTS
And I know we have to be respectful of your time, Mr.
Griffin, but I just wanted to start off with Tomah, once again,
and one question I asked didn't get a chance to answer. Is
there no standard policy for a government--for government-
wide--a standard wide policy for I.G.s to follow about the
circumstances in which I.G.s must release the reports from
their investigations and audits?
Mr. Griffin. I believe it is pretty standardized on audit
reports. Our audit reports get sent to the Hill and sent to the
department at the same time, simultaneously, electronically.
If we have a restricted report, which means that there
would be Privacy Act issues in the report, we post the title of
the report, and if we get three requests from the public for
that report we will then redact it and post the redacted
version on our Web site. Other IGs do administrative closures
just like we do, and it is a question of if it is a dry well,
let's not waste our resources on it.
Mr. Dent. Got it.
I would like to now move on to the ongoing I.G. review at
the Philadelphia Regional Office. We understand that your
office has been doing a review during the past 6 months at the
Philadelphia Regional Office and that so many allegations have
been raised by office employees that you won't be able to
investigate each allegation individually. Press reports
indicate that the concerns being raised include mismanagement,
retaliation, wasted government resources, and lack of
accountability for certain managers.
I realize the report is not yet completed, but can you give
us a sense of the scope of the problems in Philly, and how does
that office rank relative to other regional offices? Are these
problems that you see throughout the country? Is Philadelphia
responding to the allegations with staff changes and procedural
fixes?
Mr. Griffin. They have put new leadership in Philadelphia.
Frankly, we completed our draft report within the past week on
Philadelphia. It was a project that just kept growing. Every
time we went back there, more issues were put on our plate.
If you had a checklist of possible problem areas in
different locations in VBA regional offices, you could have
checked just about every one of them that came to our attention
in Philly as far as misplaced mail, unprocessed claims. There
were issues in the Veterans Service Center, they have got an
insurance center up there, they have got two call centers. We
had issues in all of those locations.
So it is a major project to get it back on track where it
needs to be. I am sure we will have many, many recommendations
in the report.
Typically, we ask for a response from the department within
2 weeks on a report like that so, you know, it should be out
soon, I guess that is the principal message here.
And as far as how it might compare to other facilities, it
is very bad. And there are a number of whistleblowers involved
there, there are a number of accusations against management
there, and that is why it has taken several months to try and
get through it all.
Mr. Dent. Thank you.
I would like to quickly move over to the contract review of
the Denver hospital. The inspector general has an Office of
Contract Review. Does this office have a regular role in
reviewing V.A. construction documents, and has that office been
involved in the controversy about the contract for the Denver
V.A. Hospital?
Has your office done programmatic reviews of the Denver
construction project during its long history? And if so, what
systematic problems has the Denver experience revealed about
the V.A. construction process?
And just a point of clarification for the members, I think
you should all be aware by now, but the total cost, according
to Sloan Gibson, over the Denver V.A. Hospital is at $1.73
billion, and that is leaving an unfunded amount of about $830
million, which is just eye-popping, and I know the authorizers
are extremely upset about this.
But it is a very serious matter and we are watching this
issue very, very closely, as--from the appropriations side
because of this colossal problem that, you know, has been
dumped on our lap and we are being asked to resolve.
Mr. Griffin. I would share with you that our audit staff
had received a congressional request over a year ago to look at
Denver. They started scoping the project and doing some
preliminary work and then we discovered that a law suit had
been filed in court by the contractor over payment issues.
It is similar to tort claims being filed by family members
who think that their loved one got improper medical care in a
V.A. facility. Once a tort claim gets filed it becomes a matter
for the Justice Department and the legal system to make the
call on whether or not the tort claim is righteous, which would
cause us to shut down a review of our health care staff on the
same subject, because at that point it is in the courts.
We are capable of doing a review of hospital construction.
We are going to launch a review. I had a request the other day
from Chairman Miller of House Veterans Affairs on the same
subject.
Most of the problems seem to be when you get into change
orders and lack of oversight as the project is rolling out. And
something else we want to look at, the previous secretary had
created a V.A. Construction Review Council a couple years ago,
which apparently didn't succeed in Denver. But we want to look
and see what has that Construction Review Council done, and
what is their charter, and does it have the right expertise in
engineering and construction and what have you to do what they
were set out to do?
Personally in V.A. they have got three levels of hospitals.
There are large ones that have the most sophisticated staff and
can handle the most difficult procedures; there are medium-
sized; and then there are small ones that are the least
complex.
Most of the hospitals are very old, but when you
successfully build one somewhere and you decide we need one in
Orlando, or we need one in Aurora, Colorado, or we need one in
New Orleans, which are where we have activities right now, and
you have got the plans for one that came in on time and on
budget, let's not reinvent the wheel if it is a similar area
that you are trying to service.
So we are going to look into that. It won't help any with
the end game on the cost in Denver, but we want to find out why
it happened.
Mr. Dent. Well, thank you. We want you to stay on top of
that because this project at $1.73 billion is more than five
times the facility's original estimate of $328 million. I have
never seen a construction disaster of this proportion.
OFFICE OF CONTRACT REVIEW
I know the ranking member has concerns as well. And so with
that, I would like to recognize the ranking member for 5
minutes.
Mr. Bishop. Thank you very much.
I know that your office has a role of counsel, and I.G. has
a contract compliance role. Is that a before-the-fact or only
an after-the-fact role? Does that particular counselor in your
office actually oversee the negotiation of the contract to make
sure the parameters are appropriate, or is it only an after-
action review at the end of the day?
I am concerned about that, to find out whether or not and
to what extent your office knew about what was happening in
Denver and how early it was known? I understand that this is
under investigation and may be involved in litigation, and
there may be some limits of what you can and can't say. But
from the procedural perspective and our oversight, I would like
to have some idea of how early your agency or your counsel was
able to get involved in these kinds of things, because as I
understand it, this contract was very unusual in that they
were--they said for X number of dollars this contractor agreed
to build to whatever specifications that V.A. wanted.
And apparently that was fine until the change orders
started to come in. I am trying to understand how there was
such a tremendous gap, why it took so long for somebody to
recognize that the expected expenditures and the ultimate needs
were going to be--there was going to be such a big gap.
Mr. Griffin. My Counselor's group is the Office of Contract
Review. You asked about that group and their responsibilities.
Our audit staff was the group that was going to look at
Denver until the case wound up in court. We were not involved
in the planning. That is a program function of the department.
The Office of Contract Review does pre-award audits when
things are going to be placed on the federal supply schedule.
The government, being the huge purchaser that it is, is
supposed to get most-favored-customer pricing.
When somebody wants to sell the government aspirin or
whatever the higher-cost drug might be, we want to make sure
that V.A. is getting a competitive price. So they will do a
pre-award to make sure that the contracting officer, who
actually works for V.A. is getting advice from our staff and
make sure that they take that advice, and ask the right
questions, and get the best price.
On the other end, there is a post-award review, where if
the vendor tells us or tells V.A., ``We will sell this pill for
a dollar apiece to you because you are the V.A. and you are a
big buyer,'' and we find out later on they are selling it to
Walmart for less money----
Mr. Bishop. I am particularly interested in this
construction, though.
Mr. Griffin. We are going to look at that in the future. We
were not involved in the planning of that facility and when we
tried to initiate a review it was already in court. We will be
looking at it in the future.
Mr. Bishop. You couldn't look at it if it is in court?
Mr. Griffin. The judge would decide.
Mr. Bishop. I understand the judge would decide, but I am
saying if it is in court, but you still should have the
opportunity to be able to review the documents and the status
of the case and have access to the court records, shouldn't
you?
Mr. Griffin. Well, we can get access and we will, but while
it is being adjudicated in court our decision wouldn't trump
the judge's decision.
Mr. Bishop. I understand that, but I am just saying for
purposes of planning and for purposes of understanding what
took place, and to be able to intercede at the earliest
possible moment to stop it from reoccurring in another
instance--in another similar instance--it seems to me that the
sooner you can get access to that information, whether it is in
court or under investigation, whatever, the better it will be
for the department.
Mr. Griffin. I don't disagree. Unfortunately, this is not
an isolated incident, as you know.
Mr. Dent. I thank the ranking member.
At this time I would like to recognize Mr. Joyce for 5
minutes.
Mr. Joyce. I thank you, Mr. Chairman.
I thank you both for being here.
I would like to follow up on the ranking member's comments,
though, I think it would be critically important to have some
understanding of what took place there so that you can advise
and counsel that it doesn't occur again in the initial startups
of any of these buildings or things that you have going up
within the Department of Veterans Affairs. And I don't take it
lightly, because I spent 25 years as a D.A. before I got here,
so it is one of those things where I really view your position
as the most important at the V.A. to make sure these types of
things don't happen.
The things that happened in the V.A.--I want to go back
to--and I understand the chairman may have asked some of these
questions before, and unfortunately I am on three committees
and all three had hearings this morning, so I apologize if I am
touching into something you already went on. But I noticed that
you launched 98 other investigations into manipulations at the
fallout from the Phoenix center, and that your testimony notes
44 of those have been referred to the V.A. Office of
Accountability Review to address the management issues.
The other 54 sites are still under investigation. Could you
share with this committee what type of conduct or mismanagement
led to the 44 referrals to the V.A. Office of Accountability
Review so far?
Mr. Griffin. There has been a range of different
methodologies involved in creating fictitious access time
lists, et cetera, and some of them were potentially criminal,
some of them didn't rise to the level, in the view of the U.S.
Attorney's Office, to be prosecuted as criminal, and when that
happens we turn them over to the Office of Accountability
Review.
Mr. Joyce. Why not the local authorities? A theft is a
theft.
Mr. Griffin. Well, you have to prove criminal intent in
every instance, and in some instances there were schedulers who
would take a call, veteran says, ``I need an appointment
because I have got this issue or that issue,'' scheduler would
book it, the next available appointment that they had open at
that facility, and if it was 120 days from now they would say
to the veteran, ``Well, Mr. Veteran, can you come in on July
15th? That is our next available appointment.''
So you are given an option of one date 120 days from now.
You trust that that is the first available date so you say,
``Well, yes, I guess I will take it.''
Well, when that gets scored as your desired date, that is
not really what you wanted. You would like to come in tomorrow,
but when it gets scored that way, now you are down in the
lowest level of the appointment chain, and for some of the
schedulers they didn't know any different. They thought,
``Well, this is the next appointment I have. I can't create
something out of nothing. If we don't have the staff here to
get this veteran in sooner,''--some didn't realize it was wrong
because it was the only thing they ever knew.
They didn't realize the bigger picture that if the Congress
was not aware of the existence of these waiting times and the
demand, which has been recognized now--I know Mr. Jolly co-
sponsored one of the bills on this--you wouldn't have got that
$16 billion in the pipeline to try and hire more staff and
create a choice card and everything else. I mean, that is the
fallacy of it.
We reported for 10 years on waiting times deficiencies, and
it only caught fire in the past year.
Mr. Joyce. But somewhere in the chain of command people
were manipulating data, correct?
Mr. Griffin. That is right.
Mr. Joyce. Okay. And so the person manipulating that data
in order to get a bonus, that is not a theft to you?
Mr. Griffin. The performance appraisals in VHA, as you may
know from your time there, might have 100 elements that people
are rated on, one of which might be access to care. In many
facilities--they are not the same elements. Someone might say,
``These are the five biggest challenges we have this year in
our network or in our medical center,'' so the director says,
``I am going to go after these five things this year.'' Access
might not be near the top of his list.
Don't misunderstand. It is outrageous. It is outrageous
when the principal deputy Under Secretary in VHA sends a letter
to the whole system and says, ``Stop cooking the books,'' and
says to the leadership out there, ``This is how they are doing
it. This is how you can catch it.'' They institute a policy to
require certification that their numbers are legitimate, and a
short time later they kill the requirement.
It is outrageous. Believe me, I am with you. And I would
like every case we investigate to be prosecuted, but I can't
control that.
Mr. Joyce. Well, I think it is ludicrous they have bonuses
in place where they can manipulate things to actually get the
bonus. People should get paid to do a day's work.
Mr. Griffin. Absolutely.
Mr. Joyce. And if you don't do the day's work to the best
of your God-given ability you should be fired.
Mr. Griffin. Absolutely.
Mr. Joyce. I see I am out of time, Mr. Chairman, but I will
come back later. Thank you.
Mr. Dent. Thank you.
Mr. Jolly.
OPIATE PRESCRIPTIONS
Mr. Jolly. Thank you, Mr. Chairman. Just a couple quick
questions.
You have studied the opiate prescription issue at length
several times over the course of the years. What is your
system-wide assessment, or your findings, perhaps, from
previous reports? I mean, it can't simply be the one location.
Mr. Griffin. Right. Dr. Daigh's team published a national
review last May; it identified a half a dozen different problem
areas from bad mixing of different drugs and what have you. And
we also published nine other individual reports on opioid use.
I would ask David to speak to the national findings.
Dr. Daigh. So in the timeframe of 2012, which is the data
that we were able to look at everybody in V.A. who received
opioids, there were a couple of problems that stood out. The
percentage of veterans who were on chronic opioids who also
have substance use disorder--that is, they are addicted to
narcotics of one sort or another--is in the range of 10 or 12
percent. The percent of veterans who, in the same category,
have significant mental illness is in the range of 40 percent.
So you have a group of patients that have a very complex
chronic disease burden that are very difficult to take care of.
Notwithstanding that, there is a guideline that has been
put out by DOD and V.A., that talks about the proper use of
narcotics in patients who are taking chronic opioids, and the
bottom line is that V.A. providers were not following, really
with astounding figures, the advice of the guideline.
So, for example, you are supposed to get a urine drug
screen at certain intervals. Wasn't occurring.
You are supposed to not give refills--early refills under
certain circumstances. That was also not occurring.
So everywhere we have looked across the system we have seen
that as a major problem.
Mr. Jolly. What triggers a site-specific review for your
office?
Dr. Daigh. At current time, last year we got 2,400
complaints of health care issues that came to my group. That
works out to be something like 10 a workday, plus. So we look
at those.
A portion of those I don't have the manpower to address so
I send a letter to the director of the VISN, usually above the
facility, and say, ``Please respond to these allegations,''
having removed the person who made the allegation, trying to
get by the whistleblower issues. We pick about 60 or 70 cases--
that is about the workload I have--and we go and look at those.
It is a combination of if everybody is out looking at
Phoenix, I have to send some out. If people are in the office
and we have the workload then we go out and look at them.
So essentially, it is an allegation either from our doing a
CAP and serving employees and hearing that there are problems
with narcotic use--we would then trigger a hotline.
Mr. Jolly. So you are responding, basically, that if you
can see site-specific allegations or concerns, and obviously if
you see a cluster of them, that is where. Shifting gears real
quickly, and I have raised the issue with the Secretary.
INACCURATE DEATH NOTICE
I have only been in office for a year, and at least four
times now I have had a constituent come in with a letter from
the V.A. expressing their regret at the veteran's passing, but
the veteran is actually fully alive. It is very disruptive to
their benefits. We work it, and about 2 months later they get a
letter saying, ``We have reviewed your file and determined you
are, in fact, alive.''
It is, as you can imagine, disruptive for benefits and so
forth.
The secretary has indicated it is something he is working
on. He has kind of put it on Social Security.
Has your office ever looked at this? I mean, I realize it
is not a crushing issue in everything else you are dealing
with, but have you had any exposure to this or looked at this?
Mr. Griffin. We are aware of the anecdotal type stories
that you have mentioned, and I don't know what to attribute----
Mr. Jolly. Okay. That is fine. And it is just a curiosity.
Mr. Griffin [continuing]. Different kind of review or
anything.
Mr. Jolly. I appreciate the Secretary's affirmation that he
is looking into it.
Mr. Chairman, no further questions. The only thing I would
say on the record is I would hope our subcommittee can find a
way to improve on the President's request for OIG.
In this year, in this time window, to give our stamp of
approval to a budget for the OIG that requires a reduction of
10 full-time employees is an issue of great concern. If
anything, I think we need to be looking at how to improve the
resources and personnel to provide the investigations and
oversight into the V.A.
So I appreciate it. Thank you.
Mr. Dent. I appreciate the member's comments, and we are
going to do our best on that front.
Now I recognize Mr. Fortenberry for 5 minutes.
Mr. Fortenberry. Thank you, Mr. Chairman.
Good morning, gentlemen.
BROKERING OUT CLAIMS
Nebraska has one of the highest V.A. rated systems, and we
are proud of that. But an ancillary problem to the larger
problem of claims processing and patient management load is
that Nebraska has taken on work from other states. Now, I think
they have gladly done that and absorbed that with the capacity
we have, but we can't get in a situation that starts--where
that starts to create backlogs for ourselves.
We have been informed by several groups that that appears
to be the case. Are you aware of this dynamic?
Mr. Griffin. We are aware and we have done an audit on the
process of brokering out claims. I am from the Heartland
myself.
Mr. Fortenberry. Well, no wonder you talk so plainly and
give straightforward answers. Thank you.
Mr. Griffin. People out there in some of those offices out
there would just seem to be able to get the job done. It is
cost of living, maybe it is better management----
Mr. Fortenberry. Good clean living----
Mr. Griffin. Exactly. But we did a review of this policy
that VBA had of shipping around these claim forms, and
naturally, if you are the person who owns the claim that is 2
years old you are happy to ship it off to somebody else.
If you are on the receiving end, frequently there is a
reason why it is 2 years old. It wasn't a ground ball, or it
wasn't something that somebody could grab hold of and quickly
dispose of and, and resolve the issue.
We found that the brokered claims that we looked at--and I
would be pleased to send a copy of that review up to you so you
can have the information in it, actually extended the time
period to get the things done----
Mr. Fortenberry. Oh, is that right?
Mr. Griffin [continuing]. As opposed to----
Mr. Fortenberry. Further complicated the situation?
Mr. Griffin. Yes.
Mr. Fortenberry. Well, that is another ripple effect of the
initial core problem, so appreciate your awareness of that.
Mr. Griffin. And frankly, when everything is electronic--it
is still a work in progress--it will even be easier to
electronically transfer a claim to a more productive office,
which conceptually might not be a bad idea, but maybe you need
twice as many people in your office in Nebraska and then you
can do more workload.
CENSORSHIP OF V.A. CHAPLAINS
Mr. Fortenberry. I want to turn to a second issue. There
are several court cases where--involving V.A. chaplains who
were censored and prohibited from applying the tenets of their
beliefs. I don't have the latest information on that, but
apparently in 2013 several were forced out of the chaplain
training program.
Is this something that you investigate to ensure that the
V.A. is not acting out of discord or confusion or against legal
precedent?
Mr. Griffin. I can tell you we have not investigated that
to date. If there is more information that you would like to
provide to my staff we will be happy to look into it.
Mr. Fortenberry. My own information is a bit limited, but
apparently these--this is some--there is a manifestation of
some real problem here. But if you would be willing to receive
additional information as we get it, that would be helpful.
Mr. Griffin. Please do.
Mr. Fortenberry. Thank you, Mr. Chair.
Mr. Dent. Thank you. And if there are other, further
questions from any of the members----
Mr. Joyce. Yes.
Mr. Dent. And before you do, I was going to ask just one
question----
Mr. Joyce. Sure.
Mr. Dent. If it is okay with the ranking member, I would
just ask--recognize Mr. Joyce briefly afterwards.
LEGIONNAIRES DISEASE IN V.A. FACILITIES
So with that, I just wanted to ask my other question, Mr.
Griffin, on Legionnaires' disease in V.A. facilities. Your
office was very active in exposing the Legionnaires' disease
patient care problems in some Pennsylvania facilities. In
response, the V.A. is using a total of $167 million in the 2015
and 2016 Choice Act funding to make infrastructure changes to
prevent the recurrence of the Legionnaires' situation.
Do you think the V.A. plans are sufficient to address this
problem?
Mr. Griffin. We did do the specific review in Pittsburgh.
We also did a national review.
I am going to ask David to respond to that. It is not
unique to V.A. facilities, and there is actually a higher
percentage of these problems in the Northeast than there is in
other parts of the country. But David could speak more
eloquently to the problem.
Dr. Daigh. Legionella is in everyone's groundwater, so
depending on the exact species of Legionella that is in the
groundwater where you reside then everyone is at some risk for
it. It is a national problem. V.A. does have a national attempt
to deal with this problem.
I am not aware of exactly the program you are talking about
that would--that you are speaking of for $167 million. I don't
know exactly what they are doing.
But clearly there does need to be an effort to try to
ensure that the water going into hospitals does not contain
pathogens like Legionella. So I haven't looked at that--I don't
know what that buys, is what I am trying to say, in order to
answer your question directly.
Mr. Dent. Thank you.
Does the ranking member have any additional questions?
Okay. Then we will recognize Mr. Joyce, and then that will
end the hearing.
PHOENIX RECOMMENDATIONS
Mr. Joyce. Thank you, Mr. Chairman.
In your testimony you referred to 24 recommendations that
the V.A. made to implement immediate and substantive changes in
response to rampant fraud in the scheduling system. As of March
2nd this year, 18 recommendations are still open.
What development have you seen in implementing those 18
remaining recommendations?
Mr. Griffin. You are referring to the Phoenix
recommendations----
Mr. Joyce. Correct.
Mr. Griffin [continuing]. Right?
I would like to give you all 18 for the record, if I may,
because I don't have all 18 of them on the tip of my tongue.
Mr. Joyce. Sure.
Mr. Griffin. One of the principal recommendations was to
finally, after many years of abortive attempts to create a
viable scheduling system, that the V.A. get that system in
place that can be remotely audited. So if someone in a facility
is playing games with the numbers, that could be detected
remotely by somebody in the main V.A. in the I.T. world or in
VHA.
I know that they put out some requests for proposals on how
they might do that. There are some off-the-shelf applications;
they are being reviewed.
I think from the standpoint of being able to demonstrate a
serious requirement being addressed, that would be one of them.
The old system, if a person wanted or if a doctor wanted to
see the veteran in 6 months, software wouldn't allow them to
schedule it immediately because it was too far out, which is
part of the answer, frankly, on some of these paper wait lists.
In order to keep track of those to insert them when you were
within the window of being able to put them into the system,
they maintained separate lists instead of the electronic wait
list, which wasn't capable of handling that information.
So certainly one of the key recommendations was on
accountability, and that is a work in progress.
I don't know, David, if anything comes to mind.
Dr. Daigh. There were a number of ethics issues and
adjustments they were going to make in terms of how they train
their workforce, and there is also the issue of notifying and
reviewing the cases we identified where harm had occurred--both
of deaths and harm that we had heard. And I don't know exactly
where they are on notification for those cases, but that would
be part of what we could provide back to you in follow-up.
Mr. Joyce. Do you feel that it is part of a
decentralization? I heard you say that you want to find
something where you can remotely check to make sure that the
numbers are not being manipulated, and this occurred as a fault
of V.A. sort of being decentralized while at these different
establishments and it would be better if we had it under a
central unit.
Mr. Griffin. As President Reagan once say--said, ``Trust
but verify.''
Mr. Joyce. Yes. Absolutely.
Mr. Griffin. I think to have the capability to monitor
remotely what is going on would certainly put a little strength
in the system. I do believe that because this went on so long
that people just get blase about it, they didn't think about
it.
Over 10 years we did 20 reports on this. We testified 19
times before the Congress. And finally it got traction, thanks
to some aggressive oversight from the Hill.
When you have the second or third-highest person in VHA
sending out a directive saying, ``Knock it off,'' and making a
requirement for certification and then very quickly it is
removed, it went to the highest levels, and it certainly
existed at the director level in some facilities. I am not
saying everybody, but it was accepted practice.
And it might have been--I mean, if a director said, ``We
don't have enough doctors to do these things in 30 days,'' and
then the requirement got cut to 14 days, well, if you can't get
them done in 30 days you are not going to get them done in 14
days.
I referred to a stretch goal, you want people to stretch
and do the best they can, but if it is unrealistic, people in
the field might be saying, ``What are they thinking about? We
are drowning in veteran demand and we don't have the resources
to deal with it.''
So there needed to be some honesty and say, ``Look, we
either need twice as much money to do fee basis work, or we
need this number of clinicians.'' But if you don't have
staffing standards, it is hard to determine what the number of
clinicians is that you need, so we have been beating that drum
also.
Mr. Joyce. It is just astounding, don't you agree, that
there are no red flags or bells and whistles that were set off
that would have caught this very early in the stages? As you
say, it went up the chain of command, and the quick rescission
of that must have made everyone think that this is okay, this
is standard----
Mr. Griffin. It was a failure in leadership at multiple
levels.
Mr. Joyce. Well, you know, just briefly, what we can do to
help you to that effect, please let us know. Because I think
everyone here is committed to make sure that it doesn't ever
happen again, or we clean up the system that is in place.
And secondly, you know, I know there are a lot of young
prosecutors, ladies and gentlemen, in city and county offices
who also have veterans in their jurisdiction and would be glad
to help you and assist you. I know the Department of Justice is
very busy, and that the U.S. Attorney's Offices are busy, but
theft is theft, and so any way we could help you or they could
help you let us know.
Mr. Griffin. We want to do quality and timely work, and at
the current inflow of requests that we get, we can't do it. And
it disturbs me greatly.
And as I said earlier, we have a 38 percent increase in
requests from the Congress. If you send me a request I don't
want to take a year or 8 months or whatever to do it; I would
like to turn it around in 90 days possibly--quicker if
possible.
But when these things--when you get any of these things
like Phoenix--Phoenix consumed half of our staff for the better
part of a year. This Philadelphia review just kept growing and
growing and growing.
And we want to be part of the solution, and in order to do
that you have to be able to do things timely, make solid
recommendations that everybody understands, get the department
to acknowledge, ``Yes, we admit we have a problem,'' and make
them describe the solution, and then we follow up until it
happens. That is what we want to do.
Mr. Joyce. Thank you very much. Good luck.
Mr. Dent. Well, thank you. This concludes our hearing.
I have several more questions I am going to submit for the
record, and hopefully you can get back to us on those two
questions, which I think you already partially addressed.
So with that, I want to thank everybody for your attendance
today.
Appreciate your presence today, Mr. Griffin and Dr. Daigh.
At this time, this meeting of the subcommittee is
adjourned.
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