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THE STATE OF VA HEALTH CARE 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

MAY 15, 2014 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

BERNARD SANDERS, (I) Vermont, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

SHERROD BROWN, Ohio 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BLUMENTHAL, Connecticut 

MAZIE HIRONO, Hawaii 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

MIKE JOHANNS, Nebraska 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

DEAN HELLER, Nevada 

STEVE ROBERTSON, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

MAY 15, 2014 

SENATORS 

Page 

Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont ........................ 1 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 4 

Prepared statement .......................................................................................... 5 

Murray, Hon. Patty, Chairman, U.S. Senator from Washington ........................ 5 

Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 7 

Blumenthal, Hon. Richard, U.S. Senator from Connecticut ................................ 8 

Heller, Hon. Dean, U.S. Senator from Nevada ..................................................... 9 

Hirono, Hon. Mazie, U.S. Senator from Hawaii .................................................... 10 

Moran, Hon. Jerry, U.S. Senator from Kansas ..................................................... 11 

Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 12 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 13 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 49 

WITNESSES 

McCain, Hon. John, U.S. Senator from Arizona ................................................... 14 

Prepared statement .......................................................................................... 15 

Shinseki, Hon. Eric K., Secretary, U.S. Department of Veterans Affairs; accompanied by Robert A. Petzel, M.D., Under Secretary for Health ................. 17 

Prepared statement .......................................................................................... 19 

Response to posthearing questions submitted by: 

Hon. Sherrod Brown ..................................................................................... 23 

Hon. Jon Tester ............................................................................................. 25 

Hon. Johnny Isakson .................................................................................... 28 

Hon. Richard Burr for Senator Jeff Flake .................................................. 29 

Hon. Richard Burr for Senator John Cornyn ............................................. 35 

Response to request arising during the hearing by Hon. Mark Begich ....... 52 

Dellinger, Daniel M., National Commander, The American Legion ................... 55 

Prepared statement .......................................................................................... 56 

Response to posthearing questions submitted by Hon. Jon Tester .............. 66 

Violante, Joseph A., National Legislative Director, Disabled American Veterans ...................................................................................................................... 66 

Prepared statement .......................................................................................... 67 

Response to posthearing questions submitted by Hon. Jon Tester .............. 72 

Tarantino, Tom, Chief Policy Officer, Iraq and Afghanistan Veterans of America .......................................................................................................................... 72 

Prepared statement .......................................................................................... 75 

Response to posthearing questions submitted by Hon. Jon Tester .............. 79 

Blake, Carl, National Legislative Director, Paralyzed Veterans of America ...... 79 

Prepared statement .......................................................................................... 81 

Response to posthearing questions submitted by Hon. Jon Tester .............. 86 

Robinson, D. Wayne, President and Chief Executive Officer, Student Veterans 

of America ............................................................................................................. 86 

Prepared statement .......................................................................................... 88 

Response to posthearing questions submitted by Hon. Jon Tester .............. 90 

Gallucci, Ryan, Deputy Director, National Legislative Service, Veterans of 

Foreign Wars of the United States ..................................................................... 90 

Prepared statement .......................................................................................... 92 

Response to posthearing questions submitted by Hon. Jon Tester .............. 94 

Page

IV 

Weidman, Richard, Executive Director for Policy and Government Affairs, 

Vietnam Veterans of America ............................................................................. 95 

Prepared statement .......................................................................................... 96 

Response to posthearing questions submitted by Hon. Jon Tester .............. 98 

Griffin, Richard, Acting Inspector General, U.S. Department of Veterans Affairs; accompanied by John D. Daigh, Jr., M.D., Assistant Inspector General 

for Healthcare Inspections .................................................................................. 115 

Prepared statement .......................................................................................... 117 

Response to request arising during the hearing by Hon. Jerry Moran ....... 154 

Marsh, RADM W. Clyde, USN (Ret.), President, National Association of State 

Directors of Veterans Affairs ............................................................................... 122 

Prepared statement .......................................................................................... 123 

Draper, Debra A., Director, Health Care, U.S. Government Accountability 

Office ..................................................................................................................... 125

Prepared statement .......................................................................................... 127 

Longman, Phillip, Senior Research Fellow, New America Foundation ............... 143 

Prepared statement .......................................................................................... 145 

APPENDIX 

Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia; prepared 

statement .............................................................................................................. 155 

Brown, Hon. Sherrod, U.S. Senator from Ohio; prepared statement .................. 155 

Isakson, Hon. Johnny, U.S. Senator from Georgia; memorandum for the 

record .................................................................................................................... 157 

Boozman, Hon. John, U.S. Senator from Arkansas; prepared statement ........... 165 

Zumatto, Diane M., National Legislative Director, AMVETS; letter .................. 166 

Brown, Ronald E., President, National Gulf War Resource Center (NGWRC); 

letter ...................................................................................................................... 168 

(1) 

THE STATE OF VA HEALTH CARE 

THURSDAY, MAY 15, 2014 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:02 a.m., in room 

106, Dirksen Senate Office Building, Hon. Bernard Sanders, Chairman of the Committee, presiding. 

Present: Senators Sanders, Murray, Brown, Tester, Begich, 

Blumenthal, Hirono, Burr, Isakson, Johanns, Moran, and Heller. 

Also present: Senator McCain. 

OPENING STATEMENT OF HON. BERNARD SANDERS, 

CHAIRMAN, U.S. SENATOR FROM VERMONT 

Chairman SANDERS. Thank you all for coming, and I want to 

thank our panelists for what is going to be a very important 

hearing. 

The format will be that I will make some opening remarks. Senator Burr, the Ranking Member, will make some opening remarks. 

Members will each have 3 minutes—and I will keep people to 3 

minutes because it is going to be a long hearing. We are then going 

to hear from Secretary Shinseki and Under Secretary Petzel. Afterward, we have an excellent second panel made up of service organizations. We look forward to hearing from them. We have a very 

good third panel, as well. So, it is going to be a long hearing. 

Let me begin by just making a few basic points. Very serious allegations have been made about VA personnel and their doings in 

Phoenix and in other locations. I take these allegations very seriously, as I know every Member of this Committee does, which is 

why I have supported an independent investigation by the VA Inspector General. 

As we speak right now, the Inspector General’s Office is in Phoenix doing a thorough examination of the allegations, and my hope 

is that their report to us will be done as soon as possible. And what 

I have stated and repeat right now is that as soon as that report 

is done, this Committee will hold hearings to see what we learn 

from that report and how we move forward, as soon as we possibly 

can after their investigation is completed. 

I think there is no Member of this Committee who disagrees, nor 

anybody in the United States, that this country has a moral obligation to provide the best quality care possible to those who have put 

their lives on the line to defend this Nation. And I believe every 

Member of this Committee will do everything we can to get to the 

truth of these allegations. 

2 

But if we are going to do our job in a proper and responsible way, 

we need to get the facts and not rush to judgment. And one of the 

concerns that I have, to be very honest, is there has been a little 

bit of a rush to judgment. What happened in Phoenix? Well, the 

truth is, we do not know, but we are going to find out. 

Now, let me say a word about VA health care in general, which 

is what this hearing is about. What we want to know about VA 

health care is what is going well and what is not going well, and 

in terms of what is not going well, how do we improve that. 

Today, we must understand that when we talk about VA health 

care, we are talking about the largest integrated health care system in the United States of America. VA has 150 medical centers, 

has over 800 community-based outreach clinics, and some 300 Vet 

Centers. Every year, the VA is serving 6.5 million veterans. Today, 

tomorrow, and next week. VA serves more than 200,000 veterans 

every single day. 

Now, what does that mean? And here is my point. If Senator 

Burr and I were to run around the country and visit every VA medical center, this is, I suspect, what we would find; we would find 

people coming out and saying, ‘‘I got pretty good health care. I like 

my doctor. I was treated courteously.’’ And then we would find people who say, ‘‘You know what? I had a bad experience. I did not 

like my doctor.’’ 

The point I want to make is that when you are dealing with 

200,000 people, if you did better than any other health institution 

in the world, there would be thousands of people every single day 

who would say, ‘‘I do not like what I am getting,’’ and we have to 

put all of that in the context of the size of VA. 

Does VA, in general, provide good quality care to veterans? It is 

a simple question. The answer is that some people think that it 

provides a very good quality care. The American Customer Satisfaction Index ranks VA’s customer satisfaction among veteran patients amongst the best in the country. And if you go out and you 

talk to veterans, generally speaking—I will tell you in Vermont— 

not 100 percent, but people say, yes, we get pretty good health 

care, not perfect. Are there problems? Absolutely, and we are going 

to talk about those problems. 

The National Commander of the Disabled American Veterans— 

these are folks who are dealing with people who have service-connected injuries, people who were hurt in war—said this before the 

Committee in February, ‘‘Across the Nation, VA is a model health 

care provider that has led the way in various areas of biomedical 

research, specialized services, graduate medical education and 

training for all health professions, and the use of technology to improve health care.’’ DAV went on to say, ‘‘Such quality and expertise on veteran-specific health needs cannot be adequately replicated in the private sector.’’ 

The Paralyzed Veterans of America today will testify, ‘‘The simple truth is, the VA is the best health care provider for veterans. 

In fact, VA’s specialized services are incomparable resources that 

often cannot be duplicated in the private sector.’’ 

Today, the President of the National Association of State Directors of Veterans Affairs, representing all 50 States, will tell us, 

‘‘The state of VA health care in our Nation is strong.’’ 

3 

Further—and here is another point that has to be made, and I 

know that it does not fit within a 12-second sound bite, but this 

is a point that has to be made—there is no question in my mind 

that VA health care has problems, serious problems. But, it is not 

the case that the rest of health care in America is just wonderful. 

Everybody who walks in, gets immediate care, gets great care at 

no cost, which is all affordable. That is not the world we live in. 

Let me give you one example of that, because it is important to put 

VA health care in context. 

A Scientific American article from September 20, 2013, less than 

a year ago, states, ‘‘How many die from medical mistakes in U.S. 

hospitals? An updated estimate says it could be at least 210,000 

patients a year, more than twice the number in a frequently quoted 

Institute of Medicine report.’’ It goes on to summize that medical 

errors are now the third-leading cause of death in America, behind 

cancer and heart disease. 

What does that mean? Have deaths been reported through medical errors in the VA? The answer is, yes, and every one of those 

deaths is a shame and something we have got to address, but it 

is not just the VA. The third leading cause of death in America are 

medical errors in hospitals. That is an issue we have to address. 

Now, having said all of that, trying to put this debate in context, 

there is no doubt in my mind that there are serious problems facing VA health care and we have got to do everything we can to address those problems. Let me just discuss a few. 

Does the VA have adequate staffing? When we talk about patient 

wait times, which is a major concern in certain parts of the country—and this issue just came up the other day in Phoenix, where 

a town meeting was held by the American Legion—the issue of 

wait times came up. Is the VA adequately staffed? Do we have 

enough doctors and nurses in various parts of the country? I do not 

know the answer to that, but that is something I want to find out. 

Further, is VA doing a good job in allocating its resources to 

where the staffing is needed most? There are some places in the 

United States where VA’s load is going down, fewer people are 

coming in, other places where it is increasing. Are we allocating resources appropriately? And let us remember that in the midst of 

all of that, we are dealing with 200,000 men and women who have 

come back from Iraq and Afghanistan with PTSD and TBI, not 

easy problems to address. 

A few years ago VA changed their wait time measure to an ambitious 14 days. If you call up, you are going to get seen in 14 days. 

Was that appropriate? Can they accommodate that with the level 

of staffing that they have? We need to discuss that. And, what happens at those facilities that are unable, in fact, to bring patients 

in within the 14-day period? Is it possible that, in some cases, unrealistic expectations have created a situation where some staff is, 

in fact, cooking the books? I want to look at that. 

So, I look forward to this hearing to get at the root of some of 

the health care problems facing VA, and with that, I want to give 

the microphone to Ranking Member Senator Burr. 

4 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Thank you, Mr. Chairman. Thank you for calling 

this hearing. 

Secretary Shinseki, welcome, and to all the other witnesses 

today, thank you for your willingness to be here with us. 

The issue before the Committee today is the state of the VA 

health care system, which we have a sacred obligation to ensure 

that those who have fought for this Nation receive the highest 

quality of services from the Department of Veterans Affairs. 

Now, in the Chairman’s opening remarks, he was correct. We are 

not here to analyze a poll that was taken about VA. But, we are 

here, rather, to look at the investigations that have already taken 

place and addressed certain deficiencies within the Veterans system that no action was taken on, or at least not corrective action. 

In fiscal year 2013, VA reported 93 percent of specialty and primary care appointments and 95 percent of mental health appointments were made within the 14 days of the patient’s or provider’s 

desired date. At first glance, these numbers appear to demonstrate 

veterans are receiving the care they want when they want it. However, we know this is not the case. I think if VA had asked hard 

questions regarding these statistics, we would not be here today 

discussing recent allegations surrounding many—and I stress, 

many—VA facilities. 

More specifically, we are here to discuss today when senior leadership in the Department became aware local VA employees were 

manipulating wait times to show that veterans do not wait at all 

for care. It seems that every day, there are new allegations regarding inappropriate scheduling practices, ranging from zeroing out 

patient wait times to scheduling patients in clinics that do not even 

exist, and even to booking multiple patients for a single appointment. The recent allegations were not only reported by the media, 

but have even been substantiated by the Government Accountability Office, the Inspector General’s Office, and the Office of Medical Inspector. 

Here are a few examples. The GAO released a report on the reliability of reported outpatient medical appointment wait times and 

scheduling oversight in December 2012 and has testified multiple 

times on this issue. Several IG reports have been issued regarding 

delays in care and scheduling irregularities, including reports on 

Temple, Texas, in January 2012, and up to the most recent and 

egregious report in September 2013 at the Columbia VA medical 

center. Two publicly released Office of Medical Inspector reports related to whistleblower allegations at Jackson VA medical center 

and the Fort Collins community-based outpatient clinics. 

Even more troubling is that with the numerous GAO, IG, and Office of Medical Inspector Reports that have been released, VA senior leadership, including the Secretary, should have been aware 

that VA was facing a national scheduling crisis. VA’s leadership 

has either failed to connect the dots or failed to address this ongoing crisis, which has resulted in disability harm and in-patient 

death. 

The question we must answer today is, even with all the information available to the Secretary starting over a year and a half 

5 

ago and specific instances of patient harm and death directly related to delays in care, why were the national audits and statements of concern from the VA only made this month? 

I thank the Chair. I yield back. 

[The prepared statement of Senator Burr follows:] 

PREPARED STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA

Good morning, Mr. Chairman. I would like to welcome all of today’s witnesses and 

thank you for being here. The issue before the Committee today is the state of the 

VA healthcare system. We have a sacred obligation to ensure those who have fought 

for this Nation receive the highest quality of services from the Department of Veterans Affairs. 

In fiscal year 2013, for established patients, VA reported that 93 percent of specialty and primary care appointments and 95 percent of mental health appointments 

were made within 14 days of the patient’s or provider’s desired date. At first glance, 

these numbers appear to demonstrate that veterans are receiving the care they 

want and when they want it. However, we know this is not the case. I think, if VA 

had asked hard questions regarding these statistics, we would not be here today discussing recent allegations surrounding many VA facilities. 

More specifically, we are here to discuss when senior leadership in the Department became aware that local VA employees were manipulating wait times to show 

that veterans do not wait at all for care. It seems that every day there are new allegations regarding inappropriate scheduling practices ranging from ‘‘zeroing out’’ patient wait times, to scheduling patients in clinics that do not even exist, and even 

to booking multiple patients for a single appointment. 

The recent allegations were not only reported by the media, but in some cases 

have even been substantiated by the GAO, IG, and the Office of the Medical Inspector. Here are a few examples: 

• The GAO released a report on the reliability of reported outpatient medical appointment wait times and scheduling oversight in December 2012 and has testified 

multiple times on this issue. 

• Several IG reports have been issued regarding delays in care and scheduling 

irregularities, including reports on Temple, TX, in January 2012, and up to the most 

recent and egregious report in September 2013 at the Columbia VA medical center. 

• Two publicly released Office of the Medical Inspector reports related to whistleblowers’ allegations at the Jackson VA medical center and the Fort Collins Community Based Outpatient Clinic. 

Even more troubling is that, with the numerous GAO, IG, and Office of the Medical Inspector reports that have been released, VA senior leadership, including the 

Secretary, should have been aware that VA was facing a national scheduling crisis. 

VA’s leadership has either failed to connect the dots or failed to address this ongoing crisis, which has resulted in patient harm and even death. 

The question we must answer today is, even with all of the information available 

to the Secretary, starting over a year and a half ago, and specific instances of patient harm and death directly related to delays in care, why were the national audits and statements of concern from VA only made this month? 

I thank the Chair, and I yield back. 

Chairman SANDERS. Thank you, Senator Burr. 

Senator Murray. 

STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Well, thank you very much, Mr. Chairman. I 

am really glad you called this hearing. 

Like most Americans, I believe that when it comes to caring for 

our Nation’s heroes, we cannot accept anything less than excellence. The government made a promise to the men and women who 

answered the call of duty, and one of the most important ways we 

uphold that is by making sure our veterans can access the health 

care they need and deserve. 

6 

So, while the Department generally offers very high quality 

health care and does many things as well as or better than the private sector, I am very frustrated to be here once again talking 

about some deeply disturbing issues and allegations. It is extremely disappointing that the Department has repeatedly failed to 

address wait times for health care. 

So, I was encouraged when you announced a nationwide review 

of access to care and I am pleased the President is sending one of 

his key advisors, Rob Nabors, to assist in overseeing and evaluating that review. His perspective from outside the Department 

will make this review more credible and more effective. 

But, announcing this review is just the first step. These recent 

allegations are not new issues. They are deep, systemwide problems and they grow more concerning every day. When the Inspector General’s report is issued and when the access report is given, 

I expect the Department to take them very seriously and to take 

all appropriate steps to implement their recommendations. 

But, there are also cases where the facts are in right now. There 

are problems we know exist, and there is no reason for the Department to wait until the Phoenix report comes back before acting on 

the larger problem. 

The GAO reported on VA’s failures with wait times at least as 

far back as the year 2000. Last Congress, we did a great deal of 

work around wait times, particularly for mental health care. The 

Inspector General looked at these problems in 2005, 2007, and 

again in 2012. Each time, they found schedulers across the country 

were not following VA policy. They also found in 2012 that VA has 

no reliable or accurate way of knowing if they are providing timely 

access to mental health care. 

But now, the IG recommendations are still open and the Department still has not implemented legislation I authored to improve 

this situation. Clearly, this problem has gone on far too long. It is 

unfortunate that these leadership failures have dramatically shaken many veterans’ confidence in this system. 

Secretary Shinseki, I continue to believe you take this seriously 

and want to do the right thing, but we have come to the point 

where we need more than good intentions. What we need now is 

decisive action to restore veterans’ confidence in VA, to create a 

culture of transparency and accountability, and to change the systemwide years’ long problems. This needs to be a wake-up call for 

the Department. 

The lack of transparency and the lack of accountability is inexcusable and cannot continue. The practices of intimidation and 

cover-ups have to change, starting today. Giving bonuses to hospital directors for running a system that places priority on gaming 

the system and keeping their numbers down rather than providing 

care to veterans has to come to an end. 

But, Mr. Secretary, it cannot end with just dealing with a few 

bad actors or putting a handful of your employees on leave. It has 

to go much further and lead to systemwide change. You must lead 

the Department to a place where we prioritize the care our veterans receive above everything else. The culture at VA must allow 

people to admit where there are problems and ask for help from 

7 

the hospital leadership, from the VISN leadership, or from you. 

This is the time to make real changes. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Murray. 

Senator Isakson. 

Senator ISAKSON. Well, thank you for calling the hearing, Mr. 

Chairman. 

Mr. Chairman, I would like to ask unanimous consent that the 

complete statement of Senator John Boozman be entered for the 

record. 

Chairman SANDERS. Without objection. 

[The prepared statement of Senator Boozman appears in the Appendix.] 

Senator ISAKSON. And, also, our best wishes from the Committee 

for his speedy recovery from heart surgery. 

Chairman SANDERS. Absolutely. 

Senator BURR. Mr. Chairman, could I ask unanimous consent 

that all Members’ opening statements be included in the record. 

Chairman SANDERS. Of course. 

STATEMENT OF HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA 

Senator ISAKSON. Dr. Petzel, Secretary Shinseki, thank you for 

being here today. 

The Chairman has said we should not rush to judgment, and 

that is always true, but we should have a rush to accountability. 

Even before Phoenix, even before Durham, even before some of the 

others—Cheyenne, Fort Collins, the others that have come to matter—we have already known and VA has admitted to at least 23 

deaths that took place, in part because of delays in GI consults. 

Seven of those were in my area, two in North Florida, three in Augusta, GA, four in Atlanta, GA, at the VA Hospital in Atlanta, GA, 

all mental health issues. 

Dr. Petzel was in my State on August 22 of last year for a twoand-one-half hour hearing on the Atlanta situation, and we knew 

and determined then that it was problems with delays in setting 

appointments for mental health patients that caused an open period of time where, in fact, they took their life because of a failure 

to get the services they should have gotten. 

So, while we need to complete the IG’s report and find out every 

problem where things are wrong, we have had 50 IG reports since 

2013, and in those reports, we have found repeatedly, over and 

over again, where there has been a gaming of the system, where 

the system is more important than the patient. I think our veterans, and I think you, Secretary Shinseki, deserve better from the 

members of the Veterans Administration and the VA health system. 

I told you yesterday on the phone when you were generous 

enough to call and have a long discussion, I think the veterans and 

yourself have been misserved by the senior management of VA. We 

need accountability. What is going on in VA is not a mystery anymore. We will find out more from the IG’s report. But, I would hope 

we would get an accountability in the chain of command at VA likened to the accountability of the chain of command in the U.S. Air 

8 

Force when I was in the service, where you are held accountability 

for your responsibility, mistakes are not tolerated—one mistake 

might be tolerated, but the second mistake on the same decision 

should never be tolerated. 

I thank you for being here today. On behalf of all the veterans 

in Georgia and in the United States of America, let us get this 

right. Let us hold the system accountable. Let us make sure no veteran dies because of a failure of the system; and see to it they get 

appointments for the care they need when they need it. 

I yield back. 

Chairman SANDERS. Thank you, Senator Isakson. 

Senator Blumenthal. 

STATEMENT OF HON. RICHARD BLUMENTHAL, 

U.S. SENATOR FROM CONNECTICUT 

Senator BLUMENTHAL. Thank you, Mr. Chairman, and thank you 

very, very much for holding this hearing, which I hope and believe 

will be bipartisan and as non-political as it possibly can be. 

Let me thank you, Secretary Shinseki, for your service to our Nation. Over many years, you have served and sacrificed for this Nation and I deeply respect and thank you for all you have given to 

the United States of America, including your 6 years as Secretary 

of VA. I know you are determined, as the President is determined, 

to unravel and reveal any wrongdoing, to remedy any damage, and 

to restore trust and confidence in VA’s Health Care System. 

I agree with the Chairman that we should avoid a rush to judgment. But, we have more than allegations at this point. We have 

evidence, solid evidence of wrongdoing within the VA system, and 

it is more than an isolated instance of wrongdoing. It is a pattern 

and practice, apparently, of manipulating lists and gaming the system, in effect, cooking the books, creating false records, which is 

not just an impropriety or misconduct, it is potentially a criminal 

act. And it is a pattern, as the chart submitted by the American 

Legion as Addendum C shows. There is a pattern across the country, in more than ten States, of this misconduct occurring. In addition, there is a history. The GAO has reported and your own Inspector General has reported these kinds of problems in the past. 

So, there is a need now for more than just an investigation. 

There is a need for action to restore trust and confidence, to assure 

accountability and transparency. Our Nation’s veterans deserve the 

best medical care, nothing less. The situation now presenting serious, pressing, unanswered allegations and uncertainty is 

intolerable. 

I have very severe and grave doubts that the resources now at 

the disposal of the Inspector General are sufficient to meet this 

challenge. I think there is a need for more than just the kind of 

appointment the President has made of Rob Nabors to oversee the 

Department of Veterans Affair’s investigation. There is a need for 

resources going to the Inspector General and possibly involvement 

of other investigative agencies from the Federal Government, because the resources currently available to the Inspector General 

simply may be insufficient. 

In addition, there are 3,000 job openings across the country in 

VA. They are listed on USAJobs.gov. I urge that positions relevant 

9 

to access to medical care be filled immediately and action be taken 

to restore not only the transparency and accountability we all expect from VA, but also to deal with the disability claims backlogs 

that continue to plague VA. 

The question now is, what does the evidence show? Is it criminal 

or simply civil? And that judgment has to be made as soon as 

possible. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Blumenthal. 

Senator Heller. 

STATEMENT OF HON. DEAN HELLER, 

U.S. SENATOR FROM NEVADA 

Senator HELLER. Thank you, Mr. Chairman and Ranking Member Burr, for holding this hearing today. 

I want to thank the Secretary and Dr. Petzel for also being here. 

The other witnesses, thank you for taking time to be with us today. 

And also for the veterans that are in the room with us today, those 

that may be watching this hearing, thank you very much for your 

service. 

What has come to light about VA in recent months has proven 

to Congress, to veterans, and to the American people that there is 

a real problem with accountability at all levels within the Veterans 

Administration. Poor management and care from VA is also a problem that Nevada veterans are facing, and it is not something that 

is new, and, in fact, it is something I have raised repeatedly with 

VA to no avail. I believe it is long overdue for this Committee to 

exert its oversight and hold leadership within VA accountable. 

Just last week I sent a letter to Secretary Shinseki asking for immediate answers about the lack of accountability on the local level 

and whether VA leadership finally plans to do something about it. 

I look forward to receiving a timely response and action on the concerns that I highlighted. 

As Nevada’s representative on this Committee, I believe it is also 

my role and responsibility to get answers for Nevada’s veterans 

about the problems they are facing with VA care and benefits. In 

Las Vegas, veterans have complained of excessive wait times in the 

emergency room, which in itself is too small to meet demand. Just 

a month ago, the VA Inspector General investigated VA’s treatment of a blind female veteran who waited over 5 hours in the 

emergency room and 2 weeks later died. The IG also found a quarter of the veterans in the emergency room wait over 6 hours before 

receiving care. Furthermore, a Las Vegas veteran wrote me a letter 

recently and said he had to find care elsewhere because the wait 

time for an appointment at VA was longer than 2 months. 

Given these concerns, as VA completes its face-to-face audits of 

VA facilities, I want assurance that all of Nevada’s VA medical centers and clinics will be thoroughly audited and I will receive and 

be able to review the results immediately. 

As the Co-Chair of VA’s Backlog Working Group, I am also extremely concerned with the claims backlog in Nevada. Although the 

Secretary promised me there would be changes, Nevada veterans 

are still waiting the longest, at 355 days, on average, for their 

claims to be processed. When my office requests the status of vetVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
10 

erans’ claims, the Reno VARO is unresponsive. It is unacceptable 

that local VA officials would limit any Congressional office’s ability 

to get answers for their veterans constituents. Despite my repeated 

requests, these ongoing issues have not been resolved. 

At some point, I have to ask if these problems in Nevada are the 

demonstration of failed leadership at the top. VA leadership is not 

holding local officials accountable and is failing to care for those 

who sacrificed on our behalf. Promises to change and do better for 

our veterans have not produced results. I want changes. I do not 

want empty promises. If VA continues on this course, I think it is 

ultimately time to look to the top for these changes. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Well, thank you, Senator Heller. 

Senator Hirono. 

STATEMENT OF HON. MAZIE HIRONO, 

U.S. SENATOR FROM HAWAII 

Senator HIRONO. Thank you, Chairman Sanders, for providing 

this forum for us to drill down to the roots of the many issues facing veterans hospitals and finding solutions to these problems. 

I certainly echo the sentiments of my colleagues in expressing 

concerns regarding VA culture, the lack of enough accountability, 

the probable need for structural and systemwide changes. 

The Veterans Health Care System is a promise we made to 

America’s veterans—that we will take care of them in return for 

their service and sacrifice. The close to ten million veterans that 

access care through VA’s system need to trust that they are receiving high-quality care when they need it. And I do note, ten million 

veterans signed up for this health care system is huge. That is 

greater than the population of a number of States, including the 

State of Hawaii. 

When we fail to provide proper care for our veterans, we not only 

fail them, but their families, as well, which these families have also 

sacrificed for our Nation’s security and provide essential care and 

support for our veterans. 

While the immediate focus may be on the Phoenix case and similar allegations regarding a number of other VA hospitals, it is important to see what is happening systematically at VA to provide 

veterans high-quality care, and so we must look at the totality of 

the VA system to see what is working and what is not. I look forward to hearing from the panel about exactly what the challenges 

and problems are, what actions have been taken and need to be 

taken to serve our veterans better. 

And while the VA Inspector General is investigating and Secretary Shinseki has called for a national face-to-face audit of the 

VA Health System, my hope is that this is the first of a number 

of hearings by this Committee to identify other changes that should 

be implemented. I look forward to hearing from you once again, 

Mr. Secretary and the other VA officials, on your plans to resolve 

the underlying issues and restore confidence in the veteran community, and, very importantly, to listen to what the veterans’ community has to say about the changes that need to be made. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Hirono. 

11 

Senator Moran. 

STATEMENT OF HON. JERRY MORAN, 

U.S. SENATOR FROM KANSAS 

Senator MORAN. Mr. Chairman, thank you and Senator Burr for 

conducting this hearing. 

Mr. Secretary, good morning. 

I arrived a few minutes late this morning because I just returned 

from the World War II Memorial, where I visited with a Kansas 

Honor Flight group. I had conversations with Kansas veterans 

again this morning. It is a moving experience each and every time 

I have the opportunity to visit with our World War II veterans, and 

again, the conversation was about, ‘‘VA is failing them. Please 

make certain, Senator Moran, that that does not continue.’’ 

Thousands of veterans across the country, but hundreds of veterans in Kansas visit with me on an ongoing basis and they tell 

me their struggling and suffering stories because of circumstances 

they find at the Department of Veterans Affairs. They would tell 

me about the sacrifice they encountered—if they were willing to 

say this less than humble sentence, they would ask, why can we 

not have the services we earned and deserve? And the reality is, 

they earned and deserve that service, and in my view, the Department of Veterans Affairs is not providing those worthy veterans 

what we have committed to do. 

The sad story is many veterans across the country, and certainly 

those Kansans that I speak to, have lost hope in the Department 

of Veterans Affairs and just believe things are never going to get 

any better. 

Your announcement of a face-to-face review across the system, 

Mr. Secretary, I find lacking in what needs to be done. The reality 

is we have had review after review, Inspector General report after 

Inspector General report, questions by this Committee and the 

House Veterans’ Affairs Committee, that, as far as I can tell, has 

resulted in no action by the Department of Veterans Affairs. 

The idea that you can conduct a systemwide—as you indicate in 

your opening testimony—review of VA using 220 VA employees 

and visiting 153 medical facilities, Mr. Secretary—we have 1,700 

VA points of access to care, and you indicate in your testimony this 

will provide a full understanding of VA’s scheduling policy and continued integrity in managing patient access to care. I do not see a 

review that lasts 2 weeks using 220 employees and looking at 153 

medical facilities as capable of providing that information. So, I 

would suggest this seems to me to be more damage control than 

solving the problem. 

I actually think we do not have the need for more information, 

although it is always welcome. What we need is action based upon 

the information that has already been provided to the Department 

of Veterans Affairs. I have served 18 years on the Veterans’ Affairs 

Committee. I have worked with nine Secretaries of Veterans Affairs. And what is seemingly true to me today is the quality of 

service and the timeliness of that service is diminishing, not increasing, and that was not true until recently. 

We have a significant number of veterans that we serve today, 

but, Mr. Secretary, we can anticipate more as our military men and 

12 

women retire from service in Afghanistan and Iraq. We have an 

aging World War II veteran population. If we cannot care for the 

veterans we are trying to care for today, how do we expect the Department of Veterans Affairs to care for those as the numbers and 

seriousness of their condition increase? 

So, Mr. Secretary, I look forward to hearing what you have to say 

today. I welcome that conversation. But, in my view, an additional 

review by your Department is not the answer. The answer is action 

by the Department of Veterans Affairs that changes the system you 

are leading and that changes the culture and nature of the folks 

that are your employees. 

I look forward to your testimony. I look forward to making certain we keep our commitment to those who served our country. 

Thank you. 

Chairman SANDERS. Thank you, Senator Moran. 

Senator Begich. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Thank you very much, Mr. Chairman, for holding this meeting, and Ranking Member Burr, for offering an opportunity to have this discussion and oversight of VA and the issues 

surrounding scheduling, but also many other issues VA faces. 

Let me first say to our two panelists, thank you for your service 

to this country in both the ways that you have done. 

But, Secretary Shinseki, immediately after the Phoenix story 

broke, I sent a letter very quickly, because I was outraged. It was 

unbelievable what I was hearing. But after a few weeks, it has now 

become a systemic issue that I am now seeing in others, as you 

have indicated through the conversations that I have had with you, 

it seems to be an issue that is occurring in other VA clinics. 

I will say, from a State that has 77,000 veterans, the highest per 

capita in the Nation, it is impactful in determining where they get 

their care. We have been fortunate, to be very frank with you. The 

work we have done with VA to be able to create access to Indian 

Health Care Services which has been able to cut some of that wait 

time and get better services throughout the State. But when we 

look at veterans, may they be in Alaska today, tomorrow, they 

might be in Arizona. Tomorrow, they might be in North Carolina. 

So, it is critical that we figure out the systematic problem. 

I do agree with my colleagues here that we have report after report after report. I have been here now a little over 5 years, and 

all I have seen is GAO reports and other reports that always indicate systematic problems we need to correct. So, I am going to be 

anxious for your commentary, as well as others, on how we are 

going to fix this once and for all. 

I know you have been burdened in some cases because we have 

had two wars and VA started to be funded aggressively in the last 

3 or 4 years after we have already started to wind down in Iraq 

and now Afghanistan, which had caused a lot of pressure. So, I 

need to understand how that has impacted some of the work of VA. 

Also, as you look at the issues and you examine what we need 

to be doing, I want to know from your perspective, what things are 

we doing through more regulation or more laws that are creating 

13 

more hurdles and red tape. If there is stuff that we should be 

eliminating to create a more streamlined process, I want to know 

that. 

But, to not have the service delivered at the highest level to our 

veterans is a disservice. They earned it. They fought for this country. They served our country. And we need to do everything we can 

to make sure the service is delivered at the highest possible level. 

So, today will be a little contentious, no question about it. I hope 

tomorrow, we take what we have learned today and move toward 

increased capacity and performance of VA. 

I thank you both for being here, but I will tell you, I was outraged and it is unbelievable what I have now seen over the last few 

weeks. Yet, I am anxious to work with you to get our veterans the 

best care possible, as we have started to do aggressively in Alaska. 

We have a very unique arrangement between Indian Health Care 

Services and VA, which I think is delivering better care than ever 

before; but more work is to be done. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Begich. 

Senator Tester. 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Yes, thank you, Mr. Chairman, and Ranking 

Member Burr for convening this hearing. I want to thank the witnesses for being here—this panel and the next two. 

You know, as an elected official, the most meaningful and most 

difficult decision I confront is the question of sending men and 

women into harm’s way, and Montanans tend to enlist in high 

numbers. We have the second highest per capita of veterans in our 

State. It is a very personal issue for me and it is why I am very 

proud to serve on this Committee. 

I am encouraged that folks in Washington are suddenly interested in access to health care for veterans. In most cases, that is 

long overdue. Before I got here, VA did not even have mandatory 

funding. They certainly did not have forward funding. So, this is 

a topic many of us have been trying to address for years. 

Given my close association with veterans issues, I am approached by veterans every time I go home, which is almost every 

weekend, and an overwhelming majority of those folks are appreciative of the care from VA in Montana. Yet when they have issues 

or concerns, they are not bashful, as veterans are not, about telling 

me about them. When I get back to my office on Monday, I work 

on those concerns, often with you two. 

The allegations they hear and the allegations I am hearing now 

are very troubling. If any of these allegations in Phoenix or elsewhere turn out to be true, swift and appropriate action needs to 

happen. If the issues are systemic, we need to make some fundamental changes and we need to make them now. If the issues are 

about employees’ misconduct and incompetence, specific heads 

should roll. 

Now, in order to move forward effectively and smartly, we do 

need the facts. I hope we get those today, in part. And, if we are 

truly interested in honoring our veterans by doing them right, the 

14 

facts will drive a productive conversation about access to health 

care for our veterans. 

So, let us talk about ways we can address VA medical workforce 

shortfalls, particularly in rural areas. Let us talk about ways we 

can improve transportation options for veterans or expanding telemedicine initiatives. Let us talk about buildings and partnerships 

between VA’s local providers and providing VA with the resources 

it needs to address its patient workloads. Let us have these conversations so we can provide veterans with meaningful action 

items, not just political talking points. 

Veterans deserve our best. They have sacrificed much. Let us 

demonstrate our best by having a productive, constructive, truthful 

conversation about what needs to be done to fix the problems out 

there in our VA. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Tester. 

Senator McCain of Arizona is not a Member of this Committee, 

but given that very serious allegations have been raised about 

treatment in Phoenix, Senator McCain requested to come before 

the Committee and we welcome him today. Senator. 

STATEMENT OF HON. JOHN McCAIN, 

U.S. SENATOR FROM ARIZONA 

Senator MCCAIN. I thank you, Mr. Chairman. I want to thank 

you for the opportunity to make a brief statement this morning, 

particularly given that many of the serious allegations that will be 

discussed at today’s hearing involve the treatment of veterans in 

my homestate of Arizona. 

Since our Nation’s founding, Americans have been fighting in far 

away places to make this dangerous world safer for the rest of us. 

They have been brave. They have sacrificed and suffered. They 

bear wounds from war losses they will never completely recover 

from and we can never fully compensate them for. But, we can care 

for the injuries they suffered on our behalf and for their physical 

and emotional recovery from the battles they fought to protect us. 

Decent care for our veterans is the most solemn obligation a nation occurs, and we will be judged by God and history how well we 

discharge ours. 

That is why I am deeply troubled by the recent allegations of 

gross mismanagement, fraud, and neglect at a growing number of 

VA medical centers across the country. It has been more than a 

month since allegations that some 40 veterans died while waiting 

for care at the Phoenix VA were first made public. To date, the 

Obama administration has failed to respond in an effective manner. This has created in our veterans’ community a crisis of confidence toward VA, the very agency that was established to care for 

them. 

At a town hall forum I hosted in Phoenix last week, the families 

of four veterans who passed away in recent months stood before a 

crowded room to tell their stories. With tears in their eyes, they described how their loved ones suffered because they were not provided the care they needed and deserved. They recalled countless 

unanswered phone calls and ignored messages, endless wait times, 

15 

mountains of bureaucratic red tape, while their loved ones suffered 

debilitating and ultimately fatal conditions. 

No one should be treated this way in a country as great as ours. 

But, treating those to whom we owe the most so callously, so 

ungratefully, is unconscionable. We should all be ashamed. 

Since the initial reports in Arizona last month, we have seen this 

scandal go nationwide, surfacing in at least ten States across 

America. Secretary Shinseki has ordered a nationwide audit to look 

at the management practices at VA medical centers. Several employees have been placed on administrative leave. And, the VA Office of Inspector General is investigating the Phoenix VA. 

I respect the important role of the Inspector General, but my fellow veterans cannot wait the many months it may take it to complete its report. They need answers, accountability, and leadership 

from this administration and Congress now. 

Clearly, VA is suffering from systemic problems in its culture 

that require strong reform-minded leadership and accountability to 

address. At the same time, Congress must provide VA administrators with greater abilities to hire and fire those charged with caring for our veterans. Most importantly, we must give veterans 

greater flexibility in how they get quality care in a timely manner 

rather than continue to rely on a Department that appears riddled 

with systemic problems in delivering care. 

How we care for those who risked everything for us is the most 

important test of a Nation’s character. Today, we are failing that 

test. We must do better tomorrow, much better. 

For the nine million American veterans enrolled in VA today and 

for the families whose tragic stories we heard last week in Phoenix, 

who I know are still grieving their losses, it is time we live up to 

President Lincoln’s injunction, which serves as VA’s model today— 

to care for him who shall have borne the battle and for his widow 

and his orphan. 

As I said, it is time for answers, accountability, and leadership 

from this administration, and I look forward to hearing from Secretary Shinseki. 

I thank you, Mr. Chairman, and I thank Ranking Member Burr 

and the Members of this Committee. 

[The prepared statement of Senator McCain follows:] 

PREPARED STATEMENT OF HON. JOHN MCCAIN, U.S. SENATOR FROM ARIZONA

Thank you, Mr. Chairman. I want to thank you for the opportunity to make a 

brief statement this morning, particularly given that many of the serious allegations 

that will be discussed at today’s hearing involve the treatment of veterans in my 

home state of Arizona. 

Since our Nation’s founding, Americans have been fighting in faraway places to 

make this dangerous world safer for the rest of us. They have been brave. They 

have sacrificed and suffered. They bear wounds and mourn losses they will never 

completely recover from—and we can never fully compensate them for. But, we can 

care for the injuries they suffered on our behalf, and for their physical and emotional recovery from the battles they fought to protect us. Decent care for our veterans is among the most solemn obligations a nation incurs, and we will be judged 

by God and history by how well we discharge ours. 

That is why I am so deeply troubled by the recent allegations of gross mismanagement, fraud and neglect at a growing number of Veterans Administration medical 

centers across the country. 

It has been more than a month since allegations that some 40 veterans died while 

waiting for care at the Phoenix VA were first made public. To date, the Obama AdVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
16 

ministration has failed to respond in an effective manner. This has created in our 

veterans’ community a crisis of confidence toward the VA—the very agency that was 

established to care for them. 

At a town hall forum I hosted in Phoenix last week, the families of four veterans 

who passed away in recent months stood before a crowded room to tell their stories. 

With tears in their eyes, they described how their loved ones suffered because they 

were not provided the care they needed and deserved. They recalled countless unanswered phone calls and ignored messages, endless wait times, mountains of bureaucratic red tape while their loved ones suffered debilitating and ultimately fatal conditions. No one should be treated this way in a country as great as ours. But treating those to whom we owe the most so callously—so ungratefully—is unconscionable, and we should all be ashamed. 

Since the initial reports in Arizona last month, we’ve seen this scandal go Nationwide, surfacing in at least 10 states across America. 

Secretary Shinseki has ordered a nationwide audit to look at the management 

practices at VA medical centers; several employees have been placed on administrative leave; and the VA Office of Inspector General is investigating the Phoenix VA. 

I respect the important role of the Inspector General, but my fellow veterans can’t 

wait the many months it may take to complete its report. They need answers, accountability and leadership from this Administration and Congress now. 

Clearly, the VA is suffering from systemic problems in its culture that require 

strong, reform-minded leadership and accountability to address. At the same time, 

Congress must provide VA administrators with greater ability to hire and fire those 

charged with caring for our veterans. Most importantly, we must give veterans 

greater flexibility in how they get quality care in a timely manner, rather than continue to rely on a department that appears riddled with systemic problems in delivering care. 

How we care for those who risked everything for us is the most important test 

of a Nation’s character. Today, we are failing that test. We must do better tomorrow—much better. 

For the 9 million American veterans enrolled with he VA today, and for the families whose tragic stories we heard last week in Phoenix, who I know are still grieving their losses, it’s time we live up to Lincoln’s injunction, which serves as the VA’s 

motto today, quote, ‘‘to care for him who shall have borne the battle and for his 

widow, and his orphan.’’ 

As I said before, it’s time for answers, accountability and leadership from this Administration, and I look forward to hearing from Secretary Shinseki. I thank Chairman Sanders, Ranking Member Burr, and the Members of the Committee. 

Chairman SANDERS. Thank you, Senator McCain. 

I would like to now welcome Retired U.S. Army General Eric K. 

Shinseki, Secretary of Veterans Affairs, to the first panel. As I 

think most people know, Secretary Shinseki is a graduate of West 

Point, served as the Chief of Staff for the Army from 1999 to 2003. 

He retired from active duty in 2003, after nearly 40 years in the 

U.S. Army. 

Following the September 11, 2001, terrorist attacks against our 

country, Secretary Shinseki led the Army during Operations Enduring Freedom and Iraqi Freedom. He previously served simultaneously as Commanding General, U.S. Army Europe, and Seventh 

Army Commanding General, NATO Land Forces, Central Europe, 

and Commander of the NATO-led Stabilization Force, BosniaHerzegovina. 

I want to also note a few of the many awards Secretary Shinseki 

received during his career: The Defense Distinguished Service 

Medal, the Legion of Merit with Oak Leaf Clusters, the Bronze 

Star Medal with ‘‘V’’ Device with two Oak Leaf Clusters, and the 

Purple Heart with Oak Leaf Clusters. 

Mr. Secretary, thank you very much for being with us today. 

Secretary Shinseki is accompanied by Dr. Robert Petzel, who is 

the Under Secretary for Health. 

17 

Mr. Secretary, your prepared remarks will be submitted for the 

record. What I would like to do now is, if both of you could rise and 

take the oath. 

Do you solemnly swear or affirm that the testimony you are 

about to give before the Senate Committee on Veterans’ Affairs will 

be the truth, the whole truth, and nothing but the truth, so help 

you God? 

Secretary SHINSEKI. I do. 

Dr. PETZEL. I do. 

Chairman SANDERS. Thank you very much. Please be seated. 

Mr. Secretary and Dr. Petzel, the floor is yours. 

STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH 

Secretary SHINSEKI. Chairman Sanders, thank you very much for 

that more than generous introduction. To you and Ranking Member Burr and the Members of this Committee, thank you for this 

opportunity to discuss the state of VA health care. 

I have been taking oaths most of my life, Mr. Chairman, so I— 

whenever I appear before this Committee, whether I am sworn or 

not, you have my best answers based on what I know, as truthful 

a presentation as I can make. 

I deeply appreciate your unwavering support for our Nation’s 

veterans. That has been true for 5 years, now, that I have worked 

with Members of this Committee. 

Mr. Chairman, I would also like to recognize that in the room 

here are others with whom I have worked very closely for 5 years 

developing good dialog, good collaboration. They have been very 

helpful in shaping what we thought was the priority in the Department of Veterans Affairs, and they have been good strong relationships, and I thank them for their partnership. I know some of them 

will be testifying before you today. In those cases where we have 

not always seen eye to eye, we have always managed to find common ground on behalf of veterans, and I expect we will do that 

again. 

We at VA are committed to consistently providing our veterans 

the high-quality care, timely benefits, and safe facilities necessary 

to improve their health and well being. This commitment mandates 

a continuous effort to improve quality and safety. America’s veterans deserve nothing less. Our quality and safety meet high 

standards and veterans should feel safe using VA health care. 

That said, in health care, Mr. Chairman, as you point out, there 

are always areas in need of improvement. Any allegation about patient care or employee misconduct are taken seriously. 

And, based on the background you just described that I followed 

most of my life—38 years in uniform—and I now have this great 

privilege of being able to care for people I went to war with many 

years ago people I have sent to war, and people who raised me in 

the profession when I was a youngster. 

Any allegation, any adverse incident like this makes me—makes 

me mad as hell. I could use stronger language here, Mr. Chairman, 

but in deference to the Committee, I will not. But, at the same time 

it also saddens me, because I understand that out of those adverse 

18 

events a veteran and a veteran’s family is dealing with—the aftermath—and I always try to put myself in their shoes. 

In response to allegations about manipulation of appointment 

scheduling at Phoenix, I am committed to taking all actions necessary to identify exactly what the issues are, to fix them, and to 

strengthen veterans’ trust in VA health care. 

First, the Office of the Inspector General, as many of you have 

pointed out, is now conducting a thorough and timely review. If 

any of these allegations are true with regard to scheduling at Phoenix and elsewhere, where we have invited the IG to come and look 

at issues that surfaced—if any allegations are true they are completely unacceptable to me, to veterans. And I will tell you, the vast 

majority of dedicated VHA employees come to work every day to do 

their best by those veterans. If any are substantiated by the Inspector General, we will act. And I take Senator Murray’s encouragement here to do something different, and Senator, I will. It is 

important, however, to allow the Inspector General to complete his 

duty, which is to conduct an objective review and provide us the 

results. 

Second, I have directed VHA, as some of you have noted, to complete a nationwide access review of all other health care facilities 

to ensure full compliance with our scheduling policy. As we have 

begun that, we have already received reports where compliance is 

under question, so we have asked the IG in a number of those 

cases to also take a look. 

Third, I have asked for and received the assistance from President Obama. The President has agreed to let his Deputy Chief of 

Staff for Policy, Rob Nabors, assist us in our review of these allegations and in any other issues we may find during these reviews. 

We start with scheduling, but we will go wherever the reviews take 

us. 

Rob is a fresh set of eyes. He is the son of a veteran and he is 

a proven performer who brings broad and significant management 

experience to this task. I welcome his assistance. I have known the 

Nabors family for a long time. Rob’s dad and I served together for 

many years; I know his mom and dad well, and I welcome the assistance of Rob Nabors. 

Even as we take these proactive measures, it is important to remember that VHA conducted approximately 85 million outpatient 

clinic appointments last year. As a large integrated health care system, VHA operates, as has been noted, over 1,700 points of care, 

including 150 medical centers, 820 community-based outpatient 

clinics, 300 Vet Centers, 135 community living centers, 104 domiciliary rehabilitation treatment programs, and 70 mobile Vet Centers attempting to reach the most remote of our veterans. This is 

a demonstration of concern by this Department, trying to make 

sure that every veteran, no matter where they live in this country, 

and even our overseas locations, have an equal opportunity to have 

access to quality health care. 

As the Chairman has noted, VHA conducts approximately 

236,000 appointments every day. Over 300,000 VHA employees 

provide exceptional care to the 6.5 million veterans and other beneficiaries annually. VA health care is comparable to that in the private sector, meeting or exceeding standards in many areas. We alVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
19 

ways endeavor to be fully transparent, fostering a culture that reports and evaluates errors in order to avoid repeating them. 

Every VA medical facility is accredited by the Joint Commission, 

the independent organization that assures the quality of U.S. 

health care through comprehensive evaluations. In 2012, the Joint 

Commission recognized 19 VA hospitals as among its top performers and last year that number increased to 32. 

Additionally, as the Chairman has pointed out, the most recent 

American Customer Satisfaction Index ranks VA customer satisfaction among the best in the Nation, equal to or better than the ratings for private sector hospitals. An overwhelming 95–96 percent of 

veterans who use VA health care today indicated they would use 

us again the next time they needed inpatient care, 96 percent; and 

95 percent for outpatient care. I want them to continue to have 

that level of trust. 

Veterans deserve to have full faith in their VA. VHA is committed to a process of full and open disclosure to veterans and their 

families whenever any adverse event occurs. We participate in multiple external independent reviews every year to ensure the safety 

and quality of health care. VA will continue to aggressively develop 

and sustain reliable systems and train employees to detect and prevent health care incidents before they happen. I have detailed some 

of our many significant health care accomplishments of VHA over 

the past 5 years in my written testimony. 

I appreciate the hard work and dedication of VA employees, our 

partners from the veterans service organizations, as I indicated, in 

this room, community stakeholders, many of whom we deal with on 

a daily basis, and then our dedicated VA volunteers. I deeply respect the important role that Congress and the Members of this 

Committee play in serving our veterans, and I look forward to continuing our work with Congress to better serve them all. 

Again, Mr. Chairman, thank you for the opportunity to appear 

here today. 

[The prepared statement of Secretary Shinseki follows:] 

PREPARED STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Sanders, Ranking Member Burr, and Distinguished Members of the 

Senate Committee on Veterans’ Affairs. Thank you for the opportunity to discuss 

with you the Department of Veterans Affairs (VA) healthcare system. We, at VA, 

are committed to consistently providing the high quality care our Veterans have 

earned and deserve in order to improve their health and well-being. We owe that 

to each and every Veteran that is under our care. 

It is important to understand the size and scope of VA care—the largest integrated healthcare delivery system in the United States. 

The Veterans Health Administration (VHA) operates over 1,700 points of care, including 150 medical centers, 820 community-based outpatient clinics, 300 Vet Centers, 135 community living centers, 104 domiciliary rehabilitation treatment programs, and 70 mobile Vet Centers. VHA conducts approximately 236,000 health 

care appointments—each day—and approximately 85 million appointments each 

year. Over 300,000 VHA leaders and health care employees strive to provide exceptional care to approximately 6.485 million Veterans and other beneficiaries 

annually. 

VA provides safe, effective healthcare, equal to or exceeding the industry standard 

in many areas. We care deeply for every Veteran we have the privilege to serve. 

VA is committed to operating with unmatched transparency and fostering an environment that reports and evaluates errors in order to avoid repeating them in the 

future; one of our most important priorities is to keep our patients safe in our 

facilities. 

20 

That said, there are always areas that need improvement. We can, and we must 

do better. VA takes any allegations about patient care or employee misconduct very 

seriously. I am personally angered and saddened by any adverse consequence that 

a Veteran might experience while in, or as a result of, our care. 

In response to allegations about scheduling and delays at the Phoenix VA Health 

Care System (PVAHCS), I invited an independent investigation by the VA Office of 

Inspector General (OIG) to conduct a comprehensive, thorough and timely review. 

If these allegations are true, they are completely unacceptable—to Veterans, to me, 

and to our dedicated VHA employees. If they are substantiated by OIG, responsible 

and timely action will be taken. 

It is important to allow OIG’s independent and objective review to proceed until 

completion, and OIG has advised VA against providing information that could potentially compromise their ongoing review. However, at the request of OIG, I have 

placed three PVAHCS employees on administrative leave until further notice, including two senior executives. 

We will work with OIG to ensure that the need to keep the public informed is 

balanced with our obligation to preserve the integrity of an important OIG investigation I have also directed VHA to complete a nationwide access review. The purpose of this review is to ensure a full understanding of VA’s scheduling policy and 

continued integrity in managing patient access to care. 

Veterans deserve to have full faith in their VA. Any adverse event for a Veteran 

within our care is one too many. Where challenges occur, VA takes direct action to 

review each incident, and puts in place corrections to improve system issues and 

quality of care provided. We hold employees accountable for any misconduct; we incorporate lessons learned to avoid and mitigate future incidents throughout the entire healthcare system. VHA’s first priority is to notify the Veteran or their representative of the adverse event, as well as the patient’s rights and recourses. 

VHA is committed to a process of full and open disclosure to Veterans and their 

families. We participate in multiple external, independent reviews every year to ensure safe and quality healthcare. VA will continue to develop and sustain reliable 

systems and train employees to prevent and detect avoidable harms before they 

happen. When this does not happen, we act to take necessary corrective actions in 

order to restore the confidence and trust in the system that serves so many. 

QUALITY OF CARE

Every year, our dedicated VA employees, many of whom are Veterans themselves, 

provide 6.3 million Veterans with the excellent care they have earned and deserve. 

VA provides a broad range of primary care, specialty care, and related medical and 

social support services. We have established a record of safe, exceptional care that 

is consistently recognized by independent reviews, organizations, and experts on key 

health care quality measures. Every VA medical facility is accredited by The Joint 

Commission, the independent, non-profit organization that ensures the quality of 

U.S. healthcare by its intensive evaluation of more than 20,000 healthcare organizations. In 2012, The Joint Commission, recognized 19 VA hospitals as top performers, 

and that number increased to 32 in 2013. 

The American Customer Satisfaction Index (ACSI) is the Nation’s only cross-industry measure of customer satisfaction, providing benchmarking between the public and private sectors. In their most recent, independent customer service survey, 

ACSI ranks VA customer satisfaction among the best in the Nation—equal to or better than ratings for private sector hospitals. 

Since 2004, on average, the ACSI survey has consistently shown that Veterans 

give VA hospitals and clinics a higher customer satisfaction score than patients give 

private sector hospitals. Veterans strongly endorsed VA healthcare, with 91 percent 

offering positive assessments of inpatient care and 92 percent for outpatient care. 

Additionally, when asked if they would use a VA medical center the next time 

they need inpatient or outpatient care, Veterans overwhelmingly indicated they 

would (96 and 95 percent, respectively). 

Of our over 300,000 employees in the VA healthcare system, our medical providers and appointment scheduling personnel were considered highly courteous with 

scores of 92 and 91, respectively, while VA medical providers ranked high in professionalism (90 percent positive). Despite these and other favorable statistics, we 

know that we can always improve. 

IMPROVING AND EXPANDING ACCESS

The number of Veterans receiving VA benefits and services has grown steadily 

and is projected to continue to rise as ongoing conflicts end and more Servicemembers transition to Veteran status. In 2015, the number of patients treated withVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
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in VA’s healthcare system is projected to reach 6.7 million, an increase of nearly 

one million patients (17.4 percent) since 2009. 

VA continues to improve access to VA services by opening new facilities and 

points of care, and improving current facilities and points of care closer to where 

Veterans live. Since January 2009, we have added approximately 55 communitybased outpatient clinics (CBOC), for a total of 820 CBOCs, and the number of mobile outpatient clinics and Mobile Vet Centers, serving rural Veterans, has increased 

by 21, to the current level of 79. 

While opening new and improved facilities is essential for VA to provide worldclass healthcare to Veterans, so too is enhancing the use of ground breaking new 

technologies to reach other Veterans. VA continues to invest in ‘‘bringing care to the 

Veteran’’—through expanded access to telehealth, sending Mobile Vet Centers to 

reach Veterans in rural areas, and by deploying social media to share information 

Veterans on the VA benefits they have earned. 

VA is using innovative telehealth primary care services to overcome geographic 

access barriers and improve the efficiency of care to rural areas. In fiscal year (FY) 

2013, VHA provided more than 1.7 million episodes of care to 608,900 Veterans 

through telehealth services linking 151 VAMCs and 650 CBOCs, as well as by connecting via telehealth with 146,804 Veterans in their own homes, of which 2,284 

were via video. The scope of VA’s telemental health services includes all mental 

health conditions with a focus on Post Traumatic Stress Disorder (PTSD), depression, bipolar disorder, behavioral pain, and evidence-based psychotherapy. 

VHA is aggressively working to increase Veterans’ access to high quality care. 

While we are progressing in delivering timely care to our Veterans and improving 

the reliability of reporting wait time information, VA is committed to honoring 

America’s Veterans and there are a number of ongoing and future actions to improve wait times: 

• No measure of wait times is perfect. However, with evidence from VHA’s 2012 

wait time study, ongoing VHA performance measures, as well as findings and recommendations from others, VHA’s action plan is designed to ensure the integrity 

of wait time measurement data collected from our access points of care; 

• VHA is constantly evaluating access and scheduling policies and technologies, 

and aggressively monitors reliability through oversight and audits; 

• We have implemented much of this plan, and we are working to implement the 

remainder of the plan in the next 12 months. VHA has also instituted site visits 

to audit patient access to care using the electronic wait list. 

Today, Veterans experience primary care at VA differently than they did five 

years ago. VA’s Patient Aligned Care Teams (PACT), the model for more personalized and team based primary care delivery, is improving both access to healthcare 

and Veteran satisfaction. Patients are assigned a PACT team that to help coordinate and personalize their care. 

Since its inception in 2010, the PACT program has transformed the way Veterans 

receive their care by offering a coordinated team approach squarely focused on Veterans’ wellness and disease prevention. PACTs provide the right combination of 

healthcare professionals to develop personalized health plans for Veterans and conveniently deliver care at primary care clinics with a goal of personalized, proactive 

and patient-driven care. Veterans are also communicating with healthcare professionals through secure electronic means with increasing frequency as services are 

available. Despite the increase of primary care patients, access to primary care has 

improved and continuity of care is better. Veteran access to primary care during extended, non-business hours has increased 75 percent since January 2013. 

IMPROVING ACCESS TO MENTAL HEALTH SERVICES

After numerous military operations over almost 13 years, the state of Servicemembers’ and Veterans’ mental health is a national priority. Meeting the individual 

mental health needs of Veterans is more than a system of comprehensive treatments and services; it is a philosophy of ensuring that Veterans receive the best 

mental healthcare possible, while focusing on the overall well-being of each Veteran. 

VA remains committed to doing all we can to meet this challenge. 

Through the strong leadership of the President and the support of Congress, Veterans’ access to mental healthcare has significantly improved. Since 2006, the number of Veterans receiving specialized mental health treatment has risen from 

927,000 to more than 1.3 million in 2013. Vet Centers are another avenue for mental healthcare access, providing services to 195,913 Veterans and their families in 

2013. 

Since March 2012, VA has added over 2,000 Mental Health professionals—exceeding requirements in the President’s August 31, 2012 Executive Order to improve acVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00025 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
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cess to mental healthcare for Veterans, Servicemembers, and military families. VA 

has also hired 915 peer specialists, exceeding the goal of 800, to augment the work 

of those clinicians. 

We proactively screen all Veterans for PTSD, depression, Traumatic Brain Injury, 

substance abuse, and military sexual trauma to identify issues early and provide 

treatments and intervention opportunities. We know that when we diagnose and 

treat people, they get better. 

VA is a pioneer in mental health research and high-quality, evidence-based treatments. We strive to maintain and improve the mental health and well-being of today’s Veterans through excellence in healthcare, social services, education, and research. In the last three years, VA has devoted additional people, programs, and resources toward mental health services to serve the growing number of Veterans 

seeking mental healthcare. 

We are developing new measures to gauge mental healthcare effectiveness, including timeliness, patient satisfaction, capacity, and availability of evidence-based 

therapies. We are working with the National Academy of Sciences to develop and 

implement measures and corresponding guidelines to improve the quality of mental 

healthcare. To help VA clinicians better manage Veteran patients’ mental health 

needs, VA is developing innovative electronic tools. Clinical reminders give clinicians timely information about patient health maintenance schedules, and the HighRisk Mental Health National Reminder and Flag system allows VA clinicians to flag 

patients who are at-risk for suicide. When an at-risk patient does not keep an appointment, clinical reminders prompt the clinician to follow up with the Veteran. 

Since its inception in 2007, the VA’s Veterans’ Crisis Line (1–800–273–TALK 

(8255), press 1) in Canandaigua, New York, answered nearly 1,000,000 calls and responded to more than 143,000 texts and chat sessions from Veterans in need. The 

Veterans’ Crisis line provides 24/7 crisis intervention services and personalized contact between VA staff, peers, and at-risk Veterans, which may be the difference between life and death. 

In the most serious calls, approximately 35,000 men and women have been rescued from a suicide in progress because of our intervention—the rough equivalent 

of two Army divisions. VA offers expanded access to mental health services with 

longer clinic hours, telemental health capability to deliver services, and standards 

that mandate rapid access to mental health services. 

ENDING VETERAN HOMELESSNESS

VA is committed to ending Veteran homelessness in 2015. No one who has served 

our country should ever go without a safe, stable place to call home. VA’s programs 

provide individualized, comprehensive care to Veterans who are homeless or at risk 

of becoming homeless. Veterans’ homelessness fell by 24 percent between 2010 and 

2013, and we expect another reduction when this year’s point-in-time counts released. Last year, VA helped more than 42,000 Veterans find permanent housing 

and awarded about $300 million in grants to our community partners for supportive 

services for Veteran families. Nearly 260,000 Veterans and family members were 

served through VA’s specialized homeless programs in FY 2013. 

OTHER HEALTHCARE ACCOMPLISHMENTS

President Obama signed the ‘‘Caregivers and Veterans Omnibus Health Services 

Act of 2010,’’ into law which helps our most seriously injured post-9/11 Veterans and 

their family caregivers with a monthly stipend, access to health insurance, mental 

health services and counseling, and comprehensive VA caregiver training. To date, 

more than 16,800 caregivers have been trained to care for our most seriously injured 

post-9/11 Veterans. VA also has a Caregiver Support Coordinator stationed at every 

VA medical center, as well as a national Caregiver Support Line (1–800–260–3274) 

and Web site (www.caregiver.va.gov) to provide support and resources to Caregivers 

of Veterans from all eras. 

VA initiated a multi-faceted approach to reduce the use of opioids among America’s Veterans using VA healthcare, seeking to reduce harm from unsafe medications 

and/or excessive doses while adequately controlling Veterans’ pain. To achieve this, 

VHA has established nine goals for safe, evidence-based, Veteran-centric pain care 

as part of VHA’s Opioid Safety Initiative (OSI). Launched in October 2013, in Minneapolis, OSI is already successful in lowering dependency on these drugs. At eight 

sites of care in Minnesota, OSI practices have decreased high-dose opioid use by 

more than 50 percent. 

OSI places an emphasis on patient education, close patient monitoring with frequent feedback, and Complementary and Alternative Medicine practices like acupuncture. These join pain management guidelines encourage the use of other mediVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
23 

cations and therapies in lieu of habit forming opiates. OSI is an example of VHA’s 

personalized, proactive and patient-centered approach to healthcare through an innovative and comprehensive plan that monitors dispensing practices system-wide, 

includes patient and provider education, testing and tapering programs, and alternative therapies like behavior therapy. 

SUMMARY

These accomplishments are the results of VA’s focus over the past five years— 

during which time we have worked to increase Veterans’ access to high quality 

healthcare, education and training, and employment opportunities in both the public 

and private sectors. There is always more work to do, and VA is focused on continuous improvement to the care we provide to our Nation’s Veterans. 

I appreciate the hard work and dedication of VA employees, our partners from 

Veterans Service Organizations—important advocates for Veterans and their families—our community stakeholders, and our dedicated VA volunteers. I also respect 

the important role Congress and the dedicated Members of this Committee play in 

serving our Veterans, and I look forward to continuing our work with Congress to 

better serve them all. Again, thank you for the opportunity to appear before you 

today and for your unwavering support of those who have served this great Nation 

in uniform. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. SHERROD BROWN TO

HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

VA has been actively downgrading—that is changing the GS–pay scale for employees downward for the same job they currently have; same job, same service to 

VA but with lower pay and promotion potential. These have devastating effects on 

morale, recruitment, and retention. 

Question 1. The position of ‘‘Scheduling Clerk’’ is one of the 17 VA is considering 

downgrading. These are the employees in charge of wait lists. Has VA reconsidered 

its policy of downgrading or done any analysis on the effect that downgrading employees has on VA performance? 

Response. Title 5, United States Code, Chapter 51 governs the classification of positions in the Federal service. This law states that positions shall be classified based 

on the duties and responsibilities assigned and the qualifications required to do the 

work. Section 5104 of Title 5 provides definitions for the grade levels of the General 

Schedule. 

The law requires the Office of Personnel Management (OPM) to define (via regulations) Federal occupations, establish official position titles, and describe the grades 

of various levels of work. To fulfill this responsibility, OPM approves and issues position classification standards that must be used by agencies to determine the Title, 

series, and grade of positions covered by Title 5. 

In order to comply with OPM’s Regulations, VA must review and possibly reclassify multiple VA positions within 17 occupational series, which may include changing some positions to a lower grade. VA must do this to ensure employees are classified in accordance with governmentwide OPM standards, and they are receiving 

equal pay for equal work. Employees impacted by this decision will not experience 

a decrease in their existing rate of pay, as they are protected by grade and pay regulations. However, VA recognizes that future earning potential may be affected and 

we will work with employees, union partners, and other key stakeholders to identify 

ways to mitigate any adverse effects where appropriate. 

The majority of positions performing patient scheduling duties as a major duty 

of their work time (25 percent or more) are excluded from this Title 5 classification 

review and will not be impacted by the reclassification of positions within the 17 

occupational series. These positions are covered by the GS–0679 Medical Support 

Assistant Series. This series was converted to hybrid Title 38 coverage on July 1, 

2012, and is no longer subject to Title 5 classification laws, rules, and regulations. 

VA currently has approximately 16,000 employees assigned to this series with over 

15,000 at the GS–5 to GS–12 levels. While the review of the 17 occupational series 

positions may include positions performing patient scheduling duties, these duties 

would represent a minor duty in the overall composition of work assigned to the position. During the review, if a position is identified as performing scheduling work 

as a major duty, it will be reviewed critically for conversion to the GS–0679 Medical 

Support Assistant Series. 

While the position of ‘‘Scheduling Clerk’’ is not specifically listed as one of the 17 

occupational groups targeted for consistency review, no downgrade of any position 

has occurred as a result of the pending reviews. No action will be taken until a thorVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
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ough analysis of each job series is completed by each impacted office. VA expects 

that this process will take approximately 15 months to complete. As the Department 

takes action to comply with Federal regulations (5 Code of Federal Regulations 

(CFR) 511.612.), it will work with its union partners, OPM, and VA human resources experts to ensure that the fewest possible employees are affected and that 

we provide employees with the highest possible degree of protection in terms of their 

position and pay. 

Question 2. 1,500 GS–6 Claims Assistants are facing downgrades. Has VA considered what this would mean to recruiting and retaining the people on the front lines 

of attacking the backlog? 

Response. The Claims Assistant GS–0998 position review is required by 5 CFR 

511.612 due to OPM’s adjudication and issuance of employee initiated appeal decisions C–0998–05–01, C–0998–05–02, and C–0998–05–02. The Claims Assistant positions included in this review are primarily located in the Veterans Health Administration (VHA) and are responsible for accepting/disputing/processing/payment of 

bills/claims against VA for medical services Veterans receive from outside of the VA 

health care system. 

The Claims Assistant position in the Veterans Benefits Administration (VBA) is 

also part of this review. VBA believes this position is properly classified for the work 

these employees perform pertaining to claims for benefits. VBA is participating in 

a work group, in partnership with the Office of Personnel Management (OPM), to 

ensure any changes to classifications do not negatively impact the timeliness and 

accuracy of benefits decisions for Veterans and their families. 

Question 3. If shortages in staffing and number of inpatient beds can be fixed with 

more funding, why is VA not asking this Committee and the appropriators for more 

money? Why isn’t it more in line with the Independent Budget? 

Response. The 2015 President’s Budget is requesting $367.9 million in additional 

funding above last year’s advance appropriations request of $55.634 billion to meet 

Veterans’ medical care needs, for a total direct appropriations request of $56.002 billion, a 3.0 percent increase over the 2014 enacted level. In addition to the 2015 appropriation request, VA anticipates the Medical Care Collections Fund (MCCF) to 

reach $3.065 billion. VA also estimates that it will receive $258 million in reimbursements and begin 2015 with $450 million in unobligated balances, which will 

allow VHA to meet its 2015 total obligation authority of $59.498 billion and support 

over 6.7 million unique patients, 9.3 million enrolled Veterans, a staffing level of 

275,122 FTE and Inpatient Care exceeding $11.5 billion. 

Final 2016 funding levels will be determined during the 2016 budget process 

when updated data and metrics on these programs’ funding needs are available. 

VA’s budget estimates are primarily based on an actuarial model that includes population changes that can significantly impact VA’s requirements, such as when Veterans become eligible for Medicare or the increased number of women Veterans in 

the current conflicts. The Independent Budget does not use such data, estimating 

future requirements as growth from the latest available obligations. 

a. The Chillicothe Medical Center, for example, has had a high turnover of primary care providers in the last 18 months—15 of 20 individuals have left—they are 

heavily relying on ‘‘extenders.’’ What can we do to correct this? 

Response. Chillicothe VA Medical Center (VAMC) leadership has authorized recruitment of up to 25 primary care providers, which include both physicians and 

nurse practitioners or physician assistants. This authorized staffing level is intended to support the long- term strategy of fully operating all Patient Aligned Care 

Teams (PACTs) year round, at the main facility and the Community-Based Outpatient Clinics (CBOC), even during planned or unexpected provider absences. This 

increase in PACTs is also meant to assure the smaller more rural clinics (such as 

those in Cambridge and Marietta, Ohio), whose patient enrollment would normally 

support only one provider, have the availability of two providers to support Veterans’ continuous access to care, even during planned or unexpected provider absences or turnover. 

There are currently 21.5 primary care providers in place with three new providers 

in pre-employment processes expected to come on board within the coming months. 

Additionally, the Chillicothe VAMC established a Locum Tenens contract for primary care providers and is now utilizing that resource, as well as assigning providers from administrative and leadership roles, to assist in clinic coverage. 

Recruiting primary care physicians is very difficult given the rural location of the 

facility; escalating practice complexity and demands; and the limitation of VA’s pay 

scale compared to the private sector, which is rapidly increasing pay for such providers. The Chillicothe VAMC prefers to engage primarily physicians to serve as primary care providers. However, like many rural practices, the Chillicothe VAMC 

25 

must rely on highly qualified nurse practitioners and physician assistants to augment provision of primary care services for Veterans across the region. Aggressive 

recruitment efforts continue to add to the Chillicothe VAMC’s clinical staff and provider team. 

Question 4. Talk to me about the Nation-wide access review at VA that you ordered. Will AFGE and others have a role? 

Response. The American Federation of Government Employees (AFGE) and the 

National Partnership Council were briefed before the Nation-wide access reviews 

were conducted. The local unions were invited to the opening and closing meetings 

with facility leadership, and all statutory and contractual requirements were followed. Changes to scheduling practices are also being communicated locally to assure that union and labor organizations are informed of revisions in policies and 

procedures as well as training and performance plans. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO HON. 

ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 5. What steps has the Veterans Health Administration (VHA) taken to 

ensure consistency and oversight in scheduling policy implementation and practices 

across the Veterans Integrated Service Networks (VISNs)? 

Response. The Secretary of Veterans Affairs directed VHA to complete a Nationwide Access Audit to ensure a full understanding of VA’s policy among scheduling 

staff, identify any inappropriate scheduling practices used by employees regarding 

Veteran preferences for appointment dates, and review waiting list management. 

This audit was designed to: 

• Gauge front-line staff understanding of proper scheduling processes; 

• Assess the frequency and pervasiveness of both desired and undesirable practices employed to record Veteran preferences for appointment dates, manage waiting 

lists, and process requests for specialty consultation; and 

• Identify factors that interfere with schedulers’ ability to facilitate timely care 

for Veterans. 

As a result of this audit, VHA has taken a number of immediate actions to address the very serious issues identified in our audit. 

• Mobilized staff and financial resources to ensure that patients waiting for care 

get their needs addressed in a timely manner. VHA will either provide care in a 

timely manner or purchase care, to the extent it exists in the private sector. VHA 

will also contact Veterans to see if they desire care sooner than the current scheduled date. 

• Initiated an across-the-board assessment of VHA’s internal capacity to meet 

needs for care. 

• Removed the 14-day performance metric from individual performance plans. 

• Suspended VHA Senior Executive Service performance awards for fiscal year 

2014. 

• Updated guidance on VHA’s utilization of non-VA medical care, to ensure use 

of all appropriate resources in the community to provide Veterans care when, where, 

and how they want it. Guidance included briefings held with VHA Veterans Integrated Service Network (VISN) Directors, virtual training sessions accessible electronically by all VA staff, communications to targeted staff of the electronic training 

sessions and written guidance targeted toward field staff disseminated though email 

and placed on internal intranet sites. Additionally, updated guidance was provided 

on VHA’s utilization of non-VA medical care (NVC), to ensure use of all appropriate 

resources in the community to provide Veterans care when, where, and how they 

want it. This guidance includes offering NVC to the Veteran in an effort to ensure 

they receive care in a timely manner. Updated guidance was also provided on the 

coordination of care to include appropriate authorizations, use of contracts, sharing 

agreements or individual authorizations, scheduling of appointments and receipt of 

medical documentation. 

• Directed field leadership to continue the process of inspection of practices to ensure VHA’s leaders have personal accountability for the integrity of the practices followed in VA facilities. 

• Renewed efforts to improve transparency of performance data. VHA will increase the measurement and use of data regarding Veterans’ satisfaction with access to care and overall experience. 

• Examined Medical Support Assistant staffing levels and compensation. Medical 

Support Assistants are central to the operation of VA medical facilities. VHA must 

reevaluate these positions to ensure staff compensation is fair. VHA will reassess 

26 

staffing requirements to ensure the appropriate internal capacity needed to provide 

timely care, and find cost effective options to purchase that care when necessary. • Work to modernize software scheduling solution that facilitates the processes of 

modern health care. 

In addition, there are many long-term actions that will need to be addressed and 

assessed as VHA moves forward. 

Question 6. What is the main issue impacting veterans waiting times for medical 

appointments? What are the biggest obstacles to reducing those waiting times? 

Response. At the direction of the Secretary of Veterans Affairs, VHA conducted 

an Access Audit which assessed the scheduling practices across VA. This audit identified the following obstacles: 1) significant lack of clarity regarding scheduling policies and practices across our system; 2) an inflexible and unrealistic 14 day performance target for new appointments; 3) inadequate staffing of providers and clerical 

support at many of the sites that were experiencing the greatest surge in patient 

demand; 4) rigid and obsolete scheduling software. The greatest single barrier identified was the lack of provider slots. 

Question 7. To what extent do VHA’s access issues reflect the same challenges in 

the delivery of private sector health care? To what extent are they VA-specific? 

Response. A recent national survey of Physician Appointment Wait Times and 

Medicaid and Medicare Acceptance Rates offers a snapshot of physician availability 

in 15 large metropolitan markets, many of them with physician-to-population ratios 

higher than the national average. For a new patient, the average appointment wait 

time to see a family physician ranged from a high of 66 days in Boston to a low 

of 5 days in Dallas. However, as the example of Boston illustrates, access to health 

insurance does not always guarantee access to a physician. In addition, the survey 

findings indicate that Medicaid is not widely accepted as a form of payment in most 

markets surveyed. http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/ 

Surveys/mha2014waitsurvPDF.pdf. 

VA-specific challenges involve the increasing complexity of combat-related injuries 

from Vietnam and Persian Gulf conflicts which typically require specialty care, such 

as Traumatic Brain Injury, Post Traumatic Stress Disorder, amputations, and environmental exposure-related illnesses. 

Question 8. What are the current accountability measures in place for facilities, 

or leadership officials at those facilities, if timeliness goals are not met on a consistent basis? Are those measures appropriate? Do you need additional authorization 

to enforce stronger accountability measures? 

Response. VA takes the allegations and findings of misconduct seriously, and is 

moving quickly to address the situation. Since allegations of delayed care and employee misconduct surfaced, VA has been conducting internal reviews to evaluate 

appointment scheduling procedures and patient care in Phoenix and nationwide. VA 

has initiated the process for removing senior leaders at the Phoenix VA Health Care 

System (PVAHCS), and VA has directed an independent site team to assess scheduling and administrative practices at PVAHCS. This team began their work in 

April, and VA is taking action on multiple recommendations from the teams’ findings. VA recognizes there is a leadership and integrity problem among some of the 

leaders of our health care facilities, which can and will be fixed. That breach of integrity is indefensible and VA will use all authorities at its disposal to enforce accountability among senior leaders. 

To help regain Veterans’ trust, Congress’ trust, the trust of the American people, 

and the trust of our employees, when we do hold employees accountable we are 

going to continue to transparently share information to the degree permitted by law, 

while respecting an employee’s privacy rights. For cases involving senior executives, 

the Veterans Access, Choice, and Accountability Act of 2014 allows us to take expedited action when VA has determined that a senior manager has committed misconduct or has performed poorly. VA’s newly established Office of Accountability Review (OAR) is monitoring the progress of all ongoing OSC and Office of Inspector 

General (OIG) investigations, and as they are completed, will help VA leadership 

determine appropriate accountability measures. 

Question 9. Understanding the goal of the VHA nationwide access review is to ensure facilities are scheduling appointments appropriately, will the review also provide feedback on why employees might have been motivated to manipulate numbers 

in the first place? To what extent will the review inform ways we can improve or 

reform the system? 

Response. Based on the findings of the audit, VA will critically review its performance management, education, and communication systems to determine how performance goals were conveyed across the chain of command such that some frontline, middle, and senior managers felt compelled to manipulate VA’s scheduling 

27 

processes. This behavior runs counter to VA’s core values; the overarching environment and culture which allowed this state of practice to take root must be confronted head-on if VA is to evolve to be more capable of adjusting systems, leadership, and resources to meet the needs of Veterans and families. It must also be confronted in order to regain the trust of the Veterans that VA serves. 

Question 10. To what extent has the VHA invested in workforce training for those 

involved in scheduling appointments for veterans? 

Response. VA recently implemented mandatory supplemental training for all employees involved with scheduling appointments. Using existing internal web-based 

resources, subject matter development, and distributed learning expertise, four new 

courses were introduced during the past 2 months. These courses were developed 

and produced internally so total course cost is primarily staff time with minimal 

contract costs for video production. Details are provided in the table below: 

TMS 

Item # Course Title Modality Total Completions 

Total 

Course Cost 

7532 Scheduling Training—Recall Reminder Web-based/eLearning ............................... 90,118 $3,494 

7533 Scheduling Training—Soft Skills ........... Conference/Workshop (conducted face-toface at local VA medical facilities).76,496 $37,044 

7534 Scheduling Training—Business Rules ... Web-based/eLearning ............................... 95,092 $3,285 

7535 Scheduling Training—Make Appointment.Web-based/eLearning ............................... 91,740 $3,494 

Total ............................................ 353,446 $47,317 

Question 11. To what extent have information technology (IT) investments been 

made to ensure the VHA is operating the most reliable and effective scheduling system? Do you believe advanced appropriations for medical-related IT would help the 

VHA connect veterans to care in a more timely manner? 

Response. VA has invested in upgrades to the scheduling system over the last 10 

years. The current scheduling application investment includes these maintenance 

upgrades as well as ongoing support. However, the current scheduling system is 

based upon a 25-year old scheduling system which consists of a roll-and-scroll system that is susceptible to error. The software is segmented into components that 

do not automatically communicate with or connect with each other, but require 

manual processes to operate. VA began an effort, the Replacement Scheduling Application (RSA), to replace the legacy scheduling system in 2000. This effort failed 

to deliver a replacement system and was stopped in 2009. During this timeframe, 

major enhancements to the legacy system were delayed due to the anticipation of 

a new system which unfortunately, never materialized. 

VA’s scheduling system needs improved interfaces for both schedulers and patients to increase scheduling efficiency and decrease errors—this includes improvements to Clinical Video Teleconferencing, Scheduling Manager Applications, and Patient Directed Scheduling Applications. Enhancements are also needed to the Core 

VistA Scheduling Software, including a resource management dashboard, aggregated clinical schedule and single queue of request lists. The long-term solution is 

to complete the Medical Appointment Scheduling System, which will be a commercial solution building on the interfaces delivered during the Medical Scheduling 

Contest. The goal is to leverage a commercial solution to provide a proactive resource management-based scheduling system. VA expects to deliver a core capability 

of the scheduling system within two years (in six months increments) after award 

using a series of six month incremental enhancements until full operational capability is reached. 

Question 12. To what extent can workforce shortages be mitigated by more collaboration between the VHA and private providers to deliver care at local access 

points for veterans? 

Response. VA has the authority to utilize non-VA medical care to provide care to 

Veterans where capacity doesn’t exist for many reasons, including workforce shortages. Non-VA medical care can be purchased using contracts. There are local contracts available as well as the recently awarded national Patient Centered Community Care (PC3) contracts for specialty and primary care. When a VA facility cannot 

readily provide needed care in-house or the care is not feasibly available to the Veteran, VAMCs will first look to provide specialty care at another VAMC or through 

28 

existing health care resources sharing agreements with the Department of Defense 

(DOD) medical treatment facilities. When it is not feasible to provide the care within the VHA system or DOD, the VAMC will consider its options for purchasing the 

care. Consideration will first be given to the availability of the care through currently awarded PC3 contracts. However, VAMCs retain the authority to execute 

local contracts with Academic Affiliates (VA Directive 1663) or other private sector 

health care providers when deemed to be in the best interests of VA. A goal is to 

order most necessary contract health care from the already awarded PC3 contracts 

to reduce administration burdens associated with additional acquisition actions. 

Additionally, Pub. L. 113–146, the Veterans Access, Choice and Accountability Act (VACAA), provided $10 billion for the new Veterans Choice program and $5 billion 

to improve access at VA health care facilities. As specified in the law, these funds 

will be used to increase the access of veterans to care and to help ensure VA is increasing its capacity to meet the current and projected future demand for services. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JOHNNY ISAKSON TO

HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 13. What is VA’s official definition of ‘‘delay in treatment’’ and ‘‘delay 

in care?’’ 

Response. VA uses the terms ‘‘delay in treatment’’ or ‘‘delay in care’’ to reflect a 

situation where a patient has received care beyond the timeframe that the medical 

profession has determined to be the standard of care for addressing a medical condition. 

Question 14. I and others believe that veterans should have the freedom to choose 

their own physician to meet their medical needs. Several of the VSO panelists cited 

a lack of access to specialty medicine, including a particular case in which a veteran 

diagnosed with skin cancer cells has been on a waiting list for eight months to see 

a dermatologist. What is the Department of Veterans Affairs currently doing to ensure continuity of care, particularly specialty care? And do you agree that allowing 

access to specialty care outside of the VA could improve continuity of care for veterans? 

Response. Non VA Care (NVC) is used when the facility cannot provide the care 

in a timely manner and is primarily used for specialty care. When a Veteran needs 

care, a determination is made if the care can be provided at VA. If VA is unable 

to provide the care timely to meet the clinical need of the Veteran, then the use 

of NVC is reviewed. When authorizing for NVC, consideration is taken as to where 

the care can be provided in a timely manner to ensure the clinical need is met. 

While allowing Veterans access to specialty care outside of VA may improve access 

to care, it does not necessarily improve continuity of care. Therefore, the VA has 

developed a Non VA Care Coordination model to ensure the care is appropriately 

authorized, scheduled and medical documentation is received in an effort to improve 

the continuity of care. 

The Non VA Care Coordination (NVCC) model provides several steps to help in 

the coordination of care for our Veterans. Once a Veteran is notified of the approval 

of non-VA medical care, they are contacted to identify availability, preferences, and 

needs. Once this information has been obtained, the non-VA medical care provider 

is contacted by NVCC staff to schedule an appointment for the Veteran. The appointment is then captured in VistA. The Veteran and non-VA medical care provider 

are sent the authorization and the appropriate release of information form(s), to ensure the medical records are received by VA. 

After the appointment date, the Veteran is contacted to verify that the authorized 

non-VA medical care has been received. If the Veteran missed or did not attend his/ 

her medical appointment, VA staff will work with the Veteran to reschedule the 

missed appointment. NVCC staff will then work with the non-VA medical care provider to obtain the required clinical documentation. The documentation will then be 

scanned into the appropriate system, and uploaded to the Veteran’s electronic medical record. If additional review and follow-up action is required from the referring 

VA provider once the clinical documentation is received, an alert will be sent to notify the VA provider of the required action. 

Question 15. Physician anesthesiologists possess 12,000 to 16,000 hours of clinical 

training and nurse anesthetists have 1,500 hours of training on average. How is the 

care provided to veterans improved by replacing a physician anesthesiologist with 

a nurse anesthetist as the anesthesia team leader? 

Response. The presence of anesthesiologists or certified registered nurse anesthetists (CRNA) in VHA health care facilities helps ensure that our Veterans have 

access to safe, high quality anesthesia care, as well as the procedures and services 

29 

that anesthesia care enables. The peer-reviewed literature points to the high quality 

of care provided by both provider types practicing together or separately. VHA does 

not require anesthesiologist or physician supervision of CRNAs; in a number of VHA 

facilities CRNAs are the sole anesthesia providers. Currently either anesthesiologists or CRNAs may serve as part of the anesthesia care team. Private hospitals, 

ambulatory surgery centers and the Department of Defense commonly use CRNAs 

to provide anesthesia services for patients without physician supervision. The proposed nursing handbook would not authorize CRNAs to replace or act as anesthesiologists, but rather increase access to care, decrease variability throughout VHA, 

and ensure continuity of the highest quality of care for veterans. CRNAs would not 

be authorized to provide any anesthesia services that are beyond the scope of their 

clinical education, training or competencies. 

Question 16. Are there specific examples of deficiencies or delays in care that led 

to the decision to change the VHA Nursing Handbook? What stakeholders were consulted in the development of the proposed handbook? 

Response. The Office of Nursing Services began the development of a VHA nursing handbook in 2009 to establish policy for the process of care delivery and the elements of practice for nursing. Within the nursing handbook, VHA is proposing the 

authorization of FPA for all APRNs without regard to their individual State Practice 

Acts, except for the dispensing, prescribing, and administration of controlled substances. This proposed change to nursing policy would standardize APRN practice 

throughout the VA system, and increase access to the highest quality of care for all 

the Nation’s Veterans. Implementation of FPA would increase patient access by alleviating the effects of national health care provider shortages on VA staffing levels, 

as well as enabling VA to provide additional health care services in medically underserved areas. 

The 2010 Institute of Medicine (IOM) landmark report, The Future of Nursing: 

Leading Change, Advancing Health, recommended removal of scope-of-practice barriers, to allow APRNs to practice to the full extent of their education and training. 

This evidenced-based recommendation by the IOM prompted VHA to propose FPA 

for APRNs. Thus, VHA’s proposed nursing handbook is consistent with the IOM recommendation to remove barriers including the variation in APRN practice that exists across VHA as a result of disparate state regulations. The proposed change is 

being driven by the efficacious use of resources and to standardize APRN practice 

throughout the VA system. As an integrated Federal health care system, the proposed policy parallels current policies in DOD and Indian Health Service. In 2012, 

all VA Program Offices provided input and concurred on the nursing handbook including Anesthesia Services. VHA has conducted meetings with several outside 

stakeholders including the American Society of Anesthesiologists and the American 

Medical Association. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR ON BE- HALF OF HON. JEFF FLAKE TO HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 17. According to GAO and OIG reports, some VHA facilities do not always follow VHA’s scheduling policies and processes. 

a. Do certain VHA facilities have any leeway regarding the scheduling policies 

that they are obligated to follow? 

Response. No, VHA facilities are expected to follow scheduling policies. However, 

the Access Audit findings illustrate that eight percent of scheduling staff indicated 

they used alternatives to the Electronic Wait List (EWL) or the Veterans Health Information Systems and Technology Architecture (VistA) package. Some of the respondents indicated that the scheduling policy was not well-understood. VA recently 

implemented mandatory supplemental training for all employees involved with 

scheduling appointments. Using existing internal web-based resources, subject matter development, and distributed learning expertise, four new courses were introduced during the past 2 months. These courses were developed and produced internally so total course cost is primarily staff time with minimal contract costs for 

video production. Details are provided in the table below: 

TMS 

Item # Course Title Modality Total Completions 

Total 

Course Cost 

7532 Scheduling Training—Recall Reminder Web-based/eLearning ............................... 90,118 $3,494 

30 

TMS 

Item # Course Title Modality Total Completions 

Total Course Cost 

7533 Scheduling Training—Soft Skills ........... Conference/Workshop (conducted face-toface at local VA medical facilities).76,496 $37,044 

7534 Scheduling Training—Business Rules ... Web-based/eLearning ............................... 95,092 $3,285 

7535 Scheduling Training—Make Appointment.Web-based/eLearning ............................... 91,740 $3,494 

Total ............................................ 353,446 $47,317 

b. If not, what disciplinary measures does the VA typically pursue when presented 

with evidence of VHA facilities not complying with scheduling policies and processes? 

Response. VHA has progressive disciplinary policies that are followed per human 

resource guidelines. Disciplinary measures can vary based on the nature of the offense. 

c. What is the existing recourse for any VA employee, service provider, or patient 

that believes scheduling policies and processes are not being followed? Specifically 

who would they report such instances to and what actions would the VA take subsequent to the report? 

Response. Employees and service providers who believe that scheduling policies 

and processes are not being followed are encouraged to report this through their supervisory chain of command. Patients may report this to their patient advocate, clinic supervisor, or Medical Center Director. Facility leadership is responsible for ensuring that training and education is provided to all employees involved in scheduling appointments. 

Question 18. In December 2012, GAO reported that some VHA facility officials 

stated that they did not use the electronic waiting list, which the VHA uses to track 

patients with whom the facility does not have an established relationship. In some 

instances, it was reported that patients were tracked by printing paper copies of 

consult requests from the electronic medical record. 

a. What measures have you taken to ensure that the electronic waiting list is used 

properly at VHA facilities? Has there been any progress in this regard? 

b. Currently, what ability do you or any of your subordinates have to terminate 

the employment of anyone found to be operating afoul of these procedures? 

VA Response (a. and b.): VA has taken aggressive action through its Accelerating 

Care Initiative, launching a coordinated, Nation-wide effort to accelerate care to 

Veterans throughout the VA system and in communities where Veterans reside. 

This effort increases timely access to care for Veterans and improves standardization of ongoing monitoring, productivity, and access to care. While the Accelerating 

Care Initiative is a near-term activity, VA will continue to monitor productivity, capacity, and access to care at local, regional, and national levels. 

VA will establish follow-up accountability actions based on the results of the 

audit. Senior leaders will be held accountable to implement policy, process, and performance management recommendations stemming from this audit and other reviews. Where audited sites identify concerns within the parent facility or its affiliated clinics, the VA will trigger administrative procedures to ascertain the appropriate follow-on actions for specific individuals. 

Based on the findings of the audit, VA will critically review its performance management, education, and communication systems to determine how performance 

goals were conveyed across the chain of command such that some front-line, middle, 

and senior managers felt compelled to manipulate VA’s scheduling processes. This 

behavior runs counter to VA’s core values; the overarching environment and culture 

which allowed this state of practice to take root must be confronted head-on if VA 

is to evolve to be more capable of adjusting systems, leadership, and resources to 

meet the needs of Veterans and families. It must also be confronted in order to regain the trust of the Veterans that VA serves. 

To help regain Veterans’ trust, Congress’ trust, the trust of the American people, 

and the trust of our employees, when we do hold employees accountable we are 

going to continue to transparently share information to the degree permitted by law, 

while respecting an employee’s privacy rights. For cases involving senior executives, 

the Veterans Access, Choice, and Accountability Act of 2014 allows us to take expedited action when VA has determined that a senior manager has committed misVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
31 

conduct or has performed poorly. VA’s newly established Office of Accountability Review (OAR) is monitoring the progress of all ongoing OSC and Office of Inspector 

General (OIG) investigations, and as they are completed, will help VA leadership 

determine appropriate accountability measures. 

Question 19. It is my understanding that the VA officials who have been placed 

on administrative leave in Phoenix and elsewhere are still being paid while the office of the VA Inspector General conducts its investigation. 

If these allegations are found to be true, what measures will you consider to not 

only discipline those responsible for the practices in question, but also to reform VA 

policies and procedures to ensure that the department is better able to provide timely and adequate care to veterans? 

Response. VA takes the allegations and findings of misconduct seriously, and has 

moved quickly to address the situation. Since allegations of delayed care and employee misconduct surfaced at Phoenix VAHCS, VA has been conducting internal reviews to evaluate appointment scheduling procedures and patient care in Phoenix 

and nationwide. VA has initiated the process for removing senior leaders at 

PVAHCS, and VA has directed an independent site team to assess scheduling and 

administrative practices at PVAHCS. Final decisions on the senior leader actions 

will be made when all relevant evidence is available. 

On May 23, 2014, VHA executed the Accelerating Care Initiative, a coordinated, 

Nation-wide initiative to accelerate care to Veterans throughout the VA system and 

in the communities where Veterans reside. This initiative was designed to increase 

timely access to care for Veteran patients; decrease the number of Veteran patients 

on the Electronic Wait List (EWL) and waiting greater than 30 days for care; and 

standardize the process and tools for ongoing monitoring and access management 

at VA facilities. VA will continue to accelerate access to care for Veterans nationwide who need it, utilizing care both in and outside the VA system. 

Question 20. Earlier this year, before allegations of manipulated wait time reporting at the Phoenix VA hospital came to light, you stated in a letter to Chairman 

Jeff Miller of the House Committee on Veterans’ Affairs that you believe that ‘‘the 

VA has sufficient authority to take swift action to hold employees and executives 

accountable for performance.’’ You went on to say that one of the ways in which the 

VA holds these individuals accountable is through ‘‘a rigorous performance appraisal 

program.’’ While VA employees and executives failure to meet performance goals is 

one thing, accusations of intentional manipulation and mismanagement resulting in 

delayed care for hundreds of veterans is another. 

a. In a letter to Chairman Jeff Miller of the House Committee on Veterans’ Affairs, you noted that ‘‘it does not appear that PVAHCS patients who were not able 

to be seen within 90 days were handled consistently.’’ What will be the repercussions for those involved in the already discovered inconsistent handling of patient 

appointments at the Phoenix facility? 

b. Beyond these apparent inconsistencies, if the troubling allegations related to 

the Phoenix facility are found to be true, would you agree that decisive and incontrovertible action—to include the possibility of termination—against those responsible for the sort of practices in question at the Phoenix VA hospital is warranted? 

VA Response (a. and b.): VA takes the allegations and findings of misconduct seriously, and has moved quickly to address the situation. Since allegations of delayed 

care and employee misconduct at Phoenix VAHCS surfaced, VA has been conducting 

internal reviews to evaluate appointment scheduling procedures and patient care in 

Phoenix and nationwide. VA recognizes there is a leadership and integrity problem 

among some of the leaders of its health care facilities, which can and will be fixed. 

That breach of integrity is indefensible and VA is using all authorities at its disposal to enforce accountability among senior leaders as quickly as possible within 

the bounds of the law. VA has also directed an independent site team to assess and 

improve scheduling and administrative practices at PVAHAC. This team began 

their work in April, and VA is taking action on multiple recommendations from 

their findings. 

Question 21. In the past, GAO has studied and been critical of VA bonus awarding 

practices. 

a. Since 2012, how many employees of VA facilities in the state of Arizona have 

received bonuses? What percentage of the entire VA workforce received bonuses? 

What was the range of bonuses awarded, in dollar value and percentage of the recipients’ salary? What is the total dollar figure associated with bonuses awarded by 

the VA in Arizona? 

Response. The following data excludes Senior Executive Service (SES) employees 

and SES Equivalents. 

32 

Since 2012, how many employees of VA facilities in the state of Arizona have received bonuses? 

FY Number of employee of VA facilities in the state of 

Arizona that have received bonuses 

2012 2,710 

2013 2,199 

What percentage of the entire VA workforce received bonuses? 

FY Percent of entire VA Workforce that received bonuses 

2012 55% (180,728 awards divided by 325,889 employees) 

2013 58% (195,954 awards divided by 338,932 employees) 

What was the range of bonuses awarded, in dollar value and percentage of the 

recipients’ salary? 

Dollar Amounts of Bonuses Awarded 

FY Minimum Maximum 

2012 ...................................................... $11 .00 $23,091.00 

2013 ...................................................... $6 .00 $16,173.00 

Percent of Salary 

FY Minimum Maximum 

2012 ...................................................... 0 .02% 99.91% 

2013 ...................................................... 0 .01% 46.72% 

What is the total dollar figure associated with bonuses awarded by the VA in Arizona? 

Dollar Amount of Bonuses Awarded in Arizona. 

FY Award Amount 

2012 ...................................................................... $2,589,793 

2013 ...................................................................... $2,647,236 

The following data represents SES and SES Equivalents. 

NOTE: For reporting purposes, the data below reflects the fiscal year in which 

awards were actually paid. 

Since 2012, how many employees of VA facilities in the state of Arizona have received bonuses? 

FY Count 

2012 ................................................................................ 4 

2013 ................................................................................ 4 

Total ....................................................................... 8 

What percentage of the entire VA workforce received bonuses? 

FY Percent of Workforce 

2012 ......................................... 71% (468 rated/331 awards) 

2013 ......................................... 60% (459 rated/276 awards) 

What was the range of bonuses awarded, in dollar value and percentage of the 

recipients’ salary? 

33 

Dollar Amounts of Bonuses Awarded 

FY Minimum Maximum 

2012 ...................................................... $6,705.00 $23,091.00 

2013 ...................................................... $7,604.00 $16,173.00 

Percent of Salary 

FY Minimum Maximum 

2012 ...................................................... 5 .0% 14.0% 

2013 ...................................................... 5 .5% 9.0% 

What is the total dollar figure associated with bonuses awarded by the VA in Arizona? 

Dollar Amounts of Bonuses Awarded at PVAHCS 

FY Award Amount 

2012 ...................................................................... $42,860 .00 

2013 ...................................................................... $40,791 .00 

b. Has the Department at any point explicitly linked bonuses to efforts to decrease 

patient wait times? 

Response. Performance Awards are monetary awards given to high-performing 

employees based on annual job performance appraisals. Senior Executives are held 

specifically accountable for achieving realistic, but challenging performance targets 

within defined timeframes, identified within the five critical elements: Leading 

Change, Leading People, Business Acumen, Building Coalitions, and Performance 

Results. Within those five critical elements, each Senior Executive is rated against 

position specific performance requirements. Among those requirements, leadership 

skills in managing wait times may be one of many factors considered in the evaluation. SES performance is evaluated through a minimum of five levels of review. The 

result of this evaluation is a rating and score. Performance awards are given based 

on the individual’s final approved rating/score. 

It is significant to note that VHA’s evaluation of SES performance is conducted 

annually in accordance with VA Handbook 5027, VA SES and Title 38 SES-Equivalent Performance Management System policy, and all applicable laws. VHA’s internal process includes a multi-level review process which increases transparency and 

accountability and ensures meaningful distinctions in ratings and awards. The rating official (supervisor) provides an initial narrative summary and submits to the 

reviewing official who provides an overall narrative evaluation. Next, VHA’s Performance Review Committee (PRC) reviews the evaluation and makes a rating recommendation to the VA Performance Review Board (PRB). The PRB reviews and 

makes a rating recommendation to the Secretary. The criteria for determining who 

receives a monetary award and the amount of the award is determined through collaboration between Corporate Senior Executive Management Office (CSEMO) and 

the Office of the Secretary. The Secretary has the final approval authority for the 

rating of record and any monetary award given. 

c. Did any of those placed on administrative leave or associated with the inconsistency related to patient scheduling received a bonus within the last two years? 

Response. 

Position/Title FY 2013 FY 2012 

Medical Center Director ............................. $0 (rescinded)* ........................................ $9,345 (effective 5/22/13) 

Associate Director ...................................... $5,000 (effective 11/06/13) ..................... $3,000 (effective 11/19/12) 

Third Employee .......................................... $3,000 (effective 11/20/12) ..................... $3,000 (effective 11/25/13) 

* The process to recoup this FY 2013 payment was initiated, but is on hold pending an appeal. 

Question 22. Regardless of the VA Inspector General’s findings, there is clearly 

a need to reform VA scheduling practices, and to ensure that the department is better able to provide timely and adequate care to veterans. 

34 

a. Aside from conducting a nationwide audit of the scheduling practices at VA 

medical facilities, what steps is your office currently taking to reduce the backlog 

for disability claims, and ensure that veterans are able to receive timely appointments at VA medical facilities? 

Response. VA is committed to improving the quality, efficiency, and effectiveness 

of the delivery of benefits and services to Veterans, Servicemembers, and their families. VBA is currently undergoing the largest transformation in its history to eliminate the backlog of disability compensation claims, and substantially improve the 

way Veterans, their families, and Survivors receive benefits and services. VA is aggressively implementing its plan to eliminate the backlog using a series of actions 

targeted at reorganizing and retraining its people, streamlining its processes, and 

deploying technology designed to achieve VA’s goal of processing all claims within 

125 days in 2015. 

Since April 2013, VA has focused on completing its oldest claims, resulting in benefit determinations for those who have been waiting the longest, many of whom are 

awarded VA compensation benefits for the first time or who have medical conditions 

that have worsened. As a result of its transformation initiatives and the focus on 

the oldest claims, VA has made significant progress, reducing the claims backlog 

(i.e., claims pending over 125 days) from its peak of 611,073 in March 2013 to 

254,778 as of September 22, 2014—a 58.3-percent reduction. Veterans are now waiting less time for their decisions and benefits. As of September 22, 2014, claims in 

the inventory have been pending an average of 153 days, a 46-percent reduction 

from the peak of 282 days in February 2013. 

At the same time, the accuracy of our rating decisions continues to improve. VA’s 

national ‘‘claim-level’’ accuracy rate, determined by dividing the total number of 

cases that are error-free by the total number of cases reviewed, is currently 90 percent—a seven-percentage-point improvement since 2011. When measuring the accuracy of rating individual medical conditions inside each claim, the 3-month accuracy 

level is 96 percent. 

VBA and VHA work together to support the Compensation and Pension (C&P) 

disability examination process for Veterans. In FY 2013, VHA clinicians completed 

nearly two million disability examinations. Additionally, VBA and VHA are maximizing the use of disability contract examiners to help maintain and improve VA 

disability examination services. In FY 2013, VHA contractors completed approximately 178,000 disability examinations, and VBA contractors completed over 

225,000 disability examinations. Utilizing contract examiners ensures timely scheduling of examination appointments and ultimately more timely completion of disability claims. Contract exams also ensure Veterans receive quality disability examinations in locations near their homes. 

VBA and VHA have instituted several initiatives to improve the timeliness and 

accuracy of claims processing based on medical evidence. For example, 71 different 

Disability Benefits Questionnaires (DBQ) are available to support Veterans’ claims. 

DBQs are designed to more efficiently gather medical evidence from VHA clinicians 

and private physicians, including disability contract examiners, by capturing all the 

medical information needed to process a claim for a specific condition at once and 

up front. 

Similarly, in the Acceptable Clinical Evidence (ACE) process, VHA clinicians review existing medical evidence and determine whether that evidence can be used 

to complete a DBQ without requiring the Veteran to report for an in-person examination. For many Veterans, this means they no longer need to travel and take time 

off for an examination, which can be a significant burden. Clinicians also have the 

option to supplement medical evidence with telephone interviews with the Veteran, 

or to conduct an in-person examination if determined necessary. 

VHA is providing certified C&P clinicians at VBA regional offices. The clinicians 

provide medical opinions, answer staff questions, correct insufficient examinations, 

and serve as a key communication link between VBA and VHA. Along with communication at the local level, the Administrations have weekly meetings to discuss the 

disability examination process and established mailboxes for any questions employees may have about the process. VBA and VHA also collaborate on training programs and development of national policy and procedures to ensure consistency and 

quality. 

Question 23. Although the VA Inspector General has yet to conclude its investigation, you stated in your testimony before the House Committee on Veterans’ Affairs 

that an administrative team from the VA has visited Phoenix and found ‘‘no evidence of a secret list,’’ and no indication that patients had ‘‘died because they have 

been on a wait list.’’ However, an NBC report indicates that internal VA memos 

show that in 2010, the VA’s deputy undersecretary for health, William Schoenhard, 

35 

was aware that some VA employees were using inappropriate scheduling practices 

to cut down on the officially reported time that patients wait for care. 

a. In light of this report by NBC, do you believe that your testimony before the 

House Committee on Veterans’ Affairs was inconsistent? 

b. According to the report from NBC, Deputy Under Secretary Schoenhard was 

aware of inappropriate scheduling practices at some VA medical facilities—were you 

aware as well? 

c. Given that the VA Inspector General has yet to conclude its investigation, do 

you believe that your statements regarding the conclusions of the preliminary findings of the VA administrative team that recently visited Phoenix were premature 

and unwise? 

d. What, if any, steps are you taking to ensure that swift and decisive disciplinary 

action will be taken if the allegations are found to be true? 

Response. While VHA has made efforts to address health care appointment scheduling and wait times for health care, further improvement is needed. On May 16, 

2014, Robert Petzel, M.D., resigned as VHA’s Under Secretary for Health. VHA’s 

testimony was based on the data that was available at that time. However, we acknowledge that within many of our health care facilities there were systemic and 

unacceptable scheduling practices. VA is taking corrective action to address these 

issues. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR ON BE- HALF OF HON. JOHN CORNYN TO HON. ERIC K. SHINSEKI, SECRETARY, U.S. DE- PARTMENT OF VETERANS AFFAIRS

Question 24. Secretary Shinseki, according to recent reports, you have ordered a 

‘‘face-to-face audit’’ of all Department of Veterans Affairs clinics. Can you describe 

in detail how you intend for this audit to be conducted, its timeline for completion, 

and what measures are being taken to ensure these audits are conducted in an independent and transparent manner? If the allegations are substantiated, what type 

of action are you willing to take to right these wrongs, and how will the responsible 

officials be held accountable? 

Response. On May 23, 2014, VHA executed the Accelerating Care Initiative, a coordinated, Nation-wide initiative to accelerate care to Veterans throughout the VA 

system and in the communities where Veterans reside. This initiative was designed 

to increase timely access to care for Veteran patients; decrease the number of Veteran patients on the Electronic Wait List (EWL) and waiting greater than 30 days 

for care; and standardize the process and tools for ongoing monitoring and access 

management at VA facilities. 

The Nation-wide Access Audit covered a total of 731 separate points of access, and 

involved over 3,772 interviews of clinical and administrative staff involved in the 

scheduling process at VAMCs, large Community-Based Outpatient Clinics (CBOC) 

serving at least 10,000 Veterans and a sampling of smaller clinics. VA released the 

results of this audit on June 9, 2014, which can be accessed online at the following 

link: http://www.va.gov/health/access-audit.asp. VA will continue to accelerate access 

to care for Veterans nationwide who need it, utilizing care both in and outside the 

VA system. 

We are in the midst of following up on the Nation-wide audit, interviewing senior 

leaders at facilities that had been flagged for further review but where OIG is not 

conducting scheduling-related investigations, or where the OIG has completed its investigation and found no basis for criminal action. This is in follow—up to the access audit and is intended to determine which supervisors, managers and employees 

may have intentionally directed or carried out inappropriate scheduling practices. 

We are also following up on OIG’s scheduling-related investigations, as OIG releases 

its findings to us, and will ensure accountability for anyone implicated in wrongdoing by the IG. 

Question 25. Secretary Shinseki, a whistleblower in Texas claims that during his 

time as a scheduling clerk for VA facilities in Austin, San Antonio, and Waco, he 

was directed by supervisors to hide true wait times by inputting false records into 

the VA’s scheduling system. VA officials in San Antonio deny this, while VA officials 

in Austin claim employees may have been discouraged from using the electronic 

scheduling tool that would reveal long wait times, but that those orders did not 

come from ‘‘executive leadership.’’ Can you confirm that supervisors at VA facilities 

in Texas have not and are not ordering employees to ‘‘game the system’’ by concealing wait times? 

Response. April 25–28, 2014, an internal fact-finding review by South Texas Veterans Health Care System (STVHCS) was completed and claims made by the emVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
36 

ployee could not be substantiated. STVHCS and Central Texas Veterans Health 

Care System (CTVHCS) leaders have made it clear to scheduling clerks that no wait 

list formats of any kind other than VistA Scheduling software should be used. 

Officials do confirm that scheduling clerks were not using the Electronic Wait List 

(EWL) and once leadership became aware, they conducted training sessions for 

clerks to begin using the EWL. The EWL is a valuable tool to help monitor appointments and determine where more resources might be needed. 

VA encourages employees to bring forth any concerns they may have regarding 

scheduling of patients so their concerns may be addressed. If during any external 

or internal review, allegations of employee misconduct are substantiated, swift and 

appropriate action will be taken. In addition, as a part of positive employee relations, VA management continues to meet with scheduling clerks both in Central and 

South Texas to encourage the hard work they do on a daily basis and to hear their 

concerns. 

Question 26. Secretary Shinseki, an Austin-based surgeon recently contacted my 

office to inform me he is not accepting any further subcontracts from the VA due 

to failures in patient care that he has personally witnessed. Specifically, he saw a 

veteran in August 2013 who was referred to him by the VA after they detected a 

lesion they suspected was cancerous. Already two months had lapsed between the 

time they detected the lesion and the time he saw the veteran. This surgeon performed a biopsy and diagnosed it as laryngeal cancer. He informed the VA that the 

veteran needed immediate chemotherapy—that they had a real chance to treat his 

cancer if they started chemotherapy right away. Almost two months later, he followed up on his case only to learn the VA never provided chemotherapy, with no 

good excuse as to why. The veteran died several days later. Can you confirm that 

veterans diagnosed with cancer of any kind that requires chemotherapy are provided that treatment in a timely manner by the VA? 

Response. VHA is committed to timely care for all Veterans including those undergoing treatment for cancer. The referenced case was reviewed by clinical leadership in Central Texas and Veterans Integrated Service Network 17. At this time, 

the information provided indicates no evidence was found indicating that patients 

with cancer of any kind undergoing chemotherapy treatment experienced that care 

in an untimely manner. VHA investigates allegations of less than adequate care, 

and when warranted, takes appropriate corrective actions. 

Question 27. Secretary Shinseki, a whistleblower in South Texas who formerly 

served as associate chief of staff for the VA Texas Valley Coastal Bend Health Care 

System in Harlingen, TX, told the Washington Examiner this week that roughly 

15,000 patients who should have had the potentially life-saving colonoscopy procedure either did not receive it or were forced to wait longer than they should have. 

He also claims that approximately 1,800 records were purged to give the false appearance of eliminating a backlog. Can you confirm that veterans requiring 

colonoscopies to detect cancer are provided with the procedure in a timely manner? 

Response. The claims against VA Texas Valley Coastal Bend Health Care System 

(VATVCBHCS) by the former Associate Chief of Staff are outlined in the Office of 

Special Counsel (OSC) report OSC File # D–11–3558 available on their Web site: 

https://osc.gov/Pages/PublicFiles-FY 2014.aspx . In the report, the allegations of poor 

patient care are unsubstantiated. In FY 2012, the completion rate within 90 days 

for VATVCBHCS Veterans requiring diagnostic colonoscopies to detect cancer, following positive fecal occult blood test results, was 82 percent (65 percent were completed within 60 days). In FY 2013, the completion rate within 90 days for 

VATVCBHCS Veterans requiring diagnostic colonoscopies to detect cancer, following 

positive fecal occult blood test results, was 86 percent (57 percent were completed 

within 60 days). All diagnostic colonoscopies are reviewed quarterly by the Invasive 

Procedures Committee. 

Question 28. In 2012, VA medical facilities in Central Texas reported that 96 percent of veterans were seen by providers within 14 days of their preferred appointment date. In the South Texas region that includes San Antonio, the statistics were 

even more impressive: 97 percent of veterans were seen within two weeks, according 

to annual performance reports. Can you produce documents that show the original 

dates of veterans’ requests for appointments for 2012? 

Response. There is no mechanism in the VistA program to allow for a retrospective review of the original dates of a Veteran’s request for an appointment after the 

Veteran has been seen for that appointment. 

Question 29. Secretary Shinseki, according to public records, the director of the 

Phoenix VA hospital, where news investigations have discovered at least 40 veterans died while waiting for care and languishing on secret lists, received more than 

$9,000 in bonus pay in 2013. Can you confirm that any bonuses or pay raises are 

37 

on hold for senior leaders at VA facilities in San Antonio, Austin, Waco, Harlingen, 

and all VA facilities where similar allegations have been made? 

Response. Acting Secretary Sloan Gibson announced on June 9, 2014, that VHA 

SES performance awards were suspended for FY 2014. FY 2013 performance incentives were paid in accordance with VA established recommendations and timelines 

for leaders at CTVHCS, STVHCS, and VATVCBHCS. 

Question 30. Secretary Shinseki, my staff attended a Quarterly Congressional 

Staffer and Veterans Service Organization Representative Meeting at the Central 

Texas Veterans Health Care System (CTVHS) Friday, May 9, 2014. Sallie HouserHanfelder, director of the Central Texas Veterans Health Care System, told meeting 

attendees that, as part of the face-to-face audits you have ordered, a quality systems 

manager from CTVHS would be sent to another VA facility to assist with investigations there. Can you confirm that staff at facilities currently under investigation for 

allegations of falsified reports will not be assigned to investigate other VA facilities? 

Response. The individual from CTVHCS that served on the phase one portion of 

the VA-directed site visits has no oversight or involvement with the scheduling of 

appointments. 

Question 31. Secretary Shinseki, former VA employee at the VA Greater Los Angeles Medical Center told the Daily Caller that employees at the Center destroyed 

veterans’ medical files in a systematic attempt to eliminate backlogged veteran medical exam requests. The former employee said, ‘‘The waiting list counts against the 

hospital’s efficiency. He said the chief of the Center’s Radiology Department initiated an ‘‘ongoing discussion in the department’’ to cancel exam requests and destroy 

veterans’ medical files so that no record of the exam requests would exist, thus artificially reducing the backlog. In addition, you have been subpoenaed by the House 

Veterans’ Affairs Committee over concerns by Chairman Jeff Miller that evidence 

in Phoenix may have been destroyed after the Committee issued a document-preservation order on April 9. A top VA official testified on April 24 that a spreadsheet 

of patient appointment records, which may have been a ‘‘secret list’’ proving misconduct, was shredded or discarded. Can you confirm that documents are being preserved at all Texas VA facilities? 

Response. All four VISN 17 facilities are in receipt of the Memorandum from General Counsel ‘‘Subj: Litigation Hold Concerning Alleged Consult and Appointment 

Delays with VA Health Care System (VHA)’’ dated May 13, 2014. They confirm that 

the message has been distributed and all records are being preserved that leadership is aware of. 

Chairman SANDERS. Thank you very much for your testimony, 

Mr. Secretary. 

I am going to start off with a simple question, and then I am 

going to ask some harder questions, and you or Dr. Petzel can 

answer. 

First, a very simple question. VA’s Health Care System is the 

largest integrated health care system in the United States of America. Six-point-five million veterans access it every single day. Gen. 

Shinseki or Dr. Petzel, what are the strengths of VA’s Health Care 

System? What are its problems, in your judgment? Is it a good 

system? 

Secretary SHINSEKI. Mr. Chairman, it is a good system and it is 

comparable to any other health care system in the country. In some 

areas and some specific occasions, we exceed even those good 

systems. 

For 5 years now, we have focused on three major goals for VA, 

all of it focused on doing better by veterans, which is what the 

President asked me to do when I came here. The first was to increase access. I think we have been successful at this. We have enrolled two million more veterans into VA health care. I think there 

is a net here somewhere around 1.4 million, 1.5 million who are net 

overall increases. But, over 5 years, we have enrolled 2 million 

more veterans. 

The second focus was to go after this thing called the backlog, 

and we have had this discussion for a number of years now. But, 

38 

we did not simply go after the backlog just to end what was then, 

5 years ago, a set of claims. We also acknowledged that we had not 

done very well by veterans of previous conflicts. And so even as we 

committed to ending the backlog in 2015, we also went and tried 

to bring justice to those who had never had an opportunity to submit a claim. I called on the good people in the Veterans Benefits 

Administration to take this on, and they did. And I promised them 

we would give them a new tool called the Veterans Benefits Management System, and in 3 years, we fielded this new automation 

tool that make them—— 

Chairman SANDERS. How did we used to do benefits? 

Secretary SHINSEKI. All paper. 

Chairman SANDERS. All paper. 

Secretary SHINSEKI. All paper, and if you wanted to go faster, 

Mr. Chairman, you had to hire more people, which we had done 

over many years. I think we have, I do not know, 11,000 people 

who process claims, which is—— 

Chairman SANDERS. What I want to do now, Mr. Secretary, is 

pick up on some of the points, I think legitimate points, made by 

Democrats and Republicans. And the major allegation—I think everybody here understands that when you treat 230,000 people a 

day, mistakes are going to be made, which is true of any institution 

of that size. But, here is the major criticism that I hear from Senator Burr, Senator Murray, Senator Begich, and others, that this 

is not new news. These concerns did not arise yesterday. They did 

not arise in Phoenix. But, in fact, there have been reports by the 

Inspector General, by the Government Accountability Office, on numerous occasions about problems having to do with scheduling and 

waiting lists. Could you address how it could happen that, year 

after year—— 

Secretary SHINSEKI. Sure. 

Chairman SANDERS [continuing]. These reports were made and 

there has not been significant action. 

Secretary SHINSEKI. Yes. I think it is important here to look at 

the GAO and the IG reports and what they intend to do, and they 

come in and give us some sense of where we could be doing better. 

And we get in there and we address those issues and take corrective action and, in essence, close out the report. It does not mean 

that we have solved every issue. It does mean that we have taken 

care of addressing those issues, and then when they come back, 

there may be another set of issues to deal with. 

I do understand Senator Murray’s suggestion that we ought to 

take a comprehensive look at this—— 

Chairman SANDERS. I think what you are hearing from a number 

of Senators including myself, is that everybody knows problems 

will arise tomorrow. That is not the criticism. The criticism is that 

year after year reports have been made talking about these problems and the problems continue to exist. Can you give us some assurance of what happens tomorrow? Where do we go from here so 

that we do not have this hearing next year or 2 years from now? 

Secretary SHINSEKI. Sure. And I think that is what the audit 

that we have created is intended to do. So, while the Inspector 

General is looking at Phoenix for evidence of employee misconduct 

and evidence that 40 veterans may have perished awaiting schedVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00042 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
39 

uling, the IG is going to get to the bottom of that. What we are 

attempting to do is to address the Senator’s broader question, to 

take a look at ourselves and not wait for the IG’s outcomes. And 

already, we have begun to see some evidence that—people are coming forward and saying, hey, I think there is an issue here, which 

I encourage. I mean, that is what we are after here. And if there 

were performance issues in the past, if they are continuing today, 

we want to put a stop to—— 

Chairman SANDERS. All right. My last question is, in your judgment, based on what you know, are people, ‘‘cooking the books?’’ Is 

that, in fact, a problem within VA’s health care system? 

Secretary SHINSEKI. I am not aware, other than a number of isolated cases where there is evidence of that. But, the fact that there 

is evidence in a couple of cases behooves us to go and take a thorough look, and that is why we have structured this audit so that 

a set of clinicians are not going to inspect their own areas. We have 

offset them so that a VISN 1 will inspect a VISN 10, and we will 

get a comprehensive—a good look. But I—— 

Chairman SANDERS. I apologize, but my time has long expired. 

Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

Mr. Secretary, again, welcome. These questions are for you, and 

I will try to go as quickly as I can for the time constraints. 

Mr. Secretary, were you aware that on October 25, 2013, the Office of Special Counsel requested that VA conduct an investigation 

into the allegations of the inappropriate scheduling at the Fort Collins Community Outpatient Clinic, and that since then, the media 

has reported about Mr. Freeman’s e-mail of June 19, 2013, that explains how to game the system to avoid being on the bad boy list. 

Were you aware of those? 

Secretary SHINSEKI. Senator, I became aware of that screen shot, 

I believe is what it was, of an employee who was suggesting there 

are ways to game. I put that employee on administrative leave—— 

Senator BURR. When was that? 

Secretary SHINSEKI. That was last Friday. 

Senator BURR. OK. Mr. Secretary, it is my understanding that on 

June 21, 2013, VA received a report from the Office of Medical Inspector regarding chronic understaffing issues at the Jackson VA 

medical center and that report described multiple patient scheduling problems, including scheduling two patients for the same appointment slot, and scheduling patients for a clinic that does not 

have any assigned providers, often referred to as ghost clinics; and 

that on September 17, 2013, the Office of Special Counsel submitted a letter to the President of the United States, on which the 

VA was courtesy copied, describing the findings of that June 21 Office of Medical Inspector report on the Fort Jackson Medical Center, including the practice of double-booking patients and the use 

of ghost clinics. Do you remember reading that report and receiving 

that copied letter to the President? 

Secretary SHINSEKI. I cannot say that I remember it today, 

here—— 

Senator BURR. OK. There was a December 23, 2013, report by 

the Office of the Medical Inspector regarding the Cheyenne Medical 

Center and Fort Collins Clinic that found that several medical supVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00043 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
40 

port assistants reported that, ‘‘medical center’s Business Office 

training included teaching them to make the desired date the actual appointment, and if the clinic needed to cancel appointments, 

they were instructed to change the desired date to within 14 days 

of the new appointment.’’ Did you read that report? 

Secretary SHINSEKI. That report has come to my attention here 

recently. 

Senator BURR. OK. On February 25, 2014, your Chief of Staff, 

Mr. Riojas, submitted a response to the Office of Special Counsel 

which included the December 23, 2013, Office of the Medical Inspector report on Fort Collins, and in that letter, Mr. Riojas states, 

‘‘However, as OMI,’’ Office of Medical Investigation, ‘‘was not provided any specific veterans’ cases affected by these practices, it cannot substantiate the failure to properly train staff resulting in danger to public health or safety.’’ Were you aware of what your Chief 

of Staff wrote? 

Secretary SHINSEKI. I was. 

Senator BURR. OK. Mr. Secretary, were you aware that the GAO 

report entitled, ‘‘VA Health Care: Reliability of Reported Outpatient Medical Appointment Wait Times and Scheduling Oversight Need Improvement,’’ which was publicly released in January 

2013, and then on December 11, 2012, to that same report, your 

former Chief of Staff, John Gingrich, sent a letter to the GAO 

which stated, ‘‘VA generally agrees with the GAO conclusions and 

concurs with GAO recommendations to the Department.’’ Do you 

remember that letter, that report and your Chief of Staff’s 

response? 

Secretary SHINSEKI. In general, I do remember that report. 

Senator BURR. Mr. Secretary, you knew that there were specific 

issues relating to scheduling and wait times as early as June 21, 

2013, at Jackson; December 23, 2013, at Fort Collins; as well as 

numerous IG reports related to excessive wait times in January 

2012 in Temple, TX; September 2012, in Spokane, WA; October 

2012, in Cleveland, OH; September 2013, in Columbia, SC; and December 2012, a GAO report which questions the validity and the 

reliability of the reported wait time performance measures, which 

brings us to today and Phoenix. 

On May 1, you publicly stated that you had removed Ms. 

Hellman as the Medical Director, and you stated then that that 

was to ensure the integrity of the IG’s current investigation. On 

May 5, Dr. Petzel conducted a conference call with all VISN Directors, all Medical Directors, and the Chief of Staffs—a rather large 

group—to discuss the ongoing face-to-face audits of all VA centers 

and large community-based outpatient clinics. I have been told by 

sources that were on that call that during that call, Dr. Petzel 

made the statement that the removal of Ms. Hellman was, ‘‘political and that she has done nothing wrong.’’ 

If you are asking us to wait until the investigation is over, does 

the same not apply to people who work for you? And, Mr. Secretary, from all I have described to you and the current investigation that is currently going on, why should this Committee or any 

veteran in America believe that change is going to happen as a result of what we are going through? 

41 

Secretary SHINSEKI. I was not aware of the phone call you referred to, and I will look into it. I would just tell you that my removal of the Director, placing her on administrative leave, was at 

the request of the IG. He is the lead in this comprehensive review. 

I do not get out ahead of him. He requested it and I put Director 

Hellman and two other individuals on administrative leave. 

Senator BURR. I thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Burr. 

Senator Murray. 

Senator MURRAY. Secretary Shinseki, as I said in my opening, 

the announcement that the President is sending one of his top advisors to assist in this nationwide review is good news and I am 

confident Mr. Nabors will help make sure that this review is comprehensive and accurate. It is critical that this review is effective, 

because at a hearing of this Committee that I called in November 

2011, I asked Dr. Mary Schoen, VA’s Director of Mental Health Operations, whether facilities were gaming the system and not fully 

reporting wait times, and she told me she was unaware of any facilities doing that and that VHA was doing audits to make sure it 

was not happening. But there, as you know, have been an overwhelming number of allegations systemwide that wait times are 

being doctored, and the oversight organizations have reported on it 

for years. 

The Department, so far, has been unable to provide me even the 

most basic information on how this nationwide review is going to 

be conducted or what it will look like, and I hope that is about to 

change. I want you to explain how this review is going to be conducted. 

Secretary SHINSEKI. Let me call on Dr. Petzel to give you details. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Senator Murray, there are going to be several phases to what we 

do. This week, we are auditing with in-person teams and an anonymous survey the first tranche of facilities, all 151 medical centers 

and our largest clinics. Starting next week, we are going to work 

our way down to all of the other sites of care, gathering information—and I think the anonymous nature of the questionnaire is 

particularly important—information about whether or not people 

have felt forced to do things that were inappropriate and lacking 

trust and integrity in the scheduling system. 

The second part of this is an assessment, as a number of people 

have mentioned, as to whether or not we have our resources deployed appropriately, whether or not we have the appropriate 

amount of resources, and just as importantly, whether or not we 

are using those resources in the best way in each one of—at each 

one of our sites. 

I think everybody needs to remember that we do 85 million outpatient visits every year. Ninety-five percent of those visits are 

with established patients and those are all accomplished within 14 

days. 

Senator MURRAY. I appreciate that. I just want the details of how 

this is going to occur so that we get good information. 

Dr. PETZEL. So, we are going to focus on the new patient and the 

scheduling system that we have for new patients and all the other 

42 

access points besides our clinics and our medical centers that we 

have got available for new patients. So, first is the review—— 

Senator MURRAY. OK—— 

Dr. PETZEL [continuing]. To see how the scheduling system is 

being done. Second—— 

Senator MURRAY. The assessment. 

Dr. PETZEL [continuing]. The look at whether or not we have—— 

Senator MURRAY. OK. Well, I would like to get the details from 

you on that, I do not want to use all my time, but it is important 

that we know how that is going to be used and we know that real 

change occurs. 

But, I just have a minute and one half left and I want to ask 

you, Secretary Shinseki, Deputy Under Secretary for Health, Bill 

Schoenhard, told me at a hearing in 2012 that gaming is so prevalent, as soon as new directives are put out, they are torn apart to 

find out how to get around the requirements. Testimony from a VA 

mental health employee said the exact same thing. 

And, at that same hearing, Linda Halliday from the IG’s Office 

told us, ‘‘If we have seen scheduling practices that resulted in gaming the system to make performance metrics look better at the end 

of the day over the past 7 days, they need a culture change. To get 

that culture change, I think they really need to hold the facility directors accountable for how well the data is actually being captured.’’ 

That was more than 2 years ago, and the standard practice at 

VA seems to be to hide the truth in order to look good. That has 

got to change once and for all. And I want to know how you are 

going to get your medical directors and your network leaders to tell 

you—whether it is through this survey or in the future—when they 

have a problem and will work with you to address it, rather than 

pursuing these secret lists and playing games with these wait 

times. 

Secretary SHINSEKI. Well, Senator, if there is anything that gets 

me angrier than just hearing allegations is to hear you tell me that 

we have folks that cannot be truthful because they think the system does not allow it. 

Senator MURRAY. Right. 

Secretary SHINSEKI. You know, trust is an important aspect of 

everything we do here, and it has been in my previous life, as well. 

In order to do that we have to be transparent and we have to hold 

people accountable. So, what I will say to you is we are going to 

get into this; and it is important for me to assure veterans, to regain their trust, whatever has been compromised here, that when 

they come to VA they come to a good, safe, caring system and that 

they will be cared for. 

And for all the employees that are listening in today, I expect our 

employees to provide the highest quality, safest care we can provide, given all the comments about how tough it is in the health 

care industry, and provide access to benefits as quickly as we can. 

That is our mission. We only have one mission. It is taking care 

of these veterans, and not ‘‘these’’ veterans, I am one of them, a 

hundred thousand of our employees at VA are veterans. We have 

a vested interest here to get this right. 

43 

Senator MURRAY. OK. This is absolutely critical. This review will 

not work if those people who are telling you the information do not 

tell you the truth. 

Secretary SHINSEKI. Agreed. 

Chairman SANDERS. Thank you, Senator Murray. 

Senator Isakson. 

Senator ISAKSON. Thank you, Mr. Chairman. 

For both of you gentlemen, do you remember or do you know William Schoenhard? 

Secretary SHINSEKI. I do. 

Dr. PETZEL. Yes. 

Senator ISAKSON. Do you know him, Dr. Petzel? 

Dr. PETZEL. I do. 

Senator ISAKSON. On the 26th of April in 2010, he sent out a 

memo to all the VISN Directors throughout VA entitled, ‘‘Inappropriate Scheduling Practices.’’ Paragraph two begins, ‘‘It has come 

to my attention that in order to improve scores on assorted access 

measures, certain facilities have adopted use of inappropriate 

scheduling practices, sometimes referred to as gaming strategies.’’ 

Then, paragraph three, and I am going to read the whole paragraph because this is the key to the question and, I think, is the 

key to the issue at VA. ‘‘For your assistance’’—and there is an 

eight-page attachment to this—‘‘for your assistance, attached is a 

listing of the inappropriate scheduling practices identified by a 

Multi-VISN Working Group chartered by the System Redesign Office. Please be cautioned that since 2008, additional new or modified gaming strategies may have emerged, so do not consider this 

list a full description of all current possibilities of inappropriate 

scheduling practices that need to be addressed. These practices will 

not be tolerated.’’ 

Are you familiar with that memorandum? 

Secretary SHINSEKI. I am—I was not. I am not. 

Senator ISAKSON. Dr. Petzel? 

Dr. PETZEL. I am familiar with that memorandum, yes. 

Senator ISAKSON. Well, if it is not going to be tolerated, and over 

4 years ago you had eight pages of known practices for gaming the 

system, what action, if any—and I do not think any took place— 

did VA take to respond to William Schoenhard’s memorandum to 

see to it the VISN and the hospital directors followed the orders? 

Dr. PETZEL. We have worked very hard, Senator Isakson, to root 

out these inappropriate uses of the scheduling system and these 

abuses. We have been working continuously to try to identify 

where those sites are and what we need to do to prevent that from 

happening. It is absolutely inexcusable. The scheduler’s responsibility is to be sure that that program is administered with 

integrity? 

Senator ISAKSON. What do you do when you uncover one? Surely, 

you have uncovered one. What do you do to hold them accountable? 

Dr. PETZEL. The individuals are, as you mentioned, held accountable. I cannot give you an example specifically, but if someone were 

found to be manipulating inappropriately the scheduling system, 

they would be disciplined. 

Senator ISAKSON. So, would they lose their job? 

44 

Dr. PETZEL. I do not know whether that is the appropriate level 

of punishment or not. 

Secretary SHINSEKI. Senator, we can probably give you a little 

better answer to this, because you are focused on scheduling. What 

I can tell you is that in 2012, we involuntarily removed 3,000 employees for either poor performance or misconduct. In 2013, another 

3,000 employees were involuntarily removed, and among them, 

there were some senior executives, as well. 

Senator ISAKSON. Are those removals a reassignment within the 

VA Health Care System? 

Secretary SHINSEKI. Some may be reassignments. Others were 

departure, some by retirement and others by, in effect, being let go 

by VA. 

Senator ISAKSON. Well, I just—I have read this entire eight-page 

memorandum and there is no gray area. It is not saying we think 

this is happening. It is saying we know this is happening; and 

there may be other ways of gaming the system. It talks about being 

done specifically for the purpose of improving scores on assorted access measures, which I guess means the way in which their performance is evaluated as an employee. Is that correct? 

Secretary SHINSEKI. I—I am going to take your direction here. 

Senator ISAKSON. No, no, no—— 

Secretary SHINSEKI. I have not read the memo—— 

Senator ISAKSON. No, no, no. I—— 

Secretary SHINSEKI [continuing]. So, I would assume that that is 

the—— 

Senator ISAKSON. And I would assume, if the System Redesign 

Office had a Multi-VISN Working Group—do you know what the 

System Redesign Office is? 

Secretary SHINSEKI. Dr. Petzel? 

Dr. PETZEL. Yes. That—— 

Senator ISAKSON. What is that? 

Dr. PETZEL. That is the group that is responsible for ensuring 

that we are designing the work within our clinics and operations 

in the most effective and efficient way; and they have been given— 

at that time, they were given responsibility for monitoring and 

keeping track of access. 

Senator ISAKSON. It says that the listing of inappropriate scheduling practice was identified by the Multi-VISN Working Group. 

So, you had a group within the Veterans Administration that identified on August 26, 2010, various and numerous practices where 

numbers were being manipulated for the purpose of better outcomes, I presume, in terms of how those people would be rated. It 

would seem to me like there should have been a systematic, written practice where the chain of command would see to it that was 

not tolerated, as the memo said, and there was accountability to be 

had, including the loss of a job. 

Dr. PETZEL. I absolutely agree with you. And we did institute 

that appropriate level of accountability. I will find out—I do not 

know whether anybody was specifically disciplined around that 

issue, but this has been a very important thing to us for at least 

the last 4 years, Senator Isakson. We have tried to root out those 

places where the scheduling system was being used inappropriately. 

45 

Senator ISAKSON. So—— 

Dr. PETZEL. It is intolerable. 

Senator ISAKSON. I know my time is up, but let me just say two 

things. One is, for the sake of the integrity of the Veterans Administration, you need to find out if there is an accountability system 

to respond to this memorandum from August 26 and what it was. 

And, second, I would like to ask unanimous consent to submit 

this Memorandum for the record. 

[The Memorandum from August 26, 2010, is posted in the Appendix under Senator Isakson.] 

Chairman SANDERS. Without objection. 

Senator ISAKSON. Thank you both. 

Chairman SANDERS. Thank you. 

Senator Blumenthal. 

Senator BLUMENTHAL. Thank you, Mr. Chairman. Again, thank 

you to you and the other veterans who are here and who are listening for their interest and involvement in this issue. 

Secretary Shinseki, can you tell me how quickly we will have 

some preliminary results to both the review and the IG investigation? 

Secretary SHINSEKI. The Inspector General has his own time 

table and I do not have insight into what that is. On our audit, we 

are taking care of most of the large facilities this week. There will 

be some follow-up next week. Perhaps in about 3 weeks we will 

have been able to assemble all the data, do a good analysis, and 

then respond in detail in a way that Members have asked. 

Senator BLUMENTHAL. Can you commit that within 3 weeks, you 

will have a report for us? 

Secretary SHINSEKI. I—I think we should be able to do that, but 

that is preliminary right now. I do not know what data is being assembled and—— 

Senator BLUMENTHAL. And—— 

Secretary SHINSEKI [continuing]. Collating it every day, but we 

will shoot for 3 weeks. 

Senator BLUMENTHAL. And I apologize for interrupting, but as 

you know, all of our time is limited. 

Secretary SHINSEKI. Sure. 

Senator BLUMENTHAL. As part of your management responsibility, do you not believe as I certainly believe, that there is a responsibility from the IG to complete this report as quickly as possible, within a matter of days and weeks, not months? 

Secretary SHINSEKI. I agree that it would be helpful for the IG 

to complete his report as quickly as—— 

Senator BLUMENTHAL. And can you give the IG a deadline? 

Secretary SHINSEKI. I am not able to do that. The IG is an independent reviewer here, and once I turn this over to him, I am primarily supporting his needs here. So, in terms of—— 

Senator BLUMENTHAL. Let me raise sort of the elephant in the 

room. Is there not evidence here of criminal wrongdoing, that is, 

falsifying records, false statements to the Federal Government? 

That is a crime under the—— 

Secretary SHINSEKI. It should be, yes. 

Senator BLUMENTHAL. And would it not be appropriate to ask for 

assistance from the Federal Bureau of Investigation or some other 

46 

similar agency, given that the IG’s resources are so limited, that 

the task is so challenging, and the need for results is so powerful? 

Secretary SHINSEKI. Again, I will work with the IG to make that 

available to him if that is his request. 

Senator BLUMENTHAL. Well, may I suggest, respectfully, Mr. Secretary, that it is your responsibility to make that judgment about 

the IG’s resources, and without rushing to judgment, without 

reaching any conclusions—— 

Secretary SHINSEKI. Sure. 

Senator BLUMENTHAL [continuing]. To involve appropriate Federal criminal investigative agencies if there is sufficient evidence of 

criminality, which, in my judgment, there is more than sufficient 

reason to involve other investigative agencies here in light of the 

evidence—more than allegations, but evidence—of potential false 

statements to the Federal Government, and the need for timeliness 

and promptness in results to restore trust and confidence. 

What I am hearing from my colleagues is the background about 

the systematic failures here and the need for also greater transparency and accountability, so let me ask my next question. 

Secretary SHINSEKI. Well, that is a discussion on resources that 

I have had repeatedly with the IG to make sure. But, again, every 

discussion about, do you have enough resources, based on what is 

underway, each new discovery adds to that workload, and, fair 

enough. I will have that discussion with him again. 

Senator BLUMENTHAL. Let me ask, will you change your management team given that the background here shows systematic 

failings over a period of, apparently, years, not just months? 

Secretary SHINSEKI. Yes. Senator, I do not want to get ahead of 

myself or ahead of the IG here. I want to see the results. I want 

to see the results of the audit, and if changes are required, I will 

take those actions. 

Senator BLUMENTHAL. If this evidence that we have seen already 

is as probative and powerful as it seems to be, would not changing 

your management team be appropriate? 

Secretary SHINSEKI. Perhaps. I am still waiting for the results of 

the audit. 

Senator BLUMENTHAL. Thank you very much, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Blumenthal. 

Senator Heller. 

Senator HELLER. Thank you, Mr. Chairman. 

Mr. Secretary, I pointed out in my opening statement about the 

IG investigation revealed the treatment of a blind female veteran 

and the way she was treated at the emergency room in the VA hospital in Las Vegas. Have you had an opportunity to see the results 

of that investigation? 

Dr. PETZEL. Senator Heller, I have had an opportunity to review 

that investigation, yes. 

Senator HELLER. What was the conclusion? 

Dr. PETZEL. The—without revealing details about the individual—— 

Senator HELLER. Sure. 

Dr. PETZEL [continuing]. It was that she did wait too long and 

that there were others that waited too long in the emergency room. 

It did not have, in the estimation of the inspector, an impact on 

47 

the eventual course of her illness, but it was inappropriate that a 

service-connected blind veteran should have to wait that long in 

our emergency room. 

Senator HELLER. Thank you for the answer. 

Mr. Secretary, do you agree? 

Secretary SHINSEKI. I do not think any veteran, whatever the 

condition, should have to wait that long in any of our facilities, 

whether it is an emergency room or a clinic. 

Senator HELLER. Mr. Secretary, have you received complaints 

about patients’ wait times, scheduling practices, for any other facility in Nevada? 

Secretary SHINSEKI. I am not aware of another facility—— 

Dr. PETZEL. I am not, either. 

Secretary SHINSEKI [continuing]. In Nevada. Dr. Petzel? 

Dr. PETZEL. I am not aware of it, either. We are not—I do not 

know the results of our visits to either Reno or the Las Vegas hospital, but I have not heard anything. 

Senator HELLER. Will all of Nevada’s VA hospitals and clinics 

have face-to-face audits? 

Dr. PETZEL. Yes, they will. 

Senator HELLER. Will VA conduct more thorough audits later 

with the IG? 

Dr. PETZEL. If we find that there were instances where there 

might have been inappropriate criminal activity, we certainly will 

enjoin the IG to come. That is difficult to predict, depending on 

what we find. 

Secretary SHINSEKI. Senator, are you talking about a continuing 

series of audits? 

Senator HELLER. Correct. 

Secretary SHINSEKI. I think, based on what we find, if there is 

a widespread, systemic issue here, we will set up a program of sustaining looks to make sure that we have rooted out the kind of behaviors that we are talking about, either alleged or in fact. 

Senator HELLER. After conducting those investigations, will you 

make that available to myself and my staff? 

Secretary SHINSEKI. Yes. 

Senator HELLER. To any member of the Nevada delegation? 

Secretary SHINSEKI. Yes. 

Senator HELLER. Great. To go back, obviously, with the issues, 

Mr. Secretary, with what is going on in Phoenix, the waiting room, 

the time waits that we are seeing across the country and, of course, 

in my State of Nevada, and, of course, the disability claims backlogs that we are seeing three times longer in the State of Nevada 

than what it should be, do you believe that you are ultimately responsible for all this? 

Secretary SHINSEKI. I am. You and I had this discussion yesterday. I think I need to provide you data that would be a little more 

current than three times the national average on waits on backlog 

claims. Perhaps true at one time, I am told that those numbers are 

down. 

Senator HELLER. OK. Today’s numbers are 355 days. 

Secretary SHINSEKI. That is on—— 

Senator HELLER. That is still three times longer than the national average. 

48 

Secretary SHINSEKI. OK. 

Senator HELLER. Would you explain to me, after knowing all this 

information, why you should not resign? 

Secretary SHINSEKI. Well, I tell you, Senator, that I came here 

to make things better for veterans. That was my appointment by 

the President. Every day, I start out with the intent to, in fact, provide as much care and benefits for the people I went to war with 

and the people that I spent a good portion of my life doing. This 

is not a job. I am here to accomplish a mission that I think they 

critically deserve and need, and I can tell you, over the past 5 

years, we have done a lot to make things better. We are not done 

yet, and I intend to continue this mission until I have satisfied either that goal or I am told by the Commander in Chief that my 

time has been served. 

Senator HELLER. Mr. Secretary, thank you for being here today. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Heller. 

Senator Hirono. 

Senator HIRONO. Thank you, Mr. Chairman. 

In his testimony, Acting IG Mr. Griffin states that VA’s core mission is to provide quality health care. Is providing quality health 

care still VA’s core mission, or have the goals of VA shifted over 

time as they have expanded into providing other benefits to veterans, as well? Of course, I note that Congress has tasked VA to 

provide job training, housing assistance, education assistance, and 

reduce homelessness. So, can you share your thoughts about what 

is the core mission now, with all these other tasks that you now 

have, programs that you now have, are there—are you able to focus 

on your core mission of providing quality health care to our veterans? 

Secretary SHINSEKI. Yes. Providing quality, safe, accessible 

health care for our veterans who have earned them is a core mission. But, in order to provide that kind of health care, they still 

have to access the system, and that means we have to do a good 

job at dealing with disability claims. If we are not able to process 

those claims, the opportunity to access health care is something 

less. 

For the current generation of Iraq and Afghanistan veterans, it 

is automatic that they have 5 years of health care from VA. So, for 

that group, that generation of veterans, it is a little different than 

others. 

So, disability claims becomes an issue here because that then 

renders the opportunity to take advantage of health care benefits. 

I would say homelessness is also part of our responsibility. Five 

years ago, we talked about homelessness as though it were a thing 

out there, and what we have learned in 5 years, because we have 

focused on ending it, is that depression—major factors that lead to 

homelessness—depression, insomnia, pain, substance abuse, substance use disorders, and then—— 

Senator HIRONO. Mr. Secretary, I am sorry to interrupt, but my 

time is rapidly expiring. The point of my question is that all of 

these areas that we have asked you to address with regard to our 

veterans—education needs, homeless issues, all of that—whether 

that is making it much harder for you to meet your core mission? 

49 

That may be a rhetorical question, so let me just move on to another area. 

As we look at the potential need for making systemic changes to 

how VA operates, I again note the IG’s testimony today on page 

eight where he says that there is no national process to establish 

what are deemed essential positions to the delivery of health care. 

There is no standard organizational chart for VA hospitals and 

clinics. So it is very hard to determine what clinics are doing better 

than others. Would you consider these two areas to be potential 

systemic changes that we should be looking at making within the 

VA operations? 

Secretary SHINSEKI. I think that is good insight here, and we will 

take a look at that. Part of our challenge is the complexity of VA 

Health Care System. We have a series of hospitals that go from the 

very largest and most sophisticated, comprehensive kind of health 

care—organ transplants, you know, brain surgery. We call them 

1As; and then there are 1Bs and 1Cs; and then Level 2 and Level 

3s, all of this distinguishing between the level of care that can be 

provided there. It is a complex system, but I think standardizing 

the definitions of key leaders within that kind of framework would 

be helpful and sensible. 

Senator HIRONO. This next question may be one for Dr. Petzel to 

very briefly respond to. We have heard that VA has used bonuses 

and compensation as staff incentives to help bring down the patient wait times, and my question is, are these individual bonuses? 

Are these clinic bonuses? Are these individual compensations that 

occur? And, how do you hold staff accountable to ensure that these 

incentives are earned in an appropriate manner? What do you have 

in place to make sure that the gaming of the system is not occurring? 

Dr. PETZEL. What you are referring to, I think, Senator, is the 

performance awards that are given at the end of the year, and each 

senior executive has a performance contract that has many, many 

elements, one of which, a subset of which, may relate to access. It 

could be stated in a variety of different ways. Has access improved, 

and then the percentage of improvement. Very few of them would 

state the absolute. Most of them are statements of what has been 

the improvement. So, it is a part of a much more comprehensive 

evaluation system for senior executives. 

Senator HIRONO. But, if you do not have accountability systems 

in place, I think it certainly encourages the kind of activities that 

we are scrutinizing today. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you very much. 

Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Thank you, Mr. Chairman. Thanks for holding 

this important hearing, which I hope is the first of many, many 

hearings. 

Mr. Secretary, as you know, I occupied a Cabinet post for a part 

of my career. There are some Cabinet posts, as you know, by their 

nature, that are kind of a lightening rod. If you are going to be the 

50 

Attorney General or the Secretary of State, you are going to get 

fired at every day. It is just part of the job description. The VA, 

on the other hand, in my judgment, does not fit into that category. 

And the other thing about VA is, because of the Ranking Member 

and Chair and those who preceded them, it is a pretty nonpartisan 

committee. We do not sit around and talk about Republican or 

Democrat stuff. We talk about how to improve the lives of veterans 

who have served our country. And I have always applauded that. 

I think that we need more of that in Washington and not less. 

The other thing I would mention is that there have been tough 

budget cycles. We know that. And yet, you, yourself, have come to 

this Committee many times and said you are resourcing us appropriately and generously under the circumstances and we thank you 

for that. We applaud you for that. So, then I look at this stuff and 

I go, what the heck? 

Mr. Secretary, one of the submissions we got from the American 

Legion was a map. Have they shared that with you, or has that 

come to your attention? 

Secretary SHINSEKI. I think I may have seen a copy of that last 

evening. 

Senator JOHANNS. This map is entitled, ‘‘Epidemic of VA Mismanagement,’’ and it goes down through Burlington, VT, Pittsburgh, PA, Durham, NC, Columbia, SC, Augusta, GA, Atlanta, GA, 

Jackson, MS, Chicago, IL, St. Louis, MO, Austin and San Antonio, 

TX, Cheyenne, WY, Fort Collins, CO, Phoenix, AZ, just place after 

place where the American Legion has thrown up their hands and 

said, my goodness, what the heck is going on here? Do you dispute 

what they are saying in this map? Do you think they are saying 

something here that is not true? 

Secretary SHINSEKI. I am not aware of the basis for that map, 

but I accept that there are places that are listed here where we 

have had adverse events, and I would also point out that, I do not 

know if in all, but in a good number, maybe a majority of those 

events, they were self-identified, initiated from within the Veterans 

Administration, Veterans Health Administration, which then allows us to go and investigate, figure out what happened, get to the 

root causes, and then be transparent, tell people what happened. 

Senator JOHANNS. But, here is where I am going with this. So 

many hearings I have come to where we have talked about the 

waiting lists and the disability claims, just kind of one thing after 

another. I just walk out of the hearing like I have been given an 

explanation so I will quiet down and let you go back to work, yet 

I do not see the change that is necessary. And, what worries me 

about this and what worries me about what we are dealing with 

here is it is systemic. It is cultural. It is people have just adopted 

this mode of operation as the way of doing business. 

Do you share my concern? Do you feel that VA culture is such 

that every rule you put out, even after this, you say, OK, folks, 

from now on, we are going to do A, B, C, and D. That is an order. 

It comes from the very top, the Secretary. Do you fear that people 

say, how do we game that? How do we get around that? 

Secretary SHINSEKI. I am sure someplace in a large organization, 

you are always going to have something like that, but this is part 

of the reason why I engage the Veterans Service Organizations on 

51 

a near-monthly basis. If there are any straight shooters here, it 

will be them in terms of being direct with this Secretary. This is 

why I have spent a good bit of time traveling the country, going 

to our facilities and talking to them about what is important and 

engaging veterans in those locations, as well. 

The voices that are most important to me are the voices of the 

veterans I encounter out there, and I will say there is an occasional 

concern that is voiced to me, which I always bring back and go to 

work on. But I have not received that systemic look that is being 

described. 

There is a distinction between a medical mistake and manipulation or cooking the books. In the case of a medical mistake, I want 

people to stand up and say, hey, something is wrong here. Something is not working, or we made a mistake, or I made a mistake. 

To do that, you have to have the confidence and honesty on the 

part of the workforce. And in many of those examples cited on that 

map, that is what initiated our concern. Manipulation, we will get 

to the bottom of. 

Senator JOHANNS. Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Johanns. 

At this point, I would like to offer Senator Begich the opportunity 

to speak. Senator Begich, do you have some questions? 

Senator BEGICH. Thank you, Mr. Chairman. I just wanted to 

catch that first vote as we were getting ready. 

First, again, I want to thank you all very much for being here. 

Thank you for the work we have done in Alaska. Let me just say 

that some of the comments I want to follow up on that other Members have had, but let me first start with one. I am struggling here, 

I will be very frank with you, Mr. Secretary. I have—again, all the 

good work we have done in Alaska to really go after some of these 

issues. Even though we are a small State, we have been able to accomplish some things that, I think, have made an improvement in 

delivery of services for veterans. And to remind folks, having 

77,000 veterans is a huge amount in Alaska. 

But, the bigger issue, as I was listening to Senator Burr’s note 

of the 4-year memo and regarding identification of the issues that 

talked about scheduling and other issues, we talked about trust a 

little bit earlier. That is important, that we have trust with delivery of services and that we trust the people who are delivering the 

services at VA. 

But, if you have—and, I will tell you from my time as mayor, if 

you have people that have been identified to have manipulated 

records, I will tell you from the city side, we would fire them—— 

Secretary SHINSEKI. Yes. 

Senator BEGICH [continuing]. Because we lost trust. If they are 

cheating, they are not trustworthy. If you just transfer them to another part of the government, then they just perpetuate what they 

have done, maybe in a different field. 

So, my question is—I know you talked about the 3,000 people 

you have moved, dismissed, retired, whatever—but I want to know 

specifically on this issue, have you ever fired anybody on this issue, 

when you find out that they manipulated the records? To me, it is 

the fundamental question, because if it is just shifting around, then 

we are not changing the system to improve it. Help me—and if you 

52 

cannot answer that right now, I do want an answer later, because 

this, to me, is a fundamental issue. As a former mayor, we would 

fire them. They would be gone. 

Secretary SHINSEKI. I would have to give you an answer that 

looked out across the specific reasons that we released 3,000 people, Senator. Manipulation, a very specific—this is something, for 

me, more recent. Without getting ahead of decisions, I would say 

manipulation of data, of the truth, is serious with me—— 

Senator BEGICH. Would you fire them? 

Secretary SHINSEKI. I will do everything I can within the—— 

Senator BEGICH. That is not the question. I understand—— 

Secretary SHINSEKI. There is a process here, Senator. Let me not 

get out ahead of it, so that, in the end, it gets reversed because of 

predetermination. 

Senator BEGICH. OK. Let me ask you this, then. 

Secretary SHINSEKI. Yes. 

Senator BEGICH. In the last—since that last document, was it 

Schoenhard’s—William Schoenhard’s? I cannot remember the 

memo, but—— 

Secretary SHINSEKI. Schoenhard. 

Senator BEGICH [continuing]. That report—— 

Secretary SHINSEKI. Right. 

Senator BEGICH. Clearly, that report identified some people who 

have been doing some manipulation. So, the question is, from that 

report—let us not talk about the future for a second. Let us talk 

about that report. Was anyone fired for that activity? 

Secretary SHINSEKI. I do not know. I had not seen that memorandum, but I would say if there was any manipulation that identified individuals, I would expect to have seen their names in that 

list of 3,000, and that is what I cannot tell you today. I need to 

do some research. 

Senator BEGICH. Can you submit that for the record? 

Secretary SHINSEKI. I will. Let me just ask Dr. Petzel if he has 

any better insight. 

Senator BEGICH. OK. 

Dr. PETZEL. I do not have any specific information, Senator 

Begich, but we can go back and try to determine whether or not 

that has occurred. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Senator BEGICH. Because if we are going to try to rebuild the 

system—and again, I want to say that we saw this problem in 

Alaska when I first came in. We had backlogs on claims. We had 

scheduling issues. We had a lot of things. But we took—we went 

after it, right; we went after it jointly to figure out how to do this. 

We did MOUs with the Alaska Native Health Clinics. We went 

after it with the Care Closest to Home program, which I know is 

going to run out of money at the end of this fiscal year if we are 

not careful. There were a variety of things we went after to try to 

fix, so, I know we can fix this problem. 

But, we still have challenges, and I think the biggest challenge 

is holding people accountable for actions that they manipulated or 

they redrafted the records to make them look better. Without accountability we are never going to solve this problem. And someVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
53 

times, you have got to have some heads roll in order to get the system to shape up, because sometimes if they think, well, I am just 

going to get transferred, or I am on leave and I still get paid, what 

is the real penalty? I can just tell you, again—— 

Secretary SHINSEKI. We are not in disagreement here, Senator. 

Senator BEGICH. Great. OK. I just wanted to hear that clearly. 

And let me again say, Mr. Chairman, I know this is just one of 

many opportunities we will have. I know you are waiting for the 

IG report. That will give us some more opportunity. I am hopeful 

that IG report, when it comes out, that there will be immediate action based on the report, not a further study of the report. When 

the IG says, here are the problems, we need to get after them, because if we do not get after them, the VAs in this country and in 

Alaska will be the ones who lose out at the end of the day. And 

I think you recognize that the veterans will be on the back end of 

this. Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Begich. 

Senator Burr wanted 2 minutes. I will take 2 minutes, as well, 

and those will be the last questions before we hear from the veteran service organizations. 

Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

Mr. Secretary, in your testimony, you said, ‘‘I invited an independent investigation by they VA Office of Inspector General to 

conduct a comprehensive, thorough, timely review. If any allegations are true, they are completely unacceptable to veterans, to me, 

and to our dedicated VHA employees. If they are substantiated by 

the OIG, responsible and timely action will be taken.’’ How do you 

define responsible and timely action? 

Secretary SHINSEKI. There is a process to be able to implement 

those findings—decisions regarding those substantiated findings. I 

will tell you, it will be as aggressive and swift as I can make it. 

But, there is a process here that is not entirely under my control. 

Senator BURR. Mr. Secretary, I am sure you are aware of the IG 

report that was released April 17 of last year regarding the mismanagement of inpatient mental health care at the Atlanta VA 

medical center, because Senator Isakson and Dr. Petzel went personally and addressed it. And, I am sure you are aware of the IG 

report regarding the unexpected patient deaths in a substance 

abuse residential rehabilitation treatment program in the Miami 

VA Health Care Center, because that was released on March 27, 

2014. 

In the IG’s testimony that Mr. Griffin will give later, it says that 

in both Miami and Atlanta, as the reports indicate, standard steps 

to ensure veterans were kept safe while under VA control were not 

taken and two veterans died. In each instance, VA managers did 

not ensure the hospital staff performed their jobs. 

One, I would assume that you find Miami and Atlanta unacceptable, and if you will, tell me what we have done in a responsible 

and timely manner to remediate that problem. 

Secretary SHINSEKI. Dr. Petzel. 

Dr. PETZEL. In Atlanta, Senator Burr, there have been seven disciplinary actions, including the retirement or removal of three senior officials. 

54 

Senator BURR. And Miami? 

Dr. PETZEL. And Miami is still in process, but we will do this as 

quickly as we are able to do. 

Senator BURR. Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Burr. 

I have two questions in my brief time. Question number 1, you 

have heard serious problems about wait times in various locations 

around the country. I think Dr. Petzel informed us that in the last 

few years, we have seen 2 million additional veterans coming into 

the system. Is that correct, Dr. Petzel? 

Dr. PETZEL. Two million new patients have arrived since 2009, 

with a net increase of 1.4 million. 

Chairman SANDERS. OK. And, I would suspect some of those patients are coming in with some serious problems in terms of PTSD, 

TBI, and difficult issues, yes? 

Dr. PETZEL. Yes, sir. 

Chairman SANDERS. All right. So, let me ask you a very simple 

question. To what degree does VA not have the resources to address that increase in patients? Are a lot of patients coming in to 

certain parts of the country and are we seeing waiting lists because 

you simply do not have the resources? What is the answer? 

Dr. PETZEL. The—may I—Mr. Chairman? The ability to, as I 

have said earlier, the ability to provide appropriate access to these 

groups of veterans depends on several things. One is the people. Do 

we have enough people? 

Chairman SANDERS. Right. 

Dr. PETZEL. Two, are we using these people most effectively. 

Chairman SANDERS. Right. 

Dr. PETZEL. And, three, are we using all the other things that 

are available to us—telehealth—— 

Chairman SANDERS. Right. 

Dr. PETZEL [continuing]. The fee basis program, et cetera. 

Chairman SANDERS. Those are the issues. What is the answer? 

Dr. PETZEL. Yes. One of the things that we are going to do is we 

are going to look at those places that are having access difficulties 

as a result of this audit and make a determination as to whether 

or not we have adequate resources there. My feeling now, my 

thought now, is that we do, but we need to look carefully at those 

places where we are having access issues to see if it is a resource 

problem. 

Chairman SANDERS. All right. Let me simply conclude, and we 

are going to get to the—— 

Secretary SHINSEKI. Mr. Chairman? 

Chairman SANDERS. Yes? 

Secretary SHINSEKI. May I add, this is not a once and done, or 

whenever we have a crisis, we do. This is an ongoing set of looks 

at ourselves. 

Chairman SANDERS. OK. 

Secretary SHINSEKI. Our patient load grows each year and the 

complexity of the issues, as you have described. So, this is an ongoing assessment that we try to get in the budget process so there 

is an orderly decisionmaking. 

55 

Chairman SANDERS. My time has expired. Let me thank both of 

you very much for being here, and I would like to call up our second panel. 

[Pause.] 

Chairman SANDERS. The VA is a little bit different than other 

agencies because, while it obviously serves and represents all of the 

people in our country, it has a very special constituency, who are 

men and women who have put their lives on the line to defend 

their country. Those are the people who utilize VA every day. And 

today, we are very pleased to have representatives from many of 

the major veterans service organizations here with us and I thank 

them all very much for being here. 

We are all interested to hear about your members’ experiences 

with VA health care services. You know more about it because your 

members access the system every day, so we look forward to hearing your suggestions and your criticisms. 

I would like to remind each of you to keep your oral presentation 

to 5 minutes, and, of course, your full statement will be included 

in the record of the hearing. 

Our guests today are Daniel M. Dellinger, who is the National 

Commander of The American Legion; Joseph A. Violante, the National Legislative Director for Disabled American Veterans; Tom 

Tarantino, Chief Policy Officer for Iraq and Afghanistan Veterans 

of America; Carl Blake, who is the National Legislative Director of 

Paralyzed Veterans of America; D. Wayne Robinson, President and 

CEO of Student Veterans of America; Ryan Gallucci, Deputy Director, National Legislative Service, Veterans of Foreign Wars of the 

United States; and Rick Weidman, Executive Director for Policy 

and Government Affairs of Vietnam Veterans of America. 

I want to thank all of you for your honorable military service and 

for being with us today. 

Commander Dellinger, we will begin with you, please. 

STATEMENT OF DANIEL M. DELLINGER, NATIONAL 

COMMANDER, THE AMERICAN LEGION 

Mr. DELLINGER. Good afternoon. Yesterday, we learned of a veteran in Vermont who died while trying to get mental health care 

from his local VA. His wife complained he would have to wait for 

hours, just to be bounced around to different counselors. The American Legion expressed our concern about this very issue before the 

House Veterans’ Affairs Committee at the beginning of April and 

again before this Committee at the end of April. Our testimony is 

a matter of public record. 

Chairman Sanders, Ranking Member Burr, and distinguished 

Members of this Committee, on behalf of the 2.5 million members 

of The American Legion plus another million of our Auxiliary and 

Sons family members, thank you for holding this hearing and inviting me to share the views of the largest Veterans Service Organization in the Nation. 

Two days ago, I was in Phoenix, AZ, where I hosted a Veterans 

Hall meeting—a System Worth Saving—which lasted almost 4 

hours. Attended by over 200, 62 spoke passionately about scheduling issues, overmedication, and various other concerns at the hospital. I will be happy to discuss the details of that meeting with 

56 

you during the question and answer period if you would like to 

hear more about that information gathering session. 

I am here today to help you understand why The American Legion believes VA needs to address specific deficiencies and also to 

let you know that The American Legion fully supports the Department of Veterans Affairs. 

We supported the creation of the Veterans Administration in 

1930 and fought hard to get VA elevated to Cabinet-level in 1989. 

We donate hundreds of thousands of hours each year to VA, along 

with millions of dollars, and have scores of claims representatives. 

We helped fund a brain research center in Minnesota and are currently representing three-quarters of a million veterans as they file 

their claims with VA. Make no mistake about it, The American Legion believes in the VA. 

The allegation of secret waiting lists at Phoenix Department of 

Veterans Affairs Medical Center that are now being investigated, 

along with the 40 or more patient deaths, have rocked the veterans’ 

community. In addition to Phoenix, we now understand at least six 

additional VA locations have been identified as participating in veteran patient wait time manipulation. 

The allegations in Phoenix were not the only reason The American Legion decided to call for a leadership change at the VA. They 

were simply the final straw in a long list of systematic leadership 

failures that include: construction delays and cost overruns; patient 

deaths due to Legionella; patient infections due to unsanitary 

colonoscopy equipment and dental equipment; unacceptable wait 

times for colonoscopies, resulting in patient deaths; the abandonment of efforts to create a true unified and interoperable Joint 

Health Care Record for use by both the Department of Defense and 

Department of Veterans Affairs; VA’s refusal to answer Congressional inquiries; and VA’s witnesses’ failure to disclose all relevant 

truths when testifying before Congress. 

On Tuesday, we heard that Senator McCaskill is concerned 

enough about mismanagement and mental health waits at the St. 

Louis VA that she drafted a bipartisan letter with Senator Blunt 

to get to the bottom of it. The list continues to grow. 

When are things going to get better? It seems that a day cannot 

pass without a news report about the problems and difficulties VA 

faces with delays and quality of care challenges. While we wait for 

things to get better, hundreds of thousands of veterans are waiting 

for a decision on their initial disability claim or appeal, which prevents them from receiving VA health care. While we wait, 

transitioning servicemembers are falling through the cracks due to 

DOD and VA’s inability to create a single interoperative medical 

record. While we wait, officials in VA’s central office are preventing 

hospitals from being transparent during a crisis. While we wait, 

veteran suicides continue to plague our Nation at a rate of 22 per 

day, with no clear strategy from VA on proactively addressing suicides. 

Again, I would like to thank you for this opportunity to speak 

with you today and welcome your questions. 

[The prepared statement of Mr. Dellinger follows:] 

57 

PREPARED STATEMENT OF DANIEL M. DELLINGER, NATIONAL COMMANDER, 

THE AMERICAN LEGION

The Department of Veterans Affairs (VA) has come under scrutiny by Congress, 

Veteran Service Organizations, the media, and in the veterans’ community for its 

failures in leadership, performance, and accountability which have resulted in quality of care or patient safety issues that have directly affected veterans. If there is 

a lack of performance and accountability among a senior executive service employee, 

the only disciplinary actions the Secretary of Veterans Affairs can take are to issue 

reprimands or transfer VA senior executive service employees to other VA facilities, 

even if that lack of performance results in the death of a veteran. 

Chairman Sanders, Ranking member Burr, and distinguished Members of this 

Committee, thank you for inviting The American Legion to testify before you today 

and discuss our views on The State of Healthcare at the Department of Veterans’ 

Affairs. 

The allegations of secret waiting lists at the Phoenix Department of Veterans Affairs Medical Center that are now being investigated along with 40 or more patient 

deaths has rocked the veterans’ community. In addition to Phoenix, we now understand that at least six additional VA locations have been identified as participating 

in veteran patient wait time manipulation just this week. The allegations in Phoenix were not the only reason The American Legion decided to call for leadership 

change at VA, they were simply the final straw in a long list of systemic leadership 

failures that include: 

• Construction delays and cost overruns 

• Patient deaths due to Legionella 

• Patient infections due to unsanitary colonoscopy equipment and dental 

equipment 

• Unacceptable wait times for colonoscopies resulting in patient deaths 

• The abandonment of efforts to create a true, unified, interoperable joint 

healthcare record for use in the Department of Defense (DOD) and the Department 

of Veterans Affairs (VA) 

• VA’s refusal to answer congressional inquiries 

• VA witnesses failure to disclose all relevant truths when testifying before 

Congress 

And the list continues to grow. 

Veterans are frustrated and concerned with VA’s construction processes and the 

continued delays and cost overruns. Every day the construction goal is not met for 

medical centers in Denver, Orlando, or New Orleans, is a day VA is failing to take 

care of our Nation’s veterans. According to a Government Accountability Office Report—Cost Increases and Schedule Delays at the Four Largest Projects—‘‘cost increases ranged from 59 percent to 144 percent representing a total cost increase of 

nearly $366 million per project with average schedule delays ranging from 14 to 74 

months with an average delay of 35 per VA major construction project.’’ In one case, 

a hospital was completed, but they forgot to install an ambulance bay, which then 

had to be renegotiated, contracted for, and installed. 

During a Subcommittee on Oversight & Investigations hearing in November 2013 

on ‘‘Correcting Kerfuffles,’’ there were several complaints on the G.V. (Sonny) Montgomery VA Medical center that cited poor sterilization procedures. The hearing also 

mentioned that pieces of bone were still attached to surgical instruments that were 

being used on other patients. 

For nearly 18 years, the dental clinic at the Dayton VA Medical Center allowed 

unsanitary practices, potentially exposing hundreds of patients to hepatitis B and 

hepatitis C. Dayton VA Medical Center Director Guy Richardson then collected an 

$11,874 bonus despite an investigation into the exposures. After nine of the exposed 

patients tested positive Hepatitis B and Hepatitis C, Richardson was promoted. 

The American Legion has also spoken out recently regarding the billion dollar 

botched development of the iEHR—Individual Electronic medical Health Record 

project. After years of promises and more than a billion dollars wasted, VA simply 

walked away from the mission and started over in January by reissuing a new procurement request. The American Legion believes that the introduction of a joint Department of Defense and VA electronic health records would have all but eliminated 

the disability backlog already, yet as of May 6, 2014, 308,285 (52.3%) of all disability 

claims have been backlogged over 125 days. 

VA’s claims adjudication accuracy is questionable. The American Legion does not 

question the ethics of the accuracy, we question the formula utilized. The American 

Legion’s Regional Office Action Review (ROAR) conducts comprehensive and holistic 

58 

1http://www.va.gov/oig/pubs/VAOIG–12–04108–96.pdf 

2http://www.va.gov/oig/pubs/VAOIG–13–00636–104.pdf 

3http://www.va.gov/oig/pubs/VAOIG–13–00940–193.pdf 

4http://www.va.gov/oig/pubs/VAOIG–13–00505–348.pdf 

claims reviews, while VA’s review looks solely at the claim and not how it may 

interrelate with other service-connected conditions. 

Nearly three years ago The American Legion partnered with the White House and 

the VA to institute the Fully Developed Claim (FDC) pilot program. The goal for 

this initiative was for VA and American Legion Service Officers to submit claims 

that were complete and ready for a rating decision, and wasn’t absent any supporting evidence or documentation. VA agreed that they would then process these 

Fully Developed Claims within 90 days or less. Today, only four VAROs nationwide 

are meeting the objective for claims with Legion Power of Attorney (POA), four 

years after the publishing of the fast letter and nearing two years after nationwide 

implementation. Eight VAROs exceed 200 days on average with Legion POA. 

During one of our most recent ROAR visits earlier this year in Seattle, Undersecretary of Benefits Alison Hickey attempted to impede our ROAR team from attending the necessary meetings to satisfy the visit, and then did not allow the proper 

access for The American Legion to adequately complete the visit. As a result, The 

Chairman of the House Veterans’ Affairs Committee sent a letter to VA and offered 

to accompany The American legion on future visits. 

Local facilities are not empowered to address a crisis when it happens. With 152 

medical centers to look after nationwide, the VA cannot manage every crisis from 

Washington. Instead, The American Legion believes VA needs to empower its leadership at medical centers to respond to crises—quickly. With incidents such as the 

Legionella outbreak in Pittsburgh, the facility had a press release ready to disseminate but VA Central Office never approved it to be sent publicly. 

The allegations of secret wait lists in Phoenix have caught some by surprise, and 

some may call for caution, waiting until the results of VA’s Office of the Inspector 

General (VAOIG) are complete before leaping to conclusions about VA’s healthcare 

system. Unfortunately, Phoenix is not an isolated event, nor is it the first such 

event to be investigated by VAOIG. Between January 2013 and the present day, 

VAOIG has conducted 18 investigations in response to concerns about the VA 

healthcare system. The majority of these investigations dealt with delays in appointment scheduling,1 delays in lab results,2 and lapses in notifying patients of biopsy 

results.3 More serious investigations addressed patient deaths under emergency care.4

The veterans of The American Legion have a vested interest in ensuring that VA 

operates efficiently and we were instrumental in seeing that the VA became a cabinet position in the first place. We did so, in order that the Secretary would have 

the power and authority to serve and fight for the best interests of veterans through 

the second largest agency within the Federal Government. 

On Monday, May 5, 2014, American Legion staff scheduled a conference call with 

Dr. Mike Davies, National Director of Systems Redesign to discuss national wait 

times and was told three days later that Dr. Davies would not be able to meet with 

The American Legion until June. 

The American Legion has a dedicated team that travels around the country visiting VA hospitals, conducts veteran town halls, and speaks directly with VA 

healthcare and administrative staff. This program is overseen by our System Worth 

Saving Task Force, and had conducted visits over the past year to problem areas 

in Pittsburgh, Jackson, Atlanta, Augusta, and Columbia, South Carolina, as well as 

Phoenix, to attempt to understand the challenges these centers face while trying to 

provide the best possible healthcare to our Nation’s veterans. A brief overview of 

some of these visits can be found in addendum ‘‘A’’ of this testimony. 

Overwhelmingly, our taskforce finds that veterans are extremely satisfied with 

their healthcare team and medical providers. We also find that administrative oversight of VA operations is a constant concern and growing frustration among patients. We’ve found veterans who are happy when they can get care, but struggling 

with a system that makes it difficult even to get primary care appointments. While 

a veteran might wait more than two weeks for most primary care appointments, 

specialty care appointments can take many months or even years. And when it 

comes to informing patients of potential problems within the VA system, we find 

that local facilities are not empowered to interact with the community and are 

under restrictive communications lockdowns imposed by VACO. 

In addition to our System Worth Saving Taskforce, which is now in its 10th year, 

American Legion volunteers donate nearly 900,000 hours of service in VA facilities 

annually at a value of over $19 million, and maintain a network of over 2,900 acVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
59 

5http://brain.umn.edu/about—us.shtml 

6http://onpoint.wbur.org/2014/05/12/veterans-affairs-scandal-death 

7 Ibid—Dr. Foote 

8http://www.cbsnews.com/news/email-reveals-effort-by-va-hospital-to-hide-long-patient-waits/ 

9http://www.military.com/daily-news/2014/02/21/lawmaker-says-va-obstructed-legion-qualityreview.html 10http://www.cnbc.com/id/101187855 ‘‘There have been some public kerfuffles in the paper 

that don’t in my mind reflect the Jackson VA facility.’’ 

credited service officers who assist nearly three-quarter of a million veterans with 

their disability claims. Wherever veterans interact with VA, The American Legion 

is there attempting to work within the system to ensure that the VA continues to 

serve the best interests of veterans. Not only has The American Legion donated millions of dollars to create and support VA programs; we have even sponsored a brain 

research center that is named after us in Minnesota.5

Over the past two weeks The American Legion has received over 500 calls, emails, 

and online contacts from veterans struggling with the healthcare system nationwide. They cite concerns ranging from the common complaint of substantially delayed appointments, to an inability to receive specialty care. One parent of a veteran 

in Phoenix spoke painfully of losing their daughter while she waited for care, and 

one veteran reported calling his local VA medical center for an appointment only 

to be told ‘‘there are no appointments within the next 30 days, please call back in 

4 weeks to schedule an appointment.’’ Even if there is not a formal ‘‘secret’’ list at 

many of these facilities, administrative staff are finding a variety of ways to game 

the system. 

According to Dr. Sam Foote, one of the first whistleblowers to come forward regarding VA’s waiting list manipulation accusations, the attempts to create a work 

around on appointments grew out of a response to VA’s attempts to address scheduling problems6 (More information on this and other recent whistleblower complaints are attached as Addendum ‘‘B’’). Because there were previous complaints 

about lengthy wait times at VA facilities, VACO officials made changes to the appointment system to automate the process and prevent employees from lying about 

wait times. The new electronic system was designed to automatically enter the time 

the appointment was requested and provide a more accurate assessment of how long 

it was taking to find appointments for veterans. To circumvent this, VA employees 

developed strategies to wait until they could guarantee an appointment within two 

weeks, and only then enter the information into the electronic system.7

A VA employee in Cheyenne, Wyoming, provided documentation to CBS News 

that explicitly details how VA employees need to ‘‘game the system a bit * * * 

when we exceed the 14 day measure, the front office gets very upset, which doesn’t 

help us.8 ’’ There is a culture created, and enforced by leadership within VA that 

the most important measure is meeting the numbers. This is true whether in the 

Veterans Health Administration (VHA) or Veterans Benefits Administration (VBA). 

VA schedulers who can’t find appointments for veterans resort to keeping secret 

lists. VA claims workers who can’t keep up with the demanded number of claims 

per day shred vital documents that could help prove a veteran’s disability. 

A year later, as the problems continue to mount and the VA appears no closer 

to solutions, we sadly feel there must be change. VA is in need of a real reformer 

who is not afraid of exposing the full extent of the problems and bringing all stakeholders in to forge a VA for the 21st century and beyond. When Arlington National 

Cemetery was beset with a disgusting scandal involving mismarked graves in 2010, 

they brought in Kathryn Condon to right the ship. During the time of transition, 

Director Condon reached out to stakeholders including The American Legion for 

guidance and support. During the crisis, officials at Arlington did not dismiss further discovery of mismanagement issues but rather sought to expose everything 

while accepting responsibility, and then engaged stakeholders to express how they 

were amending the system to ensure these problems would never occur again at the 

Nation’s most prestigious resting place for our military fallen. The handling of the 

Arlington crisis is indicative of courageous leadership that owns their own failures 

and sincerely works to correct deficiencies. 

Unfortunately, the response from Undersecretaries Petzel and Hickey at VA has 

been to question those who would impugn VA’s reputation. When VA’s accuracy figures were questioned, VA’s response was to limit access of those who advocate for 

veterans,9 rather than sincerely attempt to reform the process and retrain employees to actually end the error prone processing practices. When allegations of dangerous medical practices emerged, Dr. Petzel’s first response is to be dismissive.10

The tone is consistent. The pattern is consistent. It is perhaps most telling that 

when The American Legion Health Policy Unit contacted the VACO staff responVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
60 

11http://www.cnbc.com/id/101187855 ‘‘There have been some public kerfuffles in the paper 

that don’t in my mind reflect the Jackson VA facility.’’ 12 U.S. Medicine Magazine, VA Leadership Lacks Confidence in New $145M Patient Scheduling System, May 2009 13GAO–10–579, Management Improvements Are Essential to VA’s Second Effort to Replace Its 

Outpatient Scheduling System, May 2010 

sible for the nationwide scheduling operations last week, that VA staff chose not to 

engage the community or work with stakeholders to better understand this problem. 

Instead VACO staff informed The American Legion they could not possibly schedule 

a meeting until sometime in June to discuss the topic. 

We can’t wait months for a solution. How many more veterans will die waiting 

to see doctors? Hearings, reports, analyses and testimonies won’t fix this. America’s 

veterans deserve a solution that starts today. 

The solution MUST include input in correct measures from the Department of 

Veterans Affairs, Congress and most importantly the stakeholders—it is absurd to 

make decisions about what veterans need in their healthcare system without consulting the veterans. As the Nation’s largest wartime service organization for veterans, The American Legion will not shy away from providing a voice for those 

veterans. 

For many years now, going back to the budget troubles of 2006, Congress has 

asked VA if they had the resources they need to accomplish their mission. All parties on the Hill, from both sides of the aisle, and both the Senate and House of Representatives, have made abundantly clear that even in this austere time of belttightening budget measures, if VA needed funds to provide proper care for veterans, 

they would find them the money they need. VA has consistently answered that they 

could execute their plan with the budget they had asked for, a budget usually increased by Congress in the final tally. If VA needs more to accomplish their mission, 

and many VSOs including The American Legion have questioned whether their 

budget meets their needs, they need leadership with the courage to be honest about 

those needs. 

The American Legion has testified in nearly every hearing before this Committee, 

and the House Committee on Veterans’ Affairs concerning the VA, in which stakeholder testimony is considered and has seen firsthand how the VA has stonewalled 

congressional requests for information. The American Legion has followed the investigations and requests for information with special concern, as VA has developed a 

pattern of unresponsiveness to Congress and crises while developing a tendency to 

downplay legitimate concerns of veterans that do not do service to the veterans in 

these communities. 

While addressing patient deaths at the Jackson VA Medical Center, Undersecretary Robert Petzel referred to the concerns dismissively as ‘‘kerfuffles 11 ’’ and in a 

subsequent follow up visit to that site by American Legion System Worth Saving 

Task Force members, the facility director was hampered from cooperating with the 

local veterans and American Legion by VA Central Office restrictions. During the 

January 2014 visit, facility director Joe Battle was unable to provide the action plan 

the facility was using to address problems with patient deaths. Director Battle stated he could not release the report because it had not been cleared by VACO. Repeated follow up requests for information to VACO officials by American Legion 

staff have been met with the response that VHA cannot release this information to 

The American Legion. 

The American Legion believes there must be corrective measures taken. There are 

several improvements VA could begin implementing to start addressing these 

issues. 

As we are now over a decade into the 21st century, The American Legion believes 

that VA should also begin implementing 21st century solutions to its problems. In 

1998, GAO released a report that highlighted the excessive wait times experienced 

by veterans trying to schedule appointments, and recommended that VA replace its 

VISTA scheduling system.12 To address the scheduling problem, the Veteran’s 

Health Administration (VHA) solicited internal proposals from within VA to study 

and replace the VISTA Scheduling System, with a Commercial Off-the-Shelf (COTS) 

software program. VA selected a system, and about 14 months into the project they 

significantly changed the scope of the project from a COTS solution to an in-house 

build of a scheduling application. After that, VHA ended up determining that it 

would not be able to implement any of the planned system’s capabilities, and after 

spending an estimated $127 million over 9 years, The American Legion learned that 

VHA ended the entire Scheduling Replacement Project in September 2009.13 We beVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00064 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
61 

lieve that this haphazard approach of fits and starts is crippling any hope of 

progress. 

It has now been over three years since VHA canceled the Replacement Scheduling 

Application project, and as of today, The American Legion understands that there 

is still no workable solution to fixing VA’s outdated and inefficient scheduling system. In 2012 The American Legion passed Resolution number 42 that asked the VA 

to implement a system ‘‘To allow VA patients to be able to make appointments online by choosing the day, time and provider and that VA sends a confirmation within 24 hours.’’ Last December, VA published an opportunity for companies to provide 

adjustments to the VISTA system through the Federal Register—all submissions are 

due by June 2013. While this is a laudable attempt to address the problem, it hardly 

seems sufficiently proactive given that the problem has been identified for over fifteen years, and excessive wait times are still being experienced by many veterans 

across the Nation. 

The American Legion recognizes that over the past decade, VA has taken some 

steps aimed at improving its scheduling and access to care; we believe that there 

is still much to be done. In order to adequately address the problems of veterans, 

The American Legion believes VA should adopt the following steps toward a 

solution: 

1. Devote full effort toward filling all empty staff positions. The problems with 

mental health scheduling clearly indicate how a lack of available medical personnel 

can be a large contributing factor to long wait times for treatment. Despite VA’s efforts to hire 1,600 new staff, as recently as last month VA was noting only two 

thirds of those positions had been filled. This does not even address the previous 

1,500 vacancies, and stakeholder veterans’ groups are left to wonder if VA is adequately staffed to meet the needs of veterans. 

We believe they are not. 

If VA needs more resources to address these staffing needs, The American Legion 

hopes they will be forthright and open about their needs, and ask for the resources 

they need to get the job done. The Veteran Service Organizations and Congress have 

been extremely responsive to get VA the resources they need to fulfill their mission, 

but VA must be transparent about what their real needs are. 

2. Develop a better plan to address appointments outside traditional business 

hours. With the growing numbers of women veterans who need to balance family 

obligations and other commitments, our veterans’ abilities to meet appointments 

during regular business hours is greatly hampered. The American Legion believes 

VA can better address the community’s needs with more evening and weekend appointment times. American Legion Resolution number 40 calls on the VA to provide 

more extended hour options, and believes VA should recruit and hire adequate staff 

to handle the additional weekend and extended hour appointments for both primary 

and specialty care. 

3. Improve the IT solution. Last year The American Legion also passed resolution 

number 44, which called on the VA to create a records system that both VBA and 

VHA could share to better facilitate information exchange. A common system could 

even synchronize care visits in conjunction with compensation and pension examinations. We had hoped such a system might be included in the improvements brought 

by the Virtual Lifetime Electronic Record; however VA and DOD appear to be content to pursue individual legacy systems for that project, so veterans must continue 

to contend with VBA and VHA systems that do not communicate as well as they 

should. In any case, as VA looks outward for a solution to their scheduling program, 

all can agree that the current system is not serving the needs of veterans and needs 

to be updated. 

4. The American Legion urges Congress to enact legislation that provides the Secretary of Veterans Affairs the authority to remove any individual from the senior 

executive service if the Secretary determines the performance of the individual warrants such removal, or transfer the individual to a General Schedule position at any 

grade of the General Schedule the Secretary determines appropriate. 

5. The American Legion supports legislation and congressional oversight to improve future Department of Veterans Affairs (VA) construction programs, and urges 

VA to consider all available options, both within the agency and externally, to include, but not limited to the Army Corps of Engineers, to ensure major construction 

programs are completed on time and within budget. 

There is still room for VA to improve their triage processes. The current consult 

management program needs work to ensure it is providing better triage for veterans 

in need of life saving procedures. Primary Care Providers have relayed to American 

Legion System Worth Saving Task Force members concerns that the current triage 

62 

14http://www.cbsnews.com/news/email-reveals-effort-by-va-hospital-to-hide-long-patient-waits/ 

process has bureaucratic hurdles which make the process frustrating and presents 

a challenge to retaining top quality Primary Care Providers. 

Furthermore, regarding VA’s current 14 day wait policy, review of this policy is 

necessary to determine whether the enforcement is causing problems. The goal to 

see veterans in a timely manner is crucial; however, care must be taken to see how 

the regional facilities are viewing the policy. If they are reluctant to report longer 

wait times up to VACO because of fears of being ‘‘put on a Bad List’’ as relayed 

in the Cheyenne email,14 then a reassessment of the culture that breeds this attitude is warranted. The observance by VACO of lengthy wait times at a facility 

should trigger questions to VACO about whether the facility is adequately staffed 

and resourced to meet the needs of the community. VISNs struggling to meet timeliness standards need to be assessed to determine if they have the tools to treat the 

veterans in their communities. 

Finally, revision of these standards is only as good as the integrity of staff you 

hire and accountability and transparency for those who break the rules should be 

disclosed. VA should put a map on their Web site of hospitals that had issues and 

what corrective actions were taken to include disciplinary actions such as transfers 

or reprimands. Veterans ought to be able to see there is a top down and bottom up 

culture of accountability. That is how to restore trust in the system to the veterans’ 

community. 

The American Legion thanks this Committee again for their commitment to seeking answers about the troubling trends emerging in VA. The commitment of all parties to ensuring veterans receive quality healthcare in a safe environment is a sacred duty. Questions concerning this testimony can be directed to The American Legion Legislative Division (202) 861–2700, or lcelli@legion.org. 

ADDENDUM A 

HIGHLIGHTS FROM THE AMERICAN LEGION’S RECENT

SYSTEM WORTH SAVING TASK FORCE VISITS

2013 

Pittsburgh, Pennsylvania (Site Visit Nov. 5–6) 

• After persistent management failures led to a deadly Legionnaires’ disease outbreak in the VA Pittsburgh Healthcare System, VA Pittsburgh director Terry Gerigk 

Wolf received a perfect performance review and regional director Michael Moreland, 

who oversees VA Pittsburgh, collected a $63,000 bonus. 

Nashville, TN (SWS Visit Nov 13–15) 

• Tennessee Valley Healthcare System struggles to fill critical leadership positions across multiple departments. These gaps could cause communication breakdowns between medical center leadership and staff that work in these departments. 

El Paso, TX (SWS Visit Nov. 18–20) 

• The current situation with the future of William Beaumont Army Medical Center is uncertain and troubling for veterans in the area, and veterans need to know 

where they will be able to receive their health care. 

Huntington, WV (SWS Visit Dec. 9/11) 

• Huntington VAMC has found it difficult to recruit talent (surgeons/physicians) 

due to pay freezes, a lack of bonuses/retention incentives, and the geographical location of the hospital. 

Leavenworth, KS (SWS Visit Dec. 9/11) 

• Due to the age of the Leavenworth campus (83 years-old), space is an issue. Additionally, because the Kansas Historical Society has designated the Leavenworth 

campus as a historical site, there are limitations on what infrastructure changes can 

be made. 

2014 

Roseburg, Oregon (Site Visit Jan.9–10) 

• An active Legionnaire from American Legion Post 61 in Junction City, went to 

the Roseburg VA Medical Center this past June for what should have been a routine 

hernia operation. After the surgery, Roseburg VA Medical Center staff told the veteran’s daughter, that her father’s blood pressure had ‘‘dropped suddenly and he was 

having difficulty breathing.’’ Since the Roseburg VA Medical Center does not have 

63 

an Intensive Care Unit, the veteran was taken to PeaceHealth Sacred Heart Medical Center at Riverbend in Springfield, Oregon. Unfortunately, the veteran passed 

away en route PeaceHealth Sacred Heart Medical Center due to ‘‘intra-dominal 

bleeding, shock, hyperkalemia, acidosis, respiratory failure and recent ventral hernia surgery.’’ 

• The American Legion is not comfortable with the current status of the medical 

center following the closure of their Intensive Care Unit. The American Legion recommends that VARHS consider one of the three alternatives: fully reinstating the 

Intensive Care Unit, standing down all surgical procedures, or strengthening their 

Memorandum of Understanding with Mercy Medical Center to ensure that an Intensive Care Unit bed will be available in case of emergency, which includes remaining 

without an ICU and continue to perform ambulatory procedures that meet the strict 

criteria established by the VA as appropriate for facilities without an ICU. 

Jackson, Mississippi (Site Visit Jan. 21–22) 

• At the G. V. Sonny Montgomery VA Medical Center in Jackson, MS, multiple 

whistleblower complaints have been raised by employees who were losing confidence 

in the medical center’s ability to treat veterans. The complaints ranged from improper sterilization of instruments to missed diagnoses of fatal illnesses, as well as 

hospital management policies. 

Butler, Pennsylvania (Site Visit Jan. 8–9) 

• An attorney for the prime contractor of a Department of Veterans Affairs outpatient center being built in Butler County declined to comment Friday, July 12, 

2013 about the VA’s investigation of the contractor that led the agency to stop work 

on the $75 million project. 

• The VA Butler Healthcare Center was scheduled to open in 2015, but the termination of the lease left its future in doubt. The VA broke ground on the center in 

April 2013. The Department of Veterans Affairs yanked its lease with an Ohio company that was building a $75 million health center for vets in Butler, accusing the 

firm of ‘‘false and misleading representations’’ during bidding. The VA ordered work 

halted in June when it began to uncover problems with the project. 

• The Department of Veterans Affairs failed to properly check the qualifications 

of the former developer of an outpatient center in Butler County, according to a 

highly critical report by the VA’s Office of Inspector General released Monday. The 

report says the VA improperly calculated that a 20-year lease with Westar Development Co., valued at $157 million, would be cheaper than the VA building and owning the $75 million outpatient center on its own. 

Atlanta, Georgia (Site Visit Jan. 28) 

• Despite four preventable patient deaths, three of which VA’s inspector general 

linked to widespread mismanagement, former Atlanta VA Medical Center Director 

James Clark received $65,000 in bonuses over four years. Additionally, the facility’s 

current director, Leslie Wiggins, maintains that no employees responsible for the 

mismanagement linked to the deaths should be fired. 

Orlando, Florida/Denver, Colorado (Orlando SWS Visit-Feb.11–12, 2014) (Denver 

SWS Visit-May 13–14) 

• Costs substantially increased and schedules were delayed for Department of 

Veterans Affairs’ (VA) largest medical-center construction projects in Denver, Colorado; Las Vegas, Nevada; New Orleans, Louisiana; and Orlando, Florida. As of November 2012, the cost increases for these projects ranged from 59 percent to 144 

percent, with a total cost increase of nearly $1.5 billion and an average increase of 

approximately $366 million. The delays for these projects range from 14 to 74 

months, resulting in an average delay of 35 months per project. In commenting on 

a draft of this report, VA contends that using the initial completion date from the 

construction contract would be more accurate than using the initial completion date 

provided to Congress; however, using this date would not account for how VA managed these projects prior to the award of the construction contract. Several factors, 

including changes to veterans’ health care needs and site-acquisition issues contributed to increased costs and schedule delays at these sites. 

Dallas, Texas (SWS Visit Feb 4–5) 

• Dallas VA Medical Center Director Jeff Milligan and regional director Lawrence 

Biro have received a combined $50,000 in bonuses since 2011 despite a series of allegations from VA workers, patients and family members regarding poor care at the 

facility as well as more than 30 certification agency complaints against the medical 

center in the last three years. 

64 

Hot Springs, SD (SWS Visit Feb 17–19) 

• The VA Black Hills Healthcare System (VABHHS) is going under a reconfiguration proposal which is opposed by the local community. The issue is whether relocating services from the Hot Springs VA Medical Center to the Fort Meade VA Medical Center and the domiciliary to Rapid City are in the best interest of veterans. 

This would require veterans to travel further to receive their health care. 

Augusta, Georgia (Site Visit Mar. 11–12) 

• CNVAMC leadership first learned of delays in providing gastrointestinal (GI) 

services to veterans on August 30, 2012. Of the 4,580 delayed GI consults, a quality 

management review team determined 81 cases for physician case review. Seven of 

the 81 cases may have been adversely affected by delays in care. Six of seven institutional disclosures were completed and three cancer-related deaths may have been 

affected by delays in diagnosis. Factors contributing to the 4,580 patient backlogs 

included an explosion of baby boomers turning 50 and requiring screening, the medical center’s non-anticipation of a spike in GI consult demand, lack of an integrated 

database for tracking GI procedures, and GI physician recruitment challenges. 

Columbia, South Carolina (SWS Visit April 15, 16) 

• In September 2013, six deaths were linked to delayed screenings for colorectal 

cancer at the veterans medical center in Columbia, S.C., the Veterans Affairs Department reported. The VA’s inspector general determined that the William Jennings Bryan Dorn VA Medical Center fell behind with its screenings because critical 

nursing positions went unfilled for months. It also found that only about $275,000 

of $1 million provided to the hospital to alleviate the backlog had been used over 

the course of a year. 

ADDENDUM B 

RECENT DEVELOPMENTS

• Former employee, Dr. Sam Foote, claimed the Phoenix system is afflicted by 

‘‘gross mismanagement of VA resources and criminal misconduct ‘‘that produced 

‘‘systemic patient safety issues and possible wrongful deaths.’’ 

• Foote and other employees alleged a variety of other institutional breakdowns 

in Arizona’s VA, including: 

• Medical recordkeeping so backed up the system is 250,000 pages behind, and 

millions of records reportedly are missing. 

• A compromised mental-health system where patient suicides doubled in the 

past few years, while staff suicides also emerged as a serious concern. 

• A swamped emergency room that becomes the last resort for veterans who cannot get appointments with primary-care doctors or specialists. In some cases, VA 

health system employees have told the newspaper, vets with life-threatening conditions have waited hours without diagnosis or treatment because nurses are overworked and undertrained. 

• Discrimination, cronyism and security breakdowns in the VA police department 

that endanger the safety of patients and employees. 

• Hostile working conditions that caused an exodus of quality doctors and nurses, 

producing backlogs in specialty areas such as urology, where bladder cancer and 

other serious diseases are detected. Patients reportedly are referred to out-of-state 

VA centers or private physicians for treatment. 

• On Sunday, April 27, 2014, a second whistleblower, Dr. Katherine Mitchell reported that ‘‘patient appointment records in the Phoenix VA Health Care System 

were in danger of being destroyed.’’ 

• On Sunday, May 4, 2014, a whistleblower reported that clerks at the Department of Veterans Affairs clinic in Fort Collins, Colorado were instructed in 2013 

how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency’s goal of 14 days. 

• The VA’s official policy is that all patients should be able to see a doctor, dentist 

or some other medical professional within 14 days of their requested/preferred date. 

Any wait longer than two weeks is supposed to documented. 

Yet on Friday, May 9, 2014 Brian Turner, a Veterans Affairs scheduling clerk 

based in San Antonio, said that some who called to make appointments at his facility did end up waiting longer, yet such delays were never reported. 

For example, he said, they might be told the next available appointment wasn’t 

for several months. It would be scheduled for then, but marked in official files as 

if the patient had put off their appointment until then by choice. 

65 

‘‘What we’ve been instructed was that—they are not saying fudged, there is no 

secret wait list—but what they’ve done is come out and just say ’zero out that 

date,’ ’’ Turner said. The ‘‘zero,’’ in this case, suggests the patient didn’t have to wait 

at all. 

‘‘It could be three months and look like no days [wait],’’ he added. ‘‘It looked like 

they had scheduled the appointment and got exactly what they wanted.’’ 

66 

ADDENDUM C 


88349aC.eps
67 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

THE AMERICAN LEGION

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Thank you very much, Commander 

Dellinger. 

Mr. Violante. 

STATEMENT OF JOSEPH A. VIOLANTE, NATIONAL 

LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS 

Mr. VIOLANTE. Chairman Sanders, Ranking Member Burr, and 

Members of the Committee, thank you for inviting DAV to testify 

today about the state of VA health care. 

DAV remains deeply concerned about allegations that VA employees or management took actions that obscure the true picture 

of access problems at some VA facilities. We fully support the ongoing investigation by the Inspector General and will demand full accountability for anyone found to have violated the law or failed to 

follow and enforce VA rules and regulations. 

We also support Secretary Shinseki’s initiative to audit all VA facilities to determine whether similar problems are occurring. However, we strongly recommend the VA include outside third-party 

experts to increase its objectivity and credibility and help regain 

the full trust of veterans and the American people. 

Mr. Chairman, while no health care system is perfect and medicine is far from an exact science, veterans have earned the right 

to expect the VA Health Care System to provide high-quality medical care. While it may be weeks or months before the investigations and audits are completed, we continue to have confidence 

that VA, led by Secretary Shinseki, can and will correct any problems identified or uncovered. This Secretary has a track record of 

directly and honestly confronting problems and working with 

stakeholders to correct them. 

Mr. Chairman, we continue to believe that VA provides highquality health care for the vast majority of veterans treated each 

year and that veterans are now and will be better served in the future by a robust VA Health Care System than any other model of 

care. The real challenge facing VA and the root cause of the problems being reported today have to do with access to care rather 

than the quality of care delivered. 

For the past decade, DAV and our partners in the Independent 

Budget (IB) have pointed out funding shortfalls in VA’s medical 

care and construction budgets. In the prior ten VA budgets, funding for medical care provided by Congress was more than $5.5 billion less than the IB recommended. For fiscal year 2015, the IB 

recommends over $2 billion more than VA requested. I would point 

out that you, Mr. Chairman, did call for an increase of $1.6 billion 

for fiscal year 2015, but based on available information today, it 

68 

appears your Senate colleagues will not significantly increase the 

administration’s inadequate request, just as the House already 

failed to do. 

Similarly, over the past decade, funding requested by VA for construction and the amount appropriated by Congress has been more 

than $9 billion less than the IB recommendations. For fiscal year 2015, the VA budget request is $2.5 billion less than the IB recommendation, which was based upon VA’s own analysis. We agree 

with your views and estimate letters for the past 2 years, Mr. 

Chairman, where you stated that the administration’s budget request for construction has been, ‘‘clearly insufficient to meet the 

identified needs,’’ but unfortunately, Congress took no action to increase construction funding. 

Finally, VA needs to better utilize its purchased care authority. 

DAV believes that whenever an enrolled veteran is unable to receive care directly from VA within established timeframes, VA 

must take responsibility to find alternative means to provide and 

coordinate such care. However, since each dollar used to pay for 

non-VA care is one dollar less that is available to hire new VA staff 

required to treat veterans in a timely manner, VA must provide accurate estimates of the additional funding required and Congress 

must appropriate those dollars. 

Even with sufficient funding, how will non-VA care be coordinated with VA care? Are there even sufficient qualified providers 

available in each community? Simply giving a veteran a plastic 

card and wishing them good luck in the private sector is no substitute for a fully-coordinated system of health care. 

Mr. Chairman, looking at VA today and putting it into proper 

perspective against the entire American system of health care, we 

continue to have confidence that veterans are well served by seeking their care from VA. We remain confident that VA and Secretary Shinseki, working with stakeholders and Congress, can, will, 

and must address these challenges. American veterans deserve 

nothing less. 

Thank you. 

[The prepared statement of Mr. Violante follows:] 

PREPARED STATEMENT OF JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR, 

DISABLED AMERICAN VETERANS

Chairman Sanders, Ranking Member Burr, and Members of the Committee: 

Thank you for inviting DAV to testify today about ‘‘The State of VA Health Care.’’ 

As the Nation’s largest veterans service organization comprised completely of wartime disabled veterans, no one has more interest or greater experience and expertise 

when it comes to the quality and timeliness of health care provided to veterans by 

the Department of Veterans Affairs (VA). 

DAV is dedicated to a single purpose: empowering veterans to lead high-quality 

lives with respect and dignity. Our 1.2 million members—all of whom were wounded, injured or made ill through their military service—rely heavily on VA for some 

or all of their physical and mental health care needs. We have an enormous stake 

in making certain that VA continues to provide high-quality health care, and that 

it does so in a timely manner. 

Mr. Chairman, while I am pleased to be here today to share some insights about 

what DAV members see, hear and experience firsthand at VA’s 1,700 points of care, 

the circumstances that precipitated this hearing are troubling indeed. DAV remains 

deeply concerned about allegations of secret waiting lists, falsification of medical appointment records and the destruction of official documents that may have occurred 

in Phoenix, Arizona; Fort Collins, Colorado; Cheyenne, Wyoming; Austin, Texas; and 

potentially, other sites as well. These reports raise troubling questions about whethVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
69 

er VA employees or management took actions that, whether by design or not, obscured the true picture of access problems at some VA facilities, whether proper procedures concerning scheduling and wait list were followed, and whether any laws 

were broken. 

We fully support the ongoing investigation by the Inspector General and look forward to receiving and analyzing its results and conclusions. We will demand full 

accountability for anyone found to have violated the law or failed to responsibly follow and enforce VA’s rules and regulations, no matter who or where they are inside 

VA. 

We also support Veterans Affairs Secretary Shinseki’s initiative to audit all VA 

facilities immediately to determine whether similar scheduling issues or waiting list 

problems may be uncovered. We expect that this audit will bring greater accuracy 

to assess the number of veterans waiting to receive different services at each VA 

facility. We strongly recommend that VA bring in outside, third-party experts to increase the objectivity and credibility of this audit process in order to help regain the 

full trust of veterans and the American people. Further, it is imperative that VA 

release all data, information, findings and conclusions of this audit to both Congress 

and the public in a fully transparent manner. We stand ready to provide any assistance to VA that can help in achieving these objectives. 

Mr. Chairman we also take very seriously recent news reports that raise questions about whether VA’s inability to provide timely access to certain health care 

services may have caused or contributed to negative patient health outcomes or 

even deaths. Such grave questions must be aggressively pursued by VA as well as 

by outside experts to determine their validity. While no health care system is perfect, and medicine is far from an exact science, veterans have earned the right to 

expect the VA health care system to provide medical care at the highest level, equal 

to if not better than private sector care. Furthermore, when problems and challenges arise, as they will from time to time in all health care systems, VA must act 

swiftly, transparently and effectively to correct the problems and overcome the challenges. In the coming weeks, we will closely monitor how well and how quickly VA 

responds to these serious questions and allegations. 

Unlike private providers and health care systems, VA is required by its own policy 

to admit and publicly report all medical errors and fully investigate all untimely 

deaths. VA uses the information from these investigations for self-improvement and 

to strengthen prevention protocols system wide. To be effective, VA must have sufficient internal monitoring and reporting systems that detect and report problems 

rapidly through the chain of command in order to correct them and develop prevention strategies nationwide. These recent revelations indicate that there are troubling 

gaps in this reporting system that need to be addressed. 

Although it may be weeks or months before we have all the results of the ongoing 

investigations and audits, we continue to have confidence that VA, led by Secretary 

Shinseki, can and will correct any problems identified or uncovered. This Secretary 

has a track record of directly and honestly confronting problems that he has inherited or that were uncovered during his tenure, and then working with Congress and 

stakeholders to correct them. For example, after decades of inaction and inattention, 

the Secretary laid out a bold course four years ago to finally modernize the VA disability claims processing system, a transformation that has already reduced the 

backlog of disability compensation claims by about half in the past year. Similarly, 

when IT problems interrupted payments to thousands of student veterans under the 

new Post-9/11 GI Bill, VA leadership moved aggressively to confront and resolve the 

problems, building an entirely new IT system in less than 13 months. When access 

to mental health services became a crisis a couple of years ago, at the direction of 

the Secretary, VA rapidly hired an additional 1,600 mental health professionals, 952 

peer counselors, 300 support personnel, and increased staffing for the Veterans Crisis Line (1–800–273–8255) by 50 percent, to break down stigma barriers and increase access. 

Mr. Chairman, let me be clear, by no means have all of VA’s problems been solved 

or challenges overcome, nor is it yet clear the full scope of the problems that may 

be uncovered by current investigations and audits into waiting times and alleged 

preventable deaths. However, based on our experience, we continue to have full confidence that the Secretary can and will confront any such problems directly and honestly, just as he has throughout his career. For our part, we stand ready to work 

with him, this Committee and others in Congress to openly investigate problems, 

honestly discuss constructive solutions, and collaboratively work to fix them. 

Moreover, let me emphasize one point on which we are resolute: the VA health 

care system is both indispensable and irreplaceable; there is no substitute for it. 

Based upon our collective knowledge and experience, we continue to believe that VA 

provides high-quality health care for the vast majority of veterans treated each year, 

70 

and that veterans are now and will be better served in the future by a robust VA 

health care system than by any other model of care. The real challenge facing VA, 

and the root cause of the issues being reported today, have to do with access to care 

rather than the quality of care that is delivered. 

Mr. Chairman, as I stated at the outset, DAV and our members are not just observers of the VA health care system, but active consumers of it. Our testimony reflects both current research and analysis as well as the collective experience of our 

professional staff, which includes over three hundred National Service and Transition Service Officers and nearly two hundred hospital coordinators covering every 

VA medical center. We also have thousands of Department and Chapter Service Officers and leaders who use VA and work directly with millions of veterans enrolled 

in the system. Our transportation network, which provides more than 770,000 rides 

for veterans to and from VA health care facilities each year, is another point of contact that we have with which to assess the State of VA Health Care. There are also 

1.2 million DAV members across the Nation who regularly receive care at VA’s 

Community-Based Outpatient Clinics (CBOCs), medical centers and other facilities. 

Let me assure you that when our members see, hear or personally experience problems at VA, we hear from them at our meetings, during our conventions, in phone 

calls, via email and on Facebook. It is from this broad and diverse base of knowledge and expertise that we come to our conclusions. 

VA today operates nearly 1,700 sites of care including 152 hospitals, almost 900 

community-based and mobile outpatient clinics, 300 Vet Centers for psychological 

counseling and other facilities that provide vital health care and services to millions 

of veterans. VA provides medical services to more than 6 million veterans annually, 

out of almost 9 million enrolled in the VA system. For more than a decade, numerous independent auditors and analysts have concluded that the quality care provided by VA is equal to or better than similar care provided by private sector systems and at lower costs to the taxpayer. The 2013 American Customer Satisfaction 

Index reported that veterans themselves ranked VA hospitals among the best in the 

Nation with equal or better ratings than private hospitals. This is not to imply that 

VA faces no challenges or that no problems occur within the VA system. However, 

it is important to put in context the quality of care delivered by VA compared to 

private sector alternatives. 

The VA health care delivery model provides comprehensive, patient-centered and 

evidence-based care that leads the Nation in many areas. VA’s clinical research program has elevated the American standard of care and invented cutting edge devices 

and treatment techniques that have improved the lives of millions of veterans and 

non-veterans in areas such as spinal cord injury, blind rehabilitation, amputation 

care, advanced rehabilitation (such as polytrauma and Traumatic Brain Injury), 

prosthetics, Post Traumatic Stress Disorder, substance-use disorder, multiple sclerosis, diabetes, Alzheimer’s, Parkinson’s and dementia. VA’s model of care emphasizes preventive strategies that elevate the quality of life for millions of veterans 

while reducing health care costs overall. With its focus on preventative medicine, 

life-time care of veterans in a patient-centered model and the use of low-cost, bulkprocured medications, VA is able to provide high-quality care for less than the cost 

of Medicare and private sector providers. 

It is worth noting that in addition to providing high-quality health care to veterans, VA is also the largest single provider of health professional training in the 

world. Each academic year, VA helps train over 100,000 students in the health professions through its academic affiliation with 152 schools of medicine and over 1,800 

schools in total. 

Mr. Chairman, to better understand why the VA health care system is so uniquely suited to veterans’ needs today, it is useful to look at how the current system 

evolved. Twenty years ago, VA was still based upon the post-World War II model 

of care, with large hospitals located in major cities providing primarily inpatient 

care. At that time, VA based eligibility for services on inpatient admission status 

and routine care was often delivered in major medical centers at very high cost, and 

in often inconvenient locations and times for an increasingly suburban population. 

In the mid-1990s, with the approval of Congress, VA leadership developed a new 

paradigm that decentralized the delivery of health care and with the help of Congress reformed eligibility allowing more veterans to receive comprehensive care. As 

a result, hundreds of CBOCs were opened in every state over the next decade and 

millions of veterans living in suburban, rural and remote areas now found VA a convenient provider of high-quality care. In addition, as VA moved to a model of care 

that emphasized preventative services and focused on the comprehensive health 

care needs of veterans, both the quality and cost-efficiency of care dramatically increased. In addition, VA built a forward-looking electronic medical record system 

that contributed to the efficiency and safety of the system. Within a decade, VA was 

71 

being hailed as the ‘‘best care anywhere’’ by major independent studies, publications 

and by author Philip Longman, who wrote a book by that name. 

Today, VA has undertaken another major step forward by evolving the system to 

a patient-centered care model focusing on the needs of veterans, rather than VA 

processes. We believe that VA is on the right path forward and that the vast majority of veterans receiving medical services from VA receive high-quality care. The 

real challenge facing VA is providing all veterans seeking medical care with access 

to the VA system. 

As we have testified consistently over the past decade, we continue to find that 

access remains a problem for too many veterans at too many VA facilities. Based 

on our information, not all facilities have access problems and even at those that 

do, it may only be related to some of the services they provide. We have heard often 

from VA employees and sometimes local VHA leadership that there have been shortfalls in staffing or resources that forced them to take actions limiting services 

sought by veterans. There is now a growing body of evidence validating our concerns. For example, in December 2012, GAO investigated reports of long wait times for 

outpatient medical appointments and found that the metrics provided by VHA were 

‘‘unreliable.’’ Furthermore, GAO found that VHA’s scheduling policy and training 

documents were ‘‘unclear’’ and led to inconsistent reporting of wait times. They also 

found that scheduler training was inconsistent from one VA facility to the next. 

GAO made four recommendations that VA generally agreed with, and VA outlined 

an implementation with target dates of March 30 and November 1, 2013. We expect 

to hear from VA today if, when and how these plans were implemented, and the 

results from those changes. 

Investigations have also been reported in the news media regarding scheduling 

problems and possible violations of VA policies identified by the VA Office of Medical Inspector, and the Office of Special Counsel over the past year regarding access, 

scheduling and waiting times. Again, we look to VA to forthrightly address those 

management and administrative issues with specific responses. 

However, improved administrative procedures and management can only address 

part of VA’s access challenges. The ability of VA to provide veterans timely access 

to medical care is primarily driven by four factors: how many medical personnel are 

available to provide medical care (resources), how much usable space is available 

to treat veterans (infrastructure), can VA leverage health care capacity in the community (purchased care), and can VA produce accurate and valid data to properly 

manage access issues (metrics). 

Mr. Chairman, for the past decade, DAV and our partners in The Independent 

Budget (IB) have consistently testified before this Committee and others about 

shortfalls in VA’s medical care and construction budgets. In the prior ten VA budgets, the amount of funding for medical care requested by the Administration and 

ultimately provided to VA by Congress was more than $5.5 billion less than what 

was recommended by the IB. Over the past five years, the IB recommended $3.5 

billion more than VA requested or Congress approved and for next year, FY 2015, 

the IB has recommended just over $2 billion more than VA requested. I would point 

out that you, Mr. Chairman, did call for an increase of $1.6 billion for FY 2015 medical care funding, which we believe is fully justified, but based on available information today, it appears that your Senate colleagues will not significantly increase the 

Administration’s inadequate request, just as the House failed to do. 

Even worse, the funding shortfalls that we have consistently pointed out have 

been exacerbated by annual budget gimmicks that replace actual dollars to be appropriated with ‘‘projected’’ savings from proposed ‘‘management efficiencies’’ and 

‘‘operational improvements.’’ As GAO has consistently pointed out, VA’s projections 

of such future ‘‘savings’’ have rarely, if ever, been documented or substantiated, 

leaving VA facilities short of the funding needed to provide medical care to all veterans using the system. A similar problem occurs when VA also replaces appropriated dollars in their budget requests with anticipated collections from third party 

insurers. When the actual amounts collected through the Medical Care Collection 

Fund (MCCF) fall short of the projected levels, as has been the case almost every 

year, VA is once again forced to make do with less than its actuarial model estimates is needed to provide care to enrolled veterans. If just these two ‘‘gimmicks’’ 

were removed from the budgets proposed by the Administration and subsequently 

approved by Congress, VA would have had significantly greater resources, billions 

more, with which to increase staffing and better address access issues that have become so prevalent now. 

Mr. Chairman, in your Views and Estimates letter to the Senate Budget Committee last year you made this same point when you said, ‘‘based upon operational 

efficiencies identified as cost savings in previous VA budgets, I am concerned there 

72 

will be a similar shortfall next fiscal year.’’ You went on to express concerns about 

the ‘‘* * * potential impact that failing to achieve the identified costs savings may 

have on VA’s provision of health care.’’ Unfortunately, neither the Senate nor the 

House heeded this advice and we find ourselves today in this dilemma. 

The second challenge in access, and over the long term probably the greatest challenge that must be addressed, is providing VA sufficient resources to properly maintain, realign or expand its infrastructure. Over the past decade, the amount of funding requested by VA for major and minor construction, as well as the final amount 

appropriated by Congress, has been more than $9 billion less than what the IB has 

estimated was needed to continue delivering timely, high-quality care. Over the past 

five years, that shortfall is more than $6 billion and for next year, the VA budget 

request is more than $2.5 billion less than the IB recommendation. Furthermore, 

the IB recommendations are primarily based upon VA’s own internal analysis of 

funding needed to maintain VA’s existing physical infrastructure. 

According to VA’s Strategic Capital Investment Plan (SCIP), VA needs to invest between $56 to $69 billion in facility improvements over the next ten years; however, the Administration’s budget requests have averaged between $1 to $1.5 billion 

for major and minor construction over that time. Again, Mr. Chairman, I want to 

commend you for pointing out this fact in your Views and Estimates letters the past 

two years. You very honestly stated that the funding level proposed by the Administration for construction and maintenance has been ‘‘clearly insufficient to meet the 

identified needs * * *’’ Unfortunately, as with medical care funding, neither your 

Senate colleagues nor the House took actions to increase funding for VA’s construction and maintenance accounts, ignoring not just the IB’s recommendations, but 

VA’s own internal SCIP analysis. 

Mr. Chairman, a little over a decade ago, VA faced a similar and serious crisis 

over access to VA health care, as hundreds of thousands of veterans were found 

waiting six months or longer just to receive primary care medical appointments. The 

root cause of that situation also was insufficient resources to meet the actual demand for services. Even after VA moved to close its doors to new Priority 8 veterans, the shortfall in funding soon became unmanageable. By 2005, shortly after 

testifying before this Committee and the House Veterans’ Affairs Committee that 

the Administration’s budget was sufficient, then-VA Secretary Jim Nicholson was 

forced to return to Congress and admit that there was a shortfall of about a billion 

dollars, which Congress subsequently appropriated. Only after the funding levels for 

medical care were increased closer to the levels recommended by the IB did the wait 

lists finally begin to decline. Today it appears that VA may once again be approaching that same dangerous crossroad; unless the Administration begins to request 

more adequate funding, and/or unless Congress starts to increase insufficient funding requests, the growing problems related to access will continue. And no amount 

of administrative or management changes, or replacement of VA leadership, can 

begin to make up for the $15 billion shortfall identified by the IB over the past decade. 

The third challenge is for VA to utilize its purchased care authority when necessary to supplement and bolster the VA health care system. DAV believes that 

whenever an enrolled veteran is unable to receive care directly from VA within established timeframes, VA must take responsibility to find alternative means to provide and coordinate such care, regardless of where the veteran lives. 

In the near term, VA must to do a better job of providing non-VA care when VA 

is unable to provide timely care. The determination of which and how many veterans receive care paid for by VA is left to the discretion of each facility; however 

they must balance the fact that funding to purchase care comes out of the same pot 

of money for direct VA health delivery. Each dollar used to pay for non-VA care is 

one dollar less that is available to hire new VA staff required to treat veterans in 

a timely manner. If the VA’s purchased care program is to truly function as intended, the first step is for VA to provide accurate, complete and transparent estimates of the amount of funding required to purchase care from the private sector. 

Once VA provides an accurate estimate, Congress must appropriate the amounts 

necessary to support both VA provided and purchased care if we are to avoid rationing care. 

However, even with sufficient funding, there remain many questions to be answered and challenges to be overcome before VA’s purchased care program can be 

successful. For example, how will non-VA care be coordinated with VA care so that 

the holistic needs of the veterans are met? How will non-VA providers integrate 

their medical records into VA’s electronic health record system so that there is 

seamless record keeping ensuring integrated care and patient safety? Even if VA 

has the resources to pay for non-VA care, are there sufficient, qualified providers 

available in each community to provide such care? Simply giving a veteran a plastic 

73 

card and wishing them good luck in the private sector is no substitute for a fully 

coordinated system of health care. 

The fourth challenge is even with sufficient infrastructure and resources, VA can 

only manage and improve what they can measure. VA currently uses the Medical 

Scheduling Package (MSP), a component in its VistA electronic health record (EHR) 

system, to perform multiple interrelated functions to coordinate clinical and administrative resources as well as to capture data that allows VA to measure, manage, 

and improve access to care, quality of care, operating efficiency, and operating and 

capital resources. VA’s current MSP is more than 26 years old and does not meet 

current requirements or provide the flexibility to support new and emerging models 

of care. 

On October 16, 2012, VA announced its intention to replace the current MSP by 

open competition for a product that effectively performs VA’s scheduling and related 

legacy business functions. The winners of the competition were announced on October 3, 2013; however, no plans have been made public about next steps or when an 

actual replacement will occur. VA must quickly come forward with a detailed plan 

to replace and modernize their scheduling software, including an accurate estimate 

of all the funding and other resources needed to make it operational. In addition, 

this new system should have the capability to provide real-time measures of waiting 

times on a facility-by-facility basis and other metrics needed for effective management. In addition, VA must develop a public method or regularly reporting such 

data to Congress, veterans and the American public, similar to how the Veterans 

Benefits Administration reports detailed data about claims processing timeliness 

and accuracy. 

Mr. Chairman, looking at the VA health care system today, and putting it into 

the proper perspective of the entire American system of health care, we continue 

to have confidence that the vast majority of veterans are well served by seeking 

their care at the VA. We recognize that there continue to be access problems at 

some locations for some services, and there are troubling questions about how VA 

has responded to these problems that must be answered. In addition, there are serious questions about whether access challenges have led to negative health outcomes 

or even untimely deaths. And while we believe that VA can and must address any 

administrative or management challenges related to scheduling, the underlying 

problem has been and remains one of insufficient resources to meet veterans’ needs. 

Until and unless both the Administration and Congress openly and honestly work 

to align VA’s resources to veterans’ needs for care, problems related to access, such 

as waiting lists, will remain a threat to the health of veterans. However, we remain 

confident that VA and Secretary Shinseki, working together with stakeholders and 

Congress, can, will and must address these challenges. America’s veterans deserve 

nothing less. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

DISABLED AMERICAN VETERANS

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Thank you very much, Mr. Violante. 

Mr. Tarantino. 

STATEMENT OF TOM TARANTINO, CHIEF POLICY OFFICER, 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

Mr. TARANTINO. Chairman Sanders, Ranking Member Burr, and 

distinguished Members of the Committee, on behalf of Iraq and Afghanistan Veterans of America, I thank you for this opportunity to 

share our views and recommendations regarding the current state 

of health care with VA. 

74 

For nearly a decade, IAVA has been a tireless leader, working on 

behalf of veterans and their families to ensure that VA meets the 

needs of our community. After spending 13 years at war, VA has 

been confronted with significant challenges administering timely 

care and services to veterans. Many have been overcome, but still, 

clearly, far too many remain. 

In the past few weeks, serious allegations of misconduct have 

arisen from several VA medical facilities, indicating that records 

are being intentionally doctored in order to falsely portray patient 

wait times as reasonable and satisfactory. Disturbingly, long wait 

times are alleged to be the result of 40 deaths, 40 veterans who 

perished while waiting for care at the Phoenix VA medical facility 

alone, and since Phoenix, more allegations of misconduct at other 

facilities from coast to coast are painting a similar picture. Unfortunately, these types of incidents are not new, nor are they apparently unique. 

It is time for bold reform and new measures of accountability and 

oversight. Our members are outraged and expect substantive and 

meaningful evidence that longstanding inefficiencies are being appropriately addressed and appropriate VA personnel are being held 

accountable. Veterans must be assured that VA can deliver quality 

care in a timely manner, and veterans are tired of business as 

usual. 

IAVA also expects VA to fully comply with the subpoena issued 

by the House Committee on Veterans’ Affairs. Full and swift compliance with this subpoena will be a good first step in not only figuring out what happened in Phoenix, but demonstrating how allegations of misconduct will be addressed at other VA facilities. 

And, just like the Secretary, we are also awaiting the results of 

the Inspector General’s investigation of alleged misconduct in Phoenix, but we cannot sit around idle while the investigation is underway. We applaud the full audit of all 1,700 points of care at VA. 

However, we expect results and action in weeks, not months. Additionally, we support and encourage concurrent investigations that 

are completely independent of VA. 

Veterans need to see the Secretary step out in front on this issue 

and lead. We want a proactive Secretary, not a reactive one. Controlling the public message is critical, and if the Secretary cannot 

do it, veterans and the American public will continue to lose faith 

in the VA system. Accountability is a fundamental principle necessary for any organization to properly function, yet, VA’s incidence 

of mismanaged care would indicate that such a thing is missing 

from all levels at VA. 

Secretary Shinseki has finally started to emerge publicly and address these allegations, but we need to be clear that short-term reactive measures will not eradicate the most pervasive problems 

causing veterans to lose faith in this system. VA has a long way 

to go to earn back the confidence of millions of veterans shaken by 

this growing controversy. 

Although recently exposed by whistleblowers, allegations of long 

wait times at VA are actually nothing new. The GAO has conducted numerous studies over the last decade touching on scheduling inefficiencies at VA and their findings continue to center 

75 

around lack of oversight, inadequate training, ambiguous policies 

and procedures; in other words, weak leadership. 

Now, long wait times are one thing. Essentially, they are a management and process problem. They can be solved with a combination of people and time and resources, and more effective business 

practices. They are solvable as long as good leaders have the tools 

and information they need to fix it. That does not seem to be the 

case here. Instead of leaders coming forward to fix the system, they 

appear to be fixing the books. This is indicative of a culture of 

failed oversight and no accountability. 

Now, reasons for highlighting VA mismanagement and bureaucratic flaws are not taken lightly, nor should they be. The worst 

thing that can happen in our community is a sense that VA is so 

inefficient and terrible at administrating care that veterans lose 

faith in the system designed to take care of their needs. Now, the 

right answer to this is not to cover up problems in VA, but to solve 

them or keep them from happening in the first place. 

And this is not just a matter of communication, it is a matter of 

lives. Of the estimated 22 veterans who die by suicide per day, 17 

have not sought care at VA. Despite VA’s many problems, seeking 

care works and can save lives. It is absolutely critical that veterans 

who need care feel encouraged to seek it. 

In order to improve the system of care and reassure veterans 

about VA’s capabilities, legislation such as the Suicide Prevention 

for American Veterans Act and the VA Management Accountability 

Act should be enacted into law immediately. Our membership and 

the veterans community as a whole need to be reassured by VA 

and the Congress that, despite these issues, VA is there to serve 

them and that any charges of misconduct will be addressed and 

swiftly corrected. 

We also need to ensure that we know the full scope of mismanagement and cover-up at the VA system. This is why IAVA is 

proud to work with the Project on Government Oversight to protect 

VA whistleblowers. VA employees can come forward confidentially 

by going to VAoversight.org. 

Mr. Chairman, we, again, appreciate the opportunity to offer our 

views on this critically important and urgent topic. We look forward to continuing to work with you, your Committee, your staff, 

and VA to improve the lives of veterans and their families. Thank 

you for your time and attention. 

[The prepared statement of Mr. Tarantino follows:] 

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PREPARED STATEMENT OF IRAQ & AFGHANISTAN VETERANS OF AMERICA


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RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO IRAQ & 

AFGHANISTAN VETERANS OF AMERICA (IAVA) 

IRAQ & AFGHANISTAN VETERANS OF AMERICA, 

June 30, 2014 

Hon. JON TESTER, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR SENATOR TESTER: Iraq & Afghanistan Veterans of America is pleased to provide the following answers to the question for the record you sent to us following 

the May 15 hearing entitled ‘‘The State of VA Health Care’’ before the Senate Committee on Veterans Affairs: 

Question 1. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. There are currently over 22.4 million veterans living in the United 

States, but only 8.9 million are currently enrolled in the Veteran Health Administration according to VA. VHA currently uses multiple platforms and strategies to 

conduct outreach to veterans, but the fact that less than half of eligible veterans 

are connected with VHA raises concerns that current outreach efforts are not 

enough. 

Congress has directed VHA to provide outreach to specific veteran populations 

such as homeless veterans, elderly veterans, woman veterans and eligible dependents of veterans via legislation. VHA also uses staff to directly contact veterans 

using telephone and mailers to provide information on benefits however, these 

methods are inefficient. Additionally, VHA also disseminates information to veterans via press releases and social media, including on platforms like Twitter 

(44,300 followers) and Facebook (124,500 likes). While VHA’s use of social media to 

reach out to its target audience is commendable, the combined total of just over 

168,000 social media followers is far below what the outreach goals of VHA should 

be. 

VHA is on the right track by expanding its outreach efforts into the social media 

sphere, but the department can certainly do more to grow and expand its social 

media presence. In addition to using these web 2.0 platforms, VHA should also 

bring in more Iraq and Afghanistan-era veterans who understand the target outreach audience. Finally, VHA should partner with both traditional veteran service 

organizations and newer, hybrid veteran advocacy groups to help vouch for and 

spread the word about VA benefits and services. 

If you have any additional questions, please don’t hesitate to reach out to me or 

to our Legislative Director, Alexander Nicholson. 

Thank you again for giving IAVA the opportunity to offer our analysis and the 

views of our members as the Committee continues to consider and debate this very 

important issue for the military and veteran community. 

Respectfully, 

THOMAS A. TARANTINO, 

Chief Policy Officer. 

Chairman SANDERS. Thank you, Mr. Tarantino. 

Carl Blake is the National Legislative Director, Paralyzed Veterans of America. Mr. Blake. 

STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE 

DIRECTOR, PARALYZED VETERANS OF AMERICA 

Mr. BLAKE. Chairman Sanders, Ranking Member Burr, and 

Members of the Committee, on behalf of Paralyzed Veterans of 

America, I would like to thank you for the opportunity to testify 

today on the state of health care delivered by the Department of 

Veterans Affairs and the spinal cord injury system of care. No 

group of veterans understands the full scope of care provided by 

VA better than PVA’s members, veterans who have incurred a spiVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00084 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
81 

nal cord injury or a dysfunction. PVA members are the highest percentage users of VA health care. 

Let me begin by saying that PVA is deeply disappointed by the 

number of reports from around the country that suggest that veterans’ health care is being compromised. There are undoubtedly serious access problems in the VA. 

I would like to associate myself with the comments made by Senator Isakson and Senator Begich regarding gaming the system, and 

for all intents and purposes, cheating the standard. If that is going 

on, and when cases are found when that is going on, serious and 

appropriate action should be taken. If that means people have to 

be fired, so be it. That is what has to happen. 

However, we believe that a thorough analysis to understand the 

depth of the situation across the system should be completed before 

any final decisions about VA leadership are made. At this time, 

PVA fully stands behind Secretary Shinseki. We believe he is committed to fixing these problems and he should be afforded the opportunity to get it right. 

I would like to emphasize, however, that the narrative that has 

been created by the media does not necessarily reflect what is happening inside the walls of the VA Health Care System. If the Committee really wants to gauge what is going on and how the quality 

of care is being delivered, I would ask you to spend a day walking 

around inside a local VA hospital talking to veterans and discussing their health care experiences, not sitting in front of a prescreened, pre-selected panel of veterans to support sweeping generalizations and to stoke public outrage. 

The fact is that VA health care services, by and large, are excellent. Patient satisfaction surveys of VA support that assertion. 

The primary complaint that we hear all of the time from veterans is how long they had to wait to be seen for an initial appointment or to receive care. At its core, this is an access problem, not 

a quality of care problem. These are not the same thing. 

And, to be clear, sending veterans outside of the VA to get private care is not the solution to this problem. It might be part of 

a solution. It is not the solution, particularly for veterans who rely 

on VA’s specialized services. The fact is that there are not comparable services in the private sector to VA’s SCI service, blinded 

care, amputee care, and the wide variety of specialized care that 

the VA provides. 

Our written statement provides a snapshot of VA’s spinal cord 

injury system of care. We have clearly identified serious staffing 

shortages that exist in the SCI service, particularly on the nurse 

staffing side. The site visits that we have conducted with our medical services teams for nearly three decades provide us the unique 

authority to affirm those problems. Unfortunately, those staffing 

shortages severely limit access to the system while also placing the 

health care delivery for veterans at risk. 

Insufficient staffing, and by extension insufficient capacity, is ultimately a reflection of insufficient resources that this administration and previous administrations have requested for health care 

and insufficient resources that Congress has ultimately provided. 

The Independent Budget, co-authored by PVA, AMVETS, DAV, and 

the VFW, has made recommendations to adequately fund VA 

82 

health care for 28 years. For the last several years, Congress has 

essentially ignored our recommendations. And now, here we are 

discussing, how could this have all happened? 

I would agree with Senator Johanns, who indicated, you know, 

what the heck is going on, when he looks at this and considers the 

budgets that have been requested. 

I would suggest that the great irony of this hearing today is the 

discussion about whether the OIG adequately funded to do these 

investigations. Is the VA Health Care System adequately funded to 

deliver timely, quality care? I would suggest the answer to that 

question is no. Until the Congress and the Administration commit 

to providing truly sufficient resources to hire adequate staff and establish real capacity, the problems being reported around the country will only get worse. 

The Administration and Congress both bear the responsibility of 

these problems. Veterans pay the costs, sometimes with their lives, 

of inaction resulting from partisan bickering and political gridlock. 

Political interests do not come before the needs of the men and 

women who have served and sacrificed for this country. 

We call on this Committee, Congress as a whole, and the Administration to redouble your efforts to ensure that veterans get the 

absolute best health care provided when they need it, not when it 

is convenient. PVA members and all veterans will not stand for 

anything less. 

I thank you again, Mr. Chairman. I would be happy to answer 

any questions that you might have. 

[The prepared statement of Mr. Blake follows:] 

PREPARED STATEMENT OF CARL BLAKE, ACTING ASSOCIATE EXECUTIVE DIRECTOR FOR

GOVERNMENT RELATIONS, PARALYZED VETERANS OF AMERICA

Chairman Sanders, Ranking Member Burr, and Members of the Committee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to testify today on the current state of health care provided by the Department of Veterans Affairs (VA) and the spinal cord injury and disorder (SCI/D) system of care. 

No group of veterans understands the full scope of care provided by the VA better 

than PVA’s members—veterans who have incurred a spinal cord injury or dysfunction. PVA members are the highest percentage of users among the veteran population. They are also the most vulnerable when access to health care and other challenges impact quality of care. I will first offer PVA’s thoughts on the specialized 

services provided by the VA, particularly in the area of SCI/D care, and then I will 

focus my remarks on the VA health care system in general. 

THE VA SPINAL CORD INJURY/DISORDER SYSTEM OF CARE

The SCI/D system of care is one of the crown jewels of the VA health care system. 

Spinal cord injury care is provided use the ‘‘hub-and-spoke’’ model. This model establishes the 24 spinal cord injury centers that exist with the VA system as the 

hubs of care. All other major medical facilities in the system serve as outpatient 

clinics (spokes) that direct and refer care back to the hubs. This model has proven 

to be very successful in meeting the complex needs of PVA’s members. In fact, this 

model system of care has been so successful that the VA used the same model to 

establish the poly-trauma system of care. 

Unfortunately, the ability of the SCI/D centers to function properly is dictated by 

the numbers of qualified SCI/D trained staff that are employed within the system. 

As a result of frequent staff turnover and a general lack of education and training 

in outlying ‘‘spoke’’ facilities, not all SCI/D patients have the advantage of referrals, 

consults, and annual evaluations in an SCI/D center. 

This is further complicated by confusion as to where to treat spinal cord diseases, 

such as Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS). Some SCI/ 

D centers treat these patients, while others deny admission. We recognize that there 

is an ongoing effort to create a continuum of care model for MS, and this model 

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should be extended to encompass MS and other diseases involving the spinal cord, 

such as ALS. Ultimately, we believe admission to an SCI/D center is the most appropriate setting for treatment for all SCI/D veterans. 

In December 2009, VA developed and published Veterans Health Administration 

Handbook 1011.06, Multiple Sclerosis System of Care Procedures, which clearly identifies a model of care and health care protocols for meeting the individual treatment 

needs of SCI/D veterans. However, VA has yet to develop and publish a Veterans 

Health Administration (VHA) directive to enforce the aforementioned handbook. 

Without a directive, the continuity and quality of care for both SCI/D veterans and 

veterans with MS could be compromised. The issuance of a VHA directive for the 

handbook is essential to ensuring that all local VA medical centers are aware of and 

are meeting the health care needs of SCI/D veterans. Additionally, and perhaps 

most importantly, no dedicated funding has been provided to VA medical centers to 

implement the guidelines in the handbook. However, we believe that the current 

SCI/C system can appropriately handle all SCI/D veterans if properly resourced. 

Additionally, historical data has shown that SCI/D units are the most difficult 

places to recruit and retain nursing staff. Caring for an SCI/D veteran is physically 

demanding and requires nursing staff to provide hands-on care that involves bending, lifting, and stooping in order to transfer patients, prevent bed sores, and deliver 

care to individuals who are completely reliant on another individual for functions 

and activities that most people take for granted. These repetitive movements and 

heavy lifting often lead to work related injuries, even with the advent of patient lifts 

and other innovations. Also, veterans with SCI/D often have complex psychological 

issues and other hidden health dangers as a result of their injury/disorder. Special 

skills, knowledge, and dedication, which call for a set of competencies that can prove 

extremely esoteric even for the most skilled non-SCI/D providers, are required in 

order for nursing staff to care for SCI/D veterans. 

Recruitment and retention bonuses have proven effective at several VA SCI/D 

centers, resulting in an improvement in both quality of care for veterans as well as 

in the morale of the nursing staff. Unfortunately, facilities are faced with local 

budget challenges that result in the deprioritization of recruitment and retention bonuses. The funding necessary to support this effort is taken from local facility budgets, essentially forcing a choice between maximizing care for the most vulnerable 

versus providing care for the greatest number. A consistent national policy of salary 

enhancement should be implemented across the country to ensure that qualified 

staff is recruited. Funding to support this initiative should be made available to the 

medical facilities from the network or central office to supplement their operating 

budgets. 

Moreover, the VA has a system of classifying patients according to the hours of 

bedside nursing care needed. Five categories of patient care take into account significant differences in the level of care required during hospitalization, amount of 

time spent with the patient, technical expertise, and clinical needs of each patient. 

Acuity category III has been used to define the national average acuity/patient classification for the SCI/D patient. These categories take into account the significant 

differences in hours of care in each category for each shift in a 24-hour period. The 

hours are converted into the number of full-time equivalent employees (FTEE) needed for continuous coverage. 

However, the emphasis of this classification system is based on bedside nursing 

care that may work in non-SCI/D systems of care, but that are not necessarily appropriate for SCI/D care. It does not include administrative nurses, non-bedside specialty nurses, or light-duty nursing personnel as these individuals do not, and are 

not able, to provide full-time, hands-on bedside care for the high acuity veterans patient with SCI/D whose health needs vastly exceed that of an ICU, hospice, or geriatric patient with special needs. Because of this specialized quality, nurse staffing 

in SCI/D units has been delineated in VHA Handbook 1176.01 and VHA Directive 

2008–085 based on VA and PVA’s joint assessment of need. It was derived from the 

basis of 71 FTEEs per 50 staffed beds, based on an average acuity category III SCI/ 

D patient, which reflected a younger average age among veterans with SCI/D. However, this national acuity average was established over a decade ago. Currently, 

SCI/D inpatients require a higher level of care than category III due to higher average age and multiple chronic complications that accompany aging with an SCI/D. 

While VA has recognized our requests in the past that administrative nurses not 

be included in the nurse staffing numbers for patient classifications, the current 

nurse staffing numbers still do not reflect and accurate picture of bedside nursing 

care. VA nurse staffing numbers incorrectly include non-bedside specialty nurses 

and light-duty staff as part of the total number of nurses providing bedside care for 

SCI/D patients. When the minimal staffing levels include non-bedside nurses and 

light-duty nurses, the number of actual nurses available to provide bedside care is 

84 

misrepresented in staffing reports. This leads to ‘‘floating’’ SCI/D nurses to other 

units, understaffing that results in mandatory overtime for existing staff, and other 

practices that erode quality of care over time. It is well documented in professional 

medical publications that adverse patient outcomes occur with inadequate nursing 

staff levels. 

VHA Directive 2008–085 mandates 1,504 bedside nurses to provide nursing care 

for 85 percent of the available beds at the 24 SCI/D centers across the country. This 

nursing staff consists of registered nurses (RNs), licensed vocational/practical 

nurses, nursing assistants, and health technicians. Unfortunately, the SCI/D centers 

recruit only to the mandated minimum nurse staffing required by VHA Directive 

2008–085. As of April 2014, the actual number of nursing personnel delivering bedside care was 161.9 FTEEs below the minimum nurse staffing requirement. Factoring in the actual average acuity level, there is a deficit of 746.2 FTEE between 

nurse staffing needed and the actual number of nurses available. The low percentage of professional RNs providing bedside care and the high acuity level of SCI/D 

patients put these veterans at increased risk for complications secondary to their 

injuries. Translated into lay terms that are relevant to why we are here today, the 

low percentage of professional RNs providing bedside care coupled with the high 

acuity of SCI/D patients presents us with a completely foreseeable, remarkably costly scenario where the next headline will read ‘‘paralyzed veterans suffer secondary 

complications due to failure to properly staff SCI/D centers,’’ a claim that would be 

far from hyperbolic. Studies have shown that low RN staffing causes an increase 

in adverse patient outcomes, specifically with urinary tract infections, pneumonia, 

shock, upper gastrointestinal bleeding, development of pressure ulcers, and longer 

hospital stays. SCI/D patients are prone to all of these adverse outcomes because 

of the catastrophic nature of their conditions. We have steadily maintained, and VA 

at one point agreed, that a minimum 50 percent RN staff in the SCI/D service is 

crucial in promoting optimal outcomes. 

Unfortunately, the nurse shortage has also resulted in VA facilities restricting admissions to SCI/D centers (an issue that we believe mirrors the larger access issues 

that are being reported around the country). Reports of bed consolidations or closures have been received and attributed to nursing shortages. When veterans are 

denied admission to SCI/D centers and beds are consolidated, leadership is not able 

to capture or report accurate data for the average daily census. The average daily 

census is not only important to ensure adequate staffing to meet the medical needs 

of veterans; it is also a vital component to ensure that SCI/D centers receive adequate funding. Since SCI/D centers are funded based on utilization, refusing care 

to veterans does not accurately depict the growing needs of SCI/D veterans and stymies VA’s ability to address the needs of new incoming and returning veterans. 

As an example of this point, VA’s projections for long term care SCI/D beds in 

VISN 22 (Southern California and Southern Nevada) called for 30 beds per the Capital Asset Realignment for Enhanced Services (CARES) model, which estimated demand for health care services in order to determine capacity of its infrastructure 

to meet that demand. It seems logical to presume that more aging veterans over 

time will need extended care services in Southern California, not fewer. However, 

VA advised us that new, lowered projections based on the Enrollee Health Care Projection Model (EHCPM) dictated a decrease in scope of new construction for the San 

Diego SCI/D center in VISN 22. This leads to serious concerns about future timely 

access to specialized care. Moreover, the EHCPM fails to account for suppressed demand that can lead to false assumptions about future utilization. Such situations 

severely compromise patient safety and serve as evidence for the need to enhance 

the nurse recruitment and retention programs to build capacity. 

In order to better track these issues and ensure they are addressed by the VA, 

PVA developed a memorandum of understanding with the VA more than 30 years 

ago that authorizes site visit teams managed by our Medical Services Department 

to conduct annual site visits of all VA SCI/D centers as well as spoke facilities that 

support the hubs. This opportunity has allowed us to work with VHA over the years 

to identify concerns, particularly with regards to staffing, and offer recommendations to address these concerns. More importantly, PVA is the only veterans’ service 

organization (VSO) that employs a staff of licenses physicians, registered nurses, 

and architects to conduct these visits and report on the conditions. Our most recent 

site visits have yielded the information that is included below. This information reflects the Bed and Staffing Survey as of April 2014 for beds, doctors, nurses, social 

workers, psychologists, and therapists in the SCI/D system of care. 

Physician personnel across the SCI/D system are below the required staffing level 

by 21.8 FTEEs. Social workers are below the requirement by 15.2 FTEEs. Psychologists are below the required level by 15.4 FTEEs. Finally, therapists are 33.4 FTEEs 

below the required level. As mentioned previously, the actual number of nursing 

85 

personnel delivering bedside care is 161.9 FTEEs below the minimum nurse staffing 

requirement. The nurse shortages alone resulted in 114.0 SCI/D beds staffed below 

the minimum required number. Factoring in the actual average facility acuity level, 

this amount increases to 372.9 SCI/D beds staffed below the requirement. This 

means that there are currently 281 unavailable SCI/D beds throughout the system. 

If this number is adjusted based on the actual average facility acuity level, this 

amount increases to 539.9 unavailable SCI beds throughout the system. This absurdly staggering number has proven easy to dismiss by leaders within VHA who 

insist that we provide by-name lists of veterans with SCI/D who languish on waiting 

lists rather than interrogate the merits of our claim and objectively examine their 

own data. 

These facts are simply unacceptable. The statistics reflect the fact that many veterans who might be seeking care in the VA are unable to attain that care. But to 

be clear, these facts reflect an access problem, not a quality of care problem. Access 

and quality is not the same thing. Veterans who have incurred a spinal cord injury 

or disorder and who get regular care at the VA are very satisfied with the care they 

are receiving. In fact, patient satisfaction surveys bear out this point. Unfortunately, 

for too long the VA has been provided insufficient resources to properly address the 

tremendous staffing shortages that exist, not only in the SCI/D system of are, but 

across the entire system. 

Within the VA health care system, the capacity to provide for the unique health 

care needs of severely disabled veterans—veterans with spinal cord injury/disorder, 

blindness, amputations, and mental illness—has not been maintained as mandated 

by Public Law 104–262, the ‘‘Veterans Health Care Eligibility Reform Act of 1996.’’ 

This law requires VA to maintain its capacity to provide for the specialized treatment and rehabilitative needs of catastrophically disabled veterans. As a result of 

Public Law 104–262, the VA developed policy that required the baseline of capacity 

for the spinal cord injury/disorder system of care to be measured by the number of 

staffed beds and the number of full-time equivalent employees assigned to provide 

care (the basis for PVA’s site visits today). This law also required the VA to provide 

Congress with an annual ‘‘capacity’’ report to ensure that the VA is operating at the 

mandated levels of ‘‘capacity’’ for health care delivery for all specialized services. 

Unfortunately, the requirement for the capacity report expired in 2008. PVA’s 

Legislation staff, in consultation with PVA’s Medical Services Department, identified reinstatement of this annual ‘‘capacity’’ report as a legislative priority for 2014. 

We have worked extensively with our partners in the VSO community as well as 

with Hill offices to formulate legislation that would reinstate the annual ‘‘capacity’’ 

report. This report affords the House and Senate Committees on Veterans’ Affairs 

as well as veteran stakeholders the ability to analyze the accessibility of VA specialized care for veterans seeking that care at little to no cost. Currently, legislation 

is pending in the House Committee on Veterans’ Affairs—H.R. 4198, the ‘‘Appropriate Care for Disabled Veterans Act’’—that would reinstate this report. We urge 

the Senate Committee on Veterans’ Affairs to consider similar legislation as soon 

as possible. 

PROTECTION OF VA SPECIALIZED SERVICES

The simple truth is the VA is the best health care provider for veterans. In fact, 

the VA’s specialized services are incomparable resources that often cannot be duplicated in the private sector. However, these services are often expensive, and are severely threatened by cost-cutting measures and the drive toward achieving management efficiencies. Even with VA’s advances as a health care provider, some political 

leaders and policymakers continue to advocate expanding health care access for veterans by contracting for services in the community. While we recognize that VA 

must tap into every resource available to ensure that the needs of veterans are 

being met, such changes to the VHA would move veterans out of the ‘‘veteran-specific’’ care within VA, leading to a diminution of VA health care services, and increased health care costs in the Federal budget. 

Specialized services, such as spinal cord injury care, are part of the core mission 

and responsibility of the VA. These services were initially developed to care for the 

complex and unique health care needs of the most severely disabled veterans. The 

provision of specialized services is vital to maintaining a viable VA health care system. The fragmentation of these services would lead to the degradation of the larger 

VA health care mission. With growing pressure to allow veterans to seek care outside of the VA, the VA faces the real possibility that the critical mass of patients 

needed to keep all services viable could significantly decline. All of the primary care 

support services are critical to the broader specialized care programs provided to 

veterans. If primary care services decline, then specialized care is also diminished. 

86 

We believe that the VA itself has created conditions that require contract (or 

privatized) health care as a solution. The Committee needs to look no further than 

the wholly inadequate budget requests over many years and multiple Administrations for Major and Minor Construction to see this scenario playing out. For example, this year the Administration requested $561 million for Major Construction. 

This included funding for only four primary projects and secondary construction 

costs—this despite a backlog of construction projects that requires a minimum of 

$23 billion over the next 10 years in order to maintain adequate and serviceable 

infrastructure. If the Administration refuses to properly address this construction 

funding problem, then Congress should be filling this void. Unfortunately, Congress 

has punted on this responsibility as well. Ultimately, if VA is not provided sufficient 

resources to address the critical infrastructure needs throughout the system, then 

it will have no choice but to seek care options in other settings, particularly the private section. However, calls for using contract care options to alleviate these problems are not the answer for SCI/D veterans because comparable specialized health 

care options do not really exist in the private sector. 

VA HEALTH CARE

PVA believes that the quality of VA health care is excellent, when it is accessible. 

In fact, as mentioned previously, VA patient satisfaction surveys reflect that more 

than 85 percent of veterans receiving care directly from the VA rate that care as 

excellent (a number that surpasses satisfaction in the private sector). The fact is 

that the most common complaint from veterans who are seeking care or who have 

already received care in the VA is timely access. PVA cannot deny that there are 

serious access problems around the country. The broad array of staff shortages that 

we previously mentioned in our statement naturally lead to the access problems 

that VA is facing across the Nation. Many of the problems that the media continues 

to report are really access problems, not quality of care problems. While there are 

many detractors of the VA who would like to convince veterans and the public at 

large that the VA is providing poor quality care that is simply not true. If the Committee wants to get the truth about the quality of VA health care, spend a day walking around in a major VA medical facility (not conducting a panel with four preselected veterans’ opinions) and ask veterans their impressions of the care. We can 

guarantee that you will likely hear complaints about how long it took to be seen, 

but rare is the complaint about the actual quality of care. In fact the complaints 

of veterans about access often ring true about health care delivery in private hospitals and clinics as well. It is no secret that wait times for appointments for specialty care in the private sector tend to be extremely long. 

As we have already testified, access problems are primarily a reflection of insufficient staffing and by extension capacity. While insufficient staffing can be traced in 

some areas to the VHA inefficiently managing the resources it is provided, limited 

funding provided over many years has superseded the savings that can be generated 

from operational efficiencies and increased demand for health care services. We believe many of the access problems facing the VA health care system are the responsibility of Congress and the Administration together. The Administration (and previous Administrations) has requested wholly insufficient resources to meet the evergrowing demand for health care services, while at the same time attempting to fragment the VHA health system framework. Meanwhile, it has committed to operation 

improvements and management efficiencies that are not adequate enough to fill the 

gaps in funding. Similarly, Congress has been equally responsible for this problem 

as it continues to provide insufficient funding through the appropriations process to 

meet the needs of veterans seeking care. 

For many years, the co-authors of The Independent Budget—AMVETS, Disabled 

American Veterans, Paralyzed Veterans of America, and Veterans of Foreign 

Wars—have advocated for sufficient funding for the VA health care system, and the 

larger VA. In recent years, our recommendations have been largely ignored by Congress. Our recommendations are not ‘‘pie-in-the-sky’’ wish lists based on nothing. 

They reflect a thorough analysis of health care utilization in the VA and full and 

sufficient budget recommendations to address current and future utilization. Moreover, our recommendations are not clouded by the politics of fiscal policy. Despite 

the recommendations of The Independent Budget for FY 2015 (released in February 

of this year), the House just recently approved an appropriations bill for VA that 

we believe is nearly $2.0 billion short for VA health care in FY 2015 and approximately $500 million short for FY 2016. 

While we understand that significant pressure continues to be placed on Federal 

agencies to hold down spending and Congress has moved more toward fiscal restraint in recent years, the health care of veterans outweighs those priorities. If 

87 

Congress refuses to acknowledge that it has not provided sufficient resources for the 

VA, and that many of these access problems that are being reported around the 

country are a result of those decisions, then we will. Until Congress and the Administration make a serious commitment to providing sufficient resources so that adequate staffing and capacity can be established in the VA health care system, access 

will continue to be a problem. 

And unfortunately for those clamoring for it, contract health care is not the answer to this problem. Studies have shown that contract health care providers cannot 

provide the same quality of care as the VA at any less cost, despite claims by some 

that it can. Similarly, contract care simply is not a viable option for veterans with 

the most complex and specialized health care needs. A veteran with a cervical spine 

injury whose autonomic dysreflexia was mistakenly treated as a stroke is not better 

served at a local outpatient clinic or the local doctor’s office closer to his or her 

home. Sending those individuals outside of the VA actually places their health at 

significant risk while abrogating VA of the responsibility to ensure timely delivery 

of high quality health care for our Nation’s veterans. 

Mr. Chairman and Members of the Committee, we appreciate your commitment 

to ensuring that veterans receive the best health care available. We also appreciate 

the fact that this Committee has functioned in a generally bipartisan manner over 

the years. Unfortunately, even veterans issues are now held hostage to political 

gridlock and partisan wrangling. It is time for this to stop! Political interests do not 

come before the needs of the men and women who have served and sacrificed for 

this country. We call on this Committee, Congress as a whole, and the Administration to redouble your efforts to ensure that veterans get the absolute best health 

care provided when they need it, not when it is convenient. PVA’s members and all 

veterans will not stand for anything less. 

This concludes my statement. I would be happy to answer any questions that you 

may have. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

PARALYZED VETERANS OF AMERICA

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Thank you very much, Mr. Blake. 

D. Wayne Robinson is the President and CEO of Student Veterans of America. Mr. Robinson. 

STATEMENT OF D. WAYNE ROBINSON, PRESIDENT AND CHIEF 

EXECUTIVE OFFICER, STUDENT VETERANS OF AMERICA 

Mr. ROBINSON. Chairman Sanders, Ranking Member Burr, and 

Members of the Committee, thank you for inviting Student Veterans of America to submit our testimony on the state of VA health 

care. As the premier advocate for student veterans in higher education, it is our privilege to share our on-the-ground perspective 

with you today. 

I would like to begin by addressing the family members of the 

veterans for whom we are gathered today. We at Student Veterans 

of America honor the service of your loved ones and stand with you 

in seeking answers related to their deaths. 

Student Veterans of America, or SVA, is a network of over 1,000 

chapters on as many campuses across all 50 States and three countries. These chapters are comprised of veterans from multiple eras 

of service, with the majority having served after 9/11. Paramount 

88 

to their success is the ability to remain healthy and utilize the 

health care system provided by the Department of Veterans Affairs. 

In this testimony, we speak on student-level issues of health and 

well-being, with our main focus being on higher education. As the 

G.I. Bill makes up a major portion of the benefits administered by 

VA, we believe it is essential to consider education and the role it 

plays in the life of veterans who may simultaneously be receiving 

health care. 

As a former Command Sergeant Major in the Army, with service 

spanning nearly three decades, and as the current leader of a large 

disparate organization, I understand how difficult it is to be responsible for many locations and workforces. I also understand the 

position of older and younger veterans, as I have served alongside, 

have led, and have been taught by both. Many of these friends and 

former leaders of mine ensure that I remain abreast of the issues 

they face while accessing care. 

Our student veterans are as diverse as our Nation and are progressing toward degrees at varying stages of their lives. Likewise, 

our members have millions of experiences with VA and other large 

institutions integral to their success on a daily basis. They rely on 

VA every day for their livelihood, their health care, and the future 

success of themselves and their families. 

This support system for student veterans may be understood by 

looking at three levels of support which we term the three pillars. 

We encourage this Committee to focus on the following three pillars of student veteran well-being individually as well as collectively. 

Pillar one, institutions. Institutional support for student veterans 

is an important aspect of maintaining a strong pipeline of successful veteran graduates. 

Pillar two, individuals. Establishing an environment for the student veteran to fluidly interact with the institution and the community is a determining factor of well-being. 

Pillar three, communities. An established network across various 

university offices, academic networks, and career services enables 

the student veteran to make the transition from the campus to a 

fulfilling career. 

It is the firm belief of SVA that VA has successfully overhauled 

the education benefits process and that the same level of production should result within all levels of the Department. Over the last 

5 years, Secretary Shinseki has led the VA as it brought G.I. Bill 

processing times down to just 1 week and tripled the number of 

Vet Success on Campus sites across the country. In that same time, 

VA has paid out more than $40 billion in tuition and benefits to 

nearly 1.2 million veterans, servicemembers, and their families 

since the Post-9/11 G.I. Bill went into effect on August 1, 2009. 

We recognize that VA has a long way to go on some of its programs. It is our sincere hope that the Secretary is able to achieve 

the kind of outcomes across the Department that he has accomplished for student veterans with the implementation of its benefits 

programs. 

SVA believes that Secretary Shinseki is dedicated to America’s 

veterans more than ever. It has been under his leadership that VA 

89 

has seen substantial improvements over the years. While the recent allegations are disturbing, indeed, we would encourage the 

Secretary to take swift and decisive action when the full facts become clear. This action would demonstrate his continued commitment to student veterans who utilize the VA Health Care System 

and to veterans everywhere. 

We thank the Chairman, the Ranking Member, and the Committee Members for your time, attention, and devotion to this 

cause. As always, we welcome your feedback and your questions. 

[The prepared statement of Mr. Robinson follows:] 

PREPARED STATEMENT OF MR. D. WAYNE ROBINSON, PRESIDENT & CEO, STUDENT

VETERANS OF AMERICA

Chairman Sanders, Ranking Member Burr and Members of the Committee: 

Thank you for inviting Student Veterans of America (SVA) to submit our testimony 

on ‘‘The State of VA Health Care.’’ As the premier advocate for student veterans 

in higher education, it is our privilege to share our on-the-ground perspective with 

you today. 

I’d like to begin by addressing the family members of the veterans for whom we 

are gathered today. We at Student Veterans of America honor the service of your 

loved ones and stand with you in seeking answers related to their deaths. 

SVA is a network of over 1,000 chapters on as many campuses across all fifty 

states and three countries. These chapters are comprised of veterans from multiple 

eras of service, with the majority having served after 9/11. Our recently released 

Million Records Project showed that these student veterans are succeeding in higher 

education. Paramount to that success is the ability to remain healthy and utilize 

the healthcare system provided by the Department of Veterans Affairs. While our 

constituents may be younger, they also face very similar issues as the brave men 

and women who have come before. 

OUR APPROACH

As a former Command Sergeant Major in the Army with service spanning nearly 

three decades, and as the current leader of a large disparate organization, I understand how difficult it is to be responsible for many locations and workforces. I also 

understand the position of older and younger veterans, as I have served alongside, 

have led, and have been taught by both. Many of these friends and former leaders 

of mine ensure that I remain abreast of the issues they face while accessing care. 

Also in my travels, I speak to our chapter members who are seeking to raise their 

kids, attend classes, and deal with the effects of serving in a protracted war on two 

fronts. I am very familiar with the difficulties of developing strategy and tactics simultaneously, especially in a resource constrained environment. It is with this purview that I approach the current VA issues concerning healthcare and those deserving of it. 

In this testimony, we touch on student-level issues of health and well-being with 

our main focus being on higher education, for that is our area of expertise. As the 

GI Bill makes up a major portion of the benefits administered by the VA, we believe 

it is essential to consider education and the role it plays in the life of veterans who 

may simultaneously be receiving healthcare. 

Student veterans are as diverse as our Nation, progressing toward degrees at 

varying stages of their lives. Likewise, our members have millions of experiences 

with the VA and other large institutions integral to their success on a daily basis. 

They rely on the VA every day for their livelihood, their healthcare, and the future 

success of themselves and their families. This support system for student veterans 

may be understood by looking at three levels of support, which we term the ‘‘three 

pillars.’’ 

THE THREE PILLARS OF STUDENT VETERAN WELL-BEING

We encourage this Committee to focus on the following Three Pillars of Student 

Veteran Well-Being individually as well as collectively: 

• Pillar 1—Institutions: Institutional support for student veterans is an important 

aspect of maintaining a strong pipeline of successful veteran graduates. The ability 

of the VA to connect with and administer care at the university level—for both mental and physical health—is critical. The lack of coordination and communication at 

this level continues to be a major concern. 

90 

• Pillar 2—Individuals: Establishing an environment for the student veteran to 

fluidly interact with the institution and the community is a determining factor in 

whether or not they will achieve their goals, as those who do not feel welcome may 

not persist in their studies. Empowering on-campus health systems to meet the 

needs of student veterans can supplement VA services. • Pillar 3—Communities: An established network across various university offices, academic networks, and career services enables the student veteran to make 

the transition from the campus to a fulfilling career. Another area of improvement 

would be to connect student veterans with the various veteran-related points of contact, such as the VA certifying official, the counseling center, and potentially the 

VetSuccess advisor. The VA could facilitate these connections by making it easier 

to contact these individuals through a transparent directory available to both university staff and student veterans. 

SUCCESSES IN EDUCATION

It is the firm belief of SVA that the VA has successfully overhauled the education 

benefits process, and that this same level of production should be sought within all 

components of the Department. Over the last five years, Sec. Shinseki led the VA 

as it brought GI Bill processing times down to just one week, and tripled the number of VetSuccess On Campus (VSOC) sites across the country. In that same time, 

the VA has paid out more than $40 billion in tuition and benefits to nearly 1.2 million veterans, servicemembers, and their families, since the Post-9/11 GI Bill went 

into effect on August 1, 2009. 

With programs like VSOC, and support from postsecondary institutions signing 

onto the Principles of Excellence, veterans are operating in environments where 

they are prone to excel. The VA’s VSOC is intended to, ‘‘help Veterans, Servicemembers, and their qualified dependents succeed and thrive through a coordinated 

delivery of on-campus benefits assistance and counseling, leading to completion of 

their education and preparing them to enter the labor market in viable careers.’’ We 

see the VSOC program as a means to further enrich student veteran support across 

a variety of benefits to include healthcare. 

The targeted expansion of this program to a current total of 94 schools continues 

to show positive outcomes, and we have heard overwhelmingly positive feedback 

from our members at the campuses where it is in place. We should note that we 

feel the program is difficult to bring to a university if they have a need or interest 

due to the selective criteria of having large veteran populations of 800+ and a 25- 

mile proximity to VA medical centers. As such, some schools in rural areas or with 

smaller yet just as deserving veteran populations may never be eligible for these 

services at the present requirements. 

WHAT IS BEST FOR STUDENT VETERANS?

With the right tools and resources, SVA sees no limit to the potential of student 

veterans in higher education and beyond. When empowered and in the right environment, we know veterans lead productive and healthy lives. For student veterans, 

acting as leaders amongst our peers, balancing multiple competing priorities, and 

succeeding with limited resources are all natural challenges; indeed they are the 

very circumstances for which the Department of Defense has so effectively trained 

them. It is up to our schools, the VA, and the Nation to ensure that those veterans 

are met half-way with the proper care and benefits that they have earned. 

We recognize that the VA has a long way to go on some of its programs. It is 

our sincere hope that the Secretary is able to achieve the kind of outcomes across 

the Department that he has accomplished for student veterans with the implementation of its benefits programs. We urge the VA to nominate a candidate for the 

soon-to-be-vacant Under Secretary of Health position to replace the retiring Dr. 

Petzel as soon as possible for Senate consideration, so that new leadership can come 

to VHA to address this issue head on. 

SVA believes that Sec. Shinseki is dedicated to America’s veterans more than 

ever; it has been under his leadership that the VA has seen substantial improvements over the years. While the recent allegations are disturbing indeed, we would 

encourage the Secretary to take swift and decisive action when the full facts become 

clear. This action will demonstrate his commitment to student veterans who utilize 

the VA healthcare system, and to veterans everywhere. 

We thank the Chairman, Ranking Member, and the Committee members for your 

time, attention, and devotion to the cause of veterans in higher education. As always, we welcome your feedback and questions, and we look forward to continuing 

to work with this Committee, and the Congress to ensure the success of all generations of veterans through education. 

91 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

STUDENT VETERANS OF AMERICA

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Thank you very much, Mr. Robinson. 

Ryan Gallucci is the Deputy Director of the National Legislative 

Service for VFW. Mr. Gallucci. 

STATEMENT OF RYAN GALLUCCI, DEPUTY DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN 

WARS OF THE UNITED STATES 

Mr. GALLUCCI. Thank you, Mr. Chairman, Ranking Member 

Burr, and Members of the Committee. I wish I did not have to be 

here today, but on behalf of the 1.2 million members of the Veterans of Foreign Wars, I want to thank you for the opportunity to 

share the VFW’s concerns on VA health care delivery. 

Simply put, VFW members are outraged and I am personally 

outraged that the health care system that I use may be doing harm 

to my fellow veterans. What is more frustrating is that nearly a 

month after some of these allegations came out, we still do not 

have the facts. We do not know who the veterans are who may 

have died waiting for care in Phoenix. We do not know where hospitals are cooking the books in appointment scheduling to keep up 

appearances while veterans wait for care or pay for it out of pocket. 

Regardless of what comes out in Phoenix, Wyoming, Atlanta, 

Chicago, Spokane, or elsewhere, the VFW knows that veterans 

have died waiting. This is inexcusable. VA is supposed to have protocols in place to make sure this never happens. So, what happened? 

The VA tells us the situation is improving, but to the veterans 

affected, this is not good enough. Over the last month, we see VA 

may not be living up to its obligation to provide our veterans with 

the best care our Nation has to offer. Veterans deserve the truth, 

not vague platitudes about quotas, wait times, and pending investigations. The VFW has been frustrated at the situation, but we 

have been reticent to condemn individuals without all the facts. 

We are here today to say that enough is enough. Whistleblowers 

first brought problems in Phoenix to the attention of VA and Congress as early as 2010. CNN broke the doors off this story a couple 

of weeks back. Why are we still waiting? Last week, the VFW grew 

tired of waiting and told veterans to call our help line, 1–800- 

VFW–1899, to voice their concerns and connect with some of our 

service officers to help. While some said they were satisfied, most 

painted a picture of a VA Health Care System that is overburdened, under-resourced, and many times paranoid. 

In Durham, NC, an Iraq veteran told me that he can see his primary care doctor only once a year and that he has sought care elsewhere, out of pocket, after 10 years of misdiagnoses. 

92 

What we heard over the last week is only a small sample of the 

hundreds of concerns we heard from veterans from coast to coast, 

but the outpouring of concern was alarming and seemingly systemic. So, what is causing this failure? Is it a lack of resources, 

personnel? Is it leadership? 

The VFW also plans to conduct a series of veterans’ town hall 

meetings, talking to veterans face to face. Once we have finalized 

locations and dates, we will invite this Committee to attend and 

hear directly from our veterans. 

As a veteran who uses VA care, I worry that the recent allegations are causing veterans and their families to lose confidence in 

the system that is designed to support them and care for their 

needs. If one veteran is not receiving the care he or she needs, it 

is one too many. VFW members demand answers and we want 

those responsible for any wrongdoing held accountable at all levels 

of leadership and to the fullest extent of the law. With this in 

mind, the VFW believes it may be time to commission an independent review of VA care. 

We hope that VA would never intentionally deny care to veterans, but there have to be reasons why care takes so long to be 

delivered. The VFW worries that the current culture may be focused on making funding fit at every level, as my colleagues from 

Paralyzed Veterans of America outlined. If this is the case, the culture must change. Leadership at every level must have the confidence that if they have a need, they can ask for it to be addressed. 

We know capacity is an issue. The VFW and our other partners 

on the Independent Budget have for years highlighted the need to 

increase VA capacity. In 2004, utilization was at 80 percent. In 

2010, 122 percent. And, in 2013, down to 119 percent, which is still 

unacceptably high. This undoubtedly affects VA’s ability to deliver 

care. Plus, when there is a lack of resources, there is a tendency 

to make tradeoffs, whether through delaying care or gaming the 

schedule to satisfy quotas. 

The VA health care system was commissioned to care for those 

who served and bled for our Nation. Men and women who are chosen as stewards of this system have been entrusted with a mission 

that cannot fail. If the system is failing, it is their duty to fix it. 

It is their duty to hold underperforming employees accountable. 

Most important, if they are unwilling to perform the mission, it is 

their duty to either ask for help or step aside. 

However, in addressing any failures, we must resist any suggestion that VHA is a fundamental failure and it should be dismantled 

in favor of an alternative model. This only relieves VA of its responsibility. 

Last year, the President met with then-VFW Commander-inChief, John Hamilton, and promised that he would not leave VA’s 

problems to his successor. Last week, VFW Commander-in-Chief, 

Bill Thien, sent a letter to the President reiterating these concerns. 

We learned last night that the President shares the concerns of the 

VFW. 

Today, we ask not only for the President to live up to his word, 

but we implore Congress to do the same. We cannot sit on our 

hands and wait for the system to slowly improve. The situation 

93 

that is unfolding across the country demands immediate, decisive 

action. The mission of VA health care is far too important, and as 

veterans’ advocates and users of the system, we will not allow it 

to fail. 

Mr. Chairman, this concludes my testimony and I am happy to 

answer any questions you or the Committee may have. 

[The prepared statement of Mr. Gallucci follows:] 

PREPARED STATEMENT OF RYAN M. GALLUCCI, DEPUTY DIRECTOR, NATIONAL

VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Chairman Sanders, Ranking Member Burr and Members of the Committee: I wish 

I did not have to be here today, but I want to thank you for the opportunity to share 

the Veterans of Foreign Wars’ concerns on the Department of Veterans Affairs’ (VA) 

health care delivery. 

Simply put, the VFW is outraged over the allegations that have surfaced in recent 

weeks that VA denies care to veterans. What is more frustrating is that nearly a 

month after these allegations surfaced, we still do not have all the facts. We do not 

know who the veterans are who died waiting for care in Phoenix. We do not know 

if other hospitals are cooking the books in appointment scheduling to keep up appearances, while veterans either wait for care, or pay for it out of their own pockets. 

Regardless of the forensic facts in Phoenix, Wyoming, Atlanta, Chicago, or Jackson, Mississippi, the VFW knows that veterans have died waiting for care. This in 

and of itself is inexcusable. VA is supposed to have protocols in place to make sure 

this never happens. So, what happened? 

VA tells us the situation is improving, but to the veterans’ community, this is not 

good enough. VA’s obligation is to provide our veterans with the best health care 

our Nation has to offer. Over the last month, we can clearly see that VA is not living up to this obligation. 

Veterans want and deserve the truth, but instead we are fed vague platitudes 

about quotas, wait times, waiting lists, and ongoing investigations. The VFW has 

been vocally frustrated at the situation, but we have been reticent to condemn individuals because of these ‘‘ongoing investigations.’’ We are here today to say that 

enough is enough. Whistleblowers first brought the problems in Phoenix to the attention of VA and Congress as early as 2010. CNN broke the doors off this story 

in April. Why are we still waiting? 

Last week, the VFW grew tired of waiting and told veterans to call our help line, 

1–800-VFW–1899, to voice their concerns about VA health care, and connect with 

our service officers for help. While some said they were satisfied, or acknowledged 

improvements, most veterans painted a picture of a VA health care system that is 

overburdened, under-resourced, and many times paranoid: 

• In Durham, North Carolina, an Iraq veteran told us that he can see his primary 

care doctor only once a year, and that he has sought care elsewhere after 10 years 

of misdiagnoses. 

• In Denver, a veteran told us that when he moved to the city in 2011, it took 

a year and a half to book an appointment, and now he cannot get in for treatment 

of his service-connected conditions. 

• In Florida, a veteran who was diagnosed with prostate cancer told us that he 

had to wait five months to see his primary care doctor. 

• In Nevada, a veteran who was diagnosed with skin cancer tells us he is waiting 

eight months for an appointment after the hospital’s dermatologist quit. 

• And finally, in Phoenix, a veteran told us that he has been waiting three years 

for a surgical consult, and was told that if his condition gives him problems, he 

should just come to the emergency room. 

If one veteran is not receiving the care he or she needs, it is one too many. This 

is only a small sample of the hundreds of concerns we heard from veterans at VA 

facilities from coast to coast, but the outpouring of concerns was alarming, and 

seemingly systemic. So, what is causing this failure? Is it a lack of resources? Is 

it personnel? Is it leadership? 

As a result, the VFW will also conduct a series of veterans’ Town Hall meetings, 

talking to veterans face-to-face, allowing them to voice their concerns. Once we have 

finalized locations and dates, we invite this Committee to attend and observe, hearing directly from the veterans about VA care delivery. 

Although we are still waiting for the full reports to be issued on the latest allegations, recent preventable deaths at other VA facilities have already been confirmed. 

In South Carolina and Georgia, we learned that 23 veterans died due to recent conVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00097 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
94 

sultation errors. Last year, VA’s Inspector General released a report detailing the 

improper handling of an outbreak of Legionella at the Pittsburgh Veterans Affairs 

Medical Center (VAMC) which took the lives of at least five veterans. Another report revealed the mismanagement of inpatient mental health care at the Atlanta 

VAMC, costing at least four veterans their lives. The Jackson, Mississippi VAMC 

has been plagued by multiple problems which endangered veterans’ safety and lead 

to preventable deaths, including chronic understaffing, failure to sterilize instruments, and thousands of unread radiology images leading to missed diagnoses. Most 

recently, the VFW learned that as many as 19 veterans died nationwide in 2010 

and 2011 due to unacceptably long wait times for routine cancer screening procedures. 

In the past three weeks, whistleblowers in Phoenix, Colorado, Wyoming, Texas 

and North Carolina have alleged that these locations have ‘‘gamed’’ their patient appointment schedules to make it appear these facilities are achieving their appointment wait times. VA’s assertion that wait times for primary care appointments in 

Phoenix have decreased from more than a year to 55 days on average is unacceptable. Mental health access also continues to be an issue. VA has hired more than 

1,000 mental health care providers, but they still are not sure how many providers 

they need to fulfill the current demand. 

The lack of timely care for veterans is unacceptable. The VFW certainly hopes 

that VA would never intentionally deny care to veterans, but there have to be reasons why care takes so long to be delivered. We know capacity is an issue. The 

VFW, in partnership with the Independent Budget, has highlighted for years the 

need to increase VA medical facility capacity. Even VA’s own 10-year Strategic Capital Investment Plan (SCIP) identifies capacity as an issue. In 2004, VA’s medical 

center capacity was 80 percent. It peaked at 122 percent capacity in 2010, and in 

2013 capacity remained unacceptably high at 119 percent. Since FY 2010, appropriations for major construction projects have decreased from $1.2 billion annually 

to an FY 2014 appropriation of less than $350 million for the same account. Access 

to care can be directly linked to capacity. VA’s major lease authority is also placing 

a burden on capacity, which directly effects access. Since FY 2012, Congress has not 

authorized VA major medical lease authority. That is 27 facilities in 18 states, most 

of which should be providing direct care to veterans. 

These allegations are causing veterans and their family members to lose faith and 

confidence in a system that is supposed to care for them. VFW members and their 

families are outraged. They want answers, and they want those responsible for any 

substantiated allegations held accountable from the lowest to the highest level of 

leadership. With this in mind, it may be time to commission an independent review 

of VA’s health care system. We must all work together to ensure that the culture 

across VA is one of placing veterans’ needs first, and when veterans’ care suffers 

because of one of these reasons, those responsible must be held accountable to the 

fullest extent of the law. 

To provide timely access to care, VA must use all available tools, including purchasing non-VA care when necessary. Ideally, VA would have the capacity to provide timely, quality direct care to all those who need it, but it has become apparent 

to the VFW that they do not. Although we support expanding VA infrastructure and 

hiring enough health care professionals to meet demand at VA facilities, we recognize that this will not happen overnight. In the meantime, it is absolutely unacceptable for veterans to suffer. Non-VA care must be used as a bridge between full access to direct care and where we are now. 

If it appears that certain facilities are not making proper outside referrals due 

to improper training, lack of standards, or institutional resistance, VA must move 

swiftly to correct those problems. If VA’s new fee basis care model, PC3, is not being 

used to its full potential due to insufficient funding at the local level, we will call 

on VA and Congress to give them the resources they need. 

When there is a lack of resources, there is a tendency to make tradeoffs, whether 

it is delaying care or manipulating scheduling systems to satisfy quotas. 

It appears that the culture of leadership, management and accountability is focused on making the funding fit at every level. If this is the case, this culture must 

change. Leadership at every level must have the confidence that if they have a need, 

they can ask for that need to be addressed. VA, the Administration and Congress 

must resolve to make the true need the priority, not the need to make budget lines 

fit. 

There is no question that the Veterans Health Administration (VHA) faces significant challenges in efficiently and effectively running the largest health care system 

in the United States. Successfully executing its four major missions of providing 

care to veterans, conducting medical and prosthetic research, training this Nation’s 

physicians, and providing medical support to the public during domestic emerVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00098 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
95 

gencies is a massive undertaking. When failures are identified, it must be the responsibility of VA, Congress, veterans service organizations, and all of America to 

swiftly correct those problems with better oversight, sufficient funding, and accountability of those responsible. 

In doing so, however, we must resist any suggestion that VHA is a fundamental 

failure which should be dismantled in favor of an alternative model. Such suggestions not only serve to relieve VA of its responsibilities, but fail to take into account 

the contributions that VHA makes to veterans, their families, and the medical community as a whole. 

The VA health care system was commissioned to care for those who served and 

bled for our Nation. The men and women who are chosen as stewards of the VA 

health care system have been entrusted with a mission that cannot fail under any 

circumstances. If the system is failing, it is their duty to fix it. It is their duty to 

hold underperforming employees accountable. Most importantly, if they are unwilling to perform this mission, it is their duty to either ask for help or step aside. 

Last year, when the President met with then-VFW Commander-in-Chief John 

Hamilton at the White House, he promised that he would not leave the problems 

within VA for his successor to deal with. Today we ask not only the President to 

live up to his word, but we implore Congress to do the same. 

We absolutely cannot sit on our hands and wait for the system to slowly improve. 

Every day we hear of new allegations in another VA facility. The situation that is 

unfolding in VA facilities across the country demands immediate, decisive action. 

The mission of the VA health care system is far too important, and as a society that 

cares for the men and women who volunteer to defend our way of life, we cannot 

allow it to fail. 

Mr. Chairman, this concludes my testimony, and I am prepared to take any questions you or the Committee members may have. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

VETERANS OF FOREIGN WARS OF THE UNITED STATES (VFW) 

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response from VFW: Senator, as you will recall, DAV was a strong proponent of 

VA’s establishing an Office of Rural Health (ORH) in Public Law 109–461, and of 

Congress providing that office access to funds outside the regular allocation system 

used in VHA, so that ORH could sponsor rural health initiatives and innovations 

to account for health shortages in rural and highly rural areas. Over the past several years, using a special $250 million annual appropriation, the ORH has done 

a remarkable job in not only outreaching to rural veterans, but ensuring they can 

gain access to care in some communities and regions that are hundreds of miles 

from the nearest VA facilities. The ORH is also the co-managing office of Project 

ARCH, a pilot program authorized in Public Law 110–387, that provides veterans 

in four geographic areas access to managed care, but monitored closely by VA. While 

we have not seen VA’s report to Congress on this pilot project, from all appearances 

and from our contacts with ORH and the Rural Veterans Advisory Committee, we 

believe this pilot has been very successful and well-received. 

We are grateful to Congress for providing this partitioned health care funding for 

rural health initiatives by ORH, but we note that all those funds are now obligated 

and committed to a series of distinct initiatives, and the amount of funds has not 

been adjusted by Congress since the first authorizing year. In order for ORH to continue expanding health care options and outreach to new rural veterans and rural 

areas, additional funding will be needed in that account. 

In terms of the general waiting problem now confronting VA that suddenly has 

been so much in the news, we know of no special initiatives VA may be conducting 

to assuage that situation in terms of outreach, and we defer to VA for that response 

to you. VA is required by law, however, to periodically and routinely report to Congress on outreach efforts. 

Our public statements on the current situation in VA are a matter of record. We 

demand that any VA official or personnel who orchestrated or participated in covering up or hiding waiting lists be held accountable. However, DAV has long held 

that VA’s ability to meet its own standards and policies for waiting time could not 

be met given the funding levels requested for health care by Administrations during 

recent years, or those insufficient funding levels that were approved by Congress. 

96 

Encouraged by Congress and the veterans service organization (VSO) community, 

strong outreach by VA in the 1990s to enroll more veterans in VA health care, combined with the onrush of patients enrolling after serving in Iraq and Afghanistan 

more recently, have caused demand for VA health care to exceed available resources. Additional outreach by VA in this environment would seem foolish without 

an infusion of significant new health resources and facilities to deal with the outcome of VA outreach. However, as a part of the military discharge process, VA and 

VSO counselors do brief veterans in transition about the nature, scope and variety 

of VA programs available to them, and do encourage new veterans to explore VA, 

for health, education, compensation and other benefits and services to which they 

are entitled. Given the continual rise in demand being seen in VA, we believe these 

efforts are effective. 

Chairman SANDERS. Thank you, Mr. Gallucci. 

Rick Weidman is the Executive Director for Policy and Government Affairs of Vietnam Veterans of America. Mr. Weidman. 

STATEMENT OF RICHARD WEIDMAN, EXECUTIVE DIRECTOR 

FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA 

Mr. WEIDMAN. Thank you, Mr. Chairman and the panel for the 

opportunity to be here today. 

Let me just share one thing that has troubled us for a long time, 

and that is the lack of truthfulness on the part of some people in 

senior grades at VA, both in shading the truth in hearings on the 

Hill, but also in reporting up. And there is something else that baffles all of us from the VSOs. If I lie to our National President, John 

Rowan, I am toast. I am out of here. I am fired, as in, you are gone, 

pal. And, I would agree with that decision. You cannot run an organization, certainly not a medical organization, where people do not 

tell the truth to their superiors, because otherwise, if they do not 

have good information, they cannot manage properly. 

I will say that it is our firm contention that the majority of people who use VA get good-to-excellent care. The problem has to do 

with access and with poor quality assurance. It is very uneven. 

The plain fact is that there are not enough clinicians. It is very 

much analogous to Walter Reed MC, which I think many of you remember, in 2006. It is a question of too many clinical needs chasing too few clinicians, and what happens is distortion in the system 

and breakdown of the sequencing of care, and that was what was 

wrong with their care. That is what is wrong with the care at VA. 

There are not enough clinicians and it is the getting people to care 

exactly when they need it that is not happening. 

The question is, are there enough resources for the Veterans 

Health Administration? We have to say we do not know. What we 

have been saying for 5 years is, when the budgets started to go 

up—the largest increase in the health care budget for VA since the 

end of World War II—that too many middle-management positions 

were being created. Congress gave that huge increase to VA to hire 

more direct service providers—more doctors, more nurse practitioners, more clinicians and counselors, et cetera—but it ended up 

that, in some places, the resources are deployed all wrong. 

It may be that there has to be a supplemental, but we would 

urge that the review that goes on be a position-by-position and facility-by-facility review with everybody who is not directly involved 

in patient care. You have to justify that position and why and how 

97 

it adds to the overall enterprise of delivering quality care to veterans in a timely manner in a place where they can access it. 

Part of that problem with resources is—we have said it ever 

since they started using it at VA—the Millman formula is a civilian 

formula. It does not take into account—that is what they use to estimate the amount of resources that they would need. We have exposures to things that, from my lips to God’s ear, the civilian population of the United States will never be exposed to, and not just 

hostile fire, but chemicals, and on and on. 

What it means is that when—at VA hospitals, the average presentations or things wrong with an individual is five to seven per 

individual. The Millman formula was built on middle-class PPOs 

and HMOs and they had one to three average presentations or 

things that were wrong with them. What that means is the burn 

rate of resources at VA is much higher. That is particularly true 

as us old guys from Vietnam age and become even more aged, plus 

our uncles from Korea and our fathers from World War II, but it 

is also true of the young people coming home today. The presentations per individual of OIF, OEF, and OND veterans is over a 

dozen for each individual who comes through. 

So, the point is, we need to reprogram some money. We need to 

have picked up the Management Accountability Act on this side of 

the Hill and pass that; then reprogram money and, frankly, go for 

a supplemental, if it turns out it is needed. 

In the meantime, we would urge everybody, every hospital— 

something we have been urging is to screen everybody at the hospital for the five major killers. The Lung Cancer Alliance, VVA has 

worked with for the last couple of years. VA has yet to do one of 

these screenings on a mass basis, and do it for the five major killers: lung cancer, prostate cancer, colorectal cancer, bladder cancer, 

and for heart conditions. If you screen everybody, then it is not— 

you do not have the kind of situation that developed in Phoenix. 

I thank you very much, Mr. Chairman. 

[The prepared statement of Mr. Weidman follows:] 

PREPARED STATEMENT OF VIETNAM VETERANS OF AMERICA SUBMITTED BY RICHARD

WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM

VETERANS OF AMERICA

Mr. Chairman, Ranking Member Burr, and other distinguish members of the Senate Veterans’ Affairs Committee, thank you for allowing us to appear here today. 

We appreciate you giving Vietnam Veterans of America (VVA) the opportunity to 

express our views in regard to the State of VA Health Care. 

As we did for the 112th Congress, VVA stressed again in our annual statements 

for the 113th Congress to the Committees on Veterans Affairs that we again wanted 

to make it clear: ‘‘Funding is not the primary issue’’ when it comes to timely adjudication of claims and of appeals at VA. 

Similarly, VVA stressed that Funding is not the primary issue when it comes to 

the delivery of timely, quality medical care to veterans at the Veterans Health Administration facilities. 

We are aware that some have called for Secretary Shinseki to step down in the 

wake of press reports of significant problems with timely access to medical care at 

many VA medical centers. Some of those so speaking out are our own members. 

With all due respect, the departure of Shinseki would not change nor ‘‘fix’’ anything, 

as these problems with timely access, proper use of tools to assist in the delivery 

of medical care, and being honest in portrayal of the status of wait times by VA 

clinics (both for primary care and for specialty care) did not begin with the tenure 

of Secretary Shinseki, but rather long before he left active duty in the Army. 

The crux of the problem is that VA does not have enough clinical care deliverers 

who actually see patients for care. The reasons for this are basically that the VetVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00101 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
98 

erans Health Administration (VHA) has spent the enormous increases from FY 2007 

to date on hiring way too many ‘‘middle’’ people, often at salaries higher than the 

front line clinicians, who do not see veteran patients, and whose contribution to the 

overall enterprise is dubious at best. 

VVA has voiced this directly to the Undersecretary of Health and to the Deputy 

Undersecretary for Health and others in the VHA hierarchy for the last six years 

at least. We have also spoken directly to the VISN Directors en masse about this 

problem virtually every chance we have been given. VVA has also noted that having 

two management lines up and down the chain of command, one for policy and one 

for operations, is just too many people in management, VVA has phrased this in 

such a way that the while most of the world’s medical and other enterprises are 

going toward fewer levels of management between the CEO/COO and the actual 

workers (in this case clinicians) ( or a wide fairly flat pyramid, the VHA was becoming a steeper pyramid, with way too many VISN staff and others in slots that can 

best be characterized as administrative overhead. Much of this has been done is 

such a way as to mask this fact, both internally and externally. Whether this is intended to be less than honest is for others to decide. We do believe that this is the 

fact, however. 

There have been some remarkable Americans who have tried to make dramatic 

changes to the VA, and all of them have tried to improve the corporate culture and 

effective service to veterans. All have succeed somewhat, and failed somewhat. From 

Max Cleland to Harry Walters to Jesse Brown to Tony Principi to Eric Shinseki 

they have all striven mightily to improve the quality of the VA services from adjudication of claims to improving access to health care, as well as improving the quality of health care. 

And the fact of the matter is that while there was always some great clinical work 

going on at VA medical facilities, the quality assurance was lacking. VA had always 

tried to be prescr4iptive as to what to do and how with its clinicians, and shifted 

in 1994 to say to local VA medical centers ‘‘just take care of veterans in the best 

way you know how.’’ And that worked to some degree, but what it did not account 

for was the need for specialized services that were relatively rare outside of VA, 

such as Spinal Cord Injuries, PTSD, and prosthetics of every sort, Blind Rehabilitation Centers, and the like. What this VISN run healthcare did not do also was given 

a true account of the need. 

All of the funding models that VHA have in place consistently underestimate the 

number of clinicians needed to optimally run this system. VVA has not altered our 

position that they are systematically underestimating needs of VAMC because VHA 

is using is still using a variation of the Millman formula, which is a civilian needs 

estimation tool designed for use by private Health Maintenance Organizations 

(HMO) and PPOs who have middle-class patients. 

That formula estimates needs for resources based on an average of one to three 

presentations (things wrong with you that need to be medically addressed). Among 

veterans it was averaging three to five presentations per individual before the recently fought wars. Even with after VHA made adjustments for additional mental 

health and some specialized services, the formula continues to underestimate the 

‘‘burn rate’’ of resources for every veteran seeking care. 

Among IOF/OEF/OND/Global War on Terror veterans the presentations per individual are even higher than for earlier generations. Further, the needs of older veterans only increase as we get older. Additionally, the formula does not take into account the wounds, maladies, injuries, illnesses and adverse medical conditions that 

stem from military service, depending on what branch , what MOS, where, and 

when one served, all of which could and should be taken into account. 

By and large these are not taken into account because the clinicians have not 

been trained what to look for, never mind the interns and residents on which VA 

depends so heavily. 

There has been much talk about ‘‘secret lists,’’ but the basic information that 

should be known by all service providers is one of the best kept secrets in VHA. 

Efforts to put this into the VistA electronic health care record at VA could be accomplished without any major re-programming, but VHA always has ostensible reasons 

and excuses about why they cannot do it, or not do it now. 

For a rundown of many of these conditions, please see: http://www.va.gov/oaa/ 

pocketcard/military-health-history-card-for-print.pdf and http://www.publichealth.va 

.gov/vethealthinitiative/ 

For reforms to truly succeed there must be far better oversight of and by Managers who are paid very well (not counting bonuses) to administer a system that 

is all too obviously not functioning as it ought to. 

Management audits and assessments must be a component of annual performance 

reviews that are clear, specific, and success-oriented. There must also be focused 

99 

and hard-hitting oversight by the Veterans’ Affairs Committees in both the House 

and Senate, as well as in the Appropriations and Budget Committees. VVA has suggested joint hearings of the authorizers with the appropriators. 

Such hearings have taken place in this Congress yet we are still shy of our common objective of real accountability in the management of the Veterans Health Administration. 

With Advance Appropriations now law for VHA’s medical accounts, there can be 

no excuses as to why a VA medical center fails to hire the nurses it needs as it enters a new fiscal year, or does not purchase the new MRI machine that its radiologists insist they must have, or give the go-ahead for several of the small yet pivotal 

construction projects that in the past would have been put off pending passage of 

the budget for the next fiscal year. 

VVA maintains that measures to ensure accountability must be essential elements in funding the VA. Key to achieving this is to significantly overhaul the system of bonuses for Senior Executive Staff to reward only those who have taken that 

extra measure, who have walked that extra mile, to ensure that what they are responsible for has been done well, on time and within budget; and for those who innovate and improve the systems and projects under their auspices. Bonuses should 

be withheld from those who just do their job—that is, after all, why they are handsomely paid. Those who perform poorly need to be removed or reassigned; and any 

manager or supervisor who gets caught lying to a veteran, to their supervisor, or 

to a Member of Congress should be dismissed. And bonuses should be given with 

a caveat attached: If you accept the bonus, you promise to stay with the VA for a 

given period of time, and not just take the money and run (retire) the very next 

year. 

VVA believes that it will take several things to get a grip on fixing the VHA. 

1. A thorough review of all positions that do not involve direct patient care, from 

the Central Office to the VISN offices, to each VAMC and other remote locations. 

2. Since all of the games with scheduling appointments basically stem from not 

enough clinical direct care providers, there needs to be a thorough re-assessment of 

the number needed in each discipline at each VAMC. The increase of the numbers 

of clinicians can flow from a re-allocation of funds from middle-middle positions to 

actual care delivery. 

3. A facility by facility review to ensure that unfilled cr4itical specialties are 

o0ffering enough money to at least be reasonably competitive with the private sector 

and other sources of clinician employment. 

4. Where needed ask for the money needed to adequately staff each service delivery point as appropriate. 

5. Speed up the efforts for a ‘‘Grow Our Own’’ clinical training program within 

VA up to scale within the next 24 months. 

6. Force VHA to start to legitimately reach out to the veterans’ community at 

every level, to involve us as major stakeholders and beneficiaries. Among other 

things, this will result in better decisions, and will also hold those within the system 

honest, and grounded in what veterans seeking services actually see. 

7. A complete re-thinking of a scheduling program that obviously does not work 

as intended. Once again, if they do not involve veteran stakeholders, then this effort 

will prove fruitless. 

There are further enhancements that we believe would be helpful in making VHA 

into a ‘‘veterans’ health care system’’ that delivers quality, timely care with systems 

in place to ensure quality for every veteran. There are many tens upon tens of thousands of veterans who get high quality health care every year at VA. However, we 

must make sure that there are enough clinicians to do the job at each location. 

As to the situation at hand, VVA restates our position that there are people who 

should leave VA immediately, but that does not include Secretary Shinseki. Just as 

we did not think that firing then-Secretary Principi when there were judge scandals 

at VHA, we do not think starting over with anew Secretary is necessary. VVA would 

remind all; however, tin the above cited instance, the Undersecretary for Health and 

others did depart. 

Thank you for this opportunity to share our position, I will be pleased to answer 

any questions. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO

VIETNAM VETERANS OF AMERICA

Question. When we talk about access to health care, it’s not only about reducing 

waiting times for veterans seeking a medical appointment. It’s also about reaching 

100 

the population of veterans that may not be aware of the benefits or care to which 

they are entitled. What is the VHA doing to provide outreach to this population of 

veterans? Is it enough? 

Response. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Thank you, Mr. Weidman, and thank you all 

very much for your excellent testimony. 

Let me start off with a fairly simple question. In general, we all 

are aware—and no one here disputes—that there are serious problems and serious allegations. But, some of you have said the quality of care that your members are receiving at VA is good to excellent. Do you agree with that? Is the quality of care your members 

receive adequate? Is it good care, or is it not? We all know there 

are exceptions out there, but let me hear that answer, briefly, if I 

could. 

Commander Dellinger. 

Mr. DELLINGER. We would agree with your assessment, Mr. 

Chairman. The overall quality of care, after they get into the system and actually get into the hospitals and the clinics, is very good. 

Chairman SANDERS. OK. Mr. Violante. 

Mr. VIOLANTE. Yes, Mr. Chairman. Our members believe the 

same thing. The quality of care they receive when they get in is 

excellent. 

Chairman SANDERS. Mr. Tarantino. 

Mr. TARANTINO. Mr. Chairman, we survey our members. We find 

that their experience with VA, while a bit negative, their actual individual care is incredibly positive. 

Chairman SANDERS. Incredibly positive? 

Mr. TARANTINO. But, that is also including the use of their G.I. 

Bill and—— 

Chairman SANDERS. Right. 

Mr. TARANTINO [continuing]. Home loans and medical care, yes. 

Chairman SANDERS. OK. Mr. Blake. 

Mr. BLAKE. My comments spoke for themself [sic], Senator. 

Chairman SANDERS. Mr. Robinson. 

Mr. ROBINSON. Yes, I would agree with my colleagues, that once 

the system has been accessed, the quality is good. 

Chairman SANDERS. Mr. Gallucci. 

Mr. GALLUCCI. I would agree that the issue lies within access. To 

expand on that a little, one of things that I wanted to point out is 

I said I use VA, and I do. I was there last week. But, what happens 

is sometimes the person you get on the other end of the phone may 

not understand policies, may not understand proper procedures. 

When I see my clinicians, they offer me top-notch care, and that 

is a lot of what we heard from our veterans who responded to our 

inquiry last week. 

Chairman SANDERS. Mr. Weidman. 

Mr. WEIDMAN. It is generally good to excellent. The problem has 

to do with case management and access to the system. 

Chairman SANDERS. OK. Let me ask another question. We all 

recognize, that anybody who is lying within VA, anybody who is 

cooking the books in the VA, is absolutely unacceptable. We demand accountability. People lying should be fired. I do not think 

101 

there is much debate. We do not have to go into that at great 

length. 

But, I want to ask, what seems to be a problem, not all over the 

country but in many parts and all of you basically referred to it, 

is access. What I am hearing you say is once people get into the 

system, the quality of care is pretty good. The problem is access. 

We have heard Mr. Blake talk about the Independent Budget, 

which is the budget done by a number of the veterans service organizations assessing what they believe the needs of the VA are. I 

support that budget. 

The bottom line is, and I will start with Commander Dellinger, 

do you believe VA needs more funding in order to deal with the access issue, make sure that people all over the country can get into 

the system in a timely manner? 

Commander. 

Mr. DELLINGER. I do believe it is underfunded, but I also believe 

that there should be reallocation of funds within the system. 

Chairman SANDERS. Good point, and others can speak to that, as 

well. 

Mr. Violante. 

Mr. VIOLANTE. Yes, Mr. Chairman. I think, clearly, the problem 

rests with a log of the management efficiencies that the administrations have tried to put into the budget. A recent GAO report in 

February 2012 indicated VA reduced their budget by $2.5 billion 

based on management efficiencies, which were not realized and 

which are impacting the resources. So, this has gone on in previous 

administrations—— 

Chairman SANDERS. Right. 

Mr. VIOLANTE [continuing]. And that needs to be stopped. That 

is like gaming the system. 

Chairman SANDERS. Right. 

Mr. Tarantino. 

Mr. TARANTINO. The VA is underfunded, but throwing money at 

the problem does not help unless you have clear lines of accountability and reform for the things that are not working. 

Chairman SANDERS. Mr. Blake. 

Mr. BLAKE. I would agree with Mr. Tarantino. I mean, you cannot just throw money at the problem if it is not done smartly. Mr. 

Weidman pointed out that there were a lot of people hired and they 

were not necessarily hired where the need is. Our own written testimony points out serious staffing shortages in the entire SCI Service. So, clearly, people are not being hired there, where there is a 

demonstrated need. So, you could do reallocation of resources, but 

we believe, by extension, there is even more need for additional resources. 

Chairman SANDERS. Mr. Robinson. 

Mr. ROBINSON. I will agree with my two colleagues to my right 

that, yes, VA is underfunded. However, I would say, first, there 

should be infrastructure and systemic reviews and issues addressed. After that, after we are intelligent on where the funds will 

be allocated, then they should be funded. Thank you. 

Chairman SANDERS. Mr. Gallucci. 

102 

Mr. GALLUCCI. I would agree with our Independent Budget partners that we support the IB’s numbers and we believe that VA, in 

its current form, is underfunded. 

Chairman SANDERS. You guys are part of the Independent Budget, are you not? 

Mr. GALLUCCI. Yes. 

Chairman SANDERS. Yes. Right. 

Mr. GALLUCCI. And, I would echo the concerns of everyone at the 

table about resource utilization and proper distribution of resources. And in my written testimony spoke about VA’s capacity: 

what this has to do with is construction and facilities, a little to 

what my colleague, Wayne, was talking about. If we do not have 

the space, where are these clinicians supposed to practice? We have 

seen that problem with mental health hiring. They are able to hire 

more mental health practitioners, but where are they going to see 

their patients? 

Chairman SANDERS. Mr. Weidman. 

Mr. WEIDMAN. Part of it is the allocation of resources, but in addition, I would associate particularly not the major construction, 

but remodeling and adding to existing facilities. You have got to 

have a place to actually deliver the care. But, we are underfunded 

and do not have enough clinicians. That is why they game the system, not because they are bad people. They are under pressure not 

to admit there are not enough doctors. 

Chairman SANDERS. OK. I am going to take a little bit more 

time; and Sen. Isakson, I will give you an equal amount of time. 

I just wanted to ask one brief question, which is important. 

When you deal with a public system like VA, every problem, in 

a sense, sometimes makes the front pages. I mentioned earlier that 

there are studies out there, 200,000 or 300,000 people are dying 

from medical errors in private hospitals. You usually do not have 

hearings like this with TV cameras talking about it. On the other 

hand, the advantage of a public system is that, as citizens of the 

country and as representatives of millions of veterans, which you 

guys do, you have input into the process. 

Let me ask you this question. I do not know what the answer is. 

My understanding is that the Secretary meets with representatives 

of organizations like ours fairly frequently, that he wants to hear 

your input. Is that true, Mr. Commander? 

Mr. DELLINGER. Yes, it is, Mr. Chairman. We have a sit-down 

breakfast with him approximately once a month—— 

Chairman SANDERS. Once a month—— 

Mr. DELLINGER [continuing]. To discuss the issues. 

Chairman SANDERS. OK. And, I assume everybody thinks that 

that is a sensible idea, yes? 

Mr. DELLINGER. Yes. Input from the veterans’ organizations, of 

course. 

Chairman SANDERS. Right. And, Mr. Violante. 

Mr. VIOLANTE. Yes. Our Executive Director meets with both the 

Secretary and the Under Secretaries on a regular basis. 

Chairman SANDERS. Mr. Tarantino. 

Mr. TARANTINO. That is not true for IAVA. We had our first 

meeting with the Secretary at VA Headquarters last week, and 

that was the first time since he was—— 

103 

Chairman SANDERS. OK. So, you have not been meeting on a regular basis? 

Mr. TARANTINO. No. 

Chairman SANDERS. OK. Mr. Blake? 

Mr. BLAKE. Our situation is the same as the DAV. Our Executive 

Director meets with him on a monthly basis. 

Chairman SANDERS. Mr. Robinson. 

Mr. ROBINSON. Yes. We meet with the Secretary on a regular 

basis. 

Chairman SANDERS. Mr. Gallucci. 

Mr. WEIDMAN. We meet with the Secretary—— 

Chairman SANDERS. Mr. Gallucci first. 

Mr. WEIDMAN. I am sorry. 

Mr. GALLUCCI. Thank you, Mr. Chairman. The VFW’s executive 

leadership does meet with the Secretary on a regular basis, and 

our front-line leaders meet with his deputies on a regular basis, as 

well. 

Chairman SANDERS. OK. Mr. Weidman. 

Mr. WEIDMAN. VVA meets on a regular basis at the national 

level. Where it is not on that basis is programmatic things. The 

only place in VA that is sticking to the President’s Executive Order 

on consultation of stakeholders before decisions are made is the 

Under Secretary for Benefits, because it does not happen in many 

other areas, and if it did, the decisions would be better. 

Chairman SANDERS. Sen. Isakson, I have gone way over my time. 

You will have equal time. 

Senator ISAKSON. Thank you, Mr. Chairman. That is the prerogative of the Chair, too, I might add, so—— 

[Laughter.] 

Chairman SANDERS. But it is going to be the prerogative of the 

Acting Ranking Member. You will have that time. 

Senator ISAKSON. Following up on the tone of the discussion, it 

needs to—I am going to make a statement and I would like each 

one of you to tell me whether you agree with this statement or not. 

The question before us today is not the quality of health care delivered to veterans by VA. The question is access to the quality of 

care. Would you agree with that, Commander? 

Mr. DELLINGER. Senator, we do agree with that, but there are 

also pockets within it, like a cancer, like a skin cancer. If you get 

the small pockets out, the overall system will live. But, eventually, 

if you do not take care of that, the system will die. 

Senator ISAKSON. OK. 

Mr. Violante. 

Mr. VIOLANTE. Yes, DAV certainly agrees with that. And I would 

like to point out a task that President Bush force back in 2003 established to look at health care, pointed out at that time that there 

was a mismatch of funding and demand, and if something was not 

done about that, access was going to be affected, which is what we 

are seeing now. 

Senator ISAKSON. That is going to be my next point, but go 

ahead, Mr. Tarantino. 

Mr. TARANTINO. We would agree with that statement, Senator. 

Senator ISAKSON. Mr. Blake. 

Mr. BLAKE. Yes, sir, Senator. It is definitely access. 

104 

Senator ISAKSON. Mr. Robinson. 

Mr. ROBINSON. Our concern certainly would be the access, especially in rural areas. 

Senator ISAKSON. Right. 

Mr. Gallucci. 

Mr. GALLUCCI. Senator Isakson, we would agree with that, but 

with access, that can leach into care delivery. One of the concerns 

that we received from a veteran in Nevada was that he was diagnosed with skin cancer, a proper diagnosis. But, because a dermatologist had left the VA medical center, they were not going to 

be able to schedule him for a proper consultation until that person 

was replaced. 

Senator ISAKSON. Which is somewhat an access problem in and 

of itself. 

Mr. GALLUCCI. It is an access problem, but that is where access 

leaches into the quality of care that can be delivered. 

Senator ISAKSON. Well, capacity is one of the problems for access. 

Mr. GALLUCCI. Exactly. 

Senator ISAKSON. Mr. Weidman. 

Mr. WEIDMAN. It is primarily access, and an additional thing is 

that VA still is not systematically in the medical system addressing 

the wounds, maladies, and injuries of war and taking a military 

history and using it in the diagnosis and treatment modalities. 

Senator ISAKSON. The reason I am taking this track is I do not 

want us to leave this hearing with a mixed message. If there is any 

problem with VA quality of health care, we need to talk about that. 

But, if there is not, except for isolated cases, and the dermatology 

case is a good example, we need to talk about what the problem 

is, which is access to that health care, which is a capacity problem, 

number 1, but it also appears to be an attitudinal problem within 

the VA where there is more of a motivation to make the numbers 

look good than give access to the care to make the veteran well. 

Am I stating it fairly? Does anybody disagree with that statement? 

Mr. BLAKE. No, Senator, I think you are right. I mean, I think 

there have been concerns raised that maybe the performance accountability system promotes something like that, and so access is 

controlled in order to make performance look better. 

Senator ISAKSON. And, capacity is a function of appropriations, 

I understand that, but it is also a function of the management of 

the system internally within the VA. I do not ever recall—and I 

could be wrong, Mr. Chairman—us receiving a report from the Veterans Administration on any study it has done to improve its access to capacity, or improve its capacity so we improve access. 

What we always tend to talk about is the time it takes to get a 

determination for a disability, or how long it takes to get into a VA 

center, or some other isolated case like that, when it seems like we 

ought to have a very thorough examination of the capacity situation in terms of the VA. 

And then we have got to take a look at the issues that you addressed, Mr. Blake. I know you are not for any private delivery of 

service. You want the veterans’ hospitals to operate. And I know, 

Commander, that is the same for you. But, the option of having 

that access could help solve the capacity problem, particularly on 

a selected specialty, like dermatology, like melanoma, like most 

105 

surgery or something like that. So, is that an idea that—not replacing the VA Health Care System, but having veterans have options 

to access the private health care system. Would that work, Mr. 

Blake? 

Mr. BLAKE. Senator, I think veterans have options, even now—— 

Senator ISAKSON. They do. 

Mr. BLAKE [continuing]. And I think they are improving on it. 

The PCCC is an example of how they are trying to improve upon 

that. We certainly believe that if they are going to move some in 

that direction, there needs to be coordinated care. My point was 

that that does not particularly work, though, for veterans with specialized care needs, like SCI or blinded care or amputation, because 

those types of services do not really exist—— 

Senator ISAKSON. In the private sector. 

Mr. BLAKE [continuing]. In the private sector; at least not in the 

way that our members have come to expect it. But, we certainly 

could see where privatized care plays a role in it, or contracted for 

services with coordinated care plays a role. 

One thing I would suggest, though, is that as a solution suggests 

that that is what veterans want. But, I think some of the problem 

that we see right now validates that veterans want into VA. So, 

why would we create an option where they necessarily where they 

would go somewhere else? They want into VA. They cannot get into 

VA. So, we are not sure that allowing them to go outside is addressing what their immediate desire is. 

Senator ISAKSON. Except that wants and needs are two different 

things, and the need is the most important. If it gets them the 

service they need in a timely manner, even though it might not be 

in a VA hospital because of the particular problem, it is better than 

having them wait so long to have a life-threatening condition come 

about. 

Mr. BLAKE. I would agree with that point, Senator. 

Senator ISAKSON. All of your testimony was outstanding, by the 

way. I appreciate all of it very much. And, I am going to leave this 

hearing with a clear message for the veterans of Georgia. We need 

to solve the access and the scheduling problem and we need to do 

it now, and we need—VA needs to go internally—which Secretary 

Shinseki and I talked about this—have an accountability mechanism all the way down, because I think the senior leadership is disserving the American veteran. I think we have known what the 

problems are for some period of time and I think we know what 

the needs are. I hope we will take this hearing and move forward 

to solve those problems, hold everybody appropriately accountable, 

and have an attitude toward solving problems rather than masking 

problems. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Isakson. 

Senator Begich, I think, is next. 

Senator BEGICH. Mr. Chairman, thank you. 

I am going to follow up on Senator Isakson’s comments. You 

know, we had a similar problem. I first want to thank many of you 

because you had concerns about what I am about to talk about but 

you came—and, Carl, you are one of them, and you were really 

good in helping us figure this out—and that is, we have a huge 

106 

Alaska Native veteran population, American Indian population, in 

Alaska: 150,000-plus. We have an Indian Health Service system 

which was not very good, to be frank, many, many years ago. Now, 

in Alaska, the tribes took it over and now deliver, we consider, the 

best health care in this country, in my opinion and I think many 

others’ opinion. As a matter of fact, CMS has said it is some of the 

best health care in the country. 

So, because we do not have a veterans’ hospital, and many of us 

had these conversations over the last few years, we were trying to 

figure out a system to create better care—access is really what it 

is about. If you live in Nome, AK, and you want to come into Anchorage to the clinic, you could spend $1,500, $2,000 from one of 

the outer villages going to Nome and then coming to—very expensive for our veterans. We have 800 veterans living in Nome, AK, 

that are both native and non-native. We built a brand new hospital 

there with stimulus money, which I am very proud of—a $170 million facility for Indian Health Services, which is actually run by 

our tribal consortium. Indian Health Services does not run health 

care in Alaska. It gives a check to the tribal consortium who then 

delivers health care for our tribes. 

Because of the work you all did with our office, we now have access for our veterans. Those 800 veterans have a choice now. They 

can go to Indian Health Care Services, get that health care anywhere near their home, their village. I can tell you story after story 

about how that system has now come to be very valuable. Or, they 

can go to the clinic or go to Seattle to the hospital, because it was 

an access issue. The care that VA offers, and I think you all said 

it, we have great professionals there. They work hard. I think they 

are overworked for the amount of time they have. They have not 

enough staffing, and we can go through all those lists. 

But, the moral is, we found a solution, protecting the importance 

of VA health care, which is veterans want to be part of the VA 

Health Care System. They want to be—that is their—they earned 

it. They fought for it. It is a benefit of theirs. 

But, in Alaska, we had an access issue. We could not afford to 

have a veteran sitting out in rural Alaska waiting to catch the next 

plane when there is a hospital right next door. So, we figured this 

out. We have a model called Nuka, which, when you walk into the 

Indian Health Care Services, the odds of you getting a same-day 

appointment is probably 75 percent or better. 

And, when you come in—the question you brought up is the 

amount of ailments that someone comes in with is different than 

the model that VA has been designed for years ago. The Nuka 

Model, same situation and problem: too many ailments per one individual. So, now when you come in, you get a mental health provider, eye doctor, dentist, full health care. They meet with you as 

a team. So, they resolve the issues collectively rather than individually, and the care quality is superb. 

You know, we have been pushing on VA to look at the Nuka 

Model, because that is how we have got to deal with multiple ailments of an individual, and also same-day access. To be able to 

schedule a routine appointment and have to wait weeks or months 

is outrageous. And so maybe it is more of a statement, but I would 

be interested in—and again, I know many of you worked with us, 

107 

and I point Carl out because he and I had some good debates on 

this, but I think it is working. I have veterans now who call me 

and say thank you; not that they are not going to always go to VA. 

They are going to go to VA. But now, in a situation where they are 

living in a village or a small community, they can go across the 

street and there it is. They have a choice. 

So, I guess I would like your—you have heard kind of my comments here. I would be interested in any comments folks have. 

And, again, the Nuka Model—N-u-k-a—is a very unique delivery 

system. It is all about access. Any comments from folks? 

Mr. DELLINGER. Senator, Dan Dellinger. Thank you for that 

question, because it just so happens, I was in Alaska last month, 

and I was in Kenai, and—— 

Senator BEGICH. A beautiful new hospital down there. 

Mr. DELLINGER [continuing]. And they want to expand what they 

are doing in that area, and they are in a strip mall with the CBOC 

there—— 

Senator BEGICH. That is right. 

Mr. DELLINGER. But, they are also are looking for additional 

space. VA spent 3 years trying to get a lease worked up and they 

are frustrated. They want to do additional things. But, I agree with 

your assessment as far as accessibility, especially out West. The 

East Coast is something different—— 

Senator BEGICH. I agree. 

Mr. DELLINGER [continuing]. But, as I travel through the Western States, I see more—— 

Senator BEGICH. Like ours. 

Mr. DELLINGER [continuing]. Services—exactly. And, I think it is 

something we should build upon in—— 

Senator BEGICH. Kenai has a brand new, it is a Kenaitze Tribe 

hospital, a beautiful hospital that will partner, actually, with that 

CBOC—— 

Mr. DELLINGER. Exactly. 

Senator BEGICH [continuing]. Which is unbelievable care. Thank 

you for that. 

Any other comments on that? And, I know my time is almost up 

here, so—— 

Mr. VIOLANTE. The only thing I would like to say, Senator, is 

right now we have 27 points of access that are on hold because we 

cannot get the funding, and it is important that we move forward 

on that. I mean, going back to the Clinton administration, when 

they put a lot of construction on hold under CARES to determine 

where they wanted to build. I mean, VA has been underfunded in 

construction since the Clinton administration. 

Senator BEGICH. Good point. 

Mr. VIOLANTE. So, we need to do something about that, also. 

Senator BEGICH. Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Begich. 

Senator Moran. 

Senator MORAN. Mr. Chairman, thank you very much, and Secretary Shinseki, thank you for remaining for the testimony. I appreciate you being here. 

Let me raise a topic about the assessment that is now going on, 

the face-to-face review across our country. One of my Congressional 

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colleagues had a conversation with VA personnel in Jackson, MI, 

after the assessment presumably took place, and this is a bit of a 

paraphrase of his or her report back from what they heard about 

this assessment. 

We asked about their face-to-face review. They stated that the 

team came in on Monday, interviewed some clerks and some supervisors, and they did not find any evidence of scheduling issues. No 

veterans were interviewed. What struck this person was the apparent superficiality of this so-called audit. A day, at most, visit that 

did not comb through the electronic system or actually audit any 

reports is not indicative of a thorough review. 

And so what I tried to raise in my opening statement is we are 

going to have one more review that is to be completed within 2 

weeks. We have 1,700 facilities across the country. And so, in part, 

my concern is the quality of the review. It appears to me that this 

is more of damage control. It is what people do when there are allegations of mismanagement, improper conduct. You have another 

review planned. And so my concern is how credible will the review 

be based upon the amount of time and resources that is being devoted to it. 

But, perhaps more troubling to me is how many reports, allegations, IG, GAO, Congressional hearings do we have to have before 

there is a different approach or attitude at VA to solve the problem. And so, I guess I do not disagree with an audit across the 

country but what is this really going to accomplish? Will we be 

here 6 months from now in which VA has a plan in place to transform itself so that these access issues that you all described are not 

the same ones that we heard today, we heard last week, we heard 

last month, we heard last year? 

The Phoenix situation seems to have brought national attention 

to this problem, but I cannot imagine that there is anyone at the 

table who believes that the Phoenix situation is really what the— 

is the problem. It is a symptom of a much broader problem that 

has been ignored for a long time. 

So, Commander—and here, let me add this. I understand that 

the testimony of the Secretary this morning in response to the Senator from North Carolina in which the Senator, outlined a long list 

of audits and reviews, GAO reports, Inspector General audits, and 

the Secretary indicated that he was unaware of those audits and 

reports and, therefore, had not been used in any conclusions that 

I assume would be made at VA. 

There was an IG report that is included in that list that said the 

unexpected death report could be avoided if the VA focused on its 

core mission, to deliver quality health care. Because no two VA 

medical centers are alike, it is difficult to implement VHA directives when there are no standard position descriptions or organizational structures. The IG believes it is time to review the organizational structure and business rules of VHA. 

How can that be an IG report that a Secretary of Veterans Affairs would be unaware of? It is directly related to the management 

and organization of the Department of Veterans Affairs. 

So, my question, if there is one in my commentary, is what assurance can we have, or what assurance do you have, that when 

this face-to-face review is done, that something will be different in 

109 

the direction that VA is taking in regard to creating higher quality 

care for veterans and making certain that they have access? 

Commander. 

Mr. DELLINGER. Senator, that is quite a task. With the IG audit, 

yes. In the findings, once they come out, I think this Committee 

needs to establish, along with VA, milestones so as to rectify these 

issues as they go through. But, as you noted in your comments, 

each hospital is different, and even when a director changes, a hospital that was doing excellent then could possibly slip below the 

standard. So, it is going to be an ongoing challenge; and we would 

hope that the Secretary and VA would move forward as soon as 

possible with the changes necessary to give us the quality health 

care that all veterans deserve. 

Senator MORAN. My time is soon to expire, and I do not know 

whether the Chairman is intending to allow you to answer my 

question, but I would add that you all—almost all—indicated that 

you have, or your senior staff have, ongoing conversations with the 

Secretary or high-level individuals at the Department of Veterans 

Affairs. But, the question that I would ask is, does that result in 

a change in approach, style, management, or attitude at VA that 

actually results in higher quality care for our veterans? 

Mr. Chairman, thank you for the opportunity to issue a statement and to ask the questions. 

Chairman SANDERS. Thank you, Senator Moran. 

Senator Tester. 

Senator TESTER. Thank you, Mr. Chairman, and I want to thank 

this panel for their testimony, their perspective, and their vision. 

I also want to thank Secretary Shinseki for staying here for this 

part of the hearing and to express my apologies. I got tied up in 

the Banking Committee and votes on the floor, but we will follow 

up with you in private. 

It is good to be asking questions about fifth or sixth down the 

list because I think we have all agreed that access is the issue. 

And, we have had everything talked about from dollars, to allocation, to construction, to milestones, to manpower, to all sorts of 

stuff, which it all is good and it all is helpful. 

I am going to ask each one of you folks—because you represent 

veterans in this country that are being served by the VA, I think 

you have an understanding of what the challenges are out there, 

so, you are not Secretary of VA, you are not President of the 

United States, you are above all them. You tell me what you would 

do first to fix the VA and what you would do second. And, I assuming there would be three or four or five more down the line, but 

is it money? Is it the resources they have need to be allocated different? Is it we need to put a focus on hiring professionals? And 

you cannot say, do all of them, because we want to hold folks accountable. So, if you could give me your priorities for what we need 

to do, I think it could be helpful. 

Mr. DELLINGER. Senator, assessment, I think, is the first thing 

that needs to happen, because as we have heard VA speak about 

they have enough money, but they do not have the accurate numbers. If they are gaming the system, how many actual visits are 

they going to have a year? Instead of having 85 million, is it going 

to be 150 million? So, you cannot assess a money value to that 

110 

until you can make the assessment as to what exactly the problem 

is. 

Senator TESTER. OK. And so, then, I assume that once you get 

the assessment, you follow that assessment as a blueprint to fixing 

VA. 

Does anybody else have anything they would like to add to that? 

Go ahead, Mr. Gallucci. 

Mr. GALLUCCI. Senator, thank you for asking that question. I actually have a list of four things—— 

Senator TESTER. Perfect. 

Mr. GALLUCCI [continuing]. That I would really want to talk 

about. First is resources, as the VFW and our Independent Budget 

partners have talked about. And, it may not be a numbers game. 

It may be allocation of resources. 

Second—— 

Senator TESTER. So, what are you telling us to do? 

Mr. GALLUCCI. We would recommend taking the IB’s recommendations on how to properly fund VA and things like capital 

infrastructure and VHA’s baseline budget. 

Senator TESTER. Continue. 

Mr. GALLUCCI. Second would be training and outreach for your 

gatekeepers, the people who man the call centers at VA facilities. 

Senator TESTER. OK. 

Mr. GALLUCCI [continuing]. On outreach to veterans so they 

know what to expect when they call VA. 

Senator TESTER. OK. 

Mr. GALLUCCI. Consistency across the board, so that your experience at one VA center is very similar to your experience at another 

VA center. 

And, finally, one that I have been chomping at the bit to talk 

about is accountability. We have had a lot of talk about accountability. The Secretary said that 3,000 employees were sanctioned in 

some way, whether that was termination, retirement, transfer, or 

demotion, what have you. 

There is a problem—in having conversations over recent weeks 

about this internally with VFW, with some of our advocates and 

veterans, there are two things that we know. First of all, 

reprimanding or firing an employee in the Federal Government is 

a difficult process, a difficult legal process with significant EEO 

and other legal protections. It can take a long time to take punitive 

action against an employee. 

Second, when there is a vacancy in the Federal Government— 

this is, again, not VA exclusive—it can take between 6 months and 

1 year to fill it. So, if you have an underperforming employee—— 

Senator TESTER. Yes. 

Mr. GALLUCCI [continuing]. You have to then make—and I am 

really asking the question here—do you make the tradeoff decision. 

So, I have an underperforming employee. Is it better to keep them 

on the books at least serving some veterans or terminate them and 

have that vacuum of care for 6 months to a year, or possibly 

longer? 

Senator TESTER. I appreciate that, and that might, Mr. Chairman, bring us around to another discussion about how we can work 

with the Department—and, by the way, this could apply to all 

111 

agencies in government—to reduce the red tape for hiring, because 

it takes far too long to get that done. 

I want to just ask a little bit about the accountability portion, because accountability is really, from my perspective, really easy to 

talk about, but sometimes very difficult to put your finger on where 

the problem is, who is the problem, and, quite frankly, how you 

deal with it. Any ideas on—I mean, for example, the argument 

could be made that because we have hired all these middle-management folks—and I think you guys made a very good point on 

that; this is crazy, we should not be doing that. These should be 

on-the-ground folks. But, we have hired these middle-management 

folks to make sure the folks on the ground are actually doing the 

job. Now, how do you deal with accountability? Do you contract it 

out? Do oversight? What do you do? Or, does it strictly fall at the 

Secretary’s feet and everybody else is held harmless? Go ahead, 

Mr. Weidman. 

Mr. WEIDMAN. I think that the bill introduced by Mr. Miller on 

the House side is a good start—and people said, do you favor that 

bill—which strips SES people at VA of any protections whatsoever. 

But, there is a reasonable point in between Mr. Miller’s bill as it 

currently is and what we have now, because they cannot fire SES 

people. They say they can, but they cannot. I mean, I remember 

the lady from Kansas City a few years ago. They removed her as 

a VISN Director—— 

Senator TESTER. Yes. 

Mr. WEIDMAN [continuing]. But, every Monday morning, flew her 

to Washington, kept her here at government expense, and flew her 

back for 3 years, paying her $180,000. So, they need flexibility. 

Senator TESTER. Thank you, and thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Tester. 

Senator Johanns. 

Senator JOHANNS. Thank you, Mr. Chairman, and to everybody 

who is here. This has been extremely helpful. 

I think we are going to find that the access issue, which you all 

consistently say is the problem, is going to be easier to identify 

than to solve. You know, I think about, let us say, a VA hospital 

needs five specialists. They are probably going to recruit from the 

area around and they are going to compete with private doctors’ 

practices, they are going to compete with hospitals, and on and on, 

and that is true whether it is the doctor or the nurse or the medical 

technician, whatever it is. So, building that capacity, even with lots 

of money, would be a challenge, and I think we all agree to that. 

So, let me ask you a question, because I also agree—we are waiting for a hospital in Omaha. I am beginning to wonder if it will 

happen during my lifetime, and I am a fairly young man. I am, you 

know, not too old. And even if we could get all the money all at 

once, which would be very hard to accomplish, how much construction can you get up and going, and on and on. 

So, let me ask you a question about access. Let us say that we 

are thinking about this and we have got all this population that 

is needing more access, not less—us Vietnam-era people. It is a 

whole group of people, and we are aging. We are the Baby Boomers 

and we need more access, not less. 

112 

Would your members be open to an idea that said something like 

this: They call, they say, I need to see a health care professional 

because I have got a spot on my leg that does not look right. I 

think it might be cancer. And they say, well, we want to see you 

just as quick as we can, but that will be 4 months, or 6 months, 

or whatever. Would your members be open to an idea that says, 

look, if you cannot get in within 2 weeks, or 3 weeks, or whatever 

the appropriate timeline is, you can seek private care. You can go 

to your local doctor or a specialist or whatever. The government 

will pay the cost of that and we will cover that, because we do not 

want you to wait and we believe that that is the best way to deal 

with access, the quickest way, the most effective way. 

And the other thing I would mention in asking you this question 

is, in States like mine—we are a Western State, the State of Nebraska—access for rural veterans is especially difficult and it is especially difficult in some areas like mental health and specialized 

care. 

Commander, what is your thought about that? 

Mr. DELLINGER. Well, you know, VA right now utilizes telemedicine, so if they are at a CBOC, and even though there is only a 

nurse there, they can, by utilizing telehealth, be seen at a 

hospital—— 

Senator JOHANNS. Yes, I appreciate that, but how would your 

members react if I said, look, we are just not going to make you 

wait anymore. If VA cannot meet your needs within a certain period of time, then we will allow you, if you choose, to seek private 

care. If you want to wait, it is a free country. You can wait, too. 

Mr. DELLINGER. I understand that. We would not be opposed to 

that, because we want the best health care as fast as possible. But, 

we also have to put a caveat on that that it cannot happen exceedingly, because then there goes the entire budget as fee-based, 

which is going to be higher in the private sector versus the ability 

in the VA. 

Senator JOHANNS. Well, I get that, but we are all saying we 

want—— 

Mr. DELLINGER. I understand. 

Senator JOHANNS [continuing]. The best care. Yes, sir. 

Mr. VIOLANTE. Senator, I mean, that is the exact point; if you are 

not willing to give VA the resources it needs to allow for access in 

their facilities, you are going to need to give them more resources 

by sending veterans out into the community. Now, VA has the authority—I do not think they use it enough—for purchased care. 

And, again, as I pointed out, if a veteran cannot be seen in a certain timeframe, they should be able to get that care by a private 

doctor, but VA needs to coordinate that care. 

We need to be careful that we do not start increasing the money 

going out to private doctors and taking away from VA’s ability to 

hire internally, because all we are doing is robbing Peter to pay 

Paul, and if they do not have the money to do it now, they are 

going to have less money to do it with the private sector. 

Senator JOHANNS. I am out of time on a complex issue, but here 

is my point, again. If it results in better care, is that not what we 

are trying to achieve? And, boy, I hope some day I can have a discussion with all of you. 

113 

Thank you, Mr. Chairman. 

Mr. BLAKE. Senator, could I address that real quick? 

Senator JOHANNS. Sure. 

Mr. BLAKE. It is my understanding that the PCCC, which is Patient Centered Coordinated Care, is sort of envisioned to address 

part of what the problem is that you outlined specifically, and that 

is what we want. We want coordinated care, because the key is the 

continuity of care and ensuring that VA is ultimately responsible 

for that veteran, so they know the spectrum of what that veteran 

is receiving. So, I think maybe PCCC is moving in the direction of 

addressing the kind of concerns that you are raising. 

Senator JOHANNS. Thank you, Mr. Chairman. 

Chairman SANDERS. Thank you. 

Senator Blumenthal. 

Senator BLUMENTHAL. Thank you, Mr. Chairman. 

I want to thank all of the leaders here for your presence today, 

but also your tireless and relentless work on behalf of the veterans 

of America. And, truly, your leadership has made a big difference, 

not only in the performance and outcomes from the Veterans Administration, but in countless communities and other areas across 

the country. So, my thanks to you. 

My questions are very simple. All of you, I believe, would agree 

with me that the investigation should be as hard hitting, aggressive, thorough, and prompt as possible, and that if that requires 

the resources of other investigative agencies, they ought to be 

called upon, as well. Would you agree? 

Mr. DELLINGER. I do, sir—Senator. 

Senator BLUMENTHAL. And, second—— 

Mr. WEIDMAN. We not only—— 

Senator BLUMENTHAL. I am sorry, Mr. Weidman. 

Mr. WEIDMAN. We not only agree, but our National President, 

John Rowan, wrote to the Attorney General of Arizona last week 

and to the U.S. Attorney for the District of Arizona, asking each 

of them to launch criminal investigations into reckless endangerment, possibly resulting in loss of life. 

Senator BLUMENTHAL. Well, if you were not here earlier, let me 

just tell you that I urged the Secretary of VA, Secretary Shinseki, 

to strongly consider—in fact, I recommended that he involve the 

Department of Justice because there is ample evidence—and, I emphasize, evidence, not just allegations—of criminal wrongdoing, including destruction of documents and falsification of statements— 

to warrant the FBI to review this situation, as they do commonly 

when there are allegations of this kind, and determine, in fact, 

whether there is a basis for that investigation. 

The reason is, quite simply, not only the evidence of possible 

criminal wrongdoing, but also the Inspector General lacks the jurisdiction and authority, the resources, and the expertise to do a 

prompt and effective criminal investigation. Only the FBI can provide the resources, expertise, and authority, and the Department of 

Justice includes the U.S. Attorney in Arizona and every U.S. Attorney in every State that may be affected here. 

So, I think what we share is a determination—and I believe that 

the Secretary of VA shares it, as well—to get to the bottom, to remedy the wrongdoing, to provide relief to anyone denied access; and 

114 

I think that is a determination that unites us in this room and that 

accountability means changing the team, if necessary, at VA. I believe that there may, at some point, be a need to consider those 

changes, as well. 

So, again, thanks for being here. My time is limited. I thank the 

Chairman. 

Chairman SANDERS. Thank you very much, Senator Blumenthal. 

Senator Hirono. 

Senator HIRONO. Thank you very much. 

I do apologize if this question has already been asked, but Senator Murray had asked earlier of, I believe, Secretary Shinseki, as 

to what a face-to-face audit should involve; and I would like to ask 

you—perhaps we can start with Mr. Dellinger—what needs to happen in a face-to-face audit to truly elicit the kind of information we 

need to address the challenges and the problems at VA hospitals 

and clinics. 

Mr. DELLINGER. Thank you, Senator, for that question. I feel it 

has to start with IT first. They have to look at the process of the 

books as far as what actually occurs there. They also have to go 

through the administration, through the physicians, the employees, 

and also get input from the stakeholders in this, including the veterans. 

Senator HIRONO. Did that happen the last time? Apparently, 

there have been audits before, and when those audits were conducted, were the stakeholders, i.e., the veterans’ organizations, included? 

Mr. DELLINGER. I do not have that information. 

Senator HIRONO. Do the rest of you have any information that 

will help us? Yes. 

Mr. WEIDMAN. Often, we are not included. Actually, even more 

important than the organizations at the local level is to talk to veterans at the local level who are not hand-picked and ask, what is 

happening here? If you ask the veterans, they are smart. We got 

hurt. We got wounded. We did not get dumb. The veterans will tell 

you how to fix the facility. 

Senator HIRONO. So, would you all agree that any face-to-face 

audit should include—probably, this is a rhetorical question, but— 

input from the veterans’ organizations as well as veterans at the 

particular facility? 

Mr. WEIDMAN. Yes. 

Mr. VIOLANTE. Senator, I would agree with that. I would also, as 

we pointed out in our testimony, recommend that there be an independent third-party expert involved. It would alleviate a lot of the 

questions that Senator Moran raised about the audit and I think 

it would help everyone be assured that these audits were being 

done properly and everything was being looked at. 

Senator HIRONO. What do you mean by an independent third 

party—— 

Mr. VIOLANTE. Someone who is—I mean, I do not have the expertise—— 

Senator HIRONO. Like whom? 

Mr. VIOLANTE. I do not have the expertise to determine, you 

know, are the people cooking the books, are the veterans getting 

timely care, are they spending sufficient time or too much time 

115 

with the doctor. There needs to be someone who is an expert in 

time management, in accessing medical care, that can be there to 

make a determination if they are asking the right questions and 

are the answers sufficient to address this problem. 

Mr. BLAKE. Senator, I would suggest, also, if they are going to 

do a thorough audit, it would take more than a couple weeks, certainly, because a thorough audit would be an examination of what 

the entire capacity of the system currently is. That might involve 

clinicians, nurses, whatever it may be. 

I will suggest that if the audit that is going on right now is what 

Senator Moran suggested is happening, that is pretty damn disheartening, because that is not going to solve any problems as far 

as we are concerned. It is going to take a more thorough analysis, 

for sure, than a couple of hours out of 1 day in a week to sit down 

and figure out what is happening. It might get to the bottom of a 

problem, a shallow-depth problem at a local facility, but I am not 

sure that is going to solve the deeper-rooted problems. 

Senator HIRONO. I would envision that any kind of an assessment of the entire VA health care system would involve not just 

this process that Secretary Shinseki has described to us, but that 

it will be an ongoing kind of an assessment, which I hope will be 

the case. The Secretary is still here and I am sure that he is taking 

to heart the suggestions and comments that you are now providing. 

I had asked the Secretary, in view of all that we are asking the 

VA with regard to education issues, housing issues, homelessness, 

all of that, whether he thinks that this is taking away from VA’s 

core mission of providing health care for the veterans. Does anybody care to respond to that? 

Mr. WEIDMAN. There is no such thing as a homeless veteran. 

There are veterans whose problems have become so acute and have 

not been addressed that they have ended up without a home. So, 

it is not a whole different class of veterans, if you will. And, if the 

other services come through, then people do not end up on the 

street. Each one is a failure. It does not mean that people set out 

to fail, but somehow, we have failed those folks coming home. 

Mr. GALLUCCI. Senator, I would like to add to that the VFW believes that the resources and services the VA can provide should 

never come at a tradeoff. VA’s obligation is to provide holistic services to the veteran. That can come in the form of education benefits, employment assistance—like the resource that they launched 

a couple of weeks ago through e-Benefits—but, health care has to 

remain a cornerstone of that. 

When veterans transition off of active duty, there are a litany of 

transitional resources that need to be made available to them. The 

VA has the primary mission in delivering most of those, except for 

possibly what the Department of Labor, Veterans Employment and 

Training Service, has. 

So, we would never want to see tradeoffs made on how we deliver 

other benefits, because if we start injecting resources into health 

care, will G.I. Bill administration suffer, or will other benefits administration suffer? 

Senator HIRONO. Thank you for that perspective. 

Thank you, Mr. Chairman. 

Chairman SANDERS. Senator Burr. 

116 

Senator BURR. Mr. Chairman, just 1 second, because in my absence, Senator Moran did talk specifically about the audits and he 

read a statement. I just wanted the witnesses to know, that was 

the assessment of Chairman Miller from the House Committee. He 

actually was at Jackson, and I am not sure how many facilities he 

is covering, but that was his assessment of the audit process. 

Not that I do not love you guys, but we are going to try to get 

the next panel in before we get into a series of votes that will bring 

a finality to this, so thank you. 

Chairman SANDERS. Thank you, Senator Burr. 

First of all, thank you for what you do every day representing 

veterans, and thanks for being here. More importantly, I think we 

all know we are not going to create the great health care system 

we need in the VA without your active participation. We need you. 

So, thank you very much for being here and keep up the good 

work. [Pause.] 

And, if we could bring up the third panel. [Pause.] 

OK. Let me introduce our third panel of the day. Representing 

VA’s independent Inspector General’s Office is its Acting Inspector 

General, Richard Griffin; he is accompanied by Dr. John D. Daigh, 

Assistant Inspector General for Healthcare Inspections. 

From the National Association of State Directors of Veterans Affairs, we have its President, Retired Rear Admiral W. Clyde Marsh. 

From the Government Accountability Office, the GAO, we have 

their Director of Health Care, Debra Draper. 

Finally, joining us today is Phillip Longman, Senior Research 

Fellow at the New America Foundation. 

Thank you all very much for being here. 

Mr. Griffin, you may begin. 

STATEMENT OF RICHARD GRIFFIN, ACTING INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY JOHN D. DAIGH, JR., M.D., ASSISTANT INSPECTOR GENERAL FOR HEALTHCARE INSPECTIONS 

Mr. GRIFFIN. Mr. Chairman, Ranking Member Burr, and Members of the Committee, thank you for the opportunity to provide 

testimony at this hearing. I would like to provide an overview of 

our ongoing review at the Phoenix Health Care System. 

The OIG has assembled a multi-disciplinary team comprised of 

auditors, health care inspectors, board-certified physicians, and 

criminal investigators from across the country to address these allegations. I have directed our team to focus on two questions. Number 1, whether the facility’s electronic wait list purposely omitted 

the names of veterans waiting for care, and if so, at whose direction. And, number 2, whether the deaths of any of these veterans 

were related to delays in care. 

To get to the bottom of these allegations, the OIG has an exhaustive review underway that includes seven components: 

Number 1, interviewing staff with direct knowledge of patient scheduling practices and policies, including scheduling 

clerks, supervisors, patient care providers, management staff, 

and whistleblowers who have stepped forward to report allegations of wrongdoing. 

117 

Number 2, collecting and analyzing voluminous reports and 

documents from VHA information technology systems related 

to patient scheduling and enrollment. 

Number 3, reviewing medical records of patients whose 

deaths may be related to days in care. 

Number 4, reviewing performance ratings and awards of senior facility staff. 

Number 5, reviewing past and newly received complaints to 

the OIG Hotline on delays in care, as well as those complaints 

shared with us by members of Congress and by the media. 

Number 6, reviewing other prior reports relevant to these allegations, including Administrative Board of Investigations or 

reports from Veterans Health Administration Office of the 

Medical Inspector. 

Finally, number 7, reviewing massive amounts of e-mail and 

other documentation pertinent to this review. 

To facilitate our work, on May 1, I asked Secretary Shinseki to 

place the Phoenix Director, Associate Director, and another individual on administrative leave. This was done because of the gravity of the allegations and to ensure cooperation by Phoenix staff, 

some of whom expressed concern about talking to the OIG team. 

Secretary Shinseki immediately agreed to my request. 

I am confident that we have the resources and talent to complete 

a thorough review of these allegations at Phoenix. We are using 

our top audit experts, who have reviewed VA scheduling over the 

years, to examine all of the scheduling-related records. 

Dr. Daigh’s board-certified physicians from our Office of Healthcare Inspections will be reviewing medical records, treatment, and 

harm that may have resulted from delays in care. 

OIG criminal investigators, including IT forensic experts, are 

also assisting the team. We are working with Federal prosecutors 

from the U.S. Attorney’s Office for the District of Arizona and the 

Public Integrity Section of the Department of Justice here in Washington so that we can determine any conduct that we discover that 

merits criminal prosecution. 

Since the Phoenix story broke in the national media, we have received additional reports of manipulated waiting times at other 

VHA facilities, either through the OIG Hotline, members of Congress, or the media. In response, we have opened simultaneous reviews at several other VHA facilities. These reviews are being conducted by other OIG staff to enable the team working on the Phoenix review to focus their efforts on completing their project. We expect that these reviews will give us insight into the extent to which 

these scheduling issues are present at other VHA facilities. 

My staff is working diligently to determine the facts of what happened at Phoenix and who is accountable. While much has been 

done, much more remains ahead. Be assured, however, this review 

is the OIG’s top priority and that maximum resources are dedicated to bring about its timely conclusion. 

We intend to brief you and other members of the Congress once 

we have reached final findings of facts and are ready to publish our 

report. We project finishing the project and publishing a report in 

August of this year. 

118 

1 Healthcare Inspection—Gastroenterology Consult Delays, William Jennings Bryan Dorn VA 

Medical Center, Columbia, South Carolina (9/6/2013); Healthcare Inspection—Mismanagement of 

Inpatient Mental Health Care, Atlanta VA Medical Center, Decatur, Georgia (4/17/2013); 

Healthcare Inspection—Unexpected Patient Death in a Substance Abuse Residential Rehabilitation Treatment Program, Miami VA Healthcare System, Miami, Florida (3/27/2014); Healthcare 

Inspection—Patient Care Issues and Contract Mental Health Program Mismanagement, Atlanta 

VA Medical Center, Decatur, Georgia (4/17/2013); Healthcare Inspection—Emergency Department 

Patient Deaths Memphis VAMC, Memphis, Tennessee (10/23/2013); Healthcare Inspection—Inappropriate Use of Insulin Pens, VA Western New York Healthcare System, Buffalo, New York (5/ 

9/2013); Healthcare Inspection—Review of VHA Follow-Up on Inappropriate Use of Insulin Pens 

at Medical Facilities (8/1/2013). 

Thanks again for holding this hearing. Dr. Daigh and I will be 

pleased to answer any questions. 

[The prepared statement of Mr. Griffin follows:] 

PREPARED STATEMENT OF RICHARD J. GRIFFIN, ACTING INSPECTOR GENERAL, OFFICE

OF INSPECTOR GENERAL, DEPARTMENT OF VETERANS AFFAIRS

Chairman Sanders and Members of the Committee, thank you for the opportunity 

to testify today to discuss the quality of health care provided to veterans at Department of Veterans Affairs (VA) medical facilities. The VA Office of Inspector General 

(OIG) has issued many reports that have addressed the care at VA medical centers 

(VAMC). I am accompanied by John D. Daigh, Jr., M.D., Assistant Inspector General for Healthcare Inspections. For the purposes of this statement, I will focus on 

seven recent reports that I believe are indicative of issues facing VA in providing 

quality health care.1

BACKGROUND

The VA provides medical care to 6.5 million veterans through a system of medical 

facilities including 151 Medical Centers, 300 Vet Centers, and 820 Community 

Based Outpatient Clinics (CBOC). The Veterans Health Administration (VHA) Central Office provides leadership and policy guidance to the nationwide system of care. 

Hospitals, clinics, and related medical facilities are grouped into 21 Veterans Integrated Service Networks (VISN). VISNs and their related hospitals’ organization 

and business practices have evolved at different paces and have been significantly 

influenced by local preferences since their creation, resulting in 21 different VISN 

organizations, each charged with the same mission. 

COLON CANCER SCREENING

Colon cancer has long been recognized as a silent killer in that the cancer is often 

able to grow within the intestine to significant size before being discovered. Patients 

may be screened for this cancer by a variety of tests, some of which focus upon the 

presence of blood within stool or the physical presence of a mass within the intestine. Examinations that test stool for the presence of blood or other chemicals or 

visualize the intestine are common diagnostic tests used to discover the presence of 

this silent killer. 

In 2006, the OIG published a review, Colorectal Cancer Detection and Management in Veterans Health Administration Facilities (February 2, 2006), of aspects of 

VHA’s performance in the delivery of colon cancer screening and management of 

positive screening tests. This review found that the time between having a positive 

screening test for colon cancer and the provision of the next test to diagnose a tumor 

took several months. VA agreed that this delay in action was not acceptable. When 

colon cancer was diagnosed, surgeons and oncologists responded quickly with treatment, yet the lag between the identification of a specific risk and the determination 

that there was or was not colon cancer was not timely. 

In that report, the Under Secretary for Health concurred with the findings and 

recommendations we made to more efficiently and more timely address the lag between the positive screening test and the diagnostic test for colon cancer. The Under 

Secretary for Health indicated in the response to this report that timelines would 

be established to monitor the timeliness of colon rectal cancer diagnosis after a positive screening test and that a directive would be issued to establish national standards for the management of this process. This was accomplished with the issuance 

of VHA Directive 2007–004, ‘‘Colorectal Cancer Screening,’’ in January 2007. 

In September 2013, the OIG reported a disturbing set of events at the William 

Jennings Bryan Dorn VAMC in Columbia, South Carolina, that led to thousands of 

delayed gastroenterology (GI) consults for colon cancer screening and the determination that over 50 veterans had a delayed diagnosis of colon cancer, some of whom 

119 

2 Healthcare Inspection—Gastroenterology Consult Delays, William Jennings Bryan Dorn VA 

Medical Center, Columbia, South Carolina (9/6/2013). 3Fee basis care is non-VA/private sector care paid for by VA when the service is not available 

in a timely manner within VHA due to capability, capacity, or accessibility. 4 Healthcare Inspection—Mismanagement of Inpatient Mental Health Care, Atlanta VA Medical Center, Decatur, Georgia (4/17/2013); Healthcare Inspection—Unexpected Patient Death in a 

Substance Abuse Residential Rehabilitation Treatment Program, Miami VA Healthcare System, 

Miami, Florida (3/27/2014). 

died from colon cancer.2 After patients are screened positive for possible colon cancer or require a GI procedure, a consult to GI is usually sent by the primary care 

provider. Network and facility leaders became aware of the GI consult backlog at 

Columbia in July 2011 involving 2,500 delayed consults, 700 of them deemed ‘‘critical’’ by VA physicians. Additional funds were requested by the facility upon determining the need for a large number of GI procedures, and the VISN awarded the 

facility $1.02M for Fee-Basis colonoscopies in September 2011.3 However, facility 

leaders did not ensure that a structure for tracking and accounting was in place and 

by December 2011, the backlog stood at 3,800 delayed GI consults. The facility developed an action plan in January 2012 but had difficulty making progress in reducing the backlog. The delayed diagnosis of a patient with cancer in May 2012 prompted facility leaders to re-evaluate the GI situation, and facility, network, and VHA 

leaders aggressively pursued elimination of the backlog. This was essentially accomplished by late October 2012. However, during the review ‘‘look-back’’ period, 280 

patients were diagnosed with GI malignancies, 52 of whom were associated with a 

delay in diagnosis and treatment. The facility completed at least 19 institutional 

disclosures providing patients and their family members with specific details of the 

adverse event or delay of care and their right to file a claim. 

A confluence of factors contributed to the GI delays and hampered efforts to improve the condition. Specifically, the facility’s Planning Council did not have a supportive structure; Nursing Service did not hire GI nurses timely; the availability of 

Fee Basis care had been reduced; low-risk patients were being referred for screening 

colonoscopies, thus increasing demand; staff members did not consistently and correctly use the consult management reporting and tracking systems; critical network 

and facility leadership positions were filled by a series of managers who often had 

collateral duties and differing priorities; and Quality Management staff was not included in discussions about the GI backlogs. 

In its response to the report, VHA indicated that national VHA leadership considered delays in consult responsiveness to be of significant concern. VHA Central Office leadership took specific steps to address these issues in Columbia as well as system-wide. In January 2013, VHA undertook a national review of open consults to 

gain a better perspective on nationwide demand for consultative services. In 

May 2013, VHA launched an initiative to standardize use of the clinical consultation 

software package in the electronic health record. 

The appropriate management of patients who are at risk for colon cancer is standard medical practice. This issue has been discussed by VHA for years, and yet 

veterans were not timely diagnosed with colon cancer at this academic VA medical 

center. 

MENTAL HEALTH POLICIES AND PROCEDURES

The OIG has issued two reports recently on veterans who died of narcotic drug 

overdoses while in VA facilities for mental health care.4 In both cases, the hospital 

staff failed to ensure that veterans, who by their prior behavior were known to be 

at risk of abusing narcotic medication, were placed in environments that were secure from those drugs. 

At the Miami VA Healthcare System, in Miami, Florida, we found that a patient 

died in his room in the substance abuse residential rehabilitation treatment program (SARRTP), and autopsy results indicated the patient died from cocaine and 

heroin toxicity. This veteran had a history of multiple positive urine drug screens 

while in the SARRTP. We found that the SARRTP security surveillance camera was 

not working at the time of the patient’s death, was still not working at the time 

of our site visit, and no alternative arrangements were made to monitor patients 

in the absence of an operational camera. Moreover, we found that evening, night, 

and weekend SARRTP staff often sat in a backroom where they had an extremely 

limited view of the unit and no view of the unit’s entrance and exits. We also found 

that staff were not consistent in their methods of contraband searches and did not 

monitor patient whereabouts or unit visitors as required. 

In our report on the Atlanta VA Medical Center in Decatur, Georgia, we received 

allegations that the VA did not protect a veteran from illicit drugs while an inpaVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00123 Fmt 6633 Sfmt 6621 Z:\ACTIVE\051514.TXT PAULIN
120 

5 Healthcare Inspection—Patient Care Issues and Contract Mental Health Program Mismanagement, Atlanta VA Medical Center, Decatur, Georgia (4/17/2013). 6 Healthcare Inspection—Emergency Department Patient Deaths Memphis VAMC, Memphis, 

Tennessee (10/23/2013). 

tient on the locked mental health unit and that he died of an overdose. We substantiated that the facility did not have adequate policies or practices for patient monitoring, contraband, visitation, and urine drug screening. We found inadequate program oversight including a lack of timely follow up actions by leadership in response 

to patient incidents. 

At both Miami and Atlanta, as the reports indicate, standard steps to ensure veterans were kept safe while under VA control were not taken and two veterans died. 

In each instance, VA managers did not ensure that hospital staff performed their 

jobs. 

The OIG reported on poor management of contracted mental health care at the 

Atlanta VAMC, where between 4,000–5,000 veterans who were referred for non-VA 

mental health care at a public non-profit Community Service Board (CSB), were not 

followed or managed.5 In a sample of 85 cases, 21 percent of the referred veterans 

did not receive mental health care and, outside of the sample, several veterans were 

found to have died with a history of inadequate mental health care support from 

VA or non-VA sources. Mental Health Service Line managers did not adequately 

oversee or monitor contracted patient care services to ensure safe and effective 

treatment. This lack of effective patient care management and program oversight 

by the facility contributed to problems with access to mental health care and as a 

VA employee told the OIG ‘‘may have contributed to patients falling through the 

cracks.’’ The facility’s contract program lacked an integrated and effective Quality 

Assurance (QA) program and did not have a CSB QA process. For example, VA facility program managers did not track and trend patient complaints or conduct oversight visits to the CSB sites, as required by VA directives and the contract. 

Our review also confirmed that facility managers did not provide adequate staff, 

training, resources, support, or guidance for effective oversight of the contracted 

mental health program. Managers and staff voiced numerous concerns including 

challenges in program oversight, inadequate clinical monitoring, staff burnout, and 

compromised patient safety. Furthermore, other administrative issues contributed to 

the delay because the facility managers did not pay invoices promptly. These delays 

affected the CSBs’ ability to accept new patients and plan their patient census. 

The Atlanta VAMC was overwhelmed by the demand for mental health services 

over a multiyear period. VA leadership’s response to this crisis was fragmented, ineffective, and resulted in poor care, and may have contributed to the death of some 

of the veterans among the 4,000 to 5,000 patients referred for non-VA care. 

EMERGENCY DEPARTMENT ISSUES

In October 2013, we issued a report detailing three deaths in the Emergency Department (ED) at the Memphis VAMC in Memphis, Tennessee.6 We received allegations that three patients died subsequent to care they received in the Memphis 

VAMC ED. We found the following: 

• A patient was administered a medication in spite of a documented drug allergy 

and had a fatal reaction. Handwritten orders for this patient did not comply with 

the facility’s requirement that all provider orders and patient care be documented 

in the electronic medical record. Since the orders were not entered into the electronic medical record, systems in place to notify the provider of a drug allergy conflict with ordered medications were bypassed. The patient died of a reaction to a 

medication allergy that was identified in the electronic medical record. 

• Another patient was found unresponsive after being administered multiple 

sedating medications without being properly observed. 

• A third patient had a critically high blood pressure that was not aggressively 

monitored and experienced bleeding in the brain. 

The facility did complete protected peer reviews of the care for all three patients. 

Two of the deaths were also evaluated through root cause analyses (RCA), which 

are quality reviews designed to identify and correct systemic factors and conditions 

that may pose a threat to patient safety. However, we found that the implementation of the RCA action plan was delayed and incomplete. Additionally, the RCA documentation we reviewed contained several errors of fact, such as how long Patient 

1 was monitored in the emergency room before discharge and the number of intravenous medications given to Patient 2. 

Decisions were made which permitted the electronic medical record and its safeguards to be bypassed and to have patients on multiple sedating medications to be 

121 

7 Healthcare Inspection—Inappropriate Use of Insulin Pens, VA Western New York Healthcare 

System, Buffalo, New York (5/9/2013); Healthcare Inspection—Review of VHA Follow-Up on Inappropriate Use of Insulin Pens at Medical Facilities (8/1/2013). 

located in places difficult to monitor. Furthermore, when issues were identified 

through the RCA process, actions to prevent a recurrence were not taken seriously. 

INTRODUCTION OF NEW TECHNOLOGY

Several VAMCs including the medical centers in Buffalo, New York, and Salisbury, North Carolina, failed to introduce new technology properly into the hospital 

environment.7 This resulted in 700 patients at Buffalo and 260 patients at Salisbury 

being exposed to the risk of blood borne viral infections when insulin pens, designed 

to be used with one pen per patient, were instead used improperly such that one 

pen was used on multiple patients. 

In late October 2012, the Buffalo Chief of Pharmacy discovered three insulin pens, 

which were designed for single-patient use only, with no patient labels in a supply 

drawer of a medication cart. Facility officials subsequently found three more pens 

without patient labels in medication carts on three other inpatient units, and, when 

queried, several nurses reportedly acknowledged using the pens on multiple patients. Inappropriately using single-patient use insulin pens on multiple patients 

may potentially expose patients to blood borne pathogens. 

We identified six factors that contributed to the misuse of insulin pens at Buffalo. 

We also found that misuse of the insulin pens went undetected for 2 years because 

even though facility staff often observed pens with no patient labels on the medication carts, they did not report it because they either did not fully comprehend the 

clinical risks of sharing pens, or they accepted the unlabeled pens as standard practice believing they were both multi-dose and multi-patient devices. We found that 

VHA did not notify Members of Congress or at-risk patients until January 2013 

because of the time required for multiple levels of coordination between VA and 

VHA and inefficiencies in VHA’s internal review process for large-scale adverse 

event disclosures. 

In addition to the Buffalo incident, nurses at two other facilities were found to 

have inappropriately used insulin pens on multiple patients. In January 2013, the 

Salisbury VAMC reported that two nurses had inappropriately used insulin pens on 

multiple patients. VHA instituted a large-scale adverse event disclosure to notify 

266 at-risk patients. At another facility, a nurse acknowledged using a pen on two 

patients on one occasion. We identified two contributing factors to explain why some 

nurses misused the insulin pens: 

• Facilities did not fully evaluate the risks of using insulin pens on inpatient 

units, specifically in regards to the impact on nursing procedures. 

• Facilities did not provide comprehensive nurse education on the pens. 

We found that VHA has processes in place to identify important patient safety 

alerts, including product recalls, and disseminate this information to facility managers. VHA’s National Center for Patient Safety and Pharmacy Benefits Management Service lead VHA’s efforts to collect patient safety information and share this 

information with facilities. At the facility level, patient safety managers are responsible for disseminating alerts to appropriate administrative and clinical staff and 

tracking the facility’s response through a national database. VHA has followed up 

and tested for evidence of infection in the patients identified in this report. 

The use of these insulin pens in this fashion violates the core principles of infection control. Multiple personnel in several hospitals over an extended period of time 

failed to comprehend the impact of the decision to introduce pens of this nature onto 

inpatient wards. The decision to introduce new technology into hospital use is one 

that occurs routinely and to be done safely requires facility leaders to coordinate 

their actions and understand the implications of their decisions. Facilities with a 

singular focus on delivering high quality medical care should have recognized the 

risk these devices bring to the inpatient environment and taken appropriate actions 

to mitigate that risk. 

LACK OF ACCURATE QUALITY MANAGEMENT DATA AND STAFFING STANDARDS

The OIG and Government Accountability Office have been reporting for nearly a 

decade that VHA managers needed to improve efforts for collecting, trending, and 

analyzing quality management data. We have reported that inaccuracies in some of 

VHA’s data sources hinder the usability of VHA decisionmakers to fully assess their 

current capacity, optimal resource distribution, productivity across the system, or to 

establish staffing and productivity standards. Since July 2005, we have reported on 

122 

8 Audit of the Veterans Health Administration’s Outpatient Scheduling Procedures (7/8/2005); 

Audit of the Veterans Health Administration’s Outpatient Waiting Times (9/10/2007); Audit of 

Alleged Manipulation of Waiting Times in Veterans Integrated Service Network 3 (5/19/2008); Review of Veterans’ Access to Mental Health Care (4/23/2012). 9 Audit of VHA’s Physician Staffing Levels for Specialty Care Services (12/27/2012). 10 Healthcare Inspection—Delayed Cancer Diagnosis, VA Greater Los Angeles Healthcare System, Los Angeles, California (7/24/2007). 

inaccurate wait times and lists, and expect to report on the results of multiple reviews that are underway to the Committee later this summer.8 As recently as December 2012, we identified the continuing need for VHA to improve their staffing 

methodology by implementing productivity standards for specialty care services.9

We determined VHA had not established productivity standards for 31 or 33 specialty care services reviewed, and had not developed staffing plans that addressed 

facilities’ mission, structure, workforce, recruitment, and retention issues to meet 

current or projected patient outcomes, clinical effectiveness, and efficiency. VA 

agreed to put staffing standards for specialty care in place by FY 2015. 

OBSERVATIONS

OIG work routinely reports on clinical outcomes or performance that did not meet 

expectations. We routinely determine that there were opportunities by people and 

systems to prevent untoward outcomes. In addition to local issues at the facility, 

there are several organizational issues that impede the efficient and effective operation of VHA and place patients at risk of unexpected outcomes. 

Although health care delivery may be the first priority of many within the system, 

others are focused on research, training the next generation of health care providers, disaster preparedness, homelessness, support for compensation evaluation 

requirements, and other related missions. This lack of focus on health care delivery 

as priority one can be seen by the process commonly used at hospitals to fill vacant 

positions. A resource board reviews open positions and then determines which 

should be filled. Thus the position recently occupied by a nurse in the GI clinic, who 

is essential to the delivery of required care, may not be filled while a position that 

is important to the research or teaching community is filled. The decision by this 

board, to not fill a clinic position, may have far reaching consequences. The clinic 

that does not have the nurse may not function properly. The leadership of the clinic 

is left believing that hospital ‘‘leadership’’ does not understand or does not care 

about the care provided in that clinic. All a provider can do is ask for clinical positions to be filled, and if they are not filled, either leave VA or agree to work in an 

environment that provides less than satisfactory care. There is no national process 

to establish a set of positions that are deemed ‘‘essential’’ to the delivery of health 

care and thus are priority one for the hospital administration to resource.10 The establishment of ‘‘essential positions’’ in the context of a standard hospital structure 

would enhance the delivery of quality patient care. 

VA hospitals and clinics do not have a standard organizational chart. Some hospitals have a chief of surgery and a chief of anesthesia; others have a chief of the 

surgical care line. The lack of a common organizational chart for medical facilities 

results in confusion in assigning local responsibility for actions required by national 

directives. Variation in staff organization also creates difficulty in comparing the 

performance of clinical groups between hospitals and clinics. 

Leadership, teamwork, communication, and technical competence are among the 

most important factors in providing quality health care. However, organization, assignment of clear responsibility, and efficiency of operation all make important contributions to the process of improving the quality of health care delivered. 

CONCLUSION

The unexpected deaths that the OIG continues to report on at VA facilities could 

be avoided if VA would focus first on its core mission to deliver quality health care. 

Its efforts would also be aided by discussion of the best organizational structure to 

consistently provide quality care. The network system of organization and the accompanying motto, ‘all health care is local,’ served the VA well over the last several 

decades but does not standardize the organization of medical centers. It is difficult 

to implement national directives when there are no standard position descriptions 

or areas of responsibility across the system. VA has embraced the ‘‘aircraft checklist’’ approach to improve the chances that preventable medical errors will not occur 

in the operating room, but has taken the opposite approach to the assignment of 

duties and responsibilities in medical centers, where no two hospitals are alike. We 

believe it is time to review the organizational structure and business rules of VHA 

123 

to determine if there are changes that would make the delivery of care the priority 

mission. 

Mr. Chairman, that concludes my statement and we would be pleased to answer 

any questions that you or other Members of the Committee may have. 

Chairman SANDERS. Thank you very much, Mr. Griffin. 

Admiral Marsh. 

STATEMENT OF REAR ADMIRAL W. CLYDE MARSH, USN (RETIRED), PRESIDENT, NATIONAL ASSOCIATION OF STATE DIRECTORS OF VETERANS AFFAIRS 

Admiral MARSH. Chairman Sanders, Ranking Member Burr, and 

distinguished Members of the Committee, my name is Clyde Marsh 

and I am the President of the National Association of State Directors of Veterans Affairs. I am honored to present the views of the 

State Directors from all 50 States, the District of Columbia, and 

five Territories. 

As State governmental agencies, we are charged with the duties 

to include assisting the processing of claims for disability compensation and pension, burial services in our State veterans’ cemeteries, survivor benefits, coordinate access to health care, and provide over half of all VA-authorized long-term care in our State 

nursing homes. 

From the NASDVA perspective, the state of VA health care is 

strong. The VA has medical centers located in the majority of major 

cities in America. The VA has expanded their community-based 

outpatient clinics in recent years to many of the smaller cities and 

rural areas in our States. The VHA has moved out of the box, 

taken advantage of technology to provide telehealth, telemedicine, 

and rural consults in rural areas. They have also taken steps to 

provide transportation for those veterans in extremely rural areas 

to make their CBOC appointments. 

VA customer satisfaction has been trending higher in accordance 

with the American Consumer Satisfaction Index. The VA may not 

get everything perfectly every time. However, on a national level, 

VA has and still is one of the leading health care providers in the 

country in providing good, quality health care. 

Those of us in the health delivery business for VA, we constantly 

strive to get it right and we work on that every single day. In our 

experience, VBA, VHA, and NCA are on the same page. 

NASDVA does not endorse, nor do we agree with calling for Secretary Shinseki’s resignation, along with his top VA administration 

officials. These leaders are crucial, not only to continuing to transform our Nation’s second-largest Federal agency, but they will be 

needed to lead following actions to swiftly address or correct any 

health care or procedural issues that may be identified. It is premature to point fingers or rush to judgment, and it certainly is not 

in the best interests of our Nation’s 22 million veterans to make 

premature decisions based on allegations before the IG investigations are concluded and the facts are determined. 

Under Secretary Shinseki’s leadership, the U.S. Department of 

Veterans Affairs is transforming a pre-World War II antiquated 

claims process into a paperless claims system that has reduced 

compensation and pension claims backlog by 44 percent, has reduced veterans’ homelessness by 24 percent, and has enrolled more 

124 

than two million veterans in the health care system since 2009, receiving some of the highest quality care ratings in decades. 

NASDVA is committed to supporting VHA in caring for over 

eight million veterans enrolled in the health care system. At the 

local level, State Directors are in constant coordination with medical center directors concerning the delivery of health care. 

To assist VA, NASDVA asks that the Senate gives full attention 

to confirming those individuals that have been nominated to fill VA 

key vacant leadership positions that VA could then become fully 

manned. 

NASDVA strongly emphasizes, again, that it is imperative that 

VA, and specifically VHA, receive the necessary support that is required to adequately care not only for the eight million veterans 

enrolled today, but the anticipated one million more veterans over 

the next several years that will require medical assistance, and 

those folks will be coming as a result of the war and military drawdown. The bottom line is that VA may require more in terms of the 

budgets. They may need more doctors, nurses, technicians, clinicians, and possibly even facility expansions or operations. 

As the IG inspection results are made available and VA implements corrective measures of improved procedures in the VA 

health care system, NASDVA looks forward to participating as copartners or facilitators. 

In conclusion, NASDVA can help veterans become more informed 

about their benefits as well as how to be enrolled and receive the 

care that they have earned and need. 

Mr. Chairman and distinguished Members of the Committee, the 

State Directors of Veterans Affairs remain dedicated and committed to doing our part. We have the utmost confidence in Secretary Shinseki and firmly believe that he and his VA leaders will 

transform VA into a technology-based, more service-oriented and 

veteran-friendly 21st century agency. Thank you for including 

NASDVA in this very important hearing. 

[The prepared statement of Admiral Marsh follows:] 

PREPARED STATEMENT OF REAR ADMIRAL W. CLYDE MARSH, USN (RET.), PRESIDENT, NA- TIONAL ASSOCIATION STATE DIRECTORS OF VETERANS AFFAIRS AND COMMISSIONER, ALABAMA DEPARTMENT OF VETERANS AFFAIRS

INTRODUCTION

Chairman Sanders and distinguished members of the Senate Veterans’ Affairs 

Committee, my name is Clyde Marsh, President of the National Association of State 

Directors of Veterans Affairs (NASDVA) and Director of the Alabama Department 

of Veterans Affairs. I am honored to present the collective views of the State Directors of Veterans Affairs for all 50 states, the District of Columbia, and five U.S. Territories. 

As state governmental agencies, our Governors, State Boards and/or Commissions 

task their respective State Departments of Veterans Affairs (SDVA) with the responsibility of addressing the needs of our veterans and their families particularly 

in our role as advocates. We are charged with a plethora of duties that include processing veterans’ claims for disability compensation and pensions, burial services in 

state veterans cemeteries, survivor benefits, coordinate access to ‘‘healthcare,’’ and 

provide over half of all VA authorized long term care in state veterans nursing 

homes. 

THE STATE OF VA HEALTHCARE

From a NASDVA prospective, the state of VA Healthcare in our nation is strong. 

The VA has Medical Centers located in the majority of major cities in America. They 

have expanded their Community-Based Outpatient Clinics (CBOCs) over the past 

125 

several years to many of the smaller cities and rural areas in our states. VHA has 

moved ‘‘out of the box’’ taking advantage of technology to provide Tele-health and 

Tele-medicine consults in rural areas. They have also taken steps to provide transportation for those veterans in extremely rural areas in order to make CBOC appointments. 

VA customer satisfaction has been trending higher. VA does not do everything 

perfectly nor do they have everything they need. However, on a national level, VA 

has and still is one of the leading health care providers in the country in providing 

top quality health care. Those of us involved in the delivery of VA benefits and services strive to get it right and constantly work toward making conditions better. In 

our experience, VHA, VBA and NCA are on the same page. Overall, VA provides 

good quality care and services to our Nation’s veterans and their families. 

NASDVA, does not endorse, nor do we agree with those calling for Secretary 

Shinseki’s resignation along with his top VA officials, Under Secretary for Health 

Honorable Robert Petzel and Under Secretary for Benefits Honorable Allison Hickey. These leaders are crucial not only for the continuing transformation of the Nation’s second largest Federal agency. They will need to lead the follow-on actions to 

swiftly address or correct any health care or process issues that may be identified. 

It is premature to point fingers, rush to judgment and is certainly not in the best 

interest of the majority of veterans before the IG investigations are concluded. 

Under Secretary Shinseki’s leadership, the U.S. Department of Veterans Affairs 

in transforming from a pre-WWII antiquated VA claims process into a paperless 

claims system that has reduced the compensation and pension claims backlog by 44 

percent; has reduced veterans homelessness by 24 percent; and has enrolled more 

than 2 million veterans in the health care system since 2009 receiving some of the 

highest quality of care ratings in decades. 

ITEMS CRITICAL TO SUCCESS OF VA HEALTHCARE

NASDVA and its individual states appreciate and are committed to supporting 

the VHA in caring for the over 8 million veterans enrolled in the healthcare system. 

The States are also actively engaged in referring veterans to the VAMCs and 

CBOCs and we daily assist veterans in completing applications for medical care. At 

the local level, State Directors are in constant coordination with the VISN and 

VAMC Directors concerning the delivery of healthcare. Issues that arrive are handled personally with the leaders. We also conduct outreach events such as healthfares and ‘‘stand downs’’ to inform veterans about VA medical benefits and help 

them in obtaining them. To assist VA, we ask that the Senate give attention to confirming those individuals that have been nominated to fill key leadership positions. 

I would like to emphasize again that it is imperative that VA, and specifically 

VHA, receive the necessary support that is required to adequately care not only for 

the veterans enrolled today but also the anticipated million more veterans in the 

next year or two that will also require medical assistance. The bottom line is VA 

may require an increase in budget for more doctors, nurses, therapist, technicians 

and possibly facility expansion. 

Some outsourcing may be possible and or encouraged; however, we should not 

bank on sending veterans to outside doctors and facilities as the magic answer or 

cure. If overdone, we will be sending veterans out of a compassionate veteran centric 

environment and placing them in the ‘‘for profit’’ corporate medical system. Any outside provider would come with its own set of problems with not guarantees of significant appointment time reduction or better quality of care. 

As the IG inspection results are made available and VA recommends or implements corrective measures of improved procedures in the VA Health Care system, 

NASDVA looks forward to participating as co-partners or facilitators. We can help 

veterans become more informed about their benefits as well as how to be enrolled 

and receive the care they have earned and need. 

CONCLUSION

Mr. Chairman and distinguished Members of the VA Committee the State Directors of Veterans Affairs remain dedicated to doing our part. Thank you for including 

NASDVA in this very important hearing. 

Chairman SANDERS. Admiral, thank you very much. 

We now have from the Government Accountability Office their 

Director of Health Care, Debra Draper. Thank you. 

126 

STATEMENT OF DEBRA A. DRAPER, DIRECTOR, HEALTH CARE, 

U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. DRAPER. Chairman Sanders, Ranking Member Burr, and 

Members of the Committee, I appreciate the opportunity today to 

discuss access to care problems in VA that may delay needed medical care for our Nation’s veterans. 

For over a decade, GAO and others, including VA’s Inspector 

General, have reported that VA medical centers do not always provide timely care. In some cases, these delays have resulted in harm 

to veterans. 

Across our work on access to VA health care, several common 

themes have emerged: weak and ambiguous policies and processes, 

which are often subject to interpretation, resulting in significant 

variation and confusion at the local level; antiquated software system that do not facilitate good practices; inadequate training; unclear staffing needs and staffing allocation priorities; and inadequate oversight that relies largely on facility self-certification and 

use of unreliable data for monitoring. 

In 2012, we reported that VA’s wait times were unreliable because scheduling staff did not always correctly record the required 

appointment desired date, the date on which the veteran or provider wants the veteran to be seen. This is due, in part, to lack of 

clarity in the scheduling policy on how to determine and record the 

desired date, a situation made worse by the large number of staff 

who can schedule appointments, more than 50,000 people at the 

time of our review. 

During our site visits to four medical centers, we found that 

more than half of the schedulers we observed did not record the desired date correctly, which may have resulted in reported wait 

times shorter than what veterans actually experience. Some staff 

also told us they changed appointment desired dates so that the 

wait times aligned with VA’s related performance goals. 

We also identified other problems in how the scheduling policy 

was implemented. For example, we found follow-up appointments 

being scheduled without ever talking to the veteran, who would 

then receive notification of their appointment through the mail. In 

addition, we found that the scheduling system’s electronic wait list 

was not always used to track new patients, putting these patients 

at risk for delayed care or not receiving care at all. We also found 

that the completion of required training was not always done, although officials stressed its importance. 

Additionally, we found a number of other factors that negatively 

impacted the scheduling process. For example, officials described 

the VISTA software system used for scheduling as antiquated, 

cumbersome, and error-prone. We also found shortages and turnover of scheduling staff, provider staffing shortages, and high telephone call volumes without sufficient staff dedicated to answering 

these calls. 

We recommended VA take actions to improve the reliability of its 

medical appointment wait time measures, ensure the consistent 

implementation of its scheduling policy, allocate scheduling resources based on needs, and improve telephone access for medical 

appointments. VA concurred with our recommendations and told us 

they are taking steps to address them. We are pleased that actions 

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are being taken, but substantially more progress is needed to ensure timely access to care. 

We are currently conducting work examining VA’s management 

of specialty care consults, which is a type of medical appointment. 

Our preliminary work has identified a number of problems, including delays in care or care not being provided at all at each of the 

five medical centers included in our review, unreliable specialty 

care consult data, and systemwide closure of 1.5 million consults 

older than 90 days with no documentation as to why they were 

closed. We expect to publish our findings related to this work this 

summer. 

As the demand for VA health care continues to escalate, it is imperative that VA address its access to care problems. Since 2005, 

the number of patients served by VA has increased nearly 20 percent, and the number of annual outpatient medical appointments 

has increased by approximately 45 percent. In light of this, the failure of VA to address its access to care problems, including the accurate tracking and reporting of wait times at specialty care 

consults, will considerably worsen an already untenable situation. 

Mr. Chairman, this concludes my opening remarks. I am happy 

to answer any questions. 

[The prepared statement of Ms. Draper follows:] 

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PREPARED STATEMENT OF DEBRA A. DRAPER, DIRECTOR, HEALTH CARE, U.S. 

GOVERNMENT ACCOUNTABILITY OFFICE


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Chairman SANDERS. Thank you very much, Ms. Draper. 

Phillip Longman is a Senior Research Fellow at the New America Foundation. Mr. Longman, thanks so much for being with us. 

STATEMENT OF PHILLIP LONGMAN, SENIOR RESEARCH 

FELLOW, NEW AMERICA FOUNDATION 

Mr. LONGMAN. Thank you, Chairman Sanders and the other 

Members of the Committee, for giving me this opportunity. 

I am a little different from the other panelists you have heard 

today in that I am not a veteran. I am not affiliated with VA in 


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145 

any way. I am not affiliated with Veterans Service Organizations. 

I am here because I wrote a book, now in its third edition, called 

Best Care Anywhere: Why VA Care Would Be Better for Everyone. 

I think the title pretty much speaks for itself and I stick by it 

today. 

The inspiration for my book came from losing my wife, Robin, to 

breast cancer in 1999. Robin was treated in one very prestigious 

corner of the American health care system right here in Washington, DC. Suffice it to say that what I saw during the 6 months 

between her diagnosis and demise caused me to become radically 

interested in the questions of medical quality and safety. 

Now, shortly after Robin died, the Institute of Medicine issued a 

report that has been alluded to here already today showing that up 

to 98,000 people a year in the American health care system are 

killed by medical errors. That is equivalent to a jumbo jet falling 

out of the sky and killing everybody on board every third day. It 

goes on year in and year out. More recently, the Chairman has alluded to other estimates showing that as many as a quarter-million 

people a year are killed by various forms of over-treatment, mistreatment, maltreatment, under-treatment in the American health 

care system, making contact with the U.S. health care system the 

third leading cause of death in the United States, after all cancers 

and all heart disease. 

So, I set out at some point to find out who is doing a better job, 

and I was very surprised to find, after reviewing the literature on 

health care quality and talking to many experts, talking to many 

veterans and such, that the VA Health Care System, by many, 

many metrics, outperforms the rest of the U.S. health care system 

as a whole, and the proceedings today seem to have come to a 

broad consensus that VA health care in itself has exceptionally 

high quality. The problems we are dealing with here are access. 

So, I will not really belabor the point. I will want to say, though, 

that I would have welcomed Robin’s being treated in a hospital 

that had an Inspector General. Would that not have been wonderful? Would it not have been wonderful if there had been a committee of Congress, or maybe even two committees of Congress that 

exercised oversight of that hospital? Would it not have been great 

if there were various broad-based, effective citizens’ organizations 

akin to the American Legion that have applied scrutiny to that corner of the American health care system? So, we have to bear in 

mind what the context here is. 

I also would want to draw attention to the fact that when we 

have a problem of someone gaming a metric on wait times or gaming some other metric that VA applies, that is because there is a 

metric, right. I mean, in the rest of the health care system, by and 

large, there are no quality metrics that are exercised, let alone wait 

times. It took me 21⁄2 years to find a primary care physician in 

Northwest Washington who is still taking patients. Robin waited 

for a mammogram long enough for her tumor to grow from this size 

to this size [indicating], right. Many people in the United States 

today—most people in the United States—live in places where 

there are acute primary care shortages, right. We have a tremendous problem of access to begin with. 

146 

1 Corrigan J, et al, eds. To Err Is Human: Building a Safer Health System. Washington, DC: 

Institute of Medicine, the National Academies Press; 2000; and editorial, Preventing fatal medicl 

errors, New York Times, December 1, 1999, p. 22a. 2Starfield B. Is US health really the best in the world? Journal of the American Medical Association 2000; 284(4): 483–485. 

My final point, I will just say, too, is that on the waiting times 

so much of what we are doing is trying to determine whether somebody has a service-related disability or not, right. Is the reason you 

are losing your hearing because of the artillery fire that you heard 

in Vietnam or because of all The Who concerts you went to in the 

1960s? We have just a tremendous administrative machine that adjudicates that kind of question, and that is where most of these veterans are getting ground down, waiting to get into the VA. How 

much smarter would it be if we just opened up VA to all veterans 

and said, thank you for your service. Come on in. 

Thank you very much. 

[The prepared statement of Mr. Longman follows:] 

PREPARED STATEMENT OF PHILLIP LONGMAN, SENIOR FELLOW, NEW AMERICA FOUNDATION, AUTHOR: BEST CARE ANYWHERE: WHY VA HEALTH CARE WOULD BE BETTER FOR EVERYONE

Chairman Sanders, Ranking Member Burr and distinguished Members of the 

Committee. I greatly appreciate the opportunity to testify in these critical hearings. 

I am not a veteran nor a VA employee. I am also not affiliated with any veterans 

service organization. Instead, the perspective I bring comes from my having written 

a book about the transformation of the VA health care system. The book, now in 

its third edition, is called Best Care Anywhere: Why VA Health Care Would be Better 

for Everyone. 

The inspiration for the book came from my experience in losing my first wife, 

Robin, to breast cancer, in 1999. 

Robin was treated at a highly renowned cancer center here in Washington DC. 

I never blamed her doctors for her death. But suffice it to say that what I saw of 

this one prestigious corner of the American health-care system caused me to become 

extremely alarmed the problem of medical errors and poorly coordinated care. 

Shortly after Robin’s death, the Institute of Medicine issued a landmark report 

in which it estimated that up to 98,000 Americans are killed every year in hospitals 

as a result of medical errors . That’s like three jumbo jets crashing every other day 

and killing all on board.1

Then came another report published in the Journal of the American Medical Association, which looked not just at hospitals, but at the American health care system 

as a whole. It estimated that through a combination of under-treatment, over-treatment, and mistreatment, the U.S. health care system is killing 225,000 Americans 

per year. To put that in perspective, it means that contact with the U.S. health system is the third-largest cause of death in the United States, following all heart disease and all cancers.2

These reports, combined with my personal experience, put me on a quest to find 

out who had the best workable solutions to America’s dysfunctional and dangerous 

health care delivery system. 

The answer that emerged was not one I expected. But as study after after study 

now confirms, the VA system as a whole outperforms the rest of the health care system on just about every metric that health care quality experts can devise. These 

include adherence to the protocols of evidence-based medicine, investment in prevention and effective disease management, use of integrated electronic medical 

records, and, importantly, patient satisfaction. 

Just how the VA transformed itself is an inspiring story, involving front-line employees bringing about a revolution from below, as well as courageous leadership at 

the top, particularly during the period when Dr. Kenneth Kizer headed the Veterans 

Health Administration. 

As I also explain in my book, important structural factors were at work as well. 

For example, the VA has a nearly lifelong relationship with most of its patients and 

does not profit from from their illnesses. This gives it incentives to keep its patients 

well—incentives that are sorely lacking in most of the rest of the health care system. If the VA doesn’t teach its patient how to effectively manage their diabetes, 

147 

for example, it becomes liable down the line for the cost of their amputations, renal 

failures, and all the other long-term complications of the disease. 

Now, of course, bad medicine does happen at the VA, and when it does those who 

may be responsible need to be throughly investigated. But when such breakdowns 

occur, we should always put them in context by asking: ‘‘Compared to what?’’ 

As we’ve seen, U.S. health care system outside of the VA is exceptionally dangerous. It would have been great,for example, if the private hospital that treated 

my wife had been been under the scrutiny of an Inspector General, whose full-time 

job it was to look out for failures in patient care. But of course, private hospitals 

don’t have I.G.s. 

Similarly, if a committee of Congress such as this one was specifically focused on 

the quality of care provided by that hospital, that oversight would have likely 

helped the institution to become more accountable. Or again, more mistakes would 

undoubtedly have come to light at that hospital and many others if effective watchdogs group akin the American Legion looked out for the interest of non-VA patients. 

But, of course, that kind of scrutiny does not occur. And this asymmetry creates 

a perverse result. For the average news consumer it can lead to the impression that 

the VA is limping along from one scandal to the next, even as its patients and 

health-care quality experts applaud its superior quality, safety, and cost-effectiveness. 

Finally, I’ll close by pointing out another way in which context is often missing 

in discussion of VA health care. Overwhelmingly, the failures of the VA in recent 

years haven’t been about the quality of health care for those who get covered. Instead, they’ve mostly been about the excessive waiting times, and excessive red tape 

that our vets must go through to establish eligibility. 

Here, the Veterans Benefits Administration must accept blame for not doing a 

better job of streamlining administrative procedures. But in all fairness, it is Congress, and by extension the American people as a whole, who have established the 

laws that require most vets to prove that they have service-related disabilities before becoming eligible for VA care. 

This is the perverse root cause of the waiting time and other problems of access. 

Who can say if a Vietnam vet is losing his hearing due to expose to too much artillery fire, or exposure to too many Who concerts? 

We need to open up the VA and grow it, extending no-questions-asked eligibility 

not only to all vets but to their family members as well. This not only makes clinical 

sense, it also makes economic sense. So long as the VA remains one of, if not the 

most, cost-effective, scientifically driven, integrated health care delivery systems in 

the country, the more patients it treats, the better for everyone. 

Chairman SANDERS. Thank you very much, Mr. Longman. 

I thought all the testimony was excellent. Thank you all for the 

high-quality testimony. 

Mr. Griffin, a few questions. Thank you very much for plunging 

into this investigation, in a sense, on short notice. Briefly, let me 

reiterate—you and I have chatted on the phone—do you have the 

necessary resources to undertake the kind of thorough investigation that needs to be done regarding Phoenix? 

Mr. GRIFFIN. Yes, sir. [Off microphone.] 

Chairman SANDERS. Please use your microphone. 

Mr. GRIFFIN. Yes, we do. We have, under Dr. Daigh’s direction, 

120 medical clinicians, who, for a number of years, have been doing 

reviews of VA medical centers, a 1974 West Point graduate, 26 

years as an Army doctor, and 10 years with us. 

Chairman SANDERS. OK. 

Mr. GRIFFIN. The reason the IG system was set up the way it 

was is so that you will have people who have knowledge of the Department, and that is why we are the right group to do this review. 

Chairman SANDERS. Let me ask you this. I think you have heard 

from almost all of the Members here the desire for you to do a thorough examination and investigation, and also to do it in a timely 

manner. Now, when you told us a few moments ago that you do 

not think you can do that until August, is there any way you can 

148 

give us some preliminary information before that, maybe a preliminary report, because I think many of the Members would like to 

get a sense of what you have found out there. 

Mr. GRIFFIN. As the review progresses, if there appears to be a 

seam where it would be appropriate for that to happen, we would 

do that. But, remember, part of this review could lead to criminal 

charges being brought and we do not want to do anything to jeopardize the ultimate outcome of the facts in the case. 

Chairman SANDERS. Let me ask you this, and maybe it is premature, but if you could answer, I would appreciate it. You know, 

what we have been reading in the media, and I will quote from one 

media report, ‘‘At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care System, many 

of whom were placed on a secret waiting list.’’ At this particular 

point, can you tell us how many people you have identified who 

died while waiting on a secret waiting list? 

Mr. GRIFFIN. I cannot give you that number because the number 

40 that has been wildly quoted in the press does not represent the 

total number of veterans that we are looking at. That was one list 

that was created by the facility. We need to do an analysis of that 

list, both death records and VISTA records, by Dr. Daigh’s clinicians. But, there are also other people who have come through the 

Congress, who have come through the media, who have come 

through our hotline. So, we have multiple lists, none of them 

identical. 

We have begun to process on a preliminary basis of going 

through those lists. And the initial list that we were given, we have 

gone through, and there were only 17 names on that list. Our review to-date—we have more work to do on this because we want 

to have more than one set of eye look at all of the records—but on 

those 17, we did not conclude so far that the delay caused the 

death. It is one thing to be on a waiting list and it is another thing 

to conclude that as a result of being on the waiting list, that is the 

cause of death, depending on what the illness might have been at 

the beginning. 

Chairman SANDERS. So, at this point, the one list of 17 names 

that you have looked at has not, at this point, identified anybody 

who has died as a result of being on a waiting list and not getting—— 

Mr. GRIFFIN. That is right, for our initial review. And I want to 

ask Dr. Daigh to expand upon that so you can understand the nature of these lists. 

Chairman SANDERS. Right. This is complicated stuff. I do understand that. 

Dr. Daigh, did you want to add. 

Dr. DAIGH. Well, sir, let me try. So, we have been provided 

names of people who are on various lists, and it is true that those 

veterans whose names were on the list have died. We have looked 

at a substantial number of cases, and we have in looking at those 

cases determined that, yes, there was a delay in care frequently, 

as has been expressed. We have, in several cases, found that the 

quality standards were not met. In a subset of that, we found some 

patient harm. But, to draw the conclusion between patient harm 

and death has so far been a tenuous connection. 

149 

The records that we have looked at to date are mostly VA’s medical records. So, to the extent that a patient died, we are in the 

process of getting death certificates and autopsy reports, if they 

were in another hospital then there are procedures we need to go 

through to get the rest of those records. We may need to interview 

people who are knowledgeable about the events surrounding the 

death. 

So, it is a serious problem and it is going to just take my staff 

a little time to work through so that what we say, we can stand 

by, and that you are happy with the result. 

Chairman SANDERS. OK. Thank you very much. 

Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

Ms. Draper, in the GAO report regarding outpatient appointment 

and wait times and scheduling, the conclusion states, ‘‘Unreliable 

wait time measurements has resulted in a discrepancy between the 

positive wait time performance VA has reported and veterans’ actual experience.’’ Now, this VA report that you are talking about 

was the report that was presented to the VA in December 2012. 

Ms. DRAPER. That is correct. 

Senator BURR. It became a public document in January 2013, 

correct? 

Ms. DRAPER. That is correct. 

Senator BURR. And, what I have said so far about your comments 

on it are accurate. Am I right? 

Ms. DRAPER. That is correct. 

Senator BURR. OK. In this report, GAO recommended, ‘‘The Secretary of VA direct the Under Secretary of Health to take actions 

to improve the reliability of wait time measures,’’ and it went on 

to suggest, ‘‘The Secretary of VA direct the Under Secretary of 

Health to take actions to ensure the VAMCs consistently and accurately implement VA’s scheduling policy.’’ That is accurate? 

Ms. DRAPER. That is correct. 

Senator BURR. Ms. Draper, for the two recommendations, VA 

specified in their comments that these recommendations had a targeted completion date of November 1, 2013. Let me ask you, based 

upon the knowledge that you have today, has this process at VA 

been completed as it relates to those two actions in your report 

from December 2012? 

Ms. DRAPER. It has not been fully completed. 

Senator BURR. And, is this an ongoing conversation with VA 

about the completion of—— 

Ms. DRAPER. It is. I mean, they have told us they have taken 

steps, and we provided that in our written testimony, about the update on where they say the recommendations are. You know, to be 

quite frank, it has been almost a year and one-half. We would have 

expected more progress to have been made. 

Senator BURR. I think most of the Members of this Committee 

would probably say that they associate with that statement. 

Mr. Griffin, thank you for serving in an acting capacity. You are 

a stand-up guy and I just want you to know this Member, and I 

think I can speak for all Members, we have got great confidence 

in what you and your team will do, can produce, the accuracy of 

150 

it, and the reliability of it. I want you to understand that and 

please share that with the folks that are working so hard. 

Mr. GRIFFIN. Thank you, Mr. Burr. 

Senator BURR. Do you, or did your predecessor, have a regular 

scheduled meeting with the Secretary? 

Mr. GRIFFIN. We have meetings with the entire leadership team 

every 2 weeks. My predecessor went to one; I went to the other 

one. And we have had occasional meetings with the Secretary at 

different times during the year. 

Senator BURR. So, how many meetings have you had with the 

Secretary since the issue of Phoenix arose and you mobilized this 

IG review there? 

Mr. GRIFFIN. Well, we had one meeting that was unconnected to 

the review. It was a budget-related meeting. And we had a second 

meeting when I went over to request that certain individuals be 

put on admin leave. 

Senator BURR. But, from a standpoint of the actual investigation, 

the scope of it, all of that, who has handled that from a standpoint 

of—— 

Mr. GRIFFIN. During the course of the admin leave discussion, I 

gave an overview, not unsimilar to the seven bullets that I mentioned here, as to what we were going to be looking at. I would expect to be asked what is your basis for requesting that I put someone on admin leave. I think that was completely appropriate. But, 

I think, in the Secretary’s words, we are independent and we cannot be told to do or not do something because it would violate our 

independence. 

Senator BURR. I understand that. So, when the Phoenix report 

is finished, if it happens like every other IG report, will you or your 

staff physically sit down with the Secretary and brief him on the 

findings of that IG report? 

Mr. GRIFFIN. Not on every report, but certainly, a report of this 

magnitude. We issue probably 300 reports a year—— 

Senator BURR. And how many—— 

Mr. GRIFFIN. Not all of them would rise to that level. But we 

do—at the Assistant Inspector General level, Dr. Daigh meets with 

the VHA senior staff on a recurring basis to discuss these things. 

As we just heard about the process of getting closure on reports, 

there is an ongoing follow-up process that our personnel do until 

we are satisfied that they have taken corrective action. 

Senator BURR. How many years have you been in VA at some capacity in the IG’s Office? 

Mr. GRIFFIN. About 13 out of the last 16 years. 

Senator BURR. And, how many times have you sat down with a 

Secretary and briefed them on an IG report? 

Mr. GRIFFIN. Oh, I would say a report of this magnitude, I would 

brief him on maybe a couple times a year, depending on—again, 

there are 300 reports—I would say, maybe, at most, quarterly. 

Senator BURR. On a report, or on multiple—— 

Mr. GRIFFIN. On a report, but the door is open. It is just the 

issues typically are resolved at the Under Secretary level. 

Senator BURR. Have you ever requested a meeting with a Secretary while you have been there and the meeting was not made 

available to you? 

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Mr. GRIFFIN. No. 

Senator BURR. OK. I thank you, Mr. Chairman. 

Chairman SANDERS. Thank you, Senator Burr. 

Senator Tester. 

Senator TESTER. Thank you, Mr. Chairman. I want to thank, as 

with this panel, I want to thank you for your testimony. 

Mr. Griffin, you said you have 120 medical investigators. Are 

there more investigators than that? 

Mr. GRIFFIN. We have about 615 personnel in the IG organization. One hundred twenty of them work for David and they are 

health care inspectors. They are doctors. They are nurses. They are 

psychiatrists, psychologists, clinicians—— 

Senator TESTER. How many people—— 

Mr. GRIFFIN [continuing]. Physical therapists. We have about 150 

criminal investigators. We have people in 39 cities around the 

country. 

Senator TESTER. Got you. 

Mr. GRIFFIN. We have over 200 auditors. 

Senator TESTER. Let me cut to the chase. 

Mr. GRIFFIN. OK. 

Senator TESTER. How many people are working on this investigation—— 

Mr. GRIFFIN. So far—— 

Senator TESTER [continuing]. Total? 

Mr. GRIFFIN. So far, 185 people have touched this investigation. 

Senator TESTER. You have been working on it for how many 

weeks so far? 

Mr. GRIFFIN. This is the third week. 

Senator TESTER. Your testimony said you anticipate a final by 

August? 

Mr. GRIFFIN. That is correct. 

Senator TESTER. Do you anticipate a preliminary report before 

that? 

Mr. GRIFFIN. To the extent that it will not impact—— 

Senator TESTER. Got you. 

Mr. GRIFFIN [continuing]. The outcome of the work, to include 

the fact that we are working with two different groups from the 

Department of Justice, looking at possible criminal violations. 

Senator TESTER. OK. I want to talk a little bit about senior management staff, including the Secretary in the VA. Have you—in 

this investigation, have you asked those folks for information? 

Mr. GRIFFIN. No, we have not. 

Senator TESTER. OK. 

Mr. GRIFFIN. I mean, we—— 

Senator TESTER. Go ahead. 

Mr. GRIFFIN. We did ask them for a list that they suggested to 

us that they had of veterans who died on an electronic list, but—— 

Senator TESTER. Have—let me put it this way. 

Mr. GRIFFIN. OK. 

Senator TESTER. This is where I want to get to. Have they been 

open and transparent and—what is the other word I am trying to 

think of—helpful in your investigation? 

Mr. GRIFFIN. Yes, they have, and they have offered resources, but 

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ence is in question, so we have not received any resources, nor do 

I intend to. 

Senator TESTER. But, as far as up to this point, being fully transparent with what you need, when you ask, they deliver? 

Mr. GRIFFIN. That is correct. 

Senator TESTER. OK. Has there been any—maybe you can say 

this, maybe you cannot, if you cannot, do not—but, has there been 

any sign that, up to this point, that there has been two sets of 

books run on appointments? 

Mr. GRIFFIN. I think that over the past 8 or 9 years—there are 

a list of reports that were mentioned earlier where we found that 

waiting times were not being accurately reported, most recently, on 

mental health, where it was reported at a 95 percent level. We 

looked at the exact same data and concluded it was 49 percent. So, 

it is not a new issue and I am confident that when we finish our 

work in Phoenix, it will be the same outcome as these previous reports. 

Senator TESTER. OK. That is all, Mr. Chairman. I would just say, 

we look forward to the investigation. I know you need the time to 

do it right. Of course, in the society we live in, this case is already 

being litigated and convicted every day in the news media by some. 

So, it will be great to get the facts out there so that we can help 

VA do their job better to serve the veterans who served this country so well. Thank you all for being here. 

Mr. GRIFFIN. Understood, and the only thing I can say about the 

rush is we are not going to rush to judgment at the sacrifice of 

quality. I know you are not suggesting that. 

Senator TESTER. No. 

Mr. GRIFFIN. We are going to nail this thing, and at the end, we 

will have a good product for you. 

Senator TESTER. Yes, and at the sacrifice of people who are innocent. Thank you. 

Mr. GRIFFIN. Sure. 

Chairman SANDERS. Thank you. 

Senator Moran. 

Senator MORAN. Mr. Chairman, I understand there is only a 

minute or so left in the vote that has been called, so I will try to 

summarize very quickly. 

Ms. Draper, and then I will follow up with Mr. Griffin, the GAO 

reports, what is the process by which you have assurance that your 

report is acted on by the Department of Veterans Affairs? What is 

the follow-through, and what has been the result of GAO reports 

at the VA? 

Ms. DRAPER. Yes. For the report that we issued, it was publicly 

released in January 2013. We did a follow-up. They issue a 60-day 

letter on the status of the recommendations, so we do have that. 

Then we provided Congressional testimony for the House Committee in April. We followed up with VA to get an update on where 

the recommendations were. So, we have periodic updates with VA 

on the status of the recommendations. 

Senator MORAN. You testified earlier about this particular report 

and its current status. About other GAO reports, do you have a 

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ful and they are successful in implementing the proposals that you 

suggest? 

Ms. DRAPER. It varies. I think that we have quite a number of 

open recommendations at VA at this time across GAO. 

Senator MORAN. Mr. Griffin, in regard to the IG’s report, what— 

how are you able to determine whether or not your report and its 

suggestions, its recommendations, are followed through by the Department of Veterans Affairs? 

Mr. GRIFFIN. We do it in two different ways. In some instances, 

we will review—if we say, you need a new policy on staffing, or you 

need a new policy on waiting times, or you need to train the schedulers and you need to create a methodology where you can audit 

the scheduling process to make sure someone is not cooking the 

books, if they can satisfy us that, here is the new policy and here 

is how we are going to make this work, we may close out at that 

time. More often, if we do not have a comfort level, we will send 

a team back 6 months later and go to the same facilities to see if 

the fixes are in place. 

Senator MORAN. What is your sense—in your time as Acting, or 

if you have information about your predecessor—what is your sense 

of the Department of Veterans Affairs following the recommendations and implementing them following an IG report? 

Mr. GRIFFIN. The answer is mixed. I think, frequently, policies 

emanate from Washington. The policies look good on paper, but 

they are not always followed by the managers in the field. So, it 

is an accountability question for the field managers; when they do 

not follow it, something needs to happen. 

Senator MORAN. One of the things that I do not think you have 

anything to do with, but is an important component of an investigation of the Department of Veterans Affairs, would be the Office 

of Medical Inspector reports, and one of the things that we have 

discovered is that those are not made public and not submitted to 

Congress, so we do not know the results of those types of audits, 

investigations, or reviews. I am pursuing legislation to change that 

so we can see what that report says. We can excise the names and 

keep the confidentiality of patients straight, but I think there is a 

whole set of other reports that there is no ability for us to gauge 

whether or not a recommendation is followed. 

Let me just ask, in conclusion, Mr. Griffin, are there IG investigations ongoing that involve facilities in Kansas? 

Mr. GRIFFIN. I would like to take that for the record. I know that 

we have, in the past week and a half, our criminal investigators, 

who are located around the country, have had a rapid response to 

ten new allegations. And in the matter of 2 days over the previous 

week, they went to 50 medical centers, unannounced, in order to 

see if what was being alleged was occurring at those facilities, 

so—— 

Senator MORAN. I would be happy to know that. I actually was 

referring to more—not necessarily a current investigation beginning as a result of the current circumstance, but over the last year 

or so. The reason I asked the question is that there have been allegations of incidents, circumstances, consequences within the VA in 

my State, and our effort to find out what is going on, what response has the Department taken as a result of at least these stoVerDate Mar 15 2010 14:17 Apr 06, 2015 Jkt 000000 PO 00000 Frm 00157 Fmt 6633 Sfmt 6601 Z:\ACTIVE\051514.TXT PAULIN
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ries that are out there, we have never received a response from 

anyone at the Department of Veterans Affairs, either here in 

Washington from the Secretary in his testimony or with Kansas officials, individuals who work at VA within our State. And, I do not 

know whether or not any of those circumstances that are at least 

part of a conversation are being investigated by you. If you would 

follow up with me, that would be—— 

Mr. GRIFFIN. I will. The majority of our audit and health care reports go to the member whose district that facility is located in. 

Some of the criminal reports take longer because of the judicial 

process and privacy issues involved with the criminal cases. You 

may or may not see quickly—— 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman SANDERS. Mr. Griffin, I apologize for interrupting you. 

I think there are 95 Senators waiting for us to vote. 

This was a great panel and I very much appreciate the wonderful 

testimony. Thank you all very much. 

The hearing is adjourned. 

[Whereupon, at 2:07 p.m., the Committee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF HON. JOHN D. ROCKEFELLER IV, 

U.S. SENATOR FROM WEST VIRGINIA

Thank you, Chairman Sanders and Ranking Member Burr, for holding this important hearing. And thank you, Secretary Shinseki, for coming to speak with us today. 

Secretary Shinseki, I think your record speaks for itself. You and your leadership 

have been working tirelessly on behalf of veterans has helped improve the VA 

health care system by leaps and bounds. 

I will be honest with you, I am deeply troubled by the increasing reports of employee misconduct in VA facilities around the country. Stories like these, with the 

worst allegations coming from the VA facilities in Phoenix, are incredibly worrisome. They call into question our country’s ability to address the needs of our veterans, and they damage the reputation of a system that has made great strides over 

the past few years. 

If these reports are true, then appropriate action must be taken. Our veterans 

and their loved ones deserve nothing less. 

Amidst stories of alleged secret waiting lists and falsified records, however, I do 

believe that it is important for everyone to remember one key fact: the VA treats 

millions of veterans every year, and it treats them exceptionally well. I know that 

the men and women employed by the VA—from the doctors to the nursing staff to 

the people who work in admission—are working day and night to improve the 

health of our veterans and honor their service. It is important not to forget this. 

Currently, the VA faces major challenges. More people are enrolling in the VA 

than ever, and many of them have complex injuries. If the VA does not have enough 

doctors to see these patients, then these problems are a result of a lack of funding. 

And that is something that we in Congress can blame no one for but ourselves. 

I applaud this Administration for its continued commitment to providing funding 

for veterans. The request for a three percent increase reflects the largest increase 

for any agency in the President’s budget request. But if we’re being honest about 

the needs of the VA, a three percent budget increase is not enough. As tens of thousands of our troops continue to come home—some with mental health problems or 

severe, debilitating wounds—we’re funding an agency with incredible demands and 

health care costs at only half of our entire military budget. 

We have a moral obligation to take care of our veterans. However, this Congress 

has been falling short of its obligations to care for our veterans when they return. 

And recently, it seems that it’s only during crisis situations that we are forced to 

look at how we are prioritizing the care and long-term health of those who have 

fought for our country. 

That is not to say that swift action must not be taken if the Inspector General 

determines there has been misconduct at the VA. But for as long as we continue 

to underfund the VA, I firmly believe problems will continue to arise. 

Thank you. 

PREPARED STATEMENT OF HON. SHERROD BROWN, 

U.S. SENATOR FROM OHIO

Thank you, Mr. Chairman, for holding this important hearing and for your leadership of this Committee. 

I want to thank the VSO leaders who are testifying today and Secretary Shinseki 

for your continued commitment to serving our Nation’s veterans. 

We’ve heard some very serious allegations made against the VA. And, like any 

allegation, we are investigating the claims so we can ensure VA healthcare is the 

best possible care for our veterans. 

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The Inspector General said it would take a few months, perhaps as late as August, to do a tough, fair, independent investigation. But three months is too long 

when it comes to honoring our veterans. That is why this hearing is so important. 

VA and this Committee are not sitting idly by until we hear from the IG. 

The Secretary has taken these allegations very seriously. He requested the IG investigation. He removed employees accused from patient care responsibilities, placed 

several more on administrative leave, and ordered the Veterans Health Administration to complete a Nation-wide access review. 

And, this Committee is performing its constitutional duties that include rigorous 

oversight, of which this hearing is a part. 

So many of us admire the work done by Veterans Service Organizations. Their 

commitment to veterans cannot be questioned. 

I was extremely troubled when I heard the allegations of wait lists leading to patient deaths and of employees allegedly cooking the books. These are serious claims. 

If true, there must be reforms and serious consequences. And if true, this Committee will act swiftly and decisively. 

But we should be cautious not paint the entire VA system with a broad brush— 

many VA workers serve our veterans honorably every day. 

The Veterans Health Administration operates more than 1,700 sites, and conducts 

approximately 236,000 health care appointments each day. This amounts to approximately 85 million appointments each year. 

We also know that Secretary Shinseki has a strong commitment to our veterans 

and our Nation as well. 

We are short on time, so I will conclude my remarks and look forward to hearing 

from you. 

Thank you Mr. Chairman. 

157 

MEMORANDUM SUBMITTED BY HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA, MEMORANDUM FOR THE RECORD


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PREPARED STATEMENT OF HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS

Chairman Sanders and Ranking Member Burr, thank you for this opportunity 

and the dedicated work of the Veterans’ Affairs Committee. I enjoy serving with you 

both and all the Members of this Committee, and I look forward to reviewing the 

testimony from today’s hearing with Secretary Shinseki on the state of VA health 

care. Regretfully, I am unable to attend, as I am in Arkansas, recovering from a 

recent surgery. I appreciate Secretary Shinseki’s willingness to come before our committee and address our questions and deep concerns so we are able to move forward 

and better serve our veterans. 

Last week I sent a letter to Secretary Shinseki expressing my disappointment regarding recent allegations of ‘‘secret’’ wait lists and preventable veteran deaths. I 

have asked Secretary Shinseki for assurances that none of these deplorable practices are happening at VA medical centers (VAMCs) used by Arkansas veterans, and 

have yet to receive an acknowledgement that he even received my letter. I anxiously 

await its arrival, and a response. 

I understand that in most respects VA does provide good care, when and where 

it is actually available. Additionally, I know that employees in various roles at VA, 

like me, strongly support those who have served our Nation in uniform and believe 

the Federal Government should uphold all of its promises to our veterans and extend the best timely care to them. However, as recent reports indicate, this is not 

happening. This is a clear access problem, and warrants a full analysis of the future 

of VA health care as part of our effort at solving immediate problems. I have reservations about the ability of VA’s ‘‘face to face’’ audits to produce meaningful reform that will increase access for veterans and bring accountability to the process. 

I am supportive of rigorous oversight by this Committee and I look forward to working with all of my colleagues on both the House and Senate Veterans’ Committees, 

in consultation with the Department of Veterans Affairs, to ensure that these systemic problems are fixed. 

In conclusion, we need to be thoughtful about our responsibilities and cautious 

about our steps forward in regard to these very important issues. As always, I appreciate opportunities to work together and I will be reviewing the testimony and 

the record of today’s hearing to begin that process. 


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LETTER FROM DIANE M. ZUMATTO, NATIONAL LEGISLATIVE DIRECTOR, AMVETS 


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LETTER FROM RONALD E. BROWN, PRESIDENT, NATIONAL GULF WAR RESOURCE CENTER

NATIONAL GULF WAR RESOURCE CENTER, 

Topeka, KS, October 10, 2014. 

Hon. BERNARD SANDERS, 

Chairman, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR CHAIRMAN SANDERS: My name is Ronald Brown, and I am president of the 

National Gulf War Resource Center (NGWRC). I would like to submit testimony 

concerning issues our Gulf War Veterans from Operations Desert Shield/Storm 

(ODS) face daily at the Department of Veterans Affairs hospitals. 

Numerous ODS Veterans experience long waits to see doctors—particularly specialists—and have a hard time receiving compensation benefits. In general, they 

don’t receive proper medical care compared with other groups of veterans. Many 

ODS Veterans have been fighting for 23 years for benefits they earned from the 

honorable service they provided. Due to this honorable service, many are sick from 

exposures experienced on the most toxic battlefield in our Nation’s history of warfare. NGWRC sent surveys to Veterans concerning their VA hospitals, and they responded to us that the issues exist and happen to Gulf War Veterans across the 

country. NGWRC wants to address problems and bring solutions to fix issues, ensuring that our veterans’ health care is the best in the world. 

In January 2014, NGWRC suggested solutions to the VA during a meeting with 

Principal Deputy Under Secretary for Health, Dr. Robert L. Jesse. If implemented, 

these solutions—derived from surveys from our Veterans—would help them at VA 

hospitals across the country. Issues these Veterans brought forward were: 

1. Primary Care Providers (PCP) must be better trained on illnesses due to 

toxic exposures during Desert Storm. Many PCP doctors are not properly 

trained to provide care Veterans need for illnesses they suffer from due to environmental exposures. Many ODS Veterans feel their PCP does not believe them 

when they tell medical professionals their problems, yet science shows that Gulf 

War Illness is a physiological condition and not a psychological issue. Many Veterans, however, are still treated like it is a psychological issue. An ill Veteran 

should not have to educate the PCP on research that has been done on Gulf 

War Illness. This type of treatment must change, and the NGWRC must work 

with the VA to help our Veterans. 

2. Veterans face long wait times for PCP visits and specialist, sometimes 6 

months or longer. In our surveys, one Veteran responded that for clinics such 

as the sleep study, he encountered an 8-month backlog. Other veterans reported 

waits of 6 month or longer to referred specialty clinics like Rheumatologist for 

Fibromyalgia or Chronic Fatigue Syndrome. Some of these veterans were told 

they would not be seen in such clinics due to a current backlog. They were also 

told that they would have to pay out of pocket to have care provided for service 

connected illnesses. Accountability needs to be established at the upper levels 

of the Central Office of the VA and at the lower levels within our VA hospitals. 

It is deplorable that bonuses are issued for stellar care when it is far from stellar. Chronically ill Veterans should never have to wait months to get into specialty clinics or PCP follow-up visits. 

3. Sadly, many claims have been denied for years due to medical professionals 

who are not properly trained to treat illnesses from which many Veterans suffer. Many Veterans feel they have been left to die, which is unacceptable. These 

Veterans are your constituents, and their voices deserve to be heard. Most of 

our chronically ill Desert Storm veterans have been voicing their concerns for 

two decades to the VA. They find their voices fall on deaf ears. How much 

science must show that these veterans are suffering with real illnesses before 

they are taken seriously? How many Veterans must die from cancer? What is 

the acceptable number of deaths before these cancers can be made presumptive 

to their service? 

In conclusion, we are aware of the burden our VA health care system has on it. 

That will most likely get worse before it gets better, with the current war in Afghanistan winding down. There will be an influx of Veterans coming into an already 

overcrowded, understaffed, and underfunded health care system. The NGWRC feels 

that steps must be taken to relieve some of the burden on our VA health care system. This includes allowing Veterans to access care outside the VA with care paid 

by the VA. Another possible solution is stopping Veterans with no service connected 

disabilities who have private insurance from accessing VA hospital care. Most of 

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these veterans have jobs and private insurance, so they can go to outside doctors 

for care. Something must be done to fix issues with the VA to ensure veterans get 

proper care and services. Our expertise, obviously, is on the conditions suffered by 

Gulf War veterans and evolving treatments. The NGWRC is willing to work with 

anyone to come up with viable solutions to fix these issues. 

Respectfully, 

RONALD E. BROWN, 

President. 

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