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96–128 2015

AN EXAMINATION OF RURAL AND NATIVE 

AMERICAN VETERAN ACCESS TO CARE 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

WEDNESDAY, AUGUST 27, 2014 

Serial No. 113–85 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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


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(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

JON TOWERS, Staff Director 

NANCY DOLAN, Democratic Staff Director 

SUBCOMMITTEE ON HEALTH 

DAN BENISHEK, Michigan, Chairman 

DAVID P. ROE, Tennessee 

JEFF DENHAM, California 

TIM HUELSKAMP, Kansas 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

JULIA BROWNLEY, California, Ranking 

Member 

CORRINE BROWN, Florida 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

Wednesday, August 27, 2014 

Page 

An Examination of Rural and Native American Veteran Access to Care ........... 1 

Hon. Dan Benishek .................................................................................................. 1 

WITNESSES 

Fred Kiogima, Tribal Chairman, Little Traverse Bay Band of Odawa Indians . 4 

Curtis Chambers, Veteran ...................................................................................... 6 

Prepared Statement ......................................................................................... 36 

Carl Archambeau, Commander, Veterans of Foreign Wars Post 2780 ............... 7 

Prepared Statement ......................................................................................... 36 

Linda Fletcher LTC (ret.), Executive Director, A Matter of Honor ..................... 8 

Prepared Statement ......................................................................................... 37 

Charles R. Lerchen, A.C.V.S.O., Director of Veterans Services, Grand Traverse, Leelanau, and Benzie Counties ................................................................ 10 

Prepared Statement ......................................................................................... 38 

Paul Bockelman, Director, Veterans Integrated Service Network (VISN) 11, 

VHA, U.S. Department of Veterans Affairs ....................................................... 20 

Prepared Statement ......................................................................................... 39 

Accompanied by: 

Peggy Kearns, Director, Aleda E. Lutz VA Medical Center, (VISN) 

11 , VHA, U.S. Department of Veterans Affairs 

and 

James Rice, Director, Oscar G. Johnson VA Medical Center, (VISN), 

VHA, U.S. Department of Veterans Affairs 

FOR THE RECORD 

Grand Traverse Band of Ottawa and Chippewa Indians ..................................... 42 

Little River Band of Ottawa Indians ..................................................................... 44 

Sault Ste. Marie Tribe of Chippewa Indians ......................................................... 45 

The American Legion .............................................................................................. 47 


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AN EXAMINATION OF RURAL AND NATIVE 

AMERICAN VETERAN ACCESS TO CARE 

Wednesday, August 27, 2014 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, SUBCOMMITTEE ON HEALTH, Washington, D.C. 

The subcommittee met, pursuant to notice, at 9:59 a.m., at the 

Veterans of Foreign Wars Post 2780, 3400 Veterans Drive, Traverse City, Michigan, Hon. Dan Benishek [chairman of the subcommittee] presiding. 

Present: Representatives Benishek and Brownley. 

OPENING STATEMENT OF DR. DAN BENISHEK, CHAIRMAN 

Mr. BENISHEK. Thank you, gentlemen. The subcommittee will 

come to order. Good morning and thank you all for joining us 

today. I’m Dr. Dan Benishek, and it’s my honor to be both your 

congressman and the Chairman of the Subcommittee on Health for 

the Committee on Veterans’ Affairs of the United States House of 

Representatives. 

I’m joined here today by Congresswoman Julia Brownley, the 

ranking member of the Subcommittee on Health, Representative of 

the 26th District of California. Ranking Member Brownley is a 

steadfast leader and advocate for our service members and veterans. I am grateful to her for joining us today in Traverse City. 

Before I go any further, I would like to ask all of our veterans 

in the audience today to please stand, if you are able, or raise your 

hand and be recognized. 

[Applause.] 

Mr. BENISHEK. Thank you so very much for your service. We are 

here today for you and to make sure that the care that you and 

your fellow veterans in Michigan and around the country receive 

through the Department of Veterans Affairs is timely, accessible, 

convenient, and high quality. 

It is no secret that the VA is in crisis and has fallen far short 

of providing the care and services that our veterans have earned, 

deserve and should expect. Just five months ago a committee investigation, along with numerous whistleblower revelations from conscientious employees, exposed widespread corruption and systemic 

access delays and accountability failures across the VA Health 

Care System. 

As a result of VA’s incompetence, thousands of veterans, including some right here in Michigan, were left waiting for weeks, 

months, and even years to receive the care they needed. I want to 


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assure you all that my response to the scandal was swift and aggressive. 

I was honored to be joined by my colleagues in the House and 

the Senate from both sides of the aisle in a conference committee 

that just a few weeks ago created a bipartisan agreement that Congress passed, and the President signed into law, to improve accountability for VA employees, increase access to care for veteran 

patients, and pave the way for long-term cultural and structural 

reforms throughout the VA Health Care System. 

This law is not perfect, and the problems at VA will not be solved 

overnight; however, this bill for the first time will allow veterans 

suffering long waiting times for care the option to be seen by local 

doctors. This effort is the best chance we’ve had in years to make 

fundamental changes to the way VA operates. 

Much more needs to be done. And my work will not be complete 

until all of our veterans receive the care and treatment they’ve 

earned and they deserve. The time for excuses is over. The time for 

action is now. 

For 20 years, it is my privilege to serve as a physician at the 

Oscar G. Johnson VA Medical Center in Iron Mountain, Michigan. 

From that experience I learned firsthand from veteran patients I 

treated and hard-working care providers I worked with about the 

many challenges and frustrations they face when attempting to access or provide healthcare throughout our nation’s second largest 

bureaucracy. 

Our veterans fought for our freedom. They shouldn’t have to 

fight bureaucrats when they return home. Those challenges and 

the frustrations are nowhere more apparent than where our Native 

American and rural veterans are concerned. 

During today’s hearing we will discuss the issues these veterans 

face here in our community. We will hear testimony from tribal 

and local leaders, veterans, and VA employees. Their input, expertise, and advice is critical to informing the work we do in Washington, and I am grateful to each of them for agreeing to speak on 

the record here today and for all of you in the audience for joining 

us. Thank you so much for being here. 

Before I yield to Ranking Member Brownley, I would like to take 

a moment to recognize and thank the VFW Post 2780 for allowing 

us to use their hall this morning and for their assistance in preparing and setting up for the hearing. And, again, for the Honor 

Guard for their work and contribution, as well. Thank you for having us this morning. 

With that, I would like to recognize Ranking Member Brownley 

for any opening statement she may have. 

Ms. BROWNLEY. Thank you, Mr. Chairman. You must not have 

had your microphone on. Thank you, Mr. Chairman, and thank you 

for your extraordinary leadership on this committee and the committee as a whole and for continuing to keep the issue of access to 

quality and timely services provided to our rural veterans and our 

Native American veterans at the forefront of this subcommittee. 

And thank you to all of our witnesses here today for coming and 

talking with us about the critical issues that have plagued the Department of Veterans Affairs. I hope that with your help and testimony we may find a better way to move forward. 


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I’d also like to thank all of you in the audience who are here 

today in support of our veterans. Today’s hearing will examine the 

progress VA has made in serving Native American veterans and 

rural veterans in Northern Michigan. We will particularly look at 

the issues of non-VA care, telehealth and transportation services. 

I am pleased to be here today to support the Chairman and look 

forward to hearing the testimony of all of the witnesses. 

Like Chairman Benishek, I believe caring for our veterans is an 

ongoing responsibility of our nation. As these brave men and 

women have sacrificed so much, the country must ensure resources 

are available and programs in place to address their needs during 

and after their transition to civilian life. 

The difficulty of providing care to rural veterans and Native 

American veterans is not new and presents some complex problems. Issues such as lack of transportation, lack of access to technology, and VA reluctance to turn to the community to help support our veterans through contracting of care closer to home are 

ones that this subcommittee has examined many, many times. 

And, in fact, we have passed legislation to address some of these 

concerns, but more needs to be done. 

While this hearing will focus on access to care in Northern Michigan, I meet regularly with veterans in my home district of Ventura 

County, California, who face similar challenges regarding the long 

drive times to get to our regional medical center and the long wait 

times for appointments. 

We all know about the current crisis that has embroiled the VA 

for months now: Untenable wait times, misleading and manipulation of data, gross mismanagement. I think we can agree that this 

crisis did not develop overnight and will not be fixed overnight; 

however, our committee also has a responsibility to assist the VA 

on the road to recovery. 

We want the VA to be viewed as an employer of choice and to 

be able to attract people who want to serve our veterans. The Department has allocated over 450 million—has allocated over 450 

million system-wide to implement the Access to Care Initiative. I 

look forward to hearing from the VA today just how much of that 

funding they have received here in VISN 11 and how it has been 

used to open up access and services to our deserving veterans. 

I would also like to hear from the VA what progress is being 

made in working with the Native American community through the 

memorandums of understanding that have been signed by VA and 

the Indian Health Service. I understand that the two agencies are 

working together, but could increase collaboration and oversight to 

ensure that Native American veterans have access to quality care 

closer to where they reside. 

I am hopeful that this will be an honest, open discussion on ways 

to provide the care needed such as more partnering with the public 

and private sector, increasing the pool of providers, and other creative ways to address the gaps in health treatment and services. 

And finally I would be remiss if I did not recognize the dedication 

of the VA employees who provide quality healthcare to our veterans every day. Thank you for all that you do for our nation’s veterans. 


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And, again, Mr. Chair, I thank you for your extraordinary leadership and being a great mentor to me as a new member of the Committee. I want all of your constituents here to know how—what an 

important member you are to this Committee, and clearly your 

leadership specifically on health issues for our veterans. Thank 

you, Mr. Chair, and I would yield back. 

Mr. BENISHEK. Thank you, Ms. Brownley. We are going to begin 

today’s hearing with our first panel of witnesses who are already 

seated at the witness table. Before I introduce the panelists, I’m 

just going to gently remind you all how this all works. We have a 

5-minute limit on the testimony. We ask you all to stay within that 

five minutes. The green light says you’re good, the yellow light says 

you’ve got a minute left, and the red light means you hit the five 

minutes. So we want to have the opportunity for everyone to testify. And then we will take turns asking questions after you’ve all 

testified, and we have five minutes each, so it goes back and forth, 

we each have an opportunity to do questions. We may go back and 

forth two times depending how the time goes. 

Then we will allow the second panel to come up, and then they 

will testify, and then we will ask them questions as well. We typically have VA go up last. So thank you for that consideration. 

With us on the first panel this morning is Fred Kiogima, the 

Ogema of the Little Bay Traverse Band of Odawa Indians; Curtis 

Chambers, a veteran and a community leader in Cheboygan; Carl 

Archambeau, the Post Commander of the Veterans of Foreign Wars 

Post 2780 here; Lieutenant Colonel Retired Linda Fletcher of the 

U.S. Army Nurse Corps and Executive Director of a Matter of 

Honor; and Chuck Lerchen, a Veteran Service Officer for the Grand 

Traverse Region. 

I am so grateful to each of you for your willingness to be here 

this morning to speak candidly about the issues of importance to 

our veterans in our community. I’m honored and privileged to have 

you here. 

With that, we will begin with Ogema Kiogima. Mr. Chairman, 

you are recognized for five minutes. 

STATEMENTS OF FRED KIOGIMA, TRIBAL CHAIRMAN, LITTLE 

TRAVERSE BAY BAND OF ODAWA INDIANS; CURTIS CHAMBERS, VETERAN; CARL ARCHAMBEAU, COMMANDER, VETERANS OF FOREIGN WARS POST 2780; LINDA FLETCHER LTC 

(RET.), EXECUTIVE DIRECTOR, A MATTER OF HONOR; 

CHARLES R. LERCHEN, A.C.V.S.O., DIRECTOR OF VETERANS 

SERVICES, GRAND TRAVERSE, LEELANAU, AND BENZIE 

COUNTIES 

STATEMENT OF FRED KIOGIMA 

Mr. KIOGIMA. Good morning. I am Fred Kiogima, the Tribal 

Chairman of the Little Traverse Bay Bands of Odawa Indians in 

Harbor Springs, Michigan, and I respectfully submit this written 

testimony into the record for the House Committee on Veterans’ Affairs hearing on August 27th, 2014. 

Mr. BENISHEK. Without objection, so entered. 

Mr. KIOGIMA. On behalf of the Little Traverse Bay Bands of 

Odawa Indians, I would like to thank all those responsible for inVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

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viting us to provide testimony at this hearing. We are most appreciative to have this opportunity to bring our concerns to light. 

To address every concern that is within our purview in our work 

with the local VA reps at the county, state and federal level would 

be an enormous task; however, what I will focus on today is a list 

of issues that are most critical to us at Little Traverse Bay Bands 

of Odawa Indians. 

We do have a Veterans Liaison Office established within our 

tribe; the coordinator was trained and certified by the VA reps and 

worked hand in hand with all the levels of the VA system. 

And I do thank Jim Alton, the Emmet County Vet Rep, who 

helped train our tribal liaison. 

We do have—we currently have in excess of 145 veterans within 

our tribe. Identifying all of our vets is an ongoing process. Some of 

our vets are from World War II, like my father; I’m a retired Gunnery Sergeant from the United States Marine Corps and a veteran 

of Central America, Desert Storm, Somalia and served in support 

of Iraqi Freedom. We also have active duty Ogichidaawok ‘‘Warriors’’ that are still deployed. 

Paramount to our Zhimaaganishak or veterans is the ability or 

inability to let them know about all the programming. What’s 

available, what time frames, active, inactive, National Guard, retired. 

The second point is different wars are noted for different issues 

and concerns, and to clarify those, for example, would be the Vietnam—Agent Orange, Desert Storm—trying to get on; the registry, 

the current war in Iraq and Afghanistan—traumatic brain injury, 

PTS. 

The third one is direct client assistance is a concern for us; i.e., 

emergency funding for vets in need, homelessness, job training. 

Four: Clarifying the difference between peacetime and combat 

times. It’s confusing to many veterans that have served, why the 

distinction, and what category was the Cold War. It always leads 

to a conversation of the Cold War was an accepted war, but it’s always listed as the Cold War. 

There needs to be a better PR effort sent out to the veterans to 

offset the impact of budget cuts, sequestration, and all the bureaucratic nightmares that are still being encountered on a daily basis. 

Six: For many veterans, they still seem to associate VA 

healthcare as substandard and cumbersome. 

Accessing VA care is a continuing journey for many, without a 

clear roadmap, and the rules and regulations seem to change on a 

whim. 

Number 8, there is always room for better cultural competency 

at VA clinics and hospitals. 

We have been working with our health clinic and the VA to iron 

out some details on reimbursement. There is such a long trail to 

walk with the VA to get movement on that, and we are continually 

and actively pursuing that. 

With that being said, we know that also in Alaska with the tribal 

village clinics out there, the VA does work hand in hand with 

them. And that is—I was up in Alaska about a month and a half 

ago, talking to their reps. It’s a system that works, tribal and nontribal access those clinics. And it’s a very functional way to work. 


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Why would a non-tribal veteran have to fly down to Seattle or 

some other place when they can do it in Alaska at a tribal village 

clinic. If the stickler is the reimbursement part of it, that is what 

needs to be fixed. Our veterans need access, whether they’re tribal 

or non-tribal. It’s a lot easier to get that if the clinic is right there 

in that same village. 

We are very rural nature here in Michigan. And we know that. 

But that’s one of the things that we definitely need to look at, is 

working with the tribal clinics and the VA to iron out the reimbursement issues so we’re servicing all veterans. 

Having had access to the VA Health System for minimal appointments myself, I can understand the frustration caused by the long 

wait for appointments and the long drive—3-plus hours—to Saginaw for follow-up appointments. 

And why I cite that is, I go to get some doctors’ appointments 

done. I try to avoid it, but the system was not working the way it 

should. It took me, start to finish, about two years. But I’m also 

one of those that are able to get around by myself. 

And my theory is the veterans that do need the help, I feel that 

they need it more than I do, so they can access that care better 

than I can. They need those fundings, those issues. I’m a retired 

Marine, I can get those some other way or I can tap into my tribal 

clinic to an extent. 

In conclusion, we at LTBB have utilized the VA Health Care System to the extent reasonable given drive times, appointment times, 

and length of ongoing medical conditions. We are appreciative of 

the VA system, but it is so overrun with bureaucracy, consistently 

short-funded, and horribly short-staffed. All of these are opportunities for improvement. 

This opens the door to actively pursue a consistent approach toward working with tribal clinics to alleviate some of that stress. 

Chi Megwetch. 

Semper Fi. 

Fred Kiogima, Little Traverse Bay Bands Tribal Chairman. 

[THE PREPARED STATEMENT OF FRED KIOGIMA APPEARS IN THE

APPENDIX] 

Mr. BENISHEK. Thank you very much, Mr. Chairman. 

Mr. Chambers, you are recognized for five minutes. 

STATEMENT OF CURTIS CHAMBERS 

Mr. CHAMBERS. Thank you, Congressman. Thank you, Congressman Brownley, for being here today and holding this meeting. 

My name is Curtis Chambers. I am honored to appear before you 

today. I am equally honored to be seated with these great leaders 

here beside me today. I’m an Ottawa Indian and a Navy veteran. 

My father was a Navy veteran, and two of my sons are Navy veterans. We are all honored to serve this Great Nation as members 

of the greatest Navy this world’s ever seen. 

And I would like to speak with you today about the need for 

transportation services, telehealth, and non-VA care. My son had 

planned to be here with me today, but he’s on his way to Saginaw 

right now to have a consulting appointment for an end procedure 

he’s going to have next week. He’s going to travel twice in two 

weeks here. 


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I have had the unfortunate opportunity to deal with our present 

system and to regale you with the failings would take you more 

time than we have allotted today. Such as the 18-month waiting 

time for an existing problem that one of my sons had, or medical 

records being lost not once, not twice, but three and four times and 

much more. 

I would prefer, however, to focus on the positive and possible 

fixes to the problems today. One: Non-VA healthcare. I don’t understand why we can’t just use our present doctors and send the bills 

to the VA. 

And then Number 2, some of our health concerns and questions—preferably like my son’s going through today—could be done 

via Skype or some other sort of technology? 

Mr. BENISHEK. Telemedicine. 

Mr. CHAMBERS. Yes, exactly. And then when it comes to travel 

problems and expenses, those would all be drastically reduced just 

by doing that. Certainly in the cases of my son and other people 

in Cheboygan. 

In my experience, the actual care a veteran receives is outstanding. The hospitals that my son has gone to, the care has been 

wonderful. Just caring, loving people. But the paperwork and the 

bureaucracy are mind-numbing. And when you add this to our Native cultures, you have a rural nightmare accessing VA care. 

I believe the percentage of able-bodied men in Indian Country 

who serve in the military is about 30 percent. That’s higher than 

any other nationality and probably due to our warrior societies. We 

have hundreds, maybe thousands, of widows who probably qualify 

for pensions. There are hundreds of young vets not accessing any 

healthcare just because of the bureaucracy and the problems associated with that. 

According to the VA website, there are veterans homes and veterans trust funds available. I’d like to see more of an open dialogue 

between the VA and various societies in Indian Country. Perhaps 

we could have talking circles with vets and others associated with 

tribes and the VA itself. 

Mr. Chairman, I’m just a stump-jumping half-breed from Northern Michigan, and I realize that the devil is in the details. But it 

seems to me that in this Great Nation, and it is truly a Great Nation, that by working together, we can supply the veterans of the 

greatest military on earth, the greatest healthcare on earth. And 

they deserve no less. I thank you for your time. And thank you 

again for holding this hearing. We appreciate it. 

[THE PREPARED STATEMENT OF CURTIS CHAMBERS APPEARS IN THE

APPENDIX] 

Mr. BENISHEK. Thank you very much, Curt. And thanks a lot for 

staying within the time. Perfect. 

Let’s see, who do we have? Oh, Commander Archambeau. You’re 

up next. You have five minutes. 

STATEMENT OF CARL ARCHAMBEAU 

Commander Archambeau. Yes. Thank you for having me here 

today. First of all, I am a U.S. Marine, retired, and CW—combat 

veteran of U.S. Marine Corps, retired CW–4 of the United States 

Army. 


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First of all, thank you for the testimony of the subcommittee on 

this health program. First of all, I would like to say that the Veterans Affairs Clinic in our area is doing an exceptional job for the 

veterans considering the space and equipment, personnel that they 

have to work with. 

Also, we have a Disabled American Veterans, DAV, transportation system in place to get some of our veterans to Saginaw, Ann 

Arbor or Detroit for hospital appointments, and that’s a great thing 

to have that in our area. 

Having said that, the distances that we have to travel to get to 

the VA hospitals for an appointment are a problem. It is an all-day 

event to travel to and from the hospitals, plus waiting time at the 

hospitals, making it a hardship to our elderly veterans. 

After traveling the distance, like it’s two and a half hours to 

three hours to Saginaw, and we start out like around 3:30 in the 

morning to gather these gentlemen up, or ladies, and to get them 

down there. Plus Ann Arbor is another hour and a half. And Detroit’s another two, two and a half hours from there, which is really 

a hardship on our elderly veterans. 

By the time they get home, they are—if they were really ill, 

they’re going to be a lot worse. 

So Traverse City is more than 40 miles from the VA hospital. 

And I feel that the veterans should be allowed to use local doctors 

and hospitals for any medical needs that the local VA clinic cannot 

provide versus transporting these distances. 

The VA hospital in Saginaw is an old building. It needs to be 

redone. A new hospital in Gaylord area would better serve our veterans in Northern Michigan and Upper Peninsula area versus having them travel long distances. And that’s basically all I have. And 

I appreciate you having me here. 

[THE PREPARED STATEMENT OF CARL ARCHAMBEAU APPEARS IN

THE APPENDIX] 

Mr. BENISHEK. Thank you very much, Commander. Appreciate 

your testimony. 

Lieutenant Colonel FLETCHER. You are recognized for five minutes. Hit the button. 

STATEMENT OF LINDA FLETCHER 

Lieutenant Colonel FLETCHER. Can you hear me now? 

Mr. BENISHEK. Yes, I’ve got you now. 

Lieutenant Colonel FLETCHER. Well, I thank you, Chairman 

Benishek, for the opportunity to address this group today. I hope 

to provide an interesting perspective for the topics at hand. The recent events surrounding the VA have been very disturbing, to say 

the least, but it was Winston Churchill who said, ‘‘Never fail to 

take advantage of a crisis.’’ And that is what we have in the VA 

system today. 

Now is the time for problem identification, for opening to the consideration of conventional and unconventional ideas, and the formulation of bold steps to institute carefully conjured solutions. 

Abraham Lincoln eloquently captured the mission of this organization, which he created in 1865, with these words: ‘‘To care for 

him who shall have borne the battle and for his widow and his orphan.’’ 


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The structure and configuration of what we currently know as 

the Department of Veterans Affairs has changed through the centuries and our many wars, but the promise and the intent have not 

wavered, and the mission statement has remained the same. 

This nation has lately been generous with funding for our vet- erans: The FY 2014 budget is $152.7 billion. Approximately 40 percent of that budget, or 61.1 billion, is directly related to the provision of healthcare. And due to the recent findings regarding administrative issues, an additional 16 billion is being added. 

There can be little doubt that America wants to take care of its 

veterans and we are willing to pay whatever it takes to do so. Unfortunately, sometimes pumping in money to patch a sag in the 

ceiling isn’t the answer. Sometimes we have to start by fixing deeper foundational issues. 

I am in hopes that reformation of the VA system will begin with 

a review of the original mission statement so we can proceed to 

evaluate our existing organization in accordance with that guiding 

light. 

According to VA.gov, the VA is currently the largest healthcare 

system in the nation. In 2012, the VA provided healthcare for approximately 5.9 million Americans. That’s 2 percent of our entire 

population. 

Interestingly, of that group, some 1.6 million, or 26 percent, qualify for care which the VA categorizes as not associated with war 

related illness or injury. In view of these numbers, perhaps the answer to the situation facing us is not what seems to be the foregone 

conclusion that we need to super-size the VA; perhaps we need to 

consider streamlining the system in accordance with the mission 

statement by targeting care—by targeting care only for war related 

illness or injury. 

A restructuring that focuses specifically on that population would 

decrease the workload by 26 percent and provide a more focused 

approach to care for the remaining group. 

The care required by that smaller group could be provided in the 

local civilian sector by having the VA assume all costs associated 

with insurance provided by the Health Care Act. This mechanism 

may also be—might also be considered as an option for our many 

veterans located in rural areas where accessibility to VA facilities 

is geographically challenging. Perhaps we should consider allowing 

these veterans the option to receive equivalent local care funded by 

the VA through the HCA. 

From an administrative perspective, I would also like to recommend the VA revise their practice of hiring from within. The intellectual and cultural inbreeding that results from selection from 

the same pool chokes the breath of new ideas, perspectives and 

leadership that comes from selecting from a diverse assortment of 

potential employees. 

Lastly, care to veterans is restricted by more than just geography. There are some existing concepts emerging and/or reemerging regarding different psychotherapeutic techniques which 

target the resolution of cause, not just the current objective of mitigation of symptoms. 

Additionally, there’s a wide variety of treatment methodologies 

from acupuncture to Zen meditation available in the alternative 


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medicine communities that target stress reduction, a major component of PTSD care. In view of our less-than-successful results in 

managing PTSD to date, we need to explore, not restrict, new possibilities in theory and treatment. 

I’m well aware that this is a superficial and limited overview of 

a very complex situation. I hope that some of these thoughts will 

be helpful as this nation struggles to provide better care for those 

who give—gave us so much. And let me—let it be remembered that 

the VA may be stumbling, but with our help it can resume its revered and important position in our nation. They have a long and 

honorable history, and they can regain their glory with our support 

which includes constructive, not destructive, criticism. 

We are in crisis, and it presents the chance to take great strides 

in an abbreviated length of time. Let’s take Winston Churchill’s advice and not fail to take advantage of this opportunity to advance 

our systems for the good of our veterans. Thank you. 

[THE PREPARED STATEMENT OF LINDA FLETCHER APPEARS IN THE

APPENDIX] 

Mr. BENISHEK. Thank you very much, Lieutenant Colonel Fletcher. 

Mr. Lerchen, you are recognized for five minutes. 

STATEMENT OF CHARLES LERCHEN 

Mr. LERCHEN. Thank you, Mr. Chairman. 

Good morning. My name is Chuck Lerchen. I am a Veterans 

Services Officer and Director of Veterans Affairs for a 3-county 

area here in Northern Michigan. I would like to thank you for 

bringing the field committee together to gather information concerning the challenges confronted by veterans in rural areas in accessing and obtaining their healthcare needs. 

Speaking from the perspective of a local official who interacts 

with veterans daily, I believe I’ll be able to provide you with some 

valuable insight as to the real world challenges rural veterans encounter after enrolling and choosing the VA to provide them with 

their healthcare services. 

What’s become clear today and everybody knows is the VA is an 

agency in crisis. Both the Veterans Benefits Administration and 

the Veterans Health Administration struggle daily to accomplish 

their mission to our nation’s veterans. Their congressional mandates routinely go unheeded. 

Billions of dollars continue to be thrown at these problems with 

little or no quantifiable results. And the biggest problem is that 

lack of accountability. 

The largest obstacle confronting the VA right now is the culture 

of the VA itself. Health care provision to the significant number of 

rural veterans is just another victim of this corrosive and obstinate 

culture. So while the VA and Congress continue to grapple with the 

core problems within the agency, the veteran continues to grapple 

with the effect it has on him or her. 

It is unreasonable to think that the VA can provide every veteran in the country easy access to every kind of healthcare they 

need in their own backyard. Since it was introduced over 20 years 

ago, the clinic model for rural areas created by the VA has been 

a tremendous success. The need for rural veterans to have to travel 


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great distances for primary care has been markedly reduced; however, the question now becomes, is how do we provide the specialty 

services a veteran needs while still addressing that need for the 

unreasonable travel and appointment times necessary to receive it. 

The answer to this question may lie in the authorization for 

rural veterans to receive certain care at non-VA providers. The VA 

has long held tightly to the notion that they and they alone will 

be the provider of all tertiary care. If your primary care provider 

at a clinic orders an MRI, the VA will do it, even if it means a 10- 

hour drive in the middle of a Northern Michigan winter and you’re 

eighty-eight years old. The VA will still provide that service to you. 

This is the mindset of the VA, and it needs to be changed. 

The metropolitan VA medical centers have all the business they 

can handle. This is very clear. If the VA cannot provide the needed 

tertiary care to the rural veteran, then contract it out to the community. The military does this all the time. Our local Coast Guard 

Air Station is a good example of that. They do not fly their members down to Cleveland where a clinic or a hospital is. They are authorized to receive it in the community. Why can’t the VA do this? 

The rural veteran clogs the wait list for these services unnecessarily. Equity and good conscience must come into play. None of us 

would find it acceptable to be required to drive 5 hours one way 

to receive a needed medical service. Nor would we find it acceptable if our aging parent was required to make such trips. 

So, just as it is unreasonable to expect the VA to be able to provide all of these services to our rural veterans, it is likewise unreasonable to expect the veteran to endure the hardships currently required to receive their needed medical care. 

The rural veteran has entrusted their health and well being to 

the VA system. We are supposed to treat their ailments, not create 

more in doing so. 

We are beginning to see some progress in addressing these lingering deficiencies. VA’s move to improve the method for identifying urban, rural and highly rural veterans by adopting a method 

used by other leading federal agencies is a major step in the right 

direction. 

It is also a step in the right direction in breaking down the core 

problem within the VA. The malignant culture that has existed in 

the VA for far too long must now be replaced with a culture of altruism and service to our nation’s veterans. 

This concludes my testimony. Thank you for the opportunity to 

address your committee today. 

[THE PREPARED STATEMENT OF CHARLES LERCHEN APPEARS IN

THE APPENDIX] 

Mr. BENISHEK. Thank you very much, Mr. Lerchen. I truly appreciate your efforts and your testimony here today. 

We’ve heard some of the issues that you’ve talked about here 

today. And I’ll yield myself five minutes to ask a few questions. 

The issues that you all brought up, many of us have heard them 

before in this committee and also from veterans groups around the 

country and around the district. 

It’s the same problems that come up over and over again. It’s 

been very frustrating to me to hear the people from the VA say, 

‘‘yes, well, we understand and we’re working on it.’’ And yet, at 


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times thirty years will go by and nothing changes, even though we 

get the answer, ‘‘We’re working on it.’’ So they are not working very 

effectively on it. 

Let me just ask a couple of questions that we’ve thought of here. 

In VISN 11, which includes all Michigan except for the UP, they 

were awarded $8 million in Fiscal Year 2014 to increase access to 

care for rural veterans. Anyone seen any new programs or initiatives put into place? To improve access to care this year? Anyone 

can answer that question. They got an extra 8 million bucks. Has 

anything happened that you’ve seen as a change in care in this 

year? 

[No response.] 

Mr. BENISHEK. Mr. Kiogima, have you seen anything new? 

Mr. KIOGIMA. I have not seen anything new. And, like I say, the 

intent of how the—my Tribal Nation would like to see more local 

care. 

Mr. BENISHEK. That’s not happening. Mr. Chambers, have you 

seen any change? 

Mr. CHAMBERS. No, sir. My son is still driving to Saginaw for 

consulting problems. 

Mr. BENISHEK. Not even for the procedure, just to get the—— 

Mr. CHAMBERS. Just to talk about setting up the procedure. 

Mr. BENISHEK. Right, right. 

Commander Archambeau. 

Commander ARCHAMBEAU. I agree with the other two gentlemen. 

I haven’t seen anything. 

Mr. BENISHEK. Lieutenant Colonel Fletcher. 

Lieutenant Colonel FLETCHER. Yes, sir, I have. 

Mr. BENISHEK. What have you seen? 

Lieutenant Colonel FLETCHER. I’ve had the distinct pleasure and 

opportunity to be able to address a lot of different groups with regard to post traumatic stress disorder in the Traverse area. And, 

I’m not a counselor. I guess I’m really more of an epidemiologist 

than anything. 

And when I talk to groups, I bring up things that are important 

and—and sometimes they are destabilizing to people who have 

PTSD. I frequently have people who come to me after the talks in 

tears and needing counseling. 

So I went to the VA and I said, I need somebody here. Somebody 

here to support me with counseling so that I can say: ‘‘Here’s the 

VA, they’re right here in the community, and they want to help 

you.’’ That has happened. I have that support now. And I’m very 

appreciative of it, as are the people who are falling apart after I 

talk. So I think that’s a step in the direction—the right direction. 

And I think it’s representative of something that we probably need 

to target, and that is the confluence of the efforts of the VA and 

the community. We need to work together. Not in the—not within 

the halls of the VA, but in the community itself. 

Mr. BENISHEK. Thank you. Mr. Lerchen, do you have an answer 

to that question? Have you seen anything new in the last year as 

a result of this $8 million that the VISN got? 

Mr. LERCHEN. We have been informed—keeping in mind that 

they don’t talk to us very much, whether at the medical center 

level or the VISN level, so nothing formal has been related to us. 


VACREP180 with DISTILLER
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I do hear back from the veterans that there has been maybe a 

slight increase in authorizations to receive some local care. But 

nothing formal, nothing official, nothing that we’ve been asked to 

participate in any way, shape or form. So I can’t answer your question. 

Mr. BENISHEK. Quickly, I have a few more seconds left. Do any 

of you have any examples of what you think could be changed in 

the way that we take care of rural veterans other than, getting 

people to local clinics? Is there something else that VA should be 

doing as far as any of you think? 

Voice. I have just recently had four procedures at the Ann Arbor 

VA. I’ve had to make 12 trips, some days they were 18-hour days. 

One trip was to have a preop examination. I had just had my complete physical about a week or so with my primary care here in 

Traverse City. 

But I had to go to Ann Arbor and have my heart listened to and 

have an EKG because they said that they could not accept what 

was done here in Traverse City. Again, surprisingly, the EKG came 

up abnormal. I asked the—and I’m an RN, and I asked the nurse 

practitioner what is—what is going on with this EKG? ‘‘Oh,’’ she 

says, ‘‘I get that reading all the time. It’s an old machine.’’ So I had 

to make a 12-hour trip to go down and have my heart and lungs 

listened to, have an EKG that wasn’t—wasn’t good, and I had just 

had the care done here in Traverse City a week or so before. So 

there needs to be some consistency across the board. It’s all the 

same. 

Mr. BENISHEK. Right. 

Voice. It was wasteful. Totally wasteful. 

Mr. BENISHEK. Thank you. I’m out of time. I’m going to yield five 

minutes to Congresswoman Brownley from California for her questions. 

Ms. BROWNLEY. Thank you. Thank you, Mr. Chairman. So, I 

wanted to ask a few questions around our service to veterans who 

are Native Americans. And it was in your testimony, Mr. Chairman, you talked about knowing the programs—I think Mr. Chambers here talked about a—how did you describe it—a talking circle 

with tribes and the VA. 

What form of communication is happening now so that your veterans are well aware of all of the services that are available to 

them? 

Mr. KIOGIMA. Okay. Speaking for my tribe, we had initiated a 

Veterans Liaison Office, which we staffed as I came into office last 

year. It’s has a more administrative approach to it. 

We also transcend, the non-tribal and the tribal lands. We work 

hand in hand with the Emmet County Veterans person, point of 

contact, and he helped us get trained up all the way through the 

VA system. 

But that in itself, we don’t have a traditional approach as per se. 

Those are something that tribal nations, tribal people are kind of 

reluctant to do unless it’s just strictly tribal. Because that’s what— 

one of the uphill struggles we have with the Native veterans are 

there—it is not that they are afraid. It’s just the way we’re raised. 

You don’t go out and seek help and bring it to attention that you 


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have a problem. And that’s across the board. But it’s more so on 

Native—in Indian Country. 

I think if you talk to any of the veteran reps in this room, they 

will tell you almost all veterans are that way. They almost have 

to be falling apart before they raise their hand and say, ‘‘Help me.’’ 

That old mantra of no pain/no gain kind of kicks us in the butt 

when we’re in the military, and it catches up to us years later. 

But just in itself in the Indian Country, that’s one of the biggest 

problems we have, is the outreach. And we’re scattered into very 

rural areas. And then after that, it just kind of rolls into a big ball 

of not having access to get to the VA clinic, which is—up in the 

UP, it’s over in the Congressman’s area; down here, it’s in Saginaw. There is a lack of funding all the way across the board with 

transportation issues. But —— 

Ms. BROWNLEY. So do you think if there were talking circles and 

the VA came, would—would your folks also come? Or is it—or is 

it something that you’re going to gather for one purpose, and a VA 

person or someone who can, communicate to your folks be there? 

So I guess when you’re talking about some of the cultural issues, 

about not speaking up and needing help or asking for help —— 

Mr. KIOGIMA. When we say a talking circle, it’s more along—I 

guess here it would be called group therapy or something else. But 

it’s not to exclude anybody, but it’s almost like the veterans have 

their own world to be in. Even within that circle of veterans, for 

some reason we’ve built up a wall between combat veterans and 

noncombat. I don’t know where that came from because to me we’re 

all the same. But even when we get in our talking circle, that 

seems to be a wall there. And it shouldn’t be there. 

But a talking circle, in and of itself, on a cultural level, is for the 

tribal people. But that’s not to negate anybody could come to a 

talking circle because a warrior is a warrior. Ogichidaawok is 

Ogichidaawok, whether they’re tribal or not, and it’s a healing circle. 

But having somebody from the VA staff to sit in on one would 

probably be most appreciative so you could actually see some of the 

things that are going on and some of the concerns. Because that’s 

where you get the vocalness is within those circles, where they feel 

safe within that circle, because they are talking back and forth 

with other veterans, people who have experienced the same thing. 

Ms. BROWNLEY. So it’s not an issue, tribal and non-tribal? Together, it’s fine. 

Mr. KIOGIMA. Yes. 

Ms. BROWNLEY. Okay. Very good. And Commander, you talked 

about the transportation system here. And I think you were saying 

that you thought the transportation system was relatively successful and relatively positive. Is there something—can you describe 

the transportation system? 

Commander Archambeau. Basically we have—I believe it’s two 

vans that we utilize, and we basically transport the patients. We 

pick them up at their homes or wherever they need to be picked 

up at, and then we deliver them to—usually Grayling. And from 

Grayling, then they are transported down from a bus that comes 

out of Grayling, and then they have to ride this bus down there. 


VACREP180 with DISTILLER
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But there is times that we’ll actually transport them also all the 

way down to their appointments. Depends on how many we have. 

And I’m not really up on that as much as I should be due to the 

fact that’s—the coalition basically—I mean, the DAV people handle 

that a lot, but I do drive for them. 

But I guess it’s a good system. It works. But the thing is that 

they—we start out like 3:30 in the morning, and they don’t get 

back till sometimes till 8:30 at night, and that’s a long time for a 

veteran to be sitting around. 

Plus once they get to the hospital, if they would get priority as 

soon as they hit the hospital. Instead of the people in the local area 

that could drive to the hospital to be taken care of, these veterans, 

when they come in, should be taken care of immediately so they 

could turn them around and try to get them home in their earlier 

part of the day versus going into the evening. 

And then they don’t get to eat properly. Because the food isn’t, 

given to them while they’re there, if I am not mistaken. And, so 

the veterans have to fend for themselves while they’re there. So it’s 

a hardship on elderly veterans. 

Voice. The VA doesn’t pay for it. It’s mostly volunteer organizations and local people in communities that pony up the money to 

pay for the vans, the fuel, the maintenance. And the drivers are 99 

percent volunteers. And these are guys that go above and beyond 

all the time to make sure these guys get to their appointments. 

The VA has not contributed a dime of money that I’m aware of 

to anything in Manistee County as far as transportation of veterans to appointments. It’s all been volunteer and people in the 

local area donating money to pay for it. 

Commander Archambeau. That’s true what he’s saying, is like 

we have a fund going now, trying to make money to raise X 

amount of dollars so we could get a new DAV van. And that’s being 

done by the local people donating that $15,000. Then the rest of the 

funds are coming in—I don’t know where they’re coming from, 

but—I’m not up on that myself. But what he’s saying is true. The 

local people are supplying that money for that DAV van. And I cannot believe that the DAV—I mean, the VA can’t support that cost. 

Mr. LERCHEN. Ms. Brownley? For clarity, I’m sorry. 

Ms. BROWNLEY. Yes. 

Mr. LERCHEN. Just to be sure we’re accurate here, I ran that program locally for about 17 years. I have now turned it over to another coordinator. 

But the VA does participate with that program. It’s a collaboration between the national DAV and the VA and Ford Motor Company. It’s been going on for quite some time. 

Essentially the DAV chapters in the state and national organization raise the funds to buy vehicles; 100, 140 of them annually nation-wide. At reduced rates from the Ford Motor Company. 

They then donate those vehicles to the VA. The VA accepts ownership of those. The VA pays all of the expenses associated with 

gas and oil and maintenance, feeding the drivers, all of that. So it’s 

a collaborative effort between the VA and the DAV, and then— 

which filters down to the local—the coordinators. Those are all volunteers. 


VACREP180 with DISTILLER
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It’s still not a perfect system. But I did want to make sure that— 

to stand corrected—the VA participates actively with that program 

nation-wide. 

Ms. BROWNLEY. So if we were going to improve upon it, would 

more vans improve upon it? Or—— 

Mr. LERCHEN. We’re asking volunteers—where we live, we’re 

asking a volunteer, typically a retired person themselves, who may 

be looking for a volunteer gig—instead of working the information 

desk at the local hospital for a couple hours, we’re asking them to 

get up at 3:00 o’clock in the morning, in the middle of February, 

travel on interstate and rural roads for 5 hours one way, with a 

van load of veterans needing appointments, wait at the hospital for 

5 and 6 hours, and turn around and drive it all back. 

It’s hard to get volunteers willing to do that. And then the VA, 

you know—because of liability reasons, the VA owning the van and 

accepting all the liability associated with that, they have to pass 

a physical. The VA has to clear them to drive the vehicle. So it becomes a logistical problem. It’s hard to get and maintain drivers. 

Up here. 

Voice. Background searches, fingerprints. 

Mr. LERCHEN. Up here we lose a lot of drivers in the winter. 

They go down to Florida and Alabama and whatever. So it’s a 

logistical problem. So. 

Voice. Can I throw in things? 

Ms. BROWNLEY. I yield back, Mr. Chairman. I don’t want to go 

over my time. 

Mr. BENISHEK. We’re trying to go back and forth a little bit. I 

want to ask another question on the tribal issue. 

According to the statement of VA, they have done extensive outreach to all 13 tribes in Lower Michigan. Would you agree that the 

VA’s outreach to Native American veterans in the Lower Peninsula 

has been extensive? 

Mr. KIOGIMA. You can define ‘extensive’ probably with four or 

five e-mails a day, Congressman. There’s a difference between outreach and consultation. That’s one of the biggest problems that we 

do have in Indian Country. The determination that they call of outreach is what pops up on my computer. 

That is to me a function. It is not an outreach. That is a notification of something. An outreach is literally what we’re doing here 

or at the VA level to have the representatives up here in Northern 

Michigan occasionally so we can see one-on-one what the problems 

are and how it’s doing. So, no, that would be a negative as far as 

an outreach—workable outreach program being handled up here. 

Mr. BENISHEK. Mr. Chambers. 

Mr. CHAMBERS. I’d agree with the Chairman. You could define 

that in different ways. I would challenge anybody in the VA to 

show me a list of tribal representatives for each tribe that is connected with the VA. I don’t know that there is such a list. I’ve tried 

to put one together myself and haven’t been able to do so. 

Mr. BENISHEK. Okay. Do you have any ideas about how they 

could improve the outreach? Some of the things you’ve already 

said, I guess. I mean, having somebody actually come up here. 

Mr. KIOGIMA. To reiterate, that was the intent of our Tribal Liaison Office, was to make direct contact. Because it is a different sceVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

VACREP180 with DISTILLER
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nario with the Tribal Nation. The one-on-one should be at a higher 

level. But the VA reps, that was the intent of our Tribal Liaison 

Office, was to work hand in hand with the county reps and with 

the state reps and keep it going. That to me is an open communication and an outreach program. If it is not being done that way, 

then it’s just another blip on the radar. 

Good consultation with the VA, whether it’s semi-annually, quarterly, from Saginaw or even up at the hospital in Escanaba, somewhere needs to be. Rural America is caught in between up north/ 

Escanaba and Saginaw; everything in between seems to be rural to 

an extent that’s hard to get to the system. So outreach has to be 

preeminent in how they get out there and talk to the people. 

Mr. BENISHEK. Curt. 

Mr. CHAMBERS. And also they don’t necessarily just have to outreach to the veterans. outreach to the community itself can include 

just letters in our local bulletins. Newsletters. The widow’s fund 

that we have. There are just so—hundreds of people would be eligible for this if they knew that it existed. But they don’t. 

These things are on the web site. There’s quite a few—you need 

to search through them. I wouldn’t know about them myself except 

Jason Allen pointed them out to me. 

Mr. BENISHEK. Let me ask all of you this question. Is there some 

type of care for our veterans that you think can only be provided 

by VA itself? And not provided by the out—by, local community 

Lieutenant Colonel, do you have any thoughts toward that? 

Lieutenant Colonel FLETCHER. I do. 

Mr. BENISHEK. These microphones are something, I know. 

Lieutenant Colonel FLETCHER. Am I on now? 

Mr. BENISHEK. Yes. 

Lieutenant Colonel FLETCHER. Well, I really don’t think that 

there is anything special that the VA can offer that can’t be done 

in the community. And—if that’s what you’re asking me. 

Mr. BENISHEK. Yes. 

Lieutenant Colonel FLETCHER. And, actually, I don’t see any reason why we have to limit healthcare for veterans to the Veterans 

Administration. I mean, it—when I hear about the transportation 

issues and everything else, it looks to me like the ancillary—the 

answer is localize this stuff. 

I mean, instead of trying to make a cumbersome transportation 

system and everything else work, why don’t we just authorize a 

mechanism so that people can get their care on the local economy. 

I think that mechanism may be available through the HCA. I don’t 

know, I made that up. I have to tell you, I am not an expert on 

that. But it seems to me that for the first time there may be a fiduciary tool that we could use to, expedite that. So, no, I don’t think 

there’s anything that has to happen in the VA. 

Mr. BENISHEK. Does anyone else have a different answer than 

that? 

Mr. LERCHEN. Real quickly, and this is my perspective on it, but 

there’s nothing that the VA does that can’t be handled locally. I 

mean, it’s healthcare. The culture of veterans being former military 

members, there is a certain understanding of that at the VA facilities. And that’s important. 


VACREP180 with DISTILLER
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In my opinion, you have to look back historically. The VA system, 

is—is needed for this country. During World War II, Korea, Vietnam, the VA was responsible for treating returning casualties. We 

have to have some—we don’t have that right now. Will we ever 

have that in the future. Hopefully not again. 

But if we do, doesn’t that system have to be up and running? 

Don’t we need that system to be able to handle that if we ever need 

that again? 

In the meantime, what do we do with it? So I’m—I think it’s a 

bigger question than whether or not it can be handled. It’s the need 

and the national security, whatever you want to call it. Do we need 

that system? And history has told us, yes, we’ve needed it in the 

past. And if we need it in the future, it’s hard to get it back up 

and running again. 

So, but, keeping the focus on rural veterans, I think it was in my 

testimony, where these VA hospitals are that service. The rural 

veterans, they are already full. Why are we making the rural veterans come in there and further clogging that up, and then we 

have the incidences like Phoenix. I’m sure they were bringing rural 

veterans from Arizona in there. So a hybrid answer is probably the 

answer. 

Mr. BENISHEK. Thank you. I’m out of time here. Let’s ask Representative Brownley if she has any further questions of the panel. 

Ms. BROWNLEY. I wanted to—— 

Mr. BENISHEK. And then we’ll get to the next. 

Ms. BROWNLEY. Thank you, Mr. Chairman. And I just wanted to 

follow up with the Lieutenant Colonel on her testimony around alternative therapies for mental health. 

Lieutenant Colonel FLETCHER. Yes. 

Ms. BROWNLEY. I’m just curious to know, are there acknowledged 

alternative therapies for veterans here in this VISN for mental 

health? 

Lieutenant Colonel FLETCHER. If there are, there are very few of 

them. And the VA in general is reticent to embrace those. I think, 

across the nation, they are becoming more and more embraced. 

But the VA is being very cautious to ensure that appropriate 

standards are available for each one of those disciplines. And so 

that’s difficult, because these are sometimes ancient practices that 

don’t have those kinds of fundamental disciplines. 

The possible answer to that is to have the VA come up with some 

ideas about what it is that they would require from each one of 

those different sectors. And instead of them—those providers coming to them with the answers, the VA say: This is what we demand 

of you. And that way they could access that care. 

Ms. BROWNLEY. Well, I’ve been an advocate for the alternative 

therapies—as a matter of fact, the hearing that we had in California that the Chairman joined me on was focused on that. So I’m 

hoping very, very much that the VA will take another step towards 

that. 

Because I think, therapy through telemedicine, talk therapy, oneon-one, group sessions, these are all good. And not one method is 

going to work for every single veteran. And I know in my district 

we have equine therapy that works—— 

Lieutenant Colonel FLETCHER. Yes, we have that here. 


VACREP180 with DISTILLER
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Ms. BROWNLEY [continuing]. Very, very well. 

Lieutenant Colonel FLETCHER. And we—I think you’re—I applaud your efforts in that regard. We need—at this juncture, we 

need every single tool we can probably gather. We’re not in a position to be able to show—to shut the door on any sort of option 

whatsoever. We just need to explore everything. 

Ms. BROWNLEY. Thank you. And, one question for all of you is— 

that I would like to ask. every time I speak to a veteran, all of the 

testimony that we’ve had back in Washington—and believe me 

we’ve had hundreds of hours worth—one thing that is always consistent is veterans believe once they’re in the system, they’re getting good quality healthcare. It’s accessing the system is where the 

problems reside. So in this discussion about using local facilities 

and local doctors and—I understand the travel time and the elderly, and I’m sure in the wintertime here it’s—it must be really onerous. And—— 

But I guess the question is, if you were going to survey all of 

your veterans that are serviced here, would they all choose to go 

to a local doctor versus travel to—to the VA? Understanding that 

the one thing that I’ve heard that is true is that the healthcare is 

of good quality once they’re inside the system. So I’m just curious 

to hear generally what you might think. 

Lieutenant Colonel FLETCHER. I don’t think you can say 100 percent of the population would go with that. 

Ms. BROWNLEY. The majority? 

Lieutenant Colonel FLETCHER. Yes, I would certainly expect that. 

Voice. I have a comment. I’ve rode down several times with gentlemen who were receiving radiation therapy. It was a 5-minute radiation therapy treatment, but they would have to go down on 

Monday, stay through the week, and come home on a Friday. For 

a 5-minute-a-day treatment that could definitely be rendered here 

in—within the community. Or closer to their home. 

Ms. BROWNLEY. Mr. Chairman, I am going to let you respond to 

that. 

Mr. BENISHEK. Well, I think if you and I are out of questions, I 

think that will get VA up in the next panel and let them give their 

testimony and I’ll ask them a few questions. 

Voice. I thank you all for spending time with us here this morning. I want to tell the audience that we will have time and staff 

to answer questions and take comments after the hearing. But in 

view of the time situation, we want to keep the ball rolling. 

So please don’t think that we don’t want to hear what you have 

to say. But in the format of the hearing, we have to keep moving. 

So please talk to the staff. We will have staff here staying afterwards that you can speak with. So I appreciate everyone being here 

and their wish to comment. 

The first panel is excused. And then we’ll ask the second panel 

to come up forward. 

[Pause.] 

Mr. BENISHEK. I would like to welcome the second panel to the 

table. Joining us today from the Department of Veterans Affairs is 

Paul Bockelman, the Director of Veterans Integrated Service Network ‘‘VISN’’ 11. 


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He’s accompanied by Peggy Kearns, the Director of the Aleda E. 

Lutz VA Medical Center in Saginaw; and James Rice, the Director 

of the Oscar G. Johnson VA Medical Center in my town that I 

practiced medicine in, Iron Mountain. I want to thank you all for 

being here today. 

Mr. Bockelman, will you please proceed with your testimony. 

STATEMENT OF PAUL BOCKELMAN, DIRECTOR, VETERANS INTEGRATED SERVICE NETWORK (VISN) 11, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS; ACCOMPANIED BY PEGGY KEARNS, DIRECTOR, 

ALEDA E. LUTZ VA MEDICAL CENTER, VISN 11, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS; AND JAMES RICE, DIRECTOR, OSCAR G. JOHNSON 

VA MEDICAL CENTER, VISN 12, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF PAUL BOCKELMAN 

Mr. BOCKELMAN. Good morning, Chairman Benishek and Ranking Member Brownley. 

First, I would like to thank the first panelists for their candid 

conversations. We are all about learning. We are all about looking 

for opportunities to increase our services to veterans that will improve their experience with us. That is so important to us, so we 

appreciate their comments. 

Thank you for the opportunity to be here at VFW Post 2780 to 

discuss VA’s commitment in providing accessible, high quality, patient-centered care. 

Today, we are here to discuss VHA’s care for rural veterans and 

Native American veterans in Northern Michigan and the Upper Peninsula. I am accompanied this morning by Ms. Peggy Kearns, Director of the Saginaw VA, and Mr. Jim Rice, Director of Iron Mountain. 

We sincerely appreciate the assistance we have received from our 

partners at local veteran service organizations, Native American 

Tribes and key non-profit stakeholder groups. We would not be 

able to provide the necessary care to our rural and Native American veterans without the support of our partners who are dedicated to ensure our nation’s veterans are receiving the services 

they have earned. 

The VA’s committed to enhancing the care rural veterans receive. 

Approximately 43 percent of Michigan’s veterans enrolled in the 

VHA live in rural areas. In Michigan, we have multiple projects 

and programs in place to increase access to rural areas. These include telehealth; home-based primary care; our mobile prosthetics 

van, which brings prosthetic services to the CBOCs or the clinics; 

clinical training opportunities for providers in rural areas; and our 

program to provide mental health support to veterans living in 

rural areas. 

We also partner with the Escanaba mobile vet center to provide 

ready access to returning service members during the mobilization 

events. 

Throughout Northern Michigan, we use innovative methods to 

meet the healthcare needs of veterans in rural areas. One of the 


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ways we accomplish this is through telehealth technology. Our telehealth program ensures veterans get the right care in the right 

place at the right time very much an issue with our panelists this 

morning. 

In Fiscal Year 2013, Michigan’s telehealth programs conducted 

roughly 62,400 visits using telehealth modalities. 

Transportation is a challenge unique to the highly rural areas we 

serve. We continue to look for opportunities to expand access to 

care for rural veterans and we look forward to talking to the folks 

that spoke earlier about any opportunities they may see for us to 

expand our transportation system. 

For example, our transportation program and network of volunteer drivers—which we so much appreciate—assist veterans in 

rural communities with their rural transportation needs. Transportation is provided to the Saginaw Medical VA Center as well as 

Ann Arbor and Detroit. The Iron Mountain Medical Center also has 

a bus that travels to Milwaukee twice a week. 

Veterans have expressed satisfaction and appreciation with the 

transportation program. I would add we continually are looking for 

drivers. This is a wonderful volunteer opportunity for them, and it 

is so much appreciated by the veterans and the employees that enable them to see the veterans, as well. 

VHA has done outreach to Native American Tribes in Michigan 

to build closer relations with tribal governments and promote 

awareness of VHA services. Our efforts include charting an outreach team to connect with Native American veterans in order to 

increase awareness of benefits and services, promote VA’s high 

quality of care, receive feedback from veterans, and address access 

gaps. 

Working with local veteran service officers and tribal and community representatives, local outreach teams coordinated and participated in numerous outreach events in Fiscal Years ’13 and ’14, 

including over 20 at area Tribal Nations. 

Through collaboration, the Iron Mountain VA Medical Center established a satellite, home-based, primary care team located at the 

Lac Vieux Desert Tribal Health Clinic to provide care to our veterans living in that area. 

In addition the Saginaw, Battle Creek and Iron Mountain Medical Centers held the Third Annual Tribal Veterans Representative 

Training. This training promotes the practice of having a tribal veteran representative in federally recognized tribes throughout 

Michigan. 

VA’s goal is to provide care to veterans directly in a VA medical 

facility; however, when we cannot provide the necessary services at 

one of our facilities, we are authorized to provide that care through 

our community providers. 

We recognize that in Michigan, travel distance and the number 

of available providers is a challenge in our efforts to provide nonVA care. VA is committed to providing the high quality care that 

our veterans have earned and deserve. 

We appreciate the opportunity to appear today before you and we 

appreciate the resources Congress provides VA to care for veterans 

throughout Northern Michigan and the UP. We are prepared to answer questions you may have for us. Thank you. 


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[THE PREPARED STATEMENT OF PAUL BOCKELMAN APPEARS IN THE

APPENDIX] 

Mr. BENISHEK. Thank you very much, Mr. Bockelman. I’m going 

to start and I’m going to yield myself five minutes to ask some 

questions. I’m going to start with something that Fred talked about 

when he mentioned the tribal outreach in his testimony. The way 

he related it, it was basically some e-mails he was getting. I appreciate that they have had this outreach at the Lac Vieux Desert 

Tribe, but I was hoping maybe we could use this meeting here this 

morning to encourage you to actually get somebody to talk to Fred 

on a regular basis rather than an e-mail. Because I think he’s feeling as if there’s—could be better communication. Don’t you think 

he felt that way? 

Mr. BOCKELMAN. Always willing to look for opportunities. We do 

have some face-to-face. I think the recognition, hearing his testimony that the more face-to-face, the better. For that culture, written communication/oral communication is not as good as face-toface communication. There’s a great nugget for us to take home 

and work to increase our outreach efforts. 

Mr. BENISHEK. I think in our culture, as well—— 

Mr. BOCKELMAN. Sure. 

Mr. BENISHEK [continuing]. That works out well. I mean, we’re 

trying to develop a better relationship with Ms. Kearns here, and 

I think my office has a good relationship with Mr. Rice. And regular communication tends to help things go. And I was hoping I 

could get your commitment today to try to make that happen better. 

Mr. BOCKELMAN. You do. 

Mr. BENISHEK. Good. I have another question about—something 

that’s come up talking to veterans in the district. Is there a registry for people who have been subject to these burn pits that were 

present in the Gulf War? The people that have been exposed to 

these burn pits, and they are now starting to report medical conditions related to that? Are you familiar with that? 

[No response.] 

Mr. BENISHEK. It’s similar to Agent Orange, but in the Gulf War 

they had these burn pits in some of the camps, that people were 

exposed to ash and chemicals for a long period of time. I am beginning to hear now that those veterans are developing medical illnesses, which they feel as if it’s related to the burn pits. Is there 

anything like that going on, developing a registry of people exposed 

to these burn pits? 

Mr. BOCKELMAN. We will get back to you on the exact nature of 

the registry. I know there’s been a lot of outreach to folks that have 

been exposed to make sure we understand what kind of symptoms 

they are having. 

Mr. BENISHEK. You are not doing that now, though? 

Mr. BOCKELMAN. I need to find out if there is a registry. 

Mr. BENISHEK. Okay. All right. Another thing that keeps coming 

up, too, then, that was mentioned today by Mr. Chambers is the 

lost records issue. This is something that I hear all the time. I sent 

my records in not once, not twice, but three times and they are 

lost. How exactly does that happen? You must have heard this. 

Have you ever heard this before, I hear it a lot. 


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Mr. BOCKELMAN. I know within the VA now that we have a well 

established electronic medical record, we don’t have those problems 

within the agency like we’ve had in the years gone by. 

When we do have records that come in, it is very difficult to keep 

hands on them. We do want to make sure that we’ve got that system figured out so that it does get included in the patient’s electronic record. 

Knowing that we are going to continue to do non-VA care and expanding that in the future, this is critical. One of the concerns we 

have about expansion of non-VA care is will we lose continuity of 

care. And we will have to work very diligently to make sure we 

don’t lose that consistency. 

As a physician, the concept of knowing what other physicians 

have provided or think is important is just critical to ensuring we 

are not going off on the wrong track. So if we have opportunity 

for—— 

Mr. BENISHEK. So you don’t have an answer for that story, then? 

Mr. BOCKELMAN. I don’t have an—not for that specific question. 

Mr. BENISHEK. I still have a few minutes left. The other thing that I want to talk about is this $8 million that the VISN received 

for increased access to care for rural veterans. What exactly have 

you spent that $8 million on this year? 

Mr. BOCKELMAN. Within Michigan, Northern Michigan, we have 

spent 3 and a half million on the CBOCs that are rural up in this 

area. This was a way for us to get the CBOCs established. This is 

the third year for several of those, and after three years the funding should be within the regular budget. We’ve spent the money on 

the transportation system, several other outreach-specific—and I 

can get you the exact details on those. 

Mr. BENISHEK. That would be great, if you just sent me how you 

spent 8 million bucks. 

Mr. BOCKELMAN. I can do that. 

Mr. BENISHEK. The other thing is I know there is a bus that the 

VA provides in Iron Mountain that transports the guys back and 

forth to Milwaukee. And Madison, too, I think. I’ve heard about 

this transportation issue that these volunteers, they are getting a 

little bit older, tougher to pass the physical. 

What is the long-term plan for continuing decent transportation? 

Is there anything beyond the volunteers? Is there any other plan 

that you’re trying to implement Because it doesn’t seem to me like 

this is a very good system. Are there buses that you provide similar 

to the ones in Iron Mountain, here, down below the bridge? 

Mr. BOCKELMAN. Yes, we do. And I will have Ms. Kearns describe that. But, again, I just need to say how crucial it is to have 

the volunteers. They are wonderful. It is amazing to see, on the 

worst weather days, the volunteer drivers do get the veterans to 

care. And that is appreciated. 

Ms. Kearns, can you describe the transportation within the district. 

Ms. KEARNS. Yes, in addition to our volunteer network—which 

they service about 90 veterans a month that they are transporting 

back and forth in their vans—we also have a program through the 

Rural Health Transportation Program that we were given funding 

for. That is VA employees that drive patients down to Saginaw, DeVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

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troit, and Ann Arbor. And this starts at Gaylord, stops at West 

Branch, Grayling, Standish, picks people up, takes them down to 

Saginaw. And then we take them to wherever they need to go, 

whether they need to go to Detroit or Ann Arbor. 

Mr. BENISHEK. This is separate from the volunteers? 

Ms. KEARNS. That is separate from the volunteers. That’s our bus 

that goes back and forth, and it’s run—it’s funded through Rural 

Health Initiative money and it’s VA employees doing that. So we 

have two programs: The volunteer program and—our own bus, 

which has serviced about 1,200 veterans in the past year. 

Mr. BENISHEK. I see I’m running over time. I am going to allow 

my colleague, Representative Brownley, to ask questions for five 

minutes. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

Mr. Bockelman, thanks for your testimony, and I really appreciate your introductory comment saying that you appreciated the 

candid conversation from the first panel and always looking to 

learn and to grow. Because I honestly am a firm, firm believer that 

in order for us to really improve the VA and change culture, we 

really need to be in a mindset of continuous improvement, always—always trying to improve. 

And I also really believe that there’s not—one size doesn’t fit all. 

So, we go across the country, in different areas there are different 

needs, and we’re going to have to solve those issues differently. So 

I appreciate those comments. 

And I guess my first question to you—and after all of the crisis 

that we have had within the VA, I am convinced that communities 

need to be having ongoing conversations with one another. Just 

like we’re having today. And—but to have a process and a system 

set up where veterans in the community can talk to you and you 

can talk to the veterans and have that communication sort of back 

and forth. 

And so I’m just wondering, do you have a system like that, where 

you are, on an ongoing basis, talking to the veterans in Northern 

Michigan to make sure that you, as the VISN director, can do absolutely everything possible to sort of meet the individual needs 

throughout the area? 

Mr. BOCKELMAN. A couple things. One, within our VISN 11 organizational structure, our governing structure, we recognized last 

year at our strategic planning, a year ago, that this is something 

that we needed to crank up is how do we get more veterans’ input? 

So we’ve tasked ourselves with getting more veterans as members 

on our facility level committees. 

We value their input. They surely present different things, different perspectives of the same issue, and it always adds value to 

our discussions. So we’ve been doing that with great success. And 

with great eye-opening input from these members. So that’s something that we’ve been doing as an organization as the leaders felt 

that we needed to do that. 

As the new Secretary has identified, we will be holding town 

halls in all of our facilities over the next couple of weeks to make 

sure we look for opportunities. Typically the facilities have regular 

and routine outreach or opportunities to speak to veteran services 

officers, the congressional delegations. Most of the facilities do that 


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at least quarterly and most are in conversations with your offices 

much more frequently than that for all sorts of reasons, and we 

look for any opportunity to get input from the congressional staff. 

The veteran service organizations do simple things like suggestion 

boxes, as well. 

One of the things that we’ve heard this morning that we look forward to helping is some of the discussion on just basic information 

eligibility. It’s always tough to get that message out to everybody. 

But we can improve on that if that’s seen as a real need. We would 

look forward to reaching out and seeing if we can get that into any 

local publications. And we would ask for input from the community 

on what kind of publications would best suit the needs of them to 

hear more about the VA. 

Ms. BROWNLEY. Thank you. I appreciate that. And I think in all 

of our conversations and hearings that we’ve had back in Washington—the committee is unanimous on this—is, we want change 

and we want the VA to be veteran-centric, service-focused. And the 

veterans are at—are at the core here. 

And I think the only way that we will become a veteran-centric, 

veteran-centered organization is if we are constantly talking to the 

folks that we serve and knowing what their needs are and—and 

having a nimble enough organization to be able to bend and flex 

to meet our veterans’ local needs. So I appreciate your comments 

on that. 

And I see that I’m running out of time, so I will yield back. 

Mr. BENISHEK. When are the town halls going to be? 

Mr. BOCKELMAN. We will get you the exact schedule. Each facility is having one of those. 

Ms. Kearns, do you have yours scheduled? 

Ms. KEARNS. Ours is September 18th at the Saginaw VA. 

Mr. BENISHEK. So on September 18th you are having a town hall 

at the Saginaw VA. What time is that? 

Ms. KEARNS. It’s at 5:00 p.m. 

Mr. BENISHEK. 5:00 p.m. 

Mr. BOCKELMAN. Mr. Rice. 

Mr. RICE. Ours is September 24th and 25th. 

Mr. BENISHEK. How about here at the CBOC? 

Ms. KEARNS. That is something we are going to be planning in 

the future. We need to find a spot that is kind of central to—— 

Mr. BENISHEK. Is every CBOC going to have a town hall? 

Ms. KEARNS. We hadn’t planned on doing it at present. We were 

trying to have an area in between, so we could have two or three 

of the CBOCs come to the one spot. But we could end up having 

them at the CBOC. 

Mr. BENISHEK. That’s what we’re talking about, the difficulty 

with driving. 

Ms. KEARNS. The transportation, yes. 

Mr. BENISHEK. Can we use the CBOC as well? 

Ms. KEARNS. Yes, if we could get space like—something like this, 

we could certainly have a town hall in here. 

Mr. BENISHEK. I’m sure the communities would just be more 

than happy to be able to have a town hall meeting. There’s a lot 

of people with questions about—and it would be really helpful, I 

think. Just think what you learned here today—— 


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Mr. BOCKELMAN. Sure. 

Mr. BENISHEK. Mr. Bockelman, just from the testimony we’ve 

had my view of the leadership is you’ve got to be out there, hearing 

for yourself what’s actually going on, because sometimes the leadership gets a different view from the people that work for them 

than when they actually go out and hear what people have to say. 

So I would encourage you and Ms. Kearns also to be participating in this town hall so that you really learn from the front and 

not just lead the division from the rear. But lead the division from 

the front and see what people on the ground are actually seeing. 

So thank you for that. 

How are we going to change the culture in your VISN, Mr. 

Bockelman? I mean, frankly, Ms. Brownley and I have heard testimony—and frankly, had the Secretary tell me that we’ve increased 

the waiting list by 40 percent. And then we find out that those 

numbers have all been fudged. So we members of the committee, 

we’ve sort of become very jaded when the VA tells us, ‘‘We’re doing 

great. We’re really improving.’’ So, I think communication on your 

part, being out there and being at the front of things, is very, very 

important. Because, frankly, we’ve stopped believing most of the 

things VA says. Because their actions, haven’t—you’ve fouled up 

from what you’re saying. So I would encourage you to really focus 

on getting out there and doing outreach and that. 

I have a couple questions for Mr. Rice. What can we do, Mr. Rice, 

because you and I have talked in the past about the difficulties in 

getting providers. And, we’ve worked at the committee level—the 

Inspector General has told the VA eight different times over the 

last 30 years they need a central plan for hiring providers. 

And one of the biggest problems we have in Northern Michigan 

is having each individual VA find enough providers to provide care, 

continuity of care, so you’re not seeing a different doctor every 

time, as doctors don’t stay long. 

You and I have talked about the various challenges you’ve had. 

How can this system be changed, other than with central planning 

and more evident recruitment, to make sure that you have the providers you need to provide care? 

Mr. RICE. That’s a great question. I think one of the things we’ve 

been working on lately is really trying to recruit providers that 

want to live in Northern Michigan. We hired recently 4 new primary care providers that had a background, they grew up in the 

UP and then left. 

One of the things we’ve also started for other providers is a college program where we hired 15 kids while they’re going to school, 

and the hope is that when they graduate and they want to come 

back and raise their families they’ll think about us. But it gives 

them the exposure to the VA, so they are familiar with the VA culture. 

Personally, we had a vacancy in Sault Ste. Marie for about a 

year and a half, so I personally outreached to every provider in the 

Soo area and sent them a personal letter asking them if they would 

consider coming to work for the VA. So it’s a challenge, and we 

struggle with that every day in Iron Mountain, recruiting. 


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Mr. BENISHEK. You would agree it would be better if the VA had 

a central plan to hire physicians nation-wide to get a pipeline of 

people in the system? 

Mr. RICE. Yes. 

Mr. BENISHEK. Mr. Bockelman, do you have any more thoughts 

on that? 

Mr. BOCKELMAN. A lot of thought has gone into recruitment and 

retention. Once they get them—— 

Mr. BENISHEK. See, the problem is, it’s all happening at each individual medical center. 

Mr. BOCKELMAN. And I think there’s some value to having some 

local medical center responsibilities for that. The efforts that Mr. 

Rice has got are going to be a whole lot different than an urban 

setting, so it’s nice to have that opportunity to fine tune the recruitment. 

One of the things that came out in the law that was just passed was the ability for us to pay up to $120,000, I think for the 

amount, for education debt reduction. That will make us much 

more competitive. 

One of the things that Mrs. Kearns has brought in since her arrival a year ago is to actually use some of the recruitment incentive 

funding that has been available, some tools that just have not been 

used. 

VISN 11 is having in November a recruitment and retention 

training session. I want to make sure our providers, the leaders 

that have areas where there are critical shortages, know all the 

tricks of the trade and all the tools that are available to do them. 

We’ve got to make sure that we get as many available. We recognize not everybody is a good candidate for the VA, but we’ve got 

to get folks in the door. We do find once they come to the VA, get 

a feel for the mission, they do stay. So the recruitment, getting 

them there, is significant. 

Mr. BENISHEK. I’m over time. I’ll yield to Ms. Brownley. 

Ms. BROWNLEY. Thank you. I wanted to know—you had mentioned in your testimony identifying access gaps, I think is how you 

termed it. So what are they? 

Mr. BOCKELMAN. I think we’ve talked about the distance. I think 

if we look at gaps being the limitation to healthcare, is going to be 

the distance. The winter weather is a serious gap. Can’t do much 

about that. 

We have worked hard on the telehealth domain to get that. 

We’ve now got the capability to start to go into veterans’ homes to 

do it directly. We’re working hard to find providers that are willing 

to do that. This is new for them, too. That’s important. 

And some veterans aren’t too excited about having a screen in 

front of them. We recognize that for some it will work and some 

it won’t. But we’re expanding those products wherever we can. 

And a good example is in Beaver Island, which is an island off 

the coast here that I think we have 90 permanent residents. And 

I will share with you a picture of that island in the middle of the 

winter, and you’ll understand how difficult it is to access. 

We now have an arrangement with the local, state and rural 

health facility there to provide primary care for those veterans 

there so they don’t have to travel. They would have to fly to get 


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to the mainland, and then travel through normal ground methods 

to get there. 

We are also providing telehealth equipment that we’ll be able to 

use to work with the veterans; specifically, for mental health services that that clinic is not able to provide. As we know, much of 

healthcare is done in primary care, and so if we can avoid them 

having to come off the island except only for specialty care, which 

everybody on the island does have to come off to do, that’s the kind 

of efforts we’re making. So we’re looking for those kind of points. 

Ms. BROWNLEY. Thank you. So, before this—before we passed 

this law that’s in place now that hopefully is going to help in terms 

of access, before the law was passed, VISNs and the VA had the 

opportunity to use community partners or private practitioners 

when they couldn’t meet wait times and so forth. So in terms— 

were you utilizing that? Were you utilizing—sending your veterans, 

at least in this area, to—to community partners and utilizing that 

before the law was passed? 

Mr. BOCKELMAN. Yes. I will pass to Ms. Kearns to discuss the 

budget. But this is a significant portion of our budget. And just to 

give you a flavor of what it—the impact it has on Saginaw. 

Ms. BROWNLEY. Is using private practice for—is it a significant 

part of your budget? 

Ms. KEARNS. For the—this year—well, of our overall budget, for all nine clinics and the hospital this year we’ve spent almost $20 

million on non-VA care. In this particular—— 

Ms. BROWNLEY. What percentage is that? 

Ms. KEARNS. It’s about 17 percent of our budget. 

Ms. BROWNLEY. Okay. 

Ms. KEARNS. Is being sent out. In this particular district, this year we’ve spent over $3 million. We’ve sent out over 2,200 veterans to care in the community. 

Ms. BROWNLEY. And do you know their satisfaction levels? 

Ms. KEARNS. We—they are happy when we can send them out 

closer to home. That’s the answer. 

Ms. BROWNLEY. Do you survey the veterans that you’re sending 

out so you get a sense of the kind of care they’re getting and their 

level of satisfaction? 

Ms. KEARNS. We have not surveyed them. That’s probably something that can be done. Oftentimes getting the records back and 

finding those things out—but, yes, we could do that. 

Ms. BROWNLEY. And for the local CBOC here that I had the opportunity and pleasure to visit, what’s your average wait time for 

primary care and specialty care at this moment in time? 

Ms. KEARNS. Our average wait time for primary care is about 12 

days. Specialty care, depends on what the specialty care is, it can 

be up to 30 days. 

Ms. BROWNLEY. But it’s not—you don’t have—you’re not beyond 

30 days? 

Ms. KEARNS. No, we are not beyond 30 days in most of our areas. 

There are a few little pockets that could be—like neurosurgery is 

a difficult one to get anywhere. But in general about 30 days. 

Ms. BROWNLEY. I was very impressed with the fact that the— 

speaking to your RNs this morning, before they got into their cars 

to travel today, to have in-home care. And so that was very impresVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

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sive, and it sounds like you’re going to look further into—to the degree of, how much more of in-home care we can do. 

And I really think in the long term, with telehealth and sort of 

in-home care, too, that the combination, if we can bring telehealth 

into the home, in essence, is probably a good—a good, longer-term 

solution as well. So I’ll yield back my time. 

Mr. BENISHEK. I just want to touch on one of the things that was 

brought up in the previous panel again. Mr. Lerchen said that no 

one of us would find it acceptable to be required to drive 5 hours 

to receive a needed medical service, nor would we find it acceptable 

for our aging parent to be required to make such a trip. And Mr. 

Chambers also mentioned his son, not elderly, but driving apparently for a preop visit for an endoscopy to Saginaw. 

This is a pretty huge issue. I’m surprised that there’s not more 

local care being done or why, like, somebody has to travel preop to 

Saginaw for an endoscopy. I did endoscopy at the VA. They didn’t 

do that. I am not exactly sure what he’s getting done. 

But this—this 5-hour trip—or 3-and-a-half or whatever it is to 

Saginaw, that’s a pretty big deal for up here. And it’s a common 

theme that you hear. Why aren’t we doing more of this care here 

now? I know that the bill that we did is supposed to make it easier, 

but it’s already been within the realm of VA to make it happen. 

And don’t you think there should be more local care being given 

here so people don’t have to make that drive to Saginaw? What are 

we doing? Are you doing anything specific now to make that happen easier? 

Ms. KEARNS. One of the things that I’ve done since I’ve gotten 

there is ease up who can go out and have care if they’re eligible 

to go out and have care. We’ve spent almost $4 million more than 

last year already on non-VA care because we’re finding pockets of 

people that we can send out. 

For example, a good example I had was, it was brought to my 

attention an 88-year-old veteran who they wanted to travel to Ann 

Arbor. And when it was brought to my attention, I said, ‘‘No, he 

will go local,’’ and we paid for him to go local. So those are the kind 

of things that, I agree, we need to try to do those things like that. 

Mr. BENISHEK. So what is happening to make it be better? Because these are questions I’ve asked for three years—and, I see 

that—you say $4 million more this year than last year. And is it 

going up that fast, then, every year, then? Is it going to continue 

to improve? 

Ms. KEARNS. I would guess with the new law that’s been put into 

place, yes, it will continue to. 

Mr. BENISHEK. What about the PC–3 thing? This is something 

I’ve spoken to people in DC, about where they are to provide more 

of a tri-care like network for veterans. Where are you with that? 

Mr. Bockelman, do you have any idea where that is at? Because 

my experience is that—I was concerned, number one, what they 

were going to pay providers. And, number two is what—how many 

providers are actually signing up and when will that network be 

complete? 

Mr. BOCKELMAN. This has been a challenge in VISN 11, especially in Michigan where there is not an existing network by this 

company. They are working hard, they are scrambling to get proVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

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viders signed up. We have had some early communication—I would 

call them start-up problems with recognition of territories. Is this 

town closer than this town? And they might be sending veterans 

to the farther-away town than a closer one. 

Mr. BENISHEK. It’s not very good, it sounds like. 

Mr. BOCKELMAN. We are still struggling to get this program up 

and running. 

Mr. BENISHEK. I’m concerned about this piece of legislation that 

we passed is supposed to be able to give an access card to veterans 

from this area basically. I mean, people that live more than 40 

miles from a VA facility that provide their care. 

I mean, how are we going to—I know you probably don’t have 

the answer for that because you’re the VISN director and not the 

big wheel in Washington. But, we’re hoping for something to happen fast. So we’re not waiting two years to implement something 

that is supposed to happen right away for the people who are suffering. Do you have any comment on that? 

Mr. BOCKELMAN. I know they are working vigorously to get a full 

understanding of the law to make sure we’re able to carry it out 

as intended. We look forward to the opportunity to expedite the 

care. Especially with the choice card. 

We are concerned about the continuity of care like we discussed. 

That’s always going to be a concern, knowing in the back of our 

heads as healthcare providers that we don’t want to lose that, because that is so critical. 

There will be new rules that we will have to learn on how we’re 

going to handle that. We will have the horsepower ready to go as 

it comes to implementation so that we could do this. There will— 

I’m recognizing that any new program like this will have some 

start-up time. We will do whatever we can to expedite that and not 

be in a position to wait for action. 

Mr. BENISHEK. But do you agree that 5 hours is excessive? 

Mr. BOCKELMAN. That’s a long time. A long time, yes. 

Mr. BENISHEK. A long time to be traveling. 

Mr. BOCKELMAN. I do. 

Mr. BENISHEK. Thank you. I will yield to Ms. Brownley. 

Ms. BROWNLEY. Thank you, Mr. Chair. Mr. Bockelman, I wanted 

to ask, so how much funding did your VISN receive from the Access to Care Initiative? Do you know the number? 

Mr. BOCKELMAN. We have about $11 million earmarked for that. 

2 million of that came from the Washington component. We 

drained our reserves to put up the additional 8.8 million approximately. 

We’re on target to get all this spent in the next 5 weeks. We’ve 

been working hard to monitor our progress, to make sure that we 

got that done. If there comes a time, if we were so lucky as to have 

funds that weren’t spent, we would sure be ready to share those 

with other parts of the country that have a need that we don’t. But 

to this point—— 

Ms. BROWNLEY. So what was your criteria for disbursement? 

Mr. BOCKELMAN. We went to the facilities and asked them what 

are their needs. Where do you find delays? Where are you having 

problems meeting that within house? Come up with a budget and 


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let’s look at it. And we’ve been adjusting it a little bit more here, 

a little less there as we do find that. 

Ms. BROWNLEY. So what were the needs here? 

Mr. BOCKELMAN. Across our network, we had a lot of optometry. 

Ms. KEARNS. Audiology 

Mr. BOCKELMAN. Audiology was another area. 

Ms. BROWNLEY. So how was money going to solve those issues? 

We talked a little bit about that earlier today, but—— 

Mr. BOCKELMAN. A couple things. That will help with the backlog 

to get those done. 

Ms. BROWNLEY. Yes. 

Mr. BOCKELMAN. I think one of the things—a good example 

might be optometry, which is—plain optometry is a rather low risk/ 

high volume. That is something that we should be looking at our 

contract for, because that can be done locally. 

We’ve been doing some work with teleaudiology, which will now 

enable us to do work at the CBOCs; not just helping veterans adjust hearing aids, but actually able to plug into the computer system that will allow the audiologist back at the main facility. We 

are rolling that out over the next year. 

Ms. BROWNLEY. Very good. And then also I think in your testi- mony you said that the—your VISN had received $8 million from 

the Veterans Health Administrative Office—— 

Mr. BOCKELMAN. Yes. 

Ms. BROWNLEY [continuing]. Of Rural Health to support 25 

projects and programs to increase access to care for rural veterans. 

So, can you tell us what the process is to receive that funding? And 

do you—do you have to provide measurable outcomes at the end of 

the project? 

Mr. BOCKELMAN. Yes, we do. A couple things. One—the nice part 

about this program is the rural health office keeps a running list 

of all the successful programs, so we can look to see if there’s something that we just hadn’t thought of that we can go pick right off 

the list. 

At the same time we do ask the facilities, go and look and see 

what might work at your facility. What’s the deficit there. Maybe 

we’ve got something unique. We’ve got a lot of rural health transportation dollars coming to Saginaw because of the transportation. 

So it can come either way. We could look for projects that have 

been successful or the ground up. 

We then have a coordinator, Mr. DeLoof, who does a wonderful 

job getting these packages put together at the network level, bundled up, making sure that they’re sound, making sure that we do 

have metrics or understanding of what would be a recognition of 

success. And then they do go forward to Washington where we 

hope they compete well because there’s a lot of folks. 

Ms. BROWNLEY. Can you give me some examples of some of the 

measurable outcomes that you’ve set in place? 

Mr. BOCKELMAN. A good one that we’ve done lately, in the last 

couple years, is our prosthetics vans. Recognizing that a veteran 

might go a long way just to get a brace adjustment or an orthotic 

shoe adjustment, we now have mobile vans that go out to the 

CBOCs routinely, on schedule, that allows the veterans to get that 

work done at the CBOCs. 


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We have monitored that. We can now show you conclusively: 

Here is the cost. Here’s the gaps. Here’s the maintenance for the 

vehicle versus what we would pay for beneficiated travel to come 

to the medical center. 

Not even counting or trying to put a dollar value to the veteran 

for not losing a whole day of work. That has saved us money. 

And I think it also probably enables the veterans to be more 

comfortable in their orthosis. If it fits well, and therefore they will 

wear it more often and have better clinical successes. 

Ms. BROWNLEY. Thank you. I yield back. 

Mr. BENISHEK. While preparing—I’m going to yield myself five 

more minutes for questioning. While preparing for the hearing 

today, my office received a call from a Northern Michigan VA employee who, due to fear of retribution did not want to be identified, 

but did want to alert me to his concern regarding the alleged use 

of no call/no show lists at the Saginaw VA Medical Center. 

According to this person, some veterans are scheduled for VA appointments without being made aware of the appointment time or 

the date. When that veteran then misses the appointment, which 

he or she was never advised of, the veteran is then placed on a no 

call/no show list, and VA’s access number looks better than they 

really are. 

Needless to say this is an allegation from someone. But we are 

going to be investigating it further. 

Is there a no call list for people who have a history of not showing up at their appointments and then they get put on a list of— 

a no show list? 

Ms. KEARNS. Well, when somebody no shows for an appointment, 

it comes up in the computer when they don’t show up. It shows 

that they’re—that they didn’t show up for the appointment. So you 

would be able to track that by no shows, and we do keep track of 

how many no shows we do, so that we have access for other veterans. 

So when somebody doesn’t show up, then we can put somebody 

in that slot to see. If they—if we have somebody available at that 

point in time. But as far as a list that—I am not aware of any list 

that we put people’s names on other than we can show who no 

showed for the day. That’s part of the computer system that all 

VAs have. 

Mr. BENISHEK. Right, right, right. Is there a—consistent way of 

reminding people of their appointments? 

Ms. KEARNS. Definitely. We make phone calls. We have letters. 

We have cards. In fact, the comment we get most often is, ‘‘Quit 

calling us, quit telling us I have an appointment.’’ It’s a very good 

system with multiple reminders to people. 

I had somebody tell me just recently that they got three reminders about an appointment in the same week. So we do have a system for that, plus a calling system that goes out. So. 

Mr. BENISHEK. Right. That’s been a complaint elsewhere in the 

country. Of veterans, not being told when their appointment is, and 

then the appointment is made for them, but nobody actually spoke 

to the veteran prior to making the appointment. So that they may 

have been off to a funeral or—you know what I mean, something 

like that. So you’re saying that that does not occur, then. 


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Ms. KEARNS. No, no, what I’m saying is we—when somebody has 

an appointment, we remind them of the appointment. I was talking 

about reminders. 

Mr. BENISHEK. When people’s appointment is scheduled, are they 

usually spoken to, then, when you schedule the appointment? 

Ms. KEARNS. Generally, yes. I mean, I would have to have an example of what you’re speaking of. 

Mr. BENISHEK. We’ve heard at other testimony that VA would 

make somebody an appointment without speaking to them, so that 

they may have had other plans than the appointment. They didn’t 

speak to the veteran when they made the appointment. They just 

made the appointment and told the veteran when the appointment 

was later, and the veteran may not have been available at that 

time. You know what I mean? So you’re saying that doesn’t happen 

that way? 

Ms. KEARNS. That can happen when a consult is done, and we 

send out the consult to another facility. They may make the appointment then. 

Mr. BENISHEK. They speak to the veteran, then, when they make 

the appointment? 

Ms. KEARNS. I would hope that they speak to the veteran. 

Mr. BENISHEK. You don’t know that for sure? 

Ms. KEARNS. I don’t know that for sure when we send out the 

consult, to another facility. 

Mr. BENISHEK. Is that the standard method, then, of actually 

speaking to the patient when they make an appointment? 

Ms. KEARNS. Well, that’s what we endeavor to do every day, if 

we can actually speak with them. I—— 

Mr. BENISHEK. What I’m trying to get to is the point is that 

when a veteran is scheduled for an appointment, do they speak to 

the veteran as they schedule the appointment—— 

Ms. KEARNS. Yes. 

Mr. BENISHEK [continuing]. Or prior to scheduling the appointment, so they know the patient is going to be available that day? 

Not just: Well, the appointment is going to be on three weeks from 

Tuesday. Send the letter to the veteran that the appointment is 

three weeks from Tuesday. Do you understand? 

Ms. KEARNS. Generally a follow-up appointment is made, it’s 

made right with the veteran when they’re standing in front of us. 

Mr. BENISHEK. Right. That’s what I want to make sure happens. 

Mr. BOCKELMAN. One thing that happened after the access issue 

became so apparent, I went out and met with the scheduling people 

at the medical centers. And I know Ms. Kearns and Mr. Rice have 

done the same thing. To make sure we understood what issues 

they were facing that we might not know about, we don’t know 

about. 

One of the questions is how come these are not filtering up? And 

I think that’s the cultural question that we really need to address. 

But one of their toughest parts of their job is getting ahold of veterans for appointments. They might call. No answer. They call a 

number that’s listed, it’s not current. All those kinds of things. 

They are very reluctant, very reluctant to settle for sending a letter to a patient saying we’ve been trying to get ahold of you, can’t 


VACREP180 with DISTILLER
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get ahold of you, now we’re going to go ahead and schedule and get 

this ball rolling, we hope you can make it. 

The clerks know that is not ideal. They do not want to do it. 

They are really anxious to try to capture that appointment information before the veteran leaves in front of them if at all possible. 

Mr. BENISHEK. Thank you. 

Ms. Brownley. 

Ms. BROWNLEY. I just wanted to follow up on the no shows. So 

it sounds to me like you have a methodology, though, that if you 

do have a no show, you can fill that slot. 

Because we’ve heard some testimony in Washington that some 

folks no show, no appointment, the appointment just stands open 

and is never filled. So, in some places a doctor may see—in a clinic 

or a CBOC might see two patients. Ten were scheduled, but, because of no shows and other kinds of things, only two were seen. 

But—so there were suggestions about different systems, I guess 

that private practices utilize. And one of them being just a series 

of open appointments every single day so that if you do have no 

shows and so forth, you can fill them. And that’s what you’re 

doing? 

Ms. KEARNS. We have open slots that people can walk in. 

Ms. BROWNLEY. So what’s your average amount of—what’s your 

average—how many patients does a doctor see in a given day? 

Ms. KEARNS. Generally at the clinic here in Traverse City they 

see about 10 patients a day. 

Ms. BROWNLEY. Thank you. 

Mr. BENISHEK. I’ve got a couple more questions. In a statement 

for the record, the Sault Ste. Marie Tribe of the Chippewa Indians 

stated that they are seeking an agreement with VA to allow members who are veterans as well as non-Native veterans to receive 

care at one of the tribal clinics in the 7-county service area that 

they have. And to receive reimbursement payments from the VA to 

provide care for those veterans. Without the burden of travel and 

financial stress created by the long distance between reservations 

and VA clinics. Would you be supportive of such an arrangement? 

Mr. RICE. Actually, my facility has been working with them. We 

do have—we’ve already set up one clinic, optometry, because we 

needed access over in the Manistique area. So the clinic—the tribal 

clinic in Manistique is now seeing our optometry patients. It’s a 

veteran’s choice that’s put out on fee. 

But we have been working with them for a while to try to get 

the issue—the issue is treating non-Native Americans at their clinic. So we’ve been working at that for about 12 months to get that 

resolved. 

Mr. BENISHEK. So are you still working on individual contracts 

with clinics rather than the PC–3 thing? Because that obviously is 

a problem, it sounds like. 

From what you said, that that’s not going as well as it could. So 

you’re still contracting on an individual basis to get care for veterans at local clinics like this? 

Mr. RICE. Yes. 

Mr. BENISHEK. Can you keep me informed as to how that continues to go. 

Mr. RICE. Yes. 


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Mr. BENISHEK. I want to keep up to speed on that. 

Do you have any further questions? 

Ms. BROWNLEY. No further questions. 

Mr. BENISHEK. Well, I know that we haven’t covered all the aspects of VA’s problems that we’ve heard in Washington. I know 

that in your positions, from where you’re at, you can’t solve the 

problems of how the whole management of the system works. 

For the audience we passed a pretty major veteran reform bill 

this past time that, frankly, it’s going to come down to implementation. And is VA going to be able to implement the changes that 

we’ve made in the law to allow veterans better and easier access 

to care locally. That’s pretty much the gist of the bill. 

And the bill also demands reform of VA with outside third party 

evaluation of the entire management scheme of VA. So, this crisis 

that’s come up has led to a new secretary. It’s led to the changes 

that we made for access for care. And it’s made for an evaluations 

of the system and an ability for management to demand more accountability out of its people. 

So hearings like this help develop a communication between our 

committee and my office to VA staff. I hope that you all learned 

something from the conversation that we had with the first panel, 

and that we’ll be reaching out to members of the first panel to continue to work with them in a constructive fashion rather than adversarial fashion to improve care for our local veterans. 

So I appreciate you all being here today, and I know I’m going 

to continue to work on it, as will Ms. Brownley. 

If you have any closing comments, Ms. Brownley. 

Ms. BROWNLEY. Well, I would just say, thank you to everybody 

who has participated. And I know I don’t represent your area, but 

your concerns here have been expressed is of great interest to me 

and not only Dr. Benishek, but it’s important to the committee. 

And I know I can say with great certainty that our—the VA committee back in Washington had many, many meetings around this 

crisis. And I think it was pretty clear that we identified what the 

problems were. And this bill is a beginning step. But we know the 

most important work for us to do at this particular point in time 

now is to make sure that we provide—the committee provides the 

oversight and making sure that the execution is taking place and 

making sure that the accountability and so forth that we all want 

and believe we need is in place, so that we are improving—and as 

I said earlier, continuously improving—our services to our veterans, not only here but across the country. 

And so this is just, in my mind, a—a beginning, and we’ve got 

a long way to go. And I think—and I am not talking about VISN 

11 specifically here. I am talking about the VA in general. there’s 

got to be a major, major sort of cultural shift that has to take place. 

And cultural change is hard. And it’s hard work. And I think it’s 

our responsibility to make sure that we move forward with those 

changes. 

And at the end of the day, we want to provide high quality, 

timely healthcare to our veterans in every single corner of our 

country. And that’s our goal and that’s our mission. And what you 

have provided for us here is helpful to us. And we take that inforVerDate Aug 31 2005 14:35 Nov 03, 2015 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6633 Y:\96-128.TXT PAT

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mation back, and it will be helpful in terms of our next steps. So 

thank you. 

And I—you live in a wonderful, beautiful place. And I’ve enjoyed 

my stay here very much. Thank you, Chairman. 

Mr. BENISHEK. Once again, I want to thank all the witnesses and 

the audience members for participating in today’s conversation. It’s 

been a pleasure for me to be here and spend the morning with you. 

With that, I ask unanimous consent that all members have five 

legislative days to revise and extend their remarks, and include extraneous materials without objection. 

Mr. BENISHEK. So ordered. The hearing is now adjourned. 

[Whereupon, at 11:07 a.m., the subcommittee was adjourned.] 

APPENDIX 

PREPARED STATEMENT OF CURTIS P. CHAMBERS

My name is Curtis P. Chambers, I am honored to appear before you today, and 

I am equally honored to be seated with these great Tribal Leaders. I am an Ottawa 

Indian and Navy Veteran, my father was a Navy Veteran, and two of my sons are 

Navy Veterans. We were all honored to serve this great nation as members of the 

greatest Navy this world has ever seen. I would like to speak with you today about 

the need for transportation services, telehealth, and non-VA care. 

I have had the unfortunate opportunity to deal with our present system and regaling you with the failings would take more time than we have allotted today. Such 

as an eighteen month waiting period for an existing problem one of my sons had, 

or travel records being lost not once, not twice, but three and four times . . . and 

much more. I would however prefer to focus on the positive and possible fixes to 

the problems facing us today. 

1. Non-VA healthcare, why can’t we just use our present Doctors and healthcare 

providers and then send the bill to the VA. 

2. Some of our health concerns and questions could probably be answered via 

skype and some other such device which could be done at various VA Clinics 

3. The above ideas will both decrease travel expenses. 

I/my experience, the actual care our veterans receive is outstanding however, the 

paper work and bureaucracy are mind numbing. 

Mister Chairman, I am just a stump jumping half breed from Northern Michigan 

and I realize that the devil is in the details but I’m sure that by working together 

we can supply the Veterans of the greatest Military on earth the greatest healthcare 

on earth. 

I would like to thank Congressman Benishek and everyone involved in the efforts 

to improve our present VA care system. 

Respectfully, 

Curtis P. Chambers 

f 

PREPARED STATEMENT OF CARL ARCHAMBEAU

August 25, 2014 

Dan Benishek 

U.S. House of Representatives 

Committee on Veterans Affairs 

Subcommittee on Health 

Washington DC 20515 

Re: Testimony before Subcommittee on Health 

First of all, I would like to say that the Veterans Affairs (VA) clinic in our area 

is doing an exceptional job for the veterans considering the space, equipment and 

personnel they have to work with. Also, we have a Disabled American Veterans 

(DAV) transportation system in place to get some of our veterans to Saginaw, Ann 

Arbor, or Detroit for their hospital appointments. 

Having said that, the distances we have to travel to get to a VA hospital for an 

appointment are a problem. It is an all day event to travel to and from the hospitals 

plus the waiting time at the hospital making it a hardship on our elderly veterans. 

Traverse City is more than 40 miles from any VA hospital and veterans should be 


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allowed to use local doctors and hospitals for any medical needs that the local VA 

clinic cannot provide. 

The VA hospital in Saginaw is in an old building and needs renovation. A new 

hospital in the Gaylord area would better serve veterans in Northern Michigan and 

the Upper Peninsula. 

Commander, VFW Post 2780 

f 

PREPARED STATEMENT OF LINDA L. FLETCHER LTC/ANC (RET) 

I thank you, Congressman Benishek, for the opportunity to address this group 

today. I hope to provide an interesting perspective on the topics at hand. 

The recent events surrounding the VA have been very disturbing to say the least. 

But . . . it was Winston Churchill who said ‘‘Never fail to take advantage of a crisis’’ . . . and that is what we have in the VA system today. Now is the time for 

problem identification, for opening to the consideration of conventional and unconventional ideas and formulation of bold steps to institute carefully conjured solutions. 

Abraham Lincoln eloquently captured the mission of this organization that he created in 1865 with these words . . . ‘‘to care for him who shall have borne the battle 

and for his widow and his orphan’’. The structure and configuration of what we currently know as The Department of Veterans Affairs has changed through the centuries and our many wars but the promise and the intent have not wavered and 

the mission statement has remained the same. 

This nation has lately been generous with funding for our veterans. The FY 2014 budget is $152.7 billion. Approximately 40% of that budget ($61.1 billion) is directly 

related to provision of health care. And, due to the recent findings regarding administrative issues, an additional $17 billion is being added. There can be little doubt 

that America wants to take care of our veterans and we are willing to pay whatever 

it takes to do so. Unfortunately, sometimes pumping in money to patch a sag in the 

ceiling isn’t the answer. Sometimes we have to start by fixing deeper foundational 

problems. I am in hopes that reformation of the VA system will begin with a review 

of the original mission statement so we can proceed to evaluate our existing organization in accordance with that guiding light. 

According to www.va.gov the VA is currently the largest health care system in 

the nation. In 2012 the VA provided health care for approximately 5.9 million Americans. . . . 2% of our entire population. Interestingly, of that group some 1.6 million 

(26%) qualified for care which the VA categorizes as not associated with war related 

illness or injury. 

In view of these numbers perhaps the answer to the situation facing us is not 

what seems to be the foregone conclusion that we need to supersize the VA. Perhaps 

we need to consider streamlining the system in accordance with the mission statement by targeting caring only for war related illness or injury. A restructuring that 

focuses specifically on that population would decrease the workload by 26% and provide a more focused approach to care for the remaining group. The care required 

by that smaller group could be provided in the local civilian sector by having the 

VA assume all costs associated with insurance provided by the Health Care Act. 

This mechanism might also be considered as an option for our many veterans located in rural areas where accessibility to VA facilities is geographically challenging. Perhaps we should consider allowing these veterans the option to receive 

equivalent local care funded by the VA through the HCA. 

From an administrative perspective I would also like to recommend that the VA 

revise their practice of hiring from within. The intellectual and cultural inbreeding 

that results from selection from the same pool chokes the breath of new ideas, perspectives and leadership that comes of selecting from a diverse assortment of potential employees. 

Lastly, care to veterans is restricted by more than just geography. There are some 

exciting concepts emerging and/or re-emerging regarding different psychotherapeutic techniques which target resolution of cause not just the current objective of mitigation of symptoms. Additionally, there is a wide variety of treatment 

methodologies, from acupuncture to Zen meditation, available in the alternative 

medicine communities that target stress reduction, a major component of PTSD 

care. In view of our less than successful results in managing PTSD to date we need 

to explore, not restrict new possibilities in theory and treatment. 

I am well aware that this is a superficial and limited overview of a very complex 

situation. I hope that some of these thoughts will be helpful as this nation struggles 


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to provide better care for those who gave so much for us. And let it be remembered 

that the VA may be stumbling but with our help it can resume it’s revered and important position in our nation. They have a long and honorable history and they can 

regain their glory with our support which includes constructive, not destructive, 

criticism. We are in crisis and it presents the chance to take great strides in an abbreviated length of time. Let’s take Winston Churchill’s advice and not fail to take 

advantage of this opportunity to advance our systems for the good of our veterans. 

Thank you and God Bless America 

f 

PREPARED STATEMENT OF CHARLES R. LERCHEN, 

Good Morning, Mr. Chairman. I would like to thank you for bringing the Field 

Committee together to gather information concerning the challenges confronted by 

veterans in rural areas in accessing and obtaining their health care needs. Speaking 

from the perspective of a local official who interacts daily with veterans, I believe 

I will be able to provide you with some valuable insight as to the real world challenges rural veterans encounter after enrolling and choosing to have the VA provide 

them with their healthcare services. 

As we all know, the VA is an agency in crisis. Both the Veterans Benefits Administration and the Veterans Health Administration struggle daily to accomplish their 

missions to our nation’s veterans. Their Congressional mandates routinely go 

unheeded. Billions of dollars continue to be thrown at the problems with little or 

no quantifiable results; and the biggest problem is the lack of accountability. The 

largest obstacle confronting the VA right now is the culture of the VA itself. Health 

care provision to the significant number of rural veterans is just another victim of 

this corrosive and obstinate culture. 

So while the VA and Congress continue to grapple with the core problems within 

the agency; the veteran continues to grapple with the affect it has on him or her. 

It is unreasonable to think the VA can provide every veteran in the country easy 

access to every kind of health care they need in their own back yard. Since it was 

introduced over 20 years ago, the clinic model for rural areas has been a tremendous success. The need for rural veterans to have to travel great distances for primary care has been markedly reduced. However, the question now becomes is how 

do we provide the specialty services a veteran needs while still addressing the need 

for the unreasonable travel and appointment times necessary to receive it? The answer to this question may lie in the authorization for rural veterans to receive certain care at non-VA providers. 

The VA has long held tightly to the notion that they and they alone will be the 

provider of all tertiary care. ‘‘If your primary care provider at the clinic orders an 

MRI—we will do it even if it means a 10 hour drive in the middle of the winter, 

a six month wait to have it scheduled and OH . . . by the way we don’t care if your 

88 years old’’. This is the mind set of the VA and it needs to be changed. The metropolitan VA Medical Centers have all the business they can handle . . . this is clear. 

If the VA cannot provide the needed tertiary care to the rural veteran than contract 

it out to the community. The military does this routinely, why can’t the VA? The 

rural veteran clogs the wait lists for these services unnecessarily. Equity and good 

conscious must come into play. None of us would find it acceptable to be required 

to drive 5 hours one way to receive a needed medical service; nor would we find 

it acceptable if our ageing parent was required to make such trips. 

So, just as it is unreasonable to expect the VA to be able to provide all of these 

services to our rural veterans; it is likewise unreasonable to expect the veteran to 

endure the hardships currently required to receive their needed healthcare. The 

rural veteran has entrusted their health and well being to the VA system. We are 

supposed to treat their ailments, not create more in doing so. 

We are beginning to see some progress in addressing these lingering deficiencies. 

VA’s move to improve the method for identifying urban, rural and highly rural Veterans by adopting a method used by other leading Federal agencies is a major step 

in the right direction. It is also a step in the right direction in breaking down the 

core problem within the VA. The malignant culture of oppugnancy that has existed 

in the VA for far too long must now be replaced with a culture of altruism and service to our Nations veterans. 

This concludes my testimony. Thank you for the opportunity to address the committee today. 


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PREPARED STATEMENT OF PAUL BOCKELMAN

Good morning, Chairman Benishek, Ranking Member Brownley Thank you for 

the opportunity to discuss rural healthcare and healthcare specifically for American 

Indian Veterans within the Veterans Integrated Service Network (VISN) 11. I am 

accompanied today by Ms. Peggy Kearns, Director of the Aleda E. Lutz VA Medical 

Center (VAMC) and Mr. James Rice, Director of the Oscar G. Johnson VAMC. 

VISN 11 and Aleda E. Lutz VA Medical Center (VAMC) Overview 

The employees of VISN 11 proudly provide patient-centered care to the approximately 386,000 Veterans living in portions of Michigan, Ohio, Indiana, and Illinois. 

VISN 11 consists of 30 Community-Based Outpatient Clinics (CBOC) and 

healthcare system main campuses located in: Ann Arbor, Battle Creek, Detroit, and 

Saginaw in Michigan; Indianapolis and Ft. Wayne in Indiana; and Danville in Illinois. 

With a budget exceeding $2.1 billion, we are in a position to provide our Nation’s 

heroes with high quality care through traditional and innovative methods. VISN 11 

also has a collaborative relationship with the Vet Centers located in Macomb County, Dearborn, Detroit, Escanaba, Grand Rapids, Saginaw, and Traverse City. 

The Aleda E. Lutz VAMC, located in Saginaw, Michigan, is accredited by the 

Joint Commission and consists of the Medical Center with a Community Living 

Center (CLC) and Annex in Saginaw and CBOCs in Alpena, Bad Axe, Cadillac, Cheboygan County (Mackinaw City), Clare, Gaylord, Grayling, Oscoda, and Traverse 

City. These facilities provide care to Veterans in the 35 counties of Central and 

Northern Michigan’s Lower Peninsula. On April 21, 2014, the Aleda E. Lutz VAMC 

was awarded Planetree Bronze Recognition for Meaningful Progress in Patient-Centered Care. The Aleda E. Lutz VAMC is the first healthcare organization in Michigan to be awarded Bronze-level recognition since Planetree first introduced the recognition level in 2012. 

The Aleda E. Lutz VAMC provides primary and specialty medical services, ambulatory surgical services, mental health services, inpatient medical care, rehabilitation, dentistry, audiology, optometry, blind rehabilitation, pain management, geriatrics, and extended care. 

Expanded mental health programs include: Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) case outreach, Mental 

Health Intensive Case Management (MHICM), Posttraumatic Stress Disorder 

(PTSD) Clinical Care, Home-Based Primary Care (HBPC) psychology services, Compensated Work Therapy (CWT), recovery-based programs, suicide prevention, outpatient substance abuse programs, evidenced-based therapies, VA Caregiver Support, and Homeless Veterans Program, including Veterans Justice Outreach. 

Focus on Access 

No Veteran should have to wait for the care and services that they deserve. We 

remain committed to ensuring Veterans have access to the highest quality care that 

they have earned through their service to this country. Patients at the Aleda E. 

Lutz VAMC can consistently access primary care, specialty, and mental health services within thirty days. Access is monitored daily to assure availability. 

The Aleda E. Lutz VAMC has implemented the Accelerating Care Initiative along 

several different tracks. Approaches to assure timely access include: 

1. Increasing the use of Non-VA care; 

2. Use of Saturday clinics; 

3. Hiring a substitute provider (known as a locum tenens provider) for Primary 

Care, and; 

4. Ongoing recruitment of staff. 

There have been reductions in the number of patients waiting both on the Electronic Wait List (EWL) and the New Enrollee Appointment Request (NEAR) list. 

From May 15, 2014, to August 1, 2014, the Aleda E. Lutz VAMC EWL dropped from 

61 to 34. From June 1, 2014 to August 1, 2014 its NEAR list dropped from 110 to 

9. . 

As part of our commitment to transparency, VA is posting regular data updates 

showing progress on our efforts to accelerate access to quality healthcare for Veterans who have been waiting for appointments. These access data updates are posted at the middle and end of each month at the following link: http://www.va.gov/ 

health/access-audit.asp. 

VA Rural Health Care Program—State of Michigan 

There are approximately 660,800 Veterans in the state of Michigan, of which an 

estimated 31 percent or 207,200 live in rural areas. Approximately 227,400 Veterans 

in Michigan are enrolled in VA, and 43 percent or 97,300 enrolled Veterans live in 


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rural areas. An estimated 34 percent of all Veterans living in Michigan are enrolled 

in the VA healthcare system. 

In addition to funding allocated to VISN 11 through the Veterans Equitable Resource Allocation (VERA) system for Veterans’ healthcare, in Fiscal Year (FY) 2014, 

VISN 11 received $8 million from the Veterans Health Administration’s (VHA) Office of Rural Health to support 25 projects and programs to increase access to care 

for rural Veterans. The programs specific to Michigan include our Mobile Prosthetics Van, which brings prosthetic services typically found only at the main campus to the CBOCs; clinical training opportunities for providers in rural locations; 

telehealth; and HBPC which currently serves around 300 Veterans. Since the telehealth and HBPC services are co-located within the community Veterans Service Office, such as the American Legion building, in Ludington, MI, we are able to facilitate Veterans’ needs by working closely on Veterans Benefits Administration and 

claims issues and providing community-based services. This program is made available to Veterans in the Mason, Lake, Newaygo, Mecosta, and Oceana counties by 

the Battle Creek VAMC Northern Rural Expansion Team. 

We continue to look for opportunities to expand our care via telehealth technology. 

VHA is in the early stages of developing a collaborative effort with community providers to be able to exchange health information. We now have the capability to provide Clinical Video Telehealth (CVT) in the home, which will improve access to care 

for rural Veterans and mitigate the need for travel to a VHA site of care. We are 

also establishing additional Mental Health services via telehealth to Veterans at the 

Patriot House in Gaylord in 2014. 

The Battle Creek VAMC has taken the lead on several Veteran outreach projects 

in the rural areas of Michigan. To address low utilization rates, the Battle Creek 

VAMC signed a Memorandum of Understanding (MOU) with local Veteran Service 

Organizations, such as Veterans of Foreign War (VFW) and American Veterans 

(AMVETS), to allow VA to use their space to deliver care to rural Veterans. Additionally, the facility started delivering care in Veterans’ homes. The care provided 

included access to a nurse practitioner, psychologist, social worker, registered nurse, 

pharmacist, occupational therapist, registered dietitian and a telehealth clinical 

technician. The use of home telehealth, as well as utilization of tele-dermatology 

and tele-retinal services, has been incorporated into this team. 

These services enable rural Veterans to access VA care without long drives to one 

of the Battle Creek CBOCs. The psychologist has initiated some mental health 

groups in addition to utilizing clinical video telehealth to connect Veterans with 

other providers at the main medical center. To date, this motivated team of Federal 

employees has provided VA services and care to over 560 Veterans, with the numbers growing weekly. 

Rural Health Outreach Transportation Program 

The Aleda E. Lutz VAMC’s Rural Health Transportation Program is well developed, averaging nearly 1,200 patients per year, over 80 percent of whom reside in 

rural communities. Patient satisfaction has increased with this program. Many of 

the users of the transportation program may not otherwise get to appointments and 

are repeat customers. Veterans requiring transportation assistance have pick-up 

sites in Gaylord, Grayling, West Branch, and Standish. Transportation is provided 

to the Aleda E. Lutz VAMC, as well as the Ann Arbor and Detroit Medical Centers. 

Beaver Island Outreach Project 

The Aleda E. Lutz VAMC, the VISN 11 Rural Health Consultant, and the VISN 

11 Planner have worked with the Beaver Island Rural Health Clinic to bring VA 

healthcare services to Beaver Island Veterans using non-VA Care authorizations. 

This partnership enables eligible Veterans to receive primary care, laboratory, and 

general radiology services from the Beaver Island Rural Health Center instead of 

traveling to a VA facility. To be eligible for services, Veterans must be enrolled in 

the VA Health Care System and meet VA eligibility requirements. VA and the Beaver Island Rural Health Clinic held a VA Day on June 13, 2014, to provide information for Beaver Island Veterans on VA healthcare as well as listen for additional 

opportunities to meet their healthcare needs. As a result of the information collected, we will establish a VA telehealth clinic to provide these Veterans access to 

VA healthcare. This service will be established by October 1, 2014. 

Readjustment Counseling Service 

VA’s Vet Centers present a unique service environment—a personally engaging 

setting that goes beyond the medical model—in which Veterans, Servicemembers, 

and their families receive professional and confidential care in a convenient and safe 

community location. Vet Centers are community-based counseling centers, within 

Readjustment Counseling Service (RCS), that provide a wide range of social and 


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psychological services including professional readjustment counseling to eligible Veterans, Servicemembers, and their families; military sexual trauma counseling; and 

bereavement counseling for eligible family members who have experienced an Active-Duty Death. 

The Saginaw and Traverse City Vet Centers, like those throughout the country, 

also provide community outreach, education, and coordination of services with community agencies to link Veterans and Servicemembers with other VA and non-VA 

services. A core value of the Vet Center is to promote access to care by helping those 

who served and their families overcome barriers that may impede them from using 

those services. All Vet Centers have scheduled evening and/or weekend hours to 

help accommodate the schedules of those seeking services. 

VISN 11 Telehealth Clinic Expansion in FY 2013 

In FY 2013, VISN 11’s Telehealth program conducted 109,806 visits using telehealth modalities, reaching 12.4 percent of Veterans in VISN 11 who use the VA 

system. The Aleda E. Lutz VAMC led VISN 11 in telehealth performance targets. 

In the past 12 months, this VAMC has achieved a 20 percent increase in virtual 

visits and 28 percent increase in the number of Veterans using telehealth programs. 

Recognizing the Aleda E. Lutz VAMC is not a tertiary healthcare site, VISN 11 

is developing virtual capabilities to link Veterans with specialty care found in our 

tertiary facilities in Ann Arbor and Detroit, including care for substance abuse; and 

also provide pharmacy clinical video health services to a Veteran’s home. Utilizing 

telehealth for follow-up care helps eliminate travel and ensures Veterans receive the 

appropriate follow-up consultation. The Aleda E. Lutz VAMC is also working with 

the National Telemental Health Center to provide mental health services for patients with chronic pain—an area of growing demand and concern. 

The Battle Creek VAMC expanded their healthcare reach by placing telehealth 

equipment at the rural Volunteers of America (VOA) site. Telehealth equipment was 

purchased for the VOA site in Lansing to provide telehealth services for homeless 

Veterans. Some of the services for homeless Veterans include, telemental health 

counseling, substance abuse treatment, and case management. Future services to be 

provided will be primary care basic visits, diagnostic visits, mental health visits, and 

mental health case management. We are in the planning stages for a project that 

will allow for small, county mental health offices to have telehealth equipment to 

connect with providers located within the Battle Creek VAMC. 

Obesity is a significant problem impacting the healthcare of many in the United 

States. VA has enthusiastically engaged in weight management programs, such as 

our MOVE!® weight management program. We have and continue to expand these 

services by adding TeleMOVE!® to our CBOCs. The goal of the TeleMOVE!® Program is to assist with weight management in the comfort and convenience of the 

Veterans home through a home messaging device. Time spent with our registered 

dietitians assisting and motivating Veterans has proven to be an effective component—of a Veterans weight loss plan. 

FY 2014 Expansion Goals 

As we learn about additional opportunities or tools related to telehealth we have 

been aggressive in investigating them for utilization within VA. We still have opportunities to expand mental health programs in such areas as OEF/OIF/OND case 

outreach, outpatient substance abuse programs, evidence-based therapies, the VA 

Caregiver Support Program, telehealth for the homeless Veteran, and the Veterans 

Justice Outreach. Aleda E. Lutz VAMC is participating in a VA national telespirometry project to provide spirometry testing to patients at the CBOCs. We know 

that addressing hearing aid deficiencies is a big need for Veterans. We have learned 

there are components of such care that we can provide virtually through tele-audiology. We will be expanding this program in four additional CBOCs in Michigan. 

Homeless Veterans and the Veterans Justice Outreach Programs 

Homelessness is not just an urban issue – homeless Veterans are in rural areas 

too. We provide direct help daily through our homeless staff and programs such as 

HUD–VASH wherein HUD provides Housing Choice vouchers and VA provides case 

management services. We also recognize that it is important to create and maintain 

access points within Veterans Affairs Offices and/or local community partners where 

the homeless congregate. Our goal is to identify homeless Veterans and introduce 

them into the continuum of care we have available to serve them. We continue to 

combat homelessness proactively by working to identify Veterans who are incarcerated or at risk for incarceration and working with the court systems to intercede 

where possible. Working proactively before an incarcerated Veteran is released has 

been instrumental in avoiding Veterans instantly becoming homeless. We have Veterans Justice Outreach Coordinators located throughout the state and have strong 


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relationships with seven Veterans Courts in Michigan. We have experience with utilizing telehealth to link our Veterans and the judges involved with their care and 

we look forward to expanding this capability where possible. 

VISN 11 American Indian/Alaskan Native Veterans Overview 

The VA and Indian Health Service (IHS) Memorandum of Understanding was 

signed in 2010 to increase access and quality of care for American Indian and Alaskan Native Veterans across the Nation. VISN 11 has done extensive outreach to all 

tribes in Lower Michigan, particularly with the Little Traverse Bay Bands of 

Odawa, Grand Traverse Bay of Ottawa and Chippewa Indians, and the Pokagon 

Band of Potawatomi in Dowagiac, Michigan. 

Over the past 3 years, VHA personnel attended Pow Wows, American Indian 

health fairs, annual meetings with IHS, and VHA presentations at tribal chair 

meetings. 

In April 2014, Battle Creek VAMC entered into MOUs with the Pokagon Potawatomi and the Nottawasippi Huron Potawatomi to provide telemental health for 

tribal Veterans at the Tribal offices via telehealth technology through the Battle 

Creek VAMC. The MOUs provide for a part-time VA Tribal Outreach Worker for 

each tribe location to assist in connecting tribal Veterans to VA’s mental health providers. This new telemental health project currently has a small number of newlyenrolled, younger American Indian Veterans utilizing their VA benefits for their 

healthcare needs. It is anticipated that 130 Tribal Veterans within the 

Nottawaseppi Huron and Pokagon Band of the Potawatomi Nation will benefit from 

this project to bring access to mental health services to them in a location that is 

easily accessible and acceptable for them. 

In addition, the Grand Traverse Bay Band of Ottawa and Chippewa Indians and 

VA are working on a Reimbursement Agreement, under which VA will reimburse 

the tribe for direct care services provided by the tribe to eligible American Indian 

Veterans. Aleda E. Lutz VAMC will be representing VHA at health fairs held during 

2014 at the Little Traverse Bay Bands of Odawa Indians and Grand Traverse Bay 

Band of Ottawa and Chippewa Indians. In addition, the Aleda E. Lutz VAMC is beginning a new partnership collaboration with Little River Band of Ottawa Indians 

and will be attending the Veterans’ Warrior Society meeting in August to expand 

outreach to tribal Veterans. 

American Indian Outreach Tribal Veteran Representative (TVR) Training 

The Battle Creek VAMC and Aleda E. Lutz VAMC, along with VISN 12’s Oscar 

G. Johnson VAMC, held the third annual Tribal Veteran Representative (TVR) 

Training. VISN 11 also conducted two TVR Trainings in 2013 for tribal members 

and another was held July 21–24, 2014, in Farwell, Michigan. 

TVR training in Michigan promotes the practice of having an American Indian 

TVR in Federally recognized tribes throughout Michigan. The representative assists 

Veterans in understanding how to access benefits while also allowing VA to develop 

positive relationships with American Indian tribes in Michigan. The value in tribal 

members participating in the training is that many tribal customs are shared during discussions. This enhances the healthcare team members’ cultural understanding and appreciation of American Indian Veterans’ contributions to our country. 

Conclusion 

VHA, VISN 11, the Aleda E. Lutz VAMC, and the Battle Creek VAMC are committed to providing the high-quality care that our Veterans have earned and deserve. We appreciate the opportunity to appear before you today, and we appreciate 

the resources Congress provides VA to care for Veterans. We are prepared to answer 

questions you may have for us. 

f 

FOR THE RECORD 

TRIBAL CHAIRMAN, GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

WRITTEN BY ALVIN V. PEDWAYDON, 

My name is Alvin Pedwaydon and I am the Chairman of the Grand Traverse 

Band of Ottawa and Chippewa Indians (GTB or Grand Traverse Band). I am a Vietnam-era veteran and a resident of Northwest Michigan who has directly encountered healthcare issues, both as a provider in my capacity as Chairman of Grand 

Traverse Band, and as a recipient as a veteran and tribal member. Grand Traverse 

Band has 4,100 members or which 1,500 reside in rural Northwest Michigan. My 


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testimony reflects both my position as Chairman of GTB and my individual position 

as a Vietnam-era veteran and resident of rural Northwest Michigan. 

Grand Traverse Band has a storied and turbulent history of military service 

against and for the United States. Based on our sovereign status as an Indian Nation, like other Indian Nations in the United States, we have fought against the 

United States and we have fought for the United States. The last hostile encounter 

between GTB and the United States was the war of 1812; and our resistance to the 

United States’ attempted Indian removal of our ancestors to Kansas and Oklahoma 

in the 1830s and 40s. Our ancestors have nevertheless willingly and gratefully 

served with honor in the United States armed forces since the Civil War. Members 

of our Tribal Council, for example, have great-great grandparents who were participants in Company K, Michigan Ottawa Indian Sharpshooters, a total Ottawa Indian 

Company from our area that fought on the Union side in the Civil War. Our ancestors have also served proudly and honorably in World War I and II, Korea and Vietnam, Gulf (Operation Desert Storm) and the Iraq and Afghanistan wars. GTB also 

honors its members who participated in the ‘‘Siege of Wounded Knee’’ in 1973 as 

warriors for Indian Country. 

It is this historical complex relationship between Indian Tribes and the United 

States that defines the scope of our healthcare problems as manifested in our 

healthcare delivery systems. The history of federal Indian law and the relationships 

of the Tribes to the United States is a quagmire of complexity that represents both 

the pain and promise of federal Indian law and our historical relationship with the 

United States. Clearly Indian Tribes want to maintain their sovereign status as indigenous inhabitants to this continent and we have fought ferociously over the years 

to maintain this sovereign status. The United States has recognized this sovereign 

status in the implementation of a complex federal statutory system of federal domestic services. 

In the area of healthcare we must content with the Indian Self-Determination and 

Educational Assistant Act (ISDEA); the Indian Healthcare Improvement Act; and 

services offered to veterans under Veterans Administration (VA) delivery systems. 

The Indian Healthcare Improvement Act (IHCIA) achieved permanency status in 

the landmark legislation, the Patient Protection and Affordable Care Act (ACA), 

signed by President Obama in March of 2010. We applaud this permanency and recognition of tribal sovereign status in the ACA. The defining concept of the ISDEA 

and the IHCIA is self-determination for Indian Tribes. We administer a comprehensive and expensive healthcare delivery system for our tribal members in Northwest 

Michigan. Indeed, we are probably the second biggest healthcare payor and provider 

in Northwest Michigan. The defining characteristic of ISDEA and IHCIA is administration by the tribes under a well-defined self-governance concepts and processes 

that have had the opportunity to develop detailed and complex federal regulations 

governing healthcare delivery to tribal members. In a thumbnail, those regulations 

consist of approximately 1,000 pages of CFR regulations, or more appropriately, digital screen images, which the tribes have had the opportunity to implement and develop by negotiated rule-making. 

By any measure of modern bureaucracy, both the ISDEA and IHCIA have been 

a resounding success nationwide for Indian Country. We still argue with the Health 

and Human Services Department (HHSD) over the scope of the costs and associated 

indirect costs, but the Tribes have generally prevailed on the merits in requiring 

HHSD to fully fund indirect costs. We are now confronting and coordinating a MOU 

agreement with the VA to deliver reimbursement costs for eligible veterans who access our tribal healthcare system. This effectively melds two systems of healthcare 

delivery, and as expected, we have had problems in fully implementing all of the 

VA eligible activities into our existing Indian healthcare system. 

In particular, the VA system does not have statutory authority similar to the 

HHSD that permits an Indian tribe to negotiate a 638 self-governance contract 

under ISDEA to ultimately culminate in a totally administered tribal program. We 

would suggest that such statutory authority would provide opportunities for Indian 

tribes and the VA to work out alternative delivery systems for rural-based Indian 

veterans. Presently, the VA uses an MOU agreement on the model of a ‘‘one size 

fits all’’ regardless of the individual circumstances of the demographic picture of the 

service population. For example, it has been GTB’s experience that it is cost-effective for us to bring dental and eye care services directly in-house at our healthcare 

clinic, but that it is not cost-effective to bring auditory services in-house. Therefore, 

our service population generally has quick turn-around time for dental and eye care 

services and delayed service for auditory benefits. 

In my own personal experience, because of the remoteness of our location and the 

necessity of my application to go through a centralized processing VA system, I had 

to wait eight months to receive my hearing aid. In my position as Tribal Chairman, 


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a very public position, this was extremely frustrating and detrimental to me in effectively administering my office, which requires participation in public meetings. 

I would suggest that VA statutory authority to negotiate with a Tribe, beyond a simple MOU agreement for direct in-house service, might be a solution for rural Native 

veterans who do not have access to a VA hospital but do have access to an Indian 

health clinic. 

We applaud the efforts of the VA to have a tribal liaison office and we would suggest that VA services follow the Indian Health Services to have native-specific care 

modalities, like the Indian Health Service and tribal clinics. Currently, the VA does 

not make any concessions in services to Native-based beliefs. Though the VA is subject to Indian preference hiring, the VA has not implemented an active Indian preference hiring system for our area. Finally, because of the last decade of war, we 

unfortunately have a whole generation of wounded warriors suffering from PTSD. 

This population should receive special attention by the VA and the focus for rural 

Native Americans should be on establishing pilot PTSD programs for rural Native 

Americans directly serviced by existing Indian healthcare clinics. 

I want to thank you for this opportunity to present these views of the Grand Traverse Band and my personal experience individually and to personally commend you 

for taking the time to address this important issue for rural Native American veterans and their healthcare. 

f 

FROM: THE LITTLE RIVER BAND OF OTTAWA INDIANS

Good Morning, 

I am Larry Romanelli, Ogema or Chief and the elected leader of the Little River 

Band of Ottawa Indians in Manistee Michigan. 

I am unable to attend in person due to conflicts in scheduling but want to offer 

my support for efforts of the House Veteran’s Affairs Committee in looking at services to Native American’s in rural areas. 

It is a well-known fact that Native Americans have the highest record of service 

per capita when compared to other ethnic groups in serving the United States and 

have since the war of 1812. 

A little known fact is that the U.S. Government used other Native Americans 

from other tribes besides the Navajo to secretly communicate during World War II. 

While Navajo Code Talkers are the most notable and deservedly respected, members 

of our own Tribe were documented as ‘‘Code Talkers’’ including members of my own 

family who spoke in the Odawa or Ottawa language to keep the enemy from being 

able to understand the communications. 

It is a great thing that healthcare for veterans has made major improvements 

over the years however for many Native American veterans, access to such 

healthcare remains a roadblock. Again, Native American veterans represent the 

largest number of those rural vets. 

I thank the efforts of the House Veteran’s Affairs Committee for taking the time 

and effort to address this issue. Migwetch (Thank you) 


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Æ 


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