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RESTRUCTURING VA MEDICAL SERVICES: MEASURING AND MAINTAINING THE QUALITY OF

CARE

HEARING

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES

OF THE

COMMITTEE ON GOVERNMENT 

REFORM AND OVERSIGHT 

HOUSE OF REPRESENTATIVES

ONE HUNDRED FIFTH CONGRESS

FIRST SESSION

AUGUST 4, 1997

Serial No. 105–88

Printed for the use of the Committee on Government Reform and Oversight

(

(II)

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT 

DAN BURTON, Indiana, Chairman 

BENJAMIN A. GILMAN, New York 

J. DENNIS HASTERT, Illinois 

CONSTANCE A. MORELLA, Maryland 

CHRISTOPHER SHAYS, Connecticut 

STEVEN SCHIFF, New Mexico 

CHRISTOPHER COX, California 

ILEANA ROS-LEHTINEN, Florida 

JOHN M. MCHUGH, New York 

STEPHEN HORN, California 

JOHN L. MICA, Florida 

THOMAS M. DAVIS, Virginia 

DAVID M. MCINTOSH, Indiana 

MARK E. SOUDER, Indiana 

JOE SCARBOROUGH, Florida 

JOHN B. SHADEGG, Arizona 

STEVEN C. LATOURETTE, Ohio 

MARSHALL ‘‘MARK’’ SANFORD, South 

Carolina 

JOHN E. SUNUNU, New Hampshire 

PETE SESSIONS, Texas 

MICHAEL PAPPAS, New Jersey 

VINCE SNOWBARGER, Kansas 

BOB BARR, Georgia 

ROB PORTMAN, Ohio 

HENRY A. WAXMAN, California 

TOM LANTOS, California 

ROBERT E. WISE, JR., West Virginia 

MAJOR R. OWENS, New York 

EDOLPHUS TOWNS, New York 

PAUL E. KANJORSKI, Pennsylvania 

GARY A. CONDIT, California 

CAROLYN B. MALONEY, New York 

THOMAS M. BARRETT, Wisconsin 

ELEANOR HOLMES NORTON, Washington, 

DC 

CHAKA FATTAH, Pennsylvania 

ELIJAH E. CUMMINGS, Maryland 

DENNIS J. KUCINICH, Ohio 

ROD R. BLAGOJEVICH, Illinois 

DANNY K. DAVIS, Illinois 

JOHN F. TIERNEY, Massachusetts 

JIM TURNER, Texas 

THOMAS H. ALLEN, Maine 

HAROLD E. FORD, JR., Tennessee 

———

BERNARD SANDERS, Vermont 

(Independent) 

KEVIN BINGER, Staff Director 

DANIEL R. MOLL, Deputy Staff Director 

WILLIAM MOSCHELLA, Deputy Counsel and Parliamentarian 

JUDITH MCCOY, Chief Clerk 

PHIL SCHILIRO, Minority Staff Director 

SUBCOMMITTEE ON HUMAN RESOURCES

CHRISTOPHER SHAYS, Connecticut, Chairman 

VINCE SNOWBARGER, Kansas 

BENJAMIN A. GILMAN, New York 

DAVID M. MCINTOSH, Indiana 

MARK E. SOUDER, Indiana 

MICHAEL PAPPAS, New Jersey 

STEVEN SCHIFF, New Mexico 

EDOLPHUS TOWNS, New York 

DENNIS J. KUCINICH, Ohio 

THOMAS H. ALLEN, Maine 

TOM LANTOS, California 

BERNARD SANDERS, Vermont (Ind.) 

THOMAS M. BARRETT, Wisconsin 

EX OFFICIO

DAN BURTON, Indiana HENRY A. WAXMAN, California 

LAWRENCE J. HALLORAN, Staff Director and Counsel 

ROBERT NEWMAN, Professional Staff Member 

R. JARED CARPENTER, Clerk 

(III)

C O N T E N T S 

Page 

Hearing held on August 4, 1997 ............................................................................. 1

Statement of: 

Aversano, Daniel, LPN, veteran and Castle Point employee, Kerhankson, 

NY .................................................................................................................. 147

Blumenthal, Jerome, veteran, Middletown, NY ............................................. 151

Bove, Anne, registered nurse and daughter of deceased veteran, 

Woodside, NY ................................................................................................ 174

Buccieri, Anthony, veteran and Veterans of Foreign Wars and Disabled 

American Veterans, Newburgh, NY ............................................................ 148

Catania, James, veteran, VFW and American Legion, Walkill, NY ............ 161

Crowther, Guy, veteran, Port Jervis, NY ....................................................... 190

Demarco, Ralph, veteran and representing 27 New York veterans’ organizations, Fishkill, NY ..................................................................................... 176

Dobbs, Theodore, veteran and husband of deceased veteran, New Hampton, NY ........................................................................................................... 178

Dos Santos, Lawrence, deputy director, New York State Division of Veterans’ Affairs, accompanied by Thomas C. Agnew, director, Orange 

County Veterans Service Agency; Jerry Donnellan, director, Rockland 

County Veterans Service Agency; Al Etkin, director, Sullivan County 

Veterans Service Agency; and Jim Whoie, deputy director, Dutchess 

County Veterans Service Organization ....................................................... 125

Farsetta, James, director, Veterans Integrated Service Network 3, accompanied by Maryanne Musumeci, director, Bronx VA Medical Center; 

Michael A. Sabo; director, Hudson Valley VA Health Care System; 

and Dr. Nancy J. Wilson, director, VA Office of Performance Management ............................................................................................................... 40

Fleck, Steven, veteran and Montrose employee, Poughkeepsie, NY ............ 177

Fleming, Harry, veteran and chaplain and scouting chairman, Orange 

County American Legion, Middletown, NY ................................................ 166

Hinchey, Hon. Maurice D., a Representative in Congress from the State 

of New York ................................................................................................... 5

Ianazzi, Robert, veteran and Vietnam Veterans of America and Disabled 

American Veterans, Middletown, NY .......................................................... 189

Ippolito, John, veteran and American Legion Post 1266, Pine Bush, NY ... 175

Jinks, Pam, veteran and Castle Point employee, Montgomery, NY ............. 168

Johannes, Richard, veteran, Pleasant Valley, NY ......................................... 149

Karabec, Ralph, veteran and commander, American Legion Post 480, 

Monroe, NY ................................................................................................... 146

Kelly, Gerard, veteran and Eastern Paralyzed Veterans Association, Jackson Heights, NY ............................................................................................ 164

Kelly, Hon. Sue, a Representative in Congress from the State of New 

York ................................................................................................................ 25

Kowal, Jane, daughter of deceased veteran, Port Jervis, NY ....................... 159

Mangels, Shirley, daughter of deceased veteran, Ellenville, NY .................. 166

Mangieri, Silvio, veteran, Walkill, NY ............................................................ 189

Messina, Enrico, veteran and Castle Point employee, Poughduag, NY ....... 169

Mileo, Gerard, veteran, Marlboro, NY ............................................................ 179

Monteleone, Edmund J., veteran, Clintondale, NY ....................................... 144

Moonan, Ray, veteran and Disabled American Veterans and American 

Legion, Florida, NY ...................................................................................... 160

Morea, Daniel, veteran and assistant service officer, Department of New 

York American Legion, ninth district rehabilitation chairman, American Legion, Beacon, NY ............................................................................... 151

Page

IV

Statement of—Continued

Mussolino, Colleen, veteran and national vice commander, Women Veterans of America, Brooklyn, NY, on behalf of Montrose Women Veterans of America ........................................................................................... 162

Novak, Bill, veteran and New York State benefits protection officer, Department of New York Disabled American Veterans, Middletown, NY ... 182

O’Connor, Thomas, veteran and nurse manager, outpatient services, Castle Point, Marlboro, NY ................................................................................ 163

Parris, Ray, veteran, Washingtonville, NY .................................................... 185

Pinckney, Richard, veteran, Middletown, NY ................................................ 191

Pressley, Hugh A., Jr., veteran, Bronx, NY ................................................... 192

Reilly, Daniel, veteran and NFF 246, Beacon, NY ........................................ 165

Schiffman, Philip, veteran and New York VFW, Washingtonville, NY ....... 153

Schwartz, Sandra, veteran, wife of veteran and daughter of deceased 

veteran and Disabled American Veterans Auxiliary, Poughkeepsie, NY . 172

Shera, Craig, veteran and son of deceased veteran, Gardiner, NY .............. 178

Skyler, John, veteran and department commander, Department of New 

York Disabled American Veterans, Cheektowaga, NY .............................. 187

Spadaro, Ben, veteran and VA employee, Bronxville, NY ............................ 184

Trimble, Cindy, family of deceased veteran, Ganham, NY ........................... 147

Van Clief, Helene, veteran and treasurer, Military Women and Friends 

and member, Coalition for Fairness to Veterans and VAVs, Bronx, 

NY .................................................................................................................. 187

Wood, Gloria, wife of veteran, Pine Bush, NY ............................................... 150

Letters, statements, etc., submitted for the record by: 

Agnew, Thomas C., director, Orange County Veterans Service Agency, 

prepared statement of ................................................................................... 133

D’Amato, Hon. Alphonse, a U.S. Senator in Congress from the State 

of New York: 

Prepared statement of ............................................................................... 36

Public submissions .................................................................................... 38

Dos Santos, Lawrence, deputy director, New York State Division of Veterans’ Affairs, prepared statement of .......................................................... 128

Farsetta, James, director, Veterans Integrated Service Network 3: 

Buyout plan ............................................................................................... 99

Letter dated August 26, 1997, and draft report ..................................... 64

1997 Network Director Performance Plan .............................................. 107

Prepared statement of ............................................................................... 44

VA survey ................................................................................................... 55

Etkin, Al, director, Sullivan County Veterans Service Agency, prepared 

statement of ................................................................................................... 138

Hinchey, Hon. Maurice D., a Representative in Congress from the State 

of New York, prepared statement of ........................................................... 9

Kelly, Hon. Sue, a Representative in Congress from the State of New 

York, prepared statement of ........................................................................ 28

Shays, Hon. Cristopher, a Representative in Congress from the State 

of Connecticut, white paper on news articles ............................................. 156

Whoie, Jim, deputy director, Dutchess County Veterans Service Organization, prepared statement of .......................................................................... 142

(1)

RESTRUCTURING VA MEDICAL SERVICES: 

MEASURING AND MAINTAINING THE QUALITY OF CARE 

MONDAY, AUGUST 4, 1997 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HUMAN RESOURCES, 

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT, 

Middletown, NY. 

The subcommittee met, pursuant to notice, at 1 p.m., in Walkill 

Community Center, Middletown, NY, Hon. Christopher Shays 

(chairman of the subcommittee), presiding. 

Present: Representatives Shays, Gilman, Kelly, and Hinchey. 

Staff present: Lawrence J. Halloran, staff director and counsel; 

Robert Newman, professional staff member; and R. Jared Carpenter, clerk. 

Mr. SHAYS. I call this hearing to order. This is a hearing of the 

U.S. Congress. I apologize for the number of people who have to 

stand. This is a field hearing of the House of Representatives. We 

are going to demand absolute order in these hearings. 

Our witnesses are to be sworn in until we get to the third panel, 

and I’ll clarify that in just a second. I would like the chief to make 

an announcement since——

Audience PARTICIPANT. Who are you, sir? 

Audience PARTICIPANT. Who are you? 

Mr. SHAYS. Let me just be very clear. I will adjourn this hearing 

at a moment’s notice if we do not have order. There is to be no catcalling. There is to be no response from the audience. This is——

[Chorus of boos.] 

Audience PARTICIPANT. We don’t want to be treated like babies. 

[Applause.] 

Mr. SHAYS. Chief, do you want to make an announcement? 

Mr. COSCETTE. Yes. Good evening, everybody. My name is Chief 

James Coscette. 

We’re not here to fight or go against you. I, myself, am a veteran. 

I’m proud to have you people here. And I’m sure the board will listen to what you have to say. 

My job here is the crowd capacity here in this Town Hall. 

My officers are here to help you and assist you. Please let us remain a calm, cool, collective, bargaining people, as yourself. You’ve 

done your time. You’ve represented us. And I thank you all for 

being here. 

2

The exits are at the front here, in the rear, and in the back. 

Please, ladies and gentlemen, keep the aisles clear for all people 

wanting to come up and speak. 

Thank you. 

Audience PARTICIPANT. All right. A question was asked to the 

gentleman. All they wanted to know is who he was. 

Audience PARTICIPANT. That’s right. 

Audience PARTICIPANT. That’s all. 

Audience PARTICIPANT. It’s supposed to be a secret. 

Mr. SHAYS. Let me just welcome all of our witnesses. I’d like to 

welcome our guests as well. 

Audience PARTICIPANT. Who are you? Who are you? 

Audience PARTICIPANT. Who is speaking to us? 

Audience PARTICIPANT. That’s my question. 

Mr. SHAYS. This is the hearing of the Government Reform and 

Oversight Committee, the Subcommittee on Human Resources. 

We’re the committee that oversees the Departments of Health and 

Human Services, Housing and Urban Development, Education, 

Labor, and also the Department of Veterans Affairs for waste, 

fraud, and abuse. 

This is the committee’s first field hearing that we’ve had this 

year. And we’re having it at the request of the three Congressmen 

you see seated next to me. The purpose of this hearing is to look 

at the quality of care of the Veterans Administration in this district 

and to consider whether the quality of care is improving or declining. We will stay and hear all our witnesses. 

My name is Christopher Shays. I am the chairman of the subcommittee. 

This is the same committee that has had 10 hearings on the Gulf 

War Syndrome. This is the committee why you know of Kamisiyah 

and why you know of some other problems in the Persian Gulf. We 

have been very active in veterans’ affairs. 

We are here at the request of your three Congressmen because 

you have asked for this hearing. And we welcome you here today. 

But this is an official hearing of Congress. We have to have order. 

I really request that you provide us that order. 

And at this time, I would recognize Ben Gilman. 

Mr. GILMAN. Thank you, Mr. Chairman. [Applause.] 

I want to welcome all of our veterans who have taken the time 

out of their busy lives to be with us today. I want to welcome also 

our Veterans Administration officials who are here. We have Mr. 

Farsetta, who is the regional director. We have Maryanne 

Musumeci, who is also a regional director, now the head of the 

Bronx VA hospital. We have Mr. Sabo, who is the new Castle Point 

director. And we have Dr. Nancy Wilson, who is one of the program 

directors with the Veterans Administration. We thank our panelists for being here with us. 

Can you hear us in the back all right? 

[Chorus of yeses.] 

Mr. GILMAN. And I’m pleased that we’re joined here with Congresswoman Sue Kelly, who represents a portion of this county and 

other adjoining counties. And Congressman Maurice Hinchey represents the areas north of us and also a portion of Orange County. 

[Applause.] 

3

And I urge you, please, give respect to our panelists and to our 

witnesses. And we’re going to try to move along as quickly as we 

can. 

If I might, Mr. Chairman, I’d like to give an opening statement 

at this time. Our fellow veterans and ladies and gentlemen, I want 

to, first of all, express a great deal of gratitude to Congressman 

Chris Shays for willingness to arrange this hearing, to take time 

out of his schedule, to be over here in our area to address a very 

serious concern that we all have and to hold it in a forum that is 

accessible to our local veterans. 

As the ranking Republican on the Government Reform and Oversight Committee, I approached Chairman Shays last May and requested that his subcommittee initiate an investigation into the 

quality of care being delivered at Castle Point and at Montrose. I 

did this because we were not satisfied with the manner in which 

the VA was responding to the concerns of our veterans and their 

families who had come forward with their health care complaints. 

It’s my opinion that it was the Veterans Administration’s lack of 

compassionate response to the veterans’ complaints that poisoned 

the atmosphere and eliminated a great deal of hope for a workable 

solution with our veterans in our local communities. Their concerns 

were obviously not being addressed adequately, and we felt that 

the congressional intervention was warranted. 

And many of you have probably heard of the plan developed by 

the VA to shift funding to geographic areas that have inadequate 

resources to meet their level of demand. This plan that was known 

as the Veterans Equity Resource Allocation Model, known as 

VERA, has resulted in health care funds flowing away from New 

York State to places like Arizona, Mississippi, and California. 

By now you’re all undoubtedly aware that we have major philosophical disagreements with the proponents of that VERA program 

in both the Congress and the administration. I believe this plan is 

ultimately harmful to the veterans of the Northeast and, despite all 

assurances to the contrary, could result in a decrease in the quality 

of care provided. We hope that that will not be the ultimate result. 

The watch word for VERA has been ‘‘efficiency.’’ And, while we 

agree that there is a great deal of fat within the VA that needs to 

be trimmed, I would remind you that efficiency is not an unmitigated good. It’s possible to go too far in scaling back services in the 

name of efficiency. 

We’ve heard much in the last year about the need for the Veterans Administration to model private sector health care. To a certain extent that may be needed, but the private sector example is 

certainly not a panacea to all of our problems. 

Many of you have heard some of the horror stories about HMOs 

that have cut back too far in quality care and place the bottom line 

on profitability before patient care. That certainly must not be allowed in our Veterans Administration facilities. 

Unlike other so-called entitlements, veterans’ health care benefits were earned through blood and sacrifice. And, for that reason, 

the Veterans Administration has a public duty to our veterans and 

to the American taxpayer to deliver health care that’s equal or superior to that in the private sector. 

4

The Veterans Administration is, in essence, the steward of our 

veterans’ health. In maintaining that stewardship, the VA should 

not repeat the mistakes of the private sector with the streamlining 

of health care. 

We intend to keep a close eye on the quality of care which the 

VA delivers in Network 3. And that’s our own region, especially in 

the area of specialty care. And what we have seen so far has not 

been encouraging. 

As I have noted in the past, the Veterans Administration has a 

major credibility problem with our New York congressional delegation and with the veterans that use both Castle Point and 

Montrose. The evidence from this past spring shows that this network and its administrators forgot about the human side of VA 

health care. And we have no illusions that it was only public exposure and the threat of congressional intervention which forced 

them to reevaluate their positions. 

Regarding the general public, the VA response to those whose 

complaints appeared in the paper was, ‘‘Left a lot to be desired.’’ 

Those stories may very well have been anecdotal, but it was grossly 

irresponsible for the hospital and the VISN officials. To publicly 

state so simply because each complaint was unable to be immediately verified did not make them any less important. 

The tactic of dismissing patient and family experiences as unimportant certainly was counterproductive and gave the appearance 

that the VA had something to conceal. If nothing else, the officials 

of Network 3 owe these veterans and their families an apology for 

the treatment they did receive when they came forward. 

It has also been the distressing trend of some VA officials in 

Washington to consistently attempt to shift the fault for this situation over to the Congress, stating that the Congress had underfunded VA health care in the past. These charges had been leveled 

despite the fact that the Congress traditionally meets the President’s request for health care funding and, as a matter of fact, gave 

the Veterans Administration more funds than ever before in last 

year’s budget. In fact, last year VA officials testified that they did 

not want any additional funds for this fiscal year. 

The administration has proposed a flat budget until the year 

2002, which will treat up to 20 percent more veterans. The VA 

claims that that’s possible without any additional funds due to savings from efficiencies and retention of third party reimbursements. 

That remains to be seen. We hope that they will be able to retain 

those third party reimbursements, and we’re trying to make that 

possible through statutory language. 

So we in the Congress have repeatedly stated that we’re willing 

to work with the Veterans Administration to address the ongoing 

issues of quality of care. And if more funds are needed to assure 

proper care, we want to know about it and we’re going to try to 

help them get the kind of funding they do need. 

Moreover, those of us in the Congress may often have some significant ideas which do warrant experimentation. For example, last 

week I suggested to Dr. Kizer, the Medical Programmer in the VA, 

and Secretary Gober, our new Administrator, that Castle Point 

should contract out with local hospitals for inpatient surgical procedures, rather than transporting patients all the way to Albany or 

5

the Bronx, which incurs needless costs—[applause]—and which 

places undue stress on our veterans. Secretary Gober agreed to 

work with us on that issue as well as on doctor certification. And 

we hope to hear more about those subjects today. 

So, in closing, let me say that it’s our hope that this hearing 

today—and I speak on behalf of my fellow Congressmen over 

here—will serve as a first step toward improving the strained relationships between Castle Point and its patients. 

And we look forward to the release of the report detailing the 

findings of the medical examiner’s investigation of Castle Point as 

well as the results from a study that Congress is requesting from 

the Government Accounting Office on the effects of VERA. 

In the interim, I hope that those of you who have come forward 

with specific problems about care at Castle Point will have your situations either rectified or, if this is not possible, receive just and 

proper compensation. 

Again, we thank you for being here. We’re here to try to resolve 

problems. Let’s try to work together in those directions. Thank you, 

Mr. Chairman. 

Mr. SHAYS. Thank you, Mr. Gilman. [Applause.] 

This hearing was at the request of Ben Gilman, who I failed to 

mention is a member of this subcommittee besides being chairman 

of the International Relations Committee; also, Sue Kelly, on the 

Republican side of the aisle. 

Mr. Hinchey, on the Democrat side of the aisle, as well, has expressed bipartisan concern about this issue. And at this time I’d 

like to recognize him. 

STATEMENT OF HON. MAURICE D. HINCHEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK 

Mr. HINCHEY. Thank you very much, Mr. Chairman. And good 

afternoon, ladies and gentlemen, and welcome to this hearing. I 

also want to welcome and thank our chairman, the chairman of the 

subcommittee, Chris Shays, who represents a congressional district 

in Connecticut, for holding this first field hearing on this subject 

here in our area in the mid-Hudson Valley. We appreciate your 

coming here. We want you to feel welcome. We know that you are 

joining us in a resolve to solve this problem on a bipartisan basis, 

and we very much appreciate your being here. 

I want to say also that this hearing is held in honor and respect 

of the service and sacrifice of American veterans, and I want everyone in the audience to understand that. That is why the committee 

is here. We are determined and resolved on a bipartisan basis to 

ensure that the quality of care that is afforded for veterans improves and that it maintains the highest standard possible. 

Mr. Chairman, I have a longer statement that I will submit, but 

I have a precis of it that I would like to read into the record at 

this time. 

Mr. SHAYS. Sure. 

Mr. HINCHEY. I believe we would all agree that the purpose of 

the veterans’ health care system is to assure our veterans that they 

will always have access to quality health care. That has changed 

and evolved over the years, as it should, but that commitment remains its core purpose. 

6

Today many veterans do not come to the VA for health care, 

often because they do not need to and sometimes because it is inconvenient and sometimes, unfortunately, because they have lost 

confidence in the ability of the VA to provide the kind of health 

care that they need. [Applause.] 

They use non-VA facilities. The cost is often covered by Medicare 

or by employer-paid insurance. The VA now recognizes that it is 

not always convenient or appropriate to provide care at its hospitals and has begun developing outpatient clinics and other means 

of providing services to veterans closer to home. I think the VA deserves to be commended for this effort, but that is not justification 

for allowing the quality of care at VA health care facilities to decline. 

That should not mean that the commitment to provide quality 

health care at its own hospitals should be relaxed or abandoned. 

The VA hospitals should continue to provide quality services to 

those veterans who continue to need those services. 

I am deeply concerned that, for whatever reason, the quality of 

care at Castle Point has deteriorated. There is no question that 

many of our veterans in this area have lost their confidence in Castle Point and to a considerable degree in the VA itself. 

Audience PARTICIPANT. Did your wife die there? Mine did. 

Audience PARTICIPANT. That’s true. 

Mr. HINCHEY. All of us who are here today and who represent 

veterans in the Hudson Valley have lodged numerous complaints 

with the VA about the situation at Castle Point. We have had numerous meetings about Castle Point with VA Administrators, up to 

and including Secretary Brown and now Acting Secretary Gober. I 

think it is fair to say that we know our complaints have been 

heard, we know that the VA is paying attention, but we do not 

know if the problems are being resolved in a way that addressees 

the needs and concerns of the veterans that Castle Point is supposed to serve. 

In my written statement for the record, I have included several 

detailed case histories of serious problems that some of my constituents have encountered at Castle Point. I want to emphasize 

that the cases in my statement represent only a small sampling of 

the many complaints that I have received. 

I have been deeply disturbed not only by the number of complaints but also by the wide range of problems that have been reported to me through my office. They include allegations of: misdiagnosis by health care personnel, particularly doctors; errors in 

treatment; and surgical mistakes that suggest serious incompetence. They include complaints about poor relations between doctors and patients and the inability of doctors to communicate effectively with patients, a problem that Under Secretary Kizer—[applause]—a problem that Under Secretary Kizer confirmed in our 

most recent meeting. With regard to those complaints, I can announce to you today that the Members of Congress seated at this 

table have just introduced legislation that I have written—we have 

introduced it on a bipartisan basis—which will require that all doctors providing health care at VA facilities must be licensed to practice medicine in the State in which the VA facilities are located. 

[Applause.] 

7

We will also require in this legislation that vital statistics, including death records, be filed with the appropriate State agency, 

including the State health department, and not be restricted only 

to the VA itself in the future. [Applause.] 

I want to emphasize that this legislation is being introduced by 

the members of the committee seated here, Democrats and Republicans, on a bipartisan basis. 

The complaints that I have received are about shortages of professional nursing staff and allegations that patients have been neglected as a result of these shortages. I have heard allegations as 

well about unsanitary conditions, poor maintenance of the facility, 

and the misapplication of funds. 

Many of our veterans have expressed concern that the VA may 

be ignoring these problems because it is concentrating too much effort on more abstract management issues; most importantly, the 

shift of funding known as VERA, which Mr. Gilman mentioned a 

few moments ago. 

The VA has told us repeatedly that VERA would not reduce services or compromise quality of care at Castle Point, but that is what 

seems to be happening. Services has been reduced. Quality has 

been compromised. 

Under Secretary Kizer recently told us that there were notable 

problems at only four VA facilities that were being consolidated, 

but he did not include Castle Point on that list. We want to make 

it clear that we believe the problems at Castle Point are, in fact, 

quite notable and need to be addressed vigorously and immediately. 

Audience PARTICIPANT. ‘‘Notorious’’ is the word. 

Mr. HINCHEY. I want to make it clear that I believe these problems need to be straightened out. 

As the committee knows, I have requested that the VA’s Inspector General conduct a thorough investigation of the problems at 

Castle Point, including reports of an increased mortality rate, declining quality of care, quality and adequacy of the staff, and the 

effects of resource allocation on Castle Point. We will be eager to 

see that study when it is completed. 

My office is making available to the Inspector General specific 

case histories that have come to our attention so that the Inspector 

General will be able to direct the attention of his office to those 

specific complaints and examine in detail specific cases where severe problems apparently have occurred. 

We will be eager to see the study when it is completed. In the 

meantime, I hope the committee will consider some of the broader 

questions about government management and VA management 

itself that this situation has raised. 

Specifically, these issues are some of the issues that concern me, 

and here they are. Is management of VA health care being driven 

by computer analysis and allocation formulas while actual day-today conditions and the concerns of individual patients and their 

families are being ignored? If so, we need to remedy that situation 

immediately. 

Does the problem lie with applying uniform rules and standards 

and salary schedules across the country? Is it harder, for instance, 

8

to find good physicians and nurses here in New York than, for instance, in Salem, VA or other places in the country? 

Would the problems be alleviated if there were better communication between VA administrators and the veterans themselves? 

Is it possible to require clearer communications, as in the regulatory process, for instance? We have heard constant complaints 

that veterans’ concerns are ignored, that they are not notified 

about changes in the services provided, and that they are not consulted adequately, even with regard often to their own care. 

Finally, and perhaps most importantly, are the problems attributable to a shortage of funds? VA administrators have suggested 

this to us on several occasions, and I have asked several times if 

they need more money to provide the services veterans expect and 

deserve. We have not had an answer to that question. 

Congress may be at fault here by imposing arbitrary budget ceilings. The Administration may be at fault in its budgeting process. 

We need to know the answers to these questions. 

But if cold, hard budget decisions made in an analyst’s office in 

Washington mean that a diabetic veteran in New York is left 

unmonitored and ignored, then the public needs to know that. 

The Veterans Administration has suggested to us that this may 

be the case. We need to know the answers to these questions. And 

upon getting the answers to these questions, we need to ensure 

that these issues are dealt with adequately, forthrightly, competently, and completely. And that is the purpose of this hearing. 

And, Mr. Chairman, I thank you for being here and giving us 

this opportunity. [Applause.] 

[The prepared statement of Hon. Maurice D. Hinchey follows:]

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Mr. SHAYS. This committee is holding this field hearing, again, 

at the request of Mr. Gilman and Mr. Hinchey as well as Sue 

Kelly. And, Ms. Kelly, you have the floor. 

STATEMENT OF HON. SUE KELLY, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF NEW YORK 

Ms. KELLY OF NEW YORK. Thank you very much, Chairman 

Shays. I want to thank you for holding this hearing and for respecting the veterans in this area who use Castle Point and 

Montrose facilities enough to come up here to the district and listen to what they have to say to the Veterans Administration. 

I think this is an important hearing. I especially appreciate the 

opportunity in light of the recent reports that we’ve had of diminished quality care at both Castle Point and Montrose. I can’t think 

of a more important issue for veterans nationwide than ensuring 

the Federal Government maintains its commitment to provide 

high-quality health care to them and for their service for our Nation. 

The question here is really: Is the present veterans’ equitable resource allocation, VERA, model and the manner in which it has 

been implemented good for the Hudson Valley veterans or just 

those in select areas of the Nation? 

I can tell you now, Mr. Chairman, that I have very grave concerns that today’s VERA model shirks this Nation’s commitments 

to New York’s veterans. In this area of the country, in our network, 

we’re taking the largest cut of any other network in the Nation, a 

15 percent cut in overall veterans’ health care funding, which 

translates into a nearly $150 million cut. Yet, we have the highest 

number of veterans who need special care and the fourth highest 

number of veterans who need medical care. 

It’s the laudable goal of the VA to ensure that veterans receive 

the same high-quality care Nationwide at any medical care facility, 

but I believe all here would applaud this goal. However, the problems begin with the VA’s implementation of robbing Peter to pay 

Paul, taking from one network to give to another. 

The logic behind these actions appears to be flawed in several respects. First, the funds are being reduced in our network. And they 

are not being taken because of a lack of need in one area but for 

a seemingly greater need in another. 

Also, we can’t possibly take into consideration all of the reasons 

that one area historically receives greater funding due to factors 

that are difficult to measure, such as regional differences in cost 

of living, wage scale, as well as the presence of older and sicker patients. 

In the General Accounting Office’s May 1, 1997, report on the VA 

health care assessment of VA’s fiscal year 1998 budget proposal, 

the GAO notes a number of similar warnings about the implementation of VERA, including VERA may shift some resources inappropriately because it may not fully account for justifiable differences 

in regional cost variations. The VA may not have taken into account, for example, that veterans are sicker and need more health 

care services in different parts of the country so that additional 

case mix adjustments may be necessary to fully explain regional 

cost differences. And VERA’s incentives for lower cost per veteran 

26

and higher workload numbers could lead to unintended consequences. 

A second flaw that I find is that if the VA has been instituting 

broad-based eligibility reform proposal, which is supposed to expand the number of veterans that each network will serve while at 

the same time implementing the VERA plan, how can the VA even 

begin to accurately calculate the number of eligible veterans requiring care in the present system or even forecast future enrollment 

numbers? Further, how can the VA accurately track the real-world 

impact of the reforms while they’re shifting money from network 

to network? Shouldn’t they wait until they know what the numbers 

are? 

Additionally, and more to the point, my greatest concern is that 

these reforms will result in a reduction in the quality and accessibility to health care that veterans deserve and depend on. 

As we speak, the VA’s medical inspector’s office is finalizing its 

in-depth examination of conditions at Castle Point and Montrose, 

but the results won’t be available for at least 2 to 3 months. 

Additionally, while we are trying to get to the bottom of these reports, we have the network leadership making blanket statements 

about their ability to deliver quality care without waiting on the 

medical inspector’s reports or even the final Joint Commission on 

the Accreditation of Hospitals’ report. 

The VA has a credibility gap, to say the very least. And to fault 

these types of correspondence against the present backdrop does 

nothing to restore the full faith and confidence of our veterans in 

their VA system. 

It’s because of these latest actions on the VA’s part that I’m looking forward to an impartial, unbiased audit of our network by the 

GAO whereby they will be reviewing the human impact of the 

VERA model on the VA’s ability to deliver quality health care in 

New York. This is the language which I and many of my colleagues 

here work to secure in the fiscal year 1998 VA/HUD appropriations. 

Our veterans, like all citizens, deserve answers from their government that are clear and truthful. And I’m sorely afraid that we 

have not yet reached this point. Hopefully this GAO study will 

shed some much needed light on some of the unintended consequences of VERA’s implementation. 

So while we have no idea what the GAO may or may not conclude in their reports, I have faith that they will conduct at least 

a fair and honest accounting of the situation, just as they have in 

their past reviews of the VA and the VERA program. 

Finally, Mr. Chairman, I’d like to close by quoting the same May 

1997 report I cited earlier, which concluded that delaying a decision on VA’s legislative proposals until critical information is available, including a plan describing how the system will look and operate in 2002, may result in a better legislative decision on the 

VA’s budget proposal. It will also afford the VA and the Congress 

better time to assess how VA’s future resource needs may be affected by the new decentralized management and resource allocation initiatives. 

This is a very important point. It is this very delay I’ve been 

pressing for over these past 9 months. I will continue working for 

27

high-quality medical care that is immediate and accessible for all 

of our veterans until we get all of the answers. 

I look forward to the testimony of our witnesses. And thank you, 

Mr. Chairman, for allowing me to take part in the proceedings. 

[Applause.] 

[The prepared statement of Hon. Sue Kelly follows:]

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Mr. SHAYS. I want to thank all of you because I know a number 

of you are standing. Let me just say that for some of you who are 

sitting, maybe in an hour or so you will be able to relinquish your 

chair to someone who is standing. 

This hearing will probably go on beyond 5 o’clock today. Let me 

just state how we are going to proceed. We have two panels that 

will be addressing this subcommittee. We will be asking them questions. And the third panel will be people from the audience, who 

will be invited at random to address us and make the points that 

you would like to make. I will tell you as the chairman of this committee I will stay here quite a long time to make sure that we hear 

from as many people as possible. 

We are transcribing this hearing. We have an official record of 

this hearing. And I want to say to all of you the purpose of this 

hearing is to make change. We want to learn as much as we can 

learn. 

And I just need to get one housekeeping part taken care of and, 

ask unanimous consent that all members of the subcommittee be 

permitted to place any opening statement in the record and the 

record remain open for 3 days for that purpose. And, without objection, so ordered. 

And I ask further unanimous consent that all witnesses be permitted to include their written statements in the record. And, without objection, so ordered. And I will invite anyone from the audience as well to submit a written statement, and it will be part of 

the record and will be reviewed. 

[The prepared statement of Hon. Alphonse D’Amato and public 

submissions follow:]

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Mr. SHAYS. We will not be taking questions from the audience, 

but at this time we will be inviting our witnesses. Our first witness, Mr. James Farsetta, who is the Director of Veterans Integrated Service Network 3; accompanied by——

[Chorus of boos.] 

Mr. SHAYS. May I make a request? I have to have enough faith 

in all of you here that you will recognize that the purpose of this 

hearing is to get the truth. I can welcome applause. I can welcome 

applause for issues you agree. But I can just say to you from the 

bottom of my heart we cannot have you be rude to people. That is 

the one request I make. And I make a request that you respect the 

work of this committee for being here and that we will learn and 

make the changes necessary. 

And, as a Member of Congress, I do not place all the blame in 

one direction. Congress has to take some of the blame. The administration has to take some of the blame as well. 

We will get to the truth. We will get to the truth. And at this 

time, Mr. James Farsetta, who is the Director of Veterans Integrated Service Network 3; accompanied by Ms. Maryanne 

Musumeci, who is the Director of the Bronx VA Medical Center; accompanied by Mr. Mike Sabo, Director, Hudson Valley VA Health 

Care System. We will also be hearing testimony from Dr. Nancy J. 

Wilson, Director, VA Office of Performance Management. 

As is the practice of this committee, we swear in all our witnesses who will be testifying, even Members of Congress when they 

testify. And I would invite all of you to stand up and raise your 

right hand, please. 

Do you solemnly swear or affirm that the testimony you will give 

before the subcommittee will be the truth, the whole truth, and 

nothing but the truth? 

Mr. FARSETTA. I do. 

Ms. WILSON. I do. 

Mr. SABO. I do. 

Ms. MUSUMECI. I do. 

Mr. SHAYS. For the record, all four have stated in the affirmative. Mr. Farsetta, it’s very nice to have you here today, sir. Thank 

you very much. You may begin. 

Mr. FARSETTA. Thank you. 

STATEMENTS OF JAMES FARSETTA, DIRECTOR, VETERANS INTEGRATED SERVICE NETWORK 3, ACCOMPANIED BY 

MARYANNE MUSUMECI, DIRECTOR, BRONX VA MEDICAL 

CENTER; MICHAEL A. SABO; DIRECTOR, HUDSON VALLEY VA 

HEALTH CARE SYSTEM; AND DR. NANCY J. WILSON, DIRECTOR, VA OFFICE OF PERFORMANCE MANAGEMENT 

Mr. FARSETTA. Mr. Chairman, Congresswoman Kelly, Congressman Gilman, Congressman Hinchey, veterans, family members, 

community leaders, community individuals, thank you for the opportunity to appear before the subcommittee and provide information regarding the restructuring of services and the quality of care 

at the Castle Point and Montrose VA Medical Centers. 

As you know, in recent years VA had been receiving mounting 

criticism from Congress, General Accounting Office, private health 

care systems, and veterans about being a bureaucracy that cared 

41

for too few veterans with too many hospitals and too many beds. 

In acknowledgment of these varied concerns, the VA health care 

nearly 2 years ago adopted a new vision for how veterans’ health 

care would be delivered. 

Dr. Kizer, the Under Secretary of Health, published his ‘‘VISION 

for CHANGE.’’ In that document, which was shared with Congress 

and other stakeholders, he outlined a plan to streamline the bureaucracy, reduce excess staffing, close unused beds, improve patient satisfaction, and shift resources to take care of more veterans 

on an outpatient basis closer to their homes. A new network structure of 22 Veterans Integrated Service Networks, VISNs, was set 

up to ensure quality care and improve efficiency. During the past 

2 years, VHA has undergone tremendous change throughout the 

entire system, including New York. 

The private sector health care community has called this change 

innovative and remarkable and has said, ‘‘It is about time.’’ In the 

New York/New Jersey VISN, we have been doing many things that 

our colleagues have been doing across the country. We have carefully monitored the pace of change to ensure that care has not been 

affected. Many of our overall care indicators with respect to quality 

have actually improved. In addition, patient satisfaction across the 

network has also improved according to recent surveys. 

The VA serves a patient population that is older, more burdened 

with disease, and has more problems overall than those seen by 

other health care providers. Please understand that these risk factors would not excuse even a single occurrence of flawed care, but 

mistakes occur in every system in which people are involved in 

something as difficult as health care. 

However, with these allegations of poor care, we take them very 

seriously. When those indicators come from within our own monitoring system or come from the veterans themselves, we do what 

it takes not only to make things right but to ensure that the situation doesn’t happen again. 

We have carefully reviewed each case that has been brought to 

our attention during the past few months either by the media, our 

elected representatives, veterans, or veterans’ family members. It 

troubles me deeply about the stories of poor care. And if I didn’t 

say it before and if we didn’t say it earlier, I want to offer my personal apologies to any veterans and their families for care that we 

did not provide that we should have provided. 

We can all understand the pain of a family member whose sole 

purpose is the compassionate care and treatment of their loved 

ones. Our veterans have earned this care because they gave so 

much of their service to this country. And the only reason that we 

are here today is because of that service. 

For those cases that have been spotlighted, I want every patient 

and family member to know that we are working to ensure that 

their concerns are fully addressed and that any failures that may 

have occurred never happen again. This is my first priority and, 

therefore, the priority of each and every staff member at Castle 

Point and Montrose and in the rest of the network. 

For highlighting many of these incidents, I want to thank our 

congressional representatives and our service organization leaders 

for their undying concern and efforts on behalf of our veterans. 

42

We do acknowledge that there are some longstanding issues that 

are cause for concern I am not completely satisfied with the overall 

physical plant and cleanliness of the environment. There are problems with waiting times to see care-givers, waits to get appointments, and waits at our pharmacies. Our standard expectations for 

basic customer services are not being met as often as they should 

be. There are also issues with staff-to-patient communication and 

staff-to-family communication that also exist. These problems are 

either being addressed or have been addressed. And I won’t be satisfied until our patients and family members tell us that they are 

satisfied. 

As I have said before, I will never tell you that every veteran 

who enters our hospitals or clinics gets perfect care. I can’t say that 

because we could never achieve 100 percent perfection. I will tell 

you, however, that Castle Point and Montrose VA Medical Centers 

and Nursing Homes took care of over 16,000 veterans during the 

past year. And the vast majority of those patients are pleased with 

the care that we provide. 

Our monitors, both internal and external, as well as discussion 

with veterans and their families indicate that the care provided in 

the VA Hudson Valley Health Care System is quality health care. 

However, to provide us with even greater assurance, I have asked 

the two medical centers to contact a large sample of families of our 

inpatients to see if the allegations of systematic substandard care 

were true or perceived to be true. 

I am happy to report that the overwhelming majority of families, 

patients who were contacted are very satisfied with the care that 

they received. However, there clearly is a problem as evinced by 

the people in this room today. And I and my staff are here to listen 

to their concerns. 

As for the VA medical inspector’s visit, we anxiously await, as do 

the congressional representatives, the results of the team’s review 

of the care provided to our veterans. I initially requested the review by the Office of Medical Inspector and have ensured that the 

Hudson Valley Medical Centers provide full cooperation in this important analysis. I can tell you that we are not waiting for the final 

report to make changes to further ensure the quality health care 

of our veterans. 

Mr. Mike Sabo, who is the new permanent Director of the VA 

Hudson Valley Health Care System, has experience in operating a 

large two-division hospital. He brought that experience to the Hudson Valley and followed up with his excellent work at the Brooklyn 

VA Medical Center. 

This was also followed by the excellent work done by Ms. 

Maryanne Musumeci, who was at Montrose-Castle Point for the 

past 3 years attempting to deal with a number of issues that have 

been raised in the media and raised by our congressional representatives. 

Finally, in addition to serving over 3,500 brand new veteran 

users, we have also improved access and services to veterans in the 

entire Hudson Valley region. We have opened a new outpatient 

clinic in Rockland County and have just received approval for a 

clinic in Yonkers. We have also expanded services in White Plains, 

and have clinics currently in process for Kingston and Monticello. 

43

It is truly my desire to open a number of new clinics in all corners 

of the Hudson Valley to better serve our veteran patients. Veterans 

who use these clinics are overwhelmingly satisfied with the services that are provided. A new mobile health van is also operating 

exclusively in the Hudson Valley to reach out to areas that have 

been under-served by the VA and to pockets of veterans in socioeconomically disadvantaged areas, as well as direct outreach to 

homeless veterans in our more urban localities. 

I want to thank you for the opportunity to share my thoughts 

with you today. Please be rest assured that our first priority is 

compassionate, high-quality care for our Nation’s veterans. Anything less than that is unacceptable to me and the dedicated employees of the VA health care system. 

I will gladly attempt to answer any questions that any of you 

may have. 

[The prepared statement of Mr. Farsetta follows:]

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Mr. SHAYS. Thank you, Mr. Farsetta. 

Dr. Wilson. 

Ms. WILSON. I, too, thank the committee for the opportunity to 

attend this hearing and listen to the concerns of all veterans here 

today. 

VA has multiple strategies to assess and monitor and improve 

the quality of care that we deliver. A number of these include 

credentialing and privileging, accreditation programs, and performance indicators that measure how well we deliver bread-and-butter 

care to veterans across the country. 

In addition to that, we also have as one of our mainstays our customer feedback program that includes our patient advocacy program, our satisfaction surveys, and also our complaint assessment 

and tracking and resolution. 

In addition to that, we have an incident review process. And, in 

fact, we’ve recently, on June 6, implemented a policy to ensure that 

each and every incident that results in an untoward outcome be examined in depth to assure that that event never occurs again. Such 

events, described as sentinel events, will now be reported to headquarters within 48 hours of their occurrence along with the reviews 

and recommendations for system redesign. 

Our outside independent medical——

Audience PARTICIPANT. Hold it. 

Audience PARTICIPANT. Hold it. Hold it. 

Audience PARTICIPANT. Hold it. 

Mr. SHAYS. Slight recess. 

[Recess.] 

Mr. SHAYS. The committee will come to order. Dr. Wilson, you 

have the floor again. 

Ms. WILSON. Thank you. 

As I had said, on June 6, we implemented a policy to ensure that 

each and every incident that results in an untoward outcome be examined in depth to make sure that the system is redesigned in 

such a way as to prevent that incident from ever occurring again. 

And we now require that all such sentinel events be reported to 

headquarters within 48 hours of their occurrence along with the reviews and recommendations for system redesign. The failure to report may result in disciplinary action. These reviews will be assessed for their adequacy by our outside and independent medical 

inspector’s office. 

In light of the need to listen to folks, that ends my testimony. 

And I will be happy to answer any questions. 

Mr. SHAYS. Thank you, Dr. Wilson. 

We will have questions, and we will begin with Mr. Gilman. 

Mr. GILMAN. How about Dr. Sabo? 

Mr. SHAYS. No, no. My understanding was that they were accompanying you, Mr. Farsetta? 

Mr. FARSETTA. Yes. 

Mr. SHAYS. And they will respond to questions and assist you? 

But we have two statements. 

Mr. FARSETTA. Right. 

Mr. SHAYS. We want to get to the service representatives. Then 

we want to get to the members of the audience and allow them to 

address this committee. 

51

Mr. GILMAN. Thank you, Mr. Chairman. 

I hope that the young lady in the back there is feeling better. I 

understand it was just heat exhaustion. 

Mr. Farsetta, could you please explain for the committee the 

VA’s response to those allegations that appeared in our local newspaper which allege that the mortality rate at Castle Point doubled 

from October 1996 to April 1997? There’s been a great deal of comment with regard to that information. 

Mr. FARSETTA. Well, my response to that is that we have looked 

at all the data. We have gone back essentially 3 years, compared 

the mortality rate over that period of time. We see monthly fluctuation, but we see no marked change in the mortality rate at either 

Castle Point, at Montrose over the past 3 years. 

One of the newspapers in this area was given all the information 

that we had. They sent it out to an independent statistician. He reviewed the data. He arrived at the same conclusion. 

Dr. Wilson could probably respond to that question since they 

have also looked at the data. 

Ms. WILSON. Yes. The statistician in my office also looked at the 

data for the times in question and found no difference in the rate 

from 1996 to 1997 for those months. There’s no statistically significant difference in the rates. 

Audience PARTICIPANT. You can get stats to say anything you 

want. 

Mr. GILMAN. Mr. Sabo, who is our new director of our Castle 

Point facility, can you tell us what’s been done to improve communications between staff and patients since this situation started 

last May? 

Mr. SABO. Thank you, Congressman. And it is a pleasure for me 

to be back in the Hudson Valley. Part of what I have instituted 

since I got there on July 20 was to re-energize patient councils in 

the nursing home units. This would be an attempt to try and solicit 

feedback from those patients on areas where they have concern 

with the quality of the food, the quality of the patient care, recreational activities. 

In addition to that, I’ve reinstituted family council meetings at 

both the Castle Point and Montrose facilities, whereby representatives of the families will have a venue to come in and talk about 

issues regarding the care being delivered at both places. 

I am going to be assessing our patient representative program to 

ensure that both of those—that’s the ombudsman piece of our program—to make sure that they’re actually listening to folks and 

that information is fed to me on a regular basis. 

I’ve met with many of the county veterans’ representatives already and talked to them about their concerns they have toward 

the facility and spoke to families. 

I do have an open-door policy. If there are concerns, I certainly 

want to hear those. And I’ll make every attempt to correct those 

areas that need to be corrected. 

Mr. GILMAN. Thank you. 

Mr. Farsetta, you’ve already improvised a number of reductions 

in staff and some of the expenditures. What future reductions in 

staff and services can be expected in the next 6 months? 

52

Mr. FARSETTA. I’m not anticipating any future reductions in staff 

over the next perhaps year or two. I know that there was a letter 

that was distributed by Acting Secretary Gober or Secretary Designee Gober indicating that neither the Castle Point nor the 

Montrose VA facility will be closing. 

Our goal essentially is to in a number of areas, as I mentioned 

earlier, attempt to expand services so we could reach out to more 

veterans in the Hudson Valley area. 

I neglected to mention in my opening statement that in response 

to, I believe a comment made by, you, that the Chief of Medical Administration is currently meeting this afternoon with representatives from our other hospitals exploring the feasibility of providing 

some surgical services to the residents and veterans of the Hudson 

Valley area. 

Mr. GILMAN. That would be contract services to the local hospitals? 

Mr. FARSETTA. That’s correct. 

Mr. GILMAN. So they don’t have to travel to Albany or to Bronx? 

Mr. FARSETTA. That is correct. 

Mr. GILMAN. Appreciate that. 

Dr. Wilson, you’re in the—we’re talking about Castle Point. Dr. 

Wilson, what are the short-term plans for the Castle Point facility 

and the long-term plans? We keep hearing that Castle Point may 

be eventually phased out. Can you tell us what your program people are doing with regard to Castle Point? 

Ms. WILSON. I would quote a letter from Dr. Kizer to the honorable Ben Gilman, Mr. Gilman, that says the Department of Veterans Affairs has no plans to close the Castle Point Medical Center. 

However, I would also like to reaffirm that in accordance with 

Network 3’s strategic plan, the following are some of the anticipated changes in service delivery models and clinical care strategies, over the next fiscal year: integration of radiology, nuclear 

medicine, and lab services with the Bronx VA Medical Center, development of a consolidated kitchen throughout the network utilizing cook-chill technology, development of two to three community-based clinics in the Castle Point catchment area, and initiation 

of a community-based mobile health van. 

Mr. GILMAN. And then from what you’re telling me, there is no 

immediate plan to close Castle Point. Am I correct? 

Ms. WILSON. That’s correct. 

Mr. GILMAN. Nor close Montrose. Is that correct? 

Ms. WILSON. That’s correct. 

Mr. GILMAN. Thank you. 

Audience PARTICIPANT. Put it in writing. 

Mr. GILMAN. My time has run, Mr. Chairman. 

Ms. WILSON. It is in writing. 

Mr. SHAYS. I just want to make sure that you all realize this is 

testimony under oath. 

Mr. Hinchey. 

Audience PARTICIPANT. That don’t mean crap. 

Mr. HINCHEY. Ladies and gentlemen, first of all, let me thank 

you for some things that you have talked about here this afternoon 

in your testimony, which I think will be helpful and will improve 

care for veterans. 

53

First of all, Mr. Farsetta, you mentioned the establishment of 

clinics in Rockland County and in Westchester County and plans 

for a clinic in Kingston and one in Monticello. We have been working with you on these clinics, and I think that that is a very important and very positive step forward. 

Dr. Wilson, you mentioned that there will be a number of reports 

that will be issued if there are untoward incidents I think you put 

it. I think that is very good, but let me ask you a couple of questions about that. 

First of all, how would you define an untoward incident? 

Ms. WILSON. We define a sentinel event in the same way that the 

Joint Commission of Accreditation of Hospitals does, which is permanent loss of life, limb, or function. We also——

Audience PARTICIPANT. How many civilians have that? 

Ms. WILSON. Those sentinel events are what will be called into 

headquarters. They will be called from the facility to the network 

office within 24 hours of their occurrence and then 24 more hours 

to the headquarters office. We will then track the results of the reviews of all of those events. 

Mr. HINCHEY. Is this a new policy that you’ve recently implemented? 

Ms. WILSON. June 6, 1997. 

Mr. HINCHEY. June 6 of this year? Will there be any outside review of those event reports? 

Ms. WILSON. The Medical Inspector’s Office will review the adequacy of the reviews that are done by the facilities and the networks in addition to our headquarters team looking for system redesign issues that we might want to implement across the country. 

Mr. HINCHEY. So there will be an outside objective analysis of 

those reports outside of the VA itself? 

Ms. WILSON. Yes. 

Mr. HINCHEY. Mr. Farsetta, you mentioned in your report, in 

your statement, and what you say here is, ‘‘Many of our overall 

care indicators with respect to quality have actually improved. In 

addition, patient satisfaction across the network has also improved 

according to recent surveys.’’

That statement strikes at the heart, really, of my concern because, first of all, it is counter-intuitive. Second, it runs counter to 

all of the evidence that we have seen over the course of the last 

couple of years. [Applause.] 

It is absolutely essential if we are going to get to the bottom of 

this problem—and I think we can all agree that there is a problem 

here. It is not just a problem of perception. [Applause.] 

It is a deep and abiding problem. If we are to get to the bottom 

of this, we, first of all, have to confront the situation honestly and 

objectively. 

And I must say to you, sir, that those kinds of statements, which 

I have heard you say before in private meetings that we have had 

and in meetings with the VA that we have had—I’ve heard you say 

those things before. And I just find it absolutely incredible because 

the fact of the matter is that we see time and time again documented examples that run completely to the contrary. 

Mr. FARSETTA. I don’t want to get overly defensive about that because, as I mentioned in my statement, there’s clearly an issue 

54

here. I’m going to attempt to respond to that in two ways. The VA 

does a survey, and Dr. Wilson can speak about it. It’s a scientific 

instrument that’s mailed out to veterans. And veterans respond to 

that instrument. 

We have also hired the Gallup Corp. to take that instrument and 

utilize that instrument, mail it out to veterans in the network, specifically in the Hudson Valley area. And everyone doesn’t get a 

questionnaire. It’s sent out to a sampling, what they consider to be 

a statistically-significant sampling. It’s mailed out. 

And what the survey says, the survey doesn’t say that everybody 

is happy with everything that’s going on. What the survey results 

indicate, that as compared to services that veterans received last 

year, they are happier this year than they were last year. It doesn’t 

mean that there aren’t many areas for improvement. I’m not suggesting that, and I wouldn’t suggest that. 

[The survey referred to follows:]

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Mr. HINCHEY. I think that it’s important for us to look at this 

again comprehensively and objectively. And I am going to forward 

to you copies of the complaints that we have received in our office. 

They are numerous, one might say legional. And I know that the 

other members of the committee have received more, I believe, in 

most instances than I have. 

And I would ask that they be factored into this analysis so that 

we do not have a kind of rose-colored glasses analysis of this situation and that we look at it carefully and objectively and completely 

and do so in the context of the information that has come to us in 

addition to the survey that you have received. 

There is something called the ‘‘Farsetta report.’’ Now, I have not 

seen the ‘‘Farsetta report,’’ but I am anxious to do so. And I have 

asked the VA on several occasions if they would kindly make available to us a copy of that report. I hope that we will get a copy of 

that report directly so that we can give it some careful analysis. 

I know that the report was some time ago, but it has been reported to us that many of the actions taken by Under Secretary 

Kizer have been driven to a large extent by the recommendations 

contained in the Kizer report. Is that accurate? 

Mr. FARSETTA. There certainly were recommendations in that report. I happened to chair a committee. And that report specifically 

was looking at some fairly substantial funding reductions in the 

VA. 

I think that as it relates, for example, to some of the integrations 

and as it relates to combining some administrative services, I think 

that there are similarities. But I don’t think that there are many 

similarities or an overwhelming variety of similarities between the 

‘‘Farsetta report,’’ which probably was done in maybe 1992, 1993 

or 1994, and what’s currently going on. There certainly are some 

items that are of a similar nature. 

[The letter and the report referred to follows:]

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Mr. HINCHEY. So the report, then, is 4 to 5 years old? It was done 

4 or 5 years ago? 

Mr. FARSETTA. Yes. 

Mr. HINCHEY. OK. Again, I want that report to be available, not 

just to myself but to other members of the committee. I think it’s 

important for us to look at it so that we can see what has been 

driving these actions and we could correlate the thinking that went 

on that occasioned some of the things that have been taking place 

within the VA. I think that’s important. 

I mentioned the clinics. And I congratulate you on that. I fully 

support what you’re doing in that regard. I think that is going to 

be helpful. And I think it will improve the quality of care. 

I also would make the observation, however, that it is not the 

outpatient care that is of particular concern. It seems to me based 

upon my observation that most people are fairly satisfied with the 

quality of care that is being delivered on an outpatient basis. 

That’s the quality of care which would come from these clinics. 

[Chorus of boos.] 

Mr. HINCHEY. That may not be the case. [Laughter.] [Applause.] 

So far as the information that has come to our attention, it is primarily the inpatient care——

Audience PARTICIPANT. That’s right. 

Mr. HINCHEY [continuing]. That is really at the larger part of the 

issue. So I think that while the clinics are going to be helpful—and 

I fully believe that that does not reduce the need for our commitment to assure that the quality of care internally continues to be 

good. 

Mr. FARSETTA. I agree. 

Mr. HINCHEY. Now, as I understand it, your intention is to contract out for the care of these clinics. Is my understanding correct 

about that? 

Mr. FARSETTA. No. I think that we are going to be joint venturing 

with Network No. 2 in the Kingston clinic. And the model that they 

use is they do some contracting out for their community care, their 

outpatient care. And we’re going to pilot with them. In some of the 

other clinics in Network No. 3, we have not gone to the contract 

model. We have used a staff model. 

There are some individuals, some veterans, who seem to like the 

contract model. We’re going to try the contract model and see how 

it works and whether the veterans like it or not. 

Mr. HINCHEY. I’m also aware of—you mentioned a few moments 

ago—let me put it this way—that there were no further reductions 

in staff that are being completed. But I know also that you’ve sent 

out information recently which talks about buyouts. 

Mr. FARSETTA. Yes. 

Mr. HINCHEY. Now, as a result of those buyouts, there will be a 

reduction in personnel at both hospitals. I think the number ultimately is something in the neighborhood of 28. 

Now, you were obviously considering that when you said that 

there would be no further reduction. So what you’re saying is that 

after these 28 buyouts, there will be no further reductions in personnel contemplated? 

Mr. FARSETTA. That’s correct. 

Mr. HINCHEY. That’s correct. 

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Mr. FARSETTA. I apologize for not factoring that into consideration. And let me raise this and so I can be straight about it, that 

there are some positions that may be eliminated. OK? 

So we may eliminate any administrative position. And that job 

will not be filled, but then we will substitute someone else into that 

job in a different area, perhaps in a patient care area. So it is conceivable that 28 folks may leave, but 28 other people may be hired 

in very different jobs than the people who were in those jobs. 

Mr. HINCHEY. Well, that’s nice to hear. However, I notice the 

word ‘‘conceivable,’’ and I am not comfortable with the word ‘‘conceivable.’’ If you are telling me that when these 28 people leave and 

in the context of their leaving they will largely support administrative personnel, that you are analyzing this situation in a way that 

you expect to bring in additional health care personnel to fill those 

28 blank positions, then I find some comfort in that. But if you’re 

telling me that it’s only conceivable, then I’m not comfortable. 

So how likely is it to happen? 

Mr. FARSETTA. Since I’m on the road, I don’t want to give you 

a definitive answer, but I will provide that information to you factually. 

[The information referred to follows:]

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Mr. HINCHEY. My time is up, and I thank you. 

Mr. SHAYS. At this time, Ms. Kelly, you have the floor. 

Ms. KELLY OF NEW YORK. Thank you. 

Mr. Farsetta, when you and your deputy directors are graded on 

your annual review, isn’t it true that you’re graded on the basis of 

your ability to implement the VA’s long-term programming as written in the performance agreement, network director performance 

measures for the VISNs? 

Mr. FARSETTA. That’s correct. 

Ms. KELLY OF NEW YORK. Are not four out of five incentive measures in your performance agreement based on fiscal, rather than 

patient care standards? 

Mr. FARSETTA. No. Nancy, you may want to speak to that. 

Ms. KELLY OF NEW YORK. I have that right here in front of me, 

and it looks that way to me. [Applause.] 

Ms. WILSON. That is not true. 

Mr. FARSETTA. That’s not true. 

Mr. SHAYS. Excuse me. I need you just to repeat whatever answer because we are transcribing this, and I just need to make 

sure your responses are clear. I’m sorry. Dr. Wilson. 

Ms. WILSON. They are not fiscal. Four out of five of the performance measures are not fiscally driven. 

Ms. KELLY OF NEW YORK. How do you account for that when 

they’re talking about incentive measures as being patient satisfaction is the last one listed, bed days of care per patient—that means 

cutting them—insufficiency in C&P exams? These are things listed 

as incentive measures—the ambulatory surgery, primary care enrollment—these are things listed as incentive measures. 

Ms. WILSON. I would like to speak to that. The patient satisfaction measure is one of the first times in the history of health care 

that administrators——

Ms. KELLY OF NEW YORK. Let’s deal with the rest of them because that’s the last one. 

Ms. WILSON. There is no order to them in terms of the listing 

that you have. Patient satisfaction is very definitely an outcome 

measure that is a quality outcome measure. And this is one of the 

first times in health care that administrators are held accountable 

for their very livelihood based on patient satisfaction scores. 

The chronic disease index is a measure of how well we do things 

like get eye exams for our diabetics, how well we assess their sensation in their feet, how well we check their pulses, whether or not 

we measure blood tests for them. Our ischemic heart disease measures relate to whether or not patients who have had a heart attack 

get aspirin or beta blockers, a medication that has been shown to 

save lives, how well we monitor their cholesterol management. Our 

obesity measures relate to giving counseling for weight and exercise. Our hypertension measures relate to——

Ms. KELLY OF NEW YORK. I’m sorry, but you’re listing things. 

What I’m looking at is this incentive measures, where, in fact, I’m 

talking about in the top part of this agreement, it says, ‘‘categorized by specific mission goals.’’

Ms. WILSON. I think that you have a document that is old. 

Ms. KELLY OF NEW YORK. I have a document that is from the 

VA. 

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Ms. WILSON. I wrote the 1997 performance measures agreement, 

and I can submit for the record every measure that is in there. I’m 

intimately familiar with them. 

Ms. KELLY OF NEW YORK. This document is 4–17–96. Has this 

been rewritten? 

Ms. WILSON. It has been rewritten. 

Ms. KELLY OF NEW YORK. This is the latest one that Dr. Kizer’s 

office was able to supply us. 

Ms. WILSON. I will be happy to submit the 1997 performance 

agreements, where the majority of the measures are quality-driven. 

Ms. KELLY OF NEW YORK. Dr. Kizer said this was the latest one. 

Mr. SHAYS. Would the gentle lady yield? 

Ms. WILSON. It’s a mistake. 

Mr. SHAYS. Just for the record of the committee——

Audience PARTICIPANT. Dr. Kizer comes up with——

Mr. SHAYS. Excuse me. Excuse me, sir. Just for the record, just 

because we need to make sure we’re clear on this, the document 

that Ms. Kelly asked you, the document that preceded the one that 

you worked on, was that the operative document? 

Ms. WILSON. That was the operative document between May 

1996 and October 1, 1996. The operative document for fiscal year 

1997 is the one that you must not have. We were able to implement a number of quality indicators that were quantitative in the 

fiscal year 1997. 

In the fiscal year 1996, the quality indicators were instituting 

telephone triage, admission and discharge planning. There are a 

number of things on there. 

Mr. SHAYS. Dr. Wilson, let me just be really clear on this just because it would be in terms of candidness. When you were responding to a question, it sounded to me like this wasn’t a document that 

had been adhered to by the VA. I just need to know what——

Ms. WILSON. Oh, it was. 

Mr. SHAYS. In the document that she’s referring to that preceded 

the reform, was this the way an individual was graded? Were 

those——

Ms. WILSON. This was the way. This document represents how 

the network directors were graded between May and October 1996. 

Mr. SHAYS. So the candid answer would have been, ‘‘This was the 

document used, but we have changed it?’’

Ms. WILSON. That would be the candid answer, but the other 

part of that answer would be that there are more quality indicators 

than financial indicators in that 1996 document. 

Mr. SHAYS. OK. Can we just take the 1996 document and 

just——

Ms. WILSON. Yes. 

Mr. SHAYS. If you would just tell us what is different? And I 

would give back the floor to the gentle lady, who really controls the 

time here. She had five items. And I just need to know. You don’t 

seem to have that document in front of you, but are they—is this 

the only document you have? 

Ms. KELLY OF NEW YORK. I have another copy. 

Mr. SHAYS. You have another copy? Could you just tell us if that 

document represented a complete evaluation or what would have 

been left out of it? 

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This was given to you by Dr. Kizer? 

Ms. KELLY OF NEW YORK. It was given to me from two different 

VA sources: Dr. Hogan and Dr. Kizer. And they said that this was 

current. 

Ms. WILSON. If I may read the first sentence, ‘‘The following 

measures have been chosen for inclusion in the network director’s 

May to September 1996 performance agreements.’’

Mr. SHAYS. And in that, what are the items, just in that——

Ms. WILSON. ‘‘Hire your key personnel; write a strategic plan; implement telephone liaison programs at all facilities; a temporary 

lodging program; institute a system where people have beds available that don’t need to be admitted to the acute care wards but are 

traveling long distance for outpatient procedures; admission and 

discharge planning programs; utilization review programs; clinical 

guidelines; functional assessment of spinal cord injury patients; not 

delaying prosthetic orders; primary care enrollment,’’ which is the 

veteran saying there’s somebody in charge of their care; ‘‘ambulatory surgery, which is a financial utilization measure; insufficient 

C&P exams’’ means that when the veteran comes for a C&P exam, 

a comp and pen exam, it’s done adequate the first time. ‘‘Bed days 

of care’’ is a financial utilization measure. 

Mr. SHAYS. Does this represent—I appreciate the gentle lady 

yielding me back her time for a second. Does this represent what 

new mandates in addition to other mandates that exist or is this 

the total in which a supervisor is going to be evaluated? 

Ms. WILSON. This is part C of an overall performance plan, 

where there is a part A and a part B as well. 

Mr. SHAYS. Thank you. 

Ms. KELLY OF NEW YORK. Thank you very much. 

I have two more questions, Mr. Chairman. Is that all right? 

Mr. SHAYS. Sure. 

Ms. KELLY OF NEW YORK. OK. Mr. Farsetta, to date how many 

millions of dollars have you taken out of the Castle Point-Montrose 

system according to the implementation of VERA? 

Mr. FARSETTA. I would say in the vicinity as if one looks at 1996 

to 1997——

Ms. KELLY OF NEW YORK. A full fiscal year if you can give me 

that, please. 

Mr. FARSETTA. A total of about $4 million. 

Ms. KELLY OF NEW YORK. About $4 million? 

Mr. FARSETTA. Yes. 

Ms. KELLY OF NEW YORK. And we are due to have a total reduction of about $149 million. Is that correct? 

Mr. FARSETTA. $148 million under the VERA model. 

Ms. KELLY OF NEW YORK. $148 million under the VERA model? 

Mr. FARSETTA. But that’s for the entire network. That is just not 

for the two hospitals. 

Ms. KELLY OF NEW YORK. OK. For the VERA network? 

Mr. FARSETTA. For the network. 

Ms. KELLY OF NEW YORK. Which you are in charge of. 

Mr. FARSETTA. That’s correct. 

Ms. KELLY OF NEW YORK. Is that not correct? 

Mr. FARSETTA. That’s correct. 

Ms. KELLY OF NEW YORK. You are in charge of the entire VISN? 

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Mr. FARSETTA. That is correct. 

Ms. KELLY OF NEW YORK. Now, according to this performance 

agreement——

Mr. FARSETTA. Right. 

Ms. KELLY OF NEW YORK [continuing]. The incentive measures 

that are incorporated in this agreement, from what I understand 

from this, you will receive a bonus for cutting the full $149 million 

from our network when you achieve the reduced patient care incentive measures as your direction agreement. 

[Chorus of boos.] 

Mr. FARSETTA. I think that I’m not going to respond to that. I’ll 

let Nancy respond to that since Nancy is the one who authored 

that. And it really is much greater than just cutting the dollars. 

Ms. KELLY OF NEW YORK. Is it or is it not——

Mr. FARSETTA. I could cut the dollars and lose my job. 

Ms. KELLY OF NEW YORK. Is it or——

Mr. SHAYS. Excuse me. The gentle lady will suspend. Believe it 

or not, we do want to hear what the witness is saying. And I just 

plead with you. As veterans, I plead with you to show respect to 

individuals whom you may—I plead with you to show respect as 

veterans to people who are testifying to this committee. 

Dr. Wilson, if you would respond to that question? And would 

you ask the question again? 

Ms. KELLY OF NEW YORK. All right. I’d like, really, Mr. Farsetta’s 

answer if I could get it before——

Mr. SHAYS. Well, Dr. Wilson——

Ms. KELLY OF NEW YORK [continuing]. Dr. Wilson, but it’s my 

understanding, Mr. Farsetta, that you will receive a bonus for cutting the full $149 million from our network based on achieving the 

reduced patient care incentive measures as per your directions 

agreement. 

Mr. FARSETTA. Not true. 

Ms. KELLY OF NEW YORK. Well, that’s what it says in the——

Mr. FARSETTA. Not true. 

Mr. SHAYS. Dr. Wilson. 

Ms. WILSON. I concur with Mr. Farsetta. The performance measures in the 1997 agreement are a list of measures, some of which 

address utilization and as a proxy for cost. But all the other measures are quality measures. 

And it is the composite performance on the performance agreements that makes up the majority of the rating that the network 

director achieves in that timeframe. 

Ms. KELLY OF NEW YORK. I want to quote to you from a General 

Accounting Office testimony that was in front of the Senate Subcommittee on VA, HUD, and independent agencies, the Committee 

on Appropriations. This was testimony that was released Thursday, 

May 1, 1997. On Page 17, it says, ‘‘Performance measures and 

standards developed by headquarters are the key components of 

VA’s monitoring process. Headquarters holds network directors accountable for making progress toward VA goals by including measures and standards of performance in the director’s contracts.’’ And 

it goes on in this report to state that the directors receive a bonus 

directly due to the amount of money they are able to save in their 

VISNs. 

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Now, I need to know whether this is true or not. I think the people in this room are entitled to an answer. [Applause.] 

Mr. FARSETTA. That isn’t true. We were given an answer. That 

is not true. It is not true. 

Ms. WILSON. It is not true. It is not true. The bonus——

Mr. SHAYS. Excuse me. The lady will suspend. I’m sorry. We cannot hear the witnesses when we hear response from the audience. 

And I will continually interrupt this hearing until we are able to 

hear the witnesses. I am going to stay here as long as I have to 

stay, but I would like this hearing to be conducted in a way we can 

hear the witnesses. 

Dr. Wilson, I apologize for the interruption. 

Ms. WILSON. The bonuses are given on the basis of performance 

on part A, part B, and part C of the performance plan. The measures that we have talked about are part C. There is no measure 

in the agreement that says you must cut this amount of money. 

Mr. GILMAN. Will the gentle lady yield? 

Ms. KELLY OF NEW YORK. Yes, I will. 

Mr. GILMAN. Dr. Wilson, did Mr. Farsetta receive a bonus for the 

reductions and the revision of service in our region? 

Ms. WILSON. I didn’t give him that bonus. So I probably can’t officially answer that——

Mr. GILMAN. Well, did the administration give a bonus? Did he 

receive a bonus? 

Ms. WILSON. Yes. 

Ms. KELLY OF NEW YORK. And, Mr. Farsetta, it is my understanding that you will continue to receive bonuses for every time 

that you are able to take the money levels down until we reach 

that $150 million out of here. Is that correct? 

Mr. FARSETTA. No. 

Ms. KELLY OF NEW YORK. If not, why not? That’s exactly what 

you said. 

Mr. FARSETTA. No, that’s not what I said. I think that what Dr. 

Wilson indicated is that there are three parts to the performance 

agreement that I have with Dr. Kizer and that I need to demonstrate exceptional performance in all three parts, not in a single 

entity in one part of the performance agreement. So the bonus is 

not predicated on the amount of dollars I cut. 

Ms. KELLY OF NEW YORK. Remember, I have that agreement in 

front of me, Mr. Farsetta. We’re talking about the amount of primary care enrollment. We’re talking about the amount of ambulatory surgery. We have insufficient compensation and pension 

exams. 

Mr. FARSETTA. That has to do with a qualitative standard——

Ms. KELLY OF NEW YORK. That’s correct. 

Mr. FARSETTA [continuing]. Not a quantitative standard, a qualitative statement on the quality of C&P examinations gave and the 

amount that was remanded because they were incomplete. 

Ms. KELLY OF NEW YORK. The bed days of patient care, it says 

here, ‘‘To be fully successful, the bed days of patient care per patient will decrease in the aggregate of 20 percent. To be considered 

exceptional,’’ which you just said you wanted to be, they have to 

decrease in the aggregate by 30 percent. 

Now, Dr. Wilson, does that sound familiar to you? 

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Ms. WILSON. Those were the fully successful and exceptional performance goals in 1996, yes, for decreasing bed days of care across 

the county. 

Ms. KELLY OF NEW YORK. We don’t need to go into this any further. I think that I would like to submit some other questions later, 

but there are a lot of people standing. 

But, Mr. Farsetta, I have one last question for you. How much 

of an incentive bonus did you receive for your reforms? 

Mr. FARSETTA. $16,000. 

Ms. KELLY OF NEW YORK. $16,000? 

Mr. FARSETTA. That’s correct. 

Ms. KELLY OF NEW YORK. Thank you. 

[Chorus of boos.] 

Mr. SHAYS. Before I recognize Mr. Hinchey for backup questions, 

I do want to make sure we make sure the record is accurate. And 

I just again want to ask this question. As it relates to the performance of any supervisor who is given a bonus, is this one factor? 

Dr. Wilson, I just want to make sure that we’re really clear because the answer was pretty definitive that the reduction was not 

a factor in the bonus. Isn’t a more accurate response that it would 

be one of a number of factors that would be utilized in determining 

a bonus? I just think it’s important that both of you be very clear 

in responding. 

And I apologize for the noise that you’re receiving because this 

is important testimony. And I want you to think carefully. 

Ms. WILSON. I can speak to the fact that the objective measures 

in the performance agreement between September and October 

were part C of a performance plan that had a subjective component 

as well as the objective performance on these measures. And beyond that, the decision that the Under Secretary makes as far as 

who gets bonuses would be his. Does that help? 

Mr. SHAYS. Well, it helps, but we’re going to just pursue it a little bit better here. 

I want to encourage people who do a good job to receive a bonus 

if they’re doing a good job. And if they don’t do a good job, I obviously don’t want them to receive a bonus. 

It would strike me logically that there would be many factors for 

determining who would receive a bonus or not. I’m just a little concerned that the emphatic statement that this was not a factor 

under oath could be something that would be not something I’m 

comfortable with. 

The issue, it seems to me, is that you would be graded, Mr. 

Farsetta, on a number of factors, just not part C. I need to know 

that it does not include that at all, it is not a factor at all, or that 

it is a factor along with a whole host of other issues. That’s the two 

choices because the way the record stands now, it’s not a factor at 

all. 

Ms. WILSON. I would amend my testimony such that the performance plan includes a subjective component. And I cannot testify to 

all of the elements that are in or out of comprising the Under Secretary’s decision about that subjective part. So I would agree with 

you if that—I would agree with you. 

Mr. SHAYS. OK. I’m going to ask it another way, too. Mr. 

Farsetta, do you agree with that response? No. Don’t be——

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Mr. FARSETTA. Well, she——

Mr. SHAYS. Yes. 

Mr. FARSETTA. Well, the reality is that she’s closer to the logic 

Dr. Kizer uses to evaluate, closer than I am. 

Mr. SHAYS. Well, but that——

Mr. FARSETTA. It would be disingenuous of me to suggest that 

part of financial management wouldn’t be part of the consideration 

for my bonus. 

Mr. SHAYS. Would not be? I’m sorry. I missed that. It would be 

disingenuous what? 

Mr. FARSETTA. To think that it wouldn’t be part of the consideration. 

Mr. SHAYS. Well, you gave a very strong, emphatic answer in the 

beginning. And basically what I’m suggesting is you are amending 

your answer. 

Mr. FARSETTA. That’s correct. 

Mr. SHAYS. Not to pull this to the ‘‘nth degree’’ here, but I want 

to know from you, Dr. Wilson: What does meeting VERA’s targets 

play in the evaluation? Is it 1 percent, 10 percent, 40 percent? Can 

you get a bonus if you have not met VERA? 

Ms. WILSON. I have never had a discussion with the Under Secretary regarding VERA’s——

Mr. SHAYS. Let me just——

Ms. WILSON [continuing]. Role in having bonuses. So I don’t 

know the answer to that. 

Mr. SHAYS. Well, your response has been amended. We’ll follow 

it up, and staff will followup. I would like a sense of the answer 

to that question that Ms. Kelly asked. 

Mr. Hinchey, you have the floor. 

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Mr. HINCHEY. Well, Mr. Chairman, you have asked the followup 

questions that I was intending to ask because I think it is important to clarify this situation. Normally when people think, citizens 

think, about the people who work for the Federal Government, they 

generally think of them as being covered by Civil Service. But that 

is not the case in this particular situation, I gather, Dr. Wilson. 

People in supervisory positions—well, Mr. Farsetta, you are not 

a Civil Service employee. 

Mr. FARSETTA. Oh, yes, I am. 

Mr. HINCHEY. You are? You are covered under Civil Service? 

Mr. FARSETTA. Well, we’re part of the Senior Executive Service, 

which is part of Civil Service, yes. 

Mr. HINCHEY. And under that circumstance, there is a ruling 

which provides for the Veterans Administration to provide bonuses 

to people for what is evaluated to be a higher degree of service? 

Mr. FARSETTA. Yes. 

Ms. WILSON. Technically, it’s a performance award. My understanding is that the Federal Government does not give bonuses, 

but it is a performance award. But to me it’s the same thing. 

Mr. HINCHEY. Pretty much the same thing, isn’t it? 

Ms. WILSON. Yes. I’m just trying to be precise. I apologize to the 

group. 

Mr. HINCHEY. Well, I think the concerns of the Members of Congress are apparent at this particular——

Mr. SHAYS. Excuse me. Would the gentleman suspend? Excuse 

me. We need order here. Thank you. 

You have the floor. 

Mr. HINCHEY. I would just say this for myself. Particularly in 

view of my experience over the course of the last couple of years 

with the VA, conversations I have had, questions that I have asked 

and not received answers to, my experience over the last couple of 

years raises certain questions. And at question here is the issue of 

motivation. 

And what is on the minds of the Members of Congress is: Have 

we gotten to a point where we are rewarding people in sensitive 

positions within the Federal Government to cut funding, cut the 

amount of money that is being spent in such a way that jeopardizes 

the people that are supposed to be served? [Applause.] 

And I raise this this way because this is an important public policy consideration, one that needs to be examined by this committee, 

by the Congress, and by the administration. I think that is critically important. 

Now, I understand what is driving this. What is driving this is 

the alleged need to balance the budget and to cut funding and all 

of that business. But it seems to me in my observations recently 

that we have gone over the edge and that too much of our decisions 

are being driven purely by fiscal matters and not enough of them 

are being driven by human considerations. [Applause.] 

I would hope—I’m sure that the VA administrator, the acting administrator, Dr. Kizer, and others are aware of these hearings and 

they will go over this testimony. And I think it’s very important for 

us to look at this question because this is a fundamental issue of 

public policy. And I think it is one that has to be reviewed because 

it’s my judgment that we have gone too far. [Applause.] 

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Mr. SHAYS. Thank you. 

Mr. Gilman has a followup question. Then we’re going to go to 

our next panel. 

Mr. GILMAN. Dr. Wilson, in looking over the incentive measures 

under the performance agreement, I find that—I’m looking at the 

old one. If this differs from the new one, please let me know. We’re 

looking at the performance measures. 

The denominator for calculating the percentage of patients enrolled in primary care will be ambulatory care customer satisfaction. And to be fully successful, 65 percent of the patients enrolled 

in primary care, exceptional performance requires that 90 percent 

of VISN number of patients in the aggregate be enrolled in primary 

care. Is that still part of the performance? 

Ms. WILSON. Yes, it is. And the percentage is calculated on the 

basis of veterans who are surveyed with the customer, patient, satisfaction survey and answer ‘‘Yes’’ to the question ‘‘Is there one person or a team in charge of your care?’’ We call that primary care 

enrollment. 

Mr. GILMAN. With regard to ambulatory surgery, your achievement level states, ‘‘To be considered fully successful, at least 25 

percent of the surgical cases performed in VISN or 50 percent of 

the surgical and invasive diagnostic procedures combined will be 

performed on an ambulatory basis. And to be considered exceptional, 40 percent of surgical cases performed in VISN or 65 percent of the surgical and invasive diagnostic procedures combined 

will be performed on an ambulatory basis.’’ Is that still part of your 

performance criteria? 

Ms. WILSON. The ambulatory surgery measure is still in effect. 

Mr. GILMAN. And then with the——

Ms. WILSON. The targets, the goals have changed, however; 65 

percent is fully successful, and 75 percent is exceptional. 

Mr. GILMAN. With regard to bed days of care, ‘‘Achievement levels to be considered fully successful, bed days of care per patient 

will decrease for all VISN number of patients in the aggregate by 

20 percent and to be considered exceptional, bed days of patients 

will decrease in the aggregate by 30 percent.’’ Is that still part of 

your performance criteria? 

Ms. WILSON. The targets have changed. In 1997, we were able 

to obtain Medicare data for the country. And the target for each 

network was to reach where Medicare, where we would project 

Medicare, patients to be in 1997. This network’s target was 7 percent, was to decrease bed days of care 7 percent, which would put 

it in line with this region’s Medicare standard of care. 

Mr. GILMAN. So essentially, then, your overall program provides 

incentives if you decrease primary care, if you decrease surgery and 

make it ambulatory surgery, and if you decrease bed days. Is that 

correct? 

Ms. WILSON. No. Those are three measures out of the total number of measures. 

Mr. GILMAN. But they are included. Is that——

Ms. WILSON. These are included in the 1997 agreement with the 

targets as I stipulated. 

Mr. GILMAN. They seem to be pretty essential elements that have 

reduced the quality of care in our region. 

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Ms. KELLY OF NEW YORK. Will the gentleman yield? 

Mr. GILMAN. Yes. 

Ms. KELLY OF NEW YORK. Thank you. 

I have one more question for Dr. Wilson. Dr. Wilson, if it turns 

out that oversight is lacking in the VA by what the GAO study 

says that we think will probably be a part of the Senate request, 

if it turns out that the oversight is lacking, will you allow further 

GAO study to happen? Will the VA allow for further study? And 

will you slow down the VERA program until we are sure that 

VERA will not be in a position to offer poorer quality medical care 

for the patients in our area? 

Ms. WILSON. I don’t have the authority to answer that question. 

My understanding with GAO is that they’re an independent review 

organization, and I wouldn’t have the authority to slow them down. 

Ms. KELLY OF NEW YORK. I am talking about VERA. Do you 

think there’s a chance that the VERA program would slow down 

until we get this GAO study in terms of oversight? 

Ms. WILSON. I have no authority to answer that. 

Ms. KELLY OF NEW YORK. Thank you. 

Mr. SHAYS. Thank you. 

Our panel will be staying through the conclusion of this hearing. 

And I, frankly, as someone who is in charge of this hearing feel a 

little guilty. And I want to say this to you, that we have dedicated 

public servants, whom you may have strong disagreements with—

I’m speaking to the audience now—but they are dedicated public 

servants who have served this country long and hard. Mr. Farsetta, 

how long have you served? 

Audience PARTICIPANT. So have we. 

Mr. FARSETTA. Twenty-nine years. 

Mr. SHAYS. Mr. Farsetta, you’ve served 29 years as a civil servant or a political appointee? 

Mr. FARSETTA. Civil servant. 

Mr. SHAYS. You are a civil servant. I want to thank you, Mr. 

Farsetta, for your service to our country during those 29 years, and 

the rest of this panel and Dr. Wilson as well and to Mr. Sabo and 

Mrs. Musumeci. I want to thank our panel for being here. I want 

to thank them for responding to our questions. And we will now go 

to our second panel. 

Mr. FARSETTA. Thank you. 

Mr. SHAYS. The second panel is: Mr. Lawrence Dos Santos, deputy director, New York State Division of Veterans Affairs; Mr. 

Thomas C. Agnew, director, Orange County Veterans Service Agency; Mr. Jerry Donnellan, director, Rockland County Veterans Service Agency; Mr. Al Etkin, director, Sullivan County Veterans Service Agency; and Mr. Jim Whoie, deputy director, Dutchess County 

Veterans Service Organization. 

I’d like to make an announcement. Evidently I’m being asked to 

make an announcement that in 10 minutes the bus to Castle Point, 

the Leprechaun buses, will be leaving in 10 minutes back to Castle 

Point. 

Audience PARTICIPANT. How come we can’t be heard? 

Mr. SHAYS. Ma’am, if you want to stay longer, you will be heard. 

Audience PARTICIPANT. How are we going to get home? 

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Mr. SHAYS. Will the witnesses please stand? Would you raise 

your right hands, please? Do you solemnly swear or affirm that the 

testimony you will give before the subcommittee will be the truth, 

the whole truth, and nothing but the truth? 

Mr. DOS SANTOS. I do. 

Mr. AGNEW. I do. 

Mr. DONNELLAN. I do. 

Mr. ETKIN. I do. 

Mr. WHOIE. I do. 

Mr. SHAYS. We’re just going to go down the list after we have 

order. We will suspend until people have left who want to leave. 

[Pause.] 

Mr. SHAYS. Mr. Santos, we’re prepared to hear your testimony. 

Mr. DOS SANTOS. Thank you. 

Mr. SHAYS. Mr. Santos, we are going to hear your testimony. We 

are not going to followup with any questions to any of the Service 

representatives. And then we’ll be going to the floor and listening 

to testimony and again not following up with questions so we can 

cover more people. 

Mr. DOS SANTOS. I think that’s a great idea. 

Mr. SHAYS. OK. Thank you, Mr. Santos. There are people moving 

in and out. So you’re going to have to speak even a little louder. 

Mr. DOS SANTOS. I will. Good afternoon. 

Mr. SHAYS. Good afternoon. 

STATEMENTS OF LAWRENCE DOS SANTOS, DEPUTY DIRECTOR, NEW YORK STATE DIVISION OF VETERANS’ AFFAIRS, 

ACCOMPANIED BY THOMAS C. AGNEW, DIRECTOR, ORANGE 

COUNTY VETERANS SERVICE AGENCY; JERRY DONNELLAN, 

DIRECTOR, ROCKLAND COUNTY VETERANS SERVICE AGENCY; AL ETKIN, DIRECTOR, SULLIVAN COUNTY VETERANS 

SERVICE AGENCY; AND JIM WHOIE, DEPUTY DIRECTOR, 

DUTCHESS COUNTY VETERANS SERVICE ORGANIZATION 

Mr. DOS SANTOS. My name is Lawrence Dos Santos. And I am 

the deputy director, southern region of the New York State Division of Veterans’ Affairs. I want to point out it’s not my testimony. 

I have had the distinct honor and privilege of serving my country 

in the U.S. Marine Corps in Vietnam as an infantry fire team leader with Company C, First Battalion, Fourth Marines. Ooh-rah. 

On behalf of Director John L. Behan, who was retired at the 

rank of Sergeant from the United States Marine Corps after being 

severely wounded in Vietnam while serving with Bravo Company, 

First Battalion, First Marines, First Marine Division, I want to 

thank you, Chairman Shays, Congresswoman Sue Kelly, Congressman Benjamin Gilman, and Congressman Hinchey, for your interest and commitment to the veterans of New York State and for 

your timely response to the concerns that will be aired here today 

by veterans and families who are troubled about the diminishing 

quality of care offered at the United States Department of Veterans 

Affairs medical facilities in the Hudson Valley. 

For the past year, the New York State Division of Veterans’ Affairs has repeatedly warned that the VA’s Veterans Equitable Resource Allocation [VERA] program was nothing short of bad news 

for our State’s 1.5 million veterans, who would be shortchanged by 

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the shift of nearly $180 million from the Empire State to other 

States around the Nation. This program, while intended to fairly 

distribute health care funds throughout America, is anything but 

equitable to the veterans in New York and other Northeastern 

States. 

This program was hastily implemented without adequate study 

or research on how the loss of tens of millions of dollars at individual medical facilities would impact the care and service provided 

our aging and sick veterans dependent on VA hospitals. That is 

why we are here today. This program has not and will not work 

in New York State as it has been implemented. 

In presenting and defending VERA, then Secretary Jesse Brown 

promised that no veteran receiving health care presently would be 

denied care under the new allocation program and that budget cuts 

at individual facilities would be absorbed through greater efficiency. 

No one outside of the VA bought that promise, especially veteran 

leaders in our State. Efficiency normally is achieved through fewer 

employees doing more, not by abolishment of crucial programs, 

such as mental health care, dialysis treatment, nursing home care, 

and homeless programs, which is what has happened in New York 

State. 

The implementation of VERA has now pitted veteran against veteran and State against State for medical funds which have been inadequately appropriated Nationally and inequitably appropriated 

for individual States. This is a tragedy for our veterans and for the 

VA, whose proud legacy of competent professional and compassionate health care is being tarnished with reports and accusations 

of neglect of patients. 

Greater efficiency is a goal we should all strive for in Government, but we must be aware that there is a difference in trimming 

the fat from a budget and bare-boning to the point of crippling programs. 

The tales of patient neglect and rising deaths at VA hospitals at 

Castle Point and Montrose, which will be presented here today, are 

not unique to the Hudson Valley. We at the Division of Veterans’ 

Affairs have heard similar allegations from veterans and families 

from other areas of the State, including western and upstate New 

York and the metropolitan area. 

Veterans and their loved ones are dismayed and fearful. VA hospitals were once a beacon of hope. Now, however, veterans are 

being turned away for care they once took for granted or are being 

told that they have to go elsewhere, often distant points, for treatment or, as we are hearing, they are getting inadequate care. 

We are concerned with the changing policies and practices at the 

VA, but I want to stress that our anxiety is with the administration and not the medical facility employees, who are as much a victim of VERA as our veterans. [Applause.] 

Historically, the VA has employed dedicated and compassionate 

health care providers, whose professionalism and commitment are 

top of the line. VERA, however, has imposed tremendous hardship 

on these devoted care-givers, who now have become like Marines, 

made to do more with less. It’s something I’m quite familiar with. 

It is not fair to them or their patients. 

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VERA is now a catalyst for the VA and our Government to dismantle a health care program that has been a lifeline for millions 

of American patriots, particularly our older, infirm, and poor vets. 

We cannot allow that to happen. Professional and competent 

treatment and care at a VA hospital is a benefit that most veterans 

expect to receive from a grateful Nation for their service and sacrifice in our armed forces. 

Many of these men and women were promised this care by recruiters—remember them—eager to get them in uniform to defend 

our country and its precious principles. For many veterans, health 

care is the only benefit claimed from military service, and the least 

they should expect is that that care is available and safe. Care at 

a VA hospital should not and must not be a death sentence, as 

some now fear. And certainly its availability should not be determined by what State you call home. 

The New York State Division of Veterans’ Affairs, on behalf of 

our veterans, urges Congress and the administration of Washington, DC, to take immediate action to halt staffing layoffs and reduction of staffs at VA medical centers and to place a moratorium 

on the implementation of VERA until such time as the veterans’ 

community can be assured that any spending shifts or cuts will not 

adversely impact their rights and benefits. 

‘‘I told you so’’ is a phrase no one likes to hear. Critics of VERA 

take no pleasure in uttering that statement. The failure of VERA 

has not been borne by nor impacted the bureaucrats who thought 

up this scheme. But, rather, it has tragically been endured by veterans and their loved ones, whose pain and suffering made this 

hearing today necessary. 

On behalf of Director Behan and the New York State Division of 

Veterans’ Affairs, I urge this committee to take the lead in restoring the credibility of our Government and the VA by creating a new 

funding mechanism to provide the money necessary to guarantee 

all of America’s veterans are treated like the first-class citizens 

they are. 

I’d like to add one more statement before I close. I’d like to point 

out that these three Members of Congress here from this State are 

the only ones I know of that have taken on VERA and have been 

as vocal and spoken out as much. And I’d like to personally thank 

you. John Behan asked me to make sure I made that statement to 

all three of you, and we thank you so very much for caring about 

us. 

Thank you for the opportunity to be here and to speak to you 

today. And God bless everyone here. 

[The prepared statement of Mr. Dos Santos follows:]

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Mr. SHAYS. Thank you. [Applause.] 

Thank you, Mr. Dos Santos. 

Mr. Agnew. 

Mr. AGNEW. Thank you. 

Mr. Shays, Mr. Hinchey, Mr. Gilman, Mrs. Kelly, I appreciate 

the opportunity to share my views as director of the Orange County Veterans Service Agency and also as a two-tour combat veteran 

of Vietnam and also as a veteran of seven major Service-connected 

surgeries. So I know my way around hospitals a little bit from the 

other side. The current status of local VA health services after the 

VERA funding cuts is the subject. 

Most of the Orange County resident veterans who avail themselves of VA health care use the services provided at VA Medical 

Center at Castle Point. For certain specialties and illnesses, VA 

Medical Centers at Albany, Montrose, Bronx, and Manhattan are 

also used. The VA has been an integral part of health care delivery 

system in the Hudson Valley for many years. 

The implementation of the Veterans Equitable Resource Allocation may, in fact, achieve certain of its goals when viewed from 

other parts of the country. Few veterans advocates, myself included, would oppose allocating funds to areas where veterans are 

truly under-served or of allowing funds to follow veterans who are 

relocating in large numbers. 

The shifting of funds under VERA, however, appears to follow a 

pattern of reducing high-cost area operations in favor of low-cost 

operations. Few would deny that it is more expensive to deliver 

medical care in New York City as opposed to Jackson, MS or Houston, TX. 

Mr. SHAYS. Excuse me. 

Mr. AGNEW. While this may appear to make fiscal sense——

Mr. SHAYS. Mr. Agnew, I’ve just been told to remind whoever is 

going to Castle Point on the bus that the bus is ready to leave right 

now if there is anyone still in the room. I’m sorry to interrupt you. 

Mr. AGNEW. That’s OK. The fact of the matter is that the New 

York veterans are still here and the funds, frankly, are not. 

In our local case, the VISN which covers Castle Point and the 

New York centers was mandated in September 1995 to reduce the 

budget by $148 million over 3 years. It is now August 1997, and 

$130 million have already been cut. This massive a reduction so 

quickly denies the local communities an opportunity to assess the 

impact of reductions as they occur, as would be the case if these 

cuts were taken over 3 years. 

The Castle Point facility has lost more than 200 employees since 

1995. Whether they were bought out, retired, laid off, or fired, the 

facts are that they are gone. They used to do something, and that 

is now done by someone else or it’s not done at all. Castle Point 

is staffed by some very excellent and caring people. It is, however, 

a facility under strain, as are all of the area facilities. 

Now, you are no doubt going to hear during this session stories 

of patient abuse and poor service. If these stories are true and complete, they must be dealt with accordingly. Please keep in mind 

that this facility provides some excellent service to thousands of 

area veterans at a time when their health care options are bringing

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more and more vets to the VA for care. It is, therefore, essential 

that Castle Point and all of the VA medical facilities in the area 

and, indeed, the Northeast be saved and strengthened. 

Thank you. 

[The prepared statement of Mr. Agnew follows:]

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Mr. SHAYS. Thank you, [applause.] Mr. Agnew. 

Mr. Donnellan. 

Mr. DONNELLAN. First I would like to thank the Members of Congress as well as the members of the VA staff and Mr. Farsetta and 

his folks for coming over to listen. 

Rather than read verbatim from my text—you have that in copy, 

and it does repeat many things that have already been said—I 

would like to just ask that all of these investigations be done as 

rapidly as possible and as unbiased as possible because we are 

hearing the ills. And, as Mr. Agnew said, there are good ones. 

We in our district, Mr. Gilman’s district, have developed a VA 

outpatient clinic that without the help of the VA wouldn’t exist. 

That has brought care to 10 times, literally 10 times, the number 

of veterans that were served the previous year. 

Also, the speed I think is important as to eliminate the collateral 

damage that’s being done in that staff members, nurses, kitchen 

people, all members of the staff of the VA hospitals, are taking 

flack for these hearings. These are in general good people who have 

worked very hard. And there are many good veterans being served 

quite well. So let’s do our cutting with the scalpel, not with the axe, 

and let’s do it as quickly as possible. 

Thank you. [Applause.] 

Mr. SHAYS. Thank you, Mr. Donnellan. 

Mr. Etkin. 

Mr. ETKIN. Mr. Chairman, Members of Congress, fellow veterans, 

thank you for allowing me the opportunity to appear today and 

offer testimony regarding the VA health care situation as it affects 

our veterans in the Castle Point and Montrose VA catchment 

areas. 

In addition to my appearance primarily as the director of the 

Sullivan County Veterans Service Agency, as the lead advocate for 

my county’s military veterans and their families, I also appear as 

the hospital chairman for the Veterans of Foreign Wars Department of New York, as the Sullivan County commander of the 

American Legion, and as the commander of the Jewish War Veterans post in Sullivan County. So please regard my comments as 

spokesperson for these veterans’ organizations. 

Better than 51 percent of Sullivan County’s population is representative of the veteran community, making us the largest category of any in the county, including seniors. Since the situation 

regarding veteran care at both Castle Point and Montrose VA 

began back in May of this year, all of the media reports were indicative of cases involving both Dutchess and Orange Counties. There 

was not one example of poor patient care or deaths concerning Sullivan County resident veterans. 

Now, we transport veterans on a daily basis to Castle Point VA 

and have done so for the past 46 years. During the past 31⁄2 years 

that I’ve held my office and upon my frequent visits to our county’s 

inpatients, 99 percent of our veterans have told me that they could 

not have received better care; now, this after asking them specifically if they were, in fact, receiving good care and attention and if 

there was anything that I could do to personally assist them. So 

that speaks well for the medical staff attending them. 

136

When, in fact, there were or are situations needing attention for 

veterans and I’m informed by them, I can easily access the Chief 

of Medical Administration or the Medical Director’s office. And that 

situation is readily corrected to the veteran’s satisfaction. So in this 

regard, I cannot do less than commend the staff at both facilities 

for which we have found to be jobs well done. [Applause.] 

I want to call to your attention at this time that our veteran 

standing committee as well as the Sullivan County legislature 

passed resolutions to support the maintenance of the medical services for our honorably discharged veterans at all of our Nation’s 

172 VA medical centers, and especially at the Castle Point VA, but 

to condemn the actions of the Department of Veterans Affairs in 

the elimination of the inpatient surgery at Castle Point VA and 

possible further staff reductions. In addition, it was resolved to 

support continued VA funding to the Northeast region of the 

United States and not to the shifting of funds to other parts of the 

country. 

We question how the elimination of some 200 staff positions at 

Castle Point will allow the quality of care to our veterans to be 

maintained with less staff to provide the same level of services. 

At the same time, we question how our New York delegation 

members working as a block could vote to shift funds to other parts 

of the country if the effects of those shifts were not clear at the 

time of the vote. [Applause.] 

We are concerned that once Castle Point VA was instructed to 

delete inpatient surgery, then the facility became a clinic, a nursing home, and loss status as a hospital medical center. We are further concerned that Acting Secretary for Veterans Affairs Hershel 

Gober promised to put in writing that Castle Point VA will remain 

open and not close. 

The bottom line financially is that the VA budget has been slashed $5 billion over the next 5 years. Now, during the 104th 

Congress, the VA medical account was increased by $850 million 

over the past 2 years. 

To ensure that adequate health care would be available for our 

Nation’s veterans and because of the high population of veterans 

living in the Hudson Valley who depend upon and have earned the 

right to use this system, we were particularly concerned about the 

restructuring proposals by the Department of Veterans Affairs that 

shifted resources out of New York State to other parts of the country. And there was, in fact, no explanation of the formula as to how 

those resources were being shifted. 

Adequate financial resources should be maintained to ensure 

proper medical care for our State’s 1,900,000 veterans, of whom 

520,000 are over the age of 65 with a projection that by 2000 this 

total will have increased to 600,000. 

Now, as we are all aware but need to be reminded, following the 

conclusion of hostilities at the end of World War II, a promise was 

made by our Government that no veteran would be denied medical 

care at any VA medical center for the remainder of his or her life. 

[Applause.] 

Our Nation’s veterans have placed themselves at risk to preserve 

our country’s freedoms and democratic principles. And any deletion 

of needed resources, supplies, and medical staff resulting in the 

137

elimination of services and the inability to maintain the needed 

services to our veterans is considered unconscionable and meanspirited. 

Our Nation’s veterans, both wartime and peacetime, have preserved our Nation. It is, therefore, the inherent obligation of our 

Nation to care for our veterans’ medical needs to sustain their 

health and well-being. 

Finally, the third party reimbursement moneys that formerly 

had to be returned to the general fund in Washington, DC, can now 

be well-utilized at our VA medical centers to increase needed staff 

and resources. These moneys can now be retained at the VAs. The 

volunteers that help assist our veterans are no longer in place to 

the high numbers they once were. It’s time to do the right thing 

for our veterans and for our country. 

Thank you for your attention. [Applause.] 

[The prepared statement of Mr. Etkin follows:]

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Mr. SHAYS. Thank you, Mr. Etkin. 

Mr. Whoie. 

Mr. WHOIE. Good afternoon, Members of Congress. 

Mr. SHAYS. Good afternoon. 

Mr. WHOIE. I appreciate being able to speak with all of you this 

afternoon, and to include all of the veterans present. And that’s all 

of us, I hope. I consider it a privilege to have been invited to participate in this very important endeavor. 

I like to think that I am an advocate for veterans and their families. Since 1992, I have been allowed to practice the art of presenting issues and claims to the Department of Veterans Affairs. 

Over the years, in the opinion of many veterans that I come into 

contact with, a perception exists that medical care in general or in 

a general sense was not readily available. They are of the opinion 

that the VA, as I will call it henceforth, was on its last legs. Nickels, dimes, and quarters have slipped away, it appeared. 

By and large, most of the veterans from World War II, Korea, 

and Vietnam are very concerned about medical care in general; 

that is to say, the availability of it, the quality of it, and the cost 

of it. 

Today, at least in Dutchess County, NY, veterans have a serious 

concern about VA benefits in general, dissolving into nothingness. 

The concept that, ‘‘We want to take care of you,’’ today in so many 

ways is simply hard for veterans to swallow. 

Veterans and their families in large part believe that there is an 

unseen danger. They believe that the Veterans Affairs, at least 

when it comes to medical care, will cease to exist. Pride in what 

he or she did during a period of war seems lost in a myriad of legislative tactics. 

Veterans in this community that I hope I represent have a question: If the government abandons that veteran today, may we abandon our duties as citizens tomorrow? 

Thank you. [Applause.] 

[The prepared statement of Mr. Whoie follows:]

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Mr. SHAYS. The Service representatives agree with this committee that we would like to go and hear from participants who 

have attended this hearing. So they have agreed to forego any 

questioning. 

But I would like to at least invite any of the Members if they 

want to respond to what they heard or just make a short comment. 

Mr. GILMAN. Mr. Chairman, I would just like to thank our panelists, all of whom are out on the firing line, and for their constructive suggestions. We hope they keep doing the good work they have 

been doing. God bless. 

Mr. SHAYS. Mr. Hinchey. 

Mr. HINCHEY. Thank you, Mr. Chairman. 

I’d just like to thank all of you gentlemen for your being here 

today, for your testimony, and for your service to the veterans’ community. Thanks very much. 

Mr. SHAYS. Ms. Kelly. 

Ms. KELLY OF NEW YORK. Thank you, Mr. Chairman. 

I want to thank, in particular, Mr. Dos Santos, about his comments about the concerns on the low-income, uninsured veterans. 

That’s my concern, too, Mr. Dos Santos. And I think it’s good that 

you at the State level are also as concerned as we are. 

Thanks, all of you, for your work because without you, our veterans could not be as well-represented. You’re doing an excellent 

job. Keep it up. Thank you. [Applause.] 

Mr. SHAYS. Now, let me tell you how we’re going to proceed. I 

used to be a State legislator for 13 years, and it reminds me of the 

hearings that we have in the State legislature. 

We had a number of people who had asked to speak. I had staff 

draw at random from three piles. We put it into three piles: veterans, veteran service organization representatives and others, 

such as family members, wives of veterans, and so on. 

I’m going to call three names. We’re going to identify you. We’re 

going to just have you be able to speak from where you are. You 

can stand in place or sit in place if you’re not able to stand. 

We’re going to ask you to limit your remarks to 3 minutes because we’re going to try to get through and hear from as many of 

you as possible. 

If your name is called, let us know where you are, and the microphone will come to you. I understand that some people may have 

left. And we’ll just keep going through the list. And if we go 

through the list that was picked, then we’ll just keep going 

through. 

The first three names in the order I’m calling is Edmund 

Monteleone from Clintondale. We have Ralph Karabec, Commander, Post 480, from Monroe. And we have Daniel Aversano, an 

LPN from Kerhankson. Now, do we have any of those three 

present? We’re just going to invite you to—are you Mr. 

Monteleone? 

STATEMENT OF EDMUND J. MONTELEONE, VETERAN, 

CLINTONDALE, NY 

Mr. MONTELEONE. I am Mr. Edmund J. Monteleone. 

Mr. SHAYS. It’s nice to have you here, sir. 

Mr. MONTELEONE. Right. 

145

Mr. SHAYS. Thank you. You have 3 minutes. You can let him 

hold the mic himself. Thank you, sir. 

Mr. MONTELEONE. Yes. The only complaints I have——

Mr. SHAYS. Excuse me. You know what? Let me just say this to 

you. I’m sorry to interrupt you, sir. This is a new experience for 

me. We obviously are not going to swear in our witnesses from the 

audience, but we transcribe this hearing. So we’re going to need 

you to spell your—you know what? I have it in writing, and I’m 

just going to submit it that way. But just say your name again, and 

we’ll mark it down. And we have it in writing. Tell us your name 

and your town you’re from again. 

Mr. MONTELEONE. I am Edmund J. Monteleone, M-O-N-T-E-L-EO-N-E. OK? 

Mr. SHAYS. Yes. Thank you. 

Mr. MONTELEONE. I’m from Clintondale, 212 Rabbit Run Road, 

Ardonia. What else? 

Mr. SHAYS. Thank you. 

Mr. MONTELEONE. OK? 

Mr. SHAYS. You can give us your statement, sir. Thank you for 

being here. 

Mr. MONTELEONE. OK. I go to Castle Point. I’m from Castle 

Point. Now, the only complaint I have over there is that I asked 

the doctor to go see the dental. When I went to see the dental, I 

filled out the application. OK? But it’s not—how can I say that—

service-connected. OK? 

But when I first went into the Service, there was young doctors 

at Camp Hood, TX that filled nine teeth within a half-hour. And 

I couldn’t talk or eat for 2 days or 3 days. And I didn’t need no 

teeth filled. OK? All right. That’s one incident. 

Now another incident I had with my teeth to go to Castle Point, 

and I filled out an application. They says, ‘‘No, no. You can’t have 

that done unless you give me $125.’’ OK? That’s another incident. 

I’m not saying everybody in Castle Point is not doing their job 

or that jobs aren’t being done. But I don’t like to be pushed on the 

side. First you can’t have glasses. Then now I hear you can have 

glasses. Somebody’s got to make up their mind over there what’s 

what. OK? And I know a lot of fellows, a lot of people like me, are 

being treated the same way over there at Castle Point. 

Thank you. 

Mr. SHAYS. Thank you, Mr. Monteleone. [Applause.] 

Do we have Mr. Karabec next? Is he here? 

Mr. KARABEC. Karabec. 

Mr. SHAYS. Karabel? 

Mr. KARABEC. Karabec. 

Mr. SHAYS. Karabec? Is it spelled K-A-N-A-B-E-C? 

Mr. KARABEC. K-A-R-A-B-E-C. 

Mr. SHAYS. Thank you, sir. I’m sorry I pronounced it wrong. And 

your community, sir? 

Mr. KARABEC. No problem. That was probably my sloppy handwriting. 

Mr. SHAYS. And you’re from Monroe? 

Mr. KARABEC. I’m from Monroe Post 48. I’ve been the Commander there for 7 years. 

Mr. SHAYS. Well, it’s nice to have you here, sir. 

146

STATEMENT OF RALPH KARABEC, VETERAN AND 

COMMANDER, AMERICAN LEGION POST 480, MONROE, NY 

Mr. KARABEC. Thank you. I’m also a Vietnam war vet who has 

been operated on, had 40 surgical procedures since I returned home 

from Vietnam. 

This is my testimony, Ralph Karabec, before the Human Resources Subcommittee of the House Committee on Government Reform and Oversight on August 4, 1997. My personal experience 

with most physicians at Castle Point reflects a complete disregard 

for patients’ welfare. 

Case in point: After years of experiencing problems as a result 

of exposure to Agent Orange, I made a visit to Castle Point requesting an examination with a physician. After explaining my 

symptoms to the doctor, he made his diagnosis right from his chair 

without so much as a question, ‘‘You look fine to me. I don’t see 

anything.’’

That was the last time I used that veterans’ benefit. However, 

I continue to have a yearly cystoscopy for bladder cancer with my 

private urologist and I believe was a result of exposure to dioxins. 

A copy of the doctor’s letter is included as part of this testimony. 

After many years of annual cystoscopies and prostate exams at 

Castle Point, a PSA test was finally authorized which showed a 

15.6 diagnosis, a well-advanced malignancy. After finding out the 

results of the tests done at Castle Point, I had a more specific PSA 

test performed by my private urologist which showed a 19.4 with 

a 2 percent-free PSA. Apparently the physicians at Castle Point 

don’t even know what a 2 percent-free, what a protein-free PSA 

test is. I questioned them. A copy of the lab report is also enclosed 

as part of my testimony. 

The 30 percent differential in testing could cost a veteran his life. 

After undergoing a radical retropubic prostatectomy on April 28, 

1997, at New York Cornell Hospital—so I saved them some 

money—I discovered I was 0.1 millimeter of a surgical margin. A 

copy of the pathology report is also included in this testimony. I 

learned that I had the malignancy for approximately 6 years. 

That’s after my continually going there every single year for an 

evaluation. 

I was lucky. I managed to survive, at least for the moment. My 

Government not only trying to kill me once by exposing me to carcinogen herbicides, but with the lack of proper medical care and attention almost succeeded a second time. My fear now is that how 

many more veterans, including myself, must die due to lack of 

funding for appropriate medical care while the tax dollars of American patriots are sent overseas in the name of maintaining freedom. We penalize once more the very vets who fought unselfishly 

to keep our Nation and the world safe from tyranny, I submit. 

Mr. SHAYS. Thank you very much. [Applause.] 

Our third witness is Daniel Aversano. Is he here? 

Mr. AVERSANO. Yes, sir. 

Mr. SHAYS. Thank you, sir. 

Mr. AVERSANO. Good afternoon. 

Mr. SHAYS. If you could just suspend a second, I’m going to tell 

you the next three so they can begin. The next witness would be 

Cindy Trimble. Is she here? Cindy, Ms. Trimble? Anthony Buccieri. 

147

Is he here? And also Richard—I’m not sure how to read this. Pardon me? Johannes. That’s it, sir. And you’re from Pleasant Valley. 

Thank you. You will be following. 

Thank you. Sorry to interrupt you. 

Mr. AVERSANO. Good afternoon. 

Mr. SHAYS. Good afternoon. 

STATEMENT OF DANIEL AVERSANO, LPN, VETERAN AND 

CASTLE POINT EMPLOYEE, KERHANKSON, NY 

Mr. AVERSANO. My name is Daniel Aversano, and I work at Castle Point VA. I’ve been there for 10 years. I’m an LPN. I’m also a 

Vietnam vet. And I’ve also been taken care of by Castle Point, and 

they have been very good to me. Since being there, I’ve made a lot 

of good friends—Korean vets, Vietnam vets. And Castle Point I 

think is a very good place to work, and we try very, very hard to 

take care of our vets. 

Just one thing I’d like to put on the floor as something to think 

about: Why is it warranted to use the Vassaro R and shipping our 

Castle Point patients over there when we closed our abilities to operate at Castle Point? Does that giving—why wouldn’t it be smarter to give our staff the money and keep our vets at home, where 

we have done such very good care for many, many years? Why is 

that cost-effective? That’s just something that I just can’t understand. 

And I want to thank everybody for coming out today, and I’m 

very proud to work for Castle Point VA. [Applause.] 

Mr. SHAYS. Thank you very much. 

Ms. Trimble. 

STATEMENT OF CINDY TRIMBLE, FAMILY OF DECEASED 

VETERAN, GANHAM, NY 

Ms. TRIMBLE. Good afternoon. 

My name is Cindy Trimble. My grandfather died as a result of 

a lack of treatment at Castle Point VA Hospital. 

The short of the story is he was admitted on March 24 with a 

so-called ‘‘virus.’’ Two weeks later, when his condition had deteriorated to a point where the family could no longer just sit idly by 

and wait for Castle Point to take some type of further action, we 

had him transferred to Hudson Valley Hospital Center. That was 

a difficult task. We met with much resistance from the doctor, but 

we were able to get him down there after contacting the Acting 

Chief of Staff. 

When he arrived at Hudson Valley Hospital Center, within 1 

hour of his arrival, the diagnosis was a perforated ulcer. They took 

him in for immediate surgery, but he died 2 days later as a result 

of the preexisting infection that set in. Some of you may be familiar 

with the term ‘‘sepsis.’’ They found bacteria and acid in his blood 

that had been an ongoing condition as a result of the perforated 

ulcer not picked up at Castle Point. 

I only have 3 minutes. So, in closing, I just had a couple of things 

I’d like to add. Earlier our panel was talking a lot about statistics 

and surveys and things like reducing bed days of care. I’d like to 

ask if the death rate, the statistics on death, the mortality rate, is 

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sult from the care received in the hospital, like deaths that occur 

at home or after a patient is transferred to another hospital. 

I’d also like to respond to an earlier statement made by Mr. 

Farsetta about surveys. My grandfather did receive a survey a few 

days after he died. 

And, finally, I’d like to say that under the category of reducing 

bed days at Castle Point, we were never able to contact a physician 

during my grandfather’s care at Hudson Valley Hospital Center. 

When we did, he was very annoyed with us. And he told us that 

they—I don’t know who ‘‘they’’ are, but I assume he meant the Department of Veterans Affairs—were on his back to get my grandfather out of the hospital, that they wanted him out because they 

needed the bed. 

So I just wanted to add that as perhaps some type of proof that 

there is a push to clear these patients out. And I do think that 

while there may be some good care at these hospitals, I think the 

VERA budget funding cuts are being used as a crutch. 

And I’d like to thank Maurice Hinchey, Ben Gilman, and Sue 

Kelly for anything they can do on behalf of the veterans and their 

families. Thank you. [Applause.] 

Mr. SHAYS. Thank you. Thank you, Ms. Trimble. I believe you’re 

from Ganham? Yes. Thank you. 

Anthony Buccieri. And you’re from? 

Mr. BUCCIERI. I am from Newburgh, NY. 

Mr. SHAYS. Yes, sir. 

STATEMENT OF ANTHONY BUCCIERI, VETERAN AND VETERANS OF FOREIGN WARS AND DISABLED AMERICAN VETERANS, NEWBURGH, NY 

Mr. BUCCIERI. I’m a veteran of World War II, a recall for the Korean war. I’m a veteran at the VA hospital at Castle Point. I have 

been there as a volunteer for over 8 years. I’ve seen many changes 

at Castle Point, some for the good, some not so good. 

But I’d like to call out I’ve sent in reports to the District Commander of the Veterans of Foreign Wars. This was dated back in 

March. I also sent information to the local papers in our area, six 

of them in general. Out of six papers, only one published what I 

had to say. 

In regard to the deaths at Castle Point, when all of this broke 

out in the newspapers, I took a quick survey, picked up all the papers, and I found that out of the 12 hospitals in our immediate 

area, there were 35 deaths and only one at Castle Point. 

I’d like to explain one thing that many people—and I’ve got these 

personal calls, even at night, from veterans’ families, ‘‘Can you get 

my father’’ or ‘‘my brother’’ or ‘‘my uncle into Castle Point?’’

I went out of my way, which I didn’t mind doing, asked these 

people, ‘‘Are they registered with the VA hospital? If they aren’t, 

we’ll give you an application. Fill it out. Get a hold of your doctor, 

the hospitals from both sides. And try to get that patient into Castle Point,’’ which they did. 

The reason for going into Castle Point VA Hospital was that the 

limitation on the stay in the hospital, whether it’s Medicare or private insurance, was the cause for these patients being transferred 

to VA hospitals. 

149

They were not completely cured in a matter of months or days 

or even a year. Some of them did pass away, unfortunately, but 

many of them were cured or they had a longer hospital stay. That’s 

in regard to the mortality rate. 

As far as the patients being taken care of at Castle Point and 

as a volunteer there 2 days a week, about on the average of 7 

hours a day, I found that the staff has been overworked to a point. 

But, as was stated before, they are doing the best job they can with 

what they have. The fact that the funding has been cut, the staff 

has been cut, they are doing a good job. 

In regard to a few other details, I’d like to submit these as evidence to you. I don’t want to take up too much time. Basically the 

VA is there for veterans and veterans only. And it’s been there at 

Castle Point for 72 years. And I’ve been a patient in the hospital 

as well as a veteran and as well as a volunteer. 

I thank you. 

Mr. SHAYS. Thank you, sir. [Applause.] 

Richard Johannes from Pleasant Valley? 

Mr. JOHANNES. Yes. 

Mr. SHAYS. Sir, before you begin, let me just tell the next three 

speakers. We have, I think it is, Al Datlolo. Am I saying the name 

correctly? The second witness would be Paul Davidson. And the 

third would be Gloria Wood. Do we have those three? OK. Am I 

saying this right? This is Datlolo. Mr. Datlolo? 

So yes. Thank you, Mr. Johannes. 

STATEMENT OF RICHARD JOHANNES, VETERAN, PLEASANT 

VALLEY, NY 

Mr. JOHANNES. Good afternoon. My name is Richard Johannes. 

I’m a Vietnam veteran. I served over 5 years in the U.S. Army. 

And two of those were in Vietnam. All I knew was that if I ever 

needed health care later on in life, the VA was supposed to provide 

it for me. 

With Castle Point, over the last year, I feel that everything has 

just gone downhill. They changed us to the blue team and the 

green team. You get a doctor. First of all, I don’t even think he understands half of what I say. OK? [Applause.] 

And when I do try to tell him the different problems I have, I’m 

100 percent Service-connected. OK? They put it down for PTSD 

only because it’s a simple way to shuffle me off to one side. 

You go there. You get there early like they tell you to, a half an 

hour, an hour before. You go into your clinic. It ends up you’re 39th 

on line already, and it’s only 8:30 a.m. They’ve got six seats in the 

place. And you sit there or hang around outside until somebody 

takes care of you. Then you have to run to your next appointment. 

By the end of the day in 1 day when the doctor was supposed 

to take all the information that was done, blood work, ultrasound, 

EKG, and all that other good stuff they have to do to me, he didn’t 

have the information in his computer. So he says, ‘‘Well, if it’s not 

really bothering you, don’t worry about it.’’

And I’m going, ‘‘Hey, I’ve had this pain on and off for 6 months.’’

He says, ‘‘I’ll get in touch with you when I get the results back.’’ 

Well, that all happened in April. It is now August. And I haven’t 

heard one single word. OK? And that’s just one instance. 

150

You try to get glasses there, you have to sit and wait for 2 to 

3 months to get a pair of glasses. I can go down the street to any 

mall and get a pair of glasses in an hour. 

I needed a crown for a tooth that somebody finally figured out 

needed to be rectified since Vietnam. Well, it took them 3 months 

to make a crown. 

I can’t understand this, you know. Yes, they’re supposed to be 

moving into the computer age. But when it comes to simple things 

like glasses or new crowns or having even your teeth worked on, 

they have a hard time doing these things. 

And the attitude down there to me is just unbelievable. They 

don’t care. And I wish they would get some doctors in there who 

speak American and understand American. [Applause.] 

And that’s basically all I have to say. Tomorrow I will wander 

my way over again to the VA and ask them, ‘‘Have you finished 

and come up with the results?’’

And I can guarantee you what the answer is going to be, ‘‘We 

can’t find the files’’ because they already did that twice this year. 

Thank you very much for your time. 

Mr. SHAYS. Thank you very much. [Applause.] 

We’ll be going to Mr. Datlolo, then Paul Davidson, and then Gloria Wood. Is Mr. Datlolo here? He’s not here. So we’ll go to Mr. Davidson. Is he here? OK. And then Gloria Wood. Is Gloria Wood 

here? 

Ms. WOOD. Yes, I am. 

Mr. SHAYS. Thank you, Ms. Wood. 

STATEMENT OF GLORIA WOOD, WIFE OF VETERAN, PINE 

BUSH, NY 

Ms. WOOD. I’m speaking on behalf of my husband, who happens 

to be partially disabled. 

In January 1995, we, unfortunately, had an accident on our way 

to Florida. And he fell going into a motel. Six weeks later and two 

operations, in a private hospital, for his hip, I was told, ‘‘Take him 

home. Put him in a nursing home. He’ll never walk again.’’

I couldn’t find a nursing home as quickly as I wanted. So, in desperation, I will say, I said to my daughter, ‘‘Call up Castle Point 

and see if he can get in because he is 40 percent disabled.’’

They immediately took him in. Ten days later, he was walking 

on parallel bars. He was there for 6 weeks. He has continued to 

take therapy, and we have nothing but good things from Castle 

Point. And I think it’s nice to know that there are some of us who 

do appreciate it. 

Thank you. 

Mr. SHAYS. Thank you, Ms. Wood. [Applause.] 

We appreciate your words of appreciation. And I have you down 

from Pine Bush? 

Ms. WOOD. Pine Bush. 

Mr. SHAYS. Thank you. 

Our next three witnesses: Jerry Blumenthal from Middletown, 

Daniel Morea from Beacon, and Helen Janiszewski. Am I saying 

that name right? Janiszewski, also from Middletown. 

151

STATEMENT OF JEROME BLUMENTHAL, VETERAN, 

MIDDLETOWN, NY 

Mr. BLUMENTHAL. I thank the committee for listening to me. 

Mr. SHAYS. You are Mr. Blumenthal? 

Mr. BLUMENTHAL. Yes, B-L-U-M-E-N-T-H-A-L. 

Mr. SHAYS. A-L. I’m sorry. And it’s from Middletown? 

Mr. BLUMENTHAL. Middletown, NY. 

Mr. SHAYS. Thank you, sir. 

Mr. BLUMENTHAL. I thank you for listening to me. This will be 

short. 

There’s one thing I can’t understand. Somebody mentioned it. 

One of the people who spoke mentioned it. How come we can investigate things up to the sky, investigate things that spoil people’s 

lives, investigate everything? How could we go with the VERA 

without investigating the VA’s administrative statements? [Applause.] 

How could we make a decision to cut funds or to take these funds 

away from our areas before we really knew what could happen to 

our veterans? I would like that question answered. 

Thank you. [Applause.] 

Mr. SHAYS. Is Daniel Morea here? 

Mr. MOREA. Yes, I am, sir. 

Mr. SHAYS. I’m sorry. Where are you? 

Mr. MOREA. I’m right back here, sir. 

Mr. SHAYS. Thank you very much, sir. 

Mr. MOREA. You’re welcome. 

Mr. SHAYS. And you’re from Beacon? 

Mr. MOREA. I’m from Beacon, NY. 

STATEMENT OF DANIEL MOREA, VETERAN AND ASSISTANT 

SERVICE OFFICER, DEPARTMENT OF NEW YORK AMERICAN 

LEGION, NINTH DISTRICT REHABILITATION CHAIRMAN, 

AMERICAN LEGION, BEACON, NY 

Mr. MOREA. I’m an assistant service officer for the Department 

of New York American Legion as well as the Ninth District rehabilitation chairman for the American Legion. 

I would like to thank the chairman and the distinguished members of the subcommittee for allowing me to testify today. The testimony so far given today has been more than interesting. It has 

brought to light both what we have heard from the subcommittee 

as well as what we have heard from the audience. The action that 

follows will be even more interesting. 

The American Legion appreciates the opportunity to share our 

views on the quality of health care provided by the Department of 

Veterans Affairs. Mr. Chairman, there are several concerns with 

regard to the VA’s ability to continue to provide quality health 

care. 

Although the American Legion will defer any definitive or evaluative comments until completion of a site visit to the Veterans Administration Hudson Valley Health Care System, which is scheduled on August 19 and 20 of this year, we are, however, prepared 

to address the specific issue at hand: those concerns raised regarding the increased mortality rate and morbidity rates at Castle 

152

Point and Montrose VA medical facilities, now referred to as the 

Hudson Valley Health Care System. 

The VA has undergone significant reorganization in the past 2 

years, realigning its field operations from a system of 172 independent medical facilities within 4 geographic regions to a system 

of 22 Veterans Integrated Service Networks, called VISNs. The VA 

Hudson Valley Health Care System is a component of VISN 3 

which encompasses the VA northern New Jersey Health Care System and each of the medical centers in New York metropolitan 

area. 

Each VISN has been granted certain latitude in how it chooses 

to deliver health care services to veterans in its primary service 

areas. While there are substantial differences among these emerging networks with regard to how, when, and where health care 

services will be provided, VA headquarters has established a number of performance measures to assure accountability along with 

increased empowerment, as we have already heard testified to 

today. 

VISN 3 has adopted an integrated delivery system model based 

on network-wide care lines. Simply put, veterans who in the past 

relied on a single Veterans Administration medical center to meet 

all their health care needs are now considered network patients. As 

network patients, all of their health care will be managed by a primary care team located in close proximity to where they reside. 

That was the premise of VISN. That’s not what we have heard 

today. 

However, as need for specialty care arises, veterans will find the 

entire consortium of VA health care facilities within VISN 3 responsible for meeting their complete medical needs. As a result, the 

VA Hudson Valley Health Care System has been designated as a 

center for excellence for the network in the areas of geriatric, extended care, and mental health care. 

It seems that since the time of this transition, mortality and 

morbidity rates have increased, creating a groundswell of concern 

for many constituents and an increase in media coverage. 

As members of this committee may know, the purpose of realignment was largely in response to the VA’s need to become more costefficient in the delivery of services. Furthermore, VISN 3 was identified as the most expensive network in several key financial performance measures, including total cost per veteran. 

All of these facts combine to create an emphasis on reducing 

costs. Underscoring this need is the Veterans Equitable Resource 

Allocation, VERA, and its methodology. We believe that the initiatives to improve efficiency——

Mr. SHAYS. Mr. Morea. 

Mr. MOREA. Yes? 

Mr. SHAYS. Can I just interrupt you a second? 

Mr. MOREA. Sure. 

Mr. SHAYS. I need to be somewhat consistent on the 3 minutes. 

Are you going to be completing——

Mr. MOREA. I am just about done, sir. 

Mr. SHAYS. Thank you. 

Mr. MOREA. You’re welcome. 

153

We believe that the initiatives to improve the efficiency are in 

the best interests of veterans everywhere; however, not at the expense of accessing quality, which may be in jeopardy in some areas 

where the budgets have been cut back. 

The American Legion has proposed a GI bill of health in an effort 

to enhance and ensure quality VA health care for the future by 

opening the system to all veterans and their families currently not 

eligible for care on a premium basis. 

We have scheduled a meeting with the VISN 3 director, Mr. 

James Farsetta, on August 22, immediately following the upcoming 

site visit. Presently the American Legion accepts the VA’s explanation that the rising mortality rates at Castle Point are attributable to the decline in the number of inpatient beds and the increase in referrals from other VISN 3 medical facilities of the most 

chronic patients. However, should any concern arise as a result of 

the upcoming site visit, they will most certainly be included in a 

subsequent report for distribution to congressional Members whose 

districts overlap or are within the boundaries of the veterans, VISN 

No. 3. 

The site visit will also focus on inpatient of VERA as potentially 

creating the scenario in which changes may occur too rapidly without the benefit of adequate planning on the horizon. 

The American Legion will also evaluate VERA’s impact on specific specialty programs, such as post-traumatic stress disorder, 

chronic mental illness, and long-term care, particularly as the 

budget relates to capacity. 

Finally, we also will examine the most current customer service 

course as well as the networks’ adherence to the VA’s other stated 

performance measures. 

Mr. Chairman, this concludes our statement, and we thank you 

for your time, sir. 

Mr. SHAYS. Thank you, sir. [Applause.] 

The next three witnesses: Helen Janiszewski from Middleton, I 

think, Middletown; Philip Schiffman from Washingtonville; and 

Jane Kowal from Port Jervis. Do we have—is Helen here? Sorry. 

Good try. You must be a Marine. She’s not here. 

Are you Philip Schiffman? Mr. Schiffman, thank you. And you’re 

the State Commander? Thank you, sir. 

Mr. SCHIFFMAN. Thank you, Mr. Chairman, members of this subcommittee. 

STATEMENT OF PHILIP SCHIFFMAN, VETERAN AND NEW 

YORK VFW, WASHINGTONVILLE, NY 

Mr. SCHIFFMAN. Thank you for the opportunity to testify today 

on behalf of the 110,000-plus members of the Veterans of Foreign 

Wars Department of New York on the very important issue of 

health care our Nation’s veterans are receiving in the Department 

of Veterans Affairs’ medical centers, particularly the medical centers at Castle Point and Montrose. Thank you also for conducting 

this hearing to help you get to the bottom of the allegations made 

about quality care issues. 

First and foremost, let me state loud and clear that the VFW Department of New York is appalled at recent newspaper reports deVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00157 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
154

picting quality of care issues and high mortality rates at these facilities. 

Our veterans deserve better. We at the VFW will not tolerate 

this type of treatment of our Nation’s former defenders. We call on 

you, our elected officials in Washington, to fully investigate these 

reports and hold these VA officials accountable who are responsible. Today and future such hearings must get to the bottom of the 

situation. 

The numerous allegations of insufficient and quality care issues 

made in local newspapers by veterans, families of veterans, VA employees, and VA volunteers point to the serious problems at these 

two facilities. There obviously was a lack of management at both 

the local and network levels that allowed these situations to occur. 

I sincerely hope VA has now corrected the deficiencies. I know 

that VFW officials and members who have visited both Castle 

Point and Montrose in recent days have told me that the facilities 

are clean and everything seems to be fine. Not being a health care 

professional, I cannot determine if, in fact, all is now well. 

Some have blamed the incidents depicted in the newspapers to 

be caused by the Veterans Equitable Resource Allocation system, 

VERA, which we have heard a lot about today. VERA is definitely 

the cause of the shifting of dollars from the Northeast and Midwest 

to the Southern and Western States. However, management at the 

facilities and network management have told the Veterans of Foreign Wars on more than one occasion that money is not the problem. 

If money is not the problem, then it is obvious to me that the 

cause of our problems were inadequate and inefficient management 

coupled with our aggressiveness of network management to trim 

too much too fast from the budget of these facilities. Quality control 

mechanisms definitely were not in place. And local as well as network management were not paying attention to details. 

It is my understanding that a new management team is being 

named for the facilities, people have been transferred or who have 

left VA employment. And the VA Medical Inspector is doing a complete review of both facilities, which they do not anticipating completing until the end of this summer. I also understand that additional staff have been placed in various critical areas of these facilities. 

With all said and hopefully done, VA has a major public relations 

problem to win back the full confidence of the veterans of Hudson 

Valley. Openness and being truthful to veterans and their families 

and, yes, to Members of the U.S. Congress would be the first step 

in the right direction. 

We, the veterans of Hudson Valley, should not hear from newspapers of a closing of surgical units, possible staff reductions, and 

the quality of care issues. Faculty and network management need 

to be the ones to tell us. 

Mr. SHAYS. Thank you. 

Mr. SCHIFFMAN. One more second. We understand that the delivery of health care is changing and that the VA must also change, 

but when we hear about issues in the newspapers, rather than VA 

officials, their intentions become suspect. 

155

The VFW is the greatest supporter the VA has throughout this 

Nation and in Washington, DC. We feel that the VA health care 

system is the top-rate deliver of health care to our Nation’s veterans. However, the system cannot operate without proper funding 

and without proper management, both of which seem to have contributed to the instances noted. 

Thank you for the opportunity to address you today. We of the 

VFW look forward to working with you and with the VA to resolve 

issues addressed today and to do our utmost to help turn public 

opinion around about the quality of care our veterans receive in 

Castle Point and Montrose VA medical centers. Thank you very 

much. [Applause.] 

Mr. SHAYS. Thank you very much. 

Mr. Schiffman, I’m going to insert into the record because you focused in on the newspaper article, and I will tell you the committee 

will be examining this document. It’s from the Department of Veterans Affairs, Veterans Health Administration, VISN 3, the white 

paper on news articles about a VA Hudson Valley Health Care System. 

I’m going to read the first paragraph and the next sentence of 

the second paragraph, and then I’m going to submit those numbers, 

just to say. It said,

Issue: On Tuesday, May 13, 1997, a newspaper article about the VA Hudson Valley Health Care System appeared in the Times-Herald Record, a Dutchess County, 

New York newspaper. It alleged that since the Veterans Equitable Resource Allocation, VERA, budget cuts occurred in New York, the mortality rate at the Castle 

Point facility had doubled and at the Montrose facility had increased 80 percent. 

Congressional representatives have expressed their concern patient care is suffering 

because of VERA. 

Facts: A study of the mortality rate at VA Hudson Valley reveals there is no evidence of an increase in deaths at the two facilities. In reviewing the combined death 

rates, there is little or no fluctuation.

These are the death rates that they have during the times cited: 

October to March 1995, the number of deaths: 121; October-March 

1996, 109; October-March 1997, 123. And then they do it based on 

the number of deaths per hundred. There is a slight increase in the 

Castle Point number of deaths per hundred. 

But the document submitted to this committee is far in disagreement with the article that you have referred to. It does not in any 

way call into question the concern about VERA. It doesn’t call into 

question about the concerns of this committee. But it does state 

emphatically that what you read in the newspaper is just simply 

not true. And we will look into that, I can assure you. Thank you. 

[The information referred to follows:]

156


g:\graphics\46778.101
157


g:\graphics\46778.102
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g:\graphics\46778.103
159

Mr. SHAYS. At this time is Jane Kowal here? 

Ms. KOWAL. Right here. 

Mr. SHAYS. Thank you. Nice to have you here. 

Ms. KOWAL. Thank you. Thank you for having me. Please bear 

with me. I get very emotional. 

Mr. SHAYS. Does that just mean with all of these other veterans 

you get emotional? 

Ms. KOWAL. Well, maybe. 

Mr. SHAYS. OK. Thank you. 

STATEMENT OF JANE KOWAL, DAUGHTER OF DECEASED 

VETERAN, PORT JERVIS, NY 

Ms. KOWAL. I’m Jane Kowal. My father was Carl Irwin. He was 

a veteran, and he had gone to Castle Point for a hip operation. 

As you know, they sent him and all operations to the Bronx. He 

went through the surgery fine, came back to Castle Point about the 

17, I believe, of February. Two days later, he’s in ICU. I don’t know 

what happened. I know there are times you do develop pneumonia 

when you break a hip. But this seems so sudden. OK. 

We rushed there. He has a feeding tube. The man did at times 

need help to feed himself. OK. At the nursing home, he had signed 

a health proxy, ‘‘No CPR. And, please, no artificial feeding.’’ I 

thought being a VA-approved nursing home that these documents 

would be carried over to Castle Point. I guess I was wrong or ignorant to think that. 

Anyway, I asked about the feeding tube. I did not get any answer. I had asked about medications, ‘‘See the doctor.’’

Well, that was a joke. I could not find his doctor, ‘‘He’s not in 

this building,’’ ‘‘He’s on the floor.’’ You name it, I got it. Finally, I 

did get someone. 

My father was getting worse. He was a 195-pound man going 

down to, he ended up, 173 in 17–18 days. I wanted to know what 

was going on. A man answered the phone. He said, ‘‘What do you 

want?’’

I said, ‘‘I want to talk to someone about my father.’’ He never 

told me who he was. I don’t know if he was the doctor. I said, ‘‘I 

don’t understand the feeding tube. I don’t understand if there’s a 

problem with his heart. I know about the pneumonia. He has 

sugar.’’

And they said, ‘‘Well, his heart’s feeding.’’ And that was that. 

I was very upset. I got a hold of my sister. She carried on, finally 

got his regular doctor in, who we later found out was on vacation. 

She did her best to bring him back, but it was too late. On March 

3, he died. He died of a broken hip. Do you believe this? 

I believe in my heart I misguided my trust in the VA system. In 

the times in the past, we trusted you. You were very good. You 

were always there for us. There was no doubt about it. But due to 

these cuts, my father is dead. And I don’t know how to take care 

of this in my heart, in my mind. 

Thank you. 

Mr. SHAYS. Thank you, Ms. Kowal. 

I am having a hard time reading the signature. I think it’s Anthony Bamonch. Is it close? It’s from Clintondale. Mr. Bamonch is 

from Clintondale? He’s gone? OK. Raymond Moonan? Is Raymond 

160

Moonan here? OK. And then Dorothy Mianti? Is Raymond Moonan 

here? 

Mr. MOONAN. Yes. 

Mr. SHAYS. Thank you, Mr. Moonan. You’re from New York and 

Florida both? 

Mr. MOONAN. Sir? 

Mr. SHAYS. It says Florida here. Is that your mailing address? 

Mr. MOONAN. I’m from Florida, NY. 

Mr. SHAYS. OK. I love it. Remember now, I may be a Member 

of Congress, but I am from Connecticut. So don’t go back to your 

home and say, ‘‘This idiot didn’t even know there was a Florida.’’ 

[Laughter.] 

I had never heard of Florida, NY. I apologize. 

Mr. MOONAN. The home of Seward, who purchased Alaska. 

Mr. SHAYS. OK. Your time starts now. 

STATEMENT OF RAY MOONAN, VETERAN AND DISABLED 

AMERICAN VETERANS AND AMERICAN LEGION, FLORIDA, NY 

Mr. MOONAN. My question is last week the House approved 346 

to 85 the conference report on a bill to reduce entitlement outlays 

by more than $135 billion in 5 years by slowing Medicare, Medicaid, spending growth, restraining mandatory spending in the 

areas of housing and veterans’ benefits, agricultural subsidies, vocational education, along with separate bills cutting taxes for families with children, education, and investors in business and others. 

My question is: Why are we lumped in with the farmers? [Applause.] 

Mr. SHAYS. Why are you lumped in with the farmers? 

Mr. MOONAN. Why are we lumped in with the farmers? We’re 

veterans. You’re voting to cut veterans’ benefits along with cutting 

subsidies to the farmers and business. 

Mr. SHAYS. I’m not going to respond to every question because 

in some cases I don’t know the answer and I will find the answer, 

and that’s the purpose of these hearings. 

But, sir, there are two points. One is that the money allocated 

to the VA may have been reduced because it didn’t take into consideration additional money that now can be collected from Medicare. And there was a dialog between two Members, a Republican 

and Democrat, Cliff Stearns and the gentlelady from—New York or 

Michigan—to verify that it is the intent of Congress that there will 

be no cut. The question is just making sure that for the first time 

the VA can collect Medicare money. And, therefore, you don’t need 

to——

Mr. MOONAN. This is not happening, sir. 

Mr. SHAYS. No. It’s just starting now. 

Mr. MOONAN. That’s a subvention experiment in about three 

areas. It’s not affecting New York people. 

Mr. SHAYS. No. The other issue—and this relates to the whole 

question of VERA—is there is a reallocation of resources. Some 

States, some areas are getting more. And some States, like New 

York and Connecticut, are getting less. And that’s the issue we are 

addressing today, understanding why we’re giving more in one area 

to the detriment of an area that is getting a lot less. And in the 

161

shift is too much going too quickly, and the very valid question, 

which we’ll get an answer to and hopefully change. 

Mr. MOONAN. What I’m saying is $135 billion is going to be 

taken from these entities for a period of 5 years. Now, this is going 

to affect veterans. For 5 years, there are going to be cuts. And this 

was last week. Last week this was done. And here we are today 

talking about doing things for veterans, and we’re not doing them. 

We’re just talking. [Applause.] 

Thank you. 

Mr. SHAYS. Thank you, sir. 

Dorothy Mianti, is she here? James Catania from Walkill; Colleen Mussolino from Brooklyn; and Paul Davidson. Is James——

STATEMENT OF JAMES CATANIA, VETERAN, VFW AND 

AMERICAN LEGION, WALKILL, NY 

Mr. CATANIA. First I want to thank you gentlemen for letting me 

voice my opinion. I have something to say that Congressman Maurice Hinchey might remember and, then again, he may not because 

I wrote him a letter of my case. And he sent it to Washington. And 

I got a letter from Washington last week referring me back to Congressman Hinchey. 

I went to Castle Point 3 years ago for a hearing aid. I had quite 

an extensive examination. And the doctor said, ‘‘Mr. Catania, I’m 

going to send you down to Bronx because they have bigger and better machinery than we do, and you can get a better examination 

than we can give you up here.’’

So the next morning I got on the bus, went down to the Bronx, 

went for an examination. I waited about 4 hours, from about 11:30 

until about a quarter to 4. And I had my examination. And he said 

to me, word for word, ‘‘Mr. Catania, I’m going to send you back to 

Castle Point because they’ve got bigger and better machinery than 

we have and they can give you a better examination than we can.’’ 

[Laughter.] 

I said, ‘‘I beg your pardon?’’ And he repeated it. So I said, ‘‘All 

right.’’ And he gave me a prescription. So I went down to the pharmacy to get the prescription filled, and there were about X number 

of men waiting to get their prescriptions filled. And my bus was 

leaving in about 10 minutes. So I left. 

I went to the pharmacy at Castle Point, and they refused to 

honor that prescription. They said, ‘‘We can’t do that here. You’ve 

got to take it down to the Bronx.’’

So I got a hold of the service officer, and he got around. He got 

a hold of the doctor that finally made out the prescription and gave 

me the prescription I wanted. 

And I, for one, think that that is one of the reasons that there’s 

a saying ‘‘Use it or lose it.’’ And I think that is one of the reasons 

why we lose beds at Castle Point, because people go through the 

same thing that I went through, maybe not for the ears but for 

something else, and they say, ‘‘Well, I’m not going back there anymore.’’ I haven’t been back in 3 years because I lost faith in the 

VA. 

That’s my story, and I thank you very much for listening. 

Mr. SHAYS. Thank you very much. [Applause.] 

Colleen Mussolino from Brooklyn. 

162

STATEMENT OF COLLEEN MUSSOLINO, VETERAN AND NATIONAL VICE COMMANDER, WOMEN VETERANS OF AMERICA, BROOKLYN, NY, ON BEHALF OF MONTROSE WOMEN 

VETERANS OF AMERICA 

Ms. MUSSOLINO. Yes. Thank you. 

I’m Colleen Mussolino. I’m the national vice commander for 

Women Veterans of America. We have a chapter up in the 

Montrose VA, and I was contacted and asked to speak on their behalf, especially of the women veterans, as a national issue. 

Women only began to get their benefits in 1973. So we’re still 

trying to play a catchup game with you men. OK? We have very 

little facilities for women. We have gynecologists, but it’s taken a 

long time to get there. You could get a penile implant before you 

could get gynecology. OK? 

One of the other problems is that there is a lack of beds and 

services in the VAs. What used to be three beds of private rooms 

for women are now done to one bed and possibly sharing with a 

man. OK? We share the bathrooms. We share the showers. We 

have to have armed guards stand outside. I mean, this is ridiculous. 

These cutbacks have made it worse. We’re trying to get entitlements, and we’re getting pushed back further and further and further. And in Montrose VA, there was supposed to be a women veterans coordinator, as there is in all of the VAs, has not been replaced. It’s been now over a month. There is no women veterans 

coordinator at all for these women to go to to take their problems, 

to take their gripes. OK? They’re told that they have to go to Castle 

Point. 

That’s not acceptable. It’s not acceptable by my organization, and 

it should not be acceptable by any veterans’ organization that they 

should have to travel back and forth or to make calls back and 

forth to get issues taken care of. 

The other issue that I have is in the fact of women being put into 

situations where they have been put in with men in various different areas. And these are women that have been raped. These 

are women that have been sexually assaulted. And they’re put into 

areas where they are not protected. 

And the people are not assuming that women have gone through 

these assaults. It’s unfortunate that the statistics are so high that 

you have to assume today that 9 out of 10 women have been sexually harassed or assaulted. These statistics are extremely high. And 

then you put women in where we’ve got to put into areas where 

we are being jeopardized. That is wrong. 

Another issue is the fact is that we are tired of being ‘‘yes’’ed to 

death. Every time we make a complaint, it’s a valid complaint, but 

we are tired of the people just saying, ‘‘Yes,’’ ‘‘Yes,’’ ‘‘Yes.’’ And I 

know from Mr. Sabo and Mr. Farsetta from Brooklyn when they 

were the directors there. I have gone and met with them, asked 

them questions, and we got ‘‘yes’’ed to death. 

Thank you. [Applause.] 

Mr. SHAYS. Thank you. 

Our next three witnesses are: Thomas O’Connor; Gerard Kelly 

from Jackson Heights; and Daniel Reilly from Beacon. Do we have 

163

Mr. O’Connor from Marlboro? Right there? And then we’ll go to Mr. 

Kelly, and then we’ll go to Mr. Reilly. 

STATEMENT OF THOMAS O’CONNOR, VETERAN AND NURSE 

MANAGER, OUTPATIENT SERVICES, CASTLE POINT, MARLBORO, NY 

Mr. O’CONNOR. Good afternoon. My name is Tom O’Connor. I am 

a Vietnam veteran. I am a public servant at Castle Point and the 

nurse manager in outpatient services. 

I’ve heard it said that you shouldn’t take on anybody who buys 

their ink by the barrel, but I do have to ask that—it seems to be 

a conflict of interest that the organization of the newspaper in 

question that’s been trying to bury Castle Point, the Times-Herald 

Record. If they’re successful in what appears to me as an employee 

in their attempts to bury the hospital, one of the main beneficiaries 

is going to be their largest advertisers. 

Every Sunday, I open the paper, and there’s page after page of 

hospital advertising. I noticed that they seem free to take on Castle 

Point and throw a lot of dirt because we’re not an advertiser. If we 

go down, if our patients have to seek out services elsewhere, they’re 

going to seek out those services with the advertisers that advertise 

with them. That’s a point relative to advertising. 

Another point is I understand a lot of our patients do not want 

to travel from one hospital to another. To put it in another context, 

if I were to go to Horton Hospital and my doctor were to call me 

in and see that I needed a hip replacement and said, ‘‘Tom, I’ll tell 

you what. I want you to get the finest of care. What I’m going to 

do is I’m going to send you down to the hospital for special surgery 

which happens to be one of the most highly-rated orthopedic institutions in the country,’’ I would go home and tell my friends, ‘‘What 

a great doctor I have. He cares so much that he’s going to send me 

to get the best care.’’

Meanwhile, back at the ranch, at Castle Point, if we refer a patient to the Bronx VA, where they receive care from surgeons who 

are affiliated with the hospital for special surgery, somehow we’re 

accused of giving second-rate care, why we can’t provide it. I’m at 

a loss why the two different judgments. If I worked at Horton, I’d 

be a hero. If I work at Castle Point, I’m a devil. 

That’s all. [Applause.] 

Mr. SHAYS. Mr. O’Connor, thank you very much for giving us 

your position on that. 

Ms. MUSSOLINO. Excuse me? 

Mr. SHAYS. Yes. 

Ms. MUSSOLINO. Could I just take a second? I just noticed the 

man just decided to stand next to me. I have no problems with my 

father going for hip surgery at the Bronx. I have a problem with 

the cuts that when he came back, he was not able to feed himself. 

And they stuck a tube down him. And now we have a group called 

the Silver Spoon to volunteer and feed these men. This is what I 

have a problem with. 

If he gets special care and better treatment elsewhere, fine. But 

we should be able to have that here. That’s all. [Applause.] 

Mr. SHAYS. Mr. Kelly is over here. Do you have a mic, sir? 

Mr. KELLY. Yes. Thank you. 

164

Mr. SHAYS. Thank you. 

Mr. KELLY. Thank you. 

STATEMENT OF GERARD KELLY, VETERAN AND EASTERN 

PARALYZED VETERANS ASSOCIATION, JACKSON HEIGHTS, NY 

Mr. KELLY. I’m Jerry Kelly from the Eastern Paralyzed Veterans 

Association of Jackson Heights, but I live in New City, which is in 

the Hudson Valley. And I have been a patient at Castle Point as 

well as at the Bronx and a number of other VA institutions. 

Thank you, Mr. Chairman. We have presented testimony for the 

record in writing, and I will not try to repeat all of that now and 

just make a few points that I think are important for you to hear. 

Castle Point has been a very important part of the hospital system for our members. It has been 1 of the SEI care centers in the 

Nation, 1 of the 22 SEI care centers. 

Right now as part of the restructuring of VISN 3, the three centers have been combined under one, which will be headquartered 

at the Bronx. There will be beds at Castle Point. But what has 

happened is that we have had to move our plastic surgery program, 

which we helped to underwrite, from Castle Point to the Bronx. It’s 

no longer available in the Hudson Valley for Hudson Valley veterans. 

We have seen the number of our members who go to Castle Point 

and also the number of our members who now go to the SEI center 

reduced because of this increased need to travel further for the specialized care. 

The VA SEI care system is the only care system of its kind in 

the Nation. It’s one of the specialized care programs. It has been 

recognized as such and has been picked out or singled out for special funding. 

One of the things the SEI care system does that is not done in 

the private sector is sustaining care that they provide for our SEI 

veterans, our spinal cord-injured and disabled veterans. 

We have been concerned about the availability of that care. And 

while we recognize that the access points are a big plus for veterans in general, for veterans with spinal cord injury, they have 

not been as available because of some problems, first of all, with 

the specialized care availability and in other cases wheelchair accessibility to some of those centers. That’s also been a problem. 

The other main thing we have been concerned with is the quality 

control issues. We have discussed today with some of the witnesses 

that there are new systems being put in place to assure quality 

control is maintained on a nationwide basis in a more uniform 

basis. We talked about some of the sentinel events which will trigger investigations. We’re very happy to hear that because we have 

been tracking what’s happened about the country. 

One of the biggest problems has been mistakes which have been 

made many times because of the fact that there has not been a reporting system and investigations have not been done properly to 

followup on these. 

I’m concerned that what is identified as a sentinel event is properly done because I know there’s been some things which are the 

explanation of what a sentinel event is, which would not have been 

identified as such. And those problems would have, again, been 

165

continued. So we’re going to be watching that very carefully. And 

I know the committee will also. 

We know the VA needs to be reformed. We just hope that the 

Veterans Affairs Committee, the Government Reform and Oversight Committee, and the other Members of Congress who are responsible for overseeing what is done to our Nation’s veterans 

make sure that those changes take place in a proper manner. We 

need to save money, but let’s do it while we’re also protecting veterans. 

Thank you. 

Mr. SHAYS. Thank you, Mr. Kelly. [Applause.] 

Daniel Reilly from Beacon? 

STATEMENT OF DANIEL REILLY, VETERAN AND NFF 246, 

BEACON, NY 

Mr. REILLY. Good afternoon, Members of Congress, ladies and 

gentlemen. My name is Daniel J. Reilly. 

On December 1, 1976, after having served in the Air Force, I 

began my career with the Veterans Administration Service. I 

worked at the VA hospital in Montrose until August 1990, when I 

transferred to the medical center at Castle Point. 

I feel that in the spirit of the difficulty both Castle Point and 

Montrose are experiencing at this time, the two facilities remain a 

good place in which to work. These facilities afford veterans the 

necessary care and treatment they surely deserve. 

As a spokesman for NFF, which is the local out there, 346, I 

should express feelings of the members that our drastic downsizing 

and cutbacks are what contributed to the poor morale and bad publicity by the newspapers, what we have experienced. 

We already had experienced cutbacks and downsizing with the 

public sector in this area and now with the same happening with 

the government, families especially. We veterans feel hurt, helpless, what in the future will help us all. 

It is apparent that the government is willing to sacrifice funds 

for veterans’ programs and health care by appropriating these 

funds for other resources that are deemed more important than for 

the veterans who served their country so faithfully. 

I, as a veteran, am especially saddened when I think of where 

the future lies for the young men and women who are now serving 

and will serve their country in the future. 

In conclusion, I am among the many others here today who respectfully ask for all of you to support us in our time of need by 

doing all that you can to help see that the rights of veterans are 

upheld to the highest standards possible by keeping our veterans’ 

programs in health care alive and well for all veterans today and 

tomorrow. 

Thank you. [Applause.] 

Mr. SHAYS. Thank you, sir. 

Our next few witnesses: Kenneth LaFontaine did not give a city 

or a town, Harry Fleming from Middletown, and Shirley Mangels 

from Ellenville. Is Mr. LaFontaine here? Then our next speaker 

will be Harry Fleming. Mr. Fleming from Middletown. 

Mr. FLEMING. Thank you very much. 

166

STATEMENT OF HARRY FLEMING, VETERAN AND CHAPLAIN 

AND SCOUTING CHAIRMAN, ORANGE COUNTY AMERICAN 

LEGION, MIDDLETOWN, NY 

Mr. FLEMING. I am with the American Legion, the past commander of Post 151 here in Middletown. And also presently I’m the 

Orange County American Legion chaplain and the scouting chairman for the Orange County American Legion. 

As a whole, with Castle Point, I have not too many problems. I 

did, and which I have brought to Mr. Gilman’s attention. I’ve had 

a problem with one doctor over there. And he was a doctor that you 

could not talk to as I undergo daily pain from osteoporosis, arthritis, and diabetic neuropathy. And I have pain 24 hours a day, 7 

days a week. The doctor argues with me, tells me it’s in my head. 

And I tried talking with the doctor to no avail. 

I ended up changing doctors over there after he pulled a sneak 

one on me. He canceled an appointment on me for the hospital 

down in Manhattan. And, subsequently, I had to end up going to 

a local hospital and being transferred to Columbia Presbyterian, 

which would end up costing me $7,000 out of my own pocket because he canceled the appointment and didn’t even tell me. 

That’s all I have to say. 

Mr. SHAYS. Thank you, sir. [Applause.] 

Our next speaker is Harry Fleming from Middletown. Oh, I’m 

sorry, Harry. You just went now. I’m sorry, Harry. 

Shirley Mangels, is she here? Thank you. Way in the back there. 

STATEMENT OF SHIRLEY MANGELS, DAUGHTER OF 

DECEASED VETERAN, ELLENVILLE, NY 

Ms. MANGELS. I’d like to thank you for letting me speak here 

today. 

My father had been a patient at Castle Point, an outpatient at 

Castle Point, for 3 years. So what I’m about to tell you cannot be 

said happened because there was no knowledge as to what his 

medical status was. 

On January 20, my mother took my father, Clifford Madison, to 

the Castle Point emergency room. He had been coughing, complaining of shortness of breath, and had a frying sound when he 

breathed, audible without a stethoscope. His ankles also displayed 

some swelling. 

The emergency room doctor, whom we discovered later on was 

only moonlighting at Castle Point, was not a regular staff doctor, 

told my mother that there was essentially nothing wrong with my 

father, that he had maybe an occasional drip in his lungs, which 

was not considered unusual for an older person, but there was really nothing wrong. And on the records, what he listed my father’s 

condition as was ‘‘viral syndrome.’’

Well, guess what? In about 36 hours or so, my father became 

progressively worse to the point where he was incoherent. And on 

Monday morning, January 22, he had become critically ill and had 

to be transported to Ellenville Community Hospital, where there 

they found that both lung fields——

Mr. SHAYS. Excuse me. Would you just suspend a second? Could 

we shut the door? I’m having a difficult time hearing. I’m sorry. I 

really appreciate all your patience. We don’t have the most comVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00170 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
167

fortable chairs to sit in, and some have not been able to sit very 

long. Thank you. 

I’m sorry to interrupt you, Ms. Mangels. 

Ms. MANGELS. Quite all right. 

X rays revealed that fluid was in the lower two-thirds of both 

lung fields and that this area was filled. There were fine and 

coarse rails anteriorally and posteriorally in both lung fields. There 

was also cardiomyoglian evidence of swelling three to four plus. 

Later that day, my father was transferred to the VA facility at 

Castle Point in extremely serious condition because Ellenville did 

not have a blood gas machine that was working properly at the 

time. 

From there on, my father at one point began to progress and 

began to show signs of becoming well. And, as a matter of fact, the 

one doctor that was observing him at the time told me that my father would be home in about 3 days. 

Well, later on, my father on February 10 passed away. The same 

doctor that less than 2 weeks prior told my mother to take him 

home, same emergency room doctor, comes into my father’s room 

and pronounces him dead. 

Now, we have been to an attorney about this. And we have gotten an independent physician’s results on what he gathered from 

reading my father’s records. This is the statement that he gives,

I have read the medical records recently forwarded to me, having particularly to 

do with the above-captioned person’s visit to the Castle Point VA emergency room 

on January 20, 1996, the subsequent events at the Ellenville Community Hospital 

on January 22, 1996, and subsequently again at Castle Point VA Hospital extending 

until the time of his demise. 

On the basis of these data, it is my opinion that the emergency room record from 

Castle Point VA Hospital generated by a physician on call in the emergency room 

whose name is illegible to me represents a disgrace to the medical profession and 

certainly to the Veterans Administration. 

Among other things, this record under the ‘‘Triage’’ section does not truly, fully, 

and accurately relate the patient’s problem and complaints. Complaints at this time 

were particularly: shortness of breath, wheezing, and swelling of the feet and ankles. These problems were not indicated on this medical record. 

The section for history and physical is unbelievably below standard in essentially 

all respects. The entry shows the presence of occasional bronchi in rails and no 

wheezes, which is contrary to the history. There was no comment regarding the 

question of veins in his neck, his color, his general condition, the presence or absence of pulmonary findings on percussion, such as dullness and/or a decreased——

Mr. SHAYS. Ms. Mangels, could I just—given the severity of your 

concern, for obvious reasons, I want to give you some leeway, but 

I do need to have a sense of how much longer you’ll be because——

Ms. MANGELS. Not very much longer. 

Mr. SHAYS. OK. You’ll finish up in a minute? 

Ms. MANGELS. Yes. 

Mr. SHAYS. Thank you. 

Ms. MANGELS [continuing statement].

Under abdomen, there appears to be simple negative regarding ornagamy and 

other problems and under extremities, no entry of pedal edema, which is contrary 

to the obvious fact. 

This history is such as to contribute to the formulation of anything like a reasonable, accurate diagnosis. And indeed in this case, no such diagnosis was made. The 

physician entered as diagnosis ‘‘viral syndrome’’ with nothing whatsoever to support 

this. And he also noted ‘‘increase’’ in the person’s ‘‘pt time,’’ which in my opinion 

had nothing to do with the presenting problems. 

168

On the basis of these information errors, the doctor advised the patient’s heart 

and lungs were OK; there was an abnormality in his pt time, which should be corrected; and he was summarily discharged to go home.

I’ll just skip down through here. The doctor continues,

It is my opinion that the 2-day hiatus with no treatment materially adversely affected his cardiopulmonary situation to the extent that myocardial infarction was 

precipitated by his hypotension, hypoxia dyspepsia, . . . Pneumonia was likewise a 

direct and result of the untreated pulmonary problem over these 2 days. Therefore, 

this hiatus of no treatment in my opinion was the proximate cause of his demise.

I would like to say one thing. All of this took place before the 

talks of cuts and everything else. There was a problem before. The 

problem is just not money. That’s the tip of the iceberg. 

Your problem is having competent health care-givers at these facilities. You want to expand facilities? You want to put some facilities in Monticello and in different areas? You’d better make sure 

that you’ve got people competent enough to run these facilities because if you don’t, you’re going to have more deaths on your hands, 

more mutilations, and so forth. 

Mr. SHAYS. Thank you. [Applause.] 

Our next three speakers are: Joseph Montemarant from Hopewell, Henry Lendzian of Warwick, and Pam Jinks from Montgomery. Is Joseph Montemarant here? Is Henry Lendzian here? Is 

Pam Jinks here? Ms. Jinks? 

Let me just say to you that we’re going to just go down the list, 

and we’ll stay here until 6 o’clock. Sir, we have to have some way 

to do it. So we’ll just go on to the next person who was randomly 

picked. 

Let me just say something here. We do have one obligation, and 

that is that this room is going to be used for another group afterwards. So we’re going to try to finish up in another hour and a 

half. We’re going to go another hour and a half. That’s 6 o’clock. 

Are you ready now, Pam Jinks? Can we start? Thank you. 

STATEMENT OF PAM JINKS, VETERAN AND CASTLE POINT 

EMPLOYEE, MONTGOMERY, NY 

Ms. JINKS. My appeal is to the representatives who appear to be 

jumping on the bandwagon to use Castle Point and Montrose VAs 

as their political crusade. 

I am a veteran as well as an employee of Castle Point. I’m concerned that all the adverse publicity that we have been receiving 

is going to be the downfall of two facilities that have faithfully 

served our veteran population for more than 50 years. 

In this time of health care reform, it’s imperative that the VA 

keep abreast with the private health care industry. The VA can no 

longer continue to operate as we have in the past. And the taxpayers can no longer be expected to foot the bill of this enormous 

program without the government taking drastic measures to cut 

costs and work more efficiently. 

By doing so, we are effectively downsizing, a word well-known in 

the corporate world. Along with that comes anger and fear from the 

affected employees as well as the population we serve. 

Congress approved VERA without knowing the full ramification 

of this bill. You listened to the bean counters, who projected shift 

169

in the population. You felt this was good for the Nation, but you 

were forgetting the ones that were left behind. 

I understand that the veterans who use both the New York facilities and Florida have said that the Florida facilities are beautiful, 

but books can’t be judged by their covers. 

The New York hospitals are under attack because you’re asking 

every disgruntled patient and family to come forward. Could any 

hospital survive this type of attention? I doubt it. 

The industry is still based on human judgment, which includes 

errors. We have not entered the era yet where IBM has developed 

a program designed to perfection for the medical profession, as they 

did for chess. We still use the human physician judgments. Why 

you ever opened up the floodgate is beyond me. Along with their 

failures, there have been successes. But you never ask for them. 

I happen to be proud of Castle Point. I began working in Outpatient, then spent 10 years in Quality Assurance. So I know the 

weaknesses as well as the strengths of this facility. 

For the past 18 months, I have served as supervisor of primary 

care. I’m a member of the Women’s Veteran Committee as well as 

the POW Committee. By being a member of these committees, I 

know that the facility has identified areas for improvement and is 

continually working to resolve the issues that are brought forward. 

Positive changes and implementation have begun. We continue to 

work with the service organizations to see that corrective action is 

taken. If anything, because the administration has changed, we are 

now able to quickly make corrections and address issues without 

the barriers placed on us in the past. Though change is always resisted, I believe that the merger of the two hospitals will benefit 

the community in the long run. 

Thank you. 

Mr. SHAYS. Thank you very much. [Applause.] 

Thank you for your testimony. Our next three witnesses will be: 

Enrico Messina from Poughduag, if I’m saying that correctly, Sandra Schwartz from Poughkeepsie; and Anne Bove from Woodside. 

Is Enrico here? Thank you, sir. 

STATEMENT OF ENRICO MESSINA, VETERAN AND CASTLE 

POINT EMPLOYEE, POUGHDUAG, NY 

Mr. MESSINA. Good afternoon, ladies and gentlemen at this congressional hearing. I come before you today to speak openly and 

honestly about Castle Point VA Medical Center. I will share my experiences and blessings. 

I am a veteran of the United States Army who served as a medical corpsman in the United States and was in Vietnam for 11 

months and 26 days. I truly believe that God sent me to Castle 

Point to provide nursing care for our honorable veterans who stay 

or use the medical center and outpatient clinics. 

I started my career at Castle Point in the nursing home on the 

B–1 unit, where I met, talked to, and provided the best possible 

care with the staff assigned to that unit. I am proud to look at each 

one of you here today and say that each day the men, in some 

cases women, patients were treated with dignity, compassionate 

hands, and skilled nursing care. 

170

These veterans were called to duty, as I was, in their late teens 

and early 20’s to serve our country in a foreign war and engage in 

battle knowingly for the love of their country without asking themselves, ‘‘Why me?’’ or ‘‘Why us?’’ They just did the job and served 

honorably for their country. 

Many of these veterans’ minds and bodies were scared for life, 

requiring compassion and love. Each day every patient was provided the activities of daily living. 

Some patients lost their limbs, legs, and arms during the battles 

they fought. Therefore, washing and showering and dressing them 

in neat, presentable clothing was provided them each day. Their 

teeth were brushed. Dentures were cleaned. And their hair was 

combed. A dialog with these patients took place either in their 

daily care or while feeding them at their bedside. 

Many of our freedoms that we have today we sometimes take for 

granted. These veterans, though, through their courageous efforts 

gave us this freedom that we have today. 

I, for one, am very grateful for the freedom of speach. I as I 

stand before you today ask you that you please do not take these 

and other freedoms of our veterans away. 

I challenge you all today to let us continue to provide the best 

medical care to our loyal veterans in an expedient way, which 

should be the way to always be maintained at a level second to 

none. You now have an opportunity to fight for us at each of your 

congressional and State levels of government, representing the people; in particular, all veterans. 

The nursing home also provided a religious atmosphere for each 

veteran and their families each day from our priests, reverends, 

and rabbis. Weekly services are offered to all. Many look forward 

to going before their God and praying in their own individual ways. 

How blessed they are to have this religious dedication at our facility. 

I have seen and heard the power of prayers at a time of need 

when many of our veterans are called home by their God. And the 

support was very uplifting for their families and the staff alike. 

The recreation representatives along with many volunteers provided such things as music therapy, pet therapy, bingos, movies, 

trips to local ball games, and fishing spots, which provides ongoing 

mental and physical stimulation that is needed to progress and 

have happiness in this world. These people sometimes go unnoticed, but I, for one, want to say thanks for the many smiles and 

words of appreciation that veterans shared with me after enjoying 

these recreational experiences. 

Yes, sir? 

Mr. SHAYS. Mr. Messina, you got here at 9 a.m., and helped set 

up this room. 

Mr. MESSINA. Yes, sir. 

Mr. SHAYS. So my heart wants to let you speak a little longer, 

but we do have other speakers. So could you kind of wrap it up? 

Mr. MESSINA. I have about 3 minutes, sir. Would you give me the 

opportunity? 

Mr. SHAYS. You have used 3 minutes. You may have more than 

3 minutes. I just would like you to bring it to a close. 

Mr. MESSINA. I will try to read fast, sir. 

171

Mr. SHAYS. Maybe cut out a little bit if you have to. 

Mr. MESSINA. OK. Many of our World War II veterans require 

and will continue to require these and other surgical procedures. 

I address the OR. We’ll skip over that, sir. 

I will give you a copy of my report, sir. 

Mr. SHAYS. It will be in the record. 

Mr. MESSINA. Please be mindful that the travel for these procedures to other VA facilities outside the normal traveling radius and 

in unfamiliar areas is a true hardship for my fellow veterans and 

their families, who are in the 70’s and 80’s. They need and want 

to continue to utilize the Castle Point facility. 

What we all did without second thoughts in our healthy 20’s, 

30’s, and 40’s becomes a frightening experience for us all as we will 

increase in age and find it hard to travel. These veterans will find 

it impossible to travel outside their living areas for the medical 

support they deserve and were promised. 

This past January, I was given the opportunity to serve our veterans in the outpatient clinic area. Hundreds of our patients visit 

the clinic each week to see the physicians, nurse practitioners, and 

nurses for their medical needs and medications. 

Preventative education to the veterans is vital to the continuing 

health for the future. We all at Castle Point strive to make this a 

positive visit with quality care, love and dedication to our veterans 

being the utmost importance. 

One of our ongoing goals is to continue to track new veterans by 

offering the best quality care that they need and deserve. We are 

a proud team willing to increase our offerings and expand our programs for these men and women veterans at our clinics. 

I would not be here today if it were not for the many articles 

published in the area newspapers that were very disruptive to our 

veterans at Castle Point. This is where I work each and every day 

to provide skilled nursing with love and compassion. In response to 

these articles, I have never seen, nor would I ever stand for, any 

veteran who required care and did not receive that care in a timely 

and professional manner. 

I beg each of you here today to continue support of the veteran 

population, these veterans here today and to those who could not 

make it here. 

Mr. SHAYS. Mr. Messina, I do need to ask you to conclude. 

Mr. MESSINA. In closing, I remind you of your challenges ahead 

to not only seek the truth, but be open and honest to us as veterans. As you allocate the dollars to all Veterans Administration 

health care facilities, you, as our elected officials, have the power 

to vote into and present new laws that will affect us as veterans. 

Our veterans fought and served for us. Now the opportunity is 

yours. Fight for us so we can continue to provide the ongoing excellent health care at Castle Point. 

Respectfully submitted, Enrico Messina. 

Mr. SHAYS. Thank you. [Applause.] 

Mr. Messina, thank you again for getting here at 9 a.m., to make 

sure that we had our chairs set up and this room set up. It was 

very nice of you to do that. 

Our next speaker is Sandra Schwartz from Poughkeepsie. Where 

are you? I’m sorry. OK. Thank you. You’re on. 

172

STATEMENT OF SANDRA SCHWARTZ, VETERAN, WIFE OF VETERAN AND DAUGHTER OF DECEASED VETERAN AND DISABLED AMERICAN VETERANS AUXILIARY, POUGHKEEPSIE, 

NY 

Ms. SCHWARTZ. I am with Disabled American Veterans Auxiliary. 

I am a volunteer member of the Disabled Committee of the 

Dutchess County Human Rights Commission. I sit on the Roundtable for Racial Harmony. I have served on the board of Taconic 

Resources for Independence, which works closely with the Eastern 

Paralyzed Veterans. I am the daughter of a soldier who paid the 

ultimate price, and I am the wife of a veteran. 

The VISN statement is proudly and prominently displayed on the 

corridor wall at Castle Point. It states, ‘‘Serving those who served 

our country with quality health care second to none.’’ Likewise, the 

mission statement, also proudly displayed, echoes this intent commitment. 

Whereas, Webster’s Dictionary defines the word ‘‘quality’’ as 

meaning ‘‘a grade of excellence,’’ the veteran is aware that the 

words ‘‘quality health care’’ are being bandied about and are constantly redefined in the direction of diminished care and perhaps 

‘‘equal to none.’’

There are definite indications that the hospital as we knew it 

really doesn’t exist any more but has become a shell of itself. It has 

been downsized, peeling away on a step basis the confidence of the 

veteran and veteran’s family and raises questions as to what criteria can still apply to it as a standard if it is no longer a hospital. 

Webster also defines a hospital as being ‘‘an institution where 

the sick and injured receive medical, surgical, and emergency care’’; 

whereas, a clinic is defined as ‘‘a facility associated with a hospital 

that treats chiefly outpatients.’’ This likens Castle Point’s transformation into a satellite, a field first-aid station, as in places of 

combat, where primarily the only aid rendered was preparation referral and transfer to a base hospital. 

Contracts with Vassar, St. Francis, or other community hospitals 

are being considered to provide emergency room services. In the absence of these services for inpatient or outpatient, how can anyone 

conceive of Castle Point being considered as a medical center? 

After gutting these medical, surgical services, what remains is 

little more than a primary care referral, recordkeeping, and pharmacy service under the heading of a medical center. These actions 

combined with reduced funding and lessened services construct a 

climate which will further discourage veterans from seeking care at 

Castle Point. Perhaps this is the ultimate objective: the reorganization to compromise the veteran in the interest of budget balancing. 

Placing the burden of further travel for medical care for the sick 

and spinal cord-injured veteran, including the elderly ones, is most 

inconsiderate and tantamount to cruelty to them and their families. 

A spinal cord-injured veteran who had been sent to the Bronx 

Medical Center reported back that the ratio of patients to personnel for his ward was 7 to 1. It certainly was not an ideal circumstance. A lot of patients in this type of ward need a lot of help. 

And short-staffing endangers their lives. 

The Federal Government has promised its citizens to be the role 

model for persons with disability as provided for in the RehabilitaVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00176 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
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tion Act of 1973, as amended, and the Americans With Disabilities 

Act. Yet, we see in this reorganization a disregard to these special 

citizens through dilution of their deserved quality care by proposing contracting with non-veteran, profit-based, community entities, reducing access and availability of VA expert competency centers. 

This past Thursday as I was preparing remarks for this hearing, 

I observed a fire drill on the hottest day of the year, which caused 

a veteran in his wheelchair to be moved outdoors. It turned out 

that he was abandoned there, which resulted in his succumbing to 

the heat. And he slumped over with his head leaning against the 

hot bricks. As a bystander, I personally notified staff of his need 

for immediate aid. 

Another issue at this time when the fire drill was repeated, I noticed a very long line of 20 to 30 patients awaiting their turn at 

the scheduling desk on the third floor disregarding the alarm because they were concerned about losing their place in line and finally being herded by staff into an already-occupied small room to 

at least get them to move out of the corridor. Even the elevator 

continued to operate for a fire drill. It appeared that the actions 

taken were ill-conceived. And it caused me to wonder, ‘‘What if it 

were not just a drill?’’

On Friday, August 1, 1997, 2 days ago, I was at Castle Point and 

received a firsthand account of the eroding of quality care. A veteran who had previously undergone a bad surgical experience at 

Castle Point was scheduled for a different procedure. He had expressed his concerns to the doctor, who reassured him in order to 

allay his anxiety that the instrumentation, a flexible soft scope, 

would be used for cavity insertion to prevent injury during the examination. 

The veteran arrived at the appointed hour fasting and was kept 

waiting for 21⁄2 hours before he was summoned to garb himself in 

surgical attire. And he was placed on a gurney in the operating 

room, prepped for the procedure, which was then commenced. The 

procedure had to be abruptly halted——

Mr. SHAYS. Ms. Schwartz, you’ve been about 5 minutes now. 

Ms. SCHWARTZ. I have one page, and I think it’s important. 

Mr. SHAYS. Everybody thinks their statement is important. 

Please finish up. 

Ms. SCHWARTZ. Yes, sir. But if it’s not read and it’s not recognized——

Mr. SHAYS. Ma’am. 

Ms. SCHWARTZ [continuing]. He yields his time to me, there could 

be a lawsuit, which could be avoided. 

Mr. SHAYS. Let me be very clear here. At 6 o’clock, we’re going 

to end. There will be some people who will not be able to testify 

because some people, quote, spoke 5 and 6 minutes. I’m very willing to let her proceed, but I’m just making the point to you that 

other people won’t be able to speak at all. If you think that’s fair, 

we may proceed. 

Ms. SCHWARTZ. When the doctor called for the flexi-scope and 

was only then informed that the supply for Montrose and Castle 

Point had been used up prior to the veteran’s scheduled procedure 

and that only a rigid, thicker fiber scope was available, the explaVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00177 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
174

nation offered was that all three of the necessary devices had been 

used up prior to his scheduled appointment and the sterilization 

process before reuse had not yet been accomplished. 

So the patient was told to redress and reschedule for a repeat 

procedure. The doctor apologized, saying she was impacted by overbooking and that they had just handed her a clinic, which she was 

late for. 

Poor pre-planning and the lack of ample equipment, resources, 

and staff could hardly exemplify quality health care. Is this the 

benefit of the Castle Point-Montrose merger? Savings should not be 

accomplished at the veterans’ risk. 

Also noteworthy is the recent rash of musical chairs being played 

at Castle Point, where medical care personnel unfamiliar with patient history substitute for specialists without background in that 

specialty. Additionally, there has been substitution by practical 

nurses for consultation in the place of specialists, no doubt due to 

short staffing. 

Fairness to the veteran population dictates that they be held different in budgetary matters. Opportunities which you people enjoy 

today are because of what they sacrificed yesterday. Stop imposing 

on families for third party contributions. Stop robbing their families. Stop robbing the veterans. Stop those who have conflicts of interest and bonuses. 

Veterans are special citizens who have paid their dues and contributing fees in advance with heavy consequences to them and 

their families. The cost of war does not end at the treaty signing. 

But fairness to the veteran is recognizing that the debt is ongoing. 

Let’s not nickel and dime them to death by being deadbeats to 

our veterans. Restore funding to our Northeastern veterans. Restore funding and refresh Castle Point to the quality care hospital 

it used to be. 

Thank you. 

Mr. SHAYS. Thank you, Ms. Schwartz. [Applause.] 

Our next speakers are: Anne Bove from Woodside. Is she here? 

Anne? And let me just say who will be following: Robert Jirak from 

New Paltz. Is Robert here? Robert is not here, I gather. Karl Rohde 

from Carmel. Is Karl here? He had to leave. And after Karl is Patricia Hulse from Sparrowbush. Is she here? OK. 

Well, I’m sorry to keep you waiting. Anne. 

STATEMENT OF ANNE BOVE, REGISTERED NURSE AND 

DAUGHTER OF DECEASED VETERAN, WOODSIDE, NY 

Ms. BOVE. My name is Anne Bove. And I’m speaking on behalf 

of my mother and one of her neighbors with regards to their husbands, respectively. 

My father, Frank Bove, as well as Mr. Carmine Gracioso, were 

both World War II veterans. My father was in the Service for 10 

years. Both of the men saw combat duty during the Second World 

War. My father was 35 percent disabled. Both men recently have 

passed away. 

My father, as well as Mr. Gracioso, suffered from complications 

of what I call inadequate staffing. I’m a registered nurse that 

works in a municipal hospital in New York City, so I can understand about governmental restrictions in terms of financial compoVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00178 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
175

nents. But I think the financial components that have restricted 

the particularly nursing care with regard to what these patients 

well-deserve has gone far and above what I consider or any of these 

patients deserve. 

My father basically got wonderful care at Castle Point up and 

until February 1997, when restructuring happened. At that point, 

he was in a nursing home section and was put into another nursing 

home unit that had much more acutely ill patients with less nursing staff. 

Subsequently he broke his hip, was operated on at Manhattan 

VA, which he got excellent care at, came back to Castle Point and 

the cascade of events that happened to him, once again indicators 

of poor nursing care, resulting basically from the lack of staff. 

I think it’s important to look at morbidity and mortality, but 

there are other indicators that will show whether or not the provision of care has been adequate, such as: the number of falls a certain facility might have, the number of pressure ulcers a patient 

will develop. I think all of those things need to be considered. 

And in the case of my father and in the case of Mr. Gracioso, 

those complications did ensue and much shorten their not-too-long 

life expectancy, but a little bit more time that we could have spent 

with them in terms of quality. 

I hope that consideration is made to enhance the VA system as 

not to do away with it because it’s a much needed system for a very 

special patient population, of which my father was once a member. 

And that’s really all I have to say right now. Thank you. [Applause.] 

Mr. SHAYS. Thank you, Ms. Bove. Just again I’ll call Robert Jirak 

is not here. Karl Rohde? Patricia Hulse? None are here. John 

Earley? Is John here from Pine Bush? John Ippolito, is he here? 

John, you have the mic, sir. 

STATEMENT OF JOHN IPPOLITO, VETERAN AND AMERICAN 

LEGION POST 1266, PINE BUSH, NY 

Mr. IPPOLITO. My name is John Ippolito. I’ll make this short and 

sweet. 

What I have heard here today is that the VA hospital should be 

doing more with less. So bonuses can be paid to perpetuate human 

misery by staffing cuts in our patient services to veterans who really need hospital care. This sucks. And I hope our congressional 

Representatives who are here today do something about it and 

soon. 

Thank you. [Applause.] 

Mr. SHAYS. Thank you, sir. 

Nicholas Bucci, is he here from Marlboro? Ralph Demarco from 

Fishkill? Ralph, you’ve got the floor. What I’m going to do is I’m 

going to tell you when 3 minutes come. The will of the group—I’m 

just going to say the will of the group is to let you go. And if you 

take someone else’s time, you do. But I’ll let you know when your 

3 minutes come. 

Mr. DEMARCO. You have my statement. I’ll skip over what I 

think is important. 

Mr. SHAYS. OK. 

176

STATEMENT OF RALPH DEMARCO, VETERAN AND REPRESENTING 27 NEW YORK VETERANS’ ORGANIZATIONS, 

FISHKILL, NY 

Mr. DEMARCO. First of all, identify myself. I’m a member of the 

Board of Directors of the Veterans of Foreign Wars of the United 

States. I’m the New York State VFW legislative chairman. I’m 

president of the New York State Council of Veterans’ Organizations, legislative representative. Most important, I’m a member of 

the New York/New Jersey Management Assistance Council for Network No. 3 and Network No. 2. I’m also a member of the Care Line 

Implementation Team for Network No. 2 for the Department of 

Veterans Affairs. To let you know, I represent 27 veterans’ organizations, major organizations in the State of New York. I’ll get to 

the part where I think is important. 

As a member of the New York/New Jersey Veterans’ Integrator 

Service for Networks 2 and 3 Management Assistance Council and 

also a veteran for the Network No. 2, its Product Line Implementation Team, we have been the veteran’s advocate at all network 

meetings. The network directors at the MAC meetings provided us 

with sufficient opportunity to state our position on and issues, discuss our concerns, and have been responsive to our concerns and 

questions. 

Due to the bad press recently at Castle Point-Montrose, VA received many calls from the media, where I appeared on television 

in an hour program answering questions from the veterans across 

our State, also been interviewed by major newspapers and three 

radio stations across the State. 

With the members of the council, we have toured Montrose and 

Castle Point Medical Centers and found them to be clean and orderly. The employees went out of their way to accommodate our 

wishes. We talked to medical and nursing patients and also were 

satisfied with their treatment and services, met with Dr. Kizer at 

Castle Point, where he explained the deaths. 

As far as VERA is concerned, we have long supported the concept 

of equal access to VA health care for all veterans, but we are concerned, however, that those networks which will receive fewer 

funds will begin to limit access and service. We will watch closely 

and will examine every complaint and every individual base. 

Here’s something that our good Congresswoman is interested in: 

treatment of medically-indigent veterans. These veterans are in 

grave jeopardy of becoming victims of an inadequate VA budget. 

Even though VA mandates to provide all needed hospital care to 

low-income veterans, they will only provide care to the extent that 

resources and facilities are available. Thus, if Congress does not 

appropriate adequate funding, this class of veteran may be denied 

care. 

We have been and continue to be committed to being champion 

of the medically-indigent. We will fight to see that their health care 

needs are fully provided by the VA. 

Another thing that we find very disturbing is the VA nursing 

home closes. Nursing home eligibility has not changed with the Eligibility Reform Act of 1996. It is still discriminatory and may provide when medically indicated and to the extent——

177

Mr. SHAYS. You may keep reading, sir. I was just going to let you 

know your 3 minutes are up, but keep reading. 

Mr. DEMARCO. All right. Just to close, with the coalition of major 

veterans’ groups, we recommend that if enacted, it would strengthen programs and services provided to the Department of Veterans 

Affairs. 

These recommendations are contained in the 11th Annual Independent Budget for Veterans’ Programs developed by the Veterans 

of Foreign Wars, the AMVETS, the Disabled American Veterans, 

and Paralyzed Veterans of America. 

The report recommends—this is where we think it’s important—

$43.2 billion in appropriations for the fiscal year 1998, a 7 percent 

increase over the current appropriations, including $19.7 billion for 

compensations, pensions, and burial benefits. And the recommended appropriation for veterans’ medical care is $19.5 billion. 

The VA’s attempt to be cost-effective may in some cases be taking precedence over efforts to provide high-quality care to veterans. 

The recommended funding levels in the independent budget will 

enable the VA to continue serving our veterans. 

Thank you for your time. 

Mr. SHAYS. Thank you, Mr. Demarco. [Applause.] 

Our next speaker is Philip Oppenheimer from Greenwood Lake. 

Is he here? Our next speaker after that is Andy Layer from Beacon. Is Andy here? Our next speaker is Warren Craig from Newburgh. Is he here? James Applegate from Goshen? Jim is not here? 

Robert Kavana—am I saying that name correctly—from Crugers? 

Audience PARTICIPANT. Kavana. 

Mr. SHAYS. Kavana? K-A-V-A-N-A? 

Audience PARTICIPANT. He’s gone. He’s gone. 

Mr. SHAYS. OK. Steven Fleck from Poughkeepsie? Is Steven 

here? Yes, Steven. You have the floor, sir. I’ll tell you when your 

3 minutes are up. 

STATEMENT OF STEVEN FLECK, VETERAN AND MONTROSE 

EMPLOYEE, POUGHKEEPSIE, NY 

Mr. FLECK. All I’ve got is one short statement. I work at 

Montrose. I’ve been there 13 years, and I’m very proud at working 

at both facilities. I’ve dealt with the Bronx. I’ve dealt with Manhattan. I’ve dealt with all the things. I’m a driver. I drive these veterans around wherever they want to go. And I go out of my way 

for them. And I appreciate the hospital. I’d rather go to a VA hospital than a private hospital. 

Thank you. 

Mr. SHAYS. Thank you, sir. [Applause.] 

William Munday from Wurtsboro. Am I saying that name correctly? And Richard Thornton from Poughkeepsie. Is he here? OK. 

Let me ask you this. I have a list that I could go through. How 

many people would still like to speak? Would you raise your hands? 

OK. What we’re going to do, those of you who can stand up, would 

you just stand up so we can just identify you again? I understand. 

Those who could, sir. 

OK. What we’ll do is we’ll be able to finish. And that’s very nice 

of you. Sir, we’ll start with you. And then we’ll just go right down 

178

the line. Everybody gets to speak. You’re first. Why don’t you get 

a mic here? 

Now, let me just tell you the challenge we have. When we’re 

done, we need you to write your name and your address and everything because we need to make sure we give it to the transcriber. 

But we need the mic so people back there hear you as well, and 

we need it for transcribing. Excuse me, sir. We need it for the transcriber as well. So you’re going to have to take the mic. 

STATEMENT OF THEODORE DOBBS, VETERAN AND HUSBAND 

OF DECEASED VETERAN, NEW HAMPTON, NY 

Mr. DOBBS. Certainly. My name is Theodore Dobbs. I’m a World 

War II veteran of the Navy, as was my wife, Marian Dobbs. She 

died in the Bronx VA Hospital. Those are all her charts. I need copies of those charts back again. They’re facts of what happened. 

She was admitted with an infection. And when she was told by 

the doctor admitting her in Montrose, he said, ‘‘Is it OK if we keep 

you here for a while?’’

And she said, ‘‘It is if you can cure my infection.’’

So he says, ‘‘Well, I think we can take a crack at it.’’

So there was somebody there. And I’m not going to mention her 

name, and I hope I don’t seem like too much of a ham when I 

speak about it. 

She said, ‘‘I remember the night that your wife and your daughter and you came in here.’’ 

She said, ‘‘It was a rainy night, and it was December 18, 1996.’’

And she said, ‘‘And then it lasted past midnight. And when the 

doctor said to her, ‘I think we can take a crack at it’ so that she 

would stay there, he was lying through his teeth because we have 

no antibiotics here at all. He just said that to placate her and to 

make her obey him to stay there.’’ And so, as a result of the negligence of that problem, she died. 

I want you to know I want the veterans’ hospitals to be just as 

perfect as they can be, but I think that there’s an insurance problem here. Insurance is behind everything that the government 

funds, and that’s got to stop. 

That’s all I’ve got to say. I loved my wife, and I was married to 

her for 9 days short of 52 years. I wish I had never sent her to a 

VA hospital, but now we’re going to change those things for the 

better. We’re going to make them what they should be. Am I right? 

[Applause.] 

Mr. SHAYS. Sir, I’m going to ask everyone speaking now to fill 

out a pad afterward just to make sure we have your address. And 

we’ll be taking it over. We’ll bring it to you. And your name again 

and your town, sir? 

STATEMENT OF CRAIG SHERA, VETERAN AND SON OF 

DECEASED VETERAN, GARDINER, NY 

Mr. SHERA. My name is Craig William Shera. I was in the Navy, 

and I also was in the Army, got out of both of them. My father died 

in 1987 at Castle Point VA Hospital. 

Mr. SHAYS. What’s your community, sir? 

Mr. SHERA. Gardiner, NY. 

Mr. SHAYS. Thank you. 

179

Mr. SHERA. My father died in 1987. He was diabetic. He had 

total kidney failure. Renal shutdown they called it. And he lasted 

7 days in that hospital. He had five heart attacks. And they tried 

to save my father’s life. 

I think the people at Castle Point are getting a bum rap, and it’s 

all political. We know it. I know it. I’m not as well-educated as you 

guys are, but this is how I feel. 

The woman on the end, I don’t really know her name because I’m 

not a Republican. [Laughter.] 

I heard she voted to send the money down south to this bill. And 

if that’s the case, if she doesn’t know what she’s voting for——

Mr. SHAYS. Sir, let me just be clear on this. You’re talking about 

the Veterans Equitable Resource Allocation. 

Mr. SHERA. Yes, I am. All the terms, I lived in the military for 

14 years——

Mr. SHAYS. We call it VERA. 

Mr. SHERA. Yes. 

Mr. SHAYS. That’s a decision that we mandate to the Veterans 

Department to do certain efficiencies and so on. They then decide 

how they are going to incorporate the——

Mr. SHERA. What I want to know is——

Mr. SHAYS. Let me just finish making this point. 

Mr. SHERA. I know. I know. 

Mr. SHAYS. And the point is then Congress looks back and says, 

‘‘We’re not comfortable with the direction you’re going, and we need 

you to look at doing it a different way.’’

It would be wrong for any Member of Congress to say that we 

don’t want the veterans’ facilities to become more efficient. How 

they become efficient becomes an administrative responsibility. 

And then Congress looks at it and says, ‘‘We like the direction 

you’re going’’ and not. 

Mr. SHERA. Yes. 

Mr. SHAYS. It clearly has to be a team effort. 

Mr. SHERA. I understand that. 

Mr. SHAYS. OK. 

Mr. SHERA. But what I’m trying to say is that if they can send 

money to send that space shuttle up every fricking week like 

they’ve been doing—[applause]—why can’t they send the money to 

where we need it for Americans? We went to the Persian Gulf to 

help the Arabs. We went to all of these other countries to help 

them. Why don’t we just help our own veterans? 

My father died at Castle Point. They didn’t kill him. He died. But 

they treated him well. And it gets me mad. They treat me well 

there. And when they start closing that down, I don’t have nowhere 

to go. I have no insurance. 

Thank you. 

Mr. SHAYS. Thank you very much. [Applause.] 

Would you bring the mic, please, to our next speaker? Our next 

speaker is right there. Sir, you’re a State Commander? I’m sorry. 

The gentleman who just spoke. 

STATEMENT OF GERARD MILEO, VETERAN, MARLBORO, NY 

Mr. MILEO. My name is Gerard Mileo, Marlboro, NY, United 

States Marine Corps, Korean war. 

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Someone is to blame. I’m listening to all of these people out here. 

Thank God I haven’t had time to use the VA hospitals. Maybe I 

have a second thought now. 

I listen to these people. And they’re making a point. Who is to 

blame? You can’t solve a problem unless you find out who caused 

the problem or what caused the problem. 

My opinion is our elected officials haven’t been doing their job. 

Don’t take this personally. This goes back to 1945. You people got 

in office recently or a few years ago. But they have let us down. 

Corporate America has let the working man down. And our Government, whom you people represent, has let the veterans down. 

Congressman Hinchey, don’t take it personal. Would you send a 

member of your family to a doctor that’s not registered? You are 

aware of it. From what I’m hearing, that doctor is still doing business in a veterans’ hospital. That’s wrong. [Applause.] 

If Bethesda Naval Hospital had physicians that weren’t registered, you people wouldn’t go there. Our President wouldn’t go 

there. You know the cause. Please do something about it. 

You, Ms. Sue Kelly, Representative, in your district, you have 

two VA hospitals. And both of them are going downhill. Both of 

them are going downhill. I’m not blaming you per se, but shouldn’t 

you be looking into this matter? 

Audience PARTICIPANT. That’s why we’re here. 

Mr. MILEO. OK. You’re here now. What are you people doing 

here today? You shouldn’t be here. You elected these people to represent you. We should be home doing what we want to do. But 

we’re here reminding them of the job that should be done. And I 

think it’s wrong. I agree with you——

Mr. SHAYS. I’m going to interrupt you a second. I’m just going 

to interrupt you a second. I at least deserve the opportunity——

Mr. MILEO. All right. 

Mr. SHAYS. You’re going to get to speak a little longer, but I’ve 

just got to say to you we could have this hearing down in Washington and not have it here. We have it here at the request of the 

three Members who are by my side here——

Mr. MILEO. And I thank you people. [Applause.] 

Mr. SHAYS. And we——

Mr. MILEO. I thank you. Congressman Gilman is a personal 

friend of mine. He’s a good man. 

Mr. SHAYS [continuing]. And because they wanted you to tell this 

committee firsthand what you feel and what you’re thinking. So I 

just want you to know you can’t have it both ways. 

Mr. MILEO. OK. Congressman, please excuse me. He is a personal friend of mine. He’s a good man. He’s a decent man. 

Mr. SHAYS. Well, don’t get carried away. [Laughter.] 

Mr. MILEO. Well, I lay it where it is. You people know the problems. All these people are telling you horror stories. You know that. 

Take their horror stories and go down there and fight for us. 

I think there are some elected officials in this United States that 

care more for foreign veterans than American veterans. [Applause.] 

We have two Senators in New York State. Moynihan, he doesn’t 

even know what’s going on. D’Amato, 2 years ago, he runs to the 

Baltic Sea playing hot stuff. Why isn’t he representing we, the vetVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00184 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
181

erans? Why are they running all over the world giving my money 

away and taxing us to death? 

Audience PARTICIPANT. Because he’s just faking it. That’s why. 

Mr. MILEO. No, I’m not going to call him a fake. I’m going to call 

him he’s not eligible to do the job. Vote them out. Vote them all 

out. That’s the only power we have left. And if you don’t use it, 

then take it and I don’t want to hear your cry anymore. Damnit, 

you’ve got the power of the vote. Unite and put these people out 

of business. 

These people will go to the best hospitals in the United States. 

Bethesda Naval Hospital, I was there. When you walk in the door, 

‘‘Yes, sir,’’ ‘‘No, sir,’’ ‘‘What’s the matter, sir?’’ Get off my back. Just 

give me an aspirin. 

I’m not here to pick on anybody. [Laughter.] 

I’m here to set the—I’ve heard all your horror stories. They don’t 

want to hear them anymore. They know what they are. Tell them 

to represent you. That’s who they are, House of Representatives. 

That means they’re supposed to represent you in Congress. 

I don’t want to be here today. I came here today. Can I tell you 

one short story while I’m here today? 

Mr. SHAYS. I was just going to say you’re——

Mr. MILEO. It will take a minute. 

Mr. SHAYS. No. I know. 

Mr. MILEO. It will take a minute. 

Mr. SHAYS. You’re going to talk. I just wanted you to know you’re 

at your 3 minutes——

Mr. MILEO. Yes. 

Mr. SHAYS [continuing]. In spite of the fact that I interrupted 

you. 

Mr. MILEO. Can I talk 1 minute? 

Mr. SHAYS. You’ve got 1 more minute. 

Mr. MILEO. All right. Let me tell you what happened to me 38 

years ago. 

Audience PARTICIPANT. Did they give you a medal? 

Mr. MILEO. I earned my medals. And I’m sorry what you went 

through. 

Audience PARTICIPANT. The President gave my wife——

Mr. MILEO. I’m sorry what you went through. 

Audience PARTICIPANT [continuing]. Two medals——

Mr. MILEO. Thank God. 

Audience PARTICIPANT [continuing]. Posthumously. 

Mr. MILEO. Thank God. 

I’m going to tell you what happened to me 38 years ago. I’m 

going to talk a little low. Lloyd’s Department Store was being 

opened up in the town of Newburgh about 38 years ago, Congressman? So my wife and I, my little boy are going there. And there 

was a veteran, an American Legion guy, selling poppies. And I’m 

walking by, he jammed it in my face. 

And I say, ‘‘Sorry.’’ I kept walking. I didn’t have the money. You 

know, I’m raising a family, just got out of the Service, and et 

cetera. And he keeps following me. And that’s all I remember. His 

name was Bill. 

182

Of course, his buddy selling poppies on the other side said, 

‘‘What’s the matter, Bill?’’ ‘‘Oh, this guy don’t want to buy a poppy. 

He must be 4F or he must be a deserter.’’

I took a verbal abuse. And I swore that day that I would never 

represent any vet. I don’t belong to the American Legion or the 

VFW, which I break from both of them. I don’t. They just turn me 

off. They gave me a verbal abuse and I was a ‘‘deserter,’’ I was 

‘‘4F,’’ et cetera. 

Mr. SHAYS. You got 1 minute. You used 1 minute. 

Mr. MILEO. I’ll be done. And I swore that day I would never represent or talk about veterans. Today is the first day I’ve done it. 

You know why? My brother-in-law, Al Roberts, took a plane 

today—he was treated in Castle Point—to Tucson, AZ. You know 

why? He couldn’t be treated in Castle Point. His daughter set up 

a meeting in one of the VA hospitals in Tucson, AZ. 

Mr. SHAYS. You need to wrap it up, sir. 

Mr. MILEO. Right. Why does he have to fly to Arizona to get 

treatment? That’s the question. This woman was 100 percent right. 

Thank you. Congressman, please excuse me. 

Mr. SHAYS. OK. [Applause.] 

Sir, I want to make sure you sign. Sign the list after each speaker. Who’s our next speaker? 

Mr. NOVAK. Over here. 

Mr. SHAYS. Yes. We’re just going to go around the circle. Oh, over 

here? Yes, sir? Wait. Excuse me. I’m sorry, sir. I promised you. 

You’re next right over here. Right over here. The mic, please, over 

here. The mic right there, please. 

STATEMENT OF BILL NOVAK, VETERAN AND NEW YORK STATE 

BENEFITS PROTECTION OFFICER, DEPARTMENT OF NEW 

YORK DISABLED AMERICAN VETERANS, MIDDLETOWN, NY 

Mr. NOVAK. My name is Bill Novak. I’m past aid commander of 

the Disabled American Veterans in New York. I’m on the National 

Executive Committee. And I’m the New York State benefits protection officer for New York State. 

I’d like to start with veterans and their dependents have made 

enormous sacrifices and eminent contributions in the service of this 

Nation. Since the beginning of our Nation, it has, therefore, been 

the tradition to treat our veterans and their dependents as a special group, entitled to benefits above those available to the general 

civilian population. 

While serving in our country’s armed forces, veterans not only relinquish their liberty to allow the rest of us to continue to enjoy 

ours. They lose income and other civilian economic and educational 

opportunities, endure the rigors and hardship of military service, 

risk the hazards of war and dangerous military missions, and suffer injury and death. Of course, the heaviest burdens are borne by 

those who come back disabled. 

Most Americans deem it improper to allow those who preserve 

our freedom at personal expense to bear the financial and other 

burdens resulting from military service. In recognition of what veterans and their dependents endure as a cost of the security to our 

Nation, our country has made a commitment, a restitution for 

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these sacrifices and contributions through indemnification for disabilities and other veterans’ programs. 

Our Nation’s commitment to its veterans has endured periods of 

economic crisis and has evolved through many military conflicts. 

Although the consciousness of the needs of veterans may decline 

somewhat between periods of major conflict, the needs continue in 

the aftermath. 

The American public strongly supports veterans’ programs and 

expects the commitment to veterans to be honored. And I will support that with several polls that have been done, one of them by 

Harvard University and the Kaiser Foundation, that 93 percent of 

the American public oppose any cuts to veterans’ benefits. And another one, the Harris Poll done by Business Week magazine, found 

that 75 percent of the American public oppose any dismantling of 

the VA. 

Therefore, this Nation must continue to honor its obligation to 

care for the special needs of a special group of citizens. Because 

veterans are a special group, their programs should always have a 

priority for our Government. These programs must be adequately 

funded to assure they remain effective in fulfilling their purpose. 

Unfortunately, there are some who would abandon this commitment and balance the budget on the backs of our veterans. How 

dare they send America’s young men and women into harm’s way 

and then say, ‘‘We can no longer afford to honor that commitment’’? 

We must remain vigilant and oppose any attacks on our benefits. 

Having said that, I would just like to make a few points. For over 

11 years now, the independent budget that Mr. Demarco spoke 

about before has been sent to all Members of the Congress. It’s a 

budget put together by the AMVETS, Disabled American Veterans, 

Paralyzed Veterans, and the Veterans of Foreign Wars. And it’s endorsed by 50 other organizations and medical units and things like 

that. It has proposed ways to make the VA more efficient and save 

money for the government. 

I find it interesting that they say that they weren’t really aware 

of a lot of these things that VERA could impose because one of 

the——

Mr. SHAYS. Just to let you know, you’re at 3 minutes. 

Mr. NOVAK. OK. 

Mr. SHAYS. You may keep going, but you’re at 3 minutes. 

Mr. NOVAK. OK. One of the comments that came out of this several years ago that was sent to the Congress—and these are comments from that independent budget. It says that, ‘‘Although the 

independent budget veterans’ service organizations continue to support VA restructuring goals and advocate for operational change 

within the VA system, we fear that these efforts to be cost-effective 

may be overriding efforts to provide high-quality care.’’ This came 

out over 3 years ago. They were advising Congress that that could 

happen. 

I also found it kind of interesting that they admonished Mr. 

Farsetta before for saving that $148 million that they told him to 

save. They told him, ‘‘We’re not going to give you the money. 

You’ve got to save $148 million.’’ He did his job, and he’s admonished for it. I find it kind of interesting. 

184

Another thing, I heard a comment before. They said that the VA 

absolutely says, ‘‘We don’t need any more money.’’ there are comments from Secretary Brown or former Secretary Brown that said 

that, ‘‘If we maintain a straight-line budget for next year, we probably will be forced to deny care to 105,000 veterans and eliminate 

6,600 health care positions.’’

These are all things that were said before. And now we’re saying, 

‘‘Oh, we don’t need any more money.’’ I think the bottom line is 

that the veterans have more than—everybody wants a balanced 

budget, and we think that’s a priority for the Nation. But the VA 

budget makes up only 2 percent of our national budget. 

Yet, the cuts in the VA program—and I can show you from over 

the last 2 decades—$2 billion in the 1980’s, omnibus bill of 1990, 

$3.67 billion in cuts in veterans’ program, 1993 omnibus reconciliation, $2.6, already $8.27 billion in cuts in the VA programs and 

with the President’s current proposals, another $3 billion. By the 

year 2000, that’s $11.25 billion. 

And I think that if we want these people to maintain good programs in the hospital, you’ve got to give them the funding that was 

out there. And I see that the Congress is now finally—they’ve 

passed a resolution in the last year that they’re going to be examined in that independent budget. And I hope that they will be 

working very hard to get the proper funding to the VA to get these 

programs. 

And I thank you for the time. 

Mr. SHAYS. Thank you, sir. [Applause.] 

I just want to make sure everyone who speaks that we get a form 

just with your name and address for the transcriber. 

Mr. SPADARO. It’s been a long day. 

Mr. SHAYS. Thank you. Your name and where you live? 

STATEMENT OF BEN SPADARO, VETERAN AND VA EMPLOYEE, 

BRONXVILLE, NY 

Mr. SPADARO. My name is Ben Spadaro. I’m from Westchester 

County, Bronxville, NY. My background has always been working 

for the VA after I came out of Service, after spending 9 years. I 

then went to become the county coordinator in Westchester County. 

I retired in 1990. I was appointed by President Bush to a committee in Washington. 

And my statement is a 5-year plan approved by Congress to balance the Federal budget calls for the deepest cuts ever in VA programs. While tens of billions of dollars have been earmarked for 

new and expended Federal programs and to pay for these increases 

and $85 billion in tax breaks, the budget plan cuts the President’s 

original request for VA funding by an average of 2.3 percent over 

5 years. That’s more than twice as much as the average of the 1 

percent cut in other Federal programs. 

There’s no question that veterans want to put their physical 

house in order. But to balance the budget agreement unfairly burdens veterans’ programs and severely hampers the VA’s ability to 

provide quality health care. 

Congress has an obligation to veterans to give sufficient funds to 

provide sufficient care to the VA and to cover the cost of the health 

185

care. The Department of Veterans Affairs has over the last many 

years lost at least 40 percent of VA moneys. 

And if you take into consideration what hospitals used to be—

for instance, Montrose was a 2,000-bed hospital. It’s now a 600-bed 

hospital; 1,400 beds have been cut. Every one of those beds are considered to be money. And this was at the beginning and at the 

Carter administration and to date. 

Historically the VA has approximately $5,600 million a year. And 

that was just to pay for raises and the cost of medicine, supplies, 

and equipment. And I can go on and on. 

The VA cannot continue to operate without sufficient funds. The 

Congressmen and Congress ladies—I had to add that today—will 

continue to see medical decline. The Congress must appropriate 

more moneys and not choke the VA officials if something is wrong. 

Mr. SHAYS. I just wanted you to know your 3 minutes have come 

now. 

Mr. SPADARO. I have about 10 seconds. 

Mr. SHAYS. OK. 

Mr. SPADARO. Without sufficient funds, more and more meetings 

such as these will occur. 

Where does the problem originate? I would say from the Congress and from the several Offices of Management and Budget and 

from the Hill itself, not from the VA. Not one VA official voted for 

VERA. And the officials in charge of hospitals, they cannot continue without the moneys allocated properly to the VA. 

Thank you very much. 

Mr. SHAYS. Thank you very much, sir. [Applause.] 

May I just see how many more speakers we have? Would you 

just raise your hands to see how many more speakers we have? 

Five? OK. Well, they keep coming up here. Yes. This list is growing. I’m getting a little concerned. We started out with seven. We 

still have seven. 

Audience PARTICIPANT. I just need about a minute. 

Mr. SHAYS. OK, sir. We’re going to go there, and then we’re going 

to come to you. You’re ready. Let’s go, Bob. 

STATEMENT OF RAY PARRIS, VETERAN, WASHINGTONVILLE, 

NY 

Mr. PARRIS. My name is Ray Parris, Washingtonville, NY. That’s 

P-A-R-R-I-S. 

Mr. SHAYS. Your address? 

Mr. PARRIS. I’ve been going to Castle Point since 1980. First I 

started going for an artificial leg. I was not Service-connected, but 

the veterans would cover it. They had to send me to Manhattan. 

After about my sixth visit, I noticed the color TV was gone. And 

I said, ‘‘What happened to the TV?’’

They said, ‘‘Budget cuts.’’

I said, ‘‘Oh, well, no TV.’’

The next time I went down a few months later, I noticed the coffeepot was gone. I said, ‘‘What? No coffee?’’

They said, ‘‘Budget cuts.’’

I said, ‘‘Oh, well.’’

A couple of years later when I went to go to the city, they said, 

‘‘We can’t send you any more because the government cut back. 

186

You’re not Service-connected. We can’t give you a leg any more.’’ 

I thought that sucked. 

A couple of years ago I had a severe sore throat, could hardly 

swallow. I went to Castle Point for treatment, where I was informed by a snotty nurse that I should not have come right over 

but called for an appointment instead. She said you could only 

come if it was an emergency. I told her I thought that it was an 

emergency. 

I insisted she contact my doctor, Dr. Martinko, which, after much 

aggravation on my part, she finally did. Dr. Martinko soon came 

down, gave me a thorough examination, and gave me antibiotics. 

Dr. Martinko resigned a short time later. She was a great American doctor. She was smart, compassionate, and caring. I heard 

that she just couldn’t practice medicine there anymore because of 

how it was run. As far as I and many veterans are concerned, she 

was the best doctor at Castle Point. 

A large percentage of doctors are foreign-speaking. When they 

talk to me or I ask them a question, I cannot understand what they 

are saying with their heavy accent. This is not good. 

A couple of times I’ve asked different doctors for medicine to relieve terrible stump pain. I’m an amputee. And they just prescribe 

me medicine for stomach pain. They didn’t understand me. 

Another time a doctor asked me when I last had an ‘‘addin’’ test. 

And I said, ‘‘Iron test?’’

And he kept repeating, ‘‘Addin, addin.’’ I finally realized he 

meant a urine test. Unacceptable. This failure to communicate is 

not good for patients’ welfare. 

I will state that an overwhelmingly high percentage of doctors at 

Castle Point, 70 percent or more, are foreign. And, whether they 

are competent or not, the language barrier creates a potential for 

disaster. Then they get an excellent doctor, like Dr. Martinko, who 

speaks good English, and they let her go. 

Now we find that a lot of the doctors practicing at Castle Point 

are not New York State-licensed. This is not only totally outrageous, but should be criminal. 

The wait at the pharmacy for prescriptions is 2 hours. Short staff 

they say. This is totally unacceptable to a sick veteran that just 

wants to get his medications, take them, go home, and lie down. 

Also, they are slip-shod. I have had a draining abscess for over 

a year now and have to bandage it two or three times a day. 

Mr. SHAYS. Sir, I’m just letting you know your 3 minutes have 

come. 

Mr. PARRIS. I’ll be done in 15 seconds. 

The doctors write me prescriptions for four by four cover sponges. 

And the pharmacy keeps sending me four by four gauze. I’ve went 

to the pharmacy in person and showed them the difference between 

the two. The cover sponge is absorbent, and the gauze is not. It 

would soak right through and be useless. But the people just can’t 

get that into their heads or they just don’t give a damn. 

Any politician that doesn’t think that funds should be rerouted 

back here and the VA problems and concerns should be addressed 

and corrected should have themselves or their loved ones put into 

this VA system at Castle Point and see how they liked it under an 

alias, of course, with no publicity. 

187

I’d also like to say there’s lots of good doctors at Castle Point and 

excellent technicians and nurses. And I’ve had a lot of them. But 

there’s a lot of bad ones, too, and you’ve got to look into it and correct it. 

Thank you. [Applause.] 

Mr. SHAYS. Thank you. 

Sir to my right, you’re on. 

STATEMENT OF JOHN SKYLER, VETERAN AND DEPARTMENT 

COMMANDER, DEPARTMENT OF NEW YORK DISABLED 

AMERICAN VETERANS, CHEEKTOWAGA, NY 

Mr. SKYLER. I’m John J. Skyler, the department commander for 

the Department of New York, Disabled American Veterans. 

Why is it that lives have to be lost before Congress starts to ask 

questions? Staffing cuts will obviously have an impact on patient 

care. And cuts made too deep result in overworked staff that can’t 

keep up and cannot give the basic care that human beings, let 

alone veterans, expect when they are hospitalized. Obviously VERA 

isn’t working. 

When you made these budget cuts, they look great on paper. But 

when it comes down where these cuts will actually be made, Congress has to realize that patients deserve quality care and enough 

staff to assure that care is received. Obviously Congress would 

have served the veterans better if they search elsewhere for places 

to cut, rather than where lives are at stake. 

We should all applaud the employees and the families that have 

the courage to speak up and hope that these problems will stop. 

The veterans have already paid the price for freedom we all enjoy 

and take for granted. We would never have believed it. If we had 

known, we would have battled the enemy and survived only to 

come home so far after having battled the enemy of another kind 

and lose our lives. 

Congress, this is your wake-up call. Do not allow this to happen 

at this facility or any other in this country. The veterans made this 

country what it is today and deserve better. 

Thank you. 

Mr. SHAYS. Thank you. [Applause.] 

STATEMENT OF HELENE VAN CLIEF, VETERAN AND TREASURER, MILITARY WOMEN AND FRIENDS AND MEMBER, COALITION FOR FAIRNESS TO VETERANS AND VAVS, BRONX, NY 

Ms. VAN CLIEF. My name is Helene Van Clief. I am from the 

Bronx, and I am a disabled vet. I want to thank you all for allowing me to speak. I am also a member of Military Women and 

Friends. I am the treasurer there and a member of the Coalition 

for Fairness to Veterans and VAVs. 

The VA health care was originally set up to give health care for 

those who could not afford to pay and those who were disabled 

within the military. As it stands right now, if the health care for 

veterans goes down any further, women in the 1950’s would have 

gotten considerably better care than veteran women now. 

In Third World countries, women are seen by doctors for their 

medical care needs. They are treated for things that VA has never 

treated women for. An example of this would be pregnancy. 

188

Two years ago women-specific pajamas was considered a major 

accomplishment for the health care of women veterans in Manhattan VA. Now women at the Bronx VA are seeing a nurse practitioner for their medical treatment. 

There are a lot more women in the military now who will be getting out and looking for health care as they received in the military. With all of these cutbacks, what kind of health care can they 

suspect to find in the future? 

Why do more and more women choose not to use the VA for their 

health care needs? When women are asked, ‘‘Are you a veteran?’’; 

they usually answer, ‘‘No.’’ Is this because they know how bad the 

health care is at the VA and there is no real benefit in saying, ‘‘I’m 

a veteran’’? It is hard for women to use a system which does not 

give them total equal care as their male counterparts. 

What kind of treatment can women who get out of the military 

expect to get in the future? What do women veterans get? I can 

only speak on my own experiences. 

I was at the Women Clinic in the Bronx. I was seen there by 

that—there is a nurse practitioner. And she is the primary person. 

I had a mammogram, which was at the VA. And they sent me a 

postcard saying that I possibly had cancer. I was sent to the Cancer Clinic as a referral. And I went and got a second opinion. 

The second opinion said, ‘‘I really don’t think that there’s anything wrong. I think you had a bad mammogram.’’ Well, I opted to 

get a breast reduction and have a biopsy done on the tissue just 

in case. Since all my relatives of grandmother’s family and my 

grandfather’s family all had breast cancer, I was really afraid that, 

‘‘Maybe they’re right.’’

Mr. SHAYS. I just want you to know your 3 minutes have come. 

You may keep talking. 

Ms. VAN CLIEF. I was an LPN, and I worked both at the Bronx 

VA and at Montrose. I worked there a long time ago. And at the 

time Montrose had a big problem with drugs. I don’t know if they 

still have it and whether that was ever resolved. I worked also 

through the reserves at 24th Street VA Hospital, but that was a 

long time ago. 

So I feel I know the system. And I do feel that some of these renovations need to occur like at the Bronx VA. When I was in the 

hospital for rehab, there was no female bathroom in that section. 

You either had to go across the way to the Psych Department or 

ride the elevator up—like at the time I think my room was on the 

seventh floor—ride up about five floors just to go use the bathroom. 

How many veterans have to die before something is done? The 

VA at the Bronx was only built 20 years ago. Does so much renovations there for so—there is no money left to pay for staff. How 

much do we cut back before patients suffer? 

There were a lot of psychiatric patients who were doing extremely well at the Bronx VA and now due to cutbacks are forced 

out of that longer treatment into a shorter treatment. 

For a majority of women veterans saying, ‘‘I am a veteran’’ 

means substandard health care and no place to go. [Applause.] 

Mr. SHAYS. Thank you very much. 

We have three speakers, and then we’re concluding? Sir, you’re 

going to end up. All right? OK. Yes, sir. 

189

STATEMENT OF SILVIO MANGIERI, VETERAN, WALKILL, NY 

Mr. MANGIERI. My name is Silvio Mangieri. I’m 83 years old. I 

saw service in Germany. And I want to speak because during these 

hearings I haven’t heard what I feel is most important. 

I wish to implore and impress our Congressmen that what I feel 

is more important and more needed is a change of direction, not 

to look for redress of faults or corrections of their faults because for 

many years all I’ve heard from the Government is excuses and 

ways of growing your mind with facts and figures. 

Mr. SHAYS. Sir, would you just tell me what town you’re from? 

I didn’t ask you that. Tell me your town, where you’re from. 

Mr. MANGIERI. Oh, yes. I wasn’t aware of that, sir. 

Mr. SHAYS. Where are you from? Where is your community? 

Where do you live? 

Mr. MANGIERI. I live right here in Walkill. 

Mr. SHAYS. Thank you. 

Mr. MANGIERI. I would like to impress our Congressmen that 

what we need is aggressive, radical action. What we need is for the 

States to have something to say about the jurisdiction in the quality care that our veterans are receiving in the hospitals within our 

area. 

They need to have a greater say over what is done and what is 

required for them, what doctors and nurses should be in the hospital and the rest of the technicians and the rest of the medical 

staff. 

In this respect, I feel that Washington has grown to be too big 

a bureaucracy as far as the Veterans Administration is concerned. 

And they are too far removed now and distant from the 50 States 

and their territories. 

I can’t see how they could respond to the problems of the veterans in the many hospitals throughout the country. They need to 

be done on the spot by the people who are taking care of them right 

there and then. That is what I feel should be done. 

Thank you. 

Mr. SHAYS. Thank you very much. [Applause.] 

You’re on, sir. 

STATEMENT OF ROBERT IANAZZI, VETERAN AND VIETNAM 

VETERANS OF AMERICA AND DISABLED AMERICAN VETERANS, MIDDLETOWN, NY 

Mr. IANAZZI. My name is Bob Ianazzi. And I’d just like to say 

I——

Mr. SHAYS. And you’re from? 

Mr. IANAZZI. I’m from Middletown. 

Mr. SHAYS. Thank you, sir. 

Mr. IANAZZI. And I served with the Fourth Infantry Division over 

in Vietnam in 1966. And during the month of May was our worst 

month. We had heavy casualties. And we had over 200 people 

killed and wounded. And at the time it was not an easy sight to 

see. I’d just like to say that I’ve never forgotten it. I’ve been going 

to Montrose VA now for the last 4 years for treatments for it. I’m 

60 percent disabled. 

I’ve gone down to New York City for hearings, and I submitted 

new evidence that a VA—which seemed to be totally overlooked. 

190

They took it, and it seemed like they just shuffled it to the side. 

And then I got a letter saying that I was denied my increase in my 

disability. 

I just want to say that the way the VA is going right now we 

need all the help we can get as far as Castle Point and Montrose 

VA. We don’t need anybody to get a $16,000 bonus to shut us 

down. I think that’s appalling. 

I’ve always been proud of my country. I fly a flag every day, both 

POW and the American flag. And I’m proud of my country. 

Thank you. 

Mr. SHAYS. Thank you, sir. [Applause.] 

I’m getting a little confused. I thought we had one last speaker. 

How many speakers do we have left? Do we have you, sir? Wait 

a second. Wait a second. We have three still? 

I’m going to just say I want all three to stand. I want us all to 

see who our last three speakers are. Thank you very much, sir. No, 

no. No. You can’t go over that way. We’ve got one there, one there, 

and one there. And then we’re going to conclude. 

Thank you, sir. You may begin. 

STATEMENT OF GUY CROWTHER, VETERAN, PORT JERVIS, NY 

Mr. CROWTHER. I’m Guy Crowther from Port Jervis, NY. This 

was written preferably to represent Gilman, and I’d like to ask him 

to strike the last word, please. 

OK. I know this meeting is primarily the situation that has occurred at Castle Point, and I believe that what I have to say is of 

as much additional concern to the veterans gathered here today. 

I was watching C–SPAN this past Wednesday night when the 

appropriations for the fiscal year of 1998 were being discussed. And 

it sure made my mind go at a whirl when I heard in the amounts 

of tax dollars that were being allotted to countries outside our borders. 

And Representative Gilman is the head of the International Relations Committee. That’s why I’ve got this. It says when I heard 

of $100 million to the IMF and then about $85 million to some 

Asian group. There was also several authorizations to other foreign 

groups that were not to exceed somewhere over $1 million. 

What I’m bothered by is why our hard-earned moneys, a lot of 

which is paid by those here today, is going into the slush fund to 

many countries that are reaching out with one hand for a handout 

and stabbing us in the back with the other. 

I would like to know what the so-called discretionary fund is that 

is authorized for the administration. It is not said by the media or 

the Congress or admitted that the present administration does not 

like this United States. They would like to see the United States 

become a bank book for the world with no say by the citizens of 

the United States. And they are actively pursuing the one-world 

government philosophy. This information is being revealed by some 

of the independent think tanks and other groups of this Nation. 

I would also like to know what has been done about the situation 

with the Panama Canal treaty that I talked to you about at the 

Port Jervis meeting. I know that the House of Representatives are 

not directly involved in the treaties, but have you ever talked to 

our State Senators about this concern? I know the veterans gathVerDate jul 14 2003 14:07 Dec 03, 2003 Jkt 010199 PO 00000 Frm 00194 Fmt 6633 Sfmt 6602 W:\DISC\46778 46778
191

ered here today sure have a big concern about the movement of our 

warships between the oceans around our country. 

Finally, sir, I would like very much to know why you support the 

killing of almost 40 delivered babies in the delivery, which is unnatural anyway. 

Thank you for your time. 

Mr. SHAYS. OK, sir. I just need—[applause]—hold on 1 second. 

Bear with me 1 second here. I have three speakers that I’ve missed 

in the transcriber. Your name again is? 

Mr. CROWTHER. Guy Crowther. 

Mr. SHAYS. Bob, do you have his card? We need your card. Did 

you sign a—is it one of these three? Who was the gentleman who 

spoke just before this gentleman? Your name is? 

Mr. IANAZZI. Bob Ianazzi. 

Mr. SHAYS. I’m sorry? Bob? 

Mr. IANAZZI. Ianazzi. 

Mr. SHAYS. Ianazzi. Thank you, sir. 

And the gentleman who spoke before Bob is? Silvio? 

Mr. MANGIERI. Silvio Mangieri. 

Mr. SHAYS. Thank you. 

And the gentleman who spoke before Silvio? 

Ms. KELLY OF NEW YORK. That was a woman, Helene Van Clief. 

Mr. SHAYS. Helene Van Clief. OK. 

And Dick Pinckney? 

Mr. PINCKNEY. Pinckney. 

Mr. SHAYS. You’re ready to speak now? Is that who we’re going 

to next? 

STATEMENT OF RICHARD PINCKNEY, VETERAN, 

MIDDLETOWN, NY 

Mr. PINCKNEY. Yes. This should be very short. I want to compliment the people that held this meeting today. And I just feel 

that it’s after the fact and it should have been before the fact. Some 

of the great information that we got here today has been the same 

information that we’ve had for many years. 

I also want to say that I was down in Florida, the State of Florida. I found a full page of the Tampa Times down there. I took it 

and mailed it out to Congresspeople. 

My post—my name is Richard Pinckney, a past Commander of 

Post 151, right here in Middletown. My post received a letter back 

from a Congressperson addressed to Jake Volo saying they were 

going to look into this. My name is not Jake Volo, and Jake Volo 

has been deceased for 5 to 6 years. I just think we fell asleep someplace along the line and we should get going. 

I think over there they brought—and I would like an answer to 

this eventually. They brought in new PXes. I’ve been around the 

country in VA hospitals on visitations. The PX we have over there 

sells frying pans, cooking equipment for $59.95. I just don’t understand what a patient in a VA hospital would be doing buying 

$59.95 cooking utensils. 

I also wonder to myself because I’ve been to Lebanon, PA. I’ve 

been upstate New York to one of the Finger Lakes. I’ve been to 

Charleston, SC. I’ve been to all our veteran hospitals around here. 

I lost my brother in a veterans’ hospital. My other brother is 100 

192

percent disabled from World War II, both of them. And I just wonder. 

Let me say this. I want to thank Dick Mayfield and Congressman Gilman for calling me when there are meetings over to Castle 

Point. And I go there. And I want to thank them both for that. 

I found out the last meeting I was over there to, I found out that 

any moneys from Medicare or Medicaid that Castle Point Hospital 

gets has to be turned back over to the general fund. Is that right? 

The hospital gets no benefit from it. They furnish the medicine, the 

prescription, the doctors. Your Medicare goes back into a general 

fund. I don’t know what that means. I would think it’s the U.S. 

Government’s general fund. 

And I also have one other question that the man down here 

brought up, one of the men brought up, about sending the vessels 

into the air and all of that. I wondered with all the cuts on VA why 

the cuts to Bosnia had not been downed, they had been upped. 

And I want to thank you for your time. And when I walked in 

here, this place was absolutely filled with interested people. And I 

think some of them have left in a haste. 

Thank you. [Applause.] 

Mr. SHAYS. Let me just say it’s so wonderful that you all have 

stayed. And I realize that some had to go. So we do know this was 

an extraordinarily well-attended hearing. 

Mr. Crowther, you have the last word. Oh, I’m sorry. 

Mr. PRESSLEY. Name is——

Mr. SHAYS. Pressley. I’m sorry. I apologize. 

Mr. PRESSLEY. That’s quite all right. 

Mr. SHAYS. Let me get it correct. Your name is Hugh Pressley, 

Jr., and you’re from the Bronx? 

Mr. PRESSLEY. Correct, Bronx, NY. 

Mr. SHAYS. It’s nice to have you here, sir. 

Mr. PRESSLEY. It’s glad to be here. 

Mr. SHAYS. Thank you for coming. 

STATEMENT OF HUGH A. PRESSLEY, JR., VETERAN, BRONX, NY 

Mr. PRESSLEY. I’ve got a couple of questions I’d like to ask. One, 

is it possible that this can be continued also in the city because 

there are a lot of veterans that are being heard here and there’s 

a lot more that I know that want to be heard in the city? You get 

a tremendous turnout because they have a lot of issues as well. 

I’m a veteran, aerial veteran, of Vietnam. I served for 2 years. 

I came back. I did my time, had a job, the whole nine. And recently 

I’ve become homeless. 

And I’ve noticed not none of the homeless veterans have been 

represented or even heard from. A lot of these organizations that’s 

out here, they’re claiming to represent veterans, but they’re not. All 

they’re interested in is numbers. And the minute you have a gripe 

or you have a problem, whatever the case may be, you’re shoved 

to the side or they tell you, ‘‘Well, you’ve got a problem. We’ll get 

to it.’’ And it would be real nice if that would be looked into. 

Also I think if anybody is going to represent us, they should at 

least be a veteran. That should be one of the criteria for representing a veteran, especially if you’re in a position where you’re 

193

going to be taking funds from the veterans. You ought to at least 

know some of our needs before you start taking our funds. 

That’s all I’ve got to say. 

Mr. SHAYS. Thank you, sir. [Applause.] 

Before we conclude this hearing, I want to thank the Town of 

Walkill; in particular, the police department. It started out rather 

ominously for me. When I walked in, the police officer said that he 

wanted to make an announcement to tell you all that you needed 

to be under control. I thought, ‘‘My God. I don’t usually have a police officer opening my hearings telling you all not to riot.’’

I’d also like to thank our court reporter, Ed Johns, for helping 

us out today; and our sound system, Jim and Greg of Thunder 

Sound Productions; and also our clerk, Jared Carpenter. 

We’re going to conclude by my thanking you for being here, for 

your patience during the day. We got through it quite well. And I 

learned that you guys are in charge and I just have to follow orders. 

Audience PARTICIPANT. That’s right. 

Mr. SHAYS. It took a while for me to get that. 

At this time I’m going to recognize Sue Kelly. 

Ms. KELLY OF NEW YORK. Thank you. I really want to thank you 

all for staying as long as you have. 

The purpose of this, as I said before, is to try and help all of us 

to understand the net effect of VERA on the veterans in this area. 

We want to make sure that we get for our veterans high-quality 

patient-centered health care. I believe that we can do that. I believe it’s something that is available to us if we just all work together. 

And we needed the input we heard today. We will do something 

with it on Capital Hill, I guarantee you. Congressman Shays is 

here to prove that. 

Thank you. 

Mr. SHAYS. Thank you. [Applause.] 

At this time I’d like to call on Maurice Hinchey. And then we’ll 

go to Ben. Thank you. 

Mr. HINCHEY. Well, Chris, I just want to thank you for coming 

over here from Connecticut and holding this hearing. I want to 

thank Ben Gilman for initiating it. I think it has been very interesting and informative. And I want to thank all of you who have 

been here for the duration as well as everyone who spoke and left. 

I think it has been a productive afternoon. I’m very glad that I had 

the opportunity to be here. 

Now we have to make sure that the Veterans Administration, 

first of all, has the funding it needs to carry out its responsibilities 

and, given that funding, that it does the job it’s supposed to do. 

Thank you very much. 

Mr. SHAYS. Thank you. [Applause.] 

And, Mr. Gilman, sir, you have the last word. 

Mr. GILMAN. Well, Chris Shays, we thank you for bringing the 

committee to Orange County so that Sue Kelly and Maurice Hinchey and myself could bring our veterans together and get the benefit of their thinking and share their views. 

We’re so thankful that Jim Farsetta from the region and Mary 

Musumeci—did I get it right that time, Mary—and Mr. Sabo have 

194

stayed throughout to listen, to learn. And Dr. Wilson is still here 

also. I didn’t notice Dr. Wilson staying that long. But these are the 

key people. And they have heard your views. 

Your Congressmen and Congresswoman have heard your views. 

We’re going to put them to good use now as we meet further with 

our regional directors and the veterans’ officials to make certain 

that we try to correct some of the imperfections and try to work 

together to preserve two good hospitals that we all have a great 

deal of pride in: Castle Point and Montrose. 

Now, I can’t thank you enough, those of you who have lingered 

this long to give us the benefit of your thinking. And to our staffs 

who are here, we thank you. And our police officers, who have 

helped us to try to keep a little orderly conduct here, we appreciate 

your sticking with us. 

Chris Shays, we can’t thank you enough for coming all the way 

over from Connecticut to conduct this hearing. And we really appreciate everyone’s partaking in this issue. 

Thanks for being here. And God bless. 

Mr. SHAYS. Thank you. [Applause.] 

God bless. This hearing is adjourned. 

[Whereupon, at 6 p.m., the subcommittee was adjourned.]

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