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96–126 2015

CHALLENGES IN RURAL AMERICA: VA ACCESS 

AND MENTAL HEALTHCARE 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

WEDNESDAY, AUGUST 6, 2014 

Serial No. 113–83 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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


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(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

JON TOWERS, Staff Director 

NANCY DOLAN, Democratic Staff Director 

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

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

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

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

various electronic formats may introduce unintentional errors or omissions. Such occurrences 

are inherent in the current publication process and should diminish as the process is further 

refined. 


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C O N T E N T S 

Wednesday, August 6, 2014 

Page 

Challenges in Rural America: VA Access and Mental Healthcare ...................... 1 

OPENING STATEMENTS 

Hon. Jeff Miller, Chairman ..................................................................................... 1 

Prepared Statement ......................................................................................... 32 

Hon. Steve Pearce .................................................................................................... 4 

WITNESSES 

John Taylor, Veteran ............................................................................................... 5 

Prepared Statement ......................................................................................... 33 

Richard Moncrief, Veteran ...................................................................................... 8 

Prepared Statement ......................................................................................... 35 

Dawn Tschabrun, Chief Executive Officer, Lovelace Hospital ............................ 10 

Lisa Freeman, Interim Network Director, Veterans Integrated Service Network (VISN) 18, Veterans Health Administration, U.S. Department of Veterans’ Affairs ........................................................................................................ 19 

Prepared Statement ......................................................................................... 35 

Accompanied by: 

James Robbins M.D., Interim Medical Center Director New Mexico 

VA Healthcare System, Veterans Integrated Service Network 

(VISN) 18, Veterans Health Administration, U.S. Department 

of Veterans Affairs; 

And 

Lori Highberger M.D., Deputy Chief Medical Officer and Mental 

Health Lead, Veterans Integrated Service Network (VISN) 18, 

Veterans Health Administration, U.S. Department of Veterans 

Affairs 


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CHALLENGES IN RURAL AMERICA: VA 

ACCESS AND MENTAL HEALTHCARE 

Wednesday, August 6, 2014 

COMMITTEE ON VETERANS’ AFFAIRS, 

U.S. HOUSE OF REPRESENTATIVES, 

Washington, D.C. 

The committee met, pursuant to notice, at 11:15 a.m., at the 

Roswell Convention and Civic Center, 912 North Main Street, 

Roswell, New Mexico, Hon. Jeff Miller [chairman of the committee] 

presiding. 

Present: Representatives Miller and Lamborn. 

OPENING STATEMENT OF CHAIRMAN JEFF MILLER 

The CHAIRMAN. The meeting will come to order. Before I begin, 

there’s something we need to take care of today. And I would ask 

unanimous consent for our colleague, Steve Pearce, to be allowed 

to sit at the dais today and participate in today’s proceedings. 

Without objection, so ordered. 

Good morning, everybody. I’m pleased to be back. It was one year 

ago that I had my first opportunity to come to Roswell after driving 

down from Albuquerque with Congressman Steve Pearce. So it’s a 

pleasure to be here. 

I’m Jeff Miller, Chairman of the House Committee on Veterans’ 

Affairs. I flew in this morning from Pensacola, Florida, where we 

have more water than you do, Steve. 

I’m joined by senior committee member from Colorado, Doug 

Lamborn. I’m pleased to have him here today. And, of course, our 

friend and colleague, Steve Pearce. 

The CHAIRMAN. I know I speak for Representative Lamborn because we both feel the same way. Our friend, Steve Pearce, is a 

dedicated member of Congress. We actually sit together on the floor 

of the House almost every time we have a series of votes. 

And I know that he is keenly interested in the veteran community and the things that are going on not only here, but all over 

the United States of America. So it’s a pleasure, Steve, to have you 

joining us today. 

Mr. PEARCE. Thank you. 

The CHAIRMAN. And I’m grateful to him for inviting us to come 

back and have a chance to listen to some individuals who are going 

to testify today. 

Before we begin, I’d like to just ask, you’re a veteran, please 

stand. If you are not able to stand, raise your hand. We want to 

recognize you and say thank you for your service to our nation. 


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The CHAIRMAN. Again thank you so much for your service and 

continuing to help, as do many of you here in Roswell, your fellow 

veterans. 

Ensuring that you and your neighbors and colleagues in New 

Mexico and around the country have timely access to quality 

healthcare through the Department of Veterans Affairs is why 

we’re here today. I’m grateful to each of you for joining us because 

it is a very timely topic that we discuss right now. 

As you know our committee has been involved for quite sometime, but in a much more diligent fashion, holdings two full committee hearings a week through the summer months because of the 

crisis that exists right now within the Department of Veterans’ Affairs. 

We knew that there were wait times, we knew that there were 

issues. What we did not know until recently, and I say recently, 

late last year, when we actually started investigating, was the corruption, the lying, the cheating, and the stealing that was going on 

by some employees within the Department of Veterans Affairs as 

it relates to wait times. 

Because of that, we fashioned a piece of legislation that the 

President will sign tomorrow that I think will go a long way to 

starting the process of fixing VA. 

One thing is you cannot legislate morality, you cannot legislate 

common sense, you cannot legislate people doing the right thing. 

But what we did do was give the Secretary the ability to fire individuals who aren’t doing their job or who find that they forced 

other people to manipulate the numbers so that they can receive 

bonuses. 

We still think there may be some potential criminal claims that 

may be lodged against some of these supervisors because to change 

numbers at the federal level to get a promotion or a bonus of some 

type is, in fact, a violation of the law. We have asked the Department of Justice and the FBI to get involved, and they have. 

In the four months since this broke, April 9th was when we actually broke the story, CNN has covered it quite ostensibly. They 

didn’t even really start covering it until the end of April. But we 

have held as I said about two meetings a week. And we have continued our oversight. 

Now, for people all across the country, the media will have you 

believing that we are on a five-week vacation. That’s not quite 

what the August recess is supposed to be. 

The August recess is supposed to be an opportunity not only for 

us to go back and reconnect with our constituents, but also to travel all across the country as I do as the chairman, as Doug Lamborn 

does, and as Steve will do with me tomorrow when we go to El 

Paso to look at the issues over there as well. 

We are continuing to keep shining a light on VA to make sure 

that they, in fact, are changing the way they do business. Unfortunately it’s not going to change overnight. You know that. It didn’t 

happen overnight, it’s not going to change overnight. 

But I think the new Secretary has the right attitude. My caution 

to him is don’t let the bureaucracy eat you up, because that’s what 

happened to Secretary Shinseki. The unfortunate thing about the 

Secretary’s departure is that the very people that caused the probVerDate Aug 31 2005 08:32 Oct 07, 2015 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 Y:\96-126.TXT PAT

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lems are still employed by the Department of Veterans Affairs. But 

the Secretary was lied to and he’s gone. 

So, you know, the VA’s nationwide access audit found troubling 

scheduling practices were in place in Albuquerque at the medical 

center there. And we’re going to hear from some of our witnesses 

this morning about issues that they have had to confront. 

And, look, it may not all be bad. I’m not here just to hear the 

bad stuff. I want to hear some of the good things, because out of 

the 330,000 VA employees that are out there today, let me assure 

you that there are a lot of good ones that are going to work every 

day at the VA because they want to serve veterans and because 

they want to do the right thing. 

But we’ve got to fix the problem and get rid of the people who 

are the dead wood inside that system so that you are served better 

and you get the care that you’ve earned. 

I look forward to our discussion this morning. I thank you all for 

being here. I will now turn to my good friend Mr. Lamborn for his 

opening statement. 

Mr. LAMBORN. Very briefly, thank you, Mr. Chairman, for having 

this hearing. It’s great to be in Roswell, it’s great to be among veterans. 

My father was a World War II veteran. He passed away a couple 

of years ago. He fought in 11 campaigns in North Africa, Sicily, 

and Italy. And it changed his life. I mean it made him a different 

person. 

It was something he talked about. He was someone who talked 

about his experiences. And almost every day for the rest of his life. 

And so it was just great to sit at his feet and learn about the greatest generation. 

And then my oldest son has served in the Army. And one week 

after high school he was in for three years, serving in support of 

the 82nd Airborne at Fort Bragg. So I’m honored to be part of the 

VA committee. 

And let me just say, Chairman Miller, you may already know 

this. But he is so dedicated to veterans, his care and his concern 

and stewardship of the taxpayer dollars, and the clinics and hospitals. He’s doing such a great job. But you know that. And that’s 

why he’s here in Roswell, that’s why we’re having this hearing. 

So it’s an honor to serve with him. And it’s an honor to serve 

with Steve Pearce. As a veteran himself, he knows these issues. 

But beyond that Steve Pearce is legendary in Congress for his dedication to the person, a person off the street living in his Congressional district. 

They’ve written about him in The Wall Street Journal. And I 

don’t want to embarrass you, Steve. But he sets a great example 

that many of us appreciate and learn from and have benefited 

from. So it’s just great to be here, Mr. Chairman. Thanks for having this hearing. 

The CHAIRMAN. Thanks very much, Doug. I’m going to recognize 

Congressman Pearce in just a minute and introduce our witnesses. 

But first I want to thank them for their presence here today and 

for participating in this hearing and doing all the things that you 

do for the veterans in this local community and around this region. 


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I would also like to gently remind you, if possible, we do have 

a five-minute opening statement rule. What will happen is these 

little lights will pop up. It will go green. And when you get to one 

minute, it will go to yellow. And then when you get to red, that 

means your time is expired. 

Now, if you go longer than a minute after red, I can’t promise 

what will happen. We want to hear your entire statement. So they 

are here certainly to kind of help keep people on time with their 

statements. But we appreciate you being here to talk to us. 

At this time let me ask Steve Pearce if he would introduce our 

panelists. Thanks. 

Mr. PEARCE. Thank you, Mr. Chairman. Thank you for being 

here. Also thanks, Mr. Lamborn. 

OPENING STATEMENT OF HON. STEVE PEARCE 

Mr. Lamborn last night was going to get on the plane to come 

here. They had thunderstorms that were going to keep him from 

flying. So he and his wife got in the car and drove here. So I think 

we need to recognize the dedication that people have when they 

make commitments in Congress. It’s a very serious thing. 

The reason we’re here today has been amplified in the last two 

days since I’ve been home. Since being here back in New Mexico, 

I ran across one veteran that was driven from here to Albuquerque 

to receive an injection in the index finger. 

That’s the reason we have set this pilot project up here today, 

to stop using those kinds of long trips for things that could be done 

locally. 

Another veteran that we saw just yesterday in Jal had hearing 

loss from cannon fire back in Korea. His hearing aids broke. They 

sent him to the VA in Big Springs. 

Big Springs VA paid him miles to go there. Big Springs sent him 

to Albuquerque the next week. They paid him mileage there. They 

kept him there three days. After assessing him, then they returned 

him back to Big Springs and said he ought to have gone there to 

start with. 

And then he finally got the hearing aids and they didn’t work so 

he’s still using his old ones. And it’s that sort of ineffectiveness and 

inefficiencies that cause veterans tremendous problems. 

Then this morning I was on a call-in radio program. The young 

lady carried her 88-year-old father yesterday to the Artesia clinic. 

She had a card in her hand for the appointment time. It was made 

for 31 days later. 

They showed up. And they said they had no record. They were 

three veterans trying to get into the Artesia clinic just yesterday 

all with the same problem. And the arrogance of them is what really made people mad. 

The arrogance that you don’t have a right to be here, we told 

you, you don’t have an appointment, while they’re holding the 

cards. These are the things that drive us all. 

Today we have John Taylor. He was a combat sniper in Vietnam, 

a hospital administrator in his private life. He has a 100 percent 

disability rating for PTSD. He’s been an advocate for veterans 

throughout New Mexico. He’s a contributor to the Roswell Daily 

Record on veterans affairs. 


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Secondly, we have Richard Moncrief, a veteran living with PTSD. 

He’ll talk about services due to limited access to physical doctors 

he declares to be less than viable. He’s a veteran service officer for 

New Mexico Veterans Department. He works on a daily basis for 

the betterment of our veterans. 

We have Harry McGraw that was scheduled on this first panel. 

I’m not sure if he’s on a later panel. I’ll introduce him later if he’s 

going to come up. But again we appreciate Chairman Miller remembering his promise and coming back here. 

I would like to also acknowledge that the VA in Albuquerque has 

been cordial in two visits since the problems were first noted by the 

chairman and became a national crisis. 

Those meetings have been congenial, they’ve been transparent, 

they have honored the promise that we would indeed set up a pilot 

project. It’s ongoing today and for a couple of days where we’re actually letting local veterans see local providers. 

When the VA’s problems erupted nationwide, there was a kind 

of a clamor to take a look at what we might do. And I appreciate 

the fact that Chairman Miller looked back at what’s called Healthy 

Vets that we’ve had filed for the last four Congresses, for the last 

eight years, basically saying, if you have to drive more than a certain distance, you can go to your local providers. 

So Chairman Miller inserted that as one of the key provisions in 

one of the most dramatic reforms in the VA system since its inception. I think that the chairman has done a tremendous job in getting this bill through. 

It’s approved by the House, Senate, and is set to be signed by the 

President later this week. So I just think, if it’s approved in committee procedures, I think we ought to give the chairman a round 

of applause for remembering the rural veterans of this country. 

Mr. PEARCE. The VA has a lot of people who care deeply about 

the veterans. And they serve well and they do their job well. But 

the abuses and the problems have dominated. 

And that’s the reason that we’re here in Roswell today, to hold 

the first hearing nationwide after the passage of that historic legislation. And the chairman will see the pilot project in operation here 

in Roswell today. 

So thank you very much for being here. And I will yield back my 

time, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Steve. 

And we will begin with Mr. Taylor. We recognize you for your 

opening statement. 

STATEMENT OF JOHN TAYLOR 

Mr. TAYLOR. Chairman Miller, Congressman Lamborn, and Congressman Pearce, it is an honor to provide testimony before you 

today. 

My active duty combat military experience was with the 101st 

Airborne Rangers in Vietnam. After seeing many of my brothers 

die in heated combat situations within the infamous A Shau Valley 

area of Thua Thien/Hue and being shot twice and bayoneted on the 

same day, dying on the MASH unit surgery table, and obviously returned to life, I never imagined any of us would come back home 

to die directly related to post-combat medical care in our VA hosVerDate Aug 31 2005 08:32 Oct 07, 2015 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 Y:\96-126.TXT PAT

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pitals. Sadly, as you are now aware, that has become a painful reality. 

In the interest of saving this committee time, with respect to my 

evaluations and solution recommendations, the last committee 

hearing we held on ‘‘Service should not lead to suicide,’’ one of my 

fellow compatriots, Sergeant Josh Renschler, had a very good, very 

detailed analysis. And I would put that as a reference to what I 

have coming up. 

For my side, I would like to look more at the unique situation 

that we have here in our area of Southeastern New Mexico, a significant variation that I would term ‘acute rurality’. Being in a 

rural desert community, systemic problems encountered throughout the country are greatly intensified in Southeastern New Mexico. 

As a quick example, following the CARES Commission findings 

during President Bush’s last term in office, a Director of Rural Administration was created to help eliminate our acute problems with 

rural access in our area. 

As it turned out, that rural administrator responsible for resolving our problems was none other than our administrator of the Albuquerque VA Hospital, obviously the very person historically refusing our requests for local fee-based services. Ineffectual outcomes are obvious. A fox in the henhouse type situation. 

For the last nine years, I’ve published a weekly Veterans Advocate column in our local newspaper, the Roswell Daily Record. The 

column is a volunteered, not compensated, freelance work having 

no allegiance to any person or group except to my brother and sister veterans. 

Over the years I’ve made members of both sides of the aisle uncomfortable to say the least. However, the majority of my rants 

have now shown to be true. Like so many of the other public forum 

veterans’ advocates, we’re asking why did it take the recent deaths 

of so many of us to prove what we have been claiming for so many 

years, over ten as far as myself goes. 

It is important to note that our deaths were majorly not due to 

medical care provided by our VA medical professionals. Physicians, 

nurses, support personnel, and even support administrative people 

are doing a great job. That goes without question. 

But the administrative games played by VA administrative leaders and by system oversight groups, that’s the problem. I’ve made 

that statement publicly several times over the past nine years only 

to be ignored and politically told either we’re working on a resolution or you’re not correct in your accusations. 

Finally, saddest of all, my claims have been validated with the 

many deaths recently uncovered and still being uncovered thanks 

to courageous whistleblowers within the system. Veterans’ families 

and friends have continued to not come forward due of fear of reprisal. You guys have seen that in action also. 

The VA has historically denied this to be true. But as you yourself have recently seen, the VA seems to have a problem with the 

truth. I personally can offer proof that this has occurred long before 

the recent awakening. 


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I respectfully submitted a few of my VET ADVO columns in support of my testimony today, most of which are six to nine years old. 

But it’s the same theme coming forward. 

This illustrates real-life catastrophes I have encountered over my 

nine years as advocate, which were literally ignored or denied as 

being accurate by our state VA administrators and government officials. 

We all know now how invalid the VA denials were and still are. 

Two specific sets of columns illustrate factually the problems and 

battles we have faced with the Albuquerque VA Hospital administrators, consistently denied by the VA as being accurate. 

Number one, the first was a series of columns I did on a chronic 

PTSD veteran who over the space of more than one year threatened to commit suicide due to his Desert Storm nightmares. His 

wife approached Colonel Ron McKay, USMC Retired, and me with 

horror stories of her lack of effective treatment for her husband by 

the VA. 

Apache, my column name for my brother to respect his privacy, 

had undergone several treatable modalities listing from three days 

to three months inpatient sessions. More than once he was sent 

home in a cab for a two and a half hour drive, before which he 

would ask the driver to swing by the nearest Albuquerque liquor 

store to make his journey easier. 

His primary substance abuse/dependency directly related to his 

PTSD was alcohol. Knowing this his treatment team and/or patient 

discharge planner should have known this was a perfect storm 

doomed to failure. Each time Apache returned home totally inebriated, once again threatening suicide. 

He was instructed by his VA treatment clinician to report to a 

local VA social worker for aftercare. During the first visit by 

Apache and his wife, as reported by his wife, the counselor asked, 

‘‘So what is it you want me to do? You know, you could go to the 

A.A. and get some help.’’ So a furious Apache and his wife got up 

and left. 

In my experience as a director of a psychiatric center and an inpatient substance abuse center, aftercare for either malady requires at a minimum the services of a certified psychiatric counselor or certified substance abuse counselor. In Texas and New 

Mexico, this is required for licensure, not a social worker. 

Eventually Apache was found dead one night outside his house 

in spite of repeated requests to the VA for help keeping him alive. 

The VA response? He was noncompliant. In other words, they gave 

up. 

The second set of columns dealt with several cases that I did 

through the years. One in particular was an 87-year-old veteran 

who I was proud to two or three times a month drive to Albuquerque, a three and a half hour round trip. He had an active catheter. And his 87-year-old wife, who was in poor health, did the 

drive. There’s the problem. 

His response to me several times was, ‘‘My people don’t lie.’’ I 

have reliable witnesses to that encounter. This was in a situation 

where I had actual proof that the VA did, in fact, lie. Not 

miscommunicate as politically correct, but lie. 


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And when I approached the administrator, he didn’t want to hear 

it. He said, ‘‘My people don’t lie.’’ I said I can give you incontrovertible truth. ‘‘My people don’t lie. You’re done.’’ 

All right. Last week I measured the actual distance from our 

nearest CBOC in Artesia and found it to be about 45 miles. We’ve 

been excluded from a lot of the improvements because we didn’t 

qualify for the ‘‘less than 40 mile’’ rule. Obviously I’m 45 miles so 

I’m five miles over that limit. 

I apologize for this lengthy testimony. But after nine years of reporting on these issues and warning everyone of the obvious, predictable outcomes, I hope this report does not once again fall on 

deaf ears. 

Simply stated, systems monitored by its own department members, no matter the claims of independent watchdog status, do not 

and will not work. Paying bonuses to upper echelon administrators 

is a crafty mechanism created by upper management to milk the 

system. I know. I’ve been there. 

In my many years as a medical administrator my reward, bonus, 

if you please, was continued employment for the next year. That 

was my bonus. The contrived reason for VA bonuses reported in 

other House and Senate committee hearings is to entice and retain 

competent administrators. 

That, Honorable Committee Members, is a fallacy perpetrated on 

those who have not worked in the medical arena. Competence in 

our current VA administration based on this bonus rule has been 

proven grossly lacking among our current VA handpicked wonder 

kids. 

In my experience it’s safe to say you would find a sufficient 

queue of qualified applicants for each VA administrative position 

you currently find not up to par. Current doctors and medical administrators being RIF’d, which is reduction in force, in the administration’s military drawdown could easily and effectively be placed 

in certain comparable positions recently found lacking in the VA 

administrator network. 

I sincerely hope my testimony and attached resource materials 

will help you with your enormous task of keeping my brother and 

sister veterans alive once they return home after surviving death 

on the battlefield. 

I would be pleased and honored to answer any questions you 

may have of me. God bless you in your efforts, God bless our brother and sister veterans, and God bless our nation. Thank you. 

[THE PREPARED STATEMENT OF JOHN TAYLOR APPEARS IN THE APPENDIX] 

The CHAIRMAN. Thank you very much, Mr. Taylor. And we’ll ask 

questions after everybody has already given their testimony. 

Mr. Moncrief, you’re recognized here. Please go ahead. 

STATEMENT OF RICHARD MONCRIEF 

Mr. MONCRIEF. Thank you. I would like to thank the committee 

for giving me the chance to speak out about the lack of mental 

healthcare in the southeast corner of the state. 

I have been using the mental health services in the Artesia clinic 

for several years now. With the loss of Dr. Peter Hochla, we are 


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now being forced to use the telemed system, which is a very impersonal way of conducting mental health. 

The men and women who suffer from PTSD and TBI need to 

have a live physical being to talk to. Better yet to have group therapy with a skilled group leader and a psychologist would even be 

better. 

Having a warm body to talk to in person is better than a flat 

screen for a patient. The talk is more personal and you can see the 

body movement and make better eye contact with the person doing 

the counseling. 

Dr. Hochla, when he would come, he would come every three to 

six months and make appointments for people. Well, I still needed 

somebody to talk to because I had to let my hair down and relax 

every once in a while. 

I ended up hiring my own Licensed Professional Clinical Counselor. I tried to use TRICARE since I was retired, but they didn’t 

pay enough money. They didn’t pay up to Medicare standards. So 

I ended up paying for the counselor myself. And there’s a great 

need for some kind of skilled counselor in this part of the country. 

There are many more problems that need to be addressed. I have 

been given medication to increase my blood pressure after the hospital had already told me I had high blood pressure. 

Is the pharmacy or the doctor supposed to check to see if there’s 

a problem or is it my job as a working person without medical experience to see if the medication is bad for me. I take it it would 

be up to the medical staff to figure that one out. 

I was given a hearing test last year at the VA Medical Center. 

The doctor said my hearing had gotten worse. I didn’t receive hearing aids. I asked why. He didn’t say. 

So here in town this lady invited me to come over to check on 

a hearing test. And after giving me a hearing test, she said yes, 

my hearing was getting worse and it would be best if I got hearing 

aids for both ears before I lose my hearing totally. 

There is a shortage of housing spaces for homeless veterans in 

Southeast New Mexico. I have had to send people to Albuquerque 

to get any help either way or we have to find funds to be able to 

put them up in hotels and money to feed them. 

The major problem of veterans having a nice resting spot now 

has been solved here in the City of Roswell. We now have our own 

veterans cemetery that’s been dedicated and it’s in use as of today. 

I had to call the Hospital Executive Assistant to the Director to 

have my 100 percent total disability and permanent disability put 

in the hospital computer after nine months of waiting. The hospital 

didn’t even recognize that I was 100 percent disabled. 

And now my last question is why do veterans have to drive 200 

miles to get medical attention in Southeast New Mexico? Thank 

you. 

[THE PREPARED STATEMENT OF RICHARD MONCRIEF APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you very much, Mr. Moncrief. 

I understand Ms. Tschabrun is a late addition to the witness 

table. We appreciate you being here and willing to stand in. Thank 

you for what you have been doing. If you could in your statement 

tell us a little bit about what Lovelace is doing. 


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STATEMENT OF DAWN TSCHABRUN 

Ms. TSCHABRUN. Thank you, Chairman. Congressman Pearce, 

thank you. My name is Dawn Tschabrun. I am the CEO, chief executive officer, of Lovelace Regional Hospital here in Roswell. 

I’m coming to you today to say that we’ve seen some improvements. The Demonstration Project is working. As of this morning, 

we’ve seen five veterans in our clinic and it’s been very, very successful. 

We will see a balance of nine by the end of the week. And it’s 

been a huge satisfier to our veterans who live here in Roswell as 

well as in Southeast New Mexico. So kudos and thank you for that. 

My other comment is Lovelace stands ready to come to the table 

and discuss the needs of veterans in Roswell and Southeast New 

Mexico to eliminate travel to Albuquerque so that veterans can be 

seen at home. 

We have qualified, competent care providers from physicians to 

nurse practitioners right here in Roswell that are willing and able 

to serve our veterans. Thank you very much. 

[THE PREPARED STATEMENT OF DAWN TSCHABRUN APPEARS IN THE

APPENDIX] 

The CHAIRMAN. Thank you very much. What we’ll do now is we’ll 

start a round of questions. We’ll go through one round and then we 

may have a second round. 

And, of course, in the legislation that will be signed tomorrow, 

it does have a 40-mile requirement; if you are further than 40 

miles, the VA has to allow you to go outside the system if you 

choose. In the past the VA has had the ability to do that. 

They’ve obviously made it very, very difficult. This is supposed 

to open that gate specifically for the rural communities, much like 

Roswell. 

And, look, in the panhandle of Florida, where I live, we have 

more veterans than any Congressional district in the country. We 

do not have a VA Hospital, my veterans have to go to Biloxi. 

So they have about a three-hour drive to go to the hospital. We 

have three major medical facilities in Pensacola. It just doesn’t 

make sense. 

But let me also tell you that this entire process is in no way an 

attempt to tear the VA apart brick by brick. We’re trying to help 

supplement what they already do with local providers, local facilities, because it’s better for the veteran, it’s better for the taxpayers. 

They don’t have to pay for mileage to Albuquerque and putting 

somebody up only to get there and find out your appointment has 

been cancelled and you have to turn around and come back tomorrow or next week, whatever it may be. A lot of things are going to 

change. 

Now, this is a finite program. It was originally designed because 

of the wait list that exists out there today. But the intent is that 

it will carry on. We will have to appropriate more money to it. 

There is some fear among veteran service organizations. And 

probably the most vocal is the Disabled American Veterans. The 

Disabled American Veterans, they don’t like this at all. They think 

that this is the first step in trying to rip the VA apart. 


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Again they need to listen to you, the veterans, who have to drive 

hours to access care and understand what you’re having to go 

through. And hopefully everybody will come to like this program. 

Some will stay in the VA, some will go outside the VA and get 

their healthcare, continuity of care. All of those things are issues 

that we have to watch and provide oversight to. But our intent is 

to get the care quickly and ensure quality of care is available to 

you. 

So to Mr. Taylor and Mr. Moncrief, what I’d like to ask is the 

scheduling issues at Albuquerque, can you kind of go into detail a 

little bit and have you seen any changes in the way the scheduling 

has been done over the last several months? 

Because we’re hearing from certain people around the country 

that there are positive changes. And we want those changes to be 

permanent changes, not just temporary. 

Mr. TAYLOR. Chairman Miller, Congressman Pearce brought this 

up in one of his telephone town meetings, has anything changed locally. And I think there are excellent VA hospitals in the country, 

there are some obviously not. I’ll give you a personal example just 

last week how things have changed. 

I have to literally, excuse the pun, pull teeth in order to get dental fee-based service down here in Roswell. So last week I called. 

And I had a really painful wisdom tooth that was going nuts on 

me. 

So I called the dentist. He said, well, you have to call to Albuquerque and get the approvals. So I did. I called in, I got the dental 

clinic. It took 50 minutes going down the line, you’re the fifth caller. Finally I got to be the next caller. So after 50 minutes, I finally 

get a ring from the phone. 

I get another message saying I’m sorry, sir, the system is down. 

We’re sorry, the system is down, please call back. I did this morning and evening. And I did it the next morning and still the same 

thing. 

So have things improved? I’m hearing not. Some people have said 

yeah. But certainly in my experience this is an example of trying 

to get into the system. 

The CHAIRMAN. Mr. Moncrief. 

Mr. MONCRIEF. I haven’t had as much trouble getting appointments. I’ve been able to clinics. I had to forego an appointment this 

morning to be on this counsel this morning. I thank you for that. 

But I’ve had a lot of people that have come to talk to me and 

ask why they’re having a problem getting into the VA Hospital, 

getting into the system. And a lot of people have come in with the 

idea that they’re going to be able to get in into the healthcare system just because they’re a veteran. 

Well, if you’re anything other than service connected and you make over $30,000 as a husband and wife, you’re going to have a 

hard time getting into the VA healthcare system because the bar 

has been set. That’s as high as it’s going to go. It’s on welfare. 

So there are a lot of people that I had to turn out and say I’m 

sorry, we’re just not going to be able to get you anything. So, of 

course, they’re not going to be able to get appointments. 

There’s been a few people that have had a lot of problems with 

appointments. But I have been able to contact one very important 


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person at the hospital. And she’s sitting right behind me back here, 

Kara Catton. And she is super at taking care of a lot of the problems that I’ve had to deal with veterans. 

The CHAIRMAN. Mr. Lamborn. 

Mr. LAMBORN. Thank you, Mr. Chairman, Ms. Tschabrun, I hope 

I pronounce your name correctly. 

Ms. TSCHABRUN. Close enough. 

Mr. LAMBORN. Okay. One of the issues that we need to be really 

careful about when we start using more fee basis, which is the private sector providing healthcare, is the custody and the chain of 

custody of medical records. 

Because someone may have been going to a VA clinic or hospital 

for decades and now they’re going to like maybe your facility. And 

it just is important that the medical records have continuity. 

So how is the best way to address that? 

Ms. TSCHABRUN. There’s a couple of ways to address that, sir. 

What we’ve demonstrated today and through this week is the VA 

worked very collaboratively with us and sent those records electronically to us so that our providers here could review the history 

so that we were not starting from a zero playing field. 

Our providers have the opportunity to review that. And then, as 

we transition that care, you speak of continuity of care. That’s essential. Not only for veterans but for everyone. 

So as we see those veterans today through the week, we will 

then put that electronic record back to the VA so they can see what 

happened in their visit here. So absolutely we can do hard paper, 

we can fax, we can download to disks, we can transfer electronically through HIPAA secure mechanisms so that we keep that data 

safe. 

Mr. LAMBORN. And it could be a two-way street? 

Ms. TSCHABRUN. Absolutely. 

Mr. LAMBORN. So after receiving care in your facility, they go 

back to the VA, it will be returned to them? 

Ms. TSCHABRUN. Yes, sir. That’s imperative, because the bottom 

line is patient care, assuring that whoever the patient is, through 

that continuum of care, that the providers are knowledgeable about 

what occurred. And if either side fails to do that, then we’ve let the 

patient down from my perspective. 

Mr. LAMBORN. Well, I think that that’s such an important thing. 

We’re going to have to really stay on top of that because there are 

some IT issues there that may have to be addressed. 

Ms. TSCHABRUN. Sure. 

Mr. LAMBORN. Also I would like to ask about telemedicine. And, 

Mr. Moncrief, you expressed concern that, let’s say, for counseling 

or therapy, that there were some things lacking through telemedicine. 

We know that telemedicine negates the need for taking a long 

car trip; however, you have pointed to drawbacks. What are the 

pluses and minuses of telemedicine in your opinion? And, Ms. 

Tschabrun, your opinion also. 

Mr. MONCRIEF. The problem that I see with telemedicine, sir, is 

it’s great if you are going to take your blood pressure, you are going 

to do things that surgically you can talk to the doctors and things 

like that. 


VACREP180 with DISTILLER
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But talking to somebody mentally, you need a physical body 

there; somebody to talk to that you know is concerned about you. 

How can a TV set tell you you’ve got—you can’t show it. I mean 

it’s a little—it’s impersonal. 

As far as I’m concerned, it’s the wrong way to be doing mental 

health. You need to have a live human being sitting there that can 

understand you and see and be able—what are they going to do, 

request a TV camera? It’s not going to walk over and pat you on 

the back or make you feel better. 

Mr. LAMBORN. Ms. Tschabrun. 

Ms. TSCHABRUN. I think it’s a huge challenge. Quite honestly 

there is a deficit of providers in certain fields of medicine. So that 

brought about the telemedicine option. 

In Roswell and Southeast New Mexico, extremely rural, it’s difficult to recruit some providers in some specialties. And medical 

schools are not producing at the rate that they had been. 

So telemedicine offers a different approach to prevent travel. I 

think there are some very good uses of telemedicine. Pulmonology, 

even perhaps cardiology if it’s not that initial visit. I think initial 

visits need to be face to face. 

But telemedicine I think can help us bridge that gap. When we 

do not have perhaps the ability to recruit that provider into our 

area, it allows us to link into that provider so that we don’t have 

a deficit of care for our community. 

Mr. LAMBORN. I want to thank you all for being here. Mr. Chairman, thank you. 

The CHAIRMAN. Mr. Pearce. 

Mr. PEARCE. Thank you, Mr. Chairman. 

Mr. Moncrief, you mentioned in your testimony that you pay for 

your own counseling service. Where is that counseling service located? 

Mr. MONCRIEF. Right here in town, sir. 

Mr. PEARCE. And how much did you pay for a session, if you 

don’t mind saying in front of a room? 

Mr. MONCRIEF. It was 75 to $100. 

Mr. PEARCE. How much? 

Mr. MONCRIEF. Seventy-five to $100. 

Mr. PEARCE. Seventy-five to $100. In the next panel, I’ll be talking about how, in a very heated exchange with myself and the VA 

in Albuquerque, one of the senior staff members there was declaring he could not get people seen for less than the price of gasoline. 

How much do you get paid to drive for gasoline? 

Mr. MONCRIEF. Over $160 to go up and come back. 

Mr. PEARCE. So you get paid $160 in gas money. Then you see 

the psychologist there in Albuquerque and come back. For $75 and 

no gas money, you are able to see someone here. 

Mr. MONCRIEF. And it’s very personal, sir. 

Mr. PEARCE. Ms. Tschabrun, you said that you’re seeing six or 

eight people right now, you’re seeing five people a day and nine by 

the end of the week. What’s the scope of services provided? 

Ms. TSCHABRUN. This is family practice. 

Mr. PEARCE. So just typical stuff? 

Ms. TSCHABRUN. Just general stuff, general checkups, general reviews, ongoing type of things. 


VACREP180 with DISTILLER
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Mr. PEARCE. What is the cost that you are going to be charging 

for those visits today? I don’t want to get into your data. If you 

don’t want to say it, that’s fine. 

Ms. TSCHABRUN. I would prefer not to say it. 

Mr. PEARCE. Okay. That would be fine. 

Mr. Chairman, I also notice that the Secretary of Veterans Affairs for New Mexico is here, Mr. Hale, if we could recognize him. 

Mr. Hale is of service to his company and country and a veteran 

himself. So thank you for being here. 

Mr. Taylor, you have probably as much experience as dealing 

with the people here in this area. What has been your experience 

in fee-for-service here in the Roswell area? 

Mr. TAYLOR. Overall I found it to be excellent. 

Mr. PEARCE. I mean how easy is it to get fee-for-service payment 

back from the VA? How has the process worked? Can you just call 

up there and say I feel bad, I can’t make the drive, how does it 

work? 

Mr. TAYLOR. Right now the only one that I can use is the dental. 

And in that case, you know, I do the visit. The dentist will bill the 

VA for the services. And it’s considerably less than what is billed 

obviously. And then they pay and the dentist accepts whatever. 

Mr. PEARCE. Does everybody that wants fee-for-service get accepted for that or is that 10 percent, 90 percent? 

Mr. TAYLOR. Well, right now it’s 100 percent. 

Mr. PEARCE. I’m talking about the last couple of years. If you 

want to get fee-for-service, you can get fee-for-service? 

Mr. TAYLOR. You have to get the approval. There’s a fee-based 

director at the hospital. 

Mr. PEARCE. Mr. Moncrief, you appear to be wanting to say 

something. Do you want to add anything to that? 

Mr. MONCRIEF. I’d like to say that, when you go down to the 

Artesia clinic and they have to get an x-ray, they send you over to 

the Artesia Hospital. Well, Artesia ends up billing us. And I’d like 

to know why. 

Because it’s the VA sending us there, it’s not the Artesia Hospital. And the same thing if you get blood work, anything like that, 

done. You end up getting a bill. 

Mr. PEARCE. The gentleman in the audience today that talked 

about being required to drive to Albuquerque for blood tests and 

then have to go back to get the results. I mean again you all deal 

with as many veterans in this area. 

When people request to have their blood work done here, blood 

tests taken here, at least a sample are they given that permission 

or is that very difficult to achieve? Is that a single, isolated incident? 

Mr. TAYLOR. For the most part, let’s say the physician at Artesia 

needs that done. He can have that done and there’s not much of 

a hassle there. Again let me make one statement. 

A large chunk of our problems—there’s two areas that, if they 

can be covered locally, it would eliminate a lot of problems. One 

being urgent care and one being emergency care. 

Now, if we can get that done locally, it would be a tremendous 

savings. Plus it’s no fun driving with a 102-degree temperature 

even 45 minutes to Artesia. Try it sometime. It’s not comfortable. 


VACREP180 with DISTILLER
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So if we had a local doc in the box or urgent care center and we 

had the tie-in to an emergency room, that comfortably the vet can 

feel that it will be paid for. I mean we have the option now. 

Like I say, if you’ve got a problem, call 911 or go to the hospital. 

Many of my vets go to the hospital and find out they’re going to 

have to pay for it. 

Mr. PEARCE. One last question, Mr. Chairman and Ms. 

Tschabrun. One of the things that I hear frequently from veterans 

or providers, when they provide service, many in the VA process 

say you can go see someone because it’s an emergency. But then 

there’s trouble getting payment. What is your experience receiving 

payment for the services provided? 

Ms. TSCHABRUN. My experience is that it’s very late in payments 

coming back from the VA that extend beyond other commercial 

payers. 

Mr. PEARCE. Had you ever not get paid for anything and have 

to go back to the veteran? 

Ms. TSCHABRUN. Yeah, that occasionally happens. If we do not 

receive payment, then we will circle around back to the individual 

patient and seek payment from them. 

Mr. PEARCE. Thank you. I yield back, Mr. Chairman. 

The CHAIRMAN. Thank you, Mr. Pearce. 

Ms. Tschabrun, one of the things as you well know in the bill 

and, of course, most of the hospitals know as well is that the language was inserted into the legislation. It mostly was a repetition 

of existing law. 

But it does baffle me that an agency the size of the VA, especially when they have approved much of what gets done, have a 

hard time with it. 

I’d like to know, how has your experience been with the VA in 

trying to set up the pilot program and have they reached out to you 

since this legislation passed both houses? Because that’s the main 

focus. Folks need to get prepared. They’ve got 90 days with which 

to write the rules in order to implement this. Has there been a 

proactive part on the VA? 

Ms. TSCHABRUN. Absolutely, sir. Polly from Albuquerque VA 

reached out to our clinic and said I have this list of patients that 

we would like to get care at your facility, can we arrange those appointments. So they were done right there. 

But it was proactive on the VA’s part giving us a call. We were 

notified that we would be receiving X number. We didn’t know exactly what X meant. But then Polly was very, very quick to give 

us the phone call and say we want these patients seen and I’ll be 

shipping their records to you. 

The CHAIRMAN. And how quickly were you able to see the patient? 

Ms. TSCHABRUN. We made the appointments within five days of 

notification. 

The CHAIRMAN. Do you do that by telephone or do you do it with 

a letter or a card? 

Ms. TSCHABRUN. That was by telephone, sir. 

The CHAIRMAN. One of the biggest complaints that we heard and 

I don’t know if it’s been a problem here, is that VA in the past has 

felt like the best way to do it was with the Pony Express. 


VACREP180 with DISTILLER
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It definitely was not the time that few chose at the time they 

chose. You may not have been able to make your appointment. If 

you can’t make that appointment, then you cancelled it and/or you 

didn’t settle in the first place. So that’s something that we hope VA 

will be able to rectify as we move forward. 

Let me ask, we talked about the bad things and, John, you 

talked about that too. I’d like to hear something good about VA. So, 

John, if you want to follow up with my comment. 

Mr. TAYLOR. Definitely. There’s a lot of good particularly with 

the applied—the actual patient care. As I said the care professionals do an excellent job. 

Fortunately we have as Richard mentioned Kara Catton and 

Sonya Brown at the VA Hospital in Albuquerque. They are quick 

to respond when we’ve got a problem and then they do a fine job 

in getting it done. 

The problem is they’re putting out fires. When I was an administrator, I didn’t want my people running around putting out fires. 

It’s just like the next step is a forest fire, which is obviously what 

happened here. 

If you have a forest fire, you find out what caused it. You go to 

the system and systemically you solve the problem. So it’s good to 

do firefighting. But that should not be the course of business that 

you take. It’s not helpful. 

So several times now I just—at Artesia last week, I spent about 

an hour and a half, which is way over what my physician there 

says to spend. But we’ve got several problems. 

And after five heart attacks, he needed to do an extended 

workups on me. He took the time with the personnel out there. 

And I’ve heard some mention, well, they’re a little short tempered. 

Yeah. I guess, if you are facing a bunch of us old codgers, we 

tend to get on everybody’s nerves I’m sure. On the whole they’re 

professional and they get the job done. 

So again there are a lot of positives there. It’s the possible death 

outcome that has me concerned. 

Again I had a fellow vet that called me. To me he presented as 

having appendicitis. Of course, I couldn’t make that judgment. But 

he had all the classic symptoms. 

I called Artesia. They said, well, if he’s that bad, we can take 

him in about two weeks. We can’t take him today. Call 911 or go 

to the emergency room. Well, he was in bad shape. 

Before I could get back to him and tell him, okay, you can go, 

he didn’t have the money to pay for it. So he and his wife were already driving up to Albuquerque. 

So here’s a guy with an almost 102 temperature and acute abdominal pain, nausea. He can’t be seen by anybody and he can’t go 

to the emergency room because he can’t afford it. These are the 

real-life problems. It’s just you can’t use firefighting as your course 

of business. 

If we had an urgent care center here, what we used to call doc 

in the box, they can go over and take care of the immediate problem. So you can triage the problem, but you’ve got to have the first 

step, which is either the urgent care center, a low cost way of doing 

something, or the emergency room for critical. 


VACREP180 with DISTILLER
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So yes, they’re very positive. But we in total have to get on these 

shortcomings. 

The CHAIRMAN. Richard. 

Mr. MONCRIEF. Since receiving my 100 percent, I’ve been able to 

use the dental clinic up there. And they have been very responsible 

to me. And I haven’t had any problem of getting fee basis down 

here. 

They have gone out of their way to send me down here instead 

of having to go up there to get certain work done. They do implants 

and everything up there. But down here they’ll let you get local 

crowns and things like that put on. And I’d like to commend them 

for the job they’ve done for me. Most of the time they’re very good. 

I’ve had people call me from Carlsbad. A gentleman was—his 

wife was on chemotherapy. And he was supposed to go up to the 

dental clinic in Albuquerque to get work done. I called up there, 

got a hold of one of the doctors, and they gave him a fee basis to 

get it all done down there in Carlsbad and he wouldn’t have to 

leave his wife on chemotherapy. 

So I haven’t had problems with them. Certainly I’ve had a lot 

more problems using the orthopedics and things like that up there. 

The CHAIRMAN. Mr. Lamborn. 

Mr. LAMBORN. I want to follow up a little bit more on the medical 

records issue. Let’s say someone is using fee basis and they come 

to your facility. And they have shipped you the medical records of 

the past history. 

Do you have 100 percent assurance that you are getting the complete set of medical records? If something is left out, that can, you 

know, trigger a real problem. 

Ms. TSCHABRUN. You know, to address that, I can’t say with certainty. ‘‘I’ve got all of it’’. I have to believe in faith that they are 

sending what is appropriate to send for that specific instance in 

this—in the demonstration that we’re in right now. 

I would expect on a go-forward basis that we—as the project continues, as the veterans have choice, that they can then really give 

that full medical record. And in turn we also turn that back, because it’s got to be a collaborative partnership between the both of 

us to be successful. 

Mr. LAMBORN. I just think, as we go forward, this is something 

to really monitor closely. 

Ms. TSCHABRUN. Absolutely. 

Mr. LAMBORN. So I look forward to what’s being developed here. 

Mr. Chairman, that’s all I have for this time. 

The CHAIRMAN. Do you get the physical record or do you have 

the ability to put eyes on the VA record or how does it work? 

Ms. TSCHABRUN. These records were actually faxed to us. So we 

have the bulk of, you know, a period of time that their providers 

went back and reviewed prior to the meeting with that patient 

today. 

The CHAIRMAN. And then your physician or whoever saw them 

makes whatever—— 

Ms. TSCHABRUN. Makes their notes. 

The CHAIRMAN. Do you destroy then the set of records that you 

have or do you have the ability to keep them? 


VACREP180 with DISTILLER
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Ms. TSCHABRUN. I don’t think that we would destroy those 

records, because they’re a permanent part then of a patient being 

seen. So we would create a patient file in this facility that we saw 

them in. And then that would be an ongoing file for that patient. 

They may become an inactive patient for us. But they may remain active. But we would still maintain that encounter. 

The CHAIRMAN. Okay. Mr. Pearce. 

Mr. PEARCE. Thank you, Mr. Chairman. I’ll just make a couple 

comments and yield back. 

But you were asking for the good things that happen. So as I 

travel around, we hear those stories of people very satisfied. So we 

recently ran a poll of all the veterans in the district. 

So the result was—I can’t remember the exact numbers. But it 

was a significant number, maybe 45 percent, were extremely satisfied with the care. And so I do like to give those positive things. 

Also in our first meeting that we had with the VA after the scandal broke and the Albuquerque VA actually showed up on the list 

and we had the meeting, we took about six or seven veterans in 

there. 

And I don’t remember exactly the records that we made notes of 

at the meeting. But about three or four of the veterans had problems. But they expressed that they were content with the care 

when they got there. It was the scheduling or the distance they had 

to drive or whatever. 

And so I like to share those positive things, because there are 

good people working inside the system. It’s just the system has serious flaws and breaks in that system. 

And the last comment that I’ll make in recognition of both the 

Albuquerque and the El Paso VA, when we started seeing problems—this is when I was elected in 2002—I kept hearing the same 

problems over and over. So we made a list of those. 

There are about 23 recurring problems. At every meeting, every 

single one of the 23 things would be a problem. So I did set up corollary meetings with the lead administrator, the head of the Albuquerque VA Hospital. 

And to their credit he would bring his assistant. And he would 

come to different places in this big Second District. Every quarter 

we would address those. And as they started working from that list 

of 23 recurring things, those began to improve. 

And they were things like sending people all the way to Albuquerque, having cancelled their appointment four days before they 

get there. And one of the big complaints was they were being paid 

$0.11 for gasoline. And that didn’t come close to even covering it. 

So those meetings have continued and they still continue. And 

we can pay attention to the smaller things. But the big systemic 

problems that your committee has uncovered is what we’re dealing 

with and very difficult systemic problems. 

So again I appreciate the hearing here. And I wanted to pass 

along those good things that I do hear along with the criticisms 

and complaints. And I’ll yield back. 

The CHAIRMAN. Thank you very much. I want to say thank you 

to the first panel. We’ve got a second panel that we want to hear 

from. 

So with that you’re excused. And thank you very much. 


VACREP180 with DISTILLER
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The CHAIRMAN. I want to go ahead and call up the second panel 

while they’re getting everything set. 

We have Lisa Freeman, acting network director for Veterans Integrated Service Network 18. She is accompanied by Dr. James 

Robbins. He’s the interim medical center director for the Albuquerque VA Medical Center and Dr. Lori Highberger, the deputy 

chief medical officer and mental health lead for VISN 18. Thank 

you now for being here. 

You do need to get right up into that microphone. Don’t be 

afraid, it’s not going to bite you. It’s very difficult to hear. 

And, Ms. Freeman, you’re recognized. Please proceed with your 

testimony. 

STATEMENT OF ELIZABETH FREEMAN, INTERIM NETWORK DIRECTOR VETERANS INTEGRATED SERVICE NETWORK (VISN) 

18, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT 

OF VETERANS AFFAIRS; ACCOMPANIED BY JAMES ROBBINS 

M.D., INTERIM MEDICAL CENTER DIRECTOR NEW MEXICO 

VA healthcare SYSTEM, VETERANS INTEGRATED SERVICE 

NETWORK (VISN) 18, VETERANS HEALTH ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS; AND LORI 

HIGHBERGER M.D.,DEPUTY CHIEF MEDICAL OFFICER AND 

MENTAL HEALTH LEAD, VETERANS INTEGRATED SERVICE 

NETWORK (VISN) 18, VETERANS HEALTH ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF ELIZABETH FREEMAN 

Ms. FREEMAN. Thank you. Good morning, Chairman Miller, Congressman Pearce, and Congressman Lamborn. I too want to thank 

all the veterans who are here today for your service to this country. 

And I also want to thank the previous panel members. And I 

look forward to addressing together their concerns. 

Thank you for the opportunity to discuss the New Mexico VA 

healthcare system’s commitment to providing veterans accessible, 

high-quality, patient-centered care and to specifically address rural 

healthcare and access to mental healthcare in New Mexico. 

The New Mexico VA healthcare system serves veterans in New 

Mexico, Southern Colorado, and West Texas. The New Mexico VA 

healthcare system includes the Raymond G. Murphy VA Medical 

Center and 13 community-based outpatient clinics. 

The VA Medical Center is a joint commission accredited tertiary 

care referral center located in the heart of Albuquerque. It provides 

a full range of patient care services with state-of-the-art technology 

as well as education and research. It is the only VA medical center 

in New Mexico. 

Approximately 75,000 New Mexico veterans are enrolled in VA 

healthcare. And 47 percent of those enrolled veterans live in rural 

areas. 

The VHA Office of Rural Health currently supports nine projects, 

for a total of nearly $1.9 million in the State of New Mexico. These 

projects increase rural veteran access to mental healthcare, women’s healthcare, primary care, pharmacy services, and neurology 

services. Five of these nine projects use telehealth to deliver 

healthcare closer to veterans’ homes. 


VACREP180 with DISTILLER
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One currently funded Office of Rural Health initiative is homebased primary care for veterans residing in rural areas near Santa 

Fe and Artesia. The home-based primary care program provides 

primary care for frail, chronically ill veterans in their own homes. 

There is an increased support for group specialty care through 

the expanded use of clinical video telehealth or CVT technology. 

The use of this technology in homes is on the rise, especially aiming to assist American Indian veterans who are the most rural, isolated, and transportation challenged. 

In fiscal year 2013, the New Mexico VA healthcare system served 

over 5,000 veterans through telehealth. And 59 percent of these 

veterans lived in rural areas. Of these 1,000 veterans accessed 

mental health services through CVT, 90 percent of whom live in 

rural areas. 

The New Mexico VA healthcare system has a robust expanding 

telehealth program including more than 30 telehealth programs offering additional modalities to CVT including home telehealth, 

video to home, storage for telehealth, secure messaging, e-consultations, and Specialty Care Access Network-Extension for Community healthcare Outcomes known as SCAN–ECHO. 

The New Mexico VA healthcare system has been aggressive in 

providing comprehensive mental healthcare for veterans from prior 

wars and conflicts to the current OEF, OAF, O & D conflicts. 

This includes primary care, mental health integration, and an 

approach that considers the mental health need of veterans with 

a course that is designed to promote an optimal level of social and 

occupational function and participation in family and community 

life for our veterans. 

We continue to promote early recognition of mental health problems. Veterans are routinely screened in primary care for PTSD, 

depression, substance abuse, traumatic brain injury, and military 

sexual trauma. Screening for this array of mental health problems 

helps support effective identification of veterans needing mental 

health services. And it promotes our suicide prevention efforts. 

In September of 2013, the New Mexico VA healthcare system 

hosted a mental health summit with over 87 community participants. The New Mexico VA healthcare system will be hosting another mental health seminar in September of this year with a focus 

on mental health access. And there will also be a separate track 

on homelessness. 

There are four vet centers in New Mexico including Albuquerque, 

Farmington, Santa Fe, and Las Cruces. 

The New Mexico VA healthcare system is committed to providing 

high-quality, safe, and accessible care for our veterans. We will 

continue to focus on improving veterans’ access to care and have 

instituted numerous changes that are showing positive results. 

Our location presents unique challenges with regard to distance, 

culture, and constrained healthcare markets. Our rural health programs are robust. And we will continue to strive to meet the needs 

of veterans in rural areas. 

Mr. Chairman, this concludes my statement. Thank you for the 

opportunity to appear before you today in my 30th day on this job. 

My colleagues and I will be pleased to respond to any questions you 

or other members of the committee have. 


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[THE PREPARED STATEMENT OF ELIZABETH FREEMAN APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you very much for your testimony. Earlier 

this year PC3 was initiated. How has PC3 been utilized here in the 

Roswell area? 

Ms. FREEMAN. Mr. Chairman, I’ll ask Dr. Robbins to respond. 

Dr. ROBBINS. I’m happy to. 

Mr. Chairman, I believe it’s actually been utilized—it’s been utilized to some degree. But not as much as would be optimal. And 

one of the—although there is fee basis in this area to the tune of 

about $300,000 or more, PC3 has been not utilized very well. 

That’s one of the reasons we actually had the CEO of TRICARE 

come to the facility and meet with us about issues and found that 

to be a very productive conversation. 

And one reason that we are looking at mental health access in 

the Roswell area is that those individuals go to PC3. So we’re beginning to lay the tracks and do more interaction with them. 

The CHAIRMAN. Can you just explain for us a little bit why it 

hasn’t been utilized as much. It’s my understanding that there are 

ten mental health providers here in the area. And that obviously 

is a key. 

Obviously the older veterans seem to want to have a face-to-face. 

Many of the returning Iraq and Afghanistan veterans seem to be 

comfortable with video teleconference, they Skype a lot with their 

families so they’re okay skyping with a physician. But why do you 

think you’re not utilizing PC3 much here? 

Dr. ROBBINS. Sir, I think the VA model has largely been—we 

provide what we can in-house and send out-of-house as a secondary 

plan. I think that’s something that’s one of the very things we need 

to reevaluate now. And we’re in the process of redoing that. 

The CHAIRMAN. I hope you do. I think what we found is that the 

VA, although they do provide quality healthcare and many veterans are satisfied with the healthcare that they’re receiving, it has 

become very apparent to me that the VA wants to grow itself to 

the detriment in many cases of the veteran. 

Even in your comments, Ms. Freeman, you talked about testimony, initiatives, where you’re recruiting and adding mental 

health specialists, increasing telehealth, and reorganizing programs. But you didn’t in your testimony talk about face-to-face visits in the local communities. 

VA always seems to want to protect its own bureaucracy. Veterans need to be able to get the care they need where they want 

to get it and when they want to get it. And we are delivering 

healthcare today, the whole of healthcare. 

But the model is the same model for civilians. Forcing people to 

drive to facilities? Why? Because you have to have the patient census in those facilities in order to justify the facility being here. 

That’s not necessarily in the patients’ best interest. So why do 

you think it’s—and I’m not going to pick on you really. 

Why do you think it’s so hard? Is it just because of the way we 

have been doing it for so long? 

Ms. FREEMAN. So if you don’t mind, Mr. Chairman, my comments 

are from my experience in Palo Alto. We have facilities from Palo 


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Alto to Sonora down to Monterey. And we do face that same struggle. 

Sometimes it isn’t the desire to keep it in-house because we do 

want to treat each unique veteran and give him or her the care he 

or she needs and has earned. Sometimes it’s just a matter of, as 

one of the previous panelists had mentioned, just finding the right 

providers; that we know we want to ensure one standard of care 

in having the highest quality of care that we can provide to the veterans. 

But I do think that the choice act is going to give us more latitude to partner with community providers to provide those services 

closer to home. 

Dr. HIGHBERGER. I’d like to speak to that just from a mental 

health standpoint too. 

There are two things that I think are very unique in the VA providing care. And I can say that my father was a Korean war combat veteran. He unfortunately was not eligible to get VA services 

because of income. And he had his own insurance and that’s fine. 

I do think it would have been really beneficial to have had the 

primary care services that VA has because it can pick up on these 

things that are very specific to people who have served overseas. 

There are things medically that we look for, we hunt for these, 

to make sure they get addressed. I think that’s something very 

unique about primary care. And that’s why you see it close to 

home. I think it’s the same way with mental health. 

So I have worked in the community. I know what I see when 

people come in to me and they’re diagnosed with bipolar disorder. 

No one has ever asked them if they’ve served. 

So there’s this sense of protectiveness I think that we’ve had. 

And it’s not about the bureaucracy or the agency. It’s just very 

frustrating for us, when we feel like we own that care and we’re 

responsible for that care and we want the best care, that primary 

care and mental health are so tied to having served that we do 

tend to hold it more than sometimes I think we should. 

And I think that this process going forward will push us to really 

help with the community, help them understand what they need to 

be looking for. Because there are other veterans who are not eligible for VA care who will benefit them from that knowledge. 

The CHAIRMAN. And I think that’s a great thing, because VA 

does a lot of outreach, trying to get veterans to come into the system and be able to use the system. 

But I think you need to have outreach as well to the local providers. I think that’s a great first step. And mental health I think 

is one of the those things that, VA has to be in charge of. 

You can still do some of it on a non-VA care basis. But again why 

force a veteran to go to VA and get a flu shot. Why even knee or, 

hip replacements, those kind of things can be done outside VA to 

allow you to do the things that only you can do. So I appreciate 

that. 

Mr. Lamborn. 

Mr. LAMBORN. Thank you, Mr. Chairman. 

Ms. Freeman, you heard Mr. Moncrief earlier talk about telehealth in regards to mental health counseling. And he felt it was 

impersonal. 


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Is that a drawback that can be overcome or is it unique to each 

individual or how do you respond to that concern? 

Ms. FREEMAN. So my experience has been that I think, as the 

chairman just mentioned, that with the newer veterans they’re 

much more comfortable with the video telehealth. And they even 

say why would you do it any other way. But then you have other 

veterans of other eras. 

And, you know, I think it’s incumbent upon us to meet each veteran where he or she is and provide the kind of services that are 

going to be effective for them. If telehealth medicine is not going 

to be effective for veterans of other eras, then we have to find a 

way to provide that face-to-face care, we have to find the providers 

that we know, the protocols that we know how to treat those symptoms that are unique to servers of this country. 

Mr. LAMBORN. Okay. Thank you. Now, you said in your testimony that you were doing an outreach by going to different communities. Could you elaborate on that, especially concerning 

Roswell in particular, where you’ve sent teams out to meet the 

folks. 

Ms. FREEMAN. Sure. If you don’t mind if I ask Dr. Highberger to 

talk about that. 

Dr. HIGHBERGER. Yes. What I would say is that in general we’re 

trying to partner a lot more with the community in many ways. So, 

for example, the issue of homelessness was brought up and how do 

we help, you know. You’re a service officer here and you’re trying 

to help, you know, your colleague and what is there. 

And I think there are times where I think as VA we have to recognize we aren’t the answer in every way, shape, or form, that we 

have to work with the community. There may be times where we 

need to help develop something up. 

One way that I think we’ve demonstrated that we can do that 

is through the SSVF program, which is supporting veterans and 

their families through national grants. 

If those grants can help a community agency who is interested 

and committed in working with veterans to develop that kind of 

service that the veteran service officers and the veterans and other 

stakeholders are all identifying as a definite need, then that’s a 

good way of trying to partner in this and get those solutions together. 

So we might not be able from VA to be in every city and every 

county and have our staff there. And I think we just have to accept 

that it’s not all about us. It’s really about the community as well. 

And they’ve got great services that can assist us. 

We’ve got several instances of that throughout with incredible 

partnerships that really work as if they all work for the same agency. So I think that’s really a demonstration of success is where you 

find it. 

Dr. ROBBINS. I also think that one of the things that happens 

certainly in New Mexico and probably in other locations is it’s very 

easy to sit at the home facility and think of that as the world. And 

I think part of what we have to do is make specific and conscious 

efforts to reach out individually and personally to locations around 

the state and set up events here. 


VACREP180 with DISTILLER
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I know that we have a plan to begin visiting the different parts 

of the state every month by a member of senior management. And 

we have a homeless stand down coming up in I think it’s Carlsbad 

and one other location in the Southeast. 

So part of it is a conscious effort to reach out, understand the 

problems, and be on the ground in places like Roswell, Artesia, and 

others. 

Mr. LAMBORN. Ms. Freeman, what do you think the Patient Centered Community Care program, PC3 in shorthand, what do you 

think about that program? 

Ms. FREEMAN. So I think any vehicle that we have where we can 

provide more timely access and high-quality care to the veterans is 

fantastic. 

And I really appreciated it when Dr. Robbins told me that Mr. 

McIntyre personally came to the Albuquerque VA last Friday. And 

when Mr. Gibson was Acting Secretary, he had asked us if we had 

any challenges with PC3. 

And he mentioned how closely Mr. McIntyre and TriWest is 

working with VA. And I think that personal meeting demonstrates 

the kind of commitment that TriWest has to meet the VA’s needs 

and providing care closer where veterans live. 

Mr. LAMBORN. Okay. Thank you. 

The CHAIRMAN. Mr. Pearce. 

Mr. PEARCE. Thank you, Mr. Chairman. Ms. Freeman, you’ve 

heard the comments about the payment and it’s something that I 

hear frequently by providers. Is that something that you all dedicate an office to or staff to or how do you handle those complaints? 

Ms. FREEMAN. Sure. So there is a centralized process for fee payments; is that correct? 

Dr. ROBBINS. For the New Mexico VA health, there is a coherent 

centralized office under one management. 

Mr. PEARCE. So it exists already? 

Dr. ROBBINS. Yes. 

Dr. HIGHBERGER. Well, there are two separate things. And I 

think what you may be asking about is the actual payment of the 

bill. So the payment of the bill is actually a partnership that VISN 

18 has developed with VISN 19. 

We were struggling with paying our venders. We knew that was 

not good for our relationship and that ultimately hurts our veterans. So what we did was we found a VISN who was doing it well. 

And instead of trying to rebuild or duplicate, we said can we partner. 

And we helped with resources to them to then pay our bills. So 

in the facilities we have a non-VA care office who coordinates, who 

makes sure that everything is functioning correctly, who makes 

sure that the billing to VISN 19 is going to pay our bills. 

Ms. FREEMAN. If I may add. A target level similar to what occurred a few years ago in the third—in the medical care costs recovery, whatever the acronym for that is, for veterans paying in 

when they have a co-pay. That was centralized regionally with a 

similar effort that should be going forward in FY 15 to further centralize those payments. 

Mr. PEARCE. I’m just trying to draw attention with a little WD40, 

because it doesn’t work very well a lot of times. 


VACREP180 with DISTILLER
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Ms. Freeman, does the honor guard come under VA? Honor 

guards for burials, is that a part of the VA? 

Ms. FREEMAN. I would be happy to follow up on that. 

Mr. PEARCE. Let me make a comment in case it does. I’ve got a 

young soldier here that came today. He just got notified by text 

message that they were going to cut that department out or they 

were going to cut funding to it. 

First of all, that’s not the way that you should be telling people 

that have been cut back. And then secondly, you wonder why. Because the VA budget is not being cut. So it may not come under 

you. I’ve been asking questions about that. And I still don’t have 

an answer for myself. 

Mr. Robbins, thank you very much for making sure this pilot 

project is ongoing, because it is buzzing around the state. People 

have heard about it, there’s a sense of excitement, there’s a sense 

of relief. And I appreciate that you have honored your promise 

there at that meeting. 

How many people are going to actually be seen in this pilot 

project? Our agreement was one day. They’ve actually made it several more days to make it more comprehensive. How many people 

are we going to see, just give us an ideas of that? 

Dr. ROBBINS. It’s roughly nine, it should be nine patients today 

and tomorrow that are primary care. 

Mr. PEARCE. At one point you had 35 or 36. Did they just not 

materialize, what happened there? 

Dr. ROBBINS. It was a variety of issues. The primary issue was 

the primary care was wanting to focus on a small enough group to 

where we could be sure that we got something going as an additional start. 

Mr. PEARCE. Do you have an attempt to kind of continue this on 

and then maybe expand it out? Because the further you get away 

from Albuquerque, the longer the drive and the more intensity. 

So I was in Hobbs, Jal, and back around. They were saying when 

are we going to get our pilot project. So what’s your intent on the 

longer term? 

Dr. ROBBINS. Yes, sir. I just want to comment that I want to 

thank you very much for raising this issue to us and for collaborating with us. It’s been an excellent experience, very positive for 

the veterans. And we are thoroughly committed to this and intend 

to continue it. 

Mr. PEARCE. Mr. Chairman, I have more questions I would like 

to save for the second round. 

The CHAIRMAN. Ms. Freeman, in May of last year, the Undersecretary for Health instructed you to hold the health summit. And 

you did hold a mental health summit. And you’ve said you’ve got 

another one coming up I guess in September or October. 

One of the things they asked you to do was identify community 

partners. Who did you identify as your most active community 

partners during that summit? And did you enter into any formal 

agreements with any of them? 

Dr. ROBBINS. Sir, we did not. The New Mexico VA did not enter 

into any formal agreements based on that summit. There was a lot 

of dialogue. There were two very important issues discussed and I 

believe improved on. 


VACREP180 with DISTILLER
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One was access by who to call, who to call if you have a problem. 

We’re in the VA, we’re in the VA system to call. And the second 

was the suicide prevention coordinator developed some additional 

contacts and ability to do more outreach. 

The CHAIRMAN. How do you schedule your appointments now, 

how is that working? And mostly primary, maybe mental health. 

This is the whole thing that blew up. 

Dr. HIGHBERGER. Right. I can speak to that. What we’re doing 

and we have been doing for several years in VISN 18 is trying to 

audit, trying to find those areas to recommend specifically to a facility to modify, and trying to get to where we’re in compliance with 

the scheduling directive; and most importantly that we’re able to 

thus get people the appointments when they need them, where 

they want them. 

And it has been a challenge. It’s taking a long time. The efforts 

that we’ve been doing we’ve ramped up the speed of. I think it’s 

been hard for our schedulers to fully understand and implement. 

I think it’s a complicated process. It’s taking a lot of reteaching to 

get it right. But we’re making sure we get it right. 

The CHAIRMAN. What’s the complicated process? 

Dr. HIGHBERGER. So in that system, again it’s a blue screen DOS 

system, it is a challenge for the staff. 

The CHAIRMAN. I’m sorry. But is that not part of the problem, 

you’ve got a DOS system today? 

Dr. HIGHBERGER. I agree. I absolutely agree. 

The CHAIRMAN. Do you know how many hundreds of millions of 

dollars have been appropriated to VA for IT and we’re still using 

a DOS scheduling system? 

Dr. HIGHBERGER. I agree. 

The CHAIRMAN. Not your fault. 

Dr. HIGHBERGER. I agree. And when people come in, some people—I’m old enough, I remember the DOS system and blue screens 

and how you have to type commands prior to better technology. 

Some people have never even seen that technology and they’re 

hired into those roles. So that’s one issue. 

The second issue that I think is more important is lot of people 

who were doing it wrong had no clue they were doing it wrong, including even now with retraining we have some people speak up, 

they say this is what you do, they are able to verbalize it. 

And one of the benefits of—our staff went down observing them 

scheduling—is that they will then not do it correctly even after 

they just verbalized it correctly. 

So there’s more education and more communication that has to 

occur. There’s a lot of auditing that has to occur. We want to get 

it right. We’re trying every which way to get it right. But it’s still 

a work in progress. 

The CHAIRMAN. Whose responsibility is it to make sure it is done 

correctly? 

Dr. HIGHBERGER. I think it comes at many levels. I think one is 

that we have a direction that we’re given that is challenging, it’s 

not what we do in the community. So we talk about desire dates. 

These are things that don’t get looked at or examined in the community. So it’s a new concept to try to teach people. These are 


VACREP180 with DISTILLER
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entry level positions typically in the system. So these are people’s 

first exposure to VA. And there’s a lot of learning. 

They’re also high turnover positions. So even if you are doing the 

right thing and supervising, you’re following through and you’re 

educating, your staff are turning over repeatedly. 

And it’s a good thing because they’re usually getting promoted. 

Most of these people are veterans, most of them are getting promoted up through the system. But you’ve got to start over then. 

So I think it comes from the supervisor, it comes from the employee, it comes from what we’re directing above, you know, about 

what to do. And it’s not been a simple thing to fix. 

The CHAIRMAN. Doctor, one of the things that I’ve heard from 

physicians in particular is that they have no control over the scheduling system themselves. 

And so if you say this patient should be seen within five days, 

you don’t know whether that patient gets seen within five days. 

And we now have horror stories out there that have occurred because the doctor’s orders were not followed. How do you prevent errors like that from occurring? 

Dr. ROBBINS. So I agree, sir, that that is probably one of the 

worst things that can happen. And one thing that we’ve done is in 

our facility, one of the barriers to getting the scheduling process 

right has been that the schedulers were scattered all across the facility or organization. 

We’re beginning to unify that and pull in schedulers into a single 

organizational unit so that we can train them consistently, so that 

they can feel that they’re getting a consistent message about that. 

I will say that, because of my concern about that specific area, 

when I went around to each of the CBOCs and as well as in the 

main facility, that is something I specifically asked about for everyone. 

If the physician orders something, the physician orders some follow-up, and you cannot meet that, meet what the physician wants, 

you must go back to the physician or the provider and get clarification. It has to be a medical decision. 

The CHAIRMAN. As the acting interim medical center director, do 

you still see patients? 

Dr. ROBBINS. I do not, sir. 

The CHAIRMAN. Are you credentialed? 

Dr. ROBBINS. Sir, I have credentials as a part of my normal job 

as CMO. But I don’t have privileges so I’m not able to practice. 

The CHAIRMAN. We keep talking about lack of physicians, yet we 

have physicians all through the VA system that don’t see patients. 

I mean I know there’s a lot of things you can’t do. 

But in an emergency, when we need to serve the people I find 

that hard to believe. But that’s the way VA has always done it. So 

again I’m not trying to come down on you. But I’m just telling you, 

do you have any idea on how many physicians work for VA that 

don’t see patients? 

Dr. ROBBINS. I don’t, sir. 

Dr. HIGHBERGER. I would like to respond to that. It’s my impression, this is just my impression, that it’s about 50/50 with people 

continuing to see patients when they take on a full administrative 

load. 


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I do still see patients, I am credentialed and privileged. I have 

tried to keep even just a half day every other week. And I can tell 

you that the administrative duties have wiped that out nearly completely. 

Our business was downsized, I don’t have support staff. It’s not 

as simple as just dropping my duties. If I’m not there as the acting 

chief medical officer to review those applicants for the Phoenix facility, for Albuquerque, for El Paso who have issues with their 

credentialing, that person can’t get hired until I do it. I’m the only 

one that can do it. 

So there’s a real trade-off there. Now, I do still want to see patients. I was assisting El Paso by telehealth. I can tell you that 

that pull for me to do that is very strong. But when I go over to 

Phoenix or I go to a CBOC that I’m privileged to see patients in, 

there isn’t the space for me. 

The CHAIRMAN. Part of the bill is we have billions of dollars for 

space. But, you know, one thing the VA is not good at doing is 

thinking outside the box. Instead of extending the hours of a facility, they want to build a whole new facility. 

It’s like why not extend appointment times that just happen to 

be when a veteran probably could come so they don’t have to take 

off work to go to VA. 

But because VA wants to do fairly normal working hours, we’ve 

got to build a whole other facility because we don’t have the space. 

So we’re going to have to crack this nut. And it ain’t going to be 

easy. 

Dr. HIGHBERGER. I agree. And I did work extra evenings even to 

support that CBOC to do that. 

The CHAIRMAN. You said the key. You said the key. Support is 

important. I mean I don’t know how many veterans have told me 

their doc never looks them in the eye because they’re staring at a 

stupid computer screen. 

Why? Because they have to fill out all kinds of garbage to CYA 

VA 20 years down the road if we ask did you do this, did you do 

that. 

Look, that’s not what a highly skilled, highly paid physician 

should be doing. They don’t do that in the private sector. But VA 

does it. We’ve got to fix that. 

Dr. HIGHBERGER. I agree. I think one of the most important 

things that I see in that bill, at least specifically speaking to VISN 

18, is space. So I’ve had times where I’ve scheduled patients. 

And I literally had to take a patient over into my VISN office 

that is not set up for seeing patients. People open up my door and 

interrupt. And I had to stop because it wasn’t right, it wasn’t right. 

And so, you know, I think with additional space, you’re going to 

see a lot more patient care occurring from administrative physicians. It is a desire of mine to definitely do that. 

The CHAIRMAN. I’ll bet you don’t. I’ll bet you don’t. Because that’s 

not what they’re accustomed to doing. But I hope you’re right. 

Mr. Lamborn. 

Mr. LAMBORN. Thank you. Let me build on this really important 

line of thought that the chairman has been pursuing. 

I know VA has a lot of metrics. So many that that consumes a 

good part of your working day. Do you think that we could really 


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reduce the number of—I know probably every single one of those 

is well-intentioned. But can we do a drastic job of reducing that so 

that more patients can be seen during a given day, any one of you? 

Ms. FREEMAN. So I really appreciate the question, because there 

used to be something called a performance measure work group nationally. And I was one of the few field members as a facility director on that group. 

Every time a new measure got added, you know, if it wasn’t myself personally or my physicians, my nurses or my staff would be 

impacted by those additional metrics. 

And so I completely agree with you that my observation in the 

community where I live and my regular job, they have a corporate 

scorecard that has ten or less. And even the board pushes back and 

says it should be seven or less corporate goals. 

And that’s what community healthcare systems, at least what 

I’ve seen, operate under. So we have a very clear goal deployment. 

I’m not saying there are lots and lots of things we have to do in 

the background because we are healthcare and there’s lots of outside entities that audit us. And it’s very important to ensure the 

quality of our care. 

But we need to be able to articulate that to everyone, from the 

front-line employee to the head administrators, so that everybody 

is working toward the same direction. 

Mr. LAMBORN. I really—I hope that this is one of the things that 

the Congressional CARES Commission—I hope I pronounced that 

correctly. But one of the commissions that the bill sets up, Mr. 

Chairman, that’s going to look at VA from the ground up. 

I really know we need to get into this so that highly trained care 

providers can get back to the basics of what they are trained to do 

and do not have to have their face glued to the computer screen 

like the chairman just said. 

Dr. Highberger, what do you say about that? 

Dr. HIGHBERGER. I think what I see is that you throw so many 

metrics at people—it becomes a blur. I think sometimes it’s easy 

to get lost in the real message that’s supposed to be there. I know 

for VISN 18, what we’ve been preaching for years is that it is not 

about the metric. The metric reflects the care. 

I don’t know how well we get that message communicated all the 

way down to every employee. But I know that’s what we believe. 

I think, if you look at it that way, having more metrics perhaps is 

okay. It’s just different reflections of the care. 

I think that the way we’ve done it, though, we’ve had too many 

splittings off in too many directions and then losing the real focus, 

which is the veteran and what is the care like for them, how are 

they experiencing it. It doesn’t matter what the metric says. 

Mr. LAMBORN. And lastly, and maybe this is a metric. But what 

is the average waiting time in New Mexico for primary, specialty, 

and mental healthcare? 

Dr. ROBBINS. Sorry. Give me just a minute. The average primary 

care wait is 47 days. The average specialty care wait is 64 days. 

And the average mental health wait is 41 days. Those are new patient wait times. 

Mr. LAMBORN. New patient. If someone calls in for ongoing care, 

it could be different, higher, lower? Do you have those numbers? 


VACREP180 with DISTILLER
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Ms. FREEMAN. The VA is reporting wait times in two different 

ways. He just gave you the prospective wait times. And the completed new patient primary care average wait time is the end of 

June; is that correct? 

Dr. HIGHBERGER. Correct. It’s appointments that were completed 

at the end of June. 

Ms. FREEMAN. So for appointments it’s the end of June. For primary care for new patients the time they actually wait—— 

The CHAIRMAN. Wait, wait, wait. What the hell is a—what did 

you just call it, a primary prospective new patient? What kind of— 

you guys, quit. You keep changing the rules. 

The CHAIRMAN. All we want to know is how long does it take a 

veteran to see a doc, period? 

Dr. HIGHBERGER. Sir, I agree. 

The CHAIRMAN. Don’t give me three different ways to do it. This 

has gone real well up until this last little bit. 

Dr. HIGHBERGER. So these are the data that are published on the 

website for transparency purposes. 

The CHAIRMAN. That doesn’t mean anything. I don’t care where 

it’s published. 

Dr. HIGHBERGER. I understand. This is what we’re—— 

The CHAIRMAN. Anybody in here get a primary care appointment 

within 40 days? 

There ain’t a hand up. None. When did we start this new measuring? 

Dr. HIGHBERGER. The data is the same. 

The CHAIRMAN. No, no, no, no. When did we start this new process? Because it’s something that I’ve never heard of before. 

Dr. HIGHBERGER. So this is the new process. 

The CHAIRMAN. No. My question is when did you start it? 

Dr. HIGHBERGER. It was in May. 

The CHAIRMAN. That’s all I need to know. When the crap hit the 

fan, you changed the metric again. Stop. Stop it. These veterans 

deserve better. 

Dr. HIGHBERGER. I agree. We have no control over these metrics, 

sir. 

The CHAIRMAN. Yes, you do. Raise your voice. Tell your leaders 

it’s not working, your veterans aren’t being served. Don’t tell me 

you can’t do it. 

Dr. HIGHBERGER. We are and we have. 

Ms. FREEMAN. And we will. 

Dr. HIGHBERGER. And we will continue. 

The CHAIRMAN. Good. Steve. 

Mr. PEARCE. Thank you, Mr. Chairman. One of the things that 

I hear literally from providers from VA and from veterans alike is 

fear of reprisal. 

So many people did not want their names used as I talked about 

their items. Are you all addressing the fact that we can’t cure the 

problems when people can’t talk about it inside the system? 

Ms. FREEMAN. Absolutely. And one of the things at my home facility that we promulgate and that I have shared with some of the 

executives in VISN 18 to see if they’re interested in trying to hear 

is we really want a healthcare system where every employee that 

comes to work every day sees themselves as a problem solver. 


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So they’re all contributing to continuous improvement and improving the quality of care we provide to veterans. And it’s been 

stated, you know, over 30 percent of our employees are veterans. 

We are veterans serving veterans. 

Mr. PEARCE. But there’s still fear of reprisal. 

Ms. FREEMAN: Absolutely. And as the chairman mentioned at the 

very opening of this hearing, a culture is our habit, it’s the way we 

do things. And it won’t change overnight. 

But we have to start. We have to engage every employee every 

day and continuously improve. And raising their hand saying the 

issues that they think need to be addressed and have a system of 

closing that loop and addressing those. 

Mr. PEARCE. Dr. Robbins, we have discussed in one of the previous meetings a practice where you have the physician leave. You 

assign his patients over to a doctor that didn’t see patients in order 

to make the system sort of look like it’s working on paper or the 

computer. Has that situation been resolved? 

Dr. ROBBINS. Yes, sir. 

Mr. PEARCE. That’s all I want to know. Just it’s been solved. 

What is the scope, Dr. Robbins, of the nine people being seen here 

today and in the future, do we have any PTSD, anybody seeing 

mental health providers here as part of that? 

Dr. ROBBINS. So the nine folks today and tomorrow, those are all 

primary care. Those are primary care appointments. 

Mr. PEARCE. So you are open to people seeing mental health professionals here? 

Dr. ROBBINS. Absolutely. 

Mr. PEARCE. So you were there for a fairly energetic exchange 

between your staff member and myself over the fact that people— 

doctors, hospitals, will not see people for basically the cost of gasoline. 

I suspect that’s the reason that we’ve never moved any further 

towards letting veterans see local providers, because of that internal belief that the system doesn’t need to change and will never 

need to change. 

Is there any more clarity inside your staff there in Albuquerque 

about the willingness of local doctors, local hospitals to see patients 

and the reasonableness of the service? 

I mean you heard one guy say—you heard Mr. Moncrief say his 

appointment was 75 bucks. And you’ve got to pay him $160 for gasoline. Is that sinking in, especially the gentleman that we had the 

discussion with? 

Dr. ROBBINS. Yes, sir. We clarified that shortly after you left. 

Mr. PEARCE. Okay. I think my last—that was my last question. 

No, no. I have one more. What level did you have to go to to get 

this pilot project approved, were you able to do it or did you have 

to go to a higher chain of command, did you have to go to the Secretary level? 

Dr. ROBBINS. Sir, we spent some effort and some time trying to 

figure that out. But as it turned out, these were actions that were 

within our existing authority at the facility level. 

Mr. PEARCE. So you all were able to make the decision in Albuquerque, you did not have to get an approval to run this project 

here? 


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Dr. ROBBINS. That’s correct, sir. 

Mr. PEARCE. Mr. Chairman, I yield back. And thank you very 

much for having this committee hearing here in Roswell, New Mexico. 

The CHAIRMAN. I want to thank everybody for attending. And I 

do want to say thank you, VA, because you are the tip of the spear. 

And don’t think that, because you’re way out in Albuquerque and 

the central office is way over in Washington, that you can’t make 

a difference, because you can. You can. 

Your veterans are telling you what they need. The system has 

got to change. As a mental health provider, you know you have to 

listen. And unfortunately that’s not been the case at VA for a long 

time. 

We have a golden opportunity to help VA become the very agency 

that they should be. And I have said it a dozen times in the last 

week. 

Thank you for being here. We truly appreciate what you do on 

a daily, weekly, and nightly basis because I know you work hours 

that many don’t think you do. 

I would ask unanimous consent that all members have five legislative days in which to revise and extend their remarks. 

The CHAIRMAN. Again, thank you, everybody, for being here. This 

hearing is adjourned. 

[Whereupon, at 1:00 p.m., the committee was adjourned.] 

f 

APPENDIX 

PREPARED STATEMENT OF THE CHAIRMAN JEFF MILLER

Good morning and thank you for joining us today. 

I am Jeff Miller—Chairman of the Committee on Veterans’ Affairs for the United 

States House of Representatives and Congressman from the First District of Florida, 

where—as we like to say—thousands live like millions wish they could. 

I am joined here today by senior Committee Member and the Congressman from 

the Fifth District of Colorado, Doug Lamborn, and by our friend and colleague and 

your Congressman, Steve Pearce. 

I know I speak for Rep. Lamborn (Doug) as well when I say that I am grateful 

to Rep. Pearce (Steve) for his hard work, leadership, and advocacy efforts on behalf 

of New Mexico’s servicemembers and veterans. 

I am grateful to him for inviting us to New Mexico today and am honored to be 

here in Roswell with all of you. 

Before I go any further, I would ask all of the veterans in our audience today to 

please stand, if you are able, or raise your hand and be recognized? 

Thank you so much for your service. 

Ensuring that you and your veteran friends, neighbors, and colleagues in New 

Mexico and across the country have timely access to high-quality healthcare through 

the Department of Veterans Affairs (VA) is why we are here today and I am grateful 

to you for joining us this morning. 

As you all know, in April, a Committee investigation and whistleblower revelations exposed widespread corruption and systemic access delays and accountability 

failures across the VA healthcare system that left thousands of veterans—including 

some right here in New Mexico—waiting for weeks, months, and even years for the 

healthcare they earned through honorable service to our nation. 

In the four months since, the Committee has held multiple hearings to get to the 

bottom of the Department’s deficiencies; VA senior leaders have resigned and been 

replaced; and, nationwide initiatives have been undertaken. 

Just last week, Congress passed a bipartisan Conference agreement that will improve accountability for VA employees; increase access to care for veteran patients 

facing lengthy waiting times or residing far from the nearest VA facility; and pave 


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the way for long-term reforms that will dramatically improve the Department for 

veterans today and for generations to come. 

Needless to say, it has been a busy summer. 

However, our work is just beginning. 

During today’s hearing, we will discuss the challenges Roswell veterans experience accessing care—particularly mental healthcare—through Veterans Integrated 

Service Network (VISN) eighteen and the New Mexico VA healthcare System. 

In short, things could certainly be better. 

VA’s nationwide access audit found troubling scheduling practices were in place 

at the Albuquerque VA Medical Center and I want to hear from our witnesses— 

local veterans and local VA officials—how those practices have impacted the care 

veterans receive here and what actions have been taken and still need to be taken 

to improve access to care for New Mexico veterans. 

I look forward to our discussion this morning and to taking your thoughts and 

ideas back to Washington when we leave. 

I thank you all once again for being here this morning. 

f 

PREPARED STATEMENT OF JOHN TAYLOR, SERGEANT, U.S. ARMY (100% COMBAT

DISABLED RET.) 

Chairman Miller and Members of the House Committee on Veterans Affairs, it 

is an honor to provide testimony before you today. 

My active duty combat military experience was with the 101st Airborne Rangers 

in Vietnam. After seeing many of my brothers die in heated combat situations within the infamous A Shau Valley area of Thua Thien/Hue, and being shot twice and 

bayoneted on the same day, dying on the MASH unit surgery table (and obviously 

returned to life), I never imagined any of us would come back home to die directly 

related to post combat medical care in our VA hospitals. Sadly, as you are now 

aware, that has become a painful reality. 

After being combat disabled retired from the military, I completed my degree in 

Business Administration, with a Pre-Med Biology minor. Half of my career was 

spent in corporate management for Dun & Bradstreet. More important to this hearing, I spent the last half of my career (12 years) in medical administration; hospital 

director, nursing home administrator, medical hospital-satellite manager, urgent 

care center director, substance abuse center director and psychiatric center director. 

In the interest of saving this Committee time with respect to my evaluations and 

solution recommendations, please let me refer you to a previous field hearing you 

had on 10 July 2014, ‘‘Service should not lead to suicide: Access to VA’s mental 

healthcare.’’ One of my younger brothers’-at-arms, U.S. Army (RET.) Sgt. Josh 

Renschler’s gave an excellent testimony before this Committee. Even though we 

came from different wars, basic problems, observations, and suggested resolutions 

are essentially the same. I can, however, give you a significant variation I would 

term ‘‘acute rural’ality’’. Being in a rural, desert community, systemic problems encountered throughout the country are greatly intensified in southeastern New Mexico. As a quick example; Following the Cares Commission findings during President 

Bush’s last term in office, a Director of Rural Administration was created to help 

eliminate our acute problem of rural access in our area. As it turned out, that rural 

administrator responsible for resolving our problems was none other than our Administrator of the Albuquerque VA Hospital,—the very person, historically, refusing 

our request for local fee-base services. Ineffectual outcomes are obvious. 

For the last nine years, I have published a weekly ‘‘Veterans Advocate’’ column 

in our local newspaper, the Roswell Daily Record. The column is a volunteered, noncompensated, freelance work, having no allegiance to any person or group, except 

to my brother and sister veterans. Over the years, I’ve made members of both sides 

of the aisle uncomfortable to say the least. However, the majority of my rants have 

now shown to be true. Like so many other public-forum veterans’ advocates are asking, ‘‘Why did it take the recent deaths of so many of us to prove what we advocates 

have been claiming for so many years was true?’’ 

It is important to note, our deaths were majorly not due to medical care provided 

by our VA medical professionals (physicians, nurses and medical support personnel), 

but from administrative ‘‘games’’ played by VA administrative leaders and by system oversight groups. I’ve made that statement publicly, several times over the last 

nine years, only to be ignored or politely told either ‘‘were working on a resolution’’ 

or ‘‘you’re not correct in your accusations’’. Finally, saddest of all, my claims have 

been validated with the many deaths recently ‘‘uncovered’’ (and still being uncovered) thanks to courageous whistleblowers. The retaliation they received, as you all 


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have been made aware, is the perfect example of the VA’s response to anyone questioning the VA’s activities. Veterans, families and friends have not, and continue to 

not, come forward due fear of reprisal. The VA has historically denied this to be 

true, but as you yourself have recently seen, the VA seems to have a problem with 

the truth. I personally can offer proof this has occurred long before the recent 

‘‘awakening’’. 

I have respectfully submitted a few of my VET ADVO columns in support of my 

testimony today, most of which are 6 to 9 years old. This illustrates real-life catastrophes I have encountered over my nine years as advocate, which were literally ignored or denied as being accurate by our State VA administrators and Government 

officials. We all now know how invalid the VA denials were, and still are. Two specific sets of columns illustrate factually the problems and battles we have faced with 

the Albuquerque VA Hospital administrators, consistently denied by the VA as 

being accurate. 

1. The first was a series of columns I did on a chronic PTSD veteran who over 

the space of more than one year threatened to commit suicide due to his Desert 

Storm nightmares. His wife approached Col. Ron McKay (USMC Retired) and me 

with horror stories of her lack of effective treatment for her husband by the VA. 

Apache (my column name for my brother to respect his privacy) had undergone several ‘‘treatment modalities’’ lasting from three days to three months in-patient sessions. More than once, he was sent home in a cab (for a two and one half hour 

drive), before which he would ask the driver to ‘‘swing by’’ the nearest Albuquerque 

liquor store to make his journey easier. His primary substance abuse/dependency directly related to his PTSD was alcohol. Knowing this, his treatment team and or 

patient discharge planner should have known this was a perfect storm doomed to 

failure. Each time, Apache return home totally inebriated, once again threatening 

suicide. He was instructed by his Albuquerque VA treatment clinician to report to 

a local VA social worker for ‘‘after-care’’. During the first visit (Apache and his wife), 

as reported by his wife, the counselor asked, ‘‘So what is it you want me to do? You 

know, you could go to AA and get some help.’’ A furious Apache and his wife got 

up and left. In my experience as a director of a psychiatric center and an inpatient 

substance abuse center, after-care for either malady requires, at a minimum, the 

services of a certified psychiatric counselor or certified substance abuse counselor 

(for facility licensure by Texas and New Mexico), not a social worker. Eventually, 

Apache was found dead one night outside his house, in spite of repeated request to 

the VA for help keeping him alive. The VA response? He was non-compliant. In 

other words, they gave up! 

2. The second set of columns dealt with several cases I followed involving the unacceptable six-plus hour round-trip drive to the Albuquerque VA Hospital from 

Roswell. One involved an 86-year-old veteran with stomach cancer (with an active 

drainage catheter) who had to be driven to Albuquerque 2 to 3 times a month by 

his 87-year-old wife, who was in failing health herself. His primary care physician 

at the VA Artesia clinic had requested approval for him to be seen locally, in 

Roswell. That approval never came. To this day, I have the uneasy feeling Mr. 

Borum died prematurely due to the stress this put on his system. 

3. Additionally, in one column I actually reported a conference call I had with VA 

Albuquerque Administrative Staff concerning fee-based (local contract) dental care 

for 100% service-connected veterans in Roswell. The assurances and ‘‘promises’’ of 

local contract dental care by administrative heads in Albuquerque were later found 

to be lies, subsequent to my telephone visit with a staff dentist at the Albuquerque 

hospital. When I approached the VA Hospital Administrator at that time, he refused 

to review the incontrovertible evidence I offered him. His response to me (several 

times) was, ‘‘My people don’t lie!’’ I have reliable witnesses to that encounter. To 

the point of ineligibility for local care (fee-based services) in Roswell, Roswell has 

been denied local access to fee-based services because it was ‘‘determined’’ by the 

VA to be less than 40 miles from the nearest CBOC. That also has been a lie each 

and every time it was offered by the VA. Last week, I measured the actual distance 

from our nearest CBOC (Artesia, New Mexico), and found it to be (exactly) 45.6 

miles to my front door, and 43.8 miles from the center of town, accurately showing 

half of Roswell is at least 44 miles from the Artesia VA CBOC (greater than the 

‘‘less than 40 mile’’ rule). This certainly was not the 38 mile VA calculated distance 

given in our several denials for local contract services. Additionally, when Taos, 

New Mexico received a ‘‘shadow clinic’’ which we were also promised, we were denied due to the 38 mile determination. I did a study finding that Taos was in fact 

closer to its nearest CBOC than Roswell was to the Artesia VA clinic. In fact, there 

were over 100 clinics built in our quad-state region in violation of the ‘‘40-mile’’ rule. 

I apologize for this lengthy testimony, but after nine years of reporting on these 

issues and warning everyone of the obvious, predictable outcomes, I hope this report 


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does not, once again, fall on deaf ears. Simply stated; (1) Systems monitored by its 

own department members (no matter the claims of independent watchdog status) 

do not and will not work. (2) Paying bonuses to upper echelon administration is a 

crafty mechanism created by ‘‘upper management’’ to milk the system. I know! I’ve 

been there. In my many years as a medical administrator, my reward (bonus if you 

please) was continued employment next year. The contrived reason for VA bonuses 

(reported in other House and Senate committee hearings) is to entice and retain 

competent administrators. That, Hon. Committee members, is a fallacy perpetrated 

on those who have not worked in the medical arena. Competence in our current VA 

administration (based on this bonus rule) has been proven grossly lacking among 

our current VA ‘‘hand-pick’’ wonder kids! In my experience, it’s safe to say you 

would find a sufficient queue of qualified applicants for each VA administrator position you currently find ‘‘not up to par’’. Current doctors and medical administrators 

being RIF’ed (Reductions in Force) in the Administration’s military drawdown could 

easily and effectively be placed in certain comparable positions recently found ‘‘lacking’’ within the VA administrator network. 

I sincerely hope my testimony and attached resource materials will help you with 

your enormous task of keeping my brother and sister veterans alive once they return home, after surviving death on the battlefield. 

I would be pleased and honored to answer any questions you may have. God bless 

you in your efforts, God bless my brother and sister veterans, and God bless our 

Nation. Thank you. 

f 

PREPARED STATEMENT OF RICHARD MONCRIEF

I would like to thank the committee for giving me the chance to speak out about 

the lack of Mental healthcare in the Southeast corner of the state. 

I have been using the Mental Health services in the Artesia Clinic for several 

years now. With the loss of Dr. Peter K. Hochla we now are going to be forced to 

use the telemed system which is a very impersonal way of conducting mental 

health. The men and women who suffer from PTSD and TBI need to have a live 

physical being to talk to. Better yet to have Group Therapy with a skilled group 

leader and a Psychologist would even be better. 

Having a warm body to talk to, in person is better than a Flat Screen for the patient. The talk is more personal and you can see the body movements and make 

better eye contact with the person doing the counseling. 

When Dr. Peter K. Hochla was here every 3–6 months, I still needed to talk to 

someone to be able to let my hair down and be relaxed. I ended up hiring a MA, 

LPCC (Licensed Professional Clinical Counselor). I tried to use TRICARE, but they 

did not pay the going Medicare rate so I ended up paying for the Counselor out of 

my pocket. 

There is a very great need for some kind of skilled counselor in this part of the 

Country. 

f 

PREPARED STATEMENT OF MS. ELIZABETH FREEMAN

Good morning, Chairman Miller, Congressman Pearce, and Congressman 

Lamborn. Thank you for the opportunity to discuss the New Mexico VA Healthcare 

System’s (NMVAHCS) commitment and accomplishments in providing Veterans accessible, high quality, patient-centered care and to specifically address rural 

healthcare and access to mental healthcare in New Mexico. I am accompanied today 

by James Robbins, MD, Interim Medical Center Director for NMVAHCS, and Lori 

Highberger, MD, Deputy Chief Medical Officer and Mental Health Lead for the VA 

Southwest Healthcare Network. 

New Mexico VA healthcare System Overview 

The NMVAHCS serves Veterans in New Mexico, southern Colorado (Durango 

area), and west Texas. NMVAHCS is comprised of the Raymond G. Murphy VA 

Medical Center (VAMC) with 13 Community-Based Outpatient Clinics (CBOC). The 

Raymond G. Murphy VAMC is a Joint Commission-accredited, VHA complexity level 

1a, tertiary care referral center located in the heart of Albuquerque, New Mexico. 

It provides a full range of patient care services with state-of-the-art technology as 

well as education and research. It is the only VAMC in New Mexico. 

The Raymond G. Murphy VAMC is a teaching hospital, affiliated with the University of New Mexico School of Medicine and College of Nursing. It has an active partVerDate Aug 31 2005 08:32 Oct 07, 2015 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6621 Y:\96-126.TXT PAT

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nership with Kirtland Air Force Base 377th Medical Group and collaborates with 

Indian Health Service and Tribal healthcare organizations. The facility has an active Community Living Center, a 26-bed Spinal Cord Injury Center, and a strong 

commitment to psychosocial rehabilitation and vocational rehabilitation. VA-staffed 

CBOCs are located in Artesia, Farmington, Gallup, Silver City, Raton, Santa Fe, 

and Northwest Metro (Rio Rancho), New Mexico. Contract CBOCs are located in 

Alamogordo, Truth or Consequences, Espanola, Las Vegas, and Taos, New Mexico, 

and Durango, Colorado. The VAMC is a tertiary referral facility for Veterans from 

the VA facilities in Big Spring, El Paso, and Amarillo, Texas. 

Rural Health in New Mexico 

The VHA Office of Rural Health (ORH) supports programs and initiatives in the 

areas of Veteran transportation, telehealth, resident and allied health student rural 

clinical training and education, and care closer to home via primary care and mental 

healthcare extension teams that leave the VA facility and treat Veterans in their 

remote communities. Over 45 percent (77,493) of New Mexico’s 170,799 Veterans 

live in rural areas of the state. Approximately 74,713 New Mexico Veterans are enrolled in VHA healthcare, and 47 percent (34,982) of those enrolled Veterans live 

in rural areas. NMVAHCS serves a geographic area that is 121,826 square miles. 

ORH currently supports nine projects for a total of nearly $1.9 million in the state 

of New Mexico. These projects increase rural Veteran access to mental healthcare, 

women’s healthcare, primary care, pharmacy services, and neurology services. Five 

of these nine projects use telehealth to deliver healthcare closer to Veterans’ homes. 

One currently-funded ORH initiative is Home Based Primary Care (HBPC) for 

Veterans residing in rural areas near Santa Fe and Artesia. The HBPC program 

provides primary care services for frail, chronically-ill Veterans in their own homes. 

HBPC is available in the Gallup CBOC and is being expanded to the Santa Fe and 

Artesia CBOCs. Another ORH-supported initiative focuses on diabetes education 

and overall health and wellness for Southern Ute American Indian Veterans. 

NMVAHCS continues to work with ORH to develop innovative project ideas to increase rural Veteran access to care and services. 

In the recent past, Farmington, Silver City, Raton, and Artesia CBOCs were relocated to new clinics with increased space. New clinics for Gallup and Santa Fe 

CBOC relocations will be activating in calendar year 2014. The Truth or Consequences Contract CBOC will have a new contractor in approximately one year. 

Telehealth in New Mexico 

The VA healthcare system offers expanded access to mental health services with 

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

that mandate rapid access to mental health services. Telemental health allows VA 

to leverage technology to provide Veterans quicker and more efficient access to mental healthcare by reducing the distance they have to travel, increasing the flexibility 

of the system they use, and improving their overall quality of life. This technology 

improves access to general and specialty services in geographically remote areas 

where it can be difficult to recruit mental health professionals. In areas where 

CBOCs do not have a mental healthcare provider available, VA uses secure video 

teleconferencing technology to connect the Veteran to a provider within VA’s nationwide system of care. The program is also expanding directly into the home of the 

Veteran using Internet Protocol (IP) video on Veterans’ personal computers. 

There is increased support for group specialty care through the expanded use of 

Clinical Video Telehealth (CVT) technology. The use of this technology in homes is 

on the rise, especially aiming to assist American Indian Veterans, who are the most 

rural, isolated, and transportation challenged. Other initiatives include expansion of 

telehealth specialty service, which includes anticoagulation monitoring; dedicated 

space for telehealth education for staff and Veterans of rural health service; and 

health fairs at NMVAHCS CBOCs. 

In Fiscal Year (FY) 2013, NMVAHCS served 5,168 Veterans through telehealth, 

and 59 percent (3,031) of these Veterans lived in rural areas. Of these, 1,002 Veterans accessed mental health services through CVT in FY 2013, 90 percent (897) 

of whom lived in rural areas. 

Mental Health Services Engagement Initiatives 

VA is working closely with its Federal partners to implement President Barack 

Obama’s Executive Order 13625, ‘‘Improve Access to Mental Health Services for Veterans, Service Members, and Military Families,’’ signed on August 31, 2012. The Executive Order affirmed the President’s commitment to preventing suicide, increasing 

access to mental health services, and supporting innovative research on relevant 

mental health conditions. 


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On February 1, 2013, VA released a report on Veteran suicides, a result of the 

most comprehensive review of Veteran suicide rates ever undertaken by the VA. 

With assistance from state partners providing real-time data, VA is now better able 

to assess the effectiveness of its suicide prevention programs and identify specific 

populations, such as Veterans living in rural areas, who may need targeted interventions. This new information will assist VA to identify where at risk Veterans 

may be located and improve the Department’s ability to target specific suicide interventions and outreach activities in order to reach Veterans early and proactively. 

The data will also help VA continue to examine the effectiveness of suicide prevention programs being implemented in specific geographic locations as well as care settings, such as primary care, in order to replicate effective programs in other areas. 

In an effort to increase access to mental healthcare and reduce the stigma of seeking such care, VA has integrated mental health into primary care settings. The ongoing development of Patient Aligned Care Teams to deliver primary care will facilitate the delivery of integrated primary care and mental health services. It is VA 

policy to screen patients seen in primary care in VA medical settings for PTSD, 

MST, depression, and problem drinking. The screening takes place during a patient’s first appointment, and screenings for depression and problem drinking are 

repeated annually for as long as the Veteran uses VA services. Furthermore, PTSD 

screening is repeated annually for the first five years after the most recent separation from service and every five years thereafter. Systematic screening of Veterans 

for conditions such as depression, PTSD, problem drinking, and MST has helped VA 

identify more Veterans at risk for these conditions and provided opportunities to 

refer them to specially trained experts. 

VA operates the National Center for PTSD which guides a national PTSD Mentoring program, working with every specialty PTSD program across the VA system 

to improve care. The Center has also begun to operate a PTSD Consultation Program open to any VA practitioner (including primary care practitioners and Homeless Program coordinators from every location) who requests expert consultation regarding a Veteran in treatment with PTSD. So far, 500 VA practitioners have utilized this service. The Center further supports clinicians by sending subscribers updates on the latest clinically relevant trauma and PTSD research, including the Clinician’s Trauma Update Online, PTSD Research Quarterly, and the PTSD Monthly 

Update. 

To support Veterans who use VHA mental health services and build on the work 

of the 2012 Executive Order from the President, VHA has hired and deployed over 

950 peer support staff to mental health programs across the country. Peer Specialists are Veterans who have been successfully and actively engaged in their own 

mental health recovery for a minimum of one year and who are trained and certified 

to provide peer support services. Peer Specialists work as members of mental health 

treatment teams and help Veterans achieve their treatment and personal goals, and 

they demonstrate that recovery is achievable. 

No Veteran should have to wait for the care and services that they have earned 

and deserve. NMVAHCS intends to continue to work to meet Veterans’ needs using 

the following initiatives: 

• Recruit and fill mental health vacancies. 

• Explore recruitment incentives to entice psychiatrists to relocate to 

NMVAHCS. There is an industry shortage of psychiatrists. 

• Increase the number of Albuquerque-based mental health clinicians trained 

in and certified to deliver telehealth and other virtual care modalities such as 

CVT in the home to provide increased access for rural patients. 

• Realign all outpatient mental health programs under one outpatient Mental 

Health Division to increase patient access to specialized mental health services. 

Conclusion 

NMVAHCS is committed to providing high-quality, safe, and accessible care for 

our Veterans. We will continue to focus on improving Veterans’ access to care. Our 

location presents unique challenges with regard to distance, culture, and constrained healthcare markets. Our rural health programs are robust, and we will 

continue to strive to serve Veterans in rural areas. 

Mr. Chairman, this concludes my statement. Thank you for the opportunity to appear before you today. I would be pleased to respond to questions you or the other 

Members of Congress may have. 

Æ 


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