[Senate Hearing 114-252]
[From the U.S. Government Publishing Office]
S. Hrg. 114-252
HEARING ON PENDING HEALTH AND BENEFITS LEGISLATION
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 18, 2015
__________
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COMMITTEE ON VETERANS' AFFAIRS
Johnny Isakson, Georgia, Chairman
Jerry Moran, Kansas Richard Blumenthal, Connecticut,
John Boozman, Arkansas Ranking Member
Dean Heller, Nevada Patty Murray, Washington
Bill Cassidy, Louisiana Bernard Sanders, (I) Vermont
Mike Rounds, South Dakota Sherrod Brown, Ohio
Thom Tillis, North Carolina Jon Tester, Montana
Dan Sullivan, Alaska Mazie K. Hirono, Hawaii
Joe Manchin III, West Virginia
Tom Bowman, Staff Director
John Kruse, Democratic Staff Director
C O N T E N T S
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November 18, 2015
SENATORS
Page
Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia........ 3
Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from
Connecticut.................................................... 3
Prepared statement........................................... 5
Rounds, Hon. Mike, U.S. Senator from South Dakota................ 18
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 20
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 22
Boozman, Hon. John, U.S. Senator from Arkansas................... 24
Tester, Hon. Jon, U.S. Senator from Montana...................... 25
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 27
Moran, Hon. Jerry, U.S. Senator from Kansas...................... 28
WITNESSES
Ernst, Hon. Joni, a United States Senator from the State of Iowa. 1
Coy, Curtis L., Deputy Under Secretary for Economic Opportunity,
Veterans Benefits Administration, U.S. Department of Veterans
Affairs; accompanied by Maureen McCarthy, M.D., Acting
Assistant Deputy Under Secretary for Health for Patient Care
Services, Veterans Health Administration; and Meghan Flanz,
Deputy General Counsel, Legal Operations and Accountability.... 7
Prepared statement........................................... 8
Response to request arising during the hearing by Hon.
Richard Blumenthal......................................... 32
Response to posthearing questions submitted by Hon.
Richard Blumenthal......................................... 33
Hempowicz, Elizabeth, Public Policy Associate, Project On
Government Oversight........................................... 38
Prepared statement........................................... 40
Response to request arising during the hearing by Hon.
Richard Blumenthal......................................... 60
Hubbard, William, Vice President of Government Affairs, Student
Veterans of America............................................ 43
Prepared statement........................................... 44
Morosky, Aleks, Deputy Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 48
Prepared statement........................................... 50
Porter, Thomas, Legislative Director, Iraq and Afghanistan
Veterans of America............................................ 52
Prepared statement........................................... 54
Response to request arising during the hearing by Hon.
Richard Blumenthal......................................... 66
Zumatto, Diane, National Legislative Director, AMVETS............ 55
Prepared statement........................................... 57
APPENDIX
Kirk, Hon. Mark, U.S. Senator from Illinois; prepared statement.. 67
American Academy of Physician Assistants (AAPA); prepared
statement...................................................... 69
Clarno, Germaine, LCSW, CADC and Local President of the American
Federation of Government Employees (AFGE); prepared statement.. 70
Varela, Paul R., Assistant National Legislative Director,
Disabled American Veterans (DAV); prepared statement........... 72
Grundmann, Susan Tsui, Chairman, U.S. Merit Systems Protection
Board (MSPB); prepared statement............................... 76
Nee, Lisa M., MD, Interventional Cardiologist; prepared statement 83
Lerner, Carolyn N., Special Counsel, United States Office of
Special Counsel (OSC); prepared statement...................... 85
Paralyzed Veterans of America (PVA); prepared statement.......... 86
Wilkes, Christopher Shea, VA Truth Tellers; letter............... 88
Halliday, Linda A., Deputy Inspector General, U.S. Department of
Veterans Affairs, Office of Inspector General (OIG); letter.... 94
Ochinko, Walter, Policy Director, Veterans Education Success
(VES); prepared statement...................................... 98
HEARING ON PENDING HEALTH AND BENEFITS LEGISLATION
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WEDNESDAY, NOVEMBER 18, 2015
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 2:30 p.m., in
room 418, Russell Senate Office Building, Hon. Johnny Isakson,
Chairman of the Committee, presiding.
Present: Senators Isakson, Moran, Boozman, Rounds, Tillis,
Sullivan, Blumenthal, Brown, Tester, and Hirono.
WELCOME BY HON. JOHNNY ISAKSON, CHAIRMAN,
U.S. SENATOR FROM GEORGIA
Chairman Isakson. I call this meeting of the Senate
Veterans' Affairs Committee come to order.
Since our distinguished Senator from the State of Iowa is
here early, in a timely fashion, I do not want to make her wait
any longer, and it is always our tradition to have members of
the Senate who are not on the Committee who have bills to be
testified about speak first, and we always honor them by not
asking them any questions. That is not because we know they do
not have the answers. It is because we do not want the hearing
to go so long.
So, Senator Ernst, we are delighted to have you here. You
are our first witness and we will be glad to hear from you.
STATEMENT OF HON. JONI ERNST,
U.S. SENATOR FROM IOWA
Senator Ernst. Thank you, Mr. Chairman. I appreciate it
very much, and thank you for your service and, of course, your
service to our veterans, as well. Thank you, as well, Senator
Sullivan.
I do wish to thank all of the Members of the Committee who
have worked so hard for our veterans. This is one of the most
important Committees, I feel, to making sure that we honor our
commitments to the men and women that have served in our
Nation's military. Again, thank you for allowing me to testify
today.
I want to specifically thank my lead Democratic sponsor,
Senator Hirono, for her help with this legislation, which is
designed to improve the access and quality of care we provide
our veterans. The bill is called the VETS Act for a reason, and
that is because we all want to honor and help those that served
and sacrificed for our country.
The VA has been practicing telemedicine since 2001 and they
are largely cited as leaders and innovators in the field. Their
efforts in telemedicine have saved money and veterans' time by
eliminating often an hour or more long drives to the VA and
reducing bed days at the VA. For example, according to the VA,
in fiscal year 2014, telehealth reduced bed days of care by 54
percent, reduced hospital admissions by 32 percent, and saved
$34 per consultation in travel savings.
Our legislation is straightforward, common sense, and
builds upon this work that the VA is already doing in
telemedicine. It allows VA doctors to conduct telemedicine
across State lines for patients in their homes, something they
are already able to do within State lines. Unfortunately,
current law allows doctors to call patients at their homes if
they are in the same State but prevents them from doing so if
their veteran patient lives across State lines. VA doctors
wishing to treat patients via telehealth across State lines
must have the patient drive to a Federal facility. This is the
case even though there is no special licensing requirement for
VA doctors to practice in different States.
For example, a veteran in my small town of Red Oak, Iowa,
who wishes to have a telemedicine appointment with a doctor at
the VA hospital in Omaha, Nebraska, that is closest to my home
town, an hour away, that veteran must drive to the VA center in
Des Moines, a 2-hour drive. By contrast, if the doctor was
based in Des Moines, the patient could remain in their home in
Red Oak and have a telemedicine appointment.
Back in Iowa and in many other States, rural veterans are
often faced with the struggle of making it to a VA facility in
the city. Increasing opportunities for telemedicine is a great
way to tackle this challenge for services ranging from mental
health treatment to post-surgery follow-up.
In addition, this bill includes language we worked with the
VA on to ensure policymakers have up to date information on the
VA's telehealth program. This report language is designed not
to have a cost or create any extra work as this is data that
the Department already collects on its telehealth program.
As you may know, this legislation has broad bipartisan
support, with 12 cosponsors, three from this Committee, and is
supported by the Veterans of Foreign Wars, The American Legion,
Concerned Veterans for America, the Paralyzed Veterans
Association, Iraq and Afghanistan Veterans of America, and the
American Telemedicine Association, and Health IT Now.
I hope you all are able to see the common sense behind this
legislation and I greatly appreciate all of you taking time to
consider this legislation and listen to my remarks today. Thank
you very much, Mr. Chairman.
Chairman Isakson. Senator Ernst, we appreciate your
leadership, and Senator Hirono, your cosponsorship of the
legislation----
Senator Hirono. I am proud to.
Chairman Isakson. A proud cosponsor.
Senator Ernst. Thank you, Mazie, very much, Senator Hirono.
Chairman Isakson. I think we have five other Committee
Members who are also cosponsors of the bill.
Senator Ernst. Wonderful.
Chairman Isakson. It does address a critical need. We have
had some input, which I will go over with you, but we want to
move forward as soon as we can. It is a great suggestion that
really helps us solve a problem in a most economical way, but
it also benefits mostly our veterans, which is why we are here
to begin with.
So, thank you very much----
Senator Ernst. Thank you.
Chairman Isakson [continuing]. For submitting the
legislation. We will be with you shortly, when we do a markup.
Senator Ernst. Thank you, Mr. Chair.
Chairman Isakson. Thank you.
We will go ahead and do opening statements by the Chairman
and Ranking Member and then we will go straight to our first
and second panels, if that is OK. Thanks again to Senator Ernst
for being here today and her legislation.
Senator Ernst. Thank you.
OPENING STATEMENT OF HON. JOHNNY ISAKSON,
CHAIRMAN, U.S. SENATOR FROM GEORGIA
Chairman Isakson. Today's agenda touches on a variety of
areas, including whistleblower protection, educational
benefits, vocational rehabilitation, and improving medical
staffing and care. I want to commend Senator Ernst and Senator
Kirk, who are not Members of the Committee but have come
forward with legislation we will consider today, as well as
each Member of the Committee who has had input on the hearing
today.
VA has come under increasing fire recently for treatment of
whistleblowers and this Committee wants to see to it that
whistleblowers who truthfully come forward to testify have the
protection and the ease necessary to accomplish what they do.
It is a valuable service to make the Veterans Administration
better.
The Committee will continue to look closely at all the
programs that support the transition from service to private
sector employment and do everything we can to see to it we are
fostering the type of transition that is necessary. It is
important to evaluate new ideas to staff VA facilities
adequately and connect veterans with health care providers.
Most importantly, it is important that we always make sure that
we are providing our veterans with the services they need from
the Veterans Administration when they leave the military.
I appreciate our members that have submitted legislation
today. We will have five pieces that we will take up. We will
hear from six witnesses who will testify, and I will now
recognize the Ranking Member, Richard Blumenthal.
OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thanks, Mr. Chairman. Thank you for
having this hearing and for including priorities from the
minority side on today's agenda. Also, that you for continuing
to work with us in a bipartisan way to address the many
important bills that have been referred to the Committee.
I am particularly proud of the whistleblower protection
bill that Senator Kirk and I have introduced last night. It was
the result of many hours of painstaking and sometimes painful
work to accommodate the interests involved and balance the
rights on both sides to make sure that whistleblowers are
protected against potential reprisal and retaliation. I know
from my work as a State Attorney General as well as a Federal
prosecutor how important whistleblowers are as a source of
information and evidence and how vulnerable they may be when
they speak truth to power.
Therefore, I felt strongly and deeply about this measure,
and I recognize there may not be unanimity and support for it.
But I think it makes some critically important advances in
providing the safeguards that are needed for whistleblowers to
step forward and do what they have done throughout our history
in protecting the public interest which sometimes includes
putting that public interest ahead of their own personal
welfare. At the very least, they ought to be protected from
reprisal and retaliation, which has happened in the VA, it has
happened in the government as a whole, and that is why we have
the system of whistleblower protection that we do.
In addition, I am very pleased today that the Committee is
considering my legislation S. 2253, the Veterans Education
Relief and Reinstatement Act. Again, I want to thank colleagues
on both sides of the aisle, Senator Tillis of this Committee as
well as Senator Brown, for cosponsoring this legislation.
The catastrophic collapse of Corinthian Colleges earlier
this year left thousands of students, literally thousands of
young people, who had not received an education of any value,
let alone a degree, stranded under mountains of debt. Four-
hundred-and-twenty-two of the students impacted were
beneficiaries of the Post-9/11 G.I. Bill, which rightfully
provides our veterans and other dependents with the opportunity
to pursue higher education after military service.
Not only did Corinthian's closure mean that these veterans
had wasted a semester of Post-9/11 G.I. Bill entitlements at a
college that closed, forgoing credit for their coursework, but
this unexpected closure also led the VA to cutoff housing
allowance benefits for them and their dependents. This monthly
educational housing assistance is a crucial component of the
Post-9/11 G.I. Bill benefit. When this benefit is abruptly
terminated, it can leave beneficiaries stranded and without
supplemental income for housing, food, utilities, and other
basic necessities.
I introduced the Veterans Education Relief and
Reinstatement Act to give the VA Secretary authority to restore
Post-9/11 G.I. Bill entitlements and provide housing relief to
those who have been harmed by the permanent closure of an
educational institution such as Corinthian. I am hopeful we can
consider to advance this bill and other important education
legislation, such as the Career Ready Student Veterans Act,
through this Committee to ensure that our veterans have not
wasted hard-earned education benefits and are given the
opportunity to complete their degrees.
This June, along with Senate and House colleagues, I urged
the VA to provide more information to veterans on the G.I. Bill
comparison tool to warn users when schools are under
accreditation probation, facing heightened cash monitoring from
the Federal Government, or under probation from the Department
of Defense Military Tuition Assistance Program.
I have more to say on a number of these bills. I am going
to ask, with the Chairman's permission, that I enter my full
statement in the record----
Chairman Isakson. Without objection.
Senator Blumenthal [continuing]. And simply again thank him
for his consideration in permitting us to move forward on these
critical measures.
Thank you, Mr. Chairman.
[The prepared statement of Senator Blumenthal follows:]
Prepared Statement of Hon. Richard Blumenthal, Ranking Member,
U.S. Senator from Connecticut
opening remarks
Thank you, Mr. Chairman, for holding today's hearing on pending
legislation before this Committee, and thank you to all of the
witnesses providing testimony today. We appreciate your dedication to
the veteran communities that you serve and thank you for sharing your
insight.
Today's hearing agenda reflects the commitment of Members on both
sides of the aisle to do right by this Nation's veterans and their
families. As this Congress continues, it is increasingly apparent there
is much work to be done.
I want to thank the Chairman for including priorities from the
minority side on today's agenda, and for continuing to work with us in
order to address the many important bills that have been referred to
the Committee.
I thank my Senate colleagues for their work to advance important
bills through this Committee--specifically related to the vocational
rehabilitation program, physician assistants and workforce shortages at
VA, accountability, and education--and I am pleased that we have this
opportunity to discuss these legislative measures today.
Given the number of bills and legislative proposals on today's
agenda, I will briefly highlight a few bills we'll consider today.
education benefits
I am especially pleased that the Committee is considering consider
my legislation, S. 2253, the Veterans Education Relief and
Reinstatement Act. I thank my colleagues, particularly my distinguished
Committee colleagues, Senator Tillis as well as Senator Brown, for
cosponsoring this legislation.
The catastrophic collapse of Corinthian Colleges earlier this year
left thousands of students, who had not received an education of any
value, stranded under a mountain of debt.
422 of the students impacted were beneficiaries of the Post-9/11 GI
Bill, which rightfully provides our veterans and their dependents with
the opportunity to pursue higher education after their military
service.
Not only did the Corinthian closures mean that these veterans had
wasted a semester of Post-9/11 GI Bill entitlement at a college that
closed, forgoing credit for their coursework. But this unexpected
closure also led VA to cutoff housing allowance benefits.
This monthly educational housing assistance is a crucial component
of the Post-9/11 GI Bill benefit. When this benefit is abruptly
terminated, it can leave beneficiaries stranded and without
supplemental income for housing, food, utilities, and other basic
necessities.
A recent investigation by the Department of Education and
California Attorney General Kamala Harris determined that Corinthian
Colleges repeatedly falsified job placement rates and preyed on
veterans and taxpayers. These predatory practices took advantage of
veterans using Post-9/11 GI Bill benefits to facilitate the transition
to civilian life, and we must do more to protect the student veterans
adversely impacted by such predatory practices and resulting school
closures.
I introduced the Veterans Education Relief and Reinstatement Act to
give the VA Secretary authority to restore Post-9/11 GI Bill
entitlement and provide housing relief to those who have been harmed by
the permanent closure of an educational institution, such as
Corinthian.
No veteran should have to suffer, or lose their hard-earned
educational benefits, due to the unsound financial practices and
predatory actions of schools like Corinthian.
I'm hopeful that we can continue to advance this bill and other
important education legislation, such as the Career-Ready Student
Veterans Act, through this Committee to ensure that our veterans have
not wasted hard-earned education benefits and are given the opportunity
to complete their degrees.
This June, along with Senate and House Colleagues, I urged VA to
provide more information to veterans on the GI Bill Comparison Tool to
warn users when schools are under accreditation probation, facing
heightened cash monitoring from the Federal Government, or under
probation from the Defense Department's military tuition assistance
program.
VA recently updated the GI Bill Comparison Tool with yellow caution
flags to warn users that certain schools, notably the University of
Phoenix, are under probation. This is a good first step to ensure that
veterans are provided with the resources they need to make informed
education decisions to best use their Post-9/11 GI Bill benefits.
We must do more to ensure that our Nation's heroes are using GI
Bill education benefits to receive education training, and are not
squandering these benefits on incapable institutions. I am pleased that
the Veterans Education Relief and Reinstatement Act has broad support
from VA as well as the veteran service organizations represented at our
hearing today and in written testimony.
whistleblower protections
The agenda also includes legislation to strengthen whistleblower
protections at VA. I'd like to thank my colleague Senator Kirk for
introducing this critically important bill.
The Government Accountability Project has referred to the
provisions in this legislation as ``a major breakthrough in the
struggle for VA whistleblowers to gain credible rights when defending
the integrity of the agency mission and disclosing quality of care
concerns.''
In addition, this legislation would hold supervisors accountable
for retaliating against whistleblowers.
I'm proud to co-sponsor this legislation, and I'd like to again
thank Senator Kirk for working with me and introducing this bill. I'd
like to thank the Veterans Service Organizations, the Government
Accountability Project, and other good government organizations for
their leadership on this issue.
conclusion
In conclusion, I again would like to thank our many witnesses for
joining us today. I look forward to our continued cooperation and
bipartisan collaboration with Chairman Isakson to work toward better
serving those who have served our country.
Thank you and I look forward to hearing your testimony.
Chairman Isakson. Thank you, Senator Blumenthal.
If our first panel will come forward, I will introduce our
first panel.
First is Mr. Curtis L. Coy, Deputy Under Secretary for
Economic Opportunity, Veterans Benefits Administration, U.S.
Department of Veterans Affairs; Dr. Maureen McCarthy, Acting
Assistant Deputy Under Secretary for Health for Patient Care
Services, Veterans Health Administration, Washington, DC; and
Meghan Flanz, Deputy General Counsel, Legal Operations and
Accountability.
We appreciate you all being here today. Mr. Coy, please
limit your testimony to about 5 minutes.
STATEMENT OF CURTIS L. COY, DEPUTY UNDER SECRETARY FOR ECONOMIC
OPPORTUNITY, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY MAUREEN McCARTHY, M.D.,
ACTING ASSISTANT DEPUTY UNDER SECRETARY FOR HEALTH FOR PATIENT
CARE SERVICES, VETERANS HEALTH ADMINISTRATION; AND MEGHAN
FLANZ, DEPUTY GENERAL COUNSEL, LEGAL OPERATIONS AND
ACCOUNTABILITY
Mr. Coy. Mr. Chairman, we will do just that. Good
afternoon, Mr. Chairman and Members of the Committee. We are
pleased to be here today to provide the views of the Department
of Veterans Affairs on pending legislation affecting VA's
programs. Accompanying, as you mentioned, are my colleagues Dr.
Maureen McCarthy, Acting Assistant Deputy Under Secretary for
Health, and Ms. Meghan Flanz, Deputy General Counsel.
S. 2106, the Wounded Warrior Employment Improvement Act of
2015, would require the Secretary to develop and publish an
action plan for improving VA's vocational rehabilitation and
employment (VRE) services. While VA appreciates the support the
Committee has for our VRE program, we do not believe that a new
action plan is necessary.
VA's recent and planned efforts in this area are extensive.
For example, we have already conducted a business process
reengineering initiative from 2011 to 2014, resulting in
streamlined workload and outreach strategies, new performance
metrics, developed an automated resource center, eliminated
redundant forms, and a staffing model; developed national
training modules for VRE staff that include TBI, PTS, and other
mental health issues, and have worked with VHA on these
specialized trainings; developed partnerships with VHA,
Department of Labor and Defense on a variety of issues, to
include homelessness, mental health, telecounseling, disability
and employment, and the Integrated Disability Evaluation
System, or IDES, stationing counselors at 71 military
installations for transitioning servicemembers.
We agree with AMVETS' written testimony today and have
expanded our public-private partnerships for VRE. Of note,
public-private partnerships are of particular interest to
Secretary McDonald. He has recently engaged with over 100
different organizations to develop MOUs or agreements with more
on the way. We have expanded our Vets Success on Campus Program
to 94 campuses. As one might imagine, it has been a very busy
and transformational few years.
S. 2134, the Grow Our Own Directive: Physician Assistant
Employment and Education Act of 2015, would establish a pilot
program to provide educational assistance to former members of
the Armed Forces for education and training as physician
assistants within the VA. While VA supports the entire concept,
the cost, as we laid out in our written testimony, associated
with the legislation causes concern within our available
resources.
With respect to S. 2170, the Veterans eHealth and
Telemedicine Support Act of 2015, VA supports the section of
the bill that allows VA employed or contracted health care
professionals to provide health care and to support the
provision of health care to the VA patient by telemedicine. As
outlined in more detail in our written testimony, VA supports
certain reporting requirements but does not support other
reporting requirements that would be overly burdensome on VA
operations.
S. 2253, the Department of Veterans Affairs Veterans
Education Relief and Restoration Act of 2015, would provide
veterans affected by school closures with certain relief and
restoration of education benefits if the VA finds that the
individual was forced to discontinue a course or courses as a
result of permanent school closure. VA supports this bill and
appreciates the leadership of Senator Blumenthal and the
Committee in helping those veterans who deal with a school
closure through no fault of their own.
The draft bill regarding whistleblower complaints would
define a whistleblower complaint to include not only a VA
employee's disclosure of wrongdoing, but also a complaint made
by a VA employee assisting other employees to disclose
wrongdoing. Amongst many other requirements, we do note that it
would establish a process for employees to file whistleblower
complaints with their immediate supervisor and establish a
central whistleblower office which is not part of VA's Office
of General Counsel that would be responsible for investigating
all whistleblower complaints.
In recent months, the Department has taken several
important steps to improve how we address operational
deficiencies and to ensure that those who disclose such
deficiencies are protected from retaliation. In the summer of
2014, the Secretary reorganized and assigned new leadership to
VA's Office of the Medical Inspector, which reviews
whistleblower disclosures related to VA health care operations.
The Secretary also established the Office of Accountability
Review to ensure leadership accountability for whistleblower
retaliation and other serious misconduct.
While we appreciate the Committee's efforts to assist the
Department in these endeavors, we believe the specific
whistleblower disclosure and protection procedures provided by
this bill would be unworkable and current whistleblower
protections are effective. From a legal perspective, our
analysis suggests that portions of the draft bill present due
process problems and conflicts with other laws.
Mr. Chairman, this concludes my statement. We thank you for
the opportunity to appear before you today and we will be
pleased to respond to any questions you or other members may
have, sir.
[The prepared statement of Mr. Coy follows:]
Prepared Statement of Curtis L. Coy, Deputy Under Secretary for
Economic Opportunity, Veterans Benefits Administration (VBA), U.S.
Department of Veterans Affairs
Good morning, Mr. Chairman and Members of the Committee. I am
pleased to be here today to provide the views of the Department of
Veterans Affairs (VA) on pending legislation affecting VA's programs,
including the following: S. 2106, S. 2134, S. 2170, S. 2253, and a
draft bill regarding whistleblower complaints. At this time, VA is
unable to develop cost estimates for the ``Department of Veterans
Affairs Veterans Education Relief and Restoration Act of 2015;''
however, we will provide these to you as soon as they are available.
Accompanying me this morning are Maureen McCarthy, Acting Assistant
Deputy Under Secretary for Health for Patient Care Services, Veterans
Health Administration and Meghan Flanz, Deputy General Counsel, Legal
Operations & Accountability.
s. 2106
S. 2106, the ``Wounded Warrior Employment Improvement Act of
2015,'' would require the Secretary to develop and publish an action
plan for improving VA's vocational rehabilitation services and
assistance. Section 2(b) would require the action plan to include: (1)
a comprehensive analysis of, and recommendations for, remedying
workload management challenges at VA's regional offices (ROs),
including steps to reduce counselor caseloads of Veterans participating
in a rehabilitation program, particularly for counselors who are
assisting Veterans with Traumatic Brain Injury (TBI) and Post Traumatic
Stress Disorder (PTSD), and for counselors with educational and
vocational counseling caseloads; (2) a comprehensive analysis to
address the reasons for the disproportionately low percentage of
Veterans, with service-connected disabilities and military service
after September 11, 2001, who opt to participate in a rehabilitation
program under chapter 31 of title 38, United States Code (U.S.C.),
relative to the percentage of such Veterans who use their entitlement
to educational assistance under chapter 33, including an analysis of
barriers to timely enrollment in rehabilitation programs under chapter
31 and any barriers to a Veteran enrolling in the program of that
Veteran's choice; (3) recommendations for encouraging more Veterans who
have military service after September 11, 2001, and have service-
connected disabilities to participate in rehabilitation programs under
chapter 31; and (4) a national staff training program for Vocational
Rehabilitation Counselors (VRC) to include: (a) training to assist VRCs
in understanding the profound disorientation experienced by Veterans
with service-connected disabilities whose lives and life plans have
been complicated due to service-connected disabilities; (b) training to
assist VRCs in working in partnership with Veterans on individual
rehabilitation plans; and (c) training on PTSD and other mental health
conditions and on moderate to severe TBI that is designed to improve
the ability of VRCs to assist Veterans with these conditions, including
providing information on the broad spectrum of such conditions and the
effect of such conditions on an individual's abilities and functional
limitations.
VA does not believe that a new action plan is necessary to improve
vocational rehabilitation services and assistance provided under
chapter 31 and accordingly does not support S. 2106. VA's recent and
planned efforts in this area are already extensive.
The Vocational Rehabilitation and Employment (VR&E) program
conducted a business process re-engineering initiative from 2011 to
2014 to examine workload issues, training, roles, responsibilities, and
outreach. As a result, workload management strategies were streamlined
and a new staffing model was developed. VA has an outreach campaign
underway to increase awareness of and access to chapter 31 services.
This includes the August 2015 deployment of an online application for
chapter 31 and chapter 36 benefits through eBenefits and Enterprise
Veterans Self-Service. VR&E places VRCs in colleges and universities
across the Nation as part of the VetSuccess on Campus (VSOC)
initiative. VSOC VRCs provide information on VA benefits to a variety
of populations on campus, including Veterans, Servicemembers, and
dependents. VR&E is an integral part of the joint Department of Defense
and VA Transition Assistance Program and the Integrated Disability
Evaluation System, with VRCs placed on military installations for early
outreach and delivery of vocational rehabilitation services to
transitioning Servicemembers. VA's national training curriculum for
VR&E staff covers a variety of topics related to job duties, which
includes information on working with individuals with TBI, PTSD, and
other mental health issues. VR&E partners with the Veterans Health
Administration (VHA) on many of these specialized trainings.
Our VR&E program has also recently implemented two major
initiatives to improve services to Veterans and ensure that those
services are accurately measured. The first, TeleCounseling, fielded
nationwide in May 2015, is an optional method of coordinating case
management and supportive services for Veterans participating in a
program of vocational rehabilitation. This initiative allows the VRC
and Veteran to have more frequent face-to-face contact. The second, the
implementation of new performance measures, fielded nationwide in
July 2015, ensures that the daily activities and operations of
employees who provide direct service to Veterans are linked to program
measures that define successful outcomes for those Veterans. VR&E is
developing a new case management system (CMS), VRE-CMS, that will
streamline responsibilities, enable a paperless environment, and
improve data integrity.
The cumulative impact of these processes, trainings, outreach
programs, and initiatives encourages more Servicemembers and Veterans
with service-connected disabilities to participate in chapter 31
services by ensuring that VR&E staff understands the specialized needs
of Veterans with service-connected disabilities; provides appropriate
and timely rehabilitation services to meet those needs; provides
Servicemembers and Veterans information necessary to make an informed
choice on available VA benefits to which they may be entitled; and
removes barriers to accessing rehabilitation services.
The chapter 33 program is an educational benefit for individuals
who served on active duty after September 10, 2001. The chapter 31
program is a benefit that assists individuals with service-connected
disabilities meeting certain statutory guidelines, with a focus on
obtaining and maintaining employment and/or achieving the maximum
possible level of independence in daily living. Congress has mandated
that, in addition to a service-connected disability, the Servicemember
or Veteran must also have an employment handicap, defined as impairment
to one's ability to prepare for, obtain, or retain employment, to
qualify for services under chapter 31. Also, chapter 31 is required by
law to ensure that the vocational goal for which services are provided
is a suitable goal. The training that individuals receive for a
specific occupation should assist them in performing the duties of that
occupation. Not all Veterans with a service-connected disability will
meet these criteria or have an interest in pursuing a suitable
vocational goal. For those individuals, chapter 33 is often the program
of choice, as it provides access to education benefits regardless of
level of impairment or suitability of the educational or vocational
goal.
There are no mandatory costs associated with this legislation. To
conduct a new analysis and develop an action plan as outlined in the
proposed legislation, VA would need to use administrative funds to
procure a contract. The estimated cost to procure a contract for these
services is approximately $2 million.
s. 2134
S. 2134, the ``Grow Our Own Directive: Physician Assistant
Employment and Education Act of 2015,'' would establish a pilot program
to provide educational assistance to certain former members of the
Armed Forces for education and training as physician assistants within
the VA. While VA supports the concept, the cost associated with the
legislation would cause concern within our available resources.
S. 2134 would require the Secretary to provide information on the
pilot program to eligible individuals. An eligible individual would be
defined as an individual who: (1) has medical or military health
experience while serving as a member of the Armed Forces; (2) has
received a certificate, associate degree, baccalaureate degree,
master's degree, or post-baccalaureate training in a science related to
health care; (3) has participated in the delivery of health care
services or related medical services; and (4) does not have a degree of
doctor of medicine, doctor of osteopathy, or doctor of dentistry.
S. 2134 would also require the Secretary to select no less than 250
eligible individuals to participate in the program with a minimum of 35
scholarship participants per year. Priority would be given to:
individuals who participated in the Intermediate Care Technician Pilot
Program of the Department that was carried out by the Secretary between
January 2011 and February 2015, and individuals who agree to be
employed as a physician assistant for VHA in a community designated as
a medically underserved population and in a State with a per capita
Veteran population of more than 9 percent. Although VA supports the
minimum requirement of scholarship participants, VA is concerned that
the applicant pool of eligible individuals may be insufficient to meet
the required number.
S. 2134 would also require the Secretary, in carrying out the pilot
program, to provide educational assistance to individuals participating
in the program to cover the costs to the individuals of obtaining a
master's degree in physician assistant studies or a similar master's
degree. The legislation would call for the use of the Health
Professionals Educational Assistance Program (HPEAP) and other
educational assistance programs the Secretary considers appropriate, to
administer a 5-year pilot program.
S. 2134 would also require each individual participating in the
pilot program to enter into an obligated service agreement with the
Secretary to be employed as a physician assistant with VHA for a period
of time that is either specified in the HPEAP or other educational
assistance program or, if the individual is participating through a
program where an obligated service period is not specified, a period of
at least 3 years or such other period as the Secretary considers
appropriate.
The bill would also provide that where an individual who
participates in the pilot program fails to satisfy the period of
obligated service, he or she shall be liable to the United States, in
lieu of the obligated service, for the amount that has been paid or is
payable to or on behalf of the individual under the pilot program,
reduced by the proportion that the number of days the individual served
for completion of the period of obligated service years to the total
number of days in the period of obligated service of such individual.
The bill would also require the Secretary to ensure that a
physician assistant mentor or mentors are available for individuals
participating in the pilot program at each facility of VHA at which a
participant in the pilot program is employed.
The bill would require the Secretary to seek to partner with not
less than 15 institutions of higher education that offer a master's
degree program in physician assistant studies or a similar area of
study accredited by the Accreditation Review Commission on Education
for the Physician Assistant. These institutions would also agree to
guarantee seats in such master's degree program for pilot program
participants, and to provide pilot program participants with
information on admissions criteria and process. VA recommends that it
be granted flexibility with the final number of partnerships/affiliates
as less than 15 institutions may be sufficient to meet these
requirements.
The bill would also require four new employees to administer the
pilot program: a Deputy Director of Education and Career Development of
Physician Assistants; a Deputy Director of Recruitment and Retention; a
recruiter; and an administrative assistant. All positions would be
aligned with VHA's Office of Physician Assistant Services.
This pilot program would require scholarship recipients to complete
a service obligation at a VA health care facility after graduation and
licensure/certification. VHA has had difficulty recruiting and
retaining physician assistants for several years. Additionally, VHA
Workforce Succession Strategic Plan and Reports have listed physician
assistants in the top ten critical occupations, and VA's Office of
Inspector General's Critical Occupation Staffing Shortage Report has
listed physician assistants in the top five most critical occupations
shortages.
The total cost of the Health Professional Scholarship Program for
450 awards over 5 years would be $56,573,810.
The total cost associated with administering the pilot program over
5 years would be $2,764,667.
The total cost associated with establishment of pay grades for
physician assistants and the requirement of providing competitive pay
would be $374,921,436 over 10 years.
s. 2170
Section 2(a) of S. 2170, the ``Veterans E-Health and Telemedicine
Support Act of 2015,'' would amend title 38, U.S.C., to add a new
section 1730B, which would permit a covered health care professional to
practice their health care profession at any location in any State,
regardless of where such health care professional or the patient is
located, if the health care professional is using telemedicine to
provide treatment under chapter 17 of title 38. New section 1730B would
specify that this authority would apply regardless of whether the
covered health care professional is located in a facility owned by the
Federal Government. In addition, new section 1730B would state that
nothing in that section would be construed to alter any obligation of
the covered health care professional under the Controlled Substances
Act (21 U.S.C. 801 et seq.). New section 1730B would define ``covered
health care professional'' to mean an individual ``authorized by the
Secretary to provide health care under [Chapter 17 of title 38],
including a private health care professional who provides such care
under a contract entered into with the Secretary, including a contract
entered into under section 1703 [of title 38]'' and ``licensed,
registered or certified in a State to practice the health care
profession of the health care professional.'' In addition,
``telemedicine'' would be defined to mean ``the use of
telecommunication technology and information technology to provide
health care or support the provision of health care in situations in
which the patient and health care professional are separated by
geographic distance.''
Section 2(b) would provide a clerical amendment to the table of
sections at the beginning of chapter 17 of title 38.
Section 2(c) would require the Secretary, not later than 1 year
after the date of enactment of the Act, to submit to Congress a report
on VA's effective use of telemedicine. The report would require
specific elements such as the assessment of the satisfaction of
Veterans and health care providers with VA telemedicine; the effect of
VA-funded telemedicine on the ability of Veterans to access health
care, the frequency of use by Veterans of telemedicine, the
productivity of health care providers, wait times for appointments, and
any reduction in the use of other services by Veterans; the types of
appointments for telemedicine that were provided; the number of
requested appointments for telemedicine disaggregated by Veterans
Integrated Service Networks; and any VA savings, including travel
costs.
VA supports section 2(a) of the bill. Section 2(a) would allow VA
employed or contracted health care professionals who are professionally
licensed in a State and practicing within the scope of their VA
employment or contract, to provide health care and to support the
provision of health care to the VA patient by telemedicine, without
regard to where the health care professional is licensed or where the
patient and the health care professional are physically located.
Section 2(a) would also permit VA employees and contract health care
professionals and VA patients to be located anywhere during such
telemedicine, including in a non-VA facility. In addition, section 2(a)
would clarify that the title 38 licensure requirements apply to both VA
employed or contracted telemedicine practitioners during the
performance of their official duties, whether they are on-station or
not. In these ways, Section 2(a) would remove the barriers that might
be imposed by local licensure laws of the places where the patient or
the covered health care professional are located, or the State of
licensure of the health care professional. Further, section 2(a) would
make clear that any telemedicine services that involve prescribing
controlled substances would have to be provided in accordance with the
Controlled Substances Act.
VA supports section 2(c) of the bill in part. Specifically, VA
supports reporting on elements identified in paragraphs (A); (C)
subparts (i), (ii), (iii), and (v); and (D) of section 2(c)(2).
However, VA does not support the reporting required elements in
paragraphs (B), (C) subpart (iv), (E), and (F) of section 2(c)(2).
Reporting on these elements would be overly burdensome on VA operations
because VA lacks the resources to routinely measure and assess this
type of data over the reporting period.
VA does not have a cost estimate for section 2(a) of the bill at
this time. VA estimates that implementation of the one-time reporting
requirement in section 2(c) of the bill would cost $17,000.
s. 2253--department of veterans affairs veterans education relief and
restoration act of 2015
This bill would amend title 38, U.S.C., to provide Veterans
affected by school closures with certain relief and restoration of
education benefits. The bill would add a new subsection (d) to section
3312 of title 38, U.S.C., to allow for the restoration of entitlement
to educational assistance and provide other relief for Veterans
affected by a school closure. More specifically, no payment of
educational assistance would be charged against an individual's
entitlement to educational assistance under the Post-9/11 GI Bill, or
counted against the aggregate period for which an individual may
receive educational assistance under two or more programs, if VA finds
that the individual was forced to discontinue a course or courses as a
result of a permanent school closure and did not receive credit, or
lost training time, toward completion of the program of education being
pursued at the time the school closed.
S. 2253 also would amend section 3680(a) of title 38, U.S.C.,
authorizing VA to prescribe regulations allowing VA to continue a
monthly housing allowance stipend under the Post-9/11 GI Bill during a
temporary school closure or for a limited period following a permanent
school closure. The housing allowance would be payable until the end of
the term, quarter, or semester during which the school closure
occurred, or 4 months after the date of the school closure, whichever
is sooner.
VA supports S. 2253, as it would allow VA to restore entitlement
and continue monthly housing allowance stipend payments to Post-9/11 GI
Bill beneficiaries impacted by school closures. While VA currently has
authority to continue payments to beneficiaries when schools are
temporarily closed due to an emergency or under an established policy
based on an Executive Order of the President, there is no similar
statutory authority upon which to continue benefit payments in the
event of a permanent school closure. Furthermore, regardless of whether
a school closure is temporary or permanent, there is no statutory
authority that allows VA to restore entitlement for a term, quarter, or
semester for which a beneficiary fails to receive credit toward program
completion due to such a closure. VA would interpret the bill to apply
only to a course or courses in which an individual was enrolled in FY
2015, and all current or future enrollments. VA would also interpret
the bill as currently written to provide that the portion of a course
or courses that a beneficiary has participated in through the time of
the school's closure (e.g., the portion of an incomplete college
semester that has already passed at the time of a school closure) is
not charged against the beneficiary's entitlement. We note that there
appears to be a discrepancy between the new subsection (d)(2), which
applies to an individual who meets the criteria of both (A) and (B) of
that subsection, and the applicability provision in section 2(a)(2) of
the bill, which describes new subsection (d) as applying if the
criteria of either paragraph (A) or paragraph (B) of subsection (d)(2)
are met.
The closure of educational institutions while GI Bill beneficiaries
are actively pursuing approved programs of education or training
negatively impacts Veterans and eligible dependents in a number of
ways. First, their monthly housing benefits are suddenly and
unexpectedly discontinued in the middle of the term. In many cases,
these payments are the primary (or sole) source of funds for paying for
housing, food, utilities, and other basic necessities while attending
school. Second, while VA can pay benefits for the term, quarter, or
semester up to the time of the school's closure, the student is still
charged entitlement for that period, even though he/she does not earn
any credit toward program completion. In some instances, this could
result in a beneficiary exhausting his/her entitlement before being
able to complete his/her program at another institution.
We will be pleased to provide for the record an estimate of the
cost of enactment of this bill.
draft bill regarding whistleblower complaints
Section 2 of the draft bill would add a new subchapter to title 38,
U.S.C. on whistleblower complaints. Section 731 would define a
``whistleblower complaint'' to include not only a VA employee's
disclosure of wrongdoing, but also a complaint made by a VA employee
assisting another employee to disclose wrongdoing.
Section 732 would establish a process for employees to file
whistleblower complaints with their immediate supervisors; require
supervisors to notify employees in writing, within 4 business days of
receiving a complaint, whether there is a reasonable likelihood the
disclosure meets the statutory definition of whistleblowing; permit
employees to elevate complaints if the employee determines the action
taken was inadequate; require the Secretary to notify whistleblowing
employees of the opportunity to transfer to another position; and
establish a Central Whistleblower Office, which is not a part of VA's
Office of the General Counsel, that would be responsible for
investigating all whistleblower complaints.
Section 733 would require the Secretary to discipline any employee
found to have committed an offense listed in subsection 733(c), with a
first offense punishable by at least a 12-day suspension and a second
offense punishable by removal, and would limit the notice and reply
period associated with such discipline to not more than 5 days. Section
733 would also limit the appeal rights of employees who are removed so
that they would match the limited appeal rights of VA Senior Executives
under 38 U.S.C. Sec. 713.
Section 734 would require the Secretary to consider protection of
whistleblowers when evaluating supervisors' performance, prohibit
payment of an award to a supervisor within a year after the supervisor
is found to have committed an offense listed in subsection 733(c), and
require the Secretary to recoup an award paid to a supervisor for a
period in which the supervisor committed such an offense.
Section 735 would require the Secretary to coordinate with the
Whistleblower Protection Ombudsman to provide annual training to all VA
employees on whistleblower rights and protections, including the right
to petition Congress regarding a whistleblower complaint. Section 736
would require annual reports to Congress on the number and disposition
of whistleblower complaints filed with VA supervisors and through other
disclosure mechanisms, and would also require the Secretary to notify
Congress of whistleblower complaints filed with the U.S. Office of
Special Counsel (OSC).
Section 3 of the draft bill would amend section 312 of title 38,
U.S.C., to require that whenever the Inspector General, in carrying out
the duties and responsibilities established under the Inspector General
Act of 1978, issues a work product that makes a recommendation or
otherwise suggests corrective action, the Inspector General shall
submit the work product to: (1) the Secretary; (2) the Committee on
Veterans' Affairs, the Committee on Homeland Security and Governmental
Affairs, and the Committee on Appropriations of the Senate; (3) the
Committee on Veterans' Affairs, the Committee on Oversight and
Government Reform, and the Committee on Appropriations of the House of
Representatives; (4) if the work product was initiated upon request by
an individual or entity other than the Inspector General, that
individual or entity; and (5) any Member of Congress upon request.
Section 3 would also require that the Inspector General post the work
product on the Inspector General's Internet Web site no later than 3
days after the work product is submitted in final form to the
Secretary.
Section 4 of the draft bill would add to subchapter I of chapter 7
of title 38, U.S.C., a new section 715 dealing with the treatment of
congressional testimony by VA employees as official duty. Section
715(a) would establish that a VA employee is performing official duty
during the period with respect to which the employee is testifying in
an official capacity in front of either chamber of Congress, a
committee of either chamber of Congress, or a joint or select committee
of Congress. Section 715(b) would require the Secretary to provide
travel expenses to any VA employee performing official duty described
in subsection (a).
VA is absolutely committed to correcting deficiencies in its
processes and programs and to ensuring fair treatment for
whistleblowers who bring those deficiencies to light. The Secretary
frequently shares his vision of ``sustainable accountability,'' which
he describes as a workplace culture in which VA leaders provide the
guidance and resources employees need to successfully serve Veterans,
and employees freely and safely inform leaders when challenges hinder
their ability to succeed. VA needs a work environment in which all
participants--from front-line staff through lower-level supervisors to
senior managers and top VA officials--feel safe sharing what they know,
whether good or bad news, for the benefit of Veterans.
In recent months, the Department has taken several important steps
to improve how we address operational deficiencies, and to ensure that
those who disclose such deficiencies are protected from retaliation. In
the summer of 2014, the Secretary reorganized and assigned new
leadership to VA's Office of the Medical Inspector, which reviews
whistleblower disclosures related to VA health care operations. The
Secretary also established the Office of Accountability Review to
ensure leadership accountability for whistleblower retaliation and
other serious misconduct. VA has also improved its collaboration with
OSC, which is the independent office responsible for overseeing
whistleblower disclosures and investigating whistleblower retaliation
across the Federal Government. VA has negotiated with OSC an expedited
process to speed corrective action for employees who have been subject
to retaliation. That process is working well, and we are now beginning
a collaborative effort with OSC's Director of Training and Outreach to
create a robust, new training program to ensure that all VA supervisors
understand their roles and responsibilities in protecting
whistleblowers.
While we appreciate the Committee's efforts to assist the
Department in these endeavors, we believe the specific whistleblower
disclosure and protection procedures provided by this bill would be
unworkable. We also believe they are unnecessary in light of the long-
standing system of OSC authorities, remedies, and programs specifically
created to address claims of improper retaliation in the workplace. We
believe the current whistleblower protections are effective, and, as
noted above, VA is working closely with OSC to ensure that the
Department and its employees are gaining the maximum benefits from its
remedies and protections.
Turning to what we see as likely unintended consequences of the
draft bill, the draft bill's strict notification requirements, short
timelines, and severe penalties may create an adversarial relationship
between supervisors and subordinates that would likely hinder, rather
than foster, sustainable accountability. The draft bill would require
the supervisor to notify the employee within 4 days after receiving a
disclosure to indicate whether the supervisor has determined that there
is a reasonable likelihood the disclosure meets the statutory criteria
for whistleblowing. Four days would be inadequate in many cases for a
supervisor to come to an informed conclusion that ``there is a
reasonable likelihood that the complaint discloses a violation of any
law, rule, or regulation, or gross mismanagement, gross waste of funds,
abuse of authority, or substantial and specific and danger to public
health and safety,'' in the terms of the draft bill. The fact that
there are substantial ``downstream'' effects from these 4-day
determinations will, in our view, create unpredictable and
destabilizing effects in a workplace where collaboration and trust is
paramount.
The draft bill would also impose specific penalties on supervisors
found to have engaged in retaliation and would significantly limit the
time those supervisors have to defend themselves against the imposition
of those penalties. While well-intentioned and designed to protect VA
whistleblowers, we believe the cumulative effect of these provisions,
in combination with the 4-day notification requirement, would not only
raise a host of constitutional and other legal issues, but would also
leave supervisors too fearful about the possible penalties for
retaliation to effectively manage their employees. We also believe that
imposing onerous new requirements on VA supervisors, alone in the
Federal Government, would significantly impede the Secretary's efforts
to recruit and retain the talented leaders needed to improve service to
Veterans.
From a legal perspective, our analysis suggests that portions of
the draft bill present due process problems and conflicts with other
laws. VA is unable to estimate the costs for the draft bill at this
time.
Mr. Chairman, this concludes my statement. Thank you for the
opportunity to appear before you today. We would be pleased to respond
to questions you or other members may have.
Chairman Isakson. We will begin a round of 5-minute
questions from the Members of the Committee, and my first one
would be, would you repeat the second-to-the-last sentence of
your printed testimony you just said about this whistleblower
protection.
Mr. Coy. From a legal perspective, our analysis suggests
that portions of the draft bill present due process problems
and conflicts with other laws.
Chairman Isakson. Due process for whom?
Mr. Coy. I will let our General Counsel answer that, if I
may, sir.
Ms. Flanz. Thank you very much. Our concern is with the
version of the bill that preceded the one that we received this
afternoon, and it particularly focused on the 5-day limitation
on the reply period for a supervisor who is subject to
discipline for retaliation. Our concern based on our reading of
the case law is that that could create a problem with the pre-
decisional due process, whereby courts expect to see what they
call a meaningful opportunity to respond to charges and
evidence before a decision is made on discipline.
Having a hard and fast rule that in no case could that
individual have more than 5 days, no matter how voluminous the
evidence might be or other circumstances making it difficult to
respond, we felt some concern that a 5-day limitation could
create due process problems. The version of the bill that we
reviewed today seems to address that concern.
Chairman Isakson. How is that addressed?
Ms. Flanz. I believe the wording calls for a 14-day reply
period and did not have the restrictive language that suggested
in no circumstance could that 14 days ever be enlarged to
provide additional time for the individual to respond.
Chairman Isakson. OK. I wanted to be sure I understood what
you meant by damaging due process, because it seemed like to me
it was offering due process to somebody who felt like they had
an incident they wanted to report. You are saying the due
process violation was the short length of time to respond, and
the 14 days is preferable to the five.
Ms. Flanz. Yes, sir.
Chairman Isakson. OK. Thank you.
On the Ernst-Hirono-Tillis-Boozman-Rounds legislation
regarding telemedicine, I want to make sure I understood what
you said, Mr. Coy. You said that you were generally supportive
of the legislation, but were concerned about the overly
burdensome reporting, is that correct?
Mr. Coy. Yes, sir.
Chairman Isakson. Would you be more specific about overly
burdensome reporting.
Mr. Coy. I will ask my colleague, Dr. McCarthy, to address
that particular issue, if I may, sir.
Dr. McCarthy. Thank you, sir. Yes. I would have to say,
first of all, we wanted to thank very much Senator Ernst for
sponsoring this legislation and for the support that is behind
it, as well.
What we are concerned about are some of the reporting
requirements which we do not report at this time. We do report
patient satisfaction data. We do report the number of veterans.
We do not have wait times in terms of telehealth. Typically, a
patient gets scheduled immediately. I do not want to say never,
but typically, they are scheduled immediately in the system for
a telehealth appointment.
What we do not have are things like the satisfaction data
of the telehealth provider. There are a few things like that
that are added to the legislation that were not part of the
version that is in the House. Other than that, we are extremely
grateful for this bill to be before the Committee.
Could I clarify one thing?
Chairman Isakson. Sure.
Dr. McCarthy. What is different about this bill for us is
that it would allow a VA provider in any site, geographically
separated from a patient in any site, to be able to provide
that kind of care, and it is important for us because there are
VA employees that would have the ability sometimes to cross the
State lines. It is the VA contractors that do not. This bill
spells out particularly the VA employees and the VA contractors
and that is a very important provision for us.
Chairman Isakson. I would assume, Mr. Coy and Dr. McCarthy,
you would be willing to work with Senator Hirono and Senator
Ernst to try and deal with that issue, to make it a better
piece of legislation?
Dr. McCarthy. Absolutely.
Mr. Coy. Absolutely. We would be happy to.
Dr. McCarthy. We would be very happy to.
Chairman Isakson. For Senator Hirono's benefit and also
Senator Ernst's, who has left now, we have had an inquiry from
the AMA with regard to scope of practice issues with across
State line medical services being offered by telemedicine, and
we want to work with them to try and find out what concerns
might exist there so we can work out any difficulty. For people
like Jon Tester in Montana and for others who have sparse
populations and large geographic territories, legislation like
this is a godsend, I would suspect. Because of that, I think it
answers a significant--it helps us to solve a significant
problem. So, if you would agree to work on that, that would be
appreciated, I am sure, by all.
Mr. Coy. Happy to do that, Senator.
Chairman Isakson. Senator Blumenthal.
Senator Blumenthal. Thanks, Mr. Chairman.
Mr. Coy, would you agree that whistleblowers have been
victims of retaliation in the VA?
Mr. Coy. I do not have direct evidence of that, sir, but
Ms. Flanz may.
Ms. Flanz. Thank you for the question. We have been
challenged through the course of the last year and change to
address the volume of whistleblowing that is occurring in the
VA. I think that those who study the science of quality
improvement in health care will tell us that it is actually a
good thing when people raise their hands and their voices to
point out deficiencies in any policy or practice, and across a
system as large as ours, we have been challenged to ensure that
all supervisors understand the whistleblower protection rules
and do the right thing.
We have been gratified by the help that has been offered by
the Members of this Committee, members of your staff, and our
other partners and stakeholders, to include the Office of
Special Counsel, in providing additional training----
Senator Blumenthal. I do not mean to interrupt you. I
apologize. But, is that a yes?
Ms. Flanz. Yes, sir.
Senator Blumenthal. OK. You understand the reason for this
bill, and I assume that you have no due process objections to
it at this point.
Ms. Flanz. The concern that we had about the short reply
period for supervisors is definitely addressed by the longer
reply period.
Senator Blumenthal. Your colleague, Mr. Coy, has called
this bill unworkable. Do you agree?
Ms. Flanz. Let me explain exactly what our most pressing
concern is about the bill, and that is that although certainly
the vast majority of whistleblowers, I believe, are courageous
and are, as you stated, putting their own interests perhaps
behind that of the public and the veterans, we do have a
phenomenon--I do not think it is unique to the VA, I think it
happens across the government and in private sector, as well--
where an employee who finds himself or herself in trouble,
either due to conduct or performance issues and looks for an
opportunity for protection.
Our concern with the particularly severe penalties for
supervisors in this bill is that our supervisors, who already
perhaps feel challenged to deal with problem employees, may be
even less inclined to do the right things around dealing with
problem employees if they are concerned that an employee will
invoke the protections of this bill, become a whistleblower,
and then be able to create difficulty for that supervisor in
terms of his or her continued employment and even the
possibility of having to repay a past bonus. Our concern is
with the extent to which it is calibrated.
Senator Blumenthal. Presumably, that would be a very small
minority of the potential whistleblowers, correct?
Ms. Flanz. I hope so, but in terms of----
Senator Blumenthal. By the way, a whistleblower may on
occasion be involved in the problem that is the subject of the
complaint. I know as a prosecutor----
Ms. Flanz. Sure.
Senator Blumenthal [continuing]. Our witnesses, as we told
juries, were not always choirboys----
Ms. Flanz. Absolutely true.
Senator Blumenthal [continuing]. But the challenge here is
to get at the root of the problem to protect the public
interest, and the whistleblower is a means to protect veterans
and the public interest.
I would suggest to you that before you call this bill
unworkable, you come back to us with specific changes. I am not
guaranteeing that we will adopt them, but the spirit of the
bill is, I would suggest respectfully, the spirit of the
overwhelming number of hard working, honest VA employees who
are really diligently working every day to help veterans, and
whistleblowers are a means to root out wrongdoing among the
very small faction--we are not looking at the majority--of
employees that may be committing wrongdoing.
I believe this bill is really important in light of the
recent record, and if you have suggestions, we would be happy
to consider them.
Ms. Flanz. We share that interest, sir. Thank you.
Senator Blumenthal. Thank you, Mr. Chairman. My time has
expired and I thank you.
Chairman Isakson. Senator Rounds.
HON. MIKE ROUNDS, U.S. SENATOR FROM SOUTH DAKOTA
Senator Rounds. Thank you, Mr. Chairman.
I am very happy to be a supporter of S. 2170, the Veterans
eHealth and Telemedicine Support Act. I really do believe that
veterans should have very easy access to telemedicine services
no matter where they live. In South Dakota, we appreciate what
that means in terms of being able to access professionals from
across State lines throughout the area.
Mr. Coy, I appreciate your testimony regarding the bill.
Would you be willing to work with us to try to work through the
issues and concerns that you have expressed concerning the
reporting requirements, and if we are able to come to an
agreement on that, would you be willing to support the bill if
we get those reporting requirements amended?
Mr. Coy. Senator, we are always happy to work with the
Committee and we would be happy to see where we can make
adjustments in the bill and make those recommendations to you
and the Committee.
Senator Rounds. If we are able to work through those
specific issues, you would find the remaining portion of the
bill as being helpful in providing or responding for services
in those rural areas?
Mr. Coy. I will let my colleague, Dr. McCarthy, go out on
that note.
Dr. McCarthy. Thank you. Sir, we would be thrilled to have
this bill. You just need to know there are multiple versions of
this bill we have submitted and there is a version in the
House, as well. This bill is something we are very grateful
that it is there. It is just the details that were added, the
differences between the House and the Senate versions, that are
really just the only problem for us right now. It is minor. It
truly is minor. We are thrilled with the bill.
Senator Rounds. I look forward to working with you along
with the other sponsors on the bill----
Mr. Coy. Absolutely.
Senator Rounds [continuing]. Seeing that it be put into
law.
I do have a question based upon your testimony, Mr. Coy,
with regard to the costs involved. I recognize that the prime
sponsor and Senator Tester is here and will be wishing to
address it, as well. I am curious. You have identified the cost
as being one of the concerns with regard to the Grown Our Own
Directive: Physician Assistant Employment and Education Act of
2015. It seems to me that there were two identified items.
First of all, you indicated in your written testimony that
the cost was about $2.7 to $2.8 million for the pilot project
in terms of administrative costs, I believe. Then we are
looking at somewhere around $50-some million in terms of costs
over a 5-year period of time for the actual cost of the
program, $56 million over a 5-year period of time to add 450
awards for new PAs coming into the system.
Mr. Coy. Right.
Senator Rounds. Do we have a shortage of PAs right now
within the system itself?
Mr. Coy. I do not have that specific information, but I am
sure Dr. McCarthy does.
Dr. McCarthy. Thank you, sir. We have identified the five
professions that have the highest need in VA and PAs are within
the top five--physicians, nurses, physician assistants, so
forth. We do have a need to hire more PAs. Our PA contingent is
a group that is one-third eligible for retirement at this
point, and within--by 2021, about 47 percent of our PA
workforce will be eligible to retire.
We see PAs as being able to help us with the access
struggles that we face. I will give you an example for how
Houston----
Senator Rounds. If I could, and I----
Dr. McCarthy. I am sorry.
Senator Rounds. My time is limited, but I think what you
are saying is, yes, you do have a need for more PAs----
Dr. McCarthy. Absolutely.
Senator Rounds [continuing]. And you are going to see a
larger need coming up.
Dr. McCarthy. Yes.
Senator Rounds. I do not believe that I am a sponsor but it
looks to me like a good piece of legislation. What you are
saying is that you have the need. You are going to end up
paying PAs to come to work for you. Was the fact that you are
going to be paying PAs when they come to work for you, has that
cost been taken into account when you say that the total cost
of this program over a 5-year period of time is $56 million?
Dr. McCarthy. Sir, there are three parts to this bill. The
first part is the scholarship program, the second part is the
administration of the PA program in general, and the third part
is the adjustment of salaries of PAs to bring them up to the
right speed. The cost for the scholarships is separate. They
are kind of spelled out differently.
What we are saying is that this is of significant cost. The
scholarships themselves are not things that would normally be
in our budget. But, we definitely do need PAs. At this point,
our salary scale for the starting PAs is lower and we end up
hiring more PAs at the higher end. The third part of the bill
adjusts the salary and we would potentially be more competitive
to hire----
Senator Rounds. My time has expired. Mr. Chairman, we are
looking here basically at less than $60 million, and I know
that in D.C., we should be talking about millions being a lot
of money, but $56 to $60 million total over a 5-year period of
time for 450 new applicants coming in as PAs, you take that
over a 5-year period of time, you are talking perhaps $12
million a year. You are all aware, you paid out bonuses to
individuals over $140 million in 1 year.
It seems to me that if we have a real serious issue here
with regard to PAs and providing services at the very basic
levels, it seems that, if nothing else, we should be able to
find a way to work through the issue involved in this if that
is really where our focus is at, is providing those basic
services, which clearly Dr. McCarthy indicates is of real
concern to the Department.
Thank you, and Mr. Chairman, if they care to respond, my
time is now your time, sir, so----
Chairman Isakson. Well, I think Dr. McCarthy wants to say
something. I will give her time to respond.
Dr. McCarthy. Right. I basically wanted to just say, sir,
we definitely want to support this bill. In particular, the
part of the bill in terms of the scholarships is really
important to us. I think it is really important to veterans. It
is important to people that are leaving the military that have
some medical skills. They are going to have to have a certain
amount of training before they can even apply to go to PA
school. We would strongly support the ability of them to
participate in a program like this. I think the source of the
funding is the issue.
Senator Rounds. Thank you. Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Senator Rounds.
Senator Hirono.
HON. MAZIE K. HIRONO, U.S. SENATOR FROM HAWAII
Senator Hirono. Thank you, Mr. Chairman.
Mr. Coy, how does S. 2170 differ from the telehealth
services already available in the VA?
Mr. Coy. Dr. McCarthy, can you handle that?
Senator Hirono. Briefly.
Dr. McCarthy. Yes. I am a telehealth provider in the VA
from central office. I provide telehealth care to a small
number of patients. I can tell you firsthand, there are some
wonderful data on the kinds of telehealth that we do right now.
What, for me, the big difference in this bill is, this
gives VA what DOD has in terms of authority to cross State
lines with the telehealth care. At this point, I do want to
clarify a little bit about what Senator Ernst said. Our Office
of General Counsel has reviewed and re-reviewed and our
providers are able to provide care across State lines if they
are VA employees. The issue is contractors, and contractors are
important as part of Choice. They are important when we have
contractors that are able to provide telemedicine care. It is
the contractors--for instance, if we wanted to have someone
contracting to provide services nationally, they might have to
be licensed in every single State. What this bill allows is the
same privilege that a VA provider has, to be able to provide
care but to have one license.
Senator Hirono. Right now, the telehealth services that are
provided generally, it is within the State, within the State
that the provider is licensed, is that kind of how it works?
Dr. McCarthy. That is how we started, but that is not how
it has continued. We have teleradiology happening in Hawaii,
Palo Alto, and Durham. We have a telemental health center up in
Connecticut. We have various sites. We have telegenomics going
on in Salt Lake City. In addition, we have, for instance, when
El Paso had a need for a psychiatrist, El Paso has providers
who are based in another State that provide that mental health
care because they cannot recruit in El Paso.
Senator Hirono. The providers in another State have to do
it out of a VA facility, was that one of the----
Dr. McCarthy. Initially, that was the thinking, that they
had to be based at a VA facility, either the patient or the
provider was the next round. Then General Counsel reviewed, and
it is looking like the physician or the provider, as long as
they are licensed and they are a full-time--or, they are a VA
provider, VA employee, that that has changed at this point.
Senator Hirono. OK. For the employees, they can do that,
but this bill really allows for contractors.
Dr. McCarthy. Yes.
Senator Hirono. Is the VA able to implement the provisions
of this bill upon enactment? Do you already have whatever is
set up to implement this expansion of services?
Dr. McCarthy. Yes, ma'am. I could give you the statistics.
We had 677,000 veterans----
Senator Hirono. Yes.
Dr. McCarthy [continuing]. Receive telehealth care last
year. We are very excited about our telehealth program.
Senator Hirono. A veteran in Hawaii, for example, because
this really helps the veterans in rural areas----
Dr. McCarthy. Yes.
Senator Hirono [continuing]. Where provider availability is
an issue, distance would be an issue. A veteran in Hawaii wants
to have access to a provider in Illinois or Virginia, and it
would be made very clear how that veteran would be able to
access that provider's services.
Dr. McCarthy. Yes. Yes----
Senator Hirono. You would be able to set it up very
quickly.
Dr. McCarthy. This would help us, also. I know there is
testimony submitted by State licensing boards, but this would
clarify for us. It would be helpful for VA employees and for
contractors to have this just very blatant in a bill like this.
Senator Hirono. Mr. Chairman, I understand that the AMA has
some concerns about this bill, the scope of practice, et
cetera, and I am hopeful that we can work out those kinds of
differences, because I am very familiar with scope of practice
issues, having dealt with so many of those when I used to chair
the appropriate committee in the State legislature, where, as
you know, most licensing laws are passed. I am hopeful that we
will be able to work out whatever issues there are with the
AMA, and I am pretty sure that we can work out whatever
reporting requirements that you all raise as a concern.
Dr. McCarthy. Thank you.
Chairman Isakson. That is why I mentioned that I think they
can work them out, and I wanted to make it part of the record
today so we can work toward solving whatever problem AMA might
have.
Senator Hirono. Yes. Having worked on scope of practice
issues, we may not be able to resolve all of the concerns that
AMA has, but----
Chairman Isakson. Maybe not.
Senator Hirono [continuing]. I would say that we should
move forward with this bill.
Chairman Isakson. Well, I absolutely agree. Absolutely
agree.
Senator Hirono. Thank you.
Chairman Isakson. Thank you, Senator Hirono.
Senator Brown.
HON. SHERROD BROWN, U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman.
I want to ask a couple of questions, Mr. Coy, about
Vocational Rehabilitation and Employment services, VR&E. We get
reports that there has been an inconsistency of application, if
you will, of counselors. Some counselors have even--the words
that were used that we have heard from some students--have
ostracized and stigmatized veterans who have used this benefit
for education. I guess my questions are, I want you to make
sense of that, first of all.
My question is this. First of all, I think there is some
inconsistency in how counselors are providing services under
VR&E. Second, I think that, typically, we are hearing,
particularly from Iraq and Afghanistan veterans, that their
members are not even aware of this benefit, and it really goes
back long before this Secretary, even long before General
Shinseki, that there was not very good communication between
DOD and VA. I think you can almost make the case that the DOD
did not really care that much about what happened to these men
and women, if I can say that, when they returned Stateside.
They did not really plug them in well to health care and
education benefits and reintegration into the community. In
States like mine, where you have county veteran service
organizations, that they did not even plug them into those
organizations and they did not even know which soldiers had
left the Army or Marines had left and were left in Coshocton or
Cleveland, OH.
If you would kind of clear up for me any inconsistencies
you have seen that have been reported to you in the way that
your counselors are carrying out their job, and second, maybe
more importantly, how does the VA work more closely with DOD so
that soon-to-become veterans, so that the men and women who are
serving, as they leave the military, understand better that
VR&E is available and how we increase participation.
Mr. Coy. Absolutely. I would love to clarify that, Senator.
On the first, the inconsistencies, we have counselors at 56
regional offices and a whole bunch of outreach offices, as
well, in round numbers, about a thousand counselors. As you
know, VRE is a case management system. It is a one-on-one with
the veteran and the counselor. We work and deal with
inconsistencies, one counselor believing they have a
requirement to do one thing and across the country it very well
could be something different. It is an interpretation.
Quite frankly, when you look at the VRE, it is both an
eligibility and an entitlement requirement. you are eligible
if, for example, you have a 10-percent service-connected
disability but you have a serious employment handicap, or a 20
percent service-connected disability and just an employment
handicap. Making that determination is sometimes an individual
case and we are working very hard to try and make sure that we
lessen those inconsistencies. The employment plan from one
veteran on one side of the country to another, they also vary,
as well.
One of the other things, to answer your question about DOD
and how do we reach these veterans, as I am sure you know, we
have got an enhanced TAP program, Transition Assistance
Program, of which is now mandatory for every servicemember to
go to as they get out, and we explain all of their VA benefits
in that Transition Assistance Program. We are also putting
those kinds of things online, as well.
We also have VRE counselors, about 170-plus VRE counselors
at 71 different military installations across the country, so
they can, in fact, provide those initial services as they go
out. We are doing that through TAP IDES. We also have 94
campuses that participate in our VRE program--our vocational
rehabilitation Vets Success on Campus program. We are trying to
get out into the community, as well, particularly where those
younger veterans are in their schools.
Senator Brown. We have asked from MILCON what the right
ratio--do we have enough counselors, considering the number of
people coming home? Give us a brief assessment of sort of where
we are in that way.
Mr. Coy. We have seen our caseload per counselor grow from
about 129, average, to now about 139, about an 8-percent growth
in average caseload. We have seen a 17 percent increase in our
actual clients, the people who are applying and have been
admitted into the program.
What we are seeing from that is the good news is the
backlog is going down. As the backlog goes down, and the
backlog is for disability compensation, as that backlog goes
down, our volume of new applicants or potential new applicants
grows.
Senator Brown. What is a typical interface between a
counselor and a veteran? How long? How many times, typically,
do they counsel any single veteran? What are your averages or a
scenario you could paint quickly?
Mr. Coy. I do not know that I have an average that I am
prepared to give you right now, but the initial consultation
where we determine that you are not only eligible for the
program but that you want to partake in the program, that is a
face-to-face. Then after that, depending upon your program--so,
for example, you could be entered into a program where you are
going to an institution of higher learning and so you are sort
of checking in with your counselor on a frequent basis, but not
a lot. You are checking----
Senator Brown. Not necessarily face-to-face.
Mr. Coy. Not always. One of the good things is we are also
developing a telecounseling program, which we think is going to
be a real game changer in terms of making people come in and go
to the parking lot and park their car and sit in and come in
and sit down and go to those sessions. We are working through
those things, as well, Senator.
Senator Brown. That is a great service, Mr. Coy. Thank you.
Chairman Isakson. Thank you, Senator Brown.
Before I go to Senator Boozman, I am going to excuse myself
for about 30 minutes to make a report at a conference committee
and I am going to turn the gavel over to Senator Moran until I
come back, and I will be back in time.
With that said, Senator Boozman.
Senator Moran [presiding]. Senator Boozman.
HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS
Senator Boozman. Thank you, Mr. Chairman.
Mr. Coy, in regard to S. 2170 that spans telemedicine, do
you have any recommendations for the Committee on other ways we
can measure the impact of implementing this type of legislation
other than wait times?
Mr. Coy. I will certainly ask Dr. McCarthy to see if she
can provide that response.
Dr. McCarthy. Thank you, sir. When we look at the
effectiveness of telemedicine, we look at not just access, but
we also look, for instance, at the impact of other kinds of
telemedicine. We provide home-based telehealth services, how it
decreases the bed days of care and the length of stay if the
patients need to be readmitted, and it actually decreases
readmission rates. It does the same when we provide care in the
home to veterans who have been recently discharged from
facilities with psychiatric conditions. We have a decreased
readmission rate. We have decreased lengths of stay when they
return. Those are very veteran-centric ways that we can measure
that kind of impact.
Senator Boozman. Very good.
Mr. Coy, you mentioned that the Physician Assistant
Employment and Education Act would require VA to partner with
institutions accredited by the Accreditation Review Commission.
Can you tell us how many institutions currently meet this
requirement? Has the VA ever conducted any outreach to these
institutions or shared the opportunity to provide health care
services to our veterans? If so, were those efforts well
received?
Mr. Coy. I would again ask Dr. McCarthy if she would
provide a good response for that.
Dr. McCarthy. I am speaking from memory. I believe there
are about 191 schools that train physician assistants. We have
affiliation agreements with many of them. We train students
right now. We actually pay stipends for some of those students
and we have some partnerships with them for residency programs
for physicians. We have reached out to them.
Senator Boozman. Dr. McCarthy, then, in regards to S. 2134,
the Grow Our Own Directive: Physician Assistant Employment and
Education Act of 2015, you all state that the VA supports the
concept but is concerned about the cost.
Dr. McCarthy. Yes, sir.
Senator Boozman. The estimated cost over 10 years, $374
million. In this bill, VA is essentially providing scholarships
to former servicemembers who served as medics, and again, were
corpsmen and would like to become physician assistants. Why do
they not just use the G.I. Bill in furtherance of that
objective? I mean, why should the VA take money away from other
priorities to provide scholarships to these individuals?
Dr. McCarthy. Just so you are aware, many of the corpsmen
are not folks who have Bachelor's degrees, and a Bachelor
degree is a prerequisite for a physician assistant program.
There are courses similar to pre-med type courses--chemistry,
biochemistry, and anatomy and physiology--that are required for
PA school. Typically, the corpsmen may need to use their G.I.
Bill benefits in order to complete the prerequisites. Some do
not have an Associate's degree. Typically, the Air Force corps
medics do. What we are talking about is getting folks to their
Bachelor's degree and this would be over and above.
Senator Boozman. You are saying they would use up their
G.I. Bill in order to do that----
Dr. McCarthy. Some may. I am not the expert on the G.I.
Bill benefits, but that is the concern, sir.
Senator Boozman. Right. Certainly, that should be factored
in, that there is a possibility of the G.I. Bill being used
toward that.
Dr. McCarthy. Right, but----
Senator Boozman. So, that would reduce the cost.
Dr. McCarthy [continuing]. But it would be earlier. Yes.
Senator Boozman. OK. Very good. That is really all I have.
Thank you, Mr. Chairman.
Senator Moran. The Senator from Montana, Senator Tester.
HON. JON TESTER, U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman, and thank you all
for being here.
I am going to focus for right now on S. 2134, and using
some of your own testimony, which actually was pretty
compelling, 47 percent of your PAs currently employed will be
eligible for retirement by 2021. I was actually going to get
into the methodology of how you came up with the figures, but I
will not. I guess I will make it much more simple than that. I
think we both agree you need more medical professionals and PAs
are a big part of that. They are in, as you said, your top five
needs. Have you got a cheaper way of doing it?
Dr. McCarthy. I do not--I would not know, sir, what would
be a cheaper way to do it. I have to tell you that we are very
enthusiastic about this bill. We think it is a really wonderful
idea for the veterans who would be receiving care. For the
veterans who are leaving the military, it is a wonderful
opportunity to transition and build their skills and have them
serve veterans, and this----
Senator Tester. OK. I agree with that and I appreciate the
fact that you are concerned about the costs. I think that is a
good thing. I also think that we need to make sure that if we
do not do this, we need to make sure the costs are accurate,
first of all, going in, so we go in with our eyes wide open. If
we say no to this, is it going to be replaced with something
that is more costly, and that is really the point here, other
than all the good points you just brought up about it, about
how it can impact our veterans in a very positive way.
I am not going to get into the figures, because, for
instance, in your testimony, it talks about--let me get the
page up here--it talks about S. 2134 would require the
Secretary to select no less than 250 eligible individuals. Can
I ask, how did we come up with 450? Where did that come from?
Dr. McCarthy. OK. I am sorry. This was provided by
workforce management, physician assistant services, and so
forth. What happens is the first year you would have--PA
programs average--are between 24 and 36 months, but the average
is 27 months. There was a calculation done that was based on--
--
Senator Tester. Twenty-seven months.
Dr. McCarthy. Yes. What you would do is, if you have 50
people that start 1 year, the next year they would typically be
second years and you would start 50 new.
Senator Tester. Right.
Dr. McCarthy. So, after 5 years, you would have 450.
Senator Tester. The seven allows for the additional----
Dr. McCarthy. Yes.
Senator Tester. OK. That is fine.
Let me talk about telemedicine. The bottom line here, I
think, as we move forward on this Committee, and I know the
Chairman is committed to this stuff, too, we just need to
figure out how we give you guys the resources to be able to
provide the benefits that veterans have earned. I do not need
to give you that speech. You guys know it and you should know
it every day. In the meantime, we should be doing it in the
most cost effective way possible, and if we can help veterans
out in the process, it is a win-win deal. OK.
I want to talk about telemedicine for a second because the
previous Chairman was absolutely correct. Senator Isakson was
absolutely correct when he said telemedicine has some amazing
impacts on rural areas. Can you tell me if the Department is
doing anything to expand telemedicine capabilities in the homes
of patients?
Dr. McCarthy. Absolutely, and we are. Let me start with
telemental health, which is one I know more. Last year, we had
122,000 veterans that were treated with telemental health in
the home, and this is a 13 percent increase over the prior
year. If we looked at visits----
Senator Tester. You said 13 percent or 30 percent?
Dr. McCarthy. Thirteen.
Senator Tester. OK.
Dr. McCarthy. Yes.
Senator Tester. That is still good.
Dr. McCarthy. It is. We are looking at the technologies, as
well. I am not the technology expert as far as this goes, but
it used to be that there were just a limited number of ways of
doing it. People talk about Jabber and other kinds. I can get
more information about that, if you like. What we are trying to
do is use whatever technologies are available. We have kind of
worked with our information security people to free up some of
those possibilities.
Senator Tester. OK. That is good.
I am going to close very, very quickly. I have been out
front in getting the VA the dollars they need to be effective
because you are getting slammed by Vietnam veterans getting
older and a war that has been going on for 15 years in the
Middle East. All that said, this budget is very--what do I want
to say, the right word--it is very kind to the VA. We went over
the President's budget by a solid sum of money. I advocated
that to hold you and the people that you work with accountable
for the health care that you give your veterans, and I will be
doing that, by the way.
Dr. McCarthy. Mm-hmm.
Senator Boozman. The point is what Senator Rounds talked
about. The point I want to get to is his point, and that is
that sometimes we spend some money in some pretty goofy areas,
OK, that really we should be paying attention to. Sometimes it
is more than what we really--where we really need to be
spending the money to get the health care professionals on the
ground, whether that is MDs, nurses, PAs, nurse practitioners,
all that stuff.
What I would say is, as we move forward, if these figures
are correct and if it actually costs that much, what I would
say is we need to look at other line items within your budget
and figure out where we can get that money.
Thank you, Mr. Chairman.
Senator Moran. Thank you, Senator.
The Senator from North Carolina, Senator Tillis.
HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA
Senator Tillis. Thank you, Mr. Chair.
I want to start out by thanking Ranking Member Blumenthal
and Senator Brown for some opportunities to work with you all
on various policies here and appreciate you all's leadership in
bringing this freshman along.
I know that Senator Brown has some questions about S. 2106,
so I am going to jump down to S. 2170 and, Mr. Coy, your
testimony. You had indicated that you support Section 2(a). You
do not yet know what the costs are going to be. Do you have any
rough order of magnitude costs for what it is going to take to
implement 2(a)?
Mr. Coy. I believe Dr. McCarthy probably has those specific
numbers.
Dr. McCarthy. I am sorry, 2170?
Senator Tillis. S. 2170.
Dr. McCarthy. Is that the telehealth or the PA bill? I am
sorry. S. 2170 is the telehealth bill, sir. Actually, that is
cost neutral.
Senator Tillis. It is cost neutral?
Dr. McCarthy. Mm-hmm.
Senator Tillis. OK. So there is no surprise in terms of the
implementation of Section 2(a).
Dr. McCarthy. 2(a)--that does not include the reporting
requirement, correct?
Senator Tillis. I am about to get to that one----
Dr. McCarthy. OK.
Senator Tillis [continuing]. Because I know you partially
support 2(c), the $17,000 implementation.
Dr. McCarthy. Right.
Senator Tillis. I do not think you have estimated the other
one. I wanted to use this as an opportunity to try and figure
out how we begin to weave what I think are good proposals, the
proposals that we are discussing today, into an overall
transformation strategy to know that it may not be--I think if
you are talking about the analytics and reporting, you are not
really opposed to the value of the data that would be produced.
You are concerned with the cost of it, and the systematic
capturing and reporting without a systematic approach could be
very costly and very distracted.
I would be interested to know what it would cost only
because another bill that Senator Brown and I cosponsored
really highlighted the sort of issue that we have with the cost
of implementing good ideas. We had this one bill where, over 10
years, the total cost of the benefit by conveying benefits to
surviving family members of a combat veteran--it was a miss in
a prior bill--was $6.2 million over 10 years. But the cost to
implement the administration to provide those benefits, the
system changes, et cetera, was $5.1 million over the first
year.
I think what we need to do when your concern has less to do
with the policy and more to do with the cost and the timing of
it, we need to start doing a better job of putting in the
context of other changes that may over time make those costs
less because they are a part of a rationalized systems and
process infrastructure where these good ideas do not have huge
price tags which may come at the expense of other good ideas
that have come before them and been appropriated.
I think back to the Chair. I was going to see if we could
actually have a Committee hearing on the transformation and
then maybe use as a few case examples some of these good ideas
that just right now, with the hairball of the systems and
processes that we are dealing with, make it very, very
difficult or not cost effective to implement. I think we need
to start describing that you are not opposed to the policy. You
are concerned with the costs and the distraction based on the
current environment that you have to operate within, the 30-
year-old scheduling systems and information systems that need
to be modernized. I would be happy for you all to respond to
that if you disagree.
Dr. McCarthy. I do not disagree. I do want to tell you one
bright light. We do have a new telehealth scheduling system,
which is actually an off-the-shelf product, which allows us to
schedule the provider, the room, whatever equipment the
provider needs, the patient, the room, whatever support staff
is needed and the equipment there, with one click, which----
Senator Tillis. That helps----
Dr. McCarthy. Yes.
Senator Tillis [continuing]. That is because telehealth is
relatively new.
Dr. McCarthy. Yes. Yes. I just want to say that that is the
kind of thing, I hear what you are saying. Our new scheduling
package is supposed to marry up with that very well, so we are
excited about that. I hear what you are saying.
Senator Tillis. I will bring this back to the Secretary in
the ongoing discussions Senator Tester and I are having with
them. It would be really good to take some of these things--
there are probably people in the audience that are supportive,
too--but explain why, if all of the sudden this becomes the new
priority, and if you heed the advice of the Senator to say,
find the funding from within current resources, then what do we
lose in the process, and to what extent can we accelerate it to
get a lot more. I think a lot of that is going to be dependent
upon doing a better job with our organizational transformation.
Thank you.
Dr. McCarthy. Thank you.
HON. JERRY MORAN, U.S. SENATOR FROM KANSAS
Senator Moran. Mr. Coy, thank you very much for being here.
I think I have just a few short questions. Perhaps these get
directed to Dr. McCarthy, but how does the VA view nurse
practitioners, in a sense, versus physician assistants? How are
they utilized? Is there one that fills a different role than
the other?
Dr. McCarthy. In some situations, they fill similar roles,
but nurse practitioners, we talk about full practice authority
in terms of being able to themselves work in States that allow
it without supervising practitioners. Physician assistants
typically work with physicians, although they are functioning
not in the same physical space necessarily with the physician.
They are not exactly interchangeable, but they are both really
important to our health care.
Senator Moran. Are there different scopes of practice State
by State regarding the two professions?
Dr. McCarthy. So----
Senator Moran. Let me ask it this way. In all States, does
a physician assistant need more direct supervision than a nurse
practitioner?
Dr. McCarthy. It is hard to say ``all.'' Let me start with
nurse practitioners. Some States do allow nurse practitioners
full practice authority, no supervising practitioner, and other
States require supervision, actually. Yet, physician assistants
typically have a collaborating provider and often do not
function independently. I cannot say for sure every State.
Senator Moran. It was an unfair question when I said
``all.''
Dr. McCarthy. OK.
Senator Moran. Thank you for your answer.
One of the areas that I think we are most insufficient,
lacking the greatest number of professionals within the VA, is
mental health services, and how does a physician assistant, or
does a physician assistant help fill that need?
Dr. McCarthy. Absolutely. I can give you a personal
experience. I was an inpatient psychiatrist for a long time and
I worked very closely with a physician assistant. In an
inpatient setting, a patient may have medical needs as well as
psychiatric needs and it was very helpful for me to have a
physician assistant who could provide medical care for the
patient in a way that I might not have had the same ease of
doing, if you know what I am saying.
I can tell you, also, that physician assistants do see
outpatients. They do run mental health clinics. They, for
instance, work in our clozapine clinics for, in particular, our
seriously mentally ill individuals who need to be seen quite
frequently and have careful monitoring of their blood tests and
so forth because of side effects. Some are seeing patients
independently in the mental health outpatient setting. Many
work on inpatient settings. Some also work in our emergency
rooms.
Senator Moran. In the recruitment effort at the VA, how do
you determine whether you focus recruitment of a physician
assistant or a physician, how do you prioritize what
professional you most pursue?
Dr. McCarthy. I think we typically would look at needs and
who could best meet that need. In primary care, for instance,
we would certainly want the right mix of individuals on teams.
We would have physicians who have panel sizes of 1,200
patients, whereas PAs and NPs might have panel sizes of 900
patients.
Senator Moran. Let me ask the question this way. In the
absence of a physician, does it hinder your ability to pursue
hiring a physician assistant? If we have a shortage of
physicians within the VA, does that limit the number of PAs
that you would be able to utilize in providing services to
veterans?
Dr. McCarthy. That is not a black-and-white kind of issue,
because we can use telemedicine, for instance, for
collaborating practitioners for PAs.
Senator Moran. There is a way to make certain that the
supervision required by State law is available, and it in some
instances may be by telemedicine?
Dr. McCarthy. Correct.
Senator Moran. OK. Let me ask a question about
telemedicine. Does telemedicine save the VA money?
Dr. McCarthy. You know, that is an interesting question. If
you talk about in terms of being able to provide care that
might be more costly in another setting, yes, it saves. If you
look at the cost for the veterans to travel where we reimburse
travel costs, I think the average figure is about $20 per visit
that is saved. If you look at the hospitalizations that are
avoided because of the home telehealth, we are talking an
average of, adding in all costs, we are talking $2,000 a year.
There is a lot of savings that come from telemedicine.
Senator Moran. You know, editorial comment. It has been
surprising to me as I have visited with patients in and outside
of the VA who utilize telemedicine how much they appreciate
telemedicine. I always assumed that it would be considered kind
of the secondary, the last resort, in a sense. Patients in my
conversations do not see telemedicine as something less than
the service they are entitled to or want. Is that accurate?
Dr. McCarthy. Yes. I have been a psychiatrist in VA for
over 20 years, and some of the patients I see now, and I see a
limited number, granted, from my office, are patients I have
seen for 16 or 17 years, many veterans who have PTSD from their
experiences in Vietnam. They are so grateful to be able to see
someone that they have seen over time without having to tell
their story again.
They also feel very much like they have your undivided
attention. When you give satisfaction surveys, they talk about
the fact that they have you kind of on the screen--it is kind
of embarrassing to say that--but they have the full attention
of the provider. It is so much like Skype and FaceTime that
people do with relatives, you know.
Senator Moran. I know less about that, but----
[Laughter.]
Dr. McCarthy. For mental health, it is a lot like that.
Senator Moran. But----
Dr. McCarthy. Now, the other services, I can speak to the
others in terms of there is additional equipment. The patients
love the fact that they do not have to travel. Typically, we
started by doing it more in the Community-Based Outpatient
Clinics (CBOCs) and having the kind of the specialists in the
main clinic. There is a decreased ``no show'' rate, for
instance, and that saves us money. The patient appreciates not
having to travel. They still get the kind of interpersonal
contact that they feel they need. It saves a lot of money and
also the satisfaction is quite high.
Senator Moran. Thank you. My experience has been that
people develop a very personal relationship with the person
that they see on a screen, sometimes more so than the physician
who may change on them when they show up at the VA in person.
Senator Blumenthal asked for the opportunity to ask another
couple of questions, and I recognize the Senator.
Senator Blumenthal. Thank you very much.
Let me ask whoever wants to respond, on the Telemedicine
Support Act, I gather you are satisfied that you can screen and
supervise the contractors who may be involved in this program?
Dr. McCarthy. Yes, sir. We would--when contractors are
employed by VA, we would credential them and have the same kind
of oversight as----
Senator Blumenthal. Whether or not they are in Federal
facilities?
Dr. McCarthy. Right.
Senator Blumenthal. You are satisfied, as well, that you
can protect their privacy?
Dr. McCarthy. Umm----
Senator Blumenthal. As you do now with all your patients.
Dr. McCarthy. Yes. Let me back up to what you said about
whether or not they are in Federal facilities. For instance,
so, I am in a VA hospital and I have a contract with a
physician to provide services through Choice. The supervision
is not necessarily at the same level as if I were to have a
contract for someone to come into my facility and provide that
care. There is a different kind of supervision. We do engage in
a sort of credentialing----
Senator Blumenthal. You can oversee and supervise their
credentials and the quality of care? This is not meant to be a
trick question.
Dr. McCarthy. Right. We are in the middle of working out
the Choice requirements as a result of the second version of
Choice that passed, and we are developing standards for
qualified providers. We are looking at how we will supervise.
We have not got all the details worked out for the Choice
providers who might be providing things that the older form of
Choice is not able to provide, but we are getting there.
Senator Blumenthal. Thank you. I had asked the question as
to privacy and I am assuming that you can safeguard privacy, as
well?
Dr. McCarthy. Yes. Yes.
Senator Blumenthal. Thank you. With that understanding, I
would like to be added as a cosponsor of the bill.
I have just a couple of other questions regarding the
whistleblower bill. I guess I will ask you, Ms. Flanz. I
noticed that Mr. Coy's statement says that you believe that you
have already, in effect, dealt with this problem sufficiently.
Ms. Flanz. It has been an ongoing challenge and it
continues to be a challenge. We are dealing with it, as I said
before, with considerable assistance from the Office of Special
Counsel. As I said, the number of whistleblowers continues to
be quite high. I am not going to sit here and tell you we have
got it all under control, but we have made it a priority.
Senator Blumenthal. How many supervisors have been
disciplined or demoted because of retaliation or reprisal
against whistleblowers?
Ms. Flanz. We are working to collect that number
systemwide. We do not have a centralized H.R. system that
collects exactly that data, but we do have a couple of
oversight requests for exactly that data. We are working to
collect it now.
Senator Blumenthal. Would you provide it to this Committee,
please.
Ms. Flanz. Yes, sir.
Senator Blumenthal. Could you provide the specific cases of
discipline or demotion or discharge?
Ms. Flanz. I believe that is precisely what we have been
asked to do, to collect, and absolutely.
Senator Blumenthal. I am asking not just for the numbers,
but for the specific cases.
Ms. Flanz. I understand.
Senator Blumenthal. OK. Thank you.
Finally, let me just say, I am very hopeful that the VA
will support this bill. I think the failure to do so will send
a message unnecessarily and unfortunately about its commitment
to protect whistleblowers. It has been carefully protected to
preserve due process rights, the rights of supervisors as well
as the rights of employees who may be coming forward with
information. I understand your concern about employees
potentially exploiting this measure, but I think, as with any
whistleblower protection and with any law, the motives and the
facts can be gleaned through effective investigation. I am very
hopeful that you will take that message back to the Secretary.
Ms. Flanz. I certainly will.
Senator Blumenthal. Thank you.
[Responses were not received within the Committee's
timeframe for publication.]
Senator Blumenthal. Thanks, Mr. Chairman.
Senator Moran. Thank you, Senator Blumenthal.
I understand Senator Tillis has no additional questions. I
have just one other comment and question.
Dr. McCarthy, you were very strong in your praise for
S. 2134, which is the physician assistant issue, so thank you
for that statement. I may quote you from time to time.
Second, it occurred to me as you said it about the use of
telemedicine to CBOCs, the ability to recruit a physician
assistant is not limited by the lack of a physician because of
the use of telemedicine. Less than half of our CBOCs in Kansas
have a full-time physician. Those positions are filled, at
least the needs as best can be met for our veterans, by a
physician assistant. It occurs to me as the VA further develops
its Choice Act, what I am hoping you will agree with me is that
that is all the more reason we are going to need more physician
assistants within the VA. Can you help me by repeating
something close to that? [Laughter.]
Dr. McCarthy. I guess----
Senator Moran. Do you agree or disagree?
Dr. McCarthy. I have to say, as we continue to implement
the Choice Act, there are opportunities especially for
coordination of care in terms of what is provided in the
community, what is provided in the VA, ensuring that people get
the right services outside, and those kinds of coordinations,
there are various levels of people in VA who can do that. I
could clearly see physician assistants having a role in the
management of patients who have complicated conditions and may
need to go to multiple sites or something like that. So, yes.
That is a long answer. I am sorry.
Senator Moran. No, it is a fine answer.
Dr. McCarthy. OK.
Senator Moran. Thank you very much. I thank this panel for
appearing this afternoon and we appreciate your testimony.
Response to Posthearing Questions Submitted by Hon. Richard Blumenthal
to U.S. Department of Veterans Affairs
Question 1. VA officials testified that they generally support
S. 2134, the ``Grow Our Own Directive: Physician Assistant Employment
and Education Act of 2015 legislation which seeks to build on the
success of the Intermediate Care Technician (ICT) Pilot Program as a
means to recruit former combat veterans who served as medics and
corpsmen to work at VA as Physician Assistants (PAs). This effort is
laudable. Not only should we be looking for creative ways to ensure our
returning Servicemembers have access to jobs that match their unique
skill sets, it looks to fill a noticeable gap in the Veteran Health
Administration's capabilities. In the IG's recent assessment of the
largest staffing shortages at VHA, PAs were tied for 4th place and had
one of the highest rates of regrettable losses in FY 2014 (52.2%).
a. To date, what strategies has VA used to enhance recruitment of
PAs? What more could VA do?
b. Without legislation like this, how does VA intend to address the
issue of regrettable losses within the PA profession?
Response. The Veterans Health Administration (VHA) continues to
implement aggressive, multi-faceted, national recruitment and marketing
campaigns to attract qualified candidates. VHA is targeting recruitment
incentives toward critical occupations to compete with other Government
and private sector organizations for top talent. Physician's assistants
were one of the top five staffing shortage occupations as identified by
the Office of the Inspector General (OIG). In fiscal year (FY) 2015,
VHA increased net onboard staff by 4.7 percent overall and 6.4 percent
for physician's assistants.
To address the issues with shortages, VHA has targeted the
Education Debt Reduction Program (EDRP) and development programs such
as scholarships. VHA believes that the debt reduction program is among
VA's strongest tools available for recruitment and retention of health
care professionals, which is central to improving health care access
for Veterans. The passage of Public Law 113-146, The Veterans Access,
Choice, and Accountability Act of 2014, increased the maximum EDRP loan
amount from $60,000 to $120,000, over a 5-year period. In the FY 2015
award cycle, 82 percent of new EDRP awards recipients were individuals
in the top five shortage occupations.
VHA utilizes the electronic VA Exit Survey per VA Directive 500,
which states that the purpose of the exit survey is to provide
voluntarily-separating employees the opportunity to communicate their
reasons for leaving. The information provided is shared with VA
supervisors, managers, leadership, and human resources professionals to
assist them in identifying methods to improve employee retention and
morale at the local and national levels. Responses to the survey
indicate that advancement for a unique opportunity elsewhere, normal
retirement, relocation with a spouse, and family matters, such as
marriage and pregnancy, are the most common reasons for leaving VHA.
Physician's assistants had a 34 percent response rate to the survey.
The Under Secretary for Health (USH) has outlined five strategic
priorities for VHA, one of which is Employee Engagement. VHA is working
to create a work environment where employees are valued, supported, and
encouraged to do their best for Veterans. This includes making VA a
place where all employees and providers feel supported and able to
serve our Veterans. This priority is in alignment with the Secretary's
MyVA strategic initiative to improve the Employee Experience by
focusing on people and culture.
Table 1. Breakdown of Losses by OIG top five staffing shortage occupations (FY 2015)
----------------------------------------------------------------------------------------------------------------
Onboard All Other Total Turnover
Occupation Average Quits Retirements Removals Losses Losses Rate
----------------------------------------------------------------------------------------------------------------
0180 Psychology..................... 5,167 215 88 13 101 417 8.1%
0602 Medical Officer (Physician).... 23,743 1,263 641 76 93 2,073 8.7%
0603 Physician's Assistant.......... 2,070 89 63 23 48 223 10.8%
0610 Nurse.......................... 62,300 2,529 2,037 211 119 4,896 7.9%
0633 Physical Therapist............. 1,901 68 24 3 57 152 8.0%
All VHA Occupations................. 305,657 14,356 9,649 2,416 1,650 28,071 9.2%
----------------------------------------------------------------------------------------------------------------
Onboard staff for VHA includes all full and part-time employees in a pay status, excluding intermittent, non-
pay, medical resident, and allied health trainees, and excluding canteen service employees.
Turnover rate is defined as losses from the organization for a given year divided by the average onboard staff
for that year. This does not include internal transfers from one facility to another.
All other losses include deaths, expirations of appointment, and separations related to military service and
reductions in force.
Question 2. VA's written testimony indicates that VA supports the
general concept of S. 2170, the Veterans E-Health and Telemedicine
Support (VETS) Act of 2015. This legislation seeks to expand the use of
telemedicine through loosening current restrictions on health care
providers practicing within their scope of care regardless of where the
provider and patient are located. While this bill would remove barriers
to expanding this vital model of care, there are concerns about
potential unintended consequences of this legislation given that it
covers both VA employees and contractors who provide care to veterans.
a. Under this program, what process would VA use to ensure that
contractors providing services through telemedicine were held
accountable in the event of an adverse event that harms a patient?
Response. VA's process for accountability of VA-contracted
telehealth providers is identical to the VA process for VA contracted
(in-person) providers. The only difference is that the adverse event
reporting for VA-contracted tele-providers would not only involve the
provider site, but it could possibly involve multiple VA telehealth
patient sites supported by the contracted telehealth services, whereas
event reporting for VA-contracted in-person providers would typically
be limited to a single VA provider site.
Care purchased from community providers using contracting
authorities is subject to the terms and conditions within the contract.
In the event of an adverse event that harms the patient, such event
must be reported in accordance with the applicable terms of the
contract.
Additional Information: Telehealth in VA is a setting for the
provider to perform the privileges (e.g., mental health, dermatology,
etc.) granted at the provider's facility--the accountability reporting
and monitoring are the same regardless of the setting (i.e., in-person
or telehealth) and regardless of the type of VA appointment (i.e.,
full-time, part-time, contract, fee basis, volunteer, without
compensation, etc.). If any VA provider, including a VA-contracted
telehealth provider, is involved in an adverse event or if any clinical
care concern is identified through VA's monitoring service (details
below), the provider facility will conduct a thorough focused review,
including the telehealth patient site(s), as appropriate.
If the finding is that an adverse patient outcome resulted from the
VA contractor's substandard care, professional misconduct, or
professional incompetence, VA will report the provider to the National
Practitioner Data Bank (NPDB) in accordance with VHA Handbook 1100.17,
National Practitioner Data Bank (NPDB) Reports.
All Licensed Independent Practitioners (LIP) being considered to
perform care within VA facilities must be fully credentialed and
privileged in accordance with VHA Handbook 1100.19, Credentialing and
Privileging, and such requirements apply to any and all LIPs regardless
of their appointment status (i.e., full-time, part-time, contract, fee
basis, volunteer, without compensation (WOC), etc.) VA's thorough
credentialing and privileging process must be completed before a VA
contractor is approved to provide any care to a VA patient.
All credentialed and privileged VA providers undergo continuous
monitoring through the Focused Professional Practice Evaluation (FPPE)
and Ongoing Professional Practice Evaluation (OPPE) as required by VHA
policy and Joint Commission requirements, regardless of whether they
are providing care via an in-person setting or a telehealth setting.
Before a remote VA practitioner conducts either telemedicine and/or
teleconsultation with another facility or site, the facility or site
where the patient is physically located must enroll the VA practitioner
in the National Practitioner Data Bank--Health Integrity and Protection
Data Bank Continuous Query (NPDB-HIPDB CQ). NPDB-HIPDB CQ registration
must be renewed in accordance with credentialing and re-appraisal
requirements of VHA Handbook 1100.19. If this is not done, it must be
clearly documented why an NPDB-HIPDB query was not completed before the
VA practitioner engages in patient care using telemedicine and/or
teleconsultation.
b. Under this program, to what extent would contractors remain
accountable to state licensing boards for the quality of care they
provide to veterans?
Response. VA contractors are accountable for the care provided to
VA patients regardless of the setting (see a. above) in which they are
providing that care--in-person or via telehealth. Current VA regulation
and guidance impose specific reporting requirements for health care
professionals with appointments to provide VA care as VA employees or
VA contractors whose behavior or clinical practice substantially failed
to meet generally-accepted standards of clinical practice as to raise
reasonable concern for the safety of patients. Specifically, the
regulatory state licensure board reporting requirements cover VA
providers ``regardless of the status of the professional, such as full-
time, part-time, contract service, fee-basis, or without
compensation.'' See 38 Code of Federal Regulations (CFR 47.1 and 47.2.
Likewise, VHA Handbook 1100.18 provides guidance for reporting VA
health care professionals to state licensing boards.
Care purchased from community providers using contracting
authorities is subject to the terms and conditions within the contract.
In the event of an adverse event that harms the patient, such event
must be reported in accordance with the applicable terms of the
contract.
Additional Information: Under current practice, as set out in VHA
Handbook 1100.19, contracts for telemedicine and/or teleconsultation
services must require that these services be performed by
appropriately-licensed individuals. Unless otherwise required by the
specific contract or Federal law (such as the Federal Controlled
Substances Act), VA contract health care professionals must meet the
same licensure requirements imposed on VA employees in the same
profession whether they are on VA (Federal) property or not when
providing telemedicine or teleconsultation services. Some states do not
allow telemedicine and/or teleconsultation across state lines, unless
the provider is licensed in the state where the patient is physically
located. In these states, the clinical indemnity coverage of VA
contract practitioners may be void, even if they are credentialed and
privileged by VA. Prior to the commencement of services by the VA
contract practitioners providing telemedicine and/or teleconsultation
or remotely monitoring physiology data from Veteran patients, the state
regulatory agency in the state in which the practitioner is physically
located, as well as the state where the patient is physically located,
must be consulted. When dealing with Federal entities, additional
licenses that authorize the provision of telemedicine and/or
teleconsultation services in the relevant states may not be required.
State by State consultations and determinations of additional licensure
requirements are made on a local basis with VA Office of General
Counsel regional offices.
c. How would VA ensure that with the expansion of telemedicine,
patients' privacy would be rigorously protected and patient safety
measures tightly controlled?
Response. For more than 15 years, VA has rigorously and
successfully protected millions of Veteran patients' privacy and
tightly-controlled patient safety through its telehealth services. Last
fiscal year alone, more than 677,000 Veterans safely and securely
accessed VA care during more than 2.1 million telehealth visits. All
clinic-based and home telehealth services employ the highest Federal
Information Processing Standards (FIPS 140-2) for encrypting
interactive video between VA telehealth providers and Veterans, as well
as for image or data storing and forwarding to a VA facility from home
or from another VA facility. All VA employees and contractors are
required to take annual VA Privacy training.
Before a VA telehealth service commences, a VA Telehealth Service
Agreement (TSA) is established between the telehealth provider site and
telehealth patient site to outline roles, responsibilities, safety
risks, etc. and to ensure tight controls are in place. TSAs provide
specific patient privacy and patient safety requirements. The TSA
establishment includes a review and approval process by senior
leadership at both the provider and patient sites. The TSA outlines all
pertinent patient safety guidance and all pre-, intra-, and post-visit
requirements including communication channels (routine and emergency),
diagnostic testing and reporting, critical lab reporting, and pharmacy
protocols and procedures.
VA, through its Telehealth Services Quality Management program, has
established and implemented Conditions of Participation (CoP), a
nationally-standardized review process of all telehealth services
provided to Veterans. This biennial review process includes a
structured process for Veterans Integrated Service Network (VISN) and
program-level self-assessments and a site visit that includes
interviews with key program staff members, tracer methodology, and data
reviews. Considerations of field experiences, broad expert input, and
commendable practices identified in the course of the review create a
dynamic and evolving process that continues to advance Telehealth
across VHA. The CoP process is intended to be collaborative,
consultative, and proactive in an effort by VA to facilitate the growth
and maintenance of quality telehealth services that are safe,
effective, and efficient. In addition, this focus on quality management
has been very successful in achieving both internal standards and
readiness for external accreditation applying to all telehealth
services.
Question 3. As you may know, the U.S. Drug Enforcement Agency has
announced that it is drafting regulations that would make it possible
for doctors to prescribe narcotics via telemedicine as a way reach
patients in underserved communities.
a. In light of some of the ongoing issues with over prescription of
?pain medications/opioids within VA, how does VA plan to monitor
prescribing practices for community providers who are seeing VA
patients via telemedicine if S. 2170, the Veterans E-Health and
Telemedicine Support (VETS) Act of 2015, were enacted?
Response. VA's process for monitoring the prescribing practices of
contracted telehealth providers is identical to VA's process for
contracted (in-person) providers; the only difference being that the
adverse event reporting for contracted tele-providers would not only
involve the provider site, but it could possibly involve multiple VA
telehealth patient sites supported by the contracted telehealth
services, whereas event reporting for contracted in-person providers
would typically be limited to a single VA provider site.
All credentialed and privileged providers in VA undergo continuous
monitoring through the FPPE and OPPE, as required by VHA policy and
Joint Commission requirements, regardless of whether they are providing
care in an in-person setting or a telehealth setting. If any VA
provider, including contracted telehealth providers, is involved in
overprescribing or if any clinical care concern is identified through
VA's monitoring service (details below), the provider facility will
conduct a thorough focused review including the telehealth patient
site(s), as appropriate.
If the finding is that an adverse patient outcome resulted from the
contractor's overprescribing, the VA will report the provider to the
VHA National Practitioner Data Bank in accordance with VHA Handbook
1100.17, VHA National Practitioner Data Bank (NPDB) Reports, and to
their respective state licensing board(s), in accordance with VHA
Handbook 1100.18, VHA Reporting and Responding to State Licensing
Boards.
b. Earlier this year, Dr. Clancy informed me that VA was reviewing
prescribing practices at the provider level for VA-employed doctors to
determine whether individual doctors were inappropriately prescribing
dangerous medications. Can you please provide an update on the status
of that review and indicate whether any adverse employment actions were
taken as a result of any inappropriate prescribing?
Response. The Opioid Safety Initiative (OSI) and the Opioid
Overdose Education Naloxone Distribution (OEND) are two medication
safety initiatives VA has used to review prescribing practices at the
VA provider level to identify and mitigate opioid prescribing concerns.
These reviews are based on various clinical factors, including the
concomitant use of opioid and benzodiazepine medications and relatively
high dosages of opioid medications. VA initiated the reviews based on
directives communicated in March 2015 requiring each Veterans
Integrated Service Network (VISN) to establish an academic detailing
(AD) program to support front-line clinicians with specialty-trained
VISN AD clinical pharmacy specialists. These AD pharmacists employ
individualized provider benchmarking data and specialized educational
programming. AD was implemented to ensure provider prescribing is
consistent with evidence-based practices. AD is a service for
clinicians, by clinicians, that provides individualized, evidence-
based, educational outreach visits. AD has been effective in changing
prescribing practices and fostering the utilization of evidence-based
treatment modalities in a variety of practice settings and therapeutic
areas.
The AD approach customizes content and barrier-resolution
strategies to meet individual clinician needs in the context of local
health care delivery operations. Provider education tools that address
questions on medications (i.e., overuse, under-use, indications for
use, titrating doses, etc.) are developed, along with patient education
materials. AD can be used to effectively target opportunities for
improvement as part of an overall strategy for addressing this area of
need within VHA. The VISN academic detailing pharmacists offer one-to-
one visits with psychiatrists, primary care providers, and health care
team members to enhance prescribing through targeted education on VA's
OSI. VHA has implemented four primary OSI metrics: percent of patients
dispensed opioids, percent of patients dispensed opioids and
benzodiazepines, percent of long-term opioid patients and urine drug
screen, and percent of patients dispensed greater than or equal to 100
Daily Morphine Equivalents. Prescribing practices have shown consistent
positive trends on these four metrics. In addition, VA has dispensed
nearly 15,000 naloxone kits, provided many hours of education on
naloxone use to Veterans and documented nearly 150 opioid overdose
reversals.
In an October 2015 Presidential Memorandum, President Obama
directed that Federal agencies shall, to the extent permitted by law,
provide training on the appropriate and effective prescribing of opioid
medications to all employees who are health care professionals and who
prescribe controlled substances. VHA recognizes that many providers,
including those in VA, need more training as well as more monitoring as
part of a successful strategy to improve pain management, including
safer opioid prescribing. VHA's OSI program metrics enable facilities
and VISNs to identify providers with a pattern of inappropriate opioid
prescribing. Then facility and VISN pain management points of contact
and clinical leadership, in collaboration with the AD program, can
provide remedial education and training that helps these providers
change any inappropriate prescribing patterns. In cases where re-
education and remedial training are ineffective, disciplinary action
may be taken by the facility.
c. What process does VA have for informing state medical boards of
adverse events when non-VA employee providers are seeing patients?
Please indicate how often and in what states VA has made reports to
State Medical Boards in each of the last 3 years.
Response. If any VA provider, including contracted telehealth
providers, is involved in an adverse event due to prescription of
narcotics, or if any clinical care concern is identified through VA's
monitoring service (details below), the provider facility will conduct
a thorough focused review including the telehealth patient site(s), as
appropriate.
If the finding is that an adverse patient outcome resulted from the
contractor's prescribing of narcotics, substandard care, professional
misconduct, or professional incompetence, the VA will report the
provider to the NPDB, in accordance with VHA Handbook 1100.17, and to
their respective state licensing board(s), in accordance with VHA
Handbook 1100.18.
With respect to statistical information over the past three years,
the above-referenced reports are done on a facility-by-facility basis
and are not centrally reported. Thus compilation of an answer would
require manual review of records of facilities throughout the VHA
system, requiring significant time and resources. VA would be glad to
brief the Committee in more detail on its reporting regime.
Question 4. Deputy Under Secretary Coy's testimony stated that VA
does not currently have the authority to restore Post-9/11 GI Bill
entitlement for which a beneficiary fails to receive credit due to a
permanent school closure.
a. What actions did VA take to disseminate information to veterans
impacted by the recent closure of Corinthian Colleges?
Response. VA's Education Call Center employees called all affected
GI Bill students to inform them of the impact to their benefits and to
offer assistance. Also, an email was sent to all beneficiaries in
Hawaii in order to ensure they were aware that Corinthian was hosting
meetings to assist them with next steps. In addition, VA posted
information on its GI Bill Facebook page and GI Bill Web site regarding
the closure, resources for finding a new school, and information on the
Department of Education's student loan discharges. Finally, VA notified
the State Approving Agencies so that any available state aid could also
be provided to impacted students.
b. Was VA able to provide any support to Post-9/11 GI Bill
beneficiaries enrolled in the Corinthian institutions?
Response. While VA took the steps detailed above, no further
support could be provided as VA has no statutory authority to continue
payments to Veterans (or other enrollees) beyond the date of school
closure or restore benefit entitlement used at Corinthian Colleges.
c. Could you elaborate on how this legislation would enable VA to
provide relief and assistance, specifically in regards to the interim
housing allowances and their ability to provide stability to student
veterans in the aftermath of a sudden school closure?
Response. The proposed legislation would authorize VA to restore
entitlement and continue a monthly housing allowance (MHA) until the
end of the term, quarter, or semester during which a school closure
occurred, or 4 months after the date of the school closure, whichever
is earlier. In many cases, the MHA is the sole source of funds that
students use to pay for housing, food, utilities, and other basic
necessities while attending school. Allowing VA to provide an interim
housing allowance following a sudden school closure would prevent any
unnecessary disruption to students and their families during the
closure and would provide much needed stability until the student can
begin courses at another educational institution.
d. I understand that the Department of Education has begun to use
its established authority to provide comprehensive loan forgiveness to
former Corinthian College students with Federal student loans. Has VA
collaborated with the Department of Education to discuss support for
veteran students impacted by permanent school closures?
Response. VA continues to work closely with the Department of
Education on a range of issues and has discussed the closure of the
Corinthian schools; however, because VA lacks the authority to provide
relief in the case of permanent school closures and has no direct
involvement with student loans, as they fall under the jurisdiction of
the Department of Education, the collaboration has been limited in
scope. As noted above, part of VA's outreach to impacted students
involved the provision of information regarding student discharges and
directing those students to the Department of Education's Web site on
the topic.
Senator Moran. We will call the next panel to the table.
That panel consists of Elizabeth Hempowicz, Public Policy
Associate, Project on Government Oversight; William Hubbard,
Vice President of Government Affairs, Student Veterans of
America; Aleks Morosky, Deputy Director, National Legislative
Service of the Veterans of Foreign Wars; Thomas Porter,
Legislative Director, Iraq and Afghanistan Veterans of America;
and Diane Zumatto, National Legislative Director of AMVETS.
[Pause.]
Welcome. I would call on Ms. Hempowicz to begin.
STATEMENT OF ELIZABETH HEMPOWICZ, PUBLIC POLICY ASSOCIATE,
PROJECT ON GOVERNMENT OVERSIGHT
Ms. Hempowicz. I want to thank the Committee for inviting
me to testify today and thank you for your continued leadership
on whistleblower protections at the VA. I want to say a special
thank you to Senator Kirk, who is not here, for introducing the
Veterans Affairs Patient Protection Act.
My name is Liz Hempowicz and I am the Public Policy
Associate at the Project on Government Oversight (POGO), a
nonpartisan, independent watchdog that champions good
government reforms.
POGO has been investigating whistleblower retaliation at
the VA since May 2014, and during my last year and a half at
POGO, I have been consulted and advised on over a dozen
legislative proposals to enhance whistleblower protections in
the Federal Government.
In the last year, POGO was approached by over a thousand
current and former VA employees and veterans seeking to blow
the whistle on problems within the agency. We received multiple
credible submissions from 35 States and the District of
Columbia. These complaints made it clear that VA employees
across the country feared that they would face repercussions if
they raised a dissenting voice within the agency. Some were
willing to speak. Some were willing to be interviewed by POGO
and to be quoted by name, but others said they contacted us
anonymously because they are still employed at the VA and are
worried about retaliation.
The cultural shift that is required inside the VA cannot be
accomplished without legislation that codifies accountability
for those who retaliate against whistleblowers. This is why
legislation such as that introduced by Senator Kirk is so
incredibly important. The VA Patient Protection Act includes
many necessary improvements to how whistleblower complaints are
addressed, and perhaps more importantly, how those who
retaliate against whistleblowers are punished.
Managers at the VA have abused their discretionary
authority and have chosen not to punish those who retaliate
against whistleblowers time and time again. This bill would put
in place a minimum 12-day unpaid suspension when a complaint
that a supervisor has retaliated against a whistleblower is
substantiated.
Supervisors accused of retaliating against whistleblowers
will have 14 days in which to submit evidence to dispute the
accusation. This combination of due process and mandatory
punishment for retaliators is the right way to send and enforce
the message that retaliating against whistleblowers will not be
tolerated.
This bill also expands the definition of prohibited
personnel practice to include peer reviews and retaliatory
investigations, two common forms of retaliation that have not
previously been prohibited.
We are happy to see that this bill makes how supervisors
handle whistleblower complaints a part of the criteria for
their annual reviews, and further, that bonuses will not be
awarded to those employees who have retaliated against
whistleblowers.
It is also encouraging to see that this legislation
includes a provision that would give preference to a
whistleblower's request to transfer to another office within
the VA.
It is POGO's hope that the VA Patient Protection Act will
ensure that whistleblowers can expose wrongdoing, confident
that coming forward will not result in retaliation. This bill
is a great starting place for necessary reforms in the VA.
However, there are a few changes that we would like to see
before it becomes law in order to make sure that this bill does
not inadvertently weaken whistleblower protections.
First, stating that whistleblowers have the ability to
report wrongdoing to a direct supervisor is a good
clarification, but it should not be a required step for a
whistleblower complaint. We are worried that the legislation
appears to make it mandatory for whistleblowers to go to their
supervisors, which would narrow their ability to report
wrongdoing to less than what is currently available under the
law. There are many scenarios where an employee would not want
to disclose concerns to his or her direct supervisor and those
are not limited to the three provided in this legislation.
Therefore, we respectfully suggest that you amend provision
(a)(2) in Section 732 to say that a whistleblower may go to his
or her direct supervisor instead of shall go to them.
Additionally, we are concerned about the creation of a
central whistleblower office within the VA. While it is clear
that more resources are necessary to address the influx of
whistleblower complaints, we believe that this office would not
be sufficiently independent to do so effectively. We worry that
this lack of independence will hurt the ability to attract the
necessary expert personnel and will divert resources from other
offices already filling that role, like the Office of Special
Counsel. Our concern is that a new office would create
duplication and confusion instead of streamlining the process
as intended.
The OSC has done a great job of securing favorable outcomes
for VA whistleblowers, but they still have nearly 100 pending
VA reprisal cases. Therefore, POGO recommends that you consider
appropriating additional funds to the OSC to help with their
increased workload rather than create a new office to do
largely the same thing there.
Finally, we urge Congress to extend whistleblower
protections to contractors and veterans who raise concerns
about medical care provided by the VA. POGO's investigation
found that both of these groups also fear retaliation, which
prevent them from coming forward.
The VA and Congress must work together to end the culture
of fear and retaliation. Whistleblowers who report concerns
that affect veteran health must be lauded, not shunned, and the
law must protect them. It is POGO's hope that the VA Patient
Protection Act will ensure that whistleblowers can step forward
to expose wrongdoing, confident that it will not result in
retaliation.
Thank you.
[The prepared statement of Ms. Hempowicz follows:]
Prepared Statement of Liz Hempowicz, Public Policy Associate,
Project on Government Oversight
Chairman Isakson, thank you for inviting me to testify today, and
thank you Senator Kirk for your continued leadership on whistleblower
protections at the Department of Veterans Affairs and for introducing
the Veterans Affairs Patient Protection Act. I am Liz Hempowicz, the
Public Policy Associate at the Project On Government Oversight (POGO).
Founded in 1981, POGO is a nonpartisan independent watchdog that
champions good government reforms. POGO's investigations into
corruption, misconduct, and conflicts of interest achieve a more
effective, accountable, open, and ethical Federal Government.
fear and retaliation at the department of veterans affairs
None of us would be aware of the extent of the problems at the
Department of Veterans Affairs if not for whistleblowers. Early last
year, whistleblowers came forward to expose that managers at the
Phoenix, Arizona, VA facility were falsifying records of extensive wait
times in order to get bonuses.\1\ Quickly, news of similar wrongdoing
at VA facilities began to pop up in other parts of the country.
Although POGO had never investigated the operations of the VA before,
we were deeply concerned about what we were seeing in these reports.
Last year, POGO held a joint press conference with Iraq and Afghanistan
Veterans of America asking whistleblowers within the VA to share with
us their inside perspective in order to help us better understand the
issues the Department was facing.
---------------------------------------------------------------------------
\1\ Scott Bronstein, Drew Griffin, and Nelli Black, ``Phoenix VA
officials put on leave after denial of secret wait list,'' CNN, May 1,
2014. http://www.cnn.com/2014/05/01/health/veterans-dying-health-care-
delays/ (Downloaded July 27, 2015)
---------------------------------------------------------------------------
In POGO's 34-year history, we have never received as many
submissions from a single agency. In little over a month, nearly 800
current and former VA employees and veterans contacted us. We received
credible submissions from 35 states and the District of Columbia.\2\ A
recurring and fundamental theme became clear: VA employees across the
country feared they would face repercussions if they dared to raise a
dissenting voice.
---------------------------------------------------------------------------
\2\ Statement for the Record, Project On Government Oversight
(POGO), for the House Committee on Veterans' Affairs' Subcommittee on
Oversight and Investigations Hearing on ``Addressing Continued
Whistleblower Retaliation Within VA,'' April 13, 2015. http://
www.pogo.org/our-work/testimony/2015/pogo-provides-statement-for-house-
hearing-on-va-whistleblowers.html
---------------------------------------------------------------------------
Based on what POGO learned from these whistleblowers, we wrote a
letter to Acting VA Secretary Sloan Gibson in July last year,
highlighting three specific cases of current or former employees who
agreed to share details about their personal experiences of retaliation
after they had raised concerns about wrongdoing.\3\
---------------------------------------------------------------------------
\3\ Letter from Project On Government Oversight to Sloan D. Gibson,
then-Acting Secretary of the Department of Veterans Affairs, about Fear
and Retaliation in the VA, July 21, 2014. http://www.pogo.org/our-work/
letters/2014/pogo-letter-to-va-secretary-about-va-employees-claims.html
---------------------------------------------------------------------------
In California, a VA inpatient pharmacy supervisor was placed on
administrative leave and ordered not to speak out after raising
concerns with his supervisors about ``inordinate delays'' in delivering
medication to patients and ``refusal to comply with VHA [Veterans
Health Administration] regulations.'' \4\ In one case, he said, a
veteran's epidural drip of pain control medication ran dry, and in
another case, a veteran developed a high fever after he was
administered a chemotherapy drug after its expiration point.
---------------------------------------------------------------------------
\4\ Letter from Kelly Robertson, Pharmacy Service Chief at Palo
Alto VA Health Care System, to Earl Stuart Kallio, Pharmacy Service,
about Direct Order--Restricted Communication, June 20, 2014.
---------------------------------------------------------------------------
In Pennsylvania, a former VA doctor was removed from clinical work
and forced to spend his days in an office with nothing to do, he told
POGO. This action occurred after he reported to his supervisors that,
in medical emergencies, physicians who were supposed to be on call were
failing or refusing to report to the hospital. The Office of Special
Counsel (OSC) shared his concerns, writing ``[w]e have concluded that
there is a substantial likelihood that the information that you
provided to OSC discloses a substantial and specific danger to public
health and safety.'' \5\
---------------------------------------------------------------------------
\5\ Letter from Karen Gorman, Deputy Chief, Disclosure Unit Office
of Special Counsel, to Dr. Thomas Tomasco, about Dr. Tomasco's
allegations OSC File No. DI-13-0416, March 21, 2013.
---------------------------------------------------------------------------
In Appalachia, a former VA nurse was intimidated by management and
forced out of her job after she raised concerns that patients with
serious injuries were being neglected, she told POGO. In one case she
was reprimanded for referring a patient to the VA's patient advocate
after weeks of being unable to arrange transportation for a medical
test to determine if he was in danger of sudden death. ``Such an
upsetting thing for a nurse just to see this blatant neglect occur
almost on a daily basis. It was not only overlooked but appeared to be
embraced,'' she said. She also pointed out that there is ``a culture of
bullying employees * * *. It's just a culture of harassment that goes
on if you report wrongdoing.''
That culture clearly isn't limited to just one or two VA clinics.
Some people, including former employees who are now beyond the reach of
VA management, were willing to be interviewed by POGO and to be quoted
by name, but others said they contacted us anonymously because they are
still employed at the VA and are worried about retaliation. One put it
this way: ``Management is extremely good at keeping things quiet and
employees are very afraid to come forward.''
This kind of fear and suppression of whistleblowers who report
wrongdoing often culminates in larger problems, as the VA has been
experiencing.
veterans affairs patient protection act
Current laws have failed to adequately protect whistleblowers.
Shifting the VA's culture to identify and correct risks to veterans'
health and well-being cannot be accomplished without legislation that
codifies accountability for those who retaliate against whistleblowers.
This is why legislation such as that introduced by Senator Kirk is so
incredibly important. The Veterans Affairs Patient Protection Act
includes many necessary improvements to how whistleblower complaints
are addressed, and perhaps more importantly, how those who retaliate
against whistleblowers are punished. Accountability for illegal
retaliation has been missing in other pending VA legislation, and is
one of the strongest aspects of Chairman Kirk's legislation.
Managers at the VA have abused their discretionary authority and
chosen not to punish those who retaliate. This bill would put in place
a minimum 12-day, unpaid suspension when a complaint that a supervisor
has retaliated against a whistleblower is substantiated. This
combination of due process and mandatory punishment for retaliators is
the right way to send and enforce the message that retaliating against
whistleblowers will not be tolerated. This bill also expands the
definition of prohibited personnel practice to include peer reviews and
retaliatory investigations--two common forms of retaliation that have
not previously been prohibited.
Additionally, the misconduct committed at the VA in Phoenix has
shown how important bonuses and evaluations are in motivating
supervisors' behavior. We are happy to see that this bill makes how
supervisors handle whistleblower complaints part of the criteria for
annual reviews, and further, that bonuses will not be awarded to those
employees who have been found to have retaliated against
whistleblowers.
Both POGO's investigation and the work of Congress have shown that
working under a supervisor or alongside a colleague on whom you have
blown the whistle often prompts future retaliation or simply a hostile
work environment for everyone involved. This is why it is encouraging
to see that this legislation includes a provision that would give
preference to a whistleblower's request to transfer to another office
within the VA. This provision could make the difference between a
whistleblower feeling comfortable enough to come forward or being too
worried about rocking the boat to speak up.
We are also pleased to see that the Veterans Affairs Patient
Protection Act requires annual training for all VA employees on
prohibited personnel actions, which includes retaliating against
whistleblowers as a prohibited action. Further, VA employees will
receive an explanation of all the methods they can use to report
wrongdoing.
recommendations
It is POGO's hope that the Veterans Affairs Patient Protection Act
will ensure that whistleblowers can expose wrongdoing, confident that
coming forward will not result in retaliation. This bill is a great
starting place for necessary reforms in the VA; however there are a few
changes that we would like to see before it becomes law, in order to
make sure the bill doesn't inadvertently weaken whistleblower
protections.
First, stating that whistleblowers have the ability to report
wrongdoing to a direct supervisor is a good clarification, but it
should not be a required step for a whistleblower complaint. We are
worried that the legislation appears to make it mandatory for
whistleblowers to go to their supervisors, which would narrow their
ability to report wrongdoing to less than what is currently available
under the law. Most whistleblowers already try to solve problems by
directly going to their supervisors. But there are many scenarios where
an employee would not want to disclose concerns to his or her direct
supervisor, and those are not limited to the three provided in this
legislation. Therefore, we respectfully suggest that you amend this
section to allow a whistleblower to go to his or her direct supervisor
to make a protected disclosure, but not require them to do so.
In addition, we are concerned about the creation of a Central
Whistleblower Office within the VA. While it is clear that more
resources are necessary to address the influx of whistleblower
complaints, we believe that this office would not be sufficiently
independent to investigate whistleblower complaints. Without proper
independence, we worry this office could become an internal
clearinghouse that helps agency officials identify and retaliate
against whistleblowers. Moreover, we worry that this lack of
independence will hurt the ability to attract the necessary expert
personnel and will divert resources from offices already filling that
role--like the Office of Special Counsel. Our concern is that a new
office would create duplication and confusion instead of streamlining
the process as intended.
OSC has been working to investigate claims of retaliation and get
favorable actions for many of the VA whistleblowers who have come
forward. In 2014 and 2015 alone, the OSC has achieved favorable actions
for 116 VA whistleblowers. But the OSC still has nearly 100 pending VA
reprisal cases for disclosing concerns about patient care or safety,
among the highest of any government agency, according to Special
Counsel Carolyn Lerner. Therefore, POGO recommends that you consider
appropriating additional funds to this agency to help with the
increased workload rather than creating a new, less independent office
to do largely the same thing.
Finally, we urge Congress to extend whistleblower protections to
contractors and veterans who raise concerns about medical care provided
by the VA. POGO's investigation found that both of these groups also
fear retaliation, which prevents them from coming forward. Contractors
are only currently protected under a pilot program, but need permanent
statutory protections. In addition, a veteran who is receiving poor
care should be able to speak to his or her patient advocate without
fear of retaliation, including a reduction in the quality of health
care. A veteran should not fear that they would lose access to their
medications for blowing the whistle on problems they've experienced at
VA hospitals or clinics. Without this reassurance, there is a
disincentive to report poor care, allowing it to continue uncorrected.
The VA and Congress must work together to end the culture of fear
and retaliation. Whistleblowers who report concerns that affect veteran
health must be lauded, not shunned. And the law must protect them. It
is POGO's hope that the Veterans Affairs Patient Protection Act will
ensure that whistleblowers can step forward to expose wrongdoing,
confident that it will not result in retaliation.
Sen. Moran [presiding]. Thank you.
Mr. Hubbard.
STATEMENT OF WILLIAM HUBBARD, VICE PRESIDENT OF GOVERNMENT
AFFAIRS, STUDENT VETERANS OF AMERICA
Mr. Hubbard. Thank you, Mr. Chairman. Chairman Isakson,
Ranking Member Blumenthal, and Members of this Committee, thank
you for inviting Student Veterans of America to submit our
testimony on health care and benefits legislation pending
before this Committee.
With over 1,200 chapters across the country, we are pleased
to share the perspective of those most directly impacted by
these subjects. We would like to discuss opportunities with the
vocational rehabilitation and employment services, or VR&E, the
need for increased pathways for medical professionals at VA,
and the importance of reinstating benefits for those impacted
by school closures.
On S. 2106, the Wounded Warrior Employment Improvement Act
of 2015, a meeting between Student Veterans at a New York
university and the Secretary of VA, Bob McDonald, made one fact
readily apparent. Not enough veterans know about the VR&E
program. We believe that this is the fundamental challenge
facing VR&E today. We maintain concerns about the consistency
of information shared among counselors and are eager to work
closely with the VA on these issues if given the opportunity.
Overall, we strongly support the intent of S. 2106. However, we
encourage VA to address the components of the bill without the
requirement of legislation.
Moving on to S. 2134, the Physician Assistant Employment
and Education Act of 2015, we note that despite VA's commitment
to our veterans, fundamental problems, such as inadequate
staffing, extended wait times, and the lack of accessibility,
have plagued the system for the last three decades. As of just
this last year, the VA medical system was in need of more than
28,000 medical professionals to address their staffing
shortage. ``I am worried about our ability to recruit and
retain talent,'' Secretary McDonald said at his first news
conference at the Department's central office here in D.C. We
are highly supportive of S. 2134 and believe it would establish
a model for a broader VA hiring initiative needed to address
the ongoing gap of medical professional talent.
Research we published last spring indicates there will be
an estimated 52,000 veterans trained and qualified to work in
medical professions across the country in the next 5 years. If
that timeframe is extended to 7 years to accommodate the track
for medical school, the research projects a population of over
75,000 medical professionals trained through Post-9/11 G.I.
Bill benefits. With the thousands of veterans expected to
pursue health-related fields, we believe VA could capitalize on
this talent pool but are not currently positioned to do so.
This legislation presents an opportunity which may lead to
additional necessary hiring programs.
In addition to physician assistant pathways, residency
opportunities will be imperative to long-term VA employment. A
clearly defined path from education to employment, coupled with
previously mentioned benefits, will create a trajectory toward
health careers and VA employment for student veterans currently
in or separating from the military.
VA has shown significant improvement under the leadership
of Secretary McDonald. We continue to hear from those within
the VA system that they have positive experiences with those VA
employees. Indeed, Secretary McDonald's emphasis on the
customer experience, including the rollout of the MyVA program,
demonstrates that the Department is headed in the right
direction. Despite these leaps in improved service, we believe
there is more to be done, which VA has also publicly shared.
The Senate Veterans' Affairs Committee and this legislation
will be pivotal in that effort and we stand ready to support
that work if we should so humbly be called upon.
Last, we turn to the Veterans Education Relief and
Restoration Act. In 2014, we quickly learned of the insolvency
of the Corinthian Colleges' institutions of higher learning. As
we reached out to Corinthian leaders to address the situation,
we received no response, despite concerted efforts to attempt
to meet with their representatives. For us, it was a critical
time, as more than 8,800 student veterans were under the
Corinthian umbrella. Since then, we have been actively seeking
to remedy the situation and to protect the interests of those
student veterans directly impacted by the closures.
We are pleased to see this legislation and continue to seek
the support of Members of the Committee for this proposal. For
us, we believe this issue is a matter of maximizing the
economic impact of the Post-9/11 G.I. Bill.
Unfortunately, we have not seen the last of school
closures. The higher education industry deserves a hard look at
its practices and how schools deliver education to non-
traditional students, the growing education audience. As more
schools with faulty practices and insolvent structures close,
we should be prepared to offer them solutions. We believe this
Committee and its House counterpart are positioned to lead the
way on behalf of student veterans, carving a path for non-
traditional students.
We thank this Committee for the opportunity to testify on
these important issues and look forward to answering questions
as the Members of this Committee may have.
[The prepared statement of Mr. Hubbard follows:]
Prepared Statement of William Hubbard, Vice President of Government
Affairs, Student Veterans of America
Chairman Isakson, Ranking Member Blumenthal and Members of the
Committee: Thank you for inviting Student Veterans of America (SVA) to
submit our testimony on ``pending health care and benefits
legislation.'' With over 1,200 chapters across the country, we are
pleased to share the perspective of those most directly impacted by
this subject with this Committee.
Established in 2008, SVA has grown to become a force and voice for
the interests of veterans in higher education. With a myriad of
programs supporting their success, rigorous research development
seeking ways to improve the landscape, and advocacy throughout the
Nation, we place the student veteran at the top of our organizational
pyramid. As the future leaders of this country, nothing is more
paramount than their success in school to prepare them for productive
and impactful lives.
We will discuss opportunities with the vocational rehabilitation
services, the need for increased pathways for medical professionals at
VA, and the importance of reinstating benefits for those impacted by
school closures. Two proposals on the agenda are outside of the scope
of SVA, though we support the intent of each: S. 2170, ``a bill to
improve the ability of health care professionals to treat veterans
through the uses of telemedicine, and for other purposes;'' and, the
``Veterans Affairs Retaliation Prevention Act of 2015.''
s. 2106, ``a bill to require the secretary of veterans affairs to
develop and publish an action plan for improving the vocational
rehabilitation services and assistance provided by the department of
veterans affairs, and for other purposes''
At a meeting between student veterans at a New York university and
the Secretary of VA, Bob McDonald, one fact was readily apparent: not
enough veterans know about vocational rehabilitation and employment
(VR&E) program opportunities. We believe this is the fundamental
challenge facing the VR&E program today. We support the intent of
S. 2106, however we encourage VA to address the components of the bill
without the requirement of legislation. VA has openly made it clear
that they seek to serve their customers, our Nation's veterans, to the
fullest extent possible. As such, we believe this would be a timely
opportunity for VA to demonstrate action on a valuable program, which
we believe is critical to those transitioning from their time in
service.
The components of S. 2106 touch on several areas that we see as
necessary in addressing the success of the VR&E program. First, in our
testimony to the House Veterans Affairs Subcommittee on Economic
Opportunity on October 22, 2015, we identified the need for reduced
caseloads on VR&E counselors.\1\ Inclusion of element one would address
an issue that is consistent with the comments from our members. As a
minor note, we would strike ``disorder'' from line 19 in section two,
and refer to the particular issue instead as post-traumatic stress; we
note that inclusion of ``disorder'' is an improper characterization of
that challenge. Element two gets to the heart of the challenge with the
VR&E program, and we appreciate the thoughtful inclusion of this point.
Element three is a supporting component of the previous element, and we
similarly applaud its inclusion. Finally, element four is one issue we
would like to see VA address as a priority of any action plan. It is
our understanding that VA provides training opportunities for VR&E
counselors. However, it would be important to publish the type and
extent of that training so public comment could be shared for potential
improvements.
---------------------------------------------------------------------------
\1\ Congressional Testimony, House Veteran's Affairs Subcommittee
on Economic Opportunity, October 22, 2015, https://veterans.house.gov/
witness-testimony/mr-william-hubbard-2
---------------------------------------------------------------------------
In general, it has become increasingly clear that the consistency
of program delivery and awareness of the VR&E opportunities are points
for immediate consideration. We applaud VA for their commitment to
delivering a program with high impact and strong return on investment.
We recognize the challenge of funding in supporting the VR&E work, a
high-touch and resource-intensive program. We look forward to working
closely with VA and this Committee on implementing common sense
solutions to influence the impact and delivery of this program.
s. 2134, ``physician assistant employment and education act of 2015''
VA is charged with providing benefits and medical care for those
citizens who served our Nation and bore her battles. While the specific
medical treatments and procedures have changed since its establishment,
VA's commitment to care for our Nation's veterans has not wavered.
Despite this commitment, fundamental problems such as inadequate
staffing, extended wait times, and lack of accessibility have plagued
the system over the past 30 years. The unfortunate circumstances
leading to the investigation and resignation of senior officials at the
Phoenix, Arizona, Veterans Health Administration facility further has
exasperated an already exhausted and problematic system of abuse and
neglect.
On September 8, 2014, Sec. McDonald testified before the Senate
Veterans' Affairs Committee that the VA medical system is in need of
more than 28,000 medical professionals to address the staffing
shortage. ``I am worried about our ability to recruit and retain
talent,'' Secretary McDonald said at his first news conference at the
department's office in Washington, DC. We are highly supportive of
S. 2134, and believe it would establish a model for broader VA hiring
initiatives needed to address the on-going gap of medical professional
talent at VA.
Aligning Priorities
VA has stated that its top three priorities for the coming months
include the following: rebuilding trust, improving service delivery,
and setting a course for long-term excellence. Congress appropriated
$16.3B to address the significant challenges facing the VA; $5B is
directly targeted to hire trained and qualified medical professionals.
The size of this investment provides the VA with a historic opportunity
to shape not just the present, but the future of the entire VA.
In 2012, there were approximately one million veterans using GI
Bill benefits through data captured by the Million Records Project. It
is projected that slightly more than half of those Veterans (about
520,000) will complete an undergraduate/graduate degree program over
the next five years. Of the 520,000 graduates, roughly ten percent are
projected to earn a degree in a health-related or social work career
field. The result is an estimated 52,000 veterans trained and qualified
to work in medical professions across the country in the next five
years. If that timeframe is extended to seven years to accommodate a
track for medical school, current research projects a population of
over 75,000 medical professionals trained through Post-9/11 GI Bill
benefits.\2\ As such, we know the talent exists within the system, and
we hope VA makes the most of this opportunity.
---------------------------------------------------------------------------
\2\ Cate, Chris. Million Records Project, March 2014, http://
studentveterans.org/images/Reingold_Materials/mrp/download-materials/
mrp_Full_report.pdf
---------------------------------------------------------------------------
The Scope of the Challenge
Unfortunately, the current human resources model relies exclusively
on advertisement-heavy recruitment architecture. If minimum
credentialing standards are met, specific conditions are present for
the applicant, the applicant provides the proper information when
applying, and interview questions are answered to satisfaction, a
vacancy is filled. Unfortunately, that process is inefficient and
breeds a culture of practitioners whose narrow interest is to avoid
being unemployed.
VA lacks a national pipeline that identifies universities with
high-demand professional training programs with large numbers of prior
military enrolled in those programs, and a streamlined talent
management system. With more than 75,000 veterans expected to pursue
health-related fields, we believe VA could capitalize on this talent
pool, but are not currently positioned to do so.
A Unique Solution
This legislation presents an opportunity which may lead to
additional hiring programs. As the first initiative, the legislation
addresses a critical gap in physician assistants (PAs). In addition to
the work of the VA in response to this potential proposal, we believe
that education and veterans non-profits are in a unique position to
deliver a long-term solution to the challenge of recruiting medical
professionals. Advocacy on behalf of veterans affords SVA a unique
capability to address the immediate shortages and project fills for the
future in conjunction with VA.
As part of this solution, program partners would be in a position
to help recruit, screen and support no less than 250 student veterans
who are currently pursuing their degree in one of six critical job
fields identified by VA. These job fields include the following: M.D.'s
(emphasis on general practitioners), R.N.'s, Psychiatrists,
Psychologists, MSW's, Medical Technologists, and Health Administrators.
Based on this legislation's criteria, we have identified 15 schools
highlighted by location across the country as detailed in Figure 1
below. When evaluating the existence of priority medical programs,
schools were scored for their number of offerings in the following
disciplines: medicine (general practitioner emphasis), nursing,
psychology, psychiatry, medical technology, social work (MSW), and
health administration. In addition to this first 15, we have researched
an additional 15 schools we also feel would be worth considering, and
would look forward to working with this Committee to consider the
attributes of each school.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Figure 1. Potential Schools by Location
Additional Considerations
In addition to the work with PAs, residency opportunities will be
imperative to long term VA employment. A clearly defined path to
education and employment coupled with previously mentioned benefits
will create a trajectory toward health careers and VA employment for
student veterans currently in or separating from the Department of
Defense (DOD). The VA assisting in the branding and promotion of this
program through their various public relation channels will maximize
the audience and rates of success.
One problem identified by current research is the lack of trust in
the current VA health care system. We believe the system has an absence
of much needed medical professionals who are themselves, veterans. In
addition, this proposal leverages a significant cost-savings to
taxpayers by harnessing the existing benefits that veterans receive
through their military service in the form of the Post-9/11 GI Bill.
VA has shown significant improvement under the leadership of Sec.
McDonald. We continue to hear from those within the VA system that they
have positive experiences and appreciate the work of VA employees.
Indeed, Sec. McDonald's emphasis on the customer experience, including
the rollout of MyVA, demonstrates that the department is headed in the
right direction. Despite these leaps in improved service, we believe
there is more to be done, which VA has also publicly shared.
In recognizing current programs that VA operates, we would like to
highlight the following opportunities: the Health Professional
Scholarship Program (HPSP), Veterans Affairs Learning Opportunity
Residency (VALOR), Graduate Healthcare Administrative Training Program
(GHATP), Visual Impairment and Orientation and Mobility Professionals
Scholarship Program (VIOMPSP).\3\ These are existing programs which
would be complimentary to this legislation, and we encourage this
Committee to explore these as additional avenues to expand this
legislation.
---------------------------------------------------------------------------
\3\ HPSP: http://www.va.gov/vaforms/medical/pdf/vha-10-0491f-
fill.pdf; VALOR: http://mycareeratva.va.gov/library/internships/
veterans-affairs-learning-opportunity-residency-valor; GHATP: http://
www.vacareers.va.gov/assets/common/print/GHATP-Info-Flyer.pdf; VIOMPSP:
http://www.va.gov/vaforms/medical/pdf/vha-10-0491L-fill.pdf
---------------------------------------------------------------------------
Ultimately, this is a gap that has to be filled; it may be costly,
but it's both necessary and beneficial for the long-term sustainability
of our Nation's overall health care system. The Senate Veterans'
Affairs Committee and this legislation will be pivotal in that effort,
and we stand ready to support that work if we should be called upon.
s. , ``a bill to provide veterans impacted by school closures
certain relief and restoration of education benefits''
Last year, we quickly learned of the insolvency of Corinthian
Colleges, Inc. (CCi) institutions of higher learning (IHL). As we
reached out to CCi leaders to address the situation, we received no
response, despite concerted attempts to meet with their
representatives; for us, it was a critical time, as more than 8,800
student veterans were within their system. Since then, we have been
actively seeking to remedy the situation, and to protect the interests
of those student veterans directly impacted in the situation. We are
pleased to see this legislation, and continue to seek the support of
Members of this Committee for the proposal.
When we learned of the closures, our first reaction was to find out
how we could support the student veterans immediately impacted by IHL
closures, and we also considered the future to see what can be done to
prevent such from reoccurring. We believe it's important that VA
recovers Post-9/11 GI Bill dollars spent on reckless programs where
students are either passively or aggressively misled. The Department of
Education announcement regarding the closures provides precedent for
this authority to be granted to VA.\4\ \5\ For student veterans who
lost valuable time due to closures or misrepresentation, they should be
able to regain the benefits they earned. In initial conversations with
VA, it was clear that even though restoring these benefits was right,
the VA lacked the proper authority to justify such action.
---------------------------------------------------------------------------
\4\ Department of Education, Debt Relief for Corinthian Colleges
Students, June 8, 2015, http://blog.ed.gov/2015/06/debt-relief-for-
corinthian-colleges-students/
\5\ Federal Student Aid, Loan Forgiveness Programs, http://
blog.ed.gov/2015/06/debt-relief-for-corinthian-colleges-students/
---------------------------------------------------------------------------
Most importantly, we believe it's a matter of maximizing the
economic impact of the Post-9/11 GI Bill. For students who lose
benefits to weak schools, the investment in those student veterans is
squandered. Thousands of student veterans were left wondering what
would happen to them when their schools ceased to exist last summer; we
can't allow even one more student veteran to face such a bleak
prospect. We also note that while this proposal addresses situations
which have already occurred, we continue to encourage potential student
veterans to ask the right questions so they can avoid potential traps
in the future.
We fully stand in support of this legislation which would restore
entitlement for individuals who pursued a program of education with VA
educational assistance and failed to receive credit, or lost training
time, toward completion of the veteran's educational, professional, or
vocational objective due to IHL closures. We are pleased to see that
this proposal would continue monthly educational assistance payments,
including housing allowances, through the end of the term, quarter, or
semester in which the school closes, or up to four months from the date
of the school closure while not charging any of the veteran's
entitlement.
Unfortunately, we believe that we haven't seen the last of school
closures. The higher education industry deserves a hard look at its
practices and how they deliver education to non-traditional students--
the growing education audience. As more schools with faulty practices
and insolvent structures close, we should be prepared to offer them
solutions. We believe this Committee and its House counterpart are
positioned to lead the way on behalf of student veterans for all non-
traditional students.
We thank the Chairman, Ranking Member, and the Committee Members
for your time, attention, and devotion to the cause of veterans in
higher education. As always, we welcome your feedback and questions,
and we look forward to continuing to work with this Committee, the
Senate Veterans' Affairs Committee, and the entire Congress to ensure
the success of all generations of veterans through education.
Sen. Moran Thank you.
Mr. Morosky.
STATEMENT OF ALEKS MOROSKY, DEPUTY DIRECTOR, NATIONAL
LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED
STATES
Mr. Morosky. Chairman Isakson, Ranking Member Blumenthal,
and Members of the Committee, on behalf of the men and women of
the Veterans of Foreign Wars of the United States, I would like
to thank you for the opportunity to testify on today's pending
legislation. These bills that we are discussing today are aimed
at improving educational opportunities and health care quality
for veterans and we commend this Committee's hard work in
bringing them forward.
The VFW supports the Wounded Warrior Employment Improvement
Act, which would require VA to create an action plan to improve
the vocational rehabilitation and employment program, which
offers disabled veterans access to education and training in
order to give them the skills and counseling necessary to
transition to civilian life. This bill would require VA to
conduct an analysis of and develop a plan to remedy vocational
rehabilitation workload management challenges.
Recent figures indicate that the workload for vocational
rehabilitation counselors at many regional offices often
exceeds the VA's standard of one counselor for every 125
veterans. The VFW believes that VA must hire additional
counselors to meet this standard and then evaluate if the 1:125
ratio is truly effective, especially for counselors that assist
veterans with severe cases of PTSD and TBI.
VA would also be required to conduct an analysis on why a
higher percentage of disabled veterans choose to use their G.I.
Bill benefits over vocational rehabilitation and to conduct
outreach for the vocational rehabilitation program. The VFW
supports this provision, believing that it would be helpful in
identifying other weaknesses in the program, such as barriers
to entry and lack of awareness.
The Grow Our Own Directive. This legislation would afford
transitioning medics and corpsmen the opportunity to become
physician assistants. With the end of the wars in Iraq and
Afghanistan and the expected drawdown of military personnel,
more medics and corpsmen will be leaving the military service
and transitioning into the civilian workforce. The VFW strongly
supports efforts to leverage their medical knowledge and
experience to meet the health care needs of our Nation's
veterans.
While the VFW supports the pilot program this legislation
would establish, we believe that new funding should be
authorized for new programs so that existing care and services
are not diminished.
The VFW supports the Veterans eHealth and Telemedicine
Support Act, which would allow qualified VA physicians to
provide telehealth services to veterans across State lines,
removing the requirement that both be located in a federally
owned facility. Currently, veterans who are enrolled in out-of-
state VA medical centers may be forced to travel significant
distances to access telehealth services. Under this bill, a
veteran's physical location would no longer be a limiting
factor in his or her ability to take advantage of telehealth
services.
The VFW strongly supports the Department of Veterans
Affairs Education Relief and Restoration Act, which would
authorize VA to restore G.I. Bill benefits for student veterans
who receive no course credit or lose training due to the
closure of their educational institutions. Veterans who lose a
semester of benefits due to an unexpected school closure are
put at a disadvantage, since they may no longer have enough
time to complete their educational goals. The VFW believes it
is reasonable that their G.I. Bill benefits be restored in
those cases, allowing them to complete their courses of
education at another school before their benefits are
exhausted.
We are pleased that this authority would be made
retroactive for fiscal year 2015, covering veterans who were
impacted by the recent closure of Corinthian Colleges. The VFW
notes the Department of Education has established a debt
forgiveness program for students who were attending Corinthian
on Federal student loans and we believe it is equitable for
student veterans to receive similar relief.
Finally, the VFW strongly supports the Veterans Affairs
Retaliation Prevention Act, which would offer significant
protections to VA employees who step forward to identify
wrongdoing within the Department. These employee whistleblowers
are the first line of defense against mismanagement, abuse, and
other actions that put veterans in danger. Although they should
be commended for their actions, they sometimes suffer reprisal
from supervisors who would rather cover up problems than fix
them.
The VFW strongly believes that whistleblower must be
protected. This legislation sets up a framework for
whistleblower reporting as well as training on whistleblower
rights and protections for staff and supervisors. It also
creates mandatory standards for discipline and removal of
supervisors that engage in whistleblower retaliation. The VFW
believes these provisions are necessary and appropriate.
There has been much emphasis lately on increasing employee
accountability at VA. The VFW supports these efforts, believing
that VA must have the authority to swiftly discipline or
terminate any employee whose actions endanger veterans. Still,
enhanced firing authority could be used by managers to
eliminate whistleblowers if proper protections are not in
place.
For this reason, we strongly supported the whistleblower
protection provisions that were added to H.R. 1994, the VA
Accountability Act, before it passed the House. This
legislation contains similar whistleblower protections and we
urge this Committee to consider it as a complement to the
Senate version of the VA Accountability Act, S. 1082.
Mr. Chairman, this concludes my testimony and I am happy to
answer any questions you or the Committee may have.
[The prepared statement of Mr. Morosky follows:]
Prepared Statement of Aleks Morosky, Deputy Director, National
Legislative Service, Veterans of Foreign Wars of the United States
Chairman Isakson, Ranking Member Blumenthal and Members of the
Committee, On behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and our Auxiliaries, I would like to
thank you for the opportunity to testify on today's pending
legislation.
s. 2106, wounded warrior employment improvement act of 2015
The VFW supports this legislation, which would require the
Department of Veterans Affairs (VA) to create an action plan to improve
the Vocational Rehabilitation and Employment (VR&E) program. Similar to
education programs, such as the GI Bill, VR&E offers disabled veterans
access to education and training in order give them the skills
necessary to transition to civilian life. Additionally, it provides
other support, such as counseling and assistance finding jobs that are
suitable for their disabilities. VR&E must be viewed as a cornerstone
of VA services. Veterans who have been wounded or injured, or have
fallen ill want to be productive members of society. VR&E is the bridge
to get them there. Still, there are certain improvements to the program
that should be made.
This bill would require VA to conduct an analysis of and develop a
plan to remedy VR&E workload management challenges. Recent figures
indicate that the workload for VR&E counselors at many Regional Offices
often exceeds the VA standard of one counselor to every 125 veterans.
The VFW believes that VA must hire additional counselors to meet this
standard and then evaluate if 1:125 is truly an effective ratio,
especially for counselors who assist veterans with severe cases of
Post-traumatic Stress Disorder and Traumatic Brain Injury. VR&E must
focus on building careers for veterans--not just placement into jobs.
To do this, counselors must be able to invest the time necessary to
achieve a higher standard of success. The VFW also believes that VA
must change its current veterans' success rate tracking model from the
current 60-day threshold to the end of the veterans' probationary
period.
VA would also be required to conduct an analysis on why a higher
percentage of disabled veterans choose to use their GI Bill benefits
over VR&E and to conduct outreach for the VR&E program. The VFW
supports this provision, believing that it would be helpful in
identifying other weaknesses in the program, such as barriers to entry
and lack of awareness.
s. 2134, grow our own directive: physician employment and education
act of 2015
This legislation would build on the success of the Intermediate
Care Technician (ICT) Pilot Program. Launched in December 2012, the ICT
pilot program recruited transitioning veterans who served as medics or
corpsmen in the military to work in VA emergency departments as
intermediate care technicians. The ICT program offered transitioning
medics and corpsmen who have extensive combat medicine experience and
training the opportunity to provide clinical support for VA health care
providers, without requiring them to undergo additional academic
preparation.
This legislation would go a step further by affording transitioning
medics and corpsmen the opportunity to become physician assistants.
With the end of the wars in Iraq and Afghanistan and the expected
drawdown of military personnel, more medics and corpsmen will be
leaving military service and transitioning into the civilian workforce.
The VFW strongly supports efforts to leverage their medical knowledge
and experience to meet the health care needs of our Nation's veterans.
While the VFW supports the pilot program this legislation would
establish, we believe that new funding should be authorized for new
programs, so that existing care and services are not diminished.
s. 2170, veterans e-health and telemedicine support (vets) act of 2015
The VFW supports this legislation, which would allow qualified VA
physicians to provide telehealth services to veterans across state
lines, removing the requirement that both be located in a federally
owned facility. This would be especially helpful for veterans who do
not live in the same state as the facility in which they are enrolled.
With geographic distance remaining a significant barrier to care
for many veterans, the use of telemedicine technology has emerged as a
highly effective method of providing veterans with timely and
convenient care. Current law, however, restricts VA health
professionals from practicing telemedicine across state lines unless
both the provider and the veteran are located in federally owned
facilities. Consequently, veterans who are enrolled in out-of-state VA
medical centers may be forced to travel significant distances to access
telehealth services. By allowing VA health care professionals to
practice telemedicine across state borders, a veteran's physical
location would no longer be a limiting factor in his or her ability to
take advantage of telehealth services.
draft legislation, department of veterans affairs veterans education
relief and restoration act of 2015
The VFW strongly supports this legislation, which would authorize
VA to restore GI Bill benefits for student veterans who receive no
course credit or lose training time due to permanent closure of their
educational institutions. We are pleased that this authority would be
made retroactive for fiscal year 2015, covering veterans who were
impacted by the recent closure of Corinthian Colleges. The VFW notes
that the Department of Education has established a debt forgiveness
program for students who were attending Corinthian on Federal student
loans, and we believe that it is equitable for student veterans to
receive similar relief.
Veterans who attend schools using their GI Bill benefits are
limited to 36 months of assistance, with the assumption that this is
the amount of time necessary to complete a four year degree attending
classes at the full-time rate. Veterans who lose a semester of benefits
due to an unexpected school closure are put at a disadvantage, since
they may no longer have enough time to complete their educational
goals. While the VFW realizes that veterans have the responsibility to
be informed consumers when choosing where to use their education
benefits by using resources like the GI Bill Comparison Tool, we
believe it is unreasonable for veterans to anticipate that the schools
they currently attend will close mid-semester. For this reason, we
believe it is fully justified that their GI Bill benefits be restored
in those cases, allowing them to complete their courses of education at
another school before their benefits are exhausted.
draft legislation, veterans affairs retaliation prevention act of 2015
The VFW strongly supports this legislation, which would offer
significant protections to VA employees who step forward to identify
wrongdoing within the Department. These employee whistleblowers are the
first line of defense against mismanagement, abuse, and other actions
that put veterans in danger. Although they should be commended for
their actions, they sometimes suffer reprisal from supervisors who
would rather cover up problems than fix them. The VFW strongly believes
that whistleblowers must be protected.
There has been much emphasis lately on increasing employee
accountability at VA. The VFW supports these efforts, believing that VA
must have the authority to swiftly discipline or terminate any employee
whose actions endanger veterans. Still, enhanced firing authority could
be used by managers to eliminate whistleblowers if proper protections
are not in place. For this reason, we strongly supported the
whistleblower protection provisions that were added to H.R. 1994, the
VA Accountability Act, before it passed the House. This legislation
contains similar whistleblower protections, and we urge this Committee
to consider it as a compliment to the Senate version of the VA
Accountability Act, S. 1082.
This legislation defines a whistleblower complaint as ``a complaint
by an employee of the Department disclosing, or assisting another
employee to disclose, a potential violation of any law, rule, or
regulation, or gross mismanagement, gross waste of funds, abuse of
authority, or substantial and specific danger to public health and
safety.'' It creates a reporting system that protects employees from
retaliation by immediately involving higher level management and the
central whistleblower office, which will be responsible for
investigating all complaints. If a positive determination is made that
the complaint is valid, the whistleblower will be given the option to
transfer. VA will be required to develop a whistleblower complaint form
and conduct training on how to file whistleblower complaints and on
whistleblower rights. The VFW thinks these protections are necessary
and appropriate.
Supervisors found to have engaged in retaliation in accordance with
section 2302 of title 5 will be suspended for at least 12 days for the
first offense and terminated on the second offense. Whistleblower
compliance will be added to supervisors' performance evaluation
criteria, and bonuses will be prohibited or clawed back for any
supervisor who engages in whistleblower retaliation. The VFW believes
these provisions will act as an effective deterrent, allowing
whistleblowers to come forward with confidence that they will not
suffer reprisal.
This legislation would also require the Inspector General to submit
to Congress and make public any report that makes a recommendation or
suggests corrective action. The VFW supports this provision, however,
we suggest that any report that substantiates an allegation should also
be made public. This will promote greater transparency in cases where
the IG makes no recommendations because it believes that VA has already
taken corrective action before the report is published.
Mr. Chairman, this concludes my testimony and I will be happy to
answer any questions you or the Committee members may have.
Chairman Isakson [presiding]. Thank you very much.
Mr. Porter.
STATEMENT OF THOMAS PORTER, LEGISLATIVE DIRECTOR, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA
Mr. Porter. Chairman Isakson, Ranking Member Blumenthal,
Members of the Committee, on behalf of IAVA and our more than
425,000 members, thank you for allowing me to share our views
today.
IAVA supports each of the bills considered today, which
address issues we highlighted in our recently updated policy
agenda. I would like to focus on the main areas our members
have expressed concern, VA accountability and defense of the
Post-9/11 G.I. Bill.
Because a top IAVA priority is VA accountability, we
support Senator Kirk's draft, which directs the VA to punish
supervisors found to take retaliatory actions against
whistleblowers. We have heard whistleblowers from within the VA
detailing abuses of veterans and how they have experienced the
retaliation for stepping forward. VA must ensure that
retaliating against whistleblowers and veterans who complain
about care does not happen.
The common sense provisions that establish punishments for
violators, a formal process for filing complaints within the
VA, a central whistleblower office separate from the General
Counsel's Office, and additional training for VA employees are
welcome proposals to improve how veterans and well-meaning VA
employees are treated by their government.
Another measure that would improve services for veterans is
the Wounded Warrior Employment Improvement Act, to require the
VA to develop a plan for improving the vocational
rehabilitation services and assistance provided by the VA. To
underscore the importance of such programs, one of our Nebraska
members, an Afghanistan veteran, recently provided inspiring
testimony to the House Veterans' Affairs Committee on his use
of the VETS Success on Campus Program. Through this program, he
rebounded from numerous setbacks and is now on a path to
success. Seeing this young man testify before Congress after
overcoming so many challenges exemplifies the empowered veteran
we highlight online with the social media hashtag #vetsrising.
There is some satisfaction among our members that
participate in the program. Our 2014 member survey showed that
12 percent of respondents rated VA's vocational rehabilitation
services as good, but an equal percentage rated it as neither
good or bad or bad. Seventy-six percent of our members have not
used it.
Another of our priorities is the defense of veteran
Education benefits, such as the Post-9/11 G.I. Bill, which IAVA
fought hard to establish. Many using the G.I. Bill have been
adversely impacted when their schools closed. According to the
Veterans Benefits Administration, 70 VA approved schools closed
in fiscal year 2013 and 2014, affecting 1,605 G.I. Bill
beneficiaries. Just this April, 422 veterans receiving G.I.
Bill benefits saw their education plans abruptly end when
Corinthian Colleges closed 28 schools and filed for bankruptcy.
Because the receipt of G.I. Bill benefits is conditioned
upon enrollment, veterans education benefits are suddenly
discontinued when a school permanently closes. While the VA can
pay benefits up to the time of the school's closure, the
student is charged with the entitlement for that term but does
not earn any credit toward program completion. In addition,
their housing benefit is terminated the day the school closes.
IAVA's Rapid Response Team, made up of master's level case
managers that has helped more than 6,000 veterans connect to
resources, including with the G.I. Bill, has taken steps to get
veterans assistance with their education funds following school
closures. We understand that VA has the authority to continue
payments for up to 4 weeks when schools are temporarily closed
due to an emergency, but there is no similar authority to
continue benefits in the event of a permanent closure.
For this reason, IAVA supports the Veterans Education
Relief and Reinstatement Act, to allow VA to restore any Post-
9/11 G.I. Bill entitlement for student veterans that fail to
receive credit due to a permanent school closure. It also
directs VA to continue paying the G.I. Bill housing allowance
until the end of the term or the 4 months, whichever is sooner,
during which the school closure occurred. The Post-9/11 G.I.
Bill has sent more than one million veterans to school,
training America's next greatest generation.
Although wildly successful, it is clear that all of us,
including Congress, must be vigilant to ensure the benefit
lives up to its goals and maintains the confidence of our
veterans who depend on the benefit to transition to civilian
life. All veterans deserve the best our Nation can offer when
it comes to fulfilling the promises made to them upon entry
into the military.
Thank you for considering our views. I am happy to answer
any questions.
[The prepared statement of Mr. Porter follows:]
Prepared Statement of Tom Porter, Legislative Director, Iraq and
Afghanistan Veterans of America
------------------------------------------------------------------------
Bill # Bill Name or Subject Sponsor IAVA Position
------------------------------------------------------------------------
S. 2106 Wounded Warrior Sen. Sherrod Brown Supports
Employment
Improvement Act
------------------------------------------------------------------------
S. 2134 Grow Our Own Sen. Jon Tester Supports
Directive: Physician
Assistant Employment
and Education Act
------------------------------------------------------------------------
S. 2170 Veterans E-Health & Sen. Joni Ernst Supports
Telemedicine Support
Act (VETS Act)
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S. 2253 Veterans Education Sen. Richard Supports
Relief and Blumenthal
Reinstatement Act
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S. Veterans Affairs Sen. Mark Kirk Supports
[Draft] Retaliation
Prevention Act
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Chairman Isakson, Ranking Member Blumenthal and Distinguished
Members of the Committee, On behalf of Iraq and Afghanistan Veterans of
America (IAVA) and our more than 425,000 members and supporters, I
would like to extend our gratitude for the opportunity to share our
views regarding these pieces of legislation.
IAVA supports each of the bills before the Committee today. To
varying levels, they address issues IAVA has highlighted in our updated
Policy Agenda, which was recently released and distributed to each of
your offices. I would like to focus my testimony on the main areas that
our members have expressed concern: (1) Accountability at the
Department of Veterans Affairs (VA) and (2) Defense of the Post-
9/11 GI Bill.
Because one of IAVA's top priorities is accountability at the VA,
we support Sen. Kirk's draft legislation which directs the VA to punish
supervisors found to take retaliatory actions against whistleblowers.
Time and again, we have heard whistleblowers from within the VA
detailing abuses of veterans and how they have experienced retaliation
for stepping forward. VA must ensure that retaliating against
whistleblowers and veterans who complain about care does not happen. A
culture of intimidation is inconsistent with accountability within the
Department.
The common-sense provisions that establish strong punishments for
violators, a formal process for filing complaints within the VA, a
central whistleblower office separate from the General Counsel's
office, and additional training for VA employees are welcome proposals
to improve how veterans and well-meaning VA employees are treated by
their government.
Another measure that would improve the services being delivered to
our veterans is the Wounded Warrior Employment Improvement Act
(S. 2106), which would require the VA Secretary to develop and publish
an action plan for improving the vocational rehabilitation services and
assistance provided by VA.
To underscore the importance of such programs, one of our members
from Nebraska, an Army veteran who served in Afghanistan, recently
provided inspiring testimony across the Capitol before the House
Veterans Committee on his use of the VetSuccess on Campus program.
Through this valuable program, he rebounded from numerous personal and
professional setbacks and is now on a path to success. Seeing this
young man testify before Congress after overcoming so many challenges
exemplifies the empowered veteran we highlight online with the social
media hashtag ``Vets Rising.''
There is some satisfaction among our members that participate in
the program. Our 2014 survey of our members showed that 12% of
respondents rated VA's Vocational Rehab services as ``good,'' but an
equal percentage rated it as ``neither good or bad'' or ``bad.'' 76%
have not used it.
Another of IAVA members' top priorities is the defense of veteran
and military education benefits, such as the Post-9/11 GI Bill, which
IAVA fought hard to establish. Many veterans using Post-9/11 GI Bill
benefits have been adversely impacted when the schools they attended
closed. According to the Veteran Benefits Administration, 70 VA-
approved schools closed in FY 2013 and 2014, affecting 1,605 GI Bill
beneficiaries. Just this past April, 422 veterans receiving Post-911 GI
Bill benefits saw their education plans abruptly end when Corinthian
Colleges closed 28 schools and filed for bankruptcy.
Because the receipt of GI Bill benefits is conditioned upon
enrollment, veterans' education benefits are suddenly discontinued when
a school permanently closes. While the VA can pay benefits up to the
time of the school's closure, the student is charged with the
entitlement for that term, but does not earn any credit toward his or
her program completion. In addition, the housing benefit--oftentimes
their primary or sole source of paying for lodging, food, and other
basic necessities while attending school--is terminated the day the
school closes.
IAVA's Rapid Response Referral Program Team, made up of masters
level case managers that has helped more than 6,000 veterans meet their
goals through connections to quality resources and benefits, has taken
steps to get veterans assistance with their education funds following
school closures.
We understand that VA has the authority to continue payments for up
to four weeks when schools are temporarily closed due to an emergency,
but there is no similar statutory authority to continue benefits in the
event of a permanent school closure.
For this reason, IAVA supports the Veterans Education Relief and
Reinstatement Act, which would allow the VA to restore any Post-9/11 GI
Bill entitlement for student veterans that fail to receive credit
toward their educational goals due to a permanent school closure. It
also directs the VA to continue paying the Post-9/11 GI Bill housing
allowance until the end of the term--or up to four months, whichever is
sooner--during which the school closure occurred.
The Post-9/11 GI Bill has sent more than one million veterans to
school, training America's next ``greatest generation'' for success in
business and government careers. Although wildly successful, it is
clear that all of us, including Congress, must be vigilant to ensure
that the benefit lives up to its goals and to maintain the confidence
of our veterans who depend on the benefit to transition to civilian
life.
IAVA's members, and all veterans, deserve the very best our Nation
can offer when it comes to fulfilling the promises made to them upon
entry into the military. There is no doubt this Committee has the best
interests of our veterans in mind when drafting legislation. But we do
hope you take into consideration and implement what we, and our fellow
veteran service organizations, have had to say on these pieces of
legislation today.
Thank you for your time and attention. IAVA is happy to answer any
questions you may have.
Chairman Isakson. Thank you very much.
Ms. Zumatto.
STATEMENT OF DIANE ZUMATTO, NATIONAL LEGISLATIVE DIRECTOR,
AMVETS
Ms. Zumatto. Chairman Isakson, Ranking Member Blumenthal,
Senators Moran and Tillis, I am pleased to be here today to
share AMVETS's position on this pending legislation.
S. 2106, the Wounded Warrior Employment Improvement Act,
AMVETS supports the legislation, which directs the Secretary to
develop and publish an action plan for improving the vocational
rehabilitation program of the VA. AMVETS believes that the VA
needs to provide veterans with the highest level of transition
assistance, giving special attention to disabled veterans in a
more efficient and timely manner. AMVETS suggests improving
currently existing VA public-private partnerships and making
new connections with providers in order to provide veterans
with the broadest array of services and resources available.
It is our belief that part of the reason for the
disproportionately low participation of post-9/11 veterans in
the vocational rehabilitation program is that it is not well
publicized and, therefore, not well known as it could be in the
veteran community. The legislation's ultimate goal should be to
better enable catastrophically injured eligible veterans to
return to productive lives. Hopefully, the provisions outlined
in this bill will better able the VA to do just that.
S. 2134, the Grow Our Own Directive: Physician Assistant
Employment and Education Act, we enthusiastically support this
legislation which seeks to address the PA shortage within the
VA. AMVETS actually loves this approach, which would serve a
dual purpose of not only helping to improve timely access to
health care, but also helping to reduce veteran unemployment.
AMVETS also applauds the fact that the eligible participants
must meet certain requirements, including previous military
health care experiences, which just makes the whole program
more cost effective.
It seems obvious that by increasing the number of PAs
within the VA system, the burden on physicians and other
clinicians would be reduced. This, in turn, would make it
easier for a veteran to get in to see a doctor when that is
actually necessary.
S. 2170, the eHealth and Telemedicine Support Act, AMVETS
supports this legislation, which seeks to increase timely
access to health care resources through the use of telemedicine
services by licensed, registered, or State certified clinicians
in any State, regardless of whether either or both are located
in a VA facility. There is no denying that the practice of
telemedicine continues to expand as one of the fastest growing
and most viable health care options. Just as importantly,
however, is to ensure that those services are being provided by
properly accredited professionals.
S. 2253, the Education Relief and Restoration Act, AMVETS
also supports this bill, which seeks to protect education
benefits if a veteran, due to no fault of his own, is forced to
discontinue a course as a result of an educational
institution's permanent closure and they did not receive credit
or lost training time toward the completion of that program.
That is enough for that one.
The discussion draft to provide procedures within the VA
for whistleblower complaints, AMVETS wholeheartedly supports
this very important piece of legislation, which seeks to
address the issue of retaliation by VA supervisors against
whistleblower employees. This is an absolutely heinous practice
which needs immediate systemwide action. If a VA employee at
any level is violating laws or regulations, misusing or wasting
funds, stealing or putting veterans in danger, either by their
actions or lack thereof, then they are the ones who should be
targeted by the Department, not the whistleblower who steps
forward to report those illegal actions.
Unfortunately, it seems the whistleblower gets all the
negative attention and is the one who sometimes gets prosecuted
while the evildoer is allowed to continue unpunished. This is
both wrong and a travesty of justice. It should not be allowed
to continue under any circumstances.
This completes my testimony at this time and I would be
happy to answer any questions.
[The prepared statement of Ms. Zumatto follows:]
Prepared Statement of Diane M. Zumatto,
National Legislative Director, AMVETS
Distinguished members of the Senate Veterans' Affairs Committee, it
is my pleasure to be here today representing AMVETS' position on the
following pending legislation:
S. 2106, the Wounded Warrior Employment Improvement Act of
2015
S. 2134, the Grow Our Own Directive: Physician Assistant
Employment & Education Act of 2015
S. 2170, the Veterans E-Health & Telemedicine Support Act of
2015
S. 2253, the Veterans Education & Restoration Act of 2015
S. ------, Discussion draft--to establish procedures within
the VA for processing Whistleblower complaints.
I would like to begin today's statement with the following
introductory remarks prior to turning to each specific piece of
legislation: As the United States absorbs the aftereffects of more than
a decade of continuous war and in the face of the planned draw-down of
military personnel, the physical and mental health of our military and
veterans will continue to be priority issues for AMVETS, the veteran's
community and hopefully Congress. Thanks to improvements in battlefield
medicine, swift triage, aeromedical evacuations and trauma surgery,
more combat-wounded than ever before are surviving horrific wounds and
will be needing long-term rehabilitation, life-long specialized medical
care, sophisticated prosthetics, etc. Your committee has a
responsibility to ensure that the VA and our Nation live up to the
obligations imposed by the sacrifices of our veterans.
It is encouraging to acknowledge at this time that, despite the
extraordinary sacrifices being asked of our men and women in uniform,
the best and the brightest continue to step forward to answer the call
of our Nation in its time of need. I know that each of you is aware of,
and appreciates the numerous issues of importance facing our military
members, veterans and retirees.
pending legislation
S. 2106, the Wounded Warrior Employment Improvement Act of 2015--
AMVETS supports this legislation which directs the VA Secretary to
develop & publish an action plan for improving the vocational
rehabilitation program of the VA. AMVETS believes that the VA needs to
provide veterans with the highest level of transition assistance,
giving special attention to disabled veterans, in a more efficient and
timely manner.
AMVETS suggests improving currently existing VA public/public
partnerships and making new connections with providers in order to
provide veterans with the broadest array of services and resources as
possible.
It is our belief that part of the reason for the disproportionately
low participation of Post-9/11 veterans in the VA's Voc-Rehab program
is that it is not as well publicized, and therefore not as well known,
as it could be in the veteran community.
This legislation's ultimate goal should be to better enable
catastrophically injured, eligible veterans to return to productive
lives. Hopefully, the provisions outline in this bill will better able
the VA to do just that.
S. 2134, the Grow Our Own Directive: Physician Assistant Employment
& Education Act of 2015--AMVETS enthusiastically supports this
legislation which seeks to address the physician assistant shortage
within the VA. AMVETS loves this approach which would serve the dual
purpose of:
helping to improve timely access to healthcare; and
helping to reduce veteran unemployment
AMVETS also applauds the fact that the eligible participants must
meet certain requirements including: previous military healthcare
experiences, which make this effort more cost effective.
It seems obvious that by increasing the number of PAs within the VA
system, the burden on Physicians and other clinicians, would be
reduced. This in turn should make it easier for a veteran to get in to
see their doctor.
S. 2170, Veterans E-Health & Telemedicine Support Act of 2015--
AMVETS supports this legislation which seeks to increase timely access
to healthcare resources through the use of telemedicine services by
licensed, registered or state certified clinicians in any state,
regardless of whether either or both are located in a VA facility.
There's no denying that the practice of telemedicine continues to
expand as one of the fastest growing and viable healthcare options.
Just as importantly however, is to ensure that those services are being
provided by the properly accredited professionals.
S. 2253, Veterans Education Relief & Restoration Act of 2015--
AMVETS supports this legislation, which seeks to protect education
benefits if a veteran, due to no fault of their own, is forced to
discontinue a course as a result of an educational institution's
permanent closure and did not receive credit or lost training time
toward completion of the education program, Department of Veterans
Affairs (VA) educational assistance payments shall not, for a specified
period of time, be:
charged against the individual's entitlement to
educational assistance, or
counted against the aggregate period for which such
assistance may be provided.
This seems pretty straight forward in its intent, though I have no
actual data on how often this type of situation occurs. It seems only
right and proper, however, not to penalize a veteran for something
entirely out of his/her control, especially because whatever course
they didn't get credit for will have to be repeated elsewhere at a
future date.
S. , Discussion draft--to establish procedures within the VA for
processing Whistleblower Complaints--AMVETS wholeheartedly supports
this very important piece of legislation which seeks to address the
issue of retaliation by VA supervisors against whistleblower employees.
This is an absolutely heinous practice which needs immediate, system-
wide action.
If a VA employee, at any level, is violating laws or regulations,
misusing or wasting funds, stealing or putting veterans in danger,
either by their actions or lack thereof, then they are the ones who
should be targeted by the department, not the person (whistleblower)
who steps forward to report the illegal actions. Unfortunately, this is
not how the process currently works, in fact, it's just the opposite--
the whistleblower seems to get all the negative attention and is the
one who gets prosecuted, while the evil doer is allowed to continue
unpunished. This is both wrong and a travesty of justice and it should
not be allowed to continue under any circumstances.
This completes my testimony at this time and I thank you again for
the opportunity to offer our comments on pending legislation. I will be
happy to answer any questions the Committee may have.
Senator Moran [presiding]. Thank you all for your
testimony.
The Chairman will return in just a moment, but I am going
to use the opportunity of having the gavel to ask the first
question. I think I only have one, and that is to you, Ms.
Hempowicz. The consequences that whistleblowers face, has it
changed over time? Is it better today than it was in the past?
Do the consequences, the poor consequences to someone who
reports bad behavior, do they change?
Ms. Hempowicz. I do not know if I know far enough back to
know if they have changed over time, but I think the
consequences for blowing the whistle today are pretty severe.
You run the risk of losing your career, your livelihood. You
lose your good name if your reputation is dragged through the
mud. I think the consequences are pretty high today. I would
assume that they have always been pretty high.
Senator Moran. I was just interested in knowing whether--in
my view, leadership matters. Who is in charge of the VA, I
assume, determines the culture or the nature of how the VA
responds to these kind of circumstances and I wondered if there
was any empirical evidence, any reporting data that would
suggest that either today or in the past, it has been handled
better and, therefore, there are less instances of bad behavior
toward whistleblowers.
Ms. Hempowicz. I am not sure if we have enough information
to say that, empirically, it is better or worse. I mentioned in
my testimony that we have received over a thousand complaints
in the last year. We are still receiving complaints on a weekly
basis.
Senator Moran. I thank you very much.
Ms. Hempowicz. No problem.
Senator Moran. Mr. Chairman, thank you.
Chairman Isakson [presiding]. Senator Blumenthal.
Senator Blumenthal. Thank you, Mr. Chairman.
I would like to ask, first of all, Mr. Hubbard, have you
encountered veterans who have been victimized by the Corinthian
debacle?
Mr. Hubbard. Thank you for the question, Senator. When that
issue first came up, we did a quick survey to find out how many
student veterans were under the Corinthian umbrella, under the
Everest, Heald, and WyoTech schools. After looking at the
database on the GEOGO [phonetic] comparison tool, we found that
approximately 8,800 student veterans were studying at those
institutions. We quickly reached out to and interacted with
those students to make sure that they were taken care of, and
our initial conversations actually with the VA, I think, were
quite positive. There was the interest in addressing that
situation directly and having the authorities that identified
they did not for that situation.
Interestingly, when we did reach out, as pointed out in our
testimony, to the Corinthian executives, we received no
response for several weeks. I think that was pretty telling of
the situation. Ultimately, you know what the end result was.
Senator Blumenthal. Thank you.
I want to thank all of the folks who are here today for
your support for the Whistleblower Protection Act that I have
introduced with Senator Kirk. I want to ask you, Ms. Hempowicz,
because I gather you have some suggestions for changing it,
whether you think that the Office of Special Counsel is a
sufficient enforcement vehicle for protecting whistleblowers. I
gather you feel that a central whistleblower office would not
have the independence and that it would detract from the
resources available to the Office of Special Counsel.
Ms. Hempowicz. Yes. I think that the Office of Special
Counsel has proven itself to be well equipped to deal with
whistleblowers from VA. Our concern is less that resources
would be diverted from OSC, but that the resources that go into
the central whistleblower office could do a better job, or
could be better put to use by putting them into the Office of
Special Counsel. Any new office, there are going to be some
growing pains. So, creating a new office to do largely what
another office is doing, we think is a little bit redundant.
There is the problem of our concern that it would not be
independent enough in the same--this office, the central
whistleblower office, is supposed to be independent the same
way that the Inspector General's Office is supposed to be
independent, and especially at the VA, we have seen that is not
really the case. So, that is where our concerns stem.
Senator Blumenthal. I do not remember what the House bill
does. Do you recall?
Ms. Hempowicz. It has a very similar provision to create a
central whistleblower office, and we are still concerned.
Senator Blumenthal. In terms of contractors and veterans
that you say should also be protected against retaliation, that
would not necessarily be against retaliation by supervisors. It
would be against retaliation by anyone, I assume.
Ms. Hempowicz. Yes.
Senator Blumenthal. That would be, in effect, a separate
goal of the bill, in effect, stopping retaliation not only
against VA employees, but also against contractors and
veterans.
Ms. Hempowicz. Yes.
Senator Blumenthal. Let me ask you, are there provisions in
the House bill that you would recommend that the Senate adopt
that are not in the present bill?
Ms. Hempowicz. Not off the top of my head, but I can
certainly get back to you with an answer for that.
Senator Blumenthal. OK. Well, I would be interested in
that, if you think that the Senate bill could be improved by
any provisions or any other ideas that you or others testifying
today may have, because I agree with all of you that this is a
centrally important measure. As much as the VA may in good
faith think that it is addressing this problem, I think that
stronger deterrence and prevention are absolutely necessary.
Punishment and enforcement are really important goals.
Thank you all for your testimony today. Thank you.
[Responses were not received within the Committee's
timeframe for publication.]
Chairman Isakson. Senator Tillis.
Senator Tillis. Thank you, Mr. Chair, and Mr. Chair, I want
to mention, I think you had to be out for a moment when we were
talking with the previous panel about some of the
recommendations in the bills that we are talking about today. I
think that the VA may have some concern, less to do with the
merits of the provisions and more to do with how to pay for it
and how much it will cost. It brought up to my mind probably
the need at some point for us to get an update on the
transformation and say, if this is a good idea and it does not
work right now, tell us how the transformation is going to make
it easier to implement and something that you would support
later on. For your consideration for a future committee
meeting.
Ms. Zumatto and Mr. Morosky, you more or less supported
without qualification S. 2106. Mr. Hubbard, you support the
direction of the legislation, but you suggest that it can be
accomplished without a legislative fix, just a policy change.
Would you then say that we do not move forward with this bill
because we think the VA will act on it, or is it just a
statement that it is within their purview to address this
anyway?
Mr. Hubbard. Thank you for the question, Senator. We
believe this issue is of immediate importance, as I believe you
do, as well.
Senator Tillis. Do you think it is going to take us too
long to get it done?
Mr. Hubbard. We believe that it is important to address
currently. We believe that they have shown the intent to
address it, would like to give them an opportunity to show the
results of which and fine tune from that point forward.
Senator Tillis. Mr. Morosky or Ms. Zumatto, any additional
comment? I mean, we all think that we can get it done, but we
would also like to continue to move this to provide the
pressure to make sure that it gets done.
Mr. Morosky. Yes, Senator. I think that putting it into
legislation, codifying it, would continue to apply the
pressure. If they have a plan that is very similar than what is
laid out, then they would just have to publish it. It is also
some of the reporting requirements having to do with the
underutilization of Chapter 31. I do not think that they have
any plans of looking at that right now, so that would be
helpful, as well.
Ms. Zumatto. I would agree with Aleks. Absolutely. Thank
you.
Senator Tillis. All right. I just wanted to make sure there
was not anything beyond the point that you made. The sooner the
better, and let us hope they can get it done and render the
need to move the bill unnecessary.
Mr. Hubbard. We absolutely support the intent, without
question.
Senator Tillis. Ms. Hempowicz, you mentioned something. I
was not going to talk about whistleblowers except to say that I
support the legislation before us. I am one of the founding
members of the Senate Whistleblower Caucus, so on a broad
basis, I think there is a lot more that we need to do to
protect whistleblowers. I think, generally speaking, there is
broad consensus that we need to have more whistleblower
protections, but one of the things that comes up every once in
a while is the protections of the accused. You just said
something that had to do with a supervisor having been accused
of retaliation having 14 days to respond and prove that they
did not retaliate. In your view, do we have adequate
protections for the accused in the policies that are moving
forward?
Ms. Hempowicz. I think, yes, this is a provision that has
gotten some back and forth on the House side and on the Senate
side. The change from 14 days to 5 days happened very recently
[sic]. I think, yes, that change does address and does kind of
put in place enough due process for the accused supervisors.
Yes.
Senator Tillis. What about the discussion we had? You were
saying that in some cases, you think it makes sense to revise
the bill to have kind of a skip-level reporting option. Can you
talk a little bit more about that? Do we already have proposed
changes before us?
Ms. Hempowicz. Well, I mentioned the one word change in----
Senator Tillis. From ``shall'' to ``may''?
Ms. Hempowicz. From ``shall'' to ``may,'' yes.
Senator Tillis. But, what does that really do? One of the
things I have seen, less so in the VA, but we were having a
similar discussion over in the Department of Justice, and it is
also making sure that there are more options for reporting
potential abuses, but clarity at the same time. Am I willing to
put my reputation or my job on the line, we need to provide
some level of clarity and safe harbor for them. Do we have
draft language right to do that?
Ms. Hempowicz. I think the change from ``shall'' to ``may''
would do that. Whistleblowers already have the ability to go to
their direct supervisor. I think this is an excellent
clarification, but we believe that the ``shall'' word makes it
a mandatory step, and this bill does give three exceptions
where you could just jump that step. However, we do not think
that is an inclusive list, and rather than make it a mandatory
step with an inclusive list of exceptions, we think just that
one word switch would clarify without making it overly
burdensome for the whistleblower.
Senator Tillis. Thank you.
Thank you, Mr. Chair.
Chairman Isakson. Thank you very much, Senator Tillis.
Mr. Hubbard, you are the Vice President of Government
Affairs for the Student Veterans of America, is that correct?
Mr. Hubbard. Yes, Mr. Chairman.
Chairman Isakson. When I was listening to your testimony a
moment ago, I want to make sure I heard something correctly. We
were talking about the Corinthian issue, which is a terrible
tragedy for veterans and their families. Did you make a generic
statement, though, about all of the for-profit institutions, or
did I hear that? Did you make a reference to all of them or
just to Corinthian?
Mr. Hubbard. We made a statement on the umbrella of the
issue. We believe that this is a good example of what could be
applied more broadly. We are obviously concerned about all
student veterans everywhere, and we saw that this situation
with Corinthian identified that school closures is not
something that is going to be going away any time soon. We have
seen that the insolvent practices and the questionable
marketing techniques of many schools are of concern. I believe
that does apply more broadly, but it was not necessarily
intended to be a statement on the sector.
Chairman Isakson. Good. I wanted that clarification,
because there are some who think that, by definition, a for-
profit school is not providing quality services to their
students. I think we have to be very careful to not throw the
baby out with the bathwater. We probably need to look at the
entire issue of for-profit schools that are providing services
to our veterans and find out where there is a problem and
address the problem rather than generically castigate a
category of schools.
Because for the non-traditional students, which all
veterans really fall in the non-traditional student category,
distance learning, the use of technology in learning, and
things of that nature, which are more common to the for-profit
schools than they are for the institutions of higher learning
like universities, are a good way to deliver quality services.
We do it with the eArmyU in the military. I mean, we have 37
universities delivering college credit content over the
Internet to our soldiers in the field today. That is a program
I was very proud to start with Senator Kerry years ago.
I wanted to make sure that was not a general statement, but
I think it does beg the question. It is probably time for us to
look at all of them and make sure we know where the actors are
and what the degree of action really is, whether they are
Academy Award winners or not so good, one way or another.
Ms. Hempowicz, I could not help but laugh at myself last
night, and I apologize. The only testimony I missed today was
yours, and I apologize. I had to run out for a brief speech
that I had to make. I was sitting there reading your testimony.
I looked up at the acronym for your organization and it is
POGO, and I remember that cartoon character Pogo who said, ``We
have met the enemy and it is ourself.'' [Laughter.]
I think in the Veterans Administration, that is an
applicable thing for us to talk about for a second.
You had said your organization never received more
inquiries in your 34-year history on any investigation other
than the one for the VA, is that correct?
Ms. Hempowicz. Yes.
Chairman Isakson. How comprehensive was that input,
extremely or just tertiary?
Ms. Hempowicz. I am sorry. I do not understand----
Chairman Isakson. How comprehensive was the feedback? I
mean, did you get specific cases, specific claims, specific
grievances, things of that nature?
Ms. Hempowicz. Yes. We got very specific claims. We were
not able to follow up on every single one because there were a
lot of anonymous submissions. However, the ones that we were
able to follow up with and do some more investigation, coupled
with the anonymous complaints that we received, painted a broad
picture of fraud, waste, abuse, mismanagement within the VA.
Chairman Isakson. Using the terminology ``broad picture,''
and I do not want to put any words in your mouth. I want you to
answer this the way you would just answer, which I am sure you
would, but those comments were not limited to that Phoenix area
or were not limited to a specific area of the United States.
They came from pretty much all over, is that correct?
Ms. Hempowicz. Absolutely.
Chairman Isakson. Do you think the problem in the VA in
terms of the whistleblower problem and the problem with the
services to the veterans that we hear the complaints about so
often, it is more of a cultural problem within the VA than it
is anything else attitudinally-wise?
Ms. Hempowicz. I do. I think there is a culture of sweeping
things under the rug at the VA that needs to be addressed, and
this legislation like this that would hold those who retaliate
against whistleblowers accountable does go leaps and bounds to
addressing that culture.
Chairman Isakson. I am going to go a little bit over my
time, but this is an important point I want to try to make with
Mr. Morosky and Mr. Hubbard. I want you all to listen to what I
am about to say and then give me your comment.
The VA appears to me to be--in the last 10 months, it
appears to me the VA has improved its response on wait times
and its delivery of quality services, and I am hearing there is
improvement within the VA in delivery of those services to
veterans. Would you agree or disagree with that?
Mr. Hubbard. I would agree with that overall, Mr. Chairman.
Chairman Isakson. What about you, Mr. Morosky?
Mr. Morosky. I would, as well, Mr. Chairman.
Chairman Isakson. Here is my point. You go ask the average
American on the street, what do you think of the Veterans
Administration, they will tell you, they are really screwed up.
You know, I read about bonuses, I read about people not getting
appointments, I read about the Choice not working, and you go
on and on and on. The fact of the matter is that with the
changes this Committee originated in August of last year and
have been implemented by the VA and its new Secretary,
Secretary McDonald, are appearing to start to change the ship
of State. It is a big ship, the second largest agency of the
government.
We have to somehow find a way to do as an organization is
root out the problems by protecting the whistleblowers and
having a disciplined program to go after those that are causing
the cultural problems while at the same token elevating those
that are doing the good job, that are changing the VA
internally. I personally think that is what is going on.
We are at that crossroads where we are going to go from
being what we have not been to something we always wanted to
be, but we have got to help as a committee to do that, and your
organizations, I think, to a certain extent, do, too. Now, I am
kind of making a speech here. I am not making a question. Do
you see where I am coming from, Mr. Morosky?
Mr. Morosky. Yes, I do, Mr. Chairman.
Chairman Isakson. Mr. Hubbard.
Mr. Hubbard. Same here, Mr. Chairman.
Chairman Isakson. Mr. Porter.
Mr. Porter. Yes, sir.
Chairman Isakson. Ms. Zumatto.
Ms. Zumatto. There is no question about that, although I
will say that my own personal experience with the VA has not
been improving, unfortunately.
Chairman Isakson. Well, that is why I asked the question. I
am hearing good things about some that is improving. I hear
others that it has not changed a bit. I think we have got to
find a way to take things like this whistleblower initiative to
satisfy the entire country and the VA that we are going to go
after the problems in the VA and we are going to try and
correct them. We are going to see to it somebody that has a
constructive complaint or information can come forward without
fear of retribution, while at the same token, those who are in
the agency doing a good job have the opportunity to be pointed
out and be elevated in the public view. If we can do that, I
think we can begin to change the entire culture.
One last thing I am going to say, then I will shut up, and
I apologize. Mr. Morosky, I think you were the one that talked
about firing the people who were not performing, is that
correct? Did you make that statement, or Mr. Hubbard? Somebody
made that statement. Mr. Porter, did you make it?
Mr. Porter. Yes, sir.
Chairman Isakson. You were making it in the context of
services to the veterans, medical services to the veterans?
Mr. Porter. Yes, Mr. Chairman.
Chairman Isakson. Do you have any--and I do not know the
answer to this question, so it is an open-ended question.
Hopefully, my staff will tell me. One of the problems that we
hear from the Veterans Administration is the difficulty under
the law, under union contracts and other constraints, that they
have to actually firing somebody. Have you heard any of that,
Mr. Porter?
Mr. Porter. We have heard that there are objections by
unions to some of the proposals that would allow for firing or
transferring of bad actor employees.
Chairman Isakson. That is the part that can ultimately
perpetuate the internal culture that does not help the
productivity of the individual employees, correct?
Mr. Porter. Correct, Mr. Chairman.
Chairman Isakson. Well, I want to end by saying this, and
Senator Blumenthal, I want you to hear what I have got to say
so if I say anything wrong, you can correct me. You cannot
correct me on the first part, because you do not know the
information. But, the second part, you can correct me.
We had a terrible problem at Robins Air Force Base in
Georgia, which is an air logistics center (ALC) for our
military, our Air Force, whose on-base employment base is
mostly union workers. They are mostly civil employees. They are
not military employees. There got to be a huge problem between
the union, the management of the base, and the commanding
officer, and the throughput of that base dramatically declined
in terms of the number of F-15s and F-16s they could process
through to the point they were not meeting their goals.
A very highly qualified, very ingenious general came in and
said, ``You know, we have got to stop this.'' He invited the
union shop foreman in and said, ``What can we do to change this
from being a problem to being an asset?'' In 2 years, they have
gone from being the least productive ALC in terms of throughput
to the most productive ALC in terms of throughput. Every time I
have gone to the base the last 2 years to meet with the
general, the union leader is in there with him and they are
like a team.
My point being, we need to find a way in the agency to
foster that type of approach within the VA, as well, to where
the employees and the leadership appear as a team to carry out
the best interest of the veteran and not are enemies one to
another. I will just stop talking now, because I know I am
making a speech, but you can correct me if you think I am
wrong.
Senator Blumenthal. I enjoy your speeches, Mr. Chairman,
and I appreciate them. Can I ask a question----
Chairman Isakson. Sure. Absolutely.
Senator Blumenthal [continuing]. I did not mean to
interrupt if you have----
Chairman Isakson. I am shutting up.
Senator Blumenthal. Thank you, Mr. Chairman.
Mr. Hubbard, could you tell me, in terms of your statement
that the wait times and other performance by VA health care has
improved, what is the basis for your statement?
Mr. Hubbard. Thank you for the question, Senator. What we
are really focused on is the fact that based on what we have
seen with the G.I. Bill and the research that we conducted last
year, we understand that there is going to be an influx of
veterans into the system. Whether they go to work for VA or for
the health care system, in general, that is going to ultimately
depend on what the VA determines as far as their hiring
programs. We are hoping that over the next couple of years, if
they shift their programs and they make it possible for
pathways like the bill that is on the table currently, if those
proposals come to fruition, we think that those individuals,
who we already know have a propensity for service and want to
serve other veterans, we think that we can direct them toward
VA.
Senator Blumenthal. I am sorry. Maybe I was unclear in my
question. The Chairman asked you whether, if I understood it
correctly, whether your dealing or perception is that the VA's
performance has improved in terms of reducing wait times, and
you said yes.
Mr. Hubbard. Oh, OK. I understand what you are asking,
Senator. Yes, we do have anecdotal evidence for that. There is
not any data that we have reviewed on that subject. We----
Senator Blumenthal. Your information is strictly anecdotal?
Mr. Hubbard. It is based on the feedback we have received
from our members, yes.
Senator Blumenthal. OK. Mr. Morosky--I am sorry, the basis
for your--a similar question. I know that the VA has some
information and data out there.
Mr. Morosky. Right. We know of a lot of veterans who have
used the Choice program. We know Choice has helped a great deal
in eliminating some of the wait time backlogs, particularly for
specialty care, at a lot of health care facilities that had
significant backlogs before. It is still not perfect. It is a
pilot program, of course. I know that this Committee is going
to be doing a lot of work and discussing ways to improve on
that and roll together the various non-VA care programs into a
comprehensive program. So far, it has shown some improvement
there.
Senator Blumenthal. Mr. Porter, your information is
similarly anecdotal; in other words, stories and----
Mr. Porter. Yes, Senator----
Senator Blumenthal [continuing]. Contacts with veterans?
Mr. Porter. I would have to get back with you if we have
actually received hard data, but we have heard a lot of
anecdotal evidence from the Secretary, senior staff, media
reports, but I would have to circle back if we actually have
the hard data.
[Responses were not received within the Committee's
timeframe for publication.]
Senator Blumenthal. Finally, your feeling is somewhat
different, Ms. Zumatto?
Ms. Zumatto. I shared my personal experience. I do not have
any data from our membership. Again, it is stories, and one of
the biggest problems that we believe the VA is suffering from
is there is no continuity in service across the system. You get
the mixture of, everything is great here and everything is
terrible here. My experience has been subpar.
Senator Blumenthal. Thank you. Thank you all again for
being here. This has been very, very helpful and informative.
Thanks for your service, every one of you.
Chairman Isakson. We appreciate your time that you have
given. Your testimony is extremely helpful and we welcome you
to submit any other testimony you want to for the record. We
will be glad to hold it open for that purpose.
This meeting stands adjourned.
[Whereupon, at 4:37 p.m., the Committee was adjourned.]
A P P E N D I X
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Prepared Statement of Hon. Mark Kirk, U.S. Senator from Illinois
Chairman Isakson, Ranking Member Blumenthal, and Members of the
Committee: Thank you for allowing me to submit testimony for the record
for this legislative hearing on behalf of my bill S. 2291, VA Patient
Protection Act. I wrote this legislation after hearing harrowing
stories of retaliation and intimidation from VA whistleblowers from
across the country. Sadly a consistent theme emerged from these
accounts: the VA does not hold those who retaliate against
whistleblowers accountable for their actions and continues to fail to
combat the culture of corruption and intimidation within the VA.
Dr. Lisa Nee first came to me in the spring of 2014 and shared her
story of corruption and intimidation from her time as a cardiologist at
the Edward Hines Jr. VA Hospital in Hines, Illinois. Upon arrival at
Hines, Dr. Nee was given several bankers boxes full of unread echo
cardiograms to begin reading and assessing. She was understandably
concerned by such a backlog but was horrified to find that some of the
tests were left unread for over a year, in which some patients had
died. When Dr. Nee voiced her concerns she experienced retaliation from
Hines administration. As if this was not enough, Dr. Nee observed
another cardiologist, Dr. Robert Dieter, fraudulently inflating his
productivity by entering service codes that he did not perform. This
allegation was substantiated by the VA Office of Medical Inspection,
which found that this conduct may be in violation of criminal statutes.
I am unhappy to state that Dr. Dieter is still employed at Hines VHA
and has not been disciplined for this egregious misconduct nor has the
VA turned these findings over to the Justice Department to explore
criminal allegations. Unfortunately, the VA turned its focus and
resources on trying to discredit Dr. Nee in a response letter to my
office, which included blatantly false explanations concerning the
Inspector General's handling of Dr. Nee's allegations. I am fortunate
to work closely with Ms. Germaine Clarno, a social worker and local
President of the American Federation of Government Employees (AFGE) at
Hines VA. Ms. Clarno first disclosed wrong doing at Hines in regards to
waitlist and scheduling manipulation in the spring of 2014. She works
closely with other whistleblowers to protect their rights and counsel
them on their options. Ms. Clarno continues to work at Hines where she
observes and experiences continued retaliation from management against
whistleblowers.
Dr. Nee and Ms. Clarno's stories are not isolated cases. I have
heard from Mr. Shea Wilkes, who is an employee at the Shreveport VAMC
and discovered secret waits lists extending for months and years. Mr.
Wilkes filed complaints with the Investigator General (IG), who in turn
sent criminal investigators to look into how he obtained the wait
lists, confiscating computer equipment and asking him to submit to a
lie detector test. I met with Dr. Kathryn Mitchell, an emergency room
doctor at the Phoenix VAMC, who told me how she disclosed improper
staffing in the emergency department and secret waitlists. Management
retaliated against Dr. Mitchell by removing her as the emergency
department director. In addition to these stories, which I am
personally familiar, the Office of Special Counsel shared several
additional accounts of whistleblower retaliation to President Obama in
its letter dated September 17, 2015. These stories are just as
disturbing as what I have encountered in Illinois and continue to occur
across the VA system where the VA focuses on the conduct of employee
whistleblowers rather than the reported wrongdoing of the Department,
such as when at the Department of Veterans Affairs Medical Center
(VAMC) in Philadelphia, Pennsylvania, a food services employee reported
improper sanitation and safety practices and was fired after being
accused of eating four expired sandwiches instead of throwing them
away. At the Puerto Rico VA, the Department sought to remove an
employee who disclosed the hospital director's misconduct. Instead of
investigating the director's misconduct, the VA claimed the employee
made an unauthorized disclosure of information and then tried to remove
the privacy officer, in part because she concluded that the
whistleblower did not make an unauthorized disclosure. A VA employee in
Wisconsin sent an email to VA privacy and compliance officers
disclosing concerns about improper disclosures of veterans' health
information. Again the VA targeted the employee and fired her for
sending an email that contained personal information about a veteran.
At the Wilmington, Delaware VAMC, a nurse disclosed improper treatment
of opiate addiction and was retaliated against by receiving a 14-day
suspension for minor allegations of misconduct. Ryan Honl was an
employee at the Tomah VAMC in Tomah, Wisconsin and filed for
whistleblower protection after being asked to falsify attendance
records. Two weeks later, he resigned citing harassment and further
disclosed problems with opioid over prescription at Tomah VAMC. The VA
fired an employee who is a disabled veteran in Baltimore, Maryland, for
pre-textual reasons after the employee petitioned Congress for
assistance with the employee's own veterans benefits claim. In Kansas
City, the Department fired an employee who reported improper scheduling
practices, claiming for the first time after her disclosures that she
was acting ``too slowly'' in scheduling appointments for veterans.
These stories are the reason why I crafted this bill that will
protect our protectors. The VA Patient Protection Act seeks to set up a
process to PROTECT whistleblowers while PUNISHING those who retaliate
against whistleblowers to ENSURE better care for our veterans. My bill
will 1) increase accountability within the VA by creating a formal
process/paper trail at the VA for whistleblower complaints and
responses; 2) allow employees to file complaints with the next level
supervisor if the immediate supervisor fails to properly handle the
complaint or is the focus of complaint; 3) ties supervisors'
performance rating to how they respond to whistleblower complaints; and
4) force the VA to strongly punish those who are found to retaliate
against whistleblowers: for a first offense a minimum of a 12-day
suspension and for a second offense removal.
These measures will show VA employees that supervisors must pay
attention to whistleblower allegations, will be held accountable for
how they handle those allegations, and ultimately will be punished if
found to retaliate against whistleblowers for making allegations.
Currently, the VA has no mechanism to track whistleblower
complaints and how they are handled; this makes it difficult for the VA
to enact change and for Congress to understand what, if any,
improvements the VA has made to improve its culture of retaliation
against whistleblowers. The VA Patient Protection Act addresses this
problem by creating the Central Whistleblower Office, an independent
office to exclusively address whistleblower cases in the VA; requiring
the VA to annually conduct in person training to all employees about
whistleblower rights, Privacy Act, and HIPPA exemptions; and requiring
that the VA annually report to Congress on whistleblower complaints.
Stronger whistleblower protection is needed in the VA due to the
increase in whistleblower complaints and instances of retaliation.
According to the Office of Special Counsel (OSC), it will receive
nearly 2,000 whistleblower disclosures from Federal employees in 2015
and at current levels, approximately 750 or 37.5% of these disclosures
will be filed by VA employees.\1\ In addition, Dr. Lisa Nee, Germaine
Clarno, and Shea Wilkes provided statements for the record for this
hearing, which further illustrates the need for enacting my bill and I
ask that their statements be included with the record.
---------------------------------------------------------------------------
\1\ Written Testimony of Carolyn Lerner, Special Counsel, OSC for
US Senate Committee on Appropriations Subcommittee on Military
Construction, Veterans Affairs, and Related Agencies ``Review of
Whistleblower Claims at the Department of Veterans Affairs,'' July 20,
2015.
---------------------------------------------------------------------------
I am committed to ensuring our veterans receive the care they
deserve from our VA hospitals and care providers, whistleblowers play
an indispensable role in preventing fraud, waste, abuse, and gross
misconduct at our VA facilities. I believe that the VA Patient
Protection Act will start to change the culture at the VA by educating
VA employees on their whistleblower protection rights and holding
management accountable for their treatment of whistleblowers. Our
veterans, who bravely served our country, deserve the best medical care
and services available and at the very least deserve their leaders'
attention to people and systems that obstruct them from receiving that
care.
Thank you.
______
Prepared Statement of American Academy of Physician Assistants
On behalf of the more than 104,000 nationally-certified physician
assistants (PAs), the American Academy of Physician Assistants (AAPA)
appreciates the opportunity to submit a statement for the record
regarding S. 2134, the ``Grow Our Own Directive: Physician Assistant
Employment and Education Act of 2015.'' AAPA is very pleased to endorse
this critically important legislation.
Ready access to quality patient care is among the most critical
issues facing our Nation's veterans. AAPA believes PAs are a key part
of the solution to increasing access to quality medical care at VA
medical facilities. PAs provide high quality, cost-effective medical
care in virtually all health settings and in every medical and surgical
setting. They are educated to seamlessly work in a healthcare team, and
they manage the full scope of patient care, often handling patients
with complex diagnoses or multiple comorbidities, conditions which
commonly occur within the Nation's veteran population. The private
healthcare market has embraced and rewarded the use of PAs to alleviate
healthcare provider shortages; it is time the VA does too.
The PA profession has long been connected and committed to veterans
and veterans' healthcare. The first PA students were Navy Corpsmen who
served in the Vietnam War; and recruitment of and support for veterans
in PA educational programs continues to this day. As of 2014, nearly
12% of all PAs are veterans, active duty, or retired military in the
National Guard and Reserves, and more than 2,000 PAs are currently
employed by the U.S. Department of Veterans Affairs.
Given all that PAs can offer to the Veterans Health Administration
(VHA), AAPA is very concerned that PAs are one of the top five medical
professions experiencing shortages within the VA healthcare system.
Both the January 2015 and September 2015 VA Office of Inspector General
(OIG) reports recognize the importance of PAs as part of VHA's
healthcare team, and both reports identify PAs within the five
occupations with the ``largest staffing shortages.'' S. 2134 proposes a
two part approach to recruiting and retaining a VA PA workforce--the
GOOD pilot program and a VHA commitment to recruiting and retaining
PAs.
good pilot program
The Good Pilot Program is designed to create a pathway for veterans
to become educated as PAs and adds to the supply of PAs in VA medical
facilities. We are confident this pilot program will work because:
Medical schools and universities have recruited veterans
into PA educational programs since the profession began nearly 50 years
ago. In the last several years, the Health Resources Services
Administration (HRSA/HHS) studied best practices for recruiting and
retaining veterans in PA educational programs and GOOD will utilize
these best practices.
Data compiled by the MEDEX PA Program in Washington, which
has a long history of recruiting veterans into its program, reports
that veterans who are educated as PAs make particularly good PAs. And,
veterans who become PAs are well suited to provide medical care in
medically underserved communities.
It mirrors the National Health Service Corps, a model that
has been educating PAs and other healthcare professionals for decades
in exchange for a commitment to serve in medically underserved areas.
The private healthcare market values PAs who were former
veterans. For example, Blue Cross/Blue Shield recently invested in
instituting a PA program at the University of North Carolina, whose
mission will be to educate veterans as PAs for service in the state's
medically underserved areas. Recognizing the additional skill sets
offered by healthcare professionals who are veterans, the American
Hospital Association recently convened a series of meetings on
recruiting PAs and other healthcare professionals who are veterans to
hospitals.
national vha strategy to recruit and retain pas, including
competitive pay for pas
Critical to S. 2134 is its requirement that the VHA make a
commitment it has not previously undertaken--a plan to grow and
maintain its PA workforce. VA compensation for PAs simply can't compete
with the salaries offered in the private market. Additionally, PAs and
nurse practitioners (NPs) employed by the VA perform nearly identical
functions and are employed in the same manner, but PAs are at a
competitive disadvantage. NPs often start at a higher grade than PAs,
and it is not uncommon for NPs in the VA to be compensated by as much
as $30,000 more than PAs while providing the same medical services.
To AAPA's knowledge, the VHA has not expanded recruitment and
retention initiatives for PAs in response to the identification of PAs
as one of the VA's top five critical occupation shortages. The VA has
always had the authority to include PAs in the Locality Pay for Nurses
and other Healthcare Professionals, but has chosen not to do so. The
addition of PAs to the VA locality pay system could assist the VA in
recruiting PAs to replenish the ranks of approximately 40 percent of
the VA PA workforce eligible for retirement within the next five years.
The value of the PA profession is highly regarded and in demand by
the private market:
Demand for PAs increased more than 300 percent from 2011
to 2014, according to the national healthcare search firm Merritt
Hawkins.
Upon earning their certification, 63 percent of PAs
accepted a clinical positon and 76 percent of these received multiple
job offers. (National Certification Commission for the Physician
Assistant (NCCPA) 2014 Statistical Profile of Certified Physician
Assistants).
Nearly half (46.7%) of PAs who have accepted a position,
indicated that they did not face any challenges when searching for a
job.
64.7% of the recently certified PAs who accepted a
position indicated they were offered employment incentives. (NCCPA 2014
Statistical Profile of Certified Physician Assistants).
Employment of PAs is projected to increase 38.4 percent
between 2012 to 2022, much faster than the average for all occupations,
according to the U.S. Bureau of Labor Statistics (U.S. Department of
Labor, Occupational Outlook Handbook, 2012-2013 Edition, Physician
Assistants).
Forbes, Young Invincibles and Glassdoor.com all reported
that the #1 most promising job of 2015 is becoming a PA.
U.S. News & World Report ranked the PA profession as one
of the top 10 best jobs of 2015.
An historic lack of attention to recruitment and retention of PAs
by the VA, coupled with the high demand and economic reward for PAs in
the private healthcare market, has resulted in a significant challenge
for the VA to fill PA positions. Unless the VA invests in its PA
workforce, AAPA believes the VA will lose its PA workforce.
S. 2134, the ``Grow Our Own Directive: Physician Assistant
Employment and Education Act of 2015,'' represents a significant step
forward in building and sustaining the VA's PA workforce through
proposals to create a five year pilot program to educate veterans as
PAs and to require the VA to establish a national strategic plan to
recruit and retain PAs, including the adoption of standards leading to
competitive pay for PAs employed by the VA. AAPA would be pleased to
serve as a resource to the Committee in making recommendations to
support the VA's PA workforce. Thank you again for the opportunity to
submit a statement for the record in support of S. 2134.
______
Prepared Statement of Germaine Clarno, LCSW, CADC and Local President
of the American Federation of Government Employees
Senator Kirk, Thank you for the opportunity to provide my testimony
to discuss the culture of continued fear and retaliation at Edward
Hines, Jr. Hospital.
I also want to personally thank you for your unrelenting efforts in
protecting those that nobly care for our Nation's veterans. The VA
Patient Protection Act will include a method to protect whistleblowers
while holding those who retaliate against whistleblowers accountable
and as a result will provide better care for our veterans.
I am a Social Worker and Local President of the American Federation
of Government Employees (AFGE). I have worked at Edward Hines, Jr.
Hospital in Illinois for 6 years, 2 years after receiving a Masters in
Social Work. Social Work is a second career, it was important to me
that I work with veterans so I was elated with the opportunity to work
at the VA. It has been an honor and privilege to serve our nations
veterans in the capacity of a mental health provider. I have worked
alongside amazing dedicated employees that share the same passion for
helping our veterans heal from the invisible wounds of war.
Unfortunately, I experienced early in my career the toxic culture
of fear. Asking a simple question or suggestion can result in career
sabotage. I witnessed good intentioned professional employees be
retaliated against for simply wanting to raise issues that interfered
with quality health care for our veterans. After 3 years working in
mental health, I had experienced and witnessed deplorable treatment of
employees that dared to speak up against fraud, waste and abuse. My
dedication to our veterans convinced me to explore means to improve the
culture at Hines. The root cause was mistreatment of frontline
employees that did not have a voice or an advocate. I then became a
Chief Steward for Local 781 at Hines, with determination and the union
contract, I optimistically marched onward with an honored mission to
change the culture at Hines.
The Master Agreement (our union contract) states in our preamble
``The Department and the Union agree that a constructive and
cooperative working relationship between labor and management is
essential to achieving the Department's mission and to ensuring a
quality work environment for all employees.''
This agreement is not honored by the leadership at Hines. They
spend more time finding loop holes of the contract and ways not to
comply with this simple agreement, which is also an element of
Secretary McDonald's ``Blue Print for Excellence.'' He states ``VA will
become an organization where employees are comfortable raising issues
and concerns. Only then, can we truly thrive and innovate.'' This plan
for change was published a year ago and employees are still afraid,
more than ever.
During my time as a union representative I have seen firsthand the
obstacles for employees to perform at the highest level due to an
environment that is not conducive to enhancing employee morale and
efficiency. In the fall of 2012, after exhausting all avenues with in
her chain of command, Dr. Lisa Nee came to me, as other employees have
with overwhelming evidence of wrongdoing by the leadership at Hines.
The severe retaliation that Dr. Nee's experienced as the result of
her disclosure is not unique. Retaliation at Hines is a systematic
campaign of interpersonal destruction that jeopardizes employee's
health, careers, and the jobs they once loved. These forms of
retaliation is a nonphysical form of violence, but because it is
violence and abusive, emotional harm often is the result.
It's been over a year since I first disclosed wrong doing at Hines
in regards to waitlists--scheduling manipulation and excessive wait
time for veterans requesting individual therapy for PTSD on CBS evening
news. The very next day of my disclosure the Hines leadership had a
meeting without my knowledge, in the chapel, with approximately 300 of
my coworkers from mental health. That day 300 employees were taken away
from their work areas and were not serving veterans. The purpose of the
meeting was to discredit my claims and turn my coworkers against me.
That same day I received emails and voicemails from my supervisor
ordering me to report to the criminal division of the OIG on Hines
Campus.
What was more outrageous is that leadership attempted to discredit
a veteran that also was in this news story by sharing information from
his medical chart. Blaming him for the delays by saying that he
canceled appointments or was a no show. Veterans aren't immune to
retaliation at Hines.
I wish I could report that things have improved at Hines but the
sad truth is it has not. Just in the past couple of weeks employees
have been severely retaliated against. One of these employees is
Jasmine Ramakrishna. Jasmine gave me permission to tell her story
today. Jasmine is a Dental Hygienist at Hines, like most of our front
line employees she is dedicated to serving veterans. She has reported
wrongdoing on issues in the dental clinic to include unnecessary
procedures (for the purpose of increasing productivity) and issues with
assessments and coding procedures. As a result of her raising concerns,
she is currently being retaliated against. Jasmine has always been
rated outstanding on her performance appraisals but when she received
her performance appraisal a few weeks ago her rating was lowered.
Jasmine and I met with her supervisor to discuss her rating and he
responded that she has violated the VA Code of Conduct. Jasmine has
never been counseled or informed of any wrongdoing but in this meeting
he referenced a folder that contained information that he ``has on
her'' and is refusing to share with the employee. As you can imagine
this is devastating for this employee. This is example of a supervisor
using his power to make false allegations and violate the law to harass
and intimidate an employee. The union has filed grievances and he is
refusing to respond. As a result, the union has filed two separate
Unfair Labor Practices with the Federal Labor Relations Authority
against the agency.
This same supervisor, the Chief of the Dental clinic is also
harassing another employee, a dentist. This supervisor is asking co-
workers to surveillance him. After a meeting I had with this supervisor
to notify him that asking co-workers to surveillance other employees is
not appropriate and is illegal, he called the police and made a false a
report that I was aggressive and threatening him. This event took place
just this past Monday. Ironically, one of Senator Kirk's staff members
was in my office when the police arrived and witnessed the harassment.
That same day I notified Hines leadership of this disgraceful conduct
and I have not received a reply. Another form of retaliation is to
ignore the complaint or justify the supervisor's behavior.
My concern is for our veterans. When employees are being
intimidated and retaliated against for speaking up for quality care,
the Nation's veterans pay the price. In order to retain the best and
brightest healthcare providers, to service the needs of our Nation's
heroes, we must rid our workplace of the toxic, retaliatory practices
engaged in by management.
______
Prepared Statement of Paul R. Varela, Assistant National Legislative
Director, DAV (Disabled American Veterans)
Chairman Isakson, Ranking Member Blumenthal, and Members of the
Committee: Thank you for inviting DAV (Disabled American Veterans) to
submit testimony for the record of this legislative hearing, and to
present our views on the bills under consideration. As you know, DAV is
a non-profit veterans service organization comprised of nearly 1.3
million wartime service-disabled veterans. DAV is dedicated to a single
purpose: empowering veterans to lead high-quality lives with respect
and dignity.
s. 2106--the wounded warrior employment improvement act of 2015
This bill would require the Secretary of the Department of Veterans
Affairs (VA) to analyze VA's Vocational Rehabilitation and Employment
(VR&E) services and make recommendations in a report to Congress for
the purpose of encouraging more service-disabled veterans to use the
benefits of Chapter 31, title 38, United States Code, versus services
authorized in Chapter 33 of the Code. The bill also would require an
action plan be developed to improve the vocational and employment
services and assistance provided to veterans under chapter 31. The
required report would include a plan to remedy certain workload
management challenges at VA regional offices (VARO), including reducing
counselor caseloads for veterans participating in rehabilitation, and
in particular counselors assisting veterans with Traumatic Brain Injury
and Post Traumatic Stress Disorder, and also counselors with dual
educational and vocational counseling workloads.
The bill also would require VA to analyze and assess the decisions
and circumstances of veterans with service-connected disabilities who
served on or after September 11, 2001 who choose not to participate in
rehabilitation under Chapter 31 but instead use their entitlement to
educational assistance under Chapter 33. The analysis required by this
bill would examine barriers to timely enrollment in rehabilitation
programs under Chapter 31 and any additional barriers to a veteran's
enrollment.
The bill would require VA to report within 270 days of the date of
its enactment, and to develop and publish the action plan to improve
the services and assistance provided under Chapter 31.
DAV has no resolution from our membership on the particular issue
within this bill. While we would not oppose passage, we have identified
some concerns that we recommend be addressed prior to passage of this
bill.
DAV recognizes the intrinsic value of Chapter 31 vocational
rehabilitation services for wounded, ill and injured veterans. However,
encouraging those veterans with eligibility under Chapter 33 to instead
use Chapter 31 authority would require additional resources in VR&E to
meet the increase in demand.
Today, VR&E's counselor-to-client ratio is far too high, at 1:135.
This ratio has been historically disproportionate and contributes to
the delays in the administration of timely and effective services.
However, the average ratio can be misleading. For example, the
Cleveland VARO's counselor-to-client ratio is 1:206, but in the Fargo
VARO it is 1:64.
Ideally, an effective counselor-to-client ratio would be 1:125, as
has been advocated by the Independent Budget for the past several
years. In order to achieve the 1:125 counselor-to-client ratio in FY
2016, VR&E would require an additional 382 full-time employee
equivalents (FTEE), of whom 277 would be dedicated as VR&E counselors
and the remaining 105 employees would be in support services, bringing
VR&E's total FTEE strength to 1,824. While increased staffing levels
are required to provide efficient and timely services, it would also be
essential that these increases be properly distributed throughout VR&E
to ensure that counselors' caseloads are equitably balanced among
VAROs.
DAV calls on Congress to increase staffing levels within VA's VR&E
program in accordance with DAV Resolution No. 135, approved by our
membership at our most recent National Convention. As contemplated by
this bill, if Congress intends to encourage increased use of Chapter 31
services, versus services afforded under Chapter 33, then adequate
resources would be essential to strengthen this critical program to
meet the increased demands inherent in servicing more eligible service-
disabled veterans for their rehabilitation and vocational needs.
s. 2134--the grow our own directive: physician assistant employment and
education act of 2015
This bill would direct the VA to carry out a five-year pilot
program to provide educational assistance to certain veterans for
education and training as VA physician assistants.
Under this bill, the pilot program would target veterans with
experience gained in medical or military health while serving; had
received a certificate, associate degree, baccalaureate degree,
master's degree, or post-baccalaureate training in a science related to
health care; had participated in the delivery of health care services
or related medical services. The bill would exclude physicians and
dentists from participation.
The bill would require VA to provide educational assistance,
including scholarships, to no fewer than 250 participants. VA would
reimburse their costs of obtaining master's degrees in physician
assistant studies or similar master's degrees. The bill would require
VA to make available mentors for participants at each VA facility at
which a veteran is participating, and would require VA to establish
partnerships with other government programs and with a significant
number of educational institutions that offer degrees in physician
assistant studies.
The bill also would require VA to establish standards to improve
the education and hiring of VA physician assistants, and implement a
national plan for the retention and recruitment of VA physician
assistants.
The bill would establish a series of new, mandatory positions in
VA's national Office of Physician Assistant Services in VA Central
Office, including a Deputy Director for Education and Career
Development, a Deputy Director for Recruitment and Retention, a
designated recruiter of physician assistants, and an administrative
assistant to support these functions. The bill would specify their
major duties.
The bill would redesignate not less than $8 million in funds
appropriated prior to the passage of this bill to carry out its
purposes. The bill is silent on sources of any additional funding that
might be needed to meet its mandates.
Finally the bill would align VA physician assistant pay grades
equivalent to the pay grades of VA registered nurses.
DAV has not received a national resolution from our members dealing
with VA recruitment, training or employment of physician assistants;
therefore, DAV takes no formal position on this bill. Nevertheless, we
observe that this bill is unusually prescriptive, is not based on any
broadly understood need for VA to hire additional physician assistants,
and assumes these 250 individuals who would undergo the subsidized VA
education and training the bill would authorize, are in fact needed by
VA. Also, the bill would divert previously appropriated funds from
other purposes to serve this new, unanticipated purpose. These issues
raise a number of concerns that we ask the Committee to consider as it
deals further with this bill.
s. 2170--the veterans e-health and telemedicine support act of 2015, or
the ``vets act of 2015''
This bill would enable a health care professional of the VA,
including a contract provider, who is authorized to provide health care
by or through VA, and who is licensed, registered, or certified in a
state to practice his or her profession at any location in any state,
regardless of where the professional or veteran is located, to treat a
veteran through telemedicine. If enacted the bill would permit
telemedicine treatment regardless of whether the professional or the
patient were physically located in a federally owned facility.
The bill would require VA to report to Congress one year following
its implementation on a variety of aspects of VA's telemedicine
program, including patient and provider satisfaction, access,
productivity, waiting times and other information related to
appointments made and completed through telemedicine.
Because health professional licensure is a state-regulated
function, as a national system VA has experienced barriers in its
efforts to broaden the use of telemedicine across state lines. A number
of VA telemedicine initiatives have been frustrated because of the
interstate restriction. Enactment of this bill would eliminate that
barrier, and would promote much greater use of telemedicine, especially
in facilities whose treatment populations come from multiple states
(Martinsburg, WV--patients from VA; Washington, DC--patients from VA
and MD; Pittsburgh, PA--patients from OH; New York City, NY--patients
from NJ; Boston, MA--patients from NH, VT and ME; Fayetteville, AR--
patients from MO, OK, and KS, etc.). Enactment of this bill would open
the door to VA specialists treating veterans through telemedicine
irrespective of state jurisdiction, physical location, or the distance
that separates patient from provider (for example, VA specialists in
Seattle telemedically treating VA patients at the VA Outpatient Clinic
in Anchorage, AK), and should also be highly cost-effective and more
convenient for veterans who live at a distance from their VA medical
centers, or who must travel long distances for access to basic VA care.
Delegates to our most recent DAV National Convention approved
Resolution No. 126. Among other priorities, this resolution calls on VA
and Congress to establish and sustain effective telemedicine programs
as an aid to veterans' access to VA health care, particularly in the
case of rural and remote populations. Our delegates also approved
Resolution No. 226, fully supporting the right of rural veterans to be
served by VA. This bill is consistent with these resolutions and DAV
policy; therefore, DAV strongly supports its enactment and appreciates
the sponsors' intention to promote the use of telemedicine in the care
and treatment of veterans.
s. 2253--department of veterans affairs veterans education relief and
restoration act of 2015
This bill would address a veteran's continued entitlement to VA
education benefits in situations in which an educational institution
permanently closed prior to the completion of a term, quarter, or
semester. Under current law, a veteran in this circumstance would be
penalized by a charge against educational entitlement for failing to
successfully complete the prescribed period of education. VA also
reclaims living allowances and other payments as if the veteran simply
withdrew from the educational institution. This bill would hold
harmless a veteran in such a situation.
Under this bill, if a veteran were forced to discontinue a course
as a result of an educational institution's permanent closure and did
not receive full credit for, or lost training time toward completion
of, the VA-approved education program, VA educational assistance
payments would not, for a specified period of time thereafter, be
charged against the individual's entitlement to educational assistance,
or counted against the aggregate period for which VA assistance would
be provided in the absence of such a closure.
The bill would require VA to continue to pay the approved monthly
housing stipend following a permanent school closure, but only until
the earlier of: (1) the date of the end of the term, quarter, or
semester during which the school closure occurred; or (2) the date that
is four months after the school closure.
The bill also would require VA to continue to pay educational
assistance and subsistence allowances to veterans and other eligible
persons enrolled in specified courses for up to four weeks in any 12-
month period if their schools were closed temporarily under an
established policy based on an executive order of the President, or due
to an emergency situation.
The effective date of this bill would begin retroactively with
Fiscal Year 2015.
DAV has received no resolution from our membership that would
address the purposes of this bill. However, the bill seems to be a
reasonable accommodation for a situation that has been reported,
affecting educational entitlements of numerous veterans who are
victimized by unexpected, permanent school closures. DAV would not
object to passage of this legislation.
draft bill--the veterans affairs retaliation prevention act of 2015
If enacted this bill would sanction VA employees who take
retaliatory steps against other employees when truthful complaints are
made about waste, fraud, gross mismanagement, and risks to life and
safety of veterans. The bill also would specify a number of procedures
and actions VA would be required to take to address and document
complaints made, while protecting the VA employee(s) who made them. The
bill also would establish a central repository of complaints made that
are subject to the purposes of the bill. The bill would restrict the
payment of bonuses to VA supervisors who are found to have committed
prohibited personnel actions in circumstances as defined in the bill.
The bill would require VA to create a whistleblower training
program, and would require VA to train every VA employee in
whistleblower rights, including the right to petition Congress, and in
the processing of complaints and related matters.
The bill would require a series of reports to Congress related to
its purposes, and would require the VA Office of Inspector General
(OIG) to make public, and provide to Congress broadly and on request in
specific cases, all OIG work products that make recommendations or call
for corrective action in any VA matter.
The final section of this bill would declare that official
testimony before Congress by any VA employee to be that of official
duty by that employee, including coverage of salary and travel support.
Delegates to our most recent National Convention approved
Resolution No. 214. This resolution requires that any legislation
changing existing employment protections in VA must strike a balance
between holding civil servants accountable for their performance, while
maintaining VA as an employer of choice. Resolution No. 214 does not
directly discuss the plight of VA whistleblowers, but DAV supports
fairness for all VA employees, including those whom this bill would
declare to be whistleblowers. Therefore, DAV would not object to the
passage of this bill.
Mr. Chairman and Members of the Committee, this concludes DAV's
testimony. We thank the Committee for inviting DAV to submit this
testimony for the record of this hearing. DAV is prepared to respond to
any further questions by Committee Members on the positions we have
taken with respect to the bills under consideration.
______
Prepared Statement of Susan Tsui Grundmann, Chairman,
U.S. Merit Systems Protection Board
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______
Prepared Statement of Lisa M. Nee, MD, Interventional Cardiologist
Dear Committee members, thank you for the opportunity to provide
written testimony for the record in support of Senator Kirk's VA
Patient Protection Act. I wish to extend my gratitude to Senator Kirk
and his staff for the continued attention to the alarming matter of
whistleblower retaliation and for moving forward with this important
legislation. Although there is significant rhetoric from various
branches of government that this type of behavior is detrimental to the
care of the veteran, there seems to be no end in sight for those who
continue to face retribution for taking the courageous step of coming
forward. A September 2015 report from the Committee on Homeland
Security and Governmental Affairs stated the Office of Special Counsel
has received 35% of its entire retaliation case load from VA employees.
Despite its efforts to prioritize investigations, Special Counsel
Carolyn Lerner testified before Congress in August of this year that
the volume of incoming VA complaints remains overwhelming. This clearly
demonstrates the severe, dysfunctional culture within the VA that
encourages retaliation against the very individuals who expose harm to
the veteran and attempt to improve the health care delivery process.
There are many journeys we all participate in during the course of
our lifetime. Some are arduous, many are attainable, but none has been
more agonizing and unfulfilling than the current process of obtaining
justice for the men and women who have fought for our freedom. I
realize that not every complex situation in life presents itself with
moral clarity, however this is not one of them. Caring for our veterans
should be elementary. There should never be a single instance where a
physician must choose between self-preservation and the life of a
patient. Or suffer an assault to their character in order to obtain
accountability for criminal and inhumane acts against patients and
fraudulent behavior toward the taxpayer. The amount of bureaucratic
gymnastics coupled with agency corruption can render the strongest
individual forlorn and exhausted. Knowing when to lose with grace is an
honorable skill and one that requires precise timing--this is not that
time. Armed with voracity for equity, an insatiable appetite for the
truth and a colossal amount of evidence, I am prepared to continue this
battle until there is responsibility from leadership and transformative
action which will hold those at fault accountable.
My personal journey began over 4\1/2\ years ago with exposure to
the corruption at Hines VAMC regarding patients who died of cardiac
complications while awaiting their cardiac ultrasound to be read.
Unfortunately for them the tests were hidden in bankers boxes and left
unread for a year. The mere questioning of such an egregious act
resulted in significant retaliation, which went unabated the entire two
years I was employed at Hines. But hell hath no fury like a VA
administration scorned, and the retaliation continued even after I
resigned, with the Office of Inspector General (OIG) and its pervasive
culture of disparaging the truth teller. Multiple allegations regarding
deficiencies in cardiovascular care were made including, but not
limited to: patient's having their chest sawed open for unnecessary
procedures, disparities in care based on ethnicity, procedural
diagnostic errors resulting in harm and pervasive billing fraud. These
allegations have resulted in an initial deficient OIG investigation, a
subsequent OSC investigation, a second contemptible OIG investigation,
insistence from the OSC for an authentic and thorough investigation,
and culminating with an ongoing Office of Medical Inspector's (OMI)
investigation. It is a mind numbing process to not only keep track of
the endless agency acronyms, but also calculating the amount of wasted
taxpayer dollars consumed by these ineffectual inquiries. They are not
true investigations for they lack experienced subject matter experts
and have a pre-determined conclusion, which maintains the status quo.
The path this case has taken over the last four years has been
objectively obfuscated, and its bureaucratic oscillations can only be
the result of stunning deficiencies at all levels of the VHA
leadership. The task has become the exercise within itself. To engage
in multiple investigations by varying internal agencies which have
substantiated patient harm as well as criminal activity, and to never
mention one, single word regarding accountability--one can only
conclude this maladjusted behavior is designed to serve the agency
itself, and not the veterans. It is the VHA leadership attempting to
gain credit for oversight that the agency has failed to provide.
Duplicitous. No other word describes it. The OMI report from July 2015
substantiated some of my allegations regarding deficiencies in
cardiovascular care, deficiencies in echocardiogram processing, failure
to disclose deficiencies in care and harm to patients, inflated
productivity measures by cardiologists and evidence that Veterans were
inappropriately charged copayments for care they never received,
otherwise known as billing fraud. In regards to this billing fraud, the
report states, ``We found that these actions possibly violate 18 US
Code 208--Acts affecting a personal financial interest.'' The OMI
referred this criminal matter to the OIG who has declined to open a
criminal investigation.
Interestingly the bulk of the report is dedicated to the fraudulent
billing practices, including in depth statistical analysis,
diagrammatic explanations and extensive billing pattern documentation.
This provides a glaring contrast to the lack of investigative fervor
and expertise when dealing with patient morbidity and mortality.
However all this effort is for naught as the end result once again
allows the documented criminal activity to go unpunished. For the
agency to demand an OMI investigation yet deny the credibility of
criminal findings is administrative misconduct. The OIG must adhere to
the Quality Standards for Investigations issued by Council of Inspector
General on Integrity and Ethics (CIGIE) and the Attorney General
Guidelines for OIG with Statutory Law Enforcement Authority. You don't
get to be above the law just because you work for the VHA. Or do you?
An equally compelling question is, if the OMI substantiated findings
and then those are ignored, why do we need any of these investigative
arms within the VA? They are redundant and wasteful and should be
restructured.
To sum up the totality of all the reports to date is to call them a
mismatch between words and deeds. A failed promise to treat and protect
the veterans, while instead protecting hundreds of useless report
generators who will then retire with benefits. The investigators have
gone so far out of their way to protect the VHA leadership that it has
rendered every investigator impotent and every investigative finding
ineffectual. They are highly skilled at one part of their job,
generating a paper trail designed to justify their professional
existence. But they have failed at their original mission statement and
severely compromised the health care of the men and women who have
fought for our freedom. In order for any type of transformative action
to begin to take shape and halt systemic corruption, there must be
protection for truth tellers, accountability for those who fail at
their duties and transparency to illuminate both operational
deficiencies but also properly analyze collected data. These are far
from novel concepts and are most certainly codified in policy and
procedure. Chairman Kirk's VA Patient Protection Act will demand
accountability for those who retaliate against truth tellers and
empower those who can begin to make a positive impact on the outcomes
of patient care. Preventing retaliation in the current defective
culture of the VA requires deterrents, which should be timely,
formidable and indelible. This bill would properly punish VA
supervisors who have been found to take retaliatory actions against
whistleblowers. There can be no saving of an agency as large as the VHA
if the employees operate from a constant position of fear, rather than
conviction and collaboration.
An additional step toward agency accountability, which should be
addressed by Congress, is extending legislative authority to the OSC in
two arenas. 1. Allow the agency to embark on a criminal investigation
or partner with the Department of Justice if the preponderance of
evidence suggests illegal activity and 2. Grant the OSC the necessary
authority to determine the corrective action and punishment once the
allegations are substantiated. They have independent authority to
determine if conduct constitutes a violation of law, rule, gross
mismanagement and a substantial and specific danger to public health.
If they can determine the crime, they should be allowed to determine
the punishment.
Many people have asked me why I continue to fight for the veterans
even though I have left the VA. ``What can you do?'' I want the
American public to contemplate that question for a moment and then
consider an alternative perspective, and perceive it as ``What should I
do?'' With that, the only acceptable response would be to strive for
social justice and search for the truth.
Which brings us to the truth. A glorious, unadulterated supreme
reality, holding the ultimate meaning and value of existence,
corroborated by evidence. It does not change over time, as it never has
to rely on anybody else's interpretation. As a Nation, we can achieve
this goal for the genuine protectors of truth, our veterans.
______
Prepared Statement of Carolyn N. Lerner, Special Counsel, United States
Office of Special Counsel
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______
Prepared Statement of Paralyzed Veterans of America
Chairman Isakson, Ranking Member Blumenthal, and Members of the
Committee, Paralyzed Veterans of America (PVA) would like to thank you
for the opportunity to submit our views on legislation pending before
the Committee. We appreciate the Committee focusing on these critical
issues that will affect veterans and their families.
s. 2106, the ``wounded warrior employment improvement act of 2015''
PVA supports S. 2106, the ``Wounded Warrior Employment Improvement
Act of 2015,'' which would require the Department of Veterans Affairs
(VA) to develop and publish an action plan for improving services and
assistance provided through VA's Vocational Rehabilitation and
Employment (VR&E) program (Chapter 31). Returning to the workforce is a
critical aspect of recovery for many catastrophically disabled
veterans. This legislation would require VA to evaluate barriers to
participation in VR&E and implement efforts to improve counselor
training. It would also seek to improve counselor workload
requirements.
A client to counselor ratio of 1:125 is recognized as a full
workload in the field of vocational rehabilitation counseling. In
January 2014, the Government Accountability Office issued a report
calling on VA's VR&E program to implement performance and workload
management improvements. At that time, caseloads for VR&E counselors
ranged up to 1:139.\1\ When counselors are required to work with more
than 125 clients, the employment counseling process is delayed. This is
particularly true when counselors are working with veterans who have
significant disabilities and increased barriers to employment.
---------------------------------------------------------------------------
\1\ Government Accountability Office, ``VA Vocational
Rehabilitation and Employment: Future Performance and Workload
Management Improvements Are Needed,'' GAO-14-61, January 2014.
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Although not part of this legislation, efforts to decrease
counselor caseloads and encourage more veterans to participate in the
VR&E program must be supported through increased funding. Congress must
invest in this program to ensure that counselors have the tools and
resources needed to return veterans with disabilities to work.
Otherwise, veterans with significant disabilities, who with proper
supports and services can return to employment, are in danger of
falling out of the workforce.
s. 2134, the ``grow our own directive: physician assistant employment
and education act of 2015''
PVA supports S. 2134, the ``Grow Our Own Directive: Physician
Assistant Employment and Education Act of 2015.'' This bill would set
up a five year pilot program to provide education assistance to
veterans training as physician assistants (PAs) in the Department of
Veterans Affairs. The goal is to train veterans with medical or
military health experience to be readily employable physician
assistants at VA. Section 2 of the bill explains the prioritization of
veteran participants who are in the Intermediate Care Technician
Program and those individuals who plan to work in medically underserved
states with a high population of veterans. To meet these goals the bill
provides funding and support staff to the Office of Physician
Assistance Services. It would also require VA to establish a strategic
plan to recruit and retain PAs and adopt the standards leading to
competitive pay for PAs employed by VA. Currently the vacancy rate of
PAs at VA is 25%, the third largest shortage throughout the health care
system. Recruiting and retaining PAs at VA is critical to improving
access to high quality care. Further, this bill will provide job
opportunities for veterans with medical work histories that are hard to
translate to the civilian sector.
s. 2170, the ``vets act of 2015''
PVA supports S. 2170, the ``VETS Act of 2015.'' This bill would
improve access to telemedicine services from the Department of Veterans
Affairs. Under current law, VA may only provide at-home tele-health to
a veteran if the physician and veteran are in the same state. This
requirement can be a particularly troubling barrier for veterans who
have specific medical or mental health needs, have moved, or live in
rural communities without providers. This bill would alleviate some of
these pressures by waiving the instate requirement, allowing VA health
professionals to operate across state lines.
s. 2253, ``department of veterans affairs veterans education relief and
restoration act of 2015''
PVA supports this legislation as written. Veterans entitled to
education benefits should not be robbed of those benefits due to
external factors beyond their control. A school closure sets an
enrolled veteran back due to the lost time and effort invested without
ultimately earning course credit. This legislation ensures that the
effects of this inconvenience and loss are not amplified by the
additional loss of a semester's worth of benefits eligibility.
the ``veterans affairs retaliation prevention act of 2015''
PVA has no official position on the ``Veterans Affairs Retaliation
Prevention Act of 2015'' at this time. We acknowledge that ensuring
whistleblowers receive a level of protection adequate to encourage
government employees to come forward and expose fraud, waste and abuse
within the government sphere will always be an important issue. We
appreciate and support the initiative Congress is taking to address
these issues both within the VA and across the broader government
sector.
Once again, we thank you for the opportunity to submit for the
record. We look forward to working with the Committee to see these
proposals through to final passage. We would be happy to take any
questions you have for the record.
______
VA Truth Tellers, United States of America,
Shreveport, LA, November 18, 2015.
Hon. Johnny Isakson,
Chairman,
U.S. Senate Veterans' Affairs Committee
Washington, DC.
My personal story begins when I returned to the Mental Health
Department at the Overton Brooks Veterans Administration Medical Center
in December 2011 as the Local Recovery Coordinator (LRC). As the LRC,
my job was to consult directly with the Chief of Mental Health to
convert all existing programs to and to assure all new programs were
operating under the Recovery Model of Care. Thus, my position was
considered part of the Mental Health Leadership team.
It was early in my time as LRC that I started to notice
questionable practices within Mental Health. The first were hiring
practices, treatment of employees and issues with group therapy. It was
obvious that certain persons were given special privileges over other
employees and that certain employees were targeted by members of
leadership. As I began to learn the processes of the VA in more detail,
my role expanded. I took on a performance measure responsibility for
the service (OEF/OIF Performance Measure), attended director staff
meetings, and worked on special projects.
I saw leadership use cronyism in the hiring of a Mental Health
Service Chief that had absolutely no experience and was totally
incompetent. There were several other applicants with 20+ years of
experience, but instead they picked a good ole' boy over the most
qualified. I again watched cronyism rear its head as the hiring process
for the Assistant Chief of Mental Health was manipulated. This time I
decided to report the situation to Human Resources (HR). After speaking
to H.R. and bringing to their attention possible faulty hiring
practices, I was approached by Mental Health leaders and asked to be
the acting PTSD Clinic Coordinator.
A day later I was contacted by telephone by a Mental Health leader
(Operations Manager) who explained that the permanent PTSD coordinator
position would be coming open and it would be a highly competitive
position. My response was ``really that's cool.'' The individual
continued asking if I wanted the position. My response was ``I'd have
to discuss a decision like this one with my wife.'' The Operations
Manager quickly responded ``no don't tell anyone about this.'' Mental
Health leadership made it very clear that if I would back off the
hiring practices of the Assistant Chief of Mental Health, I would be
awarded the PTSD Clinic Coordinator position. I was offended by such an
offer as I had just turned the service in for faulty hiring practices
and now they had the audacity to ask me to do such an unethical act.
Once the leaders of Mental Health learned that I was not going to
accept their offer, the first attempt of reprisal came. The Mental
Health Chief and Operations Manager went to the Administrative Officer
to the Chief of Staff and the Chief of Human Resources and complained
that I had lied on a Learning Development Institute application.
Luckily, I was able to fight this retaliation attempt off. I had kept
cell phone text of conversations between myself and Mental Health
leaders that proved that I had not lied on my application. This
reprisal attempt quietly went away.
Eventually the incompetent Chief of Mental Health stepped down and
the service went without permanent leadership for an extended period of
time. During this time I took on many hats and at one point served as
Acting Assistant Chief of Mental Health. I completed projects for the
Director, Chief of Staff, and developed key ideas that are still being
used in Mental Health today. It was during this time that I started to
learn of number manipulation, scheduling manipulation, and other
unethical acts. I addressed these acts in Mental Health leadership
meetings, with the Chief of Staff, and others, but very little was done
to correct the issues.
Early in 2013 a VA Office of Inspector General (OIG) report was
released concerning unethical acts at the Atlanta VAMC. At this point I
had become totally frustrated with trying to address the corruption
through the internal channels of the Overton Brooks VA system. However,
I decided to give the Chief of Staff one last chance to address the
issues of manipulation of scheduling and numbers.
I reported my concerns one last time to the Deputy Chief of Staff
(COS) (acting COS at the time) about hiring practices, manipulation of
scheduling, and manipulation of numbers. I was blown off by the Deputy
Chief of Staff. It should be noted that later became the permanent COS.
After waiting a month, I decided it was time to report the wrongdoings
to the VA Office of Inspector General. In June 2013, I made an official
VA OIG report related to issues concerning faulty hiring practices
(Chief of Mental Health), manipulation of numbers related to
performance measures, and scheduling manipulation within Mental Health
Service. I never heard one word of response from the VA OIG.
It has now become apparent that the fact that I reported
information to the VA OIG June 2013, was relayed back to the facility.
Looking back it was from that point forward things began to change for
me, not only in Mental Health, but throughout the hospital.
It turned out that the individual that was selected for the
position of Chief of Mental Health was a friend of the Deputy COS.
Again, cronyism was evident--the same manipulation of hiring practice
that I had reported to the VA OIG. By the fall of 2013 I was being
billed as the problem child, trouble maker, and unstable employee. This
was for nothing more than telling the truth. I was approached by
leaders and told to let unethical acts, such as illegal access to my
medical and employment records, go and that I should move forward.
It was apparent that new leadership was not going to address the
unethical activity, but rather it would be allowed to continue and
those unethical persons would be allowed to continue to hold leadership
positions. I would not back down from unethical leaders and I continued
to bring up issues and fight to block unethical acts. This infuriated
those above me and I became a target.
I was called by the Chief of Mental Health to meet with him in his
office. In the meeting, he asked me if I had ever been seen by a
particular Mental Health provider in Mental Health Service. I explained
I had seen the doctor after returning from Afghanistan. The Chief of
Mental Health continued by saying that a colleague had told him I was
unstable and unfit to lead. I explained to him that was interesting
because I was currently the HHD Commander for a USAR Multi-functional
Medical Battalion. I continued by saying that it was obvious that
someone had been in my records. The Chief of Mental Health quickly
stated that he could not remember who told him about my seeing the
particular doctor. I went to the privacy officer after the meeting and
obtained a copy of who had been in my record. I found numerous persons
that had illegally accessed my personal information. The hospital
conducted an investigation but claimed that they had found nothing.
My fate was sealed in the Mental Health Service when I started
questioning compensation time/overtime issues. Around the end of 2013,
I began to suspect fraud related to comp time/overtime. The operations
manager, that offered me the PTSD Coordinator Position to shut up about
the hiring practices, was constantly disapproving everyone's request
for comp time and overtime except for a select few. I started to pay
closer attention to this area of discussion in meetings. The issue hit
a boiling point when the Operations Manager denied my assistant
legitimately earned 3 hours of comp time. The Operations Manager denied
the comp time due to her not being there to approve it before it was
earned. When I inquired as to why there was no other person that could
approve comp time, I was warned by the Chief of Mental Health to let
the issue go. I explained that we would take the issue to higher levels
if need be to obtain the three hours comp time.
At this point there were too many red flags surrounding the issue
for me not to investigate the possible issue more. I later put in a
FOIA request (after leaving Mental Health early 2014) for all Mental
Health leadership's comp time and overtime earned. I discovered the
Operations manager had an extreme number of earned comp time hours and
other certain individuals in the service had extremely high hours of
paid overtime.
I reported my findings through the VA OIG Hotline and had to argue
with the person on the hotline about taking my compliant. At first, I
was told by the hotline that this was a facility problem. I insisted
that it was possible comp time and overtime fraud and my compliant was
ultimately taken by the hotline.
I later learned that the OIG referred my compliant to the Faculty
Director for a response. My understanding is that the issue was passed
on to Chief of Staff, who in turn had Mental Health Leaders provide a
report. In other words, nothing happened.
When speaking with Office of Special Counsel months later, I
explained the comp time/overtime issues. The following week I was
contacted by VA OIG and told the issues were under investigation. I
understand at some point VA OIG was at the facility investigating the
issue but I never spoke to them in person. I later sent a FOIA request
to the VA OIG for information related to the case but was told the case
was still open.
I was systematically removed from Mental Health leadership through
a well-organized manipulated hiring process. The Local Recovery
Coordinator (LRC) position I held was eliminated and a Recovery
Supervisor position was created. The position was an upgrade from GS-12
to GS-13. I had received outstanding and excellent performance
evaluations during my time in the LRC Position. Since the position was
upgraded, I had to reapply. Once again, I was offered the ``hook-up''
but, once again, I declined and insisted that the job needed to be
announced and the hiring process should be completed properly.
The hiring process was completed and I was by far the most
qualified for the position, but was not selected. It was easy to see
that the hiring practices had been manipulated through screening tools.
At this time I knew that I had to get out of Mental Health as the only
positions I was offered were frontline positions under the very people
that I had turned in for unethical acts. I knew that, if I stayed, I
would face the same horrible retaliation from leaders, that I had
witnessed other employees face.
At this point I went through my NFFE Union President to ask the
Director for a transfer out of Mental Health as soon as possible. There
was arguing back and forth about the FTE, but the Director stepped in
prior to her retirement and ordered Mental Health to give up the FTE to
Primary Care so that I could be moved out. In my request, I mentioned
that I would like to move to the OEF/OIF Team, but that I had
experience in numerous areas.
I was moved to the OEF/OIF Care Team which was located on the 10th
floor. My office was located at the opposite end of the 10th floor away
from the OEF/OIF Care Team. My office was a large storage room type
office with no windows. The hospital air conditioning unit was above
the office and made a constant sound of metal grinding. I placed a work
order with engineering which informed me there was no real way to stop
the grinding sound. When I originally moved into this office I was
informed I would only be in office for a month and not to unpack my
boxes. That month turned into several months and I sat in the office
away from my new team members, packed boxes sitting in the corner. The
position created in OEF/OIF was developed to see Veterans but as an
extra staff member with no case management load and few referrals, it
was difficult to meet the expected numbers.
In April 2014 the story of the wait-list at the Phoenix VAMC
surfaced in the media. I had sat in meetings where wait-lists were
discussed and had seen wait-lists during my time in Mental Health
Department. As mentioned, I had already reported wait-time issues and
knew that the scheduling practices were manipulated so that it would
make wait-times look better. Bottom line is I knew from my time in
leadership that several methods were being used to make the 14 day
measure numbers look tremendously better than they were.
After watching the Phoenix VAMC story develop, I decided that I
could not wait any longer for VA OIG to take action on my June 2013
complaints. I contemplated what to do next and felt I had exhausted all
internal options to report the wrongdoings, so I hesitantly decided to
take my story to the media.
I went to the Shreveport Times in May 2014 and worked with a Times
Reporter for 2-3 weeks on the story. As the story develop and it was
close to being released I was told that TV was probably going to
contact me as well as other media sources. I explained that I was not
really wanting to speak with a lot of media, but I would be happy to
speak with one TV media source as long as the story was focused on
Veterans Care issues and not me.
As the time drew closer I feared that once the story was published
that the lists in Mental Health would disappear. I also knew once the
article ran in the media, my life would change forever, especially my
career with the VA. I had seen firsthand how persons who brought issues
forward were treated, but I also knew I could no longer look away as
Veteran received substandard care.
I decided at this time that I needed to secure a copy of any and
every wait-list in Mental Health I could get my hands on. I enquired
from Mental Health colleagues I had worked with previously and learned
that the numerous list had been joined to form one list. Despite fear
of retaliation, with the help of other employees, I was able to obtain
a copy of the lists and other evidence of the lists existence.
The Shreveport Times story on the issues at the OBVAMC ran on
Sunday June 1, 2014. I met for a TV interview on Tuesday, June 3, 2014.
Around the same time I, yet again, filed a report with VA OIG that I
now had a wait-list in my possession and that I knew the hospital was
manipulating numbers and scheduling throughout the hospital. When the
story hit the news, as I anticipated, the list was removed from the
share drive and replaced with a different list that was posted and
password protected.
I sat patiently and waited for VA OIG response, but received
nothing. I watched as the good ole' boy leaders of our facility circled
the wagons and started developing their cover-up stories. I was told by
my frontline supervisor that her boss, the Chief of Primary Care, had
made a visit to her office and was not happy. She explained that he
told her that what I did was wrong and that when things were all said
and done I would be standing here like the officer in the movie
``Bridge Over the River Kwai'' stating ``What have I done, what have I
done.'' Emails were sent out by the Mental Health Service Chief calling
the allegations lies and stating that I was trying to destroy Mental
Health.
He began circulating the story that the list was not a secret wait-
list but a list to help find Veterans that may have slipped through the
cracks. Numerous persons working in Mental Health approached me. They
complained that it was as if Mental Health leaders were trying to
brainwash them into believing their concocted story. But everyone knew
the truth, they knew that the lists were lists of patients who needed
appointments.
For over a month the VA was allowed to develop its story and
propaganda. The hospital even brought in public relations personal from
other facilities and prepared a dog and pony show in which they denied
everything. Several Veterans heard the VA's story of what was going on
and called the TV station and backed up what I was saying. One Veteran
did an interview and explained the exact procedures that were
occurring. He even revealed that he had indeed personally seen the
wait-list.
After patiently waiting for VA OIG to come in and investigate I
decided I could wait no more because the corrupt good ole' boys
continued to cover their tracks. I knew the longer it took
investigators to get to the facility the less they would find. I
contacted Senator Mary Landrieu who sent a letter to Acting Secretary
Sloan Gibson. I also contacted Senator David Vitter's office in an
effort to get OIG to OBVAMC. Senator Vitter office sent a letter to the
VA OIG Director Richard Griffin demanding that the list be
investigated. The next day after the letter was sent I received a call
from a VA OIG Special Agent. The agent explained that he and another
agent were headed to Shreveport from New Orleans and that they wanted
to meet with me. I was excited that finally VA OIG was coming to
investigate.
Due to the timing, I originally believed that the OIG's call was in
response to the request from Senator Vitter. It appeared that after a
year of trying to get the VA OIG's attention, that the existence of the
wait-list and other methods of scheduling manipulation were finally
going to be investigated.
A few hours after I received the first call from the OIG Special
Agents, I received another call from them explaining they had arrived
in Shreveport. They explained that they needed the list and asked if I
wanted to meet them somewhere off station.
I explained that I did not feel comfortable taking the wait-list
off hospital grounds and that one copy of the wait-list was on the
computer's hard drive. The OIG Special Agents agreed to meet me in my
office on the 10th floor.
When the OIG Special Agents arrived at my office we sat down and I
signed a release and we began discussing the issues related to the
wait-list and other scheduling practices used to manipulate performance
measure numbers. I showed the agents the wait-list on the hard drive
and explained how I got to the list on the share drive. The OIG Special
Agents asked about copies of the list and I provided them the two hard
copies I had. The agents then took the hard drive from my computer. The
agents left telling me they were headed to Mental Health to speak with
other employees. I took the rest of the day off to settle my nerves.
The next day the OIG Special Agents came back to speak with me. I
signed another waiver and we began to discuss the list again. At this
point I realized that their questions were related more toward how I
obtained the wait-list and not about why the wait-list existed. I also
realized that they were unaware of the request by Senator Vitter or of
the recent news article and television interviews.
Later that evening I spoke to a person whose name I had given to
the OIG, who explained that OIG Special Agents had explained to her
that if she had provided me access to the list that she could be an
accomplice to a crime. She explained to my attorney and I that she was
trying to get find a lawyer. At this time she also explained to my
attorney and I how the list was created and how it was used because
there were not enough providers to see everyone. My attorney made some
telephone calls and obtained her legal counsel.
My attorney contacted the OIG Special Agents and asked them if I
was under criminal investigation. The OIG Special Agents explained to
my attorney that they were criminal investigators and that they were
investigating the issue of how I obtained the list. My attorney at this
time told the OIG Special Agents that all communication should go
through him. The damage had already been done.
The OIG had come to Shreveport not to investigate the wait list and
other scheduling issues. The OIG had come to perform damage control,
intimidate other potential whistleblowers, and to investigate me, the
whistleblower. The investigation they conduct was shoddy at best and
they only interviewed Mental Health persons that would stand to face
discipline if there was a list. They intimidated the other employee
whose name I had given them. Her story totally changed from what she
had explained to my attorney and I for fear that she would be charged
with a crime.
A few weeks later the OIG Special Agents contacted my attorney.
They explained they were headed to Shreveport and asked if they could
speak to me. My attorney explained to the inspectors that he would let
the investigators talk to me about everything except how I obtained the
list. The OIG Special Agents met with my attorney at his office. The
two agents were accompanied by a polygraph tester. My attorney again
reiterated to the OIG Special Agents that he would allow them to speak
to me about anything except how I obtained the list. The agents said
that they didn't need to talk to me about anything else.
They also told my attorney that there was nothing to the list. My
attorney questioned why they had only talked to select persons in
Mental Health and not others that wished to talk. The agents then
turned to the fact that I had brought up that other scheduling
procedures were being used to manipulate the performance measures. The
agents asked my attorney for names and I provided my attorney with
names of schedulers in other areas of hospitals that had explained to
me they were instructed to schedule in such a way that numbers would
look better on performance measures.
It was at this point that I became totally discouraged and had to
shift focus into a mode of protecting myself against possible criminal
charges instead of advocating for Veterans' care. Over the next several
months I experienced the weight of an investigative agency of the
Federal Government. The pressure from having the burden of a criminal
investigation hanging over me was tremendous. I was also experiencing
pressure from OBVAMC leadership. I became extremely frustrated that
neither the OIG nor the VA leaders cared enough about the Veterans'
care to do a complete investigation into reported wrongdoings. It was
literally heartbreaking for me as an individual who has only wanted to
do two things in my life: to be a soldier and to help Veterans. Despite
my whistleblowing I continued to witness poor care being provided to
Veterans. I had put my career and livelihood on the line and all I
gained by doing so was being purposely isolated by the VA and hung out
to dry by the OIG.
There is no doubt in my mind the OIG's sole purpose of coming to
Shreveport was to intimidate myself and other potential whistleblowers
for coming forward. Their main purpose was intimidation and damage
control. The investigation was half-assed and shoddy at best. The OIG
showed no interest investigating the wrongdoings in the hospital.
Rather they interviewed select persons with the intention of
intimidating them and others not to come forward with information about
how and why the wait-lists existed. I had given the OIG Special Agents
the names of numerous witnesses who could substantiate my claims of
wrong doing. They did not take the time to interview most of them.
For coming forward and telling the truth I was now in a job way
below my ability level. I was asked to complete a training that I
explained to my leaders I was ethically unable to complete. I was told
I needed to do the training because the COS wanted 100% compliance. I
explained I was not going to complete the training because it placed my
integrity in jeopardy. I was given a letter of admonishment for not
completing the training. I filed a grievance concerning the letter of
admonishment which turned out to be a joke due to the fact that Step 1
went to the Service Chief that was ordered by the COS to discipline me
and Step 2 of the process was assigned to the COS who ordered the Chief
of Primary care to discipline me. I complained that this was a conflict
of interest to no avail. Thus, I withdrew my grievance in order to file
with the Office of Special Counsel. After filing a retaliation claim
for the letter of admonishment against my supervisor, Chief of Primary
Care, and COS things became more tense for me in the OEF/OIF team. My
supervisor and I were not getting along so I distanced myself. My
supervisor took a position at another facility. Prior to leaving she
gave me an unacceptable performance appraisal for not following
directions concerning the training and left the next day.
As I languished for a year under investigation for obtaining a list
that wasn't supposed to exist I began to contact other whistleblowers.
My anger started to increase as it became apparent the OIG had used the
same scare tactics all over the country to intimidate other
whistleblowers. To make matters worse the OIG began time and time again
whitewashing reports and attacking whistleblowers in these same
reports. This solidified my belief that the OIG was not going to help
solve the problem, but that it in fact was part of the overall problem
with the VA System. After living a VA nightmare the last year it has
become very apparent and saddens me to say that I see no real change in
how VA operates. I believe that the problems with the VA are endemic to
its structure. There will be no real reform until there is an
independent agency that is willing to conduct thorough investigations
and the system starts hold individuals at every level accountable.
The VA has become a bloated bureaucratic system in which its
leadership is more interested in perpetuating their own careers rather
than caring for our veterans. When given a performance measure, leaders
don't look at how they can adapt their programs to meet the measure,
rather they look at the performance measure and try to figure out a way
to manipulate it to make it look like they have met the expected goal.
The system needs true reform and its leadership needs to be held
accountable for its failures.
It is my belief that until we are able to protect whistleblowers
and potential whistleblowers the true depth of the corruption within
the VA will not be known. The years of cronyism and lack of
accountability have allowed least two generations of poor incompetent
leaders to plant themselves within the system. These poor leaders have
trained other poor leaders and they have isolated the VA from the real
world of efficient and effective medical treatment. The VA's continued
inability to tell the truth has caused generations of Veterans to lose
trust in their services. It is apparent that until the VA is absolutely
with no exception forced to change, it will not do so.
Very Respectfully,
Christopher Shea Wilkes.
______
Prepared Statement of Linda A. Halliday, Deputy Inspector General, U.S.
Department of Veterans Affairs, Office of Inspector General
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Walter Ochinko, Policy Director, Veterans
Education Success
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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