[Senate Hearing 118-229]
[From the U.S. Government Publishing Office]



                                                        S. Hrg. 118-229

                  VA ACCOUNTABILITY AND TRANSPARENCY:
                   A CORNERSTONE OF QUALITY CARE AND
                         BENEFITS FOR VETERANS

=======================================================================

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________


                            OCTOBER 25, 2023

                               __________

       Printed for the use of the Committee on Veterans' Affairs






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

                               ______
                                 

                 U.S. GOVERNMENT PUBLISHING OFFICE

54-762 PDF                WASHINGTON : 2024











                 SENATE COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman

Patty Murray, Washington             Jerry Moran, Kansas, Ranking 
Bernard Sanders, Vermont                 Member
Sherrod Brown, Ohio                  John Boozman, Arkansas
Richard Blumenthal, Connecticut      Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii              Mike Rounds, South Dakota
Joe Manchin III, West Virginia       Thom Tillis, North Carolina
Kyrsten Sinema, Arizona              Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire  Marsha Blackburn, Tennessee
Angus S. King, Jr., Maine            Kevin Cramer, North Dakota
                                     Tommy Tuberville, Alabama

                      Tony McClain, Staff Director
               David Shearman, Republican Staff Director









                            C O N T E N T S

                              ----------                              

                            October 25, 2023

                                SENATORS

                                                                   Page
Hon. Jon Tester, Chairman, U.S. Senator from Montana.............     1
Hon. Bill Cassidy (on behalf of Ranking Member Jerry Moran)......     2
Hon. Tommy Tuberville, U.S. Senator from Alabama.................     6
Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......     9
Hon. Bill Cassidy, U.S. Senator from Louisiana...................    10
Hon. Sherrod Brown, U.S. Senator from Ohio.......................    12
Hon. Thom Tillis, U.S. Senator from North Carolina...............    13
Hon. Joe Manchin III, U.S. Senator from West Virginia............    15
Hon. John Boozman, U.S. Senator from Arkansas....................    16
Hon. Angus S. King, Jr., U.S. Senator from Maine.................    18

                               WITNESSES

Tracey Therit, Chief Human Capital Officer, Office of Human 
  Resources and Administration/Operations, Security and 
  Preparedness, Department of Veterans Affairs; accompanied by 
  David Perry, Chief Officer, Workforce Management and Consulting 
  Office, Veterans Health Administration; Aaron Robison, Senior 
  Attorney Advisor, Accountability, Office of the General 
  Counsel; and Ted Radway, Executive Director, Investigations, 
  and Acting Executive Director, Compliance and Oversight, Office 
  of Accountability and Whistleblower Protection.................     4

                                APPENDIX
                           Prepared Statement

Tracey Therit, Chief Human Capital Officer, Office of Human 
  Resources and Administration/Operations, Security and 
  Preparedness, Department of Veterans Affairs...................    27

                        Questions for the Record

Department of Veterans Affairs response to questions submitted 
  by:

  Hon. Kyrsten Sinema............................................    37

  Hon. Marsha Blackburn..........................................    40

                       Statements for the Record

Hon. Kyrsten Sinema, U.S. Senator from Arizona...................    45

American Federation of Government Employees (AFGE), AFL-CIO......    46

The American Legion, Ms. Tiffany Ellett, Veterans Affairs and 
  Rehabilitation Division Director...............................    60

Partnership for Public Service, Max Stier, President and CEO.....    64

  Attachment--Statement for the Record for House Committee on 
    Veterans' Affairs; Subcommittee on Oversight and 
    Investigations...............................................    70

Senior Executives Association, Marcus L. Hill, President.........    84

                       Submissions for the Record

Letter dated October 25, 2023 from Joint Unions Opposing S. 2158 
  Restore VA Accountability Act..................................    89

Letter dated July 18, 2023 from Patrick Yoes, National President, 
  National Fraternal Order of Police.............................    91

VISN 1 Workforce Dashboard Chart.................................    92









 
                  VA ACCOUNTABILITY AND TRANSPARENCY:
                   A CORNERSTONE OF QUALITY CARE AND
                         BENEFITS FOR VETERANS

                              ----------                              


                      WEDNESDAY, OCTOBER 25, 2023

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 3:27 p.m., in 
Room SR-418, Russell Senate Office Building, Hon. Jon Tester, 
Chairman of the Committee, presiding.

    Present: Senators Tester, Brown, Blumenthal, Manchin, 
Sinema, Hassan, King, Boozman, Cassidy, Tillis, and Tuberville.

            OPENING STATEMENT OF CHAIRMAN JON TESTER

    Chairman Tester. Good morning. I am going to call this 
Senate Veterans' Affairs Committee hearing to order. I want to 
thank the witnesses for being here today.
    Senator Cassidy will be sitting in the Ranking Member's 
chair until Senator Moran comes, and he will be showing up 
soon.
    Look, accountability and transparency must be cornerstones 
of fulfilling VA's mission to provide high-quality care and 
benefits to our veterans, and we all agree that bad actors at 
the VA cannot and will not be tolerated. And that is why I 
worked with then-Chairman Isakson and bipartisan members of 
both chambers to pass the VA Accountability and Whistleblower 
Protection Act of 2017. That law sought to increase 
whistleblower protections at the VA, including an Office of 
Accountability and Whistleblower Protection. It also provided 
the VA with additional authorities it requested to remove 
employees for misconduct or poor performance.
    More than 5 years later, we know that parts of the law have 
worked while others have faced significant challenges. The fact 
is even one case of fraud, malicious patient harm, or abuse of 
power at the VA is one too many. And the biggest threat to bad 
actors is an informed and empowered workforce that knows its 
rights and the consequences of misconduct.
    According to VA's 2023 All-Employee Survey, 1 in 4 
employees do not feel comfortable disclosing a suspected 
violation of law or rule or regulation without a fear of 
reprisal. The VA needs to encourage reporting of wrongdoings by 
providing clear information about where to voice concerns while 
also strengthening protections for whistleblowers, and it needs 
timely, thorough disciplinary procedures that follow due 
process that hold up in court.
    That is why I introduced the LEAD Act, and I want to thank 
Senators Moran and Rounds for joining me in that effort. The 
LEAD Act builds on our work of 2017, by providing solutions to 
the evolving challenges at VA to sustain individual and 
department-wide accountability and transparency. These 
challenges have been identified and confirmed by years of 
Committee oversight and reports of independent oversight bodies 
like the VA OIG and the GAO.
    This bill recognizes that proactive VA oversight of its 
programs and having more engagement from leadership prevents 
harm from happening in the first place. This bill will help the 
VA hold bad actors accountable by giving employees the 
knowledge and the processes to take disciplinary action against 
bad actors that will stick.
    When it comes down to it, VA cannot repeat past mistakes 
when providing veterans with the care and the benefits they 
have earned or cut corners when trying to discipline employees. 
We must move forward with straightforward, bipartisan reforms 
that will ensure past mistakes simply do not happen again.
    And with that it is a pleasure for me to turn to my 
substitute Ranking Member, Senator Cassidy.

               STATEMENT OF SENATOR BILL CASSIDY
           (ON BEHALF OF RANKING MEMBER JERRY MORAN)

    Senator Cassidy. And for the record, I walked in at 3:28 
and you had already started the meeting.
    Chairman Tester. Well, they say if you are not early, you 
are late.
    Senator Cassidy. The Vince Lombardi school. Thank you, Mr. 
Chairman.
    Today's hearing is about prioritizing the best interests of 
veterans over a disorganized and cumbersome bureaucracy where 
all too often the interests of those that it was created to 
serve appear to be an afterthought. I have served on Committee 
since I first arrived in the Senate. It is clear to all serving 
here, Democrats, Republicans, and I will say to the people here 
to testify from the VA, that supporting veterans is our highest 
priority.
    But we cannot sit on our hands and not acknowledge that at 
times the VA has refused to take appropriate action to correct 
things that have gone wrong, and despite the many good things 
the VA does every day for veterans, things still go wrong 
regularly. Now some of these are just, you have got a big 
organization and it is going to happen. But some, like barriers 
to health care, lengthy delays for disability compensation, 
missing student housing checks, laws and regulations not being 
followed, and even outright fraud and wrongdoing. That is why 
we cannot take our eyes off the ball when it comes to changing 
the VA for the better, kind of like total quality management--
one policy, one medical center, one regional office, one 
cemetery at a time.
    And real change requires real accountability. In 2017, 
Congress passed the VA Accountability and Whistleblower 
Protection Act, giving VA the ability to hold bad employees 
more accountable. This included a new Section 714 authority, 
allowing for expedited removal, demotion, suspension of 
employees for poor performance or misconduct. This bipartisan 
bill, sponsored by Senator Rubio and Chairman Tester, helped 
improve both employee satisfaction and trust of veterans in the 
VA. By the way, important to note that VA employees like 
accountability. They like that they know that they are working 
hard and there is an occasional bad apple or bad actor, and 
that bad actor/apple reflects upon them all. So it improved 
employee satisfaction to have bad employees held accountable.
    Unfortunately, in recent years, actions by the courts, the 
FLRA, and the MSPB, as well as internal decisions by the VA 
have cut back the law's most important provisions. In 
particular, arbitration actions between the VA and employee 
unions have caused the VA to cease use of Section 714 authority 
entirely. Because of this, a large number of fired employees 
have been reinstated with back pay, including some fired for, 
quote, ``grievous misconduct.'' I look forward to hearing more 
from our esteemed witnesses today on this issue.
    A few weeks ago, at a hearing on veterans' mental health 
and suicide prevention, we were informed of a recent VA OIG 
report describing serious problems with the Veterans Crisis 
Line. According to the OIG, Veterans Crisis Line staff failed 
to take appropriate action with a veteran who died by suicide 
on the same night he contacted the VCL, VCL leadership 
interfered with the OIG investigation, and in the end, the 
staffer in question is still employed by the VA while his 
superiors were moved to a different facility and promoted--
promoted--into a senior advisor role to the VHA Under 
Secretary.
    I asked tough questions that day to the witnesses and 
received no real answers, like, for example, why were they not 
fired. Maybe today we will have an opportunity to learn why 
appropriate action was not taken and how we can ensure that VA 
staff are held accountable as they care for our Nation's most 
important resource, our veterans. When VA employees cannot or 
will not do the jobs assigned they should not continue working 
at the VA. Yet at least in some areas that is exactly what 
seems to be going on, as well as for veterans, their families, 
for the hundreds of thousands of hard-working VA employees who 
do it right and for taxpayers.
    When Congress first provided VA with an expedited authority 
to hold employees accountable, President Obama said, ``If you 
engage in an unethical practice, if you cover up a serious 
problem, you should be fired, period. It should not be that 
difficult,'' close quote. That was true then and it is true 
today.
    I yield.
    Chairman Tester. Thank you, Senator Cassidy, for that 
statement.
    I want to welcome Tracey Therit, VA's Chief Human Capital 
Officer, back to the Committee. Ms. Therit is joined by folks 
covering other offices related to the conversation on 
accountability and transparency. Those folks include David 
Perry from VHA's Workforce Management Office--good to have you 
here, David; Aaron Robison from the Office of General Counsel--
Aaron, thank you; and Ted Radway from the Office of 
Accountability and Whistleblower Protection--thank you for 
being here, Ted.
    It is my understanding that Ms. Therit will give the 
testimony and will be supported by these three gentlemen. 
Please know that your full written testimony will be a part of 
the record, and you have the floor for the next 5 minutes, 
Tracey.

           STATEMENT OF TRACEY THERIT ACCOMPANIED BY
           DAVID PERRY, AARON ROBISON, AND TED RADWAY

    Ms. Therit. Good afternoon Chairman Tester, Senator 
Cassidy, Members of the Committee. I appreciate the opportunity 
to discuss VA's ongoing efforts to provide world-class care and 
benefits to every veteran who entrusts us with those needs, be 
that health care, benefits, or end-of-life arrangements.
    I am accompanied today by David Perry, Chief Office, 
Workforce Management and Consulting, Veterans Health 
Administration; Ted Radway, Executive Director, Investigations, 
and Acting Executive Director, Compliance and Oversight, Office 
of Accountability and Whistleblower Protection; and Aaron 
Robison, Senior Attorney-Advisor, Accountability, Office of 
General Counsel. We look forward to discussing what VA is doing 
to enhance employee and organizational accountability across 
the Department, maintain strong labor-management partnerships, 
and ensure appropriate oversight of our resources.
    We, at the VA, are laser-focused on hiring and retaining a 
workforce that provides timely access to care and benefits. To 
that end, we thank Congress for providing the critical 
authorities and appropriations in bills such as the Reforming 
American Immigration for Strong Employment Act, the PACT Act, 
and the 2023 Consolidated Appropriations Act. We appreciate the 
intent of the VA Clinician Appreciation Recruitment, Education, 
Expansion, and Retention Support, CAREERS Act of 2023, and 
support many of the provisions in this bill as it aligns with 
several legislative proposals offered as part of VA's fiscal 
year 2024 budget submission.
    My written statement provides more detailed information on 
the two bills central to this hearing, but I would like to take 
a few moments to offer a general overview of the Department's 
position on each bill.
    First, VA agrees with the underlying premise of S. 2795, 
the Leadership, Engagement, Accountability, and Development Act 
of 2023, LEAD Act, though we propose amendments to various 
provisions in the bill. The LEAD Act nests well with VA's 
existing policies and procedures for responding to potential 
acts of misconduct and poor performance, to include training 
and standards of accountability. VA supports the establishment 
of an Office of Transparency, Engagement, Accountability, and 
Management, referred to as the TEAM Office, in the Veterans 
Health Administration, a provision that aligns with VA's 
optimization plan on which we recently briefed this Committee.
    VA also supports aligning the Office of the Medical 
Inspector under the TEAM's Office with minor technical 
amendments to ensure role clarity due to the critical oversight 
function this office provides. VA does not support Section 301, 
which would establish an Office of General Counsel within OAWP. 
OAWP's independence is crucial to avoiding a conflict of 
interest or the appearance of one in VA investigations.
    To facilitate independence, OAWP created the Investigative 
Attorney Division, IAD, in 2022, a division of skilled 
attorneys who specialize in whistleblower and Federal personnel 
law. IAD reports to the OAWP's Assistant Secretary through the 
Executive Director for Investigations, and its attorneys are 
independent of VA's Office of General Counsel.
    Second, VA does not support S. 2158, the Restore 
Accountability Act of 2023. Even without using 714 against 
American Federation of Government Employees bargaining unit 
employees since 2021, VA has taken over 4,000 adverse actions 
in each of the last two fiscal years using existing 
authorities. VA is concerned that as written the Restore 
Accountability Act will continue to be the subject of extensive 
litigation and constitutional challenges, and we strongly 
caution against enacting requirements that could create 
unintended outcomes in the future.
    VA appreciates the Committee's willingness to engage on 
these bills, and we welcome the opportunity to collaborate on 
how we can deliver care and services to our Nation's veterans 
and their families. We thank the Committee for this 
opportunity. This concludes my statement, and we welcome your 
questions.

    [The prepared statement of Ms. Therit appears on page 27 of 
the Appendix.]

    Chairman Tester [Inaudible]. The 2017 accountability law, 
which included new authorities it requested to better hold its 
employees accountable. Tracey, can you tell me what has changed 
and why the VA now concludes it does not need additional 
authorities to discipline mid- and lower-level employees from 
those outlined in Title 5?
    Ms. Therit. Senator, within the last 6 years we have seen 
the challenges that implementing 714 faces. The entire bill, we 
are using the provisions that deal with 713, which allows us to 
take actions against senior executives, and we are also 
implementing the provisions of the bill that allow us to recoup 
bonuses and awards as well as relocation expenses and reduce 
annuities. So there are many provisions of the 2017 
Accountability Act that we are using, and the fact that we have 
the OAWP established as a venue for employees to air their 
concerns and grievances and have those investigated.
    I think what we have seen with the legal challenges in the 
courts as well as with the labor partners is an opportunity to 
strengthen our processes and procedures not just on the back 
end, when it comes to proposing and deciding an action, but 
then need for that increased consistency and improvement in our 
policies and procedures as well as our reporting and collecting 
of data on the front end, and that is why the LEAD Act fits so 
much better into what we need to do to make the Department more 
accountable in the future.
    So I think what we have seen is where we need to strengthen 
our employee relations procedures so that we can hold employees 
accountable, and that is on the execution of our authorities as 
opposed to additional authorities.
    Chairman Tester. Mr. Robison, can you talk about the 
Department's position and what would happen if Congress gave 
you broader disciplinarian authorities with lower evidence 
standards and fewer due process protections?
    Mr. Robison. Yes. Thank you for the question, Senator. You 
know, obviously the details of what types of due process 
protections are being lowered and what other changes are being 
proposed matter in that type of conversation. But generally 
what we will see if additional authorities that do those things 
are provided, we will, as Ms. Therit mentioned, we will see 
legal challenges, and we will go through that litigation 
process with really no guarantee that the VA will prevail in 
those legal challenges.
    We have spent the last 6 years in administrative and 
judicial courts talking about these burden of proof and due 
process issues. And if we are talking more specifically about 
provisions such as those in the Restore Accountability Act, the 
Department has legal concerns, significant legal concerns, 
about how those would play out in court.
    And I would also like to emphasize what Tracey had 
mentioned, which is accountability starts long before we get to 
the point where we are proposing actions. So what we like about 
the LEAD Act is being able to focus our attention on that 
front-end process, where we are focusing on trying to make 
investigations more efficient, more thorough, and devoting our 
resources to that.
    Chairman Tester. After the 2017 law was passed, VA took 
several steps during implementation, and those steps landed 
them in court. Mr. Robison, why did the VA end up winning most 
of those cases, or did the VA end up winning most of those 
cases?
    Mr. Robison. So with respect to implementation there are 
kind of two lines of cases that we talk about, and the first 
line of cases is in the labor arena, where the decision was 
made in 2017 to implement and start using the authority without 
bargaining prior to implementation with the union. A grievance 
was filed at that time, and from there it culminated in the 
AFGE settlement agreement that we have discussed. And in 
between them there was a lot of litigation between those two 
points and a lot of events that occurred during that time.
    And in the second line of cases really had to do not so 
much with implementation but had to do with interpretation of 
the statute. So really when we are talking about just 
implementation that occurred in 2017, we are talking about 
those labor cases.
    Chairman Tester. And those court decisions ended up in a 
situation where a number of employees had to be reinstated. Is 
that correct?
    Mr. Robison. Well, when we are talking about the labor 
cases there was one case related to performance-based actions 
in which performance-based actions were overturned and folks 
were reinstated. As far as the other labor case that resulted 
in the AFGE settlement agreement, a smaller number than the 
pool of individuals impacted by that decision will be 
reinstated. There is a whole process that is going to have to 
play out in facilitating that settlement agreement.
    Chairman Tester. Senator Cassidy.
    Senator Cassidy. I will yield to Senator Tuberville.

                    SENATOR TOMMY TUBERVILLE

    Senator Tuberville. Thank you. Thank you, Chairman Tester 
and Ranking Member.
    You know, I am from Alabama. We are very proud of the VAs 
that we have in our State. And we have recently had a new one 
put in. It is a clinic and we are very proud of that. I have 
got some friends that have some relatives in there and they are 
doing a great job.
    And I think it is our sacred duty to take care of our 
veterans. I believe most people at the VA try to do that every 
day. I know since I have been on this Committee for 3 years we 
have worked awfully hard to make our VA better. But the fact is 
that we have had some abuses going on for a long time, and we 
all know that. I mean, it happens in every hospital.
    But we have had some happen in the VA, and we are 
responsible for that. And we knew that during the Obama years. 
We had veterans dying on waiting lists. VA's employees lied to 
cover it up. It was horrible. I mean, I have read some of the 
statements. I mean, you cannot fathom that. It is an insult to 
everybody that wears a uniform to have to go in some of these 
places.
    So these people needed to be held accountable. Frankly, a 
lot of them should have gone to jail for what I saw. When 
President Trump took office he addressed this problem head on. 
A bipartisan Congress passed the VA Accountability Act. It 
passed by voice vote in the Senate, overwhelming in the House. 
It allowed the VA to fire 4,000 employees. Now I was not here 
when that happened, but that is just amazing to me. Four 
thousand people were fired basically for not doing their job, 
at the end of the day. And they were fired for cause.
    Now these were not layoffs. These were people that just 
absolutely either did a terrible job, did not care about what 
they were doing, and they got laid off. And this is exactly 
what a bipartisan Congress intended to do is get this straight. 
Now these people have no business getting a paycheck from the 
taxpayers. It is criminal.
    The law is still on the books, but for some reason we have 
reached a settlement. Somebody has reached a settlement with 
trial lawyers and we are not enforcing this anymore. The law is 
still on the books. This is not how the Constitution works, the 
last time I looked. You know, we pass the laws and we are 
supposed to go by the law. I mean, this has been in the 
playbook for a long time on the left to try to make this work 
like this, and we cannot do it. I mean, we keep trying to make 
the VA better, and we are making it worse. I mean, we are not 
making any progress here.
    We saw under President Obama that things would change. We 
thought they would change. It did not change. Arguably, it got 
much worse. So now we have agreed to give free money to people 
that did not do their job. It is mind-boggling to me. I mean, 
we take one step forward and two steps back. This cannot be how 
the system works. I mean, that is not the reason I ran for this 
job, and hopefully the reason that you are not doing your job. 
Veterans need help, and obviously we all know it is the biggest 
health care system in the world. The VA is the biggest health 
care system, and it is hard. Understandably, it is hard.
    But now, in my State of Alabama, we have 74 people who were 
fired for cause, not laid off, and now they are getting their 
jobs back. And I have heard some horror stories about what some 
of them did. And it is embarrassing to me now to talk to 
veterans about the situation that we have got ourselves in, try 
to get ourselves out, and now we are back in it.
    So it is no secret that it is getting worse, and we cannot 
continue to do this. I do not care what we have got to do. We 
have got to make it better. But when we make a law we have got 
to go by it, and we have got to make it work.
    Ms. Therit, I want to believe that the VA is hiring only 
the best and the brightest employees, and we all want that--
sometimes you do not know what you are getting--to serve our 
veterans. But as many of us have discussed since I have been 
here for 3 years, we know not everybody in the VA is going to 
be exactly what we want.
    So how does the VA plan to protect these veteran patients 
from this grievous misconduct if we are not going to go by this 
Accountability Act? How are we going to do that?
    Ms. Therit. Senator Tuberville, I acknowledge that we want 
the best working at the VA and we want to protect the rights of 
veterans, and we do have authorities that allow us to take 
adverse actions. I mentioned in my opening statement that since 
2021 we have not been using 714 for American Federation of 
Government Employees because we were found to have not 
bargained impact and implementation with them. We have used our 
existing authorities for performance and conduction actions 
under Chapter 43 and Chapter 75, and we continue to take over 
4,000 adverse actions, which are removals, demotions, 
suspensions of more than 14 days. So we have found the 
opportunity to use the existing authorities that we have to 
hold employees accountable.
    I do acknowledge, and I do not want any views on these 
bills to indicate that we are happy with the status quo or we 
do not see opportunity to improve and do better. We know there 
is still inconsistency in how actions are executed in the 
field. We know that things still take too long. And that is why 
we want to work with this Committee on something like the LEAD 
Act, where we can look at those policies and procedures that we 
take prior to proposing an action to make sure that we have 
evidence, as the Chairman had mentioned, that is thorough, that 
is timely, and affords employees due process. So at the end of 
the day we are able to remove those employees who should not be 
working for the VA.
    We also just completed a record year of hiring, and we are 
learning from the authorities that we received in the PACT Act 
how to hire more effectively and efficiently. So with that we 
are looking at making sure that we have employees who are 
committed to those who have worn the uniform and that we are 
able to remove those with performance and conduct issues as the 
earliest point we see those issues.
    Senator Tuberville. These 4,000, will we have any special 
oversight? You know, they did something wrong at the beginning. 
You know what I am saying? I mean, somebody has got to be held 
accountable because if this happens again we will have people 
lose their lives. My goodness.
    Ms. Therit. No, I absolutely agree, Senator Tuberville, and 
what I would say in the settlement that we reached with the 
American Federation of Government Employees that impacts about 
4,000 employees, we do have a provision in that settlement 
agreement that allows us to repropose the action which the FLRA 
determined was not taken lawfully because we did not engage in 
impact and implementation bargaining.
    So even though that action taken under 714 we could not 
sustain, we can look at actions and retake them under 43 and 75 
and continue to make sure that individuals who should not be 
working in our medical centers are removed for the reasons that 
they should not be working there.
    Senator Tuberville. Well hopefully start with two strikes, 
you know, and not get three strikes.
    Thank you, Mr. Chairman.
    Chairman Tester. Senator Hassan.

                  SENATOR MARGARET WOOD HASSAN

    Senator Hassan. Thank you, Chairman Tester and acting 
Ranking Member Cassidy, and thanks to our witnesses for being 
here today. This is a really important topic of accountability 
and transparency at the VA, and I look forward to discussing 
with you.
    Ms. Therit, we have been discussing the importance of 
transparency and accountability, and the VA Office of the 
Inspector General is an important partner in this work. Senator 
Boozman and I joined together to introduce the VA OIG Training 
Act, which would require new VA employees to be trained about 
the role of the inspector general, the resources that the 
office provides, and its mission to root out waste, fraud, 
abuse, and misconduct at the VA. The Senate passed our bill 
this summer. We are hoping to see it pass the House as well.
    In order to improve oversight and accountability why is it 
important that employees understand the role of the inspector 
general?
    Ms. Therit. Senator Hassan, I support the legislation that 
you have put forth and we are ready to implement it if enacted. 
The organization that I lead is responsible for our talent 
management system so any courses that we would require of our 
workforce would be tracked and monitored in that system. But as 
the Chairman had mentioned, our latest All-Employee Survey 
shows that only 25 percent of our workforce feels comfortable 
reporting issues and not being retaliated against for that.
    Training, like what you are proposing, would help to 
increase the confidence that our employees can raise issues at 
the earliest point possible and bring them to the attention of 
either the inspector general or the Office of Accountability 
and Whistleblower Protection.
    I know my colleague, Mr. Radley, has seen tremendous 
improvement in OAWP's ability to get employees to come to them 
with issues, to investigate those issues, and hold individuals 
accountable when they are found to have engaged in wrongdoing.
    Senator Hassan. Well, I appreciate that, and I am just 
going to kind of follow up this conversation and I am happy to 
take comments. Because obviously the women and men who work at 
the VA are our most critical assets in delivering care and 
benefits to veterans, and they are also best positioned within 
the Department to see when something or someone is not meeting 
the standards that the Department sets to ensure excellent 
service to our veterans.
    Sometimes employees who notice something is wrong, as you 
are pointing out and as we are all talking about, may not know 
the right way to bring up their concerns. So training is one 
thing we just talked about, but how can the VA foster a culture 
of transparency and provide employees with that information on 
where they go to report wrongdoing?
    Ms. Therit. I will start and then pass the question to Mr. 
Radley. There is a provision in the LEAD Act that talks about 
us increasing the surveys and the training that we do. I think 
getting the information out in multiple forms, whether it is in 
that All-Employee Survey, that 75 percent of our workforce 
recently took, making sure that they know where they can go, 
and if there are concerns that they have about going to those 
resources that are available that we are able to address those 
in real time.
    I will ask Mr. Radway if he has any other additional 
thoughts on that question.
    Mr. Radway. Just on training, we have, in the past year, 
trained over 405,000 VA employees on whistleblower rights and 
protections, over 40,000 supervisors, and that is through our 
TMS video system, trained over 13,000 supervisors live. OAWP 
has been reaching out and doing live training. We have also 
been meeting with division leadership on a one-on-one basis and 
advising them about what our office does, the opportunities. 
And we have also established a whistleblower navigator position 
that helps whistleblowers navigate through the process and 
understand their rights and abilities.
    Senator Hassan. Thank you. And that brings me really to my 
last question. Once an employee has lodged a complaint as a 
whistleblower he or she is obviously entitled to certain rights 
and protections. But VA employees have shared with my office 
that once a complaint is filed they never hear anything further 
about the status of the case, for example, whether it was 
investigated, whether any action was taken.
    Now we understand that there is certain sensitive 
information that cannot be shared because of privacy concerns, 
but how can we better communicate with whistleblowers to ensure 
that they know that their concerns have been considered and 
that they can be part of the solution toward improving 
accountability at the VA?
    Mr. Radway. Senator, we have recently modified our 
procedures in OAWP, and complainants will be notified 
approximately every 2 weeks, given an update on the status of 
their complaint.
    Senator Hassan. All right. That is very helpful. Thank you 
very much. Thanks, Mr. Chair.
    Chairman Tester. Senator Cassidy.

                      SENATOR BILL CASSIDY

    Senator Cassidy. Mr. Radway, I understand that you are 
responsible for investigating VA leadership. Again, I mentioned 
earlier my concerns regarding the Veterans Crisis Hotline. The 
VA inspector general uncovered systemic issues at the VCL, and 
that the VCL Director for Quality and Training provided advice 
and incorrect information to witnesses, potentially 
compromising the accuracy and integrity of the IG 
investigation. The Executive Director called off a necessary 
root cause analysis following a patient's suicide stating, 
quote, ``There was insufficient information for us to really 
move forward.'' The root cause analysis only initiated after 
the VA received notice of an IG investigation.
    And I also am told that this person remains in a leadership 
position at the Veterans Crisis Hotline and that the Veterans 
Crisis Executive Director was promoted to a senior executive 
role at VA headquarters, now serving as a senior advisor in the 
Secretary's Office. Whoa.
    Are you aware of the IG report, and explain this in a way 
which makes us feel better about the process taking place.
    Mr. Radway. Thank you for the question, Senator. I am not 
aware of whether OAWP has a specific investigation in that 
matter but I believe Mr. Perry can provide some additional 
illumination on your question.
    Mr. Perry. Thank you, Senator Cassidy, for that question. 
To your point we do have the findings of the OIG report that 
came back early last month, so we are in the process of 
reviewing the recommendations and findings of that report.
    The actual event itself, as tragic as it is, as we all 
know, there were some opportunities for us to look at the 
process and procedures that were in place, and some changes 
have been made already to account for those changes that needed 
to be taken. So retraining occurred for those crisis responders 
and then also looking at the process of who can fill in when 
those positions need to be staffed adequately. So those changes 
have already occurred in the actual procedures itself.
    The supervisor you mentioned is still in staff but they are 
not in a direct veteran crisis responder role.
    Senator Cassidy. That is beside the point as it regards to 
the supervisor's role. The question is if they interfere with 
an investigation, as is alleged, they should not be in any 
role. Why would you have any faith in the integrity of what 
they did when apparently what they have already done was to 
interfere with an investigation and to tamper with an 
investigation?
    Mr. Perry. Yes sir, and we agree with you, and so that is 
what we are currently reviewing.
    Senator Cassidy. So you said that you received this report 
early last month.
    Mr. Perry. About 3, maybe 4 weeks ago, at most.
    Senator Cassidy. So alacrity comes to mind, or the lack 
thereof. I mean, you have had 4 weeks to investigate something 
which is fairly significant. This is not a traffic ticket. This 
is something which may have resulted, or did result in 
somebody's death, and which interfered with an investigation, 
so we are about accountability. When will you be complete, if 4 
weeks is not enough?
    Mr. Perry. Four was just from the time we received the OIG 
report. It is actively being reviewed now.
    Senator Cassidy. So when will your active review be 
through?
    Mr. Perry. I cannot give you a timeline. I can tell you----
    Senator Cassidy. I have got to tell you, 4 weeks seems 
plenty enough time to investigate.
    Mr. Perry. Agree, sir. It is on the top of our priority 
list to make sure that we take the necessary----
    Senator Cassidy. It is on the top of your priority list and 
it is 4 weeks and it still has not been done. It suggests to me 
that your priorities again lack alacrity, urgency, a reason to 
get on top of it right away. And I do not think I am being hard 
here. If there is a problem in my house I do not wait 4 weeks 
to fix it.
    This person has been elevated, I mean elevated, after this 
was alleged. So again, tell us and the Committee of Oversight 
why we should have confidence in your processes.
    Mr. Perry. Sir, the report we received from the OIG is not 
a full investigative file, and so we are working through that 
process now to look at all the underlying evidence and 
recommendations, and corrective actions will be taken upon that 
review.
    Senator Cassidy. So, Mr. Perry, briefly, how are employees 
rated? I have been told by people in the VA workforce that it 
really depends on who you know. So what are the qualitative 
measures used to rate somebody?
    Mr. Perry. We put the performance measures in everyone's 
standards performance plans and they are measured accordingly, 
based on their performance. So that is consistently across, by 
occupation.
    Senator Cassidy. And who judges their performance?
    Mr. Perry. Their first-level supervisor, and then by their 
second level.
    Senator Cassidy. And do you have any sense of this person 
who is in question what their evaluations have shown in the 
past?
    Mr. Perry. Sir, I do not have access to their actual 
performance information, but that will be something that does 
get taken under review.
    Senator Cassidy. Okay. I yield.
    Chairman Tester. Senator Brown.

                     SENATOR SHERROD BROWN

    Senator Brown. Thank you, Mr. Chairman, for holding this 
hearing. I have two letters, one from 12 labor unions including 
the AFL, AFG, SEIU, and NNU, and one from the Fraternal Order 
of Police I would like to enter into the record, raising 
concerns about provisions in the Restore VA Accountability Act 
that would undermine workers and undermine patient safety. I 
ask unanimous consent.
    Chairman Tester. Without objection.

    [The letters referred to by Senator Brown appear on pages 
89 and 91 of the Appendix.]

    Senator Brown. Thank you, Mr. Chairman. These letters share 
my concerns over a section of this bill that would override 
current collective bargaining agreements. It is always open 
season in this Committee attacking Federal labor unions, or 
attacking labor unions anywhere, maybe. These collective 
bargaining agreements are that. They are an agreement. They are 
a contract between labor and management that come from hard-
fought negotiations.
    Throwing collective bargaining agreements to the side when 
one party does not like it undermines the bargaining process 
for the hardworking and dedicated VA employees who serve our 
veterans every day, and many of whom are veterans themselves, 
of course. We owe to the Americans who work in our VAs and care 
for our veterans to respect the collective bargaining 
agreements that have been obviously agreed to by both sides.
    A question for Ms. Therit. We want employees to come 
forward and tell section chiefs what is going right and what is 
going wrong at our facilities. Ohio has large facilities at 
Dayton, Chillicothe, Cincinnati, Cleveland, and big regional, 
that are not quite VA facilities and 28, 29, 30 CBOCs. We do 
not want employees afraid to raise concerns because of 
supervisory retaliation or because they do not think anything 
will change if they do report it.
    In your judgment, will the LEAD Act improve the VA's 
process to hold individuals responsible for egregious actions 
like fraud and patient safety or retaliatory actions against 
whistleblowers?
    Ms. Therit. Senator Brown, I do. The LEAD Act gives us 
great opportunity to improve our processes, our procedures, our 
data collection, provide you with information for recurring 
reporting processes, improve our surveys, improve our training, 
and do some restructuring within the Veterans Health 
Administration to strengthen the oversight of our field.
    Senator Brown. Okay. No other comments, Mr. Chairman. Thank 
you.
    Chairman Tester. Senator Tillis.

                      SENATOR THOM TILLIS

    Senator Tillis. Thank you, Mr. Chair. Thank you all for 
being here.
    Ms. Therit, I think in your testimony you made a reference 
to quoting someone else saying, ``We are hiring and retaining 
the best, most talented, and dedicated employees in health 
care.'' Now I have recently learned that there have been at 
least 15 individuals that were let go due to grievous 
misconduct. That is defined elsewhere and I will expand the 
definition. Yet under the direction of the Central Office and 
the settlement agreement, the VISNs will have to offer these 15 
people, who were judged to have been guilty of grievous 
misconduct, to offer them reinstatement.
    So my understanding of grievous is defined as ``misconduct 
related to patient abuse, reckless or intentional disregard for 
patient welfare, racial harassment, sexual harassment, 
impairment while on duty, violent threats, reckless or 
intentional endangerment of others, and/or criminal activity.''
    So explain to me how someone who may have been separated 
due to grievous misconduct has to be offered an opportunity to 
come back to work at the VISNs?
    Ms. Therit. Senator Tillis, no one from my office was 
involved in the negotiations of that settlement. The Veterans 
Health Administration, the Office of General Counsel 
participated in those negotiations. So I am going to ask Mr. 
Perry to speak to the process for identifying grievous 
misconduct cases.
    Senator Tillis. Thank you.
    Mr. Perry. Thank you, Senator, for that question. To your 
point we did look at those cases, and so when we received the 
court ruling we had to canvass all of our field sites to 
understand what their population of these cases that met the 
criteria of grievous misconduct. In that review, if we had 
questions we worked collaboratively back with those offices to 
make sure that we had complete case files and could support the 
justification for the adverse action that was taken. In that 
review there was a lot of back-and-forth to make sure that we 
got it right, and those cases did go up, and that was part of 
the final settlement agreement.
    Ultimately, anyone that does elect to come back and be 
reinstated, we did have that carve out, as Mr. Robison 
mentioned, that allows us to propose subsequent action upon 
their return under one of our other authorities.
    Senator Tillis. Subsequent disciplinary action or----
    Mr. Perry. Based on the original actions. Yes, sir. We can 
repropose those actions under 75 or 43.
    Senator Tillis. Okay.
    Mr. Perry. Yes, sir.
    Senator Tillis. I am sorry.
    Mr. Robison. I would like to make one point. If an 
individual, under the settlement agreement, qualifies under the 
``grievous'' category, ``grievous misconduct'' category, they 
do not get reinstated.
    Senator Tillis. Okay. You all are aware of the--I want to 
make sure I get the terminology right--the critical skills 
incentive. I know that is under investigation right now. I am 
not going to dig too deep, except to say let us assume that 
somebody thought that the population that got the bonuses, the 
executives, should have been subject to some sort of process. I 
do not want to talk about who got it. I want to talk about the 
methodology that was used that would have provided a rational 
basis that these certain skill categories fit congressional 
intent. Can I at least get an answer on that?
    Ms. Therit. Absolutely, Senator Tillis. First we are very 
grateful for the authorities in the PACT Act. It helped us to 
hire record levels in both VHA and VBA this past year, grow the 
workforce by a percentage we have not seen in the last 15 
years.
    With the critical skills incentives what I can offer is the 
purpose of that incentive is to close mission-critical skills 
gaps or to promote reskilling of employees. And in our policy 
we have two categories by which someone can be eligible for a 
critical skills incentive. Either they have a shortage skill, 
which is on an approved list--that means either our human 
capital operating plan includes that shortage skill or it is in 
one of the OIG shortage lists or VHA shortage occupation lists. 
Ninety-six percent of the critical skills incentives that we 
have approved to date fall within that category of a shortage 
skill on one of those approved lists.
    Senator Tillis. Would these executive positions have fit 
into that list?
    Ms. Therit. They did not, sir. There is a second category 
called high demand skills, which you need a market factor's 
justification to support. Once these were processed and they 
were raised with our Secretary as having been approved, we 
looked back and we did not see that the precision that was 
needed to identify the individuals that were recommended for 
the CSI as having a high-demand skill that was supported by 
market factors. And the group incentives are to be very 
narrowly defined. This was way too broad, with too many 
occupational series, too many varied occupations.
    So since that occurred the Office of Inspector General is 
doing a review so they can help us strengthen our policies and 
procedures, add more internal controls to the use, and the 
Secretary has raised the delegation of authority for CSIs to 
senior executives to his level so that any recommendations in 
the future have to be approved by him.
    Senator Tillis. Okay.
    Ms. Therit. I am sorry. One more thing. We have also 
canceled all of the CSIs that were processed for our VHA and 
VBA Central Office executives, are establishing debts, and 
collecting those moneys that were paid.
    Senator Tillis. Okay. So did I hear you say clawback?
    Ms. Therit. Yes, sir.
    Senator Tillis. Good. Okay. Thank you.
    Chairman Tester. Senator King.
    Senator King. I defer to Senator Manchin. He has a 
deadline. It is not something I do every day.
    Chairman Tester. That is no excuse. Senator Manchin.

                    SENATOR JOE MANCHIN III

    Senator Manchin. Thank you. Thank you, Chairman. Let me 
just say, first of all, most everybody in West Virginia, and we 
have a lot of veterans, they all want to go to the veteran 
clinics or the veteran hospitals to get their care. They say 
they are better understood, they feel much more comfortable, 
and they feel that their care is just as good, if not better.
    The problem we are having in West Virginia comes from my 
field workers. They are getting cancellations unbelievably 
because of lack of personnel. I do not know if you all have 
been getting that up at your level, Ms. Therit and Mr. Perry, 
but the medical staff and doctors, the staff of primary care 
and specialty, they are just not there. And the wait lines are 
so long they have to get community care because they cannot get 
their veterans care.
    So I do not know what you all can do about that. If you can 
get back to me and let me know how we can help or do anything 
to recruit. We have four hospitals in West Virginia, and we 
have some CBOCs also, but we have four major hospitals, and we 
are running that--this is our highest request when they come. 
So are you getting this around the country or in rural areas?
    Mr. Perry. Senator Manchin, thank you for that question. 
Yes, we do have historic challenges in some of the rural areas 
with hiring and recruiting. I think thanks to the PACT Act that 
we received last year we are making some progress in those 
areas. To your point where we are not able to see a veteran in-
house for primary care or specialty care, we do refer out to 
the community to make sure that we are not making the veteran 
wait longer than they have to.
    Senator Manchin. I do not want to lose our veterans to--if 
we do, I can guarantee you, they might not come back. They do 
not want to go.
    Mr. Perry. Yes, sir.
    Senator Manchin. They want to stay with us, with the VA.
    Mr. Perry. Yes. So we are working aggressively. I will tell 
you that what we are focused on now in VHA is looking at our 
upcoming access, to look at where we can actually improve 
access.
    Senator Manchin [continuing]. The most egregious where we 
have in our four hospitals that we have in State, I will get 
our staff to get back with you and tell you the ones where we 
are really having shortages and long lines, long wait times.
    The other one is the compensation and pension exams. That 
is our most requested thing, and they are having a tremendous 
backlog on these. I mean, it is probably part of the same 
problem. But these compensation and pension exams is something 
that it seems like almost every veteran is asking for, to see 
if they can get a little bit more financial help.
    What I would like to know is, what is the rejection rate of 
people claiming they have a medical problem that was caused by 
the military service and you all find out it is not really 
caused by the military service?
    Mr. Perry. Yes, sir. I do not have that data. That is on 
our Veterans Benefit side. We are certainly happy to bring that 
back to you.
    Senator Manchin. That is another thing that you should 
check on, any of you, to check on this.
    I have been told that basically we have a higher percentage 
of new recruits coming into the service in all branches that 
within the first year they are claiming disability, and they 
are having a hard time justifying it, whether they were not 
examined properly before they came in. But then the Federal 
Government and the veterans end up with that responsibility. 
And we want to make sure that we are able to take care of those 
who truly have military-related illnesses and dependencies and 
different medical services, rather than those that are coming 
in with one and then claiming it once they get in. Does that 
make sense? Do you all see?
    Ms. Therit. So tracking exactly what you are saying, 
Senator Manchin, looking at the recruitment, looking at C&P 
exams, looking at the recruits identifying as having a 
disability, we are publishing, related to the PACT Act, a 
monthly dashboard that looks at all of that information. I 
think a lot of the data that we are seeing is supporting the 
information that you are providing to us as well, and we are 
happy to work with your staff on those issues.
    Senator Manchin. Okay. That is all. Thank you, Mr. 
Chairman.
    Chairman Tester. Senator Boozman.

                      SENATOR JOHN BOOZMAN

    Senator Boozman. Well, thank you, Mr. Chairman, and thank 
you very much for having this hearing, and thank you all for 
being here and the good work that you do.
    Accountability and transparency at the VA are imperative in 
ensuring quality care within the organization, and we look 
forward to continuing our work on this Committee to provide the 
VA with the tools it needs to deliver world-class care to 
veterans. And I apologize for not being here earlier but I am 
Ranking Member on VA MILCON, and we are pleased to have the 
bill on the floor right now. We are discussing it, and 
hopefully early next week we will get that passed and have some 
certainty on the Senate side and then work with our colleagues 
in the House.
    The good news is there is tremendous support. You know, we 
hear about all the rancor going on up here, but the nice thing 
about veterans, nobody cares if they are Democrats or 
Republicans, and this Committee is a very, very bipartisan 
group that with you all's help has done a lot for veterans in 
the last several years.
    Leadership at the local medical center level is important, 
especially during times of operational changes to the 
organization. This importance has been highlighted during the 
deployment of the new electronic health record system that DoD 
has been able to implement the same system at almost all of its 
facilities in the U.S. However, the VA has not yet fully 
implemented this system even in one facility. It is my belief 
that leadership at the local level is critical to the success 
of the implementation of the EHRM. And I know that we have all 
been frustrated with that. You all have been frustrated with it 
and working really hard to get it going.
    Ms. Therit, is the VA exploring options to put systems or 
processes in place to hold medical directors accountable if you 
encounter resistance in implementing EHR at their facility when 
there are no technical issues with the system?
    Ms. Therit. Senator, I am going to ask Mr. Perry if he has 
information related to the question that you posed with respect 
to VHA.
    Senator Boozman. You are like me.
    Mr. Perry. Thank you, Senator.
    Senator Boozman. Why don't you just say, ``Take it, 
David.''
    Mr. Perry. Yes, sir. I am not aware of specifically any 
leadership that is pushing back on the electronic health record 
deployment. I know what I can say is that we heard loud and 
clear from our clinical community that there were some real 
challenges with the system, and we wanted to make sure that we 
got it right. So when we made that strategic pause in the 
deployment of Cerner, that is exactly why we did so, so we 
could go back to the vendor to make sure that the concerns that 
were addressed by our clinicians were addressed, so that when 
we did go forward with more deployments we did not actually 
cause any more harm.
    In the case of where we had a leader decide not to 
implement EHR we would take appropriate steps to make sure that 
did not occur. But that was not the reasoning for delaying any 
of the deployment, sir.
    Senator Boozman. Good. Very good. That is good to hear.
    I recently joined Senator Peters in introducing the VA Peer 
Review Neutrality Act. This legislation is important. It would 
require peer reviewers to withdraw from the case where they 
have direct involvement or a conflict of interest, and have a 
peer review committee at another VA facility evaluate the 
findings. So Ms. Therit or Mr. Perry, whoever is appropriate, 
can you speak to the importance of having impartiality and 
neutrality when conducting quality management and 
administrative investigations?
    Mr. Perry. Absolutely, sir, and I think that is one of the 
main reasons we support the LEAD Act is to make sure that when 
we have those concerns come up that we have the appropriate 
oversight and reviews that happen from a point of neutrality. 
And so I think combining some of those focuses on the clinical 
and the administrative side, I think those outside neutral 
reviews are paramount to make sure that we get it right and 
that we do not have things continue to happen that lead to bad 
outcomes.
    Senator Boozman. Very good. Did you take note of that, Mr. 
Chairman, that they support this and feel like we need to get 
it pushed forward.
    Chairman Tester. It is your request, Senator Boozman.
    Senator Boozman. No, again, thank you all very much, and we 
do appreciate all of your hard work and look forward to 
continuing to work with you in the future on all of these 
different things. So again, thank you. Thank you, Mr. Chairman.
    Chairman Tester. Senator Boozman, I might add that the VA 
MILCON bill is on the floor to your good leadership.
    Senator King.
    Senator Boozman. I do not know if that is true, but we will 
take it.

                   SENATOR ANGUS S. KING, JR.

    Senator King. Thank you, Mr. Chairman. I want to follow up 
on a point that Senator Manchin made, because I think it was a 
really important one. We are turning away and losing veterans 
because of lack of staff. It is an enormous problem, and I 
understand it is a problem throughout the society. Every 
business that I talk to is short of staff. But I want to talk 
about the staffing problem in the VA, and that is where you 
might be able to help us.
    There are two issues that I have identified. One is pay and 
the other is red tape. Let us talk about pay for a minute. It 
is interesting. I will submit for the record, Mr. Chairman, a 
chart from the VA on VISN 1 on time to fill, and it is 
interesting. What I would like you to do is do some additional 
research. But of the time to fill, the lowest are generally 
urban areas and the highest are rural areas. Now this is a 
small sample, but I would like you to do this analysis on a 
broader sample and see if I am correct. But I believe that you 
will find that rural areas are having a harder time. The time 
to fill in Maine is 251, in White River Junction it is 261, in 
Providence it is 127.

    [The chart referred to by Senator King appears on page 92 
of the Appendix.]

    And so I think that is where we get to the pay part, and 
the differential in pay between different areas of the country, 
I think, is obsolete because people can work anywhere. You can 
now live in rural Maine and work remotely for the VA in Boston. 
Why would you go to work for the VA in Togus, Maine, at a 15 or 
20 percent pay cut, if you can work remotely in Boston? Do you 
see what I mean? We are hurting the competitiveness of our 
rural VA facilities.
    So I think we should really have a rethinking of the pay 
differential, which is based on times you did not have remote 
working, people were not as mobile. This is national 
competition for professionals.
    Ms. Therit, you have nodded a few times. What do you think?
    Ms. Therit. So I think Mr. Perry and I may join forces on 
answering this question. I agree. I think the authorities that 
we have in the PACT Act have helped us to level some of those 
gaps or close some of those gaps that you have talked about 
between urban and rural because we are able to offer more 
incentives to those rural facilities.
    Senator King. But I know that Togus is not competitive with 
Boston or New Bedford or Providence.
    Ms. Therit. We still have a long way to go, and then 
working with organizations like the Federal Salary Council and 
the Federal Prevailing Rate Advisory Committee. That is where I 
am trying to spearhead some of these efforts at a broader 
level.
    I know Mr. Perry's team is working on one deliverable that 
we still owe the Committee from the PACT Act, which is the 
Rural Recruitment and Retention Plan, where we can put more 
effort into reducing the red tape that you are seeing with----
    Senator King. Well, I have not gotten to that yet. But look 
at the pay issue. I mean, I believe that the whole idea of 
differential pay in different regions, based on cost of living, 
is somewhat obsolete because when you are competing, for a 
health care professional, they have nationwide choices. And to 
have a significant disadvantage in pay, I do not think it is 
any coincidence that White River and Togus are the ones that 
are lagging here, because they both have really good 
management. I know the people at Togus and they are terrific. 
So it is not a management issue. It is that they have got to 
compete, and they have to compete with local hospitals, and 
that is a real problem.
    Let me talk about the red tape issue. Well, again, let's go 
back to competition. To hire a professional at Togus or White 
River is around 250 days' time to fill. Our Northern Light 
Health Care Facility, which is in the same region in northern 
and eastern Maine, it is 56 days. Maine Health is about 89 or 
90 days, but significantly below. And yet that is who we are 
competing with.
    We have to really think hard about all the steps, and here 
is one of them. My understanding and my research tells me that 
there is something like 24 steps to hire somebody in the VA, 
and at Northern Light it is 7. We have got to rethink that, it 
seems to me, because again, we are in a competitive situation 
and the net result is less service to veterans.
    So how do we do that? I do not think Walmart has to go 
through some regional center when they want to hire somebody in 
Brunswick, Maine, or wherever they have a store. Why not 
empower the local managers, if they have a need give them a 
budget, they decide what they need, who they need, and do the 
hiring and hold them accountable. But do not have 24 steps in 
the process. Thoughts? She is passing it to you.
    Mr. Perry. Yes, sir. I agree with you there are a lot of 
steps in the hiring process, and I think we have a concerted 
effort to make sure we can streamline those where we can. Some 
of those steps that you mentioned are required.
    Senator King. Required by whom?
    Mr. Perry. Some of them are self-imposed. Some of them are 
from our Offices of Personnel Management. We have requirements 
around credentialing and privileging, so we have to make sure--
--
    Senator King. They work for you, or they work for Denis. I 
mean, in other words, if they are required by us, let me know, 
because that is something we can fix.
    Mr. Perry. Yes, absolutely.
    Senator King. If they are required within your system, that 
is what I want you to reexamine.
    Mr. Perry. And those are the ones that we are streamlining, 
sir, and to make sure that we reduce those redundant steps. But 
there are requirements that we have to apply because it is just 
the Federal rules that we have to comply with.
    To your point about the time it takes, you are exactly 
right. I think it does happen not as quickly as we want.
    To make one point of clarification, the decision to hire is 
at the local level and those budgets are managed at the 
facility level, so they have complete autonomy to decide when 
they want to hire and who they want to hire, or for what types 
of positions.
    Senator King. They still have to go through those 24 steps.
    Mr. Perry. Yes, sir. The steps do apply, so that is where 
we are looking to gain efficiency, as many as possible.
    Senator King. Well, I hope you can come back to this 
Committee and show us some changes that will deal with this 
problem because ultimately--and I know I am over time, Mr. 
Chairman--ultimately this is all about service to veterans. You 
can have the best hospital in the world, but if they cannot get 
an appointment because there is a lack of staff, then we are 
not meeting our commitment.
    Thank you, Mr. Chairman.
    Chairman Tester. Well, just to further add on because I 
know Senators Blackburn, Moran, and Senator Blumenthal is 
already here, the end result of this is we cannot compete with 
the private sector. They are beating us to the punch for good 
employees. When employees want to work for the VA it just takes 
too long and people cannot survive on their good looks. They 
have got to have a check coming in.
    And so it is important that if it is something that we need 
to do here, please let us know what that is. I have got a 
notion that King would probably write a bill up tomorrow, okay. 
I also have a notion that Boozman would probably co-sponsor it. 
So, you know, it is good.
    Senator Boozman. During COVID, did you all have the ability 
to cut through some of that stuff?
    Ms. Therit. So your question is appropriate because during 
COVID what we did is we either deferred or delayed certain 
steps in the process to get people on board in less days.
    Senator Boozman. So we have the ability to have essentially 
a study to look back and see if that caused problems, and to 
me, I do not think it did. And so, you know, it looks to me 
like you could come to us and say, ``We did it this way'' and 
somehow us be helpful of saying, ``Hey, this has worked in the 
past. Why are we not doing it now?''
    Ms. Therit. I would welcome those conversations because we 
did have a GAO report that identified some lack of compliance 
with them going back in and updating the system or following up 
on actions that were delayed or deferred. Though on one hand 
you want to respect the findings of the GAO study and say, 
well, maybe we should not have done those things, but on the 
other hand, to your point, we do not want to lose talent 
because we are taking 24 steps and it should be 7 steps. So 
trying to find that right balance.
    Chairman Tester. So I was misinformed. People got waylaid 
on their way to the VA Committee. So I want to thank you for 
being our witnesses today. We have more work to be done in this 
space. I look forward to productive discussions on this and 
other issues that have been brought up today so that we can 
move VA forward.
    The record will open for a week. This hearing is adjourned.
    [Whereupon, at 4:28 p.m., the hearing was adjourned.]






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