[Congressional Record Volume 165, Number 203 (Monday, December 16, 2019)]
[House]
[Pages H10272-H10275]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               IMPROVING CONFIDENCE IN VETERANS' CARE ACT

  Mr. TAKANO. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 3530) to amend title 38, United States Code, to direct the 
Secretary of Veterans Affairs to enforce the licensure requirement for 
medical providers of the Department of Veterans Affairs, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3530

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Improving Confidence in 
     Veterans' Care Act''.

     SEC. 2. COMPLIANCE WITH REQUIREMENTS FOR EXAMINING 
                   QUALIFICATIONS AND CLINICAL ABILITIES OF 
                   DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE 
                   PROFESSIONALS.

       (a) In General.--Subchapter I of chapter 74 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 7414. Compliance with requirements for examining 
       qualifications and clinical abilities of health care 
       professionals

       ``(a) Compliance With Credentialing Requirements.--The 
     Secretary shall ensure that each medical center of the 
     Department, in a consistent manner--
       ``(1) compiles, verifies, and reviews documentation for 
     each health care professional of the Department at such 
     medical center regarding, at a minimum--
       ``(A) the professional licensure, certification, or 
     registration of the health care professional;
       ``(B) whether the health care professional holds a Drug 
     Enforcement Administration registration; and
       ``(C) the education, training, experience, malpractice 
     history, and clinical competence of the health care 
     professional; and
       ``(2) continuously monitors any changes to the matters 
     under paragraph (1), including with respect to suspensions, 
     restrictions, limitations, probations, denials, revocations, 
     and other changes, relating to the failure of a health care 
     professional to meet generally accepted standards of clinical 
     practice in a manner that presents reasonable concern for the 
     safety of patients.
       ``(b) Registration Regarding Controlled Substances.--(1) 
     Except as provided by paragraph (2), the Secretary shall 
     ensure that each covered health care professional holds an 
     active Drug Enforcement Administration registration.
       ``(2) The Secretary shall--
       ``(A) determine the circumstances in which a medical center 
     of the Department must obtain a waiver under section 303 of 
     the Controlled Substances Act (21 U.S.C. 823) with respect to 
     covered health care professionals; and
       ``(B) establish a process for medical centers to request 
     such waivers.
       ``(3) In carrying out paragraph (1), the Secretary shall 
     ensure that each medical center of the Department monitors 
     the Drug Enforcement Administration registrations of covered 
     health care professionals at such medical center in a manner 
     that ensures the medical center is made aware of any change 
     in status in the registration by not later than seven days 
     after such change in status.
       ``(4) If a covered health care professional does not hold 
     an active Drug Enforcement Administration registration, the 
     Secretary shall carry out any of the following actions, as 
     the Secretary determines appropriate:
       ``(A) Obtain a waiver pursuant to paragraph (2).
       ``(B) Transfer the health care professional to a position 
     that does not require prescribing, dispensing, administering, 
     or conducting research with controlled substances.
       ``(C) Take adverse actions under subchapter V of this 
     chapter, with respect to an employee of

[[Page H10273]]

     the Department, or terminate the services of a contractor, 
     with respect to a contractor of the Department.
       ``(c) Reviews of Concerns Relating to Quality of Clinical 
     Care.--(1) The Secretary shall ensure that each medical 
     center of the Department, in a consistent manner, carries 
     out--
       ``(A) ongoing, retrospective, and comprehensive monitoring 
     of the performance and quality of the health care delivered 
     by each health care professional of the Department located at 
     the medical center, including with respect to the safety of 
     such care; and
       ``(B) timely and documented reviews of such care if an 
     individual notifies the Secretary of any potential concerns 
     relating to a failure of the health care professional to meet 
     generally accepted standards of clinical practice in a manner 
     that presents reasonable concern for the safety of patients.
       ``(2) The Secretary shall establish a policy to carry out 
     paragraph (1), including with respect to--
       ``(A) determining the period by which a medical center of 
     the Department must initiate the review of a concern 
     described in subparagraph (B) of such paragraph following the 
     date on which the concern is received; and
       ``(B) ensuring the compliance of each medical center with 
     such policy.
       ``(d) Compliance With Requirements for Reporting Quality of 
     Care Concerns.--When the Secretary substantiates a concern 
     relating to the clinical competency of, or quality of care 
     delivered by, a health care professional of the Department 
     (including a former such health care professional), the 
     Secretary shall ensure that the appropriate medical center of 
     the Department timely notifies the following entities of such 
     concern, as appropriate:
       ``(1) The appropriate licensing, registration, or 
     certification body in each State in which the health care 
     professional is licensed, registered, or certified.
       ``(2) The Drug Enforcement Administration.
       ``(3) The National Practitioner Data Bank established 
     pursuant to the Health Care Quality Improvement Act of 1986 
     (42 U.S.C. 11101 et seq.).
       ``(4) Any other relevant entity.
       ``(e) Prohibition on Certain Settlement Agreement Terms.--
     (1) Except as provided by paragraph (2), the Secretary may 
     not enter into a settlement agreement relating to an adverse 
     action against a health care professional of the Department 
     if such agreement includes terms that require the Secretary 
     to conceal from the personnel file of the employee a serious 
     medical error or lapse in clinical practice that constitutes 
     a substantial failure to meet generally accepted standards of 
     clinical practice as to raise reasonable concern for the 
     safety of patients.
       ``(2) Paragraph (1) does not apply to adverse actions that 
     the Special Counsel under section 1211 of title 5 determines 
     constitutes a prohibited personnel practice.
       ``(f) Training.--Not less frequently than biannually, the 
     Secretary shall provide mandatory training to employees of 
     each medical center of the Department who are responsible for 
     any of the following activities:
       ``(1) Compiling, validating, or reviewing the credentials 
     of health care professionals of the Department.
       ``(2) Reviewing the quality of clinical care delivered by 
     health care professionals of the Department.
       ``(3) Taking adverse privileging actions or making 
     determinations relating to other disciplinary actions or 
     employment actions against health care professionals of the 
     Department for reasons relating to the failure of a health 
     care professional to meet generally accepted standards of 
     clinical practice in a manner that presents reasonable 
     concern for the safety of patients.
       ``(4) Making notifications under subsection (d).
       ``(g) Definitions.--In this section:
       ``(1) The term `controlled substance' has the meaning given 
     that term in section 102 of the Controlled Substances Act (21 
     U.S.C. 802).
       ``(2) The term `covered health care professional' means a 
     person employed in a position as a health care professional 
     of the Department, or a contractor of the Department, that 
     requires the person to be authorized to prescribe, dispense, 
     administer, or conduct research with, controlled substances.
       ``(3) The term `Drug Enforcement Administration 
     registration' means registration with the Drug Enforcement 
     Administration under section 303 of the Controlled Substances 
     Act (21 U.S.C. 823) by health care practitioners authorized 
     to dispense, prescribe, administer, or conduct research with, 
     controlled substances.
       ``(4) The term `health care professional of the Department' 
     means the professionals described in section 1730C(b) of this 
     title, and includes a contractor of the Department serving as 
     such a professional.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 7413 the following new item:

``7414. Compliance with requirements for examining qualifications and 
              clinical abilities of health care professionals.''.

       (c) Deadline for Implementation.--The Secretary of Veterans 
     Affairs shall commence the implementation of section 7414 of 
     title 38, United States Code, as added by subsection (a), by 
     the following dates:
       (1) With respect to subsections (a), (c)(2), (d), and (f), 
     not later than 180 days after the date of the enactment of 
     this Act.
       (2) With respect to subsection (c)(1), not later than one 
     year after the date of the enactment of this Act.
       (3) With respect to subsection (b)(2), not later than 18 
     months after the date of the enactment of this Act.
       (d) Audits and Reports.--
       (1) Audits.--The Secretary of Veterans Affairs shall carry 
     out annual audits of the compliance of medical centers of the 
     Department of Veterans Affairs with the matters required by 
     section 7414 of title 38, United States Code, as added by 
     subsection (a). In carrying out such audits, the Secretary--
       (A) may not authorize the medical center being audited to 
     conduct the audit; and
       (B) may enter into an agreement with another department or 
     agency of the Federal Government or a nongovernmental entity 
     to conduct such audits.
       (2) Reports.--Not later than one year after the date of the 
     enactment of this Act, and annually thereafter for five 
     years, the Secretary of Veterans Affairs shall submit to the 
     Committees on Veterans' Affairs of the House of 
     Representatives and the Senate a report on the audits 
     conducted under paragraph (1). Each such report shall include 
     a summary of the compliance by each medical center with the 
     matters required by such section 7414.
       (3) Initial report.--The Secretary shall include in the 
     first report submitted under paragraph (2) the following:
       (A) A description of the progress made by the Secretary in 
     implementing such section 7414, including any matters under 
     such section that the Secretary has not fully implemented.
       (B) An analysis of the feasibility, advisability, and cost 
     of requiring credentialing employees of the Department to be 
     trained by an outside entity and to maintain a credentialing 
     certification.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Madam Speaker, I request unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and to insert extraneous material on H.R. 3530, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in support of H.R. 3530, as amended, the 
Improving Confidence in Veterans' Care Act, introduced by 
Representative Cloud of Texas.
  This legislation requires the Department of Veterans Affairs to 
conduct better oversight of its hospitals' compliance with existing 
policies on patient safety and quality of care. Specifically, the bill 
directs VA to conduct annual audits and to report to Congress on its 
ability to uphold or failure to follow standards for reviewing the 
clinical competency of its healthcare professionals.
  This bill mandates that VA examine whether its hospitals are 
appropriately assessing the qualifications and clinical abilities of VA 
healthcare professionals, both before they are hired and while they are 
caring for veterans. It also requires VA to ensure employees and 
contractors hold active Drug Enforcement Administration registrations 
if they are required to prescribe, dispense, administer, or conduct 
research with controlled substances.
  If concerns arise related to the clinical competence of VA healthcare 
professionals, this bill requires VA to ensure its officials conduct 
prompt reviews. And when quality of care or patient safety concerns are 
substantiated, it requires VA to ensure its hospital leaders promptly 
report those concerns to the National Practitioner Data Bank and State 
licensing boards.
  In addition, this measure requires VA to provide mandatory biannual 
training for hospital employees charged with reviewing VA clinician 
credentials and monitoring their clinical practice.
  The Veterans Affairs' Subcommittee on Oversight and Investigations 
held a hearing related to these issues on October 16. At the hearing, 
my colleagues and I discussed several concerning cases of clinical 
incompetency and misconduct among VA clinicians that were widely 
reported in the media in recent months. We also explored the very real 
risks of patient harm that arise from VA medical centers' noncompliance 
with departmental policies and a lack of oversight on the part of 
leaders who are higher up in VA's chain of command.
  For example, in August 2019, a former VA pathologist in Arkansas was 
charged with involuntary manslaughter, fraud, and making false 
statements in an attempt to conceal

[[Page H10274]]

years of substance abuse. Over his 11-year tenure with VA, he is 
believed to have botched diagnoses for an estimated 3,000 veterans, 
some of whom died.
  The VA facility that employed this physician either did not catch or 
ignored his previous DUI convictions when they hired him. Despite 
numerous complaints from colleagues, it took years for leadership at 
the facility to investigate allegations that the doctor was showing up 
drunk at work.
  In addition, in September 2019, the VA OIG reported that multiple 
leadership failures and poor oversight of clinical competency at a VA 
facility in the Midwest allowed an ophthalmologist to perform 
substandard surgery and clinic laser procedures for 2 years. This 
doctor regularly took hours to complete cataract surgeries that should 
have taken less than 30 minutes.
  The facility director and chief of staff repeatedly dismissed 
concerns that were raised by other staff, and facility leaders never 
called on experts to directly observe this doctor's surgeries until 
long after concerns were raised. VA's regional leaders also failed to 
carry out related oversight responsibilities.
  Both the VA Office of Inspector General and the U.S. Government 
Accountability Office have identified longstanding concerns with 
whether VA is doing enough to ensure its medical facilities only employ 
and contract with highly qualified, highly competent healthcare 
professionals.
  H.R. 3530, as amended, will require VA to implement a number of GAO 
recommendations that were discussed at the October 16 hearing. Both the 
Federation of State Medical Boards and the National Council of State 
Boards of Nursing support this legislation. I urge all Members to join 
me in approving this important bill.
  Madam Speaker, I reserve the balance of my time.
  Mr. BOST. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in support of H.R. 3530, as amended, the 
Improving Confidence in Veterans' Care Act.
  This bill is sponsored by Congressman   Michael Cloud from Texas. I 
thank him for his leadership in introducing this bill to improve the 
safety and quality of the care that is provided to our Nation's 
veterans throughout the Department of Veterans Affairs' healthcare 
system.
  This bill would make several changes to current VA processes and 
procedures to improve the credentialing and privileging of the 
healthcare providers who are treating our veterans. For example, it 
would require VA to ensure that each VA medical center complies, 
verifies, reviews, and continuously monitors certain documentation, 
including licensure and certifications, related to the qualifications 
and clinical abilities of the VA healthcare professionals.

                              {time}  1515

  It would also require VA to ensure that each VA medical center 
reviews concerns relating to quality of care delivered by VA healthcare 
professionals and, when a concern is verified, that entities like State 
licensing boards, the Drug Enforcement Administration, and the National 
Practitioner Data Bank are notified in a timely manner so that 
corrective actions can be taken to ensure patient safety and 
accountability.
  In general, VA provides an excellent level of care to the veterans 
who are enrolled in the VA healthcare system. However, several recent 
patient safety incidents across this country have called into question 
the way the VA oversees provider credentialing, monitors the quality of 
the care that veterans receive, and responds to patient safety 
concerns. Many of the provisions in this bill are based on 
recommendations made by the VA inspector general and the Government 
Accountability Office for improving VA's standard operating procedures 
in each of these areas.
  The brave men and women who have served in the Armed Forces deserve 
to know that the care they are receiving from the VA meets the highest 
quality and patient safety standards. This bill will help give them 
that assurance, and I urge all of my colleagues to join me in 
supporting this bill.
  Madam Speaker, I yield 4 minutes to the gentleman from Texas (Mr. 
Cloud), who has taken the lead on this.
  Mr. CLOUD. Madam Speaker, I rise today in support of my bill, H.R. 
3530, the Improving Confidence in Veterans' Care Act.
  This bill is presented in the spirit of those who have come before 
us, from George Washington, one of our Nation's first veterans 
advocates, to those who have worked through generations to ensure the 
men and women who serve in uniform are not forgotten.
  A report released in February outlines several cases of doctors and 
healthcare workers who were treating veterans at VA facilities despite 
having had their medical licenses suspended or completely terminated. 
These cases ranged from those needing to complete educational courses 
to very serious instances of malpractice and patient neglect.
  A similar problem was found with the Drug Enforcement 
Administration's registrations. Some doctors were prescribing drugs 
without being legally registered by the DEA to do so.
  One of the reasons the VA seemingly overlooked this problem was 
because they did not know about the resources available to check the 
status of these licenses. Had the VA checked with State licensing 
boards or online records, they could have discovered that these doctors 
were unqualified, before allowing them to treat our veterans.
  This legislation ensures that the VA hires only licensed doctors to 
provide care for our veterans and that the VA regularly checks licenses 
to make sure care providers do not fall out of compliance. Regular 
audits are common practice in medical facilities across this country, 
and our veterans deserve nothing less.
  Finally, to ensure accountability, this legislation would require the 
VA to report their progress to Congress.
  In the last few years, we turned a corner in improving care for our 
veterans, but there is still so much work to be done.
  The liberty we enjoy in the United States is not without cost. Our 
Nation's servicemembers paid for it, many with their lives and many 
more with the scars brought back from war. Our Nation owes it to our 
veterans to deliver on the promises we have made to them.
  I thank Chairman Takano, Ranking Member Roe, and their staffs for 
their work to strengthen this bill and ensure that veterans receive a 
high standard of care from qualified workers.
  Mr. BOST. Madam Speaker, I yield myself the balance of my time.
  As given witness here today, this is simply making sure that our 
veterans receive the quality care that they expect and should expect 
and that we should be giving them. There has been a failure in the 
keeping of records and making sure by our VA that the doctors remain 
qualified and that the specialists remain qualified in their 
specialties.
  What this bill does is it makes sure that our veterans continue to 
receive quality care and that records are kept. That is why we are 
joining in a bipartisan manner to move this bill forward.
  Madam Speaker, I encourage all Members to vote in support of this 
bill, and I yield back the balance of my time.
  Mr. TAKANO. Madam Speaker, I yield myself the balance of my time.
  Let me say that it was with bipartisan shock and horror that we heard 
of the revelations in Arkansas. Certainly, our bipartisan hearts go out 
to the families of those veterans in Arkansas. Rest assured, this 
committee, on a bipartisan basis, will do everything that we can to 
make sure that these sorts of hiring mistakes do not happen again and 
that the tragedy we saw in the facilities in Arkansas do not happen 
again.
  I urge all of my colleagues to support H.R. 3530, as amended, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Takano) that the House suspend the rules 
and pass the bill, H.R. 3530, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BOST. Madam Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.

[[Page H10275]]

  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________