[Congressional Record (Bound Edition), Volume 162 (2016), Part 2]
[House]
[Pages 1489-1491]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     VA MEDICAL CENTER RECOVERY ACT

  Mr. ABRAHAM. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3234) to amend title 38, United States Code, to establish 
within the Department of Veterans Affairs an Office of Failing Medical 
Center Recovery, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3234

       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 ``VA Medical Center Recovery 
     Act''.

     SEC. 2. EVALUATION AND IMPROVEMENT OF MEDICAL CENTERS.

       (a) Underperforming Medical Centers.--
       (1) In general.--Chapter 73 of title 38, United States 
     Code, is amended by inserting after section 7311A the 
     following new section:

     ``Sec. 7311B. Evaluation and improvement of medical centers

       ``(a) Identification of Underperforming Medical Centers.--
     (1) Not later than 15 days after the end of each fiscal 
     quarter, the Secretary shall publish in the Federal Register 
     and on a publically available, searchable Internet website of 
     the Department a compilation of key health metrics for each 
     medical center of the Department.
       ``(2) On a semiannual basis, the Secretary shall determine, 
     under the key health metrics, whether each medical center of 
     the Department is satisfactory or underperforming.
       ``(b) Rapid Deployment Teams.--(1) Not later than 30 days 
     after the date on which the Secretary identifies a medical 
     center as an underperforming medical center under subsection 
     (a)(2), the Secretary shall deploy a rapid deployment team to 
     the medical center to ensure that the medical center achieves 
     satisfactory performance as quickly as practicable.
       ``(2) Each rapid deployment team deployed to an 
     underperforming medical center under paragraph (1) shall--
       ``(A) identify the areas of the medical center that require 
     improvement, including with respect to the procedures of the 
     medical center, inefficiencies of the medical center, and 
     whether the medical center follows directives and best 
     practices;
       ``(B) establish a remediation plan to improve the 
     performance of the medical center;
       ``(C) review and assesses the status of any--
       ``(i) disciplinary actions taken at the medical center;
       ``(ii) recommendations made by the Inspector General of the 
     Department applicable to the medical center; and
       ``(iii) findings made by the Comptroller General of the 
     United States applicable to the medical center; and
       ``(D) provide training to the director and staff of the 
     medical center with respect to carrying out such 
     improvements.
       ``(3) The Secretary shall ensure that--
       ``(A) the director of each underperforming medical center 
     carries out the remediation plan under paragraph (2)(B); and
       ``(B) the rapid deployment team has access to all 
     facilities and all electronic systems, records, reports, 
     audits, reviews, documents,

[[Page 1490]]

     papers, or other materials the rapid deployment team 
     determines necessary to carry out this subsection.
       ``(4) Each rapid deployment team deployed to an 
     underperforming medical center under paragraph (1) shall 
     consist of--
       ``(A) subject matter experts with experience in--
       ``(i) customer service training;
       ``(ii) increasing the efficiency of organizations;
       ``(iii) clinical care specific to the areas in which the 
     underperforming medical center requires improvement; and
       ``(iv) any other areas that the Secretary determines 
     appropriate to improve the underperforming medical center; 
     and
       ``(B) an employee of the Office of the Inspector General of 
     the Department.
       ``(5) To the extent practicable, each rapid deployment team 
     shall include process improvement subject matter experts from 
     the Veterans Experience Office of the Department.
       ``(6) The Secretary shall determine the duration of the 
     deployment of a rapid deployment team under paragraph (1).
       ``(c) Investigations and Whistleblower Protections.--(1) 
     The Inspector General of the Department shall prioritize 
     investigations relating to underperforming medical centers.
       ``(2) The Office of Accountability Review shall prioritize 
     investigations of whistleblower retaliation relating to 
     underperforming medical centers.
       ``(d) Quarterly Reports.--On a quarterly basis, the 
     Secretary shall submit to Congress a report that includes, 
     with respect to the quarter covered by the report--
       ``(1) each identification of an underperforming medical 
     center made by the Secretary;
       ``(2) the actions taken by the Secretary and rapid 
     deployment teams with respect to improving underperforming 
     medical centers; and
       ``(3) an update on any progress made by each 
     underperforming medical center, including whether the 
     underperforming medical center is carrying out the 
     remediation plan pursuant to subsection (b)(3)(A).
       ``(e) Relationship to Quality Assurance and National 
     Quality Management Officer.--The requirements of this section 
     are in addition to any requirements under sections 7311 and 
     7311A of this title.
       ``(f) Definitions.--In this section:
       ``(1) The term `underperforming medical center' means a 
     medical center of the Department that the Secretary 
     determines is underperforming under subsection (a)(2).
       ``(2) The term `key health metrics' means the following:
       ``(A) The Strategic Analytics Improvement and Learning 
     (commonly referred to as `SAIL') data used by the Department 
     (or such successor data metric).
       ``(B) An evaluation system established by the Secretary 
     based on the total data described in subparagraph (A) to 
     determine whether the performance of a medical center is 
     satisfactory or underperforming and requires remediation 
     pursuant to this section.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 73 of such title is amended by adding 
     after the item relating to section 7311A the following new 
     item:

``7311B. Evaluation and improvement of medical centers''.
       (b) Initial Key Health Metrics Publication.--The Secretary 
     shall publish the initial key health metrics under section 
     7311B(a)(1) of title 38, United States Code, as added by 
     subsection (a)(1), by not later than 90 days after the date 
     of the enactment of this Act.
       (c) Initial Identification of an Underperforming Medical 
     Center.--The Secretary shall make the initial identifications 
     under section 7311B(a)(2) of title 38, United States Code, as 
     added by subsection (a)(1), by not later than 180 days after 
     the date of the enactment of this Act.

     SEC. 3. STANDARDIZED TRAINING FOR NURSES.

       (a) Training.--The Secretary of Veterans Affairs shall seek 
     to enter into partnerships with recognized schools of nursing 
     to provide undergraduate nursing students enrolled in such 
     schools with standardized training with respect to the 
     following:
       (1) The culture of the military and veterans.
       (2) Post-traumatic stress disorder.
       (3) Traumatic brain injury.
       (4) Amputation and assistive devices.
       (5) Environmental, chemical, and toxic exposure.
       (6) Substance use disorders.
       (7) Military sexual trauma.
       (8) Suicide.
       (9) Homelessness.
       (10) Serious illness at the end of life.
       (11) Benefits, services, and resources for veterans that 
     are administered by the Federal Government.
       (b) Development.--In developing the training under 
     subsection (a), the Secretary shall consult with appropriate 
     accrediting bodies, schools of nursing, and industry leaders.

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


                             General Leave

  Mr. ABRAHAM. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
add extraneous material on H.R. 3234, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  Mr. ABRAHAM. Mr. Speaker, I yield myself as much time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 3234, as amended, the 
Department of Veterans Affairs VA Medical Center Recovery Act.
  This bill would require the VA to publish key health metrics and use 
these metrics to determine semiannually which VA medical centers are 
performing satisfactorily and which are underperforming.
  If a VA medical center is determined to be underperforming, VA would 
be required to send a rapid deployment team to the facility within 30 
days to establish a remediation plan and provide needed help in problem 
areas.
  The VA would also be required to send regular reports to Congress on 
which facilities are underperforming and what actions have been taken 
to improve their performance.
  In addition, the bill would require the VA inspector general to 
prioritize investigations related to underperforming medical centers 
and the Office of Accountability Review to prioritize investigations of 
whistleblower retaliation relating to underperforming medical centers.
  This bill would also include a provision to strengthen training for 
undergraduate nurses on veterans unique issues, needs, and benefits.
  H.R. 3234, as amended, is sponsored by Congresswoman Martha Roby from 
Alabama, and I am grateful for her leadership in introducing this 
legislation.
  I yield 2 minutes to the gentlewoman from Alabama (Mrs. Roby).
  Mrs. ROBY. Mr. Speaker, I rise to ask my colleagues to support H.R. 
3234, the VA Medical Center Recovery Act.
  This bill puts the responsibility for identifying and improving the 
worst performing VA medical centers squarely on the Secretary of 
Veterans Affairs, requiring him to deploy teams of experts to turn 
around failing facilities.
  The bill would, for the first time, require the VA to publish key 
metrics known as SAIL data on the Federal Register and would require 
the Secretary to report to Congress any medical centers determined to 
be failing.
  Some of my colleagues might wonder why such a bill is necessary, 
given the VA reform law that we passed more than a year ago. That was a 
good bill, but it wasn't a silver bullet. Many problems still exist in 
the VA, and it is our responsibility to address them.
  Mr. Speaker, the Central Alabama VA in my district became known as 
one of the worst in the country. My staff and I worked with 
whistleblowers and the press to uncover major instances of misconduct, 
negligence, and mismanagement inside the Central Alabama VA, including:
  Widespread manipulation of scheduling data. A nation-leading 57 
percent of employees reported that managers instructed them to change 
appointment times to hide long waits.
  More than 1,000 patient X-rays, some showing malignancies, went 
missing for months and even years.
  A pulmonologist was caught twice falsifying more than 1,200 patient 
records but somehow given a satisfactory review.
  An employee took a recovering veteran to a crackhouse, bought him 
drugs, and paid for prostitutes, all to extort his benefits. When 
caught, the employee wasn't fired, not until a year later, after our 
office exposed it publicly.
  In the wake of these exposures, the Central Alabama VA Director 
became the first senior VA manager fired under the new law.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. ABRAHAM. I yield the gentlewoman an additional 3 minutes.

[[Page 1491]]


  Mrs. ROBY. But even after leadership changes, data showed that the 
Central Alabama VA's two medical centers in Montgomery and Tuskegee 
were ranked the worst and the second worst in the Nation for delays in 
patient care.
  By any measure, the Central Alabama VA was the definition of a 
failing VA system. We had a severe problem, and it required immediate 
attention.
  But, Mr. Speaker, getting the attention of the top VA leaders proved 
difficult. Once our problems left the front page, there wasn't a whole 
lot of followup.
  My veterans in Alabama were subject to some of the worst healthcare 
service in the country, and no one wanted to take responsibility.
  Mr. Speaker, I began to think maybe it was because we were depending 
on a broken bureaucracy to fix itself, that maybe it was because we 
were asking VA leaders, rather than requiring them, to intervene.
  Mr. Speaker, I decided that it was time that we changed that. So, in 
July, I filed that legislation and began working with the Veterans' 
Affairs Committee to get a hearing and a vote.
  I don't sit on the Veterans' Affairs Committee, so I want to thank 
the chairman, Jeff Miller; the subcommittee chairman, Dan Benishek; and 
all the members of the committee for being receptive and working with 
me on this bill.
  I also want to thank all the committee staff for their hard work.
  There is no question this bill represents a major step forward and a 
foundation to build upon.
  It should be noted that almost 2 years after the scandal first broke, 
we are making progress in central Alabama at the VA. Staffing is up, 
wait times are down. We are building a Community Veterans Health 
Network that I believe one day can be an example for the entire Nation. 
We have a long way to go, and I am truly optimistic about the future.
  But, Mr. Speaker, it shouldn't have taken this long and it shouldn't 
have taken a Member of Congress breathing down the necks of top VA 
officials to get the attention that our veterans deserve.
  You know, sometimes I wonder what would have happened if our 
courageous whistleblowers hadn't stepped up or if the reporters we 
worked with didn't think it was a story?
  What if the truth about the missing X-rays, the manipulated 
pulmonology records, and the crackhouse never came out? What if we want 
exposed all of that?
  Would our veterans in central Alabama still be subject to the worst 
health care in the country? Would we even know?
  I don't want what happened in central Alabama to ever happen again 
anywhere. This bill helps to ensure that by requiring key VA health 
metrics to be published for everyone to see and making sure that the VA 
officials at the very top cannot hide behind the layers of bureaucracy 
when it comes to severely failing centers.
  Again, I ask my colleagues to support this bill.

                              {time}  1630

  Mr. ABRAHAM. Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this legislation, H.R. 3234, as amended, is designed to 
establish criteria for the evaluation and improvement of VA medical 
centers. The bill requires the VA to create key health metrics to 
measure whether each medical center is satisfactory or underperforming.
  The metrics will be published on the VA Web site, and an 
underperforming medical center will be subject to a rapid deployment 
team being sent to the facility to create a remediation plan and bring 
them up to standards. The VA will issue quarterly reports on the 
underperforming facilities and their progress in the following 
remediation plan.
  Additionally, the bill seeks to require the VA to enter into 
partnerships with recognized schools of nursing to provide 
undergraduate nursing students enrolled in such schools with 
standardized training. The bill lists the 11 areas the training should 
involve, including PTSD, TBI, and military sexual trauma.
  Mr. Speaker, this bill addresses issues the committee has expressed 
concerns about in the past. I support its passage.
  Mr. Speaker, I urge the passage of H.R. 3234, as amended.
  I yield back the balance of my time.
  Mr. ABRAHAM. Mr. Speaker, I also once again encourage all Members to 
support H.R. 3234, as amended.
  I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I rise in strong support of H.R. 3234, 
the Failing VA Medical Center Recovery Act.
  I support this legislation because it would establish in the 
Department of Veterans Affairs an Office of Failing Medical Center 
Recovery, and the position of Under Secretary for Failing Medical 
Center Recovery to head the Office.
  The Office shall carry out the managerial and day-to-day operational 
control of each VA failing medical center.
  The bill directs that the VA shall: publish in the Federal Register 
and on a publicly available VA website a compilation of key health 
metrics for each VA medical center; certify semiannually that each VA 
medical center ranked as ``failing'' is subject to managerial and day-
to-day operational control by the Office; revoke the certification of a 
VA medical center as a failing medical center if it achieves a ranking 
of ``satisfactory'' or better for three consecutive fiscal quarters; 
submit to Congress a quarterly report on the Office, including actions 
taken by the Under Secretary regarding covered failing medical centers; 
and transfer each covered failing medical center from the direct 
control of the relevant Veterans Integrated Service Network to the 
direct control of the Under Secretary.
  The bill also ensures that the Inspector General of the VA will 
prioritize investigations relating to covered failing medical centers, 
and the Office of Accountability Review will prioritize investigations 
of whistle blower retaliation relating to such centers.
  Mr. Speaker, the reason this important legislation is needed is 
illustrated by the tragic and heart breaking cases of thousands of 
veterans who were left waiting for care for serious medical conditions.
  In the State of Texas we have 1,099,141 Veterans under the age of 65 
and 590,618 who are over the age of 65. There are over 1,689,759 
veterans living in our state.
  The 18th Congressional District has 20,607 under age 65 and 9,844 
Veterans over the age of 65.
  The Michael E. Debakey Veterans Hospital Center, located in Houston 
Texas serves the health care needs of thousands of veterans and their 
families.
  The Debakey Veterans Hospital Center provides support to veterans and 
their families who are amputees, cancer, spinal cord injuries, 
traumatic brain injury, and have visual impairments.
  The Medical center provides family support services through its 
Fisher House that provides living suites at no cost to family members 
of hospitalized Veterans and military members.
  Today, with our vote on H.R. 3234, we can renew our commitment to our 
nation's more than 2 million troops and reservists, their families, and 
the 22 million veterans who served our nation.
  I urge all Members to join me in voting to pass H.R. 3234.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Louisiana (Mr. Abraham) that the House suspend the rules 
and pass the bill, H.R. 3234, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  The title of the bill was amended so as to read: ``A bill to amend 
title 38, United States Code, to direct the Secretary of Veterans 
Affairs to evaluate the ability of each medical center of the 
Department to provide quality health care to veterans, to ensure that 
the Secretary improves such medical centers that are underperforming, 
and for other purposes.''.
  A motion to reconsider was laid on the table.

                          ____________________