Veterans Affairs SecretaryRobert Wilkie is testifying. How are we expanding that . As i am sure you are aware so 6 is a constant constellation of syndromes. There have been several definitions over the past 20 years and it takes recognizing what we call gestalt, looking at the numbers of the patient, identifying this early so you can hydrate the person and get them the antibiotics they need. Several facilities are exploring an automated way to synchronize that data that this might be a substance than for them to make a more immediate clinical decision to engage that patient. We have extensive and consistent protocols across the system for this and excellent data to show that we are effective in managing this but these advancements in Technology May take a step further and that will be important in the setting of covid19 where we know this is a complication of the illness. I would like to recognize this cart right forgive me. I take it back. I recognize mister case for 5 minutes. Thank you, madam chair. Greetings, your remembered as the first paycheck period to visit our most committees, the ranking federal official, thank you for not only trying to understand what the field every moment the veterans feel. I wanted to follow up and commend your team. They have done a really nice job through covid19 not only taking care of veterans communities but also interacting with local Healthcare Facilities and providers. May i also mentioned you are getting a new director, admiral robinson, former Surgeon General of the navy will be coming out in the next few weeks and he is an outstanding public servant. Excellent, we appreciate that very much. It is a good model, we have reliance along those lines my question goes back to testing and ppe. The question i had from my discussions with your team out there, from the Public Health perspective they have done better than the rest of the country, that has come to the expense of our economy because we shut down tourism to get low numbers so we have a tremendous economic issue where we are one of the worst in the country. From the testing side the concern is while we were doing a good job on the Public Health side the testing and ppe, including the va community, it was really considered as an integral parts of the broader community, as air supplies were allocated. The concern there has always been if we did see a surge, if there came a time because we covered tourism and saw larger numbers of cases and as our military started to move around a little bit more, the Largest Military communities in the country and largest veterans communities in the country we would see that and start to detect much greater concern over the scarcity of test kits and ppe. This also interact with the civilian Community Side where we see a patchwork where the nonveterans Care Community utilizes the delivery of services and brought more places in our country that they have an infant system in terms of the infant testing, requiring all testing to come into a procedure, but the bottom line, that is using testing and ppe, a scarce supply through the entire system. My question is what what is the ability of the Veterans Administration to deliver test kits and supply for testing to its facilities in the pacific. Do they have an independent source, a way of assuring you are doing that in a Surge Capacity regardless what the rest of the community is doing . Our privacy as early engagements, and 145 facilities have Rapid Testing. They had multiple types available in testing, rapid and and. That makes pieces, and swabs and transport media. And the havent spoke model. That helps us more rapidly process those tests to facilities and clinicians to make decisions as soon as possible and keep that care going through to derision. Using this opportunity to emphasize the importance of the outpatient healthcare access, multi specialty, that has been a 3year a too long project, fully funded and ready to go. In hearings and offline, it is still hung up and seems to be somewhere above va. The issue seems to be on the inability to understand we have higher land costs and that has to be taken into account in terms of the lease award. Higher land lease costs should not disadvantage our veterans which is a desperately needed facility and i put in the covid19 context, it was needed before covid19 but is definitely needed after and definitely part of the economic regeneration, one of the most devastated economically. It seems on its last few months so i would ask your personal attention forgetting that ordered so we can cut through what is going on, and make the award and get this project underway. In a country like this with the veterans population, one size doesnt fit all solution does not make any sense on the big island. They heard me, as you say push it across the finish line. Mister rutherford. On behalf of the 1. 6 million veterans in the state of florida, our home state of florida, i want to say thank you for the service and i want to talk about access to care a little bit. You sense covid19, we have had 900,000 telemedicine encounters. I am a little concerned. I hear people talk about telemedicine as medicine that is good enough. An individual that spoke to me about his yearly physical retired veteran who in the past would get the bloodwork up, and the doctor would go over those results with them. This year, a 5minute phone call, no bloodwork because he was in a low risk population. The whole purpose, this goes to the Underlying Health concerns highlighted as you mentioned earlier by covid19, the focus on health and finding issues before they become serious issues, that is what this physical is for. My question, can you tell me first of all, define for me what a telemedicine encounter is. In the private world it is going to be even more concerning because whether it is cms or insurance companies, exactly what is the definition of that . A 5minute phone call . Is that a telemedicine encounter . How do you find that . Are there areas where you think it is not effective . I would think if we are going to have a phone conversation, for a doctor to go over bloodwork to tell me where i am high, where i am low and what i need to follow, i think that is reasonable. For a physical to devolve into just a 5minute phone call, i question whether that is the best use of telemedicine. I will answer what has happened in the last two month and that doctor mcdonald, the practitioner, give you the details. We were the First Healthcare system in the country to stop routines. We had to do that as the chair has pointed out on numerous occasions, not only in the setting but the phone calls. I was making sure we were preserving our people and our equipment so those routine visits stop in terms of face to face but we made up for that in telemedicine encounters to protect patients and protect our staff. I would say the wave of the future for telemedicine is not what you just described. It is really Mental Health. It is allowing people to address these deep issues in the comfort of their home or can visit the library or wherever they feel comfortable to stock talk to our Mental Health professionals. I will let doctor mcdonald answer the rest. To emphasize what the secretary said, you are right that there is care that belongs in person and that high touch, that meaning of the patient and provider relationship direct persontoperson the privilege of that encounter is frankly why i went into medicine and that is important to us and to the secretarys point, that can be delivered effectively via telemedicine. To your question about physical. We are going above and beyond and conducting outreach to veterans, meeting them where they are, not causing them to wait for a physical anymore but making sure we know their concerns in advance. We are emphasizing the ability to do that through a phone call, to search them to the clickable link to send up a video and conduct that visit in a more frequent high touch way that meets their concerns before they have to wait for that annual visit. To the question of a 5minute encounter, i would offer that sometimes that is the right answer for the person but via telehealth we can still have that meaningful deep discussion and spend the time that is necessary to address their concern and that is how we are approaching it. We train our staff extensively on that so theres meaning on both sides of that virtual encounter. If i could ask one last question, this deals with access. In 2016. Quickly. Quickly. Very quickly. In 2016 the va authorized three of the four advance practicing nursing to go to full Practice Authority but you did not include the certified registered nurse in that in the argument was that there was adequate access and im hearing theres a lot of access being delayed because the crnas are not available. Can you address that . Is there any consideration to giving them fool Practice Authority . May i . You are recognized. The serna program was done carefully. We provided fool Practice Authority in those states where the state offered full Practice Authority. We only hired 18 additional ones but that is where the parameters of the practice, we did that because we needed so many hands on deck for the emergency rooms. Yes, congressman. We are finding covid19 patients as i am sure you heard from your constituents are difficult patients to ventilate at times. This can take 90 minutes, weve been a leader and teambased care and teambased anesthesia care and see nras our vital members of those teams. We moved in alignment industry in this pandemic to make sure they have full Practice Authority in states where that is occurring. To the earlier point, that gives us better ability to recruit and retain essential providers for our team. We have seen a Response Rate on our end at 80 of those, for crnas before we extend the full Practice Authority in those states it was only 8. 7 . We need these members of the team at that level of agility to respond, what we mentioned originally. Thank you, madam chair. I believe chairwoman lowy has returned. I saw her for a moment, you are recognized for five minutes. Thank you very much. Thank you for your comment in the question period. They go to the heart of many people who visit and i thank you very very much and i think the secretary for the presentation. I want to follow up with a couple questions. First of all i want to get an understanding for you what is happening with the hydroxych o hydroxychoroquine. Im concerned that this was administered, unproven for treatment of covid19 to 1300 veterans despite lack of evidence of its effectiveness. We know now that patients who are just prescribed this drug are more likely to die than those who receive standard treatment. What was the rationale for administering this to veterans . Were they fully aware of the risk before receiving it . Has the president s reckless endorsement led to an increase in veterans requesting the drug . Can you explain to me what is happening . Let me talk about the period of time, im not a medical person, im a military person. I understand there has to be hope. You cant look at a patient and say we cant give you hope. What i relied on was the vote of this congress on the right to try, the right to try endorsed by the president with his signature. This congress was very clear saying people of sound mind asked to be given experimental treatments because that may be the last thing that separates them from lifeanddeath that we do that. The other option is to do nothing. Everyone is learning in this in real time and we followed fda guidelines on this. I gave the chair a chart. We brought down the use of this. It peaks when it peaked in the rest of the country. I will ask you to positive unanimous consent to enter the chart labeled hydroxy chloroquine timeline and utilization into the record. The use of this peaked when it peaked in the rest of the country and we started ratcheting it down as we went to remdesifir and the convalescent plasma. Last week we used it 3 times. I serve on the National Coronavirus task force. Doctor fa uci said we need to leave the door open because with all these studies there still has not been randomized controlled trials. That said it is our doctors and practitioners working with our patients, people dedicated to the preservation of life. We are all learning as we go in this crisis. I would also add the rest of the world is all over the map. The government of india said it is essential to provide people to protect them, we ratcheted down as we brought treatments online and we expect that trend to continue in the future. Our mission was to preserve and protect life. Thank you very much for your commitment. I would hope that the va would respond to the science that is clearly coming from doctor fauci rather than Wishful Thinking coming from the president but lets move to another question. It is disappointing to me that the va was using that drug that doctor fauci did not endorse. I have known fauci on the committee forever, 30 years. I would listen to him when looking for scientific information. I would like to get to the Mental Health issue. Social isolation poses dangerous for the general population but particularly to the veterans suffering mental illness. Can you tell me what the va is doing to continue connections with at risk veterans during this time of stay home orders. Anticipating an increase in Mental Health services when this pandemic subsides. We have changed the way we do business when it comes to Mental Health care and that is the Silver Lining from this crisis because we have sent out over 40 million individual communications, to families and caregivers, we are unique as a Healthcare System, like the military, when someone joins, the family joins, we have expanded our footprint in mental telehealth to the benefit not only of veterans today but to the benefit of veterans to the future. I will be, madam chair releasing, inaugurating our Task Force Recommendations on Mental Health and Suicide Prevention on june 14th, that will be the First National roadmap that will fall in line with the question you just asked, when it comes to Mental Health, we will be the first organizations have a National Conversation on Mental Health, how we treat it including a roadmap on homelessness in a roadmap on addiction. That is in line with your thinking. I believe my time is up. Your time is expired, madam chair. Thank you very much. We will be doing a second round. Thank you so much. Before we move on to the next question, doctor fauci said the Scientific Data is and i quote the Scientific Data is quite evident now about the lack of efficacy. He has made it very clear where he is on the effectiveness. I talked to him after he made the statement and relayed his thoughts. Next for five minutes. At a time we are in the midst of the most Serious Health pandemic in a century the alabama Healthcare System still has multiple leadership and staff positions that are unfilled. Currently there is no permanent director. There is a pending start date for chief of staff, no permanent deputy chief of staff and an additional fixed service chief openings with no permanent staff. It remains unacceptable there are so many senior staff openings. I dont understand how you, mister secretary, can expect to bring about positive change for veterans care and management to the va employees when you have no permanent leadership to bring about this change. It is especially concerning the after the previous director, in september of 2019, we still do not have a fulltime director. We know that Central Alabama va has much improvement, at the highest level, not effectively, my office continues to have difficulty in getting answers to the simplest of questions. In preparation for this hearing my Office Reached out to staff in washington and directly, questions about staff and vacancy. My Washington Office received a barely my District Office have yet to receive an answer, made that request 13 days ago. The staffing vacancy data, had not been included in a report on may 14th. That report specific to cabinet was required by law due to language the chairwoman, to the appropriations bill last year. We had to put language into law, to communicate with me, as i said repeatedly it has been difficult if not impossible to get responses from your office. The only way we are able, when this committee requires you by law or if you are scheduled to testify before the committee, the information is nicely delivered right before a hearing. My office was left in the dark as relates to covid19. An update from cabot, the pandemic is down. Cabot has held two Congressional Staff briefing, those in april, seems to be locally inadequate. In birmingham, about an hour and a half more in montgomery, the birmingham alabama va, every two weeks. I was encouraged to hear cabot would be holding the first congressional covid19 briefing in over a month. That was fleeting. A week or two, it was postponed for an entire month, two months in total since we heard from cabot on covid19. I know you and colleagues, heard my please. And overall care for our veterans in central and southeast please know that i will continue to push for answers and actual improvement serving in congress. My wish is and my hope, not for me, we wont continue to talk about how we hope cabot is introduced but our actions at the top of the va will demonstrate those veterans, real improvement demonstrate only commitment. Is it the time . You can respond. I will say one of the first visits i made as secretary was to Central Alabama, both to montgomery and tuskegee. I was the first to visit tuskegee, very proud of it. I paid attention to it. We have changed leadership. The folks in montgomery and tuskegee provided the state of alabama with important services, a place many employees in Central Alabama and bill nichols state veterans home. That helped the veterans in deep crisis. The staffing issues you are talking about, i understand the value of permanence that those positions are occupied. I have the same issue in my office, and acting deputy, acting chief of staff. It doesnt mean the work is not being done. We are in the i agree with you, the first time you raised this issue, it was not adequate for the entire country and not adequate to Central Alabama, you know my family lives in it is a state im in a lot. We are doing everything i can to make those positions permanent. We have good leadership in atlanta and montgomery. I think the services have improved. I am very familiar with the area and i have heard you and believe me the secretary in generals focus has been to personally move on the leadership issues in the district. I wish i could say i could snap my fingers and they would all be fixed, but i think it is a better place than it was when you first raised the issue. Mister bishop has the gavel. There have been some improvement situations. I want nothing more than to celebrate improvement and care for veterans. We have a long way to go. Every time you have this conversation i am the only one that feels a sense of urgency and i just want to be, passion and urgency from your office, dedication to dealing with, we are still one of the worst vas in the country and i have been banging my fists on this issue. I want to celebrate whatever improvements there are to celebrate but just know that we have a way to go and Mister Bishop could do that as well. I think the gentle lady. Let me thank you for all the efforts you and the team have undertaken to continue services to veterans under extreme pandemic to Keep Services for batters and veterans in the process. What me ditto and join and associate myself with miss robies remarks. He represent alabama and i represent the west georgia aspect, serious concerns and continue to raise them. Not the only voice that has been raised for those concerned. The delays that have been caused by covid19 cause delays in your system. The delays have come in responding to the question last time we spoke, the center that is constructed in columbus, georgia. We are still waiting and more contract, the site that was selected my second term is a site that has no public transportation. It is away from the longest specialists for veterans and it is not very convenient at all. As i indicated last time we spoke in the time before that, we have yet to receive the best answer to that decision and whether the vote location can be changed or made more accessible. This is a process that has been ongoing for almost a decade. I would like you to comment on that and i have a second line of questions with regard to the impact covid19 has had, which cause you to pause your in person conversation and pension examinations. I understand, going to the pandemic, some has been using the Telehealth Technology and prior reviews, the acceptable Clinical Evidence initiative. And new delivery models, allowing compensation and pension examination to cross state line. I would like you to tell me what tools you need from congress to assure the exams, over the past two month, what action you take to address the ballooning back log and what are the technological changes, with elderly populations with the providers. Please address the columbus, georgia issue. If you dont mind, and let doctor lawrence answer. I can say the same issue in mister mccarthys district. We are taking a look at the way we acquire and build properties. It is a 19thcentury system stuck in the 21st century. It is doubly important in your district because at the end of this year georgia will have the fifth highest number of veterans of any state in the country. I will continue to push, and get another report as soon as i leave. It is unacceptable. When we can take these masks off i promise to come see with my eyes and be with you to look at that site. In terms of the compensation and pension exams, appreciate your question. They stopped doing these exams on april 2nd for obvious reasons of safety. We told contractors to stop on april 3rd. As you indicate you are right, failure to meet in person. You can always do the things you just described for a limited number, failure to do in person compensation and pension exams sets us back, we are partially a warning claim, and vendors go to reopen following the lane, what do we need. You do two things. And allow nondoctors, you can bring down the backlog. I know youre concerned about the backlog, 14,000, in november, 64,000, we drive it down. We are not proud of this. Our team is embarrassed, we want to open up and get back to that number. My time has expired. I recognize mister cartwright. Thank you, Mister Bishop. Thank you for coming today. I listen to your Opening Statement and we lost hundreds of veteran patients to this covid19 disease, that is what you wrote in your written Opening Statement as well. Am i correct . What i have is 1100 va patient deaths. It is 700. 700 . That is 11,000 infections and about 9000 of those, i can get you the number that fully recovered so we have a total of i got that. This committee is here to be helpful to veterans, families, caregivers and everybody is understandably frightened of this disease, Health Prospect during the pandemic. There has been some debate, how much authority the va has over state run veterans, we have the veteran center that has had no deaths. That has not been the case all over the country. We have to talk about this. State veterans that receive federal payments and are subject to federal inspections. You have taken a stance that the protection of veterans from infectious spread should be left to the states. Did that work well . There are hundreds of veterans across the country who died from Courtney Kube in state run veterans homes. Am i correct in that . We account for many of those. Might a stronger and more comprehensive united policy takes into account where our victories have been like in scranton. A stronger unified response for 50 states worked better for the state home residents where lives were lost. It is one of the most important questions that will come out. If you would indulge me for a minute i will talk about the two system is and why congress did what it did. How about 30 seconds . Congress was very clear in separating us from state veterans homes in terms of management operation, says it several times in the statute. We provide surveys as the joint commission does with 6700 hospitals around the country. I will give you the example of massachusetts. In massachusetts we deliver reports of the commonwealth of massachusetts on january 30 first. 52 pages with twee 7 recommendations, the commonwealth is the certifying authority for that home. We do provide those recommendations. When this hit i began calling governors, called your governor, the governor of massachusetts, we are likely to provide that bridge. In your neighboring state we have come in an taken control. There needs to be a debate, a clear debate on the final federal responsibility for those state veterans. I have to move on. I want to talk about testing of va employees. There is a va directive on april 21st this year. The all haphazard emergency cash program, it is an opinion in the office of general counsel, subsection f of that opinion says pursuant, va has the authority to provide certain Health Services to its employees, that includes that va provides medical countermeasures to employees. The va already provides key unionization to its own employees who are not veterans and are not eligible for routine health care, do you agree with the general counsel statement of authority, appropriate and legal. That is available. That we up to read testing va employees are routinely exposed to covid19 patients would have a prevention benefit. We move in lockstep with science and cdc guidelines. As a medical countermeasure to prevent patient threatening conditions as described in the general counsels opinion does the va offer testing to its nonveteran employees who are routinely exposed to covid19 patients . We do. Our employees who are sympathetic request are able to get one through us or outside Health Insurance should they have that. Glad you said that because here is why i asked. I am from northeastern pennsylvania. We have a va medical center. It was not offered in may or so far it wasnt offered in april or so far in may at the wilkesbarre a medical center. Employees including those caring for the absolute brightness of Leonard Pelkey fauci covid19 patients if they were not veteran themselves. And so ineligible to register with the va for comprehensive medical care. Were either of you aware of that going on at the wilkesbarre va . I was not aware of that. We will take a look at that. We need to talk about that and i will have more questions in the next round. I yield back. At this time i would like to recognize the gentle lady. Thank you. I want to thank you and your team for being with us today. I will start off a little bit where Debbie Wasserman schultz started in the question about ppe. I want to go into testing a little bit as well. You may remember this. When you were here on march 4th about your budget request. At the time heres what you answered in preparation. We train for epidemics, began moving on supply chain and preparation before this became a national issue. And to respond to the coronavirus and testified your agency had been, quote, augmenting the supply chain. Those are the assurances and lets go to mid april. The Health Administration described severe shortages, with some of your hospitals near, quote, austerity levels, personal protective equipment. It began preparation,. You face this dire situation. And and what doctor stone talked about a short time ago. The time i testified in the time doctor stone delivered those remarks, a National Emergency was declared and the provisions we made for independent supply chain and equipment. Not only had access to that is things slowed into the National Stockpile and that was spread across the country. I mentioned earlier, i am looking at ways to prevent that from happening again in the event this thing boomerangeds back in the fall. That is what happened. The rest of doctor stones remarks said we did not fall beyond two weeks of supplies in any of our hospitals, we never ran out because we had the ability to do what they call acrostic. There are huge swaths of the country where this virus is not impacted. If you look at north dallas in idaho to new mexico. Into areas that were hotspots particularly in the northern part of your state with hospital disability. You have what you need now, your level of supplies, you just mentioned in your response to me. If the numbers do take up to a greater level, the supply chain issue in your own opening remarks, how is this coming together and what assurances can you give us, veterans, employees that you will be ready . We are storing them up. Back in february, before i testified, i have been talking to ceos, the emergency subsides come we start getting large numbers of equipment from them. Everything from masks that is the plan. Im establishing the popes across the country to the military model but i have to be honest, the chair knows that right after i testified to the National Emergency was declared the we were not working in optimal conditions and we had to compensate for that. Thank the lord we had a very low incident of infection among our employees. Right now of the 330,000 employees active infection. We dont want to face another situation where i tell the chair. I have been very clear in stating that, we dont want to go through that again. My time is expired. I yield back. You are recognized for five minutes. Thank you, always good to be with you. Pass along regards to a men and women in the va on the front lines. And associate myself with the chairs amount and appreciate addressing that issue to your ability. I appreciate your remarks around telemedicine. There were tectonic shifts happening in the economy and our institutions, digital learning, telemedicine, there will be huge shifts so we want to consider a conversation how to continue to build out telemedicine with regard to the va. In addition i represent youngstown, ohio. The National Innovation center built around manufacturing. There is an ou in the works, the 3d printing in the future. I hope we can get that worked out as quickly as possible so when there is a second or third wave, we have already done the legwork and the groundwork, tapping into the Maker Movement in the United States which are very helpful in this regard. Two quick questions. I know the va reverse policy relating to the applications with disability benefits and questionnaires. My dso is back in ohio and across the country, to simplify the process to obtain sufficient medical evidence and implementation of these forms were part of the reduction, the backlog of claims. Many of the vs ohs see this as a step backward. Can you walk me through your logic on this situation and why you did it . Certainly, glad you asked because theres a lot of confusion about it. We welcome all evidence for many medical provider that could come in any form. They were a victim of fraud and misleading information, forprofit vendors were taking advantage of our veterans. By virtue of their public face we cannot keep up with the changes, we had to go through the omb process. We were very much paid for base. And overcome by evens. Any veteran can provide any medical information, in some ways it was becoming irrelevant for the situation. A real source of fraud we were working on. You are working with bsos on this . Absolutely. We formed a group to consult with them together opinions about that. It is perplexing that after we worked with them they understood the situation and it troubles us to see what is happening. The public nature of it prevented us from being able to change it is things were changing but they were all aware, they had access to our systems, to see the veterans records and the like. Welcome all information from private providers. That has ever been the issue. It has been unintentionally turned into something causing additional problems. Whatever i can do to be helpful to make sure you get everybody on the same page. I will reach out as well. Like many members of congress we rely on our dsos, boots on the ground, i want to make sure their voices are being heard in this process was a final quick question. With regard to the disability applications a lot of the older vets pretty good. I wish i could do that. They find it difficult to use technology. They are comfortable with going to the offices and getting the eyeball to eyeball in these offices were closed. What is the process you guys put in place to reengage a lot of these vets who may not be connected right now . We will follow their lead in terms of the 3step process to open using the right protocol and the like, welcoming the least risky veterans and going to the most risky using the different things, we will follow their process. To your first question we are working with the state and county as they reopen, the conservator is too. We have multiple ways of access and some veterans will not leave their home regardless of what they do. We regularly advertise the number 8008278000, we can take their application over the phone. We are sensitive to the situation and we will be communicating how we are opening and engaging the public in person. I would say i have been amazed at the embracing of many of the telehealth changes by older veterans. I am a computer neanderthal myself but we have had so many encounters. I mention the hundreds of thousands we have had, because more than half our population is over the age of 65. These are not younger veterans, they are working. Thank you, madam chair. Thank you, mister ryan. Missed secretary, we have a few members that want to ask a second round of questions. Appreciate your indulgence. I will begin by asking about testing. That is one of the biggest questions nationwide we have throughout this Public Health emergency, our capacity and access to testing, the confusion around it, the inconsistency of criteria available at testing site so i want to have you walk us through the current testing capabilities can you tell us how the Testing Process works . Do you provide consistent access to testing across all va facilities, who is a little under what conditions . How do we do to criteria to test the aa va employees, and can they be tested if they are not showing symptoms . The clerk needs to reset our clock. How many facilities have Rapid Testing available onsite . What is the turnaround time for those tests . Overall the theme of my question is the feedback im getting dsos and different types of va facilities across the country is the testing criteria and accessibility and availability is different. I am happy to say we have adequate testing in va. Weve tested more than 125,000 veterans, and most of those is the secretary referenced, and we are happy to see that high rate of recovery. Able to succeed. We also have Testing Available for our employees. Any employee who is symptomatic who is concerned they have been exposed or request a test is able to receive that. Two question of Rapid Testing we doing that in 145 facilities. We are aware there are specific tasks that have been under consideration by the fda for meeting higher accuracy. Im proud to say in no spaces in the rv relying solely on those that are under question by the fda. In most sites we have multiple forms of Testing Available and we typically receive those results for the rapid in a couple of hours. For the standard in about two days. Okay. Doctor, im really, for the entire time during the pandemic, have gotten reports that we do not have consistent access to testing based on the same criteria all the way across the v. A. , no matter are you confident and can you go back in providing with assurance and documentation that in every division we have uniform access to testing, clear criteria across the board that the veterans and employees can understand, and are you promoting and that youre promoting that access to testing . Madam chair, we would be happy to provide that and yes come into those listening today, we would so appreciate this group and those listening help us carry the message that if there is a veteran concerned about the symptoms they have or needing a cast, the v. A. Is it for them. We have more than adequate testing supply. We can conduct up to 60,000 a week and will welcome them to come and sit. I just think the messaging needs to be made consistent across all divisions so theres a clear understanding about that. Speaking of clear messaging and understanding, mr. Secretary, i mentioned yesterday in our conversation unfold i had a virtual roundtable avenue been speaking with various veteran services on ongoing basis and i was concerned about that across the board they raise issues with this heartening lack of communication from v. A. And consultation with the apples at the time. I know that you are having regular conversations with the vsos it has a mentioned yesterday their concern is there not been consulted. There merely being a form. Theres quite a difference between consultation and feedback when we want to make sure that they explain to you what works best for veterans. Thats been an ongoing issue with the v. A. We are having trouble often getting information from you and from your team. It took over a month for us to get the update on your use of hydroxychloroquine and the instructions, also that are being sent out to v. A. s across the country. I realize youre in in a covid9 pandemic environment, but the secretary of defense regularly, whos also a member of the task force and is quite busy with dealing with a military response, holds regular press conferences, is able to community were consistently and effectively. How can you make sure that you have consistency of v. A. Guidance and policies that are communicated, consult with their constituent groups, particularly the vsos, and can you commit to more regularly publicly communicating with the public and the v. A. Community . Im going to say thats a very interesting observation. Yesterday i sat down with cbs news. That was the 100 second interview that i didnt i noticed difference between, i know he have interviews. But i would say its across the spectrum. Its msnbc, National Public radio, abc. I actually raise your concerns with the vsos yesterday. About 160 representatives on my call which lasted over an hour and i mentioned that i talked to you. And i urged them to use the forum and to use the time to raise the concerns that you raised with me. Ill be brutally honest with you. I cant guess, but i asked them to send, to talk. I cant read minds. I dont mean to sound harsh, but i took your concerns yesterday and asked for exactly what you just said, that they said they wanted speeders mr. Secretary, just to make sure you understand. I mean, you are required the vsos to submit questions to you a week in advance before you talk with them. Quite frankly its a lot more intimidating auto group of 160 other organizations communicating with you to be the one or two that raise the issue that all as someone who whon a call every week with 233 other of my colleagues, its not the easiest format right now to raise concerns. I can assure you i do very large group of vsos represented, and have been they may not have wanted to tell you to your face, but i can assure you that they have let me ask what are the thing comes you mentioned the secretary of defense. Having been the under secretary and assistant secretary, there is a dedicated press corps at the department of defense. They lived there. There are hundreds of them. We dont have that. I do the best that i can given the fact that the major publications, newspapers in this country dont have anybody dedicated to the v. A. Sort of catch is catch can. Which is why done so much radio and television across the spectrum, but particularly with those venues that you would agree that most people in the republican side or controls would use. I recognize your done tv interviews. That is different than make yourself available and publicly communicating from a platform with a weekly or biweekly press conference to provide updates and also to engage in backandforth with more than just one reporter at a time, and then also the concern, i mean, im certain youre not questioning that heard this feedback from the vsos and others have as well, making sure that you consult, which is different than informing, the vsos. So they have an opportunity to give you feedback and feel like they can afford your decisions. Is a different approach than you have been taking. I agree with your observation to the extent that it is a twoway street. Yes, it is a twoway street but right now they only feel the street is going one way. And can you commit that you make yourself more publicly available rather than one reporter at a time to more broadly update the public about the ongoing response of the v. A. To the covid19 pandemic . Well, i dont think any v. A. Secretary has ever had that luxury, just because of the layout of the way we are covered. Covered. Thats what ive had to turn to however you might find an opportunity to do that, im sure that because we have such youre the largest Healthcare System in the country, that there would be response by the press to hearing from you about the impact of the virus on speeders i know you dont want to continue this but also ive made myself available to i think the most visible platform in the country, the White House Press room. Right but not consistently. I dont think any of us have been because of this not consistently. So you wont commit to more regularly making speeders i am committed to communicate it has many venues as i can. Okay. My advice to you publicly is that perhaps you could use on a more broadbased basis and to ensure that the vsos will also have an opportunity to provide you with feedback that they can give you before decisions are made. I want them to provide feedback. Im glad we had a chance for you to confirm that publicly. If you could give them a forum to do so without requiring them to submit a question a week in advance, that would probably make them feel more like theres a freeflowing i would also say, i agree, logistically thats almost impossible given the conditions we have now, but i will return to the normal process of having the leaders in the i dont know if i told speeders i dont know why it is necessary to ask them to give you questions a week in advance. You can certainly there were 160 on the phone yesterday. Right, i understand, but making sure that you can questions come up between the week before you you on the phoe with them or in i am doing speeders happening in real time all the time during this crisis. I am doing what i can all the time in connecticut. I agree with you that more information is better. Okay. I would ask you to go back and review how you might be able to make sure that in more realtime prior to your decisions are concluded that youre getting the kind of feedback that is effective for the Constituency Group that you represent. Okay. Judge carter, you are recognized for five minutes. Am i ready . Its on black. Judge carter, you are recognized for five minutes. Do you have any additional questions . I got one of the conversation id like to ask, and i thank you for the second round. In march, doctor stone authorized [inaudible] certified registered nurses full Practice Authority in the states which allow it and it was to be temporary authority. Id like to know resend that authority . I have heard stories about anesthesiologists, time on their hands at the v. A. This is important to me because i try to case back in 1984 the less about six or eight weeks, and i did everything i had wanted to hear about the intubation process and the chemical used to do that process, which was used in my case as a murder weapon. And the paralyzing of the system to integrate people adult gag reflex. So i guess maybe i know too much about anesthesiology because of that case and happened to be someone that was unfortunate to adult onset asthma come on in my 50s. I had to worry every time i go under Something Like breathing when i come out. So i want the person there should an emergency arise they will be able to provide me what i need. And im sure the nurse and anesthetist are wonderful people, and i think we owe our veterans as theyre going into a situation where theyre going under that they had the very best that we could provide. So id like to know when that will be rescinded and what methods does the v. A. Used to determine the full Practice Authority was warranted and was it more than just anecdotal . Judge, ill answer the second part. We were in an emergency situation. The original estimate that a geek to the chair the first conversation that we had after the emergency was declared was that we would probably looking at 200,000 infected veterans. We needed to find as many people as quickly as we could for emergency purposes. Thankfully, weve been able to hire over 10,000 people in the last five weeks. On the nurse anesthetist, because of the immediacy of the ventilator issue, we needed as many people who are skilled in the operation of those ventilators as we could find, and we only used in the states as you pointed out those states that already authorized been to a full range of practice. It was an emergency situation. I dont know when that emergency will abate, but that was the parameter of the decision made, and i let dr. Macdonald finish. To emphasize the secretaries secretaries. , this was bring as in line with industry in the smoke a pandemic in the states are already an active this, 17 by law and 12 executive order. Thats 29 states and that about 200 million americans living in areas served recruitment that we need for our readiness now and we need for our readiness if indeed there is a a future weight of this in the fall. So do you expect, when you expect you will resend this tipperary order that you have done are you expect [inaudible] this is temporary and action automatically expires with the end of the National Emergency. At that point would like to come back and have a conversation about the way forward. So that is actually part of the order that it will in after the National Emergency . With the end of the National Emergency, yes, sir. Thank you for the information. Thank you, judge carter. And our last member to ask questions in the second round will be ms. Bustos. You are five minutes. Thank you, madam chair. As i continue to talk with voters in our district, we have mostly will district in central western and northern part of the state of illinois. We have great goodwill in the city of peoria. What they had conveyed to me is that while youre leveraging your virtual outreach especially during this pandemic and mr. Secretary, you went over some of those numbers how youve grown the telehealth capability. What we learned is that we have many veterans and especially in rural areas where you dont have highspeed internet, but also many dont even have smart phones or any kind of digital device that would lend itself to be able to have that telehealth interaction where you can actually make eye contact virtually. Wondering, and i know will hurd asked this question i was over voting so i didnt get to hear the answer to this but i understand, mr. Secretary, you said you have a program to lend tablets to veterans. Can you talk about how you will institutionalize that . To the veterans that are areas who dont have smart phones or tablets or anything like that what can i go home and tell them about this system that you have as and how you will institutionalize that in the v. A. . It is part of our general be a outreach. To expand our footprint into rural america. We have been distributing, and the chair and the committee, subcommittee provided monies for that. We are sending these tablets out to veterans for in those rural areas. If they dont have one, please call us and will do our best to get them out. Call the v. A. Medical center that the use and we will work to that. Ive had to get back with you on the training because i dont know all of the ins and outs but it is part of a comprehensive Rural Outreach that we have. So for your veterans please call us and we will get in that. So it is literally, no question on the supply ship, it displays need to build to get those out, you have the funding . We are constantly expanding number of tablets that we purchase. Okay. Very good. Doctor, anything else to add to that . To follow on to the secretary, yes. This is part of come as a secretary mnuchin comprehensive rural health strategy. Telehealth is a piece of this endless tablets, equipped with internet access. So these are readymade devices to enable veterans to succeed in their care and engage with us. Additionally, under the secretaries leadership with a gauge in a number of publicprivate partnerships include with the Rural Broadband association to bring telehealth sites to rural areas and also offset the otherwise there would be cost of engaging in telehealth visits. Tmobile, sprint, tracfone, verizon actually waved the data fees when veterans are engaging with us on a video visit. Additionally though the in person part of world Care Provision is important as well. Our Clinical Research has delivered telehealth. They send providers to rural areas to engage veterans where they are as a necessary piece of this and, of course, that is supplemented by our Community Care engagement and availability in those areas. Do you see any impediments to this role Health Program as we have this conversation now as far as getting the tablet out, whether theres training that could take place are any issues with that, but any impediments as we have this conversation . We dont see any. As a second or said looking to drastically expand this and had during the pandemic. This started long before the story drastically expanded it. Were thankful for this partnerships, for instance, from apple with ipads who have prioritized us in the supply chain in order to get this distribution done. Thats great. Ive got a minute lets ive squeeze in this last question. Mr. Secretary, you make in at the start of your remarks your search hiring of about 10,000 employees. Can you talk about what kind of place, Mental Health . Just what is the layout geographic . Can you going to what those 10,000 toys are doing their jobs, where they are, et cetera . We have cut many corners. We have use emergency hiring authorities but we also a limited many of the bureaucratic barriers to hiring about those 10,000, about 3000 our nurses, 700 our doctors. Weve told them that they want to join us, they can stay in their homes, their home regions. I dont have a breakdown across the country but its a significant number. Do you have any . Yes. I i just want to emphasize as te secretary said weve hired more than 11,000. Earlier this month it was nurses week and we are very proud to have brought on thousands of nurses, hundreds of doctors as a secretary mnuchin, respiratory therapist, cdnas. These highpriority roles that we need to deliver healthcare in a teambased way that we know is so effective for this illness and for the chronic conditions that many of our veterans face. We are planning to continue that aggressive hiring as we move forward through to the summer o the fall to maintain our readiness stanza make sure were ready for what comes. My time is up. I yield back. Thanks for much. Thank you, ms. Bustos. That concludes this morning tutoring. Mr. Secretary, dr. Lawrence, mr, thank you preparing a today sinker we have covered a lot of ground and we have a lot to do in front of us to continue the response to protect our veterans and employees that work for the v. A. I guess the coronavirus. I look forward to continue to work with you all to do that come to continuing our ongoing conversations which a been incredibly helpful and informative and have given us a real opportunity to have the kind of give and take necessary in the midst of an ongoing crisis. Thank thank you, and on behalf r committee, and please send our appreciation to all of those that are working so hard to protect our veterans. With that the subcommittee stands adjourned. Thank you. 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Eastern on cspan come watch class of 2020 commencement speeches by dr. Deborah birx to her alma mater in new york, Ohio Governor mike to his Alma Mater Miami University in oxford, ohio. Speaker of the house nancy pelosi to Smith College in northampton massachusetts. Democratic president ial candidate joe biden delivering remarks to Columbia Law School graduates and secretary of defense mark esper to the Naval Academy in annapolis. Watch class of 2020 commencement speeches tonight at 8 p. M. Eastern on cspan and online at cspan. Org or listen on the free cspan radio app. Next senator ted cruz and mike lee discuss recent regulatory changes and the legislative response to the covid19 pandemic. The Heritage Foundation hosted this forum. Covid19 has killed hdr