Transcripts For CSPAN3 House Hearing On The VAs Response To COVID-19 20240712

Color, irrespective of party affiliation. We are one america. And lets try to act that way. And i close this briefing. Thank you. As that herring comes to a close, lawmakers discussing how the Veterans Affairs department, this is a live hearing getting under way now on cspan 3. If covid19 turned into a pandemic and portions of the United States Health Care System broke down the va may need to come back and ask for additional funds and since then congress has appropriated 17. 2 billion for vhas covid19 Pandemic Response and i was glad to help advocate for that funding. Now im not sure that many of us here on the dais know what to expect during that february hearing nor did we fully grasp the enormity of the Public Health challenges americans would soon face from the pandemic. This is largely because the administration failed to recognize these risks and communicate them to the American Public in advance of the crisis. Here we are a little more than three months later and exactly 90 days after the covid19 pandemic was declared a national emergency. Now we have almost 2 million confirmed cases of covid19 in the United States, and more than 16,000 of which are among veterans who use vha. More than 1,400 veterans and 33 va employees have now lost their lives to this disease. Fortunately va very quickly took several key actions in the first months of this pandemic to help keep veterans and va employees safe. We may never know how many veterans lives were saved by actions va took early in the pandemic. On march 10th va issued a no visitors policy at its Community Living centers or Nursing Homes in spinal cord injury units. By march 13th all vha medical facilities had established screening processes at their entrances to assess potential exposure to covid19 for each employee for each veteran, employee and visitor entering the facility. On march 18th vha suspended all nonurgent elective procedures. This freed up staff, supplies, equipment and other resources to care for the expected influx of veterans with covid19. And helped control the spread of the virus. Va clinicians increased delivery of care through telehealth by 1,000 as they replaced cancelled appointments with telephone calls and video visits as often as possible. Ive been really encouraged by the fact that va has been able to use emergency expedited hiring authorities to rapidly hire staff. Va on boarded more than 16,000 new employees in the most recent twomonth period. The pandemic has made clear just how vital our va housekeeping and custodial staff are to Infection Control. We need to make sure we pay them fairly and treat them as the essential employees that they are. To be clear a lot of things have gone right with vas response to the covid19 pandemic, and for that va is to be commended. This is also a testament to the wisdom of basing policy decisions on science, and engaging Health Care Experts. As a Health Care Organization vha should be positioned to lead during a national Public Health crisis. Tens of thousands of dedicated frontline va employees have worked tirelessly and heroically over the last three months to care for veterans and nonveterans alike and i want to thank them for their Tremendous Service to our nation. To date, va has provided Fourth Mission assistance through more than 60 formal and informal engagements and 46 states and the district of columbia. However, the pandemic has also exposed some vulnerabilities, some alarming vulnerabilities and gaps in vas pandemic readiness, especially in the area of medical supply chain and Inventory Management. Ive also been concerned about the extent to which va has fully and equitiably implementing telework and paid leave to its employees throughout the pandemic. Officials have told us theyve observed lower rates of absenteeism and requests for leave than the same period last year. It is clear that va employees have acted in good faith by showing up to work. They deserve greater flexibility from their employer as they attempt to keep themselves and their families healthy while continuing to carry out vas mission. A few weeks ago va announced its three phase plan for gradually resuming face to face care, and 20 Va Medical Centers began this process the week of may 18th. The committee is watching closely as va moves forward with this plan to ensure that this is done in the way that keeps veterans and employees safe. Finally, before i close, i want to say that the committee originally planned to conduct a fully remote hearing today in accordance with House Resolution 965. The resolution we adopted on may 15th authorizes house committees to hold virtual hearings during the period of the covid19 Public Health emergency. This is so that we can continue to do the peoples business while maintaining the social distancing and safety precautions that the Health Care Experts recommend. Yet, here we are in this Committee Room and my colleagues in the public may be wondering why. Just a couple of days ago va informed the committee that its witnesses would only participate in this hearing if i and at least one member of the minority would gather in the hearing room to listen to vas testimony in person. It is my understanding that this reflects a directive from the white house. I am concerned that this decision has needlessly put Staff Members and witnesses at risk. We have the tools to undertake our constitutional obligation to conduct oversight. In 2020 the technology exists to engage with va just as va has engaged with tens of thousands of veterans via telehealth and right now vha hasnt even reinstated critical in person compensation and pension exams. Which is contributed to a growing backlog of more than 125,000 pending disability claims. Vas attempt to inhibit congressional oversight by demanding that we sit in this room rather than conduct this hearing virtually, while va continues to tell veterans that they must stay home and continue waiting for benefits that they have earned perplexes me. Vas unwillingness to contribute with unwillingness to cooperate with the committees original plan for holding a fully remote hearing is also strange because the department generally has positive things to tell this body. This is good news because we have appropriated more than 17. 2 billion to try and get this Pandemic Response right. I reluctantly agreed to conduct todays hearing in a hybrid format because i did not want negotiations with the administration to delay it. However, i would like to remind the administration that congress is a separate and coequal branch of government and it is the obligation of the administration to be accountable to congress. Playing games and threatening to withhold witnesses unless we submit to the administrations terms is disrespectful. This pandemic is long from over. And we must remain humble in the face of the danger it poses. And with that i conclude my remarks and i now recognize dr. Roe for five minutes for his opening remarks. Before we start today we were informed late yesterday evening by the house Recording Studio that we needed your permission to obtain a direct feed of todays hearing so that we could stream it from the minoritys youtube page and other social media accounts. As you may know this is common practice. We have streamed the committees hearings in markups from minoritys all congress, to include last weeks subcommittee held virtual hearing. Other committees do it regularly. You and i serve on the Labor Committee and we do it there. Im unaware of any problem thats created and your permission has never been needed before. My staff sought your permission this morning, and our request for access to todays hearing stream was denied. No justification for that denial was provided. House rule 11, 2 e, 5 a states to maximum extent possible each Committee Shall provide audio and video coverage of each hearing or meeting for the transaction of business in a manner that allows a public to easily listen to and view the proceedings. This rule is designed to maximize coverage and transparency of committees work. Allowing the minority to stream from our social media accounts ensures that as many veterans and taxpayers as possible have access to the work we are doing on their behalf. I cant imagine that as chairman of the Veterans Affairs committee you wouldnt agree and support that. I will note that your decision today to deny us access to the video feed for this hearing not only goes against past practice but it also is only coming up now after the partisan vote last month to change the house rules to allow for Virtual Committee work. During the debate on those rules senior Democratic Leaders repeatedly promised that they would not disadvantage the minority. Your decision is a direct contradiction to that claim. I am simply baffled by it, mr. Chairman, and urge you in the strongest possible terms to reconsider. And just as an affront to this virtual hearing, the congress of the United States has never had a virtual hearing in the war of 1812, the civil war, the spanishamerican war, the flu epidemic of 1918, world war i, world war ii, the polio epidemic, the korean war, the h 2 n 2 epidemic of 1957, the h 3 n 2 epidemic of 1968, which i remember very, very well, it killed over 100,000 americans, the vietnam war, and so on. Weve never done this. And theres not any reason that we should be doing it now in my opinion and this committee has always operated on a bipartisan basis before and i would never have dreamed of making a decision like this when i was chair. I would have said absolutely do it. Will you approve allowing the Minority Access to this hearing stream now so that we can broadcast a hearing from our social Media Channels as well as yours, and will you commit to ensuring our continued access to video streams for future hearings and markups . Dr. Roe, ill work with you in the future after this hearing. Going forward. Thank you, i accept that. Thank you, mr. Chairman. As ive said before virtual hearings are a poor substitute for the oversight and engagement that occurs during inperson congressional hearings or hybrid ones like this. Our constituents elected us to represent them in washington and our work here has never been more essential than it is during this critical juncture in our countrys history. For those reasons im glad to finally be back in d. C. With you today and appreciate your accommodating my request that members be allowed to attend the Committee Hearings from the committees hearing room. It would be an understatement to say that a lot has changed since we were last in this room together 91 days ago. And that time our country and the world has faced an unparalleled challenge with respect to covid19 pandemic which has taken the lives of more than 100,000 americans and threatened the livelihoods of millions more. Before i go any further i want to express my condolences to all those whove lost loved ones to this virus. My heart particularly goes out to the families of more than 1,300 veterans and 34 Veterans Health administration employees who have died from covid19. Each one of them is in my prayers and im also praying for those veterans whos lost jobs, businesses, investments and nest eggs theyve worked for their entire lives to build because of the economic shutdown through no fault of their own and who find themselves isolated from friends and family and support systems due to stay at home orders, and who have been left reeling from this unprecedented events over the past three months. There is no doubt that these are incredibly difficult times, but in any community is prepared to weather the storm, it is this one. Our nations veterans are hard working, courageous, creative, Community Minded leaders who dont back down from a challenge. It is the department of Veterans Affairs job, along with the committee and our counterparts in the senate to support our veterans in meeting this particular challenge, and i assure you that we are up to the task. As we grieve the death and destruction of covid19, i find hope in a tremendously good job that va employees across the country have performed. Va doctors, nurses, Emergency Management personnel, food service workers, custodial staff, i. T. Technicians, Police Officers and others, up to and including va Senior Leadership right here in d. C. Have remained steadfast in making sure that our nations veterans are safe, protected and well taken care of throughout this crisis. Thanks to their dedication, va has been able to fulfill not only the departments primary mission to care for veterans, but also the departments Fourth Mission to care for those in need regardless of veteran status during times of national emergency, from New Hampshire to hawaii and beyond, va has provided beds, staff, personal protective equipment, test supplies and other needed support to state, local and tribal entities in almost every state and territory. Va has been particularly active in state veterans homes and private Nursing Homes, helping to protect those most vulnerable to the coronavirus in raising the level of care provided to the oldest and most at risk among us, wherever they reside. And just as an aside, about 42 of all deaths in this country have come from the nursing home longterm care facilities, chronic care facilities, which make up only 0. 6 of the population of the country. So i want to thank the va for their work there, i think you have saved countless lives. Theres no doubt that the work has been lifesaving and will improve the provision of care for those communities for years to come. Working hand in hand with the office of personal management, va has also undertaken an incredibly successful recruitment effort reducing time to hire to just three days, and on boarding more than 16,000 new hires since march. This absolutely ought to continue. This process that were using and not the old method. Va has expanded the availability of telehealth by more than a thousand percent on some platforms so that veterans can remain safely at home without delays or sacrificing the care theyve earned together, these efforts have caused veteran trust scores to reach historic highs during the pandemic. In april veteran trust and va reached an overall 80 in veteran trust and Va Outpatient Services in particular, reached 90 . Va should be incredibly proud of those accomplishments, we all should. However, theres more work to do. While the rate of infection for Va Health Care workforce is markedly lower than the rate of infection among nonVa Health Care workforce in the United States and abroad, va employees continue to express serious concerns about the availability of ppe, and other supplies they need to help keep themselves and veterans safe within va medical facilities. Their concerns are exacerbated by vas outdated and inefficient supply chain thats ill equipped to handle the strain that covid19 has placed upon it. It remains to be seen whether the vas current testing capabilities are sufficient to meet the demand for tests from veterans and employees, particularly as more and more Medical Centers begin to reopen to nonurgent and elective procedures. Despite the success of vas telehealth expansion, covid19 has created a backlog in care that will need to be well managed to limit wait times, fairly prioritizing care to those most in need, and ensure that no veteran falls through the cracks. And finally, even as va begins to recover and reopen, va must also prepare for a resurgence of the virus in the weeks and months ahead. I look forward to discussing these issues today with my colleagues here in the capitol and those participating virtually as well as our three witnesses from the va. Dr. Stone, ms. Kramer, and dr. Mull. I know that you all are very busy, to say the least. Thank you for being with us today and for all that youve done over the last 90 days under unbelievably difficult circumstances to care for veterans, their families, their caregivers, and their survivors. Your work has not gone unnoticed. I look forward to the hearing today and mr. Chairman, i yield back. Thank you, dr. Roe. This morning we will hear from dr. Richard stone, executive the executive in charge of the Veterans Health administration at the department of Veterans Affairs. He will discuss vhas ongoing response to the covid19 pandemic. Dr. Stone is accompanied today by ms. Deborah kramer, acting deputy undersecretary for health for support services and by dr. Larry mull, executive director for the office of Public Health at vha. Dr. Stone, without any further ado, you are recognized for five minutes. I will ask also that the witnesses remember to pause for just a few seconds before speaking. And when answering questions. So that what you say is captured on the live stream. So pause. Chairman tecano, Ranking Member roe, distinguished members of the committee, thank you for giving us this opportunity to publicly recognize the heroic work of va employees throughout the covid19 pandemic. More than 350,000 Health Care Experts dedicated to our missions of caring for americas veterans of providing leading edge education and research and ensuring success in our Fourth Mission, supporting all americans during a disaster. During these Extraordinary Events we have provided care for more than 13,000 veterans diagnosed with covid19. And we have extended our expertise to more than 10,000 additional american citizens in nonfederal facilities across this nation. Our employees have volunteered to be deployed to areas where their unique skills are needed. When we learned about the Novel Coronavirus and its ability to spread to humans in january of this year, we immediately began preparing our response. We activated our Emergency Management coordination personnel in martins burg, west virginia. And our Health Care Operations center at Va Central Office was reoriented to a potential Pandemic Response. Early in this response we published a comprehensive Response Plan for covid19, which is guided all of our actions. Because of this we made the decision, you referenced in your opening comments, sir, to bar all visitors from our Community Living centers and then our facilities. Our decision to divide our facilities into covid positive and covid negative neighborhoods has been validated by our extremely low infection rates. Vas Fourth Mission is to backstop americas Health Care System when overwhelmed by national disasters, terrorist attacks or Public Health emergencies. Covid19 is the first pandemic in 100 years. And as such it has challenged the entire nation. As the Ranking Member referenced 46 states, territories and tribal regions have requested and received our support. Over 850 va employees have supported this humanitarian response. We increased our bed capacity by over 3,000 available beds, including more than 1,500 icu beds to prepare for an influx of covid19 patients. This agility allowed secretary will key to pledge 1,500 beds to state requests for support without affecting our responsibilities to americas veterans. Overall we have admitted more than 265 critically ill american patients. Across ten states to our va facilities. We are actively involved in 33 ongoing humanitarian missions authorized by fema or interagency agreements with tribal regions or Indian Health service. Weve also shown extraordinary agility across the Va Health System to care for americas veterans. Weve tested over 200,000 patients, found more than 13,000 positives, and gratefully more than 10,000 have now recovered and reached convalescence. About 350 remain as inpatients in our hospitals today. We have hired now, sir, almost 19,000 new employees. Including almost 4,000 registered nurses since the 29th of march. Weve had tremendous support from the office of Personnel Management to help us reform our hiring practices, and meet the secretarys and my goal of hiring within three days. We leveraged our expansive infrastructure to move resources to include ppe, ventilators and personnel to areas of greatest need as the pandemic shifted across the enterprise of va medicine. Emergent needs from multiple cities and states have been received and our response has been comprehensive and welcomed by our state and tribal partners that we are proud to support. There has been much discussion around the world regarding the safety of health care workers. You have referenced this in your opening comments. The va has made every effort to ensure we assimilate lessons from other systems and employ best practices. The safety of our employees and our patients has been and remains my highest priority. The low infection rate among va employees at 0. 8 reflects that commitment. We have purchased and received over 28 million items of personal protective equipment under ms. Kramers leadership over the last five months. Our supply stocks are robust. They are growing and we prepare for a potential second wave of this virus. As we begin to recover from the changes made during the height of the pandemic we are rebalancing our Services Within a phased frame work, which can be tailored to individual visions and facilities. This recovery is informed daily by our advanced pandemic modeling as applied to individual service markets. In conclusion, mr. Chairman, i want to thank you, i want to thank Ranking Member roe and really this entire committee. For your continued support, for your frequent dialogue, for our ongoing discussions of our response, your support remains essential to our success. Mr. Chairman, my colleagues and i are prepared to answer any questions you may have. Thank you for your opening comments, dr. Stone. I now recognize myself for five minutes for opening questions. Dr. Stone, there are a couple of things id like to address before we get to the substance of todays hearing and i hope you will quickly give me a few yes and no answers before we return to the matter at hand. Unfortunately because secretary wilke declined my invitation to testify today youre stuck with the task of helping me understand some decisions that were made, quote, above your pay grade, unquote as they say. As the leader of vha, the nations largest integrated Health System i imagine you are quite comfortable with sharing information with executives nationwide through various virtual modalities. Is that right, dr. Stone . That is correct. Dr. Stone, is there anything in the testimony that you will provide today that you could not have presented virtually . No, sir. And dr. Stone is it true that the vast majority of employees at vhas Central Office in d. C. Are still working remotely for the time being . That is correct. Its my understanding that vas reopening plan requires bringing a maximum of 25 of employees back to the office thats not happening until the end of this month, is that correct . I cannot confirm that, sir. Were working on a dynamic environment. I know youd like this to be a yes or no but we are in each area, were looking at making sure we bring back appropriately based on risk. Nevertheless the point of my question is really about that you are being very cautious about how you reopen, and the point being that we wanted to be cautious too and have this be a completely remote hearing as well and the va is undertaking a similar spirit of caution. Id like to point out that its a bit hypocritical on the part of the administration to maximize telework for its own workforce, in the name of keeping people safe, while refusing to engage with those of us in the legislative branch unless we are face to face. Many people here at the capitol are working behind the scenes today to make this hearing possible, which would not have been necessary if the va had cooperated with my original plan to hold a fully remote hearing. Now, dr. Stone, thank you for your frank answers. I now turn to the more substantive issues. My first my questions are going to relate to Nursing Homes. I read that nursing home residents comprise about 0. 62 of the overall population of the United States but so far about 42 of the covid19 deaths have been among residents of Nursing Homes and assisted living facilities. Remarkably vas experience has been much different than that of the broader u. S. Population, in terms of fatality rates in vas Community Living center, clcs, the Nursing Homes that va operates. As i mentioned in my Opening Statement clcs were closed to visitors on march 10th. I understand that va also completed universal testing of all clc residents and staff in early may. And what did you find when you tested all of the residents and staff, dr. Stone . We found, sir, very, very low levels of asymptomatic positives, and, in fact, there was the majority of our clcs had no positives. But ill defer to dr. Mull for some detail on that. Yeah, i would just add, in a couple of the hot spot areas of the country is where we saw a few more cases, so it kind of aligned with the community that our clcs were located in. But we have entire regions in the nation where we tested all employees, all patients, and found no covid. Well, thank you. What is different about va Nursing Homes as compared to community Nursing Homes, you know, what about staffing and Infection Control practices . Well, we treat our clcs like an acute care medical unit. You know, in a civilian nursing home usually theres one physician whos the medical director and then theres some consultants that come in. In every one of the wings of a clc we have assigned physicians, preferably gerriatricians, we staff with large numbers of our ends and we train in Infection Control on a monthly basiss we work our way through the care. Finally, we aggressively managed comorbidities in veterans that are hospitalized in our clcs. And therefore we believe that one of the things thats made a difference for us is that diabetes and hypertension and other comorbidities are managed effectively. Well, thank you. I know my time is nearing a close but i do feel this question is important for us to get out to the public. Based on your experiences with the clcs, what kind of changes or reforms should congress focus on to enable states to better focus resources on preventing and responding to outbreaks of covid19 in community Nursing Homes and other longterm care settings that serve our most vulnerable populations . I think going back to my previous comments, it is really about staffing, especially with great highly trained nurses and physicians who are going to get us through this. And secondly, an understanding of Infection Control policies. Should we be prioritizing Testing Capacity at our nations Nursing Homes and state homes . Thats what weve done. Any mission weve accepted into a nursing home has been with the precondition that testing is done across the nursing home, including with the employees. Well, thank you, dr. Stone, i appreciate that. And i now call on dr. Roe for his well, recognize him for five minutes for his questions, thank you. Thank you, mr. Chairman. And just a point of privilege to start with, we are the leaders of the oldest democracy in the world. We ask people to go to Grocery Stores and hospitals and other areas to feed us, to grow our food, to deliver our food. In my opinion the leaders of the oldest democracy in the world should be here leading, not looking at it from a computer screen. And on testing i do want to say this. And one other thing i want to mention before we get through and chairman tekano has been very good on this to let everyone know that dr. Stone and secretary wilke is on a Conference Call with us each week for 30 minutes to an hour, along with all Ranking Members. So weve had great access to you all and we appreciate that. What i hear from my colleagues at home is in the medical community is if we have adequate ppes and adequate testing, then we can go on with our work. Because what you have to do when youre a physician, as i am, and youre in the emergency room or during a pandemic you have to assume that everybody has the disease and treat it that way. And not to assume that they dont, but that they do and you have to have adequate testing. In our state of tennessee, as of i believe the 15th, this coming monday, every single employee and every single persona nursing home will have been tested for covid, and in the prisons. So weve gone to those areas where we know that are high risk and what is the va doing as far as testing . Because i hear some complaints early on from Staff Members who are on the ground working, not at the 30,000 foot level but on the ground seeing patients every day, that they didnt have adequate ppes and they didnt have adequate testing. So can you all discuss that . I think we all understand the fall. There will probably be a rebound, a resurgence of this, and how well prepared are we going to be . Theres two parts to that question, sir. Lets start with dr. Mull, on testing. And then ms. Kramer on the ppe. Yes, sir, so in regards to testing, to date we have prioritized our testing for those veterans and those employees with symptoms. Pardon me. Any employee that experiences a high risk exposure where we have identified any outbreak in the system and we want to do full contact tracing, and now that were expanding services doing the appropriate screening and testing on individuals coming in for procedures. So that has been our practice. Our goal is to get to testing everyone so that individuals could do on demand testing and request that they be tested for active disease at that time. Dr. Mole, how far are we from that . I think thats critical. In our state right now, my county where i live, you want a test, you can get a test, go by the Health Department and get it done. And secondly, have you all done a screening of your employees for anti bodies to find out how prevalent the disease is . The first part, we are hopefully i dont want to commit to a date, but we are getting close to being able to opening up diagnostic testing widely. We have managed to finally secure a good supply of swabs for collecting the sample. The second piece is the transport media. We have enough testing bandwidth to test. We seem to be suffering what every institution across the u. S. Is suffering, which is were missing a key component to offer the whole package. In terms of anti body testing we have begun that process to get anti body Testing Available at every va Medical Center. We have begun with contracts at the National Level for the biggest providers. And that is rolling out as we speak. I think thats critical because thats going to tell you this fall if it does rebound in the fall exactly what the prevalence of that disease. We dont know the denominator, thats why the mortality rates are not accurate right now because we dont know what the denominator is. It will help us, yes, sir. Sir, as a High Reliability Organization the safety of our patients and of our staff is our highest priority. We follow osha, and cdc guidance for ppe, and every employee in vha has the ppe appropriate to the role that they have in the hospital. Well, mr. Chairman, my time is almost expired. I do want to think, going into the fall, that the va can provide great leadership and the Nursing Homes, longterm care facilities. And i think we really ought to focus like a laser beam on that because when youve got 6 10ths of the population of the country and 42 of the mortality there, that is a place that we can make a huge impact. And i think you all certainly have and i want to commend your team for that. I yield back. Sir, if i might just take a minute to please, this is one of the issues i hoped we would shine a light on, sir. Early on when we began to recognize there was a difference in the outcome and the prevalence of the disease in va clcs versus private Nursing Homes around the nation, we began looking at how we might do a leveled and staged approach to support. And im quite pleased that there are literally hundreds of va employees that are out providing Consultative Services, those Consultative Services include how do you don and doff your ppe, how do you establish a covid positive zone in a standard zone within a facility that might have connecting corridors . How do you prevent personnel from crossing over and inadvertently contaminating . But all of that will go on. Weve been literally in hundreds of Nursing Homes around the nation, continuing to provide that service. And we have been welcomed in a collegial manner in every one of those. Today as we speak were in 43 state veterans homes. And in those homes that have had some of them some pretty high profile problems with infections and deaths, we have been welcomed in every one and by state leadership. We have been welcomed as experts in geriatric care and Infection Control. Thank you. Dr. Stone. And thank you, dr. Roe. We are on the same page as it regards this, i think national focus. Let me just say, before i call ms. Brownlee, as friendly a manner as i can say, we are an old democracy. The British Parliament is known as the mother of all parliaments and it has made accommodations to deal with the virus, namely much of its proceedings go forward without all of its members present. Our own Supreme Court has conducted in an extraordinary fashion hearings, Supreme Court hearings, and questioning periods without on a virtual basis. We must recognize science and that has to impact the institution and how we adapt our proceedings accordingly. Now, ms. Brownlee, as i call on you, please remember to pause for two or three seconds, and i recognize you now for five minutes. Oh, ms. Brownlee is let me then go to ms. Rice. Ms. Rice, if you are there, please unmute, and pause for two or three seconds before you begin your line of questioning. Great, thank you. Sorry. I think i didnt wait for three seconds. This is for mr. Stone. Excuse me, ms. Rice, in the hearing room, we cannot hear you. Lets see if we can get that fixed. Why dont you try again, ms. Rice, again begin. Can you hear me now . We can, yes, problem solved. Great, great. The va inspector published a report on vas covid19 pandemic preparedness at the end of march. Secretary wilke and you, dr. Stone, were very displeased that oig made the findings of the report public. You both criticized the oigs methodology and disparaged oig for pub lying the report. I was in response to the decision to publish its report on vas covid19 pandemic preparedness around, especially since around the time i was hearing from va facilities in new york about concerns with screening processes, lack of ppe, and testing and employee safety. I strongly believe that transparency is necessary to protect our veterans, and ensure that we as members can conduct effective oversight. So dr. Stone if you could tell us why the va was opposed to the oig making its report and findings on vas covid19 pandemic preparedness public. I can because they conducted this as we were standing up screening at our front doors. It was pretty simple. We were 48 to 72 hours into an operation in a hundred year event and they they chose to go to place and traverse from place to place when we were still trying to figure out how to do something that no one else in american medicine had yet done. So, therefore the fact that that was accompanied not in a spirit of collegial work to say heres what we could see or to recognize the fact that it might have created risks from going from place to place and standing in lines. We got a report that was released publicly that frankly had little value to us. I disagreed with it then. I disagree with it now. I think the one thing that is extraordinary to me is that we had discussed prior to the ig conducting that report, or that survey, one of my frustrations that i could no longer be on the road just walking the field to see what was going on. And we were limited in that. The ig responded to that by conducting this. I think it had little value to us. I think thats been bourn out with time as literally every Health Care System in america has tried to do what thevia conducted in that march time frame. I think were all going to have to when you look back and see how we could have been betterprepared for this, theres going to have to be a reckoning with whether or not the federal government should have been more prepared given the warning signs that we were given by Health Care Experts prior to the pandemic reaching our shores. My last question because i realize im trying to adhere to the time. The va began purchasing large quantities of hydroxychloroquine before the fda issued authorization. Why did the va decide to increase purchasing at that time . So, one of the things, congresswoman, that we saw was a worldwide demand for hydroxychloroquine. In fact, as you are wellaware, we have more than 17,000 patients that have used hydroxychloroquine for Rheumatoid Arthritis and systemic lupus or cutaneous lupus. We use about 42,000 tablets of hydroxychloroquine as outpatien outpatients a day. We began to find that our suppliers could no longer supply us with the 90day refills that we were getting. So, i made a decision early on to go to 30day refills for our ambulatory patients. When that supply began to loosen up, we did a block purchase to assure that our patients could be treated effectively. At about this time there was also information on the role of hydroxychloroquine in the treatment of covid19 patients. And so we want to make sure we had appropriate supplies. But the primary reason for that 6 million purchase was to make up for the losses of the fact that i was receiving 17 to 30 of my usual supply of hydroxychloroquine. You know, since we have its my understanding and correct me if im wrong that in late march, early april, about 400 patients were prescribed hydroxychloroquine but va prescribers have significantly reduced the use of the drug since fda cautioned against its use. I would like to follow up with you whether va patients were tracked when prescribed that not for any other purpose but covid19. My time is up, but i would like to follow up with you on that if thats possible. Congresswoman, i would be happy to do so and work our way through this. Thank you. Thank you, ms. Bice. I turn to mr. Bilirakis. Please remember to pause for a few seconds. Thank you. Since chairman rice brought up the hydroxychloroquine, ive heard of several Success Stories within the va with regard to administering this drug for treating covid19. Can you elaborate on that, please . Congressman, we can to be cautious in our use of this drug clearly. One of the most disappointing things in this pandemic has been the Research Study and the data not being released in an open and fair and transparent manner. And therefore it is deeply disapointing the role the lancet played in allowing a document to go forward that substantively changed our approach to this. We are incredibly interested in the fact that in eastern india the highest malaria areas where hydroxychloroquine is used is the lowest penetration of covid19 in the entire country of india. In Subsaharan Africa is exactly the same thing. And therefore the use of prophylactic hydroxychloroquine has interest in some of the hardest hit areas in south america. The brazilians just accepted 2 million doses of hydroxychloroquine to protect their Health Care System and their health care providers. So, we believe that there is something more to this. We certainly do not believe that hydroxychloroquine is going to rescue somebody from imminent death. But there has not been any true double blinded studies that have been done that really deliver the kind of information we need. And unfortunately, we are substantially set back by the actions of editors, of medical journals that did not follow their own guidelines. Thank you, doctor. I appreciate it. Thanks for that information. Next question, doctors, what role will telehealth play in the va Health Care System as more and more Va Medical Centers reopen . And the follow up is do telehealth appointments telementalhealth appoints in particular have the same efficacy as face to face appointments . Why or why not, please . Thank you. Congressman, they do. In fact, some of our satisfaction levels are even higher in the telemedicine arena. Its extraordinary. You know, when we started this pandemic, 85 of our visits were face to face, and about 15 were using telemedicine. Were just the flip of that today. Now, i happen to think that well moderate a bit. And when we moderate a bit, i think theres times to establish an effective relationship that you need to have people face to face. So, i do think that our telemedicine will not accelerate at the 1,000 . It will moderate a bit as we go along. But our patients seem very comfortable with it. And it continues to be an extraordinary Success Story as we go forward with this. Part of that Success Story is the great work of our i. T. Partners at va who have been able to stand up multiple gateways through we had discussions very early on about our concern that we might not have enough bandwidth to allow effective telework and deliver medical care. They have now delivered about ten times the amount of capacity that we had actually planned for, and its an extraordinary Success Story. Thank you very much, doctor. Just briefly, i know we discussed this before the hearing. But give us an update on the outpatient clinics. When will they open . I know that youre going to do it in phases based on, you know, how well were doing treating the covid19. But if you could give me an explanation because we have a lot of constituents that ask. We have some wonderful centers in our district. Please, thank you. And you bring up a really important issue. And that is, around the country, all of american medicine is discovering that there has been delays in patients being comfortable enough to seek care. And therefore the safety of our patients has been the number one issue as we go through this rebalancing of our care. Prior to the pandemic, we were seeing about 300,000 ambulatory patients a day. At the depth of this, we were face to face visits at about 100,000. We are back up to about 134,000 to 140,000 a day. And we are seeing every week a increase in the amount of face to face visits. What that instate number will be cognizant of the telemedicine that patients are now comfortable with, well find out. We are seeing across some areas of the nation that our Community Care partners are really busy, and were having a little bit of trouble in a few areas getting patients in in our Community Care referrals which have been robust. So, were working our way through by market as we go through. Now, im incredibly concerned about areas in the country that are going in the wrong direction. There are areas in the country where we wanted to move forward that were having trouble doing so. The state of arizona is one that has been on a multiday process of escalating cases. Arkansas is the same. South carolina is the same. So, we are informing every days actions by a discussion with our advanced modelers of whats happening and what the trends are in every Single Market that we exist in. Thank you so much, doctor. And thank you for the weekly updates from the secretary and you, very, very important. And you give us an opportunity to ask questions too. I appreciate it very much, and i yield back, mr. Chairman. Thank you, mr. Bilirakis. I now call on ms. Brownley. I remind you to pause for two or three second bfs before you beg. Im having technical difficulties. I had to get off for a moment to get it fixed. But im back on. Dr. Stone, thanks for being with us today. And my first question i actually have three that i hope that i can get to. And that is the first is around our Women Veterans and wondering how the medical Centers Across the country are reaching out to Women Veteran patients to ensure they are aware of any changes to access to Maternity Care, contraception and fertility care and the like . A lot of these appointments require appointments at the office and not through telehealth. As you know, chairwoman brownley, were very, very proud of our equity efforts that report to my deputy Steve Lieberman and have been led very adeptly as weve looked at not only equity for Women Veterans but also equity for hispanic and black veterans and to assure that we are offering everything we can. We just published today some information on the effect ptsd has on adverse pregnancy outcomes in our female veterans. And it is the kind of work that im most proud of as we go through trying to make sure that we are reaching out effectively to potentially isolated veterans. So, we instituted very early the outreach that youre doing, if you could describe that. Yeah, very early we took our primary care pack teams and our Women Veteran advocates within those pack teams and asked them to reach out to all highrisk veterans and track all highrisk veterans. Literally theres hundreds of thousands of calls made daily for that. But it is all of those. Weve also, from our office of health equity, begun to distribute out to the field risk areas by county in our hispanic and black veterans and asked them to reach out to make sure that we are effectively mitigating risk. So, is Maternity Care in that category of urgent care that you would be reaching out for . Yes. Okay. I want to ask there are two more questions that i want to get in. First, i want to applaud the va for providing Additional Support to ihs and the Tribal Health facilities in the Navajo Nation. Im concerned about other tribes across our country and wondering if va has a singular point of contact or plans to reach out yes. Chairwoman, two things. Number one, cam matthews, who is head of Community Care, managed the 114 tribal agreements that we have with individual tribes. And then our Indian Health office is also available for that. We remain concerned. In fact, this morning i had a conversation with the leadership of Indian Health service regarding some of the issues that weve faced as weve worked to support them. And you should know that that is an incredibly collegial effort as we go forward to support not only ihs but individual tribal delivery systems. So, dr. Stone, is there just one point of contact . Thats my concern is that if the tribes are just told to contact ihs that thats calling the big bureaucracy and they might not be getting the help and the support that they need. So, what im really looking for is that there would be, you know, a universal one point of contact for people to ask for help. Yes. And to me it would be Cameron Matthews who leads that area. Im sure shell have someone in her office thats working those 114 agreements. But she has been incredibly active. And i know that she has even travelled with you to do some of those visits. She has. And my time is running out so i cant get my third question in. But i will just raise my concern about interagency agreements, the agreement which i applaud you for moving forward on with ihs, concerned about its completion, and i understand that the lawyers are wrestling with who gets billed. And i just want to say that i personally dont think that any of our native veterans should be billed in any way, shape, or form because thats or any of our native americans, quite frankly because that is our governments responsibility. We made a commitment and a trust to our Indian Tribes that they are owed health care by our nation. So, i can follow up with you on that at a later date. And with that, mr. Chairman, ill yield back. Ms. Brownley, im going to permit dr. Stone to respond. I really appreciate you bringing this up. You know, Indian Health service by law has to be the pair of last resort. We are encumbered by law to bill for our services. And therefore, both Indian Health service and va made a decision to save as many lives as we could and let the bureaucracy catch up later. But you bring up an important thing. I dont think that it is appropriate for us to bill patients directly for this. That said, i will not violate the law. And we may be looking at further discussion on where we should go by this. By the same token, for those veterans or nonveterans that come in that have medicare as primary, we cannot bill medicare as primary. And if Indian Health services secondary, that really violates where Indian Health service is. I dont want any of my comments to be misconstrued that there is any distance between Indian Health Service Leadership and us. They called for help. We provided it. As we speak today, were expecting between 7 and 8 more critically ill patients to come in to our albuquerque hospital. Well take care of the patients and figure it out later. Do you have a timeline for the agency to be finalized . I cant mainly because were up against this. But theres active discussions ongoing between the legal teams. But you should know that all of us are trying to get to the solution that you outlined. Thank you, dr. Stone. And thank you, mr. Chairman. And i yield back. Thank you brownley. I want to thank you for your concern and leadership on how we respond to our native american tribes and vas responsibility in this matter. I want you to know that i share your concerns and hope that we can work with dr. Stone and the va and the ihs to resolve this in a way that does not burden our veteran population or our native american population. Mrs. Radewagen im going to call on you for five minutes. Make sure you pause for two or three seconds before you begin. Thank you for holding this hearing. I want to commend the committee for their bipartisan effort to continue our work during this unique situation. Im glad we have rules for remote and hybrid Community Business and i hope we can continue to make adjustments and do our best on behalf. With as few interruptions as possible both during this current process and during any challenges, my question for dr. Stone is this. Despite vas success with respect to increasing the availability of telehealth apointments, theres a significant backlog of care thats been delayed since march. How are you working with your Community Care networks going to work to that backlog, limit waiting times, prioritize veterans at the highest needs, and ensure that no veteran falls through the cracks . Congresswoman, yesterday we took a review of optums three regions of the nation including how many physicians were back online. As you know 60 of physicians in Community Care were not available for anything but urgent work. Well do the same thing next week with our triwest region four and then also work through region five and six as we approach this. But this is about prioritizing care and making sure that any urgent or time sensitive issues are cared for. Unfortunately during this time i think we have seen some nontime sensitive elective problems becoming time sensitive. And its a matter of getting people in to care for this. We are tracking numbers on a weekly basis and making sure that were getting veterans in and responding to them. This is one area that i think you can help. And if veterans are expressing to you frustration, really communicating with us is very effective at allowing us to seek out areas where we may not see a waiting time or a problem that has become acute. One of the things that id like to mention, weve seen dramatic reductions in heart attacks and strokes across america. I dont believe that the comordtys that cause those have gone away. I think that the American Public have stayed away from the Health Care System, and they need to come in and feel safe. And that is our job, to reach out and really erase that backlog. I have a second question, but i dont see how much time i have. I suspect i you have time. Thank you. Dr. Stone, how is va prepared for increase in demand for Mental Health and Suicide Prevention program as a result of the pandemic. And do you anticipate increase of suicide attempts or deaths over the next year due to the loss of lives and livelihoods caused by covid19 . Some of the highest suicide rates in this nation followed the second wave of the 1918 pandemic that occurred during a time of financial strain. And all of us need to be cognizant of the fact that the strain on all generations of the American Public will need to be dealt with with enhanced availability of mental Health Services as well as the cohesiveness of our neighborhoods and communities. I have talked before regarding suicide about the fact that i grew up in a multigenerational neighborhood where literally grandparents, parents and children lived in the same house hold. And when i went out, there was my mom didnt have to worry about me because i had 30 moms on the street. And that doesnt exist today in many areas of america. So, we are very concerned, and we will continue to hire. Its the beauty of the 19,000 hires that weve done. We will continue to strengthen our delivery systems. We have also worked really hard to convert our entire crisis line system from three major areas to virtually complete telework, allowing us to handle increasing numbers of phone calls to our crisis lines and still meet our productivity guidance. Thank you, mr. Chairman. I yield back. Thank you, mr. Radewagen. I now call on representative lam for five minutes. Please remember to pause for two or three seconds before beginning. Thank you, mr. Chairman. Can you hear me okay . We can. Thank you. Dr. Stone, i had the chance to talk to some of your line workers in the pittsburgh and philadelphia hospitals, nurses, some custodial workers, that type of thing. And they relayed two concerns to me which i would just like you to address. One was whether covid infections by staff were going to be addressed through Workers Compensation claims. They had the impression early on that there was some foot dragging or obstacles in the way of that. And then secondly, i guess there were some kind of schedule and shift changes that came about in the early part of the Covid Response that had some workers going seven days on, seven off, instead of what they were accustomed to. So, if you could address both of those things and whether you see any changes coming down the line, please . I cannot address the 7 on 7 off as any sort of national policy. I would be happy to take a look at those two facilities and talk to their leadership and if they were challenged in some manner of how they were approaching it. As far as opms guidance on employees that actually became infected with covid19, i would defer to opms guidance on how that will be handled in Workers Compensation. Clearly were really proud of the fact that thousands of va workers have not only continued to show up for work as the chairman has referenced in his opening comments, but theyre also volunteering to go to places at high risk. They will only do that if they feel we are taking good care of them and protecting them effectively with appropriate ppe and really caring for those that become ill. And so i would be happy to look into the 7 days on 7 days off, but we will follow opm guidance for Workers Compensation claims. I appreciate that. If you have any opportunity to advocate for your workers in the Workers Compensation arena, i think they and i would very much appreciate it. These are people who, as you mentioned the striking thing about them when you meet them is they do this job for their own reasons. Theyre very dedicated to the veterans. Its not about money or a job for them. I think it would only be fair to take care of the people who were injured in the line of duty. With regard to the scheduling, i dont have any insight into whether its a local or national issue. But i appreciate your commitment to look into it. And i would just like you to consider that that can be a major, major sacrifice for people with kids and family members to take care of with all the other changes that are happening in our society right now. So, as the numbers do slow down, if theres any way to loosen that up, i would appreciate you looking into that. My other question is regarding telehealth, particularly in the area of Mental Health. I know its been expanding rapidly throughout the crisis, and youve talked about that on some of our calls. I was just curious, is va doing anything to collect data from those experiences to try to develop knowledge a little bit on the effectiveness of telehealth for certain types of conditions or certain types of patients so that at the end of this, you know, you might i dont know if youll be able to publish something or at least make some contribution to our knowledge about the effectiveness of telehealth when it comes to Mental Health treatment. This has been an area of interest for a number of years and it has been showing equal outcomes with actually improved accessibility of not asking a veteran to have to leave their home in order to interact with us. So, we will continue to research our outcomes, and im sure that we will get better data on not only ptsd, other depressive disorders as well as major psychoses and how we approach those. And that work will continue to be ongoing as part of our academic and research area. Thank you very much for everything youve been doing, and keep up the good work. Mr. Chairman, i yield back. Thank you, mr. Lam for your questions. I now will call on representative voss for five minutes. Representative, please pause for a couple of seconds before you begin. Thank you, mr. Chairman. Dr. Stone im going to go down the statement path, talking about the testimony increasing the telemedicine of va during the pandemic. My understanding is part of the usage was examinations of eligibility for cmp exams to be done electronically. Can you touch on vas usage of the telehealth medicine specifically with cmp . So, weve tried to continue to do that, as you know, from the increasing number of cmp exams. I dont think thats been a great Success Story for us and were anxious to reopen. Weve been working very closely with vba and under secretary lawrence. He is progressing cmp exams in areas that were opening up as we try to move our way through it. Were especially cognizant of the fact that as we get ready to move on our Care Giver Program we need enhanced cnp exams to be done. So, were all working together on that. As you know much of that work has been moved to contractor work over the last number of years as it moved from discretionary to mandatory funds. We remain supportive of all of the work bvia is doing. But i think that we need to do better in that area to move veterans through this to assure that they get the benefits that they deserve. Do you know how many veterans became eligible for cnp exams doing telecommunication . Sir, ill have to take that for the record. I do not know that. Dr. Lawrence usually answers that question and has the most uptodate information on how many are in the queue. Okay. Then if i could get that back and maybe this is going to have to be done for the record too because my follow up question was wanting to know the ones actually receiving it, the cnp exams, through telehealth, the veterans themselves. What is their experience . Has anybody checked on their satisfaction with that . Im going to have to defer that one also. Okay. And i just am not close enough to that in order to give you a good answer or the answer you deserve. Okay. Then i will leave that for another time when you can get that back to me, id appreciate it. With that, i yield back, mr. Chairman. Thank you, mr. Bost. Next ill call on mr. Levin for five minutes. Mr. Levin, please remember to pause for two to three seconds. Thank you very much, mr. Chairman. Hopefully you can hear me all right. I want to thank you for holding todays hearing and thank you to my colleagues on both sides of the aisle for continuing our important work for veterans. Dr. Stone, thanks to you and everybody for your work during this time particularly those on the front lines. As you might imagine weve been hearing from a lot of veterans in our district. And i want to ensure that va has a plan to reschedule appointments that were cancelled due to covid19 precautions. Dr. Stone, i understand that from february 1st to april 7th, bha cancelled more than 5. 7 million appointments. Do you have any more recent data that you could share with us . We have tracked all of those cancellations with a covid qualifier in our information system, in our scheduling system. We have actively been reaching out to those veterans and making sure that we continue to be in contact with them and that they are good. Not all of those will need to be rescheduled, but we need to make sure that prescriptions are refilled, that ongoing disease processes are being wellmanaged. But were working our way through all of those as we speak. I take a weekly update on that, and it has become somewhat confusing because so many of these problems have been taken care of using virtual visits, video visits, and telephonebased visits of how many are still in the queue. But it is up to each pack team to work their way through the risk factors in their assigned patients. Im very glad, obviously, that youve been able to use telehealth to replace inperson care. But of course telehealth is limited in some ways. Do you have any sense of how many of the cancelled appointments have not been replaced by telehealth and will have to be rescheduled on a goforward basis . I think as many as 40 . 40 . And thank you for briefly explaining the plan, but can you elaborate whats your plan to reschedule those 40 of appointments both in va and the community . Every single pack team is assigned a group of patients. They will go out to those patients at risk. Every patient identified with a covid cancellation modifier will be contacted and well work our way through that. I am quite pleased at the data that we got from optum in regions 1, 2 and 3 and that show robust availability of their network of providers in most markets. There are markets that are just busy and are still being substantially challenged with Covid Patients and are fiat had open not open to the level they should. In our phase one reopening, we want to get to about 25 volume. That 25 volume challenges the consumption of resources. Every patients in a mask, every provider and every employers in a mask or every employee is in a mask. Every room is wiped down and cleaned afterwards. Theres a period of time a room is left empty in order to to assure theres no chance of exposing a patient. Just like were proud of what weve done in clc, we want to ensure patients that they are safe as they come back to see us. Thank you for that answer. I want to turn with the time i have left to testing. You stated in your testimony that va has capacity for 60,000 tests per week. Based on data the va provided to my staff, the department only conducted about 26,000 tests during the week from june 3rd to june 10th. So, i wanted to ask why is so much of the vas Testing Capacity being underutilized . So, at the current time, our limitation is related to having enough swabs, having enough test media to be able to collect the samples and then ship them off for testing. So, that has been the area weve been working and focusing on to try and bring in those supplies so that we can increase testing rates even higher. Weve been averaging right around 5,000 to potentially 6,000 tests per day. Thats monday through friday. There is some variation that occurs week to week. But right now until we get those supplies to a level that we can really push our limit, were going to see the numbers of tests where they are. And as i mentioned earlier to dr. Roe, i think were getting close to having that balance. Im out of time, mr. Chairman. But i think we all want to make sure that we are helping you to pursue the greatest volume of testing possible, particularly among asymptomatic individuals. So, let us know how we can be helpful. And thank you mr. Chairman, again, for todays hearing. And ill yield back. Thank you, mr. Levin, for your participation and thank you for your very wellformed questions. Immateri i want to call on dr. Dunn for five minutes. Dr. Dunn, pause for two or three seconds before beginning your questions. Thank you. I appreciate being in washington, d. C. In an inperson hearing. I encourage resuming inperson Community Business. I dont believe that virtual and hybrid meetings offer the same opportunity for participation and member to Member Exchange of ideas the way the committee works. Congress works best when it congregates. I also want to thank dr. Stone, dr. Mull, and ms. Cramer for being here. The va fulfilled its duty and continues to do so. The va rose to many incredible challenges posed by covid19 providing health care to millions of our nations veterans and nonveterans while simultaneously executing its Fourth Mission in all 50 states and the Navajo Nation. Successfully meeting challenges on multiple fronts is the hallmark of great military leadership. And im particularly impressed by the vas ability to quickly divert personnel and resources to areas of acute need. This type of flexibility was essential as hotspots across the nation developed. I would say in military terminology that this was a great victory for the va, and i would be remissed if i did not tell you how proud i am of the Va Health System and its response to this. Now, i have a bunch of questions just like every congressman does, but i would like to id like to see if our questions can be answered by your staff, i feel confident. I would like to turn attention to a little bit more personal note and look at, dr. Stone, your leadership of the va as you pass through this crucible. Arguably the single most difficult time in the history of the va. I believe youve also faced a very personal and grave challenge of your own and it cant have been easy to deal with the risk on so many fronts. I wonder if you would be willing to share briefly your family story during the pandemic. Sir, my dad is 101 years old. He lives in florida. Hes in an assisted living. My wife, we own a home down in the west coast of florida, not near the water. But my 18yearold, my 20yearold, and my wife went down to make sure they were close to my dad right about the time that all visitation stopped. As much as they quarantined, my 18yearold developed covid, and my son did very well. Thanks for having. My son did very well. He developed bilateral pneumonia from covid. He was treated at a great local hospital down in southwest florida. Did very well on hydroxychloroquine. I was called by the e. R. Doctor who said he was on an nih protocol and had dramatic improvement. Literally could not get out of bed for two weeks. And within a few hours of taking hydroxychloroquine began to improve. Completely, sir, anecdotal, and i want to reassure you im not making any decisions based on that except i am incredibly appreciative of that local Health Care System, that doctor and the team that got him better. But it was a tough time, and weve gotten through it and he continues to improve. Im so happy for you. I know, dr. Stone, your country owes you a debt its unlikely to ever repay. But being a military officer, you knew that ahead of time. I want to personally thank you though and i want to tell you how proud i am of the work you did as a leader there. I want to salute you and say god bless you, sir. I yield back, mr. Chairman. Thank you, dr. Dunn. Thank you for your question. We all are grateful that your family is doing well, all of your children and your father, dr. Stone. And i do take to heart your recognition or your suggestion that we Pay Attention to science and double blind studies. And i think we all need to not rush to judgment either for or against any particular treatment, but we have to Pay Attention to the science. With that, let me call on the next member, mr. Brindisi. Please remember to pause for two or three seconds before you begin your questioning. Thank you, mr. Chairman. And i appreciate your work and the work of the Ranking Member dr. Roe and others on the committee who are working to support our veterans. Dr. Stone, its good to see you again, although virtually. And im glad to hear about your family. Our thoughts and our prayers go out to you, and thank you so much for your service to our nations veterans. I look forward to seeing you in person someday soon. I want to just address a couple of questions regarding the ppe supply chain. Dr. Stone, you had testified in front of the senate Veterans Affairs committee on tuesday, and you noted that covid19 shattered the global ppe and other critical item medical supply chain. Youve acknowledged the importance of domestic manufacturing and the need to boost production of americanmade ppe. What specifically is vha doing to ensure that you are buying ppe from American Companies whenever possible . Im going to defer to mrs. Cramer on this. Thank you. Yes, our First Priority is always to buy american. As you know, sir, most ppe is not made in the United States. Its made overseas. And that has created some great challenges for us. We are not working directly with overseas manufacturers. Were working through a number of different suppliers, a great number of stosbs and veteranowned businesses who then work through brokers or directly with manufacturers overseas to obtain material. But we do indeed need to bring the manufacturing back to the United States. This is an issue. This health care and Public Health are readiness issues. And to be able to ensure that were prepared for the next round or for the next pandemic, we need to bring that manufacturing back to the United States. I think we all agree with that. We have to bring this manufacturing back and these jobs back to our country so were not so reliant on adversaries during a time of national crisis. There are still some companies in the country that produce ppe. I can think of one in particular in my district. I have toured last year who said that like you did mention, 99 of this stuff is made overseas. We only have a few companies here that do make it. But for the ones that do make it within this country, does vha have any kind of preferential treatment to american manufacturers of ppe when negotiating contracts . Do you guys give any kind of preferential treatment . The law requires us to give them preferential treatment, and we do. Okay, okay. All right. I want to move on to testing. I know theres been a number of questions regarding testing. Dr. Roe asked about it, mr. Levin. And i want to ask a couple of questions. Ive heard from several constituents who have gone to their local va facility to get tested but have been sent away. Some have been told to go to another location like a local rite aid while others have left the vha facility confused as to what to do next. Ive even heard of veterans who are getting turned away who are symptomatic and unable to get tested. Can you tell me just what kind of guidance youre giving to local va facilities in terms of testing . Let me first ask, please, if you hear of cases where veterans are being turned away from testing, tell us because we need to investigate those and understand why thats happening. So, you know, it bothers me to hear that. We should be providing to a symptomatic veteran a test unless theres some circumstances where its just absolutely not available for some reason. But we do want to hear about those cases. In terms of employees, i think i refer back to what i said earlier. Weve been challenged just like everyone in the country with enough supplies to actually collect samples to perform the tests. We want to be able to test everyone and thats our goal. And thats the way our policy has been written. Can we make a excommitment he today that any enrolled veteran that shows up at a va facility that asks for a test can get a test . I would say i would like to make that commitment, but we do not have enough supplies. But as soon as we do, we will broadcast that so veterans know that that is the case. Congressman, let me commit to you that that is exactly where we want to get to, but what i dont want to happen is a sick veteran not have access to a test. And weve had we have tremendous machine capacity. What we dont have is enough transport media, cartridges, swabs in order to ensure that ondemand testing across the system. I think thats exactly where we would like to get to. But remember when people talk about drive through testing or on demand testing often you dont get your test back for a week. What we need to make sure of is if a sick patient comes in that we can make a decision quickly and have enough rapid Testing Available to assure the safety of our personnel and that patient. Thank you. I see my time is up. I had some questions about inperson care but i would like to follow up with you guys separate from this. I yield back. Thank you all. Thank you, mr. Brindisi. I now call on mr. Meuser. Before you begin your question, please pause for two or three seconds. Mr. Meuser, are you there . Have you unmuted yourself . I did unmute myself. Okay. I dont like having members of congress mute. Thats a joke. So, you may again, sir. Is he still muted . Mr. Meuser, youre still muted. So, please start again. Unmute and then begin. Thank you, mr. Chairman. My apologies. And thank you, dr. Roe. Its good to see everyone. And i certainly thank the Veterans Administration staff, particularly dr. Stone for being with us today. I do want to offer congratulations. You really managed through this crisis i think in a very strong way, actually somewhat remarkable. The positive transformation that i think has taken place with the v are you hearing me okay . Yes, mr. Meuser. Please continue. Thank you. Were hearing much more good news these days from the Veterans Administration than concerns. The data that youre providing, dr. Stone, is good, and frankly so are the stories that i receive from the Veterans Administrations in my district and adjacent to my district. Reports i get from those that are receiving treatment at my local vas has been very satisfactory. So, my first question to you, dr. Stone, is through the course of this, youre gaining a lot of data. Have you done a survey of your staff as far as their comfort levels . Are you receiving feedback from your staff in order to assure that you maintain a healthy and safe Work Environment from their perspective . We have not performed an allemployee survey during the pandemic. And we do that usually on an annual basis. But what weve used as a judge of how were doing is whether our employees are coming to work. And we have record low levels of leave being taken as employees want to come, want to be part of that. So, our employees continue to come to work and volunteer for missions that are difficult that require them to leave home as i mentioned previously. I think the other piece is the willingness of new employees to sign on has been extraordinary. And it was mentioned by one of your colleagues that these are not people that come to work for the money. They come because they believe in the mission. And when they believe in the mission, their dedication to that mission is just extraordinary. There is no doubt that these are 350,000 heroes in this effort and this pandemic. Thats wonderful. And again, thats the sort of feedback that im getting on a local level as well. So, moving on, the Nursing Homes has been an issue for all of us, for our nation and certainly pennsylvania. The veterans homes, you mentioned the work and all thats being done there, the level of care, the level of concern. What were the number of fatalities of our veterans within the veterans homes that were experienced . Sir, are you asking about the state veterans homes, how many deaths . Yes, i am. I cannot give a National Roll up of the number of veteran deaths that have occurred in the state veterans homes. What i can tell you is that we are active in 43 of those homes, providing support. I can also say to you that we have been welcomed as support and with personnel in a number of the most challenged homes as weve worked to correct the problems. But ill have to get for the record the actual numbers of deaths in the state veterans homes. I would also just be curious as to the precautions that they had, data that was followed as well as when they believe, you believe, that they may be receiving visitors again . Okay, in our clcs, we will not reach visitors until phase three of reopening. Therefore, that has not even been considered at this point. But what the state homes do, remember that the state homes are under the control of the state and under the management of the state. And i would imagine each one may be different. We have provided multiple venues to discuss our plans with the state veteran homes as well as the association that represents them. They have participated robustly in every one of those town halls that weve done, that weve discussed our plans and shared with them all of the work that weve done, that the chairman and the Ranking Member referenced in their Opening Statements. Thanks, dr. Stone. As well, what is your main primary area of concern right now, today or moving forward for the proper care of your veteran patients . My number one concern is that we make sure that we bring in those patients of their own volition, have delayed the care of potential serious comorbidities. And that is my primary concern. We have done very, very well with covid, but we need to get patients in that need care for comorbidities to prevent catastrophic outcomes. So, therefore the previous questions on how many patients do you need to take care of, how many patients have delayed care is exactly the right question that we are working on every day to get those patients in and to assure that they are safe. And lastly, financially speaking, how are you doing . I understand that your ppe procurement has increased from 10 million to 100 million a month. How is the Veterans Administration hospitals doing financially . You know, i think this is exactly an example of where the excellent communication with your leadership in this committee and on the senate side has gone a long way to making sure that the funds you provided as part of the supplementals is twoyear money. I dont think we know where were going to be until the next wave occurs. We are all hopeful that the next wave is not an absolute. I think dr. Fauci discussed this, that it depends on the behavior of the american people. But most importantly, it depends on the action of the virus. And should we do well, remember, we built that supplemental around our idea that this would be a 2 prevalence or a 2 penetration of the American Public. We are under 1 . Even new york city is right about 1 . I think we look good financially today although we need some flexibility as i discussed on the senate side earlier this week. Yes. Thank you. Thank you for your service, and i yieldback, mr. Chairman. Thank you, mr. Meuser. Thank you for participating remotely. I now call on representative rose for five minutes, representative rose, please remember to pause for two to three seconds before beginning your questioning. Mr. Chairman, thank you so much for your leadership, Ranking Member as well, and to the va, thank you for the Incredible Service that youve shown recently. My professional district has several va facilities all of whom went above and beyond, as my city became the epicenter of this crisis. In this crisis, we did relearn two very important facts about the va. The first it serves its built to serve nonveterans. And the va proudly did that for new york city and i thank you for that on behalf of my entire district. Secondly, the va has been a leader in health care innovation. In line with that, ill start off with you, dr. Stone, i believe that the va i sent the letter to the secretary says as much, is in a prime opportunity to lead the way in terms of testing and innovation. Particularly at the hospitals as well as the Nursing Homes. And im particularly urging you all to adopt whats become known as pooled testing. Are you aware of this strategy yet . Yeah, we are. And absolutely our Research Department is working very hard onto to start a number of surveillance programs including pool testing. Lets go into detail. Heres why i think it could so crucial, it would allow you to test every one of your employees at least once every week. What you would do, you would combine 50 to 100 swabs together and test that sample with just one test. If that test comes back negative, you know that all of those people are negative. If only if it comes back positive, that you test each one individually. This will give you the opportunity, and you would be the First Institution in america to do this on a wide scale, to dramatically expand testing without any additional resources. So can i have your commitment today, as much as i love to hear that your Research Department is considering this, can i have your commitment today that you will get back to us and really truly explore this and start rolling it out in your hospitals and Nursing Homes. Yeah, you have the commitment. We will get back to you, sir. Okay. Dr. Stone, do you have any additional thoughts on this . No, but recognize, congressman, one of the problems weve had is enough swabs and therefore ive just invested in additional manufacturing level 3d printers in order to push the production of swabs and this is not about the amount of Testing Capacity. It is about some very simple things that have really hung us up in this process. How much is your laboratory Testing Capacity being underutilized right now . About 50 . Thats correct. Youre telling me that as a consequence of the vas inability to procure qtips, we are not testing as many people as we could . Congressman, that is exactly what im saying. I know thats due to no fault of your own. But thats a national disgrace. Its a disgrace to our veterans and it is another reaffirmation that the president should be asserting the defense production act so as to help our veterans. To your knowledge has the president used the defense production act to assist you in those procurement of swabs and other critical supplies . I can tell you on a weekly basis i discuss with the admiral from the fema who is working the Strategic National stockpile, hes been an extraordinary partner to me in this. I believe we have a large number of swabs inbound and mrs. Kramer is going to talk about this. We received 2 million swabs this week. By the end of the month, well have another 5 million in hand. And thats in addition to what were doing with the 3d printing. So that should then add to the fact that pooled testing may be a viable approach. Thats good to hear and i say this with complete respect to you, dr. Stone, and ive expressed that privately as well, that you have been an extraordinary leader in these really trying times, but, again, due to the president s absolute unwilling to assert the defense production act, were testing 50 less veterans and staff than we have the capacity to do, due to a shortage of glorified qtips. Thats a National Embarrassment and i stand ready and willing to assist you in any way shape and form and i look forward to you all exploring pool testing. Because you would become the First Health Care institution in america to do this. I yield back. Thank you. Thank you, mr. Rose for your questions. I now call on representative pappis for five minutes. Thank you very much for conducting this hearing and i thank dr. Stone and all of the staff of the va across the system that have been doing tremendous work to protect the health and safety of your veterans. Ive seen how that has made a difference here in New Hampshire and i really appreciate your efforts. I was at the airport a few weeks ago with pam powers welcoming a shipment of ppe to help with the vas needs. Like most hospital systems, you face difficulties obtaining these supplies, these supply challenges make it all the more important for va to have an effective Inventory Management system to watch its medical supplies. With difficulties getting these materials in, the va needs to know what supplies it has across its 170 Medical Centers and more importantly what supplies each center needs. I understand the va started to obtain information on medical supply inventory across the system by requesting that each of its centers enter the information into a spreadsheet. This must be completed data so they can have close to realtime information to make decisions on supplies. Its hard for me to understand that how a large Health Care System could function without this information, even under normal operating circumstances. So im just wondering, dr. Stone, is this manual process still how the va is collecting this information on the level of medical supplies at each hospital and can you confirm that the va has had no real visibility into medical supply inventories across its Medical Centers before the pandemic . This the secretary has spoken extensively about the fact that the centerpiece of our modernization is the Electronic Health record. The modernization of the vas supply change as well as the financial Management System must be undertaken. We have in the 2020 and 21 budget, weve also asked in the 22 budget for funds and youve provided some in 20 and 21 to modernize our supply chain. But you are absolutely correct that this is a manual process today. That this is a highly decentralized Management System that ms. Kramer is going to talk about how shes working to bring this together in a unified process that is transparent and delivers the level of accountability that all of you and the secretary expect as we manage this system. Ms. Kramer . I want to reinforce, theres no way for us to run an efficient supply chain system if we dont have a modern supply Chain Management capability. We want to implement the defense support system. Its a proven system inside the department of defense and were parlaying that at the federal health care center. It will go live in august of 2020 and well be bringing on two more sites later this fall. These capabilities that it brings to us is not just Inventory Management, but by a medical management, property management, facility management, it supports enterprise decisionmaking much better than what we have today. Ppe is a critical, its in the military we would have called it a pacing item. Its something you have to know whats going on with it all the time. Theyre putting it in by hand and bring that into a dashboard for analysis and something that were looking at every day to make sure that were projecting those needs effectively. But weve got to make it easier on the on our partners in the field more than the manual processes we have now. We also cannot get Government Purchase Card orders under control if we do not have it. We can enforce internal controls and enforce the use of better buying power through using established contracts. The other thing, congressman, i want to express our appreciation to you, your leadership, as well as your governors leadership and extraordinary american citizens who have supported us in some of the work thats happened in your state, in bringing ppe and to support us. Well, were proud of the effort here in New Hampshire to bring those supplies to our residents and also to the va. If i could ask one more for the record, weve been talking for months about the issue of the issue of claims being paid, especially those legacy claims. As we recognize the financial instability of our hospitals, providers in the community today, thats more important than ever to solve that problem. Ive been in contact with my local hospitals and providers and the Medical Center and i know that progress is being made on this front, and im hoping that you can follow up with some information about how far weve come on these legacy claims, working with our third party administers and whether were going to hit the goal of having this all resolved by the end of the fiscal year. I yield back. With the chairmans permission . Yes, please. Sir, last time i sat before you in person, we had over 3 1 2 million claims that had not been paid. We now have that number under 2 million. Current claims will always be right around a million to a 1,100,000. But im very, very pleased at the amount of payment Community Care has done under dr. Matthews. This has been an extraordinary effort to drive this number down and especially sense we are paying between a billion and 1. 3 billion worth of claims each month, it does help the liquidity of americas Health Care System which most publications would say is losing about 50 billion a month and so stabilizing americas Health Care System, whatever little bit va can do, were trying to do. Thank you. Thank you. I now call on representative luria for questions. Remember to pause for two to three seconds before your questioning. Thank you, doctor stone, for joining us today, and im glad that we have a chance to hear from you and hear updates on how the va is handling this complicated issue surrounding covid. In the subcommittee that i chair, we did recently have a hearing but unfortunately i think due to scheduling issues, the va was not able to join us for that. But i just since we were able to speak to you today, i wanted to follow up on cnp exams. My understanding is as of june 3rd, there were around 1,000 exam requests pending. Could you give us an idea of the time frame and elaborate on the backlog will add additional exams and how you plan to overcome this hurdle of quite a few exams that have piled up. Congresswoman, im going to need to defer to the vba on the plan to reconcile this and i promise you that we will have them contact the committee with their plan, but that is under dr. Lawrence. We are a vendor of services to them. We are opening up in multiple areas of the country to provide services to them. They have been an excellent partner to us. But the actual plan to exhaust the backlog really is about how theyre also managing their Contract Services and i will need to defer to dr. Lawrence, the undersecretary, for benefits for that. Thank you, dr. Stone, and well look forward to getting an update from dr. Lawrence. You mentioned the fact that youre one of the entities that helps conduct these exams through the Medical Centers and i understand that theres 23 Medical Centers that have already started reopening or are reopened. Can you comment at all on whether the exams are being performed at these locations . Yes. Yes, now not all of them perform the exams and i can get you the exact list. Were reopening to cnp exams just like we are opening to the rest of health care. Okay. Thank you for confirming that and like you mentioned, we look forward to connecting with dr. Lawrence and understanding the backlog and how vba will administer those exams and get through the quite a few that are in the queue. We want to make sure they get their examinations to they can get their claims processed in a timely manner. The next thing i wanted to talk about was telework specifically. I know in the appropriations that congress did, we allocated quite a bit of resources to help the va to have the tools they need to telework. Its proven to be an effective tool to reach patients in the time of covid. I wonder if you could comment on, what will the future look like . Will you be adopting some of these practices and procedures in the long term, as theyve proven useful, as we move forward, out of the time of covid and into the Medical Center doing their normal practice. Will you still expand that and those workers who have telework agreements now, what will the standard policy be whether theyll be able to continue seeing patients via telework . Congresswoman, when this began, the head of Information Technology sat down with me and said, look, i think we have the ability to support 25,000 workers on telework. How many do you think well have . I said i think it will be about 80,000. Today we have 150,000 employees on telework. Thats a reflection of the tri agility that oint has shown through this effort. I think continuing to do telework and the productivity of our workers on this, many of the workers that i just talked about that have driven down the claims backlog have been teleworking. And it is an extraordinary example, it is moving in a dramatically different direction than much of american industry has moved. But it has been incredibly effective and we look to continue as much of it as possible, recognizing the fact that there are certain jobs in Senior Leadership that must be face to face and need the collaboration that is sometimes difficult to do in telework. So i see a balance of this. But as we are discussing with our employees on telework, many of them have found themselves extraordinarily productive during this time period. Thank you, dr. Stone, for confirming that and it looks like a Good Opportunity for the va to expand the means for people to telework in the future. If i could just one last thing, ive noticed that during this hearing you mentioned the extraordinary success in bringing people on quickly, removing some of the hiring backlog and filling the vacant positions. I would just hope and maybe dr. Stone can comment, have we changed our hiring practices so we can do this all the time and fill these positions in a routine manner, in a timely manner . From our local va here in our district, i hear the timeline to hire people is excruciating long and theres a huge barrier. Have we adopted any practices now that we can continue in the future to keep these positions filled . I think, number one, more than 85 of the people we hired are permanent. Our job is to make sure the other 15 want to stay with us permanently. And that we continue to bring people on well. I think the second thing is, we have been given through opm extraordinary latitude to bring people on and in the first two weeks theyre with us, do a lot of the bureaucracy that kept us from bringing them on before and caused us to lose people even after giving a valid offer to other Health Care Institutions that could hire more rapidly. Our goal is to make much of this permanent and i am sure that the great relationship with opm will continue as we seek to do so. It was not uncommon previously for us to take six months to bring a physician on, to do prime source validation of their credentials, to do that now in a period of three to four days and to be supported by oint that has brought 10,000 new employees on and gotten them cell phones, computers, and activated in the community in a 48hour period is extraordinary. Thank you for sharing that with us and we do hope that that those procedures can continue in the future to to speed up the hiring process because i have heard that has been a constraint at some of our Medical Centers in the past and we look forward to bringing on more good people and hopefully they will stay with the va team and continue to serve our veterans. Thank you for letting me run over a little bit. Thank you for your questions. Ill call on ms. Lee for five minutes. Remember to pause for about three seconds before you begin your questioning. Thank you, mr. Chairman. I want to thank dr. Stone for being here and giving us this important update, incredibly important. I appreciate having this opportunity. I wanted to point out, dr. Stone, that my staff talked to the Southern Nevada Health Care System this week and heard that many of the employees that they spoke with personally felt that the support and outreach from vha and va from the beginning and throughout this pandemic has been the best theyve seen in their careers with the va. I was clearly delighted to hear that and hear that youve been seeking best practices from the field and working to share that with all the facilities. Dr. Mole, i would like to move on and talk a little bit about the vas methodology in counting positive covid19 patients. The va clearly distinguishes between va employees and veterans, however, many va employees are actually are veterans themselves. So my question is, the va employee is a veteran, are you counting them in both categories and if not, have you provided guidance as to which category they do fall in . Yeah, our guidance that is available is that they are counted as a veteran. If theyre a veteran and an employee, theyre counted as a veteran. Great. Dr. Stone, in april of 2020, april of this year, the va began using this National Surveillance tool to track the cases of covid19 across the country. And i understand that this is obviously improved the data that the va has been reporting. I also understand that in the month of april, there were two substantial downtimes that caused the tool to be unavailable for about eight days. During that time, was the va able to continue to track data related to the covid19 infection rates and deaths during that time . During that time, we were able to track part of that whole portfolio of information. We were limited because of some systems issues and some other technical issues to put that full report out. Let me add to what larry has said here, congresswoman. We are operating very advanced data modeling and, look, theres 50 different models of covid around the world. We really like ours. But when those systems go down, we need a redundancy. One of the things we have is a very Robust Health Operation Center that literally twice a day brings together various leaders across the system. We were able to obtain the data we needed to manage from during the time that our primary system was down by those learning events, where literally 1,000 leaders in the system come on at 3 30 every afternoon eastern time and spend an hour back briefing us on the status of their equipment, status of their hospitalizations, status of their personnels, the number of personnel under investigation for covid as well as their positives. So the redundancy in the system helped us through this. But make no mistake, we want that system to be reliable, so were not encumbering our leaders to give us data draws any more than i find it acceptable to do manual data draws in our supply chain system. So its safe to say that there was no sacrifice in terms of the quality of the Surveillance Data as a result, because you have the redundancies . That is correct. Great. Thats great. Were you able to identify the root cause of the what caused this downtime, and if so, what are you doing to prevent future reoccurrences . You know, thats an i. T. Question. And i have not gotten a briefing on why we had found that downtime. But that is one of the things on my list. This is my third testimony in eight days. I need tomorrow to go into some depth of getting some back briefs on some of these issues that i havent been able to tackle. Im sure that there are other people in the organization that know why. I would like to hear it. That would be great. If you could follow up with me, i would appreciate that. And thank you for spending the time with us today. I appreciate it. I yield. Thank you, ms. Lee. I call on representative cisneros. Remember to pause for two to three seconds before beginning. Thank you, mr. Chairman. And, dr. Stone, i want to thank you for sharing your familys story today and i want to congratulate you and the va on your work that youve done in regards to telehealth and also your hiring practices and i hope those will continue on post pandemic. But i want to ask you first about something you brought up earlier when you said we should focus on infectious control efforts on private Nursing Homes, but there are other living situations like prisons, jails, facilities where the disabled live, where also people are living in large numbers. And i know the va has done a great job with its Fourth Mission and i appreciate what youve done in the Navajo Nation and helping out there in new york. And i am aware of one situation where the va has helped prisons, but how helpful has the va been in its Fourth Mission to provide support to these various facilities that i mentioned. So let me try to answer that in the following manner. When remdesivir came out, we were able to obtain well over 10,000 doses of remdesivir, the antiviral that has been shown to shorten the recovery of covid in some initial studies. We have been able to provide 472 tenday courses to the Indian Health service. We have also provided the bureau of prisons 43 10day courses. Were working as collegely as we can with the bureau of prisons to supply them with support wherever we can and whenever we have been asked. So i think the other area is in the homeless. As you know for many years, reducing veteran homelessness has been an effort for us. Getting veterans off the street has been an effort we have put about 80 million of the supplemental into purchasing hotel rooms to get veterans who are at risk off the street. And weve had a monumental effort at Greater Los Angeles va Medical Center where welcomed in part of our grassy areas veterans that didnt want to give up their tentage, but to get them inside the gate and start working with them to see what we could do to help them and reduce their risk. Thank you for that response. If i could just change subjects here a little bit and follow up with a question that the doctor asked regarding Antibody Testing. I know the va medical facilities and how you test and data will enhance the covid19 response, but what is the timeline and how will the va approach making antibody Testing Available . Has there been any discussion to make Antibody Testing part of a wellne wellness exam for all veterans that come in . I think your thought of a wellness exam is a good one. We have already begun doing Antibody Testing in the system. Its slowly rolling out as we learn what the results mean from those tests. Weve been pushing very hard to bring the companies on board with the technology that we have to run those tests. And so i think in the very near term, you will see antibody extensively used across the system. All right. Im also aware of a situation or not a situation, but that the va is participating in plasma treatment. Youve partnered with the mayo clinic to test that. Will the Antibody Testing be part of that to kind of determine who may have this plasma that can be taken from those veterans . The testing we would do would be like a first step in that process. The folks at mayo are going to do a specific test to determine for lack of a better term, the quality of what that donation would be. So its a twostep process, but our antibody tests would be part of that. All right. I yield back my time. Thank you for your questions. I now call on representative underwood for five minutes. Remember to pause for three seconds before beginning your questioning. Thank you, mr. Chairman. And thank you to all of the witnesses for joining us today. Mental Health Efforts must remain front of mine for va as we cope with the coronavirus pandemic. Ive appreciated the vas willingness to keep the committee updated and i sent a letter asking for Additional Information in this area and i look forward to reviewing his response. As va addresses these existing challenges, we must also be prepared to face new challenges this fall as we reenter flu season. Dr. Redfield has warned that we will face the flu epidemic and the coronavirus epidemic at the same time, end quote, this fall adding new difficulties and complications to va care. To dr. Mole, what steps is the va taking to prepare for flu season that may occur in the middle of this pandemic . So actually, thank you for that question. We initiated a basically a Rapid Response team to begin the process a week ago for this falls flu campaign. Were bringing together many of the people who have actually working on covid as well as the people who have traditionally done our Flu Vaccination Campaign season, work, to really develop a robust plan to help us move forward with the potential of having two viral diseases ongoing at the same time. Great. Does va track the overall number or percentage of veterans who get flu shots every year . Yes, we do. Do you know roughly how many of those veterans receive a free flu cost and how many face a cost of some sort . They should not face a cost for getting a flu shot. Okay. So nobody would have a copayment . They should not. Okay. Flu vaccination is an incredibly important tool if our fight against covid. What proactive steps are you taking to increase the percentage of veterans getting a flu shot . That will come out of the work thats under way this month to develop what that plan looks like, to be able to do a really large probably social and Communications Campaign to get veterans engaged, to get vaccinated, to reach out to their caregivers and families, and so forth, because we want to make sure that we have a positive impact and get those people surrounding the veteran in a safe state and get vaccinated as well. Let me just add to that, congresswoman, as we built the Community Care delivery network, we continue to have large numbers of pharmacies that are participating across all of our regions in the immunization program. A veteran does not have to come directly to us and we want to make this as easy as possible to ensure that we reduce risk. Thank you. Dr. Stone, you testified last week that vha has been unable to proceed with its plan to offer ondemand testing due to the shortages of nasal swabs. How are you addressing the shortfalls in order to meet your own testing goals for the employees . Our testing goal is to get to the point of ondemand testing to ensure our employees that they can return to their families and that they are safe. Thats the number one goal. A lot has been made in headlines of articles that were i use the term were not there yet. We are making progress every day towards a more robust system that allows us to test. Until we are there, we must provide priority to those patients that are sick while continuing to protect our employees with appropriate ppe. Right. But my question was, how, do you all have a working group . What are you all doing in order to solve this problem . Yes, dr. Mole . We have a number of people working on getting our supplies for swabs. Mrs. Kramer mentioned, we have a largest quantity coming in this week. We also have folks working on the transport media and getting those up to the numbers we need. Weve done our work to get the test numbers so the kits and reagents that we need to run the tests. Its balancing those three to be able to really expand and offer ondemand testing. Can you provide a date by which the va will have the supplies and materials it needs to meet these testing goals for va employees . To be honest, i would like to. Im very hopeful i can say soon. But it is a situation where we identify a place to purchase something. The purchases appear to be moving along and moving through. When it comes to the delivery, we dont get what was promised as part of that purchase. Were still working those kinks out. We need the defense production act activated. Thank you for your time today and for the work that you do for the community. I yield back. Thank you, mr. Chairman. Thank you. Thank you ms. Underwood. I believe that concludes the members that have questions and that are participating in todays hearing. I now ask dr. Row if he would like to make any closing remarks. I know youve spent a lot of time in front of congress in the last couple of days. We very much appreciate it and appreciate the work that your team has done. I think you had question after question about how could we be of help to you and your team and as we go forward into the fall which is unknown. But i think were going to be better prepared. I think we know what this virus can do. We know more about it than we did, just 90 days ago, so i think if youll tell us the tools you need, i think this committee and this congress will provide those tools for you and, once again, thank your team forever the great work youve done. Thank you, doctor. Thank you for your participation. I would like to thank all of the witnesses for appearing before this committee today. And i want to reiterate that i dont doubt the dedication or expertise of the witnesses before us today. Youre all excellent public servants. And i appreciate the work that youve done on behalf of your veterans and the american people. I also appreciate the thousands of va employees who continue to meet the Mission Every day as we tackle an unprecedented challenge, a True National Public Health crisis. And as stated in your testimony, dr. Stone, we have seen va employees in good faith. Urge you and the secretary to see if you can reach out to the employee unions and to try to work with them. They have shown the employees have shown their good faith by showing up and giving their all. And i think as we try to meet the challenge in the fall that that will pay dividends. I know theres some serious sore points. I hope you can overcome those. I also want to say that i agree with the doctor that we know more about this virus and who it is hurting. We know that disproportionately its affecting folks in our private Nursing Homes and congregate living situations. And one thing is clear one big Success Story that the va has to tell is its success in managing its own clcs and i congratulate you again for really showing the way in terms of how we staff those clcs and i hope that todays hearing will be the beginning. If theres any i really hope that we can instigate a National Conversation on how we regulate, how we oversee our private Nursing Homes across the country. I will have to ding again this administration for not having a National Testing strategy. I think its pretty clear that one of the conclusions from todays hearing is a focusing of testing resources, on our Nursing Homes, on our congregate living situations across the country, whether theyre in Nursing Homes, prisons, homeless shelters, we know what we need to focus resources on and so i would urge that we begin that conversation. Many members had questions about swabs and testing media and the fact that we have 50 were utilizing 50 of your capacity to conduct testing because we lack materials like swabs and testing media. I do agree that is a national shame. But weve spoken, we didnt get to explore very much in this committee hearing, about the ways and strategies you have to try and meet the manufacturing challenge and how to bring that manufacturing back to the United States and to empower many, many small manufacturers out there who need the guidance, who need the knowledge about how to use the manufacturing capacity we already have in our communities. And im very excited about that prospect and i understand that my staff has been in touch with your staff about that, and anything we can do to as you would say, democratize the files. We have to make sure that we make that Information Available to those small manufacturers. Im excited about the prospect of americans across the country meeting this manufacturing challenge. We know this country did this more than 75 years ago when we ramped up manufacturing capacity for world war ii and americans cannot understand why we do not have enough testing swabs and testing media to be able to use all of the capacity we have with these high throughput machines. And we get that Testing Capacity up, theres no reason why we cannot only meet the challenge of the ondemand, ondemand requests of our employees to get tested at the va and why we cannot also begin support the community as we face a fall resurgence to making that we do not see the mortality rates we have seen recently in our private Nursing Homes. So, let me just say that, again, i appreciate your being here to help get this story out to the american people. I do want to caution up about easing up too fast and i see that you, dr. Stone, have laid out a plan of reopening in a very cautious and careful manner. As has been reported, after memorial day, many states are seeing spikes in the cases of covid19 and hot spots continue to exist in many parts of the country. You mentioned certain states that are concerning to you that are going in the opposite direction. Theres a rise in case loads. And one state, i think you mentioned, 80 , theyre up to 80 capacity which is not good. 80 capacity of their bed space is being taken up with Covid Patients. Add to they see conditions that the coming and unpredictable and volatile hurricane and wildfire season is upon us, va will need to contend with all of these potential disasters at the same time. We may need to see va stand up yet again to meet the Fourth Mission and continue to tackle many crises that face our nation. These are not normal times. I remain concerned about the ongoing administrations response to these crisis to these crises. Im concerned that the secretary does not share the same caution since he urges us to quote unquote normalize how we conduct business when there is nothing normal about what is happening outside this room. I hope i can continue to have faith in the vas leadership and medical experts to stay the course and to continue to fight the fight as we all Work Together to keep veterans safe, healthy, and secure in the benefits that they have earned. With that, all members will have five days to revise and extend their marks and include material. Thank you for appearing before us today, i will say this hearing is now adjourned. Tonight at 8 00 eastern on