Budgets. We had employees willing to give up compensation to meet this need of veterans in the community. Maybe some bonuses too. Miss walorski. Thank you, mr. Chairman. Mr. Secretary good to see you. Thanks for being here today. The problem that i dont understand with this, this is what i dont get, is that it seems like it keeps coming back to this issue of perception. You know you come today and you have your stats and your tables and your graphs and thoed kind of things and we over here, we want Solutions Just as badly as everybody else because were fighting for veterans in our district and fighting in a bipartisan matter and doing everything we can do legally through a legislative process but what weve been up to since you been here last is multiple hearings that go on every other day and look at the whistleblower retaliation, and systematic failures in denver and waste and fraud and abuse and ive been involved and every time your i. T. Chief has been here and we talked about this as well earlier getting answers from the i. T. Department do you need any money to upgrade what you have . No maam no, we dont. Do you have what you need to keep up with . Yes, we do. Do you have a domain issue that needs to be encrypted . No, we dont. And that is what weve been answered in a body like this and this issue of trust and verify becomes dominant in my mind. Because my fear is that, you know, i love the issue of flexibility. I sit with another member im on the Armed Services committee and we did that with the d. O. D. They needed to move funds and we did that. But there was a history that we could track that was transpatient transparent and open and the American People saw it and there was a verifiable need. And my concern is back to what the other folks made is what is the guarantee when we leave here today and well continue our pursuit of this over sight of everything that goes on in the v. A. And the American People think of and i sit here shocked shocked, man, we just heard about this crisis and is there anything other than shutting down the medical facilities to take care of our veterans, str anything else that can be done, number one and if the flexibility of funds is the answer, where is the guarantee . Are we looking for a marker in six months, this is what were going to see and i guarantee it and i put the power of my Office Behind it . I think the only guarantee i can give you is one were putting the right leaders in place and those leaders are leaders who are trust worthy and we have to earn your trust. I think that is the strongest guarantee i can give you. I understand and i appreciate that and with all due respect i accept that as your answer. I guess the problem is this that weve been at this longer than youve been at the table and we are still celebrating the day that you came and took this. And i apologize for everything that happened before me. And your confirmation was a year ago and in some areas youve been incredibly helpful. But my concern is this when we talk about being flexible and moving funds and we dont see and were the eyes and the ears for a quarter of a Million People each of us and that is what we hear and see and when we get the information back and sit here in hearings and dont have the verification on 1300 people whether they are probationary or full employees and we dont see the shake, rattle and rolling on your side and those are the kind of things i want to see. It wasnt too long ago that veterans were dying because of intolerable kinds of in stances that were exposed here in this place through media of what was happening to our veterans. I want to see people go to prison. There were people that were died that will never be accounted for again and the gross abnormalities at the hands of the administrators. And i would think with the 1300 people terminated, the fbi investigations and those kind of things we wouldnt have as many hearings as weve had but we still have instances of offenses against whistle blowers and i. T. Issues that the American People shake their head at the billions of dollars spent and no reforms and nothing is working and we still sit here today and i feel bad. I wouldnt say nothing is working. A year ago more than a year ago we had virtually 300,000 people on wait lists and today we have 7 million more completed appointments and wait times on average that are five days for specialty, four days for for primary care three days for Mental Health. I defy you to find another medical system in the country that has that. We are here we are all for shining light on what were doing because we think it makes it better and we appreciate your partnership to do that. Just like we appreciate your i understand. I dont want to make light this is an easy decision and i dont want the American People to think in the state of indiana where i live. 2. 5 billion is more than real money. It is shocking money. And we toss that figure around out of 168 billion budget like were just asking for this little amount of money but im asking for a guarantee and for somebody someplace to stand up and say never again on my watch never again on the secretary of defense watch or anybody elses or this president will we tolerate what happened and i want a guarantee that says here is what history said and were still having hearings on massive amount of issues and i want a guarantee Going Forward that this will stop. And the final question i have is when did the president know there was a crisis in the v. A. . I think the president has been working on the crisis in the v. A. For a long time. When did the president know about the budget crisis. The first conversation i had was the crisis with the budget. When did the president know about this hearing today that were 2. 5 billion short. Did you tell the president . Pardon me. Did you tell the president . Of course. I told chief staff sure. When did you do that . In june, may, when it started happening . I knew about the middle of may so probably about that time. I appreciate it. Yield back my time. I do have information that your office did provide to us regarding terminations and i have 958 were probationary terminations, out of that number. Mr. Orourke. Thank you mr. Chairman. Thank you mr. Secretary and dr. Tuchschmidt for your answers today and your testimony and your service to the country. I had a town hall meeting this saturday and as with almost every town hall that i have it was dominate bid concerned about access to the v. A. And primarily Mental Healthcare access which accesses your own recent rankings out of july 1st, el paso ranked 141st were dead last. One of the veterans who came up wonderful young man, incredibly patient and polite said the friday the day before, he had a Mental Health appointment scheduled for sometime at 9 00 a. M. At 7 30 a. M. He was called to tell him his provider wouldnt be available and somebody would call him back to reschedule. In one called him back and he came to the town hall to let me know. I called gale graham the new interim director and she got him an appointment this week so he will be seen but i tell you that anecdote because even though we are ranked last, you show us that at about 17 days. When i asked the veterans in my community, we did a statistically valid survey in el paso with a margin of error under 4 and they say it takes 16 days on average to see someone. So i want to register this note of concern, given the wait time scandal that we had last year that i dont think v. A. Statistics and reporting on wait times reflect what veterans actually experience. And when i ask veterans as opposed to the v. A. I get a very different number. And so i just want to register that with you and thank you for your commitment to turning the situation around in el paso. It could not be a graver crisis. Mr. Secretary you said your Worst Nightmare is a veteran not getting access to health care because we havent given flexibility and veterans are experiencing that in el paso, despite record funding, they are unable to get access to see somebody and 34 of the veterans could not see a provider at all for Mental Healthcare access whether it was 16 days, 34 days, 16 could not get in at all. So i want to make sure we go back and look at the numbers and reflect the reality veterans are experiencing. I would suggest we do that. Lets get your numbers and our numbers and understand the basis of your research and our numbers and sort through it. Obviously we have work to do in el paso. You and i and others have been working on that and we know that. And we submitted a proposal a Pilot Project to you and i thank you for reviewing it so quickly. Would love to work with you Going Forward to implement that or a better idea if youve got one. But weve been at the bottom of the barrel and that translates into care deferred care denied suffering on the part of veterans and veteran suicides in my community and ive met with too many families surviving members of veteran families and this cant go on. I dont mean to be parochial but i have to on behalf of the veterans tell you that we are in crisis right now. So whether it is our plan our your plan, lets turn this around. I would like you to talk about i dont disagree with your request for flexibility. I think it makes sense. And i dont know that i would have a problem longterm if i knew you were going to be the v. A. Secretary for the next five or ten years to carry this out. But in thinking about a policy and a set of rules that we lay down for future secretaries and the v. A. To follow Going Forward, how do we not create a moral hazard in the aurora funding and this 3 billion shortfall and future requests from the v. A. That whatever happens at the v. A. And Additional Resources are needed congress will provide them without necessarily getting accountability or safeguards Going Forward that we wont need to plug additional gaps to the tune of billions of dollars . We want to help with that as we put together this proposed legislation we would like to put in the safe guards and restrictions that we think would be necessary regardless of who is in office. We think that is certainly a part of it. And i said that in my prepared remarks. The thing we have got to work on is to find a better way to predict what the mand will be. I talked about the 34 of veterans accessing care on a 1 point of difference being another billion and a half dollars, we have to get a handle on that and Work Together on forecasting what that will be and building that system. Because remember i said in 2014 the crisis was because of the Vietnam Veterans. If we dont get ready for our iraq and afghanistan veterans we wont be ready for them 20, 30 years from now as they age. And i would like you to consider, not my original idea, but it was brought by the somers family at a hearing on the survivors of veterans who had committed suicide because of lack after access or problems within the v. A. And that suggestion on their part was as you are referring care out and you said you had a 36 increase in Community Care last year, their suggestion which i think holds a lot of sense, is why not refer that care out that is comparable to what the civilian population would need. I use the example of diabetes or you have the flu or dental care. And then for those signature disabilities and conditions related to service in combat, post Traumatic Stress military sexual trauma, the v. A. Becomes a center of excellence for access, quality of care and outcomes. Any quick thoughts on that suggestion from the somers family . My only quick thought is that patients like to go through the same medical doctor. So if you have a primary care physician, you want that primary care physician connected to the specialty physicians. One of the things im trying to work, given Community Care, im trying to improve the understanding of the military culture amongst private sector doctors. Were working with secretary burwell on this and if somehow weve got to do that. Because the primary care physician in the private sector has to ask the question have you served and because there is a different culture and set of questions that need to be asked if they have. So we are working on that. And i think we agree with your position, actually. Im not i think coordination of care issue says we need to provide as much of the services as we can, but there are some things, Mental Health is one of them that you cannot go out and buy and we have to be the center of excellence and provide the infrastructure to support those services for veterans. Great. I would like to use this basis of agreement to actually prototype this in el paso, somewhere in the country so we can see if this works. Why el paso . I dont know. If comes to mind. Want to wish a happy birthday to dr. Rowe who is now recognized for his five minutes. Thank you, mr. Chairman. And a couple of things. Obviously, mr. Secretary, youre hear for the same reasons were here and that is to provide the highest quality of care for veterans we can provide in this country as they have earned. I think one of the frustrations that ive had on this committee is that we have, as a committee, ive been here 6 1 2 years and we keep providing more and more and more money and then we have the v. A. Come back for more money. And we see things like the building aurora we beat that horse to death and moves that cost hundreds of thousands of dollars and i think of billions of dollars wasting in aurora that could have provided v. A. Veterans health care. I dont know where it went. We have a failed system between d. O. D. And v. A. That spent a billion dollars before you got here to try to integrate two Health Care Records and vanished an the money is gone. That is the waste that i see. And no way on this earth will you have allowed that to happen at your shop when you were and no way would i have allowed that to do that when i was a mayor of the local city in tennessee where i was and in my own practice i couldnt have survived doing that. And both sides of the aisle want to provide for the care and we feel like were caught in the trap. And the chairman mentioned bonuses. And the things that we see when we go home and talk to our veterans and to mr. O rourkes point, in johnson city, tennessee, at the Mountain Home v. A. Hospital and they do a fine job and as a matter of fact, i get veterans all of the time that tell me how much they appreciate the care they get there but there is no way on this earth that the health is four day and the Mental Health is five days an the Specialty Care is three days. And mr. Orourke, not to beat a dead horse i dont know where that came from but that is a fairy tale where i live. I would love to get the information from you as to the veteran, the name, the date where you believe that is not true because we do need to make sure that our data has integrity and the only way to solve that problem is if we Work Together to make sure we have the right data. But we cant anecdotes are helpful but we need names and dates to dig into it. I can provide you a big long thick stack of names and dates of people that cant get in. And i think that is amazing that you could if this is true, i certainly couldnt do this in my own private practice. I couldnt meet that criteria, a clinic appointment four or five days, most doctors are booked up weeks and months ahead. Any way, another thing i want to bring up the Choice Program, as i understand, as we envisioned it, was to help get rid of the backlog, not the v. A. Care going on currently, but to eliminate the backlog. If that program is going to continue and it is sun setted, then i think you are right, there ought to be one system ever taking a veteran from the v. A. To the outsource care. There shouldnt be three or four ways to figure out how to do it. It ought to be easy. And i talked to one of the veterans and ill be delighted to let you talk to a veteran in hawkins, tennessee that cant make sense of the program to this day. His comment was it was a joke. I put that in the record in his letter to us and he doesnt mind us using his name. And the other issue that i think that disturbed me was when the Veterans Choice Program came out the first 500 million spent and we had a hearing on that 300 million was administration. And i dont think i dont understand that. I dont understand why 60 of the money went to the bureaucracy and 200 million actually went to get veterans in to see me as a doctor. And maybe that is maybe that was a need. I dont know. But that seemed a little excessive to me. Well that was the amount that was required to set up the network. Nevertheless, were trying to maximize the use of that network as much as we can to provide more care to veterans. I think the other thing i would like into and certainly the flexibility is talked about you need any ceo needs that to operate their shop, i agree with that. The only thing i want to comment in the last few seconds i have is the morale at v. A. Hospitals is down. They folks feel beat down. And i think there needs to be a evaluation of the morale of the physicians and so forth. I think ill bring a bill up very soon as a trial process and a lot of people have done this when you go to your doctor any more, not only does the assistant comes into the room but another person shows up and that person is the scribe and because of Electronic Health records a doctor uses a scribe so they can see more patients and i would like to do a program and let scribes and see if the physicians there or the providers are not more productive. I guarantee they will be if you do that. I had friends at the v. A. Tell me they could see 25 , 30 more people. This is a big issue about a scribe. We are piloting a program with scribes. It is uneven right now but we are in the process of systemtizing. Morale is a big issue. 91 of the Medical Center with new directors new leadership teams. We have a lot of people leave for various reasons and morale is a big i