Health initiatives, and they were very effective. One last thing, weve had lots of discussions of how we get additional va doctors into the system and what can we do as far as i guess the medical what is it . The medical so that they can get, i guess, forgiveness on their loans when they work for the va or whether in florida, for example, a lot of our interns go out of the state because we dont have the whats the word . They go out of the state residency. And so we dont have those slots. What can we do . Theres two things youre asking about. One is for people who have large med school debt and the average is pushing upwards of a couple hundred thousand now if you dont have help somewhere along the line is can we do debt forgiveness. We have some limited authority. Its insufficient. Particularly where we want to place physicians in underserved areas which is the real challenge, its less of a challenge people want to stay around where they did their residency so in urban areas with bill medical schools its much less hard. Weve been working with hersa who has the program where they pay scholarships and loan reimbursements to people who work in designated underserved areas. Many rural, but not all. And it doesnt make sense for us to build another organization within va to replicate that process if were going to go that route, which i think we should if we can. Weve got to make sure. But to tag onto them. Theyve already got the infrastructure in place, they can move out immediately, and then the other piece is increasing residency slots. Va is highly supportive of the Residency Training programs in the u. S. I think you heard earlier about 70 of physicians get some of their training in the va system. Weve expanded that in certain areas. Theres still not sufficient well, for Mental Health its not that theres not sufficient residencies. In fact, some of them have closed because theres not sufficient people going into them so how does one incentivize that Mental Health community that more physicians would want to go in there. And thats not a question that va can anticipate but we can support the slots when we need to. I think theres the other piece of this and it was also mentioned earlier is how does one leverage the use of both Nurse Practitioners and physicians assistants and the like, and its our intent within the organization that people practice to the top of their license, and so i think supporting pa schools, supporting Nurse Practitioner programs, we have the va nursing academies which are useful to bring nurses into the va system. Were also training people in interprofessional train sog that doctors and nurses train side by side and learn to work as teams, and people who go through that find that as a very satisfying career move, but weve got to start that early in the Training Programs and not wait until they grd wa graduate and then try to retrain them to a different way to practice. Thank you very much. My time is up. Youve been very gracious, mr. Chairman. Earlier you made some comments about responding to congressional requests and such. Could you restate what you stayed about that . Something about criminality or criminal if you didnt i dont think i used the word criminal but i dont think it is excusable that a physician thinks he cannot talk to his member of congress. Nor do i think anybody in va should be will the gentleman yield . Yes. Very quickly, if you can hold the clock, what im referring to is them being directed, not that the physician or whoever the clerk may be and obviously its in the investigation that a committee is trying to do as it relates to its oversight responsibility in congress, so i wasnt implying that the physician was but it is our understanding at the committee that there have been people who have been instructed not to talk to congress. Well, do you want i can maybe put some context around that because if you just hold the clock and go ahead. Okay. So right now, yesterday, today, this past week, as you know, va has been putting out a lot of the wait time data as part of being very transparent about this. There has been concern that at the facility level they may not be looking at exactly the same data that we were releasing. We wanted to be very careful that we didnt have facility or Network Directors appear to be misleading their congressionals by saying, well, this is where we are and then having this National Data release Say Something different. So there was a caution put out to wait until we had distributed the data to them that was going to be released, and i will say it was an illworded document and it was followed immediately by a statement of clarity. This was not intended that they could not talk to congressionals, to just hold off until they had the data that they could talk to them about and ensure they were getting the right data. You know, we get terribly compromised if we dont if weve got one person saying one thing and another saying another, and we want to make sure as we move forward especially and understanding what we put out this week is only the first drill at this, we will be repeating that on twoweek intervals. Thank you very much for that clarity. It does add some light onto the issue, but i will also tell you this, we were told by dr. Lynch two weeks ago because every member of this committee has been asking for the data from their facilities, and we were told that we would receive it once the report was final. The report is final. I got a call today that my local media got it before ive got it. I just dont understand why people in the va wont follow through with their commitment. Now, you dont need to respond to that, but thats a statement. I yield back. Thank you, mr. Chairman. I appreciate that. I did want to read from an email that was handed to me by i guess an acting director, and for members of the committee i did not know this. If the director and the assistant director are on vacation or on a management conference at least in wichita va facility, the acting director is the chief nurse, but handed me an email that said please immediately stand down on any further communications with stakeholders, delegation members, and others regarding the access audit, wait list, and accelerating care initiatives, and i didnt take that very well. No. Can you explain this was approved at the highest levels no, no. The stand down message. I saw that memo and i personally saw that memo probably five minutes after it went out and i said this is not acceptable. If that cannot be pulled back, then you need to put a clarification memo immediately to explain the intent is not to have you not talk to your congressionals. The intent is to wait until you have the data from us to share with them because the followup email was five hours later, actually 5 1 2 hours later after i had sat there trying to get answers to questions. Let me describe, and you might have missed this the other night because i requested this email. The facility eventually provided it to me, your office did, not the va administration. I requested that at our last hearing and had to get that from the facility, but here is what occurred m one facility and, again, there are numerous examples across the country. Im trying to draw attention to one facility in kansas thats not in my district. I do not have a hospital in my district. Here is what occurred. May 30th, the facility announced or actually had a u. S. Senator visit the facility. About noon and was told by i think if the director was there that day, i dont know, he seems to be taking a lot of time off. The acting director said we have no problem here. Three hours later a fax went out that said we have discovered nine veterans on a secret waiting list. Maybe unauthorized. Thats the magic word out of there. And that was sent out to the delegation and the public at 3 00 friday afternoon. I began calling. Once i landed in an airport, calling, sent emails, had no response for five days, no answers. Hey, well get together with you but wouldnt answer your questions. Then there was a leak to the media of 385 rumored and so i jumped in a vehicle, drove to the facility, and was handed this email and was told go away. Go away. And i did not. We stood there this is whats concerning is since then theyve discovered another 636. So theres over 1,000 veterans on the waiting list, and, doctor, here is what they told me. We didnt know we even had a near list. We didnt know that was in the system. The system thats apparently been around for 20some years. This facility didnt even know. And im not asking you to explain this, but im asking maybe this is why we need some more investigation, more people should show up and ask those questions because either theyre misleading or worse or, frankly, incompetence if you didnt know you had these veterans sitting on a list. And as i understand the numbers that were released in the audit do not include other unauthorized list. Thats still yet to be known. Is that correct . If we dont know where the unauthorized list are, we cant include them. How are you going to find them then . I understand that you dont know. Right. But you didnt make any reference to other unauthorized lists that were found in phoenix. The types found in phoenix, you didnt make any reference to those at all. So the near list everybody should know about, and i dont say this as an apology, but there is a software defect that gives a Different Number if its pulled locally than if its pulled nationally. So all of the near data is being pulled nagg eed nationally and have been directed to go to the National Center to pull their data down. But this how long did you know about this glitch in the data . As we were trying to pull this data together. Because this is a problem. We had facilities saying we dont have any weve had two weeks of hearings. This is the first time you have said the near list is a data glitch. The near list is part of the process of scheduling. It is not in the va facility that is not accurate or else theyre lying to me. My question is its not just about one center and one hospital. This is systemic nationwide where the what you tell me the near list is everywhere. Thats what they told us two weeks ago and we go to a facility and they said we didnt know there was anything such as the near list. Well, i dont know well, how about you find the answer. And in the future, i would appreciate the documents. It was not the appropriate statement and i hope we did get that corrected. Who did approve that statement . It was jan murphy well it was put out. Not every email gets approved by a gag order email, i just want to know who approved it, janet murphy . Jan murphy sent it out . Who approved it . I dont know. I saw it who approved it . No, i cant. You cant find it out . Oh, i can find it out, but i will say we tried to correct that because it was not intended to be a gag order. I thought it was a poor choice of wording. No question it sounds like that. Its not the intent. The intent was to ensure you saw the right data and you didnt get in a conflict of where they were saying one data and then you would see another piece. We want to make sure were speaking on the same page. Thank you, dr. Jesse. Miss brownlee. Oh, thats right. I let you go way over. Miss brownlee, five minutes. Thank you, mr. Chairman. And thank you, dr. Jesse. I wanted to agree with your opening comments regarding our veterans who work within the va, and i do believe that most of those veterans are working hard every single day and are doing a good job, and i believe that these men and women who served in uniform were dedicated, and i believe these men and women who no longer are in uniform are equally as dedicated. I certainly dont want the men and women working within the va to be discouraged, but they do need to understand that they have been working in a system that has lost its way in a structure thats lost its way. And as a consequence was particularly in this wait list issue doomed to failure. And so i dont want them to miss i dont want them to misunderstand in these discussions that this is not a criticism of them individually but it is a criticism of the system of which they were working in. Thank you for that. And to that end i was also curious to know from you what the va is currently doing, were all trying to get our arms around the problem, and to fully define the problem and how you have used the vsos to help in that process and how you intend to use the vsos to come up with solutions. The vsos i think are incredibly important to us moving forward. Theyve been incredibly important to us all along, but today, yesterday, tomorrow, moving forward, they are going to be critical. As i said, if were going to change an organization to one thats driven on value, we have to do whats important to those who we serve, and they are the reflection of that. And, in fact, i was very poignantly told you didnt need all your numbers to know there was a problem, we told you. You needed to listen to us. I take that very much to heart. One of the things we have done just as a top line is as i met yesterday with the group of the vsos for we have breakfast once a month, it went much longer than it normally does because there were a lot of things we were discussing, acting secretary gibson has been meeting with them quite frequently as well as we are moving things forward, but the important thing is that the facility and facility directors are also meeting with their vsos on a regular basis, and in some facilities i would guess theyre probably at among the high performing fa 1i89s, theyre listening. In other facilities they might be transmitting, but without judgment or without trying to figure out who is doing what, our instructions forward is you must sit down with your vsos and listen to them. You must sit and listen to them because thats going to be how were going to judge the progress that were making. So thats its very insightful on your part and thank you very much. If i return to my district and talk to my the Leadership Team in my county, i can be assured theyve been instructed to listen to our local vsos. You go back i hope they have, yeah, and if you go back and talk to your local vsos and theyre not getting the attention they get, weve asked the Senior Leadership in the vsos to transmit the message down to their folks that work every day in the facilities serving veterans to get that back up because thats the only feedback well have. You know, obviously we can make them send minutes of their meetings and things like that, but thats not real productive. Its are people being listened to, and web get that bawe can gk by dialogue through the systems. Thank you. In terms of my local area, we know the demand is greater than the supply. We know that we need more space. That has been confirmed both by the va and the community. And so i am just wondering, you know, how often the va looks at Longrange Capital plan updates and if you have any idea when the oxnard will be added to a long range capital plan. So theres two questions there. There is a long there is the Capital Asset management program. I dont know off the top of my head the prioritization of oxnard although i did live in oxna oxnard. I was stationed at point magoo, so i grew up there. I can find out. I appreciate it. Thank you. I yield back. Mr. Kaufman, youre recognized for five minutes. Thank you, mr. Chairman. Dr. Jesse, last year dr. Steven coughlin testified that vas 2010 National Health study included over 20 gulf war veterans and produced important data regarding their exposures to pesticides, oil well fires, and bromide pills. Those of us who served in the gulf war remember those. But va has not released these data. Dr. Jesse, is va hiding Vital Information about a quarter million gulf war veterans who are waiting for care just as va has been hiding information on veteran patient wait times . Will you provide the committee with all of the gulf war data within 30 days. Well, i will answer the first question and say categorically were not hiding data. Understanding gulf war illness is crucial. Its crucial, and we need that data to do that. In these data sets, the way that the research works, is to begin to publish the data in the studies that they can put together looking into that data set. This is what dr. Coughlin was working on. Va is also actually working on moving towards the whole construct of open science that actually put that data once it can be deidentified so you dont compromise individuals rights out into at least in a managed Public Sector that other researchers can have access to it as well. In terms of the second question, im not sure how i can answer that. I dont know the size of the database. I can probably say with more clarity and accuracy that we can provide access to the data, but to say that can we hand it over, i dont know that. There are issues related to patient privacy and other things but ill be glad to work with your staff to try to work through that. Certainly were not looking for individual names here. Were looking for the conclusion of the research, and so i think the question is, and let me repeat it again just to make sure you understand it. As a gulf war veteran im asking you will you provide the committee with all of the gulf war data within 30 days . And i answered you by saying i cant tell you i can do that because i dont know the structure of that database. I dont know can we provide it if its not if the patient privacy and protections arent taken out . And so to hand over a Large Research database, i dont know what let me ask you but we could get you access to the data. So if we say then that because i want gulf war veterans to have access to this data, not just me. If we say then that minus the hippa protections that exist in law, that youre going to turn over all the data relevant to this 2010 National Health study concerning gulf war veterans, that part that concerns gulf war veterans. I think thats a question thats too complex for right here and now. I will be glad to personally further this conversation with you. Im not sure exactly what you want. Large databases are not something that one its not just the data. So what are the questions that gulf war veterans want to answer . Thats our responsibility, to engage with them and get answers to the questions that they want and need. You know that there are active researchers that have been working within the gulf war databases. There are, you know, several incredible studies that have recently come out in terms of trying to get to the foundations of what might be behind that. But i cant tell you i can hand you over a large database. I dont know the legal authorities to do that. I dont know where it would go.