People. Iraqi the average sunni has no desire to live their life under isi rules. The good news is the average iraqi wants to move forward. Iraqi air force is basically granted, without american air power, it will be hard to turn the tide. You heard the reports the iranians say they want help. Should we encourage them to help , all of all things . We will probably need their help to hold that back. Their goal is to create a sectarian iraq. To have a puppet in baghdad, a shia dominated government where they control the outcome. Our goal is to have an inclusive iraq. Dealing with stalin, we will have to have some dialogue with iranians that say, lets coordinate efforts, but put a red line to the iranians. Do not use the crisis to take territory from the iraqi people. Put them on notice we will not iraq. Them invading into europe perspective from on the iran situation. The headline people blame the new horrors in iraq on the americanled invasion in 2003, but the exact inson why the country is civil war today is because americans are not there. Bobby is on the line in indiana for independence. Independents. [indiscernible] george bush telling everyone there were weapons of mass had to go up to iraq and get them, and when we went over there, they found from russia,tuff and we killed 7000 more of our boys. 1991, we were done. We were always told when i was we wereilitary that never to be traded. If we got caught, we would never troops forf their us. Thank you for the call. Sean is writing in on facebook. Rea \ call for independents. Your thoughts . Caller we need to take george bush junior and put him back in his military costume he loves to wear, put him in a jet along with cheney, fly them over there, and let them figure out how to get out of this mess. They got us into it in the first place. Thank you for your call and all of your calls. We will talk more about the situation in iraq tomorrow and we will get your thoughts live on washington journal. Before that, we will hear from a former virginia congressman share his thoughts on the influence of tea party in elections. And we will go over to the resources devoted to securing the u. S. Order. We will look for your calls again and your Facebook Comments and tweets. Hearingturn to a recent held by the house on the same day it was announced 57,000 veterans have waited more than three months to get doctors appointments. You will hear from officials from the v. A. And the Government Accountability office. This part of the hearing is about 2. 5 hours. [captions Copyright National cable satellite corp. 2014] [captioning performed by national captioning institute] today. That negates the need for us to move forward with a subpoena on that particular issue. We will not be having the we hads meeting originally noticed and talked to everybody here on the committee. I appreciate it. Good evening, everybody. I want to welcome you again to tonights hearing, entitled oversight hearing on data manipulation and access to v. A. , testimony from gao, dig, and v. A. Here v. A. Ht, hear throughout the Veterans Administration and negative impacts the veterans and the health care that they should be provided. V. A. Wait times and scheduling issues have been the object of many investigations for many years. Of numerous investigations by the committee for many years. We have many outstanding requests for information, and have held hearings to address the problems within v. A. That have led to veterans waiting so long for needed care. The v. A. s office and Inspector General has also repeatedly warned the v. A. About its substandard scheduling practices. From as early as 2005 in numerous reports, v. A. Oig noted medical facility dis not have effective waiting list procedures, their outpatient scheduling procedures needed improvement nationwide, their data was often unreliable and they overstated their success regarding patient wait times. In december, of 2012, gao found that v. A. s reported wait ties remained unreliable. Vhas position continued to be implemented inconsistently across v. A. , schedulers in fact lacked proper training and vhas appointment scheduling system was outdaded and inefficient. Despite these repeated warnings that have come from congress, from the gao and even from v. A. s own investigative body, issues with patient wait times and scheduling remain a pervasive problem today. Last year, this committee requested that gao conduct a separate investigation to confirm the extent of problems throughout the vha regarding ongoing issues with patient wait times and consult delays. Gao will testify as to its findings here tonight. Recently the Committee Received whistle employer complaints regarding the phoenix v. A. Health care system that explained how the falth was keeping numerous wait lists to give the impression that its wait times were much shorter than they actually were. One of the secret wait lists at the facility sources found that as many as 40 patients may have died while they were awaiting care. After the committee was able to confirm these allegations we made the issue public during our april 9th, 2014 hearing. At that hearing i asked that the v. A. oig look into those allegations that prompted its investigation. The interim results of that investigation were released on may 28th of 2014. In that report the oig substantiated a number of problems at the phoenix v. A. But noted how it opened or planned to open investigations into 42 different v. A. Medical facilities. The oig found that at phoenix, at least 1700 patients would were waiting for a primary care appointment were not on the electronic wait list. Meaning that these veterans may never receive such an appointment. Additionally, oig found that the phoenix leadership considerably underestimated new patient wait times which is noted is its metric used to consider bonuses and salary increases for v. A. Employees. V. A. oig also stated inappropriate scheduling practices like those found in phoenix are systemic across the Veterans Health administration. Finally we were notified earlier last week that v. A. Would provide the findings of its internal audit of appointment wait times by last fry. They provided us with those findings earlier this afternoon. Tonight, i look forward to hearing what v. A. Has to say about its audit, how it plans to repair the damage it has caused by tampering with veterans access to care and with that, i now yield to the Ranking Member, mr. Michamichaud. Theres nothing greater than those who serve with honorary distinction. Were moving quickly to investigate the shortcomings within the v. A. Especially those regarding access to health care. Thousand is the time for us to identify the problems so we can move forward and implement changes. That means working together or oversight and legislative solution. It also means having very frank conversations with veterans about their personal experiences. So we know what were how we can improve the system. Over the years, this committee has identified how to fix many of the problems within the v. A. But the v. A. Is clearly facing a vice cyst, a crisis that is now being addressed by the media and now increase oversight efforts. In this environment, it is especially important that we are fair in our oversight and measured in our responses. But above all, we must never fall short of doing what we need to ensure that the veterans have access to the Health Care System that theyve earned and deserved. It is important for us to Work Together to achieve the v. A. We envision. We must Work Together across the aisle and across the branches of government to fix these problems and ensure that the v. A. s caring for our veterans. When we Work Together, this Committee Works best. We now that the work that we must put forward that we must ensure that the v. A. Is receiving the necessary assistance and resources that they need to do what they have to. As i see it, there is critical questions that should be asked by this committee. Questions that get to the root causes of the problems. Questions related to the broad strategic changes needed at v. A. , changes in the leadership climate, encouragement with other agencies like d. O. D. And hhs, increased utilization of the private sector and longterm resource planning. We need to ask the hard question, what should the Department Look like in the future . These are not easy questions. Nor do they have easy simple answers. But today, more than ever, we must ask these questions and come up with these answers. I believe thoughtful measured sound policy is needed today more than ever. The answers need to be comprehensive, and when necessary, nuanced. For example, when holding leaders accountable, we need to not only focus on Senior Executive members but also the doctors and nurses who occupy administrative or executive leadership positions. As i mentioned earlier, hr433 43 the 9 closes a gap in the current package of legislation being considered by the house and the senate. Mr. Chairman, ive always been proud of the bipartisan nature in which this committee has operated. My hope is that well continue that spirit working together to help identify the problems and working towards a solution. No single individual has a monopoly on the answers. And no single individual or institution has all the answers. The work ahead of us will be hard and it will require all of us to Work Together in that regard. The Veterans Service organization, the department, this committee, the senate and the white house. And mr. Chairman, i want to thank you once again for your robust advocacy for our veterans and holding all these hearings that were having for the oversight and its my hope that when the Committee Asks for information from the department of Veterans Affairs that they provide that information in a timely manner so we will not have to issue subpoenas that we need. Thats our responsibility and expect the department to help us do our oversight hearing as well so with that, mr. Chairman, i yield back the balance of my time. I thank you very much for your comments this evening. I would ask that all members would waive their Opening Statements as customary in the committee and would invite the witnesses to please come to the witness table and as youre coming forward i will introduce you. Tonight well hear in dr. Debra draper, director of health care for the Government Accountability office, mr. Phillip mikovsky for operations of the department of veterans affair, richard griffin, acting Inspector General of the department of Veterans Affairs, mr. Griffin is accompanied by miss linda halliday, assistant interspecter general for audits and evaluations for the department of Veterans Affairs. I would ask the witnesses if you would to please stand, raise your right hand. Do you solemnly swear under penalty of perjury that the testimony youre about to provide is the truth, the whole truth and nothing but the truth. Thank you very much. Please be seated. All of your complete written statements will be entered into the hearing record. Thank you for being here tonight and dr. Draper, you are now recognized for five minutes. Chairman and ranks members of the committee i appreciate the opportunity to be here today to discuss the ongoing difficulties the veterans are experiencing in obtaining needed medical care. In 2000 and 2001 we reported problems with wait times and medical appointments scheduling and v. A. Medical facilities and 2012 reported them again including the unreliability about patient wait times and inconsistent implementation of policy which impacted the Timely Delivery of care. We are currently conducting work examining v. A. s management of outpatient Specialty Care consults, and again have identified problems that may hinder veterans timely access to care. Across our body of work on access to v. A. Health care, several common themes have emerged. These include weak and ambiguous policies and processes which result in significant variation, confusion and increased risk of undesirable practices at the local level. Software system that is do not facilitate good practices and inadequate training, unclear staffing needs and allocation priorities and inadequate oversight which relies largely on facility selfcertification without independent verification and the use of unreliable data for monitoring. My comments today focus mainly on preliminary observations from our ongoing work examines v. A. s management of Specialty Care consults. We found most of the 1250 consults we reviewed were not managed in accordance with v. A. s timeliness guidelines, specifically we found one in five consult requests were not triaged within the sevenday guideline. We also found 38 of the consults were completed but not within the 90day guideline. 19 were completed within 90 days but the provider failed to properly close out the consult in the Electronic System. And the remaining 43 were closed out the veterans being seen. V. A. Medical Center Officials told us increased demand for services, patient noshows and canceled appointments are among factors that lead to delays and impact their ability to meet v. A. s 90daikon sult completion guideline. During the course of our review we identified one consult in which the veteran experienced delays and died prior to obtaining needed care. I want to walk through the time line of events force this case. In september 2013 the veteran was diagnosed with two aneurysms. In october the Medical Center scheduled the veteran for sur surgery in november but was canceled. In december they approved nonv. A. Care and referred him to a local hospital for surgery. In late december, after the veteran followed up with the v. A. Medical center it was discovered that the nonv. A. Provider had lost the veterans information which the Medical Center then resubmitted. In february 2014 the veteran died prior to the planned surgery at the nonv. A. Provider. This particular case is insightful for a number of reasons including that while nonv. A. Care may expand capacity there are potential pitfalls. For example, nonv. A. Care requires prior approval which may delay care. More coordination is needed between the v. A. Medical center, the veteran and nonv. A. Provider and wait times for nonv. A. Cares are not vacced by v. A. Findings relative 0 our work include variation in ow head what will centers implemented new rules for specialty consults which limits the usefulness of the data for monitoring and overseeing consult systemwide and overall lack of oversight including no independent evaluation of their actions. As the demand for health care continues to escalate it is imperative that v. A. Address this access to care problems. Since 200 athe number of patients served by v. A. Has increased nearly 20 and the number of annual outpatient medical appointments has increased approximately 45 . In light of this, the failure to address a v. A. To address its access to care problems will considerably worsen and already untenable situation. Mr. Chairman, this concludes my opening remarks. Im happy to answer any questions. Thank you very much, dr. Draper. Mr mr. Mikovsky, you are prepared to make comments. That is correct. Good evening. No veteran should have to wait unreasonable time for their care. They have earned this care, american americas veterans deserve better. Secretary shinseki and acting secretary gibson say we now know within facilities there are systemic and totally unacceptable lack of integrity. This is a breach of trust. It is irresponsible. It is indefensible and untenable. Unacceptable. I apologize to our veterans, their families and their loved ones, members of congress, veteran Service Organizations, our employees and the american people. After this committee raised the issues in phoenix at the v. A. Health care system secretary shinseki directed a nationwide audit. I will be talking about that audit tonight and answering some detailed questions. This audit visited over00 locations involved over 400 of our national and field staff at the Senior Executive level, senior manager level and, frankly, Line Management level. We interviewed over 3, 700 front Staff Members. We saw this as the opportunity. The opportunity for us to set a reset, to sweep away an established cleareyed assessment of our actual performance, not our reported performance and to establish a systemwide understanding of the change we needed to realize in our agency. We released our results this morning on all v. A. Medical cent centers, most midside cbcs and these results confirm the oig interim report our may 3rd initial release and, frankly, the gao studies. Im here to answer questions about this audi and other concerns. Our audit revealed a number of things, number one, we have hardworking staff on the front line who work at a highstress, complicated environment with, quite frankly, completely outdated technology. The most frequent challenges cited by our staff are frankly a lack of appointment slots into which to schedule veterans. They have a difficulty understanding our policies and they rely on an antiquated system that requires numerous workarounds by wellintentioned staff. I have to admit that, unfortunately, we found that our staff were had received instructions to enter a date other than the date of veteran wanted to be seen. We know theres an integrity issue here. Among some of our leaders, we can and will address this issue. I want to make a comment about reprisals against employee, acting secretary gibson mentioned this, that it is not tolerated in our system. We need our staff at all levels, but most importantly at the point of care. We need them to tell us how to improve our system, to be able to deliver care better for veterans and they must feel safe to identify problems and they must feel empowered to find solutions. Acting secretary gibson has announc