Continuing to review the document and make sure that weve got it correct. The fact that it went to the Department Without the statement its a process until the last day that we sign a final report. It came up in the reason you dont put draft report out because they are subject to interpretation and they are not final and shortly after the draft came up here it was reported in the press but heres proof that somebody in the va changed it. That is not proof that just means you dont understand the process and i can show six days before the initial draft is released we were having discussions internally that if we dont declare that delay was the cause of death, we need to say so. It took a couple more drafts before it was concluded that on may 14 in the hearing where the original 17 names that we received came up i was asked if we had a chance to review those. It doesnt demonstrate the causality in a persons death. That is three and a half months before this final report. So there should have been no taking that it doesnt demonstrate the causality and i think the last statement for the record that i would hope everybody would read is that as doctor day already referred to bears that out. They have to write an acceptable response to convince us that they got it and they were going to fix it. We have made a commitment to the congress to publish that report in august. We had to cut off some work in order to be about the business of writing the report and that is why theyve gotten 3526 urology patients that would be the subject of the future review i was able to read in detail each one but it does seem to me evidence of poor care. Is it possible that those families are being notified of what happened. Those family members can pursue litigation and the va could be found culpable is that right . Thats correct. Those patients called by the auditors and healthcare inspectors so they were on the list and couldnt get an appointment timely. Some of the cases from the list were part of what we were looking at. Our methodology section laid that out. These are the 28 cases that we identify. To know why someone died is very difficult. So when you get down to an individual who commits suicide on a certain day after a certain event. The event wouldnt have occurred and in the world that feature to be able to prove we have a hard time going there. So the second group of patients that we report on. Its also important to understand that the charge is to respond to the congress, congress, to the secretary got to the under secretary of health and comments to them on the quality of medical care that is provided. So what i usually do is we look at an issue and the issues are all different and the question of this one was there a direct relationship between disappointment and got. Once we determined that there was in fact agents that have poor quality of care, we then always switch to the systemic issues that we can address. When you go to the issue of exactly who committed the va or the patient or the other hospital down the street or the nursing home what exactly do they contribute to this event or to this poor outcome that is a matter for the courts. The veterans were injured or harms and work with the va as partners to try to get this fixed. There may have been tampering of the software its different from the real numbers of waiting. How is it that the appointments could be overridden to zero out the previous employment come and do you believe that the audit controls were deliberately disabled . Yes i think there was one of two methodologies used. They show that it was there was a small number and not correct and they had a second list where they disabled the reporting function and went into the reporting software so that it would end give an accurate number of say over 200. The data shows from the inception of the list it never gives the right number. At the time is broke and out and it was 55 days. The wait was six months to get through to the 3,500. At the wait the wait was somewhere between one and a half to two years. We know they are taking a look into it and hopefully they will be able to find the forensic evidence to support that claim. A question for mr. Griffith. The language that was included in the final report regarding the come close that case of death has no relation at all to any measure of medicine. As a matter of common sense the va doesnt schedule appointments early enough to carry a disease that is highly likely that it is a potentially fatal condition that would suffer from the conditions. Does that make sense to you and do you agree with that statement . If your care is delayed comment you are very likely going to be harmed. When we started this review it seemed that with what we would find over and over again and we looked at these cases and we didnt find that so we said why didnt we find that and i think there are two of the cases in here where in fact they could say they saved a life, found a patient and a waiting list who had diabetes and critical heart care and intervened to make sure that they lived. Its also clear that the veterans have access to other sources of care beyond the va. So much nurture respect thinking about the question i think that people must have been extremely diligent where they knew the trains to and from time to try to make sure that horrible people that care. Does this apply when the report reported that veterans die while waiting for care in South Carolina and georgia . The poor quality of care was divided. Can you answer the question was the same measure applied when they died while waiting for care in South Carolina or georgia what is your answer to that . It is usually a fact pattern on exactly what happened. Im not sure exactly what report you are referring to. But usually it is a different fact pattern if we determine the quality was provided then we try to look at the system and try to get the va to do the right thing which is effective quality of care. So the report that you were discussing in the delay because of delay it colonoscopy. The same applies to you to in the columbia case in the report. In colombia they found that they have delay the colonoscopy is in a Large Population of veterans and as a result as you would expect a large number of veterans developed colon cancer that probably would have been prevented had the colonoscopy being done. The va had already taken the process to notify. Why did this happen, how is this possible and what we determined is that the va doesnt have a way to ensure that nurses and clinics if that job is critical to the clinic, refilling that position is given to the hospital where administrators decide whether or not they are going to fill the nurse position or teaching position or research position. The fact patterns were quite different. Thank you. I apologize we have had a rollcall and i would like you to have an opportunity to ask questions before we recess to go to the vote. Thank you mr. Chairman. Like its been mentioned before i am eagerly awaiting the results of the investigation that the other facilities in Southern Nevada is home to the newest va hospital many people think it is the best they have the largest medical system and im getting asked by a member of my constituents are the same number is happening here in phoenix because once you hear Something Like that and of course it makes you worry and begin to think that there are problems. Ive talked to isabel once a week to be reassured that they arent but still i just want to encourage you to finish up because not only do we not want to solve any problems you might find that i think that is a big problem of restoring trust is to get that done and move on with it. Also, you put forth the 24 recommendations and as i look at them i think there are enough and that relates specifically to phoenix, but the rest of them look at the systemic problem. Youve given those to the va. This is a big dose, a large order that you are calling for. Are you confident that the va has the facilities and the means and the intent and the ability to carry out those recommendations and solve these problems so this does not happen again . It would be the first to admit that they need additional clinical space. They need additional clinicians and a new scheduling process. They need a methodology by which they can remotely monitor what the wait times are in las vegas or any other place in the country where they have a medical center. I think they are aware of all these things and the new secretary and his team that he is assembling our dead serious about addressing those things. We do follow up on the recommendations and we have suspended states when things are supposed to be completed and we certainly follow very aggressively on these 24 recommendations and we had internal discussions about how we might scope a future project to go out and verify that everything is working according to plan. We follow up on those on a quarterly basis. I share your enthusiasm for the new secretary and i believe he is committed to the changing the attitude of the va and making these specific reforms. Do you think the bill that bill that we just passed, the compromise bill will be useful in addressing some of these 24 recommendations . Im not totally reversed on the bill. Thereve been a number of of what is later changes to assist the department in accomplishing their mission but i would like to take that for the record if i may. [no audio] the committee would like weve made an agreement that we would like to not entered into the record until weve had an opportunity to look at any other information that may need to be redacted. Yount mind sharing it with so that we are not putting something into the record that personallyse identifiable information or illnesses or diseases or anything of that nature. Thats fine. If reductions you see were done by our privacy officer to make sure that we do not have any names and their names in their. Because we havent had a chance to look at it, we agreed to thepartisan fashion reductions. You brought up an interesting point. A process and a civil process if in fact causation is found because of deaths as a result of the way times. Is it your understanding that there is now currently an ongoing criminal investigation by the Arizona Attorney general, the fbi and the department of justice . There is an ongoing criminal investigation. It involves the criminal investigators from the igs office, the fbi, the u. S. Attorneys office in phoenix. So, there is a process and case causation is found. Criminal behavior is determined through a quick are you aware of any cases that have followed filed under the claims act as a result of deaths because of wait times . Guest im not aware of any. That doesnt mean that there might not have been won. We checked on the 45 case reviews and we did not find any filed. Thank you. I want to thank you for being here and for coming forward. Ive expressed in the past that i appreciate your courage because all of us on this committee are united. That veterans get the medical care and access to that care that they really care about. Thats why i introduced the whistleblower protection act. I wish that had been in place for you. Hopefully that will make things better for future whistleblowers. Part of that act is a National Hotline that patients and workers within the ba system can call ava system can call. V. A. System can call. This committee is committed to access to care for our veterans. As you know, there was a bipartisan, Bicameral Conference Committee that was appointed in the summer. We met together and we passed the veterans access choice and accountability act of 2014. One of the primary pieces of t is the new toys card choice cards that will allow veterans to schedule an appointment to actually go to a local provider. I was concerned when you said you did not know of some of these people on the waitlist new that they had a choice to go to an outside provider. Do you think the use of a choice card which is going to go out in november to our veterans, giving them that option will help improve that . Option ofd the walking into ava Primary Care Clinic to get care. At this point, if you were not enrolled in the ba, the ba would not pay for their care anywhere else. The idea of getting care access is wonderful. Earlier wassaid that while these veterans said had a choice, they dont have a choice. Many americans dont have insurance. If they get sick, they opted not to go to a position. I dont know about other members here, but i would be have i would have a hard time paying for a visit. They kept going to the er because that was the only way to get there severely worsening symptoms taken care of. Onlye equivalent of putting up the fire, but never doing anything to prevent the fire starting. With thepe is that choice card, that will make a difference. Veterans in my area who are 40 miles away from the facility. Have 12 native american tribes. They will be able to go to their local Health Services facility to get their veterans care. A huge piece of reform was encouraging a partnership between the v. A. And the inhouse services. I thank you for your testimony in helping to guide this committee to do meaningful reform and we will keep an eye on it. Thank you very much. Mr. Kaufman. I can provide the ig emails. They will be reviewed by our privacy officer to make sure that no ones identity is left in their that shouldnt be. , the you are aware department of justice has already declined to prosecute 17 cases of possible criminal violations by ba employees v. A. Employees. The are some of the Reasons Department of justice has provided for not wanting to prosecute . Some of the reasons include that it was not determined that criminal behavior occurred. , they had the cases more rigorous prosecute of standards for the cases that would rise to the level of getting prosecution as opposed to administrative action. Fact thatem, the someone manipulated the data, but there wasnt proof of a death as a result caused them not to prosecute. Some of them said this has been a systemic problem in the department for a number of years that has been allowed to perpetuate itself. Thatbility to demonstrate someone knowingly and willingly committed a criminal offense was too difficult. Thatre you surprised at response . I think that we work with these prosecutors everyday last year, we arrested over 500 individuals. We arrested 94 employees last year. That they cant prosecute every case that they get. Frankly, our investigators would like every case that they investigate to be prosecuted. But thats not the real world. Based on the demands on the department of justice and the court system determinations are made by the department of justice in that respect. We have to live with them. Passed an amendment on an appropriations bill to put more money into the line item for the department of justice for the specific purpose of prosecuting these cases. Dont you think, oh when you maybe the systemic fact that it was a cultural of corruption, maybe its ok. Somebody does something manipulates records for the purpose of financial gain, isnt that a criminal offense . Shouldnt there be an example set by somebody being prosecuted somewhere in the system . I agree. Im not saying that there wont be, either. There havent been any at this point. You would expect that the cases with the least amount of evidence and the least amount of manipulation, if you will, or coconspiracy would be the ones set aside earliest because the additional cases will require more work. We are working feverishly on those cases because we know its important to get through all 93 of them. As we finish them, if there will criminalssed prosecution, i know that apartment is anxious to get this report so they can take appropriate administered of action. Tell me, are you surprised there were not promote prosecutions . Not at this point. The fbi still investigating. There is still retaliation against whistleblowers. There would be no reason to prosecute. It does seem like the department of justice is looking the other way. Because the situation is embarrassing to the administration. Thank you. I want to thank all of you for your work towards veterans. The situation in phoenix and elsewhere that provided even one metric of substandard care is unacceptable. I know someone heavily on the ig to provide another set of eyes and provide that unvarnished view of what was going on. Lets be very clear. Whats being implied is that the integrity of this office was influenced by the ba by the v. A. Did anybody ask you to change the report to make them look better . No. Is a normal Standard Operating Procedure form of the draft reports to be done . It is. A report of 170 pages with 24 recommendations. A case beforeeen where your methodology has been questioned to the point where you were called in front of congress to defend the methodology . No. Understanding that it is predicated on the interpretation of you were asked for the original draft . That is correct. With that being said, i want to be very clear. The report you issued is very damning to the ba the v. A. The department of justice and making sure that everyone willing to there has to be a route and an avenue for people are held accountable. From my understanding, that is in the process. The fbi and the department of justice are looking at. The investigation is ongoing in phoenix and other places. In our first recommendation in that report, refer to the names of the 45 veterans in our case reviews to the department for them to conduct appropriate reviews to determine if there was medical negligence and that. Here ought to be redrafts does the ba oig prosecute v. A. Oig prosecute cases . Traction on a get federal violation. Does this report and the way it was handled strike you how long have you been with the oig . 13. 5 years. , investigation have you been a part of roughly . Done about 520 arrests every year for the last six years. Thats about an average year. And the methodology, the folks who work for you is there anything strikingly different about this one . A very large undertaking and it was a combination of criminal. Nvestigators it was a joint project where they had ownership of the medical care in the case reviews. The audit staff have the responsibility to try to identify all of these people who were not on an electronic waitlist to a number of different sources. Her staff did that. To try to pull the different disciplines together and to get everybody on the same page as far as what makes sense there might be some language that makes sense to david that might not make any sense to they are still obviously there is still the belief that we have not gotten to the bottom of this. , i want toeing said use my remaining time. My immediate concern right now is on those 24 recommendations. Are they moving in the proper direction . Youve had people testifying before that v. A. Did not apply your recommendations. I can tell you this. A lot of the wait times issues were previously identified in our interim report. I know the department star