Good afternoon. This hearing will come to order. I want to welcome everyone who has joined us today. Today, we will address the lack of oversight and internal controls regarding controlled substances within the Veterans Health administration that leave facilities open to Drug Diversion and veteran harm. The diversion of drugs from Va Health Care facilities is an incredible Patient Safety issue that puts veterans, va employees, and the public at tremendous risk. Unfortunately, the news has recently been filled with story after story of Drug Diversion within va. In little rock, arkansas, a va Pharmacy Technician reportedly used his access to medical suppliers websites to order and divert 4,000 oxycodone pills, over 3,000 hydrocodone pills, and more than 14,000 viagra and cialis pills at a cost to va of more than 70,000. This technician was allegedly selling these drugs on the street where they had a value of more than 160,000. At a va facility in florida, a registered nurse was apparently stealing oxycodone and hydromorphone from the hospital to feed her addiction. Keep in mind, these are medications that should have been going to veterans for their care. These issues are in part a result of va having inadequate procedures in place to safeguard against theft and diversion of controlled substances. A recent Government Accountability office audit requested by this Committee Found that one Va Medical Center missed 43 of their required monthly inspections, mostly in Critical Care areas such as the operating room and the intensive care unit. In addition, three other facilities did not follow all of vhas requirements for inspections of controlled substances. This is not the first instance where weaknesses were identified in vas controlled substance Inspection Program. In 2009 and 2014, the va office of Inspector General found that some medical facilities were not conducting monthly inspections and some inspections were incomplete. Va has been given multiple opportunities to address these concerns. This leaves me wondering what va is doing to repair the lax oversight and apparent absence of accountability regarding these issues within vha. To make matters worse, there are also issues with drug testing employees to ensure that they suitable to provide care to veterans. A 2015 office of Inspector General report found that Va Medical Centers were not conducting preemployment and random drug tests for testing designated positions in many instances across vha, which amounted to tens of thousands of employees not receiving drug tests required by the drug free workplace program. Most recently, in january 2017, the oig found high backlogs in background checks, to include drug testing, for highrisk positions at the atlanta Va Medical Center. It is precisely these tools that have been put in place to help protect patients and Health Care Organizations from Drug Diversion and harm. However, va does not seem to be taking them as seriously as it should. Based on the oversight reports and the numerous diversion incidents we will discuss today, i am concerned that vas controlled substance Oversight Program is not working and that staff who fail to follow proper procedures are not being held accountable for violations. In case after case, what we see are examples of drugs being diverted for personal use or personal gain, yet there does not seem to be much progress being made by va to correct the glaring problems that allow it to happen. What is even more concerning is that programs to help deter diversion or identify illegal employee drug use are not being implemented consistently within the Va Health System. We are in the midst of an Opioid Epidemic, and it is time for va to start making effective changes to avoid putting veterans and the employees who serve them at risk. With that i recognize Ranking Member kuster for her opening statement. Thank you, mr. Chairman, thank you for choosing this topic. Im particularly interest as the culture, the founding cochair of our Congressional Task force to combat the heroin epidemic, and i appreciate his testimony. This afternoon we are again examining the use role in ensuring that Prescription Drugs are simply controlled in va medical facilities. Less than a year ago former chairman coffman and i held a hearing of the subcommittee on this very issue in colorado because the Drug Enforcement agency, dva, found several violations in the denver office. We continue to hear disturbing reports and hospitals and clinics come in our communities at some Health Care Employees are stealing controlled substances for the own personal use or personal gain. We know that these cases are on the rise throughout the country. One Health Care Employee diverting controlled substances can be a Serious Public Health risk and can cause significant harm to many patients. We learned this lesson the hard way in New Hampshire with a technician who is injecting himself with fentanyl at hospital in New Hampshire, but it turned out this it started at the baltimore Va Medical Center and continued in more than a dozen hospitals in other states. Inspecting up to 50 patients in our community hepatitis c and some of his patients were veterans. From this example it is clear that the nationwide trend of opiate diversion also impacts our va. The Va Health System is one of the nations leading prescribers of opioid medication. Diversion in the va threatens the safety of veterans and hampers efforts to address the Opioid Epidemic in our communities. Preventing diversion of these substances should be of paramount concern. Thats what i find the gao and igs findings particularly troublesome. Its unacceptable that some va medical facilities are not conducting routine inspections to prevent and identify Drug Diversion. Background investigations that could potentially identify finding employees who have a diverted drug or who may have a Substance Abuse problem were backlogged in atlanta. Health care employees at atlanta Medical Center were not subject to drug testing for six months which could identify diversion of Prescription Drugs. We need to get to the bottom of why these safeguards and processes are not being followed. I want to know if the procedures when followed would work to prevent Drug Diversion, and want to know if va has the resources it needs to contact the inspections, the background checks, and to administer its Drugfree Workplace Program. Im also concerned about the va hiring freeze that is currently in place, and that the a h. R. Employees are not exempt. The gao and ig identified that stephanie more personal and more training to properly conduct these inspections. They also identified the need for more h. R. Personnel to address the background check backlog in atlanta. Without adequate support staff in place, the a medical facilities will continue to struggle to comply with the procedures and programs that they must follow to ensure that our veterans receive safe care. Finally, i look for to learning about progress at the va with regard to the Opioid Safety Initiative that we passed within the competence of addiction and Recovery Program just last year to bring down the rate of opioid prescriptions for all of our veterans. We must do everything we can to help veterans suffering from chronic pain, and to help veterans struggling with Substance Abuse and addiction. The Opioid Epidemic is destroying the lives of veterans and their families in communities across New Hampshire and all across the country. And we need to Work Together to find Innovative Solutions to end this epidemic. As i say to my colleagues, the heroin does not choose. We could Work Together and were proud champions of the competence of Addiction Recovery act that we passed last congress. Congress. I look for to hearing about va compliance. Thank you, chairman, and i yield back. Thank you Ranking Member kuster. I asked that all members waved her opening remarks as per this committees custom. With that, i welcome our first and only panel who is now seated at the witness table. On the panel we have dr. Carolyn clancy, deputy undersecretary for help for organizational excellence, she is accompanied by dr. Michael valentino, chief consultant for the Pharmacy Benefits Management Services of the Veterans Health administration. We also have mr. Nick dahl, Deputy AssistantInspector General for audits and evaluations. He is accompanied by the Health System specials for the office of Health Care Inspections in the office of the Inspector General. Finally we have mr. Randall williamson, the director of the Health Care Team for the Government Accountability office and doctor keith berg, consultant in anesthesiology and chairman of the mayo clinic enterprise, enterprisewide medication diversion prevention committee. I ask that the witnesses please stand and raise your right hand. [witnesses were sworn in] please be seated. Let the record reflect that all witnesses have answered in the affirmative. Dr. Clancy, you are now recognize for five minutes. Good afternoon, chairman bergman, ranking membe, rankingr and members of the subcommittee. Thank you for the opportunity to discuss oversight of controlled substances and Drugfree Workplace Program at the facilities. I will address inspections to minimize diversion drug testing for selected employees and our commitment to accountability for employees who did not live up to our core values. I am a company today by Mike Valentino from pharmacy benefits. Gao was recently released report on medical facility controlled substances Inspection Programs in four of our facilities has prompted a swift response. We concurred with the six recommendations internet and limiting them come expecting to be fully implemented by october of this year. We conducted a Conference Call last week with over 450 fieldbased staff to launch the action plans and to provide tools that support that effort, followed by distribution of written instructions. Additional dissemination efforts are planned over the next two weeks. Although gao and va Inspector General identified selected instances of noncompliance with these robust controls, i believe the system is working as designed to make it difficult for va staff to divert drugs. And most important to give us the tools to be able to detect diversion rapidly and take action when it does occur. The aha incremented robust controls substance internal controls in the early 1980s. In many cases these measures exceed those required by the controlled substances act and we believe they aligned close with the mayo clinic best practices. Data from january 2 of 2014 through march 112016 show that the a report of controlled substances loss rate is. 008 . It is the internal controls the lead to the vast majority of diversion cases being identifi identified. The use of Illegal Drugs by va employees and is inconsistent with the special trust placed in those who care for veterans. Inspector general recently reviewed allegations at atlanta va radical center of the backlog, investigations and found that mandatory drug testing of new hires did not occur over a sixmonth period, resulting in a backlog of about 200 background investigations. It was also found the Drugfree Workplace Program was not administered from november 2014 to may of 2015. Atlanta va leadership implemented a number of changes in 2016 in response to these recommendations such as moving the Human Resources department under the direction, direct provision of the director and developing a secondary database for staffing and track it all background investigations. We expect that backlog will be cleared by the end of this march, and if not we will keep you informed. In addition, va has made Great Strides toward improving the Drugfree Workplace Program. An october 2015, drug drug Program Coordinators began certifying on a monthly basis that employs selected for random drug testing were tested, when they were tested, or why there were not tested. The va is developing procedures to ensure the drug testing coding of employees in approximate 180,000 testing designated physicians is accurate and complete. On march 12016 and the assistant secretary for Human Resources and administration published a memorandum stating that 100 of all applicants be drug tested prior to appointment. Va works closely with the local, state and federal Law Enforcement entities to identify specific geographic areas with reported losses and va is identification of lost clusters has to successful arrests, prosecutions and convictions. Va has developed a culture of controlled substance loss reporting and has adopted a a practice of over rather than underreporting suspected cases of diversion. Mr. Chairman, im proud of the health care our facilities provide to our veterans come including Prescription Drug services. The issues were discussing here today are closely related to our nations overarching struggle with opioid use. As a whole our nation needs to come up with a better alternative to Pain Management and opioids. Va is at the forefront of this challenge whether opioid state initiative which we pioneered in august 2013. We are actively reducing the number opioids we prescribe and the number of veterans receiving these prescriptions. Instead, were offering a variety of complementary and integrated medicine treatment for chronic pain such as chiropractic and acupuncture among many other options. Initiatives like these will reduce the number of controlled substances va prescribes making it easier to maintain their oversight. With support from congress we look forward to continuing to improve our oversight of controlled substances and Drugfree Workplace Programs, which will further improve the care of our veterans and the care that they deserve. Thank you for the opportunity to testify, and i look forward to your questions spirit thank you, dr. Clancy. Mr. Dall, you are recognized for five minutes. Mr. Chairman, Ranking Member kuster and members of the subcommittee, thank you for the opportunity to testify today on the office of Inspector Generals work related Drugfree Workplace Programs and oversight of controlled substances at va facilities. I am accompanied by a member of the oig health care inspection staff in manchester, New Hampshire, and is also a former va pharmacist. The federal Drugfree Workplace Program was initiated with the goal of establishing a drugfree federal workplace Pizza Program make it a condition of employment for all federal employees to refrain from using Illegal Drugs on or off duty. Va has designated sensitive occupational series as testing designated positions including positions such as physicians, nurses, Police Officers and Motor Vehicle operators. To drug test all applicants tested for a position right it to deployment. Instead only tested three of every 10 applicants. Second, employee random drug testing. We estimated we achieved a National Drug testing rate of 60 of employees selected for random drug testing in fiscal year 2013. In her view of 22 randomly