Navigate quicker than most and that is the key thing. It doesnt take everyone to do the same thing. Some people might be comfortable just going through the ig and the sun it covetable going to the representative or senator and some light be comfortable going to the press. But there are different levels. You dont have to go as far as we did. In some cases there is an exception that there are different ways that you can get the information out and different people that want to. Theres the civil groups, Veterans Service organizations that would be more than happy to get the information they have direct connections with other leaders in congress. There are different ways that i would tell you this. You feel better when you Say Something versus holding it in. I have no doubt there are employees listening tonight and seeing the comments and i might add that they are probably out there during all of you down for having the courage to show up. But step forward and model this other office to carry that water for the brave employee like thet was also the appreciate the commitment. If i could make a clarification even though i said i wouldnt recommend getting a job at the va i am not looking for a job elsewhere. They have the culture where it stands today. There is no doubt in my mind that you are a veteran committed. Thank you. You are recognized for five minutes. Thank you mr. Chairman. To follow up on that statement, i couldnt help but wondering during your testimony and in the answer to the questions that were asked of you as you detailed the ostracism that you were being shunted aside when you made problems for the management ending up in the position now that you are doing good but it isnt a position that you signed up for and then i know that you clarified it a earlier saying that you would recommend to somebody thinking about working for the va not now, not until we get accountability and oversight protection for the whistleblowers i couldnt help but wonder why you stayed. The work is fulfilling and important. I went back to medical school to be a va physician because i felt there was a great need. Everyone knows there are limitations. We are a federal department. The veterans are so grateful for the quality of care. You will see such a wide variety of people at the va and from the physician standpoint to interesting. In the geriatrics i have a Playing Field in fact it was urgent medicine at its best its interesting and fulfilling. I dont always feel so resilient as a physician. I am tenacious i get myself gif that but sometimes there is thats not in the center of your stomach when you just dont want to show up because as much as you love the Veterans Committee administration really wears you down and you begin to doubt your own professional ability. And they answer what you said earlier and for everyone on the panel, we keep asking about the culture that is the most important issue but probably the most difficult task before us as a country turning around but you represent a culture that i think we are looking for and that we want to see throughout the system not just that the provider level at the management and the secretary level on through this committee and as a country so i want to thank you for that and for the example that you provided. But i also want to follow up on another commente comment that y. You mentioned surviving 16 years of this and these problems didnt just occur under this administration ive been here for a year and a half it is a joint hearing in the committee where we heard from the Veterans Service organizations and i remember the commander coming before us saying i dont know the number was with a 32nd time that ive appeared and have been coming up for decades and ive been saying the same things over and over again. So, you said that this is a system worth saving but my question to you is is its salvageable . Youve got thousands of employees that are dedicated to the veterans and the welfare of the veterans. Im discouraged when i hear people say the va is too big to change. You have an entire group of people that are ready for the revolution. And they want this. They want a productive Healthcare System delivering good care. The horizontal violence has to stop. That was one of the implications of the whistleblower retaliation is that it affects care because you dont speak up to save the problems are because you are afraid of the repercussions. The corollary to that is that you begin to it is a Pressure Cooker and you pick up to each other gossip, bullying, exclusive we kind of see it on each other because we dont know they are under so much pressure and that needs to stop, to. You have given us ideas on that but i do wonder how we are going to be able to do that after so many years and so many fundamental systemic problems doctor matthews brings up the issue of not being able to trust the integrity of the data that has become obvious to all of us and i commend your efforts to measure those things that are important to the patient care and outcomes in the facility that you worked. Weve been trying to do that and in el paso we have seen similar rates of the veterans seeking Mental Health who cannot get an appointment, just give up and stop trying and we can only write now because we dont have the full story wonder at the outcomes. We introduced the ask veterans act which would integrate wyomings ea to tell us how they are doing that to ask them what you were trying to measure indoor facility. Let me just conclude by thanking you all for what you are doing and we hope the recommendations that you gave us might lead to some of the cultural changes that we all know are essential to turning the va around. Thank you. Mr. Kaufman youre recognized for five minutes. Thank you all for stepping forward as whistleblowers. I believe the rankandfile in the Veterans Administration are in fact employees that care about serving the needs of the nations veterans and without whistleblowers such as yourself who have had a courage to step forward, we would never know the problems that exist in the Veterans Administration because none of those problems have ever been self identified by their leadership in the administration. They have always been aware of them simply by the whistleblowers coming forward and sharing with us the reality of what is occurring on the ground with the Veterans Health administration. One thing i think when we became aware of the magnitude and the crisis was concerning the patient wait times, and the fraudulent changes in terms of those records often fueled by the drive for bonuses. Thats what youre saying is actually the problem was much deeper than simply patient wait times, that they were also denying people inside the system is that correct . They didnt get into collecting the applications that i think this is where we have to look at you can only get the appointment if you are enrolled and so we have systemic problems in the enrollment system and to give you some context you may hear this from the next panel the office that helps build of this center is about to start with a call for command center. This is something that they will assume to be the leadership or perhaps the committee that i want you to understand the change will only come from Real Solutions at the va. Currently this is what i call the gimmicks that go on at the va. We send about making the public and the leadership on the hill. But i will tell you when you look at this document to the communication train people perform the communication training every day. That isnt anything new. The callcenter people perform the call center task. This is not going to change anything. The strategy is to take people on the fifth floor and put them in the second floor. This is what constitutes responding to the veteran concerned that the va. Following something that works in the business that is the people sign off on the reports they turn into the congress. I can tell you what disappointing to me as a citizen at a va employee is to watch leader after leader sitting in the chairs and say i dont know. I will get back to you. So and so was supposed to do that. The General Council wont let me. That is inefficient and if you are going to be in a leadership position you need to leave for making people sign off on a Quarterly Report to say that i own the data that i turn and, i owned the enrollment, you doubt very many people in this room there was a 600,000 pending backlog in the va from the iraq and afghanistan veterans of people would have known that was going to happen if the reports have to be signed off on by people in the positions that were held formerly by the doctor this is where the change comes from another you have to document. One of the problems that we have is the first time that you go to make something public they tell you where is your proof, where is the document . Most people will not sign the document. I forget to process the applications but this is the kind of conversation where you ggo in to talk let me put it this way. If you all could comment on th this. The Veterans Administration is so dysfunctional rightparen in terms of its leadership and in terms of the culture as well. So having the new secretary come in they are still there. I hope the secretary ca can take the appropriate change but its going to be difficult. Should there be an entity outside of the Veterans Administration for what they report and let me go down to the rest of the physicians here. It is inherited if you really want the new change in the whistleblower environment where people come forward you have to take the policing power outside of the va. I agree no one trusts them to handle their own problems that we have reported it to them. I agree. If we acknowledge the problem these are expected to fix it. The position is that there is no problem. We have the numbers to prove it. Thank you for being here. I realize that we need to go outside the va that is under the point that we have to make the change because of nine of the positions including the secretary are vacant right now so if we can bring in a new Leadership Team and impress upon them the need for the accountability that we have heard repeated every hearing whether it is on the backlog or bonuses or the whistleblowers this is the message that maybe we are at a point where we can start to make a difference. Im sorry that mr. Mcdonald cant come in here and hear what we are hearing. I know sloan gibson is scheduled to come that we need to get the new secretary and as soon as we can because he needs to hear the kind of thing so that we can move this in a new direction. We have a new hospital. I met with some of the emergency room doctors at my invitation they were scared to come. They are not as brave as you all are and they want to be sure that they knew that i invited them because they feared retaliation. You travel in small circles. Have you had any contact with people at the hospital were for me or any whistleblower proble problems. We have had a significant number of the staff to relocate but i havent had a whistle blower problem. Im glad to hear that. One of the things i wanted to ask you, you mentioned that the first sponsor to the whistleblower is to try to impugn their integrity. One of the reasons you mentioned is that you often say they are just a disgruntled employee because you didnt get the bonus that you wanted. Can you talk about the nexus between the bonuses and whistleblowing. Are people getting paid to be quiet . I dont know that people are getting paid to be quiet, but i do think that there is a tendency to try to generate the motive for why someone is coming forward to when the truth and reporting wrongdoing. And its often associated with somehow personal gains for the whistleblowers but i tell you there is no personal gains of being a whistleblower even as you go through the litigation you ultimately when, you know, there is no financial incentive whatsoever. Im sure of that. Im thinking of just the opposite you keep people pat down and not speaking up if you give them regular bonuses and it keeps that culture of silence that you mentioned. The bonuses are among the chief of staff and higherups. Doctor mathews or doctor mitchell . My experience in the st. Louis va have productivity data for every psychiatrist as to the number of patients being seen. And i know that there is only one who perhaps didnt get the full performance based for what could consider to be the bonus and thats me because actually for their own reasons they were correct. You could accomplish what i set out to do but just do what you want to do it you will not get into trouble for not working. The only reason i think one can get in trouble is by identifying problems and then coming forward. So that has to change. And i think it is a complex issue with the college culture, that the fix can be very simple and demanding the data and Holding People accountable. You know, that once that starts to happen and some senior positions, not people that redesigned again, they have High Integrity that they resign because they have integrity, but the people who dont care, those people need to b be fired be fit it sends a message that this is not this cannot be tolerated anymore. So i would say that your right to the people that get the bonuses are the ones that keep quiet and keep doing what they are doing. Doctor mitchell . The difference between the performance bonus, the performance measure though this is what you get if theyve got the performance. Most o of us that are eligible e quite frustrated because the facility never ha have the resources to make the performance measures. So there is a bonus just nowhere near where we want to be reworded for the work we do in the proficiency that they are actually how he would perform through the year on our own personal merit and those are subjected. If the administrators like us they can rate as high or low and they dont have to give a reason why. Most say quiet not because there is any benefit one way or the other at least at my level. Thank you mr. Chairman. Youre recognized for five minutes. As i sit here and listen to your testimony one of the things that comes to my mind is somewhere along the line through your parents were somewhere, someone taught you about doing the right thing. And about being able to look in the mirror at the end of the day and know that you are doing the right thing and i applaud you for that. And know that you are respected by those that matter. And those that dont have their own issues and i appreciate that. I served in iraq as a doctor, and we have something that you mentioned tonight with a sense of mission. We have a shared sense of mission and everyone was on the same page. In the reserve unit we come from private practice. There is no reason for slacking and the patients were the First Priority and you work through the night if you have to. And you take shifts sleeping. Wouldnt you love to be able to practice in the environments like that every day . Theyve provided for the others that are veterans today. And it is really sad for me to hear that there is a need for an agency with a higher integrity than the va. Which was said tonight. Thats the people would be willing to accept that they need someone to watch over them because of their lack of integrity and weve brought up the mortality and wha when did e and the peer review. I needs to is you had people from the same specialty reviewing the charts and people that know they are familiar with the procedures that youre talking about and you do that to try to make things better and if someone is feeling that they have to go because the reputation is on the line. Its not fair to be punitive but to make everything better as far as care. So my question as far as whistleblowing is there any chance for the providers and put such as have too much administrative responsibility we dont get to see the patients, such as i need another clinical assistant in here i need a medical assistance then i can see by times more patients or do you have the opportunity to say so and so is a poor performer in the clinic and its slowing my time down with my patients and i dont get to see as many. Is that available . And i will start with you, doctor mitchell. In a particular form is not available. In section four and five i talk about the retaliation tactics against providers and one of them is failing the ancillary service so the providers are stretched thin and theres another they overloaded the patient panels that there is no way that they can link through. We are not at the level to be able to communicate equally with our administration. We are far below. And anyone that speaks out is retaliated against the dont have the freedom to speak freely and advocate for the patients in ourselves. Yes, by the providers. Basically the provider side they that they would no longer practice this in this area and they were responsive to that. So now it is a certain amount of perception. And it also took a lot of experience for the providers for those who as a group spoke up and said this is not right. So i do think that this is appropriate. And i think a lot of times resources are placed in areas where there are too many resources and things. So again, it involves a solution very quickly. To quickly outcome i was trying to institute a position with what is being provided. So we had those two accurate measures, we can know which facility we are putting end, 15 hours or whatever, and the answer exists with more resources. And this includes the psychiatrist that i was monitoring and so there is a solution there that has more efficiency and its not just more resources. It. Thank you very much. I appreciate it. Sir, you are recognized for five minutes. Thank you, mr. Chairman. I am grateful to all of you as well. Its interesting. Mr. Davis coming you said something i can relate to. But i have been here 18 months as well. A typical pattern of how this investigation is working out to get the health care that we promised them when they fall for liberty and freedom. So typically a panel comes in and the reference desk. And it tells us unbelievably shocking stories, back to your comment, that are so shocking and disappointing and disappointing to me representing veterans of our district. And theres nothing celebratory about it. And especially we need to commissar mentions a good future. And representative walden alluded to this as well. You will walk out of here there have been dozens of be a panelist are going to get us to answers, either that you are not telling the truth we dont have other questions to answer and thats going to happen again tonight and if it doesnt happen tonight, i will