Subcommittee on Government Operations Hearing: Ensuring Quality Health Care for Our Veterans

right a subcommittee will come to order without objection that share is authorized to declare a recess of the subcommittee at any time the subcommittee and government operations is convening today to hold this hearing on ensuring quality health care for our veterans I now recognize myself for five minutes to give an opening statement nearly a hundred thousand veterans living in the Washington DC Northern Virginia and Maryland area depend upon the Washington DC Veterans Affairs Medical Center or their medical care for years serious and urgent problems pestered at this Medical Center endangering the lives and care of these veterans from 2013 to 2016 leadership at the Medical Center and the Veterans Health Administration received at least seven written reports detailing significant and substantial deficiencies it is in our view shameful how many warning signs were ignored and/or too long in March of 2017 a confidential complainin alerted the VA office of the Inspector General to equipment and supply issues and I quote sufficient to potentially compromise patient safety the conditions were so appalling that the Office of Inspector General took the highly unusual step of issuing an interim report in April of that year the ensuing investigation culminated in the scathing March of 2018 critical deficiency report which really was the genesis of today's hearing there are far too many glaring problems in this 158 page report to enumerate but the OIG did issue 40 recommendations and we need a mechanism to monitor progress and continuing implementation of those 40 recommendations at the root of the deficiencies is what the expected General Michael missile politely deemed and I quote a culture of complacency but what I frankly wouldn't have called a culture of indifference indifference to their patience leaders at multiple levels mailed to address according to the IG failed to address previously identified serious issues with a sense of any urgency or purpose or purpose in interviews leaders frequently abrogated individual responsibilities and deflected blame to everybody else how else do you explain the laundry list of critical deficiencies known to be a leadership that threatened harm to patients and yet these problems persisted for the better part of a decade last month my colleague Eleanor Holmes Norton and I visited the facility and met with the new director mr. Hummel and his senior leadership team for several hours about actions that have been taken to address the exigent concerns raised by the OIG shortly after that visit ranking member meadows and I sent the director a letter requesting information regarding mental health treatment at the DC Medical Center today I am here to put the leadership on notice Congress will not stand for continued values that threaten the health and safety of our veterans at one out of B the VA flagship medical center unfortunately it's it's anything but according to the OIG the DC Virginia veterans Medical Center put veterans at risk through needless hospitalizations unnecessary anesthesia failure to use perform our preferred surgical techniques all because important supplies instruments and equipment were not always accessible as of March 31 of 2017 the facility had a backlog a backlog of 10,000 904 open or pending consults for prosthetic items ranging from eyeglasses and hearing aids to surgical implants and artificial limbs one patient waited more than one year for his prosthetic leg this is a veteran we're talking about and eventually he gave up and moved to another state where a different veterans facility promptly build his request the level and breadth of neglect detailed in the report is almost inconceivable and certainly callous the OIG found that some progress certainly has been made as did we after two Mills's two year period in which the facility was led by five different directors in a two-year period a new permanent director testifying before the subcommittee has taken the helm and all senior leadership positions are now occupied I believe by permanent staff in May of 2018 the OIG reported that the availability of supplies has improved and that prosthetics backlog eliminated and that's genuine progress but given the history here we must be aware of what lies behind the metrics or the extensible metrics leaders must measure and examine customer satisfaction at the end of the day our veterans receiving the appropriate care that meets their medical needs and treatment expectations our employees empowered to report patient safety incidents and do they trust that leadership one reported will in fact address them how can we ensure that this never happens again whether at this facility or any other that is charged with delivering care to those who served our nation in uniform previous wake-up calls have come and gone and veterans in need sometimes continue to suffer in February of this year one of my constituents sought inpatient admission for a drug withdrawal set of symptoms including anxiety and pain management at this facility after the hospital first evaluated him and a second doctor decided to not admit him the veterans who I found him dead of a gunshot wound in their home the following week just last month there was a shocking report of a psychiatric patient at this facility who escaped from a locked area and traveled to Virginia with by the way the help of one of the employees at the facility not that he was complicit but he apparently was not suspicious of somebody in a hospital gown and called him a cab he went to Virginia and abducted and assaulted a woman resulting in his arrest I'd like to play a clip from that NBC 4 report was the intelligence of my ranking member escaped the psychiatric ward at the DC VA Medical Center after entering the shower very late Sunday night by removing the ceiling tiles removing part of the ceiling ventilation and crawling to a neighboring office outside the locked space here's what happened next according to a relative he went through the emergency room and asked someone in the emergency room the staff at the hospital to call a taxi cab and they called him a cab they called him come he was wearing his hospital clothes he was wearing his scrub bottoms and a tank top the relative did not want to be identified because the man is accused of taking that cab ride to a home in Manassas where police said he held a woman he knew against her will and assaulted her Prince William County police arrested him it was hours later when the VA discovered their patient was missing but that relative told us something else before getting in the cab the patient called home to alert family he was at the relative then called the VA hospital twice to warn them the man had escaped but said they couldn't even confirm if he was even a patient you tried to warn them that he'd escaped they did and they didn't go look no they didn't even bother walking to check his room this is the latest in a series of black eyes for the Medical Center recent news for i-team investigations revealed a patient overdosed in the parking lot in 2017 but his body went undiscovered there for nearly a day I won't even comment incidents like this remind us that's a long road ahead putting procedures in place is the easy part eradicating the culture of indifference or complacency that's the hard part and it will take a significant investment on the part of leadership we are here today to insist that our new director mr. high male rise to the task and we'll support him assuming he does and that he stay long enough and commit to stay and work hard to hear every patient and employees concerns to rectify those issues and to communicate needed changes that foster trust within the facility we should never have to tell this story men and women who put on the uniform to protect our country had every reason to believe they would receive the highest quality health care as a statement of our commitment to them that's our part of the contract instead they encountered mediocrity at best no one inside or outside of government can possibly accept that standard for everyone who works at DC veterans medical center from the custodian to the cardiac surgeon there must be one standard one standard and that's one of excellence we'll settle for nothing less with that I call upon the distinguished ranking member my friend mr. meadows from North Carolina for his statement Thank You mr. chairman I want to thank you for your leadership and truly for working in a bipartisan way to make sure that our veterans get the the care that they deserve the care and that they were promised and honestly the care that is the least we could provide and a acknowledgement of the service that they provided and and I just want to say thank you and and to the gentlewoman from the District of Columbia I want to just say that this is a bipartisan effort you have my hundred percent commitment to work with you and the gentleman from Virginia whose constituents are served by this I have the blessing of having one of the best VA centers in the nation of the Charles George Center where we actually get quality care and we don't deal with some of the issues that have just been outlined by the gentleman from Virginia it shouldn't take an investigative team from news4 to help us fix the problems actually that investigative team is no stranger to this committee they've done work before they've done excellent work and yet to see the kind of tale that was was demonstrated just a few minutes ago on video is not only shocking but it's it's truly not going to be tolerated and and so with that I know that we've got a new team and and I many of these things were systemic problems that if it happened before your watch I get that and yet we have to make sure that the inefficiencies and the deficiencies are eliminated on your watch and that as the gentleman was talking about that they never happen again I think probably the the biggest frustration for us is is to have an IG that is doing his his work that has to give as the gentleman mentioned an interim report because it is so unbelievably poor in terms of quality of service our veterans deserve better and and I just want all three of you to here and anybody that's watching to understand that the commitment is not a 90 percent commitment it is a hundred percent commitment to get it right for our veterans and I think mr. chairman it probably be appropriate that at you know in in the next 60 days or so that the three of us make a visit back to this facility to really look at the report card and where we are and and have that with that being said I also want to to acknowledge many times medical facilities are a very chaotic place it seems like there was a little bit more in fact a lot more chaos at this facility then there should have been and and yet we have veterans director and hello I believe you were a veteran of what 30 years and and I want to thank you for your service because many times the VA they have actually veterans that are serving veterans and yet we need to make sure that there's the urgency and the quality of care that that they deserve and so so with that I know you're the fifth director we need to make sure that there is a plan in place that after all of you are gone that the next person that comes in that we're not having another hearing here with a tragedy that has happened because we don't have a system in place so what I'm looking forward to today is to hear about those systems to hear about the corrections that have been made the number of open items that the IG has identified how they've been closed when the rest of them are going to be closed and how that we make sure that the next I G investigation is on something that is totally unrelated to patient care and with that I yield back I think the distinguished ranking member and I I know he is committed and especially I mean that this issue knows no partisan line and we will work together as one subcommittee and with one committee to try to nudge and support where appropriate to make sure that the issues that we have identified and that the og has identified are fully uncompromising addressed to everybody's satisfaction especially the patients and with that I want to welcome our witnesses and I would ask all three if you wouldn't mind standing and raising your right hand it is our practice to swear in all of our witnesses do you swear or affirm that the testimony you're about to give is the truth the whole truth and nothing but the truth so help you God let the record show that the witnesses answered in the affirmative thank you today we have with us miss Tammy as our naki who is the assistant deputy undersecretary for health administrative operations at the United States Department of Veterans affair we have Michael Hyman the director of Washington DC Veterans Affairs Medical Center the new director relatively new of the Medical Center and also with us we have the Honorable Michael missile the inspector general at the Department of Veterans Affairs who is he and his team the author of the report we have discussed each of you has five minutes to summarize your testimony any written statement you have will be entered into the record fully and in the interest of time we ask you to try to summarize within five minutes because we know that votes are probably going to interrupt us at some point in this in this hearing and with that miss our naki welcome good afternoon chairman Connolly ranking member meadows and members of the committee as of 2017 I am the executive over administrative operations and I have oversight of procurement logistics I thank you for the opportunity to discuss Washington DC VA Medical Center and I am accompanied today by Michael Hale the director of the VA Medical Center the veteran's health care facilities are designed to be safe havens for women and men who have served our nation we are constantly working to improve the standards that for our veterans as deserve that the DC VA and the extended VA hospital network take pride in providing care to our veterans in a an environment that fosters compassion commitment and service hospitals though by their very nature are intrinsic risk to patients as personnel contend with unpredictable situations infection control significant care needs and changing demands on a daily basis the DC VA though is no exception and it is actively pursuing high reliability organizational principles the HRO core pillars are leadership commitment patient safety and continuous process improvement additionally we are instituting the just culture training focused on improving to care to our veterans by providing a safe environment for employees to report and speak up when they see or anticipate a problem in March of 2018 the Inspector General issued its final report on critical deficiencies of the Washington DC VA Medical Center from the April of 17 the report included 40 recommendations for the Medical Center vision 5 and VHA collectively VA has been working hard to address these deficiencies and to improve our administrative processes and environment of care at the Medical Center today 28 of the 40 recommendations have been fully addressed and closed by the OIG the remaining recommendations involve longer-term monitoring of processes to ensure the corrective actions are sustainable these involve monitoring the availability of supply stockage levels periodic equipment inventories and auditing of financial records for supplies and equipment purchases we expect that all of these deficiencies will be closed by October 31st of 2019 despite the issues raised by the OIG and events reported in the media the DC VA is comparable to other medical facilities in the Washington DC metropolitan according to the Center for Medicare and Medicaid Hospital Compare data the DC VA recorded some of the lowest Hospital mortality rates the DC VA has realized a 50% reduction in hospital card infections this year compared to the first six months of 2018 this progress has contributed to the sale reading increasing from one star to two as leadership continues to build a culture of high reliability centered on employee engagement we expect these rates continue to drop with a goal of zero preventable harm the OIG report also raised concerns about the sterilization process is resulting in unnecessary delays and risk to surgical patients tremendous progress has been made rebuilding the staff of sterile processing during the period of April of 2017 to May of 2018 the DC VA canceled 20 surgical cases due to the availability of reusable medical equipment over the same period ending May 1st of 2019 the DC VA reported five case cancellations the last occurring in December of 18 at no time during the 2018 to 2019 timeframe was a place– patient placed under anesthesia before the care team recognized that appropriate medical equipment was not available for the first time since April of 2017 the DC VA has a permanent medical center director this stability allows the DC VA to commit to a long-term plan for improvements in a consistent programmatic fashion currently there are only four key leadership vacancies among 57 department heads to be filled the permanent staff has grown by approximately 130 employees in critical areas such as nursing still processing supply chain social working community care the Medical Center plans to add an additional 300 employees between now and October of 2020 to support expanded primary care mental health and surgical services across their markets the Chairman and ranking member have shared the committee's concern regarding three unfortunate incidents that happened at the DC VA we share your concern about these incidents and are conducting thorough reviews in each case and where appropriate we have changed policies and procedures and retain retrained or disciplines to ensure that these do not occur in the future director Hummel can speak to these in detail we look forward to the opportunity to share our progress and discuss our continued efforts to restore trust of our veterans we appreciate the OIG for their report and the subcommittee for their assistance my colleague and I are prepared to respond to any questions you may have thank you right on time miss animal good afternoon mr. chairman ranking member meadows and members of the committee thank you for the opportunity to discuss the DC VA Medical Center and the work we are doing to restore our veterans and your confidence in our medical center mr. chairman I want to begin by thanking you and your staff especially Sharon and Billy for the warm welcome that I received in October and the strong relationship that we have built Sharon has my cell phone number and she knows that she or you can call me at any time if you have a concern that you would like to discuss and I extend that offer to all members who represent districts in the Washington DC VA medical centers market please know that you or your staff can contact me at any time to help resolve a concern of one of our veterans miss Holmes Norton we are building an equally strong partnership with your team I am looking forward to discussing our community-based outpatient clinic in Southeast DC with Karen and your staff tomorrow morning and I appreciate your collaboration on how we can work with the city and community partners to improve and expand the services for veterans in this underserved community I am privileged to lead a dedicated team of medical professionals at the Medical Center the OIG critical deficiencies report highlights glaring failures in the basic procedures of a medical center that are symptoms of a systemic leadership failure that team has been working hard to improve our processes and ensure safe care for our veterans over the past two years we have eliminated the backlog of process more than 10,000 prosthetics consults we have written and reviewed more than 200 standard operating procedures for sterile processing we've hired 17 additional sterile processing technicians and new leadership in both sterile processing and the operating rooms all while undertake a major undertaking a major renovation of the sterile processing workspace we have hired new leadership and supply chain entered more than 12,000 items of medical supply into the generic inventory package hired 29 additional supply technicians and conducted a wall-to-wall inventory of all medical equipment in the facility and our six outlying clinics in the last eight months we have hired 149 new staff and we expect to finish the year with a net gain of more than 200 new employees all of this is to ensure that we never repeat the failures highlighted in the OIG report when I accepted this position I promised our staff and the veterans that we are privileged to care for that I was in this for the long haul and I would not leave until I could truly say that this Medical Center is once again the flagship of veteran's health care and I fully intend to fulfill that promise thank you again for this opportunity to discuss our progress and our challenges and I look forward to answering your questions Thank You mr. hull mr. Bissell Thank You chairman Connolly ranking member meadows and members of the subcommittee I appreciate the opportunity to discuss the Office of Inspector General's recent oversight of the Washington DC VA Medical Center inspections like those performed by OIG staff at the DC Medical Center are a vital part of our overall efforts to ensure that the nation's veterans receive high-quality and timely health care services they also promote the most effective use of va resources and taxpayer dollars our March 2018 report critical deficiencies at the Washington DC VA Medical Center made troubling findings at the facility of systemic and programmatic failures the issues we identified were complex and affected multiple patient care and administrative services we did not find evidence of adverse clinical outcomes meaning death a change in diagnosis a change in course of treatment or significant change in a patient level of care this was due in large part to the efforts of many dedicated health care professionals who worked around these challenges to ensure veterans received the best quality services under the circumstances of the 40 recommendations made in the critical deficiency report 28 have been implemented and 12 remain open the OIG comprehensive health care inspection program report published in January 2019 provided 18 additional recommendations one of which is closed significantly all senior leadership positions have now been assumed by permanent staff key service chief positions have also been filled with permanent managers to ensure full implementation of the recommendations we engage our centralized follow-up staff to track the implementation of all report recommendations with the responsible VA office this consolidated function helps ensure specially-trained oag staff provide consistent management of open recommendations it also facilitates timely and accurate status reporting for our website the semi-annual report to Congress and other products that promote transparency overall we found important progress being made at the Medical Center we commend the efforts of every staff member manager and leader who has worked to make those improvements our most recent visit earlier this month showed improvements in patient safety and incident reporting reprocessing of surgical instruments and trays sterile processing service personnel training and staffing plants while timely hiring actions have helped to address the known deficiencies with in logistics and sterile processing services challenges with human resources management remain in addressing critical core services while the deficiencies we identified were at the DC facility they're not isolated to that Medical Center we have detected some of the same problems and other facilities where oversight work is being conducted whether lack of effective inventory management and controls staffing shortages challenges with specialty services like sterile processing or routine cleanliness standards our findings and recommendations should therefore alert other VA medical facilities about what red flags to look for regarding how weaknesses and logistics and other key systems can affect patient care it should then help guide their corrective actions ôhe recommendations if fully implemented should also improve integrated reviews of medical facilities and oversight by visions and BHA central office changing a culture that has allowed problems to persist for such long periods of time is never easy it will take time and require the unrelenting focus and energy of VA employees and leaders we will continue to monitor the advancements made at the DC facility and remain alert to signs that progress is either being stymied or unsustained mr. chairman this concludes my statement I would be happy to answer any questions that you or other members of the subcommittee may have thank you very much and before we begin around questioning I'd like to enter into the record a report from the partnership for public service they did a survey and the prescription for better performance for medical centers I will say and we just confirmed this in the last 48 hours in this report in their analysis they looked at a hundred and fifty medical centers and last year performance two Hahnel came on board this Center we're talking about ranked dead last in in employee engagement which obviously as a spillover effect in terms of quality of care and so I want to enter that report for the record without objection so ordered I'm gonna call on miss Eleanor Holmes Norton and I'll wait my turn a little bit because obviously she and I share jurisdictional interest in this facility a lot of our constituents and maybe yours too mister okay avail themselves of the services of the center so it affects a lot of us miss Norton for five minutes I want to thank you mr. chairman before the visit you and I made to this Center so we could see firsthand what the complaints were about and I appreciate was time how we were received and your briefing and the tour we had before I get to my question I would please indulge me for a really an urgent situation that has arisen here in the District of Columbia southeast and you alluded to this I'd like to get some information your outpatient clinic the only clinic for our veterans here in the District of Columbia for medical and preventive care is about to close now I understand that this facility is from your point of view underused it's it's open only about three days a week with who you see why it's not to use you know when you have to keep track of when the facility is open in the first place that leads to a vicious cycle and and it is therefore open under on only three or two or three days and then only half time so you see how is this plays on it on itself now I just have to ask you where are these veterans from the District of Columbia supposed to receive their care well I understand that Prince George's has a facility it's already understaffed and there is Rockville in Maryland where my my good friend represents but neither prince george's nor rockville are near any subway will you provide transportation for these District of Columbia veterans who don't have any place to go now if you close this facility man thank you very much and I want to emphasize that no decision has been made as to whether that facility were closed or not oh good to hear that the lease expires in September and I do have to make a decision as to whether we renew that lease when will you make that decisions down ma'am I would like to make it by the middle of July with input from both your staff and from the from the mayor so you're coming to see us and the mayor yes ma'am in fact we have a call scheduled for tomorrow morning with your staff to discuss the issue I appreciate that we just don't want people to be left with no place to go home and these these veterans don't exactly have the kind of resources that you and I have yes ma'am and I understand it's a very underserved community we do have a physician that is there two half days a week and one full time will unfold a a week and we also have nurse a nurse that is in the clinic five days a week with a technician and we provide telehealth services from there five days a week back to the medical center the clinic's actually been closed for about the last ten days due to a pipe break that occurred in the building that is in and decrepit in more ways than one s ma'am and so it's important that we get the Missal before my appreciate your coming to see us on that urgent matter I'm interested that you issued something that I have never seen from an inspector general it was I'm sure it happens from time to time an interim report that was in 2017 and which you noted sufficient quote and I'm quoting here is sufficient to potentially compromise problems to potentially compromise patient safety I mean those were the words is it common to come forward with interim reports like this what were you trying to to say before there was a full report when you issued this interim report I do not believe it's common to do it I'm not sure our office has ever done it certainly and the three years I've been the Inspector General we've never issued anything like that we've got information about issues at the Medical Center we immediately sent up a rapid response team and within hours they reported back to me of significant problems at the facility we then contacted VA to let them know of these problems and I didn't get the kind of response I was hoping for in terms of trying to make sure these issues which impacted patient safety when you get that kind of unusual you've heard mr. Bissell say unusual warning why wouldn't the VA get on it instantly to try to essentially perhaps save lives for the veterans who were using the facility I'm not sure mrs. Norton that I have the full answer to that I do know that we did have VA central office staff immediately deployed to that area it's what they accept with specifics and logistics and stall processing but I believe that the issues that mr. missile is discussing went well beyond both logistics and still processing and so the interim report was really helpful in identifying everything that we needed to do to support the medicals it was like an emergency report yes and I appreciate mr. missile that you were willing to depart from your usual processes in order to alert the VA and I must say that I would hope in the future to receive what mr. missile said was not immediate corrective action thank you very much mr. chairman thank you and thank you for your leadership in this matter mr. Norton and I continue look forward to continuing to work with you on an issue that affects so many of our constituents mr. Massey Thank You mr. chairman for calling this hearing on such an important topic mr. missile you said that many of the fish deficiencies that you identified as the IG at the DC facility weren't isolated to that facility that there some of those deficiencies at other facilities and that that could inform their improvement can you expound on that a little bit yes we have a very active healthcare inspection program we inspect 50 some-odd facilities every year every Medical Center is inspected on about a three-year cycle in addition we do what we call hotlines which are if we get allegations of specific issues we'll we'll do an inspection there as well so my comment on that was really related to other findings we've made both in inspections and in some of the hotlines and we publish all of our work product and so just last week we published one on the loma linda facility in california in which we identified environment of care issues so we regularly put out reports which have similar issues not the same extent but similar type issues so some of the issues that you found at the DC facility like specialty services for sterile processing we found out that other facilities and that this should be looking into those yes and that's why the DC report is a great roadmap for other facilities because they had significant sterile processing issues and when we write the reports our goal is for all the medical centers to be reviewing them to see if they have any kind of similar issues and to address them before we get there I want to thank you very much and I'm going to yield the balance of my time to mr. meadows I think the gentleman from Kentucky mr. missile let me come back to that because you say you expect other VA centers to follow the IGS report what's your degree of confidence that that's actually happening I mean because I can tell you that it's even members of Congress that a lot of times we don't see the IGS report as suits just that somehow the administration of every VA center is going to look at his his problems and associate that they have the same problem I don't know that that will really happen what's your degree of confidence we try to work hard to make sure that the information we have in the reports is disseminated as broadly as possible so for example I sometimes meet with vision directors and talk about recent cases we have again to highlight our work we also try to talk about trends we're seeing in areas and obviously it's up to the medical center directors and the leadership at VHA to ensure that they're following what we do so you so you mentioned about another facility in California is an example but but how would any of us appear know whether our VA center is is having that same problem I mean so you've got Kentucky and that's the reason why the gentleman from Kentucky was asking is it his VA center or Georgia or you know Kentucky Florida or you know we can go all the way down the line I mean are you informing that member of Congress that their particular VA center might have an issue absolutely well we when we do an inspection and we're ready to publish it in a particular facility we notify the members of Congress whose jurisdiction it's under and we're always offered to come in and talk all right so in that case no news is good news it could be good news but again it whatever whatever whenever we publish a report we will always notify it whether it's a good report or a bad report just to talk it over with it with members of car all right because one of the things that we talked about in my opening remarks is about making sure that this problem doesn't happen again and and I heard the number of standard operating procedures that have been put in place as a response and I would assume that that's meeting with applause from your and your team is that correct that's partially a good development but what we found particularly in this situation is there was such a lack of of leadership and governance issues so no matter how many procedures and processes you have in place if you don't have strong leadership if you don't hold people accountable if you don't have an effective governance structure it's going to be very difficult to have an effective organization I'm going to yield back to the gentleman just very quickly if you found any issues at the Cincinnati VA the Lexington VA Lexington Kentucky VA the Huntington West Virginia VA or the Louisville Kentucky VA would you let me know after the hearing absolutely thank you very much I thank the gentleman and I call the gentleman from Massachusetts mr. Lynch where there is a VA facility in five minutes from my family's home in West Roxbury very big one mr. Lynch Thank You mr. chairman and the ranking member for you work together on this issue and bringing it forward yeah I've got three VA facilities in my district one in Brockton one in West Roxbury near the chairman's family home and also Jamaica Plain I want to speak directly about the the veterans and active military suicide issue mr. heiss the gentleman from from Georgia and I in the National Security subcommittee had a hearing specifically on on veteran suicide and active military suicides and I see the elevated numbers here at at the DC VA center and and I'm just there's no indication in my briefing about the the the the connection among those suicides would you classify it as a as a cluster or were those connections or was there cross knowledge among the the victims here or no sir the two that had been reported in the media there was no relation between those two they were separated by quite quite a bit of time yeah and there there's no no I have no knowledge that either veteran knew each other the veteran that the Chairman spoke about his constituent actually had not been seen in the VA for about five years before he had that encounter with us all right so so I'm just trying to figure you know we've got a lot of these suicides going on we've got a lot of active military attempts and unfortunately successful suicides and I'm just trying to figure out a way to to get at that now we have reached bet a program that was initiated by the VA back in 2017 that tries to do this analysis on those who might be at risk of suicide have you have you adopted that program yes sir and and our suicide prevention coordinators are informed by that information I think one of the major challenges that that we have within the VA and I certainly experienced in my leadership roles in DoD is many times suicide or suicide attempts are driven by socioeconomic factors that we may not have visibility on we've got visibility on the healthcare issues but not all the other things that are going on in a more comprehensive system that includes that data would lead to a much better predictive model yeah yeah and that's that's exactly what I'm trying to get at so at the at the Brockton VA we have a program we actually we actually do a sort of a brain scan on our military recruits as they're going into this before they deployed and we may we have like 250,000 of these brain scans and we try to compare them with returning veterans to make sure there's not some TBI issue or something like that in in your experience is there any connection between the high number of deployments so we were members of this committee were in Afghanistan not a long time ago and we typically ask who's here on the first tour of duty and we met with a small rifle platoon of Marines there were Marines there that were on their seventh tour of duty that's unbelievable and I think that's ever happened in the in the in the history of our country and as I'm trying to figure out is there a connection between these multiple tours of duty and the psychiatric stress that that some of these young men and women are experiencing and you know because if that's the case we're gonna have some trouble going forward here as as those those burdens present Czarnecki yes I'd like to comment on that I know that our mental health department is actually doing what we call behavioral autopsies on every suicide that we become aware of and we're really trying to look for those key indicators that would would help us prevent them from committing suicide in the future yeah have you come up with any commonalities or you're still in the process of developing these profiles um we the profile development is ongoing I think that there are some some key indicators as mr. Hein will talked about a lot of the socioeconomics yeah so we have actually partnered with the law enforcement training center to develop education for the community on how to help help us as the VA identify those veterans that are out in the community who are not being seen by us that have risk factors for suicide and try to get them engaged with us at the VA so we've been doing a lot of outreach to first responders to provide education and training that's great mr. chairman I just wanted to make sure we don't see this suicide issue as just a DC VA Medical Center issue it's much wider than that and also you know I've dealt with some families who have struggle with this and so I just you know our prayers and thoughts so with those veterans in with their families thank you I yield back the gentleman makes a great point this is hardly an issue limited only to this facility of this region no question about it and your point about seven tours is right on I mean during the Vietnam War two terms would raise an eyebrow three would be almost unprecedented seven did not exist and so the fact that we have multiple multiple tours obviously puts more and more men and women at risk of PTSD and other depressive effects and it needs to be paid attention to misdemeanors did you want to get I want to make one real quick comment to the gentleman from Massachusetts mr. Lynch I want to say thank you for your leadership on this particular issue as you know it's very critical to me it's something that I've had constituents that have lost sons and and it becomes very personal when you when you have the tears of a mom or a dad you know that have lost their loved ones and so I just want to thank you for your leadership and and thank you for reminding us this is not just a DC problem this is a United States problem and it's something that we've got to come together and I yield back I thank the chairman freeze I think the gentleman and I do want to give mr. Lynch one more it's he puts his money where how many times mr. Lynch have you been to Afghanistan and Iraq about 45 times now 40 that's that's a member of Congress committed to making sure that the men and women we asked to serve have have support from the Congress the gentleman from Kentucky mr. comer Thank You mr. chairman and my questions will be for the inspector general sir do you believe the Washington DC VA is moving swiftly enough to address the issues that you outlined in your report they're moving at a very good pace and we're very glad to see it happening what are the most significant remaining issues that the DC VA still has to address to ensure that our veterans received the best medical care possible I think it would be the HR function because somebody be shoes revolve around having proper staffing so if you do not have the proper staffing that's really hard to be able to provide all of the services in a timely manner and they're still working through some of the HR issues what are some actions that this committee can do to address some of the serious issues reported not just at the DC VA but other VA that have received similar media attention for poor performance over the last few years what are some things that we can do in Congress to address that we have found staffing to be an issue across VA every year due to a congressional request we put out a staffing report which identifies major gaps in staffing in a number of different areas so one of the things could be to see whether or not there are hurdles for VA not to be filling these positions for example a medical center director to determine whether or not there any hurdles such as compensation or otherwise that prevents some of them from being filled on a permanent basis I'm very close friends with a constituent mr. Dakota Meyer Medal of Honor recipient from from my district very close to my hometown in southern Kentucky and he gives a lot of speeches across the nation on veterans issues and he talks about the VA a lot and one of the suggestions that that he bounces around that I'm beginning to hear more of my veterans suggest is that perhaps we would be better off eliminating the VA and providing our veterans with a gold card to wear if they need medical attention and they can get that medical attention at home then that would allow to do it at home and it would be it would be paid for and perhaps the savings from from not having a VA would somewhere somehow come close to pay for that I don't know if that theory is accurate or not I was wondering your opinion on that because like my colleague mr. Massey my district spread out it's five hours from the eastern part of my district to the western part of my district so my caseworkers are constantly handling VA case it's probably more VA cases than anything our caseworkers do and our my district part of my constituents go to Louisville Kentucky VA Lexington Kentucky Nashville Evansville Indiana and Marion Illinois so they're served by five different VA s and in four different states so I was just wondering if that what you thought about that proposition that mr. Meyer and other veterans that have have brought up before I have not done a comparison of the quality of the health care between the private sector and what VA provide however I would say in my time as Inspector General I've seen a lot of very high quality health care that veterans receive and that VA is preeminent and number different areas such as mental health and spinal injuries and when you look at some of the surveys done of veterans many veterans really value and enjoy the services they get at VA however there's issues that come up and that's why our office when we seize them is going to report on them fairly and accurately right and I don't think that that bold proposal would would happen anytime soon but one thing I would like to see is more choice from our veterans obviously if a veteran has received a serious specialized womb like missing a limb or something like that the VA is certainly more qualified than than most of the rural health care systems in in my state to handle that but there are a lot of issues that I think that we deal with from a casework standpoint that our constituents are having to travel two hours to a VA when they could be better served from the local hospitals I have 28 hospitals in my congressional district so that's something that that gets mentioned a lot I just wanted to hear your thoughts on that look forward to hearing from you in the future hopefully we can get this serious issue solved with the VA and again if there are things that we can do in Congress please let let us know mr. Chairman I yield back I thank the gentleman the gentleman from Maryland mr. Raskin mr. chairman thank you very much thanks to all of our witnesses mr. Hammil you have not been on the job that long less than a year still I think is that right yes sir yeah months and I just I wanted to commend you because I know you came from being the director of the Walter Reed National Military Medical Center in Bethesda but that you've definitely brought a lot of focus and purpose to the task here and I have a number of constituents a whole lot of constituents who go down to the the DC VA and they continue to have problems but we are aware that you are trying to respond and you've certainly been working well with our staff when we call up and I understand you're still you're doing these monthly meetings with congressional staff members and and also with you know other interested stakeholders and so I want to thank you I want to thank Me's Wimberly from your staff who I know has been very helpful to us as well but the morale situation is very tough with a lot of employees there and I wonder what it is you're trying to do to address that and to what do you attribute it what what is your sense of the situation there thank you sir I think it's probably one of the top t challenges that we have at the DC VA is employing aged men morale and commitment the chairman referenced the survey that we are in the process of retaking for 2019 and to give put some things in perspective in 2018 2017 we had 33 34 percent participation rate in that survey this morning we had more than 65 percent of our employees who took the all employee survey that is going to give us some very powerful feedback on the pain points of their everyday work environment that we can put action plans in place with them and actually have employee lead groups to improve them I think the biggest challenge our employees have had has been psychological safety and fear of retribution should they report a medical error or should they report a mistake that they made and that is a culture that we are trying hard to break and encourage people to speak up and I'm encouraged by the data that we're seeing in 2018 there were about 780 patient safety reports filed by our staff now that may include a patient incident it may include a near-miss like a patient that there was a question about a patient getting the right medication delivered the right way and a staff member did the right thing and asked the question and we asked those to be put in our patient safety system so we can trend what is happening and we can look where we need to make process improvements is that the kind of fear that whistleblowers experience a fear of retribution I believe I believe that's part of it and so what we've seen this year so far is we have about 870 patients we have more patient safety reports now than we had all of fiscal year 18 and 80% of those reports have a person's name on it so we can follow up with them we can ask them what they've done what the issue was and we can give them feedback on what we're gonna do to prevent it from happening again you're trying to dispel this culture of fear which is a hangover from what prior leadership prior yes sir I believe so okay well thank you for that I have received a couple of complaints from constituents about the IT situation and a huge backlog in requests for IT assistance and obviously today you really can't run a functional organization if you don't have effective IT can you explain what is behind that and what you're doing it to address that problem yes sir there there is a significant backlog as of this morning I talked to the area manager who reports up to the assistant secretary for oin T and there are about 4,000 open work order tickets within the DC VA and our six outlying clinics they have had a significant problem with staffing in the past they are almost fully staffed now they're authorized 25 people and they have 22 on board with two more being recruited and and one person who just left that they've got to process the action on the team is very engaged mr. Goff err the assistant secretary for oh I NT visited the hospital about two months ago and spent an hour with the area manager talking about the issues and challenges and these concern me a great deal because as we get ready for the electronic health record deployment at some point in the future I need the IT team really working on upgrading the infrastructure of the facility and not working on a backlog of IT tickets okay finally would you be willing to compare your experience at Walter Reed with your experience at the VA the Walter Walter Reed really now is a hyper efficient up-to-date state-of-the-art kind of facility and can you compare that to where you are now into what you you would attribute the difference sorry it's – it really gets to leadership and it's it's a very different patient population Walter Reed primarily retirees active duty service members and their family members the DC VA we do have a large portion of our population that is economically challenged and financially challenged or financially insecure would be the best term for it their their health care status and their their engagement in their health care is different than it was at Walter Reed I think the other piece of it is Walter Reed was an incredibly highly functional organization when I got there routine things happen routinely regardless of who the leader is and I followed two very talented leaders in Admiral Mike stocks and Major General Jeff Clark at the DC VA the struggle has been and and was routine things happening routinely and how we build that into our culture and empower employees to just make those things function every day regardless of who the leader is I thank the gentleman before I call on the gentleman from Florida mr. to be without objection I'd like to enter in the record the organizational alignment showing the vacancy rate for all of the positions at this facility and it goes from a high of Human Resources which mr. missile we're going to return to that 68% vacancy rate to prosthetics zero so we've made progress in some but there are there's still a lot a lot of room for improvement in the top five or six categories here it's all into that into the record without objection as it's a document for our usual mistis to be Thank You mr. chair my question is for mr. Negi am i pronouncing that correctly and I'm and I know you probably won't have the answer this question so I would just ask that you get back with me or my office the information I represent Southwest Central Florida so most of my district the the nearest Veterans Center Veterans Hospitals Bay Pines it's been reported to me that Bay Pines has stopped referring patients in need of inpatient mental health and substance use services to approve non VA community care providers instead these veterans are being added to a waiting list that already includes over 70 patients and will take one to three months before receiving treatment it appears there is significant confusion in VISN eight about how to appropriately implement the mission Act the my understanding is the purpose of the mission Act is to increase veterans access to health care yet veterans and vis and are experiencing much greater delays to mental health and substance use treatment can you explain why this is happening and what can be done in the near term to ensure that these veterans are getting the mental health and substance abuse treatment that they need um I will be glad to take that for the record and get that response back to you all right thank you does the gentleman yield back I'll yield back to mr. meadows thank you thank you and so since you're gonna take that back I'm a big one on timeframes when can we expect the response because literally these can be life or death kind of so within the next 30 days can you get back to this committee and mr. Stu beyond that request absolutely all right thank you so much I think the gentleman from Florida let me let me follow up real quickly when you mention your IG report and sharing it one of the one of the things that just came to me is is I mentioned my opening statement I have the luxury of having a five-star quality VA Center and yet every VA Center is not without its challenges and difficulties and and delays and yet there are some good practices that I know have been implemented at that particular facility what mechanism is out there to share those good practices with perhaps the director here in DC is there is there a mechanism to do that well that's why what we try to do in our reports is we try to really get into the root cause of any issue that we find because when we find an issue it's not good enough for us just to stay we found a problem we really want to get into why it happened and we see themes and that's why in our reports we're going yeah but better that's more on problems than good practices and so while I appreciate that it's the good practices mr. thank you is there any way to do that yes VA actually has a number of mechanisms to share good practices we have an innovation program where employees can submit good practices and they can be shared so how do they get rewarded for that hey your pause concerns me here's the thing is you get more of what you reinforce and and and what I'm saying is if there's a great practice that they come up with and let's say someone comes up and saves the VA hospital a million dollars how do we make sure that that is rewarded or do they just get a pat on the back and say attaboy attagirl and go on I believe that it's a mix sir I do believe that in some cases there are team Awards generally a best practice is not just an individual it's generally used here's what I would like and I didn't mean to cut you off and and here's what I'd like is is the best practice is listen you you've had just an unbelievably terrible track record that we've got to fix and the problem is each little thing that you do wrong now will be judged based on the bad track record it won't be judged you know you may be in your honeymoon phase right now but because of the systemic problems that have been outlined in the IGS report if you even mess up a little bit they're gonna say that nothing's changed so I guess what I would like from from the the two of you if you would is to get back to this committee in the next 60 days how do we best share best practices and reinforce those because part of the survey problem that you're having with employee engagement is they don't feel like their input is being valued would you agree with that director yes sir I would and from a best-practice standpoint we've brought a number of best practices from around the VA to the Washington DC Medical Center and we have exported some the work that was done in prosthetics specifically our our chief of prosthetics actually went through the VA Shark Tank process at a previous facility he brought best practices to us and some of the things that he put in place at our facility are now being spiraled out across the VA as best practice that's what I wanted to hear I'll yield back I think that I thank the gentleman the gentlelady from Michigan miss Lawrence I want to thank the chair for acknowledging me I want to say for the record I have four VA facilities in my district and this is something that I hear and I know that the best practices and I think the line of questioning that my colleague just entered into is extremely important but I hear consistently from the user from the veterans from those who are using the facility their discontent the lack of follow-up and the long waits and so are we including a way to get the voice of the patient because so often they feel discounted so it's one thing to talk to all of the employees and get those best practices but at the end of the day if you still have veterans piling into the conveyor office of the members of Congress telling them that they're not being respected they're not getting timely response and that they need services that they cannot get you may try to put stars on your wall but are we really achieving the goal I would really love to hear a comment on that I'll talk a little bit about the national level and then I'll ask mr. Homewood a comment on what happens at the Medical Center a couple of years ago we started a veteran's experience office at the department level and where we're collecting real feedback real time from veterans so that we can trend in track those and do service recovery in real time as opposed to waiting for survey results mr. Harmon I think the survey results are great but they're not they lagged the process the veteran signals V signals is a much more real-time system where we can see how veterans are reporting I look at that on a couple of times a week and it also has a very robust written comment section what I find interesting in that is is the positive comments outweigh the negative about two to one as I go through that and then I spend a lot of time talking with our patient advocates and and with veterans across the Medical Center and in our various clinics you have to deal with their issues upfront when they walk into your office with them and unfortunately a lot of times a veteran will come into my office demanding to see me and I'm not in the building because I'm out visiting an outlying clinic or I'm in a meeting but if I'm available I want to come out and I want to try to resolve that myself one of the things that does is it role models it sets the example for the rest of our staff that if you have an unhappy veteran in your clinic today don't send them down to the patient advocate do everything that you can to resolve their issue in the clinic and and it's about drawing the staff that you have the ability to address that issue one other thing and please help me because I'm having one of those moments the facilities is not a medical hospital that's in the community what do we call that a community-based outpatient clinic CBOC see that's it Seba those work very well so I'm hearing about this disconnect of the charr of the long traffic and I actually got involved because the veteran services were trying to close it and when I visit that facility the the the veterans who are there they love it it's a smaller environment you're using telemedicine which you're gonna have to use more of to be more responsive and one of the things that was impressive for me was the mental health that they could through telemedicine talk to a therapist and they go in is not all this long walk it's not crowded the the staff there we're probably the most engaged that I've seen they took such personal pride in it and I really want you to know that those work and that we I feel there's a place for that even if we look at closing a facility you must increase those see boxes we say yes ma'am and I think the mission Act drives us to doing that the access the Drivetime access standards that has department has put in place really encourage us to take the care out closer to where veterans live and work and especially in the DC market I'm very concerned because we have patients that it may take them an hour and a half two hours to get to the Medical Center in Northern Virginia the Chairman knows we have a clinic at Fort Belvoir Virginia but for a veteran living in Loudoun County that could be an hour-and-a-half commute during rush hour and we're gonna lose that patient to the community so we are working with it there's a Vet Center Extension Center in Loudoun County that we are putting a telemedicine system into and in the next couple of years we're going to look hard at putting a much more large larger CBOC in Northern Virginia the last thing I would love for you to engage with the Chairman I would love to talk about how we will we get complaints from veterans to be able to fill out a form about the customer satisfaction so that we can help you because we're gathering that data because we that's my veteran is my largest caseload thank you I thank the gentlelady and she makes a really good point I mean in a perverse way this novel being at the bottom of the pile means presumably you can only go up and and but establishing a baseline of performance and satisfaction is something I think we have to have so we can measure real progress and and and celebrate it when it occurs I also want to ask unanimous consent that my colleague the gentlelady from Virginia misen be recognized for the purpose of participating in this hearing as a full member of the committee without objection so ordered I'm gonna take my five minutes then call upon you miss Paxton you yeah they've just been yielding to me I owe my turn I thought I'm so sorry I thought I had plenty to say and not enough time to say yeah yeah yeah all right you wanna okay sure I recognized not myself but the gentleman from North Carolina Thank You mr. chairman and again I want to say thank you for your leadership director let me just come to you we we have a number of hearings where we get people that come in and make excuses and I want to say thank you for not making an excuse for what we saw on the video where the i-team did their investigation thank you for taking it seriously I know we've had discussions I appreciate that the fact that you not only have a concern for our veterans but you want to get it right here's what I would ask you and miss Lawrence just made a comment about that every year we have what we call veterans seminar where we actually go to three different parts of my district where we bring all the people together and we talk about serving the veteran as a whole so it's not just the VA it's the it's the eligibility it's everything that we have in that and bring it together sometimes its adjudication what we find in those are the weak spots that we have in our delivery system and I don't suggest that we can do that across the board but I do think it's important for us as members of Congress to understand where the weakness is do you think it would be helpful if we actually get a random survey of veterans that are served across the entire VA system not just DC but across the entire that it comes back and lets us know you know what the scorecard is the gender chairman has a scorecard which is call for tarah that actually gives a rating and we were able to follow that on i.t what if we had a rating system that we were able to do that for veterans do you think that that would be helpful in holding people accountable sir I think that one of the challenges with that is there a lot of surveys out there there are at least three serve two surveys that our veterans get if you're an inpatient you get the hCAP survey that CMS uses if you're an outpatient you get the VA s outpatient survey and you get pinged for the v– signals on an occasional basis and so those are statistically designed surveys that have statistically set sample sizes there may be something that's missing from that and feedback from members of Congress or from the committee as to how improve that survey may be very useful but I'd encourage you to look at the development of that survey all right so let's assume we've got two surveys obviously they're not working would you agree with that I mean you know if if the surveys would have stopped the poor health care results and maybe I use health care more broadly but the problems that we had at your facility where you are if we if we had just the survey and it was an action item we wouldn't be having this hearing would you agree sorry I think the question is what was leadership doing with those survey results and how are they trying all right that's exactly where I was trying to get how do we make sure that the information that we gather is not just important to you because I can tell you're taking it serious how do we make sure that when you're gone that the next person that takes the directorship of this particular facility how do we make sure that he or she is taking it serious so I think that needs to be on a report card that that Congress looks at yeah but but even on the report card I mean I guess at what point do we start holding people accountable here's the problem I've got I got veterans that enjoy great service in my district and when they tell the stories to other veterans in other states all of a sudden the other states they go well we don't have anything like that and I want to give a shout out to miss breyfogle who's no longer in in my district in fact I weep tears and actually we got a good replacement the director there now is great but miss breyfogle did what you just mentioned that you have done with the Chairman is gave me her cell phone number so that when I had a problem and it came and was elevated I could make a phone call and it was taken care of in minutes and you know what happened they ended up empowering their staff to take care of the problems where they didn't need to contact me and so how can we do that can you get to this committee some recommendations on how we can make sure that this DC debacle does not continue to happen here but also that it doesn't happen in Arizona or California or Minnesota or anywhere in between can you can you get some recommendations to us on those good practices that you were talking about sharing yes sir and I would love to do that when we submit back on on our questions for the record I'll take that one for the record because I would like to put some thought into it thank you so much I'll go back well thank you mr. meadows and and just following up on that I think and we talked about this when we met at the facility couple of months ago I think because of the unique nature of this facility and the problems that have plagued it in the past we've got to create a matrix for setting goals that have been sent certainly by the AG's office and meeting them and institutionalizing so that god forbid but you know you you're hit by bus tomorrow your successor has to follow through and has that in front of them and remember we're doing all this for our veterans to make sure they are best served so so I'd like you to give some thought about that because I think we want to institutionalize following your progress this is not going to be a one-time hearing and and we have a model we've created for IT and federal government with you know seven factors and we grade and we're gonna have a hearing on that next week if you want to see what it looks like but but we'd welcome your suggestion of that and yours as well mr. missile let me ask you you're the IG and you talked about a culture of complacency could you tell us what you meant by that wife what what led you to characterize activities at the facility as a constituting a culture of complacency what we found is that the problems that we identified were pretty well known throughout the facility that a number of staff raised those issues did not get them resolved did not get them worked out to their satisfaction and rather than working harder to get them raised either to our office or others who could do something about it that they just decided they were going to live with them and have workarounds so that they could make sure that the patient's got the best quality care under the circumstances so they just were satisfied because they felt they had no other route other than try to get the best quality care for the patients so what you've just described is sort of institutional barriers to providing quality service and they did workarounds to try to give that quality service the barriers within the system not withstanding they felt leadership was either not listening to them or not taking appropriate action and so they they felt that there were no other avenues to pursue in some cases however I mean for example we had a case where I think if I recall the blood supply had to be destroyed because it has not probably been stored is that correct I believe that's correct yes is that a function of management or a function of maintenance and making sure things kind of work properly it has to do with the leadership at the facility across all departments and all levels and they have to understand what they're supposed to do be properly trained but then if there's an issue to raise her hand not be afraid to raise an issue that if they do that they'll in some way be retaliated against and that's one thing we found at the facility a number of people who didn't raise her hand felt that if they did there would be retaliation against them mr. Hummel would you agree that that was a problem when you took over that raise your hand and being empowered and there's no retaliation based on what your report and what have you done to change that and encourage it sir it was a problem when I arrived at this facility and quite honestly there are still pockets of of that fear across the organization today and the only way that we can really overcome that is by demonstrating that leadership takes those concerns seriously we're going to address them and we actually say thank you to people who bring them to our attention and recognize them publicly reward the type of behavior from our employees that we want to see well both both the ranking member and I spent a lot of time in the private sector and one thing I think both of us would observe is and your you had a line of questioning that got to that but it's what's rewarded you can say all you want but if people notice that's not what's rewarded and in fact it could be punished it's not going to change behavior so presumably you're looking for some high-profile opportunities to show you are committed to what you just said you're committed to yes sir I try a couple of times a week to send out a tell me something good story to all the staff were where either a veteran has thanked somebody for doing the right thing or going above and beyond or a staff member discovered an issue that they raised and and they prevented a problem from happening I would like to be able to do those every single day and I would like to have a weekly good catch award where we could recognize somebody unfortunately the challenge I have right now is we still tend to focus on the negative event and not finding those positive events where we should be recognizing those behavior right presumably doesn't in between where we reward someone who takes the initiative to avoid the negative happening and that's a positive and that's exactly what we have to have in healthcare if we're going to become high reliability organizations um let me explore the issue of HR HR is the one the number one office still with a 68% vacancy rate so out of 78 designated positions only 25 armboard 53 are vacant what can go wrong with that mr. Bissell that's high vacancy rate in an HR office what could go wrong is you're not going to be able to hire the people in the other departments and divisions that you're going to need and that was what we found when we came on site at DC is their HR department was so broken that they had outsourced it to the Baltimore Medical Center so the Baltimore Medical Center HR department was not only trying to staff Baltimore but DC as well and without effective HR it is extremely challenging to make sure you have the resources and the staff necessary to do the job necessary so so HR is kind of key to an enterprise if you want to hire you want to have new hires they got to be processed absolutely HR does that absolutely if if certain things have the personnel actions have to be adjudicated termination promotion demotion demerits whatever all of that has to in some fashion go through HR is that correct I think the administrative part but you may have employee relations as well that deals with some of those issues but they should be working very closely with it well I'm terminating someone I got at the paperwork at least it's done by HR correct administrative leave I have to go through HR and I got let me see how many people two thousand five hundred and sixty-four people and you can have some turnover and some of it generated by performance some just generated naturally retirement attrition move on that could keep an HR office pretty busy yes and I still have nine hundred and sixty four positions vacant is that correct mr. Hummel yes sir so I got 25 people to do all of that I need 78 so I'm if I'm running HR I'm under a lot of pressure and frankly it may be almost an impossible task given the numbers I don't know mr. Hammil what are you finding as the relatively new director is what's the impediment to filling these critical positions in HR and what are you proposed to do to try to resolve it yes sir and and I would like to you know get beyond some of the examples you said the the 965 number of vacancies I'm trying to hire back 425 of those in our data system that we pulled that data from for your staff with the remainder positions that we are not going to hire back we should inactivate in the system so it doesn't look like there's a vacancy there that would be the proper way to do it and one of the prop challenges with the shortage that we have in HR is we're not able to do that properly which means we create a false picture I'm sorry when you say inactivated just sounds so Nick Sounion sir if you were in operative inactive here what I did whatever work the the the term we used when I wit my year in the private sector was funded headcount all right this is headcount that I am NOT going to fund I am NOT going to hire back and so there's a way to code that in the system so it does not look like a vacancy and I take that point and well that's fine but you still got a vacancy problem in HR which is kind of critical to your being able to manage the price and do everything you want to do improve morale through productivity have a more empowered staff that feels they can actually make decisions we have a arrangement with workforce management consultants from the VHA z– Human Resources Division that provides 17 full-time equivalent staff to help us process hiring actions and quite honestly that is the way we are surviving on a day to day basis right now is that two-year arrangement that we have with workforce management consultants we have prioritized in our hiring strategy filling those HR vacancies within the VHA we are also going to an HR consolidation at the vision level so we have already consolidated the classification of position descriptions which determines the pay grade we bring someone on at the vision level we are in the process of now working through consolidating across the six facilities the other human resource functions and at a national level we are going to begin consolidating our retirement processing every time the central office comes up with a we're gonna for example a retirement processing I'm happy to take advantage of the centralization of that because it means I can get better service for my employees who are retiring and free up my internal HR staff to be working staffing recruitment disciplinary action so just to be clear I want to make you could however your answer but I want to make sure I don't under misunderstand you you are not saying outsourcing HR is the long-term solution no it's just a short-term solution because of the dire need for functioning and to buy yourself some time to fill these vacancies in HR miss demand ISIL and then I'm gonna call him mister mister chairman I just would also like to add that a staffing model is so critical to ensure you have the proper staff we've been talking about numbers here in vacancies I don't know if those are the right numbers because until you have a good staffing model which tells you what you need and where you need it it's really hard to know whether or not it's effective and we put out a staffing report every year across VA and it's been very frustrating because for years we've been saying VA needs to have staffing models across all the disciplines they've done a pretty good job on primary care but there's a number of other specialty areas which they haven't done it and I don't want that to be missed and that was one of our recommendations it's still open with respect to staffing models thank you the gentlelady from Virginia is now recognized for her five minutes miss Paxton Thank You mr. chairman for yielding and for inviting me to participate in today's hearing and thank you to the witnesses for coming to testify before the committee today so my district I represent the top triangle of Northern Virginia far north bridge in Northern Virginia my district starts just outside of Washington DC and goes all the way out to the west to the Shenandoah Valley so somebody at the midpoint of my district could go to either the DC VA or to Martinsburg West Virginia and it would be a little bit more than an hour in each direction for those folks now most of the folks live on the eastern side of my district though who need those services but what we have encountered in terms of a constituent service standpoint is that is that more and more of our our veterans want to go to Martinsburg because they are not getting the satisfying care that they need at the DC VA and I'm glad that you guys have made progress it looks like you're really digging in and doing what you can in the short time you've had thus far but there obviously are still some ongoing issues that the patient's they are having to face I think understaffing has has been a lot of the cause of that I seems everybody agrees it's resulted in longer than usual wait times and unresponsive departments and a lot of our constituents are reaching out to our office in assistance of transferring their cases from DC to Martinsburg despite the fact that it's going to take them longer to get there now chairman Connolly talked a little bit about the staffing issues and I know that that you have had pervasive status staffing issues across multiple departments have you have you hired yet or is there a plan to prioritize hiring a new HR director mr. hi moe yes ma'am our new HR director came on board I believe in September of 2018 okay and is there a staffing plan to fill the vacancies that you have yes ma'am there is how are you prioritizing which which positions you're trying to fill first we looked at where our greatest pain points were when I first came on board we had prioritized 45 housekeepers as our number as one of our top priorities but we had a very functional housekeeping contract that was supporting the facility and actually doing a wonderful job I reprioritize those positions lower on our priority list and I moved up positions like Human Resources our patient safety manager in our infection control nurses so that we could provide better care and we could also hire them on board the staff that we need to support the Medical Center so you moved up the the positions that have direct patient contact care those kinds of yes ma'am or ones that were absolutely critical for us bringing on board the people that we needed to bring on we also prioritize some of our logistics and SPS positions a little higher on the list so that we could fill those critical gaps as well and one of the things that mr. Musil brought up in his remarks at the end of the Chairman's questioning was that a lot of your data from 2017 and 2018 were unavailable when it came to staffing vacancies in the HR system because it was not properly maintained as the system of record for positive for position management so basically you didn't know what you didn't know right exactly ma'am okay what changes has the facility implemented to ensure that you have accurate tracking about vacancies and what we have validated an organization chart for every single one of our departments and and technically under HR modernization HR it belongs to the vision but I validated their staffing charges well so I could make sure I have the local staff that I need to support the Medical Center that information now needs to be corrected in the HR system so that we have a position management system that allows us to function and prioritize our needs and that is the last piece that needs to be completed from the two recommendations on HR and the IG report and do you have a timeline for that to take place we expect that will be completed by 30 September of this year okay very good and what steps is the facility taking to retain top talent especially medical talent nurses I know that there's been a lot of turnover and a lot of them working a whole lot of overtime which has which has cost them interns from their satisfaction we're looking very hard at the salary rates among our competitors somebody sent me a flyer last night that one of our local competitors is offering a $20,000 recruitment bonus for nurses that means we've got to put recruitment bonus in all of our job announcements for nurses and try to match that and if any of our nurses tell us that they're gonna leave for that $20,000 recruitment bonus I would like the opportunity to match that with a retention bonus before they make a decision thank you very much I see my time is expired so I will yield back wouldn't it be nice if there were retention bonus for members account no talking crazy here mr. Gowens you're gonna request it I wasn't let the record show I didn't approve it I just you're against it I'm sure right okay as long as I am yeah go ahead I want to make just two requests in a closing comment and the chairman has afforded me that luxury and I thank him director whenever you have a hearing like this there's two things that come out of it is either a good action plan and it sounds like you're well on your way to addressing the outstanding issues and I understand by October you're gonna have those outstanding issues on the IGS report and done is that correct yes sir we expect everything to be completed by 30 September but there is a tidal wave of complaints that will come in for people that have been watching this hearing and I just they're gonna they're gonna call the i-team investigator and say yes but they're gonna call our staffs and the Chairman and the gentlewoman from Virginia the the gentlewoman from the District of Columbia will get a number of complaints and so here is my ask of you is when those come in if we you remain committed to address all of those as expeditiously as you have testified here today are you committed to do that and give Rapid Response on those complaints that come in yes sir I absolutely am all right and I'll close with this I can tell that you're sincere and and I came into this hearing so angry and so upset that our veterans had not been served partly by the the investigative team work that's done partly by the numbers that we've seen we know that you didn't create this problem in fact this is a systemic problem that has been there it appears for a number of years and and so I want to say thank you for having a sobering response and not pretending like everything is fixed I appreciate that one of the telling things is when you talked about how teams were afraid the IG point out teams were afraid to come to management and you admitted there's still pockets of that very transparent I don't know that most witnesses would would do that I want to thank you for doing that we would also like a good health report over the next 60 to 90 days on where you're coming and if you would be willing to commit to do that I think the Chairman and I would would love to look at this very closely are you willing to do that yes sir I am and I would love to have both of you visit the facility I think you and I I think again the chairman for his leadership and I yield back I thank my friend so in conclusion we're going to develop a matrix for monitoring progress and it's got to be a workable matrix for you and for us and we welcome your involvement in that of your office mr. myson so that it meets your concerns as well so if all of us sign off on yeah that's the way we're going to measure then we can look at how what we're doing but we got a first agree on one of the metrics we need to see to be satisfied that all the people were accountable to can see or not see the progress were making you've made a commitment mr. Hummel to stick around you've made a professional and and I think moral commitment to the men and women we serve to get this right you're not leaving until we do and we want to hold you to that but we also want you to know we understand the nature of that professional commitment and for God's sake please keep it so that is one I I love the team that I work with I love the veterans that we were privileged to care for and if something were to arise that would cause me to question that commitment it would be an incredibly painful day for me yeah so I am here for the long haul but I also think when you have the kind of turnover in leadership that your facility has had its it has a huge toll productivity in morale with the workforce and and it adds to that culture complacency or indifference that we talked about because I know I can wait you out average lifespan of one of you people is three months or whatever it is and and I think that's had a huge lead dilatory Asim packed on the quality of care at this facility and the commitment to the veteran having stable leadership that exacts standards of performance rewards good performance but also holds people accountable for bad performance can have a very salutary effect and the beneficiaries of that salutary effect other men and women who wore that uniform we're counting on us to deliver quality care for them and their families I thank you for coming here today this hearing is adjourned

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