Hearing of the Senate Veterans Affairs Committee - The Nomination of James Peake to Be Secretary of Veterans Affairs

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Hearing of the Senate Veterans Affairs Committee - The Nomination of James Peake to Be Secretary of Veterans Affairs

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SEN. MURRAY: Thank you, Chairman Akaka, for holding this hearing. General Peake, welcome; Senator Dole, it's good to see you again.

Mr. Chairman, I think we all know that this is a very critical and serious time in our VA's history. Our troops are fighting overseas and we see more veterans coming home and entering our system every day. We know we're facing unprecedented challenges as we try to provide the care of level that all of our heroes have earned.

I think it's no secret that you all know that I think that too many leaders at the VA have done the agency and our veterans a disservice over the last years, and that we've seen too many apologists for the administration's policy rather than being strong advocates for our veterans. Our veterans have earned the benefits the VA is supposed to provide them, but we've seen them come home to long waiting lines to see a doctor, bureaucratic ineptitude, VA claims backlogs of months, and many other serious challenges that we've all witnessed over the past several years.

Now I don't think we should dwell on the mistakes of the past but I really think we have to learn from them, and I think we have an opportunity to do that as we decide who will be the next secretary of the VA.

In fact, I think whether to confirm General James Peake may be the most important decision we make on how our veterans issues are dealt with over the next year.

I often say that no matter how Americans feel about this war today in Iraq, they uniformly believe that we have an obligation to take care of our men and women when they come home, and they are ready and willing to stand up and do that today. And I want you to know that I stand ready and willing to work with any secretary who is committee to truly fighting for the best interests of our veterans.

So Mr. Chairman, I look -- very much look forward to this hearing today, and to hearing from General Peake. General Peake has had a very distinguished career, and an impressive history of service to his country. For most of his nearly 40 years in the military he's been devoted to improving medical care for our wounded servicemen and women, including a stint as the Army's surgeon general. He's held numerous positions within the Army including commanding general of the Madigan Army Medical Center in my home state of Washington.

But we all know a strong resume is not enough. We have to have a leader at the VA today who has the fortitude, the backbone and the courage to stand up to the administration, to all of us, to be honest and upfront about our veterans' current and future needs, and to get us on the right course to caring for these heroes who risk their lives for our country.

I hope today that we will find that General Peake is the VA secretary that our veterans deserve.

Mr. Chairman, our VA system is uniquely positioned to recognize and treat the specialized injuries, medical conditions and mental health challenges that are caused by combat and military missions. Our local VA doctors and nurses are some of the most caring and compassionate people I know, and I know they are dedicated to giving our veterans the best care possible.

I was in fact out in Yakima, Washington last week at a VA clinic that we have in Yakima. It was packed to the gills with veterans who had come to tell us about the serious challenges that they were facing. And I was most impressed by our VA officials on the ground, Sharon Hellman (sp) from Walla Walla, Max Lewis who headed our VISN, who came to that hearing with a button on that sent a message to every veteran in the room, and it's the first time I have seen that happen. I shared with General Peake right before this hearing, the button, and General, when you put that on, I'll know you've gotten the message. It says, business as usual and has a slash through it.

And I think that message sent to our veterans at our meeting, that people were going to sit up and take notice and make sure their needs were met. And General, when you put the button on, I'll know you're the right man -- (chuckles) -- so I'm glad you have it.

But I think seriously that our service members really deserve better than what they've been getting from Washington, D.C., and hope that with a new VA secretary we can change the attitude of that and really get back on a bipartisan level really making sure that the men and women who serve us are served well.

Mr. Chairman, we know that Congress has together worked to solve some of these problems. We have a lot of huge challenges ahead of us. Thanks to recent advances in the battlefield medicine, our troops as we know, are surviving incredible injuries that would have been fatal in earlier conflicts. And I know some of those advances were overseen by General Peake.

However, many more of our service members are coming home with devastating and debilitating wounds that are creating a lot of new challenges for our VA. One of our biggest challenges is to ensure that our veterans are not waiting months or even years for compensation.

As of earlier this year the VA had as many as 600,000 disability compensation claims waiting to be answered. I heard at that Yakima hearing last week from a number of veterans who say they are at the end of their patience fighting for their own disability claims.

We know the claims system is old and antiquated and needs to be fixed. Both the Dole-Shalala commission and the Veterans Disabilities Benefits Commission have studied this issue and brought us recommendations, in many ways their suggestions are similar. But there are some key differences. And General Peake, if you're confirmed, you will have to work with us to address those differences and help us move forward to reform this system aggressively.

Mr. Chairman, I'm also particularly concerned about the challenges we face as we try to meet the mental health needs of our returning service members. According to the VA, a third of all of our Iraq veterans who are enrolled in the system have sought treatment for a mental health problem. That is an astounding statistic, but we also know it's probably too low because many of the veterans aren't asking for care because today we still have a stigma surrounding treatment, or because they fear that a mental health diagnosis is going to hurt their military or their civilian careers.

We know that as our troops are deployed overseas for the third, fourth, and now even fifth tour of duty, the risk of suffering from PSTD and other mental health conditions is increasing. Just a few weeks ago as I shared with the VA committee, CBS News reported on a tragic result of not treating mental health conditions. CBS found that veterans are twice as likely to commit suicide as other Americans. And perhaps I think the most disturbing to me in that report was that the risk is highest among 20 to 24-year-olds, as high as four times that of non-veterans.

Now the VA has taken steps to address that tragic situation. Congress has taken steps as well. A lot more needs to be done. The VA and the Defense Department have to focus their efforts on fighting the stigma of mental health treatment, and improve screening, improve outreach, and improve care.

Finally, thousands of our service members are suffering from traumatic brain injury which we know is the signature injury of this war. And that means many of our soldiers are going to fight subtle injuries that are going to hurt their ability to work and communicate with their families and friends.

There's still a lot we don't know, and it's very critical that we continue to do research and identify, prevent and treat TBI so we can better care for our veterans suffering from this devastating injury.

Mr. Chairman, General Peake has already answered as we know a number of questions from us. I look forward to hearing his testimony today. I believe absolutely we've got to have a secretary who's willing to roll up his sleeves and get to work because we can't wait another year to start to deal with these many challenges in front of us.

So General Peake, thank you for your willingness to take this on. I look forward to the hearing today, and to your answers and responses to our questions.

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SEN. MURRAY: Mr. Chairman, thank you very much.

I know you're waiting to be called, Mr. Secretary, but I'm curious. Do you want us to call General or Doctor today?

MR. PEAKE: (Laughs.) Ma'am, I'm comfortable being called whatever people are comfortable calling me, to be perfectly honest with you.

SEN. MURRAY: Okay. Well, thank you very much and I've tried to listen closely to your answers so far.

I did want to follow up on the chairman's question. He referenced a situation where we had a previous secretary who was not forthcoming with knowledge about the budget, and that's a really critical issue for our committee. I've often said that the VA secretary has to be a truthful advocate for our veterans, not an apologist for any administration. And nowhere is this more important than in the secretary's dealings with the annual budget process, and I know as the former Army surgeon general, you're no doubt familiar with that annual budget process and the conflicts that you are inevitably going to face. There will be times in order to get the -- there will be times when in order to get resources for your troops, you'll have to stand up to pressure from this administration to keep spending down. We know that's going to occur.

Can you share with this committee an example from your time as Army surgeon general when you bucked your chain of command and advocated for increased funding?

MR. PEAKE: What -- I can give you an example of a time when I garnered resources that weren't in the budget or, as we went through the hearings, I tried to explain what I couldn't do with the budget that I had. And what I talked about at that time was the opportunity that we had to do some things if I'd only had some resources to be able to do them. And what came of that was a notion of venture capital fund that came with new year money. It was in huge amounts in terms of perhaps the VA budget, but for me it was significant and it allowed me -- and they gave -- it was like $30 million for each surgeon general to have as a -- an incentive fund to do the right thing in terms of investment that would allow us to be more efficient.

I was counseled that I shouldn't be talking about venture capital in front of the Congress, but I -- in my testimony, that's what I did. I will tell you that I do believe in working within the system. I will tell you that I see this job as -- as I said in my written remarks, I understand I'm part of the administration. But I -- also, I have enough responsibility to the administration and to this committee to lay out the issues as I see them openly and honestly, and fight for the resources to do my job, which is to take care of veterans. And so if confirmed, ma'am, I will be working with this committee very closely to try to do the right thing by our veterans.

SEN. MURRAY: If you are confirmed, you know what you're going to get pushback from OMB on funding requests that you may see inside the VA as inadequate for the needs of the veterans. How do you reconcile the role of being a loyal member of the president's Cabinet and your role as the top advocate for veterans as the VA secretary?

MR. PEAKE: Well, I am aware that there is -- I understand that, like, about $4 billion more than what was in the president's budget that is coming forward and -- you know, I -- I would be advocating getting that bill forward and getting it passed. I mean, I -- we will be able to use that money to do good things for our veterans.

SEN. MURRAY: Can we count on you as a committee that certainly cares across the aisle on both sides to be honest with us about what the real needs are?

MR. PEAKE: I will be honest with you about the real needs, Senator.

SEN. MURRAY: Dr. Peake, I want to ask you about a story that I saw in the Washington Post this past Sunday that was very disturbing.

It was about a young woman, 1st Lieutenant Elizabeth Whiteside. I don't know if you saw the article. She apparently served in the Army for seven years, had exemplary service and when she was in Iraq, according to the story, she presented herself to a psychiatric nurse and said she was suffering mental health problems that were related to stress from serving in the combat zone. From the story, it said she ultimately fired her weapon into the ceiling and shot herself in the chest and is now, as we know, being treated at Walter Reed, where her psychiatrists are saying she was insane at the time of the incident in Iraq.

Major General Eric Schumacher, I understand, has recommended dismissal of the charges, but the Army is apparently proceeding anyway. And this is forcing Lieutenant Whiteside to choose between accepting a less than honorable discharge and the loss of all of her veteran's medical benefits or a court martial where she could be sentenced to life in prison.

In your experience, General Peake, are psychiatric findings routinely ignored by military authorities, as apparently occurred in Lieutenant Whiteside's case?

MR. PEAKE: Ma'am, I can't address this particular case, because all I know is what I read in the papers also. I will tell you my experience is that oftentimes the process needs to work its way through. I don't know that it has been decided that she's going to be court-martialed. I didn't get that from the newspaper, actually.

But my experience is that the medical evidence is fully considered and generally is, again, in my experience, accepted and appropriately weighed and that my bet is that the right decision will be made by ultimately the line chain of command, which has the legal responsibility.

SEN. MURRAY: Well, from -- in her case, to use it as an example, she's going to either be court-martialed or she's going to be dishonorably discharged and lose all of her veterans' benefits. But --

MR. PEAKE: I'm not sure that's true, actually. From what I read, that's not exactly how I interpreted it. But again, I'm not sure -- I would rather not comment on a specific case I don't know.

SEN. MURRAY: Clearly this goes to the issue at hand before all of us in recognizing post-traumatic stress syndrome, what occurs, what happens, and having that be part of understanding rather than something that's used against somebody. Maybe you could share with us, as secretary of the VA, how we could move forward and correct injustices that appear like this.

MR. PEAKE: In terms of the -- I completely agree with you about the issue of looking at mental illness and not taking unfavorable action against an individual because of mental illness, just like you wouldn't because of a traumatic injury.

The VA, I think, has the opportunity to, if there is some problem about a veteran who maybe have a question of their access to the system, I believe those kinds of things are potentially waiverable by the secretary. And I would look favorably at ensuring that veterans that need care get care.

SEN. MURRAY: Can you just tell me, if someone like Lieutenant Whiteside is court-martialed, what kind of mental health care they'd expect to get?

MR. PEAKE: Ma'am, I would need to understand the legal issue specifically. And I would be happy to get back to you for the record about the particulars.

SEN. MURRAY: Okay. Well, let me ask a more general question.

MR. PEAKE: Sure.

SEN. MURRAY: How do we get to a point where we recognize post- traumatic stress syndrome, the impacts of that, and use it in a realistic way so we're not punishing people for a real wound of war?

MR. PEAKE: I agree with you that these are real wounds of war. And I tried to make that point in my opening statement. And I think they need to be treated that way. It needs to be -- and I believe it is treatable. I think it is the kind of thing that you can make interventions and really make a difference in people's lives. I think we owe the soldier and the veteran that intervention.

SEN. MURRAY: Okay, my time is up and I've got more questions. But I think the case is that we hear a lot of rhetoric about people talking about post-traumatic stress syndrome in a better way. I'm delighted to hear the rhetoric, but there's real live case issues that keep coming in front of us where the rules, the attitudes and other things go against everything we're trying to do in trying to make mental health care wounds recognized and treated in an appropriate manner.

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SEN. MURRAY: Yes, thank you very much.

In my opening remarks I talked about the "CBS News" report that was aired recently -- I don't know if you saw it.

MR. PEAKE: The --

SEN. MURRAY: On the suicide.

MR. PEAKE: Yes, I did.

SEN. MURRAY: And I mean, I was particularly struck by the veterans age 20 to 24 that -- four times higher than civilians the same age. Can you comment on that and tell me what the VA could be doing better?

MR. PEAKE: I think this is another one of those issues, Senator, that really is part of this transition piece, because what goes on on the DOD side and the emphasis there of the family reunion as they -- the deployment cycle support kinds of aspects that help identify people that might have a problem is important at the front end. As we move into the VA system, we touch the people that have come to us. The question is: How can we outreach and -- part of it is identifying for the family members what they ought to be looking for. And not just family members, but coworkers. So it's a -- part of it's getting folks that they recognize what the danger signs are.

My understanding is that the VA is already doing a lot to reach out and asking folks, are you okay? You know, all the right questions -- have you thought about harming yourself?

All those kinds of things are really, I think, being inculcated, as I understand it from my -- at least preliminary discussions into the primary care settings of the VA. So that there is that sensitivity of a safety net to find that individual that might have a problem.

I believe in the post-deployment health assessment, the post- deployment health reassessment. I would like to work with DoD the make sure we have all that information; that we're sharing; that, in fact, that all of the Reservists that come back get that second follow-up so that we can identify the ones that we can reach out to.

I believe the -- we don't want to just be passive, and standing back waiting for somebody to have a problem. If there's ways to reach out and -- that'll help de-stigmatize as well, I believe.

SEN. MURRAY: And will that be a priority of your administration to --

MR. PEAKE: It will be --

(Cross talk)

MR. PEAKE: -- it is something that I think is one of the -- a different approach to this issue of the panoply of mental health issues. As we discussed in your office, ma'am, I think not everything is PTSD, because that -- you know, there's six criteria to have that as a diagnosis, but there are things short of PTSD, or other mental health issues, that we can, that are amendable to intervention and treatment and improving the wellbeing of our veterans.

SEN. MURRAY: Well, part of the Josh Omvig Suicide Prevention Act that we have passed requires all of the folks at the VA to be better advocates in reach -- in dealing with veterans who are calling. I assume that you will really move forward to make sure that happens?

MR. PEAKE: I will. And, as I say, I -- my understanding is that there's a lot being done from, you know, Mike Kussman and crew, to -- already in that arena, but I agree with you that it is one that we just need to continually stay on and push.

SEN. MURRAY: All right, let me change the topic a little bit. You are well aware that some of the veterans have raised some concerns about your previous employment with the QTC, and possible conflicts of interest with the duties of being VA secretary. You answered the pre- hearing questions in a very clear way that if you're confirmed, you will terminate all your connections the QTC; you'll have not financial interests in QTC; remove yourself from all matters related to QTC, and we very much appreciate that clarification. But I'd like to ask you, how do you envision how you will be able to perform your duties as secretary if you cannot make decisions about a contract that is worth, as I'm told, up to a billion dollars?

MR. PEAKE: QTC's been in the business with the VA since 1998, so I'm not -- perhaps that's over the course of that whole period of time, but I would tell you that, you know, I've been with QTC less than a year when this -- announced to this, and I would be happy to work with this committee in however you feel is the best way to deal with this. I will have, as you pointed out, no on-going financial interest with them. I will not go back to them, I've made that clear -- and made that decision I will have no deferred compensation, or bonus, or anything of that nature.

So I don't see that I will really have a conflict. If something -- you know, we have ways to create whatever firewalls are necessary --

SEN. MURRAY: I understand from your statement that you're going to separate yourself from any decisions about that, but it is a contract that is worth up to a billion dollars. So who will make those decisions about that, and how will that be done if you yourself cannot do it? That's -- that's my question.

MR. PEAKE: I will work with the Office of Government Ethics, and with the Ethics people at the VA, to make sure that the decision-level would be at the deputy's, I would assume, but it would need to create whatever is necessary to have the appropriate oversight of the contract, which is important, I think, of any contract, is to have appropriate oversight and accountabilities.

And so I honestly will work however you want to be able to make this very clear, because I want no perception of any favoritism. I believe in full and open competition --

SEN. MURRAY: But you will -- you will be out and about, and hear much of what we hear. And I hear, you know, concerns about the system. I hear about providers who don't have the expertise in relevant areas; we have providers who -- with poor English skills; evaluations that don't focus on the problems that have been identified; absence of VA medical records; QTC billing for more time than the provider spends with the veterans. And you'll hear this as you're out there. What will you tell veterans when you hear concerns about QTC in the field?

MR. PEAKE: I will collect those concerns. I would take them seriously, and I would put them into the system through the -- to get them resolved appropriately through the contracting authorities.

SEN. MURRAY: Okay. My time is expired. I do have some more questions on -- Senator Tester, I'll turn to you.

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SEN. MURRAY: Thank you.

I want to talk to you about an issue that's very near and dear to my heart, and that is the Walla Walla VA Medical Center. As you may have known, that was slated to be closed. After numerous closed-door meetings with the VA and the Senate VA Committee, a field hearing that occurred there, the right decision was made to keep that open. The community has been very, very involved with it, and the VA has now approved a 90,000-square-foot outpatient clinic to replace an existing facility there.

I have been told by the VA that the design and construction of that outpatient clinic is now going to be delayed by several years. And I want you to know that is totally unacceptable. And I would like to hear, if you are confirmed, if you will pledge to work with me to see that construction up.

This is a vitally needed center. The vets there have been told one thing and another for so long. They need the confirmation that their country is with them. And I would just like to hear from you that you will work with me to make sure of that. And I'd love to have you come out and see it personally.

MR. PEAKE: Senator, I will commit to both, coming out there and visiting with you and holding a hearing in your area if you want me to. And I will commit to you that I will work with you to look at Walla Walla and what needs to be done there.

SEN. MURRAY: I appreciate that, both for Walla Walla, and want to follow up with you on that. But I also think, as secretary, you need to be on the ground to hear what we're hearing.

The world is very different inside a VA circle here and what you see on the ground out there, as you can imagine in any agency. But I think you need to hear the passion both from community members who support veterans and are concerned about what's going on, the veterans themselves -- the frustrations they have felt, why I gave you that button and it can't -- saying it cannot be business as usual. The attitude needs to change and I would love to have you come out to my state. We have a number of very, very active places, as you know from having been at Madigan, to see what's happening at Madigan all the way through the VA system. And I would love to have you join me there once or if -- and if you're confirmed.

MR. PEAKE: If confirmed, I appreciate the invitation and I look forward to accepting.

SEN. MURRAY: Okay, good.

And one other question, and then I have a comment. We've heard a lot about this issue of personality disorders -- or discharges. And in the last six years, the military has diagnosed and discharged more than 22,000 service members because of so-called preexisting personality disorders. And I wanted to find out from you what your understanding of administrative discharges from the Armed Forces are based on this diagnosis of personality disorder.

MR. PEAKE: Can you clarify the question?

What -- yes, my --

SEN. MURRAY: There is --

MR. PEAKE: -- if you have a personality -- you get administrative discharge --

SEN. MURRAY: There's concern about the process being fair and we're hearing from a lot of men and women who have been discharged because of a so-called preexisting --

MR. PEAKE: Right.

SEN. MURRAY: -- personality disorder, and they feel they/re not being treated fairly. Are you aware of this issue?

MR. PEAKE: I'm aware of the issue. I would need to understand more specifically the individual cases.

SEN. MURRAY: Okay.

Well, that is a question I would like to work with you on. There's a very strong and real sense of the process not being fair, and I think it's something we need to pay some attention to.

Mr. Chairman, I do have a couple of other questions I will submit for the record.

I will say this, General Peake. We have had a vacuum at the top of the VA for some time that has to be filled. I am likely to support your nomination unless something else occurs. I can't imagine that that will. We expect you to take this job and to take it seriously, and obviously being confirmed is a major recognition of an achievement. But I think where history will really judge this confirmation is a year from now and whether you can begin to turn around an agency that for too long has really not gotten into the ballgame at a time when men and women are at war and we have thousands of people returning, as well as those from previous generations who really feel that they have not been given the service they need.

So an attitude change at the top will, I think, serve all of us well. There are thousands of VA employees who work very, very hard both within the agency here and out in the field who I think are open and ready to take a new challenge, and to make sure that they are seen visibly as an agency that serves our veterans well. And I think leadership at the top a year from now will be judged on what that attitude is. So I look forward to working with you very much.

MR. PEAKE: And I with you, Senator.

Thank you.

SEN. MURRAY: Thank you.

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