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Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014

Floor Speech

Location: Washington, DC


Mr. President, I would like to spend a little bit of time offering a viewpoint different from the viewpoint of the chairman of the committee on this bill.

First of all, I want to say by context that my father and his two brothers all served in World War II. My two brothers served during the Vietnam era.

There is no question we have an obligation to meet our commitments to those who have put their lives and futures on the line for this country.
But it pains me that, although we have increased spending 58 percent in the VA programs since 2009, which was fiscal year 2010, what we have seen is a complete lack of oversight of what is happening. Let my give an example. The VA Committee in the Senate last year held 30 hearings, 4 of which were oversight. If you read the transcripts of those hearings, you cannot call them oversight hearings even though they were billed as oversight hearings.

Why is that important? It is important because there are a multitude of significant, serious problems in the Veterans' Administration. Just 2 days ago it was discovered that in an L.A. VA clinic, the staff of the clinic destroyed the medical records of thousands of people so that when they do the metric on how far behind they are, we cannot measure it; or the fact that 82 veterans last year died of carcinomas through delayed diagnosis because they could not get a diagnostic procedure, such as a colonoscopy; or the fact that we have all these veterans who cannot access mental health care, and we see the suicide rate--unacceptable, to say the least.

So we have a bill on the floor that massively--and that is a small word for what this bill does--massively expands the authority and the ability of the VA to offer care to another 14 million veterans--from 6 million to 20 million.

On a system today that cannot keep up, we have 600,000 people waiting for a disability determination. We are not having oversight hearings on that. We are not having oversight hearings on a South Carolina VA hospital where people are dying from malpractice like crazy. We are not having the oversight hearings to hold the VA accountable. What we are doing is putting a bill to expand their responsibilities instead of holding them accountable for the responsibilities they have today. That is what we should be doing. Instead, we are going to add $60 billion. And that is a conservative number. That is my number.

But all you have to do is look at what the cost and the efficiency and the outcomes are through the VA system to see that we are going to diminish the veterans caregiver program by expanding it to everybody. We are going to create all sorts of new programs and no resources to actually provide them. And we are going to create more advanced funding, advanced appropriations, which will limit our ability to hold them capable and culpable in the future.

There are a lot of things we ought to be doing for our veterans right now that are already in law that we are not doing, and we come to the floor with a massive expansion at a time when we cannot even care for what we are doing. As a physician who trained in VA hospitals, I know the difference in the level of care. I can assure you it has not gotten any better. From my colleagues I speak to in the medical profession and from the veterans whom I talk to who contact me, it has gotten far worse. It does not have to be that way, but it will always be that way if, in fact, we continue to not hold those in leadership positions accountable for not stepping to the bar for performance, quality, and outcome.

From Congress to the Pentagon, we must reassess what laws, regulations, and rules can be changed to ensure that benefits and other decisions the Veterans' Administration makes are beyond reproach and based on the best facts available. Let's ensure that the Department's limited resources are focused on its core mission rather than disbursed in an effort to remedy every possible problem for every veteran. Remember, when everyone is first priority, no one is. That is what this bill is. We diminish the priority of the commitments we have made to the veterans who are out there today.

Our veterans are looking to us for help. We are about to enact legislation that is going to further strain the ability of the VA to do its most basic charge: help with the health care, mental health, and capability of those who have put it all on the line for this country.

It is shameful that Congress now is trying to claim credit for providing new benefits while our old promises are forgotten. Our heroes--our heroes--are literally dying at the hands of malpractice, incompetency, and delay.

If we really wanted to care for our veterans--those with service-connected disabilities--what we would say is, go wherever you want to go to get whatever you need because you served this country. And it actually would cost less. But because we pile them into a broken system now--and that is not all VA organizations. Let me clarify that. There are some excellent VA hospitals that do great work. Their specialists are far ahead of the private sector. But on general grounds, to put a veteran at a place with less than the best possible care dishonors their service to this country--dishonors their service to our country.

Veterans are our heroes. They are the symbol of our country of sacrifice, of giving for others. Yet we have four oversight hearings in a year? With the multitude of problems that are going on in the VA hospitals and the Veterans' Administration in terms of disability determination, we have four? The House had 34 oversight hearings, and they were rigorous. When you ask members of the committee: Have you read the House oversight hearings? No. They had 26 regular hearings and 34 oversight hearings trying to hold the VA accountable.

We are not going to hold the VA accountable with this bill. We are going to make them less accountable. And that is a disservice to the very people who have honored us by serving in the military of this country.

As of February 15, 2014, the VA has 677,000 claims pending for disability compensation. Why should it take a year for somebody who put their butt on the line for this country and received an injury and is disabled? Why should it take a year for us to determine that we owe them an extra bit of compensation and availability?

What is being done to fix that? We have a VA regional center in my home town, with good employees, hard-working employees. They are not destroying files so they can say they met a metric. Veterans seeking mental health treatment still experience weeks-long delays scheduling appointments. The epidemic of overprescription of opiates--let me say that again--there is an epidemic of overprescription of opiates for those people who served our country, making them dependent addicts because we give them the wrong treatments.

There are avoidable veterans deaths at the VA. In a recent story by CNN on misdiagnosis and improper care for gastrointestinal conditions, there were 2-year consultation delays--2 years to get in to see a specialist at the VA when you are losing blood. How do we explain that? Who is accountable? We are, because we are not holding them accountable.

There were 82 deaths last year alone--I am sure that is a far understatement--because of delayed diagnosis for just investigative endoscopies. That is just what is documented. How do we accept that? Had they been in the private sector, they would not have had a delay. They would not be dead.

So here is the proposal that I would put out. Do our veterans deserve the best of care in this country? I think they do. Should they be able to get that care where they know the quality, they know the outcomes and the transparency as to what their future might be or must they be forced into a system that is going to give them something less? That is where we are today.

The chairman in his bill increases VA medical care for everybody who served without a disability. What will that do to the VA system? We cannot handle what we have in front of us now in terms of those who have a percentage medical disability that allows them access to the VA health care system.

So when you triple that or more than triple it, where are the resources? If we really mean what we say in this bill, you are talking hundreds of billions of dollars over 10 years. You are not talking the $30 billion that the chairman says is what the cost is. You are talking hundreds of billions. But the point I would make is we have an infrastructure out there that can care for our veterans. It is the hospitals all around the country. It is the doctors all around the country. Does a veteran not have the right to get the best care? Should we not give him a card and say: You served this country. Here is your service connection. Here is your disability. You can get care at a VA hospital, if you want, or you can get care wherever you want.

But I will guarantee you what will happen is, if we give what was promised to the veterans--not what we are giving today--real care, real opportunity with real transparency as the outcome, what you will see is marked improvement in care, marked improvement in outcomes, no change in additional cost--no change in additional cost--and access that is promised but not denied and delayed.

In one South Carolina VA facility alone, 20 veterans are either dead or dying of cancer because of delayed diagnoses. They had the symptoms and presented them to the hospital, but because of delay and incompetency--just that one hospital.

The other thing we know is veterans' malpractice claims are markedly increasing--markedly. All you have to do is look at the OIG report on the claims of deficiencies at the VA in New Haven, CT. Contamination, cross-contamination, inadequate procedures for infection precautions, absence of employees that are supposed to be on duty when they are not, failure to clean operating rooms properly, failure to have the proper ventilation system in an operating room for a contaminated case. That is just one hospital.

What does that mean in real life? What that means in real life is the risk for iatrogenic or facility or physician-caused infection goes through the roof--not the fault of the physician but the fault of the VA for not managing the system properly.

Former VA epidemiologist, Dr. Steven Coughlin, testified before the House Veterans' Affairs Committee that the VA failed to follow up on over 2,000 veterans who indicated in VA surveys that they were experiencing suicidal thoughts. When the HVAC followed up on Dr. Coughlin's claims, they found that they were validated. Unfortunately, too many of those who had suggested their problems committed suicide. It is a little late.

Because Dr. Coughlin brought this up, he was admonished, bullied, and intimidated for speaking about the ethical lapses at the VA. Where is the oversight hearing? You see, if we are not going to hold the VA accountable, the quality of care is not going to rise to the level that our veterans deserve.

Another area is this. The VA wasted $3 billion over the past 10 years because they failed to secure competitive market prices for surgical implants. That is $3 billion. That is documented. That is a GAO study. GAO did that. We did not do it. We did not find it. Oh, by the way, at the end of the year when they had some money to spend, about $600,000 worth of artwork was purchased, instead of putting it into additional doctors, cleaning operating rooms, additional people to secure clearances on disability.

By expanding VA care and the potential of 22 million more veterans, you can guarantee that the veterans who are getting care now are going to get poorer quality and less access to care. You can guarantee that. That is what this bill is really about. This bill is really about a decrease in the requirements for care for our veterans. It is not about an increase. It is about a decrease because when you flood that system with people who do not have a service-connected disability, what will happen is this. Easy goes first and hard goes last. I have seen that in the VA my whole life.

There is also an expansion in the caregivers program. I am not sure I disagree with it. But certainly, for those after 9/11 a commitment ought to not be diminished if we expand this program. The minimum cost for that is $9.5 billion. The VA has not yet met its full obligation under the VA caregivers law that we have today. Yet we are not holding them accountable.

There is another area in this bill that I think is tragic. It is well intended, but it mandates that the University of West Virginia or the University of Oklahoma must give in-State tuition to anybody from anywhere that has ever served or they lose their benefits under the GI bill. That totally ignores the Constitution in this country.

Now, 20 States have already said they are doing that. Ten others have bills in the process. Eight others have a partial. So we are at 38 of the 50 States right now. But in our vision, we are going to mandate that the Tenth Amendment does not mean anything, that the 80 percent of funding on higher education in Oklahoma that comes from people in the State of Oklahoma, that we can co-opt that and coerce them and tell them what they are going to do.

It is well intended. But it is certainly not constitutional. It certainly does not respect the Tenth Amendment of the United States. Does Oklahoma or West Virginia have the right to make a decision on who they give in-State tuition to? Why not just pass a law that says: Every State will give in-State tuition to everybody.

The reason it was connected with States is because of State funding. We totally trample that. Again, the advanced appropriations will limit our ability to hold those people accountable for the very things that I have described to you. But we are going to do it anyway.

A proposal to expand VA advanced appropriations needs to be considered by the administration as a part of an across-the-government review of the advantages and disadvantages of such progress, not only for the VA but potentially other programs and agencies. Only in the context of such a broad review could the administration offer an opinion on making such a change for the VA. Therefore, we cannot offer a position.

That is from the VA. The real answer is: Give us advanced appropriations, and then it is only after the fact that you can hold us accountable, not during the fact.

Here is another GAO study that we should be highly concerned about. The VA--this is the GAO--has no idea how long most patients wait to receive care. They do not even know their own metrics.

It is unclear how long veterans are waiting to receive care in VA's medical facilities because the reported data are unreliable, because VA hospitals have tried to cover up wait times, fudge numbers, and backdate delayed appointments in an effort to make things better than they are.

That is directly from a GAO report. Where is the oversight hearing on that; or the L.A. facility that just destroyed medical records so nobody could know how long people had been waiting for appointments?

Based on GAO recommendations to improve reliability of reported wait times for new medical appointments in 2013, the VA changed the way it tracks and calculates its performances. Using the new tracking method in 2013, the VA reported only 41 percent of veterans were scheduled for a new primary care appointment and only 40 percent of veterans were scheduled for a new specialty appointment within the 14-day standard.

So 40 percent of the time, with the 6 million veterans we have now, they are getting adequate timely care, and 60 percent are not. Yet we are going to expand that to 22 million, and we don't have the resource base or the facility base or the employee base or the professional base or the caregiver base to do that?

In contrast, in 2012 the VA reported that 90 percent of new primary appointments and 95 percent of specialty appointments had met the 14-day standard.

The VA exam requests backlog purge. VA employees destroyed veterans' medical records to cancel backlog exam requests.

That is from Patrick Howley, again.

Oliver Mitchell, a marine veteran and former patient services assistant at the Los Angeles VA system, told the Daily Caller: We just didn't have the resources to conduct all those exams. Basically we would get 3,000 requests a month for medical exams, but in a 30-day period we only had the resources to do about 800. That is 25 a day. That rolls over to the next month and creates a backlog. It is a numbers thing. The waiting list counts against the hospital's efficiency. The longer a veteran waits for an exam, it counts against the hospital as far as productivity is concerned. Some patients were waiting 6 to 9 months for an exam, and the VA didn't know how to address the issue.

Is the answer to open this to another 16 million veterans or is the answer to improve the efficiency, transparency, quality, and outcomes of the present VA system before we go about expanding this system to people who are otherwise covered?

Mr. Mitchell, when he tried to sound the alarm on the VA's deliberate attempt to fraudulently reduce the backlog, was transferred out of his department and eventually terminated from his job. After he contacted Congress in 2011--2 months later when the VA found out about it--he was fired.

So do we really want transparency in what we are doing? Do we really want to know what is going on? Do we really want to fix the system? Do we really want to offer health care to veterans and make it equal to what they can get in the private sector or do we want to say we want to offer all these new benefits at the same time we are not meeting our commitment on the benefits we have already promised? That is the game that is being played.

Earlier I said the VA said the Committee on Veterans Affairs held 30 hearings. They only held 16--16 hearings; 1 every 3 weeks.

The annual budget of the Department of Veterans Affairs exceeded $134 billion a year. Delay in vet care is not for the lack of money. The delay in vet care is not for the lack of money, it is for the lack of accountability in management. Case in point: More than 20 veterans have died or are dying due to late diagnosis and treatment of cancer at the William Jennings Bryan Dorn Veterans Medical Center in Columbia, SC. Documents show only one-third of that $1 million appropriated by Congress to fix the problem was used for its intended purpose at that VA facility. Only one-third of the money we appropriated to fix this problem was actually used to pay for care for veterans on waiting lists. At the same time, the documents show the waiting list at Dorn kept growing to 3,800 patients in December of 2011.

I will be back to speak on the floor and offer amendments. I have pages and pages of examples of veterans who served this country honorably, proudly, and sacrificed to a great extent, who are getting substandard care in the system we are offering them today. Before we expand that system, what is needed is a rigorous oversight and debate about how we are doing what we are doing now.

The promise of access to care for our veterans, as shown by VA centers and clinics all across this country, hospitals all across this country, diagnostic procedures all across this country, reflects that when access is delayed, that care is denied. And that is what is happening right now far too often to the people who have served this country. We ought to be about fixing that and holding accountable those in the responsible positions, and holding ourselves accountable to do what is necessary to give at least the standard of care they could get anywhere else in the country. That is the direction in which we should go.


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