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S. 2422. A bill to improve the access of veterans to medical services from the Department of Veterans Affairs, and for other purposes; read the first time.

Mr. SANDERS. Mr. President, as chairman of the Senate Committee on Veterans' Affairs, I rise today to introduce the Ensuring Veterans Access to Care Act of 2014.

I thank the 16 cosponsors of this legislation, and they are Senators ROCKEFELLER, BEGICH, SHAHEEN, KAINE, REED, MERKLEY, CASEY, WHITEHOUSE, BLUMENTHAL, HEINRICH, UDALL of New Mexico, SCHATZ, BALDWIN, WYDEN, HIRONO, and LEAHY.

It is safe to say there is broad bipartisan agreement among all of us that every veteran in this country who enters the VA health care system deserves high-quality care and deserves that care in a timely manner.

Overall, talking to veterans in Vermont and, in fact, throughout this country, talking to the veterans service organizations who represent their interests and reading independent studies, they all confirm that by and large, once veterans get into the VA health care system, the system is, in fact, quite good.

However, it has become clear--and I think all of us are aware of what has happened in the last month--that while quality is generally good, there are too many veterans throughout this country waiting too long to access this care.

In recent years, the VA has seen a huge increase in its patient load.

In fact, in the last 4 years, 2 million new veterans have come into the system, many of them with very complicated health care cases, including TBI, post-traumatic stress disorder, and many of the needs that older veterans and older people generally have.

Despite this fact, it is still absolutely unacceptable that some veterans are forced onto long waiting lists for care, and it is totally intolerable--it is reprehensible--that any VA employee could be manipulating data in Phoenix or anyplace else to hide how long veterans have been on waiting lists to see doctors. This is an issue that must be dealt with and must be dealt with rapidly and strongly.

These problems are real, and they have to be addressed. But they should not be an excuse to walk away from a system that serves 6.5 million veterans every single year and 230,000 veterans every single day. This is a system we must fix, not a system that we should ditch.

We must focus on the underlying problems and work to transform the VA.

In general, what our legislation does is it works in three basic areas. No. 1, we give greater authority to the Secretary to fire incompetent senior officials. No. 2, we take very significant steps to shorten the wait times that many veterans are now experiencing. And No. 3, we address the long-term health care needs of the VA in terms of a shortage of staff, doctors, and nurses that currently exists in various locations around the country.

Let me go through some of those issues right now.

Several weeks ago my Republican colleague from Florida requested a vote on legislation that would allow VA Secretaries to immediately remove senior executives due to poor performance.

So let us be clear. I strongly support the effort to make sure that we get rid of incompetent or worse senior executives at the VA. There is no debate about that. But here is what the debate is about. I do not think it is a good idea to give the Secretary of an institution, of an agency that has some 300,000 employees, the ability to simply fire without any due process.

What I worry about is that you can move toward a situation where the VA health care system is politicized in a way that it should not be.

Let me give an example. A new President comes in with a new Secretary. The new Secretary says--whether it is a Democratic President or a Republican President--I want to get rid of 300 senior-level appointees and bring in 300 new people. Four years later, another President comes in--different party--and says: We are going to get rid of those 300 people and bring in 300 more people.

I do not think that provides the kind of stability that the largest integrated health care system in America needs or deserves. I worry about the politicization.

Second, I worry about an instance where a whistleblower stands up who is critical of this or that aspect of the VA. That person could be fired without due process.

I worry there may be a situation where somebody is fired--not because of bad performance; maybe they are a woman and somebody doesn't like a woman in that position; maybe they are gay, maybe they are black, maybe they are whatever--and that person does not have any ability to appeal that decision.

I think that is wrong. I think that is bad policy. On the other hand, what I do believe is that person should be taken out of his or her job immediately, but that person must have the right to have an expedited appeal.

What our legislation does is give the person a week to bring forth the appeal and gives the appropriate appeal body 3 weeks to make a decision.

Now, we are dealing with people who are M.D.s, Ph.D.s, high-level people whose professionalism is on the line. I don't think you can fire people willy-nilly without giving them a chance in an expedited manner to express their point of view.

That is one difference I have with my colleague from Florida on his proposal.

Let me talk a little bit about the major concern I have; that is, how do we shorten wait times? How do we make certain in those areas of the country where there are long waiting periods or where veterans may be geographically a long distance away from a facility that they get timely care?

The legislation that I have authored takes immediate action to provide timely access for care for our veterans.

First, this legislation would standardize VA's process for providing non-VA care when the Department is unable to provide care to the veterans within its stated goal. As the DVA--Disabled American Veterans--pointed out in a release today, VA must continue to be responsible for coordinating their care amongst various VA and non-VA providers. This legislation accomplishes that goal by providing a framework for consistent decisionmaking regarding non-VA care. Under this legislation VA would coordinate non-VA care by taking into account wait times for care, the health of the veteran, the distance the veteran would be required to travel, as well as the veteran's choice.

This bill also addresses VA systemwide health care provider shortages. But in terms of the wait lists, what we say in English is: If there is an unacceptable wait time or if a veteran is a long distance away from a provider, we are going to allow--and we must allow--that veteran to get health care through a private provider, through a federally qualified community health center, through a Department of Defense military base, if that is available, through an Indian health service, if that is available--and that exists now in Alaska--and that might be expanded. So the bottom line is if there are waiting lists beyond what is reasonable, the veterans in this country should be able to get into non-VA health care in a timely manner, and this bill does that.

But importantly, this bill also addresses a very significant issue that I think we cannot ignore, and that is it appears to me that in many parts of this country we simply don't have the doctors and nurses we need when an influx of veterans is coming into the system.

I was talking to some very knowledgeable people today who were telling me about burnout. Primary care physicians and psychiatrists are seeing many more patients and turnover rates are much too high. The last thing we want to do is to see rapid turnover because people are burnt out and don't have the time to do the quality work they want to do.

Let me quote an article that appears in the New York Times on May 29 which addresses this issue. This is what it says:

Dr. Phyllis Hollenbeck, a primary care physician, took a job at the Veterans Affairs medical center in Jackson, Miss., in 2008 expecting fulfilling work and a lighter patient load than she had in private practice. What she found was quite different: 13-hour workdays fueled by large patient loads that kept growing as colleagues quit and were not replaced.

Appalled by what she saw, Dr. Hollenbeck filed a whistle-blower complaint and changed jobs. A subsequent investigation by the Department of Veterans Affairs concluded last fall that indeed the Jackson hospital did not have enough primary care doctors, resulting in nurse practitioners' handling far too many complex cases and in numerous complaints from veterans about the delayed care. ``It was unethical to put us in that position,'' Dr. Hollenbeck said of the overstressed primary care unit in Jackson. ``Your heart gets broken.''

In this case we had a physician who wanted to do the right thing, wanted to spend the appropriate amounts of time that were needed with the patients, and she was unable to do that. What we are hearing is in many parts of this country primary care physicians are saying: We cannot do it; too many people are coming in. This is an issue that has to be addressed, and our legislation does that.

Our legislation gives the VA the ability to rapidly hire new doctors, nurses, and other health care providers in areas with identified shortages. It also enables VA's ability to recruit qualified health providers by enhancing scholarship and loan repayment opportunities.

As the Presiding Officer well knows as a member of the committee that deals with this issue, we have a crisis in this country in terms of the lack of primary care practitioners. This is a very serious problem. There are experts who tell us, in fact, that we need 50,000 new primary care physicians in the next 10 to 15 years. This is a national problem, it is a problem within the VA, and what this legislation proposes is that the VA work with the National Health Service Corps in order to provide debt forgiveness, scholarships to medical school students, so when they graduate they can get into the VA and practice the quality medicine we need there.

This bill addresses another issue that has been discussed a lot--and there is widespread bipartisan support for this and support in the House as well--and that is the authorization of 27 major medical facility leases. In many instances these leases would improve access to care closer to home and would increase the availability of specialty care services in those locations that would allow the VA to decompress overutilized VA facilities. This is an important issue in this legislation and I believe there is bipartisan support for it.

Furthermore, this bill would require the President to create a commission to look at VA health care access issues and recommend action to bolster capacity. In the last couple of days I have heard a lot of good ideas about how we can deal with the issue, but we need a high-level commission of some of the most knowledgeable people in this country appointed by the President to report within 90 days some ideas of how the VA can proceed.

I want to thank the 16 or so cosponsors we have. I look forward to working with my Republican colleagues. We have got a problem we have to address, and I hope we can do it in a bipartisan way.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.


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