Congressional Hearings
ENSURING QUALITY HEALTHCARE FOR OUR VETERANS
Congressional Hearings
SuDoc ClassNumber: Y 4.G 74/7
Congress: House of Representatives
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| AUTHORITYID | CHAMBER | TYPE | COMMITTEENAME |
|---|---|---|---|
| hsgo00 | H | S | Committee on Oversight and Reform |
[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
ENSURING QUALITY HEALTHCARE.
FOR OUR VETERANS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON GOVERNMENT OPERATIONS
OF THE
COMMITTEE ON OVERSIGHT
AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
JUNE 20, 2019
__________
Serial No. 116-36
__________
Printed for the use of the Committee on Oversight and Reform
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__________
U.S. GOVERNMENT PUBLISHING OFFICE
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COMMITTEE ON OVERSIGHT AND REFORM
ELIJAH E. CUMMINGS, Maryland, Chairman
Carolyn B. Maloney, New York Jim Jordan, Ohio, Ranking Minority
Eleanor Holmes Norton, District of Member
Columbia Justin Amash, Michigan
Wm. Lacy Clay, Missouri Paul A. Gosar, Arizona
Stephen F. Lynch, Massachusetts Virginia Foxx, North Carolina
Jim Cooper, Tennessee Thomas Massie, Kentucky
Gerald E. Connolly, Virginia Mark Meadows, North Carolina
Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia
Jamie Raskin, Maryland Glenn Grothman, Wisconsin
Harley Rouda, California James Comer, Kentucky
Katie Hill, California Michael Cloud, Texas
Debbie Wasserman Schultz, Florida Bob Gibbs, Ohio
John P. Sarbanes, Maryland Ralph Norman, South Carolina
Peter Welch, Vermont Clay Higgins, Louisiana
Jackie Speier, California Chip Roy, Texas
Robin L. Kelly, Illinois Carol D. Miller, West Virginia
Mark DeSaulnier, California Mark E. Green, Tennessee
Brenda L. Lawrence, Michigan Kelly Armstrong, North Dakota
Stacey E. Plaskett, Virgin Islands W. Gregory Steube, Florida
Ro Khanna, California
Jimmy Gomez, California
Alexandria Ocasio-Cortez, New York
Ayanna Pressley, Massachusetts
Rashida Tlaib, Michigan
David Rapallo, Staff Director
Wendy Ginsberg, Subcommittee Staff Director
Amy Stratton, Clerk
Christopher Hixon, Minority Staff Director
Contact Number: 202-225-5051
------
Subcommittee on Government Operations
Gerald E. Connolly, Virginia, Chairman
Eleanor Holmes Norton, District of Mark Meadows, North Carolina,
Columbia, Ranking Minority Member
John Sarbanes, Maryland Thomas Massie, Kentucky
Jackie Speier, California Jody Hice, Georgia
Brenda Lawrence, Michigan Glenn Grothman, Wisconsin
Stacey Plaskett, Virgin Islands James Comer, Kentucky
Ro Khanna, California Ralph Norman, South Carolina
Stephen Lynch, Massachsetts W. Steube, Florida
Jamie Raskin, Maryland
C O N T E N T S
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Page
Hearing held on June 20, 2019.................................... 1
Witnesses
Ms. Tammy Czarnecki, Assistant Deputy Undersecretary for Health
for Administrative Operations, Veterans Health Administration,
on behalf of Department of Veterans Affairs
Oral Statement................................................... 5
Mr. Michael Heimall, Director, Veteran Affairs Medical Center
(Washington, DC)
Oral Statement................................................... 6
The Honorable Michael Missal, Inspector General, Office of
Inspector General, on behalf of U.S. Department of Veterans
Affairs
Oral Statement................................................... 8
Written opening statements and witnesses' written statements are
available on the U.S. House of Representatives Repository:
https://docs.house.gov.
INDEX OF DOCUMENTS
----------
The documents entered into the record are listed below, and
available at: https://docs.house.gov.
* Report from the Partnership for Public Service; submitted by
Chairman Connolly.
* DCVA Organizational Alignment Showing Vacancy Rate; submitted
by Chairman Connolly.
* QFR: Response from Veteran Affairs Medical Center
(Washington, DC).
* QFR: Response from Veteran Affairs Office of the Inspector
General.
ENSURING QUALITY HEALTHCARE
FOR OUR VETERANS
----------
Thursday, June 20, 2019
House of Representatives
Subcommittee on Government Operations,
Committee on Oversight and Reform
Washington, D.C.
The subcommittee met, pursuant to notice, at 1:59 p.m., in
room 2154, Rayburn House Office Building, Hon. Gerald E.
Connolly (chairman of the subcommittee) presiding.
Present: Representatives Connolly, Norton, Sarbanes,
Lawrence, Lynch, Raskin, Meadows, Massie, Hice, Comer, and
Steube.
Also present: Representative Wexton.
Mr. Connolly. The subcommittee will come to order. Without
objection, the chair is authorized to declare a recess of the
subcommittee at any time.
The Subcommittee on Government Operations is convening
today to hold this hearing on ensuring quality healthcare for
our veterans. I now recognize myself for five minutes to give
an opening statement.
Nearly 100,000 veterans living in the Washington, DC,
northern Virginia, and Maryland area depend upon the
Washington, DC. Veterans Affairs Medical Center for their
medical care. For years, serious and urgent problems festered
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 for too long.
In March 2017, a confidential complainant 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 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 the progress and continuing
implementation of those 40 recommendations. At the root of the
deficiencies is what the Inspector General, Michael Missal,
politely deemed, and I quote, a culture of complacency, but
what I, frankly, would have called a culture of indifference,
indifference to their patients.
Leaders at multiple levels failed 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
responsibility and deflected blame to everybody else. How else
do you explain the laundry list of critical deficiencies known
to VA 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.
Heimall, 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 D.C. medical center.
Today, I am here to put the leadership on notice. Congress
will not stand for continued failures that threaten the health
and safety of our veterans at what ought to be the VA's
flagship medical center. Unfortunately, it's anything but.
According to the OIG, the D.C., Virginia--veterans medical
center put veterans at risk through needless hospitalizations,
unnecessary anesthesia, failure to use 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 10,904 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 filled 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 a tumultuous 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 2018, the OIG reported that the availability of supplies
had improved and the 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 ostensible metrics. Leaders must
measure and examine customer satisfaction at the end of the
day. Are veterans receiving the appropriate care that meets
their medical needs and treatment expectations? Are employees
empowered to report patient safety incidents, and do they trust
that leadership, when 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
veteran's wife 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 NBC4 report, with the
indulgence of my ranking member.
[Video shown.]
Mr. Connolly. I won't even comment.
Incidents like this remind us there'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.
Heimall, 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 employee's 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 healthcare 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 D.C. 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.
Mr. Meadows. 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 care that they deserve,
the care that they were promised, and honestly, the care that
is the least we could provide in acknowledgment of the service
that they provided. And I just want to say thank you.
And to the gentlewoman from the District of Columbia, I
want to just say that this is a bipartisan effort. You have my
100 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,
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
demonstrated just a few minutes ago on video is not only
shocking, but it's truly not going to be tolerated.
And so with that, I know that we've got a new team. And
many of these things were systemic problems that 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 as the gentleman was talking about, that they
never happen again.
I think probably the biggest frustration for us is to have
an IG that is doing 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 I just want all three of you to hear, and
anybody that's watching, to understand that the commitment is
not a 90 percent commitment; it is 100 percent commitment to
get it right for our veterans.
And I think, Mr. Chairman, it would probably be appropriate
that, you know, 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 have that.
With that being said, I also want to acknowledge, many
times medical facilities are very chaotic place. It seems like
there was a little bit more--in fact, a lot more chaos at this
facility than there should have been. And yet we have
veterans--Director Heimall, I believe you are a veteran of
what, 30 years, 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 in the quality of care that they deserve.
And 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 IG investigation is on
something that is totally unrelated to patient care.
And with that, I yield back.
Mr. Connolly. I thank the distinguished ranking member. And
I know he is committed, and especially--I mean, 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 IG has identified are fully and
comprehensively 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 Ms. Tammy Czarnecki, who is the
assistant deputy under secretary for Health for Administrative
Operations at the United States Department of Veterans Affairs.
We have Michael Heimall, 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 Missal, 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 hearing.
And with that, Ms. Czarnecki, welcome.
STATEMENT OF TAMMY CZARNECKI, ASSISTANT DEPUTY UNDER SECRETARY
FOR HEALTH FOR ADMINISTRATIVE OPERATIONS, VETERANS HEALTH
ADMINISTRATION, ON BEHALF OF DEPARTMENT OF VETERANS AFFAIRS
Ms. Czarnecki. 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 and logistics. I thank you for the
opportunity to discuss Washington, DC. VA Medical Center, and I
am accompanied today by Michael Heimall, the director of the VA
Medical Center.
The veterans healthcare facilities are designed to be safe
havens for our women and men who have served our Nation. We are
constantly working to improve the standards for our veterans as
they deserve that. The D.C. VA and the extended VA Hospital
network take provided in providing care to our veterans in 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 D.C. 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 care to our veterans by providing a safe
environment for our employees to report and speak up when they
see or anticipate a problem.
In March 2018, the inspector general issued its final
report on critical deficiencies at the Washington, DC. VA
Medical Center from April 2017. The report included 40
recommendations for the medical center, VISN 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 31 of 2019.
Despite the issues raised by the OIG and events reported in
the media, the D.C. VA is comparable to other medical
facilities in the Washington, DC. metropolitan. According to
the Center for Medicare and Medicaid Hospital Compare data, the
D.C. VA recorded some of the lowest hospital mortality rates.
The D.C. VA has realized a 50 percent reduction in hospital-
acquired infections this year compared to the first six months
of 2018. This progress attributed to the SAIL rating increasing
from one star to two.
As leadership continues to build a culture of high
reliability centered on employee engagement, we expect these
rates to continue to drop with the goal of zero preventable
harm.
The OIG report also raised concerns about the sterilization
processes 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 2017 to May 2018, the D.C. VA
canceled 20 surgical cases due to the availability of reusable
medical equipment. Over the same period ending May 1 of 2019,
the D.C. VA reported 5 case cancellations, the last occurring
in December 2018. At no time during the 2018 to 2019 timeframe
was a patient placed under anesthesia before the care team
recognized that appropriate medical equipment was not
available.
For the first time since April 2017, the D.C. VA has a
permanent medical center director. This stability allows the
D.C. 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, sterile
processing, supply chain, social work, and community care. The
medical center plans to add an additional 300 employees between
now and October 2020 to support expanded primary care, mental
health, and surgical services across the markets.
The chairman and ranking member have shared the committee's
concern regarding three unfortunate incidents that happened at
the D.C. 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
retrained or disciplined staff to ensure that these do not
occur in the future. Director Heimall can speak to these in
detail.
We look forward to the opportunity to share our progress
and discuss our continued efforts to restore the 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.
Mr. Connolly. Thank you. Right on time.
Mr. Heimall.
STATEMENT OF MICHAEL HEIMALL, DIRECTOR, VETERANS AFFAIRS
MEDICAL CENTER
Mr. Heimall. Good afternoon, Mr. Chairman, Ranking Member
Meadows, and members of the committee. Thank you for the
opportunity to discuss the D.C. 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
Center's market. Please know that you or your staff can contact
me at any time to help resolve a concern of one of our
veterans.
Ms. 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 D.C. with
Karen and your staff tomorrow morning. 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
more than 10,000 prosthetic consults. We have written and
reviewed more than 200 standard operating procedures for
sterile processing. We have hired 17 additional sterile
processing technicians and new leadership in both sterile
processing and the operating rooms, all while undertaking a
major renovation of the sterile processing workspace.
We have hired new leadership in 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
veterans healthcare, 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.
Mr. Connolly. Thank you, Mr. Heimall.
Mr. Missal.
STATEMENT OF MICHAEL MISSAL, INSPECTOR GENERAL, OFFICE OF
INSPECTOR GENERAL, ON BEHALF OF U.S. DEPARTMENT OF VETERANS
AFFAIRS
Mr. Missal. 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 D.C.
medical center are a vital part of our overall efforts to
ensure that the Nation's veterans receive high quality and
timely healthcare 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's level of care. This was due in large part
to the efforts of many dedicated healthcare 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 Healthcare 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 followup staff to track the
implementation of all report recommendations with the
responsible VA office. This consolidated function helps ensure
specially trained OIG staff provide consistent management of
open recommendations. It also facilitates timely and accurate
status reporting for our website, the semiannual 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 plans. While timely hiring actions have
helped to address the known deficiencies within logistics and
sterile processing services, challenges with human resources
management remain in addressing critical core services.
While the deficiencies we identified were at the D.C.
facility, they're not isolated to that medical center. We have
detected some of the same problems in other facilities where
oversight work was 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 in logistics and other key systems can
affect patient care. It should then help guide their corrective
actions.
OIG recommendations, if fully implemented, should also
improve integrated reviews of medical facilities and oversight
by VISNs and VHA central office.
Changing the 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 D.C. 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.
Mr. Connolly. Thank you very much.
And before we begin a round of questioning, I'd like to
enter into the record a report from the Partnership for Public
Service. They did a survey and a 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 150 medical centers. And last year,
before Mr. Heimall came on board, this center we're talking
about ranked dead last in employee engagement, which obviously
has a spillover effect in terms of quality care. And so I want
to enter that report for the record. Without objection, so
ordered.
Mr. Connolly. I'm going to call on Ms. 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, Mr. Raskin, okay,
avail themselves of the services of the center, so it affects a
lot of us.
Ms. Norton, for your five minutes.
Ms. Norton. I want to thank you, Mr. Chairman, for the
visit you and I made to this center so we could see firsthand
what the complaints were about. And I appreciate, Mr. Heimall,
how we were received and your briefing and the tour we had.
Before I get to my question, please indulge me for, 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 open only about three days a week, so you
see why it's underused, you know. When you have to keep track
of when a facility is open in the first place, that leads to a
vicious cycle. And it is, therefore, open on only two or three
days, and then only half time, so you see how this plays on
itself.
Now, I just have to ask you, where are these veterans from
the District of Columbia supposed to receive their care? While
I understand that Prince George's has a facility, it's already
understaffed, and there is Rockville in Maryland, where 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?
Mr. Heimall. Ma'am, thank you very much, and I want to
emphasize that no decision has been made as to whether that
facility will close or not.
Ms. Norton. Oh, good to hear that.
Mr. Heimall. The lease expires in September, and I do have
to make a decision as to whether we renew that lease.
Ms. Norton. When will you make that decision, Mr. Heimall?
Mr. Heimall. Ma'am, I would like to make it by the middle
July, with input from both your staff and from the Mayor's
staff.
Ms. Norton. So you're coming to see us and the Mayor?
Mr. Heimall. Yes, ma'am. In fact, we have a call scheduled
for tomorrow morning with your staff to discuss the issue.
Ms. Norton. I appreciate that. We just don't want people to
be left with no place to go. And these veterans don't exactly
have the kind of resources that you and I have.
Mr. Heimall. 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--one full day a week. And we
also have 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 has actually been closed for about the last 10
days due to a pipe break that occurred in the building that it
is in, and we should reopen----
Ms. Norton. This clinic is decrepit in more ways than one.
Mr. Heimall. Yes, ma'am. And so it's important that we look
for a new option.
Ms. Norton. I want to get on to Mr. Missal before my--I
appreciate you 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, in
which you noted sufficient, quote--and I'm quoting here,
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 say before there was a full
report when you issued this interim report?
Mr. Missal. I do not believe it's common to do it. I'm not
sure our office has ever done it. Certainly, in the three years
I've been the inspector general, we've never issued anything
like that.
We 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----
Ms. Norton. When you got that kind--Ms. Czarnecki, when you
get that kind of unusual--you heard Mr. Missal 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?
Ms. Czarnecki. I'm not sure, Ms. Norton, that I have the
full answer to that. I do know that we did have VA central
office staff immediately deploy to that area with specifics in
logistics and sterile processing. But I believe that the issues
that Mr. Missal is discussing went well beyond both logistics
and sterile processing. And so the interim report was really
helpful in identifying everything that we needed to do to
support the medical center.
Ms. Norton. It was like an emergency report----
Ms. Czarnecki. Yes.
Ms. Norton [continuing]. Ms. Czarnecki. And I appreciate,
Mr. Missal, 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. Missal said was not
immediate corrective action.
Thank you very much, Mr. Chairman.
Mr. Connolly. Thank you. And thank you for your leadership
on this matter, Ms. Norton. And I look forward to continuing to
work with you on an issue that affects so many of our
constituents.
Mr. Massie.
Mr. Massie. Thank you, Mr. Chairman, for calling this
hearing on such an important topic.
Mr. Missal, you said that many of the deficiencies that you
identified as the IG at the D.C. facility weren't isolated to
that facility, that there are some of those deficiencies at
other facilities and that that could inform their improvement.
Can you expound on that a little bit?
Mr. Missal. 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
get allegations of specific issues, 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.
Mr. Massie. So some of the issues that you found at the
D.C. facility, like specialty services for sterile processing,
you found those at other facilities, and they should be looking
into those?
Mr. Missal. Yes. And that's why the D.C. 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.
Mr. Massie. I want to thank you very much.
And I'm going to yield the balance of my time to Mr.
Meadows.
Mr. Meadows. I thank the gentleman from Mr. Kentucky.
Mr. Missal, let me come back to that, because you say you
expect other VA centers to follow the IG's 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 IG's report. And so to suggest
that somehow the administration of every VA center is going to
look at 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?
Mr. Missal. 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 VISN
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. Obviously, it's up to the medical center
directors and the leadership at VHA to ensure that they're
following what we do.
Mr. Meadows. So you mentioned about another facility in
California as an example, but how would any of us up here know
whether our VA center is having that same problem? I mean, so
you've got Kentucky, and that's the reason why the gentleman
from Kentucky was asking you. 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?
Mr. Missal. Absolutely.
Mr. Meadows. All right.
Mr. Missal. When we do an inspection and we're ready to
publish it on a particular facility, we notify the Members of
Congress whose jurisdiction it's under, and we always offer to
come in and talk about it.
Mr. Connolly. So in that case, no news is good news?
Mr. Missal. It could be good news, but again, whenever we
publish a report, we will always notify, whether it's a good
report or a bad report, just to talk it over with Members of
Congress.
Mr. Meadows. 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 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 team. Is that correct?
Mr. Missal. That's partially a good development. But what
we found, particularly in this situation, is there was such a
lack 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.
Mr. Meadows. I'm going to yield back to the gentleman.
Mr. Massie. Just very quickly. If you found any issues at
the Cincinnati VA, the Lexington, Kentucky VA, the Huntington,
West Virginia VA, or the Louisville, Kentucky VA, would you let
me know after the hearing?
Mr. Missal. Absolutely.
Mr. Massie. Thank you very much.
Mr. Connolly. I thank the gentleman.
I now call on the gentleman from Massachusetts, Mr. Lynch,
where there is a VA facility five minutes from my family's home
in west Roxbury, a very big one.
Mr. Lynch.
Mr. Lynch. Thank you, Mr. Chairman and the ranking member,
for all your work together on this issue in bringing it
forward. 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 veterans and active
military suicide issue. Mr. Hice, the gentleman from Georgia,
and I, in the National Security Subcommittee, had a hearing
specifically on veteran suicide and active military suicides,
and I see the elevated numbers here at the D.C. VA center.
There's no indication, in my briefing, about the connection
among those suicides.
Would you classify it as a cluster, or were those
connections, or was there was cross-knowledge among the victims
here or no?
Mr. Heimall. Sir, the two that have been reported in the
media, there was no relation between those two. They were
separated by quite a bit of time.
Mr. Lynch. Yes.
Mr. Heimall. 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.
Mr. Lynch. All right. 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 get at
that.
Now, we have REACH VET, 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 adopted that program?
Mr. Heimall. Yes, sir, and our suicide prevention
coordinators are informed by that information. I think one of
the major challenges that we have within the VA, and I
certainly experienced it 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. And a more comprehensive system that
includes that data would lead to a much better predictive
model.
Mr. Lynch. Yes, yes. And that's exactly what I'm trying to
get at. So at the Brockton VA, we have a program. We actually
do sort of a brain scan on our military--our recruits as
they're going into--before they deploy. And 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 your experience, is there any connection between the
high number of deployments? So members of this committee were
in Afghanistan not a long time ago, and we typically ask who's
here on their first tour of duty, and we met with a small rifle
platoon of Marines, and there were Marines there that were on
their seventh tour of duty. That's unbelievable, and I don't
think that's ever happened in the history of our country. And
I'm trying to figure out, is there a connection between these
multiple tours of duty and the psychiatric stress that some of
these young men and women are experiencing? You know, because
if that's the case, then we're going to have some trouble going
forward here as those burdens present.
Ms. Czarnecki?
Ms. 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.
Mr. Lynch. Okay.
Ms. Czarnecki. And we're really trying to look for those
key indicators that would help us prevent them from committing
suicide in the future.
Mr. Lynch. Yes. Have you come up with any commonalities or
are you still in the process of developing these profiles?
Ms. Czarnecki. The profile development is ongoing.
Mr. Lynch. Yes.
Ms. Czarnecki. I think that there are some key indicators,
as Mr. Heimall talked about, a lot of the socioeconomics.
Mr. Lynch. Yes.
Ms. Czarnecki. So we have actually partnered with the Law
Enforcement Training Center to develop education for the
community on how to 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.
Mr. Lynch. That's great.
Mr. Chairman, I just want to make sure we don't see this
suicide issue as just a D.C. VA Medical Center issue. It's much
wider than that. And also, you know, I've dealt with some
families who have struggled with this. And so, you know, our
prayers and thoughts are with those veterans and with their
families.
Thank you. I yield back.
Mr. Connolly. The gentleman makes a great point. This is
hardly an issue limited only to this facility or 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.
Mr. Meadows, did you want to comment?
Mr. Meadows. Yes. 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
it becomes very personal 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 thank you for
reminding us this is not just a D.C. problem; this is a United
States problem, and it's something that we've got to come
together on.
And I yield back. I thank the chairman for his courtesy.
Mr. Connolly. I thank the gentleman.
And I do want to give Mr. Lynch one more--he puts his money
where--how many times, Mr. Lynch, have you been to Afghanistan
and Iraq?
Mr. Lynch. About 45 times now.
Mr. Connolly. Forty. That's a Member of Congress committed
to making sure that the men and women we ask to serve have
support from the Congress.
The gentleman from Kentucky, Mr. Comer.
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?
Mr. Heimall. They're moving at a very good pace, and we're
very glad to see it happening.
Mr. Comer. What are the most significant remaining issues
that the D.C. VA still has to address to ensure that our
veterans receive the best medical care possible?
Mr. Missal. I think it would be the H.R. function, because
so many of the issues revolve around having proper staffing. So
if you do not have the proper staffing, it'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 H.R. issues.
Mr. Comer. What are some actions that this committee can do
to address some of the serious issues reported, not just at the
D.C. VA, but other VAs 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?
Mr. Missal. 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 are any hurdles, such as compensation or
otherwise, that prevent some of them from being filled on a
permanent basis.
Mr. Comer. I'm very close friends with a constituent, Mr.
Dakota Meyer, a Medal of Honor recipient 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 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 where if they need
medical attention and they can get that medical attention at
home, then that would allow them to do it at home, and it would
be paid for. And perhaps the savings from not having the VA
would somewhere, somehow, come close to paying 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. Massie, my district is 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
cases, probably more VA cases than anything our caseworkers do.
And in 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 VAs in four different states.
So I was just wondering what you thought about that
proposition that Mr. Meyer and other veterans have brought up
before.
Mr. Missal. I have not done a comparison of the quality of
the healthcare between the private sector and what VA provides.
However, I would say, in my time as inspector general, I've
seen a lot of very high-quality healthcare that veterans
receive and that VA is preeminent in a number of 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
see them, is going to report on them fairly and accurately.
Mr. Comer. Right. And I don't think that that bold proposal
would happen any time soon, but one thing I would like to see
is more choice for our veterans. Obviously, if a veteran
received a serious specialized wound, like missing an limb or
something like that, the VA is certainly more qualified than
most of the rural healthcare systems in my state to handle
that. But there are a lot of issues that I think that we deal
with from a caseworker 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 gets mentioned a lot. I just
wanted to hear your thoughts on that, and 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 us know.
Mr. Chairman, I yield back.
Mr. Connolly. I thank the gentleman.
The gentleman from Maryland, Mr. Raskin.
Mr. Raskin. Mr. Chairman, thank you very much. Thanks to
all of our witnesses.
Mr. Heimall, you have not been on the job that long, less
than a year still, I think. Is that right?
Mr. Heimall. Yes, sir. Eight months.
Mr. Raskin. 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 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 D.C. 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. I understand you're still--you're doing these monthly
meetings with congressional staff members.
Mr. Heimall. Yes, sir.
Mr. Raskin. And also with, you know, other interested
stakeholders, and so I want to thank you. I want to thank Ms.
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 is it you're trying to do to
address that and to what do you attribute it? What is your
sense of the situation there?
Mr. Heimall. Thank you, sir. I think it's probably one of
the top two challenges that we have at the D.C. VA is employee
engagement, morale, and commitment. The chairman referenced the
survey that we're in the process of retaking for 2019.
And to 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-led 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--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.
Mr. Raskin. Is it the kind of fear that whistleblowers
experience, a fear of retribution?
Mr. Heimall. I believe that's part of it. And so what we've
seen this year so far is we have about 870 patient--we have
more patient safety reports now than we had all of Fiscal Year
2018, and 80 percent of those reports have a person's name on
it so we can followup with them. We can ask them what they've
done, what the issue was, and we can give them feedback on what
we're going to do to prevent it from happening again.
Mr. Raskin. You're trying to dispel this culture of fear
which is a hangover from, what, prior leadership, prior----
Mr. Heimall. Yes, sir. I believe so.
Mr. Raskin. Okay. Well, thank you for that.
I have received a couple of complaints from constituents
about the IT situation and the 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 to address
that problem?
Mr. Heimall. Yes, sir. There is a significant backlog. As
of this morning, I talked to the area manager who reports up to
the assistant secretary for OI&T, and there are about 4,000
open work order tickets within the D.C. 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 one person who just left that they've got to
process the action on.
The team is very engaged. Mr. Gfrerer, the assistant
secretary for OI&T, 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,
not working on a backlog of IT tickets.
Mr. Raskin. Okay. Finally, would you be willing to compare
your experience at Walter Reed with your experience at the VA?
Walter Reed really now is a hyperefficient, up-to-date, state-
of-the-art kind of facility. And can you compare that to where
you are now and to what you would attribute the difference?
Mr. Heimall. Sir, it really gets to leadership, and it's a
very different patient population. At Walter Reed, primarily
retirees, Active Duty servicemembers and their family members.
At the D.C. 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
healthcare status and their engagement in their healthcare 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 D.C. VA, the struggle has been 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.
Mr. Connolly. I thank the gentleman.
Mr. Connolly. Before I call on the gentleman from Florida,
Mr. Steube, without objection, I'd like to enter into 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. Missal, we're going to
return to that, 68 percent vacancy rate to prosthetics, zero.
So we've made progress in some, but there's still a lot of room
for improvement in the top five or six categories here.
And so I'll enter that into the record, without objection,
as a document for our perusal.
Mr. Connolly. Mr. Steube.
Mr. Steube. Thank you, Mr. Chair.
My question is for Ms. Czarnecki? Am I pronouncing that
correctly?
Ms. Czarnecki. Yes.
Mr. Steube. And I know you probably won't have the answer
to 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 nearest veterans center or veterans hospital is
Bay Pines. It's been reported to me that Bay Pines has stopped
referring patients in need of in-patient mental health and
substance abuse service to approved 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 8 about
how to appropriately implement the MISSION Act. My
understanding is the purpose of the MISSION Act is to increase
veterans' access to healthcare, yet veterans in VISN 8 are
experiencing much greater delays in mental health and substance
abuse 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?
Ms. Czarnecki. I will be glad to take that for the record
and get that response back to you.
Mr. Steube. All right. Thank you.
Mr. Connolly. Does the gentleman yield back?
Mr. Steube. I'll yield back to Mr. Meadows.
Mr. Meadows. Thank you.
And so since you're going to take that back, I'm a big one
on timeframes. When can we expect a 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. Steube
on that request?
Ms. Czarnecki. Absolutely.
Mr. Meadows. All right. Thank you so much.
I thank the gentleman from Florida.
Let me followup real quickly. When you mention your IG
report and sharing it, one of the things that just came to me
is--I mentioned in 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 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 D.C.? Is there a mechanism to
do that?
Mr. Missal. 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 say 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----
Mr. Meadows. Yes. But that's more on problems than good
practices. And so while I appreciate that, it's the good
practices.
Ms. Czarnecki, is there any way to do that?
Ms. Czarnecki. 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
across the system.
Mr. Meadows. So how do they get rewarded for that?
Your pause concerns me.
Here's the thing, is you get more of what you reinforce.
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, ata
boy, ata girl, and go on?
Ms. Czarnecki. 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 team based.
Mr. Meadows. Here's what I would like. And I didn't mean to
cut you off. And here's what I'd like, is the best practices--
listen, 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 IG's report, if you even mess up
a little bit, they're going to say nothing's changed.
So I guess what I would like from 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?
Mr. Heimall. 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 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 practices.
Mr. Meadows. That's what I wanted to hear.
I'll yield back. I thank the chairman.
Mr. Connolly. I thank the gentleman.
The gentlelady from Michigan, Mrs. Lawrence.
Mrs. 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 followup 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 their 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.
Ms. Czarnecki. I'll talk a little bit about the national
level, and then I'll ask Mr. Heimall to comment on what happens
at the medical center.
A couple of years ago, we started a veterans experience
office at the department level. And we're collecting real
feedback, real time from veterans so that we can trend and
track those, and do service recovery in real time as opposed to
waiting for survey results.
Mr. Heimall.
Mr. Heimall. I think the survey results are great, but
they're not--they lag the process. The Veterans Signals,
VSignals, 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 comments section.
What I find interesting in that 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 with veterans across the medical center in our
various clinics. You have to deal with their issues up front
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 let them----
Mrs. Lawrence. It's about empowering 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 that's not a medical hospital
that's in the community, what do we call that?
Mr. Heimall. Community-based outpatient clinic, CBOC.
Mrs. Lawrence. That's it, CBOC. Those work very well.
So I'm hearing about this disconnect 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
veterans who are there, they love it. It's a smaller
environment. You're using telemedicine, which you're going to
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, and it's not all this long walk,
it's not crowded. The staff there were 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 CBOCs, as they say. Yes.
Mr. Heimall. Yes, ma'am. And I think the MISSION Act drives
us to doing that. The access--the drive time access standards
that the department has put in place really encourage us to
take the care out closer to where veterans live and work. And
especially in the D.C. 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 going to 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 larger CBOC in Northern Virginia.
Mrs. Lawrence. The last thing. I would love for you to
engage with the chairman, I would love to talk about how we,
when 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.
Mr. Connolly. I thank the gentlelady. And she makes a
really good point. I mean, in a perverse way, Mr. Heimall,
being at the bottom of the pile means, presumably, you can only
go up. But establishing a baseline of performance and
satisfaction is something I think we have to have so we can
measure real progress and celebrate it when it occurs.
I also want to ask unanimous consent that my colleague, the
gentlelady from Virginia, Ms. Wexton, be recognized for the
purpose of participating in this hearing as a full member of
the committee. Without objection, so ordered.
I'm going to take my five minutes and then call upon you
Ms. Wexton.
You?
Mr. Meadows. Yes. They've just been yielding to me. I
haven't had my turn.
Mr. Connolly. Oh, I'm so sorry. I thought----
Mr. Meadows. I had plenty to say and not enough time to say
it.
Mr. Connolly. Yes. All right.
Do you want to go now?
Mr. Meadows. Yes, that'd be great.
Mr. Connolly. Okay. Sure. I recognize not myself but the
gentleman from North Carolina.
Mr. Meadows. Thank you, Mr. Chairman. And again, I want to
say thank you for your leadership.
Director, let me just come to you. 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 in the video where the I-Team did their investigation.
Thank you for taking it seriously. I know we've had
discussions. I appreciate 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 Mrs. Lawrence just made a
comment about that. Every year, we have what we call a 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 eligibility. It's everything that we have in that and
bring it together. Sometimes it's 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 D.C. but across the entire--that it comes back
and lets us know, you know, what the scorecard is? The chairman
has a scorecard, which is called FITARA, that actually gives a
rating, and we're able to follow that on IT.
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?
Mr. Heimall. Sir, I think that one of the challenges with
that is there are a lot of surveys out there. There are at
least two surveys that our veterans get. If you're an
inpatient, you get the HCAHP survey that CMS uses. If you're an
outpatient, you get the VA's outpatient survey, and you get
pinged for the VSignals 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 to improve that survey may we very useful. But I'd
encourage you to look at the development of that survey.
Mr. Meadows. All right. So let's assume we've got two
surveys. Obviously, they're not working. Wouldn't you agree
with that? I mean, you know, if the surveys would have stopped
the poor healthcare results--and maybe I use healthcare more
broadly, but the problems that we had at your facility where
you are, if we had just the survey and it was an action item,
we wouldn't be having this hearing. Would you agree?
Mr. Heimall. Sir, I think the question is what was
leadership doing with those survey results and how were they
trying to address those.
Mr. Meadows. All right. And 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?
Mr. Heimall. Sir, I think that needs to be on the report
card that Congress looks at.
Mr. Meadows. 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've 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 Ms. Breyfogle. Who's no longer in
my district. In fact, I weeped tears. And, actually, we got a
good replacement. The director there now is great. But Ms.
Breyfogle did what you just mentioned that you had 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 take 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 D.C.
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 get some recommendations to us on
those good practices that you were talking about sharing?
Mr. Heimall. Yes, sir. And I would love to do that when we
submit back on our questions for the record. I'll take that one
for the record, because I would like to put some thought into
it.
Mr. Meadows. Thank you so much.
I yield back.
Mr. Connolly. Well, thank you, Mr. Meadows.
And just following up on that, I think--and we talked about
this when we met at the facility a 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 set certainly by the
IG's office and meeting them and institutionalizing them, so
that, God forbid, but, you know, if you're hit by a bus
tomorrow, your successor has to follow through and has that in
front of them.
Remember, we're doing all this for our veterans to make
sure they are best served. 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 we have a model we've created for IT in Federal
Government with, you know, seven factors, and we grade. And
we're going to have a hearing on that next week, if you want to
see what it looks like.
But we'd welcome your suggestion on that. And yours as
well, Mr. Missal.
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? What led you to characterize activities at the--this
facility as a--constituting a culture of complacency?
Mr. Missal. 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 work-
arounds so that they could make sure that the patients 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.
Mr. Connolly. So what you've just described are sort of
institutional barriers to providing quality service, and they
did work-arounds to try to give that quality service the
barriers within the system notwithstanding?
Mr. Missal. They felt leadership was either not listening
to them or not taking appropriate action, and so they felt that
there were no other avenues to pursue.
Mr. Connolly. 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 had not properly been stored. Is
that correct?
Mr. Missal. I believe that's correct, yes.
Mr. Connolly. Is that a function of management or a
function of maintenance and making sure things kind of work
properly?
Mr. Missal. 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 their 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 their hand felt
that if they did, there would be retaliation against them.
Mr. Connolly. Mr. Heimall, would you agree that that was a
problem when you took over, that raise your hand and be
empowered and there's no retaliation based on what you report?
And what have you done to change that and encourage it?
Mr. Heimall. Sir, it was a problem when I arrived at the
facility. And, quite honestly, there are still pockets 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.
Mr. Connolly. Well, 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 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 are committed to.
Mr. Heimall. Yes, sir. I try a couple times a week to send
out a tell-me-something-good story to all the staff 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 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 behaviors.
Mr. Connolly. Right. Presumably, there's an in-between
where we reward someone who takes the initiative to avoid the
negative happening, and that's a positive.
Mr. Heimall. And that's exactly what we have to have in
healthcare if we're going to become high reliability
organizations.
Mr. Connolly. Let me explore the issue of HR. H.R. is the
one--the No. 1 office still with a 68 percent vacancy rate. So
out of 78 designated positions, only 25 are on board, 53 are
vacant. What can go wrong with that, Mr. Missal, that high
vacancy rate in an H.R. office?
Mr. Missal. 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 onsite at D.C. is their H.R. department was so broken that
they had outsourced it to the Baltimore medical center. So the
Baltimore medical center H.R. department was not only trying to
staff Baltimore, but D.C. 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.
Mr. Connolly. So H.R. is kind of key to an enterprise. If
you want to--you want to have new hires, they've got to be
processed.
Mr. Missal. Absolutely.
Mr. Connolly. H.R. does that.
Mr. Missal. Absolutely.
Mr. Connolly. If certain things have to--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?
Mr. Missal. 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 HR.
Mr. Connolly. Well, if I'm terminating someone, I got--the
paperwork at least is done by HR?
Mr. Missal. Correct. Administratively, you have to go
through HR.
Mr. Connolly. Right. And I got--let me see--how many
people--2,564 people. And you're going to have some turnover.
And some of it generated by performance, some just generated
naturally: retirement attrition, move on. That could keep an
H.R. office pretty busy.
Mr. Missal. Yes.
Mr. Connolly. And I still have 964 positions vacant. Is
that correct, Mr. Heimall?
Mr. Heimall. Yes, sir.
Mr. Connolly. 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. Heimall, what are you finding as the relatively new
director is--what's the impediment to filling these critical
positions in HR, and what do you propose to do to try to
resolve it?
Mr. Heimall. Yes, sir. And I would like to--you know,
beyond some of the examples you said, 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, those
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 challenges with the shortage that we have in H.R. is
we're not able to do that properly, which means we create a
false picture of what our vacancies are.
Mr. Connolly. I'm sorry. When you say inactivated, it just
sounds so Nixonian. So if you were inoperative, inactive----
Mr. Meadows. Can you find a different word?
Mr. Heimall. The term we used when I--my year in the
private sector was funded head count. All right? This is head
count 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.
Mr. Connolly. And I take that point. And we'll--that's
fine. But you've still got a vacancy problem in HR, which is
kind of critical to your being able to manage the enterprise
and do everything you want to do. Improve morale, improve
productivity, have a more empowered staff that feels they can
actually make decisions, as Mr. Meadows said.
Mr. Heimall. So we have an arrangement with work force
management consultants from the VHA's 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 work force management
consultants.
We have prioritized, in our hiring strategy, filling those
H.R. vacancies. Within the VHA, we are also going to an H.R.
consolidation at the VISN level. So we have already
consolidated the classification of position descriptions which
determines the pay grade we bring someone on at the VISN level.
We are in the process of now working through consolidating,
across the six facilities, the other human resource functions.
And on a national level, we are going to begin consolidating
our retirement processing.
Every time the central office comes up with a--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 H.R. staff to be working staffing, recruitment,
disciplinary actions.
Mr. Connolly. But just to be clear, I want to make--you
can--however you answer, but I want to make sure I don't
misunderstand you. You are not saying outsourcing H.R. is the
long-term solution?
Mr. Heimall. No, I am not.
Mr. Connolly. 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?
Mr. Heimall. Yes, sir.
Mr. Connolly. Mr. Missal, and then I'm going to call on Ms.
Wexton.
Mr. Missal. Mr. 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 and
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.
Mr. Connolly. Thank you.
The gentlelady from Virginia is now recognized for her five
minutes, Ms. Wexton.
Ms. Wexton. 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 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 D.C. 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 more and more of our veterans want to go to Martinsburg
because they are not getting the satisfying care that they need
at the D.C. 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 patients there are having to face.
I think understaffing has been a lot of the cause of that. It
seems that 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 D.C. 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 you have had pervasive
staffing issues across multiple departments. Have you hired yet
or is there a plan to prioritize hiring a new H.R. director,
Mr. Heimall?
Mr. Heimall. Yes, ma'am. Our new H.R. director came on
board, I believe, in September 2018.
Ms. Wexton. Okay. And is there a staffing plan to fill the
vacancies that you have?
Mr. Heimall. Yes, ma'am, there is.
Ms. Wexton. How are you prioritizing which positions you're
trying to fill first?
Mr. Heimall. We looked at where our greatest pain points
were. When I first came on board, we had prioritized 45
housekeepers 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 reprioritized
those positions lower on our priority list, and I moved up
positions like human resources, our patient safety manager, and
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.
Ms. Wexton. So you moved up the positions that have direct
patient contact care, those kinds of----
Mr. Heimall. Yes, ma'am. Or ones that were absolutely
critical for us bringing on board the people that we needed to
bring on. We also prioritized some of our logistics in SPS
positions a little higher on the list so that we could fill
those critical gaps as well.
Ms. Wexton. Okay. Very good.
And one of the things that Mr. Missal 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 H.R. system because it was not
properly maintained as the system of record for a position
management. So basically, you didn't know what you didn't know,
right?
Mr. Heimall. Exactly, ma'am.
Ms. Wexton. Okay. What changes has the facility implemented
to ensure that you have accurate tracking about vacancies and
what----
Mr. Heimall. We have validated an organization chart for
every single one of our departments. And technically, under
H.R. modernization, H.R. belongs to the VISN, but I validated
their staffing chart as 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 H.R. 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 H.R.
in the IG report.
Ms. Wexton. And do you have a timeline for that to take
place?
Mr. Heimall. We expect that will be completed by 30
September of this year.
Ms. Wexton. 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 cost them in terms of their satisfaction.
Mr. Heimall. Yes, ma'am. 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 going to leave for that $20,000 recruitment bonus,
I would like the opportunity to match that with a retention
bonus before they make a decision.
Ms. Wexton. Thank you very much.
I see my time has expired, so I will yield back.
Mr. Connolly. Wouldn't it be nice if there were a retention
bonus for Members of--no. No. Just talking crazy here.
Mr. Meadows. You're going to regret that question.
Mr. Connolly. Let the record show I didn't approve of that.
I just asked.
Mr. Meadows. You're against it, I'm sure, right?
Mr. Connolly. I'm against it, as is----
Mr. Meadows. As I am, yes.
Mr. Connolly. Go ahead.
Mr. Meadows. I want to make just two requests and 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 going
to have those outstanding issues on the IG's report done. Is
that correct?
Mr. Heimall. Yes, sir. We expect everything to be completed
by 30 September.
Mr. Meadows. 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 going to call the I-Team investigator and
say, yes, but. They're going to call our staffs. And the
chairman and the gentlewoman from Virginia and 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--
will 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?
Mr. Heimall. Yes, sir, I absolutely am.
Mr. Meadows. All right. And I'll close with this. I can
tell that you're sincere. And I came into this hearing so angry
and so upset that our veterans had not been served, partly by
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 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 pointed out teams were afraid to come
to management. And you admitted there are still pockets of that
now. Very transparent. I don't know that most witnesses 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 love to
look at this very closely. Are you willing to do that?
Mr. Heimall. Yes, sir, I am. And I would love to have both
of you visit the facility.
Mr. Meadows. I thank you.
And I thank, again, the chairman for his leadership, and I
yield back.
Mr. Connolly. 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 to
you and for us. And we welcome your involvement and that of
your office, Mr. Missal, so that it meets your concerns as
well.
So if all of us sign off on, yes, that's the way we're
going to measure, then we can look at how well we're doing. But
we got to first agree on what are the metrics. We need to see
to be satisfied that all the people we're accountable to can
see or not see the progress we're making.
You've made a commitment, Mr. Heimall, to stick around.
You've made a professional 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.
Mr. Heimall. Sir, that is one I--I love the team that I
work with. I love the veterans that we are 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, so I am here for the long haul.
Mr. Connolly. But I also think, when you have the kind of
turnover in leadership that your facility has had, it's--it has
a huge toll on productivity and morale with the work force. And
it adds to that culture of complacency or indifference that we
talked about, because I know I can wait you out. Average life
spans of one of you people is three months, or whatever it is.
And I think that's had a hugely deleterious impact 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 are the
men and women who wore that uniform who are counting on us to
deliver quality care for them and their families.
I thank you for coming here today. This hearing is
adjourned.
[Whereupon, at 3:44 p.m., the subcommittee was adjourned.]
[all]
| MEMBERNAME | BIOGUIDEID | GPOID | CHAMBER | PARTY | ROLE | STATE | CONGRESS | AUTHORITYID |
|---|---|---|---|---|---|---|---|---|
| Clay, Wm. Lacy | C001049 | 8009 | H | D | COMMMEMBER | MO | 116 | 1654 |
| Lynch, Stephen F. | L000562 | 7974 | H | D | COMMMEMBER | MA | 116 | 1686 |
| Wasserman Schultz, Debbie | W000797 | 7892 | H | D | COMMMEMBER | FL | 116 | 1777 |
| Foxx, Virginia | F000450 | 8028 | H | R | COMMMEMBER | NC | 116 | 1791 |
| Sarbanes, John P. | S001168 | 7978 | H | D | COMMMEMBER | MD | 116 | 1854 |
| Sarbanes, John P. | S001168 | 7978 | H | D | COMMMEMBER | MD | 116 | 1854 |
| Jordan, Jim | J000289 | 8094 | H | R | COMMMEMBER | OH | 116 | 1868 |
| Welch, Peter | W000800 | 8204 | H | D | COMMMEMBER | VT | 116 | 1879 |
| Speier, Jackie | S001175 | 7817 | H | D | COMMMEMBER | CA | 116 | 1890 |
| Connolly, Gerald E. | C001078 | 8202 | H | D | COMMMEMBER | VA | 116 | 1959 |
| Gosar, Paul A. | G000565 | 7798 | H | R | COMMMEMBER | AZ | 116 | 1992 |
| Amash, Justin | A000367 | 7988 | H | I | COMMMEMBER | MI | 116 | 2029 |
| Gibbs, Bob | G000563 | 8108 | H | R | COMMMEMBER | OH | 116 | 2049 |
| Massie, Thomas | M001184 | 8371 | H | R | COMMMEMBER | KY | 116 | 2094 |
| Meadows, Mark | M001187 | H | R | COMMMEMBER | NC | 116 | 2142 | |
| Kelly, Robin L. | K000385 | H | D | COMMMEMBER | IL | 116 | 2190 | |
| DeSaulnier, Mark | D000623 | H | D | COMMMEMBER | CA | 116 | 2227 | |
| Hice, Jody B. | H001071 | H | R | COMMMEMBER | GA | 116 | 2237 | |
| Lawrence, Brenda L. | L000581 | H | D | COMMMEMBER | MI | 116 | 2252 | |
| Grothman, Glenn | G000576 | H | R | COMMMEMBER | WI | 116 | 2276 | |
| Comer, James | C001108 | H | R | COMMMEMBER | KY | 116 | 2297 | |
| Khanna, Ro | K000389 | H | D | COMMMEMBER | CA | 116 | 2308 | |
| Cooper, Jim | C000754 | 8152 | H | D | COMMMEMBER | TN | 116 | 231 |
| Krishnamoorthi, Raja | K000391 | H | D | COMMMEMBER | IL | 116 | 2325 | |
| Higgins, Clay | H001077 | H | R | COMMMEMBER | LA | 116 | 2329 | |
| Raskin, Jamie | R000606 | H | D | COMMMEMBER | MD | 116 | 2332 | |
| Norman, Ralph | N000190 | H | R | COMMMEMBER | SC | 116 | 2361 | |
| Gomez, Jimmy | G000585 | H | D | COMMMEMBER | CA | 116 | 2362 | |
| Cloud, Michael | C001115 | H | R | COMMMEMBER | TX | 116 | 2369 | |
| Hill, Katie | H001087 | H | D | COMMMEMBER | CA | 116 | 2379 | |
| Rouda, Harley | R000616 | H | D | COMMMEMBER | CA | 116 | 2382 | |
| Pressley, Ayanna | P000617 | H | D | COMMMEMBER | MA | 116 | 2405 | |
| Tlaib, Rashida | T000481 | H | D | COMMMEMBER | MI | 116 | 2410 | |
| Armstrong, Kelly | A000377 | H | R | COMMMEMBER | ND | 116 | 2417 | |
| Ocasio-Cortez, Alexandria | O000172 | H | D | COMMMEMBER | NY | 116 | 2427 | |
| Green, Mark E. | G000590 | H | R | COMMMEMBER | TN | 116 | 2442 | |
| Roy, Chip | R000614 | H | R | COMMMEMBER | TX | 116 | 2449 | |
| Miller, Carol D. | M001205 | H | R | COMMMEMBER | WV | 116 | 2460 | |
| Cummings, Elijah E. | C000984 | 7982 | H | D | COMMMEMBER | MD | 116 | 256 |
| Maloney, Carolyn B. | M000087 | 8075 | H | D | COMMMEMBER | NY | 116 | 729 |
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