Friday, May 18, 2012

Which country is he president of?










Yesterday, the House Veterans Affairs Subcommittee on Health held a hearing. 
WASHINGTON, D.C. -- Today, the Subcommittee on Health held a hearing to examine VA's current capabilities to provide state-of-the-art care to veterans with amputations. The Committee heard testimony concerning VA's proposal to change procurement processes for prostheses, potentially hindering a veteran's ability to acquire the latest prosthetic and corresponding care and support.
"VA has been struggling to keep pace with the rising demands of younger and more active veterans with amputations," stated Rep. Ann Marie Buerkle, Chairwoman of the Subcommittee on Health. "VA must continue to provide multi-disciplinary care to maintain long-term and life-time quality of life. Placing prosthesis procurement into the hands of contracting officers is alarming. VA needs to match the determination and spirit demonstrated by our wounded warriors and recommit themselves to becoming a leader once again in prosthetic care."

Currently, VA provides care to approximately 42,000 veterans with limb loss. As of August of 2011, 1,506 servicemembers had experienced amputations on active duty from Operations Enduring and Iraqi Freedom. An additional 2,248 veterans underwent major amputations at VA in 2011. VA prosthetic costs have more than doubled in the past five years, yet, VA's care has fallen behind that of the Department of Defense (DoD).
"Prosthetics are a truly individualized extension of one person's body and mobility, not your typical bulk supply purchase," stated Jim Mayer, a Vietnam veteran, double amputee, and wounded warrior advocate and mentor. "When today's warriors are referred to VA and seek the newer, cutting-edge, technologically superior prosthetics they have been accustomed to [through DoD], will VA be able to meet that demand? DoD centers of excellence provide state-of-the-art and often newly evaluative prosthetics that have allowed warriors to thrive, not just in walking, but also run competitively, compete in the Paralympics, rock climb, play myriad sports and other endeavors."
"Prosthetic technology and VA have come a long way from the Civil War era. Following World War II, veterans dissatisfied with the quality of VA prosthetics stormed the Capitol in protest. Congress responded by providing VA with increased flexibility for prosthetic options and federally funded research and development," said Buerkle. "As a result, VA has been a leader in helping veterans with amputations regain mobility and achieve maximum independence. This is why I am troubled by VA's proposed changes in procurement policies and procedures which shifts the emphasis from the doctors to contracting officers."
So what kind of change is being discussed?
Jonathan Pruden:  Under the change, only a contracting officer could procure a prosthetic item costing more than $3,000.  This policy would effect essential items including most limbs like mine and wheel chairs.  It would require the use of a system designed for bulk procurement purchases that involves manually processing over three hundred -- that's 300 -- individual steps to develop a purchase order.  This system may be great for buying cinder blocks and light bulbs but it is certainly not appropriate for providing timely and appropriate medical care.  Equally troubling, this change offers no promise of improving service to the warrior.  Instead, it would mean greater delays. The change could realize modest savings but at what cost?  A warrior needing a new leg or wheel chair should not have to wait longer than is absolutely necessary.  I know warriors who have stayed home from our events, stay home from school, from work, can't play ball with their kids or live in chronic pain while they wait for a new prosthesis.   I know first hand what it's like to not be able to put my son into the crib while I'm waiting for a new prosthetic, to live in chronic pain and to have my daughter ask my wife once again, "Why can't Daddy come and walk with us?"   With VA moving ahead on changing procurement practices, wounded warriors need this Committee's help.  A prosthetic limb is not a mass produced widget. Prosthetics are specialized, medical equipment that should be prescribed by a clinician and promptly delivered to the veteran.  We urge this Committee to direct VA to stop implementation of this change in prosthetic procurement.
At the start of yesterday's hearing, Subcommittee Chair Ann Marie Buerkle noted the hearing was entitled "Optimizing Care for Veterans With Prosthetics."  The Subcommittee heard from four panels.  The first one was featured Gulf War Veteran John Register and Vietnam Veteran Jim Mayer.  Disabled American Veterans' Joy Ilem, American Orthotic & Prosthetic Association's Michael Oros, Paralyzed Veterans of America's Alethea Predeoux and Southeast Wounded Warrior Project's Jonathan Pruden made up the second panel (we covered the second panel in yesterday's hearing).  The third panel was the VA's Office of Inspector General's Linda Halliday accompanied by Nicholas Dahl, Kent Wrathall and Dr. John D. Daigh Jr. and Dr. Robert Yang.  The fourth panel was the VHA's Dr. Lucille Beck accompanied by Dr. Joe Webster, Dr. Joe Miller and Norbert Doyle. 
We're going to stay on the issue of the proposed change.  And we're going to go to the fourth panel. The VA is just eating up time in the excerpt below.  They have no idea what they're saying -- I don't think Dr. Beck even knows what "impetus" means judging by her answer -- and you would think, "At last they're done" but then they'd launch back in.  I really think that Congress needs to address the issue of witnesses whose words wander all over but never arrive anywhere.  Yes, some people speak that way.  But with government employees, it always seem to be an  attempt to run out the clock.
Chair Ann Marie Buerkle:  I have a lot of questions.  A lot of it is based on what we heard from the three previous panels -- especially the veterans and the veterans service organizations.  I think they provide for us a reliable source of information and they identify needs for us.  My first question is: What was the impetus behind the change?  You heard the concern from the previous panels.  What was the impetus behind the change in the procurement policy?  And did you consult with the veterans service organizations and/or veterans?  Who did you talk to to make this change?
Dr. Lucille Beck: The impetus for the change, uhm, is an impetus from the department to assure compliance with federal aquistion regulations.  I have with me Mr. Norbert Doyle who is VHA's chief procurement logistics officer today.  We were anticipating some of these questions.  And he's available to provide more information about  the change and what's happening.
Chair Ann Marie Buerkle: And just if you would, before you start, so does that mean heretofore the VA was not compliant?  I mean if that's the basis for your change -- that compliance is an issue -- maybe you could make that clear to us.
Norbert Doyle:  Yes, ma'am.  Thank you, Dr. Beck.  I -- Ma'am, yes, the impetus was to bring VA contraction -- to include VHA and all the other VA contracting organizations and veteran alignment with the federal aquistion regulations.  We also, uh, it's my understanding the department recognized several years ago that they were weakened in certain areas, in contract administration and the awarding of contracts and this was also to bring it inhouse to ensure proper stewardship of the government dollars. In reference to your question "did we talk to veteran service organizations?" Uh, actually last, uh -- before -- I don't believe we did before we started the process;however, last week -- And I'm happy to meet with any organization to discuss what we're doing.  I heard the complaints from the veterans service organizations that they feel out of the loop.  I met last week with Dr. Beck, with the Secretary's Advisory Committee on Prosthetics and Special Disabilities.  We spent a great deal of time with them.  And I think that group has representatives from many veterans service organizations to east -- address their concerns that they may -- that they may have.  Again, I make that offer that I would be happy to meet with any group to discuss these.
Chair Ann Marie Buerkle: Thank you.  I think it would be in the best interest as we go forward to do what's best for our veterans and to hear from the veteran service organizations and from the veterans themselves and from those who have gone through this process who understand it intimately as did the first two panelists.  That -- It would seem like very basic to meet with them and have them identify needs and concerns.  You heard Wounded Warriors say, "We're asking you, Congress, to please freeze this change." And the other point I wanted to bring up was the pilot.  You heard Paralzyed veterans, their organization asked or mentioned a pilot.  Have you done a pilot?  If so, what were the findings?  Is that the justification for this change?
Norbert Doyle: Yes, ma'am, I actually have a number of issues to address along these lines.  First, uh, to put it in context -- and, granted, we're talking about the more expensive items that we're talking about today -- the transfer of authority from prosthetics to contracting only impacts those procurements above $3,000 which is the mandated federal aquistion -- or federal, uh, micropurchase threshold. So only 3% of orders that we estimate fall in that realm.  So 97% of prosthetic orders will stay with prosthetics.  Uh, as I said we-we are doing this to bring us more in line with federal acquistion regulations and also to address many of the issues that the IG has mentioned although those were identified, I think, previously.  Now I want to assure everybody that if a clinician  specifies a specific product for a veteran, contracting will get that product for that individual. I-I do not, as a-a-a chief -- as a chief contracting person in-in the Veterans Health Administration I do not want my contracting officers making a decision as to what goes in a veterans body or gets appended to it.  That is clearly a clinician decision. And how we, uh, going to get that, uh, product the clinician specifies for the veteran and we're going to do it under the auspices of the federal aquisition regulations.  We're going to cite the authorities of 8123 which one individual mentioned that, the broad latitude given by Congress to the veteran -- to the Veterans Administration.  We're going to do that by properly preparing justifications for approvals for sole source citing in paragraph 4 the authorities granted under 8123.  There are seven exceptions in part six of the FAR [Federal Acquistion Regulation] to full and open competition.  Exception 5 is the one that  as authorized by statute and that's the one that we will -- we will use.  We have gone through great pains to ensure success in this transfer.  And a little bit of history, even starting last summer when we started this process under the direction of the department, Dr. Beck's and my folks, uh, we formed a team.  And that team included field personnel -- both prosthetics and contracting which we thought was critical.  They developed a plan on the transfer.  It was a very detailed plan.  The plan, actually, as we got into it, got more detailed as we identified other issues.  We then worked with our union partners to make sure that they did not have issues and we could proceed successfully.  There were pilots as part of the plan which is probably the best part other than bringing field people into the planning process, the pilot was a great aspect.  We did pilot in three VISNs -- in VISN 6, 11 and 20 -- and that's the Virginia, North Carolina area, the Michigan area and the Pacific northwest.  We piloted beginning in January for about 60 days.  Those pilots concluded in March.  We did learn from those pilots and we're implementing changes to ensure that care is not impacted.  Some of the things that we learned is that our staffing models are incorrect in the number of procurements that we could do in a day.  In the contracting office, we are hiring.  We have received approval to hire additional people to ensure we can keep up.  We are streamlining the process by, I mentioned, justification approvals, by templating that process so it becomes more fill-in-the-blank with the clinicians prescription.  Those are the type process.  We're slowly now implementing in the rest of the Veterans Health Administration.  I think four more VISNs are starting that process now and the rest of the VISNs will be coming on in June and July.  The goal is to have all of this done by the end of July. There is a contingency plan that we have discussed.  Uh, we still have the legacy procurement system if something does not go right or something unexpected happens that we can fall back on.  But we don't expect-expect that to happen.
Dr. Lucille Beck:  I would like to add that this has been -- has been a very strong collaboration and partnership prosthetic and sensory aid services very concerned that we can continue to provide the services to the veterans that, uhm, they deserve and that we have always been able to do and so our prosthetics organization at our local medical centers and at the VISN level remain the eyes and ears so all orders still come through prosthetics.  Prosthetics is managing them and we're working with contracting officers to achieve the, uh, placement of the order in, uh, uhm, uh, as it's required to be, uh, meeting all of our acquisition requirements and, uhm, we-we are as Mr., uh, Doyle has said, very aware of the ability to use 8123 and have spent a significant amount of time developing justifications and approvals that allow us to use that and really reflect the needs of our -- the individualized rehab needs of our veterans.  We're very much aware that we customize these products and services, that they are selected based on an individual, uhm, veterans needs and that has been our goal as we have managed this transition.  We're coming into a critical time as we move the transition forward and extend it to other VISNs.  And, uhm, we, uh, have very, uh-uh-uh, very well developed and exact procedures in place to monitor this as we go.  And we are prepared,  I think, Mr. Doyle and I, as a team, to -- and our offices as teams to uhm, uh review this very carefully and make recommendations on the way forward based on how this process affects veterans.
Norbert Doyle:  And, uh, I'm sorry, ma'am
Chair Ann Marie Buerkle: Go ahead, Mr. Doyle.
Norbert Doyle:  I add that when I met with the Advisory Committee on Prosthetics and Special Disability uh, uh, last week, they had many of these same concerns.  I think after spending a degree of time with them, uh, they at least understood what we were doing. They're still very interested in ensuring that we do achieve success but I'll let Dr. Beck comment. I don't think we left there with a burning issue -- at least, I did not -- that we needed to address. Also as-as-as a veteran myself who made several trips to Iraq and Afghanistan both in a military and civilian capacity, you know, I am very sympathetic to the needs of the veterans population.  And I will do no -- I can assure you I will do nothing that hurts the veterans because, you know, there but for the grace of God go I actually and that's the way I look at it.
Chair Ann Marie Buerkle: Thank you.  My time is way run over. However, if my colleagues will indulge me, I just have a couple of quick follow up questions and then I'll allow you to have as much time as you need.  My first concern is that you said that with the procurements it just only pertains to those over 3,000 and you said only 3% of the orders are over 3,000.  How many requests do you have?
Norbert Doyle: Uh, that is still not an insignificant number. Uh, based on our planning estimate, our planning figures for Fiscal Year '10 in which we planned the transfer over it was, uh, 3% of the orders equals roughly 90,000 orders.
Chair Ann Marie Buerkle:  So I would suggest that because we're talking about 1500 warriors with amputations that proably are in need of prosthetics that that is probably going to be a small percentage of what you are doing; however, all of those are going to exceed that $3000 threshold.  We heard earlier about a $12,000 limb.  And if it's $25,000 that doesn't matter because the veterans need prosthetics and need state of the art prosthetics.  So that concerns me, that piece right there. But the other thing that concerns me, you mentioned you talked with your union partners.  It would seem to me more appropriate to talk to your veteran partners and to the veterans who have gone through this and be more concerned with their thoughts about this being a program that works versus talking to the union partners. And, lastly, the pilot information, the results of those pilots?  If I could respectfully request that you provide us with -- I think you said that you did three: 6, 11 and 20 VISNs. If you could provide us with the findings for those pilot programs, I would greatly appreciate it.
Tomorrow's snapshot will include US House Rep Mike Michaud's questions.  Right now, whether you're pro-union or not (I am pro-union), the VA really doesn't get it or thought everyone would overlook that.  They failed -- failed -- to speak to veterans about this change but spoke to unions?  That just doesn't look or sound right.  You're talking about, as Chair Buerkle noted at the very end of the hearing, something more than isn't a sock or a pair of pants.  Why would you leave veterans out of this discussion?  It makes no sense at all.
The pilot program that Doyle babbled on about?  That pilot program was a failure.  By his own description, it was a failure.  You can't fine tune 'we're overwhelmed.'  When that's the case, you need another pilot program to see if your adjustments worked.
There are so many problems with what was said.  And while you could pan for bits of gold with Doyle, someone needed to tell Dr. Beck that she had nothing worth saying and she really wasted everyone's time.  I do get that there's a temptation to think, "I have to speak!  The other person's gone on forever! So let me rattle something off!"  Like many temptations, that one can be resisted.  And, in fact, it should be.
From the House Veterans Affairs Committee to the Senate where Senator Patty Murray is the Committee Chair.  Her office notes:
Thursday, May 17, 2012
CONTACT: Murray 202-224-2834
                 Burr 202-228-1616
VETERANS: Murray, Burr Introduce Bill to Ensure Dignified Burials
Comes after veteran's remains were discovered to have been buried in cardboard box

(Washington, D.C.) – Today, U.S. Senator Patty Murray (D-WA), Chairman of the Senate Committee on Veterans' Affairs, and U.S. Senator Richard Burr (R-NC), Ranking Member, introduced legislation to help ensure every veteran receives a dignified burial. The Dignified Burial of Veterans Act of 2012 would authorize the U.S. Department of Veterans Affairs (VA) to furnish a casket or urn to a deceased veteran when VA is unable to identify the veteran's next-of-kin and determines that sufficient resources are not otherwise available to furnish a casket or urn for burial in a national cemetery. This bill would further require that VA report back to Congress on the industry standard for urns and caskets and whether burials at VA's national cemeteries are meeting that standard. Under current law, VA is not authorized to purchase a casket or urn for veterans who do not have a next-of-kin to provide one, or the resources to be buried in an appropriate manner.
Chairman Murray and Ranking Member Burr, joined by U.S. Senators Bill Nelson (D-FL) and Marco Rubio (R-FL), introduced this legislation after a veteran, with no known next-of-kin, was buried in a cardboard container at a VA National Cemetery in Florida. The exposed remains were discovered during a raise and realign project at the cemetery. The veteran's remains were later placed in a bag and reburied with what was left of the cardboard box.
"When America's heroes make a commitment to serve their country, we make a promise to care for them," said Chairman Murray. "That includes helping to provide them with a burial honoring their service. I was deeply disturbed when I heard this news. There is no reason why the remains of a veteran should ever be treated with this lack of dignity. I am pleased we are taking the appropriate steps to right this indescribable wrong."
"Those who have served our country in uniform deserve our honor, appreciation, and respect, and that responsibility does not end when they pass away," said Senator Burr. "My heart goes out to those affected by the problems at the Florida National Cemetery in Bushnell. We must ensure that the remains of veterans and servicemembers are treated with dignity and respect and that the families of those who have passed away have no doubts as to the quality of the final resting place of their loved ones."
"All veterans deserve a dignified final resting place," said Senator Nelson. "A cardboard box certainly isn't one. That's why we've got to make sure this doesn't happen again."
"Those who serve our nation in uniform deserve our respect and support, from the moment they commit to serve through their deaths and even beyond as we honor their legacies," said Senator Rubio. "Providing dignified burials for veterans is a solemn pledge we must uphold. Cases like this are outrageous and need to be corrected so that no deceased veteran is ever dishonored in this way again."
Meghan Roh
Deputy Press Secretary | Social Media Director
Office of U.S. Senator Patty Murray

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