Thursday, April 10, 2014

Corruption You Knew Was Coming














S. 2170, the "Hatch Act Modernization Act of 2012," which modifies penalties under the Hatch Act to provide for a range of possible disciplinary actions in addition to removal for Federal employees; provides explicitly that various provisions of the Hatch Act that are applicable to State and local governments are in the same way applicable to the District of Columbia; and applies the prohibition against State and local employees being candidates for elective office only to employees whose salary is paid completely by Federal loans or grants;


US House Rep Jeff Miller:  I had hoped that during this hearing, we would be discussing the concrete changes VA had made -- changes that would show beyond a doubt that VA had placed the care our veterans receive first and that VA's commitment to holding any employee who did not completely embody a commitment to excellence through actions appropriate to the employee's failure accountable. Instead, today we are faced with even with more questions and ever mounting evidence that despite the myriad of patient safety incidents that have occurred at VA medical facilities in recent memory, the status quo is still firmly entrenched at VA.  On Monday -- shortly before this public hearing --  VA provided evidence that a total of twenty-three veterans have died due to delays in care at VA medical facilities.  Even with this latest disclosure as to where the deaths occurred, our Committee still don't know when they may have happened beyond VA's stated "most likely between 2010 and 2012."  These particular deaths resulted primarily from delays in gastrointestinal care.  Information on other preventable deaths due to consult delays remains unavailable.   Outside of the VA's consult review, this committee has reviewed at least eighteen preventable deaths that occurred because of mismanagement, improper infection control practices and a whole host -- a whole host --  of other maladies plaguing the VA health care system nationwide.  Yet, the department's stonewall has only grown higher and non-responsive. There is no excuse for these incidents to have ever occurred.  Congress has met every resource request that VA has made and I guarantee that if the department would have approached this committee at any time to tell us that help was needed to ensure that veterans received the care they required, every possible action would have been taken to ensure that VA could adequately care for our veterans.  This is the third full committee hearing that I have held on patient safety  and I am going to save our VA witnesses a little bit of time this morning by telling them what I don't want to hear.  I don't want to hear the rote repetition of  -- and I quote --  "the department is committed to providing the highest quality care, which our veterans have earned and that they deserve.  When incidents occur, we identify, mitigate, and prevent additional risks.  Prompt reviews prevent similar events in the future and hold those persons accountable."  Another thing I don’t want to hear is -- and, again, I quote from numerous VA statements, including a recent press statement --  "while any adverse incident for a veteran within our care is one too many," preventable deaths represent a small fraction of the veterans who seek care from VA every year.  What our veterans have truly "earned and deserve" is not more platitudes and, yes, one adverse incident is indeed one too many.  Look, we all recognize that no medical system is infallible no matter how high the quality standards might be.  But I think we all also recognize that the VA health care system is unique because it has a unique, special obligation not only to its patients -- the men and women who honorably serve our nation in uniform -- but also to  the hard-working taxpayers of the United States of America.

Miller is the Committee Chair of the House Veterans Affairs Committee.  He was speaking at today's hearing on VA accountability.  And about mid-way into the hearing, it got very personal for one member of Congress who teared up during her round of questioning.

US House Rep Jackie Walorski:  I sit here as a freshman lawmaker, so frustrated that there's a bureaucracy that's out of control and if this happened in the civilian world, where negligence was proven time and time again, we would be in the street with signs saying 'shut them down.'  It's an outrage, is what it is. This is an outrage.  And so, I just join the rest of my colleagues here.  This isn't a partisan issue.  This is an American disaster that we have sat here and witnessed -- for me, probably 16 months.  And if I could change your circumstance, I would. I would do it in a heartbeat.  [Sharp intake of breath.] 

Barry Coates: Thank you.

US House Rep Jackie Walorski:  My dad -- [Voice breaking] My dad . . . was a veteran . . . that died of colon cancer.  [Sniffling] This is so personal to me. And as a Committee, I can tell you right now what the VA's going to say when they sit here. They're going to say what the Chairman read in his opening remarks.  They're going to give us long dramatic answers and nothing is going to change unless we in this Congress -- on the House and the Senate side -- decide to stand up and take on one of the biggest issues in this nation -- which is this negligence toward taking care of the people who fight for freedom, fought for liberty and allow us to sit and serve in a place called the US Congress. 

"Teared up" is not mocking Walorski.  And the ". . ." indicates lengthy pauses where she attempted to fight back tears.  I've cried at many of the VA hearings myself, I would not mock anyone for sincerely caring.  I also agree with her remarks about the frustration issue.  I've written of that myself, of how we've been going to these VA hearings since 2006 and nothing gets done.  The VA always has an excuse and the problems today are the same problems the Committees were exploring in 2006.

I was glad for her honest reaction during her time -- it was good to hear a member of the Committee express their frustration.   US House Rep Michael Michaud is the Ranking Member of the Committee. He wasn't at the hearing but this is from Michaud's prepared written remarks, "All too often, members of this Committee hear the same issues raised again and again in reports by agencies such as the Government Accountability Office and the VA’s Office of Inspector General. Findings such as inadequate training, improper oversight, lack of guidance, no accountability, and failing to follow proper procedures already in place, are too common."  Michaud was not present so US House Rep Corrine Brown was acting Ranking Member.

Ranking Member Corrine Brown:  [I]t is unfortunate that we must continually call these hearings to make sure that our nation’s veterans are receiving the care for which they have already paid dearly for on the battlefields and in service to protect the freedoms we all hold most dear.  I find it disturbing that just 2 days before this hearing, the VA has releases findings that its healthcare personnel are not fully trained in the importance of timely consults when treating a veteran. The dictionary defines a consult as the act of seeking information or advice from someone with expertise in a particular area. The system the VA set up to make these consults easier obviously broke down and it is possible that at least 5 veterans died in Florida because the right information was not shared with the right health professionals. I am concerned that in the 5 years after the colonoscopy debacle at the Miami VA, nothing has changed. To refresh your memory, in 2009, staff members at a number of VA facilities noticed improper reprocessing of endoscopes contrary to the manufacturer’s instructions. The VA properly ordered all facilities to Step-Up and get retrained on the procedures.  We want employees to feel free to report questionable issue and procedures without fear of retribution for trying to save lives.

It was a rare moment of coherence for Brown.  And she actually stood with veterans . . . while reading from her prepared remarks.

Then she wanted to insist, at the end of the first panel, that the VA is not broken: "I don't feel like it's broken, I feel like we need to do what we need to do to fix it."  Which would imply a break.

Hey lady, you lady.  Corrine Brown quickly got lost in her Charlene impression as she declared she'd been to "those areas in Florida or Tampa" -- yes, Florida is in Tampa, don't expect logic from Corrine Brown -- "I've been too, or Jacksonville or Gainseville or Lake City.  I mean, I've been to California . . ."

and anywhere I could run
I took the hand of a preacher man 
and we made love in the sun

Poor, Corrine Brown, she's "been to paradise but I've never been to me."

Well, for a few moments she wasn't the biggest joke on the Committee.  We're being real kind and not quoting Loony Corrine Brown telling a man with stage-four cancer that she's got a friend that the hospital released and told him he was as good as dead but, somehow, maybe one of her magic wigs, he's still alive today.  If the story's true, Brown really needs to learn to edit herself and grasp that cancer patients don't need lectures or your hopium.  Loony Corrine Brown.  We're going to need two straight jackets -- one for her wig.

The first panel appearing before the Committee was veteran Barry Coates, The American Legion's Daniel Dellinger (with Edward Lilly).  The second panel was the VA's Dr. Thomas Lynch and Dr. Carolyn Clancy.   The third panel was the Government Accountability Office's Debra Draper, the VA's Assistant Inspector General Dr. John Daigh.

Chair Miller explained, "Mr. Coates waited for almost a year and would have waited even longer had he not actively, persistently insisted on receiving the colonoscopy that he and his doctors knew he needed.  That same colonoscopy revealed that Mr. Coates had stage four colon cancer that had metastasized to his lungs and his liver.  Maybe that is why VA does not want to define accountability in terms of employees who have been fired."  Coates wondered what service members must be thinking as they hear of the VA's 'treatment' of veterans.  He suspected that they wondered if they and their families would suffer similarly when they went from service member to veteran?

Barry Coates:  So something needs to be done and someone needs to be held accountable for it and I understand from other sources that no one's been held accountable for it. And I think someone should be held accountable for it whether it be a director of the [William Jennings Bryan] Dorn VA hospital, whether it be the Secretary of the Veterans Affairs or even the President of the United States. 

Coates would declare that the VA "handed me a death sentence and ruined my quality of life."

Chair Jeff Miller:  Mr. Coates, in the more or less year that it took for you to receive a colonoscopy through the Department of Veterans Affairs, did anybody at any time ever tell you that you could be authorized to receive the procedure that you needed done through a private provider in the community enabling you to get a diagnosis sooner 

Barry Coates:  No, sir.  I never was advised during that time period.  During that time period, I seen, from January of 2011, when I first complained about it, till the day of my colonoscopy which was December the 9th of 2011, I've seen four different doctors that was in the VA system.  One was Rock Hill Clinic Outpatient Dr. Verma -- she was my outpatient clinic doctor I had in Rock Hill, South Carolina.  I moved to the location I live now.  I transferred.  It takes roughly anywhere from four to six months to get transferred to a different location for outpatient care which would have been the Florence clinic.  Upon that, I'd seen Dr. Verma on January, March and I think in May of that same year.  Each time, my problem got worse and she made notes in her comments because I got -- retrieved -- copies of those from the VA and she made note of those "may need colonoscopy" -- never set a consult up for it.  Upon getting transferred to the Florence Clinic in June of 2011, if I remember correctly, Dr. Neumann was my doctor there. And being a new patient, he did a full exam, looked over my information from Dr. Verma prior to treating me and he kind of got upset because she didn't have me on certain prescriptions because of taking pills for pain will cause certain problems and that I should have been on something already from that, from being on those for quite a few years. But he immediately set me up on a consult with a GI surgeon which I didn't never get to an appointment with her until probably either around the eighth month or maybe the ninth month if I remember correctly, Dr. Kim.  And upon seeing her, I seen her twice.  She delayed it another two or three months.  And I went back to her again, around the tenth month.  We didn't have a good communication ability between each other because she kind of made me mad from my first appointment because of things that she could have done then that would have resulted earlier and set a consult up for a colonoscopy if she would have done a couple of other procedures other than a physical exam.  I learned that she could have done a CT exam or a CT scan [. . .] exam which would have found the tumor which was only 5 inches in the area -- in the lower rectum area.  After that appointment with her on the 10th, she set me up for a consult for a colonoscopy to be done -- which I received the appointment in the mail two weeks later and it was actually scheduled for April of the following year -- we're talking six more months out -- and I'd already been in pain for eight months already and suffering because of this.  But I didn't let that stand in front of me, so I called the department that scheduled that appointment and they told me that that's the normal time -- usually around six months -- before you could get a colonoscopy.  There was nothing that she could have done to get it earlier, that only way you could get it done earlier was to request your physician to write the chief GI surgeon or either the gastrologist to get it done sooner.  Or you could call each day to see if anyone dropped off from the appointment schedule.  And I asked her could she write my name down and call me if someone dropped off?  She said she couldn't do that. She called me the next morning at 9:30 and asked me if I could come to an appointment around 2:30 that day which I did.  And that's when I was set up for the colonoscopy to be done at the Fort Jackson military hospital on December the 9th.  So from January to December the 9th was a whole year.

We're going to stop here a second.  'She' can't do that and she did.  She really can't -- we'll go into that in a second.  But she said she couldn't and most likely said that because she didn't want to make a promise she couldn't keep.  She probably receives several calls a week (if not a day) like Coates' call.

It's not possible.

At the time Coates spoke to the woman, he was one person needing a procedure for which there was scheduling required.

Along with Barry Coates, 'she' was facing others wanting to get in sooner.  Let's pretend for just one minute that this was just five people.  'She' doesn't have time to call them and let them know.

I'm not being sarcastic.  'She' has other duties.

But this can be set up automatically and should be.  The VA, for any scheduled procedure, should have an automated system where people waiting for a procedure and willing to take a spot that opens before their own are automatically called and hear, "Hello, veteran.  Tomorrow at 2:00 pm [or whatever time] we now have a cancellation for [whatever procedure].  We will be filling it on a first call first serve basis.  If you are interested in that time slot, please contact us."

Now that alone's going to add a lot of work to 'she' (because it's going to be more than five people calling and she'll have to explain over and over to all but one that the slot is now filled) but it can be done and it can be automated.  Can be and should be. (And if you automated the outgoing call and also automated the first-come-first serve aspect, 'she' wouldn't have to do any additional calls on this.)

Automation also means 'she' doesn't have 140 post-its on her desk that she has to keep track of regarding 'call me if there's a last minute opening.'

The VA needs to automate the system immediately.  These are things that can and should be done and that the VA Secretary should have already started implementing.

US House Rep Julia Brownley: [. . .] Have you had any formal apology from the VA?

Barry Coates:  None. 

"Before I walked up here, I apologized to Mr. Coates," the VA's Lynch wanted to insist.  Yes, yes, you did.  At a Congressional hearing, after Barry Coates had testified -- and testified that no one in the VA had apologized to him, after Coates was done testifying and right before Lynch was about to, he rushed to get in a quick and perfunctory -- we all saw it -- 'apology.'  And to make clear just how insincere it was, Lynch wanted to make his first statement to the Committee, before he started reading from his prepared remarks, "Before I walked up here, I apologized to Mr. Coates."  Give him a gold star -- for insincerity. Coates had stated he did not receive an institutional disclosure (Chair Miller had specifically asked) and to make the 'apology' even more insincere, Lynch wanted to immediately rush into "if he did not receive an institutional disclosure" -- it's not if.  It's testimony to the Committee.

Chair Jeff Miller:  Your recent national consulate delayed review revealed two deaths in Arizona but Committee investigation shows that it appears that it could be much worse than you know.  Or, if you do know that it's worse than what the Committee was told?  So I want to tell you about some information that we have received here in the Committee as it relates to Phoenix.  I've been made aware of internal e-mails from within the VA that suggest that Phoenix VA may have been using an unofficial electronic waiting list where veterans were placed on that unofficial list until an appointment became available.  These lists were supposedly designed to give the appearance that veterans were only waiting for appointments for 24, 25 days or less and they potentially contained thousands of names. In cross-referencing the two lists, it appears there could be as many as 40 veterans whose deaths could be related to delays in care. Were you made aware of any of these unofficial lists in any part of your lookback? 

Dr. Thomas Lynch: Mr. Chairman, I was not.  And Mr. Chairman, I would say that I have tried to work with your Committee, I have visited with your staff.  I was in Atlanta.  I was in Columbia.  I was in Augusta when you made those visits.  I have tried to share the information that we have gained as we are obtaining it.  I know it's not perfect information, sir, but I know that there's a desire on your part to know that information as we obtain it. I am more than willing to meet with your staffers and take their information so that I can use it, sir. If I don't have that information, I can't act on it.

Chair Jeff Miller: So your people had two lists and they even kept it from your knowledge so my question is: Does that make you even internally question the validity of the information being utilized in your lookback or review?

Dr. Thomas Lynch:  At the moment, sir, it does not.  But I am open. I am happy to meet with your staffers. I'm happy to look at the data so that we can understand it and see what the issues and the problems are.

Chair Jeff Miller: I want to provide you with a request for a preservation order for all potential evidence at Phoenix.  And I would also ask the Inspector General for health care, Mr. Day, to look into this issue as soon as possible.  I will be putting a letter to you as quickly -- but I want to make this as an official request, on the record, and we are ready to assist by providing our input and any assistance that Dr. Day may need as he goes through.  It's been mentioned a couple of times in here about Dorn being awarded a little over a million dollars -- one-million-point-two or some number like that -- to help in the backlog of fee base colonoscopy.  The money was provided in September of 2011.  I have still not been able to get a solid answer where that money went.  So I hope you'll be able to provide some insight this afternoon.

Dr. Thomas Lynch:  Mr. Chairman, I know that that information has passed through VHA.  I took the opportunity to listen to the Deputy Secretary's hearing the other day.  I know he has committed to increasing the communication with Congress and with this Committee and I support his efforts and will do what I can to get you the information that you need, sir.

Chair Jeff Miller: So, again, another piece of information the Committee awaits.  I specifically asked for a complete accounting of those dollars when I was at Dorn earlier this year.  On the 22nd of February,  in a Health Committee hearing, Dr. [US House Rep Dan] Benishek asked Dr. [Robert] Petzel to provide a list of circumstances surrounding the removal of six SES employees over the last two years.  Dr. Petzel promised at that hearing that he would provide that information at the end of that week -- this is February 26th.  It's been six weeks since the Committee asked for the information.  We have not received it.  This information was referenced in a Subcommittee on Economic Opportunity that was chaired by Mr. Florez.  And, by the way, Mr. Florez is absent today because he is at the memorial for Fort Hood in Texas.  And the Committee staff has made numerous requests  I would also note that in your -- this statistic was also noted in your written statement for this hearing.  So why is VA keeping this information from the Committee when it was an entirely reasonable request?

Dr. Thomas Lynch: Sir, I wish I had an answer for you that you would find acceptable.  I can only repeat that I support the Deputy Secretary's efforts to get you the information in a timely fashion.

Chair Jeff Miller: You know, I have a bill right now, Dr. Lynch, that gives the Secretary additional flexibility to fire SES employees out of the 320,000 employees at the Dept of Veterans Affairs we're only talking about 450 individuals.  The Secretary is pushing back, saying that he has the tools and that he has, in fact, taken the necessary steps.  And we're talking about six people.  And we've been waiting months now to get that information.  And I just -- as the Chairman and the Subcommittee Chairmen and the Ranking Members just sit here wondering why in the world it takes so long?

We could continue but we don't have the space.  Visit the House Veterans Affairs Committee's VA Accountability Watch for more examples.   On veterans issues, Iraq and Afghanistan Veterans of America's Nick McCormick has a column at Defense One where he advocates for the Suicide Prevention for American Veterans:

The same day we placed American flags on the Mall, we welcomed the introduction of the Suicide Prevention for American Veterans (SAV) Act. The bill was introduced by the first Iraq war veteran to serve in the Senate, John Walsh of Montana. In announcing the legislation and the need for new action, Sen. Walsh shared how this issue has personally affected him, including how one of the soldiers he commanded in the Montana National Guard died by suicide when the unit returned home from Iraq.
Sen. Walsh’s bill would extend VA health care for some veterans from 5 to 15 years, review wrongful discharges, and ensure greater collaboration between VA and DoD to ensure a seamless transition of care for our men and women in uniform.

Now, the House needs to introduce a similar bill and more senators from both parties need to support this bill. The biggest request veterans and the American public need to demand from Congress is this: for once, please do not let the stale election-year politics of old stand in the way of enacting necessary reforms that will save lives.   

Yesterday's snapshot covered Secretary of State John Kerry's appearance before the Senate Foreign Relations Committee hearing.  Wally reported on it in "Learn the Constitution, John Kerry,"  Ruth in "Rand Paul's security concerns re: Benghazi," Wally's "THIS JUST IN! BOTOX KERRY TALKS MONEY!" and Cedric's "John Kerry knows nothing about money" joint-post noted one aspect and Ava covered the hearing in "John Kerry gets prissy and rude before the Senate (Ava)." (Ava will be back at Trina's site tonight to report on today's House Veterans Affair Committee and tonight Ruth will continue to cover Senator Rand Paul's exchange with Kerry.)

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