[Senate Hearing 107-392]
[From the U.S. Government Publishing Office]
S. Hrg. 107-392
NOMINATION OF ANTHONY J. PRINCIPI TO BE SECRETARY OF THE DEPARTMENT OF
VETERANS AFFAIRS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
JANUARY 18, 2001
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JOHN D. ROCKEFELLER IV, West Virginia, Chairman
BOB GRAHAM, Florida ARLEN SPECTER, Pennsylvania
DANIEL K. AKAKA, Hawaii STROM THURMOND, South Carolina
PAUL WELLSTONE, Minnesota FRANK H. MURKOWSKI, Alaska
PATTY MURRAY, Washington JAMES M. JEFFORDS, Vermont
ZELL MILLER, Georgia BEN NIGHTHORSE CAMPBELL, Colorado
E. BENJAMIN NELSON, Nebraska LARRY E. CRAIG, Idaho
TIM HUTCHINSON, Arkansas
William E. Brew, Chief Counsel
William F. Tuerk, Minority Chief Counsel and Staff Director
(ii)
C O N T E N T S
----------
January 18, 2001
SENATORS
Page
Craig, Hon. Larry E., U.S. Senator from Idaho, prepared statement 12
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia,
prepared statement............................................. 4
Specter, Hon. Arlen., U.S. Senator from Pennsylvania, prepared
statement...................................................... 5
Thurmond, Hon. Strom, U.S. Senator from South Carolina........... 8
WITNESSES
Boxer, Hon. Barbara, U.S. Senator from California, prepared
statement...................................................... 15
Letters from:
Martin, Floyd, State Commander, The American Legion,
Department of California, dated January 3, 2001........ 16
Burke, Leo P., Past National Vice Commander, The American
Legion, Department of California, dated January 3, 2001 16
Standard, Stan, Vice Chairman National Legislative
Council, The American Legion, Department of California,
dated January 4, 2001.................................. 16
Blecker, Michael, Executive Director, Swords to
Plowshares, dated January 17, 2001..................... 16
Dreier, Hon. David, a Representative in Congress from the State
of California, prepared statement.............................. 18
Feinstein, Hon. Dianne, U.S. Senator from California, prepared
statement...................................................... 13
Principi, Hon. Anthony J., designate for nomination as Secretary
of Veterans Affairs............................................ 19
Prepared statement........................................... 23
Questionnaire for Presidential nominees...................... 25
Response to pre-hearing questions submitted by Hon. John D.
Rockefeller IV............................................. 27
Response to post-hearing questions submitted by:
Hon. John D. Rockefeller IV.............................. 44
Hon. Bob Graham.......................................... 51
Hon. Paul Wellstone...................................... 52
Hon. Zell Miller......................................... 54
Hon. E. Benjamin Nelson.................................. 55
Hon. Arlen Specter....................................... 56
Hon. Strom Thurmond...................................... 62
Hon. James M. Jeffords................................... 63
Hon. Larry E. Craig...................................... 64
Hon. Jeff Sessions....................................... 65
APPENDIX
Akaka, Hon. Daniel K., U.S. Senator from Hawaii, prepared
statement...................................................... 81
American Legion, prepared statement.............................. 82
Burch, J. Thomas, Jr., Chairman, National Vietnam & Gulf War
Veterans Coalition, letter dated January 11, 2001, to Hon.
Arlen Specter.................................................. 96
Campbell, Hon. Ben Nighthorse, U.S. Senator from Colorado,
prepared statement............................................. 81
(iii)
Combs, Glen E., PA-C, MA, President, American Academy of
Physician Assistants, letter dated January 11, 2001, to Hon.
John D. Rockefeller IV and Hon. Arlen Specter.................. 94
Dils, Diana, National Commandant, Marine Corps League, letter
dated January 22, 2001, to Hon. Arlen Specter.................. 95
Donohue, Thomas J., President and Chief Executive Officer,
Chamber of Commerce of the United States of America, letter
dated January 17, 2001, to Hon. Arlen Specter.................. 95
Gorman, David W., Executive Director, Washington Headquarters of
the Disabled American Veterans, prepared statement............. 91
Long, Almon J., Legislative Chairman, Veterans of Foreign Wars of
the United States, Department of Pennsylvania, letter dated
January 9, 2001, to Hon. Arlen Specter......................... 96
Miller, Thomas H., Executive Director, Blinded Veterans
Association (BVA), prepared statement.......................... 90
Paralyzed Veterans of America, prepared statement................ 92
Sommers, David W., President/CEO, Non Commissioned Officers
Association of the United States of America, letter dated 16
January 2001, to Hon. John D. ``Jay'' Rockefeller IV........... 96
Wallace, Robert E., Deputy Executive Director, Veterans of
Foreign Wars of the United States, prepared statement.......... 93
Woodbury, David E., AMVETS National Executive Director, prepared
statement...................................................... 89
NOMINATION OF ANTHONY J. PRINCIPI TO BE SECRETARY OF THE DEPARTMENT OF
VETERANS AFFAIRS
----------
THURSDAY, JANUARY 18, 2001
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The committee met, pursuant to notice, at 2 p.m. in room
SR-418, Senate Russell Building, Hon. John D. Rockefeller IV
(chairman of the committee) presiding.
Present: Senators Rockefeller, Graham, Nelson, Specter,
Thurmond, Murkowski, Jeffords, Craig, and Hutchinson.
Also present: Senator Boxer and Representative Dreier.
Chairman Rockefeller. The hearing will come to order.
Senator Specter will be here in just a moment, as will
Senator Murkowski, who obviously has a long-time relationship
and has been chairman of this committee I don't know how many
times, but whenever he chooses, basically. We are very pleased
to welcome Senator Ben Nelson, a new member of the committee.
That is an exciting thing. And one of the things that you will
discover is that when we have Veterans' Affairs Committee
hearings, there is always full attendance, and you get a sense
of that as you look around today. That is one of the things
that Frank and I worked on and Arlen and I work on--how, with
something as important as veterans, people sometimes just don't
manage to show up. It is not something I either appreciate,
condone, or like, but we have to live with people as we have to
live with them.
I am very pleased, obviously, to welcome back Anthony
Principi, who is President-elect Bush's choice to be Secretary
of Veterans Affairs. Tony, I have met your wife Liz, and I have
met your son Ryan, but did your other two children get here?
Mr. Principi. No. Unfortunately, one is stationed overseas.
Chairman Rockefeller. That would be difficult.
Mr. Principi. And the other son is making his way here.
Chairman Rockefeller. As you speak. OK. Their names are
Anthony and John. We obviously appreciate them because you are
having to move back from California if this nomination
proceeds, as I hope it will.
Zell Miller hopefully will be here, and I want to make very
sure that he is equally welcomed, along with Ben Nelson. It is
an honor to have him, as it is Ben, on the committee, both new
members. I am going to introduce Senator Thurmond for a comment
after I call on Senator Murkowski.
The committee begins its 30th year. We have a lot of
incredibly important work to do. The VA is an enormous
bureaucracy. It has a lot of work to do. It does a lot of it
very well, and some of it not so well. All of those things we
need to talk about. But it is important to recognize the 30-
year commitment of Senator Thurmond to this Veterans'
Committee.
Senator Thurmond. I organized it. [Laughter.]
Chairman Rockefeller. You organized it.
Senator Thurmond. And you have done a good job with it.
Chairman Rockefeller. Well, thank you, sir. [Laughter.]
Here comes Chairman Specter, and so we will now all have a
round of applause for Senator Thurmond.
[Applause.]
Chairman Rockefeller. Senator Nelson--for whatever vagaries
the Democratic party is involved with--is not yet officially a
member of the committee, although he is, and so I have to ask
unanimous consent that he be permitted to sit in here in full
participation. Knowing that there is no objection, he will do
so.
Tony, because of your years of service to veterans at VA,
here in the Senate where we know you very well from both
places, and from the Transition Commission, I know I don't have
to impress upon you the importance of the leadership role.
Anytime you have that many employees, leadership is everything,
absolutely everything, and you recognize that. Your history is
long, your experience is long, and because of that you will
come with an advantage. But you will also come with a higher
bar of expectation from me, from Chairman Specter, from all of
us. And that is as it should be because you are not new to the
job. You will not have a learning curve as others might.
I will be looking to you, Tony--I think it is all right to
call you Tony, if you don't mind--to define what you believe
the VA's mission is today. Now, we all say that and yet we
often do not get a very good answer. Usually, it comes to the
engraving above the entrance to the building. The mission, in
fact, is greatly more complex than that and it is changing
drastically. As the needs of veterans change, as veterans grow
older, long-term care, all kinds of other things become more
important. So I think that the vision and the mission of the VA
has become a bit more clouded recently. And we will want to
talk about that.
We have all heard the President-elect speak about the need
to revamp the VA health care system. That sounds great and
potentially is great, but what exactly does that mean? What
does that mean to veterans who depend upon the VA? We need to
talk about that. Yes, we have made many sweeping changes in the
delivery of VA health care. Health care is now very often
provided in different settings. Outpatient is the word in
health care in general, and it is very much the word in the VA
also. Outpatient clinics happily dot the VA landscape. We put
one in a very remote county in West Virginia very recently that
opened up just last week. The county is in ecstasy about it. It
is not just the fact that veterans cannot get to other places,
but there are a lot of veterans in the southern part of our
State and so they are very happy to go there. I am sure all
members have those stories.
On the other hand, we also have to improve those so-called
long-term care requirements. We have that on the books. It has
passed. Chairman Specter and I were part of the conference
committee that worked that out. But I would have to say that
the VA has been embarrassingly slow in implementing what is, in
fact, the law. And we need to talk about that.
While the past decade has brought about a lot of change and
transformation to the VA health care system, I think that we
are entering a much more difficult period--for you, for all of
us, and for veterans--a much more challenging, much more
difficult time. The VA medical system is a health care system
with enormous value, especially for veterans who are blind,
have spinal cord injuries or prosthetic devices, need
dependable mental health care, areas where other parts of the
health care system in our country are weak. As you know, I put
a very strong emphasis on research, and Chairman Specter does
too.
So we have to retain all which is great within the VA. If
confirmed, as you will be, you have to protect this very
special health care system, and I am sure you will. And I am
sure that you will also do something else, and I am sure
Chairman Specter would agree with me on this, and that is,
accept the oversight role of this Committee without rancor or
antagonism or defensiveness. It is our job to give vigorous
oversight. Do we always look for the good things? No, probably
not as much as we should. We look for how we can make things
better. That is our job. So, I hope that you will be
comfortable with, and I am sure you will, our oversight
function and the kinds of questions and probings that we ask.
The Veterans Benefit Administration is also in crisis. Last
year, Chairman Specter chaired a hearing on the veterans
adjudication system, and we were greatly disturbed by what we
heard about the lack of quality and timeliness in VBA
decisionmaking. At that hearing, there was a combat veteran
from my State of West Virginia, who is suffering with PTSD, and
he testified that it took 5 years for his VA disability claim
to be approved. Stunning. An absolutely stunning example. He
had the chronology of events. It was all documented. So it is
clear, not just from him, but from the general situation, that
a lot needs to be done. I have visited some of the new
facilities where there is a lot of new technology. But the fact
is that since we had our last hearing on this last July, we are
50,000 claims more in backlog than we were last July. So
technology does not solve all problems. It is how we do it. And
it is not easy. It is easy to complain about, but not easy to
fix. But we have to do that.
Our aging veterans population obviously cannot afford to
wait. We are looking for innovative approaches from you so that
VBA can absorb changes in the law without going into a tailspin
because it is new or because it is a directive from central
headquarters or something and people are resentful of that. We
cannot do business as usual, and everybody understands that.
So, when you are confirmed, and in my judgment you should
be and will be, our Nation's veterans will be depending on you.
VA is standing at a crossroads. It is dealing with very, very
serious issues right now. I look forward to working with you
and to a serious debate on these issues.
[The prepared statement of Senator Rockefeller follows:]
Prepared Statement of Hon. John D. Rockefeller IV, U.S. Senator From
West Virginia
I am very pleased to welcome back a friend who is not new
to this Committee--Mr. Anthony Principi, President-elect Bush's
choice to be Secretary of Veterans Affairs. Tony, I would like
to recognize your wife, Liz, and your three sons, Anthony, John
and Ryan, and thank them for their contributions to this
process, as well.
I also welcome the two new members of the Veterans' Affairs
Committee--Senator Zell Miller and Senator Ben Nelson. As the
Committee begins its 30th year, I am confident that our new
members will make important contributions as we work together,
as we do on this committee, to fulfill our Nation's commitment
to America's veterans. Speaking of commitment to veterans, I
want to take a moment to acknowledge Senator Thurmond's 30
years of service to veterans on this Committee, and ask that we
all give him a warm round of thanks for his leadership.
As Senator Nelson is not yet an official member of the
Committee, I will ask unanimous consent that he be permitted to
sit and participate fully with the Committee as if a member,
pending his final naming to the Committee.
Tony, because of your years of service to veterans--at VA,
here in the Senate, and on the Transition Commission--I know I
do not need to impress upon you the importance of the
leadership role you will soon assume at the VA. As I think you
realize, because of your long history and experience, the bar
will be set higher for you. The honeymoon period others might
enjoy in this new position may, in your case, be short lived.
We will all expect you to hit the ground running to tackle
VA's many challenges. And, of course, we will all be there to
support you.
I will be looking to you, Tony, to define what you believe
VA's mission is today. In many ways I think that has become a
bit clouded.
We have all heard the President-elect speak about the need
to revamp the VA health care system. That sounds great! But
what exactly does that mean to veterans who depend upon the VA?
Yes, we have made many sweeping changes in the delivery of VA
health care. Health care is now very often provided in
different settings, which are frequently not in a hospital.
Outpatient clinics cover the VA landscape and provide new
access points to many veterans. And veterans--unlike many other
groups--now have improved coverage of their long-term care
needs, although VA has been embarrassingly slow in implementing
some of these programs.
But while the past decade has brought tremendous change and
transformation to the VA health care system, we may, actually,
be approaching the most challenging period of all.
Through it all, we must keep our eye on the ball. The VA
medical system is a health care system with tremendous value,
especially for veterans who are blind or have spinal cord
injuries, who need prosthetic devices or dependable mental
health care. We must retain what has made VA great.
If confirmed, you will be expected to be a steward and
protector of this very special health care system. We will
accept no less.
The Veterans Benefits Administration is also in crisis.
Last year, Chairman Specter chaired a hearing on the benefits
adjudication system, and we were greatly disturbed by what we
heard about the lack of quality and timeliness in VBA
decisionmaking. At that hearing, a Vietnam combat veteran from
my state of West Virginia, suffering with post-traumatic stress
disorder, testified that it took a full five years for his VA
disability claim to be approved. The documented chronology of
events over that five-year period paints a clear picture of a
benefits system that needs a great deal of work.
We continue to be dismayed by the delays in making
eligibility determinations. And despite efforts by VBA
employees, which have yielded some gains in customer service,
the problems seem to be getting worse. In fact, the backlog has
increased by 50,000 claims just since that hearing in July. We
must do better than this.
You know the old saying: ``Justice delayed is justice
denied.'' Our aging veterans population cannot afford to wait.
We are looking to you for innovative approaches so that VBA can
absorb changes in law and new business processes without always
going into a tailspin. We can no longer continue to do business
as usual.
Tony, if--no, when--you are confirmed, our Nation's
veterans will be depending on you. VA is standing at a
crossroads. It is dealing with very serious issues right now. I
look forward to a serious debate about your approaches to these
problems.
Chairman Rockefeller. I now turn to Senator Specter for his
opening comments.
Senator Specter. Thank you very much, Mr. Chairman. It is a
pleasure to see you in the presiding chair.
Chairman Rockefeller. Two more days. [Laughter.]
Senator Specter. Actually, a little less than that.
[Laughter.]
We have had a close working relationship, really a
partnership in this committee. When they say they are going to
divide the committee 50/50, that does not present any heartburn
to me. We have not functioned on a partisan basis at all. So
whether you have the gavel or I have the gavel, it is a lot
like the positive relationship I have with Senator Harkin on
the Labor-Health and Human Services Subcommittee of the
Appropriations Committee. So with you in the chair, I feel
very, very comfortable.
I think we are fortunate to have the Secretary-designate
Anthony J. Principi here today. He has had extensive
experience, and he is a person we know and admire and trust. He
comes to this job with experience and a great deal of
enthusiasm. He has almost as much enthusiasm as he has ability,
and he has a lot of enthusiasm. I have talked to Tony Principi
about his ideas and we have talked about technology, we have
talked about the claims backlog, talked about the health care
system. There is no doubt that America owes a great deal to
it's veterans.
Senator Murkowski has a 2:30 commitment, as do I. I have to
return to the Ashcroft hearing so I am going to have to excuse
myself early. So I will not talk at length about the first
veteran I knew, my father, Harry Specter. He was not treated
right by the Federal Government. They promised him a bonus and
they backed out on the bonus. They had that great veterans
march. Today, they roll out the red carpet for demonstrators.
In 1932, they rolled out the cavalry and Major George Patton
rode down Pennsylvania Avenue with drawn saber and they shot
and killed some of the veterans. One of the blackest days in
American history. I say from time to time I have been on my way
to Washington ever since to get my father's bonus. And I still
have not gotten it for him.
So service on this committee is really very important. This
committee, I think, has done a good job for veterans as we have
fashioned legislation. I think with Tony Principi as the new
Secretary there will be a brighter day.
My full remarks will be placed in the record, if they may,
Mr. Chairman. Thank you.
Chairman Rockefeller. Absolutely, Mr. Chairman.
[The prepared statement of Senator Specter follows:]
Prepared Statement of Hon. Arlen Specter, U.S. Senator From
Pennsylvania
Good afternoon to all. And welcome, Mr. Principi, to you
and your family.
Let me open by being the first to congratulate Senator
Rockefeller on his ascension to the committee's chairmanship--
though only for this week. I know it is a fine job to have--and
I look forward to returning to majority status next week.
Just a thought or two, if I may, on how I expect to see
this committee operate this year. As anyone who has observed
this committee knows, we operate on a cooperative, bipartisan,
consensus basis here--because we all share a common goal:
honoring the Nation's commitment to those who have defended
her. That being the case, whether Republicans or Democrats are
in the majority--or whether, as will be the case this year, the
committee has equal numbers from both parties--we will work
together. And we will accomplish good things this Congress.
Veterans expect that--and they can count on it.
Since the committee last met, we have taken on two new
members--Senator Zell Miller of Georgia (who, technically,
joined us at the end of the last Congress), and Senator Ben
Nelson of Nebraska (who, technically, will join us next week
when a resolution to that effect is approved by the Senate as a
whole). Welcome to both of you--I look forward to working with
each of you.
I do not want to take an excessive amount of time; we are
all eager to hear from our witness. And I know that Senator
Murkowski is anxious to speak on behalf of Mr. Principi since
Senator Murkowski employed Tony Principi as Republican chief
counsel and staff director when Senator Murkowski's was in
charge of this committee on the Republican side in 1987-1988.
Chairman Rockefeller. I want to call on Frank Murkowski
because he also has to chair a confirmation hearing in the
Energy Committee and will need to be leaving. So I would like
to call on him now, and then Senator Thurmond, I will call on
you, sir.
Senator Murkowski. Thank you very much, Chairman
Rockefeller and Senator Specter.
I look upon the return of Tony Principi with a great deal
of fondness and anticipation. I see his wife, Liz, and his son
back there. Having been out to their home in San Diego, and
recognizing that he has traversed back and forth between his
State of California and Washington, DC, I assume torn between
his love of California and his call to duty, I don't know,
unless the lights have gone out, Tony, explain why you are back
here----
[Laughter.]
Senator Murkowski [continuing]. Other than the reality of
the call to arms your President has asked you to come and
serve.
You are no stranger to serving. I am very pleased to speak
on your behalf. As many in this committee that have a memory
would recall, you and I worked together several years ago when
I was chairman of this committee. I might add that I was the
first chairman of a full committee ever from the State of
Alaska. That was before Dictator Stevens of the--I mean Senator
Stevens, chairman of the Appropriations Committee, achieved his
current status. [Laughter.]
But enough of that. [Laughter.]
In any event, what we have before us is a true veteran.
Tony's combat record speaks for itself. He is highly decorated
from his service in Vietnam. And I think it is interesting,
after Tony came back to Washington in various capacities of
service to the veterans and served me certainly during my
chairmanship, he took the Deputy Secretary and Acting Secretary
of Veterans Affairs, and then he went back in the private
sector. I think that deserves consideration because I think
Tony got a little different feel for what it is like to be
outside Government. He was associated with Martin-Marietta in
various aspects, and he serves currently, or until a short time
ago, as president of the QTC Medical Services, Incorporation, a
group of professionals providing independent medical
examinations and medical administration throughout the Nation.
So this kind of balance and this kind of background and
this kind of expertise I think is going to be very beneficial
in updating procedures and service in serving our veterans. I
think that balance and recent experience in the private sector
is going to serve you well, Tony.
I would also like to acknowledge the reality that Mr.
Principi was tapped by our senior member, Senator Thurmond, to
chair the Commission on Servicemembers and Veterans Transition
Assistance. And those recommendations on educational benefits
served as a basis by which this committee made improvements in
the Montgomery G.I. Bill during the last Congress. And given
other findings of that report I know that our veterans are
going to be extremely happy with Tony as Secretary of Veterans
Affairs.
Tony is the type of individual who will make a decision,
and decisions have to be made relative to the changing needs of
our veterans. Some of these decisions are not necessarily
popular but they are going to have to be made because the needs
do change. We have got more domiciliary requirements for our
veterans. We are not necessarily meeting those requirements.
There is question of how far does the hospital continue to
build brick and mortar go on. These are decisions that Tony is
going to have the background and expertise and the personality
to address and resolve.
I think your desire, Tony, to serve our Nation's veterans
is stronger than ever. I think it is certainly evident in your
family. Two of your three sons, Tony, Jr. and Ryan, are future
veterans serving in the Air Force. So there is no doubt in my
mind that you are going to serve President Bush in the very
best possible manner on behalf of the veterans. I certainly am
going to support your nomination. Our friendship goes back a
long way and it is one that I value. America is very, very
lucky to have you back as you have responded to the call of
arms. I wish you well, my friend.
Thank you again, Mr. Chairman.
Chairman Rockefeller. Thank you, Senator Murkowski.
Senator Thurmond.
Senator Thurmond. Thank you. Mr. Chairman, it is a pleasure
to be here this afternoon. I join you in extending a warm
welcome to the Honorable Anthony J. Principi who will be
nominated to be Secretary of Veterans Affairs. I also welcome
members of his family, friends, and guests.
I am pleased that President-elect Bush has selected a
person of experience and ability for this important position.
Mr. Principi has a strong background and association with the
military community. He is a veteran of the U.S. Navy, a
graduate of the U.S. Naval Academy, and a highly decorated
Vietnam veteran. He also served in the Navy Judge Advocate
General Corps. I know Mr. Principi is well qualified for this
position, having previously served as Acting Secretary of
Veterans Affairs and Deputy Secretary of the VA.
I personally know Mr. Principi to be a capable and
dedicated public servant. In 1993, I called upon Mr. Principi
to be my staff director for the Senate Armed Services
Committee. Later, as chairman, I appointed him to a
Congressional Commission on Military Servicemembers and
Veterans Transition. He subsequently was elected by his
colleagues as chairman of that commission. In each of these
instances his performance was exceptional.
There are a number of important issues facing the
Department of Veterans Affairs which affect veterans, their
families, and employees of the Department. I mention a few of
these issues to emphasize my own concern and to stress to Mr.
Principi that he must aggressively address these matters.
First is the issue of veterans benefits. It takes too long
now to get initial decisions and the review process can take
years. I hope Secretary Principi will work with the Under
Secretary for Benefits to improve the VA benefit review
process.
Second is my concern with veterans health care. The
Congress and the VA have enacted and implemented a number of
reforms. The challenge now is to ensure that the availability,
delivery, and quality of health care improves.
A third issue is that of Veterans Equitable Resource
Allocation, known as VERA, V-E-R-A. As you know, the Congress
passed a bill that requires VA to allocate resources according
to veteran population and use of VA medical facilities. This
generally has meant a shift of some resources from the
Northeast to the South and West. I trust Secretary Principi
will continue to support this important reform despite
political pressures to do otherwise.
Mr. Chairman, again I congratulate Mr. Principi on his
nomination. I look forward to working with you, members of the
committee, and with the Secretary as we address the needs and
concerns of the men and women who have given much for our
Nation. Thank you.
[The prepared statement of Senator Thurmond follows:]
Prepared Statement of Hon. Strom Thurmond, U.S. Senator From South
Carolina
Mr. Chairman: It is a pleasure to be here this afternoon. I
join you in extending a warm welcome to the Honorable Anthony
J. Principi, who will be nominated to be Secretary of Veterans
Affairs. I also welcome members of his family, friends, and
guests. I am pleased that President-elect Bush has selected a
person of experience and ability for this important position.
Mr. Principi has a strong background and association with
the military community. He is a veteran of the United States
Navy--a graduate from the U.S. Naval Academy and a highly
decorated Vietnam veteran. He also served in the Navy's Judge
Advocate General Corps.
I know Mr. Principi is well qualified for this position,
having previously served as Acting Secretary of Veterans
Affairs and Deputy Secretary of the VA.
I personally know him to be a capable and dedicated public
servant. In 1993, I called upon Mr. Principi to be my Staff
Director for the Senate Armed Services Committee. Later, as
Chairman I appointed him to a Congressional Commission on
Military Servicemembers; and Veterans Transition. He
subsequently was elected by his colleagues as Chairman of that
Commission. In each of these instances, his performance was
exceptional.
There are a number of important issues facing the
Department of Veterans Affairs which affect veterans, their
families, and employees of the Department. I mention a few of
these issues to emphasize my own concern and to stress to Mr.
Principi that he must aggressively address these matters.
First, is the issue of Veterans Benefits. It takes too long
now to get initial decisions and the review process can take
years. I hope Secretary Principi will work with the Under
Secretary for Benefits to improve the VA benefit review
process.
Second, is my concern with veterans health care. The
Congress and the VA have enacted and implemented a number of
reforms. The challenge now is to ensure that the availability,
delivery and quality of health care improves.
A third issue is that of Veterans Equitable Resource
Allocation (VERA). As you know, the Congress passed a bill that
requires VA to allocate resources according to veteran
population and use of VA medical facilities. This generally has
meant a shift of some resources from the Northeast to the South
and West. I trust Secretary Principi will continue to support
this important reform despite political pressures to do
otherwise.
Mr. Chairman, again, I congratulate Mr. Principi on his
nomination. I look forward to working with you, members of the
Committee and with the Secretary as we address the needs and
concerns of the men and women who have given much for our
Nation.
Chairman Rockefeller. Thank you very much, Senator
Thurmond.
Senator Boxer, I am very aware that you need to leave at
2:45. We will try and make this work.
Senator Nelson is the next.
Senator Nelson. Thank you, Mr. Chairman. I appreciate very
much the courtesy you have extended to me to be here today
prior to my officially taking a position on this very important
committee. I also want to thank Mr. Principi for reentering
public service. As one who has done that on more than one
occasion myself, I recognize it and highly respect individuals
who do that. I will be very brief.
As most people looking at veterans services today and the
benefits and the delivery of those health care services, there
is this continuing concern about the distance of traveling
between hospitals, for example, in more sparsely populated
States like Nebraska. I always point out that we are
geographically challenged--a lot of area and more cattle than
people. But the needs are very strong and we want to make sure
that in the effort to streamline services we do not at the same
time reduce the availability of those services by extending
travel over greater distances, therefore creating unusual
hardships.
In Nebraska, two rural inpatient hospitals have been closed
in the past several years and veterans from the western part of
the State are now often forced to travel all the way to Omaha.
That does not sound like it might be a long way, but going from
western Nebraska to Omaha is like going from Omaha to Chicago.
It does cover a lot of distance.
So one of my first questions for you to ponder, and I know
that you will, is: is there a way to continue to provide
services that do not require that kind of travel. It is a
tremendous hardship to the veteran, to the family of the
veteran. We need to consolidate along the way but we must also
make sure that we give veterans a fair shake.
And on that subject of consolidation, I think we have moved
a little prematurely in some of these areas because, for
example, I do not have the figures for the year 2000, but in
1999 29,500 veterans sought care in Nebraska, and that was a 17
percent increase over previous years. So while we have an
assumption that we are losing a veteran population, in fact we
may see the need for increased services among those who remain.
I am very concerned that we consider that in any future effort
to consolidate services so that we do not start with the wrong
assumption that fewer veterans mean lower needs. In fact, there
may be fewer veterans, but because of advancing age and health
conditions, we might be having just the opposite phenomenon.
And finally, and this is something very specific to
Nebraska, following a large number of complaints from
Nebraska's veterans, the VA's Inspector General conducted an
investigation of the Omaha Veterans Hospital. And while they
found a lot of positive things about the facility, they also
discovered an alarming number of problems, including: poor
treatment of the post-traumatic stress syndrome clinic,
inconsistent followup care for veterans with hepatitis C,
failure to communicate about patient medical histories among
hospital staff, poor monitoring of narcotics, prescriptions,
and poor management and a backlog of the hospital's pain
management program.
These are management issues that involve the delivery of
quality care. They are certainly something that you have not
caused or been part of, but you will inherit them. I hope that
you can ensure that the recommendations of the Inspector
General will be followed up on with this facility, as well as
taking into account what services are going to be required over
the next several years.
Chairman Rockefeller. Thank you, Senator Nelson.
Senator Graham.
Senator Graham. Thank you, Mr. Chairman, at least for
another 21 hours and 30 minutes. I really should say 46 hours
and 30 minutes.
Chairman Rockefeller. It does not really make much
difference what you say, Senator Graham. [Laughter.]
Senator Graham. I want to announce the obvious, which is
that America is very fortunate to have Mr. Principi come back
in its service. I look forward to being an enthusiastic
supporter for your confirmation. You bring a great deal of
experience, confidence, both within the agency and among
America's veterans and here on Capitol Hill.
I will just briefly mention a few areas that will be of
particular interest to me, several of which have already been
covered. I share the comments that Senator Thurmond made about
the importance of the VERA program, which to me has the
objective of assuring that there will be a uniform level of
health care services provided to all of our veterans wherever
they might live in America. I think that is a fundamental
principle of equity and one which we are now closer to
realizing than we had been previously.
Second, I also share the concern that has been expressed by
Chairman Rockefeller and others relative to the disability
claims processing system. We have had a particularly serious
problem at one center in Florida which is charged with the
responsibility of those claims determinations. Unfortunately,
it has one of the longest times required to get a claim
resolved. I have worked with your predecessor on this matter
and look forward to working with you to deal with that specific
issue in Florida but which is really illustrative of a larger
national concern.
Third is the issue that our new colleague, Senator Nelson,
just raised; that is, some of the consequences of the 1995
decision of no new starts of hospitals. In my State, the
consequence has been that we are still growing in our veteran
population and in areas like southwest Florida between Sarasota
and Naples and in the panhandle area we have large numbers of
veterans who are quite distant from any hospital. I think we
need, if we are going to maintain a no new starts policy, to
think through the implications of that and how we can assure
that those veterans are not isolated from access to some
veterans-supported health care.
Finally, the old, old veteran. We know that the age of all
Americans including American veterans has extended. In 1930 the
average American male who reached the age of 65 had about 4 or
5 years of life expectancy. Today they have 15 years of life
expectancy. By the end of this century they will have close to
25 years of life expectancy. And so the Veterans Administration
will be dealing with much different demographics. And how the
Veterans Administration organizes to do so will be critical to
the well-being of millions of Americans now but particularly a
decade from now.
Those are just a few items on the agenda that I look
forward to working with Tony Principi on during what I am
confident will be a distinguished period of service to America
and its veterans. Congratulations.
Chairman Rockefeller. Thank you, Senator Graham.
Senator Hutchinson.
Senator Hutchinson. Thank you, Mr. Chairman. Let me first
of all welcome Mr. Principi. Good to see you. Thanks for coming
over. I want to applaud President-elect Bush for his choice. I
think it sends an unmistakable signal that this administration
is committed to the welfare of our Nation's veterans.
I will, as did Senator Graham, just mention a few issues,
some of which we had an opportunity to visit about in my
office. But the accuracy and timeliness in the processing of
veterans claims is obviously the foundation of the system. Many
veterans have lost faith in that system and it is something
that is going to need to be examined, reviewed, and improved. I
hope you will make the commitment to make that a priority.
We discussed a little bit about veterans health care and
the medical care side of the veterans system. One of my
particular interests is rural health care. I think one of the
major strides that the VA has made is in the establishment of
the community health clinics, the rural health clinics where
veterans do not have to travel 200 miles to Little Rock in
order to get the health care that they have been promised and
that they deserve. We need to continue to expand that system
where we are not just a brick and mortar based. We can be
anchored to but not reliant upon that system entirely. Primary
health care can be provided closer to home at less expense. I
look forward to working with you on that issue.
We discussed some about the concurrent receipt issue. It is
time in this age of surplus that we address the inequity in the
current system and that we come out with a fair concurrent
receipt bill that will not bankrupt the VA but that will meet
and honor the commitment that we have made to our Nation's
veterans.
And finally, we discussed also a little bit about the
Montgomery G.I. Bill. I see in the audience today the author of
that original bill, Sonny Montgomery. As times change, we need
to enhance the Montgomery G.I. Bill. You in your commission
report addressed the issue of portability. That is something,
along with other enhancements, that we need to continue to work
on. I see I have Sonny's attention back there. I think that is
something that we will work together on.
And the last thing, and this is a parochial issue but I
think it speaks to a bigger problem in the VA that I hope that
you will address. We have in Arkansas one State-run veterans
home. We want to start a second one. We have a growing veterans
population, an aging veterans population. In Fayetteville, AR,
where we have a veterans hospital, adjacent to that a regional
privately operated hospital is moving. They have offered to
donate a portion of that building to establish a second State
veterans home. We had VA architects look at the building to see
if it was appropriate. And they said, yes, it was workable.
The State applied for a grant a year ago. Our State
Director of Veterans Affairs talked to me this past week and
said they have never heard an answer. The State legislature is
in session, the State is ready to make a commitment, but we do
not know whether to put in a bill because we have never heard a
response from the VA. I know that you are promptly going to
take care of Fayetteville, AR. [Laughter.]
But we should not take a year to make those kinds of
decisions.
But I have every confidence in your ability to serve and
serve well. Your distinguished career is only going to be
enhanced as Secretary of Veterans Affairs. I look forward to
being able to support that nomination.
Chairman Rockefeller. Thank you, Senator Hutchinson.
Senator Thurmond. Mr. Chairman.
Chairman Rockefeller. Yes, Senator Thurmond?
Senator Thurmond. I ask unanimous consent that a statement
by Senator Craig be entered in the record.
Chairman Rockefeller. I was about to do that. It will be
done, without objection.
[The prepared statement of Senator Craig follows:]
Prepared Statement of Hon. Larry E. Craig, U.S. Senator From Idaho
Mr. Chairman, it is indeed a pleasure to be here at the
confirmation hearing of Anthony J. Principi for Veterans
Administration (VA) Secretary. The VA represents millions of
men and women who have served our great nation, often at
extreme sacrifice. Therefore, in gratitude it is important that
we select a VA Secretary who will insure that our veterans
receive the care and services they were promised and most
certainly deserve.
I believe that Anthony J. Principi is extremely qualified
to serve as VA Secretary. A decorated Vietnam veteran, he has
experience working with Congress and has a history of working
on numerous veterans issues both in the private sector and in
government service. Indeed, I have heard many endorsements from
VA representatives in Boise. I look forward to working with Mr.
Principi on continuing to improve access to services which
recent legislation has provided. As a fiscal conservative, I
understand how difficult it is to insure optimum commitment to
our nations's heroes while balancing the budget. I believe that
Mr. Principi's breadth of knowledge will enable him to ensure
our government honors its commitments to our veterans and
implements the most beneficial and cost effective programs.
I look forward to working with Mr. Principi when
addressing, expanding, and improving the delivery of services
and benefits so that all veterans have equal access to, and
quality of, medical care. In many areas of the country as in
Idaho, the waiting lists are long and only getting longer. Of
course, one of my major concerns is ensuring the necessary
funding for primary care, but we must not forget to provide all
the services and specialty care that many of our veterans'
require as well as making the necessary investment into
research and development into veteran unique medical problems.
The Millennium Health Care Act has had some major impacts;
however, the VA has not yet developed the policies necessary to
deal with issues such as emergency care, Hepatitis ``C'', and
Diabetes.
On a brighter note is the veteran outpatient clinics. In
rural Idaho we have two clinics in Twin Falls and Pocatello,
but have the extensive waiting lists and problems with access
that can justify a third in Lewiston. I would encourage the VA
to continue exploring under serviced areas. Any time we can
provide local as opposed to regional service, the veterans will
be grateful and overall cost reduced.
Veterans who are also military retirees are suffering
greatly in Idaho as well as other rural areas. TRICARE, which
was set up to provide medical services to active duty and
retirees, is bad and getting worse in Idaho. I implore Mr
Principi to work with the Department of Defense (DOD) in
developing procedures for providing medical services to
TRICARE-dependent military retirees in VA facilities.
Another area of concern is the current policy on travel
reimbursement rates. Reimbursing only eleven cents per mile is
inadequate in today's environment, considering soaring gas
prices and the impact of inflation since this policy was
enacted. This has a tremendous impact on our veterans in rural
states, where they may have to travel five hundred miles in a
single round trip to obtain medical care.
And finally, we must unfortunately deal with the increasing
need for Veterans Cemeteries. We must work together to insure
that all our veterans are given the proper and ultimate benefit
of their honorable service.
I believe that Mr. Principi is an excellent choice to help
define our commitment to our nation's veterans, while
recognizing the tough fiscal decisions that must be made. Let
us never forget the important role that our veterans have made
insuring our national security--the United States is a super
power and enjoys such success because of the service and
sacrifice of our veterans for whom we should be forever
grateful.
Chairman Rockefeller. Thank you, Senator Hutchinson, very
much.
I now call upon the distinguished Senator from California.
I do know where you are from, yes. [Laughter.]
We have known each other for a while. Barbara Boxer, we are
very happy that you are here. We welcome your introductory
comments.
Senator Boxer. Thank you so much, Mr. Chairman. It is a
pleasure to be here with you and the soon to be Secretary of
Veterans Affairs. My friend, David Dreier and I are very proud
of the Californians that have been nominated by President-elect
Bush.
I know that the Secretary-designate is aware of every issue
raised here this morning. I am just feeling much better knowing
you are looking after my veterans. Anything I can do to help, I
will.
We already know without my formal introduction that we have
a ``prince'' of a guy--did you get that? I can tell you that
Senator Feinstein very much wanted to be here, Mr. Chairman,
but she is at another hearing. I ask unanimous consent that her
statement be entered into the record at this time.
Chairman Rockefeller. Without objection.
Senator Boxer. Thank you very much.
[The prepared statement of Senator Feinstein follows:]
Prepared Statement of Hon. Dianne Feinstein, U.S. Senator From
California
Mr. Chairman, it is my pleasure to present my fellow Californian,
Anthony Principi, President Bush's Nominee to head the Department of
Veterans Affairs.
A Vietnam veteran who served his country for more than 30 years,
Mr. Principi will champion veterans' rights and ensure that those who
have sacrificed so much for their country are treated with the dignity
and respect that they deserve.
career highlights
Mr. Principi has a built a distinguished career devoted to the U.S.
military and the veterans who serve in it.
After graduating from the U.S. Naval Academy in 1967, Mr. Principi
served on the destroyer USS Joseph P. Kennedy, and then commanded a
river patrol unit in the Mekong Delta.
He was awarded several decorations for the tour I including a
Bronze Star and the Navy Combat Action Medal.
Subsequently, Mr. Principi earned his law degree from Seton Hall
University and was assigned to the Navy's Judge Advocate General's
corps where he served as a Navy liaison to Congress.
Later, he served as Chief Counsel to the Senate Veterans' Affairs
Committee (1984-1988) and staff director to the Senate Armed Services
Committee (1993).
In March 1989, Mr. Principi joined the Bush Administration as
Deputy VA Secretary, and he was named acting secretary for the last
four months of the administration.
With a budget exceeding $34 billion, Mr. Principi was responsible
for maintaining the nation's system of health-care services and benefit
programs for America's 27 million veterans.
In 1996, Mr. Principi served as Chairman of the Congressional
Commission on Military Service Members and Veterans Transition
Assistance.
He oversaw the commission's inquiry, which determined that many
veterans benefits and services are outdated, ineffective or wasteful.
Now, he will have the chance to take the lead in implementing the
recommendations of that commission and ensure that veterans' benefits
are adequate and effective.
In addition to his government service, Mr. Principi has also worked
in the private sector, most recently as President of QTC Medical
Services, Inc. a group of professional service companies providing
independent medical examinations and administration throughout the
nation.
future challenges
The next Secretary of Veterans Affairs will need to continue the
recent progress in correcting long-standing problems in providing
health care to veterans and in getting adequate funding for VA
operations.
I am also hopeful Mr. Principi will fight to improve medical,
education and housing benefits for service members and veterans.
Thank you.
Senator Boxer. I know Senator Feinstein is as excited and
happy about this appointment as I am.
Mr. Chairman, Anthony Principi is highly qualified for this
position. As we all know, it is a very important position. The
VA is the second largest agency in the U.S. Government; only
the Department of Defense is larger.
Our promise to America's veterans is a promise that must be
met. I want to talk to you about something that I have talked
to you about and I am going to spend just a minute on our
conversation. Right now, the number of homeless male and female
Vietnam-era veterans is greater than the number of
servicepersons who died during that tragic war. I am going to
say that one more time. The number of homeless male and female
Vietnam-era veterans is greater than the number of
servicepersons who died during that war. We cannot continue to
turn our backs on these people.
I would ask unanimous consent that my full statement be
entered into the record.
Chairman Rockefeller. Of course.
Senator Boxer. I would also like to submit a letter from a
good friend of mine who is executive director of ``Swords to
Plowshares,'' Mr. Michael Blecker. This agency has served
thousands of poor and homeless veterans in San Francisco. Mr.
Blecker writes, ``Under his direction, the DVA will make
enormous strides to address the needs of all veterans and
particularly those veterans who are homeless and at risk for
being homeless.'' I would like to put that in the record as
well.
Chairman Rockefeller. Without objection.
Senator Boxer. So, Mr. Chairman, thank you for this honor.
Thank you, Tony, and thanks to your family for allowing
this to happen because I know they have started packing. And I
want to say, perhaps just ending with a quote from our
Secretary-to-be: ``I know of no mission more worthwhile than
serving the men and women who have so honorably served this
Nation.''
Thank you very much.
[The prepared statement of Senator Boxer follows:]
Prepared Statement of Hon. Barbara Boxer, U.S. Senator From California
Thank you Mr. Chairman. I appreciate having this opportunity to
introduce Mr. Anthony Principi to your Committee this afternoon.
Mr. Chairman, Anthony Principi is eminently qualified to be the
next Secretary of Veterans Affairs.
It is an important position. The Veterans Administration is the
second largest agency in the U.S. government. Only the Department of
Defense is larger. The VA's mission to serve our 24 million veterans by
providing medical care, benefits, support and lasting memorials in a
dignified and compassionate way is a difficult, but important one.
I know Anthony is passionate about the veterans he has and will
serve. Yesterday, in our brief meeting together, he spoke eloquently
about the need to work harder to help homeless veterans. Right now, the
number of homeless male and female Vietnam era veterans is greater than
the number of service persons who died during that tragic war.
And, on this tenth anniversary of the Gulf War, the VA is reporting
that we are already seeing Desert Storm veterans in the homeless
population. All told, nearly one-third of the adult homeless population
has served in the U.S. Armed Forces.
With his experience as the VA's first Deputy Secretary and later as
acting-Secretary, I am confident that Mr. Principi understands these
tragic facts and has the energy and intelligence to work in creative
ways with this committee to find solutions.
A review of Mr. Principi's past work shows his commitment to
service to this nation.
Mr. Principi began his distinguished career in the military by
graduating from the U.S. Naval Academy in 1967.
Shortly thereafter, he volunteered for duty in Vietnam and went on
to become a highly decorated soldier, earning many combat decorations
including a Bronze Star with a ``V'' for Valor.
He went on to earn his law degree from Seton Hall University in
1975 and was assigned to the Navy's JAG (Judge Advocate General's)
Corps.
In 1984, Mr. Principi joined this Committee as Staff Director and
Chief Counsel, a position he held until 1988.
One of the greatest indications of Mr. Pnincipi's devotion to
America's veterans was his willingness to continue to work on these
issues after the end of the Bush Administration.
In 1996, he was appointed by Senator Thurmond to serve on a
Congressional Commission on Military Servicemembers and Veterans
Transition Assistance and was elected Chairman. This Commission worked
hard to find ways to improve veteran benefits and services--now Mr.
Principi will have a chance to implement those recommendations.
Mr. Chairman, I have heard from the real experts on the matter of
Mr. Principi's qualifications and ability to do this job--the veterans
of California. They are always straight with me and tell it like it is.
Today, they are telling me to support Mr. Principi.
With your permission, Mr. Chairman, I would like to enter into the
record three letters of support from the California American Legion.
They are from the State Commander, the Vice Chairman of the National
Legislative Council and the Past National Vice Commander. Just to read
from one of them:
``[Mr. Principi] possesses the tools, skills, and experience
that will permit him to do a brilliant job meeting the needs of
our military veterans.''
So, Mr. Chairman, I thank you for this opportunity to introduce Mr.
Principi before this committee. I want to recognize his wife, Liz, and
their three sons, Ryan, Anthony, and John. They know that serving in a
Cabinet position can be extremely trying and time-consuming so I want
to thank the entire family for again making this sacrifice.
Please allow me to end by quoting Mr. Principi himself:
``America now reaps the fruit of service of 24 million
veterans. However, their service imposes upon us a reciprocal
obligation . . . I know of no mission more worthwhile than
serving the men and women who have so honorably served their
nation.''
Thank you Mr. Chairman.
______
The American Legion, Department of California,
401 Van Ness Avenue, Suite 117,
San Francisco, CA, January 3, 2001.
Hon. Barbara Boxer,
U.S. Senate,
Washington, DC.
Dear Senator Boxer: I write to you in support of Senate
confirmation of W. Anthony J. Principi for the office of Secretary,
Department of Veterans Affairs. Mr. Principi is steeped in the
knowledge, skill, and experience previously acquired through serving in
this very position.
Our homeless and disabled veterans deserve the caring and
compassionate service that has been the hallmark of Mr. Principi.
Please give Mr. Principi your Senate vote when he comes up for
confirmation in the 107th Congress.
Respectfully,
Floyd Martin,
State Commander.
______
The American Legion, Department of California,
401 Van Ness Avenue, Suite 117,
San Francisco, CA, January 3, 2001.
Hon. Barbara Boxer,
U.S. Senate,
Washington, DC.
Dear Senator Boxer: It is with great honor that I commend to you
Mr. Anthony J. Principi, Secretary-Designate, Department of Veterans
Affairs. The Veterans of The American Legion, Department of California
strongly support Mr. Principi for this job. He was outstanding in the
capacity of first Deputy Secretary of Veterans Affairs and later as
Acting Secretary of Veterans Affairs. He showed great compassion in
serving our military veterans.
You could make California veterans happy by casting your senate
vote for Mr. Principi when he comes up for confirmation early within
the 107th Congress.
Respectfully,
Leo P. Burke,
Past National Vice Commander.
______
The American Legion, Department of California,
401 Van Ness Avenue, Suite 117,
San Francisco, CA, January 4, 2001.
Hon. Barbara Boxer,
U.S. Senate,
Washington, DC.
Dear Senator Boxer: Mr. Anthony J. Principi has been designated to
serve the next administration as Secretary, Department of Veterans
Affairs. He is one of three Californians that have been selected to
serve in positions, which must be confirmed by the Senate. He possesses
the tools, skills, and experience that will permit him to do a
brilliant job meeting the needs of our military veterans.
It is anticipated that Mr. Principi will come up for confirmation
early in the 107th Congress. I urge you to cast your vote to confirm W.
Principi.
Sincerely,
Stan Standard,
Vice Chairman National Legislative Council.
______
Swords to Plowshares,
1063 Market Street,
San Francisco, CA 94103, January 17, 2001.
Hon. Barbara Boxer,
U.S. Senate,
112 Hart Senate Office Building,
Washington, DC.
RE: Letter of Support for Anthony J. Principi as Secretary of the
Department of Veterans Affairs
Dear Senator Boxer, I wish to express my enthusiastic support for
the confirmation of Anthony J. Principi as Secretary of the Department
of Veterans Affairs. As a fellow Vietnam combat veteran and as director
of an agency that has served thousands of poor and homeless veterans in
San Francisco over the past quarter century, I first became acquainted
with Mr. Principi in 1990.
In that year, as Deputy Secretary of Veterans Affairs, Mr Principi
attended one of the very first Stand Down events, pioneered by Vietnam
Veterans of San Diego. These respites from the streets were
extraordinary community-building opportunities for veterans who needed
help but remained distrustful of the Department of Veterans Affairs
(DVA). Stand Downs also represented an effort by advocates and
community providers to pressure the DVA to leave its institutional
walls and join them ``in the field'' where the wounded were. Mr.
Principi's presence at the 1990 Stand Down represented the DVA's first
public endorsement of a community-led intervention on behalf of
homeless veterans.
I worked with Mr. Principi for several years beginning in 1997 when
I was appointed to the Congressional Commission on Servicemembers and
Veterans Transition Assistance. Mr. Principi was elected Chairman of
the twelve-member Commission established by Congress to review programs
that provide benefits and services to veterans and servicemembers
transitioning to civilian life. This Commission's review became the
most comprehensive since that of the Bradley Commission in 1956.
The broad scope of the Commission's charge entailed massive levels
of data collection and official presentations from such imposing
bureaucracies as the Departments of Defense, Veterans Affairs, and
Labor. Yet under Mr. Principi's leadership, the Commission made great
efforts to understand the issues from the perspective of the average
soldier completing his or her tour of duty, and of the ordinary
veteran, whether early in their civilian career or years later. Many
field visits were conducted to active military bases both stateside and
abroad. In addition, Mr. Principi led visits to homeless veteran
programs in order to examine what went wrong with those young soldiers
whose transition was to a life of homelessness. I was continually
impressed with the rapport he established with these men and women. Mr.
Principi treated all who had served with dignity and respect whether he
or she be a Commanding General, an enlisted servicemember, or a
homeless veteran.
The Commission's report reflects Mr. Principi's bold vision on
issues ranging from a meaningful Montgomery GI Bill, to re-engineering
employment and training benefits, to providing affordable and
accessible health care.
In closing, I would like to applaud your efforts and support of
Swords to Plowshares' work to provide care for homeless and low-income
veterans. During your term in public office, you have never forgotten
the veterans who have remained wounded and on our streets. Your efforts
drew congressional attention to the pressing health needs of homeless
veterans, and led to the creation of a local task force to bring
desperately needed resources to the Bay Area. Consequently, Swords to
Plowshares was able to acquire and operate supportive housing programs
for homeless veterans in San Francisco. We now house close to 200
veterans at a time, creating meaningful opportunity for them to
stabilize their lives and return to the community.
I look forward to the vision and leadership Mr. Principi would
bring to the DVA. I am confident that under his direction, the DVA
would make enormous strides to address the needs of all veteran , and
particularly those veterans who are homeless and at-risk for becoming
homeless.
Thank you.
Sincerely yours,
Michael Blecker,
Executive Director.
Chairman Rockefeller. Thank you, Senator Boxer, very much
and thanks for your patience, which is going to be matched by
the patience of Congressman Dreier----
[Laughter.]
Chairman Rockefeller [continuing]. Because a very senior
and wonderful member of our committee, Jim Jeffords, has just
arrived. So I would like to have Jim give his statement, if you
don't mind, David.
Senator Jeffords. Let me be very brief. I have had the
opportunity to discuss fully Tony's rising to this level. I am
enthusiastic about having you working with us and look forward
to that, and I will allow us to go forward with questions.
Chairman Rockefeller. After Congressman David Dreier, whom
I have known for a number of years, also has a chance. I think
you are from the 28th Congressional District, David?
Mr. Dreier. I think so. [Laughter.]
Chairman Rockefeller. Well you know so, but I am just doing
the best I can. [Laughter.]
Mr. Dreier. If you want to know the truth, I never say a
number because we have got so many in California----
Chairman Rockefeller. And they keep changing, right. I
understand. Anyway, we welcome you here.
Mr. Dreier. Thank you very much, Mr. Chairman, Senator
Jeffords, Senator Nelson. I want to join in extending a welcome
not only to Tony, but to Liz and Ryan, and to our former
colleague who was chairman of the House Veterans' Affairs
Committee, Sonny Montgomery.
I think that when you look at this assignment, it is an
extraordinarily important position, as has been pointed out.
And as I look at the statements that have been made over the
last several months by Governor George Bush, it is very clear
that he has demonstrated a desire to strengthen the sense of
pride and peace of mind among our Nation's veterans. He is
very, very committed, as you pointed out, Mr. Chairman, to
revamping the health care system and he is committed to the
goal of returning to the VA, the principle that they are
actually the advocate of the veterans of this country.
I think that when we look at the work that he has done on
this Committee, we see an extraordinary effort.
I am proud as a Californian that Tony is among, as Barbara
mentioned, a list of very distinguished people who will be
members of the cabinet or at top level posts in this
administration. Condoleeza Rice, from Stanford, is going to be
our Nation's first female African-American National Security
Advisor. Norm Mineta is going to move from his position as
Secretary of Commerce to become Secretary of Transportation. We
are very proud, as Barbara said, of Ann Veneman, who is going
to be the first female Secretary of Agriculture, whom we
introduced this morning. And of course I still call her a
Californian even though she now lives next door to me here on
Capitol Hill with our colleague, Senator Mitch McConnell, that
being Elaine Chao, who is going to be our great Secretary of
Labor. We are proud of these Californians, and Tony Principi is
clearly among them.
We all know that he is extraordinarily well equipped to
provide first-rate service. I know that he will in fact listen
very closely to the oversight provided by the Senate Veterans'
Affairs Committee. Good luck to you.
Thank you very much, Mr. Chairman.
[The prepared statement of Mr. Dreier follows:]
Prepared Statement of Hon. David Dreier, a Representative in Congress
From the State of California
Chairman Rockefeller and members of the Committee, I am
pleased to be here today to say a few words of introduction for
my friend and fellow Californian, Anthony Principi.
Anthony Principi's ties to the military and his knowledge
of veterans issues run deep. He is the son of a World War II
veteran and a Naval Academy graduate he was highly decorated
for his service in Vietnam, where he commanded a river patrol
unit in the Mekong Delta, earning the Bronze Star.
Along with his military service, Tony served as a staffer
on both the Senate Committee on Armed Services and Veterans'
Affairs Committee. Under President Bush, he was appointed to be
the first Deputy Secretary of Veterans Affairs and eventually
Acting Secretary of Veterans' Affairs. During his time at the
Department of Veterans Affairs he was one of the first to call
for the establishment of a registry to track the medical
conditions of Persian Gulf War veterans.
After he left government service, Tony continued to be
active in veterans issues. He was appointed Chairman of the
Congressional Commission on Servicemembers and Veterans
Transition Assistance where he helped to develop
recommendations to Congress on improvements for the services
and benefits for active duty service members and veterans.
During his campaign, President-elect Bush discussed the
need to restore a sense of pride and peace of mind to our
veterans. President-elect Bush has promised to improve the way
veterans are treated. His plan includes; modernizing the
veterans health care system, returning the principle of the VA
to that of an advocate for veterans who seek service-related
disability claims, and the establishment of a Veterans Health
Care Task Force to ensure that laws regarding veterans are
being fully implemented.
I believe that Tony Principi has the experience required to
implement President-elect Bush's plans to improve the care and
treatment of our veterans. Mr. Chairman, I thank you for
allowing me the opportunity to say a few words about my friend
and the next Secretary of the Department of Veterans Affairs,
Anthony J. Principi.
Chairman Rockefeller. Congressman, thank you very much.
Thank you for taking the time to be here with us. I am sure
that Tony Principi is very happy that you did that.
In closing for the moment, I note that the nominee has
completed the Committee Questionnaire for Presidential Nominees
and responded to my prehearing questions, all of which will
appear in the hearing record. Also I have reviewed the letter
from the Office of Government Ethics acknowledging that Mr.
Principi is in compliance with laws and regulations governing
conflicts of interest. As chairman of the committee, for the
moment, I have reviewed Mr. Principi's FBI report and find no
bar to his confirmation.
At this point, before you give your testimony, Mr.
Principi, I would ask that you stand and take the oath.
Do you swear and affirm that the testimony that you will
give at this hearing and any written answers or statements you
provide in connection with this hearing will be the truth, the
whole truth, and nothing but the truth?
Mr. Principi. I do.
Chairman Rockefeller. Thank you, sir. You may be seated. We
look forward to your statement, which we hope will be about 10
minutes or so long. [Laughter.]
STATEMENT OF HON. ANTHONY J. PRINCIPI, DESIGNATE FOR NOMINATION
AS SECRETARY OF VETERANS AFFAIRS
Mr. Principi. Thank you, Mr. Chairman, Senator Specter,
members of the committee. I thank you for inviting me to appear
before you this afternoon. I am indeed honored. And I again
wish to thank Senator Murkowski, Senator Boxer, Congressman
Dreier for their very kind words of introduction. I also wish
to acknowledge Congressman Sonny Montgomery, the former
chairman of the House Committee on Veterans' Affairs, who has
been an inspiration to me my whole professional life in this
city. I know I would not be sitting here today were it not for
his unyielding support for my candidacy. I am so very thankful
to him for his friendship and his advice over the years.
And, of course, I am deeply thankful for the support of my
parents; my father, now gone, who came to this country as an
immigrant, and who served his country so gallantly in World War
II, and my mother, whose health prevents her from being here.
To my wife, Elizabeth, a Navy nurse during the Vietnam war who
also, she reminds me, served as a Navy JAG, who has always told
me that there is no sacrifice too great for the opportunity to
serve in this capacity to serve our Nation's veterans; my son,
Ryan, coming from Vance Air Force Base. I wish my other
children could be here. To my extended family who came from
California, and of course the Moores, who have always been
there for me.
I am honored that President-elect Bush looked to me to
embody his commitment to our veterans.
I am honored that, if the Senate consents, I will assume
leadership over 200,000 very dedicated VA employees who have
chosen careers of public service. They are some of the most
wonderful people I have ever known and have worked with in the
past.
I am honored by the prospect that, if the Senate is
willing, I will work again in partnership with our country's
veterans service organizations.
And most of all, Mr. Chairman, I am honored and humbled by
the prospect that 24 million men and women who answered our
Nation's call to arms may soon look to me to answer their call
for the benefits they earned in the service to our great
Nation.
I have accepted this challenge for one reason. I believe
deeply in the mission of the Department of Veterans Affairs,
and in the Department itself. I am fully committed to its
mission of service to veterans. If I can just make a difference
for America's veterans, then my rewards will far outweigh any
sacrifice I may make.
I do intend to make a difference. The Department of
Veterans Affairs is at a critical juncture. Many veterans have
lost faith in VA's ability to fairly and promptly decide their
claims for benefits. Not without reason. It takes too long to
decide a claim, and the error rate remains too high.
I know that VBA's leadership has addressed these problems.
I applaud their initiative and their innovation. But veterans
do not care about process. Veterans are entitled to outcomes.
It does not matter what VBA is doing. It matters what VBA does.
President-elect Bush promised a top-to-bottom examination
of VA benefits processing. If I am confirmed, I will commission
a broad-based and inclusive task force to conduct that
examination. Mr. Chairman, members of the committee, its
charter will be narrow. I am not interested in abstract
theories of veterans' benefits. I want hands-on practical
solutions. I will not want to hear that problems can't be
solved due to the language of the law. I will work within the
law as the people's representatives in Congress write it.
It will be given a short fuse. If I leave this town with
VBA's problems still under study, I will count my tour here as
a failure.
Our history shows that America can solve just about any
problem if we are united in a common cause and committed to a
victory. And I use the word ``victory'' deliberately. The
clearest example of our country's ability to achieve great ends
while overcoming enormous challenges can be found in
undertakings such as the Manhattan Project or the creation of
entire shipyards out of bare ground in response to World War
II's shipping shortage.
It may be necessary for VA to declare its own war on claims
processing and bring all of its resources to bear in the
campaign to win that war. Success will certainly take bold
steps. All of the participants must be willing to unite in the
common cause.
I do not want to suggest today that I have a preferred
option for conducting this campaign. Nothing should be off the
table. The members of the task force should be free to propose
and discuss any idea, no matter how different it is from the
way VBA operated in 1946 or 1972 or even 1999.
VA's challenges are not limited to prompt and accurate
decisions on disability claims.
Some veterans are skeptical of VA's ability to provide them
with quality health care. I believe that, over all, VHA does
provide very high quality health care, some of the finest care
in America. I commend VHA's leadership as well for their
emphasis on patient safety and quality care. But quality health
care requires constant attention at every level within the
Department. I will keep my eye on that ball.
VHA provides health care to the extent that resources are
available. That means that inefficient or ineffective use of
limited resources would come at the expense of health care for
veterans. I will hold VHA's leadership accountable for their
stewardship of the resources entrusted to them. I must also be
held accountable, because sick veterans would pay the price for
VHA inefficiency. And that would be unacceptable to me.
As Secretary, my bottom line will be access to quality
health care for veterans. This will be particularly true for
veterans who do not have other options, either because they
need specialized services, be it spinal cord injury, blind
rehabilitation, mental health, prosthetics, whatever it might
be, or because their circumstances call on them to look to VA
as their only health care provider in America.
President-elect Bush has promised a top-to-bottom review of
VA's health care system, implementation of the Millennium
Health Care Act, and modernization of barriers hindering
veterans' access to health care. If the Senate confirms my
nomination, the President's goals will be my goals.
Again, I believe that a broad-based, inclusive, tightly
focused, and short-fused task force, drawing on the knowledge
and commitment of the VSOs, forward-looking VA employees, and
VA's partners in health care delivery, our academic
institutions, can help me deliver on that promise by
identifying problems and proposing solutions.
I believe new technology offers VA new opportunities. It
also imposes great challenges. Technology is often expensive,
and is almost always complex. Effective application of complex
technology to already complex processes, such as VA's,
frequently requires rethinking and rebuilding from the ground
up. We can't just pave the cow path and expect to improve
service.
Information technology can offer a means to break down the
bureaucratic boundaries that interfere with quick and efficient
service to veterans as well as the walls now dividing VA from
her sister departments in the Federal Government and, totally
unacceptably to me, barriers that now exist within VA itself. I
applaud outgoing Acting Secretary Hershel Gober for his
commitment and his goals to create one VA. I intend to carry
out his work.
VA has absorbed billions of dollars allocated to improving
its ability to collect, process, and communicate data. Frankly,
I do not see improvements, Mr. Chairman, members of the
committee, proportional to the resources consumed.
I do not now have a solution to VA's information technology
problems. I do know that I intend to find one. And in my search
for a solution I will not be constrained by ``how we have
always done it.'' That path is a dead end. It has not worked.
I will not come before you and claim to have in my hip
pocket an instant solution to all of the challenges faced by VA
and by the veterans VA serves. If the solutions were easy, they
would have been implemented long ago. And while I am blessed
with many friends in the veterans community, and can draw on my
experience on the Hill, in the Department, and on the
Congressional Commission on Servicemembers and Veterans
Transition Assistance, I am also aware that much has changed
during the past 8 years. While I have a rich background of
experience, I also have much to learn.
If I am confirmed, I expect that my initial months in
office will be spent building a foundation of knowledge from
which I can create a blueprint for action.
But I do not intend to come to Washington, sir, to conduct
seminars. I intend to make decisions and to act on them. Those
who know me know that I will be decisive, I will act boldly.
But I assure you I will not act impulsively. I will work
closely with you and with your colleagues in the House. I will
ensure that VSOs are enlisted as partners in developing
solutions as well as in identifying our problems. I will look
to forward-thinking VA employees for their vast experience and
their insightful knowledge.
But study will not be an excuse for delay. If the Senate
blesses me with confirmation, I will make decisions and I will
see them implemented. I will hold the individuals entrusted
with leadership within the Department accountable for their
outcomes, just as I expect to be held accountable.
In short, Mr. Chairman, members of the committee, I appear
before you today not to make a commitment to a specific plan or
programs. I have enough knowledge of the Department and its
problems to know that I still have much to learn before I can
unveil detailed plans or promise specific actions.
Rather, I appear before you today to acknowledge my
personal debt to the millions of Americans who have served our
Nation in uniform in the past, and to the millions who stand
watch today on the ramparts of freedom. I am certainly proud of
my two sons in uniform. My debt to them can be satisfied only
by a commitment to work with you and with our partners in the
VSOs, as well as the Department's employees to identify and
implement the solutions necessary to ensure that veterans
obtain the benefits and health care they have earned.
If the Senate consents to my nomination, I intend to do my
part to satisfy that debt. I know that it will be a team
effort. That is the only way it can work. Some of the team will
be found in the veterans' advocates President-elect Bush has
promised to name to his administration. Some will be found in
the Congress, building on the example set by the members of
this committee, under your leadership and that of Senator
Specter, in obtaining successive $1.7 billion and $1.2 billion
increases in VA's health care budget and, very importantly,
last year's improvements in Montgomery G.I. Bill education
rates so that more veterans can attend school. I look forward
to working with you to build on that record of accomplishment.
Thank you, Mr. Chairman, Senator Specter, members of the
committee for this honor. I look forward to your questions.
[The prepared statement of Mr. Principi follows:]
Prepared Statement of Hon. Anthony J. Principi, Designate for
Nomination as Secretary of Veterans Affairs
Mr. Chairman, Senator Specter, members of the Committee.
Thank you for inviting me to appear before you this afternoon. I am
honored.
I am honored that President-elect Bush looked to me to embody his
commitment to veterans.
I am honored that, if the Senate consents, I will assume leadership
over 200,000 VA employees who have chosen careers of service to
veterans.
I am honored by the prospect of working once again, if the Senate
is willing, in partnership with our country's veterans service
organizations (VSOs).
And most of all, I am honored--and humbled, by the prospect that 24
million men and women who answered our nation's call to arms may soon
look to me to answer their call for the benefits and services they
earned in the service of our country.
I have accepted this challenge for one reason.
I believe deeply in the Department of Veterans Affairs and am fully
committed to its mission of service to veterans. If I can make a
difference for America's veterans, then my rewards will far outweigh
any sacrifice I may make.
And I do intend to make a difference.
The Department of Veterans Affairs is at a critical juncture.
Many veterans have lost faith in VA's ability to fairly and
promptly decide their claims for benefits.
Not without reason. It takes too long to decide a claim. And the
error rate remains too high.
I know that the leadership of the Veterans Benefits Administration
(VBA) has addressed these problems and I applaud their initiative and
innovation. But veterans don't care about process. Veterans are
entitled to outcomes.
It doesn't matter what VBA is doing. It matters what VBA does. And
what VBA now does remains unsatisfactory in the minds of many veterans.
President-elect Bush promised a top to bottom examination of VA
benefits processing. If I am confirmed, I will commission a broad-based
and inclusive task force to conduct that examination.
Its charter will be narrow. I am not interested in abstract
theories of veterans' benefits. I want hands-on practical solutions. I
will not want to hear that problems are intractable because of the
language of the law. I will work within the law as the people's
representatives in Congress write it.
It will be given a short fuse. If I leave this town with VBA's
problems still under study I will count my tour here a failure.
Our history shows that America can solve just about any problem if
we are united in a common cause and committed to a victory. I use the
word ``victory'' deliberately. The clearest examples of our country's
ability to achieve great ends while overcoming enormous challenges can
be found in undertakings such as the Manhattan Project or the creation
of entire shipyards out of bare ground in response to World War II's
shipping shortage.
It may be necessary for VA to declare its own war on claims
processing and bring all of its resources to bear in the campaign to
win that war. Success will certainly take bold steps. All of the
participants must be willing to unite in the common cause.
I don't want to suggest today that I have a ``preferred option''
for conducting this campaign. Nothing should be off the table. The
members of the task force should be free to propose and discuss any
idea, no matter how different it is from the way VBA operated in 1946
or 1972 or even in 1999.
VA's challenges are not limited to prompt and accurate decisions on
disability claims.
Many veterans are skeptical of VA's ability to provide them with
quality healthcare. I believe that, over all, the Veterans Health
Administration (VHA) does provide high quality healthcare. I commend
VHA's leadership for their emphasis on patient safety and quality care.
But quality healthcare requires constant attention at every level
within the Department. I will keep my eye on that ball.
VHA provides healthcare to the extent that resources are available.
That means that the inefficient or ineffective use of limited resources
comes at the expense of healthcare for veterans. I will hold VHA's
leadership accountable for their stewardship of the resources entrusted
to them--because sick veterans would pay the price for VHA
inefficiency. That would be unacceptable to me.
As Secretary, my bottom line will be access to quality healthcare
for veterans. This will be particularly true for veterans who do not
have other options, either because they need the specialized services
provided by VA or because their circumstances call on them to look to
VA as their only healthcare provider.
President-elect Bush has promised a top to bottom review of VA's
healthcare system, implementation of the Millennium Health Care Act,
and modernization of barriers hindering veterans' access to health
care.
If the Senate confirms my nomination, the President's goals will be
my goals.
Again, I believe that a broad-based, inclusive, tightly-focused and
short-fused task force, drawing on the commitment and knowledge of the
VSOs, forward looking VA employees, and VA's partners in healthcare
delivery, can help me deliver on that promise by identifying problems
and proposing solutions.
New technology offers VA new opportunities. It also imposes great
challenges. Technology is often expensive, and is almost always
complex. Effective application of complex technology to already complex
processes, such as VAs, frequently requires rethinking and rebuilding
from the ground up. We can't just ``pave the cow paths'' and expect to
improve service.
Information technology can offer a means to break down the
bureaucratic barriers that interfere with quick and efficient service
to veterans as well as the walls dividing VA from her sister
departments in the Federal government and, totally unacceptably to me,
barriers within VA itself.
VA has absorbed billions of dollars allocated to improving its
ability to collect, process and communicate data. Frankly, I do not see
improvements proportional to the resources consumed.
I do not now have a solution to VA's information technology
problems. I do know that I intend to find one. And that in my search
for a solution I will not be constrained by ``how we have always done
it.'' That path is a dead end. It has not worked.
I will not come before you and claim to have in my hip pocket an
instant solution to all of the problems faced by VA and by the veterans
VA serves.
If the solutions were easy they would have been implemented long
ago. And while I am blessed with many friends in the veterans
community, and can draw on my experience on the Hill, in the Department
and on the Congressional Commission on Veterans and Servicemembers
Transition, I am also aware that much has changed over the last eight
years. While I have a rich background of experience, I also have much
to learn.
If I am confirmed, I expect that my initial months in office will
be spent building a foundation of knowledge from which I can create a
blueprint for action.
But I do not intend to come to Washington to conduct seminars.
I intend to make decisions and to act on them. Those who know me
know that I will be decisive. I will act boldly. But I will not act
impulsively. I will work closely with you and with your colleagues in
the House. I will ensure that VSOs are enlisted as partners in
developing solutions as well as in identifying problems. I will look to
forward-thinking VA employees for their experience and knowledge.
But study will not be an excuse for delay.
If the Senate blesses me with confirmation, I will make decisions
and I will see them implemented. I will hold the individuals entrusted
with leadership within the Department accountable for their outcomes,
just I expect to be held accountable.
In short, Mr. Chairman, members of the Committee, I appear before
you today not to make a commitment to specific plans or programs. I
have enough knowledge of the Department and its problems to know that I
still have much to learn before I can unveil detailed plans or promise
specific actions.
Rather, I appear before you today to acknowledge my personal debt
to the millions of Americans who have served our nation in uniform in
the past, and to the millions who stand watch today on the ramparts of
freedom.
My debt to them can be satisfied only by a commitment to work with
you, and with our partners in the VSOs, as well as the Department's
employees, to identify and implement the solutions necessary to ensure
that veterans obtain the benefits and healthcare they have earned.
If the Senate consents to my nomination, I intend to satisfy that
debt.
Thank you, Mr. Chairman, Senator Specter and members of the
Committee.
I look forward to your questions.
______
Questionnaire for Presidential Nominees
part i--all the information in this part will be made public
1. Name: Anthony Joseph Principi.
2. Address: P.O. Box 9335, Rancho Santa Fe, CA 92067.
3. Position to which nominated: Secretary of Veterans Affairs.
4. Date of nomination: December 29, 2000.
5. Date of birth: April 16, 1944.
6. Place of birth: New York City, NY.
7. Marital status: Married.
8. Full name of spouse: Elizabeth Ahlering Principi.
9. Names and ages of children: Anthony, 27; Ryan, 24; and John, 22.
10. Education: Institution (including city, state), dates attended,
degrees received, dates of degrees:
Mt. St. Michaels; Bronx, NY; 1958-62; Diploma; 6/62.
New Mexico Military Institute; Roswell, NM; 1962-63.
U.S. Naval Academy; Annapolis, MD; 1972-75; BS; 6/67.
Seton Hall University School of Law; Newark, NJ; 1972-75; JD; 5/75.
11. Honors and awards: List all scholarships, fellowships, honorary
degrees, military medals, honorary society memberships, and any other
special recognitions for outstanding service or achievement:
President Student Bar Assn., Seton Hall Law (Tuition Scholarship)
1974-75.
Bronze Star w/Combat V.
2 Navy Commendation Medals w/Combat V.
Vietnamese Combat Medal, Combat Action Medal; (2) Navy Commendation
Medals.
Several VA Special Recognition Awards.
New Mexico Military Institute Scholarship.
12. Memberships: List all memberships and offices held in
professional, fraternal, business, scholarly, civic, charitable, and
other organizations for the last 5 years and other prior memberships or
offices you consider relevant:
State Bar of California; 1978-Present.
State Bar of Pennsylvania; 1975-Present.
California Rea; Estate Broker; 1989-Present.
ABA; Military Committee, Chairman Leg. Subcommittee; 1983-86.
American Legion; 1985-Present.
VFW; 1985-Present.
DAV; 1985-Present.
13. Employment record: List all employment (except military
service) since your twenty-first birthday, including the title or
description of job, name of employer, location of work, and inclusive
dates of employment:
U.S. Senate Armed Services; Counsel; Sen. John Tower; 1980-83.
VA; Administrator Deputy for Congressional Affairs; Harry Walters;
1983-84.
U.S. Senate Veterans Affairs; Chief Counsel (R); Sen. Simpson/Sen.
Murkowski; 1984-88.
VA; Deputy Secretary; 1989-90.
VA; Acting Secretary; Ed Derwinski; 1991-92.
U.S. Senate Armed Services; Staff Director (R); Sen. Thurmond;
1993.
U.S. Navy Broadway Redevelopment Project, San Diego; General
Counsel NAVYCO; 1988-89.
Adams Duque Hazeltine, law firm, San Diego; partner; M. Cathrop; 5/
93-12/93.
Luce Forward, law firm, San Diego; partner; M. Cathrop; 12/93-5/94.
Lee, Principi, Reeder, Lajolla, law firm; partner; 5/94-5/95.
Lockheed Martin IMS, Santa Clara, CA; COO Sr. VP; R. Hartling; 5/
95-5/96.
O'Malley & Principi Properties, Del Mar, CA; partner in real estate
management and sales; 5/94-5/96.
Commission of Servicemembers and Veterans Transition Assistance,
Washington, DC; Chairman; 2/99-7/99.
The Jefferson Group, Washington, DC; consultant; 2/99-7/99.
QTC Management, Inc., Diamond Bar, CA; President QTC Medical
Services Inc.; 7/99-Present.
14. Military service: List all military service (including reserve
components and National Guard or Air National Guard), with inclusive
dates of service, rank, permanent duty stations and units of
assignment, titles, descriptions of assignments, and type of discharge:
U.S. Navy; USN Naval Academy; 1963-67; USS Joseph P. Kennedy
(DD850) 1967-69.
Task Force 116, Republic of Vietnam; 1969-70.
OCS, Newport, RI; 1970-72 (LCDR).
Judge Advocate General's Corp; 1975-80:
Naval Legal Service Office, San Diego Fleet Training Center,
San Diego; Commander, Training Center Pacific Fleet; Office of
Legislative Affairs, Washington, DC.
U.S Naval Reserve, Capitol Hill Unit; 1980-88.
15. Government experience: List any advisory, consultative,
honorary, or other part-time service or positions with Federal, State,
or local governments other than listed above:
Chairman, Commission on Servicemembers and Veterans Transition
Assistance.
Member, NAPA Commission.
16. Published writings: List titles, publishers, and dates of
books, articles, reports or other published materials you have written:
N/A.
17. Political affiliations and activities
(a) List all memberships and offices held in and financial
contributions and services rendered to any political party or election
committee during the last 10 years:
CA State Chairman, Veterans for Bush/Cheney.
Contributed annually to Republican Party and individual Republican
and Democrat candidated for Federal office. Contribution to Republican
Part 1989 $2,000 est.; 1990-Present $1,000/year maximum allowable by
law est.
(b) List all elective public offices for which you have been a
candidate and the month and year of each election involved: N/A.
18. Future employment relationships
(a) State whether you will sever all connections with your present
employer, business firm, association, or organization if you are
confirmed by the Senate: Yes, I have resigned my position effective
upon confirmation.
(b) State whether you have any plans after completing Government
service to resume employment, affiliation, or practice with your
previous employer, business firm, association or organization: No.
(c) What commitments, if any, have been made to you for employment
after you leave Federal service? None.
(d) (If appointed for a term of specified duration) Do you intend
to serve the full term for which you have been appointed?
(e) (If appointed for indefinite period) Do you intend to serve
until the next Presidential election? Yes.
19. Potential Conflicts of Interest
(a) Describe any financial arrangements, deferred compensation
agreements, or other continuing financial, business, or professional
dealings which you have with business associates, clients, or customers
who will be affected by policies which you will influence in the
position to which you have been nominated: None.
(b) List any investments, obligations, liabilities, or other
financial relationships which constitute potential conflicts of
interest with the position to which you have been nominated: None.
(c) Describe any business relationship, dealing, or financial
transaction which you have had during the last 5 years, whether for
yourself, on behalf of a client, or acting as an agent, that
constitutes as potential conflict of interest with the position to
which you have been nominated:
My current Corporation has a contract with the VA to conduct
compensation and pension evaluations. QTC is the the 3rd year of a 5 yr
contract. Additionally, QTC has contracts with DOL (5); DoD (1); and
provides disability evaluations for Social Security in CA, TX, and NC.
(d) Describe any lobbying activity during the past 10 years in
which you have engaged for the purpose of directly or indirectly
influencing the passage, defeat, or modification of any Federal
legislation or for the purpose of affecting the administration and
execution of Federal law or policy:
As Chairman of the Commission on Servicemembers and Veterans
Transition Assistance I testified on Commission recommendations.
(e) Explain how you will resolve any potential conflicts of
interest that may be disclosed by your responses to the above items.
(Please provide a copy of any trust or other agreements involved.)
I shall recuse myself from any and all decisions related to QTC and
ask the General Counsel to moniter and report quarterly to the
Inspector General.
20. Testifying before the Congress
(a) Do you agree to appear and testify before any duly constituted
committee of the Congress upon the request of such committee? Yes.
(b) Do you agree to provide such information as is requested by
such a committee? Yes.
______
Response to Pre-Hearing Questions Submitted by Hon. John D. Rockefeller
IV to Anthony J. Principi
Question 1. You have been described as a VA insider--hands-on and
behind the scenes--while Secretary Derwinski was the public face. If
confirmed, will you maintain this hands-on approach? How would you
define your management style or philosophy?
Answer. I do have a ``hands-on'' management style and I expect to
continue that style should the Senate confirm my nomination. I intend
to make decisions and to act on them. I will act boldly, but I will not
act impulsively. I will work closely with the Congress. I will ensure
that VSOs are enlisted as partners in developing solutions as well as
in identifying problems. I will look to forward-thinking VA employees
for their experience and knowledge. But study will not be an excuse for
delay. If the Senate blesses me with confirmation, I will make
decisions and I will see them implemented. I will also hold the
individuals entrusted with leadership within the Department accountable
for their outcomes, just I expect to be held accountable.
Question 2. What role will you play in selecting other nominees for
VA positions?
Answer. While ultimate responsibility for a Presidential nomination
lies with the President, I am pleased that President-elect Bush has
assured me that I will have a role in the selection of the officials
whom he will nominate for VA positions.
Question 3. For the past two years, Congress has approved buyout
authority for VA to enable it to hire people with the right skills-mix
to meet its changing mission, without resorting to reductions-in-force.
However, it was Congress' intent to ensure that VA continues to meet
the needs of veterans and not use buyout authority to reduce its
overall staffing levels. Please provide information on the use of
buyout authority so far this fiscal year. Include information on how
functions have been eliminated or are being performed in another
fashion. Do you intend to continue use of buyout authority and to seek
an extension of authority for next year?
Answer. My bottom line will be service to veterans. If ``buyouts''
will help improve service to veterans by providing a cost-effective
mechanism to get the right people into the right jobs, while avoiding
the disruption of reductions-in-force (RIFs), then I will support them.
For example, I am advised that, consistent with the original plans
submitted to Congress, VA's use of buyouts facilitates both the ongoing
shift away from inpatient care and the organizational efficiencies that
can be achieved through consolidations and restructuring. Resources
freed up through this effort can and must be used to add new or
restructured positions to improve quality and access to care and by
increasing resources in the Veterans Service Centers. I understand that
VA elements are developing amended operational plans, and progress
reports, on this subject for submission to the Office of Management and
Budget (OMB).
I have been informed that 2,017 buyouts were used VA-wide, November
30, 1999, through December 31, 2000 as follows:
By organization:
VHA..................................... 1,741 (229 in Title 38)
VBA..................................... 239
NCA..................................... 10
Staff Offices........................... 27
By grade:
SES..................................... 3
GS/GM-15................................ 11
GS/GM-14................................ 50
GS/GM-13................................ 168
GS-212 (include wage)................... 1,556
Title 38................................ 229
By gender:
Men..................................... 51%
Women................................... 49%
By race:
Non-minority............................ 66%
African-American........................ 25%
Hispanic................................ 4%
Other................................... 5%
Question 4. VA has been studying various options in contracting out
functions currently performed by VA employees, such as the A-76 study
on loan guaranty property management and the lists created to comply
with the Federal Activities Inventory Reform Act (FAIR). Are you aware
of the problems that HUD has had with its property management contract?
Do you support contracting out VA functions? If yes, do you have any
concerns that it will erode VA's ability to meets its mission?
Answer. I was not aware of the Department of Housing and Urban
Development's (HUD) problems until I received your question. Thank you
for bringing them to my attention.
I am informed that HUD did not conduct a formal A-76 study prior to
its decision to contract out this function. It is my understanding that
HUD was forced to terminate one of its contracts in this area for poor
performance in September 1999, and when they explored the possibility
of bringing the function back within the Department, they discovered
that their ability to perform the function had, in fact, eroded.
Unlike HUD, VA is conducting a formal A-76 cost comparison study to
determine the most cost-effective means of providing property
management services. I am told VA met with HUD representatives to
discuss lessons learned, and the project team has built in safeguards
such as stringent selection criteria, performance requirements, and
contingency plans to mitigate potential problems such as those
experienced at HUD. Should VA eventually decide to contract out for any
property management services, we must ensure a continuing ability to
exercise appropriate oversight of the performance of this important
function.
I believe the private sector can play an important role in areas,
such as information technology, where it is difficult to attract and
retain skilled workers. A partnership between VA and the private sector
can assist VA in meeting its mission. The VA has been a model
throughout the Federal government in performance based contracting and
it has served VA well.
The ability to contract out for services is critical to VA's
mission, particularly for scarce services not readily available within
the VA. The FAIR Act has forced a government-wide analysis of the
functions agencies perform internally to determine which of those
services are available commercially. I am informed that VA constructed
its FAIR Act inventory of Commercial Activities in both FY 1999 and FY
2000 in compliance with this law. I expect VA to continue to meet the
requirements of law and to apply sound business principles in
determining when and where to contract for services. However, I will
not deviate from VA's most important standard which is ``service to
veterans''. In that context, I assure you that I am aware of the value
of the Veterans Health Administration as a national asset. I do not
intend to pursue a course of action that would reduce the value of that
asset, either to veterans and to our country. Nor will I dismiss out of
hand proposals for providing better or more cost-effective service.
Question 5. During your tenure as Deputy Secretary, you and former
Secretary Derwinski advocated reforming the VA system to create
distinctions in eligibility for benefits between veterans' combat and
noncombat disabilities. Do you still promote this policy?
Answer. A 1990 review initially included a distinction between
combat and non-combat disabilities among many options for possible
discussion. Both Secretary Derwinski and I rejected that option and it
was not further pursued. I have no intention of revisiting that issue.
Question 6. Do you support unified IRM/IT funding control at the
Department level or divided within each administration (i.e., Veterans
Health Administration, Veterans Benefits Administration, etc.)? If at
the sub-agency level, how do you plan to ensure that new systems will
be compatible, fully leveraging VA's IT dollars? Please furnish a total
figure for VA's IT expenditures last fiscal year across the entire
Department, with a breakdown for each part of VA and denoting what were
nonrecurring Y2K expenditures.
Answer. As I noted in my opening statement, veterans have not
received benefits proportionate to the information technology dollars
absorbed by VA. VA has too many incompatible systems which do not
interact with each other and which obscure rather than communicate data
needed by veterans, by VA workers in the field and by VA managers. I do
not now know how I will resolve the tension between the uniformity and
compatibility benefits of centralization and the responsiveness
benefits of decentralization. I do know that VA's IT must contribute to
the effort to make VA effective and responsive to veterans and to the
effort to make ``One VA'' a reality rather than a slogan.
Managing information technology and resources devoted to IT are
among the most critical issues confronting VA. Reviews conducted by the
U. S. General Accounting Office, VA's Inspector General and others have
repeatedly cited persistent IT problems as a leading management
challenge for the Department.
The first priority is that all IT funds must be spent effectively
and intelligently. VA must be able to account for all IT funding and to
ensure that all funds are being spent on the programs and
infrastructure that return the best value for all of our stakeholders.
VA has gone through a period of significant decentralization that has
reaped significant benefits. However, decentralization has its own set
of disadvantages. I think it would appropriate for me to review the
current policies and processes very early on and adjust them as
required.
Clearly VA's IT systems must be compatible and function more as a
single entity. In order to reach this goal, three things must be in
place: (1) an overarching architecture for systems, data, and
applications; (2) clear, comprehensive standards; and (3) a strict
process of analysis, approval, and oversight of all IT initiatives
undertaken.
VA reports that during fiscal year (FY 2000) the department
expended $1.07 billion for IT. This figure breaks down as follows:
VHA--$0.88 billion
VBA--$0.13 billion
GOE (non-VBA)--$0.04 billion, which includes:
$25.1 million for OI&T
$14.7 million for HR-LINK$ expenditures
$4.4 million for other GOE
All Other--$0.02 billion (including $1 million for NCA)
During FY 2000, VA expended $12.3 million on the Y2K issue.
Overall, VA Y2K costs for the Department were $34.0 million (which
include biomedical equipment and facility-related system costs). All
costs were covered by redirected funds from within VA's existing
budget.
Question 7. Despite efforts to improve the timeliness and quality
of determinations of eligibility for benefits for veterans and their
families, VA is still facing huge delays and lagging quality levels. It
is nowhere near meeting the goals that had been set for VBA as recently
as the budget submission for fiscal year 2001. What are your plans to
address the problems of the claims adjudication process?
Answer. As I noted in my opening statement, I will make claims
processing a major priority if I am confirmed by the Senate. I will
convene a task force that will re-examine the process from top to
bottom. I will charge them with the mission of identifying problems and
proposing solutions. Nothing will be off the table. This task force
will be a broad-based, inclusive, tightly-focused and short-fused. It
will draw on the commitment and knowledge of the VSOs, forward looking
VA employees and other experts.
I will have to draw on the findings of this task force and on my
own search for more information before I can formulate a plan for
action,
I can assure you that timely and accurate claims processing will be
one of the measures of success to which I will hold VBA leadership
accountable and to which I expect to be held accountable myself.
Question 8. VBA has been restructuring the way it does business in
the last several years. It has divided itself into ``Service Delivery
Networks'' for budgetary and planning purposes. At the same time, it
furthered consolidation of certain functions, such as loan guaranty, to
fewer offices. It has shifted to a team approach to process disability
claims, and it has implemented a ``Balanced Scorecard'' approach to
measure its performance. Do you support these changes, along with the
other measures implemented through Business Process Reengineering? What
changes do you project in the near and far term?
Answer. I will need more information before I reach conclusions on
the effectiveness of the SDN reorganization, consolidation of VBA
functions, the balanced scorecard as an accurate measure of performance
and the effectiveness of process changes derived through ``business
process reengineering. If I am confirmed, it will become my duty to
obtain that information and then make judgments based upon the
information I obtain.
Question 9. Approximately 20 percent of current rating specialists
(738) are eligible to retire within the next two years. Over 600
employees have been hired or redirected from other areas of VBA and are
in the process of being trained. I understand that it takes
approximately 2-3 years to fully train a new adjudicator. What is the
attrition rate of new hires? What will you do to address the
approaching crisis as you lose your most experienced decision-makers?
Answer. I am informed that VBA has a comprehensive plan for
recruitment, training and employee development. They have engaged in a
large scale hiring effort to ensure that, when these rating specialists
do retire, there will be trained employees to step in and continue to
provide uninterrupted service to veterans. The Opportunity Program, a
focused effort to recruit and orient new employees to VBA and its
mission, started in 1998 and continues to serve as a vehicle for new
talent. The combined hiring and retraining efforts have allowed VBA to
increase its C&P decision makers by 50%. VBA informs me that the
attrition rate for new hires has been about 10% over the past three
years.
VBA informs me that they are training and developing new employees
through use of electronic job aids and on-the-job training. New hires
also receive formal training on the mission, vision and customer
service values and practices. VA is also implementing a structured
skills matrix that will assess the current and full performance skills
and knowledge of employees throughout their careers.
Question 10. All federal employers are having difficulty recruiting
and retaining quality employees due to the nation's very low
unemployment rate, particularly in the areas of the country with very
expensive standards of living. Large VA regional offices in big cities
seem to be less successful than smaller, more rural offices (as
determined by both the current Balanced Scorecard measures, as well as
the old methods of monitoring performance). Do you believe that VA can
compete in the big cities for good employees? What can be done to
enhance VA's ability to compete? Is there a problem created by the size
of such offices, beyond just amplifying the typical problems that all
offices have?
Answer. I understand VBA is utilizing the hiring authorities
provided by the Congress and the Office of Personnel Management.
Through VBA's Opportunity Program, and other recruitment efforts, over
2,000 employees have been hired in the last three years in cities all
across the country. The Department tells me that it is also looking at
more flexible and aggressive recruitment authority and retention
options. I expect VA to work with the Office of Personnel Management in
crafting the necessary methods and tools to allow greater flexibility
in hiring, pay setting and incentive programs.
Despite the recruitment and retention challenges experienced in
large cities, I believe there are valid reasons for VA to maintain a
presence in these locations. Large metropolitan areas offer a rich
source of talent and access to a diversity of potential employees. In
addition, big cities tend to have high concentrations of veterans who
seek benefits and services from the VA. With flexible, aggressive
hiring authorities and approaches, VA can be competitive in
metropolitan areas.
On the other hand, I will not rule out at this time any proposal
that can be shown to improve service to veterans. I will state that I
will not advance any proposal that is not informed by the views of the
VSOs, the Congress, and VA's employees.
Question 11. One of the stumbling blocks to more timely and
accurate adjudication of claims is inadequate or delayed compensation
and pension examinations (C&P exams). What will be VBA's future course
of action: to contract out for these examinations, to have VHA perform
the exams exclusively, or to implement a mix of the two models? Will
you be involved in this determination: If all or a portion of the exams
are performed outside of VHA, do you support reducing VHA's
appropriations for C&P exams by a corresponding amount?
Answer. In light of my prior involvement with a private sector
organization providing C&P exams on a contractual basis, I will expect
my Deputy Secretary, in consultation with other VA officials, to act as
the principal Departmental decision maker on this issue.
Question 12. I applaud VBA for being very proactive in the last
several years in establishing its predischarge separation programs.
Determining a service member's eligibility for compensation and
developing vocational rehabilitation plans before she has left the
service, rather than waiting until after separation is a great
improvement in customer service. It allows these servicemembers to
begin the next phase of their lives much sooner than under the
traditional method of adjudicating claims. Further, it is easier for VA
to develop a claim while the servicemember is still in the service and
all the records are readily available. Do you intend to continue these
programs? Will you be expanding the fledgling overseas operations?
Answer. Yes. These sites have provided enormous performance
improvements and I support continuation and expansion of predischarge
of predischarge separation programs. I strongly concur with the points
made in your question. I am informed that at this time, C&P decisions
at these sites are completed in an average of 28 days. I am further
informed that VA has established an overseas site in Korea and just
recently selected its Director. They are currently working out the
details of the MOU with Germany and hope to have an operational site
located there by the end of the fiscal year.
Question 13. The VA and veterans rely upon the U.S. Armed Services
Center for Unit Records Research (CURR) to attempt to substantiate
stressor incidents for post-traumatic stress disorder claims. I have
long recognized the valuable service that this Center provides.
However, I have also been very concerned that the Center's tenuous
funding may affect its ability to carry out this critical assignment.
On January 5, 2001, I wrote to the Secretaries of the Navy and Air
Force seeking additional staffing resources for the Center. What are
your plans for working with CURR to ensure more timely response to VA
requests?
Answer. I am informed that during the latter half of 2000, VA
worked with CURR to begin improving not only the CURR response time,
but the quality of VA's requests as well. For the period January to
June 2000, CURR was receiving approximately 340 referrals per month
with processing delays averaging more than one year.
A VBA ``Help Team'' convened in Washington, D.C., in August 2000 to
improve the quality of VA's research requests to the CURR and to
streamline the process of communicating those requests. The Help Team
made recommendations to improve the stressor verification process.
Recommendations that have been implemented include assigning a CURR
Coordinator at each Regional Office to ensure uniformity and designate
a single point of contact for CURR-related issues and inquiries; issue
interim guidance on CURR development procedures; and utilizing Help
Team findings for feedback and training.
VBA is considering longer term, system-based recommendations to
develop a standardized template for information requests to the CURR. I
hope to receive an early briefing on this matter, if confirmed.
Question 14. Another major source of delays in adjudicating claims
for VA benefits is the National Personnel Records Center (NPRC), which
supplies VA with veterans' service personnel and medical records. These
critical documents assist VA in establishing veteran's status, wartime
service, incurrence of injuries or diseases, and other necessary
information. VA increased the number of employees staffing NPRC
requests, which has helped to reduce the backlog from over 62,000
requests in October 1999 to 41,000 requests pending in November 2000.
Currently, NPRC is only staffed to handle 20,000 requests. Do you
intend to continue to devote VA employees to processing records
requests? What other plans do you have for improving the turnaround
time of requests? What coordination efforts can be made with NPRC to
maximize both VA and NPRC resources?
Answer. I intend to work closely with Secretary designate Rumsfeld
to improve the co-operation and data exchange between VA and DoD. I
will explore all means with the Secretary designate to break down the
barriers between the Departments that create obstacles to the seamless
provision of benefits and services to our men and women in uniform and
to our veterans. In the interim, I intend to continue using VA
personnel to process record requests. The Department successfully
negotiated a Memorandum of Understanding with the NPRC in March of
1999. Staffing levels have increased from seven to 28 in October of
1999. The VA staff was subsequently increased to the current level of
31 in June 2000.
I am informed that VA has substantially reduced the number of
pending requests over the past 12-14 months. VBA is reviewing funding
and space requirements necessary to add 15 additional employees to the
VA Liaison Unit at NPRC. To assure that VBA has a timely and responsive
records request system, I will consider initiating discussions to
develop service level agreements with NPRC as well as other critical
information sources such as NARA and the CURR.
VBA is establishing an electronic link (web site) that allows each
regional office to make requests to VA's own Records Management Center
and the NPRC. As advances in this type of technology continue, the
volume of paper involved in the claims process can be reduced, ensuring
tighter control of information exchange, and improvement in claims
processing timeliness.
Question 15. VBA has been working on its claims file-imaging
project, Virtual VA, to eliminate its dependence on paper claims files.
Do you support continuation of this project? If so, what other
advantages will come from Virtual VA? Do you see it as ultimately
leading to a different structure of VBA, where files are transmitted
electronically to decision-makers who may be located far away from
where the claim was initiated? Do we still need and is it appropriate
to maintain a 57 regional office structure? How would you address the
veterans service organizations' concerns regarding their access to the
files and the decision-makers?
Answer. Based on my current understanding of the process, I support
continuation of the virtual VA project that would provide a significant
degree of flexibility to move information throughout the VA, including
VHA and BVA. Virtual VA holds the promise of reducing the Department's
reliance on paper files while expediting the adjudication of claims.
The questions you raise are exactly the kinds of questions that
would be addressed by the task force I will convene to reexamine VA
claims processing if I am confirmed. I will ensure that these questions
are addressed and resolved with the participation of the VSOs, who play
an essential advocacy and representation role in the evaluation of
claims. I recognize that both veterans and VBA employees are
constituents of members of both the Senate and House and I will ensure
that the Congress is kept informed of proposals as they develop.
Question 16. It has been the VA's position that the Secretary has
the authority to add diseases to the presumptive list of conditions
associated with exposure to ionizing radiation. As Secretary would you
use this authority to add diseases to the veterans' list of compensible
conditions to be comparable to benefits for civilian nuclear workers?
Answer. I am aware that the Department of Veterans Affairs has
drafted a new regulation concerning presumptive service connection for
certain diseases for veterans who participated in radiation-risk
activities during active service or while members of reserve components
during active duty for training or inactive duty training. This
proposed amendment would add cancers of the bone, brain, colon, lung,
and ovaries to the list of diseases that may be presumptively service-
connected and would amend the definition of the term ``radiation-risk
activity.'' In general, I support a policy that ensures that veterans
who may have been exposed to radiation during military service have the
same burden of proof as civilians exposed to ionizing radiation who may
be entitled to compensation for these cancers under comparable Federal
statutes. I understand that the Office of Management and Budget is
holding this regulation until the new administration takes office,
which is appropriate. If I am confirmed, one of my early tasks will be
a review of the details of the proposed regulation.
Question 17. In September 2000, the National Academy of Sciences
released its first report on health consequences associated with
environmental exposures consistent with service in the Gulf War. Public
Law 105-277, requires the Secretary to determine whether to service-
connect such health consequences within 60 days of the NAS report. To
date, the decision has not been made. When will such a determination be
made?
Answer. My understanding is that a preliminary determination by the
Acting Secretary is undergoing review within the Administration.
Question 18. During your previous tenure at VA, you favored paying
full compensation to veterans with psychiatric conditions during the
initial period in which they try to secure and maintain a job. Do you
still support this initiative? If so, why is it limited to psychiatric
patients?
Answer. Yes, I continue to support this initiative. I am committed
to improving veterans' benefits and services and I am not afraid to
consider new ideas in this regard. During my service as Deputy
Secretary, we discussed this particular proposal and my view at that
time was that it could be beneficial to disabled veterans with physical
or psychiatric disabilities. The current rules impose a financial
disincentive on disabled veterans attempting to return to the
workforce. I believe that both veterans and the country are better off
when a disabled veteran successfully returns to the workforce.
Question 19(a). Under the Veterans Judicial Review Act, veterans
were allowed to hire attorneys to represent them after a final VA
decision. The Act further authorizes the VA, with the veteran's
permission, to withhold up to 20 percent of a past-due benefit award
for direct payment of attorney's fees. The Social Security
Administration has a similar provision for certain of its disability
appeals.
VA has proposed eliminating the VA withholding of past-due
benefits. The pro se rate for appellants at the U.S. Court of Appeals
for Veterans Claims (CAVC) is 81 percent at the time the appeal is
filed and 55 percent at the time of decision. I believe that
eliminating the VA withholding would have a chilling rate on the
already small numbers of attorneys willing to represent these veterans.
Do you intend to finalize this regulation?
Answer. This is another matter regarding which I must be thoroughly
briefed before I could prudently answer. Certainly, veterans benefit
from the assistance of counsel during judicial review of their claims.
I agree that the effect on the availability of counsel should be a
major consideration in the Department's decision. I would want to
carefully consider the available evidence regarding this, including the
public comments the Department received in response to the proposal,
before committing to a position.
Question 19(b). The law does not currently allow attorneys to be
paid a fee by veterans for representing them prior to a final VA
decision. Former Chief Judge of the CAVC, Frank O. Nebeker, has
advocated broadening a veteran's right to hire an attorney, stating
that ``we certainly get a great deal of assistance from the volunteer
lawyers that come before our court, and in any way that lawyers could
help, and I think they can, at the administrative level, it would
certainly make a more just system. . . .'' [U.S. House of
Representatives Committee on Veterans' Affairs Budget hearing for FY
99]. Do you support such a change? What impediments, if any, exist to
greater attorney involvement?
Answer. At the administrative level of claims processing, veterans
can take advantage of the representational assistance provided without
charge by veterans service organizations and state and county service
officers. I know that permitting attorneys to charge fees for providing
this same assistance was considered and rejected when the Veterans
Judicial Review Act was debated. I also appreciate the need to keep the
administrative process as non-adversarial and user friendly as
possible. To date, I have not heard a persuasive case for changing the
status quo, but I would listen carefully and be prepared to contribute
to the debate if the issue were joined. Of course, in the end, this is
a question that will be resolved by the Congress, not VA.
Question 20. One of the Transition Commission's recommendations
included limiting VA's home loan guaranties to a one-time use, while
eliminating the funding fee. VA's 1997 customer survey results indicate
that 70 percent of veterans reported they would not have been able to
purchase their home without a VA-guaranteed loan. In FY 1997, 92
percent of VA loans were made with no down payment. Do you support
limiting the VA loan guaranty? If so, how would you avoid veteran
borrowers being denied the opportunity to own their own home if forced
to move or if they lost their homes in tough economic times or natural
disasters? Would you make an exception for significantly disabled
veterans or servicemembers still on active duty who are relocated every
few years?
Answer. The VA home loan program provides veterans with an
important and valuable benefit that should be preserved. The primary
goal of the Transition Commission was to eliminate a user fee paid to
the Government for a benefit that was originally provided at no cost.
However, the Commissioners were also aware that in considering
their recommendations, Congress might require offsets to cover the cost
of program enhancements. One of the offsets proposed by the Commission
was to limit the benefit to one-time use, with the exception of
interest rate reduction refinancing loans.
Current law provides for restoration of the veteran's home loan
entitlement in cases involving natural disasters and I support this
provision. I also think it is appropriate for Congress to carefully
consider the special needs of significantly disabled veterans and
active duty personnel in formulating any program changes. The
possibility of difficult economic circumstances should also be
considered. During difficult economic times, when conventional sources
of mortgage financing are harder to find, the no down payment VA loan
becomes even more valuable to a veteran who is trying to purchase a
home. However, even under current law a veteran whose loan was
foreclosed cannot reuse that home loan entitlement until the
Government's loss has been repaid. I would not support eliminating that
requirement.
Question 21. Another key recommendation of the Transition
Commission was to fully pay veterans' education costs at the school of
their choice. What level of enhancement to existing law do you plan to
propose as Secretary? What plans do you have to ensure that the
existing benefits are fully used by veterans?
Answer. I am pleased that the Congress increased Montgomery GI Bill
benefits by more than twenty percent. This is a step in the right
direction. By increasing the full time monthly rate by almost $100
(from $552 to $650), some of the Montgomery GI Bill's lost purchasing
power has been restored. However, the new rate falls short of increases
recommended by the Transition Commission and other interested parties.
I believe that in America's information economy, education is the
best benefit we can provide to veterans if we are to give them the
foundation for a successful civilian life. In an ideal world, a
veteran's educational opportunities would be limited only by his or her
ambition, aspirations and ability. I recognize that, if I am confirmed
as Secretary of Veterans Affairs, I will have to work within the
realities of the Federal budget process, but I will continue to work
towards the goal of improving veterans' education benefits so that our
nation will receive the highest possible return from the highly capable
veterans who return to our civilian economy each year.
Question 22. Under VA's 1993 ``Veterans Service Area proposal,''
VA's four regional offices were replaced with an eventual total of 22
networks. In your estimation, what are the strengths and weaknesses of
this decentralized system of health care? Is there a need to reinstate
centralized oversight of any of the VA program functions? How do you
envision the VISN's working with you as Secretary?
Answer. One of the first items on my ``to do'' list, if I am
confirmed, will be an evaluation the effects of the VISN
reorganization. It is too soon for me to predict the effect of that
evaluation. I understand the benefits of giving leaders in the field,
and close to the scene of the action, the authority to make decisions
and then holding them accountable for the outcomes. However, I also
believe that there can be only one VA and that veterans will not be
well served if VA evolves into 22 separate systems with differing
benefits packages and access to care.
Question 23. VA continues to open community-based outpatient
clinics (CBOCs) at a high rate on the basis that these clinics improve
access to primary care for many veterans. However, in the current
climate of fixed resources, how will VA ensure that the channeling of
resources into CBOCs does not destroy VA's historical ability to offer
excellent specialized services at its hospitals?
Answer. I am advised that VHA health care facilities have been able
to fund CBOC access points as an outgrowth of the efficiencies that
have occurred through restructuring and realigning health care
delivery. This has included shifting from inpatient to outpatient care,
implementing managed care and reducing hospital lengths of stay. As a
result over the past five years, Dr. Garthwaite believes that VHA has
been able to enhance access to care through CBOCs, while continuing its
significant accomplishments in providing specialized services to
veterans. VHA's specialized services are one of the jewels in VA's
crown and one of the primary justifications for sustaining VHA as a
unique medical care system. I will not support decisions that threaten
those services and I look forward to consulting with all interested
parties as future decisions regarding specialized services evolve.
Question 24. What is your view of the right mix of services that
should be provided by VA? For example, some have advocated that VA
focus only on specialized services and contract out all services
already available in the community. Do you agree with that approach?
Answer. I believe VA should continue to be a provider of
comprehensive health care services to those veterans who choose to use
the veterans' health care system. Although I think the specialized
services and special disability programs are critical to the mission of
VA, and in many cases unique in our country, I do not support the
approach that VA should focus solely on these services. Spinal Cord
Injury, Blind Rehabilitation, PTSD and Seriously Mentally Illness
programs cannot be appropriately sustained in isolation. Veterans'
health care must be approached holistically. The uniform benefits
package, together with the long-term care services provided in the
Millennium Health Care and Benefits Act, and VA's specialized services,
provide the appropriate mix of services needed to meet the future
health care needs of veterans. This does not mean that I will blindly
endorse maintaining the status quo. VA must constantly be assessing
means to improve the services it offers, or should offer, in light of
the changing needs of veterans and changes in the delivery of health
care. Having said all this, I believe that VA must work closely with
private health care facilities, as well as other governmental health
care providers, to meet the needs of our veterans and coordinate the
delivery quality health care. I believe VA's future will be
strengthened and enhanced by forging strong relationships with others,
by providing a broad array of services, and by assuming a leadership
position in areas of special expertise. I intend to maintain close
communications and consultations with the Congress and our stakeholders
as VA healthcare evolves in our changing times.
Question 25. How will you ensure that the VA protects medical
record privacy, given the widespread access to medical records within
the VA? Will the VA's current practices for protecting patient records
prove sufficient for the newly released Standards for Privacy of
Individually Identifiable Health Information?
Answer. The rapid growth in the use and dependence on technology
has created new challenges concerning the security and privacy of
medical records going beyond the traditional concerns of physical
security. I am informed that VA has recently instituted a Department
wide Accelerated Security Program to address the immediate need to
close digital security vulnerabilities, raise the level of awareness
within the VA to the digital security threat, and establish a corporate
wide security program to manage and respond to tactical and strategic
security requirements. I intend to monitor this program personally to
insure its success.
Section 264 of the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), required the Department of Health and Human
Services to publish Standards for Privacy of Individually Identifiable
Health Information. This is one of several statutes, such as, the
Privacy Act of 1974, the Computer Security Act, the revised OMB
Circular A-130, the Clinger-Cohen Act, and the Government Paperwork
Elimination Act that have placed ever more stringent and detailed
requirements for the security and privacy of medical records in
particular and computerized records in general upon Federal Agencies.
VA will be challenged to implement the new policies and practices
necessary to meet all of our responsibilities under these acts. This is
critical if we are to sustain the trust of America's veterans and other
stakeholders. I appreciate your initiative in emphasizing, through your
question, the importance of VA's compliance with these requirements.
Question 26. I have long advocated strategies for recruitment and
retaining highly trained medical professionals within VA health care
systems, and I supported recently enacted legislation to allow
competitive pay for VA nurses and recognize the role of VA physician
assistants. What policies will you pursue, if confirmed, to improve
recruitment and retention in VHA? What is your view of performance-
based pay for VA employees?
Answer. I believe VA provides, and must continue to provide quality
and compassionate health care. To achieve this, we must have the best
possible health care, executive, and administrative workforce. Human
resource planning must be an integral component of our strategic
planning processes. I will have to obtain more information on specific
proposals for improving recruitment and retention before I can comment
on their merits.
Question 27. Public Law 106-117 contains a provision mandating that
VA provide non-institutional extended care services to enrollees. I
have been informed that ``significant program development'' is needed
to implement this provision. What is the status of this program, and
what will you do to ensure its immediate implementation?
Answer. VA informs me that the non-institutional extended-care
programs envisioned by P. L. 106-117 (adult day health care, geriatric
evaluation, and respite care) are already established in VA, and that
specific programmatic development, other than expansion, will be
minimal. I intend to assure myself of the accuracy of this assessment
as soon as possible.
I am also informed that the Department is publishing a Federal
Regulation to identify and define these services. This expansion to the
long-term care continuum will be added to home health and hospice care
services already defined as part of the basic benefits package. This
proposed final rule is under review in the Department. I expect to act
on the proposed regulation in the very near future after being briefed
on its implications.
Further, I have been informed that VHA is in the process of
developing a new strategic plan for the provision of all long-term care
services that would integrate the P. L. 106-117 provisions with
previous authorities as well as with VA's policy and budget initiatives
for expanding home and community based care services. I understand that
an integral part of this plan will be new performance measures that
ensure full implementation of these important benefits for aging,
frail, and chronically ill veterans.
Question 28. Describe your strategies for encouraging VA health
care providers to cooperate with state homes, affiliates, and community
providers to offer veterans high quality long-term care in the most
cost effective manner.
Answer. I am advised that multiple approaches are being employed to
encourage VA health care providers to partner with State homes,
affiliates and community providers.
State Veterans Homes (SVH) are an integral component of VA's long-
term care (LTC) strategy.
Most SVHs are represented on the VISN level Management
Advisory Councils (MACs).
The SVH program has greatly expanded over the past 10
years, from 63 homes in 1990 to 100 homes in 2000. Funding for
construction and/or renovation of existing homes has been approved for
23 additional projects for FY 2001. VA provides up to 65% of funding
for the construction and/or renovation. Annual increases are provided
in per them rates for ongoing VA assistance for care of veterans in
SVHs.
New regulations have expanded the program to include Adult
Day Health Care program.
Training of VA staff working directly with State homes has
been enhanced and sharing of data sources (Vista access) is encouraged.
New regional nursing home contracts promote partnership.
On December 1, 2000, VHA awarded 11 regional contracts to
organizations spanning 40 states and 900 facilities for quality
community nursing home care.
These new regional contracts (R-CNH) replace similar
``multi-state'' contracts.
The contracts were developed to reduce administrative and
direct care costs while improving access to nursing home care for
veterans. Administrative costs associated with maintaining 3,200
separate local nursing home contracts and the annual inspection process
will be reduced.
Direct care costs are expected to be reduced by providing
a more competitive rate for nursing home care.
Access to community nursing homes will be improved by
adding nursing homes and adding specialized services in selected
nursing homes.
I am also informed that VA has developed a national strategy for
performance measures to improve and expand utilization of home and
community based care (H&CBC), including specific budget initiatives to
increase spending on home and community-based services.
In general, veterans are more satisfied with their long-
term care when the location of care is shifted from institutional to
non-institutional care delivered in the home and community. I am
informed that VHA's strategies for encouraging this shift from
institutional to non-institutional long-term care include:
Performance measures with goals of increasing the
Average Daily Census (ADC) in Home & Community-Based Care
(H&CBC) by 53% from FY00 to FY02, and by 141% in FY06.
The Federal Advisory Commission on Long-Term Care
recommended that VA increase the H&CBC proportion of Long-Term
Care budget from 17.5% to 35%.
The Geriatrics & Extended Care Strategic Healthcare Group (SHG) is
developing a strategic plan to address needs of older veterans that are
not fully met through provisions in the Veterans Millennium Health Care
and Benefits Act.
The Geriatric Research, Education and Clinical Center (GRECC) has
been expanded to promote further affiliations with the academic
geriatrics community for the enhancement of care for older veterans as
well as all older Americans.
The number of GRECCs has expanded from 16 to 21 centers
over the past 18 months. Foci of new GRECCs on important issues of
aging such as end-of-life care, stroke, cardiovascular disease and
mobility.
All GRECC staff are university-affiliated and collaborate
on research projects and educational programs in geriatric care for VA
and community providers.
VA is working to promote the application of enhanced use leasing
(EAL) for access to community-provided long-term care and assisted
living; several projects are in the planning stages.
Four pilot projects for all-inclusive long-term care and assisted
living, authorized under P. L. 106-117, have seen selected and funded.
They will provide numerous opportunities for community collaboration
for enhanced service delivery and will be thoroughly evaluated over the
next three years.
VA is an active participant and visible presence among stakeholders
in key community healthcare community organizations.
VA remains the only federal participant in the in the
National Chronic Care Consortium (NCCC) and the National Alliance for
Caregiving. Both organizations are important advocacy organizations for
the improved provision of services in our communities.
Question 29. Research on drug formularies and their effects on
physician's ability to prescribe the most effective drug for a specific
patient, have shown mixed results. However, all research on formularies
shares one conclusion: good decision-making on product selection
requires well-informed administrators and good clinical oversight.
Please describe what changes you would implement, considering that the
General Accounting Office recently found that better oversight is
required.
Answer. Although I have not read the pending GAO report, I have
been informed that the GAO qualified their recommendation for better
oversight by reporting that ``veterans are getting needed drugs''. My
interpretation of the recommendation is that while VA's formulary
management strategies have improved since the advent of the VA National
Formulary and continue to evolve, enhancements are needed in the area
of administrative oversight in order for progress to continue.
Therefore, based on information provided to me by the Under Secretary
for Health, and on the assurance that health care to veterans will not
be compromised, VA will make such enhancements to ensure that field
managers comply with existing formulary policy.
Question 30. How would you alter, enhance, or improve the
coordination of joint procurement of pharmaceuticals between DoD and
VA? What advantages, savings realized by this joint procurement benefit
VA specifically?
Answer. Joint pharmaceutical contracting activities between VA and
DoD have been an interest of mine since the early 1990s. This interest
carried over into my capacity as Chairperson for the Congressional
Commission on Service members and Veterans Transition Assistance. I
fully support joint pharmaceutical contracting. Soon after taking
office if I am confirmed, I plan to request a briefing on the status of
such activities, and emphasize my support for continued progress. The
primary advantage of joint procurement is that it increases VA's
capability to treat more veterans within available resources. For
example, in July 2000, a joint contract was awarded for the drug,
terazosin, which is anticipated to reduce outlays $23 million annually.
I believe saving approaching $500 million annually can be achieved
through joint procurement, universal product numbers and a national
formulary. These savings can be used to extend the reach of healthcare
to our nation's veterans.
Question 31. Please provide some examples of occasions where
sharing between VA and DoD has been successful--both in terms of
savings and improvements in the delivery of services.
Answer. VA has provided me with the following examples where VA and
DoD have worked together to identify, and attempt to remove barriers to
sharing between the two Departments. VA would like to be DoD's first
choice for supplemental care. Some examples of successful sharing
initiatives include:
VA, DoD and FOH (Division of Federal Occupational Health
within the U.S. Department of Health and Human Services) are
negotiating a contract to provide physical examinations (including
dental screenings and immunizations) to the Army Reserve and the Army
National Guard. The goal is to establish a standardized medical and
dental readiness support system for the Guard and the Reserve while
introducing the service members to VA's health care system.
The Army established an infirmary service at the Richmond
VA Medical Center. The medical center provides living quarters
(infirmary) for those active duty soldiers who the Army determines to
be too ill to return to their personal living area on base for
recuperation. VA identified underutilized space within the medical
center, where room and board as well as ``sick call'' re-evaluation for
the soldiers assigned to the infirmary is made each morning. VA, under
TRICARE, provides health care services required by a soldier beyond the
scope of the Infirmary Service.
The Military Medical Support Office (MMSO) in Great Lakes,
IL, assumed responsibility for managing the Remote Dental Program (more
than 50 miles from a military treatment facility (MTF)) for Air Force,
Army, Army and Air National Guard, Navy and Marine Corps active duty
personnel and authorized Reserve and National Guard personnel. MMSO
also tracks all active duty members in non-MTFs and authorizes non-
emergency medical care and specialized medical/dental care.
VA medical centers occupy clinic space provided by
military facilities as a part of VA's CBOC program. For example,
Louisville, KY, VA Medical Center manages three of Fort Knox's four
primary care clinics. VA provides a broad range of services to support
these clinics including: primary care, urology, orthopedics, women's
clinic, podiatry, audiology, psychiatry, MRI and other radiology,
medical library and orothotic laboratory. The Army provides space for
the clinic, equipment and prescription services.
The Walter Reed/U.S. Army Allergen Extract Laboratory in
Washington, DC, provides delivery of diagnostic and therapeutic
allergen extracts to 29 VA medical centers and outpatient allergy
clinics. This agreement facilitates the treatment of 1,800 veterans per
year with allergy injection therapy for allergic diseases such as
insect venom anaphylaxis, asthma, and allergic rhinitis. In addition,
it is estimated that over 18,000 veterans are evaluated for allergic
diseases annually using these high quality diagnostic allergen
extracts.
Joint ventures are operating at six sites: Albuquerque,
NM; El Paso, TX; Las Vegas, NV; Anchorage, AK; Key West, FL; and
Honolulu, HI.
There are many other areas in which VA and DoD share
resources to provide cost effective services to veterans and service
members, including health information management and technology,
research, and the Military and Veterans Health Coordinating Board.
As I stated, I am committed to finding or creating opportunities to
share resources with DoD in order to expand quality services to
veterans in a cost effective manner.
Question 32. The relationship between VA medical centers and
medical schools has endured for more than 50 years, and has been
credited with improving quality of care for veterans. These
affiliations draw the best and brightest physicians, and help VA
fulfill its research and education missions. I am concerned, however,
about the viability of the relationship. Please share your philosophy
regarding the overall value of academic affiliations; including the
role affiliates play in staffing VA facilities.
Answer. I consider VA's academic affiliations to be an important
and unique characteristic of the VA health care system that contributes
substantially to high quality health care for veterans. A half-century
ago, a radical strategy was proposed to achieve quality in health care:
an academic partnership between the Veterans Administration--later to
become the Department of Veterans Affairs (VA)--and academic medicine.
This partnership has grown into the most comprehensive academic-health
system partnership in history. As you are aware, these partnerships
have expanded over some 50 years to formal affiliations with 107 of the
nation's 125 medical schools. These affiliations provide the context
for training that annually affects over one-third of the nation's
medical resident trainees, including half the nation's third and fourth
year medical students. In addition, over 54,000 associated health
trainees in nursing, psychology, pharmacy, and over 40 other
disciplines receive part or all of their clinical training in VA
facilities.
VA has a relationship with its academic partners that has benefited
both VA and the nation. For example, 70 percent of our medical staff
are members of a medical school faculty. The presence of teachers and
learners in a health care setting creates an environment that questions
and emphasizes current best practices. This benefits veterans' care by
bringing critical thinking to the bedside and clinic on the one hand,
and by contributing to the preparation of excellent health
professionals for the VA and the nation on the other. Academic
affiliations help VA recruit the best and brightest to care for
America's veterans.
Of course, VA exists to provide quality healthcare to veterans and
that paramount goal must always remain the standard against which any
decision, including decisions affecting VA's academic partners, is
measured.
Question 33. What plans do you have to maintain and improve support
for the education and research missions at affiliated VAMCs and CBOCs?
Answer. Since its inception, VA's missions of patient care,
education, and research have been inextricably intertwined. This
interrelationship is most pronounced at VA facilities that are actively
affiliated with medical schools where staff physicians holding joint
appointments as faculty at the affiliated institution customarily
provide direct patient care, teach medical students and residents, and
perform research.
This close collaboration between VA and its academic affiliates at
all levels makes a real contribution to improving care for veterans.
These relationships have played an important part in assuring excellent
care to the nation's veterans. This was true when the idea of academic
affiliations was proposed at the end of World War II, and it continues
to be true over 50 years later. VA's academic mission remains important
during these times of dramatic change in healthcare. If I am confirmed,
I will remain cognizant of the importance of this portion of VA's
mission as I make decisions concerning VHA and veterans' healthcare.
Question 34. If confirmed, what do you plan to do to strengthen VA
affiliations? Would you advocate changes in the way VA contracts with
academic affiliates in light of the financial pressures that health
care reform places on both academic and VA medical centers?
Answer. I am informed that VA maintains active dialogues with its
affiliates regarding the affiliations contribution to improvement in
many complex areas of change in health care. However, the rapidity of
change requires extra efforts at communication and I understand that
VHA is establishing a cadre of VA staff to lead a group to address VA-
academic relations. I support this effort. There are many issues to
address including ambulatory care and education, primary care,
specialty care, care for patients near the end of life, systematic
approaches to improving quality of care, more effective inter-
professional care and education, and more efficient use of scarce
health care resources. If I am confirmed, I will direct the Under
Secretary for Health to keep me fully briefed on VA's relationships
with its academic affiliations and on the opportunities those
affiliations provide for VA to provide the best approaches for
continuous improvement of health care for veterans.
Question 35. Restructuring and downsizing in several facilities
have led to contracting with community providers for care. Further,
about half of all CBOCs are run by non-VA providers. How is care
specifically monitored at these contracts? How will you ensure quality
at all these contract sites?
Answer. I am informed that the Department vigorously and completely
supports the application of quality and safety initiatives related to
contracted care. The National Center for Patient Safety and the Office
of Quality and Performance, are completing a VHA directive that
establishes mandated requirements for all contracted clinical services.
Regarding the quality of care at CBOCs today, I am informed that a
recent HSR&D study showed that care provided at CBOCs was substantially
consistent with the quality of that provided by the parent VA medical
center.
VHA's External Peer Review Program (EPRP) is a contracted review of
care specifically designed to collect data to assess and improve the
quality of care delivered to veterans. I am informed that, beginning in
3rd quarter FY 2001, EPRP will revise its sampling process to assure
that a sufficient number of CBOC cases are included to allow for
benchmarking to care provided at VHA facility-based clinics.
I believe that veterans who look to VA as their healthcare provider
should receive high quality healthcare, without regard to whether that
care is provided directly by VA or by contract with a community
provider. I will hold the Under Secretary for Health accountable for
ensuring that quality remains a high priority no matter how VA care is
delivered.
Question 36. Has VA developed a coherent and consistent plan for
quality management that systematically monitors, assesses, and
documents the quality of care provided to veterans? In addition to
programs, which mainly monitor structure and process, does the VA have
a program that monitors and documents health improvement outcomes?
Answer. It is my understanding that VHA's Performance Measurement
Program (PMP) is the primary mechanism by which VHA assesses the
quality of care provided to Veterans. PMP provides the critical linkage
between clinical activities and VHA's strategic goals for 2006 through
measures designed to assess actual clinical performance at the
National, Network, and Medical Center level.
I have been informed by VHA that each of its performance measures
maps directly to VHA's six strategic goals for 2006 (known as ``6 for
2006''):
Put quality first until first in quality
Provide easy access to medical knowledge, expertise, and
care
Enhance, preserve and restore patient function
Exceed patients' expectations
Maximize resource use to benefit veterans
Build healthy communities.
I am informed that PMP supports identification and system-wide
adoption of best practices while providing managers and clinicians with
reliable data from which they can assess their effectiveness in
implementing those practices. PMP provides timely, internal and
external comparative performance data--as well as longitudinal data,
thereby creating a culture of sustained improvement.
VHA reports that the measurement system is grounded in scientific
methods of data measurement, which require precise data definitions,
collection, and validation. Statistically valid sampling, and frequent
feedback to accountable managers, is provided to assess progress toward
goals. The Performance Measures Workgroup actively manages measures for
achieving performance targets.
In response to the question on outcome measures, the Under
Secretary for Health advised me that VHA has made great progress in
this area. PMP has evolved to include many measures that are standard,
accepted proxies for patient outcomes. Additionally, VHA has
incorporated measures of functional outcomes with special populations.
I am advised that reliable and valid tools that measure and
evaluate functional outcomes are now being used to assess the quality
of care provided to patients with the diagnosis of traumatic brain
injury, stroke, amputation, and blind rehabilitation. VHA recently
implemented outcome measures for rehabilitation patients that assesses
the change in functional status from admission to discharge. The
instruments utilized for assessing function will allow future outcome
comparison with the private sector. VHA continues to work closely
internally to evaluate and develop measures for other special
populations such as serious mental illness, PTSD, substance abuse, and
homeless Veterans. VHA is implementing measures developed in the
broader health services research community, and VHA is pioneering
measures associated with better outcomes where none exist.
Question 37. Do you believe that VA's current information systems
are up to the task of collecting, storing, translating, and
transporting timely and accurate care quality data in a way that is
accessible to clinicians?
Answer. No.
Question 38. How will you involve senior VHA leadership, Congress,
veterans service organizations, affiliates, and other stakeholders in
decisions related to the CARES initiative?
Answer. I need to be thoroughly briefed on the scope, process and
goals of CARES before I can intelligently respond to this question.
Conceptually, I have long believed that VA needs to align its capital
assets to the needs of veterans and the changing dynamics of healthcare
in America. CARES is ambitious and could be an important undertaking by
the Department. I understand that, under the CARES plan, the draft
conceptual options will be provided to veterans and their
organizations, as well as other stakeholders for immediate input, when
they are developed by the consultant.
I am informed that during the development of the CARES process,
every effort was made to incorporate a true ``One-VA'' approach.
Departmental offices of Management and Strategic Planning, as well as
VBA and NCA have been involved in the criteria and prioritization of
criteria categories. A variety of departmental leadership will be
members of the National CARES Steering Committee, the oversight
leadership group for CARES. The CARES evaluation criteria were
developed to acknowledge the interest of, and provide a quantifiable
weighting factor for, affiliates, veterans and their representative
organizations, communities, and other stakeholders. VHA has briefed
Congressional Committees, staff, and GAO on the CARES process. Periodic
briefings will continue throughout the process. The VA CARES team and
consultant are developing a communications plan highlighting critical
milestones for interactions with stakeholders, as well as identifying
the most appropriate method for those interactions.
Question 39. VA's long history of insufficient construction funding
has resulted in an aging infrastructure with urgent maintenance needs.
A 1998 Price Waterhouse study for the VA recommended that 2-4 percent
of a facility asset's replacement value should be spent each year for
facility improvement. In the face of steady decreases in the annual
construction budget, especially during the implementation of CARES, how
will VA ensure construction or renovation of facilities essential to
new medical center missions and laboratory research?
Answer. It is my understanding that the VA health care system's
future construction budget requests will reflect the need to implement
CARES decisions, as well as to correct seismic safety concerns, and
provide for an orderly reinvestment in the system's infrastructure.
These investment decisions will come after careful consideration of the
health care needs of enrolled veterans and options available to meet
those needs. A system as large as VHA's cannot maintain quality and
productivity over time without appropriate recognition of the need to
sustain appropriate infrastructure. The first CARES studies will be
done in FY 2001 and are expected to identify options for reengineering
VHA's physical infrastructure. Implementing these options may require
construction funding. However, the absence of a completed CARES study
should not prohibit consideration of a needed project if that project
can be justified on the basis of careful analysis and prioritization.
Question 40. As Chair of the Transition Commission, you advocated
moving many of VA's fee-for-service programs into DoD's TRICARE
program. Although this might provide purchasing leverage, I fear that
difficulties in obtaining specialty care through TRICARE would be
especially damaging to the veteran population, with its inherently
specialized needs. What would you do to ensure that sharing of programs
between VA and the Department of Defense preserved capacity and quality
for specialized services such as mental health, long-term care, spinal
cord injury rehabilitation, etc.?
Answer. The Commission's recommendation to move VA's fee-for-
service programs into DoD's TRICARE program was directed to VA paid
care for those VA patients whom VA had already determined that it could
not economically provide appropriate direct care. I would not support
such an approach if it would diminish VA's specialized services such as
mental health, long-term care, spinal cord injury rehabilitation, etc.
Question 41. What is the current legal status of agreements between
DoD and VA hospitals previously found to violate contracts with TRICARE
providers?
Answer. I am informed that in May 2000, DoD's Office of Health
Affairs issued a policy memorandum, ``Use of Health Care Facilities of
the Department of Veterans Affairs under TRICARE and the Supplemental
Health Care Program,'' to clarify relationships between VA medical
facilities and military medical facilities. I am informed that the
policy issue has been resolved and that VA is working with DoD to
receive reimbursement for unpaid or underpaid claims.
Question 42. What is VA's role in ensuring that men and women who
serve in our nation's military are protected from toxic exposures that
might ultimately harm them?
Answer. I am informed that VA plays a key role in coordinating with
DoD and HHS to address health consequences of military service. These
programs are collaboratively managed through the Military and Veterans
Health Coordinating Board. VA has health surveillance research and
health risk communication programs to address these concerns and
communicates its findings to veterans and their families, to VA health
care providers, and to our counterparts in the Department of Defense
(DoD). For example, VA conducts a health surveillance program for those
Gulf War veterans wounded with depleted uranium (DU) munitions in
``friendly fire'' incidents during the Gulf War. Findings from such
programs can help to provide better health care for affected veterans,
and in some cases may help DoD to identify approaches to minimize
effects from toxic exposures in the first place.
Question 43. A final action plan to implement the interagency VA/
DOD/HHS National Center for Military Health and Deployment Research
project has finally been released. How would you assess the importance
of this center to VA's mission, and how will you support continued
interagency cooperation?
Answer. Since the Gulf War, I believe that VA, HHS and DoD have
actively collaborated on Gulf War veterans' health issues. Nowhere has
the impact of this collaboration been greater than in establishing Gulf
War research goals, and in identifying critical gaps in our knowledge.
As a result, today, collectively, VA supports about 192 federally
funded research projects with projected cumulative expenditures of $155
million towards Gulf War illnesses research. The National Academy of
Sciences proposed that this highly successful interagency collaboration
be formalized as the interagency National Center for Military Health
and Deployment Health Research. This collaboration has been enormously
important to VA's mission to care for veterans, and as Secretary, I
would provide continued encouragement and support for this effort.
Question 44. Many veterans, especially vulnerable populations, rely
upon the specialized services of the VHA. Many of these services, like
spinal cord injury, blind rehabilitation, and prosthetics, are unique
to the VA and are unmatched by the private sector. In an era of
declining budgets and decentralization of funds, please describe for me
your commitment to maintaining VA capacity in these programs. How will
you ensure compliance in preserving the quality and capacity of these
programs at the VISN level?
Answer. I am, and have always been, strongly committed to VA's
specialized programs such as spinal cord injury, mental health, blind
rehabilitation, and prosthetics. VA policy decisions are made at the
Secretarial level. I expect those policy decisions to be implemented
accordingly throughout the VA. I will not accept any deviation from
that policy at any level, including the VISNs. Decentralization of
management authority and responsibility to VISN directors does not
allow them to make individual decisions that would have the effect of
negating my decisions. I intend to monitor compliance with this
closely.
Question 45. Please describe the priority that you believe VA
should place on providing care to veterans with PTSD, and how would you
ensure that priority is manifested in budget requests and programmatic
planning?
Answer. VA is a recognized leader in PTSD treatment. I support this
leadership role. I am informed that VHA policy is to accord mental
health programs, including those for treatment of PTSD, an equal
priority for treatment as medical/surgical and all other health care
services. Thus, veterans requiring care for PTSD have the same priority
as other veterans for care. In addition, Public Law 104-262, requires
VA to maintain its capacity to provide care for disabled veterans in
specialized treatment programs including those with PTSD. VA reports to
Congress annually on the maintenance of capacity for PTSD and other
special emphasis populations. To ensure that this care is provided,
Directive 99-030, published June 30, 1999, on ``Authority for Mental
Health Program Changes'' requires that any major change to a mental
health service or program proposed by a field unit shall require review
and endorsements by the Mental Health Strategic Heath Care Group in
Headquarters and approval from the Office of the Under Secretary for
Health. Finally, Public Law 106-117, the Veterans Millennium Health
Care and Benefits Act authorized additional funding for PTSD program
development, resulting in over $5 Million directed to new programming.
Question 46. Please give your general view of the Readjustment
Counseling Service (RCS) and its role within VHA.
Answer. I want to ensure that Vet Centers continue to provide
effective and meaningful service to the changing veteran population.
The Vet Center mission is to welcome veterans home with honor,
clinically assist veterans to resolve war trauma, and to help them
improve their post-military level of economic and family functioning.
General hallmarks of the Vet Center program include accommodation of
services to local veterans' needs, a full range of community-based
service functions, trauma counseling for war trauma and military-
related sexual trauma, veteran consumer-oriented attitudes and other
practices aimed at promoting ease of access and a holistic approach to
improving veterans' functioning within the community.
In 2000 the Vet Centers saw over 130,000 total veterans and
provided over 890,000 visits to veterans and family members.
Approximately 50,000 of the veterans served at Vet Centers were not
seen in any other VHA facility. For many veterans who would not
otherwise receive VA assistance, the Vet Centers are the community-
access point for VA health care. Vet Centers make over 100,000
referrals annually to VA medical facilities. In addition, the Vet
Centers make over 120,000 referrals annually to VA Regional Offices for
claims work, and over 115,000 referrals annually to non-VA community
service providers.
The Readjustment Counseling Service Vet Center program can be an
invaluable resource for responding to veterans' war-related
readjustment and health care needs, and as an important component
within VHA for addressing such needs of veterans within or close to
their communities.
Question 47. What efforts are being made by VA to ensure a seamless
mental health care delivery system for veterans being treated for PTSD?
Answer. Mental health services an integrated component of VA health
care. VA's mental health programs are part of its uniform benefits
package and treated on parity with medical services. VA has published
evaluation reports on care in all specialized PTSD programs since 1990,
and provides annual written evaluations to all VISN Directors and
Medical Center Directors. The Mental Health Strategic Healthcare Group
also provides process and outcome monitoring on all PTSD programs and
consults with local facilities where significant changes in PTSD
programming are contemplated and where PTSD programming appears to have
gaps.
Question 48. With regional centers being used for specialized care,
especially for centers for the blind, do you see a need to review VHA's
beneficiary travel policy?
Answer. I have not had the opportunity to be briefed on current
beneficiary travel issues. I am aware that VA has long had regional
centers for providing specialized care, however, I will request that
VHA brief me on the beneficiary travel program and any emerging issues.
Question 49. Ten years after the Gulf War, the VHA still cannot
tell us whether ill Gulf War veterans are getting any better as a
result of their care at VA medical centers. What will you do to improve
this situation and potential future post-deployment health care
programs for veterans?
Answer. The modern technological battleground presents new
challenges for VA in both healthcare and adjudication of disability
claims. I am not sure that VA's response has been adequate.
VA's experience treating Gulf War, Vietnam and other veterans has
taught us that new approaches are needed to address all veterans'
health needs. Combat casualties are not always obvious wounds, and some
veterans inevitably return with difficult to diagnose, yet
debilitating, health problems. Unfortunately, we do not yet fully
understand the causes of many of the illnesses suffered by veterans
returning from wars and peacekeeping missions, and therefore we often
have difficulty finding effective treatments. To respond to this need,
VA is establishing national Centers for the study of war-related
illnesses and post-deployment health issues. VA must become more
proficient at responding to these challenges and I intend to take a
leadership role in seeing that it does so.
Question 50. Hepatitis C is a devastating disease with a
disproportionately high incidence in the veteran population. Will you
support VA's recent decision to enfold hepatitis C prevention and
treatment programs into the existing HIV/AIDS program office? How do
you envision that the VA can use its resources most effectively to
educate veterans about prevention and provide the most appropriate
treatment for these complex and chronic diseases?
Answer. Although I have not reviewed VA's recent decision, it is my
understanding that the Veterans Health Administration did not
incorporate HCV into HIV programs but rather is creating a Public
Health Strategic Health Care Group in which both the Hepatitis C, HIV
programs and other programs will be managed. Both HIV and Hepatitis C
represent very complex and challenging chronic illnesses sharing many
of the same risk factors. While there is treatment available for both,
this treatment is difficult for patients and only a minority of
patients are able to tolerate therapy. Also, outreach for early testing
and counseling plays a crucial role in management of both HCV and HIV
and in the prevention of transmission to others. Both of these diseases
are not only major public health threats to our veterans and our
nation, they are also epidemic at an international level.
Veteran populations may be at higher risk because of combat
exposures to blood; blood transfusions that occurred prior to 1992;
unprotected sex with sexual partners with hepatitis C; or exposures to
shared needles, including those used for drug use or tattoos. Some
initial data from small surveys suggest that approximately 6 to 10% of
veterans may test positive for Hepatitis C. Over 69,000 veterans who
are currently receiving care from the VA health care system have a
diagnosis of Hepatitis C.
I have not been fully briefed regarding VHA's Hepatitis C program,
however, I will emphasize:
Hepatitis C awareness programs to educate veterans about
the risk factors for Hepatitis C and encourage them to get tested at
their local VA medical center or outpatient clinic.
Efforts to ensure that VA clinicians are provided with the
most up-to-date scientific information about Hepatitis C in order to
deliver the highest quality care to veterans with Hepatitis C, as well
as to assist those at risk to prevent becoming infected with the virus
that causes Hepatitis C.
Providing multiple avenues of access to veterans who wish
to be tested for Hepatitis C.
Appropriate oversight and quality management activities to
track the impact of Hepatitis C among veterans as well as continually
improve Hepatitis C care and prevention in VHA.
Question 51. VA Research not only makes a major contribution to our
national effort to combat disease, but also serves to maintain a high
quality of care for veterans through its impact on physician
recruitment and retention. Does it make sense to limit the scope of
research performed in VA facilities?
Answer. I strongly believe that VA research is mission-driven. Its
purpose is to serve the high priority health care needs of veterans,
and it is appropriate to restrict the program to that mission.
Nevertheless, VA research includes a very broad range of studies, from
basic molecular biology and genetics to large-scale clinical trials,
rehabilitation research, and health systems and outcomes research.
Because VA research is nested within a health care system, it serves as
a unique and very valuable national resource for improving health care
for veterans and for all Americans.
VA research is an intramural program. The Medical and Prosthetic
Research appropriation is allocated to VA facilities to conduct
research on veterans health care needs under the supervision of VA
employees. Unlike NIH and some other federal agencies, VA does not make
research grants to colleges and universities, cities and towns, or any
other non-VA entity. This intramural program serves as a recruitment
and retention tool that helps VA recruit the best and brightest
clinicians to provide health care to veterans and conduct research. As
an index of that quality, 70% of VA staff physicians have faculty
appointments at affiliated medical schools. While the proportion of
funded physician-scientists in the private sector has declined steadily
over the past two decades, clinicians continue to constitute 70% of all
VA investigators. In a recent national survey of VA scientists, more
than 60% of respondents said they would not work for the VA if no
research opportunities were available.
Although there are some limitations on the scope of VA research, I
am informed that 84% of respondents in the same survey were satisfied
with their autonomy to choose the direction of their research.
I will also work to make sure that VA gets credit for the findings
of researchers who are funded by VA for their work. VA's research
program is important to veterans and to the American people and over
the long run support for that research program requires the American
people to know what they are getting for their money.
Question 52. What should be the role of the Secretary in guiding VA
research?
Answer. I believe the Secretary provides guidance to assure that VA
research remains focused on such high priority health care needs of
veterans and the VA health system as:
The Secretary should encourage and, where possible, facilitate
collaboration between the VA research program and other public and
private sector sponsors of research. Collaborative relationships that
already exist, such as those with NIH, DoD, the Juvenile Diabetes
Foundation, and the pharmaceutical industry, have proven effective in
leveraging the VA research appropriation to create a more efficient and
effective research enterprise.
The Secretary should continue to seek advice from Veterans Service
Organizations, the affiliated academic community, the VA's National
Research Advisory Council, the National Leadership Board, and the
intramural research community represented by the Office of Research and
Development in formulating guidance for the VA research program.
Question 53. The 2001 DoD Appropriations bill allows retirees and
dependents to keep CHAMPUS/TRICARE coverage after they turn 65 and
change to Medicare coverage. CHAMPVA, however, has not been similarly
reformed. Dependents of service-connected disabled veterans who receive
enhanced compensation for such dependents, and survivors of service-
connected veterans who receive DIC payments, will be denied CHAMPVA
(and its drug coverage) when they turn 65. Would you support a similar
reform for CHAMPVA?
Answer. Under 38 USC section 1713, the CHAMPVA program is required
to provide benefits similar to that of the TRICARE/CHAMPUS program. VHA
advises that a proposal to address these new benefits is currently
being developed. While I am inclined to be supportive of these efforts,
I want to be more fully briefed on the matter before coming to final
conclusions.
Question 54. Do you believe that the VA should contribute funds to
assist the government's efforts to be indemnified for their medical
expenses associated with tobacco-related diseases?
Answer. Money appropriated to VA should be used for veterans
benefits and services.
Question 55. 1 understand you have visited several programs for
homeless veterans over the last few years. Given that the findings of
the National Survey of Homeless Providers and Clients indicated that
one-third of homeless adult men and one-quarter of all homeless adults
are veterans, do you believe that this problem has been adequately
addressed by the Department of Veterans Affairs?
Answer. I believe that VA has made significant progress in
developing programs and services for homeless veterans. In 1992, when I
was Deputy Secretary, Congress passed Public Law 102-590, the Homeless
Veterans Comprehensive Services Program Act of 1992. This law
authorized VA's Homeless Providers Grant and Per Diem Program, the
further development of Comprehensive Homeless Centers and the placement
of Veterans Benefits Counselors in Homeless Veterans Treatment Teams. I
fully supported this legislation.
Several years later, I served as Chair of the Congressional
Commission on Servicemembers and Veterans Transition Assistance. Our
report to Congress recommended that VA's Homeless Providers Grant and
Per Diem Program be funded at $50 million per year beginning in FY
2000. I understand this program is currently funded at approximately
$32 million.
I understand that VA's FY 2000 medical care appropriation included
an additional $50 million for homeless veterans programs and those
funds have been used to:
Expand outreach, case management and contract residential
treatment for homeless veterans across the country.
Support Stand Downs for homeless veterans.
Establish special demonstration programs for homeless
women veterans, hospitalized homeless veterans and seriously mentally
ill veterans.
Establish special demonstration dental programs for
homeless veterans in rehabilitation.
Develop additional therapeutic employment programs for
homeless veterans.
Initiate the Loan Guaranty for Multifamily Transitional
housing for Homeless Veterans Program.
Enhance VA's monitoring and evaluation of VA's homeless
veterans programs.
These new and expanded initiatives clearly show VA's strong
commitment to addressing the needs of homeless veterans. As the
Secretary of the Department of Veterans Affairs, I will use VA's
existing foundation of homeless veterans programs to strengthen VA's
partnerships with community-based providers so that, together, we can
better serve homeless veterans.
Question 56. Public Law 106-377 funds the Interagency Council on
Homeless and makes the Secretary of Veterans Affairs a rotating chair
of the Council. What plans do you have to improve services for homeless
veterans and their families in this leadership role?
Answer. While I have not yet been briefed on the provisions of PL
106-377, I support as a matter of principle coordination of services
across all federal departments and agencies. I would like to see the
Interagency Council play a more active role in developing guidance and
establishing interagency goals to address the needs of the nation's
homeless population, especially the population of homeless veterans.
______
Response to Post-Hearing Questions Submitted by Hon. John D.
Rockefeller IV to Anthony J. Principi
Question 1. What percentage of VA's community-based outpatient
clinics (CBOC's) provide mental health services, and of those, what
percentage provide more than minimal mental health services, such as
assessments? What do you believe is the right mix of services for
CBOC's to offer?
Answer. A recent report from the VHA Committee for Severely
Chronically Mentally Ill Veterans to the VA Policy Board states that
nationally, in FY 2000, 55.2% of CBOCs provided mental health care to
at least 2% of unique patients, varying among VISNs from 15.8% to
94.1%. The national percentage. decreases to 21.9% of CBOCs at the 20%
level and varied, depending upon the size of the CBOC (smaller clinics
providing a lessor percentage of mental health care). In FY 1999, 62%
of all VA primary care patients were screened for depression, an 18%
increase from the previous year. Ideally, every enrolled veteran should
have access to mental health services anywhere in the country, at
parity with medical services. Practically, the right mix of mental
health services depends upon the size of the clinic, driving distances
to clinics, availability of mental health professionals in a given
area, and local practice patterns. VHA is forming an expert panel to
work with VISN representatives to come up with appropriate standards
for providing mental health services in both rural and urban CBOCs.
Question 2. The Veterans Millenium Health Care and Benefits Act
(Public Law 106-117) mandates reimbursement for emergency treatment in
non-VA facilities for certain veterans. If confirmed, what will you do
to expedite the implementation of this provision?
Answer. The timely implementation and provision of expanded veteran
health benefits remains a high priority for the Department. I am
advised that the regulations for the emergency care provision were
completed and forwarded to OMB for review on November 22, 2000. A
meeting was held with key VHA and OMB officials to discuss the
Department's proposed regulation during January 2001. OMB requested
additional information on the Department's financial impact and demand
forecast, which was developed by an independent actuarial firm. OMB
officials also requested additional information on the development of
the OMB collection burden information. In addition, the Under Secretary
has charged a workgroup to develop the business processes required for
implementation of centralized emergency care claims processing to
include handling of electronic claims. I will need to be fully briefed
on these issues before authorizing publication of the final
regulations. VA is currently collecting the claims, but cannot process
them until the regulations are final.
Question 3. Recent pilot programs to improve care delivery to
elderly veterans have focused on Interdisciplinary care management
teams. If confirmed, how will you continue to explore and expand this
sort of case-based approach to long-term care?
Answer. VHA advises that the Long-Term Care pilots that were
authorized by the Veterans Millennium Health Care and Benefits Act will
test three different models for all-inclusive care of the elderly.
These programs will begin in February 2001 and will be evaluated over a
three year period. These clinical demonstrations will provide data on
the effectiveness of each model in improving the care delivery to
elderly veterans.
A decision has been made to adopt a standardized screening
instrument to be used by the clinical team in determining a veteran's
need for long-term care. It is anticipated that VA will continue to
utilize interdisciplinary care management teams in its well-established
geriatric evaluation and management programs and long-term care
admission and discharge planning committees.
Question 4. What is your view of the use of assisted living
facilities as an alternative to nursing home care?
Answer. VA's goal for patients needing Long Term Care has always
been to utilize the least restrictive setting such as the Community
Residential Care and the VA and State Domiciliary programs. VHA advises
that the Assisted Living Pilot program authorized by the Millennium Act
will begin in February 2001 and will be evaluated for a 3-year period.
The evaluation data of this pilot will help us determine the
feasibility of VA providing, either directly or by contract, for this
level of care in the future.
Question 5. In the last year, VA completed a Department-wide risk
assessment of computer security vulnerability and initiated an
accelerated security program to address weaknesses. How will you ensure
that plans to protect patient privacy, such as controlling user access
authority and monitoring network security, are implemented
comprehensively across VISN's and throughout medical centers?
Answer. I will ensure implementation of and compliance with
security plans and privacy directives throughout the VA by first making
it known to every VA employee and contractor that the privacy and
security of medical records are as important as their accuracy. If
veterans cannot trust that we will zealously guard their personal
information, they will not entrust it to us. I will continue the
recently initiated policy of making security a measured critical
success factor in all senior managers' annual performance plans. I will
see that the VA security program is adequately funded so that
appropriate technology is available to allow for a single logon regime,
role-based access, and stringent network intrusion detection. I will
ensure that VA is fully compliant with all relevant laws and
regulations, such as those contained in the Health Insurance
Portability and Accountability Act (HIPAA). I will ensure that
comprehensive policies and procedures are implemented to
institutionalize the protection of medical records throughout VA.
Question 6a. Although VA and DoD have made progress in joint
procurement of medical supplies, a recent report from both departments
suggests that optimal sharing will result in a smaller combined annual
savings than the $295 million projected by the General Accounting
Office, and will fall far short of the $500 million that you predict. I
am concerned that focusing on shared programs before we have
established good oversight of VA's efforts--such as its evolving drug
formulary--might result in trading veterans' services for an uncertain
economic benefit. How will you pursue combining VA and DoD efforts
without endangering our abilities to provide veterans with the best
possible health care?
Answer. I would not pursue any sharing with DoD that would decrease
VA's ability to deliver the best possible health care. Having said
that, I do not believe that the two Departments are doing all they can
to improve the mutual use of our respective resources. I believe that
access and patient satisfaction can in fact be improved if we put our
parochial differences aside and focus instead on the needs of the men
and women we are pledged to serve. If we can reduce the expense of
pharmacy purchasing, we can purchase more pharmaceuticals. Our focus
should be on ``win-win'' opportunities, both large and small, that can
benefit both Departments and our beneficiaries.
Question 6b. Please describe the plan encompassed in your
prehearing statement that NA would like to be DoD's first choice for
supplemental care.''
Answer. My prehearing statement did not refer to a specific plan.
Rather, I was suggesting that VA and DoD would benefit from a mutual
review of VA's role in providing care to DoD beneficiaries. At present,
DoDs model is to first provide care in its own facilities, and second,
to purchase care through the TRICARE networks. This model has led to
uncertainty regarding DoDs policy regarding the use of VA facilities,
and confusion with respect to VA's role. My prehearing statement simply
reflected my belief that VA could in fact be DoD's first choice for
care not provided in a DoD facility. Care that could not be delivered
in either a DoD or a VA facility could then be purchased through the
TRICARE networks. As I have indicated previously, in no event would
care for DoD beneficiaries be undertaken without assurance that VA's
beneficiaries would not suffer.
Question 6c. Please describe how you would ensure that VA's
formulary committees, Medical Advisory Panel, and the Pharmacy Benefit
Management Group are kept well informed.
Answer. VHA advises that all decisions regarding formulary
management initiatives including national contracting and joint
contracting are reviewed by VA's formulary committee, Medical Advisory
Panel and Pharmacy Benefit Management Strategic Healthcare Group. All
such efforts require their support and concurrence. All actions begin
with a clinical review of the issues, assuring that the care of
veterans is the first concern. If these organizational elements do not
agree that joint procurement is in the best interest of veterans, VA
does not participate in that action. VA will continue to consider all
joint procurement actions from the clinical perspective and the care
needs of veterans.
Question 7. In your responses to my pre-hearing questions, you
stated that VA's current information systems are unequal to the task of
collecting and delivering care quality data to administrators and
clinicians. Do you see this as an obstacle to systemwide quality
monitoring? How would you approach this problem?
Answer. I believe that timely availability of reliable data is
essential to effective, system-wide quality monitoring. As I have
stated in response to a previous question, I will not be able to
provide a comprehensive answer until I have been more fully briefed on
this matter by VHA officials and my Chief Information Officer. In the
next several months, I will look forward to learning more about the
existing system capabilities and developing plans for significant
system improvement.
Question 8. How would you ensure that VHA has a functional Quality
Advisory Board, representative of the entire health care system, that
meets regularly to evaluate program success?
Answer. I am advised that late last year, the Under Secretary for
Health recognized the need for the establishment of a new national
level committee to provide oversight on quality and safety issues and
policy. Membership is comprised of the Under Secretary for Health
(Chair), the Chief Officer for Quality and Performance, the Chief
Network Officer, the Medical Inspector, the Chief Officer for Patient
Care Services, and the Senior Advisor for Quality for the Under
Secretary for Health. It was determined at the initial meeting that the
body would begin routine meetings, on a monthly basis, beginning in
February 2001. I look forward to receiving a follow-up analysis from
the Under Secretary for Health as to the results being achieved by this
new oversight process.
Question 9. In your view, are VA's quality management programs
being routinely monitored to determine if they are attaining the
desired results? What steps has VA taken to validate the data it
currently uses in documenting its current quality of care structures,
processes, and health outcome improvements?
Answer. VHA reports that local quality management programs include
performance improvement, risk management (including patient safety and
infection control), utilization review, and credentialing and
privileging. Structurally, these programs are monitored by dedicated
staff and processes at the local, network, and headquarters level.
External accreditation evaluations and the network performance plans
(which include a broad array of structure, process, and outcome
measures) provide mechanisms to routinely monitor these programs.
VA uses highly credible external organizations, e.g., West Virginia
Medical Institute, Inc. (WVMI), Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), and Commission on the Accreditation
of Rehabilitation Facilities (CARF) for accreditation and data
collection. For example, WVMI uses internal quality control processes
that are capable of identifying unexplained variations in data. This
process has successfully identified variance in performance by WVMI
abstractor personnel and is capable of identifying unlikely practice
patterns within a facility that, once identified, would trigger further
review by VHA. VHA evaluates the validity of its data by trending
performance measures over time, comparing data amongst facilities and
networks, and when applicable, comparing data to similar data from non-
VHA facilities.
Question 10. How will you ensure that the Office of the Medical
Inspector maintains its independence and is included in the decision-
making processes that affect quality management programs?
Answer. VHA advises that the Office of the Medical Inspector (OMI)
reports directly to the Under Secretary for Health and makes
assessments of the quality of patient care and quality assurance
programs throughout the VA health care system. The OMI evaluates
allegations of less than acceptable care; and when substantiated,
assesses management controls designed to prevent and detect therapeutic
misadventures, develops recommendations for corrective action to
preclude reoccurrence, and reports evaluation results to the Under
Secretary for Health. The Medical Inspector is a member of the new
quality oversight committee established late last year--discussed in
response to question 8.
Also, Public Law 100-322 requires the Office of the Inspector
General to oversee, evaluate, and report on the patient care and
quality assurance activities of VHA, including the OMI. This provision
was created specifically to ensure that the OMI is allowed to maintain
its independence while organizationally placed within VHA.
Question 11. Do you think VERA is a fair way to allocate funds?
Does VERA sufficiently allow VA managers to sustain programs for high
cost patients and patients in need of specialized services?
Answer. I am told that the VERA methodology is still an equitable
model for distributing funds to the 22 networks. As directed by the
Senate, VA has contracted with a Federally Funded Research and
Development Center to determine whether the VERA methodology leads to a
distribution of funds that covers the special needs of some veterans,
and also to investigate the progress of this funding allocation method.
VA recently entered into a contract with the RAND Corporation to
conduct this study and the results are due to Congress no later than
August 15, 2001. I will give this study, along with the ongoing GAO
VERA audit, careful consideration. If this study identifies problems in
VERA resource allocations, VA will review and refine the VERA
methodology and will act as quickly as possible to resolve any
inequities. There are several VERA workgroups, comprising VHA field-
based and headquarters staff, that provide ongoing evaluation of the
VERA methodology and input on policy issues to improve VERA. I assure
you that VA is open to future adjustments, refinements, and
improvements to the VERA methodology if problems are identified.
Question 12. In October 1998, VA contracted with Price Waterhouse
to evaluate VERA. The contractor recommended a series of refinements--
most notably, that VA implement a transfer pricing system. What effect
have these recommendations had?
Answer. I am advised that as a result of the study, VA has
simplified data inputs, and has completed a three-year phase-in of
revised methodologies for equipment and non-recurring maintenance
components. The labor adjustment is now based on a single national
market basket for labor. The patient classification system has been
evaluated and revised. Classification of patients on the basis of
diagnostic and functional data instead of utilization characteristics
is being evaluated for a potential change in FY 2003. Review of data
accuracy and accountability has been strengthened, and the allocation
process timetable has been clarified and improved. Finally, a
suggestion box has been established electronically and is accessible to
all VA employees.
The VERA Care Across Networks Workgroup studied the need for a
transfer pricing system to account for patients that receive care in
more than one network. Under a transfer pricing methodology, networks
would receive an annual price for their ``enrolled'' patients and be
required to compensate other networks that care for their enrolled
patients. As part of a comprehensive review, the group conducted a
transfer pricing pilot project to assess the impact of implementing a
program within VA. As part of the pilot study, a software package was
developed and National Medicare rates were used to price out of network
care. The objective of the pilot project was to assess the financial
and clinical impact of implementing a transfer pricing program. After
extensive analysis, the workgroup concluded that the costs of
implementing a transfer pricing system far outweighed the benefits of
such a program. In addition, there was no clinical evidence that
transfer pricing improved the coordination of clinical care for
patients that receive care in more than one network. The workgroup
recommended that the VA not implement transfer pricing and instead
retain the existing pro-rated person (PRP) methodology to account for
care across networks. The Under Secretary for Health approved that
recommendation in March 2000. As a bi-product of the pilot project, all
networks were provided the opportunity to use the pilot test software
to review the volume and clinical care patterns of patients receiving
care outside their enrolled network. The software was provided to all
networks in FY 2000. I look forward to further discussions with the
Under Secretary for Health on this issue.
Question 13. What efforts are being made today to ensure that Gulf
War veterans, still suffering from undiagnosed illnesses, are receiving
the specialized care they need at their local VA medical centers? Are
the efforts consistent among medical centers and across VISNs?
Answer. VHA reports that most Gulf War veterans coming to VA
medical centers have commonplace symptoms and receive conventional
diagnoses and treatments. Nevertheless, some veterans have occasionally
debilitating symptoms that cannot be diagnosed even after thorough
medical work-ups at VA medical centers. To address this issue, in
August 1992 VA established the Gulf War Referral Centers for Desert
Storm veterans. The four referral centers at Houston, Texas,
Washington, DC, West Los Angeles, California, and Birmingham, Alabama
provide for inpatient stays for observation, multidisciplinary
consultation, documentation of lengthy occupational and exposure
histories, and an opportunity for frequent re-examination. The centers
place an emphasis on specific symptom complexes, such as undiagnosed
illnesses, chronic fatigue, memory loss and other neurologic
conditions, unexplained weight loss and other adverse health conditions
possibly associated with hazardous exposures in the Gulf War. About 700
Gulf War veterans have been admitted to VA's referral centers.
VHA also developed a standard protocol for assessing Gulf War
veterans who are concerned about possible health effects of their
wartime experience. If the veteran has an unexplained illness, VA
facilities use a standardized protocol consisting of a set of clinical
practice guidelines to evaluate and treat the veteran's illness. Since
1992, VA facilities have provided over 4400 Uniform Case Assessments
using this standardized protocol.
VHA has also undertaken extensive educational and outreach efforts
to improve conformity with established treatment guidelines and to
communicate the latest information about unexplained illnesses to Gulf
War veterans. These efforts include regularly scheduled and special
purpose telephone conferences, satellite conferences, and Continuing
Medical Education programs to keep medical personnel well informed
regarding Gulf War veterans health issues and developments. VA's Gulf
War Review Newsletter is regularly provided to all veterans on the Gulf
War registry.
VA's experience treating Gulf War, Vietnam and other veterans has
taught us that current medical practices are not always adequate for
addressing the health needs of veterans. We now appreciate that combat
casualties do not always result in obvious wounds, and that some
veterans inevitably return with difficult to diagnose, yet nevertheless
debilitating, health problems. Unfortunately, we do not yet fully
understand the causes of many of the illnesses suffered by veterans
returning from wars and peacekeeping missions, and therefore we often
have difficulty finding effective treatments. In response, VA intends
to fund two new Centers for the Study of War-Related Illnesses. These
centers will focus on developing superior methods for diagnosing and
treating veterans with difficult to diagnose illnesses. Proposals have
been peer reviewed, and VA expects to fund these centers by Spring
2001. I look forward to sharing the results of these new centers as
they become operational.
Question 14. A GAO report released in September 2000 highlighted
concerns about the protection of human research subjects in the VA
system. Particularly troubling was the finding that medical centers
often failed to comply with all regulations to inform and protect human
subjects. What systemwide efforts would you implement to assure
appropriate guidance, oversight, and funding of VA staff conducting
research with human subjects? What internal guidelines and sanctions
would you advocate?
Answer. VHA advises that in late FY 1999 it established an Office
of Research Compliance and Assurance (ORCA) reporting directly to the
Under Secretary for Health to respond to the issues outlined in your
question. ORCA places emphasis on education and proactive surveillance
as well as sanctions for non-compliant programs and investigators, when
necessary. Over the past year, ORCA has initiated bimonthly
teleconferences and biweekly educational newsletters for all VA sites
conducting research involving human subjects. These have provided
guidance on the requirements to protect human subjects. ORCA continues
to work with the HHS, Office of Human Research Protections and the Food
and Drug Administration along with other federal agencies implementing
the Common Rule to achieve harmonization of the regulatory
requirements.
ORCA conducts ``for cause'' inspections (Special Inquiry Force Team
[SIFT] reviews) of research activities at VAMCs. ORCA will pilot this
month the new proactive surveillance review, the Multi-Assessment
Program (MAP). This is a systematic ``preventative'' oversight
compliance program. Depending on the severity of violations of internal
guidelines, various restrictions and sanctions have been invoked
ranging from various compliance requirements to the temporary or
permanent suspension of investigators and the suspension or termination
of research programs. These actions will continue and be enforced,
depending on the seriousness of the violations. A new accreditation of
human subjects programs is under development, which will provide an
added external scrutiny to ensure additional protection of human
subjects enrolled in VA research protocols. This accreditation program
and the new initiatives through ORCA will be systematically implemented
this year.
I am pleased that VHA has initiated these efforts to assure
compliance with the highest standards when veteran patients are
involved in research studies. I will insist on VA compliance with these
standards and will work with the Under Secretary for Health to assure
any deficiencies are promptly corrected.
Question 15. How do you view the balance between funding VA
research and supporting clinical services? What should the goals of
VA's research program be, and how should the VA allocate its limited
research funds among the general areas of basic, applied clinical, and
health services research?
Answer. Funding for clinical services to veterans and for VA
research should be viewed as complementary, not competitive. Patient
care is the primary mission of the Veterans Health Administration. VA
research supports that mission by discovering new knowledge about
illnesses that affect veterans, new treatments, and enhancements in
health care delivery. The availability of research opportunities also
helps VA recruit the ``best and brightest'' clinicians to conduct
research and provide clinical services to veterans. In turn, new
research problems are identified on the basis of the health care needs
of veterans, which drive the VA research agenda.
The following goals have been established for the VA research
program:
1. Sustain a superior environment of inquiry conducive to the
highest quality research, education, and patient care.
2. Effectively integrate basic, clinical, and applied research to
best meet veterans' health care needs.
3. Effectively transfer research results to advance veterans'
health care.
4. Capitalize on VHA's value as a national research asset.
5. Lead and manage an effective and efficient research enterprise.
6. Increase awareness and understanding of the value of VHA's
research contributions for veterans and all Americans.
VA research appropriately covers a very broad spectrum, from the
most basic to the most applied studies. The majority of VA's research
funds should continue to be focused on clinical research. Basic science
research that is pertinent to veterans' health care needs should also
be supported. All research funds should continue to be allocated to VA
facilities on the basis of nationally competitive scientific merit
review.
Question 16. I know you agree that specialized services are one of
the jewels of the VA health care system. Yet for years, we have
received complaints that VA managers are foregoing their responsibility
to maintain a high level of specialized services. For example,
maintaining the level of spinal cord injury care has remained a
problem. Please describe what efforts you intend to make to maintain
VA's specialized services under your administration.
Answer. I am committed to maintaining VA's capacity to respond to
the specialized needs of veterans, and will ask the Under Secretary for
Health to brief me regularly on this matter. VHA reports that plans are
underway to improve information collection and verification of data
used in assessing capacity levels. Notable progress is being made in
the development of outcome measures that evaluate functional
improvements in each of the special programs.
In order to improve integration of activities for monitoring
capacity, VHA has created a position to serve as the coordinator for
special disability programs. This person will work with field and
Headquarters offices responsible for service delivery, data, quality
and resource reporting activities for the special disability programs
to monitor capacity and maintain specialized services. To provide
additional emphasis for improving coordination for these services, VISN
Clinical Managers will serve as coordinators for special disability
programs in the field.
Oversight of the quality of these special programs is the
responsibility of providers and managers in the field, with appropriate
guidance from the respective Strategic Health Groups and Chief
Consultants in the Central Office. In addition, it is my understanding
that the performance plans for each of the Network Directors has been
modified to clearly indicate that their performance evaluation will be
based in part on the level of services provided to special populations.
Question 17. More than 20 percent of veterans who use VA services
annually receive psychiatric care from the VA, yet VA mental health
services have seen severe cutbacks in capacity. As a result, many
veterans who relied on VA have fallen through the cracks and are no
longer receiving needed care. In light of these facts, what is your
vision for turning this situation around?
Answer. VHA reports that the number of veterans receiving mental
health care in VHA has actually increased since 1996 with the exception
of a drop of 4000 receiving specialty substance abuse treatment. We
have already begun to address this issue with regard to PTSD and
Substance abuse treatment as a result of provisions in the Veterans
Millennium Health Care Act. Decreased use of hospital beds has been
more than compensated for by greatly increased availability of
residential care, outpatient services, and community-based care. We
plan to work closely with the Mental Health Strategic Health Care Group
to assess the further need, and then develop strategies to remedy the
situation. Because there is considerable variation among VISNs, VHA
plans to continue to monitor care and work with networks individually
to improve and maintain capacity and quality of care for all veterans
with serious mental illness and substance abuse. Recent initiatives to
increase mental health treatment in community based outpatient clinics,
increase use of assertive community treatment for the most seriously
mentally ill veterans, and increased use of opiate substitution clinics
in major urban centers are examples.
Question 18. In my prehearing questions, I asked if you believed
that the VA should contribute funds to assist the government's efforts
to be indemnified for their medical expenses associated with tobacco-
related diseases. You answered that ``money appropriated to VA should
be used for veterans benefits and services.'' Please expand on your
answer, given that transfer from non-Medical Care accounts are not
prohibited by law.
Answer. By my earlier answer I meant only to indicate I would
prefer that sufficient appropriations be made available to the
Department of Justice to permit it to cover its costs of prosecuting
all litigation on behalf of the United States. If that were the case,
VA funds, needed as they are for veterans programs, would not have to
be diverted to DoJ.
Question 19. During your tenure as a panel member on the review
conducted by the National Academy of Public Administration (NAPA) of VA
compensation and pension claims processing, you submitted dissenting
views from the panel. One of the areas you mention is VBA's need to
restructure and consolidate its regional offices, due to advancements
in telecommunications and ``paperless office'' work processes. Is this
something you still advocate? If so, what criteria would you use in
this restructuring?
Answer. I advocate the expansion of the technology that would
support the ``paperless office''. Imaging and telecommunication
technology would ensure VBA has the greatest flexibility in meeting the
needs of the veterans. Upon full evaluation of the paperless
environment, I believe that there may be changes warranted in VBA's
organizational structure. Until that full evaluation occurs, I cannot
say how I would structure the organization. The most important criteria
would be ensuring quality and timely service to veterans. This is one
area where I will be requesting additional views from the task force I
have proposed to take a top to bottom review of VA's benefits claims
processing system.
Question 21. During the last session of Congress, we authorized
construction of new national cemeteries. The aging veteran population
makes creating a resting place of honor an even more important
priority. What will you do to expedite construction of these and other
new facilities?
Answer. The process of site selection is underway for new national
cemetery locations to serve veterans in the areas of Atlanta, Miami,
Pittsburgh, Sacramento, and Detroit. An offer to donate 776 acres of
land near Atlanta has been accepted by VA, the environmental assessment
has been favorably completed, and a contract for master planning of the
site should be awarded soon. An environmental assessment (EA) is
underway for a site north of Miami and will be completed within 60
days. Following completion of the EA, action will be initiated to
purchase the site, and a contract for master planning is anticipated
later this fiscal year. A contract for performing environmental reviews
is in place for the preferred site near Pittsburgh and for two sites
near Sacramento. Potential sites have been identified near Detroit, and
a site evaluation team from VA will visit these sites within the next
month to identify the most favorable location for a new national
cemetery. Acquisition of land near Pittsburgh, Sacramento, and Detroit
is dependent upon future appropriations.
The urgency of providing additional burial space for veterans has
led VA to develop rapid activation plans to expedite availability of
interment areas. At the new Oklahoma City area national cemetery
currently under design at Fort Sill, Oklahoma, we will be preparing a
``fast track'' section for burials. This section will be available up
to two years before the full cemetery is completed and dedicated. This
``fast track'' section will be created and operated as a national
shrine, and will be incorporated into the broader master plan of the
cemetery so that it will fully blend with the cemetery as it is
developed. Using this innovative method, we hope to develop ``fast
tracks'' in each of our new national cemeteries in order to more
quickly meet the needs of our Nation's veterans.
Question 23. What is your view on changing current VA disability
compensation law to allow veterans to choose a lump sum payment, rather
than monthly payments?
Answer. I am aware that last month the General Accounting Office
issued a report on this issue, 'Veterans Have Mixed Views on a Lump Sum
Disability Payment Option.'' That report indicates that veterans are
about evenly split as to whether they would support a program offering
a one-time lump sum payment in lieu of future monthly disability
payments. In addition, in 1996 the Veterans Claims Adjudication
Commission asked Congress to consider creating a lump sum option for
veterans. It is possible that the lump sum option might be more useful
to some disabled veterans as they transition from military to civilian
life. it might also allow VA to process claims more quickly for all
veterans. However, before taking a position on any new lump sum
program, a more thorough review of the proposal would be needed
______
Response to Post-Hearing Questions Submitted by Hon. Bob Graham to
Anthony J. Principi
Question 1. Mr. Principi, as Secretary of the VA, would you support
the closing of under utilized hospitals, or would you have other
suggestions for restructuring the Veteran Health Care System?
Answer. I am aware that the Veterans Health Administration (VHA)
has initiated a comprehensive review of its infrastructure needs to
support modern health care delivery requirements. This review will
first estimate health care needs out to the year 2010, then assess
whether the current infrastructure optimally supports those needs. This
initiative, called Capital Asset Realignment for Enhanced Services
(CARES), will identify and objectively assess options for changing the
current infrastructure to better meet those future needs. I expect that
we will see proposals to reduce infrastructure in some areas; expand
infrastructure in areas experiencing significant patient workload
growth; and proposals to re-configure infrastructure to better meet
current needs. The first phase of this effort is underway in the
Chicago area, following that CARES studies will be initiated in up to 7
VISNs in phase II, and all the remaining VISNs will conduct studies in
phase III.
I will support proposals to modify VA's current infrastructure if
it is shown that such proposals would better meet veteran's healthcare
needs.
Question 2. Mr. Principi, one issue of particular importance to
Florida is the Veterans Equitable Resource Allocation (VERA) program. I
would encourage you to continue to support this successful program
which was implemented in 1997. Florida, in particular, has received
some much needed budget increases to Veterans Integrated Service
Networks (VISNs) to help support the large number of veterans who
migrated to the South.
Answer. I understand that in 1997, VA implemented VERA to comply
with the requirements in Public Law 104-204 to develop an equitable
resource allocation system. VERA has been used for the FY 1997 to FY
2001 network budget allocations to shift funding from networks that
were relatively inefficient to networks that were historically
underfunded. Over the past four and one-half years, VERA has undergone
extensive scrutiny. Its effectiveness has been assessed by both the
private sector through the PricewaterhouseCoopers study (1998) and two
government sponsored GAO reviews (1997, 1998). All three of these
studies viewed the success of VERA in positive terms and as meeting the
intent of Congress. Currently, as a result of the FY 2001 Medical Care
Appropriations process, the House has asked GAO to conduct a follow-up
VERA evaluation. At the same time that GAO is assessing VERA for the
Congress, as directed by language in the FY 2001 Senate Appropriations
Report, VA has contracted with a Federally Funded Research and
Development Center to conduct a VERA study. The RAND Corporation will
conduct this study and a report to Congress is due by August 15, 2001.
VHA also has an ongoing process to continually review and refine
the VERA methodology. There are several VERA workgroups, comprising VHA
field-based and Headquarters staff, that provide ongoing evaluation of
the VERA methodology and input on policy issues to improve VERA.
In conjunction with these external studies and internal review
activities, I assure you that VA is committed to continue to review the
VERA methodology for its ongoing relevance and improvement and ensure
that the allocation of taxpayer dollars for veterans' health care is
equitable.
Question 3. Another priority for Florida is completion of a new
cemetery in South Florida. In FY 01 the VA was appropriated $15 million
to purchase 500 acres in Palm Beach County to establish a full-service
National Cemetery. For the past 13 years, South Florida has been on the
U.S. Department of Veterans Affairs' priority list for a new National
cemetery, yet one has never been built. There are nearly 500,000
veterans in the ten counties of south Florida who will potentially be
served by this new National Cemetery. This year we will seek to secure
the actual construction funds for the cemetery and ask for your
support.
Answer. Efforts are well underway to select and acquire a site to
serve the burial needs of south Florida's veterans. More than a dozen
sites have been evaluated and compared in our efforts to find the best
location. The top site, located in Palm Beach County, is currently
undergoing an environmental assessment that should be completed within
the next 60 days. I strongly support the need for a new national
cemetery to meet the needs of Florida's veterans, and appreciate the
need for additional appropriations for both design funding and
construction funding in order to help this critical project become a
reality.
Question 4. Finally, an issue which is not only adversely affecting
Florida's veterans, but all veterans is claims adjudication. This issue
needs to be addressed expeditiously. Implementation of new technology
for rating disability claims and the recent decision to add Type II
diabetes as an Agent Orange disability has increased the already huge
backlog of pending claims. I am eager to hear how you plan to improve
the disability claims adjudication process.
Answer. As I mentioned in my confirmation hearing before the
Committee, I will create a broad-based and inclusive task force to
conduct an examination of VA benefits processing. After I have
considered their recommendations I will be in position to more fully
answer your question.
______
Response to Post-Hearing Questions Submitted by Hon. Paul Wellstone to
Anthony J. Principi
Question 1. As Secretary for Veterans Affairs you will clearly play
a key role in the drafting of the VA's budget request to OMB. How do
you view the current level of funding being provided to the VA?
Answer. Congress' $3.2 billion appropriation increase for
discretionary programs over the two-year period FY 2000-2001 was
certainly appropriate and helpful. I will be a strong advocate for
maintaining appropriate funding levels for all VA accounts.
Question 2. Can you assure this Committee that you will be a
forceful advocate for full funding of veterans health care within the
administration?
Answer. As I noted in my response to the previous question, I will
be a strong advocate for maintaining appropriate funding levels for all
VA accounts, including the accounts supporting VA's health care system.
Question 3. I have been told by VA staff that they view the
Independent Budget produced by the major veterans service organizations
as a better indicator of the VA's needs than OMB's numbers. What is
your view, generally, of the Independent Budget?
Answer. Recommendations presented in the Independent Budget
highlight important concerns of the veterans' community and help to
define our national sense of duty to those who have served this
country. I welcome this input by the veterans service organizations.
Question 4. On December 27th, Acting Secretary of Veterans Affairs
Hershel Gober proposed adding bone, brain, colon, lung, and ovary
cancers to the list of illnesses presumed to be connected to the
military service of veterans exposed to radiation during their military
service. These diseases are currently on the VA's list of non-
presumptive radiogenic conditions, the effect of which has been that
atomic veterans have a negligible chance of obtaining compensation. The
denials of claims filed by individual atomic veterans for service
connection for these diseases are essentially based on arbitrary
decisions and assumptions. This regulation would correct a decades-long
injustice. The proposed regulation is currently being reviewed by OMB.
If the regulation did not get final approval before the end of the
Clinton administration, will you support and push for its enactment by
the new administration?
Answer. I am aware of the rulemaking proposal, which I understand
did not receive OMB approval during the prior Administration. If I am
confirmed, one of my early tasks will be a review of the details of the
proposed regulation.
Question 5. More than 20 percent of veterans who use VA services
receive psychiatric services annually from the VA, yet VA mental health
services have seen cutbacks in needed capacity. As a result, the
National Mental Health Association reports that many veterans who
relied on VA have fallen through the cracks and are no longer receiving
needed care. In light of these points, what is your vision for turning
this situation around?
Answer. VHA reports that the number of veterans receiving mental
health care in VHA has actually increased since 1996 with the exception
of a drop of 4000 receiving specialty substance abuse treatment. VHA
has recently distributed $15 million to fund the creation of additional
PTSD and substance abuse treatment capacity as a result of provisions
in the Veterans Millennium Health Care Act. Decreased use of hospital
beds has been more than compensated for by greatly increased
availability of residential care, outpatient services, and community-
based care. Because there is considerable variation among VISNs, VHA
will continue to monitor care at the national level and work with
networks individually to improve and maintain capacity and quality of
care for all veterans with serious mental illness and substance abuse.
Recent initiatives to increase mental health treatment in community
based outpatient clinics, increase use of assertive community treatment
for the most seriously mentally ill veterans, and increased use of
opiate substitution clinics in major urban centers are examples.
Question 6. By some estimates, as many as one third of all homeless
males are veterans. Seventy-six percent of these veterans have a mental
illness and/or a substance abuse disorder. Yet it is my understanding
that-some VISNs do not have any inpatient substance abuse care and very
little psychiatric inpatient care. Is this the case? And if so, which
VISNs currently do not offer these services? Further, what steps would
you take to provide adequate services to these at-risk veterans?
Answer. As of the end of fiscal year 2000, VISNs 2, 8, 19, and 22
reported no inpatient substance abuse workload. All VISNs have
developed some residential treatment capability to address the need for
residential treatment for substance abuse. The additional funding
discussed in response to question 5 above will improve availability of
these services this year and beyond. In FY 2000, all VISNs have
maintained inpatient psychiatric capability and only 18 of 138 medical
centers offer only outpatient mental health treatments.
Over the past 7 years VA has offered over $50 million in grants to
state and local governments and non-profit organizations to develop
supported housing and supported services centers for homeless veterans
under VA's Homeless Providers Grant and Per Diem Program. Currently,
over 2,000 community-based beds have become operational through the use
of grants and another 900 beds are available to homeless veterans under
``per diem only'' awards. Over the next few years, another 2,800 beds
will be activated. In summary, a total of approximately 6,000
community-based beds for homeless veterans have been supported under
the Grant and Per Diem Program. I will continue to support VA
partnerships with community based service providers to enhance services
for homeless veterans.
I also understand that VA is making progress in implementing the
Loan Guarantee for Multifamily Transitional Housing for Homeless
Veterans Program which was authorized by P. L. 105-368. Under this
pilot program, VA will be able to guarantee up to 15 loans with an
aggregate value of $100 million to non-VA organizations to assist with
the development of large-scale transitional housing for homeless
veterans. It is expected that 5,000 community-based beds will be
supported through this new initiative.
Question 7. The Department of Veterans Affairs has a highly
regarded research program. But while over 20 percent of its patients
use mental health services, only about 10 percent of the research
budget supports mental health research. Do you think this is an
appropriate ratio? If not, what steps will you take to bolster the
investment in mental health research?
Answer. VHA advises that the VA research program has identified
mental health and substance abuse as two of nine Designated Research
Areas (DRAs) that drive the VA research agenda. The DRAs represent the
high-priority health care needs of veterans. The VA investment in
mental health and substance abuse research has been growing steadily,
from $26.6 million in FY 1990 to $54.2 million (about 17% of all VA-
funded research) in FY 1999. VA is investing in the future growth of
mental. health research by providing mentored research experiences for
young investigators. Awardees conducting research in mental health and
substance abuse constitute 26% of Associate Investigators, 17% of Merit
Review Entry Program investigators, and 14% and 20% respectively of the
Medical Research and Health Services Research Career Development
Program awardees.
In FY 1999, VA funded almost 350 individual research projects in
mental health and substance abuse. In addition, the research program
supports Research Centers of Excellence in Schizophrenia (2 Centers),
Alcoholism (2 Centers), Mental Health Care, and Substance Abuse, as
well as pilot research projects in VHA's Mental Illness Research,
Education, and Clinical Centers (MIRECCs). Two of the eight projects
(25% of those funded thus far) in VHA's Quality Enhancement Research
Initiative (QuERI) focus on depression/schizophrenia and substance
abuse.
The Cooperative Studies Program has completed landmark studies in
schizophrenia, bipolar disorder, PTSD, and substance abuse over the
past decade, and currently has additional ongoing multi-center clinical
trials and open program solicitations in the mental health field. VA's
research portfolio in mental illness and substance abuse thus covers a
broad spectrum, including basic mechanisms of disease, large-scale
treatment trials, health services use, and quality of care. This
investment reflects VA's concern for veterans who suffer from these
common and serious illnesses.
______
Response to Post-Hearing Questions Submitted by Hon. Zell Miller to
Anthony J. Principi
Question 1. The United States of America and Puerto Rico are home
to over 24.8 million veterans. 685,000 of these veterans reside in
Georgia. Although veteran populations as a whole have been declining,
Georgia has one of the lowest relative declines in veteran populations
in the United States. Additionally, we have recently experienced a
significant increase in the populations of veterans over the age of 65.
These demographics have produced an increasing need for geriatric and
long-term care in Georgia. As Secretary of VA, what role do you think
the agency should have in helping states prepare for these needs? What
services, if any, do you believe the VA could and should provide to
local and regional communities in managing these needs?
Answer. As VA moves its long-term care (LTC) focus from nursing
home care to home and community based care (H&CBC), VA can assist
states and local communities that serve the long-term care needs of
veterans.
VA can make available the results of its Long-Term Care Planning
Model (LTC), which offers a solid basis for estimating the demand for
long-term care services. Joint planning efforts have emerged in some
states and appear to be valuable in minimizing duplication of effort
among agencies.
VA can work jointly with states and communities in long-term care
service delivery. The Department's sharing authority and the specific
adult day health care sharing authority offer exciting opportunities to
address the LTC needs of the veteran population and the frail,
chronically ill and disabled elderly population at large. Adult Day
Health Care and Assisted Living are programmatically and economically
appropriate for joint development.
VA will also examine new opportunities for volunteer work with the
Veterans Service Organizations and local communities. VA's new
authority in Public Law 106-117, to provide Respite Care in home and
community based settings, will be valuable as the Department explores
this endeavor.
Finally, VA will continue its support for the State Veterans Home
Grants and Per Diem program. As you know, through this long standing
joint federal-state effort VA works in close coordination with states
in providing long term care to veterans.
Question 2. Vietnam Era veterans make up the largest portion of the
United States' veteran population, with numbers exceeding 8.1 million.
As this population ages, they will increasingly require managed care.
As you know from your previous experience as Acting Secretary of the
Department of Veterans Affairs, many of our veterans' medical centers
are already filled to capacity. As Secretary of the VA, how will you
confront our ever-increasing problems with excess capacity in the VA
medical care system?
Answer. I am aware that the Veterans Health Administration (VHA)
has initiated a comprehensive review of its infrastructure needs to
support modern health care delivery requirements. This review will
first estimate health care needs out to the year 2010, then assess
whether the current infrastructure optimally supports those needs. This
initiative, called Capital Asset Realignment for Enhanced Services
(CARES), will identify and objectively assess options for changing the
current infrastructure to better meet those future needs. I expect that
we may see proposals to reduce infrastructure in some areas; expand
infrastructure in areas experiencing significant patient workload
growth; and proposals to re-configure infrastructure to better meet
current needs. The first phase of this effort is underway in the
Chicago area, following that CARES studies will be initiated in up to 7
VISNs in phase II, and all the remaining VISNs will conduct studies in
phase III. The study in VISN 7 (including Georgia) is in phase III and
could begin in the summer of FY 2002 and take approximately 1 year to
complete. VA will work closely with you and all the stakeholders in
VISN 7 to conduct this study.
Question 3. In recent years, the United States' veteran population
has led the national average in relocation towards Southern and
Midwestern states. In Georgia, this relocation has led to one of the
highest increases in the nation in veteran population over the age of
65. This increasingly mobile population has resulted in medical errors
due to a lack of communication between veterans' facilities. This lack
of information is due in part to inadequate funding and dated medical
equipment. As Secretary of the VA, what steps, if any, would you take
to improve coordination between providers in the VA and DoD?
Answer. The Department of Veterans Affairs has improved
coordination among VA facilities and providers by implementing and
enhancing the Computerized Patient Record System (CPRS) software that
is implemented at all VA Medical Centers. CPRS has introduced Remote
Data Views capabilities that enable VA clinicians to obtain and review
clinical care information for a specific patient regardless of were in
the VHA system that care was provided. Using CPRS Remote Data View, a
provider can quickly review a patient's most recent visits to other VA
medical facilities and then choose to view clinical data, such as
health summary components and lab results, from some or all of the
facilities at which the patient was seen. This software capability
enables providers to better care for their patients, improves patient
safety and reduces medical errors by making patient medical records
available across facilities. It also optimizes available clinical
resources by providing a mechanism for health care providers to
concurrently view and discuss patient care activities. It reduces cost
by eliminating the need for duplicate procedures and laboratory tests
previously performed at a remote facility.
VHA plans to change the existing clinical computing model by
developing a Health Data Repository that will integrate data from
multiple treatment locations as well a's allow for the introduction of
data from non-VA locations such as community nursing homes or
Department of Defense. The repository will take advantage of relational
database technology and will enable the creation of a single patient
record that delineates all aspects of a patient's care across the
continuum with and across VHA.
VHA is actively working with partners including the Department of
Defense, Indian Health Service to build the Government Computerized
Patient Record GCPR Framework. This initiative will facilitate the
exchange and integration of patient-specific data gathered from other
entities that provide health care to the veteran patient.
______
Response to Post-Hearing Questions Submitted by Hon. E. Benjamin Nelson
to Anthony J. Principi
Question 1. One of the biggest obstacles for veterans in Nebraska
seeking health care is the distance they have to travel to hospitals.
In an effort to streamline services, two rural inpatient hospitals in
Nebraska have been closed in recent years and veterans from the Western
part of our state are often forced to travel all the way to Omaha for
care. Is there a way to provide services to veterans with often unique
needs and still consolidate veterans' facilities?
Answer. Similar to rural health care throughout the country,
veterans living in rural areas such as Nebraska may travel greater
distances for primary care than urban veterans. I am advised that VHA
has addressed access to primary care in Nebraska in multiple ways.
Primary care is available at three facilities, Omaha, Lincoln and Grand
Island, as well as community based outpatient clinics located in North
Platte and Norfolk, Nebraska. Inpatient services previously provided at
Grand Island and Lincoln are now made available through a contractual
arrangement with a community hospital in Grand Island (St. Francis
Hospital) and Lincoln (Bryan LGH Hospital). The Omaha VA Medical Center
serves as the tertiary care referral hospital. Access to primary care
continues to be a priority for VHA in Nebraska.
Question 2. Also on the subject of consolidation, I am concerned
that the closing of those rural hospitals may have been too hasty. I do
not have figures for the year 2000, but in 1999 29,500 veterans sought
care in Nebraska--a 17% increase over the previous year and one of the
highest growth rates in the nation. As you know, veterans often have
special needs that can only be met at facilities specifically intended
for veterans. Can you assure me that Nebraska veterans will continue to
have convenient and quick assess to care when they need it?
Answer. VHA advises me that a contractual arrangement with a
community hospital in Grand Island and Lincoln ensures that inpatient
services are maintained at the same level as when the Grand Island and
Lincoln VA facilities provided inpatient care. In addition to
maintaining programs designed to meet the unique needs of veterans,
access to primary care continues to be a priority for VHA. In an
attempt to improve access to primary care, the VA Central Plains Health
Network (VISN 14) established community based outpatient clinics at
North Platte and Norfolk, NE as well as Sioux City, IA. This is in
addition to the primary care clinics, and specialty care clinics at the
Grand Island and Lincoln, NE facilities and the full range of tertiary
and specialty services at the Omaha facility. The need to expand
community based clinics is continually assessed and re-evaluated and
clinics will be added as needed to ensure veterans receive the best
possible care. Veterans are assisted in transportation needs via a
state wide transportation system which provides shuttle service to all
facilities in Nebraska.
Question 3. Last year, following a deluge of complaints from
Nebraska veterans, the VA's Inspector General conducted an
investigation of the Omaha VA Medical Center. While they found many
positive things to say about the facility, they also discovered an
alarming number of problems including:
Poor treatment at the Post-Traumatic Stress Syndrome
(PTSD) clinic;
Inconsistent follow-up care for veterans with hepatitis C;
Failure to communicate about patients' medical histories
among hospital staff;
Poor monitoring of narcotics prescriptions; and
Poor management and a backlog in the hospital's pain
management program.
Will the VA follow-up to ensure that the recommendations of the
Inspector General have been implemented? And what can be done to
prevent these types of problems from occurring in the future?
Answer. Since the Inspector General's report, a new Medical Center
Director has been appointed to the Omaha VA Medical Center (VAMC). The
new director has taken swift action to assure that all the
recommendations are being fully addressed. Additionally, the VA Central
Plains Health Network as well as VHA Headquarters, is closely
monitoring the Omaha VA Medical Centers progress in addressing each of
the recommendations. Changes made at the Omaha facility since the
report include:
Incorporating the PTSD program into the overall Mental
Health Clinic to improve the administration and performance of the
program. Separate from the Inspector General visit, the Omaha VA
Medical Center hired a recognized VA PTSD expert to assist the Omaha
program in making continual improvements and developing a formal
curriculum for staff education. In November 2000, A follow-up visit by
the internal VA consultant found significant improvement in the PTSD
program's quality, compliance with national VA standards, and
improvement with high patient satisfaction.
Implementation of a call-back program has been initiated
for hepatitis C virus (HCV) infected patients;
All Nebraska VHA facilities have implemented an electronic
medical record, which provides the capability of accessing medical
information and records of care;
Assuring that all narcotic prescriptions are hand written
according to VA regulation and reviewing medication records for
narcotics regularly; and
Establishing a pain management clinic to ensure an
effective pain management program. Patients with chronic pain problems
are assessed by primary care providers and referred for care to the
Anesthesiologist who is in charge of the program.
______
Response to Post-Hearing Questions Submitted by Hon. Arlen Specter to
Anthony J. Principi
Question 1. I have been blunt with prior VA Secretaries about the
importance I place on working with the Committee in its legislative and
oversight capacity. The appearance of the Secretary--not his or her
staff--before this Committee is indispensable to the Committee, and to
veterans. Can I count on you to work with the Committee so as to better
serve veterans? Can I count on you to appear when requested?
Answer. If confirmed, you can count on my active and continued
cooperation with the Committee, including testimony when required.
Question 2. VA has made significant changes in recent years in the
way it delivers health care. Some of those changes are the result of
legislation--e.g., ``eligibility reform,'' and the long-term care and
emergency care provisions of the Millennium Act. But more, perhaps, are
the result of budgetary pressures and the changing nature of health
care in the United States, generally, and its increased emphasis on
outpatient-based care. Do you foresee further restructuring of VA
health care? Has there been enough change in VA over the past five
years to effectively deliver health care to the nation's veterans?
Answer. At this time, I don't know whether there will be further
restructuring of VA health care. As I have promised, we will conduct a
top to bottom review of the VA health care system. Although I believe
VA effectively delivers health care to the nation's veterans, I would
never say that the changes over the last five years mark an end to the
process. We must continually strive to improve the VA health care
system and remain alert to the changes in the health care arena so that
VA can stay in the forefront of the health care delivery. If this
requires change, then I assure you I will strive to make the
appropriate changes.
Question 3. Senator Rockefeller and I have worked hard to secure
significant increases in VA health care funding over the past two
years. Do you believe that the VA health care system is adequately
funded? Will you seek additional funding to provide health care for our
nation's veterans? Do you have a sense of how much increased funding is
needed to make necessary improvements in the system? If so, how much?
Answer. The $3 billion appropriation increase provided by Congress
for Medical Care over the two-year period, FY 2000-2001 has
significantly helped the system. I will be a strong advocate for
maintaining appropriate funding levels for VHA. However, until I'm
briefed in detail on VHA's budget requirements and determine the
resources necessary to support the improvements I envision, I will not
speculate on the magnitude of any additional funding needs.
Question 4. In the past five years, VA's health care system has
reduced its workforce over 15%--from approximately 201,000 employees to
approximately 179,000 employees. At the same time, VA has seen more
patients--approximately 3.89 million in FY 2001 as compared to
approximately 2.86 million in FY 1996. Do you believe that these trends
can continue? Should they? Can VA continue to achieve such growth in
efficiencies and still provide quality care to veterans?
Answer. I am aware that, over the past five years, VA has
significantly restructured its health care system to improve quality,
capacity, and access to care, mainly through expansion of outpatient
health care programs. This was achieved by shifting resources through
improvements in health care services delivery and by efficiencies
gained through program and organizational restructuring, technology
improvements, and business process re-engineering.
VA informs me that the downward trend in employment has leveled off
and as of December 30, 2000 VHA employment was approximately 182,000
FTE. VA will continue its system restructuring and improvement efforts
to maximize the delivery of health care to veterans within resources
provided. I will work closely with the Congress and the VSOs to ensure
that resource levels are appropriate to meet the health care needs of
our Nation's veterans.
Question 5. It has been argued in some quarters that VA has
wasteful and overlapping ``infrastructure.'' GAO contends, for example,
that VA wastes $1 million dollars per day maintaining unneeded
building--money that could otherwise be spent on providing care. Do you
agree that VA's medical ``infrastructure'' is wasteful and overlapping?
If so, how will you stop this waste?
Answer. I agree that VA's medical infrastructure does not optimally
support modern health care delivery. I am aware that the Department has
developed the Capital Asset Realignment for Enhanced Services (CARES)
process to review its medical capital infrastructure requirements.
VA's health care system has been assembled over the past 100 years.
VA must work with all its stakeholders to identify needed changes.
Modernizing VA will also require the support of the congressional
committees responsible for overseeing the VA system. The CARES process
has the potential to provide VA with a mechanism to better justify its
capital needs and make changes that will enable it to more effectively
carry out its health care mission.
Question 6. I am very concerned about the current status of VA's
``CARES'' process--a VA contractor evaluation of allegedly wasteful and
overlapping medical infrastructure. This process needs to proceed--and
it needs to proceed quickly. Do you support ``CARES''? Please provide
me a detailed schedule of how--and when--this work will progress.
Answer. VHA advises me that CARES is not just about facilities or
buildings, but is about veterans health care needs and the
infrastructure that will be needed to meet those needs in the most
cost-effective manner in the future.
The CARES program will assess veterans health care needs in each
network, identify service delivery options to meet those needs, and
identify options for realignment of capital assets linked to those
needs. The goal is to improve both access to care and quality of care
in the most cost effective manner, while mitigating impacts on staffing
and communities and on other VA missions.
I support the goals of the CARES initiative. It is a critically
needed strategic planning mechanism. If successful, the evaluation
criteria will allow difficult decisions to be made based on measurable
criteria, with particular emphasis on quality of care.
Phasing of this project is as follows:
Phase I began on January 8, 2001 and is anticipated to
take 90 days. Phase I includes the application of the CARES Evaluation
Criteria to the results of the Delivery System Options Study conducted
for VISN 12. Phase I will also evaluate these criteria as well as the
entire CARES process and recommend adjustments.
Phase II is expected to commence in April 2001 and take
approximately one year. Phase II will comprise service delivery option
studies in up to seven of the following VISNs: VISN 1 (Boston), VISN 3
(New York), VISN 4 (Pittsburgh), VISN 10 (Cincinnati), VISN 11
(Indianapolis), VISN 21 (San Francisco), and VISN 22 (Los Angeles).
Phase III will complete the remaining VISN studies. It is
projected to also take one year to complete, beginning in May 2002.
Question 7. I think ``CARES'' is important--and I surely recognize
that, in some cities, VA has multiple facilities which appear to
compete with each other and which each appear to attempt to be ``all
things to all people.'' But I also think that CARES analysis must take
into account that multiple facilities in the same city can make sense
if they operate under a single management and in a complimentary way.
Do you agree?
Answer. Again CARES is not just about facilities, but about
veterans health care needs. Each CARES study is intended to answer the
question, ``What health care service delivery options best meet future
veteran health care needs, while assuring the highest quality care and
optimal access for a defined veteran population in the most cost
effective manner?''
VHA has made significant progress in combining services over the
last 5-6 years, integrating geographically close facilities under
single management. CARES is designed to systematically evaluate each
VISN using uniform, tested evaluation criteria.
The planning horizon for each CARES study will be 2010. The study
will concentrate on the Year 2010 demand for services, with a
sensitivity analysis performed to the year 2020 to determine whether
any longer range changes in demand could affect the viability of the
service delivery options developed. CARES studies will result in a
strategic plan for VHA for its current enrolled veterans and projected
future enrollees.
Question 8. This Committee supported the nomination of Dr. Thomas
L. Garthwaite to be Under Secretary for Health, and we approved that
nomination for a term of four years just a couple of months ago.
Nonetheless, Dr. Garthwaite had indicated that he would step down if
the next Administration does not want him to continue serving as Under
Secretary. Will you ask Dr. Garthwaite to step aside? Will it be your
decision to make? Will you assure this Committee that you will not take
that action without first consulting the Committee?
Answer. I am aware of the Under Secretary for Health's statutory
term of office and the process set forth in the statute should the
President choose to replace the Under Secretary before completion of
the term. The President has assured me that I will have a key role in
implementing his pledge to appoint veterans advocates to lead the
Department. There is no predetermined decision to seek a replacement
for the leadership of the Veterans Health Administration. I look
forward to discussing health care matters with Dr, Garthwaite in the
near future to discuss my vision for VA healthcare and the role he will
play in implementing that vision. I have committed to working in
partnership with VA's many stakeholders, including the Congress and the
VSOs, as I reach major decisions concerning VA.
Question 9a. In a recent budget submission, VA pledged to improve
the timeliness of VA medical service delivery through a ``30-30-20''
initiative--a promise that veterans will obtain an initial visit with a
health care provider within 30 days of applying for care; an
appointment to see a specialist within 30 days after referral by a VA
doctor; and an actual waiting time not to exceed 20 minutes. Are these
goals realistic? Are they obtainable? Will you commit to them?
Answer. I believe that the 30-30-20 goals are consistent with
access and waiting time goals in other service industries and are
consistent with veteran expectations. I am told that they are
obtainable, over time, given adequate resources to meet the demand for
care.
Question 9b. One measure of VA's effectiveness is veteran patient
satisfaction. Do you agree? How should VA gauge patient satisfaction?
Answer. I agree that veteran patient satisfaction is critical to
our success. And, in fact, I've been told that VHA's goal is to move
beyond mere patient satisfaction to a higher goal of ``delighting''
patients. As a veteran, I applaud them for this objective.
VHA should, and I am advised that it does, gauge patient
satisfaction using standard industry patient satisfaction instruments.
The use of these tools allows VHA to benchmark its performance relative
to the private sector. Internally, this same data is used by VHA
facilities to compare performance with other VHA facilities. This
allows VHA to identify practices that result in improved customer
satisfaction.
In addition to traditional patient satisfaction instruments, VHA
has developed instruments for assessing patient satisfaction in
clinical areas or populations not traditionally assessed in the private
sector. For example, VHA has specialized surveys for patients who
receive prosthetic devices, patients in Spinal Cord Injury Centers and
patients who receive home care services. In addition, I am told that
VHA is completing an annual study on patient satisfaction of Persian
Gulf War veterans. And with the aging of the veteran population, it
will become increasingly important to develop a patient satisfaction
tool for use in long-term care settings.
Finally, VHA has further demonstrated its commitment to patient
satisfaction by conducting semi-annual national surveys of patient
satisfaction and developing a point-of-care Patient Satisfaction
Toolkit that will allow facilities to generate surveys that are more
responsive to local issues.
Question 10. When he announced his intention to nominate you to be
Secretary of Veterans Affairs, President-Elect Bush stated that
reducing the amount of time it takes for VA to adjudicate a claim would
be a top priority. Do you view this as a Presidential charge? How will
you implement it?
Answer. As I indicated in my testimony, President Bush has charged
me with a top to bottom examination of VA benefits processing which I
will achieve by commissioning a broad-based and inclusive task force
charged with identifying problem areas and proposing solutions.
Question 11. Do you believe VA's Veterans Benefits Administration
(VBA) is now moving in the right direction to improve the quality and
timeliness of its claims adjudication process? In what areas will you
encourage VBA to continue on its present course? In what areas will you
provide new direction?
Answer. As I mentioned in my confirmation hearing before the
Committee, I will create a broad-based and inclusive task force to
conduct an examination of VA benefits processing. After I have
considered their recommendations I will be in position to more fully
answer your question.
Question 12a. Many people are familiar with your work on the
Commission on Service members and Veterans Transition Assistance. Fewer
may recall that you were a member of a 1997 National Academy of Public
Administration panel which studied VA's claims processing system. In
fact, you offered dissenting views as part of the panel's report and,
there, you made several observations about VA's claims processing
system and the role the VA Secretary ought to play in improving that
system. Please respond to the following questions relating to your
participation on the NAPA panel.
You stated in your NAPA report dissenting views that the report had
failed to identify the ``root causes'' of claims processing problems.
Among those ``root causes'' you noted were ``legislative requirements .
. . [which] creat[e] some of the most arcane and complex requirements
in all of government.'' You wrote, further, that ``[I]f VBA is to
achieve its claims processing improvement targets, Congress will need
to play an active role, including enacting legislative reform, [and]
streamlining claims processing requirements. . . .'' If you are
confirmed, what ``legislative reform'' measures, specifically, will you
propose to Congress? How would you have us ``streamline claims
processing requirements?''
Answer. There is no question that the law governing disability
compensation is extremely complex and could benefit from thoughtful
reexamination. The NAPA report could have been, but was not, a part of
that process. The forthcoming program evaluation, to be accomplished
pursuant to the mandates of the Government Performance and Results Act
(GPRA) should provide helpful guidance. But I need not remind the
Committee that this is an extremely sensitive question for which
considerable effort and time will be required to achieve consensus by
veterans organizations and the Congress. As Secretary, I would be
charged with implementing the law as the Congress has written it. VA's
immediate pressing problem is to improve the quality and timeliness of
claims processing within the framework of the law as it currently
exists. That will be the function of the task force I have proposed.
Question 12b. You also stated in the NAPA report that claims
processing problems transcend the boundaries of any one VA
organization, and that, therefore, ``[t]he Secretary should take the
lead in breaking down the stove-pipe structures and barriers existing
within VA today.'' You stated that ``[t]hose barriers are tall and
thick, and they are protected by elements more focused on turf than on
meaningful change, but change they must.'' Who or what are the
``elements'' to whom or which you referred in 1997? Are they still
present in VA? How will you break them down?
Answer. As I indicated in my testimony, I support and will continue
fostering the One VA initiative implemented over the past few years to
help break down the stove-pipe structures and overcome the barriers of
cross-Administration cooperation. I understand that this initiative
included a number of educational conferences that involved VA managers
and employees, union representatives, VSOs, State VA directors, and
Hill Staff who worked together to identify specific opportunities for
collaboration. These conferences resulted in the development of several
Statewide and National initiatives that are already underway and
improving the way VA provides service to veterans and their families.
Of greater importance, the Department's career senior leaders have been
actively involved in this initiative. Continuing and improving upon
this initiative will be an important way to further the elimination of
barriers to cooperation and will help reduce the focus on turf. As
Secretary of the Department of Veterans Affairs, I will work with my
senior leadership team to continue improving seamless service to
veterans.
Question 12c. In explaining the need for VA to work with the
Department of Defense and other Federal agencies, you wrote in your
NAPA dissent that ``[t]he Secretary should . . . look at the
opportunities that exist for real improvements in information gathering
and sharing beyond the VA. . . .'' What information does VA need to
gather from outside itself to properly--and promptly--adjudicate
claims? Why can't it get that information now? What will you do, as
Secretary, to secure such access?
Answer. As I explained in my testimony, I intend to work closely
with Secretary Rumsfeld to improve the co-operation and data exchange
between VA and DoD, particularly as it relates to service medical
records.
Question 12d. In arguing that VA's Veterans Benefits Administration
should ``initiate new efforts to restructure and consolidate, where
appropriate, its regional offices,'' you wrote that the Secretary
``should dedicate Departmental resources to the development of a
consensus among the VBA's various stakeholder organizations that a
restructuring business plan is vital. . . .'' Do you still hold the
view that a consensus needs to be built? If so, how will you build such
consensus?
Answer. As I indicated in a previous response to a pre-hearing
question, I will need more information before I reach conclusions on
the effectiveness of the SDN reorganization VBA implemented subsequent
to my 1997 remarks. The effectiveness of the current organizational
structure will be one of the issues I will ask to be reviewed by the
task force I plan to convene. I believe the ability to reasonably
project improved benefit delivery through proposed changes is the key
to achieving needed consensus.
Question 12e. I appreciate the need for consensus and
consultation--especially with this Committee. The Committee, however,
also expects you to lead--an action that sometimes must predate the
evolution of consensus. If you believe that VBA's Regional Office
structure needs to be modified, why do you not just move to fix it?
Answer. Considerable change has occurred in the VBA organizational
structure and VA's claims processing procedures since 1997. While I
will not hesitate to initiate needed changes, the decisions I will make
will be informed decisions, acting decisively but not impulsively. I
also recognize that a key to achieving change is building consensus
within Congress and the veterans community for those changes.
Question 13a. President-Elect Bush has made ``education reform''
one of his top priorities. As you know, the Committee has made
significant progress in the last four years in securing increases in
Montgomery GI benefits. Yet what we have achieved--an 87% increase in
the maximum monthly benefit paid to a full-time veteran students/
trainees still falls short of increases you advocated as Chairman of
the Commission on Service members and Veterans Transition Assistance.
Please explain the Commission's reasoning in recommending that we adopt
a tuition-reimbursement benefit.
Answer. The Commission's report will provide the most complete
explanation of the findings and rationale underlying this specific
recommendation. However, as I indicated in my response to one of the
Committee's pre-hearing questions, I believe that educational benefits
are essential if we are to give veterans the foundation for a
successful civilian life.
Question 13b. Will you advocate within the administration that VA
seek legislation to provide for a ``tuition reimbursement'' benefit for
veteran-students/trainees? How will you convince OMB to fund such a
benefit?
Answer. As Secretary of Veterans Affairs, I do realize that I must
balance my advocacy and support for ``tuition reimbursement'' with the
fiscal constraints of the federal budget. I will carefully examine the
alternatives presented to me by well-intentioned advocates of veterans'
education. As you may know, the Partnership for Veterans' Education, a
coalition of more than 50 military and veterans' organizations and
higher education groups, proposed a benchmark for veterans' benefits
that would equal the average cost of tuition and educational expenses
for a commuter student at a 4-year public college or university. I want
to examine this and other possible proposals that sufficiently honor
and reward our separating service members for their military service to
this nation.
Question 14. During the 106th Congress, legislation was enacted
expanding, for civilians exposed to weapons-related radiation, the
listing of diseases covered under the Radiation Exposure Compensation
Act, and creating a new program for compensation for civilian
Department of Energy employees who were exposed to radiation in
weapons' plants. As a consequence, civilians will now be compensated
for diseases that are not on VA's listing of ``presumptive'' diseases.
Do you agree that this situation cannot be allowed to persist? Do you
agree that veterans must be afforded benefits that are at least equal
to those afforded to civilian Federal employees? Will you propose--or
at least support--legislation to that effect?
Answer. Atomic veterans deserve fair treatment, and if those with
meritorious claims require additional presumptions in order to receive
benefits, I would support that. However, before committing to a
position on this matter, I need to be briefed on 1) the comparability
of the civilians' and veterans' radiation exposures, and 2) the
likelihood that meritorious claims by veterans would be denied in the
absence of new legal presumptions.
Question 15. As you know, Congress has enacted presumptions
relating to certain diseases and environmental exposures. In some
instances, Congress has, in addition, granted to VA explicit statutory
authority to add diseases, by regulation, to such statutory listings.
Do you believe that VA has authority to add to statutory listings of
presumptive'' disease by regulation in the absence of such an explicit
delegation of authority? If so, what is the legal source of that
authority?
Answer. The Department's long-held position is that 38 U.S.C
Sec. 501(a) authorizes the Secretary to create evidentiary presumptions
through rulemaking when they are found to be necessary for the fair and
just administration of VA benefit programs. That section provides, in
pertinent part:
(a) The Secretary has authority to prescribe all rules and
regulations which are necessary or appropriate to carry out the laws
administered by the Department and are consistent with those laws,
including--
(1) regulations with respect to the nature and extent of
proof and evidence and the method of taking and furnishing them
in order to establish the right to benefits under such laws;
Because legal presumptions are rules affecting the duty to produce
evidence, they fall squarely within this authority. It was this
authority upon which former Secretary Derwinski and I relied when, in
1991, VA first proposed rules presuming certain diseases to have
resulted from mustard-gas exposure.
Question 16. VA's Committee on Care of Severely Chronically
Mentally III Veterans has stated that VA is slow in adopting for use
the latest FDA-approved medications for treatment of the mentally ill.
Is this so? If so, why?
Answer. I am informed by VHA that a recent survey addressing the
concern expressed by the Committee on Care of Severely Chronically
Mentally Ill Veterans has shown that, overall, VA's use of the latest
medications for the care of the mentally ill is comparable to that of
systems caring for similar non-VA populations (e.g. Medicaid). It has
been noted that there appears to be some local variation in the use of
these medications. The data on use of medications for mental disorders
is being provided to the Networks and their facilities for their review
and consideration of any needed changes in prescribing practices. It
should be noted that VA's National Formulary includes virtually all of
the latest antipsychotic and antidepressant medications. I will work
with VHA to ensure appropriate treatment for severely, chronically
mentally ill veterans.
______
Response to Post-Hearing Questions Submitted by Hon. Strom Thurmond to
Anthony J. Principi
Question 1. Would you please elaborate on your prior employment at
QTC Medical Services, particularly that company's business dealings
with the VA. Would you please explain what safeguards you have in place
to avoid any conflict or apparent conflict of interest.
Answer. The VA signed a contract with QTC in February 1998 to
conduct medical examinations for compensation and pension claims
purposes. QTC was selected from three bidders after a technical
evaluation panel determined that corporation to be not only the best
qualified, but also the lowest bidder. I joined QTC in June of 1999 as
President of the Medical Services Division. I have now terminated all
relationships with QTC and waived any and all future rights or benefits
that could flow from my relationship with that organization.
Furthermore, I will execute a formal memo to the Deputy Secretary of
VA, recusing myself from any matter affecting QTC (until the Deputy
Secretary is confirmed such delegation will be considered within the
authority of the Under Secretary for Benefits). In order to ensure that
the recusal has its full effect, the memo will delegate to the
addressee all of the authority of the Secretary of Veterans Affairs to
affect such matters. Further the memo requests, and authorizes, the
Assistant General Counsel in the Department who serves as the
designated ethics official, and the Inspector General, to monitor the
implementation of the recusal.
Question 2. What are your thoughts on improving VA medical care?
Answer. I have heard from many sources that the quality and
consistency of care in VA has improved over the past 6 years. I am told
that VHA has used a data-driven, management-incentive strategy to yield
consistent, sustained improvements in care. The availability of
facility, network and national level measurement data has allowed VHA
to benchmark its performance internally and externally.
Despite recent success, I believe that all of health care,
including VA, has room for improvement. President Bush has promised a
top to bottom review of VA's healthcare system, implementation of the
Millennium Health Care Act, and modernization of barriers hindering
veterans' access to health care. I will look to the broad based,
inclusive task force I have proposed to provide recommendations on how
we can achieve these improvements.
Question 3. What are your views on the Veterans Equitable Resource
Allocation (VERA) program in VA?
Answer. As directed by the Senate, VA has contracted with a
Federally Funded Research and Development Center to determine whether
the VERA methodology leads to a distribution of funds that covers the
special needs of some veterans, and also to investigate the progress of
this funding allocation method. VA recently entered into a contract
with the RAND Corporation to conduct this study and the results are due
to Congress no later than August 15, 2001. VA will give this study,
along with the ongoing GAO VERA audit, careful consideration. If this
study identifies problems in VERA resource allocations, VA will review
and refine the VERA methodology and will act as quickly as possible to
resolve any inequities. There are several VERA workgroups, comprising
VHA field-based and headquarters staff, that provide ongoing evaluation
of the VERA methodology and input on policy issues to improve VERA. I
assure you that VA is open to future adjustments, refinements, and
improvements to the VERA methodology if problems are identified.
Question 4. Are there issues remaining from the veterans transition
commission which you would like to address at the VA?
Answer. I am pleased to note that many of the Transition Commission
recommendations have been implemented or are being developed. I expect
VA will continue to explore recommendations in the areas of outreach,
use of information technology, data exchange and VA/DoD cooperative
efforts to improve claims processing and service delivery. With respect
to the Education, Vocational Rehabilitation and Employment, and Loan
Guaranty programs, also I expect VA will continue to explore
opportunities for assisting service members in their transition to
civilian life by providing benefits that meet their unique needs.
Question 5. Do you have some ideas on how the VA can improve the
benefit determination and adjudication process?
Answer. I plan to await the recommendations of the task force
before rendering judgments on this matter.
______
Response to Post-Hearing Questions Submitted by Hon. James M. Jeffords
to Anthony J. Principi
vet centers
Question 1. When the Vet Center program was established in 1979, it
addressed the VA's mission to provide local readjustment counseling
services to veterans. Last year, Congress expanded the role of Vet
Centers by requiring them to open their doors to the counseling needs
of veterans of all wars. Would you support increased funding for the
Readjustment Counseling Service to meet this expanded mandate to
provide all vets with this very important service?
Answer. VHA reports that since enactment of enabling legislation,
the Vet Center program has provided services to approximately 110,000
Gulf War; 12,000 Lebanon, Grenada, and Panama; 30,000 World War II;
22,000 Korean War; and 5,000 Somalia veterans. Veteran feedback
indicates a very high level of satisfaction. I support the Readjustment
Counseling Program and if the need arises for additional resources, I
would be supportive.
hepatitis c
Question 2. As I understand it, Acting Secretary Gober yesterday
sent recommendations to OMB that would establish a service-connected
presumption for Hepatitis C for veterans who had blood transfusions,
solid organ transplants, and for medical personnel. Have you seen these
recommendations? If so, would you support them? If not, what is your
thought on the coverage of Hepatitis C in veterans?
Answer. I have not yet seen this proposal and would need to be
fully briefed before taking a position on it. However, if the proposed
presumptions are necessary to the fair resolution of these claims, I
would support them.
medicare subvention
Question 3. What is your view of the future for VA interaction with
the Medicare program? Would you support the Medicare Subvention pilot
program as introduced by Senator Rockefeller and myself last Congress?
How high a priority will this be for you?
Answer. With the aging of our veteran population, I believe it is
essential that there be ongoing and close interactions with the Health
Care Financing Administration and the Medicare program. It makes sense
that the care of individuals who depend on both the veterans health
care system and the Medicare program be better coordinated. This would
result in better medicine, better care for our patients, and the most
efficient use of scarce federal dollars. In addition, I think that the
Medicare program can benefit from many of the programs and research
efforts that are underway within VA. More and more it is being shown
that in many of the areas of concern to Medicare, such as patient
safety and preventive medicine, VA is in the forefront of health care
delivery today.
I support efforts to implement a Medicare Subvention pilot, similar
to that which is now underway within DoD. I think it makes sense to
take a look at all options that may bring this about. I appreciate the
effort and interest you and Senator Rockefeller have shown in this area
and look forward to working with you and other members of Congress to
gain authorization for a meaningful pilot that is fair to VA and to
Medicare.
vera formula inequities
Question 4. As you may know, last year the New England delegation
requested a study that will be conducted by the Rand Corporation
evaluating current VERA reimbursement procedures. I hope that you will
give this study careful consideration. Do you intend to devote some
attention to the problem of VERA inequities? Are you open to future
adjustments in VERA if problem areas are identified?
Answer. As directed by the Senate, VA has contracted with a
Federally Funded Research and Development Center to determine whether
the VERA methodology leads to a distribution of funds that covers the
special needs of some veterans, and also to investigate the progress of
this funding allocation method. VA recently entered into a contract
with the RAND Corporation to conduct this study and the results are due
to Congress no later than August 15, 2001. VA will give this study,
along with the ongoing GAO VERA audit, careful consideration. If this
study identifies problems in VERA resource allocations, VA will review
and refine the VERA methodology and will act as quickly as possible to
resolve any inequities. There are several VERA workgroups, comprising
VHA field-based and headquarters staff, that provide ongoing evaluation
of the VERA methodology and input on policy issues to improve VERA. I
assure you that VA is open to future adjustments, refinements, and
improvements to the VERA methodology if problems are identified.
visn structure
Question 5. What is your opinion of the value of the Veterans
Integrated Service Network (VISN) structure? Has it been successful? Do
you anticipate any changes to this structure?
Answer. VHA informs me that the VISN structure has allowed VHA to
keep pace with the rapidly changing health care industry and foster
flexibility and innovative approaches that enable the networks to
address local healthcare needs quickly. As I said in my statement on
January 18th before the committee, I believe that a broad based,
inclusive, tightly-focused and short-fused task force, drawing on the
commitment and knowledge of the VSOs, forward-looking VA employees, and
VA's partners in health care delivery, can help me deliver on President
Bush's promise of a top to bottom review of VA's healthcare system by
identifying problems and proposing solutions. I await the
recommendations of the task force.
medical histories
Question 6. Legislation that was enacted this past November
included language that requires the VA to take a complete military
history from veterans who are enrolled and treated by the VA in order
to have a more informed system to provide better treatment for
veterans. The implementation date is March 1st of this year. Will you
make implementation and enforcement of this provision a priority?
Answer. I fully intend to support the implementation and
enforcement of this provision. The VHA advises that in September 1999
the Under Secretary for Health established the Veterans Health
Initiative (VHI) in part to ensure better military histories be taken
from veteran patients, specifically to improve care to veterans. One
goal of this initiative is to ensure that all enrolled veterans will
have a comprehensive military history taken, which will become part of
their medical record. The expected outcomes are improved sensitivity to
the effects of military experiences and exposures on veteran patients
health and attitudes, improved patient satisfaction, increased
awareness of the occupational risks in a patient's history, and a data
base for future research activities.
agent orange
Question 7. Will you support continued outreach by VA to find,
treat and compensate Vietnam Veterans exposed to herbicides while in
Vietnam? As new evidence presents itself, would you be willing to add
diseases to the list of presumptive illnesses under the authority
provided to you by the Agent Orange Act?
Answer. As a Vietnam veteran myself, I feel a special
responsibility to veterans exposed to herbicides during that conflict.
I will insist that they be treated fairly and compassionately, and
provided every benefit and service to which the law entitles them. As
but one example, I would not hesitate to expand the list of compensable
diseases if the evidence presented meets the threshold requirement of
the Agent Orange Act of 1991.
______
Response to Post-Hearing Questions Submitted by Hon. Larry E. Craig to
Anthony J. Principi
Question 1. How are you planning on developing the Memorandum of
Understanding between the Veterans Administration and the Department of
Defense in order to provide medical services to TRICARE-dependent
military retirees in the Veterans Medical Centers?
Answer. I understand that VA and DoD are working together to
identify and attempt to remove barriers to sharing between the two
Departments. Section 113 of the ``Veterans Millennium Health Care and
Benefits Act'' (P. L. 106-117) authorizes the Department of Defense
(DoD) to reimburse the Department of Veterans Affairs (VA) for medical
care provided to eligible military retirees. On December 20, 2000, the
Under Secretary for Health, Veterans Health Administration (VA) and the
Acting Assistant Secretary for Health Affairs (DoD) reported on the
status of the development of a Memorandum of Understanding (MOU). The
VA stated that there are issues that require further analysis and
discussion before the drafting of an MOU could be initiated.
The major issue cited implementation of the Millennium Act in the
light of the Fiscal Year 2001 Defense Authorization Act's major benefit
restructuring for DoD's Medicare-eligible retirees and the accompanying
universal enrollment plan. Substantial changes in entitlement for these
retirees and changes in the financing of that entitlement are looming.
VA plans to revisit DoD's reimbursement for VA for medical care
provided to eligible military retirees once DoD has satisfied
legislative requirements regarding the new military retiree Medicare
benefit structure.
Question 2. Considering the rise in gas prices, are you going to
adjust the travel reimbursement rates?
Answer. The Department has advised me that the beneficiary travel
mileage reimbursement rates are reviewed on an annual basis. During the
review which took place in CY 2000, the Department elected not to
raised mileage reimbursement rates, due to potential adverse financial
impact on the medical care appropriation. During the upcoming CY 2001
review cycle, rising gas prices will need to be addressed.
Question 3. Do you plan to provide more Community Based Outpatient
Clinics (CBOC) and expand services in the existing facilities?
Answer. CBOCs are very important to the future of VA and will
continue to be a priority. Over the last several years, VA has
increased veteran access to health care services through the
establishment of close to 400 new Community Based Outpatient Clinics.
VHA Networks will be encouraged to plan for the establishment of
additional CBOCs, and/or expand services at existing CBOCs, where there
is demonstrated need and within the context of available resources.
Question 4. How are you planning to reach out and ensure that all
disabled veterans are adequately compensated for related service-
connected disabilities, and receive high quality medical care?
Answer. To promote high quality medical care for veterans, I will
work closely with VHA to monitor the success of its efforts to improve
its performance in six critical areas:
Improving the Quality of Health Care
Improving Access to Services/Health Care
Enhancing Customer Satisfaction
Building Healthy Communities
Improving Cost-Effectiveness
Improving Functional Status
I will evaluate the quality of healthcare provided by VHA through
the collection and analysis of objective performance measurement data,
which will be compared to internal and external benchmarks. I will
insist that VHA identify best practices and innovations and spread
those quickly across the entire system. I will evaluate VHA managers
relative to their success in measurably improving care for veterans.
The forthcoming program evaluation of the disability compensation
program should provide valuable information to improve that program
where needed.
Question 5. How are you planning on implementing the Millennium
Health Care Act?
Answer. VHA advises that significant progress has been made on
implementing Millennium Act requirements. However, a number of
requirements have required significant program development and the
issuance of Federal Regulations. I am advised that actions are underway
on all provisions of the Act. I understand that the Committee staff
will briefed on this in the near future
______
Response to Post-Hearing Questions Submitted by Hon. Jeff Sessions to
Anthony J. Principi
Question 1. Given the enormity of the VA claims backlog, what are
you prepared to do to guarantee that this process is improved while
ensuring reliability, efficiency, and consideration for Alabama
veterans, who are frankly becoming increasingly cynical about the
claims process.
Answer. I look forward to recommendations from the task force I
proposes at my confirmation hearing before deciding on what particular
changes need to be made.
With respect to Alabama in particular, VBA officials inform me that
numerous initiatives are underway that have been designed to provide
more efficient and accurate service to our veterans and their families.
Some of VBA's initiatives are highlighted below:
Fast Track Partnership designed to rapidly turn around
claims completely developed by our service organization partners.
Results shows over 2302 claims completed since 10-01-97 inception with
average processing time of 3.2 days.
Added 20 employees to the claims processing staff over the
past year.
Implementation of Decision Review Officer program with
five employees in November 2000 after training.
Implementation of Case Management, a proactive system
designed to closely monitor progress, improve communications, and keep
claimants informed on the progress of their claims.
Conducted Training, Responsibility, Involvement, and
Preparation of Claims (TRIP) for all Alabama service officers. This 31
hour training program was designed to enhance development skills and
improve this partnership. Approximately 100 participants completed the
program.
Implemented TPSS, Training and Performance Support System,
a computer based training system designed for rating specialists to
improve quality.
Established a Veterans Service Representative trainee
mentoring program. Established a One-VA initiative with Central Alabama
Veterans Health Care System and assigned a Rating Specialist and a
Veterans Service Representative to work at that location to facilitate
and improve the VA compensation and pension examination process.
Question 2. Alabama's three Veterans Administration hospitals have
come under increasingly harsh criticism for not properly addressing
veterans' circumstances, whether it be waiting times, thoughtfulness,
or quality of care. How will you create an atmosphere within the VA
that addresses these quality of life and care shortfalls at our VA
facilities?
Answer. Specifically, as it relates to the Alabama facilities, VHA
has advised me that there have been actions taken within the VISN 7
Network to redirect resources to address deficiencies in these areas.
Further, VHA advises me that they have moved to identify well-qualified
permanent leadership in this VISN to provide expertise, stability, and
accountability. I will also ask VHA to continue to assess the
performance of Alabama facilities in each of these areas of concern and
to keep me informed. I will assure that progress continues.
Question 3. In your testimony before the Senate Veterans' Affairs
Committee, you indicated a need to streamline the administration of the
VA around the country by implementing technological improvements for
the sake of potentially saving billions of dollars a year. How much of
the potential savings would be directed towards improving medical care
while at the same time promoting various avenues of access to quality
health care?
Answer. Until I have been more fully briefed on this matter by VHA
officials and my Chief Information Officer, I am unable to provide a
comprehensive answer to this question. I would expect that significant
cost savings and benefits generated by new or enhanced IT systems would
be directed towards improving the access and quality of care provided
to the nations veterans.
Chairman Rockefeller. Thank you very much, Mr. Principi. I
appreciated your statement and I appreciated your kind of out-
of-the-box approach to it because I think that is going to be
necessary. As I said before, it is not just what you think, but
how it is translated down through the ranks. And that I think
is the great magic of a good administrator. It can be done and
I believe you can do it.
We will now have a 5-minute round of questioning. I notice
that the designate has a time clock and we do not, so I presume
that means we can cheat a little bit. But let me start off in
my last 18 hours of glory here. [Laughter.]
You have promised a top-to-bottom look at the health care
system. That is one of the reasons, Senator Nelson, that you
will love this committee, as Senator Jeffords and Senator
Hutchinson do, because so much of its work is about health
care. And if you are intrigued by health care, this is the
place to be because it is health care at a particular phase of
life and it deals with health care matters like PTSD, which are
ignored by so many others and yet which we are discovering goes
all the way back to World War I, as well as the Korean war and
the Gulf War. So top to bottom----
Senator Thurmond. Mr. Chairman, I am going to have to
leave. I would like to submit a few questions to be answered
for the record.
Chairman Rockefeller. Thank you very much, Senator
Thurmond, and thank you for remaining as long as you did.
Senator Thurmond. Remember, I organized this committee.
[Laughter.]
Chairman Rockefeller. Yes, sir. That is now twice on the
record today. [Laughter.]
I do think we have made substantial progress in this area.
We have started some things that have not been completed, but
it has been a committee which I think has tried, working with
VA administrators, to do good work.
Let's take long-term care. Again, nothing had been done by
the Government in long-term care since Medicaid in the 1960's
until Senator Specter and I and those on the committee did it
in conference with Chairman Bob Stump a year or so ago. It has
not all been implemented, as I indicated, but nobody else in
Government has done anything about long-term care. My own view
is that, in terms of health care, the two biggest problems in
the country are the ones about which we are doing the least,
and one is long-term care and the other is mental health. And
the Department of Veterans Affairs is doing something about
both and the health care system is doing very little about
either outside of the VA. So, we can be proud of that.
You indicated that you want to take this look. My guess is
that you will probably put together a task force also to look
at how you do this top to bottom. But again with your higher
bar, you will have the experience and the instinct to suggest
to us what you think some of those changes from the top to the
bottom might look like.
Mr. Principi. Yes, sir. You talked about extended care, and
I note that this year 39 percent of the veteran population is
over the age of 65 compared to 15 percent in the general
population, and that figure grows to 53 percent over the age of
65 over the next 20 years. So we see a significant increase in
our elderly Korean and Vietnam war veteran population and we
have to address those challenges.
Clearly, I think we need to look at the entire system to
ensure that it is aligned to the needs of the veteran
population and the profound changes in health care in America
to ensure that we are meeting those needs both in urban and
rural areas. And I think there are some studies on this subject
ongoing at this time.
Members have talked about the growth in the number of
outpatient clinics, which I think is a very, very positive
step. However, I believe GAO has reported we spend a million
dollars a day on maintaining, heating, and cooling empty
hospital beds. How do we make better use of those beds? Should
they be converted, should they be closed, should their mission
be changed to extended care facilities or assisted care
facilities?
We need to look at our specialized programs to ensure that
the intent of the law is being met with regard to maintaining
capacity in spinal cord injury, in blind rehabilitation, and
PTSD. VA plays an enormous leadership role in those specialized
programs. We need to maintain our leadership role and do more.
Research is another important component of that.
So I think there are lots of different parts of this health
care system that we need to look at. We have to identify how we
are going to do this top-to-bottom review and over what period
of time we will conduct it. Those are some of the points that I
would want to look at as well as looking at the organizational
structure, the VISN structure, to ensure that we have
uniformity of access throughout the system so that veterans in
one VISN are not being treated differently than veterans in
another VISN. We need to ensure that wherever you live or
reside, you have equal access to the health care in the system.
Chairman Rockefeller. Which is both the problem but not
necessarily the problem of my State, where we have four
different VA hospitals, each of which report to a different
VISN. You cannot say by definition that is bad. But one also
needs to know that it can work and is an integrated system. And
I know that is on your mind.
Mr. Principi. I would not want to see the VA evolve into 22
separate health care systems. We are a national resource. We
are one national health care system with uniform policies and
procedures and standards that should be followed through the
entire system. I believe in centralized policy formulation
combined with decentralized policy implementation.
Chairman Rockefeller. I have a number of other questions.
But I call now upon Senator Jeffords.
Senator Jeffords. Thank you very much, Mr. Chairman.
Chairman. I will repeat that twice. It is a pleasure to be with
you again. I look forward to working with you.
I want to followup perhaps a little bit on the previous
questions and on how we can improve the financing of the
various health care options that we have. I would like to talk
a little bit about Medicare subvention and what is your view on
the future of the VA interaction with the Medicare program, and
would you support the Medicare subvention pilot program as
introduced by Senator Rockefeller and myself in the last
Congress. I kind of loaded the audience for that one. How high
a priority is that?
Mr. Principi. It is a very, very high priority. I have
always been a supporter of Medicare subvention. I think the
pilot program is the right approach to take to see how well
this could work. I have not heard of any good arguments against
Medicare subvention. I am sure there are challenges with it,
but I do believe that it could prove to be an excellent
mechanism to get Medicare eligible veterans into the VA and
with the cost of their care reimbursed by HHS. So I think it is
something that will be a very, very high priority. We need to
look at that and see if the pilot program should be made
permanent.
Senator Jeffords. Vet Centers. When the Vet Center program
was first established back in 1979 it addressed the VA's
mission to provide local readjustment counselling services to
veterans. Last year Congress expanded the role of the Vet
Centers by requiring them to open their doors to the
counselling needs of veterans of all wars. Would you seek and/
or support increased funding for the readjustment counselling
service to meet this expanded mandate? And how is it being
handled now?
Mr. Principi. Senator, quite honestly, early on in my
tenure on the Hill back in the 1980's I was somewhat concerned
about and cynical of the Vet Center program. I was wondering if
it really could meet its intended purpose. I remember visiting
a Vet Center which looked like a bunker in Vietnam and I was
concerned about it not being linked more closely with the VA.
But, as you know, the decision was made to maintain the Vet
Center program. At that point in time, I went to work to ensure
that we had high quality people staffing our Vet Centers. I
thought that was important, when I was Deputy Secretary, to
make sure that we had the right programs. I also wanted to make
sure that Vet Center staff had the breadth of experience and
knowledge to ensure that veterans who sought help through the
Vet Centers and not through the mainstream VA medical system
could get the breadth of services they needed.
I think the Vet Centers can play an important role in not
only psychological counselling, PTSD, but also in all of the
related problems--employment, training, and education. I
certainly will look at the Vet Center program. I am committed
to the program. Funding decisions must be based upon funding
priorities. I can give you a more detailed, informed decision
on whether we need to increase the funding or not when the VA
budget is sent to the Congress. But I will support the program.
Senator Jeffords. Thank you. The VERA formula inequities, I
would like to chat a little bit about that. As you may know,
last year the New England delegation requested a study that
will be conducted by the Rand Corporation to evaluate the
current VERA reimbursement procedures. I hope that you will
give your careful attention to that study. Do you intend to
devote some attention to the problem of the VERA inequities?
Mr. Principi. Yes, I certainly do. One of the first things
I intend to do, if confirmed, would be to sit down with Dr.
Garthwaite and better understand the VERA methodology, the
model and how it works, and what the issues are. I know there
have been some concerns expressed about VERA from different
Members.
So I need to take a look at it to assure that the funds are
being equitably distributed. We must both make sure that we
have adequate funding for the growing population in the
Southeast, the Sun Belt in the Southwest, and for those who
don't get down to those areas of the country. They may be in
the Rust Belt, the Northeast, but they need to be cared for as
well. So I need to look at that entire program.
Senator Jeffords. As I understand it, Acting Secretary
Gober yesterday sent recommendations to OMB that would
establish a service-connected presumption for hepatitis C for
veterans that had blood transfusions, solid organ transplants,
and for medical personnel. Have you seen these recommendations?
Mr. Principi. No, sir, I have not. I know that hepatitis C
is a major issue, a major problem. I have not seen the proposed
regulation. I have not been briefed on it, but I am aware that
it is a major problem that I will have to address.
Senator Jeffords. What are your thoughts about coverage of
hepatitis C?
Mr. Principi. If there is a linkage between exposure to
blood on the battlefield or in hospitals, or with organ
transplants, I certainly believe that veterans should be
compensated for that disease. So, generally speaking, I support
the presumption of service-connection where there is a causal
relationship to exposure. Absolutely.
Senator Jeffords. Thank you very much. I really look
forward to working with you. We have had great experiences in
the past and I know they are going to go into the future.
Mr. Principi. Thank you, Senator Jeffords.
Chairman Rockefeller. Thank you, Senator Jeffords.
Senator Hutchinson.
Senator Hutchinson. Thank you, Mr. Chairman. I want to
associate myself with some of your remarks. You may only have
20 hours left but I want to be in your good graces. [Laughter.]
You commended Mr. Principi for his willingness to think
outside the box, and that is reflected in his opening
statement. I think that is very important as well.
As we go to the 21st century, change is going to be
essential. Your willingness to look at needed change is very
refreshing. Sometimes our veterans and our friends in the VSOs
are concerned that change equates to abandonment or at least a
diminution of commitment. I think with your background in the
system as well as your experience in the private sector, you
can both reassure veterans and still have the objectivity to
support needed changes.
One of the things we had an opportunity to visit about, if
I recall correctly, was the issue of VA and DoD acquisition and
purchasing systems. We have got parallel acquisition systems
for medical supplies and equipment and that many of the items
purchased are similar, if not identical, and yet we do not have
a means by which we can realize the savings from the power of
these two departments acting as one. There is I think a certain
synergy there. But there have been political obstacles or
artificial walls that have been erected that have prevented
that from ever happening. Would you comment on your willingness
to work with Secretary Rumsfeld on trying to make that a
reality and what might be the result of it.
Mr. Principi. Absolutely, Senator. I recall during my
previous administration working closely with Senator
Rockefeller on legislation reforming pharmaceutical purchasing
in VA. That legislation saved VA countless hundreds of millions
of dollars that could be used to expand the reach of health
care.
An interesting story. When I sat down with the President-
elect, I mentioned to him how important I thought it was for
Secretary-designate Rumsfeld and myself to get together to
break down these barriers in lots of areas--in the transmission
of data, because we cannot do anything at the VA without the
medical records and the personnel records of the individual,
and in procurement.
I get quite emotional about it. Here we have these two
procurement systems for medical supplies, equipment, and
pharmaceuticals. I am absolutely convinced, based upon
testimony before the Transition Commission I chaired and
discussions during its meetings, that if we bring those two
together we can save close to $500 million a year. That is in
just the sheer purchasing power of the two agencies'
procurement program and in developing a national formulary to
cover the beneficiaries of both departments and utilizing
universal product numbering. The savings are very significant.
$2 billion over 5 years. We can buy an awful lot of
pharmaceuticals, we can provide an awful lot of health care to
needy people and service-connected veterans with that money.
I was so pleased that the other morning I was sitting in my
office and there was a knock on the door and it was Secretary-
designate Rumsfeld. He said the President-elect told me I
should come over and talk to you, that you had some good ideas
about breaking down the barriers. He said he went to the Hill
for his confirmation hearing and Senator Cleland cornered him
and said you better talk to Tony because you might have some
good ideas about how your two systems can work better together.
So I think in the procurement arena we can do a lot. I
think in data transmission we can do a great deal. And I think
that increased partnering, while maintaining the separate
identities and the missions of both health care systems, we can
certainly be a much healthier and better health care system.
Senator Hutchinson. I find that very hopeful and the two
anecdotes that you related are being very positive. I look
forward to seeing how that develops.
The chairman also mentioned what the VA had done on mental
health, and rightly to be commended. When I was on the House
side and had the opportunity to serve with Sonny Montgomery and
for a couple of years chaired the Subcommittee on Health Care
in the House Veterans' Affairs Committee we worked hard and
helped to develop the eligibility reform legislation. One
element of that legislation requires the VA to maintain its
capacity to provide specialized treatment in the area of mental
illness, mental health.
VA's own in-house experts, its Committee on Care of
Severely and Chronically Mentally Ill Veterans reported last
September that the VA is not in compliance with that
requirement of Public Law 104-262. I hope that is an area that
you will make a priority to ensure that compliance occurs.
Mr. Principi. Mental health has always been a high priority
for me. It sometimes is not very glamorous. It is tough dealing
with alcohol and substance abuse problems, the associated
problems of HIV and homelessness. These are very real human
needs in the veterans community. There will be a lot of
attention paid to chronic mental illness, mental health under
my tenure. We will work on that.
Senator Hutchinson. I know my time has expired, so I will
not again bring up the Fayetteville Veterans Home. [Laughter.]
But I just assume that when you are confirmed next week----
[Laughter.]
Senator Hutchinson. Thank you, Mr. Chairman.
Chairman Rockefeller. Thank you, Senator Hutchinson.
Senator Nelson.
Senator Nelson. Thank you, Mr. Chairman.
Mr. Principi, I again want to thank you very much for your
wading into public service again. Clearly, as a manager of a
major agency with 200,000 employees, you are going to be
challenged at every level. And it sounds as though you have
already begun the process of trying to figure out what you need
to do but also get the impact that you can receive from a study
of essential areas to help you work your way through the
management issues.
I will ask you the same question I asked Mr. Rumsfeld
during his confirmation hearing last week. As a manager going
in, while you will have specific ideas about what you want to
do and they will be supplemented by further study and
additional thoughts once you are there, but sometimes when you
go in there is one big idea that you start with or that you
hope to finish with. It is unfair for us to ask you a lot of
specifics right now because you have got to work. But is there
one big idea that you hope to bring to the management of this
agency based on your experience and your knowledge?
Mr. Principi. I have several. Clearly, eliminating the
claims backlog is probably the most important issue I face
early on. Bringing together a group of people both within
Government and outside of Government, because there are some
wonderfully talented people in the private sector in large
corporations that have done medical evaluations, insurance
companies type, to see if we can learn a little bit from them.
Their insights on how they have done it and been very
successful in the private sector coupled with our people and
the leadership of the veterans service organizations who have
focused on compensation and pension, putting this brain trust
together to come up with some concrete practical solutions is
one idea that I would like to embark on shortly after arriving.
The technology issue, of course. I believe one of the keys
to our success is technology. I think we have to leverage the
technology, our artificial intelligence software, that is out
there and incorporate that technology in everything we do. I
believe it can be enormously helpful to reduce the backlog in
claims processing, in claims evaluation and in adjudication. I
also believe it can be tremendously important on the health
care side. And the two systems have to be linked. So I want to
devote some time to that.
And I think the third area is procurement reform. We just
need to get on with it. We need to drive down pricing in
pharmaceuticals, medical supplies, and medical equipment. I
think that can be done and those dollars can be redirected to
provide more health care.
Senator Nelson. Thank you.
Chairman Rockefeller. Thank you, Senator Nelson.
Let me ask you a philosophical question. We had a hearing
this morning with Governor Thompson of Wisconsin about running
HHS, and that is also a pretty large group of folks. And within
that organization is something called HCFA, the Health Care
Financing Administration. I was talking a little bit about how
one gets control of HCFA. In other words, you have 4,000
genuine health care experts in all kinds of various fields,
most of them in Baltimore, all of them having been there a long
time, although a lot of them will retire, which is a problem
that you also face. I have been here through about four or five
HCFA directors and they have all made adamant, committed, stern
statements as to getting control of those 4,000 workers. But
none of them have been able to do it. Part of that is our fault
because we do not give them sufficient people to take in with
them so that they can place them strategically throughout HCFA
in order to carry out the will of the administrator of HCFA. So
we're talking about resources, personnel.
Your organization is slightly larger than 4,000, spread all
over the country. And this should not be taken politically, but
anybody who runs for executive office never makes the
assumption they will be in for 8 years. You hope you are and
you work for that, but you have to deal with the idea of 4
years, which is very little time. So the question I am asking
you is, how do you get control, what do you need, what do you
need to do, what do you need to say that is different from what
others have said running this second largest organization in
the Federal Government, to get management over the VA as well
as possibly be able to accomplish some of the goals that you
yourself have talked about this morning?
Mr. Principi. Great question, Senator. I think the first
thing I have to do is win the respect and the confidence of the
people in the agency at all levels of the agency. They have to
understand and know that my heart is in the agency and our
mission. I believe in our mission. I care very deeply about the
mission. And then I need to articulate a vision of where I
believe the agency needs to go in this new century. And then to
work hard. To work day and night bringing the people together,
surrounding myself with talented people and making them feel
part of the process, not excluding them from participation. And
recognizing that the buck stops with me. I have to make the
tough decisions and I have to bring those decisions to you
after consulting with you.
So I think success starts with winning the respect and
confidence of VA employees and leaders, demonstrating
leadership, and that I will listen to and want to learn from
them. Then through hard work we come up with a blueprint, a
vision, if you will, that says we must do the following, and
get on with it right away for VA to remain a viable national
resource.
You are absolutely right. I look at this as a 4-year
assignment. I know if I don't start on day one, I am not going
to get there. I have got to hit the deck running so to speak,
but not act impulsively. I have to listen and learn, but VA
must get moving and come together.
You know, the Commission on Servicemembers and Veterans
Transition Assistance was a group of 12 interesting people,
Democrats, Republicans, generals and privates, former Hill
people, and executive branch people. Somehow we were able to
subordinate our personal views to reach a consensus and send to
you a unanimous report. Four members of the Commission were
representatives of veterans service organizations, half were
Democrats. I think the point is that if I can try to take some
of the lessons in how we operated there and bring it to VA,
perhaps we can get consensus and perhaps we can begin moving
together. I guess that is the way I want to start.
Chairman Rockefeller. I think you have talked about your
own commitment and you have talked some about structure. We
have to assume that they are going to feel your commitment and
your intensity and your willingness to work hard and fight
hard. But I think a lot of it really does come down to
structure, getting your people where you need to have them so
that you have somebody who is managing something which is
tremendously important to veterans and to you, in the
measurement of your own success, as you measure your own
success, you need to have somebody there who is one of your
people.
I really believe in that. I am sure that former Governor
Nelson strongly believes in that. That is what Governors get to
do. They come in and everybody goes out and you appoint your
own people to run every single department, the Secretaries and
the Under Secretaries and the Under Under Secretaries and then
the people beneath that. Some people call that politics.
Others, if you are good Governors like Ben Nelson and Jay
Rockefeller were, consider it an effective way to run a
government. But we deprive people in the Federal Government of
doing that. We absolutely deprive them of doing that. We say
here are three secretaries, here is somebody for government
relations, one or two others, and then go ahead and change the
system.
The second thing I want to say, and we can talk more about
this, is that one of the things I think President-elect Bush is
going to be very good at, because he has shown I think the
wisdom and the courage to surround himself with strong people,
is something I happen to respect, and that is the ability to
have people take him on, his own people take him on, his own
heads of agencies, people close around him, say, ``Mr.
President, I think you are wrong on this. I think you ought to
look at this, this, this, and this, and I would like to have
another chance to discuss this with you.'' I am sure that
former Governor Nelson was the same. I never asked anybody in
the years I was Governor whether they were Republican or
Democrat. It didn't make any difference to me. I wanted to know
who they were and did they have the strength to come at my
face, so to speak, if they felt I was wrong.
And so I don't want to derail you, certainly not with this
committee, with the President-elect early on, but I would like
to know that you will be willing to do that. I can remember we
had a health care budget fight at the highest levels of
Government fairly recently and I did that. Well, it is one
thing for me to do it because they, unfortunately, have to deal
with me in one way or another, or with Ben Nelson. And we
happened to win that fight. It was a budget fight. I want you
to win those fights. And I want to know that you will be
willing to take on the President of the United States, and the
Vice President of the United States when it is something about
which you care passionately and they seem not to because they
don't know as much as you do.
Mr. Principi. Absolutely. Sir, I could not agree with you
more. And I did speak to the President-elect about that. I told
him that I intended to be a very strong advocate. I told him
that I intended to go to the mat with Mitch Daniels at OMB. I
know that in the final analysis, I may not get everything. But
I told him I was going to be that passionate advocate and I was
going to fight very, very hard for an adequate budget and the
things I thought I needed, including people around me, be they
Democrats or Republicans, but the best team possible to manage
this agency. And without that I said I could not be successful
for my agency or for his administration. And he agreed. He told
me that he respected that and that he wanted me to do that. We
seemed to reach agreement on it.
Chairman Rockefeller. And I think you will find us behind
you in that process.
Senator Nelson.
Senator Nelson. You told me this is going till 7 tonight?
[Laughter.]
Chairman Rockefeller. Yes. [Laughter.]
Senator Nelson. I really don't have any other questions. I
do look forward to working with you on these issues. I hope you
will be an advocate for the veterans, that that advocacy will
include access and availability of services and benefits in a
convenient manner that meets the needs.
I would share one thought with you that somebody shared
with me a long time ago and maybe you can use. And after you
attribute it to me once, it's yours. That is, as you face the
agency and you continue to work with the managers below you and
the good personnel who work there, to remind them that if you
always do what you've always done, you will always get what
you've always got. That is what change has to effect. Change
will create uncertainty which creates a cause for insecurity.
That will be external and internal. But I think you must be an
agent of change if you are going to correct the problems of an
overload and backlog of processing as well as the important
point of making your available resources stretch across the
needs that are out there. It is important we not shortchange
our veterans. I believe you are totally committed to making
sure we don't. I hope that we can work with you to make sure
that is the mission of the agency.
Mr. Principi. Thank you, Senator. I certainly look forward
to working with you and getting out to Nebraska as well.
Senator Nelson. I am a little intimidated to invite you
because I am the junior Senator and we have just built a new
Veterans Home in North Fork, NE. I suspect what I can do is
give you a conditional invitation that I will bring the other
appropriate inviters into the process. But that facility will
be opening shortly and we would be delighted and honored to
have you there with us if it is at all possible.
Mr. Principi. I would be pleased to be there with you,
Senator.
Senator Nelson. Thank you.
Chairman Rockefeller. Mr. Principi, just a thought. You
were talking earlier about Vet Centers and then we were talking
about taking on the President. I noticed when I said ``taking
on'' the President in a constructive sense that there were a
number of heads behind you that went up and down. That told me
exactly what I wanted. That it isn't always the new wing that
you open or the ones that you close that engage or disengage
veterans. Sometimes it is a sense of whether you are willing to
fight. And it is a very interesting thing, that Ben Nelson
knows as well as I do, that very often, I think most often, the
people have a sense of that, and I am talking about all of
these 220,000 people that work for you and all of the veterans.
And I connect the heads that are going up and down and our
earlier discussion about Vet Centers.
You at one point had questions about Vet Centers, but you
seem to have fewer of them now. If people feel with the two of
us or with you--us, our constituents, with you, our
constituents including veterans and the people that work for
you--that you are fighting for them, that you will stand up to
whomever has to be stood up to to fight to do the very best you
can, not that you can always win but that you do the best you
can, I think that often that becomes psychologically as
important, if not more important, than what might actually
happen, because I think it is sometimes the fastest way to
trust.
I think it is the human nature of people in a bureaucracy
and out there, veterans and our constituents, as they make up
their minds about whether you are on their side or not, are you
willing to fight for them or are you not; if they are in
trouble, can they go to you or can they not; and they have that
instinct and it is a yes or it is a no. And if it is a yes, you
can do all kinds of things that you could not possibly do
otherwise. And the people in your agency feel the same way and
they see that, they react to that, and they do things which
they didn't know they could do because they see somebody who is
not always on the defensive. I don't want you to be on the
defensive. That is why I mentioned these oversight hearings.
Sometimes people come here and we appear hostile or we are
hostile, we are angry about something. But it is constructive.
It is because we do not meet enough as a committee, I think,
and so when we do meet, things flow. Well, that's the same way
as when you have a town meeting. You go to a little town in
south central Nebraska and they have not seen you in several
months and they let things flow. And that is good. That is
human nature. Often, just by virtue of letting those things
flow, expressing their dissatisfaction with what you are doing
about this or that, it often takes away a lot of their angst
and, in turn, because you have heard it and you have heard
their angst, it motivates you to solve their problem. Now you
just forgive me for that.
Mr. Principi. Well I agree with you. But I want to take you
with me the next time I go to that town in southwestern
Nebraska. [Laughter.]
Chairman Rockefeller. All right. On benefits, we have
discussed already, as you have, that this is a particularly
difficult time. You are going to be losing what percentage did
you tell me in the next 2 or 3 years?
Mr. Principi. Close to half.
Chairman Rockefeller. Close to half of all the people who
have been working on this for a long time. By definition, they
will be the most experienced half, because they will be the
ones who will be retiring. So this presents you with a real
problem because we were just discussing how can we get this
done in a more rapid fashion. So you have got to train a new
adjudicator. It must take 2 to 3 years to do that properly. The
experience of that, trial and error, not everybody is willing
to help people out. I know you have training courses for that.
Technology is improving. But technology does not always do it,
and I have seen that in my own State where the technology is
incredible but the backlog grows. That could only say that
people, as we are more litigious as a society, people do that
more or they are more aware of their rights and they submit
more.
How do you approach, in general terms, how are you going to
handle that? The math is stacked against you and so are the
retirement numbers.
Mr. Principi. Sir, I know that the VA, VBA in particular,
currently has a very, very aggressive recruiting campaign to
bring on new rating specialists and get them trained. They are
working very, very diligently at that. I certainly want to look
at that from a human resources perspective to see what more can
be done. I think that part of the task force's charge will be
to address some of those issues. It comes at a time when our
economy has been golden and it has been very difficult to
compete with the private sector to get people to come to VA.
I think you need to also look at partnering with the
private sector in some regards. We need to maintain a strong
infrastructure in-house. But I think VA has been a model for
performance-based contracting, wherein companies are rewarded
for excellent service and they are penalized when their work
product falls below a certain level. I think they have done
very, very well. So I believe that we need to aggressively
bring on new people to VA, get them trained as quickly as
possible, as comprehensively as possible before we put them
into the trenches, so to speak.
We need to look at technology as part of the solution, not
the entire solution, like you said, because ultimately a rating
specialist has to rate each case, a computer cannot do that.
But a computer can help, software can help cut down the time
needed to reach a decision. I think we need to, as VA is
currently doing with virtual VA, start eliminating paper files.
I think we need to modernize and get electronic files,
including electronic signatures.
So I think it is a combination of things, Senator. But it
really starts with bringing on new people to replace these
experts. I think VA is doing that, to its credit. We may have
to accelerate that. We may have to look at new ways to deliver
the service. I don't think anything should be off the table. I
do not have enough information right now to come before you and
say I think I have specific solutions. But what I do need to do
is to identify them as quickly as possible and make sure they
are implemented and just keep our feet to the fire. We talked
earlier about the Persian Gulf War Registry and how that
somehow got off track.
What I need to do is to make sure that once we make a
decision we follow through. I think one of VA's shortfalls has
been that it has been very difficult to make decisions. I think
even during my tenure, and I am not just talking about the past
8 years, but historically, decisions at VA come about very
slowly. It is decision by management committee and it just
grinds on and grinds on. There is a lot of inertia I think
because VA is so large, not because people are not well-
intentioned. But it is very, very difficult to make decisions
at VA, at least it was. I trust it won't be under my
leadership. We have got to get on with it. There is a time for
deliberation and there is a time for decision and a time for
action. I intend to make sure we are thoughtful, but I am going
to make sure that we make the decisions at the appropriate time
and we move ahead. I think that is part of the solution: just
get on with it.
Chairman Rockefeller. I don't want to extend this hearing
but, before I ask you a couple of pro forma questions, I just
want to say two things. No. 1 is I agree with what you have
just said. But, again, I ask you to let us help. Come to us in
anger, in frustration about what you need in the way of people,
in the way of resources, in order to manage.
Mr. Principi. Yes, sir.
Chairman Rockefeller. Everybody thinks in terms of the cost
of health care and the cost of building or closing a hospital
or whatever. But we do not talk enough about the cost of not
being able to run the United States' second largest agency the
way it needs to be for the people who have sacrificed the most
so that we can be free and have our way of life. I just think
that is such an important subject and I think it is one that
you should feel very aggressive, at least insofar as I am
concerned, and I am sure Senator Specter agrees, to come to us.
I think there is a lot of dollar saving in efficiency and
performance increasing consequences of being able to get
control, and you should feel strong in coming to us in that.
The final thing I want to say before the pro forma
questions is there are some of us who have not given up at all
on the consequences of the Persian Gulf War, whether it is
pyrodostigmine bromide, or whether it is the DoD report that
came out a month or so ago saying that they had not misled
anybody at all, and that is about the fifth iteration of that I
have been through over the last 8 years. And yes, you are the
one who has worked with the Registry, started the Registry, and
we are working now with spouses and the children of some of
those Persian Gulf War veterans. But I still spend a lot of
time with people who cannot sleep, whose lives have
disintegrated, whose marriages have disintegrated, if you touch
their arm very lightly they just shriek with pain, or they have
rashes or PTSD, have all kinds of problems.
America, still to a certain extent--the VA less so than
anybody else--stands by and watches a lot of this happen. It is
something which has always made me angry at our Government, at
our Government's willingness to protect itself at the expense
of those who are hurt, people who went overseas, went to the
front lines, got exposed to all kinds of things and conditions
which we have never really fought before except I guess in
parts of the Second World War. But I just want to tell you that
this is something that at least this particular Senator in no
way has lost interest in or has given up fighting the cause on.
Mr. Principi. Senator, we share a common belief, a common
concern. I can't tell you how strongly I feel about it. I
think, as you do, that some of the greatest patriots in this
country are the men who walked the streets of Nagasaki and
Hiroshima, put their hands over their face at Bikini Atoll,
scrubbed the ships of the radiation, walked into the chambers
to test mustard gas protective equipment and came out with
chronic bronchitis, or were exposed to Agent Orange, as my
colleagues and I were in Vietnam, or those young men and women
breathing in that smoke from the fires in the Gulf.
It is tough. These are tough issues because the science is
never quite there. It is always mixed. And 20 or 30 years later
veterans have got rare forms of cancer and they believe that it
is related to their exposure to ionizing radiation and we force
them to go through you know what to try to make the case for
service-connection. We just have to do a better job. Certainly,
I want to make sure the science is there because I want to
protect the integrity of the C&P program. But at the same time,
I think we need to do a better job. We need to be more
compassionate and we need to apply the benefit of the doubt
rule. And I intend to do that. I am going to look at it
carefully, but I agree with you, Senator.
Chairman Rockefeller. Well, you and I both remember when
the so-called science did not appear to be there on Agent
Orange until a fellow by the name of Zumwalt came in and set us
straight, and then all of a sudden, the science seemed to make
less difference. So we understand each other and I am happy
with your answer.
Now these are my pro forma questions and I will conclude
the hearing with them.
Do you, Mr. Principi, have any conflicts of interest which
have not been fully disclosed to the committee, or do you know
of any other matter which, if known to the committee, would
impact upon the committee's recommendation to the Senate on
your nomination?
Mr. Principi. No, I do not.
Chairman Rockefeller. Have you fully and accurately
provided financial information to the committee in such form
that it shall be considered as if submitted today under oath?
Mr. Principi. I have.
Chairman Rockefeller. Do you agree to supply such
information, materials, documents, and other things as may be
requested by the committee in the course of its oversight and
legislative responsibility for as long as you serve as
Secretary?
Mr. Principi. I shall.
Chairman Rockefeller. You have already answered this
question, but I will ask it again. Do you agree to appear
before the committee at all such times and on such matters as
the committee shall request for so long as you serve as
Secretary?
Mr. Principi. I certainly will, Senator.
Chairman Rockefeller. Very good.
Senator Nelson, anything else?
Senator Nelson. No. I just look forward to working with
you, Mr. Principi.
Mr. Principi. As do I, Senator. Thank you very much.
Chairman Rockefeller. You have a very, very tough job
coming up. A lot of good people have taken it on; nobody has
conquered it yet. Maybe you are going to be the man.
Mr. Principi. I will try.
Chairman Rockefeller. The committee stands in recess.
[Whereupon, at 3:55 p.m., the committee was adjourned, to
reconvene at the call of the Chair.]
A P P E N D I X
----------
Prepared Statement of Hon. Daniel K. Akaka, U.S. Senator From Hawaii
Mr. Chairman, it is an honor to join you and my colleagues in
welcoming Mr. Anthony J. Principi to today's confirmation hearing on
his nomination to be the Secretary of the Department of Veterans
Affairs. The VA Secretary is an important cabinet position responsible
for ensuring that veterans are provided quality services and benefits
which they have earned through their courageous and selfless service in
defense of our nation.
I commend President-elect George W. Bush's nomination of Mr.
Principi to be VA Secretary. Mr. Principi has extensive experience with
the Executive and Legislative branches of the government. He served as
the VA's first Deputy Secretary in 1989 after being appointed by former
President George Bush, who named him the VA's Acting Secretary in 1992.
He also served as Chief Counsel of the Senate Veterans' Affairs
Committee and Staff Director of the Senate Armed Services Committee.
Most recently, he served as Chairman of the Congressional Commission on
Military Servicemembers and Veterans Transition Assistance which was
responsible for reviewing the adequacy and effectiveness of
servicemembers' and veterans' transition assistance programs.
Mr. Principi's impressive background in dealing with veterans
issues will assist him in addressing the challenges facing the VA. In
the past few years the VA medical system has changed dramatically in
order to better meet the needs of veterans. The VA has changed from an
inpatient-based system to a primarily outpatient-based system. This has
resulted in health care services which are more accessible, efficient,
and focused on the needs of patients. While the VA has been able to
treat more veterans, improve the quality of health care services, and
increase patient satisfaction, there remain areas where improvements
can and should be made. The progress made by the VA in the past does
not mean much if they are not maintained and if there is not a
continued effort to improve the effectiveness of the VA. I believe that
Mr. Principi is fully aware of the challenges he will face as VA
Secretary and is well-prepared to serve the men and women who served in
the Armed Forces.
As a highly decorated Vietnam veteran, Mr. Principi has a strong
commitment to his fellow veterans which contributes to his belief in
the Department of Veterans Affairs and its mission of service to
veterans. In addition, he has proven that he possesses the dedication,
knowledge, and experience which are needed to be a representative and
advocate for veterans as VA Secretary. These qualities will serve him
well as he leads the efforts of the VA to improve the quality of health
care services, decrease the time in which benefits claims are
processed, and enhance the adequacy and effectiveness of veterans
benefits. For these reasons, I intend to support the confirmation of
Mr. Anthony J. Principi as Secretary of the Department of Veterans
Affairs, and look forward to working with him to address the needs of
veterans.
______
Prepared Statement of Hon. Ben Nighthorse Campbell, U.S. Senator From
Colorado
Good afternoon, Mr. Chairman. I cannot be with you today because my
schedule requires me to lend support to fellow Coloradan Gale Norton in
her confirmation hearing before the Energy Committee. I welcome you,
Mr. Principi, and gladly support your nomination for Secretary of
Veterans Affairs.
President-elect Bush has said his goal is to modernize our
veterans' health care system and to speed up the agency's notoriously
slow claims process. Mr. Principi, I am pleased you were nominated to
carry out this agenda. Your appointment is a powerful sign that this
administration wants to take care of its veterans.
You have said that the nation can never ignore its debt to its
military veterans. That attitude will go a long way in tackling the
tough job ahead of you. We can all agree that one of our greatest
national responsibilities is the welfare of our nation's veterans. It
is critical that we find a balanced way to make good on the promises
made to them.
You will be heading up an agency responsible for providing medical
care and other services to 27 million veterans. Your participation in
many levels of our veterans affairs system has strengthened your
understanding of the management problems in a top-down system. This
experience will be necessary in running a department that has
experienced problems with accountability and efficiency during the past
several years.
As a fellow veteran, and as Senator of a state with one of the
highest numbers of military retirees in the country, I look forward to
working with you and enthusiastically endorse your nomination.
______
Prepared Statement of The American Legion
Mr. Chairman and Members of the Committee:
The American Legion greatly appreciates the opportunity to provide
written testimony regarding the appointment of Mr. Anthony J. Principi
as the Secretary of Veterans Affairs. While The American Legion's
legislative agenda contains several resolutions directly related to
policies and procedures within VA, which will be addressed in today's
hearing, this testimony is in no way an endorsement or denouncement of
Mr. Principi's nomination. Section 2, Article II of The American Legion
Constitution states: The American Legion shall be absolutely
nonpolitical and shall not be used for the dissemination of partisan
principles nor for the promotion of the candidacy of any person seeking
public office or preferment.
By providing written testimony for this important hearing, The
American Legion hopes to bring attention to key issues affecting the
quality and timeliness of services provided to America's veterans
through VA programs and services. The recommendations outlined in this
testimony will assist the new Secretary in carrying out his
obligations.
The past eight years have witnessed a significant reorganization
and realignment of Veterans Health Administration (VHA) resources and
programs. More has been done to improve VA health care in the past five
years than was accomplished over the past several decades. Quality,
efficiency and effectiveness are the hallmarks of today's VHA. In order
to sustain the progress made in VHA since 1992, several additional
objectives must be met. These essential actions include Medicare
subvention and greater cooperation with the Department of Defense (DoD)
health care system.
Congress must continue to increase VHA funding to maintain a world-
class health care system. There are precious little additional
efficiency savings expected throughout the system. Yet, those veterans
now enrolled and using the system will continue to rely on VHA for the
foreseeable future. Therefore, The American Legion believes Congress
must examine how to balance the annual appropriations process with
additional funding that will not be offset by the Office of Management
and Budget (OMB). The American Legion believes that a strategic goal of
VHA should be to seek opportunities to increase non-appropriated
funding. The now invalid 30-20-10 strategic goals sought to enhance the
annual appropriations process by increasing non-appropriated revenues
by ten percent by the year 2002. This goal should be revived.
The guiding principle for VA must be improved service to veterans
and to their dependents and survivors. This requires improving access
to and the timeliness of veterans' health care, increasing quality in
the benefit claims process, and enhancing access to national and state
veterans' cemeteries. Specific goals yet to be achieved include:
Set the veterans' health care system on a sound financial
footing for meaningful long-term strategic planning and program
performance,
Improve clinic appointment scheduling for access to
medical treatment,
Enact Medicare subvention legislation,
Establish pilot programs to provide health care to certain
dependents of eligible veterans,
Improve cooperative arrangements between VA and DoD's
Tricare system,
Reduce the benefits claims backlog and improve the quality
of the claims process,
Continuous enhancement of the Montgomery GI Education
Bill,
Repeal of section 1103, title 38, United States Code,
concerning service connection of tobacco-related illnesses,
Increase the rate of beneficiary travel reimbursement.
veterans health administration
The American Legion commends VHA for the evolutionary changes made
over the past several years. Most, if not all, of these alterations
were long overdue and necessary. This includes eligibility reform,
enrollment, the reorganization of the 172 medical centers into 22
integrated service networks, the elimination of certain fiscal
inefficiencies, and the expansion of community-based outpatient
clinics. For many years, VHA's annual budget appropriation was the
guiding principle behind its management decisions. To a degree this is
still true. However, today there is growing evidence that VHA strategic
planning will help guide future budget development.
The primary short-term objectives of VHA must be to improve patient
access and health services delivery. The American Legion's VA Local
User Evaluation (VALUE) guidebook cites patient access as the largest
single source of continuing veteran complaints. Paradoxically, as VA
annual inpatient admissions have decreased by 32 percent since 1994,
ambulatory care visits have increased 35 percent. This phenomenon,
along with a large decrease in administrative and clinical staff and a
significant increase in patient enrollments over the past few years,
has placed a tremendous strain on VHA's ability to meet its workload in
a timely and consistent manner. As VHA becomes more proficient in
attracting new patients, it must also provide consistent access to care
across all 22 Veterans Integrated Service Networks (VISNs).
Currently, the national average waiting time for a routine, next-
available appointment for Primary Care/Medicine is 64 days (with a
range of 36-80 days). The next available appointments for specialty
care:
------------------------------------------------------------------------
Average
Specialty Care Days Range
------------------------------------------------------------------------
Eye Care (combined Ophthalmology & Optometry). 94 42-141
Audiology..................................... 50 22-91
Cardiology.................................... 53 19-78
Orthopedics................................... 47 12-69
Urology....................................... 79 39-108
------------------------------------------------------------------------
There are additional concerns about the average clinic appointment
waiting times for dermatology and pulmonary clinics. However, these
specialty clinics are not included in the VISN director's performance
standards. Therefore, no national average waiting times were reported.
In the main, these waiting times indicate that there are serious access
differences between VA health care and private sector health care.
There are also reported concerns about large distances that
veterans in rural areas have to travel for certain care. For example,
veterans in eastern Montana must travel nearly 700 miles to Fort
Harrison, Montana for routine inpatient surgery. For complex surgical
procedures, these same veterans are required to travel to Salt Lake
City or Denver. This excessive travel places great strain on veterans
and their families. Since 1994, the Miles City, Montana VA Medical
Center has reduced its payroll over $7 million per year by eliminating
nearly 145 full time employee positions. The American Legion questions
why contract services for required surgery have not been acquired to
reduce excessive travel requirements?
In some cases, The American Legion believes VHA has gone too far,
too fast in attempting to improve its fiscal efficiency. Veterans
should not have to increase their travel time for the benefit of VA.
Rather, VHA needs to improve its cooperation with other federal, states
and private health care providers to improve the quality and timeliness
of care for veterans.
gi bill of health
Several years ago, The American Legion created a blueprint for
meeting the current and future health care needs of America's veterans
and for supplementing VHA's annual health care appropriation. By now,
Members of this Committee should be familiar with the proposed GI Bill
of Health. Once fully implemented, the GI Bill of Health would expand
VHA's patient base and increase its non-appropriated funding through
new revenue sources.
VHA's short-term and long-term future must be clearly defined to be
responsive to the veterans' community. All individuals who enter
military service should be assured that there is a health care system
dedicated to serving their needs upon leaving the military. That
concept is especially important to disabled veterans and to military
retirees. The GI Bill of Health would ensure that all honorably
discharged veterans would be eligible for VA health care on a permanent
basis, as they would fall into one of the core entitlement categories.
A unique feature of the GI Bill of Health is that it would also permit
certain dependents of veterans to enroll in the VA health care system.
The American Legion advocates that dependents and surviving spouses of
veterans be allowed to use the system and that all monies recovered
from any source based on such treatment be returned to VA. An
additional significant step will be to enact VA-Medicare subvention.
At the current workload level, VHA requires an annual appropriation
increase of approximately $1 billion to maintain current services and
meet its prosthetics and pharmacy costs. The amount of potential
efficiency savings is decreasing yearly. The projected $3 billion
funding increase over FY 2000-2001 must compensate for the flat line
budgets of FY 1997-99 and fully fund the provisions of the Millennium
Act. Consequently, there is a continuing need to adequately fund VHA's
uncontrollable cost increases at an acceptable level.
Change within VHA, over the past several years, has been the result
of a series of small steps. The American Legion acknowledges that the
progress made within VHA has been extraordinary. However, this progress
has to be sustained and reinforced. In order to accomplish this goal,
Congress must unlock the creative potential of VHA to develop
alternative revenue sources to complement the annual appropriations
process.
At a recent VA planning meeting, VHA unveiled six strategic goals
to be accomplished by 2006:
Put quality first,
Provide easy access to medical knowledge, expertise and
care,
Enhance, preserve and restore patient function,
Exceed customers' expectations,
Maximize resource use to benefit veterans, and
Build healthy communities.
The American Legion believes these are important goals. We also
think VHA must continue to improve its efficiency. However, we believe
VHA must explore all opportunities to develop alternative revenue
sources to complement its annual appropriations. To do less will
continue to force VHA to solely rely on the annual budget process to
establish patient treatment priorities. There is a distinct possibility
that if future funding does not keep pace with the needs the veterans
who seek treatment through VHA, the current open access to all seven-
priority groups will close.
medicare subvention
Public Law 105-33, the Balanced Budget Act of 1997, established
VA's Medical Care Collection Fund (MCCF) and requires that amounts
collected or recovered after June 30, 1997, be deposited in this
account. Beginning October 1, 1997, amounts collected in the fund are
available only for furnishing (1) VA medical care and services during
any fiscal year; and for (2) VA expenses for identification, billing,
auditing and collection of amounts owed the government. Public Law 105-
33 also extended to September 30, 2002, the following Omnibus Budget
Reconciliation Act (OBRA) provisions:
Authority to recover co-payments for outpatient
medications, nursing home and hospital care;
Authority for certain income verification; and
Authority to recover third-party insurance payments from
service-connected veterans for nonservice-connected conditions.
The Health Service Improvement Fund was established to serve as a
depository for amounts received or collected under the following areas
as authorized by title 38, U.S.C., Section 1729B:
Reimbursements from DoD for Tricare-eligible military
retirees;
Enhanced-use lease proceeds; and
Receipts attributable to increases in medication co-
payments.
The Extended Care Revolving Fund was also established by the
Millennium Act and was to receive per diems and co-pays from certain
patients receiving extended care services authorized in title 38, USC,
Section 1710B. Amounts deposited in the fund are used to provide
extended care services.
Clearly, Congress is providing VA with the authority to bill,
collect, retain and use revenues from sources other than direct,
federal discretionary appropriations. However, one of the major health
care payers (Medicare) is exempt from billing; yet, its beneficiaries
are welcomed and encouraged to receive treatment in VA medical
facilities.
Currently, approximately 10.1 million veterans are Medicare-
eligible solely based on their age. Criteria for Medicare-eligibility
are different than eligibility for treatment in VA. In the VA health
care network, certain veterans are eligible for treatment at no cost
for medical conditions determined to be service-connected. Other
veterans are eligible for treatment at no cost because they are
economically indigent. All other veterans must pay for treatment
received.
Medicare subvention would allow VA to seek reimbursement from the
Health Care Financing Administration (HCFA) for treatment of
nonservice-connected medical conditions of Medicare-eligible veterans,
especially those veterans who are military retirees.
More than 734,000 Medicare beneficiaries have lost HMO coverage
over the past two years and another 934,000 seniors will be dropped by
their HMO plans next year. Many VA eligible beneficiaries are included
in those dropped from coverage and will eventually come to VA for care.
The argument that VHA is already reimbursed for its Medicare population
and that Medicare subvention will result in double funding is grossly
mistaken. VHA is now mandated to provide care to all seven priority
groups; Medicare eligibility is not a mandate for care or treatment. As
more Medicare eligible veterans seek first time care in VHA, health
care costs and subsequent waiting times will increase. It is imperative
that Congress examines this issue and takes the actions necessary to
ensure that VHA receives all funding necessary to execute its health
care mission in a quality and timely manner.
tricare
The most significant recent change in military health care is the
introduction of Tricare, the DoD regional managed care program.
Introduced in 1995, Tricare today is being challenged to maintain a
quality health care delivery system for active duty military personnel,
certain military retirees, and dependents.
Today, DoD is having severe administrative problems with Tricare.
The American Legion is extremely concerned how DoD will fix these
problems and how favorably DoD Health Affairs can guarantee Tricare's
long-term success.
There are multiple reasons why Tricare is failing to meet the
expectations of its beneficiaries. Some of these include:
Infrastructure and financial problems,
Problems with provider networks--resulting in weak network
links to subcontractors,
The inability to attract and retain qualified health care
contractors,
No financial tracking system outside of the Military
Treatment Facilities,
Difficulties in processing claims in a timely manner,
Tricare lacks portability between all 12 regions,
The American Legion believes that VHA can greatly assist DoD
through expanded authority to provide care to Tricare beneficiaries.
With limited budgets, both VA and DoD must discover innovative ways to
provide care to active duty personnel, to all veterans and military
retirees, and to eligible dependents.
Congress recognized the utility of having VHA play a greater role
in the treatment of Tricare beneficiaries when it passed the Veterans
Millennium Health Care and Benefits Act (PL 106-117). This legislation
requires VA and DoD to enter into an agreement to reimburse VA for the
cost of care provided to retired servicemembers who are eligible for
Tricare and who are enrolled as Priority 7 veterans. These veterans
would not be required to pay VA inpatient and outpatient copayments.
Eight years ago, it was impractical to suggest that VHA was capable
of assisting DoD in resolving many of its patient treatment problems.
Today, although not without concerns of its own, VA is in a much better
position, both financially and organizationally, to assist with the
delivery of health care to DoD beneficiaries. The American Legion
believes that VA and DoD should closely coordinate medical care
services to the extent possible, thereby eliminating duplication of
effort and achieving greater cost efficiencies. With active planning,
VHA can become the largest single provider of health care to America's
veterans, military retirees, and their dependents. DoD could then
assume the responsibility of providing health care to active duty
servicemembers, Reserve Component members, and their dependents.
veterans benefits administration
Given the number of veterans and other eligible beneficiaries who
file claims each year and with an annual expenditure of over $19
billion in compensation and pension payments, it is imperative that
Congress maintain strong oversight of the operations of the Veterans
Benefits Administration's (VBA) Compensation and Pension Service.
Over the last several years, the backlog of pending claims has
fallen from approximately 450,000 to less than 325,000 cases. However,
it still routinely takes six months to a year or more to process
disability compensation claims, because of the increased number of
issues per claim and their legal complexity. In addition, annually,
some 30,000 to 40,000 new appeals are initiated and it will take over
two years for an appeal to reach the Board of Veterans Appeals (BVA or
the Board). The Board is currently reviewing appeals docketed in April
and May of 1999. Of the cases decided by the Board during the first
nine months of FY 2000, 25.9 percent were allowed and 29.3 percent were
sent back to the regional office for further development and
readjudication. Remanded cases may be pending for another year or two
in the regional office, and a substantial percentage will eventually be
returned to the Board. Sometimes, cases are remanded two and three
times, because the regional office fails to complete the specified
corrective action, which adds several more years to the appeal. It is
little wonder that veterans are angry and frustrated. The system
appears all too often to be adversarial and unresponsive to their
needs.
Despite this history, The American Legion believes VBA is committed
to bringing about much needed change to the claims adjudication system
with the overall goal of providing quality, timely service to veterans
and its other stakeholders. In recent years, VBA's strategic plans have
made many promises and we have, in fact, seen the implementation of a
variety of programmatic and procedural changes. However, it is obvious
that progress toward major improvements in service continues to be slow
and that much remains to be done. Unfortunately for thousands of
veterans and other claimants, the overall quality of regional office
decision-making remains inconsistent and problematic.
Beginning in late 1997, The American Legion implemented a program
of formal visits to VA regional offices (VAROs) to gain greater insight
into the underlying causes for veterans' complaints about unacceptably
long processing times, the high number of appeals, and the substantial
overturn rate by the Board. These visits have provided our staff the
opportunity to evaluate, firsthand, the quality of recently adjudicated
Legion cases. We have been very pleased with the level of cooperation
received and the support expressed for this program by VA Central
Office and regional office officials. Over this period, our staff has
reviewed approximately 350 claims involving original and reopened
claims for service connection and entitlement to an increased rating
for a service-connected disability at 15 VAROs. Some type of
substantive error was found in 40 to 50 percent of the cases reviewed.
An exit briefing has been held with the regional office director and
the service center manager at the conclusion of each visit to discuss
specific findings. Subsequently, the regional office director, the
Under Secretary for Benefits, his staff and Legion officials are
provided a written report covering management issues and the individual
case review findings.
Comparing the reports of the past two years, The American Legion
found there has been little overall improvement in the way claims are
being adjudicated. At most of the offices, there has been a pattern of
recurring problem issues, which continue to have a direct and adverse
effect on the quality and timeliness of regional office claims
adjudication. They relate to budget, staffing, training, quality
assurance, accountability, and attitude. These findings confirm our
long-held view that quality must be VBA's highest priority. Without
guaranteed quality, along with personal and organizational
accountability, thousands of claims will continue to revolve
unnecessarily through the system. Much of VBA's valuable financial and
personnel resources will be wasted, and veterans will not receive the
benefits and services they are entitled to and that Congress intended
they should have.
grants for construction of state extended care facilities
Currently, this nation is faced with the largest aging veterans'
population in its history. VA estimates the number of veterans 65 years
of age or older will peak at 9.3 million in the year 2000. By 2010, 42
percent of the entire veteran population, an estimated 8.5 million
veterans, will be 65 or older, with half that number above 85 years of
age. By 2030, most Vietnam Era veterans will be 80 years of age or
older. The State Veterans' Home Program must therefore continue, and
even expand its role as an extremely vital asset to VA. Additionally,
state homes are in a unique position to help meet the long-term care
requirements of the Veterans Millennium Health Care and Benefits Act.
State homes provide over 24,000 beds with a 90 percent occupancy
rate that will generate more than seven million days of patient care
each year. The authorized bed capacity of these homes is 90 nursing
care units in 40 states (17,844 beds); 46 domiciliaries in 32 states
(5,841 beds); and 5 hospitals in 4 states (469 beds). For FY 1999, VA
spent $255 per day to care for each of their long term nursing care
residents, while paying private-sector contract nursing homes an
average per diem of $149 per contract veteran. The national average
daily cost of caring for a state veterans' home nursing care resident
during FY 1999 was $137. VA reimbursed state veterans' homes a per diem
of only $40 per nursing care resident.
As many VA facilities reduce long-term care beds and VA has no
plans to construct new nursing homes, state veterans' homes are relied
upon to absorb a greater share of the needs of an aging veteran
population. If VA intends to provide care and treatment to greater
numbers of aging veterans, it is essential to develop a proactive and
aggressive long-term care plan. VA should work with the National State
Veterans' Homes' Directors to convert some of its underutilized
facilities on large multi-building campuses to increase the number of
available long-term care beds.
pharmacy
In 1997, VA established the National Formulary Policy that allows
for pharmaceuticals listed on the formulary to be made available
throughout the entire VA healthcare system. Once on the formulary,
those pharmaceuticals listed on the formulary cannot be made non-
formulary at the VISN or local level.
The Pharmacy Benefits Management Board (PBM) determines which
pharmaceutical items are to be included in the formulary based on
scientific evidence guidelines and prescribing privileges and not cost.
Also, VA has established a policy for requesting a non-formulary drug
and each VISN has a protocol for prescribing providers to request a
patient be treated with a non-formulary medication which must be
justified by the National PBM Board.
The American Legion is concerned that the justification process for
the non-formulary prescriptions interferes with the doctor-patient
relationship and causes doctors to fear poor performance evaluations if
they prescribe non-formulary items. VA needs to be more proactive in
communicating to the field its policy for pharmaceutical best practices
associated with prescribing, purchasing, dispensing, administering, and
tracking medications, so that providers can act in the best interests
of their patients, reduce adverse medication events, and not worry
about administrative ramifications.
The American Legion supports a program that will allow veteran-
patients access to the most appropriate pharmaceuticals regardless of
whether or not an item is formulary or non-formulary and providers
should not be penalized on their performance measures for using non-
formulary items.
gulf war veterans' illnesses
The American Legion continues to actively support Gulf War veterans
and their families, as it has since August 1990. The American Legion
created two particular programs specifically for Gulf War veterans, the
Family Support Network in October 1990, and the Persian Gulf Task Force
in October 1995. Today, The American Legion serves Gulf War veterans
and their families at the community, state, and national levels through
15,000 local posts and an array of programs and services.
Thousands of Gulf War veterans, who suffer undiagnosed illnesses
with a range of symptoms, know as ``Gulf War veterans' illnesses,'' are
not receiving adequate care or compensation from VA and DoD. In this
regard, The American Legion makes the following recommendations:
VA and DoD should conduct their respective exams in a
standard and uniform way as well as create a database that will merge
the individual data from both exams so that patterns in health can be
better analyzed,
VA and DoD should aggressively move to educate its medical
doctors about newly defined illnesses (Chronic Fatigue Syndrome,
Fibromyalgia, etc.) that are commonly misdiagnosed as psychological
conditions. VA should also discourage its doctors from giving diagnoses
for common symptoms unless diagnosed properly and so that the Registry
and CCEP data will be accurate,
VA and DoD should conduct extensive follow-up to Gulf War
veterans who participate in the Registry and CCEP examinations to
monitor health status.
In the upcoming year, the American Legion will be pursuing
legislation to amend Title 38 USC Sec. 1117, Compensation for
Disabilities Occurring in Persian Gulf War Veterans. In November 1994,
the Persian Gulf War Veterans Benefits Act (Public Law 103-446) was
enacted to compensate Gulf War veterans suffering from illnesses or
symptoms that can not be diagnosed or clearly defined. As the number of
sick Gulf War veterans continues to increase, it is quite apparent the
VA is too narrowly implementing the law (38 C. F. R. Sec. 3.317) and
effectively denying compensation to veterans that the law was intended
to help. It is clear that the intent of Congress was not only to
compensate Gulf War veterans with conditions that can not be diagnosed
but to also compensate sick veterans diagnosed with ill-defined
conditions such as chronic fatigue syndrome or fibromyalgia. The
American Legion, calls upon the VA to extend the presumptive period for
service connection for undiagnosed illnesses indefinitely.
In September 2000, in response to DoD disclosure that South Korean
troops sprayed the herbicide Agent Orange along the demilitarized zone
between North and South Korea in 1968 and 1969, VA expanded its Agent
Orange registry program to include veterans who served in Korea during
that time period. As approximately 80,000 troops may have been exposed,
The American Legion strongly urges VA to take appropriate action to
ensure that Agent Orange related compensation, currently afforded the
Vietnam veterans is extended to these veterans.
homeless veterans programs
On any given night, there are approximately 750,000 homeless people
in America. Of that number, at least one third are veterans.
Furthermore, in most major cities, the percentage of veterans in the
homeless male population is over 50 percent.
While The American Legion is concerned about the homeless problem
in general, it is particularly concerned about the plight of homeless
veterans and is committed to bringing an end to this national disgrace.
The American Legion is monitoring the problem and is acting as a
clearinghouse for information on the resources and programs that are
available to assist homeless veterans. Representatives of the Economic
and Veterans Affairs & rehabilitation Commissions within The American
Legion are working with both the public and private sectors to find
unique and effective ways of assisting homeless veterans and bringing
an end to homelessness in America.
Resolution No. 144 from The American Legion's 82nd National
Convention outlines our organizational support for the Homeless
Chronically mentally Ill program, the Homeless Domiciliary program and
the Compensated Therapy Rehabilitation program to be funded separately
from general VA funding.
medical construction and infrastructure support
Major Construction
The VA major construction program is not being funded in an
adequate manner. The major construction appropriation over the past few
years has allowed for only one or two projects per year. Meanwhile, the
number of priority projects continues to accumulate. For FY 2001, 16
major ambulatory care or seismic correction projects were submitted to
OMB. Of this number, only one major VHA project is recommended. For FY
2002, 28 major projects are submitted for funding.
VHA currently has 66 patient care and other related use buildings
that require significant seismic correction. Along with the necessary
ambulatory care and patient safety projects, it will require from $250
million to nearly $1 billion to address VHA's current major
construction requirements. Of the 28 major projects submitted for
funding consideration for FY 2002, 22 are ambulatory care related and
six are seismic correction projects.
The American Legion objects to efforts to close VHA medical
facilities for the sake of cost cutting. At a time that access to care
and service delivery is eroding, the Capital Asset Realignment Study
(CARES) process may find that VHA needs to expand service in certain
areas. It is unthinkable that the expansion of care option would not be
part of the CARES review. No planning options should be excluded; that
includes contraction, expansion, and maintaining the status quo. In the
final analysis, the CARES process must consider what is best for the
veteran, not what is best for VHA.
VHA needs to use the disposal authority it already has to begin to
reduce its unused building inventory. The CARES process may be too time
consuming to allow VHA to divest itself of unneeded buildings in an
appropriate timeframe.
Currently, ten major medical center projects are considered high
priority. Additionally, two parking structures are rated as priority
projects. These are:
Long Beach--Seismic Correction/Clinical--$26.6 million
San Diego--Seismic Correction/Bldg. 1--$51.7 million
Miami--Hurricane and Flood Addition--$23.6 million
Augusta--Spinal Cord Injury Modernization--$18.3 million
Cleveland (Brecksville)--Buildings for Special Emphasis
Programs--$39 million
VISN 6--Special Emphasis Beds--$28.9 million
Dallas--Mental Health Enhancement--$27.2 million
Atlanta--Modernize Patient Wards--$12.8 million
Fargo--Ambulatory Care/Patient Environment--$18.4 million
Cleveland (Wade Park)--Clinical Consolidation--$18.6
million
West Haven--Patient Environment--$13.8 million
St. Louis--Parking Structure--$5.2 million
Tampa--Parking Structure--$10.7 million
Minor Construction
Annually, VHA must meet the infrastructure requirements of a system
with approximately 4,700 buildings, 600,000 admissions and over 35
million outpatient visits. To do so requires a substantial inventory
investment. For the past several years, minor construction has been
funded in the annual range of $175 million. It is penny wise and pound-
foolish to reduce this investment. If Congress fails to appropriate
$175 million for minor construction in FY 2002, VHA will have to delay
approximately one-third of its priority minor projects.
summary
Mr. Chairman, VHA and VBA have made considerable progress in
addressing many of their shortcomings over the past several years. In
this statement, The American Legion has laid out the priority issues
still facing VA. Many of the issues cited will not be resolved
overnight. There is a lot of agreement within VA and among Members of
Congress that many of the subjects discussed justly require priority
attention. That being so, let's commit to developing effective short-
term and long-range strategies to address these matters and as a
result, improve the services and programs of the Department for current
and future generations of America's veterans.
There are many important issues before the Congress of the United
States. However, The American Legion believes that Congress must focus
on finding effective solutions to veterans' concerns. The veterans of
this nation have always answered when their country called. It is time
to make a fundamental commitment to make the programs and services of
VA second to none in helpfulness, effectiveness and efficiency. The
priority challenges facing VA today:
Increase access to VA health care and improve the
timeliness of such care,
Develop new non-appropriated revenue streams to complement
the VA health care appropriations process, without OMB funding offsets,
Enact the Medicare subvention provision of the GI Bill of
Health,
Enact the dependents care provision of the GI Bill of
Health,
Increase resource sharing and cooperation between VA and
DoD health care,
Provide adequate medical research and medical construction
funding,
Maintain strong oversight of Persian Gulf War statutes,
Make veteran friendly improvements to the Montgomery GI
Bill,
Continue the recent expansion of newly constructed
national and state veterans' cemeteries,
Amend the current statute that restricts veterans'
eligibility to obtain an appropriate VA headstone or marker for
previously marked graves,
Ensure qualitative improvements are made in VA
Compensation and Pension Service,
Provide necessary funding support for the General
Operating Expenses of the Veterans Benefits Administration,
Develop a realistic and viable short-term and long-range
strategic plan to include all VA programs and services,
Establish initiatives to persuade civilian employers to
recognize formal military training.
Mr. Chairman and Members of the Committee, in this statement, we
have laid out the priorities of The American Legion regarding the many
programs and services made available to the veterans of this nation and
to their dependents and survivors. As this nation begins a new century,
let us never forget those brave men and women who have honorably served
this nation and those who are still serving. Let us agree that this
nation will always make the right decisions regarding earned benefits
for our veterans, their dependents and survivors.
Thank you for allowing The American Legion to provide testimony for
this important confirmation hearing.
______
Prepared Statement of David E. Woodbury, AMVETS National Executive
Director
Mr. Chairman, I am Dave Woodbury, National Executive Director for
AMVETS. We appreciate the opportunity to provide written testimony
concerning the nomination of Mr. Anthony J. Principi to serve as the
Secretary of Veterans Affairs.
AMVETS is a congressionally chartered veterans service organization
whose membership is open to all honorably discharged veterans who have
served their country, including those currently on active duty. We are
proud of our rich tradition as veterans' advocates. We believe that a
``grateful nation'' has a sacred duty to honor veterans and to make
good on the promises made by our forebears to care for those who have
worn this nation's uniform in their time of need. We thank you, Mr.
Chairman, and the members of your committee for this opportunity to
support Mr. Principi's nomination. We also thank you for your support
and leadership on behalf of veterans' programs.
We are certainly mindful of the importance of this high national
office. The Department of Veterans Affairs is the federal government's
second largest department, responsible for a nationwide system of
health-care services, benefits programs and national cemeteries
supporting more than twenty-seven million veterans. Its role is central
to ensuring that our veterans receive critical medical care, benefits
to which they are legally entitled, and lasting remembrance for their
selfless sacrifices, patriotism, and unswerving dedication to this
nation whenever America called.
We believe the Department of Veterans Affairs should be led by an
individual who understands that freedom is not free; that the price is
too frequently measured in terms of lives lost, citizen soldiers either
physically or psychologically crippled for life--men and women whose
service to our nation left them irreparably damaged. This leader must
be a veterans advocate for he and the department he leads hold the fate
of millions of patriotic Americans in their grasp.
In these terms, AMVETS is encouraged by President-elect George W.
Bush's nomination of Anthony J. Principi to be Secretary of Veterans
Affairs. We believe the President-elect has chosen a man who possesses
the vision, commitment, dedication and compassion to successfully lead
the department in its continuing efforts to address and solve those
issues on which veterans' welfare is so critically dependent. We are
heartened by the fact Mr. Principi is a combat veteran who has
displayed a lifelong commitment to and respect for our men and women in
uniform. His earlier service as Deputy Secretary of Veterans Affairs,
as Acting Secretary, and more recently, as Head of the Congressional
Commission on Service members and Veterans Transition Assistance, has
consistently demonstrated a thorough understanding of and sensitivity
to the issues which directly impact on the quality of life of veterans.
In summary, Mr. Chairman, AMVETS wholeheartedly endorses Mr.
Principi's nomination as Secretary of the Department of Veterans
Affairs. We believe he is the right man for the job at a time when
veterans need and deserve a strong, fair, and committed advocate. We
urge you and your Committee to forward Mr. Principi's nomination
favorably to the full Senate for confirmation.
Thank you again, Mr. Chairman, for providing AMVETS the opportunity
to submit written testimony concerning the nomination of Anthony J.
Principi as Secretary of Veterans Affairs.
______
Prepared Statement of Thomas H. Miller, Executive Director, Blinded
Veterans Association (BVA)
Mr. Chairman and members of this distinguished committee, on behalf
of the Blinded Veterans Association (BVA), I want to express our
sincere appreciation for the invitation to submit written testimony on
the nomination of Mr. Anthony J. Principi to be Secretary of Veterans
Affairs. BVA is very pleased to endorse his nomination for this vital
position within the administration's cabinet.
Mr. Principi possesses outstanding credentials that will enable him
to fulfill completely and honorably the responsibilities of the
position of Secretary. In addition to being a decorated veteran of the
Vietnam War, Mr. Principi has had a long and distinguished career in
public service. As we all know, much of his service has been on behalf
of America's veterans--both in the Legislative and Executive Branches
of the government.
BVA has worked closely with Mr. Principi during his tenures as both
Staff Director and Chief Council of the committee as well as in his
capacity as Deputy Director of Veterans Affairs under Secretary
Durwinski. During his service on the Hill as well as within the VA, Mr.
Principi demonstrated the exceptional management and leadership skills
necessary to undertake the responsibilities of heading the second
largest department in the federal government. His dedication and
commitment to veterans and their families will also contribute to Mr.
Principi's success as Secretary of Veterans Affairs.
It is extremely important to highlight Mr. Principi's effective
management style during his service as Deputy Secretary. This Committee
held an Oversight Hearing in June of 1990 on Prosthetics and the
Special Disabilities Programs. The hearing occurred at a time when
these programs were suffering from lack of resources and upper-
management support. Mr. Principi was the lead witness for the
Department and committed himself to rectifying the problems identified
during the hearing. Despite repeated attempts by management at the
Health Care Service to reverse policy decisions that had resulted from
the hearing, Mr. Principi never faltered and maintained his promises.
One of the important outcomes of the Oversight Hearing was the
establishment of the Federal Advisory Committee on Prosthetics and
Special Disabilities Programs. As one of the initial members of that
Committee, I can personally attest to Mr. Principi's insistence that
the commitments he had made be fully implemented and supported. This
kind of leadership was very refreshing, and it resulted in the
successful resolution of many of the problems identified at the
hearing.
BVA has always been extremely impressed with the interest shown by
Mr. Principi in support of the Special Disabilities Programs. As BVA is
most directly concerned with the Blind Rehabilitation Services provided
by VA, Mr. Principi's exceptional sensitivity to the needs of America's
blinded veterans and their families has resulted in the organization's
strong endorsement of his nomination. Based on my personal experience
on the Advisory Committee, it is abundantly clear that Mr. Principi's
interest in the other Special Disabilities Programs was just as
genuine.
For the aforementioned reasons, BVA believes Mr. Principi possesses
all the qualities and characteristics essential to being an effective
leader of the Department of Veterans Affairs and advocate for America's
veterans. His proven record of dedicated service, his in-depth
knowledge of the Department, and his impeccable integrity leave no
questions as to the validity of his nomination. The Blinded Veterans
Association strongly urges a swift Committee recommendation to confirm
Mr. Principi as the new Secretary of Veterans Affairs.
______
Prepared Statement of David W. Gorman, Executive Director, Washington
Headquarters of the Disabled American Veterans
Mr. Chairman and members of the committee:
On behalf of the more than one million members of the Disabled
American Veterans (DAV) and its Auxiliary, I express my appreciation
for this opportunity to present the written views of our organization
on the nomination of Anthony Principi for the office of Secretary of
Veterans Affairs.
Mr. Chairman, in these challenging times that confront our nation,
the Department of Veterans Affairs (VA) stands at an important
crossroads in its history. The impact your deliberations will have upon
the present and future well being of America's veterans, their
dependents and survivors, and the Department established to care for
them, is significant.
Your actions today are of primary importance in terms of assuring
that the highest caliber of leadership is placed at the helm of our
nation's system of federal veterans' benefits and services.
The magnitude of the responsibility of the VA and the scope of its
various programs are well known to this Committee. The wide array of
specialized care to meet the unique needs of veterans, such as amputee
programs, advanced rehabilitation, prosthetics, spinal cord injury
medicine, blind rehabilitation, post traumatic stress disorder
treatment, mental health services, and long-term care is at the very
heart of the VA health care system.
In addition, the VA supplies one-third of all care provided for
this nation's chronically mentally ill. About 25 percent of the
nation's homeless are veterans, and the VA has developed broad-reaching
programs to meet their psychosocial needs. The VA is also the largest
source of health care for AIDS-related disorders. Many of the men and
women treated by VA simply do not have health insurance or cannot
afford to pay for medical care. For them, the VA is their only health
care safety net.
Mr. Chairman, the VA's responsibilities also include providing
veterans, their dependents and survivors with service-connected
disability and death compensation, nonservice-connected disability and
death pension, vocational rehabilitation, assistance in educational
pursuits, guaranteed home loans, and life insurance protection.
The individual who becomes Secretary of Veterans Affairs shoulders
an enormous responsibility to ensure our government honors America's
commitment to the men and women who served our great nation and
preserved our freedoms. This Committee, and the Congress as a whole,
assume no less of a responsibility.
The DAV believes that the next Secretary of Veterans Affairs must
be an individual who possesses those characteristics and traits of
leadership necessary to successfully direct a national system of
federal veterans' benefits and services and advance the interests of
our nation's veterans. Because VA is currently poised at a significant
crossroad in its history--restructuring its health care system to
better meet the needs of sick and disabled veterans--the next Secretary
must possess a combination of knowledge, skill, and experience of
veterans' issues to enable him or her to guide the VA down the most
appropriate path.
Mr. Chairman, I firmly believe that Tony Principi is sufficiently
qualified to be Secretary of Veterans Affairs. Indeed, as his record
demonstrates, he possesses the essential experience to lead the VA in
the 21st century, and to improve the quality of life for veterans and
their families by improving the delivery of benefits and health care
services provided by the VA.
Mr. Principi, a decorated combat veteran of the Vietnam War, served
as the first Deputy Secretary of Veterans Affairs and later as the
Acting Secretary. He is thoroughly familiar with the bureaucratic
system that is charged with delivering timely, quality benefits and
health care services to our nation's veterans.
His prior experience at the VA and on Capitol Hill, where he served
as Chief Counsel and Staff Director for the Senate Armed Services
Committee and Committee on Veterans' Affairs, will enable Tony Principi
to swiftly take command of the leadership role at VA to make certain
that veterans' issues are considered a national priority in the new
Administration and especially during this transition period.
Mr. Chairman, while we firmly believe that Mr. Principi possesses
the requisite requirements to assume the office to which he aspires, we
would be negligent in our obligation to our nation's veterans if we did
not recognize your Committee's obligation to scrutinize Mr. Principi's
qualifications and to question him about his philosophical beliefs as
to the future role VA will play in meeting the needs of America' s
veterans.
It is our belief that such an examination of the nominee will
reveal, and assure this Committee and the veterans' community, that
Tony Principi will make sure that any policy changes or reorganization
plans affecting the Department or any of its functions would not occur
unless and until it was determined that it was in the best interests of
our nation's veterans, that it would preserve the integrity and
independence of the VA and its programs, and was thoroughly discussed
with the veterans service organizations.
Further, I believe examination of Mr. Principi would also reveal
that he will have a candid working relationship with the Veterans'
Affairs Committees and Appropriations Committees in the House and
Senate, and with the Congress as a whole, utilizing a nonpartisan
concept. Additionally, I would expect Mr. Principi would surround
himself with staff members of high competence and a genuine
understanding of the needs of America's veterans. The environment he
would foster at VA will encourage dedication to duty, quality of
productivity, and personal initiative on the part of all VA employees.
Finally, examination of Tony Principi's philosophy should also
reveal that first and foremost his loyalty would be directed at
promoting the best interests of this nation's veterans and the
Department created and committed to fulfilling their needs. In closing,
let me state that not only do we support President-Elect George W.
Bush's nomination of Anthony Principi to be Secretary of Veterans
Affairs, but Mr. Principi can expect the support of the DAV in his
efforts to improve, reform, strengthen and lead the Department of
Veterans Affairs in the 21st century.
Mr. Chairman, this completes my testimony. Thank you and the
Committee for your quick action in confirming the next Secretary of
Veterans Affairs.
______
Prepared Statement of the Paralyzed Veterans of America
Chairman Specter, Minority Member Rockefeller, members of the
Senate Committee on Veterans' Affairs, the Paralyzed Veterans of
America (PVA) is privileged to be invited to submit testimony for the
record concerning the confirmation of Anthony J. Principi as Secretary
of the Department of Veterans Affairs.
The timely nomination and confirmation of a qualified Secretary of
Veterans Affairs are critical elements to the start of a new
Administration and a new Congress. The Secretary serves as the leading
representative for veterans within the highest levels of the Executive
Branch of government and is the chief advocate for ensuring the
adequacy and integrity of VA budgets, is responsible for the
administration and delivery of the benefits and services established by
Congress and is a national spokesperson on behalf of the services and
sacrifices of the men and women who have served in the Armed Forces.
Paralyzed Veterans of America believes that there are several
critical criteria for the position of Secretary. First, the individual
selected for that position must be a knowledgeable and committed
advocate on behalf of veterans. Second, the nominee must be an
unqualified supporter of an independent veterans healthcare system and
cognizant of the core function of the system's specialized services
including spinal cord dysfunction care. Third, the individual selected
for Secretary must recognize and support the broad range of benefits
that have been established to assist veterans in recognition of their
service. And, finally, the individual who will serve as Secretary must
demonstrate a willingness to deal openly and forthrightly with the
veterans' service organizations and the Congress in addressing the
current and future needs of veterans and the operations of the
Department of Veterans Affairs.
Mr. Chairman, and members of the Committee, PVA feels confident
that the current nominee, the Honorable Anthony J. Principi, meets each
of these litmus tests. Mr. Principi's long and distinguished career in
service to veterans certainly marks him as a committed advocate. His
service as Deputy and Acting Secretary in an earlier Administration was
characterized by firm leadership and dedication to the needs of the
veterans of this nation. His service on the staff of this Committee was
similarly that of an individual motivated by concern for his fellow
veterans.
Mr. Principi has demonstrated his support for the veterans
healthcare system throughout his career. It has been PVA's personal
experience that he understands and is committed to the role of
specialized services and their unique place within this system.
As Chairman of the Congressional Commission on Servicemembers and
Veterans Transition Assistance Mr. Principi demonstrated a breadth and
depth of understanding of the many benefits and services necessary for
the support and readjustment of veterans. The efforts of this
Commission reflect the nominee's concern for veterans and his
willingness to solicit veterans' views and experiences in guiding the
direction of veteran's benefits. While PVA did not agree with every
conclusion and recommendation of this Commission, we did recognize that
they were all the result of diligent evaluation and hard work that is
characteristic of Mr. Principi.
It has also been the experience of PVA and many of its members that
Mr. Principi is sincerely open and willing to entertain the views and
opinions of those most affected by the Department of Veterans Affairs.
Our relationship with Mr. Principi has been one of forthrightness and
respect. We have no reason to believe that future dealings with him and
the Department should be any different.
For the above reasons, and from our personal experience in dealing
with Mr. Principi, the Paralyzed Veterans of America is both pleased
and honored to support the nomination and confirmation of Anthony J.
Principi as Secretary of Veterans Affairs. PVA asks for your
enthusiastic support for this nominee. We believe the veterans of this
nation will be well served by Mr. Principi and we look forward to
working with him, and the Congress, in addressing the needs of
veterans.
Thank you and this concludes the statement of the Paralyzed
Veterans of America.
______
Prepared Statement of Robert E. Wallace, Deputy Executive Director,
Veterans of Foreign Wars of the United States
Mr. Chairman and members of the committee:
On behalf of the 2.6 million men and women of the Veterans of
Foreign Wars and our Ladies Auxiliary, I wish to express our sincere
appreciation for your providing us this opportunity to express our
views here today. As we now all set about preparing ourselves to
properly meet the great challenges and fully realize the enormous
potential of the 21st Century on behalf of America's veterans, it would
be hard to imagine any more significant act in this regard than the
selection of the Secretary of Veterans Affairs. It is for this reason
that we are both humbled and gratified to play a role in this process.
We of the VFW are honor bound and pledged to never waiver nor
relent in our fight on behalf of America's true heroes--our nation's
veterans: active duty, reserve and National Guard members, their
families and survivors, and our military retirees. We are committed to
the proposition that as this nation moves forward into the 21st
Century, those who stood in harm's way, who bear the scars and injuries
of body or spirit so that we might all be prosperous and free, shall
never be ignored or left behind.
This is why we are adamant this nation's veterans be provided with
the leadership they have earned and deserve a champion, an impassioned
advocate as their Secretary of Veterans Affairs!
It is our view that Anthony J. Principi fully possesses the
intellect, experience, and, most importantly, commitment to veterans to
meet this expectation.
Since his first position of leadership in the arena of veterans
affairs in 1983 as Associate Deputy Administrator for Congressional and
Public Affairs, Mr. Principi has always impressed us with his
graciousness and his willingness to discuss even potentially
controversial issues in the interest of better serving veterans. Our
respect and appreciation for Mr. Principi's integrity, strength of
convictions and candor only increased in the ensuing years.
When Mr. Principi returned to VA in March of 1989, as the first
Deputy Secretary of Veterans Affairs, his efforts to keep the newly
established Department of Veterans Affairs on course to meet the
demands imposed by a burgeoning population of sick and elderly veterans
were of singular importance and effectiveness. His leadership within
the Department and ability to reach out to the veterans' community is
his hallmark accomplishment. There may be no doubt that Mr. Principi's
numerous contributions have gone a long way toward making VA what it is
today.
We would also note here that it was Deputy Secretary Principi who
at the inception of the Persian Gulf War took the initiative calling
for the creation of a registry to track the medical conditions
affecting those who served in that conflict. There is a certain
symmetry and appropriateness to his confirmation hearing as VA
Secretary taking place on the tenth anniversary of that war.
The VFW also greatly values Mr. Principi's significant record of
legislative accomplishment on behalf of those who have served the
nation in uniform when he was chief counsel and Staff Director of the
Senate Veterans Affairs Committee from 1984 to 1988. That he was able
to achieve so much under two separate Chairmen may be seen as a
remarkable accomplishment and bears strong testimony to his strength of
character and sense of mission for serving his fellow veterans.
Mr. Principi's three years of distinguished service as Counsel of
the Senate Armed Services Committee prior to his joining the VA in
1983, also strongly attests to his commanding intellect and energy.
His most recent role as chairman of the Congressional Commission on
Servicemembers and Veterans Transition Assistance, further demonstrated
his commitment to service by making a number of major recommendations
beneficial to our men and women in uniform as they reenter civilian
life.
Given his record of advocacy, we are confident that Mr. Principi is
fully commited to meeting the many monumental challenges facing VA in a
manner that will ensure quality, timely and accessible services to all
veterans.
In closing, speaking on behalf of the membership of the Veterans of
Foreign Wars of the U.S., we offer our strong endorsement of Anthony J.
Principi to be Secretary of Veterans Affairs.
______
American Academy of Physician Assistants,
950 North Washington Street,
Alexandria, VA, January 11, 2001.
Hon. John D. Rockefeller IV,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate,
Washington, DC.
Hon. Arlen Specter,
Ranking Minority Member,
Committee on Veterans' Affairs,
U.S. Senate,
Washington, DC.
Dear Senators Rockefeller and Specter: On behalf of the nearly
41,000 practicing physician assistants represented by the American
Academy of Physician Assistants (AAPA), I am very pleased to convey the
AAPA's support for the nomination on Mr. Anthony Principi as Secretary
of the Department of Veterans Affairs.
Mr. Principi's background and experience are uniquely suited to
lead a public agency whose job is to administer programs that benefit
our nation's veterans. Mr. Principi's experiences as a Vietnam War
combat veteran, congressional staff on the Senate Veterans' Affairs
Committee, Deputy Secretary of the VA, and, most recently, as President
of QTC Medical Services, Inc., confirm his exceptional preparedness for
this important job. His earlier position as acting secretary of the
agency demonstrated the capacity to provide innovative leadership in
administering the agency during a period of transition.
Mr. Principi offers a well-rounded knowledge of veterans' issues,
demonstrated leadership, and a commitment to public service. The AAPA
is also pleased that Mr. Principi has demonstrated his understanding
and support of the role of physician assistants in providing medical
care during his previous tenure at the VA and through his work in
corporate health care delivery.
Mr. Principi will serve our nation well as Secretary of the
Department of Veterans Affairs. Accordingly, I urge your support for
his nomination as it moves forward for consideration before the Senate.
Should you have any questions regarding the physician assistant
profession, the American Academy of Physician Assistants, or the
Academy's support for Mr. Principi, please do not hesitate to have your
staff contact Sandy Harding, the AAPA's Director of Federal Affairs.
I look forward to Mr. Principi's confirmation as Secretary of the
Department of Veterans Affairs.
Sincerely,
Glen E. Combs, PA-C, MA,
President.
______
Chamber of Commerce of the United States of
America,
1615 H Street, NW,
Washington, DC, January 17, 2001.
Hon. Arlen Specter,
Chairman,
U.S. Senate Veterans' Affairs Committee,
Washington, DC.
Dear Chairman Specter: The U.S. Chamber strongly supports the
nomination of Mr. Anthony Principi to serve as Secretary of the US.
Department of Veterans' Affairs. Expanding military and veterans
benefits, including full college scholarships, and offering home loans
without down payments for our nation's celebrated veterans are just a
few of the challenging initiatives that the new Secretary will face. We
believe Mr. Principi has the experience to successfully champion these
issues.
As a graduate of the United States Naval Academy and a combat
decorated Vietnam veteran, Mr. Principi understands issues facing our
veterans. In 1989, Anthony Principi was appointed to Deputy Secretary
of Veterans' Affairs for the Department and was named Acting Secretary
in 1992 under President George Bush. Later in his career, Anthony
served as Chief Counsel and Staff Director for the U.S. Senate
Committee on Armed Services.
Currently, Mr. Principi is the Chairman of the Commission on
Servicemembers and Veterans Transition Assistance, which reviews and
reports programs that provide benefits and services to veterans and
servicemembers making the transition to civilian life. The Commission
was created under public law in 1996, and was a pet project of former
United States Senator Robert Dole.
Mr. Principi is eminently qualified to serve his country as
Secretary of Veterans' Affairs. Under his leadership, we are confident
that his experience and commitment to issues facing our veterans will
be skillfully addressed.
Accordingly, we urge the Committee to report out the nomination of
the Anthony Principi and request that you insert this letter into the
hearing record.
Sincerely,
Thomas J. Donohue,
President and Chief Executive Officer.
______
Marine Corps League,
P.O. Box 3070,
Merrifield, VA, January 22, 2001.
Hon. Arlen Specter,
U.S. Senate,
Chairman, Senate Veterans' Affairs Committee,
Washington, DC.
Dear Mr. Chairman: On behalf of the over 51,000 members of the
Marine Corps League, it is with a great deal of pleasure and honor that
we recommend the Honorable Anthony Principi for confirmation as
Secretary for Veterans' Affairs.
Mr. Principi is a proven professional in the Department of Veterans
Affairs. A man of honor and integrity, Mr. Principi has proven he has
what it takes to make tough choices in the budget arena, and at the
same time ensure that veterans' are not forgotten and receive their due
as promised by this great Nation. His confirmation as Secretary of
Veterans' Affairs would be an outstanding choice for veterans and for
all Americans.
Mr. Chairman, the Marine Corps League wishes you the very best and
continued success with the Senate Veterans' Affairs Committee,
Semper Fidelis,
Diana Dils,
National Commandant.
______
National Vietnam & Gulf War Veterans Coalition,
1660 L Street, N.W., Suite 204,
Washington, DC, January 11, 2001.
Hon. Arlen Specter,
Chairman, Committee on Veterans Affairs
United States Senate,
Washington, DC.
Dear Mr. Chairman: The National Vietnam & Gulf War Veterans
Coalition is a federation of 106 veteran groups. One of our ten (10)
goals is to have Vietnam and Gulf War veterans appointed to high
visibility government positions.
It is with the latter in mind that we are pleased to endorse and
support President-Elect Bush's nomination of Anthony J. Principi as the
next Secretary of the Department of Veterans Affairs.
I and my organization have previously worked with Tony Principi
when he served as Deputy Secretary. We were impressed with his
availability to listen to our concerns, his fairness in all matters,
and his advocacy for improving the plight of all veterans. Tony is a
man of integrity with whom we have confidence will be an effective
advocate for both the Bush administration and this country's veterans.
We urge you and the Committee on Veterans Affairs to expeditiously
forward his nomination to the Senate for a full confirmation vote.
Sincerely,
J. Thomas Burch, Jr.,
Chairman.
______
Non Commissioned Officers Association of the United
States of America,
10635 IH 35 North,
San Antonio, Texas, 16 January 2001.
Hon. John D. ``Jay'' Rockefeller IV,
Committee on Veterans Affairs,
Washington, DC.
Dear Mr. Rockefeller: The Non Commissioned Officers Association of
the United States of America strongly supports the confirmation of Mr.
Anthony J. Principi as Secretary of Veterans Affairs.
The Association highly regards Mr. Principi as the man most
qualified to be Secretary of Veterans Affairs. His distinguished public
service including Deputy Secretary of Veterans Affairs and most
recently leadership as Chairman of the Congressional Commission on
Servicemembers and Veterans Transition Assistance demonstrate not only
an awareness of issues but also the ability to decisively act on behalf
of veterans and servicemembers. He has the confidence and trust of the
Non Commissioned Officers Association.
Request his expeditious confirmation,
Sincerely,
David W. Sommers,
President/CEO.
______
Veterans of Foreign Wars of the United States,
Department of Pennsylvania,
201 N. Front Street, Harrisburg, PA, January 9, 2001,
Hon. Arlen Specter,
U.S. States Senate,
Washington, DC.
Dear Senator Specter, The United States Congress will face many
challenges and will be making decisions that will guide America and the
world into the next century.
I want to express my personal thanks to you for the way you have
represented Pennsylvania, not only as our voice in the U.S. Senate, but
your 100% commitment to all of America's veterans.
Your leadership as Chairman of the Veterans Affairs committee is a
testament that a free nation does remember. We look forward to that
same commitment in the 107th Congress.
President-Elect George W. Bush has nominated Anthony J. Principi to
be Secretary of Veterans Affairs. I believe his background and
experience make him an excellent choice for that important position. I
know that he will be asked many questions during the confirmation
hearing. I also know that you will do ``the right thing'' on behalf of
Americas Veterans. I, for one will support whatever action you take.
Sincere best wishes and I hope to meet with you and discuss
veterans issues in the very near future.
Respectfully,
Almon J. Long,
Legislative Chairman.
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