▶ 0:08:58e e
▶ 0:09:37now of course I have to get uh everything back in order um the legislative hearing of the subcommittee on health will now come to order I'd like to welcome all members and Witnesses for today's hearing we look forward to a very productive discussion on some impactful veterans legislation today we'll discuss 12 bills including bills which would enable the VA to enter into Innovative public private Partnerships research Cutting Edge hyperbaric oxygen therapy and provide some long overdue oversight of the va's budget management also on today's agenda
▶ 0:10:08are four bills I've had the pleasure of introducing before I discuss my bills I'd like to thank our Witnesses again for being here today I'd like to especially thank Dr Andrew kosminsky who is the medical director of the Hyperbaric medicine at my beloved University of Iowa I had the pleasure of touring Dr kaminsky's office um a few months ago and learned about the incredible healing proper properties that hyperbaric oxygen therapies can provide Dr Kaminsky welcome to um to my office and I'd
▶ 0:10:38like like to look forward to hearing your thoughts about Dr Murphy's Bill the veterans National traumatic brain injury treatment act now to my bills first the sports act the sport act would make sure athletic Prosthetics are defined as medically necessary for ampute veterans every year in my district severely disabled veterans gather to play golf I'm not a golfer except for ature golf but it's amazing to see how many sports even golf can improve veterans mental and physical well-being I think all veterans should be able to enjoy the benefits
▶ 0:11:09and camaraderie Sports provide and my legislation would achieve just that I'm also proud to introduce the no wrong door for veterans act this bill would reauthorize via a successful Fox grant program Fox grants enable Community organizations to provide services to Veterans screen them for suicidal ideation and connect them with the VA so they can receed the mental health support that meets their individual needs my bill would ensure organizations who have been successful in our mission to expand mental health can receive additional funds by partnering
▶ 0:11:39with the VA to reach even more veterans the fox grant program is a great example of a public private Partnerships working for the better House Republicans will continue to push the needle and protect programs like this one next I'm proud to lead the providing veterans essential medications act this bill would allow the VA to provide very H High high- cost medications to severely disabled veterans receiving Care at State veterans homes VA pays for these medications for all other veterans patients but Antiquated laws require
▶ 0:12:09VA to pay state Veterans Home a fixed prum limiting their ability to provide for veterans who desperately need these medications while residing at a Veteran's Home unfortunately these high-cost medications can cost as much as a ,000 doar per day meaning State veterans homes are not able to house many of our most deserving veterans my bill would fix this clear mistake and ensure veterans with complex needs are cared for and ironically the last bill I'd like to mention is the start act far too often
▶ 0:12:39our veterans receive Community Care referrals that are only valid for a fixed period of time but due to provider shortages and bureaucratic delays veterans might not even get in until halfway through the authorized time period my start act addresses this issue by ensuring that the validity of the referral begins only once a veteran has attended their initial appointment it's pretty common sense it's a privilege to collaborate on Crafting impactful legislation for our veterans and to address critical issues in the delivery of their health
▶ 0:13:10care I'd now like to turn to representative brownley for any opening remarks she may have representative B you are now recognized uh thank you uh Madam chair at the outset I have to say I find it a bit crazy that we're having a legislative hearing today rather than an oversight hearing the Trump administration's executive orders Mass firings of va employees Reckless contract terminations and $1 spending limit on purchase cards
▶ 0:13:40are causing significant upheaval within the veterans Health Administration that we are here today proceeding to consider new legislation as if these changes aren't already significantly impacting veterans access to care is absurd our time today would be much better spent examining the administration's plan to gut va's Workforce by 80,000 employees before September this would be in addition to the 2400 or more VA employees
▶ 0:14:11who have already been terminated committee Democrats have already heard a multitude of instances of these terminations negatively impacting patient care despite secretary Collins insisting that they're not the termination the terminations that have already OCC Ur include positions like procurement professional professionals who play a critical role in purchasing Prosthetics and medical devices veterans need we are aware of numerous VA
▶ 0:14:41medical facilities where such terminations have occurred supply chain staff who are responsible for equipping surgical suites with necessary supplies the committee has heard from several supply chain professionals who were terminated from the VA facilities in Florida Texas Oklahoma and in California Human Resources professionals who are necessary for filling clinical staff vacancies while clinical staff have largely been Exempted from
▶ 0:15:11the Trump administration's hiring free VA can't efficiently fill clinical positions without human resources professionals psychology uh technicians at the VC who perform Neo neuros Psych ological tests for individuals with neurological conditions like Strokes TBI PTSD and concussions staff that perform that perform manage and analyze mamogram
▶ 0:15:41results at the Hampton VA MC one veteran whose mamogram was cancelled due to a staffing shortage at the Hampton vamc just found out the earliest she could reschedule her appointment elsewhere is June four months from now these are just a few examples that the committee has heard about from across the Across the Nation unfortunately none of the bills we are considering today will address the very real threat to VA Health Care access quality
▶ 0:16:12and safety that veterans are facing in just the last few days my Democratic colleagues and I have received tens of thousands of emails from V veterans across the country asking that we do all we can to stop the VA Workforce cuts and elimination of crucial contracts I certainly hope that our Republican colleagues are receiving the same messages veterans do not support these Cuts I would encourage the witnesses and members here today to keep
▶ 0:16:42in mind that if we continue to see efforts to dismantle VA by firing hardworking employees Cel can cancelling vital research terminating Health Care contracts and eroding veterans trust in VA it won't matter matter what excellent legislation we put forth there won't be employees or even an infrastructure left at VA to implement these bills and veterans care will suffer because of it I would hope the chair
▶ 0:17:12shares these same concerns and I understand that we must protect the many VA employees that provide critical care to our nation's veterans however I understand that despite what I have laid out uh today we are here to consider legislation today on this committee I'm pleased I'm pleased today's agenda includes my VA marriage and family therapist Equity act I'm also glad that a bill I am co-leading with my friend from Texas congresswoman Garcia the women
▶ 0:17:43veterans Cancer Care coordination Act is on the agenda I look forward to hearing from our Witnesses on all of the bills on today's agenda with that Madam chair I will yield back thank you very much ranking member brownley we have a full agenda today so I'll be holding everyone to 3 minutes per Bill to ensure we can move in a timely manner this morning we're joined by several of our colleagues who will speak in support of their bills we appreciate the dedication to serving our nation's
▶ 0:18:13veterans with that I ask unanimous consent that all uh nons subcommittee members be waved on to speak on their bills from the Das hearing no objection we'll move forward I now recognize representative wac for 3 minutes I thank the chairwoman uh chairwoman Miller migs ranking member brownley and distinguished members of this subcommittee thank you for considering my bill HR 1107 the protecting veteran access to Tele medicine services Act of 2025 I also
▶ 0:18:43want to express my sincere gratitude for allowing me to speak in support of this legislation this bill aims to guarantee that our nation's veterans whether in bustling cities or remote rural areas have continuous access to the healthc care service they need and deserve the Ryan Hyde online pharmacy consumer protection act enacted in 2008 was designed to regulate the prescription of Controlled Substances via tele medicine in response to the rise of online pharmacies and the risk of
▶ 0:19:13misuse while this law plays a crucial role in protecting Public Health it has not been updated to reflect the realities of 2025 nor does it account for the fundamental differences between the VA and civilian online pharmacies during the covid-19 pandemic the Ryan height acts in-person consultation requirement for prescribing Controlled Substances was temporarily waved the DEA and HHS later extended these flexibilities through
▶ 0:19:43the end of this year my bill the protecting veteran access to Tele medicine services Act of 2025 would make this exemption permanent for the VA allowing VA healthc Care Professionals to prescribe medically necessary control substances via tele medicine under specific conditions this exemption has a life has been a Lifeline for our veterans without it many will face severe restrictions in accessing vital health care for veterans in urban areas letting this exemption
▶ 0:20:14expire would mean longer wait times for in-person appointments further straining and already overburdened VA Health Care System the impact is even greater for veterans in rural communities where geographic isolation and limited health care providers create significant barriers the exemption has allowed them to receive care from VA Specialists hundreds of miles away without the burden of costly and timeconsuming travel continuing this exemption isn't just a matter of convenience it's a
▶ 0:20:44necessity it ensures that every veteran no matter where they live has equal access to the care they've earned and deserve so I'm honored to speak in support of this legislation today I urge my colleagues to act swiftly in passing the bill our veterans have sacrificed so much for all of us it's our duty to ensure they receive the care they need in a way that meets the demands of today's world Adam chairwoman thank you for the time and I yield back my balance thank you very much representative wach the chair now recognizes
▶ 0:21:15representative Garcia for three minutes thank you uh Madam chair and thank you to the ranking member for giving me a few minutes to talk about my bill the Wom veterans cancer care coordinator act I'm pleased to lead this bill with ranking member brownly to improve the breast and gynecological Cancer Care that the VA provides to our heroins every day more and more American women sign up to serve in the US Military
▶ 0:21:46and as women sign up the women veteran Community also grows in fiscal year 2000 women met veterans made up just about 4% of all the veteran population today they rank at about 11.3% over 2.1 million women veterans Nationwide however as the women veteran Community ages rest and gynecological Care rates in this population will also increase the VA responded to this need
▶ 0:22:16by establishing the breast and gical oncology system of excellence in late 2020 a program that ensures women veterans are getting the appropriate Cancer Care they deserve the VA also partners with Community Care Providers to treat these veterans when the VA does not does not have the means to provide care now that sounds great but the system that we set up for women is not entirely working as it should veterans must navigate multiple facilities alone
▶ 0:22:46and ensure that providers communicate with the VA the lack of coordination between both the VA and these providers lead to treatment delays miscommunication and unnecessary stress without a well-coordinated care team A lot can go wrong no veteran fighting cancer should struggle with red tape they should be focused on getting better my bill will effectively address these challenges by creating dedicated Regional Cancer Care coordinators at the VA
▶ 0:23:16these professionals would guide veterans through their treatment Journey improve communication between the VA and Community Care Providers track patient progress and address the existing delays in their care these coordinators would also provide veterans with emergency health information and Mental Health Resources to support their well-being I firmly believe that a Grateful Nation shows its gratitude in the care and benefits we provide to our heroins supporting our veterans is one of the solemn promises
▶ 0:23:47we have made and it is a promise we must keep thank you again uh Madam chairwoman and of course to ranking member brownley for her support on this issue and I yeld thank you very much representative Garcia the chair now recognizes representative Dr Murphy for three minutes thank you madam chair um and thank you ranking member brownley uh delighted for the second time to introduce my bipartisan Bill hr1 1336 the Veteran's National traumatic brain injury treatment act being discussed
▶ 0:24:17here today it's long overdue that we do something further for our veterans who suffer from PTSD and TBI sadly enough we lose 17 up to 22 veterans a day due to Su due to Suicide many who are suffering from TBI and PTSD I'm a big fan and have been for over 30 years of the treatments of hyperbaric oxygen therapy we've used this uh in surgical wounds for wounds that won't heal um it has enjoyed great success amongst many different maladies
▶ 0:24:48uh it has been my own experience now in exploring this issue for TBI and PTSD that this is not only a viable but a very very successful uh intervention uh I'm going to introduce into the record a metaanalysis study from NIH this was done in January to March of 2020 which is an exhaustive list of mostly randomized double blind control studies which shows great objective Improvement for those veterans who have suffered from T TBI and PTSD not only in cognitive function
▶ 0:25:18but mood disorder ask this to be submitted for the record this organization now uh hbot for Heroes in North Carolina has successfully treated over 200 veterans who suffer from TBI and PTSD we had a uh witness here before the executive director Mr Ed djalo who gave very compelling testimony at a round table concerning alternative therapy specifically for hbot my bartisan bill my bipartisan Bill sets up a pilot program for five years at three
▶ 0:25:48veterans uh service networks costs are borne by donations not to the taxpayer but d d excuse me donations the veteran service or organizations are supportive multiple and listed here we also have expert witness from Dr Andrew kusminsky an MD from the great University of Iowa I think somebody went there or knows there uh who is a hyperbaric oxygen medicine specialist I have thought this through and through I believe it is sad that we get our veterans when they hit the wall when
▶ 0:26:18there is literally nothing else that the VA can offer that we are not offering this therapy to them it is a proven alternative and a successful alternative and I will say it again and I've said this before I believe it is medical malpractice that is not being offered to our veterans at this point in time so I thank you for your support I would ask that this uh committee at some point review this favorably bring this to the floor so that we can get our veterans the care that they need thank you madam chairman I'll yeld back chair now recognizes representative delusio
▶ 0:26:48for three minutes thank you chairman Miller Meeks and ranking member brownley and members of the health subcommittee it's great to be back with all of you and appreciate your flexibility work with me and my team on my bill considering uh this important measure to reduce veteran suicide saving our veterans lives Act of 2025 it's hr1 1987 I'm proud to say this has been a bipartisan effort from the start and although they're not here I commend Representatives Fitzpatrick James and lansman alongside Senators King and
▶ 0:27:19sheii and a wide variety of organizations who have come together and worked with me and others on such an important issue of Veteran suicide this bill will create a program at a to provide and distribute gun lock boxes to Veterans including those who aren't enrolled with the veterans Health Administration this aspect of the bill is very important cited in va's 2024 National veteran Suicide Prevention annual report the rate of Veteran suicide is about 17 and a half per day and the majority of those Come Those terrible deaths
▶ 0:27:49are from veterans outside of VHA so we've got to do a better job at reaching these veterans and connecting them with resources that could make a difference in their lives and this bill will bridge that Gap so that said I've read the va's testimony I know VA recommends some changes to the bill text welcome amendments and working with the subcommittee and its members to make this legislation stronger so we can save more my fellow veterans lives from the scourge of Veteran suicide Madam choman thank you for your time and engagement I yield back thank you very much representative delusio the chair now recognizes
▶ 0:28:19representative Underwood for three minutes thank you madam chair as a nurse I'm really proud to be here to testify before you today on one of the first bills that I introduced in Congress congress with my friend Senator Duckworth the co-pay fairness for veterans act while I currently sit on the Appropriations Committee I had the honor serving on the house of Veterans Affairs Committee in the 116th and 117th congresses our veterans are heroes who have given so much to our country and serving veterans and their families is one of the greatest privileges we have as members of Congress at a time where
▶ 0:28:49research shows us that veterans face worse Health outcomes in the general public and have higher burden of chronic diseases no veteran should go without the ready access to preventive health care services that can improve their Healthcare and quality of life that's why my legislation would eliminate once and for all all of the financial barriers that can prevent veterans from accessing basic care under the Affordable Care Act almost all Private health insurance plans are required to provide coverage of
▶ 0:29:19preventive services without charging co-pays however While most civilians have been able to access preventive services without co-pay for nearly 15 years thanks to the ACA this same guarantee does not exist for our veterans at least who get their Healthcare through the VA despite their sacrifices and commitment to our country veterans are still at risk of being charged out of pocket costs for services like cancer screenings mammograms Diabetes Care and screenings for depression and anxiety
▶ 0:29:50that is just unfair but luckily friends we can fix it my co-pay fairness for veterans act writes This Wrong by eliminating out of pocket cost for veterans seeking the preventive services that they need and deserve at the VA my bill will ensure that veterans are not charge copay for basic essential care such as screenings for cancer depression anxiety diabetes and other diseases interventions to prevent and treat heart disease maternal health care and breastfeeding support for new moms help with
▶ 0:30:20alcohol and tobacco abuse Well Woman visits and other critical health care services for veterans and their families I'm proud to say that this bill is endorsed by the disabled American veterans and the minority Veterans of America among others our veterans have earned the best and I urge my colleagues on both sides of the aisle to support this critically important legislation so thank you madam chair for including this bill in today's legislative hearing and thank you to our Witnesses for being here
▶ 0:30:50I Y back thank you representative Underwood as is our practice we'll forego a round of questioning for the members for those committee members you may stay around to ask questions of the witnesses if you have time uh our first panel is already at the table thank you uh joining us from the Department of Veterans Affairs is Dr Thomas um otou the uh va's Deputy assistant under secretary for health and Clinical Services for quality and field operations he's accompanied by Dr
▶ 0:31:20antoinet Chappelle va's Deputy assistant under secretary for health and patient care services and Dr Thomas IM andorfer va's executive director of Pharmacy benefit managers also on our first panel we have Dr Jeffrey gold president of the univiversity of Nebraska Health System welcome Dr gold Dr otou you're now recognized for five minutes to present the Department's testimony great great thank you and good afternoon chairwoman Miller Meeks ranking
▶ 0:31:51member brownley and members of the subcommittee thank you for inviting us here today to present our views on several bills that will affect Department of Veterans Affairs programs and services joining me today are Dr antoanet Chappelle Deputy assistant under secretary for health for patient care services and Dr Thomas emendorfer executive director of Pharmacy benefits management I joined the VA 19 years ago leaving a senior position at a large academic Health Center to work at the VA hospital
▶ 0:32:21in Providence Rhode Island The Surge and deployments needed for the Iraq War was underway we were seeing more and more veterans returning from the war needing our help and it's a decision I have never regretted I've been incredibly proud to work in the VA our commitment to Mission the professionalism and dedication of my colleagues and the Excellence and care and quality that VA provides to our nation's veterans defines us as an
▶ 0:32:52agency much of this has come from the strong partnership guidance and oversight we receive from Cong Congress and the thoughtfulness and intent of the legislation being discussed today reflects that while the department views are provided in detail and written testimony I would like to highlight several bills in my opening remarks the no wrong door for veterans act makes several amendments to the staff sergeant Parker Gordon Fox Suicide Prevention grant program
▶ 0:33:22VA strongly supports the intent and some of the Amendments the bill would make particular extending the program through fiscal year 2028 and requiring grantees to inform individuals about emergent suicide care however we do have concerns about some of the Bill's amendments and look forward to working with the subcommittee to address those further this bill aligns with the Department's priority of reaching veterans at risk suicide VA also supports the standardizing
▶ 0:33:52treatment and referrals act or start act this bill ensures that the referral period for care from a non-va provider begins on the date of the first appointment VA supports this bill however we would like the opportunity to work with the subcommittee to ensure the text is clear and doesn't result in any unintended consequences VA strongly supports we all support efforts to reduce veteran suicide however
▶ 0:34:23in its current writing we do not support the saving our veterans Liv lives act as written the bill is overly Broad and the resources needed to implement would significantly exceed the authorized appropriation of $5 million per year VA supports with amendments the women veterans Cancer Care coordination Act and the veterans supporting Prosthetics opportunities and recreation act VA supports hr20
▶ 0:34:53uh 217 the chip in for veteran acts which would allow VA to modernize infrastructure more efficiently and cost effectively VA supports efforts to ensure veteran State homes are adequately supported in covering the costs of care for veterans though we do not support the providing veterans essential medications act we would appreciate the opportunity to discuss this bill and va's concerns with the committee VA supports
▶ 0:35:23HR the co-payment fairness for veterans act with Amendment and subject to Appropriations regarding the V the veterans National TBI treatment act this bill requires VA to implement a pilot program for hyperbaric oxygen therapy or hbot for veterans with TBI or PTSD VA does not support this bill due to the lack of scientific evidence supporting hbot for these conditions and we have concerns about the funding
▶ 0:35:54the proposed funding mechanism VA does not not support HR 658 qualifications for marriage and family therapists and we defer to the comproller general regarding hr1 1823 directing VA and the comproller general to report on certain funding shortfalls in VA finally VA does not have views on HR 1107 protecting veteran access to Tele medicine services of 2025 and we will provide
▶ 0:36:24these views in a letter to the subcommittee after the hearing this concludes my statement we appreciate the continued support and oversight of the committee my colleagues and I are prepared to respond to any questions you or other members of the subcommittee may have about the legislation before us thank you thank you Dr otou the chair now recognizes Dr gold for five minutes uh thank you and good
▶ 0:36:54afternoon uh chairwoman Miller Ms ranking member brownley uh and other members of the committee and uh Congressman bacon I'm Dr Jeff gold and I have the distinct privilege of serving as the president of the University of Nebraska system which has campuses in Lincoln Omaha and Carney as well as a top ranked academic Medical Center in Omaha we educate approximately 50,000 students and do approximately $700 million in peer-reviewed medical research I myself
▶ 0:37:24I'm a recovering pediatric heart surgeon by training what for the last 10 years prior to my current position I had the privilege of serving as the chancellor of the University of Nebraska Medical Center for many decades UNMC the University of Nebraska Medical Center has had a broad and deep relationship with civilian and Military Federal departments focused on training research and clinical care however over the past decade there's been intense multi-departmental focus with key Partnerships
▶ 0:37:55in civilian and Military CBR Global Health security challenges thank you for the opportunity to testify today to support Congressman Bacon's HR 217 which seeks to make permanent the chip in for veterans act this bill supports our service members through Innovative approaches to develop and finance VA facilities through public private Partnerships since 2016 uh Congressman Brad Ashford of Nebraska
▶ 0:38:25and Senator Deb fiser were instrumental in passing this new legislation creating this pilot program that allowed public private Partnerships with the VA this opportunity led to remarkable Improvement in care for local veterans in our community including the construction of a new ambulatory Center that today serves as a key resource for outpatient diagnostic procedural and Interventional veterans cares and services in the Nebraska Western Iowa region this
▶ 0:38:55project was funded through federal dollars and private philanthropic support and has been recognized nationally as a true pillar of success however at this time the University of Nebraska Medical Center my organization has identified a significant need to replace several of our own aging academic facilities on the Omaha campus and among these is a forthcoming $ 2.19 billion project known as project Health this will serve as a state-of-the-art medical facility
▶ 0:39:25with unique training opportunities f focused on meeting Nebraska's growing need for medical professionals this project will also provide access to highquality Advanced Medical Care a unique interprofessional multidisciplinary learning environment and access to life-saving clinical trials for patients across the state and in the region project health is a collaboration of the state of Nebraska the city of Omaha the University of Nebraska the academic Medical Center and of course Nebraska's philanthropic
▶ 0:39:55Community we have proposed osed that the replacement local VA hospital now be positioned on the UNMC campus to better meet the needs of veterans in Nebraska and Western Iowa this would be constructed to replace the Aging facility currently in use this new freestanding facility would be branded staffed and operated by the VA with physical connectivity to project health for potentially shared diagnostic Interventional laboratory
▶ 0:40:25and support services this would also provide proximity for University clinicians and Learners from UNMC and also remain open to Staffing and training for other public and private academic Medical Center professional staff leveraging private construction and adjacent resources significantly creates more coste effective facilities and opportunities for renovating and replacing the existing VA hospital
▶ 0:40:56that was opened in 1950 our approach is not only cost effective but also ensures veterans receive the highest standard of Care by utilizing private sector efficiencies and philanthropic support we can significantly reduce construction timelines and costs ensuring timely delivery of quality services to those that have served our country our community has demonstrated the potential of Highly Successful public private Partnerships in veterans
▶ 0:41:26healthc care in the chip in act born in your committee this is just one example of proven success by affecting the proposed partnership in Omaha we together can set the standard for future care for those that have worn the cloth of our nation and protected our freedom I thank you for your time and look forward to your questions thank you Dr gold the chair now recognizes General bacon for three minutes to speak on his bill HR 217 thank you madam chair I appreciate the opportunity to Advocate
▶ 0:41:56on this bill B in the subcommittee and the bill is HR 217 communities helping invest through property and improvements needed for veterans act otherwise known as the chip in for veterans act this bill will make the current pilot program permanent so chairman boss has been out to our district and seen the new facility I appreciate the chairman chairwoman Miller Meeks has been out there I invite the ranking member and frankly anybody that wants to go to omahan C literally one of the most beautiful VA facilities in the country and it was done through this bill that was temporary
▶ 0:42:27that we'd like to make permanent also want to thank chairman gold for being here and Miss Sue Morris who helps manage the philanthropic operation here to make this possible the chip in for veterans act enables communities to take the lead contribute resources and complete VA construction projects on time and in a coste efficient manner benefiting taxpayers the communities and most importantly our veterans the Ambulatory Care Center in Omaha of Nebraska was the first public private partnership project for the VA now
▶ 0:42:57I'd like to get your attention on this because this is what makes this so important the VA had budgeted this for $135 million that was going to be the cost the community doing with State local financing and philanthropic Plus Federal was able to do this for $85 million so right away we save $50 million for the taxpayer it gets even better out of that $85 million $35 million came from not federal sources philanthropic state and local so in other
▶ 0:43:28words this cost went from $135 million for the VA down to approximately $50 million and this is why this bill is so so important and we can do this all over the country where folks want to donate and contribute and where States local governments want to help so since the doors open in August 2020 the Ambulatory Care Center has provided cares for 31,725 patients and over 20 261,000 visits now we want to replace the inpatient facility now
▶ 0:43:58it's and we already have approximately $100 million outside of the VA ready to invest in this facility it will be a great deal for the VA so I look forward to working with the committee to enact this legislation and with the Department of VA and the philanthropic committee to bring this to fruition another Innovative facility for the benefit of veterans across the country now you'll back thank you representative uh bacon um as is my T typical practice I'll reserve my time until all other members have had a chance to ask their questions I now recognize ranking member brownley for 5 minutes for
▶ 0:44:28any question she may have thank you madam chair uh Dr otoul um I'm disappointed that the VA is opposing my bill the VA marriage and family therapist Equity act you know VA is an outlier uh among its peers including Tri care in terms of requiring licensed marriage and family therapist to have graduated from a commission on accreditation for marriage and family therapy education program in order to be
▶ 0:44:58promoted within the VA mfts are among the occupations for which VA has been developing national standards of practice for the last several years perhaps you can reconsider this standard as part of that effort if it's still underway under the new Administration can you share any updates on the national standards of practice initiative thank you chair uh thank you congresswoman and the U National standards work is ongoing
▶ 0:45:29the intent behind that effort is to ensure that there um is minimized variance across States um in terms of accreditation and lure the VA is very supportive of um the position of marriage and family therapist we see it as an integral part of the VA our primary concern with this is that there are currently no statutory requirements for supervisor roles um in any of our title 38
▶ 0:45:59positions and our concerns with State variances um that currently exist in how those supervisorial roles are supported but we are very open and um would be happy to work with the subcommittee further to um you know further Advance this legislation in a way that would work or that our rules would work thank you for that I mean I I just believe that this kind of clinici is so critically important uh to the veteran and you know for a while we couldn't
▶ 0:46:29we didn't even accept uh marriage and family therapists now we do but in order to keep them they they have to have a road of opportunity to be promoted and I just think it's so many other states Tri care so forth does does not require this it requires another accreditation and it works pretty well so um anyway I I hope that you will continue to consider it because I think it's really really important the next question I had is um uh I wanted to
▶ 0:46:59talk a little bit about uh the V the VA and its undertaking to expand access to lock boxes and other Suicide Prevention tools for veterans um I uh you know I I I I think uh Mr Delia's bill is a good one um and I think we need to strengthen those efforts but can can you sort of expand on the lockbox distribution program that you're already providing
▶ 0:47:30thank you congresswoman and and um you know to begin we very much share the concerns about the need and essential the essential capacity of you know we have to be there to reduce veteran suicides and I can speak personally to having had patients who have died by Suicide I think all of us know sadly individuals who have family members who have friends who have died by Suicide this is a emergency currently the VA does have a lockbox
▶ 0:48:00program it began last year it's run jointly between our office of Suicide Prevention and the Prosthetics Department um to provide lock boxes for veterans identified as part of a clinical encounter in clinical screening who are determined to have um risk for suicide moderate to high risk who have access to Firearms or peripheral access to Firearms meaning a member of family uh or household um has access to firearms
▶ 0:48:30in which case they are provided a lockbox which is a proven method of trying to create space between the impulsivity of wanting to commit suicide and having access to Il lethal means um our concern with this bill is that I'm not asking about the bill I'm asking about the program and what you're doing so um I want to know uh it's my understanding uh that under the current program lock boxes have to be requested uh uh
▶ 0:49:01by their provider so how would a veteran or their provider uh know this program is available thank you ma'am we have an extensive education experience both to the veteran as well as to the provider to promote this program to both groups um to try to you know encourage its application and use okay so we know it's a a good program um you've already said that it is a good program and I
▶ 0:49:31just you know it seems to me that making sure that any veteran who wanted a lockbox should receive a lockbox because we there are many veterans out there where we might not know their situation or their vulnerability so uh I think it's important to do that and um I guess what of oh I've run out of time I yield back Madam chair thank you representative brownley the chair now recognizes representative
▶ 0:50:01Hamad for five minutes thank you chairwoman as an Army intelligence officer who served overseas I understand firsthand the obligation we have to those who wee a uniform and our veterans deserve more than gratitude they deserve action that's why I'm proud to support several of the bills before us today that will directly improve Healthcare access and quality of life for veterans all across Arizona and our country and my first question is for Dr otou the alleged budget short shortfall within the VA raise raises serious concerns about your organization's Financial
▶ 0:50:32Planning and resource allocation do you believe the VA should undergo an annual forensic audit uh thank you congressman and first I just wanted to say thank you for your service uh in the military as well as here with us today so on this particular Bill we do defer to the comproller general and what is their recommendation so um by deferring we are deferring to the comproller General on the forensic audit
▶ 0:51:02but do you believe that having a forensic audit would give confidence to Veterans and the taxpayers that their money is being spent wisely yeah do appreciate the uh question Congressman but uh we would defer to the comp troller General Dr otou the Parker Gordon Fox Suicide Prevention grant program has helped expand access to mental health care for veterans in what ways has the program been most effective and how can it be further improved to ensure veterans in crisis re receive timely mental
▶ 0:51:36healthare thank you Congressman the um this act has been uh serving our veterans very well and we support um many of the amend several of the Amendments that are in the Bill the grant program program in particular we have found very helpful and um has been uh very supportive four of the amendments in particular uh we are supportive of including the extending the duration of the
▶ 0:52:06pilot program because of its successes requiring grantees to inform individuals about their ability to receive emergency suicide care which we currently do but I think codifying it is going to be a strength um ensuring that eligible entities have provided uh mental health care and support for veterans over the excuse me Support Services in the US for the previous two years we feel strengthens it and there's some technical corrections as well we support
▶ 0:52:36the concern we have with this bill is the $500,000 cap and the $10,000 um per grantee um additional payment which we think would be difficult logistically to um manage in the context of how federal grants are currently managed uh um with providers in that in that form thank you and going off of Congressman Bacon's uh comments earlier it is a very impressive facility from what I see and I'd like to visit
▶ 0:53:06that congressman and uh my first question or third question is to Dr gold what were the biggest advantages of using the public private partnership for the Omaha Center project and how can this model be replicated across the country well thank you for asking sir and of course thank you for your service uh there are so many different advantages one was to uh of course save a lot of money and so what could have cost the VA $1 136 million ended up costing $56
▶ 0:53:37million uh out of the VA secondly was this project was finished uh uh not only exactly on budget but ahead of schedule uh which uh doesn't always happen in large Federal construction projects at least that's been my multi-decade experience but it also was able to bring to bear the experience experience that our University had uh with the being part of this small but very effective 501c3 Corporation in that we had built lots of different
▶ 0:54:07uh Health Care Facilities Ambulatory Care Centers uh C uh Ambulatory Surgery centers and many other things uh Women's Health Centers uh imaging centers Etc so being able to bring all that to bear with the Architects the engineers and with the construction contractors a lot of to accelerate the planning for the process in partnership with a local VA and deliver it on time uh and on budget a truly truly impressive project it is a beautiful
▶ 0:54:37facility an award-winning facility on time and under budget it's a pretty rare for the federal government I yield back like $85 million budget thank you very much representative Hamad the chair now recognizes representative Sheriff Liss McCormack for five minutes thank you so much I would first like to say thank you to our panelists for testifying today and for your dedication and service Dr otou representative Garcia's women veterans Cancer Care coordination act
▶ 0:55:07identifies the difficulties veterans face in navigating transitions to and from community care for instance I've heard of cases where medical records from Community providers took weeks to return delaying crucial treatment and causing unnecessary stress for the veterans and their families no veterans should navigate their battle with cancer alone Dr UL do you have does Dr otou do VA hospitals need dedicated Community Care coordinators teams
▶ 0:55:38to help veterans navigate and keep contractors accountable thank you congresswoman and first uh we agree with you absolutely no no veteran no person should have to navigate the management of cancer by themselves and we strongly support the role of care coordinators um in helping them both navigate the care within the VA and navigating the care in the community what is the impact to the veterans care when there is not a
▶ 0:56:08seamless through line between Community Care and the VA the biggest challenge congresswoman I think as we would all acknowledge is the concern about care following through the cracks not being communicated well um to different provider providers who are involved in that care for the veteran uh not knowing what was going on with their care and these are things that nobody should have to experience in their um care Journey
▶ 0:56:38Dr my second question um having a regional breast and gynecological Cancer Care coordinator for each VN has the potential to save many lives if representative Garcia's bill would it become law however I have deep concerns that Doge may work to stop this position from being being in existence over the weekend the New York Times uncovered a horrifying consequence of Doge's indiscriminate Workforce cuts the VA hospital employees responsible for enrolling veterans with throat
▶ 0:57:08cancer in an NIH clinical trial was fired as a result the clinical trial was put on hold and Veterans with cancer were left without access to potential life-saving medication Dr gold should we exempt clinical trial coordinators and the coordinator position is established by the women veterans Cancer Care coordination act from Do's firing well there is no question that access to clinical trials uh is is lifes saving particularly
▶ 0:57:38in cancer but also in endstage congestive heart failure uh in neurod degenerate diseases and so many others and our veterans should be afforded the very best quality care that our nation can provide which means they need to have access to all of those trials in order to do that we must have uh qualified Personnel uh to enroll and to perform those trials and to monitor them so you would recommend recommend expanding the exemption to other areas and other
▶ 0:58:08positions also again the access to clinical trials is absolutely state-of-the-art uh and it needs to be available to all in our nation do you believe VA has va's plan to lay off 83,000 workers will help facilitate veterans access to Cancer Care I know that the Staffing of any medical center large or small is is what makes it work the buildings are beautiful the coffee shops are important but at the end of the day it's the doctors the nurses the pharmacists
▶ 0:58:39the therapists that make it all work and I also know that you need a critical mass of that Workforce to make it successful so is that a yes or a no mind repeating your question do you believe that va's plan to lay off 83,000 workers will help facilitate the va's access to Cancer Care without understanding the details of which 83,000 workers would be laid off it's difficult to give you a specific answer but anything that materially reduces the workforce will materially
▶ 0:59:09reduce access to care and quality of care so I'll take that as a yes um well thank you I'd like to note that the VA research has led to the best treatment in the world when it comes to Prosthetics spinal cord injuries and TBI in addition VA researchers also brought use of a pacemaker nicotine patches and aspirin as a method to preventing heart attacks attacks on these Healthcare researchers and the VA affects every veteran in America not just the veterans who are presently receiving Care
▶ 0:59:40thank you so much for your time and I yield back thank you very much representative sheres McCormack the chair now recognizes representative King Hines for five minutes thank you madam chair my my question is to Dr UL I come from the the territory and and I just wanted to get your thoughts given that the Parker Gordon Fox Suicide Prevention grant program is designed to reach veterans who may not necessarily be engaged with the VA how is the program ensuring
▶ 1:00:10that the resources are effectively reaching veterans in remote or underserved areas such as US US territories like the cnmi thank you congresswoman and that's obvious VI ly of great importance I think the um intent and design of the grantee process is critical to that to ensuring and both Al also our monitoring of grantees
▶ 1:00:40to ensure that that is appropriately managed and distributed to um every veteran no matter where they live so okay then um so in addition to that question what strategies are in place to support community- based organiz ations in these areas that may lack the infrastructure or capacity to apply for and manage these grants effectively so that we um do meet the mission of serving our veterans especially in underserved remote areas
▶ 1:01:11thank you m I'd have to take the specifics of that response on the record and defer to our subject matter experts in that program um it's something though we fully agree with in terms of its importance thank you I I appreciate that I my time Madam chair thank you very um much representative King Hines the chair now recognizes Dr Dexter for five minutes thank you chairwoman Miller Meeks
▶ 1:01:41and thank you to our Witnesses for being here today and for your service to our veterans and although I'm very grateful for the opportunity to consider this legislation before us today I have to State the obvious we are proceeding with business as usual when nothing about what is happening in the world is business as usual in a matter of hours everyone on this dis will leave this room to vote on legislation put forth by my Republican colleagues to cut nearly $23 billion in advanced funding to ensure we can care for our veterans exposed
▶ 1:02:12to toxic chemicals in the line of duty and if that weren't bad enough that vote comes just days after we found out that Trump's team will fire an additional 83,000 VA workers on top of the 2400 they have already stripped of their jobs and return us to the Staffing levels we saw before implementation of the PCT act the biggest expansion of veterans benefits in Generations make no mistake these firings is are as good as a cut for veterans without those dedicated workers
▶ 1:02:42our veterans will absolutely have trouble accessing the care and benefits they have earned waiting longer for their claims to be processed or Worse not being able to access new benefits at all look I built a track record at the state level for being being able to reach across the aisle I absolutely want to get things done but several of the bills before us and several of the bills before us are good policy whether it's ensuring veterans have access to essential medicines regardless of where they're cared for improving care coordination for women veterans
▶ 1:03:12or advancing costeff effective gun safety measures but I have serious doubts about our ability to implement any of these policies if the VA doesn't have the Staffing or the funding that it needs I spent much of my Prof career practicing as a physician at Kaiser Permanente in Oregon and served first as a board member and then as chair of the board so I understand intimately the challenges of running a large medical system so I simply have a I have a simple question for you I hope Dr o tool
▶ 1:03:42um first would it make it easier or harder to implement a new initiative at the VA if it were uncertain that the VA would be provided with the funding required to do so thank you congresswoman and um excuse me I'm trying to fully I guess understand the question obviously any bill that comes through it helps to have the authorizations associated with that bill to be able to implement it okay thank you and would it make it easier or harder
▶ 1:04:13to implement a new initiative at the VA if there were no staff to do so thank you congresswoman and again um you know I think in I'm not uh I would have to take for the record specifics related to um you know current issues related to Staffing and the Staffing um uh proposals underway uh I think in general though I think the state that your question is rather self obvious though thank you
▶ 1:04:43and following up on um my colleague's questions regarding care coordination um do you have objective reasons to believe that care coordination within the vamc especially around Cancer Care is superior to care outside coordination with our community care um systems I I would need to defer to our subject matter experts who have spent you know many of them have spent their careers studying
▶ 1:05:13differences in quality between the VA and Care outside the VA I've been very proud to be a clinician in the VA system and very proud of the care that we provide and the outcomes we provide you know is is not to say we could never do better we always can um I think the role of a care of care coordination particularly in complex care that involves multiple providers it's been well proven to be an important element of that care I absolutely agree with you having had access to care coordinators throughout
▶ 1:05:43my practice as well on lung cancer treatment I'm going to ask Madam chair um if we can submit some um studies for the record looking at the comparison of outside versus inside care one of which is um um titled VA delivered or VA purchase care important factors for veterans navigating care decisions no objection thank you um I just urge my colleagues to keep in mind the importance of this legislation I certainly appreciate um the work that folks are doing but that we can't expect better
▶ 1:06:14care when we got the system that has to deliver it and with that I yield back Madam chair thank you very much Dr Dexter the chair now recognizes Dr Conway for five minutes I thank you madam uh chair and thank you uh um thanks to our Witnesses for presenting themselves uh to us today and offering information on the bills at hand um Mr OU uh this question is I think directed at you you're taking most of the
▶ 1:06:44incoming now it seems but in the last Congress um the no wrongdoer Act was introduced to demonstrate improvements in veterans mental health a very critical issue we're seeing uh said the number of suicides among that cohort going up the updated version has changed that requirement that now grantees must show that funds are being used to assist a significant number of veterans so my concern is that went from showing that there you have good outcomes to showing that you
▶ 1:07:14have quote unquote significant numbers of veterans who are receiving assistance and so the the question is what does significant mean in that context how do we measure it when when do people meet the bar thank you sir and and that reflects similar concerns that we have to the construct of this bill um absolutely these pilot programs have made a difference and um we are strong supporters of them um
▶ 1:07:44the bill is drafted in changing from the $750,000 grant amount to 500,000 with an additional 10,000 per um individual served we feel would create challenges and Logistics to um both how the grant would be administered um but also challenges to how we' how we would be assessing uh performance of those grants you know we we stand very much in support of this legislation and the intent of
▶ 1:08:14it but you know I think we share the subcommittee's concerns and try to make sure we have the best Bill going forward I agree with you the effort is more than worthwhile considering what we're seeing among of the veterans community and indeed mental health more broadly but certainly would have a a particular um uh need and Duty uh to provide that care uh to those who've given so much to our country uh next I want to address HR 1336 the veterans National traumatic brain injury treatment act uh this bill aims
▶ 1:08:44to direct the Secretary of Veterans Affairs to establish a pilot program to provide hyperbar baric oxygen therapy to Veterans suffering from traumatic brain injuries or post-traumatic stress disorder and indeed we seen studies in the traumatic brain injury space which suggests uh that the use of hyperbaric oxygen therapy um uh would be really quite beneficial um and so um VA conducted its own study um and um it which showed uh you know great promise
▶ 1:09:15um does the VA have any reservations regarding this pilot program and the potential impact of this therapy on Veterans thank you than you thank you for your question VA shares your concerns mental health and suicide preventions are huge priorities for VA we do not support this bill our VA subject matter experts are continuously reviewing scientific literature and updating and Publishing our clinical practice guidelines published results of the scientific rigorous research
▶ 1:09:46that has been done by VA and DOD repeatedly have shown the hyperbaric oxygen therapy has the same impact as Placebo what's that if you would speak into the could be very helpful published studies there you go published results of the scientifically rigorous uh research that has been done by both VA and DOD has shown repeatedly the hyperbaric oxygen therapy has the same impact as Placebo there's no scientific basis to support the use of hyperbaric oxygen therapy for PTSD and there a strong scientific
▶ 1:10:16basis that hyperbaric oxygen therapy is not recommended for traumatic brain injury um that uh we're looking at a study here on our desk that would suggest otherwise it is an NIH study and certainly you we do want to look at the prance of evidence across multiple studies that are done hopefully uh according to the most rigorous uh standards um could you um could you therefore if you don't like the hyperbaric oxygen um U as a treatment uh could you
▶ 1:10:46or suggest that alternative therapies um um that alternative therapies that we're perhaps not using now that to be deployed to deal with these important conditions thank you yes uh as I mentioned our subject matter experts are continuously reviewing scientific literature I'd be happy to provide you a review of other alternate therapies that we are uh currently considering great thank you madam chair thank you Dr uh Conway I now recognize uh General bacon
▶ 1:11:16for five minutes for any questions he may have thank you madam chair for the opportunity to be part of your subcommittee today I'd like to follow up with h president gold and some of his comments on the numbers because I think they're worthy of repeating what he said is that the VA we saved the VA or the federal government approximately $80 million what was going to cost the VA 135 million ended up costing the federal government 56 million I think I got the numbers that you said right uh there Chancellor or
▶ 1:11:47president gold could you lay out what do can we expect for the inpatient Hospital rough numbers like what is it what does the federal government or the VA think it's going to cost versus what we could probably build it at versus how much State local and philanthropic money we may get we just I want to show the benefit of this for for a future facility Well it a lot would depend uh on first of all it's a great question one we've tried to deal with as best as possible a lot would depend
▶ 1:12:17upon how much shared services we're talking about certainly replacing uh inpatient Med surge critical care and other space uh would be uh essentially uh at the standard construction rates for uh large academic medical centers high quality academic medical centers however the lot of the cost of construction uh and health care now really is not on the inpatient bed space but it's in the extremely expensive Diagnostics procedural Interventional space
▶ 1:12:47biplan fluoroscopy for instance some of the modern uh laparoscopic and endoscopic operating rooms uh Etc even in the Opthalmology world the equipment has gotten incredibly expensive with the operating microscopes and things like that so the extent that some of that space could be shared some of the clinical and anatomic pathology space some of the uh uh diagnostic space some of the even some of the outpatient space that would be need to be connected shared parking shared
▶ 1:13:18Logistics and infrastructure I mean right now the project is on the VA construction list as I believe number two prior priority for uh 2029 at if I'm correct at at $1.56 billion and I would venture to say that we could probably save the federal government if we did this in a shared fashion and shared these types of resources I bet you we could shave a half a billion dollars to the taxpayers that's what I was waiting to
▶ 1:13:48hear well the savings right there how much is saved if I may ask our VA representatives and I'll defer to which one could you talk about what this chip in bill has done what it means to you love to get your your perspective on this thank you congressman and and I think we're adding to the chorus VA supports this bill as you know we were authorized as part of the pilot um for up to five projects uh two um have uh been undertaken one
▶ 1:14:18completed in Omaha as you've heard in a hospital in Oklahoma is currently under construction we do support this legisl with that Madam chair I yield back uh thank you very much General bacon I now yield myself uh five minutes um I'm going to follow up on something Dr gold said which is uh carrying the public private partnership even Beyond I.E sharing facilities especially those expensive facil facilities and sharing parking and some people may
▶ 1:14:48be a gas at that but Dr otoul uh don't many VA uh hospitals aren't they staffed by people that have dual appointment between a medical center and a VA Center thank you Congressman Yes actually we have a very deep academic um partnership and footprint um and particularly in our level 1 a 1B and C facilities and I would note that 70% of doctors practicing in the United States all went through a veteran hospital as part of their training uh as did
▶ 1:15:18I uh Dr gold the Omaha VA Ambulatory Care Center was completed a year ahead of schedule and over $40 million under budget thanks to the chip-in uh for veterans pilot program how did the va's chip-in uh authorities Foster such a successful public private partnership uh thank you uh for the question uh it uh I think one of the biggest advantages uh that we shared was that we were able to plan this the way we would plan uh a
▶ 1:15:49commercial large academic medical center clinic and then deliver it on a schedule that we would normally do it over my decade of leadership at the University of Nebraska Medical Center we've done over a billion dollars of uh healthc care and academic uh construction and have never exceeded the budget and and have really never exceeded the timeline I mean the construction standards are absolutely critical because of the penalties associated with going over budget and going uh over timeline and anybody that has been
▶ 1:16:19involved with large academic medical centers understands that that time is money uh for all of these types of projects and that type of precision uh was used uh through the 501c3 and you'll hear from sumar in a little bit about how that actually worked but that type of precision was used in a very very careful way to be sure we delivered this project thank you and it's one of the reasons we're hoping to make this permanent and for those who are interested there's a pamphlet here that shows uh that uh Clinic it's quite outstanding
▶ 1:16:50Dr OU the Parker Gordon Fox Suicide Prevention Grant has made tremendous progress Us in connecting veterans with timely mental health care in their communities why is it vital that we quickly reauthorize the program Excuse me while I catch up to my notes here on this the um thank you and and yes we fully endorse the importance of this um my understanding is that the
▶ 1:17:20uh concern is obviously being able to um reauthorize it before the pilot project expires uh which my understanding is September 30th 2028 and we strongly endorse this legislation um as an important Armament in our effort to reduce veteran suicide so we thank Congress definitely for all of your work and support on this effort and then uh again Dr atou the start act would ensure Community Care referrals remain valid through the veterans standard
▶ 1:17:50episode of care um would this help veterans receive all the Care that the VA has determined necessary we think so Ma and I think this is an important element where this legislation will help the VA um practice to its policy obviously our our intent is obviously ensuring that it's not just the episode of care uh or the uh first appointment but rather the episode of care which can be up to one year and renewable beyond that and more importantly it's about helping the VA I think
▶ 1:18:21you know Shore up its practices to ensure that we are doing a better job job of ensuring that that is actually what we are practicing to and I think Dr gold you were asked a question that may be difficult for you to answer it was in uh uh letting people go and managing a very large Health Care Facility uh let me just say that um if you were given an increase in your budget by 126 billion over a 4-year period and over that same past four years you had an increase
▶ 1:18:51in full-time employees of 60,000 and part-time employees for 23,000 and you were looking at 880,000 employees uh exempting hiring of nurses and doctors would you consider that gutting a program I guess it would depend on the role of those individuals uh you know having been a pediatric heart surgeon for over two decades of my life uh it's not just the person that stands at the operating room or Over The Ether screen but it's the person that mops the floors
▶ 1:19:21and stocks the supply cabinets and uh and does so much else uh within our system so so you would need to know what those positions are thank you so much with that I yield back I'm going to ask if we would have our um on on behalf of the subcommittee I want to thank all of uh our Witnesses for their testimony and joining us you're now excused we're going to wait a moment while the second panel comes to the witness
▶ 1:19:53table e
▶ 1:20:43welcome everyone and I thank you for your participation today on our second panel we have Miss Su moris president and CEO of veterans trust Mr Brian Dempsey director of government Affairs for Wounded Warrior Project project Dr Andrew kosminsky medical director of Hyperbaric medicine for the University of Iowa Healthcare Mr Ed Harry's president of the National Association of State veterans homes and uh John retzer Deputy National legislative director for health Disabled American Veterans Miss Morris you're now recognized for five
▶ 1:21:14minutes good afternoon chairman Miller minks ranking member brownley and members of the health subcommittee my name is Sue Morris I am the President of veterans trust the nonprofit philanthropic entity that partnered with the Department of Veterans Affairs under the Chipen act to construct va's Ambulatory Care Center in Omaha Nebraska serving western Nebraska Western Iowa and Nebraska our nationally award-winning Ambulatory Care Center project was completed and donated to Veterans
▶ 1:21:44Affairs in July 2020 as the first public private partnership to be completed under the chip in act the project received several national awards for healthcare design and construction I'm here today to speak in favor of taking the pilot program authorized under the chip in act and making it permanent as HR 217 would do our project showed how VA in partnership with the private sector delivered a truly superb facility in a cost effective and efficient manner
▶ 1:22:15what allowed the Omaha project to be successful first the project was owned by veterans trust during the Development and Construction phases and then donated to Veterans Affairs upon completion while there was very close coordination and cooperation between veterans trust and VA officials at both the national and local levels it was not a government construction project this structure allowed veterans trust whose leadership had a history of facilitating over a billion dollars on local
▶ 1:22:45projects to use local vendors and suppliers in its procurement of services and materials leveraging demonstrated relationships for best pricing we were able to tell our partners in design and construction that they will make money on the project but not a lot of money as this is a community project to serve our veterans second was a strong commitment from Veterans Affairs senior leadership we met regularly at VA headquarters including three meetings
▶ 1:23:15directly with the secretary to ensure project Milestones were achieved there was Zero scope creep which helped the project to be delivered on time and on budget one key factor in this regard was Veterans Affairs willingness to review va's normally normally applicable construction and physical security standards we were able to come to agreement on which of those standards made sense resulting in value engineered Savings of $23 million
▶ 1:23:46in the end we delivered a facility for a total of $86 million when it was originally budgeted at 135 million saving thex taxpayers $50 million in addition the private philanthropic cont contribution to the project was3 million based upon our experience and success with this effort we recommend that HR 217 go further than simply making chip in permanent to also to consider other changes in particular we suggest the following
▶ 1:24:16add the option to construct facilities on land lease to VA not just owned or donated real property add the ability to use a program for minor construction not just major projects and make clear that the ACT applies to more than just health care but also to construction projects providing other types of facilities to Veterans such as Housing and Community centers in amending to the act itself we suggest the subcommittee and staff engage a small group of va leadership
▶ 1:24:47and private sector representatives to recommend forward-looking best practices and new models for public private Partnerships my team and board would be pleased to be included in this effort in summary we wholeheartedly support the effort to make chip in a permanent tool to deliver state-of-the-art facilities the ACT allows Veterans Affairs the ability to leverage advantages of private sector construction processes to deliver significant cost savings we are tremendously
▶ 1:25:17proud of our role in helping lead in this effort to deliver a worldclass facility to our veterans and cost savings to our taxpayers I want to add one final Point as Dr gold mentioned there is no doubt that a new inpatient facility to replace Omaha's aging VA hospital is sorely needed as in in other cities veterans trust stands ready to partment with Veterans Affairs and the University of Nebraska Medical Center to assist in developing a new state-of-the-art inpatient facility
▶ 1:25:47that will better serve the veteran Community I'm happy to serve answer any questions that you might have thank you for including me today thank you Mr dimsey you're now recognized for five minutes chairwoman Miller Meeks ranking member brownley and distinguished Health subcommittee members thank you for inviting Wounded Warrior Project to testify in legislation intended to improve va's ability to provide better access to care and ensure Better Health outcomes for our nation's veterans over 20 years ago
▶ 1:26:18when the first wounded service members returned from the battlefields of Iraq and Afghanistan the founders of our organization made a promise to be there for these Warriors No Matter What in the years since our organization has grown to provide more than a dozen programs and services to more than 227,000 veterans and service members and our reach continues to grow by the day these programs and the relationships we've built with Warriors along the way are what inform our advocacy before Congress today I'm pleased to speak on three bills from the agenda
▶ 1:26:48that we believe will have the biggest impact on those we serve first we strongly support the veterans sport act this bill would amend va's legal definition of medical services to clarify that the agency's existing ability to provide artificial limbs includes the authority to provide adaptive prosthesis and terminal devices for sports and other recreational activities if you're un familiar with what an Adaptive prosthesis or terminal device is think of the curved shaped blades you might see on someone who has lost a lower limb or a
▶ 1:27:18waterproof fin that allows someone with an upper body prosthetic to swim in a pool now think about stress relief you may know from running the community you found playing in a local softball league or the body transformation you may have seen from lifting heavy weights participating in activities like these should be simple but for veterans who use VA for prosthesis it can be a challenge under current law and stated as simply as possible veterans often struggle to get this kind of prosthetic support if they are not actively pursuing a rehabilitation plan even
▶ 1:27:48if they've completed one in the past and are very familiar with what they need to do what they want va's Reg ulations focus on the clinical need for adaptive Prosthetics but disregard their potential to improve a veterans quality of life and if a clinical need can't be found providers can't offer the equipment the veteran sport act would help these veterans by effectively removing the requirement that they be enrolled in a VA rehab VA rehabilitative program in order to receive the Adaptive prosthetics for sports and recreation
▶ 1:28:18the current population of post 911 veterans is Young mobile and energetic we believe that VA should be building an ecosystem of care that encourages an active lifestyle and makes it easier to experience the profound health benefits both mental and physical provided by Sports and other activities second we support efforts to renew the staff sergeant Parker Gordon Fox Suicide Prevention Grant pilot program including the no wrong door for veterans act our organization's approach to Mental Health Care
▶ 1:28:48appreciates that no one organization and no single agency can fully meet all veterans needs evidence-based mental health treatment absolutely works when available and when pursued but the best results will be found by incorporating a public health approach focused on increasing resilience and psychological well-being this kind of Suicide Prevention strategy Embraces Upstream prevention efforts like helping with case management peer support Outreach and establishing Financial Wellness all of which are recognized as Suicide Prevention Services
▶ 1:29:19Under the fox Grant pilot program in each year since the fox Grant pilot was launched VA has discussed it as a key Initiative for helping prevent suicide in its National Suicide data report previous Congressional oversight and legislative hearings have revealed that the pilot program is not perfect but we appreciate efforts like the no wrong door act that would continue to refine the Pilot's operation and Foster Community collaboration in ways tailored to local needs we hope that this legislation can be prioritized as a vehicle for bipartisan
▶ 1:29:49bamal action to renew this program in time to disperse grants in fiscal year 2025 third and finally we support the protecting veteran access to Tele medicine services act this legislation would extend a covid-19 era waiver from a law that requires patients to complete at least one in-person visit with a healthcare provider before that provider can prescribe them a controlled substance if the waiver expires as planned in December 2025 rural veterans who do not live near VA or Community Health
▶ 1:30:20Care facilities and who rely primarily on teleah Health Services would likely be negatively impacted appointment coordination challenges and travel Logistics may lead to interruptions in their care or lapses in prescriptions the list of Controlled Substances contains not only pain medications but also multiple mental health drugs that are important parts of treatment plans for many veterans dealing with mental health issues and for whom an in-person appointment May present additional challenges members of the committee is my distinct honor to be here on behalf of Wounded Warrior Project to speak to the
▶ 1:30:50needs of our nation's Wounded Warriors and their families thank you for letting us do our part to keep the promise this concludes my testimony and I look forward to your questions thank you Dr ksky you're now recognized for minutes good afternoon chairwoman Dr Miller Meeks and ranking member brownley and members of the subcommittee thank you for inviting me to participate in this hearing to discuss HR 1336 the veterans National traumatic brain injury treatment act I'm Dr Andrew ksky an
▶ 1:31:20emergency medicine physician with a specialization in undersee and hyper aric medicine I am the current medical director for Hyperbaric medicine at University of Iowa Healthcare and medical director for the UHC wound center this legislation aims to improve the health of our veterans establishing a pilot program for the implementation of hyperbaric oxygen therapy for veterans with traumatic brain injury or post-traumatic stress disorder as an emergency medicine physician I have cared for numerous veterin suffering from tbis and PTSD
▶ 1:31:50with my experience in Hyperbaric medicine I think the implementation of hyperbaric oxygen for these ailments would be uncomplicated veterans already use this therapy through their VA insurance for currently improved HBO indications consequently HBO hyperbaric oxygen has proven its safety after many decades of use by the medical community for these reasons this legislation has potential to help improve the lives of our friends families and neighbors I want to comment on the potential
▶ 1:32:21for an increased likelihood of oxygen toxicity seizures in this patient population as 1 in 50 TBI patients develop post-traumatic epilepsy however an oxygen toxicity seizure is a complication that trained Hyperbaric medicine professionals are well versed in how to manage and should be able to ensure continued patient safety throughout a treatment course clinical trials I will mention even even utilize a protective pressure of 1.5 ATA which
▶ 1:32:51should reduce the likelihood of this complication however this is an important reason to create a pilot program through the VA health system as this would provide a safe option for patients seeking treatment for what is currently an off Lael indication without this program desperate patients may find themselves at the mercy of popular Health Spas businesses that might not have adequately trained staff may use incorrect treatment profiles and at times pose serious
▶ 1:33:21risk to their patients for their clients the research that investigators in my field have completed on the utility of HBO for TBI and PTSD shows promise for improving Health outcomes in these patient patient populations for chronic TBI cases HBO has been found to improve cellular metabolism reduce cell death and oxidative stress and enhance mitochondrial function these mechanisms aim to promote neuronal repair and regeneration the brain injury and mechanism of action
▶ 1:33:52Bea trial published in 2016 demonstrated improved postconcussive symptoms PTSD cognitive processing speed Sleep Quality and balance function by 13 weeks after 40 60-minute HBO sessions at 1.5 ATA unfortunately these improvements did not persist beyond that six-month follow-up in February 2025 however just last month Dr Lindell Weaver a leader in my field and his team published their most recent
▶ 1:34:22study a double blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury this study showed similar results to what was observed in the beam a trial for both sham and HBO groups at 13 weeks with the HBO treatment group maintaining the Neuropsychiatric benefits at 6 months a second phase within the trial offered another 40 HBO sessions to all participants at final follow-up 3 months after the last of the second round of HBO treatments were given patients
▶ 1:34:52who received 80 HBO treatments had greater Neuropsychiatric Improvement compared to their results after 40 sessions the patients who received a maximum of 40 treatments also showed Neuropsychiatric improvements compared to their Baseline scores but less Improvement than their current than their counterparts who received 80 treatments in conclusion I find the outcomes of these trials these clinical trials to be promising establishing a pilot program for the VA to offer HBO
▶ 1:35:22therapy for veterans with tbis and PTSD could help improve these patients quality of life provide access to Safe Healthcare environments in which to receive these treatments and continue to build Insight on how best to construct and administer treatment courses in the future thank you recognize for five minutes members of the subcommittee as
▶ 1:35:52president of the National Association of State veterans homes thank you for the opportunity to testify today and offer our strong support for the providing veterans essential medications act this legislation would remove an inequity in the law concerning high-cost medications for veterans that are preventing many of them from living in state veterans homes as you know State veterans homes are not able to receive reimbursement from the VA for high cost medications provided to seriously disabled veterans
▶ 1:36:23each even though private nursing homes that contract with the VA can as a result many state homes are losing hundreds of thousands of dollars every year that could be used to improve the lives of aging and disabled veterans for example at the Iowa State veterans home they are caring for a 55-year-old service connected Air Force veteran who suffers from Crohn's disease fortunately a drug called stara can help control his symptoms however this medication
▶ 1:36:53costs about $20,000 a month which is more than the full cost of care prevailing rate the VA pays the home despite the financial burden the Iowa State home decided to care for this veteran at a significant operating loss however that likely means that they will have to cut costs elsewhere perhaps admitting fewer veterans spouses or gold star parents or maybe cutting back on social recreational or other non-clinical services
▶ 1:37:23the same situation is occurring at State veterans homes across the country at an Idaho State Veterans Home a 63-year-old service connected Army veteran was receiving a medication called dapa for Parkinson's Disease which costs the home at $6,000 a month the prevailing rate for Idaho uh that Idaho receives for this veteran does not fully cost the care of this one medication let alone the cost of all the other care provided un
▶ 1:37:53fortunately due to the financial strain from the high- cost medication some State homes can only afford to uh care for a limited number of such veterans with these uh medications for example a 76-year old 100% service connected Air Force veteran living in a VA contracted Community Nursing Home in Idaho was taking a special medication called promacta the cost of that was $188,000 a month the VA was providing this medication to the
▶ 1:38:24spouse uh who took it to the private nursing home where they would administer it to him although the private nursing home was receiving a prevailing rate for the full cost of care just like the state homes do their contract included a provision for them to receive or be reimbursed for these high cost medications the veteran wanted to move to the state veterans home and his spouse asked if he could if she could continue to pick up the medication and bring it to the home the VA told her by law they could not allow it effectively denying this veteran the ability
▶ 1:38:54to live in estate veterans homes which was his choice there are also cases where this inequity and the law is literally throwing away money that could be used to improve the care of veterans in Wisconsin a 76-year-old 100% service connected veteran a marine Sharpshooter was admitted to the state veterans homes while receiving chemotherapy medication free of charge through an aelis patient assistance program after the veteran moved to the state Veterans Home his wife brought the medication so that it could be ad ministered
▶ 1:39:24uh to him however according to the va's rules they could not use the free medication the facility itself incurred a cost of 12 $122,000 Wisconsin also had a service connected Army veteran living in one of their homes who was prescribed a chemotherapy drug by his VA oncologist which was shipped directly from the VA pharmacy to the state home when the medication arrived the VA contact or the the home contacted the VA and knew that it could not utilize this because they had not
▶ 1:39:54purchased purchased it themselves under the program when inquiring how to avoid wasting a $20,000 medication the VA told them it could not be returned even though it was in its original sealed packaging and to dispose it Madame chairwoman the providing essential or beh uh providing veterans essential medication act would require VA to furnish and reimburse State veterans officer these high cost just like they are doing
▶ 1:40:24for the private homes this would ensure that the veterans who choose where they want to spend their Twilight years without illogical statutes and regulations limiting their choices that concludes my statement and I'd be pleased to answer any questions that you or the members of the subcommittee may have Mr reder you're now recogniz thank you Mr rer you're now recognize for five minutes chairwoman Miller Meeks ranking member brownley and members of the subcommittee thank you for inviting DAV to test ify at today's legislative hearing
▶ 1:40:55DV is pleased to support the following bills the sport act seeks to include adaptive prosthesis terminal devices for sports and other recreational activities in the medical services provided to eligible Veterans of the VA DV has long recognized and continues to support the importance of adaptive Sports through our involvement with the national disabled veterans winter sports and golf clinics which helps veterans improve their physical and mental health by overcoming limitations and challenge their
▶ 1:41:26disabilities the saving our veterans lives act aims to tackle the devastating issue of Veteran suici suicide by providing secure firearm storage Firearms are involved in nearly 72% of Veteran suicides and offering lock boxes creates time and space reducing access to lethal means during moments of Crisis allowing vet reconsider their actions and seek help the marriage and family therapist qualification and veterans Health Administration act aims to ensure that veterans receive
▶ 1:41:56care for high qualified marriage and family therapists through effective supervision and improved therapeutic practices incorporating family and relationships into mental health treatment can result in more effective outcomes reinforcing coping strategies and provide a sense of belonging and stability the protecting veterans access to Tele medicine Service Act would ensure veterans can access control medications and consultations
▶ 1:42:26remotely enabling convenience scheduling and thus improving treatment adherence and health outcomes it breaks down barriers such as distance Mobility challenges and transportation limitations particularly for those in undeserved areas the women veterans Cancer Care coordination act aims to ensure that women veterans diagnosed with breast and gynecological Cancers receive seamless and tailored support through Regional care coordinators this
▶ 1:42:56would ensure veterans receive timely and appropriate care the start act aims to streamline the referral process for veterans receiving Community Care ensuring smoother Transitions and reducing administrative barriers by establishing a clear referral period it would ensure better care coordination the providing veterans essential medication act aims to address a financial burdens faced by state veterans homes ensuring veterans have access to high cost
▶ 1:43:27medications without added strain to the facilities the bill guarantees Continued highquality Care for veterans and long-term care reflecting our commitment to their well-being the co-pay fairness for veterans act aims to eliminate the co-payments for medications and prevented Health Services provided by the VA removing Financial barriers will encourage routine checkups and screenings leading to better overall health management and few emergency
▶ 1:43:59situations we commend the thoughtful intent beyond the next two bills and encourage incorporating our recommendations to enhance their effectiveness the no wrong door for veterans act reauthorizing and extending the staff sergeant Gordon Fox grant program providing ongoing support for community-based mental health services to enhance its impact daav recommends reiterating the importance of the original requirement ments of Baseline mental health screening using validating tools and measuring the effectiveness of Suicide
▶ 1:44:29Prevention Services with pre and post evaluations furthermore funding criteria should focus on improvements in veterans well-being rather than the number of participants served and payment structure should be clearly defined to avoid overcompensation for minimal Services an annual renewal process is recommended until comprehensive data confirms the program's efficacy and identifies the most effective services in reducing suicide
▶ 1:44:59risk among veterans the veterans National traumatic brain injury treatment act aims to establish a pilot program to provide hyperbaric oxygen therapy for veterans whose PTSD and TBI symptoms have not responded to traditional therapies while initial research shows promise researchers suggest further rigorous studies are necessary to validate its efficacy and saf DV recommends amending the bill to prioritize research along treatment access to ensure
▶ 1:45:29veterans receive care that is both effective and evidence-based in conclusion these legislative bills represent a comprehensive approach to addressing the Urgent needs of our veterans to receive the services and health care that they have earned this concludes my testimony on behalf of DAV and I'm pleased to answer questions you the subcommittee may have thank you very much ranking member brownley you're now recogniz for 5 minutes thank you madam chair uh Mr reder thank you for your um testimony and I certainly
▶ 1:46:00appreciate uh dav's support of the VA marriage and family therapists Equity act uh as well as your support for the women veterans Cancer Care coordination act which I'm co-leading with uh representative Garcia um on the Cancer Care coordination bill can you sort of elaborate a little bit more I know you you you did somewhat in your testimony but can can you elaborate a little bit more on why this legislation would be beneficial especially in the light of previous previously enacted
▶ 1:46:30legislation like the mammo act which expanded veterans access to highquality uh breast Imaging services and the Service Act and the pact act which expanded access to screening and made breast cancer a presumptive condition for veterans who were exposed to toxins during their military service this bill is very important to us on a couple different facets as in our written testimony we outline the importance for our women veterans to get Specialized
▶ 1:47:00Care that coordination care is so important in the challenges that VA has with addressing women veterans special needs uh especially when we look at for example breast cancer prevention we need to ensure that VA being that their infrastructure is not built to sustain all women veterans care at every VA facility we rely on Partnerships and affili to be able to supply the technical and lab work requirements plus the CL clinical Specialists that are out there to provide that care
▶ 1:47:31another thing that we saw that was really meaningful in this uh bill with regards to the care coordinators is the impact it has with honoring our pact act now that we have found that male veterans who have been exposed to toxic exposures can also be unfortunately suffering from the same illness of breast cancer we feel that this piece of legislation will open up the door to developing good care coordin not only for our women veterans who suffer with breast cancer but also for our male veterans who have exposed to toxic exposures so we feel it's very important
▶ 1:48:01with these research and the clinical finds that they work with thank you for that and speaking of the PCT act I mean I I have to ask you with uh 83,000 uh uh folks being laid off or fired in the VA and significant cuts to the packed act what impacts I think it's 23 billion um um cuts to the packed act what what are the implications of that well we are hoping for that the administration and VA and Congress
▶ 1:48:31itself work together in a bipartisan manner to ensure that these bills and they are very thoughtful bills continue to strengthen the VA system and that's the infrastructure Staffing and needs thank you Dr uh kensky um in your testimony you briefly discussed the importance of sufficient training and strict safety standards and the potential risks uh faced by patients who are seeking hyperbaric oxygen treatment for off
▶ 1:49:02for off label indications like TBI and PTSD at Health Spas um you also mentioned the recent tragic explosion of Hyperbaric hyperbaric chamber at a facility in Michigan which killed a 5-year-old child uh Dr Murphy's legislation HR uh 1336 does not seem to include any limitations or guard rails on which types of providers veterans
▶ 1:49:32with TBI or PTSD could receive treatment from under under this proposed pilot program do you think we should consider amending it to include safeguards such as ensuring uh that veterans would go to institutions that that have been accredited by the undersea and hyperic Medical Society or body and would you would you recommend other safeguards the bill literally is like two pages maybe two and a half pages and it's it's just about
▶ 1:50:02funding and having the program and starting the program but no safeguards whatsoever um I frankly I I mean I do agree that it would be best to make sure that whatever treatment they receive whatever veterans receive is done at an accredited facility um so amending the bill for that would be probably best for patient safety
▶ 1:50:33um that's it yeah thank you I I'll yield back thank you very much the chair now recognizes representative King Hines for minutes so more on along the lines of this um traumatic brain injury treatment option and I guess this is a question for Dr rer because is a policy conversation right um what additional research or oversight do you suggest or recommend is needed basically that um one um
▶ 1:51:03we could actually explore this type of treatment right that a lot of folks support uh and how do we ensure balancing the safety of our veterans I think as we see all the research that we've seen with what VA is doing and what NIH is doing and also general medicine we're seeing all these factors that have progressed throughout the years showing from a point of where there was an imbalance where it was not positive that hbot was producing the outcomes for traumatic brain angery
▶ 1:51:34and PTSD but as we started to move through the years we started to see some progress and that's the promise that we're hearing that we're wanting to see that more research so as resolution-based organization we support research strongly support continuation of va's research and also the research partners and Affiliates out there to ensure that they are looking at safe clinical practices evidence-based methods to ensuring that we are providing alternative options of care for our veterans okay thank you for that
▶ 1:52:04and this this question is also for you so given the importance of a tele medicine in providing timely care to Veterans especially those who live in remote and underserved communities like mine the c ofi um what specific safeguards are uh being considered to ensure that prescriptions for Controlled Substances via T teleah Health are both safe and effective thank you for that question and with pharmaceutical care and trying to address the issues of mental suic
▶ 1:52:34mental health and suicide prevention along with substance use abuse there is a responsibility on VA to ensure when they are providing patient care in direct environment or in the community care that there are direct communication clear Communications on the treatment processes and what medications are given so that the veterans themselves understand being informed what those interactions are and what the risk factors are and at the same time that VA and Community are speaking directly with themselves for example my time when I was stationed
▶ 1:53:05up in Alaska very remote area it is very difficult to find clinicians um in every parts of it so when you're dealing with VA and Community Care and you look at their infrastructure up there it is not built to communicate very directly or well so we hope that as we continue with the modernization the electronic health record modernization that is something that will be worked very robustly into the system of the pharmaceutical safety measures and making sure that patient safety is paramont throughout the whole development all right thank you I you
▶ 1:53:35my um thank you the chair now recognizes Dr um Morrison for five minutes thank you madam chair uh it's been my distinct privilege to join in the work that this committee leads ensuring that VA is meeting veterans diverse and evolving needs as a physician myself I've been part of teams that work together to help patients receive the highest quality of care and have witnessed firstand the impact the positive impact of building comprehensive care coordination that enables effective communication
▶ 1:54:06and supports patients through their care with the number of women veterans expected to continue growing obviously we should be proactive in our efforts to coordinate care for one of the most pressing health issues women veterans face um Mr redner you uh answered uh ranking member U Brown ley's question I'm I'm going to direct it to you now Mr Dempsey if I may um and thank you for being here today we've highlighted that breast cancer is the most diagnosed cancer for women with NVA
▶ 1:54:37and that we'll likely see a rise in the volume of Cancer Care uh that veterans need can you expand a little bit on the importance of care coordination for improving Health outcomes and women's veteran women veterans overall VA experience of course in thank you for the question um and thank you additionally for pointing out that breast cancer ranks is the second most common cancer among women in the US and within VA it's the most diagnosed cancer I think for um any veteran coming through the VA Health System
▶ 1:55:07um but in this case with the increased volume of female patients that vaes it's important that patients feel supported uh with Cancer Care in particular where a lot of that care is received in the community it's critically important to make sure that there's good good coordination between the VA direct care system and those Community providers so there's no Gap in service whether it be uh you know transfer of Records back and forth Communications between the the providers to make sure that there's no gaps in care I think overall just
▶ 1:55:37creating a culture where veteran patients feel supported by their care providers thank you I appreciate that answer I'd also like to highlight another health issue that we've discussed that affects veterans at a 1.5 times greater than non-veterans suicide rates among service members risen gradually over the decade with veterans experiencing an alarmingly disproportionate rate of of suicide by firearm as the wife of a veteran I find this absolutely heartbreaking um while we understand that mental health issues facing our veterans don't stem
▶ 1:56:07from a single cause of course it's important that we take any and every path to prevent these tragedies and Empower veterans to address their mental health conditions safe firearm storage education resources are integral to addressing the elevated risk veterans face for firearm suicide with Firearms reported to be involved in up to 72% of Veteran suicides as you noted Mr reder the evidence for continued support of intervention programs that promote potentially life-saving time delays is clear Mr rer in your testimony you do discuss
▶ 1:56:37time and space uh as critical components in preventing suicides why is approaching Suicide preventage Prevention through safe firearm storage particularly impactful for veterans and families I can speak as a veteran who owns firearms and who suffers with mental health and it's very meaningful to have this conversation because it is a responsibility not just of the veterans but the clinicians and the fam integrated to understand how to save their veteran and themselves so in our testimony we
▶ 1:57:07wrote about the community being safe and that's the end goal is to make that Community safe but where it starts is that veteran is safe I have gone through the VA process of the clinical side and I wish I was offered a lock boox I was not I met all the criterias that were actually testified and I was not given option for the lockbox but the good thing is that VA throughout the process has been doing and taking steps to ensuring that they offer these security measures for our veterans thank you
▶ 1:57:38uh the saving our veterans lives act considered by the committee today includes an education element how do you anticipate the educational component of the initiative will work with the resource component of bill that's a great question and education is always very important and that's something we the veterans have to also own for ourselves for our responsibility it's something that we come from we come from an environment of being educated and how to handle firearms in the military and hopefully that VA will build upon that knowledge that we have and
▶ 1:58:08the way that we were taught those so that it relates to us in a matter that's meaningful and it also highlights the importance education I think is going to be very important because it's going to open up the dialogue for us to talk about something that's not always easy to talk about thank you Mr rer you know the legislative efforts considered in today's hearing demonstrate critical steps toward delivering the quality care that VHA should continuously pursue I sincerely believe that finding common ground on ways to improve VA is a goal that's shared by all of my colleagues that sit
▶ 1:58:38on this Committee in recent weeks there's been a lot of conversation about R ramping up efficiency in our government every single one of the bills we've discussed today would require implementation actions that are the responsibility of va employees we cannot hope to continue to deliver care to our veterans if we throw the folks responsible for its delivery into instability and uncertainty we can't wish for improved access to care if we allow the disruption of essential functions in our VA hospitals and Facilities we
▶ 1:59:08cannot tell our service members we value their well-being if we permit critical contracts and research initiatives to be slashed I urge my colleagues particularly those that have presented their bills before the committee today to recognize your time has expired I'm sorry we have votes that are coming up now recognizes Dr Dexter for 5 minutes thank you madam chair um and again thank you to our panelists for being here and for the work that you do with our veterans um as I alluded to earlier
▶ 1:59:38I spent my career in a comprehensive Coordinated Care System very similar to the VA and so I appreciate the ability to really en embrace our veterans within the system and and deliver care um I know that these systems work for patients as you've talked spoken to and we have clear data that we'll submit for the record showing that care outcomes and satisfaction for care received inside of the VA is superior to outside I also want to make clear that our veterans have access um to
▶ 2:00:08care and and mitigate the need for our veterans to be able to access care and have um that intervention at the moment of impulsivity and despair for our um veterans at high risk for suicide is critical so thank you for your support for the lockbox um dis um policy I think that is proven very high yield um and critical it also is critical that our veterans have time to talk with a provider be able
▶ 2:00:38to reach out when they're feeling um most impulsive and desperate so I believe that that's the intention with the no wrong door Act is to be able to help people at that moment however I'm concerned conc erned about our requirement for um care delivery for mental health care and the fact that we are not going to allow tele medicine mental health um any longer that everyone's going to have to be imp person because an
▶ 2:01:09established care provider is is trusted and and certainly preferable having worked in an emergency room to walking into an emergency room and expecting high quality personalized care so so despite the good intentions of the wrong door act I it seems to run counter to the principles of a capitated inclusive um body so I also have concerns about the reauthorization of a program for which we've collected um good outcome data for only 4%
▶ 2:01:40of the participants um so I wonder Mr rer um if you would be willing to share your thoughts on um when VA interventions are um looking to be most impactful for our Su high-risk suicide patients do you feel like we have sufficient data um to be confident that the no wrong door Act is actually saving lives more than further investing in
▶ 2:02:10VA comprehensive care and and even T Mental Care thank you for that question and that is such an important issue that we have a no wrong door Act really addresses alternative options where VA can't do it by themselves that is something that we're very realistic too and with having over 9 million veterans enrolled in the VA Healthcare System and you have 2.7 million in the rural we have to be able to provide that type of resource and when the compact act came out and that was a great win
▶ 2:02:40for Congress and for American veterans to be able to get Healthcare when they were in acute crisis that is another tool so the no wrong door has the potential to do what we need to do to provide Alterna alternative uh resources and clinical support out in the community where veterans may not be enrolled in the healthcare system so I think that's the most important thing is that we don't shut the door on this we continue to see what we can do with this and that's why we recommended our recommendations and testimony to be fiscally responsible to make sure that it's not
▶ 2:03:10participants that are being engaged and we're not a production of veterans going through the shop we want Quality Care the same kind of care that we get within the VA system and the wraparound services that were're noted in the the bill with regards to ensuring that they are going back to VA and being informed about how to utilize VA so we see promise in there but we're waiting for the report and we hope to see the final report and become public for us to be able to make a determination and I absolutely share your in the intentions and
▶ 2:03:40and the suppositions of the bill I just am concerned about only 4% of output being really looked at for the outcomes and and it's not a question it's just I think that compelling Data before we invest when we have so modest um resources available to us is important um what do you think Congress can be doing better to bolster interventions to help prevent suicide which is at a critical crisis point for our veterans
▶ 2:04:11now thank you for that question I think like I said earlier is multifaced we have to look at every Avenues directly within the VA healthare system making sure we have proper Staffing we have clinical Psych PS olist Psychiatry shortages and Staffing but also to support them we have to ensure that the VA Staffing itself in general is a par so for example if we go to the phone call for the crisis line someone has to be maning that line if we go to the phone to call the public contact office someone has to be there if we go into a VA Medical Center
▶ 2:04:41the facility has to be cleaned where we have our people who are custodians that they working so all the employees that support the VA it's very important that we look at it the other thing is we need more peer-to-peer are veterans who work within the VA system they themselves know what the life is like and they have the experience to become peer-to-peer counselors or peer to peer to be able to Mentor through us and I recognize that I'm overtime so thank you for your tolerance Madam chair and um I thank you for your testimony thank you the gentlem woman yelds a chair now recognizes
▶ 2:05:12herself I was going to recognize Dr Conway but he slipped out uh thank you very much Miss Morris were there difficulties executing the construction of the VA Clinic in Omaha Nebraska in coordination with the VA and if you could improve the chip-in authorities what would you suggest if there in fact were difficulties we really did not experience a lot of difficulties in construction um if I remember you remember probably the CH the biggest challenge was the last four months
▶ 2:05:43covid hit March of 2020 and we needed to finish up the project by the end of July in order to do the transfer in August um and our construction team and our design team worked diligently to be able to get that done on time which is really kind of amazing that that was able to happen at that period were there certain waivers or exemptions that you sought from the VA in order to get Construction done under budget and under time well certainly I reference the construction manuals and the security manuals those were critical we actually spent a two-day time
▶ 2:06:13period in Omaha Nebraska where about 15 20 VA employees came out we we went through those manuals with great Precision um and and at that point in time we're able to have value engineering of about $23 million thank you Dr kmini U many aging veterans and those suffering from diabetes related uh complications sadly receive amputations due to Chronic limb memia could hbot therapies be potential prevented treatment for our veterans suffering from those
▶ 2:06:44conditions um just to clarify so preventative um in the sense of preventing those infections or amputations uh yes um I do think that hyperbaric oxygen therapy has been a fairly well proven implementation for Salvage therapy in those cases for sure and thank you so much for coming and go Hawks Mr Harry's I understand the difficulties uh your members are experiencing as a result of the va's inability to reimburse for high cost medications that the patient may have been
▶ 2:07:14on prior to coming to a facility VA testified the status quo is okay do you no we do not um the increase or the costs of these drugs that are coming in Are Climbing rapidly the other thing that is happening with the exposures chemicals that our veterans are having we're having more and more cancer diagnosis some of these high cost drugs or a good portion of them are related to chemotherapy and they in fact cover these drugs if the
▶ 2:07:45patient was at a different facility or at their home correct and uh you know looking at it from a cost perspective from the state Veterans Home the average institutional perum is $262 in cost for State Veterans Home whereas with the community homes the private contractors 424 so if you looked at balancing that out it may be a net neutral event thank you Mr dimsey how could the sport act assist post 911 veterans
▶ 2:08:15thank you for the question um the sport act would I think do a tremendous job of reforming way that UT veterans um engage with the VA prosthetic Department uh currently uh with the limitation that uh adaptive and Sport related Prosthetics only be provided as part of a clinical program um Expediting that process and getting these into uh a veteran's life is a great way to re-engage uh in the community whether it just be participating in athletics whether it be
▶ 2:08:45you know get involved in community outings golf running uh any number of activities I think a lot of people take for granted but which can be greatly enhanced by better access to these does it seem to you that the va's current uh status and parameters are geared towards elderly veterans who perhaps have amputations from medical conditions such as diabetes rather than to our younger much more active post 911 veterans well thank you for the question to be honest I I I don't know that I could speak to that I'd say that the most of the voices uh that come to our
▶ 2:09:16post 911 serving generation are those who are injured in the early 2000s for whom you know getting adaptive Prosthetics became part of their post injury life very early and so they've become familiar with how to use them how they want them and so ensuring that the process works a bit more smoothly for them is the priority here thank you um I yield uh my time uh thank you to all of you uh thank you to our Witnesses uh and for all your thoughtful input um rankling uh member brownley I'm going to uh
▶ 2:09:46ask if you have any uh closing remarks uh thank you madam chair I just wanted to associate myself with uh representative Dexter and Morrison and their comments that they have made today and I will just repeat what I said in my opening remarks and that I find it a bit absur uh crazy that we're having a a legislative hearing today rather than an oversight hearing while the Trump administration's careless executive
▶ 2:10:16orders Mass firings of va employees and Reckless contract terminations are causing significant upheaval within the veterans Health Administration and as I said earlier none of these bills we are considering today will address the very real threat to VA Health Care to VA ACC Access to Health Care quality and safety that our our nation's veterans are facing today Veterans do not support these proposed Cuts nor do
▶ 2:10:46they support 83,000 employees within the VA if we continue to see efforts to dismantle the VA by firing hardworking employees cancelling vital research terminating Health Care contracts and eroding veterans trust in VA it won't matter what excellent legislation we put forth there won't be employees or even an infrastructure left at VA to implement
▶ 2:11:16these bills and veterans care will suffer because of it we can do better than that and I yield back well thank you very much and perhaps it's uh because I'm a physician and a 24-year military veteran married to a 30-year military veteran uh that I find it completely plausible that we as members of Congress can actually make legislation go through legislation in addition to respond to things that are happening uh through
▶ 2:11:47other parts of the federal government as well let me also say that I'm just need to address some misinformation I've heard here today whether it's intentional or unintentional there is a $6 billion increase to the toxic exposure fund not a decrease let me repeat that the toxic exposure Fund in the continuing resolution that we may be voting on has a $6 billion increase let me also say that over the past four years the va's budget has increased
▶ 2:12:18$240 billion to are has increased from $243 billion to $369 billion and over $126 billion increase while nationally the level of veterans seeking care is level is level and of that in the past four years an increase of 60,000 full-time employees and 23,000 part-time employees so given my time in the
▶ 2:12:48military I remember as an O nurse I won't say what facility I was in it was 1:30 in the afternoon all of the staff with the exception of three of us and I can see Dr Kaminsky smiling because he knows what I'm going to say three of us were back putting together the instruments and putting up our instrument sets everybody else was in the breakroom so I would say to look at how we spend money in the federal government so precisely what ranking member brownley has said so that we can continue to have the funds to deliver
▶ 2:13:18high quality care to our V veterans in a timely fashion be it at the VA or in Community Care is a priority for all of us and none of this dismantles or guts or defunds uh the VA or the toxic exposure fund I want to thank our Witnesses who have been here today I appreciate your coming and testifying I want to thank our veterans most importantly who give us the opportunity to be here and to vote this afternoon and on
▶ 2:13:49behalf of the subcommittee I want to thank you all again the witnesses members who are here today and I'm looking forward to working with you to address the issues facing our veterans the complete written statement of today's witnesses will be entered into the hearing record I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material hearing no objection so ordered this hearing is now
▶ 2:15:19e e