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RESTRUCTURING VA MEDICAL SERVICES: MEASURING AND MAINTAINING THE
QUALITY OF CARE
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RESOURCES
of the
COMMITTEE ON GOVERNMENT
REFORM AND OVERSIGHT
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTH CONGRESS
FIRST SESSION
__________
AUGUST 4, 1997
__________
Serial No. 105-88
__________
Printed for the use of the Committee on Government Reform and Oversight
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COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
J. DENNIS HASTERT, Illinois TOM LANTOS, California
CONSTANCE A. MORELLA, Maryland ROBERT E. WISE, Jr., West Virginia
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
STEVEN SCHIFF, New Mexico EDOLPHUS TOWNS, New York
CHRISTOPHER COX, California PAUL E. KANJORSKI, Pennsylvania
ILEANA ROS-LEHTINEN, Florida GARY A. CONDIT, California
JOHN M. McHUGH, New York CAROLYN B. MALONEY, New York
STEPHEN HORN, California THOMAS M. BARRETT, Wisconsin
JOHN L. MICA, Florida ELEANOR HOLMES NORTON, Washington,
THOMAS M. DAVIS, Virginia DC
DAVID M. McINTOSH, Indiana CHAKA FATTAH, Pennsylvania
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
JOE SCARBOROUGH, Florida DENNIS J. KUCINICH, Ohio
JOHN B. SHADEGG, Arizona ROD R. BLAGOJEVICH, Illinois
STEVEN C. LaTOURETTE, Ohio DANNY K. DAVIS, Illinois
MARSHALL ``MARK'' SANFORD, South JOHN F. TIERNEY, Massachusetts
Carolina JIM TURNER, Texas
JOHN E. SUNUNU, New Hampshire THOMAS H. ALLEN, Maine
PETE SESSIONS, Texas HAROLD E. FORD, Jr., Tennessee
MICHAEL PAPPAS, New Jersey ------
VINCE SNOWBARGER, Kansas BERNARD SANDERS, Vermont
BOB BARR, Georgia (Independent)
ROB PORTMAN, Ohio
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
William Moschella, Deputy Counsel and Parliamentarian
Judith McCoy, Chief Clerk
Phil Schiliro, Minority Staff Director
------
Subcommittee on Human Resources
CHRISTOPHER SHAYS, Connecticut, Chairman
VINCE SNOWBARGER, Kansas EDOLPHUS TOWNS, New York
BENJAMIN A. GILMAN, New York DENNIS J. KUCINICH, Ohio
DAVID M. McINTOSH, Indiana THOMAS H. ALLEN, Maine
MARK E. SOUDER, Indiana TOM LANTOS, California
MICHAEL PAPPAS, New Jersey BERNARD SANDERS, Vermont (Ind.)
STEVEN SCHIFF, New Mexico THOMAS M. BARRETT, Wisconsin
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Robert Newman, Professional Staff Member
R. Jared Carpenter, Clerk
C O N T E N T S
----------
Page
Hearing held on August 4, 1997................................... 1
Statement of:
Aversano, Daniel, LPN, veteran and Castle Point employee,
Kerhankson, NY............................................. 147
Blumenthal, Jerome, veteran, Middletown, NY.................. 151
Bove, Anne, registered nurse and daughter of deceased
veteran, Woodside, NY...................................... 174
Buccieri, Anthony, veteran and Veterans of Foreign Wars and
Disabled American Veterans, Newburgh, NY................... 148
Catania, James, veteran, VFW and American Legion, Walkill, NY 161
Crowther, Guy, veteran, Port Jervis, NY...................... 190
Demarco, Ralph, veteran and representing 27 New York
veterans' organizations, Fishkill, NY...................... 176
Dobbs, Theodore, veteran and husband of deceased veteran, New
Hampton, NY................................................ 178
Dos Santos, Lawrence, deputy director, New York State
Division of Veterans' Affairs, accompanied by Thomas C.
Agnew, director, Orange County Veterans Service Agency;
Jerry Donnellan, director, Rockland County Veterans Service
Agency; Al Etkin, director, Sullivan County Veterans
Service Agency; and Jim Whoie, deputy director, Dutchess
County Veterans Service Organization....................... 125
Farsetta, James, director, Veterans Integrated Service
Network 3, accompanied by Maryanne Musumeci, director,
Bronx VA Medical Center; Michael A. Sabo; director, Hudson
Valley VA Health Care System; and Dr. Nancy J. Wilson,
director, VA Office of Performance Management.............. 40
Fleck, Steven, veteran and Montrose employee, Poughkeepsie,
NY......................................................... 177
Fleming, Harry, veteran and chaplain and scouting chairman,
Orange County American Legion, Middletown, NY.............. 166
Hinchey, Hon. Maurice D., a Representative in Congress from
the State of New York...................................... 5
Ianazzi, Robert, veteran and Vietnam Veterans of America and
Disabled American Veterans, Middletown, NY................. 189
Ippolito, John, veteran and American Legion Post 1266, Pine
Bush, NY................................................... 175
Jinks, Pam, veteran and Castle Point employee, Montgomery, NY 168
Johannes, Richard, veteran, Pleasant Valley, NY.............. 149
Karabec, Ralph, veteran and commander, American Legion Post
480, Monroe, NY............................................ 146
Kelly, Gerard, veteran and Eastern Paralyzed Veterans
Association, Jackson Heights, NY........................... 164
Kelly, Hon. Sue, a Representative in Congress from the State
of New York................................................ 25
Kowal, Jane, daughter of deceased veteran, Port Jervis, NY... 159
Mangels, Shirley, daughter of deceased veteran, Ellenville,
NY......................................................... 166
Mangieri, Silvio, veteran, Walkill, NY....................... 189
Messina, Enrico, veteran and Castle Point employee,
Poughduag, NY.............................................. 169
Mileo, Gerard, veteran, Marlboro, NY......................... 179
Monteleone, Edmund J., veteran, Clintondale, NY.............. 144
Moonan, Ray, veteran and Disabled American Veterans and
American Legion, Florida, NY............................... 160
Morea, Daniel, veteran and assistant service officer,
Department of New York American Legion, ninth district
rehabilitation chairman, American Legion, Beacon, NY....... 151
Mussolino, Colleen, veteran and national vice commander,
Women Veterans of America, Brooklyn, NY, on behalf of
Montrose Women Veterans of America......................... 162
Novak, Bill, veteran and New York State benefits protection
officer, Department of New York Disabled American Veterans,
Middletown, NY............................................. 182
O'Connor, Thomas, veteran and nurse manager, outpatient
services, Castle Point, Marlboro, NY....................... 163
Parris, Ray, veteran, Washingtonville, NY.................... 185
Pinckney, Richard, veteran, Middletown, NY................... 191
Pressley, Hugh A., Jr., veteran, Bronx, NY................... 192
Reilly, Daniel, veteran and NFF 246, Beacon, NY.............. 165
Schiffman, Philip, veteran and New York VFW, Washingtonville,
NY......................................................... 153
Schwartz, Sandra, veteran, wife of veteran and daughter of
deceased veteran and Disabled American Veterans Auxiliary,
Poughkeepsie, NY........................................... 172
Shera, Craig, veteran and son of deceased veteran, Gardiner,
NY......................................................... 178
Skyler, John, veteran and department commander, Department of
New York Disabled American Veterans, Cheektowaga, NY....... 187
Spadaro, Ben, veteran and VA employee, Bronxville, NY........ 184
Trimble, Cindy, family of deceased veteran, Ganham, NY....... 147
Van Clief, Helene, veteran and treasurer, Military Women and
Friends and member, Coalition for Fairness to Veterans and
VAVs, Bronx, NY............................................ 187
Wood, Gloria, wife of veteran, Pine Bush, NY................. 150
Letters, statements, etc., submitted for the record by:
Agnew, Thomas C., director, Orange County Veterans Service
Agency, prepared statement of.............................. 133
D'Amato, Hon. Alphonse, a U.S. Senator in Congress from the
State of New York:
Prepared statement of.................................... 36
Public submissions....................................... 38
Dos Santos, Lawrence, deputy director, New York State
Division of Veterans' Affairs, prepared statement of....... 128
Farsetta, James, director, Veterans Integrated Service
Network 3:
Buyout plan.............................................. 99
Letter dated August 26, 1997, and draft report........... 64
1997 Network Director Performance Plan................... 107
Prepared statement of.................................... 44
VA survey................................................ 55
Etkin, Al, director, Sullivan County Veterans Service Agency,
prepared statement of...................................... 138
Hinchey, Hon. Maurice D., a Representative in Congress from
the State of New York, prepared statement of............... 9
Kelly, Hon. Sue, a Representative in Congress from the State
of New York, prepared statement of......................... 28
Shays, Hon. Cristopher, a Representative in Congress from the
State of Connecticut, white paper on news articles......... 156
Whoie, Jim, deputy director, Dutchess County Veterans Service
Organization, prepared statement of........................ 142
RESTRUCTURING VA MEDICAL SERVICES: MEASURING AND MAINTAINING THE
QUALITY OF CARE
----------
MONDAY, AUGUST 4, 1997
House of Representatives,
Subcommittee on Human Resources,
Committee on Government Reform and Oversight,
Middletown, NY.
The subcommittee met, pursuant to notice, at 1 p.m., in
Walkill Community Center, Middletown, NY, Hon. Christopher
Shays (chairman of the subcommittee), presiding.
Present: Representatives Shays, Gilman, Kelly, and Hinchey.
Staff present: Lawrence J. Halloran, staff director and
counsel; Robert Newman, professional staff member; and R. Jared
Carpenter, clerk.
Mr. Shays. I call this hearing to order. This is a hearing
of the U.S. Congress. I apologize for the number of people who
have to stand. This is a field hearing of the House of
Representatives. We are going to demand absolute order in these
hearings.
Our witnesses are to be sworn in until we get to the third
panel, and I'll clarify that in just a second. I would like the
chief to make an announcement since----
Audience Participant. Who are you, sir?
Audience Participant. Who are you?
Mr. Shays. Let me just be very clear. I will adjourn this
hearing at a moment's notice if we do not have order. There is
to be no catcalling. There is to be no response from the
audience. This is----
[Chorus of boos.]
Audience Participant. We don't want to be treated like
babies. [Applause.]
Mr. Shays. Chief, do you want to make an announcement?
Mr. Coscette. Yes. Good evening, everybody. My name is
Chief James Coscette.
We're not here to fight or go against you. I, myself, am a
veteran. I'm proud to have you people here. And I'm sure the
board will listen to what you have to say.
My job here is the crowd capacity here in this Town Hall.
My officers are here to help you and assist you. Please let
us remain a calm, cool, collective, bargaining people, as
yourself. You've done your time. You've represented us. And I
thank you all for being here.
The exits are at the front here, in the rear, and in the
back. Please, ladies and gentlemen, keep the aisles clear for
all people wanting to come up and speak.
Thank you.
Audience Participant. All right. A question was asked to
the gentleman. All they wanted to know is who he was.
Audience Participant. That's right.
Audience Participant. That's all.
Audience Participant. It's supposed to be a secret.
Mr. Shays. Let me just welcome all of our witnesses. I'd
like to welcome our guests as well.
Audience Participant. Who are you? Who are you?
Audience Participant. Who is speaking to us?
Audience Participant. That's my question.
Mr. Shays. This is the hearing of the Government Reform and
Oversight Committee, the Subcommittee on Human Resources. We're
the committee that oversees the Departments of Health and Human
Services, Housing and Urban Development, Education, Labor, and
also the Department of Veterans Affairs for waste, fraud, and
abuse.
This is the committee's first field hearing that we've had
this year. And we're having it at the request of the three
Congressmen you see seated next to me. The purpose of this
hearing is to look at the quality of care of the Veterans
Administration in this district and to consider whether the
quality of care is improving or declining. We will stay and
hear all our witnesses.
My name is Christopher Shays. I am the chairman of the
subcommittee.
This is the same committee that has had 10 hearings on the
Gulf War Syndrome. This is the committee why you know of
Kamisiyah and why you know of some other problems in the
Persian Gulf. We have been very active in veterans' affairs.
We are here at the request of your three Congressmen
because you have asked for this hearing. And we welcome you
here today. But this is an official hearing of Congress. We
have to have order. I really request that you provide us that
order.
And at this time, I would recognize Ben Gilman.
Mr. Gilman. Thank you, Mr. Chairman. [Applause.]
I want to welcome all of our veterans who have taken the
time out of their busy lives to be with us today. I want to
welcome also our Veterans Administration officials who are
here. We have Mr. Farsetta, who is the regional director. We
have Maryanne Musumeci, who is also a regional director, now
the head of the Bronx VA hospital. We have Mr. Sabo, who is the
new Castle Point director. And we have Dr. Nancy Wilson, who is
one of the program directors with the Veterans Administration.
We thank our panelists for being here with us.
Can you hear us in the back all right?
[Chorus of yeses.]
Mr. Gilman. And I'm pleased that we're joined here with
Congresswoman Sue Kelly, who represents a portion of this
county and other adjoining counties. And Congressman Maurice
Hinchey represents the areas north of us and also a portion of
Orange County. [Applause.]
And I urge you, please, give respect to our panelists and
to our witnesses. And we're going to try to move along as
quickly as we can.
If I might, Mr. Chairman, I'd like to give an opening
statement at this time. Our fellow veterans and ladies and
gentlemen, I want to, first of all, express a great deal of
gratitude to Congressman Chris Shays for willingness to arrange
this hearing, to take time out of his schedule, to be over here
in our area to address a very serious concern that we all have
and to hold it in a forum that is accessible to our local
veterans.
As the ranking Republican on the Government Reform and
Oversight Committee, I approached Chairman Shays last May and
requested that his subcommittee initiate an investigation into
the quality of care being delivered at Castle Point and at
Montrose. I did this because we were not satisfied with the
manner in which the VA was responding to the concerns of our
veterans and their families who had come forward with their
health care complaints.
It's my opinion that it was the Veterans Administration's
lack of compassionate response to the veterans' complaints that
poisoned the atmosphere and eliminated a great deal of hope for
a workable solution with our veterans in our local communities.
Their concerns were obviously not being addressed adequately,
and we felt that the congressional intervention was warranted.
And many of you have probably heard of the plan developed
by the VA to shift funding to geographic areas that have
inadequate resources to meet their level of demand. This plan
that was known as the Veterans Equity Resource Allocation
Model, known as VERA, has resulted in health care funds flowing
away from New York State to places like Arizona, Mississippi,
and California.
By now you're all undoubtedly aware that we have major
philosophical disagreements with the proponents of that VERA
program in both the Congress and the administration. I believe
this plan is ultimately harmful to the veterans of the
Northeast and, despite all assurances to the contrary, could
result in a decrease in the quality of care provided. We hope
that that will not be the ultimate result.
The watch word for VERA has been ``efficiency.'' And, while
we agree that there is a great deal of fat within the VA that
needs to be trimmed, I would remind you that efficiency is not
an unmitigated good. It's possible to go too far in scaling
back services in the name of efficiency.
We've heard much in the last year about the need for the
Veterans Administration to model private sector health care. To
a certain extent that may be needed, but the private sector
example is certainly not a panacea to all of our problems.
Many of you have heard some of the horror stories about
HMOs that have cut back too far in quality care and place the
bottom line on profitability before patient care. That
certainly must not be allowed in our Veterans Administration
facilities.
Unlike other so-called entitlements, veterans' health care
benefits were earned through blood and sacrifice. And, for that
reason, the Veterans Administration has a public duty to our
veterans and to the American taxpayer to deliver health care
that's equal or superior to that in the private sector.
The Veterans Administration is, in essence, the steward of
our veterans' health. In maintaining that stewardship, the VA
should not repeat the mistakes of the private sector with the
streamlining of health care.
We intend to keep a close eye on the quality of care which
the VA delivers in Network 3. And that's our own region,
especially in the area of specialty care. And what we have seen
so far has not been encouraging.
As I have noted in the past, the Veterans Administration
has a major credibility problem with our New York congressional
delegation and with the veterans that use both Castle Point and
Montrose. The evidence from this past spring shows that this
network and its administrators forgot about the human side of
VA health care. And we have no illusions that it was only
public exposure and the threat of congressional intervention
which forced them to reevaluate their positions.
Regarding the general public, the VA response to those
whose complaints appeared in the paper was, ``Left a lot to be
desired.'' Those stories may very well have been anecdotal, but
it was grossly irresponsible for the hospital and the VISN
officials. To publicly state so simply because each complaint
was unable to be immediately verified did not make them any
less important.
The tactic of dismissing patient and family experiences as
unimportant certainly was counterproductive and gave the
appearance that the VA had something to conceal. If nothing
else, the officials of Network 3 owe these veterans and their
families an apology for the treatment they did receive when
they came forward.
It has also been the distressing trend of some VA officials
in Washington to consistently attempt to shift the fault for
this situation over to the Congress, stating that the Congress
had under-funded VA health care in the past. These charges had
been leveled despite the fact that the Congress traditionally
meets the President's request for health care funding and, as a
matter of fact, gave the Veterans Administration more funds
than ever before in last year's budget. In fact, last year VA
officials testified that they did not want any additional funds
for this fiscal year.
The administration has proposed a flat budget until the
year 2002, which will treat up to 20 percent more veterans. The
VA claims that that's possible without any additional funds due
to savings from efficiencies and retention of third party
reimbursements. That remains to be seen. We hope that they will
be able to retain those third party reimbursements, and we're
trying to make that possible through statutory language.
So we in the Congress have repeatedly stated that we're
willing to work with the Veterans Administration to address the
ongoing issues of quality of care. And if more funds are needed
to assure proper care, we want to know about it and we're going
to try to help them get the kind of funding they do need.
Moreover, those of us in the Congress may often have some
significant ideas which do warrant experimentation. For
example, last week I suggested to Dr. Kizer, the Medical
Programmer in the VA, and Secretary Gober, our new
Administrator, that Castle Point should contract out with local
hospitals for inpatient surgical procedures, rather than
transporting patients all the way to Albany or the Bronx, which
incurs needless costs--[applause]--and which places undue
stress on our veterans. Secretary Gober agreed to work with us
on that issue as well as on doctor certification. And we hope
to hear more about those subjects today.
So, in closing, let me say that it's our hope that this
hearing today--and I speak on behalf of my fellow Congressmen
over here--will serve as a first step toward improving the
strained relationships between Castle Point and its patients.
And we look forward to the release of the report detailing
the findings of the medical examiner's investigation of Castle
Point as well as the results from a study that Congress is
requesting from the Government Accounting Office on the effects
of VERA.
In the interim, I hope that those of you who have come
forward with specific problems about care at Castle Point will
have your situations either rectified or, if this is not
possible, receive just and proper compensation.
Again, we thank you for being here. We're here to try to
resolve problems. Let's try to work together in those
directions. Thank you, Mr. Chairman.
Mr. Shays. Thank you, Mr. Gilman. [Applause.]
This hearing was at the request of Ben Gilman, who I failed
to mention is a member of this subcommittee besides being
chairman of the International Relations Committee; also, Sue
Kelly, on the Republican side of the aisle.
Mr. Hinchey, on the Democrat side of the aisle, as well,
has expressed bipartisan concern about this issue. And at this
time I'd like to recognize him.
STATEMENT OF HON. MAURICE D. HINCHEY, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Hinchey. Thank you very much, Mr. Chairman. And good
afternoon, ladies and gentlemen, and welcome to this hearing. I
also want to welcome and thank our chairman, the chairman of
the subcommittee, Chris Shays, who represents a congressional
district in Connecticut, for holding this first field hearing
on this subject here in our area in the mid-Hudson Valley. We
appreciate your coming here. We want you to feel welcome. We
know that you are joining us in a resolve to solve this problem
on a bipartisan basis, and we very much appreciate your being
here.
I want to say also that this hearing is held in honor and
respect of the service and sacrifice of American veterans, and
I want everyone in the audience to understand that. That is why
the committee is here. We are determined and resolved on a
bipartisan basis to ensure that the quality of care that is
afforded for veterans improves and that it maintains the
highest standard possible.
Mr. Chairman, I have a longer statement that I will submit,
but I have a precis of it that I would like to read into the
record at this time.
Mr. Shays. Sure.
Mr. Hinchey. I believe we would all agree that the purpose
of the veterans' health care system is to assure our veterans
that they will always have access to quality health care. That
has changed and evolved over the years, as it should, but that
commitment remains its core purpose.
Today many veterans do not come to the VA for health care,
often because they do not need to and sometimes because it is
inconvenient and sometimes, unfortunately, because they have
lost confidence in the ability of the VA to provide the kind of
health care that they need. [Applause.]
They use non-VA facilities. The cost is often covered by
Medicare or by employer-paid insurance. The VA now recognizes
that it is not always convenient or appropriate to provide care
at its hospitals and has begun developing outpatient clinics
and other means of providing services to veterans closer to
home. I think the VA deserves to be commended for this effort,
but that is not justification for allowing the quality of care
at VA health care facilities to decline.
That should not mean that the commitment to provide quality
health care at its own hospitals should be relaxed or
abandoned. The VA hospitals should continue to provide quality
services to those veterans who continue to need those services.
I am deeply concerned that, for whatever reason, the
quality of care at Castle Point has deteriorated. There is no
question that many of our veterans in this area have lost their
confidence in Castle Point and to a considerable degree in the
VA itself.
Audience Participant. Did your wife die there? Mine did.
Audience Participant. That's true.
Mr. Hinchey. All of us who are here today and who represent
veterans in the Hudson Valley have lodged numerous complaints
with the VA about the situation at Castle Point. We have had
numerous meetings about Castle Point with VA Administrators, up
to and including Secretary Brown and now Acting Secretary
Gober. I think it is fair to say that we know our complaints
have been heard, we know that the VA is paying attention, but
we do not know if the problems are being resolved in a way that
addressees the needs and concerns of the veterans that Castle
Point is supposed to serve.
In my written statement for the record, I have included
several detailed case histories of serious problems that some
of my constituents have encountered at Castle Point. I want to
emphasize that the cases in my statement represent only a small
sampling of the many complaints that I have received.
I have been deeply disturbed not only by the number of
complaints but also by the wide range of problems that have
been reported to me through my office. They include allegations
of: misdiagnosis by health care personnel, particularly
doctors; errors in treatment; and surgical mistakes that
suggest serious incompetence. They include complaints about
poor relations between doctors and patients and the inability
of doctors to communicate effectively with patients, a problem
that Under Secretary Kizer--[applause]--a problem that Under
Secretary Kizer confirmed in our most recent meeting. With
regard to those complaints, I can announce to you today that
the Members of Congress seated at this table have just
introduced legislation that I have written--we have introduced
it on a bipartisan basis--which will require that all doctors
providing health care at VA facilities must be licensed to
practice medicine in the State in which the VA facilities are
located. [Applause.]
We will also require in this legislation that vital
statistics, including death records, be filed with the
appropriate State agency, including the State health
department, and not be restricted only to the VA itself in the
future. [Applause.]
I want to emphasize that this legislation is being
introduced by the members of the committee seated here,
Democrats and Republicans, on a bipartisan basis.
The complaints that I have received are about shortages of
professional nursing staff and allegations that patients have
been neglected as a result of these shortages. I have heard
allegations as well about unsanitary conditions, poor
maintenance of the facility, and the misapplication of funds.
Many of our veterans have expressed concern that the VA may
be ignoring these problems because it is concentrating too much
effort on more abstract management issues; most importantly,
the shift of funding known as VERA, which Mr. Gilman mentioned
a few moments ago.
The VA has told us repeatedly that VERA would not reduce
services or compromise quality of care at Castle Point, but
that is what seems to be happening. Services has been reduced.
Quality has been compromised.
Under Secretary Kizer recently told us that there were
notable problems at only four VA facilities that were being
consolidated, but he did not include Castle Point on that list.
We want to make it clear that we believe the problems at Castle
Point are, in fact, quite notable and need to be addressed
vigorously and immediately.
Audience Participant. ``Notorious'' is the word.
Mr. Hinchey. I want to make it clear that I believe these
problems need to be straightened out.
As the committee knows, I have requested that the VA's
Inspector General conduct a thorough investigation of the
problems at Castle Point, including reports of an increased
mortality rate, declining quality of care, quality and adequacy
of the staff, and the effects of resource allocation on Castle
Point. We will be eager to see that study when it is completed.
My office is making available to the Inspector General
specific case histories that have come to our attention so that
the Inspector General will be able to direct the attention of
his office to those specific complaints and examine in detail
specific cases where severe problems apparently have occurred.
We will be eager to see the study when it is completed. In
the meantime, I hope the committee will consider some of the
broader questions about government management and VA management
itself that this situation has raised.
Specifically, these issues are some of the issues that
concern me, and here they are. Is management of VA health care
being driven by computer analysis and allocation formulas while
actual day-to-day conditions and the concerns of individual
patients and their families are being ignored? If so, we need
to remedy that situation immediately.
Does the problem lie with applying uniform rules and
standards and salary schedules across the country? Is it
harder, for instance, to find good physicians and nurses here
in New York than, for instance, in Salem, VA or other places in
the country?
Would the problems be alleviated if there were better
communication between VA administrators and the veterans
themselves? Is it possible to require clearer communications,
as in the regulatory process, for instance? We have heard
constant complaints that veterans' concerns are ignored, that
they are not notified about changes in the services provided,
and that they are not consulted adequately, even with regard
often to their own care.
Finally, and perhaps most importantly, are the problems
attributable to a shortage of funds? VA administrators have
suggested this to us on several occasions, and I have asked
several times if they need more money to provide the services
veterans expect and deserve. We have not had an answer to that
question.
Congress may be at fault here by imposing arbitrary budget
ceilings. The Administration may be at fault in its budgeting
process. We need to know the answers to these questions.
But if cold, hard budget decisions made in an analyst's
office in Washington mean that a diabetic veteran in New York
is left unmonitored and ignored, then the public needs to know
that.
The Veterans Administration has suggested to us that this
may be the case. We need to know the answers to these
questions. And upon getting the answers to these questions, we
need to ensure that these issues are dealt with adequately,
forthrightly, competently, and completely. And that is the
purpose of this hearing.
And, Mr. Chairman, I thank you for being here and giving us
this opportunity. [Applause.]
[The prepared statement of Hon. Maurice D. Hinchey
follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. This committee is holding this field hearing,
again, at the request of Mr. Gilman and Mr. Hinchey as well as
Sue Kelly. And, Ms. Kelly, you have the floor.
STATEMENT OF HON. SUE KELLY, A REPRESENTATIVE IN CONGRESS FROM
THE STATE OF NEW YORK
Ms. Kelly of New York. Thank you very much, Chairman Shays.
I want to thank you for holding this hearing and for respecting
the veterans in this area who use Castle Point and Montrose
facilities enough to come up here to the district and listen to
what they have to say to the Veterans Administration.
I think this is an important hearing. I especially
appreciate the opportunity in light of the recent reports that
we've had of diminished quality care at both Castle Point and
Montrose. I can't think of a more important issue for veterans
nationwide than ensuring the Federal Government maintains its
commitment to provide high-quality health care to them and for
their service for our Nation.
The question here is really: Is the present veterans'
equitable resource allocation, VERA, model and the manner in
which it has been implemented good for the Hudson Valley
veterans or just those in select areas of the Nation?
I can tell you now, Mr. Chairman, that I have very grave
concerns that today's VERA model shirks this Nation's
commitments to New York's veterans. In this area of the
country, in our network, we're taking the largest cut of any
other network in the Nation, a 15 percent cut in overall
veterans' health care funding, which translates into a nearly
$150 million cut. Yet, we have the highest number of veterans
who need special care and the fourth highest number of veterans
who need medical care.
It's the laudable goal of the VA to ensure that veterans
receive the same high-quality care Nationwide at any medical
care facility, but I believe all here would applaud this goal.
However, the problems begin with the VA's implementation of
robbing Peter to pay Paul, taking from one network to give to
another.
The logic behind these actions appears to be flawed in
several respects. First, the funds are being reduced in our
network. And they are not being taken because of a lack of need
in one area but for a seemingly greater need in another.
Also, we can't possibly take into consideration all of the
reasons that one area historically receives greater funding due
to factors that are difficult to measure, such as regional
differences in cost of living, wage scale, as well as the
presence of older and sicker patients.
In the General Accounting Office's May 1, 1997, report on
the VA health care assessment of VA's fiscal year 1998 budget
proposal, the GAO notes a number of similar warnings about the
implementation of VERA, including VERA may shift some resources
inappropriately because it may not fully account for
justifiable differences in regional cost variations. The VA may
not have taken into account, for example, that veterans are
sicker and need more health care services in different parts of
the country so that additional case mix adjustments may be
necessary to fully explain regional cost differences. And
VERA's incentives for lower cost per veteran and higher
workload numbers could lead to unintended consequences.
A second flaw that I find is that if the VA has been
instituting broad-based eligibility reform proposal, which is
supposed to expand the number of veterans that each network
will serve while at the same time implementing the VERA plan,
how can the VA even begin to accurately calculate the number of
eligible veterans requiring care in the present system or even
forecast future enrollment numbers? Further, how can the VA
accurately track the real-world impact of the reforms while
they're shifting money from network to network? Shouldn't they
wait until they know what the numbers are?
Additionally, and more to the point, my greatest concern is
that these reforms will result in a reduction in the quality
and accessibility to health care that veterans deserve and
depend on.
As we speak, the VA's medical inspector's office is
finalizing its in-depth examination of conditions at Castle
Point and Montrose, but the results won't be available for at
least 2 to 3 months.
Additionally, while we are trying to get to the bottom of
these reports, we have the network leadership making blanket
statements about their ability to deliver quality care without
waiting on the medical inspector's reports or even the final
Joint Commission on the Accreditation of Hospitals' report.
The VA has a credibility gap, to say the very least. And to
fault these types of correspondence against the present
backdrop does nothing to restore the full faith and confidence
of our veterans in their VA system.
It's because of these latest actions on the VA's part that
I'm looking forward to an impartial, unbiased audit of our
network by the GAO whereby they will be reviewing the human
impact of the VERA model on the VA's ability to deliver quality
health care in New York. This is the language which I and many
of my colleagues here work to secure in the fiscal year 1998
VA/HUD appropriations.
Our veterans, like all citizens, deserve answers from their
government that are clear and truthful. And I'm sorely afraid
that we have not yet reached this point. Hopefully this GAO
study will shed some much needed light on some of the
unintended consequences of VERA's implementation.
So while we have no idea what the GAO may or may not
conclude in their reports, I have faith that they will conduct
at least a fair and honest accounting of the situation, just as
they have in their past reviews of the VA and the VERA program.
Finally, Mr. Chairman, I'd like to close by quoting the
same May 1997 report I cited earlier, which concluded that
delaying a decision on VA's legislative proposals until
critical information is available, including a plan describing
how the system will look and operate in 2002, may result in a
better legislative decision on the VA's budget proposal. It
will also afford the VA and the Congress better time to assess
how VA's future resource needs may be affected by the new
decentralized management and resource allocation initiatives.
This is a very important point. It is this very delay I've
been pressing for over these past 9 months. I will continue
working for high-quality medical care that is immediate and
accessible for all of our veterans until we get all of the
answers.
I look forward to the testimony of our witnesses. And thank
you, Mr. Chairman, for allowing me to take part in the
proceedings. [Applause.]
[The prepared statement of Hon. Sue Kelly follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. I want to thank all of you because I know a
number of you are standing. Let me just say that for some of
you who are sitting, maybe in an hour or so you will be able to
relinquish your chair to someone who is standing.
This hearing will probably go on beyond 5 o'clock today.
Let me just state how we are going to proceed. We have two
panels that will be addressing this subcommittee. We will be
asking them questions. And the third panel will be people from
the audience, who will be invited at random to address us and
make the points that you would like to make. I will tell you as
the chairman of this committee I will stay here quite a long
time to make sure that we hear from as many people as possible.
We are transcribing this hearing. We have an official
record of this hearing. And I want to say to all of you the
purpose of this hearing is to make change. We want to learn as
much as we can learn.
And I just need to get one housekeeping part taken care of
and, ask unanimous consent that all members of the subcommittee
be permitted to place any opening statement in the record and
the record remain open for 3 days for that purpose. And,
without objection, so ordered.
And I ask further unanimous consent that all witnesses be
permitted to include their written statements in the record.
And, without objection, so ordered. And I will invite anyone
from the audience as well to submit a written statement, and it
will be part of the record and will be reviewed.
[The prepared statement of Hon. Alphonse D'Amato and public
submissions follow:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. We will not be taking questions from the
audience, but at this time we will be inviting our witnesses.
Our first witness, Mr. James Farsetta, who is the Director of
Veterans Integrated Service Network 3; accompanied by----
[Chorus of boos.]
Mr. Shays. May I make a request? I have to have enough
faith in all of you here that you will recognize that the
purpose of this hearing is to get the truth. I can welcome
applause. I can welcome applause for issues you agree. But I
can just say to you from the bottom of my heart we cannot have
you be rude to people. That is the one request I make. And I
make a request that you respect the work of this committee for
being here and that we will learn and make the changes
necessary.
And, as a Member of Congress, I do not place all the blame
in one direction. Congress has to take some of the blame. The
administration has to take some of the blame as well.
We will get to the truth. We will get to the truth. And at
this time, Mr. James Farsetta, who is the Director of Veterans
Integrated Service Network 3; accompanied by Ms. Maryanne
Musumeci, who is the Director of the Bronx VA Medical Center;
accompanied by Mr. Mike Sabo, Director, Hudson Valley VA Health
Care System. We will also be hearing testimony from Dr. Nancy
J. Wilson, Director, VA Office of Performance Management.
As is the practice of this committee, we swear in all our
witnesses who will be testifying, even Members of Congress when
they testify. And I would invite all of you to stand up and
raise your right hand, please.
Do you solemnly swear or affirm that the testimony you will
give before the subcommittee will be the truth, the whole
truth, and nothing but the truth?
Mr. Farsetta. I do.
Ms. Wilson. I do.
Mr. Sabo. I do.
Ms. Musumeci. I do.
Mr. Shays. For the record, all four have stated in the
affirmative. Mr. Farsetta, it's very nice to have you here
today, sir. Thank you very much. You may begin.
Mr. Farsetta. Thank you.
STATEMENTS OF JAMES FARSETTA, DIRECTOR, VETERANS INTEGRATED
SERVICE NETWORK 3, ACCOMPANIED BY MARYANNE MUSUMECI, DIRECTOR,
BRONX VA MEDICAL CENTER; MICHAEL A. SABO; DIRECTOR, HUDSON
VALLEY VA HEALTH CARE SYSTEM; AND DR. NANCY J. WILSON,
DIRECTOR, VA OFFICE OF PERFORMANCE MANAGEMENT
Mr. Farsetta. Mr. Chairman, Congresswoman Kelly,
Congressman Gilman, Congressman Hinchey, veterans, family
members, community leaders, community individuals, thank you
for the opportunity to appear before the subcommittee and
provide information regarding the restructuring of services and
the quality of care at the Castle Point and Montrose VA Medical
Centers.
As you know, in recent years VA had been receiving mounting
criticism from Congress, General Accounting Office, private
health care systems, and veterans about being a bureaucracy
that cared for too few veterans with too many hospitals and too
many beds. In acknowledgment of these varied concerns, the VA
health care nearly 2 years ago adopted a new vision for how
veterans' health care would be delivered.
Dr. Kizer, the Under Secretary of Health, published his
``VISION for CHANGE.'' In that document, which was shared with
Congress and other stakeholders, he outlined a plan to
streamline the bureaucracy, reduce excess staffing, close
unused beds, improve patient satisfaction, and shift resources
to take care of more veterans on an outpatient basis closer to
their homes. A new network structure of 22 Veterans Integrated
Service Networks, VISNs, was set up to ensure quality care and
improve efficiency. During the past 2 years, VHA has undergone
tremendous change throughout the entire system, including New
York.
The private sector health care community has called this
change innovative and remarkable and has said, ``It is about
time.'' In the New York/New Jersey VISN, we have been doing
many things that our colleagues have been doing across the
country. We have carefully monitored the pace of change to
ensure that care has not been affected. Many of our overall
care indicators with respect to quality have actually improved.
In addition, patient satisfaction across the network has also
improved according to recent surveys.
The VA serves a patient population that is older, more
burdened with disease, and has more problems overall than those
seen by other health care providers. Please understand that
these risk factors would not excuse even a single occurrence of
flawed care, but mistakes occur in every system in which people
are involved in something as difficult as health care.
However, with these allegations of poor care, we take them
very seriously. When those indicators come from within our own
monitoring system or come from the veterans themselves, we do
what it takes not only to make things right but to ensure that
the situation doesn't happen again.
We have carefully reviewed each case that has been brought
to our attention during the past few months either by the
media, our elected representatives, veterans, or veterans'
family members. It troubles me deeply about the stories of poor
care. And if I didn't say it before and if we didn't say it
earlier, I want to offer my personal apologies to any veterans
and their families for care that we did not provide that we
should have provided.
We can all understand the pain of a family member whose
sole purpose is the compassionate care and treatment of their
loved ones. Our veterans have earned this care because they
gave so much of their service to this country. And the only
reason that we are here today is because of that service.
For those cases that have been spotlighted, I want every
patient and family member to know that we are working to ensure
that their concerns are fully addressed and that any failures
that may have occurred never happen again. This is my first
priority and, therefore, the priority of each and every staff
member at Castle Point and Montrose and in the rest of the
network.
For highlighting many of these incidents, I want to thank
our congressional representatives and our service organization
leaders for their undying concern and efforts on behalf of our
veterans.
We do acknowledge that there are some longstanding issues
that are cause for concern I am not completely satisfied with
the overall physical plant and cleanliness of the environment.
There are problems with waiting times to see care-givers, waits
to get appointments, and waits at our pharmacies. Our standard
expectations for basic customer services are not being met as
often as they should be. There are also issues with staff-to-
patient communication and staff-to-family communication that
also exist. These problems are either being addressed or have
been addressed. And I won't be satisfied until our patients and
family members tell us that they are satisfied.
As I have said before, I will never tell you that every
veteran who enters our hospitals or clinics gets perfect care.
I can't say that because we could never achieve 100 percent
perfection. I will tell you, however, that Castle Point and
Montrose VA Medical Centers and Nursing Homes took care of over
16,000 veterans during the past year. And the vast majority of
those patients are pleased with the care that we provide.
Our monitors, both internal and external, as well as
discussion with veterans and their families indicate that the
care provided in the VA Hudson Valley Health Care System is
quality health care. However, to provide us with even greater
assurance, I have asked the two medical centers to contact a
large sample of families of our inpatients to see if the
allegations of systematic substandard care were true or
perceived to be true.
I am happy to report that the overwhelming majority of
families, patients who were contacted are very satisfied with
the care that they received. However, there clearly is a
problem as evinced by the people in this room today. And I and
my staff are here to listen to their concerns.
As for the VA medical inspector's visit, we anxiously
await, as do the congressional representatives, the results of
the team's review of the care provided to our veterans. I
initially requested the review by the Office of Medical
Inspector and have ensured that the Hudson Valley Medical
Centers provide full cooperation in this important analysis. I
can tell you that we are not waiting for the final report to
make changes to further ensure the quality health care of our
veterans.
Mr. Mike Sabo, who is the new permanent Director of the VA
Hudson Valley Health Care System, has experience in operating a
large two-division hospital. He brought that experience to the
Hudson Valley and followed up with his excellent work at the
Brooklyn VA Medical Center.
This was also followed by the excellent work done by Ms.
Maryanne Musumeci, who was at Montrose-Castle Point for the
past 3 years attempting to deal with a number of issues that
have been raised in the media and raised by our congressional
representatives.
Finally, in addition to serving over 3,500 brand new
veteran users, we have also improved access and services to
veterans in the entire Hudson Valley region. We have opened a
new outpatient clinic in Rockland County and have just received
approval for a clinic in Yonkers. We have also expanded
services in White Plains, and have clinics currently in process
for Kingston and Monticello. It is truly my desire to open a
number of new clinics in all corners of the Hudson Valley to
better serve our veteran patients. Veterans who use these
clinics are overwhelmingly satisfied with the services that are
provided. A new mobile health van is also operating exclusively
in the Hudson Valley to reach out to areas that have been
under-served by the VA and to pockets of veterans in socio-
economically disadvantaged areas, as well as direct outreach to
homeless veterans in our more urban localities.
I want to thank you for the opportunity to share my
thoughts with you today. Please be rest assured that our first
priority is compassionate, high-quality care for our Nation's
veterans. Anything less than that is unacceptable to me and the
dedicated employees of the VA health care system.
I will gladly attempt to answer any questions that any of
you may have.
[The prepared statement of Mr. Farsetta follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. Thank you, Mr. Farsetta.
Dr. Wilson.
Ms. Wilson. I, too, thank the committee for the opportunity
to attend this hearing and listen to the concerns of all
veterans here today.
VA has multiple strategies to assess and monitor and
improve the quality of care that we deliver. A number of these
include credentialing and privileging, accreditation programs,
and performance indicators that measure how well we deliver
bread-and-butter care to veterans across the country.
In addition to that, we also have as one of our mainstays
our customer feedback program that includes our patient
advocacy program, our satisfaction surveys, and also our
complaint assessment and tracking and resolution.
In addition to that, we have an incident review process.
And, in fact, we've recently, on June 6, implemented a policy
to ensure that each and every incident that results in an
untoward outcome be examined in depth to assure that that event
never occurs again. Such events, described as sentinel events,
will now be reported to headquarters within 48 hours of their
occurrence along with the reviews and recommendations for
system redesign.
Our outside independent medical----
Audience Participant. Hold it.
Audience Participant. Hold it. Hold it.
Audience Participant. Hold it.
Mr. Shays. Slight recess.
[Recess.]
Mr. Shays. The committee will come to order. Dr. Wilson,
you have the floor again.
Ms. Wilson. Thank you.
As I had said, on June 6, we implemented a policy to ensure
that each and every incident that results in an untoward
outcome be examined in depth to make sure that the system is
redesigned in such a way as to prevent that incident from ever
occurring again. And we now require that all such sentinel
events be reported to headquarters within 48 hours of their
occurrence along with the reviews and recommendations for
system redesign. The failure to report may result in
disciplinary action. These reviews will be assessed for their
adequacy by our outside and independent medical inspector's
office.
In light of the need to listen to folks, that ends my
testimony. And I will be happy to answer any questions.
Mr. Shays. Thank you, Dr. Wilson.
We will have questions, and we will begin with Mr. Gilman.
Mr. Gilman. How about Dr. Sabo?
Mr. Shays. No, no. My understanding was that they were
accompanying you, Mr. Farsetta?
Mr. Farsetta. Yes.
Mr. Shays. And they will respond to questions and assist
you? But we have two statements.
Mr. Farsetta. Right.
Mr. Shays. We want to get to the service representatives.
Then we want to get to the members of the audience and allow
them to address this committee.
Mr. Gilman. Thank you, Mr. Chairman.
I hope that the young lady in the back there is feeling
better. I understand it was just heat exhaustion.
Mr. Farsetta, could you please explain for the committee
the VA's response to those allegations that appeared in our
local newspaper which allege that the mortality rate at Castle
Point doubled from October 1996 to April 1997? There's been a
great deal of comment with regard to that information.
Mr. Farsetta. Well, my response to that is that we have
looked at all the data. We have gone back essentially 3 years,
compared the mortality rate over that period of time. We see
monthly fluctuation, but we see no marked change in the
mortality rate at either Castle Point, at Montrose over the
past 3 years.
One of the newspapers in this area was given all the
information that we had. They sent it out to an independent
statistician. He reviewed the data. He arrived at the same
conclusion.
Dr. Wilson could probably respond to that question since
they have also looked at the data.
Ms. Wilson. Yes. The statistician in my office also looked
at the data for the times in question and found no difference
in the rate from 1996 to 1997 for those months. There's no
statistically significant difference in the rates.
Audience Participant. You can get stats to say anything you
want.
Mr. Gilman. Mr. Sabo, who is our new director of our Castle
Point facility, can you tell us what's been done to improve
communications between staff and patients since this situation
started last May?
Mr. Sabo. Thank you, Congressman. And it is a pleasure for
me to be back in the Hudson Valley. Part of what I have
instituted since I got there on July 20 was to re-energize
patient councils in the nursing home units. This would be an
attempt to try and solicit feedback from those patients on
areas where they have concern with the quality of the food, the
quality of the patient care, recreational activities.
In addition to that, I've reinstituted family council
meetings at both the Castle Point and Montrose facilities,
whereby representatives of the families will have a venue to
come in and talk about issues regarding the care being
delivered at both places.
I am going to be assessing our patient representative
program to ensure that both of those--that's the ombudsman
piece of our program--to make sure that they're actually
listening to folks and that information is fed to me on a
regular basis.
I've met with many of the county veterans' representatives
already and talked to them about their concerns they have
toward the facility and spoke to families.
I do have an open-door policy. If there are concerns, I
certainly want to hear those. And I'll make every attempt to
correct those areas that need to be corrected.
Mr. Gilman. Thank you.
Mr. Farsetta, you've already improvised a number of
reductions in staff and some of the expenditures. What future
reductions in staff and services can be expected in the next 6
months?
Mr. Farsetta. I'm not anticipating any future reductions in
staff over the next perhaps year or two. I know that there was
a letter that was distributed by Acting Secretary Gober or
Secretary Designee Gober indicating that neither the Castle
Point nor the Montrose VA facility will be closing.
Our goal essentially is to in a number of areas, as I
mentioned earlier, attempt to expand services so we could reach
out to more veterans in the Hudson Valley area.
I neglected to mention in my opening statement that in
response to, I believe a comment made by, you, that the Chief
of Medical Administration is currently meeting this afternoon
with representatives from our other hospitals exploring the
feasibility of providing some surgical services to the
residents and veterans of the Hudson Valley area.
Mr. Gilman. That would be contract services to the local
hospitals?
Mr. Farsetta. That's correct.
Mr. Gilman. So they don't have to travel to Albany or to
Bronx?
Mr. Farsetta. That is correct.
Mr. Gilman. Appreciate that.
Dr. Wilson, you're in the--we're talking about Castle
Point. Dr. Wilson, what are the short-term plans for the Castle
Point facility and the long-term plans? We keep hearing that
Castle Point may be eventually phased out. Can you tell us what
your program people are doing with regard to Castle Point?
Ms. Wilson. I would quote a letter from Dr. Kizer to the
honorable Ben Gilman, Mr. Gilman, that says the Department of
Veterans Affairs has no plans to close the Castle Point Medical
Center.
However, I would also like to reaffirm that in accordance
with Network 3's strategic plan, the following are some of the
anticipated changes in service delivery models and clinical
care strategies, over the next fiscal year: integration of
radiology, nuclear medicine, and lab services with the Bronx VA
Medical Center, development of a consolidated kitchen
throughout the network utilizing cook-chill technology,
development of two to three community-based clinics in the
Castle Point catchment area, and initiation of a community-
based mobile health van.
Mr. Gilman. And then from what you're telling me, there is
no immediate plan to close Castle Point. Am I correct?
Ms. Wilson. That's correct.
Mr. Gilman. Nor close Montrose. Is that correct?
Ms. Wilson. That's correct.
Mr. Gilman. Thank you.
Audience Participant. Put it in writing.
Mr. Gilman. My time has run, Mr. Chairman.
Ms. Wilson. It is in writing.
Mr. Shays. I just want to make sure that you all realize
this is testimony under oath.
Mr. Hinchey.
Audience Participant. That don't mean crap.
Mr. Hinchey. Ladies and gentlemen, first of all, let me
thank you for some things that you have talked about here this
afternoon in your testimony, which I think will be helpful and
will improve care for veterans.
First of all, Mr. Farsetta, you mentioned the establishment
of clinics in Rockland County and in Westchester County and
plans for a clinic in Kingston and one in Monticello. We have
been working with you on these clinics, and I think that that
is a very important and very positive step forward.
Dr. Wilson, you mentioned that there will be a number of
reports that will be issued if there are untoward incidents I
think you put it. I think that is very good, but let me ask you
a couple of questions about that.
First of all, how would you define an untoward incident?
Ms. Wilson. We define a sentinel event in the same way that
the Joint Commission of Accreditation of Hospitals does, which
is permanent loss of life, limb, or function. We also----
Audience Participant. How many civilians have that?
Ms. Wilson. Those sentinel events are what will be called
into headquarters. They will be called from the facility to the
network office within 24 hours of their occurrence and then 24
more hours to the headquarters office. We will then track the
results of the reviews of all of those events.
Mr. Hinchey. Is this a new policy that you've recently
implemented?
Ms. Wilson. June 6, 1997.
Mr. Hinchey. June 6 of this year? Will there be any outside
review of those event reports?
Ms. Wilson. The Medical Inspector's Office will review the
adequacy of the reviews that are done by the facilities and the
networks in addition to our headquarters team looking for
system redesign issues that we might want to implement across
the country.
Mr. Hinchey. So there will be an outside objective analysis
of those reports outside of the VA itself?
Ms. Wilson. Yes.
Mr. Hinchey. Mr. Farsetta, you mentioned in your report, in
your statement, and what you say here is, ``Many of our overall
care indicators with respect to quality have actually improved.
In addition, patient satisfaction across the network has also
improved according to recent surveys.''
That statement strikes at the heart, really, of my concern
because, first of all, it is counter-intuitive. Second, it runs
counter to all of the evidence that we have seen over the
course of the last couple of years. [Applause.]
It is absolutely essential if we are going to get to the
bottom of this problem--and I think we can all agree that there
is a problem here. It is not just a problem of perception.
[Applause.]
It is a deep and abiding problem. If we are to get to the
bottom of this, we, first of all, have to confront the
situation honestly and objectively.
And I must say to you, sir, that those kinds of statements,
which I have heard you say before in private meetings that we
have had and in meetings with the VA that we have had--I've
heard you say those things before. And I just find it
absolutely incredible because the fact of the matter is that we
see time and time again documented examples that run completely
to the contrary.
Mr. Farsetta. I don't want to get overly defensive about
that because, as I mentioned in my statement, there's clearly
an issue here. I'm going to attempt to respond to that in two
ways. The VA does a survey, and Dr. Wilson can speak about it.
It's a scientific instrument that's mailed out to veterans. And
veterans respond to that instrument.
We have also hired the Gallup Corp. to take that instrument
and utilize that instrument, mail it out to veterans in the
network, specifically in the Hudson Valley area. And everyone
doesn't get a questionnaire. It's sent out to a sampling, what
they consider to be a statistically-significant sampling. It's
mailed out.
And what the survey says, the survey doesn't say that
everybody is happy with everything that's going on. What the
survey results indicate, that as compared to services that
veterans received last year, they are happier this year than
they were last year. It doesn't mean that there aren't many
areas for improvement. I'm not suggesting that, and I wouldn't
suggest that.
[The survey referred to follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Hinchey. I think that it's important for us to look at
this again comprehensively and objectively. And I am going to
forward to you copies of the complaints that we have received
in our office. They are numerous, one might say legional. And I
know that the other members of the committee have received
more, I believe, in most instances than I have.
And I would ask that they be factored into this analysis so
that we do not have a kind of rose-colored glasses analysis of
this situation and that we look at it carefully and objectively
and completely and do so in the context of the information that
has come to us in addition to the survey that you have
received.
There is something called the ``Farsetta report.'' Now, I
have not seen the ``Farsetta report,'' but I am anxious to do
so. And I have asked the VA on several occasions if they would
kindly make available to us a copy of that report. I hope that
we will get a copy of that report directly so that we can give
it some careful analysis.
I know that the report was some time ago, but it has been
reported to us that many of the actions taken by Under
Secretary Kizer have been driven to a large extent by the
recommendations contained in the Kizer report. Is that
accurate?
Mr. Farsetta. There certainly were recommendations in that
report. I happened to chair a committee. And that report
specifically was looking at some fairly substantial funding
reductions in the VA.
I think that as it relates, for example, to some of the
integrations and as it relates to combining some administrative
services, I think that there are similarities. But I don't
think that there are many similarities or an overwhelming
variety of similarities between the ``Farsetta report,'' which
probably was done in maybe 1992, 1993 or 1994, and what's
currently going on. There certainly are some items that are of
a similar nature.
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Mr. Hinchey. So the report, then, is 4 to 5 years old? It
was done 4 or 5 years ago?
Mr. Farsetta. Yes.
Mr. Hinchey. OK. Again, I want that report to be available,
not just to myself but to other members of the committee. I
think it's important for us to look at it so that we can see
what has been driving these actions and we could correlate the
thinking that went on that occasioned some of the things that
have been taking place within the VA. I think that's important.
I mentioned the clinics. And I congratulate you on that. I
fully support what you're doing in that regard. I think that is
going to be helpful. And I think it will improve the quality of
care.
I also would make the observation, however, that it is not
the outpatient care that is of particular concern. It seems to
me based upon my observation that most people are fairly
satisfied with the quality of care that is being delivered on
an outpatient basis. That's the quality of care which would
come from these clinics.
[Chorus of boos.]
Mr. Hinchey. That may not be the case. [Laughter.]
[Applause.]
So far as the information that has come to our attention,
it is primarily the inpatient care----
Audience Participant. That's right.
Mr. Hinchey [continuing]. That is really at the larger part
of the issue. So I think that while the clinics are going to be
helpful--and I fully believe that that does not reduce the need
for our commitment to assure that the quality of care
internally continues to be good.
Mr. Farsetta. I agree.
Mr. Hinchey. Now, as I understand it, your intention is to
contract out for the care of these clinics. Is my understanding
correct about that?
Mr. Farsetta. No. I think that we are going to be joint
venturing with Network No. 2 in the Kingston clinic. And the
model that they use is they do some contracting out for their
community care, their outpatient care. And we're going to pilot
with them. In some of the other clinics in Network No. 3, we
have not gone to the contract model. We have used a staff
model.
There are some individuals, some veterans, who seem to like
the contract model. We're going to try the contract model and
see how it works and whether the veterans like it or not.
Mr. Hinchey. I'm also aware of--you mentioned a few moments
ago--let me put it this way--that there were no further
reductions in staff that are being completed. But I know also
that you've sent out information recently which talks about
buyouts.
Mr. Farsetta. Yes.
Mr. Hinchey. Now, as a result of those buyouts, there will
be a reduction in personnel at both hospitals. I think the
number ultimately is something in the neighborhood of 28.
Now, you were obviously considering that when you said that
there would be no further reduction. So what you're saying is
that after these 28 buyouts, there will be no further
reductions in personnel contemplated?
Mr. Farsetta. That's correct.
Mr. Hinchey. That's correct.
Mr. Farsetta. I apologize for not factoring that into
consideration. And let me raise this and so I can be straight
about it, that there are some positions that may be eliminated.
OK?
So we may eliminate any administrative position. And that
job will not be filled, but then we will substitute someone
else into that job in a different area, perhaps in a patient
care area. So it is conceivable that 28 folks may leave, but 28
other people may be hired in very different jobs than the
people who were in those jobs.
Mr. Hinchey. Well, that's nice to hear. However, I notice
the word ``conceivable,'' and I am not comfortable with the
word ``conceivable.'' If you are telling me that when these 28
people leave and in the context of their leaving they will
largely support administrative personnel, that you are
analyzing this situation in a way that you expect to bring in
additional health care personnel to fill those 28 blank
positions, then I find some comfort in that. But if you're
telling me that it's only conceivable, then I'm not
comfortable.
So how likely is it to happen?
Mr. Farsetta. Since I'm on the road, I don't want to give
you a definitive answer, but I will provide that information to
you factually.
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Mr. Hinchey. My time is up, and I thank you.
Mr. Shays. At this time, Ms. Kelly, you have the floor.
Ms. Kelly of New York. Thank you.
Mr. Farsetta, when you and your deputy directors are graded
on your annual review, isn't it true that you're graded on the
basis of your ability to implement the VA's long-term
programming as written in the performance agreement, network
director performance measures for the VISNs?
Mr. Farsetta. That's correct.
Ms. Kelly of New York. Are not four out of five incentive
measures in your performance agreement based on fiscal, rather
than patient care standards?
Mr. Farsetta. No. Nancy, you may want to speak to that.
Ms. Kelly of New York. I have that right here in front of
me, and it looks that way to me. [Applause.]
Ms. Wilson. That is not true.
Mr. Farsetta. That's not true.
Mr. Shays. Excuse me. I need you just to repeat whatever
answer because we are transcribing this, and I just need to
make sure your responses are clear. I'm sorry. Dr. Wilson.
Ms. Wilson. They are not fiscal. Four out of five of the
performance measures are not fiscally driven.
Ms. Kelly of New York. How do you account for that when
they're talking about incentive measures as being patient
satisfaction is the last one listed, bed days of care per
patient--that means cutting them--insufficiency in C&P exams?
These are things listed as incentive measures--the ambulatory
surgery, primary care enrollment--these are things listed as
incentive measures.
Ms. Wilson. I would like to speak to that. The patient
satisfaction measure is one of the first times in the history
of health care that administrators----
Ms. Kelly of New York. Let's deal with the rest of them
because that's the last one.
Ms. Wilson. There is no order to them in terms of the
listing that you have. Patient satisfaction is very definitely
an outcome measure that is a quality outcome measure. And this
is one of the first times in health care that administrators
are held accountable for their very livelihood based on patient
satisfaction scores.
The chronic disease index is a measure of how well we do
things like get eye exams for our diabetics, how well we assess
their sensation in their feet, how well we check their pulses,
whether or not we measure blood tests for them. Our ischemic
heart disease measures relate to whether or not patients who
have had a heart attack get aspirin or beta blockers, a
medication that has been shown to save lives, how well we
monitor their cholesterol management. Our obesity measures
relate to giving counseling for weight and exercise. Our
hypertension measures relate to----
Ms. Kelly of New York. I'm sorry, but you're listing
things. What I'm looking at is this incentive measures, where,
in fact, I'm talking about in the top part of this agreement,
it says, ``categorized by specific mission goals.''
Ms. Wilson. I think that you have a document that is old.
Ms. Kelly of New York. I have a document that is from the
VA.
Ms. Wilson. I wrote the 1997 performance measures
agreement, and I can submit for the record every measure that
is in there. I'm intimately familiar with them.
Ms. Kelly of New York. This document is 4-17-96. Has this
been rewritten?
Ms. Wilson. It has been rewritten.
Ms. Kelly of New York. This is the latest one that Dr.
Kizer's office was able to supply us.
Ms. Wilson. I will be happy to submit the 1997 performance
agreements, where the majority of the measures are quality-
driven.
Ms. Kelly of New York. Dr. Kizer said this was the latest
one.
Mr. Shays. Would the gentle lady yield?
Ms. Wilson. It's a mistake.
Mr. Shays. Just for the record of the committee----
Audience Participant. Dr. Kizer comes up with----
Mr. Shays. Excuse me. Excuse me, sir. Just for the record,
just because we need to make sure we're clear on this, the
document that Ms. Kelly asked you, the document that preceded
the one that you worked on, was that the operative document?
Ms. Wilson. That was the operative document between May
1996 and October 1, 1996. The operative document for fiscal
year 1997 is the one that you must not have. We were able to
implement a number of quality indicators that were quantitative
in the fiscal year 1997.
In the fiscal year 1996, the quality indicators were
instituting telephone triage, admission and discharge planning.
There are a number of things on there.
Mr. Shays. Dr. Wilson, let me just be really clear on this
just because it would be in terms of candidness. When you were
responding to a question, it sounded to me like this wasn't a
document that had been adhered to by the VA. I just need to
know what----
Ms. Wilson. Oh, it was.
Mr. Shays. In the document that she's referring to that
preceded the reform, was this the way an individual was graded?
Were those----
Ms. Wilson. This was the way. This document represents how
the network directors were graded between May and October 1996.
Mr. Shays. So the candid answer would have been, ``This was
the document used, but we have changed it?''
Ms. Wilson. That would be the candid answer, but the other
part of that answer would be that there are more quality
indicators than financial indicators in that 1996 document.
Mr. Shays. OK. Can we just take the 1996 document and
just----
Ms. Wilson. Yes.
Mr. Shays. If you would just tell us what is different? And
I would give back the floor to the gentle lady, who really
controls the time here. She had five items. And I just need to
know. You don't seem to have that document in front of you, but
are they--is this the only document you have?
Ms. Kelly of New York. I have another copy.
Mr. Shays. You have another copy? Could you just tell us if
that document represented a complete evaluation or what would
have been left out of it?
This was given to you by Dr. Kizer?
Ms. Kelly of New York. It was given to me from two
different VA sources: Dr. Hogan and Dr. Kizer. And they said
that this was current.
Ms. Wilson. If I may read the first sentence, ``The
following measures have been chosen for inclusion in the
network director's May to September 1996 performance
agreements.''
Mr. Shays. And in that, what are the items, just in that--
--
Ms. Wilson. ``Hire your key personnel; write a strategic
plan; implement telephone liaison programs at all facilities; a
temporary lodging program; institute a system where people have
beds available that don't need to be admitted to the acute care
wards but are traveling long distance for outpatient
procedures; admission and discharge planning programs;
utilization review programs; clinical guidelines; functional
assessment of spinal cord injury patients; not delaying
prosthetic orders; primary care enrollment,'' which is the
veteran saying there's somebody in charge of their care;
``ambulatory surgery, which is a financial utilization measure;
insufficient C&P exams'' means that when the veteran comes for
a C&P exam, a comp and pen exam, it's done adequate the first
time. ``Bed days of care'' is a financial utilization measure.
Mr. Shays. Does this represent--I appreciate the gentle
lady yielding me back her time for a second. Does this
represent what new mandates in addition to other mandates that
exist or is this the total in which a supervisor is going to be
evaluated?
Ms. Wilson. This is part C of an overall performance plan,
where there is a part A and a part B as well.
Mr. Shays. Thank you.
Ms. Kelly of New York. Thank you very much.
I have two more questions, Mr. Chairman. Is that all right?
Mr. Shays. Sure.
Ms. Kelly of New York. OK. Mr. Farsetta, to date how many
millions of dollars have you taken out of the Castle Point-
Montrose system according to the implementation of VERA?
Mr. Farsetta. I would say in the vicinity as if one looks
at 1996 to 1997----
Ms. Kelly of New York. A full fiscal year if you can give
me that, please.
Mr. Farsetta. A total of about $4 million.
Ms. Kelly of New York. About $4 million?
Mr. Farsetta. Yes.
Ms. Kelly of New York. And we are due to have a total
reduction of about $149 million. Is that correct?
Mr. Farsetta. $148 million under the VERA model.
Ms. Kelly of New York. $148 million under the VERA model?
Mr. Farsetta. But that's for the entire network. That is
just not for the two hospitals.
Ms. Kelly of New York. OK. For the VERA network?
Mr. Farsetta. For the network.
Ms. Kelly of New York. Which you are in charge of.
Mr. Farsetta. That's correct.
Ms. Kelly of New York. Is that not correct?
Mr. Farsetta. That's correct.
Ms. Kelly of New York. You are in charge of the entire
VISN?
Mr. Farsetta. That is correct.
Ms. Kelly of New York. Now, according to this performance
agreement----
Mr. Farsetta. Right.
Ms. Kelly of New York [continuing]. The incentive measures
that are incorporated in this agreement, from what I understand
from this, you will receive a bonus for cutting the full $149
million from our network when you achieve the reduced patient
care incentive measures as your direction agreement.
[Chorus of boos.]
Mr. Farsetta. I think that I'm not going to respond to
that. I'll let Nancy respond to that since Nancy is the one who
authored that. And it really is much greater than just cutting
the dollars.
Ms. Kelly of New York. Is it or is it not----
Mr. Farsetta. I could cut the dollars and lose my job.
Ms. Kelly of New York. Is it or----
Mr. Shays. Excuse me. The gentle lady will suspend. Believe
it or not, we do want to hear what the witness is saying. And I
just plead with you. As veterans, I plead with you to show
respect to individuals whom you may--I plead with you to show
respect as veterans to people who are testifying to this
committee.
Dr. Wilson, if you would respond to that question? And
would you ask the question again?
Ms. Kelly of New York. All right. I'd like, really, Mr.
Farsetta's answer if I could get it before----
Mr. Shays. Well, Dr. Wilson----
Ms. Kelly of New York [continuing]. Dr. Wilson, but it's my
understanding, Mr. Farsetta, that you will receive a bonus for
cutting the full $149 million from our network based on
achieving the reduced patient care incentive measures as per
your directions agreement.
Mr. Farsetta. Not true.
Ms. Kelly of New York. Well, that's what it says in the----
Mr. Farsetta. Not true.
Mr. Shays. Dr. Wilson.
Ms. Wilson. I concur with Mr. Farsetta. The performance
measures in the 1997 agreement are a list of measures, some of
which address utilization and as a proxy for cost. But all the
other measures are quality measures.
And it is the composite performance on the performance
agreements that makes up the majority of the rating that the
network director achieves in that timeframe.
Ms. Kelly of New York. I want to quote to you from a
General Accounting Office testimony that was in front of the
Senate Subcommittee on VA, HUD, and independent agencies, the
Committee on Appropriations. This was testimony that was
released Thursday, May 1, 1997. On Page 17, it says,
``Performance measures and standards developed by headquarters
are the key components of VA's monitoring process. Headquarters
holds network directors accountable for making progress toward
VA goals by including measures and standards of performance in
the director's contracts.'' And it goes on in this report to
state that the directors receive a bonus directly due to the
amount of money they are able to save in their VISNs.
Now, I need to know whether this is true or not. I think
the people in this room are entitled to an answer. [Applause.]
Mr. Farsetta. That isn't true. We were given an answer.
That is not true. It is not true.
Ms. Wilson. It is not true. It is not true. The bonus----
Mr. Shays. Excuse me. The lady will suspend. I'm sorry. We
cannot hear the witnesses when we hear response from the
audience. And I will continually interrupt this hearing until
we are able to hear the witnesses. I am going to stay here as
long as I have to stay, but I would like this hearing to be
conducted in a way we can hear the witnesses.
Dr. Wilson, I apologize for the interruption.
Ms. Wilson. The bonuses are given on the basis of
performance on part A, part B, and part C of the performance
plan. The measures that we have talked about are part C. There
is no measure in the agreement that says you must cut this
amount of money.
Mr. Gilman. Will the gentle lady yield?
Ms. Kelly of New York. Yes, I will.
Mr. Gilman. Dr. Wilson, did Mr. Farsetta receive a bonus
for the reductions and the revision of service in our region?
Ms. Wilson. I didn't give him that bonus. So I probably
can't officially answer that----
Mr. Gilman. Well, did the administration give a bonus? Did
he receive a bonus?
Ms. Wilson. Yes.
Ms. Kelly of New York. And, Mr. Farsetta, it is my
understanding that you will continue to receive bonuses for
every time that you are able to take the money levels down
until we reach that $150 million out of here. Is that correct?
Mr. Farsetta. No.
Ms. Kelly of New York. If not, why not? That's exactly what
you said.
Mr. Farsetta. No, that's not what I said. I think that what
Dr. Wilson indicated is that there are three parts to the
performance agreement that I have with Dr. Kizer and that I
need to demonstrate exceptional performance in all three parts,
not in a single entity in one part of the performance
agreement. So the bonus is not predicated on the amount of
dollars I cut.
Ms. Kelly of New York. Remember, I have that agreement in
front of me, Mr. Farsetta. We're talking about the amount of
primary care enrollment. We're talking about the amount of
ambulatory surgery. We have insufficient compensation and
pension exams.
Mr. Farsetta. That has to do with a qualitative standard--
--
Ms. Kelly of New York. That's correct.
Mr. Farsetta [continuing]. Not a quantitative standard, a
qualitative statement on the quality of C&P examinations gave
and the amount that was remanded because they were incomplete.
Ms. Kelly of New York. The bed days of patient care, it
says here, ``To be fully successful, the bed days of patient
care per patient will decrease in the aggregate of 20 percent.
To be considered exceptional,'' which you just said you wanted
to be, they have to decrease in the aggregate by 30 percent.
Now, Dr. Wilson, does that sound familiar to you?
Ms. Wilson. Those were the fully successful and exceptional
performance goals in 1996, yes, for decreasing bed days of care
across the county.
Ms. Kelly of New York. We don't need to go into this any
further. I think that I would like to submit some other
questions later, but there are a lot of people standing.
But, Mr. Farsetta, I have one last question for you. How
much of an incentive bonus did you receive for your reforms?
Mr. Farsetta. $16,000.
Ms. Kelly of New York. $16,000?
Mr. Farsetta. That's correct.
Ms. Kelly of New York. Thank you.
[Chorus of boos.]
Mr. Shays. Before I recognize Mr. Hinchey for backup
questions, I do want to make sure we make sure the record is
accurate. And I just again want to ask this question. As it
relates to the performance of any supervisor who is given a
bonus, is this one factor?
Dr. Wilson, I just want to make sure that we're really
clear because the answer was pretty definitive that the
reduction was not a factor in the bonus. Isn't a more accurate
response that it would be one of a number of factors that would
be utilized in determining a bonus? I just think it's important
that both of you be very clear in responding.
And I apologize for the noise that you're receiving because
this is important testimony. And I want you to think carefully.
Ms. Wilson. I can speak to the fact that the objective
measures in the performance agreement between September and
October were part C of a performance plan that had a subjective
component as well as the objective performance on these
measures. And beyond that, the decision that the Under
Secretary makes as far as who gets bonuses would be his. Does
that help?
Mr. Shays. Well, it helps, but we're going to just pursue
it a little bit better here.
I want to encourage people who do a good job to receive a
bonus if they're doing a good job. And if they don't do a good
job, I obviously don't want them to receive a bonus.
It would strike me logically that there would be many
factors for determining who would receive a bonus or not. I'm
just a little concerned that the emphatic statement that this
was not a factor under oath could be something that would be
not something I'm comfortable with.
The issue, it seems to me, is that you would be graded, Mr.
Farsetta, on a number of factors, just not part C. I need to
know that it does not include that at all, it is not a factor
at all, or that it is a factor along with a whole host of other
issues. That's the two choices because the way the record
stands now, it's not a factor at all.
Ms. Wilson. I would amend my testimony such that the
performance plan includes a subjective component. And I cannot
testify to all of the elements that are in or out of comprising
the Under Secretary's decision about that subjective part. So I
would agree with you if that--I would agree with you.
Mr. Shays. OK. I'm going to ask it another way, too. Mr.
Farsetta, do you agree with that response? No. Don't be----
Mr. Farsetta. Well, she----
Mr. Shays. Yes.
Mr. Farsetta. Well, the reality is that she's closer to the
logic Dr. Kizer uses to evaluate, closer than I am.
Mr. Shays. Well, but that----
Mr. Farsetta. It would be disingenuous of me to suggest
that part of financial management wouldn't be part of the
consideration for my bonus.
Mr. Shays. Would not be? I'm sorry. I missed that. It would
be disingenuous what?
Mr. Farsetta. To think that it wouldn't be part of the
consideration.
Mr. Shays. Well, you gave a very strong, emphatic answer in
the beginning. And basically what I'm suggesting is you are
amending your answer.
Mr. Farsetta. That's correct.
Mr. Shays. Not to pull this to the ``nth degree'' here, but
I want to know from you, Dr. Wilson: What does meeting VERA's
targets play in the evaluation? Is it 1 percent, 10 percent, 40
percent? Can you get a bonus if you have not met VERA?
Ms. Wilson. I have never had a discussion with the Under
Secretary regarding VERA's----
Mr. Shays. Let me just----
Ms. Wilson [continuing]. Role in having bonuses. So I don't
know the answer to that.
Mr. Shays. Well, your response has been amended. We'll
follow it up, and staff will followup. I would like a sense of
the answer to that question that Ms. Kelly asked.
Mr. Hinchey, you have the floor.
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Mr. Hinchey. Well, Mr. Chairman, you have asked the
followup questions that I was intending to ask because I think
it is important to clarify this situation. Normally when people
think, citizens think, about the people who work for the
Federal Government, they generally think of them as being
covered by Civil Service. But that is not the case in this
particular situation, I gather, Dr. Wilson.
People in supervisory positions--well, Mr. Farsetta, you
are not a Civil Service employee.
Mr. Farsetta. Oh, yes, I am.
Mr. Hinchey. You are? You are covered under Civil Service?
Mr. Farsetta. Well, we're part of the Senior Executive
Service, which is part of Civil Service, yes.
Mr. Hinchey. And under that circumstance, there is a ruling
which provides for the Veterans Administration to provide
bonuses to people for what is evaluated to be a higher degree
of service?
Mr. Farsetta. Yes.
Ms. Wilson. Technically, it's a performance award. My
understanding is that the Federal Government does not give
bonuses, but it is a performance award. But to me it's the same
thing.
Mr. Hinchey. Pretty much the same thing, isn't it?
Ms. Wilson. Yes. I'm just trying to be precise. I apologize
to the group.
Mr. Hinchey. Well, I think the concerns of the Members of
Congress are apparent at this particular----
Mr. Shays. Excuse me. Would the gentleman suspend? Excuse
me. We need order here. Thank you.
You have the floor.
Mr. Hinchey. I would just say this for myself. Particularly
in view of my experience over the course of the last couple of
years with the VA, conversations I have had, questions that I
have asked and not received answers to, my experience over the
last couple of years raises certain questions. And at question
here is the issue of motivation.
And what is on the minds of the Members of Congress is:
Have we gotten to a point where we are rewarding people in
sensitive positions within the Federal Government to cut
funding, cut the amount of money that is being spent in such a
way that jeopardizes the people that are supposed to be served?
[Applause.]
And I raise this this way because this is an important
public policy consideration, one that needs to be examined by
this committee, by the Congress, and by the administration. I
think that is critically important.
Now, I understand what is driving this. What is driving
this is the alleged need to balance the budget and to cut
funding and all of that business. But it seems to me in my
observations recently that we have gone over the edge and that
too much of our decisions are being driven purely by fiscal
matters and not enough of them are being driven by human
considerations. [Applause.]
I would hope--I'm sure that the VA administrator, the
acting administrator, Dr. Kizer, and others are aware of these
hearings and they will go over this testimony. And I think it's
very important for us to look at this question because this is
a fundamental issue of public policy. And I think it is one
that has to be reviewed because it's my judgment that we have
gone too far. [Applause.]
Mr. Shays. Thank you.
Mr. Gilman has a followup question. Then we're going to go
to our next panel.
Mr. Gilman. Dr. Wilson, in looking over the incentive
measures under the performance agreement, I find that--I'm
looking at the old one. If this differs from the new one,
please let me know. We're looking at the performance measures.
The denominator for calculating the percentage of patients
enrolled in primary care will be ambulatory care customer
satisfaction. And to be fully successful, 65 percent of the
patients enrolled in primary care, exceptional performance
requires that 90 percent of VISN number of patients in the
aggregate be enrolled in primary care. Is that still part of
the performance?
Ms. Wilson. Yes, it is. And the percentage is calculated on
the basis of veterans who are surveyed with the customer,
patient, satisfaction survey and answer ``Yes'' to the question
``Is there one person or a team in charge of your care?'' We
call that primary care enrollment.
Mr. Gilman. With regard to ambulatory surgery, your
achievement level states, ``To be considered fully successful,
at least 25 percent of the surgical cases performed in VISN or
50 percent of the surgical and invasive diagnostic procedures
combined will be performed on an ambulatory basis. And to be
considered exceptional, 40 percent of surgical cases performed
in VISN or 65 percent of the surgical and invasive diagnostic
procedures combined will be performed on an ambulatory basis.''
Is that still part of your performance criteria?
Ms. Wilson. The ambulatory surgery measure is still in
effect.
Mr. Gilman. And then with the----
Ms. Wilson. The targets, the goals have changed, however;
65 percent is fully successful, and 75 percent is exceptional.
Mr. Gilman. With regard to bed days of care, ``Achievement
levels to be considered fully successful, bed days of care per
patient will decrease for all VISN number of patients in the
aggregate by 20 percent and to be considered exceptional, bed
days of patients will decrease in the aggregate by 30
percent.'' Is that still part of your performance criteria?
Ms. Wilson. The targets have changed. In 1997, we were able
to obtain Medicare data for the country. And the target for
each network was to reach where Medicare, where we would
project Medicare, patients to be in 1997. This network's target
was 7 percent, was to decrease bed days of care 7 percent,
which would put it in line with this region's Medicare standard
of care.
Mr. Gilman. So essentially, then, your overall program
provides incentives if you decrease primary care, if you
decrease surgery and make it ambulatory surgery, and if you
decrease bed days. Is that correct?
Ms. Wilson. No. Those are three measures out of the total
number of measures.
Mr. Gilman. But they are included. Is that----
Ms. Wilson. These are included in the 1997 agreement with
the targets as I stipulated.
Mr. Gilman. They seem to be pretty essential elements that
have reduced the quality of care in our region.
Ms. Kelly of New York. Will the gentleman yield?
Mr. Gilman. Yes.
Ms. Kelly of New York. Thank you.
I have one more question for Dr. Wilson. Dr. Wilson, if it
turns out that oversight is lacking in the VA by what the GAO
study says that we think will probably be a part of the Senate
request, if it turns out that the oversight is lacking, will
you allow further GAO study to happen? Will the VA allow for
further study? And will you slow down the VERA program until we
are sure that VERA will not be in a position to offer poorer
quality medical care for the patients in our area?
Ms. Wilson. I don't have the authority to answer that
question. My understanding with GAO is that they're an
independent review organization, and I wouldn't have the
authority to slow them down.
Ms. Kelly of New York. I am talking about VERA. Do you
think there's a chance that the VERA program would slow down
until we get this GAO study in terms of oversight?
Ms. Wilson. I have no authority to answer that.
Ms. Kelly of New York. Thank you.
Mr. Shays. Thank you.
Our panel will be staying through the conclusion of this
hearing. And I, frankly, as someone who is in charge of this
hearing feel a little guilty. And I want to say this to you,
that we have dedicated public servants, whom you may have
strong disagreements with--I'm speaking to the audience now--
but they are dedicated public servants who have served this
country long and hard. Mr. Farsetta, how long have you served?
Audience Participant. So have we.
Mr. Farsetta. Twenty-nine years.
Mr. Shays. Mr. Farsetta, you've served 29 years as a civil
servant or a political appointee?
Mr. Farsetta. Civil servant.
Mr. Shays. You are a civil servant. I want to thank you,
Mr. Farsetta, for your service to our country during those 29
years, and the rest of this panel and Dr. Wilson as well and to
Mr. Sabo and Mrs. Musumeci. I want to thank our panel for being
here. I want to thank them for responding to our questions. And
we will now go to our second panel.
Mr. Farsetta. Thank you.
Mr. Shays. The second panel is: Mr. Lawrence Dos Santos,
deputy director, New York State Division of Veterans Affairs;
Mr. Thomas C. Agnew, director, Orange County Veterans Service
Agency; Mr. Jerry Donnellan, director, Rockland County Veterans
Service Agency; Mr. Al Etkin, director, Sullivan County
Veterans Service Agency; and Mr. Jim Whoie, deputy director,
Dutchess County Veterans Service Organization.
I'd like to make an announcement. Evidently I'm being asked
to make an announcement that in 10 minutes the bus to Castle
Point, the Leprechaun buses, will be leaving in 10 minutes back
to Castle Point.
Audience Participant. How come we can't be heard?
Mr. Shays. Ma'am, if you want to stay longer, you will be
heard.
Audience Participant. How are we going to get home?
Mr. Shays. Will the witnesses please stand? Would you raise
your right hands, please? Do you solemnly swear or affirm that
the testimony you will give before the subcommittee will be the
truth, the whole truth, and nothing but the truth?
Mr. Dos Santos. I do.
Mr. Agnew. I do.
Mr. Donnellan. I do.
Mr. Etkin. I do.
Mr. Whoie. I do.
Mr. Shays. We're just going to go down the list after we
have order. We will suspend until people have left who want to
leave.
[Pause.]
Mr. Shays. Mr. Santos, we're prepared to hear your
testimony.
Mr. Dos Santos. Thank you.
Mr. Shays. Mr. Santos, we are going to hear your testimony.
We are not going to followup with any questions to any of the
Service representatives. And then we'll be going to the floor
and listening to testimony and again not following up with
questions so we can cover more people.
Mr. Dos Santos. I think that's a great idea.
Mr. Shays. OK. Thank you, Mr. Santos. There are people
moving in and out. So you're going to have to speak even a
little louder.
Mr. Dos Santos. I will. Good afternoon.
Mr. Shays. Good afternoon.
STATEMENTS OF LAWRENCE DOS SANTOS, DEPUTY DIRECTOR, NEW YORK
STATE DIVISION OF VETERANS' AFFAIRS, ACCOMPANIED BY THOMAS C.
AGNEW, DIRECTOR, ORANGE COUNTY VETERANS SERVICE AGENCY; JERRY
DONNELLAN, DIRECTOR, ROCKLAND COUNTY VETERANS SERVICE AGENCY;
AL ETKIN, DIRECTOR, SULLIVAN COUNTY VETERANS SERVICE AGENCY;
AND JIM WHOIE, DEPUTY DIRECTOR, DUTCHESS COUNTY VETERANS
SERVICE ORGANIZATION
Mr. Dos Santos. My name is Lawrence Dos Santos. And I am
the deputy director, southern region of the New York State
Division of Veterans' Affairs. I want to point out it's not my
testimony. I have had the distinct honor and privilege of
serving my country in the U.S. Marine Corps in Vietnam as an
infantry fire team leader with Company C, First Battalion,
Fourth Marines. Ooh-rah.
On behalf of Director John L. Behan, who was retired at the
rank of Sergeant from the United States Marine Corps after
being severely wounded in Vietnam while serving with Bravo
Company, First Battalion, First Marines, First Marine Division,
I want to thank you, Chairman Shays, Congresswoman Sue Kelly,
Congressman Benjamin Gilman, and Congressman Hinchey, for your
interest and commitment to the veterans of New York State and
for your timely response to the concerns that will be aired
here today by veterans and families who are troubled about the
diminishing quality of care offered at the United States
Department of Veterans Affairs medical facilities in the Hudson
Valley.
For the past year, the New York State Division of Veterans'
Affairs has repeatedly warned that the VA's Veterans Equitable
Resource Allocation [VERA] program was nothing short of bad
news for our State's 1.5 million veterans, who would be
shortchanged by the shift of nearly $180 million from the
Empire State to other States around the Nation. This program,
while intended to fairly distribute health care funds
throughout America, is anything but equitable to the veterans
in New York and other Northeastern States.
This program was hastily implemented without adequate study
or research on how the loss of tens of millions of dollars at
individual medical facilities would impact the care and service
provided our aging and sick veterans dependent on VA hospitals.
That is why we are here today. This program has not and will
not work in New York State as it has been implemented.
In presenting and defending VERA, then Secretary Jesse
Brown promised that no veteran receiving health care presently
would be denied care under the new allocation program and that
budget cuts at individual facilities would be absorbed through
greater efficiency.
No one outside of the VA bought that promise, especially
veteran leaders in our State. Efficiency normally is achieved
through fewer employees doing more, not by abolishment of
crucial programs, such as mental health care, dialysis
treatment, nursing home care, and homeless programs, which is
what has happened in New York State.
The implementation of VERA has now pitted veteran against
veteran and State against State for medical funds which have
been inadequately appropriated Nationally and inequitably
appropriated for individual States. This is a tragedy for our
veterans and for the VA, whose proud legacy of competent
professional and compassionate health care is being tarnished
with reports and accusations of neglect of patients.
Greater efficiency is a goal we should all strive for in
Government, but we must be aware that there is a difference in
trimming the fat from a budget and bare-boning to the point of
crippling programs.
The tales of patient neglect and rising deaths at VA
hospitals at Castle Point and Montrose, which will be presented
here today, are not unique to the Hudson Valley. We at the
Division of Veterans' Affairs have heard similar allegations
from veterans and families from other areas of the State,
including western and upstate New York and the metropolitan
area.
Veterans and their loved ones are dismayed and fearful. VA
hospitals were once a beacon of hope. Now, however, veterans
are being turned away for care they once took for granted or
are being told that they have to go elsewhere, often distant
points, for treatment or, as we are hearing, they are getting
inadequate care.
We are concerned with the changing policies and practices
at the VA, but I want to stress that our anxiety is with the
administration and not the medical facility employees, who are
as much a victim of VERA as our veterans. [Applause.]
Historically, the VA has employed dedicated and
compassionate health care providers, whose professionalism and
commitment are top of the line. VERA, however, has imposed
tremendous hardship on these devoted care-givers, who now have
become like Marines, made to do more with less. It's something
I'm quite familiar with. It is not fair to them or their
patients.
VERA is now a catalyst for the VA and our Government to
dismantle a health care program that has been a lifeline for
millions of American patriots, particularly our older, infirm,
and poor vets.
We cannot allow that to happen. Professional and competent
treatment and care at a VA hospital is a benefit that most
veterans expect to receive from a grateful Nation for their
service and sacrifice in our armed forces.
Many of these men and women were promised this care by
recruiters--remember them--eager to get them in uniform to
defend our country and its precious principles. For many
veterans, health care is the only benefit claimed from military
service, and the least they should expect is that that care is
available and safe. Care at a VA hospital should not and must
not be a death sentence, as some now fear. And certainly its
availability should not be determined by what State you call
home.
The New York State Division of Veterans' Affairs, on behalf
of our veterans, urges Congress and the administration of
Washington, DC, to take immediate action to halt staffing
layoffs and reduction of staffs at VA medical centers and to
place a moratorium on the implementation of VERA until such
time as the veterans' community can be assured that any
spending shifts or cuts will not adversely impact their rights
and benefits.
``I told you so'' is a phrase no one likes to hear. Critics
of VERA take no pleasure in uttering that statement. The
failure of VERA has not been borne by nor impacted the
bureaucrats who thought up this scheme. But, rather, it has
tragically been endured by veterans and their loved ones, whose
pain and suffering made this hearing today necessary.
On behalf of Director Behan and the New York State Division
of Veterans' Affairs, I urge this committee to take the lead in
restoring the credibility of our Government and the VA by
creating a new funding mechanism to provide the money necessary
to guarantee all of America's veterans are treated like the
first-class citizens they are.
I'd like to add one more statement before I close. I'd like
to point out that these three Members of Congress here from
this State are the only ones I know of that have taken on VERA
and have been as vocal and spoken out as much. And I'd like to
personally thank you. John Behan asked me to make sure I made
that statement to all three of you, and we thank you so very
much for caring about us.
Thank you for the opportunity to be here and to speak to
you today. And God bless everyone here.
[The prepared statement of Mr. Dos Santos follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
.Mr. Shays. Thank you. [Applause.]
Thank you, Mr. Dos Santos.
Mr. Agnew.
Mr. Agnew. Thank you.
Mr. Shays, Mr. Hinchey, Mr. Gilman, Mrs. Kelly, I
appreciate the opportunity to share my views as director of the
Orange County Veterans Service Agency and also as a two-tour
combat veteran of Vietnam and also as a veteran of seven major
Service-connected surgeries. So I know my way around hospitals
a little bit from the other side. The current status of local
VA health services after the VERA funding cuts is the subject.
Most of the Orange County resident veterans who avail
themselves of VA health care use the services provided at VA
Medical Center at Castle Point. For certain specialties and
illnesses, VA Medical Centers at Albany, Montrose, Bronx, and
Manhattan are also used. The VA has been an integral part of
health care delivery system in the Hudson Valley for many
years.
The implementation of the Veterans Equitable Resource
Allocation may, in fact, achieve certain of its goals when
viewed from other parts of the country. Few veterans advocates,
myself included, would oppose allocating funds to areas where
veterans are truly under-served or of allowing funds to follow
veterans who are relocating in large numbers.
The shifting of funds under VERA, however, appears to
follow a pattern of reducing high-cost area operations in favor
of low-cost operations. Few would deny that it is more
expensive to deliver medical care in New York City as opposed
to Jackson, MS or Houston, TX.
Mr. Shays. Excuse me.
Mr. Agnew. While this may appear to make fiscal sense----
Mr. Shays. Mr. Agnew, I've just been told to remind whoever
is going to Castle Point on the bus that the bus is ready to
leave right now if there is anyone still in the room. I'm sorry
to interrupt you.
Mr. Agnew. That's OK. The fact of the matter is that the
New York veterans are still here and the funds, frankly, are
not.
In our local case, the VISN which covers Castle Point and
the New York centers was mandated in September 1995 to reduce
the budget by $148 million over 3 years. It is now August 1997,
and $130 million have already been cut. This massive a
reduction so quickly denies the local communities an
opportunity to assess the impact of reductions as they occur,
as would be the case if these cuts were taken over 3 years.
The Castle Point facility has lost more than 200 employees
since 1995. Whether they were bought out, retired, laid off, or
fired, the facts are that they are gone. They used to do
something, and that is now done by someone else or it's not
done at all. Castle Point is staffed by some very excellent and
caring people. It is, however, a facility under strain, as are
all of the area facilities.
Now, you are no doubt going to hear during this session
stories of patient abuse and poor service. If these stories are
true and complete, they must be dealt with accordingly. Please
keep in mind that this facility provides some excellent service
to thousands of area veterans at a time when their health care
options are bringing
more and more vets to the VA for care. It is, therefore,
essential that Castle Point and all of the VA medical
facilities in the area and, indeed, the Northeast be saved and
strengthened.
Thank you.
[The prepared statement of Mr. Agnew follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. Thank you, [applause.] Mr. Agnew.
Mr. Donnellan.
Mr. Donnellan. First I would like to thank the Members of
Congress as well as the members of the VA staff and Mr.
Farsetta and his folks for coming over to listen.
Rather than read verbatim from my text--you have that in
copy, and it does repeat many things that have already been
said--I would like to just ask that all of these investigations
be done as rapidly as possible and as unbiased as possible
because we are hearing the ills. And, as Mr. Agnew said, there
are good ones.
We in our district, Mr. Gilman's district, have developed a
VA outpatient clinic that without the help of the VA wouldn't
exist. That has brought care to 10 times, literally 10 times,
the number of veterans that were served the previous year.
Also, the speed I think is important as to eliminate the
collateral damage that's being done in that staff members,
nurses, kitchen people, all members of the staff of the VA
hospitals, are taking flack for these hearings. These are in
general good people who have worked very hard. And there are
many good veterans being served quite well. So let's do our
cutting with the scalpel, not with the axe, and let's do it as
quickly as possible.
Thank you. [Applause.]
Mr. Shays. Thank you, Mr. Donnellan.
Mr. Etkin.
Mr. Etkin. Mr. Chairman, Members of Congress, fellow
veterans, thank you for allowing me the opportunity to appear
today and offer testimony regarding the VA health care
situation as it affects our veterans in the Castle Point and
Montrose VA catchment areas.
In addition to my appearance primarily as the director of
the Sullivan County Veterans Service Agency, as the lead
advocate for my county's military veterans and their families,
I also appear as the hospital chairman for the Veterans of
Foreign Wars Department of New York, as the Sullivan County
commander of the American Legion, and as the commander of the
Jewish War Veterans post in Sullivan County. So please regard
my comments as spokesperson for these veterans' organizations.
Better than 51 percent of Sullivan County's population is
representative of the veteran community, making us the largest
category of any in the county, including seniors. Since the
situation regarding veteran care at both Castle Point and
Montrose VA began back in May of this year, all of the media
reports were indicative of cases involving both Dutchess and
Orange Counties. There was not one example of poor patient care
or deaths concerning Sullivan County resident veterans.
Now, we transport veterans on a daily basis to Castle Point
VA and have done so for the past 46 years. During the past 3\1/
2\ years that I've held my office and upon my frequent visits
to our county's inpatients, 99 percent of our veterans have
told me that they could not have received better care; now,
this after asking them specifically if they were, in fact,
receiving good care and attention and if there was anything
that I could do to personally assist them. So that speaks well
for the medical staff attending them.
When, in fact, there were or are situations needing
attention for veterans and I'm informed by them, I can easily
access the Chief of Medical Administration or the Medical
Director's office. And that situation is readily corrected to
the veteran's satisfaction. So in this regard, I cannot do less
than commend the staff at both facilities for which we have
found to be jobs well done. [Applause.]
I want to call to your attention at this time that our
veteran standing committee as well as the Sullivan County
legislature passed resolutions to support the maintenance of
the medical services for our honorably discharged veterans at
all of our Nation's 172 VA medical centers, and especially at
the Castle Point VA, but to condemn the actions of the
Department of Veterans Affairs in the elimination of the
inpatient surgery at Castle Point VA and possible further staff
reductions. In addition, it was resolved to support continued
VA funding to the Northeast region of the United States and not
to the shifting of funds to other parts of the country.
We question how the elimination of some 200 staff positions
at Castle Point will allow the quality of care to our veterans
to be maintained with less staff to provide the same level of
services.
At the same time, we question how our New York delegation
members working as a block could vote to shift funds to other
parts of the country if the effects of those shifts were not
clear at the time of the vote. [Applause.]
We are concerned that once Castle Point VA was instructed
to delete inpatient surgery, then the facility became a clinic,
a nursing home, and loss status as a hospital medical center.
We are further concerned that Acting Secretary for Veterans
Affairs Hershel Gober promised to put in writing that Castle
Point VA will remain open and not close.
The bottom line financially is that the VA budget has been
slashed $5 billion over the next 5 years. Now, during the 104th
Congress, the VA medical account was increased by $850 million
over the past 2 years.
To ensure that adequate health care would be available for
our Nation's veterans and because of the high population of
veterans living in the Hudson Valley who depend upon and have
earned the right to use this system, we were particularly
concerned about the restructuring proposals by the Department
of Veterans Affairs that shifted resources out of New York
State to other parts of the country. And there was, in fact, no
explanation of the formula as to how those resources were being
shifted.
Adequate financial resources should be maintained to ensure
proper medical care for our State's 1,900,000 veterans, of whom
520,000 are over the age of 65 with a projection that by 2000
this total will have increased to 600,000.
Now, as we are all aware but need to be reminded, following
the conclusion of hostilities at the end of World War II, a
promise was made by our Government that no veteran would be
denied medical care at any VA medical center for the remainder
of his or her life. [Applause.]
Our Nation's veterans have placed themselves at risk to
preserve our country's freedoms and democratic principles. And
any deletion of needed resources, supplies, and medical staff
resulting in the elimination of services and the inability to
maintain the needed services to our veterans is considered
unconscionable and mean-spirited.
Our Nation's veterans, both wartime and peacetime, have
preserved our Nation. It is, therefore, the inherent obligation
of our Nation to care for our veterans' medical needs to
sustain their health and well-being.
Finally, the third party reimbursement moneys that formerly
had to be returned to the general fund in Washington, DC, can
now be well-utilized at our VA medical centers to increase
needed staff and resources. These moneys can now be retained at
the VAs. The volunteers that help assist our veterans are no
longer in place to the high numbers they once were. It's time
to do the right thing for our veterans and for our country.
Thank you for your attention. [Applause.]
[The prepared statement of Mr. Etkin follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. Thank you, Mr. Etkin.
Mr. Whoie.
Mr. Whoie. Good afternoon, Members of Congress.
Mr. Shays. Good afternoon.
Mr. Whoie. I appreciate being able to speak with all of you
this afternoon, and to include all of the veterans present. And
that's all of us, I hope. I consider it a privilege to have
been invited to participate in this very important endeavor.
I like to think that I am an advocate for veterans and
their families. Since 1992, I have been allowed to practice the
art of presenting issues and claims to the Department of
Veterans Affairs. Over the years, in the opinion of many
veterans that I come into contact with, a perception exists
that medical care in general or in a general sense was not
readily available. They are of the opinion that the VA, as I
will call it henceforth, was on its last legs. Nickels, dimes,
and quarters have slipped away, it appeared.
By and large, most of the veterans from World War II,
Korea, and Vietnam are very concerned about medical care in
general; that is to say, the availability of it, the quality of
it, and the cost of it.
Today, at least in Dutchess County, NY, veterans have a
serious concern about VA benefits in general, dissolving into
nothingness. The concept that, ``We want to take care of you,''
today in so many ways is simply hard for veterans to swallow.
Veterans and their families in large part believe that
there is an unseen danger. They believe that the Veterans
Affairs, at least when it comes to medical care, will cease to
exist. Pride in what he or she did during a period of war seems
lost in a myriad of legislative tactics.
Veterans in this community that I hope I represent have a
question: If the government abandons that veteran today, may we
abandon our duties as citizens tomorrow?
Thank you. [Applause.]
[The prepared statement of Mr. Whoie follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. The Service representatives agree with this
committee that we would like to go and hear from participants
who have attended this hearing. So they have agreed to forego
any questioning.
But I would like to at least invite any of the Members if
they want to respond to what they heard or just make a short
comment.
Mr. Gilman. Mr. Chairman, I would just like to thank our
panelists, all of whom are out on the firing line, and for
their constructive suggestions. We hope they keep doing the
good work they have been doing. God bless.
Mr. Shays. Mr. Hinchey.
Mr. Hinchey. Thank you, Mr. Chairman.
I'd just like to thank all of you gentlemen for your being
here today, for your testimony, and for your service to the
veterans' community. Thanks very much.
Mr. Shays. Ms. Kelly.
Ms. Kelly of New York. Thank you, Mr. Chairman.
I want to thank, in particular, Mr. Dos Santos, about his
comments about the concerns on the low-income, uninsured
veterans. That's my concern, too, Mr. Dos Santos. And I think
it's good that you at the State level are also as concerned as
we are.
Thanks, all of you, for your work because without you, our
veterans could not be as well-represented. You're doing an
excellent job. Keep it up. Thank you. [Applause.]
Mr. Shays. Now, let me tell you how we're going to proceed.
I used to be a State legislator for 13 years, and it reminds me
of the hearings that we have in the State legislature.
We had a number of people who had asked to speak. I had
staff draw at random from three piles. We put it into three
piles: veterans, veteran service organization representatives
and others, such as family members, wives of veterans, and so
on.
I'm going to call three names. We're going to identify you.
We're going to just have you be able to speak from where you
are. You can stand in place or sit in place if you're not able
to stand.
We're going to ask you to limit your remarks to 3 minutes
because we're going to try to get through and hear from as many
of you as possible.
If your name is called, let us know where you are, and the
microphone will come to you. I understand that some people may
have left. And we'll just keep going through the list. And if
we go through the list that was picked, then we'll just keep
going through.
The first three names in the order I'm calling is Edmund
Monteleone from Clintondale. We have Ralph Karabec, Commander,
Post 480, from Monroe. And we have Daniel Aversano, an LPN from
Kerhankson. Now, do we have any of those three present? We're
just going to invite you to--are you Mr. Monteleone?
STATEMENT OF EDMUND J. MONTELEONE, VETERAN, CLINTONDALE, NY
Mr. Monteleone. I am Mr. Edmund J. Monteleone.
Mr. Shays. It's nice to have you here, sir.
Mr. Monteleone. Right.
Mr. Shays. Thank you. You have 3 minutes. You can let him
hold the mic himself. Thank you, sir.
Mr. Monteleone. Yes. The only complaints I have----
Mr. Shays. Excuse me. You know what? Let me just say this
to you. I'm sorry to interrupt you, sir. This is a new
experience for me. We obviously are not going to swear in our
witnesses from the audience, but we transcribe this hearing. So
we're going to need you to spell your--you know what? I have it
in writing, and I'm just going to submit it that way. But just
say your name again, and we'll mark it down. And we have it in
writing. Tell us your name and your town you're from again.
Mr. Monteleone. I am Edmund J. Monteleone, M-O-N-T-E-L-E-O-
N-E. OK?
Mr. Shays. Yes. Thank you.
Mr. Monteleone. I'm from Clintondale, 212 Rabbit Run Road,
Ardonia. What else?
Mr. Shays. Thank you.
Mr. Monteleone. OK?
Mr. Shays. You can give us your statement, sir. Thank you
for being here.
Mr. Monteleone. OK. I go to Castle Point. I'm from Castle
Point. Now, the only complaint I have over there is that I
asked the doctor to go see the dental. When I went to see the
dental, I filled out the application. OK? But it's not--how can
I say that--service-connected. OK?
But when I first went into the Service, there was young
doctors at Camp Hood, TX that filled nine teeth within a half-
hour. And I couldn't talk or eat for 2 days or 3 days. And I
didn't need no teeth filled. OK? All right. That's one
incident.
Now another incident I had with my teeth to go to Castle
Point, and I filled out an application. They says, ``No, no.
You can't have that done unless you give me $125.'' OK? That's
another incident.
I'm not saying everybody in Castle Point is not doing their
job or that jobs aren't being done. But I don't like to be
pushed on the side. First you can't have glasses. Then now I
hear you can have glasses. Somebody's got to make up their mind
over there what's what. OK? And I know a lot of fellows, a lot
of people like me, are being treated the same way over there at
Castle Point.
Thank you.
Mr. Shays. Thank you, Mr. Monteleone. [Applause.]
Do we have Mr. Karabec next? Is he here?
Mr. Karabec. Karabec.
Mr. Shays. Karabel?
Mr. Karabec. Karabec.
Mr. Shays. Karabec? Is it spelled K-A-N-A-B-E-C?
Mr. Karabec. K-A-R-A-B-E-C.
Mr. Shays. Thank you, sir. I'm sorry I pronounced it wrong.
And your community, sir?
Mr. Karabec. No problem. That was probably my sloppy
handwriting.
Mr. Shays. And you're from Monroe?
Mr. Karabec. I'm from Monroe Post 48. I've been the
Commander there for 7 years.
Mr. Shays. Well, it's nice to have you here, sir.
STATEMENT OF RALPH KARABEC, VETERAN AND COMMANDER, AMERICAN
LEGION POST 480, MONROE, NY
Mr. Karabec. Thank you. I'm also a Vietnam war vet who has
been operated on, had 40 surgical procedures since I returned
home from Vietnam.
This is my testimony, Ralph Karabec, before the Human
Resources Subcommittee of the House Committee on Government
Reform and Oversight on August 4, 1997. My personal experience
with most physicians at Castle Point reflects a complete
disregard for patients' welfare.
Case in point: After years of experiencing problems as a
result of exposure to Agent Orange, I made a visit to Castle
Point requesting an examination with a physician. After
explaining my symptoms to the doctor, he made his diagnosis
right from his chair without so much as a question, ``You look
fine to me. I don't see anything.''
That was the last time I used that veterans' benefit.
However, I continue to have a yearly cystoscopy for bladder
cancer with my private urologist and I believe was a result of
exposure to dioxins. A copy of the doctor's letter is included
as part of this testimony.
After many years of annual cystoscopies and prostate exams
at Castle Point, a PSA test was finally authorized which showed
a 15.6 diagnosis, a well-advanced malignancy. After finding out
the results of the tests done at Castle Point, I had a more
specific PSA test performed by my private urologist which
showed a 19.4 with a 2 percent-free PSA. Apparently the
physicians at Castle Point don't even know what a 2 percent-
free, what a protein-free PSA test is. I questioned them. A
copy of the lab report is also enclosed as part of my
testimony.
The 30 percent differential in testing could cost a veteran
his life. After undergoing a radical retropubic prostatectomy
on April 28, 1997, at New York Cornell Hospital--so I saved
them some money--I discovered I was 0.1 millimeter of a
surgical margin. A copy of the pathology report is also
included in this testimony. I learned that I had the malignancy
for approximately 6 years. That's after my continually going
there every single year for an evaluation.
I was lucky. I managed to survive, at least for the moment.
My Government not only trying to kill me once by exposing me to
carcinogen herbicides, but with the lack of proper medical care
and attention almost succeeded a second time. My fear now is
that how many more veterans, including myself, must die due to
lack of funding for appropriate medical care while the tax
dollars of American patriots are sent overseas in the name of
maintaining freedom. We penalize once more the very vets who
fought unselfishly to keep our Nation and the world safe from
tyranny, I submit.
Mr. Shays. Thank you very much. [Applause.]
Our third witness is Daniel Aversano. Is he here?
Mr. Aversano. Yes, sir.
Mr. Shays. Thank you, sir.
Mr. Aversano. Good afternoon.
Mr. Shays. If you could just suspend a second, I'm going to
tell you the next three so they can begin. The next witness
would be Cindy Trimble. Is she here? Cindy, Ms. Trimble?
Anthony Buccieri. Is he here? And also Richard--I'm not sure
how to read this. Pardon me? Johannes. That's it, sir. And
you're from Pleasant Valley. Thank you. You will be following.
Thank you. Sorry to interrupt you.
Mr. Aversano. Good afternoon.
Mr. Shays. Good afternoon.
STATEMENT OF DANIEL AVERSANO, LPN, VETERAN AND CASTLE POINT
EMPLOYEE, KERHANKSON, NY
Mr. Aversano. My name is Daniel Aversano, and I work at
Castle Point VA. I've been there for 10 years. I'm an LPN. I'm
also a Vietnam vet. And I've also been taken care of by Castle
Point, and they have been very good to me. Since being there,
I've made a lot of good friends--Korean vets, Vietnam vets. And
Castle Point I think is a very good place to work, and we try
very, very hard to take care of our vets.
Just one thing I'd like to put on the floor as something to
think about: Why is it warranted to use the Vassaro R and
shipping our Castle Point patients over there when we closed
our abilities to operate at Castle Point? Does that giving--why
wouldn't it be smarter to give our staff the money and keep our
vets at home, where we have done such very good care for many,
many years? Why is that cost-effective? That's just something
that I just can't understand.
And I want to thank everybody for coming out today, and I'm
very proud to work for Castle Point VA. [Applause.]
Mr. Shays. Thank you very much.
Ms. Trimble.
STATEMENT OF CINDY TRIMBLE, FAMILY OF DECEASED VETERAN, GANHAM,
NY
Ms. Trimble. Good afternoon.
My name is Cindy Trimble. My grandfather died as a result
of a lack of treatment at Castle Point VA Hospital.
The short of the story is he was admitted on March 24 with
a so-called ``virus.'' Two weeks later, when his condition had
deteriorated to a point where the family could no longer just
sit idly by and wait for Castle Point to take some type of
further action, we had him transferred to Hudson Valley
Hospital Center. That was a difficult task. We met with much
resistance from the doctor, but we were able to get him down
there after contacting the Acting Chief of Staff.
When he arrived at Hudson Valley Hospital Center, within 1
hour of his arrival, the diagnosis was a perforated ulcer. They
took him in for immediate surgery, but he died 2 days later as
a result of the preexisting infection that set in. Some of you
may be familiar with the term ``sepsis.'' They found bacteria
and acid in his blood that had been an ongoing condition as a
result of the perforated ulcer not picked up at Castle Point.
I only have 3 minutes. So, in closing, I just had a couple
of things I'd like to add. Earlier our panel was talking a lot
about statistics and surveys and things like reducing bed days
of care. I'd like to ask if the death rate, the statistics on
death, the mortality rate, is inclusive of those deaths that
occur outside of the hospitals, but result from the care
received in the hospital, like deaths that occur at home or
after a patient is transferred to another hospital.
I'd also like to respond to an earlier statement made by
Mr. Farsetta about surveys. My grandfather did receive a survey
a few days after he died.
And, finally, I'd like to say that under the category of
reducing bed days at Castle Point, we were never able to
contact a physician during my grandfather's care at Hudson
Valley Hospital Center. When we did, he was very annoyed with
us. And he told us that they--I don't know who ``they'' are,
but I assume he meant the Department of Veterans Affairs--were
on his back to get my grandfather out of the hospital, that
they wanted him out because they needed the bed.
So I just wanted to add that as perhaps some type of proof
that there is a push to clear these patients out. And I do
think that while there may be some good care at these
hospitals, I think the VERA budget funding cuts are being used
as a crutch.
And I'd like to thank Maurice Hinchey, Ben Gilman, and Sue
Kelly for anything they can do on behalf of the veterans and
their families. Thank you. [Applause.]
Mr. Shays. Thank you. Thank you, Ms. Trimble. I believe
you're from Ganham? Yes. Thank you.
Anthony Buccieri. And you're from?
Mr. Buccieri. I am from Newburgh, NY.
Mr. Shays. Yes, sir.
STATEMENT OF ANTHONY BUCCIERI, VETERAN AND VETERANS OF FOREIGN
WARS AND DISABLED AMERICAN VETERANS, NEWBURGH, NY
Mr. Buccieri. I'm a veteran of World War II, a recall for
the Korean war. I'm a veteran at the VA hospital at Castle
Point. I have been there as a volunteer for over 8 years. I've
seen many changes at Castle Point, some for the good, some not
so good.
But I'd like to call out I've sent in reports to the
District Commander of the Veterans of Foreign Wars. This was
dated back in March. I also sent information to the local
papers in our area, six of them in general. Out of six papers,
only one published what I had to say.
In regard to the deaths at Castle Point, when all of this
broke out in the newspapers, I took a quick survey, picked up
all the papers, and I found that out of the 12 hospitals in our
immediate area, there were 35 deaths and only one at Castle
Point.
I'd like to explain one thing that many people--and I've
got these personal calls, even at night, from veterans'
families, ``Can you get my father'' or ``my brother'' or ``my
uncle into Castle Point?''
I went out of my way, which I didn't mind doing, asked
these people, ``Are they registered with the VA hospital? If
they aren't, we'll give you an application. Fill it out. Get a
hold of your doctor, the hospitals from both sides. And try to
get that patient into Castle Point,'' which they did.
The reason for going into Castle Point VA Hospital was that
the limitation on the stay in the hospital, whether it's
Medicare or private insurance, was the cause for these patients
being transferred to VA hospitals.
They were not completely cured in a matter of months or
days or even a year. Some of them did pass away, unfortunately,
but many of them were cured or they had a longer hospital stay.
That's in regard to the mortality rate.
As far as the patients being taken care of at Castle Point
and as a volunteer there 2 days a week, about on the average of
7 hours a day, I found that the staff has been overworked to a
point. But, as was stated before, they are doing the best job
they can with what they have. The fact that the funding has
been cut, the staff has been cut, they are doing a good job.
In regard to a few other details, I'd like to submit these
as evidence to you. I don't want to take up too much time.
Basically the VA is there for veterans and veterans only. And
it's been there at Castle Point for 72 years. And I've been a
patient in the hospital as well as a veteran and as well as a
volunteer.
I thank you.
Mr. Shays. Thank you, sir. [Applause.]
Richard Johannes from Pleasant Valley?
Mr. Johannes. Yes.
Mr. Shays. Sir, before you begin, let me just tell the next
three speakers. We have, I think it is, Al Datlolo. Am I saying
the name correctly? The second witness would be Paul Davidson.
And the third would be Gloria Wood. Do we have those three? OK.
Am I saying this right? This is Datlolo. Mr. Datlolo?
So yes. Thank you, Mr. Johannes.
STATEMENT OF RICHARD JOHANNES, VETERAN, PLEASANT VALLEY, NY
Mr. Johannes. Good afternoon. My name is Richard Johannes.
I'm a Vietnam veteran. I served over 5 years in the U.S. Army.
And two of those were in Vietnam. All I knew was that if I ever
needed health care later on in life, the VA was supposed to
provide it for me.
With Castle Point, over the last year, I feel that
everything has just gone downhill. They changed us to the blue
team and the green team. You get a doctor. First of all, I
don't even think he understands half of what I say. OK?
[Applause.]
And when I do try to tell him the different problems I
have, I'm 100 percent Service-connected. OK? They put it down
for PTSD only because it's a simple way to shuffle me off to
one side.
You go there. You get there early like they tell you to, a
half an hour, an hour before. You go into your clinic. It ends
up you're 39th on line already, and it's only 8:30 a.m. They've
got six seats in the place. And you sit there or hang around
outside until somebody takes care of you. Then you have to run
to your next appointment.
By the end of the day in 1 day when the doctor was supposed
to take all the information that was done, blood work,
ultrasound, EKG, and all that other good stuff they have to do
to me, he didn't have the information in his computer. So he
says, ``Well, if it's not really bothering you, don't worry
about it.''
And I'm going, ``Hey, I've had this pain on and off for 6
months.''
He says, ``I'll get in touch with you when I get the
results back.'' Well, that all happened in April. It is now
August. And I haven't heard one single word. OK? And that's
just one instance.
You try to get glasses there, you have to sit and wait for
2 to 3 months to get a pair of glasses. I can go down the
street to any mall and get a pair of glasses in an hour.
I needed a crown for a tooth that somebody finally figured
out needed to be rectified since Vietnam. Well, it took them 3
months to make a crown.
I can't understand this, you know. Yes, they're supposed to
be moving into the computer age. But when it comes to simple
things like glasses or new crowns or having even your teeth
worked on, they have a hard time doing these things.
And the attitude down there to me is just unbelievable.
They don't care. And I wish they would get some doctors in
there who speak American and understand American. [Applause.]
And that's basically all I have to say. Tomorrow I will
wander my way over again to the VA and ask them, ``Have you
finished and come up with the results?''
And I can guarantee you what the answer is going to be,
``We can't find the files'' because they already did that twice
this year.
Thank you very much for your time.
Mr. Shays. Thank you very much. [Applause.]
We'll be going to Mr. Datlolo, then Paul Davidson, and then
Gloria Wood. Is Mr. Datlolo here? He's not here. So we'll go to
Mr. Davidson. Is he here? OK. And then Gloria Wood. Is Gloria
Wood here?
Ms. Wood. Yes, I am.
Mr. Shays. Thank you, Ms. Wood.
STATEMENT OF GLORIA WOOD, WIFE OF VETERAN, PINE BUSH, NY
Ms. Wood. I'm speaking on behalf of my husband, who happens
to be partially disabled.
In January 1995, we, unfortunately, had an accident on our
way to Florida. And he fell going into a motel. Six weeks later
and two operations, in a private hospital, for his hip, I was
told, ``Take him home. Put him in a nursing home. He'll never
walk again.''
I couldn't find a nursing home as quickly as I wanted. So,
in desperation, I will say, I said to my daughter, ``Call up
Castle Point and see if he can get in because he is 40 percent
disabled.''
They immediately took him in. Ten days later, he was
walking on parallel bars. He was there for 6 weeks. He has
continued to take therapy, and we have nothing but good things
from Castle Point. And I think it's nice to know that there are
some of us who do appreciate it.
Thank you.
Mr. Shays. Thank you, Ms. Wood. [Applause.]
We appreciate your words of appreciation. And I have you
down from Pine Bush?
Ms. Wood. Pine Bush.
Mr. Shays. Thank you.
Our next three witnesses: Jerry Blumenthal from Middletown,
Daniel Morea from Beacon, and Helen Janiszewski. Am I saying
that name right? Janiszewski, also from Middletown.
STATEMENT OF JEROME BLUMENTHAL, VETERAN, MIDDLETOWN, NY
Mr. Blumenthal. I thank the committee for listening to me.
Mr. Shays. You are Mr. Blumenthal?
Mr. Blumenthal. Yes, B-L-U-M-E-N-T-H-A-L.
Mr. Shays. A-L. I'm sorry. And it's from Middletown?
Mr. Blumenthal. Middletown, NY.
Mr. Shays. Thank you, sir.
Mr. Blumenthal. I thank you for listening to me. This will
be short.
There's one thing I can't understand. Somebody mentioned
it. One of the people who spoke mentioned it. How come we can
investigate things up to the sky, investigate things that spoil
people's lives, investigate everything? How could we go with
the VERA without investigating the VA's administrative
statements? [Applause.]
How could we make a decision to cut funds or to take these
funds away from our areas before we really knew what could
happen to our veterans? I would like that question answered.
Thank you. [Applause.]
Mr. Shays. Is Daniel Morea here?
Mr. Morea. Yes, I am, sir.
Mr. Shays. I'm sorry. Where are you?
Mr. Morea. I'm right back here, sir.
Mr. Shays. Thank you very much, sir.
Mr. Morea. You're welcome.
Mr. Shays. And you're from Beacon?
Mr. Morea. I'm from Beacon, NY.
STATEMENT OF DANIEL MOREA, VETERAN AND ASSISTANT SERVICE
OFFICER, DEPARTMENT OF NEW YORK AMERICAN LEGION, NINTH DISTRICT
REHABILITATION CHAIRMAN, AMERICAN LEGION, BEACON, NY
Mr. Morea. I'm an assistant service officer for the
Department of New York American Legion as well as the Ninth
District rehabilitation chairman for the American Legion.
I would like to thank the chairman and the distinguished
members of the subcommittee for allowing me to testify today.
The testimony so far given today has been more than
interesting. It has brought to light both what we have heard
from the subcommittee as well as what we have heard from the
audience. The action that follows will be even more
interesting.
The American Legion appreciates the opportunity to share
our views on the quality of health care provided by the
Department of Veterans Affairs. Mr. Chairman, there are several
concerns with regard to the VA's ability to continue to provide
quality health care.
Although the American Legion will defer any definitive or
evaluative comments until completion of a site visit to the
Veterans Administration Hudson Valley Health Care System, which
is scheduled on August 19 and 20 of this year, we are, however,
prepared to address the specific issue at hand: those concerns
raised regarding the increased mortality rate and morbidity
rates at Castle Point and Montrose VA medical facilities, now
referred to as the Hudson Valley Health Care System.
The VA has undergone significant reorganization in the past
2 years, realigning its field operations from a system of 172
independent medical facilities within 4 geographic regions to a
system of 22 Veterans Integrated Service Networks, called
VISNs. The VA Hudson Valley Health Care System is a component
of VISN 3 which encompasses the VA northern New Jersey Health
Care System and each of the medical centers in New York
metropolitan area.
Each VISN has been granted certain latitude in how it
chooses to deliver health care services to veterans in its
primary service areas. While there are substantial differences
among these emerging networks with regard to how, when, and
where health care services will be provided, VA headquarters
has established a number of performance measures to assure
accountability along with increased empowerment, as we have
already heard testified to today.
VISN 3 has adopted an integrated delivery system model
based on network-wide care lines. Simply put, veterans who in
the past relied on a single Veterans Administration medical
center to meet all their health care needs are now considered
network patients. As network patients, all of their health care
will be managed by a primary care team located in close
proximity to where they reside. That was the premise of VISN.
That's not what we have heard today.
However, as need for specialty care arises, veterans will
find the entire consortium of VA health care facilities within
VISN 3 responsible for meeting their complete medical needs. As
a result, the VA Hudson Valley Health Care System has been
designated as a center for excellence for the network in the
areas of geriatric, extended care, and mental health care.
It seems that since the time of this transition, mortality
and morbidity rates have increased, creating a groundswell of
concern for many constituents and an increase in media
coverage.
As members of this committee may know, the purpose of
realignment was largely in response to the VA's need to become
more cost-efficient in the delivery of services. Furthermore,
VISN 3 was identified as the most expensive network in several
key financial performance measures, including total cost per
veteran.
All of these facts combine to create an emphasis on
reducing costs. Underscoring this need is the Veterans
Equitable Resource Allocation, VERA, and its methodology. We
believe that the initiatives to improve efficiency----
Mr. Shays. Mr. Morea.
Mr. Morea. Yes?
Mr. Shays. Can I just interrupt you a second?
Mr. Morea. Sure.
Mr. Shays. I need to be somewhat consistent on the 3
minutes. Are you going to be completing----
Mr. Morea. I am just about done, sir.
Mr. Shays. Thank you.
Mr. Morea. You're welcome.
We believe that the initiatives to improve the efficiency
are in the best interests of veterans everywhere; however, not
at the expense of accessing quality, which may be in jeopardy
in some areas where the budgets have been cut back.
The American Legion has proposed a GI bill of health in an
effort to enhance and ensure quality VA health care for the
future by opening the system to all veterans and their families
currently not eligible for care on a premium basis.
We have scheduled a meeting with the VISN 3 director, Mr.
James Farsetta, on August 22, immediately following the
upcoming site visit. Presently the American Legion accepts the
VA's explanation that the rising mortality rates at Castle
Point are attributable to the decline in the number of
inpatient beds and the increase in referrals from other VISN 3
medical facilities of the most chronic patients. However,
should any concern arise as a result of the upcoming site
visit, they will most certainly be included in a subsequent
report for distribution to congressional Members whose
districts overlap or are within the boundaries of the veterans,
VISN No. 3.
The site visit will also focus on inpatient of VERA as
potentially creating the scenario in which changes may occur
too rapidly without the benefit of adequate planning on the
horizon.
The American Legion will also evaluate VERA's impact on
specific specialty programs, such as post-traumatic stress
disorder, chronic mental illness, and long-term care,
particularly as the budget relates to capacity.
Finally, we also will examine the most current customer
service course as well as the networks' adherence to the VA's
other stated performance measures.
Mr. Chairman, this concludes our statement, and we thank
you for your time, sir.
Mr. Shays. Thank you, sir. [Applause.]
The next three witnesses: Helen Janiszewski from Middleton,
I think, Middletown; Philip Schiffman from Washingtonville; and
Jane Kowal from Port Jervis. Do we have--is Helen here? Sorry.
Good try. You must be a Marine. She's not here.
Are you Philip Schiffman? Mr. Schiffman, thank you. And
you're the State Commander? Thank you, sir.
Mr. Schiffman. Thank you, Mr. Chairman, members of this
subcommittee.
STATEMENT OF PHILIP SCHIFFMAN, VETERAN AND NEW YORK VFW,
WASHINGTONVILLE, NY
Mr. Schiffman. Thank you for the opportunity to testify
today on behalf of the 110,000-plus members of the Veterans of
Foreign Wars Department of New York on the very important issue
of health care our Nation's veterans are receiving in the
Department of Veterans Affairs' medical centers, particularly
the medical centers at Castle Point and Montrose. Thank you
also for conducting this hearing to help you get to the bottom
of the allegations made about quality care issues.
First and foremost, let me state loud and clear that the
VFW Department of New York is appalled at recent newspaper
reports depicting quality of care issues and high mortality
rates at these facilities.
Our veterans deserve better. We at the VFW will not
tolerate this type of treatment of our Nation's former
defenders. We call on you, our elected officials in Washington,
to fully investigate these reports and hold these VA officials
accountable who are responsible. Today and future such hearings
must get to the bottom of the situation.
The numerous allegations of insufficient and quality care
issues made in local newspapers by veterans, families of
veterans, VA employees, and VA volunteers point to the serious
problems at these two facilities. There obviously was a lack of
management at both the local and network levels that allowed
these situations to occur.
I sincerely hope VA has now corrected the deficiencies. I
know that VFW officials and members who have visited both
Castle Point and Montrose in recent days have told me that the
facilities are clean and everything seems to be fine. Not being
a health care professional, I cannot determine if, in fact, all
is now well.
Some have blamed the incidents depicted in the newspapers
to be caused by the Veterans Equitable Resource Allocation
system, VERA, which we have heard a lot about today. VERA is
definitely the cause of the shifting of dollars from the
Northeast and Midwest to the Southern and Western States.
However, management at the facilities and network management
have told the Veterans of Foreign Wars on more than one
occasion that money is not the problem.
If money is not the problem, then it is obvious to me that
the cause of our problems were inadequate and inefficient
management coupled with our aggressiveness of network
management to trim too much too fast from the budget of these
facilities. Quality control mechanisms definitely were not in
place. And local as well as network management were not paying
attention to details.
It is my understanding that a new management team is being
named for the facilities, people have been transferred or who
have left VA employment. And the VA Medical Inspector is doing
a complete review of both facilities, which they do not
anticipating completing until the end of this summer. I also
understand that additional staff have been placed in various
critical areas of these facilities.
With all said and hopefully done, VA has a major public
relations problem to win back the full confidence of the
veterans of Hudson Valley. Openness and being truthful to
veterans and their families and, yes, to Members of the U.S.
Congress would be the first step in the right direction.
We, the veterans of Hudson Valley, should not hear from
newspapers of a closing of surgical units, possible staff
reductions, and the quality of care issues. Faculty and network
management need to be the ones to tell us.
Mr. Shays. Thank you.
Mr. Schiffman. One more second. We understand that the
delivery of health care is changing and that the VA must also
change, but when we hear about issues in the newspapers, rather
than VA officials, their intentions become suspect.
The VFW is the greatest supporter the VA has throughout
this Nation and in Washington, DC. We feel that the VA health
care system is the top-rate deliver of health care to our
Nation's veterans. However, the system cannot operate without
proper funding and without proper management, both of which
seem to have contributed to the instances noted.
Thank you for the opportunity to address you today. We of
the VFW look forward to working with you and with the VA to
resolve issues addressed today and to do our utmost to help
turn public opinion around about the quality of care our
veterans receive in Castle Point and Montrose VA medical
centers. Thank you very much. [Applause.]
Mr. Shays. Thank you very much.
Mr. Schiffman, I'm going to insert into the record because
you focused in on the newspaper article, and I will tell you
the committee will be examining this document. It's from the
Department of Veterans Affairs, Veterans Health Administration,
VISN 3, the white paper on news articles about a VA Hudson
Valley Health Care System.
I'm going to read the first paragraph and the next sentence
of the second paragraph, and then I'm going to submit those
numbers, just to say. It said,
Issue: On Tuesday, May 13, 1997, a newspaper article about
the VA Hudson Valley Health Care System appeared in the Times-
Herald Record, a Dutchess County, New York newspaper. It
alleged that since the Veterans Equitable Resource Allocation,
VERA, budget cuts occurred in New York, the mortality rate at
the Castle Point facility had doubled and at the Montrose
facility had increased 80 percent. Congressional
representatives have expressed their concern patient care is
suffering because of VERA.
Facts: A study of the mortality rate at VA Hudson Valley
reveals there is no evidence of an increase in deaths at the
two facilities. In reviewing the combined death rates, there is
little or no fluctuation.
These are the death rates that they have during the times
cited: October to March 1995, the number of deaths: 121;
October-March 1996, 109; October-March 1997, 123. And then they
do it based on the number of deaths per hundred. There is a
slight increase in the Castle Point number of deaths per
hundred.
But the document submitted to this committee is far in
disagreement with the article that you have referred to. It
does not in any way call into question the concern about VERA.
It doesn't call into question about the concerns of this
committee. But it does state emphatically that what you read in
the newspaper is just simply not true. And we will look into
that, I can assure you. Thank you.
[The information referred to follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Shays. At this time is Jane Kowal here?
Ms. Kowal. Right here.
Mr. Shays. Thank you. Nice to have you here.
Ms. Kowal. Thank you. Thank you for having me. Please bear
with me. I get very emotional.
Mr. Shays. Does that just mean with all of these other
veterans you get emotional?
Ms. Kowal. Well, maybe.
Mr. Shays. OK. Thank you.
STATEMENT OF JANE KOWAL, DAUGHTER OF DECEASED VETERAN, PORT
JERVIS, NY
Ms. Kowal. I'm Jane Kowal. My father was Carl Irwin. He was
a veteran, and he had gone to Castle Point for a hip operation.
As you know, they sent him and all operations to the Bronx.
He went through the surgery fine, came back to Castle Point
about the 17, I believe, of February. Two days later, he's in
ICU. I don't know what happened. I know there are times you do
develop pneumonia when you break a hip. But this seems so
sudden. OK.
We rushed there. He has a feeding tube. The man did at
times need help to feed himself. OK. At the nursing home, he
had signed a health proxy, ``No CPR. And, please, no artificial
feeding.'' I thought being a VA-approved nursing home that
these documents would be carried over to Castle Point. I guess
I was wrong or ignorant to think that.
Anyway, I asked about the feeding tube. I did not get any
answer. I had asked about medications, ``See the doctor.''
Well, that was a joke. I could not find his doctor, ``He's
not in this building,'' ``He's on the floor.'' You name it, I
got it. Finally, I did get someone.
My father was getting worse. He was a 195-pound man going
down to, he ended up, 173 in 17-18 days. I wanted to know what
was going on. A man answered the phone. He said, ``What do you
want?''
I said, ``I want to talk to someone about my father.'' He
never told me who he was. I don't know if he was the doctor. I
said, ``I don't understand the feeding tube. I don't understand
if there's a problem with his heart. I know about the
pneumonia. He has sugar.''
And they said, ``Well, his heart's feeding.'' And that was
that.
I was very upset. I got a hold of my sister. She carried
on, finally got his regular doctor in, who we later found out
was on vacation. She did her best to bring him back, but it was
too late. On March 3, he died. He died of a broken hip. Do you
believe this?
I believe in my heart I misguided my trust in the VA
system. In the times in the past, we trusted you. You were very
good. You were always there for us. There was no doubt about
it. But due to these cuts, my father is dead. And I don't know
how to take care of this in my heart, in my mind.
Thank you.
Mr. Shays. Thank you, Ms. Kowal.
I am having a hard time reading the signature. I think it's
Anthony Bamonch. Is it close? It's from Clintondale. Mr.
Bamonch is from Clintondale? He's gone? OK. Raymond Moonan? Is
Raymond Moonan here? OK. And then Dorothy Mianti? Is Raymond
Moonan here?
Mr. Moonan. Yes.
Mr. Shays. Thank you, Mr. Moonan. You're from New York and
Florida both?
Mr. Moonan. Sir?
Mr. Shays. It says Florida here. Is that your mailing
address?
Mr. Moonan. I'm from Florida, NY.
Mr. Shays. OK. I love it. Remember now, I may be a Member
of Congress, but I am from Connecticut. So don't go back to
your home and say, ``This idiot didn't even know there was a
Florida.'' [Laughter.]
I had never heard of Florida, NY. I apologize.
Mr. Moonan. The home of Seward, who purchased Alaska.
Mr. Shays. OK. Your time starts now.
STATEMENT OF RAY MOONAN, VETERAN AND DISABLED AMERICAN VETERANS
AND AMERICAN LEGION, FLORIDA, NY
Mr. Moonan. My question is last week the House approved 346
to 85 the conference report on a bill to reduce entitlement
outlays by more than $135 billion in 5 years by slowing
Medicare, Medicaid, spending growth, restraining mandatory
spending in the areas of housing and veterans' benefits,
agricultural subsidies, vocational education, along with
separate bills cutting taxes for families with children,
education, and investors in business and others. My question
is: Why are we lumped in with the farmers? [Applause.]
Mr. Shays. Why are you lumped in with the farmers?
Mr. Moonan. Why are we lumped in with the farmers? We're
veterans. You're voting to cut veterans' benefits along with
cutting subsidies to the farmers and business.
Mr. Shays. I'm not going to respond to every question
because in some cases I don't know the answer and I will find
the answer, and that's the purpose of these hearings.
But, sir, there are two points. One is that the money
allocated to the VA may have been reduced because it didn't
take into consideration additional money that now can be
collected from Medicare. And there was a dialog between two
Members, a Republican and Democrat, Cliff Stearns and the
gentlelady from--New York or Michigan--to verify that it is the
intent of Congress that there will be no cut. The question is
just making sure that for the first time the VA can collect
Medicare money. And, therefore, you don't need to----
Mr. Moonan. This is not happening, sir.
Mr. Shays. No. It's just starting now.
Mr. Moonan. That's a subvention experiment in about three
areas. It's not affecting New York people.
Mr. Shays. No. The other issue--and this relates to the
whole question of VERA--is there is a reallocation of
resources. Some States, some areas are getting more. And some
States, like New York and Connecticut, are getting less. And
that's the issue we are addressing today, understanding why
we're giving more in one area to the detriment of an area that
is getting a lot less. And in the shift is too much going too
quickly, and the very valid question, which we'll get an answer
to and hopefully change.
Mr. Moonan. What I'm saying is $135 billion is going to be
taken from these entities for a period of 5 years. Now, this is
going to affect veterans. For 5 years, there are going to be
cuts. And this was last week. Last week this was done. And here
we are today talking about doing things for veterans, and we're
not doing them. We're just talking. [Applause.]
Thank you.
Mr. Shays. Thank you, sir.
Dorothy Mianti, is she here? James Catania from Walkill;
Colleen Mussolino from Brooklyn; and Paul Davidson. Is James--
--
STATEMENT OF JAMES CATANIA, VETERAN, VFW AND AMERICAN LEGION,
WALKILL, NY
Mr. Catania. First I want to thank you gentlemen for
letting me voice my opinion. I have something to say that
Congressman Maurice Hinchey might remember and, then again, he
may not because I wrote him a letter of my case. And he sent it
to Washington. And I got a letter from Washington last week
referring me back to Congressman Hinchey.
I went to Castle Point 3 years ago for a hearing aid. I had
quite an extensive examination. And the doctor said, ``Mr.
Catania, I'm going to send you down to Bronx because they have
bigger and better machinery than we do, and you can get a
better examination than we can give you up here.''
So the next morning I got on the bus, went down to the
Bronx, went for an examination. I waited about 4 hours, from
about 11:30 until about a quarter to 4. And I had my
examination. And he said to me, word for word, ``Mr. Catania,
I'm going to send you back to Castle Point because they've got
bigger and better machinery than we have and they can give you
a better examination than we can.'' [Laughter.]
I said, ``I beg your pardon?'' And he repeated it. So I
said, ``All right.'' And he gave me a prescription. So I went
down to the pharmacy to get the prescription filled, and there
were about X number of men waiting to get their prescriptions
filled. And my bus was leaving in about 10 minutes. So I left.
I went to the pharmacy at Castle Point, and they refused to
honor that prescription. They said, ``We can't do that here.
You've got to take it down to the Bronx.''
So I got a hold of the service officer, and he got around.
He got a hold of the doctor that finally made out the
prescription and gave me the prescription I wanted.
And I, for one, think that that is one of the reasons that
there's a saying ``Use it or lose it.'' And I think that is one
of the reasons why we lose beds at Castle Point, because people
go through the same thing that I went through, maybe not for
the ears but for something else, and they say, ``Well, I'm not
going back there anymore.'' I haven't been back in 3 years
because I lost faith in the VA.
That's my story, and I thank you very much for listening.
Mr. Shays. Thank you very much. [Applause.]
Colleen Mussolino from Brooklyn.
STATEMENT OF COLLEEN MUSSOLINO, VETERAN AND NATIONAL VICE
COMMANDER, WOMEN VETERANS OF AMERICA, BROOKLYN, NY, ON BEHALF
OF MONTROSE WOMEN VETERANS OF AMERICA
Ms. Mussolino. Yes. Thank you.
I'm Colleen Mussolino. I'm the national vice commander for
Women Veterans of America. We have a chapter up in the Montrose
VA, and I was contacted and asked to speak on their behalf,
especially of the women veterans, as a national issue.
Women only began to get their benefits in 1973. So we're
still trying to play a catchup game with you men. OK? We have
very little facilities for women. We have gynecologists, but
it's taken a long time to get there. You could get a penile
implant before you could get gynecology. OK?
One of the other problems is that there is a lack of beds
and services in the VAs. What used to be three beds of private
rooms for women are now done to one bed and possibly sharing
with a man. OK? We share the bathrooms. We share the showers.
We have to have armed guards stand outside. I mean, this is
ridiculous.
These cutbacks have made it worse. We're trying to get
entitlements, and we're getting pushed back further and further
and further. And in Montrose VA, there was supposed to be a
women veterans coordinator, as there is in all of the VAs, has
not been replaced. It's been now over a month. There is no
women veterans coordinator at all for these women to go to to
take their problems, to take their gripes. OK? They're told
that they have to go to Castle Point.
That's not acceptable. It's not acceptable by my
organization, and it should not be acceptable by any veterans'
organization that they should have to travel back and forth or
to make calls back and forth to get issues taken care of.
The other issue that I have is in the fact of women being
put into situations where they have been put in with men in
various different areas. And these are women that have been
raped. These are women that have been sexually assaulted. And
they're put into areas where they are not protected.
And the people are not assuming that women have gone
through these assaults. It's unfortunate that the statistics
are so high that you have to assume today that 9 out of 10
women have been sexually harassed or assaulted. These
statistics are extremely high. And then you put women in where
we've got to put into areas where we are being jeopardized.
That is wrong.
Another issue is the fact is that we are tired of being
``yes''ed to death. Every time we make a complaint, it's a
valid complaint, but we are tired of the people just saying,
``Yes,'' ``Yes,'' ``Yes.'' And I know from Mr. Sabo and Mr.
Farsetta from Brooklyn when they were the directors there. I
have gone and met with them, asked them questions, and we got
``yes''ed to death.
Thank you. [Applause.]
Mr. Shays. Thank you.
Our next three witnesses are: Thomas O'Connor; Gerard Kelly
from Jackson Heights; and Daniel Reilly from Beacon. Do we have
Mr. O'Connor from Marlboro? Right there? And then we'll go to
Mr. Kelly, and then we'll go to Mr. Reilly.
STATEMENT OF THOMAS O'CONNOR, VETERAN AND NURSE MANAGER,
OUTPATIENT SERVICES, CASTLE POINT, MARLBORO, NY
Mr. O'Connor. Good afternoon. My name is Tom O'Connor. I am
a Vietnam veteran. I am a public servant at Castle Point and
the nurse manager in outpatient services.
I've heard it said that you shouldn't take on anybody who
buys their ink by the barrel, but I do have to ask that--it
seems to be a conflict of interest that the organization of the
newspaper in question that's been trying to bury Castle Point,
the Times-Herald Record. If they're successful in what appears
to me as an employee in their attempts to bury the hospital,
one of the main beneficiaries is going to be their largest
advertisers.
Every Sunday, I open the paper, and there's page after page
of hospital advertising. I noticed that they seem free to take
on Castle Point and throw a lot of dirt because we're not an
advertiser. If we go down, if our patients have to seek out
services elsewhere, they're going to seek out those services
with the advertisers that advertise with them. That's a point
relative to advertising.
Another point is I understand a lot of our patients do not
want to travel from one hospital to another. To put it in
another context, if I were to go to Horton Hospital and my
doctor were to call me in and see that I needed a hip
replacement and said, ``Tom, I'll tell you what. I want you to
get the finest of care. What I'm going to do is I'm going to
send you down to the hospital for special surgery which happens
to be one of the most highly-rated orthopedic institutions in
the country,'' I would go home and tell my friends, ``What a
great doctor I have. He cares so much that he's going to send
me to get the best care.''
Meanwhile, back at the ranch, at Castle Point, if we refer
a patient to the Bronx VA, where they receive care from
surgeons who are affiliated with the hospital for special
surgery, somehow we're accused of giving second-rate care, why
we can't provide it. I'm at a loss why the two different
judgments. If I worked at Horton, I'd be a hero. If I work at
Castle Point, I'm a devil.
That's all. [Applause.]
Mr. Shays. Mr. O'Connor, thank you very much for giving us
your position on that.
Ms. Mussolino. Excuse me?
Mr. Shays. Yes.
Ms. Mussolino. Could I just take a second? I just noticed
the man just decided to stand next to me. I have no problems
with my father going for hip surgery at the Bronx. I have a
problem with the cuts that when he came back, he was not able
to feed himself. And they stuck a tube down him. And now we
have a group called the Silver Spoon to volunteer and feed
these men. This is what I have a problem with.
If he gets special care and better treatment elsewhere,
fine. But we should be able to have that here. That's all.
[Applause.]
Mr. Shays. Mr. Kelly is over here. Do you have a mic, sir?
Mr. Kelly. Yes. Thank you.
Mr. Shays. Thank you.
Mr. Kelly. Thank you.
STATEMENT OF GERARD KELLY, VETERAN AND EASTERN PARALYZED
VETERANS ASSOCIATION, JACKSON HEIGHTS, NY
Mr. Kelly. I'm Jerry Kelly from the Eastern Paralyzed
Veterans Association of Jackson Heights, but I live in New
City, which is in the Hudson Valley. And I have been a patient
at Castle Point as well as at the Bronx and a number of other
VA institutions.
Thank you, Mr. Chairman. We have presented testimony for
the record in writing, and I will not try to repeat all of that
now and just make a few points that I think are important for
you to hear.
Castle Point has been a very important part of the hospital
system for our members. It has been 1 of the SEI care centers
in the Nation, 1 of the 22 SEI care centers.
Right now as part of the restructuring of VISN 3, the three
centers have been combined under one, which will be
headquartered at the Bronx. There will be beds at Castle Point.
But what has happened is that we have had to move our plastic
surgery program, which we helped to underwrite, from Castle
Point to the Bronx. It's no longer available in the Hudson
Valley for Hudson Valley veterans.
We have seen the number of our members who go to Castle
Point and also the number of our members who now go to the SEI
center reduced because of this increased need to travel further
for the specialized care.
The VA SEI care system is the only care system of its kind
in the Nation. It's one of the specialized care programs. It
has been recognized as such and has been picked out or singled
out for special funding.
One of the things the SEI care system does that is not done
in the private sector is sustaining care that they provide for
our SEI veterans, our spinal cord-injured and disabled
veterans.
We have been concerned about the availability of that care.
And while we recognize that the access points are a big plus
for veterans in general, for veterans with spinal cord injury,
they have not been as available because of some problems, first
of all, with the specialized care availability and in other
cases wheelchair accessibility to some of those centers. That's
also been a problem.
The other main thing we have been concerned with is the
quality control issues. We have discussed today with some of
the witnesses that there are new systems being put in place to
assure quality control is maintained on a nationwide basis in a
more uniform basis. We talked about some of the sentinel events
which will trigger investigations. We're very happy to hear
that because we have been tracking what's happened about the
country.
One of the biggest problems has been mistakes which have
been made many times because of the fact that there has not
been a reporting system and investigations have not been done
properly to followup on these.
I'm concerned that what is identified as a sentinel event
is properly done because I know there's been some things which
are the explanation of what a sentinel event is, which would
not have been identified as such. And those problems would
have, again, been continued. So we're going to be watching that
very carefully. And I know the committee will also.
We know the VA needs to be reformed. We just hope that the
Veterans Affairs Committee, the Government Reform and Oversight
Committee, and the other Members of Congress who are
responsible for overseeing what is done to our Nation's
veterans make sure that those changes take place in a proper
manner. We need to save money, but let's do it while we're also
protecting veterans.
Thank you.
Mr. Shays. Thank you, Mr. Kelly. [Applause.]
Daniel Reilly from Beacon?
STATEMENT OF DANIEL REILLY, VETERAN AND NFF 246, BEACON, NY
Mr. Reilly. Good afternoon, Members of Congress, ladies and
gentlemen. My name is Daniel J. Reilly.
On December 1, 1976, after having served in the Air Force,
I began my career with the Veterans Administration Service. I
worked at the VA hospital in Montrose until August 1990, when I
transferred to the medical center at Castle Point.
I feel that in the spirit of the difficulty both Castle
Point and Montrose are experiencing at this time, the two
facilities remain a good place in which to work. These
facilities afford veterans the necessary care and treatment
they surely deserve.
As a spokesman for NFF, which is the local out there, 346,
I should express feelings of the members that our drastic
downsizing and cutbacks are what contributed to the poor morale
and bad publicity by the newspapers, what we have experienced.
We already had experienced cutbacks and downsizing with the
public sector in this area and now with the same happening with
the government, families especially. We veterans feel hurt,
helpless, what in the future will help us all.
It is apparent that the government is willing to sacrifice
funds for veterans' programs and health care by appropriating
these funds for other resources that are deemed more important
than for the veterans who served their country so faithfully.
I, as a veteran, am especially saddened when I think of
where the future lies for the young men and women who are now
serving and will serve their country in the future.
In conclusion, I am among the many others here today who
respectfully ask for all of you to support us in our time of
need by doing all that you can to help see that the rights of
veterans are upheld to the highest standards possible by
keeping our veterans' programs in health care alive and well
for all veterans today and tomorrow.
Thank you. [Applause.]
Mr. Shays. Thank you, sir.
Our next few witnesses: Kenneth LaFontaine did not give a
city or a town, Harry Fleming from Middletown, and Shirley
Mangels from Ellenville. Is Mr. LaFontaine here? Then our next
speaker will be Harry Fleming. Mr. Fleming from Middletown.
Mr. Fleming. Thank you very much.
STATEMENT OF HARRY FLEMING, VETERAN AND CHAPLAIN AND SCOUTING
CHAIRMAN, ORANGE COUNTY AMERICAN LEGION, MIDDLETOWN, NY
Mr. Fleming. I am with the American Legion, the past
commander of Post 151 here in Middletown. And also presently
I'm the Orange County American Legion chaplain and the scouting
chairman for the Orange County American Legion.
As a whole, with Castle Point, I have not too many
problems. I did, and which I have brought to Mr. Gilman's
attention. I've had a problem with one doctor over there. And
he was a doctor that you could not talk to as I undergo daily
pain from osteoporosis, arthritis, and diabetic neuropathy. And
I have pain 24 hours a day, 7 days a week. The doctor argues
with me, tells me it's in my head. And I tried talking with the
doctor to no avail.
I ended up changing doctors over there after he pulled a
sneak one on me. He canceled an appointment on me for the
hospital down in Manhattan. And, subsequently, I had to end up
going to a local hospital and being transferred to Columbia
Presbyterian, which would end up costing me $7,000 out of my
own pocket because he canceled the appointment and didn't even
tell me.
That's all I have to say.
Mr. Shays. Thank you, sir. [Applause.]
Our next speaker is Harry Fleming from Middletown. Oh, I'm
sorry, Harry. You just went now. I'm sorry, Harry.
Shirley Mangels, is she here? Thank you. Way in the back
there.
STATEMENT OF SHIRLEY MANGELS, DAUGHTER OF DECEASED VETERAN,
ELLENVILLE, NY
Ms. Mangels. I'd like to thank you for letting me speak
here today.
My father had been a patient at Castle Point, an outpatient
at Castle Point, for 3 years. So what I'm about to tell you
cannot be said happened because there was no knowledge as to
what his medical status was.
On January 20, my mother took my father, Clifford Madison,
to the Castle Point emergency room. He had been coughing,
complaining of shortness of breath, and had a frying sound when
he breathed, audible without a stethoscope. His ankles also
displayed some swelling.
The emergency room doctor, whom we discovered later on was
only moonlighting at Castle Point, was not a regular staff
doctor, told my mother that there was essentially nothing wrong
with my father, that he had maybe an occasional drip in his
lungs, which was not considered unusual for an older person,
but there was really nothing wrong. And on the records, what he
listed my father's condition as was ``viral syndrome.''
Well, guess what? In about 36 hours or so, my father became
progressively worse to the point where he was incoherent. And
on Monday morning, January 22, he had become critically ill and
had to be transported to Ellenville Community Hospital, where
there they found that both lung fields----
Mr. Shays. Excuse me. Would you just suspend a second?
Could we shut the door? I'm having a difficult time hearing.
I'm sorry. I really appreciate all your patience. We don't have
the most comfortable chairs to sit in, and some have not been
able to sit very long. Thank you.
I'm sorry to interrupt you, Ms. Mangels.
Ms. Mangels. Quite all right.
X rays revealed that fluid was in the lower two-thirds of
both lung fields and that this area was filled. There were fine
and coarse rails anteriorally and posteriorally in both lung
fields. There was also cardiomyoglian evidence of swelling
three to four plus.
Later that day, my father was transferred to the VA
facility at Castle Point in extremely serious condition because
Ellenville did not have a blood gas machine that was working
properly at the time.
From there on, my father at one point began to progress and
began to show signs of becoming well. And, as a matter of fact,
the one doctor that was observing him at the time told me that
my father would be home in about 3 days.
Well, later on, my father on February 10 passed away. The
same doctor that less than 2 weeks prior told my mother to take
him home, same emergency room doctor, comes into my father's
room and pronounces him dead.
Now, we have been to an attorney about this. And we have
gotten an independent physician's results on what he gathered
from reading my father's records. This is the statement that he
gives,
I have read the medical records recently forwarded to me,
having particularly to do with the above-captioned person's
visit to the Castle Point VA emergency room on January 20,
1996, the subsequent events at the Ellenville Community
Hospital on January 22, 1996, and subsequently again at Castle
Point VA Hospital extending until the time of his demise.
On the basis of these data, it is my opinion that the
emergency room record from Castle Point VA Hospital generated
by a physician on call in the emergency room whose name is
illegible to me represents a disgrace to the medical profession
and certainly to the Veterans Administration.
Among other things, this record under the ``Triage''
section does not truly, fully, and accurately relate the
patient's problem and complaints. Complaints at this time were
particularly: shortness of breath, wheezing, and swelling of
the feet and ankles. These problems were not indicated on this
medical record.
The section for history and physical is unbelievably below
standard in essentially all respects. The entry shows the
presence of occasional bronchi in rails and no wheezes, which
is contrary to the history. There was no comment regarding the
question of veins in his neck, his color, his general
condition, the presence or absence of pulmonary findings on
percussion, such as dullness and/or a decreased----
Mr. Shays. Ms. Mangels, could I just--given the severity of
your concern, for obvious reasons, I want to give you some
leeway, but I do need to have a sense of how much longer you'll
be because----
Ms. Mangels. Not very much longer.
Mr. Shays. OK. You'll finish up in a minute?
Ms. Mangels. Yes.
Mr. Shays. Thank you.
Ms. Mangels [continuing statement].
Under abdomen, there appears to be simple negative
regarding ornagamy and other problems and under extremities, no
entry of pedal edema, which is contrary to the obvious fact.
This history is such as to contribute to the formulation of
anything like a reasonable, accurate diagnosis. And indeed in
this case, no such diagnosis was made. The physician entered as
diagnosis ``viral syndrome'' with nothing whatsoever to support
this. And he also noted ``increase'' in the person's ``pt
time,'' which in my opinion had nothing to do with the
presenting problems.
On the basis of these information errors, the doctor
advised the patient's heart and lungs were OK; there was an
abnormality in his pt time, which should be corrected; and he
was summarily discharged to go home.
I'll just skip down through here. The doctor continues,
It is my opinion that the 2-day hiatus with no treatment
materially adversely affected his cardiopulmonary situation to
the extent that myocardial infarction was precipitated by his
hypotension, hypoxia dyspepsia, . . . Pneumonia was likewise a
direct and result of the untreated pulmonary problem over these
2 days. Therefore, this hiatus of no treatment in my opinion
was the proximate cause of his demise.
I would like to say one thing. All of this took place
before the talks of cuts and everything else. There was a
problem before. The problem is just not money. That's the tip
of the iceberg.
Your problem is having competent health care-givers at
these facilities. You want to expand facilities? You want to
put some facilities in Monticello and in different areas? You'd
better make sure that you've got people competent enough to run
these facilities because if you don't, you're going to have
more deaths on your hands, more mutilations, and so forth.
Mr. Shays. Thank you. [Applause.]
Our next three speakers are: Joseph Montemarant from
Hopewell, Henry Lendzian of Warwick, and Pam Jinks from
Montgomery. Is Joseph Montemarant here? Is Henry Lendzian here?
Is Pam Jinks here? Ms. Jinks?
Let me just say to you that we're going to just go down the
list, and we'll stay here until 6 o'clock. Sir, we have to have
some way to do it. So we'll just go on to the next person who
was randomly picked.
Let me just say something here. We do have one obligation,
and that is that this room is going to be used for another
group afterwards. So we're going to try to finish up in another
hour and a half. We're going to go another hour and a half.
That's 6 o'clock.
Are you ready now, Pam Jinks? Can we start? Thank you.
STATEMENT OF PAM JINKS, VETERAN AND CASTLE POINT EMPLOYEE,
MONTGOMERY, NY
Ms. Jinks. My appeal is to the representatives who appear
to be jumping on the bandwagon to use Castle Point and Montrose
VAs as their political crusade.
I am a veteran as well as an employee of Castle Point. I'm
concerned that all the adverse publicity that we have been
receiving is going to be the downfall of two facilities that
have faithfully served our veteran population for more than 50
years.
In this time of health care reform, it's imperative that
the VA keep abreast with the private health care industry. The
VA can no longer continue to operate as we have in the past.
And the taxpayers can no longer be expected to foot the bill of
this enormous program without the government taking drastic
measures to cut costs and work more efficiently.
By doing so, we are effectively downsizing, a word well-
known in the corporate world. Along with that comes anger and
fear from the affected employees as well as the population we
serve.
Congress approved VERA without knowing the full
ramification of this bill. You listened to the bean counters,
who projected shift in the population. You felt this was good
for the Nation, but you were forgetting the ones that were left
behind.
I understand that the veterans who use both the New York
facilities and Florida have said that the Florida facilities
are beautiful, but books can't be judged by their covers.
The New York hospitals are under attack because you're
asking every disgruntled patient and family to come forward.
Could any hospital survive this type of attention? I doubt it.
The industry is still based on human judgment, which
includes errors. We have not entered the era yet where IBM has
developed a program designed to perfection for the medical
profession, as they did for chess. We still use the human
physician judgments. Why you ever opened up the floodgate is
beyond me. Along with their failures, there have been
successes. But you never ask for them.
I happen to be proud of Castle Point. I began working in
Outpatient, then spent 10 years in Quality Assurance. So I know
the weaknesses as well as the strengths of this facility.
For the past 18 months, I have served as supervisor of
primary care. I'm a member of the Women's Veteran Committee as
well as the POW Committee. By being a member of these
committees, I know that the facility has identified areas for
improvement and is continually working to resolve the issues
that are brought forward.
Positive changes and implementation have begun. We continue
to work with the service organizations to see that corrective
action is taken. If anything, because the administration has
changed, we are now able to quickly make corrections and
address issues without the barriers placed on us in the past.
Though change is always resisted, I believe that the merger of
the two hospitals will benefit the community in the long run.
Thank you.
Mr. Shays. Thank you very much. [Applause.]
Thank you for your testimony. Our next three witnesses will
be: Enrico Messina from Poughduag, if I'm saying that
correctly, Sandra Schwartz from Poughkeepsie; and Anne Bove
from Woodside. Is Enrico here? Thank you, sir.
STATEMENT OF ENRICO MESSINA, VETERAN AND CASTLE POINT EMPLOYEE,
POUGHDUAG, NY
Mr. Messina. Good afternoon, ladies and gentlemen at this
congressional hearing. I come before you today to speak openly
and honestly about Castle Point VA Medical Center. I will share
my experiences and blessings.
I am a veteran of the United States Army who served as a
medical corpsman in the United States and was in Vietnam for 11
months and 26 days. I truly believe that God sent me to Castle
Point to provide nursing care for our honorable veterans who
stay or use the medical center and outpatient clinics.
I started my career at Castle Point in the nursing home on
the B-1 unit, where I met, talked to, and provided the best
possible care with the staff assigned to that unit. I am proud
to look at each one of you here today and say that each day the
men, in some cases women, patients were treated with dignity,
compassionate hands, and skilled nursing care.
These veterans were called to duty, as I was, in their late
teens and early 20's to serve our country in a foreign war and
engage in battle knowingly for the love of their country
without asking themselves, ``Why me?'' or ``Why us?'' They just
did the job and served honorably for their country.
Many of these veterans' minds and bodies were scared for
life, requiring compassion and love. Each day every patient was
provided the activities of daily living.
Some patients lost their limbs, legs, and arms during the
battles they fought. Therefore, washing and showering and
dressing them in neat, presentable clothing was provided them
each day. Their teeth were brushed. Dentures were cleaned. And
their hair was combed. A dialog with these patients took place
either in their daily care or while feeding them at their
bedside.
Many of our freedoms that we have today we sometimes take
for granted. These veterans, though, through their courageous
efforts gave us this freedom that we have today.
I, for one, am very grateful for the freedom of speach. I
as I stand before you today ask you that you please do not take
these and other freedoms of our veterans away.
I challenge you all today to let us continue to provide the
best medical care to our loyal veterans in an expedient way,
which should be the way to always be maintained at a level
second to none. You now have an opportunity to fight for us at
each of your congressional and State levels of government,
representing the people; in particular, all veterans.
The nursing home also provided a religious atmosphere for
each veteran and their families each day from our priests,
reverends, and rabbis. Weekly services are offered to all. Many
look forward to going before their God and praying in their own
individual ways. How blessed they are to have this religious
dedication at our facility.
I have seen and heard the power of prayers at a time of
need when many of our veterans are called home by their God.
And the support was very uplifting for their families and the
staff alike.
The recreation representatives along with many volunteers
provided such things as music therapy, pet therapy, bingos,
movies, trips to local ball games, and fishing spots, which
provides ongoing mental and physical stimulation that is needed
to progress and have happiness in this world. These people
sometimes go unnoticed, but I, for one, want to say thanks for
the many smiles and words of appreciation that veterans shared
with me after enjoying these recreational experiences.
Yes, sir?
Mr. Shays. Mr. Messina, you got here at 9 a.m., and helped
set up this room.
Mr. Messina. Yes, sir.
Mr. Shays. So my heart wants to let you speak a little
longer, but we do have other speakers. So could you kind of
wrap it up?
Mr. Messina. I have about 3 minutes, sir. Would you give me
the opportunity?
Mr. Shays. You have used 3 minutes. You may have more than
3 minutes. I just would like you to bring it to a close.
Mr. Messina. I will try to read fast, sir.
Mr. Shays. Maybe cut out a little bit if you have to.
Mr. Messina. OK. Many of our World War II veterans require
and will continue to require these and other surgical
procedures. I address the OR. We'll skip over that, sir.
I will give you a copy of my report, sir.
Mr. Shays. It will be in the record.
Mr. Messina. Please be mindful that the travel for these
procedures to other VA facilities outside the normal traveling
radius and in unfamiliar areas is a true hardship for my fellow
veterans and their families, who are in the 70's and 80's. They
need and want to continue to utilize the Castle Point facility.
What we all did without second thoughts in our healthy
20's, 30's, and 40's becomes a frightening experience for us
all as we will increase in age and find it hard to travel.
These veterans will find it impossible to travel outside their
living areas for the medical support they deserve and were
promised.
This past January, I was given the opportunity to serve our
veterans in the outpatient clinic area. Hundreds of our
patients visit the clinic each week to see the physicians,
nurse practitioners, and nurses for their medical needs and
medications.
Preventative education to the veterans is vital to the
continuing health for the future. We all at Castle Point strive
to make this a positive visit with quality care, love and
dedication to our veterans being the utmost importance.
One of our ongoing goals is to continue to track new
veterans by offering the best quality care that they need and
deserve. We are a proud team willing to increase our offerings
and expand our programs for these men and women veterans at our
clinics.
I would not be here today if it were not for the many
articles published in the area newspapers that were very
disruptive to our veterans at Castle Point. This is where I
work each and every day to provide skilled nursing with love
and compassion. In response to these articles, I have never
seen, nor would I ever stand for, any veteran who required care
and did not receive that care in a timely and professional
manner.
I beg each of you here today to continue support of the
veteran population, these veterans here today and to those who
could not make it here.
Mr. Shays. Mr. Messina, I do need to ask you to conclude.
Mr. Messina. In closing, I remind you of your challenges
ahead to not only seek the truth, but be open and honest to us
as veterans. As you allocate the dollars to all Veterans
Administration health care facilities, you, as our elected
officials, have the power to vote into and present new laws
that will affect us as veterans.
Our veterans fought and served for us. Now the opportunity
is yours. Fight for us so we can continue to provide the
ongoing excellent health care at Castle Point.
Respectfully submitted, Enrico Messina.
Mr. Shays. Thank you. [Applause.]
Mr. Messina, thank you again for getting here at 9 a.m., to
make sure that we had our chairs set up and this room set up.
It was very nice of you to do that.
Our next speaker is Sandra Schwartz from Poughkeepsie.
Where are you? I'm sorry. OK. Thank you. You're on.
STATEMENT OF SANDRA SCHWARTZ, VETERAN, WIFE OF VETERAN AND
DAUGHTER OF DECEASED VETERAN AND DISABLED AMERICAN VETERANS
AUXILIARY, POUGHKEEPSIE, NY
Ms. Schwartz. I am with Disabled American Veterans
Auxiliary. I am a volunteer member of the Disabled Committee of
the Dutchess County Human Rights Commission. I sit on the
Roundtable for Racial Harmony. I have served on the board of
Taconic Resources for Independence, which works closely with
the Eastern Paralyzed Veterans. I am the daughter of a soldier
who paid the ultimate price, and I am the wife of a veteran.
The VISN statement is proudly and prominently displayed on
the corridor wall at Castle Point. It states, ``Serving those
who served our country with quality health care second to
none.'' Likewise, the mission statement, also proudly
displayed, echoes this intent commitment.
Whereas, Webster's Dictionary defines the word ``quality''
as meaning ``a grade of excellence,'' the veteran is aware that
the words ``quality health care'' are being bandied about and
are constantly redefined in the direction of diminished care
and perhaps ``equal to none.''
There are definite indications that the hospital as we knew
it really doesn't exist any more but has become a shell of
itself. It has been downsized, peeling away on a step basis the
confidence of the veteran and veteran's family and raises
questions as to what criteria can still apply to it as a
standard if it is no longer a hospital.
Webster also defines a hospital as being ``an institution
where the sick and injured receive medical, surgical, and
emergency care''; whereas, a clinic is defined as ``a facility
associated with a hospital that treats chiefly outpatients.''
This likens Castle Point's transformation into a satellite, a
field first-aid station, as in places of combat, where
primarily the only aid rendered was preparation referral and
transfer to a base hospital.
Contracts with Vassar, St. Francis, or other community
hospitals are being considered to provide emergency room
services. In the absence of these services for inpatient or
outpatient, how can anyone conceive of Castle Point being
considered as a medical center?
After gutting these medical, surgical services, what
remains is little more than a primary care referral,
recordkeeping, and pharmacy service under the heading of a
medical center. These actions combined with reduced funding and
lessened services construct a climate which will further
discourage veterans from seeking care at Castle Point. Perhaps
this is the ultimate objective: the reorganization to
compromise the veteran in the interest of budget balancing.
Placing the burden of further travel for medical care for
the sick and spinal cord-injured veteran, including the elderly
ones, is most inconsiderate and tantamount to cruelty to them
and their families.
A spinal cord-injured veteran who had been sent to the
Bronx Medical Center reported back that the ratio of patients
to personnel for his ward was 7 to 1. It certainly was not an
ideal circumstance. A lot of patients in this type of ward need
a lot of help. And short-staffing endangers their lives.
The Federal Government has promised its citizens to be the
role model for persons with disability as provided for in the
Rehabilitation Act of 1973, as amended, and the Americans With
Disabilities Act. Yet, we see in this reorganization a
disregard to these special citizens through dilution of their
deserved quality care by proposing contracting with non-
veteran, profit-based, community entities, reducing access and
availability of VA expert competency centers.
This past Thursday as I was preparing remarks for this
hearing, I observed a fire drill on the hottest day of the
year, which caused a veteran in his wheelchair to be moved
outdoors. It turned out that he was abandoned there, which
resulted in his succumbing to the heat. And he slumped over
with his head leaning against the hot bricks. As a bystander, I
personally notified staff of his need for immediate aid.
Another issue at this time when the fire drill was
repeated, I noticed a very long line of 20 to 30 patients
awaiting their turn at the scheduling desk on the third floor
disregarding the alarm because they were concerned about losing
their place in line and finally being herded by staff into an
already-occupied small room to at least get them to move out of
the corridor. Even the elevator continued to operate for a fire
drill. It appeared that the actions taken were ill-conceived.
And it caused me to wonder, ``What if it were not just a
drill?''
On Friday, August 1, 1997, 2 days ago, I was at Castle
Point and received a firsthand account of the eroding of
quality care. A veteran who had previously undergone a bad
surgical experience at Castle Point was scheduled for a
different procedure. He had expressed his concerns to the
doctor, who reassured him in order to allay his anxiety that
the instrumentation, a flexible soft scope, would be used for
cavity insertion to prevent injury during the examination.
The veteran arrived at the appointed hour fasting and was
kept waiting for 2\1/2\ hours before he was summoned to garb
himself in surgical attire. And he was placed on a gurney in
the operating room, prepped for the procedure, which was then
commenced. The procedure had to be abruptly halted----
Mr. Shays. Ms. Schwartz, you've been about 5 minutes now.
Ms. Schwartz. I have one page, and I think it's important.
Mr. Shays. Everybody thinks their statement is important.
Please finish up.
Ms. Schwartz. Yes, sir. But if it's not read and it's not
recognized----
Mr. Shays. Ma'am.
Ms. Schwartz [continuing]. He yields his time to me, there
could be a lawsuit, which could be avoided.
Mr. Shays. Let me be very clear here. At 6 o'clock, we're
going to end. There will be some people who will not be able to
testify because some people, quote, spoke 5 and 6 minutes. I'm
very willing to let her proceed, but I'm just making the point
to you that other people won't be able to speak at all. If you
think that's fair, we may proceed.
Ms. Schwartz. When the doctor called for the flexi-scope
and was only then informed that the supply for Montrose and
Castle Point had been used up prior to the veteran's scheduled
procedure and that only a rigid, thicker fiber scope was
available, the explanation offered was that all three of the
necessary devices had been used up prior to his scheduled
appointment and the sterilization process before reuse had not
yet been accomplished.
So the patient was told to redress and reschedule for a
repeat procedure. The doctor apologized, saying she was
impacted by over-booking and that they had just handed her a
clinic, which she was late for.
Poor pre-planning and the lack of ample equipment,
resources, and staff could hardly exemplify quality health
care. Is this the benefit of the Castle Point-Montrose merger?
Savings should not be accomplished at the veterans' risk.
Also noteworthy is the recent rash of musical chairs being
played at Castle Point, where medical care personnel unfamiliar
with patient history substitute for specialists without
background in that specialty. Additionally, there has been
substitution by practical nurses for consultation in the place
of specialists, no doubt due to short staffing.
Fairness to the veteran population dictates that they be
held different in budgetary matters. Opportunities which you
people enjoy today are because of what they sacrificed
yesterday. Stop imposing on families for third party
contributions. Stop robbing their families. Stop robbing the
veterans. Stop those who have conflicts of interest and
bonuses.
Veterans are special citizens who have paid their dues and
contributing fees in advance with heavy consequences to them
and their families. The cost of war does not end at the treaty
signing. But fairness to the veteran is recognizing that the
debt is ongoing.
Let's not nickel and dime them to death by being deadbeats
to our veterans. Restore funding to our Northeastern veterans.
Restore funding and refresh Castle Point to the quality care
hospital it used to be.
Thank you.
Mr. Shays. Thank you, Ms. Schwartz. [Applause.]
Our next speakers are: Anne Bove from Woodside. Is she
here? Anne? And let me just say who will be following: Robert
Jirak from New Paltz. Is Robert here? Robert is not here, I
gather. Karl Rohde from Carmel. Is Karl here? He had to leave.
And after Karl is Patricia Hulse from Sparrowbush. Is she here?
OK.
Well, I'm sorry to keep you waiting. Anne.
STATEMENT OF ANNE BOVE, REGISTERED NURSE AND DAUGHTER OF
DECEASED VETERAN, WOODSIDE, NY
Ms. Bove. My name is Anne Bove. And I'm speaking on behalf
of my mother and one of her neighbors with regards to their
husbands, respectively.
My father, Frank Bove, as well as Mr. Carmine Gracioso,
were both World War II veterans. My father was in the Service
for 10 years. Both of the men saw combat duty during the Second
World War. My father was 35 percent disabled. Both men recently
have passed away.
My father, as well as Mr. Gracioso, suffered from
complications of what I call inadequate staffing. I'm a
registered nurse that works in a municipal hospital in New York
City, so I can understand about governmental restrictions in
terms of financial components. But I think the financial
components that have restricted the particularly nursing care
with regard to what these patients well-deserve has gone far
and above what I consider or any of these patients deserve.
My father basically got wonderful care at Castle Point up
and until February 1997, when restructuring happened. At that
point, he was in a nursing home section and was put into
another nursing home unit that had much more acutely ill
patients with less nursing staff.
Subsequently he broke his hip, was operated on at Manhattan
VA, which he got excellent care at, came back to Castle Point
and the cascade of events that happened to him, once again
indicators of poor nursing care, resulting basically from the
lack of staff.
I think it's important to look at morbidity and mortality,
but there are other indicators that will show whether or not
the provision of care has been adequate, such as: the number of
falls a certain facility might have, the number of pressure
ulcers a patient will develop. I think all of those things need
to be considered.
And in the case of my father and in the case of Mr.
Gracioso, those complications did ensue and much shorten their
not-too-long life expectancy, but a little bit more time that
we could have spent with them in terms of quality.
I hope that consideration is made to enhance the VA system
as not to do away with it because it's a much needed system for
a very special patient population, of which my father was once
a member.
And that's really all I have to say right now. Thank you.
[Applause.]
Mr. Shays. Thank you, Ms. Bove. Just again I'll call Robert
Jirak is not here. Karl Rohde? Patricia Hulse? None are here.
John Earley? Is John here from Pine Bush? John Ippolito, is he
here? John, you have the mic, sir.
STATEMENT OF JOHN IPPOLITO, VETERAN AND AMERICAN LEGION POST
1266, PINE BUSH, NY
Mr. Ippolito. My name is John Ippolito. I'll make this
short and sweet.
What I have heard here today is that the VA hospital should
be doing more with less. So bonuses can be paid to perpetuate
human misery by staffing cuts in our patient services to
veterans who really need hospital care. This sucks. And I hope
our congressional Representatives who are here today do
something about it and soon.
Thank you. [Applause.]
Mr. Shays. Thank you, sir.
Nicholas Bucci, is he here from Marlboro? Ralph Demarco
from Fishkill? Ralph, you've got the floor. What I'm going to
do is I'm going to tell you when 3 minutes come. The will of
the group--I'm just going to say the will of the group is to
let you go. And if you take someone else's time, you do. But
I'll let you know when your 3 minutes come.
Mr. Demarco. You have my statement. I'll skip over what I
think is important.
Mr. Shays. OK.
STATEMENT OF RALPH DEMARCO, VETERAN AND REPRESENTING 27 NEW
YORK VETERANS' ORGANIZATIONS, FISHKILL, NY
Mr. Demarco. First of all, identify myself. I'm a member of
the Board of Directors of the Veterans of Foreign Wars of the
United States. I'm the New York State VFW legislative chairman.
I'm president of the New York State Council of Veterans'
Organizations, legislative representative. Most important, I'm
a member of the New York/New Jersey Management Assistance
Council for Network No. 3 and Network No. 2. I'm also a member
of the Care Line Implementation Team for Network No. 2 for the
Department of Veterans Affairs. To let you know, I represent 27
veterans' organizations, major organizations in the State of
New York. I'll get to the part where I think is important.
As a member of the New York/New Jersey Veterans' Integrator
Service for Networks 2 and 3 Management Assistance Council and
also a veteran for the Network No. 2, its Product Line
Implementation Team, we have been the veteran's advocate at all
network meetings. The network directors at the MAC meetings
provided us with sufficient opportunity to state our position
on and issues, discuss our concerns, and have been responsive
to our concerns and questions.
Due to the bad press recently at Castle Point-Montrose, VA
received many calls from the media, where I appeared on
television in an hour program answering questions from the
veterans across our State, also been interviewed by major
newspapers and three radio stations across the State.
With the members of the council, we have toured Montrose
and Castle Point Medical Centers and found them to be clean and
orderly. The employees went out of their way to accommodate our
wishes. We talked to medical and nursing patients and also were
satisfied with their treatment and services, met with Dr. Kizer
at Castle Point, where he explained the deaths.
As far as VERA is concerned, we have long supported the
concept of equal access to VA health care for all veterans, but
we are concerned, however, that those networks which will
receive fewer funds will begin to limit access and service. We
will watch closely and will examine every complaint and every
individual base.
Here's something that our good Congresswoman is interested
in: treatment of medically-indigent veterans. These veterans
are in grave jeopardy of becoming victims of an inadequate VA
budget. Even though VA mandates to provide all needed hospital
care to low-income veterans, they will only provide care to the
extent that resources and facilities are available. Thus, if
Congress does not appropriate adequate funding, this class of
veteran may be denied care.
We have been and continue to be committed to being champion
of the medically-indigent. We will fight to see that their
health care needs are fully provided by the VA.
Another thing that we find very disturbing is the VA
nursing home closes. Nursing home eligibility has not changed
with the Eligibility Reform Act of 1996. It is still
discriminatory and may provide when medically indicated and to
the extent----
Mr. Shays. You may keep reading, sir. I was just going to
let you know your 3 minutes are up, but keep reading.
Mr. Demarco. All right. Just to close, with the coalition
of major veterans' groups, we recommend that if enacted, it
would strengthen programs and services provided to the
Department of Veterans Affairs.
These recommendations are contained in the 11th Annual
Independent Budget for Veterans' Programs developed by the
Veterans of Foreign Wars, the AMVETS, the Disabled American
Veterans, and Paralyzed Veterans of America.
The report recommends--this is where we think it's
important--$43.2 billion in appropriations for the fiscal year
1998, a 7 percent increase over the current appropriations,
including $19.7 billion for compensations, pensions, and burial
benefits. And the recommended appropriation for veterans'
medical care is $19.5 billion.
The VA's attempt to be cost-effective may in some cases be
taking precedence over efforts to provide high-quality care to
veterans. The recommended funding levels in the independent
budget will enable the VA to continue serving our veterans.
Thank you for your time.
Mr. Shays. Thank you, Mr. Demarco. [Applause.]
Our next speaker is Philip Oppenheimer from Greenwood Lake.
Is he here? Our next speaker after that is Andy Layer from
Beacon. Is Andy here? Our next speaker is Warren Craig from
Newburgh. Is he here? James Applegate from Goshen? Jim is not
here? Robert Kavana--am I saying that name correctly--from
Crugers?
Audience Participant. Kavana.
Mr. Shays. Kavana? K-A-V-A-N-A?
Audience Participant. He's gone. He's gone.
Mr. Shays. OK. Steven Fleck from Poughkeepsie? Is Steven
here? Yes, Steven. You have the floor, sir. I'll tell you when
your 3 minutes are up.
STATEMENT OF STEVEN FLECK, VETERAN AND MONTROSE EMPLOYEE,
POUGHKEEPSIE, NY
Mr. Fleck. All I've got is one short statement. I work at
Montrose. I've been there 13 years, and I'm very proud at
working at both facilities. I've dealt with the Bronx. I've
dealt with Manhattan. I've dealt with all the things. I'm a
driver. I drive these veterans around wherever they want to go.
And I go out of my way for them. And I appreciate the hospital.
I'd rather go to a VA hospital than a private hospital.
Thank you.
Mr. Shays. Thank you, sir. [Applause.]
William Munday from Wurtsboro. Am I saying that name
correctly? And Richard Thornton from Poughkeepsie. Is he here?
OK. Let me ask you this. I have a list that I could go through.
How many people would still like to speak? Would you raise your
hands? OK. What we're going to do, those of you who can stand
up, would you just stand up so we can just identify you again?
I understand. Those who could, sir.
OK. What we'll do is we'll be able to finish. And that's
very nice of you. Sir, we'll start with you. And then we'll
just go right down the line. Everybody gets to speak. You're
first. Why don't you get a mic here?
Now, let me just tell you the challenge we have. When we're
done, we need you to write your name and your address and
everything because we need to make sure we give it to the
transcriber.
But we need the mic so people back there hear you as well,
and we need it for transcribing. Excuse me, sir. We need it for
the transcriber as well. So you're going to have to take the
mic.
STATEMENT OF THEODORE DOBBS, VETERAN AND HUSBAND OF DECEASED
VETERAN, NEW HAMPTON, NY
Mr. Dobbs. Certainly. My name is Theodore Dobbs. I'm a
World War II veteran of the Navy, as was my wife, Marian Dobbs.
She died in the Bronx VA Hospital. Those are all her charts. I
need copies of those charts back again. They're facts of what
happened.
She was admitted with an infection. And when she was told
by the doctor admitting her in Montrose, he said, ``Is it OK if
we keep you here for a while?''
And she said, ``It is if you can cure my infection.''
So he says, ``Well, I think we can take a crack at it.''
So there was somebody there. And I'm not going to mention
her name, and I hope I don't seem like too much of a ham when I
speak about it.
She said, ``I remember the night that your wife and your
daughter and you came in here.''
She said, ``It was a rainy night, and it was December 18,
1996.''
And she said, ``And then it lasted past midnight. And when
the doctor said to her, `I think we can take a crack at it' so
that she would stay there, he was lying through his teeth
because we have no antibiotics here at all. He just said that
to placate her and to make her obey him to stay there.'' And
so, as a result of the negligence of that problem, she died.
I want you to know I want the veterans' hospitals to be
just as perfect as they can be, but I think that there's an
insurance problem here. Insurance is behind everything that the
government funds, and that's got to stop.
That's all I've got to say. I loved my wife, and I was
married to her for 9 days short of 52 years. I wish I had never
sent her to a VA hospital, but now we're going to change those
things for the better. We're going to make them what they
should be. Am I right? [Applause.]
Mr. Shays. Sir, I'm going to ask everyone speaking now to
fill out a pad afterward just to make sure we have your
address. And we'll be taking it over. We'll bring it to you.
And your name again and your town, sir?
STATEMENT OF CRAIG SHERA, VETERAN AND SON OF DECEASED VETERAN,
GARDINER, NY
Mr. Shera. My name is Craig William Shera. I was in the
Navy, and I also was in the Army, got out of both of them. My
father died in 1987 at Castle Point VA Hospital.
Mr. Shays. What's your community, sir?
Mr. Shera. Gardiner, NY.
Mr. Shays. Thank you.
Mr. Shera. My father died in 1987. He was diabetic. He had
total kidney failure. Renal shutdown they called it. And he
lasted 7 days in that hospital. He had five heart attacks. And
they tried to save my father's life.
I think the people at Castle Point are getting a bum rap,
and it's all political. We know it. I know it. I'm not as well-
educated as you guys are, but this is how I feel.
The woman on the end, I don't really know her name because
I'm not a Republican. [Laughter.]
I heard she voted to send the money down south to this
bill. And if that's the case, if she doesn't know what she's
voting for----
Mr. Shays. Sir, let me just be clear on this. You're
talking about the Veterans Equitable Resource Allocation.
Mr. Shera. Yes, I am. All the terms, I lived in the
military for 14 years----
Mr. Shays. We call it VERA.
Mr. Shera. Yes.
Mr. Shays. That's a decision that we mandate to the
Veterans Department to do certain efficiencies and so on. They
then decide how they are going to incorporate the----
Mr. Shera. What I want to know is----
Mr. Shays. Let me just finish making this point.
Mr. Shera. I know. I know.
Mr. Shays. And the point is then Congress looks back and
says, ``We're not comfortable with the direction you're going,
and we need you to look at doing it a different way.''
It would be wrong for any Member of Congress to say that we
don't want the veterans' facilities to become more efficient.
How they become efficient becomes an administrative
responsibility. And then Congress looks at it and says, ``We
like the direction you're going'' and not.
Mr. Shera. Yes.
Mr. Shays. It clearly has to be a team effort.
Mr. Shera. I understand that.
Mr. Shays. OK.
Mr. Shera. But what I'm trying to say is that if they can
send money to send that space shuttle up every fricking week
like they've been doing--[applause]--why can't they send the
money to where we need it for Americans? We went to the Persian
Gulf to help the Arabs. We went to all of these other countries
to help them. Why don't we just help our own veterans?
My father died at Castle Point. They didn't kill him. He
died. But they treated him well. And it gets me mad. They treat
me well there. And when they start closing that down, I don't
have nowhere to go. I have no insurance.
Thank you.
Mr. Shays. Thank you very much. [Applause.]
Would you bring the mic, please, to our next speaker? Our
next speaker is right there. Sir, you're a State Commander? I'm
sorry. The gentleman who just spoke.
STATEMENT OF GERARD MILEO, VETERAN, MARLBORO, NY
Mr. Mileo. My name is Gerard Mileo, Marlboro, NY, United
States Marine Corps, Korean war.
Someone is to blame. I'm listening to all of these people
out here. Thank God I haven't had time to use the VA hospitals.
Maybe I have a second thought now.
I listen to these people. And they're making a point. Who
is to blame? You can't solve a problem unless you find out who
caused the problem or what caused the problem.
My opinion is our elected officials haven't been doing
their job. Don't take this personally. This goes back to 1945.
You people got in office recently or a few years ago. But they
have let us down. Corporate America has let the working man
down. And our Government, whom you people represent, has let
the veterans down.
Congressman Hinchey, don't take it personal. Would you send
a member of your family to a doctor that's not registered? You
are aware of it. From what I'm hearing, that doctor is still
doing business in a veterans' hospital. That's wrong.
[Applause.]
If Bethesda Naval Hospital had physicians that weren't
registered, you people wouldn't go there. Our President
wouldn't go there. You know the cause. Please do something
about it.
You, Ms. Sue Kelly, Representative, in your district, you
have two VA hospitals. And both of them are going downhill.
Both of them are going downhill. I'm not blaming you per se,
but shouldn't you be looking into this matter?
Audience Participant. That's why we're here.
Mr. Mileo. OK. You're here now. What are you people doing
here today? You shouldn't be here. You elected these people to
represent you. We should be home doing what we want to do. But
we're here reminding them of the job that should be done. And I
think it's wrong. I agree with you----
Mr. Shays. I'm going to interrupt you a second. I'm just
going to interrupt you a second. I at least deserve the
opportunity----
Mr. Mileo. All right.
Mr. Shays. You're going to get to speak a little longer,
but I've just got to say to you we could have this hearing down
in Washington and not have it here. We have it here at the
request of the three Members who are by my side here----
Mr. Mileo. And I thank you people. [Applause.]
Mr. Shays. And we----
Mr. Mileo. I thank you. Congressman Gilman is a personal
friend of mine. He's a good man.
Mr. Shays [continuing]. And because they wanted you to tell
this committee firsthand what you feel and what you're
thinking. So I just want you to know you can't have it both
ways.
Mr. Mileo. OK. Congressman, please excuse me. He is a
personal friend of mine. He's a good man. He's a decent man.
Mr. Shays. Well, don't get carried away. [Laughter.]
Mr. Mileo. Well, I lay it where it is. You people know the
problems. All these people are telling you horror stories. You
know that. Take their horror stories and go down there and
fight for us.
I think there are some elected officials in this United
States that care more for foreign veterans than American
veterans. [Applause.]
We have two Senators in New York State. Moynihan, he
doesn't even know what's going on. D'Amato, 2 years ago, he
runs to the Baltic Sea playing hot stuff. Why isn't he
representing we, the veterans? Why are they running all over
the world giving my money away and taxing us to death?
Audience Participant. Because he's just faking it. That's
why.
Mr. Mileo. No, I'm not going to call him a fake. I'm going
to call him he's not eligible to do the job. Vote them out.
Vote them all out. That's the only power we have left. And if
you don't use it, then take it and I don't want to hear your
cry anymore. Damnit, you've got the power of the vote. Unite
and put these people out of business.
These people will go to the best hospitals in the United
States. Bethesda Naval Hospital, I was there. When you walk in
the door, ``Yes, sir,'' ``No, sir,'' ``What's the matter,
sir?'' Get off my back. Just give me an aspirin.
I'm not here to pick on anybody. [Laughter.]
I'm here to set the--I've heard all your horror stories.
They don't want to hear them anymore. They know what they are.
Tell them to represent you. That's who they are, House of
Representatives. That means they're supposed to represent you
in Congress.
I don't want to be here today. I came here today. Can I
tell you one short story while I'm here today?
Mr. Shays. I was just going to say you're----
Mr. Mileo. It will take a minute.
Mr. Shays. No. I know.
Mr. Mileo. It will take a minute.
Mr. Shays. You're going to talk. I just wanted you to know
you're at your 3 minutes----
Mr. Mileo. Yes.
Mr. Shays [continuing]. In spite of the fact that I
interrupted you.
Mr. Mileo. Can I talk 1 minute?
Mr. Shays. You've got 1 more minute.
Mr. Mileo. All right. Let me tell you what happened to me
38 years ago.
Audience Participant. Did they give you a medal?
Mr. Mileo. I earned my medals. And I'm sorry what you went
through.
Audience Participant. The President gave my wife----
Mr. Mileo. I'm sorry what you went through.
Audience Participant [continuing]. Two medals----
Mr. Mileo. Thank God.
Audience Participant [continuing]. Posthumously.
Mr. Mileo. Thank God.
I'm going to tell you what happened to me 38 years ago. I'm
going to talk a little low. Lloyd's Department Store was being
opened up in the town of Newburgh about 38 years ago,
Congressman? So my wife and I, my little boy are going there.
And there was a veteran, an American Legion guy, selling
poppies. And I'm walking by, he jammed it in my face.
And I say, ``Sorry.'' I kept walking. I didn't have the
money. You know, I'm raising a family, just got out of the
Service, and et cetera. And he keeps following me. And that's
all I remember. His name was Bill.
Of course, his buddy selling poppies on the other side
said, ``What's the matter, Bill?'' ``Oh, this guy don't want to
buy a poppy. He must be 4F or he must be a deserter.''
I took a verbal abuse. And I swore that day that I would
never represent any vet. I don't belong to the American Legion
or the VFW, which I break from both of them. I don't. They just
turn me off. They gave me a verbal abuse and I was a
``deserter,'' I was ``4F,'' et cetera.
Mr. Shays. You got 1 minute. You used 1 minute.
Mr. Mileo. I'll be done. And I swore that day I would never
represent or talk about veterans. Today is the first day I've
done it. You know why? My brother-in-law, Al Roberts, took a
plane today--he was treated in Castle Point--to Tucson, AZ. You
know why? He couldn't be treated in Castle Point. His daughter
set up a meeting in one of the VA hospitals in Tucson, AZ.
Mr. Shays. You need to wrap it up, sir.
Mr. Mileo. Right. Why does he have to fly to Arizona to get
treatment? That's the question. This woman was 100 percent
right.
Thank you. Congressman, please excuse me.
Mr. Shays. OK. [Applause.]
Sir, I want to make sure you sign. Sign the list after each
speaker. Who's our next speaker?
Mr. Novak. Over here.
Mr. Shays. Yes. We're just going to go around the circle.
Oh, over here? Yes, sir? Wait. Excuse me. I'm sorry, sir. I
promised you. You're next right over here. Right over here. The
mic, please, over here. The mic right there, please.
STATEMENT OF BILL NOVAK, VETERAN AND NEW YORK STATE BENEFITS
PROTECTION OFFICER, DEPARTMENT OF NEW YORK DISABLED AMERICAN
VETERANS, MIDDLETOWN, NY
Mr. Novak. My name is Bill Novak. I'm past aid commander of
the Disabled American Veterans in New York. I'm on the National
Executive Committee. And I'm the New York State benefits
protection officer for New York State.
I'd like to start with veterans and their dependents have
made enormous sacrifices and eminent contributions in the
service of this Nation. Since the beginning of our Nation, it
has, therefore, been the tradition to treat our veterans and
their dependents as a special group, entitled to benefits above
those available to the general civilian population.
While serving in our country's armed forces, veterans not
only relinquish their liberty to allow the rest of us to
continue to enjoy ours. They lose income and other civilian
economic and educational opportunities, endure the rigors and
hardship of military service, risk the hazards of war and
dangerous military missions, and suffer injury and death. Of
course, the heaviest burdens are borne by those who come back
disabled.
Most Americans deem it improper to allow those who preserve
our freedom at personal expense to bear the financial and other
burdens resulting from military service. In recognition of what
veterans and their dependents endure as a cost of the security
to our Nation, our country has made a commitment, a restitution
for these sacrifices and contributions through indemnification
for disabilities and other veterans' programs.
Our Nation's commitment to its veterans has endured periods
of economic crisis and has evolved through many military
conflicts. Although the consciousness of the needs of veterans
may decline somewhat between periods of major conflict, the
needs continue in the aftermath.
The American public strongly supports veterans' programs
and expects the commitment to veterans to be honored. And I
will support that with several polls that have been done, one
of them by Harvard University and the Kaiser Foundation, that
93 percent of the American public oppose any cuts to veterans'
benefits. And another one, the Harris Poll done by Business
Week magazine, found that 75 percent of the American public
oppose any dismantling of the VA.
Therefore, this Nation must continue to honor its
obligation to care for the special needs of a special group of
citizens. Because veterans are a special group, their programs
should always have a priority for our Government. These
programs must be adequately funded to assure they remain
effective in fulfilling their purpose.
Unfortunately, there are some who would abandon this
commitment and balance the budget on the backs of our veterans.
How dare they send America's young men and women into harm's
way and then say, ``We can no longer afford to honor that
commitment''? We must remain vigilant and oppose any attacks on
our benefits.
Having said that, I would just like to make a few points.
For over 11 years now, the independent budget that Mr. Demarco
spoke about before has been sent to all Members of the
Congress. It's a budget put together by the AMVETS, Disabled
American Veterans, Paralyzed Veterans, and the Veterans of
Foreign Wars. And it's endorsed by 50 other organizations and
medical units and things like that. It has proposed ways to
make the VA more efficient and save money for the government.
I find it interesting that they say that they weren't
really aware of a lot of these things that VERA could impose
because one of the----
Mr. Shays. Just to let you know, you're at 3 minutes.
Mr. Novak. OK.
Mr. Shays. You may keep going, but you're at 3 minutes.
Mr. Novak. OK. One of the comments that came out of this
several years ago that was sent to the Congress--and these are
comments from that independent budget. It says that, ``Although
the independent budget veterans' service organizations continue
to support VA restructuring goals and advocate for operational
change within the VA system, we fear that these efforts to be
cost-effective may be overriding efforts to provide high-
quality care.'' This came out over 3 years ago. They were
advising Congress that that could happen.
I also found it kind of interesting that they admonished
Mr. Farsetta before for saving that $148 million that they told
him to save. They told him, ``We're not going to give you the
money. You've got to save $148 million.'' He did his job, and
he's admonished for it. I find it kind of interesting.
Another thing, I heard a comment before. They said that the
VA absolutely says, ``We don't need any more money.'' there are
comments from Secretary Brown or former Secretary Brown that
said that, ``If we maintain a straight-line budget for next
year, we probably will be forced to deny care to 105,000
veterans and eliminate 6,600 health care positions.''
These are all things that were said before. And now we're
saying, ``Oh, we don't need any more money.'' I think the
bottom line is that the veterans have more than--everybody
wants a balanced budget, and we think that's a priority for the
Nation. But the VA budget makes up only 2 percent of our
national budget.
Yet, the cuts in the VA program--and I can show you from
over the last 2 decades--$2 billion in the 1980's, omnibus bill
of 1990, $3.67 billion in cuts in veterans' program, 1993
omnibus reconciliation, $2.6, already $8.27 billion in cuts in
the VA programs and with the President's current proposals,
another $3 billion. By the year 2000, that's $11.25 billion.
And I think that if we want these people to maintain good
programs in the hospital, you've got to give them the funding
that was out there. And I see that the Congress is now
finally--they've passed a resolution in the last year that
they're going to be examined in that independent budget. And I
hope that they will be working very hard to get the proper
funding to the VA to get these programs.
And I thank you for the time.
Mr. Shays. Thank you, sir. [Applause.]
I just want to make sure everyone who speaks that we get a
form just with your name and address for the transcriber.
Mr. Spadaro. It's been a long day.
Mr. Shays. Thank you. Your name and where you live?
STATEMENT OF BEN SPADARO, VETERAN AND VA EMPLOYEE, BRONXVILLE,
NY
Mr. Spadaro. My name is Ben Spadaro. I'm from Westchester
County, Bronxville, NY. My background has always been working
for the VA after I came out of Service, after spending 9 years.
I then went to become the county coordinator in Westchester
County. I retired in 1990. I was appointed by President Bush to
a committee in Washington.
And my statement is a 5-year plan approved by Congress to
balance the Federal budget calls for the deepest cuts ever in
VA programs. While tens of billions of dollars have been
earmarked for new and expended Federal programs and to pay for
these increases and $85 billion in tax breaks, the budget plan
cuts the President's original request for VA funding by an
average of 2.3 percent over 5 years. That's more than twice as
much as the average of the 1 percent cut in other Federal
programs.
There's no question that veterans want to put their
physical house in order. But to balance the budget agreement
unfairly burdens veterans' programs and severely hampers the
VA's ability to provide quality health care.
Congress has an obligation to veterans to give sufficient
funds to provide sufficient care to the VA and to cover the
cost of the health care. The Department of Veterans Affairs has
over the last many years lost at least 40 percent of VA moneys.
And if you take into consideration what hospitals used to
be--for instance, Montrose was a 2,000-bed hospital. It's now a
600-bed hospital; 1,400 beds have been cut. Every one of those
beds are considered to be money. And this was at the beginning
and at the Carter administration and to date.
Historically the VA has approximately $5,600 million a
year. And that was just to pay for raises and the cost of
medicine, supplies, and equipment. And I can go on and on.
The VA cannot continue to operate without sufficient funds.
The Congressmen and Congress ladies--I had to add that today--
will continue to see medical decline. The Congress must
appropriate more moneys and not choke the VA officials if
something is wrong.
Mr. Shays. I just wanted you to know your 3 minutes have
come now.
Mr. Spadaro. I have about 10 seconds.
Mr. Shays. OK.
Mr. Spadaro. Without sufficient funds, more and more
meetings such as these will occur.
Where does the problem originate? I would say from the
Congress and from the several Offices of Management and Budget
and from the Hill itself, not from the VA. Not one VA official
voted for VERA. And the officials in charge of hospitals, they
cannot continue without the moneys allocated properly to the
VA.
Thank you very much.
Mr. Shays. Thank you very much, sir. [Applause.]
May I just see how many more speakers we have? Would you
just raise your hands to see how many more speakers we have?
Five? OK. Well, they keep coming up here. Yes. This list is
growing. I'm getting a little concerned. We started out with
seven. We still have seven.
Audience Participant. I just need about a minute.
Mr. Shays. OK, sir. We're going to go there, and then we're
going to come to you. You're ready. Let's go, Bob.
STATEMENT OF RAY PARRIS, VETERAN, WASHINGTONVILLE, NY
Mr. Parris. My name is Ray Parris, Washingtonville, NY.
That's P-A-R-R-I-S.
Mr. Shays. Your address?
Mr. Parris. I've been going to Castle Point since 1980.
First I started going for an artificial leg. I was not Service-
connected, but the veterans would cover it. They had to send me
to Manhattan.
After about my sixth visit, I noticed the color TV was
gone. And I said, ``What happened to the TV?''
They said, ``Budget cuts.''
I said, ``Oh, well, no TV.''
The next time I went down a few months later, I noticed the
coffeepot was gone. I said, ``What? No coffee?''
They said, ``Budget cuts.''
I said, ``Oh, well.''
A couple of years later when I went to go to the city, they
said, ``We can't send you any more because the government cut
back. You're not Service-connected. We can't give you a leg any
more.'' I thought that sucked.
A couple of years ago I had a severe sore throat, could
hardly swallow. I went to Castle Point for treatment, where I
was informed by a snotty nurse that I should not have come
right over but called for an appointment instead. She said you
could only come if it was an emergency. I told her I thought
that it was an emergency.
I insisted she contact my doctor, Dr. Martinko, which,
after much aggravation on my part, she finally did. Dr.
Martinko soon came down, gave me a thorough examination, and
gave me antibiotics.
Dr. Martinko resigned a short time later. She was a great
American doctor. She was smart, compassionate, and caring. I
heard that she just couldn't practice medicine there anymore
because of how it was run. As far as I and many veterans are
concerned, she was the best doctor at Castle Point.
A large percentage of doctors are foreign-speaking. When
they talk to me or I ask them a question, I cannot understand
what they are saying with their heavy accent. This is not good.
A couple of times I've asked different doctors for medicine
to relieve terrible stump pain. I'm an amputee. And they just
prescribe me medicine for stomach pain. They didn't understand
me.
Another time a doctor asked me when I last had an ``addin''
test. And I said, ``Iron test?''
And he kept repeating, ``Addin, addin.'' I finally realized
he meant a urine test. Unacceptable. This failure to
communicate is not good for patients' welfare.
I will state that an overwhelmingly high percentage of
doctors at Castle Point, 70 percent or more, are foreign. And,
whether they are competent or not, the language barrier creates
a potential for disaster. Then they get an excellent doctor,
like Dr. Martinko, who speaks good English, and they let her
go.
Now we find that a lot of the doctors practicing at Castle
Point are not New York State-licensed. This is not only totally
outrageous, but should be criminal.
The wait at the pharmacy for prescriptions is 2 hours.
Short staff they say. This is totally unacceptable to a sick
veteran that just wants to get his medications, take them, go
home, and lie down.
Also, they are slip-shod. I have had a draining abscess for
over a year now and have to bandage it two or three times a
day.
Mr. Shays. Sir, I'm just letting you know your 3 minutes
have come.
Mr. Parris. I'll be done in 15 seconds.
The doctors write me prescriptions for four by four cover
sponges. And the pharmacy keeps sending me four by four gauze.
I've went to the pharmacy in person and showed them the
difference between the two. The cover sponge is absorbent, and
the gauze is not. It would soak right through and be useless.
But the people just can't get that into their heads or they
just don't give a damn.
Any politician that doesn't think that funds should be
rerouted back here and the VA problems and concerns should be
addressed and corrected should have themselves or their loved
ones put into this VA system at Castle Point and see how they
liked it under an alias, of course, with no publicity.
I'd also like to say there's lots of good doctors at Castle
Point and excellent technicians and nurses. And I've had a lot
of them. But there's a lot of bad ones, too, and you've got to
look into it and correct it.
Thank you. [Applause.]
Mr. Shays. Thank you.
Sir to my right, you're on.
STATEMENT OF JOHN SKYLER, VETERAN AND DEPARTMENT COMMANDER,
DEPARTMENT OF NEW YORK DISABLED AMERICAN VETERANS, CHEEKTOWAGA,
NY
Mr. Skyler. I'm John J. Skyler, the department commander
for the Department of New York, Disabled American Veterans.
Why is it that lives have to be lost before Congress starts
to ask questions? Staffing cuts will obviously have an impact
on patient care. And cuts made too deep result in overworked
staff that can't keep up and cannot give the basic care that
human beings, let alone veterans, expect when they are
hospitalized. Obviously VERA isn't working.
When you made these budget cuts, they look great on paper.
But when it comes down where these cuts will actually be made,
Congress has to realize that patients deserve quality care and
enough staff to assure that care is received. Obviously
Congress would have served the veterans better if they search
elsewhere for places to cut, rather than where lives are at
stake.
We should all applaud the employees and the families that
have the courage to speak up and hope that these problems will
stop. The veterans have already paid the price for freedom we
all enjoy and take for granted. We would never have believed
it. If we had known, we would have battled the enemy and
survived only to come home so far after having battled the
enemy of another kind and lose our lives.
Congress, this is your wake-up call. Do not allow this to
happen at this facility or any other in this country. The
veterans made this country what it is today and deserve better.
Thank you.
Mr. Shays. Thank you. [Applause.]
STATEMENT OF HELENE VAN CLIEF, VETERAN AND TREASURER, MILITARY
WOMEN AND FRIENDS AND MEMBER, COALITION FOR FAIRNESS TO
VETERANS AND VAVS, BRONX, NY
Ms. Van Clief. My name is Helene Van Clief. I am from the
Bronx, and I am a disabled vet. I want to thank you all for
allowing me to speak. I am also a member of Military Women and
Friends. I am the treasurer there and a member of the Coalition
for Fairness to Veterans and VAVs.
The VA health care was originally set up to give health
care for those who could not afford to pay and those who were
disabled within the military. As it stands right now, if the
health care for veterans goes down any further, women in the
1950's would have gotten considerably better care than veteran
women now.
In Third World countries, women are seen by doctors for
their medical care needs. They are treated for things that VA
has never treated women for. An example of this would be
pregnancy.
Two years ago women-specific pajamas was considered a major
accomplishment for the health care of women veterans in
Manhattan VA. Now women at the Bronx VA are seeing a nurse
practitioner for their medical treatment.
There are a lot more women in the military now who will be
getting out and looking for health care as they received in the
military. With all of these cutbacks, what kind of health care
can they suspect to find in the future?
Why do more and more women choose not to use the VA for
their health care needs? When women are asked, ``Are you a
veteran?''; they usually answer, ``No.'' Is this because they
know how bad the health care is at the VA and there is no real
benefit in saying, ``I'm a veteran''? It is hard for women to
use a system which does not give them total equal care as their
male counterparts.
What kind of treatment can women who get out of the
military expect to get in the future? What do women veterans
get? I can only speak on my own experiences.
I was at the Women Clinic in the Bronx. I was seen there by
that--there is a nurse practitioner. And she is the primary
person. I had a mammogram, which was at the VA. And they sent
me a postcard saying that I possibly had cancer. I was sent to
the Cancer Clinic as a referral. And I went and got a second
opinion.
The second opinion said, ``I really don't think that
there's anything wrong. I think you had a bad mammogram.''
Well, I opted to get a breast reduction and have a biopsy done
on the tissue just in case. Since all my relatives of
grandmother's family and my grandfather's family all had breast
cancer, I was really afraid that, ``Maybe they're right.''
Mr. Shays. I just want you to know your 3 minutes have
come. You may keep talking.
Ms. Van Clief. I was an LPN, and I worked both at the Bronx
VA and at Montrose. I worked there a long time ago. And at the
time Montrose had a big problem with drugs. I don't know if
they still have it and whether that was ever resolved. I worked
also through the reserves at 24th Street VA Hospital, but that
was a long time ago.
So I feel I know the system. And I do feel that some of
these renovations need to occur like at the Bronx VA. When I
was in the hospital for rehab, there was no female bathroom in
that section. You either had to go across the way to the Psych
Department or ride the elevator up--like at the time I think my
room was on the seventh floor--ride up about five floors just
to go use the bathroom.
How many veterans have to die before something is done? The
VA at the Bronx was only built 20 years ago. Does so much
renovations there for so--there is no money left to pay for
staff. How much do we cut back before patients suffer?
There were a lot of psychiatric patients who were doing
extremely well at the Bronx VA and now due to cutbacks are
forced out of that longer treatment into a shorter treatment.
For a majority of women veterans saying, ``I am a veteran''
means substandard health care and no place to go. [Applause.]
Mr. Shays. Thank you very much.
We have three speakers, and then we're concluding? Sir,
you're going to end up. All right? OK. Yes, sir.
STATEMENT OF SILVIO MANGIERI, VETERAN, WALKILL, NY
Mr. Mangieri. My name is Silvio Mangieri. I'm 83 years old.
I saw service in Germany. And I want to speak because during
these hearings I haven't heard what I feel is most important.
I wish to implore and impress our Congressmen that what I
feel is more important and more needed is a change of
direction, not to look for redress of faults or corrections of
their faults because for many years all I've heard from the
Government is excuses and ways of growing your mind with facts
and figures.
Mr. Shays. Sir, would you just tell me what town you're
from? I didn't ask you that. Tell me your town, where you're
from.
Mr. Mangieri. Oh, yes. I wasn't aware of that, sir.
Mr. Shays. Where are you from? Where is your community?
Where do you live?
Mr. Mangieri. I live right here in Walkill.
Mr. Shays. Thank you.
Mr. Mangieri. I would like to impress our Congressmen that
what we need is aggressive, radical action. What we need is for
the States to have something to say about the jurisdiction in
the quality care that our veterans are receiving in the
hospitals within our area.
They need to have a greater say over what is done and what
is required for them, what doctors and nurses should be in the
hospital and the rest of the technicians and the rest of the
medical staff.
In this respect, I feel that Washington has grown to be too
big a bureaucracy as far as the Veterans Administration is
concerned. And they are too far removed now and distant from
the 50 States and their territories.
I can't see how they could respond to the problems of the
veterans in the many hospitals throughout the country. They
need to be done on the spot by the people who are taking care
of them right there and then. That is what I feel should be
done.
Thank you.
Mr. Shays. Thank you very much. [Applause.]
You're on, sir.
STATEMENT OF ROBERT IANAZZI, VETERAN AND VIETNAM VETERANS OF
AMERICA AND DISABLED AMERICAN VETERANS, MIDDLETOWN, NY
Mr. Ianazzi. My name is Bob Ianazzi. And I'd just like to
say I----
Mr. Shays. And you're from?
Mr. Ianazzi. I'm from Middletown.
Mr. Shays. Thank you, sir.
Mr. Ianazzi. And I served with the Fourth Infantry Division
over in Vietnam in 1966. And during the month of May was our
worst month. We had heavy casualties. And we had over 200
people killed and wounded. And at the time it was not an easy
sight to see. I'd just like to say that I've never forgotten
it. I've been going to Montrose VA now for the last 4 years for
treatments for it. I'm 60 percent disabled.
I've gone down to New York City for hearings, and I
submitted new evidence that a VA--which seemed to be totally
overlooked. They took it, and it seemed like they just shuffled
it to the side. And then I got a letter saying that I was
denied my increase in my disability.
I just want to say that the way the VA is going right now
we need all the help we can get as far as Castle Point and
Montrose VA. We don't need anybody to get a $16,000 bonus to
shut us down. I think that's appalling.
I've always been proud of my country. I fly a flag every
day, both POW and the American flag. And I'm proud of my
country.
Thank you.
Mr. Shays. Thank you, sir. [Applause.]
I'm getting a little confused. I thought we had one last
speaker. How many speakers do we have left? Do we have you,
sir? Wait a second. Wait a second. We have three still?
I'm going to just say I want all three to stand. I want us
all to see who our last three speakers are. Thank you very
much, sir. No, no. No. You can't go over that way. We've got
one there, one there, and one there. And then we're going to
conclude.
Thank you, sir. You may begin.
STATEMENT OF GUY CROWTHER, VETERAN, PORT JERVIS, NY
Mr. Crowther. I'm Guy Crowther from Port Jervis, NY. This
was written preferably to represent Gilman, and I'd like to ask
him to strike the last word, please.
OK. I know this meeting is primarily the situation that has
occurred at Castle Point, and I believe that what I have to say
is of as much additional concern to the veterans gathered here
today.
I was watching C-SPAN this past Wednesday night when the
appropriations for the fiscal year of 1998 were being
discussed. And it sure made my mind go at a whirl when I heard
in the amounts of tax dollars that were being allotted to
countries outside our borders.
And Representative Gilman is the head of the International
Relations Committee. That's why I've got this. It says when I
heard of $100 million to the IMF and then about $85 million to
some Asian group. There was also several authorizations to
other foreign groups that were not to exceed somewhere over $1
million.
What I'm bothered by is why our hard-earned moneys, a lot
of which is paid by those here today, is going into the slush
fund to many countries that are reaching out with one hand for
a handout and stabbing us in the back with the other.
I would like to know what the so-called discretionary fund
is that is authorized for the administration. It is not said by
the media or the Congress or admitted that the present
administration does not like this United States. They would
like to see the United States become a bank book for the world
with no say by the citizens of the United States. And they are
actively pursuing the one-world government philosophy. This
information is being revealed by some of the independent think
tanks and other groups of this Nation.
I would also like to know what has been done about the
situation with the Panama Canal treaty that I talked to you
about at the Port Jervis meeting. I know that the House of
Representatives are not directly involved in the treaties, but
have you ever talked to our State Senators about this concern?
I know the veterans gathered here today sure have a big concern
about the movement of our warships between the oceans around
our country.
Finally, sir, I would like very much to know why you
support the killing of almost 40 delivered babies in the
delivery, which is unnatural anyway.
Thank you for your time.
Mr. Shays. OK, sir. I just need--[applause]--hold on 1
second. Bear with me 1 second here. I have three speakers that
I've missed in the transcriber. Your name again is?
Mr. Crowther. Guy Crowther.
Mr. Shays. Bob, do you have his card? We need your card.
Did you sign a--is it one of these three? Who was the gentleman
who spoke just before this gentleman? Your name is?
Mr. Ianazzi. Bob Ianazzi.
Mr. Shays. I'm sorry? Bob?
Mr. Ianazzi. Ianazzi.
Mr. Shays. Ianazzi. Thank you, sir.
And the gentleman who spoke before Bob is? Silvio?
Mr. Mangieri. Silvio Mangieri.
Mr. Shays. Thank you.
And the gentleman who spoke before Silvio?
Ms. Kelly of New York. That was a woman, Helene Van Clief.
Mr. Shays. Helene Van Clief. OK.
And Dick Pinckney?
Mr. Pinckney. Pinckney.
Mr. Shays. You're ready to speak now? Is that who we're
going to next?
STATEMENT OF RICHARD PINCKNEY, VETERAN, MIDDLETOWN, NY
Mr. Pinckney. Yes. This should be very short. I want to
compliment the people that held this meeting today. And I just
feel that it's after the fact and it should have been before
the fact. Some of the great information that we got here today
has been the same information that we've had for many years.
I also want to say that I was down in Florida, the State of
Florida. I found a full page of the Tampa Times down there. I
took it and mailed it out to Congresspeople.
My post--my name is Richard Pinckney, a past Commander of
Post 151, right here in Middletown. My post received a letter
back from a Congressperson addressed to Jake Volo saying they
were going to look into this. My name is not Jake Volo, and
Jake Volo has been deceased for 5 to 6 years. I just think we
fell asleep someplace along the line and we should get going.
I think over there they brought--and I would like an answer
to this eventually. They brought in new PXes. I've been around
the country in VA hospitals on visitations. The PX we have over
there sells frying pans, cooking equipment for $59.95. I just
don't understand what a patient in a VA hospital would be doing
buying $59.95 cooking utensils.
I also wonder to myself because I've been to Lebanon, PA.
I've been upstate New York to one of the Finger Lakes. I've
been to Charleston, SC. I've been to all our veteran hospitals
around here. I lost my brother in a veterans' hospital. My
other brother is 100 percent disabled from World War II, both
of them. And I just wonder.
Let me say this. I want to thank Dick Mayfield and
Congressman Gilman for calling me when there are meetings over
to Castle Point. And I go there. And I want to thank them both
for that.
I found out the last meeting I was over there to, I found
out that any moneys from Medicare or Medicaid that Castle Point
Hospital gets has to be turned back over to the general fund.
Is that right? The hospital gets no benefit from it. They
furnish the medicine, the prescription, the doctors. Your
Medicare goes back into a general fund. I don't know what that
means. I would think it's the U.S. Government's general fund.
And I also have one other question that the man down here
brought up, one of the men brought up, about sending the
vessels into the air and all of that. I wondered with all the
cuts on VA why the cuts to Bosnia had not been downed, they had
been upped.
And I want to thank you for your time. And when I walked in
here, this place was absolutely filled with interested people.
And I think some of them have left in a haste.
Thank you. [Applause.]
Mr. Shays. Let me just say it's so wonderful that you all
have stayed. And I realize that some had to go. So we do know
this was an extraordinarily well-attended hearing.
Mr. Crowther, you have the last word. Oh, I'm sorry.
Mr. Pressley. Name is----
Mr. Shays. Pressley. I'm sorry. I apologize.
Mr. Pressley. That's quite all right.
Mr. Shays. Let me get it correct. Your name is Hugh
Pressley, Jr., and you're from the Bronx?
Mr. Pressley. Correct, Bronx, NY.
Mr. Shays. It's nice to have you here, sir.
Mr. Pressley. It's glad to be here.
Mr. Shays. Thank you for coming.
STATEMENT OF HUGH A. PRESSLEY, JR., VETERAN, BRONX, NY
Mr. Pressley. I've got a couple of questions I'd like to
ask. One, is it possible that this can be continued also in the
city because there are a lot of veterans that are being heard
here and there's a lot more that I know that want to be heard
in the city? You get a tremendous turnout because they have a
lot of issues as well.
I'm a veteran, aerial veteran, of Vietnam. I served for 2
years. I came back. I did my time, had a job, the whole nine.
And recently I've become homeless.
And I've noticed not none of the homeless veterans have
been represented or even heard from. A lot of these
organizations that's out here, they're claiming to represent
veterans, but they're not. All they're interested in is
numbers. And the minute you have a gripe or you have a problem,
whatever the case may be, you're shoved to the side or they
tell you, ``Well, you've got a problem. We'll get to it.'' And
it would be real nice if that would be looked into.
Also I think if anybody is going to represent us, they
should at least be a veteran. That should be one of the
criteria for representing a veteran, especially if you're in a
position where you're going to be taking funds from the
veterans. You ought to at least know some of our needs before
you start taking our funds.
That's all I've got to say.
Mr. Shays. Thank you, sir. [Applause.]
Before we conclude this hearing, I want to thank the Town
of Walkill; in particular, the police department. It started
out rather ominously for me. When I walked in, the police
officer said that he wanted to make an announcement to tell you
all that you needed to be under control. I thought, ``My God. I
don't usually have a police officer opening my hearings telling
you all not to riot.''
I'd also like to thank our court reporter, Ed Johns, for
helping us out today; and our sound system, Jim and Greg of
Thunder Sound Productions; and also our clerk, Jared Carpenter.
We're going to conclude by my thanking you for being here,
for your patience during the day. We got through it quite well.
And I learned that you guys are in charge and I just have to
follow orders.
Audience Participant. That's right.
Mr. Shays. It took a while for me to get that.
At this time I'm going to recognize Sue Kelly.
Ms. Kelly of New York. Thank you. I really want to thank
you all for staying as long as you have.
The purpose of this, as I said before, is to try and help
all of us to understand the net effect of VERA on the veterans
in this area. We want to make sure that we get for our veterans
high-quality patient-centered health care. I believe that we
can do that. I believe it's something that is available to us
if we just all work together.
And we needed the input we heard today. We will do
something with it on Capital Hill, I guarantee you. Congressman
Shays is here to prove that.
Thank you.
Mr. Shays. Thank you. [Applause.]
At this time I'd like to call on Maurice Hinchey. And then
we'll go to Ben. Thank you.
Mr. Hinchey. Well, Chris, I just want to thank you for
coming over here from Connecticut and holding this hearing. I
want to thank Ben Gilman for initiating it. I think it has been
very interesting and informative. And I want to thank all of
you who have been here for the duration as well as everyone who
spoke and left. I think it has been a productive afternoon. I'm
very glad that I had the opportunity to be here.
Now we have to make sure that the Veterans Administration,
first of all, has the funding it needs to carry out its
responsibilities and, given that funding, that it does the job
it's supposed to do.
Thank you very much.
Mr. Shays. Thank you. [Applause.]
And, Mr. Gilman, sir, you have the last word.
Mr. Gilman. Well, Chris Shays, we thank you for bringing
the committee to Orange County so that Sue Kelly and Maurice
Hinchey and myself could bring our veterans together and get
the benefit of their thinking and share their views.
We're so thankful that Jim Farsetta from the region and
Mary Musumeci--did I get it right that time, Mary--and Mr. Sabo
have stayed throughout to listen, to learn. And Dr. Wilson is
still here also. I didn't notice Dr. Wilson staying that long.
But these are the key people. And they have heard your views.
Your Congressmen and Congresswoman have heard your views.
We're going to put them to good use now as we meet further with
our regional directors and the veterans' officials to make
certain that we try to correct some of the imperfections and
try to work together to preserve two good hospitals that we all
have a great deal of pride in: Castle Point and Montrose.
Now, I can't thank you enough, those of you who have
lingered this long to give us the benefit of your thinking. And
to our staffs who are here, we thank you. And our police
officers, who have helped us to try to keep a little orderly
conduct here, we appreciate your sticking with us.
Chris Shays, we can't thank you enough for coming all the
way over from Connecticut to conduct this hearing. And we
really appreciate everyone's partaking in this issue.
Thanks for being here. And God bless.
Mr. Shays. Thank you. [Applause.]
God bless. This hearing is adjourned.
[Whereupon, at 6 p.m., the subcommittee was adjourned.]
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