<DOC>
[110 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:45293.wais]
S. Hrg. 110-608
INDIAN HEALTH SERVICE MANAGEMENT: LOST PROPERTY, WASTEFUL SPENDING, AND
DOCUMENT FABRICATION
=======================================================================
HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
JULY 31, 2008
__________
Printed for the use of the Committee on Indian Affairs
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45-293 PDF WASHINGTON DC: 2008
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COMMITTEE ON INDIAN AFFAIRS
BYRON L. DORGAN, North Dakota, Chairman
LISA MURKOWSKI, Alaska, Vice Chairman
DANIEL K. INOUYE, Hawaii JOHN McCAIN, Arizona
KENT CONRAD, North Dakota TOM COBURN, M.D., Oklahoma
DANIEL K. AKAKA, Hawaii JOHN BARRASSO, Wyoming
TIM JOHNSON, South Dakota PETE V. DOMENICI, New Mexico
MARIA CANTWELL, Washington GORDON H. SMITH, Oregon
CLAIRE McCASKILL, Missouri RICHARD BURR, North Carolina
JON TESTER, Montana
Allison C. Binney, Majority Staff Director and Chief Counsel
David A. Mullon Jr., Minority Staff Director and Chief Counsel
C O N T E N T S
----------
Page
Hearing held on July 31, 2008.................................... 1
Statement of Senator Barrasso.................................... 83
Prepared statement........................................... 84
Statement of Senator Dorgan...................................... 1
Statement of Senator Murkowski................................... 4
Statement of Senator Smith....................................... 6
Statement of Senator Tester...................................... 5
Witnesses
Kutz, Gregory D., Managing Director, Forensic Audits and Special
Investigations Unit, U.S. Government Accountability Office..... 6
Prepared statement with attachments.......................... 8
McSwain, Robert G., Director, Indian Health Service, U.S.
Department of Health and Human Services; accompanied by Randy
Grinnell, Deputy Director for Management Operations, and Athena
Elliott, Director, Office of Management Services............... 59
Prepared statement........................................... 62
Verrier, Fernand R., Former Deputy Director, Office of Finance
and Accounting, Indian Health Service, U.S. Department of
Health and Human Services; CFO, Headquarters Indian Health
Service........................................................ 66
Prepared statement........................................... 67
Appendix
Miller, Dr. Steven J., Director, IHS National Council of the
Laborers International Union of North America, prepared
statement...................................................... 87
Youpee, Isabelle Florence, Member, Fort Peck Sioux Tribe,
prepared statement............................................. 89
INDIAN HEALTH SERVICE MANAGEMENT: LOST PROPERTY, WASTEFUL SPENDING, AND
DOCUMENT FABRICATION
----------
THURSDAY, JULY 31, 2008
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:39 a.m. in room
562, Dirksen Senate Office Building, Hon. Byron L. Dorgan,
Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. BYRON L. DORGAN,
U.S. SENATOR FROM NORTH DAKOTA
The Chairman. Today, the Committee is going to hold a
hearing on a recent GAO report documenting mismanagement and
lost property at the Indian Health Service. This Committee has
held a number of hearings on Indian health care, which confirms
a full-scale crisis, including the rationing of health care in
Indian Country. These hearings highlighted the significant
unmet needs in health care facilities, contract health dollars,
and other basic services.
Despite the documented need for health care, today the
Committee will focus on the GAO report. The GAO investigation
concluded that a complete lack of direction at the Indian
Health Service from the top down led to millions of dollars in
lost or stolen property, wasteful spending, and document
fabrication.
As you can see on some charts I have, charts one and two
show the key findings of the GAO report. The report found that
5,000 property items worth $15.8 million were reported lost or
stolen. This was between 2004 and 2007. The report covered the
Indian Health Service headquarters and only 7 of the 163 Indian
Health Service units.
[The information referred to follows:]
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The losses include 1,100 information technology items at
the headquarters. That mounts to more than one-third of the
information technology equipment assigned to employees at the
headquarters. GAO also identified thousands of missing property
items controlled by the IHS. These items included tractors,
all-terrain vehicles, pickup trucks, GPS systems, and even a
Jaws of Life used by first responders in motor vehicle
accidents.
More troubling in the course of the investigation, GAO
reported employee document fabrication to cover up the
mismanagement.
The Indian Health Service has known about this
mismanagement for some time, if I can have chart three put up.
We have a letter here showing that Mr. McSwain felt strongly
enough 11 years ago when he was Acting Director of the Office
of Management Support at the Indian Health Service to address
the issue of unaccounted property. It took the department eight
years to act on his concerns. In October of 2005, the
Department of HHS issued a directive to implement a new
universal information management system.
[The information referred to follows:]
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
I had hoped the Secretary would be here today. I invited
the Secretary of Health and Human Services. He indicated he
would not come. He has some meetings on the Hill, but
apparently because of that scheduling conflict, he chose not to
attend. I will say to the Secretary, I think he should have
been here, and this Committee will ask him again to show up at
this table and answer these questions.
It seems there is no clear understanding, to me, at the IHS
headquarters of the location, condition or even the existence
of significant losses of property purchased with taxpayers'
dollars. One thing is clear, however: Migration to the property
management information system, which began or was supposed to
have begun in 2005 is clearly not functioning at the Indian
Health Service.
I understand the IHS disagrees with the characterization of
case studies that are in the GAO report. With that said, the
Service has agreed to 9 of the 10 recommendations. They
acknowledge a severe issue with property management and
security at the IHS, so we have asked Director McSwain to give
us his comments today.
This report has received a fair amount of attention in the
past few weeks. I hope the explanations that we hear today will
clear up some of this, but I must say that we have people dying
in this Country because they don't get adequate health care.
All of us see them when we go to reservations in our Native
communities. There is full-scale rationing going on. We run out
of contract health care money, in some cases early in the year
in tribal governments.
I have described before my concern about the bureaucracy in
the Bureau of Indian Affairs. I described my concern about the
management in the Indian Health Service. This GAO report, I
think, is a scathing indictment of the way things have been
done at the Indian Health Service.
Mr. McSwain has just recently been confirmed. He has been
on the job a relatively short period of time. Our Committee
confirmed his nomination, but Mr. McSwain has inherited an
agency that has, in my judgment, very serious problems.
I have described before circumstances where incompetent
employees, rather than being dealt with as incompetent
employees, are transferred from one area to another, so they
transfer the incompetents, and the next group of patients is
treated to the same incompetence and mismanagement. I tell you,
it is enough to make you pretty depressed when you take a look
at the way both the BIA and the Indian Health Service have been
managed.
That is not to say there aren't some good people working in
the system, but I am telling you, in my judgment this GAO
report describes an agency in desperate need of repair, and one
that is not doing what it should to serve the health needs of a
very vulnerable population.
Senator Murkowski?
STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
Senator Murkowski. Thank you, Mr. Chairman.
You point out the number of hearings that we have had in
this Committee that have looked to the issue of the inadequacy
of Indian Health. Just within this Congress alone, the number
of hearings that we have had, the discussion on the floor about
Indian Health Care reauthorization, and time and time again we
have heard about the struggles that the Indian Health providers
face as they try to stretch very, very limited resources to
address the increasing health care costs.
Every year, this Committee issues its budget views and
estimates letter, and we are always advocating for increases to
the health care funding. Every year we are challenging our
colleagues to do more to provide for Indian health care by
increasing the appropriations, just a couple of weeks ago with
the PEPFAR bill and efforts there.
But then to receive a report like we have before us today
from the GAO about this wasteful spending and the property
mismanagement by the IHS, I mean, it truly undermines the
confidence in the structures that we have been defending when
we say, well, we need more appropriations. But if internally we
have this level of mismanagement going on, it really causes you
to wonder how we truly move forward.
I am so disappointed that so many of the very basic
shortfalls in property management were identified within this
report. You would like to think that the management shortfalls
that have been highlighted are limited just to these instances
that are detailed in the report, but the concern that I have is
that it is indicative of a much larger problem within the
agency.
This is not just a spotlight on just a few issues that we
have identified and there is nothing more. I think it goes
much, much deeper than that.
I do understand that IHS was undergoing conversion to this
new property management system. I understand that we may hear
that the agency was short-staffed, but that is no excuse. It
absolutely does not account for the fact that the taxpayers, we
here in Congress, must be assured. We have to have the
confidence that the basic procedures, that the proper
procedures for management and accountability are in place and
that they are followed.
So I look forward to the comments this morning from you,
Mr. McSwain.
I do think that this is important to bring this up in as
timely a manner as you have, Mr. Chairman, and I appreciate
your doing so. Thank you.
The Chairman. Thank you very much.
Senator Tester?
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman, and thanks for
having this hearing. I want to express my appreciation for the
remarks that you and the Ranking Member both made on this
topic.
I guess it explains a lot, after what I have seen over the
last year and a half with IHS in the hearings we have had here
and how the health care system in Indian Country is upside-
down. I guess this is the way it ought to be. You know, $15.8
million for years, not knowing where the equipment went to.
I guess it fits in with the pattern of what we have been
hearing here for the last year and a half and probably a lot
longer before that before I came onboard.
I would just tell you this, it boils down to two things as
far as I am concerned: flat, blatant incompetence, number one;
and number two, a total vacuum when it comes to leadership.
This isn't like developing technology for battery-powered cars.
There are no excuses here.
I don't know who is responsible. It is probably multiple
folks at different levels. But I will tell you this, if there
was this kind of incompetence on my farm, people wouldn't be
working there anymore, bottom line.
GAO came forth with some recommendations, and I look
forward to hearing how these recommendations have been
implemented, but the bottom line as far as I am concerned is
that you don't get rid of incompetence like this without
getting rid of the people who were responsible for the
incompetence.
That is all. Thank you.
The Chairman. Senator Smith?
STATEMENT OF HON. GORDON H. SMITH,
U.S. SENATOR FROM OREGON
Senator Smith. Mr. Chairman, members of this Committee,
thank you for moving out the two bills that were moved in the
business part of this hearing. I appreciate that. One of them
was my own.
I also want to thank you, Mr. Chairman, for moving this
issue forward in the minds of the Senate and all those who are
concerned with Indian health. I share your concern. I
appreciate this GAO report and look forward to using it as a
vehicle to improve Indian health care.
The Chairman. Thank you very much for your comments.
We will now call to the witness table Director McSwain and
Greg Kutz from the Government Accountability Office. Mr. Kutz
is the Managing Director of Forensic Audits and Special
Investigations.
Mr. Kutz, we welcome you.
Director McSwain, we welcome you.
We will begin with the testimony of Mr. Greg Kutz. Mr.
Kutz, you and your agency produced this Government report. We
would like to hear your testimony, followed by the testimony of
Mr. McSwain. Then we will proceed to one additional witness.
You may proceed.
STATEMENT OF GREGORY D. KUTZ, MANAGING DIRECTOR,
FORENSIC AUDITS AND SPECIAL INVESTIGATIONS UNIT, U.S.
GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Kutz. Mr. Chairman and members of the Committee, thank
you for the opportunity to discuss Indian Health Service
property and equipment.
Today's testimony highlights our investigation of
allegations we received in June of 2007. The bottom line of my
testimony is that these allegations were accurate.
Specifically, IHS had millions of dollars of lost and stolen
property, including items containing sensitive personal
information.
My testimony has two parts. First I will discuss the
problems that we identified. And second, I will discuss the
causes of these problems.
First, IHS records show that from 2004 through 2007, at
least 5,000 property items with an acquisition value of $15.8
million were lost or stolen. Our own inventory work during
Fiscal Year 2008 identified similar problems.
For example, at the Rockville, Maryland headquarters, 1,100
or 36 percent of IT property items were lost or stolen. This is
based on a 100 percent inventory by my staff. In addition,
based on a statistical sample of IT equipment at seven field
locations, we estimate that 1,200 or 17 percent of these items
were also lost or stolen.
The following cases give you a flavor for what we found.
First, the poster board on my right shows four reports of lost
or stolen property totaling over $1.8 million. IHS routinely
writes off millions of dollars of these types of losses without
holding anyone accountable.
The next poster board shows the Montana region writing off
over $700,000 of equipment because it was infested with bat
dung. And according to a Phoenix-area executive officer and
others, a yard sale of Government furniture and equipment was
held in Nevada. Fliers were provided to the public advertising
this event.
We also found indications of the compromise of sensitive
personal data. For example, a computer with Social Security
numbers and medical information for at least 849 uranium miners
was stolen from a New Mexico hospital. A PDA with medical
information and patient names at an Arizona hospital was also
lost. This PDA did not have encryption or password protection.
And 17 computers that were not cleaned may have contained
sensitive information for kids at a youth patient center in
Arizona.
Let me move on to my second point, the causes of these
problems. First, let me point your attention to the same memo
the Chairman described earlier, that was in 1997 and written to
all IHS headquarters employees. As you can see, lost and stolen
property has been a problem for more than a decade. However,
management has not fixed the problem or held anyone
accountable. The clear message from the top is that the status
quo is acceptable.
Although the problems we found are chronic, they are not
complex. These are basic property management issues, or what I
would refer to as property management 101. For example, we
found lack of required annual physical inventories, property
that was not properly bar-coded, lack of required hand
receipts, and lack of required physical security. Notice that
most of what we found is not flawed policy, but the lack of
adherence to policies and procedures that are already in place.
I am encouraged that the letter we received from management
in response to our report agreed with 9 of our 10
recommendations. However, the tone of that letter indicated
ongoing denial of the problems. The letter even tries to
rationalize an IHS employee fabricating 116 documents to make
it appear that 571 property items were actually not lost or
stolen.
In conclusion, nobody at IHS has been held accountable for
the issues that we have described today, including the loss of
millions of dollars and the compromise of sensitive data. So
who then must pay for this problem? Unfortunately, it is the
American taxpayer.
Mr. Chairman, this ends my statement. I look forward to
your questions.
[The prepared statement of Mr. Kutz follows:]
Prepared Statement of Gregory D. Kutz, Managing Director, Forensic
Audits and Special Investigations Unit, U.S. Government Accountability
Office
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
______
Attachments
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The Chairman. Mr. Kutz, thank you very much.
Director McSwain, thank you for being with us. You don't
look very happy today and I understand no agency will want to
receive a report like this from the Government Accountability
Office, and certainly this Committee is concerned, and I would
say the entire Congress is concerned when they see a report of
this type.
You are here, let me explain again that I invited you to
testify. I also asked the Secretary of HHS to be present today.
He has decided not to be present, but this Committee will
continue to seek his testimony as well.
Mr. McSwain, why don't you proceed with your statement?
STATEMENT OF ROBERT G. MCSWAIN, DIRECTOR, INDIAN HEALTH
SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES;
ACCOMPANIED BY RANDY GRINNELL, DEPUTY DIRECTOR FOR MANAGEMENT
OPERATIONS, AND ATHENA ELLIOTT, DIRECTOR, OFFICE OF MANAGEMENT
SERVICES
Mr. McSwain. Thank you, Mr. Chairman and members of the
Committee.
Good morning. I am Robert McSwain, Director of Indian
Health Service. Today, I am accompanied by Randy Grinnell,
Deputy Director for Management Operations, and Athena Elliott,
Director of Office of Management Services. On behalf of
Secretary Leavitt, we appreciate the opportunity to testify on
the Indian Health Service's Property Management Program.
As you mentioned earlier, I did not envision that my term
as Director of the Indian Health Service would begin in this
fashion, but here we are. While the IHS does not agree with
some statements and allegations contained in the GAO report,
IHS takes the GAO recommendations very seriously and concurs
with 9 of the 10 GAO recommendations addressed in the report to
strengthen the overall environment, to control the environment
for property management, and has been and is now fully engaged
in the ongoing process of updating its personal property
management policies, conducting necessary investigations of any
unaccounted property, and ensuring that employees are held
accountable. I will speak to that in my closing comments.
I must point out that IHS has already been working with the
department, as was mentioned, since the early 2002 through
2005, to begin to improve our property management systems. In
fact, even more so in the recent year, we were working very
feverishly to prepare for the implementation of the unified
financial management system, which is a department-wide
financial system that requires that some of our old legacy
systems in property management be abandoned. We have now moved
on to PMIS.
I will report to you that we have been moving inventories
and training personnel in preparation for the full
implementation. There are a couple of major concerns that we
have with the GAO report, which was noted earlier, and GAO
acknowledges itself various limitations to its audit
investigation, some of which are listed, which I will talk
about in a moment here.
The report asserts that IHS did not consistently document
lost or stolen property items and concludes that the number of
currently unaccounted for items might be much higher. But I can
assure you with the new HHS PMIS system, that in fact we will
be reducing those numbers significantly in the reconciliation
process.
The report also overstates the net worth of currently
accounted for items by not taking into consideration
depreciation of those items. Some items referenced in the
report at 15- to 35-year old. As you know, like our facilities
that average 33 years across the Country, our property likewise
is quite old. I think, for example, the comment about the
property in Wyoming that was in fact infested was in fact
transferred to the warehouse at zero value and was being held
there to be disposed of by a process.
Now, the interesting thing is, this points up another major
issue that we wrestle with in Indian Country, is that our
facilities are so far out in remote locations that are not
available to GSA disposal sites for many of them, so we wind up
either housing it or putting it into a location to be able to
move it out.
In this particular instance, the Billings area has engaged
the Department of Defense and we will be moving property that
has been excessed to them for their final disposition.
Now, to highlight the report, and I think in fairness to
GAO I must point out that several of the updates on these
highlights were submitted late, and in some cases not
acceptable to the General Accounting Office, but we will
include these updates in our 60-day response. As I understand,
we have 60 days from the date of the report to the middle of
September to provide our progress report on what we are doing
with the recommendations outlined in the report.
The Alaska--I think it is so critical--the Alaska
determination, in fact the ATVs, the tractors referred to in
the GAO report as lost and sold were identified in a 2006
Alaska border survey as transfers to communities or abandoned
in place. Given the fact that Alaska, as Senator Murkowski said
at the last hearing, is identified by the remoteness of the
various locations.
When we move equipment out to these remote locations, and
they are there for a period of time until we finish the water
and sanitation projects, for example, we literally turn them
over to the community to continue to operate and maintain. So
as a matter of an artifact of process, the border survey in
fact shows that much of that equipment was in fact transferred.
Now, I think it is also important that of the 1,097 items,
the average age spans between 15 and 35 years. Two very
important factors: this is really a one-time. We were building
towards the ultimate complete takeover of the program by the
Alaska Natives. They have done that, and we have--in fact, I
have a note from a tribal leader up here that says basically
that much of the equipment that was turned over to them is
being used.
It was old, but I think it is important to point out that
the 86-121 law that enables us to build water and sanitation
facilities in Indian Country does enable us to transfer
property and equipment to them, to the tribe, for their
operation and maintenance of their system. In the case of
Alaska, 98 percent of the $6 million of property identified was
in fact transferred in that fashion, 98 percent of all the
equipment, and the law authorizes us to transfer that
equipment. This accounts for about $6 million of the $15.8
million in the GAO report.
The Tucson survey of the report for Jaws of Life, the fact
that it got a lot of press as well, we have since found those
five pieces, and in fact they were missed in one inventory. In
the subsequent inventory, they were not available. I think the
General Accounting Office made a look and couldn't find them.
We subsequently found them. We have verified that the Jaws of
Life are in fact in condition, have been used, but they are now
accounted for. We will provide that in our response for the 60-
day inventory.
The whole notion about fabricated documents is really an
attempt by an employee to in fact provide the right form. We
had actual information that tracked the property disposal. It
was not in the right form and it was not acceptable to the
General Accounting Office. But by creating these documents, it
was referred to as fabrication. We do have evidence that tracks
the actual request for property action.
The yard sale, we are investigating that as well. It was
brought to our attention by the General Accounting Office and
we have been investigating that very heavily. I think the
important part is the particular PCs that were referenced were
actually for educational purposes, for training and use in how-
to-use computerized equipment. There was no patient information
on it, nor student information on that.
But let me just close. I am sure you have questions on a
whole host of issues, but let me just say that going forward,
IHS is committed to strong enforcement and updating our
policies. We have had the policies in its final throes. I want
them on my desk in the next 60 days so that we can move forward
with clear current policies.
I have recently held a conference call with the 12 area
directors that manage the areas. I have advised them because of
this particular report and my sitting here today, they are
going to be held responsible. In fact, part of my assurance is
to put a performance element in their performance contracts
that cascades down to the service unit directors that will in
fact hold them accountable performance-wise for accounting for
and management of personal property.
We will tighten up our management internal controls. We use
a self-assessment means. I am going to ask that our staff make
random visits, as the GAO has done, to our remote sites to
ensure that they are adhering to not only receiving reports of
equipment, but also the proper disposal reports.
We will continue with the support of the department to
fully implement UFMS and the PMIS, and I am confident that with
the implementation of both, I look forward to a revisit, if you
will, by the General Accounting Office at some point as they
would desire, and that even in 60 days, I expect that our
report on the status of our accomplishments will demonstrate
significant progress, because we are doing it as we speak.
Mr. Chairman, this concludes my summary statement. Thank
you for this opportunity to report on the property management
in the Indian Health Service, and I will be happy to answer any
questions you might have.
[The prepared statement of Mr. McSwain follows:]
Prepared Statement of Robert G. McSwain, Director, Indian Health
Service, U.S. Department of Health and Human Services
Mr. Chairman and Members of the Committee:
Good Morning. I am Robert McSwain, Director of the Indian Health
Service. Today I am accompanied by Randy Grinnell, Deputy Director of
Management Operations, and Athena Elliott, Director of the Office of
Management Services. We appreciate the opportunity to testify on the
Indian Health Service's property management program.
The Indian Health Service provides health services to nearly 1.9
million American Indians and Alaska Natives (AI/ANs). In carrying out
this responsibility, the IHS maintains a unique relationship with more
than 560 sovereign Tribal governments located in the most remote and
harsh environments within the United States as well as in modern
metropolitan locations such as Anchorage and Phoenix. This geographic
diversity and major health disparities offer extraordinary
opportunities and challenges to managing and delivering health
services.
The IHS and Tribal programs provide a wide array of individual and
public health services, including clinical, preventive, and
environmental health services. In addition, medical care services are
purchased from outside the IHS system through the Contract Health
Services (CHS) program when the care is otherwise not available at IHS
and Tribal facilities.
The IHS is committed to its mission to raise the physical, mental,
social, and spiritual health of all AI/ANs to the highest level.
IHS appreciates the opportunity to respond to GAO's report on IHS
property management. IHS has been and remains committed to proper and
accountable property management. To this end, IHS Headquarters and Area
Offices have fully cooperated with GAO in the audit and investigation
by providing detailed records, performing extensive data
reconciliations upon request of the GAO, and participating in multiple
and extended staff interviews.
Overview of the IHS Inventory System
IHS currently uses the HHS Property Management Information System
(PMIS) to inventory personal Federal property. The PMIS was first
implemented in FY 2005, and provide tools that enable IHS to continue
to improve property accountability.
Indian Tribes are authorized by Public Law 93-638, the Indian Self-
Determination and Education Assistance Act, to assume control of
programs administered by the IHS, including administrative support
functions. The statute also permits IHS to transfer title to both real
and personal Federal property associated with the operation of the
contracted program to the Tribes.
Also, Public Law 86-121, Indian Sanitation Facilities, authorizes
IHS to transfer property to Indian Tribes in order to maintain
sanitation facilities. IHS also has additional authority for providing
equipment for safe water and sanitary waste disposal facilities to
Tribes under the Public Law 94-437, the Indian Health Care Improvement
Act, as amended. The Secretary of Health and Human Services (HHS),
acting through the Service, also is authorized by P.L. 86-121 to
provide financial and technical assistance to Indian Tribes and
communities in the equipping of utility organizations to operate and
maintain Indian sanitation facilities.
In early FY 2005, HHS made a decision to have all HHS Operating
Divisions, including IHS, utilize the Property Management Information
System (PMIS). At implementation, the IHS-wide inventory was comprised
of approximately 121,000 items with an original acquisition cost of
$302 million prior to assigning new and higher HHS accountability
thresholds and assessing the value of depreciation. After applying the
new HHS accountability thresholds under PMIS, the IHS inventory is
comprised of approximately 49,000 accountable and sensitive items with
a total original acquisition cost of $205 million.
The implementation of the new HHS consolidated PMIS, including
staff training, took an extensive amount of time and resources.
Training is still ongoing and is a continuous process. Conducting
physical inventories using the new system therefore lagged and many IHS
Areas reverted to some legacy systems that had not been decommissioned.
The process for conducting wall-to-wall physical inventories became
more challenging due to the volume of equipment and property, and the
time and effort required to undertake such a process.
The new HHS logistics management policy mandates that all
accountable and sensitive property, but not all Government equipment,
be tagged with a Government decal. Accountable property is any item
with an acquisition cost of $5,000 or more. Sensitive property is an
item identified to be tracked with an acquisition cost between $500 and
$4,999 that requires stricter inventory control. Property items meeting
the new, higher dollar threshold or the sensitive items criteria are
affixed with a barcode tag and entered into the PMIS. The PMIS includes
a depreciation expense feature which will adjust the book value of the
IHS inventory when it has been fully implemented, a feature which was
unavailable in the legacy property system. As of 2007, a physical
inventory was completed for 100 percent of accountable/sensitive
property in 5 of the 14 accountable areas throughout the IHS, including
IHS Head Quarters (HQ). An additional 5 accountable areas completed
partial inventories (50-90 percent of accountable/sensitive property)
and the remaining 4 accountable areas examined 15 percent or less of
their accountable/sensitive property. By the end of FY 2008, a physical
inventory of 100 percent of accountable and sensitive property will be
conducted in 14 accountable areas throughout the IHS.
Response to GAO Report
IHS worked extensively with the GAO to provide detailed information
regarding the agency's property management system. Their review was
conducted at a time IHS was fully engaged in a transition from one
outdated system to a newer, more efficient PMIS. As such, not all
concerns cited by GAO in their report are current or defensible. GAO
itself acknowledges various limitations to its audit and investigation,
some of which are listed below. These limitations seriously undercut
and are not reflected in GAO's conclusions.
<bullet> The report asserts that IHS did not consistently document
``lost or stolen'' property items and concludes that the number
of currently unaccounted for items might actually be higher
than GAO has identified. In fact, the ongoing process of
reconciling the prior property management system to the new
PMIS will reduce the number of currently unaccounted for items
as the reconciliation progresses.
<bullet> The report also overstates the net worth of currently
unaccounted for items by not taking into consideration the
depreciation value of these items. Some items referenced in the
report are 15 to 35 years old, and yet are assigned their
original acquisition cost. For example, some of the large, non-
IT items of inventory, such as all terrain vehicles (ATVs) are
valued at the original acquisition cost despite the fact that
the actual equipment was acquired between 1974 and 1999, well
past their useful life expectancy of 8 years.
While IHS met with GAO on multiple occasions to discuss specific
situations addressed in the report, GAO has persisted in defending some
inaccurate situations described below.
Alaska Tribal Self-Determination Award
The ATVs and tractors referred to in the GAO report as ``lost or
stolen,'' were identified on the 2006 Alaska Report of Survey as
``transferred'' or ``abandoned in place''. Some of the large
construction equipment in the extremely isolated locations in Alaska
has to be flown in, or shipped by barge. The acquisition dates of these
1,197 items span 15-35 years. The useful life and actual ``value'' of
these items were taken into consideration by the Board of Survey and
the Determining Authority's final decision to remove the items from the
inventory records for the Alaska Area.
At the time of the transfer of IHS property to the Alaska Tribal
compact in 2000, personal property in use in Alaska reflected a non-
depreciated value of approximately $13 million, of which approximately
$7 million was transferred to the Alaska Tribal compact under the new
agreement/award. IHS-Alaska Tribal health officials jointly researched
and reconciled the inventory and wrote off the remaining $6 million of
this original amount representing 1,197 items in a single Report of
Survey in 2006. The Report of Survey clearly stated that most of the
written off items were disposed of either by (1) transfer to local
Tribal communities; (2) transfer to a local Air Force Base; or (3)
``abandoned'' on an IHS construction site due to the extraordinary
expense associated with the removal of the equipment, leaving 68 items
valued at a non-depreciated value of $177,000 unaccounted for.
Tucson Report of Survey and ``Jaws of Life''
All of the Jaws of Life extrication equipment which the GAO report
characterizes as ``lost or stolen'' has been accounted for by Tucson
Area in early May 2008. The Jaws of Life extrication equipment had been
stored in a Rescue Truck and the inventory team missed locating the
items on their earlier attempts when conducting the physical inventory.
The Tucson Area property staff is in the final stages of completing the
2008 physical inventory which includes reconciling any differences
between the physical inventory and the property records. The initial
work on the 2008 reconciliation process has resulted in locating and
accounting for many of the items listed on the 2006 draft Report of
Survey, however, the report does not reflect this.
Allegation of Misrepresentations Made by IHS Property Staff
The GAO report continues to categorize IHS HQ inventory items that
have been accounted for by the IHS inventory as ``lost or stolen.''
When the GAO investigation commenced in August 2007, IHS property staff
were in the process of reconciling the April 2007 physical inventory of
IHS HQ property with additional information, including a follow up on-
site inspection by IHS staff and independent verification of returned
property by the Federal warehouse. While the initial IHS April 2007
inventory results indicated that 1,180 items were listed but not
located on site, and over 500 items were on site but not listed on the
HQ inventory, subsequent research of alternate records determined that
the property had been properly disposed or accounted for. Independent
verification with the Federal warehouse in 2007 confirmed that 498
items had in fact been properly disposed of as turn-ins to the
warehouse. Additionally, in a subsequent inspection by IHS staff in
late 2007, 222 items were found on site in IHS HQ that had been missed
in the initial physical inventory taken in April 2007. The entire
reconciliation process was completed in January 2008 and updated
information was provided at that time to the GAO, but GAO's report does
not appear to have considered this additional information.
GAO's Allegation of Fabricated Documents
In January 2008, an IHS property staff member, in an effort to
ensure GAO received needed information in an acceptable form, generated
blank disposal records and recorded the disposal information that was
provided from the HHS Federal warehouse onto ``Request for Property
Action'' forms commonly referred to as HHS 22 forms. An HHS 22 form is
used to document property transfers, turn-ins, and disposition
instructions. This form is also used to document new receipts when
other source documents are not available. When these ``HHS 22s'' were
provided to GAO, they reflected a current date of January 2008 and were
clearly presented as having been created for purposes of establishing
the requested audit trail using independent warehouse verification.
Although they were not backdated or otherwise falsified, GAO accused
the property staff person of ``fabricating disposal records.'' No one
in IHS conveyed to GAO that these documents were anything but newly
generated documents. The staff person who generated the HHS-22s after
the fact, created them for the purpose of recording otherwise verified
information for the review of the GAO, but there was no intent to
deceive or mislead the investigators.
Allegation of ``Wasteful'' Purchases
In 2007, IHS Headquarters initiated a procurement strategy to
increase the cost efficiency of the replacement of computer technology
used by all its employees. The useful life of many desktop computers
and smaller portable devices is 3-5 years. By buying in bulk to meet
needs in advance and making those purchases once a year, IHS can take
advantage of significant price discounts, and reduce critical down time
of vital IT tools. Only the numbers of desktops exceeding their useful
life are replaced in the annual bulk purchase. A very few additional
computers must be purchased for emergent needs arising during the year,
such as new employees or to replace faulty equipment. IHS also uses
those few additional computers, pending deployment to individual staff,
for IT training purposes of all staff at both the Albuquerque and
Rockville Headquarters locations. The 25 on-hand ``spare computers''
noted in the report as ``excess'' and examples of ``wasteful''
purchases, represents roughly 6 percent of the total number of desktops
deployed at IHS Headquarters, which is an acceptable level of inventory
to meet these needs.
GAO alleges that IHS has assigned 10 computers to each employee in
IHS Headquarters. This calculation appears to have been made by GAO by
taking the total preliminary and unreconciled inventory (3,155 items)
in April 2007 (which included items later verified to have been
properly disposed) and divided the total by the number of IHS employees
at HQ (about 300). If one uses the final reconciled number for the 2007
HQ inventory, approximately 1,500, the ratio is closer to about 5 items
per employee.
``Yard Sale''
We are initiating an investigation into the allegation that a yard
sale was conducted to dispose of surplus computers and other property.
We appreciate the matter being brought to our attention by the GAO. In
the meantime, we have verified that these computers were used for
educational purposes at the Desert Vision Youth Wellness Center, and
were not used in a clinical setting in which the computers would more
likely be used to store sensitive data.
HHS Response to GAO Recommendations
IHS concurs with nine of the ten GAO recommendations addressed in
the report to strengthen overall control environment for property
management and has been, and is now, fully engaged in the ongoing
process of updating its personal property management policies,
conducting necessary investigations of any unaccounted property and
ensuring that employees are held accountable as appropriate throughout
the Report of Survey process. IHS is committed to strong enforcement of
standing agency policies designed to ensure accurate and timely
inventories of accountable personal property throughout the entire
agency with official certification by property management staff. This
includes enforcement of policies requiring proper use, control,
maintenance and protection of federal government property and continued
use of barcodes to identify and control all accountable and sensitive
government property.
Mr. Chairman, this concludes my statement. Thank you for this
opportunity to report on the property management program in the Indian
Health Service, serving American Indians and Alaska Natives. We will be
happy to answer any questions that you may have.
The Chairman. Mr. McSwain, thank you very much for your
testimony. We all have a number of questions, of course, for
you and Mr. Kutz. Before we get to those, I am going to ask Mr.
Fernand Verrier, who is with us, he is one of three people who
worked in the agency. Would you come forward to the witness
table? You are going to give a short testimony.
You were Deputy Director of the Office of Finance and
Accounting, and Chief Financial Officer for the headquarters,
Indian Health Service, in Rockville, Maryland until March of
2008. If I might stipulate, you have in your testimony a
substantial amount of information about your service in the
Navy, the Far East, your direct commission, your service in
Operation Desert Shield and Enduring Freedom and so on; one
year at CENTCOM; one year at the U.S. Embassy in Yemen.
Let me stipulate, if I might for all of us, all of that
information about your service to our Country and thank you for
it, and ask if you would begin on page two of your information
and describe. You say on page two, ``I would like to share my
personal experience.''
Your description here is of a rather small area in the IHS,
but I think you provide it as descriptive of what you think
happens at the IHS with respect to inventory. If you would
start there and go to the end, that way we will have on record
your impression as someone who worked in those offices, then we
will go to questions.
Mr. Verrier, thank you.
STATEMENT OF FERNAND R. VERRIER, FORMER DEPUTY
DIRECTOR, OFFICE OF FINANCE AND ACCOUNTING, INDIAN HEALTH
SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; CFO,
HEADQUARTERS INDIAN HEALTH SERVICE
Mr. Verrier. Thank you. As you stated, I would like to
share my personal experience with the property management
problems at IHS.
In the fall of 2007, the IHS Property Book Office submitted
a request to our office requesting that we conduct a complete
inventory of our computer equipment. Mr. Tommy Thompson, who
was my direct boss at the time, directed me to perform this
inventory. He said that was my responsibility.
Having not been there a long time, I asked a secretary to
conduct the inventory. Out of the approximately 100 items, she
could not locate approximately 20 items in our assigned office.
Hearing this, I decided to conduct the inventory myself to
determine the discrepancy. I did conduct the inventory and
found the same discrepancy.
I then contacted the Property Book Office and asked them to
come and conduct an independent inventory to verify ours. They
performed the same inventory and came up with the same results.
I then sent an e-mail to our staff, which is approximately 35
individuals, and asked them if they knew of the possibility of
where these missing items could be located. Their response came
and we located one laptop computer and one desktop computer
that was located in the individuals' homes.
I asked for documentation that permitted these individuals
to remove the Federal Government property and take it home.
Their response was, we do not do that around here. My response
was, effective immediately, you will do this.
I then contacted the Property Book Office and informed them
of the location of the two missing items. The Property Book
Office told me that they would prepare a new property book
reflecting what they had found. My response was, okay. However,
what are you going to do about the missing items? Their
response was, we are going to write them off. My response was,
what? You are going to write them off without conducting an
investigation? And their response was, no, we write things off
as we have always done. My response was, I can't believe this.
At this point, I contacted the Property Book Officer and
informed him of what was going on. He told me he would check
into it. I would estimate that the value of the property that
was missing, the 18 items still missing, is approximately
$18,000 to $20,000. If this is what is found in a small office
at the headquarters of approximately 35 individuals, what would
you expect in the other offices throughout the agency?
I am very grateful to have the honor and opportunity to
address the Committee and to assist in the effort to help
implement property control management within HHS. Proper
property management control will allow IHS to allocate its
funding wisely and frugally in providing medical care for our
Native American and Alaskan natives which the funding is for.
At this time, I will answer any questions you have.
[The prepared statement of Mr. Verrier follows:]
Prepared Statement of Fernand R. Verrier, Former Deputy Director,
Office of Finance and Accounting, Indian Health Service, U.S.
Department of Health and Human Services; CFO, Headquarters Indian
Health Service
Thank you, Chairman Dorgan and Members of the Committee, for taking
the time to hear my testimony in regards to the blatant fraud, waste,
and abuse of property throughout Indian Health Service (IHS).
My name is Fernand R. Verrier. Until March 6, 2008, I was the
Deputy Director of the Office of Finance and Accounting (OFA) and Chief
Financial Officer (CFO) for Headquarters, Indian Health Service in
Rockville, Maryland.
I have served in the Federal Government since 1976, starting as a
GS-9 Auditor and working until my forced retirement on the 6th of March
2008, due to a hostile and stressful work environment. My final
position was at the GS-15 grade. I have served in the Federal
Government as an Auditor, Supervisory Accountant, Budget Analyst,
Supervisory Budget Analyst, Supervisory Accountant, Supervisory
Auditor, Financial Manager, Financial Advisor, Auditor, Senior Auditor,
and Deputy Director (Supervisory Accountant).
I have also served in the Navy from 1962 to 1966 in the Far East.
In 1977, I received a Direct Commission as a 1st Lieutenant in the Army
Reserves and served on Active Duty during the following periods: Just
Cause/Promote Liberty, Panama, December 1989 to September 1990; Desert
Shield/Storm in Saudi Arabia, Kuwait, and Iraq, December 1990 to May
1991; and Operation Enduring Freedom in Bosnia from May 1996 to
December 1996. After 9/11, I was once again called to Active Duty and
served 1 year at Headquarters, Central Command, and 1 year at the U.S.
Embassy, Yemen until my retirement at age 60.
My responsibility at IHS as Deputy Director of the Office of
Finance and Accounting and CFO was to serve as the Principal Deputy
Director to the office Director. This means that I fully shared in the
responsibility to exercise broad authority for development,
presentation, and justification of the IHS budget, and for the
allocation and management of financial resources available to IHS
executives on financial management matters. I also had responsibility
for implementation the provisions of the Chief Financial Officers Act
of 1990 and the Government Management Reform Act of 1994. I applied
supervisory responsibilities and managed the daily operations of the
office; supervised and provided direction to subordinate staff either
directly or through subordinate supervisors; served as principal
advisor to the CFO on accounting principles, standards, practices, and
functions and chief financial operating official requirements; and
interpreted and provided direction for the development and execution of
policies, guidelines, manual issuance, circulars, and other directives.
As Deputy Director, I reported to Mr. Tommy Thompson, Director of
the Office of Finance and Accounting, who reported to Ms. Phyllis Eddy,
Deputy Director for Management Operations, who reported to Dr. Charles
W. Grim, Director of Indian Health Service.
I would like to share my personal experience with property problems
at IHS.
In the fall of 2007, the IHS Property Book Office submitted a
request to my office requesting that we conduct a complete inventory of
all our computer equipment. Mr. Thompson, Director, informed me that as
the Deputy Director, it would be my responsibility.
I asked our secretary to conduct this inventory. Out of
approximately 100 items, she could not locate about 20 assigned to the
OFA. Hearing this, I decided to conduct the inventory myself and found
the same discrepancies. I then contacted the Property Book Office and
asked if they could send someone to conduct and independent inventory
to verify ours. They performed the same inventory and came up with the
same results. I then sent an e-mail to all our staff (approx. 35
individuals at the time) and asked whether anyone knew of the possible
location of the missing items. The responses allowed us to locate one
laptop and one desktop computer which individuals had at their homes.
I asked for the documentation that permitted these individuals to
remove federal government property and take it home. Their response
was, ``we do not do this around here.'' My response was, ``effective
immediately we will begin doing this.''
I then re-contacted the Property Book Office and informed them that
we had located two of the missing items.
The Property Book Office told me they would prepare a new Property
Book reflecting what we had found.
My response was, ``O.K., however, what are you going to do about
the items that are still missing?'' Their response was, ``We are going
to write it off.'' My response to that was: ``WHAT? Are you not going
to conduct an investigation about the missing items?'' And their
response was, ``NO, we just write it off as we have always done.'' My
response was, ``I can't believe this! ''
At this point I contacted the Property Book Officer and informed
him of what was going on. He told me that he would look into it.
I would estimate that the value of the approximately 18 items that
were still missing was between $18,000 and $20,000.
Now you are probably asking how this relates to the GAO report,
``IHS Mismanagement Led to Millions of Dollars in Lost or Stolen
Property.'' Well, I say to you, that this is proof beyond a doubt that
IHS has a very large problem in regards to property management. If this
is what was found in a small Headquarters office of only approximately
35 individuals, what would you expect in the other offices and
throughout the agency?
I am very grateful to have had the honor and opportunity to address
this Committee and to assist its efforts to help implement proper
property management control within IHS. Proper property management
control will allow IHS to allocate its funding wisely and frugally in
providing medical care for our Native American and Alaskan natives.
At this time, I am happy to answer any of your questions, if you
have any.
The Chairman. Mr. Verrier, thank you very much for your
thoughts about your observations in the Indian Health Service.
Mr. McSwain, Director McSwain, 11 years ago you wrote a
memorandum, that is March 12, 1997, in which you said, look, we
have had people stealing laptops around here, and we have a big
problem. I assume back in 1997, 11 years ago, you were not
Director, obviously. You were in the Indian Health Service
raising a question about a problem you saw. I assume back then,
just looking at that memorandum, you thought something serious
was going on. When equipment gets stolen, that is a big
problem, right?
And so you raised the question and the need to do something
about it. Eleven years later, we are sitting here in a
Committee hearing room with a GAO report saying this thing is a
complete mess.
And your testimony, I must say, seems all too defensive of
the existing system. For example, I read the report last night
in full. I had read summaries before. But the report, for
example, describes efforts by individuals in the Indian Health
Service to fabricate documents to the Government Accountability
Office. That is a very serious charge. You know, it seems to me
that you have people fabricating information, that borders on
criminal and you want to find out who would do that and get rid
of them instantly.
So tell me your response to the allegation of fabrication
of documents?
Mr. McSwain. First of all, Mr. Chairman, as I mentioned, it
was not necessary to even write those documents because we had
the backup information that would attest to the disposal of the
property. But let me just say that this particular matter has
been referred to the Office of Inspector General for their
inquiry and investigation as well. So this matter is in fact
under the IG's, I believe if the GAO didn't refer them, we
certainly have referred the matter to the IG for their look.
The Chairman. But do you think it happened? If I were in
your position and somebody did an audit or an investigation of
my agency and they said, ``IHS made a concerted effort to
obstruct our work''--that is very strong language from the GAO;
I don't know that I have ever heard that language of a Federal
agency--``a concerted effort to obstruct our work.'' And then a
misrepresentation, by the IHS Director over property items, and
then fabricating receiving reports by the IHS property
specialist.
If I were in that chair, I would be furious if you had half
a notion that any of that was true, and I would damn well find
out as quickly as I could. Your impression is, well, we are
directing this to the IG.
Mr. McSwain. As any kind of behavior of that type, we are
duty-bound to refer them to the IG and we have done that. What
I am saying is, and quite frankly the particular employee that
attempted to--the interesting thing about this particular event
was, yes, there were receiving reports that were filled out and
they were dated the day they gave it to the, which was three
months later than it was actually received. So the real fault
there is the fact that a receiving report was not prepared as
the policy requires upon receipt.
With the employee feeling that this form, this HHS-22,
which is a form that literally manages and moves property
around the system from acquisition to ultimate disposal was not
there, their attempt to simply create one based upon documents
that we already had that were not in that form, I question the
fullness of ``fabrication.'' He may have prepared a form, but
it is borderline.
It is not like he completely backdated the document to the
date of receipt. That would be fabrication, in my opinion, but
not simply preparing the report and signing on today's date,
and providing it to the GAO as requested is, in my view, not
quite the same level of fabrication as completely going back
and redoing the report and representing it as performed in
accordance with the policy. But that is just my opinion, but
the fact is that it did occur, so it has been referred to the
IG for further investigation.
Mr. Kutz. Mr. Chairman, could I address that?
The Chairman. Yes.
Mr. Kutz. I don't have an opinion. I have facts. He is
talking about two different matters. If you look at the board
up there, that is one of the 116 documents that were
fabricated, showing that 571 items have been transferred.
Notice that there are no actual signatures on there. One of the
individuals whose name was blocked out at the bottom did not
even work there at the time that this transfer supposedly took
place. We spoke to both people whose names are blacked out and
they said that those documents did not exist.
The worst situation that shows this as a fabrication, some
of the items that supposedly were transferred before April,
2007, which is what those documents say, we found in our
physical inventory after that date, clearly showing that these
are fraud and fabricated documents.
Mr. McSwain might not be aware of all the facts, but those
are the facts.
The second case is a separate case, where we asked for
three receiving reports, and that was a little bit different.
The document wasn't fabricated. We were given a document that
showed no signatures and no one had actually received the
items. We got a second document the day we asked for it with a
signature that day. So we have two copies of the same document,
one with signatures on it and a date in December of 2007, and
the other one with no signatures. So that is a separate
incident from the 116 documents that were fabricated.
The Chairman. I will come back to that, but the report
suggests that you can't locate a Caterpillar tractor? You know,
the description of the property--a pickup truck, van trailers,
heavy equipment lost or stolen. Is there a Caterpillar tractor
gone?
Mr. Kutz. It could very well be. It could be an inventory
issue. It could be that something is gone. There are issues. I
have read police reports of stolen vehicles. Other things may
be just accounting issues.
The Chairman. And so, we hear about bat dung and yard sales
and all of these issues. It seems to me, Director McSwain, that
this is a mess, and they have only looked at seven of the 163--
--
Mr. Kutz. One-hundred-and-sixty-three, I believe.
The Chairman.--seven of the 163 service areas around the
Country. I wonder what we would be talking about here if all
163 were surveyed. Do you agree that we have a huge mess on our
hands, Director McSwain?
Mr. McSwain. I would not go as far as perhaps the GAO is
going with their generalization, because a large amount of our
equipment is in the hospitals. It is in the facilities. It is
my belief that the accountability of equipment within those
hospitals and health stations and health centers, what we are
really talking about here is the disposal.
Much of what we are talking about is equipment that has
completed its useful life and now is being processed out,
either excessed in the case of the contaminated bat dung
equipment, which was at zero value, was not being used, was no
longer in the facility, even though it was health care
equipment, it was so outdated that it was in fact moved out.
That is one example.
Of course, in Alaska where the tractors and backhoes and
the like that get flown out for projects up there, we have had
conversations certainly with the native corporations, and they
are fully aware of the fact that that equipment is in those
locations and in many cases being used.
There is a term of art that we use, which is abandon in
place, meaning that--and the requirements are that is it going
to cost more to transport that piece of equipment back to a
central place, or leave it in place.
So it is complicated. I wouldn't characterize it as a mess,
but I certainly hear you.
The Chairman. But Director McSwain, your statement just now
is at odds with your own admonition 11 years ago about property
being stolen, with Mr. Verrier's experience of we have missing
property, what do we do? We write it off. We don't investigate.
We write it off.
How much of that missing property was stolen? And you are
telling us about a tractor that might have been airlifted in
Alaska. We are talking past each other, I think. We have a
GAO--the fact is that GAO is our own creation. They do work on
our behalf. They have issued a report I think that is a
scathing report, and you say today, you say that this system,
inventory information management system is fully operational,
and yet then you also say you are still migrating data and
training staff. How can you have a system fully implemented if
you are still migrating data and training staff?
Your approach here today is to suggest, you know what, the
GAO probably doesn't quite understand it all. But you
understood it 11 years ago. I am frankly surprised, Director
McSwain. I would be furious, if I were you. I would be furious
about having to answer for this staggering incompetence.
Mr. McSwain. Let me assure you that 11 years ago, I
certainly had a perception and I knew there were some things,
there were reports being given to me, and I took action then.
Fast forward to the current, I can assure you that I will make
the changes that are necessary to bring accountability for this
particular piece, as well as accountability in other parts of
our system, as well as we have done with accountability for
health care performance.
The Chairman. But do you still have the people working for
you--I assume the answer is yes--who attempted to obstruct the
work of the GAO? Who provided false information to the GAO?
They have given us a list of things here--fabricated reports,
backdated. Do you still have those folks working for you?
Because you seem to be here today explaining what they did and
the reason they did it. I don't think there is an explanation
for that. Are those folks still working there?
Mr. McSwain. Yes.
The Chairman. By what justification does that occur?
Mr. McSwain. I think, Mr. Chairman, we have had this
conversation before. As employees, at least in the executive
branch, they have rights. We will certainly deal with them, but
they also have rights as permanent employees. But we will deal
with them appropriately.
The Chairman. Mr. Kutz, the work that was done here
describes a system that is in chaos. Is that a fair
description? And you heard Mr. Verrier's comments, and you
described that the audit commenced as a result of
whistleblowers. Whistleblowers are not very well thought of by
agencies, as you know.
You started your testimony saying that the whistleblower
allegations about inventory mismanagement were documented as
accurate by the GAO. Is that correct?
Mr. Kutz. That is correct.
The Chairman. Give me your impression of this entire
system, and also answer for me, if you would, is it conceivable
that the Indian Health Service could not have a fully
operational system of property management in this period of
time?
Mr. Kutz. No, it is not.
The Chairman. If they don't have training staff trained,
and are still migrating data?
Mr. Kutz. No. I think they are migrating the system, but
this is a problem of people, process and system. As I mentioned
in the opening statement, one of the things you have is a
management culture here that has kind of allowed this to happen
over at least 13 years, because the memo there says there have
been problems for two years. So really, the problems at least
go back to 1995.
So you have the overall control environment issue. And
then, as I said, the rest of it is property management 101. You
have pretty good policies in place, but people aren't following
them, and when they don't follow them, they are not held
accountable. That is really where the culture needs to change.
So it isn't really rewriting all the policies. Property is
required to be bar-coded. Hand receipts are given, which means
like if a computer is given to me, there is some accountability
for it. They know I have it. It is in my room, and that kind of
thing. They don't use that at headquarters, for example, and
other places, so basic policies that need to be followed. So it
is going to take time to change the culture to fix a problem
like this.
The Chairman. I have additional questions, but let me call
on Senator Murkowski.
Senator Murkowski. Thank you, Mr. Chairman.
You know, you mentioned the policies in place, and your
opinion that the policies are probably adequate. It really
comes down to enforcement and the accountability aspect of it.
Mr. McSwain, you mentioned that as a consequence of what we
are dealing with, this GAO report, that you are moving to
update the policies, was the terminology that you used. And you
are going to put protocols in place, send folks out for random
visits to kind of do your own internal audit there.
I am concerned that we probably do have the policies out
there. I can't believe that we could have known to the level
that we knew back in 1997 or whether it was 1995--obviously a
good decade ago--that internally there were some property
management issues that needed to be addressed.
I can't believe that we would not adopt and address
policies at that point in time. I have to believe that the
policies are there. I am very concerned about the lack of
enforcement, and that is what it seems that we have in front of
us today.
That is what leads me to believe, based on what I have
heard described today, the background from the GAO report, that
you really do have a situation of chaos, of chaotic management,
of management that simply does not work.
I will tell you, I don't know how else to describe my
reaction other than saddened, that as a consequence of this,
what we are going to be doing now in order to address the audit
and the very obvious and glaring problems within the system, we
are going to be spending money to send people out to make sure
that we are doing what we need to be doing in terms of the
bean-counting, and it is not going to get out to the hospitals.
It is not going to get out to provide for those who have had
their health care rationed, as we talk about.
So in an effort to address this need, we are going to have
to take some of these very scarce resource dollars that we all
agree is a big part of our problem here, and we are going to
have to direct them to kind of the accounting end of it. When
we are dealing with the accounting end of it, as important as
it is, it is not getting more health care to those who need it
within the system. So I am just kind of shocked at how we deal
with some of the management issues.
Let me ask you just in terms of the new system that you
have now moved to, Mr. McSwain. We have gone through this
conversion, or it is maybe still in the process, as the
Chairman has suggested. And maybe, maybe not, this conversion
has contributed to some of the difficulty in conducting annual
audits, although I have to suggest that if it goes back as long
as we are talking about, it is not just the conversion issue
that we can point to.
But with this new property management system, are we doing
anything different in terms of the system itself, that will
ensure that we don't have the problems? Or again, does it
really all come down to whether or not we are enforcing the
policies and protocols that we already have in place? I am
trying to understand how we move forward from here.
Mr. McSwain. Thank you, Senator. As you were speaking, I
was thinking about the same sort of balancing dilemma that we
face, that service unit directors face every day out in the
service units. I could just see them saying, do I hire a nurse
or do I hire a property person? Do I dedicate resources over
here or over there? If I am sitting there and if I have a
backlog of patients, I can kind of guess where their decision
is going to be. They are going to hire the nurse. They are
going to hire the doctor. They are going to hire the health
care professionals to carry out the mission.
What I believe, and I firmly believe this, is that my
experience of being around the Indian Health Service a number
of years, we have had a number of property systems. We had
something called the NECOP system, which is a non-expended
control operating program, for years. It was a stand-alone.
Areas did it. There was some data that was moved around, but it
really wasn't a system. It was, for all intents and purposes, a
spread sheet kind of a system that accounted for inventories.
Then we moved forward to some later versions of online kinds of
equipment--again, systems that were not integrated.
This time, we have a system that is integrated as a part of
the unified financial management system that has entry points
throughout the Indian Health Service, and throughout the
department, for that matter.
So that ability to have the inputs, if you will, at the
very local level is a system-wide application. That, coupled
with--and I am not suggesting that we are going to go out and
do queries and visits to every site--but it will tell us where
the problems are and where we must go, so that we are not
taking money away from patient care at the national level to
provide these on-site reviews.
We are going to be doing that balance. So we start looking
for a system that will tell us what is going on, much like we
do with health care, the provision of health care. We look at
the data and it tells us where we need to focus our efforts. We
know from our process of GPRA outcomes which parts of the
Country, through trend analysis, where we need to deploy
resources, where we need to make decisions. I am just taking
that model and moving it to the management side.
Senator Murkowski. Let me ask you, Mr. Kutz, if you think
that this new management system is going to make a difference.
You have been looking at it.
Mr. Kutz. Yes, we haven't looked at the system necessarily,
but I don't think it is an issue of software or hardware. Let's
just use an example of bar-coding. You can have the greatest
system in the world, but if people don't bar-code equipment and
enter it into the system when it is purchased, it doesn't make
any difference. We have found many, many items across the
Country that weren't bar-coded, that weren't in the system.
You know, the $15.8 million and other items we have seen
were things that were in the system that couldn't be found.
There was a whole host of things that weren't in the system
that weren't bar-coded, and things like that, which gets into
beyond an accounting issue. If you look in the system and you
see the stuff isn't there, you might actually ask Congress for
money to buy some more. And then that doesn't go to health care
either. So it is more than an accounting issue in that respect.
Senator Murkowski. Let me ask you, on the issue that Mr.
McSwain brought up with the items in Alaska, some of the heavy
equipment. I just wanted to clearly understand, ANTHC was the
Alaska Native Tribal Health Consortium. It is not your
understanding that they were at fault or had been involved in
any way in anything inappropriate, I guess?
Mr. Kutz. No, from the documents we saw and the people we
spoke to, there was $13 million involved. Seven million of it
was inventoried and the tribal group accepted it. The $6
million was put on one of these reports of survey because it
couldn't be found, is what we understand from the people we
talked to and the documents we saw. So no, that never made it
to the tribe, because they weren't going to accept it, because
no one could find it.
Now, the other issue that came up that was interesting was
just abandoning property. I don't know if that creates
environmental issues, it is your State, so I am not sure if you
would be pleased having property abandoned.
Senator Murkowski. But your audit didn't show those assets
as abandoned in place? They didn't register anywhere, is what
you are saying?
Mr. Kutz. They were on a report of survey in six or seven
different categories. And a report of survey typically means
that items are not found, they are damaged or they are stolen
or whatever the case may be. Whereas the other $7 million that
was involved was transferred and accepted. So that is why the
$6 million is in question. There were no documents that we saw
showing that the items were found and had been transferred.
Senator Murkowski. What about Mr. McSwain's comment about
the fact that so much of what we are dealing with when the
inventory is old? We have had plenty of opportunity to talk
about the inadequacy of facilities. I have every reason to
believe that we probably have an awful lot of equipment out
there that has, its value truly has depreciated to the point.
How much of an issue was that in your findings?
Mr. Kutz. Certainly some of it is old and things that have
no value. Now, if they were still in service and they were
lost, they would still need to be replaced. However, we did
identify brand new items that were gone, also. For example, as
of April 2007, 64 at least of the items that were missing at
headquarters were in the system as new computers. There were 10
Dell computers bought last summer that were in the system that
we could not find. So it wasn't just old junk. Some of it was
old junk, certainly. But other things were new, usable items
that were gone and couldn't be accounted for.
Senator Murkowski. Mr. Chairman, I will defer to some of my
colleagues at this point.
The Chairman. Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
Where to begin? Let's start with what Senator Murkowski was
talking about. You had some kind of a document, this is for Mr.
Kutz, a document that has inventory it, and you try to find
where that inventory is and when you can't find that
inventory----
Mr. Kutz. The record was PMIS, the property management
information system, and the subsidiary records. So from that
information we would do physical inventories both from the
records to the floor and then from the floor back to the
records. That is where you find things that aren't bar-coded
and aren't in the system.
Senator Tester. So it is tough to lose a backhoe or a D8
Cat, even in a place as big as Alaska. So what is going on, Mr.
McSwain? Are the documents not being filled out when you
abandon something in place, or when you turn it over to a tribe
or whatever happens to it? Are not those documents being filled
out to show what the final resting place for a piece of
equipment might be?
Mr. McSwain. Well, bear in mind that this is part of the
86-121 program and we do buy equipment and the like, and we do
actually transfer it to the community when they take over the
system. So we don't operate and maintain, so----
Senator Tester. So why isn't that reflected on your
inventory list? Why is that equipment still on a list that the
GAO would get and try to determine where it is at?
Mr. McSwain. It goes to the very point I was trying to make
earlier, is that the whole process of moving the ownership of
equipment, either, in this case the $6 million of equipment
shown on the report of survey for Alaska was in fact
distributed to military bases and to communities and the like.
And it was indicated, at least on the report as I read, and I
like, I don't know whether GAO made a trip up there, but I have
flown around Alaska and know how remote those locations are.
That is important, Alaska is somewhat different. We don't have
the same kinds of heavy equipment in the lower 48.
But let me just say that when you buy a piece of equipment
and move it out there, it takes several years to complete its
work, then we will say, look, we will just leave it there and
turn it over to the community to use.
Senator Tester. Why isn't that reflected in the documents?
Mr. McSwain. We need to move it off, and that was the
report of survey, was to move it off of our inventory.
Senator Tester. Then why isn't it?
Mr. McSwain. That is the question that the General
Accounting Office is raising, that we didn't do that. That was
incorrect. But the fact is----
Senator Tester. So are they right, did you do it or didn't
you do it?
Mr. McSwain. We did do it. We did pull it off inventory. It
was our report of survey that they are looking at.
Mr. Kutz. The only difference is, the reports of survey I
am talking about typically document lost, stolen or damaged
property. He is representing it has been transferred. There was
no evidence we found that it was properly found and
transferred. It could have been, but the records didn't
indicate that.
Senator Tester. Which is exactly my point. The records have
to be clear. Why aren't they clear?
Mr. McSwain. Well, the issue is that in the 86-121 program,
we have various agreements we make with Indian communities when
we are building a system for them, and we transfer it to them.
And we generally will include in that document, it also
includes the following equipment for purposes of operation and
maintenance. We did not do that.
Senator Tester. Okay, thank you.
You had talked to the Chairman about the fact that
employees have certain rights when it comes to screwing up. And
you said, we are dealing with it, or something to that effect.
What exactly are you doing?
Mr. McSwain. Well, first of all, we are doing, certainly a
review of the conduct. There are two kinds of ways to deal with
employees, either through performance or conduct. In this case,
we are looking at conduct, and was that conduct enough to move
to disciplinary action. That is what we are doing.
Senator Tester. Okay, and Mr. Verrier, you talked about 20
percent of the equipment, when you did your audit, being gone.
What year, what was the time frame for that?
Mr. Verrier. That was in the fall of 2007, I believe.
Senator Tester. Fall of 2007. Okay, Mr. Kutz, is it the
same facility, was it the same outfit?
Mr. Kutz. It is at headquarters, we did a 100 percent
inventory of headquarters in late 2007 into early 2008.
Senator Tester. So are we inventorying the same equipment,
and you found 36 percent gone and Mr. Verrier found 20 percent
gone? Is it basically the same equipment?
Mr. Verrier. That was just in my office of the----
Senator Tester. Okay, so it was a bigger spectrum.
Mr. Kutz. We looked at all 3,000 plus pieces of equipment.
Senator Tester. Thank you very much. When you get the
reports, computers do depreciate fairly rapidly, is that
reflected on the reports you get, Mr. Kutz?
Mr. Kutz. Their old system did not have the ability, one of
the new features of the PMIS system is that it has
depreciation. So one of the reasons we used acquisition costs
is that is all there was. There wasn't depreciation
information.
Senator Tester. Okay, so I am just curious, did you allow
for, when you found the bat manure on the computers in Montana,
did you allow for any sort of depreciation, or did you not know
when they were new?
Mr. Kutz. The only records involved were what the
acquisition costs were. There was nothing on the report of
survey that showed the date of acquisition of any of that
property. There were things like treadmills from hospitals.
Most of it was hospital equipment, actually, the bat dung
incident. We don't know how old it was, because no records were
available to show.
Senator Tester. Sounds good. The computer that is missing
from the New Mexico hospital, that you talked about, Mr. Kutz,
the computer that was missing from the New Mexico Hospital, Mr.
McSwain, was that turned over to the police?
Mr. McSwain. Yes, it was. In fact, it was reported to the
Navajo police because it was on the Navajo reservation.
Senator Tester. And was there anything ever--I mean, what
happened?
Mr. McSwain. It took a while to get a police report from
them before we actually went through the process. I have a
whole, if you would like to know the whole detail of a series
of events----
Senator Tester. Did they find out who stole it?
Mr. McSwain. It was stolen and it was reported, and we
reported it up to the department because of the fact that it
had personal information identification information.
Senator Tester. Did they find out who stole it?
Mr. McSwain. They are still investigating it. In fact, as
of just last week, the area indicated that they are still, they
believe they have a line on who took it, and so we are still
waiting for that to occur.
Mr. Kutz. Senator, if I could just add, I read the police
report on that also. There were no signs of break-in on that,
so it was potentially inside.
Senator Tester. An inside job.
Mr. Kutz. Yes.
Senator Tester. Okay.
Mr. McSwain, you talked about a new computer system that
you implemented, at least that is what I thought I heard you
say, a new computer system you have implemented to take care of
a lot of the GAO's concerns. Is that correct?
Mr. McSwain. It takes care of the accounting part of it. I
think that----
Senator Tester. Well, the accounting part of it seems to be
a pretty big part.
Mr. McSwain. The accounting part of it is, but the most
important thing I see here, and this is something that has
surfaced with this whole process, and that is looking at boards
of survey reports from around the Country. I have not looked at
them in the past and I am looking at them now. Clearly, the
ability--where those decisions are made, because boards of
surveys take place when you have done one inventory year one,
and year two you have an inventory and you reconcile between
what happened to all the equipment that was on the year one
inventory to year two--additions, deletions, losses. And so the
system will record the first inventory and the second.
Now, bear in mind, I should by the fact that there are
threshold values that the system will not capture.
Senator Tester. Is this the new system you are talking
about?
Mr. McSwain. The new system will not--in fact, the
department's policies on whether or not certain threshold
levels, and I won't get into all those details.
Senator Tester. Can you tell me what that threshold level
is?
Mr. McSwain. Well, the threshold level currently is $5,000.
Senator Tester. So it would not capture a piece of
equipment that is less than $5,000?
Mr. McSwain. If it is sensitive equipment under $5,000 it
will capture it.
Senator Tester. But if it not sensitive, it won't capture
it. So if I have a laptop for educational purposes, it won't be
on the books?
Mr. McSwain. That qualifies as a sensitive piece equipment
so it will capture it.
Mr. Kutz. Many agencies do that, Senator. They will use a
$5,000 threshold for financial statement reporting purposes,
but they will keep track of property that has personal
information and things like that. That is what Indian Health
Service's policy is.
Senator Tester. Okay. All right.
The Chairman. On that point, my understanding is that is
the point at which the Indian Health Service does not agree
with the recommendations. They say they agree with 9 of the 10,
but one of the recommendations they apparently do not
necessarily agree with is this issue of the dollar threshold to
track sensitive equipment such as BlackBerrys and cell phones,
even if they fall under the accountable dollar threshold
criteria.
I don't quite understand that. If you are assigning, for
example, BlackBerrys to employees, you are not going to keep
track of that?
Mr. McSwain. It becomes a threshold accounting issue, but
in practice we are in fact bar-coding. I am walking around with
a BlackBerry right now that has a bar-code on it.
The Chairman. Then why would you object to the
recommendation of the GAO?
Mr. McSwain. The objection to, certainly the idea of simply
tracking all equipment under $500 is a threshold issue. And
they are suggesting, I think their recommendation is that we
track all of those items by the issuance of bar-codes, I
believe.
Mr. Kutz. Our only suggestion was the PDAs and cell phones.
That is what we disagree with, because those are gateways to
potentially sensitive information. So it is not about dollars,
it is about information. And most places do keep track of
things like BlackBerrys. So hopefully they are going to agree
conceptually with what are talking about. I think he actually
agrees with our recommendation.
The Chairman. Except that they have expressed exception to
that recommendation.
Mr. Kutz. In writing they did, but it sounds like they
agree with it conceptually, so I am not sure exactly where that
puts them.
The Chairman. Senator Tester.
Senator Tester. Just so you know, if you are not going to
keep track of that equipment, I lost my BlackBerry a while
back, it was $300. I mean, I quite frankly, hopefully that is
going to be--let's get right to the crux of it. Mr. McSwain, do
you think you have a problem?
Mr. McSwain. Yes. I believe I have a problem. But not to
the extent that is being portrayed.
Senator Tester. How much do you think it is over-inflated
by?
Mr. McSwain. I couldn't tell you at this point, but it is
certainly not $15.8 million. It is much less than that.
Senator Tester. In your opinion, do you think it has been
over-inflated by double?
Mr. McSwain. For example, we just quickly parsed out that
the $6 million worth of equipment in Alaska is deducted,
$700,000 of the----
Senator Tester. Well, I'm not----
Mr. McSwain. I am trying to answer your question as to do I
think it is inflated, yes. It is inflated, if not just from the
fact that it is at cost value, not a depreciated value.
Senator Tester. A couple of things. First of all, if we
extrapolated this out to all 163 regions, we would be talking
nearly $400 million, if the rate was the same. You could say
they are inflated figures, they may be inflated figures if
depreciation is taken into account.
But I will also tell you that it also points out to me that
you are running different sets of books. I don't know how many
sets of books you have out there, but they ought to be a lot
clearer than that. Because quite honestly, the reason that
person had to fabricate that form, by your admission, is
because you had a different set of books than they though you
had, and when they started changing forms, books, however you
want to put it, they end up screwing up, and it ends up with
two forms with different signatures on them and different
equipment.
So the whole thing seems to be pretty well screwed up. If
it is not the employees' fault, you have a systemic problem
with your tracking system that quite frankly, you need to get
somebody in to fix, and sooner, rather than later.
The other thing is this. If you have a Caterpillar that you
have given away or a backhoe that you have given away, and it
is okay to give it away under 86-121 and you are following the
rules, that is fine. But it needs to be documented. And the
truth is, what Mr. Kutz said was exactly correct. You can have
the best policies in the world, and if you don't implement
them, if there isn't somebody implementing those policies, they
are worthless. They are worthless.
What actually is more disturbing to me than anything was
the previous board you had up with a letter that was signed by
you. And it was signed by Mr. McSwain, at the bottom, talked
about 1997, that little memorandum right there, March 12th,
1997, where you said, we have a problem, it needs to be fixed.
We are light years further, we have much better technology than
we had in 1997. You knew that there was a problem, and there is
a problem now that is equally as bad, maybe worse than it was
in 1997.
The bottom line is this. I hear from folks in Native
American Country all the time about, you have to plan when you
are going to get sick, because the Indian Health Service never
has enough money, Senator Murkowski talked about it. We come in
here, we try to do the right thing, we try to get the money
down to the people who want it. And if you have employees who
are walking out the door with laptops under their arms or with
desktops, and it is not being documented, I can tell you this,
employees do have rights. And I think they should have rights,
by the way. But a thief has none.
And you guys honestly, you can downplay this all you want.
But the fact is, this isn't going to get better until you admit
there is a problem. I told the Chairman a minute ago, an
alcoholic will never get better until they admit to themselves
that they are an alcoholic. You have a problem within your
agency that needs to be fixed. And if you are in denial, it is
going to get worse. And the GAO came out with a report, you had
an employee that came up and said, hey, I pointed this out. And
I don't mean to lecture to you, but the truth is what I said in
my opening statement, this is totally unacceptable. It is
totally unacceptable. And it gives Government a bad name.
When I go home and people come up to me and tell me how
worthless the Federal Government is, I personally take offense
to it. But it's damned hard to justify it when this kind of
crap is going on in the agencies.
The Chairman. Senator Tester, thank you.
Let me ask a couple of additional questions. I don't
understand who has been in charge at the Indian Health Service
of property inventory, all of these last years since you wrote
the memorandum. Is there one person in charge in this system
that sends out information to all the other agencies and so on,
or all the other areas? And if so, who is that? Because you
keep suggesting this is a system problem. Seems to me, it is a
people problem as well, probably more a people problem.
I want to just ask Mr. Verrier, who said this. He took a
look in his area, couldn't find 20 percent of the property, and
the Property Book Office said they would prepare a new property
book reflecting that. And then he said, okay, what are we going
to about the items still missing? Their response was--was this
the Property Book Office response?
Mr. Verrier. The Property Book Officer.
The Chairman. Officer, I am sorry. Their response was, we
are going to write it off. Mr. Verrier's response was: What?
You are not going to conduct an investigation? The answer is:
No, we just write it off like we have always done.
So the question is, you know, who was in charge and is that
person still in charge, because I don't think--you know, it is
not as if a system doesn't exist for inventory 10 years ago or
today or 10 years from now. An inventory is something every
agency does, every business does.
So who was in charge, Mr. McSwain?
Mr. McSwain. Well, we have had I think a fair amount of
turnover in that particular leadership position, but let me
just clarify. I believe it is important. I didn't mean to say
it was just a system problem. I think that you accurately
describe that it is a people problem, because it is the people
who in fact, as Senator Tester says, it is the people who are
the custodial folks. These are people that are custodial
people.
There are faces on the problem. There are faces on the fix.
The Chairman. And if they are writing it off without
investigating what happened to the property, would that violate
procedures at the Indian Health Service?
Mr. McSwain. It certainly will in the future.
The Chairman. Would it in the past?
Mr. McSwain. Well, in the past, if we couldn't find it,
then this is a reasonable means. One of the things that I--
excuse me, I am having a difficult time with Mr. Verrier's
comments on the side while I am trying to speak. Thank you.
The whole issue of having the trained personnel in the
positions has eroded over the years. That is something we have
to fix. I say eroded because----
The Chairman. What does that mean? I don't understand that
at all.
Mr. McSwain. We have property officers. We don't have full-
time property officers out there. We are moving, and a part of
this new system is actually identifying individuals. In fact,
we have increased the number of people who could be trained in
proper receipt of equipment, which means receiving and tagging
and inventorying equipment.
The other end of it is custodial personnel that are
trained. When I say there has been an erosion over time, it is
that we have had retirements, we have turnovers. We need to
strengthen our people system, if you will.
The Chairman. Yes, but you have always had people in place
to do these things, and somebody obviously hasn't been doing
it. And so it goes back to my question, is anybody held
accountable?
One of the things that you have said today, it appears to
me from the GAO report, some property has been stolen, some
property has been lost, some property has been misplaced. And
you are describing to us, well, maybe that is true, but they
are over-stating the value of what has been stolen, lost or
misplaced.
You know, the fact is, I think it is pretty irrelevant what
the value is. If you have people stealing property, you have
people losing property or misplacing property, it doesn't
matter to me so much what the value is. What matters to me is
the system is broken and you have people who are supposed to be
in charge that aren't doing the job.
I want to ask a question of Mr. Kutz. What was the date on
which you finished your GAO investigation? When it was
completed generally?
Mr. Kutz. This spring, and then what we did is send a
report to the agency and give them a chance to comment.
The Chairman. But you say this spring. Generally, when did
you send the report to the agency for comment?
Mr. Kutz. May.
The Chairman. In May. Now, it is the end of July. That is
60-plus days, I suppose. Any personnel changes in your system
of inventory, Mr. McSwain, down at the Indian Health Service? I
mean, any changes with respect to those that were alleged to
have fabricated? Those who were alleged to have obstructed?
Those that I assume had been in charge, but hadn't really been
in charge?
Mr. McSwain. I guess, let me just say that I am very
fortunate in the fact that we pulled a property officer back
into the position as acting, that knows the system. Our biggest
challenge now will be to fill that job permanently, the agency
property officer.
But no, there haven't been any real changes in the last 60
days. Other than that, there were some individuals who took
other jobs and left the agency, out of the property staff. But
aside from that, there haven't been any changes in personnel or
leadership. That is not saying there won't be.
The Chairman. Do you understand how that sounds to me, when
I have a report from the GAO, and by the way, I have worked
with the GAO for over 20 years. I have read a lot of GAO
reports. We rely on them. And they say that your agency, you
had people inside the agency that worked for you, and I am
talking about the headquarters now, who tried to obstruct their
investigation, some who tried to fabricate information.
And you say, well, we have not had any changes in
personnel, and we have the GAO saying you have some people down
there that have really crossed the line in a very serious way.
How do you reconcile that?
Mr. McSwain. The way I reconcile it, certainly, is given
the bright light that has been shined on our property
management system is to review it across the Country, beginning
with headquarters. We are doing that. We will be improving the
staffing, dedicating more staff to it. I think during this
process of the last few years, we moved the property function
from Albuquerque. It was out there for a number of years, in my
recollection. We moved it to Rockville. We haven't been able to
fully staff the property function in headquarters and are
continuing to do so.
It is my sincere hope that we will fill those positions
very soon, and have the people trained and accountable, and not
have the kinds of issues that surfaced during the
investigation.
The Chairman. But these aren't just issues. These are some
pretty fundamental things that the GAO has said. Frankly, I
think you are destined to fail unless you shake this up in a
significant way. I don't hear that here.
I tell you what, if I had to explain what the GAO has said
about an agency I am now in charge of, and I recognize you have
just assumed this role. You have been there for a long while,
but you just assumed the role of Director. I would be furious
sitting here reading that someone in my agency took actions
that the GAO interpreted to be fabrication or obstruction. I
would be furious. I tell you what, employee or not, they would
be working at a different place right now, 60 days later.
At any rate, here is what I am going to suggest; I am
almost at a loss to try to figure out what we do with some of
these agencies. You know, the Indian Health Service is
desperately short of money, under-funded. You have health care
rationing going on. We have massive bureaucracy. I went through
a clinic and they said, here is where our new X-ray machine is
going to be; we desperately need it; we are waiting for it. How
long have you been waiting? Well, it has been about 18 months
the requisition has been in, but it just needs a signature, but
it has been waiting 18 months for signature at the region.
You know, I hear that stuff all the time. I just think we
have such a serious problem. This GAO report is an
embarrassment to an agency that just has to be doing much
better work to try to address health care needs that cry out
for assistance among the Native American population.
I am going to ask on this subject, Mr. Kutz, whether the
GAO could in about 90 days go back in. That is about five or
six months after you have engaged with the Indian Health
Service, and provided a report to them, if in about 90 days you
would be willing to send somebody back in and give me an
assessment of what has been done in 90 days from this date, to
give us some assurance that things are happening there that
keep track of property, that we don't have future reports of
stolen property, lost property, misplaced property.
Are you able to give us some service to do a review in
about 90 days?
Mr. Kutz. Sure. As you mentioned, we work for you, so we
would be happy to work with you and your staff and Mr. McSwain,
looking forward.
The Chairman. We will be in touch. The staff of this
Committee will be in touch with you and Director McSwain. I
really hope that we could get a report. I am not asking for a
full audit. I am just asking for a consultation between you and
the Indian Health Service so you can give us an assessment of
what has happened since you submitted this information in May
to the Indian Health Service.
Senator Barrasso?
STATEMENT OF HON. JOHN BARRASSO,
U.S. SENATOR FROM WYOMING
Senator Barrasso. Thank you very much, Mr. Chairman. I ask
that my statement become part of the record.
But you are absolutely on point. Senator Tester used the
word unacceptable. You used the word we should be furious. To
me, this is offensive. We have the Wind River Reservation. We
have the Northern Arapaho, the Eastern Shoshone. I visited with
some tribal members yesterday, others when I was back in
Wyoming on Sunday. Health care is vital to these people, and we
need to make sure that the money, the investment that we as a
Nation are making is getting to the right place, getting to the
patients who are in need, and not being used this way.
I don't want to repeat some of the questions that may have
been asked before I got here.
Mr. Verrier, if I could, in your estimation, are these
findings of the GAO, are they in any way isolated instances? Or
is this really a systematic nationwide problem with the Indian
Health Service?
Mr. Verrier. I have worked for the Department of the Army,
Department of Defense, troop support agencies, National
Institutes for Health, and I have never experienced in my over
30 years of Federal Government service or 30 years in the
military, such blatant disregard for property accountability.
The problem, as I see it, is lack of holding people
accountable for the loss, lack of documentation having
individuals sign for equipment, and lack of annual follow-up of
inventory on the property.
Senator Barrasso. There was a little interchange earlier
where there was a question of is property carefully looked at,
and you were shaking your head no in the past. Do you want to
just expound on that a little bit?
Mr. Verrier. What can I say? You know, when equipment is
missing, the procedures that I experienced with the Property
Book Office was if you have a missing piece of equipment, they
write it off. Okay? They re-do the property book, okay? To me,
that is not the answer, okay? Somebody needs to do an
investigation and inquiry on what happened to the piece of
equipment, okay?
Senator Barrasso. Mr. McSwain, I understand you have only
been there two months in this position. But Congress is being
asked to provide a substantial funding increase for Indian
Health Services, an increase. And we all know that our
facilities are held together by, as they say in Wyoming, with
duct tape and baling wire.
If taxpayers are going to increase their investment in the
Indian Health Service, then you really do need to act
immediately to correct the problems, don't you agree, to regain
the public trust?
Mr. McSwain. Yes, Senator. It is our intention to certainly
begin acting. We have already begun to act on the
recommendations, and fully engage on all of the
recommendations, and we are moving ahead. I welcome the 90-day
visit.
Senator Barrasso. That was a question for Mr. Kutz. Any
other recommendations that you would have for us as members of
this Committee on ways that we can make sure that the public is
getting their money's worth, that the folks on the reservation
in Wyoming are getting the health care that they need with the
services going to them, and not this loss?
Mr. Kutz. Well, I think what Senator Dorgan said, not to
walk away from this until you are satisfied it has been
addressed. That is what oversight is all about. So we would
support your continued oversight of these matters.
Senator Barrasso. Thank you, Mr. Chairman.
[The prepared statement of Senator Barrasso follows:]
Prepared Statement of Hon. John Barrasso, U.S. Senator from Wyoming
Last month, the Government Accountability Office--commonly known as
the ``GAO''--released a shocking and disturbing report. The GAO
uncovered and substantiated claims that the Indian Health Service or
``IHS'' has grossly mismanaged government property and taxpayer
dollars. The GAO report identified over 5,000 lost or stolen items
worth about $15.8 million. These items include all-terrain vehicles,
tractors, Jaws of Life equipment, and--most egregious--computers
containing social security numbers. A physical inventory found an
additional 1,100 IT hardware items such as laptops and digital cameras
were also missing from IHS headquarters. These lost or stolen items
cost the taxpayers another $2 million.
If Congress is going to be asked to provide significant funding
increases for Indian health services, then the IHS must act immediately
to correct the problems identified by the GAO. Safeguards and
accountability measures need to be implemented so that these issues do
not re-occur. Fraud, abuse, and theft problems are not created by small
children. These issues are the responsibility of adults--and it is time
that the people who allowed this to occur start acting like adults and
put an end to it. Inaction only serves to condone this wasteful,
abusive, and even criminal behavior. The standard defense of ``this is
just how the federal government operates'' is not acceptable.
Many of our state's IHS facilities--particularly those in rural and
frontier areas--are literally held together with duct tape. This year,
the Senate worked in a bipartisan way to pass the Indian Health Care
Improvement Act. I included an amendment in that bill requiring the GAO
to report how various government and local programs coordinate health
care services in Indian Country. This comprehensive report is even more
important now that the GAO has uncovered systemic IHS mismanagement. If
we do not know: (1) where resources are being spent, (2) the number of
programs dedicated to provide various health care services, or (3) how
health care services are coordinated; then we are not maximizing our
ability to help Native Americans and Alaska Natives.
My amendment asks the GAO to focus its research efforts on programs
such as Medicare, Medicaid, the State Children's Health Insurance
Program (SCHIP), and the IHS. It also requires GAO to explain how these
federal programs interact with efforts by state, local, and Tribal
groups to deliver essential health care services. By pinpointing
service gaps and rooting out wasteful, abusive spending, then we can
develop reasonable, commonsense solutions that streamline and improve
Indian health care. It is essential our Committee have the information
it needs to evaluate the current delivery system--exposing barriers
that prevent collaboration, networking, innovation, and sharing of
resources. This way, we can target federal funds to programs making the
greatest impact--then focus on additional areas where Native American
and Alaska Natives need our support.
Mr. Chairman, the GAO is well known as ``the investigative arm of
Congress'' and the ``Congressional Watchdog''. GAO helps Congress
improve the federal government's performance and ensure programs meet
strict accountability standards--all for the benefit of the American
people. We rely on their expert, unbiased recommendations to make sound
policy decisions. This oversight shows us ways to make government more
efficient, effective, ethical, and equitable. It uncovers what is
working, what is not, and offers advice on how best to fix it. But,
most importantly, this oversight helps us plan for the future.
I do not believe anyone wants to play a game of ``gotcha'' with the
GAO's findings. Neither can we sit back, turn a blind eye, and accept
that this is ``business as usual''. The American Taxpayers deserve
better. Native Americans and Alaska Natives who depend on the IHS for
their medical care deserve better. I am going to continue to fight to
make sure individuals living on the Wind River Reservation, and all
Native People across America, have equal access to quality medical
care. But we cannot achieve this goal when the money we invest in IHS
programs is wasted and property worth millions goes missing.
Thank you for holding this hearing today, Mr. Chairman. I look
forward to hearing the panel's testimony.
The Chairman. Senator Barrasso, thank you very much.
Senator Barrasso brings to this Committee a unique
perspective as a physician. Dealing with Indian Health Care has
been frustrating because we know there has not been sufficient
funding, and we know that the management of the system has not
been good. We know contract health care money runs out. We have
a lot of problems.
Director McSwain, we rely on you to work with us. As
Senator Barrasso indicated, we have only just confirmed your
nomination, and yet you have inherited what I think is a mess.
We want you to succeed, but we have big problems, in my
judgment.
Mr. Kutz, thanks to the GAO. We appreciate your work. We
will look forward to having an additional report from you, and
we will have a hearing on that report.
Mr. Verrier, thank you. Those that are whistleblowers, I
believe you had whistleblower status at one point. I am not
certain of that, but they are pretty nettlesome to agencies.
Agencies don't like people who speak out when they see
wrongdoing. But it is critically important that those employees
that have the courage to speak out understand the value of
that. I personally thank you, Mr. Verrier, for coming here
today.
Director McSwain, you have a lot of work to do. We
appreciate your being here. I hope you will report directly to
the Secretary of HHS, who should have been here today, but we
will seek to get his comments at another time.
Mr. Kutz, thanks to you and the GAO for your work.
[Whereupon, at 11:07 a.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Dr. Steven J. Miller, Director, IHS National
Council of the Laborers International Union of North America
Chairman Dorgan and members of the Committee, I respectfully submit
this testimony in response to the July 31, 2008 hearing on the misuse
of property at the Indian Health Service (IHS).
First, LIUNA's IHS National Council (``the Council'') wants to
commend Chairman Dorgan for holding this important hearing and for
requesting the GAO investigation into the misuse of property at IHS.
LIUNA represents over 500,000 workers around the nation, including over
8,000 Indian Health Service workers in 23 states. Our members include
physicians, nurses, dental professionals, pharmacists, engineers, food
service, medical technicians, housekeeping, and maintenance workers. We
also represent workers in the property division at IHS. Most of our
members not only work at IHS, but also use IHS services as enrolled
tribal members.
The Council has two primary goals in submitting this testimony.
First, we unfortunately must concur with GAO's finding that there is
rampant mismanagement at IHS, and believe we must share our workers'
constant problems with management with the Committee. Hopefully we can
provide the Committee with information that will assist you in working
toward our shared goal of having a well-run agency that adequately
serves our Native American population--as employees and users of IHS
services. Second, the Council wants to ensure that the workers we
represent are treated fairly in the course of this ongoing GAO
investigation. We already have reason to believe that IHS violated
federal law by failing to inform the union when our bargaining unit
employees (BUEs) were questioned during the course of this
investigation. We now want to ensure that if any of our bargaining unit
employees are disciplined that they receive the due process to which
they are entitled under federal law and the union's contracts with IHS.
Misuse of Property Is Just One Example of the Pervasive Management
Problems at IHS
LIUNA and our BUEs face constant challenges dealing with IHS
management. This is not an isolated problem in one area or service
unit. It is pervasive and severe. The result is less money and staff
for this already resource challenged Agency to provide health care
related services to Native American people. Our BUEs are constantly
harassed, demeaned, discriminated against, and otherwise mistreated by
IHS management. In a given year, LIUNA files upwards of 75 grievances,
and dozens of unfair labor practice charges against the agency. These
grievances range from wrongful discipline to management unilaterally
(and illegally) making changes in working conditions to sexual
harassment. This year, LIUNA filed a group grievance against IHS on
behalf of our BUEs for wanton and widespread Fair Labor Standards Act
overtime violations based on numerous reports that our workers were
being forced to work overtime without compensation and were improperly
classified so the agency would not have to pay them the overtime they
were owed under federal law.
I.H.S. is notorious for the misapplication of personnel practices
and policies and regulatory requirements that cost employees millions
of dollars over time such as the failure to address compensation for
standby status and failure to pay appropriate uniform allowances. Then
to add insult to injury, the delay in dealing with the problems causes
additional costs and resources. In 2002, the Union prevailed on a back
standby pay claim and the interest was in many cases equal or greater
than the back pay due.
Instead of following the law and the labor-management contract, IHS
will attempt to terminate, demote, or otherwise discipline workers who
attempt to exercise their rights at work, or who report wrongdoing at
the agency. The agency also has a widespread practice of ``shuffling
around'' supervisors who are found to have violated the law or our
contracts instead of terminating or disciplining them. This is an
unacceptable double-standard. This mistreatment of our BUEs not only is
unfair to them, but is yet another example of the widespread management
problems at IHS. These practices have created a culture of fear amongst
the IHS workforce that impairs our BUEs' ability to do their jobs.
The union's legal and contractual rights are also often ignored by
IHS. The Union has been forced off of IHS property twice in the past
year when we were exercising our legal right to organize and otherwise
assist our BUEs. And during the course of this GAO investigation into
the misuse of property, IHS failed to notify the union that our BUEs
were being questioned. This is a violation of federal law (see, 5 USC
7114(a)(2)(A)) and yet another example of management problems at IHS.
All of these issues greatly harm morale at the agency, and show
that IHS has little respect for the law, its employees, the unions
representing its workers, and the clients IHS serves. LIUNA's goal in
raising these serious issues is to hopefully shed some light on other
pervasive management problems at IHS--labor-management relations and
mistreatment of IHS employees--in order to work with the Committee, and
IHS, to remedy them.
LIUNA Wants to Ensure That the Appropriate IHS Employees Are Held
Accountable for the Property Issues at IHS
LIUNA shares the Committee's goal of holding accountable those
responsible for misuse of property at IHS. However, we also want to
ensure that the appropriate individuals are held accountable. We
believe those are the managers who make IHS policy and direct our BUEs
to follow it, not the BUEs who must follow those orders.
LIUNA is concerned that IHS management may try to ``scapegoat'' our
BUEs by unfairly blaming them for the misuse of property issues at the
agency. Managers and supervisors make decisions about property policies
at IHS. BUEs, by statutory definition, cannot make these types of
policy decisions and still be represented by the union.
If IHS managers directed or encouraged our BUEs to violate federal
law or IHS policies regarding the use of property, those managers
should be the ones held accountable, not the workers who were merely
carrying out orders. IHS managers have great power over their
employees, and employees can and do face discipline for refusing orders
from management. Workers at IHS are thus faced with the terrible choice
of standing up and refusing to violate the law or IHS policy, knowing
that many other IHS workers have lost their jobs for refusing such
orders from their boss, or following a manager's misguided orders in
order to protect themselves against being terminated or otherwise
disciplined.
If any BUEs are found to have willfully and knowingly broken the
law, LIUNA wants to ensure that they are held accountable. But if IHS,
or Congress, attempts to discipline our BUEs regarding the misuse of
property issues discovered and alleged by GAO, proper procedures must
be followed and workers' rights must be protected (such as the right to
have a union representative present during questioning, a worker's
right to present evidence in his/her defense, etc.). This right to due
process is granted to the worker under both federal law and the union's
contract with the agency. The right to due process separates those
workers who are represented by a union from those who are ``at-will,''
or lacking union representation. Unlike BUEs, ``at-will'' employees
have no statutory right to defend themselves when charged with
wrongdoing. The right to due process does not mean that the worker
cannot ultimately be disciplined; it simply means that the agency or
Congress must follow certain procedures to ensure fairness and
impartiality during the course of its investigation and any subsequent
disciplinary process.
Conclusion
LIUNA is very concerned about the allegations raised in the GAO
report, ``Indian Health Service--IHS Mismanagement Led to Millions of
Dollars in Lost or Stolen Property,'' and those raised at the July 31
hearing in your Committee. Our workers have dedicated themselves to
improving the lives of Native Americans by ensuring they have access to
adequate health care services. This mismanagement by IHS takes
essential funds away from patient care and other needed services at the
agency, makes it harder for our workers to do their jobs, and harms the
agency's reputation. The mismanagement, however, is not limited to
misuse of property.
Our BUEs face discipline, harassment, and other types of
mistreatment every day from IHS managers. The culture at IHS is one of
acceptance of this mismanagement and mistreatment of our workers, and
this is simply unacceptable. LIUNA hopes that the Committee will
continue to work to fix these rampant mismanagement problems at the
agency so that our workers can do their jobs in a supportive, rather
than a hostile, work environment. LIUNA further requests that our BUEs
are treated fairly during the course of the ongoing GAO investigation,
and not scapegoated by the managers who actually made the decisions
resulting in lost and stolen property at IHS. We look forward to
working with the Committee as you continue your work in this area.
______
Prepared Statement of Isabelle Florence Youpee, Member, Fort Peck Sioux
Tribe
Dear Chairman Dorgan and Distinguished Committee Members:
Thank you for allowing me to address this Committee.
My name is Isabelle Florence Youpee. I am 61 years old and enrolled
in the Fort Peck Sioux Tribe in Poplar, MT. I have worked in various
capacities at various Indian Health Service facilities throughout more
than 20 years of my lifetime. Most recently, from 1996 until May, 2008,
I was employed as HIPAA Compliance Officer/Computer Technician at the
Spotted Bull Treatment Center in Poplar, MT, which is an alcohol/
chemical dependency treatment center for treating residential aftercare
adolescent clients and outpatient adult clients. It is fully federally
funded through a 638 grant to the Fort Peck Tribes.
Though there are several incidents I could relate regarding this
subject, for this testimony, I wish to report on only some most recent.
I feel, in doing so, it may help shed light on ways which may help to
correct the problems resulting from IHS mismanagement.
For the past several years at Spotted Bull Treatment Center, there
has been gross mismanagement through political interference of Tribal
Council members appointing unqualified personnel to run the treatment
center. An incident stemming directly from this occurred in September
2006 when, in my capacity as HIPAA Compliance Officer/Computer
Technician, I discovered that several computers had been given away to
employees and the public without proper authorization, without proper
processing, and without the necessary cleaning and reformatting of the
hard drives. As a result, sensitive client information on those
computers was released and accessible to whomever received the
computers. This client information was completely accessible because it
was in no way coded or protected. This occurred because the Tribal
Council had appointed a Director with no knowledge whatsoever regarding
the laws, rules and regulations governing chemical dependency programs.
When I reported this information to the Billings Area Alcohol
Coordinator, Dr. Kathy Masis, she agreed that this should not have
happened but she was not concerned about it, not did she seem concerned
about the HIPAA/Privacy violations resulting from the incident. When I
requested she do an investigation, I was told, ``it's up to the
Tribes.'' Dr. Masis was satisfied to let this incident pass without any
accountability or oversight. It appeared to me that she didn't want to
ruffle any tribal feathers should she have investigated the matter and
found the Tribes at fault for hiring an unqualified Director.
Another incident occurred because the Tribal Council appointed
another unqualified Director in November, 2006. In January, 2007, this
new Director appointed a Safety Officer who was in violation of the
Indian Child Protection and Family Violence Prevention Act with regard
to background checks. When I raised the concern, by memo, with the new
Director, I was rebuffed because she was not even aware of this Federal
law and did not seem to care because this employee was a friend of
hers. In early February 2007, I took my concerns to the next higher
authority by letter to the Tribal Chairman who did not recognize the
importance of the matter and did not take any action. I then telephoned
our Contracting Specialist at the BAO IHS, Robert Wallette who did not
take any action but referred me to the higher-ups in IHS. In mid-
February 2007, I wrote to the OIG for DHHS seeking help and asking that
my correspondence be forwarded to the proper authority if necessary. On
April 3, 2007, the IHS Program Integrity and Ethics Director sent a
memo to the Billings Area IHS Director requesting a Fact-Finding
Review. It was not until July 5, 2007 that the BAO IHS Director finally
issued a Report of Findings which upheld my argument, but by then the
Tribal Chairman had been pressured by one of his political supporters
to take the corrective action. To this day, I don't believe the
Chairman took this action because of the legal necessity because I
don't believe he understood the risk to our adolescent residential
clients explained through this law; I believe he took the action
because of the political pressure he received. I say this because he
did not take any action until he heard from his political supporter,
even though he had received my letter several weeks earlier.
In relating these incidents to you, it is not my intention to
demean tribal leaders; my intention is to show that there is a severe
lack of understanding and knowledge of the laws, rules and regulations
by tribal councils when it involves managing any federally-funded
program. There is also, as I've described, a lack of engagement and
concern on the part of our immediate IHS administrators when such
violations are reported. There must be a way to insure that those
wishing to contract or manage these programs have the basic knowledge
to do so; and if it takes mandatory training and testing BEFORE taking
over a program, then so be it. There is no excuse for allowing IHS
programs to operate willy-nilly with no regard for the laws, rules and
regulations under which they are supposed to operate.
At Fort Peck, we do not have at present nor have we in the past 20+
years, anyone on our tribal council who has knowledge of how these
facilities must be operated with respect to laws, rules and
regulations. This ignorance has led to IHS management's ability to do
whatever they want, including completely ignoring their oversight
responsibilities. It seems the Area office personnel who are directly
responsible for oversight have bent over backwards to please the tribal
council by adopting the attitude that ``anything goes,'' and ``whatever
the tribe wants.'' I feel the Area and Service Unit personnel actually
depend on Congress to ignore the problems so IHS can continue operating
the way they do.
In conclusion, we will never have the accountability we need to
make IHS work the way it is supposed to until these real problems are
rooted from the system. It is never right to allow tribes to play
politics with the federally funded programs they contract, and allow
IHS personnel at all levels to ignore their oversight responsibilities
with no consequences. I am not of the opinion that IHS needs to have an
influx of additional funding , as recent findings show that there is a
great deal of waste at the administrative level, however, I do feel
that we need more funding allocated specifically for medical services.
IHS needs to be restructured, with special attention paid to overhead
and bureaucratic costs, especially the high salaries paid to Area
Office and Service Unit administrators who cannot or will not do their
jobs. Throughout the years, the Service Unit Director has never taken
responsibility for oversight in these matters; it's as though that
level of recourse does not exist in the procedural chain. To address
these issues, the structure and administration of IHS need to be
reviewed immediately and a straightforward procedure for reporting and
correcting such things in the future must be established, widely
disseminated, and promoted; employees need to know that it is not only
permissible but expected that they report such mismanagement.
Thank you for allowing me this opportunity.
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