HEARING ON H.R. 3876, H.R. 4792, AND H.R. 4625 WEDNESDAY, MARCH 7, 1984 HOUSE OF REPRESENTATIVES, Washington, D.C. The subcommittee met, pursuant to notice, at 9:07 a.m., in room 334, Cannon House Office Building, Hon. Bob Edgar (chairman of the subcommittee) presiding. Present: Representatives Edgar, Mica, Evans, Kaptur, Staggers, Rowland, Slattery, Hammerschmidt, Hillis, Solomon, McEwen, and Johnson. OPENING STATEMENT OF CHAIRMAN EDGAR Mr. EDGAR. Good morning, the Subcommittee on Hospitals and Health Care will come to order. This is our first legislative hearing for the second session of the 98th Congress. Last year we held oversight hearings into the quality and quantity of health care delivered by the Veterans' Administration in the six medical regions which make up the VA's health care system. During those hearings, we became aware of many outstanding medical services which are being provided to our Nation's veterans. We also learned of several problems which inhibit the VA's health care professionals in providing the quality as well as the quantity of medical treatment and care that was intended by the Congress. Most of the remedies to correct these problems include additional funding. Hopefully, some additional funds will be made available during the full committee's markup of our recommendations for fiscal year 1985's budget to the Committee on the Budget tomor row. Some of the problems can be resolved by enacting legislation to amend current law and practices. Today we will receive testimony on four bills, three of which I introduced and one which I cosponsored with my good friend and colleague, the Hon. Dan Mica of Florida. Two of the measures we are considering today, H.R. 3876 and H.R. 4792, will have a far-reaching impact if enacted. H.R. 3876 will authorize the VA to provide drugs and medicines prescribed by a private physician to veterans for the treatment of their compensable service-connected disabilities. Up until last summer, the VA provided this service. Then, the VA General Counsel rendered an (1) opinion that it was not in accordance with law. For many years, we had a situation where eligible veterans elected to receive treatment at their own expense and the VA provided drugs and medicine. In a way, this choice saved the VA money by avoiding the cost of treatment. Since the general counsel issued his opinion, an eligible serviceconnected disabled veteran who desires to continue receiving drugs and medicines to which the law says he is entitled has to receive his medical treatment from VA doctors. The net effect is one of increasing the demand for VA treatment and care when the VA is unable to meet the current demand. We believe our bill will save money in the long run. We will also hear testimony on H.R. 4792, which is cosponsored by the chairman of the full committee. This is the third hearing the subcommittee has held on the topic of security at VA medical center's since 1981. Quite frankly, we are puzzled at why the VA has been unable to convince the Office of Personnel Management that there is a need to change the way VA police officers are paid. H.R. 4792 requires the Administrator to come up with a plan for implementing within 90 days after the date of enactment. There is a need for reform here and we have given the internal administrative process a chance to remedy the situation and it hasn't worked. So I believe that Congress must act to insure the safety of medical center visitors and employees. The other two measures we are considering today are H.R. 4694 and H.R. 4625. H.R. 4694 would allow certain retired military physicians to work for the Veterans' Administration without waiving their earned retirement pay. Authority similar to this was contained in the Civil Service Reform Act of 1978. H.R. 4694 would merely continue that authority which expired earlier this year. H.R. 4625 is a measure recommended by the GAO to cover a situation where Congress enacts an appropriation measure more than 45 days prior to the beginning of the fiscal year. Present law did not envision the efficiency which marked the action on the VA's 1984 Appropriation Act, so that GAO was in a position of having to report on something that had not occurred. H.R. 4625 is a technical amendment which will allow the necessary time for OMB to provide the VA with the funds appropriated to employ the number of persons specified in an appropriations act and for GAO to certify that this has taken place. I would now like to recognize the ranking minority member of the subcommittee, Hon. John Paul Hammerschmidt. STATEMENT OF HON. JOHN PAUL HAMMERSCHMIDT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARKANSAS Mr. HAMMERSCHMIDT. Thank you, Mr. Chairman. As you have observed in your opening statement, in our travels around the country visiting and observing Veterans' Administration medical centers, we have often been told of the security problems that exist in many metropolitan hospitals. Low morale, high turnover, employee dissatisfaction, patient concern and difficulty in recruitment are commonplace in a number of VA hospitals in metropolitan areas. This has caused the attendant problems of training new employees and the high costs associated with that training. Under these circumstances, Mr. Chairman, I think the hearing today on this subject is very timely and I congratulate you for scheduling it. Mr. Chairman, I might add that this problem of security is not with the VA alone. It also exists in other big city hospitals. However, it has been my feeling that VA security employees' pay and other benefits in these areas often lags considerably behind those of other medical facilities. Mr. Chairman, the Office of Personnel Management has been studying this matter for a long time. However, I understand that that effort has now been suspended. It is my view that congressional action may well be needed and, to that end, I will join with you in seeking a legislative remedy to this very complex problem. Briefly on another matter, Mr. Chairman, service-connected veterans have always been those with the highest priority in the Congress. The problem of a lack of legal authorization for VA to fill prescriptions for such veterans when those prescriptions have been written by a non-VA doctor was recently brought to light. These veterans already pay for their treatment by private physicians. They do this for several reasons, including wanting their own family doctor for personal convenience, preference for nighttime or weekend treatment, and sometimes because of travel distances to VA facilities. I would hope that we can explore this problem and, if appropriate, find a legislative way to have the VA fill the prescriptions of these private doctors as it did before the legal issue arose. I would also expect that if we legislate in this area that the VA would establish necessary controls, including periodic reviews of each case to assure that abuses do not take place. Mr. Chairman, as you have said, the other two matters before us are also important. I look forward to working with you with respect to them. Thank you, Mr. Chairman. Mr. EDGAR. Thank you. I would now like to call on my colleague, Dan Mica, for an opening statement. OPENING STATEMENT OF HON. DAN MICA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA Mr. MICA. Mr. Chairman, I will not take too much time of the committee, but I would like to talk about the legislation that has just been mentioned, H.R. 3876. I simply would like to point out that I think the VA, in opposing this, may not be taking into account the effects of what the present situation is. We have veterans who are willing to pay money out of their own pocket, large numbers of veterans, to go to a doctor to receive a prescription to try to, in effect, meet their own needs and, hopefully, save a little money for the Veterans' Administration and then be told that they can't take it to the VA pharmacy to have that filled. What we are doing-and this may be the only case in the years that I have been on the Veterans' Committee-is actually encouraging utilization of VA physicians. I would like to be corrected by any member of the committee if I am wrong on this, but probably the single highest cost for any personnel in the VA system is for physicians. We are encouraging the use of VA physicians by veterans who, of their own will, use a private physician and pay that fee. Not only do I think that that is inappropriate with an already overburdened system, but it's almost disastrous in a situation such as we have in growth States like Florida, where we have such tremendous growth, and, of course, California, Texas, and many of the States where the services and facilities are pressed to the maximum. So, when they say that it would cost $7 million for drugs, I don't think there is any correlation to the cost to the VA and the impact on services when you tell a veteran, "You must come in and see a VA doctor in order to get this prescription," when, in effect, he would just as soon pay out of his own pocket to his own doctor, get the prescription and bring it in and have it filled by the VA. The bill has 65 cosponsors. The subcommittee chairman here is cosponsoring it and I think almost every member of the committee who has been presented with an opportunity, and they all will be, has signed on. The chairman of the committee has signed on. There is virtually no opposition anywhere in the country among any veterans organization, anyplace except within the VA. I would ask, with due respect, because I think you understand that we have tried to work together on these things, that you reassess your position on this, that, in fact, if you think about the time it takes from physicians to see these; it may well equal out to a savings, not a cost of $7 million. We can't calculate it here at the committee, but you may be able to calculate it and it could be very helpful for all of us, not to mention, the service it would provide the veterans. So I would appreciate your reconsideration. I can almost guarantee that this committee will virtually unanimously approve this legislation at the subcommittee level, at the full committee level, and I see no opposition on the floor of the House. So if the VA could, in its wisdom, and in light of reality, think a little bit more about the approach on this, it would be most helpful to us. Finally, I would like to note that I have just been informed here by staff this morning that up at the Bethesda Naval Pharmacy, that Defense Department pharmacies will fill prescriptions written by private physicians for certain CHAMPUS patients. So, if indeed this is already being done to some degree, whatever degree, it's obviously a precedent, it obviously was done before and we are responding to a concern that, I think, has been expressed not just in Florida, which incidentally is severely impacted, as you know, but a concern that has been expressed nationwide. I will take no more time. I thank you very much, Mr. Chairman. I appreciate the committee's time. Mr. EDGAR. Thank you. I might mention just for the record that I have requested of the chairman of the full committee to include in the budget submission tomorrow funds that would be equal to covering the cost of this legislation so that I hope all of you will come tomorrow and look at that budget carefully. There were additional commitments made over and above what the President was looking for and over and above what the VA had been able to ask for. In our particular area, I think we raised the funds about $28 million. I would like to have each of you take a look at those increases. They are not stuffing the budget with funds, they are streamlined requests that grew out of our visits across the country, including the concern that you have raised. Are there other opening statements? [No response.] Mr. EDGAR. I would like to call as our first witness, Dr. Custis. I wanted to indicate to him that we called him today because we wanted him to know that we weren't giving him up for Lent [laughter] and we would like him to come to the witness table at this time. Dr. Custis, welcome to our hearing this morning. As soon as you get settled there, it would be helpful if you could introduce all of the people at the table with you and identify them for the record. I would also like to indicate that the full text of your statement and that of anyone else in the panel, will be made a part of the full record.1 We ask you to proceed as you wish. Dr. Custis. STATEMENT OF DR. DONALD L. CUSTIS, CHIEF MEDICAL DIRECTOR, VETERANS' ADMINISTRATION, ACCOMPANIED BY MARJORIE R. QUANDT, ASSISTANT CHIEF MEDICAL DIRECTOR, OFFICE OF ADMINISTRATION; JAMES G. FASONE, DIRECTOR, SECURITY SERVICE; THOMAS PRICE, MANAGEMENT OPERATIONS STAFF CHIEF, MANAGEMENT SUPPORT OFFICE; AND JOHN MURPHY, GENERAL COUNSEL, VETERANS' ADMINISTRATION Dr. CUSTIS. Thank you, Mr. Chairman. It's a pleasure to be here again. With me at the table are Mr. Jack Price for the purpose of addressing physicians' pay and personnel issues in our security force; Ms. Marjorie Quandt, Jim Fasone, the Director of our Security Service; and Mr. John Murphy, our General Counsel. We appreciate, Mr. Chairman, the opportunity to appear before the subcommittee this morning to offer our views on the four bills pending before the subcommittee. H.R. 3876 would authorize the VA to provide drugs to service-connected veterans who are not using our fee program and who choose not to obtain their health care from the VA hospital. We are currently authorized to provide drugs and medicines prescribed by private and non-VA physicians to veterans who are receiving increased compensation or pension, because they are permanently housebound or in need of regular aid and attendance. This authority was intended to alleviate the severe inconvenience that would be imposed on such veterans, if they were required to travel to the VA facility to receive services. At the time that this authority was enacted, many nonservice-connected veterans could not obtain VA health care services because of their disability. H.R. 3876 would expand both the scope and the intent of this authority to allow the VA to provide such privately prescribed drugs and medicines to veterans for treatment of compensably rated service-connected disabilities. We cannot support enactment of H.R. 3876. 1 See pp. 69 and 72. |