Mr. Chairman, we at the VA attempt to provide veterans, particularly service-connected veterans, with complete hospital and medical services. This proposal would encourage some veterans who do not choose to avail themselves of VA medical care to use the VA solely as a pharmacy. If VA is required to fill privately written prescriptions for all veterans for compensably rated service-connected disabilities, it would seem logical to also provide those veterans with other services ordered by private physicians, such as X-rays, laboratory studies and other diagnostic tests. We feel that establishing a VA role as a mere provider of ancillary medical services would be a fundamental and unwarranted departure from the longstanding, congressionally mandated principle that VA should provide eligible veterans with all necessary care and treatment. Mr. Chairman, this proposal is suggestive of the concept whereby the VA would be relegated to a role of merely financing the provisions of health care as opposed to being a direct provider of services. Finally, Mr. Chairman, if this proposal is enacted, it will be necessary for VA to verify that prescriptions submitted to VA for filling are actually written for treatment of service-connected disabilities. This will complicate administration of the pharmacy program and will require greater resources than are now necessary. Parenthetically, Mr. Chairman, I think this situation is not to be compared to that under CHAMPUS, whereby the military provides drugs prescribed by doctors authorized in CHAMPUS. As a matter of fact, we have the same provision in the VA's CHAMPVA program. Like fee-basis care also our CHAMPVA program covers the cost of prescriptions. That is not what we are talking about in this proposal. Mr. Chairman, H.R. 4694 would give VA authority to grant waivers to the mandatory reductions in retired or retainer pay of certain retired military officers recruited by the VA as doctors of medicine or osteopathy. The title V authority to grant such waivers expired this January. We strongly support the enactment of this bill with modifications suggested in my formal statement. Currently the retired and retainer pay of most retired military officers recruited to work for the VA is subject to reduction in accord with title V, United States Code. These mandatory reductions attaching to Federal employment make employment in the private sector where no reduction in retired or retainer pay occurs much more attractive and impairs our ability to recruit physicians in selected specialties or in remote geographic locations. Before the expiration of the authority in January of this year, the VA granted exceptions for just 26 appointments to key positions involving critical mission requirements. Under these delegations exceptions were only approved when the appointee was in a scarce medical specialty, was being considered for a senior management position, or when there was a severe recruitment retention problem in filling a particular position. If this legislation is approved, we will continue to prudently use this waiver authority. Mr. Chairman, H.R. 4792 proposes to amend section 218 of title 38 to strengthen security operations in the Department of Medicine and Surgery. We are in strong agreement with the intent of this bill and favor its major provisions. My formal testimony addresses each provision of the bill so I will not repeat a full analysis. At your request, we have with us Mr. Jim Fasone, Director of the Security Service as well as our four regional security officers. Mr. Fasone will testify to the concerns that he has for maintaining adequate security of our VA medical facilities, property and personnel and will introduce the regional security officers. For some years, we have been concerned that in some locations we are not able to retain a highly qualified police force. The principal problem in the recruitment and retention of highly qualified personnel is our inability to pay competitive rates, particularly in certain geographic areas. This is evidenced by relatively high police officer turnover rates in these areas. The bill proposes to resolve the problem by requiring the Administrator to issue standards for classifying and grading VA police officers and authorizing the Administrator to increase rates of basic pay authorized for persons in such grades and classes. We do not believe it is necessary or appropriate to remove VA police officers from the title V grading and classification system. The problem is money, and although it is a widespread problem, it is not universal. We need a more flexible remedy to focus our attention on the pay disadvantage that exists in certain markets. I would recommend expanding the authority of section 4107(g) of title 38 that is already in place for recruiting and retaining title V health care personnel. Mr. Chairman, H.R. 4625 makes a technical amendment to existing law regarding the date by which the GAO must submit a report concerning VA personnel ceilings to the appropriate committees of the Congress. Enactment of the bill would have no impact on the VA and we, therefore, defer to the views of the GAO on the bill. Mr. Chairman, this concludes my statement. We will be pleased to answer any questions you or the members of the subcommittee might have. Mr. EDGAR. Thank you, Dr. Custis. Mr. Fasone, do you have a statement that you would like to provide for the record? Mr. FASONE. Yes, Mr. Chairman. Mr. EDGAR. You may proceed at this time. STATEMENT OF JAMES G. FASONE, DEPARTMENT OF MEDICINE AND SURGERY, VETERANS' ADMINISTRATION Mr. FASONE. Mr. Chairman and members of the subcommittee, I appreciate this opportunity to testify before the subcommittee regarding the Department of Medicine and Surgery Security and Law Enforcement Program. At your request, our four regional security officers are here today and I would like to introduce them. To my right rear is Mr. Paul Gately, of Boston. To my left here is Mr. Enos from California, Mr. Furr of Little Rock, Ark., and Mr. Cappello out of Indiana. Before I begin, sir, I would like to reiterate what is contained in Dr. Custis' testimony concerning the fact that the entire issue of training police officers using firearms in the conduct of Government law enforcement efforts, in general, is an important issue which must be coordinated throughout the Federal Government. In view of this new Federal initiative to improve the regulation of firearm authorization and training, I would like to briefly digress from my prepared statement to bring to the committee's attention a unique achievement of our security and law enforcement program relating to the subject of firearms and weapons in our health care environment. Despite authority to issue firearms to our police officers granted in legislation in 1973, only five special investigators are authorized to bear firearms while on assignments anticipated to involve serious criminal danger. Otherwise, we have reserved this authority for use during national emergencies, when the nature of the threat to our medical centers and our vulnerabilities can suddenly change. In place of firearms, we have adopted the nonlethal and noninjurious chemical mace projector weapon, with a measure of success I can only describe as extraordinary. In the 11 years since its adoption and our strict adherence to a clear and simple training requirement to fair rules of engagement, and to a prompt reporting requirement following each weapon use, this weapon has been employed in 965 serious, life-threatening situations in our medical centers. The analysis of each firing report received reflects that circumstances existed in one-third of these 965 incidents which would have clearly justified the use of firearms by universal police firearm standards. However, lacking firearms, the VA police officers involved successfully overcame offenders brandishing knives, guns, and other weapons, with their nonlethal, but incapacitating weapons and the killing action of firearms was averted. I think it is highly significant that as many as 300 lives were perhaps spared by our weapon policy. I bring this achievement by our medical center police officers to the committee's attention so that it may appear in the record as a tribute to the courage of our police officers, of which we are very proud and thankful. Our medical centers in many areas of the country continue to experience a high degree of difficulty in the recruitment and retention of well-qualified police officers. We have a total of 1,975 police officer positions at 172 medical centers. For fiscal year 1979 to the present, over 3,100 officers have joined and then left the security service. This turbulence causes undeniably lowered efficiency, wasted training, periods of vulnerability, and additional administrative costs. Although there are many reasons why employees leave their jobs, it is our view that a major factor has been the difficulty we have had in centers located in areas in competition with private and governmental police agencies, in surrounding communities, for officers who are able to meet our standards of performance. Entry level salaries for untrained police and deputy sheriff recruits offered by 142 nationwide agencies serving communities with populations of under 10,000 persons, provide a clear insight into our compensation problem. The average annual wage offered to untrained recruits by these small communities is $14,368. In contrast, the VA is normally limited to an entry level of $12,367 in recruiting police officers with 2 years' prior police experience or substitute education at the college level. A copy of the survey reporting these figures is submitted for possible inclusion in the record. [Subsequently, the Veterans' Administration furnished the following information:] Excerpts of the Fraternal Order of Police publication, "A Survey of 1983 Salaries and Working Conditions of the Police Departments in the United States," March 15, 1983, pages 46, 48, 50, 52 and 54. These excerpted pages describe minimum patrolman salary and working conditions of police departments serving populations under 10,000. This material follows: |