Mr. Chairman, I want to thank you for the Subcommittee’s consideration of legislation that Representatives Mitchell, Shimkus, Whitfield and I have introduced to implement reliable controls within the Veterans Health Administration (VHA) to ensure that VA physicians are sufficiently qualified.  H.R.4463, the Veterans Health Care Quality Improvement Act, would make needed reforms to current VA policies that pertain to health care quality assurance measures.  This legislation is the necessary result of unfortunate events that occurred at the Marion Veteran’s Administration Medical Center (VAMC) in my Congressional district.  Investigations performed by the VA Inspector General’s office and the Office of the Medical Inspector discovered faulty leadership at the Medical Center and significant institutional problems which directly resulted in the tragic deaths of at least nine individuals in the past two years and in significant health problems for numerous others.  While the Marion VAMC continues to be reformed and reviewed, it is unlikely that Marion VAMC is the only facility where such problems have occurred.  Healthcare quality assurance procedures across the board must be improved to ensure that this does not happen to any veteran again. 

Our legislation does several things to improve the quality of care at Veterans’ hospitals.  H.R. 4463 would mandate a more thorough and standardized process for reviewing physician qualifications.  Prospective and current physicians would have to provide a complete history of any lawsuits, civil action, or other claim that was taken against them, a complete disclosure of the history of their license to practice in each state, and the status of licenses.  Regional Directors of Veterans Integrated Services Networks (VISN) would have responsibility of investigating these records and deciding if it would disqualify a candidate from becoming a VA physician.  Having physicians give a full account of their professional history will ensure that those treating our veterans are fully qualified.

To oversee this program, the bill requires the Undersecretary of Health to appoint a National Quality Assurance Officer.  One of the most significant problems that contributed to the incidents at the Marion VAMC was that quality management responsibilities were divided among multiple groups at the facility and, in some cases, there was no oversight provided.  The National Quality Assurance Officer will be responsible for full oversight of quality assurance programs within the VA.  The National Quality Assurance Officer will also be responsible for policies regarding peer review, confidential reporting by VA personnel, and the accountability of medical facility leadership.

In addition, the bill would require the appointment of a quality assurance officer for each VISN to be responsible for the Network and a quality assurance officer to be responsible for each medical facility.  These individuals would have responsibility for coordinating, monitoring, and overseeing the quality assurance programs for their designated areas.  Instituting clear accountability for quality management responsibilities will be an important reform to current VHA practice.

This legislation also addresses the need for recruiting and retaining highly qualified physicians to Veteran health care facilities.  Certain areas of the country, such as our rural areas, have difficulty in attracting skilled physicians.  The bill includes provisions establishing a loan repayment program for qualified physicians in exchange for three years of service in hard to fill positions, as well as a health benefit program for part time physicians.

Finally, the bill requires the Secretary of the VA to conduct a comprehensive review of current policies pertaining to health care quality and patient safety at VA medical facilities.  At the conclusion of their investigations into the events at the Marion VAMC, the Office of Inspector General and the VHA’s Office of the Medical Inspector made proposals addressing institutional weaknesses pertaining to quality management.  They are a useful starting point and it is good the VA has begun implementing some of them.  For instance, the VHA is currently establishing criteria to define which surgery procedures can be performed at each medical facility.  However, more can and should be done.  That is why I am glad the Committee is reviewing HR 4463 so that we can bring it to the House floor for consideration.  The Veterans Health Care Quality Improvement Act addresses the fundamental problem of a lack of standardized methods for determining quality assurance while designating officials within the VA to be responsible for this oversight. 

Mr. Chairman, it is not enough that we only provide the resources for veterans’ health care.  We must be equally committed to providing that care in a responsible, professional manner.  We owe these reforms to the veterans who trust us to provide them with the quality care they have earned.  Mr. Chairman, thank you for continuing to hold hearings on this important issue and legislation.