Mr. Chairman and Members of the Subcommittee:

Thank you for inviting the Disabled American Veterans (DAV) to submit testimony at this hearing, and for the opportunity to present the views of our organization on the health care legislation pending before the Subcommittee today. DAV is an organization of 1.3 million service-disabled veterans and devotes its energies to rebuilding the lives of disabled veterans and their families.

The measures before the Subcommittee today cover a range of issues important to DAV, to veterans and to their families. This testimony includes a synopsis of each of the bills being considered, along with DAV’s position or other commentary on them. Our comments are expressed in numerical sequence of the bills.

H.R. 4089—To amend title 38, United States Code, to improve the collective bargaining rights and procedures for review of adverse actions of certain employees of the Department of Veterans Affairs

DAV does not have an approved resolution from our membership on this specific VA labor-management dispute that prompted the introduction of this bill. However, we believe labor organizations that represent employees in recognized bargaining units within the VA health care and benefits systems have an innate right to information and reasonable participation that result in making VA a workplace of choice, and particularly to fully represent VA employees on issues impacting working conditions and ultimately patient care.

Congress passed section 7422 of title 38, United States Code in 1991, in order to grant specific bargaining rights to labor in VA professional units, and to promote effective interactions and negotiation between VA management and its labor force representatives concerned about the status and working conditions of VA physicians, nurses and other direct caregivers appointed under title 38, United States Code. In providing this authority, Congress granted to VA employees and their recognized representatives a right that already existed for all other federal employees appointed under title 5, United States Code. Nevertheless, federal labor organizations have reported that VA has severely restricted the recognized federal bargaining unit representatives from participating in, or even being informed about, human resources decisions and policies that directly impact conditions of employment of the VA professional staffs within these bargaining units. We are advised by labor organizations that when management actions are challenged VA officials (many at the local level) have used subsections (b), (c) and (d) of section 7422 as a statutory shield to obstruct any labor involvement to correct or ameliorate the negative impact of VA’s management decisions, even when management is allegedly not complying with clear statutory mandates (e.g., locality pay surveys and alternative work schedules for nurses, physician market pay compensation panels, etc.).

Facing VA’s refusal to bargain, the only recourse available to labor organizations is to seek redress in the federal court system. However, recent case law has severely weakened the rights of title 38 appointees to obtain judicial review of arbitration decisions. Title 38 employees also have fewer due process rights than their title 5 counterparts in administrative appeals hearings.

It appears that the often hostile environment consequent to these disagreements diminishes VA as a preferred workplace for many of its health care professionals. Likewise, veterans who depend on VA and who receive care from VA’s physicians, nurses and others can be negatively affected by that environment.

We believe this bill, which would rescind VA’s refusal to bargain on matters within the purview of section 7422, through striking of subsections (b), (c) and (d), and that would clarify other critical appeal and judicial rights of title 38 appointees, is an appropriate remedy, and would return VA and labor to a more balanced bargaining relationship on issues of importance to VA’s professional workforce. Therefore, DAV commends the bipartisan sponsors for introducing this bill, and appreciates the work of the Subcommittee in considering it today. DAV would offer no objection to the enactment of this bill.

H.R. 4463—Veterans Health Care Quality Improvement Act

This bill would direct the Secretary of Veterans Affairs to prescribe standards for appointment and practice for a physician within the Veterans Health Administration of the VA. The bill would require appointees to VA physician positions, and physicians already employed by VA at the time of enactment, to disclose certain private information, including each lawsuit, civil action, or other claim made against the individual for medical malpractice or negligence, and the results or status of those claims. Also under this bill, each appointee would be required to disclose any judgments that had been made for medical malpractice or negligence and any payments made. The bill would require all new physician appointments to be approved by the responsible director of the Veterans Integrated Services Network (VISN) in which the individual would be assigned to serve and require all VA specialty physicians to be board certified in the specialties in which the individuals would practice. Also the bill would require State licensure by VA physicians in the particular State of VA practice.

The measure would establish new requirements and accountabilities in quality assurance at the local, VISN and VA Central Office levels, and would direct the Secretary to review VA policies for maintaining health care quality and patient safety at VA medical facilities. The bill also would establish loan repayment programs for physicians in scarce specialties, a tuition reimbursement program for physicians and medical students in exchange for commitments to serve in VA, and enrollment of part-time VA physicians in the Federal Employees Health Benefits Program. The bill would admonish the Secretary to undertake additional incentives to encourage individuals to serve as VA physicians.

DAV has no adopted resolution from our membership on these specific issues. Under current policy, VA is required to investigate the background of all appointees, including verifying citizenship or immigration status, licensure status, and any significant blemishes in appointees’ backgrounds, including criminality or other malfeasance, medical or otherwise. The facility in question that likely stimulated the sponsor to introduce this legislation was not in compliance with those existing requirements, thus raising questions about VA’s ability to oversee its facilities in the area of physician employment. It is our understanding that corrective action has been taken by the VA Central Office but only after some unfortunate incidents related to these lapses came to light. VA has advised that it has strengthened its internal policies to ensure no such recurrence.

We appreciate and strongly support the intent of the bill to stimulate recruitment and to promote VA physician careers with various new incentives, and, while it seems clear that additional oversight in physician appointments is necessary, we trust that the new reporting, State licensure and certification requirements in the bill would not serve as obstacles to physicians in considering VA careers in the future.  We note that in testimony on May 21, 2008 to the Senate Committee on Veterans’ Affairs on S. 2377, the Senate companion to this bill, VA raised a number of valid concerns with respect to State licensure limitations this bill would impose on practicing VA physicians.  We ask the Subcommittee to take those concerns into account as you consider the merits of this bill.

H.R. 5888—To amend title 38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility.

This bill would amend subparagraph (b)(3)(C) of section 1725 of title 38, United States Code, by striking the words “or in part” where they appear in current law. In 1999, Congress enacted the Veterans Millennium Health Care and Benefits Act, Public Law 106-117. That act provided the authority sought by VA at the time to complete its role as a comprehensive health care system for all veterans who are enrolled, by giving VA authority to reimburse costs of emergency private care under certain circumstances. Prior to passage of the Millennium Act, VA was essentially without authority to pay emergency expenses in private facilities for its own patients, unless generally they were service-connected veterans. Under prior law VA was authorized to pay for non-VA emergency treatment for a veteran’s service-connected disability, a nonservice-connected disability aggravating a veteran’s service connected condition, any condition of a veteran rated permanently and totally disabled from a service-connected condition(s), and a veteran enrolled in a VA vocational rehabilitation program.

The intent of this bill would enable a nonservice-connected veteran, enrolled in VA health care, who otherwise is eligible for VA reimbursement of certain private emergency health care expenses under the Millennium Act authority but for the existence of coverage “in part” by a form of private health insurance (no matter how major or minor such private coverage might be), to be reimbursed as otherwise authorized under the Millennium Act emergency care reimbursement program. Rescission of the words “or in part” in section 1725 would open the door for a veteran with minimal insurance coverage, such as a small medical rider on a State-required automobile insurance plan, to gain VA reimbursement for emergency care under the existing authority. Today, that veteran would be denied reimbursement, because he or she is covered “in part.”

The bill would be effective as of October 6, 2007, presumably to take into account any individuals who may have recently been denied VA reimbursement because of these current restrictions.

Mr. Chairman, we note that the House, on May 21, 2008 passed H.R. 3819, the Veterans Emergency Care Fairness Act of 2007, by a recorded vote of 412-0. Enactment of that bill, strongly supported by DAV, would also clarify and expand the circumstances in which the Secretary must pay for expenses incurred in connection with an eligible veteran’s authorized emergency treatment in a non-VA facility, including a redefinition of the term “emergency” on a reasonable layman basis. A unanimous recorded vote on that measure gives us assurance that it is the Congress’s intent to give the benefit of the doubt to a veteran who is caught in an emergency medical situation and needs VA’s assistance with issues of doubt. We believe the circumstances presented here in H.R. 5888 bear a resemblance to those that countenanced the introduction and House passage of H.R. 3819.

As in the case of H.R. 3819, DAV supports the intent of this bill. This bill’s purposes are in accord with the mandate from our membership and consistent with the recommendations of the Independent Budget to improve reimbursement policies for non-VA emergency health care services for enrolled veterans. We urge the Subcommittee to approve this bill for further consideration by the Full Committee, and we endorse its enactment into law. The DAV thanks those involved for their efforts to ensure the improvements to this essential emergency relief benefit as originally contemplated in the Millennium Act and in this bill are properly implemented.

H. R. 6114—the Simplifying and Updating National Standards to Encourage Testing of the Human Immunodeficiency Virus of 2008, or, the SUNSET Act of 2008

This bill would repeal the statutory enactment from 1988 dealing with human immunodeficiency virus (HIV) testing.

DAV has no adopted resolution from our membership dealing with this specific provision; thus, we take no position with respect to this bill.

H.R. 6122—the Veterans Pain Care Act of 2008

This measure would amend title 38, United States Code, to establish a mandatory pain care initiative throughout the VA health care system for enrolled veterans.

Both the medical literature and media reflect a growing interest by health care providers in the specialized field of pain management. A number of advances in medicine and technologies from that interest are benefitting severely wounded service personnel and veterans. A recent study of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) service personnel receiving treatment in VA Polytrauma Centers found that pain is highly prevalent. The study also noted in its clinical implications that pain should be consistently assessed, treated, and regularly documented. The report concluded that poly-traumatically injured patients are at potential risk for development of chronic pain, and that aggressive and multidisciplinary pain management (including medical and behavioral specialists) is a necessity. The report suggested the phenomenon of pain is a new opportunity for VA research in evaluating long term outcomes; developing and evaluating valid pain assessment measures for the cognitively impaired; and, developing and evaluating education or policy initiatives designed to improve the consistency of assessment and treatment of pain across the VA continuum of care.

VA has been a leader in assessment and treatment of pain. In fact in 1998 VA issued its inaugural National Pain Management Strategy (the current iteration of VA’s policy is VHA Directive 2003-021). We understand that the overall objective of VA’s national strategy is to develop a comprehensive, multicultural, integrated, system-wide approach to pain management that reduces pain and suffering for veterans experiencing acute and chronic pain associated with a wide range of illnesses, including terminal illnesses. However, we are concerned that implementation of pain management programs has not been consistent throughout VA’s nationwide health care system.

Given our concerns about implementation and standardization across the VA system, this bill is welcome. It would require, by October 1, 2008, the establishment of a VA system-wide policy on the management of pain. Under the bill, VA’s plan would be required to cover pain management; related standards of care to treat pain; consistency across the VA system of care; assurance to VA’s patients who need care for pain; conduct of research initiatives in pain; establishment of educational and training programs in pain for VA clinical staffs, and the provision of patient education in pain. The bill would require VA to report to the Committees on Veterans’ Affairs its progress and status on its required pain policy within 180 days of initial implementation. The required report would disclose VA’s progress on each of the areas of the bill’s emphasis in respect to VA’s policy and program on pain.

While DAV has no specific resolution adopted by our membership in support of establishing a legislated VA system-wide pain initiative, we believe the goals of the bill are laudable and in accord with providing high quality, comprehensive health care services to sick and disabled veterans. We believe this bill would be strongly supported by our membership; therefore, we have no objection to this measure and look forward to its enactment.

Mr. Chairman, this concludes my testimony on these bills. DAV appreciates the opportunity to provide this statement for the use of the Subcommittee, and we are pleased to address any questions you or other members may have concerning the measure under consideration.