Mr. Chairman and members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit a statement for the record on H.R. 4089, a bill to improve collective bargaining rights and procedures for review of adverse actions on certain employees of the Department of Veterans Affairs (VA); H.R. 4463, the “Veterans Health Care Quality Improvement Act;” H.R. 5888, a bill to expand veteran eligibility for reimbursement by the VA for emergency treatment furnished in a non-Department facility; H.R. 6114, the “SUNSET Act;” and H.R. 6122, the “Veterans Pain Care Act.” We hope that addressing the issues outlined in this legislation will better benefit today’s veterans and the veterans of tomorrow.

H.R. 4089, Collective Bargaining

PVA generally supports the provisions of H.R. 4089, a bill that would improve the collective bargaining rights and procedures for review of adverse actions for certain health care professionals in the VA. These changes would be a positive step in addressing the recruitment and retention challenges the VA faces to hire key health care professionals, particularly registered nurses (RN), physicians, physician assistants, and other selected specialists.

As we understand current practice, certain specific positions (including those mentioned previously) do not have particular rights to grieve or arbitrate over basic workplace disputes. This includes weekend pay, floating nurse assignments, mandatory nurse overtime, mandatory physician weekend and evening duty, access to survey data for setting nurse locality pay and physicians’ market pay, exclusion from groups setting physicians’ market pay, and similar concerns. This would seem to allow VA managers to undermine Congressional intent from law passed in recent years to ensure that nurse and physician pay are competitive with the private sector and to ensure nurse work schedules are competitive with local markets.

Interestingly, given the VA’s interpretation of current laws, these specific health care professionals are not afforded the same rights as employees who they work side-by-side with everyday. For instance, Licensed Practicing Nurses (LPN) and Nursing Assistants (NA) can challenge pay and scheduling policies, while RN’s cannot. This simply makes no sense to us.

H.R. 4463, the “Veterans Health Care Quality Improvement Act”

PVA supports H.R. 4463, the “Veterans Health Care Quality Improvement Act.” We certainly appreciate the underlying intent of this bill which is to ensure that the health care provided by the VA is the very best available. Section 2 of the legislation defines standards that must be met for physicians to practice in the VA. It requires the disclosure of certain information pertaining to the past performance of a physician and requires the Director of each Veterans Integrated Service Network (VISN) to investigate any past disciplinary or medical incompetence issues of physicians to be hired.

We would like to draw attention to one particular provision in Section 2 that we believe could be problematic. Specifically, the legislation calls for a physician to be licensed to practice in the state in which the medical facility he or she is currently working in is located. We believe that this may be an unreasonable expectation and may make it more difficult for the VA to hire physicians, particularly in specialized care fields. This provision addresses a problem that we do not think actually exists. When hiring doctors, or any health care professionals, a VA facility should properly investigate and scrutinize the professional history of that individual. Whether or not a doctor is licensed in a state has no bearing on whether or not the VA is properly vetting individuals to be hired. Moreover, we would hate to see a situation created where a VA facility is unable to hire a critical physician who provides care in one of VA’s specialized services simply because he or she does not have an in-state license, particular if that doctor is otherwise qualified.

PVA supports Section 3 of H.R. 4463 that requires the Under Secretary for Health to designate a national quality assurance officer and a quality assurance officer for each VISN. This establishes a quality-assurance program for the health care system and provides a method for VA health care workers to report incidents of inconsistency. We believe that one of the keys to high quality health care services is an affective quality assurance program. This program could be beneficial for improving accountability within the health care system.

We likewise support Section 4 of the legislation that offers incentives to attract physicians to work in the VA health care system. It also encourages the VA to recruit part time physicians from local medical schools. PVA has expressed concern in the past that the VA is struggling to attract high quality physicians, particularly to specialized services like spinal cord injury care, blind rehabilitation, and mental health.

H.R. 5888

H.R. 5888 will expand eligibility for emergency medical care at the VA for some veterans. Currently, veterans who have a secondary insurance provider that pays a portion of medical expenses in the event of an emergency do not have the balance of their medical expenses covered by the VA. This proposed legislation will eliminate that situation. It will prevent the VA from denying payment for emergency service at non-VA hospitals when a veteran is partially covered by the secondary insurance. PVA supports this legislation.

H.R. 6114, the “SUNSET Act”

H.R. 6114 repeals the requirement that HIV testing can be done only with the signature consent of the individual. This provision will allow the VA to be compliant with Centers for Disease Control (CDC) guidelines for HIV testing. PVA has no specific position on this legislation.

H.R. 6122, the “Veterans Pain Care Act”

PVA supports H.R. 6122, the “Veterans Pain Care Act.” This legislation would require the VA to develop and implement a comprehensive policy for managing pain care for veterans enrolled in the VA health care system. PVA believes that comprehensive pain care is not consistently provided across the entire system. We have seen firsthand the benefits of pain care programs as each VA facility that supports a spinal cord injury (SCI) unit also maintains a pain care program. Veterans with spinal cord injury know all to well the impact that pain, including phantom pain, can have on their daily life. The pain care programs that SCI veterans have access to have greatly enhanced their rehabilitation and improved their quality of life.

The one caution we would offer is an expectation that every facility in the VA should have a pain care program. While we understand this would be the most preferred outcome, we are not sure this would be reasonable. We see no reason why pain care and management cannot be handled in some fashion similar to the hub-and-spoke model used by the VA to provide certain types of specialized care, including spinal cord injury care. However, this suggestion does not mean that the VA cannot have a comprehensive, system-wide policy for pain care.

Mr. Chairman and members of the Subcommittee, PVA would once again like to thank you for the opportunity to provide our views on this important legislation. We look forward to working with you to continue to improve the health care services available to veterans.

Thank you again. We would be happy to answer any questions that you might have.