VA Secretary Press Conference March 2nd 2023

Terrence Hayes (Press Secretary): Good afternoon, ladies and gentlemen. Thank you for joining us again today. I’ll begin today’s press conference with the ground rules. To our press in attendance, once I open the Q&A period, please raise your hand and wait for me to recognize you. Once called upon, please step to the microphone. To those joining virtually, please remember to remain on mute for the duration of the press conference. During the Q&A, please use the raise your hand function and a member of my team will recognize you. Once called upon, please unmute and turn your camera on. Remember to mute immediately following your question. Before I introduce our guest joining Secretary McDonough, I wanted to make you aware of one of our premier adaptive sports events scheduled to occur later this month in Colorado, the National Disabled Veterans Winter Sports Clinic, co-presented by VA and AV will occur March 25th through 31st at the Aspen Snowmass Ski Resort. The secretary visited this event last year and saw the incredible impact this event has on disabled Veterans and caregivers. I’m encouraging our members of the press to make Colorado a destination in the coming weeks to meet these wonderful Vets and our world-class instructors. You’ll be blown away by what you see. That said, we are happy to have Matt Rogers, National Clinical Resource Hub Director – Office of Primary Care, join us today. Matt will share VA’s efforts to provide world-class services to Veterans through novel programs like CRH. Since there is much to discuss, I’ll step aside and turn the floor over to Secretary McDonough.

Secretary Denis McDonough: Terrence, thanks very much. Thanks everybody for allowing me to be a couple minutes late today. I stopped by our conference room up on the eighth floor where, the Disabled American Veterans are recognizing, providing a special recognition award for Dr. Matt Miller, the head of our Office of Suicide Prevention. I could not be more impressed by and appreciative of Matt. That’s why I wanted to stop by, so thanks for your flexibility. I want to start out by thanking my friend and my colleague, Deputy Secretary Donald Remy, who has decided to step down from his position as of April 1st. Donald has had an inspiring tenure here at VA over the past two years. He’s been steadfast in keeping Veterans at the center of everything we do. Our accomplishments are a product of his leadership and his hard work, and I will sorely miss Donald, but I will say he’s here for another month, so we’re going to keep working him hard. President Biden has approved Guy Kiyokawa, VA’s Assistant Secretary for Enterprise Integration to serve as acting deputy secretary when Donald departs. Guy has spent his entire career in public service, both in the Army and on behalf of his fellow Veterans. And I know he’ll bring that important perspective and experience to this next role. We look forward to working with our partners on the Hill to get a new deputy secretary confirmed quickly. Now, one thing I’ve promised you that I would do in these sessions is share with you things that I’ve been deliberating, even if they’re not yet policy or even entirely ripe. We are in March, but I also want to point out that this is the rescheduled February presser, and February is traditionally the month when we celebrate and commemorate black history across the country and here at VA. I want to talk about our promise to deliver care and benefits to all Veterans. I have acknowledged to you that we have not always kept that promise, especially when it comes to delivering care and benefits to black Veterans. And we’ve been wrestling with disparities based on race and VA benefits decisions and military discharge status. In light of this and aided partly by President Biden’s Executive Order on Advancing Racial Equity Through the Federal Government, I’ve directed the leadership team here at VA to start up an equity team immediately. That team’s first order of business will be to look into disparities in grant rates to black Veterans, as well as to all Veterans, minority Veterans, and historically underserved Veterans, and to eliminate them. I will expect that team to consider policies across VA to address these concerns, including changes related to organizational structure, training, quality control, outreach, and more. And this work will build on what we’ve already done to embed inclusion, diversity, and equity and access into everything we do at VA. But the bottom line is this, we won’t rest until every Veteran gets the world class care and benefits that they have earned. Now PACT Act – to date, we’ve received 351,851 PACT Act related claims. Of those, we’ve awarded 124,325 decisions. Out of the 153,766 claims we’ve reviewed so far, these claims have resulted in more than 661 million of benefit payments to Veterans and survivors. The last time we met, I said that we were committed to being completely transparent about our progress on implementing the PACT Act. So tomorrow we will roll out our PACT Act dashboard, which we will be updating every two weeks with the most current accurate information. I asked that our team develop this dashboard a year ago for us to use to ensure that we are on right track to provide toxic exposure related care and benefits to the millions of Vets and survivors who have earned them on a timely basis. While this has always been designed for internal purposes, I decided to make it available to VSOs, the Hill, and to the press as a confidence building measure that we’re implementing this historic law transparently. To that end, we’ve shared drafts of it over the last several weeks with Force Multipliers, among VSOs, and on the Hill. Lastly, I’d like to update you on what we’re doing in support of President Biden’s promise to be the most pro-union president in American history. I have to say, I was moved to do this after being at the very exciting nomination of Julie Su to be the new Secretary of Labor yesterday. A unionized VA workforce is a strong VA workforce. Nearly 80% of all VA public servants are bargaining union employees. Over the past two years, we’ve taken several key steps to support employees so we can better serve Vets, including reestablishing the National Partnership Council, restoring official time for union representatives, reestablishing labor management meetings with VA union partners, and bringing unions into discussions related to critical employee-centric decisions. In that spirit, I’m continuing to meet with our labor partners at every stop when I travel so we can cultivate strong lasting relationships with our unions. In fact, just yesterday here in headquarters, I met with the National Association of Government Employees. We had a great conversation about their concerns and about how jointly we can hire more quickly. We achieve great things through collective bargaining. An excellent example is the three key agreements VA reached recently with the National Federation of Federal Employees, which we call NFFE on expedited hiring, use of unpaid parental leave, and delegation of official time. These agreements will help VA better serve Veterans and support VA’s employees. Likewise, VA and National Nurses United have been working collaboratively to resolve some important matters, including a new master of collective bargaining agreement. Good faith bargaining with the American Federation of Government Employees on a new master agreement is progressing and tentative agreements on language are reached at every bargaining session. I attach great importance to these talks and have remained closely and personally engaged in them. We look forward to deepening our partnership even further with our labor partners. Now to the main event, I’m really pleased to be joined by Matt Rogers. Matt is the National Clinical Resource Hub Director, and he currently works in Boise, where I first met him a year ago, but we’ve been spending so much time together. I told him when I walked into the room and saw him, I was completely unsurprised. That’s because Matt and I had a chance to travel last week to Alaska, where I saw firsthand how these services provide care to Veterans, especially Veterans in rural and highly rural settings. With that, let me turn the microphone over to Matt.

Matthew Rogers, PA-C (Director, National Clinical Resource Hub): Hello and thank you, Mr. Secretary. I am eager to share the great work that our Clinical Resource Hub program is doing to bring care to Veterans across the United States and its territories. I’ll start with a brief background of the Clinical Resource Hub program. In 2014, VA developed a proof of concept of a hub and spoke model that brings together expert clinical teams to provide services to Veterans in areas where access to clinical care is limited. This was successful and VA scaled it in 2018, establishing a Clinical Resource Hub in each of VA’s 18 regions. Additionally, under section 402 of the Mission Act of 2018, Clinical Resource Hubs were leveraged to launch a three-year pilot of mobile deployment teams, and we reported back to Congress several recommendations to strengthen and expand the Clinical Resource Hub program. And we are eagerly awaiting that support. Clinical Resource Hubs provide care to Veterans at their local VA healthcare facility from the comfort of their own home, through technology to other non-VA facilities, or via in-person visits. This might mean, for example, a Veteran in Spokane is seeing a specialist in New Hampshire. And this is greater than just telehealth. In addition to being able to integrate in-person clinical services with telehealth technologies, VA has invested in robust digital platforms that allow Veterans to receive expert clinical care wherever they are. All Clinical Resource Hubs started with foundation of primary care and mental health services. This has now expanded and since 2018, Clinical Resource Hubs have provided over 2 million episodes of care, delivering over 30 different types of clinical services – ranging from compensation and pension, whole health, substance use disorder, suicide prevention, chaplaincy, rehabilitation, and surgical services to name a few. These services are primarily carried out via telehealth technologies and importantly, we also provide in-person services to augment telehealth when necessary. This is a really important point and one example of where VA stands out in delivering high quality clinical care to Veterans. VA connects with Veterans through telehealth in their homes using a Veteran’s own devices or through devices we send to the Veteran. What really sets us apart as an organization is the ability to perform physical examinations via telehealth using sophisticated equipment in our clinics and the Veteran home. These devices here are examples of what we send to Veterans for our Clinical Resource Hubs. Clinicians can obtain full vital signs, listen to heart and lung sounds, examine a Veteran’s ear canal, skin lesions, the mouth, the nose, the throat. In closing, I would like to summarize and stress the following important points – number one, the VA offers telehealth services that are beyond a simple video conference, allowing Veterans to receive comprehensive team-based care regardless of where they live. Number two, Clinical Resource Hubs demonstrated success with the requirements of the Mission Act, and we reported back to Congress recommendations to expand Clinical Resource Hubs. Number three, there are some important pandemic authorities that are set to expire on May 11th. We’re working with other agencies on new federal regulations to support ongoing Veteran care via telehealth. And in addition to those federal regulations, VA is seeking legislative assistance from Congress to ensure we can treat all Veterans equitably when prescribing treatments through telehealth irrespective of state lines.

Secretary Denis McDonough: Great. I want to just pile on one point. First of all, this stuff is really cool. It’s not just a stethoscope, but it’s a stethoscope that plugs into the technology that allows it to get that information back to us at the resource hub. This last point that Matt made – first of all, you see why I was thrilled that he’d come out here and talk to us. The guy’s awesome, like all of our healthcare providers, but I really want to underscore this point that we need help from Congress to be able to continue as robustly as we currently do prescribing across state lines. DEA published a proposed rule earlier this week where they’re currently taking comment on that rule. That’s an important first step to ensure we can continue to provide care to our Veterans. But it’s only the first step to be able to maintain our ability to provide timely care to 40,000 Veterans who get their prescriptions across state lines. We need legislative relief from Congress. So, we’ve been talking with them about this for the last year. We’ll keep talking to them about it and we’re really hopeful that they can help us get this done. So, Terrence, over to you.

Terrence Hayes (Press Secretary): Hey Matt, did you want to do a demonstration or are the materials, the items that you have?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  Okay, well, I’d be happy to just point out this kit is a kit that we send to Veterans directly to their. Any of our clinicians in VA have a quick easy menu order where they can pick which devices they need to send to the Veteran. This kit we send to the Veteran’s home can include and be tailored to their needs, a blood pressure cuff, a stethoscope, a weight scale, a thermometer, and we can in real time, evaluate Veterans in the comfort of their home with devices we send. We also send them tablet devices that will connect to these peripherals if the Veteran doesn’t have that. Veterans can also connect with their own devices. This equipment is one small step below what we offer in our clinics. We have similar equipment that’s very large, in each of our clinics, to provide telehealth services to Veterans, and we can do more comprehensive examinations through these modalities.

Terrence Hayes (Press Secretary): Awesome. Thanks, man. Appreciate that. With that, we’ll open the floor up to questions. Patricia.

Patricia Kime (Military.com): Thank you for doing this, Mr. Secretary. Regarding the PACT Act dashboard, are we going to get any granularity on the types of illnesses and conditions that are getting approval and what rates they’re getting approved at? I heard from a Veteran who has hypertension from Agent Orange or linked and 0% rating because it’s controlled by medicine. So his concern is are hypertension getting zero to 10%? When are we going to find out what kind of conditions these Vets are getting?

Secretary Denis McDonough: Yeah, fair enough. I think what I’ll do is, rather than front run what we’ll make available to you tomorrow, we’ll let you take a look at it tomorrow and then we’ll have every month for the next several years opportunity to talk about that. As it relates to the conditions and what kinds of ratings the conditions are eliciting, we’ll obviously talk to you about that, whether you have kind of specific individual Veterans with a question or you want to see some aggregated data on that. We’ll work to get you that.

Patricia Kime (Military.com): Okay. Just a follow up, I guess will be a month out from 120 days, are you looking at the backlog? It seems like you’re getting through a lot of these pretty quickly. What do you expect is going to happen with the backlog?

Secretary Denis McDonough: Yeah, thanks. Thanks very much for a asking that question because it allows me to do what I oftentimes forget to do, which is to give you guys, the numbers as it currently stands. The backlog today is 201,442 cases. So we have an assessment tool that we’ve been tracking. We think that we’re beating early projections on backlog. That’s a good thing. There’s a way to look at overall claims filed where we’re up about almost 25% year over year. So we’re up about 25% in the first quarter plus of this fiscal year as compared to last fiscal year. There’s a way to look at that and see that as a big number, and there’s a way to see that as a small number. I choose to see it as a small number. And what we’re trying to do by doing that is to try to ask ourselves why is it that Veterans are not filing of those who may be eligible? I think inevitably there’s ongoing need for us to communicate to Veterans, to find them, to make sure that they know that this is available. Two, I think what we’ve talked in here in this room before, that there’s ongoing trust issues, meaning some Veterans had a bad experience or talked to a Veteran who had a bad experience. And so we really want to assure them, and part of our effort at being transparent is to assure them, that we want them to come back and give us another try. Third is there are Veterans who are still concerned that they got a service connection rating or disability rating, and they’re worried that if they come back and apply for further benefits that their disability rating is going to go down. That’s based on a misunderstanding. As I’ve said in this room before, you’re more than 30 times more likely to see your benefit, your service connection rating, increase as a result of the PACT Act rather than decrease. And so, these are all things that we’re using data and quality metrics as well as quantity metrics to make sure that we’re moving those numbers as high as we can.

Patricia Kime (Military.com): Okay. Thank you.

Secretary Denis McDonough: Thank you.

Terrence Hayes (Press Secretary): I think we have a question from Quill. Good afternoon, Quill.

Quil Lawrence (NPR): Hey, how are y’all doing? Thanks for doing this. This week in, a couple of the Veterans Committee hearings, there were questions about abortion and abortion counseling. I think Dr. Elnahal said he wasn’t going to answer questions about specific numbers of services provided because they could be, I guess, somehow triangulated and there could be repercussions. Correct me if I got the wrong impression from what he said. But I’d like to know what you are doing to ensure that the VA policy is to continue providing abortion and abortion counseling? What you’re doing to ensure that you can do that in states where state laws are becoming hostile to that? NPR and others have reported on doctors feeling intimidated about performing these services and sending patients out of state. Whether abortion services would be carried out in VAs out of state with transportation, et cetera? Thanks.

Secretary Denis McDonough: Great. Quil, good to hear your voice. As we all know, that’s not always the case in this room. I couldn’t help it, man.

Quil Lawrence (NPR): That’s fair. But I have, I’ve managed to make my microphone work for the past, I think three press conferences.

Secretary Denis McDonough: Okay. All right. The statute of limitations on the joke is up then. I won’t use it anymore. So let me answer the question, but let me start with this point, which is our point is to provide the full suite of necessary care for women Veterans in our care. And especially when we have 300,000 women Veterans of childbearing age, that means being able to provide in the instances that we have laid out being rape, incest, health, and life of the Veteran abortion counseling and abortion services. So far, we have been able to provide those services consistent with the clinical needs of the Veterans and consistent with clinical practice. And so if we encounter issues where Veterans feel deterred from getting care that they need or if providers feel intimidated or deterred from providing that care, we’ll obviously continue to adapt where necessary. But so far, Quill, my understanding is that we’re able to work through that under existing policies and procedures and consistent with federal law; which, as we’ve discussed in this room, the OLC – the preeminent legal body inside the Department of Justice, has underscored in writing in their opinion, is fully legal and consistent with existing federal laws. I understand the question, but so far we’ve not encountered those situations in such a way as to impede the provision of care to our Veterans.

Quil Lawrence (NPR): And Chairman Vos did send you a letter asking for numbers and for tax dollars spent on these services, et cetera? Have you all answered that or are you going to?

 Secretary Denis McDonough: Yeah, so, he has sent us a letter. I’ve talked to him about the letter. I didn’t see the exchange, but I think what you reported comports with what I heard about the hearing earlier this week where he asked again about the letter. We are working on the letter of course, and we think congressional oversight is not only welcome but is also very important in all the conduct of the policies and procedures here at VA. We’ll obviously continue to engage with our congressional partners.

Quil Lawrence (NPR): Thanks.

Terrence Hayes (Press Secretary):  Thank you, Quil. Melissa, good afternoon.

Melissa Burke (The Detroit News): Good afternoon. Hi. Thanks for having the press conference. I’m Melissa with the Detroit News. I know you’re familiar, Mr. Secretary, with the reporting we had this week on the OMI report about the Detroit VA. I was hoping you could confirm, based on the OMI findings, whether anybody died as a result of the mismanagement there that’s alleged? And if you could share any specifics about steps that have been taken to fix the problems there and hold those responsible accountable?

Secretary Denis McDonough: Well, thanks very much and I am familiar with the reporting as I’ve said to several of your colleagues. We obviously really appreciate the role and it’s why we have the monthly press conference. Really appreciate the role that you play in holding us to account in the provision of world class care to our Veterans. Patient safety is obviously our top priority, and we take the allegations in your reporting very, very seriously. While the OMI investigation about the quality of care and review of care rendered at the Dingell VA Medical Center in Detroit is complete, additional investigations are ongoing. So, that limits a little bit what I can say. I will say though we do not tolerate the kind of behavior detailed in your reporting. The employees in question have been temporarily removed from their leadership and patient facing roles pending the outcome of these additional investigations. I am assured by the facility that we have implemented the 12 recommendations from the OMI report including administrative procedural corrections and necessary oversight reviews. I want to underscore, and I talked again with the IG about this today, this is a constant source of regular communication between me and the Inspector General, the situation in Detroit. He expressly is reviewing the implementation of those 12 recommended steps and we will make sure that we, working with the IG, adequately and entirely implement those. I want to say two additional things – our National Surgery Office has completed a review of 410 cases undertaken by the surgeon noted in the report. 17 of those did not meet the standard of care. 65 were given additional levels of peer review. One at a peer review level of a three and one at a level of review of a two. Those numbers don’t mean anything to you, but the most important thing is that they’re subject to additional review. Perhaps most importantly, the surgeon subject of the much of the reporting no longer has clinical privileges. So, as to the specifics of each individual case, pending completion of these investigations, I’m not in a position to comment much more broadly on that. But I can assure you and your reader and most importantly the Vets who get their care at the Dingell VA, that I’ll be talking to them directly about this.

Melissa Burke (The Detroit News): Just to clarify, which surgeon are you talking about in terms of the 400 that were reviewed?

Secretary Denis McDonough: I’ll get you the exact, I’ll make sure that that’s the clear point I have. Let me make sure that what I give you doesn’t go beyond what I’m legally able to give you.

Melissa Burke (The Detroit News): Okay. And just to follow up, you mentioned that there’s these ongoing investigations. For example, the review by the OIG, do you have any estimate of when those investigations will conclude? And can you commit to making the outcomes of those investigations public?

Secretary Denis McDonough: Yeah, the timeline is a better question for the IG. I’m definitely not going to speak – he’s independent, proven as much, and I’m not going to speak for the IG. I can tell you that, unless there’s some legal limitation on what we can make public, I have every confidence that the IG will make his report public. I intend and I will speak to Veterans at the Dingell facility about them and about the steps that we’ve taken.

Melissa Burke (The Detroit News):  And just one final thing, I’ve heard some from some employees at the facility who have asked why some of these leaders who have been temporarily removed are still working for the VA. Can you speak to that and can you also, is there anything you’d say to reassure Veterans who get care there that that is safe? That they should continue?

Secretary Denis McDonough: Yeah. I can say that we have four deployed additional personnel into the Dingell facility, and as a result of that, have confidence in the current leadership team that they are not only working diligently to deliver world-class high-quality care, but that Vets can have confidence in that care. And this is why I want to have that conversation with our Veterans there. I will also say to our workforce that we take very seriously the high reliability of our organization principles, that include the free flow of information in all directions in our VA facilities. And any leader or any organization where information, most particularly information that may indicate compromise of outcomes for Veterans is not freely flowing, is one where we are not providing the best available care to Veterans. And so I really appreciate those employees in Detroit who have raised concerns along the way and consistent with their bravery, we intend to ensure that we operate as a high reliability organization and allow the free flow of that information so that we can ensure best outcomes for our Veterans as, we do in every other facility in the country.

Melissa Burke (The Detroit News): Thank you.

Secretary Denis McDonough: Thank you.

Terrence Hayes (Press Secretary): Courtney.

Courtney Kube (NBC News): Hi. I actually have three follow ups on three separate issues, but they’re quick. Back to the abortion issue, I wonder if you can update us since when you first acknowledged in September that there was one abortion performed how many have been performed? Have there been any legal challenges to any of the women who have been trying to get abortion care?

Secretary Denis McDonough: I don’t have an update beyond what I said in public testimony, which at the time I said that there was one that I was aware of. I don’t have specificity on numbers beyond that. I’m under the impression that there have been additional but as Dr. Elnahal testified earlier this week, it’s a relatively small number relative to our overall appropriation. But I think it is meaningful to underscore that this is obviously a service that women Veterans need access to as the evidence of this last period underscores. There is one existing case. It is filed. I want to be careful. I think I can characterize the case, but I’m not going to do much more than that because I want to not get in the middle of ongoing litigation, but there is a VA provider or a VA nurse who felt like her access to a reasonable accommodation to not participate in the provision of abortion was not adequately exercised or was not adequately protected. That’s a case in Texas. It continues but I don’t have anything to say more than that.

Courtney Kube (NBC News): Okay. But there haven’t been any cases where like the state has come and created…

Secretary Denis McDonough: None that I’m aware of, no. Which is to say I also think I would be aware but none that I’m aware of.

Courtney Kube (NBC News): Okay. A little bit more on the prescriptions across state lines that you were talking about. So, you said that that’s something that’s been a conversation for about a year and there’s now this like, public period of it. Do you have any sense of when that could be resolved? Is it still months or years out?

Secretary Denis McDonough: So this two now – it’s the subject of a public rule making at DEA. I’m going to ask Matt to kind of talk through the specifics in a second, but this rule making can be resolved relatively quickly, consistent with the Administrative Procedures Act. So obviously it’s subject to public comment. Those comments will come in – DEA has to consider and respond to those comments. But that regulatory fix can be done, we hope but we’ll see, in time for May 11^th. The broader concern we have, and Matt can explain the difference between the two, is something that we continue to talk to Congress about. They have questions. I’ve talked to members about it as recently as this week and so that one I hope we can move pretty quickly as well. I hope that’s response to a question, but let me just see if it would be helpful for Matt to talk a little bit more about the difference?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  Yeah, thanks for the question. And, and so really we’re thrilled to have the DEA as a partner as we’re looking at the regulations. Regulations are important to be in place by May 11^th so we can continue prescribing medications to Veterans getting care via telehealth. The issue in terms of regulation and legislation – legislation is necessary to statutorily give the VA authority to prescribe medications across state lines so that we can ensure that there’s a national standard that we can follow when prescribing treatments to Veterans. Right now, every single state has different authorities that they grant. And the reality is our VA clinicians and our workforce are spread across all the states and territories, and we treat Veterans across all the states and territories so we really need some statutory authorities to get to consistent, high reliable, quality telehealth prescription standards.

Courtney Kube (NBC News): And then just one more quick one on the equity team that you talked about – have you named a lead to that or…

Secretary Denis McDonough: Have not yet.

Courtney Kube (NBC News):  And do you expect…

Secretary Denis McDonough: I’m assuming that’s going to be forthwith and we’ll publish that when we do it.

Courtney Kube (NBC News): Okay. Thanks.

Secretary Denis McDonough: Thank you.

Terrence Hayes (Press Secretary): Lucy. Good afternoon.

Lucy Bustamante (NBC10 Philadelphia): Hi, Terrance. Good to see you. Lucy from NBC in Philadelphia. Secretary, we just began a multi-NBC station and network investigation into discrimination claims from many Veterans of color that we’ve interviewed who say they’ve experienced discrimination in the dissemination of their benefits. Along the lines of the equity group that you’re creating, why now and how is this group different from the Center for Minority Veterans? For example, the difference in their role and how they’ll cooperate with ongoing, lawsuits and investigation?

Secretary Denis McDonough: Yeah, thanks so much, and as I’ve now said to a couple of your colleagues, I commend the role that you’re doing in giving voice to Veterans and holding us to account, so thank you for that. Second, what the equity team builds on is the efforts that we’ve carried out since we first arrived here in early 2021 through the establishment of a series of inclusion, diversity, equity, and access infrastructure here in VA – basically a committee that oversees basically and tries to infuse into everything we do, this concept of IDEA. The specific thing we’ll be asking the equity team to look at immediately is things like what you’ve heard about, it sounds like from in your reporting from some of the Veterans in Philadelphia or Southeastern Pennsylvania, and something that we’ve noticed in the data going back many years. That is to say there is a grant rate, for example for service connection for PTSD, that is higher for white Veterans than for black Veterans. And the question is, we’re asking the equity team to dig into is why and not only dig into answering why that’s happening, but then to put in place a series of policies, and procedures going forward that will allow us to address those differences to ensure that they don’t keep happening. And so, that’s what the equity team will do. That will just be the first assignment for the equity team. They’re going to have additional assignments and we can surely provide you more background on the Equity Executive Order that President Biden issued last month, but that’s the kind of the driving force behind this equity team. On your question about why now, this is an issue that we’ve been wrestling with. I’ve been talking about with our press here since I arrived and fact is that we’ve been trying to figure out these historic, disparate outcomes, for some time. And so it’s evident to me that consistent with the President’s EO, we need a concerted effort through this team to not only get to the bottom of the why, but then to get to enacting policies and procedures to fix it. Lastly, the third part of your question was? hat the team does and why now… Now there’s a third part, I’m sorry, I’ve forgotten?

Lucy Bustamante (NBC10 Philadelphia): How it’s different.

Secretary Denis McDonough: Oh, the difference between The Center for Minority Veterans. Okay. It’s an excellent question. The Center for Minority Veterans does a whole range of work for VA. Principally, James Albino, who is the lead of that organization and a fundamental part of our leadership team, is at every table to make sure that the interests of Veterans of color, minority Veterans, are considered in every policy deliberation that we take. He also serves a very important role in ensuring that we are aggressively reaching out to minority Veterans. And so, the equity effort, which James will be part of, is meant to be specifically focused on programmatic outcomes of dealing with equity. So I hope that’s responsive to the question.

Lucy Bustamante (NBC10 Philadelphia): Thank you, sir.

Terrence Hayes (Press Secretary): Thank you, Lucy. Orion, good afternoon.

Orion Donovan-Smith (The Spokesman Review): Thank you guys as always for doing this. Mr. Secretary, I have just a quick general question for you and then I’d actually like to ask Mr. Rogers a few things. The IG told Congress, in all his independence here the other day, that turnover at VA has overall hurt accountability and transparency to some degree. In light of Deputy Secretary Remy leaving and Dr. Adirim leaving recently, I’m just wondering if you can speak to any…will there be any changes in terms of who’s ultimately responsible for the EHRM program? Obviously we’ve got the acting officials there, but will that have any changes in terms of responsibility for that program?

Secretary Denis McDonough: I didn’t see what the IG had to say there, so I’m happy that you brought that to my attention. Let me just say, I hope if nothing else, I’ve proven to you guys how important I believe transparency is personally. And today’s press conference and our regular interactions, I hope is evidence of that. So whether there’s turnover or not, I will be very aggressive about ensuring transparency, because I think that is the best accountability to tie the two issues together, one. Two, let me just say a thing for a minute about retention. Retention in VA, especially in VHA right now, is up. In fact, interestingly, we’re not only retaining more nurses, nursing assistants and LPNs, but for the first time in a long time through the first quarter of FY 23, we grew those three categories of personnel, which are among the most hotly contested people in the healthcare labor market. So, I’m really proud of the team at VHA, really proud of their mission focus, their Vet centered, focused attitude, which I think you guys saw last month with our nurse lead from Houston, who was awesome, who ended up being an expert on Cerner as we found out after your questions. Third point, Dr. Neil Evans, who you know has great history with Connected Care, he runs the Office of Connected Care, but also has served working on issues related to the Electronic Health Record Modernization. He is the acting head of that program office, statutorily the deputy, who we intend to nominate fairly quickly, and I hope Congress enacts quickly. He will by statute be in charge of overseeing the budget of the program office. So will there be changes? Well, yes, by virtue of the changes, but structurally, no. And ultimately, my view on this, Orion, is I’m responsible for performance. I just talked to Senator Murray about that today and I communicated that directly to her as well. All right.

Orion Donovan-Smith (The Spokesman Review): Thank you. And Mr. Rogers, if I could ask you a couple things on the on Clinical Resource Hubs.

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  Sure.

Orion Donovan-Smith (The Spokesman Review): Glad to get a chance to talk to you here. I’ve heard a lot about the importance of those hubs and as a fellow U-Dub alum, good to meet you. First, just a quick point of clarification – if that DEA rulemaking process…is there some risk that it doesn’t get done in time for, I think it was May 11th date?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  I don’t think so. I believe what we’ve seen in our partnership with the DEA on this, that I believe and have every bit of confidence it’ll be in place before May 11th.

Orion Donovan-Smith (The Spokesman Review): Okay. Thank you. Specifically, because I know you’re based in Boise, is there anything sort of special about how the Clinical Resource Hubs have supported Cerner facilities so far?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  Yeah. Yes, actually. So in VISN 20, our Clinical Resource Hub has plused up their staffing to support the go-live and ongoing efforts in those facilities that have deployed Cerner. In VISN 10, the same thing has occurred with the Columbus facility as well. So, and we’re looking at that as a mitigation – one part of several solutions to mitigate, the potential of productivity decreases as Cerner goes live.

Orion Donovan-Smith (The Spokesman Review): Are there, I understand if you don’t have this off the top of your head, maybe we can follow up, but do you happen to know how many Veterans in VISN 20 use in some form a Clinical Resource Hub?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  I do have that data and not off the top of my head, but I’d be happy to get that to you.

Orion Donovan-Smith (The Spokesman Review): Okay, thank you and then just quickly…I wonder if this interstate prescription issue has already hampered care in any way for Veterans in the Northwest who are dealing with the Cerner implementation?

Matthew Rogers, PA-C (Director, National Clinical Resource Hub):  Because we have current authorities through the pandemic to operate, that has not – during the course of the pandemic.

Orion Donovan-Smith (The Spokesman Review): Okay. Thank you.

Secretary Denis McDonough: That was a nice moment. The UW thing.

Terrence Hayes (Press Secretary): It was, Orion’s not, not normally energetic like that. It’s pretty cool. Leo, we noticed that your seat is being occupied by Patricia today.

Leo Shane (Military Times): That’s an upgrade for the press room right there. Mr. Secretary, I appreciate this. Question about the equity team – do you have a timeline on when you expect some results or some reports? Is this going to be very open-ended or are you instructing them to come back with recommendations and changes on some sort of timeline?

Secretary Denis McDonough: Yeah, that, it’s a good question, Leo, the, I don’t have a timeline to announce to you now. There are certain requirements built into the President’s Executive Order where we owe him answers on this. But this issue about ensuring each and every Vet gets what they have earned and so richly deserve is something that I think will be rolling work. For example, on PACT Act, one of the things we’ve being going out of our way is to exercise certain aggressive communication efforts with our relying, for example, on the Center for Minority Vets to make sure that Veterans of color, are aware of the benefits, available under the PACT Act and are applying for those benefits. And so, you’ve heard me say this before, Leo, but one of the things that really excites me about the PACT Act is, I don’t have the data to prove this, but I think common sense tells us – that the force that was deployed in Central Command from 1991 to 2021 was not only the most effective and strongest in the history of the planet, it is the most diverse ethnically and by gender of any deployed military force in the history of the planet. That allows us a great opportunity to reopen conversations with groups whom we have had a trust issue in the past. You, we’ve said again, in this room, the younger, the more diverse and the more gender diverse the Veterans are, the less they trust us. So we now have an amazing opportunity with the PACT Act to go back to those Veterans and say, come give us another try, there are new benefits available to you, and we’re going to get to the bottom of making sure you get precisely what you’ve earned. Leo Shane (Military Times): Okay? And I know next week we’re supposed to get a look at the federal budget. I believe it’s still supposed to be released next week. Can you give us a preview of what to expect for the Department of Veterans Affairs? Do you feel confident that the White House pledge is adequately funding everything that you’re looking for? Or if you want to just give us the whole budget, I’m also happy to take that now too.

Secretary Denis McDonough: This is, like the most transparent leak in the history of the government. Leo, I think we’ll let the news be made next week on that but I will say this, Vets are so near and dear to the heart of President Biden that I have absolute confidence that the budget he submits next week will reflect precisely that and will reflect the investments consistent with his view of our sacred obligation to our troops, their families, and their survivors, our Veterans, their families and survivors.

Leo Shane (Military Times): Great. Thank you.

Terrence Hayes (Press Secretary): Neil.

Nihal Krishan (FedScoop): Thanks so much for having this. Nihal Krishan, Tech Reporter with FedScoop. I have a couple questions for the Secretary. So I was curious first of all about some of the unanswered requests that we’ve had based on digitized Veterans records. I know the unanswered requests has fallen to 404,000 from 604,000 but I’m curious if there’s been any improvements or updates there. The funding that’ll be used comes from the National Archives, cloud workspaces from the VA and I’m told that the Archives says that staff will be able to access images and conduct day-to-day processing of Veteran requests. So I wanted to see if you had an update.

Secretary Denis McDonough: I think your question is best directed to the National Personnel Record Center, which is in St.Louis, and it’s run by the National Archives. But I want to say this, if there is a Veteran who is watching now or there is a Veteran who’s reading your reporting who needs a document from the NPRC for their claim – please get in direct touch with us because we are working aggressively and have had a team forward deployed in the NPRC, a VA team forward deployed in the NPRC to get documents for our Veterans claims if they need something. So please have them contact us directly. They would not go into that 400,000-person line. We would be able to work their case immediately.

Nihal Krishan (FedScoop): But any new updates in terms of your relationship, the Archives – to make that easier?

Secretary Denis McDonough: No. Other than that we have been, as I’ve talked in this room, the efforts that we’ve taken to work jointly with the Archives to make sure that we can get those documents in a timely way. We offered some vaccine to the Archive’s personnel so they can come back to work. We have had teams deployed inside the NPRC so we can continue our work to digitize those records. It’s a very collaborative relationship, but again, I want no Veteran to be concerned that he’s going to have to go or she’s going to have to go to the back of that line. They need only contact us. We’ll get the documents. We’ve said this, we’ve said as much to Congress as well.

Nihal Krishan (FedScoop): Understood. Thank you. And then I was, I was curious, you were talking about Deputy Under Secretary, Donald Remy’s exit – I was curious what the Department is going to do to make sure his Acting Deputy Guy Kiyokawa, has the resources to effectively manage the EHR Modernization Program while you search for a replacement because it seems like this could be an opportunity for Oracle Cerner to go about their business the way that they have the past year if there’s gaps.

Secretary Denis McDonough: Well, why don’t you check in with them and see if they feel any less pressure from me and then you can report back on that.

Nihal Krishan (FedScoop): But any new sort of strategy or actions in terms of…

Secretary Denis McDonough: Only the one I’m currently employing.

Nihal Krishan (FedScoop): Gotcha. And then, and then very lastly, I was curious with, with the PACT Act, which you spoke about earlier, I’ve been in touch with some Veterans groups and associations and there’s a lot of fear that there’s going to be a significant increase in Veterans applying for benefits and going through the systems that are in place right now, and that there’s already significant delays – that’s the Veterans I’ve spoken to. In terms of receiving benefits, is there a particular plan in place, particularly with the technology? For example, like, I know Microsoft is currently the only contractor when it comes to the systems that Veterans receive benefits on. Is there a strategy to perhaps have other vendors come on board or to basically enlarge capacity and scale for the hundreds of thousands, if not more, benefits requests that the VA is expected to get, with current delays in benefits?

Secretary Denis McDonough: Yes. First, you’ll see beginning tomorrow and be able to follow very closely how we’re doing on that question, right? So we’re not going to hide anything on that. You’ll be able to see how we’re doing on that, and that’s why when I come out here every month. I give you the latest, backlog numbers, the latest hires numbers. I’ll talk to you through those in here in a second. That’s point one. Point two, I’ve also promised members of Congress and I’ve also said in this room, that we will look at every part of this process, and if we can through the use of contractors or through the use of new procedures, shorten the period to get claims to our Veterans, we will do it. And that’s one of the reasons why we now provide more claims more quickly to more Veterans than at any time in VA’s history. Third, an example of that is something that I’ve talked about in here before, which is our process to increase the use of automated decision support tools. We had last year the leader of that effort, Rob Reynolds, come in and brief you guys on how we intend and how we are using technology and new processes to make better use of all those digitized records. We’ll continue doing that but I don’t have any additional RFPs or any initial grantees or anything to announce for you today. We’re going to continue to work this to ensure that Vets get timely access to the benefits that they’ve earned and so richly deserve.

Nihal Krishan (FedScoop): So you see there’s already a sufficient plan in place for scale?

Secretary Denis McDonough: No, that’s not what I said. I’m saying that we are constantly improving the plan. Constantly. And that we’re never resting that somehow we think we’ve fixed this perfectly, and we’re constantly looking at how we can make it better, how we can make it faster. A classic example of that is the automated decision support tools. And I got to tell you, I am so proud of that team for pushing as aggressively as they are, and I urge them to keep pushing consistent with the efforts that Rob Reynolds came in here and briefed you guy about last year.

Nihal Krishan (FedScoop): Thank you very much. Thank you for your time.

Secretary Denis McDonough: Thank you.

Terrence Hayes (Press Secretary): Shaba. I pray that I’m saying your name correctly. We haven’t made…

Bigad Shaban (NBC Bay Area): Oh yeah. Shaban is the last name, but I’ve heard much worse. I appreciate you.

Terrence Hayes (Press Secretary): Well, I apologize.

Bigad Shaban (NBC Bay Area): No, no apology needed.

Terrence Hayes (Press Secretary): Thank you for joining us today.

Bigad Shaban (NBC Bay Area): Yeah. Thank you for having me. Mr. Secretary, thanks for the time. I wanted to follow up on the racial disparities that the VA has recently acknowledged. I’m giving you a chance to speak directly to black Vets. When the GI Bill was first implemented back in 1944, black Vets were often unable to get the benefits they deserved. Now, nearly 80 years later, black Vets are still facing those same struggles. Mr. Secretary, you’re at the helm of the VA. Isn’t that a gross failure of your agency?

Secretary Denis McDonough: We’ve talked a lot about this in this room, and I feel like when President Biden asked me to or told me to take this job, he didn’t say my job was to fight like hell for some Vets. He said, your job is to fight like hell for all Vets and that’s what we’re going to do. And that includes black Vets. That includes everybody. So, that’s what we’re doing. There’s more we can do and there’s more we will do.

Bigad Shaban (NBC Bay Area): And a follow up question. There are more than 2 million black Vets in America, but right now your agency can’t say how many of those Vets have been victims of the VA’s discrimination. The VA has said it as actively working to right these wrongs, but how exactly can it do that if it still isn’t clear about how widespread the problem actually is?

Secretary Denis McDonough: Thanks very much for the question. The way we are setting out about working this is we’re standing up an equity team, to build on the work that we’ve carried out to date, to ensure that we get to the bottom of what has happened and why, and to make sure that we’re implementing structural changes, procedure changes, policy changes as necessary to ensure it doesn’t happen again or doesn’t continue to happen. As I’ve indicated, I think the PACT Act is a particularly important tool for us in that effort.

Bigad Shaban (NBC Bay Area): And a last follow up, can you tell black Veterans right now definitively that that type of discrimination is no longer happening at the VA?

Secretary Denis McDonough: We had a great community forum in here all day, well, all morning and into the early afternoon, on Monday with leading black Veteran serving organizations. And it was a very powerful and very important learning opportunity for us to hear from our black Veterans about their experiences. We are applying those learnings and ensuring that we are getting better every day. Here’s what I tell every Vet – I’m here to fight like hell for all Vets. That’s what the president asked me to do. He didn’t say fight like hell for some of them. So we are going to use all the tools that we have to ensure that every single Veteran, gets timely access to world-class care and gets all the benefits that they have earned and so richly deserve.

Bigad Shaban (NBC Bay Area): And forgive me, Mr. Secretary, I didn’t hear an answer there. Can you definitively tell black Veterans that?

Secretary Denis McDonough: I can give you the answer again if you like and as I said, we had a very engaging meeting on Monday with many of our black Veteran serving organizations. We are constantly working to improve and our goal is simply stated to ensure that each and every Vet gets the timely access to world class care and gets timely access to the benefits that they have earned and so richly deserve.

Bigad Shaban (NBC Bay Area): So, I just want to clarify. You can’t definitively say that that discrimination has stopped within the VA?

Secretary Denis McDonough: I’m saying that we are fighting every single day to get every Vet everything that they have earned. And I’m going to let Veterans determine whether we’ve succeeded at that. I’ve said in this room many times that the ultimate arbiters of our success will be Veterans and their experience. That’s what interests me most, and that’s why we have continued to as aggressively push this as we have.

Bigad Shaban (NBC Bay Area): Thank you, sir.

Secretary Denis McDonough: Yeah.

Courtney Kube (NBC News):  Can I have one quick follow-up?

Terrence Hayes (Press Secretary): Yeah.

Courtney Kube (NBC News):  Forgive me if I’m wrong about this, but didn’t you create the diversity and inclusion office here? I guess what I’m, what I’m struggling with is that’s been around now since 2021.

Secretary Denis McDonough: Yes.

Courtney Kube (NBC News):  And how is this, this team going to be different? Or will it build on that? I mean, with all due respect, it kind of sounds like you are creating more teams or more groups to look at something that’s already been looked at and…

Secretary Denis McDonough: I think it’s a very fair question. And what I said, and earlier in my remarks is that the equity team, consistent with the president’s EO, will take these steps building on the work that we’ve done through our – the group you’re talking about is our IDEA committee that we’ve had since we arrived. And they are expressly to look at what are the structural changes? What are the policy changes? What are the procedures changes that we can undertake to address this historic disparate treatment on their benefits?

Courtney Kube (NBC News):  Things that were identified by the committee, the equity team will then take into an implementation phase, essentially that?

Secretary Denis McDonough: Partially, but we’re also trying to make sure that we are concretely taking steps in each administration to change policies and structures if we need to and procedures to address historic disparate treatment.

Terrence Hayes (Press Secretary): Jory. Good afternoon, Jory.

Jory Heckman (Federal News Network): Good afternoon. Sorry I can’t join you all in person, but thank you for doing this. And, Mr. Secretary, thank you for giving an update on where things stand with collective bargaining across several federal employee unions and that progress is being made on those contract negotiations. As far as the things that still are on the negotiating table, are there any items you’re able to unpack in any detail that are significant as they pertain to the federal workforce? I think one common element here is that they are very concerned about staffing up, given the increased workload under the PACT Act.

Secretary Denis McDonough: Yeah, Jory, thanks for the question. It won’t surprise you to say I’m not going to get into the specifics of the ongoing negotiation, but I think we all share a common goal to increase hiring and we all share some frustration with how, as we’ve talked about in this room – including a couple months ago with Jessica Bonjorni and Aaron Lee and Lisa Thomas about the slowness of our onboarding process across the enterprise, but we’re continuing to make progress on that as well.

Jory Heckman (Federal News Network): Alright, and then as far as I know one part of the PACT Act is staffing up on Human Resources, having those HR teams to do the kind of long-term workforce hiring and planning that they’ll need to do. Are there any updates there in terms of how things are going, getting the hiring of the hirers done and accomplished?

Secretary Denis McDonough: Yeah, so let me give you a couple of numbers. We are at end strength at VHA, through basically the first part of this second quarter of FY 23 is 2.1% up on last year. So end strength is up 2.1%, VBA new hires, pursuant to the PACT Act – 1,253 new hires, that’s this fiscal year. So, those are a couple of the numbers that I think I can share with you today.

Jory Heckman (Federal News Network): Thank you.

Terrence Hayes (Press Secretary): Patricia.

Patricia Kime (Military.com): Just one more question about the equity committee. You mentioned access to care and benefits, but are you also looking at healthcare disparities?

Secretary Denis McDonough: That would surely be something that we have been looking at, including through the IDEA subcommittee and through the Center for Minority Vets. And it’s something that we track constantly. For example, you’ll recall that we had a whole series of discussions in here about access to Covid 19 Vaccine and the priorities we placed there on ensuring that all Vets had access to Vaccine. So that’s an ongoing effort we would surely ask the equity team to look at it. We’re asking them though, to start with this question, the first order of business – is this question of benefits?

Patricia Kime (Military.com): There’s just been a number of high-profile studies, medical studies about VA and about the disparities, and access to health, to medicine for covid and other issues.

Secretary Denis McDonough: And most of them conducted by VA. And most all of them using VA data and so it’s something that is an ongoing driver of our research agenda, ongoing effort at VHA, but also an ongoing effort of our program offices, including the ones I mentioned, like the Center for Minority Vets.

Patricia Kime (Military.com): Okay. Thank you, sir.

Secretary Denis McDonough: Thank you. Pat.

Terrence Hayes (Press Secretary): Back to you, Lucy. You had a follow up? You there Lucy?

Lucy Bustamante (NBC10 Philadelphia): Yes. Sorry about that. Thank you, Terence. I was reading in a previous transcript, this is regarding the PACT Act, that 1.5 million Veterans had already been screened for toxic exposure. Do you have results on how many of them tested positive or showing any signs of cancer?

Secretary Denis McDonough: Thanks, Lucy. The number of toxic exposure screenings now since August 10th last year when the president signed the bill is now 2,115,264. So, we don’t have any updates on specific diagnoses that have come from that. What we do know, I don’t have the most recent number, but, what we had been learning from the toxic exposure screenings is that in between three out of 10 or four out of 10, so between 30 and 40% of Veterans who are screened have some additional potential exposure that we had not known of before, which is meaningful in as much as the Veterans who are getting the toxic exposure screening are Veterans already in our care. So if up to between 30 and 40% of those Veterans are telling us something new about their exposures, that gives you a sense of the breadth of toxic exposure among our Vets. And so again, I don’t have data in front of me, Lucy, that connects the screenings to ultimate diagnoses but I do know that each of those screenings gets onward forwarded for additional consideration to specialists and deeper dives.

Lucy Bustamante (NBC10 Philadelphia): Alright. Thank you sir.

Terrence Hayes (Press Secretary): Melissa.

Melissa Burke (The Detroit News): This is a quick one. I understand you guys are working on a revised calendar for the rollout for Michigan and other places for the Cerner EHR to come out in May.

Secretary Denis McDonough: Yes.

Melissa Burke (The Detroit News): And Michigan’s had some changes. I was just curious if Detroit – will they find out, for example, in May potentially, that they’re going live the next month? Are you going to be adding any… Right now I don’t think they know when they’re going live but I’m just wondering if potentially they had been scheduled for June, so I just didn’t know if you had any contact dates there?

Secretary Denis McDonough: No, nobody will be notified the month before they go live because there’s just too much prep to be ready. And that’s one of the reasons that we took the step we took, I think about two weeks ago now, when we announced the delay in the deployment to Ann Arbor, especially given that that would be the first level one facility, especially one with a very robust research department. So, we have not rolled out the additional schedule to anybody internally or externally. We’ll be doing that in the weeks ahead. And when we do that, obviously we’ll communicate that to you, but we’ll also aggressively communicate that internally to VA.

Melissa Burke (The Detroit News): Thanks.

Secretary Denis McDonough: Thanks.

Terrence Hayes (Press Secretary): Any additional questions? Neal?

Nihal Krishan (FedScoop): Thanks. Just a couple quick ones. So, on the topic of the EHR Secretary, the Michigan VA I know has been delayed by about six months now. I was curious, Dr. Elnahal mentioned this just last week when he had our conference with us. It seems like this medical research capabilities, issue is one that many VA hospitals, potentially hundreds of them, will face. I’m just curious if there’s a plan of action there, or like how long it might take to fix said medical research issues with the Oracle Cerner EHR.

Secretary Denis McDonough: I don’t have anything more to give you than whatever Shereef gave you last week, but I’m really glad that you guys are taking advantage of now the monthly press conferences with the under secretaries too. I think that’s great that you guys can get that kind of granularity with them, actually talk to people who know stuff other than our guests. Because normally you’re subjected to me, who doesn’t know anything.

Nihal Krishan (FedScoop): Okay. So nothing further. And then, I was curious, there’s been a series of interruptions in the EHR within the five hospitals, even in January itself, just in the past few weeks, any further insight or granularity?

Secretary Denis McDonough: I don’t have anything more for you on that.

Nihal Krishan (FedScoop): Okay. Thank you.

Secretary Denis McDonough: Thank you.

Terrence Hayes (Press Secretary): Well, I believe this concludes this month’s press conference.,

Secretary Denis McDonough: It’s a long, long press conference today. Terrence Hayes (Press Secretary): It was, it was. But, thank you again to the members of the press for joining us. Thank you to our teammates, watching and our Veterans as well. Sir, thank you again, Mr.Rog