The Honorable Sloan Gibson, Acting Secretary of Veterans Affairs

Dear Acting Secretary Gibson,     June 13, 2014

I am writing to express my serious concerns regarding the leadership of the VA Pacific Islands Health Care System (PIHCS), Director Wayne Pfeffer. I request your serious consideration of the issues I'm raising, and ask that you take immediate action.

The VA PIHCS leadership recently provided information to me on new enrollee wait times, and implementation of the Accelerating Access to Care Initiative in the PIHCS. The information and responses I received from Mr. Pfeffer, a man with 40 years of VA service, were dishonest, lacked transparency, and showed a level of incompetence that should not exist in the VA. I request your immediate attention and action.

On June 5, 2014 members of my staff attended a quarterly update organized by the VA PIHCS. Mr. Pfeffer and senior representatives were present as well as staff from all Hawaii delegation members. My staff representative specifically asked for the current wait time for a newly registered veteran on the New Enrollee Appointment Request (NEAR) List before receiving an appointment with a Primary Care Physician.

Mr. Pfeffer replied explaining the differences between NEAR List and Electronic Wait List (EWL), and then stated the wait time for the NEAR List was "around 30 days." He then referred to a staff member from the Enrollments Department also at the briefing, who confirmed that the NEAR list wait time was between 30-50 days.

This was an inaccurate statement, based on the overwhelming number of constituent cases processed by my office last year on this issue, as well as in light of information released in the recent Veterans Affairs Access Audit.

On June 9, 2014 I spoke to Mr. Pfeffer to question him regarding the inconsistencies in the information he provided my staff in the prior week, and the numbers released in the Access Audit.

During our telephone conversation, Mr. Pfeffer denied ever discussing wait times for the NEAR list with congressional staff at the June 5th briefing.

This blatant display of dishonesty undermines the nature of public service. Additionally, it reflects an arrogant disregard for our veterans, and being held accountable to the American people.

Moreover, during our conversation I asked whether he was implementing the Accelerating Access to Care Initiative, and if so, what was the status in making sure veterans on wait lists were receiving immediate care.

Mr. Pfeffer replied that he "assumed" it was being implemented, but could provide no details whatsoever. It appeared he was not even aware of the initiative, or that the authority to implement resides at the facility level.

As the director, Mr. Pfeffer should possess a complete understanding of the VA's strategy to implement this initiative, where that authority is executed, especially considering that Secretary Shinseki directed the initiative last month. Most importantly, he should have been aggressively taking action with this initiative to ensure long-waiting veterans were getting immediate access to care.

At the conclusion of our conversation, I requested additional information that Mr. Pfeffer was unable to provide.

(1) I requested the exact number of new enrollees awaiting care at VA PIHCS -Mr. Pfeffer didn't know the exact number but estimated it to be in the 650 range;

(2) the longest waiting time for a new enrollee;

(3) the total number of veterans waiting for care;

(4) and the measures taken to expedite the pre-approval process for maximizing non-VA care.

To date, I have received no answers to any of these questions.

On June 9, 2014 a VA PIHCS representative emailed a response to my staff, stating that the EWL at Honolulu is currently 677 veterans- however, I was not provided with information that I requested concerning the NEAR list, the total number of newly enrolled veterans waiting for care, or the longest waiting time for a new enrollee.

Additionally, VA PIHCS stated that the EWL was reduced from approximately 1,800 in May, to 677 as of June 9, and suggested the EWL is expected to soon reach zero. I have serious doubts about how such a swift reduction in the EWL could have been possible.

These responses that my staff and I have received from the office of Director Pfeffer, and Mr. Pfeffer himself are reprehensible.

I have zero confidence or trust in Mr. Pfeffer's ability to oversee the Pacific Island Health Care System, and I do not believe he deserves to be entrusted with the sacred privilege of caring for our veterans and their wellbeing.

As a Soldier, a veteran, and a member of Congress entrusted with the responsibility of serving the people of Hawaii and our nation, I demand accountability from those not executing their duties and violating the public trust.

Considering my recent encounters with Mr. Pfeffer, I say, without reservation - I have no confidence that he serves the best interest of my fellow veterans, nor do I feel as though he is competent to discharge his duties. The veterans of our state deserve far better, the taxpayers of our nation demand better, and I respectfully urge that you thoroughly review the root causes for the inefficiencies within the Pacific Islands Health Care System starting with its senior management. Mr. Pfeffer should be fired due to his dishonesty, lack of integrity, incompetence, and his flagrant lack of respect and transparency when dealing with those to whom he is ultimately accountable to - the American people and the veterans who defended freedom even when faced with certain peril.

If you require any additional information, I am available to assist you with whatever you need in honoring my requests.

Sincerely,

Tulsi Gabbard

Member of Congress

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Mr. Richard J.Griffin Acting Inspector General Department of Veterans Affairs Office of Inspector General

Dear Acting Inspector General Griffin,  June 6, 2014

I am writing to express my grave concern regarding the allegations of misconduct at Department of Veterans Affairs (VA) hospitals that is denying veterans access to care and endangering their well-being. This is unacceptable. I am eager to learn more from the internal investigation that you are leading to understand whether these incidents arc isolated or are part of a broader, systemic breakdown that the VA must confront to ensure that we do better by our veterans.

It has been brought to my attention that potential incidents of misconduct are affecting veterans seeking care in Hawaii. It is my understanding that the VA Pacific Islands Health Care System (PIHCS) has conducted its own patient access audit and found no evidence of misconduct in Hawaii. however, several constituents have contacted my office with information concerning the Spark M. Matsunaga VA Medical Center one of the facilities that the VA PIHCS reportedly audited. One constituent alleges-through secondhand information from VA doctors and nurses at the Hawaii care facility- that the Chief Administrator asked staff to wipe their computers clean regarding patient wait times. Furthermore, we are told that lower- and mid-level management personnel are being told to "cook-the-books" regarding patients' appointments. Another constituent alleges that an appointment was not entered into the VA's electronic system until throe weeks after the appointment was requested so as to disguise the true wait time.

These are serious allegations, and if there is evidence of wrongdoing then there must be accountability. I request that you investigate these allegations as part of your nationwide review of misconduct at VA hospitals. We owe it to the 117,000 veterans living in Hawaii,many of whom arc rural veterans on the neighbor islands who arc already struggling to access routine care. Moving forward I welcome the chance to work with the VA to improve veterans·health care to ensure that we are fulfilling our commitment.

Thank you for your attention to my request. I await your report on these allegations of misconduct at the VA hospital in Honolulu. Please do not hesitate to contact me if I can be of further assistance.

Sincerely,

U.S. Senator Brian Schatz

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