A panel of representatives of veterans' organizations, consisting of: John F. Sommer, Jr., deputy director, National Veterans Affairs and Reha- bilitation Commission, The American Legion, accompanied by Paul S. Egan, deputy director, National Legislative Commission; Philip_R. Mayo, special assistant, National Legislative Service, Veterans of For- eign Wars of the United States; David W. Gorman, associate deputy national legislative director, Disabled American Veterans; and R. Jack Powell, executive director, Paralyzed Veterans of America. Hon. Alan K. Simpson, chairman of the Senate Committee on Veterans' Hon. George J. Mitchell, a U.S. Senator from the State of Maine.. Hon. Rudy Boschwitz, a U.S. Senator from the State of Minnesota Donald L. Custis, M.D., Chief Medical Director, Veterans' Administration. Ewald W. Busse, M.D., dean emeritus, Duke University Medical Center, Durham, NC, and chairman of the Geriatrics and Gerontology Advisory Committee to the Veterans' Administration....... Terrie Wetle, Ph.D., assistant professor, Division of Health Policy Re- search and Education, Harvard University Medical School, Cambridge, Leonard Saxe, Ph.D., psychologist, Boston University, Boston, MA Sandra K. Hill, R.N., C.A.C., M.B.A., director, Suburban Hospital's Alco- holism Treatment Services, Bethesda, MD, and president, board of trustees, Baltimore Alcoholism Treatment Center, Baltimore, MD. Leo Ruffing, member of the board of directors, Association of Halfway House Alcoholism Programs of North America, Inc., St. Paul, MN John R. Smith, M.A., clinical program director appointee, Center for Trauma Recovery, Brecksville Division, VA Medical Center, Cleveland, Martin H. Cohen, M.D., Chief, oncology section, Veterans' Administration John F. Sommer, Jr., deputy director, National Veterans Affairs and 371 Jack J. Dack, legislative chairman, National Association of State Veter- R. Jack Powell, executive director, Paralyzed Veterans of America Gwenyth R. Vaughn, Ph.D., Chief of Audiology and Speech Pathology Service, Veterans' Administration Medical Center, Birmingham, AL.... Joe Collins, executive director, California Association of Alcoholic Recov- Joan M. Maiman, Vietnam civilian volunteer, Chicago, IL..... Maureen E. Nerli, Vietnam civilian volunteer, Burlingame, CA. Response to written questions submitted by Hon. Alan K. Simpson, chair- Ewald W. Busse, M.D., dean emeritus, Duke University, Durham, NC, and chairman of the Geriatrics and Gerontology Advisory Committee to the Veterans' Administration..... Leonard Saxe, Ph.D., assistant professor, Department of Psychology, Boston University, Boston, MA.. Sandra K. Hill, R.N., C.A.C., M.B.A., director, Suburban Hospital's Alcoholism Treatment Services, Bethesda, MD, and president, board of trustees, Baltimore Alcoholism Treatment Center, Balti- Leo Ruffing, member of the board of directors, Association of Half- way House Alcoholism Programs of North America, Inc., St. Paul, 281 283 287 Page Questions and answers-Continued Response to written questions submitted by Hon. Alan K. Simpson, chair- Martin H. Cohen, M.D., Chief, Oncology Section, Veterans' Adminis- Sharron Dreyer, B.S.N., assistant administrator, Patient Care Serv- 308 341 368 Response to written questions submitted by Hon. Alan Cranston, ranking minority member of the Senate Committee on Veterans' Affairs, from: Ewald W. Busse, M.D., dean emeritus, Duke University, Durham, Hon. Strom Thurmond, a U.S. Senator from the State of South Hon. Rudy Boschwitz, a U.S. Senator from the State of Minnesota 218 Arthur L. Arnold, M.D., Chief, Psychiatry Service, Veterans' Admin- istration Medical Center, Phoenix, AZ, dated May 3, 1984...... Dr. Donald L. Custis, Chief Medical Director, Veterans' Administration, from Hon. Alan Cranston, ranking minority member of the Senate Committee on Veterans' Affairs, dated March 13, 1984. Hon. Alan Cranston, ranking minority member of the Senate Committee Hon. George J. Mitchell, a U.S. Senator from the State of Maine, from Harry N. Walters, Administrator, Veterans' Administration, Washing- APPENDIXES APPENDIX A.-Bill S. 2514, as reported by the Committee on Veterans' Af- fairs, with an amendment and an amendment to the title, May 25, 1984. APPENDIX B.-Excerpts from Senate Report No. 98-487 to S. 2514, May 25, 548 VETERANS' ADMINISTRATION HEALTH CARE AMENDMENTS OF 1984 WEDNESDAY, APRIL 11, 1984 U.S. SENATE, COMMITTEE ON VETERANS' AFFAIRS, Washington, DC. The committee met, pursuant to notice, at 10:10 a.m., in room SR-418, Russell Office Building, Hon. Alan K. Simpson (chairman of the committee) presiding. Present: Chairman Alan K. Simpson, Senators Alan Cranston, Strom Thurmond, and George J. Mitchell. OPENING STATEMENT OF HON. ALAN K. SIMPSON, CHAIRMAN OF THE SENATE COMMITTEE ON VETERANS' AFFAIRS Chairman SIMPSON. Good morning and welcome to the Committee on Veterans' Affairs hearing. We are going to consider several legislative proposals which would address certain health-care programs administered by the VA, testimony on several bills I have introduced, S. 2514 and S. 2210, S. 2269, introduced by my fine colleague from California, and an amendment to S. 2269 proposed by Senator Cranston. The names of the various bills will be included in the record. We will hear from the VA, members of the private sector, health-care specialists, representatives from the veterans groups and see what we have for us which would improve the VA's efforts to deliver quality health care to our Nation's veterans. During my tenure as chairman, we have pondered and we have probed a number of important issues, which I believe are critical to the ability of the VA to provide high quality health-care services to the Nation's veterans. Of course, we must continue to think of the staggering size of the Federal deficit that we are dealing with on the floor of the Senate this week, its implications for all programs, not just VA; the future of fulfilling what has been an unwavering commitment to take care of the Nation's veterans who gave a special effort and who are now disabled; health care to elderly veterans, the need for which is going to continue to increase in intensity and scope, including alternatives to institutionalization; the question of eligibility and how to cope with expanding demand within the context of a very finite amount of resources; and the question of the use of limited resources to renovate, replace, or construct VA centers and nursing homes. Of equal magnitude and importance is the question of quality of care, an abstract concept which often really defies our attempts to measure and quantify. I firmly believe the issue of quality of care is an important factor in every policy decision that the Congress must make with respect to the authorization and appropriation of health-care dollars for use by the VA and every administrative and management decision that is made by the VA with respect to the allocation of those resources to improve existing services and to establish new programs. It is a tough task, because the VA must balance the need to serve large numbers of veterans with the management task of allocating sufficient numbers and kinds of staff and resources to accomplish its missions. We in the Congress would like to provide the VA with sufficient flexibility to make these very hard management decisions and to indeed practice your professional course, which is the practice of medicine and to take care of our Nation's veterans as the health-care professionals have been trained and are qualified well to do. And I have no desire to dabble in restricting or commenting upon the practice of medicine. That is not my intent, but certainly there are some guidelines that have to be discussed with regard to the VA's capabilities within the context of oversight by this committee. The responsibility of Congress is to be accountable to the citizens of the country, including the veterans, for the scope of medical care programs provided in our own VA facilities. At the same time it is the appropriate role of the Congress and my commitment as chairman to oversee more than an $8 billion medical care budget. In that regard, we continue to seek a dialog on the services it provides, what services it feels it should continue to provide, and the eligibility, all of those things, implications of those used for the future of the system. Certainly, we will not always agree on those things, but I have enjoyed working with the VA in the spirit of cooperation as we pursue that. So we seek your testimony today from these various resources that are here to testify in order that we might benefit from your experience and knowledge in these areas. We have quite a number of issues that will be discussed and I request that you summarize your statements in no more than 5 minutes and then highlight one or two issues that you may wish to particularly emphasize. And we will allow 10 minutes per member for questions on the first round and an additional 10-minute period for questions thereafter. Of course the entire statements of the witnesses will be included in the reco.d in the appropriate place. [The prepared statement of Hon. Alan K. Simpson, chairman of the Senate Committee on Veterans' Affairs, follows:] |