Improving Confidence in Veterans' Care Act
Floor Speech
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Mr. TAKANO. Madam Speaker, I move to suspend the rules and pass the bill (H.R. 3530) to amend title 38, United States Code, to direct the Secretary of Veterans Affairs to enforce the licensure requirement for medical providers of the Department of Veterans Affairs, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows: H.R. 3530
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Confidence in Veterans' Care Act''. SEC. 2. COMPLIANCE WITH REQUIREMENTS FOR EXAMINING QUALIFICATIONS AND CLINICAL ABILITIES OF DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROFESSIONALS.
(a) In General.--Subchapter I of chapter 74 of title 38, United States Code, is amended by adding at the end the following new section: ``Sec. 7414. Compliance with requirements for examining
qualifications and clinical abilities of health care
professionals
``(a) Compliance With Credentialing Requirements.--The Secretary shall ensure that each medical center of the Department, in a consistent manner--
``(1) compiles, verifies, and reviews documentation for each health care professional of the Department at such medical center regarding, at a minimum--
``(A) the professional licensure, certification, or registration of the health care professional;
``(B) whether the health care professional holds a Drug Enforcement Administration registration; and
``(C) the education, training, experience, malpractice history, and clinical competence of the health care professional; and
``(2) continuously monitors any changes to the matters under paragraph (1), including with respect to suspensions, restrictions, limitations, probations, denials, revocations, and other changes, relating to the failure of a health care professional to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.
``(b) Registration Regarding Controlled Substances.--(1) Except as provided by paragraph (2), the Secretary shall ensure that each covered health care professional holds an active Drug Enforcement Administration registration.
``(2) The Secretary shall--
``(A) determine the circumstances in which a medical center of the Department must obtain a waiver under section 303 of the Controlled Substances Act (21 U.S.C. 823) with respect to covered health care professionals; and
``(B) establish a process for medical centers to request such waivers.
``(3) In carrying out paragraph (1), the Secretary shall ensure that each medical center of the Department monitors the Drug Enforcement Administration registrations of covered health care professionals at such medical center in a manner that ensures the medical center is made aware of any change in status in the registration by not later than seven days after such change in status.
``(4) If a covered health care professional does not hold an active Drug Enforcement Administration registration, the Secretary shall carry out any of the following actions, as the Secretary determines appropriate:
``(A) Obtain a waiver pursuant to paragraph (2).
``(B) Transfer the health care professional to a position that does not require prescribing, dispensing, administering, or conducting research with controlled substances.
``(C) Take adverse actions under subchapter V of this chapter, with respect to an employee of the Department, or terminate the services of a contractor, with respect to a contractor of the Department.
``(c) Reviews of Concerns Relating to Quality of Clinical Care.--(1) The Secretary shall ensure that each medical center of the Department, in a consistent manner, carries out--
``(A) ongoing, retrospective, and comprehensive monitoring of the performance and quality of the health care delivered by each health care professional of the Department located at the medical center, including with respect to the safety of such care; and
``(B) timely and documented reviews of such care if an individual notifies the Secretary of any potential concerns relating to a failure of the health care professional to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.
``(2) The Secretary shall establish a policy to carry out paragraph (1), including with respect to--
``(A) determining the period by which a medical center of the Department must initiate the review of a concern described in subparagraph (B) of such paragraph following the date on which the concern is received; and
``(B) ensuring the compliance of each medical center with such policy.
``(d) Compliance With Requirements for Reporting Quality of Care Concerns.--When the Secretary substantiates a concern relating to the clinical competency of, or quality of care delivered by, a health care professional of the Department (including a former such health care professional), the Secretary shall ensure that the appropriate medical center of the Department timely notifies the following entities of such concern, as appropriate:
``(1) The appropriate licensing, registration, or certification body in each State in which the health care professional is licensed, registered, or certified.
``(2) The Drug Enforcement Administration.
``(3) The National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.).
``(4) Any other relevant entity.
``(e) Prohibition on Certain Settlement Agreement Terms.-- (1) Except as provided by paragraph (2), the Secretary may not enter into a settlement agreement relating to an adverse action against a health care professional of the Department if such agreement includes terms that require the Secretary to conceal from the personnel file of the employee a serious medical error or lapse in clinical practice that constitutes a substantial failure to meet generally accepted standards of clinical practice as to raise reasonable concern for the safety of patients.
``(2) Paragraph (1) does not apply to adverse actions that the Special Counsel under section 1211 of title 5 determines constitutes a prohibited personnel practice.
``(f) Training.--Not less frequently than biannually, the Secretary shall provide mandatory training to employees of each medical center of the Department who are responsible for any of the following activities:
``(1) Compiling, validating, or reviewing the credentials of health care professionals of the Department.
``(2) Reviewing the quality of clinical care delivered by health care professionals of the Department.
``(3) Taking adverse privileging actions or making determinations relating to other disciplinary actions or employment actions against health care professionals of the Department for reasons relating to the failure of a health care professional to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.
``(4) Making notifications under subsection (d).
``(g) Definitions.--In this section:
``(1) The term `controlled substance' has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
``(2) The term `covered health care professional' means a person employed in a position as a health care professional of the Department, or a contractor of the Department, that requires the person to be authorized to prescribe, dispense, administer, or conduct research with, controlled substances.
``(3) The term `Drug Enforcement Administration registration' means registration with the Drug Enforcement Administration under section 303 of the Controlled Substances Act (21 U.S.C. 823) by health care practitioners authorized to dispense, prescribe, administer, or conduct research with, controlled substances.
``(4) The term `health care professional of the Department' means the professionals described in section 1730C(b) of this title, and includes a contractor of the Department serving as such a professional.''.
(b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7413 the following new item: ``7414. Compliance with requirements for examining qualifications and clinical abilities of health care professionals.''.
(c) Deadline for Implementation.--The Secretary of Veterans Affairs shall commence the implementation of section 7414 of title 38, United States Code, as added by subsection (a), by the following dates:
(1) With respect to subsections (a), (c)(2), (d), and (f), not later than 180 days after the date of the enactment of this Act.
(2) With respect to subsection (c)(1), not later than one year after the date of the enactment of this Act.
(3) With respect to subsection (b)(2), not later than 18 months after the date of the enactment of this Act.
(d) Audits and Reports.--
(1) Audits.--The Secretary of Veterans Affairs shall carry out annual audits of the compliance of medical centers of the Department of Veterans Affairs with the matters required by section 7414 of title 38, United States Code, as added by subsection (a). In carrying out such audits, the Secretary--
(A) may not authorize the medical center being audited to conduct the audit; and
(B) may enter into an agreement with another department or agency of the Federal Government or a nongovernmental entity to conduct such audits.
(2) Reports.--Not later than one year after the date of the enactment of this Act, and annually thereafter for five years, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report on the audits conducted under paragraph (1). Each such report shall include a summary of the compliance by each medical center with the matters required by such section 7414.
(3) Initial report.--The Secretary shall include in the first report submitted under paragraph (2) the following:
(A) A description of the progress made by the Secretary in implementing such section 7414, including any matters under such section that the Secretary has not fully implemented.
(B) An analysis of the feasibility, advisability, and cost of requiring credentialing employees of the Department to be trained by an outside entity and to maintain a credentialing certification.
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Mr. TAKANO. Madam Speaker, I request unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and to insert extraneous material on H.R. 3530, as amended.
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Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in support of H.R. 3530, as amended, the Improving Confidence in Veterans' Care Act, introduced by Representative Cloud of Texas.
This legislation requires the Department of Veterans Affairs to conduct better oversight of its hospitals' compliance with existing policies on patient safety and quality of care. Specifically, the bill directs VA to conduct annual audits and to report to Congress on its ability to uphold or failure to follow standards for reviewing the clinical competency of its healthcare professionals.
This bill mandates that VA examine whether its hospitals are appropriately assessing the qualifications and clinical abilities of VA healthcare professionals, both before they are hired and while they are caring for veterans. It also requires VA to ensure employees and contractors hold active Drug Enforcement Administration registrations if they are required to prescribe, dispense, administer, or conduct research with controlled substances.
If concerns arise related to the clinical competence of VA healthcare professionals, this bill requires VA to ensure its officials conduct prompt reviews. And when quality of care or patient safety concerns are substantiated, it requires VA to ensure its hospital leaders promptly report those concerns to the National Practitioner Data Bank and State licensing boards.
In addition, this measure requires VA to provide mandatory biannual training for hospital employees charged with reviewing VA clinician credentials and monitoring their clinical practice.
The Veterans Affairs' Subcommittee on Oversight and Investigations held a hearing related to these issues on October 16. At the hearing, my colleagues and I discussed several concerning cases of clinical incompetency and misconduct among VA clinicians that were widely reported in the media in recent months. We also explored the very real risks of patient harm that arise from VA medical centers' noncompliance with departmental policies and a lack of oversight on the part of leaders who are higher up in VA's chain of command.
For example, in August 2019, a former VA pathologist in Arkansas was charged with involuntary manslaughter, fraud, and making false statements in an attempt to conceal years of substance abuse. Over his 11-year tenure with VA, he is believed to have botched diagnoses for an estimated 3,000 veterans, some of whom died.
The VA facility that employed this physician either did not catch or ignored his previous DUI convictions when they hired him. Despite numerous complaints from colleagues, it took years for leadership at the facility to investigate allegations that the doctor was showing up drunk at work.
In addition, in September 2019, the VA OIG reported that multiple leadership failures and poor oversight of clinical competency at a VA facility in the Midwest allowed an ophthalmologist to perform substandard surgery and clinic laser procedures for 2 years. This doctor regularly took hours to complete cataract surgeries that should have taken less than 30 minutes.
The facility director and chief of staff repeatedly dismissed concerns that were raised by other staff, and facility leaders never called on experts to directly observe this doctor's surgeries until long after concerns were raised. VA's regional leaders also failed to carry out related oversight responsibilities.
Both the VA Office of Inspector General and the U.S. Government Accountability Office have identified longstanding concerns with whether VA is doing enough to ensure its medical facilities only employ and contract with highly qualified, highly competent healthcare professionals.
H.R. 3530, as amended, will require VA to implement a number of GAO recommendations that were discussed at the October 16 hearing. Both the Federation of State Medical Boards and the National Council of State Boards of Nursing support this legislation. I urge all Members to join me in approving this important bill.
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Mr. TAKANO. Madam Speaker, I yield myself the balance of my time.
Let me say that it was with bipartisan shock and horror that we heard of the revelations in Arkansas. Certainly, our bipartisan hearts go out to the families of those veterans in Arkansas. Rest assured, this committee, on a bipartisan basis, will do everything that we can to make sure that these sorts of hiring mistakes do not happen again and that the tragedy we saw in the facilities in Arkansas do not happen again.
I urge all of my colleagues to support H.R. 3530, as amended, and I yield back the balance of my time.
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