Hire More Heroes Act of 2015- Motion to Proceed- Continued

Floor Speech

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Mr. JOHNSON. Mr. President, I rise also to join my colleagues in support of a couple of bills that are supporting the finest among us. I certainly want to underscore the thanks that the Senator from South Dakota expressed to the men and women of our military, people to whom we owe a huge debt of gratitude for defending this Nation and fighting for our freedoms.

I also really want to thank the good Senator from Georgia, the chairman of the Veterans' Affairs Committee, for in a very expeditious fashion taking up some very good pieces of legislation that will hold accountable those individuals who are caring for the finest among us in our veterans health care centers.

But before I address those bills, let me make a couple of points about the vast majority of men and women who are working in those VA health care centers. They are dedicated individuals, and they are doing a great job providing health care to the men and women of our Armed Forces. Upon becoming a Senator for Wisconsin, I started visiting the VA medical facilities within our State and also in Minneapolis, a center that also serves veterans from Wisconsin.

What I found did not surprise me at all. I found those dedicated individuals, and they are providing excellent health care. The veterans I spoke to in the halls and throughout the State were very satisfied with the health care they were getting. They were more than satisfied. They heaped praise upon their care providers.

The wait times were pretty long. The parking lots were pretty full. But again, they underscored certainly what I saw--that the vast majority of those men and women--the nurses, the doctors, the administrators--in our VA health care facilities are really dedicated to the task, and they are doing a great job for our veterans. But the fact of the matter is that they are not all doing a good job. It is not a perfect system--not by a long shot. I give the press corps a great deal of credit for breaking stories, first in Arizona, where we saw those long wait times actually resulting in the deaths of some veterans.

Then, in early January, I first became aware, because of a news report, of a real problem in the Tomah, WI, VA health care facility. I think maybe the best way to approach this is to provide a timeline that I provided in a field hearing that we held. It was a joint field hearing between my committee, the Senate Committee on Homeland Security and Governmental Affairs, and the Veterans' Affairs Committee in the House raising the issue in the community.

It was an excellent hearing. It afforded the surviving family members of some of the veterans who had died in the care of the Tomah VA center the ability to tell their stories, to make an impression, and to get the attention of the administrators of the VA to start correcting the problems. But in my opening statement, I laid out a timeline that I would like to repeat here.

In April of 2003, Dr. David Houlihan was disciplined by the Iowa Board of Medicine for having an inappropriate relationship with a psychiatric patient. According to the executive director of the Iowa Board of Medicine, the sanctions should have been a serious concern for future employers.

That was April of 2003. In 2004, Dr. Houlihan was hired as a psychiatrist by the Tomah VA Medical Center. In August of 2005, Dr. Houlihan became chief of staff of the Tomah Medical Center. In November 2007, Kraig Ferrington, a veteran who sought treatment for medication management, died from a lethal mixture of drugs.

Autopsy results showed Mr. Ferrington had seven drugs in his system. In April 2009, it was known and documented by employees of Tomah VA that many patients had called him the Candy Man and that veterans were ``prescribed large quantities of narcotics.'' Again, that was April of 2009.

In June of 2009, Dr. Noelle Johnson was fired from Tomah for refusing to fill prescriptions she believed to be unsafe. Dr. Johnson had raised concerns to her superiors, had sought guidance from the Iowa medical licensing board, and later spoke with the Drug Enforcement Administration about Dr. Houlihan.

In July of 2009, Dr. Chris Kirkpatrick was fired from Tomah. Dr. Kirkpatrick had raised concerns to his union about overmedication at Tomah. Tragically, later that day, on the day of his termination, Dr. Kirkpatrick committed suicide.

In August of 2011, the VA Office of Inspector General received an anonymous complaint about overprescription and retaliation by Dr. Houlihan at Tomah.

In March of 2012, a second anonymous complaint was filed with the IG against Dr. Houlihan. The OIG examined 32 separate examinations during his 2 1/2 -year-long inspection.

In March of last year, 2014, the Office of Inspector General finished its inspection of Tomah and administratively closed the case without making it public.

On August 30 of 2014, Jason Simcakoski died in the Tomah mental health wing as a result of a mixed drug toxicity. Simcakoski was a patient of Dr. Houlihan. His autopsy revealed he had over a dozen different medications in his system.

In September 2014, Ryan Honl began lodging whistleblower complaints about patient safety and quality of care at Tomah.

On January 8, 2015, the Center for Investigative Reporting published an article detailing overprescription and retaliation at Tomah. The article revealed that veterans and employees referred to the Tomah VA Medical Center as ``Candy Land.''

On January 12, 2015, Candace Delis brought her father, Thomas Baer, to the Tomah VA Medical Center with stroke-like symptoms. Mr. Baer waited over 2 hours for attention. That day the facility's CT scanner was down for ``routine preventive maintenance.'' Mr. Baer passed away 2 days later.

On February 26, 2015, the Office of Inspector General finally posted its Tomah health care inspection report on its Web site.

I called Candace Delis, the daughter of Thomas Baer, shortly after I heard of the tragic death of her father. I will never forget what she told me. She said: Ron, had I known the problems at the Tomah VA Medical Center, I never would have taken my father to the facility, and my father would be alive today.

I believe that to be a true statement. Accountability is something that is crucial in any organization. I ran a manufacturing plant for 31 years. I can't tell you how corrosive it is to an organization if individuals within that organization are not doing their job, not pulling their full weight, undermining the shared goals of the organization. It is corrosive.

I was surprised when I offered a piece of legislation and the chairman of the VA committee allowed me to present that piece of legislation to the committee, the Ensuring Veterans Safety Through Accountability Act, and the VA representatives at that hearing were opposed to holding medical professionals accountable.

Fortunately, the chairman, the Senator from Georgia, agreed with me that the only way we are going to reform this system, the only way we can make sure we honor promises through our VA health centers to the finest among us--the men and women of the military--is by holding individuals accountable, which is exactly how the bill was reported out, sponsored by the Senator from Florida.

I truly thank him for his leadership on this issue, and I am pleased to join him as the lead sponsor of that bill. The Department of Veterans Affairs Accountability Act of 2015 will hold every employee within the VA accountable. That is crucial.

Again, I thank our veterans, I thank the Senator from Florida, the Senator from Georgia, and I urge my colleagues to support this piece of legislation. Let's get it passed. Let's start holding those few bad apples--and I truly believe that. I think it is just a few people who need to be held accountable.

A little postscript to my timeline, and I think one of the reasons this piece of legislation is so important is even with that record dating back to 2004--and by the way, our own committee's investigation shows there are employees of the Tomah VA who were referring to the Tomah VA back then as ``Candy Land.'' It is crucial we hold those people accountable. But to date, nobody--after multiple deaths caused by the overprescription of opiates, after the death of Thomas Baer, a veteran who basically died of neglect--has been held accountable by being fired, by being terminated.

Again, there is not, from my perspective, any joy in terminating an employee, but for the good of the organization or to honor the promise of the finest among us, that type of accountability is absolutely necessary.

With that, I yield the floor.

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