Emotions Run High at Community Care Hearing

Witnesses share their heartbreaking stories of how they were impacted by challenges facing the VA's community care network.

January 22, 2025

⚡NIMITZ NEWS FLASH⚡

“Restoring Focus: Putting Veterans First in Community Care”

House Veterans Affairs Committee Hearing

January 22, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

Keywords mentioned:

  • VA MISSION Act, bureaucracy, accountability, timely access to care, mental health care, referrals, quality of care, coordination of care, hiring freeze, electronic health records, privatization, oversight

IN THEIR WORDS

“In my head, I felt like the VA had caused my child's death. It made me feel like I contributed because I was part of the VA.”

Ms. Lori Willis Locklear

“Make no mistake — community care is VA care. It is not a substitute, but an essential extension of VA’s mission to serve veterans where and when they need it without delay.”

Chairman Mike Bost

“I'm not sure whether you're advocating for more community care or better community care; I'm not sure which one it is. If it's better community care, I'm with you all the way. If it's more community care, I'm not sure that we have found the right balance.”

Rep. Julia Brownley

Ms. Lori Willis Locklear gave an emotional testimony about her son’s struggle with mental illness and the failures of the VA and community care that led to his passing. Later, many members of the Committee individually embraced her and thanked her for her words.

OPENING STATEMENTS FROM THE COMMITTEE

  • Chairman Mike Bost welcomed everyone to the first oversight hearing of the 119th Congress and thanked Health Subcommittee Chairwoman Mariannette Miller-Meeks for her leadership on the subject of community care. He stated that the VA’s community care program merited the full Committee’s attention due to its critical importance. He reviewed the purpose of the VA MISSION Act and its intent of delivering timely, quality care to veterans. Chairman Bost clarified that community care was intended to supplement, not privatize, VA healthcare and criticized recent administrative decisions that, in his view, created unnecessary barriers.

  • Ranking Member Mark Takano expressed anguish over veterans’ troubling experiences and thanked the witnesses for their attendance. He argued that the lack of VA officials, third-party administrators, and oversight agencies prevented the Committee from fully examining the community care program’s failures. He stated that community care constituted a significant portion of veterans’ healthcare and demanded more rigorous oversight to avoid undermining VA services. The Ranking Member warned against repeating past mistakes and rushing legislation without first identifying the root causes of access and coordination problems.

SUMMARY OF KEY POINTS

  • Mr. Paul McKenna, a retired Sergeant Major, recounted the struggles he and many veterans in North Carolina faced while trying to use VA community care. He described repeated scheduling delays and confusion regarding eligibility and referrals. Mr. McKenna compared these difficulties to more positive experiences he had elsewhere, suggesting major inconsistencies in the system. He urged the Committee to use his testimony to address these gaps and ensure veterans receive the timely care they deserve.

  • Mr. William Dooley, an Army veteran, shared his harrowing journey with colon cancer and the failures he experienced in receiving timely community care. He explained how a critical colonoscopy was scheduled months later than it should have been, causing his cancer to advance to stage 3. He pointed to communication breakdowns, billing confusion, and a lack of compassion from some VA employees. Mr. Dooley credited intervention from Rep. Keith Self’s office as the key factor in finally obtaining the treatment he needed.

  • Ms. Lori Willis Locklear recounted the story of her son Logan, a Navy veteran who battled severe mental health issues following his service. She explained that the VA system did not adequately address his needs, as he faced long wait times for appointments and little follow-up. She described how his mental health steadily declined due to frustration and distrust of the VA, ultimately leading him to take his own life. Ms. Locklear emotionally implored the Committee to improve mental health services and provide immediate support for veterans in crisis.

  • Ms. Brittany Dymond Murray, representing the VFW, discussed her personal battle with PTSD and the extensive hurdles she encountered while trying to access inpatient treatment. She revealed that rigid geographic rules and slow referral processes delayed her care, forcing her to search tirelessly for appropriate programs. She eventually found partial relief through a compromise program that offered some, but not all, of the therapies she needed. Ms. Dymond Murray argued that no veteran’s life should depend on luck or personal determination to find proper mental health services.

  • Dr. Kelley Saindon, speaking on behalf of the Nurses Organization of Veterans Affairs (NOVA), underscored that while community care was an essential option, it was never intended to replace direct VA care. She noted the rapid increase in community care referrals, which created concerns about staffing shortages, inconsistent provider quality, and insufficient oversight. Dr. Saindon advocated for firm requirements for timely exchange of medical records and enforcement of high standards for community providers. She concluded that maintaining robust VA direct care, supplemented by community care when necessary, was vital to ensuring veterans receive the best possible treatment.

  • Chairman Bost asked Ms. Locklear whether her son’s earlier awareness of his community care eligibility would have made a difference in his mental health treatment. Ms. Locklear explained that her son spent hundreds of dollars out of pocket for mental health services because he distrusted the VA. She said he tried seeking VA care later but encountered paperwork errors and months-long delays in getting a mental health appointment. Ms. Locklear added that if she had known he only received a five-month wait time, she would have intervened immediately, citing his documented history of multiple suicide attempts.

  • Chairman Bost inquired how the VA should fix the issues Mr. McKenna had encountered, especially regarding unclear guidance and multiple referrals. Mr. McKenna contrasted his positive experience in Pensacola, Florida, where referrals were completed within days, with his frustrating experience in eastern North Carolina, where referrals could take up to nine months. He stated that the lack of oversight over the third-party vendor caused delays and that he was not permitted direct contact with that vendor to resolve problems.

  • Ranking Member Takano questioned how the lack of required medical record submission from community providers affected the VA’s ability to coordinate care. Dr. Saindon said this practice posed a significant threat to effective care coordination, as VA providers did not receive critical information about treatments, recommendations, or diagnoses done outside the VA. She argued that payment should be contingent upon timely submission of medical records to the VA so veterans’ continuity of care would not be jeopardized. Ranking Member Takano noted that having the VA and the third-party administrator testify would have helped clarify how to fix this gap.

  • Rep. Greg Murphy asked Mr. McKenna to elaborate on the difference between his efficient community care experience in Florida and the obstacles he faced in North Carolina. Mr. McKenna reiterated that in Pensacola, he received quick approvals for specialty care, whereas in eastern North Carolina, his referrals often stalled for months. He believed that a more streamlined approach, coupled with immediate oversight, would reduce deadly delays in care.

  • Rep. Julia Brownley noted that many veterans report preferring VA care over community care and asked for clarification on whether witnesses wanted more or better community care. Ms. Dymond Murray stressed the need for better community care, rather than merely increasing it. She explained that significant effort often fell on the veteran to find a suitable provider, indicating a lack of VA support in coordinating these referrals. She agreed that strengthening processes and oversight in the community care system would improve veteran experiences overall.

  • Rep. Brownley and the Chairman then had a tense exchange as Chairman Bost once again sought to clarify the Majority’s position that improving community care did not equate to privatizing the VA. He reiterated that the focus must always be on veterans and getting them the care they deserve rather than protecting the existing, oftentimes failing, bureaucracy.

  • Rep. Abe Hamadeh asked what changes to the VA authorization process would ensure urgent issues, such as cancer treatment, were not delayed. Mr. Dooley stated that veterans should be informed of VA wait times first and then be given immediate referrals to community providers if the VA’s timeline is too long. He claimed that his own situation would have been far less dire if he had known how to obtain a quicker referral for his colonoscopy and cancer treatment.

  • Rep. Herb Conaway asked how a recently announced hiring freeze would affect an already understaffed VA system. Dr. Saindon explained that applicants in the hiring pipeline received automated notices rescinding their positions, which damaged the VA’s reputation and worsened staffing shortages. She predicted further limits on inpatient care and clinical access if the VA could not fill critical positions. Dr. Saindon restated that inadequate staffing would increase the reliance on community care, which itself demands additional VA personnel to coordinate effectively.

  • Rep. Keith Self highlighted how Mr. Dooley’s nine-month wait for a colonoscopy allowed his cancer to advance from stage 1 to stage 3 Mr. Dooley confirmed that the long wait reduced his chances of living a long life and forced him to rely on congressional intervention to receive care. He believed the system’s structure favored bureaucracy rather than veteran outcomes. Mr. Self passionately stated that veterans should not need their members of Congress to serve as the first line of defense in securing timely medical care.

  • Rep. Kelly Morrison asked whether any standard training or educational requirements existed for community care providers who treat veterans with complex conditions like PTSD or TBI. Dr. Saindon stated that no consistent, mandatory benchmarks were in place to ensure community providers were prepared to treat veteran-specific conditions. She expressed deep concern that veterans might receive subpar or inappropriate treatment in the community without these standards. Rep. Morrison concurred that the situation underscored the urgent need for stronger oversight and improved hiring within the VA.

  • Rep. Jack Bergman compared the challenges in VA community care to a “whack-a-mole” game, with problems constantly popping up even after several years of attention. He asked Mr. McKenna about his reaction to VA counselors’ unfamiliarity with the VA MISSION Act. Mr. McKenna said he was disappointed that many VA staff knew little about community care under the VA MISSION Act. He proposed that the VA require periodic training for employees so they could effectively explain and implement the law’s provisions.

  • Rep. Delia Ramirez thanked the witnesses for their testimony and expressed concern about ensuring that “community care” meant both choice and quality. She asked how VA clinicians were uniquely prepared to treat veterans compared to community providers. Dr. Saindon described required military competence training for VA employees and additional role-specific training for veteran-related conditions. She added that similar requirements did not exist for most community care providers, which led to inconsistencies in veteran-specific cultural and clinical competencies.

  • Rep. Derrick Van Orden stated that he had participated in multiple hearings where VA officials offered few real solutions. He formally apologized to Mr. Dooley for the government’s failure to diagnose and treat his cancer sooner. He then asked Ms. Locklear and Ms. Dymond Murray if anyone responsible for their negative VA experiences had been held accountable; they each answered “no.” He vowed that, under new leadership, Congress would push to hold VA personnel accountable for delays, waste, and negligence.

  • Rep. Mariannette Miller-Meeks described her background as a nurse, physician, and veteran, sharing that funding for the VA had risen consistently during her time in Congress. She pointed out that many veterans in remote areas are frequently asked to travel hours for VA treatment. She used Mr. Dooley’s case as an example of how a timely colonoscopy might have prevented his cancer from advancing. Mr. Dooley agreed that earlier screening would have been more cost-effective and could have protected his health.

  • Del. Kimberlyn King-Hinds did not ask any questions, but she related to the challenges described by the panelists in accessing quality care. Constituents in her district, the Northern Mariana Islands, are unfortunately familiar with this poor standard. She claimed she was crushed that this was also the case for many veterans on the mainland.

  • Rep. Mark Harris thanked Ms. Locklear for her courage and asked if the VA was following the law regarding maximum wait times and community care eligibility. Ms. Locklear stated that her son had waited five months instead of the legally mandated 20 days before referral, and she was unaware of any improvements the VA implemented. Rep. Harris then inquired how these events affected her personally, and Ms. Locklear recounted feeling ignored by the VA after Logan’s death. She disclosed that she eventually left her VA job due to the emotional toll and her persistent belief that the VA had failed her son.

  • Rep. Maxine Dexter described having been both a VA and private-sector physician, noting that health record continuity was vital to timely cancer and mental health treatments. She acknowledged that many veterans preferred receiving care at VA facilities when those facilities had the resources to provide comprehensive services. Rep. Dexter stated that building greater capacity within the VA system could control costs, rather than funneling veterans to private practices without oversight.

  • Chairman Bost assured the panel and Committee members that this hearing would not be the last on the topic and that additional witnesses—such as third-party administrators—would be brought forward for further oversight.

SPECIAL TOPICS

 🖤 Mental health and suicide:

  • Ms. Locklear described how her son Logan began exhibiting serious mental health issues during and after his Navy service, including multiple suicide attempts. She stated that Logan tried to get care at VA facilities but lost trust in the system after being turned away or facing excessive delays. She eventually convinced him to seek VA help again, yet he was given an appointment five months away—even though he had a documented high risk for self-harm.

  • Ms. Locklear recounted that Logan also spent large sums out of pocket on private counseling and medications. She felt this was partly because no one at the VA informed him in a timely or consistent way about community care options.

  • Ms. Dymond Murray testified about her personal struggle with PTSD and the delays in being referred for inpatient mental health treatment. She described how rigid location rules and slow processes kept her from accessing specialized trauma therapies (e.g., EMDR, IFS). She ultimately received partial help at an alternative program, but her experience illustrated the difficulty in obtaining immediate and appropriate mental health care through VA referrals.

  • Multiple members of Congress and witnesses noted that veterans struggling with mental health conditions often faced delays in VA scheduling or referrals to community providers. Witnesses and members emphasized that suicidal ideation often requires immediate intervention. Delayed referrals or five-month wait times for high-risk patients were universally deemed unacceptable.

👨‍💻 IT issues:

  • Rep. Van Orden criticized the massive cost overruns and functionality problems of the Cerner electronic health records (EHR) system. He noted that billions of dollars have already been spent, with the total projected cost possibly rising to $50 billion, yet the system reportedly still does not function properly.

  • Members throughout the hearing lamented that ongoing EHR failures slow down referrals, hinder care coordination, and waste funds that could otherwise be directed to veteran care.

  • Several witnesses also mentioned difficulty in transferring medical records between VA and community providers, noting faxes or repeated requests that went unanswered. Rep. Conaway pointed out that better data collection and real-time IT systems were essential to track scheduling, wait times, and care outcomes. The absence of a robust, integrated data platform was seen as a key cause of delays and miscommunication.

📋 Government contracting:

  • Ranking Member Takano and other members criticized the fact that Optum (a subsidiary of UnitedHealthcare) handles billions of dollars in VA community care payments yet did not appear at the hearing.

  • Witnesses and members accused third-party administrators of failing to ensure records were transferred back to the VA, compromising continuity of care. They also questioned why the VA did not tie provider reimbursements to timely record submission.

  • Witness testimony pointed out how complex the referral process became due to the involvement of multiple parties: VA clinics, local urgent care centers, and a third-party vendor. Mr. McKenna reported that he was forbidden from contacting the vendor directly, leaving him in the dark about the status of his delayed referrals.

  • Dr. Saindon urged Congress to add contractual requirements, such as “payment upon receipt of records,” to strengthen oversight of community providers.

  • Some members singled out the VA’s sole-source contract with Cerner to modernize its IT infrastructure, citing repeated budget increases and implementation setbacks. Concerns arose about how these large contracts were negotiated and whether appropriate accountability structures existed to penalize non-performance.

 🧠 Traumatic brain injury (TBI):

  • Mr. McKenna noted that in eastern North Carolina, any referrals he needed for specialized services—such as mental health or TBI assessments—were delayed for months.

  • Although TBI was mentioned by a few members of the Committee, it was not elaborated on in depth.

 ♀️ Women veterans:

  • Rep. Brownley brought up how women veterans often require community care due to the VA not always offering comprehensive women’s health services at every location. She noted that this reliance on outside care frequently prolonged wait times because of additional referral steps, creating confusion between VA and non-VA facilities.

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