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tv   House Appropriations Subcommittee Hearing on Female Veterans  CSPAN  March 4, 2019 6:42pm-7:51pm EST

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>> now veterans affairs officials testify on female veterans healthcare issues and a house appropriations subcommittee hearing on capitol hill. va women's health services chief consultant patricia hayes says the number of women using va health services has tripled since 2001.and women constitute about 16 percent of today's active-duty military forces. this is just over an hour. >> i like to call the meeting of the military constructions and veterans compares ãb this morning we welcome doctor patricia hayes chief consultant for women's health services and doctor susan mccutcheon national mallhe topic of our hearing today, which i am really glad we have an
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opportunity and the time to take, there are some byproduct benefits of the government shutdown. in the vice president's budget being late as we have an opportunity to slow down for a minute and take a step back and be able to have some really important discussions about the issues that we need to consider before we actually start writing our bills. and access to va health care for women is really critical and one that i think is important to shine a spotlight on. women have been serving in the military in various capacities since world war ii. the number of women in the military has continued to increase over the years. women have faced challenges in gaining access to combat roles that was not until 2016 that all combat positions were finally open to women. 2016, just like in the battle space women face unique challenges when they need
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military service and seek healthcare access to the va. just like men make up the largest population in the military the va is ãbfor men. while the va has taken great strides to increase access to care as women more needs to be done. women and men serve with equal commitment to the military and we need parity when it comes to access and gender specific locations. more resources need to be invested to increase women veterans ask us to care. women should be able to walk into any va facility and receive a basics negative care and that's not possible right now. having women doctors specific care programs facilitate the
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absolute least we can do and currently providing it. on the bright side, telehealth programs have greatly expanded access to care primarily rural or remote areas. even in places will where the service is remote but the location where the veteran is it. vha provides gender specific care through telehealth services but the va cannot rely only on telehealth services to expand care to women veterans. when veterans deserve in person up close and personal care as well. like everyone around this table the mental health of all veterans remains a top priority for me. women veterans are twice as likely to commit suicide, compared to nonveteran women in the suicide rate for women veterans is climbing much faster than for male veterans with the 45 percent increase from 2005 to 2015. thank you, i have really bad
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allergies. men who have experienced military sexual trauma are also more likely to commit suicide. we must do better to protect veterans who experience mst. while the va has made mental health it's top clinical priority, we need to dramatically reduce the numbers and veteran suicide rates and start seeing effective results of the va mental health program. doctor hayes, thank you again for being here today and i look forward to your testimony in discussing these important issues with you doctor mccutcheon's and now i would like to ã >> i'm very pleased to have you here today. thank you for being here. i know this committee has ãnot just because the ranks of the nation for military retirees and survivors. and the greatest number of veterans that exist. and maybe these veterans are willing. more and more women are serving in the military and we need to ensure that they may leave the
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services and become available for veterans ãb in our hearing tuesday i said we have no excuse for not giving our veterans the very best. it's important to ensure that. thank you for your work. to honor and support our women veterans. welcome to our subcommittee and looking forward to your testimony. thank you. thank you judge carter, now i would like to ã >> thank you. to chairman washington schultz and ranking member carter for holding this important hearing. i'm very pleased to welcome doctor hayes and doctor mccutcheon. before the subcommittee this morning. this subcommittee must address the challenges facing the
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department of veterans affairs in delivering care and benefits to the men and women who have faithfully served our nation. as the number of women veterans increases and with service academies reporting record number of female cadets and larger numbers of women entering ground combat and special forces roles. development of specific more diverse healthcare needs are critical. it's imperative that we focus on the women veterans of today ãb
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the va recently reported almost 42,000 job vacancies across the healthcare system. as of december 2018. this represents 14,000 increase from 2017 which demands on the va only increasing these shortages are a troublesome
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trend. the systemwide strain will likely attack services our women veterans now rely on ranging from primary and reproductive to mental health and long-term care. shortages of this magnitude will show progress and lead to reductions in access or delay preparations for a larger numbering of aging women veterans. the va must maintain a focus on women's veteran needs regardless of what challenges it faces now or in the future. i appreciate you appearing here today. i look forward to your testimony and i think you for your commitment to our nation's veterans. thank you. >> thank you madam chair. we will proceed with the standard departmental grounds, recognizing members in order of seniority as they were seated at the beginning of the hearing and i would ask for members to be mindful of asking questions leaving enough time for the witnesses to answer.
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i haven't seen the majority leader notice so i'm not quite sure what time last will be called but knowing it's a getaway day if everyone is comfortable doing one round today we can take other questions for the record and hopefully we won't get interrupted. i will begin i have a lot of questions. actually i'm sorry. i have so many questions that eager to ask them before you begin your testimony. it is a long day yesterday. forgive me. i'm suffering from lack of sleep. please proceed with your testimony. >> good morning. ãbi appreciate the opportunity to discuss the high-quality care ãband
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military sexual trauma and i should add that i am the director for healthcare delivery for the va. the number of women veterans who are rolling in va healthcare is increasing and placing demands on va healthcare system. women make up 16.2 percent of today's active-duty military forces and 90% of the guard and reserve. a stunned upward trend of women in all service branches the expected number of women veterans using va healthcare will continue to rise rapidly and the complexity of the injuries of returning troops is also likely to increase. more women are choosing va for the healthcare than ever before. the number of women veterans using services has tripled from 2001 going from 160,000 a year to 500,000 a year today. to address the growing number of women veterans we are strategically enhancing
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services ãbsince 2000 8/5800 healthcare providers have been trained in the national program. the va has enhanced provision care veterans by focusing on the goal to make sure we have women's health ãbthe va has implemented healthcare delivery models and ensure that women receive equitable, timely, high-quality, primary health care from a single provider and team thereby decreasing fragmentation and improving
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quality of care. the va boasts a wide range of services to women veterans including comprehensive primary care, gynecology care, maternity care, specialty care and to health services. additionally recent legislation authorizes in vitro fertilization and other infertility testing and treatment married veterans with service-connected facilities that results in an facility. va has witnessed a 154 percent increase over the past decade in the number of women veterans accessing va healthcare. over 40% of our women veterans use va have been diagnosed with at least one mental health condition, many also struggle with multiple medical and psychological challenges including trauma related difficulties. to ensure that va mental health providers have the skills and expertise to meet women veterans you unique ãbto strengthen mental health access
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services and services to our women veterans such as the new women's mental health residency. unfortunately some women experience sexual assault or harassment during military service and may struggle even years later when its aftereffects. the va services for military sexual trauma or msp can be critical resources to help them in their recovery journey. the va provides free care including outpatient residential and inpatient care for any mental and physical health condition that's related to ãband eligibility is expensive veterans do not need to have reported their experiences at the time or have any documentation that they occurred and they may be able to receive mst related care even if they are not eligible for other va care. in addition, every va healthcare system has a designated msp correlator who can help veterans access msp related services and programs. since 2007 there has been a 297 percent increase in the number of women veterans receiving msp
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related outpatient care indicating the positive impact of these efforts. the va is proud of high-quality healthcare for women veterans, ongoing forwarding measures show women veterans are more likely to receive breast cancer and cervical cancer screening than women in private sector healthcare. unlike other healthcare systems, va analyzes quality and performance measures by gender.this has been key in reduction and elimination of gender disparities in important aspects of health screening, prevention, and chronic disease management. since 2014 we've tracked access by gender and identified small but persistent disparities in access to women veterans. who overall are waiting longer for appointments than male veterans. to mitigate this disparity the va has identified sites with longest wait times for women veterans and working directly with those sites on initiatives to improve access. including designating more women veterans health providers to hiring and training and improve provider and team
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efficiency. in addition to all these primary specialty care that we deliver we deliver via telehealth ãbwomen's health services has also worked to ensure the inclusive women's pharmacist and recent initiatives to expand the availability of pharmacist via telehealth. va continues to make significant strides in enhancing the language, practice and culture of the department to be more inclusive of women veterans. these gains would not have been possible without consistent congressional commitment in the form of both attention and resources. it's critical to continue to move forward with momentum and preserve the gains thus far. your continued support is essential to provide high quality ãb [audio lost]
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>> according to the congressional research center the number of women veterans that access va care is about 238,020 15 that number increased 46 percent to almost 456,000 women veterans receiving care. i'd like to know how the va is evolving to support the ever-growing number of women in the veteran population. particularly because the findings that have been flat. since stagnant $500 million and to me that cries out for an increase amount of resources so how can va properly support the increase of women access and care without providing additional resources? >> thank you for your question. you are absolutely right. we continue to experience what i call tsunami wave of women veterans over the last 10 years. the numbers reflect lots and
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lots of women who come from ãb we've actually done that spend most specifically to address it is to develop the primary care model that wherever woman comes for care will be a designated women's health provider and we've gone from having very few of those and having them only in women's centers in the larger facilities to now having at least two and every medical center. unfortunately we are still at only 90%. we been working on that. this year one of the ways we've addressed that specifically is we are taking the training in a mobile way to the sea box. we take the team out there and stay as people can train them. >> am glad that there are creative ways you are trying to make sure you reach more women but i'm specifically asking you are you receiving ãbyou need additional resources? i don't know how you don't, given the explosion of women and the fact that we aren't even reaching all the women we
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should. >> and must clarify that the money we get goes into the medical services and goes out as zero dollars to every site. it is distributed based on the number of women and men who are at that site. in their model is obviously one that you are familiar with. in that sense the more women that are there the more men that are there presumably the dollars would go to meet increased demand. ... transport ...
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perhaps we are not allocated to fundings in the right way. think about that and follow up with us. i have a lot of questions so most of them have to be taken to the record. i do want to focus on veterans, women veterans. we just had 45% increase since 200522015. it's horrific but whatever the va is making, the research causes women's suicide rate is increasing far more dramatically than men. how you cater your mental health program two women based on their previous gender specific dramatic experiences as compared to other women is not.
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>> i can't speak to what they are researching and causes but i'd like to talk about clinical program. >> somebody who can answer that question. >> suicide prevention office. >> help us get that information. >> absolutely. we are in the continuing mental health service programming that target problems such as ptsd, addictions and they are known to side rex. we have universal screening programs. it's universally screened including messaging. we have early identification so we can refer to services. we offer evidence-based practice services at every va medical service across the country. evidence-based practices like exposure other gold standard for ptsd treatment. they also show research of
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impacting suicide risk. we've recently developed innovative folio services. we now pride training in collaboration with health services on multidisciplinary eating disorders training. there is link between eating disorders and suicide. so what we have now done is trained teens, a therapist and dietitian. to address veterans with the disorder. even though is gender neutral, we see more women with us. we have programming at every medical center. to make sure the coordination of services. we've also just recently rolled out with the call skilled
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training, effective and interpersonal relation and we know that you marginal this regulation is a cause for suicide. this is a new training we have submitted throughout the va and individuals they have problems with interpersonal relationships and emotional relation. so this is something that, we can provide for our trauma folks to trauma exposure. some that come in are really ready for this. the skill training helps them in the immediate area. >> i'm sorry, i'm way past my own time. i appreciate your input but when i would like to, we are only going one ground today. there's so much more to talk about. i think it's important for the va to speak to the women's conference. but you really about the range of issues that are important to accessing care at the va. then we controlled on two issues like suicide prevention in more detail.
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they can do that beyond justice. thank you. >> i have a lot of questions. i think the question was asked, if we do it moneywise, the issue of women's health. can you be specific as to what you needs are, where we should target the extra money, to advocate the chairman that was giving. if you don't but you can get specific in writing, that would be a great thing to do. we are very serious about this. we got to get right. i know you probably have
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doctors, is that part of the issue, female chimeric characters? to put women with women doctors? that's one of the things i like to ask about. i just went with my daughter and my daughter-in-law's treatment. i can tell you, it's a very specific and skilled area and only a few people in this country but do it right. are you in contact with that treatment? good. otherwise, i be on that. we just made a move in central texas, you may be familiar with it.
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the reason for the move was to get to their facility, they had to walk through and it's very uncomfortable. it caused that to come. most of the ptsd, other issues relative to ptsd, they swapped out. is it working out? >> i like to address your question in order. i like to get back to you about some of the areas in which we have gaps. we can describe that in writing, the really thing to determine, the need for proper care providers in women's health is critical and retaining the once we have, the issues about
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retention, the pay incentive pay, these are issues that we have difficulty with. retaining our women's of providers once we get them in place. it's extremely difficult and we have gaps about not having enough providers in rural clinics, recruitment. those are issues and then there's issues about the entire program and having enough of the right kind of support surrounding the women's program. al respond to that. in regard for fertility treatment, you're right, it is contracted out through the choice, it is very specialized procedure. i'm very aware of what you have done in support of the movement and brings up an issue about making sure the culture of the va changes to be better for women.
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we can't always move a site or the kind of program that we want to do. we have to improve, doing work we are doing with parents and staff to make sure the culture is safe, respectful and civil. that women do feel secure we are doing major efforts on harassment, veterans by finance. in order to address this issue of what is it the culture like in the va hospital? both answers are there -- >> that was the issue. >> we are making specialized services, they don't want to just have a separate place. women veterans hat want to be in a place where they are welcome, every parent should be welcome. they feel secure and comfortable. so we are working on that. >> that should not be when you come to your medical up on it. >> yeah, it should not. i think we did the right move. availability and space.
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>> just to add, we connected the staff with our national embassy support team. so they are making sure they get the appropriate training and education to make sure the treatment program. >> that's what we are looking at. >> when i hear from there is a lot of enthusiasm at the facility, it looks very nice. people are really excited about it. >> good. thank you. >> thank you. >> thank you for coming here today. a few years ago, veteran in my district went to the va medical facility in her three trimester of pregnancy. she was turned away because they
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had never seen a pregnant veteran there before. she would go away without the necessary referral. i don't know what she was doing in the first two trimesters. in literature on women's veterans under section said comments, your local va facility has a full times women's veteran manager ready to assist you. getting timely access to the healthcare you need. do va facilities other than medical centers have a women's medical medical center? if not, is there at least someone trained to assist veterans in referring them to the appropriate care? so i haven't in my district never happens again. have you heard of that before? >> i'm always discouraged when we hear these incidents in which the improper care has been delivered.
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we do have someone at every site so that while there is a woman veteran manager at the main hospital, they have a liaison trained up in other assistant there. we make sure they are trained up in these things. since several years ago, we've rapidly suspended our certainty care, we have a maternity care coordinator. someone comes in the va, regardless of their time in pregnancy, we know across the u.s., 50% of pregnancies are unintended. that may mean people are surprised by their condition. they come into the va, make sure they get assessed physically, they get all the testing and things like vitamins they are going to need, assignments from me ordinator, i care in the community as soon as we possibly can. that's an urgent appointment. then we follow them through
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their pregnancy, calling them up, at the beginning once a month or more often and we get them lactation help and anything else they might need to test a successful pregnancy. make sure they come back to the va after their postpartum care. >> you are aware of that? >> i wasn't aware of that particular one but unfortunately, bad things happen when people are not trained up correctly. >> thank you. >> making sure we have consistency of service and awareness of the way we should deal with women veterans is important. >> thank you for being here this morning. mentioned 11504% increase, women veterans accessing mental health
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care in the last decade, i noticed also 297% increase in msft. has there been any study that linked those two together? to see how much one, how much of the mental health treatment is a result of that? >> we have a universal -- >> i got so excited to answer this. we have a universal screening program, when every veteran comes in. there's two questions. while you are in the military were you sexually assaulted? or were you sexually harassed in a threatening nature? if you answer yes to one or both? , you're automatically told you can receive free mental health and physical healthcare. since we have been screening
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this last fiscal year, 219.1% of the women who have screened have indicated guess that this occurred. the numbers have been slowly creeping up. at one time we were saying, one in five or four and now at 29.1, we are moving forward. one of the good news stories out of that, we are seeing an increase of the individuals who then say yes, i want treatment for this experience. for women, flash 80.8% of our women and that number has been increasing. women are getting the good news that there are quality treatments available within mental health. you're right, lament that we see our having mental health disorders. sexual, in itself is not a diagnosis but there's many diagnosis associated with it. like ptsd. the majority of our women who have screened do so from ptsd or
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depression or addiction or things like that. >> the outreach must be pretty effective because they don't half to show up at the va for any other healthcare issues to be seen for mental health as well, correct? >> right. they just want that treatment, yes. we find that many of the women who have it have other ethical and mental health issues. we have a lot of good nations here, that's one of the good aspects of having the va. it's likely they would need other services there. >> good job. however there are 24 of the 168 facilities that don't have oncology care on site. is it because of the facilities
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locations or can you talk about that? >> we have gynecology on the majority of the facilities. those that do not are the class facility that doesn't have even surgery on site. gynecology is a surgical profession so you need the surgical service to have a clinic and to be able to perform procedures on site. those women were at those sites are seen by colleges in the community and because they are fairly rural sites, widespread veteran locality, it's better for the women to be able to go to a con ecologist closer to where she lives so she won't be traveling a very long distance to a facility and that would make sense. we need to give it to her where she lives. >> so it's not really as much related to a lack of ob/gyn doctors as it is a location --
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>> the location is frankly one in which we have difficulty finding -- gyn, there are gyn's who will do office work and we would love to have them come in and do some care in the sites but then you have their recruitment in a small town, one person and they are working at the community hospital. so we will use the mission and choice options to send them to the committee. the coronation is critical. >> last year, the service women's action that worked up the establishment of social groups for all women at but centers, how have we done bringing back together, is tha that -- >> they have a number of different counselors of women veterans or counselors there. i don't think we have to get back to about whether that is
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there. there was also be confusing once that called for your counselors. i was part of legislative request. we may need to clarify your question in terms of exactly what is -- >> there were established support groups in each facility. i guess that's part of the positions we talked about before in the women's -- >> they are also employees. >> mr. bishop. >> thank you. thank you for your work and being here this morning. you've touched on a lot of the issues already that i had an interest in. but let me go to a little different sled here. they wrote a book titled ashley's work. a team of women soldiers on a
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special operations battlefield. it's about a team of servicewomen recruit by service ops. combat missions and in afghanistan. she painted a picture while on a record number of women since 9/11, there were stories haven't really caught up with the pop culture. pop culture plays a huge part, the kind of change america listening to their stories. we often think of special ops as a male based operation but i know that now that's not always the case. as an example, i was in mind by one of my military fellows that told me he was deployed in afghanistan, special ops person there often found from the
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female soldiers to go on missions with them to find local females during areas operations. i want to ask you, do they have any special programs that work with veterans who may have endured those kinds of stressful deployed circumstances that require them that work with special ops? 's of my second question, in your testimony, you state that the va is aware of the challenges with veterans with children. of course, that is stressful for a veteran who is a single parent and who is dealing with ptsd. do you have facilities at the va
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clinics to accommodate children that may have to accompany the single-parent to the medical appointment while they wait for their care? of course, these have also special programs to deal with the stress, female veterans who have been exposed to the combat exposure? >> i like to address that question second. healthcare is not, the va is not authorized to provide healthcare to veterans because it's not medical care. we have carried out the childcare, they are limited to four sites. there's been expiring authority.
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>> can congress help? >> i think congress passed a bill the past week so i refer to your wisdom on that. we can answer questions, the other question about experiences in the military and combat and i think both physical and emotional experience is related to combat are things that we are addressing and we could go into detail about more ptsd programs to have combat components or combat sequences where women's programs that they can go to in terms of their, experiences. >> i appreciate the answer to know that you do have those programs, getting back to childcare, it seems to me and added stress for a single female veterans, parent vendor has to
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go through a medical appointment with child or children and have to keep up and manage that child while there are waiting for choir they are actually having care. if they are limited in terms of what you can do to provide childcare for female veterans, or for that matter any veteran who has to come get treatment and bring children, we, the congress to have the authority to give you a mission to do that. but we need to know if it's needed. thank you. >> just to put a final point on this, can you use more money?
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>> i see i got my self completely locked in. this is -- >> let me rephrase the question, if you have increased your people coming into your facility by a factor of three since 2001, could you let this committee know what a factor of three increasing your budget would look like? which programs that would require? the question is for you, not for the secretary of the va. >> i understand. >> texas has more be reference than any other state, 820,000. my second question is on nontraditional therapies. there's a group is an entity in my group called t perez. they do their be, cooking therapy, gender specific group therapy, how can nontraditional care like that be better integrated into the va? >> we are always wanting to hear
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about these resources so hopefully every va medical center can have a women's mental health champion. it would be their responsibility to do outreach into the community to find programs like what they offer because they offer programming that is not available at the va. so some of the social resource resources -- >> is that a function to the choice program with a get connected through the va and they should be seen with the choice provider or is it more like a va center? what is the specific style of program for there's to be called a tool that the women health champion can tell your veterans you can use? >> if a nonprofit that our women veterans can go there for free.
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it wouldn't be a choice where va pays for services. they are resources that can complement what is going on in the va. it's not really interested in therapy but we like to go into the culinary or support. every va should connect with these community resources. we can't do it all. >> i'm sure you're open to me following up and having specific conversations on this particular part. >> absolutely. it sounds like an excellent thing. >> glad we have is instructed. we are not there yet. the absence of getting there, we should not allow as judge carter alluded to, if women are not getting care because they are uncomfortable with the code gender, coed group sessions,
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then we need to address that. we need to make sure that we are able to provide them the care they need. what are you doing? so we achieve this state where this happened. what are we doing to make sure they feel comfortable to get those resources? >> we are working very hard, i appreciate your point. it's not there yet -- >> the main concern i hear from female in my area. >> i have met directly with the business directors, we are holding everyone accountable about this gender and sexual harassment. we have a major ethical going on. i appreciate the other part, you're saying that women only groups would be the ideal. i think that would be important for mental health.
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>> some of them do prefer women only groups for various reasons but some of our women do prefer gender, mixed gender groups. the va doesn't promote one over the other because women have to go out into the community where there are men. to have the opportunity to interact with males therapeutic protective environment can be part of the treatment plan. we don't want to reduce all the mixed gender programs. sometimes we work with women individually and develop skills so she may want to enter into -- >> i appreciate all that. i have nine seconds left. we do recognize that, i'm not a doctor, i'm not a clinical physician, i don't understand these things but if women are uncomfortable even getting that first step of treatment, that's what they are not coming, i hope
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we recognize that. yes, we are trying to get them back into society. but we have to ensure they get there. that's the biggest gap of why they are not getting there. >> absolutely. >> thank you. i agree, it should be the veterans choice. >> thank you. >> first of all, we're seeing the ranking members, this is us asking you what you need. to me, looking out into the future, this is completely predictable. you've got 10% now, women but 16% are increasing numbers of women going into the services, is there an actual long-term plan? let's a long-term is ten years.
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do you go within reason, what you think the number of women veterans are going to be in ten years? what percentage of the veterans there are going to be and what services they are going to need so that you can start today to build up your treatment services and to request funding over a period of time that shifts the funding mix over a little bit more to emphasize the needs of the growing disproportionate population as compared to know? we can see where this is going. i'm just curious, i don't think i know where i will be in ten years but somebody will sit in the chair in ten years and say like to do do this in ten years ago? are you starting on the right path? >> i started on this path 11 years ago, the speech i made way earlier in my career, i thought women would be 20% by my retirement. i've been running on this,
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ramping up for quite some time. the va has very good projections on in rome and now legalization, we know what we need. >> how far physical? >> the ones that go with exact numbers are 30 years, then there's 50 years. we work with local facilities on these projections. the real issue, there are many issues but one is about shifting resources. unfortunately, the world war two veterans are passing on. the korean war veterans are just behind them. the issue, as we replace those, and other stuff, that's part of the production as well. we're moving them from some of the other programs and making sure that people are trained, that's what we drink up providers.
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haven't seen men for a long time, they are comfortable with prescribing things like birth control, we train them to do this. two exams and infections and wasn't things like that. part of it is, not more money, it's making sure you're getting the right force in there. so we have people who are designated, taking certain of the women's. that's the program going on now. we've been doing it really hard, we have many more than we did, 5800 more than we did a few years or. then there's turnover, there's more coming coming and the door. as you say, are we doing it, not five years from but are we doing it for tomorrow and six months from now, when there might have been more women than today. that's the part of it that is hard to implement. >> that's really good to know. one quick question, do we know to use va more than? >> are they in the va healthcare
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system disproportionate to meant? >> no, they are underutilized, ten points lower than men. in terms of those who actually come, were eligible to come, who come. >> why? >> was grown from a gap of a greater government. more and more women are coming but the reason they don't come, we have a lot of research, number one is women do not know they are eligible. they don't identify with the word parent. they don't know it's for them, the second reason is the eight doesn't have women's health services. >> that would be for more women directed outreach. >> we do outreach, we are, have health center, the women who do not use the va. about 1.2600000 million in the last five years. we think, we have more, we are doing outreach as well as part of the effort to increase the number of women to utilize the
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va. >> thank you so much. >> thank you both for being here. since the passage of the women's veterans healthcare act of 1992, we've been playing catch-up to provide women veterans with gender specific healthcare services from the va, is there a way of quantifying them in any way, the closing of the care gap when it comes to women's health and can be ha give us more general report on the gap closing that still needs to be achieved? >> i think we can give you numbers on how many providers from each site and how many we need. can always say reasons for that gap, we have a very detailed gap and analysis. not sure exactly else we can describe for you so that would be helpful in this case. >> i like to see, i'm a numbers
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guy. i like to see ex-wife chart to show, are we closing that gap? how rapidly? we doing a good job at this? >> we do produce these reports on where we are, where we've been, it's lesson for then going forward. in terms of, we can show you utilization projections, gaps and where we are with the providers to me that. >> i'm going to get back in touch with you. >> i'd be happy to brief you on it. the numbers of help drive us to do the right care. >> exactly. thank you, that's all i have. >> thank you, thank you for being here today and the work you do for our women's veterans. i'll try to be specific, you talk about them as t, women who
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experience that, i'm happy to have the experts here today. thank you for that. let me read this strike it right. they recognize it as a valid basis for service connection discipline. 2002 created relaxed programs following. they did not generally end up in the records. it was written, the standard is only available to those with ptsd, not to those diagnosed with other mental health disorders. i'm putting a lot of focus on the benefits. there are mental health professional side, i guess i just like you to speak about to the range of mental health social disorders that sexual abuse can cause. the newly recognized, disorder, defined by americans psychological program, i think
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what i'm looking for in your professional, think you probably time to provide informed standards with a mental health disorder due to sexual trauma during the time of service that are eligible for clinical disability? i hope i made that clear. you can't qualify for benefits unless you exhibit ptsd, yet we know, and i'm sure you know that there are other things that people might exhibit. i realize you are not in charge of that, but mental health professionals should make this. >> you're right, ptsd is the most prevalent disorder, we see, as you mentioned, depression, addiction, anxiety, we are hearing a lot of eating disorders. so, being a long-time va employer, i am proud to say,
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it's more of a vba issue but certainly it has been well recognized that it's not just that. i think they come along way and understanding. i think they recognize it's more. if you have more comments to that but i think it's well-established and you have to talk,. >> just so you know, i'm working very hard on that. i fully understand it's not your lane but i do appreciate, if no for doesn't reason, you're validating my concern that we're synced women, only ptsd and
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females, sorry, go on with your life and good luck. thank you for that. >> as you know, everybody knows from a car experience accident, everybody experience event. reactions are individual and we respect that. >> thank you so much for the work you are doing. we appreciate it. >> thank you, i'll be brief. i know we've got to hustle up. mountains a thank you, for your leadership all these years. much appreciated. the dynamic women here, the committee and commerce is very important. identity women in the chair of this committee and so i feel like we can really to the news on this. i want to throw a couple of things out, to follow up on his
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question about the outside treatments, the outside groups that can help with those who do a lot of work about stress reduction. a lot of work around adverse childhood expenses and i think it would be smart for us on the defensive side before they become veterans to really start to understand some of the trauma that is happened before they even get into the military. we end up handling and dealing with a lot of that. i want to figure out how we can get more coordinated effort around childhood experiences, more and more about them everyday. long-term impact and at the center, we can figure that out for each individual, i think the better off we are going to be. so again, thank you for that. if there's anything we can do on the side to help ordinate that, i would be terrific. >> a brief, i know you're in
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that area, we find you actually have a whole mark of that offer. i wish we could hire all of our va medical centers, this is something we have in the future, you also have your there. >> data again. sorry. >> the women's mental health, a new position, we just started. i hope i get the shepherds hook, that position so that's not like the position where it's a funded position. that person has to do coordination around's mental
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health in her spare time. so the coordinator and the women's positions, they do that probably on their lunch hours, they do it whenever they can. >> we got an issue. >> that's something -- >> out just say quickly, i went up to the d.c. va, yoga, mindfulness, these are not operative everywhere. i went there when they just started it, a lot of vietnam vets whether. they would have found these modalities, treatments, techniques, whatever you want to call them 40 years ago. it healed them and their relationships, their health improved. they went back a few years later, that's couldn't get into the classrooms because they became in high demand.
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so they don't want to go on medication. they want to get that technique then can take outside of the va and work with themselves. i think we found maybe the opportunity. so thank you. >> when we write this bill, we have an opportunity opportunities here. we've been focusing on these hearings where we can shine a brighter spotlight on this that we don't normally get to spend time on. thank you both for your dedication to our women's veterans and i understand the restrictions of your ability to communicate and not be advocate here in the committee today. that is our job. so considering to follow up on how we conduct the needs of our
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woman veterans will be ongoing. so thank you. that concludes this morning's hearings, i want to remind members our next hearing will be wednesday, march six. that hearing will be 10:00 a.m. the committee stands adjourned. [inaudible conversations] [inaudible conversations]
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this week, the house begins today on hr one, democratic sponsored bill that will make changes to bottle rights, campaign-finance and of the gross. a hearing last month to examine what's in the approximately 600 page bill. tonight we will show you the entire hearing on c-span, for now, here is a preview. >> , let's play a game.
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going to be the bad guy, i'm sure half the people in the room would agree and way. i want to get away with as much bad things possible. ideally to enrich myself and advanced my interest, even if that means putting my self at the head of the american people. so, by the way, i have enlisted all of you as my co-conspirators. you're going to help me legally get away with all of this. i want to run, if i want to run a campaign that is entirely funded by corporate action committees, is there anything that really prevents me from doing that? >> no. >> okay, there's nothing stopping me from being entirely funded by corporate passed from full fossil fuel industry, the farmer, entirely one 100%
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obvious pack send it. so i am a really, really bad guy, i have skeletons in my closet. i need to cover that up so i can get elected. mr. smith, is it true you wrote this article, this opinion piece for the washington post entitled, the payment to women were unseemly, that doesn't mean they were illegal. >> i can't see the piece but i wrote a piece under that headline, that's right. >> great, we might do hush money, i can do terrible things, it's totally legal right now. that is considered speech. that money is considered speech. i use my special interest dark money camping to pay off what i needed paid off. written in, about the power to shape new cross endeavor in the united states of america. now, is there any hard limit that i have, perhaps -- in terms
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of what legislation i'm allowed to touch, is there any limits on the loss i can do, influence, especially if i am on the special interest fund right except to get me elected? >> no limit. >> i can be totally funded by oil and gas, big pharma, come in, right these laws and there's no limit whatsoever? >> that's right. >> awesome. the last thing i want to do is get rich with as little work possible. that's really what i'm trying to do as the bad guy. his or anything preventing me from holding stocks in oil or gas companies and then writing laws, deregulate that industry and potentially cause the stock
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value to store and accrue money in that time? >> you could do that. >> i could do that now with the way our current laws are set up. >> yes. >> great. my last question, one of my last questions, is it possible that any element of this story apply to our current government and our current public servants right now? >> yes. >> yes. >> we have a system that's fundamentally broken. we have these influences existing in this body. that means these influences are here, in this committee, taking the questions being asked of you all right now. >> you can watch that entirely at 9:00 p.m. eastern on c-span. nearly two dozen people are

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