WASHINGTON, DC – NOVEMBER 9: Veterans Affairs Secretary David Shulkin responds to questions asked by Washington Post Congressional Reporter Ed O’Keefe during a Washington Post Live event in the newspaper’s offices in Washington DC, 2017. (Photo by Keith Lane for The Washington Post)

Lee:                 Good morning.  I’m Jennifer Lee, director of events at The Washington Post.  Thank you for joining us today for our conversation with Veterans Affairs Secretary David Shulkin.  Today, just days before Veterans Day, we’ll explore some of the biggest issues facing America’s 22 million veterans and their families, including the VA’s efforts to reduce veteran suicide, provide quality healthcare, and ease the transition from military to civilian life.

Before we begin, I’d like to thank our presenting sponsor, Leidos, and our contributing sponsor, Samsung.

I’d now like to welcome to the stage Jonathan Scholl, president of Leidos Health Group, for a few remarks.

[APPLAUSE]

Scholl:             Good morning.  First let me thank Mr. O’Keefe and The Washington Post for the opportunity to be here today with you.  “To care for him who shall have borne the battle and for his widow, and for his orphan,” Lincoln’s inspirational words represent the high ideals of a nation committed to serving those who willingly put themselves into harm’s way and are willing to make the ultimate sacrifice, and for the families who share that privilege and the burden.  They also serve as the motto for the U.S. Department of Veterans Affairs.  As a veteran myself, and a father whose son is a veteran, wounded in the war in Afghanistan, these words mean a great deal to me personally.

In the world of healthcare there are two kinds of caregivers: those with healing hands who give direct comfort and aid, and those who with their hard work support those healing hands.  I’m privileged to lead the Leidos Health Group, an organization filled with both kinds of caregivers.  We’re the ninth largest health IT company in the United States.

We are veterans, and others, whose work spans decades.  We built some of the original health record systems used by the DOD and the VA, supported them through the years, and are now lending our expertise to help replace them.  Our work as the prime contractor and lead systems integrator for the defense health record replacement includes creating the integrated architecture, the cyber-posture, and the program management to help the program get implemented.

Of course, none of that happens without a team, and the Leidos partnership for defense health includes Cerner, Henry Schein, Accenture, and many, many small businesses working together for the success of our nation.

Leidos’ other works spans from lab to the bedside.  We patent molecules; we find cures for cancer; we develop software to case manage patients in hospitals; we have human performance and behavioral health programs in service of our nation.  And we see veterans in our clinics, this year alone having performed nearly 400,000 disability examinations.

Today, I’m privileged to be here with you and listen to a true leader in healthcare, the Secretary of Veterans Affairs, Dr. David Shulkin.  Dr. Shulkin’s leadership is driving improvement in the level and quality of care for our veterans.  He is waging war on suicide, boldly making available access and choice, high performance, timeliness, quality of service.  And his decision, with one action to align the technology of the DOD and the VA was a bold and positive move for our country.

So, as we approach Veterans Day this year, I want to express thanks to the veterans in this room, listening and around our great nation, and the companies and leaders who support them.  On behalf of everyone at Leidos, it’s our honor to serve you and serve our great nation.  Thank you.  [APPLAUSE]

Lee:                 Thank you, Jonathan.  I’d now like to welcome Veterans Affairs Secretary David Shulkin and The Washington Post’s Ed O’Keefe.  [APPLAUSE]

O’Keefe:         Thank you, Jenn, and good morning everyone, how are you?  Secretary, welcome to The Washington Post.

Shulkin:           Thank you.

O’Keefe:         Welcome everyone to The Washington Post.  My name is Ed O’Keefe.  I’m a Congressional reporter with The Washington Post, but in a previous tour of duty here at the Post actually covered federal agencies, including the VA, and was just thinking last night that among the many things I did on that beat was visit the Jefferson Barracks National Cemetery in St. Louis, and saw the work that they do, so I’m familiar with all aspects of the VA from back in the day.

On this eve of Veterans Day we’re going to talk about issues facing our veterans, issues facing the VA, and to those here in the audience, those watching online, if you want to engage in this conversation we’ll take a few questions later on.  The best way to do that is to tweet your questions using the hashtag #WPVETS, and we’ll get to some of those in a little bit.

First off, how many veterans are in the room with us here?  Just curious.  Oh, good, a fair number.  Excellent.  Well, yes.  [APPLAUSE] Thank you for your service.  Thank you for being here.

So, Secretary Shulkin was born at the Fort Sheridan U.S. Army Base in Illinois, where his father was an army psychiatrist.  He graduated from Hampshire College in 1982 and earned his medical degree from what is now Drexel University.  His wife, Merle Bari, is a dermatologist, also a medical professional.

He is the ninth Secretary of Veterans Affairs, the first non-veteran to hold the position, but I’d argue, just as importantly, you’re a healthcare management specialist, that is most of what your department is.  You are essentially the largest healthcare system in the country.  You employ how many people right now?

Shulkin:           A lot.

O’Keefe:         A lot.  [LAUGHTER] So many we’ve lost count, but that’s—it’s one thing that people forget, is that it is actually among the top three, I believe, largest departments in the country, employing hundreds of thousands of people.  You still do rounds at VA facilities across the country, right?

Shulkin:           Yeah.  I take care of patients.  I’ve always found that I primarily see myself as a physician, and I know I practice many other ways, as a healthcare executive, as a Cabinet member, but primarily I go back to my roots about why I’m doing what I’m doing, and that’s to help people—in this particular case, to help veterans improve their lives.  And the way that I stay grounded to that is by every now and then putting on my stethoscope and going and taking care of patients.

And it helps me always in doing my job better as an executive to see actually what happens as a result of some of the decisions and policies that we’re making.  Do the lab systems work?  Do the staff have the proper training?  Do the patients get the type of information that I want them to get when they come in?  So, it just helps me do a better job.

O’Keefe:         So, where did you do your most recent rounds?

Shulkin:           In Manhattan.  I practice two places, in New York City that’s where I go, and I actually work in the walk-in clinic, and that’s one of the reasons I know when I say that we have same-day services, I know that’s real, because in New York City any veteran who needs to be seen that day, that’s what I do when I practice that day.

But I also practice out of my office here in Washington, a few blocks away, where I see patients in Grants Pass, Oregon.  I’m not even sure where that is, but using telehealth, I can work with the clinical team there, and I’m the primary care doctor for patients and grants pass.

O’Keefe:         Okay.  So that’s you over the computer screen?

Shulkin:           Um-hm.

O’Keefe:         They’re sitting in a room, and the idea there is that, A, you want to understand that experience, but B, because the department is actually trying to use more of that technology as part of the look.

Shulkin:           Yeah.  I’ve been a doctor for about 35 years now, and I’ve never practiced using telehealth prior to coming to VA, so I wanted to experience that and see what that’s like, because VA does more telehealth than any other system in the country.  We last year saw over 700,000 veterans using that technology, and I’m pretty impressed about the type of exam.  I can listen to people’s hearts, lungs, look in their mouth, look in this skin, palpate their abdomen using my clinical staff who are with the patient in Oregon.

O’Keefe:         Have you ever had the internet connection go down while you’re testing the heart, because that could probably throw you off, right?

Shulkin:           Yeah.

O’Keefe:         No?

Shulkin:           No.

O’Keefe:         All right.  I would think there might be a delay there and you go, “Oh wait—oh, it’s just the Wi-Fi, never mind.”

So, actually, of those veterans in the room, how many of you might be VA customers, in essence, or VA patients?  Only a handful.  That’s important for people to remember that are not in the system or who are not as familiar with the Department.  Not every veteran actually uses the system.

Shulkin:           Yeah.  The VA, in terms of its healthcare system, takes care of about nine million veterans.  As we mentioned in the beginning, we have 21, 22 million veterans in the country.  The VA is a system for those who are service-connected, have their health issues related to their military service, or have income levels that are below a point that they could have challenges getting access to healthcare in the private sector.  So, we really in many ways are dedicated to helping a population of veterans who choose to get their care at VA.

O’Keefe:         Let’s start with one aspect that’s in the news this week.  The shooter in this situation in Texas was a military veteran.  Have you at the VA explored whether he had ever been in the system, or had come into contact with any VA facilities?

Shulkin:           Yeah.  He had not.  This is a man who was given a bad conduct discharge from the Air Force; that means that he had committed a crime.  He—as you know—was charged and found guilty of beating his wife and his child and had other violent crimes associated with it, and received bad conduct.

We do not take care of people who have bad conduct or dishonorable discharges.  There are other systems like prison systems and others that are available, and other community resources, but we feel strongly that the men and women that have served the country do not want to be associated with people like this gentleman, who have clearly deviated from the accepted moral and ethical practices of society.

And we do feel strongly, however—and this goes back to my role as a physician—that everybody does deserve help, and there are other resources, just not the VA, for gentlemen like this.

O’Keefe:         How many other—I guess one of the concerns when something like this happens—certainly we know the Defense Department is sort of exploring right now how many other cases like this may be out there.  That has to be a fear of yours, that there are people in the system who either may not be getting helped or may have slipped through the cracks, who may at some other point cause something maybe not of this scale, but violent and certainly troublesome.

Shulkin:           Yeah.  One of the difficulties in understanding this is for people who haven’t spent time in the military, is understanding the various categories of discharge.  Up to 15% of those that leave service receive what’s called an other-than-honorable discharge, which is different than a bad conduct or dishonorable discharge.

The other-than-honorable discharge category—a fair amount of people, if there’s a quarter million people leaving the military a year and talk about 15%, that could be 40,000 service members—receive this other-than-honorable discharge, sometimes for behavioral issues, you know, using, inappropriate language, maybe potentially acting out—that can often be a result of something that happened as a result of their service, you know, post-traumatic stress, for example, causing erratic behavior.

We do believe that those veterans do deserve help from the VA, that particularly when it comes to behavioral health issues, that we don’t want them not having access to the right type of care, because they tend to be at higher risk for suicide and higher risk for homelessness.  So, one of the very first decisions I made as Secretary was to expand the VA’s ability to take care of other-than-honorable discharge veterans with emergency mental health services, something previously that they had not had.

And just this week, the House of Representatives voted on a bill and passed it to allow VA to even broaden its coverage of those with other-than-honorable discharges.

O’Keefe:         Yeah.  That would allow you, then, certainly to expand the services, and there must have been a compelling need for that, then.

Shulkin:           Yes.  Yeah.  I think this is a population—in fact, you would argue maybe even the most vulnerable population—that had been out there with no access to mental healthcare services, and of course, going back to my belief as a physician and also belief that running the Department of Veteran Affairs, that is our mission, to take care of those that have been impacted because of their service to the country.  And we don’t want to exclude that population.

O’Keefe:         So, one of the things I—in studying up for this, I read through the Comprehensive Review of Veterans Suicides that you guys recently published to better understand this situation—on average, the VA says 20 veterans kill themselves every day, that’s the average.  Among the findings, though, I thought was most telling—because I think when this gets talked about broadly people may not remember this, or realize it—this is not just an issue with recent veterans of the Iraq, Afghanistan and other global war on terror conflicts.

The suicide rate among middle-aged and older adult veterans is high, if not higher.  As of 2014, it was approximately 65% of all veterans who died by suicide were age 50 or older.

Shulkin:           Yes.

O’Keefe:         What does that tell us?  Is it perhaps that these programs that are now in place, or being put in place, just simply weren’t there for them in the past?  Is that in keeping with average suicide rates among Americans generally?  Or is there something else there that is causing that?

Shulkin:           Yeah, I think there’s a lot to dissect in understanding this.  This one of the roles of VA research, to begin to start asking those questions.  And of course, we now have the largest database in the world of American suicides, and our issue is, is to study the subpopulation of veteran suicide.  So, we’ve begun to look at a lot of these questions.

There is no doubt that one of the basic conclusions that you have to come out of this by looking at this data is that what many Americans often don’t remember, is that the impact of war often is seen decades and decades after people return home.  And so, when we make the decision to send our young men and women into harm’s way, we have to be prepared for a bolus of the impacts of that, the consequences of that decades and decades later.

Our World War II veteran peak use of healthcare services was in 1986.  Today, with the average Viet Nam veteran being 66 years old, we are beginning to see the peak of the Viet Nam veterans.  Many of these suicides—you were correct—clearly the largest group in the above age 50, 55, are our Viet Nam veterans.  And so, we have to design our strategies to make sure that we’re addressing and meeting their needs.

We’ve developed vet centers and we’ve developed outreach programs specifically working with Viet Nam veterans.  There is a smaller second bolus with our younger veterans, where that’s our fastest growing segment—not the largest number—and even the subpopulation of women veterans is the single biggest increase in demographics of veteran suicide.  So, we have multiple targets that we’re designing our intervention strategies, as we begin to understand this data better.

O’Keefe:         Have you ever, in that walk-in clinic in New York, had somebody come in who said, “I’m thinking about killing myself.”

Shulkin:           Well, in VA, no.  But I will tell you about the very first patient that I saw at VA in the New York clinic.  He was a 23-year-old recent Army veteran, and he came in and it was a very strange experience for me, because he had very, very mild symptoms—maybe some stomach aches symptoms and very weird things—and I finally said to him at one point, “I don’t get it.  Why are you here?  Because I’m used to seeing people who have something pretty bothersome to them to come in to see the doctor.”  And he said, “Well, because I’m living in Central Park.  I’ve been homeless for four months; I have no place to go.  I was used to the military cooking my meals, providing me a place to live, giving me a paycheck, and now I find myself not knowing what to do.”

As soon as he said that, I knew how to help him, because VA has a very strong program in finding veterans places to live and dealing with homelessness.  I think—not that he was suicidal—but he was on a path without intervention to really getting into crisis.  And so, and I’m very proud of the way that VA has integrated behavioral health into primary care, the way that VA deals not just with physical illness, but deals with the social, psychological, economic, and spiritual aspects of well-being in an integrated approach that, frankly, you just don’t see too often in the private sector.

O’Keefe:         Did you ever follow up with him, have any idea where, how he ended up?

Shulkin:           I followed up with our homeless coordinator, who had gotten him placed that evening in a shelter, and then they, unfortunately, lost contact with him

O’Keefe:         Yeah.  And that’s just the way it is, in essence, for many of these guys, because there’s so many of them, and if they don’t keep in touch, there’s no way of knowing.

Shulkin:           That’s right.

O’Keefe:         Two other things that stuck out to me in this study.  Of the 20 veterans on average who kill themselves on a daily basis, the study found that 6 in 20 of them had been recent users of the Veterans Health Administration Services.  Does that suggest that the care isn’t sufficient, or that if you were reaching more of them through VHA this wouldn’t happen?  Have you been able to draw any conclusions from that?

Shulkin:           Yeah, I think the conclusions that I think you can clearly reach by looking at the data is that getting people help and getting them into treatment saves lives.  And that shouldn’t be a surprise.  So, of the 14 veterans a day who take their life who are not in the VA system, our concern is that they may not be getting any care at all, and that they may be very isolated and alone, and not knowing how to reach out, or not having access to services.

And clearly, access to behavioral healthcare is a true American healthcare failure.  It is just too hard to get the right behavioral healthcare that you need.  Part of it is the way our insurance system works, and economics, and part of it is still stigma, unfortunately.  Those that get the care in the VA system—it’s not that we can always prevent this terrible outcome.  But we do know that the rates are lower for those who get care in the system, and particularly in some segments like women veterans, those that get care in the VA system have actually been experiencing a decrease over the last 14 years in suicide, while those that are out in the community are seeing dramatic increases.

And that’s one of the reasons we’re using our not-for-profit partners and our private sector partners in an integrated approach, to try to reach out to all veterans.  We have public service announcement that we’ve just released last week with Tom Hanks as our narrator to get that message out there, that everybody has a responsibility to reach out to veterans, and to be there for them in their time of need.

O’Keefe:         In that same study, it found that 67% of all veterans’ deaths by suicides were the result of firearm injuries—in essence, they shot themselves.  Are you guys exploring any potential policy or legislative remedies in that regard?

Shulkin:           Yeah, this is a tough issue.  The issue, of course, most veterans are trained in the use of firearms and the issue for those who understand suicide is that when people suicide using drug overdoses, there’s a much greater chance of being resuscitated, of surviving that.  When you take your life using a gun, it’s often a fatal outcome.

We are very strong advocates and very aggressive on the education about the proper use of gun handling and storage and taking guns away from homes where there are concerns.  We hand out literally hundreds of thousands of gun locks a year.  Having said that, I don’t think that that’s enough.

My feeling is, is that one of the real interventions that we’re trying to double down on, is the issue of the buddy system.  In the culture, relying upon somebody that you trust and understands your issues—a fellow veteran—is very, very powerful.  And so, what we’re looking at are ways of using peer support to be able to help address this issue, because one veteran to another can talk about the issue of gun safety, and making sure that we do everything we can to limit these types of injuries.

O’Keefe:         When you meet with these vets when you’re providing them care, talk to them—do you get a sense of what they’re worried about, what they care about, what they’re concerned about?

Shulkin:           Yeah.  I think it’s a basic human need, and that is to feel as if they are valuable, that they’re a contributor.  You know, veterans tend to want to serve, even when they take their uniform off.  They vote more; they volunteer more; they’re active members of the community; they tend to be over-represented in Congress in terms of their percent in the population.  And when you take away a person’s ability to continue to contribute and feel valued and respected, I think that that’s often missing in people’s lives that come back and just don’t know how to relate to community.  They have a sense of belonging when they’re in the military, and that transition time can be very challenging to them.

And I am surprised at the number of veterans that I meet—spoke to a bunch last night, actually—who said how much they miss being part of something, feeling that sense of belonging.  So, I think that we’re really focused on this transition time and helping give veterans the skills that they need to continue to serve and be those contributors.  It is why the GI Bill and recent GI Forever Bill I think is so important.  Because it provides opportunities to enhance one’s skills to contribute and the voc rehab program that we have, training people how to use their disabilities to be abilities and to contribute is so important.

O’Keefe:         They are engaged in the community, they want to serve.  You get a sense they care about things like football players taking a knee and those other issues that come up in society.

Shulkin:           I think that the great thing about the military and our veterans is that they are our society.  So there are no stereotypes of veterans.  They come in all shapes, sizes, colors, religions, political views.  Americans who serve are Democrats, Republicans, and independents and agnostics and every shape.  So I never want to say that veterans feel certain ways on issues.  I think you would find a variety of opinions, but I do believe these are people who feel strongly about their country and about the freedom of expression and speech that they’ve raised their hands to defend.  So they will definitely have opinions on it.  But I think that they want to see that when people express their opinions, that they’re doing it to keep this country strong and for the ideals that this country was formed around.

O’Keefe:         Yeah, so a few things about the VA itself.  Your boss, the president, as a candidate called the department “the most corrupt agency in the United States and said the way to fix it quote “by getting Trump elected president.”  At one point, he said it was quote “the most incompetently run agency in the United States.”  You were second in command at the time.  I know you’ve been down this road before.  You’re now in charge.  I recall in the past seeing patient satisfaction surveys that put you guys off the charts.  There was a pretty overwhelming belief that things were going well.  The issues over wait times and people getting access to care obviously manifested itself in more recent years.  But have you talked to him about what we thought was so incompetent about the agency?

Shulkin:           Yeah, we spend a lot of time talking about this.  We have a pretty candid relationship and my belief is is that if you don’t talk about the problems and you don’t put them out there, you’re not going to be able to find solutions and you’re not going to be able to ask for help in finding solutions.  So I think that the president’s criticism of VA and expressing the dissatisfaction with the way that it’s been running and needing to address problems that have spanned multiple administrations for decades.  So I don’t believe that he thinks that this is any one particular administration’s problem.  But he wants to get these issues fixed and he wants to put them on the table.  And so I share with him the view that the VA has a lot of problems and the VA has to take those problems seriously if they’re going to fix them and being candid about those problems is my approach as well.  It’s why I came out and said, “We have 13 areas of high risk.  If we don’t fix the VA, we’ll continue to struggle.”  And so I think the president has recognized the progress that we’ve made so far, but knows—and I agree with him.

We have a long way to go before we can declare that the VA is a system that is truly serving optimally the veterans who deserve our services.

O’Keefe:         So we so rarely, especially at The Post, get a chance to talk to cabinet secretaries these days.  Give us a sense then when you meet with him what it’s like to have a meeting with the president.  Is he asking a lot of questions?  Is he bringing you stats that he’s discovered?  Are you presenting them to him?  He is curious, asking a lot of questions or what?

Shulkin:           First of all, it’s not atypical for me to get a call in the evening that he has a question that he wants to find out about, that he’s read a paper.  I don’t know, The Washington Post.  [LAUGHTER] But that he’s read something—

O’Keefe:         We suspect he’s read us.

Shulkin:           Or he’s seen something on TV and he’s like, “What’s going on with that?  I want to understand this better and what are we doing about it?”  So he is very inquisitive.

O’Keefe:         So he’s calling you at like 10:00 at night after watching something on TV and saying, “What’s this about?”

Shulkin:           Definitely, yeah.

O’Keefe:         And you see that come and you go, “Uh-oh.”

Shulkin:           Oh, yeah.  So worse than me—

O’Keefe:         Even if you have to wake up everyone else, right?

Shulkin:           That’s the reason I have to read The Washington Post.

O’Keefe:         Well, there you go.  [LAUGHTER]

Shulkin:           But no, this is a topic that he’s passionate about, that he’s paying attention to, that he thinks is important and so, therefore, he has a lot of questions and he has a lot of thoughts and opinions about how to do things.  But I do have to say that one of the things that in terms of his management style, my management style, he makes clear the objectives and what we have to get done and then he allows me to do the job and he’s clear that if I’m not getting the job done, he’s going to let me know and that there will be consequences, but he allows me to go out and to get things done in the way that I believe they need to get done.

O’Keefe:         And I want to get back to part of that in a moment.  Now, he has called for accountability, that the department laws that have been passed in recent months and we’re going to talk about that in a second as well, that are designed to implement a little more accountability and make it easier for you to go after people within the department.  There are some questions, however, about one of the things you did recently that some of my colleagues have struggled to figure out.  You took this trip to Europe over the summer that included some meetings in Denmark and the United Kingdom.  There was some time built in, however, for some R&R, which raised some questions.  Was that an appropriate use of VA resources and time?

Shulkin:           Yeah.  First of all, thank you for asking about that.  Look, The Washington Post did a terrible job with that.  Poor reporting.  I’m going to say that flat out.  Didn’t do their homework.  No, look, I came from the private sector for one reason and that is to serve and to fix the country and to have my personal integrity and my family’s integrity attacked, it shouldn’t be this hard to come to Washington to serve your country and to have to go through this type of stuff.  I went for business reasons.  Since 1943, five countries, the Five Eyes who fight the wars together, our allies, put on a conference to share practices about how to help veterans.  In this case, it was about mental health.  We’ve been doing this since 1943.

The last year, Secretary McDonald hosted that in the United States but every year it rotates.  This year, it was in London.  For the United States not to participate in that as largest military contributor of these allied forces would be unheard of.  The secretary always goes to this.  This was a business meeting; 40 hours of conference time that we presented, that we listened, I got tremendous value from this conference.  On nights, on weekends, the day before the conference started, I went and I did not lock myself in the hotel room.  I went out and I went to various historic and other sites in London and in Denmark, and frankly, every penny of that was paid for by me.  It was reported in The Washington Post that my wife received per diems, which is not true.  Zero.  Did not do that.

We flew commercial airlines.  Anything that we went to outside, we paid for, not the government.  So there was nothing inappropriate about this and certainly, I don’t mind.  I’m a public figure being asked about this and of course, it’s of concern to the American public but I expect that the facts should be reported accurately and the allegations about my integrity not be done without at least talking to me about that and finding out the facts.

O’Keefe:         I think that’s part of the problem, though—being able to get to you.  The questions were asked at the VA and my colleagues had trouble getting to you or getting the answers to those questions.  And that’s not just the VA, that’s a lot of sections across the administration where we’ve been asking questions and once we get to you, once we get to the person, we discover, perhaps, that it wasn’t as initially seen.

Shulkin:           Yeah, I accepted your invitation today.  I am very accessible.  I’m always willing to talk about issues.  Look, I am a strong believer in transparency.  I publish my travel times publicly, the only cabinet member that does that.  If you want to see every place I’ve traveled as secretary, how I travel, never taking a private jet, who I travel with and why I go, I am absolutely willing to talk about that because I think that’s a responsibility using taxpayer dollars.  So I’m always willing to talk about these things.  I understand.  I don’t give out my cell phone number, so you need to go through our public affairs office.

O’Keefe:         Well, I guess on behalf of the folks who have been working on this, this isn’t just to you.  This would be to virtually every cabinet department.  If you’re willing to talk about it, here’s hoping that the public affairs staff understands that and can think for you.

Shulkin:           Well, this is your chance.  Ask me any question you want.

O’Keefe:         Well, all right.  The Wimbledon tickets, did you buy those?

Shulkin:           Yes, they were privately done, no government money.

O’Keefe:         Okay.  So they weren’t given to you as a gift by folks at the Invictus Games or anything like that?

Shulkin:           No, we went with friends.  There was no business connection to that and there was no government money and it was on a Saturday for one match and last time I heard—

O’Keefe:         And that was a good one, too, right?

Shulkin:           Yeah, it was the women’s finals but last time I checked, there’s nothing illegal about going to enjoy a sporting event.

O’Keefe:         Sure.  No, absolutely.  Thank you for clearing that up.  And IG investigation continues, you’ll participate in that as needed?

Shulkin:           Absolutely.

O’Keefe:         And you said, just to clarify, you never take private jets.  There aren’t any at the disposal of the VA anyway unless they were a purchase of some kind.

Shulkin:           I think that like any cabinet member if you need to get somewhere, you can make requests.  We certainly could request certain travel if that’s necessary and past secretaries have not only traveled with their wives before but have taken military planes and private jets as it’s required.  The VA has facilities all over the country.  Some of them aren’t accessible by commercial airfare.  I have not chosen to do that.  The only military planes I’ve traveled on are when I am a guest of the president, vice president, or first lady.

O’Keefe:         You’ve mentioned the struggles of people coming to Washington to do this.  You must know of other people who have said, “No, I don’t want to get involved in this because of the potential scrutiny.”

Shulkin:           I’ve gone through my contact lists.  They stopped answering my calls now.

O’Keefe:         To take jobs at the VA?

Shulkin:           Well, yeah.  And that’s why I’m saying I think that it shouldn’t be this hard to have to want to come and serve.  A lot of people want to, but when they begin to understand what they’re put through and their families are put through, I think that people have questions.  Listen, I believe it is an honor and a privilege and I want more people to want to do that.  But I also want to see the culture of Washington change so it shouldn’t be as difficult because we need the help from leaders in this country and we need private sector people to come and to change government and so I always encourage people to take that step and to consider doing that and I would tell them it’s absolutely worth doing.  But you have to be prepared and you have to have a very thick skin in order to do this.

O’Keefe:         You did what you did at the VA, you do what you do at the VA, but you look at some of your colleagues in the cabinet and the way they have traveled or used resources—you’re a former private citizen.  You’re a public official now.  You know the importance of this.  That must bring you some pause to see others across the government perhaps not being as diligent as you are.

Shulkin:           No, I’m not going to sit here and criticize other people because quite frankly, I don’t know the facts and I know the way that I was treated by The Washington Post and I know that other people may—we may not have the full story.  So I’m not going to weigh in on this one way or the other because it’s not my job to find out the facts.  But one of the things that I’ve learned is not to rush to judgment without really fully understanding the facts.  I do know my fellow cabinet members and I know that they are there to do good and if anything, I’m going to give them a benefit of the doubt until the facts come out.

But I think that we do have appropriate mechanisms to get those facts out and to make the right judgments.

O’Keefe:         Well, would you commit to sit down with the reporters who did that initial story and go through it again?

Shulkin:           No, I have no interest in talking to those reporters.  Because quite frankly, they’ve already shown me that they had the opportunity to get that story right and to correct it.  I know that I’ve gone on the record multiple times and I’ve said where they have failed, and I have not seen a correction of that.  But that’s okay.  My job and their jobs are different.  But I appreciate the opportunity of you asking these questions and of me being able to clarify them.

O’Keefe:         Well, and I appreciate you answered them.  Now, getting back to the accountability aspect of this, you now have a new law in place that essentially allows you to discipline or fire employees.  It’s called the “Veterans Affairs Accountability and Whistleblower Protection Act”.  It also shortens what can sometimes be the years’ long appeals process and employees can’t be paid while they appeal disciplinary or firing decisions.  This again, all in the wake of the issues that happened in Phoenix and at other VA facilities across the country.  It’s been a few months.  How’s it working so far?

Shulkin:           I think that this is a piece of legislation that was necessary, and I surfaced the case of a psychiatrist who was watching pornography in the presence of a veteran during his clinical care and the fact that I wasn’t able to move them out of their job really said to me, “This has gone on too far.  We need a change in the law.  We need the ability to move people out when they have clearly deviated from professional standards and ethical standards.”  And so now we have a law that allows us to have due process for employees because I believe strongly that our employees need due process and need to be in a just environment but also allows when the facts do support it to move them out.  We have during this year, moved about 1,000 VA employees, either they’ve been fired, they’ve been demoted, or they’ve been suspended for these types of issues.  We publish that again, every week.  The only agency that does that so that we can be held accountable for our own actions.

Here in Washington, D.C., I did have to remove a director of our facility of our VA here because of management issues.  I removed them under the old accountability authorities, the judge brought them right back.  Once the accountability law went into place, I fired him again.  So twice and now we have management in place that have competency and that’s fixing the problems at the Washington, D.C. VA.  So these are authorities that I think help us do our job better and begin to change the VA to be the type of organization that we all believe it should be.

O’Keefe:         Does every one of these issues cross your desk?  All of the ones that have to be disciplined or fired this way?

Shulkin:           No, no.

O’Keefe:         So the only ones that would come to your level are like hospital managers?

Shulkin:           No, very rarely do these come to my level.  I am trying to stop the VA being run out of Washington, D.C..  The VA needs to be run out in the field where the care is and we need to give those who are responsible for running facilities, both the authority and the accountability to get their jobs done right and so this should be less about control out of Washington.  We get involved only when it’s at the very highest levels or when we’re concerned about some of the decisions being made in the field.

O’Keefe:         And so you’ve removed people from management?  You removed that one guy for doing inappropriate things in front of a patient.  What other kinds of things have led to people’s termination since the law came into effect?

Shulkin:           Well, certainly when people are found involved in diverting drugs, when there are patient safety issues.  I think what we’re trying to adhere to are the standards that the private sector uses and just trying to bring modern management techniques into government and allowing us the authority to be able to make those decisions.  We don’t want the VA to be an environment where people are fearful about their jobs.  The vast majority of our employees are dedicated, terrific professionals and we want to support them in their roles.

But if you work in the VA and you see somebody who is working alongside you who is not working and not doing their job and not respecting veterans, you don’t want them working alongside you.  So our employees have been very supportive of the accountability actions that we’re taking but they want to see that we’re doing it in a fair way and I hope we are doing this in a fair way.

O’Keefe:         You mentioned using newer technologies.  In fact, one of the questions we got was sort of along those lines.  A guy named Joe on Twitter has asked, “How is the VA using contemporary media to communicate to the younger veteran generation?”  In fact, many of the people who are even seeing this are probably watching it either on their phone or right now at their computer over the live stream.  How are you reaching veterans?  Tell people how they can interact with the department, if they need to, over social media or over the internet.

Shulkin:           Yeah, well, lots of ways but this is a VA that is transforming and modernizing.  That’s our goal to do that.  The veterans and young veterans coming out now do want their services in different ways.  They don’t want to travel to hospitals and sit in waiting rooms.  So we have just announced a program called “Anywhere to Anywhere”, where you can get your VA healthcare on your iPhone at home, on your computer.  The way that I think almost all consumer goods and products are transforming themselves to be more accessible.  And so if you go to our website, vets.gov, you can see how you can begin to now start scheduling appointments online, how you can get telehealth services and you’re just going to see the VA double down on those strategies and invest more and more in it.

O’Keefe:         So vets.gov and there’s a few different Twitter accounts as well.  I know Department Affairs I think is one and there’s a few others.  And the hashtag on the Tom Hanks PSA is—

Shulkin:           #BeThere.

O’Keefe:         #BeThere.  So if people search for that, you’ll be able to find the campaign and watch it.  Now just really quick before we go, the Choice Program.  This is the aspect now that allows people to go outside the system.  There’s been another $2.1 billion set aside to help pay for this because it clearly was either more expensive than initially budgeted for or more popular than initially thought.  How willing is the administration to go and allowing veterans to see private doctors outside the VA?

Shulkin:           The Choice Program, which was passed by Congress a little more than three years ago latest exactly until almost the day that Congress authorized its money, to August 7th, 2017.  The $2.1 billion was not because it was more expensive than it should have been.  It needed to be renewed and we need Congress to act before the December recess to make sure that Choice is a permanent part of the way that we operate the Department of Veteran Affairs.  So our belief is that we want to give veterans more choice about how and where they get their services.  We believe that what we need to create is a strong VA that focuses on issues that are important to those have received injury or disabilities during their time of military service but that we do it in a way that strengthens what the VA does best, but works with the private sector in what they do best.

So this would be an integrated system of care between a strong VA and the best private sector partners.  Choice allows us the ability to get the veteran and to allow the veteran to choose where and when they should be using the VA and where and when they could be using the private sector to get the best overall outcomes.

O’Keefe:         But never to the point, at least during this administration, where it would be privatized?

Shulkin:           No, that’s off the table.  Privatizing the VA, quite frankly, would be a huge mistake for veterans and for the country and for our national security.  The day that somebody who raises their hand has to worry about when they come back, are they going to have somebody there to help them with issues is a day that frankly, our system of a voluntary draft and of having the ability to recruit and retain the very best is going to come into question.

O’Keefe:         Should veterans’ healthcare or thinking about what it’s going to take to take care of people who end up serving in combat be part of war planning?

Shulkin:           Absolutely.

O’Keefe:         Is it right now?

Shulkin:           It is increasingly beginning to move towards that direction but there are those that believe and I’m on that side, that when you commit troops to combat, you better commit towards that entire lifecycle planning because it’s a commitment that you’re making to those men and women.  And increasingly, we are breaking down the barriers between the Department of Defense and the Department of Veteran Affairs.  I have to give credit to Secretary Mattis for this.  The culture is changing where we are looking at problem-solving together.  We’re looking at sharing facilities together.  We’re sharing now—moving towards an electronic medical record that will be together from the time of enlistment through end-of-life care.  We are looking at purchasing closer together and transition planning closer together.  In fact, our suicide prevention office is now run at VA by the person that used to run the Department of Veteran Affairs suicide prevention office.

So all over, you’re seeing these walls come down and these organizations working closer together towards that goal.

O’Keefe:         But you’re saying that someday, when a president is sitting there trying to make a decision, you’d like to know that the VA was either consulted or is even in the room saying, “If you do this, this is what it could look for you 20 years down the line, budgetary-wise, personnel-wise.”

Shulkin:           Yeah, I never want to be in that chain where the VA is making the decision to commit troops to combat, but certainly, the more upfront we can be and the more that policymakers, Congress and the presidents in the future understand that their decisions have impact on the VA and we need to appropriately plan for it; yes, I am in favor of that.

O’Keefe:         Is Secretary Mattis a VA customer?

Shulkin:           He actually is.

O’Keefe:         And what about General Kelly and Mr. McMaster?  Do you know?

Shulkin:           I don’t go into all of their personal lives.  [LAUGHTER]

O’Keefe:         But they’ve never come to you with complaints or compliments on your facilities?

Shulkin:           Secretary Mattis just happened to share with me that he had the choice, as many do who are career and they retire career-wise between Tricare and the VA and he chose to go the VA route.  But I haven’t talked to others about their choices.

O’Keefe:         Secretary Shulkin, it’s a pleasure for you to be here.  We say here “Democracy Dies in Darkness”.  You shed a little light on it today.  We appreciate that.

Shulkin:           Thank you.

O’Keefe:         Happy Veterans Day.  Good luck to you.

Shulkin:           Happy Veterans Day.  [APPLAUSE]