Veterans Affairs Committee on June 5th, 2017

[Michael Missal]

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Mr. Chair.

Thanks so much for being with us today. You mentioned the responsibilities of your mandate. One of them was investigations in regard to criminal behaviour, false claims, and benefits fraud, that type of thing. You shared very specific stats on the number of arrests, funds that were recouped, and that type of thing. On the flip side of that, is there a comparable level of investigation to determine when veterans are being denied benefits? Your system of eight different silos must make it very complex for veterans. With the long delay of up to five years to get a claim heard, I'm just wondering how they would go about it. Are there any stats on the number of veterans who you feel were unfairly denied, and the amount of funds involved in those kinds of circumstances?

[Michael Missal]

We would have different audits of benefits programs. What we typically do in an audit is take a sample, and we do a statistically valid sample, and then from there we will project out what the impact could be. For a particular issue for audits we do, we will be projecting out. Like an example you gave, if we decided to do an audit in the area, it would be of how many veterans were denied a certain kind of benefit improperly.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Okay, thank you.

On a different note, in 2013 the U.S. issued a black box warning on the use of mefloquine as an anti-malaria drug. Very recently an individual case came up with a U.S. veteran who was awarded disability benefits by VA for conditions that looked like PTSD, but that VA attributed to the chronic effects of mefloquine.

Obviously, since 2013 there have been a number of veterans coming forward and trying to determine the impact it had on them, and a number of physicians have been encouraging VA clinics to screen veterans for prior mefloquine exposure.

I am wondering if there is anything being done on that front, as it's an issue with your allies as well around the world right now.

[Michael Missal]

I don't believe we have any open projects in this area at the time. We're certainly well aware of the issue. We look at issues on a regular basis to see if we should expend resources there, but as of this time, I don't believe we have any open projects.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Okay, thank you.

In regard to pain management and the opioid crisis, we visited one hospital where they have an outpatient clinic dealing with soldiers who have gone through significant surgery and had to be on the painkillers. They're doing what I think is remarkable work in helping them to get off of them so they aren't dependent. I thought that was a very progressive approach.

Are there recommendations that you guys have put forward in regard to pain management that you could share with us to assist us in making sure that our veterans aren't ending up addicted to something that was initially there to meet a need?

[Michael Missal]

We are just finishing up a national review of pain management practices that includes recommendations. Typically our recommendations are going to be focused on what the VA policy or practice is in a particular area and whether they are following that policy or practice. If we think it's not an effective one, then we certainly will mention that, but it's really focusing on what VA is doing in a particular area, and if they are following what they're supposed to be following.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

I have one last question. You mentioned your procedures of coming forward with a report, and before it's published, the department has an opportunity to review it and make suggestions as to how they would meet those recommendations. I can see the value of that.

What happens if they say that they don't agree with that recommendation, period?

[Michael Missal]

We'll listen to why they don't agree with it. If we still think it's a valid recommendation that we think is appropriate under the circumstance, we will keep it in the report, and we will note that the department does not concur with that recommendation, but it's an open recommendation. We keep it open until they satisfy us that they've met the obligations.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Chair.

[The Chair, Liberal, Neil Ellis]

Mr. Bratina.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you. This is a really good session. I appreciate the opportunity.

Sir, one of the headlines associated with your work is, “'Highest levels of chaos' impair D.C. veterans hospital, inspector general finds”. You know what I'm referring to.

[Michael Missal]

Yes.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

In your world—and you've done this kind of work for a long time—what leads to highest levels of chaos? What's the breakdown that ends up where you have to go in?

[Michael Missal]

I think it really starts and stops at the top. The saying is that you're a reflection of your leadership.

What I think we're going to find when we finish our work in D.C. is that the tone at the top is still critical, and if you don't have the leadership at the very top of the organization that is committed to ensuring that the facility is operating as it should be, it makes it a very difficult situation.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Is your work proactive as well as reactive, or do you show up and everybody gets worried?

[Michael Missal]

Well, we hope they don't get worried. It's that we're here and we're going to do our work. It's a combination of both. For the medical centres, we have an inspection program. We now show up unannounced. We try to inspect every medical centre at least every three years or so. It could be reactive. A whistle-blower could make a complaint that we think has validity, and we'll look into it. We also use data analytics pretty aggressively to try to see what the highest risk areas are, and for areas that we think have high risks, we may initiate an audit, a review, some kind of inspection, without knowing whether or not there's any issue there.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Is it easy for you to determine a true whistle-blower versus a disgruntled individual who's just mad at everybody, and then an investigation begins? Do you go through that process?

[Michael Missal]

Yes. We treat with respect everybody who provides us information. We try to listen to what they have to say. Unfortunately, some of what is told to us is not always accurate, and at some point we have to identify that, and given our limited resources, we're not able to go further. We try to communicate that with the person providing us with the information, to ensure that person knows why we've decided not to go forward, so it's fair to that person as well.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

How big is the Washington veterans facility? Is it huge or very big?

[Michael Missal]

It's one of the larger VA medical centres. I believe it services—my numbers may not be exactly correct—over 100,000 veterans a year.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Is size an issue, too, when cultures grow in institutions?

[Michael Missal]

Size can make the culture that much more difficult to change, because the larger an organization, the more difficult it is going to be to change a culture that's been there for a while.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Right. For the investigation process, and you said you're reactive as well as proactive, did you have a learning curve in coming into the veterans world as opposed to previously, or is an investigation pretty much the same thing but just a little different?