JON TESTER. MONTANA. JOHNNY ISAKSON. GEORGIA. RANKING MEMBER CHAIRMAN JERRY MORAN. KANSAS JOHN BOOZMAN. ARKANSAS DEAN HELLER, NEVADA BILL CASSIOY, LOUISIANA RICHARD BLUMENTHAL. CONNECTICUT MAZIE K. HIRGNO, HAWAII MIKE ROUNDS. SOUTH DAKOTA JOE MANCHIN I r WEST VIRGINIA restaurant?"r 0%[8035 COMMITTEE ON AFFAIRS WASHINGTON, DC 20510 PATTY MURRAY, WASHINGTON BERNARD SANDERS. VERMONT SHERROD BROWN, OHIO December 7, 2017 Dr. Carolyn Clancy Executive in Charge, Veterans Health Administration 810 Vermont Avenue, North West Washington, DC 20420 Dear Dr. Clancy, I was concerned to read earlier this week that a Department of Veterans Affairs (VA) Medical Center in Iowa hired a physician with a highly concerning history, Dr. Schneider, to treat our nation?s veterans. I understand that the hiring process is dif?cult in many areas across the country, including my home state of Montana. However, I urge you to give your medical center and network directors clear and direct guidance about compliance with existing Federal law as well as their responsibility to hire quali?ed clinicians who will not abuse the trust of our nations veterans. The recent stories of the outcomes some veterans experienced after being treated at the Iowa City VAMC by Dr. Schneider are horrifying and beyond unacceptable. While I know that in some cases there will be medical outcomes that fall short of the patient?s desires, this should not be due to the facility having hired a surgeon with a known history of poor outcomes and malpractice, as evidenced by the loss of his or her medical license in a state. I know you share my belief that the veterans served by VA deserve nothing less than the highest quality care, delivered by practitioners who have been appropriately and thoroughly screened for a history of inappropriate behavior, consistently negative outcomes, and demonstrations of medical malpractice. That is why Congress included a provision in the Comprehensive Addiction and Recovery Act (CARA) of 201 6 requiring VA to receive and consider information on medical license violations. It is my understanding that in this case, the Iowa City facility reviewed the history of this particular physician and nevertheless decided to hire him. This highlights the challenge many facilities face in finding clinicians to ?ll vacant positions. I?ve moved multiple legislative initiatives forward that would once again allow VA to provide recruitment and retention bonuses for clinicians, expand Graduate Medical Education slots, and begin a program that allows VA to provide training to military medics in exchange for a commitment to service at VA. As we move these provisions into law, it is with the expectation that VA facilities will receive clear guidance from their leadership about how to comply with the law and exercise sound judgment when reviewing the history of providers under consideration for positions at VA. Given its direct impact on the delivery of care, I urge you to issue this guidance as soon as possible. I also urge you to ensure that Dr. Schneider, who is still licensed in the state of Montana, does not treat veterans in my state, either by being hired at a VA facility, or being reimbursed for treatment at a private facility that is in the community care network. This incident raises broad and serious issues about the hiring process at VA I?m not sure whether it was simply a lack of judgement by Iowa City VAMC, a lack of training or understanding of requirements to comply with CARA provisions, poor supervision as this decision was taking place, or a combination of all these factors and more. I urge you to rectify the guidance around the hiring process as quickly as possible. lam certain that the message VA hopes to send to veterans is not that their care should be left to physicians like Dr. Schneider. Sincerely, on Tester United States Senator